The Topeka Capital-Journal | Sunday, January 7, 2018 | 1G
Health
Care State of
IN KANSAS
Take an in-depth dive into issues affecting families in northeast Kansas and statewide
STEM CELL RESEARCH, PAGE 4G
FOOD DESERTS DOT STATE’S LANDSCAPE, PAGE 4H
MANY KANSANS DRIVE FOR HOURS FOR DENTAL CARE, PAGES 6, 7H
WHAT ARE LEADING HEALTH ISSUES IN KANSAS? PAGE 8H
PHYSICIAN SHORTAGE NEARING CRISIS POINT, PAGE 10H
2G | Sunday, January 7, 2018 | The Topeka Capital-Journal
Health care resources vital to communities St. Francis scare highlights vulnerabilities in Topeka By Morgan Chilson
morgan.chilson@cjonline.com
Topekans — and especially St. Francis Health Center employees — worried and stressed for months during 2017 awaiting the fate of Topeka’s second-largest hospital. Along with a communitywide sigh of relief when the hospital was turned over to a partnership between the University of Kansas Health System and Nashville, Tenn.-based Ardent Health came a realization of how tenuous the capital city’s health care infrastructure might be. Randy Peterson, president and CEO of Stormont Vail Health, said the loss of a hospital wouldn’t have devastated the city, but it certainly would have been damaged for a time as Stormont worked to fill the holes. It was a scenario that had been part of Stormont’s planning for a few years. “Quite frankly, from a strategic standpoint, we have been thinking about that for the past three, four or five years — what if,” Peterson said. “Scenariobased planning and what would be needed if they closed and how could we try to meet those needs, because we’re only here for one reason and that’s to take care of the needs of this community.” Stormont had determined, based on the population Topeka serves, it would have been 100 beds short, he said. “We would definitely have needed more ED (emergency department) capacity,” Peterson said. Rep. Jim Kelly, a Repub-
lican from Independence, Kan., knows what happens in a community that loses a hospital. Mercy Hospital in Independence closed in 2015, shutting doors on the community’s only emergency department and many physician services and costing 200 employees their jobs. The hospital’s closure, Kelly said, was unlike the closure of manufacturer Southwire Co., which closed down its Coffeyville facility and also put 200 people out of work. “There was a ripple that developed around the plant and into Coffeyville,” he said. “They had people from both towns. It had a limited impact on the schools, and it had limited impact on the retailers or other industries. “The ripple didn’t go out as a gigantic one. When the hospital closed, in my mind the ripple was very, very large because it touched the school. They relied on that for health care for their families. It affected other industries, because that’s where their employees got their health care and where their hospital care would be. There were several smaller counties — Elk and Chautauqua, they have very limited health care. They relied on the hospital and the physicians in Independence for their health care. “All of the residents who would not have been impacted by an industry closing were impacted by a health care system that employed about the same number of people.” The loss of an emergency department had a real impact, and also dealt a psychological blow. As some-
LMH outlines expansion
November 2017 file photograph / The Capital-Journal
Months of anxiety came to an end when it was announced that Topeka’s second-largest hospital would remain open as The University of Kansas Health System St. Francis Campus. one who had served on the hospital board for more than 25 years, Kelly said, he was familiar with statistics showing how often people use the emergency department when they don’t need to and when an urgent care provider would be more appropriate. Employers, too, worried about where their employees would get health care and how far they would have to travel. Still, despite the loss of a business that was integral to residents’ feelings of stability and safety, the community two years later has rebounded in some ways, Kelly said. Other clinics have been established, including ones founded by St. John Health System, of Bartlesville, Okla., Wilson Medical Center, of Neodesha, and Labette Health, of Parsons. Specialists come in for day clinics from Joplin, Mo., Parsons and other areas. The city has made adjustments. For two years before the emergency department
opened — and even since then because the service can’t handle all emergencies — the ambulance service had to travel 30 to 40 minutes to take people to a Bartlesville hospital. That meant adding more paramedics and buying two ambulances. While not necessarily a new problem — Mercy Hospital didn’t have a cardiologist on staff — emergency medical response staff needed to be more prepared to be on the road. Continuity of care is a problem. Because so many different clinics are providing services and their electronic medical records aren’t connected, Independence residents can end up part of multiple systems, Kelly said. Some people have learned to ask for copies of their medical records. ”It’s put more on the individual,” he said. “In some instances, it won’t make any difference, and in some instances, it could make a difference.” It has been a long road
to feeling the community’s health care is once again stable. “If St. Francis would have closed, it would have been a big impact, but it doesn’t leave Topeka without health care,” Kelly said. “You’ve still got Stormont Vail, all those clinics and everything else around. It would be bad, but it’s not like in a small town where the hospital goes and a lot of doctors go with it. “Recruiting is still an issue that will stay to some degree, because a lot of doctors want to be where there’s a hospital that they can send their patient to or have them close at all.” It’s been baby steps, and a big one came when an emergency department opened in July in Independence. “We have to be thankful for Labette coming in and having the courage and the vision to put in an ER and a clinic,” Kelly said. “And they have plans already laid out on what they think their next steps would be to add
Lawrence Memorial Hospital plans to invest nearly $100 million on a west Lawrence expansion and improvements throughout the city. LMH plans to build a new 200,000-square-foot medical office building that will cost about $64 million, LMH spokeswoman Belinda Rehmer said. As of late December, negotiations were still in process on purchasing the land, a 20-acre site close to the 6th Street and South Lawrence Trafficway. Other improvements throughout Lawrence are planned, including purchasing the Lawrence Medical Plaza, 112 W. 6th St., and purchasing the Reed Medical Building, 404 Maine St. care, and they have the land to do it. Nothing will be quick, but I think at least it’s headed the right direction.” Cindy Samuelson, vice president of public relations and political fundraising for the Kansas Hospital Association, said 112 of Kansas’ 127 hospitals are classified as rural. Of those, 82 have a negative operating margin. That doesn’t mean they are on the edge of closing their doors, Samuelson said. There can be many reasons an organization’s costs exceed revenue, and the data is a little out of date and from a single point in time. Some Kansas hospitals, such as those in oil-rich counties, have significant reserves to support their health care facilities. Still, it is concerning. The loss of dollars the state’s hospitals have experienced because of the lack of Medicaid expansion has been well documented. Samuelson said the industry still is hopeful going into the next session that legislation may pass.
The Topeka Capital-Journal | Sunday, January 7, 2018 | 3G
4G | Sunday, January 7, 2018 | The Topeka Capital-Journal
In stem cell research, possibilities abound By Luke Ranker
luke.ranker@cjonline.com
The body, as any basic biology class will teach, is made up of cells, all working to keep the heart pumping, lungs breathing and limbs moving. Of the dozens of cell types, scientists see one in particular — stem cells — as the future for healing. Since the 1960s, stem cells found in bone marrow have been used to treat leukemia and rebuild the immune system during cancer treatment. Research underway at the University of Kansas Cancer Center in Kansas City, Kan., may open the door to using stem cells found in umbilical cords. “There’s great hope, and there’s great promise,” said Joseph McGuirk, physician and medical director of cellular therapeutics at KU Cancer Center. Bone marrow is rich in stem cells, but the process to obtain them is complicated. Autologous treatments — those relying on stem cells from the patient’s own body — are preferred, because the risk of rejection and other complications is greatly diminished. But with most treatments, the patient’s immune system is too depleted, so doctors turn to allergenic therapy, where stem cells are derived from a single donor. Hundreds of thousands of patients are treated with donor stem cells successfully every year, McGuirk said, but there are complications. Even when source stem cells are derived from a close relative, patients may reject the new stem cells. In some cases, the cells are so effective at establishing themselves that they reject the host. That condition, graft-versus-host disease, can cause tissue damage and sometimes death. McGuirk said there’s evi-
Submitted photographs
Left: Teresa Turner retrieves a patient’s stem cells from a tank at KU Medical Center. Right: A technician works at Kansas Regenerative Medicine Center. dence mesenchymal stromal cells found in umbilical cords can help regulate the immune system and reduce the risk of graft-versus-host disease. The same cells also may help patients with neurological diseases like amyotrophic lateral sclerosis (ALS), joint conditions like arthritis and autoimmune disorders. As part of the University of Kansas Medical Center, the Midwest Stem Cell Therapy Center is investigating whether heartderived adult stem cells can repair heart muscle that is dead or has been damaged by heart attacks. These treatments are years from becoming standard practice, McGuirk said. That long research process starts, in some cases, in biologist Mark Weiss’ lab at Kansas State University in Manhattan. Weiss co-discovered mesenchymal stromal cells within umbilical cords and conducted animal trials on the graft-versus-host dis-
ease treatment. KU is currently seeking Food and Drug Administration approval for human trials. The work at K-State began almost 10 years ago, Weiss said, and his lab is currently working on second- and third-generation treatments that may offer better outcomes for treating immune system attacks on the body. K-State researchers recently saw some success using stem cells to treat arthritis in dogs. A doubleblind, placebo-controlled study of 75 dogs showed “striking” improvements in the 22 dogs that received stem cell therapy for joint issues. Dogs were evaluated after one, three and six months following the treatment. So far, treatments for like those done at the University of Kansas Medical Center are the only ones the FDA has standardized, but options for experimental treatments beyond cancer care are available in Kansas. At Kansas Regenerative
Medicine Center, which has offices in Manhattan and the Kansas City area, doctors use stem cells found in fat in an attempt to treat joint issues such as arthritis, rebuild nerves and repair the heart following a heart attack. The treatments have not gone through the phase testing required by doctors treating cancer. Andrew Pope, co-medical director, said procedures at Kansas Regenerative Medicine Center are done to standards set by the Cell Surgical Network. The network, based in California, uses an internal review board to vet treatments. Patient outcome data is tracked from across the country, so research on safety and effectiveness can be published, Pope said. A patent for their stem cell therapy is currently under FDA review. “The whole point is to stick with what you study, so the product is based on evidence and science,” he said. “We’re doing things the right way.”
Regardless of what’s being treated, procedures are nonsurgical and outpatient. Doctors remove a small amount of fat with a local anesthetic and separate the stem cells that reside in the connective tissue between the fat cells. Those stem cells are concentrated and then injected into the treatment area, like a knee or elbow. “I don’t have to knock you out. It’s all local numbing,” Pope said. “Most of my patients say it feels like a weird massage.” The hope is the stem cells will begin to rebuild damaged tissue in the affected area. Because the therapy relies on cells from the patient’s own body, Pope said, there’s no risk of the body rejecting the treatment. He cautioned that stem cell therapy isn’t necessarily a cure for conditions such as arthritis, but it can offer a remedy to improve symptoms. Pope said the majority of patients — about 80 percent
— report some improvement to their joint condition. “Worst-case scenario, at the end of the day they may not feel it improved them,” he said. The Center for Manual Medicine and Regenerative Orthopedics in Topeka began offering stem cell injections from the patient’s stem cells in 2016. Seth Harrison, spokesman, said the center’s physician, Doug Frye, tracks the results for every patient treated. “Every person that we’ve done has been at least 75 percent better at the year mark, with many of them being 100 percent improved,” Harrison said. One reason for that is the center is carefully screening patients. The Center for Manual Medicine only does the stem cell treatment for musculoskeletal injuries, working on joints, ligaments, tendons and arthritic joints. Reporter Morgan Chilson contributed to this story.
The Topeka Capital-Journal | Sunday, January 7, 2018 | 5G
Local infrastructure can encourage healthy choices Shawnee County master plan calls for 150 miles of trails By Chris Marshall
Special to The Capital-Journal
The environment people live in has a big influence on how healthy they are. That doesn’t mean failed New Year’s resolutions can be blamed entirely on surroundings — a healthy lifestyle is still largely determined by individual choices — but infrastructure and community initiatives can go a long way in encouraging residents to make healthier, more responsible decisions. Shawnee County is on the path to making this a reality for its residents, thanks to a variety of planned additions to trails and walkways. “Our 10-year master plan is to have 150 miles of trails in the county,” said Mike McLaughlin, communications and public information supervisor for Shawnee County Parks and Recreation. “We currently have just over 54 miles. An important element of the trails is connectivity. If we can get the current trails to connect to one another, it encourages more use, and people can use them to get to more places for more reasons.” The Kansas Department of Transportation recently provided a grant to extend the Deer Creek Trail from S.E. 10th Street through Dornwood Park to S.E. 25th Street. McLaughlin said the hope is to eventually connect it to the Lake Shawnee Trail. That would allow cyclists, or ambitious runners, the ability to start on Shunga Trail at its new
S.W. 29th and McClure entry point and travel all the way from southwest Topeka to Lake Shawnee without leaving the trail. McLaughlin said the deciding factor between whether someone hops in a car or walks or bikes to their destination often comes down to how close a trail is to their residence. That’s just one example of how improved accessibility can enhance a community’s health. “The best policies are those that make the healthy choice the easy one. That’s not always the case,” said Gianfranco Pezzino, senior fellow and team leader for public health systems and services at the Kansas Health Institute. “If you live, for example, in a place that doesn’t have easy access to affordable fresh food, the easy choice is to go to a convenience store around the corner to buy food less healthy for you.” For that reason, Pezzino said, the 2016 closure of Dillons at S.W. Huntoon St. and Washburn Ave. is a sore spot for him. While driving an extra two to three miles to another Dillons store may not seem like a burden to some, those without cars are more likely to choose unhealthy options without a grocery store within walking distance. The issues, though, are challenging. Dan Partridge, director of the Lawrence-Douglas County Health Department, said the Lawrence community has been working on the food desert issue for years, looking particularly at East and North
Thad Allton / THE CAPITAL-JOURNAL
Audrey Power, of Topeka, says she walks on the Shunga Trail every day for her health. Lawrence areas that don’t have adequate access to food. “It’s been a long road,” he said. “It’s really about a grocer has to turn a profit. It’s hard to overcome that when the market analysis doesn’t look promising.” Researchers like Pezzino at the KHI conduct studies that lead to publications created for policymakers, arming them with analysis of the community so they can make informed decisions that affect the health of Kansans. A 2017 survey by the National Recreation and Park Association showed 85 percent of Americans seek high-quality parks and recreation amenities when choosing a place to live, and 95 percent believe it’s important for their local agency to protect the environment by acquiring and maintaining parks and trails. “If people live in neigh-
borhoods that have damaged sidewalks or not enough lights, or aren’t near pleasant parks or walkways, they won’t do it,” Pezzino said. “If they don’t have the transportation, they can’t go to places like Lake Shawnee or Gage Park.” While the thought of trails passing by every neighborhood is nice, reaching the 150-mile total envisioned in the county’s master plan takes funding. McLaughlin said the community’s private companies have helped in that regard. Blue Cross Blue Shield of Kansas made contributions to fund a fitness loop trail at the Shawnee North Community Center. The health insurance company sees obvious benefits from encouraging physical activity among residents and regularly awards funding to health initiatives in its 103-county service area.
BCBS partners with the Kansas Association for Youth in a “Be the Spark” program that provides grants creating the opportunity for middle school and high school students to be physically active. Another initiative, Pathways to a Healthy Kansas, promotes physical activity, nutrition and tobacco-free environments for 16 communities across the state. “In my opinion, it makes sense for the industry we’re in to improve the health of the community,” said Marlou Wegener, chief operating officer of the BCBS of Kansas Foundation. “It’s a goal for us to place a strong emphasis on supporting the communities we serve.” Azura Credit Union made a $180,000 gift for naming rights, trail markers and maps for Azura Trails at Skyline Park. McLaughlin said the 4.7 miles of trails, which cover Burnett’s Mound,
wooded areas and prairies, offer the most panoramic views in Shawnee County. Before the signs were installed, most people didn’t even know the trails were there. If the nearly 100 miles of additions are completed as planned over the next decade, the trails — and the opportunity for a healthier means of transportation — will be hard to miss. “When thinking about changing behaviors, you need to be physically able to do it, of course, but you also need the opportunity and the motivation to make the change,” Pezzino said. “We need to make sure people have the opportunity to begin with. That alone might not be enough, but without the opportunity, people won’t have what they need to develop healthier behaviors.” Reporter Morgan Chilson contributed to this story.
