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FOCUS TOPIC PHARMACEUTICALS PEDIATRICS

November/December 2015 >> $5 December 2009

PHYSICIAN SPOTLIGHT PAGE 3

Richard E. Frye, MD, PhD, ON ROUNDS

CHI St. Vincent and Conway Regional Form Arkansas Health Alliance to Meet Challenges AHA is the First Entity of its Kind in the State

By BECKy GILLETTE

One of the state’s largest healthcare providers, CHI St. Vincent, recently partnered with Conway Regional Medical Center to form an entity that will be active statewide in creating alliances to help both small and larger hospitals become leaner and more efficient, enhancing the ability of the hospitals to fulfill their mission despite the challenge of regulations and reimbursements. “The Arkansas Health Alliance is a partnership starting with Conway Regional and CHI St. Vincent to focus on things to bring value back to each entity and position each to be successful long term,” said Jim Lambert, who was president and CEO of Conway Regional for 18 years before becoming the new president of the Arkansas Health Alliance. “The goal is to add other community hospitals and healthcare systems to the partnership and, through partnership, bring value to all involved. We are developing clinically integrated networks, going after risk-based

U.S. Drug Prices Highest in the World Reforms Needed to Stop Kickbacks, Reduce Fees, Increase Competition The price of pharmaceutical drugs in the U.S. has become an issue in the presidential primary with calls for reform being made by major candidates ... 5

(CONTINUED ON PAGE 6)

HealthcareLeader The Vision of an “Accidental” Administrator Rob Steele, MD, Saw the Opportunity to Better Community Health

Mercy Launches World’s First Virtual Care Center

By BECKy GILLETTE

Last month, Mercy unveiled the world’s first Virtual Care Center in the heartland of America. Bishop Edward Rice of the St. Louis Archdiocese officially blessed the nonprofit Catholic health system’s newest facility Oct. 6 in Chesterfield, Mo., a suburb located 15 miles west of St. Louis ... 7

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LITTLE ROCK—Pediatrician Rob Steele, MD, MBA, is the son of former Little Rock pediatrician Russell Steele, MD, who at one time was head of Pediatric Infectious Diseases at the University of Arkansas for Medical Sciences (UAMS). “My dad is probably the most unselfish person I know,” said Steele, who is senior vice president & chief strategy officer, Arkansas Children’s Hospital. “Like my dad and many others, I got into medicine because I wanted to help people. When I went to Vanderbilt Medical School, I tried to keep an open mind. But pediatrics was what I had a slant for. After my residency at Cincinnati Children’s Hospital at the Medical Center of Cincinnati, I was asked to stay on as chief resident. I got into teaching and some ad(CONTINUED ON PAGE 8)

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ATTENTION MEDICAID ELIGIBLE PROFESSIONALS

Don’t

miss out!

AFMC is now offering

no-cost assistance

to Medicaid eligible professionals* in Arkansas to achieve and sustain Meaningful Use.

2016 is the FINAL YEAR to begin participation in the Medicaid incentive program and earn the maximum incentive payment of $63,750! *MDs and DOs, dentists, nurse practitioners and certified nurse midwives, physician assistants and other specialists as established by guidelines from the Centers for Medicare & Medicaid Services (CMS).

For more information about this program and our services, visit afmc.org/healthit or call 501-212-8616.

HealthIT

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THIS MATERIAL WAS PREPARED BY AFMC HEALTHIT, A DIVISION OF THE ARKANSAS FOUNDATION FOR MEDICAL CARE (AFMC), PURSUANT TO A CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. MP2-AHIT.DMO.AD,8/15

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PhysicianSpotlight

Richard E. Frye, MD, PhD, is “All In” for Autistic Children

ACH Autism Research Program Director, Associate Professor, UAMS Department of Pediatrics By BECKY GILLETTE

At the Arkansas Children’s Hospital (ACH), Richard E. Frye, MD, PhD, wears two hats. He is director of the Autism Research Program and the ACH Autism Multispecialty Clinic. “One of my goals is to integrate clinical and research programs to improve the ability to discover treatment and disseminate new information into clinical practice,” Frye said. “We have integrated our program very well. The clinic is multi-specialty where multiple specialists see children. Children with autism have problems in a number areas that require a number of specialists like neurologists, geneticists, GI specialists and nutritionists that we have in the clinic. We know these are areas that affect autistic children a great deal. They are often affected by neurological disorders, in particular seizures. Some have genetic problems, and many have metabolic problems, which are the way cells generate energy and get rid of waste. We also know they have a high rate of GI complaints.” Autism spectrum disorder (ASD) was first described as a unique disorder in the 1940s. In the 1970s and 1980s, it was estimated that only one in 2,000 children had autism, but today the Centers for Disease Control and Prevention estimate one in 68 children aged eight years old in the U.S. have ASD. Between 1993 and 2003, the number of children with autism diagnoses increased by more than 800 percent. Early childhood intensive behavior intervention is the gold standard. But most children don’t have access to the services they need. “This is one of the things we are trying to help with,” Frye said. “One of the problems is the expense. The gold standard for treatment is for each child to have 40 hours a week of individual behavioral therapy. That is a full-time person. You can think of the economic and practical limitations of that. So, what we are trying to do is find out, what are the physiological blocks? How can we fix those so the child gets the most out of the therapy? If we can do that, the therapy won’t be as long and intensive so we can give it to more children.” It isn’t known what causes ASD or why rates of it are increasing. There has been speculation that it is related to better diagnosis than in the past. “But studies have suggested that better diagnosis is only part of the answer and there seems to be some real increases in the rates of autism – not just better surveillance,” Frye said. “The reason why it is increasing so quickly, we don’t know. arkansasmedicalnews

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Each time it is surveyed, usually every four years, we think it has reached its highest levels. But each time we look, it increases higher. It is very concerning that we don’t know what is driving it. More research needs to be done to figure that out so we can provide good treatment.” One advantage of children getting treatment at the ACH Autism Multispecialty Clinic is that they can take advantage of the latest clinical trials. This allows the child to get the benefit of the latest promising treatments. One trial just completed by Frye involved supplementation with a special type of folate that improves folate metabolism. Children with autism

have abnormalities in how they use and handle folate. “Folate is an extremely important vitamin,” Frye said. “The clinical trial with this special type of folate looks very promising. Some children are having an extremely good response. We are publishing the results of the trial, and are working on launching a large, multi-center trial so everyone in the country can benefit. This is a great example of how we integrate our clinical program and translational program to look for cutting-edge treatment.” Patients at the clinic are also able to take advantage of industry sponsored trials.

