2017
SEPTEMBER OCTOBER
Vol. 8 No. 6
Hospitalists and the Changing Face of Rural Healthcare CONSIDERING long-term care insurance
Avera offers BREAST CANCER BLOOD TEST
Why Fall is prime time for
Black Hills travel
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MIDWEST MEDICAL EDITION
Contents
HOSPITALISTS and the Changing
VOLUME 8, NO. 6 ■ SEP T EM B ER / O C TO B ER 2017
REGULAR FEATURES 4 | From Us to You 5 | MED on the Web
35 | Learning Opportunities
2017
14
10 | News & Notes Here’s what’s happening around the region
Healthcare
SEPTEMBER OCTOBER
Best and Worst States for Healthcare, Hazards in the Medical Workplace
ON THE COVER
Face of Rural
By Peter Carrels Vol. 8 No. 6
Long Term Care Insurance: The time to Plan is Now ■ By Aaron Maguire
IN THIS ISSUE 6 | Should Your Office Charge Finance Charges: What You Need to Consider ■ By Jill Heyden
24 New Breast Cancer Blood Test Now Available at Avera Avera physicians have helped make this amazing new tool a reality
9 | Is Your Practice Prepared?
■ By Thomas Johnson Lawsuit Highlights ACA’s Anti-Discrimination Rule
20 | Sanford NICU Now Offering National Clinical Trials ■ By Alex Strauss
22 | Mercy Introduces New Stent for Coronary Artery Disease
23 | Rally Accident Survivor Donates Art Piece to Spearfish Hospital
31 Four Reasons Fall is the New Summer in the Black Hills ■ By Carmella Biesiot
23 | SD’s First MRI Caring Suite Now Open in the Black Hills Patient-centered approach is designed to ease the stress of MRI
26 | Collaborative Effort Transforms Culture and Care in Rapid City Regional’s ICU ■ By Alex Strauss
28 | Tanzanian Bus Accident Victims Return Home Three children treated in Sioux City after a May bus crash have returned to Africa
Hospitalists
16
and the Changing Fac e of Rural Healthcare CONSIDERING long-term care insurance
Avera offers BREAST CANCER BLOOD TEST
page Why Fall is prime time for
Black Hills travel
THE SOUT H DAKO TA REGIO N’S PRE M IER PUBLI CATIO FOR HEALTHCA N RE PROFE SSION ALS
By Alex Strauss
Hospital medicine is the fastest growing specialty in the history of American medicine. While the largest health systems in the region have had hospitalist programs in place for some time, a growing number of rural facilities and smaller hospitals are also now coming on board. MED spoke with several key players for a better perspective on how - and why - hospitalists are changing the face of healthcare on the Great Plains.
29 | Evolving Nutrition Strategies for Infants & Toddlers ■ By Holly Swee
32 | It Gives You a Larger Voice”
■ By Alex Strauss Radiology Supervisor Shows She Means Business with a Healthcare MBA
34 | Meet the MED Cartoonist Meet the Michigan man behind MED’s new medical cartoon feature.
On the Cover: Sassen Kwasa, MD, is a Hospitalist at Sanford USD Medical Center in Sioux Falls. Sanford has now established hospitalist programs in several of its rural facilities.
page
16
From Us to You Staying in Touch with MED
A
T MED, WE LOVE CONNECTING WITH OUR READERS, advertisers and contributors each Fall at the SDAHO and SDMGMA conferences. If you are a SDAHO attendee and you have picked up our publication for the first time, welcome! We hope that you will enjoy this premier business publication exclusively for healthcare professionals in the South Dakota region. The September/October issue of MED is traditionally our biggest, most value-packed issue of the year and this year’s issue is no exception. In this issue, we offer a look at the rising number of hospitalist programs in smaller cities and rural areas. We also have more on a new breast cancer blood test at Avera, clinical trials for neonates at Sanford, and a culture change in Regional Health’s Rapid City ICU. On the business side, you’ll find expert columns on finance charges for late-paying patients, the legalities of serving patients with disabilities, and considerations regarding long-term care insurance. Of course, we also have the area’s most comprehensive roundup of medical community news and our popular Learning Opportunities to help you plan you fall and winter. Please remember that if you have news to report, an interesting case to share, or simply a story to tell, MED’s 5,000+ readers are waiting to hear from you. Email us at Info@MidwestMedicalEdition or check us out online at MidwestMedicalEdition.com where you can also register to receive the digital version of each MED magazine up to two weeks ahead of print. Here’s to chilly nights and golden days, —Alex and Steff
PUBLISHER MED Magazine, LLC
Sioux Falls, South Dakota
Liston-Holtrop Steffanie Liston-Holtrop
EDITOR IN CHIEF Alex Strauss
GRAPHIC DESIGN Corbo Design
PHOTOGRAPHER studiofotografie
MED was once again a proud sponsor of the Dakota Sight & Health 19th annual golf tournament. This year’s event raised just over $25,000 for outreach and education programs. Pictured left to right: Butch Hansen, Novak Sanitary; Steffanie Liston Holtrop, MED Magazine; Amanda Odegaard, Earthbend; Aaron Maguire, Security National Bank.
October 1 Next Advertising deadline October 5 Next Contribution deadline
4
WEB DESIGN Locable DIGITAL MEDIA
DIRECTOR Jaclyn Small Alex Strauss
MARKETING DIRECTOR Erika Tufton DEVELOPMENT DIRECTOR Kyra Torgerson CONTRIBUTING WRITERS Carmella Biesiot
Jill Heyden Thomas Johnson Aaron Maguire
NEWS AND NOTES
EDITOR VIRGINIA OLSON STAFF WRITERS Virginia Olson Liz Boyd Caroline Chenault John Knies
Next Issue: November 2017
VICE PRESIDENT
SALES & MARKETING Steffanie
COPY EDITOR Andrea Conover
Reproduction or use of the contents of this magazine is prohibited.
©2017 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5,000 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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CAN’T GET ENOUGH 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! 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
THERE IS EVEN MORE
online!
Maximize your digital marketing! List your practice or business, including contact information and links to your website, in MED’s popular online business directory for free. Add your listing in just minutes at midwestmedicaledition. com/businesses/search.
This month only on the Web
2017’s Best & Worst States for Health Care (3 are in our region!)
Hazard Alert:
How to Protect Patients and Staff from Workplace Dangers Stay up-to-date between issues. Sign up for previews of upcoming articles and advance notice of the next digital edition of MidwestMedicalEdition.com
Should Your Office Charge Finance Charges? WHAT YOU NEED TO CONSIDER By Jill Heyden
A
S YOU ARE AWARE, out of pocket expenses for patients have increased in the last few years. This fact has prompted many providers to revisit the issue of whether they should charge patients interest or late payment fees after a balance becomes past due. Money collected from these accrued finance charges is often used to offset costs that a practice will incur in its attempts to collect balances owed. Such costs include additional statements, staffing for collections calls, and/or external collections agency fees which are increasing, because of new and additional governmental regulation.
do not. Others may have the ability, but at an additional cost to you as their user. Also, consider the amount of time and work that including these charges may add for your billing team. If it does add work, is it manageable and is it worth it? Your team will also be the voice of explanation to your patients. With the implementation of additional fees, patients may need some assistance with understanding the change and the reasoning behind the change. As with all changes to patient interaction: the response from the patient is often determined in the delivery of the message.
CONSIDERATIONS
If you intend to charge additional fees on unpaid balances, the Federal Truth in Lending Act requires you to inform patients in advance (at the date of service or at the very least, on the first statement.) It is suggested to inform patients on a lobby sign, on a patient in-take form, and/or the financial responsibility form. Intentions to charge finance charges should also be printed on each billing statement. Seek legal counsel for suggested verbiage, the amount you may charge, and any relevant state laws.
There are many things to consider in deciding if your practice should charge finance charges. First and foremost, you will need to check your billing software to determine if the version that you use has the ability to accrue finance charges. Surprisingly, many
INFORMING PATIENTS
CALCULATING CHARGES Carefully consider the timing of your accrual plan. Most accounting software calculates the finance charges for you but knowing the process is helpful when you are setting your late fee amount.
To accrue charges per day, the finance percentage should be set based on a full month. First find the daily percentage rate. If you charge 2 percent per month, multiply that by 0.03 which gives you 1/30th of 2. This will illustrate a daily rate of .06 percent. Multiply the amount due by the daily rate. This option gives you the flexibility to send out invoices as often as you choose, with each invoice showing a higher finance charge. Instead of worrying about a daily finance charge, some facilities choose to set a flat monthly percentage amount. For example, say all overdue invoices will be charged a 10 percent late fee. At the end of the month, simply multiply the amount owed by 10 percent. Add the product to the principal balance that is owed.
PATIENT PERCEPTION While studies have shown that charging a fee to offset costs has fiscally assisted medical practices, the patient’s perception is also a factor. Waiving a finance charge is one way to show your patients that you are willing to work with them and want them succeed in paying their debt. Consumers as a whole are looking for ‘the best deal.’ Finance charges can be used as a negotiating tool with patients without influencing the principal balance that is owed for the services provided. ■ Jill Heyden is Director of Business Relations at Advanced Asset Alliance in Sioux Falls.
