MED-Midwest Medical Edition-March 2014

March

2014

Vol. 5 No. 2

Midwest Medical Edition

Imagining

the future of Medicine Sanford Imagenetics

New Focus for Medical Fitness Program SD Hospital in Wall Street Journal

Conference & CME Schedule South Dakota and the Upper Midwest’s Magazine f or Physicians & Healthcare Professionals

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Midwest Medical Edition

Contents

Imagining the Future of Medicine

Volume 5, No. 2 ■ March 2014

Sanford Imagenetics

Regular Features

By Alex Strauss

With the launch of its system-wide genomic medicine initiative, Imagenetics, Sanford Health is moving genomics into the forefront of adult clinical practice. New genetic experts, a new lab, and a new focus on the influence of genetics on drug metabolism and disease risk promise to transform Sanford’s approach to Internal Medicine. For their part, Internal Medicine physicians hope the initiative will also boost interest in their specialty.

2 | From Us to You 3 | MED on the Web

What’s new exclusively on the MED website this month

6 | News & Notes New doctors, certifications, clinics, and more 18 | Then & Now Sioux Falls Psychiatrist David Bean, MD, reflects on the evolution of psychiatrics in the region

22 | The Nurses’ Station Donation for ‘Guardian Angels’, New CRNAs for Worthington

25 | Learning Opportunities Upcoming Symposiums, Conferences, CME Courses

In This Issue

page

4 | Sioux Falls Program Offers Incentives

2014

Ma rch

for Prenatal and Infant Care

Vol. 5 No. 2

4 | MED Advisor Appointed to AAFP 9 | What We’ve Learned About the Uninsured

Midwes

al t Medic

14

Edition

9 | SD Poll: Medicaid Funding for the

24 R egional Hospital

Uninsured

Poll shows the public favors accepting federal funding to broaden access to Medicaid

Featured in Wall Street Journal Article:

16 | Local Hospital to Offer PROVENGE Treatment 17 | Local Football Study Published in National Journal

20 | Area Health Systems Help Launch Specialty Pharmacy Network

evamped Fitness R Program Avera’s medically-integrated fitness program has a new name and a new certification

■ By Dave Hewett

Treatment uses autologous stem cell transplantation to improve survival in advanced prostate cancer

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Hospital is recognized for its efforts to make campus navigation easier

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Program designed to improve access to specialty pharmaceuticals

21 | Trial to Test Dissolving Heart Device 22 | South Dakota Study Shows Major Weight Loss in Breast Cancer Survivors

Cover Photo: Megan Landsverk, PhD, director of the Sanford Clinical Molecular Genetics Laboratory, holds up a flow cell from the HiSeq 2500, a powerful ultra-high-throughput sequencing system that can sequence a whole genome in about 27 hours. Photo courtesy Sanford.

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25

Learning Opportunities Spring is a busy time for Conferences and CME events!

On the

COver

From Us to You

Staying in Touch with MED

W

Photo by The Moment

e have been reminded in recent months of the rising importance of genetics in medical practice in our region. This mirrors a national trend and Sanford Health is determined to be on the leading edge of that trend. With the recent introduction of Sanford Imagenetics, the health system has become one of the first in the country to move the practice of genomics from the realm of the laboratory into the forefront of adult clinical pracMED’s Steffanie Liston-Holtrop (center tice. The new initiative is the focus of this month’s front), a member of the American Heart Association’s ‘Go Red for Women’ MED Cover Feature.

Executive Leadership Team, at a recent ‘Go Like the practice of medicine, MED Magazine Red’ event in Sioux Falls. is constantly evolving to serve you better. At MidwestMedicalEdition.com you can find and download digital issues of the magazine, read the latest medical community news, find out how to contribute articles or advertise, update your mailing address, join our growing list of eNewsletter subscribers, and reach us with your thoughts and ideas.

It is our goal to be your preferred source for timely, relevant information about our rapidly changing medical community and your partner in marketing your practice and growing referrals.

Let us know how we can serve your needs better.

—Alex & Steff

2013

No VeM BeR

Vol. 4 No. 7

Marketing Made Easy

ical Edition Midwest Med

tion and sh Flow Disrup Avoid Major Ca

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Have you written for or been featured in MED? Put the exposure to work for you!

Reprints of MED articles are a classy and cost-effective way to showcase your practice or your services.

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October becau cash drawer next ase in time to send shock to your financial Cycle Services denials and incre evidence of the VP for Revenue Regarding the Heidi Babb is lting s) transition, the claim for Medical Consu out red prepa ased Partners al on the at Sioux Falls-b importance of being our neighbors Services, Clinic ess office staff Revenue Cycle no further than s Educate busin rements, which provides we need to look ll, and ition requi trans ation the ment ng, Finance, Payro Canada, when details of docu lting, Bookkeepi rs s, Consu up to the north. In code clinic of ts to for n catio nt contracts 10, there were repor consider certifi e Manageme Servic Full by took place to ICDd to rs cause with software vendo ption in cash flow rs, and hospitals. surgery cente to a 40% disru s Communicate errors, and transition entation, coding readiness for the their rm confi insufficient docum mended that, It is being recom coding delays.

By Heidi Babb

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2

Publisher

MED Magazine, LLC Sioux Falls, South Dakota

VP Sales & Marketing Steffanie Liston-Holtrop Editor in Chief Alex Strauss

Design/Art Direction Corbo Design Photographer Kristi Shanks

Web Design Locable Contributing Editor Darrel Fickbohm Copy Editor Hannah Steck

Contributing Writers

Dave Hewett

Staff Writers

Liz Boyd Caroline Chenault John Knies

Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss, Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website MidwestMedicalEdition.com

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©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.

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Now More than a Magazine, A Medical Community Hub

Enhance your MED experience!

MED now offers continually updated news and calendar events on our website, as well as an expanding free directory of area practices and businesses.

Here is some of what you’ll find exclusively online this month.

Log on Now! Online Directory

High Deductibles: How Will You Handle Them?

The changes in healthcare have resulted in a rise in the number of patients with highdeductible health insurance plans. How should your office handle these patients to avoid a negative impact on the bottom line? The healthcare management experts at Aqreva have some advice.

Food for Thought…

Challenging weather conditions are a fact of life on our region. But what do you do when patients make it to the office and office employees don’t? Is there a way to ensure employee safety in bad weather while still providing for patients’ needs? What’s your policy? Share your thoughts with us at MidwestMedicalEdition.com we’ll publish the feedback we get in an upcoming issue of MED.

NEW Learning Opportunities If you rely on MED’s Learning Opportunities column to stay on top of the latest conferences, CME courses, and upcoming events, visit MED’s searchable online calendar for newly-posted opportunities. MED’s calendar is updated regularly with new events and opportunities from around the region. Are you hosting a conference or event? You can post it for free with just a few clicks and promote it to MED’s growing online readership.

Using MED’s online Directory, powered by Locable, you can find and connect with area businesses that cater to healthcare providers. It’s easy and free for businesses and providers to be included in the Directory. With ongoing updates to our business identity solution tools, we make it simple to get the most out of the constantly-changing online environment. Being a part of MED online allows you to engage the online community in new ways and put the web to work for your practice.

Online Calendar Our online Calendar feature makes it easy to find and share local events specifically for heathcare professionals, so you will never miss a meeting or course you wanted to attend.

You can even list your own upcoming event – such as an office open house or a presentation for colleagues – for free.

MED is actively looking for doctors who are passionate about their hobbies or an artistic pursuit to feature in upcoming columns.

Write to us at Info@MidwestMedicalEdition.com to nominate yourself or a colleague.

Find links to these articles and more on the MED homepage.

March 2014

MidwestMedicalEdition.com

3

Sioux Falls Program Offers Incentives for Prenatal and Infant Care Director says physician referrals are vital to the Teddy Bear Den’s success

Every physician has encountered patients whose life situations are in as great a need of ‘care’ as their health.

Especially in the case of a pregnancy, a mother’s low income and/or lack of support can present a serious health risk for both her and her unborn child.