Another research area Frye is involved with is basic research into mitochondria, the powerhouse of cells that function abnormally in many children with autism. “This can help complement treatment and improve treatment for children with autism,” he said. Frye, a pediatric neurologist, did a fellowship in behavioral neurology and learning disabilities at Boston Children’s Hospital. He was originally interested in dyslexia. But he started getting a lot of ASD referrals from colleagues who found the autistic children difficult to treat. That led to him creating the autism clinic. “A lot of it was driven by parents and their quest for knowledge,” Frye said. “Parents who came to my clinic with children with autism seemed to think something was going on with their children that people weren’t telling them about. The level of treatment wasn’t satisfactory to a lot of parents. “Since autism falls under the behavior neurology umbrella, parents were referred to me. I became interested in certain types of epilepsies that look like autism. I knew I could do an EEG, and look for special types of epilepsy. As I started to see more children with autism, I found out other things were affecting children with autism like mitochondrial diseases. That was something I could test for. I learned that abnormal tetrahydrobiopterin (BH4) levels are found in some children with autism. Folate abnormalities are also common.” (CONTINUED ON PAGE 12)

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Hepatitis C Kills Twice As Many People in Arkansas as HIV Nearly 38,000 Adult Arkansans are Unaware They Have It By BECKy GILLETTE

Recent data show that Hepatitis C (Hep C) kills twice as many people in Arkansas as HIV-related illnesses making it the most deadly infectious disease in the state. “It is estimated that 38,000 adult Arkansans have Hep C and do not know it,” said Arkansas Department of Health Medical Director for Infectious Disease, Naveen Patil, MD. “Since we began testing in our health units in the late summer/fall of 2014, we’ve tested 2,658 Dr. Naveen people and 282 of those Patil were confirmed reactive.” The recommendation is that anyone born between 1945 and 1965 be tested for Hep C at least once. Anyone, regardless of age, who is at risk for infection should also be tested. That includes healthcare workers who might have come into contact with infected blood through a needle stick. Other major risk factors are illegal IV drug use, receiving a tattoo or body

piercing from an unregulated entity, a history of incarceration, HIV infection, or receiving a blood transfusion before 1992. “It’s difficult to estimate the number of IV drug users in the state, though some predict that number is increasing with the crackdown in prescription opioid drug abuse,” Patil said. “Individuals who are addicted can no longer acquire prescription opioids and may be turning to heroin, which can be used in a variety of ways, including injection. If national trends in IV drug use also represent Arkansas, it’s likely that we will see an increase in Hep C infections over time.” Because Hep C often doesn’t show any symptoms until years or decades after infection, it’s likely that many of those who were exposed a long time ago are just now beginning to have physical symptoms from the bacterial and viral infections that cause inflammation of the liver. Patil said Hep C can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hep C can be either acute or chronic. Acute Hep C infection is a short-term illness that occurs within the first six months after someone is exposed.

“For most people, acute infection leads to chronic infection,” Patil said. “Chronic Hep C is a serious disease than can result in long-term health problems, or even death. There is no vaccine for Hep C. The best way to prevent Hep C is by avoiding behaviors that can spread the disease, especially injection drug use. About 80 percent of those exposed to the virus contract the disease.” Andres Duarte-Rojo, MD, a University of Arkansas for Medical Sciences (UAMS) assistant professor who specializes in gastroenterology and hepatology, said the good news is that antiviral medications that have come on the market in the past year or so Dr. Andres are seeing cure rates of Duarte-Rojo above 90 percent for the vast majority of infected people. That is a great improvement over earlier medications including peginterferon and ribavirin that have been in use for about the past 25 years that are effective in about 45-55 percent of patients, across the seven different genotypes) of Hep C. “Those two medications are pretty good, but have way more side effects and about half the efficacy for the majority of patients as the newer drugs,” Duarte-Rojo said. “The efficacy and safety both are pretty good with the newer medications. Side effects are minimal. About five to 15 percent of patients will have fatigue, headaches, insomnia, diarrhea and nausea.” The newer medications for chronic Hep C include Sofosbuvir, which used with other anti-viral medications (i.e. Ledipasvir and\or Ribavirin) can cure the majority of patients within 12 to 24 weeks. A second is the three-drug combo commercialized as Viekira approved in March 2015, approved only for use in genotype one. A third one is Daclatasvir, approved in combination with Sofosbuvir for the fewer patients with genotype three infection. The medications are extremely expensive which has led to rationing of the drugs. “That is the problem,” Duarte-Rojo said. “We have medication that is very useful that can be given to majority of patients, but we cannot pay for everyone to have antiviral regimens that can cost between $84,000 to $150,000. Use is being restricted to patients with the most urgency: cirrhosis or a state previous to cirrhosis. This means, if you are a nurse

working ICU, and you get stuck with a needle from a Hep C patient and develop the chronic disease, you are not going to get treated because that medication is not covered for initial stages. That doesn’t make sense to me. It goes against the good practice of medicine, and we have some people here who work at university under that circumstance. But that is how the policies are right now. “I expect the policy will change when the price decreases. It is easy to blame it on insurance or drug companies, but the problem is actually more complicated than that. It will create a great debt to the health system if we treat everyone at the early stages of infection. So we might have to be selective on whom to treat in early stages of disease for the next few years.” While it is discouraging that the new drugs can’t be used to treat everyone, including some healthcare providers, Duarte-Rojo said we should all feel very positive about the newer medications. He expects to see the medications become more affordable and available in the near future, and is also hopeful that new anti-viral medications will be developed to treat about ten percent of the Hep C patients who don’t respond to any of the current antivirals. “I believe a time will come when all patients will be able to get treatment and have Hep C eradicated,” Duarte-Rojo said. “Anyone in dire need now can get therapy. They should not feel they are being abandoned. People who really need it are getting therapy right now.” Illegal IV drug users are the largest risk group. It is important to have a statewide strategy combining substance abuse rehabilitation and antiviral therapy so patients can remain drug-free in order to prevent re-infection. Duarte-Rojo said from the public health perspective, it does not make sense to invest a large amount of money on antiviral therapy on people with a high likelihood of getting re-infected, particularly when no support is offered for their substance abuse problem. “That is why we delay treatment of people who use IV drugs until after rehabilitation,” he said. “Otherwise, they are likely to use another dirty needle, and will get re-infected.” Duarte-Rojo recommends more people in the state be screened for Hep C. There is recent evidence from emergency departments showing people with no identifiable or disclosed risk factors having a high frequency of Hep C infection.

For more visit: Centers for Disease Control and Prevention Hepatitis C Information www.cdc.gov/hepatitis/HCV/index.htm

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U.S. Drug Prices Highest in the World

Reforms Needed to Stop Kickbacks, Reduce Fees, Increase Competition By BECKY GILLETTE

The price of pharmaceutical drugs in the U.S. has become an issue in the presidential primary with calls for reform being made by major candidates. Some Arkansas patients are reporting that the co-pays for medications they depend upon have skyrocketed, making them unaffordable. It is difficult for a patient to understand why a prescription that used to cost them a $20 co-pay per month has gone up to $400 per month. The problem comes as no surprise to Hot Springs dermatologist Dow Stough, MD, president of Burke Therapeutics LLC, which develops specialty dermatology medicines for acne, rosacea, psoriasis, pediatric dermatitis, eczema and other skin conditions. “America has the highest prices for prescriptions in the world, and that’s ridiculous,” Stough said, who has done a number of clinical trials for pharmaceutical companies for dermatological prescriptions. “We created this mess, and the question before us now is, ‘Are we going to do what it takes to fix it?’” Stough said it would take a combination of reforms to rein in the cost of prescription medicines. “The generic companies have consolidated in areas cre-

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ating a monopoly which causes prices to skyrocket,” said Stough, who is a Certified Physician Investigator with accreditation from the Association of Clinical Research Professionals. “The small pharma companies can’t come in because of very high FDA filing fees. Then they are at the mercy of the FDA to process, review, inspect and eventually approve a competitive generic. The filing fees to the FDA for new drug approval is more than $1.2 million.” The list of problems that increase the

cost of drugs is lengthy. “You pay the FDA for approval and maintenance fees,” Stough said. “You pay the wholesalers a fee from 10-18 percent after rebates, and you pay the PBMs (pharmaceutical benefit managers) to list your drug. Manufacturers of higher tier drugs work out ‘deals’ with PBMs. Many of the PBMs have received large fines for violations. Pharmacies also need to make a profit. And, finally, the pharmaceutical industry pays enormous liability insurance.”

