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Year End

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Midwest Medical Edition

Contents Volume 5, No. 8 ■ December 2014

Regular Features 4 | From Us to You 5 | MED on the Web Top 10 Medical Innovations 8 | News & Notes New doctors, certifications, clinics, and more 26 |  Wine Marketplace MED Welcomes Award-Winning Prairie Berry! 28 | The Nurses’ Station New RN-to-BSN program, Promotions at St. Luke’s 35 |  Learning Opportunities Upcoming Conferences, Events, and CME Opportunities

By Alex Strauss

year in review


Healthcare reform and the Affordable Care Act took center stage on the national front in 2014, while, in our region, growth and expansion of infrastructure, IT, patient populations, medical technology, and more, continued to be the “name of the game”. This month’s cover feature includes excerpts and news headlines from the pages of MED in 2014. Got a suggestion or submission for 2015? Let us know!


In This Issue 6 | Five Key Tactics to Help Engage Your Patients with Social Media ■ By Kimberly Martinez and Jeffrey Nasers

10 |  Upsides and Downsides of Medical Device Hacking ■ By Eric Buzz Hillestad

11 |  AMA Call for “Reboot” of Electronic Health Records 14 |  New Equipment Maintenance Rules will Require More Hospital Time, Money and Staff ■ By Stephen Grimes

24 | Avera Health Receives Federal Funding for eEmergency Network

25 | Sanford Study Reveals Fetal Alcohol Spectrum Disorders Prevalence in the US

25 | Sioux City Hospitals Provide Over $31 Million in Community Benefit

29 | Healthy Jewelry Practices for Metals ■ By Christopher A. Eads

34 | Physician Assistants by the Numbers Key Stats from the AAPA

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Year End

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By Erin Cambier

with Heat

Estate Plan Checklist ■

By Breandan Donahue

From Us to You Staying in Touch with MED

Happy Holidays!


s we Conclude another successful year of Midwest Medical Edition (MED), we, once again, bring you a wrap-up of the year’s biggest stories, as well as plenty of new and engaging content – from social media tips to critical new regulations concerning your medical devices to estate planning and wine buying. We want to extend a special thanks to all of the people, including contributors, story subjects, marketing professionals, advisors, and advertisers who helped MED (and the increasingly popular site) grow and thrive in 2014! Keep up the good work – and we will, too. MED continues to be committed to focusing on pioneering physicians, institutions, programs, and technologies that are paving the way for the future of healthcare on the Great Plains. We are now accepting suggestions for feature articles for 2015 and we have already heard from many of you. If you know of a person or program in the region that deserves a closer look, we would love to hear from you. Send your ideas and submissions to Have a safe, warm and productive holiday season and we will see in you in 2015.

MED Magazine, LLC Sioux Falls, South Dakota

VP Sales & Marketing Steffanie Liston-Holtrop Editor in Chief Alex Strauss Design/Art Direction Corbo Design Photographer Kristi Shanks Web Design Locable digital media director Jillian Lemons Copy Editor Hannah Steck

Steffanie Liston-Holtrop

Contributing Writers

Erin Cambier Breandan Donahue Christopher Eads Eric Buzz Hillestad Stephen Grimes Kimberly Martinez Jeffrey Nasers

Staff Writers

Liz Boyd Caroline Chenault John Knies

Alex Strauss

Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Alex Strauss, Editor in Chief 605-759-3295 Fax 605-231-0432 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website

year in


—Steff and Alex


2015 Advertising Editorial Deadlines Jan/Feb Issue December 5 March Issue February 5 April/May Issue March 5 June Issue May 5 July/August Issue June 5 Sep/Oct Issue August 5 November Issue October 5 December Issue November 5

Reproduction or use of the contents of this magazine is prohibited. MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

More than a Magazine, A Medical Community Hub

Give yourself a gift! Start your new year of MED a little early! Sign up for advance access to the digital issue and we’ll email you when it is released – up to two weeks earlier than print.

Only on the Web! New! Pediatric Bariatric Surgery in Omaha Children’s Hospital & Medical Center has broken new ground in its multi-faceted approach to treating juvenile obesity with a debut of a surgical response – gastric sleeve resection.

Top Ten Medical Innovations for 2015 Cleveland Clinic has unveiled its 9th annual list of the Top 10 Medical Innovations that are likely to have a major impact on healthcare in 2015. The list of up-and-coming technologies and drug therapies was selected by a panel of 110 physicians and scientists

New Book Addresses Rampant Physician Burnout The “secret life of a medical professional” — missed family gatherings, soccer games, dinners, disappointments, complete frustration with bureaucracy, low self-worth and utter exhaustion. Author Starla Fitch, MD, explores the causes and cures in her book Love Medicine Again.

n review December 2014


5 Key Tactics to help Engage Your Patients with Social Media By Kimberly Martinez and Jeffrey Nasers

“Like all technology, social media is neutral but is best put to work in the service of building a better world.”


ccording to IMS Institute for Healthcare Informatics, around 70% of adults use the internet to find information about their healthcare. At the same time, 42% of adults use social media to find out about a healthcare issue. With constant changes in healthcare, social media provides physicians a culturally relevant way to connect with their patients. However, according to Lee Aise, Director of the Mayo Clinic Center for Social Media, “Physicians and other healthcare providers have been relatively slower to become involved, often because of fears or misunderstanding about what is appropriate. Physician and hospital involvement in social media can contribute to constructive online engagement.” There is no reason to fear using social media. Here are five tactics that will help healthcare professionals to engage with patients.


Use content that informs and educates. Don’t be afraid to share interesting facts about medicine. Concerns arise about how professionals should contribute and interact on social media. To start the dialogue, consider the questions a doctor’s patients ask throughout the day. As a foundation, build on those commonly-asked questions and offer solutions or share industry-trusted resources.


— Simon Mainwaring, Social Media and Marketing Expert


Be genuine. Do not lecture or “sell” to your followers or friends. Social media is a marketplace of ideas where informed and interested individuals, eager for more information, get their questions answered. Be open to this dialogue with patients. Just be sure to communicate with authenticity and honesty.


Ask questions. Collaborating with patients allows them to contribute and be part of their healthcare decisions. Granting opportunities for patients to ask questions opens the door to a whole new level of trust and credibility. Question and answer platforms on social media can also give healthcare professionals insight into ways they might their own practices. The gesture also demonstrates that they are open to having these conversations and care about their patients’ engagement.


Use graphics, links and videos. Using visually stimulating content like graphics and/or videos will add value to the dialogue. Statistics show that using these tools helps encourage the engagement of patients, making them more likely to share a comment. According to Joe Girard, a leader in social marketing, videos get 267% more clicks than straight content posts.


