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April May


Vol. 6 No. 3

Midwest Medical Edition


Burnout The Other “Healthcare Crisis”

Paper Records? Prepare for Penalties

When Wishing

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Data Security

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




Midwest Medical Edition



Volume 6, No. 3 ■ A Pr i l | M AY 2015


Regular Features

ApR il MAy


4 | From Us to You

Vol. 6 no. 3

5 | MED on the Web Articles and Information available exclusively on the MED Website

8 | News & Notes New doctors & facilities, awards, renovations, and other news from around the region

31 |  Learning Opportunities A Spring full of Conferences, Events, and CME Courses

In This Issue 6 |  Medical Marketing Strategy

■ By Jeffrey Nasers Where are your patients and what is the best way to reach them? These questions are critical to an effective marketing strategy.

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The Other “Healthcare Crisis” By Alex Strauss

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Primary care physicians and many of their specialist colleagues are burning out at an alarming rate, impacting not only their own lives but the institutions in which they work and the patients they serve. This month, MED opens the floor to several area physicians for their insights on the growing problem of physician burnout.



18 |  Hospitals and Hungry for Changes in Food Service ■ By Michael Tolliver

  Healthcare Data, Security, 15 and ‘The Cloud’ Expert advice

19 |  June E. Nylen Cancer Center Marks 20 Year Anniversary Center celebrates two decades of treatment milestones in Siouxland.

for keeping critical healthcare data safe in the cloud. ■ By Bryan O’Neal

20 |  Mercy Medical Center Creates $195 Million Impact on Local Economy


24 |  Idiopathic Toe Walking LifeScape says early evaluation can be critical to normal development.

26 |  A Credentialing Checklist for New MDs and DOs 27 |  BCBS Recognizes Sanford for Quality Bariatrics 27 |  Rapid City Regional Hospital Receives National Award for its Donate Life Efforts

28 |  Innovative American Indian Lung Cancer Program Moves to Avera Walking Forward will collaborate with Avera’s Molecular and Experimental Medicine Program

30 |

Make-A-Wish is more than a welcome distraction for children and families fighting life-threatening illnesses. Evidence shows that it can also be a valuable adjunct to therapy.

overnment Prepares to 23 Gimplement Penalties for

On the

Doctors Paper Medical Records Legal advice for physicians who have yet to take the digital plunge. ■ By Scott Leuning


The Next Chapter Hospital pharmacy director says Master’s level training helped ease his way into management.

Wishful Thinking

From Us to You Staying in Touch with MED


ne of the most gratifying aspects of producing MED Magazine is the opportunity to meet and work with experts in so many different fields – not only in healthcare, but in the many critical support industries such as law, business, technology, etc. In this issue of MED, the region’s only business publication exclusively for the healthcare community, we are pleased to bring you some valuable content from several of those experts. Among this month’s articles you will find the pluses and pitfalls of cloud-based information management, upcoming penalties for paper medical records, medical marketing strategies, and a credentialing checklist for new doctors. Of course, MED and are also your exclusive sources for all of the area’s health news, CME opportunities and upcoming events. Have we missed something? Got something to say or announce? Our door is always open. Drop us a line at

Publisher MED Magazine, LLC Sioux Falls, South Dakota Steffanie Liston-Holtrop

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 Alex Strauss

Cheers, —Steff and Alex

Contributing Writers Scott Leuning

Lavonne McKee Jeffrey Nasers Bryan O’Neal Michael Tolliver Staff Writers Liz Boyd Caroline Chenault John Knies

Reproduction or use of the contents of this magazine is prohibited.

MED was a proud sponsor of the American Health Association’s annual Go Red for Women luncheon in Sioux Falls in February. The event, which attracts hundreds of the region’s most influential men and women, raises money for research and education to prevent heart disease and stroke throughout South Dakota.


Pictured: MED publisher Steff Liston-Holtrop [far right] with Lynn Thomas, RN, BSN, Director of Clinic Operation [left] and Tomasz Stys, MD, Medical Director of Cardiology Services at the Sanford Cardiovascular Institute.

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@midwestmedicaledition. com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

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Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Alex Strauss, Editor in Chief 605-759-3295 Fax 605-231-0432 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website

Nursing News Online! MED’s popular Nurses Station column is available online this month. More on new leadership at St. Luke’s College and Sanford Aberdeen as well as recognition for outstanding area nurses.

Will YOU help shape the future of MED? The area’s only business publication exclusively for the medical community is looking for area healthcare professionals to serve on our Advisory Board. Find out what this entails and who is already serving.

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Medical Marketing Strategy

Where are your patients and how can you reach them? By Jeffrey Nasers


he question rarely changes.

How can I get more patients through the doors of my practice? Today consumers are using a multitude of platforms to connect with businesses and to connect with each other. In an age when the majority of the population is using social media, has a smart phone, and has an e-mail account, practitioners have a great opportunity to reach out to them digitally. Before you can develop a strong strategy, you need to decide what your ideal patient looks like. This helps a medical marketing strategist analyze the best possible touch points to connect you with potential patients. I have been working with a doctor who knows exactly what his ideal patient looks like. The majority of his patients are young children and young adults with allergies and asthma. Mother’s, aged 25-47, become the primary target demographic because they are the primary decision makers for their children and serve as advisors to other young adults. For my client, mothers and young adults are going to be much more apt to use a search engine to first find what they are looking for. They are going to utilize social media to collaborate with their friends and family to get advice. They are more likely to sign up for information using their e-mail to have access to valuable information. My advice would be to lay out a plan that best utilizes these resources and positions the practice in a way that stays in constant contact with prospective and current patients. Below I have laid out three suggestions for a practice to consider when targeting patients.



In many cases, initiating an online ad campaign on a particular search engine is a great way to begin the dialogue with a patient before they even walk in the door. This is an opportunity to invite them to the site and share contact information with the marketing team. This helps populate a database of contacts that are already looking for a service that your practice offers.

engaged with patients. Patients are hit with information from all sides. If your practice is not top of mind, the greater likelihood is that they forget about your practice. The overall objective of a medical marketing strategy is to be the go-to resource for patients and to attract them as a loyal, consistent patients. ■ Jeffrey Nasers is a Public Relations and Content Strategist at 724 Factory in Sioux Falls.


Do not be afraid to e-mail your prospective patients. There are many automated programs that help practices reach out to current and new patients. The goal is not to fill their inboxes with useless information, but to serve as an expert, sharing insightful wisdom with your patients. For example, a primary care physician could remind patients to get their flu shot. A good e-mail campaign is not meant to be an attack on patients’ inboxes. Rather, it is meant to demonstrate what differentiates your practice from others in the market.


Engage patients on social media. Consumers are intelligent. They can see right through a scam and are turned off by the idea of being “sold” something. Instead, educate and engage with those patients on social media. Learn from your current patients about ways that you can improve your practice. Social media is a way to maintain a practice’s reputation and earn respect from your followers. With a variety of media touch points, it is easier to connect with patients directly. It is important to stay in constant contact and

Midwest Medical Edition

Specialized SURGICAL CARE for kids Trust your patient’s care to the team of experts at Sanford Children’s. With the largest team of specially trained pediatric surgeons in the region and the only Level II pediatric trauma facility in South Dakota, our advanced care options allow us to deliver the best quality of care for the smallest patients to young adults, often using minimally invasive techniques. Our team of board-certified pediatric surgeons treats patients with a variety of conditions including: • Fetal consultation for congenital anomalies • Esophageal defects • Thoracic diseases • Chest wall deformities • Abdominal & intestinal procedures • Pediatric trauma and emergency surgery • Surgical oncologic care

To refer a patient, call (605) 312-1050 or visit 012001-00161 3/15

(L-R) Jenifer Reitsma, CNP Sarah Jones-Sapienza, MD Jon Ryckman, MD Adela Casas-Melley, MD

Seeing patients in: Sioux Falls, Aberdeen and Rapid City

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Avera

Jonathon Adams, MD, FHRS, was recently named as a Fellow of the Heart Rhythm Society (FHRS). Dr. Adams is Cardiac

Electrophysiologist which is the science of diagnosing and treating the electrical activities of the heart. He is in practice at North Central Heart Institute, a division of the Avera Heart Hospital. Family practitioners Aaron Prestbo, MD, and Leah Prestbo, MD have joined Avera Medical Group McGreevy. Dr.

