MED-Midwest Medical Edition-April/May 2013

Vol. 4, No. 3

2013 April May

Putting Training Into Practice

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

Contents Midwest Medical Edition

April May 2013

Putting Training Into Practice

Regular Features 2 | From Us to You 4 | Meet a MED Advisor 8 | News & Notes News from around the region 14 | Complementary Therapy Water Birth

Center for Family Medicine

Water birth is growing in popularity at Sanford.

Is it a safe way to make childbirth easier?

20 | The Nurse's Station 28 | Off Hours: Sioux Falls Optometrist has his eye on the Boston Marathon

By Liz Boyd

27 | Grape Expectations: A Memorable Tasting 33 | Learning Opportunities

| By Heather Taylor Boysen

Upcoming Symposiums, Conferences, CME Courses

In This Issue 5 | Using Video in Your Practice

| By Alex Strauss How leveraging your volunteers can improve your services and your reputation

6 | The Right Online Advertising Mix Shifts Power Back to You

For 40 years, the Center for Family Medicine has been

By Tana Phelps

16 | Mercy Medical Center Achieves major Perinatal Safety Goal

putting the training of new

17 | Limb Preservation Center Opens in Sioux Falls

of caring for some of the re-

physicians into the practice

17 | Sioux Falls Surgeon Reaches Robotic Surgery Milestone

gion’s neediest patients. As

18 | Third National Quality Award for Avera McKennan

many as 80 percent of CFM

18 | New Options for Lung Cancer Care in Sioux City

residents go on to practice

19 | Functional Medicine: What does it mean for the future of healthcare?

A Talk with Family Physician Patty Peters, MD

in South Dakota or an adjacent state, fulfilling the program’s mission to care

22 | Down on the FARM Sanford USD School of Medicine hopes to produce more rural physicians with a pro-

for the mostly rural upper

gram that puts students in the middle of the action. | By Alex Strauss

Midwest. MED steps inside

24 | Federal Budget Challenges to Healthcare Continue

By Dave Hewett

26 | Embracing Change

| By Jan Chambers EHR causing upheaval in your office? HealthPOINT has the three steps for dealing with change.

this busy clinic for a look back. . . . And a look ahead.

Cover photo: Resident Dr. Alese Fox and Lab Technician Valorie Prickett in CFM’s onsite laboratory. Photo by Darrel Fickbohm.

page

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From Us to You

Staying in Touch with MED

A

s the need for primary care physicians continues to grow, both nationally and in our region, the Center for Family Medicine in Sioux Falls continues to meet that need, not only by providing state-ofthe-art family medicine services for as many as 2,800 patients a month, but also by serving as a training ground for the next generation of family physicians. The Sioux Falls Family Residency program based at CFM has graduated close to 300 primary care doctors since 1973, including some of the biggest names in family medicine and physician leadership around the region. For this month’s cover feature, we take you inside this busy clinic to learn about its humble beginnings and its hopeful future.

MED is committed to helping you do what you do more effectively and efficiently. Our thanks to those of you who responded to last month’s column on How to Handle a Media Interview. This month, we tackle the reasons to consider using video to promote your practice and educate your patients and offer some practical (and even inexpensive) ways to get started.

Plus, the experts at Cassling have advice for choosing the right mix of online advertising. And, of course, we have all the latest news from hospitals and clinics around the region.

Finally, the American medical community said goodbye to a notable leader in February. Former Surgeon General C. Everett Koop, a pediatric surgeon and outspoken public health advocate, died at the age of 96 at his home in New Hampshire.

Dr. Koop, who served from 1982 to 1989, was the first surgeon general to become a household name for his commitment to public education, particularly on the issues of smoking and AIDS. The American Cancer Society called Dr. Koop’s 1986 report on the dangers of secondhand smoke “the shot heard around the world” that marked the beginning of major public policy changes. Koop was also known as wise and witty and a great advocate for children, who said, “Life affords no greater responsibility, no greater privilege, than the raising of the next generation.”

Wishing you a pleasant and productive spring, —Steff and Alex PS–If you are traveling to Deadwood for the upcoming SDMGMA meeting April 24 – 26, we invite you to stop by the MED booth and introduce yourself.

Publisher

MED Magazine, LLC Sioux Falls, South Dakota

VP Sales & Marketing Editor in Chief

Design/Art Direction

Cover Design/Photo Photographer

Web Design

Contributing Editor Copy Editor

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

Steffanie Liston-Holtrop

Contributing Writers Heather Boysen Jan Chambers Dave Hewett Sarah McQuade Tana Phelps

Staff Writers Liz Boyd Caroline Chenault John Knies

Alex Strauss

Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss, Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website MidwestMedicalEdition.com

2013 Advertising / Editorial Deadlines Jan/Feb Issue December 5

June Issue May 5

Sep/Oct Issue August 5

March Issue February 5

July/ August Issue June 5

November Issue October 5

April/May Issue March 5

December Issue November 5

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

Former Surgeon General C. Everett Koop

e Woruits! t

t ccep We aader e r ns issio 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 alex@midwestmedicaledition.com.

Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com.

MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

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Midwest Medical Edition

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

1.855.850.KIDS (5437)

Physicians’ PriOrity Line

your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.

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Med Mag Ad, Mar. 2013.indd 1

2/27/13 1:13 PM

Be a MED Advisor

Dr. Your Name

The Med Magazine Advisory Board The following area physicians have agreed to serve on the MED Magazine Advisory

?

Q: This space has been used in 2012 to introduce and provide a forum for the members of MED’s Physician Advisory Board.

Why is there no board member this time?

A: As MED broadens its scope and circulation, it is time to also expand the list of physician advisors. MED’s editorial team is looking for forward-thinking and engaged regional physicians to help provide feedback and editorial direction in 2013 and beyond. Any practicing MD or DO within MED’s coverage area which includes South Dakota, Southwest Minnesota, Northwest Iowa and Northeast Nebraska is eligible, regardless of location, affiliation or specialty area.

Q: What does a MED Advisor do?

A: MED’s Advisory Board exists to help ensure that this publication is consistently meeting its longstanding mission to provide timely, local, relevant content to our growing readership of 5,000 physicians and healthcare professionals. MED Advisors provide their honest feedback on each issue of MED. They suggest article topics for future issues, occasionally answer clinical questions, and support the editorial team in connecting with the most appropriate contact people and interview subjects.

They also have an opportunity to promote a subject of interest or importance to them in this column.

Q: Does it take a lot of time? Does a MED Advisor have to come to meetings?

A: No, no meetings. In fact, the time commitment to serve on the MED Advisory Board is minimal, but the rewards are potentially great. Serving as a MED Advisor gives a physician the opportunity to not only keep a finger on the pulse of the very latest medical community news, but to also influence the content and direction of the area’s only local publication exclusively for doctors. MED Advisors have the ear of our editorial team and we take their suggestions very seriously.

Q: What should I do if I’m interested?

A: Send an email to Alex Strauss at Alex@ MidwestMedicalEdition.com or call us at 605-759-3295 to discuss the opportunity.

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Board in 2013. Their input will help ensure that MED Magazine continues to bring you the kind of content you want to read and will be an effective communication tool for this diverse medical community. Our thanks to them for their willingness to be a part of this new venture.

John Berdahl, MD

Dan Heinemann, MD

Ophthalmology Vance Thompson Vision, Sioux Falls Medical School: Mayo Medical School, Rochester, MN Internship: Mayo Clinic, Scottsdale, AZ Residency: Ophthalmology, Duke University Fellowship: Cornea and Glaucoma, Minnesota Eye Consultants

Family Medicine, Administration Sanford Health, Chief Medical Officer Medical School: University of South Dakota Internship: McKennan Hospital Residency: Sioux Falls Family Medicine Residency Program Board Certified: Family Medicine

Patty Peters, MD

Brad Randall, MD

Family Medicine Avera McGreevy Clinic, Sioux Falls Medical School: University of South Dakota School of Medicine Residency: Sioux Falls Family Medicine Residency Program Board Certified: Family Medicine

Forensic Pathology Dakota Forensic Consulting, Sioux Falls Medical School: University of Iowa Residency: University of North Carolina, Chapel Hill, NC Fellowship: Office of the Chief Medical Examiner, Chapel Hill, NC Board Certified: Anatomic, Clinical and Forensic Pathology

Daniel W. Todd, MD

Paul Amundson, MD

Otolaryngology Midwest Ear, Nose & Throat, P.C. Medical School: University of North Dakota Internship: General Surgery, University of Missouri Health Sciences Center Residency: Otolaryngology-Head & Neck Surgery, University of Missouri Health Sciences Center Board Certified: Otolaryngology

