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December 2009 >> $5

Randy Jordan, MD

PAGE 2

PHYSICIAN SPOTLIGHT

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FOCUS TOPICS CARDIOLOGY HEALTH LAW

Arkansas Heart Hospital Implants State’s First CardioMEMS Device New diagnostic tool for congestive heart failure promises great improvement in treatment

(CONTINUED ON PAGE 6)

By BECKy GILLETTE

Congestive heart failure (CHF) is one of the most difficult conditions to treat, and also the most expensive medical diagnosis resulting in the highest costs to Medicare in the United States. The American Heart Association estimates there are $31 billion in annual direct and indirect costs in the U.S.

At the current rate, treatment costs are ex-pected to double by 2030.

“If we don’t rein this in, the average cost per taxpayer could be $244 per year in 2030,” said Steph-anie Spencer RN, BSN, CHFN, the CHF clinical coor-dinator at the Arkansas Heart Hospital Clinic (AHHC), Little Rock.

About 25 percent of all heart failure admissions will be back in the hos-pital within 30 days. That is because the disease is so difficult to manage.

In mid-November, a new device called CardioMEMS HF System that

(CONTINUED ON PAGE 8)

By BECKy GILLETTE

The shortage of family and primary care doctors in Arkansas has become an even more critical problem with 219,000 people added with the private option expansion of Medicaid in Ar-kansas, many of whom were without access to healthcare in the past. Addressing the need is going to take more equitable reimbursement for primary care, said Arkansas Academy of Family

Physicians (AAFP) President Daniel Knight, MD, Garnett Chair and chair of the Department of Family and Preventive Medicine at the Univer-sity of Arkansas for Medical Sciences (UAMS).

“With more primary care doctors needed in our system because of the Affordable Care Act (ACA), I hope to continue to promote fam-ily physicians getting more of what they need in the way of financial resources to adequately

HealthcareLeader

Daniel Knight, MDChair, UAMS Department of Family and Preventive Medicine

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Proposed Penalties for Medicaid\Medicare Overpayments Could Bankrupt Some ProvidersFalse claims could cost $11,000 each plus three times the amount of the claim

Medicare and Medicaid abuse by providers takes away billions of dollars of taxpayer money that is meant to provide vital medical care. But a new proposed regulation from the U.S. Department of Health and Human Services Office ... 3

Westside Free Medical Clinic: Still Serving Those in Need After 45 YearsLITTLE ROCK--When the Westside Free Medical Clinic was launched around 1970 through Catholic Social Services (now Catholic Charities of Arkansas), it had a simple yet vital mission: Meet the critical medical needs of poor people with little or no access to healthcare ... 5

2 > JANUARY/FEBRUARY 2015 a r k a n s a s m e d i c a l n e w s . c o m

Randy Jordan, MDChief Medical Officer, Jack Stevens Heart Institute

PhysicianSpotlight

By BECKy GILLETTE

Randy Jordan, has been part of a two-fold revolution in cardiology. In addition to the tremendously significant improve-ments in cardiac patient care in the past 30 years, the management of cardiology practices has also changed significantly.

Jordan is president and one of the founding members of CHI St. Vincent Heart Clinic Arkansas, the largest cardi-ology practice in the state. Over the past couple of decades there has been ongoing consolidation in many medical practices, particularly in specialties.

“We merged some groups and added new members and became a 30-physi-cian group,” Jordan said. “More recently we have followed a national trend and aligned with a hospital to deal with falling reimbursement and to meet the demands of medical care today. Since our integra-tion with CHI St. Vincent Health System three years ago, we have partnered with four cardiovascular surgeons and formed the Jack Stephens Heart Institute at CHI St. Vincent.”

Being a larger group has allowed them to hire professional management, and to effectively deal with the regulatory environment of modern healthcare. It has also improved the access to capital needed to move into Electronic Health Records (EHRs) and purchase very expensive

equipment. Jordan said call has also im-proved compared to the days when two or three partners had to handle everything.

As chief medical officer for the Jack Stevens Heart Institute, Jordan spends about half of his time doing administra-tive work.

“The challenges of healthcare today

are that it is very difficult for hospitals to meet the quality expectations in the envi-ronment of reduced reimbursement, and the only way they can do that is by hav-ing the cooperation of physicians,” Jor-dan said. “We integrated with CHI St. Vincent with a focus on helping bring im-proved quality to CHI St. Vincent and the patients whom we serve while at the same time reducing cost and improving value.”

The practice of medicine is really challenging today. Nationwide, hospitals are having a tough time. Some hospitals in Arkansas have closed and many of the smaller hospitals are particularly chal-lenged. Some of those are looking to the bigger hospital systems to collaborate with or manage their hospitals.

CHI St. Vincent is owned by Catholic Health Initiatives (CHI), one of the larg-est hospital systems in the country. Jor-dan and his colleague, Marsha Atkinson, vice president of cardiovascular services at CHI St Vincent, work on a national level within CHI to bring consistency and quality to cardiovascular services at all CHI hospitals while at same time trying to contain spending by using cost effective equipment and devices, and sharing best practices to accomplish those goals.

Jordan has seen a huge evolution in cardiovascular care during the 30-year span of his career. Coronary angioplasty was just starting when he was a fellow.

There have been life-saving innovations including the development of coronary stents, internal defibrillators and percuta-neous valve replacement, as well as a host of drugs to treat hypertension, hyperlipid-emia and heart failure.

“Open heart surgery had just gotten well established when I started,” Jordan said. “Since then we have seen some de-cline in the need for open heart surgery because of the rise of percutaneous pro-cedures. These procedures represent a revolution for the patient in terms of their time for recovery and have tremendously reduced costs.”

Thirty years ago someone might have been hospitalized three days for a heart procedure that today takes only a couple of hours.

Today there are a lot of changes going on in the field of medicine, and much of it has been focused on controlling costs and implementing best practices.

“The pressures to reduce cost and im-prove quality have caused a huge amount of stress in the system,” Jordan said. “I don’t see that changing for quite some time. I think we will have these pressures for several years to come.”

While Jordan’s family is from Hot Springs, he lived in many places growing up with a father in the Air Force.

“But Arkansas has always been home as I spent summers with my grandpar-ents,” Jordan said. “My father retired just before I started college and moved back to Hot Springs. I went off to college at Northwestern University in Evanston, Il-linois, and then came back to Arkansas to start medical school at the University of Arkansas for Medical Sciences. I’ve been here pretty much ever since.”

Jordan has been married nearly 40 years to Janet Bossard, the sister of his col-lege roommate in Illinois. Her father was a physician in Indiana.

