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September/October December 2015 2009 >> $5 PHYSICIAN SPOTLIGHT PAGE 2
Research Funding Called a National Imperative
Mayshan Ghiassi, MD Mahan Ghiassi, MD
By BECKY GILLETTE
ON ROUNDS Work Proceeding To Reopen Crittenden Regional Hospital Voters Overwhelmingly Approve Sales Tax Funding Plans are proceeding by Ameris Health of Nashville to reopen the Crittenden Regional Hospital in West Memphis that had about 500 employees when it closed in September 2014 citing challenges with a struggling economy, declines in patient volume and reimbursement, physician departures and two fires, including one that closed the facility for six weeks ... 3
Faith In Action Provides Free Non-Medical Services to Elders FAYETTEVILLE – Sometimes just a little bit of help can make a huge difference in the lives of people over age 60 who can no longer drive. A ride to the doctor. A trip to the grocery store. Delivery of a prescription. Or just a visit from someone who reaffirms the worth of a senior by being willing to spend some time visiting. ... 5
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Increase in Dementia Means More Research Desperately Needed An international study published in the Surgical Neurology International Journal in August concludes that people are developing dementia ten years earlier than just two decades ago. Colin Pritchard from Bournemouth University, who led the study, said the problem is particularly acute in the U.S. where dementia-related deaths in women more than age 75 have increased more than fivefold, while deaths in men in that age group nearly tripled. The study found that between 1989 and 2010 in the 21 Western countries studied, not only were far more people being diagnosed with and dying of dementia, it was being diagnosed at earlier ages with early-onset dementia hitting people in their late 40s. The study postulates that the increase is due to pollution. “A relationship between environmental pollutants (CONTINUED ON PAGE 8)
Sue T. Griffin, Ph.D., nationally recognized for breakthrough discoveries about Alzheimer’s disease, is shown discussing Alzheimer’s research taking place at the UAMS Donald W. Reynolds Institute on Aging with other researchers and students.
HealthcareLeader Finding Joy on the Leading Edge of Patient Service Chris Barber, President & CEO, St. Bernards Healthcare By BECKY GILLETTE
JONESBORO—St. Bernards Medical Center is both a medical and economic mecca in Northeast Arkansas. The 438bed hospital that serves a 23-county area in Northeast Arkansas and Southeast Missouri that has a population of 645,000 is the largest employer in Craighead County employing about 3,000. Under the leadership of President & THE ING T T PU
W E N S NEW L CA EDI IN M
CEO Chris Barber, the medical center has developed innovative new programs and services including a new 54,000-square-foot health and wellness center, a new Level II assisted living facility which includes a separate and secure Memory Care Center for caring for patients with Alzheimer’s disease and other forms of dementia. St. Bernards – initially founded by Olivetan Benediction Sisters in 1900 – has (CONTINUED ON PAGE 6)
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Ghiassi Brothers Bring NWA Access to Advanced Stroke Care By BECKY GILLETTE
FAYETTEVILLE—In just the past year, minimally invasive endovascular neurosurgery for strokes and other cerebrovascular conditions has become the preferred standard of care. When treated in a timely manner, patients paralyzed on one side and\or unable to speak are often able to walk and talk within an hour. That is accomplished by using radiological imaging to guide a tiny catheter from an artery in the groin to the site to be treated. Clots can be removed without the risks and recovery time associated with open surgery. Arkansas has the highest death rate from strokes of any state in the country. Mayshan Ghiassi, MD, and Mahan Ghiassi, MD, are two of only about 100 surgeons in the U.S. who are dual trained in both minimally invasive endovascular neurosurgery as well as conventional neurosurgery. When deciding where to practice after completing their residencies, they decided to come to Washington Regional because of the great need. “The fact that the state is number one in stroke morbidity was a huge draw,” Mahan Ghiassi said. “We felt we could
Washington Regional neurosurgeons Mayshan Ghiassi, MD, (left) and his brother, Mahan Ghiassi, MD, are providing minimally invasive endovascular neurosurgery, the new preferred standard of care for strokes and other cerebrovascular conditions
have more impact here than anywhere else in the country because Northwest Arkansas (NWA) was underserved. The change toward endovascular neurosurgery becoming
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the standard of care for strokes happened while we were going through our training, which was very exciting. NWA is a great location, not only because of the number of people who live in this area, but the surrounding population that has easy access to Washington Regional with air ambulance services.” The brothers became co-directors of the Cerebrovascular and Endovascular Program at Washington Regional in August 2014. “We are bringing a very new technology and therapy that is minimally invasive resulting in less risks to the patients and faster recovery times,” Mayshan Ghiassi said. “It is an exceptional time to be involved in stroke care because of the dramatic improvements possible with endovascular neurosurgical techniques. Patients who previously might have been in a nursing home the rest of their lives can instead recover quickly and have a normal life. Patients feel better and do better regarding long-term survival and functioning.” The brothers said it is important for Arkansas physicians to know the intra-arterial /endovascular thrombectomy procedure gives acute ischemic stroke patients the option of the highest levels of care without the stress of traveling to Little Rock or Memphis. In addition to the benefits to the patient, the decreased costs to society from improved stroke care are tremendous. It is estimated that stroke care in Arkansas costs an estimated $300 million per year when taking into consideration direct care costs and indirect costs (i.e., loss of productivity and family leave). These new endovascular stroke therapies will significantly reduce length of hospitalization, reduce need for secondary procedures associated with debilitating strokes, decrease the proportion of severe disability after stroke and decrease loss of productivity of patients and their families.
