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The ProTein DeTecTivesSolving the myStery

of the proteome

The Heart of the Matter

It’s on You!

One On OneSusan Starks,

ArkansasPublic Health

Simple Fix not So Simple

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Chief editorSmith W. Hartley [email protected]

managing editorKaren Tatum [email protected]

editor/writerPhilip Gatto [email protected]

ContributorsClaudia S. Copeland, PhDA.D. LivelyJohn MitchellCharles Ornstein

CorrespondentsWilliam Golden, MDRay HanleyNathaniel Smith, MD, MPHJoseph W. Thompson, MD, MPHJason Miller

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photographerZoie Clift

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March / April 2017

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ContentsMarch / April 2017 I Vol. 4, No. 3

10

2010

34featuresThe Protein Detectives: .........10Solving the mysteries of the proteome

The Heart of the Matter .......20Technology, medicine and skill

shift cardiac care to the

outpatient setting

It’s on You! ..........................................28The trend toward “consumer-driven”

healthcare plans

One on One with Susan Starks ....................................34President, Arkansas Public

Health Association

How a Simple Fix to Reduce Aberrant Prescribing Became Not So Simple .......38

DepartmentsEditor’s Desk ............................................................8

Healthcare Briefs ...............................................41

Books ..........................................................................51

Hospital Rounds .................................................61

CorresponDentsDirector’s Desk....................................................52

Policy .........................................................................54

Quality ......................................................................56

Mental Health ......................................................58

Medicaid ..................................................................6038

28

8 MAR / APR 2017 I HealtHcare Journal of little rock

from an academic sense to general common understanding. Let’s ask questions. Let’s be smarter.

Look at Los Angeles. It used to be a beautiful city in a beautiful part of the world. Now it’s known for smog. I doubt if anyone consciously said, “Wouldn’t it be great if we were a city known for smog; a smog that we can breathe into our lungs, and can change the look of our California skies?” Yet, that’s where they are.

What can we do in the meantime? Well, we can deal with egregious issues. Some environmental health issues are more easily identifiable and treatable. Let’s start there. There are still many cases of people dumping their trash, some-times environmentally hazardous, as an attempt to save money by avoiding proper disposal. It’s difficult to monitor. This illegal dumping can result in fines if one is caught and convicted. Considering communities could experience ill-ness and deaths by the hundreds because of such actions, mass illness or mass murder seems like a more appropriate charge. I’m not exaggerating here; this is the reality.

It’s never bothered me if an individual chooses to smoke, eat poorly, or live dangerously, but environmental decisions affect everyone without their consent.

We’ve come a long way. But, we’ve got a long way to go. I would be wary of the motives of anyone who stood in the way of clean air, water, and environment. We can do this. We can have it all. We can have good employment, sound energy, clean foods, and all the while be responsible for the environ-mental health of each other. Why not?

Smith Hartley

Chief Editor

[email protected]

Editor’s dEsk

THErE ISN’T ANYTHINg that’s much more important than clean air and water. The chemicals and mi-croorganisms that alter our rivers, streams, and skies affect the health and lifestyles of all the living. The air we breathe, the food we eat travel on a path through our physical being and manifest into reshaping our cel-lular structure, sometimes helping to achieve an ideal health, and some-times behaving as a destroyer. We

should know the difference.Environmental health usually doesn’t get as much

coverage because it’s a slow and arduous process to measure. We don’t understand as much as we pre-sume. We pretend we have enough science to under-stand the magnitude and the process of environmental health, but in reality, our human race has a long way to go.

You can be exposed to a toxic substance one day, but won’t develop symptoms for possibly years later, thus making causation an unsolvable mystery. Under-standing the nature of a substance in relation to other living organisms is complex.

Another reason environmental health doesn’t get much coverage is because we accept degrees of im-perfection; it’s much like everything else we do. But we’re afraid to admit it. The factors that potentially create environmental health problems also produce energy, manufacture food, remove stains, and clean carpets and clothes, along with a variety of other life benefits. We can maturely approach environmental is-sues by acknowledging degrees of imperfection. Being honest with each other on the issue is imperative.

So our goal is to find balance. Some may say we have arrived. But, I think we all know we have much more ground to cover. Balance starts with awareness. After awareness comes real understanding. Understanding of complex mathematical issues, such as molecular causation of public environmental health, requires science. Scientific models must be thorough, compre-hensive, and flexible. We then shouldn’t overreact to science. Science comes in statistical degrees. We must understand statistics. Statistics must be transferrable

It’s estimated about a quarter of all disease is a result of environmental illness.

ReseaRch

Solving the MySterieSof the ProteoMe

The Protein Detectives:

By A.D. Lively

Photographs Courtesy of the University of Arkansas for Medical Sciences

How Arkansas Became a

Destination for Proteomics

Research

Pictured L-R: Lab tech Seth Ransom, Graduate student Bradley Shields, and Alan Tackett, PhD


I got into science

on a random bet,”

says Alan Tackett,

PhD, a professor of

biochemistry and

molecular biology,

pediatrics and

pathology, and director

of the graduate

Biochemistry and

Molecular Biology

Program at the

University of Arkansas

for Medical Sciences

(UAMS).

This late-night wager

took place in a Hendrix

College dormitory

room in Conway

during the mid-1990s—

right around the time

Australian researchers

on the other side of the

globe were coining the

term “proteome.”

Today, Tackett’s internationally recognized research focuses

on the study of the proteome, or “proteomics”—a combination

of the words “protein” and “genomics” encompassing all of the

proteins expressed by a cell at any given point. If the genome

contains instructions for all the proteins that a cell could con-

ceivably build or modify, then the proteome is the sum total of

what is actually being built or modified from those instructions.

at the time, however, the young Central arkansas native

was an accounting major headed for a business career, utterly

unaware of the ways in which this emerging concept would

come to define his future.

“ReseaRch

HealtHcare Journal of little rock I MAR / APR 2017 13

a FoRTUNaTE CHaLLENGE

Tackett’s college roommate, now a

physician and attorney, and still a friend,

was a chemistry student who frequently

bemoaned the difficulty level of his course-

work, thus implying that Tackett’s account-

ing classes offered an easier path. Until one

night, when Tackett threw down the gauntlet.

“We were very competitive, and he kept

saying, ‘oh, it’s so hard,’” Tackett recalls.

“and I finally said, ‘There’s no way. I guar-

antee I can score higher than you. I’m tak-

ing the class.’”

Later, in the clear light of day, that chal-

lenge might not have appeared to be the best

approach to preserving Tackett’s college

grade point average; his high school chem-

istry class had left him with the only “C” on a

transcript otherwise packed with “as.”

“I was terrible at science in high school,”

he says. “I always liked numbers, and I

always liked math. But chemistry never

interested me at all. I just hated it.” He had

something to prove, though—“I couldn’t back

down from the bet”—and signed up for Gen-

eral Chemistry I.

This time, Tackett says, the class was

“a total eye-opening experience. It all just

clicked. and after that I loved it.” Soon after

that, the accounting major became a chem-

istry major.

Now, thanks in no small part to the

research contributions of Tackett, and his

large network of colleagues and collabora-

tors, UaMS has become a major (and steadily

growing) national hub of proteomics discov-

ery and development.

and yes, Tackett made a higher grade

in the course than his roommate did—a 99

percent, to be exact.

“I remind him of that to this day,” he

laughs.

MaKING “US” HaPPEN

“Proteomics is measuring with analyti-

cal chemistry all the proteins in a cell at a

given time,” says Tackett. In short, it is the

cell’s functional output.

Investigators can use proteomics to learn

more about any type of cells, healthy or dis-

eased, creating nearly unlimited potential

for new insights and developments in areas

“Proteomics is measuring with

analytical chemistry all

the proteins in a cell at a given

time. In short, it is the cell’s

functional output.”

—Dr. Tackett

DNA polymerase IThinkstock by Getty Images

“It comes downto people and instrumentation.”

–Dr. Tackett

ReseaRch


importance of why one gene gets activated

within a cell and another one doesn’t still

remains important.

“But what happens to the proteins from

those [genes] that do get expressed is really

important, because that’s what’s present in

a cell and controls its behavior,” continues

McGehee, who is also executive director of

the arkansas Biosciences Institute (aBI).

“That’s the whole thing, they solved the

human genome a few years ago and thought,

‘there it is, we’re done,’” Tackett agrees. “Then

they realized that it’s just a bunch of instruc-

tions to be read.

“you have the same genome in a cell that’s

going to turn into, for example, a kidney ver-

sus one that’s going to turn into the tissue of

the eye, or whatever it might be, those are

different [outcomes]—but it’s all the same

instructions in all the cells.”

So, how does the cell find and read the one

set of instructions to produce the protein

that it needs?

“That’s where epigenetics comes in to

unlocking the code,” says Tackett, “and pro-

teomics helps you study epigenetics. and

then once you unlock the code, all these

proteins are expressed, and that’s the func-

tional output.”

a TaILoR-MadE aPPRoaCH

“Proteomics has real-world applications

for personalized medicine, and the work of

dr. Tackett and his talented team provides a

number of great examples of basic science

discoveries that are making their way from

the lab to the patient,” says Laura James,

Md, director of the Translational Research

Institute and associate Vice Chancellor for

clinical and translational research at UaMS.

“For example, he and his research group

have identified protein biomarkers for

numerous types of cancers which in the

future may help physicians provide better

ranging from basic science to clinical thera-

pies, and particularly in the areas of person-

alized and precision medicine.

“What it all comes down to is that what-

ever is going to happen, proteins are mak-

ing it happen,” Tackett says. “They’re the

drivers—they’re what are making the phe-

notype, the body and its behaviors, happen.

and proteomics defines what those proteins

are, in somebody who’s well or in somebody

who’s sick. That’s just the fundamental basis

of what it does.”

The diverse array of specimens that have

made their way through Tackett’s laborato-

ries for analysis is a testament to the rele-

vance and versatility of proteomics.

“I couldn’t count all the diseases—diabe-

tes, heart disease, obesity. There’s been a lot

of cancer.” He also mentions projects fea-

turing subjects as wide-ranging as radia-

tion, arsenic poisoning, fecal transplants,

and the prevention of methamphetamine

abuse. “It’d be tough for me to figure out

what we haven’t done.”

Proteomics is also useful to basic scien-

tists working with model organisms, even

something as simple as budding yeast, yield-

ing information that could ultimately lead to

improvements in clinical care. For exam-

ple, a proteomic analysis could reveal what

pathways may be dysregulated in mutated

yeast and offer insight into how to go about

studying that pathway on a larger scale.

“So it really sets the stage from anything

as simple as bacteria all the way up to the

human body,” Tackett says. “It translates the

whole spectrum.”

BEyoNd THE GENoME

The proteome is a time- and cell-spe-

cific protein complement to the genome,

the comprehensive “instruction manual”

for all of the proteins a cell might produce.

Proteomics doesn’t detract from the

importance of genomics, but rather adds

dimension to it, says Robert E. McGe-

hee, Jr., Phd, dean of the graduate school

and professor of pediatrics at UaMS. “Not

every gene is expressed in every cell. So the

“Investigators can use proteomics to learn more about any type of cells, healthy or diseased, creating nearly unlimited potential for new insights and developments in areas ranging from basic science to clinical therapies, and particularly in the areas of personalized and precision medicine.”

—Dr. Tackett

Confocal microscopy imagingof two cancer cells moving

Thinkstock by Getty Images


treatment by identifying the correct treat-

ment for cancer patients based on tumor

characteristics.”

Tackett’s research has been recognized

with continuous funding by the National

Institutes of Health, where he has served on

more than 35 funding review panels. He has

also published more than 80 peer-reviewed

manuscripts and multiple book chapters and

holds five U.S. patents. and in december

2016, he was awarded one of the highest

honors a faculty member can receive—and a

particularly rare one for a basic scientist like

himself—when he was named the inaugural

recipient of the Scharlau Family Endowed

Chair in Cancer Research for his discovery

of new molecular pathways and biomark-

ers for advancing treatments for metastatic

melanoma.

“They have identified a group of proteins

that identify patients with metastatic mela-

noma who will be likely to respond to cur-

rent immunotherapy regimens—research

that is a cutting-edge example of person-

alized medicine,” says James. “More and

more in the future, cancer will be treated

with similarly patient-tailored approaches,

ensuring that therapies are personalized

both to the patient and to the characteris-

tics of the tumor.”

as personalized medicine matures,

Tackett believes, proteomics will be a key

element.

“With genomics, you can screen people

[for a condition or disease] and say, there’s

a probability you’re going to go this way or

that way.” But, he points out, if someone’s

genetic screens indicate they are likely to go

“the bad way,” the question remains: How do

you treat them?

In order to define how to treat somebody

with personalized medicine, you need to

know both their protein makeup and their

genomic makeup, says Tackett.

“If you can kind of define the blueprint of

what’s going to make the protein with high

throughput genomics, and then what pro-

teins are actually there [with proteomics],

then you can understand how that person

works” and treat them accordingly.

“For example, he [Tackett] and his research group have identified protein biomarkers for numerous types of cancers which in the future may help physicians provide better treatment by identifying the correct treatment for cancer patients based on tumor characteristics.”

—Dr. Laura James

“In order to define how to treat somebody with personalized medicine, you need to know both their protein makeup and their genomic makeup.” —Dr. Tackett

Slides courtesy of Dr. AlanTackett

ReseaRch


the co-director of the UaMS Proteomics

Facility; director of the arkansas Children’s

Research Institute’s developmental Pro-

teomics Laboratory; director of the NIH

Institutional development award (Idea)

National Resource for Proteomics; and

director of the NIH Idea Networks of Bio-

medical Excellence (INBRE) Research Tech-

nology Core.

Each of these laboratories adds to the

network of scientific and clinical collabo-

rators throughout arkansas and the nation

that send their cells to UaMS for proteomics

“So we’ve got to understand the proteins

to understand, for example, how drugs

might work better. If you know the protein

targets, you can better engineer that drug to

work more effectively.”

MaKING CoNNECTIoNS

While it might have taken a college bet to

get Tackett into a science laboratory in the

first place, he now plays a leadership role

in multiple high-tech facilities. In addition

to running his own research group, which

focuses primarily on melanoma, Tackett is

services. In particular, each of the Idea states

(23 states and Puerto Rico that receive sup-

plemental NIH funding through the INBRE

mechanism) have direct access to Tackett

and his team as their proteomics core group.

“our capabilities are as good as anybody

in the country,” says Tackett. “It comes down

to people and instrumentation, and we’ve

been lucky with both.”

He lists a number of faculty, staff, and

graduate students he credits with keeping

the cores running and productive, includ-

ing UaMS Proteomics Core co-director Rick

It’s the ability of these powerful machines to spot the minute differences between cells from two different states—healthy and diseased, pre- and post-treatment—that makes proteomics clinically relevant.

UAMS Proteomics Core Laboratory Co-Director Ricky Edmonson, PhD.


Edmondson, Phd; associate director Sam

Macintosh, Phd; and bioinformaticist and

former post-doc Stephanie Byrum, Phd,

who helps handle the massive amount of

data generated through proteomic analysis.

He is also deeply appreciative of the fund-

ing and infrastructure from sources like the

NIH, UaMS, and aBI that have supported the

development of these teams of people as well

as the mass spectrometers and other costly

pieces of equipment upon which the Cores

depend. (Mass spectrometers, for exam-

ple, run about $1 million each and require a

$40,000/year maintenance contract.) It’s the

ability of these powerful machines to spot

the minute differences between cells from

two different states—healthy and diseased,

pre- and post-treatment—that makes pro-

teomics clinically relevant.

LITTLE dIFFERENCES, BIG RESULTS

Tackett “has the technology and the skills

and the people and the core labs and the

equipment” to spot even the smallest modi-

fications on a large protein, says McGehee,

with an astounding level of accuracy and

speed.

“Let’s say you’re looking at two giant pro-

teins”—one from a disease state and one

from a normal state, for example, or pre-

and post- chemotherapy—“and the only dif-

ference in these two giant proteins is a very

slight modification—perhaps one phosphor-

ylation group. If you look at those with crude

binoculars, you can’t tell any difference.

“Twenty years ago, we would have said

that those two proteins were exactly the

same. Now, we can compare them, and say,

‘Hey, they’re not the same. This one’s got a

single different phosphorylation group.’”

To get a sense of the difficulty level of

this task, McGehee suggests imagining two

giant semi-trucks from the same carrier roll-

ing side-by-side down the interstate at high

speed.

“They’re identical—they both have 18

wheels, they’re both red, everything. But

you know how when you put air in your

tires, there’s that little knob you unscrew?

one of those tires, on one of those trucks

going down the road at 80 miles an hour, is

missing that little knob.

“Now, how are you going tell which truck

is different? It’s not going to be easy. But alan

and his crew can do that. and they can do

it quickly.” n

Oxford, Mississippi native Bradley Shields, an MD/PhD student, is doing his graduate research on melanoma in the Tackett lab.

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By John Mitchell

The Heart ofthe Matter

Technology, medicine, and skill shift cardiac care to the outpatient setting.

cardiac care

Ask the average citizen about healthcare in America

and you’ll probably hear something about medical

insurance. What often gets overlooked in such

discussions is the quiet revolution in how healthcare gets

delivered. As a political battle rages, doctors and other scientists

have been quietly at work reinventing much about how complex

medical care is provided.


“In the world of the cath lab, I think technology is always advancing and becoming less invasive. Our goal is to help the patient recover faster and to get back to life as usual as quickly as possible.”

Nowhere is that more evideNt than

in heart care.

make no mistake, heart disease is still a

big killer. according to the Centers for dis-

ease Control’s National Center for health

statistics report, heart disease was the

leading cause of death in the U.s. in 2015.1

in arkansas and Louisiana, two southern

states covered by UshJ, heart disease death

rates are well above the national average.

arkansas ranks number four and Louisiana

ranks number five in the top five states in the

country for these types of deaths.2

even faced with such prevalent morbidity,

Little rock, New orleans, and Baton rouge

hospitals and their cardiac medical teams

are keeping pace with major changes in

treatment protocols. Nationwide, the shift

of cardiac treatment for serious heart con-

ditions from the inpatient to the outpatient

setting is on the rise. in 2014, for the first

time ever (based on medicare payments to

physicians), more patients received inter-

ventional cardiology treatment in an out-

patient setting than in an inpatient setting.3

“in 2008 we were about 57 percent for

outpatient cardiac treatment,” Keith owen,

vice President for system Cardiology at Bap-

tist health in Little rock told UshJ. “once

we got to 2012 we jumped to 61 percent.

That has gone up to 62 percent and con-

tinues to rise.”

he also said that at Baptist they have

become more proficient at identifying the

least invasive treatment option possible for

every patient. such solutions, more often

than not, are outpatient treatments.

owen and other sources from several

hospitals offered several reasons for this

transformation. these factors include:

improved prevention and drug manage-

ment; advances in medical implant tech-

nology; better surgical techniques; better

medicines; and new payment policies that

reward good outcomes over volume.

Ben schuler, Cath Lab director at Baton

rouge General medical Center, said the

switch to outpatient is driven by the ability

to work on an increasingly miniature scale

within the heart landscape.

“in the world of the cath lab, i think tech-

nology is always advancing and becoming

less invasive. our goal is to help the patient

recover faster, and to get back to life as usual

as quickly as possible,” explained schuler.

“to help with that, we are using smaller

pieces of equipment, and our approaches

have lower risks of major complications

along with shorter recovery times.”

John reilly, md, FaCC, an interventional

cardiologist who practices in the och-

sner health system in New orleans cited

advances in technique. many nonsurgical,

elective cardiac procedures can now be

accomplished by getting to the coronary

arteries though the wrist, which is known as

transradial access. Procedures such as per-

cutaneous coronary intervention, or PCi, for

example, are now more and more performed

through the arm.

