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FOCUS TOPICS ORTHOPEDICS • CFO ROUNDTABLE • MEN’S HEALTH

July/August December 2018 2009 >> $5 ON ROUNDS Avoiding Overtreatment of Prostate Cancer LITTLE ROCK—In recent years there has been controversy over the PSA test for prostate cancer and concerns that, in many cases, prostate cancer was being overtreated because, in some men, it would be so slow growing that it would never cause problems ... 3

Prominent Healthcare CFOs Talk About What it Takes to Stay on Track CFO responsibilities include more than just focusing on the numbers By BECKY GILLETTE

EDITOR’S NOTE: Below prominent Chief Financial Officers (CFOs) for major healthcare organizations in Arkansas answer questions about what led them into healthcare, how CFOs affect patient care and what kind of input they need to do their jobs.

AMN: How did your finance career lead you to healthcare?

Shawn Barnett: I originally got an accounting degree, but healthcare was not even on my radar until two years after (CONTINUED ON PAGE 4)

Shawn Barnett

Deana Thomas

William Bowes

HealthcareLeader Innovative Germandesigned Prosthesis Finds its Way to Arkansas The ability of lower limb amputees to succeed actively with a prosthesis has been largely dependent on the intimate fit of their residual limb within the prosthesis socket—especially during walking or running, when it must bear the full weight of the wearer’s body ... 7

Autologous Chondrocyte Implantation Repairs Knee Injuries with Patient’s Own Cartilage Cells Dr. Kenneth Martin has performed nearly 15,000 knee surgeries By BECKY GILLETTE

LITTLE ROCK – Performing a medical procedure frequently results in the best outcomes for patients. That is certainly the case for nationally renowned orthopedic surgeon Kenneth Martin, MD. Knee replacement and arthroscopic surgeries are his primary focus. He has done 15,000 knee surgeries and averages 1,200 to 1,400 surgeries per year at the Arkansas Surgical Hospital. Martin was named one of 14 orthopedic surgeons in Arkansas recognized as “Best Doctors in America.” He currently serves as chairman of the medical staff at Arkansas Surgical Hospital. (CONTINUED ON PAGE 6)

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PhysicianSpotlight

Avoiding Overtreatment of Prostate Cancer Urologist Ronald Kuhn touts trend of active surveillance and genetic testing By BECKY GILLETTE

LITTLE ROCK—In recent years there has been controversy over the PSA test for prostate cancer and concerns that, in many cases, prostate cancer was being overtreated because, in some men, it would be so slow growing that it would never cause problems. That has led to a shift for additional testing to identify if the patients with a high PSA test have a tumor that is likely to be aggressive, said Ronald Kuhn, MD, who practices at Arkansas Urology and performs surgery three days a week at Baptist Health Medical Center-North Little Rock. “In past years, I think there was the conception that the PSA test we use to screen for prostate cancer was perfect,” said Kuhn, who earlier in his career was chief resident of urology for the University of Arkansas for Medical Sciences (UAMS). “But, if you talk to any urologist, we all know it is not a perfect test. You cannot generalize the ‘normal’ for the whole population.” Some experts have suggested since it isn’t perfect, the PSA test shouldn’t be used at all. But Kuhn still does PSA tests

and prostate exams. When a PSA test is high, he recommends a biopsy that is then sent off for DNA analysis to determine if the tumor is likely to be aggressive or nonaggressive. “For about 30 to 40 percent of patients, the DNA test shows that they are likely to have this cancer the rest of their lives, but it will not cause them any prob-

lems,” Kuhn said. “The big push with the American Urology Association in those cases is active surveillance with a nontreatment management course. A prostate MRI can also help us sort out who will have a problem and who will not.” Kuhn said considering the number of patients with a high PSA test who don’t have an aggressive tumor, some might question if a biopsy is needed. But Kuhn said the way they do biopsies these days, the risk of infections is much reduced. “I tell a lot of my patients when we are trying to decide to do a biopsy that it is like looking both ways before you cross the road,” Kuhn said. Another relatively new development is the Provenge vaccine. It involves blood apheresis. The patient’s blood is removed, the Provenge vaccine added and the blood returned to the patient’s body. “It is immunotherapy,” Kuhn said. “It works best with low volume metastatic prostate cancer. It is not a miracle drug. There is no such thing. But it is really good for early advanced prostate cancer patients. We are more aggressive in trying to identify patients who had progression of cancer

with traditional treatments. They are going to do best with the Provenge vaccine. With metastatic or advanced prostate cancer, you layer the cancer treatments. You don’t start one and end another; you layer one on top of another. As a person progresses over the years with prostate cancer, if you start seeing failure with one treatment, you layer another treatment over that.”

