MED- Midwest Medical Edition April/May 2017 by MED- (Midwest Medical Edition)

Area Hospital Leadership Changes

2017

Health Data in the Cloud

APRIL /MAY

Interview: Opioid Addiction and the ER

Vol. 8 No. 3

The Edith Sanford Breast Center Integration and Collaboration for World Class Care

THE SOUTH DAKOTA REGIONâ&#x20AC;&#x2122;S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

ALI HAJJAJ, MD

MUMTAZ NIAZI, MD

Liver Disease

HESHAM ELGOUHARI, MD Liver Disease

JEFFERY STEERS, MD Transplant Surgery

CHRISTOPHER AUVENSHINE, DO Transplant Surgery

VICTOR SCOTT, MD

Transplant Anesthesiology

MIDWEST MEDICAL EDITION

Contents

The Edith Sanford

VOLUME 8, NO. 3 ■ A PR I L / M AY 2017

REGULAR FEATURES 4 | From Us to You 5 | MED on the Web The Sanford Data Collaborative, Dress in Blue Day for Colon Cancer, Your Policies and Procedures Manual

ON THE COVER

IN THIS ISSUE

An interview with Jared Friedman, MD, Clinical Vice 9 | Sioux Falls “Rocks the Red” at this year’s President, Emergency Go Red for Women Event Medical Service Line, Avera Health 10 | Benefits for You, Your Employees and Your Business ■ By Dave Starr Salary is no longer the only determining factor when an applicant accepts or declines a job offer.

19 | Ditch the “Rules” to Create Positive Corporate Culture ■ By Carmella Biesiot How getting up close and personal with coworkers can boost a company’s bottom line.

22 | Maintain Accurate Medical Records to Minimize Legal Risk ■ By Jeremy Wale

23 | Finnish “Baby Box” Tradition Comes to Madison

■ By Thomas Johnson

25 | Sanford Health Collaborates with Florida Hospital on Gene Sequencing Project

26 | Accolades for Avera’s Lab and Perinatal Care 28 | New West River Mental Health Alliance Leaders of three West River organizations join forces to expand options for mental health care

30 | Fostering Resilience: Discovering the Seven C’s 32 | Taxation of Investments ■

By Mark Schlueter How do you report investments, and how are they taxed?

| Exam Room Manners ■ By Alex Strauss These simple communication tweaks can help establish better rapport with patients.

27 Leadership Changes at Rapid City Regional Hospital

Health

Vol. 8 No. 3

The Edith Sanford Breast Center Integration and Collaboration for

World Class Care

Protected Health Information Migrates to the Cloud

Area

Data Leadership in theCarrels ByHospital Peter Changes Cloud

2017

Upcoming spring and early summer events

ER Doctors First Line of Defense Against Opioid Addiction

Interview: Opioid Addiction and the ER

APRIL /MAY

35 | Learning Opportunities

INTEGRATION AND COLLABORATION FOR WORLD CLASS CARE

12 | New! Medical cartoonist Jonny Hawkins brings his unique brand of humor to MED

Breast Center

page

THE SOUTH DAKOTA REGION’S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

By Alex Strauss

The Edith Sanford Breast Center in Sioux Falls offers an integrated approach to breast health that has opened the door for important collaborations and valuable clinical trials. We talk to leaders in research and patient care for this month’s cover feature.

page

From Us to You Staying in Touch with MED

ELCOME to the April/May issue of MED, the region’s longest-standing and most-respected business publication exclusively for medical professionals in the South Dakota region. Whether this is the first time you have picked up our publication, or you are a long-time reader, we trust that you will find something here to enhance both your practice and your life. To that end, in this issue we bring you articles on how your investments are taxed, how to manage your medical records to minimize the risk for legal issues, the implications of the migration of healthcare information to the “cloud”, and expert tips on creating a corporate culture that is both positive and profitable. Of course, we also have all the region’s most timely medical news, including our cover feature on how the Edith Sanford Breast Center is expanding treatment options for patients as part of a new national collaborative research effect. Finally, we’d like to welcome MED’s new “official cartoonist”, Jonny Hawkins. Hawkins is the creator of the popular Medical Cartoon a Day calendar, now in it’s 13th year, and his work has been featured in hundreds of publications including Reader’s Digest and Medical Economics. We hope you’ll enjoy his take on the lighter side of medicine. As we begin work on our summer issues, we want to remind you that MED’s mission is to be a communication tool for our wide and diverse medical community. Got an interesting case, an upcoming event, an absorbing hobby, or a new service offering to share with your colleagues? Send it our way at info@midwestmedicaledition.com. Best wishes, —Alex and Steff

MED QUOTES

“

A warm smile is the universal language of kindness. —William Arthur Ward

May 1 Next Advertising deadline May 5 Next Contribution deadline

”

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

VICE PRESIDENT

SALES & MARKETING Steffanie Steffanie Liston-Holtrop

Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER studiofotografie Alex Strauss

WEB DESIGN Locable DIGITAL MEDIA

DIRECTOR Jaclyn Small CONTRIBUTING WRITERS Carmella Biesiot

Jonny Hawkins

Thomas Johnson Mark Schlueter Dave Starr Jeremy Wale

STAFF WRITERS Liz Boyd Caroline Chenault John Knies

MARKETING DIRECTOR Erika Tufton

Reproduction or use of the contents of this magazine is prohibited.

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@ midwestmedicaledition.com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@ midwestmedicaledition.com. MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

CONTACT INFORMATION Steffanie Liston-Holtrop VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com Fax 605-231-0432 MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109 WEBSITE MidwestMedicalEdition.com

MED welcomes reader submissions!

More Than a Magazine

A MEDICAL COMMUNITY HUB! ARE YOU ON THE LIST? Add your business or practice to MED’s FREE online directory and get noticed! MED’s comprehensive and searchable online business directory makes it easy to find any business or practitioner. Thousands of area healthcare professionals visit MED’s website every month. Take a moment to list your business for free and make sure those who need your services can find you.

2017 Advertising EDITORIAL DEADLINES Jan/Feb Issue December 1 March Issue February 1 April/May Issue March 1 June Issue May 1 July/August Issue June 1 Sep/Oct Issue August 1 November Issue October 1 December Issue November 1

This month

only on the Web

Madison Gets the Blues

Disease Detectives

It’s in the Manual

Madison Regional Hospital employees go blue to raise awareness of the need for colorectal screening in cancer prevention.

Researchers from area universities and private institutions are using real-time data from Sanford Health to study patient trends in an effort to identify the underlying causes of various illnesses.Read about the Sanford Data Collaborative.

Expert advice on the value of having a policies and procedures manual for your practice and exactly what should be in it.

Stay up-to-date between issues of Sign up for previews of upcoming articles and advance notice of the next digital edition.

Emergency Doctors First Line of Defense Against Opioid Addiction A recent New England Journal of Medicine study suggests that too many cases of opioid addiction start with a short-term prescription obtained at an ER visit.