“This technique allows for a very smooth

recovery compared to facilities that don’t

have this technology,” dr. reilly told UshJ.

“Patients don’t have the soreness in their

leg. Because we can access through the two

arteries next to the thumb and wrist, and can

Keith Owen

Ben Schuler

“In 2008 we were about 57 percent for outpatient cardiac treatment,” Once we got to 2012 we jumped to 61 percent. That has gone up to 62 percent and continues to rise.”

cardiac care


Dr. John Reilly

apply pressure, the risk of bleeding is less

than half. Bleeding is one of the more com-

mon complications we have when we access

the femoral artery at the top of the groin.”

according to dr. reilly, until recently

the U.s. has lagged behind making this site

switch from the leg to the arm. he said that

according to cardiac registries, five years

ago the radial access PCi procedure was

in the low single digits in the U.s. That has

increased to about 12 to 15 percent nation-

ally, a trend dr. reilly said he is seeing in

his own group’s practice. he said that some

cardiologists have been slow to change their

technique, but the national data being col-

lected makes a strong case for the wide-

spread change in protocol. This, dr. reilly

explained, is a win-win.

he cited the case of a 40-year-old woman

who arrived at the hospital in cardiac dis-

tress. after she was resuscitated, it was

determined she did not have the right anat-

omy for a bypass surgery. her surgeon was

able to perform a PCi with a support device.

The woman was discharged home the fol-

lowing day.

“it’s a good value proposition for the

patient,” he explained. “Because they don’t

stay overnight, they are happier and at lower

risk for a hospital-acquired infection. it also

frees up a bed that we need to keep avail-

able for our sickest patients, so it makes us

more efficient.”

research supports the switch to cardiac

outpatient care. a 2015 study in Cardiac Interventions Today4 on PCi, for example,

found that “advances in clinical sciences

and procedural technology have trans-

formed PCi from a risky procedure to one

with an incredible safety profile.” it cited car-

diac registry data that found that associated

complication and mortality rates after PCi

were relatively miniscule. such complica-

tions ranged from .66 percent for death, 0.2

percent for stroke, and 0.3 for emergency

bypass grafting.

david rutlen, md, director of Cardiovas-

cular medicine at the University of arkansas

for medical sciences (Uams) said they have

seen “a big swing” in the last few years with

about half of heart procedures now done on

a same-day basis.

“we used to routinely admit patients into

the hospital for observation the night before

a cardiac procedure, but we often don’t need

to do that anymore,” he told UshJ. “This

means we can admit the patient in the morn-

ing based on their current medical record

information, and they can go home a few

hours after their catheterization.”

PCi interventions have dropped about 50

percent nationally in the past eight years,

and other coronary surgical interventional

methods have dropped less dramatically—

a good environment for outpatient growth.

This is yet another indication that the med-

ical knowledge, aided by technology and

medication, is becoming more capable at

preventing life threatening heart conditions.

“we’re doing better at controlling blood

pressure, and tobacco use is dropping. i’d

say the main reason that we’re seeing fewer

interventions overall is primary prevention.

The secondary reason is the use of drug-

eluting stents (which emit medicine pre-

venting the blood vessel from narrowing

again).”

Lance Lamotte, md, is an interventional

cardiologist and medical director of Car-

diac rehab at Baton rouge General medical

Center where their outcomes are “tracking

positively” based on National Cardiovascu-

lar data registry data. he said that no single

factor can account for the growing prev-

alence of outpatient cardiac treatments.

But he, too, believes part of the answer

is attributed to more successful primary

prevention.

“i think there are a couple of main rea-

sons (for the shift to outpatient treat-

ments),” said dr. Lamotte. “one is the prog-

ress we’ve made in medical management

and prevention, which has decreased the

level of urgency in cardiac patients. That,

combined with transitioning to less inva-

sive approaches, has made outpatient care

a more feasible option for many patients.”

he added that the shift to outpatient is

also much more cost-effective for patients

and hospitals.

so, with all the good news in primary

heart disease prevention, it begs the ques-

tion: why do Louisiana and arkansas have

some of the highest heart death rates in the

country? all of the sources interviewed put

the blame mostly on lifestyle. high rates of

obesity and smoking were most commonly

mentioned.

Dr. David Rutlan Dr. Lance LaMotte

“Louisiana’s high cardiac morbidity and

mortality stems from a perfect storm of life-

style and genetics. socio-economic issues

further complicate these risks,” said Frank

smart, md, Professor of medicine and Chief,

section of Cardiology at LCmC health’s

University medical Center (UmC) in New

orleans. “residents of our region have a

high incidence of hypertension and type ii

diabetes. we are genetically prone to higher

bad cholesterol levels and low or very low

hdL or good cholesterol levels.”

owen at Baptist health in arkansas said

that it’s no longer a matter of waiting for the

population to get sick. hospitals have a role

in helping people change their lifestyle.

“we spend more time reaching out into

the community to help people take bet-

ter care of themselves,” said owen. “we’ve

got probably 20 wellness centers, as well

as blood pressure check stations in other

places, like churches. we need to play a

role in prevention and wellness at multiple

locations.”

ochsner in Louisiana is reaching deep

into its communities to cut heart disease off

early. samira Brown, md, a pediatrician, said

that childhood obesity is an epidemic in the

state. she is working through a variety of

partnerships to bring fitness programs and

personal counseling to patients. according

to dr. Brown, a child who is obese at age 11

has a 75 percent risk of remaining so for the

rest of their life.

“obesity has such an impact on a child’s

quality of life and their future risk for early

morbidity,” said dr. Brown. “if you don’t

change the family lifestyle, it’s really hard

to change what will happen for the patient.”

to that end, she offers one-on one

Dr. Frank Smart

“Louisiana’s high cardiac morbidity and mortality stems from a perfect storm of lifestyle and genetics. Socio-economic issues further complicate these risks.”

Dr. Samira Brown

“Obesity has such an impact on a child’s quality of life and their future risk for early morbidity. If you don’t change the family lifestyle, it’s really hard to change what will happen for the patient.”

— Dr. Brown

cardiac care

“Inpatient care is expensive and safety net hospitals such as ours are always at maximum occupancy. Shifting appropriate care to the outpatient basis is both cost-effective and better for patients. It opens up beds for use by the more complex care patients.”

— Dr. Smart

in New orleans, all elective cardiology and

about 20 percent of angioplastys and stents

are performed on an outpatient basis.

according to dr. smart, the balance of

patients are treated under observation sta-

tus, for less than 24 hours.

“The use of radial artery access and vas-

cular closure devices has allowed patients

to become mobile within two hours of their

procedure,” dr. smart told UshJ. “Usually

the only patients staying overnight are

those who were emergent because of a heart

attack, or individuals with multiple co-mor-

bid illnesses such as bad diabetes, severe

anemia or severe lung disease.”

he also said they made operational

changes to make it easier for patients to get

outpatient cardiac treatment more quickly.

Now, rather than only accepting patients

through primary care clinics, patients can

also be admitted directly from the emer-

gency room, community clinics, and even

by patient self-referral.

The result of this change is that 85 percent

of cardiac patients are seen within 10 days,

which yielded an increase in clinic volume

of 24 percent from 2015 to 2016.

“we have in the last month also added

a nurse specialist and a nurse navigator to

help get patients who are more acute into

the clinic faster and avoid ed visits,” added

dr. smart.

he also credited the shift to the outpa-

tient setting to better medical knowledge

and technology to achieve lower compli-

cation rates, which he said is a fraction of

what it was even just ten years ago.

“inpatient care is expensive, and safety

net hospitals such as ours are always at

maximum occupancy,” dr. smart said in

explaining the importance of the cardiac

outpatient trend. “shifting appropriate care

to the outpatient basis is both cost-effective

and better for patients. it opens up beds for

use by the more complex care patients.” n

SOURCES1 http://www.icd10monitor.com/enews/item/

1700-icd-10-coding-the-killers2 http://www.healthleadersmedia.com/fact-file

(12/2016)3 http://www.healthleadersmedia.com/fact-

file?page=1%2C04 http://citoday.com/2015/08/ambulatory-outpa-

tient-percutaneous-coronary-intervention/

counseling with children and their parents

that is proving to be very effective at chang-

ing lifestyle when kids are young. she shared

the case of a teenage girl who achieved a

remarkable turnaround in her life. The girl

gained five pounds in one month between

visits. dr. Brown convinced the patient to

made a commitment to follow the guide-

lines that she recommends. in two years the

girl lost 30 pounds. she exercised five days

a week, with her mother working out with

her two days, and her father joining her for

two days.

“i hardly recognized her by the time

she got into high school, she lost so much

weight,” dr. Brown recalls. “she and her fam-

ily changed their entire diet and lifestyle. she

comes home from college now and tells me

that she really did get the message when she

was younger. This is no longer a diet for her,

but a lifestyle.”

however, achieving generational change

takes time. meanwhile, there are still plenty

of patients with heart disease who need care

today.

at UmC, a new state-of-the-art facility

Consumer-Driven HealtHCare Plans

Long ago, there was a time when doctors were paid mainly in cash for their

services. Not anymore—now, medical bills can be staggering, accounting for

more bankruptcies than any other cause. Health insurance is a necessity, and

yet, how much has health insurance itself —particularly the norm of employer-

purchased health insurance—contributed to the very high costs it was meant

to mitigate? After all, car owners protect themselves with comprehensive, full-

coverage insurance plans, but no matter how comprehensive the insurance,

they don’t expect their insurer to pay for oil changes or day-to-day repairs.

Same with homeowners’ insurance—no plan is going to pay to unclog a pipe

or fix a broken heater. So, why do we expect health insurance plans to pay for

similar day-to-day expenses when it comes to our health? And what would

the healthcare scenario look like if we insured ourselves in a similar way to

how we insure our cars and our homes?

By Claudia S. Copeland, PhD

It’s on You!The trend toward

“consumer-driven” healthcare plans



THe HeALTHcAre pAymeNT structure

that has evolved in the United States is

unusual. U.S. residents have traditionally

received health insurance through their

employers, with negotiations about cost

and care taking place between healthcare

facilities, insurance companies, and employ-

ers, but not patients (and often without

input from doctors, nurses, and other direct

healthcare providers, either). Since patients

have been largely shut out from negotiations

about cost, most have grown used to the

idea that insurance pays for all healthcare,

minus a copayment or reasonable deduct-

ible. Before the AcA, those who did not

receive insurance through their employers

often went uninsured, but this population,

while large, was not large enough to drive a

cash-pay medical market.

Now, driven by skyrocketing premiums,

both employers and individual consumers

are increasingly turning to high-deductible

healthcare plans (HDHps) in order to keep

their monthly insurance premiums under

control. With an HDHp, healthcare costs

are paid by the patient, up to the deduct-

ible (often $4,000 or more). In reality, many

HDHp holders consider these plans to be

insurance against “catastrophic” illnesses

that they hope to never contend with, with

day-to-day healthcare needs dealt with on

a cash-pay basis. For this reason, costs are

given more scrutiny by HDHp patients, and

there is some sign that markets are starting

to respond. retail clinics have sprung up,

with services advertised menu-style (with

prices), and less-expensive alternative medi-

cal practices, like herbal medicine, are on the

rise. As more people are driven by high pre-

miums to the high-deductible structure, they

have started asking questions about not only

how much procedures will cost, but also

options for dealing with that high deduct-

ible they are facing. One answer to this sec-

ond question is a cornerstone of the Trump

administration’s healthcare plan: increasing

the number of Health Savings Accounts, or

HSAs.

HSAs, HRAs, and stand-alone HDHPs

HSAs were introduced before the AcA,

but the numbers of people using HSAs for

health coverage increased dramatically dur-

ing the Obama years. In 2015, over 200,000

Louisianans had HSAs. An HSA is a tax-pro-

tected account that can be used for virtu-

ally any type of healthcare spending except

non-prescribed, over-the-counter drugs.

To open an HSA, the patient must have a

high-deductible insurance plan to cover

catastrophic medical expenses, should they

occur. The patient can then set aside money,

tax free, in an account to be used for out-

of-pocket healthcare costs. If the money

is not used that year, it can be rolled over

and added to the next year’s contribution.

It can even be stored in an interest-bear-

ing account.

One of the biggest advantages of an HSA is

freedom: individuals can choose where they

want to go for their healthcare, and what

kind of healthcare they want to receive—they

do not need to sort out a complicated web of

providers. (While HDHps specify a network

of providers to satisfy the deductible, many

people insured by these plans consider their

day-to-day healthcare as simply cash-pay.

The high deductible is considered their share

of what they would have to pay in the case

of a catastrophic illness.) They also are not

restricted to the standard medical prac-

tice covered in most traditional healthcare

plans. HSAs can be used for a broad range

of health-related procedures, from ortho-

dontics and acupuncture to lead-based paint

removal. (A partial list of covered benefits

“To open an HSA, the patient must have a high-deductible insurance plan to cover catastrophic medical expenses, should they occur. The patient can then set aside money, tax free, in an account to be used for out-of-pocket healthcare costs.”


is shown above. A full list can be found at:

http://www.hsacenter.com/what-is-an-hsa/

qualified-medical-expenses/) Because any

unused portion of an HSA rolls over into

the next year, individuals can choose to

save money over the years, putting them in

a better position to afford more costly pro-

cedures as they grow older.

Are HSAs a solution for everyone? No. The

common-sense view that low-income indi-

viduals don’t make enough money to ben-

efit much from a tax credit is backed up by

Government Accountability Office (GAO)

data on HSA usage. Over half of HSA par-

ticipants have incomes in the top 18% for the

population, according to the GAO, and the

average adjusted gross income of tax filers

reporting HSA contributions was over twice

as high as those for all tax filers under age 65.

meanwhile, the Urban Institute reports that

roughly half of those with HSA-compatible

policies do not open HSAs.

An alternative option that may be more

helpful to lower income employees is a

health reimbursement arrangement, or

HrA. The employer counterpart to an HSA,

the HrA is a tax-advantaged plan in which

employers complement HDHps by paying

for their employees’ pre-deductible out-of-

pocket health expenses. The HrA option can

be cheaper for employers than traditional

health insurance, while mitigating out-of-

pocket expenses for employees.

Finally, stand-alone HDHps may still be a

favorable option for healthy, low-to-middle

income individuals if one important crite-

rion is met: the premiums must be very low.

currently, this is not the case. premiums are

lower for HDHps than for traditional health-

care plans, but they are not low, and in some

states they can be extremely high. In Loui-

siana, the cost of an HDHp is about $200-

$300 per month for a young person, and

rises to over $1,000/month for a 60-year-

old, according to a December, 2016 call to

the AcA support phone line. In Arizona,

the monthly premium for the lowest-price

HDHp for a 60-year-old is over $2,300. One

New Orleans single mother and general

manager of a mid-size business decided to

simply not enroll in the company’s insurance

AcupunctureAlcoholismAmbulanceAnnual Physical ExaminationArtificial LimbArtificial TeethAutoetteBandagesBirth Control PillsBody ScanBraille Books and MagazinesBreast Pumps and SuppliesBreast Reconstruction SurgeryCapital ExpensesCarChiropractorChristian Science PractitionerContact LensesCrutchesDental TreatmentDiagnostic DevicesDisabled Dependent Care ExpensesDrug AddictionDrugsEye ExamEyeglassesEye Surgery

Fertility EnhancementFounder’s FeeGuide Dog or Other Service AnimalHealth InstituteHealth Maintenance OrganizationHearing AidsHome CareHome ImprovementsHospital ServicesInsurance PremiumsIntellectually and Developmentally Disabled, (Special Home for)Laboratory FeesLactation ExpensesLead-Based Paint RemovalLearning DisabilityLegal FeesLifetime Care—Advance PaymentsLodgingLong-Term CareMealsMedical ConferencesMedical Information PlanMedicinesNursing HomeNursing ServicesOperations

OptometristOrgan DonorsOsteopathOxygenPhysical ExaminationPregnancy Test KitProsthesisPsychiatric CarePsychoanalysisPsychologistSpecial EducationSterilizationStop-Smoking ProgramsSurgeryTelephoneTelevisionTherapyTransplantsTransportationTripsTuitionVasectomyVision Correction SurgeryWeight-Loss ProgramWheelchairWigX-ray

Funds you withdraw from your HSA are tax-free when used to pay for qualified medical expenses as described in Sec-tion 213(d) of the Internal Revenue Service Tax Code. The expenses must be primarily to alleviate or prevent a physical or mental defect or illness, including dental and vision. The following list provides examples of eligible and ineligible medical expenses. This list is not all-inclusive. Remember, the IRS may modify its list of eligible expenses from time to time. As always, consult your tax advisor should you require specific tax advice.

HSA EligiblE ExpEnSES

plan, an HDHp with a premium for women

of childbearing age of $400. (The premium

for men was less than $100.) “I just can’t

afford it,” she explained. “If I were to pay it,

I would have to take away my kids’ educa-

tion, or healthy food, or our house in a safe

neighborhood. I’m not going to pay $400

per month for a plan that doesn’t even pay

for any of the healthcare I need, when I’m

not planning on having any more children.

If I get really sick, I’ll go to mexico.”

For low-income workers, the AcA has

stepped in with subsidies that pay part or

all of the premium. If the AcA is repealed,

however, low-income enrollees would face

premiums amounting to a truly unafford-

able portion of their income. The 16 mil-

lion people who gained insurance through

the AcA would most likely go back to being

uninsured, since the premium cost of high-

deductible plans, while lower than that of

traditional plans, is still prohibitively high.

Key to the use of HDHps by lower-income

people are premiums low enough to allow

them to save money each month (either tax-

protected or not) towards out-of-pocket

healthcare costs; if the premium takes up

every last penny, there will be nothing left to

pay the deductible. If the AcA is dismantled,

ending income-based subsidies to help pay

for premiums, many low-to-middle income

healthy individuals will most probably

revert to being uninsured.



The elephant in the room: high

healthcare costs

One prerequisite for lowering premiums

(for traditional plans as well as HDHps)

is lowering healthcare costs in general.

Whether HSA-based, HrA-based, or simply

a stand-alone HDHp, this is one purported

advantage of high-deductible plans. Health-

care costs have skyrocketed, often for rea-

sons completely unrelated to the care itself.

One well-known example is the epipen, an

epinephrine injector carried as a standard

piece of safety equipment by those with

severe allergies. Back in 2009, a two-pack

of epipens cost about $100. Today, the

epipen’s current manufacturer, mylan, sells

the same two-pack for over $600. meben-

dazole, a medication used to treat pinworm

infections that has been used for decades,

costs less than $5 in europe, about the same

as it cost in the U.S. in 2010. The current

manufacturer, Impax, however, rebranded

the drug and raised its price. Now, the cost

in the U.S. for enough mebendazole to treat

a pinworm infection (2 pills) is over $800.

Unreasonable pricing is not confined to

drugs, either. One New Orleans musician

was profoundly relieved to be covered by

her new AcA plan when she saw the bill for

a 15-minute consultation with a nurse prac-

titioner and a prescription for antibiotics:

$350. The same visit at the cVS minute clinic

would have been only $120, according to a

quick phone call she made out of curios-

ity. With traditional healthcare plans, such

bills have simply been paid by the insurance

company, and the higher costs are passed on

to consumers in the form of higher premi-

ums. When patients have a high-deduct-

ible plan, though, the costs are transparent.

many policymakers believe that patients will

be motivated to shop around, and, over time,

prices will decrease accordingly.

