2016 Healthcare Magazine

the Alaska HealthCare

Journal A Guide to Healthcare & Living in Alaska

October 2016

Morris Publishing Group

2 2016 Alaska Healthcare Journal

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4 2016 Alaska Healthcare Journal

The Alaska HealthCare Journal A Guide to Healthcare & Living in Alaska Morris Publishing Group 301 Arctic Slope Ave. Ste. 350 Anchorage, AK 99518 P: 907-561-4772 F: 907-563-4744 www.alaskajournal.com Publisher Deedie McKenzie (907) 283-7551 deedie.mckenzie@morris.com

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Reporter

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Reporter

DJ Summers (907) 275-2158 daniel.summers@alaskajournal.com

Reporter

Stephanie Prokop (907) 275-2162 stephanie.prokop@alaskajournal.com

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Elizabeth Earl (907) 335-1246 elizabeth.earl@peninsulaclarion.com

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P 6: Big Hearts, Bigger Problems

By Airman 1st Class Christopher R. Morales

P 10: Specialty Health Care Requires Specialty Radiology

By DJ Summers

P 12: Mammograms An Option At 40, Do More Good At 50

By Lauran Neergaard

P 14: Orthopedic Clinics Volunteer Trainers To Keep Kids Playing

By Elwood Brehmer

P 15: Answering A Need

By Elizabeth Earl

P 19: Audiology Technology Takes Leaps Forward

By Stephanie Prokop

P 21: Hunters Shouldn’t Overlook Hearing Protection

By Rich Landers

P 24: Juneau Moms, Babies & Families Celebrate Breastfeeding

By Lisa Phu

P 26: Alaska Native Care Gets Boost From Federal Funds Under Medicaid Reform

By DJ Summers

P 29: With $55M In State Aid, Premera Files For 7.8% Rate Hike

By DJ Summers

P 30: Employment Opportunities Advertiser Index Accurate Hearing Systems 20 Alaska Heart & Vascular Institute 8, 9 Alaska Vein Clinic 17 Arctic Spine 12 Bartlett Regional Hospital 3, 22 Denali OB GYN 14 Health North Family Medicine, LLC 7 Imaging Associates 32 Laser Vein 24 Makar Eye Care 28 Midnight Sun Home Care 11 North Star Behavioral Health System 27 S.E.A.R.H.C. 31 S.R.O.C. 16 The Alaska Club 18 The Children’s Clinic 21 Women’s Care of Alaska 2,4

2016 Alaska Healthcare Journal 5

Big Hearts, Bigger Problems

By Airman 1st Class Christopher R. Morales 673d Air Base Wing Public Affairs

Photo/File/Associated Press

The heart commonly grows due to high blood pressure and coronary heart disease. If the heart isn’t exercised regularly, it can become weak and thin, resulting in a stretch of the atrium.

The heart is the most important muscle of the human body, but having a bigger heart doesn’t make it better.

Atrial fibrillation is the most common heart rhythm problem and the second most common condition seen at the cardiopulmonary clinic at the Joint Base Elmendorf-Richardson hospital, said Milisha Stevens, 673d Medical Operation Squadron cardiology physician’s assistant.

A-fib increases the risk of stroke, heart attack and other cardiovascular problems. It occurs when the electric rhythm of the heart becomes abnormal due to the heart scarring, stretching or growing.

When this occurs the top two chambers of the heart, the left and right atria, can’t pump blood out effectively, leaving blood behind. As the blood pools, it can form clots, which can travel to the brain through blood vessels and cause strokes.

Most cases of A-fib are found accidently after a stroke because the symptoms are hard to tie to A-fib alone. They include; a mild chest “tightness” or pain, feeling lightheaded, having trouble breathing during exercise and feeling as though the heart is racing or skipping a beat.

Some patients have ‘grown’ their atria to a point that they might have A-fib for the rest of

6 2016 Alaska Healthcare Journal

their life, but in other cases where the heart is a normal size, the disease can be acute or chronic.

The heart commonly grows due to high blood pressure and coronary heart disease. If the heart isn’t exercised regularly, it can become weak and thin, resulting in a stretch of the atrium.

“Sometimes, we can attribute a sudden case of A-fib to an illness, like pneumonia … and other times after a surgery [called] post-op A-fib, [that lasts] a day or two and then never shows up again,” Stevens said.

To catch it early, identify the symptoms or use an automated blood pressure cuff, one is available at the JBER hospital in front of the pharmaceutical clinic. Newer models of blood pressure cuffs can catch an irregularity in heartbeat.

Additionally, the cardiopulmonary clinic has a few machines to catch this disease when tested. Electrocardiograms and echocardiograms are tests to check for A-fib, through electric waves monitored on a graph and an ultrasound for a visual display, respectively.

If the problem is recurring, they also provide a holter monitor, which is a portable device that records the rhythm of the heart over the course of 24 to 48 hours by means of electrodes on the chest.

The cardiopulmonary clinic usually provides treatment for A-fib if the patient shows more than two risk factors that can worsen the condition. If the patient has congestive heart failure, vascular disease, hypertension, diabetes, or history of a stroke, or is a female 65 years or older, they have a higher risk of further complications.

A-fib can be treated with medicine, either to regulate the speed of the heartbeat or to thin the blood to prevent clots from forming. It can also be treated with “cardioversion,” a procedure that applies a mild electrical current to the heart to fix its rhythm.

Anyone can control a few factors that help reduce the chance of getting this disease.

Limiting caffeine and alcohol intake, as well as losing weight and exercising regularly are all ways to help regulate heartrate and heart pressure.

“The heart works well when you take care of it,” Stevens said.

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8 2016 Alaska Healthcare Journal

Examine Your Family Tree During National Family Health History Month Patients are often asked about their family history during health check-ups, but how much do you really know about your family’s health history and why is it so important? In honor of National Family Health History Month this November, we’re shedding some light on this topic and offering you a few resources you may find helpful.

Did you know that having a parent or sibling with heart disease means your risk is increased by as much as 100 percent? Or, that you have an increased chance of stroke if immediate family members have had a stroke? Family members share a lot – genes, behaviors, lifestyle habits and more – all of which can affect your risk for chronic diseases like heart disease and stroke.

The good news is that knowing and understanding your susceptibility to chronic diseases could potentially save your life.

The best way to get started is by gathering information about your family members, especially those with a history of heart disease or stroke. Here are four important questions to ask: 1. What age was the family member diagnosed with the disease?

2. Has that family member been diagnosed with other serious diseases, such as cancer or diabetes?

3. For relatives who have died, what was the cause and age of death?

4. What is your family’s ancestry?

When you share your medical and family history with one of our 27 experienced cardiologists, we can help create a strategy to reduce its potential negative effects on your health and decide whether further testing is necessary. This holiday season, as you spend time with those you love, we encourage you to put family first and get to know your history.

