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FOCUS TOPICS CMO ROUNDTABLE • ORTHOPEDICS • ONCOLOGY • HEALTHCARE REAL ESTATE

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HealthcareLeaders

ON ROUNDS

Focusing on Recovery Times and Reducing Pain

Hip and Knee Replacement Patients Do Much Better Recovering at Home LITTLE ROCK-Adam Smith, MD, an orthopedic surgeon with OrthoArkansas from 2017 to the present, was following in a family tradition when he went into medicine. His father, Bruce Smith, MD, was an orthopedic surgeon in Hot Springs, his grandfather, James Marsh, MD, was a general practitioner in Warren, and his uncle, Wallis Marsh, MD, is a liver transplant surgeon ... 3

Violence Increasing in Nation’s ERs By their very nature, emergency departments are high-stakes settings filled with vulnerable patients and frightened families. Increasingly, they are also high-risk settings for healthcare providers, staff and patients ... 7

Balan A. Nair, MD

Doug Ross, MD

Kasey Holder, MD

Eddie Phillips, MD

CMOs Thrive on Job That Allows Them to Have Major Beneficial Impact On Patient Care CMOs display medical, business and people management skills By BECKY GILLETTE

In many cases, people who are called to be physicians aren’t aiming for an administrative job, rather a career practicing medicine and fulfilling a desire to help people heal from disease and live well. But chief medical officers (CMO) of major medical facilities in Arkansas interviewed by Arkansas Medical News seem to thrive on the challenges of being a CMO, which they say allows them to have a

big impact on patient care. Balan A. Nair, MD, CMO, CARTI Cancer Center, said most physicians don’t go to medical school thinking that administration will be a significant part of their work. “I kind of fell into it in my practice as the scale and complexity of the business aspect of our practice expanded,” Nair said. “Someone was needed who could bridge the gap between the physician/

(CONTINUED ON PAGE 8)

Study Shows Potential to Decrease Neck Dissection Surgery by 21 Percent By BECKY GILLETTE

Previously head and neck surgeons had to face hard choices when determining whether a patient’s head and neck cancer had spread to the lymph nodes. If a patient’s cancer has not spread to the lymph nodes, neck dissection surgery is not necessary, which reduces the patient’s pain and recovery time. But, historically, when a doctor did a physical exam and imaging with no sign of metastasis to the lymph nodes, odds were that 20 to 30 percent of the patients already had cancer in the nodes. This created a conundrum, said Brendan C. Stack, Jr., MD, FACS, FACE, a neck endocrine surgeon who is also a professor of Otolaryngology-Head and Neck Surgery at the University of Arkansas for Medical Sciences

(CONTINUED ON PAGE 4)

Brendan C. Stack, Jr., MD

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Small Towns, Big Fight for Continued Access to Care

Rural Hospitals Face Death by a Thousand Cuts By CINDY SANDERS

More than 60 million Americans – nearly one in five residents – live in rural communities. While these small towns and wide swaths of farmland are an integral part of the American fabric, the nation has seen the rural population drop from 54.4 percent in 1910 to 19.3 percent a century later, according to the U.S. Census Bureau. As Americans have migrated to urban areas and urban clusters, it has become increasingly difficult to sustain services, particularly access to healthcare, in many of these rural communities. Although a little more than 80 percent of the country lives in urban areas and the clusters surrounding them, the actual land urbanites use is only 3 percent of the country’s total. The remaining 19.3 percent of the population is spread across 97 percent of the nation’s landscape. In a

service industry where ‘minutes matter,’ closure of a rural hospital facility likely means adding significant time to get to the next closest medical facility. By the beginning of this year, the National Rural Health Association (NRHA) counted 95 rural hospital closures since

2010 and identified nearly 700 other facilities as being vulnerable for closing. “Everything that NHRA works on can be boiled down to one thing … and that’s access,” stated Diane R. Calmus, regulatory counsel for the NRHA. The reasons for the closures are mul-

tifactorial. “It would be really easy if there was a silver bullet to solve the issues, but this has been the result of a whole lot of small cuts,” said Calmus. “A lot of cuts that have happened in D.C. have impacted rural hospitals in a way that haven’t impacted urban counterparts with a different payer mix,” she continued. In its #SaveRuralHospitals action center, the NRHA noted, “The rate of closure has steadily increased since sequestration began and bad debt cuts began to hit rural hospitals, resulting in a rate six times higher in 2015 compared to 2010.” Rural hospitals often lack the specialty services that bring in higher reimbursement to offset losses on general inpatient care and surgeries. Add to that, (CONTINUED ON PAGE 6)

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PhysicianSpotlight

Orthopedic Surgeon Adam Smith, MD, Focusing on Recovery Times and Reducing Pain Hip and Knee Replacement Patients Do Much Better Recovering at Home By BECKY GILLETTE

LITTLE ROCK--Adam Smith, MD, an orthopedic surgeon with OrthoArkansas from 2017 to the present, was following in a family tradition when he went into medicine. His father, Bruce Smith, MD, was an orthopedic surgeon in Hot Springs, his grandfather, James Marsh, MD, was a general practitioner in Warren, and his uncle, Wallis Marsh, MD, is a liver transplant surgeon. His mother, Cindy Smith, and aunt, Kathy Nasworthy, are nurses. And his brother, P. Allan Smith, MD, is also an orthopedic surgeon practicing at OrthoArkansas, the largest orthopedic group in Arkansas. “I became interested in medicine at an early age,” Adam Smith said. “I liked the surgeries. And I really love giving people a better quality of life through joint replacement.” Smith’s subspecialty focus is the reconstruction of the hip and knee. “By only focusing on one or two areas, in my case hip and knee replacement, that is all I do, all day, every day,” said Smith, who completed a fellowship in adult reconstruction (hip and knee replacement and revision) at the Mississippi Sports Medicine and Orthopedic Center in Jackson, Miss., from 2016-2017. “Not only do I not have to focus on things that are not necessarily my specialty, neither does my nurse or surgical team. Instead, we can focus on providing the best joint replacement and revision joint replacement experience to our patients.” The goal of his practice is to provide expert treatment of the hip and knee with the use of arthroscopy, partial (unicompartmental) and total knee replacement,

total hip replacement, mini-incision hip replacement, realignment procedures (avoiding joint replacement), and revision hip and knee replacements (when the prosthesis has failed).