This may or may not be true in the long

term. presently, however, it is quite diffi-

cult to “shop around” for any care outside

the very basic primary care offered at urgent

care clinics or retail clinics. For most care, it

is very difficult to find out what the cost of a

test or procedure will be up-front. most doc-

tors do not know, and their medical office

staff do not know. A true, single price for a

given procedure may not even exist—hospi-

tals often have a complicated, individually

negotiated set of different prices for differ-

ent insurers. Further, in opposition to the

idea that HSA holders will help bring down

costs through direct consumer choice, a

2010 GAO study found that HSA holders did

not tend to research costs before receiving

care. This may be related to the more afflu-

ent economic position of HSA holders and

may not hold true for other HDHp enrollees,

however. Overall, a report by the National

Bureau of economic research (Haviland

et al., 2015) found that healthcare costs—

defined as spending by patients, employers,

and insurers—flattened with high-deduct-

ible plans (also known as consumer-driven

healthcare plans), compared with steadily

rising costs in traditional plans .

The GAO also contends that HSAs could

exacerbate the problem of inequality in

healthcare coverage by removing full-cov-

erage dollars contributed by healthy, higher-

income people. HDHps are economically

favorable for healthy people but econom-

ically unfavorable for less healthy people,

and this could lead to a divide in care pro-

vision, disrupting the insurance model,

which requires input from healthy people

“Healthcare costs have

skyrocketed, often for reasons

completely unrelated to

the care itself.”


in order to cover the costs of less-healthy

people. On the other hand, it is conceivable

that responsibility for day-to-day healthcare

costs might motivate people to make life-

style choices favoring better health.

Finally, a major concern with the pay-as-

you-go system is that patients will forego

the care they need early in a medical con-

dition, resulting in much more severe dis-

ease by the time they finally do see a doc-

tor. Starting treatment for a major medical

condition later means both higher costs and

poorer outcomes, and the difference can be

extreme. This is the most important differ-

ence between health insurance and auto or

home insurance: whereas neglecting house

or car maintenance is a poor choice finan-

cially, neglecting preventive healthcare can

be deadly. For example, the 5-year survival

rate for colon cancer treated in the early

stages is about 90%; by late stage three, the

survival rate drops to 53%, and by stage four,

it drops to just 11%. clearly, colon cancer

screening can save lives. However, many

people may choose to forego screening

if they have to pay for it out of pocket. If

the AcA requirement for all plans to pro-

vide preventive care like cancer screening

is repealed, HDHp enrollees may very well

end up beginning treatment for conditions

like cancer at later stages, with poorer sur-

vival rates and other health outcomes. The

possibility of price acting as a deterrent

for preventative care is a very serious, and

potentially dangerous, side-effect of HDHps.

What about the poor? Hybrid pub-

lic options.

Louisiana ranks 7th for the lowest median

household income among the 50 states,

according to the Kaiser Family Foundation.

This means that any thought about health-

care plans for Louisianans must include pro-

visions for low-income residents. A num-

ber of analyses have shown that medicaid

for people at 138% FpL or less is the only

viable way to avoid hospital emergency

departments bearing the cost of healthcare

for this group. However, for people who are

somewhat higher in income but still not able

to afford premiums for traditional insur-

ance (for example, people between 138%

and 200% FpL), perhaps a public-private

option might be a viable solution. One such

option could be a high-deductible medic-

aid-based plan for low-to-middle-income

people, with low-cost premiums combined

with medicaid coverage after a high deduct-

ible has been met. Another may be a pub-

lic-private option analogous in structure

to an HrA. regardless of structure, funda-

mentally, it is critical to remember that any

type of high-deductible plan can only work

if premiums are low enough to allow enroll-

ees to save enough money towards out-of-

pocket costs.

Like it or not, high deductible plans are

rapidly becoming the norm: the rise in pre-

mium costs over the past couple of years

has been minimal, but the rise in deductibles

has been extreme, according to the Kaiser

Family Foundation. With the cost of pre-

miums for traditional health plans steadily

increasing, it is desperation, not choice, that

has driven most employers and individu-

als to the high-deductible option, and this

trend shows no sign of reversing. How-

ever, perhaps there might just be a silver

lining: if premiums can be lowered to truly

affordable levels, the increased freedom

and price transparency of HDHps might

just lead enrollees to become the vanguard

in diversifying healthcare options and low-

ering costs. And that could be a good thing

for everyone. n

National Bureau of Economic Research, summary of Haviland et al. by Linda Gorman.

“With the cost of premiums for traditional health plans steadily increasing, it is desperation, not choice, that has driven most employers and individuals to the high-deductible option, and this trend shows no sign of reversing.”

dialogue

President, ArkAnsAs PUblic HeAltH AssociAtion

one on one with

Susan Starks is the 67th President to lead the Arkansas Public Health Association, a pri-

vate, non-profit organization of health professionals and others, founded in 1947 to promote

and protect the public’s health. APHA is an affiliate of The American Public Health Associa-

tion. (www.apha.org/)

In addition to offering scholarships to students in health fields, APHA provides Distin-

guished Service Awards to public health workers.

The APHA annual conference will be at the Crowne Plaza Hotel in Little Rock on May 10-12,

2017. The program chair is Quinyatta Mumford ([email protected]). Last

year APHA also partnered with Southern Health Association, which includes seven states.

(www.southernhealth.net)

Susan Starks has worked at the Arkansas Department of Health for 17 years and currently

serves as ITS Manager. She is a graduate of the Arkansas Public Health Leadership Academy,

is A+ certified, and holds numerous ITS certifications. She is active in community events as

well as with FEMA and bioterrorism training.

Susan Starks

http://www.apha.org/

mailto:[email protected]

http://www.southernhealth.net

dialogue


Chief Editor Smith W. Hartley: What are

some of the public health concerns for

the citizens of Arkansas?

Susan Starks: Of course they are vast and

several, but I can center around some of

the bigger ones such as chronic disease,

cancer, unintentional injuries and death

from ATVs and wrecks, COPD with

tobacco use, Alzheimer’s Disease, lack of

transportation for the elderly, obesity, and

improvement of health literacy.

Editor: And these are all concerns that

the Arkansas Public Health Association

would address?

Starks: Of course we are part of the

American Public Health Association,

which serves a greater whole, because

with healthcare and public health there

are no borders. So, we do follow their

concerns as well, but these are some that

are affecting Arkansas directly.

Editor: You just listed a number of

things. Can you talk about a few of

them in more detail and how APHA

specifically addresses them?

Starks: We are a nonprofit association, so

we are kind of limited on how we get the

word out. We have a Facebook profile. We

also have our own webpage that we use to

blast out different concerns in different

areas. We also try to sign on to letters to

Congress. A lot of those that are sent by

the American Public Health Association,

we attach our name to. We also attend

community events and different events

that our membership is involved in,

and has asked us to get involved in. For

example, yesterday we had the Special

Olympics here at our board meeting, and

we just partnered with Health Literacy to

try to push for involvement in that area,

too.

Editor: What are some of the things you

can do in terms of health literacy?

Starks: We sponsor it at our conference.

Health Literacy will come in and set up,

and people come in and donate books;

they receive handouts and flyers. There

are different committees within every

agency, all of them trying to look at public

health, so we will carry handouts, flyers,

even books to some places, in an attempt

to help people understand that they can

actually take charge of their health. It’s

not that we don’t want to have doctors,

but prevention could take over medicine

if people just knew how.

Editor: So is the focus more on educating

citizens or trying to change the system?

Starks: Of course we would like to try

to change the system, and we do lend

our voice to that, but primarily we try to

educate the citizens as well.

Editor: What are some of the ways you

can raise awareness of public health

issues and get the public involved?

Starks: Having public health events like

healthy heart walks, billboards, getting

legislators to better understand what

public health is, health fairs. Usually,

whenever there is a carnival, there will be a

health fair going on through that. Going to

places where people are educating them,

including online and social media. We

try to steadily push out the most current

issues on our website and Facebook page.

Editor: How is the association sup-

ported?

Starks: We are fully supported by mem-

bership dues.

Editor: And how many members do you

have?

Starks: At this time we have around 600-

620, but we are really pushing for that

to increase with the move to Little Rock.

There was a time when we had more

than 3000, but with people’s jobs and

businesses, they have no time to dedicate

to associations. I think it has taken a toll

on just about every association there is.

Editor: Can you tell me a little bit about

the conference? What are some of your

goals?

Starks: This year we have completely

revamped the conference. For the last 20

years we have held the conference in Hot

Springs. Last year our keynote speaker

was Dr. Jones from the American Public

Health Association, and Dr. Waddell from

ASPHO, and as we have these conferences

we invite healthcare professionals;

anyone that has an interest in public

health is invited to our conference. They

will need to pay either a membership

or a conference fee. And we present

breakout session after breakout session

of speakers. They may be speaking on

Zika, on tobacco, we may have people

there on bioterrorism. We try to cover as

many areas as we can, and offer as many

trainings and CMEs as we can for the

people attending.

Now that we are moving to Little

Rock, we are revamping the conference

completely. Whereas before we had six

or seven breakout sessions, we found that

everyone was struggling to make it to all

of the sessions, and they missed some

they wanted to hear. Now we are going

to try to have, straight across the board,

the same three speakers per hour. Also,

the different sections will be able to have

business meetings and things like that.

Editor: What are some of the big public

health changes that you would like to

see?

Starks: Number one there needs to be

availability for all people to be able to

afford their medicine, and they need to

have accessible healthcare. You wouldn’t

believe the number of Arkansas citizens

that deal without their medications


because they can’t afford it. More

affordable and accessible healthcare

including prescription coverage, reducing

the impact of chronic diseases, and

increasing the number of Arkansans who

take part in physical activity, quitting

smoking, and making sure they have

healthy, affordable food. Those are some

of the things the Health Department is

working on now.

Editor: Does the APHA work with the

Health Department in any capacity?

Starks: A lot of our membership and

some of our Board members, like myself,

are from the Health Department so we

have a strong background in public health

to begin with. You kind of have to have

that calling.

Editor: Do you think more people

should be thinking of being signed up

for a Medicaid program?

Starks: Well, not everyone needs the

Medicaid program. Some of our elderly,

absolutely. Veterans, absolutely. But they

need a better understanding of what their

options are, and a lot of citizens right now

are a little bit concerned with what their

options might be in the future.

Editor: Is there anything that your

association is doing where you feel any

opposition?

Starks: No. Usually when we have a

proposal we do not meet opposition with

that proposal, because it’s for the citizens

of Arkansas.

Editor: And I guess you don’t overstep

on the feet of business and industry?

Starks: Not our association. Of course

the different doctors’ offices and health

departments are constantly crossing

over, especially all of these new clinics

that have opened up, probably in just

the last three years. There are walk-in

clinics everywhere. And I think places

like Walmart and Walgreens are kind of

feeling that, like with the flu shots, they

get steered in different directions. But our

association does not feel anything from

that.

Editor: We have elected a new president.

Are there any concerns about the Trump

administration?

Starks: We work with local, state, and

national leaders regardless of their

affiliation. So there may be concerns from

the American Public Health Association

as far as the repeal of Obamacare, but as

far as our association, we try to work with

whatever is in place.

Editor: From the work that the Arkansas

Public Health Association does, what

would you say are some of your most

effective programs?

Starks: Our most effective is our

conference. That’s when we have doctors,

CHWs, we have nurses, we have nurse’s

aides, we have office professionals, that

all come together, they interact with one

another, and get ideas from one another,

and they build. To me that is a very good

foundation. Also, we partnered with the

Southern Health Association last year

which includes about seven other states,

and they came to the conference, and that

was very interesting, being able to talk

about some of the things that they have

done and seen, and compare to some of

the things, like our mumps outbreak, that

we have seen.

Editor: When you say they build what do

you mean by that?

Starks: They build partnerships,

relationships, and knowledge that they

can carry back to whatever profession

they are in and share that with their

boards and their committees.

Editor: So it’s just about exchanging

knowledge and ideas?

Starks: Yes, and interacting with one

another. The best thing ever is getting

them all in a big room and having them

listen to the same speaker, then hearing

all of the different experiences. That’s a

growing environment.

Editor: What long-range goals for public

health would you like to see in the state

of Arkansas?

Starks: I would love to see the

improvement of health and well-being of

all Arkansans. I think that would be the

goal of anybody in our association, and

to have the maximum number of people

reached both economically and socially,

with healthcare and again, affordable

medication. n

“I would love to see the

improvement of health and

well-being of all Arkansans.”

Medicare Part d Fix

Not So Simple

How a Simple Fix to ReduceAberrant Prescribing Became

In 2014, the government said health providers would have to enroll in Medicare in order to prescribe drugs to seniors and disabled beneficiaries. Delay after delay has pushed back the the requirement until 2019. It’s been “much more chal-lenging” than anticipated, an official concedes.

By Charles OrnsteinProPublica, Feb. 10, 2017(This story was co-published with NPR’s Shots blog.)


Back in 2014, federal officials settled on

what they thought would be a straight-

forward fix to curb abusive pill pushing:

Require doctors and other health pro-

viders to register with the Medicare pro-

gram in order to prescribe medications for

beneficiaries.

That way, the government could screen

them and take action if their prescribing

habits were deemed improper. Officials fig-

ured the modest change would barely ruf-

fle the medical community: Doctors already

had to fill out an application, have their cre-

dentials verified and enroll to get paid by

Medicare for seeing patients, after all. But

this fix, which followed a 2013 ProPublica

investigation into questionable prescribing

in Medicare, has yet to be implemented. The

government now says it needs until 2019 to

put it in place — 3 1/2 years longer than ini-

tially expected.

“it has definitely been much more chal-

lenging” than anticipated, said Jonathan

Morse, acting director of the center for

Program integrity within the centers for

Medicare and Medicaid Services, the fed-

eral agency that runs Medicare.

as a result, the government is still cov-

ering prescriptions written by doctors who

have been kicked out of Medicare and even

some who have pleaded guilty to crimes.

Three new Jersey doctors who pleaded

guilty in July 2013 to charges related to a

bribery scheme continued prescribing drugs

to Medicare patients the following year, a

ProPublica review found.

One of those doctors, Franklin Dana For-

tunato, told ProPublica that he was advised

that he could continue treating patients

between his guilty plea and his sentencing

in May 2015.

in addition, at least 40 doctors kicked

out of Medicare before 2014 had their pre-

scriptions covered by Medicare’s prescrip-

tion drug program, known as Part D, that

year, a ProPublica analysis shows.

Much of the reason for the delay rests

with dentists. Medicare, which provides

health care to seniors and the disabled,

doesn’t typically cover dental services, but

the Part D program pays for drugs, such as

antibiotics or painkillers, that dentists order

for beneficiaries.

“Since Medicare covers very few dental

items and services, many (perhaps most)

dentists have little incentive to enroll in

Medicare” outside of this requirement, the

american Dental association wrote to cMS

in September 2016. The dental group also

said the enrollment process is too complex

and that cMS already has the information it

needs to address fraud and abuse concerns.

ProPublica analyzed all providers who

wrote at least 50 prescriptions for at least

one drug in Part D in 2014. all told, more

than 92 percent of the 428,000 provid-

ers were enrolled in Medicare. But among

18,500 dentists, almost the exact opposite

was true: More than 82 percent weren’t

enrolled.

In 2013, ProPublica documented how Medicare’s failure to oversee Part D effectively had enabled doctors to prescribe inappropriate or risky medications, had led to the waste of billions of dollars on needlessly expensive drugs, and had exposed the program to rampant fraud.

All told, more than 92 percent of the 428,000 providers were enrolled in Medicare. But among

18,500 dentists, almost the exact opposite was true: More than 82 percent weren’t enrolled.

Medicare Part d Fix


To date, officials said, Medicare has only

done so once.

But the plan to require that providers

enroll in Medicare has been met by delay

after delay after delay.

at first, cMS gave providers until June

1, 2015, to either enroll in Medicare or for-

mally opt out. Either way, the government

would have additional information about

them. if they neither enrolled nor formally

opted out, Medicare said it would no longer

cover drugs they ordered for beneficiaries.

That was delayed by a few months and

then by a year. in March 2016, the agency

delayed the dropdead date yet again—until

February 2017.

Finally, in October 2016, cMS pushed it

off until January 2019. Beginning this spring,

it said it will block prescriptions from doc-

tors who have been barred from participat-

ing in federal health programs, those ousted

from the Medicare program for other rea-

sons, and those convicted of a felony in the

past 10 years.

The delays have enabled troubled doc-

tors to continue prescribing—while still hav-

ing their prescriptions paid for by Medicare.

a family practice doctor in Michigan, for

example, was charged in December 2012

with conspiracy to commit fraud and ille-

gally distributing a controlled substance.

But he wrote 7,864 prescriptions in Part

“From their perspective, they’re basically

saying to us, what incentive do they have

to enroll,” said Morse, the head of program

integrity for cMS.

Part D, which began in 2006, has received

high marks from patients. it now covers

more than 42 million people. But experts

have long complained that the program

places a higher priority on getting pre-

scriptions into patients’ hands than on tar-

geting problem prescribers. The Department

of Health and Human Services’ inspector

general has repeatedly called for tighter

controls.

in 2013, ProPublica documented how

Medicare’s failure to oversee Part D effec-

tively had enabled doctors to prescribe inap-

propriate or risky medications, had led to

the waste of billions of dollars on needlessly

expensive drugs, and had exposed the pro-

gram to rampant fraud. at the time, Medi-

care said it had no authority to take action

against doctors or other providers even if it

found their prescribing practices troubling.

Medicare’s response, finalized in May

2014, gave officials the power to kick health

providers out of the program if their pre-

scribing is abusive, a threat to public safety

or in violation of Medicare rules. cMS said

it would use prescribing data, disciplinary

actions, malpractice lawsuits, and more to

identify problem providers.

D in 2014. in fact, 41 percent of his Part D

patients received at least one prescription

for a narcotic painkiller that year. He pleaded

guilty in 2015 and was sentenced to seven

years in prison.

and in Georgia, a nursing home doctor

kicked out of Medicare in February 2014

for “abuse of billing privileges” nonetheless

wrote nearly 45,000 prescriptions covered

by the program that year.

While cMS has delayed its enrollment

requirement, it has begun to review the

reams of data it collects to identify doctors

with aberrant prescribing patters. it sent a

round of letters to doctors, alerting them to

how they compared to peers, but a study

in the journal Health Affairs last year found

that the letters were ineffective at chang-

ing behaviors.

a second round of letters, which con-

tained stronger warnings, has led to a small

change in prescribing practices, Morse said.

“Rather than saying, ‘Hey we’ve noticed

that you have this odd or higher than aver-

age prescribing behavior,’ now it’s much

more ‘We plan to take action if your behav-

ior does not fall into line with that of your

peers,’” he said. “it has become more effec-

tive because the letter is more strongly

worded.” n

…Medicare’s failure to oversee Part D effectively

had enabled doctors to prescribe inappropriate or

risky medications, had led to the waste of billions of

dollars on needlessly expensive drugs, and had

exposed the program to rampant fraud.

HealthcareBriefs


News / people / iNformatioN

Findings May Change How Doctors Treat Underactive Thyroid in Pregnant WomenSee story next page


Healthcare Briefs

Findings May Change How Doctors Treat Underactive Thyroid in Pregnant Women

In the first national study on the topic, a Uni-

versity of Arkansas for Medical Sciences (UAMS)

researcher found evidence to suggest that

fewer pregnant women with a mildly underac-

tive thyroid should be treated than previously

recommended.

UAMS’ Spyridoula Maraka, MD, published the

findings recently in The BMJ. She is an assistant

professor in the Division of Endocrinology and

Metabolism in the UAMS College of Medicine’s

Department of Internal Medicine as well as a

staff physician at the Central Arkansas Veterans

Healthcare System and research collaborator at

the Mayo Clinic.

A mildly underactive thyroid is called subclin-

ical hypothyroidism. Symptoms are subtle and

can include fatigue, cold intolerance, weight gain,

depression, and memory problems. Despite the

mild symptoms, subclinical hypothyroidism has

been associated with pregnancy loss or impaired

fetal development.

