Page 1

Vol. 2, Issue 7

2011 November

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

THE 2011

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From Us to You

Staying in Touch with MED

A letter from the VP and Editor

Steffanie Liston-Holtrop

Alex Strauss


ach year at this time, we find ourselves taking stock of the many things for which we are thankful. We are thankful for the outstanding advertisers whose support continues to bring you this locally-produced publication free of charge. It is a luxury few other medical markets enjoy. We are thankful that healthcare professionals like you take the time to read and respond to MED, offering us not only your suggestions but also your expertise, opinions, memories, book reviews, and practice news. Your readership and submissions keep MED timely, local and relevant for a growing base of readers across three states. Keep it up! And we are thankful for the fine creative team whose time and talent has helped to build a publication worthy of the nation’s finest doctors. We hope that you, too, can take pride in MED, a publication for and about YOU, the healthcare professional in South Dakota, Minnesota or Iowa. Thank you for all you do to help and to heal. Let us know how MED can serve you better. Happy Thanksgiving! — Steff & Alex

r Referrals o f y e K y it mmun Medical Co -Wish to Make-A nted by the Make-

wish gra August marked the 90 0th r Dakota since the chapte uth So A-Wish Foundation of kYan ar- old Ashtyn Empkey of began in 1984. Three -ye a trip ed joy en ily He and his fam ton was the recipient. 65 of e on s Empkey’s wish wa to Walt Disney World. r. yea al ish in SD this past fisc granted by Make- A-W ing a in the process of receiv Fif ty eight children are . Makeare referred each month wish and new children tween be ld ch every eligible chi A-Wish’s goal is to rea medical with a life -threatening the ages of 2 ½ and 18 is defined as pro ing medical condition ten rea -th life A a. kot es condition in South Da e or condition that qualifi ant. It is not the diseas lign ma or ive rat ces ne pla ge de ion dit gressive, erral, the disease or con that, at the time of ref the child, but the fac t rdy. A-Wish. the child’s life in jeopa erral source for Makey is the number one ref nit mu com al ed to dic rag me cou e en Th qualif y are e to a child who may car al dic me ing vid ce is en pro eri Physicians A-Wish exp referral. Of ten, a Makethe ke ma d an l cal to cording to Maketake the time a challenging time. Ac g rin du ed ne ily fam d g point just what the child an d wish is often a turnin dy found that a grante stu l na tio na t en rec a , A-Wish st their illness. in a child’s fight again A-Wish Foundation of ation about the Makeorm inf re mo for or ld To refer a chi it ww w.southdakota.wis call 80 0.6 40.9198 or vis ase ple a, kot Da uth So


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©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

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Intensive Care for Newborns

In whose hands will you place her?

Physicians’ Priority Line


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

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MED Magazine 2012 Call for Nominations MED Magazine is seeking Nominations for Cover and Feature Article topics for 2012. MED is committed to focusing on pioneering physicians, institutions, programs and technologies that are paving the way for the future of healthcare in our region. No one knows these pioneers better than MED readers. If you know of a person or program that deserves a closer look, tell us about them. (Self-referrals are permitted!) Send us the following information via fax, mail or email.

Med Nomination Form Please include the following information: Name of Nominee_______________________________________________________________________________________________________ Location of Practice______________________________________________________________________________________________________ Reason for Nomination___________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ Your Name_____________________________________________________________________________________________________________ Your Contact Information_________________________________________________________________________________________________ Mail / Fax or email this form to: PO Box 90646 Sioux Falls, SD 57109—Fax 605-271-5486—email

Contents Midwest Medical Edition

November 2011

Cover Feature



Regular Features 2 |

From Us to You

20 |

NEW! Off Hours


Avera’s First Hundred

Otolaryngologist Has a Passion for the Past

29 |

Grape Expectations

31 |

N  ews & Notes

33 |

Learning Opportunities

It’s Turkey Time! By Heather Taylor Boysen News from around the region Upcoming Symposiums, Conferences and CME Courses


Avera McKennan Hospital & University Health Center turns a hundred years old this month. But the significance of the centennial reaches beyond the Avera campus. The hospital’s founding sparked a spirit of competition in the region that continues to raise the healthcare bar today. We get some insight into the hospital’s history from a few of the people who know it best.

In This Issue 6 |

Avera to Participate in Clinical Trial Collaborative

7 |

NIH Grants for Sanford Researchers

8 |

New Cardiovascular Fellowship for SD

9 |

HealthGrades Report Released

16 |

The Real Meaning of “Bending the Health Care Cost Curve” By Dave Hewett

17 |

Sanford Recognized as IT Innovator

18 |

Healing Art at St. Luke’s

22 | Managing Challenging Behaviors in the Healthcare Environment By Theresa Parish 24 |

PA’s and the HITECH Act

27 |

Research Spotlight: A Genetic Link fo Pelvic Prolapse?

28 |

New Ophthalmology and Derm Clinics for SF

30 |

A Milestone for the Bloodbank

Cover Photo: A young McKennan nurses receives her cap at an early pinning ceremony. Photo courtesy Avera.


10 5

Avera to Participate in Clinical Trial Collaborative Avera McKennan Hospital & University Health Center has been selected by the Education Network to Advance Cancer Clinical Trials (ENACCT) as one of six community-based cancer organizations to participate in the National Cancer Clinical Trials Pilot Breakthrough Collaborative. The six organizations were selected from a nationwide pool of applicants seeking to improve patient participation in cancer clinical trials, especially those from ethnic and racial minority groups and those 65 years and older. Each organization has formed an Improvement Team that will drive the organization’s efforts. “We know that cancer clinical trial participation in the United States remains under 3 percent, with even lower participation rates among ethnic and racial minority groups and those over 65,” says ENACCT Executive Director Margo Michaels. “This Collaborative is the first ever to be implemented around cancer clinical trials and the improvement strategies tested and implemented by these organizations will be shared nationwide, and will benefit community oncology practices throughout the country.” “Avera McKennan has an excellent opportunity through this collaboration to benefit the patients we serve,” adds Dr. Addison Tolentino, Physician Champion of the Avera McKennan ENACCT Improvement Team. “Cancer research is—and always has been—a priority to Avera McKennan. Without clinical cancer trials, there would be no new cancer treatments available.” ■

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

Regional Doctor Honored for

Excellence in Teaching H. Thomas Hermann, MD, a family medicine provider at Massa Berry Regional Medical Clinic in Sturgis, was recently honored by the Sanford School of Medicine at the University of South Dakota with the Edward J. Batt, MD Memorial Award. The award is given to a clinical faculty member in the Department of Family Medicine for excellence in teaching. “Dr. Hermann is respected as a teacher, dedicated physician for the community of Sturgis, and a valued member of the Regional Health team,” says Regional Health Physicians Chief Executive Officer James Keegan. Dr. Hermann is an alumnus of the University of South Dakota School of Medicine and completed his residency in family medicine at Sioux Falls Family Practice. He is also a Fellow in the American Academy of Family Practice. Dr. Hermann has been practicing with Regional Medical Clinic since 1995. ■

Exclusively promoted and recommended by the South Dakota State Medical Association.


