MED-Midwest Medical Edition-January/February 2016

2016

JANUARY FEBRUARY

Vol. 7 No. 1

HIGH DEDUCTIBLE HEALTH PLANS

and Your Bottom Line

Why Cybercriminals

TARGET EHRS UPCOMIMG CME Opportunities

Pediatric Dysphagia

More Than Just “Picky”

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MIDWEST MEDICAL EDITION

Contents

PEDIATRIC DYSPHAGIA

VOLUME 7, NO. 1 ■ JA N UA RY / FEBRUA RY 2016

More Than Just “Picky”

REGULAR FEATURES 4 | From Us to You 5 | MED on the Web

2016

JAN UARY FEBR UARY

What’s in a name?, HealthPOINT’s new Practice Transformation Network, and other content available exclusively on our website

Vol. 7 No. 1

10 | N ews & Notes

By Peter Carrels

Recognitions, new providers, accreditations, and more HIGH DEDUCTIBLE HEALTH PLAN S

27 | The Nurses' Station

and Your Bot tom

Nursing News from around the region

ON THE COVER

IN THIS ISSUE 6 | Overcoming “Scanning Anxiety” ■ By Cole McClung How not to get stuck on the first step when making the paper-to-digital switch

9 HOW HIGH-DEDUCTIBLE HEALTH PLANS MAY IMPACT YOUR AR ■ By Jill Heyden and Sara Greff Dannen

17 | Sensory Processing in the Workplace ■

By Theresa Parish

18 | Five Things You Should Know About Domestic Asset Protection Trusts ■ By Breandan Donahue

22 | Research Spotlight: Scientists Explore Novel Approaches to Peripheral Artery Disease, Head & Neck Cancer

23 | Telemedicine From Sioux Falls to Rural Montana

23 | New Faces on Regional Health’s Leadership Team

24 | Meet the VA’s New Chief of Staff 24 | Children’s Sports Medicine Clinic Provides Care to Young Athletes

29 | “Somehow it all just fits” Why SFSH’s Nursing Director went back to school

High deductible health plans are likely to affect your bottom line. Here’s how to cope

20

CYBERSECURITY: WHY YOUR EHR MAY BE TARGETED ■ By Jeremy A. Wale

30 LEARNING OPPORTUNITIES Upcoming winter and spring CME Events

Line

Why Cybercrim inals

TARGET EHRS UPCOMIMG CME Opportu nities

More Than Just “Picky”

Pediatripage c 16 Dysphagia

THE SOU TH DAKOTA REG ION ’S PRE M FOR HEA LTH IER PUB LIC CAR E PRO FES ATI ON SIO NA LS

By Alex Strauss More than a quarter of children under five and as many as 80 percent of special needs children suffer from feeding and swallowing problems, with potentially profound physical, psychological and social implications. The importance of recognizing and treating pediatric dysphagia early is the focus of this month’s Cover Feature.

page

12

From Us to You Staying in Touch with MED

Happy New Year from the region’s premier publication exclusively for healthcare professionals like YOU!

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

M

ED is proud to be starting our seventh year of publication, serving more than 5,000 print readers across South Dakota, Southwest Minnesota, Northeast Nebraska and Northwest Iowa with current news, feature articles, event calendars, and more. Thousands of readers across the region are also taking advantage of our growing list of online tools (MidwestMedicalEdition.com) to promote their practices, post and/or learn about upcoming events, connect with businesses that offer services they need, and, of course, stay up to date with community medical news.

We are gratified that so many of you read and comment on MED and pass it to your colleagues and are especially grateful for letters like this one, from recently-retired UnityPoint Health-St. Luke’s CEO Peter Thoreen.

“I have moved to Eagan, Minnesota where I will continue my career doing some consulting in healthcare. I find your magazine is a great way to keep up on the South Dakota and Siouxland markets and providers. It is good for healthcare leaders to . . . know what their colleagues and organizations are up to! Thanks much—you and your colleagues are doing a very good job with this magazine.”

— Peter Thoreen

We love praise, but we can handle constructive criticism, too. Some of you took issue with the fact that our recent “Future of Healthcare” series focused solely on the perspective of traditional hospitals and did not include input from independent clinics, physician-owned hospitals, and others. Look for more input from some of these other entities in upcoming issues.

Please keep the feedback coming in 2016. We continue to stay open to ways to better serve the communication needs of of our dynamic medical community. You can reach us any time at the contact numbers/emails listed on the facing page or through our website.

Cheers!

—Alex and Steff

VICE PRESIDENT

SALES & MARKETING Steffanie

Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER studiofotografie WEB DESIGN Locable

Steffanie Liston-Holtrop

DIGITAL MEDIA

DIRECTOR Jillian Lemons CONTRIBUTING WRITERS Breandan Donahue

Sara Greff Dannen Jill Heyden Cole McClung Theresa Parish Alex Strauss

Jeremy A. Wale

STAFF WRITERS Liz Boyd

Caroline Chenault John Knies Reproduction or use of the contents of this magazine is prohibited.

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year

by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication.

Please send your thoughts, ideas and submissions to alex@midwestmedicaledition. com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com.

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

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Midwest Medical Edition

MED welcomes reader submissions!

2016 Advertising EDITORIAL DEADLINES Jan/Feb Issue December 5 March Issue February 5 April/May Issue March 5 June Issue May 5 July/August Issue June 5 Sep/Oct Issue August 5

Give yourself a New Year’s Gift!

Sign up to receive advance access to every digital issue of MED – right in your Inbox. You’ll be “in the know” up to two weeks sooner than print readers.

On the Website this month What’s in a Name?

Move over Kayla and Isaac. We’ll update you on the most popular — and some of the most unusual — baby names at area medical centers in 2015.

HeathPOINT’s Compass PTN HealthPOINT at Dakota State University recently partnered with several states to create what it is calling a “Practice Transformation Network”.

What is it and what might it do for area medical practices?

November Issue October 5 December Issue November 5

MORE THAN A MAGAZINE, A Medical Community Hub

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

◆D ownload the Digital Issue - Want to read a back issue of MED but don’t have it on hand? Download it onto your computer, tablet or smartphone in seconds.

Click the “Archives” link on the right side of the MED homepage.

◆ L ist Your Practice - For Free - Want to enhance your online presence? Add your practice to MED’s growing online business directory and you’ll be searchable by website visitors. Add a link to your website for even more value. It takes just a minute and is completely free.

◆ S earchable Article Archive - It’s easy to reference something you’re read in MED. Search hundreds of past articles, including many that never appeared in print, by topic, date, and more - right from the MED homepage.

◆U p Your Profile - Claim one of MED’s limited website sponsorship opportunities and let us do the marketing for you! Your logo will appear throughout the website, on MED’s regular digital newsletter, here on the ‘MED on the Web’ page, and more. Plus, enjoy special content opportunities. Contact us at Steff@ MidwestMedicalEdition.com to learn more.

Overcoming “Scanning Anxiety”

By Cole McClung

S

O THE TIME HAS COME to implement a sophisticated, functional Electronic Health Records (EHR) or Document Management (DM) system, thus eliminating the frustration of loose documents and patient records flying around the office.

Where do you start? The planning, executing and conversion of the physical documents themselves into an EHR or DM system is the initial phase. It may sound straightforward, but the complexity of that phase is often eye-opening for those involved. It entails project planning, document preparation, file indexing, quality control, as well as the transportation of the documents themselves.

Because of these project requirements, the vendor selection process becomes that much more important. Trusting someone with your document scanning project takes due diligence and, at times, the patience to ask the right questions and get satisfactory answers.

Whether in terms of knowledge, character, safety protections, capabilities, etc., each vendor has different strengths and weaknesses. The key is to find a vendor that will accommodate and fit your project’s needs.

During your decision process, and to confirm you are making the right decision, below are a few questions to consider before you choose someone to do this critical job.

Reputation ■ A re you hearing anything

negative about the vendor?

■ Do they run a successful business?

■ W hat are their technical capabilities?

■ Is scanning a focal point for

them or an afterthought?

6

Conveniences

Where are they located?

Is their office building secure?

Will they pick up the documents?

Will they drop documents off once digitized, if required?

■ Do they have shredding capabilities?

■ ■ ■ ■

compliant with HIPAA and the many other laws and regulations. The good news is that many facilities that have completed the transition (and the requisite staff training) are finding that a functional EHR or DM system considerably increases efficiency and improves operational processes.

Change Supervision ■ Is the vendor trying to change

your goals?

■ A re their recommendations

out of the ordinary?

