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Psychiatry a Natural Fit with Telemedicine The shortage of psychiatrists in Arkansas means that it can take two or three months to get an appointment with one, even in large population areas like Little Rock ... 2

AHA Panelists Discuss Strategies to Prevent C-Suite Burnout Publisher’s note: The Arkansas Hospital Association annual meeting is a valuable, resourceful conference for hospital professionals across the state ... 3

Medical Marijuana is Relatively Safe, Evidence of Effectiveness Lacking Research lacking on strains and delivery methods By BECKY GILLETTE

Some healthcare professionals in Arkansas hesitate to even use the term “medical marijuana,” pointing to a dearth of scientific studies that could be used to properly prescribe cannabis for different health conditions. Regardless, purchase of a large number of different types of medical marijuana and CBD products is spreading rapidly, creating a Wild, Wild West landscape. Between the time when the first medical marijuana dispensary opened in May and November 1, more than 2,491 pounds of medical marijuana valued at $17.5 million have been sold at ten dispensaries. Another 22 dispensaries approved had yet to open. Physicians are unable to make specific recommendations about what people should do because (CONTINUED ON PAGE 4)

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Caring for the People Who Care for Patients

AR Cannabis Clinic has Statewide Reach Certifying Qualified Patients for Medical Marijuana

Jefferson Regional’s, Brian Thomas, has expanded its physician practice network responsibilities

One sign of the changing times with a conservative state like Arkansas voting to legalize medical marijuana for certain illnesses is literally a sign ... 5

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PINE BLUFF--The formula for success at Jefferson Regional focuses on hiring the best possible people, giving them the tools and resources they need to do the job, and then simply getting out of their way, said Jefferson Regional President and CEO Brian Thomas. “My job is to take care of the people who take care of the patients – the physicians, nurses, clini(CONTINUED ON PAGE 8)

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PhysicianSpotlight

Psychiatry a Natural Fit with Telemedicine Efforts aimed at alleviating the shortage of psychiatrists in Arkansas By BECKy GILLETTE

The shortage of psychiatrists in Arkansas means that it can take two or three months to get an appointment with one, even in large population areas like Little Rock. Psychiatrists are spread even more thinly in rural areas. There is also a shortage of psychiatrists who take Medicaid patients. For someone with a serious mental health problem such as psychosis or severe depression, waiting months for treatment is not acceptable, said Jessica Coker, MD, co-director of the Women’s Mental Health Program at the University of Arkansas for Medical Sciences (UAMS). Sometimes the only option is to go to an emergency room, but that isn’t the best place to receive mental health care. An option being used increasingly is telepsychiatry. “Psychiatry is one of the specialties that telemedicine is perfect for,” Coker said. “It doesn’t require extensive physical exams and we aren’t doing hands-on procedures. So, it is a great platform and is being used more and more. The VA has led the way and now other healthcare providers are adopting it. The majority of psychiatry in

rural areas is with telepsychiatry. Both patients and psychiatrists like it. Her clinic will be doing telepsychiatry and while that is a program UAMS would like to grow, part of the problem is there aren’t enough psychiatrists in the big cities,

Opioids: Is Prescribing Making You Nervous? UAMS AR-IMPACT is a weekly FREE interactive televideo consultation service designed to help Arkansas clinicians better manage their chronic pain patients and those who need their opioid dosage reduced. Televideo conferences are held Noon-1 p.m. Wednesdays. The program starts with a brief didactic presentation about an aspect of the care of these patients, followed by a case conference where doctors can present their difficult cases for discussion with their peers and with our panel of subspecialists. To join the conference, visit our website ARimpact.UAMS.edu For questions or to submit a case for our panel, email ARimpact@UAMS.edu To watch previous conferences and still receive CE credit, visit LearnOnDemand.org/lms/arimpact. Provider education: free CE for physicians, pharmacists, nurses, physical therapists and other health care professionals.

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so it is hard for them to expand. In some cases, telepsychiatry is being outsourced to providers in other states. There are also efforts to expand the number of psychiatric residencies in the state. UAMS graduates about eight psychiatrists each year and the Searcy Medical Center recently added four psychiatrist residencies to its program. Coker is also encouraged that psychiatry is becoming more popular with medical students; currently UAMS has 17 medical students interested in psychiatry. Even if they have to go outof-state to train, they might come back to Arkansas to practice. Coker said physician extenders like physician assistants or nurse practitioners are also being used to meet the needs. Because of the shortage of psychiatrists, general practitioners are often the only option for mental health care for some patients. Many GPs don’t feel comfortable prescribing psychiatric medicines. Coker’s advice for GPs is to focus on the social situation of the client because that drives a lot of the psychiatric problems in the state. “Resist the urge to use medicine to fix a problem,” Coker said. “I’m not sure that is always the best thing. A lot of times we are just covering up pressures that need to be managed in a different way. I encourage doctors to use psychotherapy more as a tool. Arkansas has the number one trauma rate in the U.S. with an extensive amount of childhood abuse. The majority of people I meet with psychiatric illness had some sort of childhood trauma. Those things are not best treated by medicine.” Psychiatrists, other types of physicians, nurses and other healthcare providers face a stressful work environment. Advice that Coker gives her medical students is to not work harder than your patients.

What about stress for the psychiatrists?

“I personally think a lot of burnout happens when we are working harder than our patients,” Coker said. “We give our recommendations, but we can’t make people change and can’t make people do things. As a whole, healthcare providers are perfectionists and want the best for everyone. But you can’t do everything for them.” Psychiatrists can be some of the worst patients. They think they shouldn’t have emotional problems and that is simply not the case. “Medical school changes who you are and how you interact with people,” Coker said. “If you are struggling mentally, I recommend therapy. Therapy can be helpful even if you are not having a major problem. It teaches you a lot about yourself.” Doctors expect to be tired, but there is a difference between being tired and being burned out. “If you are not enjoying what you do, change what you do,” Coker said. “Being a

doctor comes with flexibility and you have to create the work atmosphere that will make you the happiest.” Coker took that advice herself when she found out in medical school that she was much better at talking and listening to people than in doing procedures and managing life-and-death situations. In psychiatry, she found a specialty both challenging and rewarding. After finding out that pregnant women in Arkansas were a neglected population, Coker specialized in treating pregnant and post-partum women with mental illness. Then she further specialized by going into substance abuse in pregnancy. “I have a big heart for children,” she said. “My view of helping children across the state is to help their moms because if there is a good home structure, if parents are stable and doing well, children are more likely to succeed and thrive.” Substance abuse in pregnancy is a very emotionally charged topic. There is already a stigma around mental health, and an even greater stigma when talking about pregnant women using drugs. Coker encourages the view of drug use as an illness, not a moral issue. “From my experience, all moms no matter what want to be good moms,” Coker said. “Women using drugs have a lot of fear when they get pregnant including concern that the baby will be taken from them. Part of our mission is for them to realize there is treatment available. We are working hard to get the word out that we have this program. If they are in treatment, doing what they are supposed to do, they are less likely to face negative consequences than if they continue to do what they are doing. We have had great success with women including those with opiate use disorder. We use medication as a treatment in order to help them.” The most common substances abused during pregnancy in Arkansas are alcohol and cigarettes. Marijuana use is also common, and Coker said a difficulty with that is many women don’t consider that a problem. She said there are few treatment options for marijuana and no good treatment options for women using methamphetamine. Coker grew up in the small town of Vilonia near Conway. Her interest in medicine started with a career fair in the sixth grade. She graduated from the UAMS psychiatry residency program in 2016. She works closely with the Center for Distance Health and the Department of Obstetrics and Gynecology to provide consultation services throughout the state and to update the ANGELS psychiatry guidelines on an annual basis. In her leisure time, she enjoys outdoor activities and spending time with her husband, Ramon Barreto, and their threeyear-old daughter, Evelyn. ARKANSASMEDICALNEWS