Midwest Medical Edition

NIH Grants

Support Cancer and Teen Pregnancy Research at Sanford

Five research labs at the Center for Cancer Biology Research at Sanford Research/USD will benefit from a multimillion dollar, five-year grant from the National Institutes of Health (NIH). The NIH has awarded the Center for Cancer Biology Research $2.3 million annually for research done on breast, head and neck, colon, prostate and lymphoid cancers. The money will be used to hire more investigators to help with the Center’s ongoing research and will aid in the development of what are called “core facilities.” The facilities will be available for use by all Sanford Research investigators, not just those in the area of cancer. Investigators who will share the grant include Kristi Egland, PhD, Meena Jaggi, PhD, Subhash Chauhan, PhD, Satoshi Nagata, PhD and William Spanos, MD. At the same time, the National Institute of Minority Health and Health Disparities has awarded $1.5 million dollars to a collaborative including Sanford Research/USD, the University November 2011

of Minnesota, South Dakota Urban Indian Health, and the Great Plains Tribal Chairmen’s Health Board to study the problem of teen pregnancy in American Indians. The teen pregnancy rate for American Indians in South Dakota is four times higher than the state’s general population. “We want to better understand why the numbers are so much higher and develop a multi-site, culturally sensitive teen pregnancy prevention program for reservation and urban Northern Plains American Indian teens,” says Sanford Research/USD Health Disparities Research Center director Amy Elliot, PhD. “We will hold focus groups and interviews to look at the social norms and unique cultural factors that account for high teen pregnancy rates in our Northern Plains American Indian communities,” says DenYelle Kenyon, Sanford Research/USD Associate Scientist. “We also want to examine how those norms and factors differ for the youth living on the reservation versus an urban setting.” ■


Cardiovascular Fellowship Approved for South Dakota The University of South Dakota Sanford School of the Medicine has been approved by the Accreditation Council for Graduate Medical Education (ACGME) for the state’s first cardiovascular fellowship. The program will accept two fellows per year for the three-year program. Scheduled to begin in July 2012, the program will include rotations in areas such as cardiac catheterization, coronary critical care, electrophysiology, non-invasive cardiac evaluation, cardiac research, and others. Fellows will do their rotations with cardiologists and cardiothoracic surgeons at Sanford Heart Hospital (opening in 2012) and the VA Hospital in Sioux Falls. “These cardiovascular fellows will be among the best trained in the world,” says Adam Stys, MD, interventional cardiologist with Sanford and director of the new fellowship program. “This will strengthen the cardiovascular program at Sanford. Our cardiologists will be stimulated to teach and stay on, or ahead of, cutting edge in diagnosis and treatment of cardiovascular disease.” The new program is one of 187 approved U.S. cardiovascular fellowships and addresses a critical health care need in South Dakota. Graduates of the program will be board eligible cardiologists. ■


Midwest Medical Edition

HealthGrades Releases Quality Ratings for Nation’s Hospitals

Regional Cancer Care Institute Receives Grant from National Cancer Institute RAPID CITY, SD–The National Cancer Institute’s Centers to Reduce Cancer Health Disparities recently awarded a one-year supplemental grant of $139,968 to the Regional Cancer Care Institute’s Walking Forward Program for a web-based clinical trial education module. The web-based educational module will be used as a tool for community health educators to address the specific needs and expectations of at-risk and underrepresented communities. The Walking Forward Program’s community health educators will evaluate the value of the web module to enhance knowledge and clinical trial participation in regional underserved communities, help adapt the web module to be culturally sensitive to American Indian communities, disseminate National Cancer Institute educational materials and messages, and participate in annual National Outreach Network program meetings to exchange ideas and methods. ■

November 2011

DENVER, Colo. –HealthGrades has released its 2011 Healthcare Consumerism and Hospital Quality in America report, an analysis of patient outcomes at nearly 5,000 American hospitals. The report analyzed objective mortality and complication rates across 27 different medical procedures and diagnoses, at all of the nation’s nonfederal hospitals using 40 million hospitalization records obtained from the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services. Data was analyzed over a three year period from 2008 through 2010. The report also analyzed web use by patients from Jan, through June. 2011. According to the Pew Internet Project, increasingly patients are moving from searching disease and treatment-specific information to using the internet to find quality information on doctors and hospitals, 47% and 38% respectively in 2010, up from 21% in 2003. More than 10 million people each month research physician and hospital quality on The 2011 Healthcare Consumerism and Hospital Quality in America report found that serious gaps in quality among U.S. hospitals persist: At 5-star rated hospitals, patients had a 73% lower risk of dying when compared with patients at 1-star rated hospitals. HealthGrades quality ratings released are available to consumers at ■


McKennan Hospital, circa 1911

Story Telling


Avera’s First Hundred

Years By Alex Strauss

This month, Avera McKennan Hospital & University Health Center celebrates a hundred years of providing healthcare to Sioux Falls and the surrounding communities. But the significance of the anniversary extends beyond the Avera campus to other providers in the region. Because Avera McKennan’s story is closely connected to the story of medicine in Sioux Falls. Established as a healthcare ministry under the guidance of the Aberdeen-based Presentation Sisters, McKennan Hospital not only enhanced the healthcare options in the region in 1911 but also, by its very presence, sparked a spirit of competition that was to help make Sioux Falls the advanced medical center it is today. Competition raised the healthcare All photos Courtesy Avera


Midwest Medical Edition

Avera McKennan Hospital & University Health Center, circa 2011

bar and paved the way for a level of medical care rarely seen in a market the size of Sioux Falls. Avera McKennan credits much of its success to its stability, in both management and mission. Prompted by a $25,000 dollar bequest from Sioux Falls resident Helen Gale McKennan in 1906, the hospital has been run by the Presentation Sisters since it opened its doors on December 17, 1911. Its stated mission of compassionate, gospel-based care remains unchanged. In that first year, McKennan Hospital treated 100 patients. But as Sioux Falls grew, so did the numbers, and by 1920, 1,500 patients a year were seeking care at McKennan. Today, Avera McKennan is a 545-bed tertiary care hospital

and health network that also includes 14 regional hospitals, over 70 primary and specialty care clinics, long term care facilities and more. Annual inpatient admissions are now approaching 22,000 with over 260,000 outpatient visits and a million clinic visits a year. Under the guidance of both the Presentation Sisters and the Benedictine Sisters of Yankton with whom they joined forced in 2000, Avera McKennan became part of Avera Health, an extensive system with nearly 300 locations in 97 communities across 5 states. In recognition of the anniversary, MED asked some of Avera McKennan’s key figures to talk about the hospital’s history, mission, and future.

Avera’s story is closely connected to the story of medicine in Sioux Falls.