“It makes sense not just medically to help someone live a normal life,” Mahan Ghiassi said. “But it also makes sense economically, something that insurance companies are recognizing. It is hard in medicine to find a new procedure like this that helps not just medically, but economically.” The men were also attracted to Washington Regional because the hospital shared in their vision of bringing world-class stroke care to this underserved area of the country, which meant collaborating to build new facilities at Washington Regional, including a hybrid operating room (OR) that can be used for either open cerebrovascular or minimally invasive endovascular neurosurgery. If endovascular neurosurgery is used, but doesn’t completely clear up all the problems, the patient can be turned from the end of the table for endovascular surgery to the other end of the table designed for open neurosurgery. That prevents the need for a patient to be transported from one OR to another. “The center also provides longer care instead of a patient having to be transferred to a long-term care facility,” Mahan said. “Patient care is not fragmented.” In their first year, the Ghiassi brothers have seen even more patients than expected, especially stroke patients under the age of 40. While doing an interview for this article, they got a call and left to respond to a new 33-year-old female stroke patient. While it is difficult to know why there are so many young stroke patients in the state, they said it is probably linked to smoking, poor diet, obesity and lack of exercise, all of which can lead to high blood pressure that is less likely to be identified in younger patients. Most of the endovascular surgeries require two neurosurgeons because of the delicate nature of the work. So the brothers work together almost every day. While they don’t read each other’s minds, they work well together. “For the most part, I can pick up on what he is thinking,” Mahan said. “We are on the same page as far as the treatment processes.” The Ghiassi brothers were born in Iran. The family, members of the Baha’i faith persecuted in the predominantly Muslim country, fled in 1985. They spent a year in a refugee camp in Pakistan before they were sponsored and brought to Nashville, Tenn., when Mahan was 5 and Mayshan was 7. That is where the family continued to live up until the brothers finished medical school, residencies and fellowships at the Vanderbilt University Medical Center. Their parents relocated with their sons, their wives, and their grandchildren. Mahan has three children, and Mayshan has one with another expected soon. As for their hobbies, right now their off duty world revolves primarily around spending time with their family. arkansasmedicalnews
Work Proceeding To Reopen Crittenden Regional Hospital Voters Overwhelmingly Approve Sales Tax Funding By BECKY GILLETTE
Plans are proceeding by Ameris Health of Nashville to reopen the Crittenden Regional Hospital in West Memphis that had about 500 employees when it closed in September 2014 citing challenges with a struggling economy, declines in patient volume and reimbursement, physician departures and two fires, including one that closed the facility for six weeks. In July, voters approved a one percent sales tax to fund reopening of the hospital by a margin of nearly seven to one, with 2,846 in favor and 439 opposed. The tax set to go into effect in November for five years is expected to raise about $30 million. “The longer the hospital was closed, the more it was missed,” said K. Robert Bauer, Jr., chairman and CEO, Ameris Acquisitions, LLC. “I wasn’t surprised, but I was impressed at the high percentage of residents who voted to approve a one percent sales tax to fund the hospital. There is no doubt a population that size—there are 50,000 people in that county--can support a hospital. When we had town hall meetings with people in the community prior to the vote, we heard again and again how
much they had missed the hospital.” Since the hospital closed, not only did the county suffer a great loss of jobs and business activity, but most residents had to travel to Memphis, Tenn., Jonesboro or Forrest City for medical care. Bauer said he couldn’t provide any details yet of when the hospital might reopen, or the services it might provide. County officials have said it might be smaller than the previous 140 beds. “We are working with the county to figure the exact structure of how this is done, whether it’s non-profit or for profit, and how the facility can be re-established as a legal entity,” Bauer said. “Then we have funding issues, which include raising the working capital to re-open the facili-
ties. There are going to be a lot of expenses to get everyone recruited and trained. After you open, you don’t start collecting the money that day. You have to collect enough money to support yourselves during the startup issue.” The old hospital is in bankruptcy, so whatever is done with the facility has to be approved by the bankruptcy judge. The reopening can’t proceed until the county can provide a clean lease for the building. “The bankruptcy can be dealt with,” Bauer said. “We have some ideas in mind that we think will work.” Bauer said Ameris Health of Nashville is a good fit for taking over management of the Crittenden General Hospital. “We have a good track record,” Bauer
said. “We have been around since 1992. Our principals have been in healthcare their entire careers. Our top three guys have more than 100 years of experience, collectively. And our focus has always been small, community, rural hospitals. We have reopened closed facilities in the past, two of which are still open. You don’t always succeed because of the challenges. But you give it your best shot.” One thing that is expected to help is the large number of people in Crittenden County who signed up for the private option Medicaid expansion in Arkansas. A major effort was made to get people signed up for health coverage prior to the hospital closing. Paul Cunningham, senior vice president, Arkansas Hospital Association, said in addition to enhancing the health and well-being of the communities it served, Crittenden Regional Hospital also contributed significantly to the area’s economic health. In 2010, the estimated total annual economic impact was nearly $100 million. Those figures included nearly $24 million on goods and services and $29 million in salaries. (CONTINUED ON PAGE 10)
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MGMA Releases Latest Provider Compensation Data By CINDy SANDERS
In late July, the Medical Group Management Association (MGMA) released findings from the 2015 Provider Compensation Survey Report, an annual analysis of compensation and productivity data illustrating market characteristics across specialties and organizational settings. “MGMA has been collecting data on medical group management since 1926,” noted Todd B. Evenson, chief operating officer of the national organization for healthcare administration and medical practice management. “For the last 25 years, we’ve also been specializing in the space of physician compensation and non-physician compensation.” Based on 2014 data, this year’s survey found physicians reported salary increases over the past year with primary Todd Evenson care physician increases outpacing those of specialists (3.56 percent increase vs. 2.39 percent, respectively). Specialists, however, still report a higher median compensation at $411,852 compared to a median compensation of $241,273 for primary care physicians. The 2015 benchmarking report included information on nearly 70,000 providers across the United States. In addition to geographic diversity, Even-
son said the data was representative of both large and small practices, various ownership structures including hospital-based providers, and more than 170 specialties. Evenson said the collected data is important for a number of reasons, not the least of which is that physicians are being recruited on a national level. To remain competitive, he noted, it’s important to look at the compensation methodologies being used by colleagues in various parts of the country. While primary care physicians enjoyed a 3.5 percent increase in median compensation between 2013 and 2014, the figures are even more interesting when taking a slightly longer view. Evenson noted physicians in this space have seen a 9.2 percent increase in compensation since 2012. “Will primary care physicians be compensated at the same levels as specialists? Not likely,” Evenson said. However, he continued, “They will continue to play an integral role as care models evolve. Primary care physicians are truly the lynchpin of the new practice model as we move from feefor-service to fee-for-value.”
