MED-Midwest Medical Edition-July/ August 2013

Vol. 4, No. 5

2013 July August

Medical Homes

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

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Contents Midwest Medical Edition

July / August 2013

Regular Features 2 | From Us to You 4 | Meet a MED Advisor Jennifer Nelson, DO, Family Medicine 6 | News & Notes News from around the region 22 | The Nurse's Station Rapid City Regional’s ‘Star’ Nurses, Promotions and Awards

Medical

24 | Off Hours: Black Hills Providers Rally Around Marathon

Homes

28 | Grape Expectations: The Wines of Summer | By Heather Taylor Boysen

29 | Learning Opportunities

A New Structure for Care Delivery

Upcoming Symposiums, Conferences, CME Courses

By Alex Strauss

In This Issue 5 | Tips for improving Your Presentation Skills | By Alex Strauss

Take the terror out of public speaking, and get your point across, with these practical tips.

12 | Healthcare IT – What you need to know By Corey Steele 14 | Patient Engagement: It’s Personal

| By Jan Schuster

Can you engage better with patients and still protect your bottom line?

16 | The Avera Family Wellness Program

| By Jayden Portice

18 | UnityPoint St. Luke’s Advancing Imaging Technology in Siouxland

Once upon a time it was possible for a single provider to manage even a complex patient's many medical needs.

But as schedules fill to the brim and practices take on more risk, some have worried that the need to increase efficiency could result in less comprehensive care, especially for the most vulnerable. Enter the Medical Home concept.

Although the upper Midwest has been slower to adopt the concept than some other parts of the country, this care coordination approach is taking root here and already reaping some rewards, for both patients and providers.

18 | Three-in-One Eye Center

Opens in Sioux Falls

page

19 | Endoscopic Vessel Harvesting Less invasive procedure for harvesting vessels reduces pain, speeds recovery

21 | Choose to Leader from Where You Are | By Martha Helland

In Review

God’s Hotel By Victoria Sweet

26 | The Estate Tax is Permanent . . . Right?

| By Alice Rokahr

Reviewed by Patty Peters, MD

page 27

8

From Us to You

Staying in Touch with MED

W

elcome to the summer issue of MED Magazine, the region’s premiere business publication exclusively for physicians and

Publisher MED Magazine, LLC

Sioux Falls, South Dakota

healthcare executives in South Dakota, South-

We hope you are finding some time to enjoy the warmer weather and longer days. Some of you may have seen our own Steffanie Liston-Holtrop on the links May 20th at the 15th Annual

VP Sales & Marketing Steffanie Liston-Holtrop Editor in Chief Alex Strauss

Design/Art Direction Corbo Design

Cover Design/Photo Darrel Fickbohm Photographer Kristi Shanks

Web Design 5j Design

Contributing Editor Darrel Fickbohm Copy Editor Hannah Weise

west Minnesota and Northwest Iowa.

Steffanie Liston-Holtrop

Lions Eye & Tissue Bank Charity Golf Tournament. Though she

Contributing Writers Heather Boysen Martha Helland Dave Hewett Dale Jahr Sarah McQuade Jayden Portice Alice Rokahr Jan Schuster Corey Steele

held her own with the crowd of experienced golfers, her team, as well as 21 others, was ultimately beat out by the team at Vance Thompson Vision for best overall score. MED Magazine was a hole sponsor and Lewis Drug was the corporate sponsor of the event which raised nearly $35,000.

On a more serious note, our cover story this month takes an Alex Strauss

in-depth look at the concept many are calling the future of medi-

cine: the medical home care structure. We talked to representatives

Staff Writers

from institutions around the region to find out how they are implementing this coordinated care structure, and what it means

Liz Boyd Caroline Chenault John Knies

Contact Information

for both patients and providers.

Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com

Thank you to all of you who have taken the time to respond to what you have seen here in MED and to offer your own sug-

Alex Strauss, Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com

gestions and contributions. We are always looking for physicians with notable case stories, practice memories, interesting hobbies,

Fax 605-271-5486

musical pursuits, book reviews, or anything else you would like

Mailing Address PO Box 90646 Sioux Falls, SD 57109

to share. Drop us a line any time at Steff@MidwestMedicalEdition.

Website MidwestMedicalEdition.com

com or Alex@MidwestMedicalEdition.com.

2013 Advertising / Editorial Deadlines

We look forward to seeing many of you at the SDMGMA Annual Conference in August. Enjoy your summer!

—Steff & Alex

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.

A day on the links raised $35,000 for eye & tissue donation in the region.

e Woruits! t

t ccep We aader r e s i o ns is subm

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to 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.

2

Midwest Medical

access.

Get answers now.

Digestive Health is now available as the newest clinic of Midwest Family Care.

With same-day service and a broad range of GI expertise, our specialists will take the needed time and give the personalized care expected, to diagnose and treat diseases that affect the digestive system.

Dr. Mark Milone

Gastroenterologist & Hepatologist

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Choose Midwest Family Care Digestive Health and get the answers you’ve been looking for. Call (605) 444-8665 today.

716 E 19 t h S t r E E t S i o u x Fa l l S , S D 5710 5 Proud to be Physician Owned and Operated

A talk with MED Advisor

Jennifer Nelson, DO, Family Medicine

Q: Fewer young physicians are choosing primary care these days.

Why did you?

A: One of my biggest influences was our family doctor when I was growing up in Winner. I am the youngest of 8 children and I remember that when I went to see him, he would look me over and then start asking my mom about my other siblings. It was clear that he really wanted to know what was going on with the entire family. I was really impressed by that.

My other inspiration was my dad, who died when I was in medical school.

He always knew when to call. I would be frustrated with studying and I was ready to say ‘Bring the horse trailer and take me home!’ But by the time I got done talking with him, everything was fine.

Q: What do like most about family medicine?

A: It is a challenge and I am the first to admit that I don’t have all the answers.

But one of the challenges that I really like is that I never know what is behind the next door. It is always interesting.

EHR Incentive Payments Update Your Information with SD Medicaid to Get Paid Sooner You may have worked hard to find and implement an EHR system in your office, but unless your information is updated in the state’s Medicaid database, your incentive payments could be delayed. South Dakota Medicaid is requiring providers to update all of their records in the SD MEDX system before they will authorize payments.