“I found what he was doing was really interesting,” Jordan said. “It looked a lot more interesting than biophysics, which was what I was studying before medicine. When I was an intern in internal medi-cine, cardiology was a big part of that. The cardiology faculty members were people I identified with. There were a lot of interesting things going on in cardiol-ogy at the time. I found it fascinating and challenging.”

Jordan has served as governor of Ar-kansas for the American College of Car-diology, and president of the Arkansas affiliate of the American Heart Associa-tion. He and his wife live in the country, have two adult children, and enjoy spend-ing leisure time boating on area lakes.

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By BECKy GILLETTE

Medicare and Medicaid abuse by providers takes away billions of dollars of taxpayer money that is meant to provide vital medical care. But a new proposed regulation from the U.S. Department of Health and Human Services Offi ce of Inspector General (OIG) implementing a portion of the Affordable Care Act (ACA) has caused alarm in the healthcare com-munity because of the draconian penal-ties involved for failure to return alleged Medicare and Medicaid overpayments promptly.

Some estimates of Medicare fraud alone are $80 billion per year. But the new rules could have unintended consequence including putting legitimate healthcare companies out of business for uninten-tional errors.

“My understanding of the proposed regulation is that if an overpayment is not returned within 60 days of ‘identifi cation’ by a provider, the overpay-ment is subject to false claims liability under the federal False Claims Act (FCA), which would allow recovery of up to $11,000 per claim, plus three times the amount of money received in payment of the claim,” said Lynda M. Johnson, an attor-ney with Friday, Eldredge & Clark LLP, Little Rock. “Certainly this is a severe penalty and could bankrupt many pro-viders.”

Johnson said the overwhelming ma-jority of overpayments are received not due to fraud, but because of an honest mistake. The stiff penalties seem to come with the underlying assumption that all overpayments are a deliberate attempt to defraud the government.

Johnson said the most important thing providers can do to protect them-selves from potentially crippling fi nes is to implement effective compliance pro-grams to focus on improving their billing practices. Most importantly, try to avoid billing mistakes, which can lead to over-payments being received.

The atmosphere of declining re-imbursements while providers are ex-pected to improve quality and service has added a great deal of strain to manage-

ment of healthcare facilities. It takes at-tention away from focusing on patients.“Unfortunately, all resources are limited and any resources that must be devoted to additional compliance efforts may re-sult in a decrease in resources available for patient care, a result which is not good for anyone,” Johnson said. “The provid-ers I work with every day are trying to deliver the best patient care they possibly can with a continually shrinking stream of revenue from government payers, while, at the same time, dealing with more and more regulatory burdens.”

Providers should be aware that the Department of Justice (DOJ) is closely monitoring these issues and recently intervened in an action fi led in New York, said P. Delanna Padilla, an attorney with Wright Lindsey & Jen-nings, Little Rock.

“The ACA has a defined 60-day period in which overpayments must be reimbursed to the government,” Padilla said. “A provider’s failure to so re-imburse could lead to stiff penalty assess-ments and can be considered a violation of the FCA. This provision of the ACA is being taken seriously and will become of great concern to providers who repeatedly fail to reimburse the government for over-payments.”

If providers fail to comply with the repayment rules under the ACA, they face the potential penalty of being banned from billing Medicare or Medicaid. Pa-dilla said this would have catastrophic consequences to most providers.

Additionally, the penalties themselves can stack up all too easily. While many consider the penalty amounts to be exces-sive, Padilla said providers should be pre-pared to pay those types of sums if they knowingly and willingly withhold repay-ment.

There is concern that the new rule is an attempt to make healthcare providers settle cases rather than risk penalties that could bankrupt their organizations.

Healthcare providers are keeping an eye on the fi rst complaint under this pro-posed rule that was fi led by the New York State Attorney General’s offi ce charging Healthfi rst with failure to return overpay-ments.

Padilla said the big issue in this case is that the hospital network, Continuum, which accepted patients covered by the Healthfi rst Medicaid managed care plan, did not repay 300 overpayment claims until it received a demand concerning the overpayment. The DOJ intervened in the case and took the position that Continuum intentionally and fraudulently delayed the repayments as Continuum had under-taken an internal review and uncovered more than 900 improperly billed claims totaling more than $1 million in overpay-ments.

“Although Continuum had begun making repayments, the DOJ’s position was that the internal review occurred in February 2011 and repayments were not completed until March 2013,” Pa-dilla said. “This amount of time is obvi-ously well beyond the 60-day repayment period. The DOJ further alleged that Healthfi rst, because of its billing practices, caused Continuum to submit erroneous

claims to Medicaid, which were the basis for the overpayments. When the DOJ intervened in this action, the maximum penalty under the FCA was requested ($11,000 for every improper overpay-ment, plus treble damages). Thus, the proposed amount of the fi ne was almost $30 million.”

Providers need to initiate compliance programs, if they do not already have them, to ensure that the billing is per-formed properly and accurately.

“Although the possible penalties could be astronomical, providers need to be able to trust that their billing is being performed accurately and timely,” she said. “If they have compliance programs in place, then generally this potential headache would be avoided. Provid-ers and their employees need to be fully aware of the potential for audit, either under ACA or HIPAA. Compliance truly is no longer discretionary; it is manda-tory.”

Proposed Penalties for Medicaid\Medicare Overpayments Could Bankrupt Some ProvidersFalse claims could cost $11,000 each plus three times the amount of the claim

Lynda M. Johnson

P. Delanna Padilla

For more, visit: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/overpaymentbrochure508-09.pdf

4 > JANUARY/FEBRUARY 2015 a r k a n s a s m e d i c a l n e w s . c o m

By CINDy SANDERS, ELISABETH BELMONT & JOEL HAMME

Already one of the most highly regu-lated industries in America, 2015 looks to be another active year across healthcare’s legal landscape. Two past presidents of the American Health Lawyers Associa-tion, Elisabeth Belmont and Joel Hamme, took time to share insights and predictions for the coming year.

Subsidies in the Health Insurance Exchanges

Under the Affordable Care Act, in-dividuals with incomes between 100 and 400 percent of the federal poverty level are eligible to receive federal tax credit subsidies for purchasing health insurance on the exchanges. Hamme noted that in King v. Burwell, the Fourth Circuit court ruled the IRS acted lawfully in interpret-ing such subsidies were permissible not only for state exchanges but also for fed-erally run exchanges and those that are a federal-state partnership. However, the Supreme Court has agreed to review this decision.

