MED-Midwest Medical Edition-Jan/Feb 2014

January FebruarY

2014

Vol. 5 No. 1

Midwest Medical Edition

Playing a Primary Role Advanced Practitioners in a changing healthcare environment

Watertown’s Top-level Heart Care More MRI Power in Siouxland South Dakota Legislative Session Preview the South Dakota and the Upper Midwest’s Magazine f or Physicians & Healthcare Professionals

EXPERT CARE FOR HEAD AND NECK CANCER Andrew Terrell, MD, Otolaryngology - Head & Neck Surgery

At Sanford Ear, Nose & Throat Clinic, our cancer team provides your patients with specialized head and neck cancer care. Now, with the addition of Andrew Terrell, MD, they have expanded access to our expertise.

Our team strives to meet the individual needs of your patients while minimizing the side effects of treatment, giving them the best outcome possible and a higher quality of life. Dr. Terrell and colleagues John Lee, MD and Chad Spanos, MD utilize the most advanced surgical techniques such as robotic surgery, in combination with aggressive physical and speech rehabilitation, nutrition education, nurse navigation and survivorship care.

As part of the NCI Community Cancer Center Program, we are one of only 21 sites in the United States providing National Cancer Institute clinical trials for head and neck cancers.

Our head and neck cancer specialists know it’s more than surviving cancer. It’s about your patients’ quality of life.

Call (605) 328-8200 to refer a patient.

200-46350-0801 11/13

Sanford Ear, Nose & Throat Clinic 1310 W 22nd Street Sioux Falls, SD 57105 Monday–Friday 8 a.m. – 5 p.m.

Midwest Medical Edition

Contents Volume 5, No. 1 ■ January / February 2014

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

What’s new exclusively on the MED website this month

By Alex Strauss

Playing A

Primary

Role

4 | Meet a MED Contributor Dave Hewett 6 | News & Notes News and announcements from around the region 14 | Off Hours Now You See It, Now You Don’t: Sioux Falls Radiologist Explores the Art of Perception ■ By Sarah McQuade

22 | The Nurses’ Station A DAISY Team Award, Nurses Day at the Legislature, SD Nursing at a Glance

24 | Grape Expectations Resolve to Take Stock of The Wine “Cellar” ■ By Heather Taylor Boysen

27 | Learning Opportunities Upcoming Symposiums, Conferences, CME Courses

In This Issue 4 | Microsoft Windows 8.1 Opens New Windows into Healthcare ■ By John Hohn

Advanced Practitioners in a Changing Healthcare Environment

5 | Preparing a Budget for ICD-10 ■

By Cindy Hughes Preplanning can lessen the financial impact of ICD-10 on your practice

12 | Make-a-Wish Impact Study Do those ‘wishes’ really make a measureable difference?

13 | Preview of the 2014 SD Legislative Session

■ By Dave Hewett

15 | VA Appoints New Director for Sioux Falls 16 | Prairie Lakes Receives Top Honors for Heart Attack Care 18 | Sanford Health to Run Pediatric Clinic in Kunming, China The growing city of Kunming will be home to Sanford’s latest World Clinic

19 | Mercy Installs New MRI

Whether they are called Midlevel Providers, Advanced Practice Providers, or another similar term, Advanced Practice Nurses and Physician Assistants are playing an increasingly vital role in the delivery of healthcare on the Northern Plains.

One might be a physician’s “right hand”, the other, a town’s sole provider. What does the future hold for these versatile practitioners?

20 | Perks to Motivate Your Office Staff Improve efficiency, reduce turnover, and serve patients more effectively with these perks to keep your medical office staff happy

21 | Food for a Healthy Heart:

Encouraging Patients to Develop a Better Diet ■ By Kelly Steffen, MD

page On the Cover: Crystal Page, PA-C, Buffalo Regional Medical Clinic.

Photo by Turbiville Photography.

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From Us to You

Staying in Touch with MED

A

s we begin another year of publication, we want to not only say thank you to the thousands of loyal MED readers across the Northern Plains, but to welcome those who have recently begun receiving MED with the expansion of our mailing list. Whether you are new to MED, or have enjoyed it since the beginning, there are a few things we want you to know about this publication.

Publisher

Steffanie Liston-Holtrop

MED is Independent – Because MED is not affiliated with any medical association, health system, or organization, our news and information is unbiased. This also makes MED an excellent forum for open discussion of difficult or controversial topics. Got an opinion? Bring it on.

MED is Reader-Directed – MED is for, about, and often by physician readers. We welcome reader contributions and suggestions and take our editorial direction from an advisory board of local doctors.

MED Covers a Large Region – Unlike Medical Association journals that stop at the state borders, MED crosses state lines, to explore the common interests and issues of physicians in South Dakota, Northwest Iowa, Southwest Minnesota, and Northeast Nebraska.

MED is More Than a Magazine – With the launch of a new interactive website, MED can now provide updated news, information and calendar events, even between issues. Post an event, promote your practice, stay up-to-date, or reference past issues – all with just a few clicks.

MED is Free! – MED is distributed to more than 5,000 area providers free of charge, thanks to the support of a highly-select group of advertisers. These businesses cater to healthcare providers and have a vested interest in MED’s continuing high quality and value to readers.

With best wishes for a healthy and productive New Year!

—Alex & Steff

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

Design/Art Direction Corbo Design Photographer Kristi Shanks Web Design Locable

Contributing Editor Darrel Fickbohm Copy Editor Hannah Steck

Contributing Writers

Five Reasons to Love MED

MED Magazine, LLC Sioux Falls, South Dakota

Staff Writers

Heather Boysen Dave Hewett John Hohn Cindy Hughes Sarah McQuade Kelly Steffen Liz Boyd Caroline Chenault John Knies

Alex Strauss

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

2014 Advertising / Editorial Deadlines Jan/Feb Issue December 5

June Issue May 5

Sep/Oct Issue August 5

March Issue February 5

July/ August Issue June 5

November Issue October 5

April/May Issue March 5

December Issue November 5

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

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

Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com.

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

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Midwest Medical Edition

on the

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Now More than a Magazine, A Medical Community Hub

Enhance your MED experience!

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

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

Log on Now! Online Directory

Happy Staff = Happy Patients Want to improve office efficiency, patient satisfaction and employee retention? Keep your staff happy. Read “Three Perks for Motivating Your Office Staff” in this month’s MED then find more tips from the experts at Aqreva online.

Protein Missing on the Plates of Adolescents Beef may not be “what’s for dinner” on the plates of American teens. The South Dakota Beef Industry Council has more on a study that suggests your adolescent patients may not be getting enough protein and what healthcare providers can do about it.

News & Notes . . . As They Happen If you appreciate the opportunity to stay up-to-date with MED’s popular News & Notes column, visit MED on the Web for all the latest news between issues. MED’s online news page is updated daily so you will always have the very latest information. If you have news to share, let MED help you tell your colleagues.

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

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

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

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

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

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

Janurary / February 2014

MidwestMedicalEdition.com

3

Microsoft Windows 8.1

A talk with MED Contributer

Opens New Windows in Healthcare

David Hewett

MED: You are not originally from the Northern Plains, but you are no stranger to wide open places.

Where did you come from?

DH: My dad was a dentist in the Army and got transferred to Camp Hanford in Washington State. It’s the top secret place where they made plutonium for the nuclear bomb in World War II. In the middle of sage brush and sand in Eastern Washington. That’s where I started.

MED: Did you always envision a healthcare-related career?

DH: No. My degree was in public policy and I always thought I would be a tax policy person. I was working for a state Senator in Wisconsin when I got recruited into the world of healthcare in 1981 by the Wisconsin Hospital Association. They were looking for a lobbyist. Later, I worked for the American Hospital Association for a couple of years before coming here in 1997.

