Regional’s Flying Physician 20 Years After Corneal Transplant
Low-Cost Cyber Security Tips
VOL. 9 NO. 6
ON TOP OF
HIS GAME Sports Medicine Specialist Ryan Meis, MD
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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
EDITOR IN CHIEF Alex Strauss
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DIGITAL MEDIA DIRECTOR Alyssa McGinnis CONTRIBUTING WRITERS Lori Atkinson
• a “flying physician” from Rapid City,
• a Sioux Falls researcher who may be about to revolutionize breast cancer treatment
• 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.)
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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 ■
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.
[ T E C HN O L O G Y ]
Four Simple, Low-Cost Actions to Uplevel Your Office Security Today
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.
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
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
Download the 20 security measures (controls) recommended by the Center for Internet Security.
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Closing the Loop on Diagnostic Error BY LORI ATKINSON
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.
Access the references for this article online
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
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.
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.
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
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.
“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
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
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.”
“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
Mark with his daughter, Anna Kate
my eyes because they are literally a gift.” ❖
❱ L earn more about DMEK preloads
September / October 2018
❱ F ind out how to request tissue from DLSH
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.
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.
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.
â€˘ 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.
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.
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
• 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.
(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.
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
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.
❱ 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 •
• Happenings around the region
News & Notes
ON TOP OF HIS GAME
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
“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
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
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.
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
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!”
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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September / October 2018
[ RESE ARCH ]
Researcher KRISTI EGLAND on Survival, Inspiration, and the Test That Could Revolutionize Breast Cancer Treatment BY MED STAFF
to make a test that can monitor
Others have recurred. And I would
medical technology company
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.
“I was thinking, I want to be able
ented biomarker analysis platform
the accuracy of diagnosis.
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September / October 2018
“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
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.”
❱R ead about an alternative to blood thinners for Rapid City patients with non-valvular atrial fibrillation 24
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.”
Highly Trained Team of Specialists with Expertise in: Human Factors Engineering & Ergonomics Government Compliance and Regulation Industrial Hygiene Industrial Safety Occupational Therapy Psychology
The Heart and Vascular Institute is spreading the word about the clinic to ensure that appropriate candidates get referred. Potential candidates include those who have had frequent need for diuretic or medication adjustments, a history of
Workers’ Compensation. It’s what we do. It’s who we are.
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
Eating with Supports a Healthy
over the phone. In the long run, it will save
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
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.
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
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.
“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,
Boyce Law Firm has decades of experience in providing counsel to hospitals, health systems, health care providers, in-house counsel, and health care insurers across South Dakota. Over the years, our attorneys have been involved with shaping the health care law landscape in South Dakota. This wealth of experience helps us to provide effective and efficient legal counsel to help clients with whatever health care related issues that arise. • Malpractice Defense
family medicine doctor Nadia Tymkowych, MD, is
• Licensing, Credentialing, and Employment
pursuing her pilot’s license. ❖
• HIPAA/Privacy and Security • Fraud and Abuse/Stark • Corporate Compliance
• Roger A. Sudbeck • Lisa K. Marso • Matthew D. Murphy • Tommy L. Johnson
(605) 336-2424 • www.boycelaw.com 300 S. Main Ave, Sioux Falls, SD 57104
At Oshkosh with fiance Nadia Tymkowych, MD
September / October 2018
Hearing Loss and Dementia, the Silent Connection BY MANDY ROUNSEVILLE-NORGAARD
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
that it could use for other important
lem-solving, and other mental tasks.
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
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
❱G et tips to recognize the subtle signs of hearing loss
© 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. Insurance & Risk Solutions | MMICGroup.com
36th Annual North Central Heart
Cardiac S Y M P O S I U M Friday, Nov. 2, 2018 Sioux Falls Convention Center 1201 N. West Ave. • Sioux Falls, S.D. 8 a.m. - 5 p.m.
Learn the latest trends in the diagnosis, technology and treatment of cardiac disease during this daylong symposium.
Register at Avera.org/cardiology-symposium
4520 W. 69th St. • Sioux Falls, S.D. 57108 • AveraHeartHospital.org
September / October 2018
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.
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,”
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,
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
❱R ead what some VA providers and patients have to say about the program
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.
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.
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
primary care,” says Peterson. “Our VA is setting a model for other VAs as well as private sector hospitals.” ❖
September / October 2018
[ 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?
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
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
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
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.
WHAT YOU NEED TO KNOW BEFORE INVESTING IN REAL ESTATE
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
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
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
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
commitment. If you have
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.
❱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.
Upcoming Events September 12–14
11:00 am, Wednesday – 11:30 am, Friday
6:00 pm, Thur – 5:00 pm, Friday
8:00 am – 5:00 pm
Avera Cancer Institute Oncology Symposium
36th Annual North Central Heart Cardiac Symposium
SD Medical Group Management Association Fall Conference
Location: Prairie Center, Avera
Location: Arrowwood Resort
Sioux Falls Convention Center
by Cedar Shore, Oacoma Information: email@example.com, 605-336-1965
Information & Registration:
Information & Registration: averacon-
averacontinuingeducation@avera. org, 605-322-8950
7:00 am – 5:00 pm
11:00 am – 2:00 pm
8:00 am – 4:00 pm
7th Annual Sanford Imagenetics Genomic Medicine Symposium
Grand Opening Event for The Helmsley Center
Avera Palliative Care and Ethics Symposium
ACI Helmsley Center, Pierre, SD
Sioux Falls Best Western Ramkota
Sanford Center–Dakota Room Information:
firstname.lastname@example.org, 605-404-4212 Registration: Sanfordhealth.csod.com
Information & Registration:
averacontinuingeducation@avera. org, 605-322-8950
7:30 am – 5:00 pm
20th Annual Cardiovascular Disease and Wellness Symposium
10:00 am, Wednesday –11:00 am, Friday
Location: Rushmore Plaza
92nd Annual SDAHO Convention
Civic Center, Rapid City Information:
9:00 am – 4:00 pm
6th Annual Avera and Hazelden Betty Ford Foundation Symposium Location:
Holiday Inn Downtown, Sioux Falls Information & Registration:
Sioux Falls Co0nvention Center
UnityPoint Health–St. Luke’s 34th Annual Cardiology Conference
averacontinuingeducation@avera. org, 605-322-8950
Location: Delta Hotel,
South Sioux City Riverfront Information: 712-279-3500
sanfordImagenetics.org sanfordImagenetics.org sanfordImagenetics.org
Unlocking the blueprint Unl of you. the You are unique. No one else is quite like you. And it’s your DNA that created the blueprint for who you are. Now with a unique genetic screen, Sanford Health doctors have the power to take that blueprint to build a care plan for patients.
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