Hamme explained, “Of the 50 states and the District of Columbia, only 17 have state established exchanges; 7 have partnership exchanges and the remaining 27 are federally operated. Thus, if the Su-preme Court were to overturn the Fourth Circuit’s decision, individuals in two-thirds of the 51 jurisdictions would be ineligible for subsidies for purchasing health insur-ance on the exchanges.” He added that while there was some debate as to how det-rimental such a decision would prove to be to the ACA, certainly it would be a major setback. “The King case essentially rep-resents the last major legal hurdle for the ACA. If the subsidies challenge fails, ACA opponents will be relegated to trying to repeal or signifi cantly modify the ACA by legislative and executive branch actions.”

Medicaid Eligibility ExpansionSince the Supreme Court ruling that

mandatory Medicaid expansion wasn’t permissible, 29 states voluntarily have au-thorized Medicaid eligibility expansion or obtained federal approval of an alternate expansion plan to take advantage of gen-erous federal fi nancial support tied to the program. However, Hamme pointed out, the 2014 election results impacting gov-ernorships and state legislatures seem to have strengthened the numbers of those opposing such expansion in several states that were still weighing the options. “In at least one state, it is conceivable that Medicaid eligibility expansion will be re-scinded after having been implemented,” he said.

Hamme continued, “For 2015, the key Medicaid eligibility expansion devel-opment will be whether the slow erosion of state opposition to expansion continues as states decide that they do not want to forego the fi nancial advantages of expan-sion or whether this erosion is abated by those fi ercely opposed to the ACA.” He

added it will be interesting to see how fl ex-ible the federal government might be with respect to work and work search require-ments and benefi ciary cost-sharing obli-gations for states that are seeking waivers for alternate expansion models.

ACA Going ForwardAs Hamme pointed out, the ACA has

already generated several legal decisions and navigated a number of political and operational obstacles in its relatively short life. However, a number of hurdles … including the decision on exchange sub-sidies and the law’s unpopularity among large swaths of the public … remain.

“During 2015, interested observers should look to various barometers to as-sess whether the ACA is working … and equally important … whether it is gain-ing the public acceptance needed to as-sure its political survival,” Hamme said. He added some of those measures would include the administration of the ex-changes, whether offerings to consumers were deemed acceptable in terms of plan choices and affordability, a continued decline in the number of uninsured, and whether or not the ACA could continue to withstand legal and political assaults.

“Like 2013 and 2014, the coming year will witness numerous developments that will lead either to the ACA’s long-term viability or its premature demise,” Hamme concluded.

Fraud and AbuseOn Oct. 31, 2014, the U.S. Depart-

ment of Health and Human Services Offi ce of Inspector General (OIG) re-leased the FY-2015 Work Plan. Always eagerly anticipated, the document gives insight into the OIG’s planned reviews and activities with respect to HHS pro-grams and operations. Belmont noted, “In the introduction to the Work Plan,

OIG stated that, in the coming year, the agency plans to continue to focus on is-sues such as emerging payment, eligibility, management, IT security vulnerabilities, care quality and access in Medicare and Medicaid, public health and human ser-vices programs, and appropriateness of Medicare and Medicaid payments.”

Belmont highlighted a few areas of interest for this year:

Hospitals: With 22 substantive areas under review, the OIG is deeply engaged with hospital reviews both on the billing and payment side, and quality of care is-sues, which are a particular priority for current Department of Justice (DOJ) and OIG enforcement efforts. OIG continues to scrutinize CMS contractors’ implemen-tation of outlier reconciliation (of which the OIG has been critical for many years) and remains intensely interested in inpa-tient versus outpatient payments, the “two midnight” rule for inpatient admissions, and cardiac catheterizations.

Hospice: Hospice billings for general inpatient care, a focus of relators and the DOJ, is under close review by the OIG.

Freestanding Clinic Providers: OIG con-tinues to examine certain payment sys-tems such as provider-based services and freestanding clinic payments, with an eye toward reducing disparity of payments based on site of service.

Laboratories: OIG added a review of independent clinical laboratory billing requirements, without further specifying the billing requirements at issue. This may coincide with increased local cover-age determinations by contactors, OIG enforcement against clinical laboratories under its Civil Monetary Penalties Law authority, and OIG’s general heightened scrutiny of technical billing and payment compliance by clinical laboratories, espe-cially specialty laboratories.

Accountable Care Organizations: OIG

intends to conduct a risk assessment of CMS’ administration of the Pioneer ACO Model.

Medicaid Managed Care: OIG added a review of state collection of rebates for drugs dispensed to Medicaid managed care enrollees.

Medicare Part D: This is an area where there will be continuing scrutiny of the quality of Part D data submitted to CMS. The OIG also plans to follow up on the steps CMS has taken to improve its over-sight of Part D sponsors’ Pharmacy and Therapeutics Committee confl ict-of-in-terest procedure in the wake of the OIG’s critical 2013 report.

Health Information & Technology

“Data now is recognized as one of a healthcare organization’s most valuable assets, especially as a result of the transi-tion to a more analytically driven indus-try,” Belmont said. “Given the increasing importance of data to a healthcare organi-zation, it is advisable for the organization to implement appropriate data gover-nance best practices.”

With the accumulation of data also comes an obligation to make sure pro-tected health information (PHI) stays protected. “In 2015, healthcare privacy and security compliance will continue to expand with respect to the scope, number of enforcement bodies and increased en-forcement activity, and overlapping sets of requirements,” Belmont said. “In ad-dition to the requirements of the HIPAA Privacy and Security Rules, healthcare providers also will need to navigate re-quirements promulgated by the Federal Trade Commission, Centers for Medi-care and Medicaid Services, Offi ce of the National Coordinator, and state attorney generals. Additionally,” she continued, “increasing exposure for privacy and se-curity breaches may occur as the result of state common or statutory law, despite there being no private right of action with regard to HIPAA violations. As a con-sequence, healthcare organizations and practitioners need to manage the com-plex daily operational processes required to maintain appropriate privacy and se-curity of protected health information and devote necessary resources to ensure regu-latory compliance.”

Hot Button Legal Issues to Watch in 2015About the Experts

Elisabeth Belmont, Esq. serves as corporate counsel for MaineHealth, ranked among the nation’s top 100 integrated healthcare delivery networks. She is a member of the Board on Health Care Services for the Institute of Medicine and its Committee on Diagnostic Error in Health Care. Belmont is also a member of the National Quality Forum’s Health IT Patient Safety Measures Standing Committee. In addition to serving as a past president of the American Health Lawyers Association, she is also the former chair of

the organization’s HIT Practice Group and the current chair of the Inhouse Counsel Program. In 2007, Modern Healthcare named her to their list of “Top 25 Most Powerful Women in Healthcare.”