6G | Sunday, January 7, 2018 | The Topeka Capital-Journal
Experts: Healthy foods available to many, with work Education and planning can improve meals By Phil Anderson
phil.anderson@cjonline.com
A commonly held view is that many people on low incomes can’t afford healthy foods. Experts aren’t in agreement with this assumption, however. Some maintain anyone can eat healthy, regardless of income. Others acknowledge budgetary roadblocks make it difficult for people on low incomes to select foods that are good for them. There is agreement on one area: Eating healthy is about making good choices when selecting food. Kim Crawford, director of marketing and community outreach for UnitedHealthcare, said she doesn’t necessarily buy into the notion that people on limited incomes can’t eat healthy. “I struggle with that one,” she said, “because I don’t know if they can’t afford to eat healthy or they don’t understand how to eat healthy.” Crawford, who specializes in working with the KanCare program, which serves people on Medicaid in Kansas, said people on low incomes aren’t the only ones who don’t always eat healthy foods. “You see very wealthy people who have poor eating habits,” she said. Education is a key to helping people overcome the tendency to grab food that is fast but not always cheap and rarely healthy, Crawford said. “One of the worst culprits is your sugary soft drinks,” she said. “When you are consuming a soft drink, you are getting empty calories with no nutritional value.” “Potato chips — they’re delicious, but there’s not a lot of redeeming qualities in potato chips.”
In the final analysis, even if certain foods that are healthy also are more expensive, the extra cost may be well worth it in the long run. Eating foods that aren’t healthy could contribute to a number of health problems, Crawford said. “You’re talking heart disease, high cholesterol, diabetes — and all those things end up costing you a lot more money than if you were eating healthy,” she said. Stephanie Sisk, an advanced practice registered nurse at Stormont Vail Health, works with people to develop healthy eating habits. People on limited incomes often seek out the cheapest food option, and many times that means they’re eating foods that aren’t always healthy. Fresh fruits and vegetables tend to be expensive, and lean meats and seafood can be “really pricey,” Sisk said. To help people on low incomes stretch their food dollars, Sisk advises them to check grocery ads when they come out each Wednesday and take advantage of specials, stocking up on such items as boneless, skinless chicken breasts when they are on sale and putting them in the freezer for use at a later time. For weight management, she recommends highprotein diets that include budget-friendly foods, such as eggs, Greek yogurt and beans. Canned foods are another good option, especially if they are of the no-salt variety. Otherwise, she said, people can rinse off and drain their canned foods before cooking them. “You do want to educate yourself,” Sisk said. “Check your labels. You want to buy products that have more proteins and a little less carbs.”
Lihlani Skipper, of the Center for Agriculture and Food Systems at Vermont Law School, said low-income people in the United States have a challenge when it comes to eating healthy diets. “Although the cost of food in the U.S. is lower than that of other countries, the cost of healthy food is much higher than unhealthy food,” she said. Skipper said the Healthy Food Policy Project defines healthy food as food that is minimally processed; fresh, frozen or canned produce that has little, if any, added sugar, salt or fat; food that is culturally relevant; food that meets evidence-based nutrition standards; and food that is both nutritious and safe to eat. In spite of challenges, low-income individuals can eat foods that are healthy. “There are many resources available that provide ideas of how to eat healthy food on a tight budget,” Skipper said. “Some ideas include cooking with dried beans, peas and lentils as protein sources and using smaller amounts of meat, poultry and fish. “Other strategies include buying in bulk to get a lower cost per item, or cooking from scratch to reduce the amount of added sugar, salt and fat consumed.” In her position as executive director of the Topekabased Jayhawk Area Agency on Aging, Susan Harris works with senior adults, many of whom are on fixed incomes and struggle with balancing their budgets with healthy food choices. “Low-income seniors often state that they cannot afford to eat healthy due to the expense of healthy foods,” Harris said. “Naturally, the foods that are not processed, such as fresh fruits and veggies, are more
THAD ALLTON / The CapitalJournal (above), Phil Anderson / The Capital Journal (left and below)
Above: Scott Nickel, director of the culinary program at Washburn Institute of Technology, said people on limited incomes can eat healthy, provided they have a strategy for doing so. Left: Farmers markets offer plentiful opportunities for healthy eating during the summer months, especially with essential fresh fruits and vegetables. expensive than more highly processed, less-healthy options.” People who don’t eat healthy can be at risk for a multitude of health issues, she said. Many seniors, she noted, already have chronic conditions, such as diabetes, that are heavily affected by not eating well. Harris said people on limited incomes can find ideas to help with healthy and nutritious diets by contacting Kansas State University’s Research and Extension program.
In Topeka, there are regular opportunities through Harvesters, a community food network, to get healthy and nutritious food options at no cost. “For seniors,” she said, “the barrier is often transportation to get to the distribution sites.” Scott Nickel, a chef instructor at Washburn Institute of Technology, said people on limited incomes can eat healthy, provided they have a strategy for doing so. Individuals can gain
more knowledge on cooking by going online and searching Google, YouTube and “thousands of other sites that showcase easy, basic techniques,” Nickel said. Nickel noted people can take advantage of local food pantries, many of which are based in Topeka-area churches. Other possible sources, he said, include Topeka Rescue Mission, New Hope Food Pantry and The Salvation Army, along with Catholic Charities of Northeast Kansas, Doorstep Inc. and other charities.
The Topeka Capital-Journal | Sunday, January 7, 2018 | 7G
As kids’ mental health issues increase, districts respond By Samantha Foster
samantha.foster@cjonline.com
Some Seaman Unified School District 345 staff have spent the past few months analyzing strategies for supporting students with serious mental health concerns. A group of two dozen elementary- and secondary-level teachers, administrators, counselors, social workers and school psychologists met Nov. 30 at the district offices to discuss drafts of a suicide prevention and intervention plan that would become uniform across the district. Dedra Raines, the district’s director of special services, said district students took a Kansas Communities That Care Survey that showed higher rates of depression and suicidality. Survey data from 2016 showed 29.05 percent of Shawnee County students who took the survey said that in the past 12 months, they had felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities. Comparatively, 25.41 percent of students statewide who took the survey indicated the same. “Our children have more concerns with depression and suicide, so now we’re looking at what strategies do we have in place, what interventions do we have, to meet those needs of those students that aren’t getting the needs met within their general education classroom,” Raines said. Nancy Crago, director of psychosocial rehabilitation at Topeka’s Family Service & Guidance Center, said children now are exposed to more traumas than they were previously, which means they come to school with a set of mental health issues that schools haven’t dealt with before.
‘‘ Photographs by SAMANTHA FOSTER/THE CAPITAL-JOURNAL
Seaman USD 345 staff work in groups on developing a unified mental health curriculum during a meeting Nov. 30 at the district offices. Right: Christina Mann, a state trainer with Technical Assistance System Network’s Kansas MTSS Project, speaks to the Seaman staff members. It is critical, she said, that schools focus on mental health. “Sometimes, they’re the first people that discover that a child’s depressed or that a child’s having mental health issues,” Crago said.
Evidence-based practices
Seaman received a grant two years ago through which the Kansas State Department of Education’s Technical Assistance System Network is working to help it implement a MultiTiered System of Supports, or MTSS, an evidencebased framework for structuring academic, behavioral and social-emotional supports meant to ensure the success of every student. Christina Mann, a state trainer with TASN’s Kansas MTSS Project, led the group of Seaman staff as they worked in small groups to discuss the suicide prevention and intervention plan, then shared feedback.
Raines said each of the district’s schools already had individual plans in place similar to the one being prepared by the group. The plan is implemented when any district employee reports hearing a student say something that prompts a concern for his or her well-being. That “behavior of concern” should be immediately reported to an administrator, social worker, counselor or psychologist, who then interviews the student, asking enough questions — such as whether the student is considering suicide and has the means to do so — to determine a level of risk for suicidality. If a student is hostile or noncompliant, the person conducting the interview should assume they are at a moderate or high risk of suicidality, according to the draft protocol. The intervention plan then guides staff through contacting a parent or guardian, providing resources and following up to ensure the student is
receiving outside support, Raines said. A concern shared by a middle-school counselor during the meeting was tied to whether assessing a student’s risk of suicidality after an interview could come with liability. Mann reminded the group that records tied to the risk-level assessment were separate from the student’s health emergency. “I would hate for us to think that in an emergent situation, we’re being fearful about being able to communicate what we’re seeing,” Mann said. “We don’t diagnose. This is not a formal assessment. This is, based on an interview, we have real concern.” Mann, a licensed clinical social worker, said it’s encouraging educators are focusing on children’s socialemotional development so they can more easily implement a mental health perspective. As the need for mental health intervention grows, Raines said, schools have to be more intentional in
their response and have strategies and resources in place. The Seaman district now screens students three times each year to assess their needs, she said.
Psychosocial groups
The Family Service & Guidance Center has provided a psychosocial group program for students in Topeka USD 501 for about 30 years, according to Crago. In that time, it has grown from a single group at Capital City School to groups in several schools that serve about 150 kids. “We worked with 501 to identify the schools of greatest need, and that’s where we go,” she said. The groups’ objective is to address the social skills that cause students problems or interfere with their ability to function in school, Crago said. About eight students at a time cycle through a psychosocial group with two leaders for about an hour and a half each day to work on social
I would hate for us to think that in an emergent situation, we’re being fearful about being able to communicate what we’re seeing.” Christina Mann
trainer with TASN’s Kansas MTSS Project
skills, then return to class. Students in the groups have a variety of diagnoses that range from depression and anxiety to attention deficit hyperactivity disorder and oppositional defiant disorder, Crago said. While FSGC staff can serve any diagnosis, they focus on kids who are having difficulty functioning in school because of it. FSGC staff who run the groups are based in the schools, and their groups and offices are there, she said. They are seen as part of the school support team, which helps them develop relationships with teachers and students. Crago is the community representative on Topeka USD 501’s mental health team, which includes teachers, social workers, psychologists and administrators and works to create an overall strategic plan for schools’ mental health needs. USD 501 is in the process of training all its personnel in a trauma model.
8G | Sunday, January 7, 2018 | The Topeka Capital-Journal
Pediatric cardiologist brings care to underserved areas By Samantha Foster
samantha.foster@cjonline.com
Children and infants born with heart disease and children and adolescents who develop arrhythmia or other heart conditions can receive care sooner and closer to home because Stormont Vail Health has a pediatric cardiologist on staff. Pediatric cardiology tends to be limited to tertiary care centers, such as children’s hospitals, which are in large metro areas like Kansas City, Mo., or Denver. But Stormont Vail took an opportunity about three years ago to bring that specialty care closer to home for those living in Topeka and surrounding rural areas. Dhiraj Singh, pediatric cardiologist at Stormont’s Cotton O’Neil Heart Center, said that before he came to Topeka, a specialist from Kansas City visited Topeka once or twice a month to see patients. That meant infants, children and adolescents in need of care might wait two months for an appointment. “So the wait was two to three months, and now we have been able to cut down the wait to less than a week,” he said. “It’s been really good for the community in that sense. They have ready access to cardiology now.” There is no other fulltime pediatric cardiologist between Kansas City and Denver, Singh said, so his work includes supporting staff at hospitals that are affiliated with Stormont for specialty care. Doctors can refer patients to Singh in Topeka — or at the Cotton O’Neil Manhattan and Emporia outreach clinics, depending on scheduling — rather than sending them to the more distant
‘‘
The heart is still the same, but how you look at it is a little bit different.” Dhiraj Singh
pediatric cardiologist
Children’s Mercy Hospital or University of Kansas Hospital in Kansas City. Eva Ewers, a pediatrician at Fort Riley’s Irwin Army Community Hospital, said she has referred many patients to Singh and called him for consultations. She said having a pediatric cardiologist working in the area makes a difference. “It definitely benefits the patients, because as soon as a parent hears a child has anything to do with a heart murmur or arrhythmia or anything, they almost kind of go into panic mode,” Ewers said, “so being able to get them to a pediatric cardiologist who is relatively close and can get them in in a timely manner means a lot to them.” Singh said doctors in communities such as Hiawatha and Sabetha sometimes use telemedicine for pediatric heart patients. He also receives frequent phone calls from doctors with questions about patients. “I don’t think there is any day that I don’t get a call,” he said. “Not all calls are critical calls, but they do provide some kind of medical advantage to the primary care doctors.” Early detection of congenital heart disease is critical to ensuring the best outcome, Singh said, and that is his main focus. Because of the increased accessibility of pediatric cardiology care, more patients have been caught
THAD ALLTON/THE CAPITAL-jOURNAL
Dhiraj Singh, pediatric cardiologist at Stormont Vail Health’s Cotton O’Neil Heart Center, looks at a wall of artwork — created by infants and children with heart disease for the American Heart Association’s Heart Ball — displayed in the center’s lobby. at an earlier age, allowing care providers to optimize pre-surgery care for a better outcome. For example, Singh said, if an infant’s congenital heart disease goes unnoticed until the infant is 6 months old, they can go to surgery immediately, but the outcome won’t be as good as if it had been diagnosed earlier and managed until the baby reached that age. Infant patients receive optimized care so they can go into surgery in good shape, then Cotton O’Neil manages post-operative care after discharge from the hospital and checks to ensure the infants’ continued well-being for a period of time afterward, Singh said. He noted that care close to home is important to families whose resources are limited.
“Those type of services can now be delivered closer to home so they’re not going back and forth all the time,” he said. Ewers said communitybased pediatric cardiology care has helped ensure patients can be treated in a timely manner. “If we call (Singh) and say, ‘This is what we think this child has’ or ‘This is what the echo (echocardiogram) looks like,’ if he thinks they need to be seen sooner, he will work them in and get them seen sooner,” she said. “He’s been very good with helping us to take care of the child, whatever their needs are.” Clifton Jones, vice president for subspecialty care at Stormont, said he believes having a pediatric cardiologist in a city the size of Topeka is “relative-
ly unique.” “Whatever we can provide in the community is a service to our patients and their families,” Jones said. Singh also trains sonographers at community hospitals to perform echocardiograms of infants’ and children’s hearts. Unlike adults, babies don’t hold still for CT or MRI scans, Singh said, so the cardiac echo is all technicians have to determine whether a patient’s condition is critical and needs to be transferred for emergency care. “It’s operator-dependent,” he said. “How well you can do is dependent on how well the person is trained.” The technique used to perform scans on infants is different than that used for adults. Babies don’t have the fat or excess mus-
cle of adults, Singh said, so technicians scan through the subcostal or neck windows. “The heart is still the same, but how you look at it is a little bit different,” he said. Singh offers technicians opportunities to train by shadowing staff in Topeka, attending a continued medical education conference, or completing hands-on training during sessions offered twice a year. Under his leadership, Washburn University’s medical sonography program works with Stormont’s sonography division to give students opportunities to learn pediatric echo protocol before they enter the field. Contact reporter Samantha Foster at (785) 295-1186 or @samfoster_ks on Twitter.
