MED Magazine Sept/October 2018

Regional’s Flying Physician 20 Years After Corneal Transplant

SEPTEMBER OCTOBER

Low-Cost Cyber Security Tips

VOL. 9 NO. 6

2018

ON TOP OF

HIS GAME Sports Medicine Specialist Ryan Meis, MD

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THE VIP LIST IT’S FRE ?

E! M IDWESTME DICALEDITIO N

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THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS

S EPTEM B ER /OC TO B ER 2 01 8

“ Cure sometimes,

treat often, comfort always.

”

— HIPPOCR ATES

From Us to You

Staying in Touch with MED

W

ELCOME to the September/October issue of MED. As the weather begins to cool, vacations end, and the school year starts, things always start to heat up for events and meetings around the MED region. We are proud to provide a comprehensive calendar for your convenience in print and online.

Be sure to check out the full list of upcoming events in the back of this issue and remember to list your own events in MED’s free online calendar.

We have spent the summer talking with healthcare professionals from around the region (our favorite thing to do!) and, in this issue, we bring you. . .

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

VICE PRESIDENT SALES & MARKETING Steffanie

Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER Julie Prairie Photography WEB DESIGN Locable

DIGITAL MEDIA DIRECTOR Alyssa McGinnis CONTRIBUTING WRITERS Lori Atkinson

• a “flying physician” from Rapid City,

Mandy Rounesville-Norgaard

• a Sioux Falls researcher who may be about to revolutionize breast cancer treatment

Tracie Storo

• a PT at the VA with an innovation that has dramatically improved access to care • a Renner man with a 20-year perspective on corneal transplant Of course, we also have all the latest news and columns from experts on hot topics from public health to practice security to investing in real estate.

If you plan to attend this year’s SDAHO convention in Sioux Falls, be sure to stop by the MED booth to join the VIP list and meet the team! (And if you can’t make it, get on the VIP list anyway at MidwestMedicalEdition.com to keep getting your MED for free.)

STAFF WRITERS Liz Boyd Caroline Chenault John Knies

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 WEBSITE MidwestMedicalEdition.com MAILING ADDRESS PO Box 90646, Sioux Falls, SD 57109

Have a great Fall!!

—Steff and Alex

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Steff and her daughter Khloe enjoying time on the water Alex and daughters Gretchen and Annika in Costa Rica

4

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

Every effort is made to ensure accuracy, however Midwest Medical Edition, LLC, cannot be held responsibly for consequences resulting from errors or omissions. Reproduction or use of the contents of this magazine is prohibited. Copyright 2018 Midwest Medical Edition, LLC.

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VO LU M E 9, N O. 6

■ S E P T E M B E R / O C TO B E R 201 8

8| Closing the Loop on Diagnostic Error Why diagnosis is no longer just the physician’s responsibility

■ By Lori Atkinson

22| RESEARCH: Kristi Egland on Survival, Inspiration, and the Test That Could Revolutionize Breast Cancer Treatment

24| Regional’s Heart Failure

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Clinic Reduces Readmissions ■ By Alex Strauss

28| H earing Loss and Dementia, the Silent Connection ■ By Mandy Rouseville-Norgaard

30| Physical Therapy = Primary Care = Improved Access for Veterans Embedding PTs in primary care has improved care for musculoskeletal problems and access to specialty services at the VA ■ By Alex Strauss

ON THE COVER

ON TOP OF HIS GAME ■ By Alex Strauss

As a Sports Medicine specialist and Chair of Orthopaedics at CNOS Clinic in Dakota Dunes, Ryan Meis leads a growing team of experts dedicated to keeping players and strong, injury-free, and in the game.

PAGE

32 | I NTERVIEW: Jill Fuller, Retired President/ CEO, Prairie Lakes Healthcare System

33 | What You Need to Know Before Investing in Real Estate

By Tracie Storo ■

18

6 | Technology: Four Simple,

Low-Cost Actions to Uplevel Your Office Security Today ■ By Alex Strauss

10 | 20/20 at 20

REGULAR FEATURES 4 FROM US TO YOU 12 N EWS & NOTES Awards, accreditations, expansions and more!

35 U PCOMING EVENTS Conferences, Symposiums and other CME events

A Renner man reflects on the gift of sight two decades after his corneal transplant ■ By Alex Strauss

26 | Flying Physician Says

Aviation is Good Medicine A Regional physician and airplane enthusiast shows why medicine and aviation make such good partners.

On the cover: CNOS Sports Medicine Specialist Ryan Meis, MD. Photo courtesy CNOS.

5

[ T E C HN O L O G Y ]

Four Simple, Low-Cost Actions to Uplevel Your Office Security Today

T

HERE WAS A TIME when

you move to a pass phrase of 15

securing the medical office

characters or more, something

and sensitive data was as

easy to remember like ‘battery-

simple as putting a lock on

horsestaple’, it is going to take

the door and a password on the

much, much longer and may just

computer. Those days are long gone.

be too much trouble.”

“The world today is a different place and you can’t just leave security

2. If you have hardware connected

in the background anymore, espe-

to the Internet that doesn’t

cially in a medical situation where

need to be—such as an Internet-

you are dealing with private, personal

enabled printer—take it off line.

information.” says Lynn Soeth,

“

Manager of Security Services at

High Point Networks to find the vul-

3. D on’t use the same password or

Fargo-based High Point Networks.

nerabilities and learn how to protect

passphrase for every office user.

Soeth and her team of “ethical

their data. But, as Soeth points out,

hackers” help businesses improve

not all security tactics are expensive.

ou don’t even have to spend money Y to make yourself more secure.

”

“If everyone is using the same

In fact, some of the most

password, that is a lot of risk.

important ones cost noth-

And what do you do if someone

ing at all.

leaves? Do you change the

“You don’t even have

password?” asks Soeth.

to spend money to make yourself more secure. But

4. Establish a two-part authentica-

you do need to spend time

tion for accessing office data.

their cybersecurity through phishing

and resources thinking about it,” she

campaigns and other processes

says. One place to start is an education

The Center for Internet Security,

designed to uncover and shore up

class to alert staff to potential dan-

a national organization, has estab-

weak links—whether it is hardware,

gers. Here are some other tips from

lished 20 controls for optimal

software, or human-related.

Soeth:

protection against cyber threats. High

“It is not just about malicious attackers,” says Soeth. “It can be some-

Point Networks focuses on the top 1. Rotate passwords regularly or,

thing as simple as leaving a computer

better yet, consider using

unlocked in a waiting room and a

password phrases.

person clicks a button and gets to where they should not have gotten.”

six which, Soeth says, can make a company 85 to 90 percent secure.