Joel Hamme, Esq. is a principal with Powers, Pyles, Sutter & Verville in Washington, D.C. He joined the fi rm in 1998 and focuses his practice on long term care, Medicare and Medicaid reimbursement issues, provider licensure and certifi cation matters, and litigation in his areas of expertise. He is a member of the District of Columbia and Pennsylvania bars, as well as the bars of the Supreme Court of the United States and numerous federal appeals courts. A past president of AHLA, Hamme is a frequent speaker and lecturer on healthcare issues and has authored

numerous articles and book chapters relating to healthcare law.

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a r k a n s a s m e d i c a l n e w s . c o m JANUARY/FEBRUARY 2015 > 5

Hot Button Legal Issues to Watch in 2015 ARKANSAS on the MEND BY BECKY GILLETTE

Westside Free Medical Clinic: Still Serving Those in Need After 45 Years

By BECKy GILLETTE

LITTLE ROCK--When the Westside Free Medical Clinic was launched around 1970 through Catholic Social Services (now Catholic Chari-ties of Arkansas), it had a sim-ple yet vital mission: Meet the critical medical needs of poor people with little or no access to healthcare.

“Sister Concetta Mazzetti was the force behind establish-ing this mission,”

said Clinic Director Karen DiPippa, a pharmacy techni-cian who has a background in health education, and a mas-ter’s degree in theology. “It originally stared as an acute care clinic. We soon found out that it doesn’t help to have the clinic if pa-tients don’t have access to prescriptions. So we started a charitable licensed phar-macy, as well.”

Through the years thousands of peo-ple have come through the doors for needs as simple as a sinus infection or treatment for illnesses like diabetes that can be fatal if not properly treated. Today, the clinic sees about 1,265 patients per year for ser-vices including primary care, pharmacy services and patient education.

Westside holds five regular clinics a month, and specialty clinics such as a dermatology clinic and eye exams for dia-betic patients. Westside also contracts out dental services when funding from the To-bacco Settlement funds through the Ar-kansas Department of Health allows. The Diocese of Little Rock funds the remain-ing costs to run the clinic.

Free clinics like Westside wouldn’t exist without the generosity of the medical community.

“I cannot praise or thank our vol-unteers enough for their gift of service,” DiPippa said. “We rely on physicians, in-cluding specialists, pharmacists, RNs and APNs who all take time from their busy lives to help others. They all do so much. We could not do anything without the vol-unteer staff. They are really the heart of the clinic. We also get assistance from students from the University of Arkansas for Medi-cal Sciences School of Medicine, College of Nursing, and School of Pharmacy, in addition to students from the University of Arkansas Little Rock School of Nurs-ing. Our pharmacists have a time intensive shift because they are at the clinic the latest, filling prescriptions after the patients have seen the doctor or APN.”

It is an all-volunteer staff except DiP-ippa and her “right hand,” program as-sistant Flora Lopez, who is bi-lingual. Her main responsibility is to work with the Hispanic\Latino community and handle the eye and the dermatology clinic staff-ing and scheduling. She is assisted by 15 volunteer interpreters, most of whom are certified as medical interpreters.

As the Hispanic population has in-creased in Little Rock, there has been a demand from Hispanic Latino families. In 2002 Westside started one clinic a month for the Hispanic\Latino families.

“With the ACA, 75 percent of our English-speaking patients were able to ob-tain insurance,” DiPippa said. “We were really happy about that. That is a good thing. We still have some people who, for one reason, or not aren’t covered. They might be new to the area, in between coverage, or maybe they have been ac-cepted for the private option Medicaid expansion, but have not found a provider. But a large percentage of immigrant pa-

tients simply don’t qualify for healthcare insurance. That includes students, and visit-ing family. We have tried to meet the needs of the time. Right now it is the greatest need for patients with no in-surance. They can’t even get their foot in the door.”

The clinic has seen patients die be-cause they didn’t get timely care.

“Over the years, we have seen pa-tients without health insurance who did not want to incur the debt of an emer-gency room which they couldn’t pay and suffered early death for conditions easily treated,” she said. “These patients had families that depended on them, were working, yet didn’t have employer cov-ered insurance. We had a patient treated for hypertension who also had stage four melanoma. We were able to diagnose and refer her to a specialist, but it was too late. We’ve also seen a patient driving to get an inhaler die of an asthma attack by hitting a tree on the way. That shouldn’t happen with the advances we have in medicine.”

DiPippa said she couldn’t praise the Affordable Care Act (ACA) enough be-cause it has made a difference in people having access to life-saving care. She hopes that Arkansas continues the private option Medicaid expansion because the lives of the 211,000 covered people are at stake. The private option is in doubt because of the number of legislators who campaigned against it who were elected. Opponents have said that while the program costs nothing to the state now, in future years when the state is required to pay a portion of the cost to subsidize premiums, it could be too expensive. But DiPippa said she understands the state would be allowed to opt out later if it gets too expensive.

While all charitable clinics would be very happy to be out of business because

that would mean coverage for all, DiPippa said the ACA isn’t enough.

“We have sort of had health insur-ance reform, but not true healthcare re-form,” DiPippa said. “Healthcare costs have escalated just ridiculously from when I started. I’ve seen medicines that were a manageable price, and somehow in these last 20 years have quadrupled in price. These medicines cost only pennies to make it 20 years ago, and now they cost four times as much.”

Ellen Lamb, PD, has been a pharma-cist volunteer at the clinic since 1973 when her son was only a year old. Over the years she has gotten tremendous satisfac-tion from helping people who fall through the cracks. For example, some are over the limit for drugs on Medicaid.

“Hopefully with ACA, that has changed,” she said.

With her busy work schedule, how has she found time to volunteer for so many years?

“It is one of those things that when the clinic director Sister Concetta was calling to get me to work, it was the Lord calling me, so how could I say no?” Lamb asked. “So that is why I’ve been doing it all these years. When you see how much what we are doing means for people, it is a very rewarding situation.”

HOW CAN YOU HELP?

VolunteerMore specialists are needed

in areas such as ENT, neurology, gynecology, and orthopedics.

Medical volunteers in all spe-cialties are always needed. If you aren’t close to Little Rock, there are approximately 20 other chari-table clinics across the state where you can make a difference volun-teering. See Arkansas Association of Charitable Clinics.

DonateWestside Free Medical ClinicDiocese of Little RockP.O. Box 7239Little Rock AR 72217-72239

Westside Free Medical Clinic is run by Director Karen DiPippa (left) and Flora Lopez, program assistant.

Chris Williams, a valued volunteer and Flor Lopez, program assistant.

