med midwest medical edition-november 2015
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SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE FOR PHYSICIANS & HEALTHCARE PROFESSIONALS
NO
VEM
BER
2015
Vol. 6 No. 7
THE FUTURE of Healthcare
Pt. 2: Collaboration and Integration
How to Keep Your Best Employees
Local Doc’s Home-Brewed
Hobby
A Team Approach to Medicine
SD-IPEC South Dakota’s Interprofessional Practice and Education Collaborative
One Number Accesses Our Pediatric Surgical Specialists, Any Problem, Anytime.
1.855.850.KIDS (5437) PHYSICIANS’ PRIORITY LINE
Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.
ChildrensOmaha.org
Gastroenterology & GI Surgery
Orthopedics
Cardiology & Heart Surgery
MEDAd, Oct. 2015.indd 1 9/30/15 10:38 AM
MIDWEST MEDICAL EDITIONMIDWEST MEDICAL EDITION
VOLUME 6, NO. 7 ■ NOVEMBER 2015
ContentsREGULAR FEATURES 4 | From Us to You
5 | MED on the Web Nurses Station and other exclusive content available this month only online
10 | News & Notes – Awards, appointments, additions, and accreditations from around the Region
39 | Learning Opportunities Upcoming Winter Conferences, Events, and CME Oportunities
IN THIS ISSUE 6 | Legal Considerations
for Employee Tracking ■ By Dave Kroon
8 | Healthcare Still Lagging in Cybersecurity ■ By John Hohn
21 | The Case for Collaboration ■ By Laurie Drill-Mellum
Area CEOs discuss opportunities for hospital and
health systems in a changing healthcare environment.
26 | Tax Saving Strategy ■ By Kevin Eggebraaten Using a deceased spouse’s DSUE to save potential estate taxes
28 | Sanford Recruiting for Ebola Vaccine Trial
29 | New Tech in Sioux Falls Offers Faster Lab Results
29 | 2015 PA Salary Data The latest figures show that the PA Profession Continues to Strengthen and Grow
30 | Avera McKennan Opens State-of-the-Art NICU
31 | Teamwork is Key in Pulmonary Hypertension Clinic Pediatric heart and lung specialists join forces in new Omaha clinic
32 | Skin Treatment Enhanced by Addition of Platelet Rich Plasma
35 | Workers’ Comp 101 for Medical Providers ■ By Danyell Skillman
By Peter Carrels
page 16
American patients tend to take for granted that a team of doctors,
nurses, technicians and other health-care staff work together to provide
and monitor their care. In fact this “interprofessional” approach to
healthcare, while often existent, has not always been well-organized. But
as this month’s cover story illus-trates, South Dakota is leading the nation in the effort to boost inter-
professionalism in both medical education and care.
COVER
On the
22 THE FUTURE OF HEALTHCARE Part 2
25 Retaining Your Key Employees: A Low Cost Solution ■ By Christie Finnegan
36 OFF HOURS: HOME BREWED HOBBY Sioux Falls Oncologist Cooks up Award-Winning Beer in HIs Garage
Cover photo courtesy USD Sanford School of Medicine
InterprofessionalCare
The RISE of
Midwest Medical Edition 4
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
practices. MED is published 8 times a year
by MED Magazine, LLC and strives to pub-
lish only accurate information, however
Midwest Medical Edition, LLC cannot be
held responsible for consequences resulting
from errors or omissions. All material in
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Please send your thoughts, ideas and sub-
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MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.
From Us to YouStaying in Touch with MED
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 Dave Kroon
John Hohn
Laurie C. Drill-Mellum
Christie Finnegan
Kevin Eggebraaten
Danyell Skillman
STAFF WRITERS Liz Boyd
Caroline Chenault
John Knies
ALTHOUGH WE AT MED make a point of not
doing “themed issues”, choosing instead to
cover the rapid changes in medicine as they
happen, this issue comes pretty close. Our cover
story focuses on South Dakota’s leadership role in the
growing trend of interprofessionalism in medicine while
the second part of our featured Future of Healthcare series
shines a spotlight on the importance of integration and
collaboration. In other words, in the evolving healthcare
environment, it pays to “play well with others.”
Of course, you will also find the usual assortment of
timely information you have come to expect from MED,
including advice on managing, tracking, and retaining good
employees, saving on estate taxes, and even home brew-
ing. (How’s that for diverse?) Be sure to also check out the
News & Notes section for the region’s most comprehensive
look at area medical community news.
Finally, are you used to ICD-10 yet? As one physician
friend told us, ICD-10 is not unlike winter on the
Northern Plains - It’s harsh and takes some getting used to,
but eventually you acclimate because you have to.
MED wishes you an easy acclimation to both this winter!
Giving thanks for you and for all the generous adver-
tisers who continue to help bring MED to your mailbox,
free of charge,
—Steff and Alex
Alex Strauss
Steffanie Liston-Holtrop
Out and About with MED’s Steff Liston-Holtrop
From left to right
Lifescape Foundation Golf Tournament
SDMGMA Conference, Chamberlain, SD
SDAHO Conference
SDAHO Golf Tournament
MED is proud to help sponsor events like these in our community.
CONTACT INFORMATION
Steffanie Liston-Holtrop, VP Sales & Marketing
605-366-1479 [email protected]
Alex Strauss, Editor in Chief 605-759-3295
Fax 605-231-0432
MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109
WEBSITE MidwestMedicalEdition.com
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On the Website this month Sanford Project’s New Leader
Sanford Health’s initiative to cure type 1 diabetes has chosen a world-renowned
physician, researcher and inventor as its new leader. Read about Eckhard U. Alt, MD,
PhD, the new Todd and Linda Broin Distinguished Professor and Chair.
Benefits and Risks of TelemedicineTelemedicine is expanding not only by volume, but also by services offered.
One source estimates that the US telemedicine market “will grow from $240 million in
revenue in 2013 to $1.9 billion in 2018”—an annual growth rate of more than 50%.
Nursing NewsAwards, accolades, promotions and other Nursing News from across the region are
available in an expanded online edition of our popular Nurses Station.
MidwestMedicalEdition.com 5
Stretch your ad dollars further! Low monthly rates.
Limited spots available.NEW!Site Sponsorship
opportunity.
605-366-1479 [email protected]
MORE THAN A MAGAZINE, A Medical Community Hub
Midwest Medical Edition 6
GPS OR RFID (radio frequency identification) tracking of employees in the medical setting has been gaining
popularity with hospitals nationwide adopting mechanisms for tracking employ-ees, including those in a hospital setting. Various reasons exist for utilizing track-ing such as monitoring safety conditions, ensuring compliance with employer policies, improving business efficiencies and improving patient care. While valu-able data can be collected, important legal considerations should not be overlooked.
Employers defend GPS tracking as a legitimate means to monitor safety condi-tions, ensure compliance with employer policies, protect employer property, improve business efficiencies, and improve customer service. Some smartphone applications allow employees to clock in and out of work and fill out forms, but it also tracks employee movements at the same time.
Although there is currently no federal legislation concerning these tracking practices, individual states have begun to consider the issue. California, Texas, Wisconsin, North Dakota, Tennessee, and Minnesota are among those states that have enacted laws regulating this practice. These state laws vary, but they typically require employee consent and include excep-tions permitting the owner of a vehicle or device to track its location.
While South Dakota has no legislation governing employee tracking, it does recog-nize the tort of invasion of privacy. Although there are many different forms of the tort of invasion of privacy, the South Dakota Supreme Court has held that to recover on an invasion of privacy claim, a claimant must show an “unreasonable, unwarranted, serious and offensive intrusion upon the seclusion of another. . . . Furthermore, the invasion must be one which would be offensive and objectionable to a reasonable man or ordinary sensibilities.”
We are now beginning to see employee claims against employers alleging invasion of privacy. In a pending California lawsuit, a former sales executive for an international wire-transfer service company claimed her employer monitored her off-duty activities and bragged that it tracked employees’ driving speeds. She was disciplined and later fired for disabling the GPS-enabled tracking application on her company-issued smart phone. In her complaint, the former employee alleged that this 24/7 monitoring “would be highly offensive to a reasonable person.”
It appears to be one of the first cases of
its kind and may offer some early guidance to employers.
Employers should consider whether their employees have a reasonable expectation of privacy when using any equipment on which a GPS device or RFID device is installed. It may be difficult for an employer to success-fully argue it has the right to track an employee’s off-duty activities. In fact, most employers I represent do not want to know the personal habits of their employees, i.e. the doctors with whom they have appoint-ments, or their religious service habits.
At a minimum, employers who wish to track the whereabouts of employer property during working hours should do so only pursuant to the terms of a specific written policy, and only after obtaining a written consent from each employee. Unless there is a legitimate business interest an employer should not monitor an employer’s activities after business hours.
Until the law catches up with recent tech-nological advances, an employer should proceed cautiously. Otherwise, it may run the risk of running afoul of an employee’s rights. Utilization of the information for employment actions should be approached carefully and with the counsel of an experi-enced employment law attorney. ■
David Kroon joined Woods, Fuller, Shultz and
Smith PC in 1987, focusing on general business
practice in health and employment law issues.
He has been recognized by “The Best Lawyers
in America,” “Super Lawyers,” “Chambers
USA,” and a winner of the “Best Lawyer’s Sioux
Falls Health Care Law Lawyer of the Year.”
