Billings Clinic - The Clinic Today

ClinicTODAY

THE

Patient Care For the Future

ICU

Innovation through Health Care Design

Cardiac cAre Stories of Courage and Survivorship

economic impact Strengthening the Community’s Economy

THE Clinic TODAY

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ClinicTODAY

THE

Contents

MELDING 21ST CENTURY TECHNOLOGY WITH PERSONALIZED PATIENT CARE

Features

39 Billings Clinic ICU:

A New Era in Critical Care

44 Stayin' Alive: Gary Ljunggren 47 John R. Burg, MD Cardiac Center: A Lasting Legacy

48

Billings Clinic Cardiovascular Unit

50 New Operating Rooms:

It Takes a Team

54

Family Birth Center/NICU: Angie Higgins' Story

58

Pediatrics: Caring for Kids in the Hospital

61 A Conversation with Susan,

Breast Cancer Survivor Plus Tips from the Doc

65 Reger Family Center for Breast Health:

Transforming Women's Health Care

68

Gamma Knife: The Power of Precision Don Tapp's Story

70 Gamma Knife: Brain Surgery

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without the Knife

Departments

The Clinic: Yesterday, Today & Tomorrow The Billings Clinic Foundation

18 Marguerite Estelle Bair Lamb: A Quiet Legacy

22 31st Annual Classic

The Heartbeat of Progressive Health Care

11 What's In a Name?

12 Small People, Big Medicine

Community News

14 Preventing Childhood

16 Leading the Nation in

Blindness

Health Care Design

6 Welcome from Nicholas Wolter, MD,CEO &

Jim Duncan, President,

Billings Clinic Foundation 73 Docs by Day 80

Community Benefit

82

Building for the Future

25 Billings Clinic in the region:

Working with rural communities to support care closer to home

27 ExpressCare:

Quick, quality care in convenient locations.

Continuing Education

28 The Future of Health Care

in the Region

Economic Impact: Special fold out 34 The ‘Ripple Effect’ of Billings Clinic’s

Expansion on the Local Economy

86 Thank You To the

Generous Donors

88 Billings Clinic Expansions

and Renovations 2012-2015 92 Reflections 94 Dawn of a New Day

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The Clinic Today W e l co m e to T he C l i n i c T oday .

As an organization constantly evolving to best meet the needs of our patients and

growing community, this magazine highlights some important initiatives that have recently been achieved at Billings Clinic. We are investing in the future to ensure our staff can deliver the highest levels of care in the midst of a rapidly changing health care environment.

These efforts are the result of thoughtful planning and the generosity and support of our community.

Billings Clinic nurses, physicians and staff strive to deliver the high quality, safe and

compassionate care every patient deserves. State-of-the-art facilities and technology are critical in this pursuit of excellence. Our community has been so generous with Nicholas J. Wolter, MD

philanthropic support to help us achieve this vision. Charitable giving for our current expansion will top $10 million including $1.2 million from our own staff and physicians.

Without this support, we would not be able to achieve levels of quality that consistently place Billings Clinic among the most highly-rated health care organizations in the country.

Thank you.

We are especially proud of how this publication highlights the talent of our local

contractors and vendors who are helping us complete this major campus expansion and renovation. The Billings Clinic Board of Directors has a longstanding commitment to using local businesses whenever possible, and the resulting positive economic impact is significant.

E. James Duncan

Thank you once again to everyone who has played a role in making the advancements

highlighted in this publication possible.

Sincerely,

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Nicholas J. Wolter, MD, CEO

E. James Duncan, President

Billings Clinic

Billings Clinic Foundation

ClinicTODAY ClinicTODAY

THE

THE

About Billings Clinic

Based in Billings, Montana, Billings Clinic is a not-forprofit health care organization where specialists work together for our mission of providing health care, education and research to our local community and the region.

Our Vision Billings Clinic will be a national leader in providing the best clinical quality, patient safety, service and value.

Locations: Billings Clinic 801 North 29th Street 406.238.2500 or 1.800.332.7156 For Appointments: 406.238.2501 Billings Clinic Hospital 2800 10th Avenue North 406.238.2500 or 800.332.7156 Billings Clinic Foundation 2917 10th Avenue North 406.657.4670 or 1.800.332.7156 billingsclinic.com/foundation Billings Clinic Heights 760 Wicks Lane 406.238.2575 Billings Clinic West 2675 Central Avenue 406.238.2900

Regional clinic locations: Beartooth Billings Clinic –Red Lodge: 406.446.2345 Stillwater Billings Clinic – Columbus: 406.332.100 Billings Clinic – Cody: 307.527.7561 Billings Clinic – Miles City: 406.233.7000 Bozeman OB/GYN ­Billings Clinic­– 406.587.9202

Additional copies of The Clinic Today can be picked up at both information desks in Billings Clinic Commons & Billings Clinic Hospital.

Construction

HealthLine 406.255.8400 or 1.800.252.1246 To learn more, visit www.billingsclinic.com

PO Box 20364 BILLINGS, MT 59104 DESIGN PRODUCTS CO. Quality

est. 1954

406-652-2555 FAX: 406-652-4441

888-245-4116

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Billings Clinic was awarded high performance rankings for seven specialties: Diabetes and Endocrinology For the third year in a row, Billings Clinic has been ranked as the best hospital in Montana by U.S. News & World Report. The annual U.S. News Best Hospitals rankings – now in their 25th year – recognize hospitals that excel in treating the most challenging patients.

US News Best Hospitals rankings were developed as a data-driven resource for people to find best care hospitals for medical and surgical needs in their local regions. This year, Mayo Clinic in Rochester, Minnesota was ranked #1 in the nation for best hospital. Billings Clinic was selected to be a member of the Mayo Clinic Care Network in 2013.

For more information, visit billingsclinic.com

Gastroenterology and GI Surgery Geriatrics Gynecology Nephrology Neurology and Neurosurgery Pulmonology

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Innovation, Integrity & Exceptional Service

• Design • Build • Commercial • Industrial • Tilt-up Concrete

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Helping Billings Clinic improve quality of care in Billings & the surrounding area.

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We congratulate Billings Clinic on being a top 100 hospital!

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The Heartbeat of PROGRESSIVE HEALTH CARE

What’s in a Name?

As the largest multispecialty group practice in the region, Billings Clinic adopted many changes over the course of its rich history, including its name! Learn how its name came to be called Billings Clinic.

1907

1915

In 1907, Brother Van of the Methodist Church was called upon to bring Deaconess Hospital to the small community of Billings.

By 1927, Deaconess Hospital opened with 58 beds and a medical staff of 12 physicians and 16 nurses.

1927

1939

By 1915, two physicians were running the Movius and Bridenbaugh Clinic out of the Hart Albin building downtown. When three more physicians became partners in this practice in 1939, the name changed to Billings Clinic and soon moved across the street from Deaconess Hospital.

60s & 70s

1993

In 1993, Deaconess

During the 60s and 70s, both

Medical Center and

organizations began working together

Billings Clinic, took a

to expand services and capabilities,

bold step forward merging

pioneering kidney dialysis, cancer

together to provide a true

treatment and cardiac care in Montana.

collaboration between

In 1972, Montana’s first open heart

health care specialists and

surgery was performed at Deaconess

hospital services calling

Medical Center by a surgeon from

themselves Deaconess

Billings Clinic.

Billings Clinic.

2005

TODAY By 2005, the culture had evolved to a model similar to Mayo Clinic, and the organization’s name was changed to Billings Clinic in order to reflect that model and the progressive nature of the physician-led organization.

Today, Billings Clinic’s 280 physicians offer more than 50 specialties. Billings Clinic manages multiple critical access hospitals in Montana and Wyoming, and has numerous regional clinics and partnerships.

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Small People, Big Medicine Billings Clinic has welcomed many milestones in Pediatric Care over the course of the past 100 years.

Billings Clinic has been caring for kids since the days of Brother Van, but bringing highly specialized pediatric care to our vast rural region has been challenging. In 1978, Dr. Paul Kelker joined Billings Clinic becoming the first fellowship trained physician in Montana to treat children with cancer. Many important pediatric specialties followed, including pediatric pulmonology, neonatology, dermatology, cardiology, diabetes, ophthalmology, gastroenterology, otolaryngology, allergy and immunology, neurology, psychiatry, psychology, and pediatric hospital medicine, forming the most comprehensive care team for children in the region. Today, these pediatric specialists travel hundreds of miles to offer outreach clinics to rural communities in Montana, Wyoming, and North Dakota.

In addition, Billings Clinic’s 13 pediatricians and 34 family medicine physicians coordinate care and provide the primary care needs of infants, children, and adolescents.

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Did you

know?

In 1915, Dr. John Bridenbaugh was the second physician hired at Billings Deaconess Hospital, caring for pregnant women and delivering babies.

He specialized in obstetrics and radiology, an unusual combination by today's standards.

In 2009, Billings Clinic began offering the only invitro fertilization services in the region, offering hope to families experiencing the heartbreak and

Happy Citizens Need Both Health and Care Thank you, Billings Clinic, for keeping our community happy and healthy.

New West knows the art of healthcare is more than medicine alone. Congratulations on your great acheivements and your continued efforts to improve healthcare for Montanans.

overwhelming Top left: Pediatric cancer patient Aspen Washburn, from Belgrade, completes her last day of treatment with Dr. Courtney Lyle, an oncology and hematology (blood disorders and cancer) specialist at Billings Clinic. Bottom left: Lily Vincent listens to her own heartbeat at a visit with Dr. Kristen Day, a pediatrician at Billings Clinic West.

Top right: The new Billings Clinic Family Birth Center features warm, comfortable birthing suites along with state-of-the-art technology. Middle right: Dr. Christopher Montville and a baby celebrating at the IVF zoo birthday party. Bottom right: Dr. Stacy Shomento and her family attend the 2014 IVF birthday party at ZooMontana.

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Preventing Childhood Blindness “If one feels the need of something grand, something infinite, something that makes one feel aware of God, one need not go far to find it. I think that I see something deeper, more infinite, more eternal than the ocean in the expression of the eyes of a little baby when it wakes in the morning and coos or laughs because it sees the sun shining on its cradle.” ­—Vincent Van Gogh

Preventing a leading cause of childhood blindness When a baby is born prematurely, the development of their eyes can be disrupted. The blood vessels may stop growing or may grow abnormally and the baby can lose eyesight. This is called retinopathy of prematurity (ROP) — a leading cause of blindness worldwide. The best hope for a cure is timely diagnosis and treatment. Laser surgery can halt the abnormal blood vessel growth and preserve vision. Since more infants are surviving premature births every year, there is an increased need to care for ROP. Pediatric Ophthalmologist Daniel Weaver, MD, is one of the only pediatric ophthalmologists in the Northern Rockies region and began working at Billings Clinic in 1992.

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"One of the greatest difficulties in working in such a vast rural area is being able to screen infants for possible eye abnormalities such as ROP before permanent damage is done," states Dr. Weaver, "So we started investigating innovative ways to screen babies."

Caring for babies in the Neonatal Intensive Care Unit Diagnosis of ROP can be done by viewing digital images obtained with a wide-angle camera, called a RetCam. The RetCam creates a highly detailed image of the premature infant’s eye. With more premature babies each year and a shortage of ophthalmologists available, the camera provides a solution – it is designed specifically for infant eyes and has the ability to transmit images electronically.

Dr. Weaver and his colleagues at the Billings Clinic Neonatal Intensive Care Unit (NICU) realized their patients would benefit from a RetCam. The Billings Clinic Foundation shared the need with the Nance Family Foundation and they generously donated the RetCam for the NICU in December 2013. The Nance family was pleased to help Dr. Weaver with his work to prevent blindness in children. A team of NICU specialists and nurses are now trained to use the RetCam. “We are so grateful to the Nance Family Foundation for their donation of the RetCam to the NICU. Now we can care for the eyesight of these tiny newborns, screen their precious vision by viewing high quality eye images, and then quickly treat a serious disease that is the leading cause of blindness in children,” said Dr. Weaver.

“We are so grateful

to the Nance Family

Foundation for their

Caring for rural patients with telemedicine and the RetCam Dr. Weaver has been using the RetCam combined with telemedicine technology to check the eyes of premature babies from hundreds of miles away. Telemedicine is a private, two-way videoconference for medical purposes used widely across Montana for thousands of medical consults each year. Rural physicians use telemedicine to access medical specialists at larger medical centers like Billings Clinic. ­— Daniel Weaver, MD Telemedicine Pediatric Ophthalmologist screening for premature infants prevents extra costs and stress for families by reducing the need to transfer a newborn to another facility. Dr. Weaver’s study of ROP and telemedicine, published by the Journal of the American Association of Pediatric Ophthalmology and Strabismus, found that telemedicine screening was 100 percent effective for detecting ROP disease when compared to a bedside eye exam.

Physicians all over the world are now interested in telemedicine screening for detecting ROP. Dr. Weaver recently traveled to Singapore, Brazil, France and China to teach this method of preventing this blinding disease in premature babies.

donation of the RetCam

to the Billings Clinic

NICU. Now we can care

for these tiny newborns, screen their precious

vision by viewing high

quality eye images,

and then quickly treat

a serious disease that

is the leading cause of

blindness in children.”

www. ctagroup .com

Above: Dr. Weaver holds a premature, healthy infant in the Neonatal Intensive Care Unit, next to the RetCam with a newborn’s eye image on the screen. Photo by James Woodcock.

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Leading the Nation in Health Care Design

Mitch Goplen, Billings Clinic Vice President of Facility Services, is one of 10 national recipients of Healthcare Design magazine’s highest honor, HCD 10, a peer nominated award given to professionals who represent the most exciting, inspirational and influential health care work of the previous year.

Overseeing more than 1 million square feet of facility space, Goplen has been responsible for more than 20 expansion and renovation projects at Billings Clinic over the last two years, including 13 new operating rooms, the Reger Family Center for Breast Health, a state-of-the-art ICU and new Cardiovascular Unit, and the John R. Burg MD Cardiac Center. Armed with extensive knowledge of design and construction, he’s an advocate of evidence-based design in the planning process and a supporter of The Center for Health Care Design’s Pebble Project, registering two current Billings Clinic projects under this research initiative to improve outcomes.

