Arkansas Medical News March-April 2016

FOCUS TOPICS ONCOLOGY • ORTHOPEDICS • BEHAVIORAL HEALTH

March/April December 2016 2009 >> $5

PHYSICIAN SPOTLIGHT PAGE 3

David Hays, MD

College of the Ouachitas Print Farm Manufactures Robohands for Children

ON ROUNDS

By BECKy GILLETTE

Behavioral Health Providers Offering Wide Range of Innovative Services

Arkansas Facilities Providing Compassionate, Effective Care Throughout Arkansas, healthcare providers are innovatively adapting to the challenges of providing behavioral health services that run the gamut from caring for the severely mentally ill in hospitals to providing an Employee Assistance Program (EAP) used by businesses to include counseling in benefits packages ... 4

Demand for Joint Replacement Surgery Expected to Increase Fourfold

Today’s Artificial Joints May Last Longer Than in the Past Hip and knee replacement is one of the fastest growing areas of surgery. In 1980 there were only about 100,000 knee and hip replacements in the U.S., compared to about one million in 2013 ... 7

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3D Printing Creates Robohand for 17-Year-Old Girl Samantha Kimbrough of Hickory Plains was born without a right hand. She had a prosthetic hand starting at age four until she came home in the second grade one day crying and threw the hand across the room saying she would never wear it again.

“After a long evening of prying out of her why she’d not wear it again, she stopped crying long enough to tell me that the kids had called her robohand,” said her mother, Melody Kimbrough. “Many people after that time offered to help her get a prosthetic, but she would refuse. Then in the summer of 2015 prior to her senior year in high school, x-rays showed new bone growth that would enhance use of an artificial hand.”

After that good news, her occupational therapist, Mark Ellis, asked her if she had ever heard of a new 3D print program for kids like her called Robohand. Amazed at the coincidence between the name of the device and what kids had called her in school, Samantha and her mom both got chills and said at the same time, “It’s a God thing!”

Michael Karr is shown helping Samantha Kimbrough try on her new hand made from parts printed on a 3D printer at the College of the Ouachitas.

(CONTINUED ON PAGE 8)

HealthcareLeader

Combined Force of 4,300 Physician Members has Big Impact G. Edward Bryant, Jr., MD, President, Arkansas Medical Society

By BECKy GILLETTE

When it comes to the greatest challenges facing physicians, whether it be excessive documentation required by government programs, insurance companies that attempt to unfairly deny payments, or bad legislation, one physician alone can’t accomplish much. But the combined clout of 4,300 physicians who are members of the Arkansas Medical Society (AMS) has a huge impact, said AMS President G. Edward Bryant, Jr., MD, an ophthalmologist practicing in West Memphis.

“Physicians in the state know what a good job we are doing, (CONTINUED ON PAGE 6)

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PhysicianSpotlight

Enhanced Offerings at Newly Opened CARTI Cancer Center Includes Interventional Oncology Specialist David Hays, MD, Joins Staff at $90 Million Center

By BECKY GILLETTE

LITTLE ROCK--The $90-million CARTI Cancer Center was the largest construction project in Arkansas for two years before opening in November 2015. The world-class facility anchors a statewide network of satellite clinics, and employs 465 people. Recently CARTI brought Interventional Oncologist David Hays, MD, to the team, which provides patients access to minimally invasive, targeted treatments for cancer. That adds to the three other oncological modalities used at CARTI in the treatment of cancer: surgical, medical and radiation.

Hays said the ability to provide all treatments within one facility is physically, emotionally and financially beneficial to the patient. Providing comprehensive access to cancer treatment improves the quality of care due to the proximity of the specialists. CARTI provides nearly the entire gamut of minimally invasive procedures in the outpatient setting. It is the largest not-for-profit network of private practice cancer care specialists in Arkansas, and currently sees an estimated 20,000 patients per year.

Hays said as his practice of interventional radiology developed and expanded, interventional oncology (IO) began to encompass the largest component of his practice.

“I had always enjoyed the procedural components of IO, but I really became invested in the patients and with their families,” Hays said. “When the opportunity came up to practice full-time IO at the new CARTI Cancer Center, I could not pass it up.”

Hays said IO improves the treatment of cancer patients by providing services that in many cases can be performed in a much less invasive manner and with image guidance. This would include biopsies, venous access (including Infusaport Placement), as well local tumor treatments such as tumor ablations, and chemoembolizations. Cancer patients can also require a number of procedures that IO is well equipped for, such as fluid drainages, and feeding tube placements.

Many of the treatments provided by IO are palliative. But Hays said there is growing evidence that significant improvements in survival do occur when these techniques are combined with the appropriate conventional cancer therapies.

“Several of the IO procedures have actually been incorporated into treatment

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guidelines developed by the National Comprehensive Cancer Network,” Hays said. “As IO techniques improve and become more accepted and sought after, the number of IO physicians will have to continue to grow.”

Hays sees important advances on the horizon, improvements in not only the procedures and techniques used, but also in the devices and imaging equipment used to perform the procedures. Those are continually changing and advancing.

A promising new treatment for liver cancer is radioembolization (Y-90), a minimally invasive procedure that combines embolization and radiation therapy. There haven’t yet been any patients treated with Y-90 at the CARTI Cancer Center.

“Currently there is no billing code for this procedure to be done at an outpatient center such as ours,” Hays said. “But as soon as they do exist, we will certainly start. We are one of the few facilities considered that has the infrastructure to provide the complete spectrum of procedures included in this therapy.”

Hays is well respected by patients and co-workers.

“Dr. Hays is friendly and approachable,” said colleague Dorothy Staggs, transcriptionist. “He makes me feel appreciated and that makes me want to work even harder to make his day as easy as I

can.”

Tanya Owen, radiology assistant, said it is a pleasure working with him.

“Dr. Hays has an easy going personality and a comforting presence,” Owen said. “His wealth of knowledge and insight gives him sophistication to go along with his abundance of humility. We are thrilled to have him as a colleague.”

Hays, a native of Little Rock, got interested in practicing medicine after taking an undergraduate anatomy/physiology course and realizing that he had a real knack for anatomy.

“That piqued my interest in studying the human body which went on to grow into my pursuing medicine as a career,” he said.

Hays and his wife, Cindy, have been married 33 years and have two girls and three boys. They also have three grandchildren and are expecting a fourth. In addition to golfing, he lists as a hobby taking care of the baseball field at his children’s high school.