James Young, DO Dermatology Yankton Medical Clinic, Yankton, SD Medical School: Chicago College of Osteopathic Medicine Internship: Darnall Army Hospital, Ft. Hood, TX Residency: Grandview Hospital, Dayton, OH Board Certified: Dermatology

Family Medicine Dakotacare, Chief Medical Officer Medical School: Indiana University Residency: Sioux Falls Family Medicine Residency Program Board Certified: Family Medicine

Luis A. Rojas, MD Gynecologic Oncology Avera Cancer Institute, Sioux Falls Medical School: Universidad Nacional Pedro Henrriquez Ureña, Santo Domingo, Dominican Republic Residency: Temple University Hospital, Philadelphia Fellowship: Cleveland Clinic Foundation, Cleveland Board Certified: OB/Gyn

Tim Ridgway, MD

Kelly Steffen, DO

Gastroenterology Sanford School of Medicine, Dean of Clinical Faculty Medical School: University of South Dakota Residency: Mayo Graduate School of Medicine Fellowship: Gastroenterology, Mayo

Cardiology Sanford Heart Hospital Medical School: Kansas City University of Medicine & Biosciences, College of Osteopathic Medicine Internship & Residency: Internal Medicine, University of Kansas Medical Center Fellowship: Cardiovascular Disease, University of Kansas Medical Center Board certified: Internal Medicine

Midwest Medical Edition

By Alex Strauss

Using Video in

Your Practice

I

f you are not incorporating

video into the everyday operations of your practice, you could be missing out, not only on the opportunity to set yourself and your services apart in an increasingly competitive healthcare environment, but also to educate your patients (or prospective patients) for better health.

You could even be missing out on the chance to positively impact treatment outcomes if video is not a part of your treatment preparation or aftercare protocol.

And television is only part of the “picture”. According to the online digital statistics website, ComScore, 181 million U.S. Internet users watched nearly 37 billion online videos last April. The average viewer spent 21.8 hours watching videos online that month. And you can bet the numbers are even higher this April. Video is not going away.

Why Use Video?

Apart from the obvious reason that your patients (and potential patients) are watching, video, whether for marketing or education, has a lot to recommend it.

It’s more personal. Especially if it

features you and/or your staff – or even just your voice – video gives you a way to connect with patients in a private and lower-stress environment outside the office.

It’s simpler. Even when the subject matter is somewhat technical, such as an explanation of a complex procedure, the fact that video allows you to show as well as tell means viewers are more likely to absorb it and remember it later.

April / May 2013

It gives you multiple distribution channels.

In addition to running your video in the lobby and exam rooms, you may post it to your website or your practice Facebook page. You may use it as part of a television marketing campaign, or you may post your video on YouTube (visited by one TRILLION people in 2011) and include a link on your website, giving online viewers two ways to find you. This method has the added benefit of increasing your search ranking in Google.

Where Do I Get a Video?

One method is to hire a professional to come to your office and produce a video.

This can be a great way to introduce yourself and your colleagues or office staff, or to give patients a short tour of your facility.

A professionally produced video can also be used to showcase your services, explain a procedure, or provide aftercare instructions. Think about information you deliver over and over. Referring patients to an online video (or giving them a DVD) can maximize your time together and improve efficiency.

Patient testimonials also make powerful videos. HIPAA simply requires written consent and most patients are happy to talk about a good experience. Keep in mind that any video showcasing your practice should look as professional as your other materials.

This means, it won’t be cheap.

Some less expensive sources for video content include: v Add a link to your website to a media interview or news story you’ve done v Turn a PowerPoint or Keynote presentation into a video. v Make a screencast presentation on your computer. Tools like Camtasia and Screenflow allow you to record what is on your computer screen and export it as a video. Offer a ‘tour’ of your website, or an explanation of a procedure with illustrations se photos and music to produce v U a slideshow.

Final Tips Finally, remember to keep any video – whether you do it yourself or hire a professional – short and simple. If you or your office staff plan to be on camera, dress professionally and speak naturally. You may want to hire a professional writer or editor to polish your script. And, if you plan to use patients, make sure they are personable. ■ Do you have a communication or marketing question that you would like Alex to address in this column? Send it to Alex@ MidwestMedicalEdition.com.

MidwestMedicalEdition.com

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The Right Online Advertising Mix Shifts Power Back to You

By Tana Phelps

I

f information is power, then

the Internet has created a serious power shift in healthcare. Two decades ago, patients who were concerned about a health issue went to their doctor. Now, almost 60 percent of all adults go online to learn about medical illnesses, treatments and procedures.

In order to shift the power back to you, it’s time to invest in online advertising.

Online advertising is a powerful marketing medium that connects well-intentioned healthcare marketers with informationhungry patients. Online advertising satisfies your customers’ desire for instant gratification since answers to their questions are just a click away. In addition, online ads generally cost less than print ads, and are easier to adjust should the message need tweaking.

Plus, it’s easier to track return on investment via clicks and page views.

Print advertising—including newspaper ads, billboards and postcards mailed to patients—is certainly still valid for many healthcare organizations. After all, not every patient has access to the Internet. But just as one treatment doesn’t work for all patients, your customers (especially the younger generations) will respond differently to a mix of advertising methods.

Prioritize the user experience.

Your ads should not interrupt a visitor’s time online. Pop-up ads, for example, are a major no-no. They are the equivalent of an annoying salesman. Additionally, if you want to put an ad in your e-newsletter, consider doing a text-based ad with a small image, so that it matches the tone and doesn’t interrupt the flow of information.

Target ads to your audience.

Outstanding demographic accuracy is one of the single greatest advantages of web advertising. Ad retargeting is an effective way to reconnect with patients even after they leave your website. For example, Facebook offers advertisers the ability to target by demographics, click behavior and browsing history.

Utilize mobile ads.

With nearly 25 percent of online searches taking place on a mobile device, mobile ads get you closer to the consumer than ever before. In addition, at a much lower cost per click, mobile can be very cost effective. If you do utilize mobile ads, your website should be mobile-optimized.

Partner with local experts.

There are a number of different types of online ads. Mobile ads, for instance, must be compatible with different device platforms. In addition, while Google’s AdWords simplifies search ads, they are becoming more competitive, and display ads are best used when highly targeted. Consider partnering with a marketing group or ad agency to get the best tools for your audience. ■

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

We Invest in You! Investing in

Consider these five best practices to make the most of online advertising.

Learn best practices from industry experts for educating patients on radiation dose and improving workforce dynamics – all from the comfort of your office!

Engage patients with high-quality content.

To be competitive, you must engage your patients. Instead of displaying general online ads for your service lines, focus on education. Leverage your in-house experts to provide timely resources, such as a blog post on heart disease prevention or a free webinar on radiation dose safety.

May 15: “Radiation Safety in Today’s Radiologic Practices” June 19: “Building an Effective Multi-Generational Workplace”

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YOU

You’re invited to participate in Cassling’s complimentary learning series, Investing in You.

Seminar Series

Upcoming Free Webinars:

» Visit www.Cassling.com/events to register.

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Midwest Medical Edition

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sanford Limb Preservation Center at sanford Vascular associates We trained to oPtiMiZe patients’ health.

To PreVent leg loss.

To ProteCt patients’ independence.

To saVe limbs and lives.

When you’re in need of an expert team that can provide specialized care to your patients with increased risk of leg loss or reduced ambulation, call on Sanford Limb Preservation Center’s Special O.P.P.S. team. We trained for this.

Meet the fellowship-trained vascular surgeons and advanced-trained podiatrist at your region’s only comprehensive limb preservation center:

Greg Schultz, MD Board-certified Vascular Surgeon

Patrick Kelly, MD Board-certified Vascular Surgeon

Chad Laurich, MD Board-eligible Vascular Surgeon

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Jeffrey Wienke Jr., DPM Board-qualified Podiatrist

oPtiMiZe. PreVent. ProteCt. saVe. For referrals, call (605) 312-7300 or (800) 618-3186 1305 W. 18th St., Sioux Falls, SD totalvascularcare.com 500-55205-0125 2/13

April / May 2013

MidwestMedicalEdition.com

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Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Avera Douglas R. Ekeren, FACHE, Vice President Professional and Regional Services, Avera Sacred Heart Hospital, Yankton, has been appointed to the Council of Regents, the legislative body of the American College of Healthcare Executives. As

a Regent, Ekeren represents ACHE’s membership in South Dakota. Ekeren has served as a vice president at Avera Sacred Heart Hospital since 1993. Prior to joining Avera Sacred Heart, he was the chief executive officer at Pioneer Memorial Hospital in Viborg. Ekeren is board certified in healthcare management and has served on the boards of the Yankton Area Chamber of Commerce, the Yankton School District, and Yankton Transit. Ekeren holds at MA in Hospital Administration from the University of Minnesota and a BA in Health Services Administration from USD. Avera McKennan was named as a Blue Distinction Center in the areas of Spine Surgery and Knee and Hip Replacement. The Blue

Distinction Centers for Specialty Care program is a national designation awarded by Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality specialty care.

