Medical News of Arkansas May 2013

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PHYSICIAN SPOTLIGHT PAGE 3

Hakan Paydak, MD

HEALTHCARE LEADER PAGE 8

The Coming Broader Role of Advanced Practice Nurses for Primary Care

By BECKy GILLETTE

PAGE 8

William Franklin Hefley Jr., MD

ON ROUNDS Lupus: Difficult to Detect Experts believe an increase in the autoimmune disease lupus has been seen in recent years, heightening the importance of healthcare providers being alert to the symptoms of lupus in order to refer patients to a rheumatologist for timely diagnosis and treatment, said Elizabeth Russell, MD, who treats lupus patients and is acting chief of rheumatology at the University of Arkansas for Medical Sciences (UAMS) ... 4

Training Critical to Defusing Problems with Potentially Violent Patients or Visitors

(CONTINUED ON PAGE 12)

Inbound Marketing Becoming Increasingly Important for Healthcare Providers

By BECKy GILLETTE

With healthcare providers hard pressed to keep finances on an even keel with declining reimbursements, combined with rising costs for care, deciding to spend ... 7

A major change is afoot in the way healthcare facilities are marketing themselves. Outbound marketing with television, print and newspaper is declining, and inbound marketing is taking over because of social media, said Rebecca Pittillo, marketing director, Jefferson Regional Medical Center (JRMC), Pine Bluff.

“I don’t think it matters if you put glossy photos of all the great physicians and healthcare technology you have,” Pittillo said. “In this day and age, patients expect you to have great doctors and technology. You also have to be giving them the information they really need that is relevant to them and their healthcare concerns. Facebook, Twitter and YouTube can be used to educate your community.”

(CONTINUED ON PAGE 12)

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There is no doubt that as shortages of primary care physicians (PCP) worsen, particularly in rural areas of the state, there will be an increasing need for nurse practitioners (NP) to fill the gap.

Lorraine Frazier, RN, PhD, a professor and dean of the College of Nursing, University of Arkansas for Medical Sciences (UAMS), said there is a need to educate the public about what advanced nurse practitioners (APNs) do. NPs can work in the hospital to help coordinate patient care and oversee care when the patient transi-

tions from the hospital to home.

“I just spent three weeks in a hospital in Houston, Texas, and I could really see there is a great need for an in-hospital coordinator of care for patients,” Frazier said. “NPs have a very important role to play as hospitalists – someone to coordinate the care a patient receives in the hospital. When NPs do discharge rounds as part of a team, they can help assure that the patient is discharged at the right time, which saves money and also aids patients who often prefer to be at home. In this way, the MD\NP team could significantly decrease hospital stays.”

APNs also can play a significant role in transition care from hospital to home, a critical time for patients. And often patients feel more comfortable calling an APN with questions. “Nursing professionals are the number one trusted professionals in

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PhysicianSpotlight

Hakan Paydak, MD

Associate Professor, Director of the UAMS Cardiac Electrophysiology Program and Laboratory, the Electrophysiology Fellowship Program, and the Central Arkansas Veterans Healthcare System. money to acquire the needed equipment,” he said. “That’s when I decided to head to the United States.”

By LYNNE JETER

A year after joining the University of Arkansas for Medical Sciences (UAMS) on July 20, 2009, heart rhythm disorder specialist Hakan Paydak, MD, FACC, increased the volume for electrophysiology (EP) procedures from 50 to 250.

Paydak’s prolific work paved the way for UAMS to hire another EP cardiologist in 2010 to help facilitate EP procedures that are done daily, along with co-covering the EP clinic now open three days a week for patients from all corners of the state.

In addition to his brilliance as an EP cardiologist, Paydak has gained a stellar reputation as a physician beloved by nurses who work with him in cardiology labs, patients, administrators, and his peers.

“Arkansas agrees with me completely,” said Paydak, UAMS professor, and director of the school’s Cardiac Electrophysiology Program and Laboratory, Electrophysiology Fellowship Program and the Central Arkansas Veterans Healthcare System (CAVHS).”People are very friendly and kind. The weather’s beautiful, as is the state. We’d like to stay here for good.”

Married to Ayse Oktener-Paydak, a part-time dentist at the VA Medical Center in North Little Rock, and the father of two young sons, Ozan, 11, and Vatan, 4, Paydak has taken multi-tasking to a new level. He begins every morning at 4 a.m., by scouring media outlets for the latest news. For an hour beginning at 5 a.m., he works out with a close knit group of executives and fellow physicians at the nearby D1 Sports Club. By 6:30 a.m., he’s at the hospital. Four days a week, he teaches internal medicine from 7 a.m. to 8 a.m. And then he begins his EP caseload.

“It’s a hectic schedule, working 12 hours a day and a weekend a month, but I love it,” said Paydak, a native of the Republic of Turkey.

Obstacle Course

Born in Tarsus, an ancient city mentioned in the first page of the Bible, Paydak was the oldest of three boys born two years apart. His dad, a banker, was poised to start his own cotton factory when he died in a car accident; Paydak was 5. Because his mother, Gulay, had been a full-time housewife without marketable job skills, her family — two brothers, a dentist and internist; and a sister who taught science and math – supported the young family and influenced Paydak and his brothers to pursue medical careers.

Because he had lost his father, Paydak attended a private school in Turkey with international instructors that had been specifically designed for talented children who had lost a parent, primarily during wartime. With English required as a sec-

Square One

ond language, Paydak became fluent before adolescence. By the time he studied in the United States as an exchange student in 1981, “I didn’t have any barriers with language except my accent,” he said, with a laugh, knowing his dialect retains a distinct quality.

With his talent for soccer in his home country, Paydak was pegged as the kicker for the Jeffersonville High School football team in Indiana, effectively handling kickoffs, PATs and field goals. Also a cross-country runner, he thrived in the Marshall household, where George, a basketball coach and government teacher, and Karen, director of a rehabilitation center, became “mom and dad.”

“They live in Phoenix now, and we see them several times a year,” he said. “We’re so blessed to have an American family.”

Even though his younger brothers pursued internal medicine and dentistry, Paydak specialized in heart rhythm problems because “in my home country, it was a virgin field in 1992,” he said. “EP is one of the few branches of internal medicine where you can actually cure patients by eliminating an extra pathway or rhythm problem so patients no longer needed to take medications for heart rhythm problems.”

After graduating valedictorian of his high school class in his hometown, at the top of his class from Hacettepe University Faculty of Medicine, and completing an internship at Hacettepe University Hospital, Paydak completed an internal medicine residency at Gazi University Hospital, all higher institutions located in Ankara, Turkey. An early mentor recommended him for a fellowship program in clinical cardiac EP in The Netherlands as the best way to return to academic medicine in Turkey.

“When I returned to my home country, I tried to start an EP program, but because of economic conditions, there wasn’t

Unfortunately, Paydak had to start from scratch concerning medical training.

By the time he was 38, he had received 14 years of additional training to become triple board-certified in internal medicine, cardiovascular diseases, and clinical cardiac EP. He had studied at the University of Chicago Hospital in Illinois under the tutelage of David Wilber, MD, one of the nation’s top EPs; Case Western Reserve University Hospital in Cleveland, Ohio, under the mentorship of Albert Waldo, MD; and the Medical College of Wisconsin, under then chief of cardiology, David Rutlin, MD. By the end of his rigorous educational stint, a significant mentor, Alan Kadish, MD, called him “one of the nation’s best-trained EPs.” “Since I love what I do, and I do what I love, and with the help of my very supportive wife, we came to this point,” said Paydak, named Best Teacher in 2007 in the Medical College of Wisconsin.

In 2009, Paydak was being elevated from assistant to associate professor of medicine in Wisconsin when he decided to seek warmer weather.

“Milwaukee was cold,” recalled Pay-

dak, who called Rutlin, now the UAMS cardiology chief, for a reference to private practices in Florida or North Carolina. “He encouraged me to look at UAMS … after my second interview on campus, we were sold.”

Fertile Ground

Paydak has thrived in the heart of Arkansas, earning a Faculty of the Year for Teaching nod in the cardiovascular medicine division for UAMS/CAVHS in 2010, Character Athlete of the Month at D1 Sports in 2011, along with an Educational Excellence Award that year.

In his spare time, Paydak stays busy with his sons’ soccer teams – the Mighty Bluebirds – and teaching them the art of wrestling, a national sport in his home country. An avid movie buff, he accurately predicted that Daniel Day-Lewis would nab the Best Actor Oscar for his role in “Lincoln.” He enthusiastically cheered his mom when she was named Mother of the Year in Tarsus, for raising three sons to become highly trained medical professionals as a single mother.

