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Contents Midwest Medical Edition

March 2012

Regular Features


2 |

From Us to You

5 |

Meet a MED Advisor – Dan Heinemann, MD

6 |

The Nurses’ Station

28 |

By Darrel Fickbohm

30 |

News & Notes: News from around the region

33 |

Learning Opportunities: Upcoming Symposiums, conferences, CME Courses

10 Cover Feature

Off Hours: “Walking the World”

In This Issue 4 | An App a Day Can Help You Get Paid By Dave Hewett

5 |

Sanford Recognized for Heart Attack Care

8 |

SF Pediatrician Joins National Conversation

9 |

Identifying Birth Defects at SDSU


13 | Positioning Your Organization for Social Media Success By Jane Schuster

15 |

Clinical Spotlight: Radial Approach to Heart Cath in Sioux City

16 |

Regional Trauma Center Receives ACS Verification

17 |

South Dakota Hospital Achieves ‘Meaningful Use’ Milestone

17 |

Local Breast Surgeons Investigate IOeRT

18 | American Cancer Society’s “Cancer Connect” By Charlotte Hofer

20 |

Who Needs Practice Management?

26 |

Controlling Your Financial Destiny By Alice Rokahr, JD

In Review The Scapel and the Soul By Allan Hamilton, MD



Sponsored Feature Note: A MED “Sponsored Feature” is a commissioned and sponsored promotional article. About the cover: The distinctive heart-shaped sculpture in the lobby of the heart hospital entitled “Heart of Humanity” was created for the building by Aberdeen sculptor Benjamin Victor. The multi-dimensional work is meant to symbolize four elements: land, science, education and family.

of the


Rates of heart disease in eastern South Dakota are even higher than they are nationally, where it remains the leading cause of death for men and women. Now, Sioux Falls gets its second Heart Hospital with the opening of Sanford’s advanced new campus home for cardiac services.

From Us to You

Staying in Touch with MED

A letter from the VP and Editor


e have all heard the statistic that heart disease is the number one killer in America. But in putting together this month’s cover feature, we were surprised to learn that the rates of heart-related illnesses in eastern South Dakota are even higher than they are elsewhere in the country. This sobering fact makes this month’s opening of the region’s newest heart hospital even more significant for healthcare in our area. We are excited to offer you a first glimpse inside. Also in this issue…. We bring you clinical news including a new approach to cardiac catheterization in Sioux City, community news including new physicians and facility ownership changes, and practice news including insight into the use of social media and a profile of an innovative regional practice management firm. As always, MED continues to be brought to you free of charge thanks to the support of quality advertisers who value the work that you do. As we plan for upcoming issues, we want to encourage you to share your news, stories and opinions with your colleagues in the region through MED. We welcome your reminiscences for our Then & Now column, book and movie reviews for In Review, tales of your weekend exploits for Off Hours, and, of course, your current events for News & Notes. Are we missing something? MED welcomes your feedback and suggestions, as well as your contributions. You can reach us any time at or —Alex & Steff .

MED Magazine, LLC Sioux Falls, South Dakota


VP Sales & Marketing Editor in Chief Design/Art Direction Cover Photo & Design Photographer Web Design Contributing Editor

Steffanie Liston-Holtrop Alex Strauss Corbo Design Darrel Fickbohm Kristi Shanks 5j Design Darrel Fickbohm

Contributing Writers Dan Eness Dave Hewett Charlotte Hofer Gary Pechota Alice Rokahr Jane Schuster

Steffanie Liston-Holtrop

Staff Writers

Liz Boyd Caroline Chenault John Knies

Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479

Alex Strauss

Alex Strauss, Editor in Chief 605-759-3295 Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website

2012 Advertising / Editorial Deadlines Jan/Feb Issue December 5

June Issue May 5

November Issue October 5

March Issue February 5

July/August Issue June 5

December Issue November 5

April/May Issue March 5

Sep/Oct Issue August 5

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

e Woruits! t

t cce p We a der a re sion is s ubm

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.


Midwest Medical Edition

An App a Day

Can Help You Get Paid


e’re three months into the New Year, how are your patient’s doing on their resolution to exercise more and eat healthier? If you’re finding that they’re having trouble monitoring their progress, it comes as no surprise there’s an app for that! The American Medical Association is one of many organizations to release an app to help patients improve their overall health. The Weigh What Matters app is free, easy to use and encourages users to consult with their physician to establish personal health goals for three categories: weight, eating and activity. This is one of a variety of free apps that your patients can download to track their progress. “If you’re thinking, yeah, that’s great, but what does an app have to do with my already busy practice?” What it may have to do with it in the future is your compensation. We’ve talked about it several times in this column and as Congress continues to grapple with a physician payment fix, one trend in health care remains constant….rewarding quality over quantity. This means that physician reimbursement will increasingly be tied to how healthy you can keep your patients, not how often you treat them. A health coach is a person (they can be a licensed practitioner or not) who helps individuals develop and sustain behaviors that will cultivate and encourage optimal health for those individuals. Wellness coaches also instruct people with chronic illnesses or conditions on how to make lifestyle changes to minimize the severity of the illness and the effects of the chronic disease. As


physicians, you may now be tasked to be a health and wellness coach, as well as the healer. That makes you tired just thinking about it, doesn’t it? Doctors are trained to diagnose and treat. Most physicians aren’t trained to help people change their behavior, particularly primary care providers, as they are already over-loaded with the number of patients they must see in a day and all the documentation that follows those patients. There have been numerous examples in the literature of health coaching programs achieving positive outcomes in programs for diabetes management and smoking cessation. Some large employers in South Dakota have hired health coaches for their workforce to manage medical expenses and cut down on lost time. However, despite the positive effects that many studies have shown, the practice of health coaching hasn’t hit the mainstream because it’s not covered by health insurance. One reason for that is the field of health and wellness coaching is fragmented in terms of certification and education. When you see M.D. or D.O. you always know what you’re going to get in terms of education. When you see health and wellness coach, the level of training is suspect. So what does that mean for the future of health care? I wish I knew! One thing is certain that the current system is not sustainable, from providing the care we demand, to paying for it! As an overhaul of the pay-perservice reimbursement model is slowly taking hold – health and wellness will figure prominently in the “team approach” to medicine. That team approach must be lead by our physicians! ■

Photos Courtesy AMA

By Dave Hewett , President/CEO, SDAHO

Midwest Medical Edition

Sanford Recognized for

A talk with MED Advisor

Heart Attack Care Sanford USD Medical Center recently qualified for the American Heart Association’s Mission: Lifeline Silver Performance Achievement Award. Hospitals involved in Mission: Lifeline strive to improve care in both acute treatment measures and discharge measures for STEMI (ST Elevation Myocardial Infarction) patients. Although almost  250,000 people experience the STEMI type of heart attack annually, many do not receive prompt reperfusion therapy, which is critical in restoring blood flow.  Mission: Lifeline seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate

Dan Heinemann, MD

treatments. Before they are discharged, appropriate patients are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers in the hospital and receive smoking cessation counseling. Hospitals that receive the Mission: Lifeline Silver Performance Achievement Award have demonstrated for 12 consecutive months that at least 85 percent of eligible STEMI patients (without contraindications) are treated within specific time frames upon entering the hospital and discharged following the AHA’s recommended treatment guidelines. ■

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Family Practice Physician

Q: Congratulations on your appointment as Vice Chair to the American Academy of Family Physicians’ AMA delegation. What has it been like to be involved with this organization at such a pivotal time for American medicine? Well, it has certainly been interesting, of late. A few years ago I got to hear President Obama address the AMA House of Delegates in Chicago, which was exciting. Being involved has really opened my eyes to the opportunity we have here to make positive change. If physicians did not get involved in the redesign of our healthcare system and take an active role to make the changes that are needed, it won’t happen Q: You practiced Family Medicine in Canton for 20 years. What made you decide to take the leap into Administration? Serving on the AAFP Board of Directors from 2001 to 2004 gave me a chance to see what organized medicine can really do to improve the quality of medicine for patients in the U.S. This is the point at which I left practice and came to work for Sanford. I wanted to help more physicians have an impact on their patients. Q: What is the biggest challenge to reforming our healthcare system? The current Attorney General talks about physicians juggling balls. Some are rubber and can be dropped sometimes, and others are crystal and can’t be dropped. Patient care is the crystal ball. The challenge is to keep that ball in the air while we redesign the healthcare system. It is like building an airplane while in flight. Q: What message do you have regarding the ongoing healthcare debate? Doctors need to weigh in with their legislators and let their voices be heard. If we don’t want people without healthcare experience to do it, then we have to.