Legal Considerations
for Employee TrackingBy Dave Kroon
A healthy attitude is contagious, but don’t wait to catch it from others. . . . Be a carrier. MED QUOTES
7November 2015 MidwestMedicalEdition.com
childrens.sanfordhealth.org
012000-00260 1015
are facing, our team has the expertise, technology and facilities to deliver advanced, personalized treatment and get them back in your care.
When you refer your patients to Sanford Children’s, you are giving them access to every specialist in every location across Sanford. No matter the issue your patients
Midwest Medical Edition 8
IN AN INDUSTRY KNOWN FOR making advancements, unfortu-nately, there’s one area healthcare hasn’t improved in yet—cybersecu-
rity. Last year, I wrote an article about a BitSight Technologies’ study that compared security rankings in healthcare to the finance, retail and utilities industries. Healthcare came in the lowest of these four. According to Bitsight’s Security Rating Industry Index, that statement still holds true today.
A November 2014 study conducted by another researcher, Bitglass, found that 44% of ALL data breaches in the U.S. involved healthcare providers. The information that was stolen was up to 50 times more valuable than credit card information. Unlike credit cards that are rendered useless after the card is cancelled by either the victim or the bank, PHI contains dates of birth, medical diagno-sis, and other information that criminals can use to commit many different types of fraud. They can continue selling the information even after the victim is aware that they have been compromised.
This isn’t just about compliance anymore. Today, it can be assumed your network has been or will be compromised. While we should still try to prevent this from happening, it’s now more important to be able to detect and respond to these threats. Most organiza-tions feel a false sense of security in believing that having a firewall with endpoint security is enough. In today’s environment, it isn’t.
The following three elements are critical in developing a comprehensive security plan.
PREVENTION – Firewall, anti-virus, spam filtering, patch management and use policies
DETECTION – Real-time analysis of security alerts using security information and event management services
RESPONSE – Documented and practiced set of policies, processes and procedures to adhere to in the event of a security breach
It is important that these areas have continuity in order to truly mitigate risk. Don’t wait until your practice has become a victim. Your patients, your business and your reputation are at risk. It’s time for healthcare to improve its cybersecurity standings. ■John Hohn is Solutions Development Manager
with Rapid City-based Golden West Technologies.
By John Hohn
HEALTHCARE Still Lagging in Cybersecurity
If we could sell our experiences for what they cost us, we’d all be millionaires. — Abigail Van Buren
MED QUOTES
“ ”
9November 2015 MidwestMedicalEdition.com
Beckenhauer Construction has been providing high quality construction service to its clients for 137 years and counting. Beckenhauer Construction is a family owned general contracting firm specializing in healthcare construction and is now being directed by the fifth generation of family ownership.
Safety of the staff, the patients, visitors, and crews is always at the top of our list to control. We do so by continual training, monitoring, providing the best of equipment to assist us, and constant communication with the client so they are aware of our every move. We go above and constant communication with the client so they are aware of our every move. We go above and beyond the industry standard requirements when it comes to protecting employees, client staff, patients, and visitors. If you are not already one of Beckenhauer Construction’s clients we urge you to visit with any of our past or current clients to see what they have to say about doing business “The Beckenhauer Way”.
211 Walnut St. Yankton, SD 57078 605-260-1520
Midwest Medical Edition 10
South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes
Happenings around the region
News & NotesAVERA
Bob Sutton will serve as
Executive Vice President and
Chief Human Resources Officer
at Avera Health, effective Feb.
1, 2016. Most recently, Sutton served as Regional President and CEO of Avera St. Mary’s Region which includes operations for Avera St. Mary’s Hospital, Avera Gettysburg Hospital, two long-term care facilities and a multi-specialty clinic. Todd Forkel, Regional President and CEO, Avera St. Luke’s Region, will serve in the interim leadership role for Avera St. Mary’s. ●
Pre-Diabetes classes are
now being offered at Avera
Queen of Peace Hospital with
a series of two classes, one
on November 18 and one on
December 16. No physician referral is required. Please call 995-2260 or 995-2525 for more information and to pre-register. ●
Gareth Davies, PhD, Chief Scientific Officer and Scientific Director at the Avera Institute for Human
Genetics, has been appointed as visiting professor in the Department of Biological Psychology within the Faculty of Behavioral and Movement Sciences at the Vrije Universiteit, Amsterdam, the Netherlands. Avera’s longstanding partnership with VU has resulted in tens of thousands of DNA samples that AIHG is analyzing for the Netherlands Twin Register (NTR), the world’s largest twin study. ●
St. Michael’s Hospital Avera in
Tyndall, South Dakota held a dedication ceremony and blessing on September 2nd for a new addition that includes 12 patient rooms, a family support/hospice room, urgent care and infusion therapy, as well as a new chapel, nurses’ station and hospital pharmacy. Construction of the 7,000-square-foot, $2 million project started last summer. ●
Julie Reiland, MD,
Breast Surgeon
with Avera
Medical Group
Comprehensive
Breast Care
of Sioux Falls, presented on
Techniques for Reconstructing Partial Mastectomy as part of the American College of Surgeons 2015 Clinical Conference Oct. 3-8 in Chicago. Oncoplasty is an approach that combines removal of the lump with plastic surgery techniques to make the breast look better. Some 30 percent of women are dissatisfied with their breasts after breast cancer surgery, compared to only 7 percent after oncoplasty. ●
Avera McKennan Hospital &
University Health Center and
Avera St. Luke’s Hospital of
Aberdeen have been awarded
Community Value Leadership
Awards by Cleverley +
Associates, based in Columbus,
Ohio. Avera McKennan was the only hospital in South Dakota named to the Community Value 100 Hospitals list in 2015. This is a listing of the 100 hospitals that achieved the highest scores in their respective size/geographic group. ●
Avera Heart Hospital is the
first in the region to adapt
the Volcano SyncVision, which syncs two technologies that help heart specialists get clearer views of diseased arteries and more precisely place stents. Volcano SyncVision provides both an angiographic roadmap and intravascular details from the ultrasound. This co-registration provides detailed and accurate measures of vessel size and lumen, plaque area and volume, and the location of key anatomical landmarks. ●
The Vascular Lab at Avera
McKennan Hospital &
University Health Center has
achieved re-accreditation for
Vascular Testing through the
Intersocietal Accreditation
Commission. Accreditation includes a detailed self-evaluation and completion of the application, which requires detailed information on all aspects of facility operation as well as the submission of actual case studies for review. ●
Walking Forward has received
a $50,000 donation from the
Pink Pony Fund of the Polo
Ralph Lauren Foundation. Walking Forward is a South Dakota-based research program that is using innovative ways to address the gaps in cancer care, prevention and outcomes between the American Indian and non-American Indian populations living in the Northern Plains. Walking Forward is part of Avera’s Molecular and Experimental Medicine Program at the Avera Cancer Institute Sioux Falls. ●
Avera Sister James Care
Center and Avera Yankton
Care Center recently received
the Excellence in Action
award from My InnerView by
National Research Corporation. This honor recognizes long term-care and senior living organizations with overall resident or employee satisfaction scores that fall within the top 10 percent of the My InnerView product database. ●
Avera McKennan Hospital &
University Health Center is the
exclusive site in South Dakota
to offer a new non-surgical and
incision-free weight loss system. This new minimally-invasive weight-loss procedure, called the ORBERA Intragastric Balloon by Apollo Endoscopy, Inc., was recently FDA approved and will be performed by board-certified surgeons, Brad Thaemert, MD, and David Strand, MD. ●
The Yankton Sioux Tribe in
collaboration with Avera
plans to open a state-of-the-
art dialysis center in Wagner,
South Dakota in early 2016.
The new center will have eight patient stations, and will be located in a former clinic on Highway 46. Once the center is remodeled and equipped, Avera Dialysis will lease the center, and provide for staff and management of day-to-day operations. ●
November 2015 MidwestMedicalEdition.com 11
Casey T. Swenson, MD, and Garrett R. Cox, MD, Radiologists, have joined the Avera Queen of Peace
Medical/Dental Staff.
Dr. Swenson earned his MD at Washington University School of Medicine, St. Louis, and completed a family
medicine residency in Duluth and a Diagnostic radiology residency at the University of Iowa. He recently completed a fellowship in Neuroradiology at the University of Iowa.
Dr. Cox earned his MD at USD School of Medicine and completed an Internship in Radiology and a residency in
Diagnostic Radiology at Southern Illinois University School of Medicine. He completed a fellowship in Musculoskeletal Radiology at the University of California, San Diego. ●
Avera announced plans in
September to break ground
on a new primary care clinic
that includes the state’s first
free-standing emergency
department. The new emergency department will be part of a three-story, 70,000-square-foot Avera Family Medical Center, to be located at 28th Street and Marion Road in Sioux Falls. The ED at this location will be equipped similarly to a hospital emergency room and will be staffed 24/7 every day. ●
BLACK HILLS
Regional Health honored three caregivers in October as part of the “I Am Regional Health”
campaign. The individuals are:
Kathy Young, RN, a wound ostomy nurse in Spearfish;
Lanny Reimer,
MD, a family medicine physician in Newcastle and Upton, Wyoming; and
Tina Scott, a radiation
therapist at the Rapid City Regional Hospital Cancer Care Institute.
Joy M. Falkenburg, MD, recently received the prestigious University of South Dakota Sanford School of Medicine
2014-2015 Edward J. Batt, MD, Memorial Award for Outstanding Faculty Member during a surprise celebration at Custer Regional Hospital.