These other costs mean, Stough said, that if he produced a drug for $50 dollars a month, it would be difficult to sell it for $200 and make any profit. Stough’s prescription for reforming costs for pharmaceutical drugs is multifold: • A better distribution system. No kickbacks or rebates should be allowed to insurance companies or PBMs, • Medicare\Medicaid and large insurance companies should be allowed to negotiate prices of drugs with manufacturers, • FDA filings fees should be drastically decreased coupled with much faster review times for new drugs, • Tort\liability reform, • Better patent protection. Currently, patents are often challenged and manufacturers lose patent protection before the time period needed to recoup development costs, • Patients should be allowed to purchase drugs outside their insurance network and even outside of the U.S. “We should open up the distribution channels to make Canadian drugs readily available in the U.S.,” Stough said. “There are plenty of good foreign drugs, many of the same ones we have here, but (CONTINUED ON PAGE 6)

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CHI St. Vincent and Conway Regional, continued from page 1 contracting, looking at Medicare shared savings, and doing this in combination with each other to improve the quality of care while reducing costs. We can reduce costs by contracting for certain supplies and services. So we can drop costs or slow down increases while also standardizing care and improving the quality of care.” Lambert said the partnership is an exciting opportunity to build Jim Lambert an organization that has the potential to help not only Conway Regional, but other independent community hospitals. He said he knows through serving on the board of the Arkansas Hospital Association that many independent hospitals are seeking an ally in today’s rapidly changing healthcare environment. The trend for state and nationwide partnerships is being driven by the challenges to healthcare providers maintaining compliance with regulations at a time of changing reimbursements. With all the different models being developed, it is hard to be an independent hospital and do all that is required. “In switching from the old reimbursement model of fee for service to paying for value, you are taking the risk for that,” Lambert said. “It takes a whole different level of skill sets and infrastructure to support that. Smaller hospitals have a hard time building that infrastructure. The nice thing is that CHI St. Vincent has built a lot of infrastructure that others can access at a local level while still maintaining their independence.” While in the startup phase of the Arkansas Health Alliance, Lambert is out discussing with providers what the alliance can bring to them and their organization. “We will decide what things we can work on together and coordinate that activity,” Lambert said. “The alliance won’t be dictating what has to be done. We will decide together what to do and how to make that work for everyone’s benefit.” Conway Regional has 1,200 employees and a 156-bed hospital. An advantage for Conway Regional in selecting CHI St. Vincent is that it is part of CHI, one of the nation’s largest non-profit health systems

with 105 hospitals across the U.S. “CHI has a large infrastructure behind them,” Lambert said. Healthcare is a competitive business, but it is also one where, increasingly, success depends on cooperation to achieve economies of scale and reduce costs. Lambert expects to see the trend toward consolidation of the market for all different size hospitals to survive. Many other healthcare administrators are facing the same situation that led Conway Regional to form an alliance with CHI St. Vincent. “You look at what is coming at you and ask, ‘How do I manage all I’m doing now, while being expected to improve care and reduce costs while transitioning to a new payment model at the same time? What is the best way to go forward?” Lambert said. “Sometimes it is a sale. But other times an alliance helps get some of the services and economies of scale that happen with a larger organization without giving up independence. It made sense for Conway Regional and may make sense for other hospitals in the state.” Lambert said while this type of alliance is new to Arkansas, it is not a new model. States like Indiana, Iowa and Louisiana have had good success with alliances. “We are trying to learn from

under different names, that are incredibly cheaper than what is on the market in the United States. Patients should absolutely have access to those more-affordable prescriptions.” Stough is skeptical that the major reforms will happen anytime soon. “In the meantime, the high prices are great talking points for politicians,” he said. “But real change would take another level of interest by the U.S. government.” As prescription drug prices continue to rise, consumers who can afford it are paying more of their income for prescriptions. Those who can’t afford it are going without medicine that they need. Is there a conspiracy between drug developers, lawmakers and medical personnel? Big Pharm is one of the largest lobby group in the U.S. with estimates

NOT OFTEN ENOUGH. Almost half of people affected by obesity say they have not been advised by a physician about how to achieve a healthy weight.* Learn more about treating obesity seriously. www.ObesityCareWeek.org

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There are storm clouds ahead regarding reimbursements for healthcare providers that are causing concern. Lambert said the private option Medicaid expansion in the state has been very helpful for hospitals because they have started getting reimbursed for care they weren’t getting paid for previously. Currently, about 240,000 people receive coverage under the private option Medicaid expansion, but that is scheduled to expire at the end of 2016. “The governor has a group looking at what is the best option for the state,” Lambert said. “There is a lot of concern about the affordability of extending the private option. If it goes away, it will be something hospitals will have to deal with. The private option has been a significant financial benefit and if it is eliminated, it is going to be difficult for hospitals to continue to provide the level of service their communities expect.”

For more, visit: CHI St. Vincent http://www.chistvincent.com/ Conway Regional Medical Center http://www.conwayregional.org/

U.S. Drug Prices Highest in the World, continued from page 5

How often are physicians talking with patients about weight?

* US Center for Public Affairs Research 2012 Report.

those organizations,” he said. “Some have been in place a long time and some are just developing. The rural nature of our state makes it more challenging. I feel Arkansas hospitals have been fairly efficient. Our reimbursement rates are lower than in other parts of the country, so we have to be more efficient. We are striving to help improve our health outcomes across the state while striving to improve our reimbursement rates, and are hoping that something like this can help organizations continue to do that.” One way to improve the health of the population is wellness centers. More large employers in the state have wellness initiatives. Conway Regional has had a wellness initiative in place for employees for several years that is incorporated into their managed care. “CHI St. Vincent has a strong commitment to wellness as well,” Lambert said. “Every employer is trying to help with wellness for employees because the cost of healthcare is so high. The more we can encourage that, the better we are all served. Conway Regional has seen some significant benefits from that in its health plan. Healthier employees are happier and more productive at work and in private life. It is win, win, win if you can make this work.”

that total spending on lobbying activities from 1998-2012 at $2.6 billion. But Stough doesn’t see a major conspiracy afoot. “This is a complicated system, created over years by a series of actions that were intended to drive down drug costs, but had an alternate effect,” Stough said. “While 99 percent of doctors may throw up their hands and think there’s a smoking gun, that’s simply not true. There are not five guys in a back room somewhere manipulating the price of drugs.” Stough got involved in development of dermatological drugs after seeing areas where needs were not being met. Why was a certain drug effective for psoriasis, for example, no longer available? Or why had a drug soared in cost? “But 99 percent of the time, there was no way to get an answer,” Stough said. “There is no one to call or way to find out. Now I understand why it is so difficult to find the answer because there can be many elements. One company buys out another to get market dominance.