Be relevant to your local demographic. Yes, social media removes all borders and connects individuals across the globe, but healthcare professionals should focus on their region and the primary concerns that directly affect those patients. This helps build relationships and credibility. Social media is becoming a cornerstone of communication for patient engagement. Practitioners open the door of collaboration with patients when they put valuable knowledge at their fingertips. The above are simple tactics that will surely add value to meeting your patients’ needs. Consider them as the foundation for a strong social media plan. ■

Kimberly Martinez is the Marketing Director and Jeffrey Nasers is Public Relations and Content Strategist at 724 Factory, a Medical Branding and Marketing company based in Sioux Falls.

Log on! Pictures are Worth 1,000 Words: Improve Patient Engagement through Pinterest

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Happenings around the region

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News & Notes Black Hills


United Airlines employees visited the pediatrics department at Rapid City Regional Hospital to donate Adventure Bears in early November. The bears were

Several Avera facilities received Governor’s Workplace Safety Awards at the recent 22nd Annual South Dakota Safety & Health Conference.

purchased by United customers and employees who were invited to “give a bear, get a bear.” For a $50 contribution, the donor receives a limited-edition 2014 Adventure Bear, sends a second bear to a child in need, and makes a donation to the United Airlines Foundation. The bears will be distributed to hospitalized children by RCRH staff at a later time.

Thirty-six projects from across Regional Health competed for the top spots at this year’s 2014 Regional Health Quality Expo.

Sturgis Regional Hospital (STRH), with team leader Lynn Simons, STRH Director of Patient Care Services, won the Best of Service category and was later named Best of the Best with its Starting Right at Discharge project.

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•A  vera McKennan Hospital & University Health Center, Sioux Falls, received the Award of Honor, the highest level award, for exceptional accomplishment in reduction of injuries and illnesses in the workplace. • Avera Dells Area Hospital, Avera Gregory Hospital and Milbank Area Hospital Avera received Outstanding Achievement awards for continuing improvement and/or outstanding record.

Sanford Research’s Amy Elliott, Ph.D., and Jyoti Angal have secured more than $1.7 million in grant funding from the National Institutes of Health to study methods to reduce infant deaths in American Indian communities. The project,

“CBPR Initiative in Reducing Infant Mortality in American Indian Communities,” received a five-year award under the NIH’s Eunice Kennedy Shriver National Institute of Child Health & Human Development.

• Avera Behavioral Health Center, Avera Rosebud Country Care Center in Gregory and Avera Prince of Peace Retirement Community in Sioux Falls received Meritorious Achievement awards.

Sanford Sanford Health was among a select group of hospitals nationwide recognized by the U.S. Department of Health and Human Services (HHS)

for reaching gold, silver, and bronze levels of achievement for conducting activities that promoted enrollment in state organ donor registries. The hospitals are part of a national hospital campaign, sponsored by HHS’s Health Resources and Services Administration (HRSA), which has added 327,659 donor enrollments to state registries nationwide since 2011.

Sanford Health has opened a pediatric clinic in Kunming, China, as part of its International Clinics initiative. This quickly

growing area of China has a significant need for healthcare, particularly with children. The new pediatric clinic includes 14 exams rooms, six treatment rooms, an education and training room and general office space. For this clinic, Sanford collaborated with YMCI Calmette Medical Investment & Management Company, Ltd., a state-owned company of the Yunnan Provincial government.

Midwest Medical Edition

Genetic makeup determines how each person reacts to cholesterollowering medications, according to a new study published in Nature Communications with contributions from Sanford Health’s Russ Wilke, MD. The

international study, of unprecedented size, looked at the proportion of patient responses to statin medications that can be attributed to genetic factors. Wilke was one of the authors of the study through his combined roles in Sanford Imagenetics and the Genetics in Statin Therapy (GIST) Consortium.

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Mike and Julie Maas of Dakota Dunes were the chairs of this year’s Mercy Medical Center Foundation Fall Gala in November.

Julie was instrumental in establishing Sioux City’s Susan G. Komen Race for the Cure and Mike works for CF Industries in Sgt. Bluff as Manager of Environmental Health, Safety & Security. Since its inception, the Gala has raised approximately $3,000,000 to improve healthcare for Siouxlanders. This year’s proceeds will be directed to Mercy’s Child Advocacy Center.

At MMIC, we believe patients get the best care when their doctors feel confident and supported. So we put our energy into creating risk solutions that everyone in your organization can get into. Solutions such as medical liability insurance, clinician well-being, health IT support and patient safety consulting. It’s our own quiet way of revolutionizing health care. To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit

Stay up-to-date with new medical community news between issues. Log on!

December 2014


Upsides and Downsides of Medical Device Hacking By Eric Buzz Hillestad


acking devices has been something people have done since the birth of technology. Making something perform an unintended function or malfunction is at the heart of every hacker. But the word ‘hacker’, itself, didn’t always have the negative connotation it does today. In the 1980’s, a hacker was someone who could make a piece of legacy software operate with new functions and features. Some companies lived and died by their hackers’ abilities. Fast forward to recent times when medical devices that perform critical tasks for patients are being connected

with communication devices. Insert hackers into these devices and we have a formula for both innovation and malfunction with some serious ramifications. The biggest danger is obvious – compromised patient safety. Wired published an article last April titled, “It’s Insanely Easy to Hack Hospital Equipment”. A man by the name of Scott Erven and his team of researchers at SecMedic were allowed access to a large Midwest hospital system for a period of two years to perform their research. What they found was horrifying to many. Erven and his team found defibrillators that can be accessed through Bluetooth to deliver

unnecessary shocks to a patient’s heart, temperature settings on refrigerators that store drugs and blood that can be modified, insulin pumps that can be remotely changed to deliver far too much or too little medicine, and devices and equipment that can be reset to change configuration settings. On the up side, some frustrated parents of kids with type 1 diabetes have used hacking to innovate. “Citizen Hackers Tinker with Medical Devices” in a September issue of the Wall Street Journal describes how a group of software developers, all of whom had children with diabetes, worked to find a way to monitor their

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childrens’ insulin levels over the Internet. The system is called NightScout and allows hackers to have readings from Dexcom glucose monitors sent to a series of communications devices, including a custom-made smartphone app. Unfortunately, there is a downside to this kind of innovation. The same system that enables these parents to monitor a child’s glucose over the Internet also opens up the attack surface of the devices from merely being next to the patient to anyone with access to the Internet. The FDA is well aware of the risks and benefits. In October, the FDA released their finalized Cybersecurity Guidance covering what is required for new medical devices from both manufacturers and healthcare systems using the devices. For current devices, the guidance includes an identification of assets, threats, and vulnerabilities; an assessment of the impact of vulnerabilities on device functionality and end users/patients; an assessment of the likelihood of a threat and a vulnerability being exploited; a determination of risk levels and mitigation strategies; and an assessment of residual risk and risk acceptance criteria. The FDA also recommends that medical device manufacturers give justification in their premarket submissions for the security functions they choose for their products. Some examples include limiting access to trusted users through such methods as authentication, strong password protection, and physical locks, and ensuring trusted content by restricting software or firmware updates to authenticated code. The bottom line, get these devices into your risk assessment process and make sure that risk remediation is happening at some level. In some cases, putting devices on segregated networks or changing default passwords can make a world of difference. In other cases, the only way to control access to certain radiology devices and software is to put them behind their own firewalls and turn off communication options that aren’t needed such as Bluetooth. For many large systems, the major issue is first locating all the devices and finding out just how many of them are in their environment. ■ Eric Buzz Hillestad is Partner at Secure Healthcare Solutions, LLC and Principal Consultant.