“Here in the Midwest, and in medicine especially, the inclination

“There are password cracking

is to trust and to want to help. We

programs out there now that can

want to encourage people to trust but

health systems routinely spend thou-

crack the typical 8-character

verify,” says Soeth. ❖

sands of dollars with companies like

password,” says Soeth. “When

These days, medical practices and

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6

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Closing the Loop on Diagnostic Error

BY LORI ATKINSON

T

RADITIONALLY, DIAGNOSIS HAS BEEN THOUGHT OF as solely the physician’s responsibility; accordingly, most leaders of healthcare organizations take a hands-off approach. But, according to the National Academies of

Sciences, Engineering and Medicine, diagnostic error is not simply failing to diagnose correctly—it’s the failure to establish an accurate and timely explanation of the patient’s health problem or communicate it to the patient.1 When we include the failure to communicate the diagnosis to the patient

“

EVEN WHEN APPROPRIATE CLINICAL STEPS WERE TAKEN TO LEAD TO A CORRECT DIAGNOSIS, ERRORS IN DIAGNOSIS STILL OCCURRED DUE TO FOLLOW-UP SYSTEMS FAILURES.

”

in a timely manner, the burden of diagnosis becomes the responsibility of the entire health care team and the systems used to support them. We call these “follow-up systems,” and they include everything from communication and workflow procedures to documentation systems. Expanding responsibility to the entire team allows us to look for gaps in timeliness and communication.

A review of Constellation/MMIC malpractice claims reveals that diagnostic errors are the third most frequent type of allegation and second most costly.

We found that 58 percent of all diagnostic error cases occurred in the ambulatory setting, and of these cases, 45 percent involve breakdowns in follow-up and care coordination.

Our review strikingly revealed that even when appropriate clinical steps were taken to lead to a correct diagnosis, errors in diagnosis still occurred due to follow-up systems failures. Injuries and claims due to these errors are difficult to defend because they’re preventable with the implementation of reliable processes, policies and education.

WHAT’S CONTRIBUTING TO FOLLOW-UP SYSTEMS FAILURES? Diagnostic test and image volume is increasing. According to AHRQ, about 40 percent of patient encounters in primary care offices involve some form of medical test.2 Physician clerical burden is also increasing. The AMA estimates that physicians spend nearly two hours on EHR deskwork for every hour of clinical face time with patients,3 but many organizations don’t use a team-based care model to handle these increasing loads.

Studies also show that EHR use isn’t optimized in ambulatory care practices, with 73 percent not using EHR technologies to their full capability.4 In the hospital setting, researchers found that 70 percent of patients had at least one pending study at discharge, but only 18 percent of these were communicated in the discharge summary.5 These system inefficiencies and failures are what’s leading to diagnostic error, clinician burnout, accreditation loss, financial penalties and poor business performance.

WEB EXTRA

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HOW CAN WE CLOSE THE LOOP ON THESE ERRORS?

develop and implement policies that

should incorporate health literacy

outline the evidence-based practices

tools such as Ask Me 3, teach-back

It takes teamwork and collaboration

team members are expected to

and empathetic communication.

to make improvements to the diag-

follow, including test and result

nostic process. We recommend

management, critical test result

Improving diagnosis by address-

involving the entire team, including

reporting, patient portal communi-

ing follow-up systems reduces risk,

health information technology (HIT),

cation, and referral management.

improves team productivity, and

using these three steps:

Team-based care is a strategic redis-

affects an organization’s reputation

tribution of work among members

and bottom line by improving patient

1. Re-engineer failure-prone, inefficient processes by leveraging

of a practice team in which the phy-

experience and incurring fewer mal-

sician or advanced practice provider

practice claims. It’s a win-win for all.

proven performance improvement

(APP) and a team of nurses and/or

❖

methods, such as process mapping,

medical assistants (MAs) share

Failure Modes and Effects Analysis

responsibilities for patient care.4

(FEMA), PDSA cycles (Plan Do Study records and EHR logs, and safety

3. Engage, educate and support teams and patients. Care team

scorecards.

education should outline roles and

Act), automated audits of medical

accountabilities and include how to

2. Employ policies, teamwork and tools, including implementing

work in a team-based care model

effective clinician-led team-based

such as IPASS, SBAR and team hud-

care. After re-engineering processes,

dles. Patient engagement education

September / October 2018

using proven communication tools

Lori Atkinson, RN, BSN, CPHRM, CPPS is a patient safety expert at MMIC/Constellation.

9

20/20 at 20

Renner Man Reflects on the Gift of Sight Two Decades After Corneal Transplant

BY ALEX STRAUSS

“

I RESPECT AND HONOR MY EYES BECAUSE THEY ARE LITERALLY A GIFT.

”

M

IKE NEIMAN FIGURES he was

early in the day, I almost stepped on my ball

just 14 or 15 years old when he first

right at my feet. I picked it up and said ‘I can’t

began to notice that his eyesight

play today.’ I hadn’t told anyone what was

was not what it should be.

Fortunately, the course’s golf pro recog-

windshield covered with snow and ice,” recalls

nized a serious vision problem and suggested

the Huron native who now lives in Renner.

that Mike see an ophthalmologist in Sioux

“It was always worse in the morning, but it

Falls. It took just minutes to learn that he had

seemed to get better throughout the day. Then

a serious case of Fuch’s dystrophy, a hereditary

when I went to sleep, it would start all over

condition that causes the cornea to become

again.”

waterlogged.

His optometrist prescribed glasses and

Within days, Mike underwent penetrating

eye drops, neither of which helped. Mean-

keratoplasty (PK) on the first eye, a full-thick-

while, Mike just “tried to make it work” as his

ness corneal transplant procedure that was

eyesight gradually deteriorated. He got

the gold standard for the treatment of corneal

through school by sitting in the front row and

diseases at the time.

struggled to play high school sports. Things

“I could tell right away that my vision was

worsened throughout college. By the time

brighter and clearer, even though it was still

Mike was 29, even doing work at the computer

blurry,” he says. Fourteen month later, in 1999,

was proving very difficult.

Mike had PK on his second eye and was able

THINGS CAME TO A HEAD AT A GOLF TOURNAMENT IN MITCHELL IN 1998.

10

going on.”

“My vision would become cloudy, like a

to see the freckles on his young son’s nose for the first time. In 2005, he underwent laser surgery on his transplanted tissue which gave

“It was early in the morning and my vision

him 20/20 vision without glasses or contacts.

was very cloudy,” Mike says. “At one point

“Nieman’s transplant is special because

MidwestMedicalEdition.com

Mark (far left) enjoying a Twins game in June with his kids (l to r) Joshua, Anna Kate, Chris (Ferrel) and Ashley with their daughter, Margot

he is among the 71 percent of PK transplants

Dimond. “Even if his grafts begin to fail, he

with 20/20 vision after 15 years,” says Marcy

would not require a full thickness transplant.