In alignment with best practices around safety and with focus on reducing hospital-associated infections during construction, Goplen makes infection control practices a priority on all projects, involving all consultants and contractors in the education process.

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Congratulations Congratulation Billings CliniC

Did you

know?

Pebble Project®

It’s an honor to partner with you in creating healing environments.

The Pebble Project® is a unique and dynamic collaborative, where forward thinking healthcare organizations, architects, designers and industry partners work together to identify built environment designs and solutions that measurably improve patient and worker safety, clinical outcomes, environmental performance and operating efficiency.

Opposite page: Mitch Goplen, Vice President of Facility Services. Photo

by Hannah Potes. Top: The Cancer Center is located on the south side of Billings Clinic. Photo by Larry Mayer. Center: Open nursing triage area facilitates communication for staff. Bottom: A comfortable lobby in the John R. Burg, MD Cardiac Center welcomes patients before their appointments.

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www.RimrockArt.com THE Clinic TODAY

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The Clinic: Yesterday, Today & Tomorrow B ILLIN G S C LINI C F O U N D A T I O N

Marguerite Estelle Bair Lamb:

A Quiet Legacy

M

Marguerite Estelle Bair Lamb was born in Helena on July 1,

1889 – the same year Montana became a state. The daughter of business and ranching magnate Charles M. Bair and his wife

Mary Jacobs Bair, Marguerite spent her first years living in the

prosperous capitol city. In 1891, Charles Bair decided to focus exclusively on his sheep ranching operation and moved his family into a tiny sod-roofed cabin on his ranch near Lavina.

Looking demurely out from beneath her plumage-adorned hat, Marguerite Estelle Bair stands next to her mother, Mary Jacobs Bair, in an affluent neighborhood of Portland. The photograph, captured in the late 1920s, is one of a mere handful of images of the eldest Bair daughter. Though less has been written about Marguerite than her more gregarious sister, Alberta, Marguerite’s generous philanthropic gifts continue to be a significant source of funding for building state-of-the-art facilities at Billings Clinic. Photos courtesy of the Bair Family Museum.

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The Clinic: Yesterday, Today & Tomorrow B ILLIN G S C LINI C F O U N D A T I O N

T

Two years later, Charles again moved his family, this time to Billings

where daughter Alberta was born. While Charles was away managing his immense ranch and building a sheep empire, Mary, Marguerite and Alberta lived quietly in their home located on the present day site of the Alberta Bair Theater. In 1905, Charles purchased the original John Grant homestead in Martinsdale, Montana. Nestled in a verdant valley with rolling hills and

breathtaking views of the Crazy, Castle and Little Belt Mountains, the ranch would eventually become the family’s permanent residence – and a testament to the legacy left by the Bair Family.

"Billings Clinic is fortunate to be named as one of the recipients of Marguerite’s trust. Through her thoughtful planning, Marguerite established a legacy of caring for the lives and health of generations of Montanans."

— Jim Duncan, President, Billings Clinic Foundation

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Self-made, self-sufficient Charles Bair and his family were extraordinarily well-to-do, but their wealth wasn’t inherited – it was earned. At age 20, Charles left his native Ohio working his way to Montana where he became a conductor for the Northern Pacific Railroad. Over the next few years he invested in land before traveling to the Klondike where he made a fortune by purchasing gold mining claims. A shrewd businessman, Charles diversified his holdings by investing in banking, mining, oil and real estate. He also became a highly successful sheep rancher.

Despite their wealth, the Bair family was frugal. But education and cultural experiences were important, and both would play a key role in Marguerite Bair Lamb's legacy.

Artful ambitions By all accounts, Marguerite was a sensitive and artistic woman. Known for her exquisite singing voice, she was encouraged to pursue studies in music and art. Sometime around 1903, Marguerite was sent to the Annie Wright School in Tacoma, Washington, a college preparatory school for young women. After

preparatory school, Marguerite moved to Ohio to study at the Cincinnati Conservatory of Music.

In 1910, Charles moved Mary and his daughters to Portland. It was in Portland where Marguerite came of age.

Visionary vanguard Marguerite and her mother, Mary, shared a keen interest in antiques. The pair would frequent antique stores around the city, venturing as far as Vancouver, British Columbia, in search of rare furnishings and beautiful pieces of art. Over time, Marguerite began to document their purchases and research their origins.

After more than 20 years in Portland, Mary, Marguerite and Alberta moved permanently to the family ranch in Martinsdale. When the ladies arrived, they brought roomfuls of antique furniture, rugs and fine art. At the ranch, Alberta became more involved in managing the family businesses while Marguerite deepened her study of art and antiquities.

In 1940, Marguerite and David Lamb, the ranch foreman, eloped. The couple married at the Meagher County Courthouse in White Sulphur Springs and returned to live and work on the ranch.

A philanthropic heart Charles Bair died in 1943, and Mary Bair a decade later. Around that same time, many of the family’s investments began to mature.

Marguerite and Alberta continued to manage the ranch and the investments, and they began to think seriously of the Bair family legacy.

Neither had children; both had a deep love and respect for their parents and their values. The sisters spent a great deal of time discussing their estate, and how they wanted to benefit the counties they had lived in and the hospitals that had helped their parents when they were ill.

Dave Lamb died in 1973, and Marguerite Bair Lamb died three years later. By that time, the sisters had each created independent trusts.

Marguerite’s trust, the Charles M. Bair Memorial Trust, provides generous gifts in the realm of education and health care. Billings Clinic is fortunate to be named as one of the recipients of Marguerite’s trust. Through her thoughtful planning, Marguerite established a legacy of caring for the lives and health of generations of Montanans. Her visionary generosity has touched almost every aspect of Billings Clinic from helping to fund critically needed capital projects to establishing endowments for long term program support including Emergency Charity Care, Psychiatric Services, Cancer Research, Diabetes, Women’s Wellness, Continuing Education for Nurses, Pediatric Specialty Medicine, Mother and Newborn Care, Cardiac Services and Neurosciences.

The legacy of this pioneering and philanthropic family continues today as dollars from the Charles M. Bair Memorial Trust helped to fund many of the projects listed in this publication. Marguerite’s deep and abiding love of Montana and those who live in “the last best place” will continue in perpetuity as she continues to heal and educate future generations of Montanans for many years to come.

Top Left: Marguerite Bair portrait taken by L.A. Huffman circa 1901. Top right: Chief Plenty Coups (second from left) and Alberta and Marguerite Bair on the Crow reservation circa 1920. Bottom right: Marguerite in the family touring car ready for a parade (undated).

For more information on the Bair family and the Bair Family Museum in Martinsdale, Montana, log on to bairfamilymuseum.org.

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The Clinic: Yesterday, Today & Tomorrow B ILLIN G S C LINI C F O U N D A T I O N

Celebrating over 30 “Classic” Years The year is 1983. Ronald Reagan is President, Microsoft Word is first released, Michael Jackson dominates the Billboard Charts and the “Classic” is born. From its early beginnings as the Deaconess Hospital Celebrity Tennis Classic, this four-day event brought together well-known television and sports celebrities with local community members in support of Billings Deaconess Hospital. Glen Ellen Sorenson, wife of retired Billings Clinic cardiologist H. David Sorenson and early Deaconess Foundation board member, remembers the beginning days of the Classic. “It was great fun to rub elbows with the Hollywood stars. But my fondest memory of the Classic was how enjoyable it was to meet and work with so many members in our community.”

From the beginning, the Classic has capped off a week of fun-filled and good-natured sport rivalry with a spectacular evening of fabulous entertainment, food and friends. For the last 19 years, Billings Clinic Foundation and an army of volunteers have created a downtown street party like no other.

Thousands of twinkling lights in over 30 tents transform a com-

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mon street and parking lot into a sleek urban oasis as over 1,350 guests are entertained by well known stars of country and pop.

Most importantly, the Classic has provided an opportunity to raise awareness and financial support for such worthy causes as Diabetes, Cardiac Care, Research, Emergency Services, Psychiatric Services, Cancer Research, Neurosciences, and

Critical Care. For our 31st Classic, to be held later this month, Pediatric Care is the designated recipient. To date, millions of dollars have been raised through the Classic to advance health care, education and research at Billings Clinic. Since 2010, proceeds from the Classic have been dedicated to Billings Clinic’s current expansion plan help-

ing to make these transformational projects possible.

“Although the Classic has evolved over the years, some things have stayed constant – the generosity of our community and the support of our volunteers," stated Liz Wilmouth, Senior Development Director, Foundation.

"We cannot begin to express how thankful we are to the thousands of Classic sponsors, donors, patrons and volunteers, who over the years have played tennis, shot a round of golf, ran the 5K, competed in sporting clays, fished the Big Horn, volunteered to make it all possible or danced the night away to improve the health of our community and region. Now that’s a party worth having!”

THANK YOU BILLINGS CLINIC

Building Tomorrow’s Visions Today

DESIGN/BUILD •TURN-KEY CONSTRUCTION • PRE-CONSTRUCTION PLANNING • CONSTRUCTION MANAGEMENT • 406-248-3700 THE Clinic TODAY I 23

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The Clinic Yesterday, Today & Tomorrow co m m u n i ty n ews

Billings Clinic in the region: Working with rural communities to support care close to home

Supporting medical services in the region’s many

small communities is a vital part of Billings Clinic's mission. Through telemedicine, specialty outreach clinics and partnerships with independent Critical Access Hospitals, Billings Clinic demonstrates its commitment to enhance primary care and specialty services so patients are cared for locally.

Billings Clinic is the first health system in Montana to adopt a formal Electronic Health Record (EHR) and has helped install and support EHRs at nearly 20 rural hospitals. Without the partnership with Billings Clinic, these organizations would not have been able

to afford this capability.

Rural hospitals and clinics have come to depend on Billings Clinic’s extensive support services including lab services, clinical and business information technology support, and specialty physician outreach throughout the region.

Top: The Stillwater Billings Clinic, Columbus, Montana. Above: Livingston Peak stands over the Livingston Hospital and Clinic scheduled to open in the fall of 2015.

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The Clinic: Yesterday, Today & Tomorrow co m m u n i ty n ews

As the first telemedicine network in Montana, the Eastern Montana Telemedicine Network began more than twenty years ago as a cooperative effort between Billings Clinic and five rural health care facilities. Today this technology links over 60 medical specialists with patients in 39 rural communities using two-way interactive video conferencing, allowing patients to receive specialty care close to home.

In addition to telemedicine, outreach clinics are provided across the region. More than 50 Billings Clinic specialists in 20 specialty areas of medicine travel each month to provide face-to-face specialty care for residents of rural Montana, Wyoming and North Dakota.

In 1997, Billings Clinic accepted an invitation to begin a management agreement with Pioneer Medical Center in Big Timber. Since that initial agreement, 10 additional Critical Access Hospitals have invited Billings Clinic to enter into similar relationships and more recently, four have evolved into shared governance relationships in which representatives from Billings Clinic serve on the local Board of Directors. These shared governance affiliations include Beartooth Billings Clinic in Red Lodge, Stillwater Billings Clinic in Columbus, Livingston Healthcare in Livingston, and Glendive Medical Center in Glendive. Through this affiliation, new

hospitals have been constructed in Red Lodge and Columbus, and construction is currently underway in Livingston.

Billings Clinic Affiliates include: 1. Pioneer Medical Center – Big Timber, MT 2. Colstrip Medical Center – Colstrip, MT 3. North Big Horn Hospital – Lovell, WY 4. Daniels Memorial Hospital – Scobey, MT 5. Beartooth Billings Clinic – Red Lodge, MT 6. Stillwater Billings Clinic – Columbus, MT 7. Livingston Healthcare – Livingston, MT 8. Roundup Memorial Hospital – Roundup, MT 9. Sheridan Memorial Hospital – Plentywood, MT 10.Glendive Medical Center – Glendive, MT 11.Wheatland Memorial Hospital – Harlowton, MT

Billings Clinic Regional Partnerships Timeline e ar

hc

or

M d lan at e h W 2014

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em

ial

lt ea

H

KEY Red = Shared Governance Black = Management Services

ExpressCare Quick, quality care in convenient locations

Clockwise from opposite page left: Beartooth Billings Clinic, Red Lodge, Mont. Top: The lobby of the Beartooth Billings Clinic features artwork, décor and design representative of the Red Lodge community to help make patients and their families feel at home. Middle: The Billings Clinic Medflight team picks up a patient in Scobey, Mont. MedFlight, air ambulance service, serves Montana, northern Wyoming and eastern North and South Dakota, flying an average of 650 to 750 flights annually with approximately 40% of them less than 150 miles. Over 50% of flights are cardiac related. Bottom: Dr. Ronny Jiji, cardiologist specializing in cardiovascular imaging, conducts a patient consult via telemedicine.

Billings Clinic’s two ExpressCare retail clinics are conveniently located in the Albertsons stores located on the West End and in the Heights. These clinics offer an affordable, convenient and easily accessible option for care for minor illnesses. The visit, diagnosis, plan of care and medication are entered into the patient’s electronic medical record and the nurse practitioner or physician assistant has access to all the current patient information that is important to incorporate in the care.

ExpressCare offers sports physicals for students ages 13 to 19, and treatment for allergies, bladder infections, ear infections and ear pain, colds and/or respiratory illness, pink eye or styes, sinus infections and/or sinus pain, sore throat, rashes, cold sores, bug bites, athlete’s foot or ringworm, minor burns, and skin abrasions. Procedures include wart removal and ear lavage. Testing includes rapid strep screen, flu screen, urine pregnancy test, urine screen, and TB testing.

Vaccinations available include influenza,

tetanus, (TD, TDAP) and Hepatitis B. To help with convenience and quick access to care, ExpressCare offers a mobile application to quickly and easily reserve time on the ExpressCare schedule. In addition to the e-Scheduling option, appointments are available for walk-in customers.