“We knew we had to succeed,” said Paydak. “Every year, we travel to Turkey for three weeks to see my brothers and their families and our mom. It’s always a joyous reunion, but I’m always glad to return to Arkansas.”

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Lupus: Difficult to Detect

By BECKY GILLETTE

Experts believe an increase in the autoimmune disease lupus has been seen in recent years, heightening the importance of healthcare providers being alert to the symptoms of lupus in order to refer patients to a rheumatologist for timely diagnosis and treatment, said Elizabeth Russell, MD, who treats lupus patients and is acting chief of rheumatology at the University of Arkansas for Medical Sciences (UAMS).

“For a while, people thought the higher numbers of lupus patients might be due to more information,” Russell said. “It was being better recognized. At the moment, the thought is there might be an absolute increase in lupus worldwide. There is speculation that the increase could be linked to changes in the atmosphere, the thinning of the ozone layer and an increase in the amount of cosmic radiation.

Lupus is activated by sun exposure. It is somewhat speculative the exact waves that cause lupus, but it appears to be largely UV light.”

Russell said lupus patients are sometimes referred to rheumatologists early, and sometimes later in the progression of the disease.

“Some family practitioners may not have experience with lupus and its myriad presentations,” Russell said. “It might take longer for them to diagnose a patient with lupus than internists who have a particular interest in or who have trained in a place with a lot of exposure to rheumatology.

Sometimes lupus might initially be diagnosed as a bladder infection. After the patient has a couple of rounds of antibiotics without showing improvement, it might be obvious there is inflammation of the kidneys.”

Lupus is an antibody-induced illness that can affect every organ. Ninety

percent of patients will present with neuromuscular problems or skin rashes, but Russell cautions that not all will present with rashes. The disease strikes one in 500 African American women. Lupus is much more common in women than men, and in younger women in their teens, 20s and 30s. “It is unlikely for a 75-year-old woman to suddenly get lupus,” Russell said. “But in a young woman with rashes and joint pain, it should be considered.

There is also a genetic component, so if others in the family have lupus, it raises the index of suspicion. Common symptoms are hair loss, a change in menstrual periods, sores in the top of mouth or in the nose or around the ears, fevers, malaise and pleurisy. You can have heart or GI involvement, but we most commonly see joint pain and arthritis.”

While a butterfly rash on the face is common, Russell said lupus rashes can look like anything.

“Don’t discount it if it is not a butterfly rash,” she said. “Any time a rash is not identified, a dermatologist can go a long way to demonstrating this diagnosis.

Often you don’t diagnose lupus right away when a patient walks in the door. It is rare someone walks in and you know right away. The lab data can be very helpful: blood counts, liver and kidney tests, as well as serologies. Most patients with lupus have the ANA or SSA antibody. The serologies can be used to figure out what type of lupus it is.”

There has been only one new drug in the past 50 years, Benlysta, which came out in 2011. Russell said Benlysta is still finding its place in terms of acceptance.

“There are few people on it now,” Russell said. “It is for more moderate lupus. We are trying to find who it is most effective for. Otherwise, treatment recommendations remain same: avoid the sun, avoid fatigue, eat lots of fruits and veg-

etables, and avoid alfalfa spouts. Unless they are allergic, patients are placed on hydroxychloroquine, a drug that has been shown to decrease the number of flairs for lupus patients. Steroids may be used.

One positive development is that currently more drug companies are interested in developing new lupus medications.

“It was sort of an orphan disease for a long time,” Russell said. “Now there are a couple dozen different drug trials. There is a lot of hope there will be new agents in the future.”

It is important for patients with lupus to be referred to a rheumatologist.

“I would stress that the disease is quite different from person to person,” she said. “It is not one disease. Occasionally we hear of a general practitioner trying to manage this out in the field. That is not a good idea. Most people with lupus live normal life spans, but lupus can be deadly.”

Jamesetta Smith, president, Lupus Foundation of America, Arkansas Chapter, Inc., said there is concern that many healthcare professionals know little about lupus, which causes lupus patients to suffer unnecessarily.

“I’m hearing too Jamesetta many doctors saying Smith they don’t know anything about lupus or don’t know too much about lupus,” Smith said. “This hurts the patients. I believe doctors don’t take lupus seriously because it is hard to look at a lupus patient and say they are ill unless that person is in severe pain. I’ve experienced doctors saying I have injured myself. Sometimes this pain wakes you up during the night. It is so unpredictable.

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“Far too many lupus patients die due to complications of lupus. Sometimes this is because the doctor doesn’t pay attention to the patient and tells the patient that they are a hypochondriac, lazy or just want some drugs. I was told before being diagnosed there is no such disease as I was describing and that I just wanted some drugs.”

Smith said since lupus literally can affect any or all of your organs, skin, joints, and brain, lupus can be confusing because sometimes it mimics other diseases. “As unpredictable as it is, we have to learn to live with it,” Smith said. “The sharp pain sometimes goes and comes and sometimes it stays. Doctors often do not understand that. It is a complex disease, difficult to understand. There is not a single laboratory test you can take to be diagnosed. All of my organs are affected, which includes my brain. I see a lung doctor and a kidney doctor for those two organs.”

Smith describes the pain as sharp, like someone is drilling through your bones, meaning the pain goes throughout your bones.

“We have to suffer because of this pain and the fatigue,” she said. “And sometimes people will not listen to us.

They think we are imagining the pain.

Once you have been diagnosed with lupus, it is a lifetime disease. It can be mild to severe and it can be life threatening.

We have to learn to manage our lives and change our lifestyles.”

If lupus flares up, patients are advised to get ten to 12 hours rest per day. Lupus patients should be monitored by a rheumatologist.

“Go to the rheumatologist every three months regardless if you are sick or not,” Smith said.

The Lupus Foundation of America, Arkansas Chapter, Inc., provides patient education and support and sends out free newsletters and other educational materials. Support group meetings are held in Helena/West Helena, Texarkana, and Hot Springs.

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MedEvolve really does stand out not only in software performance, but particularly in customer service.”

Barry Seibel, M.D., Los Angeles, CA, is a worldrenowned ophthalmic surgeon, author, inventor and frequent consultant to the ophthalmology industry.

To submit or view local events visit the Medical News of Arkansas website.

A user name and password are required to submit an event. Under Member Options, go to “free sign up” to register.

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Incentives, Better Pay and Dispelling of Myths Needed To Address Shortages of Primary Care Physicians

By BECKY GILLETTE

Recruiting primary care physicians (PCPs), particularly into rural areas of Arkansas, isn’t an easy sell. Today PCPs may have 50 job offers to choose from by the time they complete their residencies.

The Community Health Centers of Arkansas (CHCA), the Arkansas Primary Care Association, has found that seeking out providers with a true passion for working and helping underserved populations is important, as well as promoting the loan repayment benefits offered through the National Health Service Corp.

CHCA employs Richard Berthelot full time as workforce development manager. Berthelot strives to build the pipeline of qualified providers to support Community Health Centers’ (CHC) workforce needs. CHCs, as Patient Centered Medical

Homes, provide access to primary and preventive care to more than 156,000 Arkansas residents in 83 rural and/or underserved communities in the state. CHCs in Arkansas employ 75 physicians and 59 mid-level practitioners to support their practices and serve their patients.

Growing your own PCPs for family practice, pediatrics, OB/GYN, general internal medicine, geriatrics and psychiatry is a good way to fill the gap.

“One strategy which seems to work well for recruitment and retention of providers in very small, rural communities is seeking providers who grew up, lived for a short time, vacationed or lived with relatives, or attended school in particular communities in Arkansas, and encouraging them to come back and serve those communities of their youthful days,” Berthelot said.

Workforce shortages are a constant

What Measures can be Taken to Fill the Primary Care Physician Gap? The majority of Arkansas Primary Care Physicians (PCPs) practice in just ten of the state’s 75 counties, leaving PCP shortages in many of the rural and underserved areas of the state. Richard Berthelot, workforce development manager with Community Health Centers of Arkansas, said there are a number of different efforts that need to be considered to help alleviate the workforce shortages that are expected to become even more critical if nothing more is done.

“Incentives to some of these physicians to practice in underserved areas, on a part-time basis, could be considered a starting point to provide access to primary medical care to many of the underserved areas of the state,” Berthelot said.

One option is to increase the number of slots in medical school, but that only works if there are enough residency slots for each student.

