FOCUS TOPICS ENT • HEALTHCARE CONSTRUCTION • CYBERSECURITY • ONCOLOGY
March/April December 2018 2009 >> $5
Hundreds of Millions Being Spent on Healthcare Construction Projects in Arkansas
Felicia Johnson, MD, Details New Procedure for Adult Eustachian Tube Dysfunction ENT Specialist treats voice, airway and swallowing disorders SPRINGDALE--A promising new procedure developed to help adults with eustachian tube dysfunction involves inserting a small balloon into the estuation tube to improve function without having to put a tube in the ear, which is essentially putting a hole in the eardrum ... 3
Arkansas Children’s Northwest, Washington Regional and St. Bernards Healthcare among the largest medical construction projects By BECKY GILLETTE
SPRINGDALE – The long-anticipated $100-million Arkansas Children’s Northwest (ACNW) opened in late February after years of planning and construction. “This marks the first time the region’s 200,000 children have had access to comprehensive pediatric care close to home,” said Hilary DeMillo, senior media relations specialist for Arkansas Children’s. “The Springdale campus joins a flagship hospital in Little Rock, a statewide transport system dedicated to delivering children in critical condition to life-saving care, and a range of outreach programs that include telemedicine, mobile
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Ransomware Attacks, Breach Notification, Security, And Rule Compliance: What You Need to Know Now
Adam Head Steering CARTI Toward Success
The Breach Notification Rule was introduced to healthcare in the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 ... 5
State’s largest cancer treatment facility responding to change by
LITTLE ROCK – Adam Head was chief operating officer of the Arkansas Heart Hospital for over 4 years until Sept. 5, 2017, when he took over as the new CEO of CARTI, an independent, not-for-profit cancer care provider that sees an average 26,000 patients per year. Head has always been drawn to situations that require transformative leadership. And that was just what was needed at CARTI, which has struggled with financial
See the Grand Rounds section beginning on page 7 for healthcare spot news from around the Natural State.
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Felicia Johnson, MD, Details New Procedure for Adult Eustachian Tube Dysfunction ENT specialist treats voice, airway and swallowing disorders By BECKY GILLETTE
SPRINGDALE--A promising new procedure developed to help adults with eustachian tube dysfunction involves inserting a small balloon into the estuation tube to improve function without having to put a tube in the ear, which is essentially putting a hole in the eardrum. “Initial research is showing long-lasting results, which is obviously encouraging,” said Felicia Johnson, MD, an otolaryngologist with subspecialty/fellowship training in laryngology, who works at the Ear, Nose and Throat Center of the Ozarks. “Potentially, this is a procedure you can do in the office under a local anesthetic, although it can be done in the hospital under general anesthesia, as well. Adults don’t always enjoy having a tube in their ear and having to keep water out of the ear. They can’t do deep sea diving.” Johnson said the primary advantage of the balloon therapy is that it is a permanent rather than short-term solution like tubes. Johnson has expertise in treating voice, airway and swallowing disorders. While swallowing is almost an automatic function for most people, problems can develop that make it difficult to swallow. “We see it in adults a lot more than in kids,” Johnson said. “There are a multitude of causes, some age-related. It is well known that swallowing as we get older gets weaker. We lose some of the ease of our swallowing. Sometimes chemo treatments can cause issues – we can see this after neck and spine surgeries. Acid reflux is a common cause of swallowing problems. A lot of that has to do with diet. And medications can cause swallowing problems due to drying out of the mouth and throat, which makes it a lot more difficult to swallow.” Her first step with a patient is diagnosing the problem. If the problem is a medication, she attempts to get the patient off the medicine and back to normal. When the cause is acid reflux, there are medications and dietary modifications. “If it is age related and after surgery, there is swallowing therapy, swallowing exercises to help you recover from that,” she said. People even develop swallowing arkansasmedicalnews
there a procedure that can be performed to medialize or push in the vocal cord that is weak so that the voice improves. We aren’t actually making the vocal cord work again, but we do make the voice work again.”
problems after a bout with the flu. “Some patients can develop blisters or severe inflammation in the throat after the flu or other flu-like illnesses,” Johnson said. People don’t think about all that goes into swallowing normally until something happens. Johnson said that makes people nervous because they don’t want to choke on food and have something go down the wrong way. But no matter the cause, once the inflammation goes down, people usually start to recover more normal function so they don’t have to think about it so much. “It is usually something that will improve with time,” she said.
Due to vocal cord nodules, we see young children with voice problems. It is common for singers who can injure their vocal chords. There are age-related vocal chord problems, and diseases like Parkinson’s that can affect the vocal cords. Another really common cause of vocal cord paralysis is the flu or another type of virus. Sometimes the vocal cords will recover on their own with time. “If the vocal cord doesn’t recover you can have surgeries to improve the voice and make the vocal cord work more like it used to,” Johnson said. “If the virus paralyzes the vocal cord, it often gets better with 6-9 months of time. If it doesn’t get better,
She also treats airway disorders that can include obstructions in the upper airway. Those can be caused by breathing tubes or they can be idiopathic. Remedies might include surgery. Johnson grew up in Grand Prairie, Texas, and decided early on that she wanted to be a doctor. She went to the University of Texas branch at Galveston for medical school, and did ear, nose and throat surgical residency training at the University of Oklahoma Health Sciences Center in Oklahoma City. She completed fellowship training in Laryngology & Care of the Professional Voice at the Vanderbilt University Medical Center in Nashville, Tenn. Johnson worked as an attending physician and medical school faculty member within the Department of OtolaryngologyHead & Neck Surgery at the University of Arkansas for Medical Sciences (UAMS). While at UAMS, Johnson directed the residency training program. She has also served as the president of the Arkansas Society of Otolaryngology.