Read what the AMA has to say about finance charges and what happens to them when an account goes to collection in the extended version of this article on our website.
6
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Healthcare on the move services within one location with a team of providers and caregivers coordinating and working together,” says Regional Health Chief Operating Officer Paulette Davidson. The institute will also include a performance and athletic enhancement center. The initiatives are a part of Regional Health’s system-wide master space planning process and represent the largest expansion and renovation project in the system’s history. The construction manager for the project is Layton/Gustafson , a joint venture between Layton Construction of Salt Lake City and Rapid City-based Gustafson Builders. Local officials and business leaders, including Rapid City Mayor Steve Allender and Rapid City Area Chamber of Commerce President and CEO Linda Rabe, were among those who celebrated the news with Regional Health executives, physicians, and caregivers at an unveiling ceremony last month. ■
Changes for Watertown
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9:43 AM
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The new Prairie Lakes Specialty Clinic will eventually be home to many services already offered by Prairie Lakes Healthcare System but will also add much-needed space for future growth. Prairie Lakes has grown from one employed specialty physician in 2003 to 21 in 2016. Today, Prairie Lakes physicians operate 17 outreach clinics in surrounding communities. “Many of our services, like dermatology and interventional cardiology, are rare to find in our type of service area,” says President and CEO, Jill Fuller. “Prairie Lakes Healthcare System needs additional space to accommodate service growth. The Specialty Clinic building will be a great addition to our campus.” The helipad will also relocate to the roof of the clinic, which will be adjacent to the emergency department and radiology services. The new clinic is expected to be complete by the Fall of 2018. ■
Community Center Gets New Name
Edition
5/22/17
9:43 AM
“Prairie Lakes Healthcare System has been a long-standing partner to the Watertown community, providing funds to initiatives that support a healthy population,” said Steve Thorson, Mayor of Watertown. “The City Council and I are so pleased to have been able to work out an agreement with Watertown’s regional healthcare provider, to help fund a facility that will serve the recreational and fitness needs of our citizens for decades to come.” ■
Brookings
PRELIMINARY PLANS FOR REGIONAL HOSPITAL INCLUDE:
● Making all current patient rooms private
and care units
● Expansion of the emergency department ● A new main entrance ● A new hospital office building for specialty
The Watertown Community
services attached to the hospital
● New parking structures, including covered parking
The announced expansion project also includes the construction of a new medical facility specializing in orthopedics, sports medicine and rehabilitation. The Advanced Orthopedic and Sports Medicine Institute will be built on 10 acres at the Buffalo Crossing development, located at the southeast corner of Catron Boulevard and Highway 16, in Rapid City. “Our goal is to have all orthopedic, sports medicine, podiatric, spine, pain management, rehabilitation, and integrative medicine
Medical
The Prairie Lakes Healthcare System Board of Directors agreed to finalize a naming rights transaction for the Watertown Community Center in April 2016. The parties agreed to a purchase price of $2.2 million for a term of 25-years. Five annual payments will be made in the first five years of the term to complete the transaction. The funds will be used by the City to support capital costs of the center. Prairie Lakes will receive sponsorship benefits.
Brookings Opens New Medical Plaza
Regional Health has announced
a multi-year, phased project to expand and renovate Rapid City Regional Hospital (RCRH) and construct an Advanced Orthopedic and Sports Medicine Institute at the Buffalo Crossing development in Rapid City.
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on New Specialty
Clinic Prairie Lakes Healthcare System has broken ground on a new specialty clinic set to open in two years. The clinic is the result of a decision made by the Board of DIrectors more than a decade ago to build specialty medical and surgical services in Watertown.
Center will officially be called the Prairie Lakes Wellness Center under a newly-announced naming rights agreement. “The biggest influence on the health of our community now and into the future will be the lifestyles we lead,” said Jill Fuller, CEO of Prairie Lakes. “With this partnership, we see an opportunity to improve the health and wellbeing of the community as a whole for years to come.” The Prairie Lakes Wellness Center will feature an open concept space including a walking track, leisure pool, racquetball and basketball courts, expanded cardio and weight area, larger fitness class space, and a social area with fireplaces for members. Four full-size courts and the eight-lane pool will be able to accommodate competitive events and spectators. Participants will have access to these facilities through a separate entrance.
Health System officially opened the newly constructed Medical Plaza building last month, completing the first leg of the health system’s hospital expansion and renovation project. Brookings Health System CEO Jason Merkley expects the new facility to help the community recruit and retain new doctors. The Medical Plaza’s first floor tenant, Avera Medical Group Specialty Care clinic, includes familiar Brookings faces. Avera Medical Group recently moved its obstetrics/gynecology, general surgery and podiatry services from the 400 Twenty-Second Avenue clinic into the new building. The Medical Plaza’s second floor is available for lease. Intentionally built as an open shell, the second floor may be set up to accommodate the needs of tenants. “The second floor of the Medical Plaza will accommodate those provider office space needs well into the future,” says Merkley. “The building even contains infrastructure to add on a third floor if the demand for space exceeds the second floor capacity.” With the Medical Plaza open for business, construction continues on the rest of Brookings Health System’s campus. Once the east hospital expansion is completed, remodeling will start inside the original 1964 building. The entire project is slated for completion Summer 2017.
■
24 Midwest Medical Edition
November 2016
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Is Your Practice
Prepared? Lawsuit Highlights ACA’s Anti-Discrimination Rule
A
By Thomas Johnson SECTION 1557 lawsuit is now
pending in an Arizona federal court. Twelve (12) hearing-impaired individuals have brought suit alleging their healthcare provider discriminated against them by not providing sign language interpreters or electronic video interpretation. Instead of providing such accommodations, the lawsuit alleges, the healthcare staff relied on notes and lip reading in an attempt to communicate with the patients. The individuals assert that the provider should have trained the staff to recognize when interpretation is necessary, provided a functioning electronic video interpretation system, and instructed the staff on how to use electronic video interpretation. The lawsuit underscores the requirements now imposed on healthcare providers under the Section 1557 of the Affordable Care Act which became effective in July 2016. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in federal healthcare programs. When interacting with individuals with sensory, manual, or speaking disabilities, healthcare providers are required to provide communication that is as effective as the provider’s communication with non-impaired individuals. This requires that healthcare providers have access to sign language interpreters, Braille handouts, visual aids, auxiliary aids, or other communications formats when the need arises. Section 1557 adopted the communication provisions that are described in Title II of the Americans with Disabilities Act (ADA),
which formerly only applied to state and local governments. These provisions allow the individual with the disability the freedom to choose the communication format he or she prefers. If the individual states a preference, the entity must honor the choice unless: (1) other equally effective communication formats are available, (2) the format would fundamentally alter the activity or program provided, or (3) the format imposes an undue financial and administrative burden. It is imperative that healthcare providers familiarize themselves and comply with Section 1557’s requirements because nonconformity puts the healthcare provider at risk of both loss of federal funding and private lawsuits. As with all healthcare compliance concerns, providers need to review and assess their current policies and procedures to evaluate the need, if any, to update and modify according to Section 1557’s requirements. Additionally, staff need to be trained to recognize the accommodations Section 1557 requires, so that the healthcare provider can maintain its compliance under the ACA. ■
When interacting with individuals with sensory, manual, or speaking disabilities, healthcare providers are required to provide communication that is as effective as the provider’s communication with non-impaired individuals.
Thomas Johnson is an attorney with Boyce Law in Sioux Falls.
MED QUOTES
“
Autumn is a second spring when every leaf is a flower.
September / October 2017
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—―Albert Camus
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Happenings around the region
South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes AVERA
BLACK HILLS
Avera has earned national recognition as a technology leader as it was named to the list of Health Care’s Most Wired for the 18th time. The
Rapid City Medical Center has added Rheumatology to its list of specialties with rheumatologist Jennifer May, MD. Dr. May
list is based on an annual survey released by the American Hospital Association. Avera received “advanced” designation. It was the sole South Dakotabased health system to receive the Most Wired Advanced Award.
Avera has launched GeneFolio, the latest advancement in providing easier access to personalized medicine using pharmacogenomics.
Pharmacogenomics is the study of DNA to understand how an individual will metabolize certain medication. The GeneFolio blood test starts at $179 plus lab fees. While it doesn’t tell the providers what to prescribe, it does give them an additional tool to select the most effective medications. Avera Health is the first member of the new Patient Care Network launched by the Hazelden Betty Ford Foundation. The network is the
first of its kind in the addiction treatment industry and will allow members to gain access to tools, resources and collaborative consultation for their organization.
earned her MD from the USD Sanford School of Medicine. She did her internal medicine residency at the Medical College of Wisconsin and completed her rheumatology fellowship at the Mayo Clinic.
Same Day Surgery Center in Rapid City, a surgical specialty hospital owned by physicians in partnership with Regional Health Rapid City Hospital, has been awarded a 5 Star Rating from the Centers for Medicare & Medicaid Services (CMS).
Same Day Surgery Center is one of only 13 HealthStream clients to receive this rating out of 936 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) eligible clients within their database. Regional Health has expanded its services in general surgery in Rapid City with the addition of Irony Sade, MD.
Dr. Sade specializes in trauma and critical care, as well as vascular, pediatric and laparoscopic surgery. He earned his doctor of medicine at Upstate Medical University in Syracuse, NY, and completed his general surgery residency at Westchester Medical Center in Valhalla, NY.