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Maybe the company bought has 20 drugs, and the buyer is really only after one. So they stop manufacturing the other drugs. Some manufacturers get shut down by the FDA. Then Generic Drug User Fee Act (GDUFA) costs are very high. So there is not much competition.” Burke Therapeutics could manufacture drugs that have been dropped from production, but are very much needed by patients. But Stough said fees and lengthy review processes usually make it cost prohibitive. “Sometimes the time frame is two or three years for the FDA to act on an application,” Stough said. “If you did get the application approved, then you have to enter the distribution system. If you don’t understand the problems with the distribution system, you can’t understand the high cost of drugs. That is why the politicians, news media and physicians all can’t understand why this drug that was $5 a month is now $200 a month. They think it is just pure greed from pharmaceutical industry. It is not. That is not the whole story. There are numerous reasons patients and healthcare payers pay high prices for drugs.” Finally, it is difficult and cost prohibitive to get liability insurance for small companies; all the policies are for big companies. Stough said there are drugs he theoretically could manufacture for $1 a pill, but liability insurance starts at $100,000. While the solutions are complicated, there is growing urgency to do something. “The growing price of drug costs is not sustainable,” Stough said. “We can’t continue to do this.” arkansasmedicalnews

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Mercy Launches World’s First Virtual Care Center City Again Serving as Gateway to a New Era By LYNNE JETER

ST. LOUIS, MO — Last month, Mercy unveiled the world’s first Virtual Care Center in the heartland of America. Bishop Edward Rice of the St. Louis Archdiocese officially blessed the nonprofit Catholic health system’s newest facility Oct. 6 in Chesterfield, Mo., a suburb located 15 miles west of St. Louis. The new $54 million building on a 38-acre campus houses the nation’s largest single-hub electronic intensive care unit (ICU/Mercy SafeWatch), and also provides a center for telemedicine innovation and a testing ground for new healthcare products and services. More than 300 physicians, nurses, specialists, researchers and support staff at the four-story, 125,000-square-foot center are tapping into technology to deliver care to patients around the clock via audio, video and data connections to locations across Mercy and around the country through partnerships with other health care providers and large employers. “This is a huge and impactful step forward for telehealth and I appreciate that Mercy leadership had the vision and

More than 300 physicians, nurses, specialists, researchers and support staff at the Virtual Care Center are tapping into technology to deliver care to patients around the clock via audio, video and data connections to locations across Mercy and around the country.

determination to demonstrate to their community and the world how telehealth is one powerful and effective solution to the issue of diminished access to healthcare that many citizens in America and across the globe are experiencing,” said Rena Brewer, CEO of Global Partnership for Telehealth Inc., and director of the Southeastern Telehealth Resource Center.  

Randall Moore, MD, MBA, Mercy Virtual president, spoke with Medical News exclusively about establishing the Virtual Care Center and the positive impact it’s already making on practices, clinics and hospitals across the United States.

How did the idea of Mercy creating a Virtual Care Center originate?

It was an evolutionary process. We launched our first virtual program – Mercy SafeWatch, our electronic ICU– in 2006, and we’ve experienced great success. As the team continued to build programs and saw the importance of virtual care becoming a transformational pathway for our health system, a light bulb went on. It made sense to create a Virtual Care (CONTINUED ON PAGE 8)

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The Vision of an “Accidental” Administrator, continued from page 1 ministrative work.” Then, he left because his plan was to be a practicing pediatrician. After Cincinnati, he moved to Springfield, Mo., where he lived for 17 years – the first ten exclusively in private practice with Mercy Health. In the final seven years he was in Missouri, he became “an accidental administrator.” “My foray into administration was somewhat accidental,” Steele said. “I did raise my hand to volunteer to do one thing. That turned into two, four, ten things.” He got deeply involved in the integration of the managed care process at Mercy Health. Physicians liked having an administrator talk to them who was also a doctor. “I got into this managed care thing, and working to understand the business side of medicine,” Steele said. “I am not smartest guy in the world or even the room. This was so far out of my comfort zone. But I threw myself into the negotiations for managed care contracting, and really got into it. It made me the total boring guy at the cocktail party.” He recalls an “aha!” moment that solidified his foray in management. He realized that while it was deeply satisfying to have impact one-on-one with patients, by being involved in the managed care and the business side of medicine, he could have positive impact on the health of thousands of people.

There were a few years both working as a pediatrician and an administrator that he said were rough on his family since they saw him little. Very long work weeks were the norm. Then, about three years before he moved to Little Rock in June 2014, he became president of Mercy Springfield Communities and cut back to about 20 percent clinical. “As time goes by, it is difficult to do administrative stuff with your doctor hat on,” Steele said. “While I’m licensed in Arkansas, I have not actively practiced here. You can come from a lot of different backgrounds and do what I do as chief strategy officer. But to align where healthcare needs to go, improve quality, and understand how changes impact the market, being a physician is helpful. You can speak both languages. You can talk to doctors about business strategy. It gives me a little bit of street cred. I know what it is like to be practicing, and the stresses and difficulties of things like electronic medical records. I know that many doctors think the paperwork hoops that Medicaid is requiring you to do are silly. I am able to tell them the strategy behind that, and why it is not necessarily silly.” In his role at ACH, Steele is overseeing a five-year plan to provide a total system of statewide care for children in Arkansas that includes a new hospital in Springdale. Because of major population growth in northwest Arkansas, ACH felt the hospital was the correct solution. “That doesn’t mean we will start

plopping down hospitals all over Arkansas,” Steele said. “That wouldn’t make sense. That is just part of a statewide network we are building. It is not just clinics, but capabilities. Other parts of the state, like Jonesboro and Texarkana, have a concentration of children not as dense, but still substantial. In Jonesboro we have a clinic already, and we go down and do clinics in Texarkana. We recognize while the total number of children is not as robust, it is still significant, so we need a presence. Are we going to go build more clinics? We might, if it makes sense. But that is an expensive proposition and in many cases not necessary. We can help coordinate the care already in the community.” In rural areas like the Delta with small populations, what works well is a combination of telemedicine and deploying physicians to clinics. Because of physician shortages in the state, telemedicine can have a major impact by providing specialist care in areas such as pediatric genetics and endocrinology. “Endocrinology has childhood obesity and diabetes in its crosshairs,” Steele said. “Those are major health concerns in Arkansas.” Another focus is on prevention. Steele said healthier children tomorrow means building a better mousetrap. “The goal is to elevate health of children across the state,” Steele said. “I think in five years we will have very specific things we can hang our hat on that show

we have moved the needle.” Steele describes his management style as “classic servant leadership” that is integrated, collaborative, and teambased. That involves recognition that you succeed and fail not as an individual, but as a team. Steele and his wife, Renee, have five children: Ryan, 22, has just entered medical school at UAMS. Mitchell, 20, is working on a degree in finance at Southern Methodist University in Dallas. Dora Jean, the sole daughter, is 11. Twins Austin and Christopher are 7. The family love the recreational opportunities that abound in Little Rock, particularly the River Trail. “I’m a big road biker, and I love being on a trail so I don’t have to worry about getting run over,” he said. “You can do 30-mile bike rides without vehicle traffic. It’s a big deal. Some people have never gotten out there. It is so awesome. It is really pretty at night. I used to mountain bike a lot, but where I lived in Cincinnati, I had to load up the bike and drive a long way to ride. Soon I will be able to get on the River Trail near my house since they are expanding the trail.”

For more visit: Arkansas Children’s Hospital www.archildrens.org/

Mercy Launches World’s First Virtual Care Center, continued from page 7 Center that worked like a hospital to bring together teams, resources and infrastructure to care for patients in a much more coordinated manner and to offer a care continuum that extends 24/7/365. We needed a facility for this conduit of care, just as we’d need one for a particular service like cancer care.