But a group called the Teddy Bear Den in Sioux Falls offers healthcare providers a tangible way to help these women deliver and raise healthier babies. The Sioux Falls program was established 17 years ago by the March of Dimes and is now independently run. Through a simple rewards program, the Teddy Bear Den encourages enrolled women to get good prenatal care, stop smoking, stay in school, participate in a food and nutrition program, and more. After babies are born and until they are 15 months old, mothers earn points for things like getting their well-baby checks, breastfeeding, and immunizing their infants on schedule.

“Physicians have to stamp or sign our

participants’ books when they come in for care,” explains executive director Sandy Lown. “As they acquire more stamps, they earn more points which they can then use to purchase things in our store.”

Housed in the basement of the Calvary Cathedral church in downtown Sioux Falls, the ‘store’ provides a wide range of new baby products, from diapers and wipes to cribs and strollers. Women can shop as often as they like, using their points for day-to-day supplies, or can bank points to purchase big ticket items.

Items are provided through donations, grants and fundraisers.

“It’s all about the future of our community,” says Lown. “These babies are our future and we have a vested interest in making sure that they get proper healthcare now. We want these women to be breastfeeding their babies and to make sure they are immunized. We know that good prenatal and infant care is going to mean these children are less likely to have health problems as they grow up.”

The Teddy Bear Den program relies heavily on referrals from area physicians.

Pregnant women who are under 18 or on WIC, food stamps, or Medicaid automatically qualify. A woman can live outside the area, but must get her healthcare in Sioux Falls. More than 1,600 area women are enrolled in the Teddy Bear Den program. Information on the program and the referral process can be found at www. teddybearden.com. ■

MED Advisory Board physician appointed to American Academy of Family Physicians Delegation Dr. Dan Heinemann to serve American Medication Association Sioux Falls family medicine physician Dan Heinemann, MD, a member of the MED Physician Advisory Board, has been appointed to the American Academy of Family Physicians’ Delegation to the American Medical Association for a two-year term.

Dr. Heinemann works in public policy and clinic administration at Sanford Health.

He has practiced family medicine for nearly 30 years and has experience in legislative affairs, quality and patient safety. Dr. Heinemann grew up on a family farm near Dell Rapids, South Dakota, and is a lifelong resident of the state. In 2012, he was appointed to serve as vice chair to the American Academy of Family Physicians’ Delegation. ■

Read bios of Dr. Heinemann and the rest of the MED Advisory Board online.

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Midwest Medical Edition

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5

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Avera

Avera Transplant Institute in Sioux Falls was recently awarded renewed accreditation from the Foundation for the Accreditation of Cellular Therapy (FACT) for

demonstrating compliance with the FACT-JACIE International Standards for the full scope of bone marrow transplant programming. This represents Avera’s fourth three-year accreditation for autologous transplant, and third three-year accreditation for allogeneic transplantation.

William Graham, DO, will serve as President of the medical staff at Avera Queen of Peace in Mitchell, South Dakota in 2014. Other elected

officers are Martin Christensen, MD, President Elect/VP, Brian Kampmann, MD, Secretary, David Malters, MD and Jennifer Tegethoff, MD, Members at Large, and Shawn Haley, MD, Hospital Based. Kelly Smith, MD, is the immediate Past President.

Jennifer Poppen has been named the interim CEO at Avera Creighton Hospital. Poppen

is a native of Madison, SD and a graduate of The University of South Dakota. She received her Masters of Health Administration from the University of Iowa, Iowa City. Poppen has been serving as an administrative fellow at Avera Sacred Heart Hospital since July 2013.

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Avera Sacred Heart Wellness Center is now a Silver&Fit participating fitness facility.

Silver&Fit is designed specifically to help older adults achieve better health through regular exercise and health education.

Silver&Fit provides eligible members with no-cost or low cost fitness memberships through arrangements with certain health plans. Silver&Fit is provided

by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated.

Benjamin C. Abbey, PA-C, has joined Chris Krouse, DO; Brian Kampmann, MD; John Swisher, DO, CAQ, Brandon Wegehaupt, PA-C, ATC, and staff at Avera Medical Group Orthopedics and Sports Medicine in Mitchell, South Dakota. Abbey has a BS in

Physician Assistant Studies and a BS in Health, Physical Education and Recreation. His healthcare background includes working as a Tissue Collection Technician for the South Dakota Lions Eye Bank and Assistant Professor of Military Science for the South Dakota State University ROTC. Dileep Bhat, MD, and his Dakota Urology Clinic practice and Avera Queen of Peace Hospital in Mitchell have formed a new alliance through an employment contract effective January 1, 2014. Dr.

Bhat and staff will now be called Avera Medical Group Urology.

Avera McKennan Hospital & University Health Center added an applied genetics team that will specialize in scientific and medical aspects of breast cancer. This team of

13 individuals, led by Dr. Brian Leyland-Jones, joined the Avera Institute for Human Genetics and Avera Cancer Institute from Edith Sanford Breast Cancer Research in Sioux Falls. Dr. Leyland-Jones previously served at the Winship Cancer Institute at Emory University in Atlanta, Georgia. Avera recently launched an initiative to use personalized medicine in pain management for patients having elective orthopedic surgery.

Black Hills Clayton Christensen has been selected as the Administrator for Regional Medical Clinic – Western Hills Professional Building in Rapid City,

overseeing nine specialty care practices, including Audiology, General Surgery, Neurosurgery, Otolaryngology, Plastic Surgery, Podiatry, Pulmonology, Sleep Medicine and Urology.

Rapid City Regional Hospital’s Cardiac Rehabilitation department hosted a 5K Fun Run/Walk in February, in recognition of National Cardiac Rehabilitation Week.

Stephen Tamang, MD, a family medicine physician, has joined the staff of Regional Medical Clinic-Aspen in Rapid City. He

joins Kathryn Barrett, MD. Dr. Tamang graduated from Saba University in Netherland Antilles and completed his residency in family medicine at Southern Illinois University in Springfield, Illinois.

Hill City Clinic medical providers Terry Graber, MD, and Amanda Taglioli, PA-C, have relocated to a new clinic location on Elm Street in Rapid City. This new location offers

improved patient experience with greater convenience and accessibility. The additional space, complete with updated décor, is more efficient in staff function and patient flow. Dr. Graber has increased his presence at the Hill City Clinic with an additional day during the week.

As part of the Tough Enough to Wear Pink Campaign, the Rapid City Regional Hospital Foundation hosted the Sixth Annual Cowgirl Pink Champagne Brunch in February at the Dahl Arts Center in downtown Rapid City. The

pink-themed event feastured brunch catered by Dakota Thyme, a silent auction, giveaways and a featured speaker. All proceeds from the brunch benefit the Regional Cancer Care Institute.

Midwest Medical Edition

United Airlines employees presented teddy bears to children in the Pediatrics Department at Rapid City Regional Hospital in January.

The Adventure Bear program allows United customers and employee to “give a bear, get a bear” for a $50 donation to the United Airlines Foundation. Both the donor and a child in need receive a limited edition bear designed by GUND. A new bear is designed and distributed each year.

Plastic Surgeon Karl Hapcic, MD, DDS, has joined Regional Medical Clinic. Dr. Hapcic

completed his MD at Eastern Virginia Medical School in Norfolk, Virginia, and residencies in cosmetic surgery, plastic surgery, general surgery, oral/maxillofacial surgery, anesthesiology and general dentistry. He will work directly with the surgical team at Regional Medical ClinicWestern Hills Professional Building. The addition of a plastic surgeon means comprehensive reconstructive surgery, as well as cosmetic procedures, are now available through Regional Medical Clinics.

Rapid City Regional Hospital’s Hospice of the Hills recently received a twostar achievement from We Honor Veterans following completion of its 20-month program. We Honor Veterans

is part of the National Hospice and Palliative Care Organization and works in collaboration with the Department of Veterans Affairs to help hospice providers recognize the unique needs of veterans and their families.