Dimond, CEO of Dakota Lions Sight and

Today’s technolog ies would allow for a

Health, which procures and prepares tissue

‘tune-up’, of sorts. The affected endothelial

for transplants like Mike’s “Beyond the

cells could be removed and a new set of donor

15-year data point, the graft failure rate is

endothelial cells could be transplanted

undocumented.”

through a 2 mm incision.”

Today, 95 percent of cornea transplants

“I did not fully appreciate at the time what

taking place in Minnesota and the Dakotas are

it really meant to receive donor tissue,” admits

endothelial keratoplasty (EK), where only a

Nieman, who now serve on the DLSH board of

layer of endothelial cells are transplanted. For

directors. “It is truly a miracle that this proce-

these transplants, DLSH staff now perform

dure was available, that there are people here

advanced processing of the corneal tissue,

capable doing it, and that there are families

saving the surgeon time and eliminating the

with the generosity and foresight to be organ

risk of tissue damage from additional

and tissue donors.”

manipulation.

“Without that, I would have had a very

DLSH is one of just a small handful of eye

limited life. Now, I can do all the things that

banks around the country now offering these

everyone takes for granted—watch my daugh-

DMEK pre-loads, which are the new gold

ters dance, work on the computer, read, attend

standard for treating Fuch’s dystrophy.

kid's events and all of that. I respect and honor

“The future is bright for Nieman,” says

WEB EXTRA

Mark with his daughter, Anna Kate

my eyes because they are literally a gift.” ❖

Read More

❱ L earn more about DMEK preloads

September / October 2018

❱ F ind out how to request tissue from DLSH

11

Happenings around the region

News & Notes

South Dakota | Southwest Minnesota | Northwest Iowa | Northeast Nebraska

AVERA Avera St. Luke’s Hospital in Aberdeen and Avera Sacred Heart Hospital in Yankton have been recognized by Premier Inc. for demonstrated excellence in performance across 13 patient safety adverse event areas of focus, as part of their participation in Premier’s Hospital Improvement Innovation Network (HIIN) program. The two Avera facilities were among 27 US hospitals recognized.

Avera Health, the University of South Dakota (USD), and Capital University Center (CUC) in Pierre have announced a new partnership to offer local nurse training in Pierre. Avera and USD will share the cost for the program at CUC for the academic years 2018-19 and 2019-20. CUC allows students to receive face-to-face instruction in Pierre. CUC has worked with all six of the state’s public universities and is expanding its undergraduate, graduate, and certificate programs.

12

Avera Cancer Institute’s sixth location, the Helmsley Center in Pierre, will hold a grand opening event on September 30 from 11 to 2.

The 57,000 square foot facility will connect patients with radiation and medical oncologists, oncology nurses, radiation therapists, physicist and dosimetrist. The Helmsley Center will also be home to orthopedics, dermatology, ENT, and urology. Avera's telehealth system will also allow patients to access additional cancer services at Avera locations across the system.

Avera Health has established a history-making scholarship fund for American Indians at The University of South Dakota Sanford School of Medicine. The Avera Health American Indian Scholarship Program Fund will provide $24,000 for students who are enrolled members of federally-recognized tribes in South Dakota or the upper Midwest. Avera and the medical school will collaborate to recruit potential student scholars for the program and recipients will be encouraged to provide care in underserved South Dakota areas.

Avera clinical psychologist and social worker Wallace Jackmon, PhD, LSW-PIP, was chosen to present at the National Association of Social Workers national convention in Washington, DC in June. Dr. Jackmon presented on a topic that is of a growing concern in the behavioral health field – Media Induced Anxiety and Depression. Dr. Jackmon has been with Avera Behavioral Health for 16 years.

Fred Slunecka After nearly 36 years with Avera Health, Chief Operating Officer Fred Slunecka announced his retirement in July.

Slunecka has been Avera’s COO since 2010. Prior to that, Slunecka served as Regional President of Avera McKennan Hospital & University Health Center for 21 years. Earlier in his career, Slunecka served as Executive Director of St. Joseph Hospital in Mitchell, now Avera Queen of Peace Hospital. David Flicek, President and CEO of Avera McKennan and Chief Administrative Officer of Avera Medical Group will assume the interim COO duties in addition to his current duties. An executive search will be conducted later this year to fill the operations role.

MidwestMedicalEdition.com

BLACK HILLS Regional Health caregiver Syrina Fields signs her name to the steel beam that will later be placed inside the large addition to Regional Health Rapid City Hospital.

Regional Health Rapid City Hospital hosted two ice cream socials in July at the top of the hospital parking garage to give participants a view of construction on the hospital expansion project and a chance to talk with Regional Health officials about it. Visitors were also invited to sign their names to a steel beam that will become part of the new hospital addition.

September / October 2018

Six physicians graduated from the Regional Health Rapid City Hospital Family Medicine Residency Program on Friday, June 29. Graduates of the three-year residency program include Crista D. Few, MD, Karla R. Ivy, DO, Matthew D. Nielsen, MD, Karla M. Polito, MD, Monaleze Saini, MD, and Christopher J. Wenger, MD.

Regional Health is one of five health systems in the United States to be honored by the American Hospital Association for efforts to create a diverse, inclusive environment for staff, patients and families. In 2016, Regional Health launched a systemwide effort to create awareness focused on cultural competency education, including special sessions for the medical staff. In 2017, this training was extended to all new caregivers on their first-day orientation, and in 2018 an additional session was included on their 90-day follow-up orientation.

Regional Health also developed a job shadowing program for Native American students and organizations.

MidwestMedicalEdition.com

13

• Happenings around the region

News & Notes

Happenings around the region

SANFORD Paullette Davidson Regional Health’s Board of Directors have named Paulette Davidson Acting President and CEO of Regional Health, replacing Brent Phillips. Davidson has been with Regional Health since 2015, serving as COO as well as President of the Rapid City Hospital and the Rapid City market. Davidson is a graduate of the University of Wisconsin and holds an MBA from Notre Dame.

Among other achievements, she helped initiate Regional’s $350 million construction project to expand and enhance primary care, emergency services, and hospital bed capacity.

14

The journey to bring The Evangelical Lutheran Good Samaritan Society and Sanford together as a combined enterprise has cleared a major milestone this summer. The Society Membership voted to approve the Restated Articles of Incorporation resulting in both organizations being able to sign the new Affiliation Agreement combining the two organizations as one, pending completion of the regulatory review process.

Each organization’s governing board has previously approved the affiliation. The Membership vote clears the way to begin the regulatory review process. The goal is to bring the organizations together by Jan. 1, 2019.

SIOUXLAND Patricia Collins Long-time Mercy Medical Center Volunteer Patricia Collins is the recipient of the 16th annual Dr. George G. Spellman Service Award.