Fred Slunecka Avera Health Chief Operating Officer and former long-time CEO of Avera McKennan

Sister Mary Thomas

Senior Vice President of Mission

Fred Slunecka

Avera Health Chief Operating Officer and former long-time CEO of Avera McKennan

I was hired at Avera McKennan in November 1982 as an Assistant Administrator. I became CEO in 1989 and served in that capacity until 2010 when I became COO of Avera Health. So out of that 100 years, I account for 29. I think that gives me about as much perspective as anyone else in the organization. You really have to tip your hat to the citizens of Helen McKennan’s time. It would have been so easy to drop the ball and not do this right. Helen McKennan gave $25,000, but the hospital cost $160,000 to build. So this little community group, under the direction of Colonel Thomas Brown (of Brown & Saenger), had to take the ball and run with it. And because hospitals at that time were primarily for the poor, they had to go out hat-in-hand from 1911 to 1940 to get donations to keep it going. It was a gargantuan task, so I think Col. Brown is as much a founder of McKennan Hospital as Helen McKennan herself. Then there were the Presentation Sister. Women-owned businesses were very rare in that age, and this one was employing a lot of people. They were making it up as they went along. Imagine the first X-ray machine and you’re a nun and you’re going ‘Now, what do I do with

this?’ When you put it in perspective like that, you realize that nothing we do today is going to be half as tough as what they had to do back then. At the same time, they have managed to preserve their original mission. There is still very much a heritage connection here. Lots of organizations have operated for 100 years, but to be owned by the original owners for 100 years is unusual. When you have a consistent message, delivered in an uncompromising way for 100 years, people begin to get it. Employees can’t help becoming totally grounded in that mission. The original hospital was located in the spot where the Emergency Department parking lot is now. Other buildings went up over the years and the main building that we now recognize as Avera McKennan hospital came about in 1975. When I walked in the doors in 1982, you could not even see the hospital from Cliff Avenue. Today, given the expanse of the campus, that is hard to even imagine. In 1977, when I started my career in healthcare at Mercy Medical Center in Sioux City, Mercy was the largest hospital in the area. Sioux Valley was the second largest, St. Luke’s in Sioux City was third and McKennan Hospital was fourth. Today, you can put all the patients that are in those Sioux City Hospitals inside Avera McKennan. The difference, I think, was the sisters’

Dr. Patrick McGreevy Retired General Surgeon, Practiced 36 years at Avera


Midwest Medical Edition

In the early years, many of the Presentation Sisters were intimately involved with the McKennan’s day-to-day operation.

commitment to rural healthcare. In 1982, when St. Luke’s in Aberdeen became our first lease agreement, most organizations weren’t willing to take on these small rural hospitals. One of the things we have done well is changing to meet changing healthcare needs. In the 1970’s, cataract surgery had just been invented and an entire floor of the hospital was devoted to ophthalmology. Specialties and technology have to change and morph over time, because what fills our hospital today might be fixed by a pill in the future. Having a large integrated system prepared us to meet these changing needs. If your mission is just to meet needs, it guarantees that you are going to remain relevant to your community. That is why I have no doubt that in another 100 years our successors will be celebrating the 200th anniversary. Avera will still be here, adapting and changing as the needs change.”

Sister Mary Thomas

Senior Vice President of Mission Helen McKennan left $25,000 in 1906 to some trustees with instructions to use the money to open a hospital. That was the equivalent of about $500,000 in today’s dollars. Not only did the trustees have to raise additional funds, but they had to find someone to run the hospital. They needed nurses, staff, managers, etc. So they engaged the help of Bishop Thomas O’Gorman and he contacted Mother Joseph Butler of the Presentation Sisters in Aberdeen. Bishop O’Gorman knew that the Presentation Sisters were already established in healthcare. The Presentation Sisters came from Ireland and set up a convent and school in Aberdeen in 1886 with a mission to educate the Lakota Sioux Indians and

the pioneers. Even though their mission was primarily education, in 1900 there was a diphtheria epidemic in the region and the convent was made into a makeshift hospital. We had to get special permission from the bishop to do this and we are one of the few groups of sisters that have their own healthcare branch. It was a real sense of a call from God. There would have been the sense that we are here to respond to the needs of people and what was needed at the time was some sort of structured response. So by the time the sisters were approached by Bishop O’Gorman about taking on McKennan Hospital, they were already running three other hospitals. At first, there were sisters in every department of the new hospital. And it was really their presence, prayerfulness and devotion to God that communicated the mission of compassionate care and promoting human dignity to the people in that department. But as the hospital

An early surgical room

The Iron Lung A modern OR

November 2011


New Avera Surgery Center

grew, there were not necessarily sisters in every department anymore. So we had to start thinking more strategically about ways to make sure that everyone working at McKennan really understood the heart and soul of the organization. The hospital has been through a lot – the influenza outbreak in the 1930’s, the World Wars, economic challenges – but we have weathered these by hanging in there with each other. The message we wanted to communicate is that this is not our ministry; it is Jesus’ ministry and we are simply carrying it out. It was in the 70’s that the Presentation Sisters decided that we should have an office – the one I hold now – to communicate the heritage, understand the themes in our history, and perpetuate the generosity of heart that we stand for. When we joined with the Benedictine Sisters to form Avera, it was a real shift for us. We had to be willing to let go of sole ownership of something that we had really put our blood, sweat and tears into. But we knew that it was the right thing to do as the hospital grew. Today, there are about 25 to 30 sisters still directly involved, 6 to 8 of them in day-to-day operations.


We recognize that the very fact that a person is coming to the hospital puts that person in a state of vulnerability. That, in itself, calls for a compassionate, mission-oriented response. When you come down to it, healthcare is very personal. The mission has to be lived out every day in our response to patients, family members, and co-workers. Avera McKennan could not be here without the community’s support. It has stood by us, supported us, and called us to be who we are today. It is really the community that has taught us how to offer this faith-filled response. We hold true to our deepest traditions and we don’t stand in isolation. This celebration is really a community celebration, too.”

Dr. Patrick McGreevy Retired General Surgeon, Practiced 36 years at Avera

I grew up in Sioux Falls and my dad was a doctor. McKennan Hospital was always a part of my life and I have many memories of it. One image that has really stayed with me is the nun who attended the reception desk in the hospital when my brother and I were kids. It would have been around 1950. My dad used to

sometimes take my brother and me along to the hospital in the evening and have us wait in the lobby while he made rounds. This nun at the front desk, in full habit, was amazing. If someone had a question, she was the information desk. If someone came for admission, she registered them. She ran the switchboard. And whenever she had a few minutes of downtime, she would get out this gigantic ledger book and start writing in it. And all the while, she was also watching my brother and me. She never seemed to get flustered. And she was not even getting paid! I have often thought through the years, that that woman really embodied the mission of selfless, compassionate care for everyone who comes through the doors. I believe that attitude still prevails here today. I left Sioux Falls to train in medicine at Creighton in Omaha and then came back to town in 1969 to join my dad and my uncle, Drs. John and Ed McGreevy, and their partners at the first McGreevy Clinic. They had built the clinic on the McKennan campus in 1962, after moving out of the building downtown that had been the Moe Hospital. At that

Midwest Medical Edition



Avera Heart Hospital, built in 2001

time, most of the doctors were located downtown. In 1969, when I came to the clinic, McKennan was a small community hospital. It wasn’t anything like the referral or specialty center that it is today. There were no computers, of course. And the physical presence of the Presentation Sisters was much more evident. Everyone knew everyone else on campus because it was so small. When I came, not a lot of things were ever referred to Sioux Falls or to McKennan. Today, there is not much that can’t be accomplished here. But even though our ability to serve patients is far more sophisticated and broad-based, somehow the Presentation and Benedictine Sisters have managed to preserve a philosophy of healthcare being a ministry that is rooted in the gospel. I can’t imagine that this has always been easy. For instance, the nuns make a vow of poverty. And yet, they have found themselves running a multibillion dollar business. I have always found that to be an interesting balance – how they keep true to their mission while running a business in a competitive environment. I think they have done an excellent job of this.” ■


Avera McKennan Hospital & University Health Center will celebrate its centennial year with the “Gala for a Century” on Friday, Nov. 11, at the Sioux Falls Convention Center. A social hour begins at 6 p.m., followed by dinner at 7 p.m., and a program, entertainment and dancing. Featured speaker is Eric J. Topol, MD, on “The Future of Health Care.” Named one of the 12 “Rock Stars of Science” by GQ Magazine, Dr. Topol is a distinguished physician and scientist working on the forefront of digital medical technology. A premier cardiologist, genetic researcher and technologist, Dr. Topol is bringing a new kind of medicine into widespread practice: specificallydesigned treatments based on an individual’s unique genetic structure. Tickets are $100 per person. Learn more about this event and purchase tickets at gala. Or, call the Avera McKennan Foundation at (605) 322-8900.