Evenson added, “There’s a particular demand for primary care physicians … both because they are the backbone of the referral system and key to a valuebased system.” The latest MGMA survey also showed a continuing shift towards newer models of care. “Historically, it was normal to see 100 percent of compensation plans be productivity based,” explained Evenson. “ I n 2012, 50 percent of respondents said they were on a 100 percent productivity based compensation plan. In 2013, it was 39 percent; and actually this year, it was 25 percent of respondents.” As he noted, that’s a 25 percent decline in that metric over the past three years. Evenson said the current data highlights the gradual shift toward rewarding practitioners for improved operational efficiencies, enhanced quality and access to care. While the direct link to quality is still relatively small, it is growing. Just a few years ago, only 3.4 percent of physician compensation was tied to quality metrics. “Now we’re seeing as high as 10 or 11 percent,” he said. “That value over vol-
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ume concept that physicians seem to be embracing is really beginning to pay off for them.” He added, “The behaviors they are trying to promote are tied to that triple aim (of healthcare) … reducing the per capita cost of healthcare, improving the health of populations, and improving the patient experience of care.” Evenson said those in the behavioral health sector are also seeing improved compensation as their work complements that of primary care providers in managing a population’s health. The industry is really recognizing a need to look to behavioral health services to better deliver quality care. The likelihood that someone dealing with a chronic health condition is also dealing with a behavioral health issue is high,” Evenson pointed out. Recognition of that link has been evident in the MGMA compensation survey over the last few years. “Since 2009, there has been a 21.9 percent increase in compensation for psychiatrists. Now, their median compensation is $244,796,” Evenson said, noting that now puts psychiatrists roughly equivalent to their primary care counterparts. Economic forces of supply and demand are another issue factoring into physician compensation. A predicted shortage of physician providers in both primary and specialty care could fuel higher compensation rates down the road. Referencing a March 2015 report from the Association of American Medical Colleges (AAMC), Evenson noted the analysis projected a shortfall of between 46,000 and 90,000 physicians by 2025. In addition to compensation figures, Evenson said MGMA’s annual report also collects information regarding total charges, collections, encounters, RVUs (relative value unit), productivity, benefits, demographics, organizational types, and regional differences all the way down to a state level. He said drilling down in the data allows those in healthcare to dissect the information in myriad ways, and added it’s critical to learn from one another to adopt best practices that address the triple aim. “You can take these benchmarks and truly understand what opportunities you have for efficiencies and for providing better care by understanding your colleagues’ activities in the industry,” Evenson concluded. For more information on the 2015 Provider Compensation Survey Report, go online to mgma.com. Detailed data is available for purchase in two formats – electronically through MGMA DataDive™ or by ordering printed reports. Compensation and the many other market forces impacting healthcare management will be explored in depth at MGMA’s annual conference scheduled for Oct. 11-14 in Nashville, Tenn. arkansasmedicalnews
ARKANSAS on the MEND
BY BECKY GILLETTE
Faith In Action Provides Free NonMedical Services to Elders FAYETTEVILLE – tors, one in Benton County and Sometimes just a little bit one in Washington County. of help can make a huge “Our mission is to help sedifference in the lives of niors 60 years and older once people over age 60 who they can no longer drive,” can no longer drive. A ride Keeter said. “We have volto the doctor. A trip to the unteers who provide free grocery store. Delivery of a non-medical services to keep prescription. Or just a visit people independent and in from someone who reaftheir homes. It might be their firms the worth of a senior home they have had for years, by being willing to spend an apartment, assisted living, or some time visiting. a rehab facility. Often times, we “When seniors are start with a senior in one place unable to provide for their and as they migrate to other own transportation, they living situations, we go with need a support system,” Volunteers with Faith In Action are shown above helping with yard work for a senior. them.” said Jaclyn Keeter, direcIn 2014, they had 113 volmaking a significant difference in a very tor of Development & Outreach Services, unteers assisting 104 clients with services vulnerable population. We are designed to Washington Regional Medical Foundasuch as transportation to appointments be that important piece of the pie so they tion. “A lot of times they don’t have family (the appointments can be with any healthcan stay independent as long as possible.” members who live locally, or who can take care provider, not just those affiliated with Washington Regional’s Faith in Actime off work to transport their parent to a Washington Regional) and help with protion was founded in 1996 with the help of doctor. When people can’t age the way they curing food, supplies and medicine. Voluna $25,000 grant from the Robert Wood want to, being independent, they start losteers are usually matched with a client who Johnson Foundation. They started with a ing themselves. They feel they have served lives nearby. At times it might take a couple half-time position, and have now grown to their purpose and now are not important. of volunteers to care for one client. include the equivalent of three full-time emOur Faith In Action volunteers help these The services needed are increasing. ployees, including two volunteer coordinaelderly people stay independent. This is “It is taking more volunteers to take
care of one client on average than it has in recent years,” Keeter said. “The earlier age we take them in, the more independent they generally are. As we support them over time and they age, the need Jaclyn Keeter for help is greater. If they have Medicaid, sometimes they can get help in the home at no additional out-of-pocket cost. But there are countless seniors whose income is too high to qualify for Medicaid. But they don’t have enough money to be able to pay for services.” Currently there is a waiting list for people who need services. Keeter said if they attract more volunteers, they will be able to take care of more elders. In July, members of the Faith in Action Advisory Board visited with clients. Lori Walker, advisory board vice-chair, said she was inspired by what she saw visiting one of the clients. “It was really heartwarming to see how much the visit meant to her,” Walker said. “She had dressed up, cleaned up her apartment, and communicated how valuable the (CONTINUED ON PAGE 10)
