MED-Midwest Medical Edition-December 2015

MACRA

The End of Fee-for-Service?

Midwest Medical Edition

Meeting Planning 101

2015

Cyber-fraud Alert

DECEMBER

HOLIDAY

Vol. 6 No. 8

A LOOK BACK SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

MIDWEST MEDICAL EDITION

Contents VOLUME 6, NO. 8 ■ DECEM B ER 2015

REGULAR FEATURES 4 | From Us to You 5 | MED on the Web The Nation’s Fattest States and other content available exclusively on our website

By Peter Carrels

10 | N ews & Notes – Recognitions, new

ON THE COVER

providers, accreditations, and more

IN THIS ISSUE 9 | Generational Differences in Technology Usage ■ By Amos Kittelson Tips to help you meet your patients - and your staff - where they are on their tech journey

6 KEEP THE HOLIDAYS MERRY

22 | The Future of Healthcare, Part 3 25 | Is Sitting the New Cancer?

■ By Buzz Hillestad How to Avoid Fraudsters and Cyber Attackers, Part 1

■

By Jeff Roach

Is sitting really as bad as we’ve heard? Find out why the studies don’t tell the whole story.”

26 | Treating Winter Allergies in Children The Allergy & Immunology Clinic at Omaha Children’s

27 | Black Hills Surgical Hospital

21 DOES MACRA SPELL THE END FOR FEE-FOR-SERVICE?

28 | Avera Joins WIN Consortium in

32

Personalized Cancer Medicine Group will advance the national utilization of personalized oncology

28 | Rural Providers to Get New CT Scanners with Grant Funds

29 | Patient Tracking & Follow Up: What You Don’t Know Can Hurt You

34 | Estate Planning, Will or Trust: Which is Right for You? ■ By Lisa Maguire

SO YOU’RE THE MEETING PLANNER? NOW WHAT?

■ By Carmella Biesiot

■ By Laurette Salzman

12

Did you miss any issues of MED this year? Don’t worry – we’ve got you covered with MED’s annual wrap-up of the feature stories and news events making headlines in 2015. We are now accepting suggestions for feature articles in 2016. Let us know what you want to see in this spot this time next year!

page

16

THE YEAR IN REVIEW

■ By Scott Leuning

Recognized for Joint Replacement

page

From Us to You Staying in Touch with MED

A

S WE WRAP UP ANOTHER YEAR of MED, we want to thank you, our readers, for your continued support of this publication and of the advertisers who make it possible to bring it to you, month after month, free of charge. Your patronage of their businesses shows them that their ad dollars are being well spent here in MED, which, in turn, keeps it coming to your mailbox. It’s a win-win-win.

In this month’s issue, not only do we wrap up the year in style (and catch you up on anything you might have missed), but we also bring you all of the latest medical community news as well as useful and timely articles on:

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

VICE PRESIDENT

SALES & MARKETING Steffanie Steffanie Liston-Holtrop

Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER studiofotografie

• avoiding cyber attacks during the holidays • generational differences in the way we use

WEB DESIGN Locable

technology (see if you can spot yourself!)

DIGITAL MEDIA

DIRECTOR Jillian Lemons

• the dangers of sitting AND how to get around them • the implications of MACRA • how to plan a meeting • deciding between wills and trusts in estate planning

CONTRIBUTING Alex Strauss

WRITERS Carmella Biesiot

Buzz Hillestad Amos Kittelson

and more!

Scott Leuning Lisa Maguire

Here at MED, we strive to be your go-to source for medical community news and information you can put to use right away in your life and work. Got ideas for us? We’re all ears. And we’re already planning for 2016. Send your feedback and suggestions to Info@MidwestMedicalEdition.com.

Best Wishes for a Happy, Healthy Holiday Season!

Until Next Year, —Steff, Alex, and the entire MED team

Jeff Roach Laurette Salzman STAFF WRITERS Liz Boyd Caroline Chenault John Knies

APRIL MAY

2015

2015

2015

MARCH

JANUARY FEBRUARY

Vol. 6 No. 2

Vol. 6 No. 1

Vol. 6 No. 3

Midwest Medical Edition

HIGH TECH

SIGHT SAVER

MEANINGFUL USE MILESTONE

in Watertown

Regional’s

New CEO

Medical Education

A TEAM EFFORT

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

4

Physician

Physician

Scientists

Burnout The Other “HEALTHCARE CRISIS”

Leading Innovation at the Bench and the Bedside CYBERSECURITY ALERT:

ASSUME A BREACH

Leadership Changes

at Area Health Systems

NEW CANCER CENTER FOR

Marshall, MN

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

Paper Records?

PREPARE FOR PENALTIES

When WISHING

is Therapeutic

Data Security

in ‘The Cloud’

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

From

NEPAL

to Rapid City. .

CAN YOU SPOT

Drug-Seeking Behavior?

Planni Tech D

SOUTH DAKOTA AND THE UPP F OR PHYSICIANS & HEALT

Midwest Medical Edition

2016 Advertising EDITORIAL DEADLINES Jan/Feb Issue December 5 March Issue February 5 April/May Issue March 5 June Issue May 5

Stay up-to-date between issues of MED!

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Sign up for previews of upcoming articles and advance notice of the next digital edition.

November Issue October 5

On the Website this month

December Issue November 5

The Nation’s Fattest States

CONTACT INFORMATION

WalletHub has released its list of states with the biggest and smallest

Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com

weight problems. North Dakota and Minnesota are both on the list.

Find out how they rank and see other key weight-related stats.

Alex Strauss, Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com Fax 605-231-0432

Hospice and Palliative Care

MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109

Approaching the end of life should not have to mean giving up quality

WEBSITE MidwestMedicalEdition.com

of life. Explore the rules and services regarding hospice and palliative

A Medical Community Hub

Vol. 6 No. 5

Accountable Care

2015

2015

2015

Vol. 6 No. 4

NOVEMBER

SEPTEMBER OCTOBER

JULY AUGUST

JUNE 2015

Disaster

MORE THAN A MAGAZINE

MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

Vol. 6 No. 6

Vol. 6 No. 7

Quality Measures Patient Portals

South o Dakota gets a

Meaningful Use Electronic Medical Records Reimbursements

Integration

ICD-10

Physical Then & Now

Father/Son Plastic Surgeons

Stay out of Trouble

Collaboration Value-Based Medicine

Fu Future ure ur SD-IPEC Healthcare Technology

HOSPITAL

South Dakota’s Interprofessional Practice and Education Collaborative

WORKPLACE VIOLENCE

Intergrative Therapies

The Siouxland/Tanzania CONNECTION

FOR VETERANS SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

PER MIDWEST’S MAGAZINE THCARE PROFESSIONALS ƒ MED July August 2015 .indd 1

December 2015

A Team Approach to Medicine

THE

of

Your Guide to the 60-Day Rule

. . and Back

ing for a

care with one of the area’s top providers of both.

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

Omaha’s Accredited Sleep Center

NATIONAL ATTENTION for Toxic Laundry Soap Study

THE FUTURE Healthcare

of

Pt. 2: Collaboration and Integration

ƒ MED NOV15.indd 1

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Local Doc’s

Home-Brewed Hobby

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

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How to Keep Your

Best Employees

10/19/15 10:10 PM

5

Keep the Holidays Merry How to Avoid Fraudsters and Cyber Attackers, Part 1

By Buzz Hillestad

F

RAUDSTERS take every advan-

ATTACKER GOAL

Weaponize Desktop

tage they can to steal IDs and money from people. The Holidays are particularly brutal for this type of activity. From social engineering attacks tricking you into giving them your information to phishing attacks designed to compromise your computer, these attacks are real and do real damage to people who fall victim to them.

One very specific type of attack that happens during The Holidays is the DHL package claim. You get an email supposedly from DHL that claims you have a package they have been trying to deliver to you and that all you need to do is follow the link in the email to claim it. While DHL isn’t always the subject of this type of email, the trick and result remain the same.

Sometimes the attackers use other mailing services or even online stores such as Amazon.com or eBay.com.

This type of attack is successful due to the way most computers work and are set up.

Below there is a diagram of a simplified

6

hacker social engineering attack kill-chain.

It is called a kill-chain due to the fact that it shows the path a hacker takes to get to what they want most, the data.

The first column of the diagram shows the attack vectors the attacker will try to exploit. If an attacker convinces someone in your organization to click the link in a phishing email, it will usually successfully drop a payload that will give the attacker what is called “shell access” to the computer. The payload is downloaded from their command and control (C&C) server out on the web.

