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November/December 2018 >> $5 December 2009

Arkansas Hospital Association Annual Meeting Provided Inspiration and Networking

ON ROUNDS Jeffrey Cohen, MD, of Clopton Clinic, Concentrates on Sleep Unrefreshing sleep with obesity usually means sleep apnea

Who’s Getting Healthcare Right? Healthgrades Releases 2019 Hospital Quality Rankings For 20 years, Healthgrades has reviewed hospital quality and released an annual analysis of performance across a number of common conditions and procedures, assigning a rating of one to five stars for each. Last month, the online healthcare information resource released its 2019 Report to the Nation ... 5

Challenges and opportunities highlighted By BECKY GILLETTE

The Arkansas Hospital Association Annual Meeting in Little Rock this October attracted attendees from across the state to interact and hear an overview of important developments in the healthcare community–from quality initiatives to leadership tools and take-a-ways, said Bo Ryall, president and CEO of the AHA. “Attendees included CEOs, CFOs, COOs, CNOs, quality directors, risk managers, nursing directors, human resources, marketing and public relations, compliance and



The adult obesity rate in Arkansas is 35 percent, and is the primary cause of sleep apnea in about 90 percent of the cases. So, it is no wonder that Jeffrey Cohen, MD, a pulmonologist who specializes in sleep medicine at St. Bernards Clopton Clinic in Jonesboro, estimates that about 20 to 25 percent of patients seeing a family doctor regarding insomnia have sleep apnea ... 3

Delegates enjoy a moment at the AHA Annual Meeting in October


Matt Troup Leads Conway Regional to Record Net Revenue Conway Regional encountering competition from new hospital has been a defining moment By BECKY GILLETTE

Three years ago, when Matt Troup became CEO of Conway Regional Health System, the organization was facing major headwinds. Baptist was opening a new 111-bed hospital presenting significant competition. And 30 Conway Regional doctors were actively engaged in negotiations to join the staff at the new hospital. In addition, Conway Regional had entered into a management agreement with CHI St. Vincent. Some employees weren’t sure what that would mean. Troup said the competition was a defining moment for Conway Regional. Conventional wisdom might have been to institute a hiring freeze and take other economic measures. Instead, Conway









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Jeffrey Cohen, MD, of Clopton Clinic, Concentrates on Sleep Unrefreshing sleep with obesity usually means sleep apnea By BECKY GILLETTE

The adult obesity rate in Arkansas is 35 percent, and is the primary cause of sleep apnea in about 90 percent of the cases. So, it is no wonder that Jeffrey Cohen, MD, a pulmonologist who specializes in sleep medicine at St. Bernards Clopton Clinic in Jonesboro, estimates that about 20 to 25 percent of patients seeing a family doctor regarding insomnia have sleep apnea. “If I was talking to a group of family doctors, I would tell them sleep apnea is rampant,” Cohen said. “It is very subtle. People live with it for decades before they come to my attention. A great screening question to ask people is, ‘Do you fall asleep watching TV?’ Another screening question is, ‘Do you wake up in the morning just as tired as the night before?’ Those are indications for inadequate rest. If they report unrefreshing sleep, it is usually sleep apnea.” Often someone with sleep apnea will say they sleep fine, but don’t feel rested. People will resist going to the sleep doctor because they think they don’t have a problem. There is also something known as paradoxical insomnia. Someone perceives minimal sleep. But if you measure their sleep objectively, they sleep a lot more than they recognize. Cohen said those people typically are not tired all day because they got plenty of rest the night before. Probably everyone has occasional insomnia, less than once a week. Approximately five to ten percent of the population has chronic insomnia. When Cohen first sees a patient, the first he does is to confirm insomnia. There are some conditions that mimic insomnia like sleep apnea or delayed sleep phase syndrome. “People come in thinking they just can’t get to sleep, but they sleep normally from 2 a.m. to 10 a.m.,” Cohen said. “If they just go to bed at 2 a.m. they do just fine.” There is also a difference between having trouble going to sleep (sleep initiation insomnia) and trouble staying asleep (sleep maintenance insomnia). If there is sleep maintenance insomnia, he suspects sleep apnea. “If I suspect sleep apnea, I would do either home sleep testing or sleep testing in a lab,” Cohen said. “So, for a medical audience, I would want them to know the indications for a home sleep test are for a high probability of sleep apnea. You have to think they have sleep apnea before you order that test. Sadly, many insurance companies will only pay for a home sleep arkansasmedicalnews


test. There are several types of devices used. Our particular device we like is a wrist mounted remote sensor pulse oximeter with plethysmography that will measure the cyclical variation of the peripheral arterial tone, the oxygen level and that heart rate. The peripheral arterial tone will vary, their pulse rate will vary and frequently their oxygen levels will drop.” That home test compares to a lab

sleep study where many more variables are observed. Some of the sleep medicines are contraindicated with sleep apnea. Sedatives make sleep apnea worse. Alcohol makes it worse. Treatment for sleep apnea could be a CPAP mask that blows a steady stream of pressurized air through a mask into the respiratory system, or a dental device. Sur-

gical options are used much less often. Sleep apnea is associated with hypertension and is a risk factor for heart disease and strokes. “For that reason, it should be treated if it is severe enough,” Cohen said. “But it is hard to get people to treat sleep apnea unless they feel better with the treatment. The mask is a bit of a hassle. Unless you see a good reason to do it, you just wouldn’t.” Since 90 percent of those with sleep apnea are overweight, the best treatment would be to lose weight. But it is very hard to get people to lose weight. “Sometimes we are talking about 150 pounds or more,” he said. “Someone who is 400 pounds might have to lose 230 pounds. For that person, it is almost unattainable. If someone is 250 pounds, weight loss is a reasonable alternative treatment if they can do it.” For someone with onset insomnia (can’t go to sleep initially), he would not order a sleep test. In that case, he would talk to the patient about good sleep hygiene habits like not napping in the day, and avoiding stimulants like caffeine, cigarettes or rich, spicy foods before bedtime. You don’t want a large dose of sun-


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Arkansas Hospital Association Annual Meeting, continued from page 1 legal counsel, as well as others,” Ryall said. “Bringing all of the areas of healthcare under one roof allows the AHA the ability to provide education on rethinking their cost structures, how they Bo Ryall will provide care and what the patient experience will look like in the future, the outlook of both the state and federal political climate, as well as legislative issues, and barriers to healthcare for segments of the state population.” Ryall said above all, the annual meeting is an opportunity for AHA members to come together for face-to-face networking; in this digital age, there is value in individuals being able to interact personally. AHA Chairman Darren Caldwell agrees nothing can beat a gathering that promotes networking. “Electronic media has its place in attempting to get people together over long distances or in a short time frame,” Caldwell said. “But since we Darren Caldwell know months in advance and should be able to schedule the time off, there is no substitute to building relationships the old-fashioned way. Otherwise we may end up like Washington

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and not even know how to communicate with one another.” Caldwell said he felt that the recent Annual Meeting was very informative and energetic. “The topics and information shared will be more applicable to our daily routine than what has been shared before,” said Caldwell, who is Senior Vice President of Regional Services for St. Bernards Healthcare. The AHA represents 101 hospitals in Arkansas and 46,000 employees. Caldwell said each hospital has Kirk Weisler special traits and most do particular things well, regardless of their size. Information moves very quickly and advances are made in the blink of an eye. “By having the AHA, we have a vehicle to collectively share information with one another no matter if there are different affiliations, profit structures, or sizes that would normally make it difficult or impossible,” Caldwell said. “It is the closest thing we have to creating a level playing field in the industry.” One speaker of note at the meeting was Kirk Weisler, Chief Morale Officer, Team Dynamics, Inc., who has consulted with companies and organizations around the globe. Weisler pulled from his background as a U.S. Army Ranger and member of the 19th Special Forces Chaplaincy to lead a session on how leaders need to refresh every now and then to keep their employees engaged and motivated. It’s about growing good employees and retaining the really good ones, including vital doctors and nurses. Weisler said Gallup research shows that 17 percent of the American workforce are actively disengaged. “That is a dark number,” Weisler said. “They are actually working against co-workers. They are withholding support. They are cynical and undermining. They suck the light out of the world. They may be those who step out the back door with company products causing shrinkage.” Another 51 percent are considered not engaged. Weisler said they show up to work and they are doing their job.

