MED-Midwest Medical Edition September/October 2015 by MED- (Midwest Medical Edition)

SEPTEMBER OCTOBER

2015 Accountable Care Quality Measures Patient Portals Meaningful Use Electronic Medical Records Reimbursements Integration ICD-10 Collaboration Value-Based Medicine

Future Healthcare Technology

THE

The Siouxland/Tanzania CONNECTION

Omaha’s Accredited Sleep Center

NATIONAL ATTENTION for Toxic Laundry Soap Study

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

Vol. 6 No. 6

One Number Accesses Our Pediatric Surgical Specialists, Any Problem, Anytime.

1.855.850.KIDS (5437) PHYSICIANSâ&#x20AC;&#x2122; PRIORITY LINE

Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.

ChildrensOmaha.org

Gastroenterology & GI Surgery Orthopedics Cardiology & Heart Surgery

MEDAd, Aug 2015.indd 1

8/3/15 2:56 PM

MIDWEST MEDICAL EDITION

Contents

Future Healthcare THE

VOLUME 6, NO. 6 ■ SEP T EM B ER / O C TO B ER 2015

REGULAR FEATURES 4 |

Challenges for Hospitals, Health Systems, and Physicians

From Us to You content available this month only online

Accountable Care

10 |

News & Notes – Awards, appointments,

Vol. 6 No. 6

s Quality Measure Patient Port als

additions, and accreditations from around the Region

Meaningful Use ical Reco Electronic Med

39 | Learning Opportunities Upcoming Winter

rds

Reimbursements

Conferences, Events, and CME Oportunities

Integration

ICD-10

IN THIS ISSUE

Collaboration Value-Based Med

■ By Jeana Goosmann

9 | Three Key Principles of Security

e r FHeuatltu hcare THE

How Many are You Following? ■ By Buzz Hillestad

nzania The Siouxland/Ta CONNECTION

18 | Fraud Alert Signals Increased Scrutiny of Physician Compensation Arrangements

veterans with a health clinic designed around their unique needs.

Funding Secured for Three New Indian Health Projects

Awards bring NIH-funded studies total to thirteen

What you need to know about diamonds ■ By Riddle’s Jewelry

36 | Transportation: A critical link to patient flow optimization ■ By Diane McCullough

38 | The Value of Balancing Protein Throughout the Day ■ By Holly Swee, SD Beef Council

page

Local doctors gain

national attention with study of laundry pod toxicity

Children’s Sleep 27 Center Earns AASM

Sponsored Features

Named to “Most Wired” List

31 | A Symbol of Everlasting Love:

In the first article of a series, MED turns to some of the region’s top healthcare administrators, from both small and large hospitals and health systems, for insights into the challenges they and their clinicians are likely to face in the coming decade.

Accreditation

28 | Healthcare Systems Again Avera, UnityPoint Health, and Sanford once again make the top tech list

NTION for NATIONAL ATTE Soap Study Toxic Laundry

N ew Women’s Health Clinic at the Sioux Falls VA Medical Center VA reaches out to the growing number of female

27 |

d Omaha’s Accredite Sleep Center

E T’S MAGAZIN UPP ER MIDWES LS OTA AND THE LTH CAR E PROFESSIONA SOU TH DAK ANS & HEA F OR PHYSICI

■ By Tom Johnson

20 |

icine

Technology

6 | A Legal Checklist to Help Physicians Sleep at Night

By Alex Strauss

2015

SEPT EMB ER OCTO BER

5 | MED on the Web Nurses Station and other exclusive

Dr. Steven Meyer and 30 Siouxland Tanzania

rology Specialists of Sioux U Falls Offers Cutting Edge Cryosurgery for Renal Cancer ■ By Alex Strauss

32 Managing Indoor

Environments for Safety, Comfort, and Efficiency ■ By G & R Controls

34 Woods, Fuller, Shultz &

to “give back” in a meaningful way

On the

COVER

Smith, PC, Helps “Simplify the Complicated”

ON THE COVER: Interventional Cardiologist Puneet Sharma, MD, of Sanford Aberdeen Medical Center. Photo courtesy Sanford.

Educational Medical Ministries A local doctor’s quest

From Us to You Staying in Touch with MED

HE METHODS BY WHICH medical care is accessed, delivered and reimbursed are changing more dramatically and more quickly than anyone in the industry can remember. But who will pay for these changes and what will they mean for the health of hospitals and patients in South Dakota, Minnesota, Iowa and surrounding states? Although MED usually focuses primarily on clinicians, we have asked several top area administrators to share their insights on the weighty topic of “The Future of Healthcare” in our region. Their answers will form the basis for a series of articles this fall and winter, beginning with this month’s cover feature. This issue is also jam-packed with news, information and expert advice to make your life easier and your practice more profitable. Worried about cybersecurity in your office? The experts at Helix will introduce you to the Three Principles to help you avoid a breach. Concerned about air quality in your medical facility? G & R Controls will explain the ins and outs of maintaining a healthy indoor environment. You’ll also find valuable legal advice, specifically for medical professionals. (Where else can you get that for free?) Finally, MED welcomed a new member to the “team” in June. MED’s Steffanie Liston-Holtrop and her family welcomed Khloe Isabella Holtrop on June 29th. Mom and baby are happy and healthy and Khloe is already learning the publishing business firsthand. Please remember that if you have news to report, a story to tell, a memory or a talent to share, or even if you’ve just read a good book, MED’s 5,000+ readers want to know. Email us at info@MidwestMedicalEdition.com or check us out online at MidwestMedicalEdition.com, where you can also register to receive the digital issue as much as two weeks ahead of print. If you have picked up this issue at the SDAHO Conference, Welcome! We hope you enjoy browsing the region’s premier publication by, for, and about medical professionals. Let us know how we can support you in your business or marketing efforts. Here’s to cool nights and golden days, —Steff and Alex

Corrections In the last issue we inadvertently ran the wrong photo for Mark Schmidt, the new President of Lead-Deadwood Regional Hospital and the Lead-Deadwood Market. This is the correct photo. On the Contents Page, the author of Addressing Hospital Workplace Violence should have been listed as Lizabeth Brott.

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

VICE PRESIDENT

SALES & MARKETING Steffanie

Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER studiofotografie

WEB DESIGN Locable DIGITAL MEDIA

DIRECTOR Jillian Lemons CONTRIBUTING WRITERS Jeana Goosmann

STAFF WRITERS

Buzz Hillestad Tom Johnson Diane McCullough Holly Swee 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.

Midwest Medical Edition

MED welcomes reader submissions! 2015 Advertising EDITORIAL DEADLINES

More than a Magazine, A Medical Community Hub

Jan/Feb Issue December 5

List your business or event for FREE with our easy only calendar and directory!

March Issue February 5 April/May Issue March 5

Here are some of the new articles

June Issue May 5

available only online…

July/August Issue June 5 Sep/Oct Issue August 5 November Issue October 5 December Issue November 5

Brookings Hospital Expansion Brookings Health System has started construction on a 62,500 square foot hospital expansion project. From New ORs to new amenities, read exactly how they’ll plan to use the new space.

The Nurses Station Online You’ll find all our local nursing news exclusively on line this month.

Cyclists Benefit Rural Healthcare – Home and Abroad 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

30 Cyclists Conquer Mountains and Miles to Raise Funds to Improve Health Care Delivery in Rural Ecuador. Rural health clinics in our region were recognized with grants along the way.

ONLY ON OUR WEBSITE! ◆ G ET MORE ATTENDANCE AT YOUR EVENT – Spread the word about an upcoming event or conference by posting it on MED’s FREE online calendar and link it to your own site. It takes just a minute to reach thousands of website readers

Fax 605-231-0432 MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109 WEBSITE MidwestMedicalEdition.com

and expand your digital presence. Check it out!

◆ P ROMOTE YOUR BUSINESS WITH A FREE OR PREMIUM BUSINESS DIRECTORY LISTING – List your business with links, contact information and maps for free on MED’s growing website. Upgrade to an eye-catching premium listing for a nominal fee.

NEW!

Stretch your ad dollars further! Low monthly rates.

Site Sponsorship opportunity. MidwestMedicalEdition.com 605-366-1479 info@MidwestMedicalEdition.com

Limited spots available.

A Legal Checklist to Help Physicians Sleep at Night By Jeana Goosmann

OU CHOSE YOUR CAREER

because you wanted to take care of patients and improve the health of others, but additional stresses and concerns might keep you awake at night. To make your lives a little easier, here are six easy steps to take to give you peace of mind at the end of the day.

Form a company. In many cases, it is a smart move for physicians to form a Professional Limited Liability Company or a Professional Corporation to protect them from liability. PLCs can help protect you from disgruntled employees, accidents, compliance issues, and wrongful practice lawsuits. To help protect your assets from an unforeseen liability, forming a company can be a smart and relatively painless solution that requires only a few steps a year in order to keep it going. Just remember to refrain from intermingling personal assets with the company assets to protect yourself.

solo, is to have adequate insurance coverage to provide a safety net you want under you in case of emergency. As a healthcare professional, malpractice liability coverage is essential; you want to look at coverage not only for civil lawsuits but also administrative actions such as licensing. Cyber liability insurance, disability insurance and life insurance could be overlooked by young professionals, but they are essential to life as a doctor.

to deduct the interest thereof, can be used to reduce taxable income. Another useful strategy is tax-harvesting losses, selling assets that have decreased in value to create a capital loss that can be used to offset other capital gains, and to a limited extent, ordinary income. â&#x2013; Jeana Goosmann, is CEO & Managing Partner at Goosmann Law Firm.