Like other physicians and residents who live throughout the region, Johnson is excited about the recent opening of the new Children’s Hospital Northwest. “I’m going to be working over there with pediatric patients,” she said. “I will be on staff there now. It is very nice, a first-rate facility. I was on staff at Arkansas Children’s in Little Rock for five years, so I am very familiar with the organization. The children’s hospital is something this area has needed for a long time. It will be nice to be able to offer some of the pediatric services that we haven’t had.” Johnson became an ENT specialist in part because she likes working with such a wide range of patients from infants to elders. She also finds the intricacies of the neck and throat area to be fascinating. Johnson and her husband, James Ragland, live in Bentonville and have a son, Evan Ragland. Her main hobbies are gardening and reading. She likes suspense fiction and medical non-fiction books that talk about the latest research. “I do a lot of reading about brain science concerning what happens to cause Alzheimer’s,” Johnson said. “It is an interesting subject with a lot of new research. It has affected some of my family, and it is just so prevalent. Incidence rates in the next 20 to 30 years are expected to increase significantly.”
For more information, go online to: Department of OtolaryngologyHead & Neck Surgery, University of Arkansas for Medical Sciences, https://otolaryngology.uams.edu/
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Hundreds of Millions Being Spent, continued from page 1 health and school-based health solutions.” ACNW has some unique offerings including 233,613 square feet of wellness space designed to maximize children’s discovery and delight. There are outdoor gardens, nature trails and interactive features designed specifically for children. Some of the medical amenities include a state-of-the-art pediatric surgery unit with five operating rooms, a full range of ancillary and diagnostic services, child-life social work and pastoral care programs. There is also a helipad and refueling station supporting Angel One, a pediatric intensive care transport service. ACNW has a staff of 30 physicians in Springdale. Subspecialists based at Arkansas Children’s in Little Rock also see children at ACNW at outpatient clinics. ACNW has received tremendous support form the community with more than 14,000 gifts totaling about $81 million in philanthropic support.
Washington Regional Medical Center
Another major project in Northwest Arkansas is a $43-million Core Renewal Project at Washington Regional Medical Center, Fayetteville. Spokesperson Gina B. Maddox said the current expansion is mostly an interior renovation with technology updates, but also will include adding about 20,000 square feet (atop existing footprint) for patient rooms. Maddox said the Core Renewal Project is designed to accommodate Washington Regional Medical Center’s current needs and also to facilitate additional growth. The total project will add a Neuro Sciences ICU that will provide an additional 20 critical-care beds. There will also be an interventional radiology room to provide capacity for interventional neuro-radiology and surgical thrombectomy procedures. Maddox said it also gives the hospital the capacity to prepare for Comprehensive Stroke Center certification. Washington Regional is currently a Primary Stroke Center, the first in the region. The project also includes patient lobby space for surgery, a heart cath lab and interventional radiology. Maddox said the total project will expand the following: • Cardiology service line, including structural heart services, additional heart cath lab capacity, additional electrophysiology operating room capacity and additional echocardiogram and cardiology diagnostics • Pre-operative and post-operative capacity • Increase inpatient dialysis capacity by 50 percent • Provide space to accommodate the recent upgrade of Da Vinci surgical robot • GI and endoscopy space • Interventional radiology oncology services • Storage for sterile and central supplies • Construction is expected to be completed by September 2019. Other recent construction projects at Washington Regional include the 4
vices and the cafeteria. The master plan was developed in conjunction with HKS, a Dallas firm that has designed healthcare projects throughout the world. Nabholz Construction, with a presence in Jonesboro, is serving as contractor.
CHI St. Vincent Arkansas Neuroscience Institute William L. Bradley Medical Plaza at Washington Regional Medical Center
133,000-square-foot Women and Infants Center that opened in November 2016 and the 76,000-square-foot William L. Bradley Medical Plaza opened in May 2017.
Baptist Memorial HospitalCrittenden.
Bernards Healthcare. The first phase, enlarging and renovating the Cancer Center, was completed in 2016 and has allowed St. Bernards to bring all cancer services together under a single roof, making care more convenient for patients, according to Kila Owens, media relations manager. She also reports that Phase II, enlarging and expanding the Heartcare Center, is expected to be complete by April 1. When this project is complete, St. Bernards will have a total of six cath and electrophysiology labs. Phase III includes construction of a new five-story intensive care and surgi-
On the Northeast side of the state, in early January a “topping out” ceremony was held when construction crews placed the final steel beam on the new Baptist Memorial Hospital-Crittenden. During the event, the final beam signed by dozens of residents was raised to the top of the building. An evergreen tree and a flag were tied to the beam, as is traditional. “We thought this would be the perfect time to show the people of Crittenden County how much progress we’ve made in the past few months,” Baptist Crittenden’s CEO and Administrator Brian Welton said at the ceremony. “Construction is on schedule, and we expect it to be complete by around this time next year.” The new 65,000-squarefoot hospital will include an St. Bernards phase III expansion gets underway. emergency room, cancer services, diagnostics and operating rooms. While construction continues, cal tower, as well as permanent changes Baptist expects to start assembling the in Emergency Department access. The hospital’s leadership team and hiring staff site preparation phase is ending with unmembers this spring. derground piers/footings and utilities underway. Project is on schedule to open in NEA Baptist Clinic 2019. Also, in fast-growing Northeast Ar“This phase literally will transform kansas, Haag Brown Commercial has the look of downtown Jonesboro while announced the development of a new, giving St. Bernards a new ‘front door,’” state-of-the-art medical facility for NEA Owens said. “The five-story tower will Baptist Clinic along Highway 49 North in have a covered entrance leading into an Brookland. The 7,000-square-foot mediimpressive atrium at ground level. From cal office will be located at the corner there, patients and visitors can access of Highway 49 North and Honeysuckle admissions and registration and visitorbetween Jordan’s Kwik Stop and Dollar friendly amenities such as a coffee shop, General. education rooms, a new chapel and Recently, Haag-Brown Developmore.” ment, LLC signed a long-term lease with One level will house 14 surgical suites the NEA Baptist Health System. The and support programs. Another will house clinic will continue to operate out of their a 48-bed critical care unit. Part of the current location on West Smith Street structure will be shelled in to allow for fuuntil construction on the new building ture expansion. The expected completion is complete, which is anticipated in the date is 2019. fourth quarter of 2018. When patient care has been moved into the new tower, Phase IV work will St. Bernards Healthcare begin. It will include renovations to the Work continues on the four-phase current medical center–patient rooms as $137.5-million Master Plan project at St. well as public areas such as nutrition ser-
