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Vol. 3 Issue 5

2012 July August


South Dakota and the Upper Midwest’s Magazine for Physicians and Healthcare Professionals

THE 2012

THE 2012

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Regular Features 2 | From Us to You 4 | News & Notes: News from around the region

New! We’re expanding our popular News & Notes section, covering late-breaking news from across our four-state coverage area. Let us know what is happening in your area and we will spread the word to your colleagues across the region. 7 | Meet a MED Advisor – James Young, DO 16 | The Nurses' Station 22 | Off Hours: Puttin' on the Stripes A local physician talks about his surprising pastime on the football field. 24 | Grape Expectations: Confessions of a Wine Glass Snob

| By Heather Taylor Boysen

29 | Learning Opportunities:

Upcoming Symposiums, Conferences, CME Courses

In This Issue 6 | P  rimary Care and Innovation | The SDAHO president explains why this month’s dual MED topics of Primary Care and Medical Innovation share some important connections | By Dave Hewett

7 | Sanford Wins Largest Operational Grant in its History 12 | Avera Launches First-of-its-Kind Customized Website 14 | C  ommunication to Female Patients:

Not ‘One-Size-Fits-All’ | A marketing specialist offers some proven tips for better communication with your female patients | By Tana Tipton

15 | Local Joint Program Receives National Recognition 18 | T  he Fate of Primary Care – Part 2

| As South Dakota and the upper Midwest head toward a critical shortage of primary care doctors, can anything be done to stem the tide? In the second part of our two-part series, we get insight from primary care providers on why they chose their field and what might be done to encourage others to do the same

20 | Physician Compensation Study Reveals Ups and Downs 21 | Now is the Time to Estate Plan

| By Alice Rokahr

25 | T  he Globally Harmonized System: What it Means for Your Office

| By Terry Dell and John Gold


Contents Midwest Medical Edition

Have you ever found yourself attempting to accomplish some task in your practice and thinking, “There must be a better way to do this”? Have you ever envisioned that ‘better way’ yourself, but later forgot or dismissed the idea? Many doctors have. But most medical tools and techniques have come directly from doctors who were willing to do whatever it took to turn their ideas into reality. In this month’s cover feature, find out exactly what it takes, and meet some local doctors who have travelled the path to medical innovation themselves.

The Path to Medical Innovation



Cover Feature

From Us to You

Staying in Touch with MED

A letter from the Editor


hen I was a kid, I remember spending whole Saturdays in my room with tape, tools, plastic wrap, small boxes and batteries, determined to ‘invent’ something. Needless to say, my efforts didn’t pay off, despite my enthusiasm. The problem was that I didn’t really NEED anything. And need, as we know, is the driving spark behind true innovation. These days, doctors often find themselves in need of a tool or technique that could help them work more effectively, safer, faster or more economically. Few have the time, the means or the know-how to turn that need into an actual product, but those who do are changing the face of medicine and, sometimes, their own financial futures in the process. We hope you’ll be inspired by the advice and encouragement we gathered from local people who have either been through that process themselves or guided others through it. To our surprise, we discovered that South Dakota is actually a prime spot for medical innovation. Also in this issue, we want to bring your attention to our expanding section exclusively for late-breaking healthcare and practice news from around the region. MED is committed to being your most timely, local and relevant medical news source. News & Notes is the place to see who is building or moving, who has been awarded or promoted, who has new equipment or is offering a new technique…. Or to let your colleagues know of similar news in your own practice life. If our large and diverse medical community was a single building, News & Notes would be the employee bulletin board. We invite you to use it that way. Finally, in the spirit of innovation, MED VP of Sales Steffanie Liston Holtrop has an invention of her own to announce. She and her husband Nate welcomed Jaxson Jon Holtrop, newest member of the MED family, on June 13th. The designers and their totally original creation are doing well. May this summer be a time of inspiration in your own life and work. Thanks for your continued support and readership of MED. —Alex “I look forward to meeting many of you in Chamberlain at the SDMGMA fall conference. In the meantime, please contact me if you want to be a part of MED’s September/October conference issue. Thanks to all of you who have wished us well with our new addition.” – Steff Steffanie Liston-Holtrop and son Jaxson



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

Heather Boysen Terry Dell John Gold Dave Hewett Alice Rokahr Tana Tipton

Liz Boyd Caroline Chenault John Knies

Alex Strauss

MED Magazine, LLC Sioux Falls, South Dakota

Staff Writers

Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 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 ccep We aader re s i o n is subm

©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

One number accesses our pediatric surgical specialists, any problem, anytime.

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, May, 2012.indd 1

5/1/12 9:55 AM

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Avera



Avera Sacred Heart Hospital in Yankton broke ground on its new Northern Lights expansion project in June. The three-story,

Regional Health Clinical Research is participating in a clinical research study, Type I Diabetes TrialNet, and was

Sanford USD Medical Center President Charles O’Brien has been listed among the 100 Physician Leaders of hospitals and Health Systems by Becker’s

$17 million+ addition will include a new kitchen, cafeteria, pharmacy, laboratory, physician amenities, sleep lab, environmental services space and meeting areas. Located on the northwest corner of the existing hospital, the project was named for the many windows that will let in natural light.

Avera Medical Group has opened new primary care locations in Sioux Falls, including

Avera Medical Group McGreevy West Benson Road, Avera Medical Group McGreevy Pediatrics South at 69th and Minnesota, and Avera Medical Group McGreevy Dawley Farm in front of the Eastside Target at 1035 S. Highline Place.

recently awarded a Certificate of Appreciation by TrialNet and University of Minnesota. Led and funded by the National Institutes of Health (NIH), TrialNet is an international network of researchers exploring ways to prevent and delay the progression of type 1 diabetes. The study aims to help researchers better predict who will develop diabetes and when it will require treatment. Custer Regional Hospital (CRH) has closed its Edgemont Clinic after 20 years in operation. Two

Avera Flandreau Hospital and Avera Medical Group Flandreau have broken ground on a $7.6 million construction and remodeling project. Phase 1

includes a new clinic, an outreach physician clinic and a new laboratory. Next winter, Phase 2 construction will begin on new hospital outpatient areas and a new Emergency Department. Avera Medical Group Worthington has begun construction on a three-story, 60,000-square-foot facility to house family practice and internal medicine, as well as

specialties including surgery, pediatrics, obstetrics and behavioral health. With this new building will come new service additions, including an outpatient surgery center, physical therapy and home medical equipment.


Brian Lassiter, President of the Performance Excellence Network, presents the Network’s Advancement Award to Avera Sacred Heart President Pamela J. Rezac and Doug Ekeren, VP of Planning and Development.

Avera Heart Hospital in Sioux Falls and Avera Sacred Heart Hospital in Yankton have received the 2012 HealthGrades

Outstanding Patient Experience Award™. This distinction ranks these two hospitals among the top 5% of hospitals nationwide based on an analysis of patient satisfaction data for 3,837 U.S. hospitals by HealthGrades. According to HealthGrades, 80% of patients treated at the nation’s best-performing hospitals would definitely recommend the hospital compared to only 53% of patients who received care from the poorest-performing hospitals.

of the three medical providers will join Lisa Brown, M.D., and Bruce Eaton, M.D., at the nearby Hot Springs Regional Medical Clinic. Patients can also obtain their health care services at the Hill City Clinic or Custer Clinic. Regional Health Laboratories has opened a new outpatient location in the Western Hills Professional Building on Fifth Street in Rapid City. The

new location offers outpatient blood draws, free parking and competitive pricing. No appointment is necessary and all insurance types are welcome.

Hospital Review. Physician leaders were selected for inclusion on this list based on their healthcare experience, awards they’ve received and their commitment to quality care.

Siouxland Mercy Medical Center has been resurveyed by the Iowa Medical Society (IMS) Accreditation Council for Continuing Medical Education (ACCME) and awarded the CME status for four years.

Mercy’s medical staff has one of the longest accredited programs in Iowa and is the only accredited provider of CME activities for physicians in Northwest Iowa. The program has been accredited continuously since 1981. The President and CEO or Trinity Health, parent company of Mercy Medical Center has been installed as Chairperson of the Catholic Health Association (CHA) board of trustees for fiscal year 2012-13. Joseph R. Swedish was

first elected to the CHA board of trustees in 2006 and was elected to his current role last year, serving as Vice-Chair/Chair-Elect during CHA’s fiscal year 2011-12.