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Patricia Fogarty, MD, has joined the geriatrics team at Regional Health in
Six physicians graduated from the Regional Health Rapid City Hospital Family Medicine Residency Program in June.
Graduates from the three-year residency program include Kyle Adams, DO, Catherine Mitchel, MD, Peter Ostler, MD, and Giovanni Paoli, DO. Chief Residents of the program include Carson Phillips, MD and Matthew Schaffer, DO. This group is the 20 th class of physicians to complete the program. David Steele, MD, and his long-time family medicine, women’s health, prenatal, and acupuncture practice, has joined family medicine services at Regional Health Medical Clinic in Hot Springs. Dr. Steele earned his
medical degree at USD Sanford School of Medicine and went on to complete his family medicine residency at Marquette, Michigan. He practiced at the Black Hills Family Health Clinic in Hot Springs for ten years before joining Regional Health. Becker’s Hospital Review ranked Black Hills Surgical Hospital in Rapid City 5th in the nation among the overall best for patientrecommended, physicianowned hospitals. BHSH
received a 93% rating from patients – more than 20% higher than the national average.
Spearfish. Dr. Fogarty earned her medical degree at the University of Otago in Dunedin, Otago, New Zealand, and completed her internal medicine residency and hospice and palliative care fellowships at the Providence St. Vincent Medical Center in Portland, Oregon. Dr. Fogarty will serve as medical director for Regional Health Home+ Hospice of the Northern Hills and for the long-term care healing environments in Belle Fourche, Spearfish and Sturgis. Bradley Archer, MD, RPH, has been appointed as the new Chief Clinical Integration and Medical Officer (CCIMO) for Regional Health in Rapid City
and joined Regional Health’s leadership team September 1. Dr. Archer received his medical degree from USD Sanford School of Medicine. He was previously Chief Clinical Officer of Iowa Health Alliance and Director of Population Health at the University of Iowa Health System. Regional Health Sturgis Hospital hosted a ribbon cutting ceremony July 13 for its new, 64-slice CT scanner.
Sturgis Hospital is one of only 41 recipients of grants by the Helmsley Charitable Trust’s Rural Healthcare Program to benefit from this round of funding to purchase CT scanners.
Midwest Medical Edition
The 28th Annual Great Black Hills Duck Race in Rapid City launched 15,500 rubber ducks in a 1.5 mile float in Memorial Park July 30. The event benefited the Children’s Miracle Network at Regional Health in Rapid City with 100 percent of the proceeds staying local. To support the fundraiser,
participants paid $5 to buy a duck.
Regional Health Home+Home Health in Spearfish, South Dakota, was awarded the Strategic Healthcare Program’s (SHP) Best Superior Performer award for achieving an overall satisfaction score that ranked in the top 20 th percentile of all SHP clients during 2016. The
annual SHP Best program was developed to recognize home health agencies that consistently provide high quality service to their patients.
Mark Ptacek, MD, and Nadia Tymkowych, MD, have joined the LeadDeadwood Regional Hospital and Clinic team.
Dr. Ptacek is a Nebraska native who earned his medical degree at the University of Nebraska Medical Center in Omaha and went on to complete his family medicine residency at the United Hospital Center in Clarksburg, West Virginia. Dr. Tymkowych, a South Dakota native, earned her medical degree at the University of Sint Eustatius in the Netherlands and went on to complete her family medicine residency at the Clarkson Family Medicine Residency Program, a department of the Nebraska Medical Center.
September / October 2017
Regional Health Rapid City Hospital nurse Amber Stebbins, RN, receive the DAISY Award for Extraordinary Nurses in June. Stebbins was nominated by
a patient whose husband received a diagnosis of kidney failure. She was described as “caring, thoughtful, understanding and sweet”. Regional Health Rapid City nurses Allison Joachim, RN,
and Trevor Dillon, RN, also
received DAISY Awards for Extraordinary Nurses in June. Joachim was nominated by a family member whose husband was brought to the emergency room with a diabetic crisis. Dillon was nominated by a patient who recognized him as an exceptional caregiver who worked well with the members of his team.
SANFORD Sanford nurse, Shawna Rorvick, RN, received the DAISY Award for
Extraordinary Nurses in April. Rorvick works in Pulmonary at Sanford USD Medical Center.
The Sanford Program for the Midwest Initiative in Science Exploration (PROMISE) at
Sanford Research and the Personal Genetics Education Project (pgEd.org) based at Harvard Medical School are creating and implementing workshops and community events in both states to bring awareness and generate community understanding about developments in genetics and how they affect our health. Bringing biomedical science education programming to the northern plains and into rural America is the focus of Sanford PROMISE. Sanford Heart Hospital received two awards from Mission: Lifeline, a program of the American Heart Association. Sanford received
the Mission: Lifeline® Gold Receiving Quality Achievement Award and the Mission: Lifeline NSTEMI Silver Quality Achievement Award. The American Heart Association’s Mission: Lifeline program’s goal is to reduce system barriers to prompt treatment for heart attacks, beginning with the 9-1-1 call and continuing through hospital treatment.
Will’s Training Table, a new sports-themed restaurant, opened in July at the Sanford Sports Complex in Sioux Falls.
The full-service restaurant and bar offers game-day favorites as well as healthier options.
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Jeffrey Wilson, MD, and Maheedhar Gedela, MD, have joined have joined the Cardiovascular Disease and Interventional Cardiology Fellowship Programs at Sanford. Dr. Wilson graduated
from American University of Antigua College of Medicine and has begun his Clinical Rotation. Dr. Gedela graduated from Rangaraya Medical College in India and is doing his NonInvasive Rotation. Mary Nettleman, MD, MS, MACP, has been elected to the Association of American Medical Colleges (AAMC) Board of Directors.
Currently, Dr. Nettleman services as Vice President of Health Affairs and Dean of the Sanford School of Medicine at USD. Her appointment begins in November.
Amy Elliott, PhD, will be the co-chair of the Biospecimens Working Group, which is part of
the Environmental Influences on Child Health Outcomes (ECHO). ECHO is an initiative of the National Institutes of Health which studies how environmental exposures affect child health and development.
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Happenings around the region
South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes
SIOUXLAND
The Accreditation Commission for Health Care presented UnityPoint Health-St. Luke’s with full accreditation status for its sleep lab services. In order to
receive the accreditation from ACHC, St. Luke’s sleep lab had to demonstrate compliance with national standards.
Mike Kramer, MD, has joined UnityPoint Health – St. Luke’s Siouxland PACE as the Medical Director. Dr. Kramer received his
medical degree from the University of Illinois College of Medicine in Chicago where he also completed his residency in internal medicine. He is board certified through the American Board of Internal Medicine. Siouxland PACE is an all-inclusive program that offers care for the elderly.
Hospice of Siouxland in Sioux City, Iowa, honored the volunteers involved in the Vet-to-Vet Program at its 4th
recognizes the hospital’s high standards of care for the treatment of heart attack patients. St. Luke’s is one of 193 hospitals nationwide to receive this honor.
Michael Guzman, Jr., MD, joined Singing Hills Mercy Medical Clinic in Sioux City in July.
Mercy Medical Center – Sioux City has received the Mission: Lifeline Gold Quality Achievement Award and the
Mission: Lifeline NSTEMI Silver Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for treatment of heart attack patients. Mercy was also recognized with the Get with the GuidelinesHeart Failure Gold Plus Quality Achievement Award for
annual Veteran’s breakfast June 23. The program pairs hospice patients who have military experience with veteran volunteers.
Dr. Guzman is a graduate of the Creighton University Medical Center School of Medicine. He completed his residency in family medicine at Creighton University.
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UnityPoint Health- St. Luke’s in Sioux City, Iowa has received the American College of Cardiology NCDR ACTION Registry Platinum Performance Achievement Award for 2017. The award
Mercy Medical Center in Sioux City, Iowa, held an open house and ribbon cutting July 13 in celebration of its new Child Advocacy Center (CAC) at 701 Jackson Street in in Sioux City.
implementing specific quality improvement measures outlined by the American Heart Association/American College of Cardiology Foundation’s secondary prevention Guidelines for patients with heart failure.
Donations from the Siouxland community helped fund the $3 million project. Over the last 28 years the CAC has helped over 17,000 children.
Midwest Medical Edition
Mercy Medical Center-Sioux City in conjunction with the Siouxland Stroke Support Network is hosting a “Retreat and Refresh Stroke Camp” the
weekend of September 15 -17. The camp brings stroke survivors and their families together for a weekend of support, education and fun.
Megan Bush, CNA with Mercy Medical Center has been awarded a $3500 scholarship from the Iowa Hospital Education and Research Foundation. Bush is pursuing
her nursing degree from Morningside College. She is from Cleghorn, Iowa.
The sleep lab at Mercy Medical Center recently achieved accreditation from the Accreditation Commission for Health Care (ACHC).
Jason Losee, DO, has joined UnityPoint Clinic Family Medicine in Sergeant Bluff as a new family medicine doctor.