To Learn More: Go online to

Arkansas Charitable Clinics,

www.aacclinics.com

6 > JANUARY/FEBRUARY 2015 a r k a n s a s m e d i c a l n e w s . c o m

promises to help better man-age fl uid status in heart failure patients was implanted into the fi rst patient in Arkansas. Wilson Wong, MD, did the procedure at Arkansas Heart Hospital.

Clinical trials indicated CardioMEMS reduced hos-pital readmissions by 37 per-cent. CardioMEMS consists of an implantable pulmonary artery (PA) sensor, a delivery system, and Patient Electronics System. The sensor about the size of a paper clip has a thin, curved wire at each end, and requires no batteries or wires. It is implanted during a right heart catheterization procedure for permanent placement. The delivery system is a long, thin, flexible catheter that moves through the blood vessels and is designed to release the implantable sensor in the far end of the PA.

Spencer said by monitoring the PA pressure and heart rate in NYHA Class III heart failure patients, the tool gives clini-cians valuable objective information about the fl uid load in the heart.

“This is a most important tool that can help us address the readmission rate,” Spencer said. “Without a tool like this, we must rely on the patient’s ability to or compliance with weighing themselves every day, or calling us if they feel bad. Patients can swing back and forth from having fl uid overload to being dehydrated. Sometimes patients don’t know if they are overloaded or not. They will call and say they just don’t feel good. They might have other issues like pneumonia or pleural effusions. This device lets us know if it is heart failure or not, and how to treat it more effectively. It gives us objective data about how to treat a patient.”

With the Affordable Care Act (ACA), hospitals can receive penalties of up to three percent of Medicare revenue if they fail to keep within the bounds of national 30-day readmission rates for CHF, which now is at 23 percent.

“The ACA shifted the focus to quality control instead of volume management,” she said.

The device is revolutionary, said Mi-chael Huber, MD, director of the AHHC CHF Clinic.

“This is an early warning system,” Huber said. “It will revolutionize the way we manage heart failure patients. We can catch them before they get so bad they have to go into the hospital. It can give us the earliest indication heart failure is start-ing to go in a bad direction. Class three heart failure patients are having symp-toms like shortness of breath every day just doing what they need to do to live a life. These patients are hard to manage be-cause even when they do all they can like watching their weight and their diet, they often wind up coming back into the hospi-tal because they can’t get it right.”

These are the most labor-intensive patients in a medical practice, Huber said, and this device can help simplify their as-sessment.

Indications for the device call for the patient being diagnosed with stage three CHF and one hospitalization for CHF in the past 12 months.

Implantation is pretty simple through the groin. Huber said once the device is put in, the patient can take readings at home by using land line or cellular connec-tions to send a few minutes of pulmonary pressure readings to the website. When clinicians see that heart failure is getting worse, more diuretics or other heart fail-ure medications can be introduced.

“Initially patients take readings once a day, but once they are stable, readings can be taken once a week,” Huber said. “Car-dioMEMS helps our team keep heart fail-ure patients out of the hospital and allow them to have a meaningful and good qual-ity of life.”

The clinic sees patients from all over the state.

“We manage large numbers of pa-tients,” Spencer said. “A lot of my patients can’t make it to Little Rock. It is really bur-densome for them to get to me. With this device, we have the potential to manage pa-tients farther away by coordinating patient lab results with family doctor visits.”

Spencer said it is really exciting to see the potential outcomes from using this tool that can save lives, including decreased costs to taxpayers and better health for patients.

“Each time heart failure patients go into the hospital, their prognosis worsens,” she said. “We know if they are going into the hospital over and over, they will not do well. On average if a CHF patient has four hospitalizations in a year, that gives them a mean survival rate of only six months. If we are able to better manage them with this device and keep them out of the hospital, their prognosis would ostensibly improve.”

Arkansas Heart Hospital Implants State’s First CardioMEMS, continued from page 1

Stephanie Spencer RN, BSN, CHFN Arkansas Heart Hospital Clinic (AHHC) Congestive Heart Failure (CHF) Clinical Coordinator and Michael Huber, MD, Medical Director of AHHC CHF Clinic, believe that the new CardioMEMS system will improve their ability to treat patients, resulting in fewer hospital readmissions and far lower costs.

For more, visit: www.arheart.com

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a r k a n s a s m e d i c a l n e w s . c o m JANUARY/FEBRUARY 2015 > 7

By BECKy GILLETTE

Less than half of U.S. residents re-ceived the influenza vaccine shot this past year, some because of doubts about its effec-tiveness and concerns about potential side effects. But some healthcare workers who decline the flu shot are finding that it could cost them their job.

More than a 1,000 healthcare workers in Rhode Island signed a petition protesting the state’s strict law for flu vaccinations for healthcare workers, claiming this violated the HIPAA patient privacy law. A pregnant nurse in Chicago filed a wrongful termina-tion lawsuit in 2013 after she was fired for refusing the flu shot. But that case was dis-missed by the court.

University of Arkansas for Medical Sciences (UAMS) Medical Center CEO Roxane A. Townsend, MD said they re-ceive few complaints from workers because most understand that this is a requirement of employment, just as is being immunized for Hepatitis B and measles.

There are workers who don’t take the flu shot for health reasons such as allergies to eggs or formaldehyde. They aren’t fired, but must wear a facemask.

“Wearing a mask is difficult for the caretakers, but our primary concern is to protect patients and other employees,” Townsend said. “We don’t want someone to come to work and potentially transmit that virus before they have realized they have the flu.”

Townsend doesn’t consider the require-ment a violation of HIPAA. Often patients and staff wear masks for many reasons.

“At a teaching facility like this where there are many students and faculty, there is not a bright line between those who have di-rect interaction with patients and those who don’t,” Townsend said. “So we encourage everyone to take the flu shot. This year we had 92 percent compliance with all our em-ployees, which total more than 10,000. The only employees who don’t get vaccinated are those who have a reason not to. We are pretty impressed with our compliance rate.”

Hospitals without at least a 90 percent compliance rate can be penalized, since it is one of the quality measures that affects reimbursement by the Centers for Medicaid and Medicare Services.

Minor side effects can include arm soreness and a slight increase in tempera-ture. More serious concerns are an allergic reaction or contracting Guillain-Barré Syn-drome (GBS), which results in the body’s immune system attacking part of the pe-ripheral nervous system. GBS can lead to paralysis.

“We have much better diagnostic ca-pabilities now and better supportive care for GBS,” Townsend said. “Many people do recover from GBS.”

Jennifer Dillaha, MD, medical director for the immunization program at Arkansas Department of Health, said the risk of GBS

from the flu vaccine is one in a million vac-cinations. There is a higher risk of GBS from flu than from the flu shot.