Tax planning is key. Failure to

To read the complete checklist, see our website.

do any tax planning is like leaving money on the table, or handing it to the government. Strategic use of mortgages, and the ability Welcome

Christopher s. huot, M.D. Ophthalmologist

Protect your family by executing a current estate plan. Estate planning is equal parts getting a plan in place and keeping it current, as recent laws might have effected old plans. Large moments in life, like marriage, having children, starting a company, mean that you should create or renew your estate plan, which has been outgrown by your lifechanging events. Setting up a Domestic Asset Protection Trust, or DAPT, in South Dakota allows a physician to create a trust for their benefit, and yet still be protected from lawsuits in a worst case scenario.

Be prepared: Review your insurance coverage. A key aspect for every healthcare professional, whether you are employed by a hospital, a member of a practice group, or practicing

J. Geoffrey Slingsby, M.D., P.C.

240 Minnesota Street â&#x20AC;˘ Rapid City SD For appointments regarding Comprehensive Ophthalmology including:

~ Cataract and Implant Surgery

~ Retinal Management and Laser/Injections ~ Plastic Surgery of the Eyelids ~ Glaucoma Management

Call 605-719-9499 Midwest Medical Edition

The Future of Surgery is Here “The Siouxland Surgery Center is now Dunes Surgical Hospital. This new name better reflects our wide range of specialty services, and world class doctors and surgeons. Our experienced, friendly staff are still the best and you can find us where we’ve always been...at the Dunes. Our partnership with Mercy combines the strengths of two proven healthcare leaders to provide enhanced coordination, cooperation and the best care for Siouxland.”

– Ralph Reeder, M.D.

President, Dunes Surgical Hospital

600 Sioux Point Road • Dakota Dunes, South Dakota, 57049 dunessurgicalhospital.com • 605-232-3332

211 Walnut St. Yankton, SD 57078  605-260-1520

Beckenhauer Construction has been providing high quality construction service to its clients for 137 years and counting. Beckenhauer Construction is a family owned general contracting firm specializing in healthcare construction and is now being directed by the fifth generation of family ownership. Safety of the staff, the patients, visitors, and crews is always at the top of our list to control. We do so by continual training, monitoring, providing the best of equipment to assist us, and constant communication with the client so they are aware of our every move. We go above and beyond the industry standard requirements when it comes to protecting employees, client staff, patients, and visitors. If you are not already one of Beckenhauer Construction’s clients we urge you to visit with any of our past or current clients to see what they have to say about doing business “The Beckenhauer Way”.

Midwest Medical Edition

Key Principles of Security How Many Are Your Following?

By Buzz Hillestad

IXTY THREE PERCENT of all cyber-attacks are perpetrated by criminals who want to steal the data to sell or monetize it. The fraud markets around the world are teaming with money as electronic files have made it much easier and much more lucrative to commit certain types of fraud. Why is it so easy for criminals to steal data? What can we do to make it tougher for them? Let’s take a look at a recent case to see where there might be some indicators of what IT security is doing wrong. Four and a half million people had their medical information stolen in a recent cyberattack on the UCLA Health System. An article in the LA Times about this story had this quote: “ . . . there is no indication that any information was stolen, the hospital system said, but it couldn’t rule that out.” They were able to ascertain that the attackers had been in certain spots of the network but did not know whether or not anything was exfiltrated. It’s very possible - and likely - that it was.

DETECTION IS KEY! This is the first big problem in security today: Organizations have no way to monitor what is leaving their networks. Data loss prevention systems, second gen firewalls, and log correlation can make a forensic investigator out of a savvy IT person. These technologies need to be present in enterprise networks. Otherwise, you will be left scratching your heads like UCLA was. According to The LA Times, “UCLA Health has been investigating suspicious activity on its network since October, but the intrusion wasn’t confirmed until May.”

RESPONSE IS KEY!

who, what, when, where, why, and how. Log correlation and alerting along with intrusion detection systems are necessary for enterprise networks for this very reason. Having a good incident response strategy and protocol is also key. If UCLA detected intruders in October, why did they not go into incident response mode immediately? Why did they not figure out the root cause of the incident and fix it? Seven months is a very long time to have attackers roaming around on your network exfiltrating data at will.

LAYERED SECURITY IS KEY! Lastly, why are attackers so easily getting into IT networks? The answer can be found within the UCLA story again. They couldn’t stop the hackers, they couldn’t detect them initially, and they couldn’t respond to them well. Why? Because they did not have a layered security approach. If you think of each security control that you have in your enterprise as a speed bump, you might start to understand layered security.

The more speed bumps the more time you have to detect and respond to the incident. The vast majority of clients I work with initially stake their entire existence on 1 or 2 technologies or speed bumps. We have to change this problem. We have to make it tougher for these attackers to make their dollar. We are losing the war against hacking. It doesn’t have to be that way. Criminals always take the path of least resistance to make their money. Currently, electronic fraud is so easy that we have cases of drug dealers and mob bosses converting their businesses over to electronic fraud. The black market fraud players group grows on a daily basis. We have to increase our detection rates, have an appropriate response to incidents, and have as many speed bumps in our enterprise networks as budget will allow. The time to start using these three principles is now. ■ Buzz Hillestad is a Principal Consultant at Helix in South Dakota.

Risk Management with

HELIX SECURITY

Get tailored risk management solutions to secure your patients' protected health information Comprehensive Information Security Consulting Regulatory Guidance IT / Compliance Auditing Penetration Testing Social Engineering Incident Response Planning Vulnerability Assessments hTRAC - Automates Rist Management Software

Time to detection is a huge issue in the industry, as well. It’s not just about whether or not there is suspicious activity going on. You also need to be able to very quickly determine

Call (605) 223 - 0013 now to protect your patients.

September / October 2015

MidwestMedicalEdition.com

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA

BLACK HILLS

The Avera Specialty Pharmacy recently earned full URAC Specialty Pharmacy Accreditation, becoming the first

The Black Hills community has once again shown great support for Children’s Miracle Network Hospitals, with 17,000 ducks sponsored in the 26th annual Great Black Hills Duck Race on July 26th. Due to high

URAC-accredited specialty pharmacy based within a health system in South Dakota. It joins just 121 other URAC-accredited specialty pharmacies nationwide. Avera McKennan Hospital & University Health Center has acquired 69 residential properties south of the hospital campus, including homes and

vacant lots, within an area between 23rd and 26th streets and 7th and Cliff avenues in Sioux Falls. The properties were acquired from Sioux Falls Surgical Physicians LLC. The purpose of the purchase is to own land in case future expansion is needed. Pat Clark began his duties as Chair of the Board and Ryan Huber became Vice Chair of the Avera Queen of Peace Foundation Board in July.

Pat Clark is retired and formerly served as Senior Vice President and CFO at Avera Queen of Peace Hospital. Ryan Huber is the Regional President of BankWest, Inc. in Mitchell and serves on the Mitchell United Way Board of Directors.

The Avera Brain and Spine Institute at Avera McKennan Hospital & University Health Center is now a Recognized Treatment Center by The ALS Association. This designation

recognizes regional institutions for their excellent clinical care for people living with ALS. The healthcare professionals assigned to the team can provide updated medical assessment and intervention, suggestions for maintaining health, adapting to changes in speech, muscle strength and daily living skills, information about local Avera St. Benedict Hospital in Parkston, SD was recently

recognized with an Excellence through Insight for Overall Employee Satisfaction in the Small Hospital category and for Overall Emergency Department Experience in the Medium Hospital category by HealthStream, Inc. To qualify for an award, a hospital must have scored in the 75th percentile or higher and surveyed a minimum of 100 patients. Avera St. Benedict Hospital for chosen for receiving the highest ratings from among HealthStream’s clients, as well as exceeding industry standards.

water levels in Rapid Creek, this year’s Duck Race was held at the School of Mines and Technology (SDSM&T) football stadium. Football players ran ducks through an obstacle course that included a slip n’ slide, tricycle race and a steeple jump.More than $75,000 was raised to provide services and equipment for ill and injured children in the Black Hills area served by Regional Health. Three Regional Health caregivers were recognized with August as part of the year-long “I Am Regional Health” campaign. They

are H. Thomas Hermann, M.D., a Family Medicine physician in Sturgis, Annalisa Anderson, an inventory coordinator in Lead-Deadwood, and Susan Weber, Director of Physician Recruitment in Rapid City.