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AHA Panelists Discuss Strategies to Prevent C-Suite Burnout Team building, a good work-life balance, town hall meetings and wellness support are all components By BECKY GILLETTE

Publisher’s note: The Arkansas Hospital Association annual meeting is a valuable, resourceful conference for hospital professionals across the state. The 89th meeting and trade show that was held in Little Rock in October was no exception. Arkansas Medical News was there, and we chose to bring takeaways from one of the sessions to our readers. A subject that hits home for many: C-Suite Burnout. We talked to four panelists who participated in the session about strategies to prevent burnout with corporate officers.

burnout. Work-life balance is an important tool for mitigating burnout.” Their team also serves on community service projects, participates in team-building activities off campus, and supports a strong family-first work ethic.  They offer on- campus and offcampus fun events with food, activities,

and socialization. For some events, staff can bring family. “We offer town hall meetings with the CEO/C-Suite,” Thomas said. “Staff members can ensure their voices are heard. We conduct yearly employee engagement surveys with  follow-up meetings to create action items. We have a

meditation garden where staff can take their breaks. Our CNO is researching the topic of ‘restorative breaks’ for the nursing division.” A review of the literature supports that spirituality appears to mitigate cognitive, physical, and emotional burnout. (CONTINUED ON PAGE 7)

Ashley Anthony, CEO, Delta Memorial Hospital, Dumas

Anthony said C-Suite burnout is common in healthcare settings, and it is important to be pro-active about supporting wellness among executives. “I come from a small, rural, 25bed critical access hospital,” Anthony said. “We have limited C-Suite staff and we all wear multiple hats. I’m not sure you can completely avoid C-Suite burnout. However, I think it is important to talk openly about this on a regular basis with your team. Discuss what the causes are, encourage time off for the staff, and for us, we like to also work on leadership development. A big part of that is self-development and the reasons why we do what we do.” Anthony said one thing she learned from the session is that each facility has its own challenges, and what works well for one is not the answer for another facility. “You really need to take a deep dive into your own organization, its culture, and community to help you in developing plans to combat burnout,” Antony said.

Kathy Thomas, MSN, Director of Risk Management, Corporate Compliance Officer, White River Health System, Batesville.

Encouraging top executives to take their paid time off (PTO) is one strategy to keep them mentally healthy. “Our organization revised our PTO policy for all leaders, director level and higher so that PTO for these leaders can no longer be banked,” Thomas said. “It must be used or you lose it by the end of the year. This encourages leaders to take much-needed time off to help prevent arkansasmedicalnews

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Medical Marijuana is Relatively Safe, continued from page 1 there is no evidence-based data to back that up, said William E. Fantegrossi, PhD, associate professor, University of Arkansas for Medical Sciences College of Medicine Department of Pharmacology and Toxicology. “Different formulations might be better for problems such as chronic back pain than for something William E. Fantegrossi, like anxiety and inPhD somnia.” All physicians can do is tell their patients with qualifying conditions that while marijuana is an option, there isn’t enough information available about which strains of cannabis may be helpful for different conditions or the best delivery method – whether edibles, topicals, inhalables or sublinguals. “People are left to their own devices to choose the medicine, which we don’t do with any other kind of drug,” Fantegrossi said. “You would never tell patients they have permission to pick out anything on the shelf. We have decided marijuana is a medicine not because anyone is overwhelmed about how effective it is, but because we voted on it. There is a lot of catching up to do to find out what it is best for, and how individual formulations may be better at treating specific conditions.” Is medical marijuana safe? Fantegrossi said it depends on how you define safety. From the gross pathology standpoint, marijuana is a very safe drug. “You don’t typically have any issues with overdose,” Fantegrossi said. “The adverse effects people experience are not particularly severe and are generally related to inexperience with the drug. They have tachycardia, and don’t know that is an expected effect. Even in cases when people buy a marijuana brownie that is meant to be split into nine doses, and they eat the whole thing by mistake, they will be intoxicated longer than they expected, but it is not a medical concern. If you think of safety that way, it is a relatively safe drug.” But someone can become dependent on cannabis and withdrawals can be unpleasant. “There are risks and benefits as there are with all drugs,” Fantegrossi said. “It is no different than with prescription drugs.” Other issues can be slower reaction

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times, foggy thinking and general impairment that can make someone unable to drive safely or perform well at work. One of the most repeated arguments for medical marijuana is that it is safer than opiates to alleviate pain. But early research indicating states with medical marijuana having a lower opiate overdose rate than states that don’t, didn’t stand up when the study was continued for a couple of years. “The initial finding was spurious,” Fantegrossi said. “That argument has gone away. That kind of sucks the air out of it. It is hard to be an advocate of it. I have never been impressed with the efficacy of cannabis for almost any of the things it is being marketed for. We have other drugs that are safe with low abuse potential. And I’m not aware of any other medications we give to people by a smoking route.” He also said telling people to smoke a raw plant material is a lousy way of getting the drug into the body. “And you have given people an entire plant, instead of what is in the plant that may be having the therapeutic effect,” he said. While there is considerable lore about cannabis in books, magazines and movies,

Fantegrossi said very little of it is based on research. “There are a lot of myths and misconceptions,” he said. However, his advice to physicians whose patients want a Physician’s Letter of Certification allowing them to get a marijuana card, is to grant the request as long as the patient meets one of the access conditions under the law. But physicians should warn patients with COPD or other lung conditions, that smoking is not recommended. “Smoking is a good way to get drugs rapidly in the brain, if that is what you are after,” he said. “It goes straight to the heart, the heart beats, and it goes right to the brain. It is about as a fast as an intravenous injection. You can understand why people smoke certain drugs of abuse.” John House, MD, who operates the Medical Canna Clinic in Springdale, agrees there is a lack of good information about how to use medical marijuana. He said that is because it has largely been illegal even to study it in the U.S. because of being designated a Schedule I drug with no recognized medical use. House said it is his understanding dis-

pensaries are required to have people on staff who would be knowledgeable on the effects of various strains. “I do give people as much information as I can about the various strains and the way they will affect a person,” House said. “I never recommend that anyone smoke it. Typically, I would recommend an edible for long action, a tincture under the tongue for short action and a topical for pain that can be reached, like a twisted knee or sprained ankle.” House said many of his patients say cannabis helps them, but he doesn’t buy some of the claims such as cannabis preventing cancer. “Obviously, I’m not seeing the case for that,” House said. “There is a lot of misinformation, but we are also seeing some very real benefits. The biggest areas people report improvement is in pain, insomnia, seizures and nausea. Those are the four areas my patients report seeing the best results. I’m hoping this coming year the legislature will expand the conditions eligible for cannabis access because there is good evidence that particular strains can help with anxiety and depression.”