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managed to continue with its mission to provide healthcare to everyone regardless of ability to pay, while also seeing its net revenue climb. For example, it climbed about eight percent to $354.6 million for the fiscal year that ended in 2013. Its mission is “to provide Christ-like healing to the community through education, treatment and health services.” “In the healthcare industry, this is a dynamic and exciting time in that we are experiencing rapid changes in the delivery and financing of care,” Barber said. “All the changes are stimulating. It is rewarding to be on the leading edge of not just how we deliver care to an individual, but also to the community that we live in regarding overall health. We continue to advance prevention and wellness activities, which are positive things. Our new wellness center provides not just exercise opportunities, but also counseling about weight loss, diabetes, chronic diseases, COPD and other illnesses. We are focused on how we can help people be healthier so they don’t need extensive medical interventions.” The medical center paid for the new wellness center out of profits from operations. “We have been very fortunate and privileged to serve as the trusted provider of healthcare throughout the region,” Barber said. “Our responsiveness to the mission, physician leadership and financial strength has allowed us to reinvest in the services to benefit the community. At the end of the day, it is still about providing good quality care to the individuals you serve. Recently we finished a 75-bed assisted living Level II living facility, which has 30 beds in a memory care unit. We have a free-standing 20-bed hospice facility, the Flo & Phil Jones Hospice House. Then there is our 12-bed neonatal intensive care unit, so families don’t have to travel. That has been a wonderful gift the community made happen.” Fifteen years ago St. Bernards began a big push to improve services for seniors. “We have a very comprehensive geriatric medicine program where we work with the whole gamut of needs for the elderly including transportation to get access to healthcare,” Barber said, “and good nutrition and socialization to stimulate daily activity. We provide retirement living, and our memory center is unique to the area. We are very proud of the work the team has done, and it has been well received by the community.” The longevity of many key employees is indicative that there is a steady hand at the helm. “We have a lot of long tenure employees throughout the organization,” Barber said. “Folks come and they stay. Our mission statement is more than just words on a page. It is a family, a community. We have been recognized for that. There is something special about our culture and environment, and St. Bernards is a great place to be. I think staying true to our core values has created the success we have had as an organization.” Barber enjoyed playing sports growing up, and was influenced a lot by teachers, coaches, community leaders and members of his church. He learned to raise his hand when volunteers were being sought. He came to appreciate the importance of hard
work. And listening. “The first and foremost thing is listening to your community about what is needed, and then reaching out to create those opportunities,” Barber said. “We partner with community groups with similar values to try to benefit the entire region. “The private option Medicaid expansion has been very important to all hospitals. It is working. We have experienced overall volume growth that has allowed us to hire new physicians, expand and provide new services. In addition, the private option may have prevented some hospitals in Arkansas from closing.” Barber prefers to refer to opportunities rather than challenges regarding hospital management. “That is how we see it,” he said. “That is part of our attitude and outlook on things. We embrace the change and see a lot of opportunities out there.” In the 23 years he has been at St. Bernards, there has always been a construction project going on. And staff has grown, as well. The medical center was successful in hiring 27 new physicians this year in what it refers to as its “Class of 2015.” More than 100 physicians have been recruited in just the past decade bringing the number of physicians affiliated with the hospital to nearly 300. Many stayed after finishing a UAMS family practice residency program at St. Bernards. Barber said when physicians come and see firsthand the good schools, low crime rate, the high quality of life and the state-of-the-art technology at their disposal, they often want to stay. “A lot of people are surprised at the advanced level of care and technology we have,” Barber said. Our physicians are progressive and focused on providing the best evidence-based medicine available. They are always looking for new cutting edge technology that will make a difference in our community. Not only that, but our physicians give back to the community through things like the annual St. Bernards Medical Group Health & Fitness Expo which attracts about 15,000 people each year and provides pre-participation physicals to secondary school athletes in Craighead County. Every year we read about young athletes who die from sudden cardiac arrest. Because we provide EKGs for athletes going into the ninth grade and higher, we have picked up 17 athletes over the last few years who went on to have procedures that likely saved their lives.” In addition, he is pleased to see the new development of the New York Institute of Technology osteopathic medical school located on the Arkansas State University campus. The medical center has one of the busiest emergency rooms in the state with more than 61,000 visits per year. And it also has Fast Care\Urgent Care for those who need treatment without appointments on a nonemergency basis. In addition, the medical center works to make sure patients get quick test results instead of agonizing for days worrying about the outcomes through services like same-day mammogram results, three days from diagnosis to treatment options for those diagnosed with cancer and more. In his available free time, Barber spends time with his wife, Michelle, and their three teenage boys who are involved in a variety of activities. arkansasmedicalnews
Naturopathic Doctors Advocate Licensure in Arkansas
Arkansas is The Natural State, so why not license naturopathic doctors? By BECKy GILLETTE
FAYETTEVILLE – Laurell Matthews, ND, former president, Arkansas Naturopathic Physicians Association, advocates licensing of naturopathic doctors in Arkansas to help provide natural healthcare to patients while helping meet the critical need for primary care in the state. “Licensing naturopathic physicians to practice in Arkansas could help eliminate the shortage of primary care doctors,” Matthews said. Naturopathic physicians are licensed in 18 states. Matthews said these natural medicine practitioners earn degrees at accredited, four-year universities, and often serve as primary care providers in rural communities where doctors are needed most. “They give shots, prescribe pharmaceuticals, order lab tests, and work hand in hand with MD colleagues to help patients,” she said. “In fact, naturopathic doctors already work in Northwest Arkansas. Unfortunately, our practice is limited by lack of legal protections given through state licensure. Changing state law to license naturopathic medicine is guaranteed to draw more naturopathic doctors to Arkansas, which would increase healthcare options for all Arkansans.” Matthews said people in Arkansas are increasingly looking for alternatives beyond conventional medicine. “The Arkansas Naturopathic Physicians Association encourages state lawmakers to help foster a healthy future by allowing naturopathic doctors to serve Arkansas,” she said. However, that is opposed by the Arkansas Medical Society (AMS), said David Wroten, AMS vice president. “They are not ‘medical’ or ‘healthcare’ providers and licensing would give the appearance that they are,” Wroten said. “They cannot replace primary care physicians or take their place. This is not meant as a knock on homeopathic remedies. They have their place in the arsenal of treatments used by medical and residency trained physicians. But the education and training to diagnose the cause of a patient’s illness and then to know how and with what to treat should be the prerequisite for licensure.” Mamie C. Burruss, ND, Little Rock Natural Medicine, finds it ironic that Arkansas is The Natural State, yet the state doesn’t license naturopathic doctors who focus on natural healing methods. “Individuals who graduated from an accredited naturopathic medical school and passed Mamie C. all licensing board examiBurruss nations should be recognized as healthcare professionals by the State of Arkansas,” Burruss said. “Prevention is the best medicine, and naturopathic doctors are armed with many tools to proarkansasmedicalnews