Midwest Medical Edition


Sue Froid, a 26year veteran of Mercy Medical Center, has been promoted to Director of Emergency/Mercy Air Care/ Ambulatory Services. Froid holds

a dual Masters degree in Nursing and Health Care Administration and has been instrumental in facilitating many special projects across the organization. Siouxland patients have a new tool in the fight against breast cancer. Two new digital

mammography machines have been installed in St. Luke’s Imaging and Breast Screening Center located in Physician Center Two on the St. Luke’s campus. Purchased through a grant from The Leona M. and Harry B. Helmsley Charitable Trust, St. Luke’s new equipment is upgradeable to advanced imaging applications, vital for the prevention and early detection of breast cancer. St. Luke’s Hospital has broken ground on its new Sunnybrook Medical Plaza for patients in the Morningside area. In anticipation

of 30% growth in outpatient services over the next ten years, the 86,000 square foot, twostory building will offer various outpatient services including a new primary care clinic with obstetrics, urgent care clinic, cardiology, digestive health, lab, imaging, infusion, maternal-fetal medicine and pulmonary care. Some of the facility’s space will be reserved for future development. St. Luke’s plans to open the new facility in the summer of 2013.

July / August 2012

Yankton Dr. Karen E. Dickes of Willcockson Eye Associates, Yankton was recently recognized as a finalist for the Patrick G. Murray, Doctor of Osteopathy (DO) Award At the 2012 American Osteopathic Association (AOA) meeting. She was awarded second

place for the second year in a row for her score on the Ophthalmic Knowledge Assessment Program (OKAP) exam. Dr. Dickes joined the Willcockson Eye Associates, P.C. practice in August 2011 and sees patients in both the Yankton, SD and Norfolk, NE office locations. Yankton Medical Clinic, PC, has received the South Dakota State Medical Association Media Award for its direct-mail publication, The Healthcare Examiner. The award was

presented to Yankton Medical Clinic’s Director of Marketing, Joanna L. Mueller, and Dr. James W. Young, at the 2012 South Dakota State Medical Association Banquet in June. The quarterly Examiner features health-related articles from by physicians of the Yankton Medical Clinic, P.C. and Vermillion Medical Clinic and includes a comprehensive photo directory of all of the primary and specialty care providers at both clinics.

Melinda Heegel, MS, CCC-A, Kristen Kaufman, Au.D., CCC-A and Lindsey Koch, Au.D., CCC-A have opened a news clinic, Audiology Specialty Clinic located at 5124 S. Western Avenue in Sioux Falls. The

group offers hearing services including hearing evaluations, hearing aid sales, cochlear implant mapping and custom earmolds. All are certified audiologists specializing in hearing health care from children to adults. Appointments can be scheduled by calling 605-275-5545.

Children’s Care Hospital and School in Sioux Falls recently received a $100,000 donation from the Children’s Care Auxiliary. The auxiliary raised the

funds through three fundraising events in the past nine months and will use the funds to provide items from a wish list created by staff. This year’s wish list items include Ipads for classrooms, an upgrade to the sensory room for children with autism and other sensory challenges, scholarships for horse therapy and aquatics, a blanket warmer for children unable to maintain body temperature, therapy bikes, and community outings.

A new television ad campaign made possible by a grant from the Leona M. and Harry B Helmsley Charitable Trust in partnership with the American Heart Association is encouraging people not to ignore the signs of a heart attack. The Telly award-

winning ads were designed by Epic Multimedia in Sioux Falls and feature EMT’s from across South Dakota recounting excuses they have heard for not calling 911 at the onset of heart attack symptoms.

Surgical Institute of South Dakota recently moved its

practice from the 8th floor to the 7th floor of the Physician Office Building on the Avera McKennan campus. The new clinic space is accommodating the growth of the practice by providing 40% more square footage for additional exam and procedure rooms, nursing and reception areas, and administrative areas.  Cardiovascular surgeon Dr. Lewis Oftein is retiring from North Central Heart Institute

after 32 years. Dr. Ofstein received his medical education at the University of Iowa and did his surgical training at Indiana University. He and six fellow physicians founded North Central Heart Institute in 1981. He was instrumental in founding the Avera Heart Hospital which opened in 2001 and served as Chief of Surgery there. Mary Dekker Nettleman, MD, MS, MACP,

began her term as Dean of the Sanford School of Medicine and USD’s VP for Health Affairs in April. Dr. Nettleman, a graduate of Vanderbilt Medical School, completed a residency in internal medicine and a fellowship in infectious diseases at Indiana University. She earned her MA in preventive medicine/epidemiology from the University of Iowa. Dr. Nettleman becomes the 14th dean of the medical school, succeeding Dr. Rodney R. Parry.


Primary Care


Innovation M

By Dave Hewett

ED Magazine's Midwest’s dual themes this month of physicians as innovators and the fate of primary care are not mutually exclusive. Far from it. In fact with the closer consideration of accountable care organizations, medical homes, health homes, value based purchasing and other concepts in this era of “reform” innovation and the future of primary care are inexorably linked. The link is forged by the general concepts that our health care delivery system should be focused on keeping people well instead of just treating them when they are ill and providing service based on value, not volume. The touchstone for turning those theories into reality is primary care. But as we are learning through the experiences of pilot projects and provider groups that have

launched headlong into these models, they can fail as easily as they can succeed if the many aspects of the new delivery models are not aligned and managed. So what are the components of these new models of care that need to be in sync? Here are a few examples: ✔ Primary care must be centered on the patient and the family.

✔ Systems of care should be closely

the provider community based on value and for keeping patients well.

✔ A greater focus on behavioral health needs of clients and patients as well as enhanced wellness coaching, screening and preventive services.

✔ Methods and programs to have the patient and the patient’s family take it upon themselves to be committed and

partnered with public health and other

compliant to a wellness plan in a world

organizations focused on wellness.

where temptations to eat the wrong

✔ Physicians and other health care providers must retool their understanding of team-based health care.

✔ Comprehensive clinical data systems that allow the primary care provider team to closely monitor the status of their patients on a real time basis.



“With a strategically placed team of engineers in South Dakota, Cassling is able to repair down equipment faster than anyone else in the business. That’s the best part about my job — supporting customers and getting their system up and running again, so they can get back to caring for their patients.” Cameron Johnsen, Field Service Engineer

Every day, we strive to respond to our customers’ equipment service needs quickly and efficiently. That’s why we’re proud to report that Cassling customers experience an average equipment uptime of 99.8 percent. Download case studies featuring Cassling customers and learn more about our personal service commitment.

things, multitask from the couch, text from the car, tan indoors, etc., abound.

All of these are major challenges for which innovations in primary care have not provided all the answers yet. By way of example, think about reimbursement systems. By and large, they continue to be based on fee-for service models that reward volume instead of value. They reward providers for doing more when people are sick. Of course there are permutations that seek to limit utilization, but in general until providers can share in the rewards for keeping people well across the payer spectrum, these medical home models will be just that – models. Primary care is ripe for innovation. Innovation will be central to transforming the currently unsustainable health care delivery system. Physicians have always taken the lead in transforming clinical care in this country – that transformation continues it will be the physician community that ultimately determines whether this foray into keeping people well succeeds or fails. ■ Dave Hewett is President/CEO of the


South Dakota Association of Healthcare WWW.CASSLING.COM | 402-334-5000 | 800-228-5462


✔ Reimbursement systems that truly reward


Midwest Medical Edition

Grant Will Boost

Local Primary Care

A talk with MED Advisor

James Young, DO Dermatologist

The federal government has awarded Sanford Health a $12 million Health Care Innovation grant – the largest operational grant in the organization’s history. The grant was awarded as part of a nationwide program that stemmed from the Health Care Reform Act. These Centers for Medicare/Medicaid grants are given to applicants who show the ability to quickly implement the most compelling new ideas to deliver better health, improved care and lower costs to Medicare and Medicaid patients and those with the greatest healthcare needs. Sanford will use the grant to expand its Medical Home program in South Dakota, North Dakota, and Minnesota. This grant will: ●

Expand the Medical Home program

Full integrating behavioral health services into primary care

Increase the number of nurse health coaches available for patients

Maximize IT, a major support system within our organization

Standardize quality reports

According to Sanford, the grant will allow the system to “develop a more holistic approach to primary care”. The hope is that, through better management of patients with chronic conditions, the number of emergency room visits can also be decreased, improving care and reducing costs. The $12 million CMS grant is one of the largest that CMS awarded under the new program. ■

Be protected, stay cool. We protect your peace of mind. It’s what we do for medical professionals. We know your work challenges are unique. And so are we. Sure, we provide medical liability insurance. But we’re also focused on your personal wellness. We want you to feel as groovy as possible, because if you’re at your best, you’ll deliver your best. It’s a Peace of Mind movement, and we’d love for you to join us. Contact your independent agent or broker or check out to see what MMIC can do for you.

