MED Magazine December 2018

A Roundup of Holiday Events Telling a Patient “No” with Grace

DECEMBER

Make-A-Wish Unveils New Referral Site

VOL. 9 NO. 8

2018

The YEAR

InterVIEWS in

JOHN PORTER • JILL FULLER • PAULETTE DAVIDSON • GARY TIMMERMAN • THE PRESENTATION AND BENEDICTINE SISTERS • DAVID PEARCE • BRADLEY COOTS • DANIEL PETEREIT AMY ELLIOTT • LORA BLACK • KURT GRIFFIN • LUCA BRUNELLI • STEVEN POWELL • KRISTI EGLAND • BLAKE CURD • RITA BLASIUS • JAY BHATT • TAMMY REIFF • CANDACE ZWEIFEL BRANDON PETERSON • JESSICA TVEDT • SREEKANTH DONEPUDI • ADAM, MARIA, AND TOMASZ STYS • CORY GEFFRE • ALI IBRAHIMIYE • CHRIS ADDUCCI • MICHAEL GREENWOOD BRIAN JOHNSON • LUIS ROJAS • EBIMA OKUNDAYE • MUHAMMAD ALSUMRAIN • RICHARD HOWARD • TOM HOWARD • CHARLES VOIGT • KATE SIGFORD • MARTIN DIGLER HUNTER MOYER • ALLISON WIERDA SUTTLE • BENSON HSU • MICHAEL BACHARACH • CASSIE HAJEK • RYAN MEIS • MIKE NIEMAN • MARK PTACEK • THOMAS ASFELDT

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ELCOME TO MED’s annual YearEnd wrap up. This year we are mixing things up by revisiting some of our most compelling interviews with leaders, researchers, clinicians, and other innovators from 2018. As always, we hope they inspire you to send us your suggestions for 2019.

Also in this issue, you’ll find expert advice on letting patients down gently. Visiting Angels offers some tips for knowing when and how to broach the subject of home care. And we speak with the new CEO of Make-A-Wish about their banner year and a new website that has streamlined the referral process. Plus, you’ll find some upcoming events for the holidays and beyond inside the back cover.

So pour yourself a cup of holiday cheer, sit back, relax, and enjoy the region’s premiere publication created specifically for healthcare professionals like you!

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Talking About . . .

10 | Leadership

page 8

12 | R esearch 15 | Expansions and Initiatives 18 | Clinical Advances 22 | Interesting People 6 | When You Need to Say No Getting beyond the fear of a patient's dissatisfaction just might save their life.

■ By Emily Clegg

26 | A Great Year for Make-A-Wish A new website streamlines

REGULAR FEATURES 4 FROM US TO YOU 28 NEWS & NOTES 31 UPCOMING EVENTS

the referral process

30 | Signs That a Patient May Need Home Care and Tips for Approaching Them

5

When You Need to Say No GETTING BEYOND THE FEAR OF A PATIENT’S DISSATISFACTION JUST MIGHT SAVE THEIR LIFE

BY EMILY CLEGG

I

N CONVERSATIONS ABOUT OPIOID PRESCRIPTIONS, there can

be unspoken fears and motivations swirling beneath the surface. The patient may be fearful, aggressive or even dishonest. The clinician may fear backlash if the answer is no, but also knows that saying no could save a life.

Dan O’Connell, PhD, is a clinical psychologist who trains, coaches and consults with clinicians

on improving communication and patient relationships. He promotes the idea that patients are not the problem, but neither is the clinician. “The problem,” he says, “is that opioids may be causing more harm than good.”

A SIMPLE STRATEGY When the answer may be saying “no,” a

“

BE SOFT ON THE PEOPLE, BUT BE HARD ON THE PROBLEM.

”

CONCLUDING THE CONVERSATION

conversation is one place to start. Dr.

After following this format, present a clear

O’Connell suggests talking about safety

conclusion. If opioids may be doing more

and effectiveness, then using the patient’s

harm than good, agreeing to a different

answers to balance the two.

plan or to a contract that includes opioids

SAFETY: Draw out the patient’s understanding related to safety, then educate to fill in gaps. Ask, “Do you find yourself needing more and more?” or, “How would you know if you were becoming addicted?”

EFFECTIVENESS: Reflect the patient’s own complaints back to them. For example,

and parameters to ensure they aren’t doing harm are two possibilities.

If a patient grows angry or disagrees, Dr. O’Connell suggests using a defusing technique such as getting a second opinion or the input of a specialist. He advises “Be soft on the people, but be hard on the problem.”

“If opioids were the most effective way to help, I would expect them to be making more of a difference,” or, “I’m hearing your biggest issues are stress and lack of

This article is reprinted by permission from the Spring/Summer 2018 issue of Brink magazine, published by Constellation.

sleep—let me propose a more effective approach.”

BALANCING SAFETY AND EFFECTIVENESS: Reframe the conversation: “I’m open to considering any plan we both agree is the safest, most effective way to help your pain, and which we are certain won’t do more harm than good.”

WEB EXTRA

Emily Clegg, JD, MBA, CPHRM, is Director of Risk Management and Client Services, UMIA/Constellation

Read More

❱ Find out how communication gaps in your care team can raise the risk of malpractice.

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20 As the regional leader in medical community news, MED is devoted to

bringing you in-depth coverage of the projects, research, initiatives, expansions, and clinical advances that are consistently putting our region on the map and earning us recognition for some of the highest quality, highest value healthcare in the US. We do it by seeking out the interesting, intelligent and innovative personalities behind these stories.