So I have spent most of my professional life debating many aspects of healthcare policy.

MED: You say you see similarities between some of what is happening now in healthcare and what was going on in the late 1980s. How so?

DH: Then and now, we saw a move from a volume-based system to a value-based one that encourages providers to keep people well instead of just treating illness. Back then, managed care took a few steps backward because people were concerned about the quality of care. That has been improved by requiring providers to report their numbers publically.

MED: What are some of the major changes you have seen since you have been here?

DH: The percentage of physicians who are employed as opposed to independents is one thing that has changed dramatically.

Medicine is technologically better. Also, even in the smaller communities, they are building or redesigning hospitals to be more outpatient-oriented. Going forward, expanded coverage is going to be a huge issue. How many uninsured will be able to enroll in the health insurance exchange?

2014 is going to be a transformational year for South Dakota.

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By John Hohn

I

magine having an assistant that

With data secured, you can use your

will transcribe and dictate at the

Windows 8.1 tablet in a variety of convenient

point of care. This assistant improves

and flexible ways that increase your

your electronic records applications

productivity.

experience, is prepared to connect you to colleagues and allows you to anywhereaccess to your research.

The newest release of the Microsoft Win-

dows 8.1 operating system will enable a tablet to be this assistant. With Windows 8.1, you can leverage the ability to work from anywhere, store data in the cloud and stay linked to patients and colleagues without the confines of traditional brick and mortar institutions.

Since its release in late October 2013, the influence of Windows 8.1 is just starting to take form. The Windows 8.1 interface is touch centric by design and meant to be the most intuitive system to date from Microsoft. Software developers will be able to design applications to take advantage of the new interface sensitivity and features. Medical research and data will easily be available at the touch of a finger on a Windows 8.1 system.

While the touch feature is not new, the difference Windows 8.1 brings to the healthcare industry is its ability to integrate a level

Windows 8.1 has:

• Flexible control options based on the application or your environment, including touch screen, pen stylus, voice, mouse and keyboard

• Access to growing number of cloud services and apps from Microsoft’s app store, including dictation and transcription apps such as nVOQ, SayIT and Recognosco.

• The ability to easily run multiple applications and connect to resources like medical journals or other colleagues

• Integration with other Microsoft embedded medical equipment, which increases accuracy and efficiencies

• Existing desktop programs can be easily merged onto tablets running Windows 8.1, allowing you access to critical applications while on-the-go

of security that ensures patient information is

With the combination of ease-of-use and

safe and secured. It enhances security of

data security, Windows 8.1 will emerge as the

mobile devices by integrating existing technol-

preferred tablet operating system for health-

ogy into its platform, allowing for:

care professionals. Browse to http://windows.

• Seamless wireless network security and secure encryption

• Management

using Microsoft’s System Center for unique mobile threats like lost devices, manage backups, security updates

• Integration with biometric authentication for improved security and integrity

microsoft.com to learn more or explore your options for updating your operating system.

You may want to consider upgrading your computing device to a tablet such as Fujitsu, which is designed to run Windows 8.1. Either way, it’s worth finding out for yourself if the time is right to start using Microsoft’s newest Windows system. ■

John Hohn is a Data Sales Engineer at Golden West Technologies.

Midwest Medical Edition

Preparing a budget for

A

ICD-10

By Cindy Hughes

s you undoubtedly know, the transition to ICD-10 has the potential of being a bigger financial drain on your practice than HIPAA and 5010 combined.

The cost of implementing ICD-10 will vary depending on the size of your practice and whether you outsource any of your billing and coding functions. Now that 2013 is over it is time to prepare your budget for 2014 and plan for the potential decrease in insurance payments in October 2014. We encourage you to have a line of credit in place to assist you with any delays from the payers.

Some physician practices will experience an increase in software and infrastructure costs to make the changes required to their systems. For some practices these will be significant, MGMA estimates this cost could be as much as $75,000 per physician. We have been working with our practice management system vendor to ensure necessary modifications are being addressed in a timely manner and included in the yearly maintenance agreements. If you use any other software in the practice that incorporates diagnosis codes – whether clinical (EHR), research or data analytics – these will also need to be reviewed for potential costs.

You should be thinking about whether your hardware will need to be upgraded due to any of the increased infrastructure. Faster computers, more RAM or hard drive space might be required.

Documentation review is a critical component to ICD-10 implementation, and there will be expenses associated with the process.

Costs are related to time required by staff to conduct reviews and/or the cost to have a company like Aqreva provide a chart audit and recommend modifications to your clinical documentation.

Appropriate training is required for clinical and some administrative staff is an

Janurary / February 2014

important part of this process. You will need are many unknowns when it comes to how to allocate sufficient funds to cover training ICD-10 will affect physician practices, one thing is certain. The transition will come expenses. with associated costs. Being prepared, Many physicians still rely on a superbill or encounter form for diagnosis coding. This reviewing specific clinical and administraform is typically a one-page document. In tive workflows, technical infrastructure and most cases, this form will need to be restaff requirements will provide you with the information to develop the budget and have designed to accommodate the increased number of codes associated with ICD-10. the financial resources in place to minimize Expert studies have suggested that a clinithe impact. Talk with your account manager cians productivity declines after moving to for more ideas and solutions to help you with ICD-10. This could translate into fewer ICD-10. ■ patients seen with an obvious decrease in generated revenue. This productivity decline Cindy Hughes, CMPE, is a Regional Manager with Aqreva. She is an active is expected to extend to your internal coding member of the National Medical Group staff, even experiencing staff turnover during Management Association. the transition. Some coders may decide not to be recertified for ICD-10.

Cash flow disruption can directly impact operations, as seen by many practices during the transition from HIPAA 4010 electronic transactions to the 5010 version.

Experts anticipate a greater disruption of cash-flow with ICD-10 as claims reject from one or more health plans.

Contingency plans, such as setting aside cash or postponing large capital investments should be drafted to ensure that you can meet the practice’s financial Dynamic Technical Building Systems Inc commitments to 106 N Indiana Ave • PO Box 787 • Sioux Falls, SD 57103 p 605.335.4397 • f 605.335.4397 staff and vendors. dtb@dtbsystems.com • www.dtbsystems.com Although there

• Nurse Call Systems • Synchronized Clock Systems • Low Voltage Specialists

MidwestMedicalEdition.com

5

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Avera

Dr. Richard Honke of Avera St. Benedict Heat Center in Parkston is the recipient of the Golden Stethoscope Preceptor Award. Sponsored

by the Rural Experiences for Health Professions Students program, the award was presented to coincide with National Rural Health Day on November 21.

Dr. Honke was nominated by an SDSU pharmacy student and a USDSM medical student, both of whom participated in the REHPS four-week Summer Experience Program last summer.

The Avera Medical Group Crofton recently presented Crofton Community School’s Athletic Department with a $600 gift. The money for the

donation was raised from the sports physicals Avera Medical Group Crofton offered over the summer.

Jamie Miller, Nurse Practitioner, Avera Medical Group Crofton, presents Ann Kramer, Athletic Director, Crofton Community School, with gift of $600.

Home health and hospice services offered by Avera Creighton Hospital have unified into a single agency called Avera@Home. The first

agencies to go live were the home health and hospice services in Mitchell, hospice services in Sioux Falls and homemaker services in Yankton. As each agency converts into the new company they will

6

also begin using a new Meditech software package specifically designed to manage home- and community-based services. Over the course of a six month period, 20 of Avera’s home health and hospice agencies will join Avera@ Home.

Black Hills Santa Claus delivered toys to hospitalized children in the Pediatrics Unit at Rapid City Regional Hospital (RCRH).

