med-midwest medical edition-january/february 2016

HIGH DEDUCTIBLE

HEALTH PLANS and Your Bottom Line

Why Cybercriminals TARGET EHRS

UPCOMIMG CME Opportunities

THE SOUTH DAKOTA REGION’S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

JAN

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Vol. 7 No. 1

Pediatric DysphagiaMore

Than Just “Picky”

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VOLUME 7, NO. 1 ■ JANUARY / FEBRUARY 2016

MIDWEST MEDICAL EDITION

REGULAR FEATURES 4 | From Us to You

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

10 | News & Notes Recognitions, new providers, accreditations, and more

27 | The Nurses' Station Nursing News from around the region

IN THIS ISSUE 6 | Overcoming “Scanning Anxiety”

■ By Cole McClung How not to get stuck on the first step when making the paper-to-digital switch

17 | Sensory Processing in the Workplace ■ By Theresa Parish

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

22 | Research Spotlight: Scientists Explore Novel Approaches to Peripheral Artery

Disease, Head & Neck Cancer

23 | Telemedicine

From Sioux Falls to Rural Montana

23 | New Faces on Regional Health’s Leadership Team

24 | Meet the VA’s New Chief of Staff

24 | Children’s Sports Medicine Clinic Provides Care to Young Athletes

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

ON THE

COVER 9

HOW HIGH-DEDUCTIBLE

HEALTH PLANS MAY IMPACT YOUR AR

■ By Jill Heyden and Sara Greff Dannen

High deductible health plans are likely to affect your bottom

line. Here’s how to cope

20 CYBERSECURITY:

WHY YOUR EHR MAY BE TARGETED

■ By Jeremy A. Wale

30LEARNING

OPPORTUNITIES Upcoming winter

and spring CME Events

More than a quarter of children

under five and as many as 80

percent of special needs children

suffer from feeding and swallowing

problems, with potentially profound

physical, psychological and social

implications. The importance of

recognizing and treating pediatric

dysphagia early is the focus of this

month’s Cover Feature.

page 12

Contents

By Alex Strauss

PEDIATRIC DYSPHAGIA

More Than Just “Picky”

HIGH DEDUCTIBLE HEALTH PLANS and Your Bottom Line

Why Cybercriminals TARGET EHRSUPCOMIMG CME Opportunities

THE SOUTH DAKOTA REGION’S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

JAN

UA

RY

FEB

RU

AR

Y

2016

Vol. 7 No. 1

Pediatric DysphagiaMore

Than Just “Picky”

Midwest Medical Edition 4

From Us to YouStaying in Touch with MED

Alex Strauss

Steffanie Liston-Holtrop

4

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

MED is proud to be starting our seventh year of publication, serving more than 5,000 print

readers across South Dakota, Southwest

Minnesota, Northeast Nebraska and Northwest

Iowa with current news, feature articles, event calendars,

and more. Thousands of readers across the region are also

taking advantage of our growing list of online tools

(MidwestMedicalEdition.com) to promote their practices,

post and/or learn about upcoming events, connect with

businesses that offer services they need, and, of course,

stay up to date with community medical news.

We are gratified that so many of you read and comment

on MED and pass it to your colleagues and are especially

grateful for letters like this one, from recently-retired

UnityPoint Health-St. Luke’s CEO Peter Thoreen.

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

— Peter Thoreen

We love praise, but we can handle constructive criti-

cism, too. Some of you took issue with the fact that our

recent “Future of Healthcare” series focused solely on the

perspective of traditional hospitals and did not include

input from independent clinics, physician-owned hospitals,

and others. Look for more input from some of these other

entities in upcoming issues.

Please keep the feedback coming in 2016. We continue

to stay open to ways to better serve the communication

needs of of our dynamic medical community. You can reach

us any time at the contact numbers/emails listed on the

facing page or through our website.

Cheers!

—Alex and Steff

Reproduction or use of the contents of this

magazine is prohibited.

©2011 Midwest Medical Edition, LLC

Midwest Medical Edition (MED Maga-

zine) 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

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lish only accurate information, however

Midwest Medical Edition, LLC cannot be

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

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 Breandan Donahue

Sara Greff Dannen

Jill Heyden

Cole McClung

Theresa Parish

Jeremy A. Wale

STAFF WRITERS Liz Boyd

Caroline Chenault

John Knies

mailto:[email protected]


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Move over Kayla and Isaac. We’ll update you on the most popular

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HeathPOINT’s Compass PTNHealthPOINT at Dakota State University recently partnered with several

states to create what it is calling a “Practice Transformation Network”.

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

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SO THE TIME HAS COME to implement a sophisticated, func-tional Electronic Health Records (EHR) or Document Management

(DM) system, thus eliminating the frustra-tion of loose documents and patient records flying around the office.

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

Because of these project requirements, the vendor selection process becomes that much more important. Trusting someone with your document scanning project takes due diligence and, at times, the patience to ask the right questions and get satisfactory answers. Whether in terms of knowledge, character, safety protections, capabilities, etc., each vendor has different strengths and weak-nesses. The key is to find a vendor that will accommodate and fit your project’s needs.

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

Reputation ■ Are you hearing anything

negative about the vendor?■ Do they run a successful business?

■ What are their technical capabilities?

■ Is scanning a focal point for them or an afterthought?

Conveniences ■ Where are they located?■ Is their office building secure?■ Will they pick up the documents?■ Will they drop documents off

once digitized, if required?■ Do they have shredding capabilities?

Change Supervision ■ Is the vendor trying to change

your goals?■ Are their recommendations

out of the ordinary?■ Do they know about your business

or do they just seem focused on getting the project?

Assessment ■ How does this vendor

compare to other vendors?■ Is the pricing clear and

straightforward?■ Does the first impression

pass the eye test?■ Can you envision a business

relationship with this vendor?

Efficiency ■ Are their employee’s full time

or part time?■ Is their software and hardware

technology up-to-date and sufficient?■ Can they meet timelines if required?