Regional Health is pleased to announce the addition of . . . Mohammad Alsumrain, MD,

a board certified physician in pulmonology and critical care; Troy Howard, MD, a board

certified physician in otolaryngology (ear, nose and throat);

Kari Lund, MD,

a board certified physician in family medicine;

Rodney Samuelson, MD,

a board certified physician in neurosurgery;

and Joni Hensley, PA-C, an advanced practice provider in dermatology.

Midwest Medical Edition

Westley Paxton, MBA, Certified Facility Manager, has been selected Regional Health’s Vice President of System Facilities Management and Construction. Paxton earned an

MBA from Marylhurst University in Oregon, and bachelor’s degrees in Construction Management and Design from Brigham Young University. He had been the Director of Plant Operations and Maintenance at a retirement community in Virginia Beach, Virginia. Regional Medical Clinic-Western Hills Professional Building pulmonologists Mohammad

Alsumrain, MD, Masaru Chiba, MD, James McCafferty, MD, and Daniel Rawson, MD have relocated to Regional Medical Clinic-Aspen Centre at 640 Flormann Street. The new location, just behind the Mount Rushmore Road Safeway, offers more space and resources for patients. Regional Urgent Care and Occupational Medicine open a new clinic in July at 1303 North Lacrosse Street across from Walmart. This 5,000

square foot space replaces the previous location at 408 Knollwood Drive and includes six exam rooms, on-site lab and X-ray, ample parking and an open, modern design. Stay up-to-date with new medical community news between issues. Log on!

September / October 2015

SANFORD Nate White, COO of Sanford Health, has been recognized in by Becker’s Hospital Review in the 2015 edition of “Rising Stars: 25 Healthcare Leaders Under 40”. The Becker’s Hospital

Review editorial team selected leaders through an editorial review process, which included peer nominations. All leaders were under 40 years old at the time of their nomination earlier this year. Becker’s has published a version of this list annually since 2012. Sanford Aberdeen Medical Center celebrated its third anniversary on July 16th.

Over the last three years, the 48-bed medical center has steadily expanded its service to include orthopedics and sports medicine, hematology/oncology, interventional cardiology, nephrology and urology. The center now has more than 40 full-time providers, with an additional 20 outreach providers offering specialty care at the hospital or clinic on a weekly or biweekly basis. Three new full-time providers—a general surgeon, an internal medicine physician and a cardiologist —will join the Sanford team this fall.

Sanford Aberdeen Clinic Surgical Services has earned the Joint Commission’s Gold Seal of Approval for Ambulatory Health Care Accreditation by demonstrating

continuous compliance with the Joint Commission’s nationally recognized standards. Approximately 2,100 organizations currently maintain Ambulatory Health Care Accreditation, which is awarded for a three-year period. For the first time in its history, the Sanford Sports Complex will be home to three major prep running events. The Nike

Heartland Preview, Nike Cross Heartland Regional and the South Dakota State Cross Country Meet are moving to the 162-acre campus for the fall of 2015. The Sanford Sports Complex provides a turn-heavy, flat course positioned in an open area ideal for athletes and spectators. Nofil Arain, MD, a fellowshiptrained pediatric cardiologist has joined the team at Sanford Sheldon. Arain received his MD

from the University of Debrecen Medical and Health Science Center in Hungary and did his pediatric residency at the University of South Alabama. He also completed a fellowship in pediatric cardiology at the University of Minnesota and holds certifications from the American Board of Pediatrics in pediatrics and pediatric cardiology. Arain also practices at Sanford Children’s Hospital and Sanford Children’s Specialty Clinic in Sioux Falls, South Dakota. He resides in Sioux Falls with his wife and kids.

MidwestMedicalEdition.com

Construction is scheduled to start October 2015 on Sanford Health’s 100,00 square foot building for its Imagenetics program. When completed, the

building will house a long list of services, including general internal medicine, dialysis, medical genetics, genetic counseling, medical genetics laboratories (cytogenetics and molecular genetics), radiology and patient access management. The Imagenetics facility will also contain teaching space for internal medicine residents, future medical genetics residents and students in the newly formed genetic counseling graduate program created in partnership with Augustana College.

SIOUXLAND Pathology Medical Services of Siouxland, PC announces the addition of Bryan Steussy, MD, to its medical staff. A Jefferson,

Iowa native, Steussy received his undergraduate degree in Biochemistry from Iowa State University and earned his MD from the University of Iowa Carver College of Medicine in Iowa City. He completed his pathology residency and fellowships in Surgical Pathology and Hematopathology at the University of Iowa Hospitals and Clinics.

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Dr. Fayaz Hakim, board-certified cardiologist and electrophysiologist, has joined the staff of Mercy Cardiology. Dr.

Hakim comes to Mercy from Loyola University Medical Center in Chicago. Dr. Hakim earned his medical degree from Government Medical College in India. He did his residency in Internal Medicine at the Mayo School of Graduate Medical Education in Rochester and completed fellowships in Cardiovascular Disease Medicine at the Mayo Clinic in Arizona and in Clinical Cardiac Electrophysiology at Loyola University Medical Center. UnityPoint Health – St. Luke’s has been awarded a $105,000 grant

from the American Heart Association as part of Mission: Lifeline, an American Heart Association communitybased initiative aimed at improving the system of care for heart attack patients throughout rural Iowa. The Mission: Lifeline system ensures STEMI patients get the right care as quickly as possible. Mission: Lifeline focuses on improving the system of care for these and all heart attack patients in Iowa. St. Luke’s is part of the network of hospitals involved in Mission: Lifeline. Physical Therapist Emily Rohmiller, PT, DPT has joined the Mercy Medical Center rehabilitation department.

Rohmiller is a graduate of the University of South Dakota with a Doctorate of Physical Therapy.

UnityPoint Health – St. Luke’s and the ALICE Training Institute have teamed up to bring ALICE Instructor Training to St. Luke’s on Thursday, October 1 and Friday, October 2. This two day

instructor course is designed to teach proactive survival strategies for violent intruder or active shooter incidents. The goal of the ALICE program is to provide individuals with survival-enhancing options for those critical moments in the gap between when a violent situation begins and when law enforcement arrives on scene. The registration fee for this training is $595 per person and can be completed online at www.alicetraining.com. The nation’s leading infectious diseases professional society, the Infectious Diseases Society of America (IDSA), has recognized Dr. Bertha Ayi as one

of the distinguished physicians and scientists from the United States and around the world by conferring on her the honorable designation of Fellow of IDSA. As Medical Director of Global Infectious Disease Services, Dr. Ayi provides consultation at Mercy Medical Center and other area hospitals, where she has shown exceptional commitment to quality care in the face of a high demand for her services, authored books and book chapters and lectured at several conferences.

Longtime Siouxland physician, Dr. Jerome Pierson has returned to the practice of interventional cardiology at Mercy Cardiology.

Dr. Pierson has been a part of the Siouxland medical community since 1992. During his twenty plus years of service to the residents of Siouxland, Dr. Pierson has developed a reputation as a high-quality physician who enjoys tremendous patient loyalty and the respect of his colleagues. Since July of 2012, he has been Mercy’s Vice-President of Medical Affairs & Chief Medical Officer (CMO). Jodi Arnold of Sioux City, an employee of Mercy Medical Center-Sioux City who is pursuing her Nursing BSN degree at Briar Cliff University, has been awarded a $3,000 scholarship from the Iowa Hospital Education and Research Foundation (IHERF),

which is supported by the Iowa Hospital Association (IHA). She is among 34 outstanding students from all over Iowa who have received assistance this year from the IHERF Health Care Careers Scholarship Program. The National Committee for Quality Assurance (NCQA) and the American Diabetes Association (ADA) announced that Cindy Inman, ARNP has received recognition from the Diabetes Physician Recognition Program for providing quality care to her patients with diabetes. Ms. Inman works at

Correctionville Mercy Medical Clinic in Correctionville, Iowa.

Mercy Home Health Care-Sioux City has received 4.5 stars out of 5 stars on Home Health Compare, CMS’s public information website for Home Health Agencies. “Comparing

Mercy Home Care with home care agencies across Iowa, only 1% received a 5 star rating and nationally only 3%. We are very proud to receive the highest star rating in Siouxland”, stated Karen Vlach, Mercy Home Care Director. Hospice of Siouxland, serving the Siouxland Tri-state area, has been selected to participate in the Medicare Care Choices Model. The model provides

Medicare beneficiaries who qualify for coverage under the Medicare Hospice Benefit and dually eligible beneficiaries who qualify for the Medicaid Hospice Benefit the option to elect to receive supportive care services typically provided by hospice and continue to receive curative services at the same time. Nationwide, this is expected to enable as many as 150,000 eligible Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, human immunodeficiency virus/ acquired immunodeficiency syndrome who receive services from participating hospices to experience this new option and flexibility. Mercy Home Care has taken home healthcare to a new level by certifying 20 agency clinicians as Certified Health Coaches. To

ensure successful behavior changes, Mercy Home Care’s Certified Health Coaches specifically design a program for each patient. They educate, motivate and inspire patients to work towards their goal. The overall goal is for patients to better self-manage their health.

Midwest Medical Edition

Mercy Medical Center – Sioux City has received the American College of Cardiology’s NCDR ACTION Registry–GWTG Platinum Performance Achievement Award for 2015.