From there, the attacker can send commands to the machine to make it do basic things.

In order to completely take it over, though, the attacker has to be able to elevate privileges on the computer. Privilege elevation is required to fully take over the computer. This means that the attacker can install her own applications and weaponize the compromised workstation. If your organization is using admin accounts or local admin accounts for the users on the computers, it’s game over. If your

Victim is taken to a C&C website

Secure Awareness Training

Privileges

Restricted Accounts

Vulnerabilities

Vulnerablity Management

Pivoting

LAN Segmentation

organization does use restricted accounts, you are protected for this first attack vector but your org is not in the clear.

If the attacker cannot gain administrator access through the compromised user credentials, she will have to exploit a vulnerability that allows her to elevate privileges outside of normal parameters. The best defense for this is vulnerability management. How often you scan for vulnerabilities and remediate them will determine your success with vulnerability management.

Lastly, your organization can have a desktop that is completely compromised but can’t go anywhere else on the network due to proper LAN segmentation. Making sure firewalls are strategically placed between LAN segments and using proper egress and ingress filtering between those segments is critical with being successful with LAN segmentation.

The bottom line is that we need to assume our workstations will get breached. We need to plan for this assumption with the controls mentioned at the very least. The second column of the diagram completes the first column by showing protections for each of the attack vectors. If we think of these protections as speed bumps, we can then focus on detection and response. Once we’ve detected our nemesis within our walls, we can figure out how they got in, with proper forensics, and how to prevent them from getting in again. Information security is a cycle not and endgame. Remember that and stay vigilant.

In the next installment of this 2 part series we will look at what the criminals can actually do with the data they steal. ■ Buzz Hillestad is Principal Consultant and Partner at SHS, LLC in Sioux Falls.

Midwest Medical Edition

The gift of organ donation means more birthdays, more bike rides and more everyday blessings.

Thank you to SDAHO and all of our healthcare partners for helping us facilitate more birthdays for recipients like Mary Jo. With your help, we provide compassionate care and support for grieving families whose loved ones give the ultimate gift—the gift of life.

Mary Jo Renner, Heart Recipient Yankton, South Dakota

1.800.24.SHARE (1.800.247.4273) www.MyDonationResource.org

Your partner for organ and tissue donation in South Dakota.

CNOS delivers stronger, more comprehensive patient care by integrating Neurological, Orthopedic and Spine services. With an experienced team of physicians, surgeons and rehab specialists, CNOS continues to improve health throughout Siouxland.

CENTER FOR NEUROSCIENCES, ORTHOPEDICS AND SPINE

8

Midwest Medical Edition

Generational Differences in Technology Usage How to meet your patients – and your staff – where they are

A

By Amos Kittelson S TECHNOLOGY CHANGES

and we adapt, we come to expect more of it.

Millennials, or members of Generation Y (ages 18-34), rely heavily on use of technological tools. Baby boomers (ages 51-69) may not be as familiar with certain technologies and simply may not have a desire to use them.

Generation X (ages 35-50) has seen technology improve very quickly but may get stuck trying to relate to both generations on either side of it. This has created a vast divide in how generations understand and relate to technology. Each generation interacts – or interfaces – differently with technology.

(Scrolling on an iPad is an example of user interface – it is the way we use that technology system.)

Patients or staff members who are Baby Boomers may be slow to adapt to a new technology because they fail to completely understand its full capabilities. They may never fully embrace it or learn all that it can do. For the best experience, give baby boomers very basic user interface – no keyboard, no mouse, labeled buttons, touch screens with instructions. For best learning results, a user interface should offer user feedback while they interact with the device. Telling the user why the system is doing what it’s doing will help them understand it. A product manufacturer should incorporate user feedback when designing something new.

Millennials have grown up with technology that has been developed for optimal performance. It is very easy for them to reach out and have a conversation at the push of a button. Their user interface is simple, pleasant to the eye, and works well.

Generation X is accustomed to technology not working because it has been developed during their lifetime and they’re

December 2015

used to things not working well. This FUN FACT: When we press a button, if may cause them to overcomplicate nothing happens after 7/10 of a second technology. Gen-X exists between (700 milliseconds), we think it’s broken a tech-savvy generation and one and try clicking again. A system’s response that might not readily acclimate to time must be very fast for people to accept it. changes in technology. Gen-X might adapt easily, but they try to learn the new technology while simultaneously technology gap, allowing everyone to teaching their predecessors. They become share technology and communicate more mediators, but they can only be good effectively and efficiently. Because there’s translators by understanding generational no “one size fits all” solution, system intedifferences and thought processes. grators can customize technologies to fit anyone regardless of position, personality, Baby Boomers and Millennials may be better able to relate to one another than or generation. Combinations of technologies – sensors, touch screens, voice recognition Gen-X can relate to either of them. The communication barrier is low for both – can be developed with user testing. Before Millennials and Baby Boomers, even though implementing technology solutions, busitheir communication systems are different. nesses should invite an expert system Baby Boomers want one simple solution integrator to provide consultation. rather than several options, and are slower More is expected of system usability and to adapt. Once they do adapt, they’ll hold reliability than ever before. Regardless of who onto it. Millennials want to consume all forms is learning a new technology, feedback will of technology and readily try new technoloenable users to better understand their device and therefore maximize its capabilities. ■ gies. Gen-X wants to know enough to have options, but without knowing too much.

Amos Kittelson is a Sioux Falls native, lifelong The best user interface is no user intertechnologist, 17 year Air Force Veteran and face. This means that having fewer – or no – barriers to operating technology will enable owner of Sidewalk Technologies. us to better utilize it. For technology to be used to its greatest potential, user interface must be simple and responsive. One of the simplest interfaces is one that is voice-activated – a device that can distinguish natural language. An example of this is iPhone’s Siri.

Ex p e r t s ca n br id ge that generational

9

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA

Doctors have treated the first patients at Avera Heart Hospital with a newly approved SYNERGY

Everolimus-Eluting Platinum Chromium Coronary Stent from Boston Scientific making them some of the first patients within a four-state area including South Dakota, Minnesota, Nebraska and Iowa to benefit from this highly anticipated new technology. The SYNERGY Stent was approved for use by the FDA in November.

Sarah Flynn, MD, has returned to Avera Medical Group University Psychiatry Associates after completing her fellowship in forensic psychiatry at the University of Colorado Denver School of Medicine. Dr. Flynn completed

her medical degree at The University of South Dakota Sanford School of Medicine and South Dakota State University.

She completed residency in adult psychiatry and fellowship in child and adolescent psychiatry at the University of Texas Southwestern Medical Center, Dallas and is board certified in adult, child and adolescent psychiatry.

10

Amber Evenson, PA-C, has joined Avera Medical Group. Amber is

now seeing patients at Avera Medical Group Internal Medicine Mitchell.

Evenson received her Associate of Applied Science Degree in Nursing from Mount Marty College and earned her Bachelor of Science Degree in Nursing and her Master of Physician Assistant Studies from the University of South Dakota.

She is a native of Scotland, SD where she and her husband now live.

Avera Heart Hospital is the first in the region to adapt the Volcano SyncVision, which

syncs two technologies that help heart specialists further evaluate diseased heart arteries and to more precisely place coronary stents. Volcano SyncVision provides both an angiographic roadmap as well as intravascular details from the ultrasound. This co-registration provides detailed and accurate measures of vessel size, plaque area and volume, and the location of key anatomical landmarks — all valuable information while placing the stent.

Save the Date: The Avera Transplant Institute Symposium will be held at the Prairie Center in Sioux Falls on March 31. To register, email averaeducationevents@avera.org or call 605-322-7879. For more information see Avera.org/ conferences

BLACK HILLS

Regional Health has announced the three caregivers who were recognized during the month of November for the “I Am Regional Health” campaign.

The individuals are:

Cindy Whitaker, a medical lab technician in Custer, Moon Hemeyer, a physical therapist in Spearfish,

Eli Christopherson, an information technology professional at the Rapid City Regional Hospital HelpDesk.

The Spearfish Regional Hospital Auxiliary is sponsoring a college scholarship fund. To be

eligible, interested applicants must be students in their second year of undergraduate studies in an accredited healthcare program.

Applications are available in Executive Management at Spearfish Regional Hospital.

Deadline for applications is Dec. 15, 2015.

Cassy Choi, RN, recently received the September DAISY Award for extraordinary nurses at Rapid City Regional Hospital (RCRH). She provides

patient care on several floors at RCRH and has worked at the hospital for more than 10 years.

Choi was nominated by the daughter of a recent patient.