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

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

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

Cole McClung is a senior consultant at Active

Data Systems in Sioux Falls.

Overcoming “Scanning Anxiety”By Cole McClung

Midwest Medical Edition Midwest Medical Edition 6

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OUTSTANDING PHYSICIANS NEEDED Black Hills Urgent Care, LLC seeks outstanding full-time physicians to serve a well-established and growing patient base in Rapid City, SD and the Black Hills Region. Ideal candidates will possess strong clinical knowledge, excellent patient communication skills, and high levels of commitment to efficiency, service, and maintaining and increasing patient volumes. Family Medicine or Internal Medicine physicians who have board certification are desired.

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◆ Do you check every patient’s eligibility for insurance benefits immediately prior to every service?

◆ Do you have patients sign a financial policy to acknowledge what they are responsible for based on their payer type?

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

◆ Are you authenticating everything that needs pre-certification, pre-authorization or pre-notification to be sure the service will be paid?

◆ Have you recently audited your contract allowables to ensure you are being paid correctly?

◆ Do you check recoupments or requests for refunds from payers and make sure they truly should be refunded?

◆ Do you collect the patient’s portion of the service at the time of service?

◆ Do you collect fees for elective services prior to providing services?

◆ Have you determined if the reason of patient non-payment is because the patient is having difficulty understanding their EOBs or billing statements?

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

◆ Do you make it simple and convenient for your patients to make payments?

◆ Do you offer your patients the ability to pay online through your website?

◆ Do you accept cash only from patients who have passed bad checks or have filed bankruptcy with your practice?

By Jill Heyden and Sara Greff Dannen

How High-Deductible Health Plans May Impact Your AR

Considering hiring a collection agency? See more

advice for choosing one on our website.

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

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

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

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

Sitting down and analyzing the questions above will give you a step in the right direction. With the rise of patient out of pocket costs, everyone must do his or her part to ensure patient care doesn’t suffer, and AR balances do not get out of hand. ■

EVALUATE YOUR REVENUE CYCLE MANAGEMENT

Jill Heyden is the the Business Development Specialist and

Sara Greff Dannen is Legal Counsel at AAA Collections, Inc.in Sioux Falls.

(and what you can do about it)


http://www.midwestmedicaledition.com/2015/12/29/98377/how-high-deductible-health-plans-may-impact-your-ar-and-what-you-can-do-about-it


News & Notes

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

AVERA

Avera Queen of Peace Hospital in Mitchell and Avera Sacred Heart Hospital in Yankton have been recognized as 2014 Top Performers on Key Quality Measures by The Joint Commission. They were recognized for performance in pneumonia, surgical care, and venous thromboembolism. The Avera facilities are the only two South Dakota hospitals to earn the recognition.

Pediatrician Peter Paul Lim, MD, has joined Avera Medical Group Pediatrics Mitchell. Dr. Lim holds an MD from Davao Medical

School Foundation, Davao City, Philippines, and completed his residency at Janet Weis Children’s Hospital–Geisinger Medical Center in Danville, Pennsylvania. He is board eligible with the American Board of Pediatrics.

Avera Health and DAKOTACARE signed a letter of intent in November through which Avera Health will purchase DAKOTACARE. With its ownership of Avera Health Plans and DAKOTACARE, Avera will become the second largest health insurer in South Dakota, serving nearly 200,000 members.

BLACK HILLS

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

Rita Stacey, Director of Patient Services in Lead-Deadwood,

Justin Muth, a pharmacist in Spearfish,

Joann Stock, RN, nurse manager of the Intensive Care Unit in Rapid City

Beginning in May 2015, Regional Health launched a yearlong campaign aimed at celebrating its nearly 5,000 physicians and caregivers. Each month, the organization showcases three exceptional individuals from

across the region who truly represent Regional Health’s purpose – helping patients and communities live well.

Regional Health and Westhills Village Retirement Community have announced a partnership to reopen the facility’s on-site medical clinic for Westhills residents. The clinic is being operated and staffed by Regional Health primary care

providers, Thane Gale, M.D., and Ashley Neisen, Certified Physician Assistant (PA-C)

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

180 runners helped bring Christmas cheer for more than 80 children in the Rapid City area by participating in the second annual Black Hills Urgent Care Trot for Tots 5K on Saturday, December 12. The race was held as a benefit for the Cornerstone Women & Children’s Home with support from Black Hills Surgical Hospital, Black Hills Orthopedic & Spine Center, and Black Hills Neurosurgery & Spine. A van packed with donated clothing, books, toys, and games was delivered to the Cornerstone Rescue offices, along with a check for three thousand dollars.

SANFORD

A Sanford Research scientist is using an innovative pig model to better understand a rare genetic disorder that causes tumors in the nervous system, thanks to a more than $1.7 million grant from the Children’s Tumor Foundation. Jill Weimer, PhD, and her team received the award as part of the CTF’s Synodos program, an integrated, multidisciplinary consortium of scientists working to develop treatments for Neurofibromatosis type 1 (NF1). Weimer is a scientist and director of the Children’s Health Research Center at Sanford Research who studies nervous system development, neural development disorders and neurodegenerative diseases.

Sanford Aberdeen has been named a 2015 Guardian of Excellence Award winner by Press Ganey Associates, Inc. The Guardian of Excellence Award recognizes top-performing healthcare facilities that consistently achieve the 95th percentile of performance in emergency room patient experience nationwide. Press Ganey assesses patient satisfaction in several areas, including wait times, staff courtesy, concern for patient comfort and overall rating of care.

Sanford Health recently celebrated 10 years since it ushered in the era of the electronic medical record at Sanford 41st & Sertoma Family Medicine. Since then, Epic has been rolled out to 38 hospital sites and all associated clinics throughout the Sanford Health enterprise, changing the efficiency of care and giving thousands of patients access to medical records online.