March 2012


The Nurses’ Station Nursing News from Around the Region

St. Luke’s College Leads Iowa with Outstanding Marks St. Luke’s College in Sioux City has announced the 2011 results of the National Licensure Examination (NCLEXRN). Among Iowa’s 30 pre-licensure nursing programs, St. Luke’s College ranks at the top with 97.78% of first time test takers passing their licensure examination. St. Luke’s College has exceeded both state and national passage rates. The success rate nationally is 87.90% with the state of Iowa at 86.28%. NCLEX-RN tests nursing graduates on proficiencies needed to perform safely and effectively as a newly licensed registered nurse. Passing the national examination indicates graduates have demonstrated competencies to launch a nursing career. All pre-licensure nursing graduates must successfully pass the NCLEX-RN examination to begin practice as a registered nurse. “Our continued success rates on the NCLEX-RN examination is an accomplishment we are very proud of at St. Luke’s College,” says Jodi Kolar, Nursing Education Department Chairperson. “We attribute much of our success to our partnership with St. Luke’s Regional Medical Center. Students receive quality clinical experiences beginning very early in their education at St. Luke’s College.” “Our nursing program has ranked in the top five for the past five years and remaining at number one for the second year in row,” says Michael Stiles, College Chancellor. “We work hard to ensure our students receive the best education their money can buy.” ■


Sanford Nurse Wins “Nurse in Washington” Scholarship Sanford Research Clinical Research Manager Lora Black has been awarded one of just two Nurse in Washington Internship (NIWI) scholarships through the Oncology Nursing Society. Each year, over 100 nurses participate in the NIWI program on Capitol Hill in February, sponsored by Nurse Organizations Alliance. NIWI enables nurses to learn how to influence health care through the legislative and regulatory processes. Participants learn from health policy experts and government officials, network with other nurses, and visit members of Congress. As an oncology nurse, Black has practiced as an inpatient chemotherapy nurse, oncology clinical care coordinator, and outpatient oncology research coordinator. She is a member of the Oncology Nursing Society (ONS), both at the national and local level. During Black’s membership with the Sioux Falls Area Chapter of ONS, she has served as both the President and President-Elect, and currently serves as Membership Chair. ■

Confused about professional boundaries in the use of social media? Where is the line between professional collaboration and revealing private patient information? What is safe to post on the Internet and what is not? The National Council of State Boards of Nursing (NCSBN) has created new resources that can help. On the NCSBN website at www. you can:

✔ Download the brochure The Nurse’s Guide to the Use of Social Media

✔ Watch the video Social Media Guidelines for Nurses ✔ Read the NCSBN official White Paper on social media ✔ Download A Nurse’s Guide to Professional Boundaries

✔ Enroll in a Respecting Professional Boundaries online course for CE credit

MED Quotes

Faith and knowledge lean largely upon each other in the practice of medicine.

~Peter Mere Latham
 Midwest Medical Edition

Intensive Care for Newborns

In whose hands will you place her?

Physicians’ Priority Line


When a newborn is critically ill, a single call gives you instant access to our neonatal intensive care specialists and a full range of pediatric and surgical subspecialists, all supported by state-of-the-art technology and equipment. It can also link you to our neonatal transport service team, who will arrange for transport to Children’s Hospital & Medical Center based on the child’s needs. Twenty-four hours a day, seven days a week, one call links you to physician-to-physician consults, referrals and admissions. There’s no problem too large, no child too small.

Med Mag Ad, Feb. 2012.indd 1

2/2/12 9:08 AM

Sioux Falls Pediatrician joins National Conversation Aaron Zylstra, MD, offers insight and advice to parents on raising healthy children Pediatrician Aaron Zylstra, MD, is joining a national conversation about raising healthy children. Parents looking for advice, information and other tools on healthy habits and more will be able to pose their questions to the Sioux Falls doctor on Sanford/WebMD’s “Raising fit Kids” website. Dr. Zylstra will respond on the public message board. “We found one of parents’ greatest challenges in talking to their kids about weight and healthy habits is simply not having the right information,” says Dr. Zylstra, Sanford Health pediatrician. “This website offers parents and families the tools they need to become healthy role models for their children.” A recent Raising fit Kids survey found

parents have trouble talking to their kids about weight. In fact, most parents find it more difficult than other touchy subjects like drugs, alcohol or sex. Dr. Zylstra is taking the reins from Sanford Health Fargo pediatrician Christopher Tiongson, MD, who began communicating with parents through the “Raising fit Kids” site last year. Since then, more than 500,000 parents have joined in. Raising fit Kids is designed to educate, empower and motivate families to live a healthy lifestyle through a comprehensive suite of online resources. It is the only initiative focusing equally on the four key contributing factors to a child’s weight: nutrition, activity, emotion and sleep. ■

Sanford Heart Hospital. Brightening the future of heart care.

“ We’re here to serve for decades and decades to come. We’re going to bring the finest heart care to Sioux Falls and to the region.” Charles O’Brien, MD

President, Sanford USD Medical Center

To hear our stories, visit 100-11395-3013 2/12


Midwest Medical Edition


Appointed to AAFP

Delegation Dan Heinemann, MD, with Sanford Health has been appointed to serve as Vice Chair to the American Academy of Family Physicians’ delegation to the American Medical Association for a twoyear term that began January 1, 2012. As a member of the AMA House of Delegates, Dr. Heinemann will serve as an important communication, policy, and membership link between the AMA and grassroots physicians. He will be a key source of information on activities, programs, and policies of the AMA. Dr. Heinemann has practiced for 20 years in Canton and has proudly served at Chief Medical Officer for Health Services as Sanford Health for the past seven years. Founded in 1947, the AAFP represents 100,300 physicians and medical students nationwide. It is the only medical society devoted solely to primary care and was the first national medical specialty organization to set continuing education requirements for its members. To maintain membership in the American Academy of Family Physicians, Dr. Heinemann is required to complete a minimum of 150 hours of accredited continuing medical education every three years. ■

MED Quotes

A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment.

~Author Unknown

March 2012

Dr. Eugene Hoyme


Birth Defects

Hoyme, SDSU researchers working to develop assessment tool Researchers with the National Children’s Study at South Dakota State University, in collaboration with Sioux Falls pediatric researcher Dr. H. Eugene Hoyme, are working to develop a standardized assessment tool that would be used to identify birth defects in infants. An evaluation model of this type would have a significant impact on the study of human genetics and birth defects. One of the main goals of the NCS is to better understand the interaction of family history and the environment during pregnancy. Much of the data collected by the NCS will require long-term follow-up before results are available. However, data about birth defects, particularly those affecting the morphology, or anatomy of the unborn baby, provide an opportunity for more immediate results. Current methods of assessing birth defects require expertise in human morphology as well as embryology. NCS hopes this project will result in a standardized tool that will eventually be available for more general use by both clinicians and research staff. Dr. Hoyme is Chief Academic Officer at Sanford Health and president and senior scientist for Sanford Research/University of South Dakota. He has led extensive research initiatives in fetal alcohol spectrum disorders and pediatric genetic and malformation syndromes. The NCS, the largest long-term study of children’s health ever conducted in the U.S., will include 100,000 children from before birth to age 21. Other entities working on the project include the Universities of Utah, California Irvine, California San Diego and the Mississippi Medical Center. ■


“Heart disease is underdiagnosed and

undertreated . . . especially in its early stages. —Dr. Tom Stys




Heart of the Hospital One of the first things to note about the new Sanford Heart Hospital, says Sanford USD Medical Center President Charles O’Brien, MD, is that, in many ways, it is not new at all.


“We have been offering specialty heart care

on this spot since 1978,” says Dr. O’Brien. “So this new building really represents an extension and an evolution of a well-established heart progr am.”


ccording to statistics, the building, which opens this month, comes none too soon. Heart disease kills 1 in 3 people nationwide, but the number of heart-related illnesses in eastern South Dakota is double the national rate. Considering the region’s aging population and the ubiquitous struggle with obesity, hospital officials expect to have no trouble filling the facility’s 56 acuity-adaptable private rooms and accommodating a growing number of cardiac outpatients. “We expect to be dealing with this disease for a very long


time,” says O’Brien. “We had simply outgrown the heart center in the current hospital. Also, we now treat more cardiac patients as outpatients, which changes the type of facility you need.” Sanford’s answer was to move heart and cardiovascular services, including 750 doctors, nurses and support specialists, out of the Sanford USD Medical Center building, into the 205,000 square foot attached Heart Hospital. With its own separate entrances and reception area, but with five floors maintaining a connection to the main hospital, the Heart Hospital manages to strike a middle ground between

being a free-standing heart center, and an extension of Sanford USD Medical Center. “Heart patients often have many other medical needs. We wanted to make sure they could still have easy access to all of the other services and specialists they might need,” says Dr. O’Brien.