Collins has served the community and Mercy for more than 50 years. She has served in the gift shop, the physician’s lounge, reception and surgery and has been a member of the Auxiliary Board, Mercy Women’s Night Out committee, and the Mercy Fall Gala committee.

Mercy Medical CenterSioux City announced that it is one of the first hospitals in Iowa to offer the world’s smallest pacemaker for patients with bradycardia.

Medtronic’s Micra Transcatheter Pacing System (TPS) does not require cardiac wires (leads) or a surgical “pocket” under the skin to deliver a pacing therapy. Instead, the device is small enough to be delivered through a catheter and implanted directly into the heart with small tines, providing a safe alternative to conventional pacemakers without the complications associated with leads – all while being cosmetically invisible.

MidwestMedicalEdition.com

AHA representative Katie Bergen and team members from Sioux City Fire Rescue and UnityPoint Health – St. Luke’s Emergency Department, Cardiovascular Associates and Intensive Care Unit.

UnityPoint Health – St. Luke’s has received the American College of Cardiology’s NCDR ACTION Registry Platinum Performance Achievement Award for 2018. St. Luke’s is one of only 203 hospitals nationwide to receive the honor which recognizes success in implementing a higher standard of care for heart attack patients.

MMC-SC has received the American Heart Association’s Get With The Guidelines Gold Plus Quality Achievement Awards in Heart Failure Care, Mission: Lifeline STEMI and NSTEMI. The awards recognize the hospital’s commitment to ensuring heart attack and heart failure patients receive the most appropriate treatment according to nationally recognized, research-based guidelines founded in the latest scientific evidence.

Jackie Kuchta Jackie Kuchta, NP-C, DNP, has joined South Sioux Mercy Medical Clinic, Mercy Internal Medicine and Pediatrics and Mercy Singing Hills Clinic.

Kuchta recently graduated from Briar Cliff University with a Doctor of Nurse Practice degree.

Prior to joining the Mercy Medical Services Clinics, she was a certified diabetes educator and insulin pump specialist at Mercy Medical Center. She has experience in treating hospitalized patients with renal disease, congestive heart failure, COPD, and other health concerns.

UnityPoint Health – St. Luke’s has also received two awards from the American Heart Association for the treatment of heart attack patients.

St. Luke’s received the American Heart Association 2018 Mission: Lifeline Gold Receiving Quality Achievement Award and the Mission: Lifeline Gold NSTEMI Award.

Mercy generates 1,440 jobs that add $200 million to Siouxland’s economy, according to the latest study by the Iowa Hospital Association. In addition, Mercy employees by themselves spend $56 million on retail sales and contribute $3.4 million in state sales tax revenue. In all, Iowa’s healthcare sector contributes $17 billion to the state economy while directly and indirectly providing 330,308 jobs, or about 20 percent of the state’s total non-farm employment.

NOW ACCEPTING NEW PATIENTS Dr. Mandy Rounseville-Norgaard, Au.D. 4948 E. 57th St, Sioux Falls, SD 57108 Ph. 605-306-3050 September / October 2018

15

• Happenings around the region

News & Notes

Happenings around the region

Mercy Medical Center is offering a line of frozen meals developed by Mercy dietitians and hand-crafted in the Mercy-Sioux City kitchen. The meals are heart healthy, low in sodium, and diabetic friendly and are designed to offer an easy meal solution for anyone with congestive heart failure, diabetes, or heart disease; those following a weight reduction plan; or anyone who simply wants a convenient and healthy option. The meals are all under $5.50 and are available for purchase in the MMC-SC cafeteria.

OTHER

(l to r) Byron Nielsen, MD, David Withrow, MD, Tyler Hanson, MD, Chuck Aman, CEO, Will Hurley, MD, David Barnes, MD, Sherri Rodgers-Conti, SE CASA Exec Dir, Crystal Gemar, case

Robert P. McDivitt Kenneth (KC) DeBoer The Prairie Lakes Healthcare System Board of Directors announced the appointment of Kenneth (KC) DeBoer as President and CEO in June. DeBoer started the job August 20, following the retirement of Jill Fuller. DeBoer holds as MS in Health Services Administration and has 27 years of healthcare management experience. He was most recently President and CEO of Jamestown Regional Medical Center in Jamestown, North Dakota.

Robert P. McDivitt, FACHE, was recently named the new Network Director of the VA Midwest Health Network. McDivitt has been with the VA for more than 35 years. He hold an MA in public management/ healthcare policy from the University of Minnesota and is board certified in healthcare management and is also an Army veteran.

McDivitt most recently served as Network Director in the Ann Arbor, Michigan VA service area.

manager.

Yankton Medical Clinic, PC, recently made a $5,000 donation to Southeast CASA, the court-appointed special advocate program for Bon Homme, Clay, Yankton, and, Union counties.

The donation will help train volunteers and support CASA services. There are currently 21 trained volunteers in the region.

MED’s Steff Liston-Holtrop with her teammates Butch Hanssen of Novak Sanitation and Clint Graybill and Bob Mayasich of Sanford.

Dakota Lions Sight & Health (DLSH) raised more than $25,000 to support education and outreach programs at the 20th Annual Gifts of Sight & Health Golf Tournament.

A total of 64 golfers from 16 teams participated and DLSH received the generous support of nearly 20 corporate sponsors.

MED Magazine was, once again, a proud sponsor of the event.

Tracie Storo Broker Associate | RE/MAX Professionals, Inc | 605-218-0052 16

MidwestMedicalEdition.com

US News & World Report has ranked Children’s Hospital & Medical Center in Omaha in five pediatric specialties in the new 2018-19 Best Children’s Hospitals rankings: Cardiology and Heart Surgery, Pulmonology, Gastroenterology & GI Surgery, Orthopedics and Diabetes & Endocrine Disorders.

This is the highest number of specialties Children’s has ranked since participating in the nationwide survey. The rankings rely on clinical data and an annual survey of pediatric specialists. They factor in patient outcomes, as well as clinical resources and adherence to best practices.

Mark T. Garry Mark T. Garry, MD, assistant professor of psychiatry at the University of South Dakota Sanford School of Medicine, has been awarded the 2018 Arnold P. Gold Foundation Humanism in Medicine Award. This award, considered one of the most distinguished recognitions of medical school faculty, is administered by the Association of American Medical Colleges’ Organization of Student Representatives, and it has been annually presented since 1999. In addition to serving as an assistant professor at the USD medical school, Dr. Garry also maintains a practice in psychiatry in Rapid City at the General Beadle Community Health Center of the Black Hills, and is on staff at Regional Health in Rapid City.

The first phase of Huron Regional Medical Center’s $3 million renovation project on the third floor of the main hospital wrapped up on August 1 and hosted its first delivery on August 3. The space includes a new central reception desk, four new delivery suites with large, spa-like bathrooms, four post-partum rooms and an expanded nursery and lactation area.