The Topeka Capital-Journal | Sunday, January 7, 2018 | 9G
How to figure out your medical bill By Phil Anderson
phil.anderson@cjonline.com
Making sense of a medical bill may be a little like reading a foreign language for the first time. Thankfully, help is available if a consumer will reach out to the agency sending the bill. Often, the best bet is to contact the health care provider directly and visit with someone in the customer relations department. Many providers have people specially trained to assist people with their questions. Larry W. Morris, administrative director of the revenue cycle for Stormont Vail Health, said people sometimes experience consternation after getting a medical bill, in large part because they are confused about what their insurance will — and won’t — cover. “Patients often find that one of the biggest frustrations is that they don’t understand why their insurance did not pay more for their visit,” Morris said. “Some patients do not have a good understanding of what a deductible or coinsurance is until they receive a patient statement. Patients often call in with questions, and we work to help explain it to them.” People who would like to see more detail on their bill can contact customer service agents at the facility where they received their care to request an itemized
listing of charges for the services they received. “Patients can always contact customer service if they believe there is an error in what they were charged,” he said. “We will have the charge reviewed to verify accuracy. We will then contact the patient to explain why the charge is correct, or let them know there was an error and how we are correcting it.” For Stormont Vail patients needing someone to help explain charges on their bill, Morris suggested several options: ■■ Patients can call (785) 354-1150 or (800) 637-4716 between 8 a.m. and 5 p.m. Monday through Friday. If they call between 5 p.m. and 8 a.m., they can leave a message with a call-back number. ■■ Patients can go online at stormontvail.org and use their “My Chart” sign-in to ask a billing question. ■■ Individuals can email their questions to billinghelp@stormontvail.org. Stormont Vail also has two customer service locations: 1500 S.W. 10th Ave., on the hospital’s first floor by the registration area, 8 a.m. to 4:30 p.m. Monday through Friday, and Cotton O’Neil Garfield, 901 S.W. Garfield, 8 a.m. to 5 p.m. Monday through Friday. Many health care providers, including Stormont Vail, will work with patients to set up plans so they can make installment payments on their bills.
“Stormont Vail Health has several payment options for our patients to pay their balances,” Morris said. “If they are unable to pay their balance in full, we offer interest-free extended payment plans. Depending on the balance owed, the payment plan can go up to 36 months. We also have a low-interest bank loan program for a longer term to lower the monthly payment.” Additionally, he said, Stormont Vail Health has a financial assistance program for patients who are unable to pay for emergency or other medically necessary care. “A patient determined to be eligible for the financial assistance program will not be charged more for emergency or other medically necessary care than amounts generally charged to patients who have insurance covering such care,” he said. “Financial assistance discounts range from
THAD ALLTON/THE CAPITAL-JOURNAL (above), Submitted (upper left)
Help is availalble for those needing assistance in understanding their medical bills, according to Larry W. Morris, administrative director of the revenue cycle for Stormont Vail Health (upper left). 65 percent to 100 percent of the balance owed, depending upon the patient’s annual income and net worth. The amount owed after applying the financial assistance discount is capped at 30 percent of the patient’s annual income and can be paid over 36 months with no interest.” Susan Harris, executive director of the Jayhawk Area Agency on Aging in Topeka, said senior adults “often get confused when the medical bills come, because they have difficulty
matching up their bill from the doctor to the statements of benefits that Medicare and their supplemental insurance company send out.” “When we do insurance counseling for a Medicare beneficiary,” Harris said, “we thoroughly explain to them how to read those statements of benefits and counsel them to not pay a bill until they are sure that all their insurance options have paid.” Medicare counselors available through the Se-
nior Health Insurance Counseling of Kansas — or SHICK — can help people figure out if the medical bill they have received is correct and if they are responsible for the bill. “We can also assist seniors with calling their medical provider to work out any issues with billing,” Harris said. Senior adults requesting more information can call the Jayhawk Area Agency on Aging at (785) 235-1367 or SHICK at (800) 8605260.
Limited plan options, ‘‘ high costs pose health Assistance available for insurance challenge Medicare beneficiaries
(Medicare.gov) is a great resource where folks can do comparison shopping for their Medicare Part D plans for drugs and also Medicare Advantage plans.” Susan Harris
executive director of Jayhawk Area Agency on Aging
By Phil Anderson
sorting through choices
phil.anderson@cjonline.com
Health insurance has been a hot topic on the national stage for many years. The good news: It is available. The not-so-good news: It isn’t cheap, and there may not be as many options as consumers would like. “It’s possible to shop around,” said Gina Ochsner, director of network development and regional relations for Stormont Vail Health in Topeka. “But unfortunately, there are not many options in the market for individual health care anymore.” With the exception of people on Medicaid or Medicare, most people find their best bet is to obtain health insurance through their employment, Ochsner said. “Most people still access health care benefits through an employerbased plan,” she said. “It is usually the best option to get your health insurance coverage through work.” Ochsner, who also is a licensed insurance agent, said if employer-based group insurance isn’t available and a person needs a private or individual policy, “you can shop for them, but there are very limited choices” in Kansas. “I would recommend a person go to the marketplace exchange for your individual insurance options,” she said. “Healthcare.gov is the best place to start.” The website will walk people through the process of obtaining health insurance and provide information on whether they are eligible for assistance with their premium costs, based on income and other factors. Individuals needing help
By Phil Anderson
phil.anderson@cjonline.com
Submitted
Gina Ochsner is the director of network development and regional relations for Stormont Vail Health in Topeka. navigating the healthcare. gov site can find help from “navigators” who work at selected not-for-profit agencies, Ochsner said. The navigators guide a person through the health care process, but aren’t allowed to recommend a policy or explain benefits. People might have a lengthy wait to meet with a navigator because of high demand. Ochsner recently said she knew of only two insurance companies participating in the Kansas portion of the federal health care exchange. Other companies have dropped off. “A lot of the carriers had lost money on the federal exchanges, which have mandated benefits,” she said. “It is difficult to keep them affordable to people.” Ochsner was quick to point out that a person seeking private health insurance “can always find an insurance agent to help them with something like this.” Regardless of whether people are getting insurance through work or
through other means, Ochsner said it is imperative that every individual has health insurance. “Health care is still one of the main factors — possibly the top factor — for personal bankruptcy,” she said. “It’s good to at least have some level of coverage.” Ochsner offered these tips for selecting the right health insurance policy: ■■ “Always look at premium cost and the schedule of benefits,” she said. “Where people often fall short is they don’t always look at the provider network provisions, meaning who are the providers they will have access to for innetwork benefits.” ■■ “The other difficult area is drug coverage for pharmaceuticals,” she noted. “Most policies have various co-insurance and co-pays to compare.” Ochsner said it’s important for consumers to make sure their physician or health care provider is in the network outlined in their health insurance policy and medications are covered in the policy.
Medicare beneficiaries have a number of options when it comes to insurance coverage, including Medicare Advantage plans, original Medicare with supplemental Medigap policies and Medicare Part D drug plans. Susan Harris, executive director of Jayhawk Area Agency on Aging in Topeka, said Senior Health Insurance Counseling for Kansans — or SHICK — can help walk Medicare beneficiaries through the various options and “help weigh pros and cons of each option and make sure that the individual understands the policy and insurance they have.” It’s possible to do comparison shopping for Medicare plans. “(Medicare.gov) is a great resource where folks can do comparison shopping for their Medicare Part D plans for drugs and also Medicare Advantage plans,” Harris said. “If a person determines that original Medicare is the choice they want, a supplemental or Medigap plan is often needed or wanted to pick up the costs that are the beneficiaries’ share under original Medicare.” The Kansas Insurance Commission website, ksinsurance.org, also has a tool for price comparison shopping. When it comes to original Medicare and supplemental policies, Harris said, the policies with
the same letter have the same coverage and are standardized. The only difference is the cost, which she said can “vary greatly from company to company.” SHICK counselors can assist individuals by explaining the coverage of each policy and providing information about costs so beneficiaries can make an informed decision. Medicare beneficiaries need to understand how deductibles, co-payments and co-insurance work with regard to the policies they have, Harris said. Some Medicare Advantage plans have zerodollar premiums but have other out-of-pocket expenses, such as co-payments and co-insurance, of which they may be unaware. Harris said it’s difficult to compare “apples to apples” when shopping for insurance, because insurance policies other than Medigap policies are typically not standardized and have different coverage options and levels. For example, Medicare Part D drug plans have a “minimum standard of coverage” that each company must follow when developing plans. “However, costs and coverage can vary greatly,” Harris said. Marketplace navigators also can assist individuals seeking insurance through the Affordable Care Act at the healthcare.gov website. The navigators guide a per-
THAD ALLTON/THE CAPITAL-JOURNAL
Susan Harris is the executive director of Jayhawk Area Agency on Aging in Topeka. son through the health care process but aren’t allowed to recommend a policy or explain benefits. Gina Ochsner, director of network development and regional relations for Stormont Vail Health in Topeka, said it can be “very difficult” for seniors to compare Medicare plans and other available options. “Working with an insurance agent as a trusted adviser is highly recommended,” said Ochsner, who is trained and certified for Medicare plans. “There are also many opportunities in the community to learn about Medicare, including free seminars or other educational events.” For more information about SHICK, call (800) 860-5260 or visit kdads. k s . g o v/c o m m i s s i o n s / com m i ssion- on-a g i n g / medicare-programs/ shick.
10G | Sunday, January 7, 2018 | The Topeka Capital-Journal
Choosing how to live his last days Topekan Michael Murphy wanted quality over quantity, daughter says By Regina Stephenson Special to The Capital-Journal
Hospice, a medical practice largely funded by Medicare, is for those who are no longer trying to cure their illness, those whom a doctor has verified as expected to die in six months or less. But sometimes you don’t have six months. Take Topekan Michael Murphy. “In February, his doctor said he had about a month,” said his daughter, Brenda Kelsey. “It was just about spot on.” Michael Murphy’s fight with cancer was much longer than a month. He knew something was wrong as early as 2014. The then-60year-old had a persistent pain in his back. After biopsies and second opinions, the diagnoses came down: renal cancer. While renal cancer can have a survival rate of 80 percent if caught early, Murphy’s cancer had spread, requiring aggressive, debilitating treatment, expensive medication and side effects that required medication themselves. After a few rounds of failed treatments, he said enough was enough. “He wanted quality of life over quantity,” Kelsey said. “He had a brother who fought colon cancer, a sister who had non-Hodgkin’s lymphoma, who fought it for seven years. … He wanted none of that.” As the director of auditing for the Kansas Department of Education, Murphy had planned to retire to a life of golf, spending time with his grandchildren and his wife of four decades, and continuing to volunteer as a scorekeeper and statistician
for Hayden Catholic High School. As a year wore on — and the treatments failed, and the tumors returned — his primary concerns were for the kind of life he would lead, with or without treatment. “He talked to his general practitioner and said, ‘If I do the pills — the expensive pills — they want me to take, how often can I golf or do volunteer work?’ Basically, the answer was, ‘Maybe, once in a while?’ ” said Murphy’s wife, Colleen Murphy. By the end of 2015, Murphy decided to seek palliative care through Stormont Vail Health, opting for what he hoped would be better — if not more — time. Brandy Ficek, a palliative medicine physician at Stormont Vail, said she sees patients facing similar choices every day. “Our patients may not be dying in the next six months, but in the future they will have hospice needs,” Ficek said. Part of palliative care, she said, is starting conversations early on about what each patient wants their last few years of life to look like and to help their family understand their decisions. “We had to realize that it wasn’t Dad giving up,” Kelsey said. “It was about doing it on his own terms.” Michael Murphy continued to spend time with his grandchildren. He helped his grandson catch his first fish. He continued to score and keep stats for his Hayden Wildcats. He almost made it through scoring all of Hayden’s 2017 league play. At the last home game that season, the community honored Murphy for his 14 years of diligent
Regina Stephenson/Special to THE CAPITAL-JOURNAL (above), Submitted by Brenda Kelsey (below)
Colleen Murphy, left, and Brenda Kelsey hold a framed photograph of Michael Murphy doing what he loved — keeping score at a Hayden Catholic High School Wildcat basketball game. Below, left: Michael Murphy hugs his grandson, Oliver Kelsey. Below, right: Murphy stands with the first Hayden Catholic High School Wildcat team he kept score for at a ceremony in his honor on Feb. 20, 2017.
and precise scorekeeping. He was even able to snap a photo with returning players — now grown — from one of the first teams he kept score for during a night the family won’t forget. “It meant so much,” Kelsey said. “I don’t think he let those boys know, but he said they were holding him up in that photo.” In February, Murphy’s doctor told the family: one month. That was it. The palliative care team asked the Murphys if they had a hospice preference. It seemed like everywhere they
turned, another friend mentioned Midland Care. Their Midland Care team of a nurse, social worker, home health aide, chaplain and volunteers soon integrated into family life. They arranged for a hospital bed to be delivered to the home and set it up in the dining room, both for ease of access and so he could get a good view of the first spring blossoms on the trees outside the window. Murphy’s daughter, Allison Murphy, who lived in Missouri, was planning a May wedding, but arranged
a last-minute photo shoot so she could have pictures with her father in their wedding duds. Despite these spots of sunshine, Murphy’s health continued to decline. After three weeks of inhome hospice, it was too much. The family called in their social worker to coordinate transporting Murphy to Midland Care’s respite facility. On March 23, 2017, Murphy died at Midland’s facility. Yet, his family’s relationship with Midland doesn’t end there. The vol-
unteer who helped them still phones to check in. Kelsey and her husband take their children to Midland’s family grief nights. They all plan to participate in one of Midland’s many events in remembrance of loved ones who’ve died. Just as family and friends referred them to Midland, the extended Murphy clan has become advocates for good palliative and hospice care. “Dad said he wished we would have known what was available through hospice,” Kelsey said.
The Topeka Capital-Journal | Sunday, January 7, 2018 | 11G
In hospice care, patient and family support paramount By Regina Stephenson Special to The Capital-Journal
HOSPICE FACTS
The Topeka CapitalJournal recently talked with Karren Weichert, president and CEO of Midland Care in Topeka, about the hospice care industry. Excerpts from the discussion with Weichert, a professional in the field since 1990, follow.
n More than 1.38 million Medicare beneficiaries were enrolled in hospice care for at least one day in 2015. n Close to half of Medicare beneficiaries’ deaths during that year occurred in a home and almost a third of the deaths were in nursing facilities. n Medicare paid hospice providers $15.9 billion for care provided in 2015. n The average length of service for Medicare patients enrolled in hospice in 2015 was 69.5 days. n The median length of service for Medicare patients enrolled in hospice in 2015 was 23 days.
Q: What is hospice, and how does one qualify for hospice services? Weichert: Hospice is something people reach for when they are no longer seeking a cure for their disease. It’s usually paid for and qualified through the federal Medicare services. It may be something a doctor refers a patient to, or they may call themselves. Either way, we’re required to have a doctor’s order. A physician must be willing to say, “If the disease progresses as expected, this patient’s life expectancy is 6 months.” Now, that doesn’t mean the patient has to actually die in 6 months. Medicaid just requires a physician to sign orders again after 90 days, then again after another 90 days, and then every 60 days for an indefinite period after that. For instance, my father lived for 18 months in hospice. Was he still qualified for hospice? Yes. The doctors underestimated his will to live, but they still had the general expectation that, if the disease progressed as they expected, he had only six months to live. Q. Why would someone choose hospice over other forms of care? Weichert: Studies have shown people who elect to begin hospice services
National Hospice and Palliative Care Organization
earlier on live longer than others with similar diseases. I think the reason is the support we provide. Patients get to focus on who they are, and focus on living their lives instead of focusing on their disease. It’s a different kind of hope. One hundred percent of us die. None of us likes to think about it, but it’s a certainty. Yet, if we can do some things and put certain supports in place, sometimes people outlive their diagnoses by quite a bit. Q: A common understanding of hospice seems to revolve around the idea that it’s just about relieving pain, keeping people comfortable until they die. Would you agree? Weichert: Hospice is still about keeping people comfortable and listening to what they want. Some people think … keeping someone comfortable means we don’t do very much. But sometimes keeping people
‘‘
One hundred percent of us die. None of us likes to think about it, but it’s a certainty.” Karren Weichert
president and CEO of Midland Care in Topeka
with opportunities for the family to grieve and hopefully come to a place of peace.