Q: As a dermatologist, you are a passionate proponent of sunscreen. Why is it so important? A: Everyone who is alive has a 1 in 55 chance of getting melanoma. It is increasing at a faster rate than any other cancer and unprotected sun exposure is a big part of the reason. One of the strongest risk factors for melanoma is a blistering sunburn before age 20. But sunburn at any age raises your risk. Q: Picking a sunscreen used to be easy, but there are so many options now. How do you decide what to use or recommend? A: The old adage goes ‘The best sunscreen is the one you’ll use’. And no sunscreen is going to do any good if you don’t use enough of it. Most people use way too little. You need about a shot glass full to adequately protect your face, hands, arms and neck. Also, people should avoid rubbing their hands together before applying because so much of it will stay on your hands. People come in all the time with sunburn and tell me they were wearing sunscreen. Q: Are there certain ingredients we need to be looking for when selecting a sunscreen? A: You want to get a ‘broad spectrum’ product, one that protects against both UVA and UVB rays. If a patient is on a medication that makes skin more sensitive to sunlight, it’s the UVA rays they need to be worried about. Same with lupus, for which sun exposure is one of the diagnostic criteria. Q: You say you try to lead by example. What sunscreen do you use?

MMIC has earned the AM Best industry rating of “A” (Excellent) for 20 consecutive years.

July / August 2012

A: I have oily skin, so I am glad to have found Coppertone Sport 50 for Faces, which is much less greasy than some other products. Fortunately, there is a sunscreen to work with just about every skin type now. If you’ll use it regularly, then it’s the right one for you.


By Alex Strauss

Eureka! . . . . . . . . . . . . . . . The Path to Medical Innovation


ave you ever had an idea you were sure could improve how you practice medicine if only you had the time, money, patience and know-how to take it to the next level? Although it can seem like a daunting task, many of the most innovative medical tools and procedures began as the brainchildren of physicians with unmet needs and ‘outside the box’ attitudes. Sioux Falls vascular surgeon Pat Kelly, MD, is a prime example. For Dr. Kelly, medicine is a second career. “I was a structural engineer for four years before deciding to go to medical school. I have always been a person who likes to solve problems,” he says. As a vascular surgeon, one of the biggest problems he noticed was the highly invasive nature of abdominal debranching for treatment of thoracoabdominal aneurysms. Although thoracoabdominal aneurysms occur most often in the elderly, many of these patients have comorbidities that make them poor candidates for major surgery. Dr. Kelly’s practice performs only about seven of these procedures annually but he believed those numbers could be higher if the procedure could be made more tolerable for fragile patients.

“If you work in a hospital system or even in a private clinic, chances are there is something in your agreement that discusses intellectual property.”

Vascular Surgeon Pat Kelly’s modified stent graft allows for repair of thoracoabdominal aneurysm through just three small incisions, making the operation feasible for even fragile patients.

Sioux Falls Neurosurgeon Wilson Asfora invented the Asfora Bullet Cage spinal fusion device, the Dakota Knife for carpal tunnel release, holds 18 patents, and owns his own medical device company. “Once you realize that you really need something, chances are others need it, too, and you should pursue it,” he says.


“Abdominal debranching is the biggest operation we do,” says Kelly. “It often involves significant blood loss, significant OR time. Many patients who could benefit from the procedure never even get referred because they could not handle it. I thought for a long time that there has to be a better fix for this.” One option is fenestrated stent grafting, which requires a custom-made graft to fit each patient’s anatomy. Few patients are candidates and few centers offer the challenging procedure. But when Dr. Kelly mentioned the need for a better fenestrated stent graft to some device manufacturer reps, they were less than encouraging. Drawing on his engineering background, he decided to find his own solution. In the Sanford lab, Dr. Kelly modified and reconstrained an existing fenestrated stent, making it useable in a far wider range of patients. “This new stent graft allows us to get the same job done with almost infinite anatomy,” explains Dr. Kelly. “Patients can have one kidney higher than the other or just about any scenario. This stent can be taken off the shelf and used by just about any patient. And we can do the whole procedure with just three small incisions.” The results in patients in whom the stent has been tested, with their informed consent, have been dramatic. Thoracoabdominal aneurysm patients who might have been hospitalized for months go home within days instead. Dr. Kelly is hoping that the stent modification will be significant enough to make the new device patentable and is beginning the process of shopping it around to medical device manufacturers.

Patents and Intellectual Property “Before you go too far down the path, it is important to know what your rights are regarding intellectual property,” says Mike Jerstad, JD, MBA, of Prairie Gold Venture Capital in Sioux Falls. “If you work in a hospital system or even in a private clinic, chances are there is something in your agreement that discusses intellectual property. Would the inventor get royalties on the invention or own it outright? Does the agreement specify who owns the patent? Or is it silent on the issue?” Many systems encourage physicians to invent by supporting their efforts with the appropriate infrastructure and offering them a share of the profits from a new product. Once the relationship is understood, the next step is determining patentability. “You can’t invent something that has already been invented or is obvious,” says Jerstad. “A patent lawyer will do a thorough search to see what is out there and can advise whether or not the idea is patentable. If it is, they can start the process of writing a patent.” At this point, Jerstad advises, the more detail, in the form of drawings, schematics, photos, models, etc. that can be provided to the lawyer, the less time-consuming and expensive the patent-writing process will be. During the process, it is best not to publish or even mention the idea, not only for fear of imitators, but because an idea that becomes “public domain” is in danger of becoming unpatentable.

Midwest Medical Edition

To protect an idea during the initial development phase, a patent lawyer may file a provisional patent, which effectively places a “hold” on the concept for a year. Eventually, a design patent may be issued for a product that represents a modification to an existing product, while the more valuable utility patent is more common for unique new inventions. But the patent process is not for the faint of heart. Those who have been through it caution that it can take years, during which legal fees can continue to rack up each time the patent lawyer must respond to the PTO’s rejection (called an “Office Action”) of a claim. For this reason, it pays to consider an idea’s marketability early in the process.

Business Considerations

release system known as the Dakota Knife, as well as another vertebral fusion device. In all, Dr. Asfora holds 18 medical device patents, many of which are marketed through his company, Medical Designs, LLC, in Sioux Falls. “Need is the mother of invention,” says Asfora. “When you are a surgeon, you need certain things. Once you realize that you really need something, chances are others need it, too, and you should pursue it.” But he is quick to add this warning: “If you have something that you think is really good, don’t give your idea away. Don’t go to a big company and show it to them, because they will take it.” Instead, he advises physician inventors who are ready to shop their product around to hire a professional with experience in negotiating licensing agreements or sales to medical device companies. “These days, one of the most important questions for new medical products is how is it going to reduce the overall cost of healthcare,” says Jerstad. “Is the product going to allow for a less invasive procedure or reduce hospital stays? These are key considerations.” Jerstad says it is also important to understand the reimbursement requirements for the new product, information that can be a vital selling point in today’s healthcare environment.