AHA Annual meeting highlights: • The keynote speaker was Pulitzer Prize-winning journalist Carl Bernstein, known for breaking the Watergate story. • Ken Kaufman with Kaufman Hall & Associates discussed legacy healthcare and the new competitors/threats, as well as the strategies for hospitals to remain relevant. • Dr. Michael Shabot with Memorial Hermann Health System in Houston, Texas, discussed their journey to “Zero Harm” providing attendees with concrete and practical tools to take back to their facilities. • A panel discussion was focused on the Provider-led Arkansas Shared Savings Entity (PASSE), a new model of organized care that will address the needs of certain Medicaid beneficiaries who have complex behavioral health and intellectual and developmental disabilities service needs. This was moderated by Jodiane Tritt, Executive Vice President of AHA, and featured PASSE providers. • Attendees interacted with one another through different games and techniques, all of which could be taken back to their facilities refresh their employees and co-workers, as well as build relationship within their teams. • Two administrators were voted as Administrators of the Year by the Hospital Auxiliary: Gary Sparks, administrator of both CrossRidge Community Hospital and Lawrence Memorial Hospital and Barry Davis of Methodist Hospital in Paragould.

But they don’t take the initiative. They aren’t retired exactly, but aren’t the kind of workers you really want in your organization. Then you have 32 percent who are engaged. They work with creativity and passion, have a sense of purpose and are connected to the mission. Millennials often want meaningful work. “Of these three categories, who do you and I want to work with?” Weisler asked. “We want to work with the engaged people. They are the ones making connections, having passionate interactions, and welcoming new opportunities. But who is likely to leave the hospital first, the actively disengaged or the engaged? The frightening answer is that the most engaged are most likely to leave. They are tired of working with the burnouts. If one of my engaged managers quits, who does that leave me working with?” Weisler said engagement has to be a primary part of the purpose of managers. There is a great loss in having to replace an engaged employee. It can cost 100-150 percent of an employee’s salary per year just to replace that employee. “It is work investing in the training and culture to create an engaged culture at work,” Weisler said. “But, as leaders,

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that is what we must do. Managers do it best by keeping themselves motivated. Enthusiasm is contagious. It is true that when you are around enthusiastic people, you feel a little better. Don’t hide the excitement you feel. It is okay to be excited. Be an agent to inspire growth in others by letting your people see you growing.” Studies have shown when people are engaged in growth and development, they are happier, their white blood cell count is higher, they recover more quickly from illnesses, and so much more. Instinctively, we know this. Weisler said one important way to improve engagement is showing or telling other employees that you appreciate them. “Create a culture of recognition,” he said. “People need recognition every seven days, not just at the annual banquet. It would be so much better if we created a culture where every employee was intentional about celebrating the positive contributions made by their colleagues. What we say more of, we’ll see more of, so getting the entire organization to focus on what’s working right will help more of the right work get done. You want to empower and inspire the whole organization.”

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Who’s Getting Healthcare Right? Healthgrades Releases 2019 Hospital Quality Rankings By CINDY SANDERS

For 20 years, Healthgrades has reviewed hospital quality and released an annual analysis of performance across a number of common conditions and procedures, assigning a rating of one to five stars for each. Last month, the online healthcare information resource released its 2019 Report to the Nation.

Why Ratings Matter

As the nation continues the move to value-based care, consumers have become more engaged in their health and healthcare. With higher deductibles and co-pays, more consumers have begun to think of healthcare in a similar fashion to other major purchases, looking online for information on cost and quality. When it comes to healthcare, however, the stakes are considerably higher than selecting a new car or refrigerator. In looking at the variation in clinical quality and outcomes across the nation, the 2019 Healthgrades analysis found patients treated at a hospital with a five-star rating, as compared to a hospital with a one-star rating, in a specific condition or procedure have a significantly lower risk of death and of experiencing complications during the inpatient stay.



To create the latest report, Healthgrades analysts looked at Medicare Provider Analysis and Review (MedPAR) data from 2015 through 2017, which provides information on Medicare beneficiaries who access inpatient services. From the data dive, the report found: “From 2015 through 2017, if all hospitals as a group performed similarly to hospitals receiving 5-stars as a group, on average 222,210 lives could potentially have been saved and 157,210 complications could potentially have been avoided.” Healthgrades Chief Medical Officer Brad Bowman, MD, noted, “Consumers have many choices for healthcare, but most important is understanding that there is a significant variation in care from hospital to hospital and doctor to doctor. In fact, hospitals within close proximity to each other can have significant differences in complication and mortality rates for the same condition or procedure. The analysis of hospital quality is intended to spotlight the importance of doing your homework before selecting your care. It could be a matter of life or death.”

National Health Index

At the same time Healthgrades released the 2019 Report to the Na-

tion, the organization also released its second annual National Health Index. Archelle Georgiou, MD, a senior advisor to Healthgrades, said the index looks at “who is getting healthcare right.” A former CMO of UnitedHealthcare and author of the book “Healthcare Choices,” Dr. Georgiou noted, “We recognize that healthcare is broader than just the quality of the hospitals.” She continued, “Health and healthcare is com- Dr. Archelle Georgiou prised of many different factors. To understand whether a city is getting healthcare right is complex, which is why Healthgrades compiled numerous industry data sets to help paint a more complete picture of healthcare at the local level in cities across the country.” Healthgrades analysts turned to four key sources to evaluate health and healthcare in 130 metropolitan areas across the country. Data was pulled from the Behavioral Risk Factor Surveillance System (BRFSS) 2016 survey at the MSA level, provider specialty information and patient experience survey scores from, 2017 population estimates from the U.S. Census Bureau, and the 2019 hospital quality rankings from Healthgrades. Dr. Georgiou said the team looked at 14 factors spread across four major categories. The big categories, she said, were: “Do people have access to care? Is the population healthy? Do they have high quality hospitals? And do they have high quality specialists?” She said in addition to having some form of insurance coverage, analysts also considered the percentage of population that didn’t feel restricted from seeking care due to cost, including high deductibles and co-pays. The group also looked at preventive and behavioral measures including the percentage of people ages 50-75 who had a colonoscopy in the past 10 years, percentage of women 40 and older who had a mammogram within the last two years, percentage who had visited a dentist in the past 12 months, had a normal body mass index (BMI), reported physical activity within the past month, and the percentage of residents who reported having at least one person they identified as their personal healthcare provider. Hospital quality measures came from





Matt Troup Leads Conway Regional to Record Net Revenue, continued from page 1 Regional elected to expand its services. And instead of losing 30 doctors, they have hired 28 new doctors. How is Conway Regional doing as a result? “We’re doing great,” Troup said. “Our net revenue in 2018 will be the highest it has been ever. We’ve had a shift in the types of services we provide. We are more of an outpatient facility than before. Still, our revenue is higher than it has ever been, which is great.” Early on Troup instituted mandatory town hall meetings every 90 days. “At those town halls, we talk about our progress and challenges,” Troup said. “Everyone has the opportunity to hear where we are going and how we are doing. Every organization will have 15 percent of employees really engaged, and 15 percent not engaged. When you can engage the middle 70 percent, that is where you get a cultural shift. Keeping people informed about how we are trying to do the right thing has led to a lot of positive outcomes.” Initially at town hall meetings, people raised their hand to ask questions. But some people don’t like asking questions in a large group. So, they went to a polling app (PollEverywhere) on phones where people could send in questions. “It is such a cool tool,” Troup said. “You can be in a meeting and use your cell phone to get feedback and ask survey questions anonymously.” Feedback is also attained through a post-Town Hall

survey. “A survey is conducted after each town hall. From that we know if different units are super engaged and if they doing well. If we know the challenges, we know where to focus our attention. Part of the effort with town halls is to try to tell our stories. Taking about revenues doesn’t motivate people. What motivates people is feeling part of the community. Conway is one of the more proud communities in the state and we have really tried to leverage that.”