How did the concept evolve into the world’s first-of-itskind telehealth center?

The Virtual Care Center evolves from the culture and charism of Mercy. The Sisters of Mercy who founded our health system were famously known as ‘the walking sisters.’ That goes back 187 years, when nuns were mostly cloistered and did good deeds from their convent for people in need. The walking sisters, who were quite independent, didn’t want to wait for people to find them. Instead, they searched for people in need and addressed those needs on the spot. They were an anomaly for their time. When you think about hospitals in general, we wait for people to come to us, and we give them exceptional care. The idea permeating our culture was to seek those needing medical care by taking virtual care teams from our clinics and hospitals and proactively identifying their healthcare needs, intervening with them earlier and more completely. It translates to a lower cost, high impact option to keep 8

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a person from deteriorating. At the board level and leadership level, (Mercy president and CEO) Lynn Britton and (Mercy CFO) Shannon Sock were the primary drivers of this project, understanding the Virtual Care Center is 100 percent consistent with our organizational mission – and also a model for us to progressively replace our hospital-based care with care when and where people need it. If we do this well, we’ll be able to realign our contracts to be rewarded for keeping people well.

How have you made the Virtual Care Center a sustainable business model while also dealing with the complexities of regulations, interstate commerce, and the like?

First, it’s important to know we didn’t go into the Virtual Care Center thinking that a fee-for-service equivalent would make it a sustainable business model. We weren’t expecting, though we’d have welcomed it, very much direct reimbursement as has panned out. In Missouri, our parity laws have helped. We’re broadening it to enable us to move our teams and our patient centricity from our facilities, which are somewhat limiting, to virtual care anytime, anywhere. If we did that with something like performance-based, population health contracts, we could intervene earlier and more effectively, and then it would pay for

itself. For example, here’s how it works in today’s environment in the hospital ICU vs. the floor. In the hospital ICU, the hospital is paid a lump sum for a patient with a given condition and it’s a fixed amount of money. The ICU is more expensive, and the patient usually doesn’t have as good an outcome. One result of our Mercy SafeWatch program shows the actual v. predicted mortality for the last few quarters in our Joplin (Mo.) hospital has been running around 50 to 55 percent. In other words, 45 to 50 percent of the patients who ‘should’ve’ died didn’t. That statistic doesn’t help much with finances, right? It should help us with market differentiation; by having Mercy SafeWatch in place, we can do a better job taking care of people. But here’s another example: Looking at the risk-predicted length of stay, both in the hospital and the ICU, our length of stay is running 20 to 30 percent less than predicted in the ICU, and 30 to 35 percent less than predicted on the whole hospitalization. If we can get a sick person well faster, that’s less time for the patient in the ICU. Looking at it financially, the direct variable ICU costs us about of $900 a day. If it costs us $650 a day to use Mercy SafeWatch, then we’re getting 100 percent return on our investment of virtual care without being paid directly for it. But the most important aspect is that a third of the ICU patients predicted to die

aren’t dying. That’s just the tip of the iceberg, and it implies that patients accessing the Virtual Care Center are doing better. We expect to deliver more efficient, effective, and higher impact care as we integrate virtual into bedside and clinic care.

What’s Mercy’s longerterm goal for the Virtual Care Center?

One of our key growth areas for our mission is to create the Virtual Care Center as a conduit of care anyone, anywhere can access. We’ve been on a 10-year, several hundred million dollar journey to get where we are. We’ve learned many positive things, and we continue to learn from missteps. We’re proposing that instead of selling our services, or having an entity trying to replicate the same services without us being able to provide much support, we’d like to build a national consortium of interdependent partners. We’d continue packaging our offerings and building our infrastructure with our partners’ support. They could buy into our entity, we could capitalize it together and replicate what we’ve learned with a fraction of time and money, and also do it in an interdependent way so we could then go to GM, Boeing, CMS, United Healthcare to offer it to people they’re covering throughout the 50 states.

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WHO’S TENDING OUR DOCTORS?

Mercy’s Virtual Care Center Tailored to Improve Physicians’ Quality of Life, Too Center. “Hopefully, we’ll approach ST. LOUIS, MO — Inter100 percent of the calls at night no nist Randall Moore, MD, MBA, longer going to our doctors,” he recalls countless nights of sleep insaid. “By not taking calls at night, terrupted by on-call requests. doctors can be more productive.” Moore, now president of Physicians have shared conMercy Virtual, is doing his part cerns about Virtual Care Center to make sure more doctors enjoy operations and how it will impact their private lives when they clock their practices, Moore shared. out of their practice, clinic or hos“The Virtual Care Center pital. isn’t a call center,” he empha“Instead of getting a 2 a.m. sized. “It should be progressively call to come in, they can sleep,” integrated into the doctor’s pracsaid Moore, who helped open the President of Mercy Virtual, Dr. Randy Moore, addresses a group of visitors. tice. We’ve designed it specifically world’s first-of-its-kind Virtual This room, like many areas of the Virtual Care Center, has the latest in the way the doctor would want it Care Center last month near St. audiovisual technology. done. You might say it’s somewhat Louis, Mo. “It’ll enable them to be of a mass customization … supmore productive, have less chance of burna community with no virtual care and he’s porting our doctors and other healthcare out, and improve their quality of life while the only intensivist, he’s on call all the time. professionals via the Virtual Care Center.” we enable better, more responsive care for It’s tough and doctors burn out. With the In one-on-one conversations with doctheir patients.” virtual team, the doctor can go home and tors, Moore is often asked how the Virtual When Mercy’s electronic intensive have a life. We do that increasingly across Care Center “can be better than what I can care unit (ICU), also known as Mercy Safethe board, not just Mercy SafeWatch. Using do?” Bolder ones ask: “Is it a threat to my Watch, was established in 2006, Mercy had a nurse-on-call feature, which is housed inpractice?” one “full” intensivist group in one site. Now, side the Virtual Care Center, 70 percent of “The Virtual Care Center is another Mercy has intensivist groups at multiple the calls our doctors were getting a couple resource for a doctor or hospital to have in sites, said Moore. of years ago are now handled without them the care of their patient when they don’t “One reason why, aside from our overbeing bothered.” have the time, resources or infrastructure arching mission of care, is to improve the Moore said Mercy will take another to do it on their own,” he said. “It’s very quality of life for our doctors,” explained step to making it easier for doctors by bringcomplementary to what they do.” Moore. “For example, if a doctor goes into ing more physicians into the Virtual Care One telehealth success story involves By LYNNE JETER

Mercy’s early warning system for sepsis. To identify patients at risk for sepsis and alert doctors to these risks for early intervention, Mercy’s Early Warning & Identification System (EWIS) monitors multiple patient variables in real-time. “We look at building programs as ways to partner with doctors to create a seamless integration for the patient,” explained Moore. “We look at how we can improve the value of that entity – practice, clinic or hospital – in the local marketplace so they can show first and foremost, they can deliver better care with documented outcomes for the patients they serve. Secondly, we show how they’ll be financially and operationally rewarded instead of having their revenue adversely affected. I’ve had doctors say, ‘I don’t know how to sustain my practice if that happens.’ Instead, we’re helping them build a financially sustainable and professionally more rewarding offering in the community.” Moore recalled a primary care physician sharing his experience after working with the Virtual Care Center. “He told me that after 35 years of the practice of medicine (without telehealth),” said Moore, “it was the most rewarding time of his professional life. That’s what we strive for, to allow doctors to get back to the basics of practicing medicine.”