Jared Friedman, MD, Clinical Vice President, Emergency Medical Service Line, Avera Health MED: ER physicians often see the fallout of opioid addiction. Do you think we have a problem in our area? Dr. Friedman: Unfortunately, yes, and we will likely continue to see the effects of it. It is not as bad here as it is in other places, but even one life lost to addiction is a tragedy. It is one of the reasons for last year’s legislation that equipped first responders in our region with naloxone. Now, pharmacies can also counsel people and offer naloxone. MED: This study suggests that addiction often starts with an ER visit. Why do you think that is? Dr. Friedman: CMS called pain “the fifth vital sign” and said we have to address it. So I think the pendulum swung to treating all and every pain. Now, we have to swing back. Part of that is managing patient expectations about tolerable and manageable pain. They have to understand that it isn’t realistic to expect to leave the ER with no pain at all.

MED: Most of the patients that come into the ER are strangers to you. How do you decide when to write a prescription for an opioid drug? Dr. Friedman: There is no objective test to determine whether a patient does or doesn’t have pain. We try to evaluate the patient and look at all of their risk factors. People with certain psychological diagnoses or other addictions are at higher risk for becoming addicted if we prescribe an opioid drug. It also depends on the type of pain. Treatment of acute pain is different from chronic pain. For chronic pain, opioids are not effective. In addition, we try to use non-opioid agents or patches, or even home remedies like icing and elevating, whenever possible. If all other alternatives have been tried or are ineffective, then we may prescribe an opioid but only for a short period of time. MED: What is being done to help reduce the risks for opioid addiction among Avera patients?

that a step further to develop a standardized chronic pain management contract. This goes into the patient’s medical record, so if they come into my ED, I can see that and have a discussion with them. Another thing that helps is the prescription drug monitoring program accessible through the state Board of Pharmacy. This is helpful in drug diversion because I can log in and see if a patient has had an opioid prescription recently. ■ According to the American College of Emergency Physicians, pain is the most common reason patients come into the ER and ER physicians see more patients in acute pain than in almost any other medical setting.

Dr. Friedman: An ad hoc subcommittee of the SD State Medical Association has developed best practices for prescribing of opioids for noncancerous pain. We have taken

MED QUOTES

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April hath put a spirit of youth in everything. —William Shakespeare

”

Midwest Medical Edition

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Together we have the power to prevent heart disease and stroke.

For over a decade, Go Red For Women has been empowering women to proudly wear red, sharing our stories of survival and elevating awareness that heart disease and stroke kill 1 in 3 women — more than all cancers combined. Together, we are stronger and unstoppable. Join us at GoRedForWomen.org

Locally sponsored by

Go Red trademark of AHA, Red Dress trademark of DHHS. 7/16DS11244

Heart disease survivor Meliah, heart transplant survivor Annemarie, stroke survivor Emily and heart disease survivor Pkaye B0735_DAK_GRFW_MED_Ad_7x4.6.indd 1

3/6/2017 2:08:19 PM

Symptoms of Heart Attack in Women ♥ Pressure or fullness in the chest that lasts more than a few minutes ♥ Pain or discomfort in one or both arms, the back, neck, jaw or stomach ♥ Shortness of breath, with or without chest pain ♥ Cold sweat, nausea, lightheadedness

See more photos from the event on our website.

Midwest Medical Edition

Sioux Falls “Rocks the Red” at this Year’s Go Red for Women Event HUNDREDS OF SIOUX FALLS AREA heart and stroke survivors, physicians, and business and community leaders “rocked their red” in celebration of Heart Month at this year’s Go Red for Women event on February 16th at the Sioux Falls Convention Center. The program featured a social hour, a silent auction, and a keynote from Melissa Johnson, founder of Oh My Cupcakes! in Sioux Falls. Event attendees also heard from other survivors and experts on ways to identify and lower their risk for heart disease and stroke. Heart disease and stroke cause 1 in 3 deaths among women each year - more than all cancers combined. The American Heart Association’s annual Go Red for Women event is designed to raise funds for research and education and promote public awareness of this largelypreventable problem. MED was once again a proud member of the Circle of Red and MED’s Steffanie Liston-Holtrop will co-chair next year’s event along with Katie Iverson, owner of the Glamour Defined boutique in Sioux Falls. ■

Katie Iverson and Steffanie Liston-Holtrop, co-chairs of Go Red 2018.

(l to r) Sarah Olson, Sanford Business Development Specialist, Amanda Saeger, Director of Sanford Vascular Associates, Diabetes & Thryoid and Nephrology Clinics, Dr. Maria Stys, Sanford Cardiologist, Medical Director of the Women’s Heart Program, Jennifer Klawitter, Director of Sanford Cardiology, Cardiac Specialty Unit, & Cardiac Rehab, Erika Tufton, MED Marketing Director, Lynn Thomas, Director of Sanford Cardiovascular Institute, Business Development, Screening Center and Center for Health and Well-being, Dr. Tom Stys, Interventional Cardiologist, Medical Director of the Sanford Heart Hospital and Professor of Medicine at University of South Dakota Sanford School of Medicine, Deb Griffith, Executive Director Sanford Heart & Vascular.

April/May 2017

MidwestMedicalEdition.com

Benefits

for You, Your Employees and Your Business

By Dave Starr MPLOYEE BENEFITS ARE A POPULAR TOPIC TODAY. This is because in today’s

job market, more employees are beginning to place value on employer-provided benefits. Salary is no longer the only determining factor when an applicant accepts or declines a job offer. Employees are increasingly interested in what else the employer has to offer, such as life, health, disability and retirement benefits. As a business owner, you’re probably interested in benefits, too. Chances are you’d like to provide benefits for yourself and your employees – and benefit your business. Employersponsored benefit plans provide many advantages for all involved.

Advantages for the Employee Employer benefit plans provide employees with coverage they may not have purchased on an individual basis. These benefits are usually provided at little or no cost to the employee. In addition, some benefits are also available for the employee’s spouse and children. Any employee costs associated with the benefit plan are usually collected through convenient payroll deduction plans. Payroll deduction allows employees to pay monthly, rather than annual premiums, and saves them the cost and hassle of writing checks.

Advantages for the Business Owner Benefit plans also provide many business advantages. They help attract and keep valuable employees. In today’s competitive job marketplace, a good benefit plan can make the difference between hiring or losing qualified job applicants. Benefit plans also boost employee morale and provide a sense of security. Employees appreciate the benefits you’re providing. They know they’re covered in case of a medical emergency – or if they become disabled. Benefit plans may provide a current tax deduction for the business.Or there may be a tax deduction available when the benefits

are paid out. Some plans include future cost recovery provisions.

Qualified vs. Nonqualified Benefits Choose between two categories of benefit plans – qualified and nonqualified.

Qualified Benefits Regulated by the Internal Revenue Service and Department of Labor, qualified benefits must be approved and comply with nondiscrimination, funding and reporting requirements. Your business receives a current tax deduction for premiums paid, within limits. Plan participants are not taxed on life and health plan premiums and benefits, within limits, and are usually allowed to defer taxation on retirement plan contributions until withdrawn.