Children of all ages received new toys from The Santa Fund and bears donated by Riddle’s Jewelry. The Santa Fund is a special RCRH Foundation fund that also helps pay for gifts at other times during the year for ill and injured children who are hospitalized at RCRH. Gift distribution took place on December 13.

Family Medicine physician Alexia Gillen, DO joined the clinic staff of Regional Urgent Care. A Rapid

City native, Dr. Gillen has provided care in Rapid City since 2009 after graduating as chief resident of the Rapid City Regional Hospital Family Medicine Residency program.

She completed her undergraduate and graduate coursework at the University of South Dakota in Vermillion, and received her medical degree at Des Moines University – Osteopathic Medical Center in Des Moines.

Valerie D. Stephens, MD, has been named the Physician of the Quarter for Customer Service Excellence at Rapid City Regional Hospital

(RCRH). Dr. Stephens is a board-certified gastroenterology physician at the Rapid City Medical Center. She has been a member of the Medical Staff at RCRH for eight years. “RCRH” says Dr. Stephens, “is a champion and leader in initiatives resulting in improved outcomes for patient care, and serves as a credible role model professionally and personally for patients, colleagues and other health professionals.”

Sanford

William Chad Spanos, MD, FACS, is among 1,622 physicians from around the world who became fellows of the American College of Surgeons (FACS) during the College’s annual Clinical Congress in October. Dr. Spanos received

his MD from the University of Louisville Medical School and currently practices at Sanford Ear, Nose and Throat Clinic in Sioux Falls. He specializes in otolaryngology (head and neck surgery) and holds membership in several professional societies.

Dr. Spanos is a fellow of the American Head and Neck Society and the American Academy of Otolaryngology – Head and Neck Surgery.

Dr. James Wallace, pediatric pulmonologist at Sanford Children’s Specialty Clinic, received the Friend of Cystic Fibrosis Foundation Award at the Breath of Life Cystic Fibrosis Foundation Gala. The award is given to an

individual that excels at working to promote a cure for Cystic Fibrosis. The event took place in November in Minneapolis.

Stephanie Ziegler, BS, CCLS joined Sanford Aberdeen’s team of healthcare providers.

As a Child Life Specialist, Ziegler ensures life remains as normal as possible for children as they spend time as patients at Sanford Aberdeen. Ziegler earned her Bachelor of Science in Human Development and Family Studies from Colorado State University, Fort Collins, CO. She went on to earn her Certified Child Life Specialist credential from the Child Life Council in 2011.

Becker’s Hospital Review named Sanford Health CEO Kelby K. Krabbenhoft as one of its 300 Hospital & Health System Leaders to Know for 2013.

This annual list recognizes men and women from a wide range of hospitals and health systems.

Some have led their organizations for more than a decade, whereas others were appointed to their chief position within the past few months. The editorial team at Becker’s Hospital Review considers these men and women to be some of the most prominent healthcare executives to watch as healthcare reform unfolds.

Midwest Medical Edition

Sanford Aberdeen celebrated National Rural Health Day in November with a themed lunch

and tours of the medical center.

With the theme “Celebrating the Power of Rural”, National Rural Health Day took place on or around November 21. Sanford Health is now the largest, rural, not-for-profit healthcare system in the nation with locations in 126 communities in nine states. The message of Rural Health Day is that rural hospitals and healthcare practices are the economic foundation of their communities.

In addition to typically being the largest employers, these providers strengthen the economic health of their communities by ensuring a healthy workforce. National Rural Health Day was created in 2011 as a way to showcase rural America and increase awareness of rural health-related issues.

Edith Sanford Breast Cancer (ESBC) has announced its partnership with the Athena Breast Health Network to advance the use of a personalized breast cancer risk assessment. The innovative

program includes a breast cancer risk assessment tool and a care plan for high-risk patients.

Additionally, it will offer patients the opportunity to participate in research aimed at gaining a better understanding of breast cancer and its risk factors, ultimately raising the standard of care for women everywhere.

Athena Breast Health Network is a collaboration among the five University of California medical centers. ESBC is its first partner outside of California and was selected because of its expertise in breast cancer genomics and its ability to integrate the risk assessment into patient care.

As part of the new standard of care, prior to a breast screening (mammogram) appointment, Sanford Health patients will complete an Athena screening questionnaire online at home or in the clinic. Patients identified with an elevated risk will be referred to additional resources.

Janurary / February 2014

Sanford Health has joined with McKenzie County Healthcare Systems in Watford City, ND, to expand key medical services to western North Dakota.

The collaboration will bring more specialty physicians to the community, expand air ambulance services and provide a new facility to support the healthcare needs of oil-producing companies.

Visiting Sanford specialists will include cardiologists, orthopedic specialists and pediatricians.

Other specialty services may be added depending on the need at a later date.

Siouxland Proceeds from the 21st Annual Festival of Trees auction benefited the Siouxland Paramedics, Inc. Funds were

used to purchase AutoPulse backboards for CPR assistance.

AutoPulse allows rescuers to provide compressions while performing other lifesaving activities, resulting in the possibility of improved survival for cardiac arrest victims. The Festival of Trees has raised over $285,000 for local charities over the last 20 years. The event took place November 25 through December 5 at the Ho-Chunk Centre in Sioux City, Iowa.

Highlights included live music, ballet, and an auction of donated items such as decorated holiday trees and wreaths. Charitable gifts of food and clothing were collected, which the Siouxland Paramedics distributed to people in need.

Other Dr. Henri Lanctin, specialist in adult and pediatric urology, has joined the Prairie Lakes Healthcare System medical staff. Dr. Lanctin is board

certified in Urology and has been practicing the specialty for the past 15 years in St. Cloud, MN. He received his medical degree from Dalhousie University in Halifax, Nova Scotia and completed his general surgery and urology residencies at the University of Ottawa in Ottawa, Ontario.

Pulmonologist Dr. Jeffrey Kowitz joined Prairie Lakes in conjunction with the opening of the region’s first full-time clinic focused on pulmonology. The clinic

opened in August. Dr. Kowitz has over 25 years of pulmonology experience and is board certified in Pulmonology and Internal Medicine. He also has extensive experience in critical care and sleep disorders. He received his medical degree from the University of Minnesota Medical School and completed both his internal medicine residency and pulmonology fellowship at the University of Wisconsin.

MidwestMedicalEdition.com

Emergency medicine physicians Dr. James Bear and Dr. Leighton Singh have joined the medical staff at Prairie Lakes Healthcare System in Watertown.

Dr. Singh is board certified in Emergency Medicine.

He received his medical degree from the University of Missouri in Kansas City and completed his emergency medicine residency at the University of Nebraska in Omaha.

Prior to joining Prairie Lakes, Dr. Singh was an emergency medicine staff physician in Sioux Falls. A Milbank native, Dr. Bear is board certified in Family Medicine. He received his medical degree from the University of Iowa Hospitals and Clinics in Iowa City and completed his family medicine residency in 1997 at the University of Minnesota in Minneapolis. Prior to joining Prairie Lakes, Dr. Bear was a family and emergency medicine physician in Alexandria, MN.

7

The Association of American Medical Colleges predicts that the country will be 90,000 physicians short by the year 2020.

“There are more and more requirements being put on MDs, which is taking time away from caring for their patients.

This opens a whole market for PAs and NPs to fill.”

–Jerry Schrier, PA-C

8

Playing A

Courtesy Sanford

Pr Courtesy Turbiville Photography

Certified Registered Nurse Anesthetists like Jason Huber, CRNA, at Sanford Medical Center, Fargo, are advanced practice nurses with graduate education and board certification in anesthesia. There are about 200 CRNAs working in North Dakota and another 424 in South Dakota.

S

ix years ago Crystal Page,

a certified Physician Assistant, was working in medical billing, thinking about her future in healthcare, and noticing a trend.