Physicians use bloodwork to look for elevated

thyroid-stimulating-hormone (TSH) levels as an

indication of subclinical hypothyroidism. It is com-

monly treated with the thyroid-hormone therapy

levothyroxine.

When Maraka began her study, the Endocrine

Society recommended that pregnant women with

TSH levels from 2.5 mlU/L and higher be treated.

Maraka estimated that if this guideline was con-

sistently followed, it would have a wide impact,

applying to 15 percent of pregnant women in the

United States, or about 600,000 a year. In fact,

Maraka and her team found that only 16 percent

of patients diagnosed with subclinical hypothy-

roidism received treatment – an indication that

the guidelines are not being followed widely,

either because there is not widespread aware-

ness or because physicians were reluctant to fol-

low the guidelines.

The study used information from a national

insurance database that included patients with

private insurance and Medicare Advantage enroll-

ees , Maraka said, noting that researchers think

the database provides a diverse sample popula-

tion suitable for studies of this kind. Maraka and

her team found 5,405 pregnant women in the

database with subclinical hypothyroidism, 843 of

whom received treatment.

Maraka and her co-authors conducted the

research in two main stages. In the first stage,

they simply compared pregnant women with

subclinical hypothyroidism who received treat-

ment to those who did not. They found that the

women who received treatment saw a 38 percent

decrease in their risk for pregnancy loss. How-

ever, they also found that the pregnant women

who received treatment were at an increased risk

for gestational diabetes, preeclampsia, and pre-

term deliveries.

In the second stage, the researchers divided

the treated women into two groups depending

on the severity of their subclinical hypothyroid-

ism and compared each group to the women

with subclinical hypothyroidism who were not

treated. The women with TSH levels of 2.5-4

mlU/L were the “mild” group, while the women

with TSH levels of 4.1 mlU/L or higher were the

“severe” group. The researchers found that the

severe group saw the biggest drop in pregnancy

loss compared to untreated women, without the

increase in complications.

“When we looked deeper into the data and

divided the patients based on the degree of thy-

roid dysfunction, the patients who really benefit-

ted where the ones with the higher TSH – and

without having the adverse effects,” Maraka said.

“Our conclusion is that women with the TSH level

of above 4 should be started with the levothyrox-

ine treatment because we see that they experi-

ence so much less pregnancy loss, but we should

still do other studies to make sure we are doing

the best thing for patient safety. The fact that

some patients are still experiencing these com-

plications indicates that there still may be issues

at play that warrant further study.”

Surgeon General Bledsoe to Lead Next Phase of PCMH Design

Arkansas Surgeon General Greg Bledsoe will

take on a new advisory role as the state seeks to

grow and enhance the Patient Centered Medi-

cal Home (PCMH) program, officials with Arkan-

sas Medicaid announced.

Medical homes are a team-based model of care

led by a patient’s primary care physician, who

serves as a coordinator among a patient’s other

providers, including specialists, pharmacists, ther-

apists, and nurse practitioners. Pioneered in the

state, the PCMH model has a continued goal of

personalizing patient care, more intensive prac-

tice transformation coaching for newly-enrolled

healthcare providers and using technology to

improve access for patients. The voluntary pro-

gram, established in 2014, has enrolled more than

900 providers and serves roughly 360,000 Arkan-

sans of all ages and levels of health.

In working with Medicaid PCMH, Bledsoe will

establish a physician-led panel with Brad Bibb,

MD, who will serve as vice chairman. Their insight

will provide knowledge and practical experi-

ence to improve metrics and design reporting

protocols, and help providers better navigate

the Medicare Access and Reauthorization Act

(MACRA) of 2015, which created new reporting

programs and payment models through the U.S.

Department of Health and Human Services (HHS).

This comprehensive model of care has a focus

on preventative services rather than acute ill-

ness, and empowers patients to actively partici-

pate in their healthcare choices. Medicaid-funded

transformation coaches are available for up to 24

months and assist with care plan development,

updating workflows and processes, interpreting

data and reports, and provide additional educa-

tional resources. Arkansas BlueCross BlueShield,

QualChoice, and Centene have partnered with

Medicaid in this program.

For more information, visit https://innovation.

cms.gov/initiatives/comprehensive-primary-care-

plus or http://www.paymentinitiative.org/medic-

alHomes/Pages/default.aspx.

Alicia Baird Named Chair of Ophthalmic Technologies

Alicia Baird has been named chair of the

Greg Bledsoe

http://www.bmj.com/content/356/bmj.i6865

http://www.bmj.com/content/356/bmj.i6865

https://t.e2ma.net/click/zg254/js4aqg/nfhfxw



https://t.e2ma.net/click/zg254/js4aqg/37hfxw

https://t.e2ma.net/click/zg254/js4aqg/37hfxw


For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com

Department of Ophthalmic Technologies in

the University of Arkansas for Medical Sciences

(UAMS) College of Health Professions. She will

also serve as director of the Bachelor of Sci-

ence in Ophthalmic Medical Technology degree

program.

She comes to UAMS from the University Hos-

pitals and Rainbow Babies Children’s Hospital in

Cleveland where she spent five years as a certi-

fied orthoptist and certified ophthalmic medical

technologist.

Baird maintains certifications by the American

Orthoptic Council as a certified orthoptist and by

the Joint Commission of Allied Health Personnel

as a certified ophthalmic medical technologist.

She is a member of the Association of Technical

Personnel in Ophthalmology, the American Asso-

ciation of Certified Orthoptists, the International

Orthoptic Association, and the American Associa-

tion of Pediatric Ophthalmology and Strabismus.

The baccalaureate program in ophthalmic med-

ical technology at UAMS is a collaboration of the

College of Health Professions and the Harvey &

Bernice Jones Eye Institute. It is one of only four

accredited programs in the country offering the

highest level of ophthalmic medical technician

training — the ophthalmic medical technologist

level. Upon completion of the two-year program,

students are eligible to take the national certifi-

cation exam.

Most graduates work alongside ophthalmolo-

gists in private practice or academic group set-

tings as ophthalmic medical technologists. Oth-

ers have continued their education and become

optometrists, orthoptists, or physician assistants.

Some graduates have gone on to work in cor-

porate ophthalmology as clinical application

specialists, clinic managers, administrators, tech-

nical directors, and program directors.

Rutledge Announces Conviction for Medicaid Fraud

Arkansas Attorney General Leslie Rutledge

recently announced the conviction of a Phillips

County woman for Medicaid fraud. Jacqueline

Young pleaded guilty in Pulaski County Circuit

Court and was sentenced to three years proba-

tion and to pay nearly $1,400 in restitution to

the Arkansas Medicaid Program and more than

$4,000 in fines and court costs.

Young, 38, of Helena-West Helena pleaded

guilty to Medicaid fraud, a Class C felony, for

billing the Arkansas Medicaid Program for ser-

vices not rendered from July to October of 2015.

The case was initiated by a referral from the

Office of the Medicaid Inspector General and was

prosecuted in coordination with the 6th Judicial

District Prosecuting Attorney Larry Jegley.

UAMS Scientists Create Mouse Model for Reaching Cure for ALS

Researchers at the University of Arkansas for

Medical Sciences (UAMS) have found a new way

to replicate Lou Gehrig’s disease in mice, in what

they hope will bring scientists one big step closer

to a cure.

Mahmoud Kiaei, PhD, an assistant professor in

the department of Pharmacology and Toxicology

in the UAMS College of Medicine, published the

project recently in Human Molecular Genetics, a

peer-reviewed journal published by The Oxford

University Press on all topics related to human

molecular genetics. https://www.ncbi.nlm.nih.

gov/pubmed/28040732

Lou Gehrig’s disease, also called amyotrophic

lateral sclerosis (ALS), attacks the nerve cells that

control muscles, called motor neurons. Patients

become progressively weaker, eventually los-

ing the ability to speak, eat, move, and breathe.

There is no cure and the disease is 100 per-

cent fatal. Death sometimes occurs as fast as six

months to a year after diagnosis.

About 10 percent of ALS cases in the United

States are inherited. In the mid-‘90s, after the

identification of one gene associated with ALS,

scientists first replicated human ALS in mice, cre-

ating a so-called “mouse model.” For many years,

it remained the only mouse model available for

ALS testing, but it failed to yield a drug treatment

that was replicable in human clinical trials.

In 2012 another gene mutation – Profilin 1 – was

shown to cause ALS. With the publication of that

discovery, researchers across the world worked

to create a mouse model with the mutation. A lit-

tle over a year later, researchers at UAMS and a

lab at the University of Massachusetts were both

successful, and Kiaei said the fact that two labs

reached similar results gives him even more con-

fidence that this will be a powerful model for use

in ALS research.

Because the model closely replicates ALS symp-

toms, researchers are able to get a better look at

what is going on at the molecular level at each

stage of the disease.

Kiaei and his team were able to create the

mouse model by injecting the human faulty

genetic material into fertilized mouse eggs. Suc-

cessive generations of the mice passed the gene

on to half of their offspring, as expected.

Kiaei’s next steps will be to study the mice

“inch-by-inch” to fully document the disease’s

progression at a molecular level. He hopes to

show how exactly the genetic mutation causes

ALS symptoms. And he expects that UAMS will

be able to do its own drug testing on the mouse

model.

UAMS Ranks Seventh for Grads Choosing Family Medicine

For the fifth time in nine years, the University of

Arkansas for Medical Sciences (UAMS) is ranked

in the top 10 nationwide for the percentage of

its graduating class to pursue family medicine.

In the latest ranking, the UAMS College of Med-

icine was listed seventh in the nation by the Amer-

ican Academy of Family Physicians (AAFP). The

ranked list was based on a three-year average

ending in 2015 of the percentage of each gradu-

ating class to go into a family medicine residency

program accredited by the Accreditation Coun-

cil on Graduate Medical Education. UAMS was

included on the ranking of Doctor of Medicine

(MD) programs.

More than two thirds of Arkansas’ 75 coun-

ties include federally designated Primary Care

Health Professional Shortage Areas. UAMS has

taken many steps to generate more family phy-

sicians and other primary care doctors. Mose-

ley and other academic leaders encourage

Alicia Baird

https://academic.oup.com/hmg/article/doi/10.1093/hmg/ddw429/2749564/Mutant-Profilin1-transgenic-mice-recapitulate

https://academic.oup.com/hmg/article/doi/10.1093/hmg/ddw429/2749564/Mutant-Profilin1-transgenic-mice-recapitulate

https://www.ncbi.nlm.nih.gov/pubmed/28040732

https://www.ncbi.nlm.nih.gov/pubmed/28040732


Healthcare Briefs

medical students to consider residency training

and careers in family medicine, and the college

works with private partners to increase funding

for scholarships for students who are interested

in primary care.

Daniel A. Knight, MD, chair of the Department

of Family and Preventive Medicine in the UAMS

College of Medicine, said that shortage of pri-

mary care providers in Arkansas and nationwide

makes this effort more important than ever.

In 2016, 56 percent of the UAMS College of

Medicine graduating class secured residencies in

one of the primary care specialties, which include

family medicine, internal medicine, pediatrics,

and obstetrics and gynecology. Thirty-three of

the 163 UAMS seniors who participated in the

National Residency Match Program matched to

a family medicine residency.

The AAFP based its most recent study on

UAMS’ three-year average rate, which was 16.3

percent. The one-year rate for the 2014-2015

school year at UAMS was 19.3 percent, well above

the national average of 8.7 percent for MD pro-

grams during the same time period.

The one-year rate was an improvement for

UAMS, where in recent years, the rate was: 14.6

percent in 2013-2014; 15.1 percent in 2012-2013;

12.6 percent in 2011-2012; and 11.9 percent in

2010-2011.

The AAFP highlights programs that are going

above and beyond to grow the primary care work-

force because of a physician shortfall in this field.

As the need for primary care grows, so does the

need for family medicine practitioners.

The Council on Graduate Medical Education

20th Report recommended that primary care doc-

tors should make up 40 percent of the physician

workforce. The most recent estimates from

2008 put that number at 35 percent and declin-

ing, according to the AAFP report. Despite the

efforts of the AAFP and other advocacy groups,

the percentage of MD program graduates enter-

ing family medicine has remained flat over the

last decade.

Bowes Promoted to Senior Vice Chancellor for Finance and Administration

William R. Bowes has been promoted to senior

vice chancellor for Finance and Administration at


(UAMS).

Bowes has served as UAMS vice chancellor for

finance and chief financial officer since 2013. In

that role, he was responsible for overall finan-

cial leadership of the university in support of its

operational and strategic goals and priorities

with oversight of finance, human resources, sup-

ply chain, and budget functions. In his new role,

he will also provide senior leadership of UAMS

Information Services, Campus Operations and

business administration across the university.

Foltz Joins UAMS as Development Officer for Myeloma Institute

Tiffani Foltz has been named a director of

development for the University of Arkansas for

Medical Sciences (UAMS) with a focus on fund-

raising activities for the Myeloma Institute. Prior

to joining UAMS, Foltz held fundraising positions

with the Arkansas chapter of the American Red

Cross and Centers for Youth and Families, both

in Little Rock.

The UAMS Myeloma Institute is the most

comprehensive center in the world for research

and clinical care related to multiple myeloma

and related diseases, such as Castleman Disease

and Waldenstrom Macroglobulemia. The insti-

tute’s team of scientists and clinicians has pio-

neered many advances that have become stan-

dards of care, leading to improved survival rates.

The institute is known for continually translating

advances in the laboratory into breakthrough clin-

ical treatments.

Ussery Invested in Endowed Chair in Biomedical Informatics

David W. Ussery, PhD, director of the Arkan-

sas Center for Genomic and Ecological Medi-

cine at the University of Arkansas for Medical

Sciences (UAMS), was invested Feb. 21 as the

inaugural recipient of the Helen Adams & Arkan-

sas Research Alliance (ARA) Endowed Chair in

Biomedical Informatics. Ussery, who has worked

with bacterial genomics since 1995, joined UAMS

in May.

An endowed chair is among the highest aca-

demic honors a university can bestow on a faculty

member and is established with gifts of at least $1

million, which are invested and the proceeds used

to support the educational, research, and clini-

cal activities of the chair holder. Those named to

a chair are among the most highly regarded sci-

entists, physicians and professors in their fields.

Biomedical informatics uses computational

approaches to assess and analyze large sets of

medical and public health data for patient care

and research programs, including sequence infor-

mation such as genetics and genomic data.

Ussery’s genome sequencing work, using low-

cost, high-output technology has some exciting

David W. Ussery, PhDWilliam R. Bowes Tiffani Foltz Christopher H. Pope, MD



potential applications for a range of emerging

infections. Ussery and his team are collaborat-

ing with the Arkansas Department of Health to

sequence outbreaks for mumps, the Zika virus,

and the flu; his group is also collaborating with

many clinicians to analyze genome and microbi-

ome data from patients at UAMS.

Ussery was presented with a commemorative

medallion by Rahn and UAMS Executive Vice

Chancellor and Dean of the College of Medicine

Pope L. Moseley, MD

UAMS provided $500,000 toward the chair,

using a bequest from Helen Adams, and the

ARA provided the other $500,000 as part of its

ARA Scholars program to attract highly respected

researchers to Arkansas to stimulate innovation

and economic opportunity.

Helen Adams was a 1929 graduate of the Uni-

versity of Arkansas and co-owner with her hus-

band, Roy Adams, of a Fayetteville flower shop.

On her death in 2004, Helen Adams left a gen-

erous bequest to UAMS to support medical

research.

Pope Named Primary Physician at CARTI Radiation Oncology in Conway

Christopher H. Pope, MD, has been named pri-

mary physician at CARTI Radiation Oncology in

Conway, according to Jan Burford, CARTI presi-

dent and chief executive officer.

Pope joined the CARTI medical staff in 1999

as primary radiation oncologist at the network’s

North Little Rock clinic, which he also helped to

open that same year before going on to provide

roving coverage at CARTI clinics across the state.

As radiation chief of staff from 2004-2011, Pope

also served as a member of the CARTI Board of

Directors.

Certified by the American Board of Radiology,

Pope has served as state chair of the government

relations committee for the American Society for

Radiation Oncology (ASTRO) since 2012 and as

national chair of the American College of Radiol-

ogy Practice Accreditation Committee since 2014.

Emergency Care Conference Set for May

ICARE (Improving Critical and Acute Care

through Regional Education), an upcoming con-

ference geared towards handling emergency

situations, will be held in northwest Arkansas in

May. It’s intended to raise awareness and provide

an educational update to frontline emergency

healthcare practitioners.

UAMS organizers developed the conference

as a direct response to educational gaps here in

Arkansas. The initiative began after the American

College of Emergency Physicians scored Arkan-

sas emergency care as a D minus.

At the ICARE Conference participants will have

real-life scenarios on dealing with treatment of

traumatic injury. They’ll also get a refresher on the

most effective strategies for promoting overall

preventive health measures in emergency rooms

to increase statewide access to care. Registration

is now open for healthcare professionals, emer-

gency responders, law enforcement officers, and

students.

Researcher Reveals Clues to Immunity as a Cause of High BP

A University of Arkansas for Medical Sciences

(UAMS) researcher has shed light on the role of

immune cells inside the kidneys in the develop-

ment of salt-sensitive high blood pressure, pub-

lishing his findings in Nature Communications.

Shengyu Mu, PhD, assistant professor in the

Department of Pharmacology and Toxicology

in the UAMS College of Medicine, and his col-

leagues used innovative techniques, includ-

ing super-resolution microscopy in UAMS’ Dig-

ital Microscopy Core, to illustrate at cellular and

molecular levels that activation of immune cells in

the kidneys can result in salt-sensitive high blood

pressure, which is a form of high blood pressure

that reacts directly to salt intake.

Specifically, Mu’s work uncovered the interac-

tion of a particular type of white blood cell with

kidney cells. Scientists suspected that these cells

– T lymphocytes, or T cells – played a role in

developing high blood pressure but scientists

were not sure how.

Mu demonstrated that too many T cells in

the kidneys might be the cause of salt sensitiv-

ity of high blood pressure. A major subtype of

these T cells interacts directly with – and actually

touches – the cells located in the area of the kid-

neys that reabsorb salt. This process enhances

sodium chloride absorption in the kidney, thereby

impairing the function of the kidneys that fil-

ter out excessive salt, consequently leading to

salt-sensitive high blood pressure.

Mu is preparing to publish additional findings

from this round of research and is writing grants

for follow-up pursuits. He would like to explore

how exactly the T cells and kidney cells are bind-

ing together.

Additional authors on the paper from UAMS

include Sung W. Rhee, PhD, associate professor

in the Department of Pharmacology and Toxicol-

ogy; postdoctoral fellow Yunmeng Liu; and tech-

nicians Tonya M. Rafferty, Jessica S. Webber, Li

Song and Beixiang He.

The work was funded by a Beginning Grant-

in-Aid from the American Heart Association as

well as UAMS Foundation Fund and departmen-

tal support.

Arkansas Hospice Celebrates 25th Anniversary

Arkansas Hospice, the state’s largest hospice

organization, recently celebrated its 25th anni-

versary. Since its inception, the community-based,

nonprofit organization has grown from one loca-

tion to eight offices and three inpatient cen-

ters that serve more than 500 patients each day

throughout a 33-county service area.

Judith Wooten, President and CEO, remarked,

“The early success of Arkansas Hospice can be

attributed to our visionary founders, Dee Bra-

zil-Dale and the late Michael V. Aureli. We have

continued to thrive because of our wonderful

employees, whose dedication and compassion

set the standard for hospice care throughout the

state. This year is not only a celebration of our

history, but also a time to look to the future, as

we continue to develop new and better ways to

serve Arkansans facing serious illness and loss.”