■ Do they know about your business

or do they just seem focused on getting the project?

Assessment ■ How does this vendor

compare to other vendors?

■ Is the pricing clear and

straightforward?

■ Does the first impression

pass the eye test?

■ Can you envision a business

relationship with this vendor?

Efficiency ■ Are their employee’s full time

or part time?

■ Is their software and hardware

technology up-to-date and sufficient?

■ Can they meet timelines if required?

The pressure to “go digital” is at an alltime high thanks to the new government regulations of the healthcare industry. If a medical office puts the necessary time and effort are into implementing these processes, it is possible to legally and securely accomplish this giant task while also remaining

The first step to guaranteeing that the system will properly serve its purpose once implemented is selecting a vendor who can accommodate your document scanning needs and goals. If the first step of implementation–the conversion of documents–is done ineffectively, it’s unlikely that your EHR or DM system will produce the results you desire. Answering the above questions will help ensure that you choose the right document scanning provider to make your scanning project a success. ■ Cole McClung is a senior consultant at Active Data Systems in Sioux Falls.

Midwest Medical Edition

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How High-Deductible

Health Plans

May Impact Your AR (and what you can do about it)

By Jill Heyden and Sara Greff Dannen

T

HE HIGH COST OF healthcare has led to the onset of employers offering their employees high deductible health plans (HDHPs).

While the shift to these plans offers cost savings to employers, these costs have to go somewhere and they are mostly being shifted to the patient. In 2003, a patient’s average deductible was $250.00, while in 2014, this average was over $1000.00.

This burden of rising medical bills affects more than just the patient–it affects everyone.

According to a recent publication from Healthcare Financial Management Association (HFMA), an Advisory Board analysis of 400,000 patient claims found that 68% of patients are likely to pay their share of care costs when the costs are between $500 and $999. But as the balance of the patient’s bills rise, that patient’s propensity to pay quickly decreases. The same study found that when patient bills are between $3500 and $5000, only half of the patients are likely to pay. And when the balance tops $5000, just 36% are likely to pay their balances.

As a result of these findings, healthcare organizations are facing increasing challenges in collecting payments. Having standard collections policies and financial obligation policies is necessary to continue delivering the best possible care. To ensure that your organization is optimizing all its Accounts Receivable (AR) management possibilities, a few questions could help identify areas that may need to be improved on.

January / February 2016

EVALUATE YOUR REVENUE CYCLE MANAGEMENT ◆ Do you check every patient’s eligibility

for insurance benefits immediately prior to every service? ◆ Do you have patients sign a financial

policy to acknowledge what they are responsible for based on their payer type? ◆ Do you verify patient’s insurance

information, do you copy the patient’s insurance cards at every visit, or at least compare their current card to the card you have on file? ◆ Are you authenticating everything

that needs pre-certification, pre-authorization or pre-notification to be sure the service will be paid? ◆ Have you recently audited your

contract allowables to ensure you are being paid correctly? ◆ Do you check recoupments or requests

for refunds from payers and make sure they truly should be refunded?

◆ Do you collect the patient’s portion

of the service at the time of service? ◆ Do you collect fees for elective

services prior to providing services? ◆ Have you determined if the reason

of patient non-payment is because the patient is having difficulty understanding their EOBs or billing statements? ◆ Do you make payment arrangements

in the office for balances after insurance has paid by communicating all possible payment options? ◆ Do you make it simple and convenient

for your patients to make payments? ◆ Do you offer your patients the ability

to pay online through your website? ◆ Do you accept cash only from patients

who have passed bad checks or have filed bankruptcy with your practice?

Sitting down and analyzing the questions above will give you a step in the right direction. With the rise of patient out of pocket costs, everyone must do his or her part to ensure patient care doesn’t suffer, and AR balances do not get out of hand. ■ Jill Heyden is the the Business Development Specialist and Sara Greff Dannen is Legal Counsel at AAA Collections, Inc.in Sioux Falls.

Considering hiring a collection agency? See more advice for choosing one on our website.

MidwestMedicalEdition.com

9

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA

BLACK HILLS

Avera Queen of Peace Hospital in Mitchell and Avera Sacred Heart Hospital in Yankton have been recognized as 2014 Top Performers on Key Quality Measures by The Joint Commission. They were

The following three Regional Health caregivers were recognized in December as part of the “I Am Regional Health” campaign:

recognized for performance in pneumonia, surgical care, and venous thromboembolism. The Avera facilities are the only two South Dakota hospitals to earn the recognition.

Pediatrician Peter Paul Lim, MD, has joined Avera Medical Group Pediatrics Mitchell.

Rita Stacey, Director of Patient Services in LeadDeadwood,

RITA STACEY

Justin Muth, a pharmacist in Spearfish, Joann Stock, RN, nurse manager of the Intensive Care Unit in Rapid City

Beginning in May 2015, Regional Health launched a Dr. Lim holds JUSTIN MUTH yearlong campaign an MD from aimed at celebrating Davao Medical its nearly 5,000 School Foundation, Davao City, physicians and Philippines, and completed his caregivers. Each residency at Janet Weis Children’s month, the Hospital–Geisinger Medical Center organization in Danville, Pennsylvania. He is showcases three board eligible with the American exceptional Board of Pediatrics.

JOANN STOCK individuals from Avera Health and across the region who truly represent DAKOTACARE signed a Regional Health’s purpose – helping letter of intent in November patients and communities live well. through which Avera Health will purchase DAKOTACARE. With its

ownership of Avera Health Plans and DAKOTACARE, Avera will become the second largest health insurer in South Dakota, serving nearly 200,000 members.

Regional Health and Westhills Village Retirement Community have announced a partnership to reopen the facility’s on-site medical clinic for Westhills residents.

The clinic is being operated and staffed

by Regional Health primary care providers, Thane Gale, M.D., and Ashley Neisen, Certified Physician Assistant (PA-C)

10

Black Hills Surgical Hospital (BHSH) has been recognized

by Healthgrades as one of America’s 100 Best hospitals for spine surgery. Healthgrades

evaluated nearly 4,500 hospitals nationwide and identified the 100 best-performing hospitals for spine surgery. Black Hills Surgical Hospital’s clinical outcomes are significantly better than expected when treating spinal disorders requiring surgery, earning it a 5-star designation. In the same study, Healthgrades also ranked BHSH among the top 10% of hospitals in the nation for joint replacements this year, in addition to 5-star designations for patient safety and outstanding patient experience.

180 runners helped bring Christmas cheer for more than 80 children in the Rapid City area by participating in the second annual Black Hills Urgent Care Trot for Tots 5K on Saturday, December 12. The

race was held as a benefit for the Cornerstone Women & Children’s Home with support from Black Hills Surgical Hospital, Black Hills Orthopedic & Spine Center, and Black Hills Neurosurgery & Spine. A van packed with donated clothing, books, toys, and games was delivered to the Cornerstone Rescue offices, along with a check for three thousand dollars.

SANFORD A Sanford Research scientist is using an innovative pig model to better understand a rare genetic disorder that causes tumors in the nervous system,

thanks to a more than $1.7 million grant from the Children’s Tumor Foundation. Jill Weimer, PhD, and her team received the award as part of the CTF’s Synodos program, an integrated, multidisciplinary consortium of scientists working to develop treatments for Neurofibromatosis type 1 (NF1).

Weimer is a scientist and director of the Children’s Health Research Center at Sanford Research who studies nervous system development, neural development disorders and neurodegenerative diseases.

Sanford Aberdeen has been named a 2015 Guardian of Excellence Award winner by Press Ganey Associates, Inc.

The Guardian of Excellence Award recognizes top-performing healthcare facilities that consistently achieve the 95th percentile of performance in emergency room patient experience nationwide. Press Ganey assesses patient satisfaction in several areas, including wait times, staff courtesy, concern for patient comfort and overall rating of care.

Sanford Health recently celebrated 10 years since it ushered in the era of the electronic medical record at Sanford 41st & Sertoma Family Medicine. Since then, Epic has

been rolled out to 38 hospital sites and all associated clinics throughout the Sanford Health enterprise, changing the efficiency of care and giving thousands of patients access to medical records online.

Midwest Medical Edition

SIOUXLAND UnityPoint at Home has announced that five of its locations – Des Moines, Fort

Dodge, Sioux City, Storm Lake and Waterloo – have been named to the 2015 HomeCare Elite, a compilation of the top-performing home healthcare providers in the United States. UnityPoint at Home in Storm Lake received an additional designation as one of the Top 500 home health care agencies in the country.