The award signifies that Mercy has reached an aggressive goal of treating heart attack patients to standard levels of care as outlined by the American College of Cardiology/American Heart Association clinical guidelines and recommendations. Mercy is one of only 319 hospitals nationwide to receive the honor. The 19th annual Siouxland Race For Hope is scheduled for Saturday September 19, 2015 at Adams Homestead and Nature Preserve in McCook Lake, South Dakota. It is expected to draw

hundreds of people and is one of the largest events of its type in Siouxland with competitive races as well as “family friendly” walking and a kid’s fun run. Last year’s event raised a record-breaking $55,000 to enhance the quality of cancer care at the June E. Nylen Cancer Center. Register at www. siouxlandraceforhope.com.

OTHER Prairie Lakes Healthcare System has received the American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Platinum Performance Achievement Award for the third consecutive year. To receive the ACTION

Registry–GWTG Platinum Performance Achievement Award, Prairie Lakes Healthcare System consistently followed the treatment guidelines in the ACTION Registry–GWTG Premier for eight consecutive quarters and met a performance standard of 90 percent for specific performance measures. The Iowa Healthcare Collaborative, Telligen, South Dakota REC and others are partnering to become a Practice Transformation Network. Practice

Transformation Networks are established when group practices, healthcare systems, and others join forces to collectively provide quality improvement expertise, best practices, coaching and assistance to clinician practices preparing and beginning clinical and operational practice transformation.

Construction is underway on Brookings Health System’s hospital expansion and renovation project. The project will add 62,500 square

feet to the east side of Brookings Hospital. The addition’s first floor will house surgery and medical imaging, two of the most common same-day procedures. The addition’s second floor will house the obstetric and medical/surgical units. Rooms on this floor will focus on patient amenities and allow ample space for families and visitors to gather. Karen Munger, PhD has joined the Sioux Falls VA Health Care System as

The new Chief of Staff for the Sioux Falls VA Health Care System

is John M. Wempe, MD, MPH, DVM, PhD. He is a retired U.S. Army Colonel.

Coordinator of Research & Development. Dr. Munger is a renal physiologist. Dr. Jeffrey Heier, a new addition to the Physician Vein Clinics team in Sioux Falls, is being officially Board Certified in Phlebology and is Board Certified by the American Board of Venous and Lymphatic Medicine.

He is also board certified in Internal Medicine and has spent the past 15 years dedicated to practicing acute care medicine in the region.

Steve Lindemann was recently selected by Brookings Health System as the organization’s new Chief Financial Officer (CFO).

Lindemann is a native of Eureka, SD, and holds a bachelor’s in accounting from the University of South Dakota. He also is a fellow of the Healthcare Financial Management Association. He most recently was the director of finance and accountable care organization director for UnityPoint Health–St. Luke’s Hospital in Sioux City.

AWARD WINNING

REGIONAL CARE In an emergency, seconds count. At Prairie Lakes Healthcare System, expert care is available and ready when you need it most. Repeating awards signify our staff’s dedication. Our team’s outstanding care to heart attack patients earned Prairie Lakes the NCDR ACTION Registry–GWTG Platinum Performance Achievement Award in 2013, 2014, and 2015. And for the past two years, Prairie Lakes received the Women’s Choice Award as one of America’s Best Hospitals for Emergency Care. Prairie Lakes Healthcare System consistently followed the treatment guidelines in ACTION Registry®-GWTGTM for eight consecutive quarters in ACTION Registry-GWTG Premier and met a performance standard of 90% for specific performance measures to receive the 2015 Platinum Performance Achievement Award.

YOUR HEALTH : OUR MISSION

prairielakes.com • 882-7000

Area administrators share their insights on the future of healthcare in our region

Jill Fuller

Paul Hanson

Jason Merkley

Brent Phillips

Fred Slunecka

TOP ADMINISTRATORS FROM HEALTH SYSTEMS AROUND THE REGION HAVE BEEN INVITED TO PARTICIPATE IN THIS SERIES. THIS ARTICLE INCLUDES INSIGHTS FROM THE FOLLOWING RESPONDENTS (listed alphabetically)

Jill Fuller, President and CEO

Prairie Lakes Healthcare System

Based in Watertown in northeastern South Dakota, Prairie Lakes Healthcare System provides care for a ten-county service area of 87,000 people.Â

Paul Hanson, President

Sanford USD Medical Center Located in Sioux Falls, Sanford USD Medical Center is a 545 bed hospital and Level II Trauma Emergency Care Center. It is one of 43 hospitals and 250 clinics in nine states that comprise the Sanford Health system.

Jason Merkley, CEO

Brookings Health System Brookings Health System is a non-profit, city-owned health system based in Brookings, South Dakota. It includes the 49-bed Brooking Hospital and serves Brooking and more than 18 surrounding communities.

Brent Phillips, President and CEO

Regional Health Based in Western South Dakota in Rapid City, Regional Health is comprised of more than 40 healthcare facilities, including five hospital and 24 clinics, and serves a patient base of 360,000 in the Black Hills region.

Fred Slunecka, President and CEO

Avera McKennan Hospital & University Health Center Avera McKennan Hospital is a 545 bed facility in Sioux Falls, South Dakota. It is a part of Avera Health, a regional system with 300 facilities in the 5-state region of SD, ND, MN, IA, and NE.

Midwest Medical Edition

Future Healthcare and beyond.

THE

Challenges for Hospitals, Health Systems, and Physicians

HANGE IS HAPPENING SO QUICKLY AS

medicine moves into its uncertain future that standing at the helm of a healthcare organization these days can feel a little like chasing a ball downhill. On one hand, providers are expected to provide better, more efficient, more technologically advanced care than ever at a lower cost than ever. On the other hand, they are being told that they must keep patients from needing care in the first place – but that they won’t be paid to do this. Although much is still uncertain about the future of healthcare in America, with issues such as the ‘meaningful use’ of Electronic Health Records, the upcoming ICD-10 rollout, regulations regarding the management and dissemination of clinical quality data, and the quantum shift from fee-for-service healthcare pending, it seems clear that the future is certain to be very different from the past. As we talked with regional CEOs (see sidebar) from both large and small health systems for our new series on The Future of Healthcare, we started by asking them to discuss what they see as the biggest challenges for hospitals and health systems – as well as for the clinicians who work within them – in the next five to ten years. By Alex Strauss

September / October 2015

MidwestMedicalEdition.com

“

Prairie Lakes Healthcare System

Quality Measures Patient Portals Meaningful Use Electronic Medical Records Reimbursements

Paul Hanson

Integration

“

Sanford USD Medical Center

Collaboration Value-Based Medicine Technology

LOOK FOR MORE INSIGHTS FROM OUR “FUTURE OF HEALTHCARE” INTERVIEWS IN THE NOVEMBER AND DECEMBER ISSUES OF

MED. WE INVITE YOU TO SHARE YOUR OWN FEEDBACK ONLINE.

One of the biggest challenges will be organizations developing a sustainable business model that balances clinical, financial and operational initiatives. Access to and management of capital, both human and financial, has never been more critical in assuring an organization’s success. Integration is key in strategic positioning within a population health model. Organizations are investing in their information technology systems at an unprecedented rate because we rely on data and the use of it to provide better care. For those systems that have made the commitment to do so nearly a decade ago, the rewards of that investment will now be realized. Sanford Health is one of those very few integrated systems that made the commitment and stayed the course. The level of connectivity within our society will continue to improve, and successful organizations must be able to adapt to these changes in a meaningful way that benefits our patients and providers.

“

ICD-10

Our biggest challenge will be the continued transformations in our business including the shift from inpatient to outpatient care settings and the transition from fee-for-service to reimbursement based on value. We will need to adapt but there are risks to changing our business model either too quickly or too slowly. Collaboration is our greatest opportunity. As we move into population health, we will need to partner with providers outside our own systems and organizations in order to reduce costs and improve outcomes.

“

Accountable Care

ON PHYSICIAN CHALLENGES ‘The cost of entry and the expertise required to operate independently as an organization or practicing physician is extremely difficult, if not nearly

impossible, for any long-term strategy. The expectations clinicians have from their patients, payers and regulatory agencies will only increase with time.”

Jason Merkley

“

Brookings Health System The biggest challenge for healthcare organizations in the next five years is the shift from volume-based to value-based medicine and how we in rural America find ways to succeed under this reformed model and payment transition. Secretary Burwell announced in January 2015 a goal of tying 50 percent of Medicare payments to alternative payment models such as ACOs by the end of 2018 and also to tie 90 percent of all FFS payments to quality or value targets. Secretary Burwell’s announcement will undoubtedly accelerate the transition to alternate value-based payment models. Although there is uncertainty regarding the pace of expansion of these models to rural hospitals and providers, Medicare and other third party payers are looking to contract with hospitals and providers who will collaborate to keep costs low while establishing and improving quality outcomes. In the next five to 10 years, those of us who provide healthcare to rural America will be challenged to do so under a much different strategy, model and payment system.

