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FOCUS TOPICS PEDIATRICS/AUTISM SPECTRUM DISORDER • COMPLIANCE • PRECISION MEDICINE

September/October December 2018 2009 >> $5 ON ROUNDS UAMS Medical Center Serves as Referral Center for Low Birth Weight Infants Arkansas has a very high population of premature infants, defined as being born at less than 37 weeks. Many of those are very low birth weight infants, or babies weighing less than 1,500 grams or three pounds and six ounces. The University of Arkansas for Medical Sciences (UAMS) Medical Center takes referrals for high risk deliveries from around the state ... 3

Compliance Programs: Are They Really Voluntary? Is having a compliance program really a “voluntary” matter for providers? There has been much written regarding the “voluntary” nature of instituting and maintaining an “effective compliance program” for healthcare providers. Much of this literature supports the concept of compliance being interwoven into the culture of an organization.  Whether Compliance Programs are truly voluntary is debatable ... 5

Questionnaire for Autism Spectrum Disorder Patients Helps Improve Care and Safety Hospital team gains insight to make stay positive and effective By BECKY GILLETTE

At Arkansas Children’s Hospital (ACH), a screening for patients who have autism spectrum disorder (ASD) or an intellectual disorder helps the hospital do a better job serving these children, which results in the hospital stay being a less stressful experience for the children. “The screening is a communication tool we use to enhance the patient experience,” said Child Life Specialist Rachel Stewart, CCLS, one of the child life specialists who administers the survey on the ACH campus. “We ask questions to help us take better care of the child. Based on those responses, we can do a more thorough assessment to find ways to enhance the hospital experience since being in the hospital can be a stressful experience.” Stewart said their goal is to make a child’s hospital stay as comfortable as possible. They do that by recognizing that the child has special needs and that the parents know their children best. “So, we ask a set of questions in order for parents to give us insight into how we can (CONTINUED ON PAGE 11)

HealthcareLeader

Aimee Olinghouse, of Arkansas AAP

Group advocates for children’s health By BECKY GILLETTE

The Arkansas Chapter of the Academy of Pediatrics (AAP) has about 250 chapter members who work in concert with the 67,000-member national AAP to advocate for the health and well-being of children across the country, as well as for the practice of pediatrics in the country. “We are structured similarly to other professional organizations in that we have a national office and then each state has a chapter,” said Aimee Olinghouse, executive director, Arkansas Chapter, AAP. “So, while we work very closely with the national office, we are our own corporation.” (CONTINUED ON PAGE 9)

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PhysicianSpotlight

UAMS Medical Center Serves as Referral Center for Low Birth Weight Infants Preemie outcomes are best at hospitals with special neonatal intensive care units By BECKY GILLETTE

Arkansas has a very high population of premature infants, defined as being born at less than 37 weeks. Many of those are very low birth weight infants, or babies weighing less than 1,500 grams or three pounds and six ounces. The University of Arkansas for Medical Sciences (UAMS) Medical Center takes referrals for high risk deliveries from around the state. Each year of the approximately 3,000 babies born at UAMS, nearly 1,000 are admitted to the Special Care, Intensive Care, or Critical Care Nursery. The problem isn’t unique to Arkansas. Nearly one in ten babies in the U.S. is born prematurely. The U.S. has one of the highest infant mortality rates (death in the first year of life) of any of the industrialized countries. More than one third of these deaths are related to prematurity. Neonatologist Whit Hall, MD, said UAMS is working with the March of Dimes to find the causes for prematurity, both in Arkansas and across the U.S. “Teen pregnancy is a factor,” Hall said. “And mothers over the age of 35 have a higher risk for pre-term deliveries. Race also plays a role. African Americans have a much higher rate of pre-term pregnancies than white or Hispanic mothers. We don’t really know the reason for that. There are some studies that show genetics play a role, as well as stress.” Studies have also shown preterm babies who are delivered in a hospital that has special perinatal services such as UAMS, do much better than if delivered in hospitals without such services. UAMS has a large referral practice because it has a perinatal unit staffed around-the-clock with neonatologists, as well maternal fetal medicine doctors who specialize in highrisk pregnancies. Hall attributes the high success rate in part to volume. “Volume plays a big role in many things like surgical outcomes and complex medical problems,” Hall said. “Studies have shown that if the volume is high, a patient will do better. We take care of the very low weight deliveries every other day. A hospital that does it once a month will not be as adept at caring for these preterm neonates. That is true all over the country. That doesn’t mean they aren’t good hospitals. But everyone around the country, including Arkansas, is trying to deliver premature babies where they can be best cared for.” Hall said Baptist Health Medical Center in Little Rock has a unit similar to UAMS and also cares for a large number of small babies. Many other hospitals in Arkansas such as St Bernard’s in Jonesboro arkansasmedicalnews

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also care for small babies – not babies as small as at UAMS and Baptist, but down to two pounds. “They do a good job,” Hall said. Arkansas now has regionalization of neonatal intensive care. Hospitals with appropriate levels of care are listed on the Arkansas Department of Health website. “The biggest thing I’ve seen in my career as far as improving the outcomes for

low birth weight babies is the regionalization of neonatal intensive care,” Hall said. “That was an effort helped not only by UAMS, but also Baptist Medical Center, the Arkansas Department of Health, the March of Dimes, Arkansas Medicaid, the Arkansas Hospital Association and parents. All these organizations did the right thing. Additionally, telemedicine, which was funded by a grant from the National

Institutes of Health through the Center for Translational Neuroscience, helped bring about this change. This initiative lowered infant mortality from 8.5 to 7 per 1,000 live births. “Regionalization of healthcare in Arkansas has saved about 60 babies a year who otherwise wouldn’t have survived,” Hall said. “In our state, regionalization is voluntary, but the hospitals and physicians have bought into this because the data show regionalization of care saves babies lives. It is all voluntary and it’s working. That is a real tribute to the physicians and hospitals in Arkansas.” Hall, who has been a neonatologist since 1993, said the biggest technology advance he has seen during his career has been the development and broad use of surfactant. That came into general use in 2000, and has saved a number of babies lives. “Surfactant is a chemical that treats premature babies’ lungs, which is probably the main reason babies require intensive care,” Hall said. “This was spearheaded by the NIH, and was spurred on by the loss of one of the Kennedy babies in the 1960s.” Hall has had a bit of an unusual career path. He had 13 years of general pediatric

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

At NYIT College of Osteopathic Medicine (NYITCOM) at Arkansas State University, we are educating the physicians of tomorrow today. NYITCOM at Arkansas State University is committed to addressing

the primary care physician workforce shortage in Arkansas and the Our medical school not only produces excellent physicians, but also cultivates “servant leaders” who Delta region. By 2030, NYITCOM at A-State will produce more than recognize that healthy choices and wellness are vital components needed for the success of the people 1,000 physicians to serve this state, region, and beyond. and communities to which they belong. Outside the classroom, NYITCOM at A-State students are in activities that provide mentorship, opportunity, and encouragement to the youth of our state Are youinvolved interested in learning more? the goal of creating more educated, engaged, and responsible citizens for Arkansas and our region. Visit uswith at nyit.edu/arkansas 870.972.2786 nyitcom.astate@nyit.edu NYITCOM at Arkansas State University is committed to addressing the primary care physician workforce shortage in Arkansas and the Delta region. By 2030, NYITCOM at A-State will produce more than SEPTEMBER/OCTOBER 2018 1,000 physicians to serve this state, region, and beyond.