Increasing services

Another effort is to treat people at Conway Regional rather than transferring them to Little Rock. One way they have done that it is to add services not presently offered in the community. Conway Regional has recruited an infectious disease specialist, a neurosurgeon and a vascular surgeon. “We are not duplicating services, but hopefully retaining patients who might otherwise go to Little Rock,” Troup said. “Any time someone goes to Little Rock, there is a stickiness factor. They go there for one doctor and then may get other treatment they need there.” Conway Regional has also opened clinics in Russellville and Pottsville, and expanded clinics in Greenbrier and Vilonia.

Best Places to Work

Another accomplishment has been

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being named as One of the Best Place to Work by Arkansas Business and by Modern Healthcare. “That is a real source of pride for us,” Troup said. “The bulk of their assessment comes from employee surveys.” Employee retention is a priority. Troup said one of the things he is most proud of is their focus on employee benefits and programs. They have doubled the amount paid for tuition reimbursement, and have a clinical ladder program which incentivizes staff to achieve higher certifications, do research, and get involved with different committees. Starting in 2019 they will offer paid parental leave for staff. And they instituted automatic enrollment for their 401(k) program driving up participation well over 90 percent – an incremental cost to the health system but a long term benefit to the employee. “If you are an individual who wants to advance your career, this is the place to be,” Troup said. “We also give employees eight hours to go work in the community. Again, that aligns with our values.” Shared governance is another way to engage employees and improve performance. Conway Regional has seven functional councils under shared governance that review issues such as patient safety and satisfaction. “Front line staff from different parts of the hospital serve on these councils to help us address the issues,” Troup said.

“They can raise concerns and advocate for things that are going to make the hospital better. We have a servant leadership philosophy. We are there to serve the community, people and our staff. The better we can serve them, the better off we are going to be.”

Accountable Clinical Management

There is also a strong emphasis on Accountable Clinical Management (ACM), an initiative started in 2016 that is a model of shared governance to promote meaningful engagement of physician leaders in partnership with hospital administrative leadership. “At Conway we are physician led and professionally managed,” Troup said. “ACM has a financial metric to it. When we do well in the hospital, the physicians do well. It is co-management with the physicians. ACM creates alignment and buyin. That has been immensely valuable in growing physician leaders at our hospital. It has been game changing. It gets physicians thinking as a team.”

The future

For the future, Troup said they plan to continue to diversify the services provided to increase retention of patients in a way that continues to meet community needs. “We are going to focus on services not (CONTINUED ON PAGE 8)

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Healthgrades’ Top and Bottom Twenty This is Healthgrades’ top and bottom according to its 2019 report. The entire Healthgrades Hospital Quality list can be found on its website.

The Top Twenty 1

Rochester, MN


Burlington, VT


Charleston, SC


Cincinnati, OH


Baltimore, MD


Philadelphia, PA


Gainesville, FL


Hartford, CT


San Jose, CA

Who’s Getting Healthcare Right? continued from page 5 the latest Healthgrades rankings; and the team looked at the number of specialists per capita across multiple disciplines, as well as patient satisfaction with those specialists. “In order to have a healthy community, it’s all these different factors,” Dr. Georgiou said of the ingredients required to enable healthiness. Rochester, Minnesota, Burlington, Vermont, and Charleston, South Carolina, led the way this year. San Francisco, which came in at 17th on the list, was identified as having the healthiest residents. Worchester, Massachusetts, with an overall rank of 55, had

the highest access to healthcare. Berlin, New Hampshire, which ranked last at 130, struggles with population health and availability of high quality hospitals and specialists. Yet, Dr. Georgiou noted, the area does have a high percentage of the population insured and an above average rate of those who can access care affordably. She pointed out every metropolitan area has different strengths and challenges to address. Some cities might need to focus on community programming or public works to create more opportunities for physical activity. Others might have to look at creative ways to entice more spe-

cialists to the area. The index, she noted, provides a starting point for those discussions and a snapshot for patients making decisions about their care. “I think the index is a step forward in our whole mentality around being consumer-focused. It looks at the full continuum from access and insurance all the way through to your personal behaviors,” Dr. Georgiou concluded. “The National Health Index is designed to help consumers understand the health of their community, to empower them to navigate their care journey with confidence and to help them access the right care in their market.”

10 Cleveland, OH 11 Milwaukee, WI 12 Toledo, OH 13 Cedar Rapids, IA 14 Sioux Falls, SD 15 Providence, RI 16 Portland, OR 17 San Francisco, CA 18 Richmond, VA 19 Boston, MA 20 Allentown, PA

The Bottom Twenty 111 Deltona-Daytona Beach-Ormond Beach, FL 112 Memphis, TN-MS-AR 113 Tulsa, OK 114 Pensacola-Ferry Pass-Brent, FL 115 Glens Falls, NY 116 Crestview-Fort Walton BeachDestin, FL 117 Cumberland, MD-WV 118 Myrtle Beach-Conway-North Myrtle Beach, SC-NC

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119 Grand Forks, ND-MN 120 Spartanburg, SC 121 Riverside-San Bernardino-Ontario, CA 122 North Platte, NE 123 Tuscaloosa, AL


124 Grand Island, NE

Matthew Hardee, M.D. LITTLE ROCK

Cheryl Payne, M.D. SEARCY

Christopher Pope, M.D. CONWAY

Christopher Ross, M.D. LITTLE ROCK


Michael Talbert, M.D. LITTLE ROCK

125 Utica-Rome, NY


126 El Paso, TX 127 Claremont-Lebanon, NH-VT 128 Minot, ND 129 Beckley, WV


130 Berlin, NH-VT arkansasmedicalnews





Keeping the Dream Alive – Fertility Preservation By COREY BURKE

Fertility preservation is a term used for protecting or preserving eggs, sperm, embryos, or reproductive tissue so that they may be used in the future to have biological children. Most commonly fertility preservation is associated with cancer treatment, but many other conditions and lifestyles can threaten one’s fertility. Endometriosis, uterine fibroids, autoimmune diseases, genetic diseases, toxic exposure, gender reassignment, and hazardous duty (Military) are all reasons to consider fertility preservation. Cancer survival is at an all-time high for many forms of cancer. The American Cancer Society reports 5-year relative survival rates of 70% for women with Stage 0-III breast cancer with a five-year relative survival rate of close to 100% in women with stage 0 or stage I breast cancer. Far more people are surviving cancer and for many that means the opportunity to start a family and live the life they dreamed of before their diagnosis. In 2013 the American Society of Clinical Oncology updated their guideline on fertility preservation. The guidance states that caregivers including oncologist, gynecologist, radiational oncologist, urologist, hematologist, pediatric oncologist, surgeons, and others should offer information about fertility preservation to all adult and

pediatric patients. It further recommends that if the patient is interested in fertility preservation they should be referred to fertility specialists and that such referrals take place early in the treatment plan. Since this guidance began the number of patients seeking fertility preservation has increased somewhat, particularly in the male population, however it is relatively infrequent that women seek this option. Several issues may explain the low numbers of women seeking fertility preservation. The procedure in men is far simpler, affordable, requires little time to complete, and usually requires no medications. All the options available to women require significantly more time to complete than men, and costs significantly more. In years past, fertility cycles were initiated based on the women’s menstrual

