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By BECKy GILLETTE

If there is an environment that is nearly as stressful as an operating room, it might be operating in the Arkansas Legislature. The past fi ve years since Robert “Bo” Ryall has been president and CEO of the Arkansas Hospital Association (AHA) have seen some of the most tumultuous changes in the history

of American healthcare. Ryall has nearly 27 years’ experience

working on Arkansas legislative issues, in-cluding the past ten years at the AHA. Most recently, Ryall has directed efforts toward pre-serving the Private Option Medicaid expan-sion, vital to Arkansas hospitals, by providing insurance for about 250,000 Arkansans.

HealthcareLeader

Bo Ryall Leads Arkansas Hospital Association EffortsCEO of AHA Advocates for Hospitals, Patients and Economy

ON ROUNDS

Nursing Schools Working to Meet Demand for Higher Skills Nursing Trending Toward More Education When it comes to nursing education in Arkansas, the trends are toward more highly educated nurses including an emphasis on preparing more nurses with Bachelor of Science in Nursing (BSN) degrees, and Advanced Practice Registered Nurses (APRNs) with Doctor of Nursing Practice (DNP) degrees ... 4

Spinal Cord Stimulator Can Change Lives of Chronic Pain Patients New MRI-compatible Device Allows Better Diagnostic Tests, No Risk of RadiationRecently, in the wake of a growing numbers, much attention has been focused on reducing prescription drug opiate abuse. Opiate overdose deaths in the U.S. grew to 29,000 in 2014, an increase of 137 percent since 2000 ... 5

By BECKy GILLETTE

The state’s largest healthcare system, Baptist Health, has joined with the State of Arkansas and the state’s largest health insurance company, Arkansas Blue Cross and Blue Shield (ABCBS), in an innovative partnership designed to improve healthcare while also boosting the state’s economy.

HubX-Life Sciences is the fi rst privately-funded and industry-specifi c business accelerator program in Arkansas.

“This program is bringing talented innovators to the state with whom we have an opportunity to showcase what Arkansas has to offer entrepreneurs,” said Troy Wells, pres-ident and CEO of Baptist Health. “Since announcing the HubX accelerator, FIS – a Little Rock-based fi nancial ser-vices company – has announced a fi nancial technology ac-celerator in partnership with the Venture Center. As we see more organizations participate in programs such as these, we will continue to see increased investment opportunities and


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PAGE 3

PHYSICIAN SPOTLIGHT

Carl Covey, MD

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Fear of Overprescribing Opiates Can Harm Patients Who Don’t Get Appropriate Pain Medicine New Regulations May Cause Primary Care Doctors to Fear Prescribing Opiate Painkillers Even When Patients Need Them

By BECKy GILLETTE

Concerns about abuse or overuse of opiate pain-killers has recently led the Centers for Disease Con-trol and Prevention (CDC) to come out with strict new guidelines to reduce prescribing. Also, just a little over a year earlier, the Drug Enforcement

Administration (DEA) rescheduled the commonly prescribed hydrocodone (Lorcet or Vicodin) from a Schedule 3 to a Schedule 2 drug, the highest level of control and scrutiny.

With the changes pa-tients can get fewer pills at one time, there are more re-strictions on refills – such as not being able to call them in – and pharmacies must follow stricter procedures. While the intention of the rule change is to prevent misuse and\or over-dose deaths, pain specialist Carl Covey, MD, medical director of the Pain Treat-ment Centers of America in Little Rock, said there could be harmful consequences.

“Primary care physicians are just downright scared of any opiate medi-cines, and it is going to get worse with the new CDC guidelines,” Covey said. “Many won’t prescribe opiates, or if they write them, will write them for only three days. They will try to get patients to take aspirin or Tylenol, but you would be sur-prised how many people can’t take these. And many people are at risk from taking too much Tylenol. For a lot of these folks, opiates are the safest medicine. Primary care doctors do not need to fear taking good care of patients. They just need to be smarter and more careful about the volume of medicine they prescribe.”

Covey said when a patient comes in and is suffering, physicians need to help them by being a mentor, giving good advice and prescribing the appropriate medicine.

Opiate pain medicines work very, very well and are very safe from a tox-icity standpoint, Covey said, so patients shouldn’t be denied the medicine because a small percentage of people will develop a psychological addiction to the medicine. And care needs to be taken to prevent a patient becoming ill from suddenly stop-

ping opiate painkillers because they can no longer get a prescription.

“Even if you have been on an opiate painkiller for just a few days, it is impor-tant to taper off of it,” Covey said. “Don’t suddenly stop the medicine because you will feel really crappy. Always taper off just like with benzodiazepines and steroids.”

Another misconception is that people who abuse or overdose on painkillers are patients. The vast majority of those peo-ple are non-patients who are stealing the medication, obtaining it fraudulently, or buying it on the street. Covey said the vast majority of patients are using these medi-cines because they need them, and have never had a problem with addiction in the past nor will they in the future.

He recommends good judgment in writing prescriptions. Don’t write more than needed just because you don’t want patients calling back for a refill.

“Even good patients don’t know what to do with leftover medicine,” he said. “A lot gets stolen out of the medicine cabinet, or given away to someone who has pain. The medical community is trying its best to reduce this volume of unnecessary medi-cine without harming the huge number of people who not only need these medicines, but benefit greatly. You have to exercise good medical judgement. It is a very, very thin tightrope we walk between taking good care of suffering patients and not putting some medicines out there that a 16 year-old takes to a party and somebody dies.”

You can take wonderful care of many, many patients, and all it takes is one fraudu-lent patient getting medicine and it makes everyone looks bad.

“You have to be really careful,” Covey said. “One prescribing mistake nullifies 100 good decisions. Doctors must be much more careful sorting out the rare people who scam the system because it makes us all look bad. Arkansas has developed the Electronic Prescription Drug Monitoring Program, which is a wonderful tool to do this. We are slowly but steadily getting better.”

Another important piece of advice is to be careful about treating symptoms. Make sure to know what the source of the pain is rather than just masking

it. For example, for someone with muscle spasms, sometimes it is better to treat the spasms than the pain. If pain is caused by inflammation, anti-inflammatory medi-cines might be a better choice than some-thing like hydrocodone that blocks pain receptors in the spine.

“You are addressing more the source,” Covey said. “But for a huge pop-ulation of pain patients, it is not inflam-mation nor is it correctable, even with multiple surgeries. Their pain is incurable. The vast majority of chronic pain patients are incurable, but manageable. That is why we call it pain management.”

Covey’s patients sometimes call him “the wizard” because he is the man be-hind the curtain. He believes it takes a good partnership with patients to address their chronic pain so they can go about their lives as normally as possible.