Aaron Prestbo practices with Avera Medical Group 69th and Western and Dr. Leah Prestbo practices with Avera Medical Group McGreevy 7th Avenue in Sioux Falls. Both hold medical degrees from The University of South Dakota Sanford School of Medicine and completed residency at the Sioux Falls Family Medicine Residency program. Both are certified by the American Board of Family Medicine and most recently practiced family medicine in Madison, SD. Becker’s Hospital Review has named Avera McKennan Hospital & University Health Center in the 2014 edition of its annual list, “100 hospitals with great women’s health programs.” The hospitals

featured all offer outstanding health services geared toward women, such as gynecology, obstetrics, women-focused heart care and women-focused cancer care, among other women’s health needs. Avera McKennan is the only hospital in South Dakota named to the list.


Avera Sacred Heart Hospital has begun renovation of its Fifth Floor/Surgical Floor.

The approximately $3.5 million project will be done in four phases and is expected to take one year to complete. As part of the renovation project, patient rooms will be re-designed with larger handicap-accessible bathrooms, new furnishings, new windows and an updated call light system. The Surgical Unit will also have new floor and wall coverings in the hallways and nurse’s station areas. In addition, the project includes a new HVAC system, which will give each patient the ability to control the temperature of his or her room. The College of American Pathologists (CAP) has awarded Avera McKennan Hospital & University Health Center’s Main Laboratory in Sioux Falls, S.D., continued accreditation to the ISO 15189:2012 standard under the CAP 15189SM Program.

Avera McKennan was the first hospital Medical & Anatomic Laboratory in the United States to receive this accreditation in 2008, and is the longest CAP15189 accredited laboratory in the nation.

Black Hills


Rapid City Regional Hospital has updated its Magnetic Resonance Imaging (MRI) technology with a new 3 Tesla unit. Contractors installed the new

Sanford Health will begin a renovation of its Lennox facility next month. The remodel of the

unit on March 24th. The old MRI was removed in January. The new 3 Tesla MRI is twice as powerful as the old magnet but takes up the same amount of space. The numbers are in. The 18th annual Hospice Benefit Ball at the Spearfish Convention Center, March 7, raised $40,000 for Hospice of the Northern Hills patients. This year’s theme was “The Golden Age of Hollywood.” The jazz group Green Dolphin entertained attendees while they browsed auction items and enjoyed a four-course dinner. The Department of Veterans Affairs National Center for Patient Safety (NCPS) awarded VA Black Hills Health Care System the Gold Standard for Fiscal Year 2014. Gold

is the highest designation for achievement in safety processes and evaluation. The distinction is a part of the Cornerstone Recognition Program whose goal is to measure and recognize outstanding patient safety efforts at the facility level. Stay up-to-date with new medical community news between issues. Log on!

clinic location on Main Street will be completed this summer. The remodel plan includes a new entrance with handicap ramp and floor to ceiling refinishing in the clinic. During the remodeling phase, clinic operations will move to a building adjacent to the current clinic location at 108 S. Main Street. Dr. Janet Lindemann, Sioux Falls, dean of Medical Student Education at the University of South Dakota Sanford School of Medicine, has been named Chair-elect of the Liaison Committee on Medical Education (LCME). The LCME

is the national accrediting agency for all medical education programs operated by universities or medical schools chartered in the United States. Lindemann will serve as Chair-elect during the 2015-2016 academic year and as Chair during the 2016-2017 academic year. Sanford Health is enrolling patients for a clinical trial using a less-invasive method to treat thoracoabdominal aortic aneurysms. Patrick Kelly, MD,

developed the investigational device and associated surgical procedure that seals thoracoabdominal aneurysms, which involve the thoracic aorta and extend into the abdominal aorta. Kelly’s stent graft system was described in a recently published article in the Journal of Vascular Surgery. The safety profile of the stent graft system will be studied.

Midwest Medical Edition

Siouxland Roger Cauthon has joined St. Luke’s College– UnityPoint Health as the Department Chair of Clinical Pastoral Education (CPE) Supervisor, a credentialed position within the Association for Clinical Pastoral Education.

Cauthon will serve as faculty and supervisor for the CPE program and will provide a leadership role within the Division of Health Sciences. Previously, Cauthon served as a senior pastor for twenty-five years, he was a private practice psychotherapist for three years, and was a PRN hospital chaplain for six years. .

April / May 2015

The June E. Nylen Cancer Center, Morningside College School of Nursing, and the Iowa Cancer Consortium

are partnering to educate high school students on the dangers of indoor and outdoor tanning. This program was organized with a grant from the ICC (Iowa Cancer Consortium). Mercy Medical Center-Sioux City has received the American

Heart Association/American Stroke Association’s Get with The Guidelines–Target: Stroke Honor Roll Quality Achievement Award at the association’s International Stroke Conference 2015. The award recognizes the hospital’s commitment and success ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, researchbased guidelines.

“Plan Not to Tan” involves

reaching out to Sioux City high school students and, through friendly competition, encourages teens not to tan for events like spring break and prom. Erik Nieuwenhuis, MS, PT, of UnityPoint Health–St. Luke’s

was recently recognized by The Wellness Council of America (WELCOA) as one of the top 10 health promotion professionals nationwide. Nieuwenhuis was also recognized for his leadership in implementing innovative solutions at St. Luke’s including a dynamic stretching program, ergonomics and injury prevention training as well as leading the organization’s safe patient handling equipment efforts.

Terry Steichen has been named the Chief Financial Officer for Siouxland Surgery Center in Dakota Dunes, SD. Steichen

holds Bachelor of Science and Master of Business Administration degrees from the University of South Dakota and has over 15 years of healthcare financial management experience. UnityPoint Health President and Chief Executive Officer (CEO) Bill Leaver will retire in January 2016. UnityPoint Health’s Board

of Directors named Executive Vice President and Chief Strategy Officer Kevin Vermeer as Leaver’s successor. Leaver has served as President and Chief Executive Officer of UnityPoint Health, formerly known as Iowa Health System, since January 2008


Physician Burnout

The Other “Healthcare Crisis”


ost discussions of the “healthcare crisis” in the United States include the fact that the numbers of physicians, particularly those on the front line of care such as critical care, emergency medicine and primary care, are in shorter and shorter supply. And yet, according to several nationwide surveys in recent years, these physicians and

many of their specialty colleagues are burning out at an alarming rate, impacting not only their own lives but the institutions in which they work and the patients they serve.

• In a 2011 physician survey, 87 percent of respondents named paperwork and administrative tasks as the primary causes of work-related stress and burnout. Sixty-three percent said their stress was rising.

• In 2013, an editorial in the Journal of General Internal Medicine reported burnout rates between 30 and 65 percent across all specialties.

• In a 2014 survey, 68 percent of family physicians and 73 percent of

internists said they would choose a different specialty if they could start over.