Jeffrey Cohen, MD, continued from page 3 light before bed as bright light late in the day can alter how you sleep. You want to make sure your sleep environment is pleasant, dark and that you have a comfortable bed. “Go to bed at the same time and get up at the same time each day,” Cohen recommends. “Limit your time in bed. Don’t spend ten hours in bed because you aren’t going to sleep ten hours. You are only going to sleep seven to eight hours. I would limit my time in bed to that many hours.” Other causes of insomnia can be anxiety disorders, PTSD and depression. If Cohen detects those sorts of thing, he recommends Cognitive Behavior Therapy for Insomnia (CBT-I) and counseling. “If someone is depressed, you have to treat the depression or they just won’t get better,” Cohen said. “It is similar for anxiety disorders; people just don’t get better without treatment. People are resistant to getting that diagnosis or treating it. I think some insurances don’t pay much for things like counseling.” There is an effort among the sleep community to make CBT-I more available. One phone app he recommends for CBT-I is put out by the Veterans Administration, cbt-i-coach. Cohen said this type of on8



line tutorial could be helpful for people engaged and intelligent enough to understand it. You have to be self-motivated. The American Association for Sleep Medicine advises against the chronic use of sleep medicine instead of treating depression and anxiety primarily. Cohen does not prescribe sleep medicine much to patients. Typically, he would refer the patient to the family doctor for chronic treatment. Some patients report that sleep medicine works initially, but then becomes less and less effective. Others find the medicine helpful and don’t have any contraindications for long-term use. Cohen rarely prescribes benzodiazepines for anxiety-related insomnia, even though he thinks there can be a use for them. “I would be fearful my patients would lean on it and not treat underlying causes, which are depression and anxiety,” Cohen said. “If the patient’s psychiatrist suggested benzodiazepines, I would have no problem with them. I would avoid using a benzodiazepine in someone without psychological cause.” Cohen graduated from the University of Arkansas for Medical Sciences and did his residency at University of Michigan and his fellowship at Vanderbilt University Hospital in Nashville, Tenn.

cycle which often added weeks to the process. An additional concern was that the process of ovarian stimulation lead to increases in estradiol levels which can drive some tumors. All are valid concerns but can be overcome and should not be a reason for not offering it to a patient. Financial concerns are valid, but options exist including financing. The time to complete treatment and stimulation concerns can be greatly reduced by using mid cycle starts and stimulation protocols to reduce the effects of increased estrogen levels. What options are available? Semen cryopreservation is the most effective means of male fertility preservation and is the choice of treatment for most patients. The process is simple, the patient provides a specimen by masturbation and cryoprotectant is added. The specimen is then packaged in straws or vials, slowly chilled to a temperature of -196°C , and stored. Once frozen semen seems to last indefinitely, the oldest specimen used successfully to date being 24 years old. While this option is fast and affordable, physicians should be reminded that one ejaculate is not enough to allow multiple attempts at pregnancy, and patients should be encouraged to provide multiple specimens prior to beginning treatment. To provide optimal results ejaculates should be between 48-72 hours apart. Usually enough semen can be col-

Matt Troup, continued from page 6 traditionally provided in Conway and do that in a bigger and better way than before,” Troup said. “We will become more and more a regional medical center. We face a lot of issues such as patients continuing to have access to healthcare through the Affordable Care Act and Arkansas Works. That is going to be huge. We face a lot of challenges in payments. We don’t get reimbursed for all services. In this state, we are in the lower third nationally in payment for the services we provide. Continuing to protect payments for Arkansas hospitals is going to be an issue.” Troup grew up in Dallas, Texas, and went to Texas A&M where he received a BA in business management. He earned a Master of Science in Healthcare Administration from Trinity University. He chose going into medical management because he wanted a career where he could do good and make a difference. He and his wife, Melissa, have been married for 26 years and have four sons ages 11 to 21. A lot of their time is spent being engaged in their children’s activities. Troup runs four to five times a week, and enjoys reading, especially books on leadership. He is a Fellow in the American College of Healthcare Executives and has a Six Sigma Green Belt.

lected in a two-week period to meet the patient’s future reproductive goals. Cryopreservation of testicular tissue is an option for prepubescent boys as well as men who are incapable of ejaculating sperm. Testicular tissue cryopreservation in prepubescent boys is considered experimental and should only be done as part of IRB approved research or a clinical trial. Gonadal shielding is an option for men undergoing radiation treatment, however cryopreservation is recommended with this option as well. Women have several options available to them. In the early 2000s a process of “freezing” eggs called vitrification became available to embryologists. Prior to this breakthrough cryopreservation of eggs was difficult and survival rates of eggs post thaw were very poor (30% or less). Freezing a cell involves the formation of ice crystals that can damage and/or kill the cell. Vitrification overcomes this problem by rapidly cooling eggs to -196° C in a fraction of a second. The temperature change approaches – 20,000°C/min and is so rapid it does not allow ice crystals time to form. Survival rates of vitrified eggs are close to 100% and overall IVF success rates are similar to IVF with fresh eggs. The process involves controlled ovarian stimulation, surgical retrieval of the oocytes, vitrification, and storage. Using mid cycle starts the process can be carried out in 3-6 weeks’ time. Embryo creation is an option for women who are married or have a partner. Oocytes are fertilized using the sperm of the patients’ partner. Embryos are then cultured in the embryology lab and vitrified using a similar procedure to that of oocytes. The advantage of embryo cryopreservation is that vitrified embryos are easier to warm than eggs because they are multicellular and if a few cells are damaged during warming the embryo will still survive and is usually unaffected by the loss of a few cells. Ovarian tissue cryopreservation is an experimental procedure with limited results to date. Samples of tissue containing thousands of primordial oocytes are removed from the ovary and cryopreserved. The tissue can later be implanted and hopefully begins to produce mature oocytes that can be harvested and used in IVF to create embryos and ultimately produce a child. So far over 70 pregnancies have been achieved worldwide, but the outlook is encouraging, especially for preadolescent women. Corey Burke is the Tissue Bank Director of Cryos International – USA. He has 20 years of reproductive laboratory experience and is an industry leader in the field of oocyte and sperm cryopreservation, running one of world’s largest donor egg and sperm banks. Working as an andrologist and embryologist, he has helped thousands of people achieve their dreams of becoming parents. Contact at usa@



Healthcare Crisis: Overmedicating of Residents, AI to Rescue? By PHILIP REGENIE

In 1972 a friend of mine worked in a senior home located in Santa Cruz California. At the time he would horrify our young novitiate minds with stories of what they asked him to administer to the seniors in his care. 40 years ago, polypharmacy and drug abuse of seniors was alive and well. Today, with the explosion of the pharmaceutical industry, both the effective use of multiple drugs and the abuse of multiple drugs are prevalent in senior care. On average, seniors take six different medications, and more than 15 percent of seniors use at least 10 drugs at the same time. The drugs are often prescribed by multiple doctors for multiple symptoms without a clear understanding of their possible interaction. The point person for drug administration for a senior might change between family members and between staff without clear communication and understanding of the potential problems. Just two nights ago a woman shared with me a story about her husband who has suffered some electrical problems with his heart having fallen and broken his hip due to drug interactions. The societal problem is significant enough that Stanford has researched and developed sophisticated polypharmacy AI to identify risks associated with the interaction of multiple medications. This is, in fact, the tip of the iceberg. The use of an additional sedative might seem very appealing to a single person on staff, left alone by a staff illness and lack of available replacements, responsible for 50 to 100 residents at 8:00pm. Just meeting the immediate needs of the community in toileting, medications, showers, and calls for help leave staff traumatized for years. The United States assisted living communities are regulated by individual states. For assisted living communities in California there are no specific staffing ratios. California law requires that facility personnel shall at all times be sufficient in numbers, qualifications, and competency to provide the services necessary to meet resident needs, and to ensure their health, safety, comfort, and supervision. It should be obvious that this flexible standard can be interpreted, and that enforcement is difficult. Staff must be 21 years of age, have at least a high school diploma and receive 40 hours of training within the year of employment. These minimal staff qualifications allow for staff in RCFEs, Residential Care Facilities for the Elderly, to assist residents with medication self-administration. The bar for being employed as staff in senior care communities is low but so are the wages. The 8th lowest paying job in America is personal and home care aides with institutional positions for senior care arkansasmedicalnews