The project, which began in February, now moves onto phase two which includes a remodel of the four existing delivery suites and post-partum rooms, a new family waiting area, and an expanded nutrition bar.

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❱ S ee extra photos and more in the full version of each of these articles on the website.

a spectrum of patient-focused care By providing innovative and personalized care at five specialty centers, Sioux Falls Specialty Hospital has earned the confidence of patients and partner referrals throughout the region. And with the recent launch of Sioux Falls Urgent Care, we offer an expanded range of health services that all have one focus – the best patient care.

Meet the team at one of our specialty centers today.

SURGERY | MIDWEST IMAGING MIDWEST PAIN SPECIALISTS | SIOUX FALLS URGENT CARE WORKFORCE OCCUPATIONAL HEALTH Proud to be Physician Owned and Operated

September / October 2018

(605) 334-6730 •

sfsh.com 17

• Happenings around the region

News & Notes

18

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ON TOP OF HIS GAME

L

Sports Medicine Specialist Ryan Meis, MD

IKE MANY ATHLETES, RYAN MEIS, MD, is always

looking for ways to up his game. But unlike other athletes, he is perfectly happy to be doing it from the sidelines. In fact, these days, that is where much of his “game” is played.

As a Sport Medicine specialist and Chair of Orthpaedics at CNOS Clinic in Dakota Dunes, Meis has become a fixture at high school, college, and even championship sporting events throughout the region—

one of a growing team of sports medicine colleagues at CNOS dedicated to keeping players strong, injury free, and in the game.

“I split my time between two different games on Friday nights, as well as the Morningside football games on Saturdays,” says Dr. Meis, who played baseball at Morningside during his own college days. “It is my job to help assess whether an injured player should go back in.

I think it is really important so I rarely miss these events.”

If those injuries need further attention, players can be seen the following Saturday morning at the CNOS sports injury clinic, saving time and reducing pain and stress for patients and their families.

“We might see ten kids on any given Saturday, but these are kids who are otherwise going to end up in Urgent Care. It’s just the right thing to do,” says Meis.

“

You could watch TV on a Sunday during football season and see who got hurt and know who was going to be in your clinic the next day

”

LEARNING FROM THE BEST Ryan Meis grew up in Council Bluffs, Iowa. After Morningside, he headed to Creighton in Omaha for medical school and on to an orthopaedic residency at the University of Wisconsin-Madison. photos courtesy CNOS

It was during his fellowship in Birmingham, Alabama, under the tutelage of pioneering sports medicine expert Dr. James Andrews, founder of the American Sports Medicine Institute, that Meis developed his passion for managing complex shoulder, elbow, and knee injuries.

BY ALEX STRAUSS

September / October 2018

19

“You could watch TV on a Sunday during football season and see who got hurt and know who was going to be in your clinic the next day,” says Dr. Meis.

“I was starstruck. That experience really jump started my career.”

In Alabama, Dr. Meis honed his skills in advanced procedures like arthroscopic

shoulder

surger y,

multi-ligament knee repair, and the so-called Tommy John elbow surgery (ulnar collateral ligament reconstruction), a potentially career-saving operation for the throwing athlete which Dr. Andrews helped refine.

THE ROAD BACK TO IOWA When Meis first began to search for a place to practice all that he had learned, he says the Sioux City area “wasn’t really on my radar.” Then he encoun-

THE EVOLUTION OF A SPORTS MEDICINE PROGRAM

tered CNOS, an innovative Dakota

From those early days, and largely under Dr. Meis’ guidance, the CNOS sports

Dunes clinic that was doing something

medicine service line grew, evolving into a comprehensive program including

unusual—integrating orthopedics and

fellowship trained physicians and surgeons, 13 certified athletic trainers, 4

neurology.

strength and conditioning specialists, and physical and occupational thera-

“Sometimes, you feel like you are

pists at 6 locations—all devoted to the idea that “life is sport”. Through

just guided to something,” he says.

screenings and on-site treatments, the team provides support to more than

“CNOS had put together something

35 area high schools and colleges.

very special. They had also gotten into

In addition, Move 365, a sports medicine initiative supported by the

sports medicine very early on, at a time

non-profit CNOS Foundation, provides athletic training, including injury

when there weren’t a lot of docs cover-

evaluation on site or at free screening clinics; strength and conditioning

ing high school and college games.

through sports performance camps, in-school training, and personal training;

When I was interviewing, they had

and physical therapy. The idea is to keep people “in the game”—whether

trainers stopping in at 48 schools. That

that game is baseball or gardening.

creates a large pool of kids who, when

“These three pillars all work together to decrease the risk of injury,” says

they need care, can get it quickly at

Dr. Meis. “We manage on the sidelines, provide care if there are injuries, and,

CNOS. When you are a sports medicine

if an athlete has to have surgery or is injured, we have physical therapy to

physician, that is exactly what you

help them recover.”

want.”

Meis also realized that his highlevel training could help uplevel

BEYOND THE FIELD

orthopedic care in the region where

When he is not on the sidelines of a game, Dr. Meis’ professional time is about

many of the complex procedures he

evenly split between the clinic and the operating room. But those aren’t the

had learned (particularly those per-

only places where his expertise comes into play.

formed through a scope) were still relatively new.

20

Dr. Meis regularly teaches courses on shoulder and elbow injuries in Florida and Omaha, which he says helps to keep him on the cutting edge of new

MidwestMedicalEdition.com

“

Sometimes you find something that you were just meant to do.

”

knowledge and techniques. “It gives

possibly could,” he says. “They need

remembers. “It turns out, she had

me the opportunity to sit down and

people there who understand and are

dislocated her toe. So I jumped in the

ask questions and figure out what

nice to kids.”

water, swam to his boat, popped the

really is new and working and what

Even vacation is not always an

toe back into place, went back to my

isn’t worth trying because it isn’t

escape from the need for his skills.

boat, and we both had great weeks!”

working well.”

With a chuckle, Meis recounts the trip

Becoming more serious, Meis

As a father of a college freshman,

to Okoboji where he was called upon

adds, “Sometimes you find something

a high school freshman, and an

to help a friend’s wife—on the water.

that you were just meant to do. I have

eighth grader, Meis also estimates

“My friend said ‘I think we just

been so lucky to have the training

that he has coached some 60 youth

passed you on the boat. My wife hurt

that I did and to work with the people

sports teams over the last 13 years.

her foot getting in the boat. Would

that I did. The stars have aligned

“I have tried to coach everything I

you mind taking a look at it?’,” Meis

nicely for me.” ❖

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[ RESE ARCH ]

Researcher KRISTI EGLAND on Survival, Inspiration, and the Test That Could Revolutionize Breast Cancer Treatment

BY MED STAFF

S

ANFORD

AND

to make a test that can monitor

Others have recurred. And I would

medical technology company

HEALTH

patients during treatment and after

always ask them ‘How did you know

Inanovate have launched a

that would hopefully be sensitive

you had recurred?’”

clinical trial to confirm the

enough to detect recurrence,” says Dr.