UAMS Expert Says CBD Products Can Contain Serious Chemical Contaminants Consumers are not protected when buying CBD products By BECKY GILLETTE

The market for CBD (cannabidiol) products in the U.S. is expected to grow from $2 billion in 2018 to as high as $20 billion in 2025. CBD comes in a staggering array of different products, and some are selling for as much as $60 per fluid ounce. Claims include that it reduces stress and anxiety, relieves severe pain, boosts cognitive function and lowers blood sugar levels. But because CBD products other than the drug Epidiolex® are not regulated by the FDA or any other agency, purchasing CBD products is a dicey proposition, said Igor Koturbash, MD, PhD, associate professor and vice-chair, Department of Environmental and Occupational Health in the UAMS College of Public Health. Other than Epidiolex®, which is approved to treat several rare forms of children’s epilepsy, no CBD products have been proven to be effective in clinical trials. Koturbash said because of the lack of regulations, consumers don’t know the CBD strength in the product they purchase, or whether it contains the psychoactive ingredient tetrahydrocannabinol (THC). Consumers also don’t know if the products contain pesticides, fungi and other contaminants. “The consumer is not protected,” Koturbash said. “You can overdose on

Igor Koturbash, MD, PhD

both CBD and THC. And how many people will stop after one or two gummy bears? Very few products available contain the amount of CBD on the label. Usually it is a very low amount. Sometimes it is a higher amount. One of the products we saw had seven times more CBD than claimed. “Some of the CBD products contained as much as 45 percent THC, which means if you take that CBD, you are going to be impaired. And you are guaranteed to fail a drug test.” Korturbash said one of the most

important things for physicians and healthcare providers to know, at this very moment, is that the hype about CBD is just hype. With so many people taking CBD products, it is important for healthcare providers to ask about it. “Several studies including those in our lab show CBD can have a strong potential to interact with over-the-counter and prescription drugs,” he said. “Physicians need to be aware of that and know if patients are taking other medications and advise people to be very careful and cautious about it because of the potential for drug interactions. Physicians need to be aware of any prescription drug patients are taking with CBD. In the best-case scenario, CBD may just negate the impact. In the worst case, there is a potential for negative health impacts affecting the efficacy of the drug.” Some people swear that topical CBD oil helps them with pain in the knees and other joints. But Kortubash said the problem is experts don’t know much in terms of how much CBD has been absorbed into the skin. “It depends on the amount of the CBD you use in that topical and the quality of that topical,” he said. “There is very little knowledge of how much CBD applied on the skin can be absorbed. So, it is very hard to assess potential for topical CBD.” arkansasmedicalnews

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AR Cannabis Clinic has Statewide Reach Certifying Qualified Patients for Medical Marijuana By BECKY GILLETTE

One sign of the changing times with a conservative state like Arkansas voting to legalize medical marijuana for certain illnesses, is literally a sign. The AR Cannabis Clinic has put up billboards across the state advertising the clinic as the current statewide leader in medical marijuana certifications. The clinic was founded by David Nguyen, MD, and his wife, Hannah Lee, both lifetime Arkansas residents. “As an emergency physician who saw first-hand the deadly effects of the opioid crisis, I wanted to do something about it,” Nguyen said. “I researched medical cannabis and felt strongly that it could make a big difference in the lives of my patients and the lives of so many Arkansans who are suffering.” At the beginning of November, AR Cannabis Clinic had five clinics open out of 12 that are planned in order to have a clinic within an hour’s drive of anyone in the state. “Our company mission is to increase

Marijuana is a natural medicine that has been used historically for thousands of years in many different civilizations… David Nguyen, MD

access to medical marijuana to as many qualified patients as we can,” Nguyen said. “Currently we are taking appointments for Little Rock, North Little Rock, Texarkana, Bentonville and Hot Springs, and a location in Fayetteville will be opening soon. Additional clinics are planned Fort Smith, Clinton, Jonesboro, West Memphis, Pine Bluff and El Dorado. We have the largest

reach and look to keep the market leader status.” The AR Cannabis Clinic certifies qualified patients for a medical marijuana card. Nguyen said not everyone qualifies and they don’t certify everyone who walks in the door. “However, what makes our clinic stand out from the others is that we do not charge the patient any money if we cannot certify them for a marijuana card,” he said. “If the patient does not quality, they basically get a free doctor’s consultation. And we do explain to patients how they might qualify in the future.” Currently the most common qualifying conditions they are seeing are chronic pain, arthritis, muscle cramps, spasms, PTSD and nausea. While some Arkansas health authorities question the efficacy of marijuana, Nguyen said to stay tuned because the medical research is catching up with the results they are seeing on the ground. “Our patients tell us they are getting great results and many come to us already knowing the medicine works better than

their other medications,” Nguyen said. “Eventually, the federal government will reclassify medical marijuana and, when they do, then federal research dollars can start to be spent on marijuana so the proof of its effectiveness will eventually come.” Nguyen said patients tell them medical marijuana is giving them great relief without the side effects of prescription medicines. Some report it helped them get off opioids for pain. And many people like that it is a natural product. “Marijuana is a natural medicine that has been used historically for thousands of years in many different civilizations,” Nguyen said. “It is not made in a lab and it has a long track record.” Nguyen said they recommend medical marijuana be ingested instead of smoked. “That delivery method results in a more sustained release of the medication and there is no risk of any lung issues that can potentially happen when you inhale or vape a medicine,” Nguyen said. “The strains that are currently available are varied. There are different growers growing the medicine and each dispensary carries (CONTINUED ON PAGE 8)

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Healthcare Trends: Compensation Still Rising Execs, Physicians Among Those Seeing Increases By CINDY SANDERS

It’s a simple case of supply and demand. An aging population, sicker patients, move to new models of care and emphasis on technologies to increase efficiency have driven up the demand for skilled clinicians, administrators and industry executives. A shortage of providers across multiple disciplines and a tight labor market have made finding and retaining knowledgeable staff a priority … and that comes at a price.

The Marketplace

“In general, there’s been greater compensation delivered over the last one to two years as the economy has improved,” said Bill Hopkins, senior manager with Global Reward Services for KPMG, LLP. Over the past few years, he said salary increase budgets have inched up from the 2.5 percent to 2.7 percent range. “Those increase budgets are Bill Hopkins now creeping back up to the 3 percent level,” he added. “And general increases for higher earners and performers tend to be above that 3 percent level.” Hopkins continued, “Turnover is very costly to organizations, especially in healthcare.” Employers have to factor in both the cost to recruit and train a new hire and lost productivity during the time it takes to get that new physician or manager up to speed. “Bringing in physicians is particularly costly because it takes time to build up a practice. A new physician isn’t going to produce at the same level as the one that left,” noted Hopkins. “Highly productive, high performance physicians are in high demand. Organizations, when looking at compensating them and making increases, want to make sure they retain them,” he said of the demand for competitive salaries and benefits. Hopkins added the same sentiment applies to any employee with institutional knowledge, with the stakes rising as you move up the organizational chart.