Healing Environment Following a nationwide trend, as well as focus group feedback, the Heart Hospital incorporates what Sanford calls a ‘Healing Environment’. That environment is created throughout the building

d 11

Constructed with 1,562 tons of structur al

steel, the heart hospital is 122 feet tall from ground to tower

with recessed lighting, calming music, a professional massage area, aromatherapy and more than 130 pieces of original artwork, including the distinctive bronze heart in the lobby. Even the bed pillows are wired for sound, allowing patients to listen to music while they recover. “The new trend is to make the whole experience more pleasant and less intimidating,” says cardiologist Tom Stys, MD., who is also enthusiastic about the hospital’s Center for Health & Wellbeing, which is devoted to prevention and education.

State-of-the-Art Technology In an ongoing effort to stay on the leading edge of one of the fastest-changing areas of medicine – cardiovascular technology – the Heart Hospital features 2 modern cardiovascular OR’s with wall and ceiling-mounted

equipment for ease of movement, 9 catheterization labs to ensure timely procedures, and an advanced hybrid operating room wherein a surgeon and interventional cardiologist can work side-by-side in procedures such as percutaneous valve replacement. Dr. Stys hopes robotic angioplasty will be on the horizon. On the diagnostic side, in addition to echocardiography and stress testing, the hospital offers nuclear medicine tests utilizing 5 Gamma cameras, designed to lessen radiation exposure to patients and physicians. Although the services are not as new as the building, Dr. Stys says the new facility will ensure they’ll have a greater impact than ever. “Whenever you have people who are devoted to delivering a specialized type of care all the time, they are going to be more experienced and the level of care improves,” he says. The new building will also be the focus

More than 750 cardiac physicians, surgeons, nurses and support staff are housed in the new hospital.

Each of the hospital’s 56 private patient rooms are acuity adaptable, meaning they are equipped to be quickly converted from standard rooms to cardiac ICU rooms, reducing the need to move patients.

for the new USDSM Cardiovascular Fellowship program which starts this summer. “We are not looking for a burst of activity,” says Dr. O’Brien. “Our goal is to be ready as the area grows to provide the education, prevention and advanced tertiary care that we know will be needed.” ■


d 12

Midwest Medical Edition

Postioning Your Organization for

Social Media Success By Jane Schuster, Marketing Specialist at CQuence Health Group


esearch shows that social media will play a greater role in strategies to improve outcomes since consumers increasingly are going online for health-care purposes. More than 1,200 hospitals participate in nearly 4,200 social networking sites, including Facebook, Twitter, YouTube, LinkedIn and blogs, according to health-care social media expert Ed Bennett. Lack of resources to devote to social media monitoring and concern over patient information privacy and security are two barriers that keep healthcare organizations from embracing or expanding a social media presence. Here are some tips to set up your organization for social media success: ♦ Incorporate social media into your organization’s strategic planning. Set clear goals on how your organization wants to use social media to advance its mission. Find out which channels your customers and competition are using. Think about how social media integrates into existing policies and procedures. Careful planning of your strategy will allow you to better leverage the power of social media.

sites. Work with your legal advisors to update the policy at least annually since social media evolves rapidly.

♦ Provide policy education for employees. During one of Cassling’s Investing in You seminars, attorneys from Baird Holm LLP in Omaha, Neb., spoke about how several organizations aren’t aware of the rules regarding employees’ use and misuse of social media. Advise employees to conduct themselves in online communities as they would in public hallways and elevators, and avoid discussing a patient’s name or condition.

March 2012

Following these steps will help your organization build a solid foundation for social media success. Be sure to check out websites such as and for other useful tips. ■

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♦ Create a robust social media policy, and update it annually. A good policy outlines how the organization will use social media to accomplish its goals and provide parameters for how employees should act on social media

Nearly one-third of consumers polled and half of those under the age of 35 have used some form of social media (Facebook, YouTube, blogs) for health-care purposes, according to PwC Health Research Institute’s report on top health industry issues of 2012.

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Avera Heart Care is nationally recognized by HealthGrades®. Here’s where we ranked for 2012: Rated #1 in South Dakota in Cardiac Intervention in 2012 (Avera St. Luke’s Hospital) One of HealthGrades America’s 100 Best Hospitals for Cardiac Care™ in 2012 (Avera Heart Hospital) Ranked Among the Top 5% in the Nation for Cardiac Surgery in 2012 (Avera Heart Hospital) Ranked Among the Top 10% in the Nation for Overall Cardiac Services for 9 years in a Row (2004-2012) (Avera Heart Hospital) These awards are only given to hospitals that excel in clinical quality and performance. Avera matches advanced technology with advanced care — giving you the best outcome for your heart. When you want the best in cardiac care, you want Avera Heart Care.

HealthGrades is the nation’s most trusted, independent source of physician information and hospital quality ratings.

Clinical Spotlight

Sioux City Surgeon

to Heart Catheterization

Takes a Radial Approach

By Dan Eness

Dr. Edward Zajac, Director of Cardiac Catheterization and Interventional Cardiology at St. Luke’s Hospital in Sioux City


t St. Luke’s Hospital in Sioux City, a new procedure has taken hold that is quietly changing the way surgeons approach the hearts of cardiac patients. Traditionally in the U.S., cardiologists access the heart for catheterization through the femoral artery. While highly successful, the traditional approach has drawbacks: it leaves the patient relatively immobile for several hours following the surgery and includes a small but measurable risk for complications. But Dr. Edward Zajac, the director of cardiac catheterization and interventional cardiology at St. Luke’s, has been using an innovative new approach for the past year. Although it requires specialized equipment and training for the surgeon, Dr. Zajac says radial access achieves the same diagnostic results as the traditional femoral access

March 2012

cardiac catheterizations, while allowing for a very different patient experience. The surgical process involves the patient’s hand being placed in special arm board. Using local anesthesia, access is achieved with a tiny micropuncture needle. Under fluoroscopic guidance, the catheter wire is advanced into the heart. Except for the approach, the procedure itself is otherwise similar to a traditional catheterization through the groin. Recovery, however, is where the benefits of this innovation become clear. “Typically with a diagnostic procedure performed from the femoral route, patients are in bed at least three to four, maybe five hours. They have some immobility and cannot move around,” says Dr. Zajac. “With the radial artery technique, patients are able to get up out of bed, off the procedure table. They are able to go back to their room and sit up in a chair. They can use their other hand to eat with. If they need to go to the washroom, they can.” Duke Clinical Research Institute’s groundbreaking RIVAL (Radial Versus Femoral access) trials determined that radial access results in significantly reduced pain and recovery time and does not require higher amounts of contrast dye, compared to femoral access. Dr. Zajac also notes a reduction in bleeding related complications using the new method. Utilizing a femoral approach, even the most skilled doctors, executing proper technique still experience

a bleeding complication of anywhere from 5 to 10 percent, a rate that has not changed for decades. In contrast, Dr. Zajac says the bleeding complication rate with the radial approach is “pretty close to zero”. Although the technique has been recognized as a possibility for about a decade, only has the recent availability of specialized equipment made it possible. Zajac estimates that within the next 2 to 3 years, a majority of access procedures will be done using the new method. ■ This article recently appeared in Innovations, a publication of the Iowa Health System.

Following the radial access procedure, the patient is fitted with a plastic cuff.


Brook Eide, M.D. and Jason Brown, R.N.


Trauma Center

Receives ACS Verification Rapid City Regional Hospital (RCRH) has received verification as a Level II Trauma Center by the American College of Surgeons (ACS), the highest level trauma center verification obtained by a hospital in most rural states. Level II Trauma Centers provide comprehensive, 24-hour, seven-days-a-week trauma care with a trauma team that includes a trauma surgeon, Emergency Department staff, respiratory therapy, radiology services, CT scanning, operating room staff, lab and blood bank resources, and a neurosurgeon and orthopedic surgeon as needed. Trauma verification by the ACS is a voluntary process and must be requested by individual health care facilities.