As we wrap up our publication year and look back at 2018, we are devoting this issue to highlighting some of our top interviews in each category. We hope that it inspires you to feel proud of the extraordinary work you and your medical colleagues are doing here and that it sparks some ideas that could help direct MED’s coverage in the coming year.

The YEAR in

INTERV

018

VIEWS December 2018

9

Talking about . . .

Leadership THIS YEAR, after more than four decades at the helm of Avera Health, and on the brink of his 70th birthday, President and CEO John Porter retired. In a March interview we asked him to name the accomplishment he was

most proud of. “The fact that we were able to take these two disparate Catholic groups who had been engaged in their own separate ministries for 100 years and bring them together,” said Porter. “At one time, they saw each other as competitors. To have them come together and share a vision of a system that could be stronger and bigger, that was significant.” • THE SYSTEM that Porter helped unite took center stage in April/May when we featured The Presentation and Benedictine Sisters of Avera Health on MED’s Cover. System Member chair, Sister Mary Kay Panowicz of the

“We are the premier eHealth system in the country. Telemedicine has helped us not only save money and improve the quality of care in rural areas, but it has also made it easier to recruit providers into these areas.

It’s about Christ serving the world through us.” •

REGIONAL HEALTH’S new President/CEO, Paulette Davidson, who worked her way to the top from hospital housekeeping, was our cover feature in November. “Community healthcare is vital for industry.

It is the economic engine of the community,” Davidson told MED

MED’S SEPTEMBER interview

as she detailed the health

with Jill Fuller, recently-retired

system’s 5-part ‘roadmap’ for

President/CEO of Prairie Lakes

the future. “Our intention is

Healthcare System in Watertown,

to be here to take care of our grandchildren and our grandchildren’s grandchildren. That means we have to make good decisions so that we can support the other four missions.” •

contained this nugget of wisdom for anyone beginning a journey in healthcare administration:

“I think it is important to really learn the culture of your organization,” advised Fuller. “In our case, our culture is very unique and we have been successful because of it.

You need to listen and learn, which is going to help you build your relationships. When you understand the context, you don’t try to apply cookie cutter solutions.” •

SIOUX FALLS Surgeon Gary Timmerman, MD, became the second South Dakota physician to serve on the American College of Surgeons Board of Regents.

Timmerman is one of 23 regents that direct the 80,000 member

Yankton Benedictines —Sacred

ACS, considered one of the world’s

Heart Monastery told MED,

foremost medical organizations.

Sr. Mary Kay Pancowicz and the Avera System Members

A professor and chair of the USD Sanford School of Medicine department of surgery, Timmerman has been active with the ACS for more than 20 years. •

MED loves to share the insights and experiences of regional healthcare leaders. Are you a leader with something to share? Contact us any time at info@MidwestMedicalEdition.com

10

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John Porter

Jill Fuller Gary Timmerman

Paulette Davidson

December 2018

11

Talking about . . .

Research REGIONAL HEALTH radiation oncologist, Daniel Petereit, MD, graced the MED cover in March for his groundbreaking work in addressing cancer disparity among Northern Plains American Indians through the Walking

Lora Black

Forward program which he started in 2002. Early this year,

IN A DISCUSSION of the

Bristol-Myers Squibb Foundation

challenges of including more

approved a 3-year 1.6 million

women in clinical trials in

dollar grant for the next iteration

March, Sanford researcher and

of Walking Forward— Increasing

USD Sanford School of Medicine

Lung Cancer Screening for High

clinical instructor Lora Black

SANFORD HEALTH gave a boost to

Risk Smokers in a Frontier

told MED, “It’s not just about equal

its global brand and fostered new

Population project—a low-dose CT

connections with the announce-

screening project which began in

ment of the $1 million Lorraine

May. “A big part of the program was

Cross national research award

just gaining the trust of the tribal community,” Petereit told MED. •

representation. Men and women differ at the cellular level. Women have different organs and different hormones. Sometimes even cycles can affect medications and dosages, etc.” NIH no longer funds projects

David Pearce

covered in MED’s January/ February issue. “Sanford already

has a national and international reputation for developing treatments and innovations,” David

ALSO ANNOUNCED in March,

that do not include a gender

another researcher with

breakdown in animal trials and

expertise in health disparities,

report on the sex, race, and

Pearce, PhD, executive vice

Amy Elliott, MD, and members

ethnicity of the people enrolled.

president of Sanford Research

of her research team joined Avera

Black says it is incumbent upon

said. “Our idea was, let’s see if we

Research Institute as the Center

providers to invite eligible female

can find and reward others like ourselves who are pushing the limits. The process will probably bring more individuals to us that need someone like us to help push their project across the finish line.” •

for Pediatrics and Community

and minority patients into clinical

Research early in the year.

trials. •

Dr. Elliott has been a principal investigator on several NIH-

IN THE APRIL/MAY issue, MED

funded research projects

announced that The Sanford

including an initiative to reduce

Project: T-Rex Study, a Phase 2

infant mortality in American

clinical trial on diabetes in

SANFORD’S SECOND trial of

Indian Communities. In August,

children, enrolled the last of its

adipose-derived stem cells began

her lab secured a $17.1 million

110 trial participants. The project

this year with Sioux Falls plastic

NIH grant for its work on a

is studying the potential of a cell

surgeon Bradley Coots, MD, at

children’s health study called

therapy developed by Caladrius

the helm. Coots was a sub-investi-

ECHO. “We are the only site in the

that uses each patient’s own

gator on the first stem cell trial

middle of the country,” said Dr. Elliott. “This is great opportunity for us to represent rural populations and the Midwest.” •

regulatory T cells, or Tregs, to fight

for rotator cuff injuries. The new trial is focused on non-healing leg ulcers. “Wounds are a huge burden

on our healthcare system, in the billions of dollars,” Dr. Coots told MED in January/February. “If we can speed up the healing process, it is going to save money, improve lives, and get more of these patients back into society.” •

type 1 diabetes. “It is still a long

way from having the answer, but reaching full enrollment essentially tells us that we are going to get there,” said Kurt Griffin, MD, PhD, director of clinical trials for The Sanford Project. •