The following advanced practice providers have joined Regional Health:

Karen Bryan, CNP, Family Medicine, Queen City Regional Medical Clinic, Spearfish, SD Ashley Neisen, PA-C, Family Medicine, Regional Medical Clinic, Rapid City, SD

Rebecca Reausaw, CNP, Orthopedic Surgery Regional Orthopedics, Spearfish, SD

Connie Tschetter, CNP, Neurology and Rehabilitation, Regional Medical Clinic–Neurology & Rehabilitation, Rapid City, SD

Midwest Medical Edition

Eccarius Eye Clinic (Scott Eccarius, MD) in Rapid City has been named a 2015 Guardian of Excellence Award winner by Press Ganey Associates, Inc. The Guardian

of Excellence Award recognizes top-performing healthcare organizations that have consistently achieved the 95th percentile or above of performance in Patient Experience.

SANFORD Kirk Zimmer assumed duties as president of Sanford Health Plan on December 1.

Zimmer was most recently CEO for DAKOTACARE, a health insurance provider based in South Dakota. He also held positions of chief financial officer, chief operating officer and senior vice president at DAKOTACARE. Zimmer holds a Bachelor of Science degree in accounting from St. Cloud State University and is a certified public accountant.

Sanford Aberdeen is helping local families in need this holiday season by hosting a food drive. All donations will

be distributed to the Salvation Army and The Journey Home, to benefit families in the Aberdeen area. The public can help by bringing any non-perishable food items to Sanford Aberdeen now through Dec. 9. Monetary donations are also accepted.

December 2015

A new clinical trial at Sanford Health is exploring how genetic changes that occur during breast cancer might help healthcare providers better identify, treat and control the disease.

The clinical trial launched earlier this month and monitors changes in breast cancer tumor tissue at initial diagnosis and, if applicable, at recurrence. Trial participants must be newly diagnosed with breast cancer to be considered for participation in the trial. The trial is open in Fargo, Sioux Falls and Bismarck.

SIOUXLAND Janice Harrison is the new Inpatient Rehabilitation Coordinator at Mercy Medical Center-Sioux City. Harrison

obtained a BA in Nursing from Creighton University in Omaha.

Most recently, she served as the Clinical Manager at Siouxland Pace where she managed the onsite primary care clinic and case management. Harrison will lead the coordination of internal and external admissions to the acute inpatient rehabilitation unit.

Julie Schiltz, Therapy Manager for Mercy Home Care, was honored at the Trinity Home Health Services Fall Conference for receiving the THHS Mission Award. This award honors

individuals who embody Mercy’s mission and values by living Mercy’s commitment to justice, stewardship, integrity and reverence to those who are poor.

UnityPoint Health–St. Luke’s Cardiology Services and Cardiovascular Associates welcomes Swapna Kanuri, MD and Roque Arteaga, MD, FACC to its cardiology staff.

Dr. Kanuri

attended medical school at Shri B.M. Patil Medical College in Bijapur, India and completed residencies in Anatomic and Clinical Pathology at Boston University Medical Center and Internal Medicine at Creighton University Medical Center in Omaha, where she also completed a fellowship in adult cardiovascular disease, also at Creighton University Medical Center.

Dr. Arteaga

earned his MD from the Universidad Catolica de Santiago de Guayaquil in Ecuador and completed a residency in Internal Medicine at Jackson Memorial Hospital in Miami and a cardiology fellowship at the Medical College of Georgia Hospital in Augusta, Georgia before completing a clinical in cardiac electrophysiology at the University of Iowa Carver College of Medicine in Iowa City. He specializes in electrophysiology.

MidwestMedicalEdition.com

Paul Johnson, MD, and Mercy Medical Center-Sioux City have been honored along with former patient John Dunning

by Madonna Rehabilitation Hospital as 2015 Chairman’s GOAL Awards Recipients.

The Chairman’s GOAL Award is presented annually to honor “miracle” patients and the physicians and trauma centers behind their recovery. Mr. Dunning was seriously injured when a tornado hit Wayne, Nebraska in 2013 and Dr. Johnson was a surgeon on the trauma team.

Mercy Breast Care Center has been awarded a three-year term of accreditation in mammography by the American College of Radiology (ACR). Mercy Breast Care Center

is the only ACR Breast Imaging Center of Excellence in the Siouxland area. The designation represents ACR accreditation in Mammography, Ultrasound, and Stereotactic Breast Biopsy.

MED QUOTES

“

Medicine is a science of uncertainty and an art of probability.

— William Osler

”

11

IN KEEPING WITH TRADITION, WE WRAP UP OUR YEAR WITH A LO Once again, technology has often taken center stage in our publication, but MED has also tackled the problem of physician stress, shined a spotlight on the dual roles of physician scientists, highlighted sight saving services at the SD Lions Eye Bank, explored the Black Hills/Nepal connection in the wake of an earthquake, and provided a platform for area healthcare leaders to discuss the future of their industry. As you read this year’s Review article, please keep in mind that we are always on the lookout for new ideas. Let us know what stories and issues you want to read about in these pages in 2016.

OOK BACK AT THE TOP STORIES AND NEWS HEADLINES OF 2015.

JANUARY / FEBRUARY 2015

JANUARY FEBRUARY

Vol. 6 No. 1

High-Tech Sight Saver THE SOUTH DAKOTA LIONS EYE AND TISSUE BANK

HIGH TECH

SIGHT SAVER

MEANINGFUL USE MILESTONE

in Watertown

Regional’s

New CEO

Medical Education

A TEAM EFFORT

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

NEWS FLASH!

Offers Rare Tissue Prep Technique to Restore Vision The South Dakota Lions Eye and Tissue Bank is one of nine eye banks in the U.S. (out of 79) with the training and experience to prepare DMEK (Descemet’s Membrane Endothelial Keratoplasty) transplants for corneal surgery. The transplants are used to treat rare conditions such as Fuch’s dystrophy, bullous keratopathy, and other cause of poor endothelial function.

Unlike previous generation partial thickness corneal grafts, the ultra-thinness of DMEK grafts means they can only be prepared manually. Under microscopic guidance, a specially-trained tissue preparation expert must carefully isolate and remove this miniscule layer of cells from the underside of a donor cornea.

“The average cornea is about 500 to 600 microns thick and the endothelium (the innermost layer) is absolutely the tiniest portion,” says Marie Bowden, CEBT, CTBS, Clinical Recovery Manager at the SDLETB in Sioux Falls. Bowden uses delicate instruments and a surgical microscope to prepare circular grafts that are approximately 8.25 to 8.5 millimeters in diameter, a mere 10 to 12 microns thick, and the consistency of wet tissue paper.

Not every patient is a candidate for DMEK and many surgeons are still not trained to perform the delicate procedure. While the demand for DMEK tissue is growing, DSAEK remains the graft of choice for most surgeons. The SDLETB stays busy delivering both.

“More surgeons want to be as minimally invasive as possible to restore sight,” says Bowden. “Our job is to get the grafts to surgeons that they desire and that their patient needs.” ■

BRENT PHILLIPS BECOMES THE NEW CEO OF REGIONAL HEALTH

PRAIRIE LAKES IS ONE OF ONLY 19% OF ELIGIBLE HOSPITALS TO ATTEST TO STAGE TWO MEANINGFUL USE

14

Midwest Medical Edition

MA MARCH

PHYSICIAN SCIENTISTS WORK AT the intersection of clinical practice and scientific inquiry, uniquely poised to bring clinical insights into the lab and vice versa. This is just one of the reasons that the three local physician scientists we spoke with for this story are so passionate about what they do.

Dr. Michael Kruer is an Associate Scientist in the Children’s Health Research Center at Sanford Research and a pediatric neurologist at Sanford Children’s Hospital. In medical school at Arizona, Dr. Kruer found his niche working with children with rare movement disorders and neurodegenerative diseases and later did post-doctoral work in a neurogenomics lab.

“I was struck by how much these patients needed someone to walk with them on this difficult path and also by how grateful they are,” says Dr. Kruer.

Head and neck cancer surgeon and researcher John Lee, MD, spends three days a week seeing patients and performing surgery at Sanford USD Medical Center and two days a week studying the causes and treatments of tonsillar cancers that are triggered by the HPV virus.

“My role is to not only see the patients but to translate new information from our lab and from labs around the world into better treatments,” says Dr. Lee. Pierre, South Dakota native and neonatologist Michelle Baack, MD, spent ten years as the only full-time pediatrician in Pierre before deciding to pursue neonatology at the University of Iowa. It was there than she was “bitten by the research bug.”