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Practicing with Precision:

Barriers, Resources to Integrating Precision Medicine By CINDY SANDERS

Precision Medicine. The very name neatly sums up providers’ universal hope to dispense medicine in the most efficient, effective, precise manner possible to the benefit of a patient based on that person’s individual profile. Yet, integrating the discipline into practice is often anything but an exact science. A number of barriers – from a barrage of new discoveries to difficulties with authorization and reimbursement – have hindered physicians as they seek to offer patients the best option to treat a range of conditions and illnesses. The American Medical Association (AMA) has taken a leadership role in working with stakeholders, from researchers and colleagues to payers and policymakers, to address a number of key issues cited by physicians on the frontlines of care. Already critical to the delivery of patient-centered care in a variety of specialty areas including oncology and rare disease, the discipline is only anticipated to grow as new discoveries come online daily. To enable that growth, the AMA has recognized physicians need readily available resources to learn about the rapidly changing field and its impact on patient care. The national organization has developed a number of educational resources, including the “Precision Medicine for Your Practice” series, which includes online modules to enhance awareness of physicians and healthcare providers of the different ways genetic testing can be incorporated to improve health outcomes for patients. According to the national organization, “The modules – developed by the AMA in partnership with Scripps Translational Science Institute and The Jackson Laboratory – cover specific topics in genomics and precision medicine, including expanded

carrier screening, prenatal cell-free DNA screening, somatic cancer panel testing, cardiogenomics, neurogenomics and pharmacogenomics. The modules offer CME free of charge and can be found on the AMA’s website.” Currently, those modules are available online at education.ama-assn.org/precision-medicine.html. However, the AMA is updating its Education Hub so the address will likely change as that transition occurs but should be searchable in the association’s new education section. The AMA is also supporting continued research as a formal partner in the National Institutes of Health “All of Us” research program, which is building a large research cohort for precision medicine. The goal of the initiative is to better understand genomic influences and how they interact with lifestyle and the environment. More information on the large-scale project is available at allofus.nih.gov. While precision medicine holds great promise for the future, current payment systems have proven to be a significant barrier to clinical integration. Additionally, more work is needed on the clinical decision-sup-

port front to assist providers in identifying and deploying appropriate testing. On a related note, the AMA said there is a widespread shortage of medical geneticists and other clinicians with specialized knowledge to help drive broad clinical integration. “The AMA is working on several fronts to address these barriers. For example, the AMA has advanced several priorities to expand coverage and payment and access, as well as educational initiatives and support for research and clinical validation,” the organization responded to the Medical News in a statement. While efforts to ensure coverage and payment for clinically validated precision medicine continue, the AMA noted, “An ongoing challenge has been the rapidly evolving coverage and payment policies of government and commercial health insurers that have not necessarily kept pace with innovation and clinical validation in genetics and genomics. There are some commercial insurers that are imposing either prior authorization requirements or other utilization management policies due to their fixed capacity to keep pace with the change, which impacts and challenges patient access and clinical

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integration.” At the beginning of 2017, the AMA joined with 16 other organizations representing the continuum of care to release the Prior Authorization and Utilization Management Reform Principles, calling for an array of improvements in utilization management including addressing the key issues of clinical validity, transparency, fairness, timely access, continuity of care, alternatives and exemptions. “The release of these principles spurred important conversations between provider and health plan organizations on the need for prior authorization reform. An important initial outcome of those discussions was the January 2018 release of the Consensus Statement on Improving the Prior Authorization Process,” stated the AMA. The consensus statement from six national organizations representing physicians, hospitals, pharmacists, practice managers and payers reflected an agreement between providers and payers to meaningful address the process impacting the delivery of cutting-edge care. With the shortage of medical geneticists and specialized clinicians deploying precision medicine … and with those who do possess that specialized knowledge and skill set often clustered at major academic centers . . . the AMA has focused on increasing access to genetic and genomic consultations through the utilization of telehealth and e-consults. Strong supporters of using technology to expand access and knowledge, the organization hailed a proposal to allow the Medicare program to cover inter-professional e-consults beginning Jan. 1, 2019. “This is very important news for physicians and patients who will be able to obtain patient-specific medical genetic consultations more rapidly and without constraints of geography, while ensuring care coordination and care delivery by the primary care provider,” the AMA stated. “With all of this optimism and promise, consistent coverage policies that reflect the evidence base remain a critical factor in the successful implementation of precision medicine, as well as the infrastructure to support widespread clinical decisionsupport for the right patient, right test at the right time,” noted the AMA. Although excited about forward movement in terms of expanding access through e-consults and the work to address prior authorization impediments, the national physician group said additional challenges remain, including concerns over affordability and accessibility. A growing concern is the potential impact of efforts that could limit the number of clinical laboratories offering testing due to payment cuts. “The AMA is committed to addressing these challenges though advocacy efforts, investing in a number of educational initiatives, as well as promoting continued discovery and innovation through the All of Us campaign.” Additional information and links to resources to assist in implementing precision medicine at the practice level are online at ArkansasMedicalNews.com. arkansasmedicalnews

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Compliance Programs: Are They Really Voluntary? By LYNDA JOHNSON and TIMOTHY EZELL

Is having a compliance program really a “voluntary� matter for providers? There has been much written regarding the “voluntary� nature of instituting and maintaining an “effective compliance program� for healthcare providers. Much of this literature supports the concept of compliance being interwoven into the culture of an organization.  Whether Compliance Programs are truly voluntary is debatable. While the Federal OIG has not formally stated that maintaining an effective compliance program is mandatory, Arkansas Medicaid has.  Ark. Code Ann. § 20-77-2511 states that any provider who receives $750,000.00 annually from the Arkansas Medicaid program, is required to implement a compliance program. Moreover, CMS provider enrollment forms for certain provider types requires a “yes� or “no� answer as to whether the provider has a compliance program meeting certain requirements. While there are multiple benefits from implementing and maintaining an effective compliance program, it is very important to recognize that there is no “one size fits all� compliance program for all providers. The specifics of a particular Compliance Program will vary based on provider type and provider size, just to name two factors. Each provider, whether a hospital, physician group, ambulatory surgery center or other provider type, should tailor its compliance program to reasonably reflect the compliance activities that the provider is able to perform.

elements of an “effective compliance program,â€? all of which are essential to demonstrating the “commitment to complianceâ€? that the OIG expects of all healthcare providers. These seven elements include: • Developing written policies and procedures. • Designating a compliance officer and compliance committee. • Providing effective compliance

training and education. • Establishing effective lines of communication. • Performing internal monitoring and auditing. • Enforcement of standards through well-publicized disciplinary guidelines. • Exhibiting a prompt response to detected problems through corrective actions.

OIG Compliance Program Specifics

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EXPERT DOCTORS. EXCEPTIONAL CARE.

Compliance Program Basics

Very generally speaking, an effective Compliance Program facilitates a healthcare provider’s compliance with federal and state laws, rules and regulations that are applicable to the provider, including (but not limited to) Medicare and Medicaid reimbursement policies and procedures. It is well documented that non-compliance with Medicare or Medicaid reimbursement policies and procedures can have devastating effects on providers, particularly smaller providers with less margin to absorb unexpected losses and refunds. An effective Compliance Program will not only provide guidelines for a provider to follow in the event of a compliance violation or breach (i.e., voluntary identification and refunding of overpayments), but will also help providers avoid compliance issues by implementing frontend auditing and monitoring processes to detect any would-be issues before they become negative compliance outcomes.

