Columbia Business Times - February 2016

Februar y 2016 medical issue

P.Y.S.K.

Lori Osborne Columbia Public Schools Page 35

Decoding medical codes Page 52

L CAL

PHARMACIES

THRIVE Page 62

Amanda Signaigoowens Tiger family chiropractic Page 30

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From the Editor

Editorial Erica Pefferman, Publisher Erica@BusinessTimesCompany.com Brenna McDermott, Editor Brenna@BusinessTimesCompany.com Matthew Patston, Assistant Editor Matt@BusinessTimesCompany.com

Medical (Issue) Disclaimer

DESIGN Jordan Watts, Editorial Designer Jordan@BusinessTimesCompany.com

›› When we drew up the list of issue themes

Creative Services Keith Borgmeyer, Senior Editorial Designer Keith@BusinessTimesCompany.com Kate Morrow, Creative Marketing Kate@BusinessTimesCompany.com

for 2016, I knew that, out of all of them, I might have the least expertise in the medical issue. Unless, of course, there was a story about fainting in doctors’ offices. Then I could not only write the copy from personal experi-

MARKETING REPRESENTATIVES Deb Valvo, Director of Sales Deb@BusinessTimesCompany.com Stacy Zorn, Marketing Consultant Stacy@BusinessTimesCompany.com Jamie Patterson, Digital Services Director Jamie@BusinessTimesCompany.com

ence, but I could probably provide some entertaining photography as well.

Yes, stick me near a blood pressure cuff-thingy (sphygmomanometer), dilate my eyes or bring a needle out of a drawer and I’m bound to turn white as a sheet, possibly

CONTRIBUTING PHOTOGRAPHERS Keith Borgmeyer, Anthony Jinson, Ben Meldrum

shed a few involuntary tears and then take a nice 10-second pass out. Have a gurney at the ready.

CONTRIBUTING WRITERS Beth Bramstedt, Chris Danforth, Nicole Flood, Al Germond, Brandon Hoops, Zach Lloyd, Brenna McDermott, Chris Nyenhuis, Monica Pitts, Tony Richards, Jason Smallheer, Peter Stiepleman

Photo by Anthony Jinson

So you will find that not one story in this issue mentions a needle of any kind. For all the fainters out there, you’re welcome.

But now that we’re wrapping up the medical issue, I’m so glad we were able to provide coverage and insight for one of the largest industries in our community. From hospitals to urgent cares to private practice, we are lucky to have some amazing health care professionals working in Columbia.

It’s another great issue of CBT for you. We’ve got trends — read about the growing number of urgent care centers in Columbia, on page 40. We’ve got profiles — get to know three local pharmacies still going strong, on page 62. We’ve got a little bit of silly — read about some of the most interesting medical codes doctors are using to diagnose patients, on page 52. (Are you suffering from cabin fever right about now? That’s code R45.1.)

Also, I want to give a big thank you to each of you who supported our 2016 20 Under 40 class.

Whether you read their online profiles, liked a post we put out about one of them on Facebook or attended our fabulous gala, thank you for helping to make it a special recognition for each and every one of them. We have so much fun celebrating our 20 Under 40 class, and I hope you’ll consider nominating someone next year!

Brenna McDermott, Editor brenna@businesstimescompany.com

For this month’s cover, we wanted to showcase the medical world without the stereotypical “doctor” shot.

Instead of a white jacket, Amanda Signaigo-Owens is rocking some modern, gray scrubs. We also wanted to break out from the typical red hues one might find on the cover of a medical issue.

Photo by Anthony Jinson.

MANAGEMENT Erica Pefferman, President Erica@BusinessTimesCompany.com Renea Sapp, Vice President of Finance ReneaS@BusinessTimesCompany.com Amy Ferrari, Operations Manager Amy@BusinessTimesCompany.com Crystal Richardson, Marketing Manager Crystal@BusinessTimesCompany.com SUBSCRIPTIONS Subscription rate is $19.95 for 12 issues for 1 year or $34.95 for 24 issues for 2 years.

To place an order or to inform us of an address change, log on to ColumbiaBusinessTimes.com.

The Columbia Business Times is published every month

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All rights reserved. Reproduction or use of any editorial or graphic content without the express written permission of the publisher is prohibited.

Don’t forget to tweet your thoughts to us @ColumbiaBiz. And, as always, thanks for reading,

Interns Caroline Harding, Jessica Kaiser, Sean Nelson, Alisiana Peters, Brooke Skiles, Sierra Stewart, Amber Taylor

FEBRUAR Y 2016 MEDICAL ISSUE

P.Y.S.K.

LORI OSBORNE Columbia Public Schools PAGE 35

DECODING MEDICAL CODES PAGE 52

L CAL

PHARMACIES

THRIVE PAGE 62

AMANDA SIGNAIGOOWENS TIGER FAMILY CHIROPRACTIC PAGE 30

OUR MISSION STATEMENT The Columbia Business Times and ColumbiaBusinessTimes.com strives to be Columbia’s leading source for timely and comprehensive news coverage of the local business community. This publication is dedicated to being the most relevant and useful vehicle for the exchange of information and ideas among Columbia’s business professionals.

columbiabusinesstimes.com /// 17

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about the last times What's happening online EPIC @epic_columbia Congrats to one of r EPIC members for being one of this year's @ColumbiaBiz 20 Under 40. Laura Roeder, u r awesome!

Mizzou Business @MizzouBusiness #proud of our alumni in @ColumbiaBiz 20Under40! Jon Galloway, Tyson Hunt, Kelsey Meyer, Chris Rosskopf, Justin Smith.

Caledon Virtual @CaledonVirtual Check out our recent #Badassery in this sweet @ColumbiaBiz article.

Around the office 20 Under 40 We had a great time partying at Stephens College with our 2016 20 Under 40 class! If you missed the biggest party of the year, don’t worry — we’ll have one next year too.

20/40 20 40 T W ENT Y UNDER F O R T Y presented by

Harold’s Doughnuts @haroldoughnuts Look at Dave Elman @Fretboardcoffee loving his craft. In a @ColumbiaBiz issue near you. More in 2016... #staytuned Liz Sensintaffar @sequinsnspecs Pull quotes and my name is spelled correctly!

Thanks @ColumbiaBiz. FIS @FISGlobal Retailers appreciate #EMV protection for customers, but many question cost and necessity (via @ColumbiaBiz) Influence & Co @InfluenceandCo Thrilled to share our president, @Kelsey_M_Meyer, made @ColumbiaBiz’s 2016 20 Under 40!

Behind theTO scenes GET READY PARTY! WHen: January 22, 2015

Where:

Kimball Ballroom, Stephens College Tickets for 20 Under 40 were completely sold out, and once again the night was a huge success. Keep an eye out for pictures, and get excited for next year!

Congratulations to our editor, Brenna McDermott.

Brenna is participating in the Columbia Chamber of Commerce 2016 Leadership Columbia program.

Wish her luck!

Marketing Manager Crystal Richardson designs the programs for the 20 Under 40 gala. It takes a village to pull off 20 Under 40 each year!

Jeff Branscom @JeffreyOwen8 Excited to see our new Cosmic Sauce ad in the latest edition of @ColumbiaBiz! Write to CBT editor Brenna McDermott at Brenna@BusinessTimesCompany.com columbiabusinesstimes.com /// 19

It’s not enough to focus on college preparatory coursework and faith formation...

Tolton Catholic students are encouraged to use their collective talents for the greater good.

Here’s what Tolton parents had to say on the topic:

“ ”

Our daughter has learned the importance of serving her community and that the sense of satisfaction in helping others is one of life’s greatest rewards.

I definitely think that the emphasis on faith results in a student body that is, on the whole, more kind and more aware and thoughtful of others. The emphasis on service is an extension of this, and is outstanding.

Tolton has an atmosphere of caring, attentiveness and service to others that made us know we made the right choice.

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CBT contributors February 2016 Nicole Flood has worked in the fields of medical education and communications and is also a contributing writer with several publications in mid-Missouri. She is an enthusiast of language, words, people and all things involving media, global health campaigns and communications.

Brandon Hoops started writing for a daily newspaper at age 15, but his love for storytelling goes back to fourth grade, when his story “The Bear that Invented Football� won a school-wide competition. A graduate of the Nicole flood

brandon hoops

University of Missouri School of Journalism, Brandon prefers vinyl records and hardcover books, and yes, to answer the question everyone asks, he loves to play basketball.

Anthony Jinson is commercial photographer specializing in editorial, corporate and advertising photography with a focus on portraiture. When not making images, you’re likely to find Anthony spending time with his son or wrenching on vintage motorcycles.

Zach Lloyd is a graduate of the Master of Science in Journalism program at Ohio University's E.W. Scripps anthony jinson

zach lloyd

School of Journalism. He lives in Columbia with his girlfriend, Amanda, and their cat, Norma.

Ben meldrum is a multimedia contributor for The Business Times Company. He is currently a strategic communication student at the Missouri School of Journalism and enjoys listening to podcasts in his free time.

Jason Smallheer has been in the marketing, media and sales fields for more than 20 years. Jason received his degree in Journalism from Southern Illinois University at Carbondale and his MBA from Webster University in St. Louis. He lives in Ashland with his wife, Courtney, children, Ben Meldrum

jason smallheer

Garrick, Gavin and Gemma, and dogs, Chewie and Dodger. columbiabusinesstimes.com /// 21

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February 2016

Vol. 22, Issue 8 columbiabusinesstimes.com

Departments

›› Medical Issue

30

Adjusting to Growth

It’s a big year for Tiger Family Chiropractic and Wellness Center. Dr. Amanda Signaigo-Owens is growing her team of doctors, and they’re settling into a new, custom built location.

40

46

Swift Care, Sweet Relief

Breakthroughs in Process

Urgent care centers fill

Three local researchers

the gap between check-

are making strides to

ups and emergencies.

fight cancer.

52 Decoding the Codes

The dust is settling after major changes to the U.S. medical coding system.

17 From the Editor 19 Letters to the Editor 21 Contributors 25 Movers and Shakers 26 Briefly in the News 29 A Closer Look 30 Business Update 35 P.Y.S.K. 39 Opinion 70 Nonprofit Spotlight 72 Celebrations 75 Education 76 Marketing 78 Startups 79 Org Health 80 Business Licenses 81 Deeds of Trust 82 Economic Index 83 By the Numbers 85 This or That 87 Did You Know 88 10 Questions 90 Flashback

58 Mental Health Checkup

What are agencies doing to serve the community’s mental health needs?

62 Patients First Three local pharmacies thrive with a customers-first attitude.

Providence Bank asked us to lead the team of service providers and facility representatives making the upgrades to their Suite. We installed their new HDTVs with painstaking attention to detail to provide a seamless visual look with the rest of the facility. Our experienced team created a unique design solution.

24 \\\ February 2016

Movers and Shakers

›› Professionals grow, serve and achieve

Suzanne rothwell

Jayme Dement

Gerald Meininger

Becky Reuter

›› Suzanne Rothwell

›› Gerald Meininger

›› Great Circle

Columbia College announced that Suzanne Rothwell has been named the executive director of advancement. Rothwell had served as the interim director since July. In her position, she oversees the development, alumni and public relations departments at the college.

Rothwell served as the senior director of public relations for more than three years.

Gerald Meininger, who is a Margaret Proctor Mulligan Distinguished Professor in Medical Research and professor in the Department of Medical Pharmacology and Physiology at the MU School of Medicine, received the Kitanomaru Award. This award is presented to outstanding leaders in the field of microcirculation research.

›› Jayme Dement

›› Hilton Peeples

Emery Sapp & Sons recently announced the addition of Jayme Dement to their team as the new marketing and communications coordinator. Dement will provide marketing and communication efforts to serve the ESS employee-owners in each of the offices: Columbia, Kansas City and Springfield. Dement has more than 10 years of marketing and customer service experience.

Hilton Peeples has joined the Thumper Entertainment team as the new assistant festival director.

Peeples will focus on social media, festival logistics and operations for The Roots N Blues N BBQ Festival.

Peeples will also serve on the board of The Roots N Blues Foundation, raising funds and awareness for The Blues in the Schools program.

Kevin Fuller has been named Great Circle’s director of advancement in the south-central Missouri region. Fuller previously served in various capacities with one of the nation’s largest retailers in a career that spanned 27 years. Sheri Williams has been named Great Circle’s statewide director of nursing.

Williams previously served as a maternal child health district nurse consultant for the Missouri Department of Health and Senior Services.

›› Central Bank of

Boone County Marianne Misiewicz

Kevin Fuller

Sheri Williams

Central Bank of Boone County announced seven employee promotions made in November. Taylor Forbis was promoted to assistant manager of the Columbia Mall location. Brooke Canzoneri, of the Columbia Mall location, was promoted to financial associate. Danielle Bothe and Jonathan Boldt were named customer service representatives in the customer service center. Javier Bautista was named a customer service representative II in the electronic banking service area. Stephanie Adams, at The Village bank, was promoted to senior teller. Madison Hart, at the Rock Bridge location, was promoted to teller II.

›› Becky Reuter Providence Bank Mortgage is pleased to announce the addition of Becky Reuter as assistant vice president, mortgage banking officer.

Reuter will be responsible for originating residential mortgage loans in Boone County and surrounding areas. Reuter has more than 10 years of lending experience.

›› Marianne Misiewicz Marianne J. Misiewicz, DPM, has been elected to serve as the first female president of the Missouri Podiatric Medical Association.

She has served on the Missouri Podiatric Medical Association’s board of governors for many years. She has been in private practice since 2003 at Columbia Podiatry and is on staff at several mid-Missouri hospitals.

›› Richard Harding Retired U.S. Air Force Lt. Gen. Richard C. Harding was recently appointed to the Columbia College board of trustees. In addition to serving on the Columbia College board, Harding serves on the advisory council of the National Crime Victims’ Legal Institute, and also as a board member for Welcome Home, a transitional facility for homeless veterans.

›› University of Missouri

Board of Curators

Pam Henrickson was elected to a one-year term as chair of the University of Missouri Board of Curators. Maurice B. “Marcy” Graham was elected vice chair.

Henrickson currently serves as chair of the audit committee, and is also a member of the academic, student and external affairs committee, as well as the compensation and human resources committee. CBT

➜ Are you or your employees making waves in the Columbia business community? Send us your news at Editor@BusinessTimesCompany.com columbiabusinesstimes.com /// 25

briefly in the news

›› A rundown of this month’s top headlines

Loop Sales Tax Passes

McDonald’s Presents Check McDonald’s of Mid-Missouri presented a check for $28,000 to the Ronald McDonald House in Columbia.

In the first annual campaign, McDonald’s invited customers to support the Ronald McDonald House by purchasing coupon booklets with offers that were redeemable at participating restaurants. All dollars raised through the sale of the coupons went directly to the Ronald McDonald House located in Columbia.

Voters approved a half-cent sales tax for the Business Loop Community Improvement District, an entity formed to make improvements to Columbia's Business Loop 70. The tax is expected to bring in more than $200,000 annually, which the CID plans to use for aesthetic and infrastructure improvements along the Business Loop.

Registered voters living inside the district were qualified to cast ballots, and the sales tax passed by a 4-3 vote. The vote was held after months of uncertainty about the number of voters in the district; 15 total ballots were sent out by the district. Four bipartisan election judges counted the ballots.

UMB Bank Ranking The American Bankers Association recently released its list of the top 100 farm lenders by dollar volume for the third quarter of 2015, and UMB Bank, headquartered in Kansas City with a branch in Columbia, is ranked 33rd on the list.

The rankings are based on information from the quarter’s FDIC data and loans within the agricultural and farmland FRB codes.

26 \\\ February 2016

City TIF Ruling

The city of Columbia has been barred from creating any new tax increment financing projects until 2020. TIF is a financing mechanism that allows designated districts to capture increases in tax revenues to fund development.

Boone County Circuit Judge Gary Oxenhandler ruled against the city in a lawsuit filed by County Counselor C.J. Dykhouse, which challenged the city’s authority to approve TIF. Dykhouse argued the city lost its authority to approve a new TIF project by not following state law concerning public notification.

CPD Analysis In September, the Columbia Police Department began participation in a study produced by Matrix Consulting designed to evaluate the patrol division’s efficiency and productivity. Among Matrix’s findings: population growth directly translates to additional workload for patrol; the department’s current beat structure is effectively positioned; two-officer patrol units were not a sustainable practice given the call volume; and shift alternatives should be considered.

The study included an in-depth analysis of call volume by day of week and time of day.

The study cost $48,000 and was paid for through asset forfeiture and budget funds.

Taste of Mid-MO Returns The Mid-Missouri Restaurant Association will host its 31st annual Taste of Mid-Missouri on Monday, March 14, from 5:30-8:30 p.m. at the MU Reynolds Alumni Center. All proceeds from ticket sales and a gift certificate raffle will benefit scholarships to students in MU’s hospitality management program. The Missouri Restaurant Association serves more than 1,300 members statewide, 200 of which belong to MMRA. Its objectives are to enhance and improve member growth and development by assisting restaurants in becoming more effective operators and improving the political and social environment for restaurants.