December 2014

AMA Calls for “Reboot” of Electronic Health Records

Are you frustrated with the lack of usability of your EMR system? According to data from the American Medical Association, you are in good company and they are calling on the industry to do something about it. Building on its landmark study with RAND Corporation confirming that discontent with electronic health records (EHRs) is taking a significant toll on physicians, in September the AMA officially called for solutions to EHR systems that have neglected usability as a necessary feature. To support the idea, they released a new framework outlining what they see as the eight top priorities for improving EHR in ways that will benefit caregivers and patients. “Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work,” said AMA President-elect Steven J. Stack, MD. “This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.” Stack says part of the problem is too many screens, scrolling and clicks required

to document a note into the patient’s electronic chart, leaving less time for patient care and making providers feel like data entry clerks. While the AMA/RAND findings show physicians generally expressed no desire to return to paper record keeping, most physicians are frustrated by the cumbersome nature of many systems. Numerous other studies support these findings, including a recent survey by International Data Corporation that found 58 percent of ambulatory physicians were not satisfied with their EHR technology. According to that study, “most officebased providers find themselves at lower productivity levels than before the implementation of their EHR” and that “workflow, usability, productivity, and vendor quality issues continue to drive dissatisfaction.” Despite the usability issues, physicians are mandated to use certified EHR technology to participate in the federal government’s EHR incentive programs. The AMA has called for the federal government to acknowledge the challenges physicians face and abandon the all-or-nothing approach for meeting meaningful use standards. ■



LinkedIn or Be Left Out

“What is this LinkedIn thing–and why all the hype?”


By Erin Cambier

s the world’s largest online networking site, LinkedIn has quickly become a vital business and career resource for professionals, managers, and executives worldwide. If you’re not on LinkedIn, not only are you missing out on a huge networking opportunity, but, most importantly, you are limiting the growth of your business and future career.

LinkedIn certainly has some impressive statistics: LinkedIn operates the world’s largest professional network on the Internet with more than 332 million members in over 200 countries and territories. Professionals are signing up to join LinkedIn at a rate of more than two new members per second. LinkedIn counts executives from all 2013 Fortune 500 companies as members; its corporate talent solutions are used by 92 of the Fortune 100 companies. *Source:

Here are the top 3 reasons why LinkedIn can help your business and career: 1 Professional Branding Today’s consumers want to know the face behind the brand or company. LinkedIn makes it possible for you to relay your professional image and brand yourself as a high performing leader. People are researching you. Developing a professional LinkedIn profile which showcases your value and includes a list of first-hand recommendations from clients and/or patients will ensure that people leave with the best impression possible. You control your brand image. 2 Powerful Business Platform Regardless of your job title, industry, or location, we are all in the business of marketing. Marketing our company, our services, and even our career has real value. LinkedIn makes it possible for you to connect with key decision makers and

network directly with people at all levels of an organization. In today’s competitive marketplace, establishing yourself as an expert in your field is critical. Through the use of the LinkedIn news feed, groups, and even article sharing, you can demonstrate your expertise and offer value to your network. 3 Career Development Ever heard the phrase “Dig the well before you’re thirsty?” Even if you’re not looking for a new career opportunity, networking on LinkedIn can help you be prepared “just in case”. And if you ARE ready for a new opportunity – LinkedIn is the #1 tool for executives and managers in a successful job search. Recruiters, especially in the medical industry, consistently state that LinkedIn is the recruiting tool they utilize most. You can not only find out about unadvertised jobs on LinkedIn, but having a professional, keyword optimized profile makes it easy for recruiters to find YOU. ■

Erin Cambier, CPRW, is the owner of Superior Resume & Career Services in Sioux Falls.

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Midwest Medical Edition


Healthcare Camera The Ricoh G700SE Healthcare Camera is the rst solution of its kind. Designed for the rigorous requirements of healthcare, it is industrial shock proof and stands up to water and disinfectants. Using just the camera, a clinician can scan patient bar codes and then use manual entry or pick lists to embed metadata into each image le. The camera interoperates with virtually any healthcare information system—including electronic medical record (EMR) systems from major vendors. 1-800-477-2425 December 2014


New Equipment Maintenance Rules Will Require

More Hospital Time, Money and Staff


By Stephen Grimes

ew regulations and standards for medical equipment maintenance were recently announced by The Joint Commission (TJC), aligning TJC’s accreditation standards with updated regulations from the Centers for Medicare and Medicaid Services (CMS) issued on December 20, 2013. The new regulations mandate substantial changes in the ways most hospitals conduct medical equipment maintenance – and these new requirements mean administrators will spend considerably more time, money and staff to maintain their medical equipment. To ensure compliance, hospital administrators must, among other steps, overhaul their medical equipment maintenance plans, compile full inventories, follow manufacturer maintenance recommendations to the letter, identify high-risk equipment, revise their policies and procedures, and closely monitor the credentials of those who maintain the equipment. Not only will compliance likely mean more financial expenditures to maintain


“Under the new regulations, hundreds to thousands of additional pieces of medical equipment will be added to hospital inventories.” medical equipment, but it will also require more attention and time from the individuals tasked with maintenance, compliance, and record-keeping. In short, the new standards will require immediate attention from hospital leaders and more money, time, and personnel dedicated to the medical equipment maintenance process. Until these latest regulations were implemented, hospitals were given a great deal of flexibility in their medical equipment maintenance practices. During the past 25 years, TJC and CMS permitted hospitals to use a popular, risk-based approach, enabling administrators to streamline scheduled maintenance and minimize associated costs so long as patient and staff safety were not compromised. This approach encouraged hospitals to focus scheduled maintenance primarily on the most critical medical equipment whose service histories provided evidence that

replacing worn components and maintaining regular testing was effective combating equipment failure. Many hospitals were able to reduce or eliminate scheduled maintenance for low risk equipment when service history evidence showed little or no benefit from the more extensive maintenance. For more than two decades, this evidence-based approach allowed hospitals to focus their limited resources on medical equipment maintenance issues that had the greatest effect on patient safety and care. Under the new regulations, hundreds to thousands of additional pieces of medical equipment will be added to hospital inventories, with administrators required to track and ensure that manufacturers’ recommended maintenance procedures are followed. Hospital leaders must ensure that their existing clinical engineering services – whether in-house or contracted through a