The award recognizes Dr. Falkenburg’s years of exceptional work with medical students during their rotations in Custer. Susan M. Anderson, MD, Associate Professor and Chair of the USD Family Medicine Department, presented the award. ●
The Regional Health
Foundation and Prairie Berry
Winery hosted the sixth annual
Pink Slip Ball on October 3rd
at the Homestead at Prairie
Berry Winery in Hill City. This community event benefitted the Regional Cancer Care Institute at Rapid City Regional Hospital. Pink was the featured color of the evening with pink décor, food, drinks and pink items available for auction. Several different live musical acts also performed. ●
In response to growing demand
for after-hours care, Regional
Urgent Care has extended its
Saturday and Sunday clinic
hours. The facility will now be open to see walk-in patients 7 a.m. to 7 p.m., 7 days a week. ●
Regional Health Heart and
Vascular care has received the
Platinum award for the ACTION
Registry from the American
College of Cardiology for the
second consecutive year. The award is the highest achievement in measuring performance for heart attack patients. ●
Spearfish Regional
Hospital (SPRH) now offers
chemotherapy treatment in
the Northern Hills, improving access to care and decreasing travel time for patients. Michael Robinson, MD, oncologist at the Rapid City Regional Hospital Cancer Care Institute in Rapid City, conducts clinic at SPRH twice a month. ●
Regional Health is pleased to announce the addition of four physicians and two caregivers.
The new physicians include:
Margaret Becker,
MD, a board certified physician in family medicine
Daniel Berens,
DO, a board certified physician in family medicine
Bhaskar Purushottam,
MD, a board certified physician in cardiology
Joshua Sole, MD, a board certified physician in physical medicine and rehabilitation and sports medicine
Troy Thompson,
PA-C, family medicine
Kelli Kartak, CNP,
family medicine
Midwest Medical Edition 12
News & NotesHappenings around the region
South Dakota Southwest Minnesota Northwest Iowa Northeast NebraskaSouth Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
SANFORD
Sanford Heart Hospital in Sioux Falls has received the Mission:
Lifeline Receiving Center – GOLD PLUS Level Recognition Award for implementing specific AHA quality improvement measures for the treatment of heart attack patients.This is the sixth consecutive year Sanford Heart Hospital has received this award. ●
Hub City Radio in Aberdeen teamed up with the Children’s Miracle Network in October for the Fifth Annual Hub City Radio Power of Hope Radiothon
presented by NVC. Proceeds from the event benefit Children’s Miracle Networks and Sanford Children’s Hospital in Sioux Falls.During the 24-hour event, hosts from Sunny 97.7, Point FM 106.7 and Pheasant Country 103.7 broadcasted live from Sanford Children’s Aberdeen Clinic. Last year’s event raised more than $46,000. ●
Construction began in September on a 100,000-square-foot building dedicated to Sanford Imagenetics, a program that integrates genomic medicine with primary care for adults.
When completed, the three-story building at 22nd Street and Grange Avenue will house a long list of services, including general internal medicine, medical genetics, genetic counseling, medical genetics laboratories (cytogenetics and molecular genetics), radiology and patient access management. The building will also have a new dialysis center. ●
Sanford Aberdeen recently
welcomed three new
physicians to its team.
Rahel Alemu, MD, is a board-certified interventional cardiologist. She received her medical degree from Addis Ababa University in Ethiopia and completed her internship and residency at Texas Health Presbyterian Hospital in Dallas. She completed a fellowship at Virginia Commonwealth University in Richmond and is board certified in both internal medicine and cardiovascular disease.
Mesfin Abera, MD,
specializes in internal
medicine. He also received his medical degree from Addis Ababa University and completed his internship and residency at Virginia Commonwealth University in Richmond.
Jason Spjut, DO, will perform
a variety of inpatient
and outpatient surgical
procedures in Aberdeen,
including colonoscopies, laparoscopic and endoscopic procedures, and hernia repair. Spjut earned his medical degree from Des Moines University and completed an internship and residency at Mercy Medical Center in Des Moines, Iowa. ●
The Denny Sanford PREMIER
Center/SMG has partnered
with the Edith Sanford Breast
Foundation to develop the Edith Sanford Firefly Guitars display, which features custom-designed guitars signed by performers who have headlined at the venue.The Edith Sanford Firefly Guitars display was unveiled in September. ●
SIOUXLAND
CNOS, PC is pleased to
announce that Dr. Daniel
Nelson is now board certified
by the American Board of
Orthopaedic Surgery. This certification is valid until 2025. Originally from South Dakota, Dr. Nelson holds a bachelor’s degree from Dakota Wesleyan University in Mitchell and an MD from the USD Sanford School of Medicine. He completed his residency and internship at the University of Oklahoma Health Sciences Center and completed adult reconstruction/joint replacement fellowship training at the Southern Joint Replacement Institute/Vanderbilt University in Nashville. ●
Mercy Medical
Center has
announced the
addition of Dr.
Vinod Khatri,
MBBS, MD to
the Critical Care
Intensivist Team. Dr. Khatri earned his MD from Bangalore Medical College. He did his residency in Internal Medicine at St. Francis Hospital in Evanston, Illinois and completed fellowships in Critical Care Medicine at the Mayo Clinic in Jacksonville, Florida and Pulmonary Medicine at Chicago Medical School. Dr. Khatri is board certified in Internal Medicine and Pulmonary Disease and is eligible for board certification in Critical Care Medicine. ●
Mercy Medical Center-Sioux
City is has introduced a new
and comprehensive wireless
monitoring sensor to manage
heart failure (HF). The CardioMEMS HF System is the first and only FDA-approved heart failure monitoring device that has been proven to significantly reduce hospital admissions when used by physicians to manage heart failure. ●
Diane Prieksat
has been
appointed Vice
President of
Professional
and Quality
Services for
Mercy Medical Center-Sioux
City. Prieksat most recently served as Mercy’s Director of Quality, Informatics and Medical Staff Services since 1999. She will provide executive leadership, direction and strategic planning for Quality & Outcomes Management, Infection Control, Patient Safety, Risk Management, and other areas. ●
The Hawarden Regional
Healthcare Diabetes Self-
Management Education
Program in Hawarden has
been awarded Recognition
from the American Diabetes
Association (ADA) effective
July 2015. Programs that achieve recognition status have a staff of knowledgeable health professionals who can provide state-of-the-art information about diabetes management for participants. ●
November 2015 MidwestMedicalEdition.com 13
Mercy Medical Center dedicated
and unveiled a new bronze
relief sculpture in October
celebrating Mercy’s 125 years of
“Caring for You!” The piece was created by artist Dale Lamphere who is known for the United 232 Memorial Sculpture at the Sioux Gateway Airport. It was paid for by a grant by the Gilchrist Foundation, the Mercy Foundation and board members of Mercy Medical Center and Mercy Medical Center Foundation. The piece is located at the 5th St. Circle Drive entrance. ●
Longtime
Siouxland leader
Sister Elizabeth
Mary Burns will
be the recipient
of the prestigious
Dr. George G.
Spellman Annual Service
Award. The award will be presented to Sr. Burns at the Mercy Foundation’s annual gala on Saturday, November 7 at the Marina Inn and Conference Center in South Sioux City. Burns retired from Mercy Medical Center in 1987 as the President and CEO. She was one of Siouxland’s first female healthcare administrators and paved the way for other women in the industry. ●
Sarah Bligh, MD,
has joined
UnityPoint Clinic
Gastroenterology.
Bligh received her MD from the USD Sanford
School of Medicine and completed a residency in internal medicine and a fellowship in gastroenterology at the University of Nebraska Medical Center in Omaha. UnityPoint Clinic Gastroenterology is a new service provided to patients for the management and treatment of diseases of the gastrointestinal tract and liver. ●
Mercy’s Cardiac Rehab
program, which is housed in the Mercy Heart Center in downtown Sioux City, earned the three year recertification following a rigorous review that verified its clinical practices. ●
Sandeep Gupta, MD, has
joined UnityPoint Clinic
Pulmonology and Critical Care.
Gupta received a Bachelor of Medicine, Bachelor of Surgery degree from Sawai Man Singh Medical College in Jaipur, Rajasthan, India and a Master in Public Health from San Diego State University. He completed a residency in Internal Medicine at Tufts University in Boston and a fellowship in Pulmonary and Critical Care at the State University of New York. ●
The Baum Harmon Mercy
Hospital Diabetes Self-
Management Education
Program in Primghar has been
awarded Recognition from the
American Diabetes Association.
The ADA Education Recognition is a voluntary process which assures that approved education programs have met the National Standards for Diabetes Self-Management Education Programs. ●
Mercy Medical Center—Sioux
City provided $16.3 million in
community benefit and
UnityPoint Health–St. Luke’s
another $10.4 million in
community benefit according to
a recently completed assessment
by Iowa Hospital Association
(IHA). The IHA report shows that Iowa hospitals provided community benefits in 2014 valued at over $1.2 billion. Community benefits include such services and programs as health screenings, support groups, immunizations, nutritional services and transportation programs. ●
UnityPoint
Health – St. Luke’s
has announced
Tammy Hartnett
as Director for
Human
Resources. In her new position, Hartnett will focus on employee engagement and retention as well as career, organization, and leadership development. She will also lead the human resources department at St. Luke’s. Hartnett has been employed at St. Luke’s for fourteen years in the human resources department. Previously she served as an Employee Relations Manager and as a Benefit/Compensation Coordinator. ●
The June E. Nylen Cancer
Center celebrated National
Breast Cancer Awareness
Month in October with
educational material and pink
ribbons and a reminder that
the Center offers a free
mammogram screening
program to focus on early
detection. Serving Our Sisters (SOS) funds provide free screening mammograms for women in need or without insurance. , applicants must meet the financial guidelines, have a physician or referring agency, and be 35 or older. ●
The American Association of
Cardiovascular and Pulmonary
Rehabilitation (AACVPR) has
re-certified the Cardiac
Rehabilitation Program at Mercy
Medical Center-Sioux City.