Information is available on the mobile app, and by scanning this QR code.

Services offered at ExpressCare have a set price ranging from $25 - $70, payable with check or credit card at the time of service. Most major insurance is accepted and customers without insurance or customers with insurance that is not accepted at ExpressCare will be required to pay at the time of service.

For more information, please visit billingsclinic.com/expresscare

Locations Billings West End

Billings Heights

ExpressCare Hours:

Inside Albertsons 3137 Grand Ave.

Inside Albertsons 670 Main St.

Monday - Friday 8 am - 8 pm

Saturday Sunday 9 am - 6 pm 10 am - 4 pm

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The Clinic: Yesterday, Today and Tomorrow co n t i n u i n g educat i o n

The Future of Health Care in This Region

I

“I was always going to be in medicine,” said Brenda Nyamogo, MD,

one of Billings Clinic’s first internal medicine residents. Dr. Nyamogo is a native of Kenya who came to the United States shortly after high school, graduating from Florida International University with a degree in biomedical engineering. “In Kenya, from a young age, you are taught to

be a doctor, engineer, or lawyer,” said Dr. Nyamogo, “I was lucky that I love science and medicine.” Dr. Nyamogo comes from a medical family; her mother is an OB/GYN physician in Kenya.

In contrast, resident Sindy Byington, MD, grew up in a small community in Idaho and is the first person in her family to graduate from college. Since childhood, she has dreamed of being a doctor. Dr. Byington is a graduate of Idaho State University Pocatello with a degree in microbiology and a graduate of Ross University School of Medicine. “I’m really looking forward to putting everything I’ve learned into practice and applying my knowledge to give excellent care to patients,” said Dr. Byington. “Most importantly, I want the patients to trust me and feel they can tell me anything.”

In June of 2013, Billings Clinic was

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accredited by the Accreditation Council for Graduate Medical Education as the first Internal Medicine Residency Program in Montana. The first group of 12 residents started in July of 2014, coming from all over the country and the world to learn from highly experienced faculty at Billings Clinic.

The residency is built on a foundation of incredible expertise. Roger Bush, MD, program director, is a home-grown Montanan raised in Scobey, Mont. Before coming to Billings Clinic to start the new residency program, Dr. Bush served as program director for the Virginia Mason Internal Medicine Residency in Seattle.

Above: 2014 Internal Medicine Residents, surrounded by current Billings Clinic physicians, at the white coat ceremony at Billings Clinic on July 1, 2014.

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The Clinic: Yesterday, Today and Tomorrow co n t i n u i n g educat i o n

Steve Gerstner, MD, associate program director, has been an internal medicine physician with Billings Clinic since 1989 and has always had a passion for teaching. Robert Ficalora, MD, associate program director, is from New York and most recently worked for the residency program at Mayo Clinic.

“Billings Clinic has an exceptional care system that creates an exceptional learning environment,” said Dr. Bush. “That’s why we were eager to build a program that will allow residents to learn from master clinicians in an innovative organization that is on the frontier of medicine.”

Internists are primary care doctors who specialize in complex medical conditions and chronic disease in adults, and they are “detectives” who look at a patient’s whole health and find the best treatment options.

Primary care, or “medical home,” is essential for the continuity of care for every patient. The focus of the Billings Clinic Internal Medicine Residency program is to help address the primary care shortage by training internal medicine physicians to stay in the region. According to the Montana Primary Care office, as of October 2013:

“We are very clear as to our residency’s mission: bring excellent general internists and primary care doctors to the region. The primary care physicians that were chosen to be our first residents were selected from a deep pool of academically wellqualified candidates likely to excel in clinical practice and settle in our region.”

• Nine counties in Montana are without any physician.

• 12 counties are without a primary care physician.

• Seven counties are without a hospital.

• An estimated 27,331 Montana residents live in counties without primary care physicians.

“We are very clear as to our residency’s mission: bring excellent general internists and primary care doctors to the region,” said Dr. Bush.

“The primary care physicians that were chosen to be our first residents were selected from a deep pool of academically well-qualified candidates likely to excel in clinical practice and settle in our region.”

They also chose Billings Clinic as a place they wished to do their residency. Many were impressed with the outstanding facility and had an attraction to Montana.

Montana is among the most successful states for retaining physicians who complete a residency program in the state, with a retention rate of 60-71% according to 2011 data from the Association of American Medical Colleges. ­— Roger Bush, MD, The residents bring fresh ideas, new energy, and bold creativity Director, Internal to Billings Clinic. They are leaders of care teams, improvement efforts and organizational initiatives. “This Medicine Residency emerging system of team-based care and learning will serve as an innovative platform for the pursuit of better care, better health for our region’s population, and better value,” said Dr. Bush. “Patients will benefit from strong personal relationships, and a sense of trust, safety and reliability.”

The residents also bring a passion for life. The 12 residents on the Billings Clinic team have skills and talents outside the clinical setting, including fluency in several languages, music, and arts. Dr. Nyamogo is an avid sports fan, and one of her motivations for moving to the Rocky Mountain region is to be close to her beloved Denver Broncos. Dr. Byington is a violinist and loves spending time in the outdoors with her three children. In other words, these young residents bring more than good medicine to Montana.

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Meet the SIMS Family

They can move, speak, bleed, breathe, and even sweat. They have a blood pressure and heart rate. They respond to treatments like real patients with accurate symptoms and vital signs. Meet the Sims Family. High tech wireless computer programming brings patient simulators to life at the new Simulation and Experiential Learning Lab at Billings Clinic.

Practice makes perfect and realistic simulation of emergency and high risk scenarios creates an evidence-based learning environment to safely practice team work, rapid assessment and intervention, disaster readiness, and perioperative (pre-surgery) management. The Lab was made possible by funds raised at the Billings Clinic Classic.

We are fortunate to have been part of BILLINGS CLINIC’S CONSTRUCTION TEAM. Cardiology Overbuild

Family Birth Center Expansion

QUALITY • EXPERIENCE • CRAFTMANSHIP • TEAMWORK • RESPECT

420 N. 25th Street • Billings, MT 59101 • 406-252-0510 • www.hardymt.com

Thank you, Billings CliniC

For over 90 years, Peterson Quality office as been an innovative force in the Billings business community. We are proud to be a partner in Billings Clinic’s vision of excellence in patient care and comfort.

502 n 32nd street

406.245.5151

pqo@petersonqualityoffice.com www.petersonqualityoffice.com

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GOOD DESIGN IS GOOD MEDICINE

“Billings Clinic challenges today’s standards, always striving for world-class healthcare and excellence in design.”

Ric Heldt, AIA, ACHA, ASAI

gratulate Is proud to con eir new project! th n o ic n li C s g Billin

u o y k n a Th d n a n o i t c u r t s n o C Jones or f n o i t c u r t s n o C r e Bau . le ib s s o p is h t e k a m helping

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It was a pleasure being on your construction team!

406-839-9066

t.brownson@bcincmt.com

www.brownsonconstr uc tioninc.com

• COMMERCIAL • RESIDENTIAL

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The ‘Ripple Effect’ of Billings Clinic’s Expansion on the Local Economy For the expansion currently underway or recently completed at Billings Clinic, goods and services were provided by 180 local vendors. (This number does not represent the sum total of local businesses that Billings Clinic relies on day in and day out to help care for patients.) By selecting local firms, every $100 in Billings Clinic spending results in over $250 of local economic activity. Billings Clinic’s commitment to using local talent and products made or sold in the region means business partners can in turn reinvest locally, creating a tremendous ‘ripple effect’ that keeps the region growing!

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Turn Page

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Local Vendors – Billings Clinic Expansion 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

360 Office Solutions, Inc. A&E Architects A&H Turf Specialties, Inc. A-1 Landscaping & Nursery, Inc. A1 Rentals AAA Striping Service Ace Electric, Inc. Acom Painting Advanced Counter Technology Advanced Office Services Advanced Protection Systems Air Controls Co., Inc. American Steel Ameriscape Apex Steel Architectural Doors & Hardware Associated Glass Ashley Furniture Homestore Automatic Doors of Montana B&B Disaster Restoration Bailey Masonry, Inc. Baker Transfer & Storage Co. Bauer Construction, Inc. Bighorn Corporation Billings Construction Supply Billings Extinguishing Systems Billings Insulation Service Billings Marble & Granite Bloedorn Lumber Brownson Construction Bruco, Inc. Burtell Fire Protection Central Products Cherry Tree Inn Colstrip Electric Commercial Roofing, Inc. Costco Billings Cotters Sewer Service Crowley Fleck Attorneys, PLLP

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This map of the Billings area represents 180 local businesses connected with Billings Clinic’s current expansion.

Every effort has been made to ensure the accuracy of this list. However, despite our best efforts, a name may be listed incorrectly or inadvertently omitted. We apologize for any mistakes and ask that you kindly report them to Billings Clinic Facility Services at 657-4038.

40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68

Crowne Plaza CTA Architects Engineers, Inc. Custom Concrete, Inc. D&R Drywall Dahlquist Flooring Contractors Davidson Design Datacomm, Inc. Dick Anderson Construction, Inc. Dovetail Designs Dupree Building Specialties Edge Construction Supply Empire Heating & Cooling Co. Empire Insulation Co. Empire Lathe & Plaster Empire Roofing Environmental Contractors, Inc. Epcon Sign Co. Fabricators Supply Familian Northwest Fastenal Fasteners Fireplace Center Flowmark High Tech Companies Frontier Fence G&T Plumbing & Mechanical Gainans General Distributing Good Earth Works Co., Inc. Grainger

Vendor list is continued on back of foldout.

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Designed with the input of the medical staff, the new Billings Clinic Intensive Care Unit fuses the highest standard of patient care with a soothing, family-oriented environment.

Billings Clinic

ICU

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A New Era in Critical Care

On a cold morning last February, Danny Jones drove to Billings Clinic, parked his vehicle and walked purposefully across the parking lot and through the automated entry.

Inside, he ascended the stairs to the second floor and turned down a short hallway leading to the newly-opened Intensive Care Unit.

It was a route Danny knew well.

Danny Jones (right) pictured with his father, Jim Jones. Photo courtesy Danny Jones.

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F

For nine months Danny and his team from Jones Construction had worked on building the new ICU, completing the project on time for a January 2014 opening. As project manager, he was highly familiar with every aspect of the new facility. But on this day, Danny’s visit had nothing to do with construction – it was personal.

“My father had been ill,” Danny said. “He was admitted to the ICU so he could be made as comfortable as possible.”

Collaborative care

While all construction projects go through a design phase, the design process for the ICU was particularly detailed and methodical.

“Before we started any actual building, we spent several months constructing cardboard mockups of patient rooms,” Danny said. The idea was to have bedside nurses and other staff members participate in creating spaces that would offer the best patient care.

While patient care and life safety issues were the highest priority, comfort was also important. The old ICU rooms were stark and small, with barely enough space for two visitors, much less a place for extended visits. A lack of privacy and no individual restrooms were also problematic.

“In addition to functionality, the design team put a great deal of thought into the aesthetics of the room,” Danny said. “The colors, layout and different equipment configurations all impact the overall patient experience.”

“I went from

constructing the building to experiencing it. You really learn to appreciate the effort the team goes to in getting it right.” ­— Danny Jones, Jones Construction

From concept to reality Construction on the new ICU began in March, 2013. On January 14, 2014, Billings Clinic hosted an open house for the community to tour the new space. It was a special moment for Danny.

“So many people worked together to make this possible – the medical staff, Billings Clinic facility services, department managers and our crew,” Danny said. “The new ICU is truly remarkable.”

Just a few weeks later, Danny’s father Jim Jones was admitted to the ICU. In the days following, Danny and his extended family spent many hours together with his dad.

“I went from constructing the building to experiencing it. You really learn to appreciate the effort the team goes to in getting it right.”

While the room was soothing and provided ample space for the large family to gather, it was the attentiveness of the doctors and nurses who cared for Jim that impressed Danny the most.

“The staff was awesome, very knowledgeable,” he said. “They explained things carefully, answered our questions and made my father as comfortable as he could be.”

In particular, Danny was moved by his father’s primary physician, a urology specialist.

“She was fantastic with my father,” Danny said. “Dad even said so, and he was a very quiet man. You knew it meant a lot to him – she was special.”

A unique perspective

Danny Jones in front of the reception desk of the new Intensive Care Unit.

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Looking back, Danny noted that he takes a great sense of pride in all of his projects, but the ICU is different. People who have been treated there or had a loved one admitted tell him how beautiful it is, and what a positive experience they had during a very hard time in their lives. It’s an experience Danny knows first-hand.

“You really don’t realize how many people it takes behind the scenes to make Billings Clinic work, and I have great respect for each of them.”

Their close relationship with Billings Clinic inspired the Jones family to make a generous financial gift to Billings Clinic in support of this project.

“The Intensive Care Unit is a true game changer,” he said.

“So many lives are saved. These people make a difference.”

A healing space Michaela Harakal, RN, manages the Intensive Care Unit at Billings Clinic. An ICU nursing veteran, she was one of the participants on the design team for the new unit.

“The trend has moved away from small,

sterile environments to rooms that are warm and encourage families and visitors to be with patients,” Harakal said.

That transition, she noted, is based on

evidence showing that family care can help in 1)

2)

3)

achieving positive patient outcomes.

In planning individual rooms, the design team, led by A&E Architects, went far beyond simply increasing square footage and adding private baths.

Each room is subtly divided into two spaces:

one for the patient and medical equipment, the other for family and visitors. A warm palette of sienna, cream and sandalwood covers the walls, evoking a warm, soothing environment. Physicians have ample room and access to leading-edge equipment while they work with a patient. On the other side, family members can sit on a comfortable sofa or armchair while waiting. The configuration facilitates interaction between the physician, patient and family, which is important when critical information is being exchanged.

