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FOCUS TOPICS WOMEN’S HEALTH • PRACTICE MANAGEMENT • CNO ROUNDTABLE • NEUROLOGY

May/June 2018 December 2009 >> $5

Arkansas Medical Group Management Association Holds Annual Conference

ON ROUNDS

Group promotes successful management of medical practices throughout the state Gynecologic Oncologist Urges Screenings for Early Detection FAYETTEVILLE--As the staff gynecologic oncologist at Washington Regional Medical Center, Randall D. Hightower, MD, sees firsthand the consequences of failure to screen for gynecologic cancers ... 3

Searching for Sustainable Solutions to the Physician Shortage Complex problems rarely have simple solutions. Certainly that is the case with the looming physician shortage facing the United States. New research published last month by the Association of American Medical Colleges (AAMC) shows increasing shortages looming for both primary and specialty care ... 9 See the Grand Rounds section beginning on page 12 for healthcare spot news from around the Natural State.

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arkansasmedicalnews

By BECKY GILLETTE

The Arkansas Medical Group Management Association (ARMGMA) has a very specific vision in mind – to develop a group that promotes the successful management of medical practices throughout the state, and one that comes together for positive experiences and networking, said ARMGMA President Jill Smith. “Our goals are to strengthen the skills of our healthcare managers by providing education, keeping them informed, and allowing opportunities to build relationships with other managers,” Smith said. “Attending the yearly ARMGMA conference that we held April 24 does just that. We try to always provide information relevant to the latest healthcare topics. These topics could include anything from current legislative issues, to performance-based payment programs, to how to deal with a difficult employee. ARMGMA helps provide necessary tools to be a successful healthcare manager as well as a great opportunity to network with other managers across the state.” Thomas H. Stearns, FACMPE, VP Medical Practice Services, State Volunteer Mutual Insurance (CONTINUED ON PAGE 8)

Jill Smith

HealthcareLeaders

Five Nurses, Five Questions, Five Perspectives

A Chief Nursing Officer has to be more than a leader behind a desk By BECKY GILLETTE

EDITOR’S NOTE: Below, the Arkansas Medical News features interviews with five Chief Nursing Officers (CNOs) about the challenges, rewards and leadership vision for the major medical institution where they head the nursing staff.

Michael Howard:

Michael Howard

Michele Diedrich

Meredith Green

Angie Smith

Louise Hickman

Michael Howard, BSN, MM, MSN, MHA, NE-BC, is the CNO for Arkansas Children’s Northwest (ACNW). He is responsible for planning, organizing and directing the overall operations of Nursing/Patient Care Services at ACNW. Howard comes to ACNW (CONTINUED ON PAGE 4)

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PhysicianSpotlight

Gynecologic Oncologist Urges Screenings for Early Detection

Randall D. Hightower, MD, authors study showing older/ younger women benefit equally from treatments for ovarian cancer By BECKY GILLETTE

FAYETTEVILLE--As the staff gynecologic oncologist at Washington Regional Medical Center, Randall D. Hightower, MD, sees firsthand the consequences of failure to screen for gynecologic cancers. “For sure, preventive screening is very important for our patients, especially for the diagnosis of a preinvasive process and catching it prior to the development of a gynecologic cancer,” Hightower said. “An example would be a Pap smear being performed for the prevention of cervical cancer. Often in patients with cervical cancer, we may see that her last Pap smear was performed after the delivery of her last child 20 years earlier. Having more frequent Pap smears could diagnose a precancer with corresponding treatment given to address it, thus, preventing cervical cancer.” As a gynecologic oncologist, Hightower not only treats gynecologic cancers, but also preinvasive diseases of these organs such as cervical, vaginal and vulvar dysplasias, as well as endometrial hyperplasia. The evaluation may include colposcopy, and treatment of preinvasive diseases may include CO2 laser, local excision, Loop Electrical Excision Procedure or cold knife conization. “These preinvasive procedures are very much the treatment of choice and can cure patients of these processes that may lead to cancer,” said Hightower, who has a clinic, Gynecologic Oncology, across from Washington Regional Medical Center. “That is the idea, to catch it early.” Hightower, who has practiced at Washington Regional since 2001, was the first in Northwest Arkansas to provide gynecologic oncology care. He grew up in Russellville and became interested in medicine by watching the role that many doctors played in the care of his mother, who had cardiovascular disease. “It required many medical and surgical interventions on behalf of my mother,” Hightower said. “I admired them and appreciated the care and compassion they showed. I witnessed what a role they provided in improving the quality of life for my mother. Those influences shaped my life and guided me toward becoming a physician.” arkansasmedicalnews

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He was attracted to the specialty of gynecologic oncology because of the challenges of working in a field where you take care of potentially very sick people

with life-threatening diseases such as ovarian, endometrial, or cervical cancer. “These people represent daughters, sisters, mothers, wives and grandmothers who play a very important part in our lives,” Hightower said. “These are the people we work with, play sports with and attend church with. To be able to participate in their care with surgery or chemotherapy and possibly improve their quality of life was a goal I wanted to achieve. My life has been made better for this endeavor. I am lucky to be able to take care of these wonderful people.” Hightower gets high satisfaction marks from patients who say he makes them feel very comfortable while also being professional, positive and encouraging. “Almost a year since this journey in my life began with ovarian cancer,” one patient wrote to him recently. “So thankful to have you as a surgeon and

also trust my health will stay. May God richly bless you in your work as you do for others.” “Comments like that make it all worthwhile,” Hightower said. Since February 2012, Washington Regional has had a da Vinci® Surgical System and currently has the newest version, the Xi. Hightower said using robotic surgery allows doctors to perform many types of procedures that in the past had been difficult or impossible to perform. “We see many advantages for our patients using robotic surgery, including shorter hospital stays, reduced blood loss, reduced pain and faster recovery times – all with the use of small incisions compared to traditional open surgery,” Hightower said. “Mainly I use it for cervical cancer and endometrial cancers. I also use it for the patient who may have certain physical conditions, such as obesity, where smaller incisions are beneficial and alleviate additional complications.” Hightower has had national influence with research he published in Cancer in 1994, titled “National Survey of Ovar-

(CONTINUED ON PAGE 8)

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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 MAY/JUNE 2018 1,000 physicians to serve this state, region, and beyond.

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Five Nurses, Five Questions, Five Perspectives, continued from page 1 from the Children’s Hospital of San Antonio, where he served as the director of pediatric emergency services. Why does there seem to be a high turnover rate for CNOs? The position of CNO requires a dedication and time commitment that can prove to be impactful to other aspects of life. As overseers of patient safety and excellence, we carry a great deal of responsibility. I believe that. The responsibility, time requirement and dedication may be hard to maintain for an extended period of time for some leaders. How do you keep morale up and retain good nursing staff? Employees want to feel that they are an important part of the team. As a leader I use communication and recognition to build up the team. I don’t see the staff in a tiered approach. Rather I envision the staff in a team approach. I believe that when all parts of the team are functioning at a high level then you will have great moral and a culture of ownership. What is your leadership vision for your hospital? I want to be part of an organization where the staff that is taking care of the patients is empowered to be leaders in the organization. I model my personal leadership after the Servant Leadership Model where the leader focuses on the growth and well-being of the staff. As a CNO, I want to see the staff strive to provide excellent nursing care and great patient outcomes. What personal experiences prepared you professionally? I spent eight years as an officer in the U.S. Air Force. This experience plus the fact that I have been blessed to have several great mentors in my professional career prepared me for the leadership opportunities as a CNO.