Once the intellectual property rights to an idea have been established and it is properly protected – or, in some cases, even before – an inventor should consider the business aspects of the potential product. “Does the invention address a real point of pain in the system, and, if so, whose pain?” suggests Jerstad. “Is it the doctors’ pain? Patients’? Hospitals’? Payors’? The government? Is your device a game-changer, or is the change it makes incremental? These may seem like obvious questions but they will guide you in knowing whether this is the kind of thing one would license to another company, or build a company around.” Sioux Falls Neurosurgeon Wilson Asfora, MD, took the latter route after inventing the Asfora Bullet Cage, a lumbar spinal fusion system that received FDA approval in 2009. Buoyed by the success of the bullet cage, Dr. Asfora went on to develop a carpal tunnel

Unlike other types of inventions, medical devices must pass muster not only with the PTO, but also with the FDA. Medical products that are similar enough to existing products may not have to start at ground zero, but may instead be able to travel the more truncated 510K path to approval. Because the burden of testing is lower, this less stringent path has the potential to bring new products to market faster than the more extensive Pre Market Approval (PMA) path. Testing is the next step. Fortunately for local would-be inventors,

July / August 2012

the upper Midwest is an ideal place for medical innovation. “Minneapolis is a real hub for prototyping,” says Jerstad. “An inventor can get this done for a reasonable price. You can get your device prototyped without having to spend gobs of money.” Funding for prototyping may come from the physician/ inventor, the institution for whom he or she works, angel investors or even personal friends. “If things start rolling and seem to be getting going, that would be the time to seek venture financing,” advises Jerstad, whose firm specializes in obtaining such financing. “The further you are down the line, the more valuable your invention is,” says Dr. Asfora. “If you have a manufacturer, have FDA approval, and have doctors using it, the value is much higher for a company. You should not sell it for peanuts.” “My message to other doctors who have ideas is not to poo poo your idea,” says Dr. Kelly, who recently presented his modified stent at a meeting of the Society for Vascular Surgery. “Even if it isn’t ‘the’ idea, it may lead to another one. Eventually, some of our ideas can become phenomenal and can really change the course of healthcare for patients.” “There is a solution to every problem,” he observes. “We just have to think of it.” ■

The FDA and Prototyping


some of our ideas can become phenomenal and can really change the course of healthcare for patients.” 11

Avera Launches First-of-its-Kind

Customized Website Site aims to walk breast cancer patients through the maze of options The Avera Breast Center at the Avera Cancer Institute has launched a new online guide to breast cancer created by Vladimir Lange, MD, an expert on helping patients and their families cope with a diagnosis of breast cancer. Avera’s Be a Survivor website is customized with over 80 short original videos featuring Avera’s own physicians and staff, describing the different types of breast cancer, diagnostic tests and procedures, and treatment options and risks. Local patients also describe their experiences with emotion and honesty. All the video was shot in the Avera Cancer Institute, located in the Prairie Center on the Avera McKennan campus. Three-D graphics are designed to help educate patients on all aspects of their breast cancer diagnosis and treatment options. The site,, is the first web resource of its kind that is customized with video from local physicians and patients, Dr. Lange who is also author of the award-winning book , “Be a Survivor – Your Guide to Breast Cancer Treatment.”. When Lange’s wife, who is also a physician, was diagnosed with breast cancer, both were overwhelmed by the complexity of the information they had to process. Dr. Lange says, “If two physicians are confused, how is a lay person expected to understand?” BeASurvivor The website is designed to help patients and their families:

kA  ssemble the best team of experts to ensure successful treatment

kD  ecide between surgical options kU  nderstand how genomic testing can determine whether chemotherapy is needed

k Deal with side effects of chemotherapy

k L earn about new treatments, such as IOeRT and Oncoplastic Surgery

kC  onsider appropriate complementary therapies

kC  ommunicate effectively Being web based makes this resource available to all women throughout the region and beyond, which is especially important to patients and their support persons who live in rural locations. ■

Incontinence Treatment for Children Sioux Falls & Rapid City

Many children suffer from various problems associated with bowel and bladder control. Children’s Care offers effective relief, fast and inexpensively, through outpatient physical therapy.

Our easy and effective treatment program combines behavioral and Inflation: CPI-U vs. Medical Care Services physical therapies, aided by state-of-the-art, kid-friendly biofeedback, and Medical Care Services CPI-U muscle management techniques. Therapy is typically weekly, lasting eight to twelve sessions. 5.9 Children’s Care can treat children over the age of four who have retentive and non-retentive difficulties, including: • Urinary incontinence • Dysfunctional voiding • Constipation • Regression wetting

• Fecal Incontinence 4.2 (including stool hoarders) • Nighttime bed wetting • Children never toilet trained

Covered by most insurance.

4.9 4.5


Robin Lund, PT, DPT 4.1 Sioux Falls


Christine Stephenson, PT, DPT 3.6 Rapid City 3.4 3.5




For more details, an appointment, or private consultation, 3.0 2.7 call (605)782-2400 in Sioux Falls, 2.7 2.5 or (605)342-4412 in Rapid City.

1.9 1.5

2501 W. 26th St., Sioux Falls, SD 57105 • 1020 West 18th St., Sioux Falls, SD 57104 • 7110 Jordan Drive, Rapid City, SD 57702 0.1 2003










Source: U.S. Bureau of Labor Statistics, Percent change from previous December


Midwest Medical Edition

Construction Underway on New Sports Complex

Sanford Health has begun construction on the multi-use sports facility which will be the epicenter of a new sports complex in northwest Sioux Falls. The Pentagon by Sanford Health is a 160,000-square-foot facility that includes nine basketball courts (six high school regulation, two professional/college practice courts and the “heritage” court). While the entire facility features modern design and amenities, the heritage court located in the center of the building is a premium NBA/college size court with design inspiration reminiscent of 1950’s/1960’s basketball. “Sanford Health’s mission is dedicated to the work of health and healing,” says Nate

July / August 2012

will be the home for Sioux Falls Junior Football league, Sioux Falls Tennis, Sioux Falls ICE as well as Dakota Alliance Soccer Club which will operate from the Sanford Fieldhouse. Announced November 2011, the Fieldhouse

will provide access to athletic performance development, comprehensive functional, physiological and biomechanical evaluations, as well as rehabilitation and nutritional consultation services. ■

White, Sanford Health’s chief operating officer for the Sioux Falls division. “While it is always our goal to heal those who need our care when they are ill, it is also our mission to keep people healthy. That includes giving them opportunities and resources to stay healthy.” The facility, as the name describes, is the shape of a pentagon. Floor space can be transitioned from basketball to accommodate 11 volleyball courts as well as wrestling and cheer/dance events. The facility is focused on athletics, but will also serve other community needs. The Pentagon will be the epicenter of the 162 acres Sanford Sports Complex which


Communication to Female Patients


one-Size-fits All


By Tana Tipton

omen today manage more roles than ever before: spouse, parent, caregiver, breadwinner and her family’s chief healthcare decision maker. In fact, 90 percent of American adult women are responsible for their household’s health-care decisions. Women also are responsible in another role – patient – and are the highest consumers of health-care services, especially inpatient services, according to the U.S. Department of Labor. In addition to being your organization’s core customer, women are your toughest critics. According to a study published in the journal Health Services Research, women tend to be less positive about their hospital experiences compared to men. Researchers studied results from almost two million HCAHPS patient experience surveys, and discovered that women were less satisfied overall and rated their HCAHPS scores lower than men. Since CMS reimbursement is now tied to HCAHPS scores, and women are more likely than men to share their health-care experiences with family and friends via blog, Facebook or other social network, it’s crucial you know how to communicate with women and cater to their health-care needs.

Follow these tips to speak to women ✔ Use language that appeals to boomers. There are millions of baby boomer women (born 19461964) and 85 percent of them dislike the way they’re portrayed in the media. Ditch words like “elderly,” “old” or “senior” in your marketing and use “experienced,” “wise,” “mature,” “seasoned” or “enduring.” beyond the experts to ✔ Look 

cater to new moms. Women prefer to turn to other women like them, rather than authorities, for information they trust. New moms and those considering pregnancy are no different. Feature real patient stories in your advertising in addition to physician education.

focus on your brand ✔ Don’t 

directly. Instead, focus on the sense of fulfillment that comes from women’s most important values like love, health and security.