In our practice, we advise clients that the Compliance Committee should be comprised of individuals with diverse responsibilities that include the revenue cycle, human resources, and information technology, just to mention a few. We have found that the most effective compliance committees meet on a quarterly basis and include on their agenda certain

&$57,ÀJKWVFDQFHUXVLQJWKHPRVWDGYDQFHGWHFKQRORJ\DQGWUHDWPHQWZLWKSK\VLFLDQVZKR VSHFLDOL]HLQFDQFHUFDUH:HDUHDJJUHVVLYH5HOHQWOHVV:KLFKLVZK\&$57,LVPRUHWKDQ\RXU PRVWFRQYHQLHQWFKRLFHIRUFDQFHUFDUH²LW¡VDOVR\RXUVWURQJHVWFKRLFH/HDUQPRUHWRGD\ • Physician collaboration for added expertise and options • Personalized, precise treatment, including immunotherapy • All service lines under one roof with 24 doctors: medical and radiation oncology, interventional radiology, surgical oncology and imaging

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A Strategy to Conquer Burnout By THOMAS P. BURNS, MD

I just spent two days at a statewide medical association annual meeting. We were there to help educate the physicians on real asset investing. I met many interesting people and likely started some new and exciting relationships. Many of the physicians stopped to talk to us about real estate investing and the benefits of passive cash flow, but there was a troubling undertone that permeated many of the conversations. A startling number of these doctors admitted that they were “burned out” to some degree with the practice of medicine. Often, I have had doctors confide in me that they are unhappy with medicine. One 58 y/o family practice doctor once told me that he “hated the business of medicine” but loved taking care of his patients. I have asked others if they would, or could, enjoy medicine if the documentation burdens and the micromanagement were removed. Almost 100 percent say that they would love to practice medicine the way they were trained, which is to put the patient first. While I am familiar with physician burnout, I was unaware of its pervasiveness. According to a 2018 Medscape survey, physician burnout has reached epidemic proportions and is above 50 percent. A 2015 Mayo Clinic article compared physician surveys from 2011 and 2014 and found that burnout increased from 45 percent to 54 percent during

those three years. Work-life balance was also significantly decreased during that time. These are staggering numbers. How did this occur and what can be done? According to a presentation given by Tait Shanafelt, MD, the Director of the Stanford WellMD Center, there are structural defects in the system that must be addressed by the institutions and physician employers. The thesis was that the burden should not be placed on the individual physician, but should be addressed at the corporate, or institutional level. One solution, proposed in Diseases of the Colon and Rectum was, “...enable(ing) physicians to devote 20 percent of their work activities to the part of their medical practice that is especially meaningful to them.” How comforting that the doctor might now be “allowed” to enjoy one-fifth of his chosen vocation! I am not sure if it is worth ten years of medical school and residency only to have a 20 percent satisfaction ceiling! While the structure and mindset does need to change, the healthcare system moves like the Titanic and will not change course easily. I do not see any short-term corporate solutions on the horizon. Given that scenario, what can we do as physicians? Certainly, doctors can lobby for change, enter politics and try to change the system. In the long-run, this may have lasting effects. In the interim, we need to take care of our personal health and our families. If we cannot change the burdensome infrastructure and oversight

that has infected medicine over the past 20 years, we must change ourselves. We may not immediately solve the systemic issue, but we can chip away at our own collective situation one doctor at a time. What can individual practitioners do to counter the potential for burnout? Doctors need to learn to talk the language of money. It sounds trite and simplistic, but none of us were taught that language in school. Many feel that it is reserved for the “experts” or the guys in the C-suites. That is simply not true. A modicum of financial education could start you on a path to gain some control over your professional life and buy back a piece of the precious time that you are losing in front of a computer screen. A physician who is less dependent on income from a medical practice is less stressed and enjoys his profession more. I can promise that your patients will notice and they will receive more compassionate care. In my case, I was slowly able to produce enough passive income outside of medicine that I have been able to mold my practice to my liking. In turn, this has, with all modesty, provided a much more pleasant and caring environment for my patients. I still work within the same system, but I now have the power to eliminate or change conditions that affect my time, my income, or my patients’ care. I love going to work each day. While I could have retired long ago, my practice is more fun now than ever. I have the freedom to spend as much time as needed

with each patient and I can treat those without insurance for free without financial angst or external oversight. I believe that an army of doctors with control over their professional lives would create the best healthcare system in the world. I created my freedom through a strategy that fit the lifestyle of a full-time practicing orthopedic surgeon. There is an infinite number of ways to buy back time and there are plenty of resources to learn them. It is not impossible, and it can be done within the time constraints of a busy medical practice. It is beyond the scope of this short article to lay out the strategy, but if you start looking, you will find seminars, articles and podcasts that will help you get started. Physicians are smart and have the capacity to do great things. Find a way to create some passive income. You don’t have to create enough to retire, you just need a little to take off some of the pressure! Thomas Burns, MD is an orthopedic surgeon in Austin, Texas. He is a graduate of Southwestern Medical School and completed his sports medicine fellowship training at the Steadman Hawkins Clinic in Vail, CO. He is a member of the Forbes Real Estate Council and is frequently featured in nationally circulated print articles and popular real estate-oriented podcasts. Dr. Burns is Principal and Co-founder of Presario Ventures, a real estate investment management firm. tom@presarioventures.com; www.presarioventures.com

Compliance Programs: Are They Really Voluntary, continued from page 5 standing items, such as a human resources report to identify any disciplinary actions taken as a result of compliance violations. We often hear our various clients remark that their compliance committee meetings are among the most informative meetings that they attend. In the early stages of organizing and implementing your compliance program, it is crucial to involve legal counsel in order to assure the entire compliance landscape is addressed by the Compliance Committee in its quarterly meetings.

Arkansas Medicaid Compliance Program Specifics

The Arkansas Legislature, in creating the Office of the Medicaid Inspector General, identified the following elements of an “effective compliance program” for Arkansas Medicaid providers:

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• Development of written policies and procedures that: a. Describe compliance expectations; b. Describe the implementation of the operation of the compliance program; c. Provide guidance to employees and others with regard to dealing with potential compliance issues; d. Identify a method for communicating compliance issues to appropriate compliance personnel; and e. Describe the method by which potential compliance problems are investigated and resolved. • Designation of an employee charged with responsibility for operation of the compliance program (i.e., a “compliance officer”): a. The employee so designated may have other responsibilities in addition to operation of the compliance program; and b. The employee so designated must report directly to the provider’s chief executive or other senior officer and must periodically report directly to the provider’s governing board on the activities of the compliance program. • Providing periodic training to employees of the provider, including executives and governing board members, with regard to the compliance program operation, compliance issues and compliance expectations. The compliance training

should also be a part of the orientation process for these individuals. • Providing lines of communication, including a method to anonymously report potential compliance issues as they are identified by employees, executives and governing board members. • Establishing disciplinary policies to encourage participation in the compliance program by affected individuals, including a policy that sets forth expectations for reporting compliance issues, assisting in the resolution of such issues and outlines sanctions for: a. Failing to report suspected problems; b. Participating in noncompliant behavior; and c. Encouraging, directing, facilitating, or permitting noncompliant behavior. • Establishing a system for routine identification of compliance risk areas specific to the provider for: a.Self-evaluation of the risk areas, including internal and external audits; and b.Evaluation of potential or actual noncompliance as a result of these audits. • Establishing a system for: a. Responding to compliance issues as they are raised; b. Investigating potential compliance issues; c. Responding to compliance issues as

identified through audits; d. Correcting problems promptly and thoroughly and implementing processes to reduce the potential for recurrence; e. Identifying and reporting compliance issues to the Arkansas Department of Human Services or the Office of the Medicaid Inspector General; and f. Refunding overpayments. • Establishing a policy of non-intimidation and non-retaliation for good-faith participation in the compliance program, including, without limitation: a. Reporting potential issues; b. Investigating issues; c. Performing self-evaluations; d. Conducting audits and remedial actions; and e. Reporting to appropriate officials.