Student Pitch Competition Four MU students won the Show-Me Business Plan Competition for their work in the Management 8550 class at MU, which is co-taught by Diana Kander, of MU, and Quinten Messbarger and Bill Turpin, of the Missouri Innovation Center. Various companies, some MIC affiliates, presented students with technologies in the early stages of development. Students were divided into teams, and each team chose a technology to develop. The 2015 winner, EcoGain, is working to commercialize a technology that helps efficiency in cattle production.

WWU Named top ONLINE EDUCATOR William Woods University has been recognized by OnlineColleges.net as a top choice for online education in Missouri. In the report, WWU ranks first in affordability among colleges and universities offering online degrees in Missouri and 13th in best online colleges. “To evaluate your online offering, we used a complex methodology that compares academics, student experience and online programs, resulting in a clear picture of the best online colleges in each state,� says Alice Wagner, communications director for OnlineColleges.net.

UM Saves Money The UM System realized at least $29 million in savings in the past year, due to increased effectiveness and efficiencies, and has now saved more than $77 million in the last two years.

These savings make it possible for the UM System to spend 75.5 percent of its operations budget on teaching, research and service. Cost savings and efficiencies for the system have come about during a time of growth, with enrollment at the four campuses of the system up by more than 40 percent since 2001. CBT columbiabusinesstimes.com /// 27

meets empathy

If you find yourself in need of an orthopaedic surgeon, you’ll want one who finds importance in staying by your side from start to finish, from head to toe. The surgeons at Columbia Orthopaedic Group have spent an average of 17 years at the practice–a practice that’s celebrating its 50th year. They make their careers at a place that, alongside Boone Hospital Center, was named the top hospital in mid-Missouri by US News and World Report. They’re part of a unique team that runs the entire gamut of comprehensive care. With physicians that specialize in virtually every area, you’ll get what you’re really seeking: peace of mind.

We’re redefining what it means to be a hospital.

28 \\\ February 2016

Another reason to choose Boone.

Visit us at boone.org/ortho

a closer look

›› A quick look at emerging companies

1. Advanced Garden Supply

3. Cisco Consulting

5. Too Rooster Artistry

Previously located in Jefferson City, Advanced Garden Supply’s new home is located at 1414 Rangeline St., Suite E. Advanced Garden Supply is a family-owned hydroponic garden supply store. “Columbia has a better market, so we figured more people would get the opportunity to come through,” says co-owner Don Willman.

Advanced Garden Supply has a wide variety of different plants, including orchids from Hawaii. “It’s really neat because they’re more like an air plant — their limbs wrap around trees,” Willman says. Of his clientele, he says: “You never know who will walk through the door. We get people both young and old, and it’s really like a hobby for most people.” Advanced Garden Supply is open Tuesday through Friday, 11 a.m. to 6:30 p.m., and Saturday, noon to 4 p.m.

Contact: Heather Willman, 573-214-2794 Website: advancedgardensupplymo.com

Cisco Consulting is an educational consulting business that provides consulting services for graduate students and faculty in the world of academia. Cisco Consulting works with groups in addition to oneon-one consultation services, academic editing and informative workshops. Cisco Consulting opened in January 2016, and they are currently accepting clients. Owner Jonathan Cisco has a Ph.D in literacy, with a focus in reading and writing at the higher education level, and more than 10 years of experience in reading and writing strategies.

“We hope we can develop relationships with universities in the area and across states to help demystify these different concepts in academia,” Cisco says.

Contact: Jonathan Cisco, 573-823-2711 Website: ciscoconsulting.org

Too Rooster Artistry is a one-person operation run by business owner and artist Cindy Scott. Scott has an extensive background in art education, as she previously taught art at the elementary and high school level for over 12 years.

Too Rooster officially launched in August 2015. Too Rooster offers creative interior decorating services, such as decorative paintings, personal shopping and on-site paintings at events. The event rates range from $500 to $1,000, depending on how much detail is wanted, the size of the canvas and how many people wish to be recognized in the painting. To see examples of Scott’s work, you can visit her on Facebook or Instagram.

Contact: Cindy Scott, 573-356-3401 Facebook/Instagram: Too Rooster Artistry

2. Palmer's Home Care

4. Charlie’s Angels

6. Hulett House MMA

Charlie’s Angels is an online clothing and accessory boutique. Owner Laura Cole has three daughters, for whom the boutique is named. “With my oldest daughter now being in college, I figured it would be a great way for my girls to help out with the business and earn money from working.” With the tagline “Where every customer’s an angel,” Charlie’s Angels offers clothing for women anywhere from ages 12 to 50. The clothing style ranges from workout to casual. “We have a wide selection that can appeal to any woman’s taste,” says Cole. You can visit Charlie’s Angels on Facebook or on Instagram. Charlie’s Angels accepts credit cards, Paypal, cash or check.

Contact: Laura Cole, 573-673-1748 Facebook/Instagram: CharliesAngels05

Hulett House, located at 707 Vandiver Drive, Suite C, is an athletic training academy and MMA fitness boxing gym. Hulett House trains MMA fighters and boxers and teaches women self-defense fitness. They also offer kickboxing and wrestling for kids and personal fitness for anyone. Owner Rob Hulett previously played football, but stopped playing after incurring problems with his knee. “A friend of mine suggested I try MMA, and since then, I have really enjoyed it,” Hulett says. Hulett House MMA operates Monday, Tuesday, Wednesday and Thursday from 4:30 to 9:00 p.m. and 5:00 to 9:00 p.m. on weekends.

Contact: Rob Hulett, 573-424-5744 Website: columbiatrainingacademy.com CBT

Palmer’s Home Care, located at 701 Hillsdale Road, has been in business since 2009 but has recently expanded and opened an office in Columbia. Palmer’s Home Care provides services for people with developmental disabilities and offers 24-hour care through the U.S. Department of Mental Health. Palmer’s Home Care currently supports 22 people, a 10-person increase from previous years. Their main goal for 2016 is to open a day program that will run Monday through Friday, 8:30 a.m. to 3:30 p.m., with about 65 to 70 employees in total. The day program will provide life skills and community activities for individuals.

Contact: Robert Palmer, 573-673-8437

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3

6 4

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➜ Are you an entrepreneur? Are you sprouting a new business? Tell us about it at Editor@BusinessTimesCompany.com columbiabusinesstimes.com /// 29

xx Amanda Signaigo-Owens, DC Photo by Anthony Jinson February 2016 30 \\\ FEBRUARY

business update

›› Transformed, trending and up-to-the-minute

➜ 3700 Interstate 70 Dr SE, Suite 110 573-443-1414 tigerfamilychiropractic.com

Adjusting to Growth

Tiger Family Chiropractic transitions from mom-and-pop shop.

By Brenna McDermott | Photos by Anthony Jinson Tiger Family Chiropractic and Wellness Center has grown from door-to-door to new barn doors in nine years.

When owner Amanda Signaigo-Owens, DC, started in 2006, she didn’t have an office space, so she went right to her patients. “One family led to another family,” she says, “and I would visit them in their homes.”

So when she, her mother, Lucinda, and brother, Jon, opened the doors of their first office, off I-70 Dr. SE, in 2007, she thought the office space would be plenty. “It was huge,” she says. “It was everything I thought I’d ever need.”

The team grew that space from one room with two adjusting tables, building one wall at a time, until the office took the shape of a question mark with four adjusting rooms. The four-doctor team was bursting at the seams.

Signaigo-Owens says going from a literal question mark to an office built with purpose reflects their team goal: serving the best interests of the patient at each turn.

New Digs The new space, more than 3,000 square feet and just up the street, at 3700 I-70 Dr SE, was built to suit and opened in April 2015. It holds seven adjusting areas with new adjusting tables; X-rays on site and a beverage station.

The office also features handcrafted wooden barn doors into patient rooms and new furniture. Signaigo-Owens describes it as welcoming, open and more purposeful, and a facility that can better serve patients.

Signaigo-Owens says the team’s goal is for 80 percent of the population to be under chiropractic care, and they built the new space to reflect that purpose. It’s a space to fit the larger team. Jennifer Isringhausen, Melanie Gilbert and Blake McGrath round out the team of doctors, with plans to hire a fifth.

The new Tiger Family office was built to suit and is in the same shopping center as their previous location.

“I joke that it’s already too small, which is so silly to say, but literally, I feel like if we had more space we could fill it with more people getting better,” Signaigo-Owens says.

But physical growth isn’t the only thing on Signaigo-Owens’ mind this year. She says a change in team mentality has been taking place. When the office consisted of three people, they operated with an all-hands-on-deck, mom-and-pop-store mentality, and it worked for them. This year is all about changing infrastructure to support the 14.5-person staff.

They’ve restructured staff, and they’ve changed training protocols and patient care models. It’ll be an evolving process as the team continues to grow. Signaigo-Owens has focused on improving her management skills during the past year.

“I think the entrepreneurial side and the chiropractic side both require constant

change and growth in order to maintain success at each new level,” she says. “I can’t imagine that I would have been prepared to handle what I am today 10 years ago.”

The year might present two different opportunities for growth, Signaigo-Owens says. She hopes to add a second location in Columbia. She’s also considered expanding to 24 hours a day.

“I don’t have an answer yet,” she says. “But we’ll see how it shapes out.”

Grassroots Mentality There’s still work to be done to get 80 percent of the community under some sort of chiropractic care. And the nature of the industry means constantly looking for new clients.

“Our goal is to take somebody who has an issue or condition, work them through that injury, that condition, getting them to a point columbiabusinesstimes.com /// 31

Alternative Health Care The chiropractic industry is healthy and growing in Boone County, Signaigo-Owens says, thanks to the large population seeking out alternative health care. She says that could be due to the young population, the amount of health care industry in the area or the generally healthy and active community.

“We have a great group of chiropractors that are in the Columbia area, and I think that really helps to increase its popularity and help people to expect it as an option and even seek it out before anything else when they feel like something’s going on [physically],” she says.

The U.S. Department of Labor has projected that chiropractor jobs will increase 17 percent from 2014 to 2024. The average growth rate for all occupations is 7 percent. The Milbank Quarterly, a journal studying health and health policy, says that in 2015 there were almost 100,000 chiropractors, a level similar to the number of practicing family physicians. That indicates a 50 percent increase in the number of chiropractors since 1990.

Boone County seems to be a good fit for an industry that, at its core, helps individuals move better. And the The new space has many amenities, including on-site X-rays, beverage station and all new furniture. variety of chiropractic professionals in the area allows the industry to thrive. where they’re stabilized with care, and then starting them out to where “The doctors that are here, that are practicing, respect one another,” they’re not here all the time,” Signaigo-Owens says. “So that creates for Signaigo-Owens says. “And we know that we do things differently, but us a constant need to have new patients come in.” there’s this camaraderie that, ultimately, we know that chiropractic care She says their goal is to have patients follow their wellness plans, works, even if I do it a little differently than you do in terms of the art of whether being treated for a specific injury or on a maintenance plan. how we express that.” CBT Showing patients X-rays a year later that shows a straighter, healthier spine helps The 3,000 square foot space features handcrafted barn doors and seven patient examination rooms. people understand the value of chiropractic care.

She says her goal, and the industry’s as a whole, is to transition from pain relief care to preventative care. And that involves a mind shift in the population away from the “tough it out” mentality.

“I really honestly think we’re some time away from people knowing that they have to take care of their spine the same way they take care of their teeth and the rest of their body,” Signaigo-Owens says. “None of us were raised to think that way.”

That shift in thinking is a grassroots effort, Signaigo-Owens says. To start that campaign, the Tiger Family team teaches classes on preventative care.

Today, everyone understands how to care and maintain teeth. “I try to picture what the dentists must have done if we were to go back in time and there was a time when people would never go to the dentist,” Signaigo-Owens says.

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P.Y.S.K. Person You Should Know

Lori Osborne

Health services coordinator at Columbia Public Schools

Job description: My job includes the care and coordination of student health; nursing services; policy and procedure management as it relates to student health and emergency management; and the hiring for my department of approximately 50 people.

Years lived in Columbia/mid-Missouri: 30.

Age:

53

Original hometown: California, Missouri.

Education: BSN and MSN from the MU Sinclair School of Nursing.

Community involvement: I am a member of the National Association of School Nurses and the Missouri Association of School Nurses. Over the years, I have held several offices within MASN. I am also on the board of directors for Family Health Center in Columbia and have served on the United Way Health Advisory Council in the past.

Professional background: I started my nursing career at Boone Hospital Center. I have also worked for MU Health Care and Research Medical Center in Kansas City. My hospital nursing experience has primarily been ICU and PACU. In 1998, I started with CPS as a school nurse in the elementary setting. I became the health services coordinator in 2009 and currently work very part time at Broadway Urgent Care.

A favorite recent project: Columbia Public Schools just completed the annual schoolbased flu vaccine clinic in all Columbia schools.

We collaborate with the Columbia/Boone County Department of Public Health and Human Resources to provide free seasonal flu vaccines to all students with parental consent.

This has been an annual event, with the help of benefactors such as the MU Children’s Hospital and the Lichtenstein Foundation.

A Columbia businessperson I admire and why: I admire all small business owners with the dream and desire to open their own business.

Favorite place in Columbia: I have lots of favorite spots in Columbia, but I think Shakespeare’s brings me back to my fun college days … and the food is great too! columbiabusinesstimes.com /// 35

Why I’m passionate about my job: I love working with children.

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School nurses work very hard to make a healthy impact on the lives of students. We have a very cohesive group of nurses and health secretaries, and the CPS administration is very supportive of our work. We are fortunate to live in a community with so many valuable resources. It’s very rewarding to see a child enter kindergarten and watch the process as they mature into young adults graduating from high school.

If I weren’t doing this for a living, I would: I’d still be working in some form of nursing.

What people should know about this profession: Nursing has many facets: health care provider, educator, community resource, counselor, family liaison, etc.

It’s both challenging and very

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rewarding working in schools to make a difference in the health and educational success of children.

What I do for fun: I love it when all my children are home. We play some pretty competitive card games!

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Roundtable › Al Germond

The Retail Wheel Spins On Dad was late to work that morning. It was Wednesday, Dec. 13, 1950 when he and my mom got up early to take my brother and me over to New York so we could sit on Santa's lap at Macy's Herald Square and tell him what we wanted for Christmas. The setting was straight out of “Miracle on 34th Street,” and it was one of my earliest recollections of Manhattan. The metropolis was all aglow with Christmas. A few weeks Al Germond is the host of the earlier, I had gone over to a neighColumbia Business Times bor's house — we still didn't have Sunday Morning Roundtable television — to watch the Macy's at 8:15 a.m. Sundays on KFRU. Thanksgiving Day Parade, followed He can be reached at

by Ben Grauer's description, on algermond@ WNBT, of the huge Christmas tree businesstimescompany.com in the middle of Rockefeller Center.

It took a while for the Macy’s brand to reach Columbia, but its arrival a few years ago was rather anti-climatic, coming as the successor to Famous-Barr, which itself seemed somewhat tardy in arriving.

Until the Columbia Mall opened in 1985, the Columbia retail market wasn’t large enough to attract anything beyond the B-level branches of major retail stores. The J.C. Penney Company was first to break the ice on April 23, 1927, with a chain store in the Hetzler Building at 708 E. Broadway. On Oct. 29, 1928, Montgomery-Ward opened a 20,000 square foot store on several floors at the north end of the Virginia Building at Ninth and Cherry. Sears, Roebuck and Company followed with a catalog store in the Stephens Endowment Building at Tenth and Broadway.

At the time, we were being lectured about "the menace of the chain store," this including a vigorous campaign waged by MFA president William C. Hirth. Shoppers craving the excitement, variety and selection of a multi-level, escalator-equipped department store always had to venture out-of-town. In downtown St. Louis, that meant visiting Stix, Baer and Fuller, Famous-Barr or Scruggs-Vandervort-Barney, housed in multi-level buildings downtown. The Jones Store Company and Macy's dominated the department store field in Kansas City, but the Macy's location there was the lineal branch of the New York flagship, way before consolidation and buy-outs in more recent times had forever altered the department store business.

Rumors flew during the 1970s about Famous-Barr — an affiliate of The May Company, of St. Louis — opening a branch in Columbia.

There were whispers of plans to build a huge regional shopping center

on the city's southeast edge, though many thought such a gargantuan enterprise would scotch downtown retail activity. More recently, a Macy's branch was vetted as the anchor of a proposed shopping center at the northwest corner of I-70 and Stadium Boulevard. But that was trumped when the Biscayne Mall was torn down and replaced by The Shoppes at Stadium, where Famous-Barr was housed in a standalone building. Now it has come to this — a 140,000-square-foot building bedecked with the Macy's logo that will close because the entire pattern of retail merchandising is being turned on its head, supplanted by competition from online sales, merchandise distributed from huge warehouses, in addition to a specialized assortment of big-box, category-killer stores.