One constant effort is working to get patients’ pain under better control and get them recovered and home faster. Patients after hip and knee replacement are typically spending, at most, one night in the hospital, before being discharged to the comfort of their own homes. “Patients do much better at home versus going to a skilled nursing facility or a rehab facility,” Smith said. “There is also a lower risk of infection by going home. Patients with knee replacements are going to outpatient physical therapy 2-3 times a week and no longer using continuous passive motion machines (CPMs) as those have been found to have no effect. Patients with hip replacement are using a walker for 7-10 days and are weaned from the walker as soon as that can be tolerated. Also, deep vein thrombosis (DVT) prophylaxis has changed from historically using coumadin, which had to be carefully monitored, to aspirin in most cases.” There has been interest in recent years in using stem cell therapy as an alternative to surgery. But Smith hasn’t seen any studies proving stem cell injections actually regrow cartilage. “From what I have read, it can help

control pain, but it is no better or worse than steroid injections,” Smith said. “I’m not doing it because it hasn’t been proven to show a benefit overall. Stem cell transplants are very expensive and a lot of insurance companies don’t cover them. In addition to not being proven, it is a high out-of-pocket expense. It is still being researched. It might depend on how much cartilage damage there is. People who have arthritis to the point of needing knee replacement probably would not benefit from this procedure.” It is common for people to delay a hip or knee replacement because of fear of surgery or the recovery time involved. Smith said patients need to decide about replacement based on how much pain they are in and how much relief they are getting with conservative treatment. “If they aren’t getting relief and it is affecting their quality of life, then it is probably time to do something more,” Smith said. Born and raised in Hot Springs, Smith attended Lakeside K-12 and then did his undergraduate work at the University of Arkansas in Fayetteville. He completed medical school at the University of Arkansas for Medical Sciences. His residency was at University of Mississippi Department of Orthopedic Surgery. While in residency, Smith participated in an AO International Fellowship in Switzerland. Smith and his wife, Wendy, have two daughters. His hobbies include cycling, hunting, watching the Razorbacks and skiing.

MEET LELAND: VETERAN, OUTDOORSMAN, EVERYDAY HERO “Being outdoors with other veterans that have been through similar experiences really helps you heal and recover in ways being indoors and around technology can’t.” READ MORE ABOUT LELAND ARLEDGE AND HOW SNELL PROVIDED HIM WITH A BETTER FITTING PROSTHESIS AT SNELLARKANSAS.COM

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Patients over Paperwork CMS recently announced its “Patients over Paperwork” initiative, focusing on reducing administrative burden while improving care coordination, health outcomes, and patients’ ability to make decisions about their own care. According to CMS, physicians say they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time away from patient care. Sound familiar? Well, CMS says it is listening to you and is taking action! In the 2019 Physician Fee Schedule, CMS proposed streamlined documentation requirements to focus on patient care and proposed modernizing payment policies so that Medicare beneficiaries can take advantage of the latest technologies to get the quality care they need. For 2019 and beyond, CMS finalized the following documentation changes for Evaluation and Management (E&M) visits that do not require changes in coding or in payment: • The requirement to document the medical necessity of a home visit in lieu of an office visit is eliminated. • For the history and examination for E&M visits for established patients, if relevant information is already contained in the medical record, physicians may choose to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and need not re-document the list of required elements if the physician documents that the previous information has been reviewed and has been updated as needed. • For the chief complaint and history for E&M visits for new and established patients, physicians are not required to redocument in the medical record information that has already been entered by ancillary staff or by the patient. The physician may simply document in the medical record that the information has been reviewed and verified.

The Authors:

Lynda M. Johnson, Partner

The current CMS documentation requirements differ for each level of care and are based on either the 1995 or 1997 E&M documentation guidelines. Billing Medicare for an E&M visit requires the selection of a CPT code that best represents: • Patient type (new vs. established); • Setting of service (outpatient setting or inpatient setting); and • Level of E&M service performed. Timothy C. Ezell, Currently, there are five levels of E&M visits which may be Partner billed for each of new patients and established patients. A Level 1 visit is the least complex visit, and a Level 5 visit is the most complex visit. Medicare pays a progressively higher amount for each level of visit. As part of the Patients over Paperwork initiative, CMS proposes, beginning January 1, 2021, to pay a single payment rate for Levels 2 through 4 E&M visits, while maintaining a higher payment rate for Level 5 visits. Also proposed are add-on codes for Level 2 through 4 visits that describe additional resources utilized in visits for primary care and certain non-procedure specialized care. CMS has also proposed a new “extended visit” add-on code for Level 2 through 4 visits to account for additional resources required when physicians need to spend additional time with patients.

For purposes of documentation, physicians may choose to utilize either the 1995 documentation guidelines, the 1997 documentation guidelines, medical decision-making, or time. If time is used to document the visit, physicians must document the medical necessity of the visit and that the physician personally spent the required amount of time face-to-face with the patient that is required by the CPT code. Documentation required for Level 2 through 4 visits will only require the documentation that is currently required for a Level 2 visit. The estimated payments for 2021 for each level for established patients are as follows: • Level 1 -$24 • Level 2-4 -$90 ($103 for primary care) • Level 5 -$148 The estimated payments for 2021 for each level for new patients are as follows: • Level 1 - $44 • Level 2-4-$130 ($143 for primary care) • Level 5- $211 CMS is also recognizing changes in healthcare practice that incorporate innovation and technology in managing patient care and aims to increase access for Medicare patients to services that are routinely furnished via communication technology. To evidence this commitment, CMS finalized policies to: • Pay clinicians for virtual check-ins involving brief, non-face-to-face assessments utilizing communication technology. • Pay clinicians for remote evaluation of patient-submitted photos or recorded video. • Pay Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for these types of services in addition to the RHC all-inclusive rate and the FQHC prospective payment system rate. Stay tuned as these programs will surely evolve over the next year to make sure you are prepared for all of the changes to come in 2021.

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Study Shows Potential to Decrease Neck Dissection Surgery by 21 Percent, continued from page 1 (UAMS) College of Medicine. “Do I operate on everybody to treat 20 to 30 percent of people who need this, knowing that this will result in unnecessary surgery for 70 to 80 percent of the patients?” Stack asks. “If you wait to do the surgery once the patient has recurred with head and neck cancer, the five-year survival rate goes down significantly.” Now there is a better option, thanks to an international study examining the effectiveness of combined PET-CT scans in determining whether a patient’s cancer has spread to their lymph nodes. Stack was co-principal investigator for the study that showed the combined PET-CT scans have the potential to alter neck dissection surgeries in about 21 percent of head and neck cancer patients. The study’s results were published online in the Feb. 15, 2019 issue of the Journal of Clinical Oncology, which is the premier cancer journal not only for the U.S., but the entire world. Stack said the findings are emblematic of personalized medicine at work. “What our study showed, among many things, was how to customize the neck dissection based on the patient’s need,” Stack said. “All the patients in our prospective study had neck dissection, but we found it wasn’t necessary in most and resulted in a change in the surgical plan for 21 percent of patients. Our study showed that when a patient has negative nodes on PET-CT scan, 95 percent of the time the result is truly negative. With a high level of confidence, we can say to a patient that if your neck is negative on PET-CT scans, there is probably no need for a neck dissection.” Stack is hopeful that researchers can take the findings as far as neck nodes and extend that to other types of cancer in other parts of the body. An example would be using the PET-CT scans to predict whether breast cancer has spread to the ancillary nodes. For people with melanoma, the scans could be used to evaluate whether cancer has spread to lymph nodes throughout the body. “Pick the type of cancer, and there is probably a nodal basin this study might apply to,” Stack said. “Ideally, research should provide information that is both usable and capable to being built upon. I’m glad to say that researchers at another institution are already designing a multicenter follow-up trial to ours, which will develop this concept even further.” A PET scan uses a small amount of radioactive material as a tracer to determine the severity of disease. In the case of this study, the tracer used was fluorodeoxyglucose, or FDG, a molecule similar to glucose. CT imaging uses X-ray equipment to produce images of the inside of the body. Stack said when combined, PET-CT gives doctors the ability to see the body’s abnormality in relation to the anatomy, making it a more precise scan.