Nonqualified Benefits Nonqualified benefit plans are more flexible because they aren’t regulated as strictly as qualified plans. Unlike qualified benefit plans, you, the employer, can pick and choose which employees you want to cover in the plan. That’s why nonqualified plans are sometimes called “executive benefits.” Executive benefit plans can provide either a current tax deduction or future cost recovery feature.

Which Plan Is Right For My Business? Many businesses find that a combination of the two work best – a broad plan covering all employees and a supplemental plan covering only “key” people. Each business and business owner is unique. You should decide which benefits you want to provide, evaluate your current benefit plan and then adjust your plan to fit your needs. The best plan is a plan that meets your objectives – for your employees, your business and you. ■ Dave Starr is Regional Managing Director with Principal Financial Group in Sioux Falls.

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April/May 2017

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Protected Health Information Migrates to the Cloud By Thomas Johnson

EALTHCARE FACILITIES, HEALTH PLANS, AND BUSINESS ASSOCIATES

are increasingly turning to cloud service providers to store, maintain and, at times, wholly manage, the company’s electronic protected health information (ePHI). As covered entities and business associates migrate their data to the cloud, these entities need to take a closer look at their obligations under HIPAA’s Privacy Rule and the Security Rule. When a covered entity or business associate contracts with a cloud service provider, the cloud service provider, generally, is a business associate of the hiring party. As a threshold matter, the covered entity or business associate needs to enter into a business associate agreement with the cloud service provider that complies with the Privacy and Security Rule. This agreement, often used alongside or as an attachment to a larger, service-level agreement, establishes the permitted and required uses and disclosures of ePHI by the cloud service provider.

Generally, when engaging a cloud service provider to receive or transmit ePHI, the cloud service provider’s experience and knowledgeability of HIPAA’s requirements will become immediately apparent at the time of initial contracting. Just as a covered entity is obligated to identify, among other things, its risk management processes and procedures in a HIPAA risk analysis, so to must the cloud service provider. Both parties must identify and assess potential threats to the confidentiality, integrity, and availability of all ePHI they create, transmit, and store.

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It is not unreasonable for a covered entity to request access to or disclosure of a cloud service provider’s data security protocols. The level of services provided by a cloud service provider will vary based upon the covered entity or business associate’s needs and complexity. A cloud service provider that provides “storage only” services is functionally different from a cloud service provider that has full access to the ePHI that it maintains. Nonetheless, the cloud service provider is obligated to comply with the Security Rule and for implementing reasonable and appropriate controls to safeguard the ePHI in its systems. The contractual relationship between the covered entity or business associate and the cloud service provider will provide for the respective obligations of each party for complying with the Security Rule. Compliance with and enforcement of these contractual obligations will be viewed by the Office of Civil Rights as an important factor during any compliance investigation of either the covered entity or the cloud service provider. In all, covered entities and business associates who utilize cloud computing services need to be aware of the implications of transmitting or maintaining their ePHI on the cloud. HIPAA compliant business associate agreements and comprehensive service-level agreements should be implemented to ensure that the confidentiality, integrity, and availability of ePHI is maintained. ■ Tommy Johnson is a healthcare attorney specializing in health information technology and data privacy at the Boyce Law Firm in Sioux Falls.

April/May 2017

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The

Edith Sanford Breast Center By Alex Strauss

VEN BEFORE THE Edith Sanford Breast Center opened the doors of its 48,000 square foot facility on the Sanford campus in Sioux Falls this year, it was already on the leading edge of cancer centers nationwide. This spring, with an eye-catching new space and integrated approach to breast health, including screening and diagnostics, genetic testing and counseling, cutting edge treatments, navigators, an extensive biobank, and clinical research associates in one setting, the center was poised to turn some heads. And turn them, it has.

BREAKTHROUGH RESEARCH In February, Cancer Breakthroughs 2020, the world’s most comprehensive cancer collaborative focusing on combination immunotherapy, announced the selection of Sanford Health as one of three sites nationwide to launch the program’s first clinical trial, an immunotherapy vaccine for patients

with unresectable or metastatic HER2expressing breast cancer. “This first trial is taking the concept of a cancer vaccine and bringing it to patients for the first time in this manner,” says medical oncologist Steven Powell, MD, a clinical investigator for Sanford Research. “It utilizes a genetically engineered adenovirus to stimulate an immune response. Essentially, it is teaching the immune system to recognize and attack breast cancer.” Cancer Breakthroughs 2020 was created in 2016 to facilitate collaboration among multinational pharmaceutical, biotechnology companies, academic centers and community oncologists in an effort to test novel immunotherapy protocols in combination with other treatment methods. The goal is to support the development of an effective vaccine-based immunotherapy to combat cancer by 2020. Sanford Cancer Center, a 2016 recipient of the ICLIO (Institute for Clinical Immuno-Oncology) Innovator

Award in recognition of its efforts to enhance treatment options with immunotherapy, has been involved with Cancer Breakthroughs 2020 since its inception. “We have a reputation of getting these types of trials up and running quickly because we are an integrated health system,” says David Pearce, PhD, executive vice president for Sanford Research. “Edith Sanford Breast Center has provided the infrastructure and focus to implement trials like this new vaccine trial. It gives us the capability to bring additional treatment options to our patients. This vaccine which will be the next step for patients who haven’t responded to other treatments for this type of breast cancer.” As immunotherapy plays a larger role in cancer treatment, genetic testing becomes more and more important. Powell says Sanford is ready. “We have a very comprehensive precision medicine program here,” says Dr. Powell, who chairs Sanford’s molecular tumor board. “We provide and

Integration and Collaboration for

World Class Care

review genetic testing on patients with all types of cancer and now have over 60 treatment options for patients who have had this testing.” The Cancer Breakthroughs 2020 vaccine trial is just one of a dozen breast cancer trials currently underway at Sanford. Some are focused on new therapies while others are exploring new options for symptom control, nausea prevention, risk factors, etc. “What’s cool is that we get to see results because of these clinical trials,” says Tiffany Facile, Sanford’s Enterprise DIrector of Clinical Research Operations. “When one of our patients receives a grave diagnosis but they are still here talking to us after three years because of a clinical trial, that is very exciting for us.”

BIG DATA TO GUIDE TREATMENTS Recognizing that data is empowering, Sanford Health recently became one of the first healthcare organizations in the country

Dr. Steven Powell

to join CancerLinQ, a national nonprofit whose purpose is to provide members with access to real-time patient data to guide cancer treatment. This learning database is comprised of 75 centers (and counting), all of whom are sharing patient data with a view toward tailoring cancer treatments that are,

as Sharon Hunt, Executive Director, Sanford Cancer, says, the “most effective and the least punishing”. “If I am trying to figure out how best to treat your breast cancer, looking at the global picture of everyone who has been treated this way can be invaluable,” says Hunt. “Our

Sanford radiologist Dr. Thomas Cink consults with a radiology technician at the Edith Sanford Breast Center

Sharon Hunt

Tiffany Facile

physicians can now go into this database and say, ‘Here is Sharon. Here is everything about her cancer and here are the outcomes that others like her have seen’. Then they can use that data to decide what is next for that patient.” The project is funded by a grant from the American Society of Clinical Oncology and donations through Conquer Cancer Foundation. CancerLinQ incorporates ASCO’s clinical guidelines and QOPI quality measures–the gold standards for clinical decisionmaking and assessment of quality of care. Sanford Health is the only healthcare system certified by ASCO in their Quality Oncology Practice Initiative in both North Dakota and South Dakota.