HealthPOINT, the regional extension center charged with helping area providers implement Electronic Health Records, offers the following advice for updating information and facilitating faster payment:

1 2

Log in to SD MEDX and ensure that all of the provider record is correct. In many cases, a provider may need to update all of their servicing provider records under step 14, including data such as license information, taxonomy information, etc.

When the license has been updated, a copy must be mailed or faxed to the state. Ownership/managing employee information must also be supplied under step 4 of the group/facility record.

For specific enrollment information, providers can contact the SD MEDX Response Team at 1-866-718-0084.

Relax.

Discover solutions that put you at ease.

Q: You have been in practice for 9 years. How do you see medicine changing in the next decade?

A: Things have changed so much just since I started.;The politics of medicine has changed, the stressors on us because of that, switching from paper charts to electronic charts. In ten years, there are going to be many new doctors who have never practiced any other way. Also, I think we are going to look more and more to mid-levels to help us do primary care. Some of my older patients especially are frustrated by that. But as we look at ways to deliver care more efficiently, I think mid-levels are going to be a much bigger part of the picture.

At MMIC, we believe patients get the best care when their doctors feel calm and confident. So we put our energy into creating risk solutions designed to eliminate worry. Solutions such as medical liability insurance, physician 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 MMICgroup.com.

4

Midwest Medical Edition

“ Many physicians would prefer passing a small kidney stone to presenting a paper.” ­— Journal of the American Medical Association

Tips for

Improving Your Presentation Skills

I

f the quote At the top of this

page describes you, you can take comfort in the fact that you’re not alone. Why does speaking to a group of peers evoke such universal dread in so many people? It may have to do with many people’s deep-seated discomfort with being the center of attention. Or it may simply be a lack of experience. Rather than dwell on the why, let’s look instead at what can be done about it.

First, take heart. There are hundreds of stories of people who have overcome debilitating shyness, speech impediments and various other problems to become not just adequate, but extraordinary speakers.

(Helen Keller comes to mind). You, with your education, brains, and desire to improve certainly can, too.

Be the Expert If you have been invited to speak, whether you are presenting your own research, addressing your Kiwanis club, or proposing a toast at the office Christmas party, it means that someone out there considers you an expert. Don’t give them reason to doubt it by revealing your nervousness or making apologies. Remember, in many cases your audience has no idea what they don’t know. Most crowds will be unlikely even to notice if you lose your place or miss a point. Just soldier on as the expert they have come to hear.

Use Acronyms If you are worried about being able to remember your speaking points, acronyms are a favorite tool of professional speakers. Arrange

July / August 2013

the first letters of your main speaking points (there should not be more than 3 to 5) into a word – even a nonsense word – and keep that word in your head, or on your notes, as you move through your points. Knowing you can always call that word to mind will help ensure that you don’t ‘draw a blank’ when the spotlight is on you.

Act the Part Even speakers who don’t get especially nervous can be guilty of poor presentation skills simply because they fail to be intentional.

Poor posture, hands in pockets, failure to make eye contact with members of the audience, and speaking too quietly or too quickly can all be major distractions and draw your audience’s attention away from your information.

A tall but relaxed stance, a clear, measured speaking voice, and appropriate hand gestures all help to build rapport with your audience and hold their attention. If this doesn’t feel natural to you, try this mental trick: Simply ‘act’ the way you imagine a professional speaker should act! Your audience won’t know the difference.

Using Props If you are one of those people who is unsure what do to with your hands when you are speaking (and, no, gripping the lectern is not the answer), a prop can help. It does not necessarily have to be a prop that is related to the topic of your speech, although that can often enhance a presentation. Even a fountain pen, clipboard, or the handheld remote you are using to advance your slide presentation, can

MidwestMedicalEdition.com

By Alex Strauss

instill confidence by giving you something to hold on to and can help hand movements come more naturally as you speak.

If you do use a projected presentation such as a PowerPoint, take advice from civility consultant Sue Jacques and keep the slides “minimal in quantity, maximum in font size, and memorable in nature”. When you want to share more detailed or complex data, use handouts instead.

Practice, Practice, Practice To feel as confident as possible in a stressful situation, organize, simplify and practice your presentation. Many professional coaches recommend taping yourself for an audience member’s perception. Be well familiar with the information and the order in which you plan to present it, but avoid memorizing or reading which can look stilted.

Finally, smile! Your job as a speaker is to put your audience at ease so that they can absorb what you have to say. A warm and pleasant demeanor makes them more open to you and to your information and is more likely to illicit appreciative nods and attentive looks that, in turn, will boost your own confidence. Everybody wins! ■ If you have a communication issue you would like Alex to discuss in this column, send an email to AlexMidwestMedicalEdition. com. If you are ready to take your communication skills to the next level, put the media to work for you, or polish your stage or video presence, Alex offers private coaching to individuals and groups. Call 336-295-3017 to learn more.

5

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Avera

Theresa Nordin, a Clinical Dietitian at Rapid City Regional Hospital (RCRH), recently passed the Specialty Certification Exam in Oncology through the Commission on Dietetic Registration. Nordin is

Avera Behavioral Health Services received the Special Contributions Award from the South Dakota Counseling Association during its April conference in Sioux Falls.

Scott G. VanKeulen, MD, joined the Emergency Department at Avera Queen of Peace Hospital in June. He is

Board Certified in Emergency Medicine and also serves as Medical Director for the Emergency Department. Dr. VanKeulen received his BA from Creighton University and his MD from the University of Minnesota.

He completed his Emergency Medicine Residency at Maine Medical Center in Portland. Dr. VanKeulen is a member of the American College of Emergency Physicians and the Society for Academic Emergency Medicine.

surgery or illness, opportunities to view nature scenes and aquariums create a calming effect, reducing blood pressure, heart rate, muscle tension, and stress hormones while benefiting mood and speeding up recovery time.

Black Hills Seven physicians graduated from the Rapid City Regional Hospital Family Medicine three-year Residency Program on June 28.

