Vol. 4, No. 7
2013
Managing the maze
Navigating Meaningful Use on the Great Plains
Text Messaging and hipaa compliance
Job interview skills for doctors
ICD-10
and your cash flow
South Dakota and the Upper Midwest’s Magazine for Physicians & Healthcare Professionals
November
Midwest Medical Edition
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Midwest Medical Edition
Contents
page
NOvember 2013
Finding the
Regular Features 2 | 3 |
Meaning in
From Us to You
Meaningful Use
MED on the Web What’s new exclusively on the MED website this month
8 |
10
By Alex Strauss
News & Notes News and announcements from around the region
With the first deadlines for Stage I
26 | The Nurses’ Station Local awards, SDNA Conference
attestation of Meaningful Use
28 | Grape Expectations Thanksgiving Wines . . .
approaching, many providers are being
Consider them Extra ‘Side Dishes’ ■ By Heather Taylor Boysen
forced to get more serious about the
29 | Learning Opportunities
government’s EHR incentive program.
Are physicians in our area successfully
Upcoming Symposiums, Conferences, CME Courses
navigating this maze? We talk to two
In This Issue
Meaningful Use experts for this month’s cover feature.
4 | Meaningful Use: Setting the New Normal in Physician-Patient Dialogue
■ By Dave Hewett
6 | Time for a Flu Shot: SD Health Systems Require
Vol. 6, No.
r Novembe
Employee/Staff Influenza Vaccinations
15 | Monitor Mobile Devices to Ensure Patient Privacy (or Pay the Price!)
■ By Tana Phelps
Midwes
18 | Research Spotlight:
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2013
Sanford Research Secures NIH Grants
20 | Black Hills Clinic Recognized for Patient Satisfaction
21 | Siouxland Gets $16.8 Million Boost in Critical Care and MRI Services
22 | Doors Open on Area’s Newest ‘Medical Home’ 23 | New Dialysis Center for Sioux Falls 23 | Same-Day Scheduling Boosts Appointment Rate
al t Medic
7 Text Messaging: Is it HIPAA Compliant? ■ By Katie Fleming
Edition
g Managain the m ze
e Great se on th ngful U g Meani in at ig Nav
Plains
16 D Os and DON’Ts for the Physician Being Recruited
■ By Tim Wieben
25 Avoid Major Cash Flow Disruption
and Get Prepared for ICD-10
g agIn Messm iance TexT pa a co pl
s r doctor skills fo rview Job inte flow
and hi
ICD-10
ur cash and yo
■ By Heidi Babb
On the
r Midwest the Uppe kota and South Da
sionals re Profes & Healthca Physicians zine for ’s Maga
COver
From Us to You
Staying in Touch with MED
T
echnology has been the name of the game for MED Magazine in the last quarter of 2013. In mid-September, MED significantly enhanced its Internet presence with the launch of a new, interactive website. The site, which includes an interactive calendar and business directory, “went live” just days before the SDAHO Convention in Sioux Falls, where we were proud to show it off using a large Google TV at our vendor booth (see the article at MidwestMedicalEdition.com) In conjunction with the website launch, the digital edition of the magazine was also streamlined, to make it easier to read on mobile devices. Finally, we distributed the first issue of our eNewsletter (after setting up an “opt-in” button on the new website). Talk about a learning curve! I say all this to say that, if you are one of the many struggling to keep pace with healthcare information technology in the digital age – we feel your pain. That is why this issue of MED is dedicated to some of the more pressing concerns surrounding HIT. You’ll find articles on the meaning of Meaningful Use, using mobile devices in a healthcare setting, the potential perils of text messaging, and the potential impact of new documentation requirements with ICD-10. And to balance things out, we also bring you all the latest healthcare news, upcoming events, and wine advice to enhance your holiday celebrations. If you have a comment, suggestion, or submission for MED, we invite you to visit us online at MidwestMedicalEdition.com, where news and event updates are continually being posted. With gratitude for your continued readership and support of MED sponsors, —Alex and Steff
Publisher
MED Magazine, LLC Sioux Falls, South Dakota
VP Sales & Marketing Steffanie Liston-Holtrop Editor in Chief Alex Strauss Design/Art Direction Corbo Design Photographer Kristi Shanks Web Design Locable Contributing Editor Darrel Fickbohm Copy Editor Hannah Weise
Steffanie Liston-Holtrop
Contributing Writers
Alex Strauss
Staff Writers
Heidi Babb Heather Boysen Kaatie Fleming Dave Hewett Sarah McQuade Tana Phelps Tim Wieben Liz Boyd Caroline Chenault John Knies
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 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website MidwestMedicalEdition.com
2014 Advertising / Editorial Deadlines Jan/Feb Issue December 5
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Reproduction or use of the contents of this magazine is prohibited.
MED’s Steffanie Liston-Holtrop shows off the new MED website on a large screen Google TV at September’s SDAHO Convention.
©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.
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on the
MidwestMedicalEdition.com
Now More than a Magazine, A Medical Community Hub As part of MED’s continuing commitment to serve the communication needs of our wide and diverse medical community, we have expanded our online presence.
Log on Now! Online Directory,
This month, you will find the following information and articles exclusively on our website:
EHR Deployed . . . Now What? It takes planning, commitment, money, time and energy to successfully deploy an electronic health record system. But, as IT expert Wade Hoffman of EarthBend explains, it’s dangerous to stop there. “Getting the new system online and in production is one element, but ensuring EHR application and performance is another,” writes Hoffman. Read the full article, including Hoffman’s list of “must-do’s” once your EHR is up and running.
Post-Interview Checklist Tim Wieben’s article “Dos and Don’ts for the Physician Being Recruited” (pg. 16) has tips for job-seeking physicians before and during the interview. If that is you, go online to see his recommendations for what to do after to interview to leave a positive impression and boost the chances of success.
Meet MED’s Contributors Hoffman and Wieben are just two of the regional business and healthcare experts who have
Using MED’s online Directory, powered by Locable, you can find and connect with area businesses that cater to healthcare providers. It’s easy and free for businesses and providers to be included in the Directory. With ongoing updates to our business identity solution tools, we make it simple to get the most out of the constantlychanging online environment. Being a part of MED online allows you to engage the online community in new ways and put the web to work for your practice.
Online Calendar Our online Calendar feature makes it easy to find and share local events specifically for heathcare professionals, so you will never miss a meeting or course you wanted to attend. You can even list your own upcoming event – such as an office open house or a presentation for colleagues –
for free.
contributed articles to MED this month. Log on to learn more about them as well as this month’s other MED contributors and find out how to get in touch with them. Find links to these articles and more under the “In Print” category on our website. Access it from the MED home page or go there directly at www.MidwestMedicalEdition.com/column/in-print.
November 2013
MidwestMedicalEdition.com
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Meaningful Use Setting the New Normal in Physician/Patient Dialogue By Dave Hewett, SDAHO
“M
eaningful Use” is the moniker by which the United States has embarked upon the development and implementation of an electronic medical record system for the nation. It’s been many years in the making and has several more to go before true “meaningful use” is achieved. But the message is clear – it will be achieved and it will be done on an ambitious timeline set by the Centers for Medicare and Medicaid Services (CMS).
The goals of Meaningful Use are delineated at healthit.gov as follows:
Complete and accurate information With electronic health records, providers have information they need to provide the best possible care. Providers will know more about their patients and their health history before they walk into the examination room.
Better Access to Information Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve the health outcomes of their patients. Electronic health records also allow information to be shared more easily among doctors’ offices, hospitals, and across health systems, leading to better coordination of care.
Patient empowerment Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families. The effort continues to be nothing short of amazing. Coordinating some of the greatest engineering and IT minds in the country, enterprising entrepreneurs, capital investment, and healthcare providers large and small to establish a healthcare records system that delivers health information to the right people, at the right time will be a monumental feat. For those of us who think this deserves some public notoriety, that hasn’t happened. But as the EMR becomes more commonplace in the delivery of healthcare services, patients’ expectations about what defines a satisfactory “trip to the doctor” will change. As one of those patients who has experienced that brave new world (and am still in awe of it) allow me to describe my last check up. It started with an email to my physician asking her if I should do anything prior to my appointment. Her assistant got back to me within a couple of hours saying that I should have some blood drawn after a 12 hour fast and named several specific tests that had been ordered. She said just stop by one of the affiliated clinics for the blood draw and the results would be ready for the appointment. I stopped by the closest clinic to my house on the way
to work and was in and out of there in 15 minutes arriving at work a few minutes late. About 15 minutes later I had an email saying I had test results available and that I could log onto my chart to view them. I did so and there were the results. Nothing short of amazing – at least for now. The bar on what’s expected by the patient was just raised and many of the goals noted above were just achieved. And hence the “new normal” was established. For physicians, it is a change as well especially as patient satisfaction scores begin to impact reimbursement and at some point are publicly reported. For the record, the status of “meaningful use” is measured in three stages with economic incentives for compliance and, in the future, penalties for non-compliance attached. Stage 1 has been devoted to capturing data and sharing and should be complete in South Dakota. Stage 2 is devoted to advance clinical processes with a 2014 deadline. Stage 3 looks for improved outcomes by 2016. Again, that’s all very important for the many people and organizations putting meaningful use in place. But for those who are actually charged with implementation – the physicians – it’s still about the patient and how this tool impacts and defines that relationship. ■
Dave Hewett is President of the South Dakota Association of Healthcare Organizations (SDAHO).