How do you like to be recognized for your work? The only recognition that I need is happy employees. When the employees are happy, engaged in the organization and we have great patient outcomes, then I know that I have been successful as a leader.

What is your leadership vision for your hospital? My leadership vision is one of transparency, fairness, evidence-based practice and empathy. I value every member of the healthcare team, and therefore I want to ensure that we do not create silos amongst our team.

Michele Diedrich

What personal experiences prepared you professionally? My parents were my role models for the person I have become professionally today. They were both driven by relationship building, customer service and loyalty. They both exhibited a positive attitude but held me accountable for my actions and the consequences of my actions. My parents came from a poor background, but through their hard work and determination became a successful business owner and executive.

The CNO of Baptist Health Medical Center-Little Rock, Michele Diedrich, DNP, MA, RN, NEA-BC, has been a registered nurse for 29 years. She began her healthcare career in 1989 upon receiving her Associates of Science in Nursing and most recently completed her Doctor of Nursing Practice last year. Diedrich joined Baptist Health as the CNO and Vice President of Patient Care Services in January. Why does there seem to be a high turnover rate for CNOs? There are many reasons for turnover in the CNO including the increase stress and demands. The CNO is responsible for professional nurse practice, clinical practice and knowledge, quality, healthcare policy, patient safety, patient experience, performance improvement and workforce planning. The role has changed over the years with a large focus on the changing environment of health care and the financial impact of those changes. The nursing shortage is an issue for many states including Arkansas. How do you keep morale up and retain good nursing staff? My goal as the CNO is to ensure that we are utilizing the correct model of care to provide a safe environment for the patients and coworkers. It is important for all co-workers to feel that their concerns are heard with response. I feel that it is important to implement shared governance to stay connected with the work challenges that are faced on a daily basis.

How do you like to be recognized for your work? The greatest recognition for me is the success of our team.

Meredith Green Meredith Green, MSN, APRN, was named Senior Vice President & CNO, Washington Regional Medical System, Fayetteville, in 2017. She was formerly Administrative Director in Women and Infants Services. Green earned both a bachelor’s degree and master’s degree in nursing at the University of Arkansas and received credentialing as a Clinical Nurse Specialist in Adult and Geriatric Health. Why does there seem to be a high turnover rate for CNOs? There are demands that come with any nursing role. But, being a new CNO, right now I am appreciating the opportu-

nity to be a mentor and advocate for our talented nursing staff. How do you keep morale up and retain good nursing staff? Washington Regional continues to embrace a culture of open communication, promoting a positive and collaborative environment. It is important for our staff members to feel empowered to grow personally and professionally. At Washington Regional, we offer and encourage participation in organizational and community-driven programs and activities. Advanced education programs and proficiencies strengthen knowledge base, critical thinking skills and positively impact employee and patient satisfaction. Since Washington Regional has a long history in this community, providing care since 1950, we see our patients as our own family. In fact, our values statement includes, “To treat others as we would want to be treated.” That fosters a very supportive for environment for our nurses. What is your leadership vision for your hospital? My vision includes Washington Regional continuing to grow to meet the needs of the rapidly expanding Northwest Arkansas community and ensuring that our hospital’s growth is thoughtfully designed to fulfill our mission–which is to improve the health of the communities we serve. What personal experiences prepared you professionally? I have been fortunate to have worked with some exceptional nurse leaders and mentors who inspired and shaped my training. Their passion for excellence in patient care and nursing practice remain a strong motivator for me. How do you like to be recognized for your work? It is exciting for me to see that some young nurses I have worked with–and in some cases, mentored–are achieving great things and growing into skilled clinicians and strong leaders. Their success is the best recognition I could hope for.

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Angie Smith, Vice President of Nursing at St. Bernards Medical Center, Jonesboro, received her BS in nursing degree in 1994 from the University of Central Arkansas in Conway. She received her MS in nursing in 2005 and her Doctor of Nursing Practice degree in 2017, both from Arkansas State. In her role as Vice President of Nursing, Smith directs all nursing activities at St. Bernards Medical Center, including education, recruitment, leadership and quality. Why does there seem to be a high turnover rate for CNOs? I am fortunate to work for an organization that has experienced longevity (CONTINUED ON PAGE 6)

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Alzheimer’s Association Sees Increase in Federal Support Patients, Researchers, Caregivers All Score Wins By CINDY SANDERS

In late March, President Donald Trump signed the massive $1.3 trillion omnibus spending bill into law to fund the federal government. Part of the spending package included a $414 million increase for Alzheimer’s and dementia research funding at the National Institutes of Health (NIH). Rachel Conant, senior director of Federal Affairs at the Alzheimer’s Association, leads the organization’s efforts to elevate Alzheimer’s disease as a priority for the federal government. She also serves as senior political director of the AlzheimRachel Conant er’s Impact Movement (AIM), which is the national association’s advocacy arm. “The Alzheimer’s epidemic has a profound impact on families,� she said, adding her own family had been touched by the disease. “The Alzheimer’s epidemic has a profound implication for state and federal budgets,� Conant continued. “Nearly one in every five Medicare dollars is spent on Alzheimer’s or related dementias.�

Alzheimer’s Stats

Just days before the spending bill was signed, the Alzheimer’s Association released a new report outlining the toll of the disease. “The 2018 Alzheimer’s Disease Facts and Figures� found increases in prevalence, deaths and cost of care. An estimated 5.7 million Americans are living with Alzheimer’s dementia in 2018, nearly two-thirds of Americans with Alzheimer’s are women, 10 percent of those 65 and older have the disease, and the incidence rates are even higher in older AfricanAmericans and Hispanics. Alzheimer’s cases are expected to spike alongside the nation’s aging population with an estimated 14 million living with the disease by 2050. Currently, someone in the United States develops Alzheimer’s every 65 seconds. The Alzheimer’s Association predicts by mid-century, someone will develop the disease every 33 seconds.

Although deaths from other major diseases have decreased, recorded deaths from Alzheimer’s disease increased 123 percent between 2000 and 2015. The sixth leading cause of death, the new report stated Alzheimer’s is the only one among the top 10 causes of death that cannot be prevented, cured, or significantly slowed.

In addition to the human toll, the financial cost is staggering. The 2018 Alzheimer’s Association report cited a $277 billion cost to the nation for Alzheimer’s and other dementias with a projection that those costs could rise to as much as $1.1 trillion by 2050. The current cost represents nearly a $20 billion increase over last year.

Plan of Action

Conant noted that in 2011, landmark legislation laying the groundwork to create a national Alzheimer’s strategy was signed into law. The National Alzheimer’s Project Act (NAPA) created an advisory council to make recommendations to the Secretary of (CONTINUED ON PAGE 7)

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Five Nurses, Five Questions, Five Perspectives, continued from page 4 in this position. I was fortunate to be able to pursue this position when the previous CNO relocated to a different state. With that being said, the key to success in a high-pressure job is creating a vision for effective leadership at all levels and empowering staff to fulfill our mission. I feel blessed to work with an excellent team and that allows me to sleep at night. How do you keep morale up and retain good nursing staff? I believe the key to retaining good staff is ensuring a healthy work environment and a team approach to patientcentered care. We recently invested in a speaker who spoke on inspired care – his message was invaluable in terms of morale and attitude. These investments, as well as education and training, are something we must continue to do along with providing a safe, work environment where people can do their job efficiently and effectively. It is also not a campaign or initiative but rather the foundation of success that must be threaded throughout all of our work. What is your leadership vision for your hospital? To continue to build and support a strong nursing culture of professionalism and patient-centered care. The patient is the center of what we do, and we must continue to invest in those who provide direct, hands-on care to those patients as well as invest in their professional and leadership growth.