Midwest Medical Edition

vendor such as ABM Healthcare Support Services – have sufficient expertise and personnel to develop and implement an aggressive and complex compliance plan. Also worth noting is that, even when equipment is serviced by the manufacturer, evidence suggests that those manufacturers often do not follow their own published recommendations, primarily because those recommendations are based on worst-case environments not applicable to most hospitals. Until manufacturers provide more nuanced maintenance recommendations, hospitals will be required to comply and ensure that maintenance strictly abides by the published recommendations. Compliance with these

new standards will require considerably more time, money and human resources than what hospitals typically spend on medical equipment maintenance, but the new regulations must be addressed. Hospital leaders, compliance officers and risk managers need to understand the issue and work with those responsible for medical equipment management in their organizations to ensure they develop a robust plan to achieve and maintain compliance. ■



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December 2014



year in

December is a time for traditions and, at MED, it has been our longstanding tradition to look back over the year in

medicine in our region, as seen in the pages of MED. On the national front, healthcare reform in the shape of the Affordable Care Act took center stage. In our region, growth and expansion – of infrastructure, IT, patient populations, medical technology, etc., continued to be the “name of the game”. Following are excerpts and top stories from the pages of MED in 2014. As we plan for 2015, please share your article ideas and submissions with us!

20 16

n review January|February

Playing a Primary Role Advanced Practitioners in a Changing Healthcare Environment

Judy Bellanger-Dahl, PA-C, practices in Sanford’s Perham Health Clinic, a large multispecialty group that includes several APPs in Perham, MN.

Whether they are called Midlevel Practitioners, Advanced Practice Providers (the term preferred by Sanford), Advanced Practice Clinicians (Regional’s choice), Advanced Practitioners, or simply ‘Midlevels’, there is no doubt that their role – both in primary and specialty care – is growing along with their numbers. Crystal Page, PA-C, is the one-and-only provider at the Buffalo Regional Medical Clinic, a do-it-all primary care clinic serving the 350 residents of Buffalo, South Dakota in the state’s Northwest corner, 85 miles from the nearest hospital. Page’s attending physician makes the 70-mile trek from Belle Fourche to visit the clinic every three months and the two have one-on-one contact once a month. “It is great to be a PA in a small town,” she says. “I think I see greater diversity of illnesses out here. A lot of people in my community are unwilling to travel, even if the weather just looks bad. So we kind of have to stay here and just figure it out.” “The number of APPs is growing not only because the population is growing, but also because we can’t recruit physicians fast enough,” says Sanford’s Chief Medical Officer Dan Heinemann, MD, president of the South Dakota State Medical Association. The shortage means that current physicians are often over-extended in terms of patient load. In addition, most are embroiled in trying to meet new federal guidelines that leave them even less time for patient care. In many clinics, APPs are helping to ease some of the burden by providing follow-up patient care, rounding on hospital patients, assisting in the office or the OR, taking patient phone calls, etc. In many cases, APPs like Page make healthcare possible in places such as Buffalo where it might not otherwise be provided. It is increasingly difficult to recruit physicians to work in communities that have no hospital. ■

News Flash

Darwin Goodspeed is appointed as the new director of the Sioux Falls VA Health Care System

News Flash

Mercy Medical Center begins using its news 3T MRI scanner

News Flash

Prairie Lakes Healthcare System receives top honors from the American College of Cardiology for heart attack care December 2014



year in March

Imagining the Future of Medicine “I describe it as a change in mindset, a change in how you approach patients,” says Dan Blue, MD, President of Sanford Clinic in Sioux Falls. “When you have a deeper understanding of these tools and resources, you begin to see how they apply to decisions you make regarding your patients.” Over the course of the next few months, Sanford’s 117+ internal medicine physicians will begin to experience that change in mindset for themselves as they train to be a part of Sanford’s new genomic initiative, Sanford Imagenetics. Sanford Imagenetics will allow internal medicine physicians to work hand-in-hand with clinical geneticists, genetic counselors and diagnostic clinical genetics laboratories to fully integrate high-tech genomic medicine into their clinical practice. Samuel

Nyamu, an internal medicine physician in Aberdeen, says it is easy to imagine a myriad of ways in which he will be able to apply this technology in his practice. “Almost every day I see someone who could benefit from this,” he says, referring to the program’s initial focus in pharmacogenetics. “Often, I see patients come back to my clinic because of drug side effects that could have been avoided had we had a better understanding of how they metabolize medicine. Without this genetic information, I have no idea how a given patient will metabolize medicine and I just have to give them a general dose and see how it goes.” “The unique thing here is that we are making it real in terms of clinical practice,” says Gene Hoyme, MD, a board-certified geneticist and president of Sanford Research. ■

News Flash

South Dakota receives an overall D+ in the 2014 American College of Emergency Physicians’ (ACEP) state-by-state report card on the environment in which emergency care is delivered

News Flash

Avera Cancer Institute is approved to offer complete PROVENGE therapy for men with advanced prostate cancer


Megan Landsverk, PhD, director of the Sanford Clinical Molecular Genetics Laboratory, holds up a flow cell from the HiSeq 2500, a powerful ultra-high-throughput sequencing system that can sequence a whole genome in about 27 hours.

Midwest Medical Edition

Photo courtesy Sanford.

Sanford Imagenetics

n review April |May

Area Experts Tackle the EHR Issue On one hand, the feder al progr am designed to incent physicians to buy and “meaningfully use” an elect ronic health record (EHR ) system has been a tremendous success. According to CMS , as of January 2014, 347,000 healthcare providers had received payment for participating in the program. On the other hand, many of these providers also admit to having annoying – and often costly – “issues” with EHR systems that they may have chosen too quickly or were inadequately prepared to use. ■

In this Special Section, we brought you advice from area EHR experts.

“With the federal EHR incentive program in its third year, we are bearing witness to a growing number of EHR replacement sales due to unsatisfied providers and EHR vendors’ inability to meet increased certification criteria. If you are not converting all data to your new system, remember to assess your policies against the record retention laws set in your state.” — Trish Lugtu, MMIC

“T he Office of Inspector General has identified copy/paste as a potential fraud vulnerability. Do you see the same information repeated over and over again in your EHR? Is the same physical exam in the H&P, progress notes and/ or discharge summary? Or is the same progress note repeated over a number of days? If so, your facility may be at risk.” — Rhoda Lagerquist, Eide Bailly, LLP

“No matter your size or location, downtime will cost you and will only get more expensive. Where is the central location of your critical data and what redundancies exist? Where and how are the servers and storage at your location backed up and how quickly could you restore that information? Does the risk of downtime warrant a second-failover connection? By performing a thorough evaluation and investing in a solid continuity plan, you can prevent downtime from truly costing your organization.” — Bryan O’Neal, Golden West Technologies

News Flash

David Basel, MD, of Sioux Falls and Scott Eccarius, MD, of Rapid City are among a select group of physicians to pass the first-ever Board Certification exam in Clinical Informatics.