MED Quotes “ Excellence is never an accident. It is always the result of high intention, sincere effort, and intelligent execution.” — Aristotle
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The views in this column do not necessarily represent the views of MED Magazine. MED welcomes reader feedback on all of our articles. You can submit your comments any time through our website at MidwestMedicalEdition.com/ContactUs.
Midwest Medical Edition
One call accesses maternal & fetal specialists, for newborns requiring immediate intervention. The Fetal Care Center at Children’s Hospital & Medical Center In affiliation with
1.855.850.KIDS (5437)
Physicians’ PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.
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Med Mag Fetal Care Ad,Oct.., 2013.indd 1
9/27/13 12:16 PM
Tana Phelps
Letters to Med
Marketing Specialist MED: You have a background in marketing. What got you interested in working for a medically-oriented company like Cassling? TP: My mother and sister are both nurses, so my interest in medicine was sparked at a young age. I spent a lot of time in nursing homes and hospitals, volunteering and such. I studied journalism and marketing in school at UNL, but I also worked in the hospital in Lincoln. I knew that I wanted to have both of these elements in my professional life. MED: What do you find most exciting about working in healthcare marketing right now? TP: Things are changing so quickly in medicine now, and the changes that are happening are things that are going to shape the future of healthcare for years to come. So it has been fun to be able to be a part of that. I also really believe that what we do at Cassling, which sells and services imaging equipment and helps practices market it, has a positive impact not only on physicians and nurses, but also on patients. MED: What is the biggest marketing challenge facing healthcare organizations? TP: I think that physicians and healthcare organizations really have to be on top of the Web and social media. It may be an unfamiliar world to some of them, but they need to be a part of that. That is how you engage the younger populations. And even if these people are not patients yet, eventually, they will be. I have really enjoyed bringing information about those kinds of trends to MED readers. MED: How do you like to spend your free time? TP I really love to run. I am from Omaha and that is where my husband and I live and I just did the Omaha half-marathon, which was my first one. I plan to run the Lincoln Half Marathon next spring. MED: Do you have a ’13.1’ magnet for the back of your car? TP: Not yet, but I get I should probably get one of those!
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Eugene Hoym Fetal Alc e, MD, Syndro ohol me and
A talk with MED Contributer
By Alex Strauss Sanford Research Understa nding ander has Devot Disorders ed Career Preven ting FAS to and Re lated
“ These children kids are jus deserv all over thet like other lives poe a chance to world and the ssible. ” live the best y
From Our Readers
“
Fetal Alcoh ol Syndr ome (FAS) Disorders and the (FASD) related present is the challe set of disord many challe nge of pinpo ers that nges for fall under and 1.5 physicians, inting their cases for the title educators prevalence. Fetal Alcoh every 1000 common and resear CDC studie ol Spect live births – as many chers, not rum . Other s put the as 1 case the least times as studies rate of out of every of which using differ many cases FAS in the U.S. 500 live ent metho of FASD between “There births. ds have as there have only And scient 0.2 found it are cases one percen been two to be even ists believ of FAS. t among prevalence e that there more school-aged MD, Profes are at least studies on FASD children, sor and three and both Chair of across the School the Depar of them entire spectr of Medic tment of showed ine. um of the Pediatrics a rate of Few physic disorder,” about at USD’ ians have says Eugen s Sanfo Disorders seen as rd e Hoym as Dr. many cases e, Hoyme. Children’s of Fetal He is the Alcohol Hospital, Chief Medic Spectrum Senior VP Sioux Falls, al Office for Child and a renow r of Sanfo ren’s Servic sometimes ned clinic rd es at Sanfo baffling al resear rd Clinic disorders. cher into in A gradu the myste ate of ries of these Augustana Pritzker School College of Medic and the more than ine, Dr. University 30 years Hoyme’s of Chica ago during fascination go “During his pediat with FAS my reside ric reside people began ncy, ncy the Chief to descri at the Unive be Fetal of Pedia rsity of us to go Alcohol tric Genet California, into the Syndrome ics there field of San Diego back in was Dr. post docto birth defect . 1973,” Kenneth ral fellow s evalua recalls Dr. Jones, one and to stay tion and Hoyme. of the first care. He on in clinic “Dr. Jones is also the al geneti inspired one who cs with many of invited him.” me to stay on as a
Clinical Geneticist Hoyme first becam Dr. Eugene in FAS e intere during his reside sted the Unive ncy at The effort rsity of Califo rnia. disorder, to understand the improve capabilities, diagno prevalence and reduc stic e its world becom e a career wide have -long
The Justice Issue Work Group
Scientists estimate there are three time s as many cases of FASDs as there are cases of FAS
passion.
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Midwest
Medical
Edition
- July /
August
2010
of the Interagency Coordinating Committee on Fetal Alcohol Spectrum Disorders
Midwest
Medical
Edition
- July /
August
2010
7
(ICCFASD) will be presenting information on Fetal Alcohol Spectrum Disorders (FASD) at the 2013 Annual Conference of the National Association of State Judicial Educators . . . We will be informing judicial educators about what judges need to know about FASD and request your permission to include among our handouts copies of the article, ‘Eugene Hoyme, MD and Fetal Alcohol Syndrome’ published in the July/August 2010 issue of MED.
Thank you for your consideration.
”
Sally M. Anderson, PhD Coordinator and Executive Secretary ICCFASD, Office of the Director National Institute on Alcohol Abuse and Alcoholism National Institutes of Health
Time for a Flu Shot! South Dakota’s Health Systems Require Employee Influenza Vaccinations In an unusual joint announcement earlier this fall, South Dakota’s three largest health systems said they will require annual influenza vaccinations for all employees, healthcare providers, and volunteers effective this flu season. “With the three largest health systems joining together in this initiative, we are making a statement that annual influenza vaccinations can reduce the number of influenza-related deaths,” said Charles E. Hart, MD, President and CEO of Regional Health. “Requiring influenza vaccination for healthcare workers is the right thing to do for patient safety.” Last year in South Dakota, 37 people died from influenza, the highest number of influenza-related deaths since 2004. Neonates, the elderly, immunocompromised and chronically ill patients are at particularly high risk of serious outcomes with influenza. “Sanford Health’s physician leadership
groups, our Boards of Governors, in all four of our regions have unanimously recommended mandatory influenza vaccinations for all employees,” said Wendell Hoffman, MD, Medical Director, Sanford Health infection prevention and control. Mandatory influenza vaccinations for healthcare workers have been endorsed by the Centers for Disease Control, American Hospital Association, American Academy of Family Physicians, American Academy of Pediatrics, the National Patient Safety Council, the American College of Physicians and the South Dakota Association of Health Care Organizations (SDAHO). Many health systems across the country are also implementing mandatory influenza vaccinations this year. “There are a few who may balk at getting the shot for whatever reason but the fact is, patient and resident safety is improved when those caring for them have received their annual flu shot,” said SDAHO President and CEO, Dave Hewett, Exceptions to the required immunization may be granted for medical or religious reasons only. ■
Midwest Medical Edition
Text Messaging Is it HIPAA Compliant?
I
By Katie Fleming
t’s been a busy day, with no reprieve in sight. You take a moment to text a cardiologist you work with on occasion, requesting a consult on patient John Smith. You get a reply of “???”. Oops. The doctor changed his phone number and now some college student just received your message about John Smith’s arrhythmia. The benefits of text messaging are obvious. Fast, efficient communication that’s easy to use is incredibly important in healthcare. However, the pitfalls and risks associated with texting are equally as important. Here are some items to keep in mind when evaluating how your practice uses text messaging.
Does the Message Contain PHI? This is the central question to consider. If your text message contains information relating to a patient’s health and that data can be “individually identifiable”, then it can be considered PHI. Data is individually identifiable if it contains the patient’s name, date of birth, a unique identifying number or one of the other 18 identifiers outlined by the US Department of Health. Technology, such as text messaging, that is used for accessing, transmitting, or receiving PHI electronically is covered by the HIPAA Security Rule. If your text contains ePHI, the Security Rule requires reasonable and appropriate administrative, physical and technical safeguards.
Potential Problems Managing these safeguards on text messaging can be difficult. As illustrated in the opening example, you cannot ensure the recipient of your text is whom you intended. Numbers can change, phones can be lost or stolen, and text messages can easily be read by others with access to the phone. Often overlooked details can put your practice at
November 2013
risk. For example, text message alerts display the first lines of content automatically, and can be read without entering the phone’s passcode. The threats to PHI in text messages are numerous and quite likely. To avoid texting ePHI, some providers may omit data that is individually identifiable from their message. While this is a prudent choice, discussing a patient’s condition and treatment without being able to identify the patient holds its own set of risks. The potential for confusion and mistakes rises and text messaging becomes a less effective form of communication.
and outside your organization, using the app. Your answering service may also use it to communicate detailed information to the oncall physician. When choosing a secure messaging vendor, determine if a business associate contract will be needed and if so, ensure they will sign one. As smartphones and mobile devices become increasingly prevalent in practicing medicine, it’s time to explore how you and your organization use text messaging. Through planning and partnership, it’s possible to keep the value of text messaging and lower your risks. ■
Compliant Communication
Katie Fleming is Business Development Manager at
To better manage compliance and communication, include text messaging in your organization’s overall risk analysis and management strategy. Determine what information is acceptable to text and train staff accordingly. Keep an inventory of mobile devices (both personal and provider-owned) and ensure devices are using passcodes and encryption. Consider using a vendor supplied secure text messaging app. These apps allow HIPAA and HITECH compliant text message style communication and are compatible with most smartphones and tablets. ePHI can be sent to contacts inside
Rapid City-based Golden West Technologies.