Revathi Truong
has been
appointed
Volunteer
and Community
Health Specialist
at Mercy
Medical Center-Sioux City.
Truong will lead the development and recruitment of Mercy’s volunteer program. She will also be responsible for growing and developing community health outreach programs, events and activities along with managing and facilitating special projects. ●
OTHER
Prairie Lakes Healthcare System
has received the American
College of Cardiology
Foundation’s NCDR ACTION
Registry–GWTG Platinum
Performance Achievement
Award for the third consecutive year. This award recognizes Prairie Lakes’ commitment and success in implementing a higher standard of care for heart attack patients. ●
Prairie Lakes Healthcare System
was recently recognized as a
top-ranked Community Value
Provider by Cleverley +
Associates, a leading healthcare
financial consulting firm
specializing in operational
benchmarking and
performance enhancement
strategies. The listing was part of the new publication, State of the Hospital Industry - 2015 Edition. ●
Midwest Medical Edition 14
Happenings around the region
South Dakota Southwest Minnesota Northwest Iowa Northeast NebraskaSouth Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
Prairie Lakes
Healthcare
System welcomes
Ferdinand E. K.
Addo, MD,
oncologist and
hematologist. Dr. Addo is board certified in medical oncology, hematology, and internal medicine and He served patients in Bismarck, North Dakota for over twenty five years. Dr. Addo received his medical degree from University of Ghana Medical School and completed residency at Howard University Hospital in Washington, DC, and fellowships in both oncology and hematology at Washington Hospital Center in Washington, DC. ●
Yankton
Medical Clinic, PC,
is pleased
to announce the
association of
April K. Willman,
MD, FAAP, a
board certified pediatrician. Dr. Willman is a graduate of the USD Sanford School of Medicine. She completed her residency training at the University of Missouri in Columbia. ●
LifeScape
welcomes Sanford
Children’s
physician Kathryn
Sigford, MD to its
team, providing
rehabilitative
medical care for children and
adults through outpatient and
residential programs. Sigford is a physiatrist, as well as a specialist in physical medicine and rehabilitation. Prior to joining LifeScape, Sigford completed her Pediatric Rehabilitation Medicine Fellowship through the University of Minnesota. ●
Melissa
Carrier-Damon
of LifeScape is
now licensed as
a Board Certified
Specialist in
Swallowing and
Swallowing Disorders (BCS-S). A BCS-S specialist provides appropriate evidence-based treatment techniques to address the swallowing problems of each individual, based upon the comprehensive swallowing assessment. Carrier-Damon is the first Speech-Language Pathologist in the state of South Dakota to become a BCS-S. ●
News & Notes
15November 2015 MidwestMedicalEdition.com
Courtney Ehlers, MSN, CPN,
director of Women and
Children’s Services at Avera
McKennan Hospital and University Health Center in Sioux Falls, has been elected to a three-year term on the Make-A-Wish South Dakota
Board of Directors. Ehlers will help Make-A-Wish toward its vision of granting wishes to every eligible child in South Dakota. ●
At MMIC, we believe patients get the best care when doctors, staff and administrators are humming the same tune. So we put our energy into creating risk solutions that help everyone feel confident and supported. Solutions such as medical liability insurance, clinician well-being, health IT support and patient safety consulting. It’s our own quiet way of revolutionizing health care.
To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit MMICgroup.com.
The more we get together, the happier and healthier we’ll be.
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Midwest Medical Edition
30
AVERA MCKENNAN HOSPITAL &
University Health Center recently cele-
brated the grand opening of its new
Neonatal Intensive Care Unit (NICU) on
the fourth floor of the main hospital.
The $7 million specialized unit is 16,500
square feet in size. Its new design features
all private rooms with frosted glass doors
that allow families to have their own space,
yet be within view of care staff. The new
unit brings together two NICU areas that
are currently on third and fourth floors, and
replaces the current third-floor unit that is
4,000 square feet. The current fourth floor
unit will be kept as overflow space.
“Based on site visits and focus groups,
we designed our unit so that parents can be
more involved in their baby’s care in intimate
space from the very beginning. There is
privacy for each family, yet still a sense of
cohesiveness and support from other NICU
families,” said Courtney Ehlers, Director of
Women’s and Children’s Services at Avera
McKennan.
The 31 rooms of the unit are grouped by
color in three neighborhoods, both for staff
efficiency and a sense of community. Two
rooms are specially equipped for twins, and
one room for triplets, bringing the total
capacity of the unit to 35 babies. Decentral-
ized nurse stations in each neighborhood
allow nurses to stay in immediate contact
with patients and families.
The new unit will incorporate the latest
NICU technology, including Giraffe
OmniBeds in every room, for an optimal
environment in terms of temperature and
humidity.Other technology includes an enhanced
monitoring system for nurses and doctors, a
new call system in which care staff receive
alerts on their phones in case of monitor
alarms or the push of a call button, and an
advanced visitor ID system with photo badges
for patient and family safety in the unit.
An Innovation project prior to construc-
tion based on Lean principles enhanced staff
efficiency, so nurses can spend more time
in patient care and education. All patient
rooms will have a mobile cart that was
designed by a multi-departmental team.
Carts are equipped with supplies and equip-
ment as well as workspace.
Through its Little Footprints, Big Hearts
campaign to benefit the new NICU, the
Avera McKennan Foundation is near its
fundraising goal of $2 million. ■
Avera McKennan Opens
State-of-the-Art NICUSOUTH DAKOTA RANKS WELL ABOVE
average is several key measures of happiness,
according to the personal finance website
WalletHub. The site conducted an in-depth
analysis of the most and least happy states
in America and found that South Dakotans
rank at the very top in getting adequate
sleep. Only three states have lower rates of
depression than South Dakota and only 5
beat the state in volunteerism.
To find the states that are home to the
happiest Americans, WalletHub compared
the 50 states and the District of Columbia
across 25 key metrics. Our data set ranges
from emotional health to income levels to
sports participation rates.
OTHER SOUTH DAKOTA RANKINGS
(1=Best; 25=Avg.)
9th – Hedonometer Score
8th – Long-Term Unemployment Rate
7th – Divorce Rate
5th – Income Growth Rate
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most-least-happy-states-in-america/6959/
Interprofessional care occurs when multiple health workers
from different professional backgrounds
provide comprehensive health services
by working with patients, their families,
caregivers, and communities to deliver
the highest quality of care across settings.
—World Health Organization
Interprofessional education occurs when learners of two or more
health and/or social care professions
engage in learning with, from, and
about each other to improve
collaboration and the delivery of care.
— Institute of Medicine of the National Academies
By Peter Carrels
InterprofessionalThe RISE of
Midwest Medical Edition 16
17November 2015 MidwestMedicalEdition.com
InterprofessionalCares
South Dakota Leads the Nation in a Team Approach to Medicine
DR. WENDELL HOFFMAN was an early, active and visible South Dakota advocate for interprofessional training and practice in healthcare.
According to Hoffman, an infectious disease specialist at Sanford Health and a highly regarded advocate for improved patient care, many physicians
learn by pragmatic necessity the value of interprofessionalism as they provide care to their patients.
“The first person most physicians talk to each morning is a nurse,” explains Hoffman. “That’s basic interprofessional practice.”
But Hoffman worried that unless a concerted effort was undertaken by educa-tional institutions, healthcare systems and others the advantages of expanding and increasing interprofessional relationships, consultation, and practice would not be better realized. He especially encouraged interprofessional education, so healthcare professionals could hit the ground running once they finished school and started work in the real world where patient outcomes aren’t hypothetical.
The Interprofessional Movement in South Dakota
That is exactly the type of effort –focused, measured and determined - characterizing the newly invigorated campaign to propel the interprofessional movement in South Dakota.
The campaign got a big boost and elevated levels of responsibility and opportunity last June when the University of South Dakota, representing South Dakota’s Interprofessional Practice and Education Collaborative (SD-IPEC), signed a Memorandum of Agreement (MOA) with the National Center for Interprofessional Practice and Education. SD-IPEC is the statewide group working to advance interprofessionalism in South Dakota.
Dr. Carla Dieter, chair of the Nursing Department in the School of Health Sciences at the University of South Dakota, also serves as chair of SD-IPEC.
“We are now part of a national effort to contribute to the measurement of the inter-professional education and practice through affiliation with the National Center,” says Dieter. “By working with the national center we can tap into resources that will help propel our work forward on a broader scale as well as contribute to the National Center’s Data Repository. It is exciting to be part of this important national effort.”
Leading a National EffortSouth Dakota is one of only 11 states to have formalized a relationship with the national organization, and South Dakota’s level of statewide organization is a rarity among states. Out of the 11 member states, only South Dakota’s and Arizona’s initiatives involve multiple educational institutions, and South Dakota is the only member state involving practice partners in their membership.