mote health and prevent chronic diseases. Rising healthcare costs are such a burden to our nation, but so much of it could be prevented. Naturopathic doctors could more fully support nationwide preventive healthcare efforts with licensure that actually recognizes the full scope of our training and skills.” Burruss said when she decided to offer naturopathic consultations in Arkansas, she didn’t realize how hungry people are for this kind of knowledge, guidance and care. “Despite advances in modern healthcare, we are getting sicker as a nation,” Burruss said. “Cancer is on the rise. Chronic disease and autoimmune disorders are commonplace. Our children are obese and developing type II diabetes at alarming rates. For the first time, we have a generation of children who may not outlive their parents. What we are doing is not working.” Burruss said people are looking for a holistic approach that focuses on addressing the root cause of their health concerns
through natural remedies and therapies. “They want to feel listened to, and they want to be educated and empowered so they can regain control of their health,” she said. “They are looking for another approach besides pharmaceuticals, which often have undesirable side effects.” Most clients she sees have been dealing with health concerns for many years. “In my experience, the positive impact that diet, exercise and natural remedies can have on health is unparalleled,” Burruss said. Both Matthews and Burruss spend a large amount of time with new patients, 90 minutes. That kind of attention alone to what can be complex medical issues is reassuring to many people. Matthews, who received her degree from Bastry University in Seattle, Wash., said naturopathic doctors complete a fouryear program designed to be similar to fouryear medical school where they learn how the body function, how it fails when there have disease, and how to diagnose those diseases. Naturopathic medical students spend more time that MDs learning about herbal remedies, nutrition, lifestyle, homeopathic remedies, and dietary supplements--all the natural options. “But we also spend time studying pharmaceutical drugs because many patients will be reliant on them,” said Matthews. Sometimes Matthews sees patients who want to get off prescription medicines such as addictive anxiety drugs or anti-depressants that are having negative side effects. She tries to work with them to find natural remedies that may include lifestyle and diet changes, in addition to supplements. Matthews asks patients to bring in all the supplements they are taking. “I definitely know what it is like to be
confused as a consumer,” Matthews said. “That confusion years ago is what made me want to get my current degree so I would have a strong scientific foundation for my opinions. There is a lot of information out there, but some is contradictory. You often don’t even know if the product you are taking has what it says is in there. There are not always studies to rely upon with herbal supplements like there are with prescription drugs.” She suggest looking for the seal GMP, which stands for General Manufacturing Principles. But some high quality companies don’t put GMP on their product. Some products need more care than others. For example, Vitamin C is inexpensive and stable, but fish oil is susceptible to going rancid. “The harder it is for there to be a quality product, the pickier I get when it comes to these things,” Matthews said. “If a fish oil supplement has an unpleasant taste and causes you to burb, it might be a sign that it is rancid. I actually taste it. I chew into the capsule, and if it is bitter or excessively fishy, I reject it.”
Go online to American Association of Naturopathic Medicine, http:// www.naturopathic.org/ Dr. Laurell Matthews, the Natural Nerd, http://drlaurell.com/ Little Rock Naturopathic Medicine Arkansas Licensure Advocated, http://www. littlerocknaturalmedicine.com/ arkansas-licensure.html.
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and dementia has been suggested in a few other studies and certainly warrants both basic research studies to determine the responsible mechanism(s), as well as clinical and epidemiological studies to determine both patient and societal impacts,” said W. Sue T. Griffin, PhD, vice chairman of research, Donald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences (UAMS). “Such findings as those reported by Pritchard’s group, together with studies tying increases in obesity and type II diabetes to the development of Alzheimer’s disease, would have both societal and economical import for our country.” The Alzheimer’s Association predicts costs for Alzheimer’s care will expand six fold from $172 billion at present to more than $1.08 trillion per year in 2050. “The cost of paying for Alzheimer’s care, lost productivity of family care givers, lost tax revenue from people leaving work to care for Alzheimer’s patients, and the whole raft of cost associated with nursing homes is comparable to the cost of recent war activities,” Griffin said. “If we don’t find a way to prevent it, Alzheimer’s disease is what is going to break the bank in the U.S.” Even though Alzheimer’s is the most expensive condition regarding cost of care, there is inadequate funding for Alzheimer’s research. “Money is being taken away from research, may be due to the fact that people
no longer see the importance of scientific research,” Griffin said. “We need to be finding some preventatives for this disease. We are working hard every day in our lab to devise compounds that will help. All over the country, scientists are trying to do this. The problem is that research funds for Alzheimer’s disease are so small, especially compared to other diseases that are less costly. I would really like to get the message out about what Alzheimer’s is doing not just to our people, but to our country’s economy. It is devastating our budget.” Griffin published a landmark study in 1989 showing that trauma by Alzheimer’s disease to the neurons can provoke an out-of-control immune response where neurons traumatized by the disease direct the release of interleukin-1 (IL-1), a small signaling molecule, or cytokine. IL-1 has been identified as a driving factor in Alzheimer’s disease, which ultimately leading to the formation of plaques made of beta-amyloid lying outside the neurons and tangles of a small protein called tau inside of neurons. Both of these lead to the dysfunction and loss of neurons. “The brain has no way to get rid of these plaques and tangles,” Griffin said. “So you end up with tangles inside the neurons. There is no evidence that getting rid of the plaques or the tangles has benefits in improving brain cognitive function. So, really, the whole thing in Alzheimer’s research is going to be about prevention because you don’t want to be in stage one or two where you can’t be in charge of yourself, hop in the car to get groceries, or fix Thanksgiving dinner.” Right now with a cure so elusive, Griffin said keeping the inflammatory index just right in the brain is critical. “Of course, keeping this inflammatory index just right in the body is important for other conditions such as inflammatory bowel disease, heart disease, and strokes, which are themselves risk factors for Alzheimer’s disease,” said Griffin, who is editor-in-chief of the internationally recognized, peer-reviewed, online scientific journal, Journal of Neuroinﬂammation. A large study conducted by the Veterans Administration showed that people who took the anti-inflammatory drugs ibuprofen or naproxen had a significantly lower risk of being in the Alzheimer’s group after five years. “It is amazing,” she said. “They found out that if you had been taking ibuprofen for five years for things like pain or arthritis, your chances of getting Alzheimer’s was decreased almost 50 percent.” For a variety of reasons, unlike baby aspirin for heart disease, it has not become the standard for physicians to recommend ibuprofen as a preventive for Alzheimer’s. Griffin advocates more being done to prevent head injuries. “Head injury is an important risk factor for development of Alzheimer’s disease, so we also need to stop sending