not far behind with an average annual income in 2017 of $26,269 a year. It is no surprise that retaining caregiver positions is a difficult task and that there is a widening gap in delivery of service to seniors. According to an assisted living employee survey the number one retention issue in assisted living communities is manager employee relations. Training managers is an absolute must in ALFs and should include acceptance of measurement of performance and ownership of improvement. Measurement needs to be done without putting an extra burden on management as they are likely taking on staff responsibilities in order to meet service requirements. Technology can help ALFs maximize the effectiveness of their personnel and keep personnel happier. Technology optimizes scheduled behavior with assessment and just in time delivery of service with improved communication. ALFs can improve performance by employing staff as firefighters who answer technology notifications for help calls, bed exits, and falls allowing other staff to perform scheduled walks, showers, and bathroom assistance to proceed unencumbered. AI is being used to identify the frail who need extra assistance, improve scheduling, performing polypharmacy analysis, and analyze real time data notifying caregivers of emergencies. Integrating it into existing systems is as easy as installing TV Players in rooms with some sensors. The technology does the rest with dashboards, smart mobile clients, and reports of staff effectiveness and resident needs. We have come a long way since 1972 but still need to ensure quality of care. We can assure quality by establishing legal standards for resident to staff ratios and increase educational standards for management. Staff ratio and management quality should be enforced through technology that does not require human resources such as smart phone check-ins and knowledge of ALFs capacity. Technology is a great equalizer when resources are stretched. ALFs need to adopt in order to meet minimum care standards. Founder and CEO Philip Regenie established Zanthion after experiencing the challenges his parents faced in their final years of life. His personal experience with the indignity of his parents’ deaths inspired him to enter the market and invest his personal finance to build a business based on dignity and care. With 35 years working in IT as a programmer, analyst and project engineer and eventually CEO/ CTO in military aircraft systems, IOT (Internet of Things) and electronic medical record management, Regenie was uniquely positioned to understand and solve the complex problems associated with senior care. Realizing that no one else in the industry was providing the solutions he knew, from his personal experience, that seniors and their families need today, he decided to create Zanthion.  

Recent CMS Rule Changes Impacting Physicians 2019 Physician Fee Schedule and Quality Payment Program Rules On November 1, 2018, CMS finalized the 2019 Physician Fee Schedule and the Quality Payment Program rule (“2019 Rules”). A couple of the stated goals of the 2019 Rules are: (1) to provide much-needed relief to providers from paperwork / documentation requirements; and (2) to modernize Medicare payment policies in order to facilitate and promote more wide-ranging access to virtual care. Many parts of the 2019 Rules will become effective on January 1, 2019. There are delayed effective dates for other parts, as discussed in this update. The 2019 Rules are in excess of 2,000 pages. The purpose of this update is to provide highlights of a few provisions of the 2019 Rules that providers may be the most interested in.

Evaluation and Management Services; Billing and Coding

The Authors:

Coding and documentation requirements for “evaluation and management,” or “E/M” services are material (and sometimes frustrating) considerations for a substantial majority of physician practices. Correct coding of and record keeping for E/M services has been the source of much frustration for physicians over the years. Many CMS overpayment recoveries are based on the alleged incorrect coding and billing for E/M services (i.e., the physician billed a level 4, and CMS alleges that the physician should have billed a level 2 E/M code instead). Historically, billing and coding for E/M services has been inherently subjective in nature. Another complicating factor of coding E/M services is that there are two different sets of guidelines possibly applicable to E/M coding and billing; the 1995 and the 1997 E/M documentation guidelines.

Lynda M. Johnson, Partner

For 2019 and 2020, CMS will continue several of the current facets of E/M billing / coding (described above). However, effective January 1, 2019, the following changes will be effective1: • For established patients, when information is already contained in the medical record, practitioners will not be required to record again the defined list of required elements for each visit, if there is evidence that the practitioner reviewed the previous information already included in the record and updated it, as needed. This will allow practitioners to focus documentation efforts more acutely on conditions that have changed.

Timothy C. Ezell, Partner

• For established patients, practitioners will not be required to enter again in the medical record information regarding the chief complaint and history, if those matters have already been entered by staff. The practitioner must indicate that he/she verified this information for the applicable visit being billed. Broader (and more material) changes will become effective beginning in 2021. These additional changes include: • Less payment variation for E/M levels. This will be accomplished by paying a single rate for E/M visit levels 2 through 4. Level 5 visits will remain possible if applicable reimbursement criteria are met. • Practitioners will be able to document E/M visits (levels 2 through 5) using medical decision-making or time spent with patient, instead of using the 1995 or 1997 E/M guidelines that have been applicable for years. Practitioners will also have the option to continue to use the current guidelines; so no change is required if a practitioner desires to continue to practice as he/she historically has.

Payment for Communication / Technology Services CMS will pay for two different sets of physician services requiring use of communication technology. The first category of services may be described as brief communication technologybased services. The applicable HCPCS code will be G2012. One example of this would be implementation of a virtual check-in service. The second category of services may be described as a remote evaluation of video (or other image) from an established patient. The applicable HCPCS code will be G2010. A primary objective of these new payment methodologies is to allow a practitioner to be reimbursed for providing services in order to determine whether a patient visit is needed. If it works as planned, these measures would ideally promote fewer unnecessary visits.

Conclusion The success or failure of these measures will be in the practical implementation of such over the next few years. Almost certainly, the measures will have to be tweaked and improved over time. Please note that this update should not be construed as the provision of billing, coding or reimbursement advice. This is intended as an update only, and providers should consult with billing / reimbursement experts prior to implementing any new or different billing / coding practices.






GrandRounds Amputation Pain Study at UAMS Enrolling Participants LITTLE ROCK — People with frequent and recurring pain from an amputated leg are being enrolled in a University of Arkansas for Medical Sciences (UAMS) research study of a device designed to reduce amputation 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. The study is testing the safety and effectiveness of an implanted device, Altius® High Frequency Nerve Block, that is designed to block nerve signals and reduce pain in an amputated limb. The investigational device sends a highfrequency electrical signal to targeted nerves to block the nerve transmission. It was developed by Neuros Medical Inc., in Cleveland, Ohio. Called the QUEST study (HighFreQUEncy Nerve Block for PoST-Amputation Pain, Identifier: NCT02221934), it is a randomized, controlled clinical study of up to 180 patients, at up to 25 clinical study sites in the U.S. Study participants will undergo surgery to be implanted with the device. It includes a cuff electrode, which is coiled around the nerve, and a pulse generator, which is similar to a pacemaker. Together they deliver an electrical signal to the nerve when activated. Once implanted, study participants can activate a 30-minute treatment session on demand, as needed for their pain. Participants will be followed for a year and seen in clinic once a month. They will also receive modest compensation for their time and travel. Eligibility requirements for participating in the study include: • Having one amputated leg • Frequent and recurring amputation pain • 21 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. An earlier pilot study involving 10 participants demonstrated that the implant device may be safe and effective for post-amputation pain. The project described is supported by the Translational Research Institute (TRI), grant 1U54TR001629-01A1 through the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Research Article By Sparks Orthopedic Physician Published FORT SMITH - As hospitals across the country work to improve the quality of care their patients receive and reduce the number of readmissions into their fa-