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2016 Alaska Healthcare Journal 9

Specialty Health Care Requires Specialty Radiology

By DJ Summers Alaska Journal of Commerce

“I see diagnostics as being central to primary care, to specialized care, to any level of our healthcare system,” said Hinger. “Primary care physicians are going to lean on diagnostic imaging just as much as specialists in a different way to better understand what’s happening with a patient and why their symptoms are what they are.”

Imaging Associates, managed by Alaska Radiology Associates, offers the only subspecialty radiology in the state, complemented with some of the state’s most advanced radiology equipment.

Typically, when a doctor refers a patient to a radiology center for imaging, general-purpose radiologists write the resulting reports. Having specifically trained radiologists can make the imaging reports far clearer for specialists.

“All of our reports here are sub-specialized,” Hinger said. “If you come here for a brain MRI, you’re going to have a neuroradiologist read it. If you come here for a knee, you’ll have a muscoskeletal radiologist read it. If a woman comes here for a breast image, you’ll have a fellowship trained breast radiologist read it.

Photo/File/Associated Press Diagnostic imaging is a crucial part of health care, and Imaging Associates in Anchorage offers the only sub-specialty radiology in the state, complemented with some of the state’s most advanced radiology equipment.

Specialty medicine is expensive, but according to Ward Hinger, CEO of Imaging Associates, it’s the cost of hiring a good doctor.

Healthcare is the fastest-growing economic sector in the state, according to the Institute for Social and Economic Reports at the University of Alaska Anchorage, or ISER.

“We’re the only group that does everything sub-specialty. And the value that provides to your physician is significant. There’s lots of studies. Access to subspecialty like this really increases the clarity to your physician as to what’s taking place.”

The equipment Imaging Associates uses for its specialized radiology matches the personnel. Staff uses high-field MRI machines and CT machines that can fine-tune radiation depending on the patient’s sensitivity and body mass.

Breast guided MRI biopsies and prostate scans can more accurately and less invasively pinpoint diagnoses.

In times of an economic downturn on the North Slope’s oilfields, the growth offers a bright spot for a state besieged by a $4 billion budget deficit. Along with overall growth in nursing and primary care, the state continues to attract more specialists.

The costs of such equipment and personnel, Hinger said, are an investment in Alaska health care despite a larger public conversation about costs. Specialty care in Alaska is a hot button issue in the ongoing discussion about the state’s sky-high health care rates, second in the U.S. only to Massachusetts in terms of money spent on care per person.

Part of keeping quality specialty care in Alaska, Hinger said, is keeping quality radiology.

According to a 2011 Alaska Health Care Commission report, physician compensation is a big piece of the puzzle.

10 2016 Alaska Healthcare Journal

“Reimbursement for physician services in Alaska is 60 percent higher than in comparison states for all payers based on a weighted average, and 69 percent higher for commercial (private insurance) payers,” reads the report. “For example, pediatricians in Alaska are reimbursed at rates 43 percent higher on average than pediatricians in the comparison states, and cardiologists in Alaska are reimbursed at rates 83 percent higher than cardiologists in the comparison states.”

Articles from the Alaska Public Radio Network and the Alaska Dispatch News picked up the thread, laying a large portion of Alaska’s healthcare woes at the feet of physicians who charge more for their services than Lower 48 counterparts.

The difference in specialists’ reimbursement rates, Hinger said, ignores a few key points and shifts the conversation away from the main thorn in the Alaska medical industry’s side, the Affordable Care Act. In 2004, the Division of Insurance in the Department of Health and Social Services implemented the 80th percentile rule. This rule

requires insurance companies to pay 80 percent of the “usual, customary, and reasonable rate” for physicians’ services.

Insurers say this rule, which is unique to Alaska, drives prices up. Hinger said the rule is the only thing keeping physicians here in the first place.

“If the insurance companies want to lower rates of reimbursement to be on par with what they are in Seattle, I assure you that 60 percent or 70 percent of our specialists will take their families and go live on Lake Washington,” Hinger said. “They will not tolerate the colder darker winters. They’re here because they’re able to be compensated more for that.”

Alaska’s remoteness makes specialty services few and far between, but Hinger said favorable salaries have drawn more and more specialists to the Last Frontier.

“You can get a lot of the services in Anchorage now that you used to have to fly down to Seattle for,” Hinger said.

DJ Summers can be reached at daniel.summers@alaskajournal.com.

2016 Alaska Healthcare Journal 11

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12 2016 Alaska Healthcare Journal

Mammograms An Option At 40, Do More Good At 50

By Lauran Neergaard Associated Press Medical Writer

WASHINGTON (AP) — Mammograms do the most good later in life, a government task force declared in recommending that women get one every other year starting at age 50.

It said 40-somethings should make their own choice after weighing the pros and cons.

When to start routine mammograms and how frequently to get them has long been controversial. The latest guidelines from the U.S. Preventive Services Task Force stick with its advice that women should one every two years between ages 50 and 74. But they also make clear that it’s an option for younger women even though they’re less likely to benefit.

Some health groups urge mammograms every year starting at 40 — although last year the American Cancer Society upped its starting age to 45.

There is some common ground emerging, that mammography advice shouldn’t always be one-size-fits all. “Age 50 isn’t magic,” said task force past chairman Dr. Michael LeFevre of the University of Missouri.

Here are some things to know about mammograms.

What The Task Force Says Women in their 60s are the most likely to avoid dying from breast cancer thanks to mammograms, but there’s clearly enough benefit for the average woman to start at 50, the task force found.

The advisory group wants younger women to understand the trade-offs before deciding: Among every 1,000 women screened, one additional death could be prevented by starting mammograms at 40 instead of 50. But there would be 576 more false alarms and 58 additional unneeded biopsies. Also, two extra women would be overdiagnosed, treated for cancer that never would have become lifethreatening.

40,000 die from it. It is most frequently diagnosed among women ages 55 to 64, and the median age of death from breast cancer is 68.

Women with a mother, sister or daughter with breast cancer have a higher risk than the average 40-year-old. Other factors can play a role, too, including genetics, breast density and menstrual and pregnancy history.

Personalized Screening Dueling guidelines mean “some people Photo/File/Associated Press get so confused they don’t get screened at A radiologist uses a magnifying glass to check mammoall. Some are too anxious or afraid not to grams for breast cancer. Mammograms do the most good do more, and it may not be better for them,” later in life, a government task force said in recommending said breast cancer specialist Dr. Laura Esthat women get one every other year starting at age 50, serman of the University of California, San and that 40-somethings make their own choice after weighing the pros and cons.

Francisco. “Maybe we should be screening in a new way.”

The January update, published in Annals of Internal Medicine, is largely a rewording Esserman leads the first-of-its-kind WISDOM of guidelines originally issued in 2009 and study that soon will begin enrolling 100,000 reconsidered in draft form last spring. This women to test whether tailoring screening to time, the task force stresses that “we think someone’s individual risk is better than agethe science supports a range of options” for based mammograms. Women given annual 40-somethings, LeFevre said. mammograms starting at 40 will be compared with others assigned more or less frequent Differing Guidelines screenings, starting at different ages, based Mammograms aren’t perfect, and different on in-depth risk assessments. health organizations weigh the trade-offs difInsurance Coverage ferently. So do women and their physicians.

