ORTHOPEDICS Medical Group
Gregory Alvine, MD
David Watts, MD
Erik Peterson, MD
Jonathan Blake, DO Jeffrey Kalo, DO
Travis Venner, DPM
Contents Midwest Medical Edition
December 2010
Regular Features Publisher’s/Editor’s Page
2 | 14 |
Then & Now
Remembering “Doc Sweet”
27 |
Grape Expectations
Inventory Your Wine Collection By Heather Taylor Boysen
28 |
Cover Feature
News & Notes News from around the region
29 |
Learning Opportunities Upcoming Symposiums, Conferences and CME Courses
In This Issue 3 |
AMA Newspaper Open Online Archive
5 |
Sanford Signs Agreements with Minnesota Providers
16 | Tips for Evaluating Practice Profitability By Gary Pechota
19 |
USDSM’s Dean Parry to Retire
20 |
Avera Kicks Off Centennial Celebration
22 | Medicaid, South Dakota’s Budget, and Physicians By Dave Hewett
24 | Splinting at Work By Stan Kulzer, OTR/L
In Review What to Eat During Cancer Treatment The American Cancer Society
page
18
Hope is in Sight Lions Eye Bank Expands its Services Since 1991, the South Dakota Lions Eye Bank has helped restore sight to thousands of people through the gift of donated corneas. Now in a new, better-equipped space, the Eye Bank is setting its sights on other services, including a highly specialized educational program, that have nothing to do with eyes… but everything to do with improving lives.
By Alex Strauss
page
10
From Us to You
Staying in Touch with MED
A letter from the Publisher
M
ED is proud to be the region’s only locallyproduced physician magazine and we are excited to be starting our second year in publication. We want to thank all of the advertisers whose support Steffanie Liston-Holtrop makes it possible for us to bring you MED 8 times a year. If you are like most magazine readers, you may not give much thought to where this publications comes from, or why. But if you are a health professional, you are receiving MED for free. The businesses that advertise in these pages believe that you deserve to enjoy a quality local publication. They are showing, with their support of MED, that they value your contributions and would like to have you as a customer. If you find MED to be valuable, I want to encourage you to thank these advertisers by using their services. As MED grows, we can bring you more local news, human interest stories, reader contributions like book reviews, and calendar items. Everyone wins. I will be busy attending conferences and meeting as many of you as possible in the next few months. Even though I may never meet you personally, MED wants to hear from you and welcomes your thoughts, feedback, advertising, and editorial contributions. With more than 3500 physicians and other health professionals on our mailing list, there is no easier way to get your message in front of your colleagues. Let me know how I can help. You can reach me at Steff@MidwestMedicineEdition.com —Steff
A letter from the Editor
M
edical advances make headlines. New equipment, new facilities and new techniques are exciting to read about and – frankly – to write about, as well. But sometimes, we come across an organization whose good work alone is worthy of attention, even if they are Alex Strauss simply doing what they have always done. Since 1991, the South Dakota Lions Eye Bank has helped give hope to thousands of people who would have lost their eyesight without a corneal transplant. As South Dakota’s only tissue procurement organization, the Eye Bank is charged with the challenging job of collecting, preparing and storing these corneas whenever and wherever they become available. It is not a flashy job but, as they say, someone has to do it. The Eye Bank does it with compassion, respect and professionalism –with or without headlines. We are glad to have this opportunity to introduce the Eye Bank and its expanding services. As we begin our second year of MED, I would like to extend a personal invitation to share more of your stories with your colleagues. We are always looking for recollections about practicing medicine in this region for our regular Then & Now column. In Review is a chance for you to let your fellow healthcare professionals know what you’re reading, watching or listening to . . . and what you think of it. And News & Notes is an excellent place to share all kinds of practice news. Don’t keep it to yourself. Send your contributions any time to Alex@MidwestMedicineEdition.com. If you need inspiration, put your feet up and enjoy this issue of MED. See you in March. —Alex
2
Publisher Steffanie Liston-Holtrop Publisher Steffanie Liston-Holtrop Editor in Chief Alex Strauss in Fickbohm Chief Alex Strauss Cover DesignEditor Darrel Design/Art Direction Corbo Design Cover Design Darrel Fickbohm Web Design 5jDirection Design Design/Art Corbo Design Contributing Writers C harlotte Hofer Web Design 5j Design Kenneth Scott, MD Heather Boysen Contributing Writers Charlotte Hofer Dave Hewett Heather Boysen Lori Berdahl Darrel Fickbohm Jeff Boonstra Gary Pechota Jamie Husher Dave Hewett Paul Krueger Stan Kulzer Patty Peters, MD
Advisory Board John Board Berdahl, MD Advisory John Berdahl, MD Mary Berg, MD Mary Berg, MD Michelle L. Daffer, MD Michelle L. Daffer, MD James M. Keegan, MD James M. Keegan, MD Timothy Metz, MD Timothy Metz, MD Patty Peters, MD Juliann Reiland-Smith, MD Patty Peters, MD Luis A. Rojas, MD Juliann Reiland-Smith, MD Daniel W. Todd, MD Luis A. Rojas, MD Published by MED Magazine, LLC Daniel W. Todd, MD Sioux Falls, South Dakota Published by MED Magazine, LLC Sioux Falls, South Dakota
Contact Information Contact Information Steffanie Liston-Holtrop, Publisher 605-366-1479 Steff@midwestmedicaledition.com Steffanie Liston-Holtrop, Publisher 605-366-1479 Steff@midwestmedicaledition.com Alex Strauss, Editor in Chief 336-295-3017 AlexAlex@midwestmedicaledition.com Strauss, Editor in Chief 336-295-3017 Fax Alex@midwestmedicaledition.com 605-271-5486 Mailing AddressFax PO605-271-5486 Box 90646 Sioux Falls, SD 57109 MailingWebsite Address PO Box 90646 Sioux Falls, SD 57109 MidwestMedicalEdition.com Website MidwestMedicalEdition.com
2011 AD / Editorial Deadlines 2010/11 AD / Editorial Deadlines
March Issue Feb. 5th Jan/Feb Issue Dec 5th April/May Issue MarchIssue 5th March Feb. 5th
June Issue May 5th April/May Issue March 5th July/August Issue JuneIssue 5th June May 5th Sept/Oct Issue August 5th July/August Issue June 5th
November Issue OctoberIssue 5th Sept/Oct August 5th December Issue November 5 November Issue October 5th
Reproduction Reproduction or or use use of of the the contents contents of of this this magazine magazine isis prohibited. prohibited.
©2010 ©2010 Midwest Midwest Medical Medical Edition, Edition, LLC LLC Midwest Midwest Medical Medical Edition Edition (MED (MED Magazine) Magazine) isis committed committed to to bringing bringing our our readership readership of of 3500 3500 South South Dakota Dakota area area physiphysicians cians and and healthcare healthcare professionals professionals the the very very latest latest in in regional regional medical medical news news and and information information to to enhance enhance their their lives lives and and practices. practices. MED MED isis published published 88 times times aa year year by by MED MED Magazine, Magazine, LLC LLC and and strives strives to to publish publish only only accurate accurate information, information, however however Midwest Midwest Medical Medical Edition, Edition, LLC LLC cannot cannot be be held held responsible responsible for for consequences consequences resulting resulting from from errors errors or or omissions. omissions. All All material material in in this this magazine magazine isis the the property property of of MED MED Magazine, Magazine, LLC LLC and and cannot cannot be be reproduced reproduced without without permission permission of of the the publisher. publisher. We We welcome welcome article article proposals, proposals, story story suggestions suggestions and and unsolicited unsolicited articles articles and and will will consider consider all all submissions submissions for for publication. publication. Please Please send send your your thoughts, thoughts, ideas ideas and and submissions submissions to to alex@midwestmedicaledition.com. alex@midwestmedicaledition.com. Magazine Magazine feedback feedback and and advertising advertising and and marketing marketing inquiries, inquiries, subscription subscription requests requests and and address address changes changes can can be be sent sent to to steff@midwestmedisteff@midwestmedicaledition.com. caledition.com. MED MED isis produced produced eight eight times times aa year year by by MED MED Magazine, Magazine, LLC LLC which which owns owns the the rights rights to to all all content. content.