Hospice of the Hills is now one of 273 level two partners nationwide, and one of only two level two partners in South Dakota.

March 2014

Pediatrician Stephen Parys, MD, has joined the Regional Medical Clinic staff. Dr.

Parys graduated from Creighton University School of Medicine in Omaha and completed his residency through Creighton University; UNMCCUMC-Children’s Hospital Joint Pediatric Residency Training Program in Omaha, and St. Joseph’s Hospital and Medical Center in Phoenix. He joins Angela Anderson, MD, and Tara Ulmer MD, at Spearfish Regional Medical Clinic.

Mike McGrath is the new Director of Clinic Services for Regional Medical Clinics in Rapid City.

McGrath has been with Regional Health Physicians since 2008, serving as the Clinic Administrator for Western Hills Professional Building and most recently Regional Urgent Care clinics.

Sanford Sanford Health’s Quinn Stein, MS, CGC, has been appointed to the National Society of Genetic Counselors Board of Directors as a director-at-large. One of the first

genetic counselors in the state, Stein is a senior genetic counselor at Sanford and specializes in adult and pediatric genetics, down syndrome, prenatal screening and diagnosis, hereditary cancer, infertility and pre-implantation genetic diagnosis. He holds a master’s degree in genetic counseling from the University of Wisconsin.

Sanford Health surgeons Dennis Glatt, MD, and Curtis Peery, MD, and the Bariatric Program at Sanford USD Medical Center recently received recertification as a Bariatric Surgery Center of Excellence by the American Society of Metabolic and Bariatric Surgery (ASMBS).

Sanford Health is now selling access to its integrated approach to weight management at retail stores in Bismarck, ND, and Bemidji, MN. Profile by Sanford utilizes meal-replacement products, nutritious food and health coaches. Members consume both

Profile-produced and grocerystore food while coaches develop customized plans for their clients and offer advice on nutrition, exercise and behavior. Each member is also outfitted with wireless devices to track body weight and measurement, blood pressure, step count, and exercise intensity.

After 35 years of dedication to rural healthcare, Ed Weiland has retired from Sanford Health.

Weiland joined the Sanford Health Network in February of 2000 and spent the last 12 years in a leadership role for Sanford.

Weiland’s service is credited for Sanford Health Network’s growth. He also helped to develop advanced services such as electronic medical records, MyChart access and specialty outreach services delivered close to home, just to name a few.

Weiland, a native of Canistota, SD, retired at the end of 2013.

MidwestMedicalEdition.com

Sanford Aberdeen announced today that Ashley Hansen, Pharm.D., BCPS, has earned certification as a pharmacotherapy specialist from the Washington, D.C. based Board of Pharmaceutical Specialties.

This certification is the pharmacy profession’s highest credential in the area of pharmacotherapy.

Sanford Health CIO Arlyn Broekhuis has been recognized in Becker’s Hospital Review’s list of ‘100 Hospital and Health System CIOs to Know’. The leaders

were selected based on their demonstrated abilities to leverage existing and new technology to further the mission of their organizations while elevating the level of patient care.

Sanford Aberdeen began offered orthopedics and sports medicine services in Aberdeen this winter with the addition of Daniel Lister, MD. Lister

came to Aberdeen from Willmar, Minnesota. He received his undergraduate degree from the University of California-Davis and his medical degree from the University of California-Irvine.

Dr. Lister completed his residency in Orthopedic Surgery at the Letterman Army Medical Center in California and earned a subspecialty certification in sports medicine in 2011.

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South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Sanford continued Emergency Medicine specialist Kara Dahl, MD, has joined Sanford Aberdeen from Sarasota Emergency Associates in Florida. Dr. Dahl earned a doctor of medicine degree from Ross University School of Medicine, Portsmouth, Dominica and completed residency training in emergency medicine at Tampa General Hospital.

Sanford Health opened its newest Sioux Falls clinic in January. The

Benefis Health System in Great Falls, Montana is transitioning physician staffing of its Emergency Department to Sanford Health. This is the

first initiative as a result of the strategic alliance announced late last year between Benefis and Sanford Health. Sanford’s telehealth system will allow rural EDs to videoconference with emergency physicians in Sioux Falls at any time. Benefis and Sanford announced a new strategic alliance late last year, with a focus on physician recruitment and services, clinical initiatives, IT, improved quality, research, and cost reduction.

The Fruit Club and Children’s Miracle Network joined forces to raise money to help sick and injured kids in South Dakota this winter. Florida grapefruits and

new family medicine and pediatric facility is located at the corner of 69th Street and Louise Avenue in Sioux Falls. The 24,000-square-foot building has 36 exam rooms where four pediatricians and one family medicine provider are practicing. It features a “kid-friendly” atmosphere and color-coded signs to help patients find their way around

tangerines were sold in Aberdeen, Brookings, Huron, Madison, Mitchell, Pierre, Sioux Falls, Watertown, and Yankton with the proceeds going to Children’s Miracle Network at Sanford Children’s Hospital.

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

continued

.

Log on!

Siouxland

Other

Drs. Charles and Mary Murphy and Dr. Kamalesh Bala served as honorary co-chairs for the 16th annual June E. Nylen Cancer Center Winter Benefit in February.

Christina Konechne is the new Director of Operations for Horizon Health Care, Inc.,

The Winter Benefit is the signature fundraising event for the Cancer Center, raising $275,000 last year.

This year’s theme was ‘Cupcakes and Snowflakes’ and featured a live and silent auction and a beer and wine tasting. Funds raised from this year’s benefit are being used to purchase a new optical guidance system for one of the two linear accelerators.

Robert (Bob) J. Peebles, President and CEO of Mercy Medical Center in Sioux City has announced his plans to retire effective April 1,

according to Mercy Health Network President and CEO David Vellinga.

Peebles made his formal announcement to the Mercy Medical Center Board of Directors at its regular meeting in January. Under Peebles’ leadership, Mercy extended its healing ministry to the poor – particularly the homeless and those with no voice regarding access to care. Peebles also had a significant impact during his five-year tenure on per unit costs through improvements in productivity through work redesign and attrition.

a Howard, South Dakota-based company which provides medical, dental and mental health care through 18 rural sites in South Dakota. Konechne hold an MA in Health Care Administration and a graduate certificate in Long Term Care Management. Konechne lives near Madison.

Horizon Healthcare has opened a new location in Aberdeen, South Dakota. The new Aberdeen

Community Health Center on 5th Avenue will provide Aberdeen community with a wide range of health services including family medicine, pediatrics, emergency treatment, x-ray, lab services and mental/behavioral health.

Horizon received federal funding in September to open a community health center in Aberdeen.

South Dakota Medical Group Management Association

Spring Conference

Kaleidoscope of Change: Maintaining Perspective in Challenging Times

April 23-25, 2014 •

Holiday Inn Sioux Falls City Centre

Featuring: Tracy Spears Vice President, Transworld Systems Marty Jackley South Dakota’s Attorney General Jeff Tobe International Speaker and Consultant Greg Williams Security & Compliance Consultant, MMIC Group

For the full schedule or to register, visit our website at 8

www.sdmgma.org Midwest Medical Edition

What We’ve Learned About the Uninsured

By Dave Hewett, SDAHO

A

Poll Finds South Dakotans Favor Using Federal Funds to Cover Uninsured Through Medicaid Public opinion polling released by the American Cancer Society Cancer Action Network (ACS CAN) shows that registered

t this point it remains unclear what direction

the South Dakota State Legislature and Governor Daugaard will take on expanding Medicaid eligibility. Both sides of the political aisle are certainly considering the issue with Democrats supporting expansion while Republicans having a more mixed perspective.

Whether South Dakota takes advantage of the federal government’s offer to pay for the lion’s share of coverage for 48,000 South Dakotans or not, the intense debate has revealed several new aspects about those who do not have health insurance.

First, it is the case that people without health insurance delay or even avoid seeking health care treatment. The examples are more anecdotal than analytical but we’ve observed uninsured patients who don’t want to know the outcome of lab tests for fear that it will bankrupt themselves and their families. It is, if you will, reflective of the “South Dakota way” – to buck up and not be a bother. That attitude, by the way, is harmful to both quality and length of life.