Robotic surgery

Kuhn uses the da Vinci® Surgical System for five or six surgeries a week. “There is better visualization of the anatomy than when we do open surgery,” he said. “A lot of things we do with prostate and kidney surgery are in relatively small areas and small spaces. The da Vinci® has ten-x magnification. You are really on top of the anatomy. The other thing about the da Vinci® is that the instruments are wristed. You can rotate it just like your hand. Actually, you get more rotation than with your hand. You can get into any space and any configuration needed to do the surgery.” In addition to prostate surgeries, he (CONTINUED ON PAGE 8)

(CONTINUED ON PAGE 8)

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Prominent Healthcare CFOs Talk, continued from page 1

over the years. Also, it is important to provide the funding necessary to implement initiatives that improve patient care experience and safety measures of the organization.

Shawn Barnett, Senior Vice President and CFO of CHI St. Vincent Place of birth: Tacoma, WA Education: BS degree in accounting from Arkansas State in 1986, MBA in Healthcare Administration in 2005 from Regis University Experience: Barnett has been involved in healthcare finances for 30 years, working for both for-profit and nonprofit health care systems. He most recently was president and chief operating officer of CHI St. Luke’s Health-Memorial in Lufkin, Texas. He was controller for what was then Methodist Hospital in Jonesboro from 1988 to 1995 and was CFO of that hospital, then called Regional Medical Center of NEA, from 1995 to 1999. He also served as CFO at Triad’s Northwest Health System in Springdale and at Woodland Heights Medical Center in Lufkin.

working in a different industry sector when I was informed about a hospital finance opening in my hometown of Jonesboro. After applying and getting the job, I managed to work my way through the rank and

file to CFO within seven years.

AMN: How does the role of CFO affect patient care?

SB: The role of the CFO has evolved

AMN: What kind of input do you get from physicians and nurses in your facility regarding the things you need to know to do your job and how do you collect that input?

SB: We prepare an annual capital and operating budget to determine what funding is necessary to provide the equipment, staffing, or other resources for patient care, clinical improvements, or improving operating efficiencies. We also garner input on a day-to-day basis for things that might need funding for unexpected items through committee forums and daily interaction with staff and physicians.

Deana Thomas, VP of Financial Services and CFO, North Arkansas Regional Medical Center (NARMC), Harrison Place of birth: Kansas City, MO Education: Bachelor’s degree in accounting from William Jewell College, master’s degree in healthcare administration from University of Maryland. Experience: Prior to NARMC, Thomas was the director of accounting for 14 years at Lake Regional Health System in Osage Beach, Mo. She began her career at NARMC in 2013 as controller. With more than 20 years of experience, Thomas oversees the finances of the not-for-profit hospital system.

AMN: How did your finance career lead you into healthcare?

Deana Thomas: My experience was actually the opposite – healthcare lead to my career in finance. While attending college, I worked in medical records at a local hospital. I was fascinated by the inner workings of the hospital, got to know a lot of people and then ended up joining the accounting department. In that role, I did a lot of job shadowing and learning how all the departments worked together to make everything happen behind the scenes for the patients. I really enjoyed it, and I’ve spent most of my career in healthcare ever since. It’s a very challenging but rewarding segment of finance.

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DT: As CFO, my responsibilities include much more than just focusing on the numbers. My team supports those who care for our patients, including registering our patients, keeping the supplies we need onhand to care for patients and helping patients understand the financial component of their visits. In my current role as CFO, I’ve been in front of patients more than ever before, and that really gives perspective to the numbers and what we do every day. On the financial side, we must be good stewards of our resources so that we can provide the services that our patients need. Making smart financial decisions allows us to purchase necessary equipment, expand services, hire quality healthcare providers and so much more. It ultimately comes down to keeping both our patients and our hospital healthy. A financially healthy hospital is integral to the health of the community.

AMN: What kind of input do you get from physicians and nurses in your facility regarding the things you need to know to do your job and how do you collect that input?