In the center of the state, CHI St. Vincent is building a new destination for its Arkansas Neuroscience Institute (ANI) at CHI St. Vincent North in Sherwood. ANI will be relocated from the main campus when the building is complete. Chris Stines, vice president of operations for CHI St. Vincent North, said there are two projects. One involves $13 million worth of renovations to the existing CHI St. Vincent North hospital and the second is a brand new $12-million, 40,000-square-foot Neuroscience Research and Education building that will be adjacent to the hospital that is being constructed for ANI to provide clinic space, office space for physicians and staff, an expanded cranium/spine research lab, a 150-seat auditorium and a medical office building for new tenants. “We are the destination location for neurosciences in Arkansas,” Stines said. “This expansion will allow us to become a larger presence. We outgrew our space at the current location at the Infirmary at the main campus. By moving neuroscience here, we will be able to expand capability for neuroscience and allow for future growth at the main location to continue to better serve the needs of our communities. It is pretty groundbreaking in terms of unifying the two sides of the river and erasing a perceived separation between the north and the south sides of the river. Sherwood and North Little Rock leaders are excited for us to complete the work we have started.” Stines said by moving neurosciences to this location they will be creating more opportunity for patient care centered on neurosciences as clinical staff will be primarily focused on the neuro patient, which will lead to more consistent care of the neuropatient. Nexcore is the developer for the new Research and Education Building and the general contractor is Clark Construction. For hospital side, the general contractor is Nabholz. Taggart Architecture is the architect for both the new building and hospital projects. Groundbreaking is scheduled April 27 with the project estimated to be completed first quarter of 2019. The new building will allow CHI St. Vincent to expand its existing international focus and focus on research and education. “ANI has a large international presence with other neurosurgeons throughout the year and holds six educational (CONTINUED ON PAGE 8)
Ransomware Attacks, Breach Notification, Security, And Rule Compliance: What You Need to Know Now By LORETTA DUNCAN, FACMPE
The Breach Notification Rule was introduced to healthcare in the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. Since that time, more than 2200 covered entities and business associates have reported breaches affecting 500 or more individuals, with the total number of individuals impacted by these breaches exceeding 170 million. The majority of these breaches involve electronic protected health information. Ransomware occurs when a cybercriminal obtains access to a covered entity’s ePHI and holds the data hostage until a ransom is paid. This type of attack on healthcare data is considered one of the “biggest current threats to health information privacy,” according to the Office of Civil Rights (OCR), the agency that enforces HIPAA Rules. A ransomware attack can virtually paralyze a medical practice’s operations. Following an attack, there will be a frenzy of activity to limit the damage and restore normal operations; however, there may be even more devastation and hardship from
a HIPAA standpoint. Guidance issued by the OCR states that a ransomware attack will be considered a breach unless it can be proven that the ePHI was not compromised. The sheer presence of ransomware indicates that a medical practice’s systems were compromised, and ePHI could have been at risk. The OCR states, “Whether or not the presence of ransomware would be a breach under the HIPAA rule is a
fact specific determination.” Therefore, it is up to the organization to determine whether or not a breach occurred and to respond appropriately. This requires medical practices to perform a forensic investigation to uncover the underlying details of the attack and to ensure ePHI was not compromised. The primary purpose of ransomware is to extort the victim for money - at least, that is how it appears on the surface. Ran-
somware works by encrypting computer files, thus making them unreadable by the computer system that holds the data. To complete the encryption process, the ransomware must access and process the data in question. One must assume that additional payloads (malicious intentions) could be present and executed on the system. For instance, did the perpetrator read, alter, or transfer the data offsite prior to encrypting? Did they leave a backdoor that provides future access? These are just some of the facts that will be uncovered during a forensic investigation. Organizations need a well-defined incident response plan to guide their actions in the event of an attack. HHS OCR references NIST SP800-61 Rev. 2, Computer Security Incident Handling Guide for those needing additional information. In general, incident response plans include the following phases (NIS SP800-61 Rev.2): Preparation – includes educating employees, conducting risk assessments, development of incident response plans, and implementation of preventative controls Detection and Analysis – identi(CONTINUED ON PAGE 6)
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The Anatomy of an Audit- Part II UPICs – The Newest Kind of Auditor
It is no secret that there are extensive challenges facing healthcare providers in today’s regulatory environment. In particular, the significant increase in government healthcare program audit activity over the last ten (10) to fifteen (15) years has created additional uncertainty and risk in the healthcare industry. The prudent provider is always aware that the government has a bevy of resources, including contracted audit review companies, to facilitate audits of providers, and associated overpayment refund demands. In a relatively recent development, the Unified Program Integrity Contractor, or “UPIC,” is one type of entity that providers will beThe Authors: gin to see and hear more from, as the existing ZPICs1 (Zone Program Integrity Contractors) are replaced by the UPICs. In this regard, CMS recently awarded UPIC contracts in five geographically defined jurisdictions.2 Health Integrity, LLC was awarded the UPIC contract for the South-Western jurisdiction.3 One of the stated purposes of the UPICs is to facilitate the streamlining of (and hence “unify”) efforts of government healthcare program contractors who are auditing providers, for the purpose of identifying billing practices that could be alleged as fraud, waste or abuse. These efforts have Lynda M. Johnson, historically been fragmented. In the CMS issued document, “Comprehensive Medicaid Integrity Plan. Fiscal Years 2014-2018,” (the “Plan”)4, the HHS Secretary established a comprehensive plan for ensuring the program integrity of the Medicaid program. As a result, CMS developed the concept of the UPIC auditors. The Plan lists six (6) broad areas— mainly focusing on streamlining efforts among the government and the states to protect beneficiaries and the integrity of the Medicaid program. The Plan notes that because of the overlap of beneficiaries and providers, there are opportunities to safeguard both Medicare and Medicaid from fraud, waste, and abuse through data analytics, coordinated audits, and collaboration among both state and federal law enforcement agencies in investigations and prosecutions.