“A great deal of my free time has been devoted to chasing my kids around at their athletic events,” Hays said.

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LETTER TO THE EDITOR I was shocked, dismayed, angered and in disbelief after reading your article “Naturopathic Doctors Advocate Licensure in Arkansas” (Sept./Oct. 2015) To be brief, because I could write volumes on this, Arkansas medicine has come a long way from the 19th century in discarding bleeding, leeches, snake oil, goat gland surgery for male impotence, etc.

As a medical student, I did not even know of the existence of “naturopaths” until on my neurosurgical rotation I received a patient from north Arkansas. He had been “treated” for many months by a naturopath for a scalp infection. By the time he arrived to us, the fungal infection was the size of a tennis ball and had eroded well into his calvarium.

Everyone can make mistakes, but this was absurd beyond belief. The patient finally went to a real doctor who then referred him to UAMS. A litmus test for quackery is advocating that water can cure or improve diseases beyond an expected placebo effect. That is exactly what homeopathy proposes. The greater the dilutions, the more effect the product is supposed to have. Some claim the water has “memory” which has been thoroughly debunked.

We need “evidenced-based medicine” – showing beneficial cost effective results, and NOT a return to the 19th century.

Now, I think I will try to calm my boiling blood. AMN can do better.

Thank you, Jim Cherry, MD Fayetteville, AR Please send comments or letters to pharris@medicalnewsinc.com

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MARCH/APRIL 2016

Behavioral Health Providers Offering Wide Range of Innovative Services

Arkansas Facilities Providing Compassionate, Effective Care

By BECKy GILLETTE

Throughout Arkansas, healthcare providers are innovatively adapting to the challenges of providing behavioral health services that run the gamut from caring for the severely mentally ill in hospitals to providing an Employee Assistance Program (EAP) used by businesses to include counseling in benefits packages.

Psychiatrists are in short supply, particularly in rural areas, which makes staffing for behavioral health services challenging.

“As the need for inpatient psychiatric care grows, we are finding it more difficult to find psychiatrists who are interested in practicing as an in-patient care provider,” said Bob Burchfield, system director of Behavioral Services at Baptist Health, which has 19 psychiatric intensive care beds and 16 geBob Burchfield riatric beds at their Little Rock facilities, 24 adult beds at their Malvern Hospital (Baptist Health- Hot Spring County), and eight beds at their geriatric unit in Baptist Health-Stuttgart.

“We have addressed this by employing physicians and mid-level practitioners (APN’s and PA’s). We are able to offer predictable income for our practitioners and allow them to focus on treating patients without the hassle of having to navigate through the ever-changing regs regarding billing for services. They report the stable income, along with health insurance benefits, retirement, and paid time off as real benefits for being a staff psychiatrist here at Baptist Health.”

Burchfield said they are facing the same on-going challenges as other providers meeting the needs.

“We are all competing for the few spots available,” he said. “Couple that with the few beds available at the Arkansas State Hospital, and we find ourselves struggling to get patients to the most appropriate care, especially those with chronic mental illness. We are exploring new ways for patients to access care by the use of new technology, particularly telemedicine. We hope this will get our patients plugged in to outpatient care more readily available through this new technology. It really is incredible, the possibility to reach those who need help, but find themselves in rural areas with little or no outpatient services.”

The UAMS Psychiatric Research Institute (PRI) is one of nine facilities of its kind in the U.S. It is working to change the way mental illness is treated as well as

perceived in today’s society, said PRI Director of Nursing Judy Seidenschnur, RN. “The treatment model places a heavy emphasis on the relationship between mental Judy Seidenschnur and physical health and patient and family centered care,” Seidenschnur said. “In the treatment model of the inpatient units, psychotherapy in conjunction with psycho-educational activities is provided by a multidisciplinary team comprised of MD’s, APN’s, other nurses, social workers, nutritionists, occupational and speech therapists, pharmacists, psychologists, health educators and chaplaincy staff.”

The PRI inpatient units have a total of 40 beds providing specialized care to women, children and adult patients.

The Women’s Unit provides individualized behavioral healthcare for issues unique to the female patient. The focus of patient and family centered care is provided in a secure, strong and supportive environment with an average length of stay of 5-7 days.

The Child Unit is a diagnostic center providing intensive evaluation and treatment for young children ages 2- 12 years.

It is dedicated to patient and family-centered treatment using the Collaborative Problem Solving Model with the philosophy that a “child will do well if they can.”

The length of stay is 28 days.

The Adult Unit serves patients with acute psychiatric needs and major psychiatric disorders.

“The significance of medication compliance and lifestyle modifications is emphasized,” Seidenschnur said. “Patients participate in psycho-educational groups related to medications, diet, physical and sleep hygiene and healthy recreational activities. The length of stay averages 6-7 days.

“The three inpatient units provide state-of-the art comprehensive mental health services for the citizens in the state of Arkansas. The inpatient services stand out as a leader for patients struggling with mental illness.”

CHI St. Vincent Behavioral Health Center has 49 beds in Little Rock at the CHI St. Vincent Infirmary and 21 geriatric behavioral health beds at the CHI St. Vincent Hot Springs.

“At CHI St. Vincent Infirmary, we carefully plan and carry out therapy and treatments that are individualized for each patient with the goal of having the best possible outcome,” said Shawnte’ Hill, BSN, RN, nurse manager, Behav-

ioral Health, CHI St. Vincent Infirmary.

“And while individual therapy is important, our patients also benefit from daily focus groups and therapy sessions with other patients. Also, because we know that families have a stake in the care of our patients, we provide an option of including family members in therapy sessions. Therapy and appropriately administered medication are how we focus on the whole person – body, mind and spirit.”

St. Bernards Behavioral Health services provided at the 60-bed inpatient unit in Jonesboro include individual therapy, group therapy, family therapy planning, activity therapy and medication management.

“St. Bernards also operates the St. Bernards Counseling Center that offers two intensive outpatient programs, one on eating disorders and the other on chemical dependency,” said Kevin Byron, director of St. Bernards Behavioral Health.

“Services also include outpatient therapy for grief management, marriage problems, gambling issues, depression and anxiety.”

Also offered is an Employee Assistance Program (EAP) used by businesses to include counseling and therapy services in benefits packages for their employees.