DT: It’s vital to have input from the front-line staff and physicians. They make (CONTINUED ON PAGE 5)

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Prominent Healthcare CFOs Talk, continued from page 4

sure we know when they need more staffing, more space and equipment in order to provide the best care for our patients. We have formal and informal channels that help us gather their input, including medical staff committees, a weekly capital expense and contract committee for significant investments, a standardize budgeting process that each department is actively involved in, and simply rounding through the hospital and our clinics to talk to the staff about their needs.

Williams Bowes, Senior Vice Chancellor for Finance and Administration, University of Arkansas for Medical Sciences (UAMS)

AMN: How does the role of CFO affect patient care?

WB: As the individual responsible for overseeing revenue cycle operations – the process that begins with patient appointments and ends with the collection of payments, usually from third party payers, the CFO can affect the patient’s experience with clinical operations in a very substantial way. The efficiency with which the revenue cycle functions, such as the time necessary to get appointments, the accuracy and timeliness of medical bills, the verification of insurance and so on all contribute to the effectiveness of the care the patient

receives. Of course, the CFO also plays a critical role to ensure that he is aligned and working closely with physicians to ensure resources are adequate to meet patient needs, whether it is staffing, the acquisition of medical equipment or the financing of facilities.

AMN: What kind of input do you get from physicians and nurses in your facility regarding the things they need to do their jobs and how do you collect that input?

WB: Most of the input is provided as

part of the annual budget process in which meetings are held with each service line at UAMS to understand resource requirements leading to an allocation strategy that fits with patient demand. It may occur also during the course of the year as opportunities surface to expand clinical services, usually these are initiated by the physicians or clinical staff but may ultimately involve senior leadership, including me as CFO. The need for the CFO to develop a solid understanding of clinical operations is critical to developing the relationship and alignment with physicians, nurses and other support staff.

Place of birth: Glen Cove, NY Education: BA in Economics, Hofstra University, Hempstead, New York; MS in Urban and Policy Sciences, SUNY at Stony Brook, New York; Certified Lean Six Sigma Black Belt, Villanova University, Villanova, Pa. Experience: Assistant Commissioner /Financial Affairs, Connecticut Department of Higher Education, Hartford, Conn.; Vice President for Finance and Administration, Southern Connecticut State University, New Haven, Conn., Vice Chancellor for Fiscal Affairs and Treasurer, Board of Regents, University System of Georgia, Atlanta, Ga.; Senior Vice President for Finance and Administration Georgia Health Sciences University (now Augusta University), Augusta, Ga.; CFO, Board of Regents for Higher Education, Connecticut State Colleges & Universities, Hartford, Conn.

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AMN: How did your finance career lead you into healthcare?

William Bowes: I had already had a long career in higher education when I met Daniel Rahn, MD, in 2000 as he assumed the roles of president at the Medical College of Georgia and senior health affairs advisor to the University System of Georgia (USG) Chancellor. In 2006, the Chancellor asked me to serve as his designee with the Medical College Board. Two years later, Rahn hired me work with him at the Medical College (which became Georgia Health Sciences University and subsequently Augusta University). In 2013, Rahn brought me to UAMS in Little Rock. During the many years I was with the USG Board of Regents, I became heavily involved in the affairs of the Medical College through various initiatives the college was pursuing, and others that came from the Board of Regents. My responsibility for budget development, execution and monitoring for all system institutions also brought me into regular contact with the Medical College on financial matters. arkansasmedicalnews

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Protecting Your Practice from a Business Associate’s Breach Ponemon Institute recently calculated the average cost of a healthcare data breach in 2017 to be $380 per record.1 In addition, the most recent enforcement data provided by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) indicates that the OCR has settled or imposed Civil Monetary Penalties (CMP) of nearly $79 million dollars since the enactment of HIPAA.2 Not only does the OCR impose financial penalties, but depending on the circumstances, OCR may impose corrective actions3 or corrective measures.4 Because the financial and reputational effects of a breach of any size, regardless of who is at fault, can be devastating, it is imperative to protect your patients’ health information, not only through your own policies and procedures, but also through your relationships with your Business Associates (BAs) and accompanying Business Associate Agreements (BAAs). This article discusses matters to consider before and during a relationship with a vendor who will be handling your patients’ PHI, and thus become your Business Associate. The Authors:

Know Your Vendor

Before you agree to do business with a particular vendor involving PHI, the following actions are advisable: • Ask the vendor about their privacy and security practices. • Request to see their policies. • Inquire about how they handle breaches and ask to speak to their Privacy Officer. Responses to these questions and requests will give you feedback to help you determine the vendor’s commitment to HIPAA compliance.