Sculpture outside the Avera Behavioral Health Center

November 2011


The Real Meaning of “Bending the Health Care Cost Curve” By Dave Hewett , President/CEO, SDAHO


e’ve been hearing that phrase for a long time. It’s a phrase that has been used by both sides of the political aisle during the ongoing debate on health care reform. It has also been used by the provider community to spur us on to think creatively about a health care delivery system that is more efficient, more organized, and more sustainable. But for the general public, the idea of bending the health care cost curse has also become somewhat of a hollow phrase as increases in the cost of health care continue to outpace price increases in general. The frustration is well illustrated by this graph. The graph shows the rate of general inflation and medical inflation over time. Not surprisingly, the red line (medical inflation) has exceeded the blue line (general inflation) for quite some time. The implications are: The percentage of gross domestic product devoted to health care continues to grow Health insurance premiums continue to rise Our federal and state elected officials continue to search for ways to reduce provider reimbursement to contain costs Now when policymakers talk about “bending the cost curve” I believe what they are really saying is that the goal of health care reform is to have medical inflation rise at a rate no greater than general inflation. Simply stated, they want the red and blue lines to take on a purplish hue. Their desire to “bend the cost curve” has produced other phrases such as “doing more with less”, “value not volume”, “quality not quantity”, and


“doing less with less”. (Of course, the ability to achieve all of these goals are tempered the public’s insatiable appetite for more, high tech health care and access to that care on a moment’s notice… but that’s another story.) That said, new data strongly suggests that South Dakota physicians and other members of the health care provider community are more than doing their share to achieve the cost saving goals that Republicans, Democrats, and Independents espouse. First, according to recently released data from the Dartmouth Atlas, Medicare costs per beneficiary in South Dakota are among the lowest in the country. Expenditures varied from $6,264 in the Rapid City region to $7,118 in the Sioux Falls region. That compares to the highest in the country, Miami, Florida where the cost per beneficiary is $15,571.

We are also doing comparatively well on quality and patient safety numbers. Readmission rates in SD are low compared to national averages and other patient safety indicators are equally favorable. For example, according to recently released CMS-issued readmission rates, South Dakota ranks 3rd from the best for heart attacks, 13th for heart failure, and 9th best for pneumonia. Are we perfect? Far from it. We need to work on how our patients view the treatment we provide and while our rankings may be favorable today, everyone is trying to get better and reduce the rate of increase in health care spending. This becomes all the more important as the policies of spending less are spelled out in reformed reimbursement policies that have already reached the hospitals and will likely reach the physicians soon. ■

Midwest Medical Edition

Sanford Health Recognized as IT Innovator Interactive EMR system and emergency preparedness were key considerations

For the sixth consecutive year, Sanford Health has made the InformationWeek 500, an annual listing of the nation’s most innovative users of business technology. The 2011 list was revealed at a gala awards ceremony at the InformationWeek 500 Conference in Dana Point, California. A key consideration in this year’s recognition was Sanford’s disaster preparedness plan aimed at protecting its critical EMR system, “Sanford One Chart”, in an emergency. Sanford not only purchased new hardware, but also upgraded the existing hardware and developed new procedures designed to mitigate the effects of planned and unplanned downtimes for the EMR. “‘Sanford One Chart’ allows us to speak with one voice with each other and with our patients, and provides connectivity to deliver a seamless experience across a large, rural network”, says Sanford Health Chief Information Officer Arlyn Broekhuis. On “My Sanford Chart,” a web adaptation of “Sanford One Chart,” patients can access their medical records, review lab results and schedule appointments. More than 30,000 Sanford Health patients are active users. “For 23 years, the InformationWeek 500 has chronicled and honored the most innovative users of business technology,” said InformationWeek Editor In Chief Rob Preston. “In this day and age, however, being innovative isn’t enough. Companies and their IT organizations need to innovate faster than ever before to stay a step or two ahead of their customers, partners, and competitors. This year’s ranking placed special emphasis on those highoctane business technology innovators.” InformationWeek has been identifying and honoring the nation’s most innovative users of business technology for 23 years. Past winners have included The Vanguard Group, CME Group, Conway,

November 2011

National Semiconductor, Kimberly-Clark, Hilton Hotels and Unum. The InformationWeek 500 rankings are unique among corporate rankings for spotlighting the power of innovation in information technology, rather than simply identifying the biggest IT spenders. ■


St. Luke’s Enhancing Healing with

New Art The photography of Paul Schiller on display at St. Luke’s Regional Medical Center in Sioux City.

St. Luke’s Regional Medical Center in Sioux City is enhancing its healing environment with the nature photography of Sioux Falls photograph Paul Schiller. The hospital’s new Art & Healing project, made possible through the Wrede and Barbara Smith family, includes the installation of 160 pieces of tranquil artwork throughout the hospital. “It definitely enhances the healing environment, not only for patients but also for their families and even for the healthcare workers,” says Steven Shook, MD, of Family Health Care of Siouxland, Indian Hills Clinic. “Looking at these images of areas and plants that are familiar can take a person temporarily out of the hospital environment in their mind and into a more peaceful place. I have seen many people out in the halls looking at the photographs. It is like stepping into a museum every time you go there.” Numerous studies have shown the healing impact of peaceful artwork and its connection to improved patient outcomes. St. Luke’s says the new artwork is “closely aligned with the hospital’s patient and family-centered care philosophy”, a philosophy the Smith family also embraces. ■


MED Midwest Medical Edition

Hypertension is one

of the most serious health problems in the country. Fortunately, it始s also one of the easiest to diagnose and treat. You know the classifications and risks. Don始t assume your patients do. Talk to them about their BP and do it often. Breaking the silence is one of the best ways to fight this silent killer.

November 2011


Off Hours

Passionate Pursuits Outside the Office

Dr. Patrick Collison Otolaryngologist and Student of Archaeology

By Darrel Fickbohm


t took very little coaxing to convince Dr. Patrick Collison, an Ear, Nose and Throat specialist with Yankton Medical Clinic, to talk about his long-standing interest in archaeology. But he was also quick to differentiate between a “hobby” and an “avocation.” As with many other physicians, Dr. Collison’s passion for his extracurricular occupation turned out to be much more than merely dabbling. “My interest in archaeology first came to me while I was doing research for an article on mastoiditis in children” says Dr. Collison. “I came across some articles by Dr. John Gregg, an ENT in Sioux Falls, who had developed a second career in archeology. He had 20

Patrick Collison, MD published articles about fascinating things like evidence of ear diseases in 500- or 600-year-old Native American skulls. It just caught my interest.” Dr. Collison, who was in his 50’s at the time, began to feed his growing interest with Internet classes through USD and the University of Iowa, eventually completing an undergraduate degree in archaeology. After that, he took a seminar class per semester that met once a week – the only schedule he could manage with his ENT practice. Eventually, over a number of years he “cobbled together” a course of study that earned him a Masters Degree in Interdisciplinary Studies, primarily Archaeology and Anthropology.