In total, the ICU has 22 patient rooms plus two isolation rooms for patients with communicable diseases. There is also a waiting area, which is purposefully separated into two sections – a quiet area for reflection and a casual area for visiting. The new space also offers a private family consultation room, and a peaceful, Top photo: Ribbon cutting at ICU with Dania Block, CVU Manager, Mitch Goplen, Vice President Facility Services, Mayor Tom Hanel, Nicholas Wolter, MD, CEO, and Scott Millikan, MD, Cardiac, Thoracic and Vascular Surgeon. Smaller photos from left to right: 1) Scott Millikan, MD, Cardiac, Thoracic and Vascular Surgeon and Michaela Harakal, ICU Manager. 2) Lu Byrd, Vice President Hospital Operations and Chief Nursing Officer and Dave Bunkers, Executive Director of Critical Care Services.

3) Jock Michelotti with Robert “Spike” Pueringer, MD, ICU Medical Director. Bottom: The private family sanctuary overlook the rimrocks and the Deaconess Healing Garden.

private sanctuary for family members overlooking the rimrocks and the Deaconess Healing Garden.

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“Billings Clinic patients receive critical care in

Design Team: Nurses, Doctors, Patients and Family

the ICU, and the construction of this new unit provides an optimal environment for our doctors and nurses who work together to provide the highest level of care for years to come.

The increase in square footage also ensures that the people who matter most to our patients

Billings Clinic welcomed its first patients to the new advanced Intensive Care Unit in

January of 2014. Beginning a new era in critical care, this 24-bed Intensive Care Unit (ICU) is located on the second floor of the hospital directly above the Emergency and Trauma Center and provides a significant increase in space from the former ICU, increasing the unit to 24 rooms and doubling the size of each room.

The critical care design team spent months perfecting the layout of the optimal patient

room. In advance of building, mock rooms were created out of cardboard allowing caregivers

are incorporated

the opportunity to “test” designs before the actual construction began. Patient rooms in the

into their care

provide an equipment management system providing central power, monitoring and oxygen

experience. It’s the ideal set-up.” ­— Robert Pueringer, MD ICU Medical Director

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new ICU have leading edge boom systems mounted to the ceilings. These retractable arms for critically ill patients. Most importantly, the booms give caregivers immediate 360 degree access to the patient.

Above: The new ICU patient rooms utilize leading edge boom systems mounted to the ceiling that provide immediate 360 degree access to the patient. Next page top: More than twice the size of the former ICU rooms, new rooms feature private bathrooms and designated area for the patients’ family to stay at the bedside. Middle: Private family waiting areas specifically designed to meet the needs of friends and family members of critically ill patients. Bottom: The new waiting areas incorporate design elements that include comfortable furnishings, soothing colors, and peaceful artwork. Large windows provide stunning views of the Rimrocks.

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Stayin’ Alive

If you ask Chris Ljunggren what she gives thanks for every Thanksgiving, her answer will always be the same: “One more sip of coffee.”

If you ask her husband Gary, his answer comes just as easily: “My wife, because she saved my life.”

It’s hard to imagine how directly related each of these answers are, but in Gary’s case, one could argue that each is as important as the other… or at least they both were on Thanksgiving Day of 2011.

Up bright and early, Gary retreated to the basement for a walk on the treadmill.

Equally as motivated, Chris, keys in hand, was headed for the gym, pausing only momentarily for one last sip of coffee.

That’s when she heard the “thump.”

Right: Gary and Chris Ljungren stand in front of the Deaconess Healing Garden on the Billings Clinic Campus.

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C

Curious, she quickly headed for the basement. The hum of the treadmill provided a brief reassurance, but

when she reached the bottom of the stairs she found Gary slouched on the chair next to it, making guttural gasping noises. His eyes were rolling into the back of his head. Chris had to act fast.

“I called 911 and then just started frantically pumping his chest while I sang “Stayin' Alive.” (The song they tell you in CPR training to use for the rhythm.) I was so thankful I could remember at least that much.”

For two days after his collapse, Gary’s life hung in limbo at Billings Clinic ICU. In an effort to save him, Gary was put into a cold therapy induced coma. His heart needed a pacemaker – but he needed to wake up first. Miraculously, 48 hours later, he did just that.

Chris’ swift action three days earlier saved his brain function.

Now, the cardiovascular team at Billings Clinic could begin the necessary treatment needed to fix his heart.

Repeat Offender

Gary had no indication of illness; no history of heart disease.

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Of average build, he had recently been exercising on the treadmill regularly. Diagnosed with a condition called ventricular defibrillation, Gary needed a heart defibrillator to regulate the erratic electrical impulses that were causing his heart to quiver uselessly.

Gary immediately began cardiac rehab, and learned to navigate through what he now describes as a new normal.

The following year, Gary began feeling unnecessarily winded when performing common activities, like mowing the lawn. It soon became clear that Gary needed a stent due to a blocked artery.

Two years later, Gary’s original stent formed scar tissue and needed to be addressed again.

Gary’s exercise physiologist, Joani Hope, now refers to Gary as her favorite repeat offender.

John R. Burg MD Cardiac Center A lasting legacy of caring for the hearts of a community

“Joani takes good care of me,” Gary laughs. “When you go through cardiac rehab, you really become pretty close to those folks.

It’s scary to work out after these kinds of things. They make you feel comfortable and secure. When you graduate from cardiac rehab, you know your limits and what you can and can’t do.”

“Patients who receive cardiac rehab have drastically lower reoccurrence rates. I joke with Gary but honestly, his commitment to get himself back on track and be comfortable on the treadmill again is really admirable, and I have no doubt that it’s keeping him from additional cardiac events,” shares Joani.

The first week in April, Gary met Joani in the new cardiac rehab suite, supported by a donation from Merilyn and Bill Ballard, located in the new John R. Burg M.D. Cardiac Center. Located on the fourth floor of the clinic building, this new 22,500-square-foot facility brings all specialized cardiology care back into the main clinic, supporting greater interaction between key service lines such as primary care, surgery and the hospital. In addition to a cardiac rehab space nearly twice its previous size, the John R. Burg MD Cardiac Center also includes additional exam and diagnostic testing rooms and some of today’s most advanced

technology in cardiac care.

“When events like this happen to you, you start thinking about how to get yourself healthier. It just doesn’t become an option anymore. When you spend as much time in cardiac rehab as I have over the course of the past few years…well, let’s just say that the new space is just gorgeous and it makes it a lot easier to be here.”

The John R. Burg MD Cardiac Center was designed by CTA and Hardy Construction Company was the local contractor.

Dr. John and Pat Burg at the dedication of the cardiac center.

In 1973, Dr. John Burg had just finished his fellowship training in cardiology at Oregon Health and Science University, one of the most innovative heart programs in the country. He was drawn to the practice of cardiology for the great challenges diagnosing patients with heart disease presented. Without the sophisticated 3D imaging and array of laboratory testing available today, early cardiologists had to rely heavily on a patient’s symptoms and a thorough physical examination. According to Dr. Burg, diagnoses were “made

Counting Blessings

between our ears with the aid of a stethoscope and the

As Gary and Chris reflect on the last few years, they both admit that it’s difficult to narrow their gratitude list down to one thing.

“I’m here because Chris knew CPR and she did it right away, but there are so many things that could have killed me along the way, and they just didn’t. Everything fell in to place in my case.” Gary reflects.

Chris agrees. “The fact that I was home, the extra sip of coffee that I just had to have…the fact that we live close to Billings Clinic…all of those things saved his life. The care we received was extraordinary. I still remember Gary’s ICU nurse, Mary Horman. You don’t forget people who save lives. We’ll be forever grateful.”

investigative skills of a great medical detective.”

Left: Excercise Physiologist Joani Hope works with Gary as he works out on an elliptical machine in the new cardio suite.

Top: The new cardiac rehab center features the latest equipment.

When deciding where to practice medicine, Dr. Burg

turned his sights to Billings. Just a year earlier, Montana’s first open heart surgery had been performed at Deaconess Hospital. He was excited for the opportunity to help build a heart program from the ground up, a true leap of faith as there was little to no infrastructure in place to support specialized heart care. Over the decades, Dr. Burg and his partners embraced the rapid technological advancements in their field, bringing many new diagnostic and treatment methods to patients in the region.

To honor the philanthropic legacy of his parents and in

gratitude to Billings Clinic, Dr. Burg, with the encouragement of his wife Pat, continued his commitment to caring for the hearts of others by making a significant gift toward the construction of the new heart center. Dr. Burg’s compassionate and caring spirit will be appreciated every day by the many patients who will walk through the doors of the John R. Burg MD Cardiac Center.

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Billings Clinic Cardiovascular Unit The new Billings Clinic Cardiovascular Unit (CVU) is a state-of-the-art hospital floor where patients receive advanced care when recovering from open heart surgery, heart and lung operations, serious heart disease and vascular issues, including stroke.

The CVU, formerly known as the Ambulatory Telemetry Unit (ATU), moved from the hospital’s east wing to one floor above the new ICU, which allows for ease of patient transport from one unit to the other.

The CVU was built using evidence-based design. Nurses, CNAs, Unit Clerks and doctors worked on design elements that provide the very best patient care.

“Having the architects incorporate our perspectives was so rewarding,” said Nurse Clinician Robin Wicks.

“We have listened to comments and suggestions from patients and families over the years so we know what is best to accommodate our patients.”

“The unit is three times larger than the old space and all of the 29 new rooms have large windows with views and plenty of space for family and nursing staff to be with the patient,” Wicks said. “There is a family area and a care area in each room.”

Dr. Scott Millikan, CVU medical director and cardiac, thoracic and vascular surgeon added, “While the facility is new, the incredibly skilled, compassionate and professional staff remains the same. They are poised to deliver the very best, highest quality, safe patient care.”

Top: Dr. Scott Millikan addresses guests at the opening of the renovated Cardiovascular Unit (CVU) in March 2014. Above: Visitors tour one of the private patient rooms. Right: Occupational therapists Shadra Robison, left, and Jennifer Potts give visitors a tour of the Billings Clinic Cardiovascular Unit's therapy room during an open house.

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“While the facility is new, the incredibly skilled, compassionate and professional staff remains the same. They are poised to deliver the very best, highest quality, safe patient care.” ­­— Dr. Scott Millikan, Cardiac, Thoracic and Vascular Surgeon and Medical Director of CVU

Incorporating warm colors from nature, artwork, wood paneling and big windows with views promote healing. A pullout bed for a family member improves family involvement.

New technology includes 24-hour-a-day monitoring systems and a call light system that pages directly to a nurse’s or staff member’s cell phone. The patient can talk directly to the nurse rather than waiting for an answer to a call light.

“I think the most beautiful room on the floor is the therapy gym. It has floor-to-ceiling windows, sunshine and views of the rimrocks. It is designated for physical, occupational and speech therapy. Patients really like to go there.

It’s so bright and uplifting,” said Wicks.

With patient privacy at the forefront, the space includes elements to minimize noise. This increases patient and staff comfort.

"When something critical is going on with a patient, the other patients and families are not aware of it, and the overall stress level of everyone is much lower,” said Wicks. “Now the clinical staff feels calmer because of the environment being serene and quiet.” The CVU, which is 29,700 square feet, was designed by A & E Architects and Dick Anderson Construction was the general contractor. Many local subcontractors were used in building the unit.

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I

It Takes a Team

“I am very proud of this space,” says Jackie Hines, RN, Director of Perioperative

Services at Billings Clinic. “It improves our ability to look after patients while incorporating world-class advances in operating room technology. I just know that this is the best space and allows us to provide the best patient care.”

Jackie is enthusiastic while explaining the new features and changes taking place

as part of the ongoing expansion and renovation of the hospital's operating rooms.

Now, multiple monitors hang from 10foot ceilings, beaming in radiologic images, electronic medical records, video for laparoscopic procedures, neurosurgical navigation tools, and even journal articles, providing optimal viewing for all sides of the operating table.

Sizeable equipment once wheeled in on heavy carts, lives on overhead booms strong enough to house a Volkswagen yet lowered for use with the touch of a thumb. Windows display supplies stored in “pass throughs” to central storage staff on the other side, who stock rooms without entering.

Gurneys transporting patients to the OR table slide out of sight under flat, easy-to-clean work surfaces without traveling back to the hallway to await completion of the operation.

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Invisible air handling units draw potential airborne contaminants from the room while new LED lighting envelops the surgeon, casting no shadow over the surgical field.

High tech operating rooms are only the

Opposite page: Surgery team operates in one of the new ORs designed for patient safety. Above: Director of Perioperative Services, Jackie Hines (left), and Dr. Paula Roos, medical director of surgery, lead the quality and safety initiatives to provide best care to patients.

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beginning of a six phase overhaul and expansion of hospital perioperative services, which will include relocation and expansion of preoperative care, expansion of the recovery room and family waiting area, and three additional new operating rooms, increasing present capacity by 30 percent. The design, construction, and implementation of this monumental project engendered a spirit of teamwork emblematic of the commitment to and stewardship of patient care and the patient experience at Billings Clinic.

“Safety was our number one goal,” says Hines of the multidisciplinary team tasked with creating the evidence-based design. As Director of Perioperative Services, she worked with physicians, facilities experts, architects and builders to research the best technology and designs for safety, quality, and efficiency.

Strategic features designed to minimize traffic around the operating table are critical to reducing hospital- acquired infections and providing a safer work environment. CTA designed the ORs and Bauer Constuction was the local contractor.

“The physical space does enhance the processes in the operating room,” says Dr. Paula Roos, anesthesiologist and Medical Director of Perioperative Services. “The design of these rooms studied flow and efficiency, infection control, and the patient experience. Every detail

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present in the OR, in the pre and post-op areas, was all carefully evaluated and planned with these factors in mind.”

Roos speaks with palpable pride of the 120 plus pre-surgery care staff, from central sterilization to housekeeping. “It’s been inspirational,” she says, watching them hone new processes and adapt to their constantly changing environment.

The construction process has been complex with a rigorous and precise time schedule that helped the teams prepare for the ongoing changes in their department.