Lynda M. Johnson, Partner

Importance of Business Associate Agreement

If you have not before, engage counsel to help you prepare a reasonable and comprehensive form of Business Associate Agreement, or BAA. Many times, vendors will agree to sign the provider’s form of BAA. If the vendor insists that your practice sign the vendor’s form of BAA, ask your counsel to review. Regardless of whether you sign the vendor’s BAA or the vendor signs your BAA, know what it says. There are certain requirements, responsibilities and obligations that the BAA should address for both parties, particularly in the event of a breach.

Breach Determination

Timothy C. Ezell, Partner

Not all incidents involving protected health information are considered to be breaches and must be investigated very carefully in order to make that determination. It is important to allow enough time for both parties to fully investigate all facts, determine if a breach occurred and have adequate time to notify affected individuals. Determining whether a particular incident is a “breach” under the HIPAA regulations is an analytical and sometimes tedious determination. Engage counsel to assist with these determinations.

Breach Reporting

Tonya S. Gierke, RN,

CIC, Associate The HIPAA regulations regarding breach reporting are very detailed, requiring legal determinations of whether a breach has occurred; notification processes to persons possibly impacted by the breach; and possible reporting to the Department of Health and Human Services (HHS).5 A provider (i.e., Covered Entity) has the most direct relationship with the patient whose information is at issue. As a result, the CE should maintain control for the content, manner, and timeliness of any required breach notifications, whether to patients or to HHS. Failure to comply with the breach notification requirements could result in the possible assessment of additional financial penalties.6

With that in mind, if your vendor (i.e., your Business Associate) is at fault in causing the breach, even though the provider / CE should maintain control of reporting, it may very well be appropriate, and/or contractually required through the BAA, that the BA bear some or all of the cost of reporting (and possibly of fines or penalties). This is where a well-drafted BAA can be very valuable to a provider practice. While your vendor / BA may cooperate with a provider in an effort to maintain the provider’s business moving forward, the vendor / BA may or may not be ready and willing to share in costs associated with a breach. It is important to involve counsel early in the process in the event of a possible breach. Counsel can assist you with determining whether a breach has even occurred and also help the Covered Entity navigate through the contractual language of its BAA, particularly when the vendor / BA may be at fault. See https://www.hipaajournal.com/healthcare-data-breach-costs-2017-8854/ See https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/data/enforcementhighlights/index.html 3 Corrective actions obtained by the OCR have resulted in change that is systemic. 4 Corrective measures are applied where an investigation indicates noncompliance by the Covered Entity or the Business Associate. 5 See 45 CFR 164.401, et seq. 6 See http://wayback.archive-it.org/3926/20170127111957/https://www.hhs.gov/about/news/2017/01/09/ first-hipaa-enforcement-action-lack-timely-breach-notification-settles-475000.html 1

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Autologous Chondrocyte Implantation Repairs Knee Injuries with Patient’s Own Cartilage Cells, continued from page 1 “As CEO of Arkansas Surgical Hospital, I have been privileged to work with Dr. Martin,” said Carrie Helm. “He is one of the best orthopedic surgeons I have worked with. He provides an exceptional level of care and service to his patients. He is always looking for new opportunities to improve even though he is one of the top ranked physicians in the nation for his patients’ results and outcomes. Dr. Martin has been a leader at our hospital and is one of the reasons our hospital has excellent outcomes. We are nationally ranked for top outcomes.” Martin is in surgery four days a week. With his busy schedule, that doesn’t leave much time for hobbies. “I really do like what I do,” Martin said. “I like being a surgeon more than any hobby that I have.” Martin grew up in Rosin, Ark., which is about 20 miles from Pine Bluff. In high school, he was thinking about a career in engineering until he did some volunteer work at the health department. That led him to major in pre-med at the University of Arkansas, Fayetteville, before earning his medical degree from the University of Arkansas for Medical Sciences (UAMS) in Little Rock. Martin played football and ran track in high school, so he was naturally drawn to sports medicine. “My interest in athletics, as well as my fascination with the mechanical nature of the musculoskeletal system, led me to orthopedics,” Martin said. “After starting orthopedics, I liked most aspects of it, but especially the knee joint. Knees are so often injured, and I like working with athletes.” Martin works with teams at Little Rock Christian Academy, the University of Arkansas at Monticello, and Ouachita Baptist University. “Being able to participate in athletic activities is a very real-life quality issue for athletes, whether they are professional or just weekend warriors,” Martin said. “It is critical for their well-being that they be restored to their full range of living. Plus, athletes are fun to take care of. They are really motivated to maximize their health.” Martin has seen great improvements in orthopedics since he began practicing. “Even though I do a lot of knee replacement, an exciting part right now is knee preservation,” Martin said. “A really great thing we have right now is autolo-