• Coming in November – new clinic location in White Hall! • PTCOA has multiple locations statewide • PTCOA’s team consists of physicians and nurse practitioners with over 100 years of combined pain management experience • PTCOA accepts all major insurances including Medicare, Medicaid, and all government expansion programs. • All physicians of PTCOA are anesthesiology-trained interventional pain management specialists

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Outside Influences

Improving the Environment to Improve Health By CINDY SANDERS

It’s easy to think of many of the key target areas for environmental health specialists as pertaining to ‘someone else.’ After all, the United States has clean drinking water, sewage containment, air quality standards and large federal agencies focused specifically on food safety, emergency preparedness and infectious disease. Yet, a second glance underscores how real those problems are here, as well. National Environmental Health Association Executive Director David T. Dyjack, DrPH, CIH, pointed out concerns at home include transitions in the conditions under which individuals live, the food they eat, drought and other effects of climate change, emerging threats brought into the country, and an aging infrastructure. Adding stress to that infrastructure is a shifting population pattern. America, like most of the rest of the world, is rapidly urbanizing. Dyjack noted 5 percent of local health departments now service 50 percent of the U.S. population. As needs shift, the field of environmental health is also evolving. While prevention has always been a focus, the need for early intervention has taken on increasing importance. “In line with the social determinants of health, 80 percent of a person’s health

status has little to do with a person’s clinical care … 80 percent is related to where you live and lifestyle choices – what you eat, what you drink, how you recreate,” he said, adding that is the purview of the environmental health specialists that make up NEHA’s membership. “This is why clinicians and environmental health professionals need to work together much more collaboratively.” Prevention, he said, is a ‘pennies on the dollar’ proposition. However, Dyjack continued, “The irony is over 95 percent

of every health dollar spent in this country is spent on clinical care, and less than 5 percent is spent on prevention.” He added, “Public health and environmental health is a best buy for citizens of this country. The investment is inverted.”

One Health

“One of the issues that is not getting the attention it deserves is what is being referred to as ‘One Health,’” Dyjack said. He explained the concept seeks to unify the health of animals and humans.

The initiative looks to forge collaborations “between physicians, osteopathic physicians, veterinarians, dentists, nurses and other scientific-health and environmentally related disciplines,” according to OneHealthInitiative.com. In addition to emerging zoonotic diseases, the One Health concept recognizes the ease of geographic transmission of illness in modern society. “The world is effectively globalized,” said Dyjack. “The diseases that are incubating in megacities and in the developing world, those diseases can easily be transported in a day.” He continued, “For the record, what happened this last year with Ebola was entirely predictable, entirely preventable, and environmental health professionals should have played a major role in both the prevention and mitigation of the chaos that ensued.” Dyjack added that a system should have been put in place after the breakout in the 1970s to thwart future epidemics. However, money wasn’t allocated at that time. “And we paid the price for that lack of investment this year,” he said. In addition to the very real human toll, the World Health Organization estimates $32 billion has been spent in the aftermath of the recent Ebola crisis. Dyjack pointed out building health systems in West Africa (CONTINUED ON PAGE 12)

ICD-10 Implemented, Sky Still Intact By CINDY SANDERS

In the end, perhaps the hardest part of the ICD-10 launch was simply getting to it. After years of ‘sky is falling’ prognostications surrounding the changeover, the launch date of Oct. 1 came and went pretty quietly. Of course, the numerous delays and a compromise hammered out this past summer between the Centers for Medicare & Medicaid Services and the American Medical Association regarding a grace period for providers, might well have contributed to the relatively smooth kickoff. “People have just done a tremendous amount of work over the last four years for this transition,” said Ed Hock, managing director for Revenue Cycle Solutions at The AdviEd Hock sory Board Company, a national healthcare research, technology, consulting and performance improvement firm. He added the issues that cropped up in the wake of the launch tended to be relatively minor technical glitches. However, Hock noted, any kinks in reimbursement or cash flow probably won’t show up 10

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until this month or beyond as bills begin to make it through the claims processing cycles of payers around the country. Helping physicians during the transition to the much more complex diagnostic coding system is an audit and denial moratorium (for specificity) granted to practitioner claims submitted under Part B for a period of 12 months. CMS has also installed an ICD-10 Ombudsman to help triage provider issues. Hock, who works primarily with larger health systems across the country, said it’s important for those in the industry to understand the caveats attached to the moratorium. First, he noted, “The grace period only applies for the physician portion of the claims.” Hock added that for inpatient claims, hospitals need to get it right from the start. “The professional portion of the claim still has the grace period but not the technical portion of the claim,” he explained. Hock continued, “Even in the professional portion, the physician has to use an ICD-10 code, and the code has to be within the correct family so the physician has to make a good effort.” For example, a provider bill coded for pneumonia under ICD-10 should still be paid even if it the practitioner didn’t drill down far enough to note this was a sec-

ond occurrence … or if an office visit was billed for acute serous otitis unspecified, when it really should have been coded for the left ear. Hock again noted that hospitals do not have that same luxury. “Hospitals are very much at risk for denials, audits and lower reimbursement based on codes,” he said. “It does set up a potentially difficult situation for hospitals because they are so dependent on the physicians practicing in their hospital getting the codes and documentation correct, while that same physician has a grace period for his or her claims.” From his observation, hospitals and health systems that have worked with both contracted and employed physicians to thoughtfully train them on the importance of detailed documentation have the best chance to be successful. “What’s most effective is showing them the impact full and complete documentation can have on their quality metrics such as observed vs. expected length of stay or observed vs. expected mortality rate,” he said. “Once physicians see how a few words in a patient’s record can dramatically change how they measure up to their peers in these categories, they are much more willing to spend an extra moment ensuring the documentation is complete,”

Hock continued. He added that outside of the coding and payment side of the equation, ICD-10 offers a tremendous amount of information and analytics to physicians that could be used to better inform decisions. The question, Hock noted, is “How do we, as a system, begin to use this data to improve care?” While that answer might not be immediately known, Hock said the potential is exciting. Circling back to reimbursements, Hock said even if concerns are somewhat mitigated for individual practitioners and their office staff over the next months, it’s still crucial to make every effort to use the exact diagnosis code … both because codes have to be in the right family and because the clock is ticking on the grace period. “This is a golden opportunity for them to practice in an era without penalty so they need to make sure they are periodically calling in outside auditors or having an office manager do spot checks. That way when the grace period ends on Oct. 1, 2016, they are prepared,” he said. “Practices don’t want to fall into a false sense of security. Working towards correct documentation and coding will set them up for success in 2016,” Hock concluded. arkansasmedicalnews