Mercy Medical Center-Sioux City has announced the appointment of Susan Bartholomaus as Director of Patient Care Services. Bartholomaus received

her BN from Briar Cliff University in Sioux City and her MS in Health Information from the University of Walden in Minneapolis. In her position, Susan will oversee and manage acute inpatient care units. She will have oversight of the patient experience, including patient satisfaction, coordination of care, and handoff.

Greg Brostad is the new Manager of Outpatient Behavioral Health at Mercy Medical Center-Sioux City.

Brostad obtained his Master’s Degree in Clinical Mental Health Counseling from Wayne State College. He will oversee and manage the Mercy Pathways Outpatient Behavioral Health program which provides treatment to patients with mental illness and co-occurring mental illness with substance use disorders and provide group psychotherapy.

January / February 2016

UnityPoint Health and HealthPartners plan to jointly launch a new insurance company, offering individuals and employers a new integrated option when it comes to their healthcare and coverage.

The partnership, named “HealthPartners UnityPoint Health,” will leverage UnityPoint Health’s network of providers and HealthPartners’ scale, health plan sophistication, and expertise.

The parties will equally own and govern the insurance entity.

OTHER HealthPOINT has partnered with Georgia, Iowa, Kansas, Nebraska, and Oklahoma to form a practice transformation network. The Compass Practice

Transformation Network (Compass PTN) is a national initiative funded by the Center for Medicare & Medicaid Innovation (CMMI) to support primary and specialty care clinicians. Through coaching, mentoring and assisting in the identification and development of core competencies necessary to transform clinical practices, the Compass PTN is designed to position clinicians to meet quantifiable improvements, outcomes, achieve the Triple Aim and thrive in the value-base environment.

Doctors, community leaders, workers and the public gathered at a downtown Sioux Falls bar In November to celebrate the fifth anniversary of the state’s smoke-free air law. The law,

which eliminated indoor smoking in all public places including bars, restaurants and video lottery establishments, passed through a statewide referendum in 2010 with overwhelming 65 percent support.

New positions at The South Dakota Association of Healthcare Organizations (SDAHO): Jeanette (Jen) A. Porter, EdD, MBA, has been named Vice President of Post-Acute Care.

Porter earned both her bachelor and master degrees from the University of South Dakota and completed her Doctor of Education in Leadership from Creighton University in 2014.

She has more than 20 years of career experience in planning and oversight responsibilities for nursing facilities, home health and hospice agencies, senior living and community-based services.

Debra Owen, JD, has been named Vice President of State and Federal Relations at SDAHO. Owen

Timothy Tracy, CEO of Sanford Vermillion Medical Center, in Vermillion, South Dakota was elected Chairperson of SDAHO at the annual business meeting. Tracy has worked as a

healthcare administrator in South Dakota and North Dakota since 1983, and has been the Chief Executive Officer of Sanford Vermillion Medical Center since April 2004. He will provide leadership and direction along with the 14-member SDAHO Board of Trustees.

has a bachelor’s degree in Business Administration from Augustana College and JD from USD. She joins SDAHO’s Policy and Advocacy Team and will provide leadership in the area of public policy and advocacy, and will serve as chief lobbyist on State issues.

Stay up-to-date with new medical community news between issues.

Log on!

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11

PEDIATRIC More Than

Just “Picky”

F

The mechanics of eating require the engagement of 26 muscles and 6 cranial nerves, making eating more physically complex than either walking or talking.

12

OOD AVERSIONS and obsessions, strange mealtime habits and behaviors, delays in developing the mechanics or the skills to self-feed, aspiration of liquids, difficulty swallowing, and flat-out refusal to eat.

These are daily realities and a source of anxiety for as many as 25 to 50 percent of babies or young children and their families. For these children, mealtimes are often fraught with emotion and marred by coughing, choking, gagging, retching and crying. Whether the problem is physical or behavioral in nature, parental stress tends to be high and child nutritional status low. In the most severe cases of feeding and swallowing problems–also known as pediatric dysphagia–a child may receive 100% of her nutrition and hydration from a feeding tube.

“Feeding is a complex activity,” says Megan Johnke, Director of Therapy at LifeScape in Sioux Falls. “It is physical, social, and emotional. One child’s feeding problem may be just as complex or more so than another’s.”

Just the mechanics of eating require the engagement of a staggering 26 muscles and 6 cranial nerves, making eating more physically complex than either walking or talking. And yet, pediatric dysphagia, especially in its less severe forms, is often dismissed as “picky” eating by both parents and medical professionals, many of whom believe that a child will grow out of it.

While this can happen, research suggests that the longer a child’s dysphagia persists without intervention, the greater the chance for long-lasting consequences which can range from malnutrition to damaged family relationships, emotional challenges and even delayed development.

“I think it’s very important for physicians to be aware of feeding and swallowing problems as these can lead to long-term issues such as severe oral aversion and refusing to eat which can, in its most severe form, end up

Midwest Medical Edition

DYSPHAGIA

By Alex Strauss

requiring patients to receive a gastrostomy tube,” says Sioux Falls pediatric gastroenterologist Brock Doubledee, DO. “Other problems such as aspiration must not be overlooked because they can lead to problems as severe as aspiration pneumonia.”

RECOGNIZING DYSPHAGIA The first step in helping families sidestep those potential long-term consequences is recognizing pediatric dysphagia early and making an appropriate referral for therapeutic intervention.

But how do you recognize true dysphagia from a normal childhood “phase”? While there can be a fine line between “picky” eating and dysphagia, research conducted at Children’s Hospital of Chicago and published in the Journal of Parenteral &

Enteral Nutrition in 2014 suggests that even picky eaters manage to maintain satisfactory nutrition even with a limited diet, while those with dysphagia often do not.

“We start to get concerned if a child is eliminating an entire food group, such as no fruits or no vegetables,” says LifeScape Speech-Language Pathologist Heather Hewitt, who works closely with kids across the dysphagia spectrum. “Or they may be eliminating a particular texture such as any food that is crunchy or wet. Sometimes the problem is that they are not really able to manipulate it around in their mouth.”

A child transitioning off of a G-tube may need help learning to eat again, while an infant graduating from the NICU may never have experienced the sensations, or used the muscles, needed for swallowing. Kids with sensory problems may need help getting more comfortable with certain foods, while

those with behavioral problems may need to learn more appropriate mealtime habits.

Even children who are simply late starting on solid foods may have difficulty adapting if the switch from liquids to solids occurs after the ideal 6-month mark.

“I had one child that we thought was just a picky eater,” says Hewitt’s colleague, Therapy Manager Melissa Carrier-Damon, the first South Dakota Speech-Language Pathologist to be board certified in swallowing disorders. “We noticed that she was wincing when she was swallowing and it turned out that she just had such large tonsils that she just didn’t feel safe with anything other than pureed food. It took a referral to identify the problem.”

As common as feeding problems are in typically-developing children, they are even more common among those with special needs. It is estimated that as many as 80 percent of these children suffer from some level of dysphagia.

PATIENT-CENTERED THERAPY

Speech-language pathologist Heather Hewitt, MS, CCC-SLP, works with 2-year-old Marcus on accepting a variety of foods.

January / February 2016

MidwestMedicalEdition.com

Because feeding challenges are unique to each child, there is no one-size-fits-all therapeutic solution. In recognition of this, the feeding and swallowing program at LifeScape, is multidisciplinary, involving the skills and expertise of speech-language pathologists, occupational therapists, and child psychologists to address individual problems from every angle. In some cases, a dietician may even be called in to help.

“Our staff are trained in a variety of approaches and are typically pulling pieces from several approaches to customize therapy for each patient,” explains Johnke.

Hewitt and Carrier-Damon are among seven speech therapists at LifeScape who

13

WHEN TO REFER Consider recommending an evaluation in cases such as . . .

• A baby who is not eating at least soft solid food by 12 months • T he “picky” eater who consumes only a few specific foods •A toddler or child who refuses to eat from certain food groups

• A ny child with

chewing problems

•A child with difficulty swallowing liquids

concentrate much of their time on feeding and swallowing issues. Although most of these issues occur in babies and toddlers, the team also works with older children and even young adults using a range of cutting edge techniques such as VitalStim, Beckman Oral Motor, and Sensory Oral Sequential (SOS).

“I think people can get stuck in doing

things one way and, when things don’t get better, they just keep doing it,” says Carrier-Damon. “No one approach is the right way to manage feeding and swallowing issues. I think we do a good job of finding what works.”