ON PHYSICIAN CHALLENGES

“

Jill Fuller

“Both independent clinicians and those employed by systems will need to find their role within healthcare reform and how they work with local communities to manage the health of the populations they serve given the transformation from fee-for-service to a more value-based reimbursement model.”

Brent Phillips

“

Regional Health

Recruiting and retaining a quality healthcare labor force could be a significant challenge well into the future. We have a huge shortage of several hundred thousand doctors across the United States today, and that shortage is only going to manifest

Midwest Medical Edition

ON PHYSICIAN CHALLENGES “The bureaucracy and regulations are a major challenge for physicians. Physicians are just as frustrated as patients. The other

September / October 2015

challenge is the ability – given the pace of change and the advance of science – to stay current with new discoveries and technology. It’s almost overwhelming.”

Fred Slunecka

Avera McKennan Hospital and University Health Center

“

Regulatory and technology disruption will be a challenge. An example of regulatory disruption is the passing of MACRA, the Medicare Access and CHIP Reauthorization Act, last spring. MACRA fundamentally revamps how Medicare pays physicians by linking payments with quality, value measurements, and participation in alternative payment models. The new model includes strong incentives for patient-centered medical homes, a concept Avera has been championing for many years. The payment structure involves bundled payments, like 90-day bundles with set fees for a given healthcare event, such as a knee replacement. So we’ll

MidwestMedicalEdition.com

see new partnerships and collaborations as healthcare providers figure out how to most effectively provide quality care while covering expenses. In the coming decade, we’ll also be continually challenged by emerging science and technology disruptions. From evolutions of patient medical records to advancements in genetics and the study of microbiomes, we will understand care at completely different levels.

“

itself more in the face of an aging workforce and an aging population. Equal to (the shortage of doctors) are shortages in nursing and all of the other healthcare professions. The shortage impacts rural areas such as South Dakota to a greater extent than some urban areas. In my opinion, the labor shortage exists because it is difficult to practice medicine today with all the rules, regulations, paperwork and litigiousness. To deal with the paperwork, the regulations, the insurance and all of that complexity – it’s a burden on patients, families, physicians and caregivers. It’s toughest for smaller medical practices. In order to be able to negotiate contracts with insurance companies or suppliers in the changing healthcare financing field, you have to be big. You can’t do it as a small player.

ON PHYSICIAN CHALLENGES “The rise of consumerism and consumers’ easy access to knowledge [will be a challenge for physicians]. Patients are extraordinarily resourceful and they have many options today from a watch that measures your heart beat, contact lenses that measure your blood sugar, and personal devices that monitor sleep patterns to websites that rate physicians and hospitals. So it’s a challenge for physicians to stay up to date and prepared for these very informed consumers.” ■

Fraud Alert Signals Increased Scrutiny of Physician Compensation Arrangements

By Tom Johnson

ECENT REGULATORY guidance may be causing physicians and hospital executives to lose more sleep than usual these days. In a Special Fraud Alert (Fraud Alert) issued earlier this summer, the Office of Inspector General (OIG), the Division of the Department of Health & Human Services tasked with combating healthcare fraud and abuse, reiterated its long-standing position that physician compensation arrangements are considered suspect under the Anti-kickback Statute, and by extension, the Stark Law, if the arrangement compensates a physician for his or her past or future referrals of Medicare/Medicaid business. The Fraud Alert referenced a recent settlement the OIG reached with twelve individual physicians who had entered into medical directorship and office staff arrangements that the OIG questioned. The OIG alleged that the payments made to these physicians constituted improper remuneration because, among other things, the

payments made to the physicians took the physiciansâ&#x20AC;&#x2122; volume or value of referrals into account and did not reflect fair market value for the services to be performed. This settlement is also notable because it was reached between the OIG and individual physicians, not a healthcare entity. While not announcing anything new, the Fraud Alert provides cause for the healthcare providers to reevaluate and scrutinize their physician compensation arrangements, notably medical directorships and office staff arrangements. Although Federal Law makes it illegal to pay, or provide value to, physicians in exchange for referrals, physician compensation arrangements can be structured to fall within a safe harbor to the Anti-kickback Statute, or an exception to the Stark Law. Falling under an applicable safe harbor or exception provides assurances that the compensation arrangement does not run afoul of Federal Law. For those hospitals and health systems currently utilizing or moving towards a direct-employment model for its physicians, compensation arrangements generally are structured to fall under the employment safe harbor to the Anti-kickback Statute and the similar bona fide employee exception to the Stark Law. Alternatively, for those hospitals and health systems following an affiliated group practice model of integration, physician compensation arrangements can be structured to fall under different safe harbors or exceptions, notably the personal services safe harbor to the Anti-kickback Statute and the similar exception to the Stark Law.

Although the applicable safe harbor or exception relied upon by a healthcare provider may vary, it is well-established that any compensation arrangement must (1) be consistent with fair market value, and (2) not be determined in a manner that takes into account the value or volume of referrals generated by the physician. Even if a particular compensation arrangement is properly in place, the contracting parties would be well-served to appropriately and adequately document the transaction and include, in the compensation contract, all the required elements of the applicable safe harbor or exception, including that total compensation is consistent with fair market value and does not take into account the volume or value of the physicianâ&#x20AC;&#x2122;s referrals. For larger, more complex transactions, fair market value opinions from appraisers may be recommended. The integration model of healthcare organizations certainly favors the practice of contracting with staff physicians or utilizing employed physicians to provide services either as medical directors or other roles. The Fraud Alert provides a signal to the healthcare industry that the OIG may be ramping up its enforcement efforts relating to these compensation arrangements, and serves as a reminder for providers to carefully evaluate its existing compensation arrangements and ensure that any future arrangements are structured to comply with Federal Law. â&#x2013; The Special Fraud Alert can be found at: https://oig.hhs.gov/compliance/alerts/guidanceFraud_Alert_Physician_Compensation_06092015.pdf Thomas Johnson is an attorney with Boyce Law Firm, LLP, in Sioux Falls.

Midwest Medical Edition

ORTHOPAEDIC

URGENT CARE WALK-IN CARE FOR BONE & JOINT INJURIES

FAST ACCESS TO QUALITY, SPECIALTY CARE MON – FRI • 8AM to 5PM

575 SIOUX POINT RD, DAKOTA DUNES, SD

September / October 2015

MidwestMedicalEdition.com

| 605.217.2667 | CNOS.NET

New Women’s Health Clinic at the Sioux Falls VA Medical Center By Shirley Redmond and Charlotte McGrath

Veteran Cynthia Ault-Schmitz receiving care at the new women’s clinic.

L to R: VA Women’s Clinic staff include Margaret Devick, MD, primary care provider; Shelley Morrison, MD, gynecologist; and Lindsey Mayer, NP, primary care provider.

LTHOUGH MOST VAs, including the Sioux Falls VA Medical Center, were built to care primarily for men, women now represent about 30 percent of post-9/11 Veterans. Even though some may not consider themselves to be Veterans because they did not serve overseas or were not in combat, the Department of Veterans Affairs is making an effort to let these women know it is there for them, too. As part of its effort to be more welcoming and acknowledging of women Veterans, the Sioux Falls VA opened a new Women’s Health Clinic at the end of August. It joins more than two dozen VA women’s health centers that have opened across the country in the past five years with equitable access

to high quality comprehensive healthcare. A group of women Veterans provided input for the design, look, and feel of the local clinic, which is on the south wing of first floor of the medical center. The environment reflects their request for a clinic focused on women only in a separate, yet convenient, location with its own waiting area and a team of all female providers. VA uses a team concept of care, and women are assigned a specialized women’s health provider, RN, LPN, and scheduler. Margaret Devick, MD and Lindsey Mayer, Nurse Practitioner, are the clinic’s primary care providers. Shelley Morrison, MD, gynecologist will join the group on October 1. Additionally, women Veterans have access to a dietician, pharmacist, mental

DID YOU KNOW... Last year , over 70,000 people in the United States received the gift of sight through corneal transplant surgery. At SDLETB, we contribute to this by screening, recovering, evaluating, and providing this tissue to surgeons throughout our region, our country, and the world. Learn more and sign up today to be an eye, tissue, and organ donor at: www.sdletb.org/register

www.sdletb.org

REFERRAL HOTLINE 1-800-245-7846 EXT 4

Midwest Medical Edition

health professional, and social worker as part of their team. Working for and with the Veterans, the team develops a personalized health plan to help each Veteran achieve her goals. The team is working to provide timely, high-quality, comprehensive healthcare services in a sensitive and healing environment.

Looking for a better way to manage risk?

Get on board.

Vital Statistics Sioux Falls VA Health Care System has seen the number of women Veteran users nearly double since 2007 (from 877 to 1673). ••• There are approximately 7000 women Veterans in the area served by the Sioux Falls VA Health Care System–Eastern South Dakota, Northwestern Iowa, and Southwestern Minnesota. •••

At MMIC, we believe patients get the best care when their doctors feel confident and supported. So we put our energy into creating risk solutions that everyone in your organization can get into. Solutions such as medical liability insurance, clinician well-being, health IT support and patient safety consulting. It’s our own quiet way of revolutionizing health care.