Insurance usually pays for mammograms.

The American Cancer Society says to begin Because of concern about how the task force annual mammograms at 45 but switch to every other year at 55. After menopause, tumors recommendations might be implemented, tend to grow more slowly and women’s breast Congress recently extended for two years legislation preserving access to routine mamtissue becomes less dense and easier for mograms without copays starting at age 40. mammograms to penetrate, says chief medical officer Dr. Otis Brawley. Between ages 40 When to Stop and 44, when breast cancer is especially unThe task force says more research is needed common, the society also says women should to know whether to continue mammograms make their own choice. at 75 and beyond. The cancer society says to keep screening as long as women are in “We’re moving away from paternalistic medicine where we doctor organizations used good health and have a life expectancy of at least 10 years. to tell women, ‘You must do this,’” Brawley said. “We’re saying, ‘This woman is at higher What’s Next risk, therefore maybe she should get screened The task force said more research is needed at 40. This woman is at lower risk, maybe she to tell if newer 3-D mammograms should be can wait a little later.’” used for routine screening and if women with The American College of Obstetricians and dense breasts benefit from extra testing, such Gynecologists stands by annual mammograms as with ultrasounds or MRIs. starting at 40, while urging patient education The cancer society’s Brawley said the mamand shared decision-making. mogram age argument has distracted from a Things to Consider bigger urgency: “We ought to say this more: We need a better screening test for younger More than 200,000 women are diagnosed women.” with breast cancer each year, and about

2016 Alaska Healthcare Journal 13

Orthopedic Clinics Volunteer Trainers To Keep Kids Playing

By Elwood Brehmer Alaska Journal of Commerce

Photo/ Michael Dinneen/ For the Journal Athletic trainer Bryan Beachem checks out Eagle River player Sierra Love’s ankle during a flag football game against Chugiak.

Orthopedic physicians provide certified trainers to the majority of sporting events in the Anchorage School District, which dates back to when the Alaska High School Activities Association began enacting concussion protocols after a law was passed by the state Legislature in 2011 requiring such guidelines.

Southcentral specialty care clinics are donating their time to help Alaska’s future athletic stars.

Orthopedic Physicians of Alaska and Anchorage Fracture and Orthopedic Clinic offer the services of their certified athletic trainers at “the majority of our sporting events” Anchorage School District

Activities Supervisor Derek Hagler said.

The athletic trainers monitor the student athletes for concussions — a focal point in contact sports — but also act as the first line of defense against just about any injury the kids endure.

Hagler said the relationship between the district and the clinics began when the Alaska School Activities Association, or ASAA, began enacting concussion protocols to ensure athletes are fully recovered from their injuries to prevent lingering side effects.

“It just kind of developed hand-in-hand where not only did we develop these concussion models but we had folks in the community step forward and say, ‘Hey, we’d like to be your certified athletic trainers,’” he said. “So certainly we were eager to have that partnership develop.”

OPA began volunteering the services of one athletic trainer to the district in 2008. In 2011, the Alaska Legislature passed a law requiring the ASAA to develop concussion management guidelines to monitor athletes suspected to have endured a concussion.

Since, the clinic has added six more full-time trainers that spend their time at high school games and often even at practices. Trainers attend all games of the “high impact” sports, Hagler said.

They also instruct the athletes on proper safety techniques and injury management at practices

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when available.

“We can prevent injuries before they occur to your young adults,” OPA lead athletic trainer Lynne Young said. “We can also be there and take care of them initially. Sometimes it’s a sprained ankle and we can get them back; sometimes it’s a trip to the ER and we’re there to help with the rehab.”

Young said she and the other OPA trainers regularly spend 60 hours per week or more at games or practices during the school year — all free of charge to the district.

“It’s goodwill on the part of my docs sending us out there,” she said.

Hagler said OPA and Anchorage Fracture and Orthopedic Clinic hang banners at the games, but that’s it.

OPA’s trainers usually work with the same schools, and students, season after season, gaining an important rapport with the students, according to Young.

“I see these kiddos every day. I see when they’re having a bad day because they missed a question on a test and you’re just part of their — it’s just the most rewarding thing and the hardest job in the world,” Young said.

OPA CEO Rick Watson said the clinic offers its athletic trainers as one of many ways it tries to do its part to better the communities it serves. The effort began when OPA physicians noticed they were often treating student athletes with preventable injuries. Clinic leaders went to the Anchorage School District and asked to help.

“What we said was, ‘Look, we just want to help prevent injuries,” Watson recalled.

Hagler said the donated services, which OPA has extended to some Matanuska-Susitna schools through its Wasilla office and state tournaments, provides significant savings to the district.

Watson estimated the districts would have to spend up to $80,000 per year to keep each certified athletic trainer on staff.

“If we were to look carefully at the economics of it, it’s good PR, it’s good name recognition, but financially it’s a loser,” he said.

Young admitted she often takes the wins and losses of the students she works with every day home with her as if she were a member of the teams, and added the reward of seeing the student athletes return to form after an injury makes the night and weekend work completely worth it.

“You took this kiddo that got hurt and they’re able to have an active lifestyle after that,” she said.

Elwood Brehmer can be reached at elwood. brehmer@alaskajournal.com.

Answering A Need

On The Kenai Peninsula, Cancer Care Markedly Improved

By Elizabeth Earl Peninsula Clarion

Photo/ Elizabeth Earl/Peninsula Clarion Central Peninsula Hospital’s new infusion clinic in Soldotna opened for medical use in spring 2016. The new clinic expands Central Peninsula Hospital’s cancer treatment space from a first-floor outpatient infusion center to its own clinic on the third floor of a newly constructed building with additional bays and private rooms.

A cancer diagnosis on the Kenai Peninsula used to carry the subtext of a lot more than just chemotherapy and radiation.

It meant weeks of driving back and forth on the winding highway to Anchorage, regardless of weather. It meant finding a hotel room in Anchorage and taking time off work to stay for a few days when surgery was necessary.

Today, the world looks different for a patient diagnosed with cancer. Other than for specific types of surgery or medical oncology services, which are not always necessary in cancer cases, a patient can go all the way through a course of treatment without ever having to leave the peninsula.

That’s a huge improvement, said Cathy Gensel, foundation director and concierge services coordinator for Central Peninsula Health Foundation, a nonprofit that supports health initiatives and promotes healthy lifestyles on the peninsula.

“When I first took over this position in 2011, there was no radiation on the peninsula … I would ask (some cancer patients), ‘How long does it really take to go get the radiation done?’ And they would say, ‘Oh, five minutes,’” Gensel said. “So I was just floored. You drive all the way back and forth from Anchorage for five or six weeks, in one day, for five minutes? If people were diagnosed in the summertime, they would say, ‘I will just wait, because I can’t afford the hotel rooms.’”