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gous chondrocyte implantation. That is where we take a patient’s own cartilage and are able to culture additional cartilage cells and then implant that into cartilage defects in the joint. We have been doing it three years or more now. We send the patient’s cartilage cells to a company and they send us back cells implanted on a sheet of biologic tissue. Then we implant that into the joint. It is mainly approved in younger people from ages 15 to 55, and only certain defects qualify. But we have been able to help a lot of younger people with knee pain from early cartilage damage that we didn’t have a good option for before. We have people in their 20s and 30s with defects causing significant pain. We transplant these chondrocytes into the knee and it greatly improves their pain and their quality of life.” Martin would like other healthcare providers in the state to know that there are excellent options for younger people that allow surgeons to be more aggressive on joint repair rather than replacement. “If people are young and have joint pain, there are some options besides replacement that we can do,” he said. One reason he does so many surgeries is the demand for joint replacement is rising because of the large number of baby boomers turning age 65 and older. Joint replacement surgery has also improved in recent years and saves numerous patients from spending their retirement either in pain or in a wheelchair. “Knee replacement is a great operation,” Martin said. “I just like to have knee replacement be the last resort. Most joint replacements we do last 15 years. About 85 to 90 percent of them are still intact at 15 years. He started Martin Orthopedics at 5320 Markum in Little Rock in 1990 after leaving another group in Pine Bluff. He was solo for ten years, and it could be challenging not having anyone else available to take his calls. But now he has two partners, Clay Riley, MD, and Joel Smith, MD. “I never dreamed I would have such a busy practice,” Martin said. “I am busier than I have ever been and have hired several para-professionals and two young orthopedic surgeons to help in the practice.” Although he doesn’t have many hobbies besides reading, he recently started playing golf. “I just started taking a few lessons, but so far it has been fun and challenging,” he said. “I just need more time.” Martin’s wife of 43 years, Susan, works in the office handling financial aspects of the practice. They have four children: Laura, 40, Anna, 36, Mary Susan, 33, and Drew, 32. They also have four grandchildren. They attend New Life Church of the Greater Little Rock campus. Martin is on the trustee board and his wife teaches a women’s Bible study. arkansasmedicalnews

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Innovative German-designed Prosthesis Finds its Way to Arkansas Water-pressured socket delivers new level comfort By JUDY OTTO

The ability of lower limb amputees to succeed actively with a prosthesis has been largely dependent on the intimate fit of their residual limb within the prosthesis socket—especially during walking or running, when it must bear the full weight of the wearer’s body. A recent innovation in the method by which prosthetic sockets are fitted is making a globally-recognized difference in comfort, adhesion, and control that is now available to prosthesis wearers in Arkansas — currently one of only 17 states to have gained access to the new technology. Called ‘a revolution in impression technology for prosthetic sockets,’ the Symphonie Aqua System was conceived by Andreas Radspieler, a German orthotic and prosthetic clinician working with patients in his own practice, and developed through Romedis GmbH, based in Neubeuern, Germany. The Symphonie Aqua System uniquely uses water pressure to measure the three-

The new Symphonie Aqua System uses a pressurized hydraulic chamber and a vector control pump to capture the shape of an amputee’s residual limb under weight-bearing stresses.