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The Avera Sports Institute and Warwick Workouts are partnering to enhance basketball opportunities in Sioux Falls at all age levels.

The 25th annual Avera Race Against Breast Cancer will take place May 11 at the Avera McKennan Fitness Center.

Each year, the Avera Race brings together family, friends, cancer survivors and others – all racing toward a common goal: to enhance cancer care for people in Sioux Falls and surrounding communities. This event funds programs and services that benefit local cancer patients, including the All Women Count program, Avera Cancer Institute Resource Library, BRCA genetic testing, breast cancer support groups, the Cancer Fitness program, dietitian consultations, integrative medicine, patient navigation, Think Pink education kits, and wigs for cancer patients.

Chuck McCullough, a physical therapist at Avera Medical Group Brookings Clinic has renewed the Certified Hand Therapist (CHT) designation.

A graduate of the University of North Dakota, McCullough has been a physical therapist since 1992. He has worked in Brookings since 1997 and has been a certified hand therapist since 2003. McCullough is specifically trained and experienced in workman’s comp issues and on-site industrial medicine.

To house the new program, Avera plans to build a new gymnasium facility in Sioux Falls. The 17,000 square-foot space will accommodate two college regulation-size basketball courts and four regulation-size volleyball courts. Warwick Workouts offers advanced offensive player development basketball camps and clinics for youth in grades K-12 as well as at the college and pro levels.

Planned for opening in midsummer, the new facility will serve as training headquarters for Warwick Workouts, as well as team basketball and volleyball training. Sioux Empire Volleyball will also use the facility for training.

Greg Beckmann is the new Finance Controller at Avera Creighton Hospital.

Beckmann is a native of Bloomfield and a graduate of Midland Lutheran College in Fremont. Beckmann’s previous work includes Mutual of Omaha as a staff auditor in the Medicare Reimbursement Department, and KPMG as a senior audit associate.

After a brief stint at home helping with his step-father’s farm, he returned to Omaha as a senior audit associate at Reed & Associates CPAs.

Todd Forkel, regional president and CEO of Avera St. Luke’s Hospital, has been named South Dakota’s 2013 Grassroots Champion by the state branch of the American Hospital Association. Each year, the

American Hospital Association recognizes one hospital leader from each state for their work in effectively delivering the hospital message to elected officials, helping broaden the base of community support for hospitals, and advocating on behalf of patients, hospitals and communities. Forkel will be honored at the eighth annual “Breakfast of Champions” on April 30th in Washington, DC. Forkel started his career at Avera St. Luke’s as a radiology technologist, later serving as Director of Radiology and Vice President of clinics. He also worked as Director of Radiology at Mayo Clinic and as Senior VP of operations for Essentia in Fargo. Forkel is a graduate of Presentation College and Northern State University.

Midwest Medical Edition

Ashli Danilko is the new Executive Director of Organizational Excellence at Avera Sacred Heart Hospital.

A Yankton native, Danilko will focus on establishing, maintaining and implementing a hospital-wide program of service excellence, work process design, and operational efficiency according to established best practices and standards. Danilko previously served as the Avera Regional Director of Clinical Process Improvement in Sioux Falls. Prior to that, she was the director of LEAN Network Operations at Mercy Medical Center in Sioux City. Danilko holds a BS in Health Administration from USD and an MA in Healthcare Administration from the University of Missouri.

Black Hills The Children’s Miracle Network (CMN) raised $97,200 during a two-day One Call, One Miracle Radiothon. The event took place

on February 28th and March 1st in the lobby of Rapid City Regional Hospital and aired on New Rushmore Radio Stations. Money raised through special events such as the radiothon enables CMN to purchase medical equipment and fund programs for children’s services at Rapid City Regional Hospital. One hundred percent of the money raised locally stays in the area.

April / May 2013

During the month of March, Veterans were able to learn about telehealth tools up close at the VA Black Hills Health Care System facilities.

Veterans also met clinic staff involved in the telehealth program to ask questions and learn more about the services offered.

Julie Poppe, Rapid City Regional Hospital Clinical Quality Coordinator, recently

received certification as a Certified Cardiovascular Care Coordinator through the Society of Cardiovascular Patient Care. As a Clinical Quality Coordinator, Poppe is responsible for continued process improvement to ensure patients are receiving evidence-based care within cardiovascular disease processes. Poppe is among a small number of individuals to earn this certification.

Sanford Sanford Health medical centers in Bismarck, Fargo and Sioux Falls receive Blue Distinction designations in Spine Surgery and Knee and Hip Replacement. The Blue

Distinction Centers for Specialty Care program is a national designation awarded by Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality specialty care.

Sanford USD Medical Center’s cancer program was named to Becker Hospital Review’s list of “100 Hospitals and Health Systems with Great Oncology Programs.” The Becker’s

Hospital Review editorial team selected each organization based on clinical accolades, quality care, and contributions to the field of oncology. Each organization has demonstrated a focus on patient-centered cancer care and an emphasis on continual innovation in treatments and services. Sanford is a National Cancer Institute Community Cancer Centers Program site and is accredited by the Commission on Cancer of the American College of Surgeons.

Sanford Health has opened a Sanford Children’s Safety Center in Sioux Falls. The

CHILD Service office now includes a safety store featuring everything a parent or caregiver needs to know to help keep children safe. The store is set up with dedicated stations, demonstrating how best to safety-proof typical rooms found in any home.

MidwestMedicalEdition.com

Siouxland The Siouxland Iowa Physician Orders for Scope of Treatment (IPOST) Coalition is hoping to improve communication between patients and providers on end-of-life issues with a new form. Rolled out at

a press conference in February in accordance with the IPOST Law, the IPOST form is a tool that consolidates and summarizes an individual’s preferences for life-sustaining treatment and interventions and may be relied upon across medical settings.

Other Midwest Family Care in Sioux Falls celebrated national colorectal cancer month in March by promoting their new Digestive Health Clinic.

Headed by gastroenterologist Mark Malone, MD, the clinic offers a number of screening and diagnostic tests and treatment for a range of digestive and hepatic conditions. Providers are encouraged to remind patients over 50 to get screened for colorectal cancer. Midwest Family Care is a division of Sioux Falls Specialty Hospital.

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The Center for Family Medicine

Putting Training into Practice W

hen the poet Rudyar d K ipling wrote that ‘East is East and West is West and never the twain shall meet’, he might as well have been talking about South Dakota’s largest health systems. In the highly competitive South Dakota medical market, there are few places where these two systems ever ‘meet’. The Center for Family Medicine, a dynamic family medicine clinic and home to the Sioux Falls Family Medicine Residency program for 40 years, is one such rare place.

CFM’s 16 faculty providers include 12 family physicians, a clinical psychologist, a licensed nutritionist, a PharmD and a geriatric nurse practitioner. The CFM-based residency program, which has graduated nearly 300 residents and provides care for thousands of local patients, is jointly sponsored by Avera McKennan and Sanford Health Hospitals and is affiliated with the University of South Dakota Sanford School of Medicine.

Because residents play such an integral role in the practice, CFM literally incorporates their cutting-edge new knowledge into its patient care model while the graduates themselves are learning the practical application of that knowledge.

“Our mission is to train family physicians for South Dakota and other areas in the upper Midwest, which has a lot of rural and frontier areas, so they have to be pretty broadly trained,” explains David Brechtelsbauer, MD, a board-certified family physician and geriatrician who has worked and taught at the Center for Family Medicine since 1985. “But even while all of this is going on, from the patient point of view, CFM should just look like an efficient and attractive family medicine clinic.

Except that the docs are a little younger. Or a little older, as the case may be,” he laughs.

By Alex Strauss

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Mission Statement . . . . . . . . . .

..

Center for Family Medicine

Timeline 1969 Family Medicine Established as a Specialty

1973 Sioux Falls Family Medicine Residency Program accredited

1981 Family Practice Center moves from its original location on Summit Avenue to a new building on Dakota Avenue

1985 Number of residents cut from 12 to 8

2002 Dr. Kemp one of ten recipients of the “Courage to Teach� Award from among 8,000 residency program directors nationwide.

2002 CFM moves to the Avera McKennan campus

2012 Residency spots expanded from 8 to 9 Resident Dr. Ben Liscano and Dr. David Brechtelsbauer, Geriatrician and Associate Director of the Residency Program.