The biomarkers Egland linked

accuracy of a breast cancer blood

Egland. “That could give us a shot at

with breast cancer have been licensed

test developed by Sanford researcher

curing more patients.”

to Inanovate which will use its pat-

and breast cancer survivor Kristi Egland, PhD.

Egland’s test, announced this summer, is based on antibodies in the

to analyze the blood draw.

Dr. Egland had been studying

blood of breast cancer patients which

“Inanovate is exciting because

breast cancer for four years when she

recognize seven different proteins

it was like they had the iPad and

received her own diagnosis in

I had the app,” says Egland. “I

2007. She says it was that diag-

still remember when they first

nosis that drove her to develop the new test.

“While you are being treated, you are comforted by the fact that you’re doing something,” she says. “But after treatment was done, I kept saying to my oncologist, ‘Am I cured?’ My

“I kept saying to my oncologist, ‘Am I cured?’ My fear is always, do I have a recurrence?

Because you rarely die of a primary tumor.”

fear is always, do I have a recur-

explained their technology to me and I thought, ‘This is perfect!’”

The newly-launched 2-year clinical trial of the assay is being funded by an NIH grant and will include 1,250 women at sites in Fargo, Bismarck, Sioux Falls, and Bemidji, Minnesota. If the accu-

rence? Because you rarely die of a

associated with a tumor. If these

racy of the test is confirmed, it could

primary tumor. The problem is when

proteins were manufactured in the

potentially be used to not only detect

breast cancer metastasizes.”

lab, Egland reasoned that they could

recurrent breast cancer before symp-

then be used as the basis of a test for

toms appear, but it could also be used

these specific antibodies.

alongside mammography to improve

Frustrated by the lack of a reliable way to monitor for recurrence beyond periodic exams and liver function

“After breast cancer, you become

tests, Egland got to work on a tool that

part of a sort of sorority of survivors,”

“My goal is to convince myself that

could detect metastatic cancer even

says Egland. “You see the same people

it is good data and it is real,” says Dr.

before symptoms appeared.

at races, events, and in clinic. Some

Egland. “This is going to be a huge

of them moved on with their lives.

breakthrough.” ❖

“I was thinking, I want to be able

22

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the accuracy of diagnosis.

MidwestMedicalEdition.com

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September / October 2018

23

“IF WE UTILIZE OUR TELEMONITORING SYSTEM TO FOLLOW THEIR PULMONARY ARTERY PRESSURES AND WE STAY ON TOP OF THEIR MEDICATIONS, WE CAN OFTEN KEEP THEM OUT OF THE HOSPITAL AND FEELING GOOD.”

Jessica Tvedt is a CNP in Regional Health Heart and Vascular Institute's Heart Failure Clinic. Photos courtesy Regional Health.

REGIONAL’S HEART FAILURE CLINIC REDUCES READMISSIONS

BY ALEX STRAUSS

H

EART FAILURE IS THE MOST COMMON AND COSTLIEST reason for admission to the hospital for older Americans. And yet, more than three in four HF patients who end up in the emergency room get admitted to the hospital. Often, these readmissions are for an ongoing condition.

But the Regional Health Heart and Vascular Institute has found a way to reduce

both the number of patients whose symptoms drive them to seek care in the ED and the number of hospital readmissions. Through a combination of education, interventions such as IV diuretic therapy, and careful, continual monitoring, the multidisciplinary Heart Failure Clinic provides both an alternative to the emergency room and peace of mind for HF patients and their doctors.

“If their heart function is less than 35 percent and no one is keeping a close eye on them, they may end up with a defibrillator down the road,” says Jessica Tvedt, CNP, AGACNP, BC, who works in the clinic along with cardiologists Dr. K. John Heilman and Dr. Alexander Schabauer.

“But if we utilize our telemonitoring system to follow their pulmonary artery pressures and we stay on top of their medications, we can often keep them out of the hospital and feeling good.”

WEB EXTRA

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❱R ead about an alternative to blood thinners for Rapid City patients with non-valvular atrial fibrillation 24

MidwestMedicalEdition.com

MEDAd2018_RAS_Layout 1 3/22/2018 3:25 PM Page 1 HF readmissions at Regional hover at or below the national average at 16 to 18 percent. Regional implemented CardioMEMS, an implantable, battery-free PA monitoring system, in 2016. Research suggests the system can reduce HF hospital admissions by 37 percent and Tvedt says Regional’s

Applying a Human Factors and Occupational Health Philosophy to Risk Management.

experience has mirrored that trend.

In addition to reducing hospitalizations and improving quality of life, the clinic also helps take some of the burden of managing these often-complex patients off of referring physicians.

“Most of these patients are really sick,” says Twedt. “They have COPS or diabetes or kidney disease. They take a lot of time and work. It is difficult and it takes a lot of manpower.”

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hard-to-manage systolic or diastolic dysfunction, multiple hospital admissions or ED visits, etc.

“Once we get them into the clinic, we are able to get their buy-in very quickly,” says Tvedt. “Patients like that people are watching them very closely. Once I see them once in the clinic, I can manage a lot

Mediterranean-Style

Lean Beef

Eating with Supports a Healthy

over the phone. In the long run, it will save

Heart

Recent research demonstrates that following a Mediterranean-style eating pattern that includes up to 18 ounces of cooked, fresh lean beef and pork per week – along with poultry and fish – is just as effective at improving certain heart disease risk factors (such as blood pressure and total and LDL cholesterol) as a Mediterranean-style eating pattern that limits red meat.1

them office visits, as well.” ❖

THE HEART FAILURE CLINIC PROVIDES: • Proactive, individualized management of HF symptoms • Frequent follow-up to assess and treat symptoms •A lternative to repeated ED visits • Careful evaluation and adjustment of prescribed HF medications •P atient education for effective self-care

September / October 2018

BeefItsWhatsForDinner.com/newsroom/Mediterranean-Diet 1

Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2015. Available at https://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf A Mediterranean-style eating pattern with lean, unprocessed red meat has cardiometabolic benefits for adults who are overweight or obese in a randomized, crossover, controlled feeding trial. Am J Clin Nutr 2018, nqy075. https://academic.oup.com/ajcn/article/108/1/33/5036105

* Fresh meats were defined in the study as requiring no further preservation or processing beyond refrigeration or freezing; they are not cured, salted or smoked or include chemical preservatives.

25

Flying Physician says Aviation is Good Medicine

”

if you are ‘bitten’ by the aviation bug and that becomes part of who you want to be, it is a very good fit with medicine.