It is not hyperbole to observe that South Dakota’s initiative to advance interprofes-sional education and practice rates as among the most aggressive and resourceful in the nation. Carla Dieter and her colleagues in SD-IPEC are leading a singularly unique effort that has elevated the state to national prominence.
One of SD-IPEC’s objectives is to further and appropriately broaden those participating in the effort. The group recognizes that the state’s rural composition and its diverse and far-flung constituencies demands greater engagement and participation. That means communities, community organizations, and local and state governmental representation in SD-IPEC is imperative. Whereas some states are pursuing interprofessional health care emphasizing specifically parochial locales, South Dakota is doing just the opposite. It truly is a statewide effort.
The National Center for Interprofessional
Practice and EducationThe National Center and its Nexus Innova-tions Network are housed at the University of Minnesota, in Minneapolis. The Center was founded in 2012 to provide leadership, resources and evidence to advance interpro-fessional healthcare across the country, and it functions as a unique public-private partnership with funding from the Health Resources Services Administration (HRSA), the University of Minnesota, and the three private foundations: Josiah Macy Jr. Founda-tion, Robert Wood Johnson Foundation, and the Gordon and Betty Moore Foundation.
Barbara Brandt, PhD, director of the National Center has been keenly interested and involved in South Dakota’s interprofes-sional initiatives, and she is delighted with the state’s direction and progress. “South Dakota,” said Brandt, “provides us a unique opportu-nity to see the potential of a unified, statewide collaborative of higher education and health system partners working towards the shared goal of improved population health.”
The Need for Interprofessionalism
The need for interprofessional education and practice in healthcare is convincingly and poignantly described by Dr. Dieter.
“Current research shows that ineffective communication among healthcare profes-sionals is a leading cause of medical errors,” she says. ”This requires a response in how we educate healthcare students. By provid-ing opportunities for students to learn together, they not only understand each other’s roles, but recognize the expertise of each team member and the value of their contribution.”
“The ultimate goal is to educate students interprofessionally so that it becomes so ingrained in their nature to work together that when they enter practice it will translate into sound interprofessional practices and produce positive patient outcomes,” says Dr. Dieter.
Midwest Medical Edition 18
An estimated 70 percent of healthcare errors are due to poor communication. In simulations like this one, professionals from multiple disciplines can work on not only their medical skills but their interprofessional communication skills, as well.
19MidwestMedicalEdition.com
The History of Interprofessionalism
in South DakotaThe history of the interprofessional
movement in South Dakota does not date back far. As Dr. Wendell Hoffman was urging greater interprofessional progress in the state leadership at the University of South Dakota’s School of Health Sciences recognized the need to begin organizing to accomplish that movement.
In 2012 Carla Dieter organized her colleagues in the USD School of Health Sciences into a group they called IPE (Interprofessional Education) Champions, a collective that included Dr. Michael Lawler, dean of the School of Health Sciences, Dr. Bruce Vogt, director of USD’s Area Heath Education Center (AHEC), and leadership from the depart-ments of nursing, physical therapy, medical laboratory science, physician assistant stud-ies, addiction studies, dental hygiene, occupational therapy, and social work.
The group discussed matters of inter-disciplinary education and how student education could be improved by collabora-tion between departments, and the use of interprofessional concepts and curriculum. Their deliberations led to a 2013 statewide gathering titled an Interprofessional Educa-tion Summit that was held in Chamberlain, South Dakota.
The so-called “Summit” was attended by approximately 125 leaders and representa-tives from academic institutions, healthcare
systems, govern-ment, regulatory bodies and com-m u n i t y - b a s e d o r g a n i z a t i o n s f rom across South Dakota. This meeting was especially mean-ingful for several
reasons. For the first time educators, practi-tioners and others involved in healthcare and public health were able to learn what was happening in a broad scale across the state in matters related to interprofessional educa-tion and practice. It was also an opportunity for participants to discuss their visions about interprofessional education and practice, and to discover shared perceptions and objectives.
Barbara Brandt of the National Center gave the Summit’s keynote address, and she and Carla Dieter developed a close working relationship.
Establishment of the SD-IPECThe Summit also led to the establish-
ment of South Dakota’s Interprofessional Practice and Education Collaborative (SD-IPEC), and that group’s mission is straight-forward and ambitious: Organize and implement IPE efforts throughout South Dakota. This is the group Dieter was selected to lead. It is a dedicated and ever-evolving team comprised of health educators and leaders from institutions across the state.
Key members of the group include the University of South Dakota, Augustana University, Dakota State University, South Dakota State University, Avera Health, and Sanford Health. The group organized com-mittees investigating various outcomes of interprofessionalism, and an advisory coun-cil has been formed to serve as a sounding board for the core team and also to allow team members access relevant expertise and to provide important connections to those in influential positions in South Dakota.
The Future of the Interprofessional MovementNext steps for the interprofessional effort in South Dakota are conducting projects that include interprofessional teams and specific objectives. These projects are pursued under the title “Nexus Innovations Network Proj-ects”. The National Center approves Nexus projects and through these projects seeks to test new ideas and drive sustainable national change in healthcare and health professions education. A handful of projects are already planned or underway.
It’s tempting to dismiss interprofession-alism as a trendy idea or some dreamy, ivory-tower-type healthcare application. But if you do so you’d be wrong. Interprofes-sional healthcare is serious and sincere business. It’s the next progressive step in an evolving approach to healthcare. Interpro-fessional might be a clumsy word, but through its training and practice it is intended to streamline and improve the delivery of healthcare services. At its root is the genuine intention to better serve patients. ■
Peter Carrels is Communications Coordinator
for the University of South Dakota and the USD
Sanford School of Medicine.
November 2015
Dr. Carla DieterDr. Wendell Hoffman
Phot
os c
ourt
esy
USD
San
ford
Sch
ool o
f Med
icin
e
“ The ultimate goal is to educate students interprofession-ally so that it becomes . . . ingrained in their nature to work together,” says Dieter.
Midwest Medical Edition 20
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21November 2015 MidwestMedicalEdition.com
AS THE HEALTHCARE INDUSTRY RELIES more on advanced practice providers, how can we increase our effectiveness while minimizing risk?
As chief medical officer at MMIC, I am immersed in the world of medical malpractice and an increasing volume of patients. It is through that lens that I view what is occurring in our industry.
I note, for example, an increasing shortage of primary care providers. In the emergency medicine world, the shortage of physicians and the quest to provide more cost-effective, high quality care have led to more advanced practice providers (APPs) working in emergency departments (EDs), as well as the development of “medical homes” that enlist multi-disciplinary teams to deliver care. I see how these stressors play out in increased physician burnout, lack of engagement, strained communication, unspoken conflict, and short-changed patients . . . in a phrase: increased risk.
Even as we accustom ourselves to the unfamiliarity of this changing landscape, we also need to think in new ways about risk, as more players become involved in providing care, and new rela-tionships are forged among them. It is increasingly apparent that collaboration among members of these newly constituted health care teams will be key to realizing the promise and benefits of these new models, while minimizing their associated risks.
What are the risks?We are seeing more claims against APPs but there are more APPs providing care, so we would expect that. Whether the increase is disproportionate is harder to determine, primarily because many claims against APPs are dropped owing to the deeper pockets imputed to the supervising MDs, hospitals or clinics insuring the APP.
It is more revealing to look at the causes of loss specified in those claims.
In reviewing malpractice data from emergency medicine, where physician assistants or nurse practitioners have been named in claims or lawsuits, one thing quickly becomes evident: APPs who provide urgent and emergency medical care have many of the same “underlying causes of loss” as physicians do.
We found that, for physicians and APPs alike, the three most frequent causes of loss specified in claims are:
♦ Delayed or missed diagnoses Accounting for about 50 percent of paid expenses for the investigation, defense and indemnity (or payment) to the plaintiff, the majority of these cases ended in a permanent injury or death.
♦ Treatment-related allegations Accounting for about 30 percent of closed claims, allega-tions include failure to initiate the appropriate treatment, improper or negligent performance of a treatment, and improper or delayed medical management in a variety of scenarios.
♦ Medication-prescribing allegations Including failure to recognize known contraindications to the use of certain drugs in certain clinical circumstances, dangerous adverse drug interactions, wrong medication, wrong dose, and mismanagement of patients on long-term anticoagulation therapy.
We encourage providers to do several things that research has shown reduces risks in the above areas, including:
♦ Developing better systems for tracking abnormal lab data
♦ Ensuring appropriate follow-up or consultation
♦ Developing clearer evidence-based practice guidelines
♦ Focusing on improving communication with patients and among members of the healthcare team
This last point is more important than many healthcare practi-tioners realize; miscommunication is an underlying cause of loss in 80 percent of malpractice cases. Not only does working effectively together reduce the risk of lawsuits … it can lead to increased patient safety and better outcomes. And MMIC can help with that. ■
Laurie C. Drill-Mellum, MD, MPh, is Vice President and Chief Medical
Officer at MMIC.
This article originally appeared in the Winter 2014 issue of Brink, a quarterly risk solutions magazine published by MMIC. Published with permission.