Some will be disappointed as Macy's takes its curtain call. Others have noted — and this is purely subjective — that Macy's, née Famous-Barr, never exuded the golden glow and novelty such a store might have presented at another time. In early 1984, Dillard’s department stores, of Little Rock, Arkansas, acquired the 12-store, St. Louis-based Stix, Baer and Fuller chain. As one of the original anchors of the Columbia Mall, Dillard’s has been considered a midlevel retailer on par with Famous-Barr and the Macy's brand in what was a rather seamless transition.

Nearly $170,000 in property taxes will diminish on the soon-to-be vacant building at 204 N. Stadium Blvd, while sales taxes and receipts from the one percent TDD fee will evaporate for the time being. Wish lists abound for possible retail replacements, but the bigger question has to be the future of brick-and-mortar retailing. Thirty years ago, the region was all fired up about the Columbia Mall, the long anticipated, 800,000 square foot super-sized regional shopping venue that seemed to take forever to get here. Earlier venues that pecked away the city's conglomeration of downtown retailers included the Broadway Shopping Center, Parkade Plaza, the Forum Shopping Center and the Biscayne Mall, but they always paled when compared to what was available in Missouri's two largest metropolitan areas. Stop and consider how many of the Columbia Mall's original tenants still are there, other than Dillard’s, Sears and Target. With Macy's decision to fold its Columbia tent, it will be interesting to see what will occupy this two-story, escalator-equipped building.

For years, visionaries have prognosticated about the potential impact of computers, the vehicle to interconnect them and how all this excitement will alter our lives. While Internet sales gallop along, brick-and-mortar retailing will always be with us because of the experience it presents. Macy's is gone. But our lives will go on because other stores will come along. For now, the biggest loss will be the receipts from sales and TDD taxes.

Christmas, 1950 – Santa came through with the American Flyer “Talking Railroad Station” I asked him to bring. CBT columbiabusinesstimes.com /// 39

40 \\\ FEBRUARY February 2016

swift care, Sweet relief Urgent care centers fill the gap between check-ups and emergencies.

by Zach Lloyd

Image Source: ThinkStock columbiabusinesstimes.com /// 41

Dr. Eric Bettis hurriedly pushes his guitar case off the hospital chair he uses as visitor seating in his office. The room is decorated with portrait collages of two smiling brothers and their sister, and a sign on the wall reads, “Behind every good kid is a great dad.” Bettis grins as he sits on the arm of the chair. He’s kind of bouncing with energy, like a kid who was forced to pause in the middle of building a fort and is ready to get back to it. He says he loves his job, and his enthusiasm shows it as he bounds out of the room, mid-interview, to visit an elderly patient who just walked in.

Bettis is the owner of Broadway Urgent Care, at 2003 W. Broadway, where he also practices as a physician. In 2010, he and his partner, Dr. Ross Duff, entered the booming American urgent care industry, looking to fill the niche that many American patients now demand — the aptly named need for immediate and urgent care.

Urgent care differs from emergency room care or regular practice on multiple levels.

Urgent cares can be more affordable, available for walk-in visits and open for extended evening and weekend hours. They’re often located in high-accessibility consumer areas like strip malls and professional parks. The growth of the industry seems just as fastpaced as Bettis himself.

Bettis and Duff opened the center in 2010 after spending time working in a St. Louis urgent care center as a trial run. It had been Bettis’ dream for years to someday own his own center, and he used his time in St. Louis to get familiar with the ins and outs of operating an immediate care facility.

“We were there to make sure it was something we wanted to do,” Bettis says, “but also to learn what mistakes they made, so we could learn more about how their business plan worked. It was basically like we were able to do a practice run without our own money.”

And when it comes to money, the urgent care industry has plenty of it. hen Bettis and Duff opened their clinic on Broadway, they became one of many “doc in the box” operators that comprise a $14.5 billion industry in America. Around one-third of the nation’s urgent care centers are owned by hospitals or joint-venture relationships, though independent private care centers are still a major chunk of the market.

W

42 \\\ February 2016

"If something is broken, we want it fixed right now and we don’t want to put our lives on hold. Urgent care has been the mainstay.”

– Dr. Eric Bettis And it’s a growing market.

Popping up in strip malls, vacated offices and industrial parks, there are now more than 7,000 urgent cares in the U.S. Even in a small (albeit growing) town like Columbia, there are seven established urgent cares— not including the quick care centers you can find in Hy-Vees — with more on the way.

According to the Urgent Care Association of America, 3 million patients visit urgent care centers each week.

Urgent cares have become popular due to the niche they fill for working Americans.

Born out of convenience in the late ’70s, the ease-of-access, flexible hours and affordable costs are attractive to patients busy with work or family responsibilities.

“We are a country that is more and more into wanting immediate care and gratification,” Bettis says. “If something is broken, we want it fixed now and we don’t want to put our lives on hold. Urgent care has been the mainstay.”

Say a working mother with two children has a job that requires her to stay on the clock until 6 p.m. When she gets home, the babysitter tells her one of the children is

running a fever. Their primary care doctor’s office has closed for the day, and the soonest appointment is four days away. Her options now come down to taking her child to the emergency room, waiting until the pediatrician is available, or running to the nearest urgent care where, hopefully, her kid can be seen immediately.

Urgent care centers can be a good financial option for some patients as well. The average visit to the urgent care costs around $150, and most centers participate with major health insurance plans, according to Becker’s Hospital Review. Comparatively, the average ER visit can cost upwards of $1,300.

A 2015 article in Health Affairs reports that around half of all emergency room visits are for non-emergency reasons, and that 13.7 to 27.1 percent of all ER visits could have been handled in an urgent care setting, which means there are huge potential savings for patients. When the difference between a visit to the urgent care and a visit to the ER means a difference of $1,000 or more, the issue then becomes educating patients about when and why to seek the appropriate level of care.

Conditions for

Urgent care • Respiratory issues • Sprains • Strains • Musculoskeletal injuries • Lacerations • Febrile illness • Broken bones • X-rays • Vaccinations • Preliminary diagnoses for chronic issues e.g. cholesterol, blood pressure, diabetes

Conditions for

quick care • Cough • Cold • Vaccinations • Minor sprains and swellings • Soreness • Achiness

Conditions for

ER /Primary care • Life-or-limb threatening issues • Chronic illnesses or issues, such as ongoing diabetes, blood pressure, fibromyalgia, etc.

• Any issue or illness that requires ongoing treatment

teve Sellars is a board member and president-elect for the UCAOA, as well as the CEO of Premier Health, an urgent care management association in Baton Rouge. Steve sees the role of American urgent care as somewhat of a blanket middleman for patients with a variety of ailments that require quick diagnosis and treatment. While he made it clear that urgent care should not be utilized as a replacement for a primary care physician and is not appropriate for life-or-limb threatening injuries (those require an ER), he does believe that urgent care centers can cover just about everything else.

“Lacerations, flus, fevers, cuts that may need stitches, possible broken bones, sprains, strains — those things are all appropriate for an urgent care setting, and we still see a lot of people going to the ER for those kinds of issues,” Sellars says. He also says that acute conditions are perfect for being handled in an urgent care setting, while chronic or emergency conditions — like ongoing high blood pressure issues or a heart attack — are more suited for primary physician and emergency care. He sees the role of urgent care as a sort of symbiotic relationship within the health care industry, as patients utilizing urgent care will lessen the stress and overcrowding that emergency room professionals often deal with.

“Urgent care centers allow primary care physicians to focus on ongoing care of chronic conditions,” Sellars says. “The way I like to think about it is that urgent care centers provide convenient access to quality, cost-effective health care services. So, for those times where a patient is unable to get in, [urgent care centers] are a very good alternative.”

So, exactly what kind of conditions are appropriate for an urgent care visit, and when might an issue need a higher level of care?

Dr. Tara Flynn is the medical director for MU Urgent and Quick Care. She began her job at the university three months ago after being employed at a privately owned urgent care.

“We heavily see acute respiratory illnesses — things like strep, flu, bronchitis and pneumonia — acute kid illnesses, like febrile illnesses, ear infections, worried parents who think they might miss something with their kids if they wait,” Flynn says. “Then we have another huge category, which is musculoskeletal injuries that have happened acutely, and a lot of the time

S

columbiabusinesstimes.com /// 43

1 8 5

2

10

9

6 7

centers in town

4. Mizzou Quick Care 25 Conley Rd. 65201

7. Mizzou Urgent Care 551 E. Southampton Dr. 65201

1. Boone Convenient Care 601 Bus. Loop 70 W, Ste 275 65203

5. Mizzou Quick Care 3100 W. Broadway 65203

8. Providence Urgent Care 403 Stadium Blvd. 65203

2. Broadway Urgent Care 2003 W. Broadway 65203

6. Mizzou Quick Care 405 E. Nifong 65201

9. Providence Urgent Care 202 E. Nifong 65203

3. Children’s Hospital Urgent Care 404 Keene St. 65201

** Pharmacies with Quick Care Centers

10. University Physicians Urgent Care 1020 Hitt St. 65212

44 \\\ February 2016

3 4

"Urgent care centers allow primary care physicians to focus on ongoing care of chronic conditions."

- Steve Sellars Another factor contributing to the growth of the urgent care industry is an aging population.

“That percentage of the population that is 65 and older is growing at a very fast pace, and these are people who tend to access care more than others,” Sellars says. “And we also have the Affordable Care Act, and we have 12 to 15 million other people with some form of coverage today who did not otherwise have coverage before.”

According to the Centers for Disease Control and Prevention, the population over the age of 65 will double to approximately 72 million during the next 25 years. Even though this group only makes up around 13 percent of the American population, they account for one-fourth of all physician hospital visits, 38 percent of all ER visits and nearly half of all diagnostic treatments and tests — again, a hefty chunk of health care and a large potential market for the urgent care industry. ll of these factors combine to create an unprecedented issue for health care access, which increases the need for convenient, affordable health care via quick or urgent care centers.

Unlike urgent cares, quick care centers are walk-in, preliminary options that are typically found in grocery stores, drug stores and even some big-box stores, like Target and Wal-Mart. These locations typically offer more topical diagnoses and treatments, like examining sore throats and swollen joints, or administering flu shots. Thought of as the first line of defense in health care, the quick care industry is growing right alongside urgent clinics to fill the instant-gratification demand around the country. They

A

these people can’t get in to see their regular doctors for these kinds of things soon enough, and they’re worried about causing more damage.”

Musculoskeletal injuries mean any injury to the bones, muscles or skin and include things like lacerations, sprains, strains and broken bones. By addressing these issues at an urgent care, the patient can save a lot of money, and the issue of ER overcrowding is lessened.

are often used as a triage of sorts, and many patients are referred to an urgent care or primary setting after they’ve been seen at a quick care location. While they can help with small, acute issues, quick cares are not able to do anything intensive, such as administer X-rays, examine broken bones, or diagnose heart issues.

MU Health System opened three new quick care locations in Columbia’s Hy-Vee grocery stores on Conley, West Broadway and East Nifong. Flynn also oversees these new locations and has high hopes for their future. Now, shoppers can get their groceries and flu shot in the same building, a level of instant health access that has never been seen before.

There are even digital health care options that complement a fast-paced lifestyle.

Emerging digital technologies like the service HealthTap, founded by Stanford Graduate School of Business alum Ron Gutman, allow patients to talk with accredited doctors all across the country from their laptops, cellphones and tablets. The app, which has been called “Uber for doctors,” allows a person subscribed to this service to speak to a health professional, be diagnosed, and even be prescribed medicine without ever having to leave their home or actually meet a doctor face-to-face.

However, like quick and urgent care centers, digital health care services cannot replace emergency departments and ongoing primary care. It’s important for patients to know what level of care their ailment requires and to establish a relationship with a regular primary care provider. But life happens fast. Sometimes, urgent care is the right option. CBT columbiabusinesstimes.com /// 45

46 \\\ FEBRUARY February 2016

long RACE for the

CURE MU cancer researchers must overcome obstacles for medical breakthroughs.

BY Jason Smallheer

Image Source: ThinkStock columbiabusinesstimes.com /// 47

More than 34,000 new cancer cases were reported in 2015, according to the American Cancer Society. While some forms can be prevented, three MU researchers are making measurable progress in their research to eradicate the disease — but not without barriers in transitioning from research to mainstream medicine.

Doctors M. Frederick Hawthorne, Senthil Kumar and Kattesh Katti are taking different approaches in their cancer research and seeing favorable results in their testing.

""The research is ongoing.

The results are unique, mild, and we can do it again and again.""

- M. frederick hawthorne Boron Breakthroughs Hawthorne, the director of research for the Institute of Nano and Molecular Medicine at MU, has pioneered boron neutron capture therapy, or BCNT. The process involves injecting a cancer patient with a compound that contains Boron-10, 48 \\\ February 2016

which collects around cancerous cells and destroys them. Hawthorne has had success with his program in mice and small animals.

Research on BNCT has been ongoing since the 1930s, when neutrons were discovered. Hawthorne’s breakthrough is offering a cancer solution unlike anything in use today.

“This (process) is better than traditional chemotherapy,” Hawthorne says. “Chemo kills all cells. This just attacks the cancer, with no side effects.”

Common side effects of chemotherapy include hair loss, nausea, digestive problems, lack of energy and mouth ulcers.

Cancer cells grow faster than traditional cells, and as a result, they absorb more of their surrounding material. Hawthorne’s process takes advantage of this aggressive nature. The cancer cells take in more and more boron and subsequently destroy themselves, leaving the healthy cells intact.

Hawthorne’s BNCT process has achieved the same results multiple times in animals, specifically mice, with remission taking place in as little as a week.

“The research is ongoing,” he says. “The results are unique, mild, and we can do it again and again.”

Hawthorne’s BNCT work earned him the National Medal of Science, the highest award that can be given to a scientist “deserving of special recognition by reason of their outstanding contributions to knowledge in the physical, biological, mathematical, or engineering sciences,” according to the National Science Foundation. President Obama presented the award to Hawthorne in 2012.

Moving Targets Kumar, assistant director of the Comparative Oncology and Epigenetics Laboratory at the MU College of Veterinary Medicine, has been working on his project for 10 years.

His research includes studying genes and identifying molecules to treat different types of cancers. Kumar says part of the challenge in his research is cancer cells adapting to drugs, pulling dormant cells out of remission because the cancer finds ways to combat treatments; when a new drug is used, another level of cells awakens and combats it.

“Our hope is to unravel the complexity of the [cancer] gene and develop a more effec-

tive drug,” he says. “When you use too many drugs, the problem is enhanced. The goal is to have a more personalized treatment.”

He says his work is progressing well, but a vaccine is still being sought.

Kumar, like Hawthorne, agrees that chemotherapy has both advantages and disadvantages. The advantage is that cancerous cells are killed. But the healthy cells are also killed; there are side effects, such as losing hair, and the recovery is tough on the patient.

“We need to be careful in a targeted approach,” Kumar says. “We want to make sure we are not activating other bad cells.”

Kumar has seen progress in his chemotherapy research using both humans and dogs as test subjects.

Gold Rush Kattesh Katti is the senior research scientist at the MU Research Reactor, and he’s work-

Sprouty Suppression A surprising find from an MU professor.

ing on shrinking prostate tumors using gold particles. According to the American Cancer Society, prostate cancer is the second most common cancer in men (skin cancer being the most common). Annually, more than 220,000 men are diagnosed.

The chemicals Katti uses are non-toxic and come from the natural environment.

“Nanotechnology starts in the kitchen,” he says. “The highlight is that we are using chemicals in the human food chain — tea, mangos and soybeans. The rest of the world is using toxic chemicals.”

Toxicity, like that found in chemotherapy, can be devastating to the human body. This green nanotechnology seeks to avoid toxicity and could be used for both breast and pancreatic cancers.

Because the chemicals are natural, the costs associated with his process are significantly lower.

Katti says his process involves aggressively shrinking particles surrounding prostate cancer cells or, in some cases, eliminating the particles altogether.

“The results have been stellar in both small and large animals,” he says.

65 or older. Katti compares prostate cancer to a car, saying as a car gets older, it’s more prone to problems. The same goes for other organs: the older the person, the more prone they are to problems.

Katti’s work has yielded global recognition. He received the Hevesy Medal Award in 2015, honoring outstanding achievements in radioanalytical and nuclear chemistry; was elected to the fellowship of the National Academy of Inventors; was named 2015’s Distinguished Professor under the Brazilian Scientific Mobility Program; received the 2015 Annual Oration and Award by the Society for Cancer Research and Communication; and landed on the Ingram’s 2015 “50 Missourians You Should Know” list.

Another process, related to Katti’s work but being done internationally, uses tiny gold spheres, smaller than red blood cells.

Gold is unusual in that it is nontoxic and

The light heats the gold particles, resulting in an artificial contamination of the cancer cells, destroying them.