“There was a Canadian study pub-lished last year in The Lancet Infectious Diseases that found that the risk of GBS was 15.81 times more likely with influenza illness compared to the risk with influenza

vaccine,” Dillaha said. “Of all the GBS cases, 1 percent was found to be caused by the influenza vaccine, while 17 percent were found to be caused by influenza illness. The remainder was caused by a variety of other causes.”

For healthcare workers and others with an egg allergy, Dillaha recommends an

egg-free formula that is approved for adults through age 49. But many allergists and pri-mary care providers are giving the standard inactivated flu shot to people with a history of egg allergies.

“Even though egg is listed on the ingre-dients, it is present in only trace amounts,

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Opposition Persists on Mandatory Flu Shots for Healthcare Workers UAMS Medical Center sees 92 percent compliance with flu shot

(CONTINUED ON PAGE 8)

8 > JANUARY/FEBRUARY 2015 a r k a n s a s m e d i c a l n e w s . c o m

care for their patients,” Knight said. “It is problematic that Congress, Medicare and private payers have not been willing to fully support primary care to the extent that is needed to provide chronic and pre-ventive care. Over the past two years, we have seen projects such as AR Medicaid Patient-Centered Medical Home Project and the Medicare Comprehensive Pri-mary Care Initiative that have begun to do this, but it hasn’t been as universal as it needs to be.

“We will continue to try to increase the number of medical students choosing family medicine and family care as their specialty. It has been dropping since 1998 when the previous gatekeeper role was re-jected.”

Knight said family doctors are now seeing patients who have been uninsured for years getting critical care for illnesses such as hypertension and diabetes control. But having services covered by insurance is of no value if patients can’t find a family doctor.

UAMS has seen a small, but sig-nificant, uptick in the past couple years in interest by medical students in family medicine, and a significant increase in the number of applications to family medi-cine residencies in the state. Knight said UAMS is also working with the two os-teopathic medical schools in the state to increase the number of graduate medical slots, especially for primary care.

A large number of family doctors are nearing retirement age and will need to be replaced. That could increase pri-mary care shortages from what they are today, which is estimated at greater than 500 statewide, with the problem especially acute in rural areas.

“Most rural areas have a lot of Medi-care\Medicaid patients, so reimburse-ment is not as good as in urban areas where there are more people with com-mercial insurance,” Knight said. “There-fore, trying to keep a rural practice open is hard. There are many considerations for physicians locating in a rural area. Are the schools good? Are there enough things for the family to do? You have to consider the whole family, not just the physician.”

Knight said UAMS has not always had a focus on primary care. In the past, there has been more effort placed on ter-tiary care. But Knight said both at UAMS and nationally, there is increased recogni-tion of the importance of primary care.

“UAMS is building several new fam-ily medicine clinics in Central Arkansas,” he said. “We are soon going to open an-other outlying clinic. We also want to af-filiate with other providers throughout the state to be partners who can help make their practices grow and thrive. We can offer help with services for things like management and Electronic Health Re-cords (EHRs).”

To help promote the Primary Care Medical Home (PCMH) initiative, the AAFP has been working with Community Care of North Carolina to help develop an organization in Arkansas to provide care management assistance to practices. The

academy is also exploring how to improve working with Advanced Practice Nurses (APNs).

“We believe APNs are a very im-portant part of the team who should be included,” Knight said. “We also believe APNs should be supervised by physicians. We want them to be in a team. A lot can be done with physicians supervising rural APNs virtually with telecommunications. But a barrier is that we are finding many APNs don’t want to practice in rural areas, either. They have the same issues as physicians.”

Knight came from a family with a lot of bankers, but he didn’t find business very fulfilling. He loves working with people, and has an aptitude for science. He felt like medicine was a merger of those two things.

“Medicine is very stimulating,” Knight said. “I originally chose family medicine because I liked the interactions with people in it and the variety in it.”

It was a long road to leadership in family medicine. He earlier worked in pri-vate practice and as an ER doctor. After being hired for a job at UAMS, he fell in love with academics even though he took the job at a time of challenges.

“We were in dire trouble the minute I walked in door,” he said. “I had to work hard to revamp some procedures. I got a big taste of leadership, and found I en-joyed it. That is what led me into the chair position.”

Knight said his management style ini-tially was top down and domineering.

“Then I went to some leadership training and got feedback from my super-visors, and began to change my manage-ment style,” Knight said. “Now I feel that I am a very collaborative manager. People don’t work for me; they work with me. I have an idea of what needs to happen, but I let staff members use their skills and assets to be the best they can be. I think overall we are much more successful now with great overall leadership.”

UAMS is undergoing reorganization right now.

“It is a lot of change,” Knight said. “We are trying to come out with a sys-tem that is more patient-focused. We will be providing a large amount of care to a larger patient population. We have de-veloped policies and procedures that flow across the enterprise improving access and services for patients. We have developed a patient portal for EHRs that has been a good thing for patient communication with providers.”

One of the accomplishments he is most proud of is taking on a research team when he became chair. That has grown to include five PhD/EdD full-time research-ers and a staff of 40 doing research in early childhood development. “We hope to ex-pand more into clinical research in the next few years,” Knight said.

Knight was born at St. Vincent’s in Little Rock, and loves traveling when he has the opportunity. In addition to state-wide vacations, he has traveled to China, Peru, Africa, Australia and New Zealand.

Healthcare Leader: Daniel Knight, MD, continued from page 1

H E R S O U T H . C O M

L O V E ?N E E D A G I F T S H E W I L L

and most people don’t react to it,” Dillaha said. “If you are concerned about it, see an allergist or primary care doctor with expe-rience in the recognition and management of severe allergic conditions. They can you give the shot and then monitor you for 30 minutes. Once you have safely received the shot, you can feel confident about getting it the next year.”

The U.S. government has a National Vaccine Injury Compensation Program created to pay for illnesses caused by vac-cinations. But an AP article in November 2014 concluded that the program is over-whelmed with delays in receiving compen-sation stretching ten years or longer. The fund was established primarily for children injured by childhood vaccinations, but now is dominated by people who got GBS after receiving the flu shot.

Also controversial is the effectiveness of the vaccine that is manufactured ahead of the flu season before it is certain which flu viruses will dominate. In years where this is a good match between the vaccine and the strains of flu in circulation, the flu vaccine is 50 to 70 percent effective in preventing the disease. If you do get the flu, the vac-cine greatly reduces the risk of severe illness. Studies have shown that vaccination is as-sociated with approximately a 70 percent reduction in flu-related hospitalizations for adults and an 80 percent reduction in flu-related deaths.”