“I could see that the doctors around me were always working and it seemed like the PAs had a little more time for their families,” says Page, who had wanted to be a pediatrician when she was in 4th grade. But, after she married while still in college, she decided that the faster track of a PA suited her better than medical school. “PAs have a professional healthcare career just like MDs and Dos, but they always have someone to turn to when they have a question,” she says.

Today, Page is the one-and-only provider at the Buffalo Regional Medical Clinic, a do-it-all primary care clinic

serving the 350 residents of Buffalo, South Dakota in the state’s Northwest corner, 85 miles from the nearest hospital. Page’s attending physician makes the 70-mile trek from Belle Fourche to visit the clinic every three months and the two have oneon-one contact once a month. Beyond that, with the exception of the clinic receptionist, Page is largely on her own.

“It is great to be a PA in a small town,” she says. “I think I see greater diversity of illnesses out here. A lot of people in my community are unwilling to travel, even if the weather just looks bad. So we kind of have to stay here and just figure it out.”

Many of the 227 other South Dakota PAs working in primary care – often in the state’s smallest communities – are undoubtedly doing the same thing.

Midwest Medical Edition

rimaryRole

By Alex Strauss

Courtesy Turbiville Photography

Advanced Practitioners in a Changing Healthcare Environment

Staffed by one PA and a receptionist, the Buffalo Regional Medical Clinic serves a town of about 350 people in Buffalo, SD, 85 miles from the nearest South Dakota hospital.

What’s in a Name?

Whether they are called Midlevel Practitioners, Advanced Practice Providers (the term preferred by Sanford), Advanced Practice Clinicians (Regional’s choice), Advanced Practitioners, or simply ‘Midlevels’, there is no doubt that their role – both in primary and specialty care – is growing along with their numbers.

As of December 2013, there were 1651 APPs working in South Dakota – 530 Physician Assistants and 1121 Advanced Practice Nurses, which include Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), Clinical Nurse Specialists (CNSs) and Certified Nurse Midwives (CNMs).

“The number of APPs is growing not only because the population is growing, but also because we can’t recruit physicians fast enough,” says Sanford’s Chief Medical

Janurary / February 2014

Crystal Page, PA-C, is the sole practitioner at the Buffalo Regional Medical Center. “You have to be willing to do it all,” she says.

Officer Dan Heinemann, MD, president of the South Dakota State Medical Association.

A quick look at the numbers makes it clear why this is. The Association of American Medical Colleges predicts that the country will be 90,000 physicians short by the year 2020. Already, hospital executives are reporting a nationwide vacancy rate for clinical professions of 17.6 percent in 2013 – up from 10.7 percent just four years ago (Source: AMN Healthcare 2013 Clinical Workforce Survey). Physicians were reported to be the most difficult professionals to recruit, followed by nurses, nurse practitioners and physician assistants.

The shortage means that current physicians are often over-extended in terms of patient load. In addition, most are embroiled in trying to meet new guidelines and

MidwestMedicalEdition.com

demands that leave them even less time for patient care. In many clinics, APPs are helping to ease some of the burden by providing follow-up patient care, rounding on hospital patients, assisting in the office or the OR, taking patient phone calls, etc.

“The care of the future is going to be less about individual care and more about populations or group care,” explains Heinemann.

“As we transition from taking care of disease to managing populations to maintain their health, there will still be a need to see a sore throat or a sprained ankle or a complex diabetic, but having members of the team who can take care of multiple levels of complexity will be very helpful.”

In many cases, APPs like Page make healthcare possible in places such as Buffalo where it might not otherwise be provided.

It is increasingly difficult to recruit

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The care of the future is going to be less about individual care and more about populations or group care. There will still be a need to see a sore throat or a sprained ankle or a complex diabetic, but having members of the team who can take care of multiple levels of complexity will be very helpful.

– Dan Heinemann, MD Courtesy Mercy Medical Center

Anita Wilson, NP, works in Mercy Medical Center’s Short Term Cardiology Unit in Sioux City.

physicians to work in communities that have no hospital.

Supporting the Team

For Jerry Schrier, PA-C, healthcare is a second career. The Sioux Falls PA left newspaper journalism after he found himself doing more managing than writing. Now at Avera Medical Group Nephrology, Schrier is one of the 145 South Dakota PAs working in a subspecialty area. By seeing complex dialysis patients on a regular basis, Schrier provides his 5 physician colleagues with the freedom to concentrate on more acute problems.

“The physician can only be in one spot at a time,” says Schrier. “But these dialysis patients have complex medical histories and issues that need frequent attention. These patients are labor intensive in terms of their medical needs and our nephrologists are very busy people. I see many of these patients three times a month.”

“What Jerry does for us is invaluable, on many levels,” says Schrier’s colleague, nephrologist Arvin Santos, MD. “We utilize

10

Courtesy Sanford

As a Family Medicine provider in Sanford Hartford Clinic in Hartford, South Dakota, Troy Van Overbeke, PA-C, may see multiple generations within the same family.

our midlevel the way we might use a resident.

That is how we train them and they need to be on that level. Jerry has really become our right arm.”

Schrier says his relationship is slightly different with each of the five doctors he works with and, while he sometimes has to remind himself which doctor prefers which kind of support, he has no doubt about his value in the clinic.

“All of this is being driven by patient care,” says Schrier. “As healthcare changes, there are more and more requirements being put on MDs, which is taking time away from caring for their patients. This opens a whole market for PAs and NPs to fill. If you have a patient with a complicated medical history and they can be seen more often, that is a good thing. It’s all about frequency.”

The frequency of visits made possible by having a PA on staff is not just good for patients; It’s also good for business. With Schrier on board to see dialysis patients multiple times a month, the clinic can meet the four-times-per-month level required by Medicare for maximum billing.

“Dialysis patients are chronically ill and on life-sustaining therapy,” says Dr. Santos.

“You need to see them quite frequently because of how sick they are, but our practice is so busy that it is practically impossible for us to see them four times a month. Medicare allows us, as physicians, to see the patients at least once a month if a midlevel sees them the other three times. From a revenue standpoint, the difference between one visit and four visits is almost half of the maximum billing.”

Getting Along

While busy doctors like Santos welcome the help of an APP – even calling him or her their “right hand” – not everyone is happy about the increasingly central role of midlevel providers in patient care. And, although Dr. Santos says relationships between physicians and midlevels are generally good, tensions do sometimes arise, especially in cases where the non-physician provider has more experience than the physician with whom he or she is working.

“For instance, nurses who become NPs tend to be very smart, very driven. Most have

Midwest Medical Edition

Courtesy Sanford

Courtesy Sanford

Ann Gilbertson, CNM, provides gynecologic and obstetric care to women of childbearing age at Sanford Health Broadway Clinic in Alexandria, Minnesota.

There are approximately 219 CNMs practicing in Minnesota and 31 in South Dakota.

done specialty work,” says Santos. “They might say, ‘That’s not how we did things in the ICU.’ And that can rub a younger, more headstrong physician the wrong way. But I’d say that, 95% of the time, we all do really well together.”

“Some physicians are very adamant that they don’t want their patients treated by someone with less medical education than a physician. That’s one extreme,” says Larry Sellers, MD, an Internal Medicine physician at Mercy Medical Center in Sioux City, Iowa.

Sellers and his partner have a part-time PA on whom they both rely.

“On the other end of the spectrum are physicians who want to hire as many midlevels as the law will allow because they can double or triple the amount of revenue going through their office.”

“Most of us are somewhere in the middle,” he says.

Ultimately, both Sellers and Santos say that the keys to successful and patient-benefitting working relationships are mutual respect and trust. “If the trust isn’t there, the relationship is not going to work,” says

Janurary / February 2014

Judy Bellanger-Dahl, PA-C, practices in Sanford’s Perham Health Clinic, a large multi-specialty group that includes several APPs in Perham, MN.