Regina Stephenson/Special to The Capital- JOURNAL
Karren Weichert, president and CEO of Midland Care, has worked for decades to provide hospice services in the Topeka area. comfortable takes a lot of knowledge, of course, medication, listening to what’s going on, understanding their suffering. Often, it’s not about their physical self. People become more isolated with prolonged illness, because there’s a lot of loss — loss of friends, loss of mobility, loss of a life they envisioned, loss of their faith. A lot of what we do in hospice addresses the social, emotional and spiritual losses, as well as physical losses a patient experiences. “Keeping them comfortable” seems simple, but it actually takes a comprehensive team. Q: What is one of the challenges facing hospice care? Weichert: In 1990, when I started in hospice, the average stay was about 80 days. Now, it’s at about 40 days. People spend less time in hospice because they delay starting care. They see hospice as giving up. Now, when people get a diagnosis of something ter-
minal, the first thing they do is get on the internet, Google it and find numerous treatments — some experimental — to try. Sometimes this access to information is good; you can take things to your doctor that maybe they hadn’t thought of. But, most of the time, I find it gives people with terminal illness a false sense of hope. They put off calling hospice, because there are so many more treatments that there weren’t 40 years ago, and people want to believe an aggressive treatment will extend their life. I’m a two-time cancer survivor. I know how important it is to hope, to research, to survive. But I think sometimes we do it to the detriment of our quality of life. Q: What does a hospice experience look like for a typical family? Weichert: A family will work with a whole team for support. Each team has a nurse, a social worker,
chaplain, home health aide and volunteers. The nurses will assess the patient and their home and teach the patient and family about what to expect and how to care for their loved one. The social worker helps the patient get plugged into resources like Meals on Wheels, can help communicate with insurance and can help the patient and their family emotionally through this process. The chaplains walk with people where they are, helping the patient reconcile with whatever their belief system is, so they can die free from guilt, comfortable and at peace. The home health aides deliver actual in-home care, things like help with bathing and toileting, or even light housekeeping. The volunteers are there just to befriend the patient and family through this time, maybe by talking or reading, or just sitting and holding the patient’s hand. We also help both during an illness and after
Q: What does the cost of hospice look like? Weichert: Midland Care is a not-for-profit, so while much of our funding comes through Medicare claims, we try to fundraise the rest. The majority of patients are over 65, but even for those younger — and we unfortunately do have young patients every year — most commercial insurance has a hospice benefit of some type. I think sometimes people think they can’t afford this, when, in fact, most of our patients likely won’t have to pay for much of anything. Q: What do you think is important for people to know about end-of-life care? Weichert: Your family should have conversations about what you want the end of your life to look like. You have to have those discussions with your family whether you’re 81 or 21. Having an accident or a trauma, family members have to make decisions in this traumatic environment, and families argue and just tear apart. There are a lot of resources available, though, if you just reach out and ask for help.
12G | Sunday, January 7, 2018 | The Topeka Capital-Journal
Access to care Hospitals and urgent care centers in an 11-county area
POTTAWATOMIE COUNTY HOSPITAL
JEFFERSON COUNTY
URGENT CARE
Wamego Health Center Address: 711 Genn Drive, Wamego Hours: Round-the-clock hospital care Website: wamegohealthcenter.org Community Healthcare System Inc. Address: 120 W. 8th, Onaga Hours: 7 a.m. to 5 p.m. weekdays and 8:30 to 11 a.m. Saturday, main office; round-the-clock hospital care Website: chcsks.org
HOSPITAL
K+STAT Urgent Care Address: 930 Hayes Drive, Manhattan (east of Walmart Supercenter) Hours: 8 a.m. to 7 p.m. MondaySaturday, 9 a.m. to 6 p.m. Sunday Website: kstaturgentcare.com Ortho On-Call Address: 1600 Charles Place, Manhattan URGENT CARE Hours: 5 to 8 p.m. Monday-Thursday, Manhattan Care Primary 1 to 8 p.m. Friday, noon to and Urgent Care 4 p.m. Saturday-Sunday Address: 1404 Beechwood Terrace, Suite C Website: kansasortho.com/ and D, Manhattan services/ortho-on-call-urgentHours: 8 a.m. to 8 p.m. Mondaycare-for-bone-and-joint-injuries Saturday, 10 a.m. to 3 p.m. Sunday Website: mhkcpu.com
Geary Community Hospital Address: 1102 St. Mary’s Road, Junction City Hours: Round-the-clock Website: gearycommunityhospital.org
URGENT CARE Alpha Care Address: 1102 St. Mary’s Road, Junction City Hours: 9 a.m. to 7 p.m. weekdays, 1 to 5 p.m. weekends Website: gearycommunity hospital.org/alphacare
URGENT CARE MedExpress Urgent Care
JACKSON COUNTY
Address: 3420 W. 6th St., Lawrence Hours: 8 a.m. to 8 p.m. daily Website: medexpress.com/ location/ks/lawrence/lak
HOSPITAL
Holton Community Hospital Address: 1110 Columbine Drive, Holton Hours: Round-the-clock Website: holtonhospital.com
MORRIS COUNTY RILEY
Morris County Hospital Address: 600 N. Washington, Council Grove Hours: Round-the-clock hospital care Website: mrcohosp.com
Goal is to be a partner for lifelong health through a range of inpatient and outpatient health services. Address: 325 Maine St., Lawrence Hours: Round-the-clock care Annual operating budget: $271,794,448 for 2018 Specialty services: Cardiology, surgery, oncology, pulmonology services, orthopedics and spine surgery Website: lmh.org ■ Founded in 1921 ■ Community-owned, not-for-profit ■ 249 physicians ■ 1,700 employees ■ 193,396 patients served annually ■ 174 patient beds
URGENT CARE
Via Christi Hospital Address: 1823 College Ave., Manhattan Hours: Round-the-clock hospital care Website: viachristi.org/location/ via-christi-hospital-manhattan
HOSPITAL
Lawrence Memorial Hospital
Winchester Medical Clinic Urgent Care Address: 408 Delaware, Winchester (inside F.W. Huston Medical Center) Hours: 4:30 p.m. to 8:30 a.m. weekdays; round-the-clock on holidays and weekends Website: fwhuston.com/ clinics.html
RILEY COUNTY
HOSPITAL
HOSPITAL
HOSPITAL
F.W. Huston Medical Center Address: 408 Delaware, Winchester Hours: Round-the-clock hospital care Website: fwhuston.com
Walk-in Clinic Address: 711 Genn Drive, Wamego (inside Wamego Family Clinic) Hours: 7 a.m. to 7 p.m. Monday-Saturday Website: wamegohealthcenter.org/ now-offering-walk-clinic
GEARY COUNTY
DOUGLAS COUNTY
POTTAWATOMIE
MinuteClinic
Address: 2300 Iowa St., Lawrence (inside CVS pharmacy) Hours: 9:30 a.m. to 1:30 p.m. and 2:30 to 7:30 p.m. weekdays, 9 a.m. to 1 p.m. and 1:30 to 5:30 p.m. Saturday, 10 a.m. to 1 p.m. and 1:30 to 5:30 p.m. Sunday Website: cvs.com/minuteclinic/ clinics/Kansas/ Lawrence/ 2300-Iowa-Street/676/md
JACKSON JEFFERSON
Prompt Care
GEARY
WABAUNSEE
SHAWNEE DOUGLAS
WABAUNSEE COUNTY
MORRIS
No hospital or urgent care in Wabaunsee County.
OSAGE LYON
LYON COUNTY
Address: 3511 Clinton Place, Lawrence Hours: 8 a.m. to 8 p.m. weekdays, 11 a.m. to 4 p.m. weekends Website: promptcareks.com
Walgreens Healthcare Clinic
Address: 3421 W. 6th St., Lawrence Hours: 8:30 a.m. to 7 p.m. weekdays, 9:30 a.m. to 5 p.m. Saturday; 9 a.m. to 4 p.m. Sunday Website: walgreens.com/locator/ walgreens-3421+w+6th+ st-lawrence-ks-66049/id=3055
First Med Family & Walk-In
Address: 420 W. 15th HOSPITAL Ave., Emporia Newman Regional Hours: After 7 p.m. Health Address: 1201 W. 12th Monday-Thursday, after 5 p.m. Friday, Ave., Emporia anytime SaturdayHours: Round-theSunday clock hospital care Website: newmanrh.org Website: URGENT CARE flinthillshealth.org/ Flint Hills Community emporia-ks/3665106 Health Center Urgent Care
OSAGE COUNTY No hospital or urgent care in Osage County.
Address: 2323 Ridge Court, Lawrence Hours: 8 a.m. to 6 p.m. Monday-Saturday, 1 to 5 p.m. Sunday, overnight minor emergency patients seen at 7:45 a.m. Monday-Saturday Website: firstmedpa.com /home/2738068
SHAWNEE COUNTY HOSPITALS Colmery-O’Neil VA Medical Center Part of the VA Eastern Kansas Health Care System, which also includes the Dwight D. Eisenhower VA Medical Center in Leavenworth and nine community-based outpatient clinics in eastern Kansas and northwest Missouri. Address: 2200 S.W. Gage Blvd., Topeka Hours: Round-the-clock Specialty services: inpatient and outpatient care, psychiatric services, extended care supported by nursing home care units Established: 1946 Annual operating budget: $312 million-plus Website: va.gov/directory/Guide/ facility.asp?ID=138 ■ 100 physicians ■ 1,947 employees ■ Nearly 35,000 patients served annually ■ 196 hospital beds
Website: stormontvail.org
Established: 2007 ■ Nonprofit ■ 256 physicians, 216 advanced practice Owner/partners: Stormont Vail
providers ■ 5,000-plus employees ■ 23,827 inpatient admissions, 66,143 emergency visits and 141,319 outpatient visits at Stormont Vail Hospital in 2017; 708,593 clinic visits at Cotton O’Neal facilities in 2017 ■ 586 patient beds at Stormont Vail Hospital
Health/Cotton O’Neil Website: stormontvail.org/ExpressCare ■ Nonprofit ■ 3 physicians ■ 17 employees ■ 52,718 visits across all Cotton O’Neil Express Care locations
Cotton O’Neil Express Care Urish Address: 6725 S.W. 29th St., Topeka University of Kansas Health Hours: 9 a.m. to 8 p.m. weekendys, System St. Francis Campus 11 a.m. to 5 p.m. weekends Comprised of a Topeka-based hospital Established: 2006 (formerly known as St. Francis Hospital) Owner/partners: Stormont Vail and 15 medical clinics, now known as Health/Cotton O’Neil the University of Kansas Physicians Website: stormontvail.org/ExpressCare Topeka. ■ Nonprofit Address: 1700 S.W. 7th, Topeka ■ 3 physicians Hours: Round-the-clock ■ 22 employees Specialty services: wound care, cardiac Cotton O’Neil Express Care North services, neurology, diabetes and Stormont Vail Health Address: 4505 N.W. Fielding Road, in endocrinology center, cancer center, Integrated health care system based in Hunter’s Ridge area, Topeka Topeka that serves a multicounty region bariatrics, primary care and birthing Hours: 11 a.m. to 8 p.m. weekdays, center in eastern Kansas. It is comprised of 11 a.m. to 5 p.m. weekends Established: Founded in 1909; current Stormont Vail Hospital, an acute care Established: 2015 ownership since Nov. 1 facility, and the Cotton O’Neil medical Owner/partners: Stormont Vail Owner/partners: University of Kansas group. Health System/Ardent Health Services Health/Cotton O’Neil Address: 1500 S.W. 10th, Topeka, hospital Website: stormontvail.org/ExpressCare Website: kutopeka.com and business offices; seven clinics ■ Nonprofit ■ Nonprofit in Topeka and clinics in Carbondale, ■ 3 physicians ■ About 250 physicians Emporia, Lebo, Manhattan, Meriden, ■ 11 employees ■ 1,350 employees Osage City, Oskaloosa, Rossville and ■ 130,000-plus patients served annually Cotton O’Neil Express Care NOTO Wamego ■ 378 patient beds Address: 1130 N. Kansas Ave., Topeka Hours: 8 a.m. to 4:30 p.m., business Hours: 9 a.m. to 6 p.m. weekdays office; round-the-clock hospital care Kansas Rehabilitation Hospital Established: 2007 Specialty services: Level III neonatal Address: 1504 S.W. 8th Ave., Topeka Owner/partners: Stormont Vail intensive care, Level II trauma center, Website: kansasrehabhospital.com Health/Cotton O’Neil endocrinology, cancer, orthopedics and URGENT CARE Website: stormontvail.org/ExpressCare sports medicine, heart center, digestive health, medical research, Baker School Urgent care walk-in clinic for patients of all ■ Nonprofit ages to care for minor illnesses and injuries of Nursing ■ 2 physicians that can’t be immediately treated by one’s Established: Founded in 1884 as Christ’s own physician or aren’t severe enough to ■ 6 employees Hospital, the facility merged with Jane require a visit to the emergency room. SerCotton O’Neil Express Care Corporate View C. Stormont Hospital and Training vices include X-ray and lab tests. Awarded Address: 601 S.W. Corporate View Road, the Urgent Care Association of America’s School for Nurses in 1949. Stormont Suite 200, Topeka Vail and Cotton O’Neil Clinic merged in Accredited Urgent Care designation. Hours: 9 a.m. to 8 p.m. weekdays, 11 a.m. 1995 to form Stormont Vail Health. Cotton O’Neil Express Care Croco to 5 p.m. weekends Owner/partners: Independent, Address: 2909 S.E. Walnut Drive, Topeka Established: 2017 not-for-profit health system governed Hours: 9 a.m. to 8 p.m. weekdays, Website: stormontvail.org/ExpressCare by a community board 11 a.m. to 5 p.m. Saturday-Sunday
■ Nonprofit ■ 1 physician ■ 7 employees
Cotton O’Neil Express Care Midtown Address: 909 S.W. Mulvane St., Topeka Hours: 9 a.m. to 8 p.m. weekdays, 11 a.m. to 5 p.m. weekends Established: May 2017 Owner/partners: Stormont Vail Health/Cotton O’Neil Website: stormontvail.org/ExpressCare ■ Nonprofit ■ 2 physicians ■ 15 employees Stormont Vail Work Care Address: 1504 S.W. 8th, Topeka (west entrance of the Kansas Rehabilitation Hospital) Hours: 8 a.m. to 5 p.m. weekdays Website: stormontvail.org/stormont-vail-workcare MedExpress Urgent Care Address: 1834 S.W. Wanamaker Road, Topeka Hours: 8 a.m. to 8 p.m. Website: medexpress.com/location/ ks/topeka/tpk/ Minor Med Address: 1119 S.W. Gage, Topeka Hours: 9 a.m. to 8 p.m. weekdays, 1 to 5 p.m. weekends Website: minormedtopeka.com Kids First Pediatric Urgent Care Address: 6750 S.W. 29th St., Topeka Hours: 8 a.m. to 6 p.m. weekdays, 10 a.m. to 1 p.m. weekends Website: kidsfirsttopeka.com The Clinic at Walmart Address: 2600 N.W. Rochester Road, Topeka (inside the North Topeka Walmart store) Hours: 8 a.m. to 8 p.m. weekdays, 8 a.m. to 5 p.m. Saturday, 10 a.m. to 6 p.m. Sunday Walgreens Healthcare Clinic Address: 2121 S.W. Fairlawn Road, Topeka Hours: 9 a.m. to 7 p.m. weekdays, 9:30 a.m. to 5 p.m. Saturday, 9 a.m. to 4 p.m. Sunday Website: walgreens.com/locator/ walgreens-2121+sw+fairlawn+rdtopeka-ks-66614/id=4557
The Topeka Capital-Journal | Sunday, January 7, 2018 | 1H
2H | Sunday, January 7, 2018 | The Topeka Capital-Journal
The Topeka Capital-Journal | Sunday, January 7, 2018 | 3H
4H | Sunday, January 7, 2018 | The Topeka Capital-Journal
Health foundations make collaboration part of remedy Six powerful Kansas groups work to promote healthy eating By Tim Carpenter
timothy.carpenter@cjonline.com
The Sunflower Foundation is striving to make heroes of residents in rural areas of the state hungry for ways to avoid being drawn into a food desert. Under the Healthy Eating: Rural Opportunities program, the Topekabased nonprofit earmarked $230,000 to sustain access to grocery stores and the full range of fresh, healthy food options for families. Retaining or reviving local grocery stores is the goal of HERO pilot projects in Allen, Crawford, Harvey, Hodgeman and Marion counties, the cities of Plains and St. John, and two projects serving a 10-county area in northwest Kansas. “More and more Kansas communities are losing ready access to nutritious foods, with residents facing round trips of an hour just to buy fresh vegetables,” said Billie Hall, Sunflower’s president and chief executive officer. “Over time, the consequences of families having less healthy diets will be stark.” Sunflower Foundation is part of a philanthropic coalition featuring Kansas Health Foundation, of Wichita; Health Care Foundation of Greater Kansas City, of Kansas City, Mo.; REACH Healthcare Foundation, of Merriam; Wyandotte Health Foundation, of Kansas City, Kan.; and United Methodist Health Ministries Fund, of Hutchinson. The organizations operate independently with their own boards and budgets, but all engage in health-related collaborations. Bridget McCandless, president of Health Care Foundation of Greater Kansas City, said the partnerships generated leverage to tackle Kansas’ health and wellness challenges. For example, HCF can’t alone solve delivery of mental, oral and health care to vulnerable populations.