Bradley Coots

12

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IN THE SAME issue, MED reported that

Daniel Petereit

Children’s Hospital & Medical Center and the University of Nebraska Medical Center (UNMC) would take part in one of the nation’s first large-scale trials of clinical whole-genome sequencing (cWGS) in the neonatal and pediatric intensive care unit (NICU and PICU) environments. “In the next 10 years, we will see a dramatic shift in the implementation of precision neonatal medicine, coupled with improvements in areas such as ventilation, nutrition and pharmacogenomics,” said Luca Brunelli, MD, PhD, Children’s Specialty Physicians, Division Chief of Neonatology at Children’s. • THE KEYNOTE trial on the immunotherapy drug pembrolizumab (Keytruda) at Sanford Health, which wrapped up in 2018, had important implications for non-small cell lung cancer patients in the region. Thanks to Sanford’s involvement, patients with an illness that is often fatal within a year, had access to a promising new treatment long before they might otherwise have even heard about it.

“Now we can run any National Cancer Institute trials, we get to pick from pharmaceutical trials, and some of the universities are even contacting us,” lead investigator Steven Powell, MD, told MED in June. “It is great to be able to offer

cutting-edge trials to our patients.” •

Amy Elliott

December 2018

Luca Brunelli

Kurt Griffin

13

Talking about . . .

Research

Kristi Egland

SANFORD HEALTH and medical

WHEN THE WINNERS of 2018’s

technology company Inanovate

Nobel Prize for Medicine were

have launched a clinical trial to

announced in October, we

confirm the accuracy of a breast

turned again to Sanford

cancer blood test developed by

Researcher Steven Powell, MD,

Sanford researcher and breast

an immuno-oncology researcher,

cancer survivor Kristi Egland,

to share his thoughts in the

PhD. Egland says it was her

November issue. “These guys found a piece of the puzzle that was integral to making immunotherapy work,” said Dr. Powell.

“We now have about a half dozen trials looking at other immune checkpoints, besides the ones identified by Allison and Honjo.

We are also trying to learn how to use immunotherapy with chemotherapy, radiotherapy and other treatments to get the most out of it.” •

diagnosis that drove her to develop the new test. “I was

thinking, I want to be able to make a test that can monitor patients during treatment and after that would hopefully be sensitive enough to detect recurrence,” Dr. Egland told MED in September. “That could give us a shot at curing more patients.” •

Steven Powell

Are you a researcher (or know one) doing something extraordinary? We want to know about it.

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Talking about . . .

Expansions and Initiatives SIOUX FALLS Specialty Hospital opened its first urgent care facility just over a year ago in Sioux Falls. In January/February, CEO Blake Curd, MD, talked to MED about what makes this facility different from other area urgent

cares. “For one thing, it was built from the ground up to be an urgent care facility,” said Dr. Curd. “Secondly, a significant portion of the building will be dedicated to occupational medicine. We are the first facility to put these two things together.” Curd says the facility was designed without a central

IN THE SPRING, Prairie Lakes

waiting area to make patient flow more streamlined and efficient. •

iVantage list of Top 20 Rural

Healthcare System in Watertown became the only independent hospital in the region to make the Community Hospitals. In June,

IN MARCH, Rita Blasius, President

AHA Senior Vice President and

MED asked then President and

and CEO of Avera St. Benedict in

Chief Medical Officer Jay Bhatt,

CEO Jill Fuller how this hospital

Parkston, spoke with MED about

MD, told MED in the April/May

in a town of just 22,000 people

the pervasive problem of housing

issue, “As healthcare delivery

medical workers in rural areas.

“Many times, we have had the chance to hire someone but couldn’t find a place for them to live in our community,” said Blasius. In partnership

changes from fee-for-service to a value-based system, it is incredibly important to have physicians shaping the future along with administrative leadership.” The initiative provides

made the cut. “Our board made a strategic decision in 2003 . . . that we were going to better serve the 90,000 people in our 10-county service area by expanding our services,” said Fuller. The hospital recently built

with Avera and the Parkston Area

tools and resources for senior

a $32 million dollar specialty

Development Foundation, the

physician leaders at AHA member

clinic and offers more than 10

hospital helped fund a four-plex

institutions as well as frontline

specialties including cardiology,

housing unit specifically for

employed physicians. •

nephrology, and wound care. •

healthcare workers. Meanwhile, SDAHO has established a website dedicated to supporting facilities like Avera St. Benedict in their efforts to create more workforce housing. • THE AMERICAN HOSPITAL Association invited physicians to “Lead Well. Be Well. Care Well” as part of a new initiative to support well-being and encourage leadership among medical professionals.

December 2018

Rita Blasius

Jay Bhatt

15

Talking about . . .

Expansions and Initiatives

Tammy Reiff

Candace Zweifel

Sreekanth Donepudi

THE SIOUX FALLS VA Health Care System was recognized once again

AVERA CANCER Institute’s sixth

this year as a leader in LGBT Healthcare Equality by the Human Rights

location, the Helmsley Center in

Campaign Foundation, the educational arm of the country’s largest

Pierre, held a grand opening in

LGBT civil rights organization. The VA is the only healthcare facility

September. The 57,000 square

in South Dakota to receive the honor, which is awarded to facilities

foot facility connects patients

that meet key criteria for equitable care, including nondiscrimination

with radiation and medical

policies and LGBT health education for staff. “It is not just about having

oncologists, oncology nurses,

policies in place that say we’re LGBT friendly,” says VA primary care

and radiation therapists, as well

social worker Tammy Reiff. •

as a physicist and dosimetrist.