Avera McKennan Hospital & University Health Center and the Sertoma Butterfly House & Marine Cove in Sioux Falls have teamed up to introduce UnderSea TV. Through this

new partnership, footage of the Marine Cove’s aquariums is streamed to Avera McKennan patient rooms via AveraVision, Avera McKennan’s patient information, in-room movie and television system. Research suggests that when patients are recovering from

6

now a Board Certified Specialist in Oncology Nutrition and the only one with this certification at RCRH. Nordin is the primary dietitian on the Oncology floor at RCRH and also works with Oncology patients at the Cancer Care Institute.

The class includes, back row, L-R: Heith L. Waddell, MD, Christopher J. Robbins, MD, Scott A. Balson, MD, and Gary P. MacDonald, DO. Front row, L-R: Nathan K. Allen, DO, Kristine E. Nelson, DO, and Lacey A. Olson, MD. Drs. Allen and Waddell were the Chief Residents.

Four Rapid City Regional Hospital (RCRH) VolunTeens recently received scholarships from the hospital’s Auxiliary.

Dr. Hilary Kindsfater of VA Black Hills Health Care System was unanimously voted the Psychology Doctor of the Year by the South Dakota Disabled American Veterans.

Kindsfater works in the Post Traumatic Stress Disorder (PTSD) Outpatient Program at the Fort Meade VA Medical Center.

Dr. Kindsfater recently helped facilitate the semi-annual PTSD Women’s Retreat at VA BHHCS and serves as the Training Director for the Pre-doctoral Psychology Internship Program.

Allison Eaton, Sean Feehan, Claire Foerster, and Claire Porter each received $2,000 scholarships to help them pursue a medicalrelated field of study. To qualify for a scholarship, students had to meet the RCRH Auxiliary Scholarship Committee’s criteria of completing a minimum of 100 hospital volunteer hours, maintaining a 3.0 high school GPA, and receiving acceptance to a college to pursue a medicalrelated field of study.

The Rapid City Regional Hospital (RCRH) Foundation presented its ninth premier wine tasting event, Grape Time, to benefit Women’s and Children’s Services at RCRH. The event took place on

June 15 at the Golf Club at Red Rock in Rapid City. Grape Time featured wine tasting stations, cuisine from several local caterers, a silent auction and local entertainment.

Midwest Medical Edition

Pathology and Laboratory Medicine at VA Black Hills Health Care System (BHHCS) Hot Springs and Fort Meade VA Medical Centers have been awarded accreditation by the College of American Pathologists (CAP). This

stringent inspection program is designed to specifically ensure the highest standard of care for all laboratory patients.

Regional Rehabilitation & Sports Medicine hosted a health fair on June 4 in Spearfish. Free screenings for

hearing, cardiac risk, osteoporosis and balance testing were available as well as discounted pricing on lab testing and consultations with a diabetes educator.

Sanford Sanford Health has been named to Becker Hospital Review’s list of “100 Integrated Health Systems to Know.” The

Medical Technologist Lynn Padilla places blood in the cooler in the Fort Meade VA Medical Center Laboratory.

Diana Boyle, an Employee Assistance Program Counselor with Regional Health, was awarded National Board Certification as a Board Certified Bariatric Counselor by the American Association of Bariatric Counselors. Boyle

is a National Certified Counselor, Licensed Professional Counselor, and Certified Employee Assistance Professional. Her expertise includes issues of domestic violence and weight management. Boyle is a member of Regional Health’s Wellness Committee which promotes wellness for all Regional Health employees.

health systems that appear on Becker’s Hospital Review are chosen by its editorial team and are based on rankings by the healthcare analytics company IMS Health, as well as health systems’ financial, clinical and operational strength.

Eight area high school students and eight regional educators were selected by Sanford Research as Program for the Midwest Initiative in Science Exploration (PROMISE) scholars and science educator fellows for 2013. The Sanford PROMISE

Scholars Program offers regional high school students the chance to complete research projects in mentor laboratories at Sanford Research during the summer between their junior and senior years. Students receive hands-on training in biomedical techniques and ethics, and develop projects that will impact research conducted in their mentor’s lab.

The Science Educator Research Fellowship Program supports heath research performed by middle and high school science teachers with a focus on pediatrics.

Two-time NFL pro-bowler and Super Bowl champion Joe Theismann and Olympic triathlete Hunter Kemper were added to the Hy-Vee/ Sanford Legends list of celebrity athletes for 2013.

Legends’ mission is to play a part in providing area youth with the tools and confidence to help them make good decisions. To provide youth with the opportunity to experience the positive influence of sports, Legends provides an annual event where youth can gather for free specialized training in multiple sports. Since 2005, Hy-Vee/Sanford Legends has raised $958,000, making 2013 the $1 million milestone year.

This years’ Legends events took place in June.

National healthcare network VHA Inc. gave Sanford Health a 2013 VHA Leadership Award for Supply Chain Management Excellence. The award honors the

organization for improving the efficiency of its supply processes and reducing costs to help ensure delivery of quality patient care. Of VHA’s national network of more than 1,350 not-for-profit health systems and 72,000 non-acute facilities, Sanford was one of only 11 to receive a Leadership Award for Supply Chain Management Excellence. The VHA Leadership Award for Supply Chain Management Excellence recognizes organizations that have implemented changes over the last 12 to 18 months to enhance their supply chain in sourcing and resource management processes, as well as distribution, logistics and inventory management.

MidwestMedicalEdition.com

The American Heart Association has recognized three Sanford Health medical centers for their commitment and success in implementing the highest standard of care for heart attack patients.

Sanford USD Medical Center in Sioux Falls received the American Heart Association’s Mission: Lifeline Gold Receiving Quality Achievement Award for the second year in a row. Sanford Medical Center Fargo received the Silver Quality Achievement Award, and Sanford Medical Center Bismarck received the Bronze Quality Achievement Award.

Siouxland Jason Anderson, DPM, joined Siouxland Podiatry Associates, PC March. A native

of Rock Valley, Iowa, Dr. Anderson graduated in the top of his class from Des Moines University, College of Podiatric Medicine and Surgery.

He completed a three-year surgical residency in Trauma and Reconstructive Foot and Ankle Surgery at Jewish and University of Louisville hospitals.

Dr. Anderson also completed a Fellowship in Plastic and Reconstructive Foot and Ankle surgery at the same institutions.

He has been in practice with Neurologic and Orthopaedic Specialists in Decatur, Illinois the last four years.