“Through collaboration we can explore creative ways to address some of the toughest health issues facing our communities. Often, our combined voice helps us tackle issues Hall we wouldn’t be able to on our own,” McCandless said. The Alliance for a Healthy Kansas put the collective weight of all six foundations behind a campaign to expand eligibility for Medicaid health insurance to 150,000 working poor Kansans. In 2015, the battle took shape with the coalition arguing expansion of KanCare could mitigate financial strain on rural hospitals, stimulate the economy by adding jobs and offer a hand up to citizens in need. The 2017 Legislature responded by passing an expansion bill. It was vetoed by Gov. Sam Brownback, and the GOPcontrolled House narrowly voted in April to sustain the veto. “There have been many opportunities over the years to work together to improve the health of Kansans, like we have with Medicaid expansion,” said Steve Coen, president and CEO of Kansas Health Foundation. “Our collaborative partnerships in Kansas are really unique and quite enviable.” Kansas Health Foundation, or KHF, developed a program known as GROW, or Giving Resources to Our World. Its goal is development of community foundations, and work began in 1999 with a dozen organizations holding $19 million in assets. KHF provided $30 million and leveraged $28 million in other gifts. A decade later, the 12 foundations had assets of $95 million. Kim Moore, who served until recently as president of United Methodist Health Ministry Fund, said the organization’s footprint extends beyond
Submitted
The Kansas Health Foundation, of Wichita, supports the expansion of fresh produce markets, including the Kansas Grown Farmer’s Market in Wichita.
THE BIG SIX Health Care Foundation of Greater Kansas City, of Kansas City, Mo.: Established in 2002 to eliminate barriers and promote quality health care for the uninsured and underserved in a service area covering Allen, Johnson and Wyandotte counties in Kansas and Cass, Jackson and Lafayette counties in Missouri. Grants are concentrated on improvements for medically indigent and underserved populations. Kansas Health Foundation, of Wichita: The private philanthropy is guided by a belief health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The foundation, created in 1985, focuses its grantmaking in four primary areas: Hutchinson into the western two-thirds of the state. The fund is dedicated to overall access to health services, but now concentrates on emotional development of children younger than 6 and best practices for breastfeeding. “The fund has also worked throughout Kansas to support universal screening for early childhood social and emotional development issues and to build capacity for early treatment where needed,” he said.
access to care, healthy behaviors (decreasing tobacco use and increasing physical activity and healthy food access), civic or community engagement and educational achievement. REACH Healthcare Foundation, of Merriam: Started in 2003, the nonprofit works to improve access and quality of health care for poor and medically underserved individuals with programs and initatives in eastern Kansas and western Missouri. Sunflower Foundation, of Topeka: The nonprofit directs resources statewide toward people and communities working to achieve and maintain optimal health and by improving access to health care, eliminating barriers, emphasizing prevention and promoting personal responsibil-
Wyandotte Health Foundation president Cathy Harding said the nonprofit invested heavily in Wyandotte County safety-net clinics serving low-income, uninsured individuals. In a recent change, she said, the foundation moved to address “adverse childhood experiences” linked to abuse and neglect, mental illness and substance problems. Exposure to these environments raise the risk of children falling short in educational
ity for health. Established in 2000. United Methodist Health Ministry Fund, of Hutchinson: The fund was launched in 1986 with the objective of advancing health, healing and wholeness throughout Kansas. It issues grants to promote healthy lifestyles for young children, social and emotional development of young children and access to health care. It works on behalf of 600 United Methodist churches. Wyandotte Health Foundation, of Kansas City, Kan.: On behalf of Wyandotte County residents, the foundation was established in 1997. The nonprofit concentrates on access to primary-care services for individuals underinsured or without health insurance. The foundation supports health prevention, intervention and education.
attainment, enduring obesity or chronic diseases and confronting teenage pregnancy or jail time, she said. “There is a significant body of research that shows kids, especially those zero to 3, with multiple adverse childhood experiences will have a number of challenges,” Harding said. REACH, led by president Brenda Sharpe, invests in quality, affordable health care services in a six-county service area.
Dependable access to primary care, oral health and mental health services to the uninsured is a point of emphasis. In November, Sharpe said, REACH granted $1.4 million to 27 care, advocacy and policy organizations that are “leaders in strengthening the health care safety net, advocating for consumers and providing valuable information and assistance to individuals who are uninsured and medically underserved.”
Rural grocery stores scramble to provide healthy options By Luke Ranker
luke.ranker@cjonline.com
For Mark Wellbrock, Jetmore Food Center is a passion as much as it is a business. “Our customers deserve it. Our community deserves it,” Wellbrock said of the store he’s owned since 2001. For the 800 or so who live in the western Kansas town, the store is the only source of fresh food. Without the food center, residents would have to drive nearly 30 minutes to reach grocers in either Ness City, Dodge City or Garden City. The store makes the town a bit unique for Kansas — less than a third of incorporated cities with a population of 2,500 or less have a grocery store, according to data from the Center for Engagement and Community Development’s Rural Grocery Initiative at Kansas State University in Manhattan. David Proctor, the center’s director, said the number of small-town groceries has dropped since 2007 when he first began studying food access in rural Kansas. As a major supplier of wheat, Kansas may be known as a breadbasket, but the state is dotted with food deserts — low-income areas with limited access to fresh food. In those areas, a third of the population lives more than a mile from a grocery store in urban areas or more than 10 miles in rural areas, according to the U.S. Depart-
ment of Agriculture. Proctor’s department estimates about 30 percent of Kansas counties have residents living in a food desert. In many cases, the entire county lacks access to fresh food. “In so many towns, they can’t run to get a gallon of milk or a head of lettuce,” said Elizabeth Burger, director of the Sunflower Foundation’s Healthy Living & Active Communities program. “They can go to the convenience store where there’s less fresh food. It’s all high-fat food, and that’s obviously not good.”
Growing access to healthy foods
Marci Penner, director of the Kansas Sampler Foundation, a nonprofit organization in Inman that promotes rural culture, first saw the decline of small-town grocery stores in the early 2000s, when she toured “every town in our state.” Small populations struggled to support the local stores, she said, and when one shuttered, the town went with it. “Access to groceries is vital to our little towns,” she said. “If it’s hard to get food, people leave.” Decades ago, Penner and the Kansas Sampler Foundation encouraged members of its Kansas Explorers Club to spend just $5 at a small-town grocery store in the towns they visited in an effort to build support. At the same time, Penner
started building a network of rural stores that could support each other. She said the effort saw some success. That work has influenced K-State’s Rural Grocery Initiative, which provides resources to small-town stores, and in January 2017, the Sunflower Foundation launched a pilot program with about $150,000 in grants to help rural stores remain relevant. The grant program provided grants for eight Kansas communities to plan and research ways to grow their business and healthy food options. In Jetmore, through Hodgeman County’s Economic Resource Development Council’s GROW Hodgeman, Wellbrock researched online ordering options. Large stores like Walmart and Amazon recently have moved to online purchases that can be picked up or delivered in some areas. Wellbrock thinks a similar system would help the Jetmore Food Center stay competitive and increase grocery purchases. Simply maintaining access to fresh food isn’t enough, so much of the program is geared toward healthy eating campaigns, Burger said. The Sunflower Foundation hopes those programs, like Eat Well Crawford County, will increase interest in healthy foods while also increasing the demand at local stores. “We’re all creatures of habit,” she said. “Offering
Submitted photograph by Matt Cure
Candice Ruff, left, buys groceries with her family at Jetmore Food Center as Julia Chambers checks items at the register. healthy food isn’t an option if there isn’t a demand.”
Challenges and solutions
In small towns across Kansas, grocery stores are economic hubs, but the smaller stores are harder to operate, said Wellbrock, who operated stores in the Kansas City area, Dodge City and Amarillo, Texas, before settling in Jetmore. Just like stores in larger cities, rural grocery stores must maintain competitive prices and quality, but they face shrinking demand. “There’s huge pressure on rural communities to sustain themselves,” he said. “It’s hard to grow population.”
The biggest challenge for rural grocery stores is the cost and availability of distribution, Proctor said. Food distributors often require a minimum purchase, which can be hard for small-town grocers to meet. Increasingly, stores are banding together to make bulk purchases, he said. Some stores have seen success bypassing the distributor altogether. In this case, a group of stores will purchase a warehouse in a central location and distribute the food themselves. However, such coops are still rare in Kansas. Many small grocery stores also face draining profits because of old, in-
efficient buildings. Proctor said K-State’s Energy Extension provides energy audits and can help store owners find grants to improve lighting, heating and insulation. Recently, Wellbrock invested in new refrigerated cases for the Jetmore Food Center. For Wellbrock, staying vital to the community has been about building relationships. “This is our community,” he said. “When people walk in here, they know the owner. They know they’re going to get help. I think that’s what helps us compete with the big stores more than prices. It’s the small-town relationships.”
The Topeka Capital-Journal | Sunday, January 7, 2018 | 5H
6H | Sunday, January 7, 2018 | The Topeka Capital-Journal
State of decay: Dental care scarce for many Charity clinics demonstrate demand By Mary Clarkin The Hutchinson News
What Hutchinson will witness when the Kansas Mission of Mercy takes place Feb. 9-10 on the Kansas State Fairgrounds will be an outpouring of charity by those providing free dental treatment. Also visible will be the need. People will drive for hours to arrive before the sun rises. Kim Moore, the outgoing president of the United Methodist Health Ministry Fund in Hutchinson, worked the gate at the first Mission of Mercy in 2003 in Garden City. A snowstorm didn’t prevent people from lining up at 4 a.m. “And then there was the point when I shut the gate and didn’t let any more people through,” he said, explaining the gate was shut because they had run out of time. At a subsequent Mission of Mercy in Pittsburg, a high school student and scholar from a small town came with family members every day of the three-day clinic because they needed multiple treatments, Moore said. “Finally on the last day, he opened his mouth and smiled,” he said. “People just don’t understand the burden of dental diseases.” These big-event clinics have treated nearly 28,000 people. To Moore, they illustrate the problem with access to dental care. “We have a market failure,” he said.
Why they don’t go
Cathleen Taylor-Osborne, a dentist and director of the Kansas Department of Health and Environment’s Bureau of Oral Health, is eager to see the results in 2018
of a demographics study of those who don’t go to the dentist annually. When people picked the reason out of more than a dozen choices for why they hadn’t been to a dentist in the last 12 months, nearly 70 percent said cost, Taylor-Osborne said. That response dwarfed the number saying it was fear or travel distance. “Dentistry is a cash-andcarry business,” Moore said. “You don’t get services unless you pay for them, and frequently you pay on the spot.” Some employers don’t offer dental insurance, and insurance coverage can be limited. Medicare doesn’t have a dental care benefit, and Medicaid recipients may or may not have dental coverage. Further, some dentists don’t accept dental insurance, which controls what they can charge. Many more dentists don’t accept Medicaid patients or limit the number they take. When a budget crunch in 2016 prompted Gov. Sam Brownback to cut Medicaid reimbursements by 4 percent, that affected private dental practices, Taylor-Osborne said. Hays dentist Melinda Miner opened her testimony in November 2016 to a legislative committee by saying: “Almost 7,000 children in western Kansas need a new dentist, and there will likely be more in this situation. Why? After the reimbursement rate cut was announced, at least four dentists in western Kansas and two more in eastern Kansas canceled their KanCare contracts due to the lack of funding, appreciation and value put on the dental care they provide. I am one of those providers.”
2011 file photograph/THE Hutchinson News
More than 900 volunteers — including dentists, dental hygienists, assistants and general labor — donated their time and services for the Mission of Mercy dental clinic in 2011 at the Kansas State Fairgrounds in Hutchinson. The business model for a dentist is different than a physician’s. The latter is more likely to be part of a clinic or hospital. The former has more in common with the Main Street business or entrepreneur. Dentists face the pressure of bringing in income from the start. A graduate leaves dental school with “a minimum of a $150,000 debt,” Taylor-Osborne said. Investing in equipment or potentially buying the practice of a retiring dentist adds to the debt. Those factors contribute to a concentration of dentists in urban areas, rather than in more sparsely populated regions.