The employer-funded EAP provides six therapy sessions each year for an employee and his or her family.

Byron said Bernards plans early this year to begin offering a new non-invasive, non-systemic outpatient procedure that has been proven to reduce and/or eliminate symptoms for patients who have clinical depression and have not achieved desired symptom relief with other forms of treatment. Called Transcranial Magnetic Stimulation (TMS), the therapy uses magnetic pulses in a series of short treatments over the course of 10 to 12 weeks and will be administered at the Counseling Center under the supervision of a psychiatrist.

“St. Bernards will be one of the few sites in Arkansas that offers TMS,” Byron said.

Nick T. Ogle, PhD, LPC, director of Mental/Behavioral Health Services at Mercy in Lowell, said the facility is staffed by three psychiatrists and other professionals who currently serve roughly 282 people per week.

“We have a waitlist of more than a year to get in with a psychiatrist,” he said.

“We can get someone in with a therapist within three weeks. Our outpatient program provides services for people suffering from/dealing with all different kinds of issues.”

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Combined Force of 4,300 Physician Members has Big Impact, continued from page 1 especially in the legislative session where we continue to keep patients from being abused by unsafe medical practices,” Bryant said. “Some of the legislation is driven by corporations more interested in profits than good medicine. We work to protect the patients.”

One example is a big push for inappropriate telemedicine such as corporations that offer a “doctor in a box” kiosk where patients can do a teleconference and pay $40 or $50 to be diagnosed and treated by a physician. Bryant said the AMS has helped the Arkansas Medical Board develop practice patterns for telemedicine that include an initial physical encounter with the patient.

“Once a patient becomes part of the practice, then a phone call consultation from the physician may work,” Bryant said. “But, initially for a patient to call a doctor anywhere in the U.S., someone who has no idea who you are or your medical history, that is not a good practice pattern. We want to keep quality at the forefront of medical care, not convenience.”

There is no opposition to telemedicine when used properly such as emergency room consultations for stroke patients.

But inappropriate telemedicine can lead to poor or delayed care, and could exacerbate problems such as the overuse of antibiotics.

The AMS also works with its national counterpart, the American Medical Association, on national legislation to address problems such as excessive record keeping.

“The Affordable Care Act has some good insurance reforms, but other things are not good for the physician\patient relationship,” he said. “Federal regulations regarding meaningful use and electronic medical records are burdensome and don’t provide better care for patients. To overburden physicians with redundant paperwork and place a computer between us and the patient in the office is not helpful.

We are trying to improve quality, and we can’t do that with redundant paperwork. I think the Centers for Medicaid and Medicare Services have good intentions, but it becomes more focused on a bureaucracy rather than helping patients one-on-one.”

Bryant spends a lot of time going to meetings.

“I want physicians to try to communicate with other physicians,” he said. “I try to go to every meeting I can to meet other physicians. With a united voice we can accomplish something and protect quality patient care. There are so many commercial entities out there that want to control the practice of medicine. There are hospitals that want to control doctors, and nurses who want to practice like physicians, but don’t have the training to be physicians. There are businessmen who want to own clinics who are more interested in profits than good healthcare. The medical society is about advocating good patient care. We have a combined voice people listen to.”

An example where the medical soci-

ety can be helpful is with unfair insurance company payment denial by alleging coding irregularities.

“If one physician is trying to fight that, you lose,” Bryant said. “Big nationwide companies are hard to stand up to.

But when the medical society comes in and intervenes, we can prevent that. We have actually gotten insurance companies to stop unfair recoupment of payment.”

Many physicians don’t realize how much work the medical society does with legislation governing medicine on the state level. To address that, the AMS has developed a video detailing the accomplishments of the most recent session of the Arkansas Legislature.

“The state legislature looks to physicians and the medical society if they really want to find out what is going on with medical care,” he said. “They trust us to be straightforward and honest. We don’t give them propaganda. We tell them the facts and the facts usually are on our side getting a bill passed or stopping bad legislation. Once a law is passed, physicians help formulate regulations based on the law, for review by the legislative committees.”

The video will first be distributed to Northwest Arkansas. One of Bryant’s goals is to increase membership in that area, which has a tremendous number of new physicians.

The AMS has been successful in maintaining a fair legal system for malpractice lawsuits.

“In Arkansas we do have the lowest malpractice lawsuit rate in the country, which is good,” Bryant said. “It is a small state and we have high quality medical care.”

Bryant grew up in a medical family in Helena. His mother was a surgical nurse, and his father is an optometrist. He has three uncles and a number of cousins who are physicians in Mississippi. He recalls grinding lenses in the family’s optical lab when he was barely tall enough to see over the top of the machine. The pay was 25 cents per hour.

Bryant earned his medical degree at the University of Arkansas for Medical Sciences. Early in his medical career, he worked for his uncles delivering four or five babies a week in Shelby, Miss. He ran an emergency room company in Arkansas for several years prior to a residency in ophthalmology. He has been in solo practice in West Memphis for 30 years.

Bryant is an avid golfer who also enjoys water skiing, wind surfing and kayaking. He and his wife, Dione, who works with him in the practice, have five children and one grandchild with another on the way.

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Demand for Joint Replacement Surgery Expected to Increase Fourfold Today’s Artificial Joints May Last Longer Than in the Past

plants will have longer life expectancy because wear is less. Time Hip and knee replacement is will tell.” one of the fastest growing areas of The other reason surgeons are surgery. In 1980 there were only now operating on younger adults about 100,000 knee and hip rethan in the past is that it is best to placements in the U.S., compared to keep people active. “The problem is about one million in 2013. Estimates if you wait too long for someone who are for that number to grow fourfold has significant arthritis, and people to four million surgeries by 2030. are inactive as a result, the patient “Certainly it is the fastest growcan develop other illnesses such as ing type of orthopaedic surgery,” diabetes and heart disease that are said C. Lowry Barnes, MD, chair of not only a problem in themselves, the University of Arkansas for Medibut also increase the risk of having cal Sciences (UAMS) Orthopaedic complications with joint replaceSurgery Department. “The aging of C. Lowry Barnes, MD, chair of the University of Arkansas for Medical ment surgery,” Barnes said. baby boomers and trauma increase Sciences (UAMS) Orthopaedic Surgery Department is shown above doing a There is a new trend around the need for hip and knee replace- knee replacement procedure. country looking at outpatient joint ments. Fortunately, we have good replacement. Currently it is not treatment for those who need joint replacedone in Arkansas. Barnes said while almost In the past physicians would recomment. The success rate is very good now, all patients go home the day following surmend patients wait until later in life to have and patients return to near normal activity gery, and most could be done on an outpajoint replacement because the artificial very quickly. As results continue to improve, tient basis, Medicaid and private payers in joints lasted on average only 15 years. But the popularity of the operation increases.”