people into harm’s way, for example in wars with exposure to blast injuries, or in high impact sports,” Griffin said. “They might not have external injury you can see, but the brain’s nerve cells may have taken a real beating. Stop putting kids in harm’s way. The prospect for stopping war doesn’t seem very good, but the way kids do sports could be modified. I love sports. Kids should be playing. It is good exercise. But they shouldn’t be trained as if all will be in the Olympics and they should not be exposing their head to multiple traumas like you can see in practice sessions for soccer or football.” A factor that increases the risk for far more people than head injury is obesity. Griffin is alarmed by the trend towards increasing childhood obesity. Much more needs to be done to encourage healthy eating habits and exercise starting in childhood. One of the biggest risk factors for Alzheimer’s disease is Type II diabetes. One in three adults in Arkansas is obese, and Type II diabetes has reached epidemic levels in Arkansas. “It used to be okay to eat Southern cooking like people did in the past because they also did a lot of physical labor,” Griffin said. “But now the lack of exercise makes that kind of diet a killer. We must have some way to keep an account so that we don’t gain weight. There just seems to be too much food around everyone all the time, and there is a failure to recognize what is happening.” Griffin said extreme type of diets are hard for people to stay on. Instead, she advocates eating less. “It would be better if people never ate anything they didn’t really want,” she said. “Rather, you should eat what you really want so that you’ll be satisfied, and won’t try to get satisfaction by over-eating what you don’t really want. The problem is they make it so hard. Our society makes everything so tempting. It is right in front of you and mostly you can afford it.” Glucose is the sugar that feeds neurons, and Griffin agrees that Alzheimer’s involves a failure of glucose availability to neurons. “If a neuron is doing well, it is not having problems taking in enough glucose to thrive,” she said. “If a neuron, because of the change in insulin receptors, releases downstream proteins, you can see this neuron is insulin resistant, meaning the neuron is deprived of glucose it needs, creating further stress on the neuron.” However, not all Alzheimer’s can be pegged to lifestyle choices. “There are people who have lived their whole lives perfectly with a good diet and exercise, and they still get Alzheimer’s,” she said. “That is the confounding part, highlighting the importance of research into genetic factors that increase risk for Alzheimer’s. This is a major focus in the Griffin research group at UAMS.”
For more visit: Journal of Neuroinﬂammation, www.jneuroinﬂammation.com 8
ATTENTION MEDICAID ELIGIBLE PROFESSIONALS
AFMC is now offering
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.
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
Faith In Action, continued from page 5 visit was to her. One of the first things she did was read us a poem about what her volunteer means to her. For so many of them, the volunteer is their best friend. They also like that it is someone who is not being paid, who is doing it from their own free will. It was very meaningful for me to see this.” Walker said she understands from her per- Lori Walker sonal experience the challenges of families providing this type of care. Her grandmother lives in assisted living in Fort Smith. But with a busy professional life, it is hard for Walker to drive 90 miles one way to take her grandmother to the doctor and then 90 miles back home. “I can tell you from my grandmother’s perspective, it is difficult to not be able to run down the street and get groceries, a prescription or a card for a grandson’s birthday,” Walker said. “And it goes beyond just fulfilling needs for food and medicine. They want to feel valued and that they are a priority to someone. Having someone volunteer to meet basic needs helps self-esteem.” Walker said research shows that elders who are depressed and don’t feel valued are at risk for suicide. “Research indicates that population is more likely to take their lives,” Walker said. “One in four suicide attempts in that population will be successful because of a feeling of hopelessness, not belonging, and not feel-
ing valued.” When the advisory board met recently with clients, the staff provided gift cards to a local store where items were purchased that the elder needs. Faith in Action also operates the Healthy Food Pantry and provides one week of food and other supplies to lowincome clients per month. The group’s fundraiser is Savor the Flavor, a popular restaurant walking tour on Dickson St. in downtown Fayetteville where restaurants provide samples of their food. This year Savor the Flavor is scheduled Sept. 8 in Fayetteville, and has been expanded to also be held in downtown Bentonville Thursday, Sept. 17. Tickets can be purchased for one or both events.
How can you help? • Volunteer by calling Faith in Action at 479-463-2113, or by sending an email to firstname.lastname@example.org. • Attend the annual Savor the Flavor food tasting events in September. • Participate with civic groups who come out to do larger group projects such as yard and home upkeep. On Sept. 16, 80 people were expected to repaint the outside of an elder’s home and re-carpet her house.
Go online to www.wregional.com/faithinaction
Work Proceeding, continued from page 3
“Hospital payroll expenditures serve as an important economic stimulus, creating and supporting jobs throughout the local and state economies,” Cunningham said. “Dollars earned by Crittenden Regional Hospital employees and spent on groceries, clothing, mortgage payments, rent, etc., generated approximately $53,343,000 in economic activity and created an additional 350 jobs for the local economy. In 2010, Crittenden Regional Hospital spent $1,562,000 on buildings and equipment. Capital spending by Crittenden Regional Hospital generated approximately $2,875,000 for the local economy per year. Cunningham said the high rate of approval for passage of the tax increase shows that people in the community certainly valued their hospital. Local tax support for hospitals is common, particularly in rural areas where hospitals are often the biggest employer and largest contributor to the economy. “Including the new vote, there 22 communities in the state who have voted over the years to provide local tax support for their hospital,” Cunningham said. “There are a couple of exceptions where property taxes are used to subsidize the hospital, but typically they are funded through sales taxes. Most of these hospitals have common characteristics of being small and rural, usually under 100 beds and possibly, in most cases, even under 50 beds.”
Crittenden County voters approved an earlier sales tax increase. Cunningham said if the sale tax increase approved by Crittenden County voters had kicked in sooner, it might have prevented the hospital from closing down.