UnityPoint Health – St. Luke’s Now Serving Siouxland in a New Location Visit us at St. Luke’s Sunnybrook Medical Plaza 5885 Sunnybrook Drive | Sioux City Conveniently located right off the bypass from Highway 20 and Highway 75, this new outpatient facility is home to several services that UnityPoint Health and UnityPoint Clinic provide in collaboration with physician partners. From family and internal medicine to specialty services, health care is delivered in a whole new way at Sunnybrook Medical Plaza. Experience our coordinated care approach. Visit unitypoint.org/sunnybrook. At UnityPoint Health, the point of unity is you.
Sunnybrook Now Open Ad 3.43x4.6_clr.indd MidwestMedicalEdition.com
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10/3/13 11:32 AM
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Happenings around the region
South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes Avera Thomas Gaeckle, MD, retired from his cardiology practice at North Central Heart on September 30. He will
begin a medical practice in Internal Medicine at the Thames Community Hospital in New Zealand later this year. Dr. Gaeckle worked with North Central Heart since 1994. Prior to that he was an Internal Medicine physician. Hesham Elgouhari, MD, has received the 2012-13 Department of Internal Medicine Service Award from The University of South Dakota Sanford School of Medicine. Dr. Elgouhari
is a hepatologist and medical director of Avera Medical Group Liver Disease Sioux Falls. He is an associate professor of medicine at USD, and has been a faculty member for five years. He serves on the Health and Public Policy Committee of the SD chapter of the ACP, on the Faculty Development and Research Committees at the medical school, and the Clinical Appointment Committee for the Department of Internal Medicine where he is also a research mentor and Grand Rounds speaker.
The Traumatic Brain Injury Unit in Irene, South Dakota celebrated its 5 year anniversary in September. This
Samuel Camp, MD, joined the Avera Medical Group Emergency Medicine staff in Yankton. Dr. Camp
graduated from the Sanford School of Medicine in 2007 and completed his Family Practice residency at Sioux Falls Family Practice Residency in 2010. He is board certified in Family Practice as well as NRP, ACLS, PALS and ATLS. Dr. Camp comes to Yankton from Willmar, Minnesota where he was employed by Affiliated Community Medical Centers.
Avera Sister James Care Center and Avera Yankton Care Center recently received the Excellence in Action award from My InnerView by National Research Corporation. This
honor recognizes long term care and senior living organizations that achieve the highest levels of patient satisfaction.
Jessica Claussen, MD, Ophthalmologist, is the newest addition to the Avera Queen of Peace Medical/ Dental staff. Dr.
Claussen earned her MD from Loma Linda University School of Medicine and completed an Internship and Residency at the University of Missouri-Columbia. A native of Spearfish, South Dakota, Dr. Claussen treats a wide range of eye disease including Cataract, Glaucoma, Macular Degeneration, and Diabetic Eye disease along with Oculoplastics, Diseases of the Cornea, and Trauma.
The Avera Cancer Institute has won a national Association of Community Cancer Centers’ 2013 Innovator Award for its program to unify chemotherapy administration standards across 45 sites.
Established in 2011, ACCC’s Innovator Awards are sponsored by GE Healthcare to honor exceptional cancer programs that exhibit forward-thinking strategic planning and have developed pioneering, replicable programs for cancer care delivery. The award recipients presented the details and outcomes of their programs at the ACC National Oncology Conference in Boston in October. A total of 10 Innovator Awards were given The 6th annual Simply D’Vine Wine Event took place on October 25 at the Avera Sacred Heart Pavilion. The event
featured over 70 varieties of wine and champagne, as well as a silent and live auction. All funds raised benefited the Avera Sacred Heart Cancer Center in Yankton.
Black Hills Cedar Hills Family Clinic, P.C. joined the Regional Health family of healthcare providers.
The clinic, with locations in Newcastle and Upton, will continue to provide care to residents and those from the surrounding area. The Newcastle location is now known as Newcastle Regional Medical Clinic. The Upton location is now called Upton Regional Medical Clinic.
Michael “Mick” Gibbs is the new Chief Operating Officer for Rapid City Regional Hospital (RCRH). Gibbs is a Fellow of the American College of Healthcare Executive (FACHE). He comes
to RCRH from Sanford Health in Fargo, where he was the Vice President for the Heart, Vascular, Surgery and Radiology programs since 2010. Prior to working for Sanford Health, Gibbs was employed by Regional Health for eight years. Gibbs is a graduate of the University of North Dakota and earned MAs in BioMedical Ethics from Case Western Reserve University in Cleveland and Health Care Administration from the University of Minnesota. Eight-year-old Owen Salway from Rapid City represented South Dakota at this year’s Children’s Miracle Network (CMN) Champions Across America Conference in Orlando and Washington, D.C. in October. Salway was born at
28 weeks weighing only 2 lbs, 10 oz. At 5, he was diagnosed with Angelman syndrome, a neurogenetic disorder. During his visit to Orlando and Washington, D.C., Salway and his family participated in the national CMN Celebration at Walt Disney World and toured the nation’s capitol along with other CMN Champions.
was the first facility of its kind in the state of South Dakota.
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Midwest Medical Edition
Neurosurgeon Kym Chandler, MD joined the Regional Medical Clinic staff. Dr. Chandler received her undergraduate degree from Iowa State University, in Ames, Iowa.
She earned her medical degree at the University of Maryland School of Medicine, Baltimore, M.D. After medical school, Dr. Chandler completed her residency in general surgery at Case Western Reserve University, Cleveland, Ohio, and a fellowship in neurosurgery at University of Saskatchewan, in Saskatoon, Canada. Family physician Heather Preuss, MD, has joined the Hot Springs Regional Medical Clinic. Dr. Preuss
received her undergraduate degree from the University of Nebraska-Lincoln and her MD from the University of Nebraska in Omaha. Dr. Preuss completed a residency at Clarkson Family Medicine in Omaha and has been practicing in the Hot Springs area since June 2009.
Sanford
The Sanford Pentagon sports complex in Sioux Falls opened in October. The five-sided,
160,000-square-foot facility houses a variety of programs and events to help keep youth fit and active while teaching them valuable life lessons through sports.
November 2013
In October, Blue Cross Blue Shield of Minnesota and Sanford Health launched the new BlueConnect health plan.
Designed to remove barriers to good health through Blue Cross’ portfolio of health and wellness tools, BlueConnect brings a more personalized health plan approach to western Minnesota. BlueConnect is available where Sanford Health has a presence within the Blue Cross and Blue Shield of Minnesota coverage area, including 26 counties in Minnesota and select border counties in North Dakota, South Dakota and Iowa.
Michael Fiegen, MD and Kevin Benson, MD, specialists from Sanford Female Pelvic Medicine & Reconstructive Surgery Clinic, are now board certified in female pelvic medicine and reconstructive surgery. This is
the first time this certification, given by the American Board of Medical Specialties, has been offered in this specialty. Drs. Fiegen and Benson provide care to patients suffering from bowel, bladder or pelvic floor issues. Scott Hettenbach, CSCS, the former head strength and conditioning coach for the University of Wisconsin, men’s basketball program joined Sanford POWER as its new manager. Most recently
the associate director of sports conditioning at the University of Wisconsin, Hettenbach led strength and conditioning efforts for the Badger men’s basketball program from 1995 to 2013. Hettenbach earned his bachelor’s and master’s degrees from the University of Wisconsin-LaCrosse. He is a Certified Strength and Conditioning Specialist and a member of the National Strength and Conditioning Association.
Lior Borovik, MS, CGC, recently achieved his Board Certification in Genetic Counseling by the American Board of Genetic Counselors.
Borovik is one of five certified genetic counselors at Sanford Health in Sioux Falls and specializes in hereditary cancer counseling, prenatal diagnosis, screening and pediatric genetics.
Siouxland
The sixteenth annual June E. Nylen Cancer Center Race for Hope raised over $50,000 and was attended by more than 800 people. The event took place
on September 21 at the Adams Homestead & Nature Preserve in McCook Lake, SD. Proceeds from this year’s Race for Hope will support various programs and services at the Cancer Center. The CNOS Clinic in Dakota Dunes has added six new physicians in neurology, neurosurgery, hand surgery, sports medicine and orthopaedic surgery. Daniel Nelson, MD, is a graduate of the Sanford School of Medicine. He completed his
residency at the University of Oklahoma Health Sciences Center and an adult reconstruction fellowship at the Southern Joint Replacement Institute at Vanderbilt University in Nashville. Dr. Nelson specializes in joint replacement and general orthopaedics.
