Area's Medical Options Increase in Size, Scope

Kathey is cq

Marq Walker is a woman

At A Glance

How Many Doctors?

The Association of American Medical Colleges 2013 State Physician Workforce Data Book shows Arkansas has 5,629 total active physicians, 687 medical or osteopathic students and 754 medical residents.

Osteopathy is a health care philosophy with many of the same goals as traditional medicine, but places greater emphasis on the relationship between the organs and musculoskeletal system.

Areas with the most providers in Arkansas include: primary care, 2,238; internal medicine, 461; pediatrics, 356; and obstetrics and gynecology, 258.

The Arkansas State Medical Board lists 529 licensed medical doctors in Benton and Washington counties. That is how many active licenses are in the two-county area, but does not mean every license holder is a practicing physician.

Filling open slots is a problem facing medical institutions across the country. The association reports there are about 250,000 primary care doctors working in America. The association predicts that in 10 years the United States will need 130,000 more doctors than medical schools are graduating.

Source: Association of American Medical Colleges

Additional physicians, expanding facilities and cutting-edge technology and procedures are strengthening Northwest Arkansas' health care ecosystem.

The region faces a growing demand for medical professionals and new service as its population increases.

"In the late 1980s, early 1990s we were behind, but we have caught up" in health care offerings, said Dr. Steve Goss, president of Mercy Clinic Northwest Arkansas. "It would have to be highly specialized care for a patient to have to go outside the area for help."

Kathey Parker, administrator at Highlands Oncology Group, said more services are available than some people realize.

"I think what is available to patients in Northwest Arkansas is top-of-the-line," she said. "I don't think people always realize everything that we do offer, what they can get right here at home."

Staying current with health care offerings is important for the area's growth, said Mike Harvey, chief operating officer at the Northwest Arkansas Council. He said health care is one piece of the quality of life puzzle people and businesses look at. when considering whether to locate a business here or move to the area.

"You come to expect a certain level of services in a midsize market," he said. "The health care industry is growing very rapidly."

Growth Plans

New clinics are popping up across the area as medical systems expand and relocate offices to more convenient locations.

Eric Pianalto, president of Mercy Hospital Northwest Arkansas, said the system is continuously evaluating where to open new clinics. Mercy Northwest Arkansas is part of the nonprofit Sisters of Mercy health care system headquartered in St. Louis. The local system includes a hospital in Rogers and 22 clinics.

"Clinics are going to be where the people are," he said.

Mercy will open new clinics in downtown Rogers and Centerton in September or October. It recently opened a 30,000-square-foot multispecialty clinic with an extended lab and imaging services, pharmacy and coffee shop in Bella Vista.

Mercy is also adding a bariatric surgeon and two neonatologists this year. Bariatric surgery is performed to help individuals lose weight. A neonatologist treats critically ill premature and full-term infants.

"There are neonatologists in Washington County, and we wanted to provide that service in Benton County," Goss said.

Willow Creek Women's Hospital had the area's first neonatologists on staff. The hospital is adding a third neonatologist later this year, said Dan McKay, chief executive officer of Northwest Medical System.

"That is probably one of those things I can look back at and feel really proud about," McKay said about service expansion at the women's hospital.

Willow Creek in Johnson is part of Northwest Health System, owned by Community Health Systems, which is headquartered near Nashville, Tenn. Northwest Health also includes full-service hospitals in Springdale and Bentonville and 40 area clinics.

Northwest plans to open three new clinics this year. Each new clinic will range from 12,000 square feet to 15,000 square feet and employ five to six physicians. It opened a nearly 9,000-square-foot clinic near the Pinnacle Hills Promenade in February. The clinic has digital X-ray and lab services and offers extended hours.

McKay said expanded services have been a clinic trend the past couple of years.

"It's a one-stop-shop," he said. "Get it all, get it fast and get it convenient."

Washington Regional is putting a new focus on brain disorders. The hospital is building an endovascular neurosurgical hybrid operating suite that will help in advanced treatment of brain disorders. Two endovascular neurosurgeons will join the hospital's medical staff by summer.

"We are pleased to be able to provide Northwest Arkansas with advanced neuroscience services that are currently available in only a few communities nationwide," said Bill Bradley, Washington Regional president and chief executive officer. "We have an extraordinary opportunity to make a significant, positive difference in the lives of patients and families who are affected by neurological disorders."