And in this year’s annual Medscape survey, half of all family physicians, internists and general surgeons surveyed reported feeling burned out. Bureaucracy, administrative tasks, and too much time spent at work were cited as the more frequent causes. In an effort to prompt conversation on this important topic, MED opened the floor to several area physicians (and one out-of-area physician, for a retiree’s perspective) for their insights into the problem of burnout, its causes, and what should be done to combat it. Our contributors included: Daniel Lister, MD, Orthopedic Surgeon – Sanford Aberdeen Clinic, Aberdeen, SD Jill Kruse, DO, Family Medicine, Medical Director of Avera’s LIGHT program – Avera Medical Group, Brookings, SD Quentin Durward, MD, Neurosurgeon – CNOS Clinic, Dakota Dunes, SD Craig Uthe, MD, Family Medicine, Sanford’s Physician Wellness Lead – Sanford Family Medicine, Sioux Falls, SD Albert Strauss, MD, Retired pediatrician – The Children’s Doctor, Hagerstown, MD* * father of MED Editor Alex Strauss

Not all of these physicians answered all questions, but we have included their top answers. 10

Daniel Lister, MD

Is physician burnout a real problem? Have you seen it in yourself or your colleagues? Dr. Kruse: Yes, physician

Jill Kruse, DO

Quentin Durward, MD

burnout is real and burnout has been well researched and studied since the 1970’s. I have personally experienced burnout during my second pregnancy and shortly after delivering. My maternity leave was devoted to working on dealing with my burnout and finding my love of medicine back. Once I went through that experience I could see the signs in several colleagues, but it is usually something that we as physicians try very hard to hide from others and sometimes even from ourselves. 

Dr. Strauss: It is a terrible

Craig Uthe, MD

problem particularly in the realm of primary care, just when we need MORE primary care as the ACA brings many more people into the healthcare system – hopefully into the primary care office rather than the Emergency Room. Dr. Durward: Yes. One colleague currently has gone half time. One has announced a slow-down and early retirement in 2 years. Another one has just retired early.

Dr. Uthe: Yes, it is a real

Dr. Strauss: Terrible reim-

problem, although most do not like to admit it. We do know that physicians are at slightly higher risk than the general public for addiction.

bursement is the number one cause, at least as far as primary care is concerned. Primary care is devalued in the insurance world, particularly when time is spent in counseling or providing follow-up care. Number two is the number of hours required to earn a living. The hours are impossible when one is trying to do something other than just practice medicine.

What do you feel is the primary reason for burnout among physicians? Dr. Lister: The primary reason is the ever-increasing amount of information that has to be processed with respect to documentation, as well as keeping current and efficient in an ever-expanding body of medical knowledge while being held accountable for any failures but at the same time having a lesser role in the decision-making process.

Dr. Durward: Massive increase in work and frustration related to electronic medical records, Medicare mandated rules on privacy and documentation, second-guessing by medical insurance companies of physician patient care decisions, increasing overhead costs to stay legally compliant but decreasing reimbursement from insurance companies and Medicare.

Dr. Kruse: I think there are many contributing factors. First of all, we are never taught how to take care of ourselves during medical training or residency. In fact, the workaholic “never need help, go it alone” mentality is praised. So when we do have issues, many students, residents, and even seasoned doctors don’t feel comfortable asking for help or even knowing where they can turn for help that will be a safe environment to share these concerns. They’re often just perceived as “personal weaknesses” that need to just be pushed through.  

Albert Strauss, MD

April / May 2015


One Approach to Physician Burnout A conversation with Mary Wolf, program director of Avera Medical Group’s LIGHT Program Why do physicians burnout? Mw: Some qualities more common in physicians than in the general public put them at a higher risk for burnout. Those qualities include a driven personality, competitiveness, high standards and a need for control. Other factors that make physicians more vulnerable to burnout are the lack of self-care training in medical school, and many physicians do not have a primary care physician. From your perspective is physician burnout worse in our region than it is elsewhere? Mw: People in our region tend to wait to ask for help until the end stages of burnout when depression or substance use disorder has developed. LIGHT’s goal is to proactively offer support and resources to reduce and prevent the symptoms of burnout. We want physicians to feel comfortable and safe seeking assistance earlier.

When was the program established and why? Mw: In September 2014, the Avera LIGHT program started as a burnout prevention program for physicians and advanced practice providers. LIGHT offers proactive strategies for enhancing resiliency at both work and home. Whether physicians are looking for ways to renew their enthusiasm in their practice or are feeling overwhelmed by burnout, LIGHT offers resources to help. The LIGHT program shows them that they are cared about as people and not just for their productivity. In addition, we know that physician burnout effects medical errors, malpractice claims, patient satisfaction, turnover rates and suicide rates. LIGHT helps to optimize performance while improving quality of life. How does the LIGHT program help? Mw: LIGHT (Live, Improve, Grow, Heal, Treat) teaches physicians how to recognize burnout and understand its causes and gives simple tools to lower stress and prevent burnout. This program will provide multiple strategies to enhance personal and professional well-being through a website with self-assessments and resources, CME’s, and eventually peer coaching. Also, LIGHT has implemented a steering committee charged with using doctors’ suggestions to build a better work environment.


Dr. Uthe: I think it’s just about overload. I can only be on the top of my game for so long. Capacity is finite. But the workload is not. And that has grown exponentially. When your capacity is less than your workload, that’s overload. Most physicians like and want to be challenged but you can only handle overload for a short period of time. Most are working on overload all the time. With new documentation requirements, it often, it comes down to, ‘If I pay attention to the patient now, I will have several more hours of work to do later and that is time that I can’t spend with my family.’”

Are physicians in our region more or less likely to feel burned out? Why? Dr. Lister: I feel physicians in our region are more likely to feel burned out due primarily to the fact that we are in an underserved area with limited resources and support as compared to larger metropolitan areas.

Dr. Kruse: Burnout is a worldwide problem. Geography doesn’t dictate it as much as medical specialty, as noted in the Medscape article. Each clinic is a unique environment with a culture that can promote or prevent burnout.

How do you personally avoid feeling burned out? Dr. Lister: After 30 years of practice, I have come to accept my limitations and strive hard to try to improve on a daily basis, one patient at a time.

Dr. Kruse: Burnout isn’t something you just fix once and it goes away, it requires mindful attention to where your priorities are that day. Journaling has always been a stress reliever for me. I have also worked very hard at developing healthy boundaries between work and life. Learning when it is appropriate to say “no” after years of training when you couldn’t is a hard skill to learn and practice.  Spending time with my family and not feeling guilty for doing so after I sign out a patient to a colleague or leave for the weekend has been a great help for preventing burnout.  I’ve also learned how to work as a better team with my nurse. 

Dr. Strauss: I personally loved what I did and was lucky enough to have practiced in the era before electronic medical records. Things were simpler and more patients could be seen comfortably so that one could earn a good living.  Now, with EMR, the number of patients that can be seen in a certain period of time has markedly diminished and this, of course, affects the bottom

Midwest Medical Edition

Dr. Durward: I have had to hire extra staff to help me manage and control the incredibly burdensome requirements of these mandates at my own cost. In other words, I’ve had to take a significant pay cut in order to stay sane in practice.

Dr. Uthe: Personal health and wellbeing is number one. I know what my five deepest core values are and I know what the three top loves of my life are (faith, family, friends) so I just focus on those things. I ask myself is the thing I’m being asked to do is a worthy endeavor? How is it going to affect my three loves? And third, what am I going to give up in order to do it? Then I make a decision based on my answers.

Can anything be done about the problem of burnout in healthcare providers?

Dr. Lister: In the little over a year that I have been with Sanford Health I am encouraged by their team-oriented approach and genuine concern for the delivery of quality

April / May 2015

healthcare in a cost-effective manner. As an organization, Sanford has positioned itself well to meet these ever-growing demands on the healthcare system and its providers and I am definitely encouraged by this degree of support.

Dr. Durward: We need to see cut backs on the mandated requirements, particularly the punitive EMR requirements, many of which not only are burdensome, but quite frankly dangerous. The crisis that was engendered in Texas last year by the Ebola patient whose travel history to West Africa was lost in the EMR and missed by the treating ER doctor is a classic EMR screwup. The EPIC EMR system used at the Texas hospital and in Sioux City is so complicated to use that missed critical clinical information, errors in entering medical treatment orders, inability to share patient information with other hospitals and clinics are frequent daily occurrences in our city in my experience.