Midwest Medical Edition
AMA Newspaper Opens Online News Archive More than ten years of health care reporting is accessible on the Web American Medical News, the award-winning newspaper published by the American Medical Association (AMA), is now offering unrestricted access to its online news archive at amednews.com. The online news archive dates back to January 2000, with selected earlier content. It represents a rich resource on issues confronting physicians and trends in medicine. Content includes in-depth reporting on the business and regulatory sides of health care, practice management and hot issues in public health and patient care. “The American Medical Association hopes the accessible online news archive, and digital conveniences offered by American Medical News, will better help readers stay on top of the trends and forces shaping a complex, ever-changing medical environment,” said AMA President Cecil B. Wilson, M.D.
From the Vault
Fighting frivolous lawsuits
The ‘From the Vault’ page offers fullpage news articles of enduring relevance and practical value. The page showcases a rotating selection of archival Editor’s picks, which features a special search targeted at stories previously unavailable. Examples of the feature stories now available from the online archive, include:
Doctors engage in an uphill battle Many physicians have fantasies about suing the lawyers they believe frivolously named them in medical malpractice lawsuits. Few, however, actually turned that fantasy into reality. Of those who have, few have emerged victorious from the courtroom. This story examines why and looks at other tactics doctors can use instead of a countersuit. (October 2003)
Medicare payment — past, present, future: Prelude to a crisis This three-part series examines the Medicare program’s troubled history with physician reimbursement and helps put the current news about the sustainable growth rate formula in perspective. (September 2006)
Never too old to quit You can help the elderly stop smoking Older smokers face a unique set of challenges when it comes to kicking the cigarette habit, and primary care physicians are central to their success. This story examines the unique problems this age group face when trying to quit and gives physicians practical ideas for targeted cessation counseling and assistance. (February 2005) ■
The site provides an in-depth reference for anyone following healthcare, offering tables, charts and essential tools such as: • Listings of news stories by health plan and region of the country • Headlines via e-mail or RSS • Multimedia features on stories of enduring relevance • A n interactive health-plan earnings tool on the nation’s publicly traded health plans • A convenient new mobile version with full text, pinch and zoom, topics and search
January 2011
MidwestMedicalEdition.com
3
Cancer Center’s ‘Arts in Healing’ Program Gets Boost from National Organization Avera McKennan Hospital & University Health Center has long understood the healing nature of art, and includes a wide variety of original art throughout its many facilities, including the Prairie Center, home of the Avera Cancer Institute and the Avera Surgery Center. The Avera Cancer Institute has been named as LIVESTRONG® Community Impact Project award recipient. The project, created by LIVESTRONG, the organization founded by cancer survivor and champion cyclist Lance Armstrong to serve people affected by cancer and empower them to take action, will bring proven cancer support programs to 55 communities across the United States. One hundred seventy-nine qualified hospitals, cancer centers and community organizations in eight regions across the United States were selected to participate in an online voting campaign. Over a two-week period, more than 260,000 votes were cast and the Avera Cancer
Institute was among the finalists. The Avera Cancer Institute will use the $16,000 award to further establish the Arts in Healing Program for cancer patients and their families. The Arts in Healing program offers patients the opportunity to learn about and become absorbed in their own creative resources as they meet the challenges of diagnosis, treatment and survivorship. The program will work bedside and in small group settings with men, women and children – in oncology units, bone marrow transplant units, intensive care/respiratory units, hospice and palliative care programs. LIVESTRONG is committed to supporting community organizations in
White Hummingbird by Frank Howell.
their efforts to help cancer survivors face the challenges and changes that come with cancer. Since its inception in 1997, the organization has invested more than $68 million in community-centered organizations. ■
Helping Kids Be Kids...
If you know of a child 2 1/2 - 18 years of age suffering from a life-threatening medical condition, please call us at 800-640-9198.
Make-A-Wish Foundation® of South Dakota www.southdakota.wish.org
4
Diagnosed with Acute Lymphocytic Leukemia
for a child diagnosed with a life-threatening medical condition, a little hope, strength and joy goes a long way on the road to recovery. Noah, 7, Box Elder Wish Granted: Sept. 2010
Midwest Medical Edition
North Country Health Services, Bemidji, MN
Sanford Signs Agreements with Minnesota Providers North Country Health Services, Appleton Area Health Service to Join Forces with Sanford Health North Country Health Services, a long standing healthcare system based in Bemidji, Minnesota, has announced plans to become part of the Sanford Health System. The Boards of Trustees signed a Letter of Intent in November that will begin the process of creating a news, integrated system in Bemidji. NCHS opened in 1898 and is an acute care hospital serving a region of approximately 100,000 people in northern Minnesota. It contains approximately 80 acute hospital beds. Under the agreement, Sanford will invest $75 million into the community through facilities, recruitment and technology over the next January 2011
ten years. Five million dollars will be given to the NCHS Foundation to begin the process. NCHS and the existing Sanford Clinic Bemidji have worked together for many years. “We are seeking new ways of improving health and access to care for people across the entire region, including key services like heart, cancer, orthopedics and neuroscience,” said Paul Hanson, CEO and president, NCHS. NCHS has more than 900 employees, 25,000 emergency visits per year, 5,500 acute admissions per year and 1,000 births. The NCHS campus also includes a large outpatient rehab center. Bemidji has a population of more than 13,000 MidwestMedicalEdition.com
Paul Hanson
people and serves as an important link to services for people in a broad region of northern Minnesota. Meanwhile, community-owned Appleton Area Health Services in Appleton, Minnesota has entered into an associate agreement with Sanford Health. Appleton Area Health Services consists of a 15-bed Critical Access Hospital, a long-term care facility, congregate living facility, home health and a primary care clinic. It employs approximately 170 full and part-time people. Sanford Health has several levels of relationships with area hospitals. These relationships range from associate to managed, leased or owned status. ■ 5
2010-2011 Season
January with your
South Dakota Symphony Saturday, January 8th | 7:30 pm
Beethoven’s Symphony No. 8 Special Guest Artist
Guitarist Eliot Fisk Vivaldi Guitar Concerto Robert Beaser Guitar Concerto
Saturday, January 29th | 7:30 pm Sunday, January 30th | 2:30 pm Vivaldi The Four Seasons Piazzolla The Four Seasons of Buenos Aires
Vi br a n t u l Ma s t er f Al iv e!