In a March interview, Pierre

IN THE JULY/AUGUST issue, we highlighted LSVT Big & LSVT Loud,

oncologist Sreekanth Donepudi,

programs that are allowing Parkinson’s Disease patients at Sanford

MD, said the center will help him

facilities in Vermillion and Canton to make major strides in their

and his colleagues deliver better

ability to move and speak more normally. “Having them concentrate

care. “At least a third to a half

only on being loud improves not only volume but articulation, pitch range, and even swallowing,” said Speech-Language Pathologist

of cancer patients need radiation therapy,” he said. “It is difficult to tell patients they have to go somewhere else for six to eight weeks of treatment.” •

Candace Zweifel, MA, CCC-SLP. LSVT Big adopts the same concept to improve slow walking and small movements. 100% of LSVT Loud patients report improved communication while LSVT Big patients walk faster and have better balance. •

Avera Cancer Institute

16

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THE SIOUX FALLS VA Healthcare System is in year two of a bold experiment integrating physical therapy into primary care. Since 2016, patients who visit the VA’s primary care clinic for a musculoskeletal issue see a PT first, cutting out the time and delay involved in getting a referral first. “We are meeting

the veteran’s needs comprehensively and providing better care while simultaneously saving time for the primary care doctor,” said Brandon Peterson, DPT, Cert.

MDT, who heads up the project.

“Our VA is setting a model for other VAs as well as private sector hospitals.” • AS MED TOLD you in September, Regional Health Heart and

Jessica Tvedt

Vascular Institute has reduced the number of patients who seek care for heart failure in the ED, as well as the number of patients who are readmitted for HF. Through a combination of education, interventions such as IV diuretic therapy, and monitoring, the multidisciplinary Heart Failure Clinic provides both an alternative to the emergency room and peace of mind for HF patients and their doctors. “If

their heart function is less than 35 percent and no one is keeping a close eye on them, they may end up with a defibrillator down the road,” said the clinic’s Jessica Tvedt, CNP. •

What expansions and new initiatives are going on where you are? MED wants to know! Send news our way at info@MidwestMedicalEdition.com

December 2018

17

Talking about . . .

Clinical Advances PEOPLE WITH non-healing wounds in Aberdeen got easier access to hyperbaric oxygen therapy thanks to the installation of two hyperbaric oxygen chambers early in the year. “What was happening is that patients who needed this treatment just weren’t getting it,” Chief Nursing Officer

Chris Adducci

Cory Geffre said in MED’s

PRAIRIE LAKES Urologist Chris

January/February issue. Before

Adducci, MD, brought transurethral

the new chambers were

radiofrequency thermal therapy

installed, the nearest hyper-

with the Rezum system to qualified

baric chambers were in Fargo,

Watertown patients who either want

Sioux Falls, or well into

to get off medication for BPH or

Minnesota and many patients

avoid it altogether. “This represents the latest in-office procedure for BPH but it is one that is very, very tolerable,” Dr. Adducci told MED in

were unwilling or unable to travel for treatment. •

March. Adducci says Rezum can be used for a wider range of patients than some other minimally invasive BPH treatments and does not cause

Adam & Tomasz Stys

incontinence or ED. • MED’s first cover story of 2018 focused on Warsaw natives and Sanford cardiovascular disease specialists Adam, Maria, and Tomasz Stys of Sioux Falls who are responsible for significant

Cory Geffre

advances in heart care at Sanford.

As director of the Women’s Heart Program, Maria Stys is active with

CARDIOTHORACIC surgeon

AHA’s “Go Red for Women” and

Ali Ibrahimiye, MD, of Children’s

has worked to establish a clinic

Specialty Physicians in Omaha

for pregnant women with heart

introduced several complex

disease. Her husband Adam helped

cardiothoracic surgical procedures

establish Sanford’s cardiology

as part of the new Pulmonary

fellowship and was a major force

Artery Rehabilitation Program at

behind the Heart Hospital. His

Children’s Hospital and Medical

younger brother Tomasz, medical

Center. One of the new procedures

director of Sanford Cardiovascular

offered is unifocalization, a procedure to repair tetralogy of

Institute, counts the transcatheter

Fallot with pulmonary atresia and major aortopulmonary

aortic valve implant (TAVI)

collaterals. “A surgeon has to do a lot of these operations to learn

Ali Ibrahimiye

program among his proudest

how to do it well and be comfortable performing it,” Dr. Ibrahimiye

achievements at Sanford. •

said in a March article. •

Maria Stys

18

MidwestMedicalEdition.com

CNOS ORTHOPEDIC surgeon Brian Johnson, MD, of Dakota Dunes has become a regional expert in a procedure that

Ebima Okundaye

attempts to get around one of the problems inherent in a diseased

REGIONAL HEALTH Rapid City

or injured rotator cuff: the fact

Hospital began offering therapeutic

that it is unlikely to support

plasma exchange or plasmapheresis

a standard total shoulder

for patients with autoimmune

replacement. Johnson performs

conditions such as lupus, Guil-

reverse total shoulder replace-

lain-Barre, Goodpasture syndrome,

ments, which reverse the ball and

and myasthenia gravis. “We can now treat them by combining a treatment like TPE to remove [immunoglobulins and antibodies] with immunosuppressive therapy to stop their production,”

socket of the shoulder joint. As MED reported in April/May, Johnson has performed more than 500 of these procedures over the past 11 years. “This procedure offers options for something that didn’t have options,” he said. •

nephrologist Ebima Okundaye, MD, told MED in June. Before TPE was available, some patients declined treatment or took higher doses of immunosuppressants to avoid having to travel to get treatment. •