In 2013, about 71 percent of the peninsula’s population thought the central Kenai Peninsula needed Continued on page 18

2016 Alaska Healthcare Journal 15

16 2016 Alaska Healthcare Journal

2016 Alaska Healthcare Journal 17

Continued from page 15 more cancer care services, according to the 2013 edition of Central Peninsula Hospital’s Community Health Needs Assessment, a survey completed once every three years.

Fewer women received cancer screenings compared to the average both in the state and nationally. At the time, 8.2 percent of the respondents to the survey had experienced cancer at some point in their lives, slightly up from the survey conducted in 2009.

Central Peninsula Hospital, the largest hospital on the peninsula, located in Soldotna, began to make plans to accommodate for more cancer care and design plans for new services, many of which are now up and running.

At the time when Community Health Needs Survey was conducted in 2012, cancer was the leading cause of death on the Kenai Peninsula. In 2013, it dropped to second place, behind cardiovascular disease, similar to the national trends, according to the Alaska Bureau of Vital Statistics.

Keeping It Close To Home It’s a big deal for a lot of patients and their families to skip the three-hour drive to Anchorage.

“Our treatments can be daily for up to seven weeks,” said Melissa Bilyeu, department manager and radiation therapist at the Peninsula Radiation Oncology Center. “That’s a huge amount of travel for patients and their families. It seems like more

18 2016 Alaska Healthcare Journal

and more care is coming to the peninsula … The biggest thing I’ve heard is how thankful they are to have something closer to home.”

The Peninsula Radiation Oncology Center opened in 2013 near Central Peninsula Hospital. Before that, chemotherapy had been available in an infusion center at the hospital, but the opening of the center provided a full radiation and imaging center as well as naturopathic counseling through a physician who travels from Anchorage twice per month.

Still, because of the long history of having to travel to Anchorage for medical care, some people are still don’t know the clinic is there, she said.

“We offer the same treatments, the same technology down here, closer to home,” Bilyeu said. “We are smaller and we’re in a smaller community, so we try to get to know people pretty well … People become our families. It’s nice to have a friendlier atmosphere.”

Peninsula Radiation Oncology used to be a small gray building in the corner of the Central Peninsula Hospital parking lot. Today, it is situated on the bottom floor of a new red brick and glass tower, called the River Tower, full of specialty clinic services.

The hospital, though not affiliated with Peninsula Radiation Oncology, built the tower right on top of the old building, and now patients enter the center through glass doors etched with the center’s name.

Central Peninsula Hospital’s chemotherapy pa-

tients used to get their treatment on the bottom floor of the hospital near the obstetrics wing. After the opening of the River Tower in spring 2016, cancer patients go to a corner clinic on the third floor, light pouring through wraparound windows into treatment bays with comfortable armchairs. Two private rooms are available for treatment as well.

Bruce Richards, external affairs and marketing manager for Central Peninsula Hospital, said the new clinic has been well-received.

“It’s a much, much better environment for people who are sick and struggling,” Richards said. “It’s better for a healing environment.”

Remaining Challenges Right now, the center is comfortably meeting the community’s needs, but Bilyeu said she expects the demand to grow over time.

“I think that hopefully when people see that, it will draw more providers,” she said. “It’s more rural and it can be difficult to attract the physicians required.

I’m hoping as things grow, we can continue to keep attracting them.”

Alaska only has 1,723 total practicing physicians, 12 of whom are oncology specialists, according to the Kaiser Family Foundation. Only one practices on the Kenai Peninsula — Dr. Larry Lawson, who offers medical oncology services at South Peninsula Hospital in Homer — and he travels between Homer and Palmer.

Central Peninsula Hospital’s administration designed its new infusion clinic with space for a medical oncologist, hoping to attract one in the future. So far, the hospital has not secured one, but the administration is working on it, Richards said.

Transportation provides another challenge for many patients, Gensel said. The central Kenai Peninsula, with infrastructure spread out along highways and limited public transportation, can be a roadblock for patients.

The Central Peninsula Health Foundation does what it can for patients who don’t have transportation, sometimes calling volunteers who said they would help drive patients to and from medical appointments. The peninsula does have a public transportation organization, the Central Area Rural Transit System, which patients can book 24 hours ahead of time and pay for with a punch card.

Unless the patient manages to get a volunteer driver, the ride can be expensive. Central Peninsula Health Foundation offers grants to cancer patients from four funds: a cancer care fund, a breast cancer fund, a prostate cancer fund and what is known as a WOW fund — short for the “Way Out Women,” the name of a snowmachine ride fundraiser that takes place in the Caribou Hills near Homer every February.

The WOW fund gives applicants $1,000 each calendar year to use as they need, on anything from

groceries to medical supplies.

Gensel said the community has provided support for cancer patients in a variety of ways, from transportation to styling wigs for cancer patients to distributing breast prostheses.

“I think there’s probably still some needs out there,” Gensel said. “It’s just a matter of getting everybody working together.”

Elizabeth Earl is a reporter for the Peninsula Clarion. Reach her at elizabeth.earl@peninsulaclarion.com.

Audiology Technology Takes Leaps Forward

By Stephanie Prokop Alaska Journal of Commerce

Photo/File/ Associated Press Instead of the bulky, beige analog hearing aids one’s grandparents wore, tiny technology has bred a sleeker, smarter and more inconspicuous generation of hearing aids. The sounds of hearing

From analog to digital to smart technology and beyond, hearing devices have evolved just like the advent of the telephone has spawned what is now the “internet of things.”

With healthcare accounting for 17 percent of U.S. gross domestic product according to the World Health Organization, it’s no surprise that many manufacturers are staying competitive by incorporating smart technology and constant connectivity into frequently improved product lines. However, while many users may appreciate the increase in options on the market, most still prefer discrete devices that are barely noticeable.

“Hearing aids haven’t ever become something as ‘desirable’ as say, eyeglasses,” said Deborah Berndtson, Associate Director of Audiology, AmericanSpeech Language Hearing Association, referring to the wide variety of designer frames and bold colors available in eyewear.

In other words, those who require hearing aids simply prefer to hide them while eyeglass wearers make their frames a fashionable, functional accessory.

Berndtson, a member of ASHA since 1979, has seen the field of audiology grow and the evolution of devices and solutions on the market.

Ring, ring Today’s high-tech hearing devices originated with the invention of the telephone. Before that came along, one would need to wear an “ear trumpet” which, as the name implies, was funnel-shaped,

2016 Alaska Healthcare Journal 19

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Accurate Hearing Systems is committed to helping you select the best solution for your hearing loss based on your individual needs and lifestyle.

Call today for a FREE hearing screening! (907) 644-6004 Alaska law permits a hearing aid dealer who is not a licensed physician or a licensed audiologist to test hearing only for the purpose of selling or leasing hearing aids; the tests given by a hearing aid dealer are not to be used to diagnose the cause of a hearing impairment. pAid Advertisement

20 2016 Alaska Healthcare Journal

large and clunky.

However, after Alexander Graham Bell found a way to successfully transmit and receive speech and sound, inventors discovered how to translate it to wearable hearing devices, first with carbon and then via vacuum technology.

By 1952, transistor hearing aids were introduced, followed by magnetic microphones, with the earliest digital device making its debut in 1983.