We have seen that the uninsured do rely on the emergency room for their primary care and they wait too long to seek care for problems that were once simple to treat, but now involve much more expensive treatment paths.

Second, the economic benefit of coverage goes well beyond just the injection of

federal monies into the South Dakota economy. Enhanced coverage will reduce bankruptcies, which help not just providers but all businesses in the state. Enhanced coverage also will result in South Dakota having a healthier and more productive workforce. This is especially important given the state’s already full employment economy. Moving forward with coverage will also help larger employers (those with 50 or more employees) avert business penalties provided for in the Affordable Care Act. Finally, private insurance rates will moderate as uncompensated care provided in hospitals decline.

But we’ve also heard that new teambased approaches to managing the health of individuals are making inroads in improving the overall health of enrollees and reducing costs. Medicaid’s Health Homes initiative, inspired by enhanced federal reimbursement, is having a real and positive impact on enrollees as the provider community is tasked with, and rewarded for managing the health of these individuals.

We continue to hear that eventually South Dakota will adopt enhanced Medicaid eligibility. It’s unclear when that will happen but for every day it delays, very real South Dakotans are making unhealthy and expensive decisions about their personal health care. It’s costing the State coffers and it’s hurting the state’s economy.

That’s what we’ve learned through the first few months of 2014. ■

voters in South Dakota want the state to accept federal funds to broaden access to health coverage through Medicaid. By a 32-point margin, South Dakota voters support the decision, a move that would as allow as many as 48,000 low-income South Dakotans to get preventive care and treatments for cancer and other serious diseases.

The statewide poll, conducted by national political and public affairs research firm Public Opinion Strategies, was fielded in November 2013. South Dakota lawmakers currently face the decision of whether to make health coverage under Medicaid available to individuals and families up to 133 percent of the federal poverty level, as urged by federal health care reform. The poll was answered by 400 registered voters in South Dakota and has a margin of error of +/- 4.9 percent.

Regardless of self-reported political ideology, the poll shows that nearly two-thirds of South Dakotans support accepting the federal funding to cover more South Dakotans through Medicaid. Respondents in South Dakota were twice as likely to support accepting federal dollars to cover more people than they were to prefer turning down federal funds and leaving vulnerable populations uninsured.

According to ACS CAN, accepting the federal dollars to increase access to health coverage through Medicaid will allow more South Dakotans to see a doctor regularly, access preventive services such as Pap tests, mammograms and smoking cessation aids, and avoid unnecessary expensive visits to the emergency department. In addition, covering

MED Quotes

more of the uninsured through Medicaid will

“ Of all the liars in the world, sometimes the worst are our own fears.” — Rudyard Kipling

that hospitals and other health care providers

March 2014

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reduce the amount of uncompensated care provide. ■

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Dr. Samuel Nyamu, Internal Medicine, Sanford Aberdeen Medical Center.

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Photos courtesy Sanford

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e, in internal medicine, are very excited because we believe that this has the potential to really re-energize our specialty, . . .

Imagining the Future of Medicine

E

ven before biochemists Frederick Sanger and Walter Gilbert shared the 1980 Nobel Prize in chemistry for their separate work in DNA sequencing, medical scientists understood that the ability to create and analyze chromosomal representations would revolutionize the way medicine was practiced. After all, as the National Human Genome Research Institute states, “Virtually every human ailment, except perhaps trauma, has some basis in our genes.”

But, until the results of the Human Genome Project were released in 2003, the application of genetics in medical practice was largely limited to a set of diseases for which chromosomal abnormalities had been identified. It is only since the costly instrumentation and technical support necessary for gene sequencing has come within reach of South Dakota laboratories that genomic medicine has been poised to have a major impact on clinical practice in the region.

“I describe it as a change in mindset,

a change in how you approach patients,” says Dan Blue, MD, President of Sanford Clinic in Sioux Falls. “When you have a deeper understanding of these tools and resources, you begin to see how they apply to decisions you make regarding your patients.”

Over the course of the next few months, Sanford’s 170 internal medicine physicians will begin to experience that change in mindset for themselves as they train to be a part of Sanford’s new genomic initiative, Sanford Imagenetics.

Funded by a $125 million dollar gift from philanthropist Denny Sanford, Sanford Imagenetics will allow internal medicine physicians to work hand-in-hand with clinical geneticists, genetic counselors and diagnostic clinical genetics laboratories to fully integrate high-tech genomic medicine into their clinical practice. With in-depth evaluation of family history and targeted genetic testing, Sanford says patients can expect better health outcomes and a higher overall quality of care.

“The unique thing here is that we are

By Alex Strauss

Sanford Imagenetics March 2014

MidwestMedicalEdition.com

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T

here is so much to be learned and explored here. The amount of information is just mind-boggling.

That is why we believe it is important to be on the front edge.

Dr. Megan Landsverk, director of the Sanford Clinical Molecular Genetics Laboratory with a flow cell from the HiSeq 2500, the dominant sequencing platform at major U.S. genome centers.

making it real in terms of clinical practice,” says Gene Hoyme, MD, a board-certified geneticist and president of Sanford Research.

“There are some health systems that have dipped their toe in the water, in terms of pharmacogenetics, but we are truly moving this into the realm of everyday practice.”

A number of Sanford specialty providers, including physicians with Edith Sanford Breast Cancer, Sanford Children’s, Sanford Women’s and other areas, already regularly use genetic evaluation as part of their treatment planning for specific illnesses. In addition to providing high-end genetic testing for internal medicine doctors who request it, Sanford Imagenetics will imbed genetic counselors into its four largest internal medicine practices in Sioux Falls, Fargo, Bismarck, and Bemidji, Minnesota. Sanford plans to add four more clinical geneticists to its current group of five. In some markets, physicians, counselors, geneticists, educators, researchers and lab services will be housed together.

Education of current and future providers

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is another major component of the initiative, as are intensified research efforts through the Sanford Clinical Molecular Genetics Laboratory. This newly-developed lab will provide single-gene sequencing, whole exome sequencing, and targeted mutation analysis in oncology and selected single gene disorders. The lab is currently seeking certification through the Clinical Laboratory Improvement Amendments program.

“Sanford Imagenetics is a major initiative because it means having the resources, the scientists, the research, the genetic counselors, the data people, the bioinformatics, etc., to make it meaningful,” says Dr. Blue. “As physicians, our role is going to be to practically apply it every day.”

Clinical Application of Genomics Samuel Nyamu, MD an internal medicine physician in Aberdeen, is one of the physicians who will soon be able to take advantage of the Sanford Imagenetics initiative in the

”

treatment of his patients. Dr. Nyamu – ‘Dr. Sammy’ to his Aberdeen patients and colleagues – says it is easy to imagine a myriad of ways in which he will be able to apply this technology in his practice.

“Almost every day I see someone who could benefit from this,” he says, referring to the program’s initial focus in pharmacogenetics. “Often, I see patients come back to my clinic because of drug side effects that could have been avoided had we had a better understanding of how they metabolize medicine. Without this genetic information, I have no idea how a given patient will metabolize medicine and I just have to give them a general dose and see how it goes.”

When physicians like Dr. Sammy identify patients for whom they believe they could use additional genetic information, such as those who need blood thinners, statins, or anti-anxiety medication, a blood sample is sent to the molecular lab in Sioux Falls.

Sanford expects to begin offering the initial DNA analyses for a broad panel of pharmacogenetic screening tests this spring. Results

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will become part of the patient’s private electronic medical record, where they can serve as a reference for future prescribers.

Internal medicine patients will also have the opportunity to undergo genetic counseling for familial disorders as well as precise genetic testing from a simple blood draw.

Educating for the Future Sanford will provide training to its internists on the practical applications of genetics and genomics, including not only the testing itself, but also how and when to work with their genetic counselor colleagues. Sanford Imagenetics has partnered with the Sanford School of Medicine of the University of South Dakota, as well as Augustana College to develop new academic programs for the next generation of doctors, nurses and scientists in genomic medicine. A certification program and other types formalized genomic training are being considered.