“There were little surprises along the way,” says Roos of the initial building phase. “But the teams, including facility services, construction crews, and the OR staff and physicians, all had a common goal: to deliver continuity of care that is focused on quality and safety.”

In his 28 years practicing cardiovascular and thoracic surgery, Dr. Scott Millikan notes surgery has become more demanding, operating on people with more complicated medical conditions. Yet outcomes are better.

Technology helps, but he gives an increased focus on teamwork the lion’s share of credit.

“We’re all talking to one another,” says Millikan. "Its planning before surgery, communication during the operation and post-surgery collaboration.That leads to safer care. ”

The Art of Visual Communication

“The design of these rooms studied flow and efficiency, infection control, and the patient experience. Every detail present in the OR, in the pre and post-op areas, was all carefully evaluated and planned with these factors in mind.”

— Dr. Paula Roos, Anesthesiologist and Medical Director of Perioperative Services.

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CongrAtulAtIons

Above: Cardiac, Thoracic and Vascular Surgeon Alexander Kraev, MD, performs many lung and chest procedures robotically with the daVinci surgical system. Left: Joy Rodriguez, RN, and Kristin Ronquillo, RN,5 assist during procedures in one of the new operating suites at Billings Clinic.

Coordination across that spectrum was a critical issue for the surgeons, according to Hines. The single-floor, “one stop shop” design of the pre- and postoperative spaces, currently under construction, reflects this demand.

Patients will check in, be interviewed, get their IV line, and wait for transport to the OR, all in the same room, large and comfortable enough to accommodate five or six family members.

“For people, surgery is very scary,” says Hines. “Having that family member right there is good for the patient and extremely beneficial for the family.”

As patients leave for the OR, family members step next door to the waiting room, designed to be open, spacious, and calming.

As an anesthesiologist, Roos “loves” the new space in the operating rooms, but as a member of the design team, she’s more excited about this latest phase of construction, the completion of which will greatly improve the patient and family experience.

Hines echoes this sentiment.

“It’s been three years of planning,” she says. “This has been a huge team effort which is indicative of how we practice. To see it finally come to fruition – it just makes my heart happy.”

BIllIngs ClInIC

Downtown

Is Where It’s At!

• Walk to downtown • Guest controlled heating • 24 hour coffee pot • Low rates & cooling • 24 hour front desk

• Elevator • Your small pet welcome • FREE continental breakfast • Family owned • Guest laundry • Winter plugins

Come stay for

• Electronic security • Kitchenettes • Easy airport access • Exercise room and sauna • Close to MSU Billings

60 a Night *

as little as $

*Before taxes

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Room for the Family to Grow

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Angie Higgins, RN, started out as an adult intensive care unit nurse at Billings Clinic. Her career

path quickly changed twelve years ago after her first

child decided to come into the world at only 33 weeks gestation. Angie’s water broke while she was visiting

North Dakota. An ambulance and plane ride later, she was home in Billings and under the care of the Family Birth Center physicians and nurses.

When her son, Cole, was born, like most premature babies he immediately went into the care of the Neonatal Intensive Care Unit. “I tried to think more like a nurse during the time he was in the NICU,” said Angie, “I would look at the tubes and think, oh those are so tiny and cute compared to the ones in the adult ICU.”

Above: Cole Higgins as a preemie in the NICU in 2002. Right: Cole and Angie Higgins today. Cole is an active 12 year old and Angie is now an RN in the NICU

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T

The care that Angie received and personal experience of being a mother to a preemie gave her the drive to switch her career from caring for adults to caring for tiny babies. Twelve years later, she continues to work in the NICU and Cole is a strong and happy almost-teenager.

“Babies are so strong. It’s amazing. If you can fix their lungs they have a really good chance,”

Angie explained.

The NICU and the entire Family Birth Center has seen many changes since opening in 1999. The Family Birth Center is designed to allow mothers to labor, give birth, and care for their baby all in the comfort of a large private birth suite.

The birthing suites incorporate soft colors and soothing fabrics with ample space for family and friends. Each room is equipped with a sofa bed allowing birth partners the opportunity to stay in the room through the night, nurturing the important bonds established during the first days of a baby’s life.

The need for women’s and children’s services at Billings Clinic has grown significantly in recent years. In part, this growth is due to the Maternal Fetal Medicine program caring for women with complex pregnancies. Dr. Dana Damron and Dr. James Alexander care for patients from a large geographic region covering central and eastern Montana, Northern Wyoming and western North Dakota. Many MFM patients stay at the Family Birth Center for several consecutive days to weeks before

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giving birth to have their health and the health of their babies closely monitored.

In response to the growing need for services, in the spring of 2013, the Level III Neonatal Intensive Care Unit (NICU), located at the center of the Family Birth Center, was renovated and expanded to accommodate up to 20 babies and their families.

Nadine Seger, MD, Fermin Blanco, MD and Patrick Sauer, MD, care for babies in the NICU, often for months at a time.

“Neonatology at Billings Clinic is growing and advancing, and the expanded space allows us to provide greater care to more infants,” said Dr. Seger, “Having an infant in the NICU is very challenging for families. We are pleased that this expansion also makes it more comfortable for parents to spend time with their baby in a more spacious and private environment.”

Six new birthing suites were added to the Family Birth Center in the spring of 2014. The rooms feature beautiful wood furnishings, a pull out couch for sleeping, flat screen TV, wifi, and views of Dehler Park and the Rimrocks. They have modern

design and walk-in showers for women who have C-section births. There is a bassinet for the baby that can easily be moved around the room and placed right next to mom for ease of feeding. A bathing sink in the room gives nurses the chance to show parents how to bathe their baby once they get home. The operating rooms were also expanded and updated to include state-ofthe-art technology and more room for the surgical and care team.

The Family Birth Center and NICU are designed to prepare parents to care for their infant when they go home. Nurses, breast feeding consultants and physicians educate new parents and make them feel more comfortable leaving the hospital with the responsibility of caring for a tiny new life.

Angie Higgins said the most rewarding part of her job is seeing the once weak and fragile babies who spend time in the NICU grow up and become healthy, normal, active children. “I love when I get to see them after the fact and everything is okay.” .

Opposite page: NICU baby. Newly remodeled State-of-the-Art NICU. Left: The Giraffe OmniBed combines advanced technology, exceptional performance, and innovative design to provide an excellent, developmentally supportive, family-centered critical care environment for your high acuity newborns. Top: Nurse monitors preemie in incubator. Above: Highly trained nurses monitoring our tiniest patients.

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Caring for Kids in the Hospital Treating children is much different than treating adults. Kids respond to illness in a unique way. They need a gentle touch and the comfort of their imaginations to build up resiliency. They need their favorite pajamas and stuffed bear to feel safe and a space to call their own. They also need the comfort of knowing mom and dad are close by.

Olivia Clyde, 14, has been hospitalized for chemotherapy on and off since she was diagnosed with osteosarcoma, a bone cancer, in the fall of 2013. With her mom or dad at her side, she has been cared for by Dr. Courtney Lyle, Billings Clinic pediatric oncologist/hematologist and Dr. Courtney Stout Paterson, Billings Clinic’s first pediatric hospitalist, as well as the nurses and social worker of pediatric oncology and inpatient cancer care.

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Top left: Dr. Courtney Lyle, pediatric oncologist/hematologist and Dr. Courtney Stout Paterson, pediatric hospitalist, check on Olivia Clyde in the Hospital.

Top right: Billings Clinic’s Pediatric Specialty Medicine Team includes (back row, L-R) Crystal Knight, MD, pediatric gastroenterology; Jeremiah Lysinger, MD, pediatric pulmonology; Abbey Volf, NP, pediatric pulmonology; Fred Gunville, MD, diabetes; (front row, L-R) Jeremy Archer, MD, pediatric cardiology; Nadine Seger, MD, neonatology; Courtney Lyle, MD, pediatric hematology/oncology; Tara Haman, NNP, neonatology; Fermin Blanco, MD, neonatology.

Bottom: Oliva Clyde, 14, smiles as she is treated for bone cancer in the cancer care unit.

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Olivia Clyde celebrates her last chemotherapy treatment with a party complete with a piñata.

The humorous banter between doctor and patient really demonstrates the depth of the relationship they have built over the course of her treatment.

“We’ve played many games of Skipbo and Spot It,” said Olivia.

“She tries to cheat though,” Dr. Lyle added with a smile.

“My favorite thing about the doctors is that they’re funny,” said Olivia.

“Not just funny looking,” Dr. Lyle teased.

Billings Clinic has an incredible team that understands the needs of teens and children and, thanks to generous donors, is constructing its first dedicated inpatient pediatric unit beginning in the fall of 2014. The $1.4 million space is being funded 100 percent through philanthropy, including the proceeds from the 2014 Billings Clinic Classic headlined by country superstar LeAnn Rimes.

Dr. Courtney Stout Paterson joined the Billings Clinic team in the summer of 2013 in anticipation of the future opening of the unit. She joined a team of 22 pediatricians and pediatric specialists. Dr. Stout Paterson loves kids and the focus of her practice is entirely on taking care of them in the hospital.

“Having a dedicated space for children is absolutely vital, because they require a different style of care,” said Dr. Stout Paterson, “We pride ourselves on providing a team-based multi-disciplinary approach and having a pediatric unit will really help us do that.”

“Not only do we take care of the patient, but the whole family,” added Dr. Lyle, “It’s a very complex structure. We also care for children at

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many different developmental stages, from infancy to adolescence.”

Prior to building the hospital unit, pediatric patients admitted to the hospital at Billings Clinic have been placed throughout the adult inpatient care areas. The pediatric unit will provide a safe and caring environment specifically for children and adolescents. Patient rooms also create space for family members, who are essential to the well-being and healing of young patients. Plans for the unit include a separate, cheerful treatment room, where all painful or uncomfortable procedures or treatments will be performed. This provides children with a sense of security in knowing their room is a safe haven. Additionally, an “Imagination Room” will provide a safe space for positive distraction, so young patients and their siblings can play together.

Leading security measures are being incorporated into the unit design, giving parents peace of mind for the safety of their children if they cannot be at their bedside.

Focus groups were conducted to learn what parents would most like to see in the new unit. Other pediatric units from around the country have also been examined to incorporate best practices into the design. Dr. Michelle Pierson, Department Chair of Pediatrics, has had a leadership role in planning for the new space.

“Many exciting things are happening in pediatric care at the Billings Clinic,” said Dr. Pierson.

“We are continuously growing to meet the health care needs of children in our community. Billings Clinic has the most comprehensive pediatric specialty services in the region, and with the recent expansion of the Family Birth Center and Neonatal Intensive Care Unit, now more than ever is the time to build a dedicated pediatric inpatient space to better meet the needs of the families and children we serve.”

Olivia is a true testament to the strength of youth facing challenging diseases like cancer. She says she is grateful for the fantastic care that Billings Clinic doctors, nurses, and staff have provided to her. “I like all the nurses, they play games with me, and they give me attention and push me to get out of bed.”

The new unit will bring patients like Olivia closer to their peers and provide an environment just for their care and comfort.

Features that patients and their families told us are important to them in the creation of a new care unit: • Security features • Play room • Creative décor with animals or cartoons • Privacy • Spacious rooms with moveable items • Central monitoring • Natural light • Parent lounge • TV • Family accommodations • Outdoor space

A Conversation with

Susan Pilcher,

Breast Cancer Survivor

There is something special that lies within the

hearts and minds of people who’ve battled cancer. Billings Clinic gets the distinct privilege of meeting and caring for many amazing breast cancer survivors throughout their life changing journey.

What is discovered in the process,

however, is that these women tend to teach caregivers much more than could ever be repaid in care. As breast cancer survivor Susan Pilcher shares, a cancer patient’s journey may begin at diagnosis, but the unspoken wisdom a patient survivor acquires along the way never really leaves you.

Photo Courtesy of Ric Zimmerman

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I’ve been given so much by those who’ve cared for me; my faith in humanity and God has

strengthened.

So, it makes me feel good to make others feel better and meet them where they’re at in their journey.

Meet Susan, then never forget her Walking Susan Pilcher through the Billings Clinic Cancer Center could be likened to

escorting a celebrity. Though her treatment is long behind her, Susan still graces the halls of Billings Clinic every Thursday as a volunteer in the American Cancer Society (ACS) wig boutique, where she meets women at a critical moment in their journey with cancer. She is often greeted by radiation technicians, who, arms open wide, lean in for a warm embrace, soaking up Susan’s positive energy and warmth (she’s a hugger, not a hand shaker).

Recently, on a quick tour through the new Reger Family Center for Breast Health at Billings Clinic, Pat Mahana, Billings Clinic’s Diagnostic Breast Navigator and the first person Susan saw after receiving her diagnosis, was overcome with joy and tears when Susan walked through the doors for a quick reunion. In other words, in a world so dependent on the advancement of medicine to cure us, Susan reminds us all that there are many kinds of healers in this world – of which she is certainly one.

Diagnosed with stage 2B lobular carcinoma found in her left breast on Valentine’s Day of 2012, Susan has come a long way, baby. After a mastectomy, Susan faced weeks of chemo and radiation. Over the course of that past year, she lost her energy, her taste for food, and her hair. What she gained, however, is the regal dignity of one who has looked fear in the eye, invited it to dinner, and greeted it at the door with a long embrace. How’d she come full circle? We’ll let her tell you.

On facing the “C” word: Chemo and radiation weren’t fun, but they weren’t the worst thing in my life. People don’t believe me when I say this, but cancer in my life was a blessing. It was all a growing, strengthening experience that gave me something I’ll have for the rest of my life.

Everything is so different in your life when you’re going through treatment, though I would argue that the cancer patient has an easier time than the family. I knew I had to find my own way through this journey, and I needed to do it with peace and dignity.

On giving back I’ve been given so much by those who’ve cared for me; my faith in humanity and God has strengthened. So, it makes me feel good to make others feel better and meet them where they’re at in their journey. When women come in to the wig boutique, it’s really a critical time. They’re tender. They need someone to say “I have been there. You will get to the other side.”