The Case for CollaborationBy Laurie C. Drill-Mellum
Midwest Medical Edition 22
Opportunities for Hospitals and Health Systems
Paul HansonJill Fuller Jason Merkley Fred SluneckaBrent Phillips
By Alex Strauss
Top administrators from a number of health systems around the region were invited to participate in this series. This article includes insights from the following respondents (listed alphabetically): Jill Fuller, President and CEO, Prairie Lakes Healthcare System, Paul Hanson, President, Sanford USD Medical Center, Jason Merkley, CEO, Brookings Health System, Brent Phillips, President and CEO, Regional Health, Fred Slunecka, COO, Avera Health
“
“
“
“
Fred Slunecka Avera Health Fragmentation has been a hallmark of healthcare delivery in the United States and a source of inefficiency and excessive expenditures. Integration is the key to success.
Integrated delivery systems can improve care coordination, reduce waste and service duplication, and improve health out-comes. The success of integration depends largely on how systems work together with physicians and other clinical staff by developing shared goals and visioning as well as how well the system can operationally align service delivery and patient experience. One key way we ensure integration at Avera is through dyad physician-executive leadership in our medical group and through our service lines.
Workforce shortages, continuing cost inflation and service demand intensify the call for more effective and efficient use of resources. There will be no new money, so there’s increased pressure to get more out of the dollars we do have. Everyone will need to work smarter and more closely together.
Jill FullerPrairie Lakes Healthcare System Collaboration is our greatest opportunity. As we move into population health, we will need to partner with providers outside our own systems and organizations in order to reduce costs and improve outcomes.
IN THE FIRST PART OF OUR MULTI-PART
INTERVIEW SERIES ON THE FUTURE OF
HEALTHCARE, WE TALKED TO THE HEADS
OF LARGE AND SMALL AREA HEALTH
SYSTEMS ABOUT THE CHALLENGES THEY
FORESEE FOR BOTH THEIR ORGANIZATIONS
AND THE PHYSICIANS THAT WORK WITHIN
THEM IN THE COMING 5 TO TEN YEARS.
THIS MONTH, WE TAKE A MORE POSITIVE
APPROACH AND ASK THE SAME GROUP TO
SHARE WHAT THEY SEE AS THE GREATEST
OPPORTUNITIES FOR THEIR SYSTEMS TO
ADAPT AND GROW IN A RAPIDLY-CHANGING
HEALTHCARE ENVIRONMENT.
23November 2015 MidwestMedicalEdition.com
Part Two
FutureHealthcare
THE
of
“
“
“
“
“
“
Brent Phillips Regional Health There are opportunities in genomics, regenerative medicine and applications for improving the quality of life. Another great opportunity is the fact that healthcare is moving from a treatment-only approach to a more balanced approach, focusing on prevention, education and treatment.
Jason Merkley Brookings Health System The greatest opportunity is collaboration within and amongst all providers who care for and impact the patient, from the patient’s primary care provider, specialty physicians, hospital and ancillary staff to post-acute providers such as assisted living, skilled nursing, home health and everyone else in between.
The structure and business strategy associated with “collaboration” can and will have many different faces of success. That said, I think the rural market will continue to see alignment and creative partnerships between hospitals, providers and others who are continuing to search for more efficient ways to care for patients.
Paul Hanson Sanford USD Medical Center Choosing your partner, either professionally or per-sonally, is one of the most important decisions that you will make in your career and life. An aligned mission and vision begin to set the course and expectations of organizations seeking integration.
In addition, the move from fee-for-service to value-based services demands standardization, mass customization and safe and reliable systems and processes. This shift will challenge the historical perspective that more is better.
Finally, full implementation of the ACA will continue to drive patient engagement and shift costs to the consumer. Consumers have already become more active and engaged in their care – and expectations are changing – to a heightened focus on quality healthcare that is more conveniently accessible. Relationships will become more and more virtual as systems deliver on these consumer demands. The mantra, ‘It’s your health, so take control of it,’ will continue to inform healthcare delivery models.
Midwest Medical Edition 24
“I am so glad
my family
physician
recommended
Hospice
of Siouxland
for my mom.”
• Serving Siouxland for over 30 years
• Community based non-profit.
• Locally owned by:
Mercy Medical Center Sioux City and
UnityPoint Health- St. Luke’s.
4300 Hamilton Blvd. • Sioux City, IA
712-233-4144 • 1-800-383-4545
Hospice of Siouxland is locally owned by
Serving Siouxland for more than 30 years. 4300 Hamilton Blvd.Sioux City, Iowa
712-233-4144 • 800-383-4545
& National Hospice Palliative Care Month!
Celebrating
• 90 percent of patients don’t know that Medicare pays for hospice care• Fewer than 10 percent know that hospice provides relief for the terminally ill• Three out of four are unaware that hospice care can be provided at home
Hospice is a special concept of care focused on enhancing quality of life, preserving dignity and addressing end of life issues while providing emotional support for patient’s, caregivers, and families.
WALK-IN CARE FOR BONE & JOINT INJURIES
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25November 2015 MidwestMedicalEdition.com
THE KEY to success for every healthcare business, whether it is a hospital, multi-practice clinic or single practitioner is having a
well-trained and professional staff. Train-ing costs, employee engagement, burn out, retention strategies and limited talent pool are the top concerns that healthcare professionals consistently raise regarding retaining their key employees.
There are many models and ways to arrange your benefits plans that take into consideration structure, tax impact and cash flow needs when creating your total rewards program. But there is sometimes an alternative, less expensive benefit that helps retain key employees and drive lifestyle behavioral changes.
Help manage your employees’ stressThe latest research shows employee health directly influences employee work behavior, work attendance and on-the-job performance. Stress is the identified risk factor for 43% of the annual medical costs in low risk adults. So what is causing your employees stress?
According to PricewaterhouseCoopers’ (PwC) 2015 Employee Financial Wellness Survey and the Society for Human Resource Management’s (SHRM) 2011 Promoting Well Being Report, one key aspect is their finances:
♦ Nearly one-third of employees earning $100,000 or more consistently carry balances on their credit cards
♦ 51% of employees worry about not having enough savings for an emergency expense
♦ 33% of the nation’s full-time employees have difficulty meeting their monthly expenses
♦ 20% of employees are using credit cards for monthly necessities they otherwise could not afford
♦ Only 43% of the workforce feels they will be able to retire when they want
♦ Only 37% of employees have a Will. The percentage of those who have a Will increases with age, but even by age 55 to 64, only 56% have a Will
♦ Nearly half of employees find dealing with their financial situation stressful. 35% report that their stress level related to financial issues increased over the last 12 months
♦ 37% say that at work each week, they spend 3 hours or more dealing with issues related to their personal finances.
Simply providing your employees with a higher salary is not realistic. What you can give your key employees is access to knowl-edge to help educate them and empower them to overcome the personal stresses that could be impacting their productivity in your busi-ness or healthcare organization.
Educate and empower your team on-siteOne low-cost solution to address this financial stress is to provide personalized information to help your employees make more educated decisions. Most organizations share a benefit overview annually. But just as you look at your employee population’s
most-pressing health issues, look at which of your benefits are being left on the table. When you know what your key employees are not taking advantage of within the options they have, proactively educate them on how to maximize the value of their com-pensation and benefit program.
Be proactive in providing peace of mind and gain loyaltyIn the long run, helping your key employees become educated and empowered to handle what causes them the most stress outside of work will improve their health, and thus improve their performance and your bottom line. But at its core, helping to provide your key employees peace of mind in their personal lives will be an intangible that helps increase their loyalty to your company because as the commercial says, “peace of mind . . . priceless.” ■
Christie Finnegan is the Executive Director
of Estate Planning for Goosmann Trust Law
Counsel, a part of Goosmann Law Firm. She
was a healthcare professional for 15 years.
Retaining Your Key Employees A Low Cost SolutionBy Christie Finnegan
For some additional strategies to
keep good employees happy with
valuable education, see the full
article on our website.
Midwest Medical Edition 26
A N ESTATE THAT ELECTS porta-
bility is required to file an
estate tax return (Form 706)
even if the estate has a value
less than the current 2015 threshold of
$5,430,000 under Section 6018(1). Porta-
bility is elective(2), rather than automatic,
and refers to the ability of a surviving
spouse to inherit the unused Federal estate
tax exemption of a predeceased spouse.
Why is this important? Let’s look at an
example.
If Kevin & Renee are married and
have a net worth of $7,000,000 (Kevin
–$3,000,000 and Renee $4,000,000)
and Kevin passes away, there will be no
estate tax due on death. Filing Form
706 for portability purposes allows for
Renee to avoid possible estate tax
issues after her death.
In our example, if the executor of
Kevin’s estate makes a decision to file
for portability this allows Renee to
avoid estate taxes on the first
$7,860,000 of her gross estate upon
her death. The $7,860,000 is made up
of $5,430,000 of her unused exemp-
tion as well as $2,430,000 portability
election known as DSUE.
So, if all of Kevin’s net worth passes
to Renee, her net worth would be
$7,000,000 and she has available to her
$7,860,000 of exclusions. If her net
worth does exceed $7,860,000 at her
death, then her estate would not owe
any income tax in our example.
What if she lives another 5 years and
now she is worth $10,000,000. Renee’s
estate would owe estate taxes on
$2,140,000 less any inflation adjust-
ment for her unused exemption. On
$2,140,000 of taxable estate her estate
would owe over $800,000 in estate
taxes based upon the current law.
Can this possibly be avoided? Let’s
assume that Renee remarried and her
new spouse’s name is Rick. One
planning opportunity, and there are
many, would be to gift the remaining
DSUE / Portability amount of
$2,430,000 of the last surviving spouse
(Kevin) to the beneficiaries. She would
need to file a gift tax return to account
for this gift. In other words, Renee
doesn’t lose the DSUE / portability
amount from Kevin until Rick dies for
gift tax purposes, since it is deemed to
be the last surviving spouse’s death.