“Eventually, we plan to develop a residency in genetics,” says Dr. Hoyme. “This will be a two-year training program, from prenatal genetics through adult life. Students would come right out of medical school and do a combined internal medicine/genetics residency. That is on the docket.”

“It is important that we not only expand and educate the current workforce, but that we prepare the genomic medicine workforce of the future to work at Sanford as elsewhere,” adds Dr. Blue. “We know that genomics are going to explode over the next few years and there are going to be national shortages. We are trying to be proactive.”

Genomic Research Initiatives Although it is hard to underestimate the potential value of genomic information, genomic testing is not cheap. It relies on advanced equipment and highly trained technicians and can range from $200 to several thousand dollars per test. Until the clinical benefits can be proven and documented, few payors will cover the testing. Sanford is hopeful that the data collected by Sanford Imagenetics

March 2014

will help change that. Until then, cash options and payment plans will be available.

“All of the things that we are suggesting need to be validated so that when they are rolled out in practice, it can be shown to be helpful to patients and insurance companies will cover them,” says Dr. Hoyme. Sanford Imagenetics will include development of a rigorous research program to define the genomic markers most successful in managing primary care for adults. “Research outcomes are written into the deliverables,” We are going to be documenting and stretching and pushing the envelope.”

Genomic testing will be voluntary.

Although pharmacogenetics is unlikely to raise ethical considerations, more complex questions may arise with the evaluation of disease risk. For this reason, the Sanford Imagenetics team will include a genetics bioethicist whose job it will be to help guide providers and patients through what Hoyme says can be a “quagmire” of ethical dilemmas. Genetic counselors are trained to help patients explore their thoughts and feelings surrounding genetic testing and to weigh the costs and benefits.

While the implications of genomics are far-reaching for patients, Dr. Sammy says he and his internal medicine colleagues are hoping the infusion of new knowledge will also be a shot in the arm to for the specialty itself. “We, in internal medicine, are very excited because we believe that this has the potential to really re-energize our specialty,” he says. “Internal medicine can sometimes be seen as ‘boring’ in relation to other specialties, but we hope that this injection of new information and new knowledge, bringing something that has been happening behind the scenes into the forefront, will get more people interested in working in internal medicine.”

“It is a lot more than sending off a saliva or a blood sample and getting a report back,” says Dr. Blue, who says the experts of Sanford Imagenetics will serve as a resource for providers both in and outside of the Sanford system. “There is so much to be learned and explored here. The amount of information is just mind-boggling. That is why we believe it is important to be on the front edge.” ■

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Certified Genetic Counselor Quinn Stein, MS, CGC, was one of the first genetic counselors in the state of South Dakota.

S

anford Imagenetics is a major initiative because it means having the resources, the scientists, the research, the genetic counselors, the data people, the bioinformatics, etc., to make it meaningful. As physicians, our role is going to be to practically apply it every day.

”

Eric Larson, MD, board-certified internal medicine physician will be one of the 170 internal medicine doctors taking part in Sanford Imagenetics.

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Revamped Fitness Program Promises More Accountability, Better Communication The Avera Fitness Center in Sioux Falls has refined it’s medically integrated health and fitness program to improve outcomes for patients and make it more ‘user friendly’ for referring physicians.

“We have been a referral-based, medically integrated center since before the pouring of the foundations,” says Barbara Sogn-Frank, Marketing Manager of the Avera McKennan Fitness Center. “What has changed is the name of our program, which is now called Next Steps Medical Integration, as well as some of the offerings and structure of programs for specific purposes.”

Next Steps is an 8-week program that typically starts with a referral from a physician or physical therapist. Based on the results of an initial fitness assessment and recommendations from the referring physician, the transition program establishes a personalized independent exercise program organized around core fitness categories and supported by weekly checkins with a fitness specialist.

“We have identified 8 categories in which physicians may want their patients to have some extra help resuming their normal activities,” explains Medical Integration Coordinator Jenni Struck. These categories include:

independent exercise in the pool, etc. SognFrank says the Next Steps program has enhanced its ability to track patients’ progress and made it easier for providers to connect with someone at the fitness center for updates.

“Our goal is to work closely with the referring entity,” says Struck. “We want to make it easy for physicians, who can fill out a referral form or just call the center. We follow-up to let the doctor know when a patient has started the program and we communicate their recommendations or restrictions to the fitness specialist. If anything changes during the course of the program, we get in touch with the physician again.”

“Increasingly, physicians are being urged and rewarded for supporting wellness care,” says Sogn-Frank. “We hope that the documentation, tracking, and communication involved in this program will be of value to them, as well as their patients.”

All Next Steps Medical Integration staff members have at least a 4-year degree in exercise science. Several have multiple certifications through the American college of Sports Medicine and other accrediting bodies. The cost of the 8-week program is $99. ■

All Next Steps Medical Integration staff members have at least a 4-year degree in exercise science.

• Pulmonary • Cardiac • Diabetes • Orthopedic • ‘Prehab’ prior to surgery • Weight management • Transitional care Patients enrolled in the program are required to have at least two contacts with the center each week, but are welcome to come as often as they like. Depending on the goals, that might be through classes, supervised instruction on the fitness floor,

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Photos courtesy Avera Fitness Center

• Functional (arthritis)

Midwest Medical Edition

South Dakota Receives Poor Marks for Emergency Care Environment South Dakota received an overall D+ in the 2014 American College of Emer-

gency Physicians’ (ACEP) state-by-state report card on America’s emergency care environment. The state received three D’s and an F in five categories, struggling with issues such as medical workforce shortages and unmet needs for substance abuse treatment and a plummeting number of psychiatric care beds. Unfortunately, they are in good company.

“America’s Emergency Care Environment: A State-by-State Report Card – 2014” evaluates conditions under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers. It has 136 measures in five categories including access to emergency care (30 percent of the grade), quality and patient safety (20 percent), medical liability environment (20 percent), public health and injury prevention (15 percent) and disaster preparedness (15 percent). While America earned an overall mediocre grade of C- on the Report Card issued in 2009, this year the country received a near-failing grade of D+.

“South Dakota has improved slightly in some measures, and we have successfully implemented some telemedicine programs to help meet the needs of our rural population, but we struggle with having an adequate medical workforce to meet the needs of our residents, and we need a state EMS medical director,” said Dr. John Travnicek, president of the South Dakota Chapter of ACEP. South Dakota’s Access to Emergency Care has substantially worsened since 2009 to a D+, with low levels of providers and concerns regarding mental health care. South

Dakota ranks among the bottom 10 states in per capita rates of emergency physicians and plastic surgeons and faces substantial unmet needs for both primary care and mental health providers. The number of psychiatric care beds has plummeted since 2009, from 25.7 to 15.6 per 100,000 people. Additionally, only 36 percent of the population is within an hour of a level I or II trauma center.

The state received a failing grade in the category of Quality and Patient Safety Environment. According to the Report Card, South Dakota does not provide funding for quality improvement of the emergency medical services (EMS) system or an EMS medical director. The state also lacks a uniform system for providing pre-arrival instructions, which could help save lives in a rural state where EMS providers may have long response times.

South Dakota received a D- in the category of Public Health and Injury Prevention.

According to the Report Card, immunization rates for children and vaccinations for older adults are among the worst in the nation.

Traffic fatalities are a major cause of preventable death and a driver of emergency care needs in South Dakota (15.7 per 100,000 people). The state also has the weakest child safety seat and seat belt laws in the country, resulting in the second lowest seatbelt use rate of 73.4 percent.

The state earned a C+ with Medical Liability Environment and is ranked 19th in the country. It has the third lowest medical liability insurance premiums for primary care providers and specialists.

The Report Card’s recommendations for improvement include: t Fund a state EMS medical director and

quality improvements of the emergency medical services system. t I ncrease the health care workforce to

meet the needs of an aging population.