What personal experiences prepared you professionally? I have been fortunate to hold a variety of nursing positions including bedside, education, recruitment and quality. I also believe that I have had the best mentors who have taught me through role modeling. How do you like to be recognized for your work? The best reward is a sincere, personal thank you. However, I believe the key to success is usually team-oriented and that is what gives me the most pride and accomplishment.

Louise Hickman Louise Hickman, RN, BSN, MA, CLNC, Vice President, Patient Care Service and CNO of Jefferson Regional Medical Center (JRMC) in Pine Bluff, has been with JRMC since 1988 when she was recruited to help launch a new cardiac program. She received a bachelor’s degree in nursing from Arkansas State University, and a master’s in health services administration from Webster University. Hickman is president of the Arkansas Organization of Nurse Executives. She was a past board member of the Arkansas Association of Health Quality.

Why does there seem to be a high turnover rate for CNOs? The complexity of care, increased cost pressures, nursing shortage, competition for experienced nurses and focus on “never events” are some of the challenges faced by CNOs. The stress of not maintaining a black bottom line leads to turnover of top executives including CNOs. The quest to provide high-quality care, high staff satisfaction, and low turnover can cause expenses to exceed both budge and planned variances. Competent succession planning can avoid major disruptions in morale and programs that are producing the desired outcomes. How do you keep morale up and retain good nursing staff? Gaining respect, support, and assistance in implementation to achieve the nursing agenda. Our organization has recently begun a culture transformation journey with some top executive changes, engagement with partner to assist and provide the roadmap for this journey, more staff engagement and input, implementation of shared governance professional practice model for nursing, leadership training on rounding, vital conversations, and other types of frontline management training along with staff training. We are beginning to see the shift in some of our outcomes of these efforts in a positive light.

What is your leadership vision for your hospital? We are committed to excellence in patient-centered care because it is the right thing to do. We will know we have been successful when we are recognized as the hospital and employer of choice in Southeast Arkansas. We must be accountable to one another and lead by example every day. Our nursing vision is: “Nurses embracing healthcare excellence – one patient at a time.” What personal experiences prepared you professionally? I started my nursing career in a small hospital and got to do a variety of positions to enhance my skills. I have had several mentors along the way to assist me in my career and to enhance my skill sets. I have maintained current knowledge of nursing practice and have been involved my state organizations for quality and nurse executives. There are a great group of peers in Arkansas that have helped me along the way also that I am very grateful for. How do you like to be recognized for your work? I want to be recognized as an expert in my field of nursing and nursing leadership. I want to leave a legacy that my facility is a better place upon my retirement and that I have left the nursing division in great hands with lots of successful nursing leaders. I also want to leave a scholarship to continue the contribution to the education of nurses.

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Alzheimer’s Association Sees Increase in Federal Support, continued from page 5 Health and Human Services in three key areas: research, clinical care, and long-term services and support. “That was the first time we really saw the federal government put an emphasis on Alzheimer’s funding and research,” Conant said. She added with this latest $414 million NIH increase earmarked for Alzheimer’s and dementia research, federal funding has now risen to $1.8 billion. A great deal of work is being done to better understand the underlying mechanism of Alzheimer’s and related dementias, and there are a number of promising drug trials underway that hope to stop or slow down disease progression. “We’re really excited about the focus not only on treatment but on prevention,” said Conant. “We just announced the 2018 launch of the Pointer Study, which is a two-year clinical trial to look at multifactorial and lifestyle interventions to prevent cognitive decline and dementia,” she continued. The intervention methods will include exercise, nutritional counseling, cognitive and social stimulation, and improved self-management of health conditions. For more information, go online to alz.org/uspointer.

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locate missing individuals.

RAISE-ing Caregivers Up

Kevin & Avonte’s Law

Also included in the omnibus bill was funding for Kevin and Avonte’s Law, bipartisan legislation to protect seniors with dementia and children with developmental disabilities who are prone to wander. Conant said AIM has spent several years working on the bill, which reauthorizes the Missing Americans Alert Program through fiscal year 2022 and expands the program to include those with developmental disabilities. Introduced by Reps. Chris Smith (RNJ) and Maxine Waters (D-Calif.) in the House and Sens. Chuck Grassley (R-Iowa) and Amy Klobuchar (D-Minn.) in the Senate, the new law provides up to $2 million in grants each year to state and local agencies for programs to prevent wandering or

Yet another legislative win for the Alzheimer’s Association and AIM came earlier this year with passage of the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act. “From the Alzheimer’s perspective, we know there are more than 15 million caregivers providing unpaid care to individuals,” said Conant. The 2018 Facts and Figures report estimated these individuals provide 18.4 billion hours of care valued at over $232 billion. Research has shown caregivers of people with dementia report higher levels of stress, depression and worse health outcomes than those caring for individuals without dementia. In 2017, these additional stressors led to Alzheimer’s caregivers incurring an extra $10.9 billion in health costs. Sens. Susan Collins (R-Maine) and Tammy Baldwin (D-Wis.) and Reps. Gregg Harper (R-Miss.) and Kathy Castor (D-Fla.) introduced the bipartisan legislation. The new law directs the Department of Health and Human Services to develop a national strategy to provide education and training, long-term services

and supports, and financial stability and security for caregivers. Conant said her organization worked closely with AARP to push for passage of RAISE, which was modeled off of NAPA. “It will require a plan to be updated annually,” Conant said. “It’s also going to create a National Family Caregiving Council to provide recommendations to the (HHS) Secretary.”

Providers & Care Planning

Conant said the Health Outcomes, Planning and Education (HOPE) for Alzheimer’s Act that passed in November 2016 provides a funding mechanism for providers to be reimbursed for assessing and discussing a diagnosis of Alzheimer’s disease and available treatment and support options to improve or maintain quality of life. “Beginning in 2017 for the first time, people living with Alzheimer’s now have access to care planning with a medical professional, and it’s paid for by Medicare,” she said, adding the Alzheimer’s Association has a downloadable care planning toolkit for providers. For more information, go online to alz.org/careplanning.

Moving Forward

“The goal is to prevent or effectively treat Alzheimer’s by 2025,” said Conant. “We’re excited about our progress, but we know we have a long way to go.”

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Arkansas Medical Group Management Association, continued from page 1 Company, gave a presentation on Gems of Management, Lessons Learned in Life and Work. Stearns tells life stories that are personal and illustrate his points. “One is to act happier than you feel and you will be happier than you are,” he said. “Another is to make one person you don’t know happy each day. I do that with servers a lot. For example, when a server hands me a drink, I say, ‘I won’t take it until you smile.’ When you make peo- Thomas H. Stearns ple smile, you can’t not feel better.” Stearns also spoke about the importance of asking advice. “As a medical manager, it is important to get advice from people who are going to be affected,” Stearns said. “Being a good manager is being a good person. Touch people you work with every day. For example, I always give Valentines to the people I work with. Also, as a leader you have a responsibility to care for your people.” Stearns doesn’t tell medical managers how to send bills and balance the books, but how to be a better person. “As a result, they are a better manager and the organization is better for it,” he said. Stearns said it is important to understand people remember kindnesses. For example, if your receptionist’s mother dies and you send flowers, it is something that she will always remember. Other pieces of advice he talked about is if you snooze, you lose – you’ve got to show up and even in the closest friendships one person works harder to make it work. He said it is also important to give back to your community, family and friends, balance your life and consider “What would mother want me to do?” when making important decisions. It is a good way to judge what you are about to do.