Approximately 30 percent of these women receive VA medical care, with VA’s goal to provide care to 50 percent of them by 2020. •••

Active duty and recruiting data project the percentage of women Veterans to increase to almost 16 percent of the entire Veteran population by 2040.

To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit MMICgroup.com. VA also has a breast surgeon and plastic surgeon on staff. Same day, after hours (early morning, late afternoon), and Saturday morning appointments are available. VA partners with community providers for obstetric care, infertility services, and mammography. Inpatient care, as well as long-term care and in-home care are also part of services available to Veterans. ■

September / October 2015

MidwestMedicalEdition.com MED POMM ADs.indd 1

21 8/10/2015 2:54:34 PM

Midwest Medical Edition

Photos courtesy Urology Specialists

Urology Specialists of Sioux Falls Offers Cutting Edge Cryosurgery for

Renal Cancer

NYONE WHO HAS EVER SPENT TIME outdoors in a Northern Plains winter likely understands the danger of frostbite. As the temperature drops, exposed tissue first becomes tingly, then painful, then numb. If not brought back into the safe temperature range, exposed fingers, toes or ears can sustain permanent damage within minutes. Cryosurgery takes advantage of this same cellular sensitivity to freezing temperatures to target and destroy cancer cells. Boardcertified urologist Matthew Witte, MD, of Urology Specialists in Sioux Falls says the technique has changed the way he and his colleagues approach renal carcinoma â&#x20AC;&#x201C; particularly for patients who are not candidates for a more invasive surgical technique.

By Alex Strauss

Sponsored Feature

“

People have really done great with this, . . . Out of those 130 cases, only four have required retreatment. One person had progression of their disease. None of our other patients have died from their cancer. —Dr. Matthew Witte.

”

less risks of damage to larger vessels, and less risk of developing a fistula. The procedure is done under sedation using local anesthetic. Although patients could often go home the same day, Dr. Witte says most are kept in the hospital overnight for monitoring since many have multiple health problems.

Cryosurgery Overview

Because the freezing temperatures used in cryosurgery (cancer cells die between minus 20 and minus 40 degrees Celsius) are so lethal to all body tissues, precision is critical. The procedure starts with a baseline CT scan of the kidney to locate the mass and to take a core tissue sample for the pathologist to review. During the same session, lidocaine is

Dr. Witte

injected and the patient is under mild sedation. Using CT guidance, a series of cryoprobes are inserted through the skin and into the tumor. The number of probes used depends on the size and shape of the tumor. Each probe can create a spherical ice ball that extends about a centimeter around its tip. For this reason, cryosurgery is usually reserved for masses smaller than about 4 centimeters. When the probes are in place, Argon gas is circulated under pressure into a small chamber inside the tip of the needle where it expands and cools, reaching a temperature well below -100 Celsius. This produces an ice ball with a predictable size and shape. The freezing temperature is maintained for about ten minutes. Toward the end of that time, another CT scan is performed to gauge the treatment’s effect. “Usually what you can see is that the mass itself turning very dark under CT imaging,” says Dr. Witte. “Depending on the treatment effect noted on imaging, you can determine whether you need to place additional cryoprobes.” Typically, two freeze/thaw cycles are used to ensure that the maximum number of cancer cells are destroyed. The most common complication is bleeding which occurs in 2 to 3 percent of cryosurgery patients.

Drs. Witte and Gillett have some impressive outcome data to report. “People have really done great with this,” says Dr. Witte. “Out of those 130 cases, only four have required retreatment. One person had progression of their disease. None of our other patients have died from their cancer.” Urology Specialists now perform two to three cryosurgeries a month for kidney cancer and expect those numbers to continue to rise as the technique is refined and perfected. Although it is currently reserved primarily for poor surgical candidates, Dr. Witte says there are other advantages to cryosurgery that may make it a desirable option for more people in the future. “For instance, people who have recurrent disease after partial nephrectomy. It is technically very difficult to re-operate on these people and many end up with the whole kidney removed, but conceivably you can treat them with cryosurgery and preserve the remaining normal kidney,” says Dr. Witte. “Now that we are starting to have more data on the efficacy, I expect that we are going to see more people using cryosurgery as a first line treatment, even in younger patients.”

Positive Outcomes

Refer to a urologist first.

At its outset, Dr. Witte says cryosurgery was “a new technique looking for an application.” Now, five years into their experience with the technique and with more than 130 cases under their belts,

[

Dr. Witte has one caveat for doctors of patients with suspected kidney cancer: “If the patient has a biopsy first, it can create more problems than it solves, in that it might make it technically more difficult to do perform a partial nephrectomy later,” cautions Witte. “Because we understand the natural history of this disease and we know all the management options, we can help patients make the most informed decisions.” ■

]

CRYOSURGERY for KIDNEY CANCER

• Lower morbidity • Overnight hospital stay • L ow pain (Usually Tylenol only)

September / October 2015

MidwestMedicalEdition.com

• Fewer complications • Normal activity in three weeks • Little or no change in kidney function

Local doctors gain national attention with study of laundry pods

Did you Know? 2014

SEptEMbER OctObER

vol. 5 no. 6

G GeT The Codin need. supporT you is medical coders

the Preparing fores Denial Proc s

skilled The demand for levels at your staffing already high. Look you you have the coders now to make sure for external arrangements need or make firm. tation with a quality coding augmen to contract cost-effective It may be more large y than to train with another compan

nating your Tips for elimi y s problems Toda iCd-10 Claim

By Natalie Bertsch

denial s. o one likes

Train your

people.

numbers of new

patient is involved with Everyone who learn the take the time to records should need. format they’ll standardized code and ns, schedulers Nurses, physicia can patient records anyone who touches code that to integrate get prepared now

they happen:

MED Reprinted from

Magazine

877-858 -5307

dt-trak.com

2014

JUly / aUgU st

Vol. No. 55

Risks surro u

AlAR m

Jillyan

Repri nted

from

Moran

m n in th e He ANAge ding althc are s meNt ettin g

o BSE

MED Maga zine

he iss ue of a ‘cente alar r m fa Tigue the las stage’ con cer n t two an d for hea paTie dec (eCri) The num nT sa named ades. in fac lthcare pro feTy ber of viders ala rm t, the patien has alarm hazard across t each emerg sig nal s as the day – the cou become ency thousa wh Ca #1 he ntr y ove nds ich can s in healthc alth Tec re resear are fac they can throughou r translat ch ins hnolog ilities t the e to tho reach titute hos y ha zar can sur desens overwh pital. usands pass d in itized, While elming of ala alarm rms on several hun 2013. quantit The risk overwhelm s are dre every ies. so, ed or an imp s to pat can inc unit and d per immune it’s no ortant ient lud tens of wonde to the par t of The Joi e falls, del safety are sou r that clin patien nds, and rea ays in nt Co t car icians can treatme l. Common mmissi Januar can bec e, inju ries suffer fro y 200 on sen nt, me ome m ‘al 9 and dicatio tinel per ma resulti arm fat June datab n errors nent ng fro igue.’ 201 loss of ase rep m ala , or in unfor rm haz functio 2. of the orts 98 tunate the wo 98 rep ards n, and ly, the alarm rst cas orted in Jun se occ -relate five in e – dea events e 201 urrenc d eve unexpe goal es are nts bet th. (npsg 3, the Joint cted add , 80 resulte happen ween Co d in dea ) to add npsg itional ing mo ress imp mmission th, requir care or re and establ es roving a prio extend 13 in more ished rity, est hospital and the saf freque ed stay a new ety of ablish ntly. critica . 201 4 nation clinica a for ma l access l alarm l policy al pat hospita ien system and pro l leader s in hos t safety vide sta s to set pitals. alarm ff trai The ning around management alarm as safety .

, MH

detergents

those

into detergent packets suffer

study, Drs. Bottei and

convenient all-in-one deter-

severe injuries while others

Zellmer found that packets

gent delivery systems, more

have only minor problems.

containing thicker deter-

pods,

poisonous than conven-

Since the introduction

gent required more force to

tional liquid or powdered

of concentrated detergent

burst. The brands of laundry

detergent in some cases?

packets in the U.S. in 2012,

packets with thinner liquids

It’s a question point control

young children who acciden-

could make the detergent

experts in Iowa are working

tally burst packets have

more likely to get into a

to answer.

been hospitalized at a rate

child’s airways. Preliminary

of about one a day. While at

findings are documented

Medical

least seven people have died

in a research paper that is

Director/Toxicologist, and

after ingesting their con-

under review.