SPECIALIZED APPROACHES TO DYSPHAGIA One approach that has proven helpful for many children with dysphagia is VitalStim, a specialized form of neuromuscular electrical stimulation designed to help strengthen weak swallowing muscles. Carrier-Damon, Hewitt and three other LifeScape therapists are trained in the technique, which involves the use of a hand-held device with lead wires connected to muscles on the child’s neck, head and/or cheeks.

Like a number of feeding and swallowing therapies, the process typically starts with a parent questionnaire and often includes a video swallow study to pinpoint the source of the problem. Then, while the child eats, the therapist gradually increases the intensity of the electrical impulse while listening for an audible swallow to indicate maximum intensity.

Inpatients going through VitalStim therapy at LifeScape may see marked improvement in their swallowing problems within 3 weeks to 3 months of once or twice

daily sessions. For outpatients, who may only be able to attend therapy sessions a few times a week, it can take up to 4 months to see maximum benefits.

Sensory Oral Sequential is another highly-specialized approach to managing pediatric dysphagia by gradually increasing a food-averse child’s comfort level with certain foods.

“This is a very structured form of therapy,” explains Hewitt. “I start by evaluating how the child is sitting at the table. Is he positioned correctly? Then we would bring out foods one at a time. I’m looking at things like, can the child visually handle having the food at the table? Can they pick it up and play with it? Can they tolerate it on their hands?”

If I child can tolerate “foods she dislikes” at the table or even on her hands, the next step would be to try it on the tongue. Hewitt evaluates the child’s oral-motor skills to determine if appropriate chewing is occurring and whether or not the child can manipulate food in the mouth.

Beckman Oral Motor therapy, another approach to pediatric dysphagia used at LifeScape, is an oral motor technique that involves a series of manipulations of the lips, face, cheeks and neck. The goal is to increase functional response to pressure and movement, and to allow for greater strength and control of the muscles that move the lips, cheeks, jaw and tongue.

Often, therapists use a combination of these approaches and others, along with plenty of positive reinforcement and parental support, to encourage children to try new things, push themselves, and learn to embrace and even enjoy their mealtimes.

Photos Courtesy of LifeScape

MEETING PATIENTS WHERE THEY ARE

Speech-language pathologist Jaime Stratman, MA, CCC-SLP, uses VitalStim therapy to help strengthen 8-month-old Hudson's swallowing muscles .

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Beyond the specific therapies used to address pediatric dysphagia, Johnke says the most important factor in success is a willingness to work with patients and families to develop a therapeutic plan that both meets their needs and considers their lives.

“For instance, if someone lives far away

Midwest Medical Edition

Photos Courtesy of LifeScape

Occupational Therapist Melissa Pitz (l) and Speech-Language Pathologist Melissa Carrier-Damon, MA, CCC-SLP, BCS-S, (r) work with special needs patient Grace.

and can only come once every other week, we will put as much into developing a home program as possible so that they can continue to progress,” says Johnke. “On the other hand, if we need to see them intensively over just a few weeks, we can do that, too. We

January / February 2016

use the tools that are most appropriate for each patient, recognizing that no two patients are identical.”

Feeding research suggests–and LifeScape’s experience shows–that almost all children with feeding problems will

MidwestMedicalEdition.com

benefit from some type of therapy and Carrier-Damon says the medical community is becoming more willing to address the problem. “The bulk of my patients are referrals from physicians, but I think patients have had something to do with that,” she says. “Now with social media, people are seeing the successes that their friends have had with feeding therapy and are asking their doctors to refer them.”

For many children and their families, therapy means that mealtimes are no longer frustrating and tear-filled. Picky eaters have broadened their diets and become physically healthier and parents have learned how to more effectively reinforce better eating habits. Even children who were never expected to eat orally are eating and drinking regular diets after spending time in therapy for their dysphagia at LifeScape.

“It is so important for the child emotionally, socially, and nutritionally and it’s really important for the family,” says Hewitt. “This is important for development in general. We want eating to be a happy and fun time.” ■

15

Cover Story 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

16

Midwest Medical Edition

Sensory Processing in the Workplace

W

By Theresa Parish

E LIVE IN A world full of sights, sounds, smells, tastes, and textures– sensations that affect our ability to think, reason, and even be productive at work. We also deal with the forces of gravity each and every day. Some of us are more affected by these sensations than others.

Sensory processing is the way each of us responds to incoming sensory information.

We learn and grow through our senses which include touch, sight, sound, smell, taste, proprioception, and vestibular sensations.

We manage our day-to-day activities through all the information our bodies take in. Ninety percent of this information is actually below our conscious level of awareness.

Those of us whose sensory systems are “normal” respond appropriately to most situations. We are able to adapt to our surroundings without much difficulty.

However, when we have increased stress, our ability to adapt may be compromised and adaptations may become more difficult.

For example, a person may do just fine working in a cubicle until a deadline is looming or she hasn’t gotten much sleep due to a sick child. Now she hears every sound as though it is amplified and concentrating is proving to be impossible. She may be unaware that the noise level hasn’t changed a bit and that her brain is just having

January / February 2016

difficulties adapting due to stress and lack of sleep.

Some people have sensory processing issues that affect their life on a daily basis.

They may be unaware that their sensory system is any different than anyone else’s but wonder why they struggle so much at home and at work. Touch, smells, sound, and visual distractions are the most common issues people deal with. A person may or may not be able to tell you what noxious sensations they are experiencing; therefore, they may not know how to adapt to them. This can cause challenges in the workplace.

Inability to focus in a noisy or busy environment, headaches caused from bright fluorescent lighting or perfumes, colognes, and air fresheners, can all be detrimental to productivity for someone with sensory processing issues. For someone with a sensory processing diagnosis, such as sensory defensiveness, it may be even more serious. For example, a person defensive to touch may have increased anxiety due to being touched or even the thought of being touched. This increased anxiety can affect not only their ability to work, it can affect their entire life.

Many workplaces have ways they can adapt for medical conditions or they can get assistance from an occupational therapist in order to make ADAAA accommodations.

Most companies may not even be aware of

MidwestMedicalEdition.com

sensory processing issues and how much they can affect some people’s lives. Awareness is key and simple changes can drastically affect some people’s lives and work performance.

Some accommodations for sensory processing issues can be as simple as placing someone who is visually distracted away from the flow of walking traffic. White noise in offices may need to be turned up or down in certain areas for different people. People who don’t notice sensory input may need checklists or reminders to pay attention to details or work in teams where other team members are more detail-oriented. People who are easily distracted will do better in clean, organized spaces.

For more serious issues, a person may need to work with an occupational therapist.

Fortunately, once basic sensory-driven needs are provided for, people tend to be more comfortable, less annoyed by incoming sensations, and thus, more productive.

If you suspect a sensory issue and are unsure of how to help, consult with an occupational therapist who can help you, your employees, patients, or family members live and work sensationally. ■ Theresa Parish is an occupational therapist and a Ready Associate for the Ready Approach. She is an Ergonomics and Loss Control Specialist/Sensory Processing Specialist with RAS.

17

5 THINGS YOU SHOULD KNOW

About Domestic Asset Protection Trusts

By Breandan Donahue

L

AWSUITS ARE COMMONPLACE THESE DAYS. You are most likely to be targeted by one if you have wealth or work in a high-risk profession. There are many techniques for protecting your wealth against such risks; for example, maintaining appropriate insurance and structuring assets across several limited liability companies. These are strong strategies, but they do have their gaps and blind spots. Here are five things you should know about Domestic Asset Protection Trusts (DAPTs).

1

Your Wealth Protection Vehicle

A Domestic Asset Protection Trust, or DAPT, is a wonderful complement to the above approaches and serves as a fantastic wealth protection vehicle. A DAPT is a type of trust a person creates for himself or herself that can protect the assets held in the trust from creditors, but still leave a door open for those assets to support the trust creator. This was not always possible.

Over the last two decades, approximately 15 states have enacted laws that allow an individual to do just that: create a trust, be a beneficiary of that trust, but still wrap the trust in creditor protection. These trusts are known as DAPTs. Fortunately for those of us in this geographic area, of all the states that have DAPT laws, South Dakota is among the best in its features and protections.

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Midwest Medical Edition

2

The South Dakota Advantage

3

Who Are DAPTs For?

4

Don’t Put All Your Eggs In One Basket

5

Now, Not Later

There are certain requirements that need to be met in order to take advantage of South Dakota’s DAPT laws. First, the grantor of the trust (the one creating it) cannot be trustee of the trust. Second, the trust needs to be housed in South Dakota and be governed by at least one trustee that is located there as well. Third, the trust must be unchangeable. In short, a grantor must be comfortable relinquishing a large measure of control over the assets. This seeming inconvenience is more than offset by the substantial protection and safety net the trust creates.