“We chose to apply for this verification at RCRH and it was a rigorous process,” says Shaye Krcil, R.N., RCRH Director of Trauma Services. “Our trauma committee worked on enhancing hospital policies and procedures related to trauma and reviewed trauma team staffing in preparation for the ACS on-site visit. The commitment of the Medical Staff, especially the surgeons, was integral to our achieving this recognition.” “The American College of Surgeons survey process is the gold standard of trauma center verification and this designation demonstrates our commitment and ability to meet high standards of quality patient care,” said Tim Sughrue, CEO of RCRH. “Obtaining Level II Verification is another step toward achieving overall excellence.” The state of South Dakota has been in the process of developing, implementing, and administering a trauma care system, including a statewide trauma registry that involves all hospitals in the state. In the Black Hills, Spearfish Regional Hospital is designated as a Community Trauma Hospital. Custer, LeadDeadwood, and Sturgis Regional Hospitals are designated as Trauma Receiving Hospitals. ■

MED Quotes

Our profession is the only one which works unceasingly to annihilate itself. ~Martin H. Fischer

Midwest Medical Edition

South Dakota Critical Access Hospital Achieves

‘Meaningful Use’ Milestone Faulkton Area Medical Center (FAMC) a 12-bed critical access hospital in Faulkton, S.D., has met Stage 1 Meaningful Use criteria using a certified electronic health record (EHR). By successfully attesting for Stage 1 Meaningful Use with the Centers for Medicare & Medicaid Services (CMS), Faulkton can receive payments from an EHR incentive payment program recently initiated in South Dakota. The incentive payments would help FAMC partially recover costs already incurred to meet federally mandated program guidelines. FAMC is one of the first facilities in South Dakota to achieve this milestone. Since implementing their EHR more than 3 1/2 years ago, FAMC has experienced significant adoption among the hospital’s staff. The Stage 1 Meaningful Use attestation demonstrates the facility’s ability to satisfy federal standards as they demonstrate adoption of a certified electronic health record. “We will continue to progress through this sometimes confusing and frustrating process,” says Tom Hericks, Director of Nursing at Faulkton Area Medical Center. The facility has worked closely with HealthPOINT, South Dakota’s federally designed Regional Extension Center based on the Dakota State University campus in Madison, which was set up to help rural facilities like Faulkton. “We are very proud of our accomplishments here at FAMC and continue to work hard to meet and exceed the challenges placed on us,” says Hericks. “Without a team effort by all, Meaningful Use Attestation would not have been possible.” “Faulkton’s team has achieved what many others are still working towards and their dedication is remarkable,” says Kevin Atkins, Engagement Manager for HealthPOINT. “As one of the first critical access hospitals in the state to achieve attestation, this is a milestone for their facility as well as their patients, who will all benefit.” ■

March 2012

Dr. Julie Reiland and Dr. Wade Dosch perform an IOeRT procedure.

Local Breast Surgeons

Investigating IOeRT The breast surgeons of Avera Medical Group Comprehensive Breast Care in Sioux Falls, a practice dedicated exclusively to breast care, are involved in trials of groundbreaking technology for the treatment of breast cancer. Julie Reiland, MD, is principal investigator and Wade Dosch, MD, is subinvestigator in the use of IntraOperative Electron Radiation Therapy (IOeRT) for the treatment of early stage breast cancer. In addition, Dr. Reiland provides oncoplasty, in which the surgeon not only removes the cancerous lump, but also uses plastic surgery techniques to restore or even improve the appearance of the breast. “Virtually all breast cancer patients undergo some type of surgical procedure, ranging from removal of only the affected area of the breast and a sample of lymph nodes, to bilateral mastectomy,” said Dr. Dosch. “Breast cancer treatment is very dynamic. There are excellent advancements coming out all the time,” Dr. Reiland said. “We hope to change the impact of breast cancer from a devastating, fearful diagnosis, to that of a very treatable condition.” Dr. Reiland holds a medical degree from the University of South Dakota Sanford School of Medicine at Vermillion, and completed residencies at the Sanford School of Medicine and Creighton University Medical Center of Omaha. She is certified by the American Board of Surgery. Dr. Dosch serves as Avera’s cancer

liaison physician to the American College of Surgeons’ Commission on Cancer, and also serves liaison physician to the CoC for the state of South Dakota. Dr. Dosch also graduated from USDSM and completed residency at Michigan State University at Lansing. He is certified by the American Board of Surgery. Avera Medical Group Comprehensive Breast Care works closely with the Avera Breast Center, which covers all aspects of breast care including prevention, early detection and diagnosis of breast cancer, as well as all treatment modes, follow-up and survivorship care. The program also includes patient navigation services and a weekly multidisciplinary case conference. “Dr. Reiland and I share a commitment to work with Avera’s multidisciplinary breast team to ensure that each patient gets the best and highest quality of care, at the same level as any cancer center in the country,” says Dr. Dosch, who also practices general surgery with Avera Medical Group McGreevy 7th Avenue. “Breast cancer is not a ‘one-size-fits-all’ disease. It requires a comprehensive, multidisciplinary approach, and this is Avera’s approach through the Avera Breast Center,” adds Dr. Reiland. ■


Photo by Kristi Shanks

Pictured, left-right: Kelly Smith, KDLT TV; Dr. Gayle Reardon, Restorative Aesthetic Dentistry; Annie Johnson, cancer survivor; Charlotte Hofer, American Cancer Society; Chair Dr. Kathleen Schneekloth, Avera Radiation Oncology; and Dr. Delf SchmidtGrimminger, Avera Research Institute.

American Cancer Society

By Charlotte Hofer


“Cancer Connect” Raising Community Cancer Awareness

group of medical professionals and community members in South Dakota has come together to form ACS “Cancer Connect,” a volunteer publicity workgroup dedicated to raising cancer awareness. Headed by the American Cancer Society, Cancer Connect is comprised of doctors from Sanford and Avera, a dentist, cancer survivors, and other community members. Most have personal as well as professional reasons to dedicate their time to the cause. “I grew up on a small dairy farm and was involved, with the help of my parents, in 4H,” says group member and Sanford Health physician Dr. Lee, who recently lost his mother after an 8-year battle with cancer. “The motto of this 4H group is to ‘make the best better.’ I really feel my mother did receive the best care currently available. Obviously this was not enough, and as her life shows, we have the responsibility to make the therapy better.” Cancer Connect chair Dr. Kathleen L. Schneekloth, a radiation oncologist at Avera Cancer Institute, lost her own mother when she was only nineteen. “Cancer continues to touch my life every


day through my patients,” says Dr. Schneekloth who has been a member of the ACS’s South Dakota State Leadership Council for many years. “As physicians, we treat the whole person and are trained to care for the patient and treat his or her cancer, regardless of the name on the facility or insurance card. Cancer and cancer awareness are indiscriminate.” Dr. Schneekloth says awareness is her primary goal for the group. “I hope to accomplish an increased awareness of cancer in our community, not only in how to treat it, but also ways to detect it early, and possibly prevent it altogether by adapting healthy behaviors and routines.” “I think the public has to know several things about cancer care,” agrees Dr. Lee. “It cannot get better unless people are not satisfied with the current therapies. Bringing novel therapies into current standards means funding basic research, clinical trials, and having this desire to seek change.” Nationally, there are many groups dedicated to community cancer education, but ACS Cancer Connect is unique in its South Dakota focus. According to recent data from the American Cancer Society, South Dakota will lose 1,600 people to cancer this year,

an average of 4 deaths per day. By promoting greater community involvement, Cancer Connect aims to create stronger dialogue between patients and medical professionals. “I believe an increased awareness of cancer leads to an increase in questions,” says Dr. Schneekloth. “This may lead to an increase in screening, early detection, and more curable presenting stages. An increase in awareness of the technology and the expertise we have right here in our own Sioux Falls region would help assure people in our community that they can stay close to home and still get the highest quality cancer care available.” “I have been many places in the U.S. and world, and I feel the people of South Dakota have the most pioneering spirit of any place I have been,” adds Dr. Lee who encourages other doctors to get involved in a group like ACS Cancer Connect. “By working together, we can lead the nation in defining the best therapies by combining this innovative spirit with the hard work of new trials and research.” ■ For more information on ACS Cancer Connect, contact Charlotte Hofer at

Midwest Medical Edition

You Take Care of your patients, we’ll take care of the rest. We pride ourselves in our ability to proficiently handle the needs of physician practices large and small. We understand the complexities of your business and work as a team to facilitate sound decision making, reduce practice costs and maximize profits. WE CAN HELP YOU WITH: ✢ EMR Solutions: Intergy - Implementation and Training ✢ Contracting and Credentialing Services ✢ Compliance ✢ Meaningful Use Assistance ✢ Billing and Accounts Receivable Management ✢ Full Accounting Services, Including Payroll and & Accounts Payable ✢ Practice Administration Contact Carla Campbell or Kay DeWitt for an initial assessment


Empowering Integrated Care

Introducing the CARE clinic for infants with plagiocephaly and torticollis. Infants can experience misshapen skulls due to a variety of factors, including neck muscle tightness. Torticollis and/ or plagiocephaly can also affect a child’s development, facial alignment, and even vision. Early detection allows for appropriate treatment and parent education. The clinic’s team of therapists and orthotists, with onsite physician availability, aim to provide comprehensive CARE for this complex diagnosis.