MidwestMedicalEdition.com
Elizabeth Hartman, MD, is a board certified neurologist and multiple sclerosis (MS) specialist. She is a graduate
of the University of Nebraska College of Medicine. Dr. Hartman completed her residency at the Cleveland Clinic Foundation and her Multiple Sclerosis/ Neuroimmunology fellowship at the University of Chicago Medical Center. Her specialties include multiple sclerosis, movement, cognitive and gait impairment disorders, headache and neuropathic pain syndromes. Benjamin Bissell, MD, is a board certified orthopaedic surgeon specializing in sports medicine, shoulder, knee and hip surgery and general orthopaedics. He is a graduate
of the University of NebraskaOmaha College of Medicine. Dr. Bissell completed his orthopaedic surgery residency at University of Vermont Fletcher Allen Health Care and an orthopaedic sports medicine/shoulder fellowship at the University of Michigan. Michael Nguyen, MD, is a board certified primary care physician specializing in sports medicine. He is a graduate of
the Saba University School of Medicine (SUSOM) in Saba, Netherlands Antilles. Dr. Nguyen also received a Master’s degree in Hyperbaric Medicine from SUSOM and a Master’s degree in Health Services Research from Texas State University at San Marcos. He was fellowship trained in sports medicine at Morristown Medical Center in New Jersey.
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South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes John Pracyk, MD, received his MD and PhD through the Medical Scientist Training Program at Duke University School of Medicine. Upon
concluding his doctoral work in the Department of Pharmacology & Cancer Biology, he was awarded a Davison Fellowship to study at Cambridge University in England and was awarded a postdoctoral research fellowship at the National Institutes of Health in Bethesda, Maryland. He specializes in neurosurgery of the brain, nerves and spine. Bruce Watkins, MD, is a graduate of the American University of the Caribbean (AUC) School of Medicine. He
completed his internship in general surgery at the University of Minnesota Medical Center and his residency at Marshfield Clinic-St. Joseph’s Hospital at the University of Wisconsin. Dr. Watkins is the only fellowship trained hand surgeon in the area, having trained in Orthopaedic Hand and Upper Extremity at the University of Colorado School of Medicine at Denver. He specializes in hand/ upper extremity and laparoscopic surgeries. Mercy Medical Center’s Safe Kids Woodbury County joined community volunteers and FedEx employees at various intersections greeting children as they walked or biked to school on October 9 to raise awareness about pedestrian safety on International Walk to School Day.
More than 250,000 children across the United States participated in the annual event to learn safe walking skills and to encourage the creation of safe walking environments. Mercy Medical Center staff and FedEx volunteers worked with third grade students teaching the importance of driver visibility and pedestrian awareness, using FedEx trucks and school buses to simulate real street environments.
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Cherokee Regional Medical Center entered into a formal alliance with UnityPoint Health– St. Luke’s on October 1. CRMC is
the latest of several area hospitals to join UnityPoint Health but is the first to enter into such an agreement within the St. Luke’s region. The Trauma Center at Mercy Medical Center has been verified as a Level II Trauma Center by the Verification Review Committee (VRC), an ad
hoc committee of the Committee on Trauma (COT) of the American College of Surgeons (ACS). Established by the American College of Surgeons in 1987, the COT’s Consultation/Verification Program for Hospitals promotes the development of trauma centers in which participants provide not only the hospital resources necessary for trauma care, but also the entire spectrum of care to address the needs of all injured patients from the prehospital phase through the rehabilitation process. B.J. Van Kalsbeek, Manager of Spiritual Care and Mission Services at Mercy Medical Center, is the recipient of the annual Catherine McAuley Excellence Award for 2013.
The McAuley Excellence Award is in honor of the founder of the Sisters of Mercy and is presented each year to an employee who exemplifies Mercy’s values and lives its mission. Van Kalsbeek has been with Mercy Medical Center since 2003. He holds a bachelor’s degree in religion from Northwestern College in Orange City, Iowa and a Master of Divinity from Western Theological Seminar in Holland, Michigan.
continued
Mike Wolpert, MD, was chosen by the Mercy Medical Center Foundation as the 2013 recipient of the Dr. George G. Spellman Annual Service Award.
Dr. Wolpert is a general surgeon and has served the Siouxland community for over 30 years. He was nominated for the Spellman Award by his colleagues at Midlands Clinic, P.C. Dr. Wolpert has served as Trauma Medical Director at Mercy Medical Center and currently serves on the Medical Staff Credentials Committee. Dr. Wolpert is a past member of the United Way of Siouxland Board of Directors, Queen of Peace Board of Directors, and has coached junior high boys and girls basketball at Blessed Sacrament schools. The Mercy Foundation established the Spellman Award in 2002 to recognize those who exemplify the values of Mercy and whose actions contribute to the betterment of the Siouxland community.
Other Board Certified Family Medicine physician Carrissa Pietz, MD, joined the physician staff at Yankton Medical Clinic, PC. Dr.
Pietz is originally from Lesterville, South Dakota and completed her undergraduate degree at Mount Marty College. She is a graduate of Sanford School of medicine and completed her family medicine residency at Sioux Falls Family Medicine Residency.
Horizon Health Care, Inc., a Federally Qualified Community Health Center (FQHC) with 18 medical and dental clinics in South Dakota, was recently awarded a Rural Health Information Technology Workforce Program Grant of $300,000 annually for three
years through HRSA’s Office of Rural Health Policy (ORHP). The grant will fund the “It’s a HIT!” –Health IT Training for Rural Healthcare Providers initiative which includes Prairie Health IT Network Members including Horizon’s 14 medical clinic locations and two additional rural FQHC organizations for a total of 21 primary care clinics across the state. Yankton Medical Clinic Pulmonologist Michael P. Pietila, MD, FCCP, was awarded the Early Career Physician Award by the South Dakota chapter of the American College of Physicians (ACP) at the annual state meeting in Deadwood in September. Dr.
Pietila is the outgoing Chief of Staff and current Vice Chairman of the Executive Board of Directors at Avera Sacred Heart Hospital in Yankton. Currently he is an Assistant Academic Professor of Internal Medicine at the Sanford School of Medicine. The Early Career Physician Award recognizes outstanding achievement by a physician member who is within 16 years of graduating from medical school and who is not an ACP Medical Student Member or Resident/ Fellow Member.
Midwest Medical Edition
Women Veterans of all eras were invited to the Sioux Falls VA Health Care System’s 20th annual Women Veterans Conference on October 18 in Sioux Falls. This yearly District 18 Representative Bernie Hunhoff and Avera Sacred Heart President & CEO, Pamela Rezac
State Representative Bernie Hunhoff received the South Dakota Association of Healthcare Organizations’ (SDAHO) Distinguished Service–State Legislator Award of 2013
at a reception held at the SDAHO Annual Convention in Sioux Falls on September 19. Hunhoff is known for defending healthcare access and supporting education.
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gathering offers women Veterans an opportunity to obtain health and benefit information, network with other women Veterans, and meet VA staff and Veterans Service Organization leadership. The keynote speaker, Charnel Hill-George, served in the SD Army National Guard, US Army and Army Reserves.
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November 2013
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Meaningful Use By
now it is a term with which every American healthcare provider is intimately familiar. Some would say all too familiar. But when the words “meaningful use” first entered our vocabulary as part of the American Recovery Reinvestment Act of 2009 as a way to bring medical care into the digital information age, they were, for many providers, a source of anxiety, confusion, and even fear. “Stage I was the hardest because it asked people to make an enormous shift in their business model,” says Holly Arends, Clinical Program Manager with HealthPOINT. Based at Dakota State University, HealthPOINT is the regional extension service charged with daunting task of helping area providers not only implement Electronic Health Records systems but to use them “meaningfully” according to criteria established by the Recovery Act and administered by the Centers for Medicare and Medicaid Services (CMS). “We fully anticipated that there would be fear, challenges, blockades and barriers with meaningful use,” says Arends. “You’re talking about a change in workflow and a major disruption in business.” “This has been a tremendous amount of work for everyone – providers, security teams, clinical informatics, nurses, IT departments – everyone,” agrees Hailey Schepp, Sanford Health’s Director of Meaningful Use. Sanford has attested to Stage I and is gearing up for Stage II. Schepp says education has been a major part of her job for the last two years. “It is so easy to get overwhelmed with the details of meaningful use, but we have to remember that this initiative really is about the patient and improving the patient care experience.” While a healthy percentage of providers and hospitals in our region have successfully launched their own EHRs, Arends and Schepp both say that it is in the next stage (Stage II) of meaningful use implementation, which begins next year, that the real benefits – and not just the headaches – of the plan will begin to be apparent.
By Alex Strauss
Holly Arends Clinical Program Manager with HealthPOINT
The Meaning of ‘Meaningful Use’ Over time, the meaning as well as the far-reaching and game-changing implications of meaningful use have become very clear, if not always easy to accept or implement. The term ‘meaningful use’ was adopted as part of a plan to incent eligible providers not just to purchase an EHR system, but to jump into the digital age with both feet by incorporating that system into their day-to-day medical practice in a real and measurable way.
Hailey Schepp Sanford Health’s Director of Meaningful Use
In Stage I, this means activities like collecting and compiling patient data electronically so that it can be readily accessed by both providers and patients in and outside the office. In Stage II and III, there will be greater emphasis on patient involvement with the EHR system and required reporting on quality measures designed to demonstrate how well the whole system is working. The ultimate goals of the five-year plan are to improve patient safety by making sure all of a patient’s healthcare providers have ready access to their accurate, up-to-date health information and to empower patients to take a more active role in their own healthcare by giving them more to work with. To encourage providers to get on board, doctors and hospitals that demonstrate meaningful use of their EHR by achieving all of the objectives set forth for Stage I are eligible to receive significant incentive payments. At the same time, to discourage foot-dragging, the program also includes penalties for noncompliance. Providers who have not attested to at least one year of the two-year Stage I meaningful use process by September 30, 2014 (which means they had to have started the process this September) will see a 1% reduction in reimbursements beginning in 2015, and an additional 1/% reduction every year thereafter until they “catch up”.