Dr. Losee received his Doctor of Osteopathic Medicine from A. T. Still University-Kirksville College of Osteopathic Medicine in Kirksville, Missouri. Losee completed his residency for Family Medicine at Henry Ford Hospital/Henry Ford Wyandotte Hospital. He completed his sports medicine fellowship at Evergreen Sports Medicine in Augusta, Maine. A study by the Iowa Hospital Association says Mercy Medical Center – Sioux City created a $192.5 million impact on the local economy. The hospital
generates 1,324 jobs. The study also reported that Iowa’s healthcare sector provides nearly 325,000 jobs across the state. The same report indicates that UnityPoint Health in Sioux City has a $203 million impact on the local economy and generates 1,665 jobs.
OTHER Vance Thompson Vision in Sioux Falls recently became the first center in the United States to perform Refractive Laser-Assisted Cataract Surgery with Zepto. This technology,
developed by Mynosys, uses low-energy pulses to create a precise capsulotomy, independent of pupil size, corneal clarity or lense density. The automated incisions mean fewer logistical challenges and reduced, overall time a patient spends in surgery.
Emily Murphy, MD, has joined Surgical Institute of South Dakota. Dr. Murphy
is a Sioux Falls, South Dakota native who graduated from the USD Sanford School of Medicine, completed her general surgery residency at Christiana Care Health System in Newark, Delaware, and recently completed her fellowship in endocrine surgery at Medical College of Wisconsin. Watertown’s Brown Clinic announces the retirement of Edwin S. Gerrish, MD.
Dr. Gerrish was a general surgeon who started practicing at Brown Clinic in August of 1983. He retired July 1.
A collaboration between Madison Regional Health System and Orthopedic Institute in Sioux Falls, South Dakota, has made it possible for Madison area residents to have orthopedic surgeries closer to home.
Keith Baumgarten, MD, of Orthopedic Institute has been an outreach provider in orthopedic care and sports medicine at Madison Regional Health System for 11 years. Now he is performing carpal tunnel release, trigger finger release and knee scope surgeries at MRHS. Kate Sigford, MD, has been named as LifeScape’s new Medical Director of Rehabilitation Services. She will oversee rehabilitation and medically complex services at LifeScape’s Specialty Hospital and Rehabilitation Center. Dr. Sigford is a graduate of the University of California at Davis School of Medicine and completed her residency in Physical Medicine and Rehabilitation at Stanford University in California. She completed a fellowship in Pediatric Rehabilitative Medicine at Gillette Children’s Specialty Healthcare through the University of Minnesota.
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September / October 2017
• Just What the Doctor Ordered •
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Long Term Care Insurance The time to plan is now By Aaron Maguire
T
HE LIFETIME PROBABILITY OF
becoming disabled in at least two activities of daily living or of being cognitively impaired is 68% for people 65 and older.* As we look to the future, did you know that long-term care expenses can deplete resources 2–3 times faster than intended?1 There are a few misconceptions about longterm care shared by many:
● ● ● ●
It won’t happen to me. edicare and Medicaid have me M covered. That’s what my savings are for. y family will be able to take M care of me.
As healthcare costs continue to rise, it’s important to understand how you’ll pay for long-term care (LTC), and put a plan in place as early as possible to help ensure you won’t outlive your income. While projected longterm care sounds like a king’s ransom to most of us, the earlier you plan, the longer your assets have for potential growth to help outpace inflation. And if you’re considering long-term care insurance, the younger you
are when you purchase a plan, the less costly the premiums. For many retirees, Long-Term Care (LTC) insurance can offer a helpful safety net for protecting retirement income in the event of a serious illness or incapacitation. Clients often have concerns when it comes time to plan, like not qualifying for a traditional Long-Term Care insurance policy due to age, a chronic illness or other factors. Some are reluctant to pay for covered custodial services that may never be used. For these reasons and more, options for LTC planning have become more flexible in recent years. While it’s critical to factor longterm care and rising healthcare expenses into your overall retirement income plan, there are alternatives to traditional LTC policies, including life insurance and annuity products with LTC riders. Another strategy involves swapping an older Life Insurance policy that has accumulated a large cash value for a hybrid policy that would offer a death benefit and LTC benefits. If benefits aren’t used for care, the policy eventually will pay a death benefit. ■ Aaron Maguire is a Financial Consultant with Security National Financial Services. Securities and insurance products are offered through Cetera Investment Services LLC (doing insurance business in CA as CFGIS Insurance Agency), member FINRA/SIPC. Advisory services are offered through Cetera Investment Advisers LLC. Neither firm is affiliated with the financial institution where investment services are offered. Advisory services are only offered by Investment Adviser Representatives. Investments are: Not FDIC/NCUSIF insured, May lose value, Not financial institution guaranteed, Not a deposit, Not insured by any federal government agency. *[ AARP. Beyond 50.2003: A Report to the Nation on Independent Living and Disability, 2003, (11 Jan 2005). ]
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September / October 2017
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HOSPITALISTS Hospitalists are not only clinicians but teachers and administrators, as well. Pictured is Regional Health Rapid City Hospital Hospitalist Dr. Shahid Ahmad, a member of the USD clinical faculty, working with students.
Photo courtesy Regional Health.
HOSPITAL MEDICINE
is the fastest growing specialty in the history of American medicine. That is despite the fact that, since the term “hospitalist”
was first coined in 1996, these physicians have often been defined in terms of their relationship to other physicians–i.e., the one managing patients for primary care doctors in order to 1) free up the primary care doctor’s time, 2) reduce the primary care doctor’s stress in running between the clinic and the hospital, 3) take certain less desirable tasks off the primary care doctor’s plate, etc. Today, with the profession now 20 years old, hospitalists, who come from many different specialities including family medicine, internal medicine, pediatrics, even Ob/Gyn and cardiology, are being defined in terms of their own pivotal role in the medical system. The Society for Hospital Medicine defines a hospitalist as “a practitioner who is engaged in clinical care, teaching, research, and/or leadership in the field of hospital medicine.” While the largest health systems in the South Dakota region have had hospitalist programs in place for some time, a growing number of rural facilities and smaller hospitals are also now coming on board. But hiring the hospitalists they want may not be easy; for every five open positions nationally, there is only one hospitalist to fill it. MED spoke with several key players for a better perspective on how – and why – hospitalists are changing the face of healthcare on the Great Plains.
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Midwest Medical Edition
By Alex Strauss
and the Changing Face of Rural Healthcare MIAN JAVAID, MD, PRAIRIE LAKES HEALTHCARE SYSTEM, WATERTOWN Mian Javaid, MD, hospital medicine specialist at Prairie Lakes Hospital in Watertown, discovered in his third year of residency that he was not cut out for spending his days in a clinic. “I found out that I was not too happy in the clinic. In clinic, someone else was dictating your time,” says Dr. Javaid. “I was a lot more happy on the floor in acute situations, where I was better able to prioritize things based on what I thought was important.” Dr. Javaid, who grew up and trained in New York, came to Prairie Lakes from Bismarck, North Dakota, where he still holds a full time hospitalist position. In order to provide maximum continuity for hospitalized patients, hospitalists typically work schedules that are more like nurses–longer hours
but fewer days in succession or longer periods of time off. In some places, that means seven days of 12-hour shifts, followed by seven days off. Recently, the trend in larger centers is shorter, more frequent shifts. Dr. Javaid’s regular road trips are just one example of the complex scheduling maneuvers that are often required to provide hospitalist care in facilities with a small daily census. “We do mostly 12-hour shifts so your number of days is reduced,” says Javaid. “I spend ten days a month in Bismarck and 10 to 12 days in Watertown, depending on what they need at Prairie Lakes.” Prairie Lakes has six hospitalists (some of whom are locum tenens) and one nurse practitioner providing care 24/7 and benefitting both the hospital and community in multiple ways. “Hospitalists are proving to be very valuable in terms of saving money,” says Dr Javaid. “It reduces the number of tests
that get done because we can order what we need right when we need it. Smaller hospitals are also recognizing the benefits of always having one or two doctors in the hospital providing continuity.” Javaid says nurses tend to feel more supported with a physician accessible any hour of the day or night. Primary care doctors enjoy the chance to focus on outpatient care (access to each other’s EMR system keeps both them and hospitalists in the loop). And, although some patients are initially skeptical, Dr. Javaid says they usually come around quickly when they understand what a hospitalist means for their care. “If you tell people that you are there to provide continuity of care 24/7, they like that idea,” he says. “I have never had an experience where they said ‘we don’t want you’. When family has comfort, the patient has psychological relief which in turn helps them feel better.”
MATTHEW WERPY, DO, DIRECTOR OF HOSPITAL MEDICINE, REGIONAL HEALTH RAPID CITY HOSPITAL Matthew Werpy, DO, Director of Hospital Medicine at Regional Health Rapid City Hospital, says a lot has changed for primary care physicians since he was growing up as the child of a family physician in Pierre. And those changes are driving the unprecedented growth in his own specialty. “I think a lot of it has to do with the demands on primary care doctors today,” says Dr. Werpy. “Doctors are seeing more patients in a shorter period of time. Hospitalists allow them to focus on those 30 patients a day that they are now having to see. These primary care docs cannot continue to do everything. It would be
September / October 2017
great if they could, but they can’t.” But hospitalists are not just a safety net for doctors and their hospitalized patients. Werpy says patients who end up in the hospital without a primary care physician are also better served by a hospitalist program. “Hospitalists have taken care of that large subset of patients,” Werpy says. “We may set them up with a primary care physician to go to when they are discharged, or set them up based on their ability to pay.” With 26 daytime hospitalists, 9 nocturnists (nighttime hospitalists), and four NPs, the hospitalist program at Rapid City is one of the largest in the state and is still recruiting. And the larger the program, the more challenging–and critical–communication becomes.