Physician Compensation Trends

At the end of May, the Medical Group Management Association (MGMA) released its 30th annual Provider Compensation and Production Report, a comprehensive view of compensation across the country with data from more than 147,000 physicians and non-physician providers (NPPs). Pointing to the latest data, Andrew Hajde, CMPE, assistant director of Association Content for MGMA, noted primary care physicians saw a 3.40 percent increase 6

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in median total compensation from 2017 to 2018. Specialists saw a 4.41 percent increase on average, and NPPs realized an increase of 2.95 percent. The Midwest and South reported the largest compen- Andrew Hajde, CMPE sation for physicians last year. The report also showed the largest increases in total compensation for established providers were for the medical specialties of diagnostic radiology, general obstetrics and gynecology, neurological surgery, noninvasive cardiology and neurology. Hajde said providers have seen around a 7 to 11 percent increases in total compensation over the last five years. In comparison, inflation rates have been right around or below 2 percent since 2012. “They (providers) are continuing to be better off year0ver-year,” he noted. However, he said it might not always seem that way from the physician’s perspective. “What it doesn’t take into account is the amount of effort they have to put in to achieve that salary,” Hajde explained. “Is it worth it to get that extra few percent if it takes 25 percent more effort?” Cristy Good, MPH, MBA, CPC, CMPE, senior industry advisor with MGMA, said compensation is being driven by competition and those numbers extend beyond physicians. Other providers also are being actively recruited with good wages and benefits to fill gaps in care. “We’ve seen Cristy Good an increase in NPPs,” said Good. She said there is both a greater need for advanced practice providers in the wake of physician shortages and more capacity for individuals to become physician extenders with expanded programming at colleges and universities. “It allows a physician to be effective in a different way,” she added of the increased need for these clinicians. Both Hajde and Good said they expect to see continued high demand and tight supply of physicians and other providers in the near term.

Ownership vs. Employment

Citing a 2019 American Medical Association report, Hajde noted the national organization’s Physician Practice Benchmark Surveys found that fewer physicians are now owners than employees. The AMA Policy Research Perspec-

tive by Carol Kane, PhD, stated, “2016 was the first year in which less than half of practicing physicians (47.1 percent) had an ownership stake in their practice. With this report a new milestone has been reached — 2018 marked the first year in which there were fewer physician owners (45.9 percent) than employees (47.4 percent).” The report also found the distribution of physicians continues to slowly shift from very small practices to much larger ones. The reasons for the changes, which have been part of a longer trend, are multifactorial. Good said there is certainly a “hassle factor” when it comes to addressing myriad regulatory requirements as an owner, but she also sees the move as a generational shift. “There’s probably more of a security factor in going to an employed model rather than starting your own practice,” she pointed out. “To start a private practice and to build your patient base when you’re up against all these big organizations, it’s challenging.” She also noted supply and demand play a big role in employed physician recruitment. Quite simply, she said if a hospital or health system has a need for a particular specialty, “then you may see them reaching out to private practices to entice those physicians into employment.” Finding a work/life balance is another consideration between being employed and owning a practice. Hajde noted physicians have to consider whether they are willing to see patients 40-50 hours a week and then spend another 30 hours a week being a business owner.

The Impact of Tax Reform

Could tax reform turn the tide on the trend towards employment over ownership? Do new tax rules benefit private practices? The trio agreed it’s too early to determine the answer to the first question. However, Hopkins noted, “The spirit of Section 199A and the way it’s designed should give solo practices and smaller groups, especially those in the rural areas, more incentive to stay independent.” Hajde agreed, “If they have more money than ever before in their pockets, they aren’t going to be as prone to seek out a different situation.” As for the overall employed physician trend, Hajde continued, “I expect, at the very least, it may slow down. Will it reverse? I don’t think we have the data to know that, yet.” He added monetary considerations are only one part of the equation in any decision to leave an ownership position for an employment model. As for whether tax reform benefits private practices, the answer is quite possibly. Hopkins said considering median incomes for many physicians, the Section 199A deduction for pass-through organizations could be beneficial to practice owners. “As

long as their taxable income as an individual is below $157,500, they get the full benefit of the 20 percent deduction. From $157,500-$207,500, they get part of the deduction; and over $207,500, you’re out of the deduction,” he explained. However, Hopkins continued, those numbers double for married providers. Anything below $315,000 of taxable income (considering both partners) receives the full 20 percent deduction, with the deduction phasing out between $315,00-$415,000. Hopkins added the income threshold is based on taxable income so all other deductions should be considered first. He also said providers in private practice might want to weigh the benefits of taking time off to stay under the cap compared to making extra income. If the additional income pushes a provider past the deduction levels, it might be a win/win to earn a little less but realize a greater net income by keeping the deduction while achieving a better work/life balance. Tax implications also impact company decisions in structuring benefit packages. “Both tax exempt and for-profit healthcare companies are looking at bonus, retirement and tax deferred payment plans to make sure they are designed to be efficient given tax reform changes,” said Hopkins.

Burnout & Balance

While compensation is always important, Good and Hajde reiterated it isn’t the only consideration driving change. Burnout is very real for physicians and practice administrators. There is a growing sense of frustration over the ‘other things’ that get in the way of caring for patients. While administrative simplification has been a rallying cry for MGMA and provider organizations – and has even gained traction in D.C. – the promise has yet to become reality. When asked if there are any significant steps forward, Good noted, “We keep hoping, but I think from the physician’s perspective, they would say ‘no.’” While some physicians are all about the work 24/7, Hajde said some newer physicians are rethinking the model with a view toward achieving a better balance. “It’s very much a generational expectation in terms of what it means to be a physician,” he said. For those who want a distinct division between work and life, Hajde noted they tend to hover closer to the MGMA median of compensation. Those in the 75th percentile and up typically are working longer hours. “It can be done, but it’s a bit more difficult to have it all,” he said. On the flip side, it’s possible compensation evens out over time if those with somewhat shorter hours have longer careers by avoiding burnout. “It really depends on the individual philosophy of the physician,” Hajde added of the best path to take. arkansasmedicalnews

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AHA Panelists Discuss Strategies to Prevent C-Suite Burnout, continued from page 3 Thomas said their organization offers a voluntary Monday morning prayer time led by a local community church leader for their C-Suite. “Topics weighing heavy on our mind are prayed about during this meeting. I’m not sure how others on our team feel about this,” Thomas said. “However, I know my week goes much better when it starts with that meeting. We also offer a voluntary Bible study twice a month, during the lunch hour, led by a local church leader.”

Matt Troup, president and CEO of Conway Regional Health System, Conway

Troup said C-Suite burnout is common in all workplaces. “Healthcare, in particular, is a field that you are called into,” Troup said. “Our staff believe wholeheartedly in our mission to provide high-quality, compassionate healthcare, and we make a promise to be bold, exceptional, and called. With that calling comes the desire to perform at a high-level and be fully immersed in your work.” Troup said they believe that employee happiness and satisfaction stems from feeling fulfilled by your work and heard by your peers. “For this reason, we implemented quarterly town halls where we come together as a team to share current projects and celebrate accomplishments,” Troup said. “It is a wonderful time to share in the great work we are doing, as well as hear suggestions and thoughts on how we might improve. Conway Regional was named a Best Place to Work by Modern Healthcare in 2018 and 2019, as well as an Arkansas Best Place to Work in 2017, 2018, and 2019. Employee benefits such as employee counseling, work celebrations, maternity/paternity leave, and tuition reimbursement lead to a more fulfilled and satisfied staff.”