A big part of what he does is not just take care of the patient’s symptoms, but to protect their integrity because they are constantly questioned by family, primary care doctors, and pharmacists. Patients need to make sure they don’t allow their medicines to get stolen or take additional pain medications for another condition without notifying their physician.

“I have to protect your integrity, so don’t do things that make it hard to do that,” Covey said. “Always call. Always ask.”

Covey grew up in western Benton County in Gentry. He got his undergrad-

uate degree at the University of Arkansas Fayetteville in industrial engineering and spent two years working as a computer system analyst for Honeywell before de-ciding to attend medical school.

“Working in engineering is mostly dealing with machines, devices, plans and paperwork,” Covey said. “I really enjoy dealing with people. My grandfather was a family practice physician in Paris, and his grandfather practiced medicine in Fort Smith. My mother and grandmother both told me I ought to be a doctor someday. I enjoy the science of medicine, so I went to med school and ended up in anesthesiol-ogy.”

He practiced in Fayetteville for 15 years, founding the Pain Clinics at Wash-ington Regional Medical Center and the Northwest Rehabilitation Hospital before moving his practice to Little Rock in 1997.

Covey is a self-described “tinkerer.”“I tell people my day job is a doctor,

but I’m really a carpenter,” he said. “I like to build things. My wife, Paula, and I have been married 43 years. We have a cabin in Northwest Montana. Paula is a VIP chef for Verizon Arena banquets. She really enjoys that, and I enjoy eating her food. We have a couple of grandkids here close, and we love to play with the grandkids. I’m just an old country boy. I like simple things.”

PhysicianSpotlight

To learn more:

Arkansas Electronic Prescription Drug Monitoring Program, http://arkansaspmp.com/

CDC Injury Prevention & Control: Opioid Overdose, www.cdc.gov/drugoverdose/prescribing/resources.html

US Dept. of Justice Drug Enforcement Administration Office of Diversion Control, www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0822.htm

The New England Journal of Medicine “A Proactive Response to Prescription Opioid Abuse,” www.nejm.org/doi/full/10.1056/NEJMsr1601307

Office of National Drug Control Policy, 2015 National Drug Control Strategy, www.whitehouse.gov/ondcp/national-drug-control-strategy


By BECKy GILLETTE

When it comes to nursing education in Arkansas, the trends are toward more highly educated nurses including an em-phasis on preparing more nurses with Bachelor of Science in Nursing (BSN) de-grees, and Advanced Practice Registered Nurses (APRNs) with Doctor of Nursing Practice (DNP) degrees. Currently there are four Arkansas universities approved to offer the DNP degree.

“Certainly the data has shown the more highly educated the nursing work-force is, the better patient outcomes are, and the less issues there are with safety,” said Patricia A. Cowan, PhD, RN, dean of the College of Nurs-ing at the University of Arkansas for Medical Sci-ences (UAMS).

About 40-45 percent of the graduates from programs in Arkan-sas are baccalaureate prepared. The other 55-60 percent go to two-year, associate degree programs (two nursing programs in Arkansas recently transitioned to associate degree programs).

Cowan said there is a goal of having 80 percent of nurses baccalaureate pre-pared. This recommendation comes from the Institute of Medicine’s 2010 report, The Future of Nursing: Leading Change, Advanc-ing Health. Having nurse managers with at least a BSN is one of the qualifi cations for a hospital to receive Magnet Recognition from the American Nurses Credentialing Center (ANCC), an affi liate of the Ameri-can Nurses Association, recognizes hospi-tals that satisfy a set of criteria designed to measure the strength and quality of their nursing.

Cowan said hospitals with Magnet designation are also more likely to retain nursing staff who are qualifi ed at a higher level.

While there are over 35,000 RNs li-

censed in Arkansas, according to the latest report available, there are still plenty of vacancies in hospitals, especially for nurses with a BSN.

“There are areas within Arkansas where we are not meeting the need for healthcare professionals,” Cowan said. “Information from the U.S. Department of Health and Human Services shows that there are 80 primary care provider Health Professional Shortage Areas (HPSA) in Ar-kansas.”

APRNs are playing a particularly im-portant role in these areas where there are shortages of primary care providers. Data coming from the Arkansas State Board of Nursing indicate there are approximately 2,800 APRNs licensed in Arkansas, with the majority being nurse practitioners and fewer nurse midwifes, nurse anesthetists, and clinical nurse specialists.

“We are fi lling the health professional shortage gap,” Cowan said. “The demand for APRNs is certainly a growing fi eld. UAMS has nurse practitioners at many of the regional centers, previously called the Area Health Education Centers. Part of what we do is provide education to nurse practitioner students in rural areas through-out the state. If we can train APRNs close to where they live, they are more likely to work in those areas once they graduate. The UAMS Regional Centers are located in Batesville, Fort Smith, Magnolia, Tex-arkana, Fayetteville/Springdale, Pine Bluff, Jonesboro and Helena\West Helena.”

One barrier to training more nurses is a faculty shortage in Arkansas, as well as the rest of the country. Often nursing in-structor salaries lag behind what the nurses can make elsewhere.

“Unfortunately, a good number of faculty across the country are aging out,” Cowan said. “The average age of a faculty member is 51. But here at UAMS, as at many other colleges, we have faculty con-tinuing to work into their 70s. It shows their strong commitment to preparing the next

generation for the nursing workforce.”One trend in training of all types of

healthcare professionals is simulation.“Simulation provides students with

safe opportunities to not only practice skills, but deal with tough situations in a simulation before they do it in a real world setting,” Cowan said. “A great simulation is someone comes into a clinic or hospital and the healthcare worker suspects child or elder abuse,” Cowan said. “How do you deal with it? What agencies need to be involved and how do you deal with the agencies? I’ve also seen simulations with end-of-life care that are very effective. It is helpful to explore your feelings about these situations. Debriefi ng following the simula-tion provides a means for refl ecting on the simulation learning experience.”

Another trend involves more inter-professional education. Cowan said it is im-portant to provide educational experiences in both didactic and in clinical situations with other healthcare professionals.

“It is hard to practice collaboratively and professionally unless you have some training on how to do it,” she said. “All of the professions bring a different insight. The goal of inter-professional education, respecting what each brings, is a better pa-tient outcome. The efforts that have been made to do more inter-professional educa-tion allow people to develop more trust in the knowledge base of individuals and the expertise they bring.”

Nursing instruction is also offered at all 22 state community colleges.

“Not only is nursing in high-demand in Arkansas, it’s also a great career pathway that leads to high-paying jobs,” said Col-lin Callaway, chief op-erations offi cer, Arkansas Community Colleges. “Many of our students start out with a Nurs-ing Assistant certifi cate. They may go to work for a while, and then come

back to college to add courses that lead to a Practical Nursing certifi cate or a Registered Nursing associate degree. Each level along the career pathway requires more educa-tion and skill, which results in a higher pay-check.”