Kim Zellmer, PharmD, of the

tents, thousands of children

American manufactures

Iowa Poison Control Center

have also experienced only

are being encouraged to

were recently featured in a

minor symptoms.

coat their laundry packets in

Bottei,

procedu res have Some codes and Develop a ed to ICD-10. been translat are where the denials process to identify ne which you can determi happeni ng so Set up a more training. areas will require this informacommun icate to now system e on staff. tion to everyon

Contac t us at

involving children. In the

Sioux City’s Edward

ls. d your denia undersTan already

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

why some children who bite

coders.

ready. Be finanCially allow your healthstrategy that will

Have a first few ng and to weather those Not only is it frustrati care organization and to have to budgets are aligned a waste of time months. If your whatever but waiting be ready for resubmit claims, prepared, you’ll a significan also cause happens. for reimbursement revenue an organization’s cant threat to -10 world is depenpost-ICD a . in systems Success adapt across all and cash flow. in Oct. tion’s ability to is implemented 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 growth. ■ now using to or hospital for at what you are clinic look e’s bottom line. your least, everyon very d to affect field length have room for the Medicare and Medicai 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, are for physician system is set up Claims error rates Make sure your 100 to 200 percent. to and data ng, registration from three percent orders, scheduli expected to increase days in coding. that use ICD-10 percent. The average systems as much as 10 grow from le are likely to accounts receivab 40, 20 to as high as re organizations Successful healthca right about denials should start thinking are five deadline hits. Here now – before the al denial beyond tradition tips for moving to not only reduce management strategy e their causes before eliminat to denials, but

WHAT MAKES LAUNDRY

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

MD,

Wall Street Journal article

Drs. Bottei and Zellmer

a foul-tasting substance,

entitled “Dangers Behind

studied the physical proper-

make containers opaque

Laundry Pods Stump Poi-

ties of laundry packets to

and harder to open, and

son-Control Experts”. The

see if they played a role in

two are trying to determine

the severity of the accidents

{

enlarge warning labels. ■

}

So Much care, So cloSe to hoMe.

Family Medicine

Yankton Medical clinic, P.c., Yankton, South Dakota is seeking a physician, Be/Bc in Family Medicine to join an established practice. No oB call. call 1:5. competitive salary and outstanding benefits.

ENT

Yankton Medical clinic, P.c., Yankton, South Dakota is seeking a Be/Bc in eNt to join an established practice. call one week per month. competitive salary and outstanding benefits.

Internal Medicine

Yankton Medical clinic, P.c., Yankton, South Dakota is seeking a Be/Bc traditional Internal Medicine Physician to join an established practice. call 1:7. competitive salary and outstanding benefits.

No state income tax. one year track to ownership. Works closely with 3rd year medical students from uSD Sanford School of Medicine.

Yankton Medical clinic, P.c. is a 42 Physician independently owned, multispecialty clinic. located in the southeast corner of South Dakota along the Missouri river, Yankton is a community of 13,700 people, with excellent schools, low crime rate, and all season recreation. For additional information please email ann ryken at aryken@yanktonmedicalclinic.com.

Midwest Medical Edition

1104 West 8th Street • Yankton, SD 57078 • 605-665-7841

Apply online at: www.YanktonMedicalClinic.com

Midwest Medical Edition

Children’s Sleep Center Earns AASM Accreditation THE SLEEP CENTER AT CHILDREN’S

Hospital & Medical Center in Omaha has earned accreditation from The American Academy of Sleep Medicine (AASM). Under the direction of Casey Burg, MD, a pulmonologist double-certified in pediatric pulmonology and pediatric sleep medicine, the Sleep Center offers a comprehensive sleep medicine program for young patients. In addition to Dr. Burg, staff members include board-certified pediatric pulmonologist Mark Wilson, MD, Ivan Pavkovic, MD, a pediatric neurologist double-certified in neurology and pediatric sleep medicine, Brett Kuhn, PhD, Nebraska’s only psychologist certified in behavioral sleep medicine, Amber Widstrom, PA-C, a physician assistant specially trained in pediatric sleep medicine, 10 respiratory therapists with advanced certification in sleep medicine, and a clinic RN, coordinator and supervisor who are all specifically dedicated to pediatric sleep medicine. Inadequate sleep can affect a child’s mood, academic performance and general health. The Sleep Center treats children for a variety of conditions, including sleep apnea, narcolepsy, snoring, and restless leg syndrome. Children are often referred to the Sleep Center by their pediatrician or other pediatric specialists. In many cases, sleep problems can be effectively managed and treated in the clinic through a combination of therapies including lifestyle and behavioral changes, medication management, continuous positive airway pressure (CPAP) and/or surgical recommendations. For physician-to-physician consults, referrals, admissions and transport service, contact the Physicians’ Priority Line at 855-850-5437 for a 24-hour link to pediatric specialists. ■

September / October 2015

Funding Secured for Three New Indian Health Projects | Awards bring NIH-funded studies total to Thirteen

Three projects have been selected for funding by the National Institutes of Health (NIH) as part of the Collaborative Research Center for American Indian Health (CRCAIH) and its pilot grants program.

The following projects were selected for funding: Sara DeCoteau, BA, Sisseton-Wahpeton Oyate of the Lake Traverse Reservation, Human Services/Division of Health Services Bonny Specker, PhD, South Dakota State University, Ethel Austin Martin Program

P ROJECT: Pregnancy Health Survey for Parents of Newborns on the Lake Traverse Indian Reservation Amanda Fretts, PhD, University of Washington, School of Public Health

P ROJECT: Healthy Food Healthy Families Feasibility Study Tai Mendenhall, PhD, University of Minnesota, Family Social Sciences and Kathy Denman-Wilke, MEd, St. Paul Area Council of Churches, Department of Indian Work

P ROJECT: East-Metro American Indian Diabetes Initiative: An Evaluation of Innovative Community-based Programs to Improve the Health of Native Men and Youth The CRCAIH’s pilot grant program, now in its third year, was created to fund cutting-edge transdisciplinary research addressing health disparities experienced by American Indians in South Dakota, North Dakota and Minnesota.Sanford Research and a broad base of partners in 2012 received a $13.5 million grant from the National Institute on Minority Health and Disparities to create the CRCAIH. The research center has now supported a total of 13 pilot grant awards across the region to explore how social determinants of health impact American Indians. The pilot projects were selected based on five major scoring criteria, including purpose, priorities and significance; scientific approach; innovation and potential for future funding; investigators and environment; and collaborative relationships. Researchers from the first round of pilot grants awarded in 2013 presented their findings in a spring seminar series at Sanford and the CRCAIH Annual Summit this past June in Rapid City. ■ ■

We Know Health Law. Jeana Goosmann CEO & Managing Partner Marie Ruettgers Managing Attorney

9 Years in Hospital Administration

Scott Leuning Attorney

Over 20 Years of Health Law Experience

Call Us Today! 605.371.2000 www.GoosmannLaw.com 5010 S. Minnesota Avenue, Suite 100, Sioux Falls, SD

MidwestMedicalEdition.com

When you need it.

Healthcare Systems Again Named to ‘Most Wired’ List HEALTH DATA SECURITY AND PATIENT ENGAGEMENT are

top priorities for the nation’s hospitals, according to results of the 17th annual HealthCare’s Most Wired survey from the American Hospital Association’s Health Forum and the College of Healthcare Information Management Executives (CHIME). This year marks Avera Health’s 16th year on the Most Wired list, Sanford’s fifth, and UnityPoint Health’s fourth. The survey of more than 741 participants, representing more than 2,213 hospitals, examined how organizations are leveraging IT to improve performance for value-based healthcare in the areas of infrastructure, business and administrative management, quality and safety and clinical integration. At Sanford, bar-Code Medication Administration (BCMA) was further implemented and video visits were launched to connect patients with providers over a mobile device or computer for non-emergencies. Avera also recently introduced its own video visit system, AveraNow, a mobile video visit with Avera providers, available 24/7. UnityPoint Health says it put IT to work creating “greater alignment between hospitals and physicians” and getting patients actively involved in their health and healthcare through a secure patient portal. Among some of the key findings nationally this year:

Medical professional liability insurance specialists providing a single-source solution ProAssurance.com

In 84 percent of Most Wired organizations, physicians can view and exchange other facilities’ results in the portal compared with 63 percent of hospitals surveyed. 76 percent use the portal and electronic health record (EHR) to exchange results with other EHRs and health information exchanges compared to 56 percent of those surveyed. 81 percent can communicate with patients via email or alerts in contrast to 63 percent of all respondents. 67 percent of Most Wired hospitals offer the ability to incorporate patient-generated data. 63 percent offer self-management tools for chronic conditions.             60 percent offer patient-specific education in multiple languages. HealthCare’s Most Wired™ Survey, conducted between Jan. 15 and March 15, 2015, is published annually by Health & Hospitals Network. ■

Midwest Medical Edition

MBA in Healthcare and Nursing Programs.

master your career. MBA in Healthcare: Gain practical business skills and transform the future of healthcare. MBA Certificate Programs: Business Innovation and Marketing, Healthcare Management, Management and Project Management. Accelerated Nursing Program: Become a nurse in 15 months.

“The program offered me an opportunity to utilize my diverse background in project management and learn from my peers while transitioning into the healthcare arena.”

Online RN-to-BSN Program: Complete your bachelor’s degree in nursing quickly and conveniently.