7

Medical A New Structure for Care Delivery According to the NCQA, the national certifying body for what they term Patient-Centered Medical Homes, a Medical Home is a primary care setting that “facilitates partnerships” between patients and providers and one in which “care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.”

8

Midwest Medical Edition

Homes What’s in it for Doctors?

It is not difficult to see how a model designed to systematically provide more comprehensive care to the sickest patients will benefit patients. But what does it mean for doctors across the Northern Plains, many of whom are just beginning to hear about or experience the system for themselves?

“Almost every physician initially reacts by saying ‘I am already doing this’,” says Markham.

“It is almost as if you are saying that they haven’t been doing something right. The problem is that it hasn’t been systematic. It may have been great care, but it hasn’t been proactive.”

And all indications are that it hasn’t been working for doctors either. Sixty-five percent of

Photo Courtesy Sanford

Or

as Laurie Jensen, Director of Clinic Operations at Sanford Luverne Clinic, itself a certified Medical Home for more than a year, explains it, “It is about achieving a team, including the patient, the doctor, the RN health coach, the family, etc., that works together to optimize care.”

“This is not a program, but a philosophy of how we manage care.”

Chad Markham, VP for Clinic and Network Development at UnityPoint St. Luke’s in Sioux City, puts it even more succinctly: “It’s about setting up a network of people to make sure that no one falls through the cracks.” UnityPoint St. Luke’s new Sunnybrook Medical Plaza in Morningside includes a primary care clinic designed – both physically and logistically – entirely around the Medical Home model of care coordination.

“We visited many other clinics that had be ‘retrofitted’ as Medical Homes and we knew that there were certain structural features that we wanted to bake into our project,” says Markham.

“One of them was a larger nurses’ station so that the physician can more easily sit with the nurses and discuss next steps for the patient, instead of just going directly back to his or her office.”

Patients at Sunnybrook will be risk stratified using population analytics and referred to a care coordinator for connection to additional services, as needed. Although any patient is eligible, the system will be most beneficial to patients with chronic and multiple medical issues. Markham says such a design allows physicians to see as many as 5 to 10 percent more patients “and still go home by 5”.

The medical home concept in action: Dietician Margaret Kuiper and Diabetes Educator Jamie Reisdorfer, RN, work with patient Jake Boomgaarden in Sanford Luverne’s Diabetes Education Center.

By Alex Strauss

July / August 2013

MidwestMedicalEdition.com

9

The biggest challenge has been “getting doctors to understand

Photo Courtesy UnityPoint-St. Luke’s.

how this is different from what they’re already doing.” — Terri Carlson, VP of Sanford Clinics

Family Physicians DJ Todt, MD, and James Webb, MD, stand in the construction site which will be their new professional home. St. Luke’s Sunnybrook Medical Plaza, which opens in August, features clinic space that has been specifically designed to facilitate the medical home approach to care delivery.

10

Photo Courtesy Sanford Health.

“What has been fun is when we have doctors who were not initially sending their patients to the health coach, come back and say ‘Wow! What have you done? I have been trying to get this patient to do this or that for years and they finally have!’ It increases physician satisfaction to see their patients doing well.”

Cost Savings Beyond boosting patient care and physician satisfaction, the other major aim of the Medical Home idea is cost savings. As more patients use Urgent Cares and Emergency Rooms as their source for primary care, costs are driven up, the system is bogged down, and underlying medical issues remain unaddressed. Systematic coordination of care, in contrast, saves money in both the short- and long-term.

“As we look at the future and at accountable care organizations, population health is becoming increasingly important,” says Amy Slevin, RN, Director of Clinical Program Development at Mercy Medical Center.

Mercy currently has five primary care clinics in the process of Medical Home development.

“We know that a healthy population uses less of the more costly healthcare things. So you want to keep your healthy patients as healthy as you can, and your chronically ill patients in the management category so that they

Photo courtesy UnityPoint-St. Luke’s

physicians are so frustrated with the current state of healthcare that they would retire tomorrow if given the chance. With physician burnout at an all-time high, local healthcare organizations are hoping that a system that removes some of the time pressure will help.

Under the Medical Home model, the most costly and time-consuming patients are funneled into a system to connect them with needed support services without clogging up the works or throwing off the schedule.

“I would see one of these patients with multiple medical problems show up on my schedule and think, ‘Oh my gosh. . . . This patient is scheduled for 15 minutes and they are going to take up an hour of my time!’,” says Tad Jacobs, MD, Chief Medical Officer

for Avera Health. “When you are chasing your schedule, it is hard to give the detail of care that you want to give. Often, after you see one of these complex patients – say, a diabetic – you would wonder, ‘Did they really get what I was telling them?’”

Avera’s answer is the Avera Coordinated Care Program being implemented in 6 regional hubs, including McGreevy Clinics in Sioux Falls, where the first patient was enrolled this spring. As with most Medical Home-like approaches, the system will focus first on the sickest patients, a task made more feasible – if not exactly easy – by electronic health records and registries.

“When we visited some other Medical Homes, we found that the health coach, or care coordinator, was often very overwhelmed with collecting this kind of data,” says Dave Flicek, Senior VP for Avera Medical Group. “So, in our model, we have included a documentation specialist whose job it is to go through the medical record and help support the nurse in coordinating care.”

“The biggest challenge has been getting doctors to understand how this is different from what they’re already doing,” says Terri Carlson, VP of Sanford Clinics, where the Sanford Medical Home model has been used in some form for 6 years. In the last 2 years, RN Health Coaches have been made available to all Sanford Clinics.

Artist’s rendering of the 86,000 UnityPoint St. Luke’s Sunnybrook Medical Plaza.

Midwest Medical Edition

Dave Hewett on Medical Homes

A Frontline to Prevention

By Dave Hewett, SDAHO don’t progress into the more expensive category.”

Although Slevin admits that health coaches and the extra time they spend with complex patients is not without cost – and it is a cost that, for now, is not directly reimbursable – she believes it is a cost that will be recouped over time.

“If we are managing these patients correctly according to the Medical Home concept, there is likely to be an increase in revenue in the form of more regular office visits, additional screening tests, certain lab work, etc.,” says Slevin. “But by making sure they get these relatively low-cost services when they need them, we hope to keep them out of the hospital and the emergency room, which are much more expensive.”