Counties without dentists
Dentists in Hutchinson
advertise and compete for patients. It’s even more competitive in some larger cities. But there has been no dentist in Ness County for years. The Ness County Chamber of Commerce’s Cinda Flax said she goes to Hays for dental care. There is no dentist in Clark County, and some residents there drive to Brian Headrick’s dental office in Meade. Comanche and Kiowa counties don’t have dentists, either, and some people there go to Headrick, too. Oklahomans and Texans also drive to Meade for dental care. Dentist-less Barber County has residents variously driving to dentists in Harper, Pratt, Hutchinson, Wichita and Oklahoma. A September 2011 report, “Mapping the Rural Kansas
Dental Workforce,” found that counties without a dentist weren’t exclusive to western Kansas, but that region had most of them. “Our county really worked hard,” said Wichita County Economic Development Inc.’s Director Diana Kirk, of the concerted economic development efforts that attracted dentist E. Joanne Brown, originally from Arkansas. “Leoti had a whole bunch of stuff in place to entice us to get out here. They had been without a dentist for seven years before we moved in,” said Craig Sandlin, married to Brown and the office manager at the practice, Great Plains Family Dentistry. There were too many dentists in Arkansas, and they looked at Kansas. They paid four site visits — At-
wood, Medicine Lodge, Stockton and Leoti — before choosing Leoti over 17 years ago. The land was donated and favorable loans enabled acquisition of equipment and construction of a building. At last count, the practice had patients in 13 counties in Colorado and 27 counties in Kansas. “There are not enough dentists out in western Kansas for the need,” Sandlin said. Meade’s Headrick grew up in Dodge City and graduated from Creighton University Dental School in Nebraska. He thought about locating in a more urban area such as Tulsa, Okla., but knew he wanted to raise a family in a rural area, he wrote in an email. DENTAL continues on 7H
The Topeka Capital-Journal | Sunday, January 7, 2018 | 7H
Dental: Proposed shortfall solutions look to payments, providers Continued from 6H
Meade County was in need of a dentist because of a retirement. Headrick contacted the older dentist and ended up purchasing the practice. “I’ve been here for 33 years and never regretted a minute of it,” he wrote. Headrick had a satellite office in Cimarron for 22 years and closed it after his children graduated from high school. That gives Headrick and his wife more time to travel. His practice is busy, but he isn’t overwhelmed. He plans to continue to work as long as his health is good. “We must look for people who will appreciate the rural quality of life to replace us,” he said.
Safety net
There are 22 safety net clinics in Kansas — including Hutchinson’s federally qualified health center PrairieStar Health Center — that provide medical and dental services to the uninsured or underinsured. “We want to take care of these patients who don’t have anywhere else to go,” said Bryan Brady, the chief executive officer of First Care Clinic in Hays and board president of the Kansas Association for the Medically Underserved. First Care Clinic is fully staffed when it has two dentists on board, but when Brady was in Topeka on Feb. 14 for a House Health and Human Services Committee hearing, he testified the Hays clinic had only one dentist. The Hutchinson News talked to Brady in November and the outlook had worsened. “We’ve actually seen a reduction in Medicaid providers in Ellis County,” he said, and the clinic, which accepts Medicaid patients,
still had only one dentist. PrairieStar has two dentists: dentist director Scott Rohr and Emily Knee. Rohr was in the U.S. Air Force and now is in the Air Force Reserves. “I think it was a natural transition,” he said, from the Air Force to public health and “taking care of our underserved and people in need.”
PrairieStar serves eight counties, and a sliding scale for fees takes into account a patient’s income. The services available range from teeth cleaning to root canals and crowns. “It’s definitely possible to make more in private practice,” Rohr said, adding PrairieStar provides a guaranteed salary and assisting staff and equipment. A par-
tial college loan repayment program also can be an incentive at clinics. Before the addition of Knee, patients were being scheduled two to three months out to see Rohr. Now the wait is a few weeks.
Solutions?
Ideas for improving Kansans’ access to dental care include raising Medicaid re-
imbursement rates, creating the licensure of mid-level dental care providers and establishing a dental school in Kansas. “We are advocating to get a comprehensive adult dental Medicaid component and higher rates,” said Tanya Dorf Brunner, executive director of Oral Health Kansas Inc. There are no restorative services — such as fillings — for adults under Medicaid, she said. Although Medicaid coverage is available for preventative services for adults, if rates aren’t higher to cover a dentist’s costs, dentists won’t take Medicaid patients. The state could raise reimbursement rates if there was money to do it, she said. The economic development approach used by Wichita County to entice a dentist may not be an option for cities where population and resources have declined, Moore said. Moore is an advocate for licensure of dental therapists. Such therapists would work under the supervision of a dentist, but the dentist wouldn’t be required to be onsite. A dental therapist would have more training and would be able to perform more procedures than a hygienist, under House Bill 2139. Alaska and Minnesota have dental therapists, and the push to add this in Kansas has been a years-long effort. At a Feb. 14 hearing before the House Health and Human Services Committee, proponents for the dental therapist legislation outnumbered opponents and included Moore, Brady, Miner, Kansas Association of Counties, AARP-Kansas and the free-market Americans for Prosperity-Kansas. “We have a shortage of dentists in many parts of Kansas, and a severe shortage of dentists willing to accept Medicaid. At the same
time, we have untapped talent in our pool of Kansas dental assistants and hygienists who are willing to step up to help,” wrote Americans for Prosperity’s Jeff Glendening in his testimony. Opponents to the bill included the Kansas Dental Board and Kansas Dental Association. The KDHE was neutral. “If the Legislature pursues funding of the new dental school, which would become the first dental school in the history of Kansas, the board stands ready to collaborate with interested parties in the accreditation process,” testified Lane Hemsley, executive director of the Kansas Dental Board. The committee didn’t act on the bill. “We’ve been fighting, but we can’t get it to the floor,” Moore said. Funding for a dental school hasn’t been authorized, but Taylor-Osborne thinks the school would make a difference. Kansas has limited spots at in-state tuition rates in the University of Missouri-Kansas City Dental School. Paying out-of-state tuition at other institutions exacerbates a dental student’s debt. Meanwhile, Taylor-Osborne said one of the things KDHE is doing is working with extended-care permit hygienists to provide preventative care to schoolchildren. During 2016-17, nearly 170,000 children received a dental screening, she said. Those children identified as having urgent problems requiring a dental visit within 24 hours were less than 3 percent, but that was still about 3,600 children. Taylor-Osborne shares Moore’s mixed feelings about Mission of Mercy. “It’s an amazing program,” said Taylor-Osborne, “but I wish that we had another way of providing services other than that.”
8H | Sunday, January 7, 2018 | The Topeka Capital-Journal
10 eye-popping numbers about health in Kansas
Health care professionals at all levels are more actively tracking and working to change social determinants that affect health. For instance, obesity and lack of exercise affect diabetes, heart disease and even cancer rates. Access to health care professionals, along with food and transportation, all affect the population’s health.
1
135
1,330 to 1
TOPEKA
70
Ratio of Kansans to primary care physicians, average statewide
15,940 to 1
Osage County
2,095 to 1
(highest)
Jefferson County
4,160 to 1
1,899 to 1
Cherokee County
2,940 to 1 Sumner County
2,824 to 1 Geary County
1,310 to 1 Crawford County
1,190 to 1
2,341 to 1
1,504 to 1
1,160 to 1
Wabaunsee County
2,320 to 1
Leavenworth County
2,170 to 1 Ford County
2,150 to 1 Stafford County
2,130 to 1 Franklin County
Jackson County
1,450 to 1 Butler County
1,444 to 1 Lyon County
1,440 to 1 Shawnee County
Adult obesity rate in Kansas (2015) That’s up from 29.6% in 2011
Pratt County
1,635 to 1 Riley County
2 34.2%
1,230 to 1
2,510 to 1 Kiowa County
35
1,330 to 1
1,860 to 1
Pottawatomie County
WICHITA
Ellis County
McPherson County
1,761 to 1
35
1,527 to 1
Morris County
Finney County
KANSAS CITY
Saline County
Adults who exercise, aerobic and strength and conditioning
4 9.7% Kansas adults diagnosed with diabetes
1,132 to 1 Douglas County
5 17.7% Kansans who smoke tobacco in 2017
890 to 1 545 to 1
Gove County (lowest)
1,680 to 1 Reno County
Number of people employed by Kansas hospitals (About 4.3% of all Kansas jobholders)
3 19.3%
Harvey County
Brown County
7 84,421
18.1%: national average of tobacco smokers
6
$12.3 billion Total sales from hospitals in the state
8 7,841 Number of people employed by Shawnee County hospitals. They generate $1.2 billion in sales.
9 31% Number of Kansans who report less than 7 hours of sleep nightly, on average
10 43.7% Number of Kansans who reported eating fruit less than one time a day (2015) That’s up from 41.4% in 2011
Sources: Kansas Health Matters; Kansas Hospital Association; County Health Rankings
GATEHOUSE MEDIA
Health care pros track top issues, mark preventive shift By Morgan Chilson
morgan.chilson@cjonline.com
Obesity, inactivity and other ways Kansans struggle to take care of themselves exacerbate poor health in the Sunflower State. In Kansas, heart disease, cancer, chronic lower respiratory disease, accidents and strokes top the causes-of-death list, with heart disease and cancer flipping back and forth for the top two spots, according to the Centers for Disease Control. Health professionals at every level — from nonprofit organizations like the Sunflower Foundation and Kansas Health Foundation to hospital CEOs — closely follow the top health issues in the state, because doing so helps them determine ways to combat the issues. Many of them have worked together as part of Kansas Health Matters to create a website that makes accessing the data easy and serves as a place where best practices are shared so successes can be replicated. For Randy Peterson, president and CEO of Stormont Vail Health, keeping his finger on the pulse of the community’s top health problems is necessary, because need dictates services his organization must provide. For instance, rising cases of diabetes in young people, often linked to obesity, have pushed the Stormont system to hire four pediatric endocrinologists. “If you looked at our population, you’d say we shouldn’t have four pediatric endocrinologists,” Peterson said. “But they’re busy. Pediatric diabetes is a big issue, and we can’t recruit enough endocrinologists to take care of the adult diabetics.” Kansas ranks as the 22nd-mostobese state, with 31.2 percent of adults falling in the obese category, with body mass index 30 percent and above, according to The State of Obesity project. On the Kansas Health Matters website, a list of key health indicators highlights significant factors that affect health, said Cindy Samuelson, spokeswoman for the Kansas Hospital Association. The 20 indicators dig into issues from multiple angles, including exercise, nutrition, access to healthy foods,
mortality data, smoking, immunizations, crime and poverty. “We have identified early on what are the key health indicators every community should be looking at first and foremost,” Samuelson said. “If you’re looking to improve the health of the members of your community, start here.” Many of those indicators play into the top health issues. Obesity is a significant problem for the state, raising rates of diabetes and other diseases, Peterson said. “Kidney issues are secondary to diabetes. Cardiovascular disease is often related to diabetes. We’re pretty high on respiratory diseases — well, that probably correlates with (being) fairly high on smoking and tobacco use,” he said. “You kind of look at this stuff and you go, ‘OK, what’s the root cause?’ I think that’s where we’re shifting as an organization — from the sickness mode to the population and wellness mode.” Samuelson said the health indicator for obesity is a problem. “We’re over the U.S. value. We’re worse than we were before, and we’re not near the target,” she said, adding it’s the same with the traffic injuries indicator. The shift to focusing on population health and how to prevent illness is happening nationally, and it’s a challenging move, pushing providers to think about care differently. Health professionals are excited about the concept: the idea of keeping people from getting sick by changing behaviors and affecting social factors that often pre-determine health problems. The shift is showing up in health organizations talking about going from volumebased care to value-based care, which looks more toward the end product of a healthy population rather than counting how many procedures were done that month. “I think I’m most hopeful that as we continue down the path of value-based reimbursement and begin to take on more of the accountability for a population’s health and the cost, that we find a way to gather community’s resources to address the social determinants of health,” said Robert S. Kenagy, a physician and Stormont’s senior vice president and chief medical officer.
But right now, the health care world’s reimbursement system is set up to pay for procedures, tests, doctor visits and other care that fits into the volume-based treatment model. Stormont is making that shift to becoming a population health organization, pushing forward even though reimbursement isn’t yet there. “I do feel positive,” Peterson said. “It’s a risky venture to say you’re going to be a population health organization when you’re not getting paid adequately to do that. But that’s got to be our future. I’ve said for years (that) I’ll be excited someday when we’re paid to prevent illness and not just be treating sickness.” Reimbursement is beginning to move in that direction, but it’s not where it needs to be, he said. For instance, as a Medicare Accountable Care Organization, Stormont receives some care management dollars. It also is reimbursed for wellness visits, which wasn’t previously the case. Wellness visits are opportunities to talk to Medicare patients about their health and challenges more comprehensively. Initiatives that educate patients about their own health care — or work with them to monitor medication usage, for example — can pay for themselves when those same patients become healthier and don’t end up in the hospital. This year, Peterson said, Stormont implemented such programs and was able to impact its cost per beneficiary for the “assigned lives” that Medicare has attributed to the hospital, or those people on Medicare taken care of primarily by Stormont,dropping the total dollar amount of their care for the yer by $5 million. When any health care system is effective in preventing sickness, it is also effective at reducing its revenue. It’s a big shift with big implications, Samuelson said. “As a hospital executive, you’re sitting there going what programs are we going to invest in that don’t make us any money and keep people out of the hospital,” she said. “It will be interesting to see how hospitals can find the right mix to survive in that environment.”
Causes of death Heart disease and cancer consistently top the list of leading causes of death in Kansas and Shawnee County. In recent years, both causes account for more than 11,200 deaths. The leading causes of death in Kansas, based on 2015 data from the Centers for Disease Control and information from other agencies, are: 1. Heart disease (5,624 deaths): The leading cause of death in the United States, heart disease includes several types of ailments. The most prevalent is coronary artery disease, the build-up of plaque in the walls of the arteries. Primary factors affecting CAD are high blood pressure, high cholesterol, smoking, diabetes, lack of exercise, obesity and diet. Heart disease mortality in Shawnee County from 2014-16 was 161.3 deaths per 100,000 population, a little higher than that of the state, which was 157.4 deaths. In 2002, deaths in Shawnee County from heart disease were 260.9. 2. Cancer (5,604 deaths): In 2014, the rate of new cancer cases in Kansas was 449.1 per 100,000 people; the death rate from cancer was 166.6 per 100,000 people. Of the 14,400 new cancer diagnoses expected in the state in 2017, the most common was expected to be breast cancer, followed by lung and bronchus and then prostate. 3. Chronic lower respiratory disease (1,704 deaths): Formerly called chronic obstructive pulmonary disease, this category of diseases includes chronic bronchitis, asthma and emphysema. Although the primary cause in the United States is smoking, exposure to air pollutants, genetic factors and respiratory infections can be causes. Chronic lower respiratory disease is increasing in the Kansas Medicare population, and in 2015, 11.4 percent of that population had the disease. 4. Accidents (1,475 deaths): Unintentional injury deaths may be fourth on the statewide list, but in ages 15 to 24 years, it is the leading cause of death. This category includes burns, automobile accidents, falls and drownings. 5. Stroke (1,364 deaths): Someone in the United States has a stroke every 40 seconds, and nearly 800,000 people have strokes annually. In Kansas, the stroke death rate has been higher than the national rate throughout the 2009-13 period. In 2013, the Kansas age-adjusted stroke death rate was 3.9 percent higher than the national age-adjusted rate. Risk factors for strokes include high blood pressure, diabetes, heart disease and
smoking. 6. Alzheimer’s disease (865 deaths): Every 66 seconds, someone in the United States develops Alzheimer’s disease. Since 2000, heart disease deaths have decreased by 14 percent while Alzheimer’s disease deaths have increased by 89 percent. “It is the only top-10 cause of death that cannot be prevented, cured or even slowed,” the Alzheimer’s Association reported. 7. Diabetes (684 deaths): Kansas has the 13th-highest obesity rate in the nation. In 2016, 9.6 percent of the Kansas adult population had diabetes. It’s estimated that 69,000 Kansans have diabetes and don’t know it. Each year, about 13,000 Kansans are expected to be diagnosed with diabetes. One in 14 Kansas adults have been diagnosed with pre-diabetes. 8. Flu/pneumonia (682 deaths): The age-adjusted death rates from influenza and pneumonia have decreased 3.8 percent each year since 1999. About 85 percent of all flu/pneumonia deaths occur in people aged 65 and older. Between 2005 and 2014, the number of people receiving a flu vaccination doubled, to 43.7 percent of individuals in the United States. In 2014, 38.1 percent of Kansans got the vaccine. The pneumonia vaccine is recommended for older adults and certain people in special circumstances; in 2014, 58.7 percent of adults over 65 received the vaccine. 9. Kidney disease (582 deaths): The incidence of chronic kidney disease in the general U.S. population is 14 percent, and more than 661,000 Americans have kidney failure. About 468,000 are on dialysis and 193,000 live with a kidney transplant. High blood pressure and diabetes are the primary causes of kidney disease, and almost half of the people with chronic kidney disease have diabetes and/or selfreported cardiovascular disease. 10. Suicide (477 deaths): Suicides in Kansas increased 7.3 percent from 477 deaths in 2015 to 512 in 2016. Suicide is the second-leading cause of death in the 15- to 44-year-old age group, and the third-leading cause of death for the 5- to 14-year-old age group in the United States. The average age of death by suicide was 44.3 years in Kansas in 2016. (Sources: Centers for Disease Control; Kansas Department of Health and Environment: Kansas Health Matters; American Cancer Society; Kansas Suicide Resource Prevention Center; Alzheimer’s Association; American Diabetes Association; Robert Wood Johnson Foundation; American Lung Association)
The Topeka Capital-Journal | Sunday, January 7, 2018 | 9H
New technologies help Topekans battle old issues By Samantha Egan
Special to The Capital-Journal
Whether it be hearing loss, skin damage or debilitating dry eyes, the Kansas climate and culture puts its population at higher risk for certain health issues. Fortunately for Topekans, local doctors and specialists are staying on top of new technologies that can better treat common issues in hearing, vision and dermatology.