Off to a Good Start Far from dragging their feet, more South Dakota-area providers are on track to receive incentive payments and avoid penalties than in many others states. Arends says South Dakota is in the top 10 states nationwide in adoption of electronic health records, with more than 53 percent of the state’s providers having a ‘live’ EHR system. As of MED’s publication date, the latest figures from CMS showed that 1,447 South Dakota providers had attested to Stage I meaningful use since January 2011, a figure Arends say represents about 75 percent of the state’s eligible providers. These providers have received more than $64,269,503 in Medicare and Medicaid EHR Incentive Program payments since the program started. Nationwide, more than half of doctors’ offices will have EHRs by the end of 2013, up from just 17 percent in 2008, according to a 2012 CDC survey. Likewise, although only 9 percent of eligible hospitals were using an EHR system in 2008, today more than 80 percent have demonstrated meaningful use of EHRs. There are now more than 415,000 eligible professionals and hospitals actively registered in the incentive program, exceeding the goals of the U.S. Department of Health and Human Services and illustrating the fact that, despite the difficulty, expense, and necessity (in most cases) of a massive overhaul in workflow processes, American healthcare providers are coming to grips with the idea that EHRs are Here to stay.
Meaningful Use At a
Glance 1,455
South Dakota Providers attesting to Meaningful use
$64,269,503
Incentive payments made to SD Providers
53%
SD providers with live EHR systems
January 2011
EHR Incentive Program starts
January 1, 2014 Stage II begins
September 30, 2014 Stage I, year one date to avoid penalties
1% per year
Reimbursement reduction for non-compliance
5%
Required rate of ‘secure messaging’ in Stage II
Managing
the Maze
November 2013
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(Cover Story Continued) “This is really just the bottom floor of the changes that are coming,” says Arends. “We are moving into an entirely new way of doing business in healthcare and the providers here in the upper Midwest understand that. They are doing a great job with this and really should be applauded.”
What is Next?
Ask ur tO Abou dge Lo e! g Packa
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As South Dakota-area healthcare providers move into Stage II in 2014, meaningful use experts say there is good news and bad news. The good news is that the worst – the total paradigm shift that caused such upheaval, stress and expense in medical offices, even driving some providers to throw up their hands and opt for early retirement – is largely over. With systems in place, the focus is now on optimizing their use. The bad news is that Stage II will require a great deal more from providers in terms of patient engagement, data collection and documentation. As an example, Stage II, which begins on January 1, requires that more than 50 percent of a provider’s patients have online access to their healthcare information. Five percent of patients also need to be interacting with their providers online by doing things like sending a secure message, accessing test results, or scheduling an appointment. “This is going to require a culture change for patients and providers,” says Schepp. “Not only do we need to provide online access to our patients, but we are also going to need to demonstrate the value or benefit to those patients so that they will actually use it. This will be a challenge.
Patients who don’t have Internet access may not even be aware of this.” Among the other Stage II requirements are optimal packaging of electronic health information so that it can be successfully exchanged with other providers, medication reconciliation, improved patient education, and thorough collection and reporting of patient demographic, health and outcome data. “There is no question that Stage II is more demanding,” says Arends. “But when you look at the big picture, what it is going to mean for patient care, I think it is easier to get on board with this.” To make this second, more demanding Stage of meaningful use, which includes 20 different criteria, a little less burdensome, providers are only required to demonstrate that they are meeting the criteria during one quarter of 2014. As subsequent stages of meaningful use are implemented, the need to secure sensitive patient information will become even more critical, requiring security risk analysis. By 2016, the data collected and reported by providers will be made publically available, giving patients more information on which to base their own healthcare decisions. “Meaningful use is a lot of work, but it is all about improving the quality of care that we provide,” says Schepp. “I do feel strongly that, in the latter part of Stage II or Stage III, we are going to begin to see the proof in the pudding. I believe that this is going to reduce health disparities, improve patient safety and care coordination, and increase efficiency, which is what CMS intends. It is really all about the patient.” ■
Midwest Medical Edition
Monitor Mobile Devices to Ensure Patient Privacy (or Pay the Price!)
M
By Tana Phelps obile devices have
become an essential part of healthcare delivery, with nine out of ten physicians and mid-level practitioners using smartphones or tablets at the point of care, according to a report from Physicians Practice. While the impact of mobile devices on quality of care lacks research, the impact on patient privacy is unquestionable. If lost or stolen, mobile devices pose a major risk for patient data breaches – which can cost clinicians and their employers big time. In January 2013, the Department of Health and Human Services announced its aim to better protect patient privacy and safeguard patients’ health information. When the final omnibus rule went into effect, the HHS Office for Civil Rights began enforcing—quite vigorously—the new HIPAA privacy and security rules. From unencrypted devices being lost or stolen to employees snooping in patient medical records, the OCR is penalizing healthcare organizations for patient data breaches with hefty fines worth millions of dollars.
occurs, your organization can be found liable—even if an employee is responsible— if you do not outline appropriate use of mobile devices. Encryption. If a device is lost or stolen and not encrypted (whether it is owned by the facility or the employee), OCR will likely fine the employer. Most mobile devices have built-in encryption capabilities, or you can buy and install more advanced encryption tools to protect information sent by and stored on phones and tablets. Security. Other methods to secure PHI include using a password and activating a screen lock after the device has been idle for 60 seconds. In addition, disable file-sharing
applications and keep your security software up to date. It’s also smart to use adequate controls when accessing Wi-Fi. Social media. Eliminate the temptation to tweet about an ill-mannered patient or post a photo of a patient’s broken extremity by banning social media apps on mobile devices. If identifiable patient information is released in this manner, you can expect a fine from OCR. Other consequences include employee termination, decreased patient satisfaction scores and even a class-action lawsuit. ■ Tana Phelps is a marketing specialist at Cassling, a Midwest healthcare company that provides local imaging equipment sales and service, and marketing and professional services.
The more we get together, the happier and healthier we’ll be.
To prevent a patient data breach, consider these best practices for mobile device use at your facility Ownership. A breach of PHI is less likely when a facility owns its employees’ mobile devices and requires certain passwords and privacy settings be followed, suggests the National Federation of Independent Business. Consider putting an employee agreement in place regarding expectations for minutes, reimbursement and personal use. Training. Your internal policies and training regarding HIPAA adherence must be all encompassing and well documented. If a patient data breach or HIPAA violation
November 2013
At MMIC, we believe patients get the best care when doctors, staff and administrators are humming the same tune. So we put our energy into creating risk solutions that help everyone feel confident and supported. Solutions such as medical liability insurance, physician well-being, health IT support and patient safety consulting. It’s our own quiet way of revolutionizing health care. To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit MMICgroup.com.
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DOs and DON’Ts for the Physician Being Recruited By Tim Wieben
T
he time has come to find your first practice or relocate to a new location. Below are some tips that can guide you through the process. Previous interviews and working with physician candidates have provided me with some great experiences; some very good, and some not so good. I hope these help as you make your decision to begin anew. First and foremost, be realistic with your expectations, be honest, leave your ego at home and make timely responses to phone calls and emails. A simple phone call or email to let someone know you are not interested is just as important as pursuing the opportunity.
Before the Visit DO have a simple, concise CV. Limit it to two pages if possible. If you feel you need more, offer to send an addendum.
DON’T overstate your qualifications or experience. Imperative to the success of this process is complete honesty.
DO have a list of four (4) references. Provide the list after there is mutual interest. Make sure you contact the references in advance so they can expect a call for information.
DON’T have breaks in employment or
DO narrow your options. This is a timeconsuming and expensive venture for both parties. Location, community size, practice dynamics, group size, employed or partnership, time table . . . have an idea what you want.
DO start your search early. I can assure you it is never too early. Clients are signing physicians when they begin residency. Practices can offer stipends, money for student loans, relocation help, signing bonuses and more. Of course, those niceties come with obligations in the form of a “pay back loan” and
training. Include an explanation of any open
time commitment.
time frames.
DO research the organization/employer.
DO disclose any “issues”. Is there anything
Knowing something about the organization
in your history which could become an issue
allows you to ask more thoughtful, intelligent
or impair your ability to perform the duties
questions.
of the practice? If you are on a Visa make
DON’T forget that they have other options.
sure they know the requirements for employment in advance.
Remember the practice may have other candidates to consider. Stay the course to completion.
DON’T be afraid to ask about salary and benefits. The process is expensive and time consuming for all parties. If the salary and benefits do not meet your expectations there may be no need to make the trip.
DON’T forget to involve the family. The interviewing practice should be willing to provide a sitter, if needed, and someone to spend time with your spouse while you are interviewing.
DO ask about proper attire for you and your spouse. Location and type of practice will dictate the proper attire. It is always best to ask in advance.
Find a list of things to do AFTER the interview on the MED website.