PERSONALIZED DIAGNOSTICS In addition to providing a campus “home” for the comprehensive treatment of breast cancer, the Center also houses all of the advanced technology needed to screen for it. The addition of another

3D mammography unit means that more patients can be screened more rapidly. The Center also offers stereotactic biopsy for both prone and upright 3D imaging. Contrast -enhanced mammography recently became available and whole breast ultrasound is on its way. (See sidebar for a full list of diagnostic services) “These different technologies all have their place,” says Hunt. “Again, it is about figuring out the best screening plan for each individual patient. More tools means we can better individualize our screening.” Even with all the best tools in place, one of the most important features of the Edith Sanford Breast Center is one that can’t even be seen. The Initiative that underpins the work being done here is focused on unravelling the complex genetics behind breast cancer with a view toward prevention, earlier intervention, individualized treatments and, ultimately, a cure. An example is the national “Women Informed to Screen

Depending on Measures of Risk” or WISDOM trial. Through a collaboration with Athena Breast Health Network, a national breast cancer research project, Sanford’s genomic lab will become a repository for specimens collected in a five-year study of personalized breast cancer screening based on genetic testing. The trial will enroll 100,000 consenting women across the US. “Right now, we try to characterize risk through mammography, but WISDOM adds genetic analysis to that,” says Dr. Pearce. “This is a way for us to get a better idea of who is actually at highest risk, based on more than just breast density.” “The current guidelines for breast cancer screening are very generalized and outdated,” says Facile. “For a woman who has to have multiple biopsies, the emotional and psychological burden can be very difficult. The WISDOM trial will compare traditional mammography and a more personalized risk-based

Midwest Medical Edition

“

EDITH SANFORD BREAST CENTER HAS PROVIDED THE INFRASTRUCTURE AND FOCUS TO . . . BRING ADDITIONAL TREATMENT OPTIONS TO OUR PATIENTS. — Dr. David Pearce

”

approach to determine if one is safer or more effective and financially responsible than the other.” Sanford plans to open enrollment for the WISDOM trial this summer with hopes to enroll more than 20,000 patients. Women aged 40 to 74 who have not had a prior breast cancer diagnosis and receive care at an Athena site like Sanford are eligible to enroll.

UNDER ONE ROOF Although many of these collaborations and innovations were underway before the Edith Sanford Breast Center building opened, Hunt says having so many elements of breast health under one roof is a benefit to all patients, regardless of why they have come here. “Instead of having to work around the way buildings were designed 20 years ago, we were able to take information and ideas and frustrations from patients, families, and clinicians and construct a center that supports breast care delivery models of the future, right now,” she says. A big part of that model includes the recognition that to be truly effective, breast care must encompass all aspects of the patient and family experience– from diagnosis and screening, through treatment, and beyond. The building welcomes patients with a calming, wood-tone interior but also with evidence of advanced

April/May 2017

care; the molecular genetics laboratory with its glass front and the breast clinic for high risk women are also right up front. Importantly, the building is also designed with plenty of “nooks and crannies” to facilitate the integration of research associates into the Center’s day-to-day patient care activities. “Before the building, we didn’t have space for research associates to hang out in the clinical space,” says Hunt. “Now, they are able to interact on a daily basis with our navigators. That physical proximity helps us to generate a team that clicks along and works best for patients.” Patients who come here for screening enter a different area from those who have been diagnosed. For breast cancer patients, the building features larger exam rooms to accommodate multiple clinicians or family members and conference space where each case can be discussed by a multidisciplinary team. More than 67 commissioned art pieces adorn the walls and patients themselves are invited to express their own feelings in special art creation areas. The Kirby lobby features dedicated computers for breast cancer research and education. “Cancer is an anxious time and information helps to mitigate that anxiety,” says Hunt. “We have tried to create an environment that is as supportive as possible for patients as they go through this journey.” ■

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Breast Health

Imaging Services at Edith Sanford

• Low Dose 3D Screening Mammography • Screening/Diagnostic Digital Mammography • Computer Aided Detection (CAD) • Breast Ultrasound • Breast Ultrasound Guided Biopsy and Aspiration • Stereotactic Core Biopsy • Pre-op Needle Localization • Breast Specific Gamma Imaging • Breast MRI • Mammosite • Regional and Local Mobile Mammography Service • Bone Density Testing

Support Services • After-Breast-Cancer (ABC) Support Group • Look Good, Feel Better • Edith Sanford Athena Breast Health Program • Sanford Cancer Survivorship Warm Water Exercise • Oncology Care Coordinator–Breast Cancer Services • Comprehensive Lymphedema Program • Genetic Risk Assessment & Counseling For information on the Cancer Breakthroughs 2020 trial, call 1-87-SURVIVAL.

Of all the recent advances in care, one of the most important is learning how to minimize risk.

Visit us at MMICgroup.com for medical professional liability insurance, patient safety and more!

Midwest Medical Edition

Ditch the “Rules” to Create a Positive Corporate Culture

By Carmella Biesiot HERE IS NOTHING MORE IMPORTANT TO YOUR BUSINESS than your work

culture. Establishing a strong bond with your colleagues will undoubtedly lead to better productivity, creativity, and to an overall better understanding of each other. Why are these things important? The answer begins with defying some of the office norms that you never thought you should.

MAKE FRIENDS › The first office “rule” I am going to crush is the idea that colleagues are “teammates” and “co-workers” but not necessarily friends. I disagree wholeheartedly. Step outside of this norm and try to befriend your co-workers. If you know who your colleague is outside of the office, you are more likely to understand why they make certain decisions and you are then more likely to support them, even when they are not there. That is huge. Friends will never let you fall. I get it–it sounds a bit fantastical. Every office has a Negative Nancy or a Debbie Downer. Some people do take effort, but if they are an integral part of your organization and not going anywhere soon, it will always be beneficial to be their pal. If you’re reading this, it is your responsibility to make it happen.

LUNCH › I have been in the business world for approximately 12 years. If there is one thing I have learned, it is the power and importance of lunch. In my early years of selling, I would schedule business lunches constantly. I would have a potential or current client meet me at a trendy downtown restaurant. I would order something eclectic and let it serve as a conversational piece and then go on to discuss a bunch of crap outside of the business deal that didn’t matter. Stop that. Less than 5% of actual business is accomplished during a “business lunch”. If you are going to allocate time for lunch during your day (which you should), I recommend having lunch with your team, instead. If possible, have lunch with them daily, if not

April/May 2017

more than once per week. I have lunch with my co-workers every single work day. We discuss business, we discuss ideas, and sometimes we just laugh. I cannot tell you how much this has built our friendship and respect for each other.