“It was like getting a second life without actually being illegal or immoral,” jokes Dr. Collison who calls his archaeology studies a “mood elevator”. “On the other hand, it wasn’t easy. You must interact with professors without being a know-it-all, obviously. And I will never have the traditional student’s quick memory or computer skills. But it stretches you. I took way more classes than I needed to—I didn’t want it to end. The study was the end, so I dragged it out.” Among other things, Collison says his academic studies helped revive his writing skills and his ability to express himself without using jargon or Midwest Medical Edition

“medicaliese”. More than that, he says archaeology has broadened his world view. “Archaeology is a social science as opposed to a biological science like medicine,” he explains. “Medicine emphasizes scientific positivism to a strict degree, so it’s very different in its world outlook. Looking at things from an anthropological standpoint gives me a more inclusive worldview. Archeology dovetails with medicine by its very contrast, if you will. It helps me in my practice, indirectly. It gives me an overview of different perspectives.” Over time, Dr. Collison’s passion also began to pay off in practical ways and the devoted student also became a teacher. “Suddenly, they were giving me research to do and I loved it! I enjoyed the challenge of figuring out ‘Who made this? Where did it come from?’ And then I was coming up with a report to describe it all. (And I got paid for some of it, too.) Meanwhile, if I needed to, I could drop everything that day and suddenly go work in the ER.” Dr. Collison began teaching classes at USD on the study of artifacts and methods of studying historically important diseases through the analysis of skeletal remains. He has analyzed the records of the 7th Cavalry for Ear, Nose and Throat diseases, which will soon be part of a new book. “All of this gives me a widening future,” says Dr. Collison. “I’m hoping to stretch this to a nice part-time retirement job after I’m out of the practice. My family supports this, although my kids roll their eyes when I’m ranging into some obscure details out loud. My wife actually goes along on some of the fieldwork. “When you think of archeology, you think of Indiana Jones to us! going after the Arc of the CoveTell us about your nant. That’s the wrong attitude. own ‘passionate pursuits’ outside What we’re trying to acquire is the office. understanding, not stuff. That’s what motivates me.” ■


November 2011


Managing Challenging Behaviors in the Healthcare Environment By Theresa Parish, OTR/L

As physicians and healthcare workers, do you serve clients who have challenging behaviors such as hitting, kicking, pulling hair, biting thus injuring themselves or others? Do you also serve the employees who are injured by these behaviors? Are you sometimes at a loss as to what you can do to help both the clients and employees? If so, simple solutions may be found by exploring sensory processing issues. Sensory Processing Evaluation A comprehensive sensory processing evaluation may lead you to conclusions that help you understand that the behaviors you are seeing are brain driven. Sensory processing is the way each and every one of us responds to incoming sensory information. We learn and grow through our senses which include touch, sight, sound, smell, taste, proprioception and vestibular sensation. We manage our day-to-day activities through all the information our bodies take in. Of which, 90% is actually below our conscious level of awareness. It is the foundation for emotional, language and cognitive processing. Without the foundation, individuals struggle.

Behaviors are not “On Purpose” Those of us whose sensory systems are “normal” respond appropriately to most situations. We are able to fix the situation without much difficulty. Now think of some of the clients you serve. They may be unable to tell you what noxious sensations they are experiencing or how to adapt to them. They are living in an environment that puts stress on their system little by little until their


Stay at Work/Return to Work body reacts because it can’t take the stress anymore. This is when a challenging behavior will occur. It is actually a normal chemical response of their nervous system. The reaction is brain driven.

Behavior Management Managing and controlling difficult client behaviors can be very exhausting. Caregiver and client safety are of the utmost importance and many times people are unaware that there are methods available to help improve client behaviors and improve safety when the foundation for behavior is addressed first. Many organizations have good behavior management programs and still have caregivers and clients being injured or property damaged. These programs generally work well to deescalate individuals; other times nothing seems to work. Support Staff do not look forward to coming to work to get hit, bit, grabbed, and have their hair pulled when assisting a person with challenging behaviors. However, the reality is that it happens all too often.

When an employee is injured, it is difficult for the physician to send the injured employee back into this situation, so return to work can become a problem. If this is a concern, determine if their employer has safe, modified job duties. A comprehensive program for management of challenging behaviors is also important. Companies should have written policies and procedures, training, behavior intervention plans, documentation, debriefing, modified job duties for injured employees, as well as annual reviews of their processes.

A Non-Traditional Approach In addition to behavior management programs, some organizations are beginning to implement Sensory Processing Intervention (SPI) to help reduce client behaviors. However, some organizations have never heard of SPI or how to easily implement it into their daily activities. All behavior has a meaning. Using SPI is just one piece of the puzzle when looking at the big picture. It is a non-traditional approach to helping with behavior management. The first step is awareness.

Midwest Medical Edition

It is Brain Driven Awareness that every brain has basic needs of safety, security, and comfort is key. The brain drives an individual to achieve those basic needs; sometimes, without regard to who is getting injured. If these basic sensory driven needs are provided by caregivers, then fewer challenging behaviors occur. This improves the quality of life for everyone involved. If you are unsure of how to help, a sensory processing evaluation and a sensory flow of the day may be the missing piece in a comprehensive plan. This solution will require special training for the caregivers, but the techniques are simple, easy and fun. The benefits are incredible and even life changing. ■

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November 2011

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EHR Equality PA’s Say Bill Would Extend Promise of Electronic Health Records to Underserved Communities The American Academy of Physician Assistants is welcoming legislation to amend the Health Information Technology for Economic and Clinical Health (HITECH) Act to extend electronic health record Medicaid incentive payments to all physician assistants who meet the Act’s criteria in serving Medicaid patients. The Health IT Modernization for Underserved Communities Act of 2011 would amend the HITECH Act to apply to PA’s whose patient volume includes at least 30 percent Medicaid recipients. “For the HITECH Act to have a far reaching impact on the healthcare environment, it is imperative to include not only Physician Assistants that lead Rural Health Clinics and Federally Qualified Health Centers, but all PA’s that serve a high Medicaid patient volume,” says Holly Arends, Clinical Manager of HealthPOINT, South Dakota’s Regional Extension Center, a part of Dakota State University. “This could not come at a better time as the urgent need for practices to adopt an electronic health record is crucial.” “Enhanced, quality patient care is the goal of electronic health records. The current HITECH limitation on Medicaid EHR limits the development of EHR systems for Medicaid beneficiaries who are served by PAs. This legislation extends additional support to community health centers and other medical practices in which PAs provide care to a high volume of Medicaid patients,” said Rep. Karen Bass (D-CA), one of the legislation’s sponsor’s. The HITECH Act currently offers the incentive payments to physicians and nurse practitioners who provide primary care to the requisite 30 percent threshold of Medicaid recipients, but limits the EHR incentive payments for Medicaid services provided by physician assistants in rural health clinics and federally qualified health centers with PAs at the helm.