Conclusion

Twenty (20) plus years ago, the concept of Compliance Programs was introduced as “voluntary.” Arguably, in some cases implementation of a Compliance Program may still be voluntary. However, as noted in this article, an effective Compliance Program is legally mandated for some providers advisable for all. Lynda Johnson, and Timothy Ezell are both Partners at Friday, Eldredge & Clark, LLP. Visit www.FridayFirm.com

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Cybersecurity Insurance for Medical Practices – the Basics By DAVID J. EISMONT

More medical practices are purchasing – or at least considering – an insurance policy to cover the substantial costs of a data breach. Medical malpractice policies often provide basic coverage for this threat, but many practices find their risks have grown to the point where they are looking to a stand-alone cybersecurity policy to better meet their needs. The following provides an overview of what your practice can expect from a cybersecurity policy. Keep in mind that not all policies are the same and actual coverage will be determined by a policy’s terms, conditions, and exclusions. Coverages are typically split into two types— first-party and third-party:

First-Party Coverage

First-party coverage addresses the costs and expenses your practice incurs from a data security or privacy breach event, such as: A physician comes to the office one morning and logs in to the computer, but the screen goes blank and a message pops up claiming to have hijacked the data and demands payment to get it back. The “extortion threat” section of a

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cybersecurity policy may assist with this type of breach. Professional experts hired by the carrier will contact the cyber criminals to attempt to get the data released, including potentially paying the ransom. You should also be concerned with not only the financial impact to your practice, but also the impact on the treatment of your patients if your systems are down for any length of time due to a breach. The business interruption section of a cyber

policy may provide reimbursement of lost profits during your downtime. Many standard property policies do not cover this exposure, since there was no physical damage to the equipment. A physician discovers her system has been hacked and worries her patients’ personal health information may have been compromised. If you discover your system has been hacked, your carrier can provide data

breach response services to work with your IT staff to ascertain what happened. These forensic experts assess the nature of the hack and evaluate how much data has been compromised. This section of your coverage can assist with the costs of required patient notification. If you have records of patients from outside your home state, your insurance company should know the notification requirements for those states. You may also be required to provide those patients with credit monitoring services. Your coverage should help set up these services and cover the costs. The costs to notify patients and set up credit monitoring is approximately $8$10 per patient record. If patient records are compromised, the data recovery and restoration section of your coverage could reimburse you to unencrypt, recover, restore, recreate, or recollect data. The CEO of a company sends an e-mail to the CFO instructing the movement of funds into an account. The CFO makes the transfer, only to discover that the CEO’s e-mail was a spear phishing attack in which the email address was a clever fake, and those funds are long gone. Your coverage’s cybercrime section may cover the cost of the funds that were (CONTINUED ON PAGE 8)

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10 Unexpected Realities Nurses Face By NANCy CONGLETON, RN

When I decided to become a nurse, I didn’t have a clue. I wasn’t aware of the educational options available to me, what nursing school was really like, or what to expect if I actually graduated and was thrown into the heart of the jungle! Here are some insights from my years in the trenches, and the realities of nursing that most people don’t realize. Be Prepared to Think and Act for Yourself. It’s a common misconception that nurses simply carry out the doctors’ orders. Physicians may chart the course for patient care by diagnosing diseases and writing orders, but nurses are front and center—monitoring patients’ responses to prescribed interventions and notifying physicians when unwanted or negative outcomes arise. Nurses are responsible for ALL orders that are carried out, including those that are wrong or contraindicated. Therefore, nurses must make sure that the orders they receive from physicians are appropriate for their patients, and they must use their skills and training to know when to interrupt, or stop, an order. You Know Everything, Right? Be prepared for your family, friends, and the community, to expect you (the nurse) to know EVERYTHING from all areas of nursing and healthcare. On one hand, it’s

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a compliment for people to think of nurses as having all the answers, but it’s unrealistic and annoying. Don’t Take the Things Patients Say Personally. I’ve heard it all from patients doubting my capabilities, “You can’t be my nurse, you’re just a little girl!” or “Do you even have a license?” Remember that patients are often scared, hurting, frustrated, and feel as if they don’t have a voice. So, try not to be too self-absorbed; on many occasions it’s not actually about you. Get Comfortable with Bodily Fluids, and Other Squishy, Gross Things. In addition to snakes in buckets, I’ve been handed fingers over ice in cups and seen the aftermath of toes colliding with lawnmowers. There’s no set pattern or criteria for the ER, anything is possible. But if the ER isn’t your cup of tea, don’t worry, there are many other specialties of nursing you can go into. Just keep in mind,

they will have their own version of gross things, too. Demanding Families. Nurses are taught that patients are their primary focus. In reality, a nurse’s time with the patient is often cut short because they need to address unattainable expectations from the patient’s family members. Watch Out for Your Back. As a nurse you are faced with a great deal of heavy lifting - someone could faint or have a seizure, you might have to turn a patient or help them get out of bed or to the bathroom. In nursing, a patient who’s 125 pounds or less is considered a lightweight. Yet, many construction workers (who are usually big, strong men) are restricted to lifting far less than that. Nursing School Doesn’t Prepare You for Everything. Prospective nurses go to nursing school to learn how to be a nurse. However, it is impossible for nursing instructors to cover every disease,

symptom, and treatment that a future nurse will encounter. Take advantage of every chance to give a shot, start an IV, or witness a procedure. Most nurses are so busy they don’t have time to encourage you to participate, so be watchful for these learning opportunities and step forward when they arise. 12-Hour Shifts, Seriously? Yes, but I actually prefer this to the Monday – Friday, 8 to 5 schedule. I know my day’s going to be long, but that’s ok because I won’t be doing it five days in a row like a mindless drone. Plus, the nursing profession provides many options, so you can find a time frame that suits you best. But also, be aware that your shift’s not over until they say it is. A nurse’s shift may be over according to the clock but that doesn’t mean that they can leave. If a nurse heads out the door without being officially cleared to do so, they could be charged with patient abandonment. Being in Charge Ain’t a Picnic. In addition to being responsible for patient care, one day you may also be in charge of other nurses, nurse aids, nurse techs, medical assistants, etc. Being in charge of coworkers requires a delicate balance of leading by example, being firm when needed, and sometimes just letting snarky remarks roll off your back. Keep Calm and Nurse On. Try not to panic too much regarding weight gain, bouts of crying, or brief moments of insanity. At some point, it happens to all of us. Keep your eyes on the prize and take care of business. Nancy Congleton, RN, is a Registered Nurse and author of Autopsy of the NP: Dissecting the Nursing Profession Piece by Piece, released August 22, 2018. Learn more at: www.nursenancyrn.com

Cybersecurity Insurance, continued from page 7 transferred. Employees who click on such phishing links could compromise your system. This section of your policy may also assist in those situations.

Third-Party Coverage

Third-party coverage provides protection from claims made against you by outside parties. It would not be unusual to have claims brought by regulatory agencies, such the U.S. Department of Health and Human services in the case of an alleged HIPAA violation involving a breach of patient records. Cybersecurity coverage for regulatory fines and penalties may allow for payment of fines on your behalf. If your practice accepts credit card payments and is not PCI-compliant (adhering to all the Payment Card Industry Data Security Standards), you could be subject to fines from the credit card companies. Policies with payment card industry coverage may provide payment for those fines.