Kyle Matthews, CMPE, CEO of Phoenix Heart PLLC, spoke about ten financial reports doctors want to see. The following is a summary of the reports he recommends: Kyle Matthews • Practice Dashboard. These are the highlights that your doctors need to see on a weekly basis. These includes financial stats, deposit details, accounts receivable (AR) by individual docs with green flags indicating AR percentages are improving and red flags alerting physicians and matters they need to investigate. “It allows us to identify any issue immediately instead of waiting until there is a major catastrophe already in progress,” Matthews said. • Productivity Dashboard. This dashboard is specifically looking at the work being generated by each physician. It is used in the case that a practice is worried not all physicians have the same work load or there is something that is skewing the work toward one physician more than another. List each doctor and their charges per week. It allows for discussions about how the schedule can be adjusted to have more balanced output for physicians. Green or red highlighting is used to show if a doctor is above or below budget. • Monthly Overview. This includes the beginning AR, charges, payments, collection percentage, adjustments and the ending AR. Doctors are particularly interested in the collection percentage. If you have a large amount written off for a bad debt or untimely filing, it is important to know as soon as possible. You should have the discussion of what went wrong instead of glossing over amounts written off as adjustments. • Previous year-to-date variance. This report is generated from the accounting system instead of the practice management system. Look at anything

that has a 15 percent variance both negative and positive with revenue or expenses. He recommends this on a quarterly basis. This shows the wins and losses of the management team. • Referral Dashboard. “This is the report we either live or die by,” Matthews said. “I want to know on a monthly basis where the referrals are going. It lists all the physicians who refer into the practice in the given time frame so they know which physicians send the most and the least patients and how that changes over time. Particularly, I look at when referrals have gone down because I need to contact the referrals office to find out why referrals have gone down. If something has happened to upset them, you want to take care of it immediately. It works the other way, too. If a new referral source shows up, go visit and thank them.” • Procedure Cash Flow. This report is done for all ancillary services and serves as a cash flow predictor. It is also a very good compliance tool. If one physician has ordered triple the number of tests than any other physician, you want to know why. • Physician Summary. This is year-to-date production and compensation data. It lists doctors and their charges, gross compensation, their RVUs (relative value units) in office, lab and hospital, and totals. “Regardless of the specialty of the physician in the practice, compensation per RVU allows me to level the playing field and see if we are over or under compensating a physician,” Matthews said. • Pro Forma. The best pro formas are simple and do not include things like depreciation. They are really basic. Every new process goes through the same pro forma. This helps them decide which ideas that the doctors come up with will be financially worthwhile. The hard rule is: Any new product or service being considered must go through this report. • Compensation vs. Production. This is something that is done if you

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are looking for a problem or have found a problem. It is a report that shows each doctor and their charges, collections, compensation, and ratio. This is a decision point report. If you are trying to make a decision or trying to get the board to make a decision, you would access a report like this. Is this physician covering their overhead and expenses? You are only talking about professional fees, not ancillary revenue. This can be emotional for doctors. This is a private report only shared on paper – never electronically. • Appointment Analysis. This report is tracking each doctor’s availability. When is the next available appointment for a new patient? This is a good report to use not only to see what your appointments are, but also to justify when to hire a new provider. If utilization is approaching 90 percent, that means you will likely have no space available for new patients or follow-ups in the months ahead.

Gynecologic Oncologist Urges Screenings, continued from page 3

ian Carcinoma IV: Patterns of Care and Related Survival for Older Patients,” that showed older women benefited as much as younger women from surgery and chemotherapy for ovarian cancer. “The conclusion from this study was that it appeared conservative treatment contributed to the decreased survival of older ovarian cancer patients,” Hightower said. “Some physicians tend to think older individuals would be unable to tolerate chemotherapy or surgery and do not offer that type of treatment to the patient. However, they can usually tolerate it just as well as younger women. I’ve treated individuals up to 100 years old without problems. Of the 12,316 patients evaluated in the study, 1,115 were 80 years of age or older. There was no increase in anesthesia problems or other complications in the different age groups.” Hightower received his medical degree from the University of Arkansas for Medical Sciences and did his residency at the Naval Medical Center in Portsmouth, Va. He completed his fellowship at the University of Miami/Jackson Memorial Hospital, Miami, Fla. Hightower’s professional recognitions include an award for Outstanding Achievement in Cancer Research by Upjohn, named one of “The Best Doctors in America,” and one of “America’s Top Oncologists.” Hightower has been married to his wife Amy for 38 years and they have three children, Nathan, 36, Ashley, 33, and Kelli, 28, and three grandchildren. In his leisure time, Hightower enjoys fly fishing on the White River and local ponds in the area and likes to work in his yard. The Hightowers have raised German Shepherds since 1993. “They are like part of the family,” Hightower said. arkansasmedicalnews

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UPICs and Medicaid— The New Partnership The Medicaid Program Integrity Manual1 (“MPIM”) has been very recently revised to more thoroughly and specifically address the role of Unified Program Integrity Contractors (“UPICs”)2 and the UPICs’ work with State Medicaid Agencies (“SMAs”). These MPIM revisions were issued on February 2, 2018 and became effective April 3, 2018. The general purpose of CMS’s creation of UPICs is to “unify” the efforts of various types of government program audit contractors. And now, with the recent MPIM release, we have more detail about how the UPICs will work closely with the various SMAs to protect the Medicaid program. According to the MPIM, prior to the UPIC opening a formal investigation, the UPIC will vet the providers (or suppliers) at issue with the local SMA to determine whether the SMA is already conducting a similar audit or investigation for similar Medicaid issues.3 The purpose of this collaboration is to reduce The Authors: duplicative audit efforts.

Searching for Sustainable Solutions to the Physician Shortage

Adequate GME Funding Continues to be a Concern By CINDY SANDERS

Complex problems rarely have simple solutions. Certainly that is the case with the looming physician shortage facing the United States. New research published last month by the Association of American Medical Colleges (AAMC) shows increasing shortages looming for both primary and specialty care. The new data outlined in the 2018 update of “The Complexities of Physician Supply and Demand: Projections from 2016-2030” provides a forecast based on a number of supply and demand scenarios, including an aging population on the demand side and heavier reliance on other physician extenders on the supply side. Recognizing it is impossible to accurately predict exactly how market forces will play out over the coming years, each supply scenario is paired with a demand scenario to create a projected shortfall range. Part of AAMC’s commitment to annually updating physician workforce projections, the latest report increased the forecasted physician shortfall to between 42,600 and 121,300 by 2030. This is up from last year’s report, which projected a physician shortfall of 40,800 to 104,900 by that same year. The shifting demographics of the U.S. population continue to be a key driver of demand. “Our data shows by 2030, the U.S. population aged 65 and older will grow by 50 percent,” said AAMC’s Chief Public Policy Officer Karen Fisher. She added the supply side of the equaKaren Fisher tion is impacted by sevarkansasmedicalnews

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eral factors including the hours physicians are willing to work, the number of providers nearing retirement, and the quantity of young physicians completing training to fill in those gaps.

Schools Step Up

Allopathic and osteopathic medical schools have both seen increases in enrollment over the last several years as academic centers have pledged to help alleviate projected workforce shortages. According to AAMC data, there were 21,338 new enrollees in allopathic medical schools for the 2017-2018 academic year, a 1.5 percent increase over the previous year. Total enrollment for 2017-18 was 89,904 students compared to 81,936 in the 201213 year, a nearly 10 percent increase over the last five years and closer to a 20 percent increase over enrollment a decade ago. The American Association of Colleges of Osteopathic Medicine (AACOM) saw first-year matriculation jump with a nearly 7 percent increase in fall 2017 enrollment over the prior year. Preliminary figures from AACOM placed 2017 total enrollment at 28,981, an all-time high for the 34 accredited colleges of osteopathic medicine in the United States.