Arkansas don’t recognize it as an outpatient now joint replacement is offered earlier in Barnes said currently there is not a sigprocedure. life. nificant mismatch in need for surgical treatOne of the most significant risks for “Although artificial joints have a limment and surgeons available to deliver that joint replacement surgery is post-operative ited life expectancy, we think the life expeccare. However, the projected increases in infections, but that risk is less than one pertancy of implants is getting longer because joint replacement over the next couple of decent. Barnes said studies have shown there implants and materials are better,” Barnes cades will make this a real challenge, he said. are fewer complications with surgeons who said. “Everything suggests the newer imBy BECKY GILLETTE

do the surgeries more frequently.

“Surgeons who do a lot of joint replacements are quicker at doing the operation and have developed techniques to decrease the infection risk,” Barnes said. “The same is true related to hospitals. Those hospitals that do higher volumes have lower complication risks, including infections.”

Terry Sites, MD, an orthopaedic surgeon who is chief of orthopaedic surgery with Advanced Orthopaedic Specialists, Fayetteville, said there has been ongoing work in reducing the complication risk of total joint arthroplasty.

“Smoking, diabetes Dr. Terry Sites and obesity have all been shown to increase the risk of wound healing problems and deep infection,” Sites said. “Delaying total joint arthroplasty to lose weight and achieve a BMI of less than 30 has been shown to significantly decrease the surgical risks of infection, deep vein thrombosis, and death.

Delaying surgery to lose weight has no deleterious effects on total joint arthroplasty outcomes.”

(CONTINUED ON PAGE 8)

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3D Printing Creates Robohand for 17-Year-Old Girl, continued from page 1

Ellis arranged for the Kimbroughs to meet with Michael Karr at the College of the Ouachitas (COTO), which had invested funds to acquire 50 Makerbot 3D printers.

“We all met and saw a video that showed how much the hand could change Samantha’s quality of life,” Melody Kimbrough said. “I was in tears and her eyes got as big as saucers with excitement. She knew that no one would make fun of her any more with this new technology/hand.”

Karr told her that he wouldn’t know if she would be a good candidate for the hand until after he built it for her. In mid-December, they watched Karr construct Samantha’s hand.

“It was fascinating to watch him mold, construct, and reconstruct her hand out of all the 3D pieces Michael had made for her,” Kimbrough said. “Mark Ellis also had previously helped us with some of the parts, and we gave them to Michael who began to form everything to her little hand to how it felt best.”

Later that day she used her new right Robohand to shake hands with the college president.

“The RoboHand has changed Samantha’s life only for the better,” Kimbrough said. “She loves it. She can move it, pick things up, and live a normal girl’s life.”

This is the second hand produced at the college. The first was for a young boy in Chicago. The college has printed the components for approximately fifty hands which are currently in storage ready to be shipped to Robohand for final assembly.

Printing a Robohand looks simple.

However, Karr said printing Kimbrough’s hand was definitely one of the harder prints he has been able to successfully complete.

“It took me approximately two weeks of attempted prints before I had a full set of functional parts – but the real task was just beginning,” Karr said. “I spent the next three days manually sanding and gauging each part to ensure it fit as specified. We scheduled the fitting for December 10. It was a very emotional moment in all of our lives.

I remember receiving several pats on the back and told how extraordinary this work was. Yet, what I did, anyone can do with the proper training. That is the real beauty of 3D printing, especially when it comes to orthopedics and helping others.”

The total cost of materials is only about $250, making in reach of people who couldn’t afford more expensive solutions.

They do not call the Robohand a prosthetic device, instead preferring the term Anatomically Driven Mechanical Device.

“While it can function like a prosthetic, and potentially be a better fit for some people, we are not medical professionals,” Karr said. “3D printing itself is an exciting area in which to work. Technological advances in 3D printing have now made it possible to print in mediums we would have never thought possible, including living tissues.

Access to 3D printers is becoming the norm and it is becoming more affordable for individuals to own 3D printers. I saw one (a Makerbot) for sale the other day at Sam’s Wholesale Club.”

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Anyone who has ever had a hand injury knows how difficult it can be to go through a day or a week with only one hand. Over time, people adapt to using only one limb.

However, it is still very difficult in today’s world.

“Prosthetic limbs are generally complex and expensive pieces of hardware and software, which often are not robust enough to survive the life of a kid,” Karr said. “With a 3D printed mechanical hand, if something breaks, a replacement part can be printed and fit. There are no electrical components, so it can be used while swimming or bathing. Further, with a wide arrangement of filament choices, a hand can be printed in nearly any color, or even from exotic materials such as PLA infused with wood or bronze. This makes a Robohand a valid option for children and those that cannot afford a more expensive alternative.”

Karr said it was very rewarding to hear the new enthusiasm that Samantha has since receiving her hand.

“I have also heard from others that the psychological impact of having a new hand is tremendously positive, helping reinforce self-esteem, the ability to perform everyday tasks more successfully, even picking up new hobbies or talents that require two hands, rather than just one,” he said.

COTO currently offers an entrepreneurial class for 3D printing. The primary focus is on how 3D printing is currently being used in various industries.

To learn more: College of the Ouachitas, coto.edu Robohand, http://robohandus.com/

Joint Replacement Surgery, continued from page 7 For diabetics, it has been shown that HbA1c levels of greater than or equal to 10 gave patients an increased risk for surgical site infection, delayed wound healing, mortality, pulmonary and neurologic complications, increased the length of the hospital stay, and resulted in greater pain as compared with non-diabetic patients.

“Therefore, in patients with co-morbidities, the risks associated with total joint replacement can be significantly reduced by addressing these co-morbidities and maximizing their improvement prior to surgical intervention,” Sites said.

There has also been increased interest in the biologic treatment or solution for some arthritic changes.