✔ Be realistic. Women don’t appreciate unrealistic age portrayals or body types for their age group. To gain women’s trust and advocacy, an accurate portrayal of women is a must. ■

Tana Tipton is a marketing specialist at Cassling, a Midwest healthcare company that provides local imaging equipment sales and service, and marketing and professional services.

South Dakota Medical Group Management Association Fall Conference

surviving in the Changing Healthcare Environment

August 22-24, 2012 Cedar Shore Resort Chamberlain, SD

For the full schedule or to register, visit our website at


Midwest Medical Edition

Cancer Study Seeking Cancer-Free Participants The American Cancer Society’s Epidemiology Research Program is inviting men and women between 30 and 65 years who have never personally been diagnosed with cancer to join the Cancer Prevention Study-3. CPS-3 is a national grassroots effort that allows local communities to support cancer research not just through fundraising, but also by participating actively in this historic research study. The goal is to enroll at least 300,000 adults from various racial/ethnic backgrounds from across the U.S. in order to better understand the lifestyle, behavioral, environmental and genetic factors that cause or prevent cancer and to ultimately eliminate cancer as a major health problem for this and future generations. Enrollment is available locally in partnership with Avera McKennan, Sanford Health, the City of Sioux Falls, Citibank and Premier Bankcard. Enrollment appointments are being offered during August. ■

Geoffrey Tufty, MD

Pediatric Ophthalmology Sanford Eye Center and Optical

To learn more or to schedule an enrollment appointment, go to:

Joint Program Receives

National Recognition Sanford USD Medical Center in Sioux Falls has earned The Joint Commission’s Gold Seal of Approval for its hip fracture program as well as its knee replacement, hip replacement, and shoulder replacement programs. Sanford is the only health system in the nation to receive all four certifications. “Achieving Joint Commission certification in hip fracture, hip replacement, knee replacement and shoulder replacement is extremely challenging,” says Charles P. O’Brien, MD, president, Sanford USD Medical Center. “The certifications serve to validate our commitment to ongoing quality and our focus on continuing to raise the bar.” As part of the voluntary process, Sanford Health recently underwent rigorous on-site surveys for each of these four programs. A team of JCAHO surveyors evaluated Sanford for compliance with standards of care specific to the needs of patients, including infection prevention and control, leadership and medication management.  “This is not just a one-time event, but rather how we provide care to our orthopedic patients on a day-to-day basis,” says O’Brien. ■




anford Children’s team is a family of pediatric specialists who offer additional expertise to physicians in need of compassionate, partnered care for their patients with eye conditions. Dr. Geoffrey Tufty is the only fellowshiptrained pediatric ophthalmologist in the region. He specializes in the diagnosis, treatment and management of diseases and infections of the young and developing eye.

For referral information or to refer a family, call (605) 328-9200.

MED Quotes To array a man's will against his sickness is the supreme art of medicine. ~Henry Ward Beecher

July / August 2012

500-55210-0046 5/12


The Nurses’ Station Nursing News from Around the Region

Avera Sacred Heart Hospital

Named as Action Coalition

Avera Sacred Heart Hospital and Avera Education and Staffing Solutions have been selected as an Action Coalition by the Future of Nursing: Campaign for Action, coordinated through the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation (RWJF). Avera Education and Staffing Solutions is working with the campaign to implement the recommendations of the landmark Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health. For more information about the Campaign for Action go to ■ Poppe Receives 10th Annual Lori Schrempp Memorial Nursing Scholarship Mount Marty College nursing student and Avon native Megan Poppe, has received the 10th Annual Lori Schrempp Memorial Nursing Student Scholarship. The award is in memory of Lori Ann Schrempp, RN, a 22-year veteran of Avera Sacred Heart Hospital who died in a Life Flight helicopter crash in 2002. The scholarship fund is administrated through the Avera Sacred Heart Foundation, the philanthropic arm of Avera Sacred Heart Hospital. Poppe’s husband, Jeff, presented the award to her. ■

Crandall, Koch Named Sister Cleopha Scholarship Winners Meaghan Crandall (left), RN, Avera Sacred Heart Hospital, and Candace Koch (right), RN, Avera Sacred Heart Hospital, are the recipients of the 2012 Sister Cleopha Scholarship for Continuing Education. The Sister Cleopha Scholarship was established as a scholarship for nursing staff of Avera Sacred Heart Hospital to attend workshops. Crandall will be using the scholarship to attend a perinatal care conference and Koch will be using the scholarship to purchase a CD to learn how to write effective appeal letters when your claims have been denied. The award was presented to Crandall and Koch by Frani Kieffer, Executive Director of the Avera Sacred Heart Foundation. ■


Rapid City Regional Hospital (RCRH) recently honored eight outstanding employees with Nursing Star Awards, recognizing excellence in nursing. The Star Awards, developed by RCRH’s Nurse Shared Governance Council, encourage employees to nominate their fellow nurses.

RCRH Nursing Start Award Winners: Back row, pictured left to right: Dr. Keshav Panday, Carol Dugan, Melinda Wells, and Virgina Espeland. Front row: Joann Stock, Gretchen Errea, Judith Amo, and Nellie Isaacs.

♦ Guiding Star Mentor Award Judith Amo, RN, NICU

G  old Star Service Award

Gretchen Errea, RN, Infusion Services

♦ Shining Star Community Award

Virgina Espeland, RN, Wound Care

♦ Rising Star Novice Award

Melinda Wells, RN, Clinical Coordination

♦ Super Star Expert Award Joann Stock, CRN, ICU

Blazing State Advanced Practice Nurse Award

Carol Dugan, Advanced Practice Clinician, Regional Heart Doctors

♦ The Supportive Star Award

Nellie Isaacs, Health Unit Clerk, Ortho/Neuro/Surgical area

♦ T he Luminary Nurse Advocate Award Keshav Panday, MD, Hospitalist

New Director for

MERCY PATIENT REFERRAL PROGRAM / Mercy Medical Center in Sioux City has named Cassandra “Cassie” Twillman, RN, BSN to direct the 2Mercy initiative. 2Mercy gives physicians a onecall, hassle-free process for direct patient admissions to Mercy. Twillman joined Mercy in 2011 after nine years in the Sanford Health System. Most recently she worked with Dr. David Lucke in Mercy Internal Medicine. Twillman will work with local and regional physicians to facilitate their patient admissions to Mercy.

Midwest Medical Edition

TerBeest Honored with Rapid City Regional Hospital’s

Bankers Trust Company of South Dakota



Providing Experienced & Personalized Trust Services


John TerBeest has received the first DAISY Award for Extraordinary Nurses at Rapid City Regional Hospital (RCRH.) TerBeest is a Registered Nurse in the Intensive Care Unit and has worked at the hospital for 19 years. DAISY is an acronym for “diseases attacking the immune system” and has grown into an on-going recognition program, now in seven countries, that celebrates the skill and compassion of direct care nurses. A patient’s family described TerBeest as, “a friend, a nurse, and a very devoted man to his job.” He is recognized for his respect, comforting nature, and commitment to providing excellent care to patients and their families. RCRH has committed to the DAISY Award program and will be honoring one extraordinary nurse per month. ■

• • • •

Asset Protection Product Knowledge Comprehensive Solutions Personal Service

MED Quotes

5032 S. Bur Oak Place Suite 131 Sioux Falls, SD 57108

I defy the tyranny of precedent. I go for anything

(605) 338-5033

new that might improve the past.” —Clara Barton

Be part of

Research at Regional Health.

Research provides opportunities to build the foundation for the future of health care. Everyone is affected by research in one way or another. Our physicians are invested in your best health opportunities and we are at the forefront of these treatment options. Before these discoveries can happen community volunteers like you are needed.

It takes you to find a cure.

(605) 716-3982


July / August 2012


Dr. Wallace “Skipper” Fritz, family practitioner, Sioux Falls



The Fate of

Primary Care

As thousands of baby boomers reach retirement age every day while the world’s population continues to surge, the need for primary care providers

– the so-called ‘gatekeepers’ of healthcare – is greater than ever. In the first

Primary care allows one to interact with patients at a much different level.