GME Bottleneck

While growing medical school enrollment is a positive step, Fisher and colleagues point out increasing the number of students won’t translate into more physicians and surgeons if there aren’t adequate training slots for graduates. “The Medicare program has been a key financer of graduate medical education,” said Fisher, who added Medicare historically funded GME on a proportion-

The UPIC may also perform a “medical record probe audit” to validate the data analysis or allegation(s) by selecting a small representative sample of claims—typically 20 to 40 claims. The provider will typically receive a record request letter for specific medical records relating to Medicaid recipients. Providers should promptly consult their healthcare counsel when receiving such a letter. If the provider fails to produce the records within the specified timeframe, the provider is at risk for having the entire amount recouped. As with other CMS contractors before it, the UPIC may also review certain data from CMS, including claims, to identify aberrant billing patterns and other documents to establish the facts and magnitude of the alleged fraud, waste, or abuse. The UPIC will also take note of other issues that may indicate potential fraud, such as obliterated sections, missing pages, inserted pages, the use of white out, and excessive late entries (i.e., information documented numerous days after the actual service was performed). It is also important to note that undated or unsigned entries handwritten in the margin of a document will not be included as part of the review. After the UPIC review is complete, the UPIC will send an “Initial Findings Report” (“IFR”) to the SMA for review and comment. CMS may also review the IFR and provide comments. All comments are reconciled before determining the overpayment amount and sending the audit results to the provider. Overpayment settlement negotiations will remain a function of the SMA. If the provider owes overpayment amounts to the SMA, the State must also return the federal share to CMS. For investigations where extrapolation may be used, the UPIC will seek agreement from the SMA before employing extrapolation.

Lynda M. Johnson, Partner

Timothy C. Ezell, Partner

Tonya S. Gierke, RN,

CIC, Associate The UPIC also has the authority to recommend that a provider be suspended from the Medicaid program, based on credible allegations of fraud. However, payment suspension is an SMA function. Again, it is important for providers to involve counsel early in the process after receiving correspondence from a UPIC. Many times, correspondence on the front end (i.e., before a suspension is recommended) is more fruitful than disputing a decision that has already been made.

UPICs are so new to the scene that there are not currently many, if any, UPIC “war stories.” However, please be reminded of how severe these audits can be. Based on our experience with ZPIC audits (and other types of audits), a “probe” audit requesting a seemingly innocuous volume of medical records can quickly turn into a multimillion dollar overpayment demand. It is not uncommon for an auditor to base its findings on an erroneous interpretation of coding guidelines, Medicare regulations, or Local Coverage Determinations which may not even have been in effect when the applicable services were provided. The best advice is to avoid being an outlier, and have a functioning, effective compliance plan in place. As part of your compliance plan, review your documentation to ensure that it supports all reimbursement requirements and guidelines for the services that you most commonly bill. In the event that you receive a medical record request from a UPIC (or another audit contractor), engage legal counsel early in the process to assist you. See https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-OnlyManuals-IOMs.html.

1

2 UPICs are contracted entities with CMS that conduct investigations and audits in an effort to reduce fraud, waste, and abuse in both the Medicare and Medicaid programs. Qlarant is the UPIC for Arkansas. For more information about Qlarant, see http://www.qlarant.com/.

The UPIC will defer to the applicable state’s look-back period when selecting claims.

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Male OB-GYNs Are Growing Rare. Is That A Problem? By ALEX OLGIN, WFAE

As she left a 12-hour day on the labor and delivery shift, Dr. Katie Merriam turned off her pager. “I don’t know what I’d do without it, you know?” she said, laughing. The third-year OB/GYN resident at the Carolinas Medical Center hospital in Charlotte, N.C., works in a medical specialty dominated by women, treating women. “You just, you can feel what they feel and understand why they feel certain ways. I do feel a special bond,” she said. Nationally, 82 percent of doctors matching into OB-GYN residency programs are women. Many OB-GYN patients say they prefer female doctors. Merriam’s residency class is a bit of an anomaly — half of its members are men, but Merriam said she and some of her female colleagues also like the perspective men bring to the work environment. It’s important to have men in the field, she said, if only to continue to give patients options in their choice of providers. But most of her friends and other women she talks to, she said, want female doctors. Blake Butterworth, a fourth-year OB/

GYN resident at the Medical University of South Carolina in Charleston, said he doesn’t take it personally when he hears that. “I don’t get discouraged; I don’t get offended,” Butterworth said. “I gladly hand that patient off.” He’s one of only two male residents in the program of 24 at MUSC and said he finds it rewarding when he can win a patient’s confidence. “I have patients that clearly express disdain to have to see a guy,” he said. “Then I develop rapport with her. And she says, ‘I expected you to be X, Y, Z, and you were better than that.’” Butterworth said he chose OB/GYN because it lets him develop long-term relationships with patients. Butterworth said male students need to know it’s OK to have an interest in the field. In fact, says Dr. Ashlyn Savage, an associate professor of OB/GYN at MUSC, it may be the opposite. “We might consider an applicant with a slightly lower board score — just to enhance how many men we are considering,” said Savage. It has been a challenge to find male

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OB-GYNs for the program, she said. The gender that at one time dominated the field is now at some schools considered a diversity hire. “The interesting thing to me is the primary motivation to (seek a diverse candidate pool) is so patients have the opportunity to seek out physicians who might … feel like themselves,” she said. “In this particular case … all of the patients for OBGYNs are women.” Among practicing OB-GYNs in the U.S., a little fewer than half are men, according to the American College of Obstetricians and Gynecologists. But ACOG predicts that 10 years from now, two-thirds of the doctors in the specialty will be female.

Still, male doctors hold many key leadership posts. “Leadership tends to be held by people who are older,” Savage said. “And we are still in a scenario where [more of] our older faculty tend to be men.” A study published last fall found that women are underrepresented in leadership roles in medical school departments of obstetrics and gynecology throughout the country. Savage said she recently learned that her program’s incoming class of OB-GYN residents next year will be all female. This story is part of a partnership that includes WFAE, NPR and Kaiser Health News.

Searching for Solutions, continued from page 9 ate share of a resident’s training. For example, if a resident trained at a facility where Medicare made up 30 percent of the patient population, then the federal program would pay 30 percent of the physician’s GME cost. However, continued Fisher, “In 1997, Medicare placed a cap on that support … so for over 20 years, Medicare’s support has been capped at the number of residents in 1996.” For every resident above the hospital’s cap, she said, the facility has had to absorb that extra cost. “It’s like they are taking a cut every year by virtue of that cap,” Fisher added. For the most part, she continued, there have been slots available for graduates because hospitals have borne the additional training costs. In some cases, states have stepped in to help with additional funding, as well. However, Fisher said sustaining the current setup is an ongoing concern. “When clinical revenues get tight, we’re very concerned about the ability of teaching hospitals to continue to train residents above the cap,” she said. “It’s important that we continue to receive stable, predictable financing to offset the significant costs associated with training new physicians.” AAMC, along with AACOM, strongly supports legislation that would moderate the chilling effect the current cap has on physician training. “We’re asking for 3,000 residency positions each year for five years for a total of 15,000 residency positions,” noted Fisher. The bipartisan Resident Physician Shortage Reduction Act of 2017 (HR 2267, S 1301) was introduced last May but didn’t make it out of committee. However, Fisher said there might be another chance to gain some traction if Congress takes up infrastructure this year. “I think the physician workforce is an important infrastructure need for the health of our country,” she pointed out.