“Being a researcher makes me think about patients and their medical care in more innovative ways,” she says. ■

December 2015

THE YEAR IN REVIEW

2015

Leading Innovation at the Bench and the Bedside

MARCH

Physician Scientists

Vol. 6 No. 2

Physician

Scientists

Leading Innovation at the Bench and the Bedside CYBERSECURITY ALERT:

ASSUME A BREACH

Leadership Changes

at Area Health Systems

NEW CANCER CENTER FOR

Marshall, MN

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

NEWS FLASH! MERCY MEDICAL CENTER UNVEILS THE DA VINCI XI SURGICAL SYSTEM USD SANFORD SCHOOL OF MEDICINE EXPANDS ITS RURAL MEDICINE PROGRAM

15

APRIL / MAY 2015

APRIL MAY

Vol. 6 No. 3

Midwest Medical Edition

Physician Burnout The Other “Healthcare Crisis” MOST DISCUSSIONS OF THE “HEALTHCARE CRISIS” IN THE UNITED STATES

Physician

Burnout The Other “HEALTHCARE CRISIS”

Paper Records?

PREPARE FOR PENALTIES

When WISHING

is Therapeutic

Data Security

in ‘The

Cloud’

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

NEWS FLASH! JUNE E. NYLEN CANCER CENTER MARKS 20TH ANNIVERSARY IN SIOUX CITY

JUNE JUNE 2015 Vol. 6 No. 4

include the fact that the numbers of physicians, particularly those on the front line of care such as critical care, emergency medicine and primary care, are in shorter and shorter supply.

And yet, according to several nationwide surveys in recent years, these physicians and many of their specialty colleagues are burning out at an alarming rate, impacting not only their own lives but the institutions in which they work and the patients they serve.

In 2013, an editorial in the Journal of General Internal Medicine reported burnout rates between 30 and 65 percent across all specialties.

In a 2014 survey, 68 percent of family physicians and 73 percent of internists said they would choose a different specialty if they could start over.

And in this year’s annual Medscape survey, half of all family physicians, internists and general surgeons surveyed reported feeling burned out. Bureaucracy, administrative tasks, and too much time spent at work were cited as the more frequent causes.

“We are never taught how to take care of ourselves during medical training or residency.

In fact, the workaholic ‘never need help, go it alone’ mentality is praised,” says Jill Kruse, DO, Family Medicine, Avera Medical Group, Brookings, South Dakota. “So when we do have issues, many students, residents, and even seasoned doctors don’t feel comfortable asking for help.” ■

From Nepal to Rapid City . . . and Back THE BLACK HILLS OF SOUTH DAKOTA ARE A LONG WAY FROM

From

NEPAL

to Rapid City. . . and Back CAN YOU SPOT

Drug-Seeking Behavior?

Planning for a

Tech Disaster

Intergrative Therapies

FOR VETERANS

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS ƒ MED JUNE 2015 .indd 1

5/17/15 8:34 PM

NEWS FLASH! THE SIOUX FALLS VA MEDICAL CENTER INTRODUCES NEW INTEGRATIVE THERAPIES FOR VETS 16

the mountains of Nepal. But for 12 Nepali doctors who work at Rapid City Regional Hospital, Rapid City has come to feel almost like home. Now, in the wake of Nepal’s devastating earthquake on April 25th, some of them are making the long journey back again to help their homeland recover.

RCRH Hospitalist Binod Dhungana, MD, is one of ten hospitalists and two specialists who have settled in Rapid City in the last five years. Within days of the earthquake, he became the first of the doctors to book his ticket home.

Ironically, this was the first year since moving to the US that the young doctor had decided not to use his summer vacation time to go home to Nepal. He had hoped to introduce his extended family to the Black Hills, where he has lived for the past two years.

By the time Dr. Dhungana left for Nepal, the American Nepal Medical Foundation had already collected more than $250,000 dollars to support the relief effort in Nepal. Some of that money came from group members, but some was directed to the foundation from other organizations, looking for a way to contribute. One of the biggest contributors was Rapid City Regional Hospital.

“It really means a lot to be part of such a great organization that is willing to help,” says Dr. Dhungana. “The support of the community has been great, too.” ■

Midwest Medical Edition

JULY/ AUGUST 2015

Groundbreaking public health report provides comprehensive look at the state of healthcare in South Dakota

JULY AUGUST

South Dakota Gets a Physical

Vol. 6 No. 5

South o Dakota gets a

Physical Then & Now

Father/Son Plastic Surgeons

Stay out of Trouble Your Guide to the 60-Day Rule

By Peter Carrels

HOSPITAL

WORKPLACE VIOLENCE

IN THE EXECUTIVE SUMMARY OF THE REPORT TITLED “Focus on South Dakota, A Picture of Health” the following statement summarizes the scale and importance of this newly-released statewide analysis.

“South Dakota and other largely rural states face many challenges in meeting the healthcare needs of rural and underserved communities, in part because data to guide improvement is often limited or unavailable. The South Dakota Health Survey provides unprecedented statewide survey data on regional patterns of behavioral health prevalence and access to care.”

Unprecedented is an ambitious word, but it is indeed likely that South Dakotans have never before been the beneficiaries of such a comprehensive analysis of their health and their access to healthcare.

To conduct this health needs assessment, 7,675 randomly-selected households from across the state were surveyed by phone, mail and in-person.

The report identifies several “key” findings of special interest, including: ●

outh Dakota may have rates of alcohol misuse, S anxiety, and post-traumatic stress disorder that are higher than national rates.

●

Hospitalization use for mental health issues is high.

●

I ndividuals utilizing hospital emergency rooms present high rates of mental health concerns.

●

here are pockets of high rates of depression, T heavy alcohol misuse, unmet medical needs, and adverse childhood experiences.

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS ƒ MED July August 2015 .indd 1

6/22/15 6:22 PM

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Survey results indicate that Buffalo, Lake, Lyman, Union and Yankton counties are the healthiest counties in the state. At the same time, surveys suggest that McPherson, Potter, Harding, Clay, and Fall River counties are among the state’s least healthy counties. ■

December 2015

THE YEAR IN REVIEW

17

SEPTEMBER/OCTOBER 2015

SEPTEMBER OCTOBER

Accountable Care

Vol. 6 No. 6

Quality Measures Patient Portals Meaningful Use Electronic Medical Records Reimbursements

Integration

ICD-10 Collaboration

The Future of Healthcare

Value-Based Medicine

Fu Future ure ur Healthcare Technology

THE

of

The Siouxland/Tanzania CONNECTION

Omaha’s Accredited Sleep Center

NATIONAL ATTENTION for Toxic Laundry Soap Study

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

NEWS FLASH! SIOUX FALLS VA MEDICAL CENTER OPENS ITS FIRST WOMEN’S CLINIC UNITYPOINT HEALTH, AVERA, AND SANFORD AGAIN MAKE CHIME’S “MOST WIRED” LIST

Challenges for Hospitals, Health Systems and Physicians AS WE TALKED WITH REGIONAL CEOS from both large and small health systems for our new series on The Future of Healthcare, we started by asking them to discuss what they see as the biggest challenges facing healthcare in the next five to ten years.

Jill Fuller, Prairie Lakes Healthcare System: “Our biggest challenge will be the continued transformations in our business including the shift from inpatient to outpatient care settings and the transition from fee-for-service to reimbursement based on value.”

Paul Hanson, Sanford USD Medical Center: “One of the biggest challenges will be organizations developing a sustainable business model that balances clinical, financial and operational initiatives.

Access to and management of capital, both human and financial, has never been more critical in ensuring an organization’s success.”

Jason Merkley, Brookings Health System: “The biggest challenge for healthcare organizations in the next five years is the shift from volume-based to value-based medicine and how we in rural America find ways to succeed under this reformed model and payment transition.”

Brent Phillips, Regional Health: “Recruiting and retaining a quality healthcare labor force could be a significant challenge well into the future. We have a huge shortage of several hundred thousand doctors across the United States today, and that shortage is only going to manifest itself more in the face of an aging workforce and an aging population.”