The colleges, in partnership with UAMS College of Nursing, just wrapped up a four-year grant funded through the U.S. Department of Labor and the De-partment of Workforce Services called Arkansas Partnership for Nursing’s Future (APNF).

“One thing we learned through this project is that fi nding enough clinical train-ing sites for students can be a challenge,” Callaway said. “To help address this short-age, simulated clinical environments are becoming more sophisticated. We were able to use APNF grant funds to help our colleges purchase equipment and develop curriculum to create or enhance their simulated training facilities. In a simulated clinical setting, students are exposed to real world medical scenarios that they may never actually see in a traditional clinical setting. Plus, it creates a safe environment for students to learn.”

Eight community colleges are work-ing together through the Arkansas Rural Nursing Education Consortium (ARNEC) on an on-line program specifi cally designed to advance students from Practical Nurses to Registered Nurses. Courses are delivered to the eight college campuses via distance education. This allows colleges to share nursing faculty and allows students to ad-vance their careers without leaving their hometowns.

Another university that trains nurses in the state is Arkansas Tech University in Russellville.

“The faculty of the Department of Nursing at Arkansas Tech University seeks, through its professional program, to implement the mission of the university; a mission committed to prepare students to meet the de-mands of an increasingly competitive and intellec-tually challenging future,” said Rebecca Burris, PhD, RN, head of the Ar-kansas Tech Department of Nursing and a professor of nursing. “The university pro-vides opportunities for intellectual growth, skill development and career preparation.”

Burris said the curriculum is designed to prepare the student for basic nursing practice, to be competent, self-directed and capable of demonstrating leadership in the application of the nursing process in a variety of healthcare settings. The graduate should demonstrate initiative for responsible change, the ability to think critically and a lifelong quest for knowl-edge and growth.

Nursing Schools Working to Meet Demand for Higher Skills Nursing Trending Toward More Education

Dr. Patricia A. Cowan

Collin Callaway

Dr. Rebecca Burris

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By BECKy GILLETTE

Recently, in the wake of growing num-bers, much attention has been focused on reducing prescription drug opiate abuse. Opiate overdose deaths in the U.S. grew to 29,000 in 2014, an increase of 137 percent since 2000.

While the govern-ment is taking steps to address the problem that now claims more U.S. lives than traffic ac-cidents, many primary care physicians might not know they can refer some chronic pain patients for spinal cord stimulation neurosurgery that can be successful reducing chronic pain without long-term use of addictive opiate painkill-ers.

Spinal cord stimulation involves sur-gically implanting small electrodes con-nected to a pulse generator over specific

regions of the spinal cord. The electrodes for this technology, similar to a cardiac pacemaker, produce electrical impulses that affect transmission of pain signals.

Erika Petersen, MD, associate pro-fessor in the University of Arkansas for

Medical Sciences (UAMS) College of Medicine’s De-partment of Neurosurgery, does this type of surgery for about 100 patients per year.

“The majority of healthcare practitioners in Arkansas have limited ex-perience with these devices, and may not know which patients would be good candidates for one, or how to connect a patient to a practitioner who is able to evaluate a patient for this procedure,” Petersen said. “I see patients who have been treated for a chronic pain for a decade or more who tell me, ‘No one has ever talked to me about a stimulator.’ Or they had a physician say, ‘They don’t

work. You don’t want one.’ There is a lack of awareness and some misinforma-tion about spinal cord stimulators in the medical community.”

Most people trust what their doc-tor recommends in terms of technology.

Petersen said the advances in technology over the past two years mean that many clinicians may not realize that today spi-nal cord stimulators are a proven technol-ogy that can provide durable pain relief to people with refractory pain.

“Physicians like me are trying to get the word out to educators and providers about the advantages of this technology to promote better patient access to the whole spectrum of treatment options,” Petersen said. “A lot of people don’t recognize there are technologies like a spinal cord stimulator that can effectively address chronic pain for patients who think they have no other option besides use of pain-killers. Especially with Centers for Disease Control and Prevention (CDC) putting out new guidelines that recommend mini-mizing use of narcotics for chronic pain, the goal is avoiding opioids. One way this can be done is to use electrical stimulation, instead of narcotics, to change the pain signals. In a lot of instances, this surgery is covered by insurance and Medicaid.”

Spinal cord stimulators can be con-sidered for long-term, chronic back pain including pain that gets worse even after

Spinal Cord Stimulator Can Change Lives of Chronic Pain Patients New MRI-compatible Device Allows Better Diagnostic Tests, No Risk of Radiation

Erika Petersen (right) is shown prior to operation to implant spinal cord stimulator.



By CINDy SANDERS

Oregon has done it. California is in the process of implementing it. Tennes-see, Colorado, Washington, Missouri and a number of other states are at least con-sidering it.

“It” is a pathway to allow women to receive oral and/or transdermal contra-ceptives with a visit to the pharmacy rather than the physician’s office.

Addressing changes to prescribing and dispensing laws, Tim Tucker, PharmD, the former president of the American Pharmacists Association (APhA), noted, “The biggest, most important message here is patient access. Anything the pro-vider – anybody who is part of the health-care team: physician, pharmacist, nurse practitioner, physician assistant – can do to improve access is where we have to go in today’s environment.”

Tucker, who owns City Drug Com-pany in the small western Tennessee town of Huntingdon, continued, “I want every patient who can to have an OB/GYN.” However, he added, that isn’t always fea-sible as a matter of insurance, geography and other issues impacting access. “This is an alternative where pharmacists can help the OB/GYN or PCP.”

He added these new laws help women

who are trying to be proactive in prevent-ing unintended pregnancies.

A similar mindset was behind a new prescribing law in Oregon that went live Jan. 1, 2016. Rep. Knute Buhler, MD, worked with colleagues and the Oregon State Board of Pharmacy to expand access to self-administered oral and transdermal birth control products by allowing phar-macists who meet mandated requirements to prescribe these hormonal contracep-tives.

Oregon State University College of Pharmacy played a key role in help-ing pharmacists meet those requirements through the creation of an education and certification program.

OSU Pharmacy Instructor Lorinda Anderson, PharmD, who was instrumen-tal in crafting and rolling out the certifica-tion program, said the Board of Pharmacy approached OSU even before the law was passed to ensure a robust educational platform would be in place. Physician members of the American College of Ob-stetricians and Gynecologists (ACOG) pro-vided input for both the patient screening tool and pharmacist coursework.