Robert Wooten, AAPA president, said he was pleased with the legislation. He says medical practices and clinics that employ a large number of PA’s are penalized through the Medicaid EHR incentive limitation. Physician Assistants are often the sole health care professionals in medically underserved communities. Yet, an incentive program that fully recognizes physicians and advance practice nurses, but not PA’s, creates a financial disincentive for medical practices to hire PA’s. “The ultimate beneficiaries of electronic medical records are patients, and this bill extends the promise of improved medical care to the Medicaid patients served by physician assistant,” Wooten said. ■

Midwest Medical Edition

Rising Number of South Dakota PA’s Mirrors National Trend The number of Physician Assistants in South Dakota – and the amount of money they are earning – is on the increase, reflecting a national trend that has more PAs in practice than ever before. “When I came six years ago, we had approximately 350 PAs practicing in South Dakota,” says SDAPA Executive Secretary Mary Nafus. “Now, that number stands at least 450 and may even be higher.” Numbers in other states tell a similar story. According to new census data from the American Academy of Physician Assistants, the number of practicing PAs reached 83,466 in 2010, a 100 percent increase over the last 10 years. PA salaries are also up by an average of 2 to 8 percent nationwide, but in South Dakota, that increase was more than 9 percent over the previous year. Only Rhode Island and Missouri PAs saw a pay increase that large. Nationwide, more than 30 percent of PAs practice in primary care, making them an important commodity in states like South Dakota where access to primary care is limited. “PAs are the only health care providers educated and credentialed with a primary care focus, providing a strong foundation for any specialty in which they may choose to practice,” said AAPA President Robert Wooten, PA-C. “The information from AAPA’s salary and census reports clearly confirm what PAs and the health care world have known for years: The PA profession is growing rapidly, and it is key to expanding access to quality health care for millions of Americans.”  Other AAPA census figures show that nearly 30 percent of PAs practice in single-specialty physician group practices, and 40-percent have been in their current primary specialty for at least six years. The Census also shows that PAs enjoy their work, as 66 percent indicate they are satisfied or mostly satisfied with their career. While the majority of PAs are in clinical practice, an estimated 5,079 PAs work either alone or concurrently in health care education, administration, research and public health – a figure that demonstrates the growing role PAs play in influencing the entire health care field. ■

November 2011

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New Choppers for Sanford’s Fleet Sanford Health has purchased three EC145 helicopters from American Eurocopter. The aircraft will be part of an initiative to expand Sanford’s coverage area and its services to patients. Sanford Health is, geographically, the largest rural not-for-profit health care system in the nation with locations in 112 communities across seven states. Orlen Tschetter, Vice President at Sanford Health, says there was a long selection process for the EC145s. “We knew we wanted an established product with the size to accommodate passengers and equipment, and the performance to provide the range to service our growing coverage area.”

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Midwest Medical Edition

Research Spotlight

A Genetic Link to Pelvic Prolapse? A Sioux Falls doctor’s research into a genetic link shared by women with reoccurring pelvic organ prolapse may soon help patients around the world.

Michael Fiegen, MD, recently presented the results of his two year study at the annual scientific meeting of International Urogynecology Association in Lisbon, Portugal. The specialist in urogynecology and reconstructive pelvic surgery was one of a select group of researchers chosen to present their findings to the meeting’s 1500 international attendees. Dr. Fiegen’s study focused on differences in gene expression among women who experience recurrent pelvic organ prolapse and those for whom a single surgery is sufficient to correct the problem. By studying three groups of women, some with pelvic organ prolapse, some without the condition and others who have had a recurrent prolapse, Dr. Fiegen was able to identify a genetic expression unique to the recurrent group. If a process can be used to identify these women prior to surgery, doctors may be able to plan procedures to significantly reduce the risk of recurrence. “About 30 to 40 percent of women have a higher rate of recurrence,” says Dr. Fiegen. “So one out of three women who has gone through this major surgery will end up needing surgery again. If we are able to identify a genetic predisposition beforehand, we may approach the intervention differently from the outset.”

November 2011

Dr. Fiegen says a ‘stepped up’ surgical intervention, for those shown to be at higher risk for prolapse recurrence, might incorporate the use of prolene mesh for extra support of the pelvic organs. “It would first be a matter of discussing this with the patient and making her aware of her risk,” says Dr. Fiegen. “Then the patient could decide for herself whether she wants to take an augmented approach to surgery.” Phase I of the “. . . one out of three research is complete women who has gone and Dr. Fiegen and his colleagues are through this major now working on surgery will end up protocol assignment needing surgery again” and funding for the next phase, which he hopes will include multiple centers for a large patient sample. Dr. Fiegen, a graduate of University of South Dakota and Ohio State University School of Medicine, practices at Sanford Clinic Urogynecology and Female Pelvic Medicine in Sioux Falls. ■


Newly open in Sioux Falls

Victoria Knudsen, MD

Jeffrey Stevens, MD

Avera McKennan Hospital & University Health Center has opened two new clinics in Sioux Falls, including its first ophthalmology clinic. Jeffrey Stevens, MD and Victoria Knudsen, MD will provide a range of ophthalmologic services, from eye exams and prescriptions to eye trauma, treatment for inherited or congenital conditions, and eye diseases common in seniors including glaucoma and cataracts. Dr. Stevens completed his medical degree and ophthalmology residency at Drexel University College of Medicine in Philadelphia. Dr. Knudsen received her MD from Yale University School of


Avera Opthamology and Dermatology Clinics Medicine and did a residency in ophthalmology at the University of California, San Diego. She is fellowship trained in vitreoretinal surgery and has special expertise in the treatment of retinal conditions such as macular degeneration and diabetic retinopathy. “Demand is growing for ophthalmologic medical care, and a key reason is our aging population,” said Dr. David Kapaska, Avera McKennan regional president and CEO. In addition, incidence of diabetes is on the rise, a key complication of which is diabetic retinopathy. The new clinic is located in the Avera Doctors Plaza 2

on the Avera McKennan campus. At the same time, the hospital has opened a new dermatology clinic on Minnesota Avenue. The newly constructed facility replaces the former clinic at 69th and Minnesota which is now Avera Medical Group McGreevy Clinic Pediatrics. The 22,000 Sq. Ft. dermatology clinic includes Drs. Brian Knutson, Douglas Pay, Jana Johnson, Michelle Wanna and Valerie Flynn; as well as one certified nurse practitioner, Heidi Furth. The clinic has its own histology lab, state-of-the-art procedures rooms, and on-site pharmacy. ■

Midwest Medical Edition

Grape Expectations

It’s Turkey Time! By Heather Taylor Boysen


e remodeled our house a couple of years ago and the construction included my dream kitchen. An agreement with my parents to host all future family holiday gatherings in exchange for living accommodations wasn’t out of line considering two adults and two young children were going to be invading their living space for an unknown amount of time. That Thanksgiving day was gorgeous with the crunch of leaves underfoot and the sunlight making the colors of the season glow. Our two turkeys had been brining in massive coolers for 24 hours and were ready for their trip into the ovens. Yes, you read correctly, we always have two turkeys because most of us want dark meat! We had 16 people coming to our house and everyone was bringing different side dishes and desserts. As a wine shop owner, I wasn’t worried at all about the food (although my Mother called me very early in the morning to make sure the turkeys were in the oven), but rather what wine would go with all of those different flavors? In our family the Thanksgiving meal is the same as it has been since I was a kid. Salty appetizers, cheese and relish trays, sweet potatoes and cranberry sauces, starchy mashed potatoes with butter and garlic, white and dark turkey meat, the obligatory green bean casserole, homemade buns and pies – lots of pies. As I tell all of my clients who come to my wine shop, it isn’t about the turkey on Thanksgiving when it comes to