MidwestMedicalEdition.com
“In South Dakota, we are not quite where we need to be in terms of developing a system of care around patients,” says Werpy. “We need a system that takes the patient from community into hospital into rehab and back into community without any hiccups along the way.” At Regional Health, everyone on the care team receives a discharge summary with diagnosis, treatments, and recommended follow-up in an effort to support communication and a “team approach” that is critical to the success of a hospitalist program. “For this to work, we need strong outpatient primary care, strong hospital medicine, and strong primary care to go back to,” says Dr. Werpy. “Both parts are extremely important.”
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Photo courtesy VA Health Care System
Photo courtesy Brookings Health.
Pictured, left to right: Real time communication with the care team is one of the advantages of a hospitalist program. Pictured are Brookings nurse Bonnie Nelson, RN; Hospitalist Dr. Natalie Owens Sloan and Erica Sanderson, RN (seated).
Sioux Falls VA Medical Center Hospitalists David Malters, MD, Jeffrey Heier, MD, and Hillary Peirce, PA-C.
ERIC HILMOE, VICE PRESIDENT OF OPERATIONS, SANFORD HEALTH NETWORK How big does a facility have to be to sustain a hospitalist program? According to Eric Hilmoe, Vice President of Operations at Sanford Health Network, an average daily census of 10 is the minimum. “We use hospitalists primarily in Worthington, Thief River Falls, and Aberdeen, because they are big enough,” says Hilmoe, who says recruiting and retention, which are already challenging in rural areas, are big reasons why. “A lot of it comes down to the ability to recruit new physicians to rural markets. A
physician who practiced for 30 years assumes that inpatient care is part of their responsibility. But new physicians want better work-life balance. In order to provide them with the kind of lifestyle they want, we have to have hospitalists.” But not all physicians feel this way. To help ease the concerns some may have about “handing over” their patients to another provider, Sanford has adopted a “hybrid” approach to hospital medicine in Aberdeen, where Advanced Practice Providers cover inpatient care only during the day while physicians are busy in the clinic. But Hilmoe does not expect that to last long term. “Usually what we see is, once the primary care doctors have a level of comfort with how the hospitalist program works
and they see how their patients are being managed, they typically want to move on to a full time hospitalist program,” he says. Sanford is looking at other creative ways to use hospitalists in even smaller facilities, such as having a hospital medicine specialist cover both the hospitalized patients and the ER. In the meantime, the increased efficiency and responsiveness in the facilities where hospitalists are already in place is paying off for Sanford. “In places where we have implemented a hospitalist program, our patient satisfaction scores have improved drastically,” says Hilmoe. “Patients like that we can respond to care needs faster and we can often even discharge patients earlier in the day.”
TAMMY HILLESTAD, RN, CHIEF NURSING OFFICER, BROOKINGS HEALTH SYSTEM Brookings Health System’s hospitalist program has been in place since February, making it one of the newest programs in the state. Chief Nursing Officer Tammy Hillestad, RN, CNO, was a part of the planning process. “For us, it was a twofold decision that was primarily physician-driven,” says Hillestad. “We had some discussion with the medical staff about quality of life and the challenge of caring for both clinic and hospital patients. So we started listening.” The committee concluded that patient
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care was likely to improve with a physician in house. But there was another consideration, as well. “We had to look at the financial ramifications of an expensive program. And we had to consider, what financial advantages there could be,” says Hillestad. “To justify the cost, we would need more admissions and higher acuity cases. In our discussions, we felt like having someone in house made that a possibility.” Brookings hired five hospitalists who rotate week-long shifts covering hospital patients from 8:00 am to 8:00 pm every day and on weekend nights. To ease patient concerns, they explained that hospitalists work in partnership with their primary care
doctors. Six months after launch, ICU days, acuity, and admissions are all up, as hoped. “Our goal is for it to break even,” says Hillestad. The program has worked especially well in the emergency department, where patients who are being admitted are able to meet face-to-face with the physician who will oversee their inpatient care. A less-easily-measured result of the hospitalist program has been the formation of more cohesive care teams. “Hospitalists attend our daily huddle (care conference) where we discuss each patient,” says Hillestad. “Before, it was the team but without the physician.”
Midwest Medical Edition
JENNIFER GRECO, MD, CHIEF OF SPECIALTY MEDICINE SIOUX FALLS VA HEALTH CARE SYSTEM Jennifer Greco, MD, is another example of a hospitalist taking a leadership role within her health system. Greco, who started as a hospitalist with the VA in 2009, is now the Chief of Specialty Medicine, overseeing all inpatient hospital services and medical subspecialties, including the VA’s 7 full-time and two part-time hospitalists. Two hospitalists are in the hospital from 7:00 am to 7:00 pm and one covers the nighttime hours. With an average daily census of just 20 patients and a clinic connected to the hospital, Dr. Greco says the VA has been able to avoid some of the communication challenges of large, private sector hospitalist programs. “As a hospitalist, if I have a question or if the patient says ‘Have you talked to my
September / October 2017
doctor about this?’, I can bop down to the clinic and ask,” says Dr. Greco. “It is a lot easier to track someone down than when you are working in a huge system.” The fact that the clinic and hospital share the same EMR system is icing on the cake, making discharge and follow-up much simpler than they might otherwise be. The VA utilizes hospitalists for many of same reasons that private sector hospitals do–to free up clinic time for primary care providers, to increase efficiency, and to ensure timely patient care. But Dr. Greco says hospital medicine is valuable in its own right as a subspecialty. “As a primary care physician, you may be aware of sepsis, but if you don’t see a patient every day that is septic, you lose those skills,” says Dr. Greco. “For this reason, I believe that we are often more adept at caring for the sickest patients
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because we see them every day, we can stay up-to-date on the relevant literature, etc.” While South Dakota area hospitalists are improving the quality of inpatient care and clinic doctors have enjoyed the ability to focus on their patients, Greco says both groups could do a better job of communicating with each other. “I would like to see outpatient providers try to interact with hospitalists a little more,” she says. “If you know someone and you have met them, you are much more likely to do that handoff and to give them a call and say ‘I’m discharging Mr. Jones.” “Also, it means a lot to patients for the hospitalist to be able to say ‘I’ve talking to your doctor, so I know all about you.’ That way, they don’t feel that their outpatient provider doesn’t care about them or their hospitalist doesn’t know them. You have instant trust.” ■
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Klara Klawitter in the Sanford NICU and [inset] on the day she left the hospital.