Some patients may bring claims against you for violating applicable privacy laws. The data security and privacy section of your cybersecurity policy may help in providing a defense and make payment to these claimants, if necessary. Employees of your practice could file such claims if their information was compromised. If you maintain a website or social media platforms, you might have a claim brought against you in the event someone believes your site or media content is defamatory or reveals private information about them. The cyber media section of a cybersecurity policy may also provide coverage in this case. Healthcare accounted for 53 percent of reported data breaches in 2017, more than double the total of any other industry, according to Privacy Rights Clearinghouse. With healthcare data breaches on the rise, cyber liability insurance can help you recover faster in terms of financial coverage and remediation. In 2015, U.S. healthcare data breaches cost companies

an average of $363 per record, the highest of any industry, according to the Ponemon Institute. Depending on the size and scope a fines and damages for a HIPAA violation related to a breach of unencrypted personal health data can run into the millions of dollars. Ask your agent or underwriter for more details about what’s included in your policy and whether it meets your needs. If you have cyber insurance, check your liability limits to determine if you need to increase your coverage. To learn how to comply with HIPAA rules in the event of a breach, how to thwart ransomware attacks and prevent spear phishing, and more, download the free guide Your Medical Practice Is at Risk of a Data Breach from The Doctors Company. More resources are available on the company’s cybersecurity page. David J. Eismont, ARM, is senior director of business development for The Doctors Company

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Aimee Olinghouse, continued from page 1 Olinghouse said the Arkansas Chapter considers it vital that children have access to quality care and that the services they receive are covered by insurance or Medicaid. “Medicaid covers a large number of children in our state,” she said. “We work with our members to ensure every child who is eligible for Medicaid and needs services is able to receive those services. We work directly with the Division of Medical Services to make sure that children are enrolled, that they have a provider and the proper services are being reimbursed. We also work directly with the state legislature on various issues, including ensuring that Medicaid is adequately funded. We have a number of our members who have testified in legislative committees on various issues from vaccines to immigration, to access to care and injury prevention.” Other ways they improve the health and well-being of children include working with clinics to include developmental screenings into the clinic flow. And they have worked to help clinics implement asthma action plans to decrease the number of emergency department visits for asthma related issues. Helping clinics improve their efficiency drives down the overall cost of healthcare and increases the quality of care that is delivered. Another important effort the organization undertakes is to have a presence at the state capitol and work to educate the legislature on policies that affect children. For example, currently Arkansas allows people to receive exemptions for vaccinations for religious and philosophical reasons. The chapter continues to make sure that these exemptions aren’t broadened to include other reasons not to vaccinate children because there is no scientific evidence that vaccines are harmful. “We feel like vaccinations are really important to the health and well-being of kids, and that is true not just of the individual who is vaccinated, but it also helps children who are too young to be vaccinated against certain diseases or who are too medically fragile (like the seniors) to be vaccinated. It helps prevent outbreaks and exposure to those populations. We fight for public awareness that there is no research that vaccinations cause autism.” AAP has also taken a firm stand against separating children from their parents at the Mexican border. “We feel it is in the best interest of children for families to be united,” she said. “Separating children from their families causes both short-term and longterm issues. The president of the national AAP has spent a lot of time at the border looking to reunify families and reinforcing the need for the children to be with their families.” Medicaid provides health insurance for more than 300,000 kids in the state, and not all have equal access to medical care. Olinghouse said that is particularly a problem in rural Arkansas where there are fewer pediatricians per capita than in urban areas of the state. “Lots of kids in rural areas are seen arkansasmedicalnews

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by family practice physicians because there is not a pediatrician in their community,” she said. The chapter also works with University of Arkansas for Medical Sciences (UAMS) and the Department of Pediatrics to raise interest in pediatrics among medical students and working on retaining pediatric residents in the state after they finish residency. “We attend a couple of Pediatric Interest Group meetings per year,” Olinghouse said. “This is a club that medical students can join. Recently we attended a meeting where we hosted a panel of several pediatricians to talk to the medical students about what it’s like to actually practice pediatrics. We also present to the pediatric residents at their noon conference, which is a daily meeting for residents. Annually, we give an overview of what the AAP does and how we advocate for our members and all children. We also send a welcome letter at the beginning of every academic year that introduces ourselves and reminding residents that they are members of the state chapter at no cost to them.” Some of the other programs the chapter has spearheaded are projects to help pediatricians improve care for ADHD patients, teaching clinics to implement the latest guidelines from the National Heart Lung and Blood Institute/ National Asthma Education and Prevention Program and involvement with Reach Out And Read Arkansas, a nonprofit organization dedicated to increasing awareness of the importance of early literacy intervention and the critical role it plays in a child’s development. The organization also works to promote the Patient Centered Medical Home concept as an important mechanism for uniting the many segments of a child’s care, including behavioral and oral health, to accomplish these goals. Once a month the academy hosts a webinar where there is discussion about topics that are relevant to pediatric practices at that moment. Olinghouse, who has been executive director of the Arkansas Chapter AAP for 13 years, grew up in San Antonio, Texas. She graduated from the University of Texas in Austin. Prior to her present job, she worked in government relations at Arkansas Children’s Hospital, in institutional advancement at UAMS and as a fundraiser at Camp Aldersgate. She’s married to Tate, and together they have three children: Lauren, 17, a freshman at Hendrix College; Mitchell, 14, a freshman at Catholic High School in Little Rock; and Beck, 10, who is in the 4th grade at Prince of Peace School in Plano, Texas. In her free time, Olinghouse teaches indoor cycling classes at the Little Rock Racquet Club. She is an avid tennis playing and recently started playing golf. She will be mentoring a girl at Henderson Middle School this year through the Lessons for Life Ministry. The family attends the Greater Little Rock campus of New Life Church.

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UAMS,

Questionnaire for Autism, continued from page 1

continued from page 3 practice in Little Rock before he went back for a neonatology fellowship in 1990. He was medical director of the UAMS Neonatology Intensive Care Unit from 1993 until this year – a total of 25 years. This year, he turned that duty over Sara Peeples, MD. That UAMS is now a Baby Friendly Hospital, one of only two in the state with that designation, a high accomplishment. Hall has been involved in the Helping Babies Breathe Program and has been to Africa twice to help under-resourced countries with neonatal resuscitations. He has also been heavily involved in two major research projects. His group spearheaded a neonatal pain trial in 2000. And since 2007 he has also been involved with research into the use of telemedicine in lowering infant mortality. He is grateful for the funding provided by the NIH through the Center for Translational Neuroscience and his mentor, Edgar Garcia-Rill, PhD. Hall is on the board of directors of the March of Dimes and the Ronald McDonald House at Arkansas Children’s Hospital, which just finished a new expansion to help take care of families who live a long way from the hospital. Hall, 71, would like to focus the rest of his career on outreach. “We would like to concentrate on trying to improve the outcomes, particularly infant mortality, for babies in Arkansas,” he said. “We have also reached out to Oklahoma and its Native American community to work with them to decrease infant mortality in their state, as well. One of the big areas where Arkansas and Oklahoma fall behind is in post neonatal infant mortality or death between 29 and 365 days. After the first month, deaths are primarily sleep related, which are mostly preventable.” Every parent needs to know about the “Back to Sleep” initiative, putting the baby on his or her back to sleep, no co-bedding, using a firm mattress and not putting things like stuffed animals in bed with the baby. The baby should sleep in the same room as the mother, but not in the same bed. You can put a blanket on the baby, but Hall said a sleep sack is even better. He prefers that the baby just be dressed warmly and not have a blanket that might get caught over the nose. “That could be one of the predisposing factors to why children have premature death,” Hall said. “The two other ways to prevent sudden unexpected infant death are not smoking around babies and breast feeding. If everybody did these things, we could lower the infant mortality in Arkansas by another 2 per 1,000 live births annually. That is a message to everyone. That is one of the things we really want to concentrate on.” Hall himself is father to nine children, including four biological children and five adopted children. He and his wife, Lisa, now only have one more child still living at home. In his spare time, he tries to keep up with his kids. For hobbies, he likes to hunt, fish and do almost anything else outdoors.