Vickie Henderson, MD, CMO, Saint Mary’s Regional Health System, Russellville

Henderson said it isn’t possible to talk about C-Suite burnout without talking about physician burnout. “Whatever affects physicians affects the entire healthcare team,” Henderson said. “Revolting against the entire system is unpractical, but neither is yoga going cure a malady that results in turnover, increased medical errors and decreased patient satisfaction. Nevertheless, we need to do something.” ARKANSASMEDICALNEWS

.COM

The root cause of burnout is multifactorial. Henderson said while the electronic health record (EHR) rises to the top of physician frustrations, it is only a piece of the greater problem. “In many ways, physicians have been stripped of their role as healer, and demoted to highly-educated clerical workers,” Henderson said. “It’s not why we went into medicine. Henderson said whether or not the EHR is the culprit, it isn’t going away. Physicians can master it or let it master them. Highly intelligent and pressed for time, they figure out a way to navigate the technology. “Often it isn’t the most efficient way, which fuels frustration in the moment,” Henderson said. “The most impactful solution we’ve found is ‘help stations’ for the EHR. Cards with a red help button logo are located at every work station. On a daily basis, the cards are collected and a solution is pursued. A stoplight report is regularly shared to let them know what aspects of the EHR they have been able to ‘fix’ with their suggestions. In addition, there is relentless follow-up to ensure they understand the resolution. Often there’s a bit of disconnect between the docs and IT and either the proposed solution is complicated, too tedious or too infrequently utilized to master.” What people need most is to be heard. For that reason, St. Mary’s tackled the ‘Second Victim’ syndrome for all front-line staff. Anytime there is an unexpected adverse outcome, healthcare workers involved are invited to attend a debriefing session. “Recognizing the toll these events take on the emotional health of our staff, counseling is provided,” Henderson said. “This primarily consists of talking through the stages of processing the event and validating their feelings. What usually happens next is a spontaneous outpouring of support for all the team members. One necessary component is a box of tissues.” There is no one prescription to treat burnout, but a good place to start is talking about it. “Affirm the existence and impact,” Henderson said. “Burnout is not going to be solved with any one action, but action is needed or we all lose.”

DEPARTMENT OF HEALTH AND HUMAN SERVICES PROPOSES STARK AND ANTIKICKBACK REFORMS FOCUSED ON VALUE-BASED AND COORDINATED CARE On October 9, 2019, The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued two highly anticipated proposed rules to reform the Physician Self-Referral Law (the “Stark Law”) and the Federal AntiKickback Statute (AKS) regulations. The proposed rules come after HHS announced its “Regulatory Sprint to Coordinated Care” initiative, signaling the Administration’s priority to modernize and clarify the fraud and abuse laws. HHS expects the proposals to ease the compliance burden for healthcare providers, while maintaining strong safeguards to protect patients and programs from fraud and abuse. Background The Stark Law generally prohibits physicians from making referrals for certain healthcare services payable by Medicare if the physician (or an immediate family member) has a financial relationship with the entity performing the service. The federal AKS provides criminal penalties for whoever knowingly and willfully offers, pays, solicits, or receives remuneration to induce or reward the referral of business reimbursable under a Federal health care program, including Medicare and Medicaid. Providers may seek to comply with statutory and regulatory exceptions and safe harbors so that they have assurance their business practices will not be subject to an enforcement action. The Civil Monetary Penalty (CMP) statute prohibits beneficiary inducements and provides for the imposition of CMPs against any person who offers or transfers remuneration to a Medicare or State healthcare program beneficiary that the person knows or should know is likely to influence the beneficiary’s selection of the particular provider, practitioner, or supplier of any item or service for which payment may be made, in whole or in part, by Medicare or a State healthcare program. CMS published Request for Information (RFI) on June 25, 2018, seeking stakeholder input to address regulatory barriers to a value-based healthcare payment and delivery system under the Stark Law. The OIG issued a RFI from stakeholders regarding the AKS and CMP beneficiary inducement rules in August 2018. CMS and the OIG considered stakeholder input from these RFIs in drafting the proposed rules.

The Authors:

Lynda M. Johnson, Partner

Proposed Changes to the Stark Law Stakeholders responding to CMS’s RFI stressed that providers are largely unwilling to enter into innovative arrangements that would improve focus on quality outcomes, as there is currently no clear exception or safe harbor for such activities, and penalties for violations of the Stark law are significant. The proposed modifications to Stark would create new exceptions for value-based arrangements. CMS has also proposed revised definitions for terms such as “fair market value” and “commercially reasonable” to offer more clarity in response to feedback from providers.

Timothy C. Ezell, Partner

Proposed Changes to the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements The AKS proposed rule would create the following new safe harbors for certain remuneration exchanged between or among eligible participants: 1. care coordination arrangements aimed at improving quality and outcomes; 2. value-based arrangements with substantial downside financial risk; and 3. value-based arrangements with full financial risk.

Amie K. Alexander, Associate

The OIG has also proposed a new safe harbor to the AKS for innovation models sponsored by CMS, which it says will reduce the need for separate fraud and abuse waivers in the future. The rule also proposes modifications to the existing and widely used safe harbor for personal services and management contracts, which should add flexibility for outcomes-based payments and part-time arrangements. The AKS proposal also includes the following: • a safe harbor for certain tools and supports furnished to patients to improve quality, outcomes and efficiency; • proposed modifications to the existing safe harbor for local transportation; and

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• proposed amendment to the definition of “remuneration” that incorporates a new exception for telehealth efforts furnished to in-home dialysis patients. CMS and the OIG have attempted to incentivize cyber-security efforts by proposing a new safe harbor and exception for donating cyber security technology and services, and removing the sunset date for the existing safe harbor and exception for electronic health records. Next Steps for the Proposed Rules The agencies are accepting comments to the proposed rules through December 31, 2019. After the comment period closes, the agencies will review comments and consider them in its formulation of its final rules. The final rules may differ in substance than the proposed rules, however, they must be a “logical outgrowth” of the issues and solutions discussed in the proposed rules. While it may still be some time before HHS is ready to implement changes to fraud and abuse laws, the issuance of the proposed rules certainly signals a step in the direction of increased clarity and assistance for provider compliance.

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Caring for the People, continued from page 1 cal and support staff,” Thomas said. “Treat team members right by creating an environment they are happy to work in. Hire competent people, and invest in them to do their job. Effective leaders cannot focus on their role if they are micromanaging everyone else.” Since taking the top job at Jefferson Regional, Thomas has focused on opportunities to rebuild a culture that people are proud of. “The first thing we did was start from the ground up by focusing on treating everyone with respect,” Thomas said. “Then, we began hiring people who embraced that philosophy and style.” The entire workforce has undergone training on enhancing the patient care experience, and employee engagement has gone from the single digit percentile three years ago to the 75th percentile in the most recent survey. “That is phenomenal,” Thomas said. “I give a lot of credit to the management team. As word has gotten around that this is a great place to work, recruiting has become easier. People in other parts of Arkansas are hearing good things about our organization. That makes our job easier when people learn this is a place that is successful and that they want to be part of it.” To make sure the momentum continues, Jefferson Regional holds off-site retreats several times a year that engage managers and directors to focus on improving the way they do business. Thomas said that has been successful because leaders feel they have a direct role to play in providing the absolute best environment for patient care. “You would be surprised at what you learn at sessions like that,” Thomas said. “The culture has really changed so people aren’t afraid to speak up. And showing that management cares about what is going on creates a different environment.” Thomas said Jefferson Regional’s greatest asset is the quality of their staff. “They find every way under the sun to take care of patients,” Thomas said. “We do an exceptional job of that and it has only gotten better the past several years. We continue to find success no matter what the challenges are.” Currently they are focused on partnerships to provide the kinds of specialty services that will keep patients in Southeast Arkansas rather than traveling to Little Rock. Arkansas Urology and Arkansas Children’s Hospital are the most recent additions to Jefferson Regional’s list of healthcare partners. “We recently lost two outstanding urologists and were able to secure a new urologist through a collaborative effort with Arkansas Urology,” Thomas said. “With Arkansas Children’s, we are focusing on how to bring the next generation of pediatricians to our region. I’ve been impressed with how the team at Arkansas Children’s has stepped forward to build and maintain the pediatrics platform in our community for years to come. I can’t think of a better partner than Arkansas Children’s. The focus is not to be all things to everybody, but figure out how we can partner with the right groups and organizations in a way that 8