“Not only does the training program incorporate the guidelines for eligibil-ity criteria but also the Oregon Board of Pharmacy’s rules they put into place,” said

Anderson, noting there is a procedural al-gorithm that walks through conditions and exclusion criteria that would require a pa-tient be referred to a physician to obtain a prescription for contraceptives.

“I’ve been really happy with how the training has turned out,” Anderson said. “Mostly because pharmacists have come out of this feeling prepared and comfort-able to do this (prescribe), which is exactly what we had hoped.”

Paige Clark, RPh, who leads pro-fessional development efforts for OSU’s College of Pharmacy and is a member of APhA, said about 350 pharmacists had al-ready completed the course and passed the certification examination. “We expect to have 1,200 pharmacists certified and pre-scribing by the end of June,” she added, noting that approaches the halfway mark of retail pharmacists in just six months.

While it’s too early for hard numbers, Clark said from anecdotal evidence, “We are seeing a 90 percent prescription rate and a 10 percent referral rate, which is ex-actly what ACOG physicians would hope to see.” She added individuals with an in-creased risk of stroke, high blood pressure or who simply want to explore other birth control options would be among those re-ferred to a physician.

“We found Oregon patients were so excited to be able to access this service,” said Clark. “This can dramatically increase the availability of hormonal birth control therapies to women in every county of Or-egon.”

She added, “We’ve had such a smooth rollout due to a lot of folks pulling together in a robust way. Patients are happy. Phy-sicians are happy, and our public health officials are thrilled beyond belief because we’re already making an impact.”

Clark called pharmacists an “un-tapped resource” and pointed to the five-fold increase Oregon has seen in im-munization rates since involving pharma-cists in the process. As for concerns that patients might skip physician visits for rec-ommended screenings with birth control now available at the pharmacy, Anderson noted the Oregon law tried to address this issue. She said pharmacists are routinely talking to patients about the importance of those visits.

“After three years, if the patient doesn’t have evidence of having a woman’s healthcare clinical visit, then the pharma-cist can no longer write a birth control pre-scription for them,” Anderson added.

Although ACOG would much pre-fer birth control pills be available over the counter, Tucker, who is also a past presi-dent of the Tennessee Board of Pharmacy, said he is opposed to that move. “I think it’s so very important with contraceptives that there is some oversight by a health-care team member.” He added that without a prescription, it would be impos-sible to track usage habits and changes in health that might impact the effectiveness or safety of oral contraceptives. “If we fill

a prescription, we have a profile and can have a patient history,” he pointed out.

Why ACOG Thinks Good Isn’t Great

ACOG’s opposition to pharmacy pre-scribing laws for birth control pills stems not from an effort to protect physician ter-ritory but rather the belief that access to oral contraceptives should be even more open.

“I think it’s a mistake to go in that di-rection because it still creates a barrier,” AGOG President Mark S. DeFrancesco, MD, MBA stated of the current wave of state laws putting oral contraceptive pre-scribing power in the hands of pharmacists.

In terms of the new Oregon law and others that might follow, DeFrancesco noted, “Although ACOG members par-ticipated in the development of the patient screening tool and the pharmacist training program, this should not be interpreted as ACOG support for this concept. Once the new law was a reality, ACOG members did assist with implementation in order to assure that appropriate guidelines were fol-lowed.”

However, he continued, “We’d like to see unfettered access. ACOG’s policy is we don’t want anybody to be between the patient and the pill. We feel like it is time for it to be available over the counter. The pill has been out long enough to be proven extremely safe.”

DeFrancesco added that many OTC options – ranging from medications for pain relief to those addressing gastric is-sues – have at least as much, if not more, potential to harm certain patients than hormonal contraceptives. As with current OTC medications, he said, “The things that are absolute contraindications for the pill could be outlined on the label.”

He also noted that his patients who have a condition that prevents taking oral contraceptives such as migraines or deep vein thrombosis (DVT) are typically keenly aware of the fact. In addition, the physi-cian pointed out unintended pregnancies can also carry health risks for patients, including those with high blood pressure. Furthermore, DeFrancesco said he be-lieved it was a fair assumption that if the number of unintended pregnancies was reduced, the nation would see a drop in the abortion rate.

As for the argument that requiring a physician visit to receive a birth control prescription is the impetus to get women through the doors for annual health screens, DeFrancesco said, “We shouldn’t be holding patients hostage to the pill pre-scription.”

While he said he recognizes the claim might have some limited merit and that a small percentage of women might, in fact, skip their annual OB/GYN appointment, DeFrancesco said, “That puts the onus on us to explain that the annual visit is more than just a pap smear and pelvic exam.”

Of Pills, Prescriptions, Pharmacists & PhysiciansThe Push to Remove Barriers to Oral Contraceptives



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Moving Behavioral Health Reimbursement Toward Parity

By LyNNE JETER

Reimbursement for behavioral healthcare in the United States has been moving from a fee-based to value-based system in a slower, more fragmented man-ner, with nearly half the states taking ac-tion to bring it more in line with primary care, while nearly one-fourth of the states are waiting and watching.

That’s what Dale Jarvis, CPA, told attendees at the National Council for Be-havioral Health Conference (NATCON) 2016.

“Medicare is the biggest health pro-gram that hasn’t embraced behavioral health parity,” said Jarvis, managing con-sultant for Dale Jarvis & Associates LLC in Seattle, Wash. “Alternative payment models are coming into Medicaid for be-havioral health and that’s where change is starting to occur. The commercial sector is very slow on the uptake around behav-ioral health reform in most parts of the country.”

As a result, many behavioral health providers are lost in the labyrinth data.

“Challenges that folks with behavioral health disorders face involve too little ef-fective care and too much sick care,” Jar-vis said. “Under the too little effective care umbrella are big gaps between the behav-ioral health need and capacity, high rates of untreated chronic health conditions, and insufficient evidence that behavioral health-care is working. Under too much sick care, the issues involve crisis and emergency room care, medical and psychiatric inpa-tient care, diagnostic imaging and medical specialty procedure-based care.”

Major Funding Shift Jarvis pointed out three categories of

behavioral health payment reform. Those who have been reforming

for years and continue refining payment methods. For example, Seattle and Mary-land are old hands at managing case rates – bundled payments that cover the cost of a defined episode of care.

Those who have recently started developing alternative payment models, such as case rates exemplified by projects in Oregon.

The remainder who continue prac-ticing business as usual and haven’t done much innovation around payment reform. “Those in the third group shouldn’t get seduced into thinking that’s how it’s al-ways going to be,” he explained. “They’re going to have to make aggressive changes to keep up. Through the Medicare pro-gram over the last two years, the federal government has really put a stake in the ground, saying they’re going to very ag-gressively move Medicare into value-based purchasing. Within the last month, they announced they’re ahead of schedule and they’re moving all things medical in Medicare into new payment models that are defined as pay-for-performance and different kinds of base payments, such as capitation and case rates.”