RITA STACEY

JUSTIN MUTH

JOANN STOCK


News & Notes

SIOUXLAND

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

Mercy Medical Center-Sioux City has announced the appointment of Susan Bartholomaus

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

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

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

UnityPoint Health and HealthPartners plan to jointly launch a new insurance company, offering individuals and employers a new integrated option when it comes to their healthcare and coverage. The partnership, named “HealthPartners UnityPoint Health,” will leverage UnityPoint Health’s network of providers and HealthPartners’ scale, health plan sophistication, and expertise. The parties will equally own and govern the insurance entity.

OTHER

HealthPOINT has partnered with Georgia, Iowa, Kansas, Nebraska, and Oklahoma to form a practice transformation network. The Compass Practice Transformation Network (Compass PTN) is a national initiative funded by the Center for Medicare & Medicaid Innovation (CMMI) to support primary and specialty care clinicians. Through coaching, mentoring and assisting in the identification and development of core competencies necessary to transform clinical practices, the Compass PTN is designed to position clinicians to meet quantifiable improvements, outcomes, achieve the Triple Aim and thrive in the value-base environment.

Doctors, community leaders, workers and the public gathered at a downtown Sioux Falls bar In November to celebrate the fifth anniversary of the state’s smoke-free air law. The law, which eliminated indoor smoking in all public places including bars, restaurants and video lottery establishments, passed through a statewide referendum in 2010 with overwhelming 65 percent support.

New positions at The South Dakota Association of Healthcare Organizations (SDAHO):

Jeanette (Jen) A. Porter, EdD, MBA, has been named Vice President of Post-Acute Care. Porter earned both

her bachelor and master degrees from the University of South Dakota and completed her Doctor of Education in Leadership from Creighton University in 2014. She has more than 20 years of career experience in planning and oversight responsibilities for nursing facilities, home health and hospice agencies, senior living and community-based services.

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

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

Timothy Tracy, CEO of Sanford Vermillion Medical Center, in Vermillion, South Dakota

was elected Chairperson of SDAHO at the annual business meeting. Tracy has worked as a healthcare administrator in South Dakota and North Dakota since 1983, and has been the Chief Executive Officer of Sanford Vermillion Medical Center since April 2004. He will provide leadership and direction along with the 14-member SDAHO Board of Trustees.

Stay up-to-date with new medical community

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January / February 2016 MidwestMedicalEdition.com 11



FOOD AVERSIONS and obsessions, strange mealtime habits and behaviors, delays in developing the mechanics or the skills to self-feed, aspiration of liquids, dif-

ficulty swallowing, and flat-out refusal to eat.These are daily realities and a source of anxiety for

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

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

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

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

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

More Than Just “Picky”

The mechanics of eating require the engagement of 26 muscles and 6 cranial

nerves, making eating more physically complex than

either walking or talking.

PEDIATRIC


By Alex Strauss

Speech-language pathologist Heather Hewitt, MS, CCC-SLP, works with 2-year-old Marcus on

accepting a variety of foods.

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

RECOGNIZING DYSPHAGIA

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

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

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

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

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

those with behavioral problems may need to learn more appropriate mealtime habits. Even children who are simply late starting on solid foods may have difficulty adapting if the switch from liquids to solids occurs after the ideal 6-month mark.

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

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

PATIENT-CENTERED THERAPY

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

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

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

DYSPHAGIA



Speech-language pathologist Jaime Stratman, MA, CCC-SLP, uses VitalStim therapy

to help strengthen 8-month-old Hudson's swallowing muscles .

Phot

os C

ourt

esy

of L

ifeSc

ape

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

“I think people can get stuck in doing

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

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

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

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

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

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

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

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

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

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

MEETING PATIENTS WHERE THEY ARE

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

“For instance, if someone lives far away

Consider recommending an evaluation in cases such as . . .

• A baby who is not eating at least soft solid food by 12 months

• The “picky” eater who consumes only a few specific foods

• A toddler or child who refuses to eat from certain food groups

• Any child with chewing problems

• A child with difficulty swallowing liquids

WHEN TO REFER


Occupational Therapist Melissa Pitz (l) and Speech-Language Pathologist Melissa Carrier-Damon, MA,

CCC-SLP, BCS-S, (r) work with special needs patient Grace.

Phot

os C

ourt

esy

of L

ifeSc

ape

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

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

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

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

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

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


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Cover Story

CENTER FOR NEUROSCIENCES, ORTHOPEDICS AND SPINE

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Sensory Processing in the WorkplaceBy Theresa Parish

WE LIVE IN A world full of sights, sounds, smells, tastes, and textures– sensations that affect our

ability to think, reason, and even be productive at work. We also deal with the forces of gravity each and every day. Some of us are more affected by these sensations than others.

Sensory processing is the way each of us responds to incoming sensory information. We learn and grow through our senses which include touch, sight, sound, smell, taste, proprioception, and vestibular sensations. We manage our day-to-day activities through all the information our bodies take in. Ninety percent of this information is actually below our conscious level of awareness.

Those of us whose sensory systems are “normal” respond appropriately to most situations. We are able to adapt to our surroundings without much difficulty. However, when we have increased stress, our ability to adapt may be compromised and adaptations may become more difficult.

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

difficulties adapting due to stress and lack of sleep.

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

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

Many workplaces have ways they can adapt for medical conditions or they can get assistance from an occupational therapist in order to make ADAAA accommodations. Most companies may not even be aware of

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

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

For more serious issues, a person may need to work with an occupational therapist. Fortunately, once basic sensory-driven needs are provided for, people tend to be more comfortable, less annoyed by incoming sensations, and thus, more productive.

If you suspect a sensory issue and are unsure of how to help, consult with an occupational therapist who can help you, your employees, patients, or family members live and work sensationally. ■

Theresa Parish is an occupational

therapist and a Ready Associate for the

Ready Approach. She is an Ergonomics

and Loss Control Specialist/Sensory

Processing Specialist with RAS.



LAWSUITS ARE COMMONPLACE THESE DAYS. You are most likely to be targeted by one if you have wealth or work in a high-risk profession. There are many techniques for protecting your wealth against

such risks; for example, maintaining appropriate insurance and structuring assets across several limited liability com-panies. These are strong strategies, but they do have their gaps and blind spots. Here are five things you should know about Domestic Asset Protection Trusts (DAPTs).