make the child’s hospital stay as positive and safe as possible,” Stewart said. “Some of those areas that we ask questions include about how their child communicates. For example, does he use single words, sentences, sign language or a communication device? Can he accurately respond to ‘yes’ or ‘no’ questions? Is he able to Rachel Stewart respond to verbal instructions? Does he respond to his name when called? Does he follow commands? Can he follow multistep commands?” A second area in the questionnaire is related to how the child processes sensory input. Some children who have ASD can be overstimulated by certain triggers. It is important to know how the child processes the senses of touch or tactile sensations. Parents are asked if their child has any problems with the sense of touch. Does he avoid some type of touch? For example, maybe the blood pressure cuff squeezing on his arm is a problem for them, which might make it hard to get a blood pressure reading in hospital. “That is good for us to know so we can minimize that or find another way to get their blood pressure taken,” Stewart said. “Also, kids with sensory processing disorders or autism respond to senses differently. Sometimes they seek out certain sensations and sometimes they avoid different sensations. We use this tool to access what these things are. That is different for each patient.” Other issues covered in the sensory portion of the questionnaire include questions about hypersensitivity to sounds and lights. Certain lights are very overstimulating for some kids. Dimming the lights can help a child remain calm. “We ask about their oral sensations,” she said. “Some children like chewing on

things. We can provide certain tools so they can chew on something safe here in the hospital. Then we ask about different things about smelling and movement. Some children like movements like rocking back and forth.” The questions help spur conversations about what helps the child cope with the illness or hospitalization. Sometimes children with ASD can’t verbally communicate. “Using a parent for the questionnaire gives us insight into what their life looks like outside of the hospital and how we can better meet their needs individually,” Stewart said. “All those kids are somewhat different, so what might be helpful for one child might trigger unwanted behavior in another child. We always want to best meet the patient and family where they are at.” With one patient she worked with recently, she was able to identify an item that really helped with the hospitalization. Without the questionnaire, she wouldn’t have known. For another patient, the color red was a trigger. Avoiding a red toothbrush for that patient was helpful. Another section of the assessment covers safety. Does the child exhibit any self-

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injurious behaviors, injurious behaviors for others, does he tend to run away, and does he have a poor awareness for danger? Responses help keep children safe and help keep other people in the hospital safe, as well. “We have multiple questions that we ask throughout this assessment, which goes into an electronic chart so the entire medical staff has access to the information so we can better serve the patient and family,” Stewart said. The questionnaire helps parents feel like they are being heard. “They know things about their child we will never know,” Stewart said. “It allows parents to feel a part of the team in taking care of their child. In the hospital, the term we use for that is family-centered care.” Stewart said she is really thankful they have this questionnaire tool because it is such an important piece of her work in the hospital. “My job as a child life specialist is to reduce anxiety and to increase coping,” she said. “Specifically, with children with autism or any other sensory disorder, this is a huge tool for me to find out how I can best meet that child’s needs.”

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GrandRounds Multiple Providers Join Mercy Clinics ROGERS – The following providers recently joined Mercy Clinic in Northwest Arkansas: Board-certified neurologist Dr. Ryan L. Kaplan has joined Mercy Clinic Neurology – Physicians Plaza. Dr. Kaplan has worked in private practice in Fayetteville since 2002, seeing adult patients for a broad range of neurological diseases. He has served as an adjunct professor in neu- Dr. Ryan Kaplan rology at the University of Arkansas for Medical Sciences since 2003. Dr. Kaplan earned his medical degree from the University of Miami Medical School and completed an internship in internal medicine and a residency in neurology at the University of Illinois at Chicago. In addition, he completed a fellowship in neuromuscular diseases and electromyography at the University of Michigan in Ann Arbor. He is a member of the American Academy of Neurology and the Arkansas Medical Society. Meredith Krohn, an advanced practice nurse in pediatrics, has joined Mercy Clinic Pediatrics – Highway 102. Krohn earned a Master of Science in nursing in pediatric primary care from the University of Arkansas for Medical Sciences. She also holds a Bachelor of Science in nursing from the UniMeredith Krohn versity of Arkansas. Her previous nursing experience includes convenient care, pediatrics and emergency department care. Amanda Manning has joined Mercy Clinic Primary Care – Moberly Lane as an advanced practice nurse. Manning completed a Master of Science in famAmanda ily practice nursing at Manning

Harding University. She holds a Bachelor of Science in nursing from the University of Arkansas and worked for 16 years in nursing, including emergency room, and labor and delivery. She also was a nurse manager for five years. Paige Boles has joined Mercy Clinic Convenient Care – Highway 102 as an advanced practice nurse. She earned a Bachelor of Science in nursing from the University of Arkansas and a Master of Science in nursing from Georgetown University in Washington, D.C. Paige Boles UAMS Researcher Receives $2.1 Million Grant To Determine Best Nutrition for Military Combat, Training

LITTLE ROCK — University of Arkansas for Medical Sciences (UAMS) researcher Arny Ferrando, PhD, recently received $2.1 million from the U.S. Department of Defense to determine the best possible nutrition for military personnel engaged in combat and combat training. UAMS and its scientists like Arny Ferrando continue to demonstrate how the university is leading in research that promises not just to benefit Arkansas but the nation said UAMS Chancellor Cam Patterson, MD. Ferrando is a researcher in the UAMS Donald W. Reynolds Institute on Aging and a professor in the UAMS College of Medicine Department of Geriatrics. The five-year grant was awarded by the U.S. Army Medical Research and Material Command in the Department of the Army within the Department of Defense. Jeanne Wei, M.D., Ph.D., executive director of the Reynolds Institute said that maintaining the health of our military in training and in combat is vital to their wellness and effectiveness. The first step in the study will be to determine the required essential amino acid intake under conditions often experienced by U.S. military personnel in com-

bat or combat training. Then, researchers will look at the best delivery format, whether through food and/or supplements. The results from these studies will then be tested during a simulated training scenario and, eventually, during realtime military combat training exercises. There is a critical need for effective and feasible interventions that sustain and maximize warfighter health and performance during real-world operations according to Ferrando. The use of a combat ration item designed from this research will be used to promote recovery and increase combat effectiveness by offsetting losses of body and muscle protein. During combat operations, not consuming enough calories and protein often results in a loss of body and skeletal protein. Prolonged muscle and protein loss may compromise physical performance, increase injury risk and lost duty time, and diminishing readiness overall. The results of this research could also be applied to athletes and patients in intensive care, institutional care and other settings. Developing methods for delivering the best nutrition and protein can provide “the warfighter, as well as clinical and athletic populations maximum benefit at little or no risk.