For tickets call the Washington Pavilion Box Office 605-367-6000 sdsymphony.org
6
South Dakota Surgeon Elected to American College of Surgeons Board of Governors Executive Committee Gary L. Timmerman, MD, FACS, Sioux Falls, SD, recently was elected to a two-year term as a member of the Executive Committee of Board of Governors of the American College of Surgeons (ACS). He has served as a Governor-At-Large representing the state of South Dakota since 2007, and was elected to the Executive Committee during the College’s annual Clinical Congress, which was held in Washington, DC, in October. Dr. Timmerman is a general surgeon at Sanford Surgical Associates and a clinical associate professor of surgery at Sanford School of Medicine of the University of South Dakota, Sioux Falls. Dr. Timmerman received an MD degree from Washington University, St. Louis, MO, in 1984. He completed his residency in surgery at Rush Presbyterian-St. Luke’s Hospital, Chicago, IL, in 1989. He attained board certification from the American Board of Surgery in 1990, and became a Fellow of the American College of Surgeons in 1992. As a member of the Board of Governors, Dr. Timmerman has served as Chair of the Nominating Committee of the Fellows; a member of the Nominating Committee of the Board of Governors and the Committee on Chapter Activities; and as a liaison to both the Committee on Surgical Practice in Hospitals and Ambulatory Settings and the Committee to Study the Fiscal Affairs of the College. He has also served as Chair and Vice-Chair of the Committee on Young Surgeons and as a member of the General Surgery Coding and Reimbursement Committee. Dr. Timmerman has also been a member of the Member Services Liaison Committee of the College’s Board of Regents. On the local level,
Dr. Timmerman served as President of the College’s South Dakota Chapter from 1997 to 1998 and as the chapter’s State Advocacy Representative from 2003 to 2006. With his election to the ACS Board of Governors Executive Committee, Dr. Timmerman was appointed to the Governors’ Committee on Surgical Practices to serve as an Executive Committee Liaison. As a liaison, he will be the link between that committee and the Governors’ Executive Committee. The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The Board of Governors is an important organizational element of the College. Governors act as a liaison between the College’s Board of Regents and Fellows of the College. Although the Board of Regents has the ultimate responsibility for managing the affairs of the College, it relies heavily upon its 270-member Board of Governors to keep it informed of the concerns of the College’s more than 77,000 members. ■ Midwest Medical Edition
Partnering for Healthier Hearts in Our Community Thanks to our strong partnerships with North Central Heart Institute and Avera McKennan, Avera Heart Hospital was able to stand out against more than 1,000 hospitals nationwide with cardiovascular programs. Because of this collaborative effort, the Avera Heart Hospital was selected as one of the Thomson Reuters 50 Top Cardiovascular Hospitals. For the fifth year in a row we’re the ONLY hospital in South Dakota to receive this honor. This award is only given to hospitals that have superior performance – which means 93 percent of their patients remain complication-free, so patients have better outcomes. It’s an honor we share with our partners as we continue to work together to build a community of healthier hearts.
With all of this expertise,why go anywhere else?
January 2011
www.AveraHeartHospital.com
MidwestMedicalEdition.com
7
Local Programs Recognized with New Awards, Certification Sanford Hematology and Oncology and Avera Transplant Institute Sanford Hematology and Oncology in Sioux Falls and the Avera Transplant Institute in Sioux Falls have each received national recognition recently. Sanford Hematology and Oncology has become one of the first oncology practices in the nation to be recognized by the Quality Oncology Practice Initiative (QOPI®) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO). The QOPI® Certification Program is a new initiative to certify oncology practices that meet rigorous standards for high-quality cancer care.
QOPI is a voluntary, self-assessment and improvement program launched by ASCO in 2006. Through the QOPI program, practices abstract data from patients’ records up to twice per year and enter this information into a secure database. QOPI analyzes individual practice data and compares these to more than 80 evidence-based and consensus quality measures. Sanford Hematology and Oncology is one of only 42 that have currently received the inaugural certification in 2010. At the same time, the Avera Transplant Institute is among the top 21
percent of transplant centers in the nation awarded through a new program which recognizes high performing transplant programs. Avera Transplant Institute is the only transplant program in South Dakota and one of only two transplant centers in the Dakotas and Minnesota to earn the recognition. The new award process was developed by the federal government’s Health Resources and Services Administration (HRSA) Donation and Transplantation Community of Practice’s Transplant Center Task Force. The program measures performance, taking into account post-transplant survival rates, transplant rates, and mortality rates after being placed on the organ transplant waitlist. A total of 159 transplant programs were awarded, with one gold award nationwide, 10 silver, and 148 bronze. Avera Transplant Institute received a bronze award. ■
Sioux Falls
Go Red for Women Luncheon Friday, Feb. 25, 2011
Sioux Falls Convention Center 10 am Breakout Sessions & Silent Auction Noon Luncheon
local cause sponsor
media partners
special thanks to
SD Beef Industry Council First Premier Bank • Empire Mall PSA sponsored by MED Midwest Medical Edition.
©2010, American Heart Association. Also known as the Heart Fund. TM Go Red trademark of AHA, Red Dress trademark of DHHS.
Visit heart.org/southdakota for details. 2011 GRL SF ad.indd 1
8
12/3/2010 4:04:50 PM
Midwest Medical Edition
Inpatient Medically Complex Program Our specialty hospital provides excellent 24-hour nursing care for your pediatric patients!
Julie Johnson, MD Medical Director of Rehabilitation Services
James Wallace, MD Medical Director of Respiratory Care Services
The 18-bed specialty hospital at Children’s Care offers cost-effective care for children through age 21 who need 24-hour medical monitoring. Services include: • IV Medication Delivery • Suctioning, Oxygen Administration • Tracheostomy Care • Ventilator Use & Weaning • Skilled Nursing Observation following casting or surgeries • Nutritional therapy via gastrostomy, jeujostomy, NG or NJ
Call Rebecca Weeldreyer, RN, for details: (605) 782-2475
CHILDREN’S CARE HOSPITAL & SCHOOL For Children with Special Needs and Their Families 2501 W. 26th St., Sioux Falls, SD 57105-2498 (605) 782-2300
www.cchs.org
Electronic Health Records Improving the Future of Healthcare A solitary hunter from Brookings travels to the Black Hills for a weekend of turkey bow hunting, but the weather turns icy and his car hurtles into the ditch just west of Chamberlain. Unconscious, he is rushed to a critical access hospital, where the only piece of information the doctors have is the man’s driver’s license. Because of the hospital’s Electronic Health Record technology and connection to the SD Health Information Exchange, the doctors are immediately able to review the man’s medical records, determine his allergies, medications and recent health history, saving precious life-saving time in treating the unconscious man.
January 2011
Using health information technology to improve the quality of healthcare for all South Dakotans is the goal of the collaborative efforts of the: • S D Department of Health and its SD Health Information Exchange (SDHIE) project • SD Medicaid and federal incentive programs for healthcare providers • Two new grant funded projects at Dakota State University’s Center for the Advancement of Health Information Technology (CAHIT) — HealthPOINT, South Dakota’s federally-designated regional extension center, and the — SD Health IT Workforce Development project. This innovative collaborative effort is part of the national HITECH Act to promote the use of Health IT to impact the quality of patient care, especially in geographically disperse areas like South Dakota. Please visit www.cahit.dsu.edu and www.healthpoint.dsu.edu to get an idea of how these projects will transform the delivery and results of patient care in South Dakota.
MidwestMedicalEdition.com
9
Hope is in Sight
By Alex Strauss
For 20 years, the South Dakota Lions Eye Bank
has been quietly helping to restore sight to thousands of people in South Dakota and surrounding states. Although many people, even within the medical field, do not often think about the non-profit group whose mission is to procure and process corneas and other tissues for transplantation, more than 6000 recipients think of it every time they open their eyes. “In 2010, we have provided corneal transplants to nearly 500 people,” says Eye Bank Executive Director Jens Saakvitne. “The South Dakota Lions Eye Bank has about 400 eye donors each year and their generosity has helped us restore site to thousands of people, many of whom would be blind without a transplant.” Although solid organs such as hearts and kidneys are procured by Minnesotabased LifeSource, all donated corneas, and many other types of tissue, are procured and carefully handled by the South Dakota Lions Eye Bank.
Courtesy Lions Eye Bank/Gail Ries
Building for the Future
Linnea Bodenhamer and Talena Truman, Recovery Team Leaders, load a van in preparation for travelling to procure cornea and tissue donations. The Eye Bank has 21 per diem staff and 3 full time staff who travel to recover donations across the entire state of South Dakota.
10
With the need for transplantable corneas and tissues continuing to rise, the Eye Bank recently opened the doors of a new, expanded facility. The 16,000 square foot building on North 61st Street in Sioux Falls more than doubled the available space, allowing the Eye Bank to safely and efficiently serve more patients and physicians. In addition to added space for tissue processing and storage, the building features surgical suites with hospital grade HEPA filtration for on-site recovery, more space for eye and tissue research projects and staff training, and biohazard, shower and laundry rooms to meet all OSHA safety requirements. When a donor dies, regardless of when or where it happens, Eye Bank specialists either travel to the hospital to operate on site, or bring the donor’s body into one of the Eye Bank’s new operating suites to remove corneas and tissues there. A network of procurement specialists is on call 24/7 across the state.