“

Ptacek in the cockpit of his plane with son Travis and grandson Remington

F

AMILY MEDICINE PHYSICIAN Mark Ptacek, MD, was first introduced to the world of aviation in medical school at the University of Nebraska Medical Center in Omaha. The Nebraska native, who now practices at Lead-Deadwood Regional Hospital and Clinic, was dreaming of a

far-away small town he wished to visit when a flight instructor classmate told him “You need to get a pilot’s license.”

“My friend said I’ll be your instructor,” remembers Dr. Ptacek. “I had inherited some money from my uncle so I decided to do it.”

After some on-again, off-again training, Ptacek earned his pilot’s license in his second year of residency at the United Hospital Center in Clarksburg, West Virginia and purchased his first plane, a Piper Cherokee Six. Ptacek quickly got involved with the Flying Physicians Association, a national group that promotes aviation safety, cross-disciplinary medical education, and charitable and social activities for physician pilots. He has been a member for more than 30 years.

26

MidwestMedicalEdition.com

“When I go to CME events, I get just the family practice perspective, but at FPA, if we are talking about, say, prostate disease, we’ll have oncologists, urologists, and other specialists.” says Dr. Ptacek.

“You get the ability to see things from another angle.”

On a visit to the Experimental Aircraft Association’s annual AirVenture convention in Oshkosh, Wisconsin, Dr. Ptacek was inspired to take his passion for aviation a step further and build his own aircraft. “You get a whole different appreciation for aviation when you actually build the airplane,” he says.

He spent five years building a 4-seater aluminum Van’s RV-10 from a kit and flew his homemade

EXPERIENCED IN HEALTH CARE LAW

airplane for the first time in O’Neill, Nebraska on leap day, February 29, 2008.

“I practiced in a small town in Nebraska for 25 years and the ability to fly gave me access to larger communities and continuing education opportunities that I would not have been able to take the time to drive to,” says Ptacek, who is also a certified RV-10 mechanic.

“I encourage young docs, especially if they are going to be in a rural area, to go and get a pilot’s license,” says Ptacek. “Then, if you are ‘bitten’ by the aviation bug and that becomes part of who you want to be, it is a very good fit with medicine. I’m able to not only fly to see my kids around the country, but also to do locums work for several organizations.”

Ptacek’s enthusiasm is, indeed, infectious; his son, a medical resident in Rapid City, is also a pilot and Ptacek’s fiance and Lead-Deadwood colleague,

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September / October 2018

27

Hearing Loss and Dementia, the Silent Connection

BY MANDY ROUNSEVILLE-NORGAARD

R

ESEARCH IS UNCOVERING more evidence

when you can’t hear. Some research

that hearing loss can

lonely or isolated and dementia.

has shown a link between feeling

increase the onset or

The brain has to work harder to

progression of dementia, a condi-

process sound if you are not hearing

tion marked by memory loss and

well. That may take away resources

trouble

that it could use for other important

with

thinking,

prob-

lem-solving, and other mental tasks.

activities.

There may be things that can be

If your ears can no longer pick up

done to lower the chances for mental

on sounds, your hearing nerves will

decline, even if you or a patient starts

send fewer signals to your brain. As a

to have trouble hearing.

result, auditory deprivation may occur

What’s the Link?

What Can You Do?

Research has found that a person’s

If you want try to lower your chances

chances for mental decline tends to

of hearing loss as you age, try to keep

increase the worse their hearing prob-

your heart healthy, protect your hear-

lems are. For example, patients with

ing from loud noises, and do not

moderate hearing loss had the same

smoke.

mental decline in 7.7 years, on average,

Also, if you suspect hearing loss

as someone with normal hearing

or think your hearing has changed,

showed in 10.9 years.

get a hearing test. If there is hearing

Researchers do not know for sure

loss, treat it with the use of amplifi-

how the two conditions are connected.

cation. Treating hearing loss is a very

Frank Lin, MD, PhD, of Johns Hopkins

simple intervention that could make

University, reported a combination of

a big difference with improving qual-

three things may be involved:

ity of life and delaying the onset or

Those with hearing loss tend to feel

Mandy RounsevilleNorgaard, AuD, is a Sioux Falls native who practices audiology at Sioux Falls Audiology Associates.

progression of dementia. ❖

isolated, since it’s hard to join in conversations or be social with others

WEB EXTRA

Read More

❱G et tips to recognize the subtle signs of hearing loss

28

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© 2018 MMIC Insurance, Inc.

Because your patients always need your best game.

At MMIC, we make it our practice to protect your practice.

That’s why we’ve built a responsive team of experts— to help you minimize potential risks, stay current in the ever-changing health care industry, and keep your practice thriving. And, in the event of a claim, we’re here for you.

Because you’re here for them—with your very best game.

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September / October 2018

29

PHYSICAL THERAPY + PRIMARY CARE = IMPROVED ACCESS FOR VETERANS

PT Brandon Peterson works with a client in the primary care clinic at the Sioux Falls VA.

T

HE SIOUX FALLS VA HEALTHCARE

“The research has repeatedly shown that, the

system is in year two of a bold experiment

quicker someone can receive hands-on treatment

that is changing the way patients access

after musculoskeletal injury, the quicker they

care for musculoskeletal dysfunction—for

resolve and the quicker they return to normal life,”

the better.

says Dr. Peterson. “I had a lot of objective informa-

Since 2016, the VA has had a physical therapist embedded in the primary care clinic. The goal of

tion to share with my leadership when we proposed this in 2016.”

the program—which started as a three-month trial

Before the new process was implemented,

and quickly became permanent—was to not only

veterans, like patients in the private sector, saw

speed up the time it takes for patients to be eval-

their primary care doctor first for things like back

uated by a PT, but also to streamline the triage

pain, neck pain, sprains and strains, and received

process for musculoskeletal issues, free up time

a referral to a PT for further evaluation. Once

for primary care doctors to concentrate on other

referred, the patient had to wait again for an

ailments, and eliminate unneeded neurology,

appointment.

radiology, and orthopedic referrals.

Under the new program, the patient can see a

According to Brandon Peterson, DPT, Cert.

PT first in the primary care clinic. If the problem

MDT, who heads up the project, it has accom-

is simple, such as needing a cane or walker or a

plished all of these goals and more.

low back pain screening, it may be taken care of

WEB EXTRA

Read More

❱R ead what some VA providers and patients have to say about the program

30

MidwestMedicalEdition.com

Make Monday

BY ALEX STRAUSS

“

We are meeting the veteran’s needs comprehensively and providing better care while simultaneously saving time for the primary care doctor.

It is a win for everyone.

fun day!

”

then and there. If further evaluation is needed, the appropriate referral can be made immediately without waiting for a PT appointment.