Call (605) 782-2400 for details on the CARE (Cranial Asymmetry Repositioning Evaluation) Clinic at the Children’s Care Rehabilitation Center in Sioux Falls.


1020 W. 18th St., Sioux Falls, SD 57104 (605) 782-2400

March 2012



Can outsourcing ‘non-core’ business functions help your practice run more smoothly? Is it possible to improve both the bottom line and patient care? DT-Trak Consulting says it is. And they have the growing customer base to prove it.


Needs Practice Management

DT-Trak Consulting Makes the Case for Outsourcing


ike most success stories, the story of DT-Trak Consulting began with the recognition of a problem: The challenge of delivering efficient, high quality medical care in the increasingly harsh regulatory environment of the 21st century. “It is so much harder today than it was even ten years ago,” admits Aris Assimacopoulos, MD, an independent Infectious Disease specialist in Sioux Falls and a DTTrak client. “Today, there is so much more you have to worry about… Medicare regulations, changing documentation requirements, electronic health records. And if some of the new healthcare legislation survives, it is going


to be even harder for independent practitioners to stay afloat.” To protect his own 3-physician practice, Infectious Disease Specialists, PC, Dr. Assimacopoulos did what an increasing number of large and small practices are doing – he decided to outsource billing and several other ‘non-core’ but critical practice management jobs. “From our standpoint, it alleviates a lot of headaches so that we are then able to concentrate on what we are good at, which is seeing patients,” says Dr. Assimacopoulos. “There is no way that we would be able to do what we do and manage things like billing and collections in house. It would also be way too costly.”

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Photo by Kristi Shanks Jewel Kopfmann, VP, Technical Services and Dr. Aris Assimacopoulos of Infectious Disease Specialists, PC in Sioux Falls.

Growing Business

Natalie Bertsch, VP, Administrative & Business Development

Jewel Kopfmann, VP, Technical Services

DT-Trak President Gary Pechota

March 2012

“We saw that there were practices that needed help, but that their choices were limited for getting that help – and it was often very expensive,” says Natalie Bertsch, RHIT, DT-Trak’s Vice President for Administrative and Business Development. “We believed that we could offer more and at a lower cost.” Bertsch herself spent ten years in health information management at a Huron hospital before founding DT-Trak with partner Jewel Kopfmann, RHIT, CCS, CPC, Vice President of Technical Services, in 2002. Five years later, the two added a third partner, Gary Pechota, MBA, who is now the company’s President. With the goal of strengthening the region’s healthcare by strengthening medical practices, the company set out to offer a menu of practice management services – including coding, billing, medical claims management, revenue enhancement training and on-site consulting, EHR with IT support services, Meaningful Use assistance, provider credentialing, and practice promotional assistance – at prices that even smaller or struggling practices could justify. Practices can choose only the services they need including full practice management with or without EMR leasing, as DT-Trak can also work on an existing practice system.

“We recognize that it is very difficult to make money in medicine anymore and for providers to get paid what they deserve,” says Bertsch. “On the one hand, the practice has to take care of patients directly, but on the other hand, they have to be indirectly running the business.” Pulmonary and Sleep Medicine Specialist Rizan Hajal, MD, knows that balancing act all too well. His own single-physician practice, Pulmonary & Sleep Consultants, PC in Sioux Falls, was struggling with billing issues when he turned to DT-Trak for help more than 3 years ago. Today, his billing and coding worries are behind him, the practice is fully compliant, and he couldn’t be happier to be free to concentrate on patient care. “I admit that we were a little skeptical about the technical capabilities of a company headquartered in a small town like Miller,” says Dr. Hajal. “But when I began to investigate, I found them to be very sophisticated and up-to-date. Then, when I saw how many major clients they have all over the country, I was convinced. Given the depth of their knowledge and expertise, it just did not make sense for us to hire and train a billing person and then risk having that person leave.” The concept of affordable services aimed at improving practice profitability quickly took off. The company that started in Miller


with a handful of regional clients has evolved into a full-service practice management firm with more than 90 employees, three office locations in South Dakota, and a decidedly national footprint. From small (fewer than 10 physicians) practices to large hospital systems in 12 states, DT-Trak says it is solving problems, one client at a time, without losing sight of the Midwest values on which it was built. “Just like a medical specialist, we believe that you get better by specializing in one area and doing it well,” says Bertch. “We focus on revenue generation and compliance – not tax preparation or bookkeeping – and that makes us different. One of our client practices in Sioux Falls made ten percent more last year than they had the year before, with almost the same amount in billed claims.” “We have a history of increasing revenues wherever we go.”

Efficiency + Accuracy = Profitability DT-Trak’s track record at increasing revenues has much to do with enhancing the efficiency and accuracy of billing, coding and claims management. When a claim is denied or a bill is unpaid, recouping that income can be a major problem, especially for an already overburdened practice. One answer is to keep these kinds of problems from arising in the first place with correct and complete front end data collection, including copies of insurance cards, most current patient demographics and other relevant support documentation. But “details” like data collection and revenue recovery (think call after call for a busy office staff!) can get put on the back burner in favor of patient care needs… with serious consequences for the ‘bottom line’. But Bertsch says when timely, complete and accurate data capture is combined with Certified Medical Coding services from a company like hers, the result is optimal reimbursement for each patient, fewer claims denials, and better cash flow. In addition, DT-Trak’s experts Accounts Receivable Management service has been proven to shorten the days that accounts are outstanding and improve cash flow.


“Aside from the obvious benefit of working with someone who does this all the time, it is also a huge benefit to have someone who is familiar with compliance issues and can tell you if you are documenting appropriately,” says Dr. Assimacopoulos. “Medicare audits are happening all over the country,” says Bertsch, whose company is adept at working seamlessly with a variety of practice management and billing systems. “The doctor is ultimately responsible, but we feel that it is our responsibility to look at the work and make sure they are documenting the patient episode of care correctly and we don’t charge extra for this.” Sometimes, one of the biggest challenges for a practice is in knowing exactly where it stands financially and managing cash flow appropriately. DT-Trak’s Revenue Generation Cycle Analysis and Management services are designed to give healthcare providers ‘the big picture’ on financial performance and offer tools to simplify clinical

and administrative processes while improving the quality of patient care. The result, says Bertsch, is a simplified workflow, quicker reimbursements and more resources on hand to invest in practice needs.

A Cure for EHR Headaches Another major dilemma for both large and small practices is the question of Electronic Health Records and the quest for ‘meaningful use’. EHR Systems range wildly in cost and the level of training and tech support. A practice that hasn’t done its homework could end up with a confusing, work-slowing system and no one to help them use it. For this reason, some practices have opted to lease a system – such as the meaningful-use certified Vitera Intergy EHR System (formerly Sage Intergy) offered by DT-Trak – that provides software, training and ongoing updates and support for a monthly fee. Vitera Intergy has been rated

Sponsored Feature

Photo by Kristi Shanks

Accounting Firm Offers A

Healthy Bottom Line Natalie Bertsch, VP, Administrative & Business Development and Rizan Hajal, MD, of Pulmonary and Sleep Consultants, PC in Sioux Falls

by Forbes as one of the nation’s top EHR system. Dr. Assimacopoulos says leasing from DT-Trak made sense for his practice, especially since they were already using the Sage billing software. “No one can make the EHR transition process entirely painless, but this is about as close as I think you can get,” says Dr. Assimacopoulos. “I can text or email our DT-Trak tech guy any time and get an answer if I ever have a problem.” “They are very professional and knowledgeable while also being very approachable and friendly,” agrees Dr. Hajal. “I can call and talk to the CEO if I need to. We have found them to be very responsive.” The bottom line for medical practices? “You don’t have to be overwhelmed by the details of running a quality medical practice,” says Bertch. “There is reasonably priced help available, right here in South Dakota. You don’t have to overpay and you don’t have to go out of state.” ■