This type of treatment, called a “targeted drug therapy,” holds many benefits for patients and physicians. Targeted drug therapies can attack the cancer cells where they live, resulting in fewer side effects, and they can react with cancer cells at a specified time. The new methods are also less expensive and, in some cases, less invasive because they don’t require surgery.

Breakthrough Barriers The Food and Drug Administration has a division tasked with examining nanotechnology and its applications in the fight against cancer. While not all drugs have been approved, the FDA acknowledges some of the benefits to nanotechnology, specifically targeted drug therapy.

As MU’s researchers know, cancer treatment is complicated; progress doesn’t always move forward. Over the course of three years, associate professor Sharad Khare studied the effects of Sprouty2, a gene proven to suppress tumor growth in various cancers. In most cases, the gene blocks molecular circuits that contribute to metastasis, or the spreading of cancer to other organs, but Khare found something different: in certain cases of colorectal cancer, Sprouty2 boosts tumor growth.

Sprouty2 had been tested in breast, prostate and liver cancer, with encouraging results. “We presumed that the gene would also work with colon cancer,” Khare says. “But we found something surprising.”

The team tested Sprouty2 in different sample models, including mice and human biopsy samples, and found that the gene had reversed its expected effect: when Sprouty2 was activated, or up-regulated, it increased the cancer’s ability to spread.

Khare’s research, though groundbreaking, raises more questions than answers. The team believes that Sprouty2’s growth effect may only take place in a subset of colorectal cancers, and that more research would be needed to determine why the gene behaves differently in different cancers.

The study’s resulting research paper was published in Oncogene, a cancer treatment medical journal.

The article spent more than a year in review before publication, meaning that Khare’s team needed airtight research to support their findings. Now, they’re hoping for help.

“We can’t do everything in one place,” Khare says. “We need to collaborate with other people who have different patient populations. It can’t be done in one lab, or at one university.”

Sprouty2’s unintended consequences in colorectal cancer highlight the difficulty in designing treatments — and, eventually, cures — for cancer. “We should not presume things,” Khare says, “like this gene suppresses cancer, this gene promotes cancer. We have to look deeper.”

The process has been non-toxic to dogs, and Katti hopes to be able to begin testing on humans soon.

Prostate cancer will affect one in seven men during their lifetime, and 60 percent of those cases will occur when the patient is

does not react to most compounds. These qualities make it ideal for medical use.

One of the processes being studied around the world uses gold nanoparticles that are absorbed by cancerous cells and accumulate until they are acted upon by infrared light.

According to the FDA website, “One of the drawbacks of conventional chemotherapy for the treatment of cancer is the inability to deliver the drug in adequate quantity to the tumor site without undesirable side effects.

The major advantage of using nanomaterial columbiabusinesstimes.com /// 49

In 1971, President Nixon officially declared “war on cancer.” Since then, there has been research, would-be cures, new cancers detected, and new research conducted. Is the war on cancer being won?

Source: CDC.org, Cancer.org

Cancer since 1971

$500 billion Amount spent on cancer research since 1971.

589,430

Number of people that will die of cancer in the United States this year.

1,600

Number of Americans that die from cancer each day.

$20,000

Amount spent on research for every person that has died of cancer in the last 40 years.

$10,000

Average cost per month for chemotherapy in 2015.

3.3

Increase in life expectancy, in years, for cancer patients due to current research.

2

Second most frequent cause of death in America, after heart disease.

50 \\\ February 2016

as a carrier for anticancer drugs is the possibility of targeted delivery to the tumor.”

While headway is being made in the research realm, there are challenges that slow the process, one of which is the necessary equipment and facilities. Hawthorne has made progress, thanks to his national recognition, and MU currently houses the largest campus nuclear reactor in the country.

Another barrier researchers have is the process of testing on animals. Without successful tests on animals, it becomes difficult to move the process to human testing.

PETA, for example, spends more than $15 million annually conveying their message against animal testing. This opposition often slows the animal testing process at MU. To combat the challenge, some research has been moved abroad where there are facilities and a culture that is more accepting to testing on animals. However, the same ethical challenges would eventually come into play internationally, and the research would then return to the United States while alternatives were sought.

According to PETA, the United States has spent more than $200 billion on cancer research since 1971, and there are still more than 500,000 cancer-related deaths each year, an increase of more than 71 percent since the Nixon administration.

The group Americans for Medical Progress takes the opposite stance of PETA, say-

ing animal rights groups are hurting medical progress. Through their website, AMP says their goal is to “protect society’s investment in research by nurturing public understanding of and support for the humane, necessary and valuable use of animals in medicine.”

AMP attributes humane animal testing for more than 50 percent of the gains made in cancer research, specifically targeted cancer therapies. Some cancers, like childhood leukemia, had a four percent survival rate in 1962. AMP says the survival rate is now more than 80 percent, with the help of the animals used as test subjects. Researchers have also made progress in breast cancer and lung cancer that used mice in testing.

The European Animal Research Association outlined more than 40 benefits to using animals as test subjects.

Humans share more than 95 percent of our genes with a mouse; animals and humans have an organ system that functions the same way; and animals suffer from some of the same diseases as humans.

The EARA further attributes advances in cancer drugs due to testing on mice, and, in some cases, dogs, due to the similar natures in which the disease attacks both species. One of the benefits in working with dogs is that they are a larger animal, and, in some cases, cancer cells act in a similar fashion as they do in humans.

Kumar says one of his greatest challenges is not in the test subjects or the facilities, but in the cancer cells themselves.

“Trying to find the molecules that stop the aggressiveness [is the challenge,]” he says. CBT

""Our hope is to unravel the complexity of the [cancer] gene and develop a more effective drug.""

- Senthil Kumar

columbiabusinesstimes.com /// 51

52 \\\ FEBRUARY February 2016

C R A C K I N G T H E C O D E Months after a nationwide transition in medical coding, how have University of Missouri health care providers adapted?

BY BRANDON HOOPS

Image Source: ThinkStock columbiabusinesstimes.com /// 53

The week when hospitals and health care providers across the United States stared down a potentially cataclysmic event, likened by many to Y2K, Dr. Aaron Gray was celebrating his 10th wedding anniversary with his wife in the Pacific Northwest.

It was their first visit to the region. They hiked to waterfalls, explored the coast and dined at some of Portland’s best restaurants. It proved to be the perfect place for Gray to take refuge from the nationwide transition to a new medical coding system.

“I joked with people that our vacation came at a good time,” says Gray, a physician who splits his time between family medicine with University Physicians and sports medicine at the Missouri Orthopaedic Institute. “As a provider, there was a lot of fear because of the unknown of what this change was going to mean.”

Change has come in steady doses for Gray and many others in the Columbia medical community in recent years.

Some of that change involves the construction of immense multi-million dollar structures with fancy exterior glass and bright interior corridors. The $40 million addition developing at the corner of Monk Drive and Stadium Blvd. is one Gray looks down on from his office on the fourth floor of the Missouri Orthopaedic Institute.

Other change isn’t as glamorous, but it has to be done — like when the Department of Health and Human Services mandated that all health care providers across the country convert to a new coding system on Oct. 1, 2015. The new system, from the 10th revision of the International Classification of Diseases, also known as ICD10, replaced ICD-9, which had been used in the U.S. since 1979.

Although ICD-10 moves U.S. health care into the future, it seemed like an abrupt and intimidating transition from the shallow to the deep end of the pool. The number of diagnostic codes jumped from 14,000, in ICD-9 to 69,000 in ICD-10, while the number of procedural codes exploded from 4,000 to more than 70,000.

Gray was especially concerned about the extra demands ICD-10 could place on physicians. But when Gray returned from his vacation, he quickly realized the months, even years, of conjecture and uncertainty might have been a bit overstated.

“In reality, it wasn’t that bad,” Gray says.

“Things didn’t break, and it has been less of a burden than I feared.”

54 \\\ February 2016

Getting Their Act Together A lot of what a skilled physician does, Gray says, is similar to a journalist’s inquiry — digging for information, trying to get to the bottom of a patient’s condition.

But instead of telling stories in sentences and paragraphs, health care providers work in a universal alphanumeric coding system.

These medical codes are used to identify and record health conditions as well as create claims to be paid by insurers. Appropriate codes are extracted from a physician’s notes or a patient’s lab work.

ICD-10 requires more detail than ever to describe health conditions. This means physicians have to ensure they’re reporting the circumstances and particularities of an injury or illness.

always has given a detailed note. That's why it was probably easy for him to adjust. He could just stay status quo and keep on going.”

In the year leading up to the change, MU Health Care provided training and resources specific to orthopedic injuries and fractures for physicians and coders at the Missouri Orthopaedic Institute.

The learning curve was steep for the coders.

Not only did they need to get comfortable with the expansive catalogue of ICD-10 codes, creating cheat sheets with frequently used codes, they needed extra time after Oct. 1 to make sure they were coding as accurately as possible.

But the biggest challenge for coders has been insufficient documentation from physicians. If something is missing or something limits their ability to pinpoint a code, then a coder has to

"As a provider, there was a lot of fear because of the unknown of what this change was going to mean." - Dr. Aaron Gray

“I just have to be more intentional and thorough in my documentation,” says Gray, who completed his residency at the MU in 2010.

"The information was probably in my notes before, now it's just required. In the dayto-day, it really hasn't been that much extra work for me, and my interaction with patients hasn’t changed at all.”

For most physicians, ICD-10 is more of an acquaintance than an intimate friend. Unless Gray orders a test, he is not the one who decides what codes are attached to a patient’s visit.

That’s the job of Stephanie Smith, a reimbursement consultant at the Missouri Orthopaedic Institute, and her team of 10 coders and billers.

They review Gray’s sports medicine and orthopedic notes and determine the most accurate codes to send to insurers for reimbursement.

“I can't give Dr. Gray kudos enough,” Smith says. “He truly does have a detailed note and

contact the doctor and request more information or clarification. Since coders didn’t need a high level of detail in ICD-9, Smith says some physicians got lax and would write something as simple as “knee pain” in their notes.

That doesn’t fly anymore. Doctors have to specify which knee is injured. According to the Centers for Medicare and Medicaid Services, more than one-third of the increase in ICD-10 codes is due to addition of laterality (indicating left, right or both).

Orthopedics has experienced the largest increase of all the various sections of code sets.

For an example, Smith highlights the number of codes for a distal radius fracture (or a broken wrist, in layman’s terms), which has gone from two to 20 codes.

Smith’s three clinical coders experienced a significant lag time in coding after Oct. 1, largely because of subsequent back-and-forths with

physicians. Before the changeover, clinical coders submitted coding two to three days after a patient’s visit. For the two months following, they ran 10 to 12 days behind. By December, they were around five days.

“The codes are only as accurate as the skill and accuracy of the original doctor who saw the patient,” Gray says. “If the doctor does their job, then this is all pretty easy on the coders.

It’s when the doctors don't put enough detail in their notes that it takes a lot of time.”

In 2016, Smith’s team will focus on improved collaboration with working physicians and medical residents to get even better documentation. She expects to be back down to two to three days soon.

“I can feel like I’m nagging sometimes,” Smith says. “But recently a physician told me,

‘We’re just so thankful we have you guys to remind us we need to be doing those things.

I don't view it as being a nag or a bad guy. It’s what is required, and you're just ensuring we get to that requirement.’”

Partying Like It’s 1999 The minimal drop in physician and staff productivity is a testament to the hard work

Coding Comedy Hour family's annual touch football game on Thanksgiving Day (Y93.62).

There's a code for the problems that developed between you and your in-laws during the holiday season (Z63.1).

In the absence of drama during the switch from ICD-9 to ICD-10, there has been ample entertainment provided from some of the new diagnostic codes.

"You can't help but laugh when you look at some of these ICD-10 codes," says Aaron Gray, MD, who occasionally tweets his favorite oddball codes from @MizzouSportsDoc. "There are just some crazy things in there. I would have loved to have been in the boardroom where someone proposed the code for getting sucked up into an airplane."

In case you’re wondering, the code for being sucked into a jet engine is V97.33XA. And you guessed it, there's even one for a subsequent jet engine incident (V97.33XD).

But the fun doesn't stop there.

There's a code for the time my youngest sister got a Lifesaver Mini stuck in her nose (S00.35XA).

There's a code for the injury your uncle sustained in your

There's a code for the cabin fever you have from being stuck indoors too long this winter (R45.1) and for that burn you sustained from your electric blanket (X16.XXXA) while trying to stay warm.

There's a code for an injury sustained at the library (Y92.241) or bizarre personal appearance (Y93.

D1) or low self esteem (R4581).

There's even an assortment of codes for bites from animals, including a cow (W55.21XA), a turtle (W59.21XA), an alligator (W58.01XA) and Punxsutawney Phil (W53.81XA).

"ICD-10 has been the butt of many jokes, and it probably deserves to be because it can be quite humorous," Gray says.

Unfortunately, there still isn't a code for an ICD-10 induced laughing fit. Unless you were laughing so hard you walked into a wall, in that case, there’s a code for you (W22.01XA).

columbiabusinesstimes.com /// 55

and preparation put in throughout the MU Health Care system.

Dr. Thomas Selva, the chief medical information officer for MU Health Care, engineered much of the transition. His primary role was to be a liaison between IT and many of the physicians and health care providers, educating them on the details of the transition and ensuring they understood how to use the systems.

“We wanted to be at an optimal place when the cutover occurred, to avoid issues like bills being dropped and then having to deal with appeals down the road,” says Selva, who has been with MU Health Care for 27 years.

Many of the Y2K-esque alarms triggered by ICD10 centered on technology, specifically whether the computer systems could adjust to new codes and a higher volume of traffic. Fresh memories of the tumultuous Healthcare.gov rollout in 2013 fueled some of those fears.

MU Health Care is no stranger to incorporating technology into its daily operations — it’s been recognized as one of the “most wired” health systems in the country, thanks to a partnership with Cerner through the Tiger Institute for Health Innovation. In 2014, MU Health Care became the ninth health system in the country to meet federal stage 2 “meaningful use” standards for electronic health records.

Cerner helped create and manage IT solutions so MU Health Care could navigate the uncertain build up to ICD-10.

“If you go back to 2012, we started getting early versions of ICD-10 codes so we could begin to test it and see the impact,” says Bryan Bliven, who oversees the IT infrastructure for MU Health Care. “We’re always trying to move forward. We don’t like to hold steady and then unveil a big change. We’re constantly making changes to make what we do better.”

The night ICD-10 went live, Bliven and his team set up a command center and worked through the night to keep an eye on things and

troubleshoot any problems. Although Selva approached the night with a more confident demeanor than most, Bliven couldn’t disguise his anxiety.

“There were a lot of unknowns,” Bliven says.

“What if you hit midnight and you make the changes to the systems and nothing works? But once we flipped all the switches, crossed our fingers and watched the first couple go through, we were like, ‘OK, it’s working.’”

Stephanie Smith shared Bliven’s concerns

instances of backlog, but less than five percent of coding has moved through this service since ICD-10 launched.

The post-implementation project phase for ICD-10 at MU Health Care extends into February. This allows more time to sort through data about claims being denied or rejected. It’s still too early to determine the impact of the changes.

At the end of October, the Centers for Medicare and Medicaid Services announced that about 10 percent of claims submitted nationwide were rejected during the first month with ICD-10. In fact, out of 4.6 million claims per day, two percent were rejected because of incomplete or invalid information, and .09 percent were rejected for invalid ICD-10 codes.

“So far, and not to jinx us, I’ve been surprised by how smooth it’s gone,” Selva says.

“If a tidal wave hasn’t hit by February, with the volumes we do, it means we’re probably OK.” Most of the benefits of ICD10 will not be realized for some time. Since more detailed medical information is being put into digital systems, there’s a better chance to get data output to improve health care outcomes, track disease outbreaks, facilitate international communications (other countries already use ICD-10), and perform advanced research.

Gray is particularly excited about the research opportunities at MU Health Care because good patient data can be the foundation for better health care.

“It'll be nice when we start seeing some of the research,” Gray says. “But it's probably three to five years away.”

In the meantime, Selva and Bliven have started moving down their to-do lists. The all-consuming push to prepare for ICD-10 meant a lot of other important projects had to be put aside.

“We’re hoping there are no repercussions with ICD-10 in 2016,” Selva says, “because we have a lot of other things on our checklist that we need to get done to move forward and advance as an institution.” CBT

"We don’t like to hold steady and then unveil a big change. We’re constantly making changes to make what we do better."

- Bryan Bliven

56 \\\ February 2016

about a system crash and struggled to fall asleep the night of the change. She had no trouble at work the following morning.

“You wouldn’t have even have known there was a transition, on the technical end of it,” Smith says. “It was smooth.”

MU Health Care set up a command center to support IT and coding following the transition. The plan was to make it available for a few weeks. It was disbanded within a week, for lack of use.

In all, MU Health Care has about 90 coders and billers, including the addition of one part-time and one full-time coder in 2015. A contracted coding service is available for rare

columbiabusinesstimes.com /// 57

58 \\\ February 2016

columbiabusinesstimes.com /// 59

F

Five years ago, a group of social service agencies began meeting to discuss the needs of the children and families in Boone County.