“There must be a residency slot for every medical school student to guarantee that they will be able to complete their education and residency program,” Berthelot said. “If the UAMS Medical School and the AHEC residency programs were limited to mostly Arkansas residents, that might increase the number of Arkansas trained providers to practice in Arkansas.”

“Another solution could be to build another school in the state to prepare students to become primary care providers. CHCs could serve as clinical rotation sites for students and physician residencies, which would help steer PCPs to rural and underserved areas.

Berthelot said incentives other nearby states use that Arkansas could consider implementing, in order to keep PCP residents in-state after graduation include the following: • Alabama – Merit-Based Award offered to incoming first year medical students • Louisiana – Med Job free job posting for health care facilities; Louisiana State Income Tax Credit for Physicians and Dentists $5k per year for five years; Louisiana Rural Health Services Loan; SEARCH grant; Louisiana State Loan Repayment Program $18K/yr for 2, $20K/yr for 3, $30K/yr for 3 in top 10 priority parishes; North LA AHEC Rural Scholars; • Kansas – Scholars in Rural Health: Kansas State Loan Repayment program; Kansas Bridging Program; SEARCH grant; • Kentucky – State Loan Repayment Program 50/50 match for rural primary healthcare educational repayment; • Tennessee – Tennessee Health Access Incentive Program; Tennessee Residency Stipend Program $25K/yr for 4 years; SEARCH grant; Tennessee State Loan Repayment Program; Tennessee Rural Health Loan Forgiveness Program $12K per academic year; • Missouri – Missouri Recruitment and Workforce Development; Missouri Health Professional Loan Repayment; Missouri Primary Care Resource Incentive.

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issue at CHCs, a task that never ends. Just when a health center is fully staffed, someone leaves or retires and the search starts all over again. The average time to fill a vacant provider position is over a year for physicians and six to nine months to fill a midlevel position.

There is a serious concern about the number of PCPs in Arkansas now and for the foreseeable future. According to a report published in 2011, by the University of Arkansas for Medical Sciences (UAMS), Center for Rural Health, more than 40 percent of practicing physicians in the state are older than 55, which raises concerns about even higher vacancy rates in the future.

Arkansas has several incentives to encourage medical students to enter primary care. UAMS offers two programs, the Rural Practice Match Program and the Rural Physician Recruitment Program, both of which offer financial incentives to PCPs to practice in rural areas of the state after completing a residency in one of the five primary care specialties.

The National Health Service Corps (NHSC) offers tax-free student loan repayment in amounts based on the Health Professional Shortage Area score of the facility and approval as a NHSC approved site.

A Student to Service Program, which also offers tax-free student loan repayment, is available to fourth year med students. This program has been offered for the last two years.

“The NHSC also offers scholarships to students,” Berthelot said. “All of these programs require a minimum of two years of service at an NHSC approved site after completion of the residency program. Several Specialist Associations also offer scholarships, based on their individual criteria, to students and resident physicians.”

The Conrad J-30 Waiver program allows international medical school residents to remain in the U.S. without returning to their home country within two years after completing their residencies. This program requires the provider to work three years in an underserved area.

Berthelot said it should also help that one significant incentive of the Affordable Care Act mandates that Medicaid payments to PCPs be comparable to Medicare payments to PCPs for the same service.

Arlo Kahn, MD, professor in the UAMS Department of Family and Preventive Medicine, said there is no question that far more PCPs will be needed if 400,000 people in the state will have insurance for the first time. If the Arkansas legislature approves the Affordable Care Act expansion of Medicaid, 250,000 would be added to Medicaid. Another 150,000 residents would be eligible to buy insurance from private companies through a new insurance exchange.

Equally important to total numbers of providers is the current mal-distribution

with a better ratio of PCPs to patients in urban areas.

“The distribution problem is almost as bad as the shortages,” Kahn said. “We need to address both the number of primary care providers and improve distribution, particularly in the southeast part of the state, the Delta.”

Dr. Arlo Kahn Kahn said it is vitally important to change reimbursements so there isn’t such a huge gap between payments for PCPs and other specialists.

“Typically in the past, primary care has not paid anywhere close to other specialties,” Kahn said. “On average, other specialists earn three times as much. And there is a perception that primary care providers have to work harder, especially in rural areas. People don’t want to go to areas where they will have to work more and get paid less. Fortunately, the payment structure is changing and all the signs point toward more favorable conditions for primary care.

There are several initiatives now where primary care doctors are or soon will get paid more. Another thing that is happening that could relieve stress and provide a better lifestyle for PCPs is telemedicine, where instead of feeling isolated, rural PCPs can instantly access UAMS or other centers when help is needed with a patient.”

Medical students in Arkansas are now exposed to family medicine in the third year of school working at clinics at the universities or one of the AHECs. Kahn said exposing students to this specialty dispels myths and increases interest in primary care.

Even the most optimistic projections show that it isn’t going to be possible to turn out the number of primary care physicians needed, so Kahn said it is important to look at some of that healthcare being delivered by advanced practice nurses (APNs) and physician assistants (PAs) working under the supervision of primary care doctors.

“Those people will be doing a major share of primary care in the future,” Kahn said. “UAMS just started a PA program in the past couple of years, and the UAMS nursing school is doing its best to crank out APNs, as well. Typically, APNs have seven years of training after high school compared to 11 years for most PCPs. That is why, in my opinion, they shouldn’t be out there operating completely independently. But they can provide a large portion of family care perfectly adequately. In our state we are going to have to make better use of them because we don’t have, and won’t have anytime soon, enough primary care doctors.”

Shortening medical school from four to three years for some students is also being explored, which Kahn said would save students money and allow them to get to work faster. medicalnewsofarkansas

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Training Critical to Defusing Problems with Potentially Violent Patients or Visitors

By BECKy GILLETTE

With healthcare providers hard pressed to keep finances on an even keel with declining reimbursements, combined with rising costs for care, deciding to spend money training employees on how to deal with violent patients or visitors might seem low on the priority list.

There were 425 workplace homicides in 2010 in the U.S., in addition to a lot of injuries. Fifteen percent of all workplace homicides occurred in the healthcare industry.

Some people might look at those statistics and say the odds are low that their facility will be the site of workplace violence. Good training on how to recognize and best respond to threats from violent patients or visitors is costly and time consuming.

“Administrators have to make a tough decision,” said former Secret Service Agent Michael Corcoran, PhD, president of The Workthreat Group, a company that provides techniques, training procedures and recommended policies to identify and reduce violence and liability in healthcare facilities. “Do they spend money on good doctors Dr. Michael Corcoran and nurses training in their specialty, or do they spend money on a workplace violence prevention program? Those are tough decisions.”

An important consideration is if an incident occurs and the healthcare facility has not followed what are now considered the National Standard for dealing with workplace violence, the facility may have difficulty defending itself in a lawsuit.

“The American Society of Industrial Security International, the largest security organization in the world, and the Society of Human Resources Management (SHRM), which has 220,000 members across the U.S., got together and did a two-year study on a violence prevention program,” Corcoran said. “They came up with an 80-page report that is very extensive. It was subjected for review by the American National Standards Institute and is now considered the National Standard.

It was approved in November 2011. That doesn’t mean it is law. But it means if anyone decides to question why a company, organization or hospital did what they did during an incidence of workplace violence, they will refer to this National Standard and ask, ‘Why didn’t you do this?’”

Both the National Standard and OSHA in its directive to their investigators highly recommend training to deal with workplace violence.

The types of workplaces where violence occurs can vary a lot with retail outlets like convenience stores and fast food restaurants being most common. But hospitals are not far behind.

“Even though the arenas are different, the violent perpetrators’ psychological makeup or background that brings them to this point are pretty much the same,” said Corcoran, who has a PhD in behavioral scimedicalnewsofarkansas

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ence. “What we know about violence is it is not a spontaneous act. We like to think that violence just happens; someone just snapped.

We have been able to show time and time again it is a process. The person who abuses his spouse didn’t just decide to smack her.”

Usually in a hospital setting when an individual becomes violent, there have been warning signs. That is good because it gives people who know what to look for an opportunity to head off the violence.

“That gives everyone time to look at what is happening to see if this person is becoming more volatile,” he said. “The biggest thing is to interrupt the plan or thought process at any level to mitigate or eliminate an incidence of violence. The most important thing in everyone’s training and education is to understand what these principles are, what to be looking for, how to approach someone, and how not to approach someone to have a better chance of dealing with violence before it occurs.

“What I’m looking at is patterns of behavior. We know people are creatures of habit. Looking at past behavior is one of the best predictors of present and future behavior. I look for patterns of behavior to make my determination about the degree of threat that person represents.”