2013 CFM working to become certified Medical Home

The Sioux Falls Family Practice Family Medicine Residency Program is devoted to providing an excellent education which prepares physicians for practice in South Dakota and other areas of the mostly rural upper Midwest.

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CFM offers comprehensive in-house radiology services including X-ray and limited ultrasound.

A graduate of USDSM, Dr. Alese Fox (also on the cover) will finish residency at CFM in 2014.

Photos by Darrel Fickbohm

International Flavor

Although patients may not immediately notice it, in many ways, CFM is not a typical Sioux Falls family medicine practice.

“Partly because of our relationship with community health, we are not quite the standard office in Sioux Falls,” says Dr. Brechtelsbauer, who serves as Associate Director of the residency program. “I have a friend who says that coming to our office is like being in the United Nations. One time when we did a tornado drill, we all had to go to the downstairs conference room. I looked around and we had people of all ages and nationalities. Even people in African dress.

It was quite something.”

The diverse patient makeup means that CFM’s doctors are more likely to encounter patients with rare or unusual conditions. “For instance, it would be unusual to see elephantiasis in a town the size of Sioux Falls, but we have seen it,” says Dr. B. “This is why it is a culturally and intellectually stimulating environment for teaching and learning. I have to think about certain things that not many doctors in the region have to think about very often, if at all.”

CFM physicians and residents staff the community health centers in Sioux Falls where they see approximately 1,300 to 1,400 patients monthly and are responsible for expanding care far beyond the baby shots and STD clinics that used to be the health center’s primary services. Residents spend a portion of their training (less in the first year and more in years 2 and 3) working in the main downtown clinic in Sioux Falls or in one of three school-based satellite

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Dr. Earl Kemp has been Director of the Sioux Falls Family Medicine Residency Program for 31 of its 40-year history

community health clinics. They also provide care in OB clinics at Sanford or Avera, where needy patients can receive low-cost prenatal care and hospitalization.

History of the Residency Program

Accredited in 1973, the Sioux Falls Family Medicine Program is one of the oldest of its kind in the country. Prior to 1969, the year in which family medicine was established as a specialty, both McKennan and Sioux Valley hospitals in Sioux Falls provided one-year graduate training programs for residents who could go on to practice or go through a residency in another specialty.

“There was an explosion of information in medicine at that time,” says Earl Kemp, MD, a University of Iowa Med School graduate who has headed the Sioux Falls Family Medicine Residency program for 31 of its 40-year history. “In many states, you could start a practice right out of medical school.

But as time evolved, hospitals began to say ‘We need docs who can take care of undifferentiated patients’. The idea was to train people who would have a greater depth of knowledge than the old-time General Practitioners.”

From the beginning, family medicine was unique because it was the only residency that was required to be clinic-based. The 3-year Sioux Falls program originally accepted 12 residents a year with the idea that some of them would be trained in Rapid City. But the historic East vs. West tensions in the state eventually forced the program to drop back to 8, all of whom would be trained in the

The busy CFM clinic on the campus of Avera McKennan sees approximately 1,300 to 1,400 patients each month.

Sioux Falls area. After major dips in interest in family medicine in the early 1990s and again around 2007, it has seen resurgence in recent years.

The program size has recently expanded to 9 with the result that, at any given time, about 27 residents are working in the practice. Organized into teams by class, each group works under the guidance of a faculty team leader and an upper level resident. In addition, faculty physicians take turns being the go-to provider for residents who are working in the clinic on that day.

First-year residents work in the CFM clinic one half-day a week while also spending time in one of the local hospitals and doing rotations in other specialties to broaden their knowledge base. Because the goal of the program is to prepare doctors specifically for rural practice, it includes a month-long rural rotation. As residents build their practice, they will spend more time managing patients at CFM.

State-of-the-Art Care

CFM’s home clinic is state-of-the-art for family medicine. Located for many years in a small building on North Dakota Avenue, the clinic changed its name from Family Practice Center and moved to its current location on the campus of Avera McKennan 10 years ago.

Today, the approximately 1,400 patients who come through the doors every month will find a bright, spacious, modern building providing a full range of medical services, including counseling, nutrition, preventive medicine and referrals. The building includes an on-site laboratory and offers acute-care services not

found in some family practice clinics, including the ability to take X-rays on site and perform limited ultrasound.

“We have this challenging task before us of trying to provide residents with what they need to know but what they need to know keeps changing,” says Dr. Kemp. “To some extent, we have to unlearn some things that we used to know. There is still a lot in medicine based on ‘well, we think this should work’. But we’re trying to do more evidence-based medicine.”

As the structure of healthcare changes, one of the things new doctors need to know is how to work effectively as part of a team.

Drs. Kemp and Brechtelsbauer, both of whom have won South Dakota’s Family Doctor of the Year Award, say the team approach afforded by the on-site residency program means that patients have the advantage of the faculty physicians’ years of experience, as well as the residents’ most current training.

“The faculty has a lot of clinical experience, but the residents are newly-minted,” says Dr. Brechtelsbauer. “The advantages of having young physicians around here really showed up when we implemented EMR.” And like other physicians who work closely with residents or medical students, CFM’s faculty physicians say the presence of the residents tends to raise the overall quality of the care they all provide.

“For one thing, the pace at which patients are being seen tends to be a little slower here than in private practice, so each patient is seeing the doctor for a little longer,” says Dr. Kemp. “And patients get the advantage of the very current knowledge of the youngest physicians who have just been on rotation with some subspecialist, as well as the wisdom of the faculty physicians who are supervising them.”

The Future of Family Medicine

Dr. Kemp says the residency program’s recent expansion reflects a growing national interest in primary care. Whereas there was a time when only a few dozen people interviewed to fill the 8 spots, this year 63 applicants applied for the program’s 9 positions. Most of these people still come from

South Dakota and the surrounding states, but an increasing number are gravitating to the program from farther afield. About 20 percent of residents in the program come from outside the region.

“As we have gotten a national reputation, we have gotten more people from all over the place,” says Dr. Kemp. “We had a resident about ten years ago that had never been west of Massachusetts. We told him that he had to learn to deal with cow tipping injuries.

We have fun with people who don’t have roots in this region.”

By all accounts, the CFM-based residency program is accomplishing its mission.

About half of the young doctors who graduate from the program stay in South Dakota and about 20 percent stay in Sioux Falls. A full 80 percent are either in South Dakota or surrounding states. Two thirds are in rural practice according to national standards. And a full forty-five percent practice in communities of less than ten thousand people.

Regardless of where they receive their care, Dr. Kemp says that, ideally, all patients should have a central place where all of their ongoing health maintenance needs can be managed and met. That is why the next move for the Center for Family Medicine is to become a certified Medical Home. To achieve the designation, CFM is incorporating multiple staff members to do things like remind patients of important tests and screenings between office visits and to help them with transitions from one care setting to another to help eliminate the medical errors sometimes associated with discharge.

“This is part of the team effort that goes into becoming a Medical Home,” says Dr. Kemp, who recently won the SDAFP’s Lifetime Achievement Award for his commitment to forward-thinking family medicine. “Family Medicine has always been a leader in the team approach and we will continue to be. If I have a patient and I want to make sure that they have all of the recommended services for maintaining their health, it is very difficult to do that in a limited time frame and by oneself.

At CFM, we all work together on this and we teach others how to do it. Because no doctor can do all of this alone.” ■

The Sioux Falls Family Medicine Residency Program

By the Numbers 300

People who did their residency at CFM

2,600– 2,800 Number of patients treated by CFM physicians and residents (at main clinic and through Community Health) monthly

80%

Program graduates who practice in South Dakota or surrounding states

20% Graduates who practice in Sioux Falls

2/3

Fraction of graduates working in rural practice by national standards

45%

Graduates practicing in towns smaller than 10,000

13

Complementary Therapy Supporting a Holistic Approach

Therapy

Water Birth Is water delivery a safe way to make labor easier?

T

he idea behind water birthing is simple but profound: Harness powerful natural forces – including the buoyancy of water and the pain-fighting endorphins released when a mother is immersed in it – to make childbirth easier. While it has been popular in Europe (and in some larger U.S. institutions, such as Northwestern) for decades, water birthing is just beginning to gain acceptance here in the South Dakota region.

“Some local physicians are very supportive of water birth and others think it’s not a good idea,” says Terry Engelmann, a Certified Nurse Midwife at Sanford who has performed many of the hospital’s 30+ water births in a movable pool. “This is new to South Dakota and new to the hospital setting. So, right now we are using inflatable pools.”