As the providers of many of Boone County’s mental health services, the group had a general idea of the county’s needs, but past attempts at publicly funded support for childhood mental health had been unsuccessful.

Their coalition, named Putting Kids First, was comprised of representatives from Lutheran Family and Children's Services, Children's Foundation of Mid-America, Pathways Community Health, Burrell Behavioral Health and Great Circle (formerly Boys and Girls Town). Putting Kids First funded the campaign to get a child mental health tax on the November 2012 county ballot. Calling for a quarter cent sales tax increase in perpetuity, this measure was estimated to bring in $5.4 million per year for area mental health agencies.

The 2012 ballot marked the third attempt to pass the tax, which voters voted down in 2007 and 1994.

“There wasn’t an opposition — it was really more of an apathy,” says Anita KiesslingCaver, who worked for Presbyterian Children’s Homes and Services at the time and was a committee member of Putting Kids First. She is currently the principal of Kiessling and Associates Psychological Group. “We had to do some education to get it on the ballot,” she says.

Putting Kids First targeted key members of Boone County. They set up community meetings, hired political consultant firms for neighborhood mailing campaigns, and contracted with the Institute of Public Policy, at the MU Truman School of Public Affairs, to study specific needs of the county. The tax passed in 2012, with 57 percent of votes. So what changed in the five years between 2007 and 2012?

“A lot of people didn’t feel that mental health issues are real,” says Keesling-Caver. “If we could communicate these facts, we could convince people to care about mental health

60 \\\ February 2016

for children. There’s a lack of understanding of the reality about mental illness issues.”

Revenues collected from this tax are put into the children’s services fund, which is managed by a board of nine Boone County citizens whose mission is to strategically invest in services for children and families in need.

Truman School of Public Affairs, Institute of Public Policy Report

According to Missouri Statute 210.861, the Children’s Services Fund may be expensed to purchase the following services for children age 0-19 within Boone County:

1.

Up to 30 days of temporary shelter for abused, neglected, runaway, homeless or emotionally disturbed youth

Putting Kids First contracted the Institute of Public Policy, an organization within MU’s Truman School of Public Affairs, to conduct a study of Boone County’s child services. The study’s goal was to better understand child services in the county to wisely allocate funds. Here are some findings of note:

2. Respite care services

•

The report identified 60 agencies with 128 programs that provide child services, including mental health care.

6. Home-based family intervention programs

Of those 60 agencies, 11 were also recipients of the 2015 Boone County Children’s Services Fund, which is partially funded by the child mental health tax.

8. Crisis intervention services (including telephone hotlines)

•

•

The report identified three obstacles to child services for Boone County families: access; structure and systems; and education.

Access concerns things like agency capacity and funding problems; structure and systems concerns logistical problems with access, like poor insurance coverage; and education concerns awareness of mental health problems and knowledge of resources and best practices.

3. Services to unwed mothers and unmarried parent services 4. Outpatient chemical dependency and psychiatric treatment programs 5. Counseling and related services as a part of transitional living programs

7.

Community-based family intervention programs

9. Prevention programs that promote healthy lifestyles among children and youth and strengthen families 10. Professional counseling and therapy services for individuals, groups or families 11. Psychological evaluations 12. Mental health screenings

The board reviewed 58 bids for program funding and accepted 23. By the end of January 2015, the board had awarded $5.1 million in contracts for services. Funding was provided either

MU-Affiliated Programs

The Boone County Children’s Services Fund allocated $5,104,165 to 13 agencies in 2015. Here’s the breakdown: University of Missouri 26% • $1,352,197

Family Counseling Center 4% • $205,925

Boone County Schools Mental Health Coalition 23% • $1,190,865

Lutheran Family and Children’s Services of Missouri 4% • $186,280

Columbia Housing Authority Low-Income Services 11% • $558,284 Burrell Behavioral Health 8% • $392,006 Central Missouri Community Action 7% • $337,505 Rainbow House 6% • $323,244 Great Circle 5% • $235,325

Columbia/Boone County Health and Human Services 3% • $134,758 Heart of Missouri CASA 2% • $90,000 Phoenix Programs 1% • $55,776 Sustainable Farms and Communities 1% • $45,000

for 12 to 18 months, with an option for two 12-month renewals. All programs set to expire in 2016 were renewed, and new funding was allocated for four agencies.

Of the $5.1 million allocated for the 2015 contracts, roughly half was distributed to programs with MU affiliations. From this, almost $1.2 million was awarded to Dr. Wendy Reinke, an associate professor at MU who specializes in early childhood education and mental health, on behalf of the

Department of Psychiatry

$488,163

Psychological Services Clinic

$254,136

Project LAUNCH

$246,582

Dr. Bell, Psychological Services Clinic

$201,927

MU Health, Pediatric Division

$86,105

Assessment and Consultation Clinic

$75,284

Boone County Schools Mental Health Coalition. When the sales tax was passed, Reinke was consulted by a group of Boone County superintendents.

“In discussion with them, we did a needs assessment across six districts,” Reinke says. “They were lacking the infrastructure and capacity to provide good treatments.”

Much of Reinke’s program is based around educating teachers and faculty about mental health and training them to utilize best practices in the classroom. “We’re training teachers on how to support children.” Reinke says. “Where there was no systematic way to identify students before, now teachers will be able to rate students based on mental health indicators.”

According to Reinke, trainings help teachers gauge the mental health of their students based on key indicators. Three times per year, teachers are expected to submit data on their students. From this data, mental health professionals are able to tailor their methods to specific groups of students.

“We try to give the teachers tools,” Reinke says. “Things that are done in the classroom can impact kids who have depression, anxiety or other mental health issues.”

While this is the program’s first year in Boone County schools, Reinke notes that they have already seen enthusiasm from teachers and faculty, particularly in areas of Boone County that went unserved before.

“Harrisburg had nobody, and they are so excited about having a regional director to help them out,” she says.

The Coalition’s upward trajectory continues to have support from the Lutheran Family and Children’s Services Fund, driven by Children’s Services the tax passed in 2012. of Missouri “This is a very unique model that $73,736 we don’t have the opportunity to Phoenix Programs implement in many places.” Reinke $67,496 says. “This model is going to be

$

new funding to be executed in 2016

good for communities throughout the nation, and without the tax, this wouldn’t be able to happen." CBT

Amounts collected by child mental health tax per year, plus interest 2012: $0

2013: $4,806,600

2014: $6,560,000

Boys and Girls Clubs of Columbia $250,000 CHA Low-Income Services $10,771

2015: $6,577,800 columbiabusinesstimes.com /// 61

Over the Counter

c a re Customer service keeps local pharmacies competitive.

By Nicole Flood | Photos by anthony jinson

T he landscape of pharmaceuticals has grown and evolved with each new wave of change in the industry. Fifty years ago, most pharmacies in the United States were small and independently owned. Then came chain-store pharmacies, and then the industry progressed further — today, pharmacies can be found in most big-box stores and grocery stores. The advent of third party administrators, called pharmacy benefits managers, has altered the delivery of prescription medications. But although much has changed, the locally-owned, independent pharmacies are still a staple of the industry, aligning themselves with a focus on personalized, customer-driven service.

columbiabusinesstimes.com /// 63

D&H Drugstore 64 \\\ February 2016

D&H Drugstore has been serving the Columbia area since 1956, when Harold Decanniere and Leslie Hoium opened the Broadway location. Blaine Alberty opened the second location on Paris Road with his wife in 1975.

With the many changes that have taken place over the years, D&H is still dedicated to maintaining quality service in an atmosphere that is family friendly.

Darran Alberty, a doctor of pharmacy and Blaine Alberty’s son, now works with his wife, Tanya Alberty, a registered pharmacist, to serve the community at D&H. Darran first worked at D&H as a cashier and delivery driver in high school. While in pharmacy school, he worked as a technician, and he joined his father and the rest of the staff as a pharmacist in 1997.

In 2001, Darran became a part owner of D&H, and he became the sole owner in 2015. Tanya joined D&H as a pharmacist in 2001.

Darran says he enjoys “just helping our patients overall, some of whom have been coming to us so long that they are like a part of the family.” Tanya adds, “I enjoy talking to our patients about their medications, helping them to understand why it’s important to take their medication, helping them with adherence and seeing their condition improve as a result.” For Tanya, this includes coordinating the Sync My Meds program, which synchronizes the patient’s medications so they can all be filled at the same time.

Darran says that D&H competes with big-box stores through customer service and access to pharmacists and staff. He believes all pharmacists, regardless of practice location, wish to provide great customer service, but that locally owned pharmacies are able to provide that service in a different way because of management practices.

“Locally owned pharmacies make it easier for pharmacists and staff to do what is most important, and that’s taking great care of our patients,” Darran says.

Throughout their time in the pharmaceutical business, Darran and Tanya have seen the pharmacy environment change. “We sold cigarettes until the early-to mid-'90s,” Darran says. “And of course, the advent of the Internet has been beneficial for the pharmacists and patients.”

Tanya adds that more is expected of retail pharmacy now. “The focus has shifted to management of the whole

patient and not just on filling prescriptions,” she says.

“Clinical services like medication therapy management and immunizations have been incorporated.”

Technology changes sped up the development of several elements in the pharmacy. Keeping up to speed on new developments helps them stay competitive. Darran says, “We try to use technology to help patients get the most out of their care at a level they are comfortable with, be it the ability to submit refill requests from a smartphone, online or even talking to a live person.”

Changes in health insurance have not made the medical landscape easier, but D&H tries to help their patients understand their insurance benefits and find ways to make their health care more affordable.

"Insurances oftentimes dictate where a patient can fill their medications, taking the choice away from the consumer,” says Tanya.

“It is difficult when we lose a patient because their insurance is forcing mail order.”

Throughout her career, Tanya says she has learned that the pharmacy field is always changing. “New medications, new drug classes, new changes to the pharmacy practice,” she says. “I never imagined how much education it would take after college to stay current, or that I would ever be giving immunizations.

You have to be willing to D&H on adapt to the changes.”

Broadway Darran says what 1001 W. Broadway Columbia, MO caused him to come to 65203 D&H — and what has 573-777-7333 caused him to stay — are -----------------------------------the people he gets to work with and for. “[It’s] buildD&H on Paris ing and having those rela(Rte. B) 1814 Paris Road tionships with our staff Columbia, MO and customers and mak65201 ing them part of our fam573-777-7373 ily,” says Darran.

“Insurances oftentimes dictate where a patient can fill their medications, taking the choice away from the consumer. It’s difficult when we lose a patient because their insurance is forcing mail order.”

- Tanya Alberty

Darran and Tanya Alberty

LOCATIONS

columbiabusinesstimes.com /// 65

Flow’s Pharmacy has been serving the Columbia area since 1974, with an emphasis on filling prescriptions in 10 minutes or less. Randy Flow moved to Columbia in 1972 and worked at a chain pharmacy before purchasing a pharmacy that had been in business for ten years. Around 20 years ago, Flow took on Dan Cornell as a partner and opened a second store, on Keene Street, shortly after. “We have a lot of good, loyal customers who have been with us a long time,” Flow says.

“I’d say the most fulfilling thing is solving problems within the store and with customers,” he adds. Flow also enjoys “helping patients with questions they may have about their prescription or over-the-counter medications.”

“It’s much more important now — service, friendly personnel, getting to know the people and being helpful is how you compete now.

You’re really not competing on price.”

- Randy Flow Competition has changed a lot over the years. Originally, competition would have been among the independent pharmacies, but the evolution of the pharmaceutical industry has brought many changes in how pharmacists deliver services to their customers. “Then came chain drug stores, grocery stores and big-box stores, and mail order followed soon after,” says Flow. “Now, for all pharmacies, the hardest thing to deal with are PBMs [Pharmacy Benefit Managers].

They tell pharmacies, patients and physicians what they are going to pay for and how much.”

PBMs originally served as a computerized way to track prescriptions that were being filled, insurance coverage and what customers’ co-pays and deductibles would be. In this regard, the service aided efficiency. Flow and others now say it is difficult to work with the PBMs because they dictate so much of the market in terms of how much reimbursement costs are and which prescriptions to use. Flow 66 \\\ February 2016

sees the PBMs as the biggest problem in the pharmaceutical industry right now. “All of us, the independents, and even the chain stores and the public would benefit in looking into the practices and policies of PBMs,” says Flow, adding his thoughts that more transparency is needed in the health care industry in general.

All local pharmacies are now competing against mail orders and the big-box stores, rather than with each other.

The local focus is more on customer service. “I think we’ve always had to do that, but it’s much more important now — service, friendly personnel, getting to know the people and being helpful is how you compete now,” says Flow. “You’re really not competing on price.”

Flow remembers when customers came in and paid cash for their prescriptions, even if they had insurance; then, at the end of the year, they would submit their claims to the insurance companies and get reimbursed for them.

This system led pharmacies to keep records for the customers so they could submit those claims. “It used to be customary for pharmacies to keep handwritten patient profiles, with a record of each prescription filled, the price, etc.,” says Flow. “The customer would then come in at the end of the year, and we would total their purchases up and give them a copy to turn in to their insurance. Now, customers can come in and get a print-out from our computer in seconds.”

The aging baby boomer population has increased the amount of prescriptions being filled, as older people tend to take more medication. Flow says another change has been in the evolution of generic drugs, products comparable to a certain brand of drug in terms of the medicinal qualities it portrays — like a grocery store brand of a pain reliever versus a name brand pain reliever you see advertising for. Regulations have also increased throughout the years, and Flow says they spend more time dealing with paperwork and red tape now.

Flow says one of the biggest lessons he has learned during his career has been to “always be ethical — do Flow's on what’s right for the patient.”

Broadway To make an independent 1506 E. Broadway pharmacy successful, Flow Columbia, MO says it all has to do with peo65201 ple and customer service.

573-449-5366 “One of the big things for all -----------------------------------the independents is hiring good employees, good techFlow's on nicians who are good with Keene people, who know their 303 N. Keene Street job and do it well,” he says.

Columbia, MO “We’ve been really fortu65201 nate with that.”

573-447-8093

LOCATIONS

Left - Dan Cornell Right - Randy Flow

Flow’s Pharmacy columbiabusinesstimes.com /// 67

Kilgore’s Medical Pharmacy 68 \\\ February 2016

Kilgore’s Medical Pharmacy serves the community with two locations in Columbia and one in Ashland.

Bill Morrissey, a doctor of pharmacy, is the current president of Kilgore’s and one of five partners in the business.

Morrissey started working at Kilgore’s part-time in 1996, while working full-time for a chain pharmacy in Columbia.

“The chain I worked for, if you came in to fill a prescription, we took care of that, but if there was anything complicated, we didn’t do it there,” says Morrissey. “I found myself continually referring people to Kilgore’s. My customer service nature didn’t feel right having to send people away.” Morrissey eventually switched his roles around so he worked full-time at Kilgore’s and part-time at the chain. He later bought in as a partner.

“From a business standpoint, I’ve learned a lot. Business is different than health care, and pharmacy kind of blends them. In health care, we’re focused on taking care of people. Business is focused on trying to make money. Those two things don’t always go together; sometimes what’s right for the patient isn’t the most profitable choice.”

- Bill Morrissey

Bill Morrissey

Morrissey says that working in a flexible environment is the most fulfilling aspect of his career. “Helping those people and seeing how grateful they are is probably the thing that really lets you sleep well at night,” he says. Morrissey adds that in running a business, the manager hears when customers are dissatisfied. “But if they’re very happy with the service and want to tell you how much your employees have helped them, that’s what really makes you smile and makes you feel like it’s worth it.”

To be competitive with other independent pharmacies and big-box stores, Morrissey says it’s about service. Everyone sells the same pills, and prices are regulated for the most part. “You go to a chain pharmacy and you’re going to wait for over an hour. But you’re sick and you don’t want

to wait … we offer free delivery within city limits, our drivethru is very fast, and our typical wait time for a prescription is 15 minutes or less,” Morrissey says. Kilgore’s also stays competitive by offering various programs for customers, including providing medical equipment, having staff nurses administer medicine, and offering compounded medicine.

Morrissey has also seen the changing role of PBMs in his business. He says those companies have now grown and evolved to a point where they negotiate directly with the manufacturer, making operating without PBMs impossible.

Technology has also changed the landscape, adding different robots and counting machines that aid in accuracy and efficiency for the pharmacy. Kilgore’s has added some of this, but the company also tries to stay true to being an independent pharmacy focused on customer service. “We choose to employ technicians who will count out the prescriptions and talk with customers in the store and on the phone,” Morrissey says. “In the world we live in, technology is cool, and it brings a lot to the table, but there are also things we lose in not having a face-to-face conversation.”

The aging population has caused an increase in the prescriptions they fill daily. “From a business standpoint, you might say ‘great, more prescriptions means more business,’ but in reality, you have the PBMs, so the reimbursement we get paid for prescriptions has gone down significantly, especially in the last 10 years,” Morrissey says. To break even, pharmacies have to fill more prescriptions in the same amount of time.