DAPTs are great for those people that find themselves in one or more of the following categories: business owners or executives, high-liability professions such as medicine, and those with high-net worth. Those with the most to lose and that, for reasons of their positions or professions, are lucrative targets for lawsuits and claims.

The asset types that are typically placed in DAPTs are stocks, bonds, cash accounts, mutual funds, closely held business interests, and occasionally real estate. When placing property into the trust, it is important to understand that for a DAPT to be effective, it cannot become the house for all of your assets.

You can fund the trust with significant assets, but you cannot go so far as to impoverish yourself. DAPTS are just one part of a larger overall asset protection strategy. It is a fine line that needs to be walked very carefully, but do it correctly and it will create a creditor “lockbox” over a sizeable portion of your assets.

DAPTs are proactive measures. A DAPT must be done long before there is a need for one. If you wait to form one until there is a problem or even just the hint of a lawsuit, then you’ve waited too long. Every DAPT state has a curing or ripening period before the asset protection becomes effective as to future creditors. After the property is placed in the trust, the countdown begins. In South Dakota, this window of time is 2 years. It varies in other states. The practical byproduct of this is that if you want to take advantage of this type of trust, you must act sooner rather than later.

If you are in a high-risk profession, and want to take advantage of a DAPT, it is critically important to get started today. Talk to an estate planning attorney to help you take the proper proactive measures toward your wealth protection.

Don’t wait until it’s too late. ■

Ask ur tO Abou dge Lo e! g Packa

Breandan Donahue is an Estate Planning Attorney at Goosmann Law Firm.

January / February 2016

MidwestMedicalEdition.com

19

Cybersecurity WHY YOUR ELECTRONIC HEALTH RECORDS MAY BE TARGETED

By Jeremy A. Wale

W

ITH THE increased use of technology comes increased risk of cyberattacks. Anything transmitted or stored electronically is at risk of being stolen by a hacker.

Many people don’t believe—or don’t understand why—medical information is valuable or at risk. According to a compilation of data breach statistics, there were 783 security breaches in the United States in 2014. Of those, 42.5% were breaches of medical or healthcare information. This equated to over eight million individual records being accessed or stolen by cyberattacks.

Large healthcare systems, hospital networks, and individual healthcare providers have all been attacked, but the size of the entity is no clear indication of the size of the breach. For example, one Blue Cross Blue Shield attack yielded only 300 records, while a large system in Tennessee yielded approximately 4.5 million records. Several individual physician practices were breached as well, yielding as many as 7,500 records from one practice.

WHY ARE MEDICAL RECORDS TARGETED? Medical records seem to be targeted because they contain all of an individual’s personal information: finances, social security numbers, health information, and family information. This gives thieves more potential uses for the stolen information, including applying for credit cards, store accounts, or other lines of credit. They also can use the information to steal healthcare services.

These are just a few reasons why a medical

20

record can fetch up to $50 on the black market, while a credit card number may only earn $5.

Another example of how valuable a medical record may be: a security firm CEO shared an example of a black market advertisement to sell ten Medicare numbers.

“It costs 22 bitcoin—about $4,700 according to today’s exchange rate.”

The transition to electronic health records has given criminal hackers more opportunities to steal medical records. The chief information officer for a hospital system in Salt Lake City states his hospital system “fends off thousands of attempts to penetrate its network each week.”

Another reason is ease of access. Some hospitals and healthcare providers are using systems that have not been updated in more than ten years. While hospital systems and healthcare providers rush to prepare for ICD-10 implementation and meaningful use, cybersecurity seems to be falling through the cracks. Many healthcare systems “do not encrypt data within their own networks.”

Once a hacker penetrates whatever security the system does have, the unencrypted information is there for the taking.

Criminals also use stolen medical records to fraudulently bill healthcare insurance providers and Medicare/Medicaid. The victims may not discover the theft for several months—or even years. In some instances, victims have received debt collection requests for medical services they never received.

WHAT CAN YOU DO TO SAFEGUARD ELECTRONIC MEDICAL RECORDS? When implementing or updating an EHR system, talk to your vendor about cybersecurity. Ask whether the stored information is encrypted. It also is a good idea to determine if or when the vendor will provide security updates for your EHR software.

Organizations may need to “invest more money and employee talent in shoring up the walls around their electronic data.

Cybersecurity is a highly specialized area that requires a certain expertise. Your EHR vendor may be able to provide some assistance in this area, but remember their expertise is creation and functionality.

Hiring in-house cybersecurity experts or contracting with a cybersecurity firm specializing in this area may be the best options to protect your organization and your patients.

Several organizations, such as the Department of Homeland Security, the American Hospital Association, the Centers for Medicare & Medicaid Services, and the National Institute of Standards and Technology, offer guidance and resources on cybersecurity. Their web addresses are included in the endnotes of this article.

These are just a few of the vast number of resources available to organizations regarding cyber-security. ■ Jeremy Wale, JD, is a Risk Resource Advisor with ProAssurance.

For a complete list of the references for this article, see the full version on our website

Midwest Medical Edition

January / February 2016

MidwestMedicalEdition.com

21

Research Spotlight

Photo courtesy Sanford

Dr. Patrick Kelly

Scientists Explore Novel Approaches

to Peripheral Artery Disease, Head and Neck Cancer

T

HE UNIVERSITY OF South Dakota and Sanford Health are collaborating to develop more effective drug-coated balloons to treat peripheral artery disease.

The two new devices, which can more precisely deliver drugs to specific arteries, are based on intellectual property jointly created by Sanford’s Patrick Kelly, MD, and USD’s Gopinath Mani, PhD. Drug-coated balloons deliver drugs to arteries to repair damaged walls and prevent future renarrowing. Traditional balloons release drugs in a burst profile, demanding the use of more balloons and

22

release of medicine to areas not in need of repair. The methods designed by Mani and Kelly use a special coating that can be tailored to time the release of medicine and prevent release of drug while tracking to the target site. They also allow for treatment in multiple arterial segments.

“This time-released method of delivering drugs via balloons is economical and may reduce the amount of unneeded chemo therapeutic agent that enters the body,” said Kelly. “If this technology works the way we think it will, we may also be able to use fewer of these costly balloons.”

At the same time, as part of the multiphase Profile Ketogenic Clinical Trial, Profile by Sanford and Sanford Research have developed a nutrition plan they hope may improve outcomes for patients with squamous cell carcinoma of the head and neck.

Profile is a low-carbohydrate, low-fat system for weight management. Recent Sanford Research studies using a ketogenic, or reduced-sugar, nutrition plan in mouse models have shown promise for cancer therapy. “Cancer cells thrive on sugar; naturally, reducing sugar intake could better equip the body to help fight off progression of the disease,” says Andrew Terrell, MD, head of the new trial.

Study participants will follow the Profile system along with receiving standard cancer treatment therapy. Outcomes will be compared to patients who also received standard cancer treatment therapy but ate a non-regulated diet. Tumor size and various metrics to measure quality of life will be analyzed between the two groups to determine the effectiveness of the ketogenic nutrition plan. ■

Midwest Medical Edition

Telemedicine– From Sioux Falls to Rural Montana Patients as far away as Montana will soon benefit from the expertise of specialists at Avera. Avera eCARE has announced the opening of its latest eEmergency site at Roundup Memorial Healthcare in Roundup, Montana.

This partnership between Roundup Memorial and eCARE Service will link local physicians to emergency specialists with just the click of a button. Using two-way video equipment, rural doctors are linked to emergency-trained physicians and specialists at all times. The eEmergency team can provide consultations during emergency situations so that patients are more likely to be able to stay in their local emergency room.

Since its creation, eEmergency has helped partner hospitals avoid more than 3,000 transfers and has saved $26 million in health care costs.

“A second set of eyes on cases not only provides a deeper level of care for patients, it decreases the stress level of local physicians,” said Jay Weems, Executive Director of eCARE Client Management.

Avera eCARE offers one of the largest telehealth networks in the United States, supporting more than 235 health centers,

New Faces On Regional Health's Leadership Team Paulette Davidson, FACHE, CMPE, MBA, has been selected Regional Health’s new Chief Operating Officer and Ronald Amodeo is the new Innovation and Growth Officer.