New Medical Staff Joins NARMC Team HARRISON – The medical staff of North Arkansas Regional Medical Center (NARMC) continues to grow in response to patient needs. NARMC is proud to announce several new physicians are joining the NARMC team. In August, Dr. Michael Clarke, Dr. Elizabeth Morgan and APRN Caleb Kasper joined the medical system, followed by Dr. Ashley Merrick this month. And finally, Dr. Evan Branscum has committed to practicing in Harrison after completing his residency. Dr. Clarke, a University of Arkansas for Medical Sciences College of Medicine (UAMS) graduate will be working as an NARMC Pathologist. Clarke comes

NEA Baptist First in Arkansas to Implant New Generation Heart Stent JONESBORO — The interventional cardiology team at NEA Baptist recently became the first hospital in Arkansas to offer patients with coronary artery disease the newest-generation Abbott XIENCE Sierra™ Heart Stent. In June, Dr. Anthony White, cardiologist at NEA Baptist, implanted the XIENCE Sierra heart stent in a patient with coronary artery disease. The Abbott XIENCE Sierra™ Stent makes it easier for cardiologists to access and unblock difficult-to-reach lesions. New features include a thinner profile, increased flexibility, longer lengths, and small-diameters. XIENCE stents are among the world’s most-used and studied stents and have exceptional safety standards with low rates of complications. The stent was specifically developed by Abbott for the treatment of complex cases, including people with multiple or totally blocked vessels, which now account for up to 70 percent of cases. For U.S. Important Safety Information about XIENCE Sierra visit: https://www.vascular.abbott/us/products/coronary-intervention/xience-sierra.html#prodisi

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Pictured (l to r), Trey Fracchia, Xcience Representative, Karen Hollis, RN, Heath Murdock, RRT, Kendra Orick, RN, Natalie Reece, RRT, Lindsey Stewart, RRT.

to Harrison from Laguna Hills, California, where he was Co-Laboratory Director at Orange Coast Women’s Medical Group and Pathologist at Saddleback Memorial Medical Center. Dr. Morgan, a graduate of UAMS, comes to Harrison after completing her residency at Shasta Community Health Center in Redding, California. She will be practicing family medicine and obstetrics at the Family Medicine Clinic. Caleb Kasper, MNSC and Certified Family Nurse Practitioner, is relocated to NARMC from Baxter Regional Medical Center where he was a Registered Nurse in their Emergency Department for the past five-years. Kaspar holds a Masters of Nursing from the UAMS and is practicing at the Harrison Mediquick location. A native of Harrison, Dr. Merrick has joined NARMC from Mercy Clinic in Springfield, Missouri. She is a graduate of UAMS, completed her residency at Arkansas Children’s Hospital and holds certifications from the American Board of Pediatrics and the Missouri Board of Registration for the Healing Arts. Dr. Merrick specializes in pediatrics. Dr. Branscum, a graduate of UAMS, is currently a resident physician at Cox Family Medical Care Center in Springfield, Missouri. He will be opening a practice in Harrison after completion of his residency. Over the past seven years, NARMC has actively recruited healthcare providers to our community. The NARMC goal is to provide comprehensive healthcare to North Central Arkansas, and we look forward to continuing to do so with these new team members.

Parks Adds To Critical Care Team FORT SMITH – Even at a young age, Adebayo Fasanya, MD, was drawn to medicine. But it was his upbringing in Nigeria, where access to medical care was limited, that helped shape his compassion and desire to help those in need. Dr. Fasanya is board Dr. Adebayo certified in both internal Fasanya and pulmonary medicine and is now seeing patients at Sparks Clinic Lung Center inside Sparks Regional Medical Center at 1001 Towson Avenue. He also specializes in critical care medicine and will treat patients in the Intensive Care Unit at Sparks. As a biology and mathematics major, Dr. Fasanya says he’s always been good with critical thinking and enjoys working in fast-paced environment making the ICU a natural environment for the physician. He earned his medical degree at Saba University School of Medicine in the Netherland Antilles before completing a residency in internal medicine at Atlantic Health System in Summit, New Jersey, and a fellowship in pulmonary/critical care at Allegheny General Hospital in Pittsburg, Penn. (continued on page 13)

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GrandRounds During his time at Allegheny, he served as the Chief Fellow and pioneer of a pulmonary embolism response team. In 2015, Dr. Fasanya earned certification in Medical Humanities from Drew University allowing him to take a holistic and multidisciplinary approach to treating his patients and collaborating with the patient’s family.

Kick Off Marks $6 Million Family Medical Center Renovation PINE BLUFF — A kick-off ceremony marked the official start of remodeling work for a new $6 million UAMS Family Medical Center in the Jefferson Professional Building II on the northwest corner of West 40th Avenue and Mulberry Street in Pine Bluff. University of Arkansas for Medical Sciences (UAMS) Chancellor Cam Patterson, M.D., Jefferson Regional Medical Center officials and UAMS officials received construction hard hats to mark the start of the remodeling of 33,000 square feet of space on the first two floors of Jefferson Professional Center II. The renovated facility will provide space for the merger of UAMS’ three Pine Bluff clinics along with the physician residency program at the UAMS South Central Regional Campus. UAMS South Central and the Family Medical Center-Pine Bluff are showing that their commitment to patients, enhancing the patient experience and improving

health outcomes will continue well into the future according to Patterson. UAMS will lease the space from Jefferson Regional, repaying the cost of the remodeling over the next 20 years and reimbursing the Jefferson Hospital Association, which operates the hospital. The UAMS South Central residency program for training new physicians graduated its first class in 1981 and has 30 in the program today. Since 1981, more than 365 resident physicians have completed family medicine training at UAMS South Central and Jefferson Regional. In addition to Patterson and Deal, others at the groundbreaking included Sterling Moore, MBA, vice chancellor for UAMS Regional Campuses; Brian Thomas, Jefferson Regional Medical Center CEO; Toni Middleton, M.D., UAMS South Central Residency Program director; and Phil McNeil, assistant vice chancellor for UAMS Campus Operations. The construction is scheduled to be complete before the end of the year with the physician residents moving into the renovated space in mid-January. The architects are Witsell, Evans, Rasco of Little Rock. The general contractor is Clark Contractors of Little Rock. The Family Medical Center-Pine Bluff provides primary care medical services to patients of all ages — including pediatric care, treatment of immediate medical needs and ongoing management of chronic conditions such as asthma,

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diabetes, hypertension and arthritis. The clinic provides convenient diagnostic and support services on site and minor surgical procedures.

Washington Regional Launches Area’s First Neurosurgical ICU FAYETTEVILLE — Washington Regional recently opened Northwest Arkansas’ first neurosurgical intensive care unit, with 20 beds to serve patients who are recovering from surgery due to a spinal cord injury, brain injury, neurological illness such as epilepsy or brain event such as stroke. With the Neurosurgical ICU, Washington Regional has made a commitment to provide a level of complex care not available elsewhere in the region according to Mark Bever, Executive Vice President and Administrator at Washington Regional Medical Center. Kasha Pinkerton, BSN, RN, SCRN, nursing manager of the Neurosurgical ICU, says patients receive highly skilled care from an interdisciplinary team comprised of physicians, nurses, respiratory therapists, physical therapists, occupational therapists, speech pathologists, dietitians and pharmacists. Care team physicians include specialists with advanced training in neurosurgery, stroke neurology, intensivist medicine and interventional neuroradiology. Along with specialized skills, it requires a holistic

approach involving all areas to provide optimal care for neurosurgical patients, Pinkerton says. Nurses in the Neurosurgical ICU are specially trained in techniques for examining the brain and central nervous system. When caring for patients after neurological surgery, it’s important to be aware of intracranial pressure and how the brain controls blood flow. This patient population is very delicate and requires constant monitoring Pinkerton says. In addition to the specialized medical equipment typically found in an intensive care unit – such as ventilators and cardiac telemetry machines – the Neurosurgical ICU also provides advanced neurological tools such as continuous electroencephalography, a non-invasive method of monitoring and recording electrical activity of the brain. The nursing unit has a dedicated waiting area for visitors and also features dimmable lights in all patient care areas, specialized ceiling-mounted patient lifts for turning and repositioning patients, bedside monitors and a nurse call system that helps to identify patients with certain risk factors. A work room ensures patient privacy by providing space for physicians to dictate notes and review charts. Located on the hospital’s first floor, the Neurosurgical ICU is the first new service made possible by Washington Regional’s current Core Renewal Project, which will also include expansions to cardiovascular services and the laboratory.