Morrissey says that the insurance outlook has changed significantly over the years, especially with the Affordable Care Act, but he doesn’t think the full impact has been seen yet. “We have seen an increase in people who have an insurance card,” says Morrissey. “Do I think the insurance plans that have been put out there have helped people financially? I question that.”

One of the main takeaways Morrissey has learned over the years is the importance of giving everyone the empathy they deserve. “From a business Kilgore's on standpoint, I’ve learned Providence a lot,” he says. “Business 700 N. Providence, is different than health Columbia, MO care, and pharmacy kind 65203 of blends them. In health 573-442-0194 care, we’re focused on tak-----------------------------------ing care of people. Business is focused on trying to make Kilgore's on money. Those two things Chapel Hill don’t always go together; 1608 Chapel Hill Rd sometimes what’s right for Columbia, MO the patient isn’t the most 65203 profitable choice.” CBT 573-447-4444

LOCATIONS

columbiabusinesstimes.com /// 69

nonprofit spotlight

›› Rain-Central Missouri, Inc.

Surrounded by Care

Rain helps AIDS patients and their families.

BY Alisiana Peters | photos by Keith borgmeyer In 1992, the human immunodeficiency virus, also known as HIV, was at its peak and, if contracted, was seen as a death sentence.

When left untreated, the disease is formally classified as acquired immunodeficiency syndrome, or AIDS. That same year, members of the United Methodist Church founded Rain (then Regional AIDS Interfaith Network) of Central Missouri. These church members organized care teams to work with individual patients who were diagnosed with this disease. The teams provided transportation to doctor appointments, food, bedside company and more to ensure that patients died with dignity and were surrounded with care.

However, as the disease started to change, the organization changed as well.

Today, the focus is no longer only to help patients dying of AIDS, but also to support Jamese Edmonson "I am involved in this organization to provide services to clients who need it most and to raise awareness of HIV/AIDS services."

70 \\\ February 2016

individuals living with HIV or AIDS, which is possible thanks to medical advancements.

Rain’s goal is to be the region’s prevention resource, focusing on education, early detection and compassionate care.

“It’s really an amazing story and has totally evolved from our beginnings,” says Echo Menges, Rain board chairwoman.

“The religious aspect has now turned over to health.”

Rain’s central office is located in Columbia at 1123 Wilkes Blvd., Suite 250. Their team consists of 14 full-time staff members.

Rain offers a wide range of resources for people living with HIV or AIDS, including prevention programs, free testing and more.

“I think the most important thing we do as an agency is increase awareness,” Menges says. “It gets put on the back burner in a lot of people’s minds and the attention gets Heidi Wick-Houser "I believe, wholeheartedly, in the services provided and it’s an incredible feeling to know such an underserved population is able to take advantage of services like ours and improve their overall quality of life."

shifted away from HIV/AIDS, but people are still getting the virus.”

Programs and Services One of Rain’s largest services is their case management team. Rain received its first case management contract under the Ryan White Care Act in 1998, a federal legislation supporting AIDS patients. Shortly after the bill passed, Rain hired their first two case managers, hiring additional case managers as their client number increased.

Today, the organization has a total of nine case managers to help serve a total of 336 clients. The case management team covers 37 counties, and about 90 percent of clients are from Columbia.

Rain can assist clients with financial assistance; medications and doctors; treatment or medication management; and housing.

Steve Santoyo "My proudest moment was helping a single mother of five children get off the streets, get medical care and get her kids in school."

➜ 1123 Wilkes Blvd. Suite 250 573-875-8687 missourirain.org

In 2002, Rain’s housing program was implemented to provide monetary assistance to clients, including rent, utilities, emergency repairs and more. The organization expanded their housing services in 2004, after an existing apartment building was renovated, and now provides housing to eligible clients through the city’s Shelter Plus Program. In 2012, Rain secured a contract with Doorways, an AIDS housing program, to include housing assistance and referrals for 29 counties in the southwest region of the state.

Impact of Services Rain Executive Director Cale Mitchell has dedicated 14 years to helping people infected by HIV/AIDS in the community.

Mitchell says the Rain case management team can help those in need quickly. One couple relocated from New York to Columbia to live with relatives; the two were illegal immigrants, with three children all under the age of three. Once their relatives got news of their HIV-positive diagnosis, the relatives threw out the family, along with all of their belongings, leaving them homeless.

Kim Wright "I wish people knew we could provide additional services with cash donations."

"We prevented homeslessness, got people working – it is truly amazing to see all of that come together."

- Cale Mitchell After seeking help from Rain, the family was given transportation assistance to get to and from work. The family was also given housing, food, furniture, medical care, diapers, clothing and more.

“The case manager accomplished all of these things within a five-day span,” Mitchell says. “It is those types of activities that inspire me. We were able to stabilize a fam-

Christine Varner "I wish more people knew the truth about HIV and living with the disease, rather than believing stereotyped information."

ily within our own community. Without our intervention, we don’t know where they would have been.”

Mitchell noted that these are the kinds of successes that translate to community impacts.

“We prevented homelessness, got people working — it is truly amazing to see all of that come together,” Mitchell says.

Aside from the case management program, Rain also has a Prevention Education program. In 2003, Rain expanded this program’s services to provide off-site presentations, testing and other related information.

Rain provides HIV testing, along with STD and STI testing, free of charge.

Mitchell describes one of the biggest myths about people who have been infected with HIV. “I think one of the biggest myths is the disease only affects one certain kind of person,” Mitchell says. “The disease can range from the 17-year-old kid with risk behavior to the 70-year-old woman who contracted the disease from her husband. Many people in this community living with the disease have stable, highly responsible jobs. It is not a onesize-fits-all, it can literally be anyone.” CBT

Meghan Stephens "My proudest moment is every time one of our clients says, 'Thank you for all you do.'"

Cale Mitchell "What we do affects our community as a whole, keeping individuals and families healthy and productive."

columbiabusinesstimes.com /// 71

xx Anderson, CNM, left and Dr. Courtney Barnes Lori Photo by Anthony Jinson 72 \\\ February FEBRUARY 2016

celebrations

›› MU Women’s and Children’s Hospital

Home Away From Home

➜ 404 N. Keene St. 573-875-9000 muhealth.org

By Sierra Stewart

MU Women’s and Children’s Hospital offers low-intervention birthing suites.

With the rate of out-of-hospital births increasing since 2004, MU Women’s and Children’s Hospital has matched a growing desire for natural births, studied by the Centers for Disease Control and Prevention, with a safe, low-intervention option for parents looking not only for the comforts of home, but also medical supervision.

INCEPTION When Dr. Courtney Barnes, medical director of MU’s low-intervention birth program, joined the Women’s and Children’s Hospital six years ago, she noticed that babies were separated from their mothers moments after delivery, a procedure that Barnes felt needed to be changed.

“I didn’t want that to be the case anymore, so I got people together who had the same interests and we started skin-to-skin contact between the mother and child and breastfeeding in the room,” Barnes says. “A natural progression through all of this has been looking at every single thing we’re doing in the hospital and asking why we’re doing it, is it necessary, what are the risks and benefits and does everybody need it?”

After two years of reviewing their care procedures, the MU Women’s and Children’s Hospital became the fourth hospital in Missouri to earn the Baby-Friendly designation from the World Health Organization and the United Nations International Children’s Emergency Fund. Mitch Wasden, chief executive officer and chief operating officer of MU Health, provided financial support to integrate midwives into the birthing procedure, which Barnes says is the biggest support in creating the low-intervention birthing program and the accompanying suites.

“It was a perfect storm of financial backing, administrative support and nursing interest,” she says. “When you look at the outcome of deliveries in the United States, our maternal-fetal outcomes are not necessarily as good as other countries, so I think lots of people are asking the question of ‘are some of the things we do routinely causing harm?’”

EXPERIENCE Deacon Markijohn was the first baby born in the low-intervention suite, at 8 pounds, 2 ounces, on November 23, 2015. With two siblings at home, both of whom were induced, Deacon gave his mother, Jill Markijohn, the opportunity to experience natural childbirth.

“There’s nothing wrong with not having a natural birth, but for me, I feel like I had spent nine months watching everything I put into my body, and if I could [give birth] without having to put in any drugs to ease the pain, I’d want to do that,” Markijohn says. “ I felt like if I could go into labor on my own, it would keep me set on a natural birth.”

The suite’s main purpose, according to the hospital, is to provide “a home-like atmosphere with ample nurturing for expectant moms and limited technological monitoring.” Although the patients look for as little medical intervention as possible, they do receive regular prenatal check-ups. For women to qualify for the suites, they must meet all low-risk pregnancy qualifications.

In comparison to her previous two births, Markijohn saw noticeable differences with Deacon, including her shockingly low level of pain throughout the birth and after. She says, “I said while we were still in the hospital, postpartum, ‘I’m totally open to the discussion of more kids.’”

The suites include a large bed that Markijohn says is anything but a hospital bed — specialized European birthing stools, a spacious bathtub with adjustable heat, labor balls, mats and suspension ropes. Hidden in walls and tucked away, all necessary technology is in the room, in case of an emergency.

Patients are allowed to bring their own birth coaches or doulas to the facility to work with the certified nurse midwives, like midwife Lori Anderson. Anderson is on staff at MU, giving the expecting par-

ents two ways to receive information and support during childbirth.

“It was more than just the room that made it, it was the whole staff.” Markijohn says. “They have it set up so you don’t feel like you’re in a hospital. My birthing team felt like my best friends, and I’d only met them that night.”

With 1.36 percent of United States births now taking place outside of a hospital, the suites strip down the typical hospital room and give that percentage of Americans a home-like option in the safety of a hospital.

“This program is really about everyone having a low-intervention delivery unless they need the intervention.” Barnes says. “The great part about the program is not the room, it’s the policies, the training and the education that we have with our staff.” CBT

Timeline 1974 › MU Children's Hospital founded.

2010 › MU Children's Hospital moves to Columbia Regional Hospital, and the name is officially changed to University of Missouri Women’s and Children’s Hospital.

2012 › MU Women's and Children's Hospital joins national breastfeeding initiative.

2013 › MU Health Care clinics awarded top designation for advanced electronic medical records.

2014 › MU Women's and Children's Hospital recognized by the state for breastfeeding initiatives.

2014 › MizzouThon Neonatal Intensive Care Unit expanded.

2015 › MU Women’s and Children’s Hospital earns global babyfriendly designation.

2015 › Low-intervention birth program launches.

2015 › First baby born in lowintervention suite. columbiabusinesstimes.com /// 73

Columbia Chamber of Commerce

Business Showcase presented by:

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Tuesday, March 1

At the Holiday Inn Executive Center Additional sponsors include: Gold Columbia College and Columbia Daily Tribune/Tribune Publishing Co Supporting Holiday Inn Executive Center, Epoch Health and Missouri Employers Mutual; Mixer Caledon Virtual; Hospitality Bleu; Exhibitor Rounds Robert J. Trulaske Sr. College of Business; Aisle Jes Holdings, LLC.

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Education

›› Dr. Peter Stiepleman talks the business of education­­— Part 3/4

CPS Will Never Be The Same Each year, I like to thank my team for the work they do with a small gift. Last year, I relied on Zuni symbols, figurines carved from shell or stone. I gave our deputy superintendent, Dana Clippard, a wolf because of her fierce loyalty to the success of others. I gave our CFO, Linda Quinley, an eagle because of her ability to work with details while also understanding the big picture. Ben Tilley, our assistant superintendent for elementary education, received a bear, representing his drive to get the work done.

This year’s gift, an antique map of Missouri, symbolized that much has changed since Missouri became a state.

Throughout the past year, I have said that our community will never look the same. In 14 years, we have grown from a school district of 16,400 to 18,000 students. We’ve said that our budgets will never be the same. It costs our district $11,000 to educate each child, for which we are reimbursed $3,000 from the state. Each child we add is an $8,000 cost to the school district. As one business owner said to me, “It’s like planning a wedding for 100 guests and having 300 show up instead!”

In December, our board of education authorized a community vote, in April, of a 65-cent levy increase and a no-tax-rate bond issue, because they recognize that in order to be the best district we can be, we need to maintain the status quo of operating our buildings. We will need to end deficit spending. It’s not a question of simply cutting expenses; our growth makes that impossible. The board of education recognizes that we need to recruit and retain high-quality employees because parents have made it clear that they want a highly qualified teacher who will provide a nurturing environment for their children. The board recognizes that to be the best, we will need to invest in the programs that make us great: our Columbia Area Career Center; our Advanced Placement course offerings; our AVID program; our responsive programs for second language learners, homeless students, and students from economically stressed homes. Our community’s investment in its public schools is directly linked to its long-term economic vitality.

In five years, it’ll be the 2021-2022 school year and Missouri’s 200th birthday. With this, I began exploring the changes we’ve seen in that time.

In 1821, Missouri came into the Union as a slave state. As to not disrupt the balance of slave states versus free states, Maine was also admitted. The population of Missouri was 66,000, agriculture was the economic driver, and the major modes of transportation were horses, riverboats and railroad.

One hundred years later, in 1921, the 19th Amendment had just passed and women could vote. Even though a growing number of the state’s 3.4 million people were moving to the cities, agriculture, especially cotton, fueled the state’s economy. A network of highways had been developed, suggesting

P eter Stiepleman

that cars and trucks would begin playing a bigger role in moving people and products, and people still preferred to communicate through letters.

As we consider what our state will look like in 2021, we must anticipate a few things. Communication will look different. Email, texts and video conferencing will likely still be present. However, we must expect that virtual reality (check out Sarah Hill’s StoryUp) will revolutionize how we see the world, and we can expect that tools like universal translators will make the world an even smaller place. And while highways will remain a major way to transport goods (we might expect drones to gain market share), the information highway will bring additional opportunities and challenges. Among those challenges is the schools’ responsibility in preparing students for a changing and unpredictable world. Careers in IT will most certainly continue to grow (including careers in programming and cybersecurity).

The map served as an important symbol. A symbol that much has transpired since Missouri became a state. Since 1821, rights have been conferred to those with few or none, and things have gotten better. Since 1821, issues of race and class, of gender and orientation, of religion and ability have improved. But issues surrounding each of these identities have also become more complex. The map is a reminder that our state was here before we were born and will be here after we are gone. Our job is to make sure that in 2121, someone will look back on what we accomplished as a community and marvel on how we improved the lives of our youth, our community and our economy. I know no better city than Columbia to make that so. CBT

➜ Superintendent of Columbia Public Schools columbiabusinesstimes.com /// 75

MARKETING

›› Monica Pitts talks marketing trends and tips

Preparing For A Website Design Horror stories from jilted businesses wishing they’d hired a different web designer is a recurring theme in my office.

A few months ago, I had just such a conversation with Jennifer Gardner, assistant store manager of a local small business. She says, “Truly, this web design has been a full-time job. Had I known that going in, I would have gone about the whole process much differently.”

Before starting a project of this size, you just don’t know what you don’t know. Hopefully our combined experience can help shed some light on how to uncover the unexpected. Ask potential design candidates:

What can I expect from your design?

Design can mean a lot of things. It’s not just how the website looks, but how it functions as well.

Will it be a custom design or a template site? A custom design generally takes longer than modifying a pre-designed template. Clarify which option is included in your proposal to make sure you’re comfortable with the level of consultation and customization.

Will it look good on multiple devices? According to comscore.com, more people use smart phones and tablets to view the Internet than desktop computers. Make sure your estimate includes a responsive or adaptive template that adjusts to display well on multiple devices.

What will I be responsible for (other than the bill)?

One of the most time-consuming tasks when building a website can be writing the content and finding or taking the right photos to represent your company. Know who is responsible for those tasks up front, as well as when the tasks are due and to what standard they need to be completed.

Gardner says you should ask your web designer to clearly define what will be expected of you. “I was totally blindsided by how much work I had to do to get this website up and going, and I was not made aware of that when I signed up. I guess I thought the designer was also a marketing genius who was supposed to know everything about my business. I was not prepared to write every blurb, to find and organize every picture, as well as to find everything needed from my staff.”

m o nica pitts 76 \\\ February 2016

How much will it REALLY cost me?

How much your site will cost is sort of a big deal. An even bigger deal would be thinking it will cost one amount and then being charged for another.

“If your potential designer is not thoroughly discussing things like additional cost of photography, additional costs of marketing blurbs, what your commitment to the project needs to be, then find another designer,” advises Gardner. “They are not being realistic, and they’re glossing over the reality. Your website may not meet your expectations.”

Is it fixed bid or sliding scale? Read the fine print and determine if the bid is fixed and you’re only responsible for the amount on the contract or if the company can charge you a fixed price plus a certain percent over the estimated price.

How will payments work? Learn about how the website payments will work. Most designers either ask for half down and half upon completion or break the payments into thirds. If you’re being asked to pay for it all up front, that may be a red flag.