Corneal Donation The cornea is the clear, delicate tissue that covers the outer surface of the eye. Corneas procured and stored quickly after someone has died, are the best hope for patients who have lost their sight due to illness or injury; science has yet to create an ideal artificial cornea.
Midwest Medical Edition
Courtesy Lions Eye Bank
Lions Eye Bank Expands its Services The Lions Eye Bank relocated to its new building on 61st Street in Sioux Falls in August 2010. The new space gives them 16,000 feet to harvest, process and store corneas and other tissues.
Courtesy Lions Eye Bank/Gail Ries
As an ophthalmologist in Sioux Falls, Dr. John Berdahl routinely uses corneas from the Eye Bank to restore sight in his patients. He also serves as the Eye Bank’s Medical Director. “Corneal transplantation is a great operation because it can really restore people’s quality of life and can bring them back from the brink of blindness,” says Dr. Berdahl. About the size and thickness of a dime, donated corneas are placed into a vial of preservative before they are put through a series of tests to determine their suitability for transplantation. A computer-controlled device is used to determine the cellular density of the endothelium – more endothelial cells make for better transplants. The cornea is then examined with a slit lamp for evidence of scars, infections or infiltrates. With proper handling, corneas have a shelf life of 14 days, but most surgeons prefer to use them within seven. “Thirty years ago, if you were going to have a cornea transplant you’d have to stay at home and sit by your phone, waiting for a donor,” says Dr. Berdahl. “Now, with the ability to preserve tissue, people can schedule these in advance like you would any other operation.” To save surgeons time and ensure a good fit, specialists at the Eye Bank offer pre-cutting of corneas for lamellar transplant surgeries. To pre-cut a donor cornea, an ultra-precise cutting instrument or laser is used to divide the cornea into upper and lower halves, either or both of which can be used for transplant. This highly specialized service requires a great deal of expertise and is offered by very few of the country’s eye banks.
Tissue Donation The Eye Bank will soon add the word ‘Tissue’ to its title to reflect the expansion of its procurement services over the past decade. Eye Bank professionals now regularly collect a variety of tissues other than corneas, including bone, connective tissues like tendons and ligaments, heart valves and veins. Tissues procured by the Eye Bank are shipped to one of several national processing centers to be prepped for national distribution. The most widely performed transplant surgery, bone transplantation can be used to repair defects, heal fractures and stimulate bone growth in cancer patients, trauma
January 2011
MidwestMedicalEdition.com
Corneas and other tissues brought into the Eye Bank must be held within a narrow temperature range to maximize their shelf life. Although corneas remain viable for 14 days, most U.S. surgeons prefer to use them within 7 days. When there is no immediate local need, older corneas may be shipped out of the region or even overseas where they are in great demand.
11
Courtesy Lions Eye Bank/Gail Ries
Alan Berdahl, Tissue Distribution Specialist, examines a cornea to determine its integrity. Each cornea is examined by computer to determine its cell count. Afterwards, Berdahl then examines each one by hand for evidence of scars, infections or infiltrates which would make it unsuitable for transplant.
victims or those with crippling bone infections. The transplantation of connective tissues such as ligaments and tendons is a more recent medical advancement. Tendons are the tissue of choice for repairing sports-related knee injuries. The fascia lata that encases the thigh muscles is used to treat eyelid abnormalities and spinal cord injuries. One tissue donor can provide up to ten tendons and the fascia can help four to eight people. Donated heart valves can be lifesaving for people with inherited heart defects. The aortic and pulmonic valves can be used, even if the heart itself was damaged by heart attack. Veins – particularly the saphenous veins – are
12
commonly used for heart bypass surgery and to salvage limbs in patients with serious vascular conditions. Every year, the Lions Eye Bank collects tissues from about 100 donors. According to Saakvitne, for each donor, there will be at least 25 recipients – and sometimes up to 60 – who will receive a life-changing transplant of some kind. Tissues or corneas that are not viable for transplantation can often still be valuable for research.
Lifesaving Learning One of the most exciting new projects made possible by the new facility is a training program for emergency responders. With the permission of the donor’s
family, emergency medical technicians as well as flight paramedics and nurses have the rare opportunity to practice complex life-saving techniques, such as placement of chest tubes, on real human bodies rather than mannequins. “Most people never get to do this on a real person before they are faced with having to do it in a very stressful emergency situation,” says Dr. Berdahl. “This is a tremendously valuable service that can give these emergency responders the confidence they may need to someday save a life out there when there is no one else around.” “We have probably had 20 donors since we started offering this six months ago, and for every one of them we have
Midwest Medical Edition
Lions Eye Bank
had 4 to 15 people in here, learning,” says Saakvitne. “It is just fascinating to see how hard they work to make the most of this rare training opportunity. There is also an extraordinary atmosphere in the room because they recognize what a gift this is and they appreciate it so much.” Even though improved facilities, new equipment and advanced technology are enabling the Eye Bank to touch more lives than ever, Saakvitne, who has been in the organ procurement business for 3 decades, says it is still the donors and their families who must get the greatest credit. “It starts with a family. It if weren’t for people being willing to sign up as donors and families being willing to say, in the midst of unspeakable grief, ‘Yes, we believe in this’, none of these miracles could happen. It is their incredible kindness that makes all of this possible.” To learn more about the Lions Eye Bank and their services, visit them on line at www.sdleb.org. ■
Ryan Dott, CTBS, CEBT, Clinical Manager, performs a DSAEK cut to preprocess a corrneal graft for use by a transplant surgeon. The Eye Bank began offering this custom preparation method 2 years ago and now performs about 100 of these cuts a year.
The new Eye Bank facility has two Surgical Recovery Suites for removing corneas and tissues. The suites are also where EMS trainees can practice lifesaving procedures on cadavers before having to perform them in the field.
January 2011
13
Then & Now Our Changing Medical Landscape
Remembering “Doc Sweet” By Darrel Fickbohm
T
he year was 1958. Office calls were sometimes six to eight dollars. It cost $96 dollars to deliver a baby. And the new physician had just arrived in the sand hills community of Burke, South Dakota. He was Edwin Sweet, M.D., originally from across the border in Dustin, Nebraska. He was fresh from the United States Coast Guard, and he would work his entire career at the same post, although he could not have known it at the time. He hated to have his photo taken, and even his home town newspaper editor had a difficult time supplying one for this article. But to a grateful town and surrounding countryside, he was a familiar face that was present during some of their most trying times. Everyone called him “Doc Sweet,” and the man who graduated at the top of his class from the University of Nebraska Medical School in Omaha,
14
Nebraska, certainly seems to have earned his gentle name. He lived alone and had very few interests other than medicine. He liked cars, motorcycles, and coins, but the job itself kept him too busy for most other things. Because he was the only doctor in the region at the time, he found himself always on call. When he finally did take time off, he had to bring in a doctor from Yankton or somewhere in northern Nebraska to stand in for him. By all accounts, the profession seemed to have fascinated Dr. Sweet. These were the days before CAT scans and MRIs and his keen interest made him very adept at diagnosis. He received many letters from other doctors complimenting his skill, and was especially good at diagnosing specific cardiac problems. Ob/Gyn specialists often depended on him because he always seemed to know when to get additional help. He had a phenomenal memory, often
recalling patient records and histories perfectly, and remembering babies’ names for years. “I’m sure he would have hated the modern way of documenting into a computerized database,” says his long-time colleague Fran Eide, RN. She further recalled: “Doctor Sweet was a quiet man who liked things quiet. When we were chattering in the office about the latest news, he would pass the door making yakkity-yak signs with his hands.” Dennis Hoffman, a policeman and long time acquaintance of Dr. Sweet, remembers that he often didn’t charge the full fee to a lot of people, and he didn’t seem to care about money—he secretly gave it away, especially to college bound kids who were on their way to study medicine. No one could say for sure where the money came from, however, because Dr. Sweet preferred to remain anonymous. Although “Doc” Sweet died in 1996, at the early age of 66, he is still talked about today as a beloved friend to the small community. ■ Looking back lets us see how far we’ve come. Do you have a memory or musing on the practice of medicine in our region? How have things changed since you saw your first patient? What’s better? What’s harder? We want to hear from you! Send your reflections to Alex@ MidwestMedicalEdition.com.