cilities, John Harp, BSCE, MD, of Sparks Clinic Orthopedics, is spearheading a study focused on better measures for monitoring the air quality in orthopedic operating rooms. His clinical test study was recently published in the Journal of Bone and Joint Surgery Open Access publication. JBJS has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field, according to the website. Dr. Harp has been performing joint replacement surgeries as part of the Sparks Orthopedic and Spine Center since it opened three years ago. While the center has a low complication rate which is comparable to other joint replacement centers across the nation, according to Dr. Harp, he wanted to examine ways to further reduce periprosthetic joint infection. The focus of his clinical test is to measure airborne microbialcarrying particles in the operating room environment. Currently, there is no standard technique in the United States to measure intraoperative airborne microbe-carrying particle contamination during total joint replacement, nor are there guideline levels for interpretation, Dr. Harp writes in his study. During the study, Dr. Harp worked closely with Dr. William Whyte, DSc, of the University of Glasgow, Scotland, who is an authority on the topic. A simple test using “settle plates” placed in various areas of the operating room allowed Dr. Harp to measure the amount of bacteria in the air that had settled in high-traffic areas of the room. Over a period of 11 months, 47 procedures were monitored by Dr. Harp. The result is a very simple and low cost way to check air quality, as well as guideline standards that other healthcare providers across the country could use. Dr. Harp has been in practice for more than 20 years. He, along with four other orthopedic physicians joined Sparks to form Sparks Clinic Orthopedics last fall. The clinic is located in the Sparks Medical Plaza on Dodson Avenue. In addition to outpatient services, Dr. Harp provides surgical solutions for patients suffering from joint pain. With the aid of specially trained nurses and therapists, Dr. Harp and his fellow orthopedic surgeons are able to help patients on the Sparks Orthopedic unit walk soon after surgery and spend a mere 1-2 nights in the hospital. The 9-bed unit has provided a simplified process for joint replacement surgery for hundreds of patients and saved them a long commute outside of the River Valley. Sparks Health System includes Sparks Regional Medical Center, Sparks Medical Center – Van Buren, Sparks Clinic, Sparks PremierCare and the fully hospital-integrated Marvin Altman Fitness Center. For more information about Sparks Health System, visit www.

Spiro Clinic Adds Nurse Practitioner

Vital Signs Good for Healthcare Real Estate

FORT SMITH – Spiro Family Medical Clinic, a Sparks Clinic, has added an additional healthcare provider to better serve the needs of residents of LeFlore County. Tracy Fiser, APRN, is now seeing patients alongside Linda Rodriguez, DO. As a Tracy Fiser nurse practitioner, Fiser works directly with patients to manage acute and chronic illnesses, as well as perform physicals and diagnostic tests and procedures. At Spiro Family Medical Clinic, Fiser treats patients of all ages. Fiser has been a nurse for more than 10 years and has experience in family clinic, assisted living and rehabilitation settings. She earned her degree from the University of Central Arkansas in Conway in 2014. Both Fiser and Dr. Rodriguez are accepting new patients. For more information or to schedule an appointment, call 479-782-CARE. Sparks Health System includes Sparks Regional Medical Center, Sparks Medical Center – Van Buren, Sparks Clinic, Sparks PremierCare and the fully hospital-integrated Marvin Altman Fitness Center. For more information about Sparks Health System, visit www.

According to Cushman & Wakefield’s 2018 Healthcare Investor and Developer Survey, there is a continued optimism for the healthcare sector as demonstrated by favorable yields and sizable medical office building rent growth in key U.S. cities. Cushman & Wakefield surveyed a cross-section of healthcare developers and investors on their preferences related to geography and property type, in addition to project outcomes including cap rates and development yields.

Conway Regional Welcomes Two Hospitalists CONWAY- Whitney Philamlee, MD, and Ben Burkett, MD, have joined the medical staff of Conway Regional Health System. They began practicing in early September. Dr. Philamlee completed a residency in Medicine/Pediatrics Dr. Whitney at the University of Philamlee Arkansas for Medical Sciences in Little Rock and also holds a medical degree from UAMS. A native of Jonesboro, she achieved her bachelor’s degree from UCA. Dr. Burkett Dr. Ben Burkett completed a Medicine/ Pediatrics residency at the University of Mississippi. He holds a medical degree from the University of Mississippi School of Medicine. Prior to relocating to Arkansas, Dr. Burkett practiced medicine at Merit Health Wesley in Hattiesburg, MS. The Conway Regional Hospitalist program is comprised of 14 healthcare providers who provide in-hospital care at Conway Regional and Ozark Health Medical Center in Clinton.

The respondents included private equity, institutional owners and REITs, along with developers specializing in the healthcare sector. Some operate locally and regionally, while others have a national footprint. The report delves into these four key takeaways and more: • Most respondents expect their portfolios to grow in size (SF) over the next year • The medical office property type continues to be highly favored • 75% of respondents indicated a willingness to invest in value-add and opportunistic assets • Development yields have been strong, ranging from 6%-8% on the high end with a credit anchor tenant See the report at research-and-insight/2018/vital-signsnov2018

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GrandRounds UAMS Receives 5-Year $3.29 Million Grant from CDC to Reduce Obesity LITTLE ROCK — The Department of Family and Preventive Medicine at the University of Arkansas for Medical Sciences (UAMS) has received $3.29 million from the Centers for Disease Control and Prevention (CDC) for a fiveyear project to reduce obesity, increase physical activity and improve nutrition in Arkansas, especially in the Delta. The State Physical Activity and Nutrition (SPAN) project funding began Oct. 1 and was awarded to the Department of Family and Preventive Medicine’s Community Health and Education Division. Alysia Dubriske, director of Community Health and Education at UAMS, is leading the grant. The whole premise of the grant is to try to reduce obesity rates. The CDC has identified target areas, including access to better nutrition, increasing breastfeeding, encouraging healthier foods and physical activity in early childcare centers, and improving activityfriendly communities Dubriske said. UAMS staff will be working in partnership with local leadership and stakeholders across the state, but especially in counties where life expectancy is lower than national and state averages. Many rural counties in the eastern Arkansas Delta fall into this category.

Obesity, diabetes, high blood pressure, low physical activity, poverty and lack of access to health care are factors. The project aims to: Develop and implement food service guidelines for food pantries, early childhood education centers, developmental disability day centers and local parks. Support breastfeeding by partnering with family practice clinics, early childhood education centers and developmental disability day centers and by offering continuing medical education hours and early childhood center and developmental disability center professional development training. Partner with communities to create activity-friendly routes to connect everyday destinations by implementing local policies to include bike routes, sidewalks and trails that increase safety and access for all abilities. Implement nutrition standards and physical activity standards into early childhood education centers across the state by changing the Quality and Improvement Rating System in Arkansas to increase physical activity, increase nutrition and physical activity education to staff, and decrease screen time. Assisting Dubriske with the project are Christopher Long, Ph.D., senior director of Research and Evaluation at the

UAMS Northwest Regional Campus; and Leanne Whiteside-Mansell, Ed.D., director of the Research and Evaluation Division in the UAMS Department of

Family and Preventive Medicine. Bettie Cook, senior research administrator at UAMS, assisted with the successful grant application.