December 2014


Photo courtesy Life Scape


year in


Better Together The New LifeScape Offers Continuum of Services for Children and Adults with Disabilities Both South Dakota Achieve and Children’s Care Hospital and School have long been recognized for their ability to adapt to the changing medical needs of Sioux Falls and surrounding communities. Now, these organizations have proven, once again, their ability and willingness to adapt to changing times by joining forces to form LifeScape. By combining these two demographics, the new non-profit organization has the capacity and expertise to support the varied medical, educational, emotional, mental, and social needs of patients with disabilities at any stage of life.

“Even just the fact that two non-profits were able to put their egos on the shelf and look at what was going to serve the community best is quite something,” says LifeScape CEO Anne Rieck McFarland. “We are planning to take advantage of the things these organizations have learned about serving people with disabilities.” Although the two organizations that combined to form LifeScape will continue to provide the services that have always been associated with them, Rieck McFarland and LifeScape’s Vice President of Medical and Therapy Services, Kristin Tuttle, say

With the goal of helping all people with disabilities reach their full potential, LifeScape provides employment training, preparation, and placement. LifeScape will be able to serve certain clients in ways that have not previously been possible. Hence, the “Better Together” slogan in LifeScape’s marketing. One area of service expansion under the LifeScape banner will be mental health, an area with which many service organizations for adults with disabilities struggle. Respite care to provide a break for the caregivers of adults and children with disabilities is another area of planned service expansion. “Whether they need to be an inpatient or they are looking for rehabilitation medical supplies, we can help direct them so that they get what they need,” says Tuttle. ■

News Flash

Regional Health President and CEO Charles Hart retires

News Flash

Sanford Health announces plans for an integrated breast health building at its Sioux Falls campus


Midwest Medical Edition

n review July | August

What we learned from . . . Flight 232

Twenty-five years later, two Siouxland doctors look back

“I had just finished an operation at Marion Health Center (now Mercy Medical Center) in Sioux City… and heard that there was maybe going to be an airplane crash,” recalls Quentin Durward, MD, of the events of July 19, 1989. “So, I wandered down to the ER to see what this was all about.” The first victim of Flight 232 arrived at the Marion ER a miraculous 16 minutes after the crash at the Sioux City airport. Dr. Ralph Reeder, who now works with Durward at the CNOS Clinic in Dakota Dunes, was the only other neurosurgeon in Sioux City at the time of the crash. He had moved to town just two weeks earlier. “I

barely knew where the bathrooms were,” he says. Fortunately, he had plenty of help. Hundreds of volunteer physicians, nurses, and medical techs flocked to the hospitals – many of them with no previous trauma experience. “No one was concerned about hierarchy or privilege. We all just saw jobs and did what had to be done. Because you knew that if you didn’t do what you could, right then, the person was going to die,” says Dr. Reeder. Of the 296 people on the plane, an amazing 184 survived, thanks to the phenomenal skill of the flight crew in the air and good

planning, early warning, and quick thinking on the ground. When they remember the blur of non-stop workdays that followed the accident, both doctors say they are humbled by the experience. “The community response spoke very highly of Sioux City,” says Dr. Durward. “In my career, I have never seen anything even remotely like it.”■

News Flash

Make-A-Wish South Dakota celebrates its 30th anniversary

News Flash

Avera Flandreau Hospital holds its grand opening.

September | October

Independent But Not Alone SD Community Hospitals Stay Strong with Creative Collaboration

Do a quick Google search of ‘Independent Community Hospitals’ and you’ll find two types of articles – those devoted to ways to “save” community hospitals, and those that say it can’t be done. Several long-standing independent rural hospitals in the South Dakota region are banking on the fact that the naysayers are wrong. The environment for community hospitals is challenging. The push for expensive hightech services and the rising expense of facility upgrades, the cost of attracting and retaining physicians, reimbursement reductions, the increasing role of managed care companies, and the move from fee-for-service to value-

December 2014

based healthcare all hit inordinately hard for facilities with smaller budgets and lessaffluent patient populations. While some have managed by aligning with large health systems, others have found creative alternatives such as partnerships, joint ventures, joint operating agreements, telehealth, and clinical and management service arrangements. In the case of Prairie Lakes Healthcare System in Watertown, CEO Jill Fuller says diversification of services, controlling costs, and collaboration are been keys to their independence. “Going from competition to collaboration is the way to regionalize health services and that has been our approach,” says Fuller.

But can independence work for even smaller hospitals? Tammy Miller, CEO of the 25-bed Madison Community Hospital in Madison, South Dakota says yes – with the right structure. “I believe that the number one thing for independence is community support.” Miller says a stable workforce and stable physician base are also critical to success as an independent. ■

News Flash

The first Sanford School of Medicine students start work in the new FARM rural medicine program.



year in



Patient Portals and the Future of Provider/ Patient Communication

Getting patients to come and actively engage with a patient portal system, which is needed to meet meaningful use requirements, is forcing many practices to take a new look not only at portal systems and their capabilities, but also at the meaning of the word “marketing”. “We make patients aware of our portal at the time of registration,” says Kelly King, Director of Nursing at Sioux Falls Specialty Hospital in Sioux Falls. SFSH implemented the patient portal offered through its EMR provider, McKesson Paragon, about 6 months ago. “When they register, we describe the portal, what they can do with it and how they access it. Inpatients are also made aware of the portal during our daily rounds.” Through a patient portal, patients can get online access to their health information, including diagnoses, medication lists (in total and by condition), allergies, and recent test results. Depending on the system configuration, they may be able to access a summary of their most recent visit, including the topics discussed and the provider’s recommendations. Some may also include the date and time of the next visit and a list of scheduled tests. “It is a great tool for engaging patients,” says Allison Wierda Suttle, MD, Chief Medical Information Officer at Sanford Health. “This lets you be more of a mentor to the patient.” David Klocke, MD, Chief Medical Officer for Regional Health in Rapid City, says portals may benefit the profession in a less obvious way, too. “Having a portal in place increases patient engagement, but it also raises the bar for doctors,” says Klocke. “When I walk in to see a hospitalized patient, I know that they may already know their lab results, so I better know them, too!” ■

News Flash

Avera eCARE celebrates its 10th anniversary.