dimensional changes in form and shape a residual limb undergoes during full weightbearing. It’s the first time prosthetists have been able to determine the residual limb’s burden within the prosthetic socket under

actual conditions, and to capture an accurate plaster-cast impression of the individual’s body weight and tissue contours under weight. From this custom mold, a precise and more perfectly fitted socket can be created than has ever before been possible, Radspieler claims. The originality of his concept, and its significant value to individuals with lower limb loss, earned Radspieler the 2017 German Federal Innovation Prize. During a recent visit to Little Rock, Radspieler described his decision to choose a water-based approach to creating a more comfortable socket. “Socket fit is vital to the comfort, suspension, control, and acceptance of a lower extremity prosthesis,” he said. “With traditional casting methods, it is impossible to accurately capture a limb under weight-bearing conditions exactly as they would be inside a prosthetic

socket. Air pressurized concepts for measuring a limb under weight-bearing conditions have been on the market for 20 or 30 years, but air is just too compressible as a medium. Anyone who has used a bicycle pump knows that it takes a lot of pumping with your thumb over the hole before you feel some resistance. I thought that since water is incompressible, that might be a better medium to choose — and water is available everywhere.” The patient’s residual limb is hand-cast in the standard manner by wrapping it with bandaging strips covered in wet plaster, which capture the shape of the limb they encompass. The patient then immerses the limb in the Symphonie hydraulic chamber, shifting their full body weight onto a gel bladder suspended in the fluid. Paired with its vector control pump, the chamber can be custom-pressurized for each patient, using the Symphonie VC app readings on a smart device. Readings are based on the patient’s weight, size of the stump, firmness of the connective tissue, and the athleticism of the patient. Under the compression of full weightbearing within the custom-pressurized chamber, the limb and its plaster cast as(CONTINUED ON PAGE 8)

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Interested In Owning Foreign Real Estate? The New Swiss Bank Account

Avoiding Overtreatment, continued from page 3 finds robotic surgery useful for kidney surgery. “In the past if there was a kidney tumor, you would just take the whole kidney out,” Kuhn said. “Now the evolution in urology with the aid of the Da Vinci® is to take the tumor out and preserve the kidney. As you age, the more renal mass you have, the better chance of avoiding complications and dialysis.” Kuhn grew up in El Dorado, went to Rhodes College in Memphis, Tenn., where he majored in biology. He did research at St. Jude Children’s Research Hospital in Memphis a couple of semesters. That solidified his interest in medicine. He went on to earn his medical degree from UAMS. He thought he was going to specialize in internal medicine. “I spent six weeks with an internist I really admired, but I thought, ‘This is not for me’,” Kuhn said. “I went back to medical school and had a talk with the dean of

the Medical School, Dr. Dick Wheeler. He recommended I go hang out with these urologists. I did a rotation in urology and that is what did it for me.” One thing he likes about urology is having a real office practice. In general surgery, often when you operate on somebody, you may not see a lot of them again. But in urology, patients are followed for years. “When you start practicing as a urologist, you see and do everything,” Kuhn said. “As you get older and the practice matures, you can kind of get into the nook of what you want to practice. My practice has really evolved into robotics and mainly oncology. I focus more on the surgical aspects of cancer. It took me 20 years to get to that point.” Before joining Arkansas Urology in 1999, Kuhn was associated with the Urology Group in Baton Rouge, La. While at UAMS he was named the Pfizer Outstanding Urology Resident.

Innovative Prosthesis, continued from page 7

I am a retired Pathologist from Jonesboro, Arkansas. I have been the director for 13 annual medical missions to Panama. I’ve also invested in a beautiful real estate development there. This is a secure, gated 67 acres overlooking the Pacific ocean. Lots one acre or larger are available as well as construction using sustainable concepts, such as Earthship or tropical style construction. On-site amenities include a zip line, organic garden, communal meeting/ picnic site, jungle tours, and proposed equine center and mini-medical clinic. Area recreation includes many beautiful beaches, deep sea fishing, surfing, and scuba diving. Or perhaps just sitting on your veranda with your feet propped up looking at the gorgeous ocean vistas.

There are many reasons to consider owning foreign real estate! Owning foreign real estate is one of the very few ways Americans can legally keep some of their wealth abroad and still retain their privacy. Foreign real estate held directly in your name - not in an LLC or a partnership - is not reportable to the IRS. Revenue is reportable. (Always confirm and work closely with a tax professional.)