Training isn’t cheap, and there are some organizations that offer training without having sufficient experience. Corcoran said at a minimum employers should make sure the trainer is accredited by the Association of Threat Assessment Professionals.

Also, look for someone with a minimum of ten years experience in a threat assessment

career with the Secret Service, the FBI, the State Department or other organizations.

Advice for healthcare professionals is to avoid the mistake of concentrating only on the physical needs of a patient and overlooking the emotional needs. Pay more attention to the psychology of patients, including listening and responding that you understand their concerns.

“Anything that can be done to show more understanding and patience will go a long way in mitigating volatility,” Corcoran said. “That patient or visitor wants to know they are being heard. They have to believe that person is listening and wants to understand what you are trying to tell them. Sometimes people forget that.”

Recent mass shootings in the U.S. have focused attention on the role of mental illness. Corcoran said that often mentally ill people are easier to defuse than someone who is not mentally ill, but very determined in a course of action that results in violence or death.

“There are plenty of studies to show a person with mental illness is likely to be less volatile outside than inside a healthcare institution,” he said. “With most of these mass shootings, a person was on prescription drugs or didn’t take drugs he should have been taking for a mental problem.

From my experience, I have more luck dealing with a person with mental illness than a person who doesn’t have mental illness. A person with mental illness doesn’t really want to have that mental illness. Anyone who is mentally ill is looking for some control in his or her life. So if I can give

them something that makes them feel more in control, like giving them boundaries or limitations like a restraining order, they are more likely to follow that than the person without mental illness who doesn’t care what I say, he wants to kill that person. He is going to carry out his plan.”

One warning sign is alcohol and\or drug abuse. In Corcoran’s experience, 90 percent or more of individuals who commit or are prepared to commit a violent act have either a drug abuse and\or alcohol problem or a history of it. While he respects anyone with a drug or alcohol problem who works to overcome it, it remains that violent people are likely to have a history of drug and\or alcohol problems.

Corcoran recommends a threepronged approach to considering the potential for violence. First, look at the bad guy and his potential to commit a violent act. Second, look at the potential victim. Is this person widely disliked? Three, overlooked by most people, look at the environment. Is the environment conducive to committing a violent act? Will there be a time where the violent person and victim will be in the same place?

“You have to show a relationship between the three elements,” Corcoran said.

“The stronger the relationship, the stronger the likelihood of potential violence.”

For more information, visit www.workplacethreat.com.

Navigate Health Care Initiatives with Confidence Our office ripped and replaced our EHR system and achieved Meaningful Use in three months.

We would not have been able to do this without HITArkansas.

—Dr. W. Ladell Douglas Hope, AR

n HITArkansas helps providers receive federal Meaningful Use incentive payments n We are assisting over 1,400 providers in achieving Meaningful Use n Our experts can help you prepare for future state and federal initiatives

For more information, contact HIT Arkansas at

501-212-8616 hitarkansas@afmc.org www.hitarkansas.com

This maTerial was prepared by hiTarkansas, a division of The arkansas foundaTion for medical care, in collaboraTion wiTh The universiTy of arkansas for medical sciences. afmc is a cooperaTive parTner of The office of The naTional coordinaTor (onc). hp4-hiTss.mna.ad,1-3/13

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HealthcareLeader

William Franklin Hefley Jr.

Orthopedic Surgeon, OrthoSurgeons, Little Rock; Medical Entrepreneur, MedEvolve among the nation’s top 10 hospitals for spine surgery, hip replacements and knee replacements.

By LYNNE JETER

In 1981, Bill Hefley, MD, landed a job that involved flying daily in a helicopter to an island in the Arctic Ocean to clean up an oil spill.

“I was making good money,” recalled Hefley, who had just earned a biochemistry degree from Harding University. “I considered delaying medical school to finish the job.”

Hefley stayed on track, graduating from Vanderbilt University School of Medicine in 1985.

“In medical school, I realized I liked working with my hands and really wanted to be a surgeon,” said Hefley, who initially considered cancer research. “I was attracted to orthopedics because I love fixing things that are damaged or broken and making them like new again. I also wanted to be able to cure a patient’s problem and not simply manage it. I liked the idea of working with athletes and patients of all ages.”

After completing a transitional internship and residency in orthopedic surgery at UAMS in 1990, and receiving additional training in sports medicine and joint replacement surgery at St. Mary’s Hospital System and the Royal National Orthopedic Hospital in London, England, Hefley returned to his native Little Rock and began his practice that same year.

Now a senior partner with OrthoSurgeons in Little Rock, Hefley focuses on joint replacement surgery and arthroscopic procedures of the hip, knee, and shoulder. “I’m surrounded by the best staff,” said Hefley, “and blessed to work with an excellent group of surgeons that sub-specialize in other areas of orthopedics, which allows me to concentrate on my areas of interest.”

In 2002, he began collaborating with a team of surgeons at Zimmer, global innovators of personalized joint replacement technologies, to develop minimally

Deep Local Roots

invasive techniques and implants for joint replacement arthroplasty. He was quickly elevated to lecture and demonstrate the techniques to other surgeons around the world.

In 2005, Hefley was among a group of nationally-ranked orthopedic surgeons and neurosurgeons who established Arkansas Surgical Hospital in North Little Rock, a hospital that primarily focuses on orthopedic and spine surgery, and also pain management treatments with an emphasis on excellence in every facet of the patient experience. As a result, Arkansas Surgical Hospital has garnered state and national recognition. It’s been ranked the leading hospital in Arkansas for total joint replacement and spine surgery, and

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Hefley’s upbringing had a great impact on his decision to pursue a medical career. His dad, Bill Hefley Sr., a retired allergist in Little Rock, graduated from medical school at the age of 23.

“My father was a well-respected physician in the community,” he said. “A big part of my career choice was emulating him. Now, he’s one of my best friends who I turn to for wisdom and advice.”

His mother, Jane, a former English teacher and valedictorian in high school and college, is “the greatest … very witty … she corrected my grammar constantly,” he said.

The middle of three children – the only boy in the family, and the only grandson on both sides – Hefley admits “I was spoiled … there were lots of women taking care of me!” His older sister, Laura, is a registered nurse. His younger sister, Sarah, is an attorney, former judge, and former member of the Governor’s Cabinet.

Growing up, Hefley played sports year-round, was active in the family’s church, and spent most of his spare time outdoors, either camping and water-skiing, or fishing and hunting with his dad, uncles, and cousins.

“I was very close to both of my grandfathers as a boy,” Hefley recalled. “One died suddenly while I was sleeping over … and I watched the other succumb to a painful three-year battle with cancer that involved multiple surgeries and protracted home treatments. I’m certain those experiences influenced me to want to be a physician.”

Hefley also has a robust entrepreneurial streak. For a few years, Hefley had a cutting horse breeding operation at his farm. In 1998, he co-founded MedEvolve, a healthcare IT firm that provides practice management, electronic medical records, and revenue cycle management services to physician partners, along with e-prescribing, data analytics and other ancillary products and services. With four offices, the company covers practices of all specialties and sizes across the United States. (See “IT Acceleration” on the adjacent page.)

Despite a hectic schedule of juggling orthopedic surgical work and serving as President and CEO of MedEvolve, Hef-

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MAY 2013

ley’s greatest challenge is striking the right balance between work and family.

“When my oldest was almost two, she told mom that ‘Daddy doesn’t live here. He lives at the hospital.’ That cut me to the quick! I resolved not to be the absentee surgeon dad from then on,” he said.

Up to Speed

Married for 25 years to Lisa, a former journalist, the Hefleys have four children – Bailey, 21, a singer/songwriter working in Nashville and Los Angeles; Hannah, 19, a champion barrel racer and freshman pre-med student at Texas Christian University (TCU) with a 4.0 GPA; Will, 17, a high school sophomore and starting quarterback this fall who also plays basketball and the guitar; and Ren, 13, an energetic sixth-grader with athletic and artistic bents.

“My girls were heavily involved in music and equestrian activities while growing up,” recalled Hefley. “This involved hauling horses around Arkansas and neighboring states competing in barrel races. My oldest daughter, Bailey, performed at music festivals and as an opening act for local groups. The boys played sports 24/7 and as time passed, they focused on football and basketball. Both boys play quarterback in football and shooting or point guard in basketball.”

For the last decade, Hefley has coached his children’s football and basketball teams, sometimes juggling three or four teams at once. “Life was very busy,” he emphasized, quickly adding that “coaching has been very rewarding for me.”