March 2012

Although financial services like accounting, tax preparation and financial planning fall outside the realm of practice management, DT-Trak recognized that many medical clients also need these services. After all, timely reimbursement and smooth-running Accounts Receivables lose their impact if the resulting funds are not carefully and creatively managed. Their answer has been to form an affiliation with the oldest and one of the most respected accounting firms in South Dakota – Nelson & Nelson, CPA’s. “My grandfather, James Nelson, started the business in 1927 and my father, Wesley Nelson, came on board after serving in the Korean War,” explains Charles “Chuck” Nelson, a USD graduate and the third generation of Nelsons to devote his professional life to money management. The firm now has clients around the world, but retains its local commitment from a single office in Sioux Falls. “The more we spoke with DT-Trak, the more we realized that, between our two firms, we can truly handle all of the financial needs of healthcare clinics, from the time the patient steps out of the office to the time that the doctor needs to file a tax return,” says Nelson. “We can even help them with financial planning to meet personal and practice goals.” From an accounting standpoint, Nelson & Nelson is what Chuck Nelson calls a ‘turnkey’ operation for medical offices. The company offers everything from payroll services (including payroll checks or direct deposit) to complete management

Chuck Nelson of Nelson & Nelson CPA’s in Sioux Falls

of Accounts Payable, bookkeeping, and tax preparation – all delivered with the highly individualized approach that has made this family-owned business one of the most trusted accounting firms in the region for 85 years. “We recognize that the life of a physician is complicated enough, so we want to simplify things,” says Nelson, whose brother is a physician. “I do not know how to read an X-ray, but I trust my doctor to explain it to me in a way that I can understand. When it comes to numbers on a page, we are very good at interpreting them for these busy professionals.”

Among the services offered by Nelson & Nelson, CPA’s are: ✔ Bank reconciliation ✔ Payment of Accounts Payable ✔ Payroll, payment of payroll taxes, preparation of payroll reports ✔ QuickBooks Consulting ✔ Customer refunds ✔ Electronic ACH bank payments ✔ Quarterly doctor bonus payments ✔ Time-sensitive year-end bonus calculations for doctors ✔ Year-end business planning ✔ Tax return preparation


Black Hills

Cardiovascular Research on Plavix Trial Results

Results of a national Plavix (clopidogrel) drug trial, in which Black Hills Cardiovascular Research in Rapid City was a participant, were recently presented at an American Heart Association Scientific Session in Orlando, Fla. The study, called ELEVATE-TIMI 56, found that people with a common gene variant fared better on Plavix when given in higher doses. ELEVATE-TIMI 56 focused on patient reactions to Plavix based on their genetics with a goal of helping health care providers

customize their patients’ treatment. Previous studies have shown that up to one third of the general population does not achieve optimal results on the current 75 mg dose of Plavix, a drop commonly prescribed to prevent blood clots. “This study highlights the importance of tailoring people’s therapy based on their genetics,” said L. Norman Ferrier, M.D., Principal Investigator, of Regional Heart Doctors. Dr. Ferrier said although genetic testing is not available in the Black Hills,

platelet function testing is available at Rapid City Regional Hospital. “This is a quick test to determine how well patients are responding to their anti-platelet medication and can aid health care providers in their decision-making,” Dr. Ferrier says it is important for Black Hills residents to be aware of significant clinical research in the region. BHCR also recently participated in the final trial of Xarelto, a newly-approved alternative to Coumadin for non-valvular atrial fibrillation. ■



Midwest Medical Edition

Controlling your

Financial Destiny


he concept of using a trust to protect assets from creditors has been used for centuries, yet it is only within the past two decades that states have permitted a person to protect one’s own assets against creditor claims. The general rule is that the person who creates a trust cannot evade his own creditors. In 1997, Alaska enacted the first legislation which permits a person to become a beneficiary of his own trust and still obtain creditor protection. (also known as a DAPT) Since then, 12 states that have enacted laws which allow a person to establish DAPT trusts and have assets protected from present and future creditors. South Dakota, a nationally recognized leader in attractive trust

laws, enacted DAPT legislation in 2005. Under South Dakota’s law, a person who establishes a trust specifically using the statutory criteria can protect assets in the trust from most creditor claims. Discretionary distributions can be made to the settlor; however, the settlor doesn’t have the power to demand a distribution. The settlor can remain the trust’s investment advisor and direct how assets are managed. DAPT’s protect assets against future creditors. Some existing creditors can still bring claims. The list of creditors who receive special exemptions allowing them to invade the trust is established by each state’s law. South Dakota’s only exempt creditors are claims for existing child or spousal support. DAPT are considered effective pre-nuptial

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By Alice Rokahr, JD

agreements because a future spouse is not a “creditor”. Protection for past debts is not automatic on day one. Each state establishes a “lookback” period for creditors to file claims. South Dakota’s look-back is shorter than most states with a period of three years after the trust was created or within one year of learning the trust was created, whichever is longer. The federal government imposes a ten year look-back under bankruptcy laws. How much can be reached? Assume a DAPT is created on December 1, 2011 and assets are contributed. Any debt that is incurred after that date is protected. If a second contribution is later made to the same trust; a new look back period is triggered for the new contribution. Debts arising between the creation and the second contribution could be the basis of a claim against the amount of the new contribution. Only the amount necessary to satisfy a creditor’s claim is paid from the trust. The trust is not invalidated. Further, any distributions from the trust are deemed as withdrawals from the most recent contribution. DAPT’s are attractive to many individuals. Professionals who fear future lawsuits like the protection as do persons who sell their company and later want to start a new venture without putting prior assets at risk. Someone who inherits and wants to be able enjoy the lifetime benefit but also wants to pass some to the next generation finds a DAPT attractive. The attributes of South Dakota’s trust laws are even more attractive with the availability of this type of trust. ■ Alice L. Rokahr, JD, is the Wealth Planning Officer at Bankers Trust Company of South Dakota.

Midwest Medical Edition

In Review What You’re Reading, Watching, Hearing

Author Allan Hamilton, MD

The Scapel and the Soul

Encounters with Surgery, the Supernatural, and the Healing Power of Hope Reviewed by Alex Strauss, Editor


irst published in 2008, Dr. Allan Hamilton’s The Scalpel and the Soul is a candid and courageous look at a side of medicine about which few doctors ever speak openly. A Harvard educated brain surgeon, Dr. Hamilton draws from 30 years’ worth of patient stories – including his own experience as a patient – to illustrate a spiritual and metaphysical depth and breadth in the doctor/patient experience that is rarely seen in a medical memoir. The book is arranged in a series of vignettes, each of which uses a patient encounter or case as a springboard to explore a spiritual concept. Some of the stories are humorous, like the one about the gypsy queen whose family ignited hospitalwide panic by lighting candles at her bedside in the ICU. (Everyone was surprised when nothing blew up!) Others are inspirational, like the one about the young burn patient whose unfailing spirit survived the horror of unimaginable wounds. Still others are tragic, like the one about the medical resident pushed past his breaking point and into the news headlines. But probably the most memorable of the tales is the story of the young surgical patient who recounted whole conversations and visual details that took place in as operating room in which she was clinically dead. This one leads to some fascinating observations about the nature of consciousness, the power of faith, and, above all, the staggering volume of knowledge that still eludes physicians and non-physician alike. Dr. Hamilton writes,

March 2012

“Can we not, as doctors, allow ourselves to entertain the possibility that the supernatural, the divine, and the magical may all underlie our physical world? Would we not be the richer for just challenging our imaginations? Can we not admit we yearn to glimpse the mystery of the spirit? And we need to ask questions when we stumble across evidence that consciousness survives beyond the life of the brain.” Although the vignettes are built around patient experiences, they are also deeply personal as Dr. Hamilton candidly shares his own doubts, superstitions (of which he has many), fears and mistakes. While some of these admissions may make the more stable-minded reader squirm (after the book’s publication, Dr. Hamilton says some colleagues could no longer meet his eye in elevators), it is hard not to respect his unapologetic if sometimes clumsy headlong dive into the unknown. Would that we could all find such courage when it is truly needed. ■

Wruitse! to

“When a health crisis strikes, we confront great dangers and dark fears. Yet illness can offer opportunities to tap into unseen powers beyond the physical world. When we reach out, the world of the spirit becomes ours.” Allan Hamilton, MD

hav e a Do you view? re ia d icle? me , or art k, film A boo d us a note S en


Alex @ d edicalE M t s idwe


Off Hours

Passionate Pursuits Outside the Office

Dr. Quentin Durward (right) and hiking companion celebrate a successful hike.