Address the need for primary care and mental health care providers across the state. t Improve traffic laws to decrease the

number of preventable deaths and implement stronger seatbelt and child safety seat use laws and distracteddriving laws for all drivers. t Build on the systems and infrastructure

it has created for Disaster Preparedness to improve the Quality and Safety Environment. A uniform system for pre-arrival instructions could improve emergency response outcomes, as could a destination policy for trauma patients.

See the full report card and learn more about ACEP on our website.

March 2014

15

Clinical Spotlight

Avera Cancer Institute Approved To Offer Comprehensive PROVENGE Treatment Avera is the only site in the region to offer this therapy, offering hope for men with advanced prostate cancer Avera McKennan Hospital & Univer-

sity Health Center and the Avera Cancer Institute are now approved to offer complete PROVENGE therapy for men living with advanced prostate cancer. Men taking PROVENGE have experienced increased longevity with few side effects.

PROVENGE (sipuleucel-T), manufactured by Dendreon Corporation, is designed to stimulate a patient’s immune system to target prostate cancer cells. As an autologous cellular immunotherapy, each dose is made individually for every patient, using his own immune cells. The treatment involves both cell collection and then reinfusion of cells, repeated three times approximately every two weeks.

Avera Cancer Institute medical oncologists have been offering PROVENGE infusion of cells since 2011, and now, Avera is the only site in this region to offer the collection of cells, making Avera the only PROVENGE comprehensive site, with the next closest sites being Minneapolis, Des Moines and Omaha. What this means is that men no longer need to travel to

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Minneapolis, Des Moines or Omaha to have their cells collected, but can have both the collection and reinfusion at Avera.

Avera McKennan’s Apheresis Unit collects immune cells from the patient through a process called leukapheresis.

Collected cells immediately are shipped to a Dendreon manufacturing facility where the cells are manufactured into the patient’s own personal dose of PROVENGE. Each dose of PROVENGE is individualized to consist of the individual’s own immune cells that have been activated to identify and attack prostate cancer cells. It is the first in a new class of therapy to use this approach.

Dr. Mark Huber, Medical Oncologist with Avera Medical Group Oncology & Hematology, said the main benefit of the treatment is a four-month survival advantage, on average, with minimal side effects. “There’s a good survival benefit with few side effects or risk,” Dr. Huber said. “It’s nice to be able to provide this new state-of-the-art treatment for this specific group of patients at Avera McKennan and the Avera Cancer Institute,” Dr. Huber said.

In a PROVENGE clinical trial • More men in the PROVENGE group were alive three years after the start of the study than men not treated with PROVENGE

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• PROVENGE reduced the risk of death by 22.5 percent for patients in the PROVENGE group • Only 1.5 percent of men discontinued treatment with PROVENGE due to side effects

Patients who qualify for this treatment are those with prostate cancer that has spread beyond the prostate and is resistant to hormonal treatment.

Patients also must be free of severe pain or symptoms due to prostate cancer.

Dr. Huber said that while PROVENGE does not cure prostate cancer, it delays it without harsh side effects. Side effects are generally mild to moderate, and most commonly include chills, fatigue, fever, back pain, nausea, joint ache and headache.

According to the American Cancer Society, prostate cancer is the most common non-skin cancer among men, with an estimated 238,590 new cases diagnosed in 2013. More than 2 million men in the United States count themselves as prostate cancer survivors.

Prostate cancer is the second leading cause of cancer deaths in men, with nearly 30,000 deaths annually. One in six men will be diagnosed with prostate cancer during his lifetime. ■

Read more about PROVENGE therapy at Avera on our website.

March 2014

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Local Football Study Published in National Journal Assessments show no postseason deficits in neurologic function A pilot study titled

“Effects of Youth Football on Select Clinical Measures of Neurologic Function: A Pilot Study” has been published in the Journal of Child Neurology. The Sanford Research study \was led by Thayne Munce, PhD, associate director of the National Institute for Athletic Health & Performance at Sanford Health in Sioux Falls.

The neurologic function

of 10 youth football players was assessed prior to and immediately following a 12-week season. There were no deficits among any of the clinical measures used, including tests of balance, memory, reaction time and reading speed. In fact, some improvements were discovered in areas such as postural stability and reaction time.

Researchers at the National Institute for

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Athletic Health & Performance started tracking youth football players in 2012 using accelerometers placed inside the helmets of players. Those accelerometers track the number of hits, magnitude of hits and location of hits to the players’ heads during practices and games. The overall goal is to gain a better understanding of the risk of brain injury in youth football in an effort to improve player safety. ■

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Then & Now Our Changing Medical Landscape

Dr. David Bean, Psychiatrist Professor of Psychiatry at USDSM and Vice Chairman for Forensic Services

D For anyone who truly wants to understand the history of psychiatric medicine – or, even the history of medical education – in the South Dakota region there are few better resources than David Bean, MD, a board-certified psychiatrist with Avera Medical Group University Psychiatry Associates in Sioux Falls, a USDSM Professor of Psychiatry, and Vice Chairman for Forensic Services. As the psychiatric residency program prepares to celebrate 27 years this summer, Dr. Bean shared some of his recollections, as well as his wit and wisdom, with MED.

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r. David Bean, one of the

best-known psychiatrists in the region, did not start his career in psychiatric medicine. After graduating from the University of Minnesota School of Medicine and joining the Air Force in the early 60s, Dr. Bean spent several years delivering babies in Minot, North Dakota. “At the time, they said, ‘What do you want to do?’ and I said ‘I want to do surgery.’” Bean says the program’s director simply ‘declared’ him an orthopedic surgeon and he became a part of a preeminent pediatric orthopedic surgery program. That is just one of Dr. Bean’s many colorful stories.

But Bean was not destined for a surgical career. More than a decade later, in 1977, Bean was moving to South Dakota to chair the growing medical school’s department of psychiatry and to help transform the state psychiatric hospital in Yankton – whose name had changed from the Yankton State Hospital to the South Dakota Human Services Center in 1974 – as its new director. Bean was hired through a joint agreement between the South Dakota Department of Corrections and the state Board of Regents.

“The treatment programs were slightly better than nothing when I got there, but not by much,” recalls Dr. Bean, who, along with one other psychiatric colleague, was responsible for the care of 700 hospital patients.

While attitudes toward the mentally ill had changed dramatically since Austrian physician Leo Kanner, the world’s first child psychiatrist, worked at the facility in 1924, Bean says they still had a long way to go.

“The long and short of it was that I said I would come if we could take over the state

“The long and short of it was that I said I would come if we could take over the state hospital and turn it into a modern hospital. That was the deal.” hospital and turn it into a modern hospital.

That was the deal.”

He started with the staff. “At that time, unlicensed doctors could be certified to work in the state hospitals as psychiatrists. This was not uncommon in states. The idea seemed to be that, even if you weren’t good enough to treat regular patients, you were good enough to care for the mentally ill.”

The woeful understaffing with unlicensed doctors had much to do with the pay scale – about $20,000 a year.

“The Kneip [Governor Richard Kneip] administration said ‘How much do you need?’ and I told them that we needed to be paying these people $50,000 a year. We began to advertise for competent physicians who could teach medical students and were willing to work in a hospital to resurrect it.

I let the unlicensed doctors know that they had to get licensed or leave. We became the

Midwest Medical Edition

highest paid psychiatric institution in the nation and eventually we got a full complement of ten fully-trained psychiatrists.”

By the time Dr. Bean left the hospital in 1984, the modernized facility was delivering higher-quality psychiatric treatment, had restarted its adolescent unit, and had added a geriatric psychiatric program which became Medicare-certified.

Although the state hospital was changing, so was psychiatric education in the region. The psychiatric residency program, which welcomed its first residents in 1987, was the first residency program offered after USDSM became a 4-year medical school. The program recently expanded from 4 to 6 residents per year. As of last June, it had graduated 79 fully-trained adult residents, 24 of whom extended their residency training to include a two-year child fellowship. The Child and Adolescent Fellowship program was approved in 1995 and has graduated 33 Child and Adolescent Psychiatrists, currently one of the most-needed specialties nationwide.