Santos. “My PA was a medic in Iran,” says Dr. Sellers, as an expression of the trust he puts in his own PA. “He saw a lot more trauma than I have ever seen in my life. So he is my go-to guy for that kind of thing.”

“There is always going to be some contention,” concedes Dr. Heinemann. “Some APPs say ‘We can replace primary care physicians’ which can make physicians bristle.”

But Heinemann says, in his experience, relationships between midlevels and physicians tend to be even better in the Plains states than they are elsewhere in the country, largely because of the needs in rural communities.”

“Physicians from the Midwest who know how critical APPs are to providing care, especially in the rural communities, sometimes shake our heads with some of our ‘big city’ colleagues who say ‘Why are you letting them do that? They shouldn’t be doing that!’

Don’t tell that to a resourceful and independent PA like Crystal Page or to the residents of Buffalo who depend on her services. “Healthcare is just not growing as quickly as the population,” observes Page.

MidwestMedicalEdition.com

“We are growing and we are aging and someone is going to have to pick up the slack.”

As ICD-10 threatens to slow down productivity in medical offices across the country, Page says she would not be surprised to see more people seeking care from midlevel providers in smaller clinics like hers, which may be able to offer perks like sooner appointments.

“The reality is that healthcare is going to be delivered, more and more, by non-physicians,” says Dr. Sellers. “As a profession, we can either stay committed to the belief that they are not as well-educated and can’t sort through the nuances and complexities at the same level as physicians. Or we can face reality and realize that they are critical to providing healthcare opportunities to our patients.”

“We know that their role is going to expand. We just don’t know exactly how,” agrees Heinemann. “I believe that APPs have a significant role to play in the future of team-based healthcare and physicians need to be open to working with them. There is no question that our patients are better served when we work together.” ■

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“As physicians, we have so many unknowns coming our way...

Make-a-Wish Releases Results of National Impact Study Can a wish for a child facing a life-threatening medical condition impact the child’s health status?

In July 2013, Make-A-Wish concluded a national survey, which included parents, volunteers and medical professionals. The final piece was to interview former wish kids who are now adults to learn how

One thing I am certain about is my malpractice protection.”

their wishes impacted them. The results of the survey suggest that fulfilled wishes can empower children with life-threatening medical conditions to fight harder against their illnesses. When they are granted a wish, they get more than just a great experience for a day, two days, or a week; The study results indicate that that experience can improve their quality of life and that of their entire family.

Adult former wish kids, wish parents, and attending health professionals agreed that a wish experience has the following impact on wish kids’ health status:

• The wish experience can improve a wish kids’ physical health.

• A wish come true can mark a positive turning point in the child’s battle for health.

• A wish come true makes kids feel stronger and more energetic.

• The wish experience helps them comply with difficult, but vital, treatment regimens.

Medicine is feeling the effects of regulatory and legislative changes, increasing risk, and profitability demands—all contributing to an atmosphere of uncertainty and lack of control.

What we do control as physicians: our choice of a liability partner.

I selected ProAssurance because they stand behind my good medicine. In spite of the maelstrom of change, I am protected, respected, and heard.

I believe in fair treatment—and I get it.

• In addition, a strong majority of adult former wish kids say that the wish experience helped to save their lives.

• 83 percent of adult former wish kids say they experienced improved physical health and strength.

• A combined 89 percent of nurses, doctors, social workers and child life specialists surveyed say they believe the wish experience can influence wish kids’ physical health.

• 71 percent of adult former wish kids believe the wish experience contributed to saving their lives.

• 97 percent of adult former wish kids say they experienced improved mental and emotional health.

“I believe everyone would agree that wishes are nice for kids who are sick, but now there is evidence that wishes do impact the status of a child’s health,” says Paul Krueger, president and CEO of Make-A-Wish South Dakota. “These findings are significant and now more than ever, we want to make sure that every eligible child in South Dakota receives

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a wish.” ■ For more information about the national wish impact study, or to refer a child you are treating to Make-A-Wish South Dakota, please call 605.335.8000 or 800.650.9198.

Midwest Medical Edition

Preview of the 2014 SD Legislative Session

T

By Dave Hewett, SDAHO

he 2014 Session of the South Dakota State Legislature has unofficially begun. The Governor’s Budget Address last month laid out the monetary parameters around which SDAHO’s messaging on the Budget will take shape. And then there are the other 500 bills that will likely emerge during the Session.

The Federal Scene

This is what is on our radar thus far

One other point of emphasis

Some general information about healthcare costs and the directions healthcare delivery are taking in the near term and long term.

The basic message is that healthcare’s cost curve is bending.

The most important part of the legislative process is your participation. Typically, we have administrators, board members, and other staff contacting local legislators.

Physicians, this is YOUR chance to connect with those legislators and tell them about healthcare delivery in their legislative districts. It also gives you a chance to establish or improve lines of communication during the session.

Medicaid SDAHO is grateful for the 3% update being proposed by the Governor. But for several of our members, we are still not back to payment rates offered as far back as 2010.

Medicaid Eligibility Expansion: SDAHO continues to be a strong supporter of expansion. Expansion can take several forms and while the Association is not wedded to one particular model, the coverage plan must maximize federal payment for coverage and provide coverage for the entire affected population, i.e., individuals between 52% and 138% of poverty.

On the Medicare “Doc Fix”, it appears that an outline for addressing the issue are coming together on a bi-partisan basis but the “payfors” have not yet been identified. Most are now saying that the Medicare Physician payment levels will be extended for yet another three months while a more comprehensive package is assembled for this spring.

Remember the goals of an effective advocate (1) A legislator will call you for advice on how to vote on a measure related to healthcare and (2) When that legislator is speaking on the floor of the House or Senate or in Committee, he/she is doing so with your feedback in mind.

And so, the 2014 Session begins. As always, there are challenges ahead. It will be your active involvement in the Session that allows healthcare delivery and coverage to be addressed fairly and adequately over the next three months. ■ Dave Hewett is President and CEO of the South Dakota Association of Healthcare Organizations.

MED Quotes “ It is not the mountain we conquer but ourselves.” — Edmund Hillary

Medical School Enrollment The Governor has proposed expanding class size in the Medical School by 11. SDAHO is supportive.

Other Legislation: This is a fluid list, which typically grows longer as more presentations are made. Initially we will be talking about legislation that would curtail many of the reforms made to healthcare delivery meant to moderate cost increases.

Janurary / February 2014

MidwestMedicalEdition.com

13

Off Hours Passionate Pursuits Outside the Office

Now You See It, Now You Don’t Sioux Falls Radiologist Explores the Art of P erception

By Sarah McQuade

W

hen Dr. David Schlesinger was five years old, his grandfather pulled a coin out from behind his young ear and ignited a passion in his heart.

From then on, Schlesinger immersed himself in the science of perception and the art of illusion.

He quickly started performing magic tricks and illusions, and even did children’s birthday parties for a time.

Dr. Schlesinger is now a Fellowship-trained breast radiologist at the Breast Health Institute at the Edith Sanford Cancer Center and Assistant Clinical Professor of Radiology at the University of South Dakota School of Medicine. He continues to collect, study and occasionally perform magic tricks to the delight of his friends and family.

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After all these years, Schlesinger says magic continues to inspire a sense of wonder in him. “I’m fascinated to learn the inner workings of each trick. There are only about 10 principles in all of magic. After that it’s just adaptations. It’s very neat to find out how these things are done. I marvel at the creative mind that creates each trick or illusion.”

Born and raised in Long Island, New York, Schlesinger and his family have lived in Sioux Falls for the last year-and-a-half. Between his work and keeping up with his busy two-year-old son, Schlesinger doesn’t have as much time to practice his magician skills these days. For now, his main magical pursuits include collecting and reading up on the latest illusions to stay current. But, when given the right moment with the right patient, Schlesinger says he occasionally does a quick magic trick to lessen anxiety during an appointment.