Clearer sound with less fuss
Hearing loss is the third most prevalent chronic health condition in older adults, according to the National Center for Health Statistics. Fortunately, the latest hearing aid technology is allowing those with hearing loss to experience better sound quality with less hassle. Belinda Gonzales, a hearing instrument specialist and owner of NuSound in Topeka, said her patients struggled with older hearing aid technologies. “Many patients would take off hearing aids in a restaurant because the background noise would become unbearable,” Gonzales said. “Those issues have been negated with new technology.” Gonzales said new Bluetooth hearing aids are a giant step toward improving the quality of life for those with hearing loss. The devices can be synched to an iPhone, allowing users to easily adjust the bass and treble. They’re also more sensitive to their environment, helping to diminish the background noise problem posed by older devices. This technology also is being used to protect the hearing of hunters, allowing them to hear a gunshot and the low activity of a deer in the distance.
“They look good, they’re comfortable, and there’s less manual adjustments,” she said. Looking ahead, Gonzales said hearing aid technology will become even more advanced and could possibly resemble hearable devices that are on the market now, which can act as headphones, language translators and fitness trackers. “I believe in five to 10 years no one will wear a Fitbit,” she said. “It will be in your ears.”
Fighting skin cancer with earlier detection
In the past 15 months, Cotton O’Neil Dermatology has diagnosed more than 90 cases of malignant melanoma, the most dangerous form of skin cancer. “All skin cancers are on the rise due to people living longer, tanning bed exposure and our beautiful Kansas sun,” said Grant Ghahramani, a physician and member of the medical team at Cotton O’Neil Dermatology. Ghahramani and his team are combatting the troubling trend with new technologies like dermoscopy. Using polarized and nonpolarized light with magnification that allows them to see features that can’t be seen with the naked eye, dermoscopy helps doctors like Ghahramani detect and treat skin cancer earlier. Matthew Ricks, a physician and medical director and founder of Ricks Advanced Dermatology in Topeka, also sees many skin cancer patients, including soldiers from Fort Riley, farmers and landscapers. “I think skin cancer will continue to rise,” Ricks said. “It’s not leveling off.” However, using advanced blue-light technology in a procedure called Blue U,
Photographs by CHRIS NEAL/THE CAPITAL-JOURNAL
Dermatologist Matthew Ricks, right, and licensed practical nurse Nichole Slade demonstrate the Blue U procedure on Terri Geiken at Ricks Advanced Dermatology. Below: Belinda Gonzales, a hearing instrument specialist and owner of NuSound in Topeka, holds a Bluetooth hearing aid, which can be synched to an iPhone. Ricks is helping to more effectively treat precancerous regions, thus potentially reducing the amount of fullfledged skin cancers. Blue U uses a light-sensitizing chemical solution that is applied to the skin area, which is then exposed to blue light. The chemicals react with the blue light to generate reactive oxygen radicals that destroy the precancerous or cancerous skin cells. While effective, Ricks said, Blue U is expensive and only makes sense for patients with a large area of skin damage, rather than two or three isolated spots.
Lasting solution to chronic dry eye
Thanks to high winds, generally temperate weather and a high pollen count, Kansans can be more sus-
‘‘
They look good, they’re comfortable, and there’s less manual adjustments.” Belinda Gonzales
owner of NuSound in Topeka
ceptible to chronic dry eye than other Americans. If dry eyes don’t seem like a significant burden, Babak Marefat, an ophthalmologist at Stormont Vail Health, would venture to say you’ve never experienced it. Chronic dry eye is uncomfortable and can impede vision. “Imagine you have nothing but hangnails in your
eye,” he said. Until recently, Marefat could only treat chronic dry eye with artificial tears and one type of prescription drops. But since amniotic membrane graphs emerged 18 months ago, things have started to look brighter. The procedure involves gluing or sewing fragments of the patient’s own plasma
onto a contact lens, which helps keep corneas healthy and effectively treats dry eyes without a trip to the operating room. “It’s been really exciting, because something that has been either ignored or untreatable has really changed,” Marefat explained. “We no longer treat the symptoms with drops. We’re now treating the root of the problem.”
10H | Sunday, January 7, 2018 | The Topeka Capital-Journal
Nation, Topeka challenged to fill physician needs
‘‘
Local providers are recruiting By Morgan Chilson
morgan.chilson@cjonline.com
The United States is facing a critical shortage of physicians, expected to escalate to a shortfall of more than 61,000 doctors by 2025. The Topeka health care community could use more doctors to meet consumer needs, especially in particular specialties, according to leaders from Stormont Vail Health and The University of Kansas Health System. A new patient appointment to see an endocrinologist can take three to five months, for instance, a situation that was exacerbated when a busy Topeka doctor recently moved out of state. Other specialties are also needed, said Robert S. Kenagy, a physician and Stormont senior vice president and chief medical officer. “We’d like to add another cardiothoracic surgeon, rheumatology, neurology and urology,” Kenagy said. “We continue to recruit in general surgery, as well. We’ve really had good success in primary care. We continue to recruit in primary care.” Stormont has been aggressively recruiting physicians and advanced practice providers, such as nurse practitioners, in recent years, raising its medical group providers from 335 in 2013 to 448 this year. Of that total, 265 are doctors and 183 are advanced practice providers. Nationally and locally, the need for primary care physicians — often filled by family practice or internal medicine doctors and advanced practice providers — is concerning, said Jackie Hyland, a physician and chief medical officer at the University of Kansas Health System St. Francis Campus. She called internal medicine a “huge shortage” on the outpatient
side of services. “Nurse practitioners and PAs (physician assistants) are really helping with the primary care demand,” Hyland said. Steven Stites, a physician who is vice chancellor for clinical affairs and senior vice president for clinical affairs for The University of Kansas Hospital Authority, said the primary care situation is not the only shortage nationally and locally, but the problem runs across the board in specialties. “In Kansas, a high percentage of our physicians are over the age of 55,” Stites said. “We know the financial crisis of 2008 kept people in practice longer than what we may have otherwise seen. I think we’re all very concerned about what’s going to happen at a county level. “In every area of medicine, you can find a projected shortage. Psychiatry, pulmonary, cardiology — everything. And part of that is because of the aging of the U.S. population, and part of it is an issue around distribution, and part of it is an issue that we haven’t really increased the number of graduate residents leaving training.” Dan Partridge, director of the Lawrence-Douglas County Health Department, said primary care physician shortages affect his community, as well, but he’s also concerned about the lack of mental health providers and dental providers. “Number one for me is dental access, especially for the Medicaid population and the uninsured,” Partridge said. “The demand far exceeds the availability to meet that.” From a medical school perspective, class size has been increased to keep up with demand by 15 to 20 percent, Stites said. “GMEs (Graduate Medical Education) medical slots have not kept up with
In Kansas, a high percentage of our physicians are over the age of 55. We know the financial crisis of 2008 kept people in practice longer than what we may have otherwise seen.” Steven Stites
University of Kansas Hospital Authority
THAD ALLTON/THE CAPITAL-JOURNAL
Robert S. Kenagy is a physician and Stormont Vail senior vice president and chief medical officer.
THAD ALLTON/THE CAPITAL-JOURNAL
Jackie Hyland, an anesthesiologist and chief medical officer at the University of Kansas Health System St. Francis campus, recruits physicians to work in Topeka. that,” he said. “Some places dropped GME physicians because the government has not kept up with funding new positions.” Stites was referring to a problem receiving attention as the physician crisis looms — there aren’t enough residency slots in Kansas for the medical students in school. Kansas leaders have been talking about adding an osteopathic medical school, but Stites said that won’t address the root problem created by having too few residency slots. If medical students take residency positions in other states, it’s likely Kansas is simply training students to go to work elsewhere. In a medical roundtable discussion conducted by
The Topeka Capital-Journal, Hyland said she would like to see a former family medicine residency program in Topeka reopened. The program ran from 1992 to 2002, established by the Kansas Medical Education Foundation and supported by both Stormont and St. Francis. Looking to the future as the University of Kansas Health System and Ardent settle into their new Topeka location at St. Francis, Stites said he’s hopeful resident training could be re-established in the capital city. “We’ve got to get a lot of hoops done. We have to stabilize the clinical enterprise, we have to work closely and very tightly with Ardent to grow the
number of physicians at St. Francis and if things are healthy there — we will consider the introduction of resident training,” he said. Stites said KU and Ardent would have to agree to a residency program, and reiterated, “We’ve got a lot of work to do to get it there.” Kenagy said Stormont has increased family medicine providers from 29 in 2013 to 36 physicians in late 2017. Growth overall in advanced practice providers has been high, and that’s reflected in primary care. In that specialty, Stormont had 63 doctors and 39 advanced practice providers in 2015. This year, the numbers are up to 76 doctors and 62 advanced practice providers. Stormont closely tracks access to its physicians, clinics and hospital services to help determine where to grow its provider network, Kenagy said. “We track the number of days it takes for a patient calling with an acute need to be seen, how long it takes us to get them in, and how long it takes for a patient calling as a new patient to get established,” he said. The recruitment of surgeons and advance practice providers is a necessary part of running a Level 2 trauma center, along with skilled nursing staff, Kenagy said. Within the hospital, Stormont has grown its hospitalist group from 16 physicians in 2013 to 23 this year. Maintaining stability in hospitalists, who treat patients when they are in the hospital, helps with standardization of care, he said.
More than a year of uncertainty at St. Francis created challenges for Hyland, who said they are slowly rebuilding medical staff with the support of Ardent and KU Health. Primary care will be a strong initial focus in hiring. Pulmonology and urology are other areas she’d like to see additions. Manhattan struggles to recruit physicians, and Bob Copple, president of Via Christi Health in the university town, said he’s concerned about the future for other rural communities. Before joining the Manhattan health system, he worked in rural areas in Nebraska. “It doesn’t matter where you are, the issues are all the same,” he said. “They’re even more challenging the farther west you go in our state. You lose the population density so it gets harder and harder to support physicians, especially specialties, and recruitment is hard because hiring new young physicians … if you don’t have a community that has some amenities and a good education sytem, they won’t go. It is surprisingly difficult to recruit physicians to Manhattan.” Although Manhattan is experiencing significant economic growth, it just doesn’t have the amenities that Topeka has, Copple said. “You have more restaurants, you have more stores,” he said. “I wish we had a Lowe’s or a Kohl’s.” Manhattan’s list of physicians needs “is actually very long,” Copple said, identifying need in primary care, cardiology, neurology, pulmonology, gastrointerology, and infectitious disease.
‘Robust’ nursing education system helps fill gaps in care By Chris Marshall
Special to The Capital-Journal
The combination of understaffed hospitals and decreased enrollment at nursing and medical schools has led to an increased need for trained professionals at a national level. Like many industries, nursing is seeing the effects of the baby boomer generation entering retirement. Hospitals’ oldest workers are retiring in scores, and with fewer young graduates to call on, the health care industry finds itself with more jobs than there are people to fill them. Topeka’s two largest hospitals — Stormont Vail and University of Kansas Health System St. Francis Campus — have been able to avoid the staffing shortfall common in many states, in part because of the support provided by northeast Kansas colleges. Enrollment at Baker University’s and Washburn University’s nursing schools hasn’t dropped, and both programs work closely with area health care facilities to help ease students’ transition into the workforce. Despite some states’ struggles, Monica Scheibmeir, dean of Washburn’s nursing school, said the school’s application and admission numbers are as high as they were five years ago. “Three statements are true,” she said. “Statement 1: We have a national shortage. Statement 2: The shortages are geographic. Statement 3: There are pockets of shortages in Kansas, but we have a fairly robust system in place across the state. “In comparison to Colorado, we look like shining stars. They probably have double the positions open.
The west and south also have much larger work shortages relative to Kansas.” Maintaining a high number of graduates will be key going forward, as the Kansas Department of Labor projects registered nurses will have the most openings due to growth among all health care careers. A projected 36,955 registered nurses will be employed in Kansas in 2020, a 25-percent increase from 2010. Darlene Stone, vice president and chief human resources director at Stormont Vail Health, recently moved from Florida, where she spent a majority of her career, and agreed Kansas is in a better position than most states because of its nursing schools. She also said Stormont Vail has better systems in place to retain staff than what she experienced in Florida. “We’re not using any traveling nurses or agencies,” she said. “It’s better for our patients to use our own staff. Our nurses train with us and are ingrained in our culture. Our team is our team. They’re here for the long run.” In many cases, that onsite training starts when potential employees are still in school. Lisa Alexander, chief nursing officer at University of Kansas Health System St. Francis Campus, said the hospital takes a proactive approach to encourage students to pursue medical careers. “It’s important to celebrate the versatility of nursing school and promote that as an option for folks,” Alexander said. “We have a nice pipeline with Baker and Washburn right here in the city, and they’ve been a strong partner for us. We also reach out to local high schools for intern-
CHRIS NEAL/THE CAPITAL-JOURNAL
Nursing instructor Susan Maendele shows five Washburn nursing students how to set up an IV bag while working at Stormont Vail Hospital. ship and job shadowing programs.” Washburn and Baker place students in area hospitals for internships and clinicals, which benefits both parties. Students get real-world experience and build rapport with a potential employer, and hospitals get help from a staffing perspective while observing a student who is months away from entering the workforce. Of Baker’s 40-person spring 2017 graduating class, 26 were hired by Stormont Vail, Stone said. “Washburn has done a great job maintaining enrollment, and Baker is increasing its enrollment from 40 to 60,” she said. “Our market is blessed to have great nursing pro-
grams funneling to us.” Other hospitals in the state, including those in rural areas and smaller towns, also have tapped into area nursing schools to help their staffing situations. “We strive to have good working relationships, and not just with big hospitals,” Scheibmeir said. “A lot of our students want to go work in Hiawatha, Onaga, near Emporia. We try to really spread out our relationships.” Alexander said St. Francis currently has more openings than usual, but that has more to do with the hospital’s transition to the University of Kansas Health System than any trend in staff shortages. “We have a younger nursing staff through our con-
nection with nursing programs, but I would also say we have a good bell curve with experienced folks, too,” she said. “I have seen articles about baby boomers retiring, and that stresses the supply part of our positions. That’s why I think it’s really important we’ve got the schools here in town.” St. Francis’ student nurse tech employment model gives those pursuing a degree a chance to work part time or as needed while gaining an understanding of the workplace’s culture. Stormont Vail also offers career entry paths for new hires, including a laddering program that allows registered nurses to advance through the ranks as they receive experience and skills certifications.