Washington Regional Medical Center is a not-for-profit, community-owned and locally governed health care network operating a hospital in Fayetteville and 19 clinics throughout Northwest Arkansas.

Medical Associates of Northwest Arkansas, an independent physician group, is strengthening existing resources. Many of its clinics are open nights and Saturdays, and two are open seven days a week.

"Part of our growth plan is to offer extended hours to help meet the needs of our patients," said Jason Wilson, Medical Associates chief executive officer. "Almost all of our clinics have walk-in hours."

The group has 70 physicians practicing in 17 clinics ranging from family practice to neurology, he said.

Wilson said they are expanding services in gastroenterology and pulmonology this year. Gastroenterology focuses on the digestive system and pulmonology deals with the respiratory tract.

Extended Services

Patients are finding an increasing number of health services available online.

Mercy and is experimenting with electronic visits, allowing patients to log onto the "My Mercy" web portal and fill out a questionnaire to identify the illness or condition. A doctor will review the information between office visits and submit a response by the end of the day.

Mercy charges the same fee for an electronic visit as it would for an office visit, and the patient must prepay before a session begins.

Wilson said online visits could be beneficial, but most insurance plans, including Medicare and Medicaid, don't cover online appointments.

Medical Associates of Northwest Arkansas is launching a smart phone application through iTunes this spring that will feature a patient portal. Patient portals are health care-related online applications that allow patients to interact and communicate with their health care providers.

Washington Regional's patient portal, WR HealthLink, will launch this spring, said Gina Maddox, system spokeswoman. She said the patient portal is one component of Washington Regional's electronic medical record system that allows for storage and retrieval of health care records electronically.

HealthLink also allows patients to schedule a clinic visit, get lab results, request a prescriptions renewal and make online payments, she said.

"If they want to schedule a clinic visit, they can get information about the nearest clinic location, earliest available appointment and even the number of patients who are waiting at each location," Maddox said.

Nathan Ray, director of HITArkansas Regional Extension Center, said increased use of electronic medical records will create more efficient and better care. HITArkansas is a division of the Arkansas Foundation for Medical Care and provides training, support, technical assistance, outreach and collaboration for implementation of electronic health records. The group's goal is to create a statewide health information exchange system.

HITArkansas has 1,542 providers signed up with 1,281 starting the electronic medical record program and 867 using it regularly.

"Northwest Arkansas has done a really good job with implementation," Ray said. "What we are seeing are those facilities that are using electronic medical records and are going above and beyond can provide better care. They are more proactive."

Marq Walker, HITArkansas program manager, said patient portals are a goal this year.

"Patient engagement is an important measure," she said. "Its about improving quality of individual practices."

Mercy and Northwest are also utilizing health coaches. Programs assign patients to a medical worker who will helps them schedule appointments and lab tests, answer questions and suggest screenings.

Mercy's program is called Care Management and is implemented at the hospital and clinics.

Northwest's program is being used in five clinics and will be rolled out to additional sites this spring. McKay said they are in the process of hiring people to serve as health coaches.

"We are being more proactive on the preventative side," he said. "For example, we are doing more screening mammograms than ever."

Areas of Need

Mental health services is one area health care leaders point to as lagging despite recent additions to the market. Wilson said low insurance reimbursements for mental health services is one barrier. Goss said training, pay and the fact it is not a high-volume practice area also add to the shortage.

"As the area grows, it just makes a bigger hole, and needs continue to grow," he said.

Mercy opened a Senior Behavioral Health Program on the hospital's seventh floor in June 2013. The $3.5 million project is designed to help patients aged 55 years and older with psychiatric issues.

The average stay at the Mercy unit is seven or eight days, and patients have full access to medical care. The program is not a dementia unit, but between 60 and 70 percent of the patients have some form of cognitive impairment. Problems are often traced back to a medical issues such as an infection or a reaction to medication.

"We are paying a lot of attention to the problem, but we can't solve it alone," Goss said. "We can be a catalyst."

The area's only assisted living facilities with certified Alzheimer's special care units are Butterfield Trail Village in Fayetteville and Windcrest Health and Rehab in Springdale. The Meadows, an independent and assisted living facility in Bentonville, also has 10 certified Alzheimer's care beds.