DAKOTA LIONS Sight and Health in Sioux Falls became one of just a few elite eye banks in the country to begin offering pre-loaded corneal tissue for transplant surgery. In the April/May issue, Fargo ophthalmologist Dr. Michael Greenwood of Vance Thompson Vision, told

Luis Rojas

MED that the Descemet Membrane Endothelial Keratoplasty (DMEK)

AVERA GYNECOLOGIC oncologist

grafts make the corneal transplant

Luis Rojas, MD, is changing the

procedure less stressful for

way endometrial and cervix

everyone involved. “It not only

cancers are being treated in the

AS MED reported in July/August,

saves me a step but it also means that I don’t have to worry about the possibility of making a mistake while I am preparing the tissue,”

region. Instead of removing as

Brookings Health System became

many lymph nodes as possible

the second facility in South Dakota

throughout the pelvis, which

to offer robotic-arm assisted total

results in lymphedema in nearly

knee, partial knee and total hip

he said. •

half of patients, Rojas now

replacements with Stryker’s Mako

dissects only the first set of

System. The Mako system negates

lymph nodes — or sentinel nodes

the need for manual templates and

— into which the uterus drains.

cutting blocks, allowing for a truly

“We know that the sentinel nodes are the nodes with the highest likelihood of having metastatic disease,” says Rojas. In the first 20

personalized approach to surgery

test cases at Avera, the sentinel

Mark Mayer

based on each patient’s diagnosis and anatomy. “Now, I can say, let’s take another ½ mm off of the end of the femur and then reassess,”

nodes were 100 percent accurate

said surgeon Mark Mayer, MD, who

in predicting the presence of

relocated to Brookings this year.

metastatic cells in other nodes. •

“You can make that decision during surgery.” •

DMEK

December 2018

19

Talking about . . .

Clinical Advances

Muhammad Alsumrain

RAPID CITY pulmonologist Muhammad Alsumrain, MD, brought a higher level of knowledge on a range of complex and rare lung disorders to Regional Health this year. Alsumrain has been fellowship trained in interstitial lung disease and pulmonary vasculitis at Mayo Clinic. “In the past, we often

had to send patients for surgical lung biopsy to confirm the diagnosis,” Dr. Alsumrain told MED in July/August. “But with more understanding of the different radiographic findings and ordering the right blood

Tom Howard and Richard Howard

IN JULY/AUGUST, MED also introduced readers to the eye-opening power of UV photography and skin analysis with VISIA at The Body Garage Medical Spa in SIoux Falls. “With this tool, we can look for skin

cancer, fine lines, do pore counts and, most impressively, perform a UV damage index,” said plastic surgeon Richard Howard, MD. Howard and his son and partner Tom Howard, MD, use VISIA to determine skin type, texture, special needs, etc., in order to recommend a product or procedure that may help prevent further damage. “It’s just like

exercise,” says Dr. Howard. “If you quit taking care of your skin, you lose the effects.” •

tests, we have been able to decrease the likelihood of

IN NOVEMBER, we reported that

needing surgical intervention

interventional radiologist Charles Voigt,

to make a diagnosis.” •

MD, had begun performing Selective Internal Radiation Therapy (also called radioembolization) at Regional Health Rapid City Hospital. The minimally invasive procedure involves injecting tiny resin beads filled with the radioactive isotope yttrium Y-90 into the blood vessels Charles Voight

that feed liver tumors. The microspheres block the tumor’s blood supply while the radioactive isotope destroys cancer cells.

“We felt it was important to bring this here because, once cancer happens inside the liver, systemic chemotherapy is not usually very effective,” said Dr. Voigt. • MED wants to know about the clinical advances happening at your institution.

Send your suggestions our way at Info@MidwestMedicalEdition.com.

20

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Peace, JOY and

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December 2018

21

Martin Digler

Kate Sigford

Talking to . . .

Interesting People

22

Hunter Moyer

LIFESCAPE’S Medical Director of

IN MARCH, Martin Digler, a

RAPID CITY plastic surgeon

Rehabilitation Services once swore

PA at Regional Health Heart and

Hunter Moyer, MD, was an

she would never be a physician. In

Vascular Institute, told MED the

established expert in breast

January/February, Kate Sigford,

story of his harrowing escape from

reconstruction in Atlanta when

MD, told MED that watching her

violence, disease and poverty in

his wife was diagnosed with

parents return to med school late

his West African homeland of

breast cancer at the age of 35. His

in life convinced her that it was

Liberia. Joel Swiesow, a Rapid City

personal experience, along with

not for her. “I thought it just looked

man on a two-week mission trip

his training in Emory’s large breast

like an awful lot of work,” said the

to Liberia in 1999, eventually

reconstruction program, have

physical medicine and rehabilita-

arranged Digler’s move to the US,

made him especially passionate

tion specialist. But she was

hosted him in his home, and

about this area of plastic surgery.