Midwest Medical Edition
Intensive Care for Newborns
In whose hands will you place her?
Physicians’ Priority Line
1.888.592.7955
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.
www.ChildrensOmaha.org December 2010 MEd Midwest Med Ed, Nov, 2010.indd 1
MidwestMedicalEdition.com
15 11/8/10 10:48 AM
Putting a Compress on Practice Profitability By Gary Pechota, President & CEO, DT-Trak Consulting
H
ealth care is more resilient than many other sectors of the economy but it is not immune from economic slowdowns. The effect of the economy is seen in decreased patient visits, delayed health care treatments and a higher percentage of uncollectible accounts. Even more disconcerting is the overall uncertainty regarding reimbursement and tax rates in the future. As we move into 2011 it may be a good time to take a fresh look at your medical practice business model. The majority of costs in a medical practice are physician and staff salaries, typically making up 80% of total costs. While all costs should be scrutinized, it isn’t realistic to expect a reduction in the other 20% of costs to offset the impact of reduced billings and higher uncollectible accounts. To maintain profitability, primary efforts must be focused on productivity, coding and billing expertise, and the right mix of skills to support practitioners. Productivity is one of the keys to a profitable medical practice. A simple analysis of visits per medical professional per day over the month is important. Look for time variations between physicians for the same treatment, average time spent per patient and medical versus administrative time. A review of revenue by CPT code and associated costs of delivering the service should be performed at least annually. There may be services that are only marginally profitable and, even if they are not eliminated, at least there will be an awareness of the financial implications of providing them. Coding and billing should be current at the end of the day or certainly by the end of the second day. Having qualified
16
coding and billing personnel with up to date training is critical because the insurers are working to minimize and extend the timing of payments. Proper coding and billing should minimize the number of denials and facilitate prompt payments by the insurers. Collections should be monitored daily. The financial challenges facing health care providers will continue so it is important to take a proactive approach. The following questions may help: Does the administrative staff have the skills needed to support the providers? Does the practice have the right mix of physicians, PA’s and NP’s? Is productivity consistent with other similar practices and is there an
understanding of the profitability on each service? Are coding and billing personnel adequately trained and cost effective? Would periodic outside audits be of value? Does the financial review focus on both net income and cash flow and are funds reserved for equipment replacement, growth or expanded services? What can be done to market the practice? Financial needs will differ depending on whether the practice is new, mature or growing. However, one characteristic all practices have in common is the need to monitor both operating and financial results on a monthly basis to maintain profitability. ■
Midwest Medical Edition
AMA Physician Groups urge CMS to Pay Overdue Reimbursements to Physicians The American Medical Association (AMA), along with medical societies representing all 50 states and the District of Columbia and 57 national medical specialty societies, called on the Centers for Medicare and Medicaid Services (CMS) to use the $200 million allocated by Congress to provide physicians with long-overdue Medicare reimbursements for payments they should have received in 2010. The funds were part of the Medicare & Medicaid Extenders Act of 2010, which was passed by Congress in December.
January 2011
“After weathering a year filled with uncertainties from continuous threats of cuts to Medicare payments, many physicians are not in a position to rely on IOUs from the government,” said Cecil B. Wilson, M.D., AMA President. “This week Congress allocated $200 million to help CMS comply with the new health reform law by reimbursing physicians for payments they should have received this year under the Affordable Care Act. We urge CMS to provide physicians with prompt information about how these claims will be handled, and to make the reimbursement process
MidwestMedicalEdition.com
as quick and simple as possible.” In a letter sent to Health and HumanServices Secretary Kathleen Sebelius, the organizations outlined the six provisions in the Affordable Care Act that called for physicians to be reimbursed at new payment levels. These provisions stated that the new levels would be retroactive and apply through all of 2010, including the months prior to the legislation’s enactment. However, those payments were not processed and physicians are currently waiting to receive reimbursements from the first half of the year. “These missing payments are having a real impact,” said Dr. Wilson. “Seventy eight percent of office based physicians are in small practices. Waiting for these reimbursements can cause them particular hardship as they struggle to keep their practices viable and care for Medicare patients.” ■
17
In Review What You’re Reading, Watching, Hearing
From the American Cancer Society
What to Eat During Cancer Treatment The Ultimate Comfort-Food Cookbook for Cancer Patients By Charlotte Hofer
P
eople going through cancer have special diet needs, and a patient’s appetite may change daily based on the type of treatment they are receiving. Although nutrition is critical to getting well from cancer, eating is often one of the hardest things cancer patients have to face —due to treatment side effects such as nausea, vomiting, diarrhea, constipation, mouth sores, swallowing problems, and unexpected weight loss. Now there’s a cookbook that will make life a whole lot easier for people with cancer – and their families. The American Cancer Society’s new cookbook, What to Eat During Cancer Treatment, helps cancer patients by providing 100 nutritious recipes, and advice about cancer nutrition. Healthy and delicious recipes such as “Mini Shepherd’s Pies,” “Crunchy Asian
Salad” “Mini-Chicken Pot Pies” will not only meet the needs of the person undergoing treatment, but will also be ideal for the entire family, eliminating the hassle of preparing separate meals. Recipes are organized by symptom and flagged with colorful “symptom icons” for easy reference. Although there are 100 recipes in the book, many of the recipes may be used for multiple symptoms, providing more than 220 options for symptom relief. For example, for nausea, try Brie & Apple Grilled Cheese on page 11. For taste alterations, try Honey-Teriyaki Salmon, p. 110. For sore mouth or difficulty swallowing, try Sherbet Shake, p. 72. The cookbook also includes 6 Bonus Features, including: Advice for the caregiver Tips to make eating out easier A kitchen staples list
Brie and Apple Grilled Cheese 1 serving
Advice on avoiding excess weight gain during treatment Tips on assembling a take-along food “survival kit,” A helpful list of organizations that provide information on nutrition and cancer. The result is the ultimate comfortfood cookbook that focuses on helping people with cancer get well. ■
1. Spread the Brie on one side of each piece of bread. Place apple on top of one slice and top with the other slice, cheese side down. Spread the butter on the othersides of the bread.
Prep Time:15 minutes or less Total Time:15 minutes or less 1½ ounces Brie cheese, white rind trimmed, or other cheese, 2. Place in a skillet over medium heat. Cook until at room temperature the bottom is golden and the cheese begins 2 slices raisin bread to melt. Carefully turn the sandwich and cook 2 to 3 thin slices peeled Granny Smith or other apple until golden and the melted completely. 1 teaspoon butter, softened Reprinted, with permission, from the American Cancer Society. What to Eat During Cancer Treatment: 100 Great-Tasting, FamilyFriendly Recipes to Help You Cope ( Atlanta, GA: American Cancer Society, 2009), 11. cancer.org/bookstore.