Depending on Rick’s net worth, this
could save Renee’s estate close to
$1,000,000 in estate taxes. (2,430,000 *
40% = $972,000). If Renee doesn’t take
advantage of gifting the DSUE amount
from Kevin’s death prior to Rick’s death
the opportunity will be lost.
Estate planning can be very complicated
and there are many other planning oppor-
tunities that potentially need to be discussed
with your attorney and tax advisor to assure
compliance and see if there may be some
tax saving opportunities. Remember it is not
“how much you make” but “what you get
to keep or pass on” that matters. ■
Kevin Eggebraaten is a Certified Public
Accountant with Casey Peterson.
Tax Saving StrategyUsing a deceased spouse’s DSUE to save potential estate taxes
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Midwest Medical Edition 28
Sanford Recruiting for Ebola Vaccine TrialSANFORD HEALTH is seeking participants to enroll in a clinical trial testing a vaccine for the Ebola virus. The Merck- sponsored study will explore the vaccine’s ability to safely generate antibodies that could protect against future exposure to the virus.
The clinical trial, which is free, is open to adults age 18 to 65 who have not previously had Ebola or been in contact with some-one who contracted the virus. Sanford is enrolling 30 total patients at sites in both Sioux Falls and Fargo to determine if the vaccine can trigger an immune response that might help guard against Ebola.
An Ebola outbreak occurred in West Africa last year. Accord-ing to the Centers for Disease Control and Prevention, Ebola is a rare virus that attacks the immune system and organs and causes internal and external bleeding. The virus, which was discovered in 1976, is highly contagious, can be transmitted by bodily fluids and currently has no vaccine
Trial participants are required to receive a single shot. Ninety percent will get the vaccine, and the remaining 10 percent will receive the placebo. To monitor the body’s immune response, all participants must complete three follow-up visits during the six-month study.
Enrollment is open in Fargo and Sioux Falls. For more information on how to participate, call (855) 305-5064. ■
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29November 2015 MidwestMedicalEdition.com
THE LABORATORY DEPARTMENT at Avera McKennan Hospital & University Health Center in Sioux Falls recently acquired an instrument that allows for rapid, accurate and inexpensive identifica-tion for bacterial and fungal organisms.
MALDI-TOF, or Matrix Assisted Laser Desorption Ionization – Time Of Flight, can provide identification information up to 24 hours faster than traditional methods.
After allowing a 24-hour specimen-growth period, MALDI-TOF can accurately iden-tify bacterial or fungal specimens found in patient infections within five to 15 minutes.
Receiving the correct identification faster can allow the physician to enact a treatment plan that specifically attacks the bacteria or fungi responsible for the patient’s infection or illness even sooner.
MALDI-TOF uses a laser in its ID pro-cess. After the growth period, a small amount of the patient’s sample is placed on a stainless steel plate called a target. Then, a single drop of matrix is added. When the laser strikes the sample, the bacteria float to the top. This allows MALDI-TOF to read the proteins that make up the bacteria and then match the profile in its library.
After discovering a match, MALDI-TOF then confirms its finding with a confidence rating. For example, it may report a 98-per-cent certainty rate that the identified bacterium is E. coli or strep or staph, etc.
“We can serve a large variety of patients, from those with wound infections to sepsis,” said Avera Laboratory Operations Manager Kacy Peterson. “This technology can be used for the vast majority of patients who need infectious organisms identified.”
Avera McKennan is the only clinical laboratory in South Dakota with MALDI-TOF technology. ■
New Tech in Sioux Falls Offers Faster Lab Results
The PA Profession Continues to Grow
2015 PA Salary DataCompensation for America’s physician assistants (PAs), recognized as one of the top professions in the country, continues to rise, according to new data from the 2015 American Academy of Physician Assistants (AAPA) Salary Survey.
The median base salary for a PA in
2014 rose to $93,800 a year, a $3,800
increase from 2012. The survey found that in
addition to salary, more than half (54%) of all
PAs received monetary bonuses and more
than 75 percent of PAs receive some other
form of additional compensation, such as
research stipends, profit sharing, student loan
repayment, paid relocation, tuition reimburse-
ment or signing bonuses.
The AAPA survey provides high-quality,
detailed information on PA compensation
and benefits, including base salary, hourly
wages and bonus, by region, specialty,
employer, setting and experience.
● PAs in the cardiovascular and cardiothoracic
surgery specialty reported the highest
median base salary ($117,000) followed
by interventional radiology
($105,500), emergency medicine
($102,960) and pediatric surgery
($102,500).
● PAs with less than one year
of experience had a base
salary of $85,000, which
rose to $89,000 for those
with 2 to 4 years, and
$96,000 for those with
5 to 9 years’ experience.
AAPA administered the online
survey between February and
March, 2015. More than 10,000
AAPA members and nonmembers responded.
HIGHLIGHTS OF THE AAPA SALARY SURVEY 2015:
● PAs at critical access hospitals ($115,000), industrial facilities
($115,000), and hospital emergency departments ($101,920)
reported the highest median compensation levels.
Midwest Medical Edition 30
AVERA MCKENNAN HOSPITAL & University Health Center recently cele-brated the grand opening of its new Neonatal Intensive Care Unit (NICU) on the fourth floor of the main hospital.
The $7 million specialized unit is 16,500 square feet in size. Its new design features all private rooms with frosted glass doors that allow families to have their own space, yet be within view of care staff. The new unit brings together two NICU areas that are currently on third and fourth floors, and replaces the current third-floor unit that is 4,000 square feet. The current fourth floor unit will be kept as overflow space.
“Based on site visits and focus groups, we designed our unit so that parents can be more involved in their baby’s care in intimate space from the very beginning. There is privacy for each family, yet still a sense of cohesiveness and support from other NICU families,” said Courtney Ehlers, Director of Women’s and Children’s Services at Avera McKennan.
The 31 rooms of the unit are grouped by color in three neighborhoods, both for staff efficiency and a sense of community. Two rooms are specially equipped for twins, and one room for triplets, bringing the total capacity of the unit to 35 babies. Decentral-ized nurse stations in each neighborhood allow nurses to stay in immediate contact with patients and families.
The new unit will incorporate the latest NICU technology, including Giraffe OmniBeds in every room, for an optimal environment in terms of temperature and humidity.
Other technology includes an enhanced monitoring system for nurses and doctors, a new call system in which care staff receive alerts on their phones in case of monitor alarms or the push of a call button, and an advanced visitor ID system with photo badges for patient and family safety in the unit.
An Innovation project prior to construc-tion based on Lean principles enhanced staff
efficiency, so nurses can spend more time in patient care and education. All patient rooms will have a mobile cart that was designed by a multi-departmental team. Carts are equipped with supplies and equip-ment as well as workspace.
Through its Little Footprints, Big Hearts campaign to benefit the new NICU, the Avera McKennan Foundation is near its fundraising goal of $2 million. ■
Avera McKennan Opens State-of-the-Art NICU
SOUTH DAKOTA RANKS WELL ABOVE
average is several key measures of happiness,
according to the personal finance website
WalletHub. The site conducted an in-depth
analysis of the most and least happy states
in America and found that South Dakotans
rank at the very top in getting adequate
sleep. Only three states have lower rates of
depression than South Dakota and only 5
beat the state in volunteerism.
To find the states that are home to the
happiest Americans, WalletHub compared
the 50 states and the District of Columbia
across 25 key metrics. Our data set ranges
from emotional health to income levels to
sports participation rates. ■
OTHER SOUTH DAKOTA RANKINGS (1=Best; 25=Avg.)
9th – Hedonometer Score
8th – Long-Term Unemployment Rate
7th – Divorce Rate
5th – Income Growth Rate
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31November 2015 MidwestMedicalEdition.com
A PEDIATRIC HEART specialist and pediatric lung specialist at Children’s Hospital & Medical Center in Omaha have grown accustomed to collaborating over the last year, working closely together in a crucial space where where their two disci-plines intersect.
Scott Fletcher, MD, medical director, Cardiovascular MRI and Exercise, and Paul Sammut, MD, clinical service chief, Pediatric Pulmonology, partnered in early 2013 to launch the Pulmonary Hypertension Clinic.
“Dr. Sammut and I visit the patients together. Families hear us speak one after another. I’m listening to Dr. Sammut and Dr. Sammut is listening to me as the family is listening to both of us,” says Dr. Fletcher. “We speak with a more common voice, and our care is much more coordinated than it
would be if there was one cardiologist seeing patients independently and one pulmonolo-gist seeing patients independently. That is not optimal. Teamwork is critical.”
Progressive and potentially fatal, pulmo-nary hypertension (PH) is a type of high blood pressure that can affect the arteries in the lungs and the right side of the heart. Some estimate as many as 20 percent of patients going into adulthood who have had corrected congenital heart disease have some component of PH.
Diagnosis begins with an echocardio-gram. If PH is suspected, the gold standard treatment is cardiac catheterization.
“If we get to patients early on, we have a much better chance of keeping them from progressing to the severest forms of the disease,” Fletcher says.
The Pulmonary Hypertension Clinic is
held the third Wednesday of the month. The team also includes a pulmonology nurse and a cardiology nurse. In addition to treating pediatric PH patients, both in-clinic and those admitted to the hospital, Drs. Fletcher and Sammut feel it is their job to raise aware-ness of PH among their colleagues.