During a water birth, the laboring mother is in a pool of warm water at a temperature between 96 and 100. Sanford’s pool, which is used in one of two dedicated rooms, is 172 gallons, big enough for an adult to be immersed to about the armpits. Because warm water is believed to relax the muscles and release endorphins, anecdotal evidence shows that labor tends to progress more quickly and with less pain.

Relaxed pelvic muscles and the smooth, steady progression of labor may also reduce the risk of perineal trauma.

“We always get a lot of guff about it,” says Engelmann.

“They say ‘Are you wearing your speedo?’ But, actually, the provider stays outside the tub.” Because water births can progress more quickly, the provider does stay in the room with the laboring mother. “It is just so nice to see the reaction of moms. So much tension and fear is released,” Engelmann says.

As the baby emerges from the birth canal, it is assisted to the top of the water. Water birth relies on the newborn’s instinct not to breathe until he feels air on his face. As long as there are no complications, mother and baby may stay in the water together, reaping the oxygen-, glucose- and blood pressure-normalizing rewards of skin-to-skin contact.

14

By Alex Strauss Although women who have experienced water birth are often enthusiastic about the experience, Certified Nurse Midwife Teresa Buell admits that it is not as easy to quantify the benefits scientifically. “It is a tough thing to study because these babies are not hooked up to monitors,” says Buell, who also works at Sanford. Opponents of water birthing worry about the risk of infection from contaminated water, drowning, or an entangled umbilical cord. But a Cochrane review from 20041, as well as a number of European studies, found water birthing to be neither harmful nor beneficial to mothers or babies. Although an article from the British Royal College of Obstetricians and Gynecologists2 suggests there may be a theoretical risk of embolism if water enters the mother’s bloodstream, both the RCOG and the Royal College of Midwives “support laboring in water for healthy women with uncomplicated pregnancies”.

Buell says her own experience with water birthing at Sanford has been overwhelmingly positive. “What we do know is that babies born in the water tend to be very relaxed and very alert. They pick up their chests and bodies and look at their mom and dad. They are often very quiet and tend to seem less stressed.”

Because water birthing precludes the use of epidural, women are encouraged to express their desire to deliver this way by 28 weeks, so that they can be better prepared through hypnobirthing or another prenatal class. Giving birth in a pool does make it more difficult to monitor and intervene if problems arise, which is why the method is not used in high risk pregnancies. Women with HIV or hepatitis, gestational diabetes, preeclamsia, or active herpes are not candidates for water birth. It is also not recommended for women who have had a previous C-section or who are delivering before 37 weeks. ■ 1 Cluett ER, Nikodem VC, McCandlish RE, Burns EE. “Immersion in water in pregnancy, labour and birth”, Cochrane Database Syst Rev. 2004;(2):CD000111.

2.LMM Duley MRCOG, Oxford. “Birth In water: RCOG Statement No. 1.”

Royal College of Obstetricians and Gynecologist. January 2001

.

Midwest Medical Edition

Mercy Medical Center in Sioux City has achieved a safety and quality goal that will help further ensure the safety of babies born in its labor and delivery unit.

Every member of the labor and delivery team is now certified in Electronic Fetal Monitoring. As a quality and safety program, the certification allows for standardization of EFM interpretation and implementation of best practices to improve patient safety and reduce the risk of medical errors during labor and delivery.

“This new level of certification goes above and beyond what most hospitals would require and that ultimately means Mercy has created the safest environment possible to have a baby,” says Jerome Pierson, MD, Chief Medical Officer at Mercy.

Throughout labor, EFM helps clinicians evaluate a baby’s heart rate frequently and effectively, watching for signs of problems, like an abnormal fetal heart rate pattern that may indicate the need for interventions. Often, a simple intervention, such as changing maternal position, additional IV f luids, or supplemental oxygen is sufficient to turn things around. In other situations, more extensive interventions may be needed.

With their C-EFM designations, labor and delivery teams are now more adept at determining which heart rate changes are normal

Courtesy Mercy

Mercy Medical Center Achieves Major Perinatal Safety Goal

Sirena Sigears, RN, works with a small patient at Mercy Medical Center

and which are cause for concern.

The NCC’s Certificate of Added Qualification in Electronic Fetal Monitoring (C-EFM) is open to RNs, nurse practitioners, physicians, physician assistants and nurse midwives and takes a significant commitment to coursework, practice and examinations.

Mercy’s Family Birth Center is designated as a Level II Center for perinatal services. ■

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Midwest Medical Edition

Limb Preservation Center Opens in Sioux Falls New program helps patients at risk for amputations Sanford Health has opened a limb

preservation program in Sioux Falls, specializing in the treatment of lower extremity wounds in patients at high risk of amputation and compromised leg and toe function, particularly those with diabetes and peripheral arterial disease.

“Having a compromised leg or toe has a large impact on a person’s daily function including walking up the stairs, going to the grocery store and getting out of bed. Sometimes, illness or disease can even lead to amputation,” says Patrick Kelly, MD, vascular surgeon at Sanford Limb Preservation Center.

“Our mission to protect, prevent and save function in the legs and toes is truly about keeping our patients as mobile as possible.”

Led by a team of fellowship-trained, board-certified vascular surgeons and an advanced-trained podiatrist, Sanford Limb Preservation Center coordinates multidisciplinary care with other Sanford specialists

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Apply online at: www.YanktonMedicalClinic.com in infectious disease, endocrinology, cardiology, nephrology, plastic surgery, orthopedics, wound care and rehabilitation. The Sanford Limb Preservation Center team also includes Sanford Health’s wound clinic, which is home

to nurses trained in managing and treating acute infections of the lower extremities.

The Sanford Limb Preservation Center is the region’s only comprehensive limb preservation center. ■

Sioux Falls Surgeon Reaches Robotic Surgery Milestone ogist at Sanford Gynecologic Oncology Clinic and Chief Medical Officer for Sanford Development and Research, recently completed her 1,000th robotic surgery at Sanford Health.

Sanford acquired its first daVinci robotic surgical system in 2004 and Dr. Bell was one of the first surgeons in the region to incorporate robotic surgery into her practice. A graduate of Augustana and the University of South Dakota Medical School, Dr. Bell now provides surgeries for gynecologic malignancies, performs gynecologic

April / May 2013

surgeries for patients with benign conditions, and administers chemotherapy.

With Dr. Bell’s internationallyrecognized expertise, Sanford Women’s is excelling in the world of robotic surgery.

Nationally, the rate for patients who receive any open surgery is approximately 30-40% according to Solucient Data. At Sanford Gynecologic Oncology Clinic, the open rate is only 5%, also based on Solucient Data.

This is a huge differentiator for Sanford and for Dr. Bell as other healthcare providers in the area currently operate at the national level. ■

MidwestMedicalEdition.com

Courtesy Sanford

Maria Bell, MD, gynecologic oncol-

17

Third National Quality Award

for Avera

McKennan

Avera McKennan Hospital & University Health Center

has been named a Top 100 Hospital by Truven Health Analytics, formerly the healthcare arm of Thomson Reuters. Avera McKennan is the only hospital in South Dakota to be named to the list.

This is the fifth time Avera McKennan has been listed on the Top 100 list and it is the third national quality award for the Sioux Falls hospital this year. Avera McKennan was also named among the nation’s Best Hospitals and the No. 1 hospital in South Dakota by U.S. News & World Report, and in the top 5 percent of hospitals for clinical performance as measured by Healthgrades.

The Truven Health 100 Top Hospitals study evaluates performance in 10 areas: mortality; medical complications; patient safety; average patient stay; expenses; profitability;

patient satisfaction; adherence to clinical standards of care; postdischarge mortality; and readmission rates for acute myocardial infarction, heart failure, and pneumonia.

To conduct the 100 Top Hospitals study, Truven Health researchers evaluated 2,922 short-term, acute care, non-federal hospitals. They use public information — Medicare cost reports, Medicare Provider Analysis and Review (MedPAR) data, and core measures and patient satisfaction data from the CMS Hospital Compare website. Hospitals do not apply, and winners do not pay to be considered. The study has been conducted since 1993.

Winning hospitals were announced in the February 25 edition of Modern Healthcare magazine.

More information on this study and other 100 Top Hospitals research is available at www.100tophospitals. com. ■

The June E. Nylen Cancer Center in Sioux City is now incorporating Stereotactic Body Radiotherapy (SBRT) into its lung cancer treatment program. Because it allows for precision delivery of high doses of radiation, this surgical alternative is yielding high cure rates in patients with stage one non-small cell lung cancer. Standard therapy for these patients is thoracotomy.