Other Options

AAMC officials have repeatedly stressed the need for a multi-pronged ap-

proach to addressing the physician shortage. While enrollment and GME are huge components to the solution, there are other factors being addressed, as well. “Overall, our modeling certainly looks at the role and growth of nurse practitioners, physician assistants and telehealth,” she said of utilizing teams and technology to extend the delivery system. AAMC also supports non-GME incentives and programs, including Conrad 30, the National Health Service Corps, loan forgiveness programs and Title VII/ VIII, which are used to recruit a diverse workforce and encourage physicians to practice in shortage specialties and underserved communities. Fisher said foreign-born physicians are another potential part of the solution and noted those trained outside of America must undergo a rigorous assessment before being allowed to practice in the United States. “They are an important source of physicians in this country,” she said. “Many of them tend to practice in rural and underserved areas,” she added of filling gaps in care. Additionally, AAMC has been a champion of increasing the physician workforce in a manner that embraces diversity and cultural competency to mirror the nation’s changing demographics and to work towards eliminating health disparities. Fisher noted the AAMC also has released several statements calling for healthcare workers with DACA status to be able to continue their education, training and research. Similarly, the organization has expressed concerns over executive actions on immigration and travel impacting researchers and clinicians. In an issue brief from March 17, 2018, the organization noted, “Because disease knows no geographic boundaries, it is essential that we continue to foster, rather than impede, scientific cooperation with clinicians and researchers of all nationalities as we strive to keep our country safe from all threats.” Fisher concluded, “We certainly support national security, but we believe this is an issue of national health security.” arkansasmedicalnews

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America Needs to Import More Physicians Desperately needed internationally trained physicians, many of them American citizens, are ready to work in the U.S. By G. RICHARD OLDS, MD

A wave of doctors will soon hang up their stethoscopes. More than one-third of physicians will be 65 or older within a decade, according to a report from the Association of American Medical Colleges. Their retirements, coupled with our nation’s aging population, spell trouble for the health care system. By 2030, the country may have 105,000 fewer doctors than it needs to meet patient demand. Over 40 percent of that shortage will be in primary care. The solution to that shortage lies abroad, at international medical schools. Graduates of these schools have historically been far more likely to enter primary care and practice in underserved areas than their domestically educated peers. The United States needs more of them. It’s no secret that America is aging. By 2030, the share of Americans ages 65 and older will grow by 55 percent. The doctor corps is not exempt from this demographic trend. Consider just one crucial specialty — obstetrics and gynecology. Only 14 percent of OB/​GYNs today are younger than 40. Many regions throughout the coun-

try, especially rural ones, can ill afford to see their doctors retire. At present, South Dakota has enough primary-care physicians to meet 37 percent of the state’s total demand. Nebraska’s primary-care workforce can meet only 42 percent of demand. Worse, help is not on the way — at least, not from U.S. medical schools. Less than 40 percent of U.S.-trained graduates chose primary care in 2015. And even that number is high. Many of this “primary care” group selected internal medicine but plan to subspecialize within the field. Less than 9 percent of graduates from American M.D. programs entered a family medicine residency between 2014 and 2015. Graduates of international medical schools, on the other hand, are ready to meet America’s primary care needs. Last year, nearly 70 percent of internationally trained doctors who accepted residencies did so in primary care. Many of them were U.S. citizens, returning home after training abroad. Despite lying outside U.S. borders, St. George’s University in Grenada, where I teach, is America’s top source of new primary-care doctors. Last year, threequarters of the more than 900 residencies

our graduates took were in primary care. Most of our students are actually Americans — 74 percent of our student body has U.S. citizenship, and 19 percent are U.S. permanent residents. We’re not the only international medical school fortifying the ranks of America’s primary-care workforce. In 2015, the Society of Teachers of Family Medicine reported that five medical schools in the Caribbean each sent 40 or more graduates into family medicine residencies. St. George’s was one of them; we sent more than 100. Despite this apparent influx of doctors educated abroad, America still needs more — particularly in primary care. Here’s how it can get them. First, U.S. leaders must create more residency positions, especially in areas with doctor shortages and in high-need specialties like family medicine and primary care. The majority of doctors who have completed their training since 2007 are practicing in the state where they did their residencies. Therefore, underwriting residencies in high-need areas is an effective way to address their shortage of doctors. Currently, the federal government

caps the number of slots available for federal funding — a policy that artificially suppresses the supply of residencies when America needs to be training more doctors. Raising that cap would go a long way toward alleviating America’s doctor shortage. There’s room for private interests, including foundations and charities, to help address the issue, too. In 2016, the Walmart Foundation gave the Northwest Arkansas Community Internal Medicine Residency Program $750,000 to cover its first two years of operating costs. The goal is to fund 24 medical residents by this year in an area of the state that could use almost 150 more. The current resident shortage equates to about 3,700 appointments that don’t happen each day — appointments that would likely be taken by the most medically underserved. Patient demand for doctors is far outstripping the ability of U.S. medical schools to supply them. Graduates of international medical schools are eager to fill that gap. America’s leaders must find ways to let them. G. Richard Olds, MD, is president of St. George’s University (www.sgu.edu).

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GrandRounds Baxter Regional Medical Center Welcomes Dr. Lee Morisy MOUNTAIN HOME – Baxter Regional Medical Center welcomes Lee Morisy, MD, a board certified general surgeon, in practice at Ozark Surgical Group. Dr. Lee Morisy is a Cornell University graduate and attended Chicago Medical School. He completed Dr. Lee Morisy a surgery residency at The Hartford Hospital, University of Connecticut. Board certified by the American Board of Surgery, Dr. Morisy is a fellow of the American College of Surgeons, where he’s served as a General Surgery Coding and Reimbursement Committee Member, a representative of the American Hospital Association ICD-10 Editorial Advisory and on the Board of Directors of the SurgeonsPAC. He is a member of the American Medical Association, American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal Endoscopic Surgeons.

Pain Management Doctor Joins Mercy FORT SMITH – Dr. Natalie Strickland’s goal is to treat patients like she’d want her family members to be treated. That’s good news for her patients at Mercy Clinic Interventional Pain Management. Dr. Strickland recently joined the clinic on the River Valley Dr. Natalie Strickland campus. She treats pa-

InCharge Correction Arkansas Medical News would like to make a correction to the listing of Gary Paxson in our InCharge 2018. He is listed correctly below and we offer our sincere apologies. Gary Paxson Administrator White River Medical Center 1710 Harrison Street Batesville, AR 72501 870-262-1200 As the Administrator of White River Medical Center (WRMC), Gary Paxson, RN, BSN, MS, manages the day-to-day operations of the 224-bed regional referral center in Batesville, Ar. Paxson has 23 years of healthcare experience. His career includes positions in nursing, healthcare information systems, and executive management. Paxson earned a Bachelor of Science in Nursing from Saint Anthony College of Nursing in Rockford, Illinois, and a Master of Science in Information System Management – Healthcare Administration Concentration from Bellevue University in Bellevue, Nebraska.