Davidson is a Certified Medical Practice Executive (CMPE) who comes to Regional Health from Nebraska Medicine in Omaha, where she was system Chief Human Capital and Patient Experience Officer. A Fellow in the College of American Health Care Executives (FACHE), Davidson has a Master’s degree in Business Administration (MBA) from the University of Notre Dame – Mendoza College of Business in South Bend, Indiana and a Bachelor’s degree in Business Administration from the University of Wisconsin in Madison.

Davidson had previously worked as the Chief Executive Officer of Nebraska Medicine’s Bellevue Medical Center in Bellevue. She also worked at Indiana University Health Goshen Hospital in Goshen, Indiana where she fulfilled several senior leadership roles, including Chief Operating

Officer and Vice President of Hospital Operations.

In her new position, Davidson will focus on clinical operations and strengthening corporate culture to benefit patient care and services. She will also oversee several key leaders within Regional Health.

Amodeo comes to Regional Health from the Mayo Clinic, in Rochester, Minnesota where he was Director of the Office of Business Development.

He holds an MA from Carnegie Mellon University in Pittsburgh and Bachelor’s degrees in Biology and English from Allegheny College in Meadville, Pennsylvania.

Amodeo has successfully implemented joint and new business ventures, including some international and is the founder of several startup companies in the technology, engineering and consulting industries. In his new role at Regional, Amodeo will focus on strategies related to business growth in the marketplace, service line enhancement, retail opportunities, and improved business development. ■

clinics, long-term care centers and correctional facilities within an eight-state region across 545,000 square miles. This virtual service supports the local healthcare workforce by improving retention and recruitment in rural areas. Patients have access to round-the-clock care management and health facilities can operate more efficiently. eCARE’s growing line of services includes eEmergency, ePharmacy, eICU Care, eCorrectional Health, eConsult, and eLong-Term Care. ■

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For a more detailed explanation of each of these eCARE areas, log on to our website.

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January / February 2016

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23

Meet the VA’s NEW Chief of Staff DR. JOHN (JACK) WEMPE, the new Chief of Staff for the Sioux Falls VA Health Care System, says he came to South Dakota because of the people.

Wempe, who spent 3 decades in the military, says he especially appreciates the “Midwestern values” and work ethic of the VA staff with whom he now works.

Dr. Wempe has experienced much of life, and of higher education, since leaving Parkston to earn his BS at South Dakota State University. He went on to earn a Doctor of Veterinary Medicine degree from Kansas State University, MPVM and MS degrees from the University of California-Davis, a PhD in Pathobiology from the University of Illinois–Champaign, Doctor of Medicine from the University of South Dakota Sanford School of Medicine, and a Masters of Public Health from Johns Hopkins University.

During his 30 years in the U.S. Army, he had multiple leadership positions in the United States and overseas. He most recently served as the Assistant Dean of Medical Student Affairs for the University of South Dakota Sanford School of Medicine prior to coming to VA. Having spent his career in the military, Dr. Wempe says coming to the VA is an extension of his service to the country and he praises VA providers and other staff who also regard Veterans and their service with admiration. ■

Children’s Sports Medicine Clinic Provides Care to Young Athletes LIKE ANY EXERCISE, playing a sport can help children control weight, improve self-esteem and do better in school. There are dangers for child athletes, however. More than 3.5 million Americans age 14 and younger are treated for sports injuries every year.

“Sports injuries in adolescents and teenagers are difficult,” says Kody Moffatt, MD, pediatrician and sports medicine specialist at Children’s Hospital & Medical Center in Omaha. “The body, bones and joints aren’t fully developed. We want to make sure these injuries are diagnosed and treated before they create a chronic, long-term problem that could impact the child’s ability to compete successfully down the road.”

A significant focus of the Children’s Sports Medicine Clinic is diagnosing and managing post-concussion recovery, particularly with regard to helping injured athletes transition back into the classroom, a process often referred to as “return to learn.” Appropriate management of the “return to learn” process is a critical part of concussion recovery. At the Sports Medicine Clinic at Children’s, a customized “return to learn” plan is created for each patient.

Most sports-related injuries do not require surgery. However, Layne Jensen, MD, a pediatric orthopaedic surgeon who specializes in surgical repairs for young athletes who are still growing, can provide on-site consultation. Dr. Jensen specializes in pediatric surgical

MED QUOTES

“ 24

”

alking is man’s best medicine.

W — Hippocrates

techniques such as ACL reconstruction for children who cannot undergo traditional procedures due to skeletal immaturity. In addition, Children’s pediatric cardiologist Chris Erickson, MD, contributes to the multi-disciplinary focus with comprehensive heart evaluations, when needed. ■

Midwest Medical Edition

Inpatient Rehabilitation for Your Pediatric Patients Our rehab team provides short-term intensive rehabilitation after accident, illness, or surgery.

After discharge, patients can seamlessly transition to outpatient care at our Sioux Falls or Rapid City location – or to a local provider.

■

Admissions: Shannon Vanden Bosch, RN, 605.444.9556

Sioux Falls & Rapid City • LifeScapeSD.org

January / February 2016

MidwestMedicalEdition.com

Led by Julie Johnson, MD, (left) & Kate Sigford, MD, Physical Medicine & Rehabilitation, and Charlie Broberg, PA-C.

25

Congenital heart disease in adults

O

By Kelly Steffen, DO

VER THE PAST FEW decades,

It is recommended for the ACHD patient

there’s been a revolution in

to receive regular follow-up visits at least every

delivery and low birth weight; risk to the

treating

heart

1 to 2 years if they have moderate or complex

baby from medications the mother needs

defects. Advances in diagnosis

CHD and every 6 to 12 months if they have

to take, such as blood thinners; possible

and surgery have made it possible to fix or

very complex ACHD. Even if low-risk, simple

complications during pregnancy and

repair most defects, even those once thought

CHD, they should be evaluated at least once,

delivery; and importance of preventing

to be hopeless. Many people with these

to determine if future follow-up is needed.

blood clots during and after delivery.

congenital

defects are now reaching adulthood and

It is important to have the patient transition

living full, active lives. According to the

into seeing an adult congenital heart disease

Centers for Disease control, there are about

specialist to receive specific information and

1 million children and 1 million adults living

advice about health issues that are affected

with CHD.

by your CHD, including:

the American Heart Association have devel-

❤ Exercise and participation in sports

oped standards for treating adults with

❤ P reventive health habits for overall

congenital heart disease are working to improve the health care system, so that teens and young adults have an easier time making

❤ P atients with CHD face an increased risk for getting an infection that can spread to the lining of the heart and heart valves—infective endocarditis (IE).

❤ It’s not uncommon for adults with

The American College of Cardiology and

congenital heart disease (ACHD). Experts in

❤ P regnancy, including the risk of premature

CHD to have an irregular heart rhythm (arrhythmia), which is caused by problems in the heart’s electrical system.

good health

To raise awareness about the number one

❤ Genetic testing and counseling

heart defect the American Heart Association

❤ S afe and effective birth control,

is handing out knitted red hats to every baby

the transition from receiving health care in

especially the need for some women

pediatric cardiology centers to receiving care

with ACHD to avoid estrogen-

from specialists in adult cardiology.

containing birth control pills

born in the month of February at participating hospitals, including all Sanford facilities. ■

Dr. Kelly Steffen is a cardiologist at Sanford in Sioux Falls.

TO OUR MEDICAL PROFESSIONALS AND PARTNERS

Thank You! As we reflect on the past year and look forward to the future, we are thankful for your partnership and helping us fulfill our mission of helping to enable the restoration of the gifts of sight and health.

In the past fiscal year, we were able to help restore sight to 766 individuals through corneal transplantation. Thousands more were helped through non-ocular tissue and research donation.

To all who helped us restore sight and health, Thank You!

www.sdletb.org

26

TO MAKE A REFERRAL 1-800-245-7846 EXT 4

Midwest Medical Edition

The Nurses’ Station Nursing News from Around the Region

When you need it.

Sanford Pulmonary nurse Muharema Mustic, RN, was recently recognized with a DAISY Award for exceptional nurses.

The following excerpt comes from her nomination letter:

“

My Mom suffers from Neuropathy in both feet.

That was not the reason we were sent to the hospital, but Muharema listened and cared for her feet and made my Mom feel as comfortable as she could.

Muharema really listened and discussed the pain and tried to make my Mom comfortable. She was genuinely caring and sympathetic towards my Mom’s problems.

My Mom was upset about having to spend that extra night in the hospital and if Muharema had not been her nurse that night, I think it would have been a very different outcome. My Mom was calmer and felt safer with Muharema as her nurse. In the morning when shift change occurred, Muharema hugged my Mom and wished her well. You could tell the sincerity in her actions and her words. My Mom was feeling much better about the decisions that needed to be made about her continual care.