For the time being, salaries are an area that remain a drawback for nurses. In 2016, Kansas had 27,130 registered nurses making an average salary of $58,260. For that reason, programs that encourage a smooth transition into the working world are critical for a profession the Department of Labor says will be the fastest-growing between now and 2024. “In the next 10 years, 1 million of the nation’s 2.7 million current nurses will retire,” Scheibmeir said. “It’s also anticipated 80 million men and women will be over 65 in 2050. That’s a large group of people who will need help taking care of themselves, and one of the main groups helping will be nurses.”
The Topeka Capital-Journal | Sunday, January 7, 2018 | 11H
For speciality care, telemedicine a breakthrough Patients in underserved areas see benefits By Allison Kite
allison.kite@cjonline.com
Before Julie Laverack’s son, Lincoln, could have his autism medications managed through telemedicine, treating him at home in Pittsburg meant “trial and error.” Laverack said Lincoln has aggression associated with his autism and attention deficit hyperactivity disorder, or ADHD. She took him to the Community Health Centers of Southeast Kansas — where she works as a pediatric care coordinator — but he wasn’t getting the specialized medication management he needed. Once, a change in his medications sparked an onset of serotonin syndrome, which can cause agitation or restlessness, confusion, headache and loss of muscle coordination among other symptoms. It can be lifethreatening. “He ended up having to be hospitalized for five days for it in a psychiatric hospital,” Laverack said. Managing Lincoln’s treatment was difficult until the last few years, Laverack said, but the community health center now offers medication management through telemedicine. Lincoln gets services from providers at Marillac, a psychiatric hospital in Overland Park that was recently acquired by the University of Kansas Health System. Lincoln is one of many Kansans in underserved areas who has benefited from increased access to treatment through telemedicine. Behavioral health care, specialty medicine and psychiatric treatment services have all come online to serve Kansans in shortage areas, but health care providers are split on whether
Kansas has fully embraced telemedicine. Laverack said there were no other providers who could manage Lincoln’s medication in the Pittsburg area, so he didn’t get specialty care. “Unless you have people that are working with kiddos every day doing this and specializing in it they don’t know the right combinations,” Laverack said. When he developed serotonin syndrome, he became dangerous to himself and tried to climb out the school bus window. Laverack said she had to stay home with him while they waited for a psychiatric bed to open up. “This was not my child,” Laverack said. “I mean, he’s never done anything risky like that before.” Laverack said having Lincoln’s treatment available through telemedicine has been amazing. “It’s been a blessing to us because we have that expertise of the specialists,” Laverack said. The community health center in southeast Kansas, which provides care for several counties, has expanded its telemedicine services in recent years. Health center president and CEO Krista Postai said the clinic brings in specialty care from providers around the country through a contract with Wichita-based FreeState Healthcare. It also provides behavioral health care through telemedicine, and is Pittsburg-based provider can see patients in other clinics across southeast Kansas. Postai said telemedicine was working “smarter, not harder,” but she didn’t think Kansas had fully embraced telemedicine. She said the state was on the edge of
recognizing the need, especially in rural areas. “There is no public transportation, and we have an aging population and there are no specialists,” Postai said. “We’ve got to do something.” Julie Stewart, an internal medicine and pediatric physician at the health center’s Pittsburg location, said the clinic decided to expand its reach through telemedicine after the Independence hospital closed and office-based internal medicine physicians left Coffeyville. “As a federally-qualified health center, in the state’s poorest and least healthy sector, yes — that is one of the driving forces for us doing telemedicine is to reach people who otherwise don’t have access to care,” Stewart said. “And you’re talking about insured patients that used to have access to care, and now they don’t even have access to care.” Michael Kennedy, associate dean for rural health at the University of Kansas Medical Center, said telemedicine was an effecive resource for behavioral health and psychiatry as well as coaching patients managing long-term conditions. He said he thought the state had been an early adopter of telemedicine but lagged in recent years. Providers with the Community Health Center of Southeast Kansas shared that view. Stewart said the organization provided services regardless of patients’ ability to pay, but getting reimbursement for telemedicine services can be difficult for providers who don’t work in safety-net clinics. Uyen Dinh, of Wichita, is a psychiatric advanced practice registered nurse for the clinic. She commutes to
Photo illustration by Stephanie Potter /THE morning sun
On screen, Advanced Practice Psychiatric Mental Health Nurse Practitioner Uyen Dinh, PMHNP-BC prepares for a patient to arrive at the Community Health Center of Southeast Kansas. Pittsburg once a week and provides care from Wichita for the remainder. She said she thought the community health center was one of the most advanced in its use of telemedicine. Richard Barohn, a professor of neurology for the University of Kansas Medical Center, said he thought KU and Kansas were “ahead of the curve” on telemedicine. He helped establish a multi-disciplinary clinic in Wichita where patients with ALS, or Lou Gehrig’s disease, can get treatment from various therapeutic provider. Barohn can provide neurological care from Kansas City through telemedicine. “They just feel like they’ve gotten a whole other level of health care through that approach,” Barohn said. One barrier, however, is that KU can’t bill on behalf of the respiratory therapists, nutritionists, speech therapists and other health care professionals work-
STEPHANIE POTTER/The Morning Sun
Julie Stewart, M.D., communicates with a nurse at another facility at the Community Health Center of Southeast Kansas. Stewart is able to access documents while communicating with patients, nurses and doctors. ing in Wichita. Barohn said providers needed to be able to bill for telemedicine the same way they bill for inperson care. The Wichita ALS clinic is one of several telemedicine programs KU has begun. Eve-Lynn Nelson, director of the KU Center for Telemedicine & Telehealth, said KU has been able to extend its reach through tele-
medicine. KU has brought a range of services to families in southeast Kansas through a partnership with the community health center, called Telehealth ROCKS. Specialists at KU can also advise primary care doctors in rural areas though Project ECHO, which started at the University of New Mexico.
12H | Sunday, January 7, 2018 | The Topeka Capital-Journal
Medical advances transform treatments For many, hepatitis C can now be cured By Rick Peterson Jr.
richard.peterson@cjonline.com
A diagnosis of hepatitis C was often a death sentence for patients 15 to 20 years ago. “I can remember days when I was in medical school here in Kansas City, not that long ago, where we didn’t have treatment options for patients with hepatitis C,” said David Wild, a physician with University of Kansas Medical Center. “It would progress to cirrhosis and ultimately liver failure, and they would die in the hospital.” That isn’t the case anymore for the majority of patients with hepatitis C, thanks to medical advances in treatments. The disease, a bloodborne viral infection that can lead to liver damage and chronic health problems, affects about 3.9 million people in the United States but is no longer fatal if treated properly. “Hepatitis C now has antiviral treatment that can cure disease. It doesn’t work for every single patient, but it works for a good majority of the patients,” Wild said. “That is
a great example of an antiviral treatment for a disease that used to be fatal.” While hepatitis C, which was discovered in 1989, is easier to treat than ever, the number of virus infections of the disease is currently at a 15-year high in the U.S. and has nearly tripled in the last five years, according to the Centers for Disease Control and Prevention. The highest overall number of new infections are among 20- to 29-year-olds, which the CDC attributed to the “increasing injection drug use associated with America’s growing opioid epidemic.” But the hepatitis C virus also can be cured in as little two or three months with proper treatment. The U.S. Department of Health and Human Services recently released the National Viral Hepatitis Action Plan, which aims to prevent new hepatitis infections. The National Academies of Sciences, Engineering and Medicine, also concluded in a report that eliminating hepatitis C as a public health threat in the United States is feasible if the right steps are taken.
The strides made in treating hepatitis C are a prime example of breakthroughs in medicine over the last 20 years, said Wild, who has executive responsibility for performance improvement teams at KU Med and manages physician performance at the hospital. “I think there are situations where we’ve all but eradicated diseases,” Wild said. “Even within the past 20 years, malaria for most of the world, is really not an issue. It might be in third-world countries, but definitely not our part of the world. I think our ability to offer vaccines, the targeted vaccines for even things like chickenpox has changed dramatically the quality of life that people in the United States have. “Antibiotics as well, you think about the change and the increase in the antibiotic treatments that we’ve had available to us over the past, even, 10 years is pretty dramatic.” Wild said some of the most obvious advances have been in cancer treatments. “We’ve been able to, over the last 20 years to pro-
File photograph/The Associated Press
A patient with hepatitis C gets blood drawn. Hepatitis C used to be fatal but is now a treatable — and often curable — disease vide very targeted radiation therapy, very targeted chemo therapy for specific cancers that has changed the way we provide treatments and changed the outcome of the results of treatment for patients,” he said. “And really maybe just in the last two or three or four years, we’ve really started to be able to provide therapy, treatment for cancer specific to that patient. Where we charge up, if you will, their immune system by their own spe-
cific cancer. I think that is likely to be the largest area of advancement in the next two or three years among cancer treatment. “There’s technology advancement as well in the ability to do 3D imaging for cancer screening and treatment, for lung cancers and many others.” In regard to treating heart disease, Wild also noted that what used to be done in the operating room can often be done now with a minimally invasive
surgery. Wild said more groundbreaking medical advances are likely on the way over the next decade. “I am amazed every day by the technology, whether it is in monitoring equipment or the drugs that we have available for use — antibiotics and pain medication, the medicines for high blood pressure and heart failure,” he said. “But I’m also amazed by the ongoing improvement that happens in health care.”
Roundtable: Health care experts discuss today’s pressing issues Continued from 1H
Patient responsibility
“One of the problems that I see with health care in general in the United States, and certainly in our area, is there’s this assumption that we are responsible for health care,” Owen said. “The fact is, if you look at a lot of the health care problems, they’re not ones that we can have. They’re ones that the patients have to fix. Obesity is a good one. They come and they get bypass surgery or whatever … but the fact is, so many of the problems facing health care right now are really problems the patient has ultimate control of. “They go home from the hospital, and we can’t force them to take their medication. Now, if some of them can’t get the medication, that becomes society’s problem,” he added. “But even the ones who have medication, you can’t get ’em to take it. So there has to be some level of personal responsibility.”
Physician responsibility
Yes, the physician has a responsibility to educate the patient, but the method has to be approached with careful consideration, Meier said. The Centers for Medicare and Medicaid Services is incentivizing the way physicians are reimbursed and the importance of education to avoid penalties. “But education turns into a printed sheet that you hand to the patient as they walk out the door, and then you’ve got your box checked,” Meier said. “You know, honestly, if you think about it, it might be the physician who doesn’t take the time and check the boxes and print the sheet who’s giving a better education to that patient. But when you look at the national surveys online, it’s those who check the boxes who are going to look like the physician compare sites’ good doctors. I think the education needs to change.”
Medicaid and emergency departments
“Nationally, we’re seeing more people use the ER rather than fewer,” Owen said. “But interestingly, earlier,” Voth added. “Earlier in their illnesses, and that’s kind of the whole theory
behind expanding Medicaid. You get people to access health care before they’re a train wreck and spend maybe $100 or $1,000 on your care rather than these gigantic disasters that roll into the ER and tie up tremendous services, cost hundreds of thousands. “One of the things I find most disturbing, not just here but nationally, too, is this has become such a political hot potato. Both sides need to come together to say, ‘Let’s figure out how in the heck to fix this,’ rather than you and you, and good guy and bad guy, and Republican and Democrat. It’s just nonsense. “The whole Medicaid expansion thing is a perfect example. Would we have walked away from $2 billion of Department of Defense money or highway monies or anywhere else? This was $2 billion worth of fairy dust that could have been sprinkled on Kansas, and now it’s jeopardized nationally.”
Behavioral health needed
In using numerous wrap-around services from social workers, behavioral health, care managers and others to help high-risk patients, Voth said the “toughest crowd” seems to be patients who have psychiatric and behavioral health issues underlying their medical problems. “They’re very hard to get services to and very hard to get to come to services,” he said. “They shut down the state hospital, and those people didn’t just vanish. Those populations are out there — some being served and a heckuva a lot not being served, getting sicker.” Is behavioral health care a primary consideration in Topeka? As a group, the six answered, “Absolutely.”
Electronic medical records
“I think what’s a frustrating situation for physicians now, but I think will be exciting in the next 10 to 15 years, is the electronic medical record and the amount of information we’re going to be able to get from the record on the population health side,” Hyland said. But right now, the EMR is a bit of a pain. “I had a discharge from the hospital day before yesterday that was 36 pages long, and I couldn’t find out what the patient was there for,” said Iliff, who uses pa-
per charts in his practices. “We’re in the infancy of EMR, and frankly, so far, personally I think it’s been detrimental,” Owen said. “It’s extremely expensive. It’s capable of putting all sorts of information into the chart automatically, but just try and find the part that I care about, which is what we think is really going on with the patient … it’s a struggle.”
Positives?
Generic drugs, Iliff said. “I think the generic drugs I’ve got to treat the most common problems of my overweight, under-exercised patients are terrific,” he said. “I can get all their numbers in the right place with really cheap stuff.” Iliff, who puts out a newsletter as part of his practice, doesn’t usually pull punches about the patient’s responsibility to take care of himself or herself. Does he attempt to work with his patients to make changes? “I used to, but I’ve thrown up my hands,” he said. “Nothing I do makes any difference. It’s a waste of time. I give ’em pills and make ’em better. They know what I think. They’ve heard it over and over and over again, because I’ve been here for 35 years practicing. They don’t do it, and we smile and go on.”
Personal rant
“One thing I’m on a personal rant about is the cost of pharmaceuticals,” Voth said. “It’s staggering. Staggering. And you know, companies need to make a profit, I understand that. But this is a killing. A hepatitis C cure is $99,000, or rheumatologic drug is $4,000 a month. That’s ridiculous. That is absolutely criminal, and nobody’s standing in the way of that. There’s a lot of things that could be done.” Heads nodded around the table. And aren’t there shortages are some of the cheap drugs, sometimes because they aren’t as profitable? “You can’t get normal saline right now, 200ccs to a bag — a particular bag, the way it’s packaged, that a lot of people use,” Jones said. “It’s not like some complex chemotherapy agent,” Owen added. “It’s sodium bicarbonate. It’s saline.” “Narcan for opiates. Narcan used to be dirt cheap. Now, it’s terribly expensive,” Voth said. “Inexcusable.” “There’s a lot of gaming that goes on in big
pharma,” Iliff said. “All of this stuff could be fixed by our congressmen.”
What’s on your wish list?
“I would have kept the family practice residency in Topeka,” Hyland said immediately. She referred to a residency program supported by Stormont and St. Francis that offered
residency slots to interns and helped the hospitals to retain those physicians as they completed their schooling. It closed in 2002. “I’m nostalgic for the days when I was a young doctor and physicians interacted on a regular basis and worked in the same places and saw each other frequently,” Jones said. “The days before things that are huge, like
hospitalists taking care of patients efficiently. The primary doctors would come to the hospitals to care for the patients and interact with the specialists. … Everybody is siloed now.” “I’d like to see medical education completely overhauled and a really serious national commitment to it,” Voth said. “Right now, it’s a mess.”