The study has been underway since Stack started the project 18 years ago when he was at Penn State University. He developed the concept with co-principal investigator Val J. Lowe, MD, professor of radiology at the Mayo Clinic in Rochester, Minn. It took nine years to get the National Institute of Health to fund it. The study itself took six years, from August 2010 to December 2016, and was conducted in 25 locations around the world. It required two years of follow up afterward in order to complete the data collection and do the analysis. “This represents a very long-term commitment,” Stack said. Stack said while it was commonly assumed by physicians that a negative scan of the neck meant there was no need for a neck dissection as part of cancer therapy, this assumption had never before been established in a prospective, multi-institution trial. Of the total 286 patients enrolled, 42 were from UAMS. “More patients participated in this study at UAMS than at any other center,” said Stack, “Our first article hypothesizing this concept was published in the journal Cancer in 2001. Now, almost two decades later, we have shown that with the help of PET-CT technology, it may be possible to significantly reduce and/or modify neck dissections performed on head and neck cancer patients.” Cancers that are collectively known as head and neck cancer typically begin in the squamous cells inside the moist surfaces of the head and neck. These cancers can affect the oral cavity, throat, larynx and nasal cavity. The study was initiated by the American College of Radiology Imaging Network, which later joined with the Easter Cooperative Oncology Group, the nation’s premier clinical trial cooperative group funded by the NIH. Results were presented at the American Society of Clinical Oncology annual meeting in Chicago in June 2017, and a two-year patient follow-up concluded in December 2018. The Cancer Clinical Trials and Regulatory Affairs office provided internal support for the study while it was being conducted at UAMS.

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The Answer is YES

HEALTHCARE REAL ESTATE

But research the options and opportunities available By JERRY HALSEY, JR. CCIM, CRB, SIOR

I’ve been doing commercial real estate for a while. Longer than I care to admit some days, seeing as how I got my license right out of high school and last year, I celebrated the BIG 50! But, if it’s true that with age comes experience, and with experience comes wisdom, then it’s my hope that what I’m about to share will be of some value to you. Over the course of my career, I have been privileged to work with several professionals in the medical field. Some as clients, some as partners. Whatever the relationship, I have had the occasion to represent and work with many of them as they pondered what role real estate played in their business model. The questions covered the entire spectrum of possibilities. “Should I own my own building? If so, should I have more space than I need to rent out to someone else? Should I lease space for my office? Should I treat real estate for my practice as an investment? Or should I treat it as an expense?” In case you haven’t guessed from the title of the article, that answer to each of these questions is a resounding yes! Allow me to reiterate. You can actually answer yes to each of the aforementioned questions, and the results are not mutually exclusive. In fact, if you follow the counsel I am asking you to consider, you will employ each strategy to your ultimate benefit. How can you do that? I am so glad you asked! I have found that the best way to reap the maximum benefit, with the least amount of risk, is to personally become a member of a partnership entity that would own the real estate, and then your practice would become a tenant. This scenario offers a multitude of benefits. First of all, it allows you to spread the risk of commercial real estate with a group of investors; some of whom I would suggest could also be tenant users. At least one of the partners should be a developer or real estate professional. That way, someone with the time, expertise and resources to help market and manage the building is a part of the ownership. It frees everyone up to practice the profession they are trained to do, and takes the burden of managing real estate off you. Secondly, it gives you the ability to expense your rent for your practice. You will need to consult your tax professional for the specific benefits as it pertains directly to your situation. Thirdly, in the event that you eventually retire, it allows other existing tenants to expand into your space (if they need it at the time), or it gives your partner/ property manager the time to market your space and back fill it with a new tenant. Either way, your personal investment in the real estate remains a part of your portfolio. If you decide you no longer want arkansasmedicalnews

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to own, you have other partners to whom you could turn to for an opportunity to buy your interest in the building. The actual structure of the partnership is something else that you should discuss with your tax professional as well as your real estate adviser. Two of the most common for this type of investment is a Limited Liability Company (LLC) and a Tenant In Common (TIC). While there are multiple differences, one of the

primary differences deals with how you manage the tax consequences and what options you have, as either individuals or a group, should you choose to sell the real estate at some point. I respect the fact that investing in commercial real estate is a major undertaking, and I am not trying to trivialize all the factors that go into such an important transaction. But I do think, in many cases, busy medical professionals miss some in-

credible investment opportunities because they find it difficult to find the time to properly research the various options and opportunities available. If you have a commercial broker in your market that you already have a relationship with and that you trust, I highly recommend that you give them a call and schedule some time to visit. If they have a CCIM designation, all the better. If you are (CONTINUED ON PAGE 11)

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Small Towns, Big Fight for Continued Access to Care, continued from page 2 Calmus continued, “Rural Americans tend to be older, sicker, poorer than their urban counterparts.” She continued, “We know from MedPAC that at least since 2016, Medicare margins have been, on average, negative. By definition, rural hospitals are providing that frontline care, and that’s where negative margins are even worse.” Calmus said the bad debt cuts have been particuDiane R. Calmus larly hard for rural hospitals for a couple of key reasons. Prior to the Affordable Care Act, hospitals could write off a significant portion of their bad debt. However, since ACA was supposed to expand health insurance to everyone, the theory was bad debt would drop dramatically. Therefore, a bad debt cut was put in place. When Medicaid expansion was overruled by the Supreme Court, it left a coverage gap for a lot of Americans, which has been disproportionately felt by rural hospitals with a smaller patient census to offset uninsured care. Even when serving patients with insurance, rural hospitals often have been left with bad debt since paying a $5,000 deductible is nearly impossible for many people. The very nature of frontline care

means that rural hospitals often stabilize a patient before sending that individual to an urban counterpart for more specialized treatment. Rural hospitals have found their services fall into the ‘deductible’ part of patient care, whereas insurance has kicked in by the time the patient is transferred to the larger urban center for continued services. “We’ve seen a 50 percent increase in bad debt at rural hospitals that we haven’t seen at urban hospitals,” noted Calmus. Sequestration is another area where federal cuts have made it increasingly difficult for some rural hospitals to keep their doors open. “Critical Access Hospitals were paid 101 percent the cost of providing care. That was cut by 2 percent by the sequester. If you do the not-so-difficult math, they are not being paid the cost of care,” Calmus said of the cost deficit faced by CAH-designated facilities. The ‘death by a thousand cuts’ reality has taken a steep toll on rural hospitals across the country. “From 2018, 46 percent of rural hospitals were operating at a loss. That’s up from 44 percent in 2017 and 40 percent the year before that,” outlined Calmus. Yet another threat to access is a lack of providers. “Recruitment and retention of physicians is always an issue for rural hospitals,” said Calmus. This is particularly true for a number of specialties. “Between 2004 and 2014, we’ve seen more than 200 rural communities lose their

hospital-based obstetrics. Now, the majority of rural counties don’t actually have a place to deliver a baby,” she continued. Coinciding with the decrease in obstetric services has been an increase in precipitous deliveries with more rural babies delivered at home, in ERs, or in the back of an ambulance or in a car en route to a larger facility. On a more positive note, Calmus said, “340B is one of the bright spots in rural healthcare.” In addition to keeping the doors open, she said a number of hospitals are using the 340B money in innovative ways to improve care delivery … and, she stressed, the 340B money isn’t paid for by taxpayers. “The threats to 340B are frequent. We ‘re working constantly to educate legislators and the administration on how well hospitals are using this money,” she admitted. Happily, there are plenty of success stories to share. “Rural hospitals are uniquely positioned to know their patients in a way doctors in urban communities can’t,” she pointed out. Calmus noted one hospital in Kansas kept seeing a family in the emergency room because they had an infestation of bed bugs. Using just a few 340B dollars took care of the problem at a fraction of the cost of an ER visit. Similarly, another patient was having a hard time controlling his diabetes. Tapping into resources to pay his electric bill meant his insulin could be properly refrigerated and therefore more effective.