Along the way, between the original analog versions and when modern digital devices appeared in the late 1990s, various components were invented to shape amplification and frequency response. As the years went by, devices also became smaller and the distance between microphone and receiver decreased.

With the heralding of digital tech, manufacturers have been more able to increase intelligibility of speech and lower the background noise even further.

“They are not perfect and do not restore hearing to normal but manufacturers are doing a better job making speech sound more normal,” said Berndtson.

A common complaint, she heard often, is that hearing aid users thought their own voices sounded like a machine, or a recording, and now this has changed.

For those with severe hearing loss, Cochlear implants are an option when hearings aids are unable to help. Rather than amplifying sound, as hearing aids are designed to do, implants channel sound, working with auditory nerves and the brain. As one may imagine, surgical implants are not off-the-shelf devices and require an audiologist’s recommendation.

A Growing Need According to the Centers for Disease Control and Prevention, hearing loss is the “third most common chronic physical condition in the United States, and is more prevalent than diabetes or cancer” while occupational hearing loss is the most common work-related illness, with 16 percent of construction workers having some degree of hearing impairment, second only to the mining industry.

As an aging population grows, the Bureau of Labor Statistics projects that audiologists as a profession will increase 29 percent by 2024. Currently, Alaska has 82 active, licensed audiologists in the state.

For communities that do not have easy access to primary care, let alone audiology, there is telehealth. The Audiology Department at the Norton Sound Health Corporation in rural Nome, for example, relies on telemedicine to provide services and cut down on patients waiting for in-person appointments.

Audiology Going Forward Numerous closed captioning apps are now available for download, and hearing tests will eventually be developed to test for autism in infants. Meanwhile, researchers at MIT have come up with an infrared device that may make ear infection diagnoses even more accurate.

What Else is in the Works?

Cochlear has released Kanso, an off-the-ear hearing device, while Turtle Beach Corp. has received FDA clearance on its HyperSound technology designed to alleviate Tinniutus, a ringing in the ears.

Phonak has launched new hearing aids featuring built-in lithium-ion rechargeable batteries, based on its Belong technology, a “next generation hearing aid product platform.”

And finally, Oticon is now offering Opn, a Bluetooth enabled hearing aid that allow users to receive notifications from doorbells, baby alarms and smoke detectors, connect directly to the television audio stream, and even turn on the thermostat when not at home.

Hunters Shouldn’t Overlook Hearing Protection

By Rich Landers The Spokesman-Review

electronic hearing protection. “And every day we hear from hunters who wish they’d been clued in on hearing protection at a younger age.”

Procrastination used to be understandable. Earplugs may prevent a hunter from hearing the wing beat of a flushing pheasant or the snap of a stick that might indicate a deer is approaching.

But technology has erased the shortcomings of the standard earplug. Excuses for neglecting hearing protection in the field are obsolete.

A single gunshot, rated at about 140 decibels, or dB, can cause permanent hearing damage, according to government guidelines. Maybe it’s just a little at a time, but the damage adds up hunt after hunt.

Bird hunters who shoot multiple rounds a day are at high risk, especially waterfowl hunters in a blind where they are bombarded with the deafening muzzle blast from their partners’ guns as well as their own.

Earplugs of some sort should be on the required equipment list for every member of every family headed to the field to hunt with a firearm.

Inexpensive earplugs with noise-suppressing mechanical baffles ($10-$15) are a viable alternative for any budget.

But any plug must be properly inserted.

Continued on page 23

Photo/File/Associated Press This undated photo shows an electric set of smart hearing protection for hunters, from Sound Gear in Spokane, Wash. Technology has erased the shortcomings of the standard ear plug, making excuses for neglecting hearing protection in the field obsolete.

SPOKANE, Wash. (AP) — While most shooters would never walk onto an active gun range without earplugs or muffs in place, hunters who use firearms tend to neglect precautions to protect their hearing.

In the heat of the hunt, it doesn’t seem to matter.

Yet every shot at a bird, deer or elk erodes one of our most valuable hunting assets.

“Shooter’s ear — we see it every day in our business,” said Lance Kraemer of Starkey Hearing Technologies, a manufacturer of hearing aids and

2016 Alaska Healthcare Journal 21

22 2016 Alaska Healthcare Journal

Continued from page 21 “Foam plugs are notorious for working out slightly so they’re offering less than 50 percent of maximum protection,” Kraemer said, citing Occupational Safety and Health Administration research.

I’ve been using standard ear plugs while hunting for decades, but not before I’d already lost some hearing acuity. Even in my protective years, it’s been hard to be consistent at plugging my ears.

For instance, while hunting wild turkeys, I usually insert earplugs before taking a stand and calling. But I often remove the plugs when I’m moving or setting up again for a better chance of hearing distant yelping or gobbling.

More than once I’ve had a gobbler come into sight unexpectedly while my plugs were out.

Since the movement of reinserting the plugs could spook a sharp-eyed tom, I’ll bite the bullet, call the bird and perhaps take the shot with ears unprotected.

Technology has made these lapses of protection unnecessary.

Trapshooters and other gun-range enthusiasts have been steadfastly using electronic hearing protection for years. Amplified muffs allow a shooter to hear conversations normally while instantly suppressing the sharp noise of a gunshot.

Muffs are very effective and continue to be my choice at a shooting range.

In fact, I used the maximum protection of earplugs combined with muffs to safely endure a Ted Nugent rock concert after interviewing the celebrity notorious for being extremely loud.

Bulky muffs aren’t always handy in the field, but small, convenient electronic alternatives are available.

Some manufacturers are using hearing aid technology to produce electronic hearing protection devices, with automatic noise suppression, that are no more bothersome than ear plugs. Models come in three styles: • Custom (about $1,200).

• In the canal (about $400).

• Behind the ear with a tube to the plug in the canal (about $300).

I field tested two of these types with positive results.

In-the-canal models are ready to use out of the box. The tiny devices come with different sized soft-rubber covers that fit the product in the ear like a regular earplug.

Custom models are fitted by hearing-aid dealers, who make an impression of your ear canal for a perfect and comfortable fit. These larger

devices also have more features and volume adjustments.

Electronic hearing protection devices are not considered hearing aids, although they share some of the same technology.

“Most hearing aids don’t have a seal; they’re vented,” Kraemer said. “They let air into the ear so the user can hear ambient sound to prevent the feeling of having the ear plugged in everyday living.

“A hearing aid can be adjusted so it won’t amplify damaging loud sounds, but since there’s no seal, a hearing aid is not providing ear protection.”

Also, hearing aids are custom-engineered to pick up frequencies an individual is missing.

“There’s a lot more science involved in a hearing aid, hence the extra cost,” Kraemer said.

The SoundGear custom and in-canal products I tested provide about the same amount of protection as a properly inserted foam plug. The big difference is that the user can hear normally as though the ear isn’t plugged.

The digital sound enhancement has a slightly unnatural sharpness but is not uncomfortable or distracting.