State law requires any long-term care facility that advertises it has a special unit for residents with a dementia diagnosis gain certification through the Office of Long-Term Care. Any assisted living facility or nursing home that does not advertise it has a memory care unit does not require any special regulatory steps other than those already place on long-term care facilities.

The area is getting a pair of new specialized care units.

Clarity Pointe Fayetteville is opening this spring with 59 beds for patients with Alzheimer's and other forms of dementia. It will be a state-certified Alzheimer's unit. Clarity Pointe will be the area's first free-standing assisted living community designed solely for patients with Alzheimer's and other forms of dementia.

Culpepper Place Assisted Living, also in Fayetteville, will break ground later this year on a 64-bed memory care facility next to its assisted living facility.

Another area of medical care that expanded last year, but still falls short of meeting the region's needs is hospice care.

The Arkansas Health Service Permit Agency reports Benton County needs 32 more hospice beds. The need is 13 more beds in Washington County.

There are only three standalone facilities in the two-county area offering hospice care: Circle of Life has Legacy Village in Bentonville and the Earlene Howard Hospice Home in Springdale, and Washington Regional Medical Center operates the Willard Walker Hospice Home in Fayetteville.

Legacy Village, a 24-bed hospice home, opened last April, giving Benton County its first licensed hospice beds.

The Earlene Howard Hospice Home opened in 2006 with 16 beds and added eight more in 2009. The Willard Walker Hospice Home opened with 12 beds in 2011.

Help Needed

New facilities, specialties and programs won't improve the area without the proper medical professionals in place. Filling all the physician openings in Northwest Arkansas is an ongoing problem.

McKay said with medical systems across the country courting the same limited number of physicians, it can be challenging convincing them to come to Arkansas. Northwest Health recruited 100 doctors and opened 17 clinics in the past three years.

"Once we can get a doctor to come and see the area, we have a much better chance of hiring them," he said. "When they see the area, it often changes their perceptions."

McKay said amenities, including schools, museums and shopping, show applicants the region has a lot to offer. He said expansion at the University of Arkansas for Medical Sciences Northwest campus will help.

"It helps produce more qualified candidates and opens up a pipeline of new candidates, especially in internal medicine," he said. "It's good for the community and good for all the hospitals."

The medical school opened the Fayetteville campus in 2009 and has grown to 190 students in medicine, pharmacy, nursing and health professions and residents in family medicine, psychiatry and pharmacy.

A physical therapy program will start in 2015 and an internal medicine residency program is working through the approval process. Dr. Peter Kohler, vice chancellor for the Northwest campus, said he expects the program to start in 2015.

Goss said there is also a need in pulmonary and critical care.

"Only 50 percent of those positions get filled nationwide because of a shortage," he said.

Pianalto said an aging physician population is also added to the shortage. The 2,500 retiring doctors nationwide wide will only be replaced by 1,700 new graduates, he said.

The Association of American Medical Colleges reports 28.6 percent of Arkansas' active physicians are aged 60 and older, ranking the state 15th. Arkansas ranks 34th in the number of students enrolled in medical or osteopathic school with a ratio of 23.3 per 100,000 people.

Medical Associates of Northwest Arkansas is narrowing its physician gap by hiring more advanced practice registered nurses, also called mid-level providers, who can see patients in a family practice setting. These specialized nurses, who can prescribe medication, take some of the caseload off family practitioners.

Wilson said his group hired six mid-level providers in the past year, accounting for the majority of new employees who see patients.

The Association of American Medical Colleges reported in 2012 there were 260.5 active physicians per 100,000 population in the United States, ranging from a high of 421.5 in Massachusetts to a low of 180.8 in Mississippi. Arkansas ranked 48th with a ratio of 190.9 per 100,000.

Leaders in the medical field warn against using the state's ranking as a barometer for access to care in Northwest Arkansas.

Janie Ginocchio, spokeswoman for the Arkansas Foundation for Medical Care, said the state's average is pulled down by its rural areas. Northwest Arkansas and the state's central area around Little Rock fare better.

The foundation specializes on quality of health care, and Ginocchio said one difference in care across the state is a 10-year longer life expectancy in Northwest Arkansas compared to the Delta area.

NW News on 03/23/2014

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