By focusing on a technique called motivational interviewing, health coaches or care coordinators, who are usually RNs, enlist the patient’s participation in health modifications such as lowering blood pressure, losing weight, addressing psychosocial issues or managing diabetes. Patients may be referred to dieticians, counselors or social workers, as needed.

Although the approach is currently focused on the sickest patients, most agree that the greatest benefits will be seen when the Medical Home idea is extended to all patients. Medicaid is already forcing the issue in many states with the establishment of the Health Home initiative for highutilization individuals. While it remains to be seen how many patients can feasibly receive care coordination under the current model, those involved in the experiment say the system is clearly here to stay.

“This is our new way of doing business,” says Dr. Jacobs. ■

Despite spending more than twice what

homes is to apply

most other industrialized nations spend on

them to those who

healthcare, the U.S. ranks 24th out of 30 such

suffer from multiple

nations in terms of life expectancy. A major

chronic conditions

reason for this startling fact is that we spend

and manage the care

only 3 percent of our healthcare dollars on

of those individuals in

preventing diseases (as opposed to treating

a

them), when 75 percent of our healthcare

manner. The care

costs are related to preventable conditions.

management fee is

(American Public Health Association Issue

appropriately high because managing the care

Brief June 2012)

for these individuals will be expensive. It’s also

more

efficient

How many years have we been talking

understandable that focusing on the chronically

about developing a medical model that focuses

ill will produce more savings and has the poten-

on keeping a person well instead of just treating

tial for generating greater savings. But in the

them when they are sick? Right — a long time.

long-term, getting healthy people into the medi-

For the past several years, the loose-knit model

cal home model may prove even more efficient

by which that goal is achieved at least in theory

– especially if the model can keep people from

has been the “medical home”.

acquiring a chronic condition in the first place.

The “Medical Home” is a concept that we all

The second barrier is the reimbursement

have become familiar with in a general sense but

model. Many medical home projects still main-

for several reasons just haven’t found the time or

tain a fee-for-service reimbursement system

the inclination to embrace it as the new direction

with a care management fee and quality indica-

for healthcare. One reason may be the traditions

tors that need to be met. They don’t include a

on which the country’s health system has been

broader capitation-type payment system or

built. Another is the way healthcare is paid for

some kind of reward-based system where both

primarily on a fee-for-service basis, which rewards

the payer and the provider share in measured

volume, not value. Yet another is a silo mentality

savings.

that excludes other considerations that promote

Finally, there continues to be a real discon-

health like what we eat, where we live, and how

nect between public health, human services,

we otherwise take care of ourselves.

and the healthcare community when trying to

Well, after years of talk, it now appears that the medical home model is actually being tested

coordinate the overall care and health status of the state’s population.

on a limited basis. In South Dakota, the Medicaid

Despite these barriers, medical homes are

program is in the final stages of implementing

healthcare’s future. And it will be the physicians

a “Health Home” model of care for nearly one-

who will lead this effort both in terms of pro-

third of those on the program. That is happening

moting the policy and implementing the model.

in other states and we see more health systems

But to make medical homes truly successful,

and payers.

there will have to be a reallocation of how

But the tests are just that – limited. And the

healthcare dollars are spent – because relying

real worth of medical homes may not be fully

on just 3% of healthcare resources to keep

demonstrated or appreciated for years to come.

people well won’t satisfy a new delivery model

Here is why: First, the current focus on medical

that truly rewards keeping people well.

■

“This is not a program,

but a philosophy of how we manage care.”

– Laurie Jensen, Director of Clinic Operations, Sanford Luverne Clinic

July / August 2013

MidwestMedicalEdition.com

11

IT in Your Office

What you need to know to be informed about your information management practices

retention

By Corey Steele, Systems Engineer

I

nfor mation Technology may be neither new nor exciting but it’s an area that virtually every business needs to pay attention to.

While HIPAA did much to raise the general awareness about information management, the regulations were broad and

storage. That is, we have all of the data in a single location. This is typically achieved in the form of a storage area network or network area storage — two deceptively similar terms that have significantly different capabilities and costs.

Once centralized, there are two challenges: keeping data centralized and properly “labeling” the data. Keeping data centralized is typically a training issue, i.e. teaching staff to store all their files on the centralized file server. Labeling, in this sense, means identifying what information is protected health information (patient records), and which information is otherwise sensitive (e.g. payroll, finances, etc.) and implementing the necessary controls to ensure the data is protected from unauthorized access.

non-specific. Consequently, information management in medical practices is often left to the IT department or outside consultants. So what do you need to know to be informed about your information management practices? Let’s try to answer that by walking through the data life-cycle after the data is created: storage, retention and destruction.

data storage

Data storage, from a regulatory perspective, typically requires some form of centralized

Retention has two aspects: the regulatory aspect and the practical aspect. With paper records, the physical bulk of old files was basis alone to purge them periodically, but with data there is no such physical bulk — those 1s and 0s that make up the file exist in microscopic spaces such that millions of files can exist on a drive no bigger than your thumb. So, why purge those old electronic files? Two reasons: cost and liability.

Keeping old and unnecessary files around means those files are included in your data backups, migrated from system to system,

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12

www.sdmgma.org Midwest Medical Edition

MED Quotes and contribute to the overall demands placed on your information management, all of which costs money. In addition to cost, the liability of keeping unnecessary files onhand is relevant; Is it worse to have a data loss scenario (i.e. loss or theft of your records) involving 1,000 active patients, or every patient ever treated in your facility?

destruction

Deleting data – whether part of an annual retention audit or because a storage system is being upgraded or replaced, or even just because a PC is being decommissioned – needs to be done correctly to prevent data from being left behind. The best approach is to contract a company that has the special equipment to destroy hard drives completely.

Also consider that office systems (e.g. PC’s) shouldn’t be given away or sold with their hard drive in place. These practices ensure that you and your patient information will be protected.

Corey Steele is a Systems Engineer at

“In the middle of difficulty lies opportunity.” — Albert Einstein

Seeking SDAHO Distinguished Service Award Nominations Every year the South Dakota Association of Healthcare Organizations recognizes one or more individuals for their exemplary services to health care through its Distinguished Service Awards. The selection process begins with nominations from you!