Dr. Brian Bell, Arkansas Hospice Chief Medical

Officer, added, “Arkansas Hospice realizes that

our patients are more than just the illness they

have, and we strive not only to meet their physi-

cal needs but their emotional and spiritual ones

as well. Knowing and understanding them as a

person is just as important to us as knowing their

medical history. It is an honor and privilege to

care for those living with a life-limiting illness. Our

goal is to ensure that they and their loved ones

get the highest quality care we can provide.”

As a nonprofit organization, Arkansas Hospice

has a special commitment to patients and families

in rural areas of the state, minorities, and other


Healthcare Briefs

underserved populations, providing the same

high-quality care to all, regardless of ability to pay.

Arkansas Hospice is the state’s only Level 4 Part-

ner with We Honor Veterans, a nationwide pro-

gram that focuses on improving care for veterans

nearing end-of-life. They are also the first hospice

in the nation to employ a fully accredited veter-

an’s claims agent to help veterans secure the VA

benefits they deserve.

Arkansas Palliative Care, a subsidiary of Arkan-

sas Hospice, was formed in 2015 to make pallia-

tive care services available to patients earlier in

their disease process. Last year alone, they served

almost 500 patients through our first community

partnership with Unity Health – White County

Medical Center.

Arkansas Hospice is the only hospice in the

state to have a dedicated pediatric team. The

pediatric program cared for the end-of-life needs

of over 30 children and their families in fiscal year

2016.

Over the last 25 years, Arkansas Hospice has

won multiple awards for its service to Arkansans,

most recently being named the Best Nonprofit/

Charitable Organization in the 2016 Arkansas

Business Best of Business Awards. In addition,

Arkansas Hospice’s signature event, A Fair to

Remember, was chosen as the Best Nonprofit

Fundraising Event in 2016.

Methodist Family Health Programs Recognized as Evidence-based by NREPP

The recent publication of results from a large

National Institute of Mental Health-funded

research study prompted Substance Abuse and

Mental Health Services Administration’s National

Registry of Evidence-based Programs and Prac-

tices (NREPP) to include the comprehensive

model of care accredited for use by Methodist

Family Health, the Teaching-Family Model (TFM),

as a promising evidence-based practice.

As of December 5, 2016, NREPP, a highly selec-

tive registry of evidence-based practices in men-

tal health services, officially recognizes the Teach-

ing-Family Model as a promising evidence-based

practice for the treatment of “Non-specific Men-

tal Health Disorders and Symptoms.”

The study published in the Journal of Emo-

tional and Behavioral Disorders found the Teach-

ing-Family Model to “produce significantly better

outcomes” for youth post-discharge. “Short-term

gains are relatively common, but for developing

youth, shifts in long-term trajectories form the

springboard for improved development, social-

ization, functioning, and flourishing,” write the

study authors.

Teaching-Family Model programs at Methodist

Family Health provide that springboard for men-

tal health care for children and youth ages 5-18

and their families.

The Teaching-Family Model has been recog-

nized as a promising evidence-based practice

since 2008 by the California Evidence-Based

Clearinghouse for Child Welfare (CEBC), a sim-

ilar and oft-cited registry of evidence-based

programs. The American Psychological Associ-

ation has recognized the Model as an evidence-

based practice since 2003, prior to the creation

of NREPP or CEBC.

The American Psychological Association’s pro-

file of the Teaching-Family Model suggests that

the Model has “given hope” that children and

youth “with even the most difficult problems or

behaviors can improve the quality of their lives

and make contributions to society.”

CARTI Introduces New PET/CT Equipment

Cutting edge imaging equipment and technol-

ogies recently introduced at CARTI are designed

to significantly improve physician diagnosis and

staging of cancer, according to officials with the

statewide network of cancer care facilities.

The Discovery MI, a new PET/CT system devel-

oped by GE Healthcare that just received US FDA

clearance in October 2016, was recently installed

and unveiled at the CARTI Cancer Center in Lit-

tle Rock.

“This is an exciting new advance for the future

of cancer care,” says David Hays, MD, interven-

tional radiologist at CARTI. “This system not only

makes it easier to diagnose and stage disease

as early as possible, but it also helps guide us in

developing treatment strategies.”

“Early detection has always been a prime

component when it comes to improving sur-

vival rates,” says Hays. “This technology not only

improves our ability to recognize and identify can-

cers sooner, but the clarity of the imaging sig-

nificantly impacts the precision of our treatment

planning so that we can most effectively and

aggressively target the area of concern.”

Hays said the introduction of the Discovery MI

at CARTI is part of the statewide healthcare net-

work’s ongoing mission of providing the high-

est quality of cancer treatment and compassion-

ate patient care by making new, state of the art

equipment and technologies available to physi-

cians for their patients.

CARTI is an independent, nonprofit network

of cancer care facilities with locations through-

out Arkansas in Little Rock, North Little Rock,

Benton, Clinton, Conway, El Dorado, Heber

Springs, Mountain Home, Russellville, Searcy,

and Stuttgart.

Study Shows Chemotherapy Induces Senescence

Chemotherapy for cancer causes a pro-inflam-

matory stress response that promotes adverse

side effects and cancer relapse, says a research

team that includes the University of Arkansas for

Medical Sciences (UAMS). Daohong Zhou, MD,

associate director for basic research in the UAMS

Winthrop P. Rockefeller Cancer Institute, is a co-

author of the study published Dec. 22 in Can-

cer Discovery.

While chemotherapy is often a life-saving treat-

ment for some cancer patients, it affects both

healthy cells and malignant cells throughout

the body, often causing debilitating side effects,

including fatigue.

The study shows that chemotherapy induces

cellular senescence — or cellular aging — in nor-

mal tissues, which triggers a pro-inflammatory

CARTI new PET/CT system



stress response and promotes the adverse effects

of chemotherapy as well as fatigue and cancer

relapse and metastasis. Eliminating the senes-

cent cells in mice prevented the side effects and

cancer relapse and metastasis.

“One of the side effects of chemotherapy is

bone marrow suppression, which can lead to

reduction in blood cell production and contrib-

ute to chemotherapy-induced fatigue,” said

Zhou, also a professor of pharmaceutical sci-

ences and deputy director of the Division of Radi-

ation Health in the UAMS College of Pharmacy’s

Department of Pharmaceutical Sciences. “Elimi-

nating senescent cells can promote bone marrow

recovery after chemotherapy.”

Judith Campisi, PhD, of the Buck Institute for

Research on Aging, was the senior scientist on

the study, which highlights the dual nature of cel-

lular senescence — it permanently stops stressed

cells from dividing, but also contributes to aging

and late-life cancers.

The research was led by Marco Demaria, PhD, a

former postdoctoral scientist in the Campisi lab.

The research utilized transgenic mice that permit

tracking and eliminating senescent cells. Results

showed that eliminating chemotherapy-induced

senescent cells reduced several short-and long-

term effects of treatment, including bone marrow

suppression, toxicity to the heart, cancer recur-

rence and metastasis, and physical activity and

strength. Common chemotherapy drugs Doxo-

rubicin, Paclitaxel, Temozolomide, and Cisplatin

were used to treat the mice.

Demaria, who is now a principle investigator at

the European Institute for the Biology of Aging at

the University of Groningen in the Netherlands,

said some of the most striking results involved

running speed – an indicator of fatigue in mice.

Eliminating senescent cells was sufficient to

almost entirely rescue remedy the decline in

physical activity in the treated mice, Damaria

said. “Normally, mice spend 40 percent of their

time running. After chemotherapy that activity

dropped to 10 percent. When we knocked out

the senescent cells the mice returned to normal

running.”

“Fatigue, which can be long-lasting, is a big

deal for patients on chemotherapy,” said Nor-

man E. Sharpless, MD, director of the Lineberger

Comprehensive Cancer Center at the University

of North Carolina in Chapel Hill and a co-author

of the study. “Years later they often say that was

the worst part of the treatment.”

In addition, Sharpless looked at blood markers

of cellular senescence in 89 women with breast

cancer before they underwent chemotherapy

aimed at curing their disease. Women who went

into chemotherapy with the most senescent cells

experienced the most debilitating fatigue after

treatment, he said.

Other co-authors from Zhou’s lab at UAMS

include Mr. Jianhui Chang and Dr. Lijian Shao.

Citation: Cellular senescence promotes adverse

effects of chemotherapy and cancer relapse DOI:

10.1158/2159-8290.CD-16-0241

Campisi and Zhou are co-founders of Unity Bio-

technology, which is developing drugs to elimi-

nate senescent cells. Sharpless and Demaria have

equity in the company. Sharpless is a founder and

has a financial interest in HealthSpan Diagnostics.

Mitin is an employee of HealthSpan Diagnostics.

All other authors declare no financial interests.

Harps Food, UAMS Create Program for Pharmacists

Springdale-based Harps Food Stores Inc. and


(UAMS) College of Pharmacy together have cre-

ated a novel training program to teach phar-

macists to work more directly with patients to

improve their health.

Pharmacists and pharmacy technicians will be

trained to work as a team on medication therapy

management (MTM), which is medical care pro-

vided by pharmacists to ensure medications are

helping patients achieve the best possible health

from their prescriptions.

The program is called MTM The Future Today

(mtmthefuturetoday.com) and could bring signif-

icant changes to the pharmacy profession, said

College of Pharmacy Dean Keith Olsen, PharmD.

Olsen and Duane Jones, Harps pharmacy dis-

trict manager, formalized the alliance in October

to create the program, which includes training for

pharmacists and pharmacy technicians.

MTM can include reviewing a patient’s med-

ications to make sure there are no unintended

interactions and advising patients on any prob-

lems they are having with medications. Pharma-

cists also can instruct patients on taking medica-

tions on schedule and give vaccinations.

Nikki Scott, PharmD, was completing a

pharmacy residency with Harps in 2015 and took

on the project of creating a step-by-step protocol

and training program to teach pharmacists and

pharmacy technicians how to implement MTM

services within the daily work and bustle of a com-

munity pharmacy.

After her residency, Scott began working for

Harps and developed the program into what

became MTM The Future Today. It shifts all non-

clinical duties to pharmacy technicians so phar-

macists can turn their attention to patient-cen-

tered activities like medication reviews and

management, taking the time to provide advice

to patients about their drug therapy.

Scott and Jones in October 2015 trained 63

Harps pharmacists and 34 Harps pharmacy tech-

nicians how to put MTM into practice using MTM

The Future Today.

In the first 10 months of 2015, Harps phar-

macists completed 35 medication reviews with

patients. In the last two months of 2015, after the

training program, they completed 260. The pro-

gram boosted it to eighth place in the first quar-

ter of 2016 in a national ranking of regional chains

for CMR completion rates. In the second quarter

Harps moved up to fifth place. Before the MTM

program Harps pharmacies were not even placed

in the top 50.

The training program impressed Nicki Hill-

iard, PharmD, professor in the College of Phar-

macy Department of Pharmacy Practice, and she

brought it to the attention of Olsen, who joined

with Harp’s so the college could help promote

the innovative program and evaluate its success.

Medicare Part D reimburses pharmacies for

completing more medication reviews in MTM.

Doing more reviews will help ensure that reim-

bursement continues and could convince private

insurers of MTM’s advantages as health outcomes

improve and costs drop, Jones said.

Hilliard also is president-elect of the American

Pharmacists Association (APhA), and has experi-

ence marketing a national training program. She

plans to use her experience and connections to

help expand the program throughout the coun-

try. In mid September, Scott trained 25 Ohio phar-

macists and 25 technicians.

Summer Food Program Provider Application Open

The 2017 Arkansas Summer Food Service

http://pharmcollege.uams.edu/departments-units/pharmaceutical-sciences/radiation-health/

http://pharmcollege.uams.edu/departments-units/pharmaceutical-sciences/radiation-health/

https://dx.doi.org/10.1158/2159-8290.CD-16-0241


Healthcare Briefs

Program (ASFSP) application opened Feb. 20 for

schools and government agencies and will open

March 20 for other potential provider sites. The

Department of Human Services (DHS) program

provides healthy snacks and meals to children,

ensuring children who receive free or reduced

lunches during the school year have nutritious

weekday meals when school is out.

“Unfortunately, we are tied with Mississippi as

the most food insecure state in the nation, with

one in five Arkansans suffering from not enough

to eat in the last year,” said Tracey Shine, DHS

Health and Nutrition program administrator. “We

are down to ninth for child hunger, but that’s not

good enough. Less than 15 percent of kids who

qualify for free or reduced lunches during the

school year are getting the same high-quality

meals in the summer.”

Last year, three million meals and snacks were

provided to children in Arkansas at nearly 700

sites across the state. Youth ages 18 and younger,

regardless of color, sex, race national origin or

disability, and people over 18 who are deemed

either mentally or physically handicapped are

eligible for assistance. The program is federally-

funded at 100 percent by the U.S. Department of

Agriculture (USDA), and therefore all meals and

snacks must meet USDA nutritional guidelines.

Typically schools and daycares are summer food

program providers, but any public or non-profit

summer camps, community centers, churches,

government agencies or similar groups can apply.

Providers will be asked to supervise the produc-

tion, distribution and administrative tasks of their

site.

Potential ASFSP sponsors must complete an

eligibility process that includes training and

approval by DHS, USDA, and the Internal Rev-

enue Service. Organizations that qualify for the

program will be reimbursed the costs for meals

and snacks served.

The application deadline is Friday, April 28. For

more details about the program call 501-628-8869

or visit https://dhs.arkansas.gov/dccece/snp/

SummerInfoM.aspx to complete the application.

To find sites across the state to assist children

and adults in need of free food, Arkansans should

visit www.whyhunger.org or call 1-800-5HUNGRY

or text their ZIP code to 1-800-548-6479.

UAMS Names Evans, Low to College of Medicine Development

Kim Evans has joined the University of Arkan-

sas for Medical Sciences (UAMS) as a senior direc-

tor of development, and Christy Low has joined

UAMS as a director of development, both with

the UAMS College of Medicine.

Evans and Low will work closely with College

of Medicine Dean Pope L. Moseley, MD, the col-

lege’s board of visitors, and development lead-

ers to advance the college’s philanthropic goals.

Evans has more than 25 years of nonprofit expe-

rience as a development director, planned giv-

ing officer, board member and volunteer. She is

a former Arkansas assistant attorney general and

served as a law clerk in U.S. District Court. Evans

worked previously as director of the University of

Arkansas at Little Rock (UALR) Center for Non-

Profit Organizations and served most recently

with the Arkansas Community Foundation. She

holds a Juris Doctorate from the UALR William H.

Bowen School of Law and a Bachelor of Science

degree in foreign service and international eco-

nomics from Georgetown University.

Low has spent the last 20 years in fundraising,

having previously served as a full-time volunteer

in Jonesboro, before becoming a professional

development officer at Arkansas State Univer-

sity, her alma mater, in 2005. She was director

of development at Arkansas State University for

five years. Low also served as regional director

of development at both Washington University

in St. Louis and the St. Louis Children’s Hospital

Foundation before returning to her hometown

of Little Rock.

Relationship Expert Wakefield to Head Couples Center at UAMS

A nationally recognized expert in the field of

couples therapy has joined the faculty of the Uni-


to establish a program designed to treat those

with issues related to interpersonal relationships.

Chelsea Wakefield, PhD, LCSW, is an assistant

professor in the UAMS College of Medicine’s

Department of Psychiatry and director of the Cou-

ples Center, a program created to help couples

with the relationship problems that are so com-

mon in today’s modern world. The center will also

offer training and a certification program for pro-

fessionals who are seeking to develop their clini-

cal skills in this important area of life.

Wakefield said exhaustion from a couple’s many

roles and responsibilities such as work demands,

caring for children and aging parents, and hor-

monal changes that occur with aging can all lead

to relationship problems.

Wakefield has led educational retreats and

workshops around the world, and plans to offer

community workshops for those wanting to

improve and enrich their relationships. She holds

a bachelor’s degree in psychology, a master’s in

social work, and a PhD in clinical sexology. She

has published two books, which are valued by

both clinical professionals and educated lay audi-

ences, Negotiating the Inner Peace Treaty and

In Search of Aphrodite: Women, Archetypes and

Sex Therapy.

Seupaul Named to Inaugural Stanley E. Reed Professorship

Rawle A. “Tony” Seupaul, MD, professor and

chair of the Department of Emergency Medi-

cine at the University of Arkansas for Medical

Sciences (UAMS), was invested Jan. 19 as the

Kim Evans Chelsea Wakefield, PhD, LCSW

Christy Low

https://dhs.arkansas.gov/dccece/snp/SummerInfoM.aspx

https://dhs.arkansas.gov/dccece/snp/SummerInfoM.aspx

http://www.whyhunger.org



inaugural recipient of the Stanley E. Reed Pro-

fessorship for Emergency Medicine, Trauma, and

Injury Prevention.

Seupaul was presented with a commemorative

medallion by UAMS Chancellor Dan Rahn, MD,

and Pope L. Moseley, MD, UAMS executive vice

chancellor and dean of the College of Medicine.

“This professorship has very special meaning

because it’s established in honor of Stanley Reed,

who touched the lives of many across Arkansas,”

said Rahn. “Today, we celebrate an outstanding

faculty member in Tony Seupaul, who is rapidly

shaping our emergency medicine program into

one of national prominence.”

An endowed professorship is the among the

highest academic honors a university can bestow

on a faculty member and is established with gifts

of $500,000, which are invested and the pro-

ceeds used to support the educational, research

and clinical activities of the chair holder. Those

named to a professorship are among the most

highly regarded scientists, physicians and pro-

fessors in their fields of expertise.

Initial funds for the professorship were made

in memory of Reed, the noted farmer and public

servant who died in 2011 following an auto acci-

dent. Reed was a member of the University of

Arkansas System board of trustees and was a for-

mer Arkansas Farm Bureau president. He served

as the first chairman of the UAMS College of

Medicine Advisory Board and was a member of

the UAMS Foundation Fund Board.

Reed played a significant role in promoting

Arkansas agriculture products to international

markets, leading trade missions to several coun-

tries. He grew up on his father’s farm in Marianna.

After graduating from the University of Arkan-

sas at Fayetteville in 1973 and obtaining his law

degree from the University of Arkansas School of

Law in 1976, Reed briefly established a law prac-

tice in Marianna before returning to the life of

farming he loved so dearly.

Reed operated a highly successful family farm-

ing operation in Lee and St. Francis counties. He

was posthumously named to the Arkansas Agri-

culture Hall of Fame in 2012, the Arkansas Busi-

ness Hall of Fame in 2014, and the University of

Arkansas College of Engineering Hall of Fame

in 2016.

Seupaul joined UAMS in 2013 from the Indiana

University School of Medicine, helping greatly

expand the Department of Emergency Med-

icine. Seupaul noted that UAMS created the

Department of Emergency Medicine in 1983, a

mere four years after emergency medicine was

named a medical specialty. “That is remarkable –

that UAMS rode the crest of that wave as an early

adopter, recognizing the field of emergency med-

icine for what it is,” Seupaul said.

Seupaul mentioned the third-year rotations

his residents do in rural areas of Arkansas, and

how more residents are choosing to stay in rural

areas after their residency. “That is one of the

many ways that we will expand emergency med-

icine from UAMS into the rural areas to improve

health care, and I think that’s exactly what Stan-

ley would’ve wanted,” Seupaul said.

Seupaul has focused his academic career on

evidence-based medicine education and the

application of science to health care. Evidence-

based medicine integrates clinical experience

with the best-available research information.

Research Opens New Possibilities for Osteoporosis Treatment

A team of University of Arkansas for Medical

Sciences (UAMS) researchers have made key

advances in the understanding of how bone is

maintained, opening new avenues for the devel-

opment of treatments for osteoporosis, arthritis,

and bone metastasis of certain types of cancer.