Walking the World


e doesn’t remember a time when he didn’t walk, but that might be true of most of us. The difference between this physician and the average person is in the “Where to?” and “How far?” For Quentin Durward, MD, board certified Neurosurgeon with the CNOS clinic in Dakota Dunes, a day’s walk might last as long as 13 hours, as in the final ascent of Mt. Kilimanjaro. He speaks of that weeklong hike


in September of 2010 with a rhythm that almost sounds like striding: “You hike to about 15,000 feet—it takes about three or four days to get there; then you do the 19,300 foot summit and then go back down to 13,000 feet all at once—you have to do that last part in one day; you can’t camp up high on that mountain. It takes about eight hours and it’s a hard slog to do it, almost completely uphill. I hiked this one with my friends. There were eight of us. We saw monkeys and lizards down low

By Darrel Fickbohm

on that hike, but once you get up high it’s volcanic: very dry and dusty. It gave some of us a severe cough. Then, as you near the summit, you’d better have a good parka. The top is a permanent glacier.” Most hobbies that become serious begin innocently enough. For Dr. Durward the mountains were the real beginning. “I always enjoyed mountains and in the winter it was skiing, of course, but if you want to go in the summer, the only thing that is really akin to skiing is hiking. I

Midwest Medical Edition

“As you near the summit, you better have a good parka. The top is a permanent glacier.” started hiking, I suppose, as much as 25 years ago. I try to keep in shape by going on a fairly significant hike at least once a year. The last one I took was with my family in Papua, New Guinea; that was last year.” The New Guinea hike was an eight-day trek that most people have never heard of called the Kokoda trail. The length of the trail was the scene of a famous battle between the Australians and the Japanese invaders in World War II. The hike is difficult, even for an experienced hiker, requiring the ascent and decent of 45,000 feet and the crossing of almost 50 rivers and smaller streams. But history unfolded for Dr. Durward and his companions on the trail, as setting after setting represented a dramatic portion of the battle. “That hike was definitely goal-oriented,” asserts Durward, “but most hikes that I take are just to see the scenery pass and are about being in nature. Sometimes we talk on the trail, sometimes it’s silent, and sometimes we bring our iPods out and then it’s soft rock or country as I walk along.” As one step follows the other in hiking, there always seems to be the next trail calling from the future. By the time this issue of MED is published, Dr. Durward will be deep in the wild places of his home country of New Zealand. “I’m going to be trekking one of the most beautiful trails anywhere. It’s a moderate four-day hike that goes from ‘hut to hut.’ The hikers don’t have to carry anything. The supplies are helicoptered into the huts and we’ll also have the benefit of showers, which makes the hiking very nice. The countryside of the Milford Trek is right near the film sites of the Lord of the Rings. If you’ve seen the movie, it’s that kind of magnificent and lush scenery—all this is a great break, a great stress reliever from the practice of neurosurgery.” to us! When asked about future walks, Dr. Durr you ut Tell us abo own ‘passionate ward immediately confesses that he also has pursuits’ outside lately been daydreaming of the Incan ruins in the office. the mountains of South America and maybe the great Himalayas, themselves. “I would love to trek there… Maybe even to the Mt. Everest base camp.” ■


March 2012


News & Notes Happenings around the region

Regional The Regional Rehabilitation Institute, a department of Rapid City Regional Hospital, was recently accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) for its Inpatient Rehabilitation programs and services. Regional Rehabilitation Institute received a three-year accreditation, which represents the highest level of accreditation that can be awarded to an organization. The Regional Rehabilitation Institute is a 51bed facility and outpatient clinic located at Rapid City Regional Hospital.The latest accreditation is the ninth consecutive threeyear accreditation the Regional Rehabilitation Institute has received from the international accrediting commission.

Sanford Sioux Falls pediatric neurologist, Michael Kruer, MD, has been recognized

nationally for his research in child neurology. Dr. Kruer received this year’s Shields Award from the Child Neurology Foundation. The Shields Award will provide $50,000 per year for two years to fund Kruer’s research in applying next-generation sequencing techniques to identify the genetic basis of dystonia, a neurologic movement disorder. As many as 250,000 people in the United States have dystonia, making it the third most common movement disorder behind essential tremor and Parkinson’s disease. The Clearwater County Board in Bagley, MN has announced that they have signed a definitive agreement with Sanford Health to purchase the operations of Clearwater Health Services (CHS). This fall, the two organizations announced a letter of intent to join and this is one of the final steps in that process.  Clearwater Health Services will then be known as Sanford Bagley. Sanford Bagley includes Sanford Bagley Medical Center in Bagley, with the attached Sanford Bagley Clinic; the Sanford Bagley Ambulance Service; and the Sanford Bagley Clearbrook Clinic in Clearbrook,

Minn. Sanford Bagley will have a total of 7 physicians and advanced practice providers and over 80 staff. Over the next few months a local advisory board will also be forming. Broadway Medical Center in Alexandria, MN and Sanford Health announced they have also signed a definitive agreement, the final step in the merger process. Broadway Medical Center will now be known as Sanford Health Broadway Clinic. It has a total of 25 physicians and advanced practice providers and over 100 staff in Alexandria with a satellite clinic in Parkers Prairie, MN. Medical services include: endocrinology, family medicine, general surgery, hospitalists, internal medicine, OB/ GYN & midwifery care, oncology and podiatry. Sanford Children’s Clinic in Duncan, Oklahoma has been awarded LEED Certified status. This certification is established by the U.S. Green Building Council. LEED is the nation’s preeminent program for the design, construction and operation of high performance green buildings. Sanford Children’s Clinic in

SEEKING ED MEDICAL DIRECTOR BE/BC Emergency Medicine or BC Primary Care Physician with EM experience ready to lead an advanced Emergency Department currently seeking Trauma III Certification. Yearly volume of 10,000 patient encounters with superior staff and speciality care back-up. Teaching hospital with excellent compensation and benefit package. Medical Directorship responsibilities plus seven 24-hour shifts per month and three Saturdays per year. NO STATE INCOME TAX. Physician Recruiter Mindy Schwitzer (605) 664-6463 Avera Sacred Heart Hospital has positioned itself as a regional health care center since 1897, serving 120,000 residents in 15 counties.

500 West Summit Street ~ Yankton, South Dakota 30

Duncan achieved LEED certification for energy use, lighting, water and material use as well as incorporating a variety of other sustainable strategies. By using less energy and water, LEED certified buildings save money, reduce greenhouse gas emissions and contribute to a healthier environment for residents, workers and the larger community. The newly hired board certified plastic surgeons Drs. Pamela Antoniuk and Diane Schmidt-Krings are proud to introduce the new Sanford Plastic Surgery Center located at 2801 South University Drive in Fargo. Sanford has been recruiting physicians to fill this specialty for several years. The center will have a focus on medical procedures, which represent a large area of need in the market, in addition to the more well-known cosmetic procedures.

Avera Radiation Oncologists Dr. Kathleen Schneekloth and Dr. Barbara Schlager have recently joined Avera Medical Group Radiation Oncology as employed physicians. Dr. Schneekloth, a South Dakota native, received her medical degree from Creighton University and completed her Radiation Oncology residency at St. Mary’s Medical Center in San Francisco. She has two years of specialty training in High Dose Rate Brachytherapy and was the Medical Director for San Francisco Brachytherapy, where she established four prostate seed implant programs. Dr. Schlager specializes in the treatment and diagnosis of breast, gynecologic, gastrointestinal tract and prostate cancers. She holds a medical degree from the Medical College of Pennsylvania, Philadelphia. She completed residency and fellowship in Radiation Oncology at Albert Einstein Medical Center, Philadelphia, and a residency in Midwest Medical Edition

News & Notes Happenings around the region

Cost Based Charity Care and Cost Based Bad Debt

Source: Health Forum, AHA Annual Survey of Hospitals, published in SDAHO’s Unified Voice newsletter; Totals are for SD hospitals and include both reported and est. data. Uncompensated care is the estimated cost of bad debt and charity care to the hospital. This figure is calculated for each hospital by multiplying uncompensated care charge data by ratio of total expenses to gross patient and other operating revenue. The uncompensated figure does not include Medicaid or Medicare underpayment costs, or other contractual allowances.