Dr. Kruse: The first step is to acknowledge that this is a problem and that we need to do something about it. This is where Avera is unique nationwide. We are one of the first  health systems in the country to create a program specifically designed to acknowledge that burnout is a problem and to work on ways to prevent and treat it–the Avera LIGHT program. [see sidebar]

Dr. Strauss: The answer to this is way too long for this forum. Primary care must be valued and the practitioners’ time must be reimbursed rather than basing pay on a per patient basis. Also, the idea of pay being based on results is a terrible one and will cause even more docs to quit.  The basic premise of this idea is flawed and assumes that people will always behave in a pre-determined way.  Patients are not machines and never will be.

emotional wellbeing. And we try to find all sorts of resources we can to help them do that. Most physicians like their work. It’s just that balance is needed. You need enough partners to share the call. You want enough flexibility in your schedule that you can take care of the patients you have. Putting a TEAM together helps to take the pressure off. The Medical Home concept helps with this.

Dr. Uthe: At Sanford, we really stress staying healthy, getting enough sleep, eating nutritiously, exercising regularly, and seeking spiritual and

3 classic signs of physician burnout


Emotional Exhaustion The doctor is tapped out after the office day, hospital rounds or being on call and is unable to recover with time off. Over time their energy level begins to follow a downward spiral.

Source: The Maslach Burnout Inventory

line. I also loved children and got to meet and play with them on a regular basis and this was therapy for me. I eventually did burn out, even though quite late in a long career.


Depersonalization This shows up as cynicism or a negative, callous, excessively detached response to their job duties. Often burned out doctors will begin to blame and complain about their patients and their problems.


Feelings of Reduced Accomplishment Here physician burnout has the doctor start to question whether they are offering quality care and whether what they do really matters at all.

Final thoughts? Dr. Kruse: Burnout is common, but it

Dr. Strauss: I worry for our country

Dr. Durward: Doctors, not admin-

should never be accepted as normal or seen as doctors just whining about their jobs. We can do something about it together so we can all love the profession we all worked so hard to achieve. When doctors love their work and their life outside of work everyonewins–happier doctors, happier families, happier nurses/staff, happier patients. If doing the right thing isn’t reward enough (for the financial office people)–treating burnout saves the health system tons of money. A Florida Hospital system with a mature burnout program estimated that their program saved the hospital more than $5 million dollars in 2 years.

and its medical system. I worry about who is going to take care of ME as I get older and who will take care of my children and grandchildren.  I do not know the answer(s) to what can be done but I do know that practicing physicians must be the majority of the people on whatever committee makes future medical decisions. Not having this sort of committee make up is partially what is wrong with our system today. I hope we still have men and woman willing to put up with the rigors and expense of medical education in the future.  The profession has certainly lost the allure and prestige it once had. 

istrators, should be allowed much more control of patient care in the medical system. We are the ones who live by the oath we have taken to put patient care and safety above all other considerations. Administrators, health policy advisors, politicians and insurance executives do not live by that sacred oath.

Log on to add your own voice to the conversation.

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Midwest Medical Edition

Healthcare Data, Security, and

‘The Cloud’ By Bryan O’Neal


he healthcare industry is fast becoming

one of the biggest adopters of cloud based services. According to the 2014 HIMSS Analytics (a subsidiary of the Healthcare Information and Management Systems Society) Cloud Survey, 83% of IT executives reported that they are currently using some type of cloud service. There are three main categories of cloud computing solutions which are Infrastructure as a Service (IaaS), Platform as a Service (PaaS), and Software as a Service (SaaS). IasS is when a service provider hosts the hardware, software, storage, servers and other infrastructure components on behalf of their customers. PaaS allows organizations to develop, run and manage web applications without building and maintaining their own infrastructure. SaaS refers to applications that are hosted by a service provider and made available to customers over a network, usually the internet. In the study by HIMSS Analytics, SaaS was the most popular of these three categories (66.9%). Clinical applications, Health Information Exchange, Human Resources applications, and Back Up and Disaster Recovery are areas where many healthcare organizations are using the cloud. So, why are companies switching to cloud based solutions? Some reasons are cost effectiveness as well as the reduction of the administrative burden associated with application and hardware support and improving Health Information Exchange abilities. They can be quickly deployed and may alleviate staffing concerns for IT departments by serving as an augmentation of the technological capabilities of a healthcare organization. As you shift more of your applications and other services to the cloud, there are some things that you need to give careful consideration. These are especially important since the dependability of your Internet and local network has now become the most critical point of potential failure.

■ C  onsider using two separate providers for Internet service to avoid interruption

■ A  dd redundant gateway appliances for increased uptime if one device fails

■ A  ctively monitor critical devices 24x7x365 with a firm that can notify or respond with a defined service level to resolve the outage

■ Isolate power and add battery backup for all critical communication equipment

■ Be diligent on network and device security to avoid prolonged outages and data leaks

By carefully considering these items and choosing the right service provider, your healthcare organization can benefit from a cloud strategy. If implemented and used appropriately, cloud services can increase your efficiency, mobility, and technological capabilities while decreasing your costs. The forecast looks to be “cloudy” with a chance of sunshine. ■ Bryan O’Neal is a healthcare technology consultant at Golden West Technologies in Rapid City, SD.

Log On for O’Neal’s article, “The Many Possibilities of Integrated Security”.


Madison, 10, of Marion, wished to go to Hawaii.

Wishful Thinking By Staff Writers


Do you have a young patient who could use a “boost”? Here’s how to refer them to Make-A-Wish: Phone: 605-335-8000 or 800-640-9198 Find out more at


re you wishing for a

way to help your youngest patients deal better with life-threatening illness? Make-A-Wish has a suggestion . . . and the research to back it up. Make-A-Wish South Dakota, part of the national organization that provides once-ina-lifetime opportunities to children and young adults with life-threatening medical conditions, has had a chapter in South Dakota since 1984. That year, the organization granted six wishes to South Dakota children (the first was a chance to meet John Denver). Today, that number has risen to about 60 wishes every year and more than 1,130 total. “If you think about the fact that these wishes impact not only the patients themselves, but also their families, we are impacting thousands of people across the

state,” says President and CEO Paul Krueger. Make-A-Wish is more than a fun distraction for sick children and their families. The organization’s mission is to measurably improve their lives – and support them in their treatment – through the hope, strength and joy that a “dream come true” can provide. Whether the dream is to meet a sports icon, travel to a foreign country, or go to Walt Disney World, evidence suggests that the experience does much more than bolster a child’s spirits at a critical time. “A valuable aspect of Make-A-Wish is that it provides families with anticipation of a larger than life experience and helps them through some very trying times,” says Dr. George Maher, a pediatric oncologist at Sanford who calls Make-A-Wish “a valuable therapeutic adjunct.” “Many families choose to travel to Walt

Midwest Medical Edition

Photos Courtesy Make-A-Wish

Emmit, 7, of Brandon, met Mickey Mouse at Walt Disney World.