“These include cartilage restoration techniques such as autologous chondrocyte implantation where a small amount of cartilage can be removed from an individual patient and grown to millions of cells in the laboratory and then surgically re-implanted into the joint to restore the articular surface,” Sites said. “These types of techniques are currently being used today and hold even more promise for the future. In some situations, these techniques can be used to prevent the young to middle-aged person from needing joint replacement.”

Sites said there has also been ongoing focus on the nonsurgical management of osteoarthritis of the knee which include low-impact aerobic exercise, weight loss, pharmacologic agents and intra-articular injections.

Sites said improvements have been made in terms of pain management at the time of total knee arthroplasty utilizing multi-modal pain protocols that include peripheral nerve blocks, intravenous acetaminophen and others to decrease the need for postoperative narcotics.

“These multi-modal pain protocols also allow for earlier and more efficient rehabilitation in the first couple of days following surgery,” Sites said.

D. Gordon Newbern, MD, an orthopaedic surgeon with Arkansas Specialty Orthopaedics, Little Rock, said the best results from total joint replacement occur when narcotics are avoided and minimized.

Patients have best and most rapid recovery when they require fewer narcotics.

“Less narcotic means patients are much more alert and mobile, have much less nausea, constipation and urinary retention,” Newbern said. “Patients on longterm narcotic therapy often exhibit ‘opioid-induced hyperalgesia’ with amplified and difficult-tocontrol pain after surgery.

Dr. D. Gordon Studies have shown this to Newbern lead to poorer functional recovery and poorer overall success of the surgery. Even reducing the long term narcotic user narcotic dose by 50 percent for two weeks before the surgery can greatly reduce this effect. Due to the problems that narcotic pain pills cause for patients, we recommend narcotics not be used to manage long-term arthritic conditions.”

Newberg said with increased training and experience, hip and knee replacements are quicker than in years past, now taking 50-90 minutes to perform.

“Pain control and mobility are much better than just three to four years ago and now 95 percent of patients go home the day following their surgery,” Newbern said. “People with hip replacements are fairly sore for seven to ten days, but well recovered in six to eight weeks. Knee replacements are more painful and slower to recover, taking three to four weeks to get past the more significant pain and stiffness and then 10-12 weeks to near recovery.

Hip replacement patients can do their own therapeutic exercises, but knee replacement patients require outpatient physical therapy for several weeks after surgery.”

To learn more: University of Arkansas for Medical Sciences Orthopaedic Surgery Department, http://ortho.uams.edu/ Arkansas Specialty Orthopaedics, http://www.arspecialty.com/ Advanced Orthopaedics Specialists, http://www.aoshogdocs.com/

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By the Numbers: The Latest Cancer Stats & Facts all cancers are preventable due to lifestyle change.”

By CINDY SANDERS

When it comes to reducing cancer mortality in America, there is no question the nation has seen steady improvement with the death rate down 23 percent in just over two decades. Yet, it is also abundantly clear more work remains with cancer supplanting heart disease as the number one cause of death in 21 states.

Drilling deeper, it’s also apparent not all cancer care is created equal.

Otis Brawley, MD, MACP, chief medical officer for the American Cancer Society (ACS), shared insights from Cancer Statistics 2016. Released in January, the new report analyzes information through 2012, the most recent year for which data is available.

“I think the take- Dr. Otis Brawley away is that we’ve had a 23 percent decline in the cancer mortality rate from 1991 through 2012,” he said.

“That translates into 1.7 million cancer deaths averted from 1991 onward.”

Projecting out to 2016, Brawley said the drop in the mortality rate was expected to be about 25 percent. The ACS projects a total of 1,685,210 new cancer cases and 595,690 deaths from cancer this year.

Looking at the four most recent years of data (2009-2012), men have enjoyed a 3.1 percent decrease in new cancer diagnoses, while the rate for women has stayed steady over the same time period. Some of the decline in male diagnoses is believed to be linked to changes in screening recommendations for prostate cancer (see below).

Brawley noted cancer mortality rates rose for most of the 20th century, peaking in the early 1990s. Since 1991, however, mortality rates have declined every year.

While the 23 percent overall decline is good news, some types of cancer have enjoyed even greater progress over the past 21 years.

The Big Four

In 2016, the ACS expects 44 percent of all newly diagnosed cancer cases in men to be attributable to lung, prostate or colon cancer with prostate cancer accounting for about 1 in 5 cases. For women, the most common new cancer diagnoses will be lung, breast or colon cancer with breast cancer accounting for 29 percent of those new cancer cases.

Lung, colon, breast and prostate cancers also continue to be the most common causes of cancer death with lung cancer leading the way. However, the big four have also have seen significant decreases in death rates as resources, research, and education have been applied to prevention, early detection and treatment.

“The death rate in lung cancer arkansasmedicalnews

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Unequal Opportunity

dropped 38 percent from 1991-2012 in men, and 13 percent from 2002-2012 among females,” Brawley said. He explained lung cancer death rates for women actually continued to rise until 2002, which aligns with historical smoking patterns where women did not begin to widely use tobacco products until much later than men. “The decline for men started in 1955, and it’s gone from a 55 percent prevalence of cigarette smoking to 20 percent today. Women went from a 35 percent prevalence in 1965 to about a 16 percent prevalence today,” Brawley said.

“The death rate in colorectal cancer and breast cancer declined by nearly 40 percent,” he continued. Brawley added colorectal screening has significantly impacted prevention by allowing for the removal of pre-cancerous polyps. Among adults ages 50 to 75, colonoscopy use has increased from 19 percent in 2000 to 55 percent in 2013. Colon cancer incidence and mortality rates have declined about 3 percent a year for both sexes over the last decade.

However, not all screening is created equal. Prostate cancer, Brawley added, is a bit trickier to judge. “We’ve had a decline in prostate cancer … and we hope that’s a good thing,” he said. “On paper, our prostate cancer mortality rate has declined by nearly 50 percent.”

As for why mortality rates are down so much, Brawley said there are multiple theories. Some of the decline could be linked to accounting issues. Some could be due to improved treatments in regional and metastatic prostate cancer. Some researchers have published data suggesting certain treatments might have led to an increase in cardiac deaths. And, Brawley added, another theory is that screening might actually work.

In addition to the United States, the prostate cancer death rate has gone down in 20 other countries. It should be noted, Brawley stated, that 17 of those 21 countries do not screen for prostate cancer.

Furthermore, he continued, “The pros-

tate cancer rate went down in the United States before we started screening.”