1 Your Wealth Protection Vehicle A Domestic Asset Protection Trust, or DAPT, is a wonderful

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

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

5 THINGS YOU SHOULD KNOW

By Breandan Donahue

About Domestic Asset Protection Trusts

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2 The South Dakota Advantage There are certain requirements that need to be met in

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

3 Who Are DAPTs For?DAPTs are great for those people that find themselves in

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

4 Don’t Put All Your Eggs In One Basket

The asset types that are typically placed in DAPTs are stocks, bonds, cash accounts, mutual funds, closely held business interests, and occasionally real estate. When placing property into the trust, it is important to understand that for a DAPT to be effective, it cannot become the house for all of your assets. You can fund the trust with significant assets, but you cannot go so far as to impoverish yourself. DAPTS are just one part of a larger overall asset protection strategy. It is a fine line that needs to be walked very carefully, but do it correctly and it will create a creditor “lockbox” over a sizeable portion of your assets.

5 Now, Not Later DAPTs are proactive measures. A DAPT must be done

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

If you are in a high-risk profession, and want to take advantage of a DAPT, it is critically important to get started today. Talk to an estate planning attorney to help you take the proper proactive measures toward your wealth protection. Don’t wait until it’s too late. ■

Breandan Donahue is an Estate Planning Attorney

at Goosmann Law Firm.


www.deadwoodlodge.com


WITH THE increased use of technology comes increased risk of cyberattacks. Any-thing transmitted or stored

electronically is at risk of being stolen by a hacker.

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

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

WHY ARE MEDICAL RECORDS TARGETED?

Medical records seem to be targeted because they contain all of an individual’s personal information: finances, social secu-rity numbers, health information, and family information. This gives thieves more poten-tial uses for the stolen information, including applying for credit cards, store accounts, or other lines of credit. They also can use the information to steal healthcare services. These are just a few reasons why a medical

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

Another example of how valuable a medical record may be: a security firm CEO shared an example of a black market advertisement to sell ten Medicare numbers. “It costs 22 bitcoin—about $4,700 according to today’s exchange rate.”

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

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

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

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

WHAT CAN YOU DO TO SAFEGUARD ELECTRONIC MEDICAL RECORDS?

When implementing or updating an EHR system, talk to your vendor about cyberse-curity. Ask whether the stored information is encrypted. It also is a good idea to deter-mine if or when the vendor will provide security updates for your EHR software.

Organizations may need to “invest more money and employee talent in shoring up the walls around their electronic data. Cybersecurity is a highly specialized area that requires a certain expertise. Your EHR vendor may be able to provide some assistance in this area, but remember their expertise is creation and functionality. Hiring in-house cybersecurity experts or contracting with a cybersecurity firm specializing in this area may be the best options to protect your organization and your patients.

Several organizations, such as the Department of Homeland Security, the American Hospital Association, the Centers for Medicare & Medicaid Services, and the National Institute of Standards and Technology, offer guidance and resources on cybersecurity. Their web addresses are included in the endnotes of this article. These are just a few of the vast number of resources available to organizations regarding cyber-security. ■Jeremy Wale, JD, is a Risk Resource Advisor

with ProAssurance.

Cybersecurity By Jeremy A. Wale

For a complete list of the refer-ences for this article, see the full

version on our website

WHY YOUR ELECTRONIC HEALTH RECORDS MAY BE TARGETED


http://www.midwestmedicaledition.com/2015/12/29/98406/cybersecurity-protecting-your-electronic-health-records


www.bodygaragemd.com

www.richardhowardmd.com


Research Spotlight

Scientists Explore Novel Approaches

THE UNIVERSITY OF South Dakota and Sanford Health are collaborating to develop more effective drug-coated

balloons to treat peripheral artery disease. The two new devices, which can more precisely deliver drugs to specific arteries, are based on intellectual property jointly created by Sanford’s Patrick Kelly, MD, and USD’s Gopinath Mani, PhD.

Drug-coated balloons deliver drugs to arteries to repair damaged walls and prevent future renarrowing. Traditional balloons release drugs in a burst profile, demanding the use of more balloons and

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

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

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

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

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

to Peripheral Artery Disease, Head and Neck Cancer

Dr. Patrick Kelly

Photo courtesy Sanford


Telemedicine–From Sioux Falls to Rural MontanaPatients as far away as Montana will soon

benefit from the expertise of specialists at

Avera. Avera eCARE has announced the

opening of its latest eEmergency site at

Roundup Memorial Healthcare in Roundup,

Montana.

This partnership between Roundup

Memorial and eCARE Service will link local

physicians to emergency specialists with just

the click of a button. Using two-way video

equipment, rural doctors are linked to emer-

gency-trained physicians and specialists at all

times. The eEmergency team can provide

consultations during emergency situations so

that patients are more likely to be able to stay

in their local emergency room.

Since its creation, eEmergency has helped

partner hospitals avoid more than 3,000

transfers and has saved $26 million in health

care costs.

“A second set of eyes on cases not only

provides a deeper level of care for patients, it

decreases the stress level of local physicians,”

said Jay Weems, Executive Director of eCARE

Client Management.

Avera eCARE offers one of the largest

telehealth networks in the United States,

supporting more than 235 health centers,

clinics, long-term care centers and correctional

facilities within an eight-state region across

545,000 square miles. This virtual service

supports the local healthcare workforce by

improving retention and recruitment in rural

areas. Patients have access to round-the-clock

care management and health facilities can

operate more efficiently.

eCARE’s growing line of services

includes eEmergency, ePharmacy, eICU

Care, eCorrectional Health, eConsult, and

eLong-Term Care. ■

For a more detailed explanation of each of these eCARE areas,

log on to our website.