Sanford NICU Now Offering National Clinical Trials By Alex Strauss
T
HIS SUMMER, SANFORD HEALTH extended its clinical trial opportunities to its youngest patients when it was selected to become a member of the National Institutes of Health’s Neonatal Research Network (NRN). The network was established in 1986 to conduct multi-center clinical trials in neonatal medicine. There are 15 trial sites across the country and Sanford Health is a participating hospital with the University of Iowa. Members of the network design and
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implement clinical trials across the network for high-risk babies. Neonatologist and clinical investigator Michelle Baack, MD, will lead the effort for Sanford Health. Infants enrolled in studies at Sanford will be followed after discharge through the NICU’s follow-up clinic led by neonatologist Laurie Hogden, MD. The follow-up clinic will help study the effect of early childhood care throughout the child’s lifetime. “This is really going to broaden our research involvement,” says Dr. Hogden, who trained at Cincinnati Children’s Hospital, which is also part of the NRN. “The NRN is a group of major large academic centers with large NICUs and they are the leaders in driving neonatal care. For us to be able to participate is exciting.” The network seeks to solve the issue that few institutions see more than a few very high-risk babies every year. “By putting large centers together, you suddenly have a lot more babies to study so we could create trials that could involve a lot more infants,” says Hogden. When you have a larger number, you can analyze outcomes statistically.” Sanford nurse Jennifer Klawitter understands the research value of such a network on more than just a professional level. Two-anda-half years ago, her daughter Klara was one of those high-risk
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Laurie Hogden, MD
babies. When Klara was delivered at just 26 weeks, she weighed 1 pound 0.3 ounces. “She had three doses of surfactant at birth, was intubated for 8 weeks, had eye ablation surgery, a G-tube, and a hernia repair and was on oxygen when she came home,” says Klawitter. “As a parent, I appreciated the fact that every treatment they did for Klara could be backed up with research. They could explain very articulately why one treatment may be better than another based on the research.” “This is great for Sanford because it elevates our care and our awareness, but it is also exciting for neonatal care in general,” says Dr. Hogden. “When you look at a map of centers involved, the Great Plains is minimally represented. So our involvement will really add to the value of the NRN by enabling it to include a broader range of patients, backgrounds, and genetics.” In the past, the network has gathered and used data to better understand mortality rates for very low birth-weight babies and the causes of early-onset sepsis. Sanford’s first clinical trial as part of the NRN will examine the use of hydrocortisone as a way to help get NICU babies off of mechanical intervention after preterm birth. “I am not surprised that Sanford was chosen for this network,” says Klawitter whose daughter now weighs 19 pounds. “I can’t wait for the world to see what they can do here.” ■
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Mercy Introduces New Stent for Coronary Artery Disease
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Sioux City, Iowa, used its first commercial implant of the newly FDA-approved Medtronic Resolute Onyx Drug-Eluting Stent (DES) in June. Mercy is the only hospital in the area to use the new drug-eluting stent for patients with coronary artery disease. “This stent is easier for the interventional cardiologist to guide through areas of the vessel that previously would have been difficult to maneuver through,” says Mike McCarthy, Director of Mercy’s Heart Hospital. The Resolute Onyx DES is the first and only DES to feature Core Wire Technology, an evolution of Continuous Sinusoid Technology (CST). CST is a unique Medtronic method of stent manufacturing which involves forming a single strand of cobalt alloy wire into a sinusoidal wave to construct a stent. This enables greater deliverability and conformability to the vessel wall. With Core Wire Technology, a radiopaque inner
core is incorporated within the cobalt alloy wire to enhance visibility for accurate stent placement. The technology also enables thinner struts while maintaining structural strength. With the first 4.5 mm and 5.0 mm DES sizes available, the Resolute Onyx DES helps expand treatment options for patients with extra-large vessels. In addition, it is designed with the transradial approach in mind, including 5 F catheter compatibility with stent sizes up to 5.0 mm. The Resolute Onyx DES is supported by the Resolute ONYX Core (2.25 mm – 4.0 mm) Clinical Study as well as the long-term safety and efficacy with low stent-thrombosis rates in the Global RESOLUTE Clinical Program. It uses the BioLinx polymer – specifically designed for DES – that features a unique hydrophilic and hydrophobic blend, allowing rapid endothelial healing with minimal inflammation and low risk of stent thrombosis. ■
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Midwest Medical Edition
SD’s First MRI Caring Suite Now Open in the Black Hills BLACK HILLS IMAGING CENTER (BHIC) in Rapid City has
Dr. Richard Little, orthopedic surgeon, artist Scott Jacobs, and painting donor Steve Streeter, stand with an artist’s enhanced print of “Face to Face” inside the lobby of Regional Health Spearfish Hospital
Rally Accident Survivor Donates Art Piece to Spearfish Hospital A FORMER PATIENT and Sturgis Motorcycle Rally enthusiast from Denver has donated an artist-enhanced print to Regional Health Spearfish Hospital as a way of saying thank-you for their care after a motorcycle crash in 2008. The crash occurred as Steve Streeter, a South Dakota native, was pulling into a Whitewood area campground with his friend. When Streeter stopped, his friend ran into Streeter’s leg. The friend ended up in a ditch with life-threatening injuries. Streeter was transported to Spearfish Hospital where orthopedic surgeon Richard Little, MD, worked on his leg. “Frankly, they saved my leg and my friend’s life,” says
September / October 2017
upgraded its facility with a new MRI Caring Suite. The Caring Suite is the first in South Dakota and is designed to make the process of getting an MRI more personal and comfortable. The Caring Suite’s new General Electric MRI scanner features a wider bore opening which gives patients more room during scans and also allows for feet-first entry into the machine. The wider bore is designed to help patients who may be predisposed to feelings of claustrophobia. In addition, the scanner is quieter than traditional MRI machines. Patients also have greater control of their imaging experience with customizable options on Caring Suite’s interactive menu. A 60-inch 4K resolution ceiling display is mounted above the table and scanner. Patients can select from more than a dozen 4K HD original videography themes and pair it with their choice of ambient room lighting and music using an interactive touch screen. Patients also have the option to provide their own media. “We are extremely excited to be the first in South Dakota to provide patients with an unrivaled MRI experience with our new Caring Suite,” said Cindy Hougland, Imaging Manager. “The ability to give patients control and customize their imaging experience to what fits their mood helps ease anxiety and stress, and provides us with exceptional image quality.” ■
Streeter, who has now recovered fully from his injuries. “In most cases, patients return to their home communities,” Dr. Little said. “So we seldom learn of the outcome.” Streeter donated a print of “Face-to-Face”, a painting of artist Scott Jacobs’ father encountering Mt. Rushmore for the first time on a Harley-Davidson CVO–the same bike that Streeter was riding at the time of his accident. The print was enhanced by the artist, who painted in extra shadows and highlights. Spearfish Hospital and Market President Larry Veitz accepted the donation on behalf of the hospital’s physicians and caregivers in an August ceremony. ■
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New Breast Cancer Blood Test Now Available at Avera By MED Staff
M
ORE THAN HALF of women who have annual mammograms will have at least one false positive results over a ten year period. Of these, about 10 percent will be recommended for biopsy. Fortunately, most of the time (70 to 90 percent), those biopsies are benign. Unfortunately, between the recommendation for further testing and the pathology report, there can be significant stress, anxiety, discomfort and, in many cases, procedures that might have been avoided. “We need to do a better job finding the women who really need a biopsy,” said Tricia
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Merrigan, MD, Avera Medical Group breast surgeon in an interview with MED. “This is where Videssa can play a great role now.” Videssa Breast, developed by Provista Diagnostics, Inc., is the first blood test for the specific protein biomarkers and autoantibodies associated with breast cancer. Avera Cancer Institute was one of just 13 sites nationally to help validate the new test over the last five years, and the only site in the Midwest. Avera Breast Center Director of Mammography Josie Alpers, MD, was primary investigator and co-author of the Videssa study published in the June 2017 issue of
Journal of Clinical Breast Cancer. “This is very exciting work,” said Dr. Alpers, noting that Videssa and the research surrounding it has been accepted as part of the federal government’s Cancer Moonshot program. “When a mammogram yields an abnormal result, the challenge is to decide which patients need follow-up, further imaging or biopsy. A test that is well-validated in a prospective trial means clinicians have a new way to accurately identify which patients may or may not need additional follow-up.” In the trial cohort of women under 50, the negative predictive value of Videssa was 99.3 percent.
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Josie Alpers, MD
Tricia Merrigan, MD
“This is huge because the get cancer,” says Dr. Merrigan. have breast cancer, or advise population was enriched,” says “Younger women do get breast them that they should have Alpers. “All of these women had cancer and their tumors tend to further testing, such as biopsy.” lumps or something suspicious be more aggressive. We just need When used in conjunction in their findings.” a better way to sort them.” with breast imaging tests such as Significantly, in younger Videssa has the potential to digital mammography and contrast-enhanced populat ions, Dr. Alpers says spectral mammog“We need to do a better job finding 30 to 40 percent the women who really need a biopsy,” raphy (CESM), of cancers may Videssa could — Tricia Merrigan, MD, be missed by reduce the need for make that sorting easier and at breast biopsy by up to 67 percent. mammograms because of the density of their breast tissue. But half the cost of a biopsy and a ACI is an early access site for breast density makes no differfraction of the cost of an MRI. the new test and is now using it ence with Videssa. in its day-to-day breast cancer “The results tell us that this “When you look at some of test is extremely effective in diagnostic care, primarily in lowthe reasons why some of the sociruling out breast cancer,” Alpers risk women who have multiple eties argue that younger women said. “After an abnormal mamsuspicious lesions. should not have mammograms, mogram, this is exactly what “The test is still in its infancy it is because their imaging is so we are being very conservative women need to know. Videssa difficult and the findings can be in our utilization, but it has amazallows us to confidently give confusing–not because they don’t women assurance that they do not ing promise,” says Dr. Alpers. ■
Burnout Prevention Program Earns National Award AVERA HEALTH’S LIGHT program has received the Catholic Health Association’s Achievement Citation for its innovative approaches to helping physicians and advanced practice providers address burnout. LIGHT stands for Live, Improve, Grow, Heal and Treat. The program was established in 2014 and has served Avera’s 900 providers with the goal of preventing or reducing burnout. The program uses strategies to build resilience, encourage enjoyment of job and home, implement needed practice changes and improve work-life balance. Services include executive and peer coaching, a couple’s retreat, a women’s retreat, an emotional retirement series and continuing medical education
September / October 2017
credits for completion of courses on well-being strategies such as mindfulness. There are also noagenda socials, and Schwartz Rounds – a gathering to process the social and emotional aspects of being healthcare providers. Mary Wolf, MS, LPC-MH, is LIGHT program director and Justin Sharp, MD, an Avera Medical Group neonatologist, serves as medical director of the program. “LIGHT services touch people from residency to retirement,” says Wolf. The program
also supports both rural and urban doctors. “The settings are much different, but the challenges are remarkably similar,” says Tad Jacobs, DO. Dr. Jacobs was a family practitioner in the rural community of Flandreau, SD, and is now Chief Medical Officer for Avera Medical Group, which developed the LIGHT program. “We have all heard of the phrase, ‘a rising tide lifts all
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boats.’ Our goal in LIGHT is to seek ways in which we can ‘lift the boats’ among our clinical practitioners,” says Jacobs. “In receiving the CHA distinction, we hope to raise awareness and provide ideas that other health systems can apply in their own settings.” ■
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John Kappes, Critical Care pharmacist, recommends de-escalation of antibiotics to the team during interdisciplinary rounds to support the hospital’s antibiotic stewardship program.