Please consider submitting nominations for individuals who have advanced the causes of health care delivery in South Dakota from these six fields:

v Distinguished Service Award – Trustee Service Award – Media Personality Distinguished v Distinguished

Service Award – State

Distinguished Service Award – State Official Distinguished v Legislator

Service Award – Health

v Care Professional v Distinguished Service Award – HealthCare Hero Some or all of these categories may be conferred at the SDAHO Convention’s Distinguished Service Awards Reception on Thursday, September 19, 2013. Nomination forms can be found on the SDAHO website.

EarthBend in Sioux Falls.

Time to Treat Toe-Walking Children’s Care will soon be offering a clinic for idiopathic toe walking (ITW) – led by Medical Director of Rehabilitation Services, Julie Johnson, MD, with specialists from the Children’s Care staff, including a physical therapist and an orthotist.

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July / August 2013

MidwestMedicalEdition.com

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13

Patient Engagement

It’s Personal

By Jane Schuster

T

he new era of healthcare

focuses on patient engagement as a way to reduce costs and improve outcomes. Practically everyone in the industry agrees that patient engagement is important, but there is no consistent definition.

A survey conducted by the National eHealth Collaborative last year revealed that some health leaders thought patient engagement meant using educational material and online resources to better understand their condition, while others believed it meant being comfortable enough to discuss questions and health issues with doctors face-to-face.

While patient engagement will continue to be difficult to define, the lack of consensus gives healthcare organizations flexibility to experiment with different approaches. Keep these things in mind as your organization seeks to improve patient engagement.

There is no one-size-fits-all approach to patient engagement. Proactive, personalized outreach is key. Healthy patients need to focus more on disease prevention and wellness, while those with chronic illness will need more intensive care management. The future is data analytics, which will help healthcare organizations identify high-risk patients who require more intervention.

Embrace EHR technology. Technology has empowered consumers in nearly every part of our lives—from online banking and bill paying to social networking and enter t ai n ment— a nd now it’s enabling us to become more active in our healthcare. Engaging patients in their healthcare is a central

14

tenet of Meaningful Use, also called the Electronic Health Records (EHR) Incentive Program. This policy aims to improve patients’ understanding of their health and related conditions so they can take a more active role in their healthcare. Experts say providers’ adoption of EHR is critical to transforming a healthcare system to one that focuses on outcomes rather than services.

Mobile health provides an incredible opportunity. A recent mHIMSS.org article says mobile health strategies will drive greater patient engagement and provider accountability— helping you r organization stay plugged into every patient need.

Consu mers are increasingly turning to apps on their smartphones to help them manage their diet and fitness, and even measure their

blood pressure. New mobile health monitoring devices are constantly being introduced to the market, giving organizations another opportunity to engage and empower their patients.

Patient engagement is not a new concept, but it’s certainly the buzz phrase of the healthcare industry. At the end of the day, the goal is to reduce costs while engaging consumers to proactively manage their care. ■ Jane Schuster is a marketing specialist at Cassling, a Midwest healthcare company that provides local imaging equipment sales and service, and marketing and professional services.

Midwest Medical Edition

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By Jayden Portice, Clinical Research Manager, Avera Research Institute

T h e A v e r a F a m i ly W e l l n e ss P r o g r a m

Strengthening Families, Shaping the Future

By Jayden Portice

Photos Courtesy Avera

M

ental health disorders that occur before the age of 6 can interfere with critical emotional, cognitive, and physical development, and can predict a lifetime of problems in school, at home, and in the community. Conventional treatment models have not proven effective in treating children at risk for developing behavioral issues, and despite all of the efforts and dollars spent, there remains a high incidence of children with mental health needs.

According to five years of outcome data, the Avera Family Wellness Program is having an impact by helping children of at-risk families experience greater success in school, especially in the areas of behavior and attendance.

“Our goal was to create positive

16

experiences for children at young ages, in order to prevent behavioral health conditions from developing in later childhood and early adulthood,” said Dr. Timothy Soundy, Avera psychiatrist and a developer of the Avera Family Wellness concept. “Our approach has resulted in documented success at school, and we know this also indicates other positive outcomes in homes in the community. We’re hoping that Avera’s model can become a leading model of care that may one day be replicated in other communities.”

Collaboration The Sioux Falls School District had noticed an increasing number of preschool students receiving out-of-school suspensions, mostly resulting from behavioral disruptions.

Equally concerning was the inability for these preschool children to maintain regular

school attendance or even to meet the expectations of “school readiness” by the time they entered kindergarten. The school district was becoming overwhelmed by the number of children struggling with emotional and behavioral disorders.

In the spring of 2008, Avera McKennan Hospital & University Health Center partnered with the Sioux Falls School District to determine a solution. The Avera Family Wellness Program (AFWP) was formed as a way to address the behavioral health needs of preschool students and their families.

AFWP reaches children enrolled in early childhood HeadStart and Title I programs at two elementary schools in Sioux Falls, providing Suzuki-like violin training for the child during the school day and supporting the family with wellness coordination.

Midwest Medical Edition

Photo Courtesy Averas

Violin Instruction Early music instruction has been shown to contribute to brain development as well as emotional and social growth. Using child-sized instruments and simple standing and holding techniques, the Suzuki-like violin lessons enables even prereaders to begin studying music. Lessons, provided by members of the South Dakota Symphony and local Suzuki violin instructors, begin in early childhood classes and continue into early elementary grades.

Family-Based Approach Rather than serving only the child, AFWP uniquely integrates family health coordination. Wellness coordinators establish close connections with families to positively influence and encourage better health and consistent parenting strategies.

For families struggling with behavioral issues, the coordinators guide them to appropriate services. The coordinators assist families in accessing child or adult therapies, child and adult psychiatry, and other behavioral health services.

Additionally, family health coordinators support families with needs other than mental health issues, such as referrals to child care, disability applications, diabetes education, travel assistance, vehicle access, support groups, GED application completion, hearing impaired services, housing concerns, budget planning, and other services to minimize stressors for the family.