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

Davidson is a Certified Medical Practice Execu-tive (CMPE) who comes to Regional Health from Nebraska Medicine in Omaha, where she was

system Chief Human Capital and Patient Experience Officer. A Fellow in the College of American Health Care Executives (FACHE), Davidson has a Master’s degree in Business Administration (MBA) from the University of Notre Dame – Mendoza College of Business in South Bend, Indiana and a Bachelor’s degree in Business Admin-istration from the University of Wisconsin in Madison.

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

Officer and Vice President of Hospital Operations.

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

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

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

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

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Meet the VA’s NEW Chief of Staff

DR. JOHN (JACK) WEMPE, the new Chief of Staff for the Sioux Falls VA Health Care System, says he came to South Dakota because of the people. Wempe, who spent 3 decades in the military,

says he especially appreciates the “Mid-western values” and work ethic of the VA staff with whom he now works.

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

During his 30 years in the U.S. Army, he had multiple leadership positions in the United States and overseas. He most recently served as the Assistant Dean of Medical Student Affairs for the University of South Dakota Sanford School of Medicine prior to coming to VA.

Having spent his career in the military, Dr. Wempe says coming to the VA is an extension of his service to the country and he praises VA providers and other staff who also regard Veterans and their service with admiration. ■

Children’s Sports Medicine Clinic Provides Care to Young AthletesLIKE ANY EXERCISE, playing a sport can help children control weight, improve self-esteem

and do better in school. There are dangers for child athletes, however. More than 3.5

million Americans age 14 and younger are treated for sports injuries every year.

“Sports injuries in adolescents and teenagers are difficult,” says Kody Moffatt, MD,

pediatrician and sports medicine specialist at Children’s Hospital & Medical Center in

Omaha. “The body, bones and joints aren’t fully developed. We want to make sure these

injuries are diagnosed and treated before they create a chronic, long-term problem that

could impact the child’s ability to compete successfully down the road.”

A significant focus of the Children’s Sports Medicine Clinic is diagnosing and managing

post-concussion recovery, particularly with regard to helping injured athletes transition

back into the classroom, a process often referred to as “return to learn.” Appropriate

management of the “return to learn” process is a critical part of concussion recovery. At

the Sports Medicine Clinic at Children’s, a customized “return to learn” plan is created for

each patient.

Most sports-related injuries do not require surgery. However, Layne Jensen, MD, a

pediatric orthopaedic surgeon who specializes in surgical repairs for young athletes who

are still growing, can provide on-site consultation. Dr. Jensen specializes in pediatric surgical

techniques such as ACL reconstruction for children who cannot undergo traditional

procedures due to skeletal immaturity. In addition, Children’s pediatric cardiologist

Chris Erickson, MD, contributes to the multi-disciplinary focus with comprehensive heart

evaluations, when needed. ■

Walking is man’s best medicine. — Hippocrates

MED QUOTES

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Inpatient Rehabilitation for Your Pediatric Patients

Sioux Falls & Rapid City • LifeScapeSD.org

Our rehab team provides short-term intensive rehabilitation after accident, illness, or surgery. After discharge, patients can seamlessly transition to outpatient care at our Sioux Falls or Rapid City location – or to a local provider.

■ Admissions: Shannon Vanden Bosch, RN, 605.444.9556

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


southdakota.wish.org

lifescapesd.org


www.sdletb.orgTO MAKE A REFERRAL1-800-245-7846 EXT 4

TO OUR MEDICAL PROFESSIONALS AND PARTNERS

Thank You!As we reflect on the past year and look forward to the future, we are

thankful for your partnership and helping us fulfill our mission of helping to enable the restoration of the gifts of sight and health.

In the past fiscal year, we were able to help restore sight to 766 individuals through corneal transplantation. Thousands more were

helped through non-ocular tissue and research donation.

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

OVER THE PAST FEW decades,

there’s been a revolution in

treating congenital heart

defects. Advances in diagnosis

and surgery have made it possible to fix or

repair most defects, even those once thought

to be hopeless. Many people with these

defects are now reaching adulthood and

living full, active lives. According to the

Centers for Disease control, there are about

1 million children and 1 million adults living

with CHD.

The American College of Cardiology and

the American Heart Association have devel-

oped standards for treating adults with

congenital heart disease (ACHD). Experts in

congenital heart disease are working to

improve the health care system, so that teens

and young adults have an easier time making

the transition from receiving health care in

pediatric cardiology centers to receiving care

from specialists in adult cardiology.

It is recommended for the ACHD patient

to receive regular follow-up visits at least every

1 to 2 years if they have moderate or complex

CHD and every 6 to 12 months if they have

very complex ACHD. Even if low-risk, simple

CHD, they should be evaluated at least once,

to determine if future follow-up is needed.

It is important to have the patient transition

into seeing an adult congenital heart disease

specialist to receive specific information and

advice about health issues that are affected

by your CHD, including:

❤ Exercise and participation in sports

❤ Preventive health habits for overall

good health

❤ Genetic testing and counseling

❤ Safe and effective birth control,

especially the need for some women

with ACHD to avoid estrogen-

containing birth control pills

❤ Pregnancy, including the risk of premature

delivery and low birth weight; risk to the

baby from medications the mother needs

to take, such as blood thinners; possible

complications during pregnancy and

delivery; and importance of preventing

blood clots during and after delivery.

❤ Patients with CHD face an increased risk

for getting an infection that can spread

to the lining of the heart and heart

valves—infective endocarditis (IE).

❤ It’s not uncommon for adults with

CHD to have an irregular heart rhythm

(arrhythmia), which is caused by

problems in the heart’s electrical system.

To raise awareness about the number one

heart defect the American Heart Association

is handing out knitted red hats to every baby

born in the month of February at participating

hospitals, including all Sanford facilities. ■

By Kelly Steffen, DO

Congenital heart disease in adults

Dr. Kelly Steffen is a cardiologist at Sanford

in Sioux Falls.


www.sdletb.org

ProAssurance.com

Medical professional liability insurance specialists providing

a single-source solution

When you need it.The Nurses’ StationNursing News from Around the Region

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

FNP, earned her Doctor of Nursing

Practice and Family Nurse Practitioner

degrees from South Dakota State Uni-

versity and is certified by the American

Academy of Nurse Practitioners Certi-

fication Program (AANPCP). She is now seeing established patients

at Avera Medical Group Internal Medicine Olegario Clinic.