eventually drawn to PM&R for its

helped him pursue a college

ability to deliver “whole person”

education. After graduating from

“The first goal is to eradicate disease,” Dr. Moyer said in a

care without what she saw as the

the School of Mines and Technol-

March interview with MED. “But

downsides of primary care. “When

ogy, Digler earner his PA at Long

a lot of studies and my personal

I started doing my primary care

Island University and returned

experience has shown that the

rotation, I realized that I couldn’t

to the Black Hills to work. “God

secondary goal of restoring form

do coughs and colds every day,”

just opened up the doors for me,”

can have a huge impact on how

said Sigford. •

he says. •

women feel about themselves.” •

MidwestMedicalEdition.com

Allison Wierda Suttle

Benson Hsu

Michael Bacharach

IN THE APRIL/MAY issue, we

SANFORD’S Chief Medical

VASCULAR MEDICINE specialist

brought you a profile of Allison

Analytics Officer, Sioux Falls

Michael Bacharach, MD, spoke

Wierda Suttle, MD, MBA, Chief

Pediatrician Benson Hsu, MD,

to MED this summer about the

Medical Officer at Sanford. Suttle

became one of 24 people chosen

origins of the Avera Heart Hospital

is the Daughter of a Sioux Falls

from a pool of 751 applicants to

which grew from a program he

radiologist who grew up around

receive a 2018 Bush Fellowship.

helped to start at North Central

medicine. After a decade as an

The fellowship provides up

Heart. “[The Heart Hospital]

Ob/Gyn, Suttle earned an MBA at

to $100,000 over 1 to 2 years.

USF and, in 2015, became a full

Dr. Hsu told MED he wants to use

time administrator. “It is an

the money to find better ways of

consolidated and improved heart care in the community and became a model for the future, too,” said

amazing time to be in healthcare,”

stopping preventable childhood

Bacharach, who came to Sioux

said Suttle. “It’s fascinating to think

illnesses and injuries. “I always

Falls from Cleveland Clinic in

about our work as physicians and how that changes. We are now moving into more collaboration with patients.” Suttle keeps herself

have this lingering thought: Is there something we could have done to keep this child from needing care in the first place?” said Hsu. “My mind

1995 for what he expected to be

connected to the healing arts as

goes to immunization, nutrition,

a part time yoga teacher. •

seatbelts, ect.” •

December 2018

a short-term stay. “Although Sioux Falls was a small community, it had skilled, well-trained subspecialists and offered advanced procedures,” he said. •

23

Mark Ptacek

Mike Nieman

SANFORD GENETICIST Cassie Hajek,

IN SEPTEMBER, MED gave readers

MD, told MED in July/August that she

a firsthand look at the impact of

expected to have to leave her home

corneal transplant with the story of

state of South Dakota for good when she

a Renner man who has been living

decided to move from primary care into

with his for more than 20 years.

complex genomic medicine. She had left

Mike Nieman was just a teenager

the area twice before, first to pursue an

when he began to experience the

engineering degree and later to do her

effects of Fuch’s Dystrophy. Full

primary care residency. But after her

thickness corneal transplants in the

medical genetics fellowship at UCLA,

late ‘90s and laser surgery in 2005

Hajek found just what she was looking

eventually fully restored his sight.

for in Sanford’s Imagenetics program.

“Nieman’s transplant is special

“What we are doing here at Sanford is very rare,” she says. “I knew it was a huge opportunity that I would be unlikely to find elsewhere.” •

because he is among the 71 percent of

Cassie Hajek

PK transplants with 20/20 vision after 15 years,” said Marcy Dimond CEO of Dakota Lions Sight and Health. “I did

OUR SEPTEMBER cover story,

not fully appreciate at the time what it really meant to receive donor tissues,”

CNOS Sports Medicine Specialist

said Nieman, who now serves on the

Ryan Meis, MD, of Dakota Dunes, has

DLSH board of directors. •

become a fixture on the sidelines of high school, college and championship

FAMILY MEDICINE physician Mark

sports events in the region. Meis

Ptacek, MD, of Lead-Deadwood Regional

has a passion for managing complex

Hospital and Clinic, was first introduced

shoulder, knee, and elbow injuries

to the world of aviation in medical school

and performs advanced procedures

in Omaha. He earned his pilot’s license

like arthroscopic shoulder surgery,

in his second year of residency and has

multi-ligament knee repair and ulnar

even built his own plane. A long-time

collateral ligament reconstruction.

member of the Flying Physicians

He told MED he felt “drawn” to the CNOS

Association, Ptacek has this advice for

clinic, which integrates orthopedics and

healthcare professionals considering

neurology. “We manage on the sidelines,

aviation: “I encourage young docs,

provide care if there are injuries, and... have physical therapy to help them recover,” said Meis. •

especially if they are going to be in a rural area, to get a pilot’s license. If you are bitten by the ‘aviation bug’ . . . it is a very good fit with medicine.” •

Ryan Meis

24

MidwestMedicalEdition.com

EXPERIENCED IN HEALTH CARE LAW Boyce Law Firm has decades of experience in providing counsel to hospitals, health systems, health care providers, in-house counsel, and health care insurers across South Dakota.

Thomas Asfeldt

LAST MONTH, we brought you the story

Over the years, our attorneys have been involved with shaping the health care law landscape in South Dakota. This wealth of experience helps us to provide effective and efficient legal counsel to help clients with whatever health care related issues that arise.

• Malpractice Defense

of Thomas Asfeldt, RN, BAN, MBA,

• Licensing, Credentialing, and Employment

Director of Outpatient Cancer Services

• HIPAA/Privacy and Security

at Sanford who had a very personal experience with palliative care this summer. Asfeldt spoke to MED about the loss of his father-in-law and how

• Fraud and Abuse/Stark • Corporate Compliance

palliative care helped to make his passing easier on him and his family by clarifying goals and making a plan.