Fred Slunecka, Avera Health: “Regulatory [i.e. MACRA} and technology disruption will be a challenge. From evolutions of patient medical records to advancements in genetics and the study of microbiomes, we will understand care at completely different levels.” ■

18

Midwest Medical Edition

NOVEMBER 2015

South Dakota Leads the Nation in a Team Approach to Medicine

NOVEMBER

The Rise of Interprofessional Care

Vol. 6 No. 7

A Team Approach to Medicine

SD-IPEC

South Dakota’s Interprofessional Practice and Education Collaborative THE FUTURE Healthcare

of

Pt. 2: Collaboration and Integration

How to Keep Your

Best Employees

Local Doc’s

Home-Brewed Hobby

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE F OR PHYSICIANS & HEALTHCARE PROFESSIONALS

By Peter Carrels

THE CAMPAIGN TO PROPEL THE INTERPROFESSIONAL healthcare movement in South Dakota got a big boost and elevated levels of responsibility and opportunity last June when the University of South Dakota, representing South Dakota’s Interprofessional Practice and Education Collaborative (SD-IPEC), signed a Memorandum of Agreement (MOA) with the National Center for Interprofessional Practice and Education. SD-IPEC is the statewide group working to advance interprofessionalism in South Dakota.

Dr. Carla Dieter, chair of the Nursing Department in the School of Health Sciences at the University of South Dakota, also serves as chair of SD-IPEC. “We are now part of a national effort to contribute to the measurement of the interprofessional education and practice through affiliation with the National Center,” says Dieter. “By working with the national center we can tap into resources that will help propel our work forward on a broader scale as well as contribute to the National Center’s Data Repository. It is exciting to be part of this important national effort.”

South Dakota is one of only 11 states to have formalized a relationship with the national organization, and South Dakota’s level of statewide organization is a rarity among states. Out of the 11 member states, only South Dakota’s and Arizona’s initiatives involve multiple educational institutions, and South Dakota is the only member state involving practice partners in their membership.

“The ultimate goal is to educate students interprofessionally so that it becomes so ingrained in their nature to work together that when they enter practice it will translate into sound interprofessional practices and produce positive patient outcomes,” says Dr. Dieter. ■

December 2015

THE YEAR IN REVIEW

ƒ MED NOV15.indd 1

10/19/15 10:10 PM

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Midwest Medical Edition

Does MACRA Spell the End for Fee-For-Service?

I

By Scott Leuning

N THE TWO most recent issues of MED Magazine, the leadership of the major healthcare systems in South Dakota have all concurred that one of the primary issues facing the future of healthcare is the shift in reimbursement mechanisms away from fee-for-service and toward quality-based models of payment.

The recent passage of the Medicare Access and CHIP Reauthorization Act (MACRA), a bipartisan bill that permanently repeals the Medicare sustainable growth rate (SGR) formula, takes a significant step toward eliminating fee-for-service for physician reimbursement. Medicare’s feefor-service payment system had been long criticized for rewarding physicians who produced a high volume of services without taking into consideration the value received for those services. MACRA now creates a mechanism to shift away from fee-for-service as a primary means of reimbursing physician care under Medicare Part B and it signals a significant change in the landscape for physician reimbursement.

Under MACRA, Medicare fee-forservice reimbursement for physician services will increase annually by 0.5%, starting July 1, 2015 and going through 2019. But the focus of reimbursement takes a significant shift beginning in 2019. Medicare’s fee-for-service will continue as a reimbursement option after 2019, but reimbursement levels will remain locked at the 2019 level through 2025.

Beginning in 2019 physicians who want to receive higher Medicare reimbursement levels will have the option to participate either in a modified fee-for-service reimbursement program or shifting to an alternative payment model. The details of these options are explained below.

December 2015

OPTION 1 MERIT-BASED INCENTIVE PAYMENTS—A MODIFIED FEE-FOR-SERVICE MODEL The Merit-Based Incentive Payment System (MIPS) closely resembles the existing Medicare Physician Payment System.

The MIPS option is essentially for physicians who want to continue to be paid predominantly under Medicare’s fee-for-service model, with some twists.

The MIPS program consolidates three existing programs—meaningful use (MU), the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBPM)—into a single program.

Under MIPS, physician performance is evaluated in four categories: ●

Clinical quality (30%)

●

Resource use (30%)

●

Meaningful use of certified EHR

technology (15%) ●

clinical practice improvement activities (25%).

Based upon those assessments, each physician receives a score generated on a 0 – 100 point scale which will be used to differentiate between the best and worst performers.

OPTION 2 ALTERNATIVE PAYMENT MODEL The alternative payment model (APM) option under MACRA facilitates and encourages physician participation in accountable care organizations, bundled payment programs or other performancebased contractual payment systems where physicians assume more risk for the cost and quality of the patient care that they provide.

MidwestMedicalEdition.com

The APM option provides the opportunity for physicians to receive larger financial reimbursement, but there are also more stringent rules that must be followed by physicians who choose this option.

Now Is the Time for Physicians to Plan and Prepare for Change Under MACRA. While MACRA does not completely eliminate fee-for-service reimbursement for Medicare providers, those physicians who stay with the current system will accept flat reimbursement starting in 2019, whereas physicians who shift to the new alternative payment options of MIPS or AMP have greater opportunity for higher reimbursement, along with higher risks associated with their performance.

A major shift in physician reimbursement is now on the horizon with the passage of MACRA and now is the time for physicians to plan and prepare for that shift by deciding if they are going to participate in MIPS or AMP and by determining what steps to take to be prepared for the transition that occurs in 2019. Strategic planning and decisions regarding partnerships between physician groups, health systems and hospitals should be examined to determine the best course of action during the transition period. ■ Scott Leuning is an attorney at Goosmann Law Firm.

For a more detailed explanation of how physicians will be paid under the MIPS and APM models, see Scott’s full article on our website.

21

Future Healthcare THE

Part Three

of

By Alex Strauss

In the first two parts of our Future of Healthcare series, we talked to the heads of large and small area health systems about challenges and opportunities for their organizations and for the nation as the American healthcare system continues to evolve over the coming decade.

In this third and final part of our series, we bring you their thoughts on what they see as unique considerations not only for their own organizations but for providers across MED’s upper Midwest coverage area.

Paul Hanson

Sanford USD Medical Center “The geographic size of Sanford’s footprint can be a challenge. Larger, metro-based systems may have a 15- to 25-mile radius around their core services with a highly concentrated population base. By contrast, our system delivers services across one of the largest contiguous areas of the country. Communication, standardization and optimization are challenges that we work on daily. Engaging the medical staff and allocating capital are keys to future success.”

Brent Phillips Regional Health “Recruiting and retaining physicians and caregivers can be challenging. We have a history of being a progressive region in terms of healthcare delivery in the upper Midwest, but I would say recruitment is our biggest challenge and opportunity.

The current healthcare model must change. It needs to have a much more balanced focus that includes physician and caregiver engagement, better patient and family experiences, a culture of safety and quality care, and greater community and financial stewardship. We need focus on these key areas. As healthcare providers, we are significant shareholders in our communities. We have responsibilities not only in our healthcare systems, but in the greater community as well.”

22

Fred Slunecka

Avera Health “In our specific region, the small size of rural hospitals and their fragility is extraordinary. Bundled payments could have a significant impact on them. Additionally, it’s hard to recruit physicians and other healthcare employees to rural communities, and our rural workforce continues to shrink.

At Avera, we are turning to technology as a solution. Telemedicine seems to be coming into its own for a variety of reasons.

Consumers have grown accustomed to conducting many interactions remotely and online, so why not get your healthcare that way? The use of telemedicine has helped in recruiting and retaining a workforce in rural areas, allowing physicians to have greater balance and an expanded network of support. We can keep healthcare local by using Avera eCARE, and that’s important to our region.”

Jason Merkley Brookings Health System “I am not sure if this is a unique challenge of ours in the upper Midwest or not; however, I will say with unemployment rates dropping, the availability of a workforce to fill the vacancies within our organizations becomes increasingly more difficult every day. While we face a nation-wide shortage of physicians and nurses, recruiting professionals to work and live in rural areas

is much more difficult than our metropolitan counterparts.

Hiring ancillary and non-professional staff, from certified nursing assistants to housekeepers and dietary aides, is probably as challenging because we live in an area where there are more job opportunities than people. We are going to have to find creative ways of competing for human resources and implement a strategy that develops the personnel necessary to functionally staff our organizations in the future.”

Jill Fuller Prairie Lakes Healthcare System “Meaningful Use has caused us to change our business processes more than it is changing the way we provide care. We have gained some efficiencies but we are also less efficient in many areas as a result. The added requirements related to security will likely have the biggest impact on our industry – along with the added risks associated with protecting data in an electronic format.” ■ MED plans to run additional Future of Healthcare articles in the coming months featuring leaders from other types of healthcare organizations. Do you have ideas for who you would like to see us talk to? Send us an email at Info@ MidwestMedicalEdition.com.