SBRT is administered by fitting the patient into a customized immobilizing body frame to minimize lung movement from breathing. Because high doses of radiation can be administered to the tumor with minimal impact on surrounding healthy tissue, SBRT carries a lower risk of long term complications and a cure rate comparable to surgery.

Patients with stage one non-small cell lung cancer who are unwilling or unable to undergo lung cancer surgery are candidates for SBRT. The technology presents elderly patients, patients with severe lung disease, or patients with significant comorbidities such as severe heart disease, a curative, non-invasive alternative to surgery.

The Nylen Cancer Center is also now offering access to a Nurse Navigator to help patients understand their diagnosis, evaluate treatment options, connect with relevant community resources, and navigate their way through the treatment process. All Nylen Cancer Center lung cancer patients are eligible to use the services of the Nurse Navigator. ■

Courtesy Nylen Cancer Center

Courtesy Avera

New Options for Lung Cancer Care in Sioux City

MED Quotes “ A clinician is complex. He is part craftsman, part practical scientist, and part historian.” —Thomas Addis, US Physician

18

Lung with tumor depicting SBRT.

Midwest Medical Edition

Functional Medicine

What Does it Mean for the Future of Healthcare?

Sioux Falls family physician Patty Peters has long been an advocate of a holistic approach to medicine. Long before the term ‘functional medicine’ had become a recognized part of the healthcare discussion, Dr. Peters was working to combat chronic health problems in her patients through better nutrition, physical activity, stress management, and strategic use of supplementation. As she works toward her certification in Functional Medicine this Fall (the culmination of a four-year process), she talked to MED about why this approach is gaining momentum nationwide.

MED: Doctors like you have been advocates of functional medicine concepts for a long time. Why do you think it is gaining more attention now?

Dr. P: I think it is because we have so much chronic disease now. Also, many female baby boomers have been going through perimenopause and menopause and they are just not content with feeling bad. They are used to being active and they are not content not to feel good. So they are going to their doctors and asking for real answers. And recent research is finding that there really are better ways to deal with chronic problems like heart disease and obesity. As science processes, so does the field of functional medicine.

MED: So, functional medicine is still

in the care of patients can take a functional medicine approach. When I go to national meetings for the Institute for Functional Medicine, there are people from all kinds of backgrounds and from all over the world.

They all believe that people can change their health by changing their lifestyles.

MED:

In what kinds of patients do you take this approach?

Dr. P: I think about functional medicine principles with pretty much every patient who comes in to my office now, especially when it comes to guiding them toward better eating and other disease-prevention techniques. Inflammation is a big topic in functional medicine because it is a big underlying factor in many diseases.

Also, fatty tissue. Fat releases certain hormones and this, too, can have an impact on disease. And, of course, obesity is linked to diabetes, heart disease, hypertension, probably dementia. If we can help more people fight their weight issues, it would go a long way to tackling many chronic diseases. ■

More information on Funcitonal Medicine can be found at the Institute for Functional Medicine website at www.FunctionalMedicine.org.

Health IT brings power to the people.

science-based?

Dr. P: Yes. One image we like to use is of a tree. The trunk and branches are what we see, but we are trying to get back to the roots. It is about getting back to the biochemistry behind physical processes. A functional medicine approach goes back to the cellular level.

The interactions in the body are so complex. The thyroid, the vascular system, hormones – there are connections everywhere and science is helping us to better understand them.

And power to your practice.

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MED: Who is involved in Functional Medicine?

Dr. P: Functional Medicine crosses multiple disciplines… physicians, dieticians, naturopaths, chiropractors, psychologists. Anyone who is involved

April / May 2013

MidwestMedicalEdition.com

19

The Nurses’ Station Nursing News from Around the Region

St. Luke’s

Kolar Named One of Iowa’s Best

Jodi Kolar of St. Luke’s College has been named among the greatest nurses in Iowa. Kolar was recently honored as one of the 100 Great Iowa Nurses, a recognition program of the Iowa Nurses Association, for her commitment, competence and courage in the field of nursing.

Kolar serves as department chair and associate

High Praise for RCRH Critical Care Nurse Adam Bergdale received the

professor in the Department of Nursing Education

at

Luke’s in 1983, working as a staff nurse in St.

Rapid City Regional Hospital (RCRH). He has been a Registered Nurse in the

Luke’s surgical unit. She went on to join St. Luke’s

Medical Intensive Care Unit at RCRH for three years.

College in 1989 as a nursing instructor and then

February DAISY Award for Extraordinary Nurses

Bergdale was nominated for the award by a physician who says he showed true concern for a critically ill patient and worked closely with the physician

at St. Luke’s College. She began her career at St.

assistant professor before being named as associate professor in nursing in 2008.

throughout the night to address the patient’s needs. The nomination stated Bergdale “took the

Kolar received a BS in Nursing from Mankato

lead, speaking with other services when needed, thinking clinically and staying one step ahead of

State University and an MS in Nursing from

events throughout the night…He calmly managed it all.” In the nomination, Bergdale was also described as “the best of critical care nursing.” ■

Creighton University in Omaha. ■

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Midwest Medical Edition

Mercy Medical Center Celebrates

Certified Nurses Day Mercy Medical Center celebrated Certified Nurses Day on March th

19 by honoring its 45 board certified nurses at a tea reception.

“We applaud those nurses who have received their certification, which fosters professional growth and contributes to excellent patient care,” said Tracy Larson, Chief Nursing Officer at Mercy Medical Center.

Board Certification of nurses plays an increasingly important role in the assurance of high standards of care for patients and their loved ones. Nursing, like healthcare in general, has become increasingly complex. There is a growing perception that, while a registered nurse (RN) license provides entry to general nursing practice, the knowledge intensity of modern nursing requires additional education, as well as a strong personal commitment to excellence.

Mercy Medical Center encourages national board certification for all its nurses.

Celebrating Nurses National Nurses Week Starts May 6th The South Dakota Nurses Association will join the American Nurses Association in commemorating National Nurses Week, May 6-12. The annual celebration is meant to increase awareness of the value that the nation’s 3.1 million registered nurses bring and the vital role they play in American healthcare. The week culminates on the birthday of Florence Nightingale, the founder of modern nursing.

History of National Nurses Week 1954 – National Nurse Week is first observed in October on the 100th anniversary of Florence Nightingale’s mission to Crimea.

1974 – T he International Council of Nurses proclaims May 12 International Nurse Day 1982 – T he ANA Board of Directors formally acknowledges National Nurses Day on May 6 1993 – T he ANA designates May 6 to 12 as permanent dates for National Nurses Week 1997 – The ANA designates May 8 as National Student Nurses Day Nurses Week events will be held throughout the week across the region. Visit the SDNA website at www.sdnursesassociation.org (or iowanurses.org) for information and registration for other planned events.

April / May 2013

MidwestMedicalEdition.com

21

Down on the Problem:

The nation’s

medical schools are graduating fewer primary care physicians and rural America continues to be underserved. The problem is even more pronounced in the upper Midwest, where an aging population needs skilled medical care more than ever.

Solution:

Introduce

medical students to the joys and challenges of rural practice early by allowing them to spend extended time living and working with established providers in one of several carefully-chosen small communities. The USD Sanford School of Medicine calls it the Frontier And Rural Medicine program – FARM.

there. They are going to have a better understanding of what it’s really like to work and live in a small town,” says Susan Anderson, MD, Director of the FARM Program.

Community Immersion

Clinical Experience

Instead, beginning in the Fall of 2014, six 3rd-year medical students, chosen from a large pool of applicants, will spend nine months working alongside providers in one of five South Dakota communities of fewer than 10,000 people. The South Dakota State Legislature approved an expansion of the school’s class size in 2012 to accommodate the new program and Milbank, Mobridge, Winner, Platte and Parkston were chosen as clinical sites in the competitive selection process.

“We have gifted teachers in these rural communities and we want to utilize their expertise to help increase the number of students who will go into primary care and serve rural communities,” says Dr. Vogt. To prepare for their rural experience, these students will complete 12 weeks of prerequisite training, including clinical clerkship experiences, hospital rotations in intensive care, and training in the Parry Center for Clinical Skills and Simulation.

“They are going to be immersed in the community because they are going to live

“Another advantage is that they are also going to be one of the only learners there. In other programs, there may be a number of learners. But a FARM student may be first assist on a procedure the first day they’re at their clinical site. They may also be the first medical person that the patient sees.”

The FARM program is similar to the long-running and highly successful Minnesota Rural Physician Associate Program.

Established in the 1970s, that program has demonstrated a statistical increase in the number of new doctors choosing rural practice in the state. National studies have demonstrated that students trained in similar rural programs perform at least as well as their traditionally-trained colleagues on tests of their clinical skills.