Have you read a book, seen a movie, heard a concert, etc. that moved you? Whether it made you mad or made you laugh, MED wants to help you share it with your colleagues. Send your reviews to Alex@MidwestMedicalEdition.com
18
Midwest Medical Edition
USD Medical School Dean to Retire
R
odney R. Parry, M.D., will retire in June 2011 as Dean of the Sanford School of Medicine of The University of South Dakota as well as USD’s Vice President of Health Affairs. In 2004, Parry was named Interim Dean and became Dean in 2005. He has been a medical school faculty member for 35 years. “It has been my honor to be able to serve the University for these many years,” Parry said. “Few people have the opportunity to work with so many gifted and dedicated individuals. My life has been greatly enriched by the faculty, staff
January 2011
and leadership as well as patients, students, residents and their families.” A native of Canistota, S.D., Parry received his undergraduate degree in pharmacy at South Dakota State University in 1965. After earning a B.S. in medicine from USD in 1967, he received his M.D. from the University of Wisconsin in 1969. He completed his internship in mixed medicine and pediatrics at the Good Samaritan Hospital in Phoenix, Ariz., in 1970 and completed his residency in internal medicine at the Mayo Graduate School of Medicine in Rochester, Minn., in 1972. Parry’s professional training also
MidwestMedicalEdition.com
includes a fellowship in pulmonary disease at the Mayo Graduate School of Medicine, which he accomplished in 1976. From 1973 to 1975, he served as a major in the Department of Medicine, United States Army, and was chief of internal medicine and allergy from 19741975. In 1976, he became one of the state’s first pulmonologists when he moved back to South Dakota. He also was named head of pulmonary medicine for the medical school that same year. In 1988, he became the medical school’s executive dean. “For more than three decades, Dr. Parry has worked tirelessly on behalf of the Sanford School of Medicine and The University of South Dakota. His vision, leadership and commitment have shaped the lives of generations of students, residents, scientists, physicians, and health professionals of all disciplines,” noted James W. Abbott, President of The University of South Dakota. “I wish Dr. Parry and his wife, Ruth, nothing but the best in his retirement from the Sanford School of Medicine and the USD School of Health Sciences.” Parry became the 13th Dean of the medical school, succeeding Robert C. Talley. During Parry’s tenure, the medical school received one of the best re-accreditations in its history. In addition, scholarship funding has increased significantly, a new pediatrics residency received approval, the School of Health Sciences was created and research funding increased. Additionally, the state-of-the-art Lee Medical Building was completed in Vermillion and the Avera Sacred Heart Professional Office Pavilion and Education Center was constructed in Yankton. In 2006, philanthropist T. Denny Sanford pledged $20 million to the school for new program development and faculty development. A search committee is being formed to find Parry’s replacement. ■
19
A
vera McKennan Hospital & University Health Center will observe a year-long celebration of its centennial throughout 2011, culminating with a centennial gala event on November 11, 2011. The theme for the centennial year is “A journey of faith, a destination of excellence.” “Our commitment to gospel values, and rich heritage of mission and ministry provided through the guidance of the Presentation and Benedictine Sisters have made the past century a journey of faith. Our destination continues to be excellence, with a priority on advanced technology, medical expertise and evidence-based care,” said Dr. David Kapaska, regional president and CEO of Avera McKennan. McKennan Hospital was founded and dedicated on December 17, 1911. In 1906, Helen Gale McKennan left $25,000 in her will to found a new hospital in the city of Sioux Falls. The Presentation Sisters of Aberdeen, S.D., already operated hospitals in Aberdeen and Mitchell, and agreed to open this new hospital. The hospital, state-of-the-art for its time, had 55 beds, many in private rooms with private baths. At a cost of $110,000 to build and equip, it had a surgical suite, and many modern amenities such as electricity, telephone service and an elevator. The Argus Leader noted that while this local hospital was not as large as many that were in existence, “it could safely be said that there was not a more up-to-date, or better equipped hospital in the northwest.” McKennan’s first patient came in only a few hours after the hospital dedication ceremony on Dec. 17, 1911, for an emergency appendectomy. Only 100 patients were seen during McKennan’s first year, yet admissions had grown to 1,500 annually by 1920. Today, annual inpatient admissions are nearly 22,000, with over 260,000 outpatient visits and nearly 1 million clinic visits. Avera McKennan is nationally recognized for quality. Each year since 2006, it has been listed among the nation’s 100 Top Hospitals® by Thomson Reuters. In 2010, Avera McKennan was on a list of Top 10 Trailblazing Hospitals by FierceHealthcare for quality and innovation. In 2009, the Avera Cancer Institute received the Outstanding Achievement Award from the American College of Surgeons’ Commission on Cancer. ■
20
100
Avera McKennan Hospital & University Health Center Kicks Off Centennial Celebration
0 Years
MidwestMedicalEdition.com
21
Medicaid, South Dakota’s State Budget, and Physicians By Dave Hewett, President/CEO, SDAHO
I
t accounts for 38% of South Dakota’s total State Budget of $3.2 billion; it provides health insurance coverage to over 14% (or 1 in 7) South Dakotans; it is the primary payment source for 50% of children under age 1 in South Dakota. So it goes without saying that South Dakota’s physicians are big part the State’s Medicaid program. The key issue for just about all providers in the State is the inflationary update that the Legislature and Administration approve each year. You know that the last two years has seen no increases in provider payment rates. And given the State’s projected fiscal situation that may be the most providers can hope for State Fiscal Year 2012. So what are the major fiscal
challenges facing South Dakota’s Medicaid program? The first one is enrollment. During this economic downturn, the number of Medicaid beneficiaries has swelled from about 100,000 in 2007 to nearly 114,000 at the present. The second is the Federal Medical Assistance Percentage or FMAP. FMAP is the percentage of the State’s Medicaid budget that is paid by the Federal government. In South Dakota that amount has typically been about 60%. Over the past two years the amount was significantly greater (almost 70%) because the Feds provided some extra, one-time assistance to all states. Well, in 2012, that extra Federal money goes away and South Dakota’s actual FMAP will likely slip below 60%. Bottom line, the State
You’re always there for them.
We’re always here for you. We have defended and supported the individual needs of health professionals for more than 30 years. And nobody is more personally committed to protecting you from the risks you face every day. To learn more, call 888-397-3034 or visit MMICGroup.com
Exclusively promoted and recommended by the South Dakota State Medical Association.
22
will have to find about $40 million in state revenue just to stay even. The third is utilization. With more enrollees comes more utilization and expenses for the program increase. That notwithstanding, Medicaid is paying physicians at rates that are typically less than 50% of their charges. And those rates are not going up anytime soon. Certainly for some physicians and other providers these payment rates create new issues about how they manage their practices and business operations. Medicaid payments to physicians account for about 28% of South Dakota’s Medicaid program (total budget for FY2011 is projected to be $682 million). And it would be easy for some physicians to make the decision to distance themselves from the program. But before coming to that conclusion, it is also important to consider why the Medicaid program exists. It exists to provide some level of coverage to those who lack resources. Typically to qualify for Medicaid a family must have less than $2,000 in assets and an annual income at 133% or less than poverty (about $30,000 for a family of four). Medicaid represents a partnership between the State and the provider community to ensure that many people without financial means have access to
Midwest Medical Edition
basic health services. It is not be the best payer, but it is a reliable payer and it helps to us fulfill our obligation to provide essential services to those in need. But partnership is a two-way street and that’s why it will be so important for physicians to make a concerted effort to explain their funding needs to State legislators during this 2011 Legislative Session. State revenue dollars are in short supply and how they are distributed will ultimately depend on those groups that can best “tell their story.” If you need assistance in telling “that story,” go to www.sdaho.org and click on the advocacy tab to learn more. ■
Avera Heart Hospital of South Dakota has been named one of the nation’s 50 Top Cardiovascular Hospitals by Thomson Reuters. The study, now in its twelfth year, examined the performance of 1,022 hospitals by analyzing outcomes for patients with heart failure and heart attacks and for those who received coronary bypass surgery and percutaneous coronary interventions such as angioplasties. This is the fifth year that Avera Heart Hospital has been recognized with this honor. This year’s winners were announced November 15 in Modern Healthcare magazine. The study shows that 96 percent of cardiovascular inpatients survive and approximately 93 percent remain complication-free, indicative of improved cardiovascular care across-the-board over the past decade. The 50 top
January 2011
A CT SYSTEM THAT ADAPTS TO THE NEEDS OF YOUR PATIENTS AND YOUR HOSPITAL Siemens SOMATOM Definition AS Available in 20, 40, 64 and 128-slice configurations
» Siemens’ unique dose-saving features aid in reducing dose by up to 68 percent. » Adapts to almost any patient, organ or clinical need with a large 78 cm bore and weight capacity of 660 lbs. » Provides detailed, quality images physicians utilize to help them make a fast, accurate diagnosis. Cassling offers Siemens imaging equipment in addition to unbeatable local service and end-to-end efficiency solutions.