» AMY BAETE, MBA Healthcare

Research Project Manager & Evaluator, Sanford Research

usiouxfalls.edu/MasterYourCareer

605-331-5000

September / October 2015

MidwestMedicalEdition.com

admissions@usiouxfalls.edu

Dr. Steven Meyer and Siouxland Tanzania Educational Medical Ministries EIGHTEEN YEARS AGO, Steve Myer, MD,

now an orthopedic surgeon with the CNOS clinic in Dakota Dunes, was at one of the lowest points in his life. After many years of “living the dream” as a successful surgeon, his marriage was failing and he found himself questioning his purpose, his values, and his future. That’s when a chance encounter altered the course of his life. A woman whose broken leg he was asked to attend to late one night at Mercy Hospital would eventually connect him with a Christian mission team from Arkansas and a life-changing trip to China. “While we were going to church one day in Hong Kong, I felt a hand on my head and I heard the voice of God tell me ‘It’s time. I’m calling you to work for me’,” says Dr. Meyer. Less than a year later, Meyer was leading his own mission trip to Africa, a country he had visited briefly in medical school, and the idea for STEMM – Siouxland Tanzania Educational Medical Ministries – was born.

“I believe that God changes us not by what he does for us but by what he allows us to do for others,” says Meyer, who helped to found STEMM with his new wife and several others in 1997. He has since made 32 trips to the impoverished country, several with some of his six children. ”We try to be the hands and feet and heart of God for the people of Tanzania.” Since its founding, STEMM volunteers have performed nearly 1000 orthopedic, general and ENT surgeries in a country with only one physician for every 100,000 people and fewer than two dozen orthopedic surgeons to serve a population of 45 million. Meyer himself performed the country’s first hip and knee replacement. Although fewer than ten percent of Tanzanian children ever go to high school, STEMM has also helped send nearly 10 thousand of them to high school and university. “We have produced doctors, teachers, engineers and multiple nurses,” says Meyer. STEMM’s latest endeavor, launched in 2005, is STEMM Children’s Village, a village-style orphanage in a remote part of Tanzania. When filled to capacity, the homes on site – each complete with a “Mama” to care for the children – will accommodate up to 180 of Tanzania’s 2 million orphans. According to the group’s website, “The SCV will not merely save children from starvation, exploitation and death, but will also provide a Christian environment for them to thrive.” The next phase of construction at the SVC will add four more children’s

homes to the “village”, an on-site guest house for visiting volunteers, and, eventually, a school. STEMM also provides support to several other orphanages in the poor Arusha region. Always looking for new ways to innovate, STEMM has plans to help fund the orphanage and other ministries through a new agricultural endeavor. The group now owns 100 acres of land and a dozen dairy cows.

Dr. Meyer with his family and several children from STEMM Children’s Village. Photo courtesy Dr. Meyer

“God just keeps bringing all these amazing blessings. But it requires tons of talent and treasure and time,” says Dr. Meyer. “We need people who want to give something back who can go to Tanzania.” Meyer says the group welcomes new ideas that could help them better care for the physical, educational and spiritual needs of Tanzanians. “If someone says ‘Have you thought about this?’, we listen.” ■ For more information about STEMM and its ministries, visit their website at stemm.org. Visit MED’s website to see more photos from STEMM’s Tanzanian ministries.

Dr. Steven Meyer and a Tanzanian girl whose leg he surgically straightened. Photo courtesy STEMM.

Midwest Medical Edition

A symbol of everlasting love

W hat youto need know

D iamonds

about By Riddle’s Jewelry

1 2 3 4 5

What a Diamond Means

The Four Cs – Keys to Diamond Quality

What to Spend – A Diamond Buyer’s Guide

What to Choose – Selecting the right item

To establish a diamond’s

When you start to think

How can you be sure to

– Confidence, the fifth “C”

For centuries, men and

quality, jewelers examine

about buying a diamond,

choose the perfect

A jeweler who is a

women have found that

the 4 C’s - Cut, Clarity,

and the love it will

diamond for the one you

diamond expert can help

the sparkle and brilliance

Carat Weight, and Color

symbolize, you naturally

love? She or he may

you select the right

of a quality diamond

of a diamond. The

want the best you can

already have dropped

stone, as well as, explain

expresses their deepest

combination of the 4 C’s

afford and a beautiful

hints by admiring a

the diamonds properties

emotions and symbolizes

determines the value of a

stone you will treasure

photograph or some-

to you. Trustworthy

their enduring love. Yet

particular diamond. For

forever. Diamonds can be

one’s diamond. Browse

jewelers work to

with many beautiful

example, a colorless

found in a range of prices

together and with a

establish long-standing

diamonds to choose

diamond is at the top of

and you are certain to

trusted jeweler like those

relationships with

from, and no two alike,

the scale in color, but if it

find one that suits your

found at Riddle’s Jewelry.

customers and take pride

how do you pick the

lacks clarity or is small or

taste and budget.

Share you knowledge of

in finding quality

right diamond while

not well cut, it will be of

If you are about to

the 4 C’s and surprise

diamonds for their

spending wisely?

a lower value. The finest

purchase a Diamond

your significant other

customers. Riddle’s

stones possess the rarest

Engagement ring, you

with a diamond beyond

Jewelry has experts who

strong understanding of

quality in each of the 4

may want to consider

all expectations.

are knowledgeable and

the 4C’s, along with the

C’s, and are the most

spending the commonly

guidance of a trusted

valuable. Having a strong

accepted guideline of

finished jewelry items like

to explain the 4 C’s, as

jeweler like Riddle’s

understanding of the 4

two to three month’s

earrings, necklaces and

well as, show you a

Jewelry, will lead you to

C’s will help you make an

salary. But it is up to you

solitaires make sure to

selection of diamonds in

the answer.

informed purchasing

to select the diamond

purchase diamonds that

both quality and price ranges.

– The Enduring Gift of Love

Arming yourself with a

Selecting a beautiful

When it comes to

How a Jeweler Can Help

accessible that will work

decision. Ultimately, you

that will represents your

capture the true brilliance

diamond that combines

will discover which

deepest emotions and

of the moment. Selecting

the qualities of the 4 C’s

unique combination of

the promise you are

a quality diamond to

beautiful, only by

that you value the most

the 4 C’s make a

making for your future.

celebrate life’s most

comparing stones in

will allow you to give the

particular diamonds

intimate occasions is a

person will you be able

most enduring gift of

beauty and brilliance

truly rewarding experi-

to appreciate what makes

love. Born of the earth,

stand out to you.

ence. Choose the one

one more rare and

that “speaks” to you!

valuable than another.

reborn out of love, a

Go to riddlesjewelry.

While all diamonds are

diamond is more than a

com and page down to

Keep in mind, there are

precious gem…it is a true

the lower right corner for

no “bargain” diamonds;

symbol of love that will

Diamond Knowledge

only diamonds of

last forever!

different values, weight and brilliance.

MANAGING INDOOR ENVIRONMENTS for

Safety, Comfort and Efficiency

By G & R Controls

HEN a medical facility’s internal environment – temperature, humidity, air quality – is not what it should be, the problem can be more than uncomfortable for staff and patients; it can even be dangerous. Health conditions can be complicated by environmental conditions and contaminants can spread if ventilation systems aren’t properly managed. In addition, when a facility’s energy needs are not managed effectively, the resulting inefficiencies, while they may or may not have a direct impact on the comfort of occupants, can drive up the cost of healthcare and negatively impact the bottom line. A properly configured building automation system

can minimize these risks. P roper temper at u re controls and appropriate programming can significantly conserve energy, improve HVAC system performance, lower emissions and reduce overall operating costs, all while maintaining indoor air quality and comfort for both staff and patients. Building automation systems can be as simple or complex as you desire. The system can be set to simply heat and cool on demand or as complex as reacting to schedules and occupancy to automatically prompt the system to a set temperature and humidity level, turn the lights on and even manage access to different areas. Rooms and areas can be controlled individually. Think

of the different areas of a healthcare facility and how diverse their needs are. Patient rooms, operating rooms, laboratories and kitchens all have very different needs and schedules. Allowing each area of a hospital or clinic to be individually controlled for their respective purpose allows greater comfort for staff and patients. Building controls can automate all the important environmental aspects to ensure indoor air quality and the highest satisfaction rates of occupants as well as increase efficiency and save money.

SAFETY

Concerns for infectious disease control and bioterrorism are much greater today

than in the past. Hospitals and clinics need to keep patients and staff safe and comfortable while providing the highest level of care. Building automation systems can be a factor in keeping staff, patients and visitors safe. With appropriate programming, rooms can be monitored for air quality as well as security. For example, isolation rooms can be managed to prevent the spread of infectious diseases by activating alarms to alert staff of improper and unsafe conditions. The integration of security systems with building automation controls allows greater flexibility and increased safety throughout the facility. Let staff members take care of their number one job, the patients, and let the building controls monitor indoor air quality and security. Today’s healthcare needs are very different than twenty, or even ten, years ago. Building automation systems have the ability to rapidly adjust to the changing needs of the healthcare industry today and tomorrow. ■

G & R Controls engineers designing a plan for optimal environmental management.

G & R Controls is a Siemens Independent Field Office specializing in building automation and energy management since 1977.