Rodney Parry, MD, retired dean, USD Sanford School of Medicine

part of our two-part series (“The Fate of Primary Care – Part I”, June 2012), we explored some of the reasons why the American Academy of Family Physicians predicts a critical shortage of primary care doctors in the next 8 years. Medical student debt, growing workload (read, long hours), lower reimbursements and salaries, and even a stigma against the specialty in some of the nation’s medical schools may all share part of the blame. And with a state ratio of 769 primary care doctors per citizen (the national benchmark is 631 to 1), South Dakota’s providers may be working even harder than their colleagues in other parts of the country, making primary care even less attractive. Yet, despite the downsides, more than 850 South Dakota doctors do practice Internal Medicine, Family Medicine or Pediatrics ( and the Sanford School of Medicine turns out 4 percent more Family Medicine graduates than the national average. In Part II of our series, we explore what brings physicians to these fields in our area, and what keeps them there.

A Taste for Variety

David Barnes, MD, a Family Medicine specialist with the Yankton Medical Clinic, initially planned for a career in orthopedics. “My interest in orthopedics is what got me into medicine in the first place,” he recalls. But after spending time providing general medicine services for the Indian Health Service, paying off his medical school debt, he found that he “didn’t want to give up anything”. Like many primary care physicians, it was the diversity – of problems and of patients – that ultimately hooked him.


“There is enough variety to really keep you on your toes,” says Dr. Barnes, who doesn’t hesitate to turn to his specialist colleagues when he needs to. “It can be a challenge to stay up on so many things, but it also ensures that you don’t get too comfortable and miss something.” Sioux Falls pediatrician Sam Schimelpfenig, MD, thought he would be an adult cardiologist. But that changed after a mid-winter pediatric rotation. “January and February are the busiest months for pediatrics, but every day I was excited to go in and see kids.” And what about those medical school loans? “I care more about people than a paycheck,” he says. A fortunate thing for his growing patient base.

Long Term Relationships

“Primary care allows one to interact with patients at a much different level,” explains retired Sanford School of Medicine Dean Rodney Parry, MD. The school has a stated mission to produce more primary care graduates, especially those willing to practice in underserved areas. “These doctors really get to know their patients on a deeper level, and are able to give more comprehensive care, over a longer period of time. So primary care can be very rewarding.” The number of primary care graduates from USDSM typically hovers around the national average of 39%, but the school is hoping to raise that number. The curriculum has been altered to introduce clinical experience earlier in the student’s medical education. Each student will also have the opportunity to follow patients for an

July / August 2012

entire clinical year, exposing students to the longitudinal aspects of primary care. “Our hope is that, by giving students more relevant clinical experience earlier, and giving them the chance to follow patients longer, they will have more self confidence to go into primary care, where the body of knowledge must be so large,” says Dr. Parry. “I was most attracted to the well-roundedness of patient care,” says Krista Hoyme, DO, a thirdyear resident with the Sioux Falls Family Medicine Residency Program. “I love the idea of being able to be involved in the care of patients from baby care to the nursing home. It is true that you have to have a huge body of knowledge, but you have to weigh that against the continuity of care and the relationships that you get to develop.” Sioux Falls family physician Scott Boyens, MD, sums up his approach to primary care this way: “Most of the time the important thing is just to be human and to really listen to people.”

Saving Primary Care

Few dispute the necessity of primary care, or the fact that the numbers of providers are dwindling. But opinions vary as to the answer. One place to start, says Dr. Schimelpfenig, is by reducing the burden of debt that can make other specialties more alluring. According to the AMA, most medical students leave medical school as average of $156,000 in debt. “The college loans, the medical school loans, and the necessities of life all come due at the same time

they may be starting a family, too,” says Dr. Parry. According to Dr. Mark Schwartz, author of a major Internal Medicine study and an associate professor at New York University Medical School, the total salary difference between a cardiologist and a general internist over a 40-year career is almost $3.5 million. When faced with a choice between two equally interesting specialties, some students feel they have little choice but to take the better-paying path. “It is a hard pill to swallow, especially for people who want to go into primary care,” says Schimelpfenig. “If debt management could be improved – either by making medical school more affordable on one end or providing better reimbursement on the other end – it would be easier for people to justify going into primary care, especially in a rural situation.” “Most family practice people don’t go into it for the money, but it’s definitely an important consideration,” says Dr. Barnes. Barnes says the ability of primary care providers to assess which patients need specialty care and which don’t saves time for overworked specialists and money for the healthcare system. As Washington looks for a solution to the nation’s healthcare dilemma, Barnes says lawmakers would do well to pay attention to the plight of primary care. “Whatever solution we come up with to boost the numbers, it is going to take ten years to get it up and going,” he says. “The people in Washington need to be aware that family practice is limping along. It is not like some specialties where ten people apply for one position.” ■

I love the idea of being able to involved in the care of patients from baby care to the nursing home. Krista Hoyme, DO

Dr. Angela Meyer, family practitioner, Sioux Falls


Physician Compensation Study Reveals

There was both good news and bad news in this spring’s annual Physician Compensation Report from Medscape. According to 24,216 physicians across 25 specialty areas, about half are making slightly less this year than they did last year. Radiology and Orthopedics continued to be the highest-paying specialties on the list with average annual compensation of $315,000. Internal Medicine, Family Medicine and Pediatrics – the three primary care specialties – were at the bottom of the list in a range from $156,000 to $165,000. But the news wasn’t all bad for primary care. All three primary care specialties made the list of those whose compensation levels were increasing, albeit slightly. At the same



time, radiology and orthopedics saw a nationwide drop in compensation of 10% while general surgeons are making 12% less than they did last year. Physicians in single-specialty group practices tended to earn the most, followed by those employed by healthcare organizations. When asked if they feel fairly compensated, half of doctors surveyed (51%) said they did. But the number was lower for primary care doctors; only 46% felt they were fairly compensated. Regardless of their compensation level, a fair number of doctors apparently feel it’s not worth it. Citing the frustra-

Half of doctors surveyed feel fairly compensated


tion of increased regulation and documentation, 46% said they would not choose medicine as a career again, if they had their lives to live over.

Study details can be found at

Midwest Medical Edition

Now is the Time to

Estate Plan


By Alice Rokahr, JD

ave you thought about your estate plan recently? Do you need to create one . . . or update one? Any estate planning today involves a myriad of challenges. How should one react to skyrocketing healthcare costs, the ever increasing American deficit, the extreme stock market volatility, the likelihood of longer life spans, the constantly changing family dynamics and the list goes on? Add to those concerns the fact that financial planners and advisors are unable to offer any long term advice since the current federal estate and transfer tax is set to expire at year’s end and we have no idea what the new tax laws will look like. It is very unlikely that we will see a congressional resolution given the recent lack of bipartisan co-operation. Doing nothing should NOT be an option you choose. Every plan you execute must include as much flexibility as possible to be able to address whatever happens. Fortunately, South Dakota is nationally recognized as having some of the best trust laws in the nation. Many of the tax advantages can only be gained with irrevocable trusts; but, that does not mean you lose flexibility. HB 1045 which was signed by the governor and will become the law on July 1 contains several amendments and enhancements to our already flexible laws so that some of the concern over estate planning unknowns can be eliminated.

the written notice a creditor must give to the the instructions given by the investment or trustee in order to disgorge distributions made distribution trustee, the administrative before its claim was filed. trustee has no duty to review or question the The decanting statute, already attractive directive and cannot be held liable for any for allowing a trustee to decant where there loss caused by following the directive. This was any discretion over the trust, was further same clarification applies to the retention of refined. Now, the trustee in drafting the life insurance. An administrative trustee has second trust can indirectly extend the trust’s no duty to review the stability of the underlyduration by giving the beneficiary the power ing company. The same guideline also allows to appoint assets to continue in trust. the administrative trustee to rely on a tax A new statute addresses the right of a return prepared by others. The trustee is trust beneficiary to “contest” the trust. The relieved of a duty to independently determine the accuracy of the return. law validates the use of such clauses which The new amendments and laws offer penalize a person who objects to the terms additional flexibility to anyone who is conof the trust. The law still authorizes certain claims if they are based upon undue influence sidering the implementation or change in or in instances where a beneficiary was an estate plan. Take advantage of these actively involved in the drafting or execution attractive planning options now since the of the trust. federal tax exemptions are set to expire on South Dakota’s directed trust statutes December 31. The time to create your estate were also modified to clarify the roles of the plan is NOW! ■ trustee when the trust appoints a distribution trustee or investment trustee. It is now clear Alice Rokahr, JD, is the Wealth Planning Officer at -Bankers Trust Company of1South Dakota. that if an administrative trustee outISSUE Quarter Page Horizontal 3.875 x 5.275carries MAR 2012 FINAL 2012-02-02_Layout 2/2/2012 9:41 AM

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Highlights of the new law arE: South Dakota allows a person who creates a trust to be both a creator and beneficiary and still achieve asset protection from creditors. The law giving creditors three years to bring a claim was amended to two years. Now, a creditor must bring suit against the trust within two years of any contribution in order to reach those assets. Once that time has passed, all clams are barred. The law specifies

July / August 2012

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Page 1

Off Hours

Passionate Pursuits Outside the Office

I’ve gotten run over a couple of times, or more often. Since I’m not a small guy myself, players will run into me and they fall and I don’t. Dr. Boyens in center.