Gardner shares: “If expectations and timelines start to sour with a company, it becomes very difficult to ‘cut and run’ if they have a lot of your money. I would say never sign a contract without checking two recent references.”

Are there monthly charges? Also, ask about any monthly charges that will begin during or after the site is completed, like hosting or ongoing maintenance charges.

➜ C h i e f c r e at i v e d i r ecto r at M ay ec r e at e d es i g n

What’s not included? You may have spoken about a lot of things in your meeting but that doesn’t mean it’s all in the proposal. Sometimes client budgets and expectations do not align perfectly, so initially discussed items are trimmed to meet the budget. Make sure you know up front which of your requests were and were not met within the proposal.

One of the most time-consuming tasks when building a website can be writing the content and finding or taking the right photos to represent your company.

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“It isn’t always obvious who needs help. In our crazy, frenetic lifestyle we don’t always know how to help.

Thanks, United Way, for this chance.”

www.soccerpro.com

When it’s all over… then what?

This question often becomes a sticking point when you’re unhappy with your service provider and seeking to have another finish or maintain the site.

What happens if they don’t fulfill the contract? In most contracts, the payments made to the vendor are non-refundable — though if your vendor doesn’t fulfill his or her end of the bargain, you may want to negotiate a refund, or at the very least, paying in installments so you can decide not to make any more payments.

Gardner advises, “If you have done your part and your designer starts to miss deadlines, do not let it get out of hand. Be direct and revisit your signed contract. Worst case scenario, demand a refund and find another company.”

“We’re committed to not only serving the pets and their owners in this community, but every citizen so that we can all have a better place to live.”

www.RollingHillsVetHospital.com

Can you update the website on your own? If you’ll be able to update the site on your own, make sure they give you a username and password to do so. Clarify what type of training is available and if it is online, in person or in a printed guide. Also determine how long training is available without an additional charge and how many people can attend.

Who owns what? If your vendor owns the site after it’s completed, it’s difficult to switch vendors. Be on the lookout for this, especially if you’re only paying a low monthly rate for your site. This often indicates you’ll be using a proprietary software to create the site and you may not be able to transfer the site away from their service once it’s completed.

Do your due diligence and ask before signing the dotted line! For more information to prepare you to make an educated decision, download our free Design Company Interview Guide at Mayecreate.com. CBT

are community partners.

To become a member of the LU365 Small Business Circle visit uwheartmo.org/live-united-365 columbiabusinesstimes.com /// 77

Startups

›› Chris Nyenhuis shares startup lessons learned

Health Care Technology: Is Columbia Too Late?

You don’t have to spend much time or look too hard to see that the health care industry plays a central and influential role in job creation, the economy and infrastructure in Columbia. During my Christmas break, I was back in Columbia, and I was amazed to see how many new medical buildings and offices have sprung up around the city.

On one of my drives around town, I counted at least four new structures being built. These structures weren’t small-town offices, but rather big-city complexes. It made me wonder — with all of these doctors’ offices, hospital extensions and research facilities, why aren’t there more health care tech companies being founded in Columbia?

Columbia should be a Mecca for high growth health care technology companies in Missouri.

During my time at the Missouri Innovation Center, I was aware that there was a large focus on health care startups and businesses in Columbia, but, when asked by a friend recently, I couldn’t give him one high-growth health care technology startup in the ecosystem.

This shocked him and, quite frankly, embarrassed me. Columbia has numerous companies focusing on pharmaceuticals, animal health, research and devices, yet there is very little focus put on high growth health care technology startups.

Columbia should be doing everything in its power to attract, develop and create high growth health care technology companies.

I personally have had little involvement in the health care technology sector in my entrepreneurial career, but I have been fortunate in meeting some founders who are launching incredible companies and ventures that are doing amazing things, directly and indirectly, with the health care industry. These companies vary from a firm focusing on helping patients and hospitals with their billing to a plastic surgeon who is helping patients find cost-effective solutions to cosmetic

C hris N yenhuis 78 \\\ February 2016

surgeries. I recently read, in Fortune magazine, that between 2010 and 2014, the number of venture funding deals in the health care industry grew more than 200 percent, and in 2014 alone, more than $6.4 billion was invested into new health care ventures.

With health care reform, an aging population and our general fascination with technology advances (wearables, video chats, health and fitness apps), the industry is booming. Recently, some experts at Markets and Markets estimated that the global health care IT market will reach more than $228 billion by 2020, and wearables alone are expected to gross more than $2 billion in revenue by the end of 2016.

Many cities across the world are competing to attract these startups and the billions of dollars that could be invested in them. They are creating and developing programs that are purely focused on high growth health care technology companies. These programs include incubators, accelerators and other formal programs that provide favorable terms and investment opportunities for founders and startups. These programs not only offer financial opportunity, but also access to health care networking, office space, service providers and large industry partners.

Columbia has one of the best health care ecosystems in the country and has some of the best minds in the health care industry in its midst. Columbia should be doing everything in its power to attract, develop and create high growth health care technology companies. If not, I think it’s fair to say the community will be passing on the possibility of being a leader of this global technology. CBT

➜ Managing Director of Eyes on Freight

ORGanizational HEALTH

›› Tony Richards coaches organizations into good health

Five Ways Growing Pains Appear In 1979, I had the first of two knee surgeries. The initial one was the result of a horse accident on my family farm; the second occurred in 1983, from a sports injury. In 1991, I was involved in a terrible car accident, in which I required some plastic surgery to my face. Last summer, I underwent a shoulder surgery to repair my rotator cuff and to remove some bone spurs. Pretty severe physical pain accompanied all of these medical conditions. They all required pain tolerance, focus and perseverance to move forward.

Every day, I work with clients who are experiencing a different kind of pain, but it is just as real. This kind of pain takes just as much focus, perseverance and, yes, tolerance to overcome. The difference is that it's psychological and emotional pain, rather than physical pain.

Our natural neural reaction to physical pain is to try to stop it as soon as possible. However, with growing pains for entrepreneurs and executives, stopping the pain can have negative results. When the pain stops, the progress of growth stops. It takes a little bit of time for the leader to realize that pain equals growth. New experiences and situations facing a leader cause this kind of situation. For instance, sometimes executives leave companies to form their own enterprises — this is a very different experience, which causes different pain.

In some cases, as leaders, we have to get away from our successful technical expertise to become business managers and people developers; these situations also create new pains of growth. Here are just five of the many ways growing pains can manifest themselves in a growing leader:

1. Becoming Tired: No doubt about it, applying your energy in ways you haven't previously applied it sucks the energy right out of you. In familiar situations in which we have become skilled, we've learned when to push, when to pull and when to take a break. In new growth situations, we are learning and growing, which requires a lot of focus. Focus requires a lot of energy reserve, and we end up draining it.

2. Stress and Pressure: There's a big difference between healthy pressure and stress. Healthy pressure is usually applied to ourselves when we want to grow intentionally or reach a new, desired goal. We push ourselves to achievement. Stress is usually created by outside forces that have come to control us emotionally and mentally. Unhealthy stress typically exists when we apply a mental or emotional negative meaning to an existing factual event or situation.

3. Criticism: The next three can be sized up the same way as stress and pressure. When we receive criticism, what meaning do we attach to it? The thing to remember is that the more you grow and the more you achieve, the

To ny R ichards

more criticism you will attract. It's the way our world works. Leaders who have a penchant for being defensive operate with a chip on their shoulder.

They want the criticism so they can fight back. This is pointless. Critics go away and move on. If you want productive growth pain, find trustworthy people who can give you accurate, improvement-oriented feedback in your best interest. This is the healthy and productive way.

4. Fear: As human beings, we face and deal with many types of fear. Fear creates emotional discomfort. When leaders need emotional comfort, they lack the capacity to remain present and engaged when faced with resistance from others. They tend to avoid emotionally charged discussions and miss the natural opportunity for learning and growth. Leaders who attempt constant emotional comfort become cut off from their own emotions and therefore unable to correctly respond to the emotions of others. It is almost impossible for leaders to make difficult decisions when they are paralyzed by the fear of the emotional responses of others. You need a small team of three to five emotional support people to help you conquer a fear attack.

5. Failure: Fear plays a big part in this one as well. One of the characteristics of leadership is the sense of adventure one gets out of the daily process.

When leaders begin to possess a fear of failure, they are often reluctant to act.

They may procrastinate in decisions and miss great opportunities. Unless someone has a highly analytic personality, most effective leaders do not need every possible piece of information before moving forward. Questions are always the key. Fear of failure will force a feeling of information poverty. Allor-nothing thinking is never where you want to be as a leader. Small steps and little victories are key to forward progress. CBT

➜ F o u n d e r o f Cl e a r V i s i o n D e v e l o p m e n t G r o u p columbiabusinesstimes.com /// 79

New Business Licenses

›› Columbia residents and their upstarts

WE’RE OPEN. Gravity, your mid-Missouri Apple Authorized Service Provider.

Cricket Wireless

Maid 4 U

1009 E. Broadway

2529 S. Providence Road

Wireless retail store

Motel

Lawfer Time Shop

American Dent Center

601 E. Broadway

1800 Commerce Court

Whatever your issue, we can

Watch repair shop inside L.C. Betz &

Automotive detailing

fix any Mac® made between

Associates

1980 and tomorrow (within the laws of physics, of course).

Welcome Inn Columbia Be The Witness LLC

1612 N. Providence Road

1601 Birmingham Court

Motel

Internet sales of clothing Regan Homes & Remodeling Spa Nails I

New construction and remodeling

805 E. Nifong Blvd.

Nail salon

Jamba Juice 260 S. Tenth St.

Arch City Vapors LLC

Juices and smoothies

1305 Grindstone Pkwy.

Electronic cigarettes, vapor products

Brent’s Repair General contractor

Nam

In or Out of Warranty Repair / Business Services / Consultation / House Calls / Training

2137 E. Northwood Drive

CoinStar

Delivery and cooking services

205 E. Nifong Blvd.

1729 W. Broadway

Brave Wisdom Therapy

2900 Paris Road

2024 Cherry Hill Drive

3001 W. Broadway

Counseling services

1201 Grindstone Pkwy.

415 Conley Road

ECOATM Inc.

Self-service coin counting machine

415 Conley Road 573.443.1555 info@gravitycolumbia.com gravitycolumbia.com 810 East Walnut St. / Columbia, Missouri 65201 Mon - Fri 10am - 6pm / Sat 10am - 2pm Authorized Service Provider Apple and Mac are trademarks of Apple Inc. registered in the U.S. and other countries.

80 \\\ February 2016

1201 Grindstone Pkwy.

Body FX

Fully automated kiosk – purchases

3301 Broadway Business Park Court

electronics

Tanning services

Zach Mayfield Carpentry

Cortex

806 Medina Drive

714 Campusview Drive

Trim and finish carpentry

Technology developer CBT

Deeds of Trust

›› Worth more than $399,200

$1,639,400 Bartels, Roland S & Tina L Landmark Bank LT 709A Villas At Old Hawthorne Plat 7 The $1,639,400 Bartels, Roland S & Tina L Landmark Bank LT 125B Villas At Old Hawthorne Plat 1 The $1,639,400 TERC, LLC Landmark Bank LT 2 Bearfield Plaza Subdivision $1,639,400 TERC, LLC Landmark Bank LT 402 Perry Automotive Plat 4 $900,000 Ryarc Enterprises LLC Hawthorn Bank LT 6 BL 2 Bear Creek Sub $760,000 Bartels, Roland S & Tina L Landmark Bank LT 709A Villas at Old Hawthorne Plat 7 The $615,563 Walker, Raymond IV & Laine BBMC Mortgage, LLC STR 8-47-12 /NW/SE SUR BK/ PG: 513/621 $580,000 Williams Crossing LLC Landmark Bank LT 5 FF B F Stewart’s Sub $563,000 Shaw, Deborah S & Marty D Exchange Bank of Missouri STR 17-47-13 /E/NW

$540,000 Nelson, Christopher S & Sarah Central Bank of Boone County STR 28-48-13 //SE AC 3.105 FF PT Of Tracts 1&2 SUR 8016 $520,000 Dietiker, Kristin L & Nathan Commercial Trust Co. STR 16-50-13 /SW/SE $518,425 COMO Tire Supply Inc. & CTS Inc. First Midwest Bank of Poplar Bluff LT 1D Rockbridge Sub BLK 9 $509,276 Fiola, Frederic J & Sharon A Carrington Mortgage Services LLC LT 45 Thornbrook Plat NO 1 $500,000 MU House Corporation of Delta Gamma Central Bank of Boone County LT 17 PT Lagrange Place PT LT 17,18,19,26,27,28 $480,000 Knorr, Stephen C & Wendy J Mid America Mortgage Services Inc. LT 244 Thornbrook Plat NO 7 $417,000 Mank, Jerome John & Martha C Central Bank of Audrain County STR 32-51-11 //SW SUR BK/ PG: 3393/47 AC 28.52 FF Lot 3

478

Deeds of trust were issued between 11/30 and 12/24

Nationally recognized award-winning IT solutions right here in Columbia

$417,000 Finn, Nicholas A & Lisa Y Central Bank of Boone County STR 17-46-12 //SE SUR BK/ PG: 1558/881 FF Tract 1 $417,000 Brown, Kevin J & Linda Kathleen Landmark Bank LT 29 Woodrail Sub Plat 4 $417,000 Kent, Derek K & Kelli L The Callaway Bank LT 513 Thornbrook Plat NO 15 $417,000 Driskill Family Revocable Living Trust Landmark Bank LT 10A Meadows Ledg Sub Plat 1 LTS 10-13 $416,300 Clifton, Heather N & Ned R Central Bank of Boone County LT 126 Gates Plat NO 1 – Rearrangement The $416,175 Lenz, Alison K & Joseph D Flat Branch Mortgage Inc. LT 10 Bradbury Estates $412,000 Crow, Regan R & Jeremy L NBH Bank STR 18-46-11 //SW SUR BK/ PG: 1514/723 AC 13.5 FF TRACT 2 $399,200 Kim, Sang S & Park, Jiyeon Flat Branch Mortgage Inc. LT 160A Heritage Estates Plat NO 1-A CBT

U.S. Chamber of Commerce Blue Ribbon Small Business of the Year Award winner for 5 Consecutive Years

First Place Top IT Company

There IS a better way to manage your IT. Call today. 573.499.6928 MidwestComputech.com

columbiabusinesstimes.com /// 81

Economic Index

›› It’s all about the numbers

Labor: November 2015 – Columbia, Missouri Labor Force: 69,941 Employment: 68,005 Unemployment: 1,936 Rate: 2.8 percent November 2015 – Boone County, Missouri Labor Force: 103,589 Employment: 100,694 Unemployment: 2,895 Rate: 2.8 percent November 2015 – Missouri Labor Force: 3,112,927 Employment: 2,984,423 Unemployment: 128,504 Rate: 4.1 percent

Construction: Residential building permits, November 2015: 94 Value of residential building permits, November 2015: $12,861,437

Commercial additions and alterations, November 2015: 12 Value of commercial additions and alterations, November 2015: $1,389,994

Utilities: Water December 2015: 47,875 December 2014: 47,438 Change #: 437 Change %: 0.921 percent Number of customers receiving service on January 1, 2016: 47,884

Electric December 2015: 48,622 December 2014: 48,061 Change #: 561 Change %: 1.167 percent Number of customers receiving service on January 1, 2016: 48,634

Housing: Single-family home sales, November 2015: 104

Detached single-family homes,

Single-family active listings on

November 2015: 34

market, November 2015: 645

Value of detached single-

Single-family homes average

family homes, November 2015:

sold price, November 2015:

$7,481,359

$211,648

Commercial building permits,

Single-family homes average

November 2015: 14

days on market, November 2015: 66

Value of commercial building permits, November 2015:

Single-family homes pending

$5,903,994

listings on market, November 2015: 130 CBT

82 \\\ February 2016

By the Numbers

›› Boone County statistics

hospital recommendation Patient survey Source: medicaid.gov

MU Health Statistics Source: MU Health, 2015

Would you definitely recommend this hospital?