Midwest Medical Edition

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Midwest Medical Edition

Is Sitting the New Cancer?

M

By Jeff Roach UCH HAS BEEN said

and written lately about the dangers of sitting.

Research on the negative effects of prolonged sitting has shown higher incidences of heart disease, metabolic syndrome, diabetes, and premature mortality. For many in today’s society, time spent watching television or using the computer at home is added to eight or more hours of a sedentary office job.

The latest research, however, has shown that it is not sitting but the lack of movement that may be contributing to poor health outcomes. “Our study overturns current thinking on the health risks of sitting and indicates that the problem lies in the absence of movement rather than the time spent sitting itself,” Dr. Melvyn Hillsdon, of the University of Exeter, said in a press release.

“Any stationary posture where energy expenditure is low may be detrimental to health, be it sitting or standing.”

For this article, I will focus on solutions to combat the negative effects of sitting and lack of movement in the work environment.

As an ergonomics specialist, I have seen a trend of employees requesting an accommodation (with or without a physician recommendation) for a standing desk. This likely is in response to the research mentioned above and/or from feeling discomfort after

December 2015

hours of prolonged sitting at work. If the employer accommodates the request, the employee then begins standing at the fixed height workstation. Inevitably, these employees have discomfort from prolonged standing so they request anti-fatigue mats or tall stools with foot rings. This is not the ideal solution to the problem.

Height adjustable workstations are recommended as an alternative to fixed height desks. That way employees can change positions whenever they want. With this solution there should be no need for mats or tall stools. Employees simply sit or stand for a predetermined time or change positions based on mild fatigue rather than pain. If done consistently, employees should have more energy and have less discomfort at the end of the day and the end of the week. If an employee plans to stand and walk more, he or she should ensure they are wearing high quality footwear with good arch support and consider gel insoles.

To guard against the effects of a lack of movement, companies should encourage employees to walk occasionally throughout the work day. Employees should plan ahead to get up and walk during scheduled breaks, to get a drink or snack, and discuss work related matters with co-workers instead of emailing (when appropriate).

Some may be concerned about a reduction

MidwestMedicalEdition.com

in productivity with this sit/stand/walk approach. However, people are able to better problem solve and increase their focus with frequent changes of position. I can think of many examples of walking away from a frustrating problem and returning to find the solution to be much more obvious. Employees that develop fatigue, pain, and lack of focus with static positions are not likely to be as productive.

Now to the topic of exercise balls and treadmill desks. I do not recommend sitting on exercise balls when working due to the lack of back support and the risk of injury from falling off the balls. I would rather have employees changing positions more frequently than having employers investing in treadmill desks.

In summary, prolonged sitting and lack of movement is detrimental to our health.

The solution does not lie with static standing at fixed height work surfaces. The solution is to change positions more frequently and move throughout the day. ■

Jeff Roach is an occupational therapist and a member of the South Dakota Occupational Therapy Association and the American Occupational Therapy Association. He is an Ergonomics and Loss Control Specialist with RAS.

25

Treating Winter Allergies in Children WITH THE BEGINNING of winter come freezing temperatures that end seasonal fall pollen allergies. However, many warm weather irritants – such as pet dander, mold and mildew – are around all year, and exposure can peak once the furnace kicks on and the windows are closed for the winter.

Whether a patient suffers from seasonal allergies, or food, medicine or insect allergies, Hana Niebur, MD, a pediatric allergy and immunology specialist at Children’s Hospital in Omaha, says it takes a special touch to treat younger patients.

“Children may not be as understanding as adults about why they have restrictions,” she says. “I think it’s important that kids are able to play outside, to have fun and to be children. My approach is to make treatment work for what a child can tolerate on a daily basis. My goal is to make them feel like they can have a normal life.”

Allergies can affect anyone, but are generally more common in kids and tend to run in families. Confirming a diagnosis typically involves skin testing, blood testing or challenge testing, which involves taking a very small amount of allergen by mouth, inhalation or a combination of both methods.

“Skin testing is still the most accurate form of testing for environmental allergens.

For food allergies, it can be a bit trickier, but it usually requires a combination of skin testing and blood testing,” Dr. Niebur says.

Allergy sufferers may become used to chronic symptoms, but Dr. Nieber says these symptoms can usually be prevented or controlled with help from an allergy specialist. In some cases, allergy shots are needed to desensitize the immune system to the allergy. Treatments vary based on a child’s age, overall health and other factors. ■ See the website for more on the Pediatric Allergy and Immunology Clinic at Children’s.

26

Sioux Falls Specialty Hospital

Honored with 5-Stars in Patient Survey SIOUX FALLS SPECIALTY HOSPITAL recently received a 5-Star Rating from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) for 2015.

The only hospital in Sioux Falls and one of only four hospitals in the state to receive a 5-Star rating, Sioux Falls Specialty Hospital earned very high marks from patients in every category on the survey: ●

Overall Hospital Rating

●

Cleanliness of Hospital Environment

●

Responsiveness of Hospital Staff

●

Quietness of Hospital Environment

●

Pain Well Controlled

●

Discharge Information

●

Communication with Nurses

●

Understood Their Care When

●

Communication with Doctors

●

Communication about Medicine

They Left the Hospital ●

Would Recommend Hospital

The HCAHPS survey is the first national, standardized, publicly reported survey of

patients’ perspectives of hospital care. ■

Researchers Develop Model for Neurodegenerative Disease SANFORD RESEARCH scientists have developed a pig model for a neurodegenerative disease that could help better treat the disorder and other physiological conditions.

The findings of the project are published in Human Molecular Genetics.

Sanford Research President David Pearce, PhD, staff scientist Rosanna Beraldi, PhD, scientist Jill Weimer, PhD, and their team of investigators engineered the pig model to replicate ataxia telangiectasia (AT), a progressive multisystem disorder caused by genetic mutations in the AT-mutated gene.

AT causes neurological degeneration and motor impairment, primarily in children.

Its progression is accompanied by immune disorders and increased susceptibility to cancer and respiratory infections.

“The creation of a more accurate animal

model can help bring research of this condition closer to application in human disease,” said Pearce. “We are particularly interested in the role of the AT-mutated gene in the progression of this disease and how treatment methods for similar physiological conditions might benefit from this pig model.”

While several mouse model have been produced for AT, the Sanford Research pig model better replicates the neurological characteristics of the disease, according to Pearce.

Sanford Research often replicates diseases in animal models to explore therapeutic approaches. Last year, Pearce’s mouse model for Batten disease, a group of rare neurodegenerative disorders in children, was also outlined in Human Molecular Genetics. ■

Midwest Medical Edition

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Black Hills Surgical Hospital Recognized for Joint Replacement ORT HOPEDIC CA R E AT Black Hills Surgical Hospital (BHSH) has been recognized among the top 10% in the nation as measured by risk-adjusted complications, according to this year’s evaluation from Healthgrades.

Every year Healthgrades evaluates hospital performance at nearly 4,500 hospitals nationwide for 33 of the most common inpatient procedures and conditions. As a result of this ranking, BHSH has again received the 5-star designation for orthopedics.

Black Hills Surgical Hospital not only performs at a 5-star level in Total Knee and Total Hip Replacement, it outperforms other hospitals in the nation in Joint Replacement and as a result has been recognized with the 2016 Healthgrades Joint Replacement Excellence Award™.

The Healthgrades report demonstrates how clinical performance continues to differ dramatically between hospitals both nationally and regionally. This variation in care has a significant impact on health outcomes.

For example, from 2012 through 2014,

if all hospitals as a group, performed similarly to hospitals receiving 5 stars as a group, on average 222,392 lives could potentially have been saved and 166,086 complications could potentially have been avoided. A 5-star rating indicates that Black Hills Surgical Hospital’s clinical outcomes are statistically significantly better than expected when treating the condition or conducting the procedure being evaluated. ■ See our website for a link to complete Healthgrades 2016 Report to the Nation.

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MidwestMedicalEdition.com

27

Avera Joins WIN Consortium in Rural Providers Personalized Cancer Medicine to Get New CT AVERA CANCER INSTITUTE recently became the fifth medical institution in the United States to join the Worldwide Innovative Networking (WIN) Consortium.

The WIN Consortium is a global network of leading academic, industry, insurance and non-profit research organizations working to make personalized cancer care a reality for patients worldwide.

Avera joins Memorial Sloan-Kettering Cancer Center in New York, New York University Langone Medical Center, University of Texas MD Anderson Cancer Center and University of California San Diego Moores Cancer Center.