Puttin’ on the Stripes By Darrel Fickbohm


amily practice physician, Scott Boyens, MD, has an

unusual way of spending his off hours, for a doctor. In fact, he can think of only one other physician in the state of South Dakota who is also a high school football referee. Dr. Boyens is easygoing about the subject. And whether you like the sport or not, it’s not hard to be drawn in by his enthusiasm for a hobby that started by chance and grew into a serious pastime. “A long-time ref here in town asked me to do it, so I said I’d give it a shot,” recalls Dr. Boyens. “I just like football and what better way to see the games than right down on the field? I also played football at Washington High School and then Augustana. But really, there’s just nothing better than a Friday night football game in small town South Dakota. Nothing like that feeling.” Because referees are at a premium in South Dakota, Boyens says he has to be ready to follow the games – wherever they may take him. “Wherever they schedule the games, we get in the car and go. We never know where the next assignment is. It’s an escape. And on Friday we start off to the preparation time. So right away I’m into a completely different thing.”


To the obvious question of having to run a lot while out on the field he replies, “Oh no. I’m the guy in the middle—we don’t move much but you still want to stay in shape, not because of the running,” he laughs, “but the uniform. The stripes are going the wrong way to make you look thin.” As a medical student, Boyens couldn’t imagine having time for “any life outside the office”. In fact, people are often surprised to hear about his unusual and sometimes timeconsuming avocation. But, like many other physicians, this busy father of four has found his hobby to be a welcome rest from the demands of family life and family practice. “I think my biggest stressor [in medical practice] is the possibility of making a mistake,” he says. “There’s not a doc out there who wants to hurt anybody. We don’t want to miss anything but we’re human, too, and we make so many decisions a day. It can be stressful. So it helps to get out.” And what about stressors in the game itself? Some consider the referee an underappreciated or even abused figure in sports. Dr. Boyens considers. “Well, the game moves pretty fast to dwell on a bad call. But my pet peeve is that fans don’t realize there are different rules for high school, college, and then pro,

so if they’ve just come from watching college football they sometimes don’t understand it when you make a certain call in a high school game. The important thing is, does the call have to do with safety or outcome of the play? Those are the decisions we have to get right.” As for memorable moments, Dr. Boyens says there have been many. “I’ve gotten run over a couple of times, or more often. Since I’m not a small guy myself, players will run into me and they fall and I don’t. “I especially remember things like the Aberdeen/Washington championship. That was quite a night. But it’s always as a team (of referees) that we tend to be most satisfied when we’re considered to have done a good job. You’re a crew. And when you’re chosen for playoff games and championships— that’s what you’re to us! hoping for. Tell us about your own ‘passionate Sometimes it’s pursuits’ outside over whelming the office. down on the field, though. You think: I’m looking at ten guys— and they’re all moving!” ■


Midwest Medical Edition

Today I educate. The Year of the Nurse. For Michelle McGregor, RN, BSN, being a good nurse is about finding your passion then applying it. She loves learning and finds reward in sharing that with other nurses. As a cancer survivor she understands the patient perspective and she shares that with the new generation of nurses. It’s work that’s not for everyone. To make a difference through education. For Michelle and all of our nurse educators, we thank you for sharing your knowledge.

100-11395-4166 6/12

100-11395-3255 2/12

Michelle McGregor, RN, BSN

Grape Expectations

Confessions of a Wine Glass Snob By Heather Taylor Boysen


am a wine glass snob. I’m perfectly willing to admit it and it is an affliction that I try to share with as many people as possible. It all began about 11 years ago, shortly after we had opened our wine shop and I had my first experience with Riedel stemware. My experience with wine glasses to this point had been Waterford crystal, bad restaurant glasses and dare I say the occasional plastic cup. One day a customer came to the store looking for stemware called Riedel (pronounced Ree’dal, not Rye’del like the high school). Although I had heard of it, we didn’t have a distributor in the market and I was at a loss as to where to find it. After searching on the internet, I was intrigued. All of the information regarding Riedel stemware I could find claimed that these were the best things that had happened to wine in 100 years! According to the Riedel website, Claus Riedel, over 30 years ago, was the first person in the long history of the glass to design its shape according to the character of the wine. “He is thus the inventor of the functional wine glass.” I really needed to get a hold of this stemware! Imagine my astonishment when a couple of weeks later one of my wine salespeople told me her company was going to begin selling Riedel to accounts next week and a Riedel


representative was coming into Sioux Falls to conduct a comparative glass tasting. Not only did I not know what a comparative glass tasting was, I also had no clue that this glass tasting would change the way I drink wine for the rest of my life. If you’ve never done a Riedel glass tasting, it is really an extraordinary experience. There are four glasses placed in front of you on a tasting placemat. The four Riedel glasses on the mat include the Bordeaux (Cabernet, Merlot), Burgundy (Pinot Noir), Montrachet (Chardonnay) and the Sauvignon Blanc. Throughout the tasting you are constantly putting one type of wine into each of the glasses. For example, you begin with the Sauvignon Blanc glass and its matching wine. Then you smell the wine, notice the color, then you taste. With the same wine, you then pour it into the other glasses and proceed to smell and taste from each glass. The tasting proceeds through all of the glasses using four matching wines. I’ve never been in a room full of people that goes completely silent with the first transfer of wine from the appropriate glass to another glass on the placemat. Then a collective gasp followed with outright exclamations of disbelief. The change in wine, all of the wine, from glass to glass was astonishing and magical. It is like this stemware gives wine the life that it needs to dance across our palates and perform with the utmost vibrancy for our senses. As Robert Parker Jr. of The Wine Advocate stated, “the finest glasses for both technical and hedonistic purposes are those made by Riedel. The effect of these glasses on fine wine is profound. I cannot emphasize enough what a difference they make.” Riedel stemware has become an obsession with me and my husband. We were

watching TV the other day and the show had characters drinking wine from Riedel glasses. It was satisfying to notice that they were using Riedel. It was nice product placement for Riedel until the character in the show poured Pinot Noir into the Montrachet glass. I couldn’t believe the producers of the show hadn’t done the appropriate research into what glass should have been used! Cabinets have been built in our home specifically to house our continually growing Riedel stemware collection. Our friends are amazed as my husband and I take out new glasses for every course of wine served in our home. Washing that many glasses is the price we are willing to pay for sipping a lovely wine from the appropriate glass. It is respectful of the wine and adds so much pleasure to the wine experience. In my world, there are no exceptions. Pinot Noir just does not belong in a Chardonnay glass, not even on television. ■

Midwest Medical Edition

The Globally Harmonized System (GHS)