”

Lacey Bonte, who has been an RN in the ICU at Avera Queen of Peace Hospital, has joined Avera Medical Group. Bonte, DNP, FNP, earned her Doctor of Nursing

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Practice and Family Nurse Practitioner degrees from South Dakota State University and is certified by the American Academy of Nurse Practitioners Certification Program (AANPCP). She is now seeing established patients at Avera Medical Group Internal Medicine Olegario Clinic.

MED QUOTES

“

he aim of medicine is to prevent disease T and prolong life. The ideal of medicine is to eliminate the need of a physician.

— William James Mayo

January / February 2016

”

MidwestMedicalEdition.com

27

GO PAPERLESS AND

GET ORGANIZED For some time now, research has shown that consuming protein in balanced amounts at each meal may be more beneficial to improving the impact of higher protein intake on various health outcomes.1

SAY GOODBYE TO YOUR PAPER MESS AND

HELLO TO INCREASED EFFICIENCY

WITH DOCUMENT SCANNING FROM ACTIVE DATA SYSTEMS

take control

Challenge yourself to eat protein-rich foods at every meal and feel the difference!

Visit BeefItsWhatsForDinner.com/ ProteinChallenge.

1 Mamerow M, et al. Dietary protein distribution positively influences 24-h muscle protein synthesis in healthy adults. J Nutr.2014;144:876-80.

“

2 Paddon-Jones D, et al. Protein, weight management, and satiety. Am J Clin Nutr. 2008;87:1558S-61S.

}}

3 Noakes M, et al. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr.2005;81:1298-306.

4 Symons T, et al. A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. J Am Diet Assoc. 2009;109:1582-6.

#proteinchallenge

Active Data Systems was able to scan all the paper charts, which made it very seamless and easy for us to import these records into our EMR software, saving our busy practice countless hours.

“

Significant research shows that some people can lose and maintain a healthy weight2, support a healthy metabolism3, and age more vibrantly4 when they consume more highquality protein, within calorie goals.

Dr. Rizan Hajal Pulmonary & Sleep Consultants

your business technology leaders 2504 West 46th Street, Sioux Falls, SD 605-335-5906 // www.activedatasystems.com

ProteinChallengAd_Nutrition_SD.indd 1

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11/30/2015 12:47:53 PM

Midwest Medical Edition

“ Somehow it all just fits”

DID YOU KNOW

By Alex Strauss

2014

vol. 5 no. 6

the Preparing fores Denial Proc s nating your Tips for elimi y s problems Toda iCd-10 Claim

G GeT The Codin need. supporT you

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Be finan Train your your healthpatient that will allow is involved with Have a strategy Everyone who first few learn the ng and to weather those take the time to Not only is it frustrati care organization and records should need. to have to budgets are aligned format they’ll a waste of time months. If your standardized code whatever and but waiting be ready for ns, schedulers resubmit claims, prepared, you’ll Nurses, physicia can a signifipatient records can also cause happens. anyone who touches code for reimbursement tion’s revenue to integrate that now organiza an to prepared get cant threat -10 world is depen.

Success in a post-ICD across all systems and cash flow. ability to adapt Oct. in tion’s nted is impleme dant on your organiza in coding When ICD-10 Tools likely to see levels of expertise and clinics are to a need for new evaluaTe your Making the 2015, hospitals denied documentation. effect: more claims efficiency and and sysTems. you avoid an immediate to a new n. This now will help good time to shift waiting for resolutio changes you need Now may be a prepare At the and longer times is likely they happen and records system. coding regimen problems before electronic medical new highly detailed now using to for growth. ■ at what you are e’s bottom line. your clinic or hospital very least, look d to affect everyon field length the Medicai for and e room have Medicar make sure you The Centers for new codes in the early required for the estimates that and characters records.

Services (CMS) rise by of more detailed denial rates will and the inclusion stages of ICD-10, up for physician set is error rates are system Claims Make sure your 100 to 200 percent. to and data ng, registration from three percent orders, scheduli expected to increase days in ICD-10 coding. percent. The average systems that use 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 a Some codes and Successful healthca right to ICD-10. Develop about denials ed thinking translat been are should start are five where the denials deadline hits. Here process to identify now – before the ne which al denial you can determi beyond tradition happeni ng so Set up a tips for moving more training. to not only reduce require strategy will ment areas manage this informacauses before commun icate eliminate their system now to denials, but to staff. e on tion to everyon they happen: denial s. o one likes

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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SEptEMbER OctObER

January / February 2016

every Wednesday evening. She spent her weekends writing and studying.

One of the first things King says she learned in the program was respect for her fellow students. “I was the second oldest person in my cohort and at first I thought ‘Gee, how much are these younger people really going to be able to contribute to the discussion?’,” King recalls, somewhat sheepishly.

“But I quickly learned how conceited that was. I learned an enormous amount from every individual in the program and we all learned to appreciate our varying perspectives. In a way, we really mentored each other.”

In addition to giving her the business acumen she was after, King says her MBA also turned out to be a journey of selfdiscovery. Through a required self-assessment, she uncovered what she calls her “heart for volunteerism”, which led her to help establish SFSH’s Employee Driven Group Events (EDGE) program to support employee volunteerism. “I would say that that class sparked a light and helped develop that in our organization,” says King.

King credits a good portion of her success in pursuing her MBA to her family’s support (her hubby hired a cleaning service for their home and her children gave her school supplies), and has this advice for other busy professionals considering additional education: “Somehow it all fits. You shift things around. You study when you can. After you graduate, you wonder ‘How did I make time for that?’ But somehow, if you want it, you just do.” ■

Photo courtesy USF

W

HEN KELLY KING, Director of Nursing at Sioux Falls Specialty Hospital, decided to go back to school in the Fall of 2011, she knew that what she did not need was more education in the nursing profession. King, who graduated from Mt. Marty college in Yankton in the 1980’s, hit the ground running in Mobridge, working in areas ranging from pediatrics and OB to the ER and the ICU at the town’s small hospital. “It was an excellent place for a new RN to start her nursing career,” she says.

Within a few years, King moved to Sioux Falls and took a position as a staff RN in the post anesthesia care unit (PACU) at what was then the Sioux Falls Surgical Center.

That was 25 years ago. When the hospital changed its licensure to become a specialty hospital in 1996, King stepped up to manage the new recovery care unit. Today, as Director of Nursing, King’s duties have moved beyond just the clinical to include environmental services, clinical informatics, quality, infection prevention, and employee health for the 35-bed facility. But as her responsibilities continued to grow, King felt that there was still one area in which she was lacking–business.

“In a position like mine, you are required to make a lot of decisions and a lot of the decisions I have to make are business decisions,” says King. “So it was almost like a catch-up. I had the clinical side. I had the leadership side. But I knew that I needed to understand the business side of medicine better. I wanted to be a valuable voice at the table. That is why I decided on an MBA instead of a Masters in Nursing.”

King chose the Healthcare MBA program at the University of Sioux Falls which was both close and flexible for a working person with a family. For just over two years, King and her cohort of healthcare professionals from around the region, met

Vol. 5 No. 5

Risks surrou n

AlARm

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he iss ue of ala rm a ‘center faT igu stage’ e an d concern the last paT ien for heal two deca T saf thca re (eCri) des. in eTy has prov ider named The num become s across alar m haz fact, the eme ber of alar the rgency patient ards m sign Care res cou ntry over each day als in heal as the #1 hea earch – which thousand lth Tec thcare inst itute can tran hno s through facilitie slate s can surp logy hazard they can out to thou in 2013 ass seve reach over the hospital. sands of . ral hun While alar ms desensiti whelmin dred per alar on zed, over ms are g quantiti ever y unit an imp whelme es. so, and tens The risk ortant d or imm it’s no of s to pati part of won une can incl patient to der that ent safe ude falls care, ty are real the sounds, and clinicia , delays ns can The Join can suff . Com mon become in trea er from t Com inju ries tment, mission ‘alarm January medicat resulting fatigue. sentine 200 ion erro from alar ’ l dat aba rs, permanen 9 and June or m se repo hazards in the 2012. of t loss of rts 98 worst case the 98 unfortu function alar m-r reported – death. nately, elated events, these occu , and five in events in June unexpe 80 resu between rrences 2013, the cted add lted in goal (np death, itional Joint Com are happening 13 in sg) to care or more and mission add ress extende npsg establis more freq improvi requires d stay. hed a new uently. ng the hospital a priority, safety and criti of clinical 2014 nationa establis cal acce l patient h a form alar m syst ss hosp safe al policy ital lead ems in ty and prov hosp ers to set ide staf alar m man itals. The f training agement around as alar m safe ty.