Why Panama? • Washington Post, May 25, reports a town in this area as one of 10 best places in the world to live abroad. • Considered the safest part of the safest Central America country. • 25 minutes from a medical clinic and hospital • Panama uses the US dollar as its currency. • Easy access – 2 ½ hours from Miami; 4 hours from Houston. • No hurricanes! • Low cost of living & friendly people

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sume the weight-bearing shape that is later duplicated when fabricating a matching prosthetic socket from that mold. The full contact and weight-bearing that the patient experiences during the casting process also provides proprioceptive feedback to the patient, who can then give the practitioner valuable information concerning bony and sensitive parts of the limb before the socket is made, often eliminating the need for cast modifications or multiple test sockets. Arkansas amputees who have been prosthetically fitted using the system report consistently better results, noting the absence of bone discomfort previously experienced, and a more secure fit that enables confident participation in high activity sports such as martial arts. An inventor by nature, Radspieler had previously designed new concepts, built prototypes, and acquired patents — then sold the technology to investors to develop and market. This time, however, he recognized the potential of this unique method of applying hydrostatic pressure to socket design, and developed the concept himself, producing prototypes used to benefit his own patients, and investing in CAD technology, machining and milling

equipment for his new venture. The first system was assembled in March 2015. A friend asked to try out an Aqua System model at his own O&P business, reported phenomenal results, and bought one two weeks later. Word spread largely by grapevine and word of mouth, until Radspieler’s small start-up company had sold 100 systems during its first year—far more than anticipated. Today, in less than three years, the Symphonie Aqua System has been used to fit more than 16,000 patients worldwide, from Beijing to New Brunswick to Melbourne, Australia. A new digital version of the system premiered in May in Leipzig, Germany, “capable of providing a 3-D animated fullvolume model of the residual limb that can go directly from scanning the weight-bearing residual limb within the Aqua System to a manufacturing process like 3-D printing,” Radspieler explained. “The future of prosthetics will definitely be in a different kind of manufacturing process,” he believes, “and for that future, we will need a digital file of the residual limb at full weight-bearing.” The Symphonie Aqua System is in use in Arkansas at Little Rock-based Snell Prosthetics & Orthotics, www.snellarkansas.com.

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GrandRounds Russellville Family Clinic Joins Conway Regional RUSSELLVILLE - Conway Regional Health System is the new owner of Russellville Family Clinic. The clinic has been renamed the Conway Regional Medical Clinic-Russellville. Family Practice doctors Kenneth B. Turner, MD, and Ben J. Kriesel, MD, MRO, and the clinic staff are now Conway Regional employees. Both Drs. Turner and Kriesel will remain on the active medical staff of St. Mary’s Regional Medical Center to accommodate patients who do not want to leave Pope County for hospital services. Both physicians hold medical degrees from the University of Arkansas for Medical Sciences in Little Rock. Dr. Kriesel completed a three-year residency in Family Practice at the University of Wyoming in Cheyenne. He then spent two years in Missouri with the Public Health service before coming home to the River Valley. Dr. Turner came to the clinic in 1990 following his practice in Garden City, Kansas. His Family Practice residency was in Fort Smith and training was completed in 1987. Dr. Turner holds a Bachelor of Science in Chemistry from Harding University.

Baptist Health and Arkansas Health Group Welcome New Physicians LITTLE ROCK – On June 1, Dr. Paul Williams joined Drs. Ali Khan, MSPH, and David Sosnoff, DO, as part of the Baptist Health Gastroenterology Clinic at Baptist Health Medical Center-Little Rock. Williams, who has more than 25 years of Paul Williams experience as a physician with the Little Rock Diagnostic Clinic, is board certified in internal medicine and gastroenterology. After graduating from medical school, he completed an internal Ali Khan medicine internship and residency at the University for Medical Sciences in Little Rock followed by a fellowship in gastroenterology and nutrition at the University of Texas Health Science Center David Sosnoff in San Antonio. Hospitalists Khan and Sosnoff, also Little Rock Diagnostic Clinic providers, joined Baptist Health and Arkansas Health Group’s Gastroenterology Clinic in early April when it was first established. Khan has more than 15 years of diverse experience in the specialized field of gastroenterology. After earnarkansasmedicalnews

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ing his medical degree, he completed a residency at the University of Alabama Medical Center before coming to Arkansas to practice medicine. Sosnoff has over 11 years of experience in the field of medicine. He graduated from the Kansas City University of Medicine & Biosciences College of Osteopathic Medicine in 2007. Baptist Health Gastroenterology Clinic is located on the Little Rock hospital campus.