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Midwest Medical Edition
During the Interview DO arrive on time. If someone is not picking you up, plan to arrive 10 to 15 minutes early, in case of traffic.
DO be courteous to everyone you meet. A receptionist who finds you rude could have a great impact on your ability to get a position, regardless of how smooth you come across in the actual interview.
“As physicians, we have so many unknowns coming our way...
DO have a firm, solid handshake. Regardless of your culture, a limp, weak handshake never makes a good impression.
DO stay calm and maintain eye contact. You don’t have to stare, but keep consistent visual contact with the interviewer’s general facial area. It is customary in the US to make eye contact throughout the interview.
DON’T forget that interviewers are not always trained in interviewing. You may find an interviewer rambling on about the position and the practice without asking you any questions
One thing I am certain about is my malpractice protection.”
about yourself.
DO establish rapport. Remember the interviewer’s name, and use it a few times throughout the interview. Show interest, smile when appropriate, and be involved.
DO ask questions. Be engaging without dominating the conversation. Asking questions shows that you are listening and are interested in learning more about the organization.
DON’T discuss politics and religion.
Every interviewer is going to want to answer some basic questions about you, including:
Are you a team player?
Medicine is feeling the effects of regulatory and legislative changes, increasing risk, and profitability demands—all contributing to an atmosphere of uncertainty and lack of control.
hat are your strengths? (Avoid sounding W presumptuous. Stick with what your colleagues and supervisors have said about you.)
What are your weaknesses? ( The point of this question is to determine how self-aware and realistic you are.)
Why should we hire YOU? When can you start?
What we do control as physicians: our choice of a liability partner. I selected ProAssurance because they stand behind my good medicine. In spite of the maelstrom of change, I am protected, respected, and heard. I believe in fair treatment—and I get it.
Acknowledge each person when you are introduced, stay focused and listen carefully to their questions, and address your answer to the person who asked the question. Everyone is anxious during an interview, so don’t worry if you feel butterflies. Just remember that the person who can answer the above questions to the employer’s satisfaction will get the job. ■
Tim Wieben, CMPE, is President and CEO of North Dakota-based Medical Recruitment Associates, Inc.
November 2013
MidwestMedicalEdition.com
Professional Liability Insurance & Risk Management Services ProAssurance Group is rated A+ (Superior) by A.M. Best. ProAssurance.com • 800.292.1036
17
Clinical Spotlight
Sanford Research Secures NIH Grants $14+ million will support genomic, cancer, and pediatric research Dr. David Pearce (left)
The National Institutes of Health’s Centers of Biomedical Research Excellence has awarded a five-year grant
for more than $11.6 million to the Children’s Health Research Center at Sanford Research. Led by David Pearce, PhD, VP and COO for Sanford Research, the Children’s Health Research Center focuses on pediatric translational research and is the home to several research initiatives designed to understand the underlying basis of several congenital defects and childhood diseases. Among those diseases are neurodegenerative disorders, pediatric brain cancers, cystic kidney disease, primary ciliary dyskinesia, developmental defects of the nervous system and pancreas, oxidative injury in the perinatal lung, disorders relating to defects in the cell nucleus and fatty acid deficiencies in newborns. The center’s team has exper- Institute in La Jolla, CA. tise in a wide range of disciplines Two other Sanford researchincluding genetics, molecular ers have received separate grants biology, cell biology, develop- from the NIH totaling more than mental biology and biochemistry. $2.6 million for studies involvPearce is one of the world’s top ing genomic proteins and a Dr. Kyle Roux (left) researchers of Batten disease, cancer-killing drug. a neurodegenerative disorder, Kyle J. Roux, PhD, earned a BioID and advance the rate at and leads the Pearce Lab for five-year, $1.52 million award which scientists characterize proGenetically Inherited Diseases from the NIH’s National Institute teins and their interactions, of Children at Sanford Research. of General Medical Sciences which helps in the design of The Coordination of Rare (NIGMS) for his project titled therapies for human disease. Diseases at Sanford (CoRDS), an “Developing methods for Keith Miskimins, PhD, international and central registry proximity-dependent protein and his study,“Molecular mechaof individuals who have been labeling.” Last year, Dr. Roux nisms by which the diabetic diagnosed with a rare disease, is unveiled a new way to identify drug metformin kills cancer a cornerstone program within the the proximity and interactions cells,” will receive more than Children’s Health Research between proteins in living cells $1.18 million over four years Center. The Children’s Health called BioID. The system pro- from the NIH’s National Cancer Research Center also includes vides insight into the underlying Institute (NCI). Dr. Miskimins’ collaboration with the Sanford- mechanisms of disease. His grant study will explore the molecular Burnham Medical Research will allow him to further develop and cellular mechanisms by
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Dr. Kyle Roux (left)
which metformin, a drug used to treat type 2 diabetes, kills cancer cells. In cultured cells and animal models, metformin has been found to kill Dr. Keith Miskimins cancer cells and slow tumor growth, but the drug behaves differently when other compounds are present or nutrient availability changes. ■
Midwest Medical Edition
November 2013
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iPad Project Receives Award from SD Health Department The South Dakota Department of Health’s Healthcare Coalitions Project has awarded Sanford Health’s emergency management team in the Sioux Falls region the Outstanding Emergency Preparedness Partner Award for a project that uses iPads and iOS technology to improve emergency preparedness. The Sanford emergency management committee and its incident management team was created in 2005 after recognizing a need for a standard format for hospital preparedness. Sanford received a grant from the state Health Department for the iPad project, which implemented the lightweight, inexpensive technology of Apple iOS into its command center communications structure. The iPad project created multiple layers of communication capability that easily link to existing technology. The project effectively created a “safety net” for its command center that makes powerful communication
tools available from anywhere there is a cellphone or Wi-Fi signal. “The iPad project is changing the health care system and allowing us to work more efficiently,” says Sanford emergency manager Greg Santa Maria. “In addition, The South Dakota Department of Health’s Hospital Incident Command System (HICS) has allowed us to expand the project further. We have created an intelligence section in the hospital command center that now has the tools and capabilities to receive information, objectives and resource requests in real time from any of our facilities as well as our external partners. This section can be accessed remotely using these iPads and can send real-time video and images from an affected facility back to the command center for evaluation and assessment.” The iPad project was fully tested during a Sanford regional exercise last November. Sanford is in the process of adding facilities to this existing project. ■
Black Hills Clinics Recognized for Patient Satisfaction Regional Health Physicians and three of its clinics have been recognized for superior clinic satisfaction. The ‘Excellence through Insight’ award from HealthStream recognizes providers that score above the 75th percentile rank in the HealthStream database representing more than 1,050 clinics and 6,000 providers nationwide. The final rankings are based on scores from more than 200,000 completed patient satisfaction surveys. Regional Health Physicians was recognized in the Overall Clinic Satisfaction category and ranked in the top 1 percent in the nation as one of five national winners. Three Regional Health clinics were specifically recognized as the best in clinic satisfaction for their category: Family Practice Lead-Deadwood Regional Medical Clinic, Deadwood General Surgery Western Hills Professional Building, Rapid City
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cians. “This award exemplifies the dedication to quality and patient-centered care by Regional Health Physicians, providers and employees. We are committed to providing healthcare excellence in the communities we serve.” ■
MED Quotes “ If people let the government decide what foods they eat and what medicines they take, their bodies will soon be in as sorry a state as the souls who live under tyranny.” — Thomas Jefferson
Midwest Medical Edition
Siouxland Gets $16.8 Million Boost in Critical Care and MRI Services 13.8 Million ICU Renovation
Mercy Medical Center-Sioux City has begun construc-
tion on a $16.8 million investment in Mercy’s critical care and imaging services. The investment includes renovation of the current intensive care units and the installation of a 3.0 Tesla (3T) Magnetic Resonance Imaging Scanner to replace the existing unit. Investment includes $13.8 million for the ICU renovation and $3.0 million for the MRI. Mercy is the Siouxland area’s only Level II Trauma Center and serves over 1,700 critical patients in the intensive care units. The three ICUs will be renovated to form one 20-bed unit with supporting nurse stations and storage. The new unit will consist of all private patient rooms and family waiting space. Updated equipment, including new beds and monitoring equipment will outfit the new ICU. The project will involve remodeling the existing ICU with an addition over the Radiology services on the 4th floor. Renovation is expected to be complete in January 2015. Mercy is also the only Joint Commission accredited Stroke Center in the Siouxland region. The 3T MRI meets the highresolution requirements of acute brain and neurovascular imaging. Emerging clinical evidence indicates perfusion imaging, diffusion tensor imaging, and MR spectroscopy are all enhanced by 3T MRI. In addition, the 3T MRI provides Mercy with the ability to perform breast MRIs, cardiac MRIs, abdominal MRI/MRA and services to bariatric patients. ■
November 2013
MidwestMedicalEdition.com
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Major Expansion for Sioux Falls Retirement Campus Work is progressing on a new 90-bed long-term care facility at Avera Prince of Peace Retirement Community in southeast Sioux Falls. Construction began in October on the two-story, 117,000-square-foot, $25 million expansion. The facility will house 64 long-term care beds, 26 rehabilitation beds and 20 additional assisted living beds. A $3 million community campaign is currently under way to fund the 18-month project. The new construction will replace Avera Prince of Peace’s existing long-term care and rehab rooms. The facility’s 32 assisted living apartments will remain, for a total of 52 with the new addition. The rest of the existing building will be repurposed. Laurel Oaks independent living apartments at Avera Prince of Peace will remain as is. The 74 apartments range in size from three-bedroom, two-bath units to studio floor plans. The new facility replaces semi-private rooms with all private rooms and bathrooms, as well as a number of amenities and updates including: ✦ ✦ Intimate neighborhood living and dining spaces ✦ ✦ Expanded chapel space ✦ ✦ A deli, general store, salon and bank ✦ ✦ Expanded kitchen ✦ ✦ Additional rehab suites ✦ ✦ Expanded therapy space and new outpatient therapy space ✦ ✦ Indoor garage space to allow for resident loading and unloading for travel to appointments or outings ✦ ✦ Secure, landscaped courtyards for residents dealing with dementia Avera Prince of Peace Retirement Community was constructed in 1986 with later additions. Avera McKennan President and CEO, Dave Kapaska, says the project was driven by consumer demand. ■
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Doors Open on Siouxland’s Newest ‘Medical Home’ St. Luke’s Sunnybrook Medical Plaza ready for projected 30% increase in demand for outpatient services over the next decade Siouxland patients are experiencing healthcare in a new way with the opening of UnityPoint Health–St. Luke’s new Sunnybrook Medical Plaza. After a 14-month construction period, the two-story, 86,000 square foot medical facility opened for business in September. Located in the heart of Sioux City’s bustling Sunnybrook Business District, Sunnybrook Medical Plaza provides a new access point for expanded outpatient and physician services, advanced medical technology, and unique amenities. Built around the increasingly-popular Medical Home model of care coordination, Sunnybrook Medical Plaza advocates seamless scheduling between physicians, clinics and other healthcare services, strong patient involvement in the healthcare decision-making process and enhanced communication between providers involved in the patient’s care. “Studies have shown effective care coordination leads to improved patient outcomes,” says Dr. D.J. Todt, a primary care physician with UnityPoint Clinic Family and Internal Medicine at Sunnybrook. Our patients will receive integrated care based on their own unique needs. We help healthy patients stay healthy and help those with ongoing health issues make informed decisions and maintain the highest quality of life possible.” The new facility was built with the expectation that demand for primary care services will continue to climb with the aging population and the expansion of affordable healthcare options. “Healthcare is constantly changing, and Sunnybrook Medical Plaza is a vital step in ensuring we provide the services and care our patients will need in the future,” says Dr. James Webb, another primary care physician with UnityPoint Clinic Family and Internal Medicine at Sunnybrook. “Our philosophy of care is centered on the patient and their family. Coordinated care will no longer be the exception but an expectation of patients at Sunnybrook.”