Haibo Zhao, MD, PhD, associate professor of

medicine and physiology in the Department of

Endocrinology and the Department of Physiology

and Biophysics in the UAMS College of Medicine

– published his findings recently in JCI Insight,

a leading peer-reviewed journal in biomedical

research.

Zhao’s work improved scientists’ understand-

ing of osteoclasts – bone cells that remove old or

damaged bone. Other cells – called osteoblasts

– come behind osteoclasts and form new bone.

Both cells must be functioning properly for bones

to grow and stay strong.

For example, in osteoporosis, osteoclast activity

outpaces that of osteoblasts, meaning a greater

amount of bone is removed than is replaced. This

causes bones to weaken and become more sus-

ceptible to fractures.

Rawle A. “Tony” Seupaul, MD, (center) with UAMS Executive Vice Chancellor and College of Medicine Dean Pope L. Moseley, MD, and Chancellor Dan Rahn, MD.


Healthcare Briefs

Springdale, UAMS Southwest in Texarkana and

UAMS West in Fort Smith. The four UAMS clinics

in Little Rock are UAMS Family Medical Center,

UAMS Internal Medicine Clinics, the Thomas &

Lyon Longevity Clinic and Neighborhood Clinic

at Rahling Road.

The predecessor initiative — Comprehensive

Primary Care Initiative (CPCI) — began in 2012

and included 500 clinics in eight states.

Payers in the national partnership include the

Centers for Medicare & Medicaid Services (CMS),

state Medicaid agencies, commercial health

plans, and self-insured businesses.

Through CPC+, CMS will pay primary care prac-

tices a care management fee, initially set at an

average of $15 per patient per month in Track 1,

and $28 per patient per month in Track 2, to sup-

port enhanced, coordinated services on behalf

of Medicare beneficiaries. Simultaneously, par-

ticipating commercial, state, and other federal

insurance plans are also offering enhanced pay-

ment to primary care practices.

In addition, a monthly incentive payment

amount ($2.50 or $4.00) is included if high-qual-

ity outcomes are achieved. And, finally, traditional

Medicare fee-for-service payments are included.

The sum of these three payments serves to sub-

stantially increase the reimbursement for these

team-based, primary care services.

The five-year model started on Jan. 1 with CMS

recruiting a diverse pool of commercial health

plans, state Medicaid agencies, and self-insured

businesses to work alongside Medicare to sup-

port comprehensive primary care. In addition to

Arkansas, public and private health plans in 14

regions nationwide from New Jersey to Hawaii

will participate in this model.

Eligible primary care practices in each market

were invited to apply to participate in the winter

of 2016. Through a competitive application pro-

cess, CMS selected primary care practices within

the selected markets to participate in CPC+.

Among the criteria used in choosing practices

for the partnership were their use of health infor-

mation technology, participation in practice trans-

formation and improvement activities and diver-

sity of geography, practice size, and ownership

structure. n

Scientists have previously outlined this relation-

ship between the cells that remove old bone and

cells that form new bone, but Zhao’s work focused

on what causes osteoclasts to malfunction, which

is less understood.

Zhao targeted a specific type of protein – PLE-

KHM1 – and demonstrated that its absence

decreased the function of the osteoclasts. Fur-

ther investigation found that the protein is a crit-

ical factor in some of the intracellular functions

– specifically involving lysosomes – that are essen-

tial for osteoclasts to operate.

“The major finding of this work is how this pro-

tein works,” Zhao said. “PLEKHM1 and its inter-

acting molecules could represent very useful drug

development targets for the treatment of osteo-

porosis and other bone diseases.”

After determining its function, the next step

will be to better understand PLEKHM1’s struc-

ture so that it can be targeted by drugs that could

treat osteoporosis and other bone conditions in

which osteoclasts malfunction. Zhao has already

secured National Institutes of Health funding to

pursue this next step, along with Kottayil I. Var-

ughese, PhD, professor in the Department of

Physiology and Biophysics, who is co-principal

investigator on the project.

The article, titled “PLEKHM1/DEF8/RAB7 com-

plex regulates lysosome positioning and bone

homeostasis,” was published Oct. 20. UAMS

faculty who assisted with the work were Manola-

gas; Varughese; and Daniel E. Voth, PhD, of the

Department of Microbiology and Immunology,

and Samuel G. Mackintosh, PhD, of the Depart-

ment of Biochemistry and Molecular Biology,

both in the College of Medicine. Postdoctoral

fellows Toshifumi Fujiwara, MD, PhD; and Shiq-

iao Ye, PhD, assisted with the work, as did grad-

uate student Caylin G. Winchell, PhD

The work was funded by a grant from the NIH/

National Institute on Aging to Manolagas and

the Center for Osteoporosis and Metabolic Bone

Diseases of more than $1 million a year for five

years; and a grant from the NIH/ National Insti-

tute of Arthritis and Musculoskeletal and Skin Dis-

eases to Zhao of $220,500 a year for five years.

The project’s next phase will be funded by a grant

from the NIH/NIAMS to Zhao and Varughese of

$135,000 a year for two years.

DBHS Director Charlie Green Resigns

After 18 years with the Arkansas Department

of Human Services, Division of Behavioral Health

Services (DBHS) Director Charlie Green has

resigned from the agency to take a job in the

private sector.

Jay Hill, Arkansas Health Center director, will

be interim director of DBHS and will manage the

division facilities, including the Arkansas State

Hospital. Paula Stone, assistant director for DBHS,

will have primary responsibility for programs and

take a lead role in transformation.

Green began work at DHS in 1999 as the super-

intendent of the Alexander Human Development

Center. He then served as the state’s Develop-

mental Disabilities Services Commissioner from

2003-14, when he was tapped as director of

DBHS.

Family Medical Centers, Clinics Participating in Public-Private Partnership

Five regional Family Medical Centers of the Uni-


and four UAMS primary care clinics in Little Rock

are joining more than 2,900 primary care prac-

tices nationwide in a partnership between pay-

ers and providers.

Called Comprehensive Primary Care Plus

(CPC+), the partnership is designed to provide

access to quality healthcare at lower costs and

will provide primary care practices with addi-

tional payment to improve coordination of care.

CPC+ is administered by the federal Center for

Medicare & Medicaid Innovation (CMS Innova-

tion Center).

For patients, this means that physicians may

offer longer and more flexible hours, use elec-

tronic health records, coordinate care with

patients’ other healthcare providers, better

engage patients and caregivers in managing their

own care, and provide enhanced care for patients

living with multiple chronic diseases.

The five UAMS Family Medical Centers are part

of UAMS Regional Programs: UAMS Northeast in

Jonesboro, UAMS Northwest in Fayetteville and

HealtHcare Journal of lIttle rocK I MAR / APR 2017 51

R e v i e w s b y t h e b o o k w o R m

Here’s something important: your pants don’t fit anymore.

The blame, you’re sure, lands squarely with the holidays: too

many toddies, too much figgy pudding. Perhaps it’s just bad genes

or, well, maybe you have no willpower. Or maybe, as you’ll see in

“The Secret Life of Fat” by Sylvia Tara, PhD, your fat is not your fault.

Back when she was in college, Sylvia Tara came to realize that

“we are not all created equal…” To maintain her “skinny jeans” frame,

Tara had to nearly starve herself, while one of her classmates ate

everything put in front of her.

So unfair.

And so fascinating. Tara began to research the

subject of fat.

It’s hard to believe that plumpness was pleasing until around the

turn of the last century. Men desired zaftig women and mothers

wanted chubby babies then; today, magazines use barrels of ink on

weight-loss advice, countless trees have died for diet books, and

the fact remains that “more than 78 million Americans are consid-

ered obese...”

And yet, says Tara, fat “is not all bad.”

Science tells us that there are two kinds of fats; one (white fat)

hoards energy, the other (brown fat) burns energy. Even before we’re

born, nature makes sure we have both – and of the former, girl ba-

bies get more than boy babies. As we grow, fat molecules specialize,

so to speak, and “some… can do fantastic things.” Fat helps

us think, it strengthens our bones, insulates our bodies,

moisturizes skin and scalp, repairs wounds, promotes

puberty, gives us fertility, and might extend our lives;

while fat molecules, “collectively referred to as lipids,”

do even more.

And then we age. We become sedentary, stressed,

sleepless, and fat seems to hibernate on thighs and belly.

It’s “wily.” Sneaky. What can you do?

Fat, as Tara indicates, is somewhat like Goldilocks. Too

much can lead to disease and other problems. Too little can kill

you. What’s needed is a just-right, somewhere in the middle.

“If one is healthy, that’s the main thing.”

Feeling guilt over your gut? Too much thought going into your

thighs? Or maybe you’re regretting that last Christmas cookie,

but there’s no need for that. “The Secret Life of Fat” puts it all into

perspective.

Conventional wisdom is tossed out the window in this fresh, fun,

but seriously heavy book on why we need fat – but not too much.

Author and biochemist Sylvia Tara uses case studies, interviews

with researchers, and scientific findings to explain more about this

misunderstood organ, what we know, and what we don’t. There’s

a whodunit here: we read about weight gone awry, and how lab-

sleuths link medical mysteries to fat. And yes, there’s both good

news and bad, but it’s given gently, and with hope.

Though it does contain some advice, this is not your usual diet

book. There are no recipes, no plans to follow, and no shame. If

you’re trying to lose a few pounds, in fact, you might find it refresh-

ing. You may find that “The Secret Life of Fat” just… fits. n

By Sylvia Tara, PhDc.2016, W. W. Norton

there’s both good news and

bad, but it’s given gently,

and withhope.

52 MAR / APR 2017 I HealtHcare Journal of lIttle rocK

dialogue

columnDirector’s Desk

reaction oncologists saw to the first dose of

a medicine was incredibly unusual.

When the oncologists reported these ad-

verse events, it was clear that the reaction

was only being identified in Southern states.

Around the same time, allergists were de-

scribing another highly unusual phenome-

non of delayed-anaphylaxis occurring three

to six hours after meat consumption. Ulti-

mately, scientists realized that both of these

groups had history of exposure to Lone Star

ticks, and that previous tick exposure sen-

sitized patients to react in this way.

Alpha-gal and TicksOver the last five years, investigations

have demonstrated the relationship between

Alpha-gal allergy and tick bites. The rela-

tionship appears strongest with Amblyoma

Alpha-gal AllergyALphA-gAL is a carbohydrate epitope, for-

mally called galactose-alpha-1, 3-galactose,

which is present in tissues and on the sur-

face of cells of all mammals except primates.

Allergy to Alpha-gal was first identified by

oncologists in patients who had life threat-

ening anaphylactic reactions to their very

first dose of the cancer drug cetuximab, a

monoclonal antibody medicine made in

mice, which ultimately was found to include

Alpha-gal moieties.

As a rule, anaphylaxis, marked by sudden

weakness, nausea, diarrhea, hives, swell-

ing of the throat, lips and tongue, difficulty

breathing and sometimes unconsciousness,

is a life threatening allergic reaction that oc-

curs anywhere from seconds to hours after

exposure to an allergen that the patient has

been exposed to previously. Therefore, the

I was called urgently to come see a colleague who had passed out at work. He was unconscious and diaphoretic with a palpable but rapid pulse. The differential diag-noses clicked off in my mind as we waited for the paramedics to arrive: vasovagal syndrome, hypoglycemia, acute MI, seizure, anaphylaxis? When he regained con-sciousness, he complained of generalized itching. After his initial evaluation in the Emergency Department and multiple follow up visits with various specialists, he was finally diagnosed with Alpha-gal allergy.


Nathaniel Smith, MD, MPHDirector and State Health officer,

Arkansas Department of Health

americanum or the Lone Star tick, which is

most prevalent in the central and south-

eastern United States. Lone Star ticks are

often identified by a single white spot on the

back of an adult female that can look like a

star or diamond. Interestingly, because tick

saliva contains Alpha-gal, it is not necessary

for a tick to bite another mammal before

biting a person.

The association between tick bites, im-

munoglobulin E (IgE) antibodies to Alpha-

gal, and delayed reactions to red meat now

has been reported from multiple countries

including Australia, France, Japan, Korea,

Spain, and Sweden, as well as the United

States. In the United States, Alpha-gal al-

lergy is most often seen in the central and

southern regions where the Lone Star tick

is most common.

Allergy to Alpha-gal is associated with

two forms of anaphylaxis:

— Immediate onset anaphylaxis during first

exposure to intravenous cetuximab

— Delayed onset anaphylaxis three to six

hours after ingestion of mammalian food

products

Mammalian food products include beef,

pork, lamb, venison, goat, bison, and any

meat by-products or derivatives such as

dairy or gelatin. poultry or fish do not have

Alpha-gal and do not cause these reactions

in affected patients.

Alpha-gal in Arkansasphysicians are not required to report pa-

tients with this allergy, so the true number

of affected individuals is unknown. This is

partially because the United States Food and

Drug Administration (FDA) has not yet ap-

proved the lab test most physicians use to

identify the allergy. With no formal test or

case definition for surveillance or diagnostic

guidelines, the true epidemiology of Alpha-

gal remains unclear.

however, using data submitted from two

“The association between tick bites, immunoglobulin E (IgE) antibodies to Alpha-gal, and delayed reactions to red meat now has been reported from multiple countries including Australia, France, Japan, Korea, Spain, and Sweden, as well as the United States.”

commercial laboratories that perform Al-

pha-gal testing, at least 270 patients were

diagnosed with Alpha-gal allergy between

January 2013 and September 2015 in 33 of

the 75 counties in Arkansas. In 2015, it be-

came apparent that increasing numbers

of Arkansas residents were living with this

allergy. The general Assembly enacted Act

1247, which created the Task Force on Alpha-

gal to “promote awareness and encourage

efforts to treat Alpha-gal in the state” and

to “make recommendations designed to im-

prove and increase knowledge and treat-

ment throughout the state for Alpha-gal,

especially for emergency room healthcare

professionals.” The Task Force on Alpha-gal

is a multidisciplinary group of individuals

representing public health, insurance, agri-

culture, hospitality, and medical fields.

The Task Force on Alpha-gal submitted

a Citizen’s petition to the FDA urging the

agency to support the inclusion of mam-

malian meat, dairy, and other products de-

rived from mammalian sources on the list

of major food allergens and to support the

labeling of Alpha-gal containing medica-

tions, cosmetics, and other products. This

group has also developed recommenda-

tions to educate the public, restaurants, and

medical professionals about Alpha-gal, its

symptoms, and how to identify the exten-

sive list of products that contain ingredients

from mammals. The Arkansas Department

of health is participating on the Task Force

on Alpha-gal and is working with physicians,

laboratories, state representatives, and

members of the community to distribute

information to the public.

In addition, the general Assembly enacted

Act 1108 which expanded public access to

auto-injectable epinephrine and expanded

immunity to include any authorized entity

that prescribes epinephrine, which encom-

passes first responders such as Emergency

Medical Services (EMS), firefighters, and

police officers.

Recommendations:Individuals who believe they may have

Alpha-gal allergy should contact their pri-

mary care physician’s office and consider

referral to an allergist for an appropriate

workup. given that tick bites do occur in

Arkansas, all physicians and medical pro-

fessionals in the state should be aware of

Alpha-gal allergy symptoms, risk factors,

diagnosis, and prevention. people with the

allergy should vigilantly avoid meat or meat

products, as well as tick bites. n


dialogue

columnpolicy

to acknowledge participants. Teams repre-

senting the House, Senate, and Governor’s

office have been formed, and individuals

may compete with each other as well. The

Capitol GO! Challenge offers a fun opportu-

nity to spotlight the value of physical activ-

ity in promoting healthier lifestyle choices.

Capitol GO! is essentially a steps challenge,

allowing the various teams and individuals

to compete for the highest average number

of steps per day, per participant. Participants

A new iniTiATive Of HAA, the Capitol

GO! Challenge, has invited state legislators

and the Governor’s office to support physi-

cal activity through friendly competition.

Legislators and others now have an oppor-

tunity to lead by example and participate

in efforts to bring some of HAA’s priority

areas to the forefront. Supported by the Ar-

kansas Center for Health improvement, the

challenge is being held during the legislative

session with an awards ceremony scheduled

Arkansas has the sixth highest adult obesity rate in the nation, according to The State of Obesity: Better Policies for a Healthier America, released in September 2016 by a collaborative project of the Trust for America’s Health and the Robert Wood Johnson Foundation. Specifically, the state’s current adult obesity rate is 34.5 percent, which has grown significantly since 2000 when it was 21.9 percent and 1995 when it was only 17 percent. This dramatic increase points to an equally urgent need for strategies to combat this obesity epidemic, which is a root cause of major health conditions affecting our citizens—heart disease, diabetes, hypertension, cancer, and more. Healthy Active Arkansas (HAA) was launched in 2015 as a Governor-endorsed framework for encouraging and enabling healthier

lifestyles in Arkansas to help fight this epidemic.

The CapiTol Go! ChallenGe:

A Great Opportunity to Move


Joseph W. Thompson, MD, MPHDirector, Arkansas center for Health Improvement

track their steps using mobile devices such

as a fitBit and log their progress on a mo-

bile app. A leaderboard updated on a weekly

basis is prominently displayed at the Arkan-

sas State Capitol building, recognizing team

rankings, average numbers of steps, and top

performers.

A resolution was adopted this year by the

Arkansas General Assembly that expresses

support for HAA and its nine priority areas.

The resolution supports a “health in all poli-

cies” approach for the legislature with the

specific goals of promoting healthy eating

and physical activity. The resolution, titled

“To Support efforts of the Healthy Active

Arkansas initiative in Combating Obesity

with a Systematic Statewide Strategy,” was

sponsored by Reps. Jeff wardlaw, R-Hermit-

age; DeeAnn vaught, R-Horatio; and Lanny

fite, R-Benton, and by Sens. Missy irvin, R-

Mountain view; and Trent Garner, R-el Do-

rado. The “health in all policies” concept is a

reminder that decisions made every day af-

fect our health—not only those about health,

but also how we design our communities

and build our roadways. By incorporating

health considerations into decision-making

across sectors and policy areas, it is intended

to ensure that decision-makers are informed

about the health, equity, and sustainability

consequences of various policy options as

decisions are made.

Sen. Missy irvin, a champion of the Capi-

tol GO! Challenge, says, “The Capitol GO!

Challenge is an excellent opportunity for

legislators and members of the Governor’s

office to lead by example in demonstrating

the importance and positive impact of the

Healthy Active Arkansas framework. As a

former professional classical/ballet dancer,

i know firsthand that being more physically

active throughout the day has a multitude

“By incorporating health considerations into decision-making across sectors and policy areas, it is intended to ensure that decision-makers are informed about the health, equity, and sustainability consequences of various policy options as decisions are made.”

of health benefits. The energy generated by

even mild exercise can lead to greater pro-

ductivity. when our population is healthier,

we have fewer strains on our health care

systems, leading to lower overall health care

costs for everyone. A healthier population

means a more productive workforce and

the type of workforce that is attractive to

prospective employers.”

Rep. wardlaw, another champion of the

Capitol GO! Challenge, has also voiced his

support. “i appreciate the competition be-

cause it motivates me to stay active during

the legislative session, when my usual ex-

ercise routine is disrupted while i’m away

from home. The challenge also helps curb

the negative health effects of eating out

more than usual or eating at odd times due

to my busy schedule serving as a lawmaker,”

says Rep. wardlaw.

The Blue and You fitness Challenge, now

in its thirteenth year, is another program

that puts the HAA framework into action.

The fitness challenge, a program of Arkan-

sas Blue Cross and Blue Shield and the Ar-

kansas Department of Health, is an annual,

three-month contest designed to encourage

physical activity. A leaderboard tracking this

year’s participation may be seen at www.

blueandyoufitnesschallenge-ark.com/prog-

ress.aspx. Although this year’s Blue and You

fitness Challenge is already underway, you

and your organization may establish an

employer or household challenge anytime.