Calmus said rural hospitals have become incubators for innovative practice. “In so many ways, it’s the rural hospitals who are figuring out how to do more with less,” she pointed out, adding that work mirrors the national call to deliver highvalue care in the most cost-effective manner possible. Despite the many ongoing threats to the nation’s rural healthcare facilities, Calmus said there is much to be excited about, as well. “Rural America is a great place to practice medicine in the cradleto-grave model so many providers say they want to practice.”

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Violence Increasing in Nation’s ERs By CINDY SANDERS

By their very nature, emergency departments are high-stakes settings filled with vulnerable patients and frightened families. Increasingly, they are also high-risk settings for healthcare providers, staff and patients. Last fall, the American College of Emergency Physicians released data and insights into the rising violence in U.S. Emergency Departments. In a poll of more than 3,500 emergency physicians nationwide, nearly seven in 10 said ED violence is increasing, and nearly eight in 10 said the violence harms patient care. “More needs to be done,” said ACEP President Vidor Friedman, MD, FACEP, in presenting the survey results during the organization’s annual meeting. “Violence in emergency departments is not only affecting medical staff, it is affecting patients,” he continued. Findings from the poll, included: • 47 percent of emergency physicians reported having been physically assaulted at work, with 60 percent of those assaults occurring in the past year. • 71 percent personally witnessed others being assaulted during their shifts. • 77 percent said patient care was being affected with 51 percent of those saying that patients also have been physically harmed. • 50 percent believe the majority of attacks are from people seeking drugs or

(L-R) Drs. Terry Kowalenko, Vidor Friedman and Leigh Vinocur present survey findings at an ACEP meeting.

under the influence of drugs or alcohol. While 70 percent of those surveyed said hospital administration or hospital security did respond to the incident, only 21 percent said hospital security arrested the assailant

or enlisted law enforcement to do so; 6 percent said hospital administration advised them to press charges; and 3 percent said hospital security pressed charges. The other 70 percent said response to the assault re-

sulted in a behavioral flag being added to a patient’s chart or ‘other’ measure. The vast majority of physicians said patients were responsible for the attack, but (CONTINUED ON PAGE 10)

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CMOs Thrive on Job That Allows Them to Have Major Beneficial Impact On P clinical care teams and the management executive teams. There were a few of us who helped out in that regard. And when my senior partner Lawrence Mendelsohn, MD, decided to give that up, I stepped into that role.” Nair said the role of CMO requires a business mindset and also a number of soft skills that are not taught in medical school. “But we all learn continuously throughout life and as physicians we certainly bring some unique talents to the table as well,” Nair said. “While we are able to bring to our patients many exciting developments in our field, the pace of innovation and staying ahead remains the number one challenge we face and the best way to handle it is to constantly learn, listen and humbly execute. I also rely very heavily on the team of physicians who are involved in administration, as well as clinical care.” Doug Ross, MD, CMO, CHI St. Vincent, entered the medical field simply with a calling to help people. His first leadership experience in medicine was being elected as chief resident in his class. “I found that I enjoyed this role, but certainly did not think I would transition my career to administration,” Ross said. “In Hot Springs, I found that while I tremendously enjoyed working on the front lines in our emergency department, I found that I could touch and help more people in an administrative role. At this point, God opened some doors that have

Balan Nair, MD, CMO, CARTI Cancer Center Nair graduated from Grant Medical College, one of the oldest and highly ranked medical schools in Mumbai, India. He was torn between pursuing an engineering versus a medical degree and eventually decided on medicine because he found the science of cell biology quite mesmerizing. He did all his post medical degree training in the U.S. and was drawn to hematology/oncology by Lyle Sensenbrenner, MD, who was his attending physician in Detroit and also an early pioneer in bone marrow transplant.

Eddie Phillips, MD, CMO, Baptist Health. Phillips was born in Little Rock, attended Little Rock Public Schools. He graduated from Southern Nazarene University in Bethany, Okla., and then earned his MD from the University of Arkansas for Medical Sciences. He completed a residency in obstetrics and gynecology and started private practice on the campus of Baptist Health in 1980. He became the chief medical officer for Baptist Health in 2013.

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helped me with this desire to help others from more of a leadership position. I now have the opportunity to help spread our healing ministry across the State of Arkansas.” Ross said his number one challenge is encouraging their teams to think differently, to transform healthcare. Current models of care are unsustainable. “This is why we need to continue to innovate, to deliver high quality care at the lowest possible cost,” Ross said. “We approach this first by engaging our physicians and coworkers in this work and helping them understand the ‘why’ of needing to think differently. Once we have our teams engaged, we work together to design an innovative process that meets our goals.” Kasey Holder, MD, CMO of St. Bernards Medical Center, said it was actually a pretty difficult decision to move away from direct patient care into more of an administrative role. “There were many factors that played into that decision but, ultimately, I felt I had an opportunity to affect the quality and delivery of patient care on a broader scale and couldn’t pass that up,” she said. Holder said today the role is more than just a liaison between the medical staff and administration. In the transition from volume to value, responsibilities now include quality and safety management, reducing care variation, ensuring evidence-based practice and appropriate resource utilization, process improvement, regulatory compliance and more. “We are very fortunate at St. Bernards to have an exceptional medical staff so persuading them of the importance of our goals related to improving patient care is typically not a struggle,” Holder said. “However, knowing that there are so many important things to accomplish to achieve cost-effective, high-quality care and being mindful of the fact that physicians are asked to do so much already and burnout is a real and serious problem, the biggest challenge for me has been establishing priorities and implementing change in a way that is not burdensome to physicians. I depend a lot on our physician leaders for input and prefer, when possible, that they be a large part of identifying areas of focus and developing solutions.”  Eddie Phillips, MD, CMO, Baptist Health, said almost all physicians choose to practice medicine to improve the quality of life for those people they see. “I never considered an administrative role until asked by the Baptist Health CEO in 2013,” Phillips said. “I thoughtfully considered the position and accepted it with the idea that I could continue to affect and influence the quality of care for many more Arkansans.” arkansasmedicalnews

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Patient Care, continued from page 1 keep in touch with how others are thinking,” he said. Ross said he stays engaged with patients by staying visible and in constant contact with patients. “Consistent and purposeful rounding on staff and patients helps me stay connected with the work at the bedside,” he said. “This feedback in invaluable to me as we constantly evaluate our processes of care.