Mercy Hospital Ozark Breaks Ground on $5.13 Million Expansion OZARK – Mercy Hospital Ozark broke ground Thursday on a $5.13 million project that will result in added services, equipment and space. The 14,759-square-foot project is expected to be completed by November 2019. Franklin County is funding $1.47 million of the cost. The project will focus on tearing down and rebuilding the east side of the hospital complex that was built in 1952 and included administration offices, physical therapy and the county health department clinic, which has moved to a new location. Construction will result in expanded physical therapy space, new equipment and room for additional outpatient services such as cardiac rehabilitation. During construction, physical therapy and administration offices will be relocated to the medical-surgical area of the hospital. Studio 6 Architects in Fort Smith designed the project. General contractor is SSI of Fort Smith. Black Hills Energy donated $25,000 for the project.

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St. Bernards First in Arkansas to Implant New Stent JONESBORO – Physicians at St. Bernards Medical Center became the first in the state of Arkansas to implant the Eluvia™ Drug-Eluting Vascular Stent System, specifically developed for the treatment of peripheral artery disease (PAD). St. Bernards is only one of 20 hospitals in the country currently implanting the Eluvia. Dr. Max Arroyo and Dr. Ahmed Ahmed, cardiologists at St. Bernards, implanted the stent, which was specifically designed to treat blockages in the arteries (often referred to as PAD) of the lower extremities. This stent system allows the patient to receive sustained drug release over an extended period of time, providing treatment directly at the blockage site. The Eluvia stent, developed by Boston Scientific, utilizes a drug-polymer combination to offer sustained release of the drug paclitaxel for a one-year timeframe, designed to prevent tissue regrowth that might otherwise block the stented artery. The Eluvia stent was compared in head-to-head trials with the only other drugcoated peripheral stent on the market and the Eluvia has superior outcomes with 88.5 percent patency of the treated blockage at 12 months. Additionally, of those patients treated with the Eluvia stent, fewer went on to require surgical intervention when compared to other peripheral drug-coated stents on the market. Approximately 8.5 million people in the United States are affected by PAD, which occurs when fatty or calcified atherosclerotic material, called plaque, builds up on the walls of the arteries of the legs, restricting blood flow and causing pain, swelling and a diminished quality of life. If blood flow is not restored and maintained, severe cases of PAD can lead to pain, ulcers and even amputation of the affected limb.

Mercy Holds Blessing, Ribbon Cutting at North Bentonville Clinic BENTONVILLE — Mercy’s newest clinic in Bentonville offers four primary care providers in the thriving North Walton Boulevard Corridor Enhancement area that is less than a mile from four public schools. Mercy held a blessing and ribbon cutting to celebrate the opening of Mercy Clinic Primary Care – Walton Boulevard in early October. The clinic’s providers – Dr. Jim Byrum, Dr. Kim Chapman, Dr. Robert Holder and advanced practice nurse Meredith Finley – offer family medicine,




pediatrics and internal medicine. The clinic is among seven Mercy will open as part of a $277 million expansion in the region that includes the addition of a seven-story tower to the Rogers hospital. Mercy Clinic President Dr. Steve Goss said the area of north Bentonville is growing quickly and has a need for more primary care physicians. In researching its Community Presence Plan, Mercy found that residents prefer care close to where they live and work. Mercy’s investment in the site and building totals $4.1 million. The clinic is Mercy’s sixth location in Bentonville.



GrandRounds Arkansas Children’s Hospital & Medical Center of South Arkansas Bring Nursery Alliance to El Dorado

EL DORADO – Medical Center of South Arkansas (MCSA) has announced that it is joining the Arkansas Children’s Hospital (ACH) Nursery Alliance in a move that will directly coordinate care between neonatologists at ACH’s Neonatal Intensive Care Unit (NICU) and physicians at MCSA in El Dorado. The collaboration elevates neonatal care for the region’s newborns and addresses one of the state’s most vexing health problems: infant mortality. For every 1,000 babies born in the state, eight die before their first birthdays. Through the Arkansas Children’s Nursery Alliance agreement, ACH will support MCSA to help ensure the care families count on close to home will continue in the nursery. The arrangement will include formal processes for coordinating care prior to transport, including elevating care to a higher level if a baby’s condition requires it. In addition, families will have access to post discharge follow-up by monitoring and measuring late morbidities through an expanded High Risk Newborn Clinic network. The neonatal period is specific to the first four weeks after birth (neonate or newborn), a time when changes happen rapidly. Many critical changes can occur in this period: Feeding patterns are established; bonding between parents and infant begin; the risk of infections that may become more serious are higher; and many birth or congenital defects are first noted. This care is usually centered on newborn infants with a range of problems, varying between prematurity, birth defects, infection, cardiac malformations and surgical problems. Through the alliance, neonatologists at ACH also will provide educational support, quality data review and implementation of best practices to physicians and staff at MCSA. The alliance also provides training through telemedicine for the purpose of enhancing neonatal care and creates support as needed to help the babies at MCSA or at ACH get the best care possible. MCSA Women’s Center has five labor, delivery and recovery rooms; 14 postpartum rooms and a 12-station well-baby nursery and specialty care nursery for 1500 gram babies or greater or 32-week babies. The Women’s Center provides HUGS Infant Security for continuous monitoring of infants, a lactation consultant on staff and on-call and all obstetric nurses are trained in Advanced Fetal Monitoring. The staff is trained in neonatal resuscitation program (NRP), all nursery nurses are S.T.A.B.L.E. certified and the unit is Safe Sleep Certified. MCSA is the fifth hospital member of the ACH Nursery Alliance, which was established in 2016 when Conway Regional Health System joined as the first hospital member. Arkansas Children’s Hospital operates the state’s only designated Level IV NICU (100 beds), the highest level of acute care, and has access to pediatric specialists from all disciplines.



UAMS, Arkansas Children’s Announce Agreements LITTLE ROCK – Arkansas’ children have a healthier tomorrow before them, after the University of Arkansas for Medical Sciences (UAMS) and Arkansas Children’s today signed updated research collaborative and affiliation agreements. The agreements, which took effect Oct. 1, continue the strategic partnership of the state’s only medical university and the state’s only children’s health system. UAMS Chancellor Cam Patterson, MD, MBA, and Arkansas Children’s President & CEO Marcy Doderer, FACHE, called the agreements “a vital step and the next milestone” in the more than 40-year relationship of the two institutions. The two describe the agreements as enhanced strategic partnerships between UAMS and Arkansas Children’s. The institutions agreed last year to explore a closer relationship. The agreements announced today have met the due diligence and regulatory approvals of both institutions. The updated agreements aim to provide high level care to children and young adults, integrate pediatric research activities and continue to advance leading pediatric clinical care and academic programs with national recognition, attract and retain top staff, and improve operating performance.

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GrandRounds New Director Named At Wound Care Center FORT SMITH – Melissa Sikes, MPA/EHCA, has returned home to join Sparks Health System as the director of Sparks Wound Care and Hyperbaric Center. Sikes was born at Sparks and grew up in Fort Smith where she graduated from SouthMelissa Sikes side High School. After 35 years of pursing her career and education in Texas, she says she’s glad to be home. Sikes holds a Masters of Public Administration, Executive Healthcare Administration from the University of Texas at Tyler. Sikes most recently served as the Corporate Director of Provider Relations at East Texas Regional Healthcare System where she worked closely with executive leadership, physicians and referral hospitals to support the system’s growth. Before that, she was a program director of the facility’s Healogics, Inc., wound care program. As the director of Sparks Wound Care and Hyperbaric Center, Sikes oversees daily operations of the clinic and supports providers Dr. Quyen Ha, MD, CWSP, and nurse practitioners Ashley Crow and Kennan Ashton Moore, who conduct more than 650 patient visits a month. Millions of people across the country are living with physical wounds that haven’t healed for months or even years. An aging population and increasing rates of conditions such as diabetes, obesity, and the late effects of radiation therapy, contribute to this common problem. Sparks Wound Care and Hyperbaric Center, a member of the Healogics network, offers advanced therapies to patients suffering from chronic wounds. Untreated, chronic wounds can lead to diminished quality of life and possibly amputation of the affected limb. People with wounds that have not improved with traditional methods of treatment in four weeks may benefit from a visit to Sparks Wound Care and Hyperbaric Center. Your doctor can refer you or you can call directly to make an appointment.