Set your goals, identify participants, and get

going!

fitness challenges offer specific, focused

opportunities to boost physical activity and

promote healthy habits. Through the Capi-

tol GO! Challenge, our elected legislators

are leading in action and demonstrating the

need to improve the health of all Arkansans.

However, it is important to remember that

everyone is a policy maker in his or her own

right. even a trip to the grocery store is an

opportunity for us to “vote” with our dollars

to improve our health. Let’s carry forward

the momentum generated by community

challenges and legislative action by mak-

ing basic, potentially life-saving changes in

our daily exercise and dietary routines. The

ripple effect could help make Arkansas a

healthier, more productive, and more cost-

efficient place to live, work, and play. n

http://www.blueandyoufitnesschallenge-ark.com/progress.aspx




columnquality

“Medical” Marijuana coming to arkansas

In November 2016, Arkansas voters approved, by a several point mar-gin, a constitutional amendment to allow the cultivation, sale and use of marijuana for “medical” purposes. That was the easy part. Now the state has to implement the program, respecting the will of the voters.

ArtIcle VI, clAuse 2 of the united

states constitution is the “federal su-

premacy clause,” which makes federal

law the supreme law of the land, not to be

contradicted by any state law. Why start

an article on medical marijuana with a

constitutional law lesson, you might ask?

The fact is: federal law prohibits the

cultivation, sale or use of marijuana. The

Drug enforcement Agency lists marijua-

na as an illegal schedule I drug which,

per the Food and Drug Administration

(FDA), has no currently accepted medi-

cal use. The Obama Administration and

its Justice Department have for the past

few years chosen to ignore federal law

on the medical use of marijuana. In the

past couple of years, they have made no

efforts to prohibit states like colorado

and Washington from allowing the sale of

the drug for recreational purposes. All are

waiting to see if the new trump Adminis-

tration will enforce federal law that makes

no allowance for marijuana use, medical

or otherwise.

I’ve elected to put “medical” in quotes

because marijuana will not be treated like

a medicine in any traditional sense in Ar-

kansas, nor in most other states, because

of the conflict with federal law. The short

history of the country’s path to legal use

of marijuana began with the first failed ef-

fort on the california ballot in 1972; later

votes in california made such use legal.

today, counting Arkansas, “medical” mar-

ijuana is legal in 28 states and the District

of columbia (Dc), recreational use is legal

in seven of those states and the Dc. All of

this violates federal law.

It’s important to understand that in

Arkansas, “medical” marijuana use is not

just a law enacted by the General Assem-

bly, but a constitutional amendment that

allows “prescribed” marijuana use. This

amendment allows the General Assem-

bly to amend provisions by a two-thirds

vote. However, no amendment is possible

regarding the numbers of dispensaries

and cultivation facilities, and the Gener-

al Assembly cannot limit the legal use of

medical marijuana. The General Assembly

has deleted a provision of the amendment

that required physicians to provide writ-

ten certification that the potential health

benefits would outweigh the risks for the

patient. There is no established medical

standard for prescribing.


Ray HanleyPresident and cEo,

Arkansas Foundation for medical care

What is clear so far, following the rec-

ommendations of the newly created Med-

ical Marijuana commission, is that this

will be big business, and the price of en-

tering as a grower or dispenser will be ex-

pensive. The amendment allows between

four and eight growing facilities; the

commission opted to start at five. It will

cost $15,000 to apply for one of the five

licenses, plus a $100,000 annual license

fee and assets of $1 million or a surety

bond. In addition, applicants must show

they have $500,000 in working capital.

Without these funding streams, the state’s

revenue is limited to state and local sales

taxes, as prescribed in the amendment. It

is predicted that taxes and fees will fall far

short of the actual cost to administer the

program.

As to the dispensaries, the amend-

ment allows up to 40 but is starting with

32. licensed dispensers must pay an an-

nual license fee of between $10,000 and

$32,500, depending on whether the dis-

pensary chooses to cultivate up to 50

mature plants. All politics are local, and

there will be vigorous debates about

where growing facilities and dispensaries

can be located. counties and cities can

vote themselves “dry” and ban production

and dispensing. They can have regula-

tions about distance from churches and

schools, and other zoning regulations, if

the regulations are the same as those for a

licensed retail pharmacy.

Against the backdrop of the expensive

entry and operation of the new busi-

ness enterprise, is the fact that banks

can’t finance any of it or handle the large

amounts of cash generated. Federal bank-

ing law prohibits banks from having con-

tact with illegal enterprises. Additionally,

the state must conduct in-depth back-

ground, criminal, and other checks on

cultivation and dispensary applicants.

calling marijuana “medicine” is a bit of

a challenge when looking at the role phy-

sicians will play. Instead of a prescription,

physicians who choose to participate will

give the patient a letter certifying he or she

has one of the medical conditions spec-

ified in the law: cancer, glaucoma, HIV/

AIDs, Hepatitis c, lou Gehrig’s’ disease,

tourette’s syndrome, crohn’s disease, ul-

cerative colitis, post-traumatic stress dis-

order, severe arthritis, fibromyalgia and

Alzheimer’s disease. Additional certifiable

conditions include any chronic or debili-

tating disease that produces any of these

conditions: wasting syndrome, peripheral

neuropathy, intractable pain, severe nau-

sea, seizures, or muscle spasms as in mul-

tiple sclerosis. The Arkansas Department

of Health (ADH) can add to the allowable

conditions list and the public can also pe-

tition to add diseases or conditions.

Any discussion of medical marijuana

should include its effects and why pa-

tients might perceive a benefit. Inhaling

the smoke from a marijuana cigarette

provides rapid delivery of tetrahydrocan-

nabinol (tHc) to the brain. tHc is almost

immediately absorbed into blood plas-

ma with peak concentrations coming in

about 10 minutes. Knowing how it works

doesn’t begin to answer the questions

about safety and whether it does more

harm than good.

to obtain medical marijuana, the pa-

tient will take his or her letter to the ADH

and complete an application to obtain a

“registry identification card.” If the card is

granted, the patient will take the card to

a licensed dispensary to buy the marijua-

na at a price yet to be determined by the

market. It won’t be cheap; the Arkansas

Times predicts somewhere between $400

and $500 an ounce, more than the report-

ed current illegal street value. Keep in

mind that private insurance, Medicaid or

Medicare will not cover the drug because

it is not approved by the FDA.

Pharmacies are subject to governing

regulations and oversight, but they will

not be involved. Only growers and dis-

pensers who have the extensive means

to buy into the business will market mar-

ijuana. Because this arrangement is un-

avoidably loose, it will pose a substantial

risk of abuse.

Arkansas, alone in the south aside from

Florida, is about to enter into a complex

program, for a product illegal under fed-

eral law, that may or may not survive the

trump Administration and an Attorney

General nominee who has voiced past

opposition to legal marijuana. It’s merely

conjecture, but possible to make a guess

based on observations about what the

new administration will do. Aggressive

federal enforcement would, however,

conflict with the President’s philosophy

that the federal government should re-

turn power to states. Attorney General

nominee Jeff sessions will, I think, chal-

lenge congress to make medical marijua-

na legal if they want states to continue to

allow its sale and use. Odds are at least

even that, with 28 states allowing medi-

cal use, this would pass. I think there are

zero odds that congress would allow rec-

reational use. Whether or not Arkansas

is still a southern island in the “medical”

marijuana business a year from now re-

mains a very interesting question, even as

the state makes a good faith effort to carry

out the will of the voters. n


dialogue

columnMental HealtH

It’s ComplICated:Addictions

Addiction. It is, without a doubt, a complicated thing. Whether you call it “substance abuse,”

“addiction,” or “chemical dependency,” it is all the same, complicated thing that impacts mil-

lions of lives in the United States every year. Worldwide, the issue is even more severe, as it

impacts healthcare, jobs, productivity, crime, and so on in almost every developed country

in the world. An addiction to alcohol, drugs or other substances impacts not only the indi-

vidual but those around them in substantial ways. These are their stories!


JASON MILLER, CEOThe BridgeWay

“JAck” WAS A 39-yeAr old father of 3

who fell on hard times. He began smoking

at age 9 with his friends in the neighbor-

hood and was soon using illicit drugs on a

regular basis. He always turned to drugs for

his crutch to make it through a problem. He

spent tens of thousands of dollars on them,

but worked hard to hide his addiction from

everyone around. yet, when he was finally

treated, he realized almost everyone in his

circle knew he had a problem. Few of them

brought it up, and none of them pushed him

to get help. Jack got the help he needed, but

it was complicated…

“Brad” was a 20-year old college student

who was pushed by his family to be a suc-

cessful athlete. In high school when Brad

struggled with his grades, his teachers and

his family gave him a free “pass” as long as

he could throw that touchdown pass in the

game Friday night. Brad found it harder to

please everyone and began to drown his

growing depression in alcohol. Brad drank

almost every night of the week by the end

of his freshman year in college. His friends

failed to realize Brad was spiraling out of

control. Before Brad was even of legal drink-

ing age, he was already an alcoholic. He con-

templated suicide many times and continued

to drink until he was forced into rehab by

his quarterback coach. Brad found a way to

battle back through his addiction, but it was

complicated…

“Sherry” was a 58-year old mother and

grandmother who suffered from severe back

pain due to a motor vehicle accident 10 years

prior. Sherry visited physician after physician

for help, but was never able to remedy the

pain. even after back surgery, she still had

constant pain and continued to take nar-

cotics every day. When depression set in,

she added antidepressant medications. Her

life was impacted, as she became severely

addicted to the pain pills. She lost friends

and much of her life savings buying “black

market” opiates when her prescriptions

weren’t enough. And then she struggled to

find a psychiatrist in her small town when

her primary care physician could no lon-

ger treat her because of the addiction. She

received treatment, and continues to focus

on managing her pain through alternative

therapies. But it was complicated…

“Patrick” was a 61-year old divorcee who

struggled with alcohol all his life. Patrick

had been in and out of treatment facilities

in 3 different states since the age of 24. His

longest stint without drinking was for nearly

3 years, until his youngest son died in Iraq

and he divorced from his wife. life changed

often for Patrick, and alcohol always fol-

lowed those changes. His family tried to

help him, but never really knew what to do.

As such, he continued to spiral, and con-

tinues to drink heavily to this day. Patrick

was diagnosed with cirrhosis of the liver in

2016 and needs a liver transplant to survive.

While Patrick wants to stop drinking, it’s just

so complicated.

Addictions are very complicated. And un-

fortunately, the substances used by Brad,

Sherry, Jack, and Patrick are the same sub-

stances being used every day by our friends,

our family, our neighbors, our patients. Be-

cause we strive to reduce physical pain,

the use of opiates and other narcotics has

reached an all-time high in our society. And

because they are so prevalent, our children

are robbing our medicine cabinets to get

access to the “high” obtained from most

of these drugs. Alcohol is often recognized

more for its impact on drunk driving than on

the damage it causes to the body and mind.

Medications are often used as the first treat-

ment for anxiety or depression rather than

prescribing something non-addictive…like

therapy. And even though my generation

was raised in that “Just Say No” era, the use

of illicit drugs, like heroin, cocaine, and meth-

amphetamine is still very high in Arkansas

and the U.S.

like addiction, life is also complicated. We

have to work, take care of our families, attend

school functions for our kids, put food on

the table, pay our bills, and find a little time

to sleep. Who has the time to worry about

our problems, right? Moreover, who has

the time to even admit we (or a loved one)

might have a problem? do we “run the race”

so much that we forget to notice our addic-

tions or those of the people around us? Who

helped Jack or Brad or Sherry with their ad-

diction? did someone press them to call the

hospital or find them a therapist who could

help? These substances controlled their life,

causing physical, emotional, and financial

problems like nothing else they’d ever known.

Would we be there for them?

Substance abuse is complicated because

it is personal. No one is immune to the im-

pacts of addiction, whether as an individual,

a family member, or a tax-paying citizen. And

the moment we think otherwise, we leave

ourselves vulnerable to a complicated aspect

of life that needs attention like everything

else. Treatment is effective, yet challenging.

The problems are manageable, yet often feel

overwhelming. The symptoms are evident,

yet often overlooked because we are so fo-

cused on so many other things. The situation

is salvageable, yet we need to come together

to help those around us. reach out to some-

one who needs you. Ask for help if you need

it. don’t bury the issue or pretend it does not

exist. It’s complicated, but it’s ok. Help is of-

ten just a phone call away. My best to you. n

“do we ‘run the race’ so much that we forget to notice our addictions or those of the people around us?”


columnmedicaid

William Golden, MDArkansas medicaid medical Director

In response to the challenging economics of healthcare delivery and affordable insurance programs, there is an increased emphasis on providing effective health care. Utilization review and financial incentives seek to achieve greater steward-ship of available healthcare resources. This task is rather complex. As a result, the term Low Value Healthcare has become a new buzz phrase in health policy circles.

What exactly is Low Value Health-care?

One definition states that it reflects pro-vision of services that presents a higher likelihood of harm than benefit to a pa-tient. Harm could mean complications, misdiagnosis, overtesting, inconvenience, or financial burden to name just a few con-cepts. Identifying and reducing Low Value Healthcare constitute good talking points, but can actually be fairly subtle in devel-oping interventions to make a difference.

The American Board of Medical Special-ties launched its Choose Wisely campaign several years ago. It facilitated the identifi-cation by different specialty organizations in medicine of low value activities that should be curtailed or eliminated because of ineffectiveness in managing patient presentations. While the Choose Wisely campaign featured dozens of recommen-dations, many of the targeted items had previously been supplanted by modern management used by a majority of the clinicians. Nevertheless, there are several items of note such as:• Order only lipase and not amylase when as-

sessing acute pancreatitis (ASCP)

• Not removing ovaries of premenopausal

women during a routine hysterectomy (Am

Urogynecologic Soc.)

• Not screening for breast, colon, or prostate

cancer in patients with less than a 10-year

life expectancy (AMDA)

• Not performing PAP smears in low-risk

women over the age of 65 or after total hys-

terectomy for benign disease. (Am. College

of Preventive Medicine)

• Order only a TSH in the initial evaluation

of thyroid disease and avoid other testing

The Challenge of low Value healThCare(ASCP)

• Do not routinely screen for prostate can-

cer with a PSA or digital rectal examination

(AAFP)

• Avoid fluoroquinolones as first line therapy

for routine urinary tract infections (Am Ur-

ogynecologic Society)

Commonality between physicians and patientsPhysicians and patients both contribute to low value care. Numerous studies and per-formance measures speak against sleeping pills for the average patient, particularly older individuals. Nevertheless, patient demand, pharmaceutical marketing and time constraints coalesce to sustain the prescribing practice. It is not easy to stop sleeping pills in patients who have been users for many years. The best approach is to refrain from initiating new usage or to limit the chronicity of the medication in patients with new requests for support.

Another way of identifying potential Low Value Healthcare is to study prac-tice variation. For example, in Arkansas the use of urine cultures for ambulatory urinary tract infections in the emergency room varies from 10 percent of cases to 90 percent depending on which ED a patient visits. There is an obvious lack of consen-sus about the appropriate use of such test-ing with the potential for unnecessary use of resources and financial payments for avoidable testing. More complex examples of practice variation include: the use of echocardiography, coronary angiography, chemotherapy for cancer, genetic testing, and various forms of physical and behav-ioral therapy.

Practice variation will be the main

theme of future health care budgeting. Insurance premiums will continue to rise without a more effective health care sys-tem. Financial incentives built into the payments for hospitals and health profes-sionals to manage efficient patient presen-tations will cause individual providers to study their routines to limit low value in-terventions. Reduced use of pathology for tonsillectomy and inpatient rehabilitation after total joint replacement are examples of new decision-making by clinicians in response to financial incentives rewarding more effective health care.

The patient’s best interest Ultimately, patients will be the benefi-

ciary of a decreased amount of low value care. Successful programs will reduce their out-of-pocket costs and sustain affordable insurance programs.

However, identifying low value care and implementing the mechanisms to change ingrained clinical behavior is difficult. Pa-tient expectations and clinical routine can be resistant to new approaches to common problems. It will take considerable flexibil-ity and creativity to make a difference. Yet, if we’re able to succeed, our communities will have efficient, safer, and better care in the future. http://www.choosingwisely.org/. n

Bill Golden, MD, Professor of Medicine at UAMS, who holds a secondary appointment in the COPH Department of Health Policy and Management, has been appointed to serve as a member of the guiding committee for the na-tional Health Care Payment Learning and Action Network. Dr. Golden, who has been a leader in state and national efforts to move towards pay-ment models that emphasize value over volume, also serves as Medicaid Medical Director for the Arkansas Department of Human Services.

http://www.choosingwisely.org/

http://www.choosingwisely.org/


HospitalRounds

H o s p i ta l n e w s a n d i n f o r m at i o n

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Hospital Rounds

difference in the healing process.

also, joining the Board are:

•ThadHardin,MD,aFamilyPracticephysician

withBanister-LieblongClinicandaphysicianon

themedicalstaffatConwayRegionalMedical

Center.

•JeffD.Standridge,recentlyretiredVicePresi-

dentofAudienceSolutionswithAcxiomand

thefounderofCadronCreekCapitalandteam

leader of the Conductor initiative.

Greg Kendrick, md, is the new Chief of staff for

theConwayRegionalmedicalstaff,whichnum-

bersmorethan200physicians.Dr.Kendrick,an

internalmedicinespecialist,isthemedicaldirector

oftheHospitalistprogramatConwayRegional.

HesucceedsJamesFrance,MD,aurologistwith

ConwayUrology.

Dr.Williamswill remainontheBoardand is

joinedbyAndreaWoods,JD,ViceChairman;

AndrewCole,MD;TomPoe,WayneCox,and

JimRankin,Jr.

TwomembershavedepartedfromtheBoard:

•JackEngelkes,aCPAandmanagingpartnerin

theaccountingfirmofEngelkes,Connerand

Davis,Ltd.,completedtwosix-year terms in

December.HejoinedtheBoardin2005.

•BartThroneberry,MD,afamilypracticephysi-

cianinConway,servedeightyearsandremains

anactivememberoftheConwayRegionalMed-

ical staff.

Head and Neck Surgeon Joins UAMSHead and neck surgeon Chelsey Warmack

Smith,MD,hasjoinedtheUniversityofArkansas

forMedicalSciences(UAMS).Sheseespatients

intheHeadandNeckCancerClinicintheUAMS

leadershipteam,includingPresidentandCEO

matt troup.

Troup,whohasworkedwithDr.Williamsfor18

months,expressedhisappreciationofherservice

aschairmanoftheBoard,inparticulartheroleshe

playedinConwayRegional’smanagementagree-

mentwithCHI-St.Vincent.

Inadditiontothemanagementagreement,Dr.

WilliamsledtheBoardintakinganumberofstra-

tegicactionsoverthepasttwoyearstoimprove

howConwayRegionalprovidescaretothecom-

munityincluding:

•$5.8millioninimprovementstothemedicalcen-

ter that included a facelift for the patient care

floors, lobbies and the er waiting area.

•Morethan$4millionincapitalimprovements

including a new Ct scanner, a new cardiac

catheterization laboratory, renovationof the

gastroenterologylab,andtheadditionof3D

mammography.

•AdditionoftwoprimarycareclinicsinConway

andPottsvilleaswellasestablishingtheConway

regional Cardiovascular Clinic

in addition to his duties at true Holiness saints

CenterandatConwayRegional,Rev.Maltbiahas

beenappointedbyGov.AsaHutchinsontothe

UniversityofCentralArkansasBoardofTrustees.

troup added, “Cornell can bridge a lot of rela-

tionships because he is so well-known and well

respectedbysomanypeople,notjustinConway

but throughout the state.”