Midwest Medical Edition
Offering services in collaboration with physician partners, Sunnybrook Medical Plaza houses:
k UnityPoint Health – St. Luke’s Imaging and Breast Screening Services
k U nityPoint Clinic Family and Internal Medicine
k U nityPoint Clinic Podiatry k UnityPoint Clinic Urgent Care k UnityPoint Clinic Occupational Medicine
k UnityPoint Health – St. Luke’s Cardiology Services and Cardiovascular Associates’ new main clinic
k UnityPoint Clinic Multi-Specialty including nephrology and surgery
k UnityPoint Health – St. Luke’s Infusion Services
k UnityPoint Health – St. Luke’s Diabetes Services and Education
k UnityPoint Health – St. Luke’s Lab Services In addition, Wadzinski Eye Clinic, Sunnybrook Dental and DaVita Dialysis are currently developing on the Sunnybrook Medical Plaza campus. ■
New Dialysis Center for Sioux Falls Avera McKennan Hos-
pital & University Health Center recently announced plans to open an outpatient dialysis center on its Sioux Falls campus. Avera McKennan Dialysis Sioux Falls will be located in newly renovated space in Plaza 3 Suite 4000, and will be furnished with state-ofthe-art equipment, including Crit-Line technology and specially designed patient chairs with heat and massage. Plaza 3 is home to comprehensive organ disease services, including nephrology, liver disease, organ transplantation, endocrinology and diabetes care.Patients will also benefit from valet services and the convenience of
a parking ramp adjoining Plaza 3 by skywalk. In the past, Avera McKennan has contracted with DaVita to provide outpatient dialysis service on its campus. Avera McKennan has operated its own inpatient dialysis center for a number of years, and has operated numerous outpatient dialysis centers throughout the region. The 11,000-square-foot dialysis center will have 22 patient stations. The center will have up to four shifts Monday through Saturday, so the center will accommodate all current patients with capacity for growth. In conjunction with the outpatient dialysis center, Avera will offer peritoneal dialysis and
home hemodialysis care, with all the training and support from experienced staff that patients need for these types of care. Avera nephrologists who served as medical directors of the DaVita center on the Avera McKennan campus will now serve as medical directors of the new dialysis center. Insurance coverage also will be more seamless for those patients whose carriers prefer a comprehensive approach to kidney disease care, from nephrology, to dialysis, to kidney and pancreas transplantation. Avera is home to the region’s longest-standing kidney transplant program, now celebrating its 20th year. ■
MED Quotes “The only thing worse than being blind is having sight but no vision.” — Helen Keller
Same-Day Scheduling Boosts Appointment Rate Physicians with Avera Medical Group
McGreevy in Sioux Falls have seen a 10.2 percent growth in appointments scheduled in the past year, thanks to the implementation of same-day scheduling. Avera Medical Group McGreevy has used the new scheduling process, whose goal is to set up an appointment for the patient by the end of the first conversation, for a year. Now, Avera Medical Group Internal Medicine has now joined the same-day process. Schedulers at these clinics can schedule patients with acute conditions into any available appointment slot at participating Avera clinics, without the patient having to call another location or wait for a call back. “We have two goals whenever a patient calls for an appointment. One is to give that
November 2013
patient what he or she wants by the end of that conversation – an appointment; and two is to never lose a patient,” said Deb Soholt, Administrative Liaison to Avera McKennan’s Primary Care Innovation Council. Before the project began, Avera Medical Group McGreevy was averaging 70 “first calls” per week from patients that did not end in a scheduled appointment. Now, that number is virtually zero. Through this new plan, providers make time for same-day appointment availability, and also earmark appointments where double-booking is possible in advance. Open slots are made available electronically to all schedulers, so those open appointments can be offered to patients if their own provider and clinic have a full schedule.
MidwestMedicalEdition.com
Dr. Shawn Culey practices family medicine at Avera Medical Group McGreevy West Benson Road, one of several Avera clinic locations offering same-day appointments.
Soholt says physicians appreciate having a streamlined schedule which allows them to be more productive. In addition, new physicians get more opportunity to more quickly work up to their capacity. “We’re finding that patients are grateful to be seen, and we are using our primary care system to its fullest,” Soholt said. ■
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Midwest Medical Edition
Avoid Major Cash Flow Disruption and
Get Prepared for ICD-10
Q
By Heidi Babb uick trivia: What do Myan-
mar, Liberia and the U.S. have in common? Answer: We’re the only countries that still haven’t adopted the metric system. As further evidence of our stubbornness as a nation, we have been snubbing our nose at the rest of the world regarding disease classification by remaining one of the last holdouts still using ICD-9. But on October 1, 2014, we will concede one of these points by adopting the ICD-10 system and join the rest of the industrialized world. If you’re like me, my initial instinct would be to “file” away a reminder in the next September file (which is right next to my “order Chicago Cubs World Series tickets” file) and go about my day. Unfortunately, this transition will require more attention if you want to avoid a severe shock to your cash drawer next October. Regarding the evidence of the financial importance of being prepared for the transition, we need to look no further than our neighbors to the north. In Canada, when the transition took place to ICD-10, there were reports of up to a 40% disruption in cash flow caused by insufficient documentation, coding errors, and coding delays. It is being recommended that, in addition to allotting appropriate time for the transition, that each facility make certain that their cash reserves are increased to be ready for a potential disruption. One way to reduce the amount of additional cash reserves is to make certain your facility has done everything possible to prepare for the transition. This will require time to make sure you have properly educated personnel and tested processes. Plan on at least six months for this entire preparation phase to make sure all aspects have been covered. During this process, you will want to ensure the following: November 2013
s C reate a detailed project plan that outlines specific tasks to be completed by certain people on specific dates.
s W ork with physicians to review documentation to ensure proper detail is being recorded
s C reate a budget for staff training, possible system upgrades (anticipate a cash flow disruption beginning in October because of an increase in denials and increase in time to send out claims)
s T est communications between system and clearinghouse and payers to ensure proper data transmission
s E ducate business office staff on the details of documentation requirements, consider certification for coders s C ommunicate with software vendors to confirm their readiness for the transition s C reate a crosswalk for your most common procedures to understand ICD code changes s C ommunicate with payers, billing company (if outsourced) and clearinghouse.
Each ASC will have its own specific issues and areas that will require unique attention, but this list highlights the areas to focus on. One more thing to remember: Don’t worry if you’re becoming frustrated with all the commotion surrounding ICD-10 . . . The first version ICD-11 is due out later this year. ■ Heidi Babb is VP for Revenue Cycle Services at Sioux Falls-based Partners Medical Consulting which provides Revenue Cycle Services, Clinical Consulting, Bookkeeping, Finance, Payroll, and Full Service Management contracts to clinics, surgery centers, and hospitals.