Collaborative Effort Transforms Culture and Care in Rapid City Regional’s ICU By Alex Strauss
I
N 2014, ONLY A THIRD of the nurses
surveyed in Rapid City Regional Hospital’s Intensive Care Unit felt that they had the support they needed to do their jobs well. And they weren’t the only ones suffering. Patient satisfaction scores were less than desirable as ICU staffers labored to care for them in what the Nursing Director now calls a confusing and disjointed environment. “Because of the open model of care we had at the time (any physician could admit into the ICU), everyone was having to go to the charts to try to figure out what to do,” says Angie Mills, RN, Nursing Director
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of the ICU. “Everyone worked in independent silos and it was very confusing.” Based on feedback from focus groups, the decision was made to close to ICU and dive headlong into an effort to completely overhaul how the department was run. “We decided that we needed to change the culture, so we started with the physicians,” says Mills. “We only wanted physicians who were willing to support the culture we were trying to create, including supporting nurses, working in collaboration, and conversing with families.” Nurses, too, were made aware of the new vision and expectations for department-wide
cooperation and collaboration. “We drew a line in the sand,” says Mills. “Now, the medical director and I come together and make unified decisions. We do not always agree, but we always come away ready to offer mutual support.” “The ultimate goal of the new model is to improve patient care,” says Sri Gangineni, MD, Medical Director of the ICU. “There is typically a hierarchy in healthcare where the physician gives the order and expects it to be implemented. But we now know that if you don’t work as a team, it is very difficult to improve patient care or obtain good patient satisfaction.”
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Today, physicians, nurses, pharmacists, of 63 ICUs in the nation working with the nutrition support, case managers, and others Patient Centered Outcome Research Instiwork collaboratively in a patient-centered tute. The ICU is also one of the few in the ICU. To facilitate better two-way communicountry that rounds with patient families cation, upper present and even offers video conferencing for level adminis“We do not always agree, trators were those who can’t be but we always come away invited to get a there. Physician and ready to offer mutual first-hand look caregiver collaboration support.” — Angie Mills, RN at the workings scores have improved of the ICU by from the lower third to rounding with providers. Morale-boosting the 90s and the monthly service line meetings initiatives like “Notable November”, typically have more than 15 physicians which offered a movie ticket to any ICU involved. Hospital-acquired infections have worker who reported on a co-worker’s act even decreased. of compassion, served to further solidify Mills and Gangineni say the next goal is to take their success system-wide with the new team atmosphere.“Another thing we have done to improve collaboration collaborative quality initiatives to improve throughout the hospital is write collaboraboth culture and care throughout all Regional tive working agreements with all of the facilities. specialties that see patients in the ICU,” “Our bar is always set very high,” says Dr. Gangineni. “All of these things are part says Mills. “We rarely have any conf licts now because we have already set expectaof a continuous process. It’s not a one-time tions and we are all on board.” thing. It takes a lot of hard work and team Regional’s ICU has been selected by the work to sustain the culture that has been Society of Critical Care Medicine as one created.” ■
Regional ICU Nursing Director Angie Mills, RN, and Regional ICU Medical Director Sri Gangineni MD. Photo courtesy Regional Health.
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(l to r) Tanzanian Critical Care Nurse Simphorosa Silalye, Grace Christopher and Doreen, Ambassador of the United Republic of Tanzania Wilson Masilingi, Neema Matemba and Wilson and Zaituni Abdulkader and Sadhia pose for a photo following the farewell news conference at Mercy Medical Center.
Tanzanian Bus Accident Victims Return Home
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THE THREE TANZANIAN CHILDREN who were transported to Mercy Medical Center–Sioux City after surviving a bus accident in May returned home on August 16th. Mercy Medical Center held a new conference and farewell celebration the previous week. Doreen, Wilson and Sadhia suffered more than 20 fractures and numerous injuries from the crash that claimed 36 lives. “It’s really amazing watching what the kids have done,” said Dr. Larry Volz, Chef Medical Officer at Mercy. “Considering the shape they were in when they came in, emotionally and physically, and how badly they were injured, [it has been exciting] watching them progress through that.” A group of Siouxland Tanzania Educational Medical Ministries (STEMM) missionaries, Kevin Negaard, Jennifer Milby and Manda Volkert were some of the first on the scene of the bus accident. Samaritan’s Purse, an international humanitarian aid organization, funded the childrens’ trip home. ■
MED QUOTES
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The best preparation for tomorrow is to do today’s work superbly well.
”
— William Osler
Midwest Medical Edition
Evolving Nutrition Strategies for Infants & Toddlers
Keeping the game fair...
By Holly Swee
N
UTRITION RESEARCH is ever changing and research regarding recommendations surrounding infant and toddler nutrition continues to emerge. It’s known that during the first year of a child’s life, the main source of nutrition is breast milk or an iron-fortified baby formula. Experts agree that meeting iron and zinc requirements during key stages of growth and development in the first year of life is crucial. Around six months of age the infant will start showing indications that they are ready for solid foods.1-3 The transition from exclusive breastfeeding or formula feeding to the addition of solid foods, is referred to as complementary feeding. 1-3 There is new evolving research available to help health professionals provide a variety of nutrition strategies so parents can make informed choices when providing nutritious complementary first foods that supports early growth and development of the child. ■
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Holly Swee, RD, LN, is Director of Nutrition & Consumer Information at the South Dakota Beef Industry Council 1 A merican Academy of Pediatrics. Pediatric Nutrition Handbook. 7th ed. Elk Grove, IL: American Academy of Pediatrics; 2014. 2. P an American Health Organization/World Health Organization. Guiding principles for complementary feeding of the breastfed child. Washington DC: Pan American Health Organization/World Health Organization; 2003.
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3. US Department of Agriculture, Food and Nutrition Service, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Infant Nutrition and Feeding: A Guide for Use in the WIC and CSF Programs. Washington, DC: US Government Printing Office, 2009. [FNS-288]
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ADHD Diagnosis
Requires Comprehensive Evaluation A COMPREHENSIVE EVALUATION that includes objective testing is essential in accurately diagnosing attention deficit hyperactivity disorder (ADHD), particularly when there is a concern regarding the presence of other comorbid disorders. The Multimodal Treatment of ADHD (MTA) study, sponsored by the National Institute of Mental Health (NIMH), found that nearly 70 percent of the participants with ADHD also had another mental health diagnosis. “Oppositional defiant disorder and mood/ anxiety disorders are the most common comorbid conditions,” says Lindsey Corr, MD, child and adolescent psychiatrist at Children’s Behavioral Health in Omaha. While studies indicate about three-quarters of children with ADHD are diagnosed before age 9 and one-third of those by age 6, “symptoms and impairments can often be seen as early as age 3,” she says. At Children’s Behavioral Health, evaluations of children and adolescents are typically conducted by Kimberly Levering, PhD, a licensed clinical psychologist who started the ADHD Clinic at Children’s in 2008 and serves as its coordinator. Children must be at least five years old to be evaluated.
“Many of the behaviors associated with formulations. Long-acting, non-stimulant ADHD can be developmentally appropriate ADHD medications are available as well. in preschool, when they are less likely to “One exciting ADHD medication option have had to sit and focus for longer periods on the horizon is a delayed- and extendedof time in a structured environment like release methylphenidate capsule which the school,” says Dr. Levering “That is why I child could take at bedtime and experience am more inclined to refer families with the effects upon awakening,” she says. preschoolers for outpaFor children and adotient behavior therapy to lescents with multiple "Many of the behaviors try to treat symptoms diagnoses, Children’s associated with ADHD first.” provides a wide range of can be developmentally At Children’s Behavtreatments targeting variappropriate in preschool, ioral Health, children ous symptoms that may when they are less and adolescents undergo affect functioning. These likely to have had to a full clinical evaluation, can include medication sit and focus for longer including a review of management, cognitive periods of time . . ." collateral information behavioral therapy, and consideration of the trauma-focused therapy developmental context. The team of child and parent-child interaction therapy. If a pediatrician questions whether a child and adolescent psychiatrists and therapists collaborate not only with each other, but meets the criteria for ADHD, Dr. Levering also with pediatricians and other says, Children’s can help. specialists to provide comprehensive, evi“Our psychiatrists are always willing to dence-based treatments, including consult with primary care physicians if they have questions regarding medication manmedication management and behavior therapy. agement of symptoms,” says Dr. Levering. Dr. Corr says more medication admin“If the physician has tried managing medicaistration options are available today, such tion and the child is non-responsive, or is as the methylphenidate patch and longhaving too many side effects, they can refer acting liquid and chewable stimulant to one of our psychiatrists directly.” ■
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Midwest Medical Edition
Four Reasons Fall is the New Summer in the Black Hills By Carmella Biesiot
I
T’S NO SECRET THAT the Black
Hills are a destination for all demographics; families, couples, groups, and individual travelers typically visit our gorgeous territory during the months of June, July, and August. However, the newest trend in statewide tourism is vacationing to the western part of the state during the fall. Here are some reasons you might be missing out on what we have to offer west river after the peak season ends.