Asfeldt’s experience has made him an even more vocal advocate for palliative medicine. “It improve quality of life and

decreases the cost of care. Why would be not want to use it for every appropriate patient?,” he said. •

Do you know a fascinating medical professional?

Someone with a great story to tell? Share it with MED at info@midwestmedicaledition.com!

December 2018

• Roger A. Sudbeck • Lisa K. Marso • Matthew D. Murphy • Tommy L. Johnson

(605) 336-2424 • www.boycelaw.com 300 S. Main Ave, Sioux Falls, SD 57104

25

[ INTERVIEW ]

A Great Year for Make-A-Wish

2

018 HAS BEEN A BIG YEAR for the South Dakota chapter of Make-A-Wish. The organization got a new President and CEO in February and, by the end of its fiscal year in August, had achieved an 11 percent year-to-year increase in the number of

wishes granted to critically ill children in the state. MED spoke with CEO Sue Salter about this banner year and the new referral process that will be the icing on the cake.

MED: How many wishes did Make-A-Wish grant this year and what does it mean for the organization?

SS: By August, we had granted 80 wishes to South Dakota children with critical illnesses. The vision of Make-A-Wish is to grant a life changing wish to every eligible child. The Number of wishes granted is a key metric for us and we see the upward trend continuing.

MED: Why do you think it was such a successful year for wishes?

SS: I think a lot of it has to do with the clarity of our mission and vision.

We grant life-changing wishes to critically ill children in our state. It is crystal clear and that clarity attracts donors and referrals. It is one of the things that impresses me most about Make-A-Wish.

MED: Tell us about the new referral process.

SS: We recently rolled out a new online referral and medical eligibility process. It eliminates paper, saves time, and makes the process of referring a child to Make-A-Wish much more streamlined. In addition to these efficiencies, there are algorithms built into the site that can determine medical eligibility almost immediately.

MED: How will the site impact wish recipients?

SS: The streamlined process not only saves time for the person making the referral, but it will also cut down some of the time between when a wish is approved and when it is actually granted. There is naturally going to be some delay there, but we are always looking for ways to reduce it. â?–

To refer to a child to Make-A-Wish South Dakota, visit MD.WISH.ORG.

26

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Compassion . Experience . Trust

 �

Â?

Â? Â?

 ­ 605.334.1930 6301 S. Minnesota Ave., Suite 300 www.plasticsurgerysiouxfalls.com

December 2018

27

Happenings around the region

News & Notes

South Dakota | Southwest Minnesota | Northwest Iowa | Northeast Nebraska

AVERA

For the first time ever, Avera Careflight has based a new PC-12 fixed-wing plane in South Dakota’s capital city. A new 13,000-square foot hangar at the Pierre airport provides 10,000 square feet of hangar space plus staff sleeping quarters, a meeting room, training room, commons area and storage space. A staff of three are stationed at the hanger around the clock, including a nurse, a paramedic and a pilot. In addition to Pierre, Avera Careflight has a fixed-wing plane and helicopter based in Sioux Falls and a helicopter in Aberdeen.

28

Avera Health was recently named one of the nation’s Top 10 Most Wired organizations in healthcare. This is the 19th time that Avera that received the Most Wired honor. As a Top 10 winner, Avera was recognized on stage in San Diego last month. In addition to its telehealth system, other innovative uses of technology at Avea include a virtual visit platform, a patient portal, smartphone with secure messaging for hospital staff, and a fully integrated EMR that can be accessed from the patient bedside. Avera was the only South Dakota health system named to the 2018 list.

BLACK HILLS SAMANTHA LOEN Samantha Loen, an RN at Regional Health Rapid City Hospital has been recognized with a DAISY Award for outstanding nursing. In her nomination, the family member of a former patient thanked Loen for her “advocacy”. “She kept dad’s medical team informed and helped make decisions regarding his care,” stated the nomination.

Regional Health Home+ Home Health in Rapid City has been awarded the Strategic Healthcare Programs (SHP) Best Superior Performer award. Home Health achieved an overall patient satisfaction score that ranked in the top 20th percentile of all SHP clients during the 2017 calendar year. Rapid City Home+ offers a wide array of home health services including hospice, skilled nursing care, rehabilitative therapy, palliative care, specialty and long-term-care pharmacy, home infusion and home medical equipment.

SANFORD MEGHAN LUPICA

JORDAN ANDERSON Jordan Anderson recently joined Avera Health Plans as Vice President of Sales.

Anderson will work with both DAKOTACARE and Avera Health Plans to grow both business models.

He comes to Avera from UnitedHealthcare where he was Director of Sales.

Nurse Meghan Lupica of Sanford’s RN Central Resource Pool was recognized with a DAISY Award this Fall. She was described as caring, compassionate, creative, prompt, positive, and thoughtful.

SIOUXLAND DAVID SLY Dave Sly, DO, FAAFP, has joined UnityPoint Clinic Family Medicine–Sunnybrook. Sly received his undergraduate education from Northeast Missouri State University/Truman State University in Kirksville, Missouri and his DO from A.T. Still University - Kirksville College of Osteopathic Medicine in Kirksville, Missouri. He completed his residency in Family Medicine in Illinois and is passionate about preventative medicine, chronic disease management and nutrition.

MidwestMedicalEdition.com

PHINIT PHISITKUL RUSLAN SAFAROV Orthopedic Surgeon Phinit Phisitkul, MD, and Sports Medicine Physician Ruslan Safarov, MD, have joined Tri-State Specialists, LLP, in Sioux City. Dr. Phisitkul is fellowship trained in orthopedic foot and ankle surgery as well as sports medicine and has expertise in minimally invasive arthroscopic and endoscopic procedures, ankle replacement, tendon and ligament reconstruction, and the correction of bunions, hammertoes, and flatfoot.