BE A PART OF SOMETHING BIGGER › Recently, our company got involved with United Way. Once or twice per year, we leave property and do something together to better our community. We get our hands dirty. We work. We laugh. We make it an experience to cherish. Community involvement and volunteer work not only benefit the city or town that helps your business flourish, but they create a positive company reputation and build your team relationships. Find a cause and make it an office effort. When people feel that they are part of something bigger, they are more grateful, happier, and do their jobs better.

LIGHTEN UP & LEARN SOMETHING ABOUT EACH OTHER. › I discuss things in the office that aren’t ‘generating revenue’ all of the time! I have one personal goal regarding work culture. I find out what each teammate values outside of their career. I make a solid effort to figure out what their passions are. Once I have learned what I needed to about them, I engage with them at least once per day on that topic. Our assistant general manager prides himself on the crazy socks he wears each day. It is always the first thing we discuss each

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morning. Now, every place I travel, I make it a point to get him a funky pair of socks that represents where I was. Maybe Susie loves to cook. Share recipes with her. Perhaps John likes to work out. Ask him how his fitness session was yesterday. Engage with your co workers on what makes them happy and what fulfills them. When my boss found out I was a runner, he started running with me a few times a week. We never discuss business when we run. We talk about our family vacations, about what we had for dinner, and what we would do with a million dollars, but it’s never work related. I can sincerely say that I am aware of every single person’s values in my office and it has led to a deep admiration and respect for each one of them. When you develop respect and admiration for each other, you will work better together and if the team works well together, the team will accomplish more. Rocket Science? Not even close. There is no such thing as a perfect group of people placed into the perfect office scenario, but we have the power to make it great. With a little effort (or sometimes a lot), we can build a positive office culture that produces better ideas and friendships. It will produce camaraderie. It will produce respect and understanding. Lastly, it will produce. A strong work culture will not only generate better productivity, it is the face of your company. Make it a priority and see immediate results! ■ Carmella Biesiot is is Director of Hotel Sales & Marketing at The Lodge at Deadwood. Read more of Biesiot's recommendations on corporate culture in the extended version of this article on our website.

WHERE THE

WORLD LOOKS

FOR VASCULAR CARE CREATING THE GLOBAL STANDARD FOR VASCULAR HEALTH Through his groundbreaking devices and his transformative approach to care, experts from across the globe turn to Dr. Patrick Kelly for advice, solutions and results. Thanks to his unique background in engineering and his determination to find answers, Dr. Kelly is able to offer care options for vascular patients that nobody else can.

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ADVANCED AORTIC PROGRAM Sanford’s Advanced Aortic Program provides diagnosis, second opinions and noninvasive treatments for disease and disorders of the arteries, veins and lymphatic system outside of the heart. Our highly experienced team of vascular medicine surgeons provides innovative and novel care for all forms of vascular disease, injury or trauma.

For questions or to refer a patient, call (605) 312-7720.

Maintain Accurate Medical Records to Minimize Legal Risk By Jeremy Wale

MEDICAL RECORD IS cru-

cial to the defensibility of a legal case; occasionally it can be the biggest hurdle. The primary purpose of a medical record is to provide a complete and accurate description of the patient’s medical history. This includes medical conditions, diagnoses, the care and treatment you provide, and results of such treatments. A well-documented medical record reflects all clinically relevant aspects of the patient’s health and serves as an effective communication vehicle. The medical record also has a critical secondary function: it is the most important piece of evidence in the successful defense of a medical professional liability claim. On average, a medical malpractice lawsuit takes five years to resolve.1 Most physicians cannot recall specific patient encounters from several years ago—so it is important to have accurate, thorough, and timely documentation of all your patient encounters. Good medical record documentation may help prevent a lawsuit. Your defense team may be able to disprove a patient’s assertions if the physician has thoroughly and accurately documented the patient encounter.

Good medical record documentation includes, but is not limited to, the following elements: LEGIBLE › If your handwriting is not legible, consider dictating your notes. TIMELY › Most electronic medical record systems document the date and time of all entries. If you still use paper records, note the date and time of each entry, with an accompanying signature or initial. It is

best to chart patient encounters either contemporaneously or shortly after the visit for more accurate and thorough documentation.

ACCURATE › Ensure your documentation accurately reflects what occurred during a patient encounter. CHRONOLOGICAL › Documentation is more easily understood when it is sequential by date and logical in process. The SOAP (subjective, objective, assessment, plan) format, or something similar, is suggested when documenting patient encounters. A logical, clear thought process is compelling evidence to present to a jury. THOROUGH › The old adage “if it’s not documented, it didn’t happen” still applies today. It is challenging to show something happened if there is no documentation to support that assertion. SPECIFIC AND OBJECTIVE › Make documentation as specific as possible (e.g. using actual measurements rather than descriptors such as “small” or “large” in size). Additions, corrections, or addendums may be pertinent in certain situations, but altering a medical record is strongly discouraged. It will destroy your credibility in the eyes of a jury and cast doubt on the legitimacy of the entire chart. Alterations include modifying accurate information for fraudulent or self-serving reasons. To properly correct a written chart, strike a single line through incorrect information,

“

Good medical record documentation may help prevent a lawsuit. Your defense team may be able to disprove a patient’s assertions if the physician has thoroughly and accurately documented the patient encounter.

”

leaving it readable. Then make the correction or addition as needed. Be sure to authenticate the change with a time and date, along with your initials or signature. In the event of litigation, be prepared to be questioned about any changes made to the patient’s chart— especially if they occurred after the incident in question or suit was filed. Follow the same authentication principles in electronic records; consider using a “strike through” function rather than deleting information. Making any corrections or additions to a medical record after a claim or lawsuit has been filed—or after receiving notice a claim or lawsuit may be filed—is strongly discouraged. These actions will likely be viewed as self-serving and could severely undermine your defense. ■ Jeremy Wale is a licensed attorney and a Risk Resource Advisor for ProAssurance. 1. Suszek A., “How long will it take to settle your medical malpractice case?”AllLaw.com, accessed on October 31, 2016.

Midwest Medical Edition

St. Thomas Aquinas Brings Finnish “Baby Box” Tradition to Madison

Peggy Kayser, Fr. DeWayne Kayser and Beth Graff, Director of Clinics and Community Services at MRHS with “boxes for babies”. The program started at Madison Regional Health System in October with donations from St. Thomas.