“We’ve won many championships and tournaments and had great fun along the way,” he said. “The greatest reward is running into former players who say, ‘Hey, Coach Hefley!’”

For the past 11 football seasons, Hefley has stood on the sidelines of Pulaski Academy every Friday night as team physician.

“I’m double-dipping in that capacity in that not only do I get to be involved with some great young athletes and their families, I also have the opportunity to learn from one of the greatest coaching staffs around,” he said, referencing Coach Kevin Kelley, “a great leader of young men, nationally recognized football innovator and brilliant offensive coordinator.”

To keep pace with a hectic lifestyle, Hefley turns to yet another special interest: running. He’s completed three marathons, and several half-marathons, 5k and 10k runs.

“Running is a great stress reliever,” he said. “It’s a great time to meditate and solve challenging problems.” medicalnewsofarkansas

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IT Acceleration

MedEvolve finds ‘sweet spot’ niche providing PM and EMR software and RCM services to physician practices nationwide

By LYNNE JETER

LITTLE ROCK – When Bill Hefley, MD, was a junior partner at a Little Rock orthopedic practice more than two decades ago, he was tasked with choosing a new information technology (IT) system to replace an antiquated one. After completing due diligence on various options, he played it safe and purchased a new system from the nation’s largest vendor.

“It was a complete disaster,” recalled Hefley, noting the software was different than the demonstration version, the trainer was “preoccupied and disinterested,” and customer support was practically non-existent. “Our practice collections soon approached zero. I knew there had to be a better way.”

A hobbyist computer programmer, Hefley devoted his energies to filling the void in the marketplace. From it, he established MedEvolve as a truly collaborative industry partner to solidify the IT backbone of medical practices. The success of MedEvolve’s practice management (PM) software – it not only organizes patient databases, scheduling and billing, but also allows extensive data reporting – led to the launch of its revenue cycle management (RCM) division. In a fairly crowded field of practice management software companies, MedEvolve stands out not only in software performance, but especially in a vital yet often overlooked area – customer service.

The Drawing Board

In searching for a better solution in the early 1990s, Hefley connected with Pat Cline, president of Clinitec International Inc., then a startup company based in Horsham, Pa., and a pioneer in the emerging field of electronic medical records (EMR).

“Intrigued, I became an early investor and a development partner focused on orthopedic clinical content,” he said, noting that a small public company acquired Clinitec, which became known as NextGen Healthcare, now one of the world’s leading healthcare IT companies. Hefley, an orthopedic specialist in minimally invasive surgeries for the knee, hip and shoulder using arthroscopic and joint replacement procedures, became a development partner with NextGen in 1994, working on the development of clinical content for orthopedists. “By 1997, I felt opportunities still existed in the physician PM software industry. While most physician practices were utilizing computerized billing and scheduling, the available systems were DOS- or Unix-based and not taking advantage of the Windows GUI interface, much less the Internet. More importantly, healthcare IT vendors in the physician sector remained notoriously atrocious in delivering support and customer service. I frequently heard my physician friends and colleagues recount horror stories of flawed software systems with dismal support that were making it impossible to run their practices successfully. I remembered my personal bad

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experience with the large national vendor and the stellar reputation of a small local firm, MBS (Medical Business Services Inc.), which I’d also checked out.”

In 1998, Hefley and Steve Pierce of MBS, a 9-year-old IT firm with a mature DOS-based PM software product, founded MedEvolve with the vision of becoming the first Windows-based physician PM system that employed the Internet and delivered impeccable support and customer service.

“My practice became the beta site for the first version of our new Windows-based PM system,” recalled Hefley, MedEvolve’s president and CEO. “We began to sell our product regionally initially and eventually throughout the United States. We integrated our PM product with several specialty-specific EMR systems to reach more physician practices. We continually worked to upgrade the software and deliver new, innovative functionality. By our tenth year, we had several thousand users nationwide.”

With the success of MedEvolve’s PM product, Hefley recognized a growing need among physician clients for expertise in RCM. “Physicians were struggling with increasingly complex third-party payor systems, growing documentation requirements, mounting government regulations, and threats of audits, fines and imprisonment,” said Hefley. “Practices were searching for a partner with expertise in these areas that could relieve them of the burden of constantly attempting to stay abreast of the ever-changing rules and regulations.

Physicians wanted to focus on the practice of medicine and leave the headaches to people that specialized in those matters.”

MedEvolve developed an RCM division, acquired three small RCM companies, and now has a division that includes experienced practice administrators and dozens of billing and coding specialists.

“With specialization, scale, and great software, we’ve been able to produce some of the best results in the industry – 97 percent first-pass claims success, 27 percent average increase in practice revenue, and a 38 percent average reduction in accounts receivable days through MedEvolve RCM services,” he said. “By switching to MedEvolve’s RCM service, providers immediately experience less hassle, lower costs and increased revenue that result in an improved bottom line and peace of mind.”

tices save time and money and improve the quality of patient care,” said Hefley. “The resulting MedEvolve EHR is fully integrated with the MedEvolve PM system and is designed for the high volume practice with an emphasis on fewer clicks, fewer screens, faster data input and faster data retrieval.”

Hefley has placed a strong emphasis on customer service as the bedrock principle of MedEvolve. It’s not just a catchy slogan; he rewards employees for “outrageously excellent customer service” with WE (Whatever, whenever, Exceed expectations) awards. The WE Award comes with a cash bonus and a new title on the employee’s email signature. As a result, employees strive to achieve the distinction of a “Four-time Recipient of the MedEvolve WE Award.”

“In the software business, that means several operators are at the ready for periods of peak call volume,” he said. “We maintain support-to-client ratios above the industry norm. We design our software to be intuitive with online help so that less support is necessary. In the RCM division, we work claims as much as necessary to ensure our providers are fully paid for the services they’ve performed. We’re not some detached, impersonal entity; we partner with the practice in achieving their goals.”

Today, MedEvolve offers PM and EMR software and RCM services to physician partners, and also electronic prescribing, data analytics and other ancillary products and services. With four offices, the company covers all specialties and the entire United States, from solo practitioners to practices with more than 50 physicians. Commitment to service has garnered MedEvolve a reputation of trust among physician partners, allowing the company to rise above the scores of small physician IT companies nationwide.

By year’s end, MedEvolve will outgrow its new corporate headquarters in downtown Little Rock, a refurbished red brick bakery built circa 1919, necessitating yet another expansion.

“We’re now in that sweet spot where we have the expertise and resources to meet our clients’ every need, and yet we remain nimble and able to move quickly in a rapidly changing healthcare environment,” he said. “We’re proud to be privately held so that we aren’t a slave to our stock price and quarterly reports, but rather free to do what’s right for our client. Our foremost concern remains the principles upon which the company was founded – elegant, user-friendly software and unparalleled customer service.”

Health Reform Impact

The 2009 American Recovery and Reinvestment Act (ARRA) authorized the Centers for Medicare & Medicaid Services (CMS) to award incentive payments to eligible professionals who demonstrated Meaningful Use of a certified electronic health record (EHR) system.

“With the new criteria defined, MedEvolve saw a need for a modern EHR product designed from the ground up to meet Meaningful Use mandates and finally deliver on the industry’s promise of a cutting edge, customized solution that helps pracMAY 2013

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Yours, Mine and Ours: The Ideal Physician Referral Relationship

By LESLIE HEIZMAN

Ultimately, the desired outcome of a physician referral relationship is an excellent continuum of care for the patient.

Everyone – the patient, the primary care provider who’s making the referral and the specialist all have the same goal in mind.

A quality outcome for that patient and a clear understanding of what to expect

throughout the process, and that looks different for each of them.

The Patient wants:

• To see a specialist as soon as possible • To understand what to expect • A diagnosis and a plan of care • To be cared about and listened to • To feel better By the time the patient is ready to re-

quest a referral to a specialist, he or she has often been in pain for some time. The patient is finally ready to take action so they can feel better. Our job is to reduce patient anxiety by streamlining the referral process, and to make sure we get them an appointment as soon as is reasonably possible.

We don’t just have insurance.

We own the company.