“It takes a while for students and instructors to get to know each other and for trust to develop,” observes Dr. Vogt. “So, when a student is on a briefer 6 or 8 week rotation in Sioux Falls or Rapid City, there is less time to get to the point where the instructor is comfortable letting the student do more.

Photos Courtesy USD

“We have had shorter rural programs for many years, but these are just one-month experiences in the 2nd and 4th year,” says Bruce Vogt, MD, Professor & Chair of the Department of Family Medicine and Program Director of the SD Area Health Education Center. “But the need in rural areas is just continuing to grow. We recognize that it is very important for a

student to really be able to engage the rural community and to understand the challenges and rewards of practicing there. You just don’t get this in 4 weeks.”

Dr. Jason Wickersham, Parkston, SD

22

Dr. Christopher Boschee and Dr. Jason Wickersham, Parkston, SD

Dr. Josh Henderson, Mobridge, SD

Midwest Medical Edition

FARM

By Alex Strauss

Because they will have more time with their mentors, FARM students are likely to be able to become more participatory members of the healthcare team.”

They are also likely to be more participatory members of the community, a critical aspect of choosing to eventually practice there.

“It has to do with developing an emotional attachment to the community,” says Dr. Anderson, who lives and practices in a rural community herself. “They may be in the local paper. They will get invited to the rotary club or the country club. The community will embrace them.”

Beyond that, Anderson says that students will experience the satisfaction of delivering high-quality care to patients who may have few other healthcare options.

Medical Students & Rural Communities

a Match Made in Med School

Partners in Training And what do the rural community physicians get? “Ultimately, they hope to get a partner,” says Dr. Vogt. “But, if they don’t get that, they may at least get another physician in a nearby area. I think that they see this as a real carrot for their healthcare community. We’re also hoping this will help dispel some of the myths about rural practice. You can have a life, you don’t have to be isolated, and there is support.”

Although the expectation was that most FARM students would be natives of small communities, Dr. Anderson says most are graduates of the state’s largest high schools. Based on the response from both student applicants, new medical students who were asked about the program, and rural communities which applied to be clinical sites, she is hopeful that FARM can be expanded to include additional locations in the coming years.

“Ultimately, these doctors, regardless of the field they go into, will benefit from their involvement in this program,” says Dr. Vogt. “This sort of immersion with increased involvement in care cannot help but be beneficial to your training.” ■

Dr. Nanci Van Peursem, Milbank, SD

Dr. Regg Hagge, Platte, SD

Dr. Collette Reule, Mobridge, SD

April / May 2013

Dr. Jerome Bentz, Platte, SD

23

Federal Budget Challenges to HealthCare Continue

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W

hen it comes to federal spending and

budget issues, conventional thinking among many may be that with current Medicare payment levels for physicians in place until the end of 2013, there really isn’t anything else to worry about. Nothing could be further from the truth. And it will behoove all providers to pay very close attention to what’s going on in Washington over the next several months.

There are three general elements to the Budget Debate in Washington. The first is the Sequester, which among other things automatically cuts all Medicare reimbursement to providers by 2% effective April 1. It also cuts funding for the National Institutes of Health by as much as 9%. As this article is being prepared it appears that Congress is allowing the Sequester to take effect. The second is expiration of the Continuing Resolution (CR) that keeps government running through March 27th. Unless the CR is extended or a budget passed, the federal government would shut down.

Again, as this article is being prepared, it is unclear whether Congress and the President will agree to an extension or have a government offering only “essential services”.

The third element is the federal government’s debt ceiling which is due to expire sometime in mid-May but may be extended though July.

The resolution of these three elements is what the political commentators are referring to as the “Grand Bargain”. Now it is unclear whether Republicans and Democrats can come together on any budget package. But whether they do or don’t, we do know that as long as negotiations are progressing, everything is at risk.

That includes a myriad of Medicare and Medicaid funding reductions that ultimately impact providers including Medicare payments to physicians. So, while Medicare Part B might appear to be offthe-table for now, anything is possible when Congress, the two political parties and the President are talking.

Staying engaged and informed with the federal budget talks will be essential for the remainder of the year. The nuances of negotiations in Washington can and do translate into very real issues affecting access to and affordability of healthcare in South Dakota. ■

MED Quotes “Health and cheerfulness naturally beget each other.”

—Joseph Addison, English literary figure

Midwest Medical Edition

New Clinical Research Suggests Nutrient-Rich Protein May Help Preserve Muscle Mass Sarcopenia is an age-related condition that causes loss of muscle mass and strength as you get older, making it difficult to perform daily tasks.

A recent study published in Applied Physiology, Nutrition and Metabolism found that moderate consumption of protein plus exercise may help delay or counteract sarcopenia. Study participants who consumed a 6-ounce serving of 85% lean ground beef following resistance exercise experienced an approximately 50 percent increase in muscle protein synthesis compared to those who did not consume beef. This is great news for patients seeking ideas on living well through the years.

South Dakota Beef Industry Council

www.sdbeef.org

Reference: Robinson MJ, Burd NA, Breen L, Rerecich T, Yang Y, Hector AJ, Baker SK, Phillips SM. 2013. Dose-dependent responses of myofibrillar protein synthesis with beef ingestion are enhanced with resistance exercise in middle-aged men. Appl. Physiol. Nutr. Metab. 38: 120–125.

Embracing Change HealthPOINT Says Rapid City Doctor is an ‘Innovator’ in Change Management

By Jan Chambers

A

s the entire healthcare industry undergoes massive movement to implement electronic health records (EHR) and improve patient information, care, and safety, certain individuals have emerged as leaders, not only embracing the changes but inspiring others to do the same.

Rapid City ophthalmologist Scott Eccarius, MD, Medical Informatics Officer at Regional Health, is a prime example.

The Eccarius Eye Clinic implemented an EHR system seven years ago and currently uses Athenahealth’s practice management, EHR, and patient portal software. Dr. Eccarius also serves on Athenahealth’s national Physician Advisory Broad. As Medical Informatics Officer since 2007, Dr. Eccarius advocates for Clinical Information Systems, their value to patients, and the organizational imperative of Meaningful Use. “Providers are fearful of the loss of productivity, patient backlog, and the loss of revenue due to some of the horror stories floating around,” says Dr. Eccarius. “The real key in this is planning for change and having the willingness to adapt to it.”

HealthPOINT, South Dakota’s Regional Extension Center (REC) and the organization charged with helping area practices make the transition, calls Eccarius an innovator. “We are pleased to acknowledge the service Dr. Eccarius is providing to the healthcare community by inspiring and encouraging change,” says HealthPOINT Executive Director Dan Friedrich.

Dr. Eccarius is helping HealthPOINT spread the message about Change Management in a webinar on the organization’s website.

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The Three Steps of Change Management

1 Communication Change Management is divided into several key steps. Communication and planning are critical during the first stage. As the leader of the practice, the provider should define the reason for the change as well as benefits and talk about them in a positive way to staff. Realize that no project is perfect and each has its risks and rewards. Providers should expect members of the team to experience a wide range of emotions including denial, anger, fear, frustration, uncertainty and disorientation. Organization leaders and providers should establish a timeline and goals for this change and communicate them to staff.

2 Training & Direction Stage two of Change Management is pivotal in the movement into the positive stage of change. During this time, the practice should be going through training, workflow analysis and re-design, and be progressing through the timeline. Providers will need a strong sense of direction during this time as well as patience and encouragement for their staff. Resentment toward change and low morale can be expected from staff but words of encourage and celebration of small steps can help the team through the difficult journey.

3 Revitalization During the final stage of Change Management, providers can expect to see a revitalization of their team. New skills and workflows have taken hold. Providers and organization leaders should set longer term goals and begin evaluating the impacts of the change on the practice and the patients served. ■ For more information on Change Management, listen to Dr. Eccarius’ presentation in the webinars section of the HealthPOINT website at www.healthpoint.dsu.edu. If you are a provider or know a provider who advocates for Meaningful Use and change to EHR, please contact HealthPOINT at healthpoint.info@dsu.edu.

Jan Chambers is the business operations manager at HealthPOINT.

Midwest Medical Edition

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Off Hours

Passionate Pursuits Outside the Office

Marathon Man

Sioux Falls Optometrist Has His Eye on Boston

By Liz Boyd

Justin Schweitzer’s young family will be there cheering him on when he runs the Boston Marathon on April 15th.

Justin Schweitzer, OD, Vance Thompson Vision

S

ioux Falls Optometrist

Justin Schweitzer started running in 7th grade, long before he had any idea how far his passion would take him. Within a few years, the Jamestown, North Dakota native claimed the high school state

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cross country championship, and went on to win state titles in the mile and 2-mile runs in his senior year.