Dr. Safarov completed his sports medicine fellowship at Lenox Hill Hospital in New York and sees patients with shoulder, elbow, and knee problems. He also has special expertise in arthroscopic surgery as well as the treatment of work-related injuries and fracture care.

OTHER Prairie Lakes’ $40 million Specialty Clinic opened in October after two years of construction. Specialty services in the Prairie Lakes Specialty Clinic include cardiology, dermatology (skin), general surgery, nephrology, pulmonology, and urology. The 65,000 square foot building also includes a lab, PT, OT, Glacial Lakes Orthopaedics, and a therapy pool. The campus also got an east entrance canopy and the helipad was relocated. A public open house was held October 23rd.

Children’s Hospital & Medical Center in Omaha was named a Best Children’s Hospital by the Women’s Choice Award in November. Children’s also earned its Best Children’s Emergency Care Award, based on being an accredited pediatric trauma center and offering a regional pediatric ICU. “Our Best Children’s Hospitals award helps raise awareness of the top quality care offered for children—not only the critically ill—with specialists, services and technologies for their unique needs,” says Delia Passi, founder and CEO of the Women’s Choice Award.

Children’s Hospital’s Hand in Hand program has been recognized by the American Hospital Association for providing innovative and collaborative palliative and end-of-life care. With the Circle of Life Award Citation of Honor, the AHA praised Children’s program for its “devoted support for seriously ill patients and their families from diagnosis through end of life and beyond”. The program was also commended for its efforts to reach families throughout a multi-state rural area and to overcome economic disparities.

Tracie Storo Broker Associate | RE/MAX Professionals, Inc | 605-321-6987

December 2018

29

SIGNS THAT A PATIENT MAY NEED HOME CARE and Tips for Approaching Them

P

ROVIDING CARE for elderly patients presents some unique challenges for healthcare providers. In patients facing physical or cognitive decline, the idea of “care” sometimes needs to reach beyond what can be offered in a clinic or hospital setting to include

what is needed at home. The difficulty of broaching the subject can be compounded by the fact that deciding what to do about a parent or grandparent’s decline can be mentally taxing and emotionally draining for the patient’s family members.

But according to a 2016 article in Family Practice Management, the official journal of the American Academy of Family Physicians, “Collaboration with home care providers allows family physicians to extend their influence over patient outcomes and health care costs.” In an increasingly value-based payment environment, such collaborations can be key to influencing positive health outcomes.

Visiting Angels, a provider of senior home care services in Sioux Falls, offers the following list of signs that it may be time to consider home care for a patient or loved one. Although some suggestions may seem obvious, together they help paint a picture that can make a difficult decision a little more clear-cut. ◆ If a patient poses a threat to his or

◆ If a patient is having trouble

her own well-being, care options

preparing his or her own meals,

should be considered immediately.

home care should be considered.

◆ A recent hospital discharge can make

◆ Patients who cannot maintain their

it difficult for a loved one to under-

lifestyles independently might be

take his or her usual daily routine.

in need of assistance.

◆ Physical limitations in general can

hinder daily activities. ◆ Patients of any age might be in need

of homecare if they are undergoing rehabilitation. ◆ Memory lapses can impede daily

functions and can lead to a potentially dangerous environment.

◆ If a patient often needs help in

the middle of the night, caregiver assistance should be considered. ◆ Patients who overburden the

personal schedules of their loved ones are most likely in need of full-time care. ◆ If a patient’s family member is

exhausted by caregiving duties, it might be time to seek a professional caregiver.

WEB EXTRA

Read More

Reference: Labson, M and Wyatt, R, “Home Care Gets a New Place in the Medical Neighborhood”, July/Aug 2016, Family Practice Management, https://www.aafp.org/fpm/2016/0700/p18.html

❱ Find tips for talking to families and patients about homecare in the extended version of this article.

30

MidwestMedicalEdition.com

December, January, February

Upcoming Events Because many area institutions take a hiatus from conference and symposiums during the holiday season, we are giving you a jumpstart on 2019 with a look at events coming up in the Spring.

DECEMBER 7

FEBRUARY 1 – 8

APRIL 5

7:00 pm

UnityPoint Health Mid-Winter Medical Education Conference

9:00 am – 6:00 pm

Holiday Jam with the Hegg Brothers (LifeScape Benefit) Location: Performing Arts Center, Rapid City

Location: Fairmont Orchid, Big Island, Hawaii Registration: 800-441-1414 (by Jan. 1 for discounted rate)

Tickets and Information: LifeScapeSD.org/events

DECEMBER 16 4:00 pm Holiday Jam with the Hegg Brothers (LifeScape Benefit) Location: Orpheum Theater,

FEBRUARY 22 – 23 8:00 am Friday – 4:00 pm Saturday 39th SD Conference in Emergency Medicine Location: Hilton Garden Inn,

Edith Sanford Breast Center Symposium Location: Delta Hotel

by Marriott, Fargo

MAY 16 1:00 pm – 2:00 pm Sanford Imagenetics Lecture Series Location: Schroeder Auditorium, Sanford USD Medical Center

Sioux Falls Information: sdacepconference.com

Sioux Falls Tickets and information: LifeScapeSD.org/events

THROUGH JANUARY 1 5:30 pm – 9:30 pm Christmas at the Western Mall, (Freewill donations benefit Make-A-Wish South Dakota) Information: WesternMallChristmas.com

JANUARY 7 5:00 pm Grand Opening Event

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