While, Bean is excited about the future of the program and the specialty, he is also eager to remind anyone who will listen of its proud history. As we wrapped up our interview, he added, “There is only one medical specialty board represented by a signer of the Declaration of Independence and that was Benjamin Rush, a psychiatrist from Philadelphia. He wrote the book on psychiatry in America and was the father of the American Psychiatric Association, which was the first medical association, established even before the AMA.” ■

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March 2014

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19

Area Health Systems Help Launch

Specialty Pharmacy Network

Avera Health in Sioux Falls and Regional Health in Rapid City have both agreed to commit resources, expertise and capital to support a new model of integrated care for patients who require specialty drugs.

ExceleraRx Corp. is a national network of specialty pharmacies based at health systems. It was formed in 2012 to enable member organizations to gain access to limited-distribution drugs and provide continuity of care for patients with complex conditions. Avera and Regional Health are joined in this venture by Fairview Health Services of Minneapolis, Catholic Health Initiatives based in Denver, Intermountain

Healthcare of Salt Lake City, Henry Ford Health System of Detroit, and Marshfield Clinic in Eau Claire, Wisconsin.

“We are thrilled to partner with these visionary health care organizations in the forming of Excelera,” said Dr. Dave Kapaska, Regional President and CEO of Avera McKennan Hospital & University Health Center. “Through the Excelera network, we are collaborating with these partners to establish best-practice care protocols, and effective management of specialty pharmaceuticals for the best possible patient outcomes.”

Specialty pharmaceuticals are expensive

drugs that may require special handing and administration and are often used to treat the most ill and clinically complex patients, such as those with multiple sclerosis, cancer, or rheumatoid arthritis. Within the conventional pharmacy model, providers cannot easily monitor whether patients with complicated illnesses are taking medicines properly or getting the best benefit from the medication.

The Excelera network will negotiate on behalf of its member organizations to remove barriers to specialty drug access and monitoring. Patients and providers of health systems in the Excelera network will benefit

Toe-Walking Clinic Children’s Care now offers a multi-disciplinary team approach to evaluating Idiopathic Toe-Walking (ITW).

Pediatric Physiatrist Dr. Julie Johnson, a physical therapist, and a certified orthotist provide a collaborative evaluation for optimum treatment of toe-walking.

Benefits of Our Toe-Walking Clinic ■

■

■

Early identification of ITW to prevent shortening of the calf muscles and abnormalities in gait and balance.

Thorough evaluation of musculoskeletal, neurological systems, and gait pattern – plus, screenings for sensory processing, motor development, and foot/ankle alignment.

Team approach to treatment to determine if physical therapy or a custom-fit orthotic would assist in normalizing the gait pattern.

Call (605) 444-9700 in Sioux Falls or (605) 791-7400 in Rapid City to schedule an appointment.

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1020 W. 18th St., Sioux Falls, SD 57104-4707 7110 Jordan Drive, Rapid City, SD 57702-8738 www.cchs.org

Midwest Medical Edition

by working with a specialty pharmacy that is a member of their care team, can easily access specialty pharmaceuticals, and knows the patient’s care plan.

“Specialty drugs represent the fastest-growing segment of health care today,” says Steve Petersen, Assistant Vice President for Pharmacy Services at Avera McKennan.

“These are high-cost drugs with narrow indications. The Excelera network not only helps with access, but also careful management

of these drugs, so that our health systems will not incur costs due to inappropriate or ineffective use of specialty drugs.”

Avera Health and Regional Health were among founding members that developed the vision for Excelera. “As we move into an era of Accountable Care Organizations, we will be responsible for managing covered lives. The Excelera network gives us an even greater ability to deliver high-quality care while controlling costs,” says Petersen. ■

Trial to Test Dissolving Device for Heart Patients Sanford Heart Hospital has started a clinical trial to study a dissolving device in patients with coronary artery disease (CAD). The ABSORB III clinical trial will investigate the safety and effectiveness of the Absorb Bioresorbable Vascular Scaffold (BVS) device, manufactured by global health care company Abbott. Absorb is a small mesh tube designed to open a blocked heart vessel, restore blood flow and dissolve into the blood vessel over time.

ABSORB III is the first U.S. clinical trial to evaluate the potential benefits of Absorb in comparison to a metallic drug eluting stent, in patients with CAD, the most common form of heart disease. Sanford is one of a select group of hospitals in the region and in the country to enroll patients in this trial, which could potentially lead to new treatment options for heart patients.

CAD is a leading cause of death for men and women in the United States.

Since the 1970s, physicians have treated patients with CAD with balloon angioplasty, metallic and drug eluting metallic stents, allowing many patients to avoid open-heart surgery. Unlike a metallic stent that remains permanently in the body, Absorb is made of polylactide, a naturally dissolvable material commonly used in medical implants such as dissolving sutures.

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The ABSORB III clinical trial will enroll approximately 2,250 patients, the

majority in the United States. ■

March 2014

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21

South Dakota Study Shows Major Weight Loss in Breast Cancer Survivors

Results of an Avera-sponsored research study in which breast cancer

survivors achieved significant weight loss were presented at the 36th Annual San Antonio Breast Cancer Symposium in December 2013. The study consisted of 24 postmenopausal breast cancer survivors with an average body weight of 220 pounds who lost an average 44 pounds during a five-month period when placed on a lowcarbohydrate diet.

“Obesity and weight gain remain significant issues in breast cancer survivors,” said Amy Krie, MD, Medical Oncologist with Avera Medical Group Oncology & Hematology, and Clinical Director of the Avera

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Breast Center at the Avera Cancer Institute.

Research has demonstrated that postmenopausal obesity increases the risk of developing breast cancer. For survivors of breast cancer, being obese has been shown to increase the risk of cancer recurrence and death.

“Some of this may be related to fat cells being a source of estrogen which fuels most breast cancers in postmenopausal women,” Dr. Krie said. “However the relationship between obesity is probably more complex than just that and probably has something to do with increased inflammation in the body as well.”

The women in the study had early-stage, estrogen receptor-positive breast cancer.

They were an average age of 67 years and were all under treatment at the Avera Cancer Institute. They had completed surgery and adjuvant chemotherapy but had no underlying inflammatory conditions or diabetes.

Participants in the study ate protein-based meal replacements (0.5 g protein per pound of actual body weight) for three of four daily meals. The diet was restricted to include less than 40 g of carbohydrates and 800 to 1,200 calories per day.

During the 19-week period, the mean weight loss was 19.9 percent of total body weight, or the equivalent of 43.7 pounds.

Total body fat lost was 6.85 percent. Weight loss averaged 5.5 pounds in week 1, and 2.14 pounds per week in weeks 2 to 19. “All but one of the women in this study were receiving endocrine therapy, making the significant weight loss remarkable, as anti-estrogen therapies are known to contribute to weight gain,” Dr. Krie said.

Not only were patients able to lose a significant amount of weight, but the weight loss was accompanied by rapid and significant reductions in serum hormonal levels and inflammatory markers, the study authors reported. Some of these inflammatory markers have been shown to be associated with poor prognosis in other breast cancer studies.

The study design was based in phases.

Phase 1 is characterized by rapid weight loss.

Three following phases are structured around a goal to reintroduce normal foods. During the three end phases, dietary and exercise counseling is introduced to help women maintain their newly achieved weight. The diet is currently being offered at the Avera Cancer Institute in Sioux Falls through the Ideal Living program.

With the positive results of this smallscale feasibility study, larger trials evaluating the role of carbohydrate restriction in cancer survivors are currently underway. ■

Midwest Medical Edition

The Nurses’ Station Nursing News from Around the Region

FACT Because of expected retirements, South

Dakota will need over 8,000 new healthcare workers by 2020 to maintain current levels of access.