The Chatter about CCBHCs NATCON networkers were buzzing

about a new federal plan to create pilot

programs for the behavioral health equiv-alent of federally qualified health centers (FQHCs).

Created by the Excellence in Mental Health Act of 2014, pilot programs for behavioral health will launch at Certi-fied Community Behavioral Health Clin-ics (CCBHCs) in eight states. “President Obama has increased the number to 14 in his budget. Some bills pending in Con-gress increase the program to fund all 24 states receiving planning grants to design their CCBHC system,” said Jarvis.

The pilot program includes payment reform via two models: daily or monthly bundled payment. If a state takes the larger payment, quality results are man-dated. “Otherwise,” Jarvis said, “there’s more opportunity to take the money and run.”

Louisiana has been in a very serious cost-cutting mode on behavioral health budget items, Jarvis pointed out, noting the state didn’t pursue the CCBHC pro-gram. Healthcare providers are being laid off, programs are closing, and “it’s not a pretty situation,” he said.

Popular Formula for Health Systems

Many health systems are headed to a particular formula that aims to reduce inpatient admissions, reduce days and cost per day, plus reduce emergency room visits, diagnostic imaging, and specialty procedures. The end result is

behavioral health, primary care, phar-macy, medical specialty, medical inpa-tient, and system transformation in a shared risk pool.

Jarvis said balancing the portfolio involves a very simple strategy known by several names, including value-based purchasing and DSRIP (delivery system reform incentive payments). DSRIP fi-nancing of Medicaid is taking place in Texas, New York and California. The concept involves the accumulation of an innovation fund, with seed money com-ing from the purchaser, such as the Cen-ters for Medicare and Medicaid Services (CMS), and carving money from current budgets.

For example, in California, two DSRIP projects – PRIME (public hospital redesign and incentives in Medi-Cal) and WPC (whole person care) – involve new money for complex care management for high-cost patients with behavioral health disorders. PRIME represents $7.5 billion; WPC, $3 billion.

“One size doesn’t fit all,” he empha-sized. “Of the two primary accountable payment models, Alternative Payment Method (APM) Component 1 involves the base payment layer, with four base payment models. APM Component 2 involves the bonus/shared savings layer that’s married to the hip with key per-formance measures, and needs to be a substantial percentage of the total pay-ment.”

And, he continued, ACOG is promot-ing that broader practice message not only to women … but to their own members, as well. “It’s time physicians and women separate the pill from the annual visit,” DeFrancesco stated, adding there are al-ready many women who no longer require contraceptives that continue to come for an annual exam.

DeFrancesco said he suspects laws al-lowing women to seek oral contraceptives and transdermal patches from pharmacists are well meaning in their intent to allow broader access to birth control. Whereas moving hormonal birth control options to OTC status would most likely require in-dividual manufacturers to apply for such a change with the U.S. Food and Drug Administration, state legislative action on prescribing laws broadens the reach with-out reclassifying the drugs.

Yet, DeFrancesco fears, this halfway step might unconsciously prove to be di-versionary, diminishing the push for truly barrier-free access. “In that sense, the good would be the enemy of the perfect,” he said. “We might settle … and that’s not good enough.”

Of Pills, continued from page 6


continued exposure and growth for the state of Arkansas.”

Wells said Baptist Health is partner-ing with HubX-Life Sciences because Baptist is committed to improving the lives of Arkansans by changing the way healthcare is delivered.

“HubX-Life Sci-ences invites innovative technology solutions to traditional healthcare challenges that could result in better patient outcomes, better patient experiences and overall increased efficiency,” Wells said. “At Baptist Health, we are constantly evaluating our performance and striving to fulfil our mission, vision and values in new and innovative ways.”

Wells said all of the companies partic-ipating in the accelerator have developed medical devices or digital health platforms that could potentially have tremendous impact on the quality of patient care and or patient engagement/satisfaction.

The seven companies were chosen based on a set of selection criteria de-veloped collectively by Baptist Health, ABCBS, and the Arkansas Regional In-novation Hub.

“Essentially, we were looking for companies that were attempting to solve problems that we as healthcare provid-

ers and payers deemed important,” Wells said. “The most important criteria was evaluating whether we as Baptist Health, ABCBS, and the Innovation Hub could provide value to a company and could they, in turn, add value to our organiza-tions. We received over 70 applications from all over the world, and we worked diligently to get that number down to seven.”

Several months of national and inter-national recruitment went into selecting the startup companies that will participate in the 13-week program. Each company will receive seed investment, as well as in-tense mentorship and assistance, as they rapidly proceed from concept to product development and customer acquisition. Initial seed investments into the compa-nies will range from $25,000 to $50,000, and the companies will also qualify for ad-ditional back-end investments.

Wells said they believe that the ac-celerator has the potential to attract high tech entrepreneurs to the state of Arkan-sas. It is their hope that more technology-based companies consider Arkansas a place where innovation can occur and be maintained.

“We believe that the accelerator program has the potential to contribute to Gov. Asa Hutchinson’s strategic ob-jectives for the State of Arkansas,” Wells said. “The governor has taken consider-

able steps to promote technology profi-ciency throughout the education system, as well as the economy. We hope that, col-lectively, all of our efforts make Arkansas more attractive and known for business development and technology-driven en-trepreneurial activity.”

“We’re delighted and honored to have a cohort of healthcare founders of this quality,” said Jeff Stinson, the direc-tor of entrepreneurship at the Arkansas Regional Innovation Hub, who also directs HubX-Life Sciences. “The ability to attract technology and talent of this caliber to a first-year accelerator is due in no small part to the access provided by Baptist Health and Arkansas Blue Cross and Blue Shield, each of whom have been tremendous partners in this undertaking. We really can’t wait to get these found-ers to Arkansas and begin working with them.”

Mark White, president and chief executive officer of ABCBS, said in the ever-changing healthcare environment, it is imperative to innovate and recreate the way business is done to better serve their members to ensure they have access to quality healthcare and reliable, affordable health insurance.

“Effectively reaching healthcare con-sumers, empowering them with informa-tion they can understand for making good decisions, and providing them with the tools they need to make the process easy are all paramount to the future health of our members and all Arkansans,” White said. “We want to encourage compa-nies with bright, motivated employees to consider the possibilities of a great, new healthcare system.”

Warwick Sabin, executive direc-tor of the Arkansas Regional Innovation Hub, said the program is well positioned to make Arkansas a national leader in healthcare innovation and entrepreneur-ship.

The participating companies will be selected based on their potential to pro-vide solutions to several key priorities identified by Baptist Health and Arkansas Blue Cross, which include digital health-care platforms, healthcare services and medical devices.