Positive Outcomes The approach of treating the entire family has clearly had a positive impact. Based on standardized questionnaires from teachers at the beginning and end of the school year, children in the program showed significant reductions in total problem behaviors and aggressive behavior compared to children who had not receive AFWP services. Data from the school district indicate AFWP children also have reduced absenteeism and tardiness in kindergarten to grade three. In addition, discipline events were three times higher in the general population than with the AFWP children. ■

Wellness coordinator Julie Fieldsend, RN, works with an enrolled child and his family.

July / August 2013

A Less Invasive Approach for AAA at Avera Heart The Avera Heart Hospital is the first hospital in a five-state region to be certified by the FDA to offer a new modified procedure for repairing an abdominal aortic aneurysm (AAA).

Percutaneous endovascular aneurysm repair, or PEVAR, allows surgeons to place a stent graft without a major incision.

“Being able to perform the procedure using this percutaneous method reduces the incision required to place the device that excludes the aneurysm,” says J. Michael Bacharach, MD, who participated in clinical trials of the newly-approved technique along with colleague Tommy Reynolds, MD. “This allows for faster recovery and reduced potential for groin wound complications.”

During the PEVAR procedure, a small puncture incision is made in each leg artery. On one side, closure devices are placed before the endograft is delivered. After the endovascular repair, the closure device sutures are tied. A closure device is then also placed on the other side.

With standard stent graft AAA repair, a larger groin incision is made that requires a more comprehensive surgical repair. The PEVAR procedure was developed through collaboration between Endologix which manufactures an endoluminal stent graft and Abbott Vascular, which has developed a percutaneous non-surgical closure device. ■

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17

Three-in-One

Eye Center Opens in Sioux Falls

The new Vance Thompson Vision building in Sioux Falls will offer three

types of eye care in one location. A concept its designers says is the first-of-its-kind, the highly-visible 31,000 square foot, $6 million dollar facility on 57th Street is built around cataract and laser eye surgeries.

“For the last two decades, we have been improving the way laser technology works,” says Dr. Vance Thompson, whose practice has worked to keep pace with rapid changes in eye surgery, especially procedures designed to reduce dependence on glasses and contact lenses. LASIK (laser vision correction) procedures have been a cornerstone of the clinic, which now offers five different types of laser technology.

Previously located on the Sanford campus in Sioux Falls, the company has used its roomier setting to also open an adjacent surgery center. “The same laser technology we have been using to improve outcomes in LASIK surgery can now be applied to the most variable steps of the cataract surgery process,” says Dr. John Berdahl, referring to Refractive Laser Assisted Cataract Surgery (ReLACS), a new option for cataracts.

Finally, the new building also includes an on-site skin and laser center which specializes in removing extra skin around the eyes, either to improve vision or for aesthetic reasons.

The building was designed by the doctors in concert with Eye Care Specialty Hospital and design teams in Chicago and St. Louis.

It incorporates plenty of natural light and is designed to enhance both patient comfort and confidence.

“One of many things we’ve learned in the last two decades is that the number one reason people don’t have ocular surgery is fear,” says Dr. Thompson. “We’ve built the center from the ground up to reinforce the safety standards related to the surgeries we do.” Vance Thompson Vision physicians have performed more than 60,000 procedures and participated in close to 40 clinical trials. ■

18

UnityPoint Health–St. Luke’s Advancing Imaging Technology

UnityPoint Health—St. Luke’s in Sioux City has become the first Siouxland facility to begin using a Siemens Definition AS 64 CT scanner. The advanced new scanner will provide superior image detail and clarity and features unique Safire software designed to help reduce the amount of radiation exposure during an exam by up to 60%.

Engineered to accomodate patients of all ages and sizes, the new scanner also works faster, reducing the total time patients have to spend in the machine.

“Scanning patients more quickly is especially important when we have pediatric and critical care patients who may find it difficult to lie still for long periods of time,” says Dr. Dan Jensen, Director of St. Luke’s Radiology Department. “We are thrilled to offer technology that can reduce patients’ exam times while still providing exceptional image quality.”

The new CT scanner will be housed in a new space located near St. Luke’s Emergency Department, a location that will provide improved accessibility for both inpatients and outpatients at the hospital, says Jensen. St. Luke’s CT Department utilizes a team of BoardCertified Imaging Technologists and all exams are read on site by Board Certified Radiologists. ■

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Midwest Medical Edition

Endoscopic Vessel Harvesting Reduces Pain, Risk and Scarring There was time when many heart

bypass patients experienced more pain from the incision made to harvest a leg vein than from the heart surgery itself.

Traditionally, this vessel, which cannot be nicked or injured during harvesting, was removed through a long incision that extended from the ankle to the groin. In addition to a painful recovery and risk of healing problems, patients also ended up with a massive scar.

“It used to be that we would spend almost the entire post-operative visit looking at the incision in the leg, worrying about poor healing in diabetic patients (which make up a large portion of this patient population) or putting people on antibiotics,” says Sanford vascular surgeon Verlyn Nykamp, MD. Since October, however, Nykamp has been harvesting leg veins for bypass surgery through a much less invasive endoscopic procedure.

Using technology developed by Maquet, the surgeon makes a 1.5 cm incision just below the knee to insert an endoscope. The vein is then carefully removed through a second 3 to 4 cm incision in the groin.

Although the procedure was initially more time-consuming than the traditional method, after more than 200 procedures, Dr. Nykamp says he can now perform endoscopic vessel harvesting almost as quickly as the traditional method. Just as importantly, Dr. Nykamp says his patients who have had the procedure, which is now the standard of care in many parts of the country, report much less pain and no complications.

“There was a learning curve to this but now I would 100 times prefer to do it this way,” says Dr. Nykamp. Not only does endoscopic vessel harvesting reduce the risk of discomfort, healing problems, and infection, but, by doing away with the long incision, it also produces better cosmetic results. The procedure is appropriate for most heart patients. ■

MED Quotes “ It had long since come to my attention that people of accomplishment rarely sat back and let things happen to them. They went out and happened to things.” —Leonardo da Vinci

July / August 2013

MidwestMedicalEdition.com

19

Edith Sanford convenes National Thought Leaders Council The Edith Sanford Breast Cancer Foundation recently convened the first meeting of its National Thought Leaders Advisory Council, a think tank designed to help formulate fresh new strategies for building grassroots support.