Contact Shane Slaughter, Cassling Account Executive (605) 321-6909 | sslaughter@cassling.com
hospitals’ performance surpasses these high-water marks as indicated by: Better risk-adjusted survival rates (33 percent fewer deaths than non-winning hospitals for bypass surgery). Lower complications indices (21 percent lower for heart failure complications). Fewer patients readmitted to the hospital in the 30 days following discharge. Shorter hospital visits and lower costs. Top hospitals discharge heart patients a half day sooner and spend $1,300 less per case than non-winners. The study evaluated general and applicable specialty, short-term, acute care, non-federal U.S. hospitals treating a broad spectrum of cardiology patients. Thomson Reuters researchers analyzed 2008 and 2009 Medicare Provider Analysis and Review (MedPAR) data, Medicare cost reports, and Centers for Medicare and Medicaid Services (CMS) Hospital Compare data. They scored
MidwestMedicalEdition.com
www.cassling.com
hospitals in key performance areas: riskadjusted mortality, risk-adjusted complications, core measures (a group of measures that assess process of care), percentage of coronary bypass patients with internal mammary artery use, 30-day mortality rates, 30-day readmission rates, severity-adjusted average length of stay, and wage- and severityadjusted average cost. ■
The Avera Heart Hospital is: • Among the top 3% nationally for overall patient satisfaction • The lowest 30-day, riskadjusted heart attack mortality and readmission rates in the region. • An accredited chest pain center by the Society for Chest Pain Centers
23
Splinting At Work By Stan Kulzer, OTR/L
M
edical clinics often see patients with work related overuse injury to the hand, wrist or elbow. Whether the diagnosis is tendonitis, carpal tunnel syndrome or some other condition, one of the first treatments for these diagnoses may be the application of a pre-fabricated wrist splint to be worn at work. Work splints are occasionally helpful. But after watching employees work in a splint, you realize splints can actually add strain to the patient’s hand if applied without the correct knowledge. Follow these steps when considering the application of a splint for work.
Know the Job Does tool use on the job require bending and twisting the wrist? Will the splint hold the wrist neutral but then transfer the motion to the shoulder causing strain there? Would ergonomic education right at the job site be a better choice for preventing the unwanted movement and strain?
24
Explain Splinting Goals If preventing wrist motions that could worsen the injury is part of your goal, explain the concept of neutral wrist posture to the patient. I’ve seen employee’s push against the splint, bending and twisting their wrist while using a tool or handling material. The splint didn’t keep them neutral at all. In fact, it added resistance and increased the strain level. None of these individuals understood the splint was supposed to help them prevent the use of the awkward wrist postures.
Splint Fit Remember that if the patient is going to be working in the splint, you need the fingers and thumb to move freely. If they can’t, they’ll be straining against the splint which leads to more overuse! The only way to tell is to try the splint on. You should have several brands, styles and sizes on hand to give you the best fit options. To fit, the end of the splint should fall below the distal palmar crease (represented by the red line in the left photo
above). Notice it slants downward from the index finger to the small finger. The black splint in the middle photo below is a good fit for the thumb opening, but a bad fit for crossing the distal palmar crease. The tan splint in the right photo below does a better job of falling below the distal palmar crease, allowing adequate finger movement without resistance. ■ Stan Kulzer is an ergonomic and loss control specialist with Risk Administration Services..
Midwest Medical Edition
Regional Cancer Care Institute Receives CDC Grant
L-R: Daniel Petereit, M.D., Radiation Oncologist at the Regional Cancer Care Institute and Walking Forward Grant Principal Investigator; B. Ashleigh Guadagnolo, M.D., MPH, of M.D. Anderson Cancer Center, Radiation Oncologist and Walking Forward collaborator; & Vanessa Short Bull, Walking Forward Community Research Supervisor.
The Centers for Disease Control and Prevention (CDC) recently awarded a grant totaling $250,000 each year for two years to the South Dakota Department of Health to increase patient navigation in South Dakota. The Regional Cancer Care
Institute’s (CCI) Walking Forward Program is a partner on this grant and will receive $140,000 over two years. This patient navigation project will demonstrate opportunities to extend program reach and assist in the coordination of care in large health delivery
systems. It will focus on two priority populations that experience high chronic disease occurrence and significant barriers to care: American Indian women ages 40-64 and low income, rural women ages 40-64 in South Dakota. The project will support expansion of existing patient navigation through the Walking Forward Program, implementation of patient navigation support at three urban Indian health clinics built on the experience of the Walking Forward Program, and establishment of a patient navigation model for federally qualified community health centers in collaboration with Falls Community Health in Sioux Falls. A state health department web-based interactive resource will be expanded to link people through patient navigation. The CDC utilizes grants to assist other health-related and research organizations that contribute to CDC’s mission of health promotion through information dissemination, preparedness, prevention, research, and surveillance. ■
Our Region’s Heart Team www.heart-doctors.com 1-800-HEART-22 14368-1210
January 2011
MidwestMedicalEdition.com
25
Theme Chosen for 2011 Hospice of the Northern Hills Benefit Ball
Mavis Jewitt, (far right) Hospice of the Northern Hills Director, presented 2011 Hospice Ball tickets to (L-R) Bryan and Cathy Lessly and Kathy and Jim Sigle, winners of the theme-naming contest for the Hospice of the Northern Hills (HNH) Benefit Ball.