Baptist Health Heart Institute Welcomes Drs. Jerson Mendoza and Kapil Yadav LITTLE ROCK – Drs. Jerson Mendoza and Kapil Yadav, both interventional cardiologists with Arkansas Cardiology, recently joined the Baptist Health Heart Institute-North Little Rock. After receiving their medical degrees and finishing their resiDr. Jerson dencies, the physicians Mendoza became fellowship




trained in Cardiology and Interventional Cardiology. Mendoza completed his fellowships at the University of Miami/ Jackson Health System in Miami Florida and the Albert Einstein College Kapil Yadav of Medicine in Bronx, New York, respectively. Yadav completed his at Tulane University School of Medicine in New Orleans and the University of Arizona College of Medicine in Phoenix, respectively. Mendoza has been practicing medicine for 10 years and Yadav for eight. Both are board certified in Internal Medicine, Cardiovascular Disease, Echocardiography and Nuclear Cardiology. Their expertise combined includes Coronary Angiography, Vascular and Intravascular Ultrasound, Fractional Flow Reserve, Optical Computer Tomography, High-risk Coronary and Peripheral Vascular Interventions, Percutaneous Mechanical Circulatory Support, Balloon Aortic Valvuloplasty, Transthoracic Echocardiography, Transesophageal Echocardiography, Myocardial Perfusion and Peripheral Vascular Imaging, Coronary Artery Calcium Scoring, Holter monitoring, Ankle-Brachial Indexing, Nuclear Medicine Stress Testing, and A.V. Graft Studies. Baptist Health Heart Institute-North Little Rock is located in Baptist Health Medical Center-North Little Rock.

Conway Regional Announces New Chief Financial Officer CONWAY - Troy B. Brooks has joined Conway Regional Health System as its Chief Financial Officer (CFO). As CFO, Brooks will be responsible for the financial operations of the health system which includes Conway Regional Medical Center, Conway Regional Rehabilitation Hospital, Con- Troy B. Brooks way Regional Surgery Center, an outpatient imaging center and 10 primary care clinics located throughout north Central Arkansas. He will lead Conway Regional’s Accounting, Business Office/Admissions and Medical Information teams. Conway Regional is an independent health system governed by a local volunteer board and managed by CHI St. Vincent. Under the terms of Conway Regional’s five-year management agreement, Brooks is an employee of CHI St. Vincent. Brooks comes to Arkansas with more than 37 years of experience in advanced healthcare financial management and leadership. He served Piedmont Newton Hospital in Georgia as their CFO for the majority of his career where he was responsible for the financial operations of their hospital as part of an integrated system. His responsi-

bilities at Piedmont Newton included the development of new service lines including imaging and women’s services, lab expansion, contracting, and leading the organization through five major revenue bond Issues for campus expansion. Brooks holds an MBA from Mercer University and a Bachelor of Science in Accounting from the University of South Alabama in Mobile. He is a member of the American College of Healthcare Executives as well as an advanced member of the Healthcare Financial Management Association where he was awarded the Bronze Merit Award for his chapter. While in Georgia, he was active in the community serving on the board of the chamber of commerce along with multiple non-profit organizations boards and committees. Troy and his wife of 33 years, Wendy, have moved to Conway. They have two adult children. Their son, Andrew, is in his first year of a Pediatrics residency at Dell Children’s Medical Center in Austin, TX and their daughter, Delanie, has relocated to Austin to work with behavioral students at the KIPP Austin High School.

CV Surgeon Greiten Joins Arkansas Children’s, UAMS LITTLE ROCK – Lawrence Greiten, MD, MSc, has joined the University of Arkansas for Medical Sciences (UAMS) College of Medicine as a cardiothoracic surgeon and will practice at the Heart Center at Arkansas Children’s, creating even better care for Dr. Lawrence kids with cardiovascuGreiten lar disorders. He will serve alongside Brian Reemtsen, MD, who took the helm as director of the Arkansas Children’s Heart Center last year. Dr. Greiten comes to Arkansas Children’s and UAMS after completing a congenital cardiac surgery fellowship at the Children’s Hospital Los Angeles. Prior to this, Dr. Greiten completed his general surgery and adult cardiothoracic training at the Mayo Clinic in Rochester, Minn., where he also earned a master’s degree in biomedical and clinical science. He attended medical school at University of Arizona College of Medicine in Tucson.

Arkansas Surgical Hospital Named Physician Hospital of the Year LITTLE ROCK -- Arkansas Surgical Hospital (ASH) has received the coveted Physician Hospital of the Year award for 2018. Each year, Physician Hospitals of America (PHA) recognizes one physician-owned hospital or clinic that exemplifies high quality, community service and leadership. Physician-owned hospitals are centers of excellence, providing the high-

est quality of healthcare while giving back to their local community said PHA President John W. Dietz, Jr., MD. As an example, Dr. Dietz cites that ASH was one of only 19 hospitals in the United States last year to receive “double five-star” status from the Centers for Medicare & Medicaid Services, obtaining the highest rankings for both overall quality and patient satisfaction. To be named Hospital of the Year, ASH had to meet the following criteria: 1. High achievement in published measures of clinical care, patient experience, outcomes and efficiency. 2. Recognition via nationally-esteemed awards and accolades. 3. Exceptional record of community service and outreach. 4. Demonstrated activity in support of PHA priorities such as legislative fly-ins and grass roots initiatives. 5. Must be an active member of PHA in good standing.

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GrandRounds Mercy Celebrates Tower “Topping Out” ROGERS – Mercy celebrated a significant milestone in the progress of its new seven-story tower during a “topping out” ceremony in September. The hospital tower is the biggest piece of a multimillion dollar expansion Mercy announced in April 2016 that includes the addition of seven new clinics in Northwest Arkansas. Leading up to the event, Mercy has encouraged co-workers to sign a beam that will be hoisted into place Monday. The $141 million patient tower will take Mercy Hospital Northwest Arkansas from 200 beds to 300-plus beds with space available for future inpatient growth up to 360 beds. Some enhancements to the hospital include a new hybrid cardiac catheterization lab, expansion of the neonatal intensive care unit and a new 500-space parking lot. The building’s contractor, McCarthy, projects the tower will be complete in August 2019. Mercy’s investment in hospital and clinic expansions is expected to total $277 million. Along with the expansion, Mercy will add 1,000 health care jobs, including about 100 physicians.

McElfish Named Vice Chancellor for UAMS Northwest Campus LITTLE ROCK – Pearl McElfish, Ph.D., has been promoted to vice chancellor of the Northwest Arkansas Regional Campus of the University of Arkansas for Medical Sciences (UAMS). McElfish has been serving as associate vice chancelDr. Pearl lor since Peter Kohler, McElfish M.D., retired as vice chancellor in 2016. As vice chancellor, McElfish will lead all campus-wide efforts, provide leadership to ensure coordination across all UAMS programs in the region and work closely with area partners. McElfish joined UAMS in 2010 as the study director of the National Children’s Study for the Department of Pediatrics. In 2012, she was named the founding director of the Office of Community Health and Research. Then in 2015, she founded the Center for Pacific Islander Health, the first center in the United States that focuses solely on Pacific Islander health issues. Prior to joining UAMS, McElfish worked for various community health organizations, improving efficiency and quality of care and developing strong, sustainability research and community health programs. She holds a doctorate of philosophy in public policy from the University of Arkansas at Fayetteville.



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Arkansas Medical News November-December 2018