The Scenery Mid-September is when the leaves are at their prime color variety. A drive through Spearfish Canyon will take your breath away. A jot into Deadwood will likely entice a side-of-the-road photo across from Tatanka, and there is no doubt that the Mickelson Trail will sweep you off of your feet with glimmering foliage of gold, pumpkin, and crimson. Speaking of foliage, there is also less of it at this time of year, which increases the likelihood of spotting wildlife.
The Monuments and That Race No matter how many times I have seen Mount Rushmore or Crazy Horse, each time I visit, I am taken aback by their detail,
September / October 2017
beauty, and magnitude. Thousands of people from all over the world visit these monuments every year, but primarily in the summer. The fall provides a little more space and a little less chaos for you to sit back and enjoy these amazing sites. Coupled with the beautiful colors of fall, it’s pretty much photographic heaven. If you or someone you know is a runner, you may want to consider the Crazy Horse half or full marathon, which begins directly in front of the monument. Having run it myself, I must say that, unlike other races, the Crazy Horse Marathon is a spiritual experience. Instead of a gun or pop music prompting the start, it is silent and runners begin by native drums and song. The Crazy Horse Marathon ends in the heart of Hill City which is known for is wineries, retail, and absolute beauty.
Custer State Park Custer State Park is an amazing attraction all year long and a great place for wildlife encounters. The Buffalo Roundup takes place at the end of September and attracts people from all over the world. Thousands gather in the early morning for an authentic cattleman’s breakfast complete with bison sausage and pancakes, then take their places
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to watch the massive herd dominate the land. It is followed by a wagon wheel-style lunch and art exhibits.
Deadwood Deadwood has 4 major events during the fall that have gained popularity in the past few years . With such headlines as Michelle Branch and Jewel, the Wild West Songwriters Festival (October 12–14) is an event quickly attracting national attention. You can hear the stories behind songs that were written for famous people such as George Strait and listen to jam sessions at various Deadwood locations. This has become my favorite Deadwood event. Three other vacation-worthy events to consider are the 20+ year-old music festival known as Deadwood Jam (September 15–16), Oktoberfest (September 28–30), featuring all things “beer”, and Deadweird (October 27–28), featuring all things “fear”. With fun things to do, lower hotel room rates, discounted attractions, great scenery, and gorgeous weather, it is no wonder that fall is becoming the new summer in the Black Hills! ■ Carmella Biesiot is Director of Hotel Sales & Marketing at the Lodge at Deadwood Gaming Resort.
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Tessa Olson with some of her fellow graduates from the Healthcare MBA program at USF.
“It Gives You a Larger Voice”
Radiology Supervisor Shows She Means Business with a Healthcare MBA By Alex Strauss
I
T IS NOT UNUSUAL for adult students
to decide to pursue an MBA because they want to take their careers in a different direction. But in Tessa Olsen’s case, USF’s MBA program was all about accelerating her down the path she was already on. “I think you don’t get a master’s degree unless you are serious about what you want to do,” says Olsen, a Diagnostic Radiology Supervisor at Sanford who graduated from the Healthcare MBA program last October. “I intend to stay in this for life.” Olsen graduated from USF in 2009 with a BS in Radiologic Technology and has been with Sanford for ten years. With an ultimate goal of teaching others to do what she does, Olsen chose pursue an MBA with a view toward eventually running an accredited program. “It is getting to the point now where it is very difficult to move into any kind of leadership position in healthcare without
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the cost accounting implications of it all.” an MBA,” she says. “It is a pretty much a While most of her fellow students came necessity.” Although Olsen considered several to the program from careers in the healthdifferent MBA programs, she ultimately care field, Olsen says she appreciated the settled on USF’s 2- year program because chance to interact with business students from other fields, as she did it was local, it offered a one“Investing in your day per week schedule that in her Leadership and MBA tells your boss Ethics class. “It was really allowed her to continue to that you are serious interesting to see this work fulltime at Sanford about your job,” totally different mindset. It (“Dropping down to one income was not an options,” she says), and really gave you perspective on what is unique about healthcare,” she says. because it was surprisingly affordable. Even Olsen’s colleagues have benefitted “Investing in your MBA tells your boss from her training when they have asked that you are serious about your job,” says Olsen, who adds that her new knowledge what she has learned that she could apply has already afforded her opportunities to in a given situation. Thanks to her degree, learn about budgeting and other “inner she is now able to offer thoughtful, knowlworkings” in her department. edge-based solutions. “It has even given me insight into things “Healthcare is so complicated now I was doing that I had no idea why,” says and there are so many moving parts,” she Olsen. “For instance, I order supplies for says. “Having an MBA really gives you a our department. It is so helpful to to learn larger voice.” ■
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Better Banking 74TH & SOUTH LOUISE
September / October 2017
Darren Melstad Mortgage Banker
26TH ST & I-29
MidwestMedicalEdition.com
Lorrie Selbo Mortgage Production Specialist
snbsd.com
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Our dedicated team of board-certified plastic surgeons; Dr. Richard Howard & Dr. Thomas Howard, Physicians Assistant Tammi Strangohr & clinic staff are determined to partner with you & your patient to achieve the highest quality of care and the best end results. Whether your patient needs a surgical procedure or noninvasive treatment call us today to schedule a referral.
Compassion . Experience . Trust
6301 S. Minnesota Ave., Suite 300
605.334.1930 www.plasticsurgerysiouxfalls.com Meet the MED Cartoonist WE HOPE THAT YOU HAVE BEEN ENJOYING the
lighter side of the medical profession in the last few issues with help from MED’s new cartoonist, Jonny Hawkins, and thought you might appreciate knowing a little bit about him. Hawkins is a full time cartoonist whose work has appeared in over 900 publications since 1986. Places like Reader’s Digest, Parade Magazine, Guideposts, Medical Economics, Air and Space, American Heart Association, Medical Post and 76 Chicken Soup for the Soul books and have featured his single panel funnies. Hawkins has drawn more than 50,000 cartoons, has published 20 books, and has created 61 page-a-day cartoon calendars (over 700,000 sold), most of them for the world’s leading calendar publisher, Andrews McMeel. One of those is the Medical Cartoon a Day calendar, now in its 13th year. His latest book is Mirth in the Morning … And All Laughternoon (Schiffer Publishing), a coffee table book collection of 1,001 of some his best cartoons. Jonny lives and works from his home in the country in Sherwood, Michigan with his wife, Carissa, their 3 children, and 8 cats. ■
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Midwest Medical Edition
Learning Opportunities
Fall / Winter 2017 September 8 8:00 am–5:00 pm 6th Annual Imagenetics Genomic Medicine Symposium
October 12 8:00 am–5:00 pm 4th Annual South Dakota Health Link Fall Forum
Location: The Sanford Center, 2301 E. 60th St. N, Sioux Falls
Location: Holiday Inn City Centre, Sioux Falls
Information: 605-312-6513, norma.eie@sanfordhealth.org
Registration and Information: SDHealthLink.org
September 20–22 SDAHO 91st Annual Convention Location: Rushmore Civic Center, Rapid City
October 18 8:00 am–5:00 pm The Opioid Epidemic: A Wicked Problem of the Worst Kind
Information & Registration: SDAHO.org, 605-361-2281
Location: Sioux Falls Convention Center Information: Avera.org/conferences
September 28-29 6:00 pm–4:35 pm 18th Annual Avera Cancer Institute Oncology Symposium Location: Prairie Center, Avera McKennan Hospital
November 2 8:00 am–5:00 pm 35th Annual North Central Heart Cardiac Symposium
Information: 605-322-7879, Avera.cloud-cme.com
Location: Sioux Falls Convention Center
Registration: Avera.org/conferences
Registration: Avera.org/conferences Information: 605-977-5122
October 6 7:00 am–5:00 pm 17th Annual Community Response to Child Abuse Conference
November 7 9:00 am–4:00 pm Avera Palliative Medicine Symposium
Location: Sioux Falls Convention Center
Information: Avera.org/conferences
Information: 605-333-2200 elizabeth.groff@sanfordhealth.org Registration: sanfordhealth.csod.com
EXPANDED GENERAL SURGERY Prairie Lakes General Surgery in Watertown offers an expanded range of services, diagnostic testing, and laparoscopic procedures. Call 605-882-6850 or visit prairielakes.com to learn more.
Board Certified General Surgeons Dr. Kamlitz, Dr. Gerrish, and Dr. Schaeffer
Customized care for heart stent patients is here – ONLY AT SANFORD HEART HOSPITAL. Sanford Heart is proud to be part of a health system that has focused on integrating genomic medicine into primary care, which is dramatically changing how we deliver care to your patients. Now with one simple genetic test – not available anywhere else in the region – heart stent patients can significantly reduce their risk of future heart attacks. This test allows our experts to pinpoint the most effective anti-clotting medication for each patient, based on their DNA.
National study* reveals vital information for patients with heart stents About 30% of all patients have a genetic deficiency that impairs how they react to Plavix (clopidogrel), which increases the risk of heart attack or stroke. *Sanford Heart is a participant in this study
Call (605) 312-2278 to learn if this genetic test is right for your patients.
Tom Stys, MD, FACC, FSCAI
T H I N K H EA RT T H I N K U S . CO M /PL AV I X 013000-00452 7/17
Medical Director of Cardiology Services at Sanford Heart Hospital