News Flash Northeast South Dakota Healthcare Foundation (NESDHCF) breaks ground on Milbank’s new $23 million healthcare campus. Most MED articles come from the suggestions of MED readers. If you know of a physician, program, or institution that you think is worthy of coverage in MED, write to us at


Midwest Medical Edition

December 2014


Avera Health Receives Federal Funding for eEmergency Network Avera has been awarded $400,000 through the EvidenceBased Tele-Emergency Network Program to develop the Midwest Rural eEmergency Access and Research Network. The network will serve 21 rural and frontier communities in South Dakota, Kansas, North Dakota, Iowa, Nebraska and Minnesota, an area with a total population of more than 194,000. Eighteen hospitals in these communities are receiving eEmergency services through Avera eCARE, and three critical access hospitals in Kansas will implement eEmergency as part of the project. Due to the limited availability of healthcare personnel in these areas, many facilities would not be able to maintain 24-hour emergency department services without eEmergency which links rural locations to a “virtual hospital” hub in Sioux Falls through interactive video and computer technology. At the touch of a red button on the wall of a local emergency room, staff can be in contact with emergency physicians within a matter of seconds, around the clock. eEmergency serves 88 hospitals, including a number of non-Avera sites. The project goal is to enhance rural access to emergency services through research efforts and development of an evidence base related to telemedicine support for emergency chest pain, stroke and intubation services. There are 21 rural hospital sites in the network, including 15 hospitals unaffiliated with Avera, as well as six owned or operated by Avera. Gary Hart, PhD, Director of the University of North Dakota Center for Rural Health, will serve as Research Director for the network and will lead efforts to evaluate how this program impacts rates of hospital admission, transfers to tertiary facilities, patient outcomes, cost efficiency, and provider satisfaction. The tele-emergency grants were part of $22 million in funding to support healthcare in rural areas recently announced by the Health Resources and Services Administration (HRSA). Awards went out to more than 100 communities in 42 states. “Rural communities have some of the greatest needs for expanding access to healthcare,” said HRSA Administrator Mary K. Wakefield, PhD, RN. “These investments represent our commitment at the federal level to support partners on the ground, who are working to strengthen healthcare delivery in every area of the country.” ■

MED Quotes “First do no harm (Hippocrates) . . . Second, do some good.” —Anne M. Lipton, MD


Midwest Medical Edition

Sanford study reveals higher-than-expected prevalence of fetal alcohol spectrum disorders in US Nearly 5 percent of US children may be affected by fetal alcohol spectrum disorders, according to a new study co-authored by Sanford Research’s Gene Hoyme, MD, and Amy Elliott, PhD, and published by Pediatrics. The study, “Prevalence and characteristics of fetal alcohol spectrum disorders,” explored the incidence of fetal alcohol spectrum disorders (FASD) among first-grade students, or 6 to 7 year olds, in Sioux Falls, a “representative Midwestern community”. Students were enrolled from all Sioux Falls elementary schools, both public and parochial. The research team gathered data on two groups of children related to physical growth, development, dysmorphology, cognition and behavior. The first group was made up of small children who were in the 25th percentile or less in height, weight and head circumference; the second group, or the control group, was randomly selected. The mothers of children from both groups were interviewed for maternal risk related to alcohol consumption while pregnant. Around 2.4 percent to 4.8 percent of all the children studied were found to have some form of FASD based on cognitive and physical attributes. Furthermore, women who had

affected children displayed higher levels of weekend binge drinking before discovering they were pregnant, sought prenatal care later and less frequently, and noted the fathers of their children were frequent drinkers. “Previous estimates of fetal alcohol spectrum disorders put the occurrence at around 1 percent in the United States,” said Hoyme. “By actively assessing the children who were part of this study, our team was able to develop a more accurate figure for the prevalence of this disorder among the predominately middle class population of Sioux Falls and identify key risk factors that can predict it.” Hoyme is internationally known for his work with FASD and also serves as president of Sanford Research and chief academic officer for Sanford Health. Elliott leads the Center for Health Outcomes and Prevention Research at Sanford Research and is involved with national and international investigations about FASD and its consequences. FASD characteristics are both physical and cognitive and can include abnormal facial features, smaller-than-average physical growth, poor coordination, learning disabilities and vision and hearing problems. The study is the first school-based ascertainment study to be completed as a measure of FASD prevalence in American children. ■

Sioux City Hospitals Provide Over $31 Million in “Community Benefit” Mercy Medical Center – Sioux City provided $17.8 million in community benefit and UnityPoint Health – St. Luke’s another $13.2 million in community benefit in 2013 according to a recently completed assessment by Iowa Hospital Association (IHA). The IHA report shows that Iowa hospitals provided community benefits, including such services and programs as health screenings, support groups, immunizations, nutritional

December 2014

services and transportation programs, valued at nearly $1.6 billion. According to the IHA report, St. Luke’s reported nearly $4.8 million in charity care as well as $2.2 million in subsidized health and community services. Mercy reported $5.8 million in charity care in addition to $7.6 million in subsidized health and community services. “Our mission of improving the quality of life of all we touch including the poor or the

underserved and underinsured is as strong and focused than ever,” says Jim FitzPatrick, CEO of Mercy Medical Center. “We are collaborative in our approach and strategic in order to make as big a positive impact as we possibility can.” “Through community benefit, we are able to provide vital programs and services that benefit our overall health,” says Lynn Wold, Interim President and COO of UnityPoint Health – St. Luke’s. ■



Sponsored by Prairie Berry Winery and Prairie Berry East Bank


Sandi Vojta, Prairie Berry Winery

Co-Owner and Winemaker

If you enjoy an oak-aged red wine with your holiday turkey or pork, Prairie Berry Winery Jingle wine is for you. This fruit forward merlot is best served at cool room temperature and offers dense plum and cherry with hints of anise and leather on the nose. On the palate, it brings notes of plum and cherry vanilla with light cedar and a lingering earthy finish. Jingle is available through December at Prairie Berry East Bank in Sioux Falls, at our tasting room at Prairie Berry Winery in Hill City, SD or online at

Q: Why are food and wine pairings important to consider this holiday season? A: When properly paired, wine can

elevate a standard holiday dinner to a new level—the wine highlights subtle flavors in food while the dish’s ingredients showcase the flavor notes in the wine. Pairing each course of your holiday meal with wine is a fun way to bring something new to the table and to have a little fun with flavors this season.