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makes good business sense. This is really where healthcare is going.” Another new effort is a plan to provide oncology services in the hospital by 2020. Furthermore, the hospital has been working on a $180-million modernization project that is anticipated to begin in 2020. “The goal is to develop the next generation of facilities needed to take care of patients in this market,” Thomas said. “Healthcare is very competitive these days. Driving to Little Rock to get services is not unusual, so we have to be more aggressive to make sure patients come our way.” As proof of that, over the last decade, Jefferson Regional has expanded its physician practice network responsibilities from just seven specialties with 17 providers to 19 specialties with 70 providers. Another major challenge in the Delta is a shrinking population base. “The population of our region is becoming smaller,” he said. “But we remain committed to providing excellent healthcare to not only Pine Bluff, but all of Southeast Arkansas. There are a number of critical access hospitals near us that rely on us to care for patients who need that next level of service.” Jefferson Regional is not the only organization in Pine Bluff preparing for growth. There are major efforts underway to promote economic development in the local community, including the Go Forward Pine Bluff Initiative, where Thomas serves on the board of directors. “It is exciting to see good things happening in Pine Bluff,” Thomas said. “These efforts are being supported by companies and taxpayers. Everyone in the community is committed to success.” Pine Bluff now has a casino, which is expected to help the area’s economy. Furthermore, Arkansas Children’s Hospital is spending $4 million on construction of medical offices. “These actions are a strong signal of what constituents think about Pine Bluff,” Thomas said. “It is exciting to watch.” Thomas was born in Shreveport, La., and moved to Texas at age seven. He graduated from Louisiana Tech with a degree in health information management\medical records administration and then earned master’s degrees in Health Administration and Business Administration from the University of Birmingham in Alabama. He first joined Jefferson Regional Medical Center in 1998, serving as administrative director of operations and physician practices. He then took a position as CEO at Howard Memorial Hospital in Nashville, followed by chief operating officer roles for Tenet Healthcare in Indio, Calif., and Community Health Systems in Huntsville, Ala. In 2010, he returned to Jefferson Regional as senior vice president/COO. Thomas began serving as interim CEO in March of 2016 and was named permanent president & CEO in February of 2017. Thomas and his wife, Angela, have two daughters. Kaleigh attends Ouachita Baptist University, and Laura Kate is a ninth grader. In addition to enjoying watching his daughter play in volleyball tournaments, Thomas loves to hunt, fish, and play golf.

GrandRounds Kumar Joins Mercy Clinic Cardiology in Fort Smith FORT SMITH – A passion for medicine runs deep in Dr. Aswini Kumar’s family. As a cardiologist, she involves patients in every step of their medical journey and encourages them to make lifestyle changes to improve their health. Dr. Aswini Dr. Kumar is origiKumar nally from Chennai, India. She received her medical degree at Chengalpattu Medical College in India. She completed a residency in internal medicine at State University of New York Upstate Medical University in Syracuse. She was also fellowship trained in cardiovascular disease at the University of Connecticut’s Hartford Hospital. Outside of work, Dr. Kumar enjoys traveling and painting. Her husband is an oncologist who will join Mercy in Fort Smith next summer.

CHI St. Vincent Welcomes Geriatrician Dr. Meaghan Masini HOT SPRINGS VILLAGE - Dr. Meaghan Masini has joined CHI St. Vincent Primary Care Clinic, located at the West Gate in Hot Springs Village. Dr. Masini specializes in geriatric medicine and help ensure residents of the Village continue to Dr. Meaghan have access to the very Masini best in care right in the community where they live. She is now seeing patients at the clinic located at 4417 Highway 7 North. Dr. Masini most recently served as a physician specialist at Kings County Hospital Center in Brooklyn, New York, caring for adult and elderly patients. She was also a faculty teacher and lecturer at SUNY Downstate Medical Center in Brooklyn. Dr. Masini attended medical school

AR, continued from page 5

a wide assortment of products. Typically, if you do not want to experience a ‘high,’ you would opt for a strain with a lower percentage of THC. However, the combination of the THC and CBD together usually is more effective than one component alone because they work in synergy in the body.” Nguyen’s advice for physicians who are reluctant to certify a patient for medical marijuana is that the AR Cannabis Clinic is happy to help. “We will take care of your patients,” he said. “Medical marijuana is here and it is not going away. Please refer interested patients to the AR Cannabis Clinic since we are the only specialized medical marijuana clinic in the state that is fully registered with the Arkansas State Medical Board.”

at St. George’s University School of Medicine in Grenada, West Indies, where she also obtained her master’s of public health. She completed her residency training in internal medicine and fellowship training in geriatric medicine at SUNY Downstate Medical Center. Dr. Masini has board certifications in geriatrics and internal medicine.

New Orthopedic Surgeon Joins Mercy in Fort Smith FORT SMITH – After spending four years as a physical therapist, Dr. Bryan Smith went back to school so he could offer surgical solutions for patients. Dr. Smith received his bachelor’s degree in kinesiology from the University of Illinois at Dr. Bryan Smith Urbana-Champaign and his doctorate in physical therapy from Washington University in St. Louis. He completed his medical school training at the University of Oklahoma College of Medicine in Oklahoma City and his orthopedic surgery residency at Loyola University Medical Center in Maywood, Illinois. He recently completed an orthopedic surgery sports medicine fellowship at the University of California, Los Angeles. During his fellowship, he served as one of the team physicians for several UCLA sports teams and was an assistant team physician for the Los Angeles Lakers. In his free time, Dr. Smith enjoys traveling, watching movies, attending sporting events and spending time outside with his wife and son.

Medical Center of South Arkansas Welcomes Althea T. Conley, MD, PhD EL DORADO - Althea T. Conley, MD, PhD, has joined the Medical Center of South Arkansas Medical Withdrawal Management Program as Medical Director. Dr. Conley has been practicing Psychiatry in South Arkansas for over 15 years. She Althea T. graduated from mediConley, MD, PhD cal school at the University of Arkansas for Medical Sciences in Little Rock, Arkansas. She earned her PhD in clinical psychology with an emphasis in the diagnosis and treatment of heath related and psychosomatic conditions from University of Arkansas in Fayetteville, AR. She is a member of the American Academy of Child and Adolescent Psychiatry and is certified by the American Board of Psychiatry and Neurology, Adult, Child and Adolescent Psychiatry. The MCSA Medical Withdrawal Management Program is a 3-5 day medical stabilization for individuals that are seeking help recovering from substance abuse. arkansasmedicalnews

.com


GrandRounds Mercy Welcomes New Pediatric Psychiatrist to Fort Smith FORT SMITH – Dr. Bryant Virden is Arkansas born, raised and trained – and proud of it. Just a short 100mile drive from where he grew up, Virden is happy to call Fort Smith his new home and looks forward to addressing the mental and behavioral health Bryant Virden, MD needs of children and adolescents in the community. When Dr. Virden enrolled in medical school, he knew he wanted to care for children. It was his time working on the Child Diagnostic Unit at the University of Arkansas for Medical Sciences’ Psychiatric Research Institute in Little Rock that sparked his interest in child psychiatry. He received his bachelor’s degree in biology from the University of Arkansas in Little Rock. He earned his medical degree and completed his residency in general psychiatry and fellowship in child and adolescent psychiatry at the University of Arkansas for Medical Sciences. Outside of work, Dr. Virden enjoys playing golf, cooking and traveling with his wife, Rebecka.