choosing great wine pairings. The turkey is more of the structure or backbone of the meal. It is the plethora of sides that creates the difficulty in choosing a wine or wines for the meal. I have several rules for Thanksgiving wine that have given me great success throughout the years in pairing wine for this particular meal. Stick with wines that have an alcohol content under 14%, enough acidity to balance the food, low tannins and very little oak. Two reds that rarely work with this type of Thanksgiving fare are Cabernet Sauvignon and Merlot. The alcohol content is too high in most cases and will taste “hot” and the tannins will take on unpleasant bitter notes. Unless Prime Rib is on your menu I would avoid these varietals completely. I would also recommend staying away from big, creamy, oaky Chardonnays as they have a tendency to cling to your palate and obliterate the delicateness of the turkey as well as taste terrible with most of the sides. I love to begin our gathering with a sparkling wine. Whether it is French, Italian or domestic, it is up to you and your budget. The bubbles cleanse the palate, put you in a festive mood and go with just about everything. The white wines I love to put on a Thanksgiving table include unoaked Chardonnays, preferably French, with bright acidity and a crisp lively finish. Pinot Blanc, Viognier, Dry Rieslings and Pinot Gris are also wonderful especially if your guests don’t want a bone-dry white with their meal. My go-to reds include lighter style Pinot Noir and Beaujolais. Both of these

November 2011

reds have a pleasant acidity as well as bright fruit flavors that are beautiful for Thanksgiving. A very refreshing and light Rosé made from Syrah or Pinot Noir grapes is also fantastic as a bridge between white and red. If you want something a little bigger but not too over the top, a Syrah or even Zinfandel would fit the bill. Let me be clear – Red Zinfandel – not White Zinfandel! Desserts including pumpkin and apple pie scream for high acid, sweet botrisized dessert wine including late harvest Rieslings and Ice Wine. A very simple Moscato d’Asti would also work well. Please make sure all of your wines are served at a proper temperature. Kitchens have a tendency to get very warm with ovens and burners going full blast which will heat up your bottles of wine, so throw your reds in the fridge to get them around 60 degrees before you serve them and keep your whites either in the fridge or in a nice bucket of ice water if you can. Above all, remember that it is a celebration. Raise your glass, celebrate with your loved ones, eat until you can’t eat anymore, watch a little football and worry about washing the dishes later! ■ 29

Community Blood Bank Celebrates 20 Years of Mobile Service The Community Blood Bank of Sioux Falls is celebrating its 20th anniversary of providing mobile service through its bloodmobile program. It was November 1991 and the Community Blood Bank Board of Directors and staff members had high hopes of collecting additional blood for local hospital patients by implementing a “bloodmobile.” The bloodmobile would offer a complete donor room facility on wheels going out to businesses, schools, and residents within a 50-mile radius of Sioux Falls. This would be a custom-built coach with state-of-the-art equipment and a full staff to expand the donor base of the Community Blood Bank, ensuring an adequate blood supply for the nine hospitals that Community Blood Bank services. The first blood drive would take place at Citibank in Sioux Falls on Nov. 20, 1991. Upon completion of the bloodmobile’s first blood drive, 58 pints of life saving blood were collected, it was apparent that the mobile operations would be successful. Today, Community Blood Bank services a 150- mile radius of Sioux Falls providing blood to 29 hospitals throughout southeastern South Dakota, northwestern Iowa, and southwestern Minnesota. Community Blood Bank currently operates two bloodmobiles which collect over 20,000 units of blood, providing over 80% of the blood supply for the area. Since Community


Blood Bank’s mobile operation began, there has been a total collection of 241,000 blood donations to help area patients. “At the core of our service to the people of our region is a sense of ‘community.’ It is in our name, in the cooperation between Avera and Sanford, in the support of businesses and organizations and in the spirit of each and every donor who offers blood as a gift of life,” states Henry Travers, MD, Community Blood Bank Medical

Director / Board Chair. Dr. Travers has been instrumental in developing the mobile operations along with Medical Director / Board Chair Keith Anderson, MD, Board Member Dianne Breen, Recruitment Supervisor Rita Nelson, Lead Driver David Liesinger, and Bloodmobile Supervisor Pam Sandro. Community Blood Bank is a nonprofit, cooperative of Avera McKennan Hospital & University Health Center and Sanford USD Medical Center. ■

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Midwest Medical Edition

News & Notes Happenings around the region

Avera Avera McKennan Hospital & University Health Center has been named a winner of the 2011 AARP Best Employers for Workers over 50 Award. Each year, AARP selects 50 employers that have demonstrated exemplary practices with regard to recruitment, retention and promotion of older workers. Programs at Avera McKennan which are attractive to older workers include flexible work environments and scheduling, educational opportunities, life and health benefits, retirement plan, a commitment to work-life balance, and an employee health program. The Avera McKennan Radiology Department and Imaging Center has been awarded three-year accreditation in MRI by the American College of Radiology. The ACR gold seal of accreditation is awarded to facilities meeting ACR Practice Guidelines and Technical Standards after a peer-review evaluation. Image quality, personnel qualifications, adequacy of facility equipment, quality control procedures and quality assurance programs are assessed. Avera Heart Hospital has been recognized as a Gold-Level Start! Fit-Friendly Company by the American Heart Association’s Start! initiative for helping employees eat better and move more. Last year, Heart Hospital employees had the opportunity to attend a free wellness fair, participate in a team weight loss challenge, gain training tips to run a 5K, and participate in national Walk at Work Day.

November 2011

Karl Richards has been named Clinic Administrator of Avera Medical Group Pierre. Born and raised in Pierre, Richards is a lifetime resident of the community. He holds a BS in public relations and advertising from USD. Avera Medical Group Pierre has a total of 24 physicians in 10 specialties, including family practice, internal medicine, pediatrics, hospitalist care, orthopedics, neurosurgery, OB/GYN, general surgery, podiatry and urology. Avera Queen of Peace Hospital in Mitchell and Avera Heart Hospital in Sioux Falls have been named in the nation’s top performers for key quality measures by JCAHO, the leading accreditor of health care organizations in America. To be recognized as a top performer on key quality measures an organization must meet 95 percent performance thresholds. Avera Queen of Peace Hospital was recognized for achieving these thresholds for pneumonia and surgical care and Avera Heart Hospital was recognized for achieving these thresholds for heart attack, heart failure and surgical care. North Central Heart Institute has welcomed two new physicians: Elden R. Rand, MD, FACC, received his medical degree from the USD Sanford School of Medicine. He completed his internal medicine residency at the Brooke Army Medical Center in Fort Sam Houston, Texas, and his cardiology fellowship training at San Antonio Uniformed Services Health Education Consortium. Dr. Rand is board certified in Internal Medicine, Cardiology, Echocardiography, Cardiovascular CT and Nuclear Cardiology.

Jeremy W. Scott, MD, received his medical degree from the USD Sanford School of Medicine and completed his internal medicine residency at the Mayo Graduate School of Medicine in Rochester. Dr. Scott then completed his cardiology fellowship training and interventional cardiology training at the University of Nebraska Medical Center in Omaha. He is board certified in Internal Medicine and Cardiology.