The program will partner with Iron Yard Ventures, which operates a Digital Health Accelerator that is ranked among the top five health accelerators in the na-tion. Iron Yard Ventures will share its expertise, training, mentor network, and other assets during its engagement with HubX-Life Sciences.

For more information visit www.hubx.biz.

Largest Healthcare System, Partners with Largest Insurer, continued from page 1

Troy Wells

Jeff Stinson

Ryall began his career as an analyst for legislation being considered in the Ar-kansas House of Representatives. A lot of the projects he worked on for 13 years were healthcare related. He served as ex-ecutive director of the HomeCare Associ-ation of Arkansas before joining the AHA in 2005 as executive vice president. In 2010 when Phil Matthews retired, Ryall was appointed to replace him as president and CEO.

“It certainly can be stressful,” Ryall said. “We have had a lot of close votes. The 2013 legislative session when the Pri-vate Option first passed, trying to obtain the three-quarters vote threshold was very challenging. It took a lot of people getting involved. The governor, legislators and other groups of supporters were all needed to secure its passage. Then it was the same thing for 2014.”

This year, while the vote was being considered, Ryall was working to inform legislators that hospitals couldn’t afford to stop getting payments for the 250,000 newly insured people at the same time that the Affordable Care Act (ACA) has made huge reductions in Medicare reim-bursements for hospitals representing a loss of $2.5 billion for state hospitals over a ten-year period.

Uncompensated care costs for hos-pitals in Arkansas were $380 million per year prior to the Private Option, which reduced the uncompensated care costs by $149 million from 2013 to 2014.

“It is huge,” Ryall said. “Look at the

percentage of people coming in from un-insured to insured. We had a 48 percent reduction in the number of people admit-ted as inpatients who were uninsured. In 2013 before the Medicaid expansion, we saw some hospitals in financial difficulty, and layoffs. Since then jobs have been added and hospitals have stabilized. It has obviously been good for hospitals.”

Legislators opposed to the Arkansas Works program have stated the state’s share of costs for Medicaid will grow in the future to the point of being a major strain on the state’s budget. Ryall consid-ers it a big part of his job to communicate to legislators that Arkansas Works is good for the state budget.

“There is a benefit of $757 million to the state budget from 2017 to 2021 even with paying the state match over that pe-riod,” Ryall said. “This also sustains em-ployment at hospitals, which are often the largest employer in the area where they are located.”

Ryall regrets that healthcare has got-ten so politicized.

“Not everything that has to do with healthcare has something to do with Obamacare,” Ryall said. “That has been a significant challenge since the Supreme Court ruling upheld the ACA in 2012.”

Ryall said he feels his success leading the AHA comes from hiring good people and recognizing good talent.

“We have some excellent experienced people,” Ryall said. “People stay around a long time. Paul Cunningham has been

here 35 years. Paul is excellent on data and research, and knows hospital finances. Jodiane Tritt does an excellent job repre-senting us at the state capital. We have an excellent staff here. They know their jobs and do them well.”

About four years ago, AHA started a quality program and hired Pam Brown as vice president for quality and patient safety. Brown has worked with state hos-pitals to improve quality, reducing in-fections and readmission rates – factors deemed important by Medicare.

“We have about 50 hospitals in our healthcare engagement network,” Ryall

said. “They regularly share information and data with us which we can reproduce and allow hospitals to compare themselves to benchmarks and improve quality. This program has been very successful and has helped hospitals tremendously.”

About 100 hospitals in Arkansas are members of AHA, nearly every hospital in the state. Ryall said they join AHA be-cause they are too busy for each to moni-tor legislation and regulations.

“The hospitals excel at patient care and we strive to improve on all aspects of our association work, from advocacy to education to quality,” Ryall said.

Bo Ryall Leads Arkansas Hospital Association Efforts, continued from page 1

Medicaid Expansion Survives

The Arkansas Private Option (Arkansas Works) expansion survived another cliff hanger in the Arkansas Legislature when on April 20 the Senate garnered the 27 votes needed to approve a bill to authorize the state receiving $8.4 billion for the Arkansas Department of Human Services, which includes $1.7 billion in spending for Arkansas Works.

Earlier the expansion fell several votes short of the three-quarters vote needed for passage of spending bills in the legislature. Gov. Asa Hutchinson threatened to withhold the entire $8.4 billion budget for DHS if the Medicaid expansion wasn’t extended. He said failure to approve Arkansas Works would have left the state with a budget gap of more than $100 million. Hutchinson had also hinged his support for a special session to consider highway funding issues later in the year on passage of the Medicaid expansion.

The bill made it through the Senate after legislators agreed to amendment that opposed the expansion, which the governor had promised to kill with a line item veto. That left funding intact.

At press time the legislation had not been finalized, but was expected to be approved after going to the Arkansas House of Representatives. To sign up for email notifications of breaking news alerts, please email [email protected].


surgery to correct it, nerve pain or numb-ness in the arms or legs, complex regional pain syndrome, and other neuropathic pain syndromes.

There has also been a recent major improvement in the devices now being MRI-friendly, allowing patients to have more freedom of choice for diagnostic procedures.

“Studies show that 82 percent of pa-tients implanted with a spinal cord stimula-tor are expected to need an MRI within five years of receiving their implant, and this de-vice offers patients the confidence of know-ing that they can receive optimal diagnostic imaging anywhere in the body should the need arise,” Petersen said. “This is a huge deal because of concerns over excessive

X-ray exposure. So if you have the ability to get an MRI, it may be a safer diagnostic test. The other advantage is that MRI shows tis-sues in a different way. For example, if I look at a CT scan, I can see the outline of the spi-nal cord, but I may not be able to see subtle swelling that might suggest cancer or injury. MRI shows the spinal cord tissue much bet-ter. Access to MRI without any restrictions is a huge impact for patients. This is the first SCS paddle electrode that has no restrictions on which body part is imaged with MRI as long as it’s done in an appropriate scanner.”

Petersen broke new ground by being the first surgeon in the world to implant two of the first commercially available Medtronic spinal cord stimulator devices.

Petersen said it is very rewarding to

see how patients are helped by the surgery.“Often people are depressed because

they can’t work, they can’t play with the grandkids, or even go to the end of the driveway to check their mail,” she said. “If I can have an impact on their function and quality of life, that is immense. People tell me it has made a big difference for them, helping them decrease the amount of medication they take, and being able to function more normally. That is very gratifying.”