“Personalized medicine is a concept of giving the right drug at the right time for the right person,” said Vladimir Lazar, MD, PhD, founder and Chief Operating Officer of the WIN Consortium. “WIN was created with a goal to go beyond what is now possible. As a member of the WIN Consortium, Avera will be on the front line of this transition.”

To date, the approach in cancer care has

been population medicine – treatments based on what has been shown to be most effective for people with a certain type of cancer. In comparison, personalized medicine uses genomic analysis to discover the specific genetic drivers of a tumor, and target those drivers with treatment regimens.

Avera’s genomic oncology team consists of Brian Leyland-Jones, MB BS, PhD, and Casey Williams, PharmD, as well as Avera Cancer Institute physicians (surgeon, oncologist, pathologist and interventional radiologists), research scientists, experts in bioinformatics, nurse practitioners and specialized nurses and pharmacists. The team collaborates with experts from across the nation in clinical oncology, pharmacology, clinical genetics, genomic informatics, bioethics and pathology.

“This is the age of genomic medicine.

We’re at a pivotal moment in cancer research, when we can apply genomic profiling to targeted therapies. This will be absolutely transformative in the history of cancer care,” Leyland-Jones said. ■

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Scanners with Grant Funds

THIRTY SEVEN RURAL healthcare providers across the upper Midwest will get new 32-slice or higher CT scanners thanks to a $14 million in grants from the Helmsley Charitable Trust.

The funding initiative was the result of a survey of Critical Access Hospitals in the Rural Healthcare Program’s seven-state funding region. According to the Trust, capital equipment, particularly CT scanners, was identified as a top capital need by many hospitals.

“Our goal is to ensure that people who live in rural America have access to quality healthcare as close to home as possible,” said Walter Panzirer, trustee of the Trust.

“Rural hospitals need to be viable and they need to have up-to-date equipment so patients can receive essential healthcare services locally.”

The new CT scanners will come just in time for some hospitals as a new Medicare policy on January 1 will reduce reimbursement for certain studies on CT scanners that do not meet radiation dose requirements. Critical Access Hospitals with a 16-slice or lower CT scanner were invited to apply for grant funding to purchase new CT scanners. More than a hundred hospitals applied.

Among the MED coverage area, hospitals chosen to receive funds for new CT scanners are Sanford Chamberlain Medical Center in Chamberlain, SD, Community Memorial Hospital in Redfield, SD, and Avera Gettysburg Hospital in Gettysburg, SD. ■ You can access the full list of recipients in 7 states on our website.

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28

Midwest Medical Edition

Patient Tracking & Follow Up –What You Don’t Know Can Hurt You

DID YOU KNOW

?

By Laurette Salzman

■ test is performed ■ results are reported to the office ■ physician reviews the results ■ physician communicates the results to the patient

■ results are properly acted upon ■ results are properly filed.

It is important the physician or allied health professional (AHP) review, authenticate, and date all diagnostic test results as soon as they are available—before filing.

When test results are abnormal, it is important to let the patient know both the results and the need for follow up. If the patient does not follow through as advised, it is prudent to make—and document—repeated efforts to encourage the patient’s return.

December 2015

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Services (CMS) rise by of more detailed denial rates will and the inclusion stages of ICD-10, are for physician system is set up Claims error rates Make sure your 100 to 200 percent. to and data ng, registration from three percent orders, scheduli expected to increase days in coding. average ICD-10 The use percent. systems that as much as 10 grow from le are likely to ls. accounts receivab d your denia 40, undersTan already 20 to as high as re organizations procedu res have Some codes and Successful healthca Develop a right about denials ed to ICD-10. been translat are should start thinking are five where the denials deadline hits. Here process to identify which now – before the can determi ne traditional denial you so beyond ng happeni Set up a tips for moving more training. to not only reduce areas will require management strategy this informacauses before commun icate eliminate their system now to denials, but to e on staff. everyon to tion happen: they g Inc., Dt-trak consultin nal is co-owner of ide professio natalie Bertsch providing nationw enhancement, which has been revenue management, since 2002. medical claims consulting services training and onsite

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2014

Establish a tracking system that documents and follows patients referred for diagnostic imaging or laboratory testing. An effective system will verify the:

vol. 5 no. 6

JUly / aUgU st

Lab and Diagnostic Tests

Tracking missed or cancelled appointments will help you improve patient care and reduce liability risk. When patients miss or cancel appointments, attempt to reschedule and document both the reason for cancellation and each of your efforts to reschedule.

We suggest the AHP review all missed or cancelled appointments and discuss them with the physician to determine if follow-up is necessary. More aggressive follow up may be necessary for patients with urgent conditions. Document all such efforts in the medical record.

2014

ing follow up, can lead to dire consequences beyond those to patient well-being. Substantial malpractice settlements and verdicts have been paid as a result of “lost” diagnostic reports and physicians’ failure to review and follow up.

Patients who miss or cancel appointments risk undetected and untreated medical conditions, threatening continuity of care.

If the patient later experiences an illness or injury, he or she may hold you responsible.

The best way to prevent such lapses—and the corresponding malpractice allegations they create—is to develop written policies and procedures. The goal is to effectively track lab and diagnostic tests, as well as missed appointments and referrals.

Cancellations and No-Shows

SEptEMbER OctObER

L

APSES in patient care, includ-

Vol. No. 55

Consultations/Referrals Plan to develop an effective system to identify and track patients who are scheduled for referrals and consultations. Document in the patient’s medical record all recommendations that a patient see a specialist for consultation or continued care. Include any letters or other communications between physicians in the medical record.

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he iss ue of a ‘cente alar r m fa Tigue the las stage’ con cer n t two an d for hea paTie dec (eCri) The num nT sa named ades. in fac lthcare pro feTy ber of viders ala rm t, the patien has alarm hazard across t each emerg sig nal s as the day – the cou become ency thousa s in which Ca #1 he ntr y ove nds can tran healthcare alth Tec re resear they can throughou r facilit ch ins slate hnolog t the ies can reach to tho titute hospita y ha zar desens overwh usands sur pas l. Wh d in 201 itized, elm s sev of ile alarm ing qua 3. alarm s on eve eral hundre The risk overwhelm s are ntities. ed or d per an imp ry uni s to pat so, it’s can inc immune t ort and ien no wo ant par lud t tens of to the nder The Joi e falls, del safety are that clin t of patien real. Co sounds, and ays in nt Co t car icia can trea mm mmissi e, Januar ns can suf tment, on inju y 200 on sen becom medic ries res fer from ‘al 9 and tinel per ma e ation arm fat ulting June datab nent errors from igue.’

201 loss of ase rep , or in unfor alarm functio 2. of the orts 98 tunate the wo hazard 98 rep n, and ly, the alarm rst cas s orted in Jun se occ -relate five in e – dea events e 201 urrenc d eve unexpe goal es are nts bet th. (npsg 3, the Joint cted add , 80 resulte happen ween Co d in dea ) to add npsg itional ing mo ress imp mmission th, 13 requir care or re and establ es hos in rov a prio ext mo ish ing end re fre pital and rity, est ed a new the saf ed stay quently ety of ablish critica .

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Types of Tracking Systems Tracking systems do not have to be complex or expensive; they just have to work. Many medical practices use simple and inexpensive methods, such as logbooks. Others utilize tracking functions provided in their electronic medical records system.

Whatever tracking method you choose, be sure to follow up on laboratory and diagnostic tests, cancellations, no-shows, and consultations. ■

You can purchase a digital file of any article you contribute to MED. Email it to clients, use it on your website, or print it for a cost-effective marketing tool!

Laurette Salzman, MBA, CPHRM, is Senior Risk Resource Advisor with ProAssurance

This article is not intended to provide legal advice and no attempt is made to suggest more or less appropriate medical conduct.

MidwestMedicalEdition.com

29

Sepsis Project Saving Lives A PROJECT AT AVERA HAS SUCCEEDED in reducing sepsis mortality by 45 percent to an average mortality rate of 8.8 percent – well below the national average of about 14 percent.

Sepsis, the rapid onset of organ dysfunction caused by an overwhelming immune response to infection, accounts for one in five hospital deaths nationwide and kills 258,000 Americans annually. Sepsis not only puts patients at risk, but it also puts hospitals at risk with longer lengths of stay and higher 30-day mortality rates, which can threaten Medicare’s incentive payments under value-based purchasing.

An Avera-wide quality work group has improved its sepsis rates through a project called “Seeing Sepsis,” in which frontline caregivers can quickly identify patients and ensure they get the necessary treatment – fast. This project was done in alliance with the Minnesota Hospital Association.