While he loves the competitive nature of the sport, Schweitzer says, for him, running is about what it does for his own body and soul. “It is just such a wonderful

stress reliever,” says Schweitzer. “I can think clearly when I’m out there running.

Those are the times I can be by myself and think.”

And those times are at a premium these days for the father of a six-monthold and a preschooler. Except for a brief

Midwest Medical Edition

“I can think clearly when I’m out there running.

Those are the times I can be by myself and think.” hiatus during optometry training, Schweitzer has continued to run almost daily. To fit it in between an increasingly busy work and family life, Schweitzer is up and running by 5:15 every day, usually outside. Yes, even in the winter.

“I do have a treadmill in the basement for when the weather is really severe,” says Schweitzer. “But most of the time, I go outside. Thankfully, running gear is so much better than it used to be. There are thermal tights and tops and of course I wear a face mask.” He also tracks his miles and pace with a GPS watch that syncs with the computer. And, like a miner headed to work in the pitch dark, he’s outfitted with a head lamp.

Good gear, strategic training and serious determination are now driving Schwetizer to his next big goal: The Boston Marathon on April 15th. Schweitzer ran the Portland marathon back in 2003 and last year qualified for Boston at the Twin Cities Marathon with a run time of 2:39:08.

“One of the reasons I wanted to do Boston is that it is one of the ones you have to qualify for,” says Schweitzer. “The history is legendary. If you are a runner – or even if you’re not – you have heard of the Boston Marathon. It’s something that a lot of serious runners want to do at least once in their life.”

Determined to beat his Twin Cities time, Schweitzer is in the midst of an 18-week marathon buildup, which includes both speed training and pace training. Those early morning runs are adding up; he’s now averaging 70 miles a week and will peak, just before the marathon at 75 miles in a week. But even when he’s not training for a marathon, Schweitzer is no slacker, averaging 35 to 40 miles a week and burning through a new pair of running shoes every 3 months or so.

“Running keeps me grounded,” he says. “Exercise definitely gives a person more energy. But it also keeps me in a routine, which is helpful for me. I know that I’m going to get to bed early and I’m going to get up and run. I am going to be the best I can be throughout and the day and then do the same thing again.

There is something about a healthy routine that makes life easier.”

Schweitzer’s young family will be cheering him on in Boston this month, where he hopes to set a personal record. As for what’s next, he says it will depend on their support and the support of his “work family” at Vance Thompson Vision.

“It’s a serious commitment and I couldn’t do it without a lot of support. I would love to do more because I do think that, when you can be a less stressed-out person, you can be better at everything you do.” ■

April / May 2013

MidwestMedicalEdition.com

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Grape Expectations

A Memorable Tasting

Staglin Family Vineyard

By Heather Taylor Boysen

I

really love wine tastings. Not only because I enjoy wine, but also because it

is one of the best ways to try many different wines all in one setting. It is a wonderful way to experiment with different varietals, food pairings and price ranges and to become educated about wine in a fun and relaxing atmosphere. As much as I love to plan and be the hostess at my own events, I also love to attend them. Being a guest recharges my batteries, lets me focus on the wine and gives me new ideas for my own tastings.

The last tasting I attended was particularly memorable and featured Staglin Family Vineyards. Staglin is a family-owned vineyard in Napa Valley that truly produces world class wine, and I was fortunate enough to be able to visit their estate the last time I was in Napa. This tasting, which was presided over by Shari Staglin herself, featured two of their Chardonnays and Cabernet Sauvignons and here are my thoughts on each of them: The flagship Staglin Family Vineyard 2008 Chardonnay was brilliant. The wine presented with beautiful tropical notes and a wonderful floral aroma. It was creamy and smooth as well as refreshing and vibrant.

The minerality and acidity gave it great balance and the ability to pair it with many different foods.

The 2009 Salus Estate Chardonnay was darker in color than the Estate and reminded me of warm baked apples with hints of tropical stone fruit. I kept getting really beautiful honey notes, but it had a brief hint of minerality that seemed to cut through the richness of the wine and balance it perfectly.

This wine is drinking beautifully right now.

The Staglin 2005 Cabernet Sauvignon was elegant with dark fruit flavors complemented by subtle earthiness and oak. The presence of the dark fruit flavors was intense, yet not overblown. There was spice in the backbone and a very pleasant tannic finish. It was definitely ready to drink and makes me wonder what kind of treasure the 2006 that is in my store will be.

The 2007 Salus Estate Cabernet comes from the vintage that many experts called the California vintage of the decade so I was very eager to give it a try. What a rush of flavor. Blackberries, coffee, chocolate and smoke flavors and aromas all come together finishing with just enough dryness to pull it back from the fruit and give it a wonderful and very long finish. This will continue evolving in the bottle and should get even better in the next year or two.

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One interesting side note: The Salus label is named after the Roman goddess of health and wellbeing and the Staglin family donates 100% of the proceeds from the sale of the Salus wines toward fundraising for mental health research. When Shari and Garen Staglin’s son, Brandon, was diagnosed with schizophrenia in 1990, they created their own non-profit organization, of which their son, thanks to treatment and family support, is now Director of Marketing.

I walked away from the tasting knowing that all of us in attendance had experienced some fantastic wine. But even more rewarding was the knowledge that I had enjoyed wines I know to be made with passion, commitment and, at their heart, family. Now that is a tasting! â–

Midwest Medical Edition

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FR I DAY, M AY 17, 2 013 SI O UX FAL L S CO N V EN T I O N CEN T ER SI O UX FAL L S , S O U T H DAKOTA , 8 : 0 0 A M – 4: 30 PM Latest on Diagnosis and Treatment of Vascular Disease

Registration brochure available at www.northcentralheart.com.

Call 605-977-5311 for more information.

J. Michael Bacharach, MD, MPH, FACC; Tommy R. Reynolds, MD, FACS Directors of Vascular Symposium 4520 WEST 69Th STrEET • Sioux FallS, SD 57108

April / May 2013

MidwestMedicalEdition.com

www.northcentralheart.com

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Building Miracles for kids is dedicated to making a positive difference in the lives of sick and injured children. Our goal is to bring everyone in the community and building industry together to help us build a Miracle Home. The proceeds of the sale of the home will be donated to the Children’s Miracle Network at Sanford’s Children Hospital.

Building Miracles for kids aims to help the most important people in our community, the children.

Make a difference in a child’s life and be part of a miracle.

To learn how to help contact: Rosewood Homes, Inc. 605.310.4475 www.BuiltByRosewood.com email: Info@BuiltByRosewood.com Sanford Children’s Miracle Network Building Miracles for kids

Learning Opportunities April / May April 11 Transplant Education Day 8:00 am – 5:00 pm Location: Sanford USD Medical Center, Schroeder Auditorium Information & Registration: 605-328-8290 April 16 – April 17

2013 SDAHO Continuing Care Conference Location: Ramkota Hotel, Pierre Information & Registration: 605-224-6877

April 16 8:00 am – 12:30 pm

South Dakota Society for Anesthesiologists Location: Clubhouse Suites, Sioux Falls

April 17 7:30 am – 4:00 pm

21st Annual Trauma Symposium: Excellence in Trauma & Surgical Care Location: Sioux Falls Convention Center Information: mckeducation@avera.org, 322-8950 Registration: www.Avera.org/conferences

April 19 8:30 am – 5:00 pm

Head & Neck Cancer Symposium Location: Sanford Center, Dakota Room Information: 605-328-8200, michele.fleming@sanfordhealth.org Registration: Sanfordhealth.org, keywords: head and neck symposium

April 23 Hospice Foundation of America – Living With Grief Video Education Program 12:30 – 4:00 pm Location: Prairie Center. Avera McKennan campus, lower level conference room Information: mckeducation@avera.org Registration: 322-8950, www.Avera.org/conferences April 24 – April 26

Spring SDMGMA Conference Location:The Lodge at Deadwood Information & Registration: www.sdmgma.org, 605-336-1965

May 3 – May 4

Sports Medicine Symposium Location: Best Western Ramkota Hotel, Sioux Falls Information: Sanforhealth.org Registration: Sanfordhealth.org, keyword: Sports Med Symposium

May 17

North Central Heart – Vascular Symposium Location: Sioux Falls Convention Center Registration: www.NorthCentralHeart.com Information: 605-977-5311

June 14 9:00 am – 3:00 pm

2013 Avera Pulmonary Symposium Location: Prairie Center, Avera McKennan campus, lower level classroom Information: mckeducation@avera.org Registration: 322-8950, www.Avera.org/conferences

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 Alex@MidwestMedicalEdition.com.

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