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Soapware Eases the Pain of ICD-10 Transition ICD-10 rollout. Physicians and other healthcare professionals who use these codes and have memorized their most frequently used ICD-9 codes will need become familiar with the expanded code set. There are almost five times as many ICD-10 codes compared to ICD-9, and the format of ICD10 codes is significantly different than ICD-9, with similar diagnoses having complete different codes. In addition, not all specialties receive equal weight — some specialties have a disproportionate number of new codes and rules. Regardless, this transition will be timeconsuming for practitioners of any specialty. The ICD-10 superbill template published by the American Academy of Family Practice is 9 pages in length. (ICD-9 was 2 pages). In addition to more codes, the mappings from one code set to another can also be more complicated with incomplete or non-reciprocal mappings. A recent study in the Journal of the American Medical Informatics Association suggests that the specialties that will experience the most significant impact include obstetrics, psychiatry, and emergency medicine. SOAPware is dedicated to making the transition as seamless

as possible for you and your practice. It is our intent for the degree of inconvenience, as well as expense, of transitioning from ICD-9 to ICD-10 to be far less for SOAPware clients than what is becoming the norm in the industry. We are happy to conference with your ICD10 Implementation Planning Committees. This is especially true for sites not yet using SOAPware who are facing unacceptable, added burdens for both clinicians and coders in order to achieve ICD-10 compliance. Consider that it may likely be far less costly to switch to SOAPware, than purchase and implement the ICD-10 upgrade paths offered by many other systems. Also, if you are an enterprise challenged with transitioning your outlying medical practices, we can discuss the options to bring in their ICD10 codes from SOAPware into the enterprise billing system. This will likely save significant time, expense and frustration. This is likely to be far more practical than attempting to force use of the enterprise EHR system into them. Contact us today for more information about SOAPware and ICD-10. What are you waiting for? Find out more about SOAPware today and let us ease your ICD-10 concerns!

Visit http://www.soapware. com/icd-10! • Experience You Can Trust Our products and services are derived from more than 20 years of experience. “With SOAPware, I am so efficient that the record is completed before the patient leaves the office!” — A. Herbert A., MD Orthopaedics, SOAPware User since 2002 Check out what our SOAPware Users are saying about their ICD-10 Transition! “I’m pretty impressed with the SOAPware ICD-10. It’s super easy. Even a little fun.” “Our ICD-10’s are going to our billing software quite smoothly. With all the hard work at Soapware, it has been a breeze.” At SOAPware, we make it easy to get in touch with our staff. Contact us today! Call: 1-800-455-7627 7a-7p M-F | 10a-4p Sat. (CST) Chat: Visit www.soapware. com/contact to start a live chat with a SOAPware EHR Specialist Email: Marketing@soapware. com Social Media: Twitter: twitter.com/ soapware Facebook: facebook.com/ soapware Blog: soapware.com/blog

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Richard E. Frye, MD, PhD, is “All In” for Autistic Children, continued from page 2 Initially, it was thought that one thing was causing autism. But Frye said it now appears six or more things cause autism or make autism worse. All those factors complicate autism, but understanding all the factors holds out hope for improvement. Prior to beginning his medical career, Frye worked doing smell and taste research. He met doctors and medical students, and got attracted to the idea of going into medicine. “At that time, I had no idea how difficult it is to actually get into medical school,” he said. “But I was lucky. I got in

my first time.” In his free time, Frye loves spending time with his family traveling, hiking and biking. He and his wife, Cara, have two children – Mairin is five and Quinn is three months old. Frye is particularly fond of the River Trail and Pinnacle Mountain in Little Rock, and takes in the exercise and great views several times a week. For more information about Autism and the Autism Research and Clinical Program at Arkansas Children’s Hospital go to www.arkansasautismalliance.org

For more visit: Arkansas Children’s Hospital Autism Multispecialty Clinic www.archildrens.org/Services/Autism-Multispecialty-Clinic.aspx Arkansas Children’s Hospital Autism Research and Clinical Program www.arkansasautismalliance.org Treating Oxidative Stress And The Metabolic Pathology Of Autism Phase 1 & 2 achri.archildrens.org/Clinical_Research/Studies/OxidativeStressAutism.html

Outside Influences, continued from page 10 would have been a fraction of the cost. “It is in our own interest to ensure rudimentary health systems are in place where organisms like Ebola are likely to be present. Hygiene, sanitation, water systems, the use of personal protective gear … this is the domain of environmental health.”

U.S. Water Supply

A safe water supply isn’t only a challenge for less developed nations, however. Dyjack said it is a very real issue for Americans, as well. “On average each year in this country, we lose about one trillion gallons of fresh water,” he said, adding the loss comes from cracks in a crumbling and aging infrastructure.

That loss impacts both economies and the health of populations. The combination of water management processes and prolonged drought has had a dire effect on a number of agricultural counties in California. In addition, Dyjack said, valley fever has become a growing problem in the area as the desiccation of the land allows wind to blow around organisms in the topsoil and spread fungi into the air. Other water-borne issues include the spread of Legionella (which can lead to Legionnaires’ disease and Pontiac fever), a bacteria that has been showing up in commercial buildings in the ventilation systems and can be inhaled through water aerosols. In the Great Lakes area, an algae bloom producing the toxin microcystin is contami-

nating the water supply, posing a challenge for traditional water treatment systems. In the Pacific Northwest, the algae has also led to economic damage as crab and clam harvests have had to be closed down at times.

Leading NEHA Efforts

Passionate about his profession, Dyjack took the helm of the NEHA in May of this year. He has almost 30 years experience in environmental health, emergency preparedness and response, public health informatics, infectious disease, workforce development, governmental infrastructure, maternal and child health, health equity, and chronic disease. A board certified industrial hygienist, Dyjack also has advanced degrees in public health with a

doctorate from the University of Michigan and a master’s degree from the University of Utah. Previously he served as associate executive director for programs with the National Association of County and City Health Officials and also has 18 years of academic experience in public health at Loma Linda University. “I believe environmental health is central to health and wellness of individuals, to families … and frankly, to economies of cities, counties and states,” Dyjack said. When we have resisted moves to intervene early, he noted, the cost has often been much heavier on the back end. “We just have to have the courage to redirect resources from the clinical environment to a prevention strategy,” Dyjack concluded.

Your Primary Source for Professional Healthcare News Just Got Better! Why wait for your monthly print edition to come in the mail? Visit our newly designed web site … experience its easy navigation and increased functionality. You can read the latest about professional healthcare – Business, Clinical, Regulatory & Compliance, Research, Grand Rounds, Feature Profiles, and a complete line-up of Events and Top Headlines.

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GrandRounds UAMS First in Arkansas and Among First in Nation to Make Physician Ratings by Patients Available Online LITTLE ROCK – The University of Arkansas for Medical Sciences (UAMS) recently became the first medical center in Arkansas — and one of the first in the United States — to display patient ratings and comments about its physicians on its website. The patient ratings of UAMS physicians use a five-star rating system, with five stars being the best. A physician’s rating is posted on the website once the physician has a minimum of 30 completed surveys. Physician ratings can be found at UAMShealth.com/ratings. Patients who are seen by a UAMS physician in an outpatient setting receive a survey. The results are based entirely from patients who have been treated by the physician. Patients receive the survey from NRC and patients complete it to provide comments regarding aspects of care. UAMS receives the survey results from NRC and then uses patient feedback to improve and enhance the patient’s experience of care. As part of its commitment to transparency, UAMS will post all relevant feedback — both positive and those ratings and comments showing opportunities for improvement. However, comments are not posted that are libelous, profane, or that risk the privacy of patients. Every provider rating is published regardless of comment status. The surveys ask patients to evaluate how well their physician communicated, listened, and showed courtesy and respect toward them. Results are used to evaluate patients’ overall perception of care and to identify areas for improvement. Patient names are not displayed through the online ratings and commentary reviews. All personally identifiable information is removed prior to display. UAMS uses the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Practice survey, which was developed by the Agency for Healthcare Research and Quality for use in hospitals and medical practices nationwide.

an Executive Master of Business Administration degree from Jacksonville University in Florida. In her role as Vice-President of Physician Services, Twombly will oversee all clinic operations and administration. Twombly says her primary focus is patient access and patient experience. She will work closely with physicians to develop a strategic plan for each Sparks clinic in Arkansas and Oklahoma.