Advice for Physicians Eyeing a CMO Position

Kasey Holder, MD, CMO, St. Bernards Medical Center

Kasey Holder: I would encourage anyone interested in a CMO position to talk with other CMOs to ensure they have a good understanding of what the role entails, then evaluate their strengths and weaknesses relative to the role and develop an education plan. While the medical knowledge and practice experience physicians have is important in this role, many of the necessary knowledge and skills aren’t learned in medical school, residency or clinical practice. The scope of the CMO role varies at different institutions but, for many physicians pursing this position, leadership development, understanding healthcare organizational

structure and function, change management, quality improvement, regulatory compliance and payment structures are areas. Balan Nair: The CMO typically should be a person who loves a challenge, can understand how management is likely to view an issue and why, who likes to make decisions, who is not afraid to do new things, who can work with a team mindset and one who can humbly lead with integrity. If this description fits you, jump right in because you will love every minute of it! Eddie Phillips: Physicians considering an administrative role in the future, such as CMO, should maintain an excellent relationship with patients and fellow physicians. In addition, preparation with executive courses provided by such institutions as the Sam Walton College of Business at the University of Arkansas would be an excellent investment. Doug Ross: The job is incredibly challenging, but that is what makes it most rewarding. A CMO can help transform how we deliver healthcare in this country. If that does not excite you, I do not know what will...

Holder was born in Little Rock, and grew up in Paragould. She received a BS in biology from Arkansas State University and attended University of Arkansas for Medical Sciences for Doctorate of Medicine. She completed Family Medicine residency at UAMS-Northeast in Jonesboro 2007. She worked in an ambulatory clinic in Paragould for a few years then returned to UAMS-Northeast Family Medicine residency program as a faculty member before transitioning into a St. Bernards hospitalist position about six years ago. She has been married 19 years and has two children—a son, 13, and a daughter, 8. “My father is a family medicine physician so I grew up with a lot of exposure to the medical field,” Holder said. “I spent many hours visiting him at his clinic or a call room at the hospital. Although I had an interest in medicine, I initially didn’t think it was conducive to having a family so had planned to pursue a different path. However, in college, I found that I really enjoyed and had an aptitude for science, physiology and critical thinking. I really felt the pull to go into medicine when I realized I could help others by applying what I was good at and enjoyed.”

Phillips said the number one challenge most health systems face today is financial constraints. As CMO, he is expected to communicate these challenges to their physicians and work with them to mutually navigate these challenging times. Phillips stays in touch with patient needs by continuing to read medical journals. In addition, many former patients stop by his office to visit and he always makes time to listen to them and help them understand their medical concerns and questions. “Also, I make patient rounds at Baptist Health Medical Center-Little Rock on an almost daily basis, and talk to and listen to our patients,” Phillips said. “I also visit with staff physicians on a daily basis and inquire about needs for our medical staff and the patients they are privileged to serve.” arkansasmedicalnews

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Holder said they ask patients for their feedback. “There’s always something to learn from a patient’s experience - positive or negative,” Holder said. “We elicit input from our patients daily during their hospitalization and after discharge so we are aware of positive recognition of physicians and staff, as well as any concerns or questions. In addressing questions or concerns, I have many conversations with patients and families related to the care they expected, the care they received, what we did well and what we can do better. I also participate in our patient and family advisory council and hear many good insights from our patient’s perspectives.”  Nair said it helps that he still has a fairly busy clinical practice and tries to listen to what patients feel are their pain points. “Conferences are another way to

Doug Ross, MD, CMO, CHI St. Vincent. Ross was born in Michigan, but moved to Fort Smith in junior high, and calls himself an Arkansan. He married his high school sweetheart, who was born in Arkansas. He went to the University of Arkansas for undergraduate training and studied chemical engineering, went to the University of Arkansas for Medical Sciences, and then did his emergency medicine residency at the University of South Carolina. After residency, he moved to Hot Springs and has been there ever since.

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Violence Increasing, continued from page 7

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28 percent reported being assaulted by a patient’s family member or friend (results totaled more than 100 percent because some respondents had been attacked more than once). 83 percent of emergency physician respondents said a patient has threatened to return to harm them or their emergency staff. The most common types of assault are being hit, slapped, spit upon, punched, kicked or scratched. In addition, to physical attacks, 80 percent of male and 96 percent of female emergency physicians report having a patient or visitor make inappropriate comments or unwanted advances. 34 percent believe a lack of punitive consequence is the biggest contributing factor to the issue, and another 32 percent said behavioral health patients are driving the increases in violence (and 41 percent think the majority of attacks are from psychiatric patients). “Just in hospitals and healthcare in general, people are at their most vulnerable, and family members are at their most worried. The ER is the worst-case scenario for most, so it is this extremely volatile experience,” said Leigh Vinocur, MD, FACEP, past chair of ACEP’s Emergency Department Violence Committee and a national spokesperson for the organization. She added that when most people think about doctors and nurses being harmed or killed, they think of those practicing in war-torn counties. “Yet, here in the United States, it’s possible for your ER physician to become a victim of violence.” The reasons for increasing violence are multifactorial. “I always say the emergency department is a microcosm of society – gun violence, domestic violence, homelessness, psychiatric issues. As there is an increase in violence in society, it’s going to spill over into the emergency department,” noted Vinocur, a board-certified emergency physician with more than 25 years of experience. Add overcrowding and boarding into the mix of heightened emotions, and Vinocur said it isn’t surprising to see tempers flare. While nearly half the physicians surveyed have been physically assaulted and more than 70 percent have witnessed someone else be assaulted, Vinocur said the numbers climb even higher when verbal abuse is added to equation. And while this poll was conducted among emergency physicians, she said nurses are often on the front lines of the potential danger. “The person who is more hands-on with the patient is susceptible to even more abuse,” she pointed out. “If you look at the Bureau of Labor Statistics, being a healthcare professional is one of the most dangerous professions … and it’s very underreported,” Vinocur said, noting those in healthcare chose the profession to help people and often don’t report incidences because they recognize patients are under stress and don’t want to stigmatize them. (CONTINUED ON PAGE 11)

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Even while being mindful the situation might cause patients and family members to act in ways they normally wouldn’t, Vinocur said she believes hospitals are trying to get in front of bad behaviors that could quickly escalate. “Hospitals and health systems realize it’s the safety of their employees and also the safety of their patients,” she said. Of increasing concern, however, are freestanding EDs and urgent care centers. While most hospitals have guards, Vinocur pointed out, “In these ambulatory settings where you are siloed and there’s no security, you are even more vulnerable … and a lot of healthcare is moving to ambulatory settings.” To offset the disturbing trend in violence, Vinocur said there are a number of concrete steps facilities and health systems could take to improve safety. Additional security is one key step whether that is in the form of more guards or more cameras on site. When adding security cameras, it’s beneficial to have the devices visible so that individuals are aware their actions are being recorded. Improved visitor screening is another crucial step. In some areas, particularly large urban areas, metal detectors help screen for weapons. In addition, Vinocur said staff should be trained to ask patients if there is anyone who shouldn’t be allowed in to see them to help curb potential domestic violence interactions. “Training people to deescalate situations, too, is important … teaching hospital staff to recognize the signs of someone who is escalating as they are starting to get more and more agitated,” she said. Vinocur noted clinicians could also play a vital role in easing agitation through clear communication with patients and family members to keep them up to speed. While it’s easy for physicians to get distracted because they are so busy, she said it’s crucial to be aware of how stressful the situation is for patients and their families and why it’s so important to foster engagement. “Tensions run high,” Vinocur concluded. “Open communication can help allay fears and help mitigate out-of-control feelings. It can help ameliorate the very emotional experience of healthcare.” And a calmer emergency department is ultimately a safer one.