Regional Rita Stacey, RN, CDE, Director of Patient Services at Lead-Deadwood Regional Hospital, was recently recertified in Diabetes Education by the National Certification Board for Diabetes Educators. Stacey has been employed at LDRH for more than 20 years, 15 years as a diabetes educator. Currently, there are more than 17,000 diabetes educators who hold NCBDE certification. Certification is awarded for a five-year period. Regional Health Network has entered into a management agreement with Crook County Medical Services District in Sundance, Wyoming. A wide range of management support services are provided to assist the local organization in quality, costeffective health care delivery. The Board of the local organization retains control over policy setting and fiduciary obligations.  Crook County Medical Services District includes a 16-bed critical access hospital, 32-bed skilled nursing facility, home health services and three clinics.

Kelly Stacy, M.D., an internist with Regional Medical Clinic, has been named the 2011 South Dakota American College of Physicians Young Physician of the Year. A native of Midland, Texas, Dr. Stacy completed her medical school training at St. George’s University School of Medicine in New York and her residency in Internal Medicine at University of Roanoke/Salem in Virginia. Dr. Stacy is also active in teaching Internal Medicine to third and fourth year medical students and is an Academic Assistant Professor with Sanford School of Medicine. Dr. Stacy has been with Regional Medical Clinic since 2007. The Intersocietal Commission for the Accreditation of Vascular Laboratories has granted a three-year term of accreditation in Extracranial Cerebrovascular Testing to Regional Heart Doctors Vascular Laboratory. Accreditation is given to facilities that comply with national standards in providing quality patient care.

Sanford Sanford Medical Center has been named a Consumer Choice Award winner by National Research Corp. Sanford Sioux Falls & Fargo were both recognized for the 6th consecutive year. The list was published Monday Oct 17, in Modern Healthcare. The award is based on the hospital that possesses Best Overall Quality, Best Overall Image/Reputation, Best Doctors and Best Nurses. Sanford is ranked alongside hospitals like Mayo Clinic, Mass General, Cedars-Sinai, and Cleveland Clinic as winners in their respective markets this year. 


News & Notes

Happenings around the region

Sanford continued David P. Munson, MD, has received the Pioneer Award from the South Dakota Perinatal Association. The award recognizes “the pioneering efforts of those who have broken ground in caring for new families.” Dr. Munson received the award the 36th annual South Dakota Perinatal Association Conference. Dr. Munson practices neonatal and perinatal medicine and pediatrics with Sanford Children’s. The American Society for Gastrointestinal Endoscopy recently recognized Sanford Health and its physicians for quality and safety. The Sanford Health gastroenterology/endoscopy suite is one of 314 endoscopy units granted the honor from the ASGE Endoscopy Unit Recognition Program since 2009. David Rogers is the new CEO of Sanford Webster Medical Center/ Bethesda Home. Rogers spent the past two years serving as the administrator of Webster’s Bethesda Nursing Home and Heritage Village. A Watertown, SD native, Rogers earned his bachelor’s degree in Sioux Falls at Augustana College. He also holds a master’s degree in health care administration from Bellevue University in Bellevue, NE.


Sanford Health Brookings Clinic is now offering Acute Care for patients with nonemergency medical conditions such as minor burns and cuts and illnesses. Acute Care patients can visit the office without an appointment Monday-Friday, 4:30-8:30 p.m., Saturday, 8 a.m.-12:30 p.m. Acute Care is located in Sanford Health Brookings Clinic’s location at 922 22nd Avenue S. Sanford Health has announced Letters of Intent with Clearwater Health Services and Broadway Medical Center in Minnesota. An LOI is a non-binding first step in a potential merger. CHS includes Memorial Hospital in Bagley, the attached CHS clinic, the Clearwater Ambulance Service and the CHS clinic in Clearbrook. CHS currently has a management contract with Sanford. Broadway Medical Center in Alexandria has 34 providers and over 100 staff in two locations. Services include: allergy, emergency, family practice, general surgery, hospitalists, internal medicine, OB/GYN, oncology and podiatry.

Eric Hilmoe, Administrator/ CEO of Sanford Hospital CantonInwood, was elected Chairperson at the Annual Business meeting of the South Dakota Association of Healthcare Organizations (SDAHO). Hilmoe served last year as ChairpersonElect of SDAHO. A native of Colman, Hilmoe received his degree in healthcare administration from USD. He has been the Administrator/CEO in Canton since 2002 and has served on the SDAHO Board of Trustees since 2004. Hilmoe assumed his leadership role at SDAHO’s 85th Annual Convention in Rapid City.

Radiologists at Sanford are now using a new piece of equipment designed to improve image quality and speed up imaging through ease of use, while lowering patient radiation dose. Sanford has installed Konica Minolta’s Wireless Aero DR system in the Emergency Department and will use three more of the units in the Sanford Heart Hospital when it opens next year. Sanford reports that the new equipment has allowed for a 40 percent reduction in radiation dose over the Xpress CR system, which had itself reduced dosage over the previous CR system.

Other Yankton Medical Clinic, P.C. is pleased to announce the association of Internal Medicine physician, Clarissa Barnes, M.D., Obstetrician/Gynecologist Jill F. Sternquist, M.D.and Nephrologist Byron S. Nielsen, M.D. Dr. Dr. Barnes is a graduate of The Johns Hopkins School of Medicine. She completed her Internal Medicine residency training at The Johns Hopkins. Additionally, Dr. Barnes completed internships with the Global AIDS Alliance, the Center for Biosecurity, and the Department of Health and Human Services during her years in medical school. Dr. Sternquist is a graduate of USD School of Medicine. She completed her Obstetrics and Gynecology residency training at Creighton University Medical Center. Dr. Sternquist will provide medical and surgical treatment of diseases unique to women, regular examinations, pap smears, infertility treatment, family planning and care of women before, during and after childbirth. Dr. Nielsen is a graduate of USD School of Medicine. He completed his Internal Medicine residency training and his nephrology training at the University of Iowa. In additional diagnosing and treating kidney disease, Dr. Nielsen also specializes in the treatment of hypertension, electrolyte disturbances, the medical management of kidney stones, and provides both inpatient and outpatient dialysis.

Midwest Medical Edition

Learning Opportunities Happenings around the region

November 2011 November 3 – 4 7:30 am – 4:45 pm

Perinatal Clinical Update: Maternal-Newborn/Low Risk Newborn NCC Certification Review Course

Location: Sanford USD Medical Center, Schroeder Auditorium Information and Registration:, 605-328-6353

November 4

5th Annual Denny Sanford Pediatric Symposium

7:30 am – 5:30 pm

Location: Sanford Center 6.0 AMA PRA Category Information and Registration:, 605-328-6353 1 CME Credits, 6.4 CNE Contact Hours

November 7 7:00 am

4th Annual eHealth Summit

Location: Sioux Falls Holiday Inn Downtown Information:, 605-256-5555

November 11 & 12

Van Demark Spinal Cord Injury Symposium

Location: Sanford Center, Dakota Room Information and Registration:, 605-328-6353 12.5 AMA PRA Category 1 CME Credits

November 18 8 am.-4 pm

2011 Avera Pediatric Symposium

Location: Avera Education Center Auditorium Information:, 322-8950; click on Events Calendar

December, multiple dates

Perinatal Nurse Fellowship

8 am – 5:00 pm


Information on dates and locations:,

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


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MED-Midwest Medical Edition-November 2011  

MED - Midwest Medical Edition November 2011 Issue

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