John O. Lytle, M.D. South Arkansas Orthopedic Center Pine Bluff, AR Orthopedics

F. Scott Ferguson, M.D. Outpatient Radiology Clinic, P.A. West Memphis, AR Diagnostic Radiology

The Primary Care Provider wants:

• To know the patient will be seen quickly • To know when the patient is scheduled for an appointment • Courtesy and respect for their patient coordinator or scheduler when making a referral • Assurance that they will receive patient notes within five (5) days each patient’s appointment • Clear communication of the plan of care for both the patient and referring physician • Initial appointment with the specialist, not a physician’s assistant • Confidence that the patient will be returned to their informed care • Recognition of the patient coordinator or scheduler’s efforts Sometimes a primary care provider or his/her scheduler request that the patient being referred NOT be seen by a physician’s assistant. Why not? The PA is an extension of the physician who can see and assess the patient sooner, a boon if the patient is in chronic pain. Of course, if the patient needs treatment, the specialist will see him/her anyway. The team approach keeps the patient from feeling rushed, allows for questions to be answered and reduces anxiety.

Specialists: do you know where your best referrals come from? What is the new patient coordinator’s name at the referring practice? Has someone in your practice written a thank-you note, made a phone call of acknowledgement or even asked for feedback about how to make the process better? Better yet, has somebody in your practice gone to make a personal call on the referrer? Yes, it sure takes time, but that visit can be the cement that formalizes the referral pattern!

The Specialist wants:

Medical Professional Liability Insurance “Together, we’ve practiced medicine in Arkansas for a lot of years. It’s been a wonderful experience, and along the way, we’ve seen SVMIC serve as a source of strength for the physicians of this great state. In 2001, for example, hundreds of Arkansas physicians faced an emergency crisis when another insurance carrier ceased writing policies. SVMIC was there to save the day, with the financial strength to protect these physicians and their livelihood. That financial stability is still a hallmark of the company. SVMIC has been our choice since they first came to the Razorback state in 1989. And that’s not about to change.”

Mutual Interests. Mutually Insured.

Contact Sharon Theriot or David Willman at mkt@svmic.com or 1-800-342-2239.

Follow us on Twitter @SVMIC

www.svmic.com

• To be the go-to referral resource • A method to track where referrals are coming from • Complete information prior to the patient’s first appointment, including: patient demographics, insurance information, any MRI, X-rays, etc.

• Previous surgical history on the patient, including names of previous surgeons • Referring physician’s office to appreciate when the specialist’s practice requests a patient’s medical records • Feedback from referring physician or their staff if any problems are encountered • The specialist requests records to ensure the patient is scheduled with the appropriate specialist in the practice. The more information made available, the better the match for the patient.

Sometimes problems occur. That’s (CONTINUED ON PAGE 13)

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Meaningful Use: The Next Step

By PEGGY STARLING, MARQ WALKER and JENNIFER BARNETT REED

Close to 2,800 Arkansas healthcare providers have already started the journey toward meaningful use of electronic health record (EHR) systems in order to qualify for federal financial incentives through Medicare or Medicaid. While the meaningful use (MU) of EHRs is a requirement of the federal incentive programs, its purpose is much broader. Meaningful use of EHRs supports other transformative programs in healthcare, including the Arkansas Health Care Payment Improvement Initiative, the Comprehensive Primary Care Initiative and the Patient Centered Medical Home initiative. It also improves the quality of care within a practice and promotes wellness in the patient population.

The process of reaching full MU has multiple stages, each of which is designed to build on the previous one. Stage 1 focuses on giving eligible professionals (EPs) and eligible hospitals an introduction to the capture of structured data and reporting quality measures. Stage 2, which goes into effect for some providers in 2014, builds on Stage 1 by applying

the criteria more broadly to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible. The federal Department of Health and Human Services is currently developing criteria for Stage 3, which will focus on improved outcomes. Stage 3 is scheduled to go into effect in 2016. And while the original outline of MU contained only three stages, HHS is also beginning to look at possible objectives for Stage 4, which will focus on consumer engagement.

As the incentive programs move into their third year, participating providers will encounter a number of changes to the

goals and requirements for MU. First, CMS has released a list of changes to the Stage 1 criteria.

Some changes go into effect this year, while others go into effect in 2014.

The Stage 1 changes effective in 2013 involve five core objectives: • Computerized physician order entry (CPOE).

The original measure required that more than 30 percent of all of an EP’s unique patients with at least one medication must have at least one medication order entered using CPOE. Providers and hospitals now have the option of using an alternative measure: More than 30 percent of medication orders must be recorded using CPOE. • E-prescribing. CMS has amended the criteria for exclusion to include any EP who does not have a pharmacy within his or her organization and whose practice location is not within 10 miles of a pharmacy that accepts electronic prescriptions.

• Vital signs. The original measure has been updated to require blood pressure measurement for all patients ages 3 and over, as well as height and weight measurement for all patients regardless of age. The number of exclusions has also

been expanded.

• Electronic exchange of key clinical information. CMS has removed the Stage 1 requirement for this category, instead including a more expansive requirement in Stage 2.

• Clinical quality measures (CQMs). CMS has eliminated this category as a core objective and instead made it a stand­alone element of the definition of being a meaningful user. CQM reporting will remain the same through 2013.

Further, CMS has changed the requirements for the public health reporting menu objective. Beginning this year, the Stage 1 public health objectives will require that participating providers conduct at least one test of their EHR’s capability to send data to public health agencies, even when not required by law or by practice. This could include the state vaccine registry. If the test is successful, providers should begin regular reporting with the agency involved in the test.

Finally, effective in 2013, CMS has expanded the definition of a Medicaid encounter to include a service rendered on any one day to a Medicaid-enrolled individual, regardless of payment liability. This includes zero-pay claims (those denied or paid at $0 for one of several reasons) and ARKids First encounters for patients in Title 19 and Title 21 Medicaid (CONTINUED ON PAGE 13)

Valvular heart disease is very common, and it often requires intervention. Here at Walker Heart Institute Valve Clinic we strive to accurately diagnose valvular heart disease, provide education on the disease process, monitor progression with followup physical examinations and carefully evaluate routine imaging studies. If intervention is necessary, our multispecialty team meets to determine the appropriate course of action.

The program is led by Geetha Ramaswamy, M.D., FACC, who is board-certified in interventional cardiology, echocardiography and nuclear cardiology. Along with a complete assessment supervised by Dr. Ramaswamy, patients receive one-on-one consultation with the clinic coordinator, Danielle Hayes, P.A., who specializes in valvular heart disease.

Improving the Care of Patients with Valvular Heart Disease Walker Heart Institute Valve Clinic

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For more information or to schedule a valve clinic appointment, call 479.571.4338.

walkerheart.com

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The Coming Broader Role of Advanced Practice Nurses, continued from page 1 America,” Frazier said. “People feel comfortable calling a nurse.”

Post-hospital care by NPs has been shown in studies to improve three outcomes: continuity in care, better patient access to care, and patient satisfaction.

“Patients have higher satisfaction when NPs are part of the healthcare Lorraine team,” Frazier said. “It is Frazier not a NP or a MD. It is a team working together.”

NPs are also experts in patient education. As education advocates, they emphasize lifestyle issues critical to the care of chronic conditions such as obesity, diabetes, high blood pressure and coronary heart disease.

Frazier said one thing that needs to come across to the public is that NPs impact care with good outcomes. It is not just about cost. The care NPs provide is linked to better outcomes for the patient and fewer revisits to the emergency room. The NP impact on care is decreased costs, decreased readmission rates, and better health outcomes.

Sometimes physicians have poor attitudes towards NPs, but those prejudices usually evaporate once physicians actually work closely with them. Frazier said often once physicians hire an NP for a team, later

they want to hire more.

“They see how NPs can expand what they do and improve patient outcomes,” Frazier said. “We like the integrative and collaborative model. That is the future of healthcare. If Arkansas elects to go with the Medicaid expansion, there is going to be a lot of work, especially in medically-underserved counties. NPs will be critical to meet the expanded healthcare needs of the state.”

The transitions in healthcare today are challenging, but provide opportunities for innovation. “House calls possibly may come into use again for chronically ill patients who are not able to come to the doctor’s office,” she said. “It is exciting to read about new concept care delivery models being considered. The U.S. currently spends more than other countries on healthcare, and yet our outcomes are not as good as many countries that spend less. These are exciting times for the country, but transitions are always challenging. I am really proud of how our healthcare professionals have stepped up to the plate to find ways to meet those needs.

American nurses are leading the way in expanding the scope of practice. We need to put more light on what we do.”

UAMS has greatly increased enrollment in NP programs. “In the fall of 2002, we had an enrollment of about 120 to 130 NP students,” said UAMS College of Nursing Assistant Professor Matthew Hadley, RN, DNP.

“In the fall of 2012, we had 270 students, basically doubling our enrollment numbers.