Timothy C. Ezell, Partner
By and large (at least in our experience) State Medicaid program audits of providers have been conducted at the State level, primarily relying on State employees and State departments to conduct the audits and make decisions regarding overpayment demands and settlement amounts, in the event that an overpayment is alleged. While State Medicaid programs may have Tonya S. Gierke, RN, received some assistance from Federal healthcare CIC, Associate program contractors in connection with these audits (perhaps in the nature of data mining and similar background work), providers have typically corresponded directly with local, State employees and departments in connection with these audits. It appears that CMS’s plan going forward is for UPICs to be heavily involved in State Medicaid program audits. It is currently unclear how much discretion will remain with the local State Medicaid programs to determine overpayment demand amounts and to agree to settlements, etc. However, we do not consider UPIC involvement in State Medicaid audits to be good news for providers. Providers should expect UPICs to conduct their post-payment record reviews and audit activities in a manner similar to ZPICs. The Medicare Program Integrity Manual specifically states that all references to ZPICs in the manual shall also apply to the UPICs unless specifically noted. Providers should read document requests very carefully and note what types of documents are being requested. This could provide some insight as to what the focus of the review is. It is unclear when the UPICs will entirely phase-out the ZPICs. In the event that you are the recipient of a post-payment audit from a UPIC (or a ZPIC), consider bringing your legal counsel in early during the process to protect your interests. 1 AdvanceMed Corporation located in Nashville, Tennessee is the current ZPIC for Arkansas. 2 The UPIC jurisdictions include the Western, Mid-Western, South-Western, North-Eastern, and South-Eastern. Arkansas is located in the South-Western region which also includes Colorado, New Mexico, Oklahoma, Texas, Louisiana, and Mississippi.
Ransomware Attacks, continued from page 5
About the Writer Loretta Duncan, M.S., FACMPE, is a Senior Medical Practice Consultant with SVMIC and specializes in assisting policyholders with HIPAA compliance. She holds a Master of Science in Health Law and Policy from Samford University, Cumberland School of Law.
fies indicators of compromise plus preliminary analysis to understand the incident Containment, Eradication and Recovery – containment isolates the infected system and prevents propagation to other systems; eradication removes the ransomware; recovery restores encrypted data and returns systems to normal operations Post-Incident Analysis – examines the evidence to establish a detailed report of the incident; fulfills post breach responsibilities; includes lessons learned for future improvement It is during the post-incident analysis phase that the forensic investigation will occur and subsequently determine if a breach took place. Investigators will be interested in the particular strain of ransomware infecting the system(s). Antivirus vendors and security researchers closely identify, follow, and analyze ransomware as well as other types of malware. Once the strain has been identified, the characteristics and behaviors will be known. This knowledge can be used to demonstrate whether or not the ransomware exhibits behavior that puts ePHI at risk. Known characteristics and key indicators of compromise include: • infection and propagation methods • types of targeted data such as banking, health, or personal information • if data exfiltrated to the Internet • if backdoors used to give perpetrators unauthorized, future access Log files produced by technical security controls hold valuable information and aid the forensic investigation. These logs are found on desktops, servers, firewalls, web filters, and intrusion detection systems. However, these devices must first be configured to collect the necessary information. It is important that medical practices talk with their information technology and security providers to ensure the appropriate controls are in place and properly configured. If an entire medical practice’s patient database has been compromised in a ransomware attack, the practice will usually be required to provide written notification to all patients, notice to the OCR through their online portal,
3 The UPIC contract is for 60 months. See http://www.fedhealthit.com/2017/09/cmsawards-87m-upic-contract-south-western-jurisdiction/. 4 See https://www.cms.gov/Regulations-and-Guidance/Legislation/DeficitReductionAct/ CMIP.html.
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and notice to local media. This notification must take place within 60 days of discovering the breach. A breach of this magnitude will also require the practice to be listed on the OCR’s publicly accessible website that displays all covered entities and business associates with breaches involving 500 or more individuals. More importantly, this type of breach will prompt an investigation by the OCR. Even though a ransomware attack is not necessarily an intentional breach of ePHI, it can still lead to substantial costs to a medical practice. When the OCR investigates a breach of ePHI, whether due to a ransomware attack or the loss or theft of a device containing patient information, the dollar amount of a settlement or potential civil monetary penalty will be based on the covered entity’s level of compliance with the HIPAA Security Rule. Medical practices should review their compliance with the Security Rule, especially now, since cyber-crime is at an all-time high and healthcare information is so valuable. Steps that can be taken to help protect covered entities from a cyberattack: • Conduct a risk analysis to identify threats and vulnerabilities to electronic protected health information (ePHI) and establish a plan to mitigate or remediate those identified risks • Implement procedures to safeguard against malicious software • Train authorized users on detecting malicious software and report such detections • Limit access to ePHI to only those persons or software programs requiring access • Maintain an overall contingency plan that includes disaster recovery, emergency operations, frequent data backups, and test restorations All of these steps are requirements of the Security Rule. Compliance with the Security Rule not only protects medical practices from a potential breach and a large potential settlement with the OCR, it also protects patients. If ePHI is held for ransom, corrupted or lost due to a computer malfunction, patients may not receive the care they need in a timely fashion. It is imperative that medical practices take the time and allocate the financial resources to ensure the security of all ePHI that is created, received, maintained or transmitted. Copyright 2018 SVMIC. Reprinted with permission. This article is intended for educational/informational purposes only and is not intended to constitute legal advice.