On losing her hair: Losing your hair is the first reality that you have cancer. You hold a clump in your hand and look at yourself in the mirror and say “Wow, I really do have cancer.”

My friends and family and I had a hair party when I started to lose my hair. Everyone came over and I cut my hair in a short bob and dyed it such a bright red that I can tell you it wouldn’t look good on anyone! Everyone else at the party put a touch of red in their hair too. We laughed and had a great time, and then I shaved it all off.

Did I love being bald? Absolutely! My skin was so soft! A little mascara and eye liner and I was done. I didn’t have to worry about my hair. It felt really liberating.

On where she’s at today: Now, my priority is helping other people. I get to do that through the wig boutique and sometimes just by having conversations with other patients. It’s what makes me feel the absolute best. It’s my passion and it’s what I want to do. Really, it’s what helps me continue to heal.

On what she’s learned: You never know how strong you are when strength is all you have – that is it really.

That’s cancer.

Susan Pilcher works in the wig shop helping patients pick the perfect hair style.

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Tips from the Doc Billings Clinic radiologist Jeff Lindenbaum MD shares a few things every woman should know about breast health.

stage 2 or 3. Today, about 60% are classified as stage 1.

Tip #3: About 20% of women whose deaths are attributed to breast cancer were diagnosed in their 40’s, so annual screening for breast cancer should begin no later than age 40. Get screened on your birthday every year so you’ll never forget to do it. If there is something there, early detection is the best gift you could give yourself.

Tip #4: Your risk increases with age, so screening should continue even after the age of 70. Approximately 40% of all new breast cancer cases happen after this age.

Tip #1: Tomosynthesis, BillJeff Lindenbaum, MD ings Clinic’s new 3D imaging technology, allows us to find 40% more invasive cancers than conventional screening exams with fewer false positives. That’s a win for everyone.

Tip #5: About 80% of women with newly diagnosed breast cancer have no known major risk factors. That said, know your family history.

Your risk of developing breast cancer greatly increases if you have a first degree relative who’s had breast cancer.

Tip #2: Since the introduction of widespread screening, we’ve been able to detect cancers at significantly earlier stages. In the 1980’s, about 60% of the cancers we discovered were classified as

Tip #6: The majority of lumps that women find in their breast are non-cancerous, but it doesn’t mean you should ignore something if you find it. Have it checked by your doctor right away. You’re always better safe than sorry.

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The Reger Family Center for Breast Health Transforming Women’s Health Care In October of 2013, Billings Clinic opened its doors to the new Reger Family Center for Breast Health, made possible in its entirety thanks to the generosity of donors. The charitable gifts, totaling more than $1.2 million dollars, advance the availability of stateof-the-art technology while also creating a beautiful new breast center that will serve future generations. The new center is the only facility in the region with leading-edge tomosynthesis technology, providing a three-dimensional view of the breast, making fine details more clearly visible, allowing even earlier detection of cancer.Â

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Care led by comfort The new 4,300 square foot Reger Family Center for Breast Health provides patients seeking breast imaging services an experience that fosters a feeling of ease and comfort in a relaxing environment. The Center’s waiting area includes floor-to-ceiling windows, warm colors, a fireplace and an opportunity to privately view educational videos about breast health and selfbreast examinations. Private changing rooms offer robes rather than exam gowns and provide a direct entry into one of three mammography rooms. Private patient consultation rooms allows radiologists and Billings Clinic’s breast care nurse navigator a space to display images to illustrate findings for patients and family understanding.

The Center for Breast Health accommodates technology for ultrasounds of the breast, stereotactic biopsies, and new breast tomosynthesis technology. This technology can reveal small cancers and

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provide state-of-the-art imaging that will reduce the need for repeat testing or additional mammograms. DEXA Scans, a superior technology for measuring bone health, can also be performed in the new Center. The Center also includes a specialty boutique supplied with merchandise specifically designed for women who have had a mastectomy, along with other related products.

Billings Clinic is accredited by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons, and a designation only given to centers that have voluntarily committed to the highest level of quality breast care. Candidates undergo a rigorous evaluation process of their performance and technology, including a multidisciplinary team approach for coordination of treatment options, information about clinical trials and, most importantly, quality breast care close to home.

Additionally, Billings Clinic is designated

as a Breast Imaging Center of Excellence by the American College of Radiology (ACR), an honor achieved by Centers of Excellence that have earned accreditation in mammography, stereotactic breast biopsy, and breast ultrasound (including ultrasound-guided breast biopsy). Peerreview evaluations conducted by boardcertified physicians and medical physicists have determined that Billings Clinic’s breast center has achieved high practice standards in image quality, personnel qualifications, facility equipment, quality control procedures, and quality assurance programs.

Billings Clinic is also a Pink Ribbon Facility, a designation from Hologic, granted to centers providing excellence in breast health paired with a commitment to support women of their community. The addition of the tomosynthesis technology further substantiates this recognition for those seeking centers of excellence in breast health.

The Reger Family for whom the center is named gave a generous gift.

Reger Family Center for Breast Health A transformational gift of hope to our community Moved by their desire to do something incredible for our community, Steve and Debbie Reger made a transformational gift to make the dream of a new breast center a reality at Billings Clinic. Through personal experiences with loved ones who had battled breast cancer, the Regers desired to create a center with a healing atmosphere while ensuring the availability of state-ofthe-art technology to this region.

Their gift is a remarkable

example of the shared commitment Opposite page: The reception area is designed to be warm and inviting. Top: Cathie Bach from Glendive takes a tour of the Reger Family Center for Breast Health to check for handicap accessibilty.

Above: The Breast Boutique provides post mastectomy patients with bras, clothing and gifts. Left: The staff of the Reger Family Center for Breast Health.

the Reger family and Billings Clinic have in advancing health care in our community. We are proud the Reger name graces our facility and are tremendously grateful for their contribution that will help us continue the healing legacy of Billings Clinic for a very long time.

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The Power of Precision It was the middle of a spring afternoon in May when Don Tapp sat down to check his emails. He casually scrolled, read and deleted, clicking his mouse to control his actions. It was just another routine activity for the afternoon. Routine, at least, until he was suddenly unable to control the clicker with his right hand. Suddenly, his hand ached and began clamping up. His movement was jerky and uncontrolled. “Dixie,” he called loudly, “we have a problem.”

Only days later, Don and Dixie would learn that Don had lesions in his brain and would be treated through a minimally invasive procedure using the Gamma Knife: the most advanced technology and treatment for patients with a wide spectrum of brain tumors and other brain abnormalities.

Don Tapp is 86 years old and he and Dixie met each other five years earlier. They had both been through tremendous hardship and greatly value the love and care they give to each other. In 2008, Dixie sat beside her late husband at the hospital in Forsyth, caring for him in the days before he passed away that December. Meanwhile, at a nearby nursing home, Don sat with his ill wife, easing her pain in the days before she left this world in February of 2009.

Don had cared for his wife for many years and learned the value and rewards of delivering love and care for another person. After his wife passed away, he prayed for God to send him another kind woman that he could love and care for. Turns out that God had already started working on this project. Dixie was just down the hall from Don. After both Don and Dixie lost their spouses, Dixie continued her volunteer work at the nursing home and, there, she met Don. They shared their stories and found that they both had similar perspectives and goals for the next phase of their lives. Those early days of dating delivered hope and faith for the future. Don put a lot of miles on the tires and carved a few ruts in the road as he drove from his house in Colstrip to her home in Forsyth. They set aside time for each other and they fell in love.

Sadly, Dixie was diagnosed with breast cancer that spring. The relationship took a turn and scheduling was not so often for dinner and social visits, but now revolved around doctor’s appointments and long drives to Billings Clinic for treatments. That was five years, ago. Today, Dixie proudly shares that she is in total remission and feels great.

So when Don called out to Dixie that Spring afternoon, he knew that any issue with his hand was just one more hurdle that comes

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with the experiences of life. An appointment was made with Billings Clinic and the two of them moved forward with next steps for Don’s health.

On May 15, Dr. Michelle Proper, a radiation oncologist at Billings Clinic, ordered an MRI. The results showed lesions in Don’s brain. She talked with Don and Dixie about new technology called the Gamma Knife that is used to treat brain lesions. She shared that the procedure could take place in the next few days and they would be back at home that same night. She told them that the procedure would be quick, minimally invasive, nearly painless, and often delivered results that were observed right away.

Don and Dixie’s appreciated the minimal effect the treatment would have on their lives. Don turned to Dr. Proper and said “Let’s do it. Let’s get it done!”

The next day, Don arrived at Billings Clinic. His neurosurgeon, Dr. Miguel Lopez-Gonzalez met him at o-dark-thirty to get ready for the procedure and to place the halo on his head to ensure stability.

“There wasn’t any real pain because the Novocain numbs you up,” shared Don. “It’s just a little needle under your skin and the halo is real light metal so it’s not really even noticeable on your head.”

After the placement of the halo, Don was introduced to the Gamma Knife, the machine that would deliver radiation to the lesions in his brain. Working as a team, the radiation oncologist, the medical physicist and the neurosurgeon determine the precise dose and placement of the radiation beams.

“You don’t feel a thing,” said Don. “I was listening to music the whole time. The only bad part was that I was hungry. That’s a long time to go without food when you get up that early.”

During the surgery, Dr. John Schallenkamp, a radiation oncologist at Billings Clinic, used the Gamma Knife to treat the lesions in Don’s brain. After the surgery, the halo was removed.

“I didn’t have any strong thoughts or emotional reaction to what was happening and I wasn’t stressed,” shared Don. “My only thought was about the pancakes, strawberries and the works waiting for me at Perkins.”

Don and Dixie drove home that same Friday afternoon. He slept well. He did not need any pain medication. He felt good.

Saturday evening, after a great day at home, Don sat down at his desk to write his first thank you letter to his physicians. His hand responded. Movement was relaxed and fluid. He wrote easily….

“Dear Doctor…”

Don and Dixie appreciated the minimal effect the treatment would have on their lives.

Don turned to Dr. Proper and said “Let’s do it. Let’s get it done!”

Don and Dixie Tapp, of Forsyth, enjoy life with a walk in Pioneer Park.

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Gamma Knife:

Gamma Knife速 radiosurgery is a sophisticated radiation therapy technique that precisely delivers a single, finely focused, high dose of radiation to well-defined, small targets in the brain.

Stereotactic radiosurgery (SRS) is the most advanced treatment available for brain cancers, as well as certain functional disorders.

Illustrations courtesy of Elekta

Brain Surgery without the Knife

192 radioactive beams are focused on the target in the brain to be treated. A stereotactic head frame ensures pinpoint accuracy.

With the Gamma Knife, there is no scalpel, no incision, and no general anesthesia and patients experience little discomfort. Most patients are treated during a single outpatient session and resume normal activities within a day or so. The Gamma Knife is preferred for its extreme accuracy and efficiency.

Gamma Knife surgery is performed in leading hospitals and clinics around the world. Billings Clinic is the only health care organization in a 5-state area offering treatment using the Gamma Knife (Leksell Gamma Knife Perfexion速).

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What was the decision process for Billings Clinic to select this piece of technology, at this time, for patients in this region?

Dr. Schallenkamp: When we looked at the region including Idaho, Montana, Wyoming, and the Western Dakotas, there were no facilities with the Gamma Knife. This is the standard of care for high-precision, non-invasive treatment of lesions in the brain. Billings Clinic has expertise in the Neurosciences and, as a group, felt it was an appropriate time to bring this level of care to the region.

What are the benefits of this type of procedure as opposed to traditional surgery?

Dr. Schallenkamp: The Gamma Knife is actually not a knife. It is a fast, precise, non-invasive treatment which requires no incisions. It has been used to treat hundreds of thousands of patients across the globe and has a trackrecord of being safe, efficient and effective. The Gamma Knife is often preferred for lesions in deep or critical regions of the brain where traditional surgery may be too risky or the lesions are very small, requiring the highest precision possible. Treatment is delivered by a single, high-dose of radiation to a very precise area using 192 very small beams of radiation. For appropriate patients, this is an outpatient, single treatment which avoids the need for surgery, hospitalization and intensive care unit stays.

Can you walk us through the process from diagnosis to the time the patient has healed?

Dr. Piedra: The entire Gamma Knife treatment is performed in one day with patients going home the same day. Coordinated care delivery is facilitated through a dedicated nurse navigator. Upon arrival to the hospital, a frame will be attached to the head, and the patient will have

Billings Clinic Gamma Knife Team (L-R): Dennis Cheek, PhD, Medical Physics; Eugen Dolan, MD, Neurosurgery; John Schallenkamp, MD, Radiation Oncology; Mark Piedra, MD, Neurosurgery; Michelle Proper, MD, Radiation Oncology; Christopher Veale, MS, Medical Physics; Christopher Goulet, MD, Radiation Oncology; Miguel Lopez-Gonzalez, MD, Neurosurgery

an MRI scan and CT scan. Once these scans are complete, the patient can wait comfortably while the neurosurgeon, radiation oncologist, and medical physicist prepare the treatment plan. The patient then enters the Gamma Knife suite and is placed on the treatment table. The treatment itself is completely silent and painless apart from small movements of the treatment table. In most cases, the treatment is over in less than one hour. The head frame is then removed, and the patient can go home. We encourage patients to resume their normal activity right away. Treatment effectiveness is assessed with MRI at follow-up.

What does this mean to you as a neurosurgeon?

Dr. Piedra: As a neurosurgeon, this allows me to safely treat conditions that previously required high risk surgery, long recovery times, and damage to normal healthy brain tissue. It allows me to treat patients that would normally not be candidates for traditional surgery. It also allows me to treat multiple brain tumors, common in conditions such as breast or lung cancer that has spread to the brain, in a single session without the need for the patient to be hospitalized.

What kind of functional disorders can be treated with Gamma Knife?

Dr. Piedra: It can effectively treat trigeminal neuralgia, acoustic neuroma and arteriovenous malformations. Certain Parkinson’s patients may also be candidates for the Gamma Knife.