Rev.MaltbiajoinedtheConwayRegionalBoard

in2010afterservingonthehealthsystem’sCom-

munityAdvisoryBoardforseveralyears.Hehas

spentmanyhoursat thehospitalwithchurch

membersandfamiliesandhasobservedhowthe

staff’sattitudeandprofessionalismhasmadea

Day at the Races to Benefit Cancer Institute Youareinvitedtoenjoyadayofthoroughbred

racing while also supporting cancer patients at

the winthrop p. rockefeller Cancer institute at

theUniversityofArkansasforMedicalSciences

(UAMS).

DayattheRacesissetfor11:30a.m.March16

atOaklawnJockeyClubinHotSprings.Guests

willenjoylunchandanafternoonofthorough-

bredracing.Ticketsare$50perpersonandcan

bepurchasedatwww.giving.uams.edu/dayat-

theracesorbycalling(501)526-2277.Seatingis

limited,andparkingisavailableintheparkinglot

near the north entrance.

HonorarychairsfortheeventareCharleenand

EdCopeland.Hosts areBernardCluck,Beryl

Cumberworth and honorary member Elaine

Gartenberg.

Maltbia to Chair Conway Regional Board of Directors

rev. Cornell maltbia, the pastor and founder of

TrueHolinessSaintsCenterinConway,isthenew

chairmanoftheBoardofDirectorsforConway

RegionalHealthSystem.

HesucceedsBarbaraWilliams,PhD,RN,the

recently retiredchairmanof theUCADepart-

ment ofNursing, who completed a two-year

termaschairmanoftheConwayRegionalBoard

inDecember.

TheConwayRegional BoardofDirectors is

madeupof10volunteersfromthecommunity

whoservestaggered,six-yearterms.TheBoard

approves the budget and strategic direction of

thenot-for-profithealthsystembasedontherec-

ommendationsofConwayRegional’sexecutive

Rev. Cornell Maltbia Thad Hardin, MD Jeff D. Standridge Greg Kendrick, MD

http://giving.uams.edu/s/1496/16/interior.aspx?sid=1496&pgid=1300&gid=1&cid=3331&ecid=3331&post_id=0

http://giving.uams.edu/s/1496/16/interior.aspx?sid=1496&pgid=1300&gid=1&cid=3331&ecid=3331&post_id=0


ForweeklyeNews updates and to read the journal online, visit HealthcareJournalLR.com

winthrop p. rockefeller Cancer institute and the

Ear,NoseandThroatClinicintheUAMSJack-

son t. stephens spine & neurosciences institute.

Smith isanassistantprofessor in theUAMS

CollegeofMedicineDepartmentofOtolaryn-

gology–HeadandNeckSurgery.Herspecialties

includevascularanomalies,facialpain,sinusdis-

ease,throatdisorders,allergies,head/neckcan-

cer, and sleep disorders.

ShecompletedherundergraduateattheUni-

versity of Arkansas at Fayetteville where she

playedvolleyballfortheLadyRazorbacks.After

earninghermedicaldegreefromtheUAMSCol-

legeofMedicine,Smithcompletedherresidency

andservedasassistantattendingphysicianofoto-

laryngology–headandnecksurgeryattheUni-

versityofOklahomaHealthSciencesCenter.

SheisamemberoftheAmericanAcademyof

Otolaryngology–HeadandNeckSurgeryand

hasservedonitsnationalcommitteesforplastic

andreconstructivesurgeryandmediaandpub-

lic relations.

Endeavor Foundation Commits $2 Million to Arkansas Children’s NorthwestEndeavorFoundationhasdonated$2million

to Arkansas Children’s Northwest (ACNW) in

springdale. the gift will ensure aCnw can pro-

videessentialprogramsimmediately,andeffec-

tivelydelivercomprehensive,family-centeredcare

closetohomeforeverychildwhoneedsit.

ArkansasChildren’shasa100-yearhistoryof

caringforthestate’smostvulnerablechildren.

Theorganizationtreatseverychild–regardlessof

theirabilitytopay.Eachyear,ArkansasChildren’s

spendsmillionsofdollarsmeetingtheneedsof

childrenwhosefamiliesareunderinsured,unin-

sured, or whose parents are not in a position to

fundtheircare.Thiscommitmentbreaksdown

significant barriers to receiving healthcare.

Children’s hospitals are unique in that they

deliverfamily-centeredcare,includingcaregivers

aspartofachild’shealthcareteamandsupporting

theentirefamilyinavarietyofways.Criticalpro-

grams—likefinancialcounseling,volunteerser-

vices,andpastoralandpalliativecare—areessen-

tialcomponentsoffamily-centeredcareandare

hallmarksofArkansasChildren’s.Suchservices

arekeytoprovidingahealthiertomorrowforthe

children of northwest arkansas.

Whilecriticaltothemissionofachildren’shos-

pital,theseprogramsdonotgeneraterevenue.

ThegrantfromEndeavorwillhelpcoverthecosts

offamily-centeredprogramsandservicessothat

thechildrenofNorthwestArkansaswillhavecom-

prehensivepediatriccareclosetohome.Addi-

tionally,amodestportionofthegiftwillfundan

assessmenttoevaluatetheimpactofproviding

familyservicesasanintegratedpartofthehealth-

care plan.

EndeavorFoundationmakesgrantsthataddress

the common needs of Northwest Arkansas

throughinnovativethinkingandlongtermsolu-

tions.Thisincludesimprovingaccesstoresources

forindividualsandfamilieswhostrugglewithbasic

needs, such as healthcare.

WhenitopensinJanuary2018,ArkansasChil-

dren’sNorthwestwillbetheregion’sfirstandonly

comprehensivepediatrichealthcarecenterand

will include:

•24inpatientbedstocareforchildrenrequir-

ingovernightstays

•24-hourpediatricEmergencyDepartment

•Pediatricsurgeryunitwith5operatingrooms

•Anoutpatientclinicwith30examroomssupport-

ingmorethan20subspecialtyareasandagen-

eral pediatric clinic

•Afullrangeofancillaryanddiagnosticservices,

child-life and pastoral care

•Outdoorgardens,naturetrails,andinteractive

features designed for children

•AhelipadandrefuelingstationsupportingAngel

One,oneofthenation’sleadingpediatricinten-

sivecaretransportserviceswithmorethan2,000

transportsannually.

InAugust2016,ArkansasChildren’sannounced

apubliccampaigntoraisefundsforArkansasChil-

dren’sNorthwest.Todate,thecampaignhascel-

ebratedpublically$57millioninpledges.Arkan-

sasChildren’shasannouncedthefollowinggiftsas

partoftheCareClosetoHomecampaign:

•TysonFamilyandTysonFoods,Inc.,$15million

•WalmartandWalmartFoundation,$8million

•RobinandGaryGeorge,CathyandDavidEvans

andtheirfamilies,$7.5million

•J.B.HuntTransportServices,Inc.,$5million

•WillGolfforKidsandColorofHope,$5million

•WaltonFamilyFoundation,$3million

•FadilBayyariFamily,$1million

•CynthiaandKirkDupps,$1million

•RobinandGaryGeorge,$1million

•TheestateofMildredandJarrellGray,$1million

•KarenandDarrenHorton,$1million

•J.B.andJohnelleHuntFamily,$1million

•PremierConcepts,Inc.,$1million

•SchmiedingFoundation,$1million

•CentralStatesManufacturing,$250,000

•Bikes,BluesandBBQ,$200,000

•BlackHillsEnergy,$100,000

Thegrant fromEndeavorFoundation is the

firstprogramminggiftannouncedbyArkansas

Children’s.

Baptist Health Urgent Care Center Holds Open House BaptistHealthinvitedthecommunitytoanopen

houseforBaptistHealthUrgentCare-Jackson-

ville–itslatestinvestmentinprovidingurgentand

familycare,aswellaswellnessservices,onawalk-

in basis to residents of central arkansas.

BaptistHealthUrgentCare-Jacksonville,which

islocatedat1813T.P.WhiteDriveacrossHigh-

way167fromWal-MartinJacksonville,officially

openedJan.30.Dr.ChadSherwoodandnurse

practitionerPamelaSpeedaretheprimarycare

providersatthecenter.Dr.Sherwoodcurrently

servesasUrgentTeam’sChiefMedicalOfficerin

Arkansas.Speedhasmorethan25yearsofexperi-

enceinruralhealthcareandmostrecentlyworked

atSherwoodUrgentCareinSearcy,anaffiliateof

UrgentTeam.

the new urgent care center will provide con-

venient access to care as well as support Baptist

Healthphysicianswhoseektoprovideanafter-

hoursoptiontotheirpatients.Urgentcareisalso

quickerandlessexpensivethananemergency

Chelsey Warmack Smith, MD


Hospital Rounds

throughouttheUnitedStatesthatimplementour

infantsafesleepprogramintheircommunities.

Nutrition Director Joins Conway RegionalLoriDather,RDN,LD,ofConway isthenew

director of Nutritional Services for Conway

RegionalHealthSystem.AsdirectorofNutri-

tionServices,sheoversees40employeesinclud-

ing cooks, registered dietitians, cashiers, servers,

aides, supervisors, and assistants.

Datherbrings27yearsofexperienceinvarious

managementandclinicalservicestotheposi-

tion.Datherhassomechangesplanned,thefirst

ofwhichisthepurchaseoftheJasperzJavacoffee

shopadjacenttotheConwayRegionalGiftShop.

Shehasbegunacontesttorenamethecoffee

shop,whichremainsopenfrom6:30amto2:30

pm,weekdays.

DathercomestoConwayRegionalafterwork-

ing in a health and wellness position with midwest

DairyCouncil.Priortothat,shewasthedirector

of nutrition services for the arkansas state Hospi-

tal in little rock.

a native of south dakota, dather holds a bach-

elor’sdegreeindieteticsfromSouthDakotaState

University.Sheandherhusband,Darren,have

sevenchildren,allofwhomareattendingorhave

attendedConwayschools.Datherisanavidrun-

nerwhoseexperiencesincludea50-miletrailrace

andmultiplemarathons.

Shoulder Specialist Charles Pearce Joins UAMS

Charles “Chuck” pearce, md, has joined the

University of Arkansas for Medical Sciences

(UAMS)asanorthopaedicsportsmedicinesur-

geonspecializinginshoulderproblems.Hewill

seepatientsattheUAMSOrthopaedicClinicon

shackleford road. He is also an assistant profes-

sorintheDepartmentofOrthopaedicSurgeryin

theUAMSCollegeofMedicine.

Pearceisexperiencedinperformingminimally

invasive shoulder and knee surgeries in which a

tinycameracalledanarthroscopeisinsertedinto

thejointthroughasmallincision,therebyavoid-

ingtraditionalopensurgery.Hetreatsconditions

like rotator cuff tears and knee tears like those

to themeniscusor anterior cruciate ligament

(ACL),conditionscommoninsportsandworkers’

NationalSafeSleepHospitalcertificationprogram

asaGoldCertifiedSafeSleepChampion.

WhenfamiliesvisitArkansasChildren’s,theycan

be sure their newborns are sleeping in the saf-

estmannerpossible.Parents,grandparents,and

support networks also have resources at arkansas

Children’stolearnhowtomakesurebabiessleep

safelyathome.

As a Gold Certified Safe Sleep Champion,

ArkansasChildren’sHospitalhasmadethefol-

lowingcommitments:

•Developandmaintainasafesleeppolicyforall

infants visiting the hospital.

•Ensuresafesleeptrainingforstaffwhoworkon

allunitsservinginfantsandchildrenunderayear

old.

•Provideinfantsafesleepeducationtothepar-

ents of all infants prior to discharge.

•Use safe wearable blankets in the Neona-

talIntensiveCareUnitandotherareaswhere

babies sleep.

•Performregularauditstoshowprogressand

report success using the Crib for Kids checklist

tool.

•Conductoutreachactivitiesinthecommunity

related to safe sleep.

•AffiliatewithorbecomeaCribsforKidsPartner.

“Whatismorepreciousthanasleepingnew-

born?”saidMaryAitken,MD,medicaldirectorof

theInjuryPreventionCenteratArkansasChildren’s

HospitalandaprofessorofPediatricsattheUni-

versityofArkansasforMedicalSciences(UAMS)

CollegeofMedicine.“Itisourcommitmentto

putchildrenfirstfromthemomenttheyjointhe

world.BysettingtheexampleasaGoldCertified

SafeSleepChampion,ourteamishelpingfami-

liescreateahealthiertomorrowfromDayOne.”

EveryyearintheU.S.,thereareapproximately

3,500infantsleep-relateddeathsduetoacciden-

talsuffocation,strangulation,orundetermined

causes during sleep.

Since1998,CribsforKids®hasbeenmakingan

impactontheratesofbabiesdyingofacciden-

tal, sleep-related death in unsafe sleeping envi-

ronmentsbyeducatingparentsandcaregiverson

theimportanceofpracticingsafesleepforinfants,

andbyprovidingGraco®Pack‘nPlay® portable

cribstofamilieswho,otherwise,cannotafforda

safe place for their babies to sleep. Cribs for Kids®

currentlyhasmorethan600 licensedpartners

roomforreceivingcareforpainorconditionsthat

arenonlife-threatening.Withnoappointment

needed, patients are seen on a walk-in basis for a

varietyofmedicalneeds.

Arkansas Heart Hospital Welcomes Bledsoe

arkansas Heart Hospital is pleased to announce

anewpartnershipwithDr.SamuelBledsoe.Dr.

Bledsoe, a board-certified bariatric surgeon will

lead the Bariatric and metabolic institute at

arkansas Heart Hospital.

Before joining arkansas Heart Hospital, dr.

Bledsoe served as the medical director for Bar-

iatricSurgeryatChristusCabriniMedicalCen-

terinAlexandria,Louisianawherehecompleted

morethanathousandsuccessfulbariatricsurger-

ies. He served in several other leadership posi-

tions at his hospital including the section Chief

ofSurgeryandtheMedicalExecutiveCommit-

tee.Hehasalsoauthoredmanyjournalarticles

and book chapters in the field of bariatric and lap-

aroscopicsurgery.

dr. Bledsoe, md, faCs, fasmBs is a board cer-

tified general and bariatric surgeon. He is a fellow

oftheAmericanSocietyforMetabolicandBariat-

ricSurgeryandaFellowoftheAmericanCollege

ofSurgeons.Heholdsadditionalmembershipin

theSoutheasternSurgicalSocietyandtheSoci-

etyofAmericanGastrointestinalandEndoscopic

Surgeons(SAGES).

Arkansas Children’s Named a Gold Certified Safe Sleep Champion ArkansasChildren’sHospitaliscommittedto

ensuringbabiessleepsafely.ArkansasChildren’s

wasrecognizedrecentlybytheCribsforKids®

Samuel Bledsoe, MD


ForweeklyeNews updates and to read the journal online, visit HealthcareJournalLR.com

compensationinjuries.

PearceearnedhismedicaldegreeatUAMS,

wherehealsoservedhisresidencyinorthopae-

dicsurgery.Hecompletedfellowshiptrainingat

san antonio orthopaedic Group in san antonio.

HehasbeenpracticinginLittleRockfor28years.

HegraduatedfromFayettevilleHighSchooland

earnedhisundergraduatedegreeinchemistry

fromtheUniversityofArkansasatFayetteville.

PearceisamemberoftheAmericanAcademy

ofOrthopaedicSurgeons,theAmericanBoard

ofOrthopaedicSurgeryRecertification,Arkansas

MedicalSociety,SouthernMedicalAssociation,

SouthernOrthopaedicAssociation,Arthroscopy

AssociationofNorthAmerica,andMid-America

orthopaedic association.

Hand Surgeon Frazier Joins UAMS G.ThomasFrazierJr.,MD,hasjoinedtheUni-

versityofArkansasforMedicalSciences(UAMS)

asahandandupperextremitysurgeon.Hewill

seepatientsattheUAMSOrthopaedicClinicon

shackleford road. He is also an assistant profes-

sorintheDepartmentofOrthopaedicSurgeryin

theUAMSCollegeofMedicine.

Frazierspecializesinhandandmicrosurgeryand

hasaspecialinterestinjointreplacementofthe

hand,wristandelbow,andjointarthroscopyfor

theelbowandwrist,minimallyinvasivesurgeries

inwhichatinycameraisinsertedintothejoint

throughasmallincision,therebyavoidingtradi-

tionalopensurgery.

FrazierisboardcertifiedbytheAmericanBoard

ofOrthopaedicSurgeryandtheAmericanAcad-

emyofOrthopedicSurgeons,withacertificateof

addedqualificationsinhandsurgery.

Frazier is a member of the Southern

orthopaedic association, arkansas orthopaedic

Society,ArkansasMedicalSociety,PulaskiCounty

MedicalSociety,AmericanAcademyofOrthopae-

dicSurgery,ArkansasHandClub,Mid-America

OrthopaedicAssociationandAmericanSociety

forSurgeryoftheHand.

Conway Regional Welcomes New HospitalistBrandyL.Utter,MD,hasjoinedthehospital-

iststaffatConwayRegionalHealthSystem.Utter

most recently practiced atUnityHealthAfter

HoursClinicinSearcy.

AnativeofMarmaduke,Ark.,Utterholdsamed-

icaldegreefromUAMSinLittleRockandabach-

elor’sdegreeinBiology/PreMedfromOuachita

BaptistUniversityinArkadelphia.Shecompleted

a three-year residency in FamilyMedicine at

WakeForestUniversityinWinston-Salem,North

Carolina.

UtterjoinedateamoftenhospitalistsatCon-

wayRegional.Whilehospitalistsdonotmaintain

aprivatepractice,thesephysicianstakecareof

patientsexclusivelywhiletheyarehospitalized

and work in partnership to provide follow-up with

thepatient’sprimarycarephysician.

Baptist Health Hosts Open House Tocelebratethereopeningofthenewlyremod-

eled Gathright medical plaza located adjacent to

Baptist Health medical Center-arkadelphia, Bap-

tistHealthhostedacommunity-widedrop-inopen

houseonTuesday,March7.

Residentswereinvitedtotourthefacilityafter

theribbon-cuttingceremonyandmeetthepro-

viders and the clinic staff that will be located in the

medicalofficebuilding.

Locatedat2913CypressRoad,theGathright

medical plaza houses the arkadelphia medi-

cal Clinic-a Baptist Health affiliate with provid-

ersDrs.BryanMcDonnellandNolandHagood

and advanced practice registered nurses Char-

ityLowdermilk,EmilyMoore,andDeniseHeard;

Baptist Health surgical and orthopedic Clinic

withDr.KevinMcLeod;andBaptistHealthNeu-

rosurgeryArkansassatelliteclinicwithDr.Jona-

than reding.

UAMS Offers Freedom from Smoking Program Anyonereadytoquitsmokingisinvitedtopar-

ticipateinafreeseven-weekprogramattheUni-

versityofArkansasforMedicalSciences(UAMS).

The small-group Freedom from Smoking

programwillmeet from4-5:30p.m. forseven

WednesdaysbeginningMarch8inroom10104on

the10thflooroftheUAMSWinthropP.Rockefeller

Cancer institute. there is no cost to participate.

participants receive one-on-one support, hear

first-handstoriesfromformersmokers,andget

informationonnicotinereplacementtherapies,

healthyeatinghabits,andstressmanagement.

SinceitwasintroducedbytheAmericanLung

Association(ALA)almost30yearsago,theFree-

domFromSmokingprogramhashelpedmore

thanamillionAmericansendtheiraddictionto

nicotine.TheprogramisofferedbytheUAMS

winthrop p. rockefeller Cancer institute and uses

materialsprovidedbytheALA.n

Lori Dather, RDN, LD Charles “Chuck” Pearce, MD G. Thomas Frazier Jr., MD

http://uamshealth.com/orthopedicswlr/

http://uamshealth.com/orthopedicswlr/


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