“I can take a bill of any denomination, use a regular yellow wooden pencil and pierce the bill,” he explains. “Next, I rip the pencil

through the bill, but what you don’t know is the ripping noise is actually part of the illusion. I then fold the bill long-ways and appear to melt the pencil through it. At the end, I open up the bill and show that it’s still completely whole.” He says he appreciates how a quick magic trick can give him an opportunity to break the ice and show his human side in an otherwise serious situation.

And yes–strange as it may sound, Dr. Schlesinger says he does see parallels between his profession and his hobby. “As a radiologist, my job requires a keen sense of perception so I can discern abnormalities. As a magician, I alter the audience’s perception and make them see something that really can’t happen.”

“Magic is a visual art, and so is radiology. It’s looking at an image and perceiving what’s there, and then making a diagnosis. It’s not black and white. There are a lot of things that you have to let go of and accept as normal. You have to know what’s important and what’s not. In this way, there is an art to all of medicine in general.” ■

Midwest Medical Edition

VA Appoints New Director for Sioux Falls The US Department of Veterans Affairs (VA) is pleased to announce the appointment of Darwin G. Goodspeed as the new Director of the Sioux Falls VA Health Care System.

Mr. Goodspeed has worked more than 16 years in healthcare leadership positions within VA, Department of Defense (DoD), and the private sector. He most recently served as Associate Director of the Louis Stokes Cleveland VA Medical Center and as Acting Director of the Chalmers P. Wylie Ambulatory Care Center, Columbus, Ohio.

Mr. Goodspeed holds graduate degrees in Management from Webster University, St.

Janurary / February 2014

Louis, Missouri; a Master in Business Administration from Southern New Hampshire College, Manchester, New Hampshire, a Master in Healthcare Administration from Baylor University, Waco, Texas and an undergraduate degree in Business Management/Information Systems from the University of Maryland, College Park, Maryland. He is a Fellow of the American College of Healthcare Executives.

“We are excited to bring Mr. Goodspeed on board as the new Director of the Sioux Falls VA Health Care System,” said Ms. Janet Murphy, Veterans Integrated Service Network (VISN 23) Director. “His sound leadership qualities and proven experience will be valuable assets for the healthcare system, the

MidwestMedicalEdition.com

employees, volunteers, and most importantly, for the Veterans we are honored to serve.”

The Sioux Falls VA Health Care System provides healthcare to approximately 29,000 Veterans in South Dakota, southwestern Minnesota and northwestern Iowa, The healthcare system is a teaching hospital providing a full range of patient care services with state-of-the-art technology, as well as education and research, a community living center and five community-based outpatient clinics. Comprehensive healthcare is provided through primary and long-term care in areas of medicine, surgery, psychiatry, physical medicine and rehabilitation, neurology, oncology, dentistry, geriatrics, and extended care. ■

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The Prairie Lakes cardiac cath lab team includes: Salem Maaliki, MD; Jennifer Jones, MD; Evelio Garcia, MD; Leah Le, RN, cath lab director; Becki Jarabek, CVT; Jacklyn Karli, RN; Sheila Voelsch, RN; Megan Flemming, RN; and Haley Ellis, RN.

Prairie Lakes Receives Top Honors for Heart Attack Care

Ask ur tO Abou dge Lo e! g Packa

16

Prairie Lakes Healthcare System has received the American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Platinum Performance Achievement Award for 2013. It was one of only 197 hospitals nationwide to do so. The award signifies that Prairie Lakes has reached an aggressive goal of treating these heart attack patients according to standard levels of care as outlined by the American College of Cardiology/ American Heart Association (ACC/AHA) clinical guidelines and recommendations.

To earn the award, Prairie Lakes consistently followed the treatment guidelines in the ACTION Registry–GWTG Premier for 8 consecutive quarters and met a performance standard of 90% for specific performance measures. Following these treatment

guidelines improves adherence to ACC/AHA Clinical Guideline recommendations, monitors drug safety, and enhances the overall quality of care provided to STelevation myocardial infarction (STEMI) and non-STEMI patients.

“The time is right for Prairie Lakes to be focused on improving the quality of cardiovascular care by implementing ACTION Registry–GWTG,” said Prairie Lakes Cath Lab Director Leah Le. “The number of acute myocardial infarction patients eligible for treatment is expected to grow over the next decade due to increasing incidence of heart disease and a large aging population.”

ACTION Registry-GWTG empowers healthcare provider teams to consistently treat heart attack patients according to the most current, science-based guidelines and establishes a national

Midwest Medical Edition

GRANT Has Black Hills Cardiovascular

Seeking Patients for Heart Attack Study Research

Leah Le, Cath Lab Director at Prairie Lakes Healthcare System, accepted an American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Platinum Performance Achievement Award at the 2013 American Heart Association Scientific Sessions on November 18 in Dallas, Texas.

standard for understanding and improving the quality, safety and outcomes of care provided for patients with coronary artery disease, specifically high-risk STEMI and NSTEMI patients.

“The American College of Cardiology Foundation and the American Heart Association commend Prairie Lakes Healthcare System for its success in implementing standards of care and protocols,” stated James Jollis, MD, FACC, ACTION Registry-GWTG Chair and Professor of Medicine and Radiology at Duke University Hospital.

“The full implementation of acute and secondary prevention guideline-recommended therapy is a critical step in saving the lives and improving outcomes of heart attack patients.”

ACTION Registry–GWTG is a partnership between the American College of Cardiology Foundation and the American Heart Association with partnering support from the American College of Emergency Physicians and the Society of Cardiovascular Patient Care. ■

Janurary / February 2014

Black Hills Cardiovascular Research (BHCR) has received a $390,500 grant from drug company AstraZeneca, enabling BHCR to seek participants for a clinical research study called RELATE. The objective of RELATE is to compare the antiplatelet effects of two platelet inhibitors, ticagrelor and clopidogrel, in American Indians who have had a heart attack at least one year ago and are on a low dose of aspirin. RELATE will explore the platelet inhibiting effects of ticagrelor and clopidogrel in patients with stable coronary artery disease, specifically looking at day one and day seven platelet inhibiting effects.

James S. Walder, MD, FACC, Cardiologist and the Principal Investigator for the study explains, “Since we now know that drugs work differently in the body based on one’s genetics, medicine is now being studied in certain ethnic groups (Japanese, Hispanic/Latino, African-American). Roger DeRaad, CNP and our Director of Research at BHCR, wrote this research study to include another important ethnic group in our Black Hills community, the Native American population.”

Eligible study participants must be Native Americans, 18 years or older, with documented stable coronary artery disease and be taking 75-100 mg of aspirin daily. To refer a patient, contact Franco Garcia, BHCR Clinical Research Coordinator, at (605) 718-6296 for more information. A link to more information on all Regional Health research studies can be found on the MED website at www.MidwestMedicalEdition.com. ■

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17

Sanford Health executives broker a deal with Chinese company to provide pediatric care in rapidly-growing Kunming.

Sanford Health to Run Pediatric Clinic in

Kunming, China

Sanford Health has announced a new collaboration with a healthcare system in the rapidly growing city of Kunming, China as part of its World Clinics initiative.

Sanford and YMCI Calmette Medical Investment & Management Company, Ltd., a state-owned company of the Yunnan Provincial government, plan to develop a pediatric clinic.

With a population of more than 6 million, Kunming is the political, economic, communications, and cultural hub of Yunnan and the seat of the provincial government. Northern Kunming is experiencing tremendous growth and has a significant need for primary care for children. Currently, northern Kunming has 60 kindergartens, 30 primary schools and 11 middle schools.