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Learning Opportunities Winter /Spring 2016 January 23

Sanford Health Cerebrovascular Symposium

7:00 am - 4:00 pm Location: Ramada Plaza and Suites, Fargo, ND Registration: SanfordHealth.org, search “Fargo Cerebrovascular Symposium”

March 4 & 5

UnityPoint Health-St. Luke’s EMS Conference 2016

Location: Sioux City Convention Center Information: http://www.unitypoint.org /siouxcity/services-professional-education.aspx

March 21 & 22

4th Annual Regional Health Sports Medicine Symposium

8:00 am - 6:00 pm,

Location: The Lodge at Deadwood

7:30 am - 12:00 pm

Information: Education@Regionalhealth.com, 605-755-8015 Registration: Regionalhealth.com/sportsmed

March 31

Avera Transplant Institute Symposium

8:15 a.m.-4 p.m.

Location: Prairie Center, Avera McKennan Information: averaeducationevents@avera.org, 605-322-7879 Registration: Avera.org/conferences April 8

15th Annual Avera Pediatric Symposium

8:00 am - 4:00 pm Location: Prairie Center, Avera McKennan Information: Avera Education Events, 605-322-7879 Registration: Avera.org/conferences

April 13

24th Annual Avera Trauma Symposium

7:30 am - 4:00 pm

Location: Sioux Falls Convention Center Information and Registration: Avera.org/conferences

April 29 - 30

10th Annual Sanford Sports Medicine Symposium

8:00 am - 6:00 pm Location: Ramkota Hotel & Conference Center, Sioux Falls Information: 605-312-7808

Do you or your organization have an event for the MED Calendar?

Post it online for free through the calendar link on our home page.

MED reaches more than 5000 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for 30

the Learning Opportunities calendar to the editor at Alex@MidwestMedicalEdition.com.

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t Medical

/ October

2015

Edition

Father and son

in the “T-Ball”

days

For Drs. Rich ard and Tom

Plastic Surger y is

By Alex Strauss

S

Edition

30

Medical

Then and No w

surgically

Midwes

Now It’s Your Turn

Howard,

a Family Affair

IOUX FALLS Dr. Tom Howard PLAST IC surand his father, most of his rotation geon Richard Dr. Richard Howard Howard , MD, s outside of Sioux He decided that says it was T-Ball Falls. who is hoping he wanted to that originally to cut back his do cardiovascular surgery prompted him own workloa by 25 to 30 percent. .” d to establish practice in Sioux his “I think it will But things changed Falls in 1992. be a lot of fun. And for Dr. Tom Howard the timing for Specifically, his son when he realized me right now Tommy’s T-Ball. couldn’t be better.” how the cardiov “We were living ascular landsca pe had changed in Kansas City Like his father, in recent years. time and we had at the Dr. Tom Howard “Interventiona one son. It was says he enjoys the persona l cardiologists T-Ball season and, if I wanted l nature of plastic become so proficie have to catch a game, surgery and the opportu nt that the surgeon it was a nity to get to 45 minute drive to get the very s tend know there and then patients over time, such sickest patients another 45 as over the course minutes back . That means more challen to the office to of a breast reconst ruction. ges, longer finish up,” says Dr. Howard.

As much as recover y, more problems,” says “An hour and he knows he stands to learn the younger a half to watch from his dad, one game. Living Dr. Howard, who completed he’s also hoping in the big city to be able to teach his Plastic & had pros and cons but, some, too.

Reconstructive Surgery at that point, residency at the “I am hoping the cons were outweighing that he will show University of Oklahoma in the pros by a me some of the old tried-an June. “With plastics, long shot.” d-true things Leaning on advice everyone seemed really that always work and I’ll be from his father happy and excited able “a man who that to show him some to go to work. Their patients fails his family that are on the things fails his life”, tend to be happier, forefront of the Dr. Howard moved It all seemed too. specialt y,” his family and says Tom, who much more attractiv surgical will be studying practice to Sioux e.”

After discussi for his board Falls, enjoyed exam in the fall. ons with his dad as much T-Ball as he could, and evaluation of the local and never looked For his part, Dr. medical landscap back.

Richard Howard Twenty-three e, the idea of coming home years later, that , whose Sioux Falls Center to Sioux Falls emphasis on family appears for Plastic and with his wife Katie (also a to be paying off Reconstructive Surgery Sioux Falls native) in spades.

Not only did has been primari and young son seemed more Thomas Howard ly practice a solo attractive, too. , is glad to be , MD, decide to follow his father gaining not “My dad and into medicine, only a partner he likes I get along great,” but he has and trusts, but recently decided Tom. “He’s a says also a closer – after some relationship with wonder ful teacher, considerable debate – to follow his three-and-a-half a talented surgeon, and him into his old grandson, year great with people.

Sioux Falls Benjamin. practice.

I would be missing a great “He’s my only opportu nity if I went anygrandson and “Tom told me where else.” years ago that now I am going to get to he was absogo to his T-Ball lutely not going “I’m confiden games,” says to go into plastic Dr. Howard. t knowing Tom’s ■ surgery,” recalls Dr. Howard personality, his high with a laugh. standar ds, and “He got into medical how he approaches taking school at USD NOTE: Dr. and arranged care of people, Tom will join that he will do very Dr. Richard practice at the well here,” says in Sioux Falls Center Dr. Richard, for and

July / August

Reconstructive

2015

Surgery in August.

Plastic

MidwestMedicalE dition.com

9

Off Hours

Passionate Pursuits Outside the Office

“

I think what I and a lot of other physicians really love about brewing is that it is a blend of science and art.

”

Dr. Steven Powell works in his garage/brewing

Photos Courtesy Dr. Powell

Home Brewed Hobby

By Alex Strauss

this biochemist in him was not content with relax wants what a lot of people want–to he soon simplified version of brewing and with a great beer. instead began working with whole grains Making a great beer, that is. control of prepackaged extracts for more beer “Honestly, I wasn’t even much of a over the finished product. really fan until I started brewing. That is use You scientific. very “It’s actually of a what got me into it,” says Dr. Powell grain malted grain and you grind or mill the a small home-brewing hobby that started as spray to crush it,” he explains. “Then you over stove-top operation and has now taken it to water over the grain, which causes a home the garage. “My wife bought me at a sprout. As a brewer, you’re using water were brewing kit for my birthday when we activate certain try to temperature specific year living in Minneapolis during my first Differenzymes and break down the sugars. it of residency. I like to cook, so she thought You S A MEDICAL oncologist ent grains will produce different flavors. might be something I would like.” the and researcher at Sanford in use a mixture of ingredients to produce It turns out, she was right. Like most Sioux Falls, Steven Powell, flavor you want.” extract home brewers, Powell started with his batch sizes–grew, MD, spends the bulk of his interest–and his As likens he brewing small batches, a process into time trying to answer some of the trickiest Dr. Powell moved the brewing operation the to making cake with a mix. But he questions in medicine. In his off hours,

SIOUX FALLS ONCOLOGIST COOKS UP AWARD-WINNING BEER IN HIS GARAGE

A

Midwest Medical Edition

burners the garage where he now uses propane couple to make about 10 gallons of beer every 6 hours of months. A single batch can take 5 to —a of active work, but the payoffs are big a prodprocess he finds fun and relaxing and

uct he is proud to show off and to share. a lot “I give a lot of beer away and I have he says. of requests from family and friends,” to be “It’s amazing how many people want friends with you!”

He has also won more than one first-place impresribbon at the Minnesota state fair (an sive feat in a region he describes as a “hotbed” chocoof home brewing) and recently took a in a late coffee stout all the way to the finals international competition. Powell says the yeast, play of different grains with hops and like as well as the use of exotic additions November 2015

laboratory.

brewer fruits and flowers, allows the inspired styles to create an almost infinite array of and flavors.

“I think what I and a lot of other is that it physicians really love about brewing Powell. is a blend of science and art,” says Dr. you can “If you happen to be a science geek, the like details little get very involved in even artistic chemistry of the water you use. On the side, you can do all sorts of creations, focusing

on how it looks and how it tastes.” own While he continues to refine his next brewing process, Powell says his qualify goal is to fine-tune his taste buds and have to as a certified brewing judge. “You senses, take tests and sort of realign your he but I think that would be very cool,” says. ■

MidwestMedicalEdition.com

37

36

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