“Come Fly With Me” has been selected as the theme for the 2011 Hospice of the Northern Hills (HNH) Benefit Ball. Each year there is a themenaming contest for the Ball. Bryan and Cathy Lessly and Jim and Kathy Sigle submitted the theme at the
2010 Ball. As winners, each couple received two tickets to the March 5, 2011 ball at the Northern Hills Holiday Inn Convention Center. “This will be our 14th annual ball and it has improved each year,” said Mavis Jewitt, HNH Director. “We start
planning the next ball just as soon as the last one is done. We have great support from generous local businesses and sponsors for this vital charity event to make it successful.” This formal, black-tie-optional event is HNH’s major fundraiser of the year, helping HNH meet the needs of Hospice patients. The 2010 Benefit Ball raised more than $27,000 for Hospice patients in the northern Black Hills. “Hospice Ball tickets make a wonderful Christmas or Valentine’s gift,” Jewitt said. “We will, once again, be having a gourmet sit-down meal, complete with the superb vocal entertainment of Michael Shaw. Dick Dittman Band will provide the music that everyone loves to dance to. Boyd Larson will oversee the always diverse and exciting live auction.” Tickets are $65 each if purchased on or before Feb. 14, 2011 and $75 each after Feb. 14. As past Hospice Benefit Balls have sold out, the public is encouraged to purchase tickets as soon as possible. For more information, to sponsor, make a donation, or to reserve tickets, call Hospice of the Northern Hills at (605) 644-4242. ■
Make-A-Wish has a goal of
Reaching All Eligible Children Since 1984 the Make-A-Wish Foundation® of South Dakota has been granting wishes to children across the state. The Foundation is dedicated to making every eligible child’s wish come true. As members of the medical community, you can help by referring children with life-threatening medical
26
conditions by calling the office in Sioux Falls. Make-A-Wish® has more than 200 volunteers and a dedicated staff ready to make wishes come true. Last year, the organization granted a record 63 wishes and is on pace for another record year. Make-A-Wish has granted more than 860 wishes
over the last 27 years. You can also get involved by attending one of our many fundraising events across the state or by adopting a wish as an office or staff. For more information, visit www.southdakota.wish. org or call 800.640.9198 statewide or 605.335.8000. ■
Midwest Medical Edition
Grape Expectations
Resolution: Inventory Your Wine Collection By Heather Taylor Boysen
T
he thing I notice the most about January and February is the silence. The retail craziness, school breaks, holiday vacations and parties have all ended. Typically it is ice cold with lots of snow on the ground and we have all begun what I call South Dakota hibernation. It is a time we can all catch our breath, adhere to our New Year resolutions (or not), and get ready for another year. In my case, I reconnect with my family after a long but fun holiday season and do many things I love such as cooking, having coffee with my friends and doing inventory. Yes, inventory. I inventory everything. Clothes, books, magazines, towels, you name it and I inventory it. If I haven’t used it, worn it, or read it, it leaves my house one way or another. I also inventory my wine. Whether it is my home wine cellar or the wines I carry in my store, I take a hard look at what I have and determine what needs to happen with all of the products I have in my inventory. In the case of the wine I have at home, I look at what is reaching
its prime and needs to be consumed. This time frame varies from bottle to bottle. Everything from the quality of wine, type of grape and cellaring conditions come into play when making these decisions. I do not have a fancy cellar. What I have is an old house with a room in the basement which maintains a constant temperature and humidity throughout the year. It has no direct light source other than overhead lighting and has cinderblock walls and cement floors that aid in keeping humidity constant as well. In most storage conditions, it is temperature fluctuation and sunlight that will destroy wine. A dark closet without any kind of heat source is an option in most houses. Wines under cork will need to be laid on their sides to keep the corks wet. Wines under screw cap will do fine upright. Please do not store wine in your kitchen unless it is in a wine fridge. In many kitchens I see built in wine racks above refrigerators and next to stoves. The heat and vibration from these appliances will absolutely kill wine. It may look pretty, but unless you want vinegar do not consider these areas as adequate storage. The wines I choose to store are typically reds, with high tannin or acidity. The “babies” that I have and want to open in a decade or so are also very high quality, made to age and several are in magnum bottles which age better than the standard bottle size. If you are collecting wine you want to be able
MidwestMedicalEdition.com
to store for a period of time, please discuss with your wine merchant what might be the best amount of time for the wine you have purchased. I have been known to contact wineries directly to ask that very question. Being armed with information is better than guessing what’s right for your prized bottles of wine. So I challenge you to make one more resolution for the New Year. Go through your wine collection and make sure those bottles you’ve been saving are cellared well and are not past their prime. Find a reason to enjoy those that should be consumed before it’s too late. And when you end up with some holes in the wine rack, well, that’s just a good excuse to go out and buy some new wines to keep your cellar well stocked.
27
News & Notes
Happenings around the region
Regional The local chapter of the Blue Knights (South Dakota 1) recently donated books, movies, videogames and items for babies to hospitalized children through the Children’s Miracle Network (CMN). The gifts totaled more than $2,000. These items will be used by children in Pediatrics, the Emergency Department, and the Regional Behavioral Health Center in Rapid City, and at Lead-Deadwood Regional Hospital. Each year, the local Knights travel 1,000 miles, within 24 hours, to raise the funds for charity. For the second consecutive year, Press Ganey Associates, Inc., has named Custer Regional Hospital (CRH) one of its 2010 Summit Award Winners.
The award recognizes top performing facilities that sustain the highest level of customer satisfaction for three or more consecutive years. CRH is one of 80 organizations to receive this honor for 2010. Press Ganey currently partners with more than 10,000 health care facilities — including more than 50% of U.S. hospitals — to measure and improve the quality of their patient care. The company’s databases are the largest in the industry and allow facilities nationwide to benchmark their results against peer organizations. The Rapid City Regional Hospital (RCRH) Laboratory has successfully fulfilled the requirements for receiving accreditation from the College of American Pathologists (CAP), the world’s largest association composed exclusively of board-certified pathologists and widely considered the leader in laboratory quality assurance. CAP inspectors examine the laboratory’s records and quality control of procedures for the preceding two years as well as examine laboratory staff qualifications, equipment, facilities, safety program and overall management of the laboratory.
Athletic trainers with Regional Orthopedics Sports Medicine donated $3,208.32 to the John T. Vucurevich Regional Cancer Care Institute on Friday, Nov. 19. Proceeds came from donations to the Pink Tape Against Cancer events held at high school sports events in Belle Fourche, Lead-Deadwood and Spearfish during the month of October. For a donation, athletes could choose pink tape for their pre-game wraps, which were provided by the trainers. Regional Health’s Infection Control departments have announced the organization’s 2010 Infection Prevention and Patient Safety Ambassadors. Six Regional Health employees were selected for the honor based on their
commitment to keeping hospital patients, employees, and visitors safe and free from infection. The recipients included: Lisa Baldridge, RN, Rapid City Regional Hospital; Sylvia Cuka, LPN, Regional Medical Clinic-Aspen Centre; Dorna Kightlinger, RN, Lead-Deadwood Regional Hospital; Annette Peldo, Environmental Services Supervisor, Sturgis Regional Hospital; Susan Warner, Environmental Services Director, Spearfish Regional Hospital; and Martha Watkins, Lab Technician, Rapid City Regional Hospital.
Avera Avera McKennan Hospital & University Health Center has earned the Silver Medal of Honor for Organ Donation from the Department of Health and Human Services for achieving and sustaining national goals for donation, including a donation rate of 75 percent or more of eligible donors. Avera McKennan has earned the Medal of Honor since 2005.
Finding Balance low sex drive 7 out of 10 women complaining of low sex drive have a hormone imbalance
hot flashes
8 out of 10 women complaining of hot flashes have a hormone imbalance
depressed
2 out of 3 women complaining of depression have a hormone imbalance Pharmacy Specialties will help you find balance again. Call today to schedule an appointment!
2333 W. 57th Street - Suite 107 Sioux Falls, Sd | 605-334-1672 0000239966
28
Midwest Medical Edition
Learning Opportunities Happenings around the region
January, February, March 2011 January 6 9:00 am - 3:30 pm
On the CUSP: Eliminating Central Line-Associated Blood Stream Infections Location: Ramkota Hotel, Sioux Falls Contact Email: rhonda.christensen@sdaho.org Website: www.sdaho.org
January 11
SD Legislative Session Opens Location: Pierre, SD
January 13
Pediatric Grand Rounds: Extracorporeal Membrane Oxygenation
8:00 am
Location: Sanford USD Medical Center - Schroeder Auditorium Credits Offered: AMA PRA Category 1 - 1.00; Attendance - 1.00
Feb. 2-3
Advanced Cardiac Life Support Provider Course
7:45 am
Location: Avera McKennan Education Center, Classroom 2
February 3-5
SDAFP Winter Seminar Location: The Lodge at Deadwood Information: www.sdafp.org CME Offered: Up to 70, with follow-up materials
February 16-17
Fundamental Critical Care Support Program
8 am - 5 pm
Location: Avera McKennan Education Center, Classroom 1 Information: 605-322-8950
February 25
American Heart Association, Go Red for Women Conference
Location: Sioux Falls Convention Center Information: heart.org/southdakota
March 4 - 5
Black Hills Winter Conference on Emergency Medicine
Location: Holiday Inn, Rapid City, SD CME Offered: 12 Information: 605-719-8045
MED reaches more than 3500 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at Alex@MidwestMedicalEdition.com.
January 2011
MidwestMedicalEdition.com
29
Customized care A patient is diagnosed with cancer. A team of specialists comes together. Oncologists, surgeons, pathologists, radiologists, nurses, researchers, counselors and nuclear medicine just to name a few. Multiple eyes focusing on that one patient’s case. Determining the best treatment plan for that unique patient. At Sanford Cancer, most cancer cases – whether simple or complex – are discussed by our multidisciplinary team which delivers the highest level of care. Meets national guidelines. Strengthens the care team. Simplifies things for the patient. Overlooks nothing. Why customize care? When it comes to cancer treatment, this is what you do.
100-11395-2083 12/10