GrandRounds Families Inc. Counseling Services Welcomes Pawel Kurylo, MD PARAGOULD - Families Inc. Counseling Services is pleased to announce the addition of psychiatrist Pawel Kurylo, MD, to our Jonesboro and Paragould clinics. Kurylo is a native of Poland and moved to Little Rock, with his family when he was just five Dr. Pawel Kurylo years of age. He joins Families, Inc. after serving in the Central Arkansas Veterans Affairs Heathcare System since July, 2011. He received his Bachelor of Science in Biology from the University of Arkansas at Little Rock, graduating Magna Cum Laude, and his Doctor of Medicine from the University of Arkansas for Medical Sciences. In addition, he completed his psychiatric residency at UAMS. Kurylo is board certified in psychiatry and neurology. Medical Director, Dr. John Burnett said he was pleased to add Kurylo to the existing team that is comprised of psychiatrists and psychiatric nurse practitioners. Kurylo has two dogs and enjoys fishing, drawing, and music.
Albertson Promoted To Director Of Radiology VAN BUREN - Heather Albertson, BSRT(R)(N)(CT), NMTCB, was recently promoted to Director of Radiology and Imaging at Sparks Medical Center Van Buren. Albertson has been with Sparks since 2000 and most recently served as Radiology Heather Albertson Manager. As director, she will oversee the daily operations of the radiology department. Albertson also serves the facility Radiation Safety Officer. Last Spring Albertson was added to the American Registry of Radiologic Technologists (ARRT) for Computed Tomography. It was her third registry with the ARRT and fifth registry overall. To be on the registry, radiologic technologists must meet clinical experience requirements and pass appropriate examinations. This advanced-level certification through the ARRT shows a dedication to quality and safety. She is also currently a clinical instructor for the University of Arkansas.
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Adam Head Steering CARTI Toward Success, continued from page 1 losses in recent years. “With multiple acquisitions and needing subsequent integration of many different clinics and practices, CARTI has suffered from very poor financial performance in the past couple of years,” Head said. “The main facility has state-of-the-art cancer treatment equipment but was expensive to build – $90 million. The challenges of this transition were multi-faceted including physically relocating various oncology groups into one large space, as well as bringing many different teams and many varied cultures into one building, all with the desire to take excellent care of patients.” Head said while CARTI has a wonderful mission of helping patients all over the state diagnosing cancer and providing the very best in treatment options, these recent transitions created some significant leadership challenges. Head saw an opportunity to bring all the pieces together. “Our biggest accomplishment is that
Hundreds of Millions, continued from page 4 conferences per year,” Stines said. “We will be able to transmit images of surgeries we do in the new operating rooms via technology over to the new auditorium of the Research and Education Building so learners can view those surgeries in 3D animation.” In addition to renovating four operating rooms, they are also adding 10 additional ICU rooms and their total critical care beds will go up from eight to 18. They will be getting an additional 3T MRI and also getting an additional 128slice CT. “The 3T MRI technology will allow us to better diagnose clinical problems than with the 1.5T MRI,” he said. “For example, it is more advanced in diagnosing seizure activity. In addition to those two pieces of advanced radiology technology, we are adding an Angio suite, which includes a bi-plane for neurointerventional radiology. We are also building a new pharmacy on our ground floor and as well as a helipad.” The hospital work is expected to be complete in the fourth quarter of 2018.
Mercy Therapy Services
Another healthcare construction project in Northwest Arkansas was celebrated recently when a blessing and ribbon cutting were held Feb. 19 for the quadrupling of space at Mercy Therapy Services at 1101 S. Horsebarn Road in Rogers. Mercy Therapy Services now totals about 10,000 square feet housing 11 providers, including six physical therapists, who can help patients recovering from surgery, injury or illness. The space was renovated to add new treatment areas and equipment, wide-open exercise spaces and curtained treatment rooms for individualized therapy. “Now we have this shiny, sparkling new space, and we have the ability to care for more patients in a way that doesn’t feel like they’re on top of each other,” said Joe Manthe, Mercy’s director of therapy services. 8
we now have a leadership team working collaboratively with CARTI’s physicians,” Head said. “We are all pulling the same direction. I think everyone was ready for something new and different. I don’t want to say the ship is back on course. I can very confidently say the ship is on a new course. We are aggressively leaning forward into all we see this place can become.” Head said it is common for organizations to resist changes because of the ageold mentality, “we have always done it this way.” To overcome that means having a culture of leadership intentionality, as well as a solid foundation of strong communication and collaborative working relationships with team members and providers. “When you do something the same way for a long, long time, it can be difficult to look at things in a brand-new light,” he said. “But if you do that, you have unlocked unlimited potential for the future. You do that organization-wide and all of the sudden you can dig into areas you never thought you could before.” Head found that CARTI’s leadership landscape was ripe with opportunities. “When I initially engaged, I set up a plan of attack and a lot of that involved listening, finding out what is going on,” Head said. “It didn’t take me long to see we needed some fresh eyes on the scene with our leadership team. Our entire executive team has been here less than a year and we work together really well. That is true not just of the executive team, but physician leaders, as well. We now have an environment where momentum is steadily building. We just hired our 26th physician.” Head sees communication as vital to discuss not just what is going well, but what might not be going well. You have to be willing to hear the hard stories such as, “I’m upset because of this,” or “I’m burned out here,” etc. Once you’ve heard it all, you call a truce jointly and, in a way, set everyone
free to move forward toward a new and common vision. “I believe leadership is the ability to inspire people to work toward a common goal,” he said. “As CEO of CARTI, the buck may stop with me. After all, it is my job to see the vision and communicate it. I am accountable for the success of CARTI. But it is not about me. Every role is important here. We believe in equal value, different function. But, truthfully, it is not even about any member of this team. It is always about the patients and families we serve.” Head has high expectations of himself and others. “I probably am harder on leaders more than others,” he said. “Part of that is because of the pressure I put on myself as CARTI’s leader.” Head names as one of his most influential mentors Charlie Smith, former CEO of Arkansas Heart Hospital. “He really challenged and mentored me in healthcare leadership when I first got out of the Army and showed me what leadership in healthcare looks like,” Head said. “He taught me if you do right by patients, you never go wrong. He also taught me to be a challenger.” Certainly, his new position is a challenging one since CARTI has been losing millions on operations alone in recent years. “Pulling everyone together, working with our physicians face-to-face, restructuring how we do things, we’ve seen some real success,” Head said. “It is a team effort. The results are CARTI has just had its fourth straight month in a row with a positive margin. This is the first time that has happened since 2015. It requires great intentionality and there is reason to be excited. But, at the same time, we take that humbly and are never satisfied.” For 2018, he wants to see CARTI to continue to grow.