The Answer, continued from page 5

fortunate enough to have an SIOR (Society of Industrial and Office Realtors) at your disposal, then you are in as good of hands as you can expect to be in this industry. If you do not have a professional that meets these criteria, or if you just want a “second opinion,” feel free to reach out to me and I will do whatever I can to help put you on the path to success. Jerry Halsey, Jr., CCIM, CRB, SIOR, is Principal Broker for Halsey Thrasher Harpole Real Estate Group in Jonesboro. Visit http://www.halseythrasherharpole.com or email jerry. halsey@hthreg.com arkansasmedicalnews

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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.

Who’s incHarGe in 2019? Are you interested in learning more? Visit us at nyit.edu/arkansas 870.972.2786 nyitcom.astate@nyit.edu

A POWERFUL ECONOMIC DRIVER, Arkansas’ diverse healthcare offerings impact the industry on a local, regional and national basis. Knowing who is ‘in charge’ is important to fostering relationships and partnerships to

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GrandRounds Quang Joins ACH, UAMS as Chief of Pediatric Emergency Medicine, Pharmacology & Toxicology LITTLE ROCK – Lawrence (Larry) Quang, MD, has joined Arkansas Children’s Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS) College of Medicine as chief of Pediatric Emergency Medicine, Pharmacology and Larry Quang, Toxicology. He will also MD serve as professor of Pediatrics and Emergency Medicine in the UAMS College of Medicine. Dr. Quang comes to UAMS and ACH from Oklahoma University College of Medicine, where he served as associate professor of pediatrics. Prior to joining the OU College of Medicine, Dr. Quang held a faculty appointment as assistant professor at Case Western Reserve University School of Medicine in Cleveland, Ohio. He was also the inaugural holder of the $2 million Children’s Medical Research Institute/Express Employment Services Endowed Research Chair in Pediatric Emergency Medicine.

In addition to his leadership and clinical responsibilities, Dr. Quang will establish a research lab with Arkansas Children’s Research Institute (ACRI), studying behavioral and molecular effects of antenatal exposure to selective serotonin reuptake inhibitors (SSRIs). Dr. Quang has recently concluded a fiveyear grant for this research from the National Institute of Mental Health, part of the National Institutes of Health (NIH), and will continue this work at ACRI. Dr. Quang completed his medical school training at the 6-year combined accelerated BS/MD Program at Kent State University/Northeast Ohio University College of Medicine and continued on to Children’s Hospital of Michigan/ Wayne State University for his pediatric residency. He then completed his medical toxicology training at Children’s Hospital of Boston/Harvard Medical School. He completed the first two years of pediatric emergency medicine training at Children’s Hospital of Boston and concluded at Children’s Hospital Medical Center of Akron. Dr. Quang maintains board certification in general pediatrics, medical toxicology and pediatric emergency medicine.

Mercy Announces Promotions in Operations ROGERS – Mercy Hospital President Eric Pianalto recently announced promotions of two Mercy co-workers. Vanessa Harper was promoted to vice president of operations for Mercy Hospital Northwest Arkansas in Rogers. Harper has more than 25 years of health care experience, including 18 years in human resources. A co-worker at Mercy since 1993, Vanessa Harper Harper most recently served as executive director of strategic initiatives. Her experience includes working with nursing departments, process improvement initiatives, as well as spending time in her early career in Mercy clinics. Harper will oversee hospital operations in environmental services, linen, nutrition services, dieticians and security. Will Tommey has been promoted to director of operations for Mercy Hospital and Mercy Clinic in Northwest Arkansas. With Mercy since 2015, Tommey most recently served as the manager of business surgical services. He earned a master’s degree in acWill Tommey counting from the University of Arkansas and is currently pursuing a master’s degree in health care administration. Tommey is a U.S. Army special forces veteran and has experience working as a revenue accountant. He will provide analytical and operational oversight supporting multiple areas throughout the hospital and clinics.

UAMS Researchers Lead First Rapid Sequencing of Multiple Viruses Using Pocket-Sized Device Construction Starting on $35 Million Medical Facility LITTLE ROCK — A $26 million construction loan from Arvest Bank was closed yesterday for the development of the “Premier Medical Plaza” to be located in the longtime vacant Kmart store located at 10901 Rodney Parham Road. The project is being developed by Premier Gastroenterology Associates (PGA) and Newmark Moses Tucker Partners (NMTP) of Little Rock. The architect for the project is WER Architects and the general contractor is Clark Contractors. A formal groundbreaking ceremony will take place at the property within the next three weeks. Construction will begin on Monday, March 18th. PGA is expected to occupy the building, which will include both clinical space and a surgery suite, during the 4th quarter of this year. The facility’s name will recognize its owner and principal occupant, Premier Gastroenterology Associates of Arkansas, who will occupy approximately 45,000 square feet of space in the building according to Bill Greene, Premier’s CEO who also states that it’s an ideal location for their physicians and the thousands of patients seen each month from the Greater Little Rock area and around the state. Chris Moses, President & Chief Executive Officer of NMTP explained that the renovation will include a complete new look for the property both inside and out. The Kmart store will not be recognizable once the exterior improvements to the building are complete. In addition, the center will have a new parking lot with extensive landscaping, a new entry off both Rodney Parham and Shackleford Roads and signage. It will transform not only the largely vacant center but also the neighborhood around it. Upon completion in the 4th quarter of 2019, the Plaza will provide new medical, clinical and surgery facilities for several medical groups in 100,000 square feet of space. For additional Information please contact Chris Moses at cmoses@newmarkmtp.com

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LITTLE ROCK — An international team of researchers led by the University of Arkansas for Medical Sciences (UAMS) is the first to deploy a pocketsized nanopore device for rapid genetic sequencing of multiple human viruses. The findings are published in the journal Frontiers in Microbiology, the world’s most cited microbiology journal. UAMS’ Thidathip (Tip) Wongsurawat, Ph.D., and Piroon Jenjaroenpun, Ph.D., developed the technique, setting the stage for rapid, mobile virus tracking in rural regions across the globe. They were joined by collaborators from UAMS, including David W. Ussery, Ph.D., a professor in the Department of Biomedical Informatics, College of Medicine, and Intawat Nookaew, Ph.D., associate professor in the department. Using the new hand-held device, in just two hours they had complete genomes of six viruses, Wongsurawat said. The research project’s external collaborators are from the University of Tennessee Health Science Center in

Memphis; University of Sao Paulo Ribeirao Preto, Brazil; Mahidol University, Bangkok, Thailand; and University of Louisville, Kentucky. The team’s findings were made possible by recent advances in gene sequencing technology. The team used an Oxford Nanopore Technologies device called MinION, the only portable real-time device available for DNA and RNA sequencing. Wongsurawat, a postdoctoral fellow who joined UAMS in 2017, said the results show the hand-held device can be used in real-world settings where human biosamples may contain multiple viruses. The team demonstrated the sequencing from a sample containing six viruses: Mayaro virus, Venezuelan equine encephalitis virus, Chikungunya virus, Zika virus, vesicular stomatitis Indiana virus, and Oropouche virus. Wongsurawat said the team overcame challenges of rapid diagnoses of infectious disease epidemics, which are primarily driven by RNA viruses. Sequencing of RNA viruses previously required a number of steps (for reverse transcription of RNA to cDNA) that significantly slowed the process. Using this method, they were able to skip these steps and provide real-time sequencing, which makes rapid detection and characterization of emerging pathogens possible, Wongsurawat said. The team’s work was supported by the Helen Adams & Arkansas Research Alliance Endowed Chair, the National Institute of General Medical Sciences of the National Institutes of Health (NIH) award P20GM125503 and NIH award R01AI103053.