General Radiology at the Medical College of Pennsylvania. Drs. Schneekloth and Schlager provide comprehensive radiation therapy services in the Prairie Center on the Avera McKennan campus and at an Avera Cancer Institute satellite clinic on Minnesota Ave. in the former Med X-Ray location. Several Avera hospitals held their annual “Heart & Soul” Heart Health events in February. These elegant evenings featured heart healthy eating, wine tasting, education and entertainment in celebration of heart month. More than 200 people attended the events in Aberdeen, more than 100 in both Yankton and Mitchell, and another 250 at the Avera Heart Hospital

March 2012

in Sioux Falls where nationally known speaker Donna Harley gave the keynote address. Avera Sacred Heart Cancer Center is offering free group chair exercise classes to cancer patients, cancer survivors and caregivers. The classes began in January and are offered every Tuesday from 10-10:30 a.m. at Avera Sacred Heart Cancer Center. After the first session, chair massages will be provided by an Avera Sacred Heart Massage Therapy licensed therapist, available from 10:30 to 11:30 a.m. Participants can RSVP to (605) 668-8850.

Wade Dosch, MD, became a partner in Avera Medical Group Comprehensive Breast Care in January, joining breast surgeon Dr. Julie Reiland. Dr. Dosch will also continue to practice general surgery with Avera Medical Group McGreevy 7th Avenue. Dr. Dosch holds a medical degree from USDSM and completed residency at Michigan State and a surgical fellowship at Naval Hospital, Twenty-Nine Palms. He is certified by the American Board of Surgery, is a member of the Avera Breast Center’s Breast Health Professional

Advisory Board, and serves as Avera’s cancer liaison physician to the American College of Surgeons’ Commission on Cancer. At the January General Staff meeting, the following physicians were elected to serve on the Avera Queen of Peace Medical Executive Committee for the 2012 Medical Staff year commencing on February 1, 2012: Jennifer Tegethoff, MD, President; Kelly Smith, MD, President Elect/ Vice President; David Malters, MD, Secretary; William Graham, DO, and Martin Christensen, MD, Members at Large; Shawn Haley, MD, Hospital Based; and Robert Snortum, MD, Immediate Past President. In addition to the duties associated with Medical Staff leadership, as President of the Medical Staff, Dr. Tegethoff will also represent the Medical Staff on the Avera Queen of Peace Board of Directors. David A. Balt, DO, will join Robert A. Snortum, MD, and James L. Nielsen, MD, in providing 24-hour physician coverage in the Emergency Department at Avera Queen of Peace Hospital. Dr. Balt has been doing locum tenens work at Avera Queen of Peace for the past 18 months. David A. Balt, DO, received his Bachelor of Science Degree in Biology from Northwestern College, Orange City, IA, and his Osteopathic Degree from Kirksville College of Osteopathic Medicine, Kirksville, MO. He completed his Family Practice Residency at Charleston, SC, Naval Hospital. Dr. Balt is a member of the American Academy of Family Physicians and the American Osteopathic Association.


News & Notes Happenings around the region

Richard Zieske, Certified Physician Assistant and Heidi Gehrke, CNP, have joined Avera Medical Group, in Mitchell, SD. Rich Zieske, PA-C, received his BA from Southwest Minnesota State University and his MA in Exercise Physiology from Minnesota State University. He holds a BS in PA Studies from USDSM. Gehrke received her AA in Nursing from Dakota Wesleyan University and earned her BS in Nursing and her Masters of Nursing in Family Nurse Practitioner from SSDSU. Zieske and Gehrke see patients at Avera Urgrent Care in Mitchell. HealthGrades has awarded Avera Heart Hospital a FiveStar rating for cardiac surgery for a 6th year in a row, a Five-Star rating for coronary bypass surgery for 9 years in a row (2004-2012), a Five-Star rating for treatment of heart attack for 10 years in a row,a Five-Star rating for valve surgery for 10 years in a row, and a Five-Star rating for carotid surgery for 4 Years in a Row. 

Other Black Hills Surgical Hospital has been named to Becker's Hospital Review’s list of the “101 Hospitals with Great Spine & Neurosurgery Programs”. The hospitals have been recognized for excellence in this specialty by reputable healthcare rating resources, including U.S. News & World Report, HealthGrades, Thomson Reuters, Blue Cross Blue Shield Distinction Centers for Spine Surgery, Delta Group CareChex, and the American Nurses Credentialing Center. The Becker's Hospital Review editorial team selected them based on nominations, clinical accolades, quality care, and other spine and neurosurgical proficiencies.  For a complete list visit www.


Urgent Care

Physician 42 physician independently owned multi-specialty clinic seeking BE/BC Family Medicine physician to staff our urgent care Clinic. Current schedule is Sun, T-F with Saturday and Monday off but could be subject to change with the right person; Urgent care clinic is open 5-9 M-F and 12-5 Sat and Sun. Competitive salary and outstanding benefits; No State Income Tax; work closely with 3rd year medical students from USD Sanford School of Medicine; teaching opportunities.

1104 West 8th Street • Yankton, SD 57078 605-665-7841 •

So Much Care, So Close to Home. ®

Tickets Now on Sale for Cancer Gala! Be a movie star for a night and fight cancer at American Cancer Society’s

“Lights, Camera, Action!” Hollywood Gala on Saturday, March 23 at the Washington Pavilion. The star treatment starts at 6:00. Imagine yourself walking the red carpet to the flashing bulbs of the paparazzi. Picture yourself in elegant attire, enjoying cocktails and a silent auction, mingling with other A-listers in our community. Enjoy an elegant dinner and Awards Show, where we’ll be honoring three community leaders—all for their efforts to fight cancer. Finally, wrap up the night with desserts and dancing at the After Party! Tickets: 605.323.3555. Info at:

South Dakota Medical Group Management Association Spring Conference

successful leadership: C r e a t i n g a n d M a n a g i n g a W i n n i n g Te a m

Featuring: Don Meyer, Ph.D., Retired Coach, Northern State University Kim Hoogeveen, Ph.D., President, MindSet®, LLC Steve Narans, MS, Principal, Human Capital Division, SilverStone Group Torri Criger, JD, Advisor, Risk Management & Regulatory Affairs, SilverStone Group Juli Burney, Teacher, Humorist, Author

April 25 - 27, 2012 Holiday Inn Sioux Falls City Centre Sioux Falls, South Dakota For the full schedule or to register, visit our website at


Midwest Medical Edition

Learning Opportunities March / April / May 2012

March 3 8:00 am – 12:00 pm

Nuclear Medicine Conference Location: Avera Cancer Institute Information & registration:, 322-8950

March 17 8:30 am – 3:30 pm

Creating Assistive Technology Solutions

March 29 & 30

21st Annual Perinatal, wNeonatal & Women’s Healthcare Conference

April 19 12:30 pm – 4 pm

L ocation: Sanford Center, Sioux Falls Information and Registration:

Sanford Medical Center, Sioux Falls, SD Contact Sanford for more information

Living With Grief: End-of-Life Ethics Location: Avera Education Center Auditorium Information and Registration:, 322-8950 Website:; click on Events Calendar

April 19

Sanford Pediatric Trauma Conference

May 1 7:30 am – 4 pm

20th Annual Trauma Symposium: Excellence in Trauma and Surgical Critical Care

Location: Sioux Falls Convention Center Information and Registration:, 322-8950

May 4 8 am – 5 pm

May 11 7 am – 5:15 pm


17th Annual North Central Heart Vascular Symposium Location: Sioux Falls Convention Center Information: 605-977-5316

6th Annual Sanford Sports Medicine Symwposium Location: Best Western Ramkota Hotel, Sioux Falls Information and Registration:, 328-6333

Save the Date June 15 – 16

Black Hills Pediatric Conference

Distance Learning Opportunities through


March 6 8:30 am – 10 am Physician Supervision for Provider-Based Clinics: Ensuring Compliance

March 22 12:00 pm – 1:00 pm The Executive Guide to Achieving ICD-10 Compliance

March 23 12:00 pm – 1:30 pm What’s All the Uproar About April 1, 2012 – MDS for Senior Leadership

March 29 9:00 am – 10:00 am Care Transitions and Reducing Hospital Readmissions

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


Midwest Medical Edition

MED-Midwest Medical Edition-March 2012  
MED-Midwest Medical Edition-March 2012  

2012 March Issue of Midwest Medical Edition.