Calling mass screenings a ‘mistake,’ he noted, “We had an epidemic of prostate cancer screening before any research showed any efficacy.” In fact, the latest edition of the ACS report states about half of the overall decline in new cancer cases for men is because of the recent rapid decline in prostate cancer over-diagnoses since routine screening with the PSA test is no longer recommended.

Brawley continued, “Currently, no professional organization in the United States, Canada or Europe says men should be screened for prostate cancer.”

He added there are several organizations, including the ACS, that say men should be told about the potential risks and benefits and should be allowed to make an informed decision about screening in concert with their healthcare provider.

Some Cancers on the Rise

Unfortunately, not all forms of cancer have shown decreases in incidence and mortality rates. Incidence rates increased from 2003 to 2012 among both men and women for tongue, tonsil, small intestine, liver, pancreas, kidney, and thyroid cancers and some types of leukemia.

Additionally, men saw increased incidence rates for melanoma, multiple myeloma, male breast cancer, testicular cancer and throat cancer. For women, incidence rates increased for anal, vulvar, and endometrial cancers.

Brawley said some pancreatic, uterine, endometrial and liver cancers are linked to the increase in obesity. In the case of throat cancer, he noted there have been huge decreases in cases linked to smoking and drinking but big increases in throat cancer tied to HPV. “The leading cause of cancer in the United States is still tobacco smoking,” Brawley said. “About 30 percent of all cancers are correlated to obesity, lack of physical activity and high caloric intake,” he added. “It’s fair to say 40-50 percent of

Brawley said another issue of key concern is care disparity. “It correlates with socioeconomic status more than anything else and then with geographical status.”

He added the uninsured, underinsured, and those without financial means receive less than optimal care. “We’ve got data to show in the United States, as a whole, you are better off having stage 2 colon cancer with insurance as opposed to stage 1 colon cancer without insurance.” Brawley added the data showed a 10 percent difference in five-year survival in favor of the group with more advanced cancer and insurance.

Similarly, there are regional disparities in care. “There is a huge geographical disparity,” Brawley stated. “While you’ve had a 40 percent decline in colorectal and breast cancer death rates, there are some states with less than a 10 percent decline.” Alabama, Arkansas, Louisiana, Mississippi, and Missouri are among the 14 states that have seen the much smaller decrease in mortality rates.

Brawley added the findings supersede race. “There is this fallacy that race defines biology,” he said. “I don’t think anyone thinks the biology is different for a white woman living in Mississippi or Alabama versus a white woman living in Ohio or Indiana, yet we see drastic difference in breast cancer rates.”

He also noted the racial disparities in breast cancer deaths have become more pronounced in the wake of major treatment improvements that occurred in the 1970s. “The disparities have increased every year since 1980 … and they are more in 2012 than in 2000,” he said, adding the gap has continued to widen as newer, more expensive treatments have become available. “Socioeconomics and education are a far greater driver of this than anything else.”

The Bottom Line

Brawley said he thinks one of the most important byproducts of the American Cancer Society’s annual statistical analysis is that it helps define the problems, which opens the door to meaningful dialogue.

“If access to appropriate care is a problem in the United States, then we need to figure out how to overcome that problem,” he stated. Brawley added the detailed data also highlights gaps in care to help guide decisions about allocation of resources.

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Staffing Predicaments of Full Open Enrollment

By LYNNE JETER

When Jason Leverant co-developed the Affordable Care Act (ACA) Cost Calculator for the American Staffing Association (ASA) on a 6-person team, he was thrilled when the interactive tool – a worksheet to help firms determine whether they should “play or pay” and includes several cost recapture scenarios – beJason Leverant came available in 2012.

“It’s aimed at helping staffing companies calculate potential costs under healthcare reform,” said Leverant, president and COO of AtWork Group, a national staffing firm with revenues of $257 million annually. “It’s been well received, with a few updates since then to keep up with changing regulations.”

Leverant, named to the Staffing Industry Analysts’ most influential “Staffing 100” list for the past two years, has now turned his attention to the impact of full, open enrollment in staffing large health systems.

“Now that both the individual mandate and the employer mandate provisions of the Affordable Care Act are in full force, open enrollment was a hectic time for all of us,” admitted Leverant. “The enrollment process caused an ‘all hands on deck’ moment, where team members in our staffing organization had to ensure we were compliant in our offering of coverage to all fulltime employees.”

As a staffing firm that supports large health systems, Leverant knew this was a critical benefit that many nurses were seeking, and he wanted to do it right.

“In 2015, we ended up offering a 3-tiered health benefit offering to our employees, a low-cost fixed-indemnity plan, which provided base benefits – but wasn’t ACA-compliant due to coverage limits – and a Minimum Essential Coverage (MEC) option, which allowed employees to accept a very low cost ACA-compliant solution to meet their individual mandate requirements, and a full Minimum Value Plan (MVP) to provide our employees with a robust benefit package. As to be expected, though, we didn’t have a tremendous amount of people enroll in this coverage -less than 1 percent of our workforce. This confirmed our initial thoughts that people don’t approach staffing firms for their benefit packages. They’re looking for a gateway into one of our client partners, or they’re looking for a pay check. Moving into 2016, we’re adapting our compliance strategy knowing this fact, and look forward to what the year has in store for us.”

Since the advent of the ACA, a key issue faced when it was introduced was a lack of available benefits, said Leverant.

“Major medical health insurance was never a benefit that staffing firms concerned themselves with because of the inherent nature of staffing – it’s temporary,” he ex10

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plained. “The mindset has always been that if someone was interested in major medical health insurance, they’d look for a position that was ‘temp-to-hire’ and the client company would offer those benefits to the those employees when an associate transitioned to their payroll.”

Under the ACA, staffing firms have had to work closely with benefit providers to create plans that made sense for the staffing industry, said Leverant.

“One of the primary challenges that needed to be taken into consideration was the issue of group participation,” he said.

“In the past, if a staffing firm attempted to offer a traditional ‘fully-insured’ health plan to their employees, the insurance carriers required a minimum participation of at least 75 percent or more of the workforce, but the reality is that most temporary employees aren’t approaching staffing firms for a robust benefits package. They’re looking for a paycheck. Fortunately, we have some great vendor partners who were able to work with the major health insurance carriers to build out plans that have very minimal participation requirements, some as low as 1 percent. These have truly been a great resource for us in our quest to remain compliant with this complex law.”