Q: What are the basics of wine and food pairings to remember for upcoming holiday parties? A: Plan the menu and then find wines to pair with the various


Mulled Wine

Fill your home with the comforting scent of mulled wine this December. Mulled wines are fun options to bring to holiday gatherings and they offer warmth and a delicious taste to enjoy before or after holiday dinners. Our mulling spice is made at our winery in Hill City and features a warming blend of dried orange peels, allspice, cinnamon and cloves. It’s available at Prairie Berry East Bank in Sioux Falls, at our tasting room at Prairie Berry in Hill City and on our website,

W inery Cra ry er B ie ir ra P d e l u M

nberry W ine

e ranberry win ry Winer y C er B ie ir ra P 1 bottle wn sugar ns light bro ice 2 tablespoo ry mulling sp s Prairie Ber n o o sp le b 2 ta gment rving, put 1 orange se . For easy se n a p t, ce u sa ium until ho gredients in Heat on med ll. Combine in a b a te a spice in the mulling eat to il. Reduce h o b ’t but don r 20 -30 and mull fo medium low Enjoy! rv in and se e. minutes. Stra


dishes. For example, if you’ll be serving prime rib, choose a full-bodied red wine such as our Pheasant Reserve dry red to match the beef’s hearty flavor. For dessert, select a sweet wine that will match the sweet flavor of pumpkin pie or other treats. Pink Slip is a light, sweet Moscato that pairs well with many desserts.

Q: What are some new and fun pairings that people can bring to their holiday gatherings? A: New Year’s Eve is a prime occasion to have fun with food

and wine pairings. Create various pairing stations throughout your party’s space and fill the stations with cheese plates, charcuterie boards and complements, each paired with wines. Here are just a few of the many artisan pairings available at Prairie Berry East Bank:

CHARCUTERIE • Bresaola Piccola by Creminelli Fine Meats and Anna Pesä Cabernet Sauvignon • Smoked Duck Breast by Smoking Goose Meatery with Pheasant Reserve dry red CHEESE • Pleasant Ridge Reserve by Uplands Cheese Company with Anna Pesä Zinfandel • Boulder Chévre by Haystack Mountain Goat Dairy with Raspberry Honeywine COMPLEMENTS • Salame di Cioccolato by Olympic Provisions with Gold Digger semi-sweet wine • Kick Ass compote and chévre with Red Ass Rhubarb semi-sweet wine Midwest Medical Edition

Explore our holiday wines, local craft beers and artisan pairings. Make your holidays Berry and Bright with Prairie Berry East Bank. 322 E. 8th St, Downtown Sioux Falls | 605.496.7175 |

December 2014


The Nurses’ Station Nursing News from Around the Region

No Time for a BSN?

Promotions and New Hire for Area Nursing School | St. Luke’s College – UnityPoint Health announces the promotion of the following faculty: Dr. Susan Bowers, EdD, MSN, RN, Dean of Nursing, will provide administrative leadership to all nursing education programs and services of the College. Dr. Dan Jensen, Dean of Health Sciences, will provide administrative leadership to the Departments of Respiratory Care Education, Imaging Sciences Education, Medical Laboratory Sciences Education and Clinical Pastoral Education. Danelle Johannsen, MA, BS, Dean of Student Services, will provide administrative leadership to Student Services and to the Library.

Pam Briese, MS, MLS, has been promoted to Associate Professor in the Division of Medical Laboratory Science Education.


Lori Hoesing, MS, RN has been promoted to Associate Professor in the Division of Nursing Education.

Beth Sitzmann, MSN, RN, CNE, has been promoted to Associate Professor in the Division of Nursing Education. Pam Fox, MSN, RN, has been promoted to Assistant Professor in the Division of Nursing Education.

In addition, the college has named Sonya Hiserote, RN, MSN, as Assistant Professor for the Division of Nursing Education.

Busy RNs who want to get their bachelor’s degree now have a more convenient option locally thanks to USF’s new online RN-to-BSN program. According to USF, there is an increasing national effort to ensure that all RNs are prepared at the baccalaureate level in order to practice in an increasingly complex healthcare environment. The USF program is 100% online, with the exception of select clinical requirements. Director of Nursing Dr. Jessica Cherenega says the coursework, which covers ethical, cultural, spiritual, physical and psychosocial aspects of professional nursing, is designed specifically for working RNs who are unable to attend traditional classes. “They can take classes at their own pace, choosing to take one or more at a time,” says Cherenegar. “Everything about our online RN-to-BSN revolves around working nursing.” The program requires about 10 to 12 hours a week, outside of class time, to be completed within two years, but students also have the flexibility to set their own pace and complete the program on their own schedule. A total of 124 credits is required to graduate with a BSN. USF is currently accepting applications for the Spring RN-the-BSN program. Application deadline is January 21. An information request form can be found on the USF website or can be obtained from

MED Quotes “It is very expensive to give bad medical care to poor people in a rich country” —Paul Farmer, MD

Midwest Medical Edition

Healthy Jewelry

Jewelry is more than just a financial investment; it is often a cherished reminder of the events of our lives. But, like anything else, jewelry requires maintenance to maintain its health. In between professional inspections, there are some things you can do to maintain your jewelry on your own. Personal care of your jewelry can be categorized into two basic areas of concern: gemstones and metals. In the last issue, we discussed gemstones. In this issue, we’ll address care of your metals. Jewelry metals are rarely used in their pure form because they are too soft. Metals such as gold are alloyed with other metals, such as copper, to add durability. It is still recommended to take off jewelry during strenuous activities that could easily bend or break these metals. It is also advisable to take off your jewelry before going to bed to prevent damage to chains, earrings, and to avoid other complications.

Jewelry alloys are also reactive to many other things found in hair products and makeup. Cosmetics are made from minerals that are harder than jewelry metals. Avoid “black smudge” from metallic abrasion by putting on jewelry after makeup. Additionally, irritation from soap and water trapped under a ring can cause a common form of dermatitis. Avoid washing and bathing with jewelry on to prevent this.

By Christopher A. Eads

Jewelry alloys can be damaged by exposure to chemicals Chlorine in a swimming pool or hot tub will cause stress corrosion cracking, essentially disintegrating jewelry and causing irreversible damage.

We at Riddle’s Jewelry hope this brief advice will help you establish good jewelry care practices that will keep your jewelry looking good for years to come. Please come and see us. We’d be happy to answer any questions you might have.

Christopher Eads is an Accredited Jewelry Professional G.I.A., with twelve years industry experience.

December 2014


Complementary Therapy Supporting a Holistic Approach

Infrared Saunas-Healing with Heat Business: SuiteSweat Sauna Studio, Sioux Falls Owners: Penny Paclik and daughter Tiffany Hansen Infrared saunas, which use infrared light to raise the body’s core temperature, have been used medicinally in Eastern medicine for centuries. Some of the benefits attributed to infrared therapy include detoxification, lower blood pressure, stress relief, reduced joint pain, skin improvements, better circulation, and even weight loss. At the SuiteSweat Sauna Studio in Sioux Falls, medical grade heaters in private sauna “suites” emit a consistent dose of infrared light between 9 and 12 microns – believed to be the best wavelength for human absorption.Owners Penny Paclik and Tiffany Hansen are hoping that the local medical community will take a closer look at the potential health benefits of this ancient practice – for themselves and their patients.