“Say a veteran comes in with a laundry list of things they want to discuss with their primary care provider,” says Dr. Peterson. “The provider can address all of their needs and can refer that patient to me for

©2018 National Pork Board, Des Moines, IA USA. This message funded by America’s Pork Producers and the Pork Checkoff.

pork.org/cooking

the low back pain part of it. So we are meeting the veteran’s needs comprehensively and providing better care while simultaneously saving time for the primary care doctor. It is a win for everyone.”

In the first year of the program, the number of specialty consults from primary care dropped by more than 220. There were also more than 500 fewer X-rays ordered and 200 fewer MRIs, a situation that not only saves money but also improves access to imaging tests for those who need them.

Meanwhile, because primary care doctors no longer have to spend their time on musculoskeletal issues, the wait time for an outpatient primary care visit has improved by six-days. Thanks to numbers like these, the program is being implemented in the remaining 8 sites within the

Join Our Team • ConvenientCare Physican Assistant Supervisor • Dermatologist

regional VA service area.

“There is starting to be a national movement toward embedding PTs in

www.YanktonMedicalClinic.com/recruitment

primary care,” says Peterson. “Our VA is setting a model for other VAs as well as private sector hospitals.” ❖

September / October 2018

31

[ INTERVIEW ]

Jill Fuller, Retired President/CEO, Prairie Lakes Healthcare System MED: You are a couple of years shy of

MED: What advice would you give to

retirement age. How did you decide

someone who is just beginning his or

that now was the right time to leave?

her

administrative

journey

in

healthcare?

JF: I had originally planned to wait until 2020. But we were going to

JF: I think it is important to really

have five board members term out

learn the culture of your organiza-

and it seemed like now was a good

tion. That can be hard for people

time for our organization to make

because they tend to want to make

a transition. We just achieved this

changes right away. In our case, our

great milestone of building a new

culture is very unique and we have

specialty clinic. I had a defined

been successful because of it. You

period of growth. It is a good time

need to listen and learn, which is

for the next person to come in and

going to help you build your rela-

say what’s the next body of growth?

tionships. When you understand the context you don’t try to apply

MED: What is one accomplishment

cookie cutter solutions.

that you are particularly proud of?

MED: I understand you are moving to JF: The development of new ser-

your cabin in North Dakota. What is

vices lines. When I joined the

next for you?

organization as CNO in 2000, we

L

only had oncology. My predecessor

JF: I am not yet done with my

added cardiology in 2007 and we

working career. I want to go back

developed eight more since I

to my patient care roots. I still have

became CEO in 2009. We also

an RN license and I have enrolled

AST MONTH, KC DeBoer

moved to an employment model

in a refresher course in North

succeeded Jill Fuller as

for those specialty doctors. We

Dakota. I have a great big book

President and CEO of Prairie

truly filled a lot of important gaps.

that’s been sitting on my desk,

Lakes Healthcare System

intimidating me. Eventually, I

in Watertown following a nationwide

MED: Can you share some nugget of

might end up going back into

search. In a recent interview with MED,

wisdom you have learned during your

academics.

Fuller, who started her PLHS career 18

40 years in healthcare?

MED: What are you going to miss

year’s ago as Chief Nursing Officer, reflected on her eight years at the helm

JF: In healthcare, we ride waves.

and shared some words of wisdom for

We have ups and downs. You have

the successful leadership of a health-

to be able to survive those waves,

JF: The phenomenal people I

care organization.

even when it is challenging. You

work with and the community of

have to remember that this, too,

Watertown. I guess I am going to

will pass. The world doesn’t come

have to get a Facebook account!

most when you leave?

to an end, even with the pressures of reimbursement, etc. We all know, at the end of the day, we need to provide services.

32

MidwestMedicalEdition.com

WHAT YOU NEED TO KNOW BEFORE INVESTING IN REAL ESTATE

H

AVE YOU BEEN THINKING ABOUT invest-

Real estate Investing is

ing in real estate? Many people today work

a learning process, in

investing in rental

for money, but the smart ones let their money

which you learn by doing

property, consider

work for them. That is what investing in real

If you are a little timid in

who you are renting to.

estate does for you: You take the money you have

getting started, start small

Tenants can be your

today, invest it, and allow it to create a nest egg over

and gain the knowledge to

best friends or your

time. So, when the time comes that you no longer

grow in your investing.

worst enemies. Make

want to work, you have money to fall back on.

If you continue to invest wisely, you will have continual cash flow.

Now that you have the basics about investing, it’s time to find your investment. Here are some additional things to think about when looking for the right property:

3. If you are thinking of

sure to check potential tenants background, credit and rental history.

Consider investing in Real Estate Investment

Here are some essentials you should know before jumping into the real estate investment game:

more time or enough

Know your financial

rental property,

situation and know how

residential or commercial.

to see what is the best

to purchase real estate

Remember, real estate

type of investment for

Real Estate is a great avenue

Understand what you are

Investing is a business;

you. Narrow down the

to start investing your money.

able to consistently invest

you aren’t buying a

options by looking

There are varied ways to get

and never buy under your

personal home. Don’t let

at your plan and goals.

started. Find what best suits

name. Speak with a

your emotions drive your

Don’t wait for the

you by first meeting with a

financial advisor on what

decisions. You won’t be

perfect one, remember

financial advisor. Then create

your best options are and

living there. Always run

this is a business, not

a plan and set goals for what

how to create a business

the numbers to know if the

your personal home.

you want your money to do.

under which you buy.

property will make enough

Have a plan and a goal before you start investing.

income to hire property management, you might consider investing in

profit to cover all of your expenses.

Know how much time

Before you purchase an

you have to devote to

investment property,

your investment. There

build a network of people

are many types of property

to help. You don’t want

you can invest in, pick

to do it alone so, consider

one that aligns with your

property management,

commitment. If you have

maintenance, financial

less time, a laundromat

advisors, lawyers, real

or storage units might

estate agents, lenders, etc.,

be something you are

to help you along the way.

interested in. If you have

tools to help you with these. You could also hire a property management company to help

1. Look at lots of properties

you get started.

Start small and work your 2. Make sure you know

way up to something bigger

and invest in a good

and watch your money start

location & neighbor-

to work for you. ❖

hood. You can change the property but you can’t change its location.

Location will determine your rent levels, potential tenants, and yearly expenses. Do some research on the area in which you plan to invest. Study the home sales, crime rates and areas of interest in

Tracie Storo is with RE/Max Professionals in Sioux Falls.

the neighborhood.

WEB EXTRA

Read More

❱B uying a home? Here’s how to choose the best agent.

September / October 2018

❱B asic terms to know when investing in Real Estate.

33

[ T HE Q UE S T IO N ]

It’s Not Rocket Science.

Home loans are better when they’re online & local.

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event/92nd-annual-convention

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averacontinuingeducation@avera. org, 605-322-8950

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