Dillaha said that in the 2013-2014 flu season the FluMist nasal vaccine was not ef-fective against the predominant H1N1 virus.

The strain included in the vaccine was not a good match for the circulating flu strain. “The manufacturer is looking at trying to understand why that has happened, whether it was a flaw in the manufacturing of their vaccine or some other reason,” Dillaha said.

Healthcare workers being required to get the immunization is a patient safety issue that Dillaha considers on par with washing your hands. It just makes sense.

In addition to the dangers of employees transmitting a virus, often healthcare facili-ties are short staffed.

“Employees have pressure or personal drive to come into work when they are not well because there are very sick people that we need to take care of,” Dillaha said. “Al-though we may not feel sick enough to stay home, sometimes we still have the flu. If people are partially immune to the flu, they may not have such a severe case that they would be too sick to come to work. But they could still be contagious.”

Healthcare workers are at an increased risk for being exposed to the flu because of the people served. And if there is influenza pandemic, every healthcare worker will be needed.

“We really need the healthcare work-force immunized because many times the pandemic will show up in an unpredictable way,” Dillaha said. “Healthcare profession-als need vaccines in order to take care of the sick population.”

Opposition Persists, continued from page 7

For more, visit: www.cdc.gov/flu/

a r k a n s a s m e d i c a l n e w s . c o m JANUARY/FEBRUARY 2015 > 9

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By JULIE PARKER

Missed family gather-ings and soccer games, frus-tration with bureaucracy, dwindling self-worth and utter exhaustion often overshadow the initial call to heal others.

In the environ-ment of protracted work days, count-less rounds, scarce breaks, and pagers ringing incessantly have led many physicians to opt for early retirement, second-guess their chosen profession, and/or suffer pro-fessional burnout.

Alarmingly, more than 400 doctors commit suicide annually; the suicide rate is four times higher for women physicians than women in other professions.

According to a recent Medical Econom-ics survey, more than one-third of physi-cians reported that if they could go back in time, they would choose a different specialty – or a different career altogether.

With an estimated 90,000 too few physi-cians practicing by 2020, America’s doctors will continue to work over-time to meet the demand.

“Most of us followed a calling to serve others through practicing medi-cine,” said Starla Fitch, MD, author of Remedy for Burnout: 7 Pre-scriptions Doctors Use to Find Meaning in Medi-cine (Langdon Street Press, 2014). “We’ve dedicated our time, talent and treasure to healing others, but as we (did), many of us forgot how to heal ourselves.”

Encountering burnout led to an ex-perience for Fitch, a board-certifi ed oph-thalmologist specializing in oculoplastic surgery, which renewed her spirit. One result: she established the popular love-medicineagain.com, an online community to help medical professionals reconnect with their passion for the practice after surviving life-altering burnout. A featured blogger for Huffi ngton Post, certifi ed life coach and CBS contributor, Fitch wrote Remedy for Burnout to benefi t colleagues and doctors-in-training.

“The level of burnout among physi-cians is at an all-time high,” said Fitch. “A great many of my burned-out colleagues are frustrated with the changes in the re-lationships within medicine.”

One such dysfunctional relation-ship: the tie between doctors and insur-ance companies. Case in point: a large managed-care network recently removed Fitch’s practice from its list of preferred providers.

“Had we not taken good care of our patients? Weren’t we available for those patients 24/7? Did patients complain that

my partners and I didn’t de-liver quality care? No. No. And no.

The managed-care network decided to

provide the types of ser-vices we provide,” Fitch

explained. “It opted to move the services in-house

to save money, regardless of the consequences to its

patients.”The impact of that de-

cision? One affected patient had been diagnosed with eye-

lid cancer. Surgery had been scheduled to remove the growth,

followed by another surgery for reconstruction, Fitch said.

“The loss of continuity that has emerged in our healthcare system hasn’t only disrupted our patients’ health,” she said, “it’s disrupted physicians’ quality of care.”

Fitch’s personal prescriptions call for doctors to:

Develop resilience.Practice faith, which Fitch describes

as “front and center faith … the kind we doctors have when we make that fi rst inci-sion and trust we’ll be able to later close the wound.”

Cultivate self-worth. “Too often, we see ourselves incorrectly,” explained Fitch. “Instead of looking in the mirror and see-ing the specialness we possess, we allow

what we think other people think about us to enter the equation.”

Promote creativity. “Your staff has more creative tips up their sleeves than you can imagine,” said Fitch. “Brainstorm with them on ways to improve patient fl ow, appointment time congestion, or any number of things that will allow for hap-pier employees and healthier patients.”

Fitch also included a section on inter-personal prescriptions, encouraging physi-cians to:

Foster support. “’Grinning and bear-ing it’ isn’t a successful coping mechanism,” said Fitch. “The stigma around doctors ask-ing for help lingers, unfortunately.”

Embrace compassion. When Fitch asked a colleague advice he would give his 29-year-old self, the doctor said: “Try to be more empathetic. That’s more impor-tant than anything else. Having some idea of a patient’s situation really changes the way you treat people.”

Encourage connection, “the spark that ignites when you have a conversation in the doctors’ lounge and you laugh at the same jokes, commiserate over the same wins or losses of sports teams, or offer con-gratulations or condolences for the highs and lows we all experience,” she said. “These relationships have a profound im-pact on doctors’ lives and are, therefore, the ones that need fostering.”

Going forward, Fitch hopes physi-cians fi nd their own personal remedy to overcome burnout. She uses “entrain-

ment,” a word from the biomusicology world that means “the synchronization of organisms to an external rhythm, often produced by other organisms with which they interact socially.”

“Sometimes when I’m in the OR, I ask the anesthesiologist to slightly turn down the volume of the patient’s pulse ox-imeter,” she said, “as I can feel my own pulse trying to keep time with the patient’s rhythm.”

Fitch encourages physicians to “be brave and reach out to others in the com-munity.”

“Together,” she said, “we can all fi nd meaning in medicine.”

The Secret Suffering of DoctorsOphthalmologist pens book about the looming crisis in medicine, a remedy for burnout

Dr. Starla Fitch

ARKER

Missed family gather-ings and soccer games, frus-tration with bureaucracy, dwindling self-worth and utter exhaustion often overshadow the initial

early retirement, second-guess their chosen profession, and/or suffer pro-

my partners and I didn’t de-

provide the types of ser-vices we provide,” Fitch

explained. “It opted to move the services in-house

to save money, regardless of the consequences to its

patients.”The impact of that de-

cision? One affected patient had been diagnosed with eye-

lid cancer. Surgery had been scheduled to remove the growth,

followed by another surgery for reconstruction, Fitch said.