Disney World which is, in many ways, ideal, in that it provides a physically sheltered environment and a nearly surreal atmosphere which allows families to escape crushing realities, regroup and return refreshed and ready to resume the fight,” he says. Even the planning and anticipation of a trip can go a long way toward relieving stress and anxiety. According to a 2012 national ‘Wish Impact Study’, adult former wish kids, wish parents, and attending health professionals agree that the wish experience ✶C  an improve overall physical health ✶C  an mark a turning point in a child’s battle for health ✶M  akes kids feel stronger and more energetic ✶H  elps kids comply with difficult but vital treatments ✶M  ay help save their lives (according to the majority of adult former wish kids) Krueger says Make-A-Wish’s vision is to grant a wish to every eligible child and, unlike many non-profit organizations, they have the means to make it happen. But referrals from healthcare professionals, one of the largest sources of new wish kids, lag behind the number of eligible children. Krueger suspects that it may be because too many are confused about the eligibility requirements. “A lot of people still think that we only serve kids who are terminally ill and that just creates unnecessary stress for families,” says Krueger, who calls health professionals “the eyes and ears of Make-A-Wish” in the community. Nationally, about 70 percent of wish recipients do go on to beat their illnesses. “Sometimes people will say that they don’t want to ‘take the opportunity away from another child’ by accepting a wish, but we work hard to have the funds to be able to grant the wish of every child who comes our way,” says Krueger. Individuals with direct knowledge of the child’s illness, including parents, family members, doctors, nurses, social workers, and even the sick children themselves can make a referral to Make-AWish, though a physician has to confirm that the child meets the criteria. To be eligible, a child must be between 2 ½ and 18-years-old and facing a life-threatening condition at the time of referral. Some of the most common conditions prompting Make-A-Wish referrals are cancer, heart conditions, cystic fibrosis, organ transplants and duchenne muscular dystrophy. Chronic medical conditions such as diabetes or developmental or psychological disorders do not qualify. “Ideally, we like to have kids referred when they are right in the middle of battling their illness because that is when things can seem darkest and we can give them something to look forward to,” says Krueger. “We believe that every child with a life-threatening illness deserves the chance to have a life-changing experience.” ■

April / May 2015

Ask ur tO Abou dge Lo e! g Packa


Hospitals are Hungry for Changes in Food Service By Michael V. Tolliver


hen most of us think

of “hospital food,” we think meatloaf and Jell-O — basically bland, tasteless, and not particularly healthy. Traditionally, the hospital was someplace where you had to eat, not a place where you would choose to eat. And the cafeteria was mainly a place for time-challenged staff and distracted guests to eat quickly and inexpensively. Factors such as the Affordable Care Act (ACA) and a general uptick in health conscious consumers have put food service on the front burner. Patient satisfaction scores and readmission rates are now much more important to vital reimbursements and in generating hospital revenue. Food service operators are being pressured to meet higher nutritional standards to help keep patients heathier and reduce the risk of readmission, as well as offer great tasting food that can help leave patients and guests with a more positive overall experience. Complicating consumer demand for more nutritious dining options, shifts in the economy have turned up the heat on healthcare facilities. Rising food costs and budget cuts continue to squeeze the bottom line. Department directors are being challenged to find new revenue sources and to increase retail operations to off-set the cuts while still keeping food affordable. More and more, they require partners who can help them meet the demands for better dining options.

Log On! to read the extended version of this article, including details on each of the hospital food trends mentioned.

Trends on the Menu The most savvy food service directors are combating these growing pressures by turning them into exciting opportunities to transform their traditional food service models. Taking cues from their retail counterparts, they are embracing new trends that include expanded menu options; authentic foods from other cultures; healthier and sustainable food programs; use of local sourcing; food education and special events; community outreach, and more. These trends are leveraging the significant value food service can add to patient satisfaction and the bottom line while banishing the stereotype of blah and bland hospital food for good. Popular trends in the healthcare food service industry today include:

Cafeteria to Café To increase retail revenues, attract more patients and outside customers, and improve eating conditions for caregivers, many hospitals are turning the cafeteria into a more modern bistro.

Production Managers to Executive Chefs Hiring executive chefs to run the new café-style operations allows hospitals to meet today’s more stringent nutritional requirements while providing great tasting, high quality food.

Hospital Food to Room Service More and more hospitals are adopting hotel-style room service that allows patients to order their meals anytime from an expanded menu.

Focus on Nutrition More healthcare facilities have committed to improving the nutritional profile of food they serve to patients, guests, and staff as part of an overall strategy to show nutrition can come with delicious tasting food, while meeting new standards on health.

Home Grown and Local Food Sourcing With the focus on improved nutrition, healthcare institutions are looking to take advantage of affordable, fresh ingredients.

Food Education and Community Outreach As mentioned, under the ACA, hospitals are penalized for patient readmissions. By providing healthier food options during the patient stay, food service directors are helping the hospital avoid these penalties. Hospitals are also promoting new food offerings for the community such as senior dining and after church programs.

Consult an Expert Implementing these trends can be time and resource intensive for hospitals and their staff, as well as challenging. To minimize confusion, waste, and risk during the transition, it is best to work with a food service consultant that can not only give advice but also provide innovative ways to help design and implement these changes. The right partner will have the experience and people to assess a hospital’s needs and goals and be able to customize a plan that provides the maximum value with the least amount of disruption for patients, staff, and guests. ■

Michael V. Tolliver is ABM Healthcare Support Services Vice President for Food & Nutrition.


Midwest Medical Edition

June E. Nylen Cancer Center Marks 20 Year Anniversary The June E. Nylen Cancer Center

in Sioux City is celebrating 20 years of being a regional leader in comprehensive cancer care. The Siouxland Regional Cancer Center opened its doors March 27, 2005 as a not-for-profit joint venture of UnityPoint Health–St. Luke’s and Mercy Medical Center–Sioux City. A gift that same year from Mark and Mary Ellen Nylen resulted in a name change to the June E. Nylen Cancer Center. Along with the new name came new technology. Intensity Modulated Radiation Therapy (IMRT) was first offered in 2005. In 2007, a capital campaign and a major donation made possible the purchase of one of the most aggressive, cancer-fighting weapons in the region – Trilogy, a radiotherapy system used to provide multiple types of targeted radiation treatment from one machine. The first Stereotactic Radiosurgery (SRS) was performed at the June E. Nylen Cancer Center in 2008 and the first stereotactic body radiation therapy (SBRT)

April / May 2015

was performed five years later. Both procedures are designed to target cancer with minimal damage to healthy tissue. With both SRS and SBRT, radiation can be delivered in a single session or in a short series (typically up to five treatments). Center officials say the last five years have also seen an increase in the use of oral oncology drugs with more supportive agents available. More targeted agents are available to help in the treatment of lung, breast, colon and renal carcinomas as well as for lymphoma and CLL. Today, the Cancer Center offers a full array of cancer support services including nutritional care, emotional and spiritual care, a patient navigator, a wig boutique, support groups, education and a resource center, patient transportation services, acupuncture, massage, herbal therapies, and other forms of complementary therapies. A staff of 101 professionals provides care in the Sioux City area and through fourteen satellite locations in Iowa and Nebraska. The center partners with the

National Cancer Institute’s Clinical Community Oncology Program including Mayo Clinic to offer access to clinical trials. More than 3,300 Siouxland cancer patients have taken advantage of this opportunity to access new and emerging therapies. Patients ring a Hope Bell in the Cancer Center lobby when they leave after completing their last treatment. An anniversary celebration was held for patients and families on March 26th. ■


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Mercy Medical Center Creates

$195 Million Impact on Local Economy

This year’s economic report from the Iowa Health Association finds that Mercy Medical Center’s impact on the region’s economy continues to grow. The report finds that Medical Center-Sioux City generates 1,292 jobs that add nearly $136 million to Siouxland’s economy. In addition, Mercy employees spend $56 million on retail sales and contribute $3.4 million in state sales tax revenue. According to the newly released IHA report, Mercy has an annual payroll of $97.7 million. Mercy jobs have a positive “spinoff” effect in the community that creates 2,261 total jobs in the area. The employment statistics include the impact of the main medical center and clinics. Mercy also manages or owns rural hospitals across Siouxland. The IHA study examined the jobs, income, retail sales and sales tax produced by hospitals and the rest of the state’s healthcare sector. The study was compiled from hospital-submitted data on the American Hospital Association’s Annual Survey of Hospitals and with software that other industries have used to determine their economic impact. The study found that Iowa hospitals directly employ 71,324 people and create another 50,131 jobs outside the hospital sector. As an income source, hospitals provide $4.2 billion in salaries and benefits and generate another $1.8 billion through other jobs that depend on hospitals. “Hospitals positively influence their local economies not only with how many people they employ and the salaries of those employees, but also through hospital purchases from local businesses as well as the impact of employee spending and tax support,” said Kirk Norris, IHA president/CEO. “Whether at the local level or statewide, there are few Iowa employers that generate economic activity comparable to hospitals.” ■