Medical Center of South Arkansas Welcomes Brad Lindsey, MD El Dorado - Brad Lindsey, MD has joined Medical Center of South Arkansas Wound Care and Hyperbaric Center as Medical Director. Dr. Lindsey will lead a team of wound care specialists at the Center, which offers an evidence-based, systematic approach to advanced wound Brad Lindsey, care. Treatment plans MD are developed and scheduled based on each individual patient’s needs. A patient’s personalized treatment plan may include specialized wound dressings, debridement, compression therapy, hyperbaric oxygen therapy, advanced cellular products and topical growth factors, edema management and/or non-invasive vascular assessments. Once treatment is complete, the patient will return to their primary physician to continue routine care. Dr. Lindsey is originally from Camden, AR and received his medical degree from the University of Arkansas for Medical Sciences in Little Rock, Arkansas. He interned at the University of Arkansas AHEC Program in Pine Bluff, Arkansas. His Anesthesiology residency was at the Mayo Clinic in Rochester, Minnesota. He is Board Certified in Anesthesiology by the American Board of Anesthesiology and Board Certified in Chronic Pain Management by arkansasmedicalnews

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the American Board of Pain Medicine. Dr. Lindsey is Fellow of the American Academy of Anti-Aging Medicine. In joining the Medical Center of South Arkansas, as a member of the Healogics network, Dr. Lindsey collaborates with a network of academic medical centers, hospitals and thousands of professionals committed to advancing wound healing by creating, sharing, and activating wound prevention and care expertise.

UAMS Baptist Health Orthopaedic Clinic-Conway Welcomes Dr. Sean Morell CONWAY – Sean Morell, MD, recently joined UAMS Baptist Health Orthopaedic Clinic-Conway, providing care for a wide range of problems with the hand, wrist and forearm. Dr. Morell, a native of Russellville, received his medical education Sean Morell, MD from the University of Arkansas for Medical Sciences, where he also completed his residency in orthopedics. The physician’s training also includes a fellowship at the University of Colorado-Denver. UAMS and Baptist Health-Conway have teamed up to provide complete orthopedic services, giving patients at UAMS Baptist Health Orthopaedic Clinic-Conway the expertise of the state’s largest fellowship-trained orthopedic team combined with the state’s largest, most comprehensive health care network. For more information about the services that UAMS Baptist Health Orthopaedic Clinic-Conway, 625 United Drive, Suite 350, offers, visit baptisthealth.com

NARMC Successfully Completes CDC Training Initiative to Support Optimal Infant Nutrition HARRISON - North Arkansas Regional Medical Center (NARMC) is among the first hospitals in the nation to successfully complete the EMPower Training initiative, a skills-based competency training to advance knowledge and skills in evidence-based maternity practices supportive of optimal infant nutrition. Funded by the Centers for Disease Control and Prevention (CDC), the EMPower Training initiative is committed to safe implementation of maternity care practices to support optimal infant nutrition, including breastfeeding, toward the ultimate goal of improving the public’s health. This initiative will allow NARMC staff to develop, implement and monitor an individualized training plan of their own. This way, every team member, present and future, will be trained consistently. As part of this effort, NARMC committed to training staff in accordance with the World Health Organization (WHO) and UNICEF Baby-Friendly Hospital Initiative (BFHI) guidance outlined in the Ten Steps to Successful Breastfeeding. With the help of the EMPower Training initiative, NARMC is now equipped with skills needed to help support mothers in the safe implementation of optimal infant nutrition. The EMPower team consists of a partnership of three organizations, including Abt Associates, Carolina Global Breastfeeding Institute and Population Health Improvement Partners.

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GrandRounds CARTI Opens Cancer Center in Russellville RUSSELLVILLE - CARTI has relocated and expanded to create a comprehensive cancer center in Russellville, with Dr. Thomas Sneed continuing to lead the way. A Grand Opening was held in October for the new location at 209 S. Portland Avenue. CARTI will be providing world-class cancer treatment, enhanced comfort and convenience with: • Comprehensive services, including medical oncology, CT, a full lab and imaging, all on-site • Infusion suite with 20 heated chairs and family member seating • Private infusion room • Leading-edge imaging with a Philips Ingenuity CT scanner • Convenient parking for easy access

Dr. John Sims Joins Head and Neck Surgical Department at CARTI Cancer Center LITTLE ROCK - CARTI Cancer Center has added John Sims, Jr., M.D., head and neck oncologic and microvascular reconstructive surgeon, to its staff. He comes to CARTI from Mount Sinai - Beth Israel in New York City, New York, where he completed a fellowship in head and neck oncologic and microvascular reconstructive surgery. He is now accepting

new patients at CARTI Cancer Center, 8901 CARTI Way, Little Rock. As a fellowshiptrained head and neck surgeon specializing in transoral robotic surgery and microvascular John Sims, Jr., MD reconstructive surgery, Dr. Sims will bring new practices to the head and neck surgical oncology department says Adam Head, president and chief executive officer of the statewide network of cancer care providers. Dr. Sims has served as a member of the American Head and Neck Society and the American Academy of Otolaryngology - Head and Neck Surgery. Scott Stern, M.D., head and neck surgeon at CARTI said Sims brings an extraordinary training experience and the expertise to perform both robotic and complex microvascular reconstructive surgery for head and neck cancer patients. Dr. Sims completed his residency in otolaryngology - head and neck surgery at The Mayo Clinic in Rochester, Minnesota, followed by a fellowship in head and neck oncologic and microvascular reconstructive surgery at Mount Sinai Beth Israel in New York City, New York. He earned his medical degree from the University of Arkansas for Medical Sci-

Arkansas Spine & Pain Performs World Class Procedure on First International Patient LITTLE ROCK - Dr. Julio Olaya, of Arkansas Spine and Pain performed a world class procedure on the first international patient in October at the Central Arkansas Surgery Center making it the first surgery center to implement this procedure in Arkansas. The patient, Ms. Yasuko Marumoto, is an 80 year old female, from Mexico City. She suffered from spinal stenosis from a young adult age. The procedure lasted less than 45 minutes. The patient and her family stayed the weekend in Little Rock and then traveled back to their home in Mexico. The procedure is called the Superion and was developed by Vertiflex, a privately held medical device company headquartered in Carlsbad, California. It is a new revolutionizing treatment of lumbar stenosis providing patients with a minimally invasive approach that puts their comfort and safety first, offering the only treatment on the continuum of care between conservative care and surgery. Superion is implanted through a small tube the size of a dime to reduce tissue damage and blood loss. Mrs. Teramoto, Dr. Julio Olaya, Ms. Yasuko It’s a simple outpatient procedure with Marumoto (patient) and Mr. John Rodriquez, a rapid recovery time and no destabiVertiflex Representative. lization of the spine. The implant acts as an indirect decompression device. Its anatomic design provides optimal fit and preserves a patient’s anatomy and ability to maintain motion. It acts as an extension blocker, relieving pressure on the affected nerves in the manner that one would achieve relief in a seated or flexed position. Available in multiple sizes to accommodate varying patient anatomy, Superion ensures controlled movement and minimizes post-procedure complications. Superion was developed to provide patients with a safe and effective alternative when conservative treatment has failed and laminectomy is too aggressive.