Spinal Cord Stimulator, continued from page 5

To learn more:University for Arkansas Department of Neurosurgery, http://neurosurgery.uams.edu/

Heiser Joins NARMC as Rehabilitation Director

HARRISON - North Arkansas Re-gional Medical Center is pleased to an-nounce Rick D. Heiser, OTD, OTR/L, CHT, CLT, has joined their team as Director of Outpatient Rehabilitation & Sports Medicine. Mr. Heiser is certified in Lymphedema Therapy, Manual Lymph Drainage, & Hand Ther-apy. He is also a licensed Occupational Therapist. Rick is a fellow of the Texas Women’s University Hand Therapy. He earned his clinical Doctor-ate of Occupational Therapy from Rocky Mountain University of Health Profession in Provo, UT, and his Bachelor of Science in Occupational Therapy form Kansas Newman College, Wichita, KS.

Prior to joining NRMC, Mr. Heiser was employed in Missouri, Texas, and Alaska in a variety of capacities including management. Sparks Hospitals Recognized for Stroke Care Performance

FORT SMITH - The Arkansas Depart-ment of Health (ADH) has recognized 18 hospitals statewide for stroke care perfor-mance as documented in the Arkansas Stroke Registry (ASR).

Both Sparks Regional Medical Cen-ter in Fort Smith and Sparks Medical Cen-ter – Van Buren were among those receiv-ing performance awards.

The awards were given to hospi-tals for outstanding adherence to stroke care performance measures for stroke patients treated between July 2014 and June 2015. Measures include: providing all applicable stroke patient care, known as defect-free care, completing a patient stroke screen, documenting when Emer-gency Medical Services notifies the re-ceiving hospital that a suspected stroke patient is enroute and performing a swal-lowing screen.

With a stroke, every second counts. Shelly Cordum MSN, RN, CEN, System Chief Nursing Officer, said that’s why their hospitals work closely with emergency services and other centers to make sure quality care begins immediately for any patient showing signs of a stroke.

Sparks Regional Medical Center re-ceived an award for Outstanding Stroke Patient Care (Defect-Free Care) and Outstanding Completion of Swallow-

ing Screen (Dysphagia Screening), while Sparks Medical Center – Van Buren was recognized for Outstanding Documenta-tion of EMS Notifying Hospital that Sus-pected Stroke Case En Route (EMS Pre-notification).

The performance measures are American Heart Association/American Stroke Association (AHA/ASA) endorsed quality and achievement measures of the Get With The Guidelines®-Stroke Patient Management Tool. These measures are benchmarked according to the standards of evidence-based stroke care guidelines to assure stroke patients receive appro-priate and timely care.

Sparks has been a part of Get With The Guidelines® program for more than 10 years and is annually recognized for outstanding stroke care. Sparks Regional Medical Center is a Gold Seal accredited Primary Stroke Center offering neurovas-cular medical and surgical care for pa-tients suffering strokes and/or aneurysms.

Visit www.healthy.arkansas.gov for more information on stroke prevention in Arkansas.

Arkansas Heart Hospital Welcomes Dr. Greg Bledsoe as Clinical Innovation Director

LITTLE ROCK – Arkansas Heart Hospital is pleased to announce the ad-dition of its newest team member, Greg Bledsoe, MD, MPH, who also serves as the Surgeon General for the State of Arkansas. Bled-soe will serve as Arkansas Heart Hospital’s Director of Clinical Innovation, a role which will encompass many areas such as cutting-edge clinical modernizations, process improvement, and vetting of the latest medical technologies.

In January 2015, Bledsoe was ap-pointed by Governor Asa Hutchinson to be the Surgeon General for the state of Arkansas.

Arkansas Heart Hospital offers the latest technology teamed with highly trained support staff and Arkansas’ lead-ing cardiologists and cardiovascular

surgeons. It provides comprehensive in-patient and outpatient cardiac care, a 24-hour full service Heart Emergency Center, and the best possible setting for the di-agnosis and treatment of cardiovascular disease.

Bledsoe is a board certified Emer-gency Medicine physician and complet-ed a two-year fellowship in International Emergency Medicine and a Master in Public Health (MPH) from the Johns Hop-kins Bloomberg School of Public Health. Bledsoe has extensive experience in international travel having visited over 50 countries has been an instructor and medical consultant for the United States Secret Service, and served as the chief editor of the textbook entitled Expedi-tion & Wilderness Medicine that was published by Cambridge University Press in the fall of 2008.

Dr. Michelle Schofield Joins Physicians at St. Bernards Medical Center

JONESBORO - Dr. Michelle Scho-field has joined the medical staff at St. Bernards as a psychia-trist. She sees patients at St. Bernards Behavioral Health and at the St. Ber-nards Counseling Center.

Schofield comes to Jonesboro from Atlanta, where she served as med-ical director of behavioral health at Cancer Treatment Centers of America Southeastern Regional Medi-cal Center and was the chief executive officer and medical director at Cross-roads Center for Transcranial Magnetic Stimulation and Wellness.

Schofield earned her Medical De-gree from Meharry Medical College in Nashville, Tenn., and completed a resi-dency in adult psychiatry at Emory Uni-versity in Atlanta. She holds a bachelor’s degree in biology from Howard Univer-sity in Washington, D.C.

She also has worked as a staff psy-chiatrist at Anchor Hospital in Atlanta and was affiliated with Georgia Regional Hos-pital in Atlanta.

At St. Bernards Schofield will offer a relatively new treatment – Transcranial Magnetic Stimulation Therapy – for pa-tients who suffer from clinical depression and have not achieved satisfactory results from other treatments. TMS therapy is a noninvasive, nonsystemic outpatient procedure performed in an office setting under direct supervision of a psychiatrist

Schofield holds membership in the American Psychiatric Association.

Cornea Specialist Tayyeba Ali, MD, Joins UAMS

LITTLE ROCK - Cornea and uveitis specialist Tayyeba K. Ali, MD, has joined the University of Arkan-sas for Medical Sciences (UAMS), and sees patients at the Harvey & Bernice Jones Eye Institute.

Ali is also an assistant professor in the Depart-ment of Ophthalmology in the College of Medicine. She comes to UAMS from the Bascom Palmer Eye Insti-tute in Miami, ranked the No. 1 eye hospi-tal in the country for 12 consecutive years by U.S. News & World Report. There, she completed two surgical fellowships in cor-nea/external disease and uveitis.

Ali earned her medical degree from the Emory University School of Medicine. She completed her intern-ship in internal medicine and residency in ophthalmology at UAMS. During her residency, Ali received the Raymond and Mary Morris Ophthalmology Re-search Award, given each year to the top three researchers as judged by fac-ulty, residents and a visiting professor. While at Bascom Palmer, she received the Fellow of the Year Award, given to the instructor who was most influential in resident education.

Ali will be one of two ophthalmolo-gists in Arkansas to provide services for the Boston Keratoprosthesis, an artificial cornea. Additionally, she has expertise in treating complicated anterior segment issues and various forms of lamellar cor-neal transplantation.