My Mom suffers from

Neuropathy in both feet.

That was not the reason we

were sent to the hospital,

but Muharema listened and

cared for her feet and made

my Mom feel as comfortable

as she could.

Muharema really

listened and discussed the

pain and tried to make my

Mom comfortable. She

was genuinely caring and

sympathetic towards my

Mom’s problems.

My Mom was upset

about having to spend that extra night in the hospital

and if Muharema had not been her nurse that night, I

think it would have been a very different outcome. My

Mom was calmer and felt safer with Muharema as her

nurse. In the morning when shift change occurred,

Muharema hugged my Mom and wished her well. You

could tell the sincerity in her actions and her words. My

Mom was feeling much better about the decisions that

needed to be made about her continual care.

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

The following excerpt comes from her nomination letter:

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

— William James Mayo

MED QUOTES

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“

”


proassurance.com


For some time now, research has shown that consuming protein in balanced amounts at each meal may be more benefi cial to

improving the impact of higher protein intake on various health outcomes.1

Signifi cant research shows that some people can lose and maintain a healthy weight2,

support a healthy metabolism3, and age more vibrantly4 when they consume more high-

quality protein, within calorie goals.

take controlChallenge yourself to eat protein-rich foods

at every meal and feel the di erence!

Visit BeefItsWhatsForDinner.com/

ProteinChallenge.

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

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

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

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

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ProteinChallengAd_Nutrition_SD.indd 1 11/30/2015 12:47:53 PM

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WHEN KELLY KING, Director of Nursing at Sioux Falls Specialty Hos-pital, decided to go back to

school in the Fall of 2011, she knew that what she did not need was more education in the nursing profession. King, who grad-uated from Mt. Marty college in Yankton in the 1980’s, hit the ground running in Mobridge, working in areas ranging from pediatrics and OB to the ER and the ICU at the town’s small hospital. “It was an excellent place for a new RN to start her nursing career,” she says.

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

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

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

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

every Wednes-day evening. She spent her week-ends writing and studying.

One of the first things King says she learned in the program was respect for her fellow stu-dents. “I was the second oldest person in my cohort and at first I thought ‘Gee, how much are these younger people really going to be able to contribute to the discus-sion?’,” King recalls, somewhat sheepishly. “But I quickly learned how conceited that was. I learned an enormous amount from every individual in the program and we all learned to appreciate our varying perspectives. In a way, we really mentored each other.”

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

King credits a good portion of her success in pursuing her MBA to her family’s support (her hubby hired a cleaning service for their home and her children gave her school supplies), and has this advice for other busy professionals considering additional education:

“Somehow it all fits. You shift things around. You study when you can. After you graduate, you wonder ‘How did I make time for that?’ But somehow, if you want it, you just do.” ■

“ Somehow it all just fits”

You can purchase a digital fi le 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!

Reprinted from MED Magazine

Preparing for the

Denial Process

No one likes denials.

Not only is it frustrating and

a waste of time to have to

resubmit claims, but waiting

for reimbursement can also cause a signifi-

cant threat to an organization’s revenue

and cash flow.

When ICD-10 is implemented in Oct.

2015, hospitals and clinics are likely to see

an immediate effect: more claims denied

and longer times waiting for resolution. This

new highly detailed coding regimen is likely

to affect everyone’s bottom line.

The Centers for Medicare and Medicaid

Services (CMS) estimates that in the early

stages of ICD-10, denial rates will rise by

100 to 200 percent. Claims error rates are

expected to increase from three percent to

as much as 10 percent. The average days in

accounts receivable are likely to grow from

20 to as high as 40,

Successful healthcare organizations

should start thinking about denials right

now – before the deadline hits. Here are five

tips for moving beyond traditional denial

management strategy to not only reduce

denials, but to eliminate their causes before

they happen:

Train your people.

Everyone who is involved with patient

records should take the time to learn the

standardized code format they’ll need.

Nurses, physicians, schedulers and

anyone who touches patient records can

get prepared now to integrate that code

across all systems.

evaluaTe your Tools

and sysTems.

Now may be a good time to shift to a new

electronic medical records system. At the

very least, look at what you are now using to

make sure you have room for the field length

and characters required for the new codes

and the inclusion of more detailed records.

Make sure your system is set up for physician

orders, scheduling, registration and data

systems that use ICD-10 coding.

undersTand your denials.

Some codes and procedures have already

been translated to ICD-10. Develop a

process to identify where the denials are

happening so you can determine which

areas will require more training. Set up a

system now to communicate this informa-

tion to everyone on staff.

By Natalie Bertsch

Tips for eliminating your

iCd-10 Claims problems Today

SEptEMbER

Oc

tOb

ER

2014

vol. 5 no. 6

GeT The CodinG

supporT you need.

The demand for skilled medical coders is

already high. Look at your staffing levels

now to make sure you have the coders you

need or make arrangements for external

coding augmentation with a quality firm.

It may be more cost-effective to contract

with another company than to train large

numbers of new coders.

Be finanCially ready.

Have a strategy that will allow your health-

care organization to weather those first few

months. If your budgets are aligned and

prepared, you’ll be ready for whatever

happens.

Success in a post-ICD-10 world is depen-

dant on your organization’s ability to adapt

to a need for new levels of expertise in coding

efficiency and documentation. Making the

changes you need now will help you avoid

problems before they happen and prepare

your clinic or hospital for growth. ■

Contact us at 877-858-5307 dt-trak.com

natalie Bertsch is co-owner of Dt-trak consulting Inc.,

which has been providing nationwide professional

medical claims management, revenue enhancement,

training and onsite consulting services since 2002.