ST. THOMA S AQU I N A S PA R ISH I N

Madison, South Dakota is on a mission to ensure that every newborn who goes home from Madison Regional Health System is equipped with all of the newborn necessities along with a safe place to sleep. The

“boxes for babies”, as they are called, are filled with all kinds of items new parents might need including a handmade diaper bag, onesies, blankets, diaper rash ointment and more. The box itself, which is made of sturdy

cardboard, can even be used for the newborn to sleep in as it comes with a firm mattress and fitted sheet. The box provides a guaranteed safe sleep environment for the baby for the first few months of life. For convenience, the box can easily be moved from room to room. While this may not be a familiar tradition for US health systems or new parent, the country of Finland has been handing out baby boxes for more than 80 years. Interestingly, Finland has one of the lowest infant mortality rates in the world at just 1.9 deaths per 1000 births in 2015. In contrast, the US had an infant mortality rate of 5.6 per 1000 births in 2015. The first statewide program in the US to provide baby boxes for new parents launched in New Jersey at the beginning of 2017. St. Thomas has already provided 11 boxes for babies to MRHS mothers and newborns since October. ■

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Sanford Health Collaborates with Florida Hospital on Gene Sequencing Project SANFORD HEALTH AND NICKL AUS

Children’s Hospital in Miami have unveiled plans to sequence the genes of nearly 1,000 Latino and Hispanic people as part of the Nicklaus Children’s Personalized Medicine Initiative. Genomic medicine focuses on the use of genetic and genomic information to personalize patient care. Once the sequencing project is done, it will be easier to characterize and interpret gene variances which may predispose a person to certain diseases or predict their likely response to a particular medication. “This program will allow us to better understand, and then help serve the Latino

and Hispanic communities,” says Dr. Catherine Hajek, MD, of Sanford Health. The information gained in the project will be used to help build a database of common genomes in underrepresented populations and also look for rare diseases. “Bringing these two organizations together will help Sanford diversify its work and research with genomic medicine,” said Kelby Krabbenhoft, president and CEO of Sanford Health. To launch the initiative, Sanford Health and philanthropist Denny Sanford, a longtime friend of Jack Nicklaus for whom the Miami hospital is named, have jointly given $7 million. ■

Stem Cells 101 SANFORD RESEARCH scientists recently

published a review article in an issue of Stem Cells Translational Medicine focused on the study of and utility of adult-derived stem cells. The article, “Fat and Furious: Harnessing the Full Potential of Adipose-Derived Stromal Vascular Fraction,” is a review of the various types of stem cells found in humans and how they can be used in medical applications. In the article, the researchers emphasize the difference between the stromal vascular fraction (SVF) isolated from adipose tissue and the pure adipose-derived stem cells that have been purified and maintained in a culture dish. Understanding those differences can help dictate appropriate therapies and regulations, particularly in countries where the SVF could be less regulated than other stem cells. It’s also important to understand how SVF composition varies in healthy versus disease states.

April/May 2017

New Executive Director for Sanford Worthington Medical Center SANFORD WORTHINGTON MEDICAL

“Continued research into the application of SVF and adipose derived stem cells has the potential to transform treatments and therapy options,” said Daniel Kota, assistant research scientist for Sanford Research and an author on the paper. “But it all starts with putting scientists on the same page – tracking results following transfusions, using appropriate nomenclature and examining regulations.” Last month, Sanford began enrolling participants in the “Safety and Efficacy of Adult Adipose-Derived Stem Cell Injections into Partial Thickness Rotator Cuff Tears” clinical trial. The trial uses stromal vascular fraction (SVF), a mixture of cells and nutrients isolated from a patient’s own body, that contain adipose-derived stem cells, as a potential therapy for partialthickness rotator cuff tears. Sanford scientists and clinicians are exploring the application of this type of stem cells for other conditions. ■

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Center has named Jennifer Weg its new executive director. Weg had been serving on an interim basis since October. Before her interim leadership experience, Weg was the director of nursing and clinical services for Sanford Worthington Medical Center. She managed nursing and other patient services along with quality and risk management. Weg joined the hospital management team in 2005 as the assistant director of nursing and previously served Nobles-Rock Public Health Service as a public health nurse and supervisor. “Sanford Worthington is an important part of our community,” says Greg Raymo, chairman of the Sanford Worthington Advisory Board. “A local hire like Jennifer solidifies our commitment to the community. It truly is a best-case scenario.” Weg has a degree in nursing from Briar Cliff University in Sioux City, Iowa, and a master’s degree in nursing administration from South Dakota State University in Brookings, South Dakota. ■

Accolades for Avera’s Lab and Perinatal Care THE LABORATORY AT AVERA McKennan

Hospital & University Health Center has once again earned 15189 accreditation from the College of American Pathologists’ International Organization for Standardization, making it the longest-standing, continuously accredited hospital lab in the country. The lab was the first in the US to earn this accreditation in 2009. “ISO is the gold standard internationally,” says Mary Maertens, Avera Laboratory Service Line Administrative Leader. “This news is much like a perfect Joint Commission survey only focused on our laboratory services. It is a big deal to have a lab with this credential.” An estimated 70 percent of the objective data found in a patient’s medical record comes from the medical laboratory, making laboratory competence a vital part of high quality patient care. “To reach this elite level of accreditation

touches almost every aspect of the healthcare our system provides,” says Avera McKennan Laboratory Medical Director Raed Sulaiman, MD. ISO is a non-governmental organization, comprised of more than 150 countries. At the same time, Avera McKennan has also earned the Perinatal Care Certification from the Joint Commission. Reviewers evaluated the hospital for key perinatal care standards including:

The Joint Commission awards Perinatal Care Certification for two-year periods of time only in hospitals that hold accreditation with it. ■

 Integrated, coordinated patientcentered care that starts with prenatal and continues through postpartum care  Early identification of high-risk pregnancies and births  Management of mothers’ and newborns’ risks at a level corresponding to the program’s capabilities  Available patient education and information about perinatal care services

Midwest Medical Edition

Leadership Changes at Rapid City Regional Hospital RAPID CITY REGIONAL HOSPITAL has

a new interim president while a nationwide search continues for someone to fill the position permanently. Paulette Davidson, Chief Operating Officer at Regional Health, took over the interim spot as president of both the hospital and the Rapid City market from Dennis Millirons who completed his engagement with Regional Health in March. Millirons joined Rapid City Regional Hospital in August 2016. During his tenure as interim president, RCRH was named one of the top three hospitals in South Dakota by U.S. News and World Report and was recognized with a Distinguished Hospital award from Healthgrades. Also since Millirons’ arrival, the hospital began the first phase of a multi-phase construction

project that will include a new emergency department, inpatient bed tower, and a physicians’ office building. Davidson joined Regional Health in October 2015 from Nebraska Medicine in Omaha, where she was system Chief Human Capital and Patient Experience Officer. Davidson previously worked as the Chief Executive Officer of Nebraska Medicine’s Bellevue Medical Center and as the COO and Vice President of Hospital Operations at Indiana University Health in Goshen. A fellow in the College of American Health Care Executives (FACHE), Davidson holds an MBA from the University of Notre Dame and a bachelor’s degree in Business Administration from the University of Wisconsin, Madison. ■