Rick D. Heiser

GrandRounds

Dr. Greg Bledsoe

Dr. Michelle Schofield

Dr. Tayyeba Ali

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Conway-Based Adcock Family Foundation Receives Recognition for $30,000 Gift Made to Local CARTI Clinic

CONWAY - Members of the Adcock Family Foundation, a Conway-based chari-table organization, were recently honored with the dedication of exterior signage at CARTI Radiation Oncology in Conway in recognition of a recent $30,000 gift made to the local clinic of the statewide cancer care network.

Designated primarily for building improvements specific to CARTI Radiation Oncol-ogy in Conway, specific projects for improvements courtesy of the Adcock Family Foun-dation grant will include improvements involving the facility’s CT room/control area, as well as exterior landscaping and waterproofing.

CARTI is a statewide network of independent cancer care facilities with locations in: Little Rock, North Little Rock, Benton, Clinton, Conway, El Dorado, Heber Springs, Mountain Home, Russellville, Searcy and Stuttgart.

Conway is unique in that it is the only city outside of Little Rock in which CARTI has a dual presence.

CARTI Radiation Oncology, on College Avenue, opened in 1996 and provides ra-diation therapy for cancer patients. Bryan Imamura, M.D. is the radiation oncologist at the clinic.

CARTI Medical Oncology, on Dave Ward Drive, opened in 2013 and provides che-motherapy and hematology services to cancer patients. Medical oncologists for the clinic are: Lawrence Mendelsohn, M.D.; Thomas Sneed, M.D.; and Jamie Burton, M.D.

The Adcock Family Foundation, which awards more than $100,000 annually in Faulkner County, was honored with the dedication of exterior signage at CARTI Radiation Oncology in Conway in recognition of a $30,000 gift made to the cancer clinic. (Pictured, from left: Brian Wilcox, Matt Barnhardt, Hillary Adcock, Bunny Adcock and Carol Adcock, of the Adcock Family Foundation; and Stacie Edwards and Traci Niece of CARTI Radiation Oncology.)

UAMS West Breaks Ground On $10.5 Million Building in Fort Smith

FORT SMITH - More than a dozen golden shovels turned dirt marking the start of work on a $10.5 million UAMS Family Medical Center at the corner of South 12th and South E streets in Fort Smith.

State legislators, local dignitaries, University of Arkansas for Medical Scienc-es (UAMS) Chancellor Dan Rahn, MD, and Don Heard, EdD, MBA., UAMS West cen-ter director spoke.UAMS officials wearing hard hats broke ground on the project that will create a new, 30,000-square-foot Family Medical Center at UAMS West. The new facility will provide space for the growth and enhancement of patient care programs and medical education.

One block from the current facility at 612 S. 12th St., the new building will pro-vide UAMS patients, residents and staff with a state-of-the-art outpatient clinic that includes 48 examination rooms, x-ray facilities, a laboratory, procedure areas, patient counseling rooms and a children’s immunization area.

The new Fort Smith Family Medical Center will be located three blocks from Sparks Regional Medical Center, the teaching hospital affiliated with UAMS West.

Other dignitaries at the ground-breaking included Fort Smith Mayor San-dy Sanders; Dan McKay, Sparks Health System CEO; Jeremy Drinkwitz, Sparks chief operating officer; Tim Hill, vice chancellor for UAMS Regional Programs; Mark Kenneday, UAMS vice chancellor for campus operations; and other state and local officials.

The construction is scheduled to be complete in 10 months. The architects are Witsell, Evans, Rasco of Little Rock, work-ing in collaboration with HDR of Dallas, Texas. The general contractor is Kinco Constructors of Little Rock.

Once the new facility is completed, UAMS West will remodel sections of its building at 612 S. 12th St. to accommo-date administrative, financial, and educa-tion needs. It has been at that location since 1992. It expanded there in 2007 and purchased a small, 4,500-square-foot clinic in 2011.

The remodeling project is expected to take four months and will be com-pleted sometime in 2017. Together, the two projects — the new building and the remodeling — will more than double the interior space available for UAMS West, providing growing room for the next 15-20 years.

Fort Smith Family Medical Center provides primary care medical services to

patients of all ages. The center also offers pediatric and obstetrical care, as well as treatment of immediate medical needs and ongoing management of chronic conditions such as asthma, diabetes, hy-pertension and arthritis. The clinic pro-vides convenient diagnostic and support services on site and minor surgical proce-dures.

It serves 13 Arkansas counties: Con-way, Crawford, Faulkner, Franklin, John-son, Logan, Perry, Polk, Montgomery, Pope, Sebastian, Scott and Yell.

ACHRI, ACNC Researchers Receive $1.6 Million to Study Obesity Factors in Infancy

LITTLE ROCK - Scientists at the Ar-kansas Children’s Hospital Research Insti-tute (ACHRI) and the Arkansas Children’s Nutrition Center (ACNC) will use a $1.6 million grant from the National Institutes of Health to study how development dur-ing infancy affects childhood obesity.

The study, which will last five years, will examine body fat distribution in in-fants and children during a phase of rapid growth before they reach age 2.

They are hoping to reveal factors during this stage of life in babies that influence later-childhood obesity devel-opment according to Elisabet Borsheim, PhD, an associate professor of Pediatrics in the University of Arkansas for Medical Sciences (UAMS) College of Medicine who works on the campuses of ACHRI and ACNC. Dr. Aline Andres, PhD, an associate professor of Pediatrics in the UAMS College of Medicine and associate director for Clinical Research at ACNC, and Dr. Borsheim are co-principal investi-gators for the study.

Nearly a quarter of U.S. children be-tween 2 and 5 years old are overweight, and another 11 percent are obese, ac-cording to the Centers for Disease Con-trol and Prevention. Previous research has demonstrated that if children are obese as early as age 2, they are much more likely to face obesity as adults, putting them at higher risk for obesity-related health issues.

The grant, funded by the National Institute of Diabetes and Digestive and Kidney Diseases, will allow researchers to explore metabolic mechanisms that have not been previously investigated in relation to childhood obesity. The project will bridge work from ACNC’s “Glowing Study” — which has examined mothers and their newborns — to look at how chil-dren take in and expend energy.

They are looking more at what hap-pens after a baby is born using this new grant, Borsheim said. Then they’ll com-bine pregnancy data and postnatal infor-mation to get an even better picture of important factors driving early-life weight gain.

Preliminary work to support the proj-ect was funded by USDA-ARS Project 6026-51000-010-05 and by the Arkansas Biosciences Institute, the major research component of the Tobacco Settlement Proceeds Act of 2000.

GrandRounds


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