UAMS Establishes Otolaryngology Chair LITTLE ROCK — UAMS has established the Pamela Rakhshan Chair in Otolaryngology with a $1 million gift from her father, Chris Rakhshan, in gratitude to James Y. Suen, MD, distinguished professor in the UAMS College of Medicine, who saved her life during a 10-hour operation and compassionate follow-up care. The chair will be at UAMS for as

long as UAMS exists, and the interest can be used year after year for research, helping find cures for patients that have vascular anomalies.

At NYIT College of Osteopathic Medicine (NYITCOM) at Arkansas State University, we are educating the physicians of tomorrow today. Our medical school not only produces excellent physicians, but also cultivates “servant leaders” who recognize that healthy choices and wellness are vital components needed for the success of the people and communities to which they belong. Outside the classroom, NYITCOM at A-State students are involved in activities that provide mentorship, opportunity, and encouragement to the youth of our state with the goal of creating more educated, engaged, and responsible citizens for Arkansas and our region.

At NYIT College of Osteopathic Medicine (NYITCOM) at Arkansas State University, we are educating the physicians of tomorrow today. NYITCOM at Arkansas State University is committed to addressing the primary care physician workforce shortage in Arkansas and the Our medical school not only produces excellent physicians, but also cultivates “servant leaders” who Delta region. By 2030, NYITCOM at A-State will produce more than recognize that healthy choices and wellness are vital components needed for the success of the people 1,000 physicians to serve this state, region, and beyond. and communities to which they belong. Outside the classroom, NYITCOM at A-State students are in activities that provide mentorship, opportunity, and encouragement to the youth of our state Are youinvolved interested in learning more? the goal of creating more educated, engaged, and responsible citizens for Arkansas and our region. Visit uswith at nyit.edu/arkansas 870.972.2786 nyitcom.astate@nyit.edu NYITCOM at Arkansas State University is committed to addressing the primary care physician workforce shortage in Arkansas and the Delta region. By 2030, NYITCOM at A-State will produce more than 1,000 physicians to serve this state, region, and beyond.

Are you interested in learning more? Visit us at nyit.edu/arkansas 870.972.2786 nyitcom.astate@nyit.edu MEET DENA: ARTIST, CAR ENTHUSIAST, DRIVEN WOMAN

“When I overheard that women my age don’t really walk again after this type of injury, I thought: Just watch me.” READ MORE ABOUT DENA PECKHAM AT SNELLARKANSAS.COM

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GrandRounds Neurosurgeon Joins Sparks Clinic FORT SMITH – Neurosurgeon Kenneth Tonymon, MD, FAANS, has joined Sparks Clinic Neuroscience Center and will provide a much needed medical service to the community. As a neurosurgeon, Dr. Tonymon focuses on prevention, diagnosis, and surgical Kenneth treatment of disorders Tonymon which affect any portion of the nervous system including the brain and spinal cord, such as head and nerve injuries, chronic pain and stroke. Dr. Tonymon has been in practice for more than 30 years and earned his degree and completed residencies in both general surgery and neurosurgery at the University of Arkansas for Medical Sciences in Little Rock. He most recently worked at Essentia Health-Fargo in N.D., and HSHS St. Vincent in Green Bay, Wis.

PUBLISHER Pamela Z. Harris pamela@arkansasmedicalnews.com EDITOR Pepper Jeter editor@arkansasmedicalnews.com

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Dr. Kenneth Martin

Over 15,000 Knee Surgeries Martin Orthopedics

Over 35 years of experience improves lives at my hospital. Our surgeons wanted a hospital where they could practice medicine the right way. So they built one. When it comes to medical care, there’s no substitute for experience. Having performed over 15,000 knee surgeries, he’s one of the most respected orthopedic surgeons in the area. To Dr. Martin, that number is nowhere near as important as the feeling of improving thousands of lives through his work. If you’re suffering from knee pain, call Arkansas Surgical Hospital at 501-748-8088 for help scheduling an appointment with one of our specialists.

Physician Owned. Patient Focused. 87 7-918 -70 20 | w w w. ark surgical hospi tal .com

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When you have questions, we AR here with life-saving answers. As the only health sciences university in the state, we’re constantly uncovering breakthroughs that lead to faster diagnoses�—�while also researching tomorrow’s cures and training tomorrow’s doctors. It’s compassion and advanced technology working together. When you need health care that simply cares more, we AR here for you.

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