Why did the two of you decide to open SuiteSweat?

What kiNds of people use these saunas?

We talked about working together in a meaningful business that we could grow with. We kept seeing common threads in people. Everyone was always wishing that they could feel better, look better, and live a healthier, longer life. We also saw how people just couldn’t relax or get enough rest. We saw the fear of cancer every time someone new was diagnosed. We saw people hurting and just living with the pain, whether it was physical or mental. We wanted something that could help better people’s lives and this was exactly that.

Initially, the members we received were the people who were into health and wellness. Then athletes came to enhance their work outs. We have cancer patients, people with aches and pains, people just trying to avoid illness. Some people use infrared saunas to distress and improve their mental health and we have people who are trying to lose weight.

Does an infrared sauna feel different from a traditional sauna? Unlike the saunas of the past that would just heat your skin and make you uncomfortable, infrared saunas are dry heat. One interesting thing about sweating out toxins is that our clients don’t experience a sweat smell. At the same time, it is also possible to achieve that “runner’s high” that comes with intense physical activity, without actually doing the activity.

What has been the response from the medical community? Thankfully, the benefits of infrared therapy are becoming well known. There is a Health Insurance Billing Code for Infrared Therapy (97026) and over the years we have seen more and more physicians “prescribing” infrared therapy to their patients to complement their treatments. Depending on the patients’ health insurance, some are reimbursing our clients for their therapies when submitted by the patient (we don’t bill directly). We have seen some dramatic improvements in our clients’ overall health and we invite any healthcare provider to come and experience a complimentary session and learn more about us.

Midwest Medical Edition

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Midwest Medical Edition

Estate Plan: End of the Year Checklist Breandan Donahue, Estate Planning Attorney


ith the end of the year at hand, it is an appropriate time to review your estate plan. Failing to keep a plan up-to-date can frustrate any goals you may have for your estate plan and run up costs for your estate. Here are some simple, categorical items to consider as you dust off your plan.

Is your plan older than two years? This is not a hard and fast timeframe, but many changes to the estate planning landscape became permanent at the beginning of 2013. For example, take the federal estate tax exemption—the amount of property an individual can pass on before estate taxes are levied. At this moment, the exemption is currently $5.34 million. This is vastly different from the $3.5 million exemption as it existed at the end of 2009, or the $675,000 exemption of 2000. There is also the advent of portability—the ability to pass on unused exemption amounts to a surviving spouse. Portability did not exist in the last decade.

Is your disability planning in shape? Estate planning means planning for disability as well as death. Your Health Care Power needs to be kept current to track changes with HIPAA and state law. Durable Powers of Attorney—or Financial Powers of Attorney in casual conversation—should also be kept up-to-date for an altogether more practical reason: Financial institutions scrutinize these pretty closely and are wary of accepting any documents that are more than a couple of years old.

December 2014

Have you checked your beneficiary designations? Beneficiary designations are incredibly important and often forgotten. These accompany your retirement accounts and life insurance policies and dictate to whom property should go upon your death. If you do not keep on top of your designations, they will not keep pace with your life. So, as the rest of your life is changing—you get married, divorced, or have children—your designations will remain the same. This could mean property going to an ex-spouse or property failing to go to your children. Beneficiary designations override the rest of your estate plan. To avoid frustration, dredge up your life insurance and retirement accounts, verify you have current statements, and ensure that your beneficiary designations are current.

Have there been any significant changes in your own life?

State law goes a long way in trying to protect your estate plan, but it is not prudent to rely on it if there have been significant changes in your own life. Have you recently been married or maybe you were just divorced? Has there been a birth or death in the family? Maybe there has been a significant change in your finances. Any of these are reasons to return to your estate plan and see if it still addresses your goals and aspirations. Periodically revisiting your estate plan is inescapable. By establishing a time to review your plan once a year, though, it becomes a manageable task that maximizes the benefit of your estate plan to you and your family. ■

Breandan Donahue is the estate planning attorney for Goosmann Trust Law Counsel, a boutique estate and business succession planning department within Goosmann Law Firm, with offices in Sioux City and Sioux Falls.


PAs Practice Medicine





Primary care includes family medicine with and without urgent care, general internal medicine, OB/GYN and general pediatrics.



Compensation refers to PAs who work full-time, are not self-employed and receive a salary as their primary form of compensation.






23.2% 15.4%

66% 34 %


* *

* Source: AAPA 2013 Annual Survey + Source: NCCPA 2013 Statistical Profile of Certified Physician Assistants

American Academy of Physician Assistants


Midwest Medical Edition

Learning Opportunities

February – April February 6

8:00 am – 5:00 pm February 7

8:00 am – 12:30 pm March 13

8:00 am – 4:00 pm March 26

7:30 am – 4:30 April 24

8:00 am – 5:00 pm April 30

8:00 am – 4:00 pm

Avera Ethics Conference Location: Hilton Garden Inn Downtown, Sioux Falls Information:, 605-322-8987 Registration: Nuclear Medicine Conference Location: Prairie Center, Sioux Falls, Classroom A Information: Registration: Begins at 7:30 am 8th Annual Brain & Spine Institute Conference Location: Hilton Garden Inn Downtown, Sioux Falls Information & Registration: Perinatal, Neonatal & Women’s Health Conference Location: Sanford USD Medical Center, Schroeder Auditorium Information: 14th Annual Pediatric Symposium Location: Sr. Colman Room, Prairie Center, Avera McKennan Information:, 605-322-8987 Registration: Sanford Kidney Symposium Location: Sanford USD Medical Center, Schroeder Auditorium Information:, 605-328-9290 Registration: Coming soon

Log on to MED’s calendar to see the newest upcoming events or add your own.

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 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

December 2014


Our team just got

EVEN BETTER. Sam Milanovich, MD Pedatric Oncology & Hematology

Only pediatric oncology program in the region. Sanford Children’s Speciality Clinic At Sanford, we understand the importance of giving your child the best care possible. That is why we offer the latest in cancer diagnosis, treatment and therapy for infants to young adults. Our focus is on providing exceptional medical care in a child-friendly, supportive environment where hope and play are an important part of each child’s experience. In order to deliver the utmost in care, we welcome our newest team member. Sam Milanovich, MD, is an expert in pediatric oncology and hematology who provides comprehensive care for children with cancer or blood disorders. Call Sanford Children’s Specialty Clinic at (605) 312-1000 to refer a patient. Choose expert care. Choose Sanford.

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MED-Midwest Medical Edition-December 2014  

The Year in Review-2014

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