The new two-story, 18,000-square-foot Sanford World Clinic in Kunming will have the capacity to hold up to 10 primary care

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pediatric physicians. YMCI Calmette may also utilize the clinic for rotating pediatric sub-specialists.

YMCI Calmette currently operates the nonprofit First Hospital of Kunming, which was established in 1914 and is rated as one of the top 100 hospitals in China. YMCI Calmette is developing a new 1,100-bed hospital complex in the northern part of Kunming, which also will include a consolidated and expanded outpatient pediatric clinic in collaboration with Sanford. The hospital and clinic are expected to open in the spring of 2014.

Under the new agreement, YMCI Calmette will own the pediatric clinic, and Sanford World Clinics will manage the dayto-day operation as well as provision of medical services. The children’s clinic will also have connection to Sanford Health’s extensive clinical, research and administrative expertise in South Dakota.

“The decision to expand into China stems from our goal to expand healthcare services to areas of need, especially where children need healthcare,” said Dave Link, Sanford’s senior executive vice president. “This clinic also allows us to better understand how healthcare is delivered and financed around the world.”

The connection to Kunming and YMCI Calmette was made possible through Zhiguang Guo, PhD, a research scientist with Sanford who previously worked with YMCI Calmette physicians.

In addition to the planned clinic for Kunming, Sanford World Clinics has opened facilities domestically in Oklahoma, California and Oregon and has developed four international clinics in Ghana, Africa. Sanford also is pursuing projects in Israel and Mexico and is evaluating several other locations worldwide. ■

Midwest Medical Edition

Mercy Installs New MRI Scanner Mercy Medical Center-Sioux City, Siouxland’s only Joint Commission-accredited Stroke Center, is ready to begin using its newly-installed 3.0 Tesla (3T) Magnetic Resonance Imaging Scanner.

The new replacement unit and renovation are the result of a $3 million dollar investment in imaging services at Mercy.

The 3T MRI meets the high-resolution requirements of acute brain and neurovascular imaging. Emerging clinical evidence indicates perfusion imaging, diffusion tensor imaging, and MR spectroscopy are all enhanced by 3T MRI. In addition, the area’s most powerful MRI will allow Mercy to perform breast MRIs, cardiac MRIs, abdominal MRI/MRA and services to bariatric patients.

Mercy’s Director of Radiology, Barb Black, says the investment will pay off for patients who might otherwise have travelled outside the region for such high-end imaging services. Mercy staff will receive onsite training and expect to be using the new MRI by January 13. ■ MED Quotes “ Here’s good advice for practice: go into partnership with nature; she does more than half the work and asks none of the fee.” — Martin H. Fischer

Janurary / February 2014

MidwestMedicalEdition.com

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3

Perks for Motivating Your Office Staff

H

appy, hardworking employees are a cornerstone to practice success. A smiling recep-

tionist makes patients feel welcome. A cheerful attitude creates a positive team atmosphere that improves efficiency in completing daily tasks. A motivated team can improve patient satisfaction, productivity, and employee retention.

But there is no “silver bullet” for motivation. One employee may be motivated by a flexible work schedule while another may value public recognition for a job well done.

The good news is that the basic principle for designing motivational perks that work is simple: Ask your employees what they want, and design ways for them to earn it. Here are two ideas to start the conversation.

1

Rethink work schedules

Many employees appreciate the option of varied hours, flex time, or time off as a reward for good performance. This flexibility can be particularly motivating to Generation Y and those with working spouses or partners — the latter often prefer more time off instead of an increase in pay. Consider giving employees the opportunity to work longer days and shorter weeks, work part of their day during nontraditional office hours (such as 6 a.m. to 2 p.m.), take additional days off when physicians are on vacation, or work from home if it makes sense for their job role. If your flexible hours include evenings or weekends, you may discover that this benefits more than just employees. Many practices find that offering “non-traditional” hours is a competitive advantage that attracts new patients and revenue.

2

Ask for input, not feedback

They are not the same thing. Including staff in EHR selection is more empowering than asking for feedback on the final two systems you’re considering. Shared

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decision-making indicates that physicians and managers value employee opinions and expertise, and this pays big dividends in employee morale.

Include employees on committees or advisory boards. Allowing them to help design policies and programs that affect them builds a culture of trust and mutual respect.

Many managers find adding employees to the practice’s advisory board for employee benefits selection was a big win.

3

when it’s given in front of coworkers. A busy dermatologist in Massachusetts created a “Share the Limelight” initiative. Patients’ words of affirmation are shared with the practice in an effort to recognize and motivate staff. The initiative has created a positive buzz, and the physician insists that the weekly affirmations help staff recognize that patients care as much about them as they do about the providers — a big morale boost for everyone. ■

Accentuate the positive

It takes a village to run a practice, but patient compliments about staff or the practice aren’t always passed on after the physician hears them. Let “the village” hear them by sharing and celebrating the compliment. Even the most humble among us appreciates a pat on the back — especially

This article was provided by Aqreva and was reprinted by permission. There is more where these ideas came from. Visit the MED website for additional proven staff-motivating perks from Aqreva.

Relax.

Discover solutions that put you at ease.

At MMIC, we believe patients get the best care when their doctors feel calm and confident. So we put our energy into creating risk solutions designed to eliminate worry. Solutions such as medical liability insurance, physician 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.

Midwest Medical Edition

Food for a

Healthy Heart

WOMEN GO RED

Wear Red. Speak Red.

Encouraging patients to develop a better diet

Heart disease is no match for the power of women’s voices.

O

By Kelly Steffen, DO

pen any consumer magazine, turn on any talk show, or peruse any health-related website, and you’ll encounter an endless barrage of diet ideas. As a physician, it can be hard to convince patients that these aren’t always the best plans of attack for a healthy lifestyle.

On the whole, the diets of the American population need to improve.

Current Opinion in Cardiology reported that coronary heart disease mortality rates in seven countries show that the rate of death and cholesterol levels of Americans is second only to Northern Europe.

According to the World Health Organization, 2.7 million deaths are attributable to diets low in fruits and vegetables. These statistics indicate how vital it is for us as physicians to encourage our cardiac patients to find the right diet.

Research indicates that one healthy way for patients to eat a cardiachealthy diet is by following the Mediterranean Diet. This diet consists primarily of plant-based foods, including fruits, vegetables and whole grains. These foods are high in phytochemicals, low in calories, and associated with low risk of CVD. Fish and seafood are also prominent in Mediterranean cuisine instead of the red meat that is found in most American diets.

Eating meals with omega 3 fatty acids offer several benefits. These foods can have anti-arrhythmic, anti-thrombotic and anti-inflammatory effects. They have also been found to lower triglycerides, lower blood pressure, and are associated with reduced risk of CVD and sudden death. Meals included switching butter for the healthier option of olive oil. Red wine is also prevalent in a Mediterranean diet. Being high in phenolic antioxidants, red wine can raise HDL, inhibit platelet aggregation and is associated with a reduced risk of CVD. This change in diet has been shown to have positive benefits for a patient’s heart health. A 2011 study in the American Journal of Clinical Nutrition1 determined that the consumption of a Mediterranean diet induced the reduction of endothelial damage and dysfunction, which is associated with an improvement in the regenerative capacity of the endothelium. ■

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Luncheon Keynote Speaker Dee Dee Raap: “Follow Your Heart” Survivors and Go Red Challenge Participants share their life-changing journey toward a heart-healthy lifestyle

locally sponsored by

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Dr. Kelly Steffen is a Cardiologist with Sanford Heart Hospital.

Raise your voice at GoRedForWomen.org 1 Marin, C, et al, “Mediterranean diet reduces endothelial damage and improves the regenerative capacity of endothelium”, February 2011, American Journal of Clinical Nutrition, pp. 267-74.