Midwest Medical Edition



Improving Combat Veterans Care

Supporting Families

Providers will gain important will information about These education opportunities deliver important Keynote Speakers: identifying and assessing Veterans’ issues and resources. information that will assist healthcare providers and Bob Goodale -- Director other as staff they from workthe to support families of Speakers for professionals the day include Department of Veterans Citizen Soldier Support Program Veterans and our Citizen Soldiers in South Dakota Affairs and the South Dakota National Guard. Emphasis will be on Dennis Mohatt -- Vice President and Northern treatment options and resourcesNebraska. for clinical practitioners. Western Interstate Commission for Higher Ed

SD Universities & Research Center or also known as the “University Center”

May 30, 2012 April 23, 2015 Sioux SD April Falls, 24, 2015


He who did well in war, earns the right to begin doing well in peace. Robert Browning

This publication was partially funded by the Health Resources & Services Administration Award No. U76HP16105.


For more information contact Yankton Rural AHEC:

For more information: or call (605)655-1400 Yankton AHEC NESD AHEC

N Nebraska AHEC (402)644-7253

April / May 2015





Midwest Medical Edition

Government Prepares to Implement Penalties for Doctors Using

Paper Medical Records By Scott Leuning


hange never comes easy,

but the federal government has been pushing the healthcare industry into the digital age over the last several years and those physicians who have not shifted from paper records to electronic health records (EMR) may soon face monetary penalties. Under the federal government’s mandate for the use of EMR, physicians who have either not adopted certified EMR systems or who cannot demonstrate “meaningful use” by the EMR deadline in 2015 will see Medicare reimbursements reduced by 1% in 2015. The deduction rate increases in subsequent years by 2% in 2016, 3% in 2017, 4% in 2018, and up to 95% depending on future adjustment. The federal government has given over $30 billion in incentives to assist doctors in installing and using electronic medical records since 2009. Most of these funds have been provided to physicians who are eligible to receive as much as $44,000 in EMR incentive payments over a five-year period from Medicare. Despite these incentives, which typically only cover a portion of the costs to transition from paper records to EMR, there is growing resistance within the health care sector to make the shift to EMR because of concerns of the efficiency and effectiveness of current technology for EMR. In January 2015 a group of 37 medical societies, led by the American Medical Association sent a letter to Health and Human Services, criticizing the government’s plans regarding electronic medical records, claiming that the current system is cumbersome, decreases efficiency, and presents safety problems for patients.

April / May 2015

The primary criticism of EMR is related to technology glitches, such as self-populating fields that must be closely monitored. The issue of “cutting and pasting” information in a patient’s chart has also raised liability concerns. In a federal government survey in 2014 15% of the responding 10,000 physicians stated that EMR had led them to choose the wrong medication or lab order. While 45% of the respondents to that survey said that technology had alerted them to safety problems, the error rate is considered very high within the medical field. Many physicians agree in principal with the concept of EMR but because of these patient safety problems there is a concern that the push by the government is coming too fast. Another criticism of the shift to EMR is that doctors now spend more time typing into computers in the exam room instead of interacting with patients. While the technology of EMR may make it easier to send patient health records from one facility to another, it is possible that quality interaction with the patient, which is often a necessary component in diagnosing and treating a patient, will be lost in the process. The Centers for Medicare and Medicaid Services responded to these complaints by stating that it will ease reporting burdens on doctors in a proposed rule, set to come out in the spring of 2015. However, the proposed rule will not eliminate penalties levied on physicians who do not make the switch to electronic health records. The federal government is continuing its shift from paper records to EMR and it is evident that it is expected that healthcare providers will move with it to this new technology. ■

Attorney Scott Leuning is a new addition to the Goosmann Law team. He brings twenty years of legal experience to his health law clients. His areas of practice include but are not limited to health law compliance and regulation, physician licensing, medical malpractice defense, employment law, and complex civil litigation. As part of his continuing education, Leuning is completing his postgraduate Masters of Law in Health Law Compliance at the Beazley Institute for Health Law and Policy at Loyola University Chicago School of Law.

Log On! for Leuning’s advice on important legal considerations to ensure that your practice is in compliance with all applicable regulations.


Clinical Spotlight

Idiopathic Toe Walking Early Evaluation Can be Critical to Normal Development


By Staff Writers hildren typically experi-

co Photo

ment with walking on their tip toes between one and two years of age – after they first begin walking. However, if a more mature walking pattern, which includes placing the heel first and pushing off with the toes, has not developed by about age three, there could be cause for concern. “When looking at young patients, physicians should make sure that the child’s toes can still come up and that there is not a strong push response,” says Pam Dahm, a physical therapist with LifeScape’s Idiopathic Toe Walking clinic. “Checking of the reflexes can show if there is a strong reflex. And, of course, if they are just constantly up on their toes, it’s a sign they may need to be evaluated.” While there can be many reasons for idiopathic toe walking (ITW), one cause can be abnormal bone growth. Another can be weakness in in the child’s abdominal and/or leg muscles. Walking on the toes allows the child to lock the ankles, knees and hips in a straight position and reduces the work that the muscles do. Toe walking can also be one of the first signs of a sensory integration disorder. If uncorrected, toe walking can lead to pain, imbalance, weakened muscles, and growth abnormalities. “If a child is up on his toes, for whatever reason, the balance is naturally going to be thrown off,” says Dahm. “If this is mild and short-lived, it may not be a problem. But if you walk on your toes for a lifespan, it can lead to contracture of the ankles, pain in the joints because of extra strain, and can also limit balance and affect bone growth and gross motor development.”

Evaluation of ITW at LifeScape begins with a family history and an assessment of the movement in the foot and ankle and observation of the child’s walking pattern by a physical therapist. Children with signs of sensory problems are referred to an occupational therapist. A physical therapist who specializes in ITW may use stretching and strengthening exercises along with gait activities to promote a typical walking pattern. Serial casting may be utilized when other therapy activities are not successful. Supportive orthotics may be recommended to help maintain improved gait in conjunction with idiopathic toe walking treatment. Early interventions like these can often help patients avoid more invasive orthopedic surgery later in life.

urte sy LifeS ca pe .


“The interdisciplinary aspect of the toe walking clinic here at LifeScape is one of the most important aspects,” says Therapy Supervisor Melissa Carrier-Damon. “Sometimes the problem turns out to be sensory in nature, sometimes it’s a tone problem, sometimes we never know exactly why it’s happening. The wide variety of expertise that we have here to diagnose and treat it is a real advantage.” ■ To refer a patient or for more information on the evaluation process, call the LifeScape Rehabilitation Center. Physical therapist Melissa Beckstrom works with a young patient in LifeScape’s Idiopathic Toe Walking clinic.

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April / May 2015


A Credentialing Checklist for New MDs and DOs

When you need it.

By Lavonne McKee


s the medical/osteopathic student comes to complete his/her training program, there is a cre-

dentialing process that must first take place before the new healthcare professional may practice. This process includes getting a permanent state license in the state in which they are going to practice, a national controlled state substance license (if applicable), a state controlled substance registration (if applicable), credentialing with all the insurance companies in which they choose to serve as a provider or preferred provider, government medical companies such as Medicare & Medicaid, and healthcare facility privileges. To complete this process the newly trained healthcare professional should put a portfolio together before he/she leaves the educational facility where they have received their healthcare diploma and training certificates. Below is a list of items that should be placed in the Professional Healthcare Portfolio.