“The Edith Sanford initiative was founded as a catalyst for transformational change in the way we think about and treat breast cancer,” said Kimberly Simpson, president of the Edith Sanford Breast Cancer Foundation. “Part of our success depends on going beyond the mainstream and leveraging the experience, connections and insights of creative, entrepreneurial thinkers from a wide variety of professional backgrounds.”

The council represents recognized leaders in areas including biotechnology, IT, healthcare, food, consumer goods, apparel, digital media, finance, and political

consulting. Each member was carefully selected to ensure a diversity of experience and perspective that the Foundation will draw on to help identify and maximize engagement, grassroots fundraising and major gift philanthropy opportunities.

“Edith Sanford stands out because it embraces innovation in everything from its mission to the way it does business,” said council member Ron McCray, a private investor and corporate director who has also served as chief administrative officer of Nike, Inc. and as chief legal officer of Kimberly-Clark Corporation. “Every for-profit business knows that a culture of creativity and innovation is the key to success, but it’s unique for a charitable nonprofit to be so nimble and forward thinking.”

In addition to McCray, the council boasts names such as Jan Fields, former president

of McDonald’s USA, LLC, who has been named to the Forbes list of “The World’s 100 Most Powerful Women.” “I am very excited about the bold new approach to breast cancer,” said Fields. “I think Edith Sanford is the answer to finally ending this devastating disease.”

Another leader on the council is Craig Arnold, president and CEO of Permara LLC. Arnold previously served as a director of the Bill and Melinda Gates Foundation, where he led initiatives to bring access to computers and the internet to small towns and large cities in the U.S., Canada, Mexico and Chile.

“I believe in Edith Sanford’s approach to ending breast cancer and raising the standard of care for women everywhere. I’m eager to contribute to the success of its mission,” said Arnold. ■

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Marvin Smoot, M.B.A Clinic Manager, Plastic Surgery Associates of South Dakota

20

Midwest Medical Edition

Choose to Lead From Where You Are

By Martha Helland, MBA, PhD

D

uring the first evening

of the MBA Healthcare class on leadership and ethical management at the University of Sioux Falls, I ask everyone if they are currently in a leadership role. Invariably those who directly manage others answer yes, and those who do not answer no.

The responses to my question are not surprising. We often think of leaders in organizations as the top executives, the senior administrators or managers and team leaders who supervise others. These are the people who develop and articulate a mission, determine how to move an organization forward, take charge when troubled waters have to be navigated, and ensure that goals are set and inspire the rest of us to meet them. We see leadership as something others provide or should provide because it is their job. How many times have you heard discussions where someone says, “If only there was better leadership around here”?

Many of us simply don’t understand that leadership is bigger than a person’s job. Leadership can come to life at any time, in any place, because leadership is a social influence process. It can and does occur between people, regardless of their positions.

Sometimes, a team member may inspire another or a staff person may encourage a manager or a nurse might support a physician by making suggestions about working with a particularly troubling patient. None of these people report to each other but each one is engaging in leadership. Attending to the needs of others with encouragement and support and coaching others to be the best they can be are acts of leadership. Moments requiring an act of leadership arise throughout each day and each of us is capable of providing that leadership.

July / August 2013

Early in my career, I did not understand this. Like many others, I defined leadership as a position in an organization that made sure things got done. However, after many years of trial and error as a leader, I came to see leadership as something quite different. I came to see leadership as serving the needs of those around me, including those who may not report directly to me. I strive to make sure my actions build others up, promote wellbeing and foster a sense of community. It does not take an official title to live this way.

Leading by choice begins with having a sense of purpose. Then, it takes practice and reflection. Think about these questions: v What is my purpose today? v How will I live out my purpose today?

Make-A-Wish Appoints New Medical Advisor Black Hills pediatrician Dr. Donald E. Oliver has joined Make-A-Wish South Dakota as a new volunteer medical advisor.

In this role, Dr. Oliver will help educate others about the mission of Make-A-Wish, what qualifies a child for a wish, and the referral process.

Dr. Oliver is a board-certified pediatrician with a special interest in pediatric intensive care. He is a clinical professor with the USD Sanford School of Medicine and a fellow of the American Academy of Pediatrics. Dr. Oliver is also a former Chief of Staff at Rapid City Regional Hospital.

He received his MD at Tufts University School of Medicine in Boston and completed a residency at William Beaumont Army Medical Center in El Paso. As one of the founders of Black Hills Pediatrics and Neonatology, LLP, Dr. Oliver has been serving the needs of children and youth in the Rapid City area for more than 30 years. Dr. Oliver joins current Make-A-Wish medical advisors Dr. James Wallace with Sanford of Sioux Falls and Dr. Clark Likness with the Brown Clinic in Watertown. ■

v In living out my purpose today who will I impact? v W hat will my impact look and feel like to others?

Do your answers reflect who you want to be and how you want others to see you as a professional? If not, then you may have to change your purpose and your behavior. If yes, then forge ahead and, when a moment calls for leadership, provide it. It does not matter whether or not people report to you.

It does not matter what job you have or what level you are. Choose to lead from where you find yourself today. ■ Martha Helland is an Assistant Professor of Business Administration who teaches in the University of Sioux Falls Healthcare MBA Program.

MidwestMedicalEdition.com

21

The Nurses’ Station

Leigh Named Clinical Nurse Manager of Operating Services at Mercy

Nursing News from Around the Region

April Leigh has been appointed Clinical Nurse Manager of Operating Room Services at Mercy

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

Medical Center. Leigh has been at Mercy for six years. She has served as a staff nurse as well as Clinical Educator in the OR. She has also served as the Nurse Reviewer for the department and as past coordinator for the da Vinci service line.

Leigh has been instrumental in participating and facilitating many projects in OR, including the development of the OR nursing education program. She holds a Bachelor’s Degree in Nursing from Briar Cliff University.

he Guiding Star–Mentor Award ➊ TDonna Johnson, RN, Intensive Care for 19 years

he Gold Star–Service Award T ➋ Marty Bauman, CRN, Cardiac Intervention Unit for 6 years

he Shining Star–Community Award ➌ TJennifer Murray, RN, Trauma Services for 4 years

➊

➋

➌

➍

he Rising Star–Novice Award ➍ TRon “JR” Lavielle, RN, ICU for 7 months he Super Star–Expert