DID YOU

KNOW?

denials, but to eliminate their causes before areas will require more training. Set up a

system now to communicate this informa-

tion to everyone on staff.


management strategy to not only reduce

denials, but to eliminate their causes before

they happen:

natalie Bertsch

which has been providing nationwide professional

medical claims management, revenue enhancement,

training and onsite consulting services since 2002.


JUly

/ aU

gU

st2

014

Vol. 5 No. 5

Risks surrounding AlARm mANAgemeNt in the Healthcare settingT he issue of alarm faTigue and paTienT safeTy has become

a ‘center stage’ concern for healthcare providers across the country over

the last two decades. in fact, the emergency Care research institute

(eCri) named alarm hazards as the #1 health Technology hazard in 2013.

The number of alarm signals in healthcare facilities can surpass several hundred per

patient each day – which can translate to thousands of alarms on every unit and tens of

thousands throughout the hospital. While alarms are an important part of patient care,

they can reach overwhelming quantities. so, it’s no wonder that clinicians can become

desensitized, overwhelmed or immune to the sounds, and can suffer from ‘alarm fatigue.’

The risks to patient safety are real. Common injuries resulting from alarm hazards

can include falls, delays in treatment, medication errors, or in the worst case – death.

The Joint Commission sentinel database reports 98 alarm-related events between

January 2009 and June 2012. of the 98 reported events, 80 resulted in death, 13 in

permanent loss of function, and five in unexpected additional care or extended stay.

unfortunately, these occurrences are happening more and more frequently.

in June 2013, the Joint Commission established a new 2014 national patient safety

goal (npsg) to address improving the safety of clinical alarm systems in hospitals. The

npsg requires hospital and critical access hospital leaders to set alarm management as

a priority, establish a formal policy and provide staff training around alarm safety.

Jillyan Morano BSE, MHA

By Alex Strauss

Photo courtesy USF



Winter /Spring 2016

January 23 Sanford Health Cerebrovascular Symposium7:00 am - 4:00 pm Location: Ramada Plaza and Suites, Fargo, ND

Registration: SanfordHealth.org, search “Fargo Cerebrovascular Symposium”

March 4 & 5 UnityPoint Health-St. Luke’s EMS Conference 2016 Location: Sioux City Convention Center

Information: http://www.unitypoint.org

/siouxcity/services-professional-education.aspx

March 21 & 22 4th Annual Regional Health Sports Medicine Symposium8:00 am - 6:00 pm, Location: The Lodge at Deadwood

7:30 am - 12:00 pm Information: [email protected], 605-755-8015

Registration: Regionalhealth.com/sportsmed

March 31 Avera Transplant Institute Symposium8:15 a.m.-4 p.m. Location: Prairie Center, Avera McKennan

Information: [email protected], 605-322-7879

Registration: Avera.org/conferences

April 8 15th Annual Avera Pediatric Symposium8:00 am - 4:00 pm Location: Prairie Center, Avera McKennan

Information: Avera Education Events, 605-322-7879

Registration: Avera.org/conferences

April 13 24th Annual Avera Trauma Symposium7:30 am - 4:00 pm Location: Sioux Falls Convention Center

Information and Registration: Avera.org/conferences

April 29 - 30 10th Annual Sanford Sports Medicine Symposium8:00 am - 6:00 pm Location: Ramkota Hotel & Conference Center, Sioux Falls

Information: 605-312-7808

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 [email protected].

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

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

30

Learning Opportunities

http://www.midwestmedicaledition.com/calendar


To submit an article, share an idea, offer a news

item, or suggest a story, VISIT OUR WEBSITE.

Now It’s Your TurnSouth Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

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.

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 fellowship-

trained 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.

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.

September / October 2015

MidwestMedicalEdition.com

11

AVERA

The Avera Specialty Pharmacy

recently earned full URAC

Specialty Pharmacy

Accreditation, becoming the first

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.

BLACK HILLS

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

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.

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.

News & NotesHappenings around the region


10

News & Notes

Stay up-to-date with

new medical community

news between issues.

Log on!

Regional Health is pleased to

announce the addition of . . .

a Family Medicine

Sturgis, Annalisa

Lead-Deadwood,

and Susan Weber,

practice provider

in dermatology.


his duties as

Chair of the

Board and Ryan

Huber became

Vice Chair of

Small Hospital category and

for Overall Emergency

Department Experience in

the Medium Hospital category

a Family Medicine

Sturgis, Annalisa

coordinator in

Lead-Deadwood,

and Susan Weber,

Recruitment in

Vice Chair of the Medium Hospital category

a Family Medicine


30

Visit MED’s website to see

more photos from STEMM’s

Tanzanian 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 sur-

geon, 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 sur-

geons 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 uni-

versity. “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 accom-

modate up to 180 of Tanzania’s

2 million orphans. According

to the group’s website, “The

SCV will not merely save

children from starva-

tion, 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, eventu-

ally, a school. STEMM also provides

support to several other orphanages in the

poor Arusha region.

Always looking for new ways to inno-

vate, 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.

“God just keeps bringing all these amaz-

ing 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, edu-

cational 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.

Dr. Steven Meyer and Siouxland

Tanzania Educational Medical Ministries

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

Photo courtesy STEMM.

Dr. Meyer with his family and several children from

STEMM Children’s Village. Photo courtesy Dr. Meyer


Visit MED’s website to see

more photos from STEMM’s

Tanzanian ministries.