Take 5 for 5 Tips. Enjoy these best practices from our marketing team: 1. 2. 3. 4. 5.
Define your differentiators. Know your audience’s pain points. Get social and mobile. Capitalize on current events. Prove your worth.
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25
The Nurses’ Station Nursing News from Around the Region
Front row: Dr. Maritza Lopez, Back row, L-R: Amy Thiesse, Sue Alley, Lori Sisk & Brenda Knutson
Sanford Heart Nurse Receives Certification in Heart Failure | Ladene Case, RN, BSN, CHFN, has become a Certified Heart Failure Nurse through the American Association of Heart Failure Nurses (AAHFN). Case is one of two CHFNs in the state of South Dakota and one of fewer than 600 worldwide.
DAISY Award Winners Across the Region Sue Alley, RN, of Sanford Canby Home Health in Canby, Minnesota received a DAISY Award for Extraordinary Nurses in September from the Sanford Health Enterprise Network. In her nomination of Alley, Dr. Maritza Lopez wrote,
Case graduated from South Dakota State University
“Taking care of one of my patients, Sue Alley
with Bachelor of Science degree in Nursing. She began
went beyond her call of duty and treated the
her career at Sanford Health in May 2004 in the Coronary Intensive Care Unit,
patient so kindly that I felt if I am a patient,
which later combined with the Intensive Care Unit. In 2006 she moved over to
I would like her as my nurse.” Alley’s man-
the Sanford Cardiovascular Institute. In January 2013 she became the Heart
ager calls her an “excellent clinician” who
Failure Nurse Coordinator and oversees Sanford’s Heart Failure Program in the
has earned the respect of her department
Sioux Falls region. ■
with excellent interpersonal skills and a willingness to ‘pitch in’.
Rapid City Pair Recognized for 20 Years of Specialty Nursing Certifications Wendy Asher and Cheryl Greenwood with Rapid City Regional Hospital recently received national recognition for consistently maintaining nursing certifications for the past 20 years. Asher, a Pediatric Nurse Practitioner, is certified as a Wendy Asher
“ [Laws} stepped up during the disaster-like
Association of Critical Care Nurses (AACN). CCRN desig-
scenario, pitching in and playing multiple
nation indicates advanced knowledge and clinical expertise
roles from nursing assistant to charge nurse
in the care of acutely and critically ill patients and their
to triage nurse to primary care nurse, even
Greenwood, Director of Regional Dialysis Services at RCRH, is certified in Nephrology Nursing through the Nephrology Nursing Certification Commission (NNCC). She has been employed at RCRH for more than
26
Laws was nominated for the award by Patrick Tibbles, MD, who described an exceptionally busy night in the ED when Laws was the charge nurse. Dr. Tibbles says,
Critical Care Registered Nurse through the American
families. Asher has been employed at RCRH for 12 years.
Cheryl Greenwood
Recent DAISY Award winners in Rapid City include Kimberly Laws, who has been with the Emergency Department at RCRH for three years and Kherdine Weber, an RN in the Cardiac Interventional Unit for two years.
23 years. ■
to social worker to assist in handling multiple critically-ill patients.”
The nomination went on to say that despite being exhausted from many hours of work, Laws displayed some of the most heroic behavior the physician had ever witnessed.
Midwest Medical Edition
“When is the last time you reviewed your billing process?”
Weber was nominated for the award by a patient who said she “performed far above the call of duty.” When the patient had a scare one night and Kherdine Weber was afraid to go to sleep, Weber stayed by the patient’s bedside and was there when the patient woke up. “People like her make this hospital a great place to visit any time, and mostly as a patient,” the patient said.
DAISY
is an acronym for “diseases attacking the immune system.” The DAISY Award was established by the DAISY Foundation in California in memory of J. Patrick Barnes who died at age 33 of an autoimmune disease. The DAISY Award has grown into an ongoing recognition program in partnership with healthcare organizations in seven countries. At RCRH, monthly DAISY Award winners receive a certificate, pin, tote bag and a Healer’s Touch sculpture carved by
Billing Experts Billing Audits Coding Contracting www.partnersmedco.com 605.906.1272
artists of the Shona Tribe in Africa. ■
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Clinic Manager, Plastic Surgery Associates of South Dakota
November 2013
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27
Grape Expectations
Thanksgiving Wines
Consider Them Extra ‘Side Dishes’ By Heather Taylor Boysen
T
here is about a week or two at the end of October and the beginning of November that begin signaling to me that Fall has arrived and the holidays are right around the corner. It is the time when we open the windows in the house and breathe in the fresh, crisp smell of fall. It is the sound of leaves skittering across the ground and the search for sweatshirts, jackets, coats and gloves as the days get cooler. I love fall and everything it brings to our little corner of the world. For South Dakotans it means the annual preparation for hunting season specifically the wily Ringneck pheasant. It is also the time we begin getting ready for both Thanksgiving and Christmas. Whose year is it to host, what are we cooking, who is coming to the celebration and who is responsible for bringing the wine? Our Thanksgiving is a smorgasbord of food goodness all revolving around turkey. I have the best set up for cooking a large meal with a couple of monster turkeys so everyone comes to our house. The only drawback for me is getting up at the crack of dawn to put the turkeys in the oven. The
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advantage is having our house filled with family and the smell of mouth-watering food permeating every room in the house. If you could bottle the aromas and sell it, one would probably make a fortune! Obviously, I am also in charge of the wine and I have learned over the years, especially with my family, that much like the food, we also have a smorgasbord of wine in attendance at our Thanksgiving Feast. Our Thanksgiving meal is actually more of a lunch as we typically serve the first salvo of food at around 1pm in the afternoon. Pairing wine with a Thanksgiving meal is almost impossible. Wine just cannot be paired with only the turkey. Thanksgiving is all about the side dishes people! Sweet potatoes, mashed potatoes, dressing/stuffing, green bean casserole, wild rice, cranberry sauce, pecan and pumpkins pies and more depending on your family preferences scream for attention when you consider your wine choices. I have given up trying to pair and serve wines in a precise and orderly fashion for Thanksgiving and Christmas both. My stepfather will break into the pinot noir when no one is looking and Aunt Vickie will drink whatever white is close by. My sister and I go for the Rosé while my brother and mom go right for the Zinfandel or Cabernet. My husband, Reed, usually begins with a nice Belgian Ale before moving to wine and we all love anything sparkling. Having learned from past mistakes, I try to pick lighter, low-alcohol wines to open and drink while we are putting the finishing touches on the meal. A Grüner Veltliner, Rosé
of Cabernet or Syrah and Verdicchio or Vermentino are my favorites as they are refreshing and thirst quenching for all of the hard workers in the kitchen. They are also crowd pleasers as my family’s tastes for wine run from sweet to big, big, big and delicious so these are right in the middle and will make everyone happy. Between bouts of Dominos, catnaps and football games as we get ready for the evening meal and “Round 2” of Thanksgiving, the reds start to make a bigger appearance. Pinot Noir, Zinfandel and Cabernet Sauvignon are the stars of our show as those are the reds everyone who sits around our Thanksgiving table enjoys. Consider your wine choices as just a few more side dishes to any holiday meal. Thanksgiving is really all about the joy of family and the celebration of the day, not whether you had the perfect wine pairing with the perfect dish. ■
Midwest Medical Edition
Learning Opportunities November / December November 7 8:00 am – 12:00 pm CPR Instructor – Basic Life Support for Healthcare Location: Sanford Health Center for Learning, Sioux Falls Information: 605-328-6327 Registration: www.SanfordHealth.org
November 22 7:45 am – 5:00 pm Sanford Behavioral Health Conference Location: Ramada Plaza Suites, Fargo, ND Information: 800-437-4010 Registration: www.SanfordHealth.org
November 22 7:45 am – 4:15 pm 13th Annual Avera McKennan Pediatric Symposium Location: Prairie Center, Sr. Colman Room Information: mckeducation@avera.org, 605-322-8950 Registration: www.Avera.org/conferences
December 2 – 5 8:00 am – 4:00 pm Sanford Perinatal Nurse Fellowship Location: Sanford USD Medical Center Information: amy.l.johnson2@sanfordhelath.org, 605-328-7140 Registration: www.SanfordHealth.org Looking Ahead…
March 27 8:00 am – 5:00 pm Avera Transplant Institute Symposium Location: Prairie Center, Presentation Room Information: mckeducation@avera.org, 605-322-8950 Registration: www.Avera.org/conferences
Note: Many of these Learning Opportunities offer CME credits to providers. Check with the individual conference coordinators to determine if credits are offered.
See whats going on and Post your events for free.
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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.
Breast cancer genetic counseling
FOR YOUR PATIENTS’ PEACE OF MIND Edith Sanford Breast Specialty Clinic provides a full scope of genetic counseling that is unmatched in the region. Our specialized team can identify your patients’ specific risk factors and what steps they can take to minimize those risks. Dr. Jesse Dirksen, fellowship-trained breast surgeon, and Kristen DeBerg, genetic counselor, will review their medical status and history to help determine a course of action specific to their needs. We can help your patients understand their risks, and put their mind at ease. CALL (605) 328-4592 TO REFER A PATIENT.
SANFORDHEALTH.ORG/EDITH
Jesse Dirksen, MD
500-52600-0155
Kristen DeBerg, MS, CGC