“We want to get the news out that we are not just digging our way out of a hole,” he said. “We are scaling CARTI’s operation to new levels. We are thrilled about the future because we have the ability to serve patients in an even greater way than historical norms.” In addition to the main campus in Little Rock, CARTI has 10 other sites. Head said they want CARTI to be a destination for cancer patients both inside and outside this state. “We literally have some of the best diagnostic and treatment technology in the nation and some of the best physicians right here in the heart of Little Rock,” Head said. “A lot of people don’t know that.” A native of North Little Rock, Head received an Army ROTC scholarship to the University of Arkansas that got him interested in leadership. In the aftermath of 9-11, he became an officer in the Army Medical Services Corps and spent a year in Iraq in 2005. “Leading soldiers in a combat environment is the ultimate proving ground,” Head said. “Being in that environment really helped shape me into who I am today. In this setting, as I see it, we have assembled a powerful team with the most sophisticated weapons to go to war together in our larger scale fight against cancer, and in how we want to deliver care to the entire state and beyond.” Head and his wife, Courtney, have been married 15 years and have four children. “We have a lot of fun and love living life together,” he said. “I follow the Theodore Roosevelt principle of life by regularly taking part in intensive physical training. I like to get up at 4:30 a.m., spend some time praying, and then put myself through intense workouts for an hour or so. It is a stress reliever and creates a flint-like focus. I’ve done that since I was in the Army.”
by Robin and Gary George, Cathy and David Evans and their families, a $7.5 million investment in the region’s children. Arkansas Children’s leadership announced plans for the hospital, which has benefitted from tremendous community investment, in August of 2015, embarking on an ambitious design-build plan. They developed ACNW as one component of a statewide network of care designed to reach more kids in more ways as close to their homes as possible. The new campus joins a flagship hospital in Little Rock, a statewide transport system dedicated to delivering children in critical condition to life-saving care, and a range of outreach programs that include telemedicine, mobile health and schoolbased health solutions. As the region’s only comprehensive pediatric health center, Arkansas Children’s Northwest also offers families: • 233,613 of wellness space designed to maximize children’s discovery & delight • A state-of-the-art pediatric surgery unit with 5 operating rooms
• A full range of ancillary and diagnostic services, child-life social work and pastoral care programs • Outdoor gardens, nature trails and interactive features designed specifically for children • A helipad and refueling station supporting Angel One, one of the nation’s leading pediatric intensive care transport services After opening outpatient services in January, Arkansas Children’s Northwest passed state licensure requirements with the Arkansas Department of Health in February. This cleared the way for the fivestory hospital and its wellness-focused campus to welcome families for surgeries, chemotherapy infusions and diagnostic tests, among other services. The staff of Arkansas Children’s Northwest, including its Emergency team, has been training on site since December. Day-in-the-life exercises and constant monitoring of the region’s situation have prepared the team for an influx of patients on Day 1.
GrandRounds Arkansas Children’s Northwest Opens as Region’s First and Only Pediatric Hospital and ER SPRINGDALE – The 200,000 children of Northwest Arkansas will have access to comprehensive pediatric medical care 24/7 with the opening of Arkansas Children’s Northwest (ACNW), the region’s first and only children’s hospital and pediatric emergency department. This milestone marks the first time that pediatric emergency medical services have been available where Northwest Arkansas children live, learn and play. Arkansas Children’s Northwest is designed, staffed and equipped just for children. Resources ranging from bed size to play-focused therapy and medications are specially tailored to children’s unique sizes and needs at ACNW. The health system moved existing outpatient clinics from Lowell to the new facility in January. Offering 24 inpatient beds and 30 clinic rooms, ACNW was built on 37 acres in Springdale donated
GrandRounds Dr. Doug Ross Promoted To Chief Medical Officer For CHI St. Vincent LITTLE ROCK – CHI St. Vincent announced that Dr. Doug Ross has been promoted to the position of Senior Vice President and Chief Medical Officer. Dr. Ross, of Hot Springs, previously was vice president of medical affairs for CHI St. Vin- Dr. Doug Ross cent Hot Springs. In his new position, he will oversee medical services throughout the CHI St. Vincent system. Ross has played a key role in helping CHI St. Vincent develop an integrated emergency medical group covering all four CHI St. Vincent hospitals in central Arkansas and Conway Regional Medical Center. He has also played an essential role in quality improvements at CHI St. Vincent Hot Springs. Ross joined what was then Mercy Hot Springs in 2003 as an emergency medicine physician. He has also served as chief of staff, medical director of informatics and medical director of the emergency department. He is board certified in emergency medicine and he completed his residency in emergency medicine at the University of South Carolina. He is a graduate of the University of Arkansas for Medical Sciences
Crystal Bohannan Named VP of Operations For CHI St. Vincent Hot Springs HOT SPRINGS – CHI St. Vincent Hot Springs has named Crystal Bohannan as vice president of operations. In her new position, Bohannan will be responsible for overseeing finance and revenue for CHI St. Vincent’s locations in Hot Springs, which include a hospital Crystal Bohannan and multiple clinics. Bohannan joined CHI St. Vincent Hot Springs in 2014 as market director for operational finance. She earned her bachelor’s degree from Southern Arkansas University and Master of Business Administration degree from Mississippi State University. In her new role, Bohannan will assume leadership in a variety of operational sectors at CHI St. Vincent Hot Springs, including prevention services, volunteer services, senior services, environmental services and nutrition services. She will continue her responsibilities in health information management, patient access, IT and materials management.