The ACA has significantly impacted internal costs for staffing firms, Leverant said.

“As with anything that requires additional products, tracking, reporting, support, and so forth, our overhead costs have increased,” he pointed out. “Based on the already competitive nature of the staffing industry, many firms weren’t able to fully absorb these costs, which means they had to work directly with their client partners, passing through some of the increased costs to their clients. These have been challenging conversations for the most part, but our clients have understood that we’re not alone in the increased costs

of doing business in this current legislative and economic climate.”

Leverant emphasized that staffing firms have been hindered by a skills gap in the healthcare industry.

“With the passage of the ACA, this is only going to increase,” he said. “As we see more and more people gaining access to affordable health insurance, we’re going to see increased patient populations at facilities across the country. This demand is going to strain an already short workforce even further. We continue to see demands in our primary fields of staffing - nursing, with a tremendous shortage for trained and experienced RNs experienced working in an acute-care environment.”

Health IT (HIT) is a growing staffing sector, Leverant noted.

“The increase of cybercrime has expanded the need for qualified professionals to create better security systems, while advancements in HIT systems are pushing hospitals and physicians to find qualified interoperability experts now more than ever before,” he said. “This job outlook will grow in the next few years.”

From a trending perspective, staffing firms continue to see U.S. employers leaning more frequently on staffing firms to help them build “contingent workforces,” including healthcare facilities.

“This is because of the inherent value we bring to the table to these entities, including time savings, flexibility, cost savings and risk mitigation,” he said.

“That fourth ‘value-add’ – risk mitigation – seems to stand out as one of the most valuable. As a staffing firm, we’re the ‘employer of record,’ which means that we carry insurance liability on all fronts for our employees – their workers compensation, general liability, professional liability and unemployment. This value has increased exponentially, based on the ACA and post-recession economic conditions.”

Groundbreaking Celebrates Construction of Medical Plaza FAYETTEVILLE - Area leaders celebrated the official groundbreaking for a medical services building designed to improve patient access to clinics. Washington Regional Medical Plaza is set to open in early 2017 at the corner of Bob Younkin Drive and Appleby Road in Fayetteville.

The four-story building, set on 5.22 acres, will offer more than 66,300 square feet of space to accommodate a variety of medical services in a convenient location. Some of the services slated for the building include: Urgent care, family practice, internal medicine, urology, endocrinology and gynecologic oncology; Outpatient imaging center with on-site radiologists, providing X-ray, MRI, CT, Ultrasound and Fluoroscopy.

Located across Appleby Road from Washington Regional Medical Center, the building is designed so that the urgent care clinic and imaging center can be served by the hospital’s backup generator, ensuring that vital medical services remain available if needed during a community emergency response.

The construction project is part of Washington Regional’s plan to meet the healthcare needs of Northwest Arkansas, according to Bill Bradley, Washington Regional president/CEO. Designed by Key Architecture, Inc., the facility will be built

by CDI Contractors.

PUBLISHED BY: SouthComm Business Media, Inc. MARKET PUBLISHER Pamela Harris pharris@medicalnewsinc.com 501.247.9189 EDITOR Pepper Jeter pjeter@southcomm.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com 931.438.8771 GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak Abbie Leali Liz Loewenstein CONTRIBUTING WRITERS Becky Gillette, Lynne Jeter, Cindy Sanders CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: pharris@medicalnewsinc.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com

SOUTHCOMM BUSINESS MEDIA, INC. Chief Executive Officer Chris Ferrell Chief Financial Officer Ed Tearman Chief Operating Officer Blair Johnson Executive Vice President Mark Bartel Vice President of Finance Carla Simon Vice President of Production Operations Curt Pordes Vice President of Content/ Communication Patrick Rains Controller Todd Patton Creative Director Heather Pierce Arkansas Medical News is published bi-monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm Business Media, Inc. ©2016 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.

All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

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GrandRounds Washington Regional Joins Network to Improve Supply Chain Efficiencies and Reduce Costs FAYETTEVILLE - Washington Regional has joined the Upper Midwest Consolidated Services Center, a collaborative network of hospitals and health systems focused on reducing the cost of healthcare products and services through the aggregation of buying power and collective decision making.

UMCSC, a VHA Inc. supply network, includes more than 50 healthcare organizations, including Mayo Clinic, across 21 states with $6.5 billion in supply chain purchasing power. Their members collaborate to increase efficiencies and reduce expenses by aggregate spending and establishing contracting strategies that meet the unique needs of their members. Since it was established in 2008, UMCSC has provided more than $300 million in savings to its members.

As healthcare reform progresses and value-based care models continue to evolve, the hospital needed to be more proactive in reducing costs and improving clinical outcomes said Bill Bradley, president and CEO of Washington Regional. By joining UMCSC, he said they are helping to reduce costs and improve the delivery of care to patients and the communities they serve.

St. Bernards Official Earns Fellow Status in National Professional Organization JONESBORO - Brenda Million, vice president of women’s and children’s and perioperative services at St. Bernards Medical Center, has earned fellow status in the American College of Healthcare Executives.

ACHE is an international professional society of 40,000 healthcare Brenda Million executives who lead hospitals, healthcare systems and other healthcare organizations. Its mission is to advance its members and healthcare management excellence through a network of 80 chapters that provide education and career development opportunities.

Million earned fellow status and board certification in healthcare management by meeting a number of requirements and successfully completing a board of governors’ examination.

She holds a bachelor’s degree in nursing from Arkansas State University and a master’s in healthcare administration from Kennedy-Western University.

She has been on staff at St. Bernards since 1991 and previously worked as a staff nurse at Baptist Medical Center in Little Rock and Baptist Memorial Hospital in Memphis, where she also served as manager of the cardiac catheterization lab.

Million is a member of Sigma Theta Tau (an honorary society of nursing), has arkansasmedicalnews

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been active in the Jonesboro Regional Chamber of Commerce, is a life and associate member of Junior Auxiliary of Jonesboro and has served as a board member of the American Organization of Nurse Executives, the Arkansas State University Technical Center and the March of Dimes. In addition, she is a graduate of Leadership Jonesboro, has served as chairman of the March for Babies and is a former Jonesboro Business Woman of the Year.