Go online to Ameris Health, www. amerishealth.com/ Arkansas Hospital Association, www.arkhospitals.org/
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GrandRounds White River Medical Center Participating in Perioperative Surgical Home Pilot Project BATESVILLE - White River Medical Center is one of 40 hospitals in the United States, and the only community hospital voluntarily participating in a pilot project with the Centers for Medicare and Medicaid Services called The Perioperative Surgical Home (PSH). The program was developed through the collaboration of the American Society of Anesthesiologists, the Premiere Alliance and hospitals throughout the country. Rather than describing a place, the perioperative surgical home describes an innovative approach to surgical care that improves care coordinator, patient education, and hospital processes to improve health and reduce costs. Under the leadership of co-directors, Chris Steel, M.D. and Jeff Angel, M.D., the WRMC PSH is achieving results and sharing best practices with other hospitals in the pilot group. Additionally, Matthew Hazel serves as the business manager of the program, and Gloria Vaughn, Christina Howard, Jacquelyn Wright and Lisa Crumley work with patients who are a part of the program. Administratively Gary Bebow, WRHS Chief Executive Officer; Tammy Gavin, Chief Clinical Officer; and Gary Paxson, Chief Quality Officer provide leadership and administrative support. As an organization, Approve Home Medical Services, Inc., are training Health Coaches on Patient Education. At WRMC, the project began with total knee replacement surgeries with orthopaedic surgeons, J.D. Allen, M.D., Jeff Angel, M.D. and Dylan Carpenter, M. D. who enthusiastically supported the project. The PSH is built around the concept that patients who accept an active role will experience a better result, and the standardization of clinical processes will improve efficiency and reduces cost. In the hospital, the PSH Team examines every part of the surgical process to develop protocols that standardize processes using evidence based best practices proven to improve patient care.
Baptist Health Medical Center-Conway Holds Topping-Out Ceremony CONWAY – Baptist Health held a topping-out ceremony in July on the 37acre site in Conway to mark the completion of the main steel structure for Baptist Health Medical Center-Conway. Baptist Health president and CEO Troy Wells, civic leaders, community members, local physicians, and Baptist Health employees celebrated this milestone for the 111-bed hospital located on the west side of Interstate 40 in Conway. Since construction began, the hospital has already increased in size to 264,000-square-foot and is now 111-beds after the expansion of the Women’s Center added labor and delivery. The medical center is still on track to open in the spring of 2016 with eight operating rooms and a Level III trauma-center emergency room. Baptist Health collaborated with some 30 Conway-based physicians to design and develop the new medical center. Employees throughout the Baptist Health system as well as the community had an opportunity to personally sign their names on the beam that was used in the topping-out ceremony. Jamie Carter was the last person to sign the beam before it was put into place with large cranes. The construction project has generated more than 250 jobs and currently Baptist is working to hire the 425 healthcare professionals and staff that will work in the Conway medical center. The estimated cost of the entire project is now at $170 million. GSR Andrade is providing architectural design services and CDI is the General Contractor.
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GrandRounds Baptist Memorial Hospital Announces New Assistant Administrator JONESBORO - Melanie Edens, a tenured employee of 18 years, was recently announced as the new assistant administrator of NEA Baptist Memorial Hospital. As an assistant administrator, Melanie will oversee radiology, phar- Melanie Edens macy, physical therapy, respiratory therapy and radiation oncology. Edens has been with NEA Baptist for 18 years – starting as a CT tech and then promoted to radiology coordinator followed by a promotion to radiology director. Among her many accomplishments include designing the radiology department, complete with 17 new radiology systems, on the new NEA Baptist medical campus that opened in 2014. In 2007 Melanie was awarded the Outstanding Young Executive by Northeast Arkansas Business Today. In 2013 she was recognized as an Outstanding Alum from the Arkansas State University College of Nursing and Health Professions and in 2014, received the American College of Healthcare Executives Early Career Healthcare Executive (ACHE) Early Career award for Healthcare Executives. She is a graduate of Arkansas State University and participates in several com-
munity and civic organizations, including the 2015 class of Leadership Jonesboro. Melanie is active in the Jonesboro Chamber of Commerce, Arkansas Hospital Association, Relay for Life as well as Arkansas State University and church based activities. Melanie and her husband Matt reside in Jonesboro with their two children.
Conway Regional and CHI St. Vincent Announce Strategic Partnership CONWAY – In August, the boards of directors of Conway Regional Health System (Conway Regional) and CHI St. Vincent announced that the two health systems signed an agreement whereby Conway Regional enters into a five-year management agreement with CHI St. Vincent. Under the agreement, effective August 17, each health system retains its name, governance and autonomy. This agreement comes after months of discussions between the two organizations, the final phase of a process that began in late 2013 when Conway Regional’s board announced they were seeking a strategic affiliation partner to ensure that Conway Regional will be well positioned to continue providing access to high quality health care services for Faulkner County and the north central Arkansas area. As a result of these discussions, the two companies also announced the for-
mation of a new corporate entity called the Arkansas Health Alliance. Jim Lambert, President and CEO of Conway Regional, becomes President of the Arkansas Health Alliance effective August 17. The Alliance is the only organization of its kind in Arkansas designed to help independent community hospitals and health care systems lower their costs while achieving a level of clinical integration and coordination of care to promote more accessible, higher quality and lower cost care for the communities served by Alliance members. As part of the management agreement, Matt Troup, Vice President of Ancillary and Support Services for CHI St. Vincent, succeeds Lambert as CEO of Conway Regional. Troup has nearly twenty years’ experience serving in administrative leadership positions at large medical centers in very competitive markets. Commenting on the agreement, Barbara G. Williams, Chairman of the Conway Regional Board, said that their responsibility will always be the health and well-being of the residents of the five counties they have served since 1938. This partnership will provide the community with expanded services and specialties while working to reduce health care costs. Chad S. Aduddell, CEO of CHI St. Vincent, said that through this agree-
ment, they plan to work together to grow the health services provided in their communities. Their approach will be consumer-focused and based on the value of services provided rather than the volume of care, as in the traditional fee-for-service method and that Conway Regional and CHI St. Vincent can lead the way for other health care systems in the state.
Amita Heaser, MD, Joins Cooper Clinic FORT SMITH - Amita Heaser, MD, has joined Drs. Phil Agent, Mohsen Keyashian, Macon Landers, Sumer Phillips, Brent Reeves, and Becky Yarborough of the Cooper Clinic Department of Internal Medicine. An Adult Medicine Specialist, Heaser Dr. Amita Heaser completed her medical training at Rush University Medical Center in Chicago and practiced in that area for the past four years. She is Board Certified in Internal Medicine and well trained to diagnose and treat conditions including diabetes, high blood pressure, and weight issues, while focusing on preventive health. Heaser’s practice is located in the main Cooper Clinic location in Fort Smith. New patients, including those with Medicare coverage, are now being accepted.