Don’t Miss the Big Event www.ArkansasMedicalNews.com From industry conferences and continuing educational units to fun ways to support the area’s many non profits ... check the online calendar for healthcare happenings.

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Twombly Now VP of Physician Services FORT SMITH – Melissa Twombly, MBA, CPC, is now Sparks Clinic’s VicePresident of Physician Services. Twombly brings with her more than 15 years of practice leadership and revenue cycle management, most recently Melissa serving as the Southeast Twombly Missouri Market Director for the primary care and specialty clinics of Poplar Bluff. She earned a Bachelor of Science degree in Management and

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GrandRounds UAMS, UA Athletics Partner in State’s First Sports Medicine Fellowship FAYETTEVILLE - The state’s first sports medicine fellowship for family physicians, offering advanced training on diagnosis and treatment of sportsrelated illness and injury, started this past summer on the University of Arkansas for Medical Sciences’ (UAMS) northwest Arkansas campus with cooperation from the University of Arkansas Athletics Department and clinical partners. Sports medicine fellows gain clinical experience seeing patients at UAMSaffiliated clinics as well as working with University of Arkansas student-athletes while under supervision of UAMS faculty and clinical partners, including Advanced Orthopaedic Specialists, the official sports medicine provider for the Arkansas Razorbacks. UAMS received accreditation for the fellowship in October 2014 from the Accreditation Council for Graduate Medical Education (ACGME). Completing the fellowship will enable a physician to sit for the sports medicine subspecialty board exam conducted by the American Board of Family Medicine. Kyle Arthur, MD, was selected as the first fellow in the program and began the one-year program in July after completing his family medicine residency at the UAMS northwest Arkansas campus in Fayetteville. In the future, UAMS will host two fellows annually. The fellowship provides physicians a year of experience focusing on the evaluation, management and treatment of a wide range of injuries and illnesses related to athletes and active lifestyles. The fellowship includes instruction on non-operative options related to musculoskeletal injuries along with the complexities of medical issues pertaining to athletes ranging from cardiac care to asthma to concussion.

Dr. Khaled Krisht Joins Physicians at St. Bernards Neurosurgery JONESBORO - Khaled M. Krisht, MD, has joined the medical staff at St. Bernards Medical Center as a neurosurgeon and is seeing patients at St. Bernards Neurosurgery in Jonesboro. He is one of 27 new physicians in the St. BerDr. Khaled M. nards “Class of 2015.” Krisht Krisht completed his Bachelor of Science degree in biology at Emory University in Atlanta where he was inducted into the Phi Beta Kappa honors society upon graduation for his high academic achievement before earning his Doctor of Medicine degree with distinction from the American University of Beirut in Lebanon. He completed an internship in general surgery at the University of Arkan-

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sas for Medical Sciences in Little Rock, followed by his neurosurgical residency training at the University of Utah in Salt Lake City, where he served as chief resident. With a wealth of neurosurgical training at the University of Utah along with an enfolded residency training at both the Huntsman Cancer Center and Intermountain Medical Center, Krisht brings novel and minimally invasive techniques, including the transnasal microscopic approach to the sellar and suprasellar regions for removal of difficult brain tumors. He is well adept at utilizing stateof-the-art computer image-guidance in addition to performing surgery on awake patients to remove difficult lesions while ensuring minimal postoperative deficits. Krisht is experienced in the treatment of brain, pituitary and spinal cord tumors, simple and complex cervical and lumbar spine disease, cranial and spinal trauma, stroke and pain disorders. He has published more than 20 peer-reviewed articles and four book chapters. Krisht has lived in Lebanon, Greece and the United States. His interests include soccer, snowboarding, snorkeling, diving and traveling.

Washington Regional Earns Advanced Primary Stroke Certification FAYETTEVILLE - Washington Regional Medical Center recently became the first healthcare provider in its primary service area – Benton, Boone, Carroll, Madison and Washington counties – to earn The Joint Commission’s Gold Seal of Approval® and the American Heart Association/American Stroke Association’s Heart-Check mark for Advanced Certification for Primary Stroke Centers. The Gold Seal of Approval® and the Heart-Check mark represent symbols of quality from their respective organizations. Washington Regional underwent a rigorous onsite review in which Joint Commission experts evaluated compliance with stroke-related standards and requirements, including program management, the delivery of clinical care and performance improvement. An independent, non-profit organization, The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in healthcare. The certification is just the latest demonstration of Washington Regional’s commitment to provide advanced stroke care in Arkansas, which has the nation’s highest rate of death from stroke. Last year Washington Regional expanded its Northwest Arkansas Neuroscience Institute, adding a stroke neurologist and three neurosurgeons to its already highly skilled team and building an innovative hybrid operating suite dedicated primarily to the treatment of stroke and other brain disorders.

HMH in Nashville Welcomes Brian Caldwell, MD NASHVILLE - Howard Memorial Hospital is pleased to announce that Brian Caldwell, MD, has joined the active medical staff. Caldwell is a Family Practice physician who received his Bachelors in Biology degree at Henderson State University; Dr. Brian his Masters in Biology at Caldwell the University of Central Arkansas; Doctorate of Medicine at the University of Arkansas for Medical Sciences. He completed his internship at UAMS and his residency in Family Practice at AHEC – Southwest. He is also a member of the American Board of Family Medicine, Fellow American Academy of Family Physicians. Caldwell was Chief Resident and an honors graduate from UAMS.

Ribbon-Cutting Ceremony Held for New CARTI Cancer Center LITTLE ROCK - Representatives with the largest not-for-profit network of private practice cancer specialists in Arkansas – and one of the largest in the U.S. southern region – participated in the official ribbon-cutting ceremony for the new CARTI Cancer Center in October. Recognized for the past two years as the largest construction project in Arkansas, the CARTI Cancer Center sits along the Little Rock medical corridor on 37 acres just south of Interstate 630 in Little Rock. The new world-class, multi-disciplinary cancer center serves as the administrative hub of the CARTI network and will house about 350 employees and staff 11 medical oncologists, four radiation oncologists, four diagnostic radiologists and one surgical oncologist projected to treat approximately 700 patients per day. Officials broke ground on the 170,000 square foot, $90 million cancer center on December 11, 2013.

Cooper Clinic Adds Dermatologist FORT SMITH - Nedil A. Antonini, MD, FAAD is joining Luke Lewis, MD, in the Cooper Clinic Department of Dermatology. Antonini was previously in private practice in Laredo, Texas and is a Board Certified Dr. Nedil A. Dermatologist. He earned Antonini his medical degree from the University of Massachusetts Medical School and has more than 15 years of experience in his specialty. In addition to clinical practice, he has provided dermatology education to pediatric and internal medicine residents from Michigan State University and served as an Assistant Professor at the University of Florida, Department of Dermatology. Antonini’s practice will be located in the main

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