82%

71%

70%

Boone Hospital

State Average

National Average

614,133 clinic visits

1,837 births

Missouri State Health Ranking Source: America’s Health Rankings, 2015

highest missouri ranking

#10

23,472

279,655

major surgical operations

radiological exams and treatments

71,962

576

FEWEST CHILDREN IN POVERTY

overall ranking

#36

lowest missouri ranking

#48

MALES VACCINATED AGAINST HPV

Boone County in-state Health Ranking

emergency and trauma center visits

patients transported by helicopter

Patient origin: All 114 Missouri counties, plus several states and foreign countries

J. Otto Lottes Health Sciences Library Source: MU Health

Source: County Health Rankings, 2015

overall ranking

health risk ranking

out of 114

out of 114

7 3

287,912

volumes in collection columbiabusinesstimes.com /// 83

INTRODUCING

O COM COMO DECEMB ER/JANU

CULTURE HOMES FASHION

ARY

C

O

O

M

ISSUE THE HOLIDAY

E AND CULTURE IA LIFESTYL E ABOUT COLUMB VOL.1 / A MAGAZIN

LI V ING

VOL.1 / A MAGAZIN E ABOUT COLUMB IA LIFESTYL E AND CULTURE

DECEMB ER/JANU

CULTURE HOMES FASHION

LI V ING

ARY

C

THE HOLIDAY ISSUE

Booze-Infused Desserts YS FOR THE HOLIDA PG. 34

Booze-Infused Desserts Dressed to the Nines Dre ssed to the Nines

+

FOR THE HOLIDA YS PG. 34

IT’S FUN TO PLAY SOMETI MES PG. 42

01

DRESS UP

IT’S FUN TO PLAY DRESS UP SOMETI PG. 42 MES

2016

$5.95 US

A Splash of Boldness

JESSE BODINE AT HOME WITH PG. 71

D E C /J A N

01

D E C /J A N

2016

$5.95 US

DEC/JAN 2015/16

OFFICIAL V2.indd

COMO Living

1

DEC/JAN 2015/16

AT HOME WITH

OFFICIAL V2.indd

+

A Splash of Boldness AM 11/16/15 10:09

COMO Living

JESSE BODINE PG. 71

1

11/16/15 10:33 AM

C U LT U R E FA S H I O N HOMES EVENTS

84 \\\ February 2016

O O

M

THIS OR THAT

›› Columbia professionals answer the hard questions

Photo by Ben Meldrum

THIS Mac Money

Influence

Business

Casual

Today

Tomorrow

Learn

Teach

Phone

Email Feet First

Books

Magazines

Coffee

Tea

DIY

Buy

Handwritten

Typed

Print

Digital

Quiet

Lively

Clean Volunteer Solo Sitting Desk Outlook Lunch In Drive to Work Doughnut

Owner, Letrisha A. Thomas, DDS

PC

Writing

Cursive

Letrisha Thomas

THAT

Reading

Head First in t h e C of f e e , tea g in n m or bed! b e f or e

or

Print Cluttered Donate Team Standing Desk Gmail Lunch Out

Bagel Analytical

Introvert

Extrovert

Laptop

Desktop

Optimistic

Realistic

Happy Hour

I’ m n o t great w it h e it h e r though .

Public Transportation

Creative

Travel

Clutter is new to me with my 16-month -old!

Staycation Home

columbiabusinesstimes.com /// 85

TOP B2B PRODUCT DELIVERY SERVICE

First Place: Culligan Water 1801 Commerce Court, Columbia, 573-874-6147, culliganmidmissouri.com Second Place: Major Brands

TOP HAPPY HOUR

First Place: 44 Stone Public House Second Place: The Roof

TOP ARCHITECT

First Place: Jennifer Hedrick Second Place: Nick Peckham

TOP COMMERCIAL BUILDER/CONTRACTOR First Place: Coil Construction Second Place: Little Dixie Construction

TOP REAL ESTATE DEVELOPER

First Place: Starr Properties Second Place: John Ott, Alley A Realty

TOP PLACE TO WORK

First Place: Veterans United Home Loans Second Place: Hawthorn Bank

TOP ENGINEER

First Place: Timberlake Engineering Second Place: Trabue, Hansen & Hinshaw Inc.

TOP ACCOUNTING SERVICE

First Place: Williams-Keepers Second Place: Accounting Plus Inc.

TOP CATERER

First Place: Hoss’s Market & Rotisserie Second Place: Bleu Restaurant & Catering

TOP STAFFING COMPANY

Second Place: The Insurance Group

TOP COMMERCIAL LENDER

First Place: Matt Williams, Landmark Bank Second Place: Drew Smith, Commerce Bank

First Place: Influence and Co. Second Place: Global First Responders

TOP WEB DEVELOPER

First Place: MayeCreate Design 700 Cherry St., Suite C, Columbia, 573-447-1836, mayecreate.com

First Place: JobFinders Second Place: Caroline and Co. Inc.

TOP CULTURE

First Place: Veterans United Home Loans Second Place: Murry’s Restaurant

TOP OFFICE DIGS

First Place: True Media Second Place: Woodruff Sweitzer

TOP BUSINESS WITH A COMMITMENT TO PHILANTHROPY First Place: Veterans United Home Loans Second Place: Joe Machens Dealerships

TOP JANITORIAL SERVICES

First Place: Atkins Building Services Inc. Second Place: Tiger Maids

TOP COMMERCIAL PHOTOGRAPHER Second Place: Delta Systems

TOP ADVERTISING AGENCY

First Place: Woodruff Sweitzer Second Place: MayeCreate Design 700 Cherry St., Suite C, Columbia, 573-447-1836, mayecreate.com

First Place: LG Patterson Second Place: Casey Buckman Photography

TOP EVENT LOCATION

First Place: The Tiger Hotel 23 S. Eighth St., Columbia, 573-875-8888, thetigerhotel.com

TOP PLACE TO HAVE A BUSINESS LUNCH

First Place: Murry’s Restaurant Second Place: D. Rowe’s Restaurant & Bar

TOP OFFSITE TEAM MEETING LOCATION

First Place: Logboat Brewing Co. 504 Fay St., Columbia, 573-397-6786, logboatbrewing.com

TOP COFFEE MEETING LOCATION

First Place: Kaldi’s Coffee Second Place: Dunn Brothers Coffee

TOP AMBASSADOR OF BUSINESS IN COLUMBIA First Place: Dave Griggs Second Place: Mary Ropp

TOP NEWBIE TO BUSINESS

TOP BUSINESS INSURANCE

First Place: Mike Messer Agency – Shelter Insurance 908 Rain Forest Parkway, Columbia, 573-442-5291, shelterinsurance.com/ CA/agent/mikemesser

TOP BUSINESS WITH INTERNATIONAL IMPACT

Second Place: Les Bourgeois Vineyards, 14020 W. Highway BB, Rocheport, 800-690-1830, missouriwine.com

TOP PLACE TO CLOSE A DEAL

First Place: Nick Hardy Second Place: Max Prokell

TOP CHAMBER VOLUNTEER

First Place: Wally Pfeffer Second Place: Michele Spry

TOP LOCAL TEAM-BUILDING EXPERIENCE First Place: Logboat Brewing Co. 504 Fay St., Columbia, 573-397-6786, logboatbrewing.com

TOP OLD-TIMER IN BUSINESS

First Place: Kat Cunningham Second Place: David Keller

TOP COMMERCIAL VIDEOGRAPHER

First Place: 44 Stone Public House Second Place: Boone County Title Co.

First Place: Spectrum Studios Second Place: Baker HD

TOP BANK

TOP HR FIRM

First Place: Boone County National Bank Second Place: Landmark Bank

Second Place: Stoney Creek Hotel & Conference Center

First Place: MoreSource Inc. Second Place: Accounting Plus Inc.

Second Place: The Canvas on Broadway

TOP IT COMPANY

First Place: Midwest Computech 311 Bernadette Drive , Columbia, 800346-8934, midwestcomputech.com

Second Place: Easy PC

did you know?

›› Fun facts CBT staff discovered while reporting this issue

According to Dr. Lindall Perry, partner at Central Missouri Dermatology Associates, the most important thing to do for your skin is to protect it from the sun. Read his tips, along with more skin care information, in this month’s 10 Questions on page 88.

Did you know that more than 34,000 cases of cancer were reported in 2015, according to the American Cancer Society? Read about what some MU professors are doing to study and develop new treatments for cancer on page 46.

D&H Drugstore has been locally owned in the Columbia community since 1956. Read more about D&H, Kilgore’s Pharmacy and Flow’s Pharmacy on page 62.

The U.S. medical industry recently underwent huge changes in the medical coding system. The number of diagnostic codes increased from 14,000 to 69,000, and the number of procedural codes jumped from 4,000 to 70,000.

Read more about how these changes have impacted the medical community on page 52 (If your younger sister got a Lifesaver Mini stuck up her nose, she’d be diagnosed with S00.35XA).

This month’s PYSK, Lori Osborne, health services coordinator at Columbia Public Schools, lived with singer-songwriter Sheryl Crow during college. Read more about Lori on page 35.

Image Source: thetalsu.com

There’s a new monthly staple in each CBT — we ask Columbia professionals the really tough questions, like ‘peanut butter or jelly,’ each month in This or That, on page 85. This issue, find out whether Dr. Letrisha Thomas prefers coffee or tea to jumpstart her day.

The urgent care business is a $14.5 billion industry in the U.S., and Columbia is no exception to the growing number of urgent and quick-care centers. Read about this change to the health care industry on page 40.

? columbiabusinesstimes.com /// 87

10 questions

➜ 401 N. Keene St. 573-876-1616 centralmodermatologygroup.com

›› Get to know your professionals

Protecting Skin Year Round

Lindall Perry, MD, Partner, Central Missouri Dermatology Associates

2. What’s the best way to check for skin cancer? The American Academy of Dermatology suggests using the “ABCDs of melanoma” to remember what to look for on your monthly skin self-exam. A is for asymmetry of the lesion. B is for irregular border of the lesion. C is for a varied color pattern within a single lesion.

D is for a diameter of more than 6mm (1/4-inch) for a single lesion. I would always recommend an annual full skin exam by a board certified dermatologic physician if a person has a personal or family history of skin cancer or melanoma.

3. How can I improve my skin through lifestyle changes? A healthy respect for the aging and damaging effects of chronic ultraviolet exposure. By this, I mean wearing sun-protective clothing and/or sunscreen when outside from 10 a.m. to 4 p.m. Daily moisturizing and mild cleansers can help everyone have better skin health. I would always discourage purposeful tanning, in a tanning bed or outdoors.

F U N FACT: 88 \\\ February 2016

4. How does winter weather impact my skin, and what can I do to combat it? Winter in the Midwest is our low humidity time. When the furnace is blowing warm air, our skin is being dried out. You will recognize this as dry lips, dry nasal passages and dry, itchy skin. The remedy is to add back the moisture via over-the-counter moisturizers. Your local dermatologist can recommend the best products during your next visit.

7. What kind of sunscreen is best?

A broad spectrum sunscreen is best. This means a sunscreen that blocks the cancer-causing and aging effects of ultraviolet rays from the sun. Broad spectrum means it impedes UVA and UVB rays; SPF 30 is optimal.

8. What is the one thing I might not know about skin care? Ultraviolet injury to your skin cells can take 10 to 20 years to promote a skin cancer. Any protection you do today can help your skin health for many years.

5. What’s Central Missouri Dermatology’s approach to skin care? We offer a complete skin care team for encouraging healthy skin.

We can treat all skin, hair and nail maladies, and our services include diagnosis; treatment; Mohs skin cancer removal; phototherapy; laser treatment of excess hair and veins; facial rejuvenation, including Botox; fillers; chemical peels; and a complete line of cosmetic pharmaceuticals.

6. You have locations in Columbia, Jefferson City, Boonville, Mexico and Moberly. What’s next for your growing practice? We are always looking for new and more efficient ways to serve our community of central Missouri. We are excited and grateful for each patient who entrusts us with the care of their skin. We will likely increase our staff as the community grows and develops a need for more dermatologists. Please let us assist with all of your skin needs.

9. How do I know if I’m aging well? Protecting your skin from the sun's damaging effects will manifest as skin that appears less aged and mottled. Your friends will be jealous of your youthful appearance. You will also enjoy fewer problems with skin cancer and sun-induced wrinkles.

Photo by Ben Meldrum

1. What’s the single most important thing I can do to protect my skin?

Vigilant sun protection. I see so many folks with skin cancers on their face or bodies from sunburns and years of sun exposure without any protection. A modest amount of sunscreen and/or sun-protective clothing can prevent most future skin cancers. I also would say that skin will look younger and healthier.

➜ Perry loves riding his bike on the Katy Trail (fully protected from the sun, of course.)

10. What should I look for in a dermatologist? A board certified dermatologist with a good bedside manner — someone who is expertly trained in keeping your skin healthy. I, of course, recommend Central Missouri Dermatology Associates. We have put together the most complete team of skin specialists in central Missouri. Give us a try. CBT

ADVERTISER INDEX 43Tc.......................................................................................................................................10

GFI Digital............................................................................................................................3

Accent Press................................................................................................................. 33

Gravity...............................................................................................................................80

Accounting Plus.........................................................................................................91

Harold's Doughnuts...............................................................................................84

Accurate Rx Pharmacy........................................................................................... 33

Hawthorn Bank...........................................................................................................92

Anthony Jinson Photography.......................................................................... 13

Heart of Missouri United Way............................................................................ 77

Boone Hospital............................................................................................................ 28

La Di Da................................................................................................................................20

Budget Blinds................................................................................................................18 Caledon Virtual........................................................................................................... 4 Carpet One......................................................................................................................38 Celebration Limousines & Buses.......................................................................18 CenturyLink Yellow Pages................................................................................... 12 City of Columbia Water & Light..........................................................................8 Columbia Chamber of Commerce.................................................................... 74 Columbia Regional Airport................................................................................. 37 Commerce Bank............................................................................................................. 15 Cosmic Sauce..................................................................................................................14 D & M Sound...................................................................................................................... 24

LAMM Technical Resources, LLC.......................................................................38 Landmark Bank................................................................................................................2 Massage Envy................................................................................................................ 37 MayeCreate Web Design............................................................................................5 Midwest Computech..................................................................................................81 Moresource Inc..............................................................................................................7 Naught Naught Insurance Agency...............................................................84 Providence Urgent Care...................................................................................... 24 Room 38.............................................................................................................................. 22 Socket................................................................................................................................ 82

Edward Jones................................................................................................................ 22

State Farm Insurance - Stephanie Wilmsmeyer.....................................38

Equipment Share............................................................................................................9

The Bank of Missouri................................................................................................34

European Wax Center.............................................................................................89

University Club............................................................................................................36

Family Focus Eyecare.................................................................................................11

University of Missouri Health Care............................................................... 51

Father Tolton Catholic High School........................................................20

Wilkerson & Reynolds Wealth Management......................................... 33

Foundation Recovery Systems........................................................................ 57

Wilson's Fitness...........................................................................................................16

LET THE BROWVENTURES BEGIN

FIRST WAX FREE* *This fab offer expires 2/26/16

COLUMBIA / 573 442 8554

waxcenter.com

2703 E Broadway Suite #133

*May be redeemed only by first-time guests. Guests must reside in state where redeemed. Not valid for all services. Additional restrictions may apply.

Visit waxcenter.com for complete terms and conditions. Š 2015 EWC

columbiabusinesstimes.com /// 89

flashback

➜ 115 Business Loop 70 W 573-882-3591 maa.missouri.edu

›› Columbia, then and now

By Amber Taylor Photo by ben meldrum

Mizzou North was built as home to Ellis Fischel Cancer Center, the first state cancer hospital west of the Mississippi River and only the second in the nation.

The original state bill called for the hospital to be built in Columbia under the authority of MU. Columbia was selected because of its central location in Missouri and the city of Columbia’s donation of 40 acres of land for the hospital.

The construction for the building was funded by an appropriation of $500,000 from the legislature and $409,000 from the Public Works Administration. The building was designed by St. Louis architectural firm Jamieson and Spearl.

The hospital was dedicated on April 26, 1940.

On MU Health’s website, it compares the sevenstory building to a layered chocolate cake, with each successive story looking like a smaller “layer.” The hospital housed 85 beds and had the latest technology for treating cancer at the time.

More than 1,000 patients were treated at the hospital during its first full year of operation. At that time, the hospital fulfilled its original intent of treating only Missouri residents who were unable to pay for their care.

In the 1950s, new landscaping and technology came to the building. In 1952, the Columbia Garden Club planted a therapy garden on hospital grounds. Flowers were delivered from the garden to hospitalized patients.

In 1973, the Missouri legislature appropriated $7.6 million to build a new wing for the hospital. This three-story addition opened in 1975, expanding outpatient clinics and laboratory space and adding a new operating room suite.

In 1990, Ellis Fischel Cancer Center merged with MU. In March 2013, the center relocated from Mizzou North to a new patient care tower located on the University Hospital campus.

Mizzou North is now home to the Museum of Art and Archaeology and the Museum of Anthropology. These museums moved to Mizzou North from the MU campus in 2013 and 2014, respectively.

Alex Barker, director of the Museum of Art and Archaeology, says after the museum moved to Mizzou North in October 2013, it was renovated in 2014 and opened its doors to the public April 19, 2015. The Museum of Anthropology has yet to open its doors to the public due to renovations at Mizzou North.

Mizzou North is also home to various MU departments, programs and offices. The building holds the Central Missouri Regional Arthritis Center, the Law Enforcement Training Institute, the Missouri Folk Arts Program, the American Lymphedema Framework Project, the Missouri Water Resources Research Center and more. CBT

➜ We love Columbia business history. If you have any interesting photos and stories, please send them to Editor@BusinessTimesCompany.com 90 \\\ February 2016

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