New Director of Surgical Services named at Conway Regional CONWAY - Tyler McDonald, RN, of Springhill is the new director of Surgiarkansasmedicalnews
cal Services for Conway Regional Health System. The position requires expertise in clinical and business operations of a surgery department that includes eight inpatient operat- Tyler McDonald ing suites, outpatient surgical services, preoperative, postoperative and sterile services. Overall, he oversees the work of 104 employees. McDonald is also responsible for working with physicians to improve surgical processes and ensure a safe patient environment for surgical procedures. Prior to joining Conway Regional, McDonald spent eight years in leadership positions at CHI-St. Vincent including most recently Market Director of Nursing Operations for the health system. McDonald holds a Bachelor of Science degree in Nursing from the University of Central Arkansas and a master’s degree in Health Administration from Ohio University. A native of El Dorado, McDonald and his wife, Kami, have lived in the Conway area since 2004.They have three children.
Anesthesiologists join Conway Regional to form Conway Regional Pain Management Center CONWAY - Anesthesiologists Jevin Smith, MD, Brad Lindsey, MD, and Jonathan Lee, MD, have partnered with Conway Regional Health System to form the Conway Regional Advanced Pain Management Center. The center opened in Jan. in Suite 304 of Dr. Jevin Smith the Conway Regional Medical Tower, located off the East Lobby of Conway Regional Medical Center. Office hours are Monday through Thursday, 8 am to 5 pm, Dr. Brad Lindsey closing from 12 to 1 pm and Friday 8 am to 12 pm. Drs. Lindsey, Smith and Lee formerly practiced pain management as Conway Pain Clinic. They evaluate, diag- Dr. Jonathan Lee nose and provide interventional treatment for a wide range of disorders including acute pain, chronic pain and cancer pain. Drs. Lee and Smith will also remain in practice alongside Drs. Carol Angel and Jennifer Bishop with Conway Anesthesiology Consultants. They can be contacted for pain management services at (501) 358-6560.
North Arkansas Regional Medical Center Named Top 100 Rural & Community Hospital for Second Consecutive Year HARRISON - North Arkansas Regional Medical Center (NARMC) is honored to be named one of the 2018 Top 100 Rural & Community Hospitals in the United States by The Chartis Center for Rural Health. This is the second consecutive year NARMC was named to this prestigious list. NARMC scored in the top 100 of rural and community hospitals on iVantage Health Analytics’ Hospital Strength INDEX®. The INDEX is the industry’s most comprehensive and objective assessment of rural provider performance, and its results are the basis for many of rural healthcare’s most prominent awards, advocacy efforts and legislative initiatives. The list of the Top 100 Rural & Community Hospitals can be found at www.ivantageindex. com/top-performing-hospitals The Top 100 Rural & Community Hospitals play a key role in providing a safety net to communities across America – and the INDEX measures these facilities across eight pillars of hospital strength: Inpatient Share Ranking, Outpatient Share Ranking, Cost, Charge, Quality, Outcomes, Patient Perspective and Financial Stability. The Hospital Strength INDEX provides a true benchmark for helping rural providers to better understand performance levels and identify areas of improvement. When looking across the spectrum of rural-relevant INDEX indicators, the Top 100 Rural & Community Hospitals are establishing a new standard for how to deliver higher quality care to their communities despite an unpredictable healthcare environment says Michael Topchik, National Leader of The Chartis Center for Rural Health.
Vann Achieves Certification as Advanced Neurovascular Practitioner FAYETTEVILLE - Sara E. Vann, MS, PA-C, ANVP-BC, Stroke Program Physician Assistant at Washington Regional Medical Center, recently achieved designation as an Advanced Neurovascular Practitioner-Board Certified. To earn this Sara E. Vann credential, she was required to meet certain eligibility guidelines and pass a nationally administered exam. Vann, who joined Washington Regional in 2015, earned a bachelor’s degree from Rutgers University in New Brunswick, N.J., and a master’s degree in physician assistant studies from Thomas Jefferson University in Philadelphia. She earned certification from the National Commission on Certification of Physician Assistants and is a member of the American Academy of Physician
Assistants, Arkansas Academy of Physician Assistants, Association of Neurovascular Clinicians, Neurocritical Care Society and American Heart Association/American Stroke Association.
Dr. Jeff Mayfield Appointed to Special Commission of AAFP LITTLE ROCK - Dr. Jeff Mayfield, a family physician at Baptist Health Family Clinic-Bryant, an Arkansas Health Group clinic, was recently appointed to the commission on Continuing Professional Development of the American Academy of Family Physicians. Dr. Jeff Mayfield He, along with his fellow commissioners, will meet three times a year reporting directly to the AAFP board of directors. One of the main duties of the CPD commission is to assign how much Continuing Medical Education credit will be given to every CME activity (over 3000) available to AAFP members and what each activity is valued. Some of CPD’s other priorities include: • AAFP CME Accreditation – Guidance and perspective on AAFP’s accreditation or provision of CME/CPD delivery methods, such as live group activities, interactive lectures, problembased learning discussion, procedural workshops, self-study learning activities, and other innovative methods for teaching, learning assessment or improvement • CME aspects of Maintenance of Certification and Licensure • Performance Improvement Continuing Medical Education • Oversight of the planning provision and evaluation of all AAFP provided CME activities. Mayfield’s term of office began in December 2017 and ends Dec. 14, 2021. He was nominated by the Arkansas Chapter of the AAFP Board of Directors. Mayfield has served the AAFP Arkansas Chapter for over 20 years having served in every elective office including president (2011-’12) and currently as alternate delegate to the AAFP Congress of Delegates and the Executive and Nominating Committee. The AAFP is the nation’s second largest medical specialty organization with over 129,000 members nationwide with chapters in every state as well as Uniformed Services, Virgin Islands, Guam, and Puerto Rico with the mission to improve the health of patients, families and communities by serving the needs of members with professionalism and creativity. The four objectives of the AAFP is Advocacy, Practice Enhancement, Education and Health of the Public. The AAFP Arkansas Chapter has over 1,350 members.