10 > JANUARY/FEBRUARY 2015 a r k a n s a s m e d i c a l n e w s . c o m

Parkey Named Incoming Executive Director for St. Bernards Medical Group

JONESBORO — Lydia Parkey of Jonesboro has been named incoming executive director for St. Bernards Medical Group, the area’s largest volun-tary association of physi-cians.

A 2005 graduate of Samford University in Bir-mingham, Ala., she has a Bachelor of Arts degree in journalism and mass communica-tions. Parkey recently moved to Jones-boro from Washington, D.C., where she worked for eight years on Capitol Hill, most recently as the director of sched-uling for Sen. John D. Rockefeller IV of her home state of West Virginia. In Jonesboro, she has worked in the offi ce of the president and CEO of St. Ber-nards Healthcare.

Parkey is active in the community as a member of the Downtown Jones-boro Association, the St. Bernards Ad-vocates, the Jonesboro Young Profes-sionals Network and the St. Bernards Women’s Council.

Her husband, Justin, is a Jonesboro native and is an attorney at Waddell, Cole & Jones, PLLC. The Parkeys are members of Southwest Church.

Advanced Practice Nurse Joins Sparks Adult Medicine Specialists

FORT SMITH – Elaine Thrift, MSN, APN, FNP-BC, has joined Sparks Health System.

Thrift specializes in Endocrinology and has extensive experience in the treatment of patients with Type I and Type II Di-abetes, including insulin pump management and thyroid disorders. Thrift also has more than 25 years of experience in nursing and caring for residents of the River Val-ley.

In her free time, the Mulberry, Ark., native enjoys running and training for half-marathons and spending time with her family.

Thrift will see patients alongside Doctors Charles and Holly Jennings, Jon Harper, and Richard Hinkle, Jr., at Adult Medicine Specialists. For more information on the services the clinic provides, please call (479) 709-DOCS.

Change of Leadership for Cooper Clinic

FORT SMITH - A change of lead-ership has been announced for the physician-owned medical group, Cooper Clinic, P.A. Douglas J. Babb, CEO, has chosen to retire at the end of the year, and Curtis Ralston, Chief Op-erating Offi cer, has been named as his successor.

The announcement was made by Michael Callaway, MD, current Presi-dent of the Board of Directors, and Daniel Mackey, MD, incoming Board President.

Babb had advised the Board of Di-rectors earlier this year of his intent to retire and has worked with Board mem-bers to implement an orderly succes-sion plan.

Babb assumed the CEO position in July, 2007. His history of leadership included serving as Executive Vice President and Chief Administrative and Legal Offi cer at Beverly Enterprises and Senior Vice President at the Burlington Northern Santa Fe Corporation.

Ralston, a CPA and native of Okla-homa, joined Cooper Clinic in 2011 as Chief Financial Offi cer. He most recent-ly served the group as Chief Operating Offi cer. Ralston earned his Master’s and Bachelor’s Degrees in Accounting from Oklahoma State University and has 19 years of accounting experience, includ-ing nine years in CFO positions in the healthcare industry. He and his wife, Brent, have two children.

Otolaryngologist Alissa Kanaan Joins UAMS

LITTLE ROCK – Alissa Kanaan, MD, an otolaryngologist, has joined the Uni-versity of Arkansas for Medical Sciences (UAMS) and will see patients at the Ear, Nose and Throat Clinic in the Jackson T. Stephens Spine & Neu-rosciences Institute.

Kanaan, an instruc-tor in the Department of Otolaryngology – Head and Neck Sur-gery in the UAMS College of Medicine, offers endoscopic nasal and sinus sur-gery and treatment for chronic sinusitis, nasal obstruction and fungal sinusitis.

She received her medical degree at the American University of Beirut in Beirut in 2007, where she also did an in-ternship in general surgery in 2008 and residency in otolaryngology-head and

neck surgery in 2012. She completed a fellowship in pediatric otolaryngology-head and neck surgery at McGill Uni-versity Montreal in Quebec, Canada in 2013 and one in rhinology and allergy at the University of Pittsburgh Medical Center in 2014.

She is a member of the American Rhinologic Society and American Acad-emy of Otolaryngology.

South Central Telehealth Forum to be Held March 2

LITTLE ROCK – The third annual telehealth conference for the Arkansas, Mississippi and Tennessee region pro-moting the use of telecommunications technologies to support distance health care will be March 2 at the Hilton Jack-son Hotel in downtown Jackson, Missis-sippi.

The South Central Telehealth Fo-rum is organized by the University of Arkansas for Medical Sciences (UAMS) Center for Distance Health and the South Central Telehealth Resource Cen-ter, which serves Arkansas, Mississippi and Tennessee. Experts from the region will give presentations, lead discussions and network about telehealth.

The cost is $160 per person. An ear-ly bird rate of $135 is available through Feb. 1. For more information and to reg-ister, go to learntelehealth.org/sctf2015 and click on “Conference Registration,” or call (855) 664-3450.

Nationally recognized reimburse-ment expert Nina M. Antoniotti, R.N., M.B.A., Ph.D., will be the keynote speaker. She is the program director of the Marshfi eld, Wisconsin-based Marshfi eld Clinic TeleHealth Network. Antoniotti has been involved in the de-velopment of national technology and operational guidelines for telehealth standards and has presented at regional and national telehealth and technology conferences in the areas of integration, business plan development, clinical ser-vices, evaluation, Health Insurance Por-tability and Accountability Act (HIPAA) and needs assessment.

The conference also will feature na-tionally recognized speakers and pan-elists from the South Central region of Arkansas, Mississippi and Tennessee. Discussion panels will focus on clinical, education, administrative and technical aspects of developing telehealth pro-grams and will demonstrate regional programs.

For more information or to register for a workshop, go to: learntelehealth.org/sctf2015 and click on “PreConference Registration.” The cost is $45 per person.

Several technology vendors and other businesses and organizations also will have booths and exhibitions at the conference. Continuing education credits will be offered.

Arkansas Medical News is published bi-monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2015 Medical News Commu-nications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore uncondition-ally assigned to Medical News for publication and copyright purposes.

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Stacy Sells, Breast Cancer SurvivorStacy Sells, Breast Cancer SurvivorStacy Sells, Breast Cancer SurvivorStacy Sells, Breast Cancer SurvivorStacy Sells, Breast Cancer Survivor

the“When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of “When I was diagnosed with stage IIIB inflammatory breast cancer, I knew I was in for the fight of

the Beating Odds

stacy sells ad_medical news.indd 1 10/14/14 1:01 PM