What is interesting is that APN nurses can stay in their own locale while going through our program. We have done this by utilizing Blackboard technology – online learning. Like yesterday afternoon, I had a class in front of me and I had students Matthew in Fayetteville, Batesville, Hadley Eldorado, and Texarkana.

In real time we had class together. When nurses can stay in their own hometown and continue practicing while they earn advanced degrees, it enables communities to grow their own healthcare professionals.”

Hadley practiced in a small rural area of Texas for 20 years, and said that experience showed him that to get healthcare professionals to stay in rural areas, you have to grow your own.

“These students are able to stay in their own community and most of the time continue to practice nursing while going to school, which is rather unique and great,” he said. “That is an important effort in trying to fill that void for healthcare providers.”

UAMS has recently started a Doctor of Nursing Practice (DNP) program.

Hadley, director of the program, said DNPs are one part of the whole picture

when meeting today’s needs for primary care.

The first DNP classes start this fall.

Hadley said the program is going to be one more way to give nurses the tools they need to change healthcare.

“Why should nurses be interested in this? Why is it important?” Hadley said. “We all want better patient outcomes. Also, as time goes on, third party payers will be reimbursed if we are following evidence-based practice guidelines. With the advent of recovery audit contractors being implemented by Medicare and Medicaid, practices will be reviewed to make sure care is evidence-based. If not, there will be questions on reimbursement. We all want better patient outcomes, and we want to get there in an evidence-based way. This is going to be very important. We are on the cusp. Things are changing in healthcare and this will be something we have to keep on the forefront.”

NPs and DNPs can deliver care in a cost effective way, and acceptance of them is gaining as the medical community sees the value of what these nurses provide.

“APNs students are very motivated, and a joy to teach,” he said. “Today, there are 80 NPs at Arkansas Children’s Hospital, when there used to be only a few. We do a great job at what we can do. Arkansas is going to need all the healthcare providers possible, regardless if they expand Medicaid or not.”

patients or post about their specific medical condition using social media.”

Surveys show about 20 percent of clinicians use two or more social media sites for personal and professional use, with Facebook the most popular medium for personal use. Online physician communities are more popular for professional use.

“Doctors who are familiar with patient portals or communities agree that they have a positive impact an individual’s health, but awareness of these social media sites is low,” Reeves said. “With the goal to confer, refer and learn from experts, 28 percent of doctors use professional physician communities.”

Reeves offers some “best practice” tips and guidelines for physicians: • Do not blog about specific cases, or reveal any customer data, • Do not offer medical advice or any remedy that would require a doctor visit first.

• Engage and educate–don’t diagnose.

• Do share something of value - recommend other sites, articles, links, tools, tips.

A new survey finds that patient’s expectations for healthcare providers have evolved. A majority expects their doctors to communicate with them proactively – even when they’re well – via texts, emails and proactive smartphone alerts.

“Nearly 80 percent of respondents say it’s their doctor’s job to keep them healthy, not just to treat them when they’re sick,” Reeves said. “They wish there was more communication when they’re feeling OK. According to the survey, 50 percent of respondents said they believed texts, emails or smartphone apps with tips, reminders and encouragement could have helped them avoid a past health problem. Just 25 percent

of those polled said they felt their healthcare provider was accessible to them when they have questions or concerns.”

Reeves said there’s a stereotype that doctors shun technology that might threaten patients’ privacy and their own pocketbooks.

But a new breed of physicians is texting health messages to patients, tracking disease trends on Twitter, identifying medical problems on Facebook pages and communicating with patients through email.

“Due to HIPPA, a doctor’s office can’t tweet patients to let them know it’s time for their next check-up or dental cleaning,” she said. “They can send a basic text alert (if the patient opts in to text alerts) that their appointment is upcoming, but nothing more specific.”

As healthcare continues to change, it is more important than ever to find meaningful ways to connect with patients and the communities served by healthcare providers, said Stacy Johnson, marketing manager for Sparks Health System.

“Our communities want a personal face to healthcare,” Johnson said. “Websites and social media sites are still emerging for most hospital systems. Our system is also still finding a way to connect with our patients through these sites.”

Sparks Regional Medical Center and Summit Medical Center, sister hospitals, have recently combined marketing teams.

Johnson said both hospitals have been successful in marketing and promoting services and physicians through free educational seminars held at the facilities.

“Both hospitals have recently revamped the hospital websites to include more health related topics, and we hope through the use of our social media sites we can give our patients a voice about local health care,” Johnson said.

Inbound Marketing, continued from page 1 The new approach instead of “Hey, look at us,” is more like, “Hey, we’re looking at you.”

“Healthcare marketing is making a shift in the right direction with more inbound marketing efforts in place,” she said.

“Inbound marketing engages the customer with relevant messaging that matters on a personal level. If we as healthcare marketers look at the customers’ needs, and then provide the tools to help meet their needs, they have to buy in.”

Rebecca It’s the difference bePittillo tween an ad that reads, “Our hospital has the latest technology to detect heart disease” versus offering a video series with local cardiologists giving tips on staying heart healthy while covering symptoms, causes, prevention and treatment of heart failure. Pittallo said inbound marketing allows hospitals to improve their community outreach efforts, engage the patient, offer screenings and tools to educate the consumer and promote the hospital.

“One of the most effective inbound marketing tactics includes social media participation,” Pittallo said. “Many healthcare consumers are talking about hospitals and physicians on social media outlets such as Facebook and Twitter and making healthcare decisions based on what their ‘friends’ or ‘followers’ have to say about a hospital or physician. Hospitals have realized the need for a presence and are using social media for dispersing medical information, physician blogging, collaborating across health systems, crisis management, fundraising, internal communication, guests relations and customer service.”

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This puts people in control of the healthcare information they receive and where they choose to find that information.

Many hospitals are offering patient portals to their customers. Pittallo said this tool provides patients with real-time access to key clinical information in their own medical records. Jchart is the latest development in JRMC’s fully integrated Electronic Health Records (EHR) system. Since patient information is now entered and maintained electronically, it goes directly into the Jchart, as well.

“Complete medical records are not available on the Jchart, but individuals who have been patients at JRMC or at one of JRMC’s clinics can log on to the Internet and have immediate access to their lab and radiology results, as well as discharge information,” Pittallo said. “One patient who recently started using the system went to JRMC for blood work, and said: ‘My lab results were in the Jchart by the time I got back to my office’.”

Emily Reeves, director of Digital Innovation & Insight Planning with Stone Ward, Little Rock, said social media makes it easier than ever for patients and physicians to connect outside the exam room. More than 1,300 doctors have already registered with TwitterDoctors.net, a database of physicians who Emily Reeves tweet. Beyond link sharing, doctors are still wary about engaging with patients. “Personal questions will still be handled through doctor’s office visits or phone calls,” Reeves said. “Since Twitter and Facebook aren’t secure and don’t comply with HIPAA rules, doctors can’t tweet

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Meaningful Use: The Next Step, continued from page 11 expansion programs. The EP must have an auditable system for documenting and counting zero-pay encounters.

The Stage 1 changes effective in 2014 include: • Electronic copy/access to health record. CMS is combining two original objectives into a single new objective: Provide patients the ability to view online, download and transmit their health information within four days of it being available to the EP. The measure for this objective is that at least 50 percent of all unique patients the provider sees during the EHR reporting period must have electronic access to their health information within four business days. A patient portal is required.

• Menu objective exclusions.

Starting in 2014, EPs cannot count an objective toward the total needed for MU if the provider claimed an exclusion for that objective.

• Upgrade to 2014-certified EHR technology required. To help with this process, CMS is changing the required MU reporting period for 2014 only to a single three-month period. Medicare EPs must select a calendar quarter, but Medicaid EPs can choose any three consecutive months. It is very important for EPs to monitor their vendor’s progress toward 2014 certification.

Stage 2 of MU will become effective in 2014 for providers who have met Stage 1 MU for at least two years. Stage

2 includes new objectives to improve patient care through better clinical decision support, care coordination and patient engagement. It also is designed to save money, time and lives through more robust use of EHRs. Stage 2 includes 17 core objectives, all of which are required. Some carry over from Stage 1, and some are new. Changes include: • New objective: View, download and transmit electronic personal health information (ePHI) Seven objectives are not new, but have been reclassified from menu objectives in Stage 1 to core objectives in Stage 2 • New objective: Use of secure electronic messaging There are a number of changes to the core objectives that carry over from Stage 1. For a complete list and comparison grid, visit www.cms.gov.