“The Gamma Knife is actually not a knife.

It is a fast, precise, non-invasive treatment which requires no incisions.”

John Schallenkamp, MD, Billings Clinic Radiation Oncologist

Are there other technologies with similar outcomes to consider?

Dr. Schallenkamp: There are other technologies that provide stereotactic radiosurgery, but industry-wide, the Gamma Knife is considered the gold standard for non-invasive brain surgery. And it is the only stereotactic radiosurgery technology that is exclusive to the brain. The Gamma Knife offers treatment in one session with precise accuracy to limit damage to tissue outside of the target.

Other technology, such as the linear accelerator-based technologies, like Novalis, Cyberknife, or BrainLab systems, may deliver a bit more radiation to unintended nearby targets. Gamma Knife has the least scatter to normal brain and can target even very-small targets with extreme accuracy.

What does it mean to your patients to have access to this equipment and this type of surgery?

Dr. Schallenkamp: We can all be proud of this accomplishment. Now, our patients and their family members do not have to consider the expense and time away from work to travel across the nation for this type of care. They can have access to the best possible treatment options, because they are available here.

For more information, visit billingsclinic.com/gammaknife or call (406) 255-8400 or 1-800-252-1246.

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Congratulations Billings CliniC! We’re proud to Be a part of your design team.

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MEDICAL GASES AND PRODUCTS

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Great Falls · 430 17th Avenue NE Helena · 800 Florence Butte · 701 South Warren Bozeman · 103 Bridger Center Drive Billings · 1327 South 29th Street W. Glendive · 720 N Sargent

“Montana’s Best Gas and Welding Distributor Since 1948” 72 I THE Clinic TODAY

Meet 15 doctors who provide you with excellent care and when their shifts are done, jump from planes, make wishes come true and play a mean guitar.

Say hello to these...

Docs By Day...

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Docs By Day...

Dr. Loren Budge Hiker

By Day: Cardiac Electrophysiologist On the weekends: Mostly I’m spending time with my family, but I really enjoy hiking, running, playing ice hockey, skiing, and playing guitar.

Second calling: Teacher.

Proudest accomplishment: My happy and successful marriage.

For the greater good: I spend a lot of my time volunteering for my church as well as with a local unit of the Boy Scouts of America.

Favorite guilty pleasure: I have to admit even though I’m a cardiologist, I am also a big fan of ice cream (disclaimer: I occasionally eat healthy too.)

Dr. Zachary Bland Wounded Warrior Volunteer By day: Vascular and Interventional Radiologist On choosing vascular and interventional radiology: I chose this subspecialty because it allows me to directly interact with patients and other doctors in almost every discipline. I get to diagnose and treat diseases in nearly every organ system in the body with minimal risk to the patient and maximized health outcomes.

On the weekends: I’m usually chasing kids around sporting events or out enjoying what Montana has to offer, including fly fishing, backpacking, hunting, and skiing.

Biggest “day job” challenge: Staying abreast of the constant changes in medicine is a never ending challenge.

There is never a dull moment.

For the greater good: Over the last several years I’ve been able to be a part of the Wounded Warrior Program. Spending a couple days with both active duty and retired Marines, taking them fishing on the river, exploring the hills in search of deer and elk, and spending time with them around a fire pit is undoubtedly one of the most rewarding experiences I have ever been a part of.

Guilty Pleasure: I’m a native Montanan, so my favorite guilty pleasure is stealing time away with my kids or family to go float a river, sit in a duck blind, or walk a tree row with our labs.

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▲ Dr. Eric Arzubi

Anti-Bullying Advocate

By Day: Child and Adolescent Psychiatrist Second Calling: I used to be a financial journalist and then bond trader on Wall Street. I think I’ll stick to being a doctor.

Biggest passion: My biggest passion is making our community a better place for children, so I’m lucky that my passion and career intersect. I am especially committed to promoting safe environments in schools. It is clear to me that Billings Public Schools makes this a prority, too. It has been a pleasure to work closely with the Superintendent and his colleagues toward this common goal.

On Billings Clinic: Initially, I joined Billings Clinic because of its national reputation for excellence. Today, I am committed to working at Billings Clinic because it’s clear to me that the reputation is wellearned.

Favorite band: I can’t get enough of old school hip-hop and 1990s grunge rock.

Most inspired by: My pediatrician, Dr. Richard Narkewicz. He was my doctor from 9 months to 21 years, when he politely told me I needed to see a doctor for grown-ups.

Dr. Mary Gaddy

Competitive Ballroom Dancer

By Day: Neurologist Second calling: Forest Ranger.

Guilty pleasure: A movie theater, a Friday night, and as much popcorn as I want.

Inspired by: My mother.

On Billings Clinic: The medical care at Billings Clinic is superior. Staff from ALL departments make my job so much easier.

▲ Dr. Jennell Duey,

Family Tree Board Member

By Day: Family Medicine Physician On choosing Family Medicine: I love taking care of families and being there for them in the most intimate times of their lives, from birth to the end of their lives. I really believe I have the best job in the world!

Second calling: Being a stay at home mom…preferably on a ranch.

Favorite hobby: Competitive racing and mountain biking.

Biggest challenge on the job: The documentation and paperwork, hands down. Caring for patients is the fun part!

First Job: Raising 4-H steers until I graduated from high school played a big part in putting me through college.

Off the ranch, my first job was as a CNA at a nursing home.

Dr. Charles Wittnam,

Chess Coach

By day: Internal Medicine Physician Second calling: University professor.

On choosing Internal Medicine: I always loved the challenge of diagnosis and managing multiple complex problems. Combining that with sharing in a patient’s life over time, and there’s really nothing else I’d rather be doing.

On the weekend: Gardening, fly fishing, hiking, working with computers and amateur radio, playing chess, and writing essays, short stories and poetry.

Greatest accomplishment: Raising two responsible kids with my wife.

Favorite song: “Gimme Shelter” by the Rolling Stones. When I hear that song I am 17 again.

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Docs By Day...

Dr. Larry Severa

Big Sky Honor Flight Volunteer

By Day: Family Medicine Physician Second calling: Working in a third world country on education, health care and development.

What I’m reading: Books on World War II. First paid job: My dad would “farm me out” to other neighbors to bale hay and do other chores on their farm.

Biggest passion: My faith and my family.

Greatest accomplishment: Being able to sit with someone in my office and see their quality of life and health improve.

Dr. Matthew Wolpoe

Lacrosse Coach

By Day: Facial Plastics and Ear, Nose,Throat Physician Second Calling: Believe or not, I’d be a lawyer. I love constructing arguments.

Just ask my parents.

▲ Dr. Michelle Pierson

Montana Make-a-Wish Advisory Council Member

Biggest “day job” challenge: Performing surgery on the face is very challenging.

The face is what defines us, and the difference between a great outcome and a disaster can be a millimeter or two.

On being a Montanan: I am a fourth generation Montanan, so this is my turf, my town and my people. Enough said!

On being a Montanan: My wife and I used to have a joke during my training at Johns Hopkins that I was going to quit and move to Montana and become a writer. Obviously I didn’t quit, but I still got to make Montana my home and take full advantage of the outdoors…from biking to skiing to hiking.

On Billings Clinic: Billings Clinic has the best structure and administration foundations to fulfill the medical needs of Montanans. We’re not part of a big conglomerate of hospitals with out-of-state governance…we are Montanans caring for Montanans…just as it should be.

Favorite Movie: Shawshank Redemption. In medical school I did not have cable, so in my free time I would watch this over and over. Sigh, confessions of a nerd.

Guilty Pleasure: I could spend all day watching American Pickers! I love those guys!

First job: Busing tables to save money for a U2 Concert.

By Day: Pediatrician Second Calling: Wedding planner.

On choosing pediatrics: I always knew I wanted to be a kid doc. Kids are cute, fun and resilient. Somehow getting puked on by a 2-year-old is more endearing than by an adult.

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Dr. Courtney Stout Paterson

Expert Angler

By Day: Pediatric Hospitalist Second Calling: A carpenter. I love building things and remodeling.

On choosing pediatrics: I actually did not go to medical school thinking I would be a pediatrician.

However, pediatrics was my first rotation and everything after that just paled in comparison. The perseverance of kids humbles me every day.

Biggest accomplishment: My kids.

Favorite Movie: No matter how old I become, I will probably always think the original Star Wars trilogy are some of the best movies ever made. I have my two big brothers to thank for that!

First job: I worked at the Dairy Queen in Bozeman. I can still make the signature swirl on top of a soft serve ice cream cone!

Dr. Guy Schmidt

Parachutist

By day: Orthopedic Surgeon

Dr. Scott Millikan Guitarist for the Midlife Chryslers

By Day: Cardiac, Thoracic and Vascular Surgeon Biggest Passion: Being a dad and a husband. Fishing, skiing, hiking and playing guitar take a close second.

On choosing Cardiovascular Surgery: Every day I get the opportunity to help take folks from a dangerous path and put them on a good path. Cardiac surgery is a good mix of science and art.

Greatest Accomplishment: Raising five great kids.

On practicing in Montana: Honestly, I live in Montana because Billings Clinic is here.

Our integrated model allows me to provide the best care for our patients.

On being Montanan: My family has been in Montana for generations.

My parents still live in the same house I grew up in! I was fortunate to be able to spend time training on both coasts, but I always knew that I would return home. I love that I only have a twelve minute commute (by bike).

On choosing Orthopedics: I love to operate, and for me, few things in life compare to the satisfaction and fulfillment of working to give each patient the best possible outcome.

On the weekends: You can usually find me riding my mountain bike or running on the rims or hiking The Back Nine. Last summer, two of my co-workers and I summited Granite Peak in a 30 hour roundtrip. Great adventures and great memories.

Greatest accomplishment: Receiving my United States Parachute Association license in 3 days. The license requires completing 25 solo jumps demonstrating specific maneuvers and tasks. I had to control my fear, focus mentally, and execute physically.

First job: Cleaning horse stalls.

First job: The day I turned 16 I worked as a bag boy at Lucky’s Grocery Store, and I stayed with that chain all the way through my first year of medical school.

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Docs By Day...

Dr. David Lehnherr

Ironman Athlete

By Day: Radiologist

On choosing radiology: I’ve always been drawn to images… looking at them and taking them. I love the technology of radiology.

Biggest “day job” challenge: I look at thousands of images every day, and have to pick out the abnormal from the much more common normal. I’m constantly searching for Waldo.

On being a Montanan: Montana is the last, best place.

At Billings Clinic the physicians are employees, and patient care is placed first. Period.

Guilty pleasure: Streaming movies from Netflix.

First Job: Working at the Ben Franklin store in Livingston.

Dr. Angela Goodman Equestrian

By Day: Family Medicine Physician Biggest Passion: Anything with four legs and fur, especially horses! Building a relationship of trust and understanding with an animal that is 700-1000 lbs and having them strive to do that task for me for nothing more than a pat on the head is amazing!

Favorite TV Show: I still love Friends! It got multiple friends of mine and me through med school.

Biggest “day job” challenge: The paperwork and documentation is the necessary evil of medicine.

Inspired by: My patients.

First job: Watering the neighbors' plants when they were on vacation.

Dr. Erin Stevens

Black Belt In Tang Soo Do Karate

By Day: Gynecologic Oncologist On the weekends: You can find me running my daily mile run on the rims or working out at the Power Martial Arts karate studio. I also love trying new restaurants!

On Montana: Although I was raised on the east coast, I love the person I am in Montana.

Biggest “day job” challenge: Delivering news to patients that they truly aren’t expecting is very challenging but I’m lucky to get to treat them at our Cancer Center. We have access to clinical trials, extraordinary support staff and a beautiful facility close to home, and at the end of the day, celebrating a remission makes the challenge worth it.

For the greater good: I love supporting the Billings community through fundraising activities from Relay for Life and Pack the Mall in Pink, to local road races for causes like the Ramsey Keller Memorial – the people in town are so giving of themselves.

First Job: Cashier at American Steakhouse in Meridian, Connecticut.

78 I THE Clinic TODAY

s g n i l l i B Clinic Thank you

For all you provide to our community.

Permanent Exteriors BRICK : STONE : BLOCK STUCCO : DRYVIT Dan Weis 406-860-3471 1045 Wilona Drive Billings MT 59105 danjweisl@bresnan.net

Congratulations Billings CliniC

1937 - 2012

5610 Interstate Avenue Billings, MT

We are proud to have worked, for over 75 years, alongside the great companies that help our community grow.

406-839-5035

THE Clinic TODAY

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Caring for

Community

Billings Clinic is a not-for-profit, physician-led medical group practice integrated with a hospital and long-term care facility based in Billings, Montana. Community stewardship includes financial assistance for the uninsured and underinsured, education, research and unreimbursed health services provided to the community each year.

Financial Assistance

Health Professions Education

Last year 6,000 patients received financial

The new Billings Clinic Internal Medicine

assistance (charity care) for 40,388 visits to Billings

Residency was accredited in 2013, and the first

Clinic at a total cost of $15.8 million. Of the total

class of physicians started in July. More than 700

assistance, 63% was for hospital patient care, 36%

college students in medical, pharmacy, nursing

for clinic patient care, and 1% for long-term care.

and other health professions received training at

Medicaid Shortfalls

Billings Clinic, as well as continuing education for

More than 100,300 patient visits were covered

by Medicaid, with shortfalls in government reimbursement of $2.9 million.

Subsidized Health Services Billings Clinic provides many health services that are not fully reimbursed for the cost of care provided – such as pediatric specialty care, telemedicine, long-term/continuing care, behavioral health and psychiatric care for youth and adults.

hundreds of health professionals in this region.

The Science Expo helped 360 students explore science and medicine.

Research Billings Clinic is dedicated to the pursuit of new medical knowledge with research that benefits patients with diseases such as cancer and diabetes for adults and children. Innovative research is also done by the Center for Clinical Translational Research, Nursing Research and National Cancer Institute Community Cancer Centers Programs.