The custom model with volume adjustment enhances hearing with high-definition sound reproduction that’s especially useful when hunting from a stand.

The amplification is meant to compensate only for the hearing loss from insertion of the device.

However, while the manufacturer can’t claim hearing enhancement, I found a clear improvement with both models in what I could hear without the devices in place.

I spend a lot more time listening to chickadees and other critters than I do absorbing the blast of a gunshot, but I want to be equipped for both.

The electronic hearing protection models I tested have a Noise Reduction Rating of 24 to 25dB. That means a muzzle blast rated at 140dB, which poses immediate danger to hearing, is reduced to about 115 dB — the rate of a baby’s cry or a jet ski.

National standards say 115dB will cause hearing damage if sustained for 15 minutes.

Electronic devices use sound-activated compression to trigger instant suppression of any noise over 95dB. “These products are bringing noise down into a safer range,” Kraemer said. “You’re still exposed to loud sounds, but at a safer level. The guideline is that exposure to noise over 85db for eight hours will cause permanent damage.

Continued on page 25

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24 2016 Alaska Healthcare Journal

Continued from page 23 “The biggest problem is that most hunters don’t wear any ear protection at all, not even kids. They rationalize that they’ll only take a few shots.”

Take this advice from someone who’s already lost the joy of hearing the cascading call of a canyon wren or the distant bugle of a bull elk: protect your hearing with something.

If you want the best performance, buy electronic protection devices that will guard your hearing from muzzle blasts while helping you hear clearly for better communication, hunting success and safety in the woods.

Let’s hope that educated observation doesn’t fall on deaf ears.

Juneau Moms, Babies & Families Celebrate Breastfeeding

By Lisa Phu Juneau Empire

Photo/Michael Penn/Juneau Empire Women gather to breastfeed their children during the Big Latch On event at Dimond Park Fieldhouse on Aug. 6. The two-hour family event was organized by the Juneau Breastfeeding Alliance, a group of individuals and health care organizations, like Bartlett Regional Hospital; Juneau Public Health Center; the Women, Infants and Children program at SEARHC and Valley Medical Care.

Juneau mom Ericka Beery sometimes breastfeeds at Fred Meyer. In the past, when nursing was still fairly new, she used to sit down in the furniture section to feed her son. Now, she can breastfeed her third child — a six-month-old daughter — while walking and shopping.

“I never feel weary of nursing anywhere in public in Juneau,” the 34-year-old said.

Beery was one of about 30 moms who sat together at the Wells Fargo Dimond Park Field House Saturday morning and breastfed their babies. They were all participating in The Big Latch On, a global celebration promoting and supporting breastfeeding.

“I think it’s important to get the awareness out for new moms who are nervous about breastfeeding or breastfeeding in public. They can see how it’s normal and it doesn’t have to be a full-on exposing or it doesn’t have to be a spectacle,” Beery said.

“It’s not that everyone’s watching you while you’re

nursing; people hardly even notice usually.”

Shakira Vallejo said it’s important to normalize breastfeeding. Vallejo, 34, was born and raised in Juneau and moved to Seattle two years ago, but she still spends the summers here with family.

“Nowadays, a lot of people don’t look at it like it’s normal, like it’s taboo to breastfeed in public when it shouldn’t be. The most natural thing in the world is to breastfeed your baby,” she said, while nursing her 10-month-old daughter.

She’s read about and seen videos on the internet of difficulties mothers have faced while breastfeeding in public. It made her nervous to do it, “but then I said, ‘My baby is hungry. I’m going to feed her and I don’t care what you think. If you don’t like it, don’t look,’” Vallejo said laughing.

As a mom, in Seattle and Juneau, she breastfeeds “anywhere in public,” like restaurants and airports.

Vallejo was pleasantly surprised by the turnout at Juneau’s first Big Latch On event.

“I didn’t expect this many people to be breastfeeding all at the same time here. It was really nice to see and feel a lot of support,” Vallejo said.

The two-hour family event was organized by the Juneau Breastfeeding Alliance, a group of individuals and health care organizations, like Bartlett Regional Hospital; Juneau Public Health Center; the Women, Infants and Children (WIC) program at SEARHC and Valley Medical Care.

Shayna Rohwer, a perinatal educator at Bartlett and certified lactation counselor, is part of the alliance. She said the goal of The Big Latch On was to support breastfeeding moms and help them build connections.

“Support is the best predictor of breastfeeding success — having support from your family, your partner and then from your community and workplace,” Rohwer said.

In Alaska, more than a third of mothers stop breastfeeding before their babies reach four weeks of age, according to the Alaska Department of Health and Social Services. Reasons include pain, not enough time and trouble helping their baby latch on.

Rohwer said there are several free resources in Juneau that offer breastfeeding help and support, like four lactation consultants at Bartlett, baby groups at Bartlett and the Juneau Family Health and Birth Center, peer-to-peer support through the Breastfeeding Cafe at the birth center and a Juneau Breastfeeding Cafe Facebook group.

The Juneau Breastfeeding Alliance was initially created about four years ago to support women in the workplace. Rohwer said it’s important for employers to support breastfeeding moms by providing accommodations like time and space (that’s not a bathroom).

2016 Alaska Healthcare Journal 25

“It’s a great investment to make. Children have fewer illnesses, mothers have fewer sick days.

Because of that, you have better employee performance and retention,” she said.

Juneau public health nurse Chastity Wilson said the benefits of breastfeeding extend to babies and moms. Breastfed babies are healthier overall than formula-fed babies, have less digestive issues, are easier to sooth, have less allergies, fewer ear infections, grow faster, have a decreased risk of obesity, among other things. Mothers who breastfeed have a decreased risk of cancer. Breastfeeding is also good for bonding and is more affordable.

Wilson said not all communities are as supportive of breastfeeding as Juneau. When she lived in California and nursed her first child, people looked at her and made rude comments.

“But Juneau’s great,” she said. “Women are out walking trails with their babies latched on. I love it.”

Contact reporter Lisa Phu at 523-2246 or lisa.phu@juneauempire.com.

Alaska Native Care Gets Boost From Federal Funds Under Medicaid Reform

By DJ Summers Alaska Journal of Commerce

Photo/Office of Gov. Bill Walker Gov. Bill Walker signs Senate Bill 74 on June 21 at the Southeast Alaska Regional Health Consortium in Juneau.

The bill could save the state more than $365 million in the first six years.

Improving Alaska Native access to healthcare is a key result of the Medicaid reform bill signed by Gov. Bill Walker on June 21.

About 150,000 Alaskans covered under the Alaska Tribal Health Compact will move one step closer to expanded specialized care coverage as care centers expand in rural areas.

The omnibus healthcare and Medicaid reform bill has been one of the few items to survive a contentious and grueling 2016 legislative session, passing both chambers and only awaiting Walker’s signature to put its dozens of changes into law.

Among the bill’s changes, the most potential cost savings come from shifting more Alaska Na-

26 2016 Alaska Healthcare Journal

tive healthcare expenses to federal dollars. This includes a change that allows full federal reimbursement for Native travel and for Native care in non-Tribal facilities.