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GrandRounds General Surgeon Joins the Conway Regional Health System Medical Staff CONWAY- Anthony Manning, MD, General Surgeon, has joined the medical staff of Conway Regional Health System. He will practice alongside General Surgeons Mike Stanton, MD, Brock King, MD, and William McColgan, MD, at Surgical Dr. Anthony Associates of Conway. Manning Dr. Manning completed his undergraduate degree at the University of Central Arkansas and medical school at the University of Arkansas for Medical Sciences. He completed a five- year surgical residency at Baylor Scott & White in Temple, Texas. He joined Surgical Associates in early August. General surgery focuses on diseases of the GI tract, including the esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder, appendix, bile ducts, and the parathyroid and thyroid glands, in addition to breast and hernia surgeries.

Cardiothoracic Surgeon Gamal Marey Joins Baptist Health Surgery Clinic LITTLE ROCK – Baptist Health Cardiothoracic Surgery Clinic welcomes Dr. Gamal Marey to its team. Marey, who completed residencies at State University of New York Downstate Health Science Center and Tufts University Medical Center in Dr. Gamel Marey Massachusetts, is fellowship trained in Advanced Aortic Surgery from the Cleveland Clinic Founda-

tion in Ohio. The surgeon has 12 years of experience in his medical specialty which includes advanced aortic surgery, minimal access mitral/aortic valve replacement and repair, endocarditis, CABG, myectomy, pericardiectomy, transcatheter aortic valve replacement and heart transplantation. Marey, along with Drs. Bo Busby and James Day from the clinic, perform virtually every type of cardiac surgery including elective or emergency surgery for heart valve disease, aortic aneurysm, coronary artery disease, arrhythmias, heart failure and other less common conditions using the newest surgical techniques, equipment and devices, including minimally invasive surgery, off-pump bypass, and robotically assisted and percutaneous procedures.

Cardiologist Joins Baptist Health Heart Failure and Transplant Institute Team LITTLE ROCK – Baptist Health Heart Failure and Transplant Institute welcomes Dr. Onyedika Ilonze – the seventh member to its cardiovascular team. Ilonze, who received his medical degree from the University of Nigeria College of Dr. Onyedika Medicine in Enugu, NiIlonze geria, finished his residency at Rochester Regional Health/ Unity Health Program – An Affiliate of the University of Rochester located in New York. In addition, he completed two accredited fellowships – one in General Cardiology and the other in Advanced Heart Failure, Mechanical Circulatory Support, Heart Transplantation and Pulmonary Vascular Disease. Board certified in Internal Medi-

cine, Adult Echocardiography and Nuclear Cardiology, Ilonze has nine years of experience in the medical field. His specialized interests include Advanced Heart Failure, Heart Transplantation, Left Ventricular Assist Devices (LVAD), Mechanical Circulatory Support and Pulmonary Hypertension. Some of his services are management of heart transplant patients and patients with LVADs, management of patients with advanced heart failure and pulmonary hypertension, endomyocardial biopsies, heart catheterizations, transthoracic and transesophageal echocardiograms and nuclear cardiology studies.

Training Grant of More Than $740,000 to Encourage Drug Development is Renewed LITTLE ROCK — A prestigious grant has been renewed for $742,840 over five years that gives Ph.D. students in the biomedical sciences at the University of Arkansas for Medical Sciences (UAMS) an added foundation in pharmacology and toxicology research. The National Institute of General Medical Sciences awarded the Institutional Predoctoral Research Training Grant (T32) to the Department of Pharmacology and Toxicology in the UAMS College of Medicine. The funding will allow the department’s Systems Pharmacology and Toxicology (SPaT) Training Program to provide two trainees a year with a stipend, specialized coursework, research mentorship and training in entrepreneurship, career development, networking, leadership and grant writing. UAMS is one of only 31 pharmacology and toxicology training programs in the nation to receive the funding. Others include Vanderbilt University, Emory University, Harvard Medical School and Johns Hopkins School of Medicine.

The trainees come from a variety of areas of interest and pursue research that combines these interests with a focus on pharmacology and toxicology. Trainees supported by the first grant worked on drug abuse and behavior; cancer; drug toxicity; and bone, kidney and cardiovascular health. Thirty-one UAMS faculty have partnered with the SPaT Fellowship to provide training and mentorship. SPaT is a partnership of the UAMS’ Graduate School, College of Public Health and College of Pharmacy; Arkansas Children’s; and the National Center for Toxicological Research, which is part of the Food and Drug Administration. The UAMS Translational Research Institute, UAMS College of Medicine and Arkansas Biosciences Tobacco Research Committee provide matching funding for the grant, allowing there to be one additional SPaT trainee each year along with the two funded by the federal grant.

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GrandRounds CHI St. Vincent Opens New Urogynecology Clinic LITTLE ROCK - Dr. Susan Barr and Dr. Sallie Oliphant have joined CHI St. Vincent, which has announced the opening of its new urogynecology clinic. Dr. Barr and Dr. Oliphant are welcoming patients at the clinic located at the CHI St. Vincent Blandford Build- Dr. Susan Barr ing, 5 St. Vincent Circle, Suite 300, in Little Rock. Urogynecologists specialize in treatment of women’s pelvic floor disorders and treating conditions such as incontinence, organ proDr. Sallie Oliphant lapse and bladder pain. Dr. Barr is a graduate of the University of Arkansas for Medical Sciences, and she completed her residency and fellowship at St. Louis University Health Sciences Center. She was a faculty member at St. Louis University before launching the Female Pelvic Medicine and Reconstructive Surgery Division of the Department of Obstetrics and Gynecology at UAMS. She is board certified in female pelvic medicine and reconstructive surgery. Dr. Oliphant earned her medical degree from the University of North Carolina School of Medicine and completed her residency and fellowship at the University of Pittsburgh Magee-Women’s Hospital in Pittsburgh. She also has a master’s degree in clinical research and is board certified in both obstetrics and gynecology and in female pelvic medicine and reconstructive surgery.

Christi Whatley Named VP/ Chief Quality Officer At CHI St. Vincent LITTLE ROCK – CHI St. Vincent has named Christi Whatley as vice president/ chief quality officer, a position that oversees clinical quality outcomes throughout CHI St. Vincent’s hospitals and clinics and directs initiatives to ensure and improve excellent paChristi Whatley tient care. Whatley was most recently director of business and service development for National Park Medical Center in Hot Springs. Before that, she spent nearly two decades at then-St. Joseph Mercy Health in Hot Springs, which became CHI St. Vincent Hot Springs in 2014. While at Mercy, she worked as vice president of quality and as vice president of operations. Whatley is a certified public accountant. A Hot Springs native, she earned both her undergraduate degree and Master’s in Business Administration from Henderson State University in Arkadelphia. She obtained a master black belt certification in GE Healthcare’s Lean Six Sigma program. arkansasmedicalnews

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Arkansas’

FIRST & ONLY Certified Comprehensive Stroke Center As a certified* stroke center, UAMS Medical Center ranks among the top stroke centers in the country. This means UAMS has a dedicated team of stroke specialists to handle the most complex stroke cases, including resources such as: 24/7 care for patients with stroke and any cerebrovascular disorder an emergency department with a dedicated stroke program and an available stroke team on-site coverage by a neurospecialist endovascular procedures and post-procedural care 24/7 dedicated neurointensive care unit beds for complex stroke patients 24/7 neurosurgical services available 24/7 on-site coverage for NICU by neurospecialist

UAMS offers your patients quick, comprehensive care − providing a greater chance of not only surviving, but leaving here in the best health possible.

UAMShealth.com/stroke *The Joint Commission is an independent, not-for-profit organization that evaluates and accredits more than 20,000 health care organizations and programs in the U.S.

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