View the 2013 Community Benefit Report online at billingsclinic.com (About Us)

80 I THE Clinic TODAY

Community Health Improvement Services and Support Support of programs to assist patients in the past year included: The Medication Assistance Program at Billings Clinic helped more than 3,200 patients receive free or low-cost medications (valued at $4 million).

Nearly 2,800 students received free injury prevention education at driver’s safety and brain and spine injury prevention programs.

Billings Clinic provides health care for rural residents in medically-underserved counties, including travel to Bad Debt and Medicare Shortfalls Community Benefits do not include the costs of bad debt or Medicare shortfalls.

The cost of bad debt for FY13 was $16.2 million for 134,200 medical visits.

The Medicare shortfalls were $25 million for 395,600 medical visits.

provide nearly 100 specialty care clinics per month at 23 regional locations for residents of rural Montana, Wyoming and North Dakota.

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Moving forward

82 I THE Clinic TODAY

Billings Clinic Building for ­— the Future

It is an exciting and rewarding time at Billings Clinic. Many transformative construction projects have been completed over the past year, bringing together award-winning care with innovative health care design. Reading the inspiring and touching stories patients and their families have shared in this publication truly brings home the vital importance of exceptional health care.

Billings Clinic’s obsessive dedication to patient safety, clinical quality, service and value is reflective in the

organization’s thoughtful strategic planning. The process is daunting as aging facilities and inadequate space must be addressed together with evolving care practices and advances in technology. With limited financial resources available to address these complex challenges, decisions are very difficult.

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Moving forward

A

As a community governed organization, Billings Clinic relies on the collective wisdom of a Board of Directors. They are committed, above all, to what is best for patients and the health and well being of the region. With the care of patients at the forefront, the Billings Clinic Board of Directors approved a number of critically needed facility expansion and renovation projects to be completed by 2015.

Making complex decisions in challenging times Moving forward on these projects was a weighty decision given the evolving health care delivery system in the United States. For the past two decades reimbursement from Medicare, Medicaid and other government and private health care insurers has been steadily reduced as personnel and supply costs continue to rise. This trend has contributed to a serious under-funding of the actual costs of providing quality care and is expected to not only continue, but worsen over time as more retirees enter the Medicare system. Adding to this uncertainty is the unknown fiscal impact to health care organizations with the implementation of the Affordable Care Act. “One of the most serious by-products of the financial pressures facing health care organizations across the country has been the severe shortage of capital funds to establish or expand vital clinical services and to replace aging and obsolete facilities and equipment,” said Connie Prewitt, Chief Financial Officer, Billings Clinic.

Working to cut costs sensibly Billings Clinic understands the significant impact of health care costs on individuals, families and businesses. In 2010, the Billings Clinic Board of Directors added the cornerstone principle of “value” to Billings Clinic's vision statement, rededicating themselves to controlling health care costs. As well, Billings Clinic initiated a cost-saving program focusing on continuous improvement, common problem solving and eliminating unnecessary waste without sacrificing quality patient care. The projected financial benefit from Billings Clinic’s Operational Excellence initiative since its inception in July 2008 is approximately $41 million.

Financing large capital improvements in health care today So how do health care organizations pay for greatly needed capital improvements? Not-for-profit health care organizations, including Billings

84 I THE Clinic TODAY

Clinic, have three options: pay for projects from yearly income, borrow the money, or raise money through philanthropy. Billings Clinic does not pay for these projects by raising the cost of services to patients.

It is extremely difficult to fund significant capital improvements solely out of earned income. The replacement of aging equipment, investment in new technology and routine care and maintenance of facilities all vie for funding each year. Billings Clinic’s slim operating margins are, in large part, a conscious decision driven by the needs of patients. Regardless of the impact certain services have on the bottom line, Billings Clinic is steadfast in its belief that all individuals deserve health care, regardless of ability to pay and regardless of the financial return to Billings Clinic. In 2013, Billings Clinic provided over $35 million in community benefit to the region, including $15.8 million in financial aid (charity care) to over 6,000 needy patients.

Funding health care excellence through philanthropy Billings Clinic Foundation launched the Facilities Expansion and Renovation 2012-2015 Campaign in support of these much needed construction projects that will improve patient care for generations to come.

Billings Clinic is fortunate that the regional community is filled with visionary individuals, foundations and corporations who understand the critical need for philanthropy in health care and want to make a difference in the level of care available for their families, friends and communities. Bringing together the fundraising power of the Classic since 2010 and the generosity of over 2,000 donors, Billings Clinic Foundation has raised $7.4 million dollars to date toward the needed $9 million. For more information on the campaign or ways to help, contact Billings Clinic Foundation at 657-4670.

Opposite page: The main entrance to Billings Clinic Hospital.

Top: Billings Clinic Commons is the front door to over 500,000 patient visits each year. Above: Steel workers secure framework for The John R. Burg MD Cardiac Center.

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Thank You

Your Gift Gives Hope‌ You give hope to others you may never meet.

You lend a helping hand during what may be the most difficult time in a patient’s life.

You partner with us to provide innovative programs.

You create outstanding facilities where our patients heal.

You inspire us to deliver the very best care.

On behalf of the Billings Clinic Family, thank you to the countless donors who have made a difference in the lives of others through a gift.

We are forever grateful for the trust you have placed in us.

Billings Clinic Foundation

86 I THE Clinic TODAY

Congratulations Billings Clinic We are proud to be your business partner.

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406-256-7823 240 Moore Lane THE Clinic TODAY

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Moving forward

The Campaign for the Expansion and Renovation of Billings Clinic 2012- 2015 1) John R. Burg MD Cardiac Center – Construction of the 35,000 square foot center was completed this spring. Located within the downtown multispecialty clinic, the center provides advanced cardiac care in a warm and supportive environment. Most importantly, the location of the new center will allow for even greater interaction and coordination between key services lines such as primary care, surgery and the hospital.

2) Intensive Care Unit – This January marked the opening of Billings Clinic’s new 24-bed intensive care unit. By constructing this unit in unoccupied space above the Emergency and Trauma Center, the planning and design team were able to build a best in nation unit to care for the sickest of patients.

In addition to each room being equipped with state-of-the-art technology, special space was created for families allowing them to stay comfortably at the bedside of their critically ill family member.

3) Operating Rooms – With the final stages of the operating room expansion and renovation to be completed in 2015, the greatly expanded space will allow for all phases of the

surgical experience to take place on the same floor. All operating rooms will be expanded and completely renovated with patient safety incorporated into all design decisions.

4) Cardiovascular Unit - The 29-bed unit opened this March and is primarily dedicated to the care of patients with heart or vascular disease. The new unit addressed many of the challenges of the old unit and provides patients with spacious private rooms with handicap accessible bathrooms and dedicated space for patients to undergo rehabilitation from their illness.

5) Family Birth Center and Neonatal Intensive Care Unit Expansion – Just completed this May, the expansion of five cribs in the Neonatal Intensive Care Unit and six rooms in the Family Birth Center will allow more families to begin their first days of life together under the compassionate and skillful guidance of our staff.

6) Inpatient Pediatric Unit – Billings Clinic will open a six bed pediatric unit for hospitalized babies and children later this year. The unit is being designed to minimize the fear and stress on young patients while supporting the family, who is critical to the child’s care and well being.

7) Medical Laboratory –

7

5

Expansion of the laboratory began this summer and will allow Billings Clinic to keep pace with the growing numbers of patients being seen throughout the region.

6

8) Expansion and Renovation of the Clinic –

3 2

1

4 8

9

Multiple departments in the multispecialty clinic are experiencing a shortage of clinical space to meet current demand and future growth. Renovation of the clinic is planned to help meet this pressing need.

9) Reger Family Center for Breast Health –

NORTH 88 I THE Clinic TODAY

Design team and staff incorporated what women asked for: warm robes, private rooms with entrance to the mammography suite, beverage area and the latest 3D technology.

Congratulations

PROUD TO HAVE BEEN

to the BIllIngs ClInIC

It is an honor to be a key partner in your success.

A PART OF THIS PROJECT

Graybar of Billings, is one of Graybar’s 240 North American locations. Graybar is a leading distributor of high-quality electrical, communications and data networking products, and specializes in related supply chain management and logistics services.

1465 Monad Road Billings, MT 59101

Locally and family owned business founded in 1976.

Phone:

(406) 252-0171 www.graybar.com

r g n o C

s n o i t a l u t a

Billings Clinic We are proud to be involved with this project!

Specializing in commercial projects Licensed. Bonded. Insured.

2915 Hannon Rd. • 406-245-6100

406-252-3566 www.hlostermiller.com l

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For more than 40 years at Montana-Wyoming Systems, we have offered solutions to protect people and what’s important to them, all while simplifying lives. Our philosophy is simple: We strive to not only meet our customers’ needs, but to exceed them.

Congratulations Billings CliniC

We look forward to working with you in the future!

406-252-4334 mtwysystems.com THE Clinic TODAY

I 89

Billings Clinic has a proud tradition in Nursing Excellence.

Congratulations Billings Clinic DECORATORS, INC.

943 Poly Drive, Billings, Montana 59102 245-4606

Parking Lot Stripping CONGRATULATIONS BILLINGS CLINIC! HaPPy to be a Part of your renovation!

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New Construction - Residential - Commercial

259-1956 – LocaLLy owned & operated

AAA Striping Service Inc.

BEFORE

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Bob Adler • 406-248-5539 • 138 Orchard, Billings, MT 59101

Thank you

Billings Clinic for allowing us to assist you with microbial control during this construction process. We were proud to provide a safe indoor environment for everyone.

Indoor Air Quality, Fire and Flood Restoration

90 I THE Clinic TODAY

• Doors • Frames • Door Hardware • Windows

New Doors Are Opening!

Congratulations Billings Clinic

We are proud to have been a part of your building project!

125 Regal Street • Billings, MT. 252-0131

Service is our First Priority

THANK YOU BILLINGS CLINIC FOR ALL THAT YOU DO!

Family Owned & Operated Since 1958

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Heating, Ventilation and Air Conditioning Contractors Commercial – Industrial Institutional Systems Custom Metal Fabricators

Security Management Systems

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Billings, MT 59102 1045 Central Avenue, Billings, MT 59102 Office: 406.245.1533 Billings, MT 59104 Fax: 406.245.7732 • Cell: 406.855.5596 FAX: (406) 245-7732 • (406) 245-3141 E: rickt@bresnan.net

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PO Box 30776 Billings, Montana

Phone: 248-1757 • Fax: 248-6320 Sheet Metal and Air Conditioning Contractors National Association – SMACNA

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We appreciate being a part of your construction team.

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SowleS Steel erectorS thank Hardy construction for making us part of their team on this successful project.

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Congratulations

BILLINGS CLINIC It’s been a pleasure and we look forward to the future!

406.248.4361 www.sowles.com

KC Interior Construction 134 Yellowstone, Billings MT 59101

406-860-8035 THE Clinic TODAY

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Reflections

Every day unfolds differently at Billings Clinic as patients and their families enter our doors with a variety of needs and

concerns. We have the incredible privilege of listening to their stories. We may hear the story of their day, their health crisis, or their lives. Our goal is to come alongside, make a personal connection, and discover how we can offer support.

We seek to bring healing, hope, caring, and to change lives.

Whether our patients come to Billings Clinic for an hour’s appointment, outpatient therapy, or a hospital stay, our prayer is

that all who need renewed health will find encouragement and help in our care.

I’m so grateful for our Billings Clinic family. Our donors help us to keep learning, growing, dreaming, and developing, whether we are building a new medical unit, pioneering a leading-edge program, or promoting personal service excellence. Our volunteers gift us with their time, energy, and wisdom. Our roles as staff members may vary from mending hearts, tending wounds, or cleaning rooms, to offering a prayer or delivering a meal, to checking vital signs or creating discharge plans, but our aim is the same--to support patients physically, emotionally, and spiritually with compassion and kindness.

Every life has a story. Every story is important. We have the deep honor of touching the lives of our patients and their families

at tender moments when our stories connect. And in those sacred moments, our lives are touched and changed and we are blessed.

­— Pastor Susan Thomas Billings Clinic Chaplain

92 I THE Clinic TODAY

Congratulations Billings Clinic

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We’re so proud to have assisted in the expansion of the beautiful suites in the Family Birth Center.

Top op Line Services, LLC Final Construction Clean-Up Concrete Staining & Sealing Diamond Polishing

252-5239 • toplineservicesLLC.com THE Clinic TODAY

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The Future of Medicine

Dawn of a New Day Billings Clinic Internal Medicine Residency Program

Billings Clinic is committed to addressing the serious shortage of primary care physicians practicing in our region. As the only Internal Medicine Residency Program in the state of Montana, six or more new Internal Medicine physicians will graduate each year with the hope they will choose the "last best place" to call home.

Internal Medicine Residents: (L-R): Reno Terribilini, MD; Malathy Tharumarajah, MD; Thomas Grillot, MD; Sindy Byington, MD; Sean Jones, MD; Noelle Thomas, MD; Sierra Gross, MD; David Stordahl, MD; Brenda Nyamogo, MD; Giorgos Hadjivassiliou, MBBS; Shelby Halsey, MD; Jot Preet Singh Sahi, MD

94 I THE Clinic TODAY

Helping make life easier for you and your family.

- Locations BiLLinGs (406) 252-3441

BoZEMan (406) 556-1430

BUttE (406) 533-6892

HELEna (406) 449-4165

KaLisPELL (406) 752-6644

MissoULa (406) 523-3600

BisMaRcK (701) 223-6585

WiLListon (701) 572-2200

casPER (307) 265-2279

cHEYEnnE (307) 426-4100

sHERiDan (307) 673-3000

a commitment to Quality since 1895 www.crowleyfleck.com Clinic 95 THE

TODAY

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ClinicTODAY ClinicTODAY

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If you work for Billings Clinic, you’re seeing it all come together.

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There’s just

one piece left for you.

You’re an exceptional person if you work in Healthcare.

96deserve I THE Clinic TODAY You an exceptional credit union. Montana Health.

MontanaHealthFCU.org