Baptist Health Names Brent Beaulieu As System’s Chief Financial Officer LITTLE ROCK – Baptist Health has named Brent Beaulieu as the system’s next senior vice president and chief financial officer. Beaulieu, who has spent 21 years in health care, joined Baptist Health in 2007 as assistant vice president of finance and was promoted to vice Brent Beaulieu president of finance in 2008. He received a degree in accounting from Harding University. Beaulieu has been an asset to Baptist Health in various finance-related positions during his more than 10 years within the system said Troy Wells, president and CEO of Baptist Health. Beaulieu succeeds longtime senior leadership team member Bob Roberts, who formally retired as the system’s chief financial officer on Friday, Jan. 18. Replacing Beaulieu as vice president of finance is Brock Holman, who joined Baptist Health in 2012 as the leader for a newly created Managed Care/Decision Support Department.

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GrandRounds Rheumatologist Dr. Safwan Sakr Joins the CHI St. Vincent Little Rock Diagnostic Clinic LITTLE ROCK — Dr. Safwan Sakr has joined the team of leading rheumatologists at the CHI St. Vincent Little Rock Diagnostic Clinic. Dr. Sakr is now seeing patients at the CHI St. Vincent Little Rock Diagnostic Clinic at 10001 Lile Drive in LitSafwan Sakr, MD tle Rock. In 2003, Dr. Sakr founded the Baxter Rheumatology Clinic in Mountain Home where he served for the past 15-years. He attended medical school at the University of Damascus Medical School in Damascus, Syria, and completed his residency with the Tesheren Military Academic Hospital in Damascus. He completed his fellowship training in rheumatology at the University of Arkansas for Medical Sciences in Little Rock. Established in 1961, the Little Rock Diagnostic Clinic grew to become a large multi-speciality medical practice providing diagnostic and treatment services to patients throughout Central Arkansas. The physicians, providers and coworkers of the Little Rock Diagnostic Clinic joined CHI St. Vincent Medical Group in September of 2018.

Family Practice doctor joins Conway Medical Group CONWAY - Dr. Billy Reid McBay, a family practice doctor, has joined Conway Medical Group, a Conway Regional Primary Care Clinic. Dr. McBay has more than 29 years of experience as a family medicine specialist. He is currently in practice alongside Drs. Laura Massey and Jarrett Lea. Billy Reid A graduate of the McBay, MD University of Central Arkansas, Dr. McBay achieved his medical degree from the University of Arkansas for Medical Sciences in 1990. He completed a three-year residency in Family Practice Medicine at Louisiana State University Medical Center in Shreveport as well as an internship in obstetrics/ gynecology at LSU Medical Center. He moved his practice to Conway in July of 2001. Conway Medical Group is located at 437 Denison St., off of College Ave. For an appointment with Dr. McBay, call (501) 327-1325. Conway Medical Group is one of nine family practice clinics in the Conway Regional Primary Care Network serving Conway, Mayflower, Greenbrier, Vilonia, Clinton, Pottsville and Russellville. The Conway Regional After Hours Clinic is also part of the network.

Since 1996!

Arkansas Surgical Hospital Names New Chief Financial Officer LITTLE ROCK - Arkansas Surgical Hospital announced that Andrew Covington, CPA, CHFP, has been promoted to Chief Financial Officer. He previously served as the Director of Financial Services for the hospital. As a Certified Andrew Healthcare Financial Covington, Professional, CovingCPA, CHFP ton has acquired a broad range of business and financial skills essential for succeeding in today’s high-value healthcare environment. Covington, a graduate of Harding University, is a member of the American Institute of CPAs and the Healthcare Financial Management Association.

CARTI Cancer Center Adds Breast Surgeon, Genetic Counselor LITTLE ROCK – CARTI Cancer Center has recently added breast surgeon Jerri Fant, MD, FACS, and genetic counselor Marianne Lotito, MS, CGC, to its staff. Dr. Fant, a surgical oncologist specializing in breast cancer management, brings more than 15 years’ experience to CARTI and its patients. She is a Fellow of

the American College of Surgeons, a diplomat of the American Board of Surgery, a member of the Governor’s Breast Cancer Control Advisory Board, and a volunteer for the American Jerry Fant, MD, Cancer Society. FACS Dr. Fant earned her medical degree from the University of Arkansas for Medical Sciences before completing a fellowship in breast surgical oncology at Baylor University Medical Center in Dallas. Lotito has returned Mariaanne to Arkansas after devel- Lotito, MS, CGC oping similar genetic programs in Seattle and the Northwest. She has 20 years experience in genetic counseling, including program implementation of genetic testing for hospitals and oncology practices around the country, as well as direct patient care. Lotito holds a master of science degree in genetic counseling degree from University of Pittsburgh and is board certified by the American Board of Genetic Counseling. She is a member of the professional education committee for the Arkansas Cancer Coalition.

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GrandRounds Three with Arkansas ties named to board of National Hospice & Palliative Care Organization Little Rock – Two Arkansans have been named to the 2019 Board of Directors for the National Hospice & Palliative Care Organization (NHPCO). Greg Wood, M.S., L.S.W., Executive Director for Hospice of the Ozarks, has been elected and named Chairman of the Board of Directors for NHPCO. Wood has served on the NHPCO Board of Directors for the past five years as a national director and vice-chair for the past two years. There are 28 elected national directors on the board of directors representing large and small, urban and rural, not-for-profit and for-profit hospice and palliative care providers across the country. Even though each provider type is uniquely different, together they can influence and ensure quality care is offered and provided to all Americans at the end of their lives. Wood also serves on the Hospice & Palliative Care Association of Arkansas (HPCAA) Board of Directors. He has been the Executive Director for Hospice of the Ozarks since April 2012 and prior to that he was the CEO for Hospice of North Central Oklahoma for 10 years. Dr. Brian Jones has been named as National Director to the NHPCO board. Dr. Jones serves as the President/CEO of the SHARE Foundation in El Dorado, AR. The SHARE Foundation is a non-profit operating foundation with many programs and agencies, including Life Touch Hospice. Dr. Jones holds a doctorate in Health Sciences from A.T. Still University. He has worked in the field of hospice and palliative care for over 15 years, authoring several peer reviewed journal articles and has spoken around the country on end-of-life care issues. He previously served as Vice-President, Regulatory Chair, and Education Chair for the Kentucky Association of Hospice and Palliative Care, and on the Executive Committee of the National Council of Hospice and Palliative Professionals. Dr. Jones began his career in hospice as a staff chaplain. He also teaches part-time in the public health department at Southern Arkansas University and in the Doctor of Behavioral Health Program at Freed-Hardeman University. He currently serves on the Arkansas Governor’s Council on Aging. A third Arkansas-related appointment to the 2019 NHPCO board is Carla Davis, CEO of Heart of Hospice, which owns hospices in Helena and Fort Smith, Arkansas as well as Louisiana, Oklahoma and Mississippi. Heart of Hospice is based in Charleston, SC. Lisa Vaden, Executive Director of Hospice & Palliative Care Association of Arkansas (HPCAA). All appointments were effective January 1, 2019, and are for a term of three years.