According to a report by the Federal Bureau of Health Professions, during 2008 to 2010 California had 743 registered nurses per 100,000 people per capita compared to South Dakota at 1,248 RNs per 100,000 people. ■

Donation Honors ‘Guardian Angels’

The Avera Sacred Heart Foundation recently received a donation in honor of Amanda Archer, Lynette Auch, Liz Healy, Sr. Corrine (MMC Nursing Professor), Paul Foss (MMC Nursing Student), Linda Peterson, Dr. Jill Sternquist and Dr. Stephanie Wieman.

The donation comes from a couple who wanted to honor these staff members for the care that was provided to them during the birth of their daughter, and did this with a “Guardian Angel” donation to the Women’s Center Fund. The couple said, “My husband and I were extremely blessed to have our first child at Avera Sacred Heart… We are forever grateful for your hospitality and will continue to sing your praises for the care we received.”

The Avera Sacred Heart Foundation’s Guardian Angel Program gives patients and families the opportunity to honor their physician, nurse, housekeeper, volunteer or any care giver who made a difference in their stay. Each person honored receives a “Guardian Angel” pin. ■

Elmellouki

Three New CRNAs for Worthington | Sanford Worthington Medical Center welcomed 3 new certified registered nurse anesthetists (CRNA’s) in late 2013.

David Kallas, CRNA, received his master’s degree in nurse anesthesia from Mount Marty College and worked for 20 years as an RN at Sanford in Sioux Falls. Misty Hill, CRNA received her MS from Mount Marty College. She worked in Kansas City before coming to Sanford Worthington. Andrea Roberts, CRNA, received her Masters of Nursing in Anesthesia Nursing from the U.S. Army Graduate Program in Anesthesia Nursing. She previously

worked in Arkansas, Maryland and Delaware. ■

Turnis

Hunter

Regional Recognizes DAISY Award Winners Andrea Elmellouki, Mindy Turnis, and Kathleen “Kate” Hunter all received

DAISY Awards for Extraordinary Nurses from Rapid City Regional Hospital in recent months.

Elmellouki has been a Registered Nurse (RN) in the Medical Unit for nearly two years and nominated for the award by a patient. The nomination described the patient’s hesitancy about a procedure but praised Elmellouki for going beyond expectations to make sure he understood the entire process and procedure. “She genuinely cared about my anxiousness,” the patient said. “She honestly cared about my stress and went to great lengths to make sure I was comfortable with everything that was happening.”

Turnis has been an RN in the Progressive Care Unit for a year. She was nominated by a patient’s family who said Turnis always came in the mornings with a beautiful smile and would always say goodbye to the family before going home. “She was so gentle and compassionate to our mom,” the family said, “Mindy’s caring was a blessing.”

Kate Hunter has been a hospice nurse for three years. She was also nominated by a patient’s family member who described her as, “a very kind-hearted, loving and caring woman.” The family member said Hunter, “went beyond just caring for my dad, she became close with him and he even said she was his favorite nurse. She made the process of losing him a little bit easier.” ■

The Wall Street Journal Feature’s Regional Hospital’s Navigation Project An article in The Wall Street Journal in February focused on a major project designed to help patients navigate the campus at Rapid City Regional Hospital. The article quotes hospital CEO Tim Sughrue and features a photo of a Regional Hospital employee demonstrating one of the hospital’s new direction-guiding digital kiosks.

In the past year, Rapid City Regional Hospital completed a significant project to improve how visitors and patients get around the hospital.

Among other things, the $300,000 project included detailed new signage with simplified language, color coding, and the digital kiosks. As Wall Street Journal reporter Laura Landro observes, hospital navigation —or what design experts call ‘wayfinding’— is a challenge for many healthcare facilities, even though polls consistently show that it is a major component in patient satisfaction.

Rapid City Regional Hospital and its project were featured

in the February 4th issue of The Wall Street Journal. ■

24

Midwest Medical Edition

Learning Opportunities March – May 7:30 am – 4:00 pm.

22nd Annual Avera Trauma Symposium

March 7 & 8

April 16

EMS Conference 2014 Location: Sioux City Convention Center, Sioux City, IA Information & Registration: www.unitypoint.org/professional-education

Location: Sioux Falls Convention Center Information: mckeducation@avera.org Registration: 605-322-8950, www.Avera.org/conferences

March 14 & 15

April 25 – 26 Friday 3:45 pm – Saturday 5:00 pm

South Dakota Emergency Medicine Winter Conference

13th Annual Sanford POWER Strength & Conditioning Clinic

Location: Rushmore Plaza Holiday Inn, Rapid City Information & Registration: 605-719-8222, sjankord@regionalhealth.com

Location: Sanford Fieldhouse Information & Registration: 605-312-7809 Sanfordhealth.org/forms/PowerStrengthConditioning

March 27

8:00 am – 5:00 pm Avera Transplant Institute Symposium

May 2 – 3

Location: Prairie Center, Avera McKennan Information: mckeducation@avera.org Registration: 605-322-8950, www.Avera.org/conferences

Location: Best Western Ramkota Hotel, Sioux Falls Information: 605-312-7808, tryg.odney@sanfordhealth.org

7:00 am – 5:15 pm 8th Annual Sanford Sports Medicine Symposium

8:00 am – 3:45 pm 40th Annual Perinatal Conference May 7

8:00 am – 6:30 pm Sanford Pancreatico-Biliary Symposium, Making Pancreatic Cancer History April 4

Location: Sanford USD Medical Center, Schroeder Auditorium Information: 605-328-6190, Brenda.wolles@sanfordhealth.org

8:00 am – 6:30 pm Sanford GI Symposium, Current Trend in GI April 5

Location: UnityPoint Health – St. Luke’s, Sioux City, IA Information & Registration: 712-279-8941; www.unitypoint.org/professional-education

8:00 am – 6:00 pm 19th Annual North Central Heart Vascular Symposium May 9

Location: Sanford Center, Dakota Room 2130 Information: 605-328-6190, Brenda.wolles@sanfordhealth.org

Location: Sioux Falls Convention Center Information & Registration: 605-977-5311, www.Avera.org/conferences

7:30 am – 5:00 pm Pediatric Trauma Symposium

NOTE: The faculty, staff, and students of the Health Information Management Programs at Dakota State University will join with others in recognizing the American Health Information Management Association (AHIMA) Health Information Professionals (HIP) Week, March 16‒22, 2014. This year’s theme is “Transforming Healthcare with Information.” Health information management (HIM) is an allied health profession that is responsible for ensuring the availability, accuracy, and protection of the clinical information needed to provide healthcare-related decisions. For more information about the AHIMA, visit www.ahima.org and for more information about Dakota State University’s Health Information Management Programs, visit www.dsu.edu/bis/him

April 8

Location: Sanford Center, Dakota Room Information: www.Sanfordheaht.org/ClassesandEvents

8:30 am – 5:00 pm Avera McKennan Diabetes Conference April 11

Location: CJ Callaway’s Restaurant, Sioux Falls Information: mckeducation@avera.org Registration:605-322-8950, www.Avera.org/conferences

7:00 pm – 11 pm “The Big Grape: Next Generation” Fundraising Event April 11

Location: Prairie Center, Avera McKennan Hospital Information & Tickets: www.AveraFoundation.org

Visit our website calendar to see the newest upcoming events or add your own

Midwest Medical Edition

.com

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

When a patient is looking at a possible amputation, refer them to the experts at the Sanford Limb Preservation Center. Our team of fellowship-trained vascular surgeons works together to save and reduce the unnecessary amputation of the legs and feet.

Patients would benefit from this expert care if they have: • Diabetes • Peripheral arterial disease • Peripheral vascular disease • Non-healing wounds • Have been recommend for amputation

Patrick Kelly, MD, Board-certified, Vascular Surgeon

Chad Laurich, MD, Board-certified, Vascular Surgeon

Angelo Santos, MD, Board-certified, Vascular Surgeon

Greg Schultz, MD, Board-certified, Vascular Surgeon

REDUCE UNNECESSARY AMPUTATIONS FOR YOUR PATIENTS.

Call (605) 312-7300 or (800) 618-3186 3186 to refer a patient to the experts at Sanford.

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