The policy change in SB 74 would take advantage of the new 100 percent Medicaid reimbursement to Native patients referred to non-Tribal providers.

The Department of Health and Social Services estimates the changes to the Medicaid system in SB 74 would save the state more than $31 million right away in fiscal year 2017 starting July 1.

Those savings are expected to increase to nearly $114 million per year by 2022 as the programmatic reforms are fully implemented.

Like many of the Legislature’s cost-shaving plans, some of SB 74’s changes try to fund more services with federal dollars to reduce state spending.

By far the most of the forecasted savings to be wrung from SB 74 — $29 million in 2017 growing to $97 million in 2022 — would come from getting more Medicaid services for Alaska Natives fully covered by the federal government.

Under federal law, Medicaid provides for 100 percent reimbursement for all Indian Health Services beneficiaries under certain circumstances, but the criteria are often difficult to fulfill for 100 percent coverage.

“It tends to be a rather narrow definition,” said Jon Sherwood, deputy commissioner of the Alaska Department of Health and Social Services.

Under the current system, care provided for IHS beneficiaries in non-Tribal or non-IHS facilities is only eligible for 50 percent reimbursement by Medicaid.

In order to get 100 percent reimbursement, three conditions must be met. The recipient must be an Alaska Native or American Indian, must be treated at an Indian Health Services or tribal facility, and must be Medicaid eligible.

This narrow criteria leaves some kinds of care more difficult for rural and Tribal healthcare recipients to access.

Indian Health Service, or IHS, is an agency within the U.S. Department of Health and Human Services. It provides healthcare for every federally recognized Tribe in the nation.

The Alaska Area Indian Health Services provides healthcare services for just less than 150,000 Alaska Natives and American Indians, according to the Center for Medicaid Studies. There are 228 federally recognized Tribes in the state, each of them incorporated into the Alaska Tribal Health Compact.

There are IHS-funded, Tribally managed hospitals in Anchorage, Barrow, Bethel, Dillingham, Kotzebue, Nome, and Sitka. Statewide, there are 58 Tribal health centers, 160 tribal community health aide clinics and five residential substance abuse treatment centers.

Alaska Native Medical Center in Anchorage is the only statewide IHS facility, and the facility that serves as the focal point for specialty care. Not all, or even most, of these facilities have specialty care or often MRI capability.

An IHS recipient may have hard luck finding a gastroenterologist within the IHS network, and need to be referred outside the Tribal system to find the necessary care.

This puts financial strain on IHS beneficiaries who need specialized care.

On the surface, the change seems like a win-win for providers and recipients. For healthcare recipients, this means increased access to specialist services unavailable in tribal facilities. For providers, it means full reimbursement for care.

To implement the changes, DHSS will have to work with Tribal and non-Tribal healthcare providers to compile lists of recipients to share among them.

“From our perspective,” said Sherwood, “we’re

going to have to work with Tribal and non-Tribal providers to make sure the sharing is in place.

We’re going to have to develop an adequate tracking system to ensure we have the ability to identity claims that would be eligible.”

The policy change allows rather than commands involvement. Neither the state nor the federal government can force private healthcare providers join the program, so the new system will require a new network of participating providers.

“This is voluntary,” Sherwood said. “The state can’t impose this onto either provider or individual recipients. This has to be a cooperative effort.”

Providence Medical Center, the state’s largest non-Tribal healthcare facility, said it plans to participate in the change, though representatives say it’s too early to discuss any particulars.

IHS changes come during a wave of land and construction agreements for Alaska Native medical centers across the state.

The Yukon-Kuskokwim Health Corp., or YKHC, signed a joint venture agreement with IHS on March 29.

The agreement secured increased funding for additional provider and a new primary care clinic, the 188,000 square foot Dr. Paul John Calricaaraq Continued on page 29

2016 Alaska Healthcare Journal 27

28 2016 Alaska Healthcare Journal

Continued from page 27 Project, as well as a remodel of Bethel’s existing 105,000 square foot hospital.

Expanding populations in areas like Bethel make the existing healthcare structures somewhat outdated.

The YKHC hospital in Bethel received about 88,000 patient visits in the early 1990s. The number has nearly doubled to 150,000 by 2015.

This follows an October 2015 grant for the same project. The U.S. Department of Agriculture’s Rural Development agency made a funding commitment for $165 million in low interest loans to YKHC for the Dr. Paul John Calricaaraq Project in October 2015, the most the agency has ever given to an organization nationwide.

At the federal level, Alaska’s congressional delegation is securing Alaska lands for Native health purposes.

On April 27, U.S. Senate Committee on Indian Affairs passed legislation introduced by Alaska U.S. Sens. Lisa Murkowski and Dan Sullivan directing the U.S. Department of Health and Human Services to give property to both the Tanana Tribal Council and Bristol Bay Area Health Corp.

The land transfers allow the Tanana Tribal Council to develop a Community Wellness Center and the Bristol Bay Area Health Corp. to expand a dental clinic.

DJ Summers can be reached at daniel.summers@ alaskajournal.com.

With $55M In State Aid, Premera Files For 7.8% Rate Hike

By DJ Summers Alaska Journal of Commerce

Premera Blue Cross Blue Shield of Alaska filed its request for 2017 individual insurance rates in July, ending a two-year run of exorbitant increases but still costing the beleaguered state checkbook $55 million.

Premera, the state’s sole remaining individual insurance provider, filed for an average rate increase of 7.8 percent on 6,800 individual metallic plans across the state. Statewide, Premera has 140,000 customers with the vast majority in group plans.

The rate is a break from two straight years of leaping increases. Premera’s rates rose approximately 37 percent and 39 percent in 2015 and 2016, responding to a high-risk patient pool that lost the company $13 million since 2014.

The comparatively palatable rate increase for 2017 comes from a bill passed by the Legislature in June and signed by Gov. Bill Walker on July 18.

The bill established a reinsurance program, which subsidizes plans by spreading the cost around to other users.

In this case the reinsurance plan, which will cost $55 million, draws proceeds from a statewide insurance premium tax. This tax of 2.7 percent per plan typically draws between $50 million and $60 million per year according to Lori Wing-Heier, director of the Division of Insurance.

Premera praised the Legislature’s actions as having staved off a third year of rate increases and potentially the worst year yet.

“Had the legislature not passed the reinsurance legislation to provide some relief to Alaskans, Premera’s 2017 rate increase request would have been more than 40 percent, based on medical claims data from 2015,” according to a Premera press release.

The Legislature feared dedicating too much state revenue to a shifting situation, and installed a two-year sunset for the reinsurance program. The Legislature also used the opportunity to establish a working group dedicated to studying Alaska high medical costs.

“The reinsurance program will sunset after two years, but we remain committed to working with legislators, the Division of Insurance and other stakeholders to find a longer term solution,” stated Premera.

The state’s dwindling insurance provider ranks and spiking rates trace their roots to federal healthcare policy. Other states with Alaska’s geography and rural demographics have had similar outcomes.