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tients who suffer from a variety of conditions including headaches, neck, back and joint pain, post-operative pain or pain due to cancer. Dr. Strickland, who is board certified in pain management and anesthesiology, also diagnoses and treats other types of pain, including: • Sciatica – pain radiating along the sciatic nerve, which runs down one or both legs from the lower back • Neuralgia – intense, typically intermittent pain along the course of a nerve • Complex regional pain syndrome – chronic arm or leg pain developing after injury, surgery, stroke or heart attack. Dr. Strickland received her medical degree from the University of Oklahoma Health Sciences Center in Oklahoma City. She completed a pain medicine fellowship at Vanderbilt University in Nashville, Tennessee, and an anesthesiology residency at Washington University in St. Louis. She has medical teaching experience at the University of Arkansas for Medical Sciences in Little Rock and at

Emory University and the Winship Cancer Institute in Atlanta. Dr. Strickland, who works alongside Dr. Brian Goodman and nurse practitioner Heather Manchester, is available for appointments at the clinic.

Urgent Care in Jacksonville Welcomes New Providers JACKSONVILLE - Baptist Health Urgent Care in Jacksonville is pleased to welcome Jessica Anderson and Chelsea Havelka to its team of healthcare providers. Anderson, a family nurse practitioner, brings several years’ experience in pediatrics, Jessica Anderson as well as urgent care to the center. Anderson most recently served as a family nurse practitioner with CVS Minute Clinic in Phoenix, AZ. Prior to that, she was a registered nurse at Phoenix Children’s Hospital. Anderson received her Master of Science in Nursing as well

as her Bachelor of Science in Nursing degree from Grand Canyon University in Phoenix. Havelka earned her Doctor of Nursing Practice (DNP) degree from the University of Tennessee Health Center in Memphis and most recently served as nurse practitioner with Access Medical Clinic, managing the care for more than 200 sub-acute rehab and long-term care patients in five nursing homes. Formerly she was a registered nurse at Baptist Health-Little Rock in the intensive care unit. She also served as an adjunct nursing faculty member for the Nursing program at the University of Central Arkansas in Conway. The center treats a variety of urgent care and family health needs from allergies, skin conditions and stings/bug bites – to broken bones, childhood illnesses and vaccinations. No appointment is needed and walk-ins are welcomed. New patients can register online prior to visit. For more information visit UrgentCareBaptistHealth.com.

Mercy Continues Massive Expansion Mercy Northwest Arkansas is in the middle of investing $277 million on capital projects and equipment between 2016 and 2021, an expansion in health care facilities and services that is expected to create 1,000 new health care jobs. “Our hospital and clinics have been serving the community at a very high capacity,” said Eric Pianalto, Mercy Hospital president. “To ensure we carry out our mission and continue to meet the needs of Northwest Arkansas, we developed this $277 million community presence plan that will allow us to serve our patients into the future by providing additional access to quality care and advancing the region as a health care destination.” Among expansion plans are: • A new patient tower that will take Mercy Hospital Northwest Arkansas from 200 beds to 300-plus beds. Construction will accommodate future inpatient growth, with the goal of a total of 360 beds. The hospital tower is expected to open in the fall of 2019. • The addition of multiple primary care and specialty clinics in Benton County and north Washington County. Mercy opened four new clinics in 2017, opened a primary care clinic this spring and will open another primary care clinic this fall, both in Bentonville. • A $40 million, 60,000-square-foot multispecialty clinic in Springdale that initially will house two dozen primary care and specialty providers and a 24hour emergency department with a trauma room. • Enhancements to the hospital’s already robust areas of specialty care, including the heart and vascular center and women’s and children’s services. • Establishment of a University of Arkansas for Medical Sciences community internal medicine residency program in partnership with the Veterans Health Care System of the Ozarks in Fayetteville. The program will provide training to eight doctors the first year, growing to 24 doctors in three years. “Having more clinics and recruiting new doctors and advanced practitioners to Mercy will allow our patients to get care close to home,” said Dr. Steve Goss, president of Mercy Clinic. “Our intent is that these expansions will positively impact the health and wellness of the community.”

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GrandRounds Thomas Pepler Named to State Association Board

HARRISON - Thomas Pepler, RN and Manager of the Home Health and Hospice division at North Arkansas Regional Medical Center (NARMC) has been elected to serve as a member of the Board of Directors for the Hospice and Palliative Care Association of Arkansas Thomas Pepler (HPCAA). HPCAA is Arkansas’s professional organization for hospice and palliative care. In addition, Vince Leist, CEO of NARMC said, that Pepler has been appointed to serve as the Palmetto GBA Hospice Coalition representative from Arkansas. This coalition meets three times a year at Palmetto Headquarters to present information gathered from throughout the states to Palmetto representatives and receive feedback and information to bring back to the states. He said that everyone in the market should be excited that Thomas will be taking information to Palmetto GBA and representing our area in such an important group since Palmetto GBA is one of the 12 Medicare Administrative Contractors and covers seven of the south Central US states.

Neurologist Krishna Mylavarapu Joins Neurology Outpatient Clinic

LITTLE ROCK - Dr. Krishna Mylavarapu has joined the Baptist Health Neurology Outpatient Clinic in Little Rock. With Mylavarapu’s particular expertise, the clinic now offers two new services Botox injections for migraine prevention and inpatient seizure evaluations. Dr. Krishna Mylavarapu, who Mylavarapu is board certified and fellowship-trained in neurology, treats a variety of Neurologic Diseases such as muscular dystrophy, Alheimer’s disease, stroke and cerebrovascular problems, Parkinson’s disease, multiple sclerosis, seizures, migraine disorder, epilepsy, movement disorders and behavioral neurology. He also provides specialized services including electromyography and nerve conduction studies. Mylavarapu is one of four physicians practicing at the Baptist Health Neurology Outpatient Clinic. The others include Drs. Mohammad Daaif, Richard Pellegrino and Michael Chesser.

CHI St. Vincent Names Shawn Barnett as Senior Vice President and CFO

LITTLE ROCK - CHI St. Vincent announced that it has named Shawn Barnett as its senior vice president and chief financial officer. Barnett has an extensive background in health care administration, working for both for-profit and nonprofit Shawn Barnett arkansasmedicalnews

.com

Mercy Celebrates New Clinic in Southwest Bentonville BENTONVILLE — A heavy downpour couldn’t dampen the spirits of about 75 Mercy co-workers and friends who gathered to attend the blessing and ribbon cutting for Mercy Clinic Primary Care – I Street in Bentonville. Pediatrics and primary care providers will begin seeing patients Wednesday at the 14,000-square-foot clinic at 4100 S.W. I St. near the Bentonville Community Center. The clinic initially will add eight more providers to increase access to care in southwest Bentonville, with more providers being added to the clinic roster this summer. Bentonville Mayor Bob McCaslin praised Mercy for adding to the city’s quality of life while bringing hope and healing through its faith-based health ministry. He also complimented Mercy’s choice of a high-traffic location. The clinic is part of a multimillion dollar expansion plan announced in April 2016 that will add seven clinics in the region and a tower to the Rogers hospital. First described as a $247 million community investment, the expansion has grown to $275 million because of increases to the scope of several projects. Dr. Steve Goss, president of Mercy Clinic Northwest Arkansas, said studies identified the I Street area as being close to multiple residential neighborhoods and in need of additional primary care services. That’s a testament to the city’s growth in an area that once was on the outskirts of town, he said. Primary care providers joining the clinic are Dr. Raj Dondeti, Dr. Patrick Greenburg, physician assistant Lauren Greenhaw and nurse practitioner Sarah Keith. In pediatrics, the clinic’s providers will be Dr. George Schaefer, Dr. Rachel MacLeod and nurse practitioner Julia Adams. Additional providers will be brought on board in late summer. In addition to primary care, the 29-room clinic will offer specialty providers on a rotating basis. There is space to add another 14 exam rooms. Mercy’s investment totals $7.7 million in the clinic, begun by Crossland Construction Co. In addition, construction is underway on Mercy’s sixth location in Bentonville. Mercy Clinic Primary Care – Walton Boulevard will house four providers and feature 14 examination rooms at 1401 N. Walton Blvd. It’s expected to open in August.

health care systems. He most recently was president and chief operating officer of CHI St. Luke’s Health-Memorial in Lufkin, Texas. A Jonesboro native, he was controller for what was then Methodist Hospital in Jonesboro from 1988 to 1995 and was CFO of that hospital, then called Regional Medical Center of NEA, from 1995 to 1999. He also served as CFO at Triad’s Northwest Health System in Springdale and at Woodland Heights Medical Center in Lufkin. Barnett has a bachelor’s degree in accounting from Arkansas State University, and he earned an MBA with an emphasis in health care management from Regis University in Denver.