9

July / August 2015


SIOUX FALLS PLASTIC sur-geon Richard Howard, MD, says it was T-Ball that originally prompted him to establish his practice in Sioux Falls in 1992. Specifi-cally, his son Tommy’s T-Ball.“We were living in Kansas City at the time and we had one son. It was T-Ball season and, if I wanted to catch a game, it was a 45 minute drive there and then another 45 minutes back to the office to finish up,” says Dr. Howard. “An hour and a half to watch one game. Living in the big city had pros and cons but, at that point, the cons were outweighing the pros by a long shot.”Leaning on advice from his father that “a man who fails his family fails his life”, Dr. Howard moved his family and surgical practice to Sioux Falls, enjoyed as much T-Ball as he could, and never looked back.Twenty-three years later, that emphasis on family appears to be paying off in spades. Not only did Thomas Howard, MD, decide to follow his father into medicine, but he has recently decided – after some considerable debate – to follow him into his Sioux Falls practice.“Tom told me years ago that he was abso-lutely not going to go into plastic surgery,” recalls Dr. Howard with a laugh. “He got into medical school at USD and arranged

most of his rotations outside of Sioux Falls. He decided that he wanted to do cardiovas-cular surgery.”But things changed for Dr. Tom Howard when he realized how the cardiovascular landscape had changed in recent years.“Interventional cardiologists have become so proficient that the surgeons tend to get the very sickest patients. That means more challenges, longer recovery, more problems,” says the younger Dr. Howard, who completed his Plastic & Reconstruc-tive Surgery residency at the University of Oklahoma in June. “With plastics, everyone seemed really happy and excited to go to work. Their patients tend to be happier, too. It all seemed much more attractive.”After discussions with his dad and evalu-ation of the local medical landscape, the idea of coming home to Sioux Falls with his wife Katie (also a Sioux Falls native) and young son seemed more attractive, too.“My dad and I get along great,” says Tom. “He’s a wonderful teacher, a talented surgeon, and great with people. I would be missing a great opportunity if I went any-where else.”

“I’m confident knowing Tom’s personal-ity, his high standards, and how he approaches taking care of people, that he will do very well here,” says Dr. Richard,

who is hoping to cut back his own workload by 25 to 30 percent. “I think it will be a lot of fun. And the timing for me right now couldn’t be better.”Like his father, Dr. Tom Howard says he enjoys the personal nature of plastic surgery and the opportunity to get to know patients over time, such as over the course of a breast reconstruction. As much as he knows he stands to learn from his dad, he’s also hoping to be able to teach some, too.“I am hoping that he will show me some of the old tried-and-true things that always work and I’ll be able to show him some things that are on the forefront of the specialty,” says Tom, who will be studying for his board exam in the fall.

For his part, Dr. Richard Howard, whose Sioux Falls Center for Plastic and Recon-structive Surgery has been primarily a solo practice, is glad to be gaining not only a partner he likes and trusts, but also a closer relationship with his three-and-a-half year old grandson, Benjamin.“He’s my only grandson and now I am going to get to go to his T-Ball games,” says Dr. Howard. ■

NOTE: Dr. Tom will join Dr. Richard in practice at the Sioux Falls Center for Plastic and Reconstructive Surgery in August.

Then and Now

By Alex Strauss

For Drs. Richard and Tom Howard, Plastic Surgery is a Family Affair

Father and son in the “T-Ball” days

Dr. Tom Howard and his father, Dr. Richard Howard

July / August 2015


will do very well here,” says Dr. Richard, practice at the Sioux Falls Center for Plastic and Reconstructive Surgery in August.

37


36

November 2015MidwestMedicalEdition.com

Home Brewed HobbySIOUX FALLS ONCOLOGIST COOKS UP AWARD-WINNING

BEER IN HIS GARAGE

AS A MEDICAL oncologist

and researcher at Sanford in

Sioux Falls, Steven Powell,

MD, spends the bulk of his

time trying to answer some of the trickiest

questions in medicine. In his off hours, he

wants what a lot of people want–to relax

with a great beer.Making a great beer, that is.

“Honestly, I wasn’t even much of a beer

fan until I started brewing. That is really

what got me into it,” says Dr. Powell of a

home-brewing hobby that started as a small

stove-top operation and has now taken over

the garage. “My wife bought me a home

brewing kit for my birthday when we were

living in Minneapolis during my first year

of residency. I like to cook, so she thought it

might be something I would like.”

It turns out, she was right. Like most

home brewers, Powell started with extract

brewing small batches, a process he likens

to making cake with a mix. But the

biochemist in him was not content with this

simplified version of brewing and he soon

began working with whole grains instead

of prepackaged extracts for more control

over the finished product.

“It’s actually very scientific. You use

malted grain and you grind or mill the grain

to crush it,” he explains. “Then you spray

water over the grain, which causes it to

sprout. As a brewer, you’re using water at a

specific temperature to try activate certain

enzymes and break down the sugars. Differ-

ent grains will produce different flavors. You

use a mixture of ingredients to produce the

flavor you want.”As his interest–and his batch sizes–grew,

Dr. Powell moved the brewing operation into

the garage where he now uses propane burners

to make about 10 gallons of beer every couple

of months. A single batch can take 5 to 6 hours

of active work, but the payoffs are big — a

process he finds fun and relaxing and a prod-

uct he is proud to show off and to share.

“I give a lot of beer away and I have a lot

of requests from family and friends,” he says.

“It’s amazing how many people want to be

friends with you!”He has also won more than one first-place

ribbon at the Minnesota state fair (an impres-

sive feat in a region he describes as a “hotbed”

of home brewing) and recently took a choco-

late coffee stout all the way to the finals in a

national competition. Powell says the inter-

play of different grains with hops and yeast,

as well as the use of exotic additions like

fruits and flowers, allows the inspired brewer

to create an almost infinite array of styles

and flavors.“I think what I and a lot of other

physicians really love about brewing is that it

is a blend of science and art,” says Dr. Powell.

“If you happen to be a science geek, you can

get very involved in even little details like the

chemistry of the water you use. On the artistic

side, you can do all sorts of creations, focusing

on how it looks and how it tastes.”

While he continues to refine his own

brewing process, Powell says his next

goal is to fine-tune his taste buds and qualify

as a certified brewing judge. “You have to

take tests and sort of realign your senses,

but I think that would be very cool,” he

says. ■

By Alex Strauss

Off HoursPassionate Pursuits Outside the Office

I think what I and a lot of other physicians really love about brewing

is that it is a blend of science and art. ”

“

Dr. Steven Powell works in his garage/brewing laboratory.

Photos Courtesy Dr. Powell

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