“We really feel that we have come across some children who would have died without the recognition of the problem and adequate treatment,” Dr. Sammut says. “Many have had resolution of symptoms, and that’s very gratifying.” ■
Teamwork is Key in Pulmonary Hypertension Clinic
Midwest Medical Edition 32
DOCTORS HAVE BEEN harnessing the power of plate-let-enriched blood plasma to enhance healing since the
1980’s. Now, Sioux Falls plastic surgeons Richard and Tom Howard, owners of The Body Garage Medical Spa, are putting it to use to enhance skin treatments for anything from wrinkles and stretch marks to scars and burns.
Platelet-rich plasma, or PRP, was devel-oped in the 1970s and first used as part of an open heart procedure in Italy in 1987. Based on the idea that platelets contain growth factors and other cytokines that stimulate healing in bones and soft tissues, PRP is produced by drawing blood and spin-ning it down in a centrifuge to separate out the platelets. The result is a substance which contains five times the typical 200,000 per µL baseline blood platelet count.
At the Body Garage Medical Spa, the platelets from about 23 cc of the patient’s own blood are then extracted with a syringe and applied directly to the skin. The aim is
to stimulate healing and collagen production as part of a cosmetic procedure called microneedling or collagen induction therapy (CIT).
“Microneedling creates channels into the skin without disrupting the epidermal layer, so people heal quicker,” explains Body Garage medical aesthetician Sara Fiedler LE, COE. “If someone has acne scarring, it can go down and disrupt the tethering in the scar. As an antiaging treatment, it stimulates the skin underneath to produce new collagen.”
With the addition of autologous PRP, which is applied topically during several sessions, Fiedler says microneedling becomes a super-charged healing treatment for a variety of skin conditions, with mini-mal down time. Unlike lasers, which can damage natural healing or growth factors and can thin the skin over time, CIT with PRP can safely be repeated. Mild wrinkles may be reduced with just three sessions, but more problematic issues such as serious burns or acne scarring may require more.
In the three months the clinic has been offering the combination, Fielder says the results have been encouraging.
“We are seeing better results from three CIT sessions with PRP than we did with six sessions of microneedling alone,” says Fiedler, who tells clients that it typically takes 21 days after the procedure to begin to see the effects of collagen stimulation. Scars and burns must be fully healed before they can be treated with microneedling. ■
By Alex Strauss
This season, register t o be an Organ, Eye, and Tissue donor at www.sd letb.org/register
Each year, t housands chooset o give t he gifts of Sight and Healt h
We lc ome t o t he
Skin Treatment Enhanced by Addition of Platelet Rich Plasma
Photo courtesy Dr. PRP USA
33November 2015 MidwestMedicalEdition.com
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A SANFORD RESEARCH SCIENTIST has received nearly $440,000 to support her research of a rare neurodegenerative disease that affects mostly children. Jill Weimer, PhD, is the recipient of a one-year grant from the Charlotte and Gwenyth Gray Foundation to Cure Batten Disease.
The Gray Foundation was created by Kristen and Gordon Gray, whose two young daughters are battling Batten disease. Weimer’s lab is among only a few in the world studying the condition, which is a group of neurodegenerative diseases most commonly found in children that can cause seizures, blindness, motor and cognitive decline and premature death. Genetic muta-tions disrupt the ability of cells to dispose of waste and causes abnormal accumulation of proteins and lipids within nerve cells.
Weimer’s research is complimented by collaboration with leading scientists at major universities across the United States and cooperation with another Batten disease lab run by Sanford Research President David Pearce, PhD.
Using cells derived from patients with Batten disease and mouse models, the grant funding will allow Weimer to screen several different treatment methods, which could include gene therapy or stem cells.
“Because conditions like Batten disease are rare and may not receive the awareness they deserve, it is critical that organizations like the Gray Foundation exist to fund and advance research,” said Weimer. “By focusing our efforts on what we believe to be key therapies, we hope to expedite a clinical trial for this aggres-sive disease.”
Weimer recently appeared with the Grays on the national television show “The Doctors” to help raise awareness of Batten disease and their foundation. ■
Sanford Scientist Lands Grant to Support Batten Disease Research
Phot
o co
urte
sy S
anfo
rd
35November 2015 MidwestMedicalEdition.com
WHEN AN EMPLOYEE is injured on the job, he or she gives notice to the employer who files a claim with the employer’s workers’ compensation carrier. Once a claim is filed, the carrier assigns a claim number to be used when submitting medical claims for payment. The employee is also assigned an adjuster by the
carrier who may or may not work in conjunction with a nurse case manager. The nurse case man-ager can help to coordinate the employee’s care, authorize treatment, and review the employee’s progress until they have recovered to their pre-injury health status.
Below are some tips that medical professionals may find helpful in better understanding workers’ compensation.
♦ The patient provides his or her claim number, the date of injury, and the information required to file a claim to the appropriate payer. The patient’s private health insurance is not billed for services that are covered by workers’ compensation; however, non-work related treatment provided in conjunction with authorized services are billed to the patient’s own insurance.
♦ The adjuster may authorize services from the employee’s regular primary care provider or the employee may be directed to receive medically necessary services from the carrier’s own network of providers.
♦ Each state has its own guidelines for workers’ compensation claim payments. In states that have fee schedules, the schedules function the same as a provider contract. If the provider treats a workers’ compensation patient, the medical bills are reduced accord-ing to the fee schedule.
♦ Like other healthcare claims, workers’ com-pensation claims should be submitted using the CMS-1500 Claim form. Claims may be submitted to the insurance carrier using their Payor ID and submitting the CMS-1500, along with proper records, to the appropriate electronic clearinghouse. When completing the CMS-1500, medical billers fill in the fields that indicate the patient’s condition is work-related, the date of injury, and the date of service. Instead of an insurance ID number, the patient’s claim number is supplied to the payer to ensure that the appropriate injury is being treated and paid for.
♦ When the charges are found to be appropriate, the adjuster reprices the charges in accor-dance with the state’s fee schedule. Unlike other insurance coverage, medical providers are not allowed to bill patients for the balance between the fee schedule and the full amount of charges submitted. Workers’ compensation insurance does not include co-insurance or co-payments. Instead, providers agree to accept the fee schedule rates as payment in full for services rendered.
By Danyell Skillman
Workers’ Comp 101 for Medical Providers
For more money-saving Workers’ Comp tips from
RAS, see the full article on our website.
Some medical providers may not have a lot of experience with workers’ compensation claims, so to answer questions and to resolve any problems, it is best to communicate with the carrier as often as necessary. ■Danyell Skillman is a Claims Supervisor with RAS.
Midwest Medical Edition 36
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
By Alex Strauss
Off HoursPassionate Pursuits Outside the Office
37November 2015 MidwestMedicalEdition.com
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
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
Midwest Medical Edition 38
LifeScape WelcomesKate Sigford, MD Physical Medicine & Rehabilitation
Sioux Falls & Rapid City • LifeScapeSD.org
For referrals or to schedule an appointment, call 605.444.9700.
Dr. Sigford joins Julie Johnson, MD, and Charlie Broberg, PA-C, in providing rehabilitative medical care for children and adults at LifeScape Rehabilitation Center. Dr. Sigford is taking patients with cerebral palsy, spina bifida, neuromuscular disorders, spinal cord and brain injuries, congenital brain malformations, hemiparesis, gait abnormalities, musculoskeletal conditions, brachial plexus palsy and similar diagnoses.
39MidwestMedicalEdition.com
Learning Opportunities
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].
November
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.
November 1 Sanford Cancer Immunotherapy Symposium8:30 am – 4:00 pm Location: Sanford Center Dakota Room, Sioux Falls, SD
Information: [email protected]
Registration: www.SanfordHJealth.csod.com
November 20 Sanford Behavioral Health Symposium7:30 am – 4:30 pm Location: Ramada Plaza and Suites, Fargo, ND
Information: [email protected]
Registration: www.SanfordHealth.csod.com
SAVE THE DATE March 31, 2016 Avera Transplant Institute Symposium8:15 am – 4:00 pm Location: Prairie Center, Sioux Falls
Note: Many health systems take a break from
offering CME courses during the holiday season.
MED reserves this space for any area healthcare practice or organization host-
ing an event, course, symposium or other type of learning opportunity. These
events are also posted on our website. Do YOU or your organization have an
event coming up during the next few months that we could help you promote?
Send it our way!
You can purchase a digital file of any article you contribute to MED. Email it to clients, use it on your website, or print
it for a cost-effective marketing tool!
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.
Reprinted from MED Magazine
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
DID YOU
KNOW?
Survival is at 98% and 92% at two and four years post-treatment for all oropharyngeal cancer patients and 100% and 95% for HPV positive patients at two and four years. These numbers are considerably higher than the national average of 72%.
But it’s not just our survival rates that set us apart, but the quality of life your patients can have after treatment. We implement minimally invasive techniques including robotic and endoscopic surgery for quicker recovery and less impact on the throat and mouth.
sanfordhealth.org/headandneck
Through research and
innovative clinical trials using
immunotherapy, the team of
physician scientists at Sanford
Cancer Center in Sioux Falls,
South Dakota, are producing
some of the best survival
rates in the nation.
Call 1-87-SURVIVAL to refer a patient today.
Pictured left to right: Johnathan Cohen, MD , Andrew Terrell, MD , Chad Spanos, MD , John Lee, MD
011000-00128 9/15