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GrandRounds Sparks Names New Chief Operating Officer

CHI St. Vincent Breaks Ground On Arkansas Neuroscience Institute Project SHERWOOD - CHI St. Vincent marked a milestone in the expansion of its Arkansas Neuroscience Institute today with the formal groundbreaking for a $17 million education and research center at CHI St. Vincent North in Sherwood. The new education and research building at CHI St. Vincent North near Little Rock will be part of a destination neurosciences institute that provides advanced neurosurgery care to patients in Arkansas, in the United States and internationally. The Arkansas Neuroscience Institute, currently located a few miles away at CHI St. Vincent Infirmary in Little Rock, will relocate its surgical and clinical operations to the newly expanded center in Sherwood by the end of this year. The education and research center will open its doors in early 2019. The Arkansas Neuroscience Institute is known for its internationally-recognized neurosurgeons who perform more than 1,000 complex surgeries a year and serve as mentors to clinicians seeking to learn the most advanced, sophisticated techniques for treating neurological disorders said CHI St. Vincent CEO Chad Aduddell. The education and research center will be adjacent to the hospital on the CHI St. Vincent North campus. It will feature an expanded laboratory and classrooms, an auditorium, the Arkansas Neuroscience Institute clinic and office space for the institute and for other physicians. The laboratory will be the only one of its kind in the world, featuring a patented teaching model developed by Dr. Emad Aboud, director of the lab. Denver-based NexCore Group is the developer for the project and will oversee construction. Work is already underway to renovate part of CHI St. Vincent North to house the Institute. Among those renovations are the addition of 10 intensive care unit rooms, updated operating rooms, an angiography suite, a new pharmacy and advanced imaging technology including a 128-slice CT scanner and 3T MRI equipment. The Arkansas Neuroscience Institute is led by Dr. Ali Krisht, a renowned neurosurgeon who specializes in vascular microsurgery involving the treatment of aneurysms, arterio-venous malformations, cavernous sinus tumors and acute treatment of stroke. Krisht is the chief editor of the journal, Contemporary Neurosurgery. Patients from 38 states and from all 75 counties in Arkansas have been treated at the Arkansas Neuroscience Institute. The institute is a comprehensive program that incorporates all aspects of neurosurgery and a full spectrum of neurological disorders.

Patient Benefits From New Heart Technology JONESBORO – Earlier this year, Dr. D.V. Patel, cardiologist at NEA Baptist, utilized the first Bluetooth® enabled pacemaker at NEA Baptist to help regulate the heart of his patient, Matthew Rollins. The Azure Pacemaker by Medtronic is one of the newest pieces of technology used in heart care to help control abnormal heart rhythms, or arrhythmias. Matthew Rollins is a 68 year old retiree who is active in church and enjoys being a great grandpa. Mr. Rollins has been a patient of cardiologist, Dr. D.V. Patel for more than 13 years and in 2007, he experienced a heart event which resulted in stents. Following that procedure, Mr. Rollins quit smoking and has been very active. In January 2018, Mr. Rollins was at NEA Baptist for an appointment and his heart arrhythmia was discovered. Dr. Patel had recently been educated on the new pacemaker technology and proposed that he utilize the pacemaker for Mr. Rollins. At the end of January, Mr. Rollins came in for the procedure, which went well. He was back for a follow-up appointment the next week and was very impressed by his entire experience the week before. The Azure Pacemaker by Medtronic is redesigned with BlueSync™ technology for secure, wireless communication via Bluetooth® low energy. Utilizing this new technology, clinicians can program the device to send secure notifications. The technology has also proven to detect and reduce atrial fibrillation (AF), the quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications. Testing has shown that design of the technology accurately detects AF and can even reduce false positives. All data collected by the device is protected by enhanced security with Dr. D.V. Patel, Matthew Rollins, Jennifer Smith, APRN data encryption and pacemaker protection.

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FORT SMITH – Aimee Arzoumanian, MHA, MS, PA-C, has been promoted to Chief Operation Officer of Sparks Health System. She joined Sparks in 2009 as a Hospitalist Physician Assistant and later became an Aimee Assistant AdministraArzoumanian tor in 2013. Since 2016, Arzoumanian has served as Assistant Chief Executive Officer at Sparks Medical Center – Van Buren. She earned a master’s degree in Physician Assistant Studies from Mercy College in New York and a master’s degree in Health Care Administration from Trinity University in San Antonio. Arzoumanian succeeds Shane Knisely who joined a health system in Cincinnati, Ohio, last month.

PUBLISHER Pamela Z. Harris pamela@arkansasmedicalnews.com EDITOR Pepper Jeter editor@arkansasmedicalnews.com SALES Jennifer Sifford 870-897-0766 jennifer@arkansasmedicalnews.com Kristen Owensby 219-781-1744 kristen@arkansasmedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com GRAPHIC DESIGNERS Susan Graham, Katy Barrett-Alley CONTRIBUTING WRITERS Becky Gillette Cindy Sanders All editorial submissions and press releases should be sent to pamela@memphismedicalnews.com Subscription requests can be mailed to the address below or emailed to pamela@memphismedicalnews.com. Arkansas Medical News is now privately owned by Ziggy Productions, LLC. P O Box 1842 Memphis, TN 38101- 1842 President: Pamela Harris Vice President: Patrick Rains Reproduction in whole or in part without written permission is prohibited. Arkansas Medical News will assume no responsibility for unsolicited materials. All letters sent to Arkansas Medical News will be considered the newspaper’s property and unconditionally assigned to Arkansas Medical News for publication and copyright purposes.

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GrandRounds

Dr. Phillips Appointed to State Medical Board FORT SMITH – Gov. Asa Hutchinson has appointed Dr. Don R. Phillips to the Arkansas State Medical Board in acknowledgement of his career-long commitment to patient care and serving fellow health care practitioners. Dr. Phillips, board certified in obstetrics and gynecology with Mercy Clinic OB-GYN in Fort Smith, was appointed to a six-year term that expires Dec. 31, 2023. He replaces Dr. William Dudding of Mercy Clinic Family Medicine – Free Ferry. The state medical board’s mission is to protect the public and act as its advocate by effectively regulating the practices of medical doctors, osteopathic medical doctors, physician assistants, respiratory therapists, occupational therapists, occupational therapy assistants, radiology practitioner assistants, radiologist assistants and medical corporations. Dr. Phillips received his medical degree and completed a residency at the University of Arkansas for Medical Sciences. Dr. Phillips believes he especially can be helpful when it comes to women’s health. In Arkansas, he said, too many unsolved women’s health issues are underfunded, such as improving access to prenatal care. The board recommends Arkansas legislation on medical issues, such as the current opioid crisis. Dr. Phillips’ first task on the board was attending an opioid public forum.

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