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■ C  ME – Continuing Medical Education ■ C  V – Curriculum Vitae ■ D  EA – Drug Enforcement Administration – Nation Controlled Substance License ■ S tate CSR – Controlled State Registration ■ T ranscripts


■ Government ID Numbers ■ Healthcare Certificates ■ Healthcare Malpractice Insurance ■ H  ealthcare Articles, Publications, Papers ■ Healthcare Affiliations ■ Immunizations ■ Military Documents ■ Past/Present employment ■ Past/Present Residencies ■ State Healthcare License

Midwest Medical Edition

Photo courtesy Regional Health

As the healthcare professional starts his or her career, it’s important to start taking continuing medical education (CME) classes as soon as possible. Be sure to ask if there are CME requirements on the state level, healthcare facility level, and healthcare specialty board level. Each of these entities – depending on the state, facility and board where licensed – will reflect how many CME’s a healthcare professional will need to maintain. It’s important to keep all data updated, copies of CMEs, CME summaries and all credentials legible. When completing the credentialing application, it is required to include complete addresses, phone numbers, and email addresses. Another requirement is to have complete dates. Keep all data with start and completion dates in the format of MM/DD/YYYY. The more complete the credentialing application is, the faster the process will be completed and the sooner the healthcare professional will be able to practice. ■ LaVonne McKee is President and Credentialing Specialist at Credentialing USA in Sioux Falls. Log On! for McKee’s comprehensive credentialing checklist with detailed explanations for each category.

BCBS Recognizes Sanford for Quality Bariatrics Wellmark Blue Cross and Blue Shield has recognized Sanford USD Medical Center as one of the first healthcare facilities in the nation to receive a Blue Distinction Center+ designation in the area of bariatric surgery. Blue Distinction Centers are nationally designated healthcare facilities shown to deliver quality specialty care based on objective measures, which were developed with input from the medical community, for patient safety and better health outcomes. To receive a Blue Distinction Center+ for Bariatric Surgery designation, a healthcare facility must demonstrate success in meeting patient safety, as well as bariatric-specific quality measures, including complications and readmissions, for gastric stapling and/or gastric banding procedures. A healthcare facility must also have earned national accreditations at both the facility level and the specific bariatric care level, as well as demonstrate better cost efficiency relative to its peers. The estimated annual healthcare costs of obesity-related illnesses are $190.2 billion, or nearly 21 percent of annual medical spending in the U.S., according to the Journal of Health Economics. Only those facilities that first meet Blue Distinction’s nationally established, objective quality measures are considered for designation as a Blue Distinction Center+ ■

April / May 2015

Tasha Frisinger, RN, Rapid City Regional Hospital Clinical Coordinator Staff Director, right, shows the federal, gold award. Mick Gibbs, RCRH President, left, and Susan Gunderson, LifeSource CEO and Founder, center, look on.

Rapid City Regional Hospital Receives National Award for its Donate Life Efforts Rapid City Regional Hospital has been recognized with a federal gold award for its efforts to educate staff and the public on organ and tissue donation and increase the number of registered donors. In 2014, RCRH had 100 percent referral of potential donors, 100 percent compliance with Centers for Medicare and Medicaid Services (CMS) referral requirements, 100 percent families of potential donors approached about donation opportunity, five organ donors, and 19 tissue donors. Susan Gunderson, LifeSource CEO and founder, of Minneapolis presented the Gold Recognition National Hospital Organ Donation Campaign Award to RCRH President Mick Gibbs and staff at a public ceremony on March 12. The award is a component of Workplace Partnership for Life and is given by the US Department of Health and Human Services’, Health Resource and Services Administration (HRSA), Healthcare Systems Bureau, Division of Transplantation.

LifeSource, the nonprofit organization dedicated to saving lives through donation in the Upper Midwest, recommended RCRH for the award. “I applaud our caregivers, particularly those on our Donor Resource Team, who work directly with donor families and also strive to increase public education about the importance of organ and tissue donation,” said Gibbs, who also thanked Gunderson and LifeSource “for being exceptional partners in our Donate Life efforts.” This is not the first time that RCRH has been honored for its organ and tissue donation efforts. In 2012, the hospital received the HRSA Bronze Medal of Honor for Organ Donation and was the 2013 recipient of the LifeSource Partner of the Year Award. In 2014, LifeSource named RCRH the Hospital Partner for Excellence in Tissue Donation. ■ For more information about organ and tissue donation, or to register as a donor, visit


Innovative American Indian Lung Cancer Program Moves to Avera Walking Forward, a South Dakota-based research project using innovative ways, such as mobile technology and customized text messaging, to promote smoking cessation and prevent lung cancer among American Indians will become a part of Avera Health under the terms of a new partnership. Walking Forward was started in 2002 by Rapid City oncologist and principal investigator Daniel Petereit, MD, in partnership with Rapid City Regional Hospital (RCRH) and the National Cancer Institute. Dr. Petereit is a radiation oncologist affiliated with RCRH, and a native of Sioux Falls. “Walking Forward was created to address the disparities – or gaps – in cancer care, prevention and outcomes between the American Indian and non-American Indian populations living in the Northern Plains,” says Dr. Petereit. “Cancer for cancer, American Indians present with more advanced stages of cancer, and therefore, experience lower cure rates.” Over the past 12 years, Walking Forward has helped improve cancer cure rates and treatment in the American Indian population through various programs, including patient navigation,


access to clinical trials and the latest technology, palliative care, and screening for colorectal, cervical, breast and prostate cancer. Walking Forward’s NCIfunded smoking cessation program provides cell phones so participants can receive tailored text messages, as well as pre- and post-cessation counseling, and nicotine replacement therapy. The study is still enrolling participants, with a goal of 256 adults living on Rosebud and Pine Ridge Indian Reservations and in Rapid City. Currently, approximately 140 are enrolled. A pillar of Walking Forward is the availability of patient navigators on reservations who are members of those tribes. “Navigation through the complexities of the health care system, especially where resources are scarce, is very important,” says Simone Bordeaux, RN, Community Research Representative for Walking Forward at Rosebud. “Navigators help patients and families overcome barriers that exist in order to concentrate on their health care and healing.” Through the new partnership, Walking For ward becomes a program of Avera Health, grant monies will be managed through Avera, and

Walking Forward employees become employees of Avera. Dr. Petereit, while working in partnership with Avera on this project, remains in practice at RCRH in Rapid City. Walking Forward will specifically collaborate with Avera’s Molecular and Experimental Medicine Program at the Avera Cancer Institute Sioux Falls. ■

Log On! Read more about the history of the Walking Forward program, including the innovative use of text messaging.

Approximately 44 percent of Native Americans on the Northern Plains of South Dakota smoke, compared with 18 percent of all American adults. The average age of smoking a first cigarette is 13.7 among American Indians, younger than most other racial groups in the United States.