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Wiegel Earns National OBGYN Board Certification HARRISON - North Arkansas Regional Medical Center (NARMC) is proud to announce that Dr. Micah Wiegel has received his National Board Certification of Obstetrics and Gynecology from the American Board of Obstetrics and Gynecology. This makes Dr. Wiegel the Micah Wiegel, MD only Board-Certified OB-GYN available to patients within NARMC’s five county service area, including Boone, Carroll, Marion, Newton and Searcy counties. According to the American Board of Medical Specialties board certification plays a vital role in making sure physicians critically evaluate their practices, acquire new skills and adapt their practices to changing patient health needs. Board-certified OB-GYNs are also frequently called upon to assist other physicians with patient complications. Dr. Wiegel earned his bachelor’s degree in Biology from Arkansas Tech University and went on to University of Arkansas for Medical Sciences. He joined the NARMC team in 2015. Shortly after starting with NARMC, Dr. Wiegel started his board certification process. In total, the certification is a three-year process that includes both a written and an oral exam. Board certification is a voluntary process and demonstrates a physician’s expertise in a particular specialty. Patients can see Dr. Wiegel before, during and after pregnancy depending on their need. As an OBGYN, he helps women with health issues ranging from birth control, child birth, menopause and everything in between. Dr. Wiegel can screen for cancer, treat infections and specializes in gynecological surgery. Dr. Wiegel was the recipient of the Outstanding MIS Resident Award from the Society of Laproendoscopic Surgeons. Dr. Wiegel practices at NARMC’s Family Medicine Clinic located at 724 North Spring Street in Harrison. To schedule an appointment, call 870-365-0850.

History of Medicine Society to Hold Annual Dinner April 5 LITTLE ROCK — The public is invited to the Society for the History of Medicine and Health Professions’ annual dinner and lecture from 6-9 p.m. April 5 at the University of Arkansas for Medical Sciences (UAMS). The meeting will be held in the UAMS Medical Center Lobby Gallery. Parking is available in the Parking 1 deck. Laura Smith, a history instructor at the University of Arkansas in Fayetteville, will present the lecture “A Tale of Two Communities: The Business of the Medical School and Physician Respect in the Nineteenth-Century South.” Cost for the event is $25, which includes a reception at 6 p.m., with dinner and a business meeting following at 6:30

p.m. Smith’s lecture begins at 7:15 p.m. Reservations are required and must be made by March 27 by sending a check to the Historical Research Center, UAMS Library, 4301 W. Markham St., Slot 586, Little Rock, AR 72205-7199. Student tickets cost $15. For more information, contact Timothy G. Nutt, director of the Historical Research Center, at 501-686-6735 or tgnutt@uams.edu. Society members, campus supporters and community guests are welcome. Dress is business casual. The annual dinner and lecture is cosponsored by the UAMS Library’s Historical Research Center. The society provides support for the Historical Research Center in the UAMS Library. It awards an annual research grant to encourage research into the history of the health sciences in Arkansas. Membership is open to anyone with an interest in preserving the history of UAMS and medicine in Arkansas.

Diabetic Pain Study at UAMS Enrolling Participants to Test Spinal Cord Stimulation Device LITTLE ROCK — People with chronic painful diabetic neuropathy are being enrolled in a University of Arkansas for Medical Sciences (UAMS) research study of a spinal cord stimulation device designed to reduce the pain. Led at UAMS by Erika Petersen, M.D., a neurosurgeon and researcher, the study is part of a clinical trial being conducted at sites across the United States. Implanted spinal cord stimulation devices have been shown to relieve chronic pain, but this study is the first to test a device’s effectiveness when used specifically for continuous diabetic neuropathy pain in the legs and feet said Petersen, director of Functional and Restorative Neurosurgery and associate professor in the UAMS College of Medicine. About a quarter of Americans with diabetes have painful diabetic neuropathy, according to the national Centers for Disease Control and Prevention. In Arkansas, where an estimated 363,000 people have type 2 diabetes, about 73,000 of those residents (20 percent) would be expected to have painful diabetic peripheral neuropathy. The number could be higher — a National Institutes of Health-funded study in five rural Arkansas counties concluded that diabetic peripheral neuropathy was alarmingly underdiagnosed. Diabetic peripheral neuropathy is a debilitating, painful disease for which there are few effective treatments said Johnathan Goree, M.D., a sub-investigator on the study and director of the Chronic Pain Division of the Department of Anesthesiology in the UAMS College of Medicine. If this spinal cord stimulation system proves to be effective, it could provide excellent pain control without many of the side effects of opioid medications. The device, Senza® Spinal Cord

Stimulation system, was developed by Nevro, a medical device company based in Redwood, Calif. It works by sending electrical pulses to interrupt pain signals and provide pain relief. The system’s implantable pulse generator is placed under the skin of the abdomen or buttocks along with the leads – thin wires that deliver the electrical pulses from the pulse generator to the spinal cord. Study participants will be randomly placed in one of two groups: One providing conventional medical treatments, such as medications and physical therapy; and the other using the spinal cord stimulation device. Eligibility requirements for participating in the study include: • A diagnosis of painful diabetic neuropathy of the feet and/or legs • Having tried standard treatments • Be 22 years of age or older • Those interested in learning if they are eligible may contact the UAMS Translational Research Institute study coordinator, 501-398-8622.

PUBLISHER Pamela Z. Haskins pamela@arkansasmedicalnews.com EDITOR Pepper Jeter editor@arkansasmedicalnews.com ADVERTISING SALES 501.247.9189 pamela@arkansasmedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com GRAPHIC DESIGNERS Susan Graham, Katy Barrett-Alley CONTRIBUTING WRITERS Timothy Ezell, Becky Gillette, Jerry Halsey, Jr. Lynda Johnson, Cindy Sanders ºAll editorial submissions and press releases should be sent to pamela@memphismedicalnews.com Subscription requests can be mailed to the address below or emailed to pamela@memphismedicalnews.com. Arkansas Medical News is now privately owned by Ziggy Productions, LLC. P O Box 1842 Memphis, TN 38101- 1842 President: Pamela Z. Haskins Vice President: Patrick Rains Reproduction in whole or in part without written permission is prohibited. Arkansas Medical News will assume no responsibility for unsolicited materials. All letters sent to Arkansas Medical News will be considered the newspaper’s property and unconditionally assigned to Arkansas Medical News for publication and copyright purposes.

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