The Stage 2 menu objective list includes six options, of which EPs must choose three: • Submit electronic syndromic surveillance data • Record electronic notes in patient records • Make imaging results available through EHR • Record patient family health history • Report to cancer registry • Report to specialized registry In Stage 2, EPs will be required to submit data on a total of nine clinical qual-

ity measures (CQMs). The nine must be selected from at least three of six National Quality Strategy domains. CMS has developed a list of nine key CQMs for adults and nine for children, and encourages but does not require EPs to choose from those lists. There are 64 CQMs altogether. For a complete list, visit www.cms.gov. CMS is also working to align CQMs across several quality reporting initiatives, including the Physician Quality Reporting System and the Medicare Shared Savings Program. Beginning in 2014, Medicare-eligible providers in their second year or later must report their CQM data to CMS electronically.

HITArkansas, the state’s federally designated HIT Regional Extension Center, works with eligible providers and eligible hospitals to assist with achieving meaningful use. Because the criteria for MU change and each stage builds on the one before, HITArkansas encourages providers to become actively engaged in understanding MU and what it requires. HITArkansas has produced a variety of training materials that are available at http://hitarkansas. com, including a webinar on the upcoming changes to Stage 1 and Stage 2 MU. For more information, call 501-212-8616 or email hitarkansas@afmc.org.

Peggy Starling, CMPE, is vice president for Medicaid services and provider strategies at the Arkansas Foundation for Medical Care. Marq Walker, CPHIT, CPEHR, is program manager for HITArkansas. Jennifer Barnett Reed, MSJ, is a writer for AFMC.

Yours, Mine and Ours, continued from page 10 why continued open lines of communication are so important! We can’t fix a problem if we don’t know that a problem exists.

The specialist would always rather solve a problem than lose the referral source, and end up causing the patient delays in getting quality care.

Referral relationships require care and feeding. Figure out what works best for each of the parties in the relationship, and develop methodologies to track what matters. Once you’ve defined how the process should work, be consistent in your execution, but open to process improvement.

Here’s a side benefit: bet your word of mouth referrals-patient to patient-increase as well.

Build trust by keeping your promises to your patient, and to each other. That’s a win-win.

Leslie Heizman is the Business Development Director for Arkansas Surgical Hospital, a physician-owned hospital specializing in joint and spine surgeries. Her responsibilities include connecting prospective patients and potential partners to the hospital. She is responsible for developing referral resources and new product lines for the hospital. Heizman has more than 30 years in television broadcasting, primarily in sales and management. She also spent 4 years developing new business for advertising agencies.

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GrandRounds Dr. John Allen Burnett Joins Medical Staff at St. Bernards Dr. John Allen Burnett has joined the medical staff at St. Bernards as a psychiatrist.

He earned his M.D. from the University of Arkansas for Medical Sciences in Little Rock and completed a residency in psychiatry there.

John Allen The Arkansas State Dr. Burnett University graduate earned a bachelor’s degree in interdisciplinary studies and was recognized as a President’s Scholar upon graduation.

As an undergraduate, Burnett served as a research assistant with Dr. William Burns at ASU, producing computer software that allows chemistry students to compare theoretical with actual titration results. He co-authored an article on that work that was published in the Journal of Chemical Education in August of 2006.

He holds membership in the American Psychiatry Association, the University of Arkansas for Medical Sciences Psychiatry Interest Group, the Arkansas Medical Association and the American Medical Association.

Burnett treats both adult and geriatric patients and has special areas of interest in treatment resistant depression, anxiety disorders and dementia with special emphasis on simplifying complex medication regimens in patients suffering from both mental and physical illnesses.

Burnett is an avid outdoorsman who enjoys fishing, scuba diving and bow hunting.

On the medical staff at St. Bernards, he is a member of St. Bernards Medical Group and SHARP (St. Bernards Healthcare Associated Regional Providers).

NEA Baptist Memorial Hospital Names New CFO Kyle Sanders has been named as Chief Financial Officer for NEA Baptist Memorial Hospital in Jonesboro, Arkansas.

Sanders has worked at NEA Baptist since 2007 as controller and recently took on the interim position of CFO before being Kyle Sanders promoted to the position.

Hospital officials stated that Sanders is more than qualified for the position and has proven to be a valuable asset to the department and the hospital.

As CFO of NEA Baptist Memorial Hospital, Sanders will be responsible for several departments, including patient financial services, patient registration, health information management, materials management, and the hospital’s financial planning and budget processes.

He will also serve as the chief privacy and compliance officer for the hospital.

Sanders, who grew up in Newport,

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AR, is a graduate of Arkansas State University in Jonesboro, AR with a bachelor of science in finance and a master degree in business administration. Prior to joining NEA Baptist in 2007, he served as controller at Ski-Bosch Power Tool Co. in Walnut Ridge, AR.

Michele Wood named to Direct Hospital Marketing Michele Wood has recently been named Director of Marketing for White River Health System (WRHS) by Gary Bebow, Administrator/CEO. She is responsible for overall marketing and planning at WRHS and overseeing CommHealth, Physician Michele Wood Liaison Services, and Public Relations.

Wood graduated with high honors from Walden University in 2011 where she received a Bachelor of Science in Business Administration with a concentration in Marketing Management. She also has an Associates of Arts in Business from the University of Arkansas Community College at Batesville, where she also graduated with honors.

Wood joined White River Medical Center (WRMC) in 1992. She has worked in Administration for 15 years; first as the Administrative Assistant and, most currently, as the Executive Assistant. She has also worked with Pharmacy and Human Resources at WRMC.

LAMMICO Declares Dividend The Board of Directors of the Louisiana Medical Mutual Insurance Company (LAMMICO) has approved a sixth consecutive dividend for all LAMMICO policyholders in Arkansas and Louisiana. The announcement affects just over 6,000 policyholders, who will receive a 10 percent dividend of a policyholder’s written premium early next year.

The total dividend declared is approximately $5.1 million. LAMMICO’s dividend plan was approved on December 6, 2012.

A 10 percent dividend was also declared in 2011, 2010 and 2009, preceded by two separate 20 percent dividends that were declared in 2008.

All Arkansas policyholders (including individual physicians and other health care professionals, groups & healthcare facilities) holding a LAMMICO policy in force as of December 5, 2012, will receive dividend checks during the first quarter of 2013.

Dr. Abe Martinez Joins Physicians at St. Bernards Heart and Vascular Dr. Abe Martinez has joined St. Bernards Heart and Vascular (formerly Cardiology Associates) in Jonesboro. He comes to Jonesboro after completing an interventional car-

Dr. Abe Martinez

diology fellowship at Parkland Memorial Hospital, University of Texas Southwestern Medical Center in Dallas.

A native of Mexico, he holds an M.D. degree from University Panamericana, School of Medicine in Mexico City. He completed a clinical effectiveness program at Harvard School of Public Health in Boston and served both an internship and a residency in internal medicine at Massachusetts General Hospital, Harvard Medical School.

Martinez served a fellowship in cardiovascular medicine at Parkland Hospital before completing an interventional cardiology fellowship at Parkland. He is board certified in both internal medicine and cardiovascular disease by the American Board of Internal Medicine. Martinez is a fellow in the American College of Cardiology and the American Medical Association. He has been published in peer-reviewed journals and other publications.

Arkansas Mutual Insurance Donates To Impaired Physician Fund Arkansas Mutual Insurance Company, a medical malpractice insurance carrier for Arkansas physicians, recently donated $15,000 to the Impaired Physician Program administered by the Arkansas Medical Foundation. This is the third annual donation by Arkansas Mutual Insurance Company to this critical support program for physicians in the State of Arkansas.

The Arkansas Medical Foundation was formed in 1983 to provide confidential treatment and follow-up monitoring for physicians struggling with impairment, and to promote public health and safety by insuring the continued availability of skilled and highly trained medical professionals for the benefit of the public.

Three Named to UAMS Cancer Institute Foundation Board The board of directors of the Winthrop P. Rockefeller Cancer Institute Foundation at the University of Arkansas for Medical Sciences (UAMS) has announced the election of three new board members.

The new members are Virginia Stuart Chapman Cobb, Steven Collier, M.D., and Stacy Sells.

Cobb is a member of the UAMS Foundation Fund Board, the Chancellor’s Circle, the UAMS Hospital Auxiliary and the Cancer Institute Auxiliary.

Collier has been a family practice physician for 31 years and has served as the CEO of ARcare for 10 years. He serves on the board of the Bank of Augusta, Baptist Health and Ouachita Baptist University.

Sells is senior vice president of strategic planning at Cranford Johnson Robinson Woods.

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