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Obesity Remains a Problem for SD Kids ALMOST ONE-THIRD OF South Dakota’s kids and teens are overweight or obese, according to a new state health report. The 2015-2016 School Height and Weight Report found 16.1 percent of South Dakota’s 5-19 year olds were obese and another 16 percent were overweight. That compares to 16.0 percent obese and 16.2 percent overweight in 2014-2015. “It’s good news that the child obesity rate is no longer rising,” said Ashley Miller, chronic disease epidemiologist for the Department of Health. “But bringing the rate down won’t happen overnight, just as reaching these levels didn’t happen overnight. It’s going to take long-term effort from schools, communities and parents.” A total of 172 schools submitted student height and weight data for this latest survey, accounting for 34.6 percent of students in the state. The survey defines obese as at or above the 95th percentile body mass indexfor-age when compared to kids of the same age and gender; overweight is between the 85th and 94th percentiles. The department’s goal is to reduce the percentage of students who are obese to 14 percent by the year 2020. ■

Healthgrades Recognition for Area Hospitals RAPID CITY REGIONAL HOSPITAL is in

the top 5 percent of hospitals in the nation for delivering high-quality care in at least 21 of the 32 most common inpatient conditions and procedures, according to Healthgrades, the leading online resource for comprehensive information about physicians and hospitals. RCRH and Sanford USD Medical Center were the only two South Dakota hospitals to receive the Healthgrades 2017 Distinguished Hospital Award for Clinical Excellence. According to Healthgrades,

patients treated in hospitals receiving this award have a lower average risk of morbidity and mortality than thosen treated in hospitals that did not receive the designation. RCRH and Sanford are two of only 258 recipients of the Distinguished Hospital Award for Clinical Excellence nationwide. Those 258 stand out among nearly 4,500 hospitals nationwide for overall clinical excellence across a broad spectrum of care. Healthgrades evaluates hospitals on risk adjusted mortality and in-hospital complications. ■

New West River Mental Health Alliance LEADERS OF THREE WEST RIVER organizations – two public, and one private – have formed an alliance to begin a community conversation about identifying appropriate resources and developing solutions to address the increasing mental health needs of western South Dakota. The alliance is a collaborative effort by Regional Health, the Pennington County Sheriff’s Office, and the Rapid City Police Department. Regional Health Chief Operating Officer Paulette Davidson, Rapid City Regional Hospital President

of Medical Services Mark Harlow, MD, Rapid City Police Chief Karl Jegeris, and Pennington County Sheriff Kevin Thom are the founding members of the West River Mental Health Alliance. “This is the beginning of an important dialogue to drive opportunities for collaboration with all stakeholders who are profoundly aware of the gaps, and are serious about identifying solutions and the necessary resources to begin addressing these gaps,” the leaders said in a joint statement.

The West River Mental Health Alliance held an invitation-only kick-off meeting in March and plans to add more stakeholders to get input from the broader mental health community. Regional Health has been working closely with the police and sheriff’s office to identify long-term care solutions for people in need of mental health services. The West River Mental Health Alliance was conceived to further examine other mental health needs within the region. ■

Midwest Medical Edition

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Fostering Resilience: Discovering the Seven C’s RESILIENCE IS DEFINED AS a person’s

ability to recover from life’s hardships, stresses and setbacks, according to mental health professionals. Licensed clinical psychologist Michael D. Vance, PhD, director of Children’s Hospital & Medical Center’s Behavioral Health Department, says children who are dealing with challenging medical conditions should be helped to understand how resilience applies to them. He offers the recent example of a 13-year-old patient. “When I asked, ‘What does resilience mean to you?’ he replied, ‘Suck it up, deal with it. Don’t tell anyone you’re hurting,’” Dr. Vance recalls. “That misconception will not help a child who is truly hurting.” Instead, Dr. Vance introduces children to the idea of resilience as adaptability and persistence. “It is the ability to be comfortable being uncomfortable and the ability to ask for support,” he says. Dr. Vance says he looks for opportunities to foster the

“Seven C’s of Resilience” in his young and adolescent patients. These Seven C’s were developed by Kenneth Ginsburg, MD, a pediatrician specializing in adolescent medicine at The Children’s Hospital of Philadelphia. “If you look at a child or adult who truly has resilience, each has some combination of these seven C’s,” Dr. Vance says. “Whether it is a child with diabetes, or a child in our weight management program, or a child in our Hematology/ Oncology program, or a child with severe anxiety, it is our job to help them recognize these seven C’s and identify with them.” Developing resilience in every child may require a personalized approach based on that child’s stresses and needs, Dr. Vance says. “By listening and identifying those needs, we can improve our patients’ quality of life and, hopefully, their conditions and outcomes.”■

THE SEVEN

C’s

OF RESILIENCE COMPETENCE. When we notice what young people are doing right and give them opportunities to develop important skills, they feel competent. We undermine competence when we don’t allow young people to recover themselves after a fall. CONFIDENCE. Young people need confidence to be able to navigate the world, think outside the box and recover from challenges. CONNECTION. Connections with other people, schools and communities offer young people the security that allows them to stand on their own and develop creative solutions. CHARACTER. Young people need a clear sense of right and wrong and a commitment to integrity. CONTRIBUTION. Young people who contribute to the well-being of others will receive gratitude rather than condemnation. They will learn that contributing feels good and may therefore more easily turn to others, and do so without shame. COPING. Young people who possess a variety of healthy coping strategies will be less likely to turn to dangerous quick fixes when stressed. CONTROL. Young people who understand that privileges and respect are earned through demonstrated responsibility will learn to make wise choices and feel a sense of control.

Midwest Medical Edition

The Largest Medical Genetics Team in the Region

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Taxation of Investments By Mark Schlueter

T’S NICE TO OWN STOCKS, BONDS, AND OTHER INVESTMENTS. Nice, that is,

”

until it’s time to fill out your federal income tax return. At that point, you may be left scratching your head. Just how do you report your investments and how are they taxed?

Calculating your capital gain or loss If you sell stocks, bonds, or other capital assets, you’ll end up with a capital gain or loss. Special capital gains tax rates may apply. These rates may be lower than ordinary income tax rates. Basically, capital gain (or loss) equals the amount that you realize on the sale of your asset (i.e., the amount of cash and/or the value of any property you receive) less your adjusted basis in the asset. If you sell an asset for more than your adjusted basis in the asset, you’ll have a capital gain. For example, assume you had an adjusted basis in stock of $10,000. If you sell the stock for $15,000, your capital gain will be $5,000. If you sell an asset for less than your adjusted basis in the asset, you’ll have a capital loss. For example, assume you had an adjusted basis in stock of $10,000. If you sell the stock for $8,000, your capital loss will be $2,000. Schedule D of your income tax return is where you’ll calculate your short-term and long-term capital gains and losses, and figure the tax due, if any. You’ll need to know not only your adjusted basis and the amount realized from each sale, but also your holding period, your marginal income tax bracket, and the type of asset(s) involved. See IRS Publication 544 for details. HOLDING PERIOD: Generally, the holding period refers to how long you owned an

“

You can use capital losses from one investment to reduce the capital gains from other investments.

asset. A capital gain is classified as short term if the asset was held for a year or less, and long term if the asset was held for more than one year. The tax rates applied to longterm capital gain income are generally lower than those applied to short-term capital gain income. Short-term capital gains are taxed at the same rate as your ordinary income. MARGINAL INCOME TAX BRACKET: Marginal income tax brackets are expressed by their marginal tax rate (e.g., 15 percent, 25 percent). Your marginal tax bracket depends on your filing status and the level of your taxable income. When you sell an asset, the maximum tax rate that applies to the gain will depend on your marginal income tax bracket. In 2016 and 2017, a 0 percent long-term capital gains tax rate generally applies to individuals in the 10 or 15 percent tax bracket, a 15 percent maximum rate applies to those in the 25 percent, 28 percent, 33 percent, or 35 percent tax bracket, and a 20 percent maximum rate applies to those in the top (39.6 percent) tax bracket. TYPE OF ASSET: The type of asset that you sell will dictate the capital gain rate that applies, and possibly the steps that you should take to calculate the capital gain (or loss). For instance, the sale of an antique is taxed at the maximum tax rate of 28 percent even if you held the antique for more than 12 months.