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ences, where, as the highest ranking student in his class, received the Barton Foundation Scholarship. This scholarship is awarded to students who completed the prior year of medical school with a 4.0 GPA. He received his Bachelor of Science in Biological Sciences from Ouachita Baptist University in Arkadelphia, Arkansas.

UAMS Launches Statewide Health System LITTLE ROCK — The University of Arkansas for Medical Sciences (UAMS) is organizing all of its clinical enterprises in Little Rock and around the state under the UAMS Health umbrella. Chancellor Cam Patterson, M.D., MBA said UAMS is more than a hospital, it is more than a university and it is more than cutting-edge research. UAMS Health includes the UAMS Medical Center, Neighborhood Clinics, orthopaedic clinics, women’s clinics, the Family Medical Centers at UAMS regional sites, digital health clinics and the affiliated clinics that UAMS operates in conjunction with other health care providers. As a state-supported health sciences university offering unique specialty care and programs, UAMS serves residents in every county of Arkansas. What started with one campus in Little Rock in 1879 has evolved into a multi-campus clinical delivery system that includes eight regional campuses strategically placed across the state with plans to add more, Patterson said. Patterson also said UAMS is increasing its focus on digital health. Programs pioneered by the Institute for Digital Health & Innovation are erasing miles, allowing for physician-to-physician consults and for patients to communicate with physicians without leaving home.

Hematology/Oncology Physician Joins Multispecialty Clinic CONWAY - Rachana Yendala, MD, has joined the team at Conway Regional Health System. Yendala will be practicing alongside Alok Surana, MD, Pulmonologist, at the Conway Regional Multispecialty Clinic. Yendala received her internal medicine residency training at Rachana the University of ToYendala, MD ledo. She then went on to complete her Hematology/Oncology Fellowship at Texas Tech University in Lubbock, TX and served as the Chief fellow for the past year. Yendala began practicing on August 19. Hematology/Oncology Physicians see and treat a wide variety of

blood diseases and cancer. The multispecialty clinic is located at 525 Western Ave. Suite 305, and now provides hematology, oncology and pulmonology services.

Sia Vue, APRN Joins Washington Regional Urgent Care FAYETTEVILLE - Sia Vue, APRN, recently joined Washington Regional Urgent Care where she provides nonemergency care for all ages in Johnson and Fayetteville. Vue earned a Master of Science in nursing from University of South Alabama and earned both a Bachelor of Science Sia Vue, APRN in human development from the University of Wisconsin and a Bachelor of Science in nursing from Belin College of Nursing. She is a certified Family & Adult-Gerontology.

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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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GrandRounds Dr. Paul Daidone Joins Eureka Springs Family Clinic EUREKA SPRINGS — Paul Daidone, MD, recently joined the Washington Regional Eureka Springs Family Clinic. Dr. Daidone joins Dr. Stacey Burnett, Dr. John House, Dr. Gregory Kresse, Dr. Jon Loudermilk, Shaela Collier, APRN, Jennifer Paul Daidone, Henderson, APRN and MD Jennie Spears, APRN to provide comprehensive medical care for all ages. Dr. Daidone earned his medical degree at St. George’s University School of Medicine in St. George, Grenada and completed residency in internal medicine at the University of Medicine and Dentistry of New Jersey. He is board certified by the American Board of Internal Medicine.

Nephrologist Mohammed Alhajji Joins St. Bernards JONESBORO - Nephrologist Mohammed Alhajji, MD, has joined the medical team at St. Bernards. Dr. Alhajji graduated from Dow Medical School - Karachi University in 2001. He practiced medicine in his hometown in Saudi Arabia at King Fahad hospital for the next seven years before furthering his training in internal medicine at Franklin Square Medi-

cal Center, University of Maryland, from 2010-2013. He served as a hospitalist at St. Bernards Medical Center for the next four years, where he covered general medicine floor and ICU. He then pursued a nephrology fellowship at University of Minnesota, focusing on renal disease and hypertension. He has joined St. Bernards Clopton Clinic as a nephrologist. Dr. Alhajji is married to Fatima and has three children. He is currently accepting new patients at St. Bernards Clopton Clinic, located at 300 Carson Street.

Arkansas Children’s and Jefferson Regional Make Historic Announcement PINE BLUFF – Arkansas Children’s in association with Jefferson Regional made an historic announcement to advance pediatric care in Jefferson County and South Arkansas. Together, Arkansas Children’s and Jefferson Regional will establish a new pediatric clinic on the campus of Jefferson Regional in Pine Bluff. The pediatric clinic will provide care close to home for families in Southeast Arkansas, including preventive care, developmental screenings, community resources and health education. Early planning estimates that the Arkansas Children’s Hospital Pine Bluff Clinic will be an approximately 9,700 square-foot facility with 15 outpatient

exam rooms staffed by pediatric providers. The physicians will also provide frontline care to newborns delivered at Jefferson Regional. The new clinic requires a $17.5 million dollar investment to cover the construction and operation over its first 5 years. Arkansas Children’s has announced the public phase of the Campaign for a Healthier Tomorrow, a bold $250 million campaign designed to support the promise of unprecedented child health, defined and delivered, for children in Arkansas. The expansion of services through the Arkansas Children’s Hospital Pine Bluff Clinic is the first announcement in a week-long series to publicly launch the Campaign for a Healthier Tomorrow. Philanthropic Investment Thanks to the support of the Pine Bluff community and donors across the region, more than $6 million in philanthropic investment has been secured for the Arkansas Children’s Hospital Pine Bluff Clinic. Capital and operational gifts include a $3 million gift from the estate of Merle and Deloris Peterson of Dumas. The Peterson Trust named Arkansas Children’s as a beneficiary of the estate, providing support for the Arkansas Children’s Hospital Pine Bluff Clinic. Merle and Deloris were longtime supporters of Arkansas Children’s and members of the Ruth Olive Beall Society, a group of

supporters who have designated Arkansas Children’s in their estate. Additionally, an anonymous donor from outside the state gave a $1 million gift to support the Arkansas Children’s Hospital Pine Bluff Clinic. More than a dozen statewide supporters have collectively given more than $2 million including statewide volunteer group Circle of Friends, the Kline Family Foundation, and Arkansas Children’s Foundation board members and Pine Bluff natives Jason LaFrance and his wife Cassie, Charlie Whiteside and his wife Cappy, and Jennifer Buckner Schueck. Charlie Whiteside and his wife Cappy will also serve as the 2019 chairs for the Campaign for a Healthier Tomorrow. Arkansas Children’s invites the public to make a gift to support statewide initiatives that help deliver on the promise of a healthier tomorrow for the children of Arkansas. Visit giving.archildrens.org

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824 E. Matthews | 1.04 acres

1000 e. matthews | 20,000 sqft. multi-suite complex

St. Bernards Medical Center The medical mile

Jonesboro, AR

870.972.9191 | HalseyThrasherHarpole.com

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Here’s to 30 years. As a mutual malpractice insurance company, we share a common interest with our policyholders in lowering their risk and protecting their practices. We are proud to say that for the last 30 years, we have helped the physicians and other medical professionals in Arkansas to do just that.

Providing protection and support for Arkansas is our natural state.

svmic.com | 870.540.9161

Profile for Medical News

Arkansas Medical News November-December 2019  

primary source for professional healthcare news

Arkansas Medical News November-December 2019  

primary source for professional healthcare news