GrandRounds large or difficult and would not do well with standard endoscopy or have failed with it previously. A shock wave, sent via probe to the stone, is able to disintegrate the stone in seconds. The EHL procedure is a valuable tool that allows for a more efficient means of breaking up the stones. Now, with EHL technology, the stones are broken up quickly and much more easily, and patients are potentially able to avoid major surgery.
Mercy Health Foundation Receives Dental Grant Sparks Celebrates Opening Of New Cath Lab
Family Medicine Group Moves into New Location HARRISON - North Arkansas Regional Medical Center (NARMC) is proud to announce that Dr. Reese and his team have moved into a new location. Patients can now visit the Family Medicine Group at 715 West Sherman Street Suite J in Harrison. Dr. Ronald Reese has served the Harrison community for 42 years. He was the first physician to join forces with North Arkansas Regional Medical Center (NARMC). He and his team are looking forward to continuing to serve their patients in a new facility. Amy Raver has worked with Dr. Reese for 12 years and with NARMC for six years. Kim Pemberton has worked with NARMC for 29 years and Michele Baker has worked intermittingly for NARMC since 1984. Please join us in welcoming Dr. Reese and his team to their new office!
UAMS Jones Eye Institute Opens Walker Eye Surgical Simulation & Education Center LITTLE ROCK - A portion of the ninth floor at the University of Arkansas for Medical Sciences’ (UAMS) Harvey & Bernice Jones Eye Institute has been transformed into an instructive, collaborative center where ophthalmology residents and UAMS students can learn surgical techniques and procedures outside the confines of an operating room, thanks to a $600,000 donation from the Willard & Pat Walker Charitable Foundation. UAMS faculty, staff and supporters celebrated the opening of the Walker Eye Surgical Simulation & Education Center on March 7 with a dedication ceremony, complete with tours of the simulation center, classrooms and clinical space that comprises the renovated floor. Johnny Mike Walker, Walker Foundation trustee and son of Willard and Pat Walker, and Mandy Macke, foundation associate director, were in attendance. The Walker Center features simulation machines, microscopes and other equipment to help the next generation of ophthalmologists hone their skills. Under new curriculum requirements, ophthalmology resident physicians will have to show proficiency in certain surgical techniques and procedures, including suturing, cataract surgery and glaucoma surgery. The center will also be open to medical students and ophthalmic medical technology students.
FORT SMITH - Sparks Health System celebrated the opening of a new Cardiac Catheterization Lab at Sparks Regional Medical Center with a ribbon cutting and tour with the Fort Smith Regional Chamber of Commerce. The new cardiac catheterization laboratory, or “cath lab,” is the fourth procedure room of its type at the hospital. The room performs important imaging functions that view inside patients’ hearts and blood vessels to see if they have heart disease. Working together, physicians and nurses perform both diagnostic cath procedures, as well as provide emergent care during heart attack, like placing a stent in a blocked artery. In addition to the space, Sparks has also invested in the latest technology in order to meet the demand for cardiac care and provide valve replacement surgery for patients diagnosed with valve disease, like aortic stenosis. A construction crew broke ground on the cath lab expansion in August and cardiology staff will begin utilizing the room this week. The 1,600 square foot expansion is located on the southeast corner of the hospital and connects to the existing cath and cardiology procedure areas. Sparks is an accredited Chest Pain Center by the American College of Cardiology. Nearly 5,000 procedures were performed in the cath labs at Sparks last year and that number is expected to grow as more people struggle with high blood pressure, obesity and heart disease.
Baptist Health Performs First of its Kind Procedure on Bile Duct Stones in Arkansas
Pictured left to right: John P. Shock, M.D., JEI founding director; interim UAMS Chancellor Stephanie Gardner, Pharm..D, Ed.D.; Mandy Macke, Walker Foundation associate director; Johnny Mike Walker, Walker Foundation trustee and son of Willard and Pat Walker; Nancy Shock; Terri Westfall; and Christopher T. Westfall, M.D., JEI director, interim UAMS College of Medicine dean, and director of its Department of Ophthalmology.
LITTLE ROCK – Many people are familiar with kidney stones or gallstones in the gallbladder, but a small percentage of those with gallstones will have gallstones in the bile duct. Previously, patients in Arkansas with particularly difficult bile duct stones would need invasive surgery or would be sent out of state. Now, there is another option. The first procedure utilizing electrohydraulic lithotripsy (EHL) to break up gallstones in the bile duct in Arkansas has been performed at Baptist Health Medical Center-Little Rock by Dr. Ali Khan, gastroenterologist. EHL can be used to fragment common bile duct stones that are particularly
FORT SMITH - Delta Dental of Arkansas Foundation has awarded a $20,000 grant to Mercy Health Foundation in Fort Smith to help underserved cancer patients at Mercy receive oral health care. The grant was awarded to provide oral health education, preventive care and treatment for underserved patients with head and neck cancer, since these patients have the highest risk of developing oral complications before, during and after cancer treatment. Their health outcomes are directly impacted by treatment delays and nutritional issues caused by dental problems.
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