Midwest Medical Edition

Texas Instruments, Sanford

create ‘STEM Behind Health’ Classroom activity series turns disease into math, science lessons Texas Instruments and Sanford Health have partnered to create a classroom activities series called “STEM Behind Health.” Developed with top medical experts and researchers from Sanford, “STEM Behind Health” provides teachers and students with an interactive, hands-on way to explore the math and science concepts behind diseases still in need of a cure. STEM stands for science, technology, engineering and mathematics. “By focusing on the math and science behind the causes, treatments and research of certain diseases, Texas Instruments, along with researchers and scientists at Sanford Health, are bringing STEM to life in the classroom,” said Peter Balyta, president of

Texas Instruments Education Technology division. “We are very excited to work with Sanford Health to capture students’ curiosity and cultivate a lifelong interest in STEM subjects and careers.” Teachers and students can download “STEM Behind Health” to the TI-Nspire CX graphing calculator, Student Software or TI-Nspire Apps for iPad. The first activity in the series, “Managing a Critical Ratio,” engages students in the math and science behind insulin replacement therapy by sharing the daily struggle of Sanford nursing student and diabetic, Chelcie Weber. “For me, life is a never-ending math problem,” said Weber. “By bringing awareness of type 1 diabetes to students and

teachers around the country, I hope to inspire a student to go on to one day develop a cure.” Weber is studying to become a pediatric nurse so that she can help others kids diagnosed with the disease. Type 1 diabetes is the focus of The Sanford Project, a cornerstone research initiative at Sanford Research. The Sanford Project team provided Texas Instruments with expertise on the condition as the activities were created. “Texas Instruments and Sanford Health are committed to engaging more students in STEM subjects and getting them interested in future careers in medicine and research,” said Kurt Griffin, MD, PhD, director of clinical trials and scientist for The Sanford Project. “By exploring STEM careers on the front lines, students will understand how insulin ratios are critical to keep blood sugar in a safe range for individuals with diabetes.” ■ More information is available at


at LifeScape

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BREAKFAST CLUB** June 2, 4, 9, 11, 16, 18, 23, 25; 7:45-8:45 am; Cost: $150; A group setting to overcome picky eating.

SOCIAL SKILLS* 10 weeks starting May 19; Tuesdays & Thursdays; 4:30-5:30 pm; Cost: $350; Group experiences to build social awareness/interaction skills.

LET’S TALK WITH AAC** July 27-30;

4-5 pm; Cost: $200; Speech-language pathologists help develop clear articulation of speech sounds.

9-11:30 am; Focusing on peer interactions while using voice output devices.

HELPING HANDS** July 13-16, July 20-23; 9 am-12 pm; Constraint-induced movement therapy June; 9-10 am; Cost: $100; Toddlers and preschoolers develop speech and language skills through play and everyday activities. for children with hemiplegia.


MOVE ‘N GROOVE** June 1, 3, 8,10; 9-10:30 am; Cost: $100; Promoting physical activity for individuals of all abilities through adaptations and modifications.

POWER MOBILITY** Call to schedule

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** Insurance may apply to medical-based camps.

Call 605.444.9700 for details. April / May 2015

individual times; Experience the latest technology in power mobility.

Formerly Children’s Care 1020 W. 18th St., Sioux Falls, SD 57104


The Next Chapter Pharmacy Director says master’s level training helped ease his way into management.


By Staff Writers vera McKennan Hospi-

tal’s Director of Hospital Pharmacy, Thomas Johnson, knew a great deal about pharmacy when he graduated from North Dakota State with his Pharm D in 1997. But a decade in the field taught him that he still had a lot to learn about the business of medicine. Johnson was teaching at South Dakota State University’s College of Pharmacy

would have had to ask if I had not had this training.” Johnson says he leans on information he learned in his USF courses nearly every day, depending on what he is being called on to do. He points to Professional Communication, Financial Analysis, Organizational Structure and Design, Ethics in Leadership and Marketing as particularly valuable to his daily work. But Johnson says the value of the

I knew that I wanted to do something different and I wanted to create some additional options for myself. when he made the decision to pursue a Health care MBA at the University of Sioux Falls. “I could tell that I probably wasn’t going to continue in my current position for the entirety of my career,” says Johnson. “I knew that I wanted to do something different and I wanted to create some additional options for myself.” Johnson started on his MBA in 2006. Working several evenings a week while continuing to work full time, he finished the program in 2009. Almost immediately, an attractive new option opened for him. Johnson interviewed for Avera’s Director of Hospital Pharmacy position in 2010 and officially stepped into the role in January of 2011. Today, he manages not only a multimillion dollar budget, but a staff just shy of 120 people. Neither were things he learned in pharmacy school. “The USF MBA program definitely helped me know what I was supposed to do in this position,” says Johnson, who now teaches strategic management in the MBA program. “I had a lot of questions when I started and I can only imagine how much I


program goes beyond academics. “One of my favorite aspects was getting to know the people who were going through the program with me,” he says. “I know that I learned as much from them as I did from the course material. You become good

friends and you have the opportunity to learn from people in many different areas of healthcare.” Now, four years into his management role at Avera, Johnson recommends the Director of Pharmacy, USF MBA program Hospital Thomas Johnson to anyone who aspires to help direct the future of healthcare. “If healthcare management is in their future, I would definitely encourage them to seek master’s level training. This is really necessary anymore in order to navigate the complicated world of healthcare. This kind of information makes that role so much easier,” he says. ■ For more information on the University of Sioux Falls Healthcare MBA program, visit www.

Midwest Medical Edition

Learning Opportunities April — June April 8 Avera Trauma Symposium 7:30 am – 4:00 pm Location: Sioux Falls Convention Center Information: 605-322-8987, Registration: April 17 2015 Avera McKennan Diabetes Conference 8:30 am – 4:30 pm Location: Hilton Garden Inn Downtown, Sioux Falls Information:, 605-322-8987 Registration: April 17 Mercy Medical Center – Protecting Families Spring Conference 8:15 – 4:30 pm Location: Bev’s On The River, Sioux City Information: 712-279-2507, April 24 14th Annual Pediatric Symposium 8:00 am – 5:00 pm Location: Sr. Colman Room, Prairie Center, Avera McKennan Information:, 605-322-8987 Registration: April 30 Sanford Kidney Symposium 8:00 am – 4:00 pm Location: Sanford USD Medical Center, Schroeder Auditorium Information:, 605-328-9290 May 1 North Center Heart 2015 Vascular Symposium 8:00 am – 5:00 pm Location: Sioux Falls Convention Center Information: 605-322-8987 Registration: May 1 Avera Caring Professionals Conference: Nurturing the Caregiver 8:30 am – 3:30 pm Location: Holiday Inn City Centre Sioux Falls Information:, 605-322-8987 Registration: May 1 – 2 9th Annual Sanford Sports Medicine Symposium 7:15 am – 4:30 pm Location: Ramkota Hotel and Conference Center Information: 605-312-7808, Registration: June 4 Avera Splinting Workshop for Primary Care Providers 2:00 pm – 4:00 pm Location: Presentation Room, Prairie Center, Avera McKennan Information:, 605-322-8987 Registration: June 10 – 11 Collaborative Research Center for American Indian Health 3rd Annual Health Research Summit Location: Rushmore Plaza Holiday Inn, Rapid City Information:

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.

June 12 Avera McKennan Pulmonary and Critical Care Symposium 8:00 am – 4:00 pm Location: Hilton Garden Inn Sioux Falls Information:, 605-322-8987 Registration:

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 April / May 2015 Opportunities calendar to the editor at


High-risk pregnancies deserve the highest level of care Sanford Fetal Care Center At Sanford Health, your high-risk patients have access to an entire team of experts, all working together to give both mother and baby the care they need. On one medical campus, we offer: • Comprehensive and personalized high-risk obstetrical care from our two board-certified maternal-fetal medicine physicians at Sanford Women’s • 60 newborn and pediatric specialists at Sanford Children’s ready to diagnose fetal conditions and provide integrated care before and after the baby is born • An advanced Level III neonatal intensive care unit (NICU) with the area’s most experienced NICU physicians and team

051001-00150 3/15

• Continual support from nurse coordinators who are with patients every step of the way and guide them through the entire process

Our board-certified maternal-fetal medicine physicians are available 24 hours a day, seven days a week for urgent clinical consultations, referrals and maternal transports.

Choose expert care. Choose Sanford. Call (605) 328-4600 to refer a patient, or after clinic hours, call the Physician Priority Hotline at (605) 328-4645., keyword: Fetal Care Center

MED-Midwest Medical Edition-April/May 2015  
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