“Treatment with antibiotics is most effective within the first hour of the onset of sepsis. For every hour that goes by, there’s a 7 percent increase in mortality,” said Dawn Tomac, RN, Director of Clinical Quality Initiatives for Avera Health.

THERE ARE MULTIPLE STEPS TO “SEEING SEPSIS” TO ENSURE ITS SUCCESS.

■A nurse-driven screening protocol that’s hardwired to the electronic medical record.

Evidence-based order sets. Antibiotics are listed in order of which to give first for the site of infection, rather than alphabetical order.

■A transfer trigger tool, to help caregivers know exactly when patients should be transferred to ICU or a tertiary care center.

■ E ducation. This included videos and an easy-to-follow 100-100-100 infographic created by the Minnesota Hospital Association to use in early sepsis identification.

Ask ur tO Abou dge Lo e! g Packa

30

■ Measurement and feedback ensure that sepsis mortality rates continue to improve.

“The bottom line is that more patients are surviving sepsis at Avera. This is the result of the hard work of hundreds of employees,” says Tomac. ■

Midwest Medical Edition

December 2015

MidwestMedicalEdition.com

31

So You’re the Meeting Planner?

Now What?

By Carmella Biesiot

Planning a meeting can be daunting. These tips will save your sanity.

Know your budget before planning Whether you have to report to a committee, a board, or just one boss, make them be clear about the amount of money they are willing to spend. There is nothing worse than detailing for weeks or even months, with your catering manager, audio visual crew, and hotel contact just to have to go back to the drawing board due to budget concerns. Keep

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in mind that your venue crew will spend hours detailing your meeting-especially if it is a larger conference, and although sometimes things just happen and reevaluating the agenda is unavoidable, going back to the drawing board wastes your time and your hotel crew’s time. Another benefit to knowing your budget prior to planning is that your sales and catering managers will be able to help you make budget-friendly decisions.

Be the Only Contact for your venue personnel Nothing is more counterproductive than having too many cooks in the kitchen. One meeting planner will accomplish more than five; especially if they are not in the same office and relying on email to communicate.

Have a million meetings with people who matter, but keep them from contacting your hotel personnel. It only leads to confusion.

Midwest Medical Edition

PHYSICIANS

Too Many Agenda Items =Weaker Attendance It is important to have a clear and detailed agenda, but too many items will exhaust your conference goers. So many meeting planners want to plan activities in between sessions or after the work day, and although their intentions are great, the reality is that people are tired. They’re away from home and likely have work to catch up on. Unless it’s a cocktail hour or dinner, keep the non-conference related activities to a minimum. At the end of the day, people want to relax and have some free time to answer emails, exercise, and simply unwind. Plus, it’s less work for you, the meeting planner!

Keep Things Unique & Interesting If you are planning a meeting or conference that is a yearly event, remember to keep things fresh. Simply having different speakers or chicken instead of beef for dinner isn’t enough. Add a different theme each year, or a different focus. Perhaps one year you provide your attendees with a goody bag filled with items that represent the city you are in (CVB’s love providing these things), or provide them with some entertainment which is unique to where you are.

This can be easy if your event jumps around a region or the country, but if your event is at the same venue, it can get tricky. Don’t forgetyour hotel/venue personnel are a huge resource for ideas. Ask their opinion. They want you to have a successful meeting too as it is a reflection of their work.

Black Hills Urgent Care, LLC seeks outstanding full-time and part-time physicians to serve a wellestablished and growing patient base in Rapid City, SD and the Black Hills Region. Ideal candidates should possess strong clinical knowledge and skills, excellent patient communication skills, and high levels of commitment to efficiency, service, and maintaining and increasing patient volumes.

Family Medicine or Internal Medicine physicians who have board certification are desired. Key features of this opportunity include: • Practice includes both Urgent Care and Primary Care medicine.

• Practice located in beautifully designed facilities with state of the art equipment.

• Benefits include competitive compensation consisting of base pay, incentive pay based on production, and comprehensive benefit package.

Rapid City is located in the beautiful Black Hills and is a great place to live and work. Enjoy superior outdoor activities including hiking, biking, skiing, fishing, hunting, kayaking, and much more. With a population of 60,000 plus, Rapid City has the charming feel of small town, yet has abundant amenities, reasonable cost of living, low crime rate, excellent transportation access, public and private schools, and close proximity to colleges and universities.

Celebrate Yes, celebrate. Don’t forget-your attendees are away from their offices, their families, and their routine. Create an agenda item each day that celebrates them-whether it’s a spotlight on their business or industry, an awards ceremony, a cocktail mixer, or even a widely embellished “thank you” can go a long way. Treat them. Make them want to come back next year and make them glad they took time out of their life to attend. Cheers! ■ Carmella Biesiot is Director of Hotel Sales and Marketing

Interested parties, please contact Dr. Wayne Anderson at 605-786-8044 or e-mail wayne.anderson@bhsh.com.

Apply Online at www.bhucare.com Black Hills Surgical Hospital – HR Dept.

1868 Lombardy Drive, Rapid City, SD 57703 Email: humanresources@bhsh.com Black Hills Urgent Care, LLC, is a wholly owned subsidiary of Black Hills Surgical Hospital, LLP, which is proudly owned by physicians.

EEO Employer/Protected Veteran/Disabled

for The Lodge at Deadwood.

December 2015

MidwestMedicalEdition.com

33

Estate Planning

Will Or Trust – Which Is Right For You?

D

By Lisa Maguire O YOU NEED a Will? Or a

Trust? It depends upon your circumstances. For some, a Living Trust can be a useful and practical tool. For others, it may be unnecessary. Below you will find some basic information that can help you when making this estate planning decision.

WHAT IS A WILL? A Will is a written document governing distribution of property at death.

It is subject to amendment during your lifetime and allows appointment of a guardian for minor children.

WHAT IS A LIVING TRUST? A Living Trust, sometimes called a Revocable Trust, provides for property management during lifetime and after death. It is also subject to amendment during your lifetime.

A Living Trust can:

♦ ♦ ♦ ♦

Avoid probate after death

♦

P revent financial affairs from becoming public record

♦

Provide creditor protection for heirs

Avoid costs and delays Plan for incapacity ontrol what happens to C property after you are gone

Living Trusts have some drawbacks. It is usually more expensive to set up than a typical Will and is somewhat useless unless it is funded. A Living Trust only can control assets placed into it. If assets have not been

34

transferred, or if you die without funding the Trust, the Trust will be of little benefit as your estate will still be subject to probate.

WILL VS. TRUST CONSIDERATIONS There are many reasons to establish a Trust, but it will involve more upfront effort and expense. To determine if you should make the extra effort and invest in the expense of a Trust, answer these questions:

Is informal probate an available option?

In South Dakota, unlike many states, probate is not a complex or burdensome process, making a Will appropriate if you do not need a Trust for other reasons.

Do you have real property in multiple states?

If you have real property in other states, each state requires its own probate for such property. This may cost more in attorney’s fees, time, and trouble. If you have real property in multiple states, consider a Trust.

Do you have minor children?

A Trust allows you to establish provisions specifying when a child will be entitled to assets. (In many cases, a Testamentary Trust can be included in a Will if you do not want a stand-alone Living Trust.)

Do you have children, grandchildren, or other dependents with special needs?

Access or control those heirs have over inherited property may need to

be limited. With a standard Will, your property can be passed on to those heirs, but a Will alone does not allow you to exercise much control over their use of the property. (Again, a Testamentary Trust in a Will might also work in this instance.)

Will your estate be subject to estate taxes?

If the value of your estate exceeds the federal estate tax threshold, you might consider a Trust with tax planning provisions. Currently, the federal estate exemption amount is $5.43 million per person, and it is scheduled to increase to $5.45 million on January 1, 2016.

Will you actively manage your estate plan?

If not, a Living Trust may not be a suitable solution.

In many ways, a Living Trust and a Will accomplish similar objectives. A Living Trust, however, gives you options that a Will cannot. Those advantages don’t come without a price. Whether a Living Trust is better than a Will depends on whether the additional advantages are worth the cost.

One size does not fit all. Your estate plan should be prepared to address your own personal needs. ■ Lisa J. Maguire, Attorney/Shareholder, at Woods Fuller Shultz and Smith, PC practices primarily in the areas of estate planning, guardianship and conservatorship, probate and trusts. Lisa has over 17 years’ experience assisting individuals with their estate planning needs.

Midwest Medical Edition

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