©2013, American Heart Association. Also known as the Heart Fund. TM Go Red trademark of AHA, Red Dress trademark of DHHS.

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Janurary / February 2014

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12/16/2013 4:33:46 PM

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The Nurses’ Station Nursing News from Around the Region

The largest-ever study of American nurses, the Harvard Nurses Health Study, finds that being obese can be hard on hearing. Surveys of the 68,000 nurses in the study found that those who were significantly overweight – especially if the weight was carried around their middle – were the most likely to experience hearing loss. The findings were reported in December.

The South Dakota Nursing Workforce

February 10th and 11th will mark the 39th Annual ‘Nurses Day’

at the South Dakota State Legislature in Pierre.

The South Dakota Nurses Association, the professional association representing the nearly 15,000 RNs across the state, urges nurses to attend the event and have a voice in helping to shape public

at a Glance

• There were 16,852 licensed

healthcare policy consistent with the goals of nurses and the nursing profession. The event takes place at the Capitol Building and the Ramkota Hotel and Convention Center. ■

nursing professionals in 2011

• Average annual salary is

DAISY AwardS

$55,710

Darling Crow, RN, recently received a DAISY Award for Extraordinary Nurses at Rapid City Regional Hospital (RCRH) . Crow has worked in the Oncology Department for

• An anticipated shortfall between the number of available nurses

three years. | Crow was nominated for the award by a patient’s

and the demand for nursing

family who wrote, “At the end of our mother’s life, an angel

professionals of almost

was sent to us.” The nomination described Crow as “patient and

23 percent is expected

sincere” and considerate of the family’s needs. Crow was said

in 2020.

• At $26.78 per hour, South

to have gone out of her way to make sure the family was aware of what they needed to do when they took their mother home. “Darling was an awesome

Dakota is at the bottom of the ten

example of what a true RN should be,” the family said. ■

lowest paying states according to

Sanford recently awarded its first DAISY Team award.

The prize went to

with more flexibility and regard-

Bili Dizdarevic, PCT, Cheryl Haack, RN Case Manager, Connie Bryne Olson –

• South Dakota follows a statewide articulation plan, assisting nurses

(pictured)

Dr. Terri Peterson Henry,

the Bureau of Labor Statistics.

ing their education for advanced degrees.

(Source: Education Career Articles)

Mental Health Counselor, Deb Springer, RN.

MED Quotes Team Award winners not pictured include Tammy Krogh, RN, Yvonne Nies, RN, Jo Wehde, RN, Michelle Mehlhaff, PCT, Elizabeth Toomajian, CNP.

22

“ What lies behind us and what lies before us are tiny matters compared to what lies within us.” — Ralph Waldo Emerson

Midwest Medical Edition

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Grape Expectations

Resolve to Take Stock of The Wine “Cellar”

By Heather Taylor Boysen

I

love the month of January.

Many might ask why since it is bitterly cold with too much snow on the ground and a lot of shoveling and de-icing going on. I love January because it is quiet. The hustle and bustle of the holidays is behind us and it just feels as if you can take a deep breath and relax.

January is also a month for taking stock and creating resolutions. January is a great month to purge closets, clean cupboards and organize my entire household. The first place I will start organizing is my wine cellar. You might think I have an extensive wine collection and cellar because I own a wine shop, but I don’t. I have some lovely wine that perhaps I’m not quite ready to drink or because I’m saving it for a special occasion, but my collection is small compared to a lot of folks I know who collect wine.

My most prized possessions in the cellar are actually two magnum bottles of Chimney Rock Reserve Cabernet in the vintage years of 2003 and 2004, the birth years of my children. My husband and I purchased them on a trip to California in 2007 in the hopes that we would open them on a special occasion with our children perhaps, for a 21st birthday or a wedding. We chose the large format bottles because this size actually ages

24

better long-term and we knew these bottles needed to cellar for at least 18 years.

I live in an older home and we have a perfect room in our basement to store wine.

If you plan on cellaring or aging wine for any amount of time, storage conditions are vital for making sure your wines are living in the best environment for their well-being.

Heat is enemy number one to aging wine.

Our “cellar” is actually a storage closet with cinderblock walls and a cement floor. It is the Northeast corner of our home and stays cool year round. We don’t need any fancy equipment to keep the temp less than 65 degrees, which is important. Wine should be cellared at around 55 to 65 degrees.

Extreme temperature fluctuations will kill a wine very quickly.

While humidity is needed to keeps corks from drying out over a long time, so many wines are being closed under screw cap to avoid cork taint, that it is possible to store wines upright with no increase in humidity for storage. I find it easier to lay everything down for ease of storage, but it no longer is a must unless there is a cork closure.

Since many wines produced today are meant to be consumed almost immediately and do not need long term storage to reach their full potential, I take stock of what is in our cellar every January. There may be people who disagree with me, but I find that 5 to 8 years out of vintage date is a good place to start when looking at what wines you need to start drinking before they start to diminish in flavor and aroma. If you do not know how long a wine can be stored, please consider contacting the winery directly to ask. It may take a little bit of time, but I’ve found email

to be valuable in this instance!

My Chimney Rock Reserve Cabernet will stay on the “do not drink” shelves in my cellar, obviously, but most of the wine I have from 2006 to 2009 will probably get moved to the “drink now drink soon” shelves. When I buy wine to lay down for a period of time I usually buy at least 6 bottles so if I move them to drink now status and find that they could still stand a little time, then I’ll move them back to hold status. If the same wine has started to diminish in flavor, they get added to the “drink fast” shelf, which is in my kitchen.

However you cellar or store your wine, consider January as the month to take inventory and determine what you have in your collection. Wine is meant to be consumed and leaving it on a shelf in a cellar to waste away is certainly not what anyone ever intends for those favorite bottles. ■

Midwest Medical Edition

Learning Opportunities January / February February 5 – 6 8:00 am – 5:00 pm Fundamental Critical Care Support Program

April 8 7:30 am – 5:00 pm Pediatric Trauma Symposium

Location: Avera McKennan Hospital Information: 605-322-8950

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

February 10 CPR for Healthcare Providers 6:00 pm – 10:00 pm

April 16 7:30 am – 4:00 pm.

22nd Annual Avera Trauma Symposium

Avera McKennan School of EMS, Sioux Falls Information: 605-322-2086

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

March 27 8:00 am – 5:00 pm Avera Transplant Institute Symposium Location: Prairie Center, Avera McKennan Information: mckeducation@avera.org Registration: 605-322-8950, www.Avera.org/conferences

April 4 8:00 am – 6:30 pm Sanford Pancreatico-Biliary Symposium, Making Pancreatic Cancer History Location: Sanford USD Medical Center, Schroeder Auditorium Information: 605-328-6190 Brenda.wolles@sanfordhealth.org

April 25 – 26 Friday 3:45 pm – Saturday 5:00 pm 13th Annual Sanford POWER Strength & Conditioning Clinic Location: Sanford Fieldhouse Information: 605-312-7809 Registration: Sanfordhealth.org/forms/PowerStrengthConditioning

May 2 – 3 7:00 am – 5:15 pm 8th Annual Sanford Sports Medicine Symposium Location: Best Western Ramkota Hotel, Sioux Falls Information: 605-312-7808 tryg.odney@sanfordhealth.org

April 5 8:00 am – 6:30 pm Sanford GI Symposium, Current Trend in GI Location: Sanford Center, Dakota Room 2130 Information: 605-328-6190 Brenda.wolles@sanfordhealth.org

May 9 8:00 a – 6:00 pm 19th Annual North Central Heart Vascular Symposium Location: Sioux Falls Convention Center Information & Registration: 605-977-5311 www.Avera.org/conferences

Midwest Medical Edition

.com

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

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