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With the healthcare community eyeing 2007, Medical News of Arkansas surveyed healthcare leaders from around the state to determine what they believe will be priority issues next year.

All were asked the same question: What are some things to be on the lookout for in Arkansas healthcare in 2007?



Dr. I. Dodd Wilson, Chancellor, University of Arkansas for Medical Sciences, Little Rock

Part of the continued emphasis for 2007 will be to promote healthy behaviors for Arkansans. The Clean (Indoor) Air Act recently passed in special session by the Legislature and various efforts at curbing childhood and adult obesity will play a major role. We all need to encourage other healthy behavior such as more frequent exercise and eating a healthy diet.

A second approach has been through a federal waiver to Arkansas for providing health insurance to employees of small businesses that presently are unable to afford this insurance. The program is in the pilot phase and was developed by the Insurance Roundtable of the Arkansas Center for Health Improvement. Governor Huckabee has been a major promoter of these endeavors.

Finally, we need to continue to work on providing improvements in healthcare both in quality and availability. This will be especially important in the area of primary care where individuals need to have sufficient time with primary care providers. The problem in part is the obvious disparity of payments that goes to primary care office visits compared to those that are received by many of the specialties in medicine.

A second need that must eventually be addressed is the need for better treatment of chronic disease. Using diabetes as an example, better control of diabetes would result in fewer patients who are disabled due to blindness, renal failure, heart disease and peripheral vascular disease, resulting in amputations. Diabetes is a major cause, and a very expensive one, for each of these health problems.

Doug Weeks, Senior Vice President and Administrator of Baptist Health Medical Center, Little Rock

We continue to see the recruitment of physician specialists as a challenge. Our focus will be to recruit physicians where there are shortages in key areas such as perinatology, neurosurgery, vascular surgery and transplant cardiology.

Providing care for the increasing number of Arkansans without health insurance is a significant challenge. At Baptist Health, the number of our patients without health insurance continues to grow, and by the end of 2006, we expect to provide in excess of $111 million in patient care that is either charity and/or results in bad debt expenses.

As more and more people are without health insurance, access to care is impacted by our emergency department being used as a primary care site. This will continue to lead to overcrowding which leads to diversion.

Ron Rooney, President, Arkansas Methodist Medical Center, Paragould

I believe the immediate future of healthcare in the state of Arkansas will largely be a continuation of what we saw in 2006. Unfortunately, many of these trends point to increasing financial difficulties for many providers and patients alike. At the same time, I also believe we are seeing advancements that contribute to increased quality of care.

I believe in 2007 we could see even more of our hospitals close. As fewer patients have insurance, competition among providers increases and reliance on emergency rooms increases, our medical centers are forced to bear an ever greater financial and operational burden. However, the outlook is not entirely bleak.

Technology continues to improve healthcare. Diagnoses and treatments are more accurate and faster due to information management technologies, diagnostic tools and improved pharmaceuticals. While the costs for these advances are often high, many medical centers, like Arkansas Methodist Medical Center (AMMC), have made these investments for the benefit of their communities.

Perhaps the biggest trend I see in the medical marketplace is competition based on good old-fashioned customer service. At AMMC, we don't believe it is enough to simply provide excellent care in a clean environment. We believe that patients recover better when they are also treated with kindness, enjoy the food, and enjoy a restful and private environment. In short, our motto says it all: "AMMC, caring for you, caring about you."

As a result of these trends, I believe the patient will enjoy shorter stays, an increase in attention to patient care and satisfaction and more information about healthcare providers and care options.

Healthcare providers will continue to fiercely compete for market share in 2007. The winners will be the providers that focus on the patient, provide a desirable work environment for physicians and staff and find creative answers to growing financial difficulties.



Nick J. Paslidis, MD, PhD, MS, CEO, Arkansas Foundation for Medical Care, Little Rock

Health information technology (HIT) will continue to be on the rise in Arkansas and across the nation. An increasing number of Arkansas hospitals and clinics are making the transition to electronic records, and that trend is expected to continue throughout 2007.

Research has shown that HIT can help reduce medical errors, smooth workflow and save money by providing quick, easy access to a patient's entire medical history. Payers and consumer advocacy groups are pushing for HIT adoption, and the president has called for electronic health records to be in use in physician offices nationwide by 2010.

HIT implementation affects each team member, from clinicians to clerical staff. Success requires an ability to evolve as lessons are learned and technology advances. Planning is crucial, and facilities must evaluate their processes and tailor their workflow to make effective use of the technology.

Any facility adopting HIT needs forward-thinking executives who are supportive and willing to tackle a challenge. Experienced IT staff members are critical. Patients also must understand the benefits before they can be fully realized.

Quality improvement organizations, including the Arkansas Foundation for Medical Care, will play a key role in HIT adoption. Arkansas was one of four pilot states to take part in the national DOQ-IT (Doctors' Office Quality Improvement Technology) program in 2004 and will launch another HIT demonstration program in late 2006. AFMC is currently helping hospitals assess their readiness for bar coding, computerized physician order entry and telehealth, and working with primary care offices and home health agencies to help them select an HIT system and make the most of the technology. Our goal is to help our state's healthcare providers overcome barriers to HIT adoption, and the early adopters are already proving that the benefits far exceed the challenges.



Dr. Debra Fiser, Dean, UAMS College of Medicine, Little Rock

Patient safety is on the front burner for most hospitals with vigorous efforts to prevent complications such as bloodstream infections and ventilator associated pneumonia. I think patients can anticipate more attention to pain control as well. There will be more hospital based providers, such as intensivists and hospitalists. With pay for performance on the horizon, attention to quality and outcomes will be very important.

I think medicine in the future will be characterized by what the NIH refers to as the 4 P's — predictive, personalized, pre-emptive, and participatory. By this, I mean that we can expect to have genomic tools available in the coming years to predict a person's risk of certain diseases. We can even expect more gene based clinical trials down the road with subjects stratified based on their genomic risk. Knowing an individual's risk, the possibility exists to employ pre-emptive interventions to avoid that disease ever becoming manifest or at least reduce the risk. Or we can tailor treatment to an individual's metabolic makeup using pharmacogenomics. Finally, we can expect that patients will be better informed of their health options and increasingly involved in decisions regarding their own health maintenance.

I think we will see an increasing number of options for preventive care such as the HPV vaccine released this year. And I anticipate more focus on a healthy food supply revolving around reduction of trans fats and protection of fresh produce and other products from contamination such as that which occurred recently with bagged spinach.




December 2006

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