Advanced Neurosurgical Care in Arkansas Northwest Arkansas Neuroscience Institute at Washington Regional offers two physicians who have dual training in both neurological surgery and endovascular neurosurgery. Their skill and expertise in the emerging field of endovascular neurosurgery provides minimally invasive treatment options, performed in an innovative hybrid operating room, that are not available elsewhere in the Northwest Arkansas region.
Mayshan Ghiassi, MD – Endovascular, cerebrovascular, brain tumor and spine surgery Dr. Mayshan Ghiassi earned his medical degree from Vanderbilt University School of Medicine, where he also completed a residency in neurological surgery as well as a fellowship in endovascular neurosurgery. He received additional training with an Academy Fellowship at the National Institutes of Health in Bethesda, Md.
Mahan Ghiassi, MD – Endovascular, cerebrovascular, brain tumor and spine surgery Dr. Mahan Ghiassi earned his medical degree from Vanderbilt University School of Medicine. He also completed a residency in neurological surgery as well as a fellowship in endovascular neurosurgery from Vanderbilt.
3336 N. Futrall Dr. | Fayetteville, AR 72703 | 479.463.3000 | nwaneuro.com
GrandRounds North Metro Medical Center Joins UAMS-Led Program to Provide Emergency Stroke Care LITTLE ROCK – North Metro Medical Center in Jacksonville has partnered with the University of Arkansas for Medical Sciences (UAMS) to provide life-saving emergency care for stroke patients in the region. Called AR SAVES (Arkansas Stroke Assistance through Virtual Emergency Support), the program uses a high-speed video communications system to help provide immediate, life-saving treatments to stroke patients 24 hours a day. The real-time video communication enables a stroke neurologist to evaluate whether emergency room physicians should use a powerful blood-clot dissolving agent within the critical three-hour period following the first signs of stroke. The AR SAVES program is a partnership between the UAMS Center for Distance Health, the state Department of Human Services, North Metro Medical Center and 47 other Arkansas hospitals. Since the program began Nov. 1, 2008, more than 2,791 patients have received stroke consults through AR SAVES and 751 patients have received the blood-clot dissolving agent. Forty-seven other Arkansas hospitals are participating in the AR SAVES program.
Hip and Knee Surgeon Simon C. Mears, Joins UAMS Orthopaedic
Family Physician Brings Experience to Spiro Clinic
LITTLE ROCK — Hip and knee surgeon Simon C. Mears, M.D., Ph.D., has joined the University of Arkansas for Medical Sciences (UAMS), and is seeing patients at the UAMS Orthopaedic Clinic. Mears is also a professor in the DepartDr. Simon C. ment of Orthopaedics Mears in the UAMS College of Medicine. He is a board-certified orthopaedic surgeon with special interests in total hip and knee replacement, hip fracture care and geriatric orthopaedics. Mears has won the prestigious Jahnigen Award in geriatric medicine. He comes to UAMS from the Total Joint Center at Baylor Regional Medical Center at Plano, Texas, where he served as clinical professor in the Department of Surgery at the Health Sciences Center in the Texas A&M University’s College of Medicine. Mears earned his medical degree and Ph.D. in neurobiology from the University of Pittsburgh School of Medicine. He completed his orthopaedic surgery residency at the Johns Hopkins School of Medicine, and a fellowship in orthopaedic traumatology at the R. Adams Cowley Shock Trauma Center at the Mayo Clinic.
FORT SMITH – Linda M. Rodriguez, D.O., FAAFP, has joined Spiro Family Medical Clinic located on West Broadway. As a seasoned physician, she brings a wealth of experience and knowledge to Sparks Health System. Rodriguez has cared Dr. Linda M. for patients in southeastRodriguez ern Oklahoma since 1998. The Shelbina, Missouri native completed her Michigan State University Family Practice residency at Flint, MI.
Attention Medical Practice Managers NOW MORE THAN EVER, IT’S IMPORTANT TO STAY ON TOP OF HEALTHCARE ISSUES! An Expanded Resource. Network with other experienced medical practice managers to gain information, advice and support! Keep up with News. Our newsletters give you access to MemberOnly information and keeps you up to date on current issues! Being a member of the ARMGMA gives you a voice in our Government! Because we work closely with the Arkan-
sas Medical Society, the State Legislature, Third Party Payers and other officials and organizations, you will be kept abreast of what’s going on with government related healthcare issues! Our annual conference is a learning experience and offers you CEC’s from the American College of Medical Practice Executives. Membership is an investment in your career and your practice!
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NARMC Welcomes Micah David Wiegel, MD HARRISON- North Arkansas Regional Medical Center is pleased to announce that Micah David Wiegel, MD has joined the active medical staff. Wiegel received his Bachelor of Science degree, Magna Cum Laude, from Arkansas Tech UniDavid versity, Russellville and Dr. Micah Wiegel his Doctorate in Medicine, Cum Laude, from the University of Arkansas for Medical Sciences, Little Rock. He completed his obstetrics and gynecology residency at University of Arkansas for Medical Sciences, Little Rock. He joins NARMC’s Women’s Health and Surgery Center.
Dr. Nolan Jaeger Accepting Patients at St. Bernards Plastic Surgery JONESBORO - Dr. Nolan Jaeger has joined the medical staff at St. Bernards as a plastic surgeon and is seeing patients at St. Bernards Plastic Surgery in Jonesboro. He is one of 27 new physicians in the St. Bernards “Class of 2015.” Dr. Nolan Jaeger received his Jaeger medical degree from the University of Oklahoma College of Medicine in Oklahoma City. He completed a six-year integrated plastic surgery residency at the University of Nevada School of Medicine in Las Vegas and also holds an undergraduate degree in international studies from the University of Miami in Coral Gables, Fla. Jaeger specializes in all avenues of reconstructive surgery, including breast and skin cancer reconstruction, hand surgery, burns and trauma reconstruction. Additionally, he offers a full spectrum of aesthetic surgery and non-operative anti-aging interventions. He is a member of St. Bernards Medical Group and St. Bernards Healthcare Regional Providers (SHARP).
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