What it Means for Your Office

By Terry Dell and John Gold, CSHM


xposure to certain chemicals in the workplace can cause or contribute to serious health effects or may create serious safety hazards. Healthcare employees have exposures to chemicals such as disinfectants, hazardous drugs and pesticides. As an employee, it is your right to know about the chemicals you work with in the workplace. OSHA requires a written Hazard Communication program that provides worker training, warning labels and access to Material Safety Data sheets. OSHA also regularly enforces the standard. The Hazard Communication Standard is the #2 most commonly cited regulation for healthcare facilities in the last year to the Bloodborne Pathogen standard. The Hazard Communication Standard is changing to incorporate international standards. All employers must make changes to their hazard communication program over the next few years. The primary benefit of the GHS is to increase the quality and consistency of information provided to workers, employers and chemical users by adopting a standardized approach to hazard classification, labels and safety data. The GHS provides a single set of harmonized criteria for classifying chemicals according to their health and physical hazards and specifies hazard communication elements for labeling and safety data sheets. Under the GHS, labels would include signal words,

July / August 2012

pictograms, and hazard and precautionary statements and safety data sheets would have standardized format. These changes will not change the framework and scope of the prior HCS but will help ensure improved quality and more consistency in the classification and labeling of all chemicals. This will enhance worker comprehension, resulting in appropriate handling and use of chemicals. The harmonized format of the safety data sheets will enable workers to access the information more efficiently. In addition, currently multiple labels and safety data sheets must often be developed for the same product when shipped to different countries. This creates a major compliance burden for chemical manufacturers and those involved in international trade, increasing the cost of providing hazard information. The adoption of GHS will minimize this burden. Timeline Summary of the Hazard Communications Changes:

♦ March 26, 2012 Final Rule was published

♦ May 25, 2012 Rule goes into effect

♦ December 1, 2013

Employees must know how to read and understand the new labels and SDS’s

♦ June 1, 2016

Complete training on all updates to your Haz Com program

Preparing for the Change Your current MSDS library will need to be completely replaced by the new SDS’s. Vendors should already be providing this new information. If not, you should be contacting your suppliers. This duty is on your shoulders. You need to ensure your company has a system in place to collect the SDS’s as they come in, and that they get to those responsible for the program. Where do you begin? The thought of this change can be daunting. We recommend that you start with bite size pieces such as conducting an overall chemical inventory review. Use a copy of your completed list as a “checklist” to ensure that you have the SDS’s for each of your chemicals. You also need to begin planning your employee SDS and label training and set a target date before December 2013 to have everyone up to speed. The bottom line, you need to be fully transitioned to Global Harmonization by June 2016. ■ For more information, you can visit the OSHA website at dsg/hazcom/index.html. Terry Dell is a Risk Analyst/Loss Control Specialist and John Gold is a Loss Control Specialist with RAS, a provider of workers’ compensation in the Upper Midwest, headquartered in Sioux Falls, SD.



Midwest Medical Edition


South Dakota

Since 1984, Make-A-Wish South Dakota has been

granting wishes to children with life-threatening medical conditions across the state. During 28 years, more than 950 wishes have been granted. While the wishes range from trips to shopping sprees to meeting celebrities, the wish kids and their families have one thing in common: the wish is a positive experience during a very difficult time. A recent national survey* of wish children, parents, volunteers and medical professionals concludes that the positive effects of wishes include emotional and social benefits, life enrichment, social awareness, inspiration, enhanced resilience and coping ability, gratification and – for wish children – improved strength and desire to overcome their illnesses.

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

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

Responses from medical/healthcare professionals regarding the impact of a wish on a child’s well-being include: u 96% believe that a wish improves the wish child’s mental and emotional health.

u 79% see increased feelings of hope in wish children. u 7 5% see decreased feelings of depression or sadness in wish children.

u A recurrent theme from the medical professionals is that children who receive a wish are motivated to overcome their illness and endure treatment

“Wishes allow children and families to have a normal experience and be a family having a positive experience without having to think about the disease that is a major focus of their lives at all other times. It is an invaluable experience for patients and families!” says one doctor surveyed. “Many of the wish children I have worked with ‘rally’ physically before the wish (from excitement/anticipation) and during the wish (fun and joy of the wish experience) beyond what would have been expected or thought possible given the nature of the illness and status of treatment” observes another physician. Medical professionals are key referral sources for MakeA-Wish. ■

Medicine is feeling the effects of regulatory and legislative changes, increasing risk, and profitability demands—all contributing to an atmosphere of uncertainty and lack of control. What we do control as physicians: our choice of a liability partner. I selected ProAssurance because they stand behind my good medicine. In spite of the maelstrom of change, I am protected, respected, and heard. I believe in fair treatment—and I get it.

To learn more about qualifying conditions for a wish or to refer a child, please contact Make-A-Wish South Dakota at 800.940.9198 or 335.8000. *2010, 2011 Wish Impact Study, Make-A-Wish® America.

MED Quotes People pay the doctor for his trouble; for his

Professional Liability Insurance & Risk Management Services ProAssurance Group is rated A (Excellent) by A.M. Best. • 800.279.8331

kindness they still remain in his debt. ~Seneca

July / August 2012


New Sculptures

Now on Display at Avera McKennan Hospital hosts fifth Annual the indoor SculptureWalk.




Location: Plaza

Matt Miller 4, First Floor Lobby

There are 24 new sculptures on display on the Avera McKennan campus, part of this year’s annual SculptureWalk. Avera McKennan began hosting Sioux Falls’ first indoor SculptureWalk in May 2008. Avera’s indoor SculptureWalk is an extension of the downtown SculptureWalk, and visitors are encouraged to see the wide range of sculptures on display at both locations. At Avera McKennan, brochures directing visitors through the walk are available in the front lobby or in racks located on most sculptures. Interested in the health of the whole person, Avera McKennan has designed the one-mile walk as a healthy journey. Sculptures, owned by the artists, are on

loan to the exhibit for one year. Employees are encouraged to join the public in voting for their favorite sculpture, and Avera McKennan will purchase the People’s Choice and add it to our permanent art collection. Vote by paper ballot or online at “The healing power of art is very profound,” said Dr. David Kapaska, regional president and CEO of Avera McKennan. “Art has the power to calm our nerves, soothe our spirits, and restore feelings of hope and courage. We want to share the healing power of art with our patients, visitors and staff in every way possible, and so we host the indoor SculptureWalk in addition to having our own original art collections throughout our various facilities.” ■

© 2010 American Cancer Society, Inc.

The less cancer there is, the more birthdays there will be. Patients count on you to remind them of what they can do to prevent cancer. Remind your patients of appropriate screenings and healthy lifestyle choices.


Ojibway River



You can help create a world with more birthdays. Visit Or call 1-800-227-2345. Together we’ll stay well, get well, find cures and fight back.

Chris Powell

Location: Prairie

Center, West River

Midwest Medical Edition

Learning Opportunities August / September 2012 August 13 9:00 am – 3:00 pm

Avera Behavioral Health Services Update L ocation: Avera Education Center Auditorium

Information & Registration: or call 322-8950

August 22-24

SDMGMA Fall Conference L ocation: Cedar Shore Resort, Chamberlain, SD

September 13 - 14

September 14

September-December – Multiple Dates Sept. 21-22

September 27 – 28


37th Annual South Dakota Perinatal Association Conference L ocation: The Lodge at Deadwood Registration and information:, 333-5210

Community Response to Child Abuse L ocation: Sanford Information:

Sanford Perinatal Nurse Fellowship Information: 328-6353

2012 Avera Cancer Institute Oncology Symposium L ocation: The Prairie Center Information:; click on Events Calendar Registration: or call 322-8950

2012 Upper Midwest Regional Pediatric Conference L ocation: The Marina Inn & Conference Center Information: or (712) 279-3235

September 28 8:00 am – 2:00 pm

Avera Transplant Institute Symposium L ocation: The Prairie Center

Information:; click on Events Calendar Registration: or call 322-8950

October 4 8:30 am – 4:00 pm

Avera Rural Health Conference L ocation: Sioux Falls Convention Center

Information:; click on Events Calendar Registration: or call 322-4645

October 17 9:00 am – 3:00 pm           

28th Annual Cardiology Conference L ocation: Sioux City Convention Center

Information & Registration:

November 2 8:00 am - 5:00 pm

30th Annual North Central Heart Fall Cardiac Symposium L ocation: Sioux Falls Convention Center

Information: Registration:, 605-977-5316

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



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MED-Midwest Medical Edition-July/August 2012  

MED - Midwest Medical Edition July/August 2012 Issue