Sparks Welcomes New OB/GYN FORT SMITH - The loss of a child inspired Mark J. Fowler, MD, to become a physician and enter the field of Obstetrics & Gynecology. Dr. Fowler was working as a nuclear reactor operator on a U.S. Navy submarine in Groton, Conn., when he and Dr. Mark J. his wife lost their first Fowler child at 20 weeks.

He applied to medical school and earned his degree from the Uniformed Services University of Health Sciences, F. Edward Hebert School of Medicine in 1996. He completed his residency in Obstetrics and Gynecology at the National Naval Medical Center and Walter Reed Armed Medical Center National Consortium in 2000.

Dr. Fowler will provide obstetrical care, annual gynecological exams, and birth control options to patients at Sparks Obstetrics & Gynecology located inside Sparks Plaza on Dodson Avenue.

Dr. Fowler will also begin training on robotic surgical procedures at Sparks.

When asked what his favorite part of his job is, Dr. Fowler says he enjoys providing care for expectant mothers.

Before coming to Fort Smith, Dr. Fowler practiced at Great River Medical Center in Blytheville, Ark. He also once served as the Department Head of OB/ GYN at a Naval Hospital in Okinawa, Japan. In addition to a medical degree, Dr. Fowler also has a Bachelor’s Degree in Psychology and an Associate’s Degree in Nuclear Science.

Baptist Health Names New Administrator For Baptist Health Medical Center-Conway CONWAY - Joanie White-Wagoner has been named as the vice president and administrator of the soon-to-beopened Baptist Health Medical Center-Conway.

Joanie is a U.S. Air Force veteran with more than 18 years of leadership experience in the healthcare setting. She Whitecomes to Baptist Health Joanie Wagoner from Midlothian, Texas, where she has been serving as the COO/administrator of Texas General Hospital. She previously served as vice president of operations and chief of Health Administration Services based out of the Veterans Health Administra-

tion in Dublin, GA. In addition to her outstanding credentials in hospital administration, Joanie received her MBA and MHA from the University of Maryland University College. She also received a Black Belt/Lean Six Sigma certification, master’s certificate from Villanova University and is a fellow in the American College of Healthcare Executives. Joanie is married to Darren and they have five children.

Construction on Baptist Health Medical Center-Conway continues.

The 111-bed hospital is located on the west side of Interstate 40 in Conway.

Since construction began, the hospital has already increased in size to 264,000-square-foot after the expansion of the Women’s Center. Baptist Health Medical Center-Conway is expected to open fall 2016.

UAMS Cancer Researchers Publish Findings on Rare Childhood Leukemia LITTLE ROCK – New findings on juvenile myelomonocytic leukemia (JMML) by researchers at the University of Arkansas for Medical Sciences (UAMS) and collaborators at other institutions were published online this month by the medical journal Nature Genetics.

UAMS scientists collaborating on the research titled “The Genomic Landscape of Juvenile Myelomonocytic Leukemia” were led by Peter Emanuel, M.D., director of the UAMS Winthrop P. Rockefeller Cancer Institute and a professor in the Division of Hematology/Oncology, and included Y. Lucy Liu, M.D., Ph.D., assistant professor in the Division of Hematology/Oncology, and Kimo C. Stine, M.D., professor in the Department of Pediatrics, all in the UAMS College of Medicine.

JMML is a very rare and aggressive form of childhood leukemia most often found in children younger than 6. Only about 50 children in the United States are diagnosed with JMML each year.

While the most successful therapy is bone marrow transplantation, this intensive treatment is only effective for about 50 percent of patients and can result in long-term side effects.

The UAMS study, published Oct. 12, confirms two important findings that can assist doctors in determining which patients will most likely respond to existing treatment options and which are candidates for experimental or other therapies.

The findings include confirmation that JMML arises due to abnormalities in the Ras signaling pathway within blood cells. Ras proteins control signaling pathways that affect cell growth and division and can lead to the mutations found in tumors. The study also revealed that the number of genetic mutations present at diagnosis is an important predictor for prognosis and survival.

These findings are a major step forward in understanding the development of this rare disease and future advances in treatment, not only for JMML but also for other more common leukemias according to Emanuel, who has studied JMML since 1986 and was one of the first - along with Kevin Shannon, MD, professor of pediatrics at the University of California San Francisco - to hypothesize the study’s findings concerning the Ras signaling pathway.

Emanuel and Shannon’s research groups have collaborated on JMML research for 23 years. Additional investigators from the Broad Institute of Harvard and MIT and St. Jude Children’s Research Hospital participated in the study, which used cell and tissue samples collected during a five-year nationwide clinical trial conducted by the National Cancer Institute’s Children’s Oncology Group.

A second JMML study also published on Oct. 12 by Nature Genetics corroborated the UAMS group’s findings and referenced Emanuel’s research as supporting documentation.

UAMS Establishes Women’s Health Clinic at Pulaski County Detention Center LITTLE ROCK – The University of Arkansas for Medical Sciences (UAMS) has established a Women’s Health Clinic to provide prenatal care for pregnant inmates at the Pulaski County Regional Detention Center.

The clinic will hold weekly onsite prenatal visits as well as see patients by interactive video operated through the UAMS Center for Distance Health and the UAMS College of Medicine’s Department of Obstetrics and Gynecology.

The Center for Distance Health has installed telemedicine equipment in the detention center’s medical facility. The equipment includes a video monitor and camera to enable a live, interactive video connection between pregnant inmates and health care providers at UAMS as well as a fetal heart rate monitor and ultrasound capability.

If the pregnant inmates have medical complaints outside of clinic hours, the detention center medical staff can place a video call to triage nurses and obstetricians at UAMS. They will evaluate the inmates from the hospital three miles away using video equipment to speak to the women while analyzing the fetus’ well-being through the detention center’s heart-rate monitor.

The university has worked with pregnant inmates in Arkansas state prisons since 2007, but Little Rock is the first detention center in the state to host a similar telemedicine clinic.

In addition to providing medical services at the detention center, the video equipment will also be used for continuing education for detention center staff.

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Associate Professor and Primary Care Doctor, Tobias “Toby” Vancil, M.D. (second from left) in clinic with student and patient

we

educating the future of health care As the state’s only academic health sciences center, we are educating the best and brightest health professionals who will shape the future of health care. At UAMS, the next generation of compassionate medical professionals receive the specialized education they need to care for you and your family. We are UAMS, and we’re here for a better state of health. UAMShealth.com

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