The Affordable Care Act, or ACA, forced insurers to accept high-risk patients for coverage. This drew high-risk patients away from the Alaska Comprehensive Health Insurance Association with lower cost, federally subsidized plans. When federal reimbursements for insurer losses came up short, insurance companies hemorrhaged money and have been forced to raise insurance rates to recoup losses or leave the state altogether.

In two years, Alaska’s individual insurance market provider pool shrank from five providers to one. On May 1, Moda Health announced that it is leaving the Alaska individual market in 2017. Aetna, State Farm, and Assurant Health left Alaska’s individual insurance market in June 2015. Moda officials said the company could no longer operate in Alaska without a substantial increase in insurance premiums, which had already increased by 29 and 37 percent in 2015 and 2016, respectively.

Rates have cooled for now, but it remains to be seen whether or not the reinsurance program will lure Alaska’s former providers back into the market.

The two-year sunset doesn’t promise that subsidies will last long enough for the state to substantially lower healthcare costs for the high-risk users driving insurance prices.

2016 Alaska Healthcare Journal 29

Employment Opportunities Bartlett Health Connections Pharmacy Analyst $26.16 + DOE Under the supervision of a pharmacist, the pharmacy analyst provides support for the electronic systems used in the pharmacy which may include, but are not limited to provision of medications and supplies, inventory management, distribution, packaging and labeling of medications, record keeping, reporting, and charge capture. Develops, implements, supports and maintains medication and pharmacy related components including, but not limited to, Meditech, Omnicell, and Macro Helix. For more information go to https://www.bartletthospital.org/ Clinical Nurse RN Surgical Services/OR $36.74 - $41.23 DOE This position is an Operating Room Nurse, seeking an experienced, enthusiastic Circulating Nurse. Experience with minimal invasive, general, ENT, eyes, plastics, orthopedics, spines, urology, endoscopy cases preferred. With CNOR certification recommended or willingness to obtain within one year of employment. The ideal candidate would have one (1) year of OR experience within the last three (3) years. PACU experience or willingness to learn PACU required.

RN II: Advancement from CN RN I or a minimum of one (1) year continuous recent experience in a comparable patient care setting. Clinical competency in primary specialty and a minimum of one (1) float area required within one year of attaining CN RN II status. For more information go to https://www. bartletthospital.org/ RN III: Advancement from CN RN II or a minimum of 3 years current acute care experience 2 of which are in primary unit specialty. Clinical competency in primary specialty and a minimum of one (1) float area required within one year of hire. For more information go to https://www.bartletthospital.org/ Clinical Nurse RN Surgical Services/OR $32.44 - $41.23 DOE Mental health nurses support people with a range of mental health issues. They aim to build good relationships with patients and their families so that everyone is involved in the therapy process. A mental health nurse has to be sympathetic and non-judgmental. You will need to be able to gain a patient’s trust. You’ll also need to manage emotional situations. For more information go to https://www. bartletthospital.org/ RN I: New graduate RN, RNs with less than one (1) year current acute care or comparable experience, or RN with no nursing experience in the past five (5) years. New graduates will remain at the CN I level for at least six (6) months.

Must advance to CN II within one year of hire. Proven competency in specialty area. Communicates the mission, ethics, and goals of the facility. For more information go to https://www.bartletthospital.org/ RN II: Advancement from CN I or a minimum of one (1) year continuous recent experience in a comparable patient care setting. Clinical competency in primary specialty and a minimum of one (1) float area required within one year of attaining CN II status. For more information go to https://www.bartletthospital.org/

SEARHC Nursing Manager – Juneau, AK The position functions as the supervisor and leader of the SouthEast Alaska Regional Health Consortium (SEARHC) ELMC Nursing department in Juneau. The Nursing Manager works closely with the Clinic Administrator and Medical Director to improve clinic functions and flow, enhances the patient experience, and ensures staff training and competency.

The position assumes primary responsibility for leadership and development of

30 2016 Alaska Healthcare Journal

the ELMC Nursing staff. This includes administrative supervision, programmatic development, and continued quality improvement for clinical services. The candidate provides direction for the professional development of clinic nursing staff, maintains operational aspects of the clinic in collaboration with ELMC Clinic Administrator and Medical Director, works cooperatively and closely with all ELMC department heads and staff to promote improved patient and staff satisfaction.

For more information, or to apply online, visit www.searhc.org.

Registered Nurse – Multiple locations SouthEast Alaska Regional Health Consortium (SEARHC) is seeking registered nurses in all areas, including ER/CCS, OB/Labor & Delivery, and Operating Room.

Baseline Qualification Requirements: A graduate of an accredited school of Nursing (Bachelor’s degree in Nursing, Associate Degree in nursing or Diploma in nursing).

Prior experience is preferred.

A valid, current, full and unrestricted RN license in the State of Alaska.

For more information, or to apply online, visit www.searhc.org.

Medical Laboratory Scientist – Sitka, AK SouthEast Alaska Regional Health Consortium (SEARHC) is seeking a candidate who, under minimal supervision, applies advanced technical skills and seasoned judgment to independently and competently provide a full range of sample test analyses and laboratory services in a hospital-based laboratory. Shift work and night and weekend call are required to provide 24-hour laboratory coverage. Perform all levels of testing including CLIA defined high complexity testing. Works with infants, children, adolescents, adults, and geriatric patients.

For more information, or to apply online, visit www.searhc.org.

Behavioral Health Consultant (Wellness Advisor) – Juneau, AK Want to build bridges? SEARHC Wellness Advisors are Behavioral Health Consultants, working as an active member of the primary care team and bridging the gaps between a clinic visit and longer term support. This position provides brief counseling to patients at the time of their primary care visits and helps to determine next steps that support behavioral health and health promotion for the patient. This is a dynamic position working in concert with primary care, behavioral health and health promotion.

For more information, or to apply online, visit www.searhc.org.

Radiology Manager – Sitka, AK This position manages the radiology program for SouthEast Alaska Regional Health Consortium (SEARHC). Assure that there is Consortium-wide consistency in radiology policies and procedures. Assess and monitor on-going staff training and competency. Develop and monitor radiology quality improvement activities.

Coordinate with other SEARHC departments as appropriate. Make recommendations on capital purchases. Monitors and supervises employees remotely. Ensure proper training of employees who have no radiologic background who will perform radiologic studies at field sites. Develop business proposals to meet the radiology needs of the consortium.

For more information, or to apply online, visit www.searhc.org.

Dental Practice Administrator – Juneau, AK This newly created position will support the success and growth of the SouthEast Alaska Regional Health Consortium (SEARHC) Dental Division. Primary duties include planning for, directing and coordinating the operations of the SEARHC Dental Division in collaboration with the Dental Division Director. Responsibilities include ensuring and improving the performance, productivity, efficiency, and profitability of operations through the provision of effective management methods and strategies. SEARHC offers competitive compensation, an exceptional benefits package, and relocation assistance. Become part of a team that is working together to be both the “Provider of Choice” and “Employer of Choice” in our region.

For more information, or to apply online, visit www.searhc.org.

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