Using capital losses to reduce your tax liability You can use capital losses from one investment to reduce the capital gains from other investments. You can also use a capital loss against up to $3,000 of ordinary income this year ($1,500 for married persons filing separately). Losses not used this year can offset future capital gains. Schedule D of your federal income tax return can lead you through this process.

Getting help when things get too complicated The sales of some assets are more difficult to calculate and report than others, so you may need to consult an IRS publication or other tax references to properly calculate your capital gain or loss. Also, remember that you can always seek the assistance of an accountant or other tax professional. ■ Mark A Schlueter, CFP, CLTC, FIC, is a Financial Consultant with Thrivent Financial in Sioux Falls.

How do you know if it’s ordinary income or a capital gain? Get the answer and advice for categorizing your ordinary income in the extended version of this article on our website.

Midwest Medical Edition

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Exam Room Manners

SIMPLE COMMUNICATION TWEAKS FOR BETTER RAPPORT

s a professional communicator, I pride myself on being able to establish rapport easily with most people in most situations. The exception is when I am rushed, overtired, overworked or distracted. Almost without exception, if I am going to have a conflict with someone, it is most likely to happen when I am in this state of mind. Unfortunately for healthcare professionals, rushed is practically the norm and distraction is difficult to avoid with so many required “hoops” to jump through. But with patient satisfaction increasingly linked to the bottom line, it pays (literally) to remember to use some of the subtle communication cues that can make the difference between simply treating a patient’s ailment and truly putting them at ease.

ACCORDING TO A 2014 META-ANALYSIS, A POSITIVE DOCTOR-PATIENT RELATIONSHIP, PARTICULARLY WITH REGARD TO EMPATHY, CAN HAVE STATISTICALLY SIGNIFICANT EFFECTS ON HEALTHCARE OUTCOMES.

MAKE–AND HOLD–EYE CONTACT The need to enter data into the electronic health record is a fact of modern medicine and most patients understand this. However, taking just a few seconds at the outset to look directly at the patient, extend a warm greeting, and listen (even briefly) before entering information can set the tone for the whole appointment. You might be surprised how many practitioners fail to do this and dive right into documentation mode with little more than a smile and a nod. USE “OPEN” BODY LANGUAGE People are naturally more forthcoming and at ease when they feel that their audience is receptive. Demonstrate receptiveness by not crossing arms or legs, leaning forward as the patient speaks, and positioning yourself so that the computer is not directly between you and the patient.

By Alex Strauss

OFFER ACKNOWLEDGMENT As every physician knows, sometimes patients just need to be heard. Often, important information can be hiding just behind their words. Keep them talking and ensure you’re getting the full picture by acknowledging that you’re listening, even while you are taking notes. This is easy to do by nodding, looking up occasionally, and offering verbal encouragement such as “I see”, “Go on”, “Okay”, etc. SMILE This can be surprisingly hard, especially in the midst of a difficult day. But remember–You may be seeing 30 patients that day, but for your patient, their encounter with you is likely the most important of their day, if not their week. Take a moment to make a connection with a warm smile, even if you have to force it. As the saying goes, “Patients will not care how much you know until they know how much you care.” A simple smile speaks volumes. SAY GOODBYE You may know that you won’t be back into the exam room, but it may not always be obvious to the patient, especially if there are other things to be done (a blood draw, an injection, etc.). Even if you’re rushed (who isn’t?), take a moment to thank them for their time, reiterate next steps, and simply say goodbye so that they never feel left “hanging”. At the end of the day, the doctor/patient interaction is an exchange between two human beings and every one of us is flawed. Keep it as real as possible, be human, and if you fail to do any of the above, remember that a simple apology can go a long way toward preserving and nurturing the relationship. ■

Alex Strauss is a communication consultant and the Editor of MED Magazine.

Midwest Medical Edition

Learning Opportunities

Spring / Summer 2017 April 12 7:30 am – 4:00 pm 25th Annual Avera McKennan Trauma Symposium

May 5 8:00 am – 5:00 pm 22nd Annual North Central Heart Vascular Symposium

Location: Sioux Falls Convention Center

Information: 605-322-7879, averaeducationevents@avera.org

Registration: Avera.org/conferences

April 21 8:00 am – noon 16th Annual Pediatric Symposium

May 16 8:30 am – 4:00 pm Avera Caring Professional Conference

Location: Prairie Center, Avera Mckennan campus

Location: Sioux Falls Convention Center

Information: 605-322-7879, averaeducationevents@avera.org

Registration: Avera.org/conferences

Registration: avera.org/conferences

April 28 8:30 am – 4:30 pm Avera McKennan Diabetes Conference

June 8–9 3:30 pm – 7:30 pm, 7:45 am – 4:00 pm Avera Sports Medicine Symposium

Location: Hilton Garden Inn, Downtown Sioux Falls

Location: Ramkota Hotel

Information: 605-322-7879, averaeducationevents@avera.org

Registration: Avera.org/conferences

April 26–28 11:00 am – 7:30 pm, 7:00 am – 7:30 pm, 7:00 am – 11:30 am SD Medical Group Management Association Spring Conference

June 8–9 10:00 am – 8:00 pm, 8:45 am – 3:00 pm SD Association of Healthcare Marketing and Public Relations Summer Conference

Location: The Lodge at Deadwood

Information: 605-366-1479

Information and Registration: SDMGMA.org

Registration: steff@midwestmedicaledition.com

April 28–29 8:00 am – 6:00 pm, 8:00 am – 4:30 pm Sanford Sports Medicine Symposium Location: Ramkota Hotel & Conference Center, Sioux Falls

June 16 9:00 am – 5:00 pm Innovation in Management of Cancer Conference: A Focus on Breast

Information: 605-312-7808, tryg.odney@sanfordhealth.org

Location: Prairie Center, Avera McKennan campus

Registration: sanfordhealth.csod.com

Information: 605-322-7879, averaeducationevents@avera.org

Location: Cedar Shore Resort, Chamberlain, SD

Registration: Avera.org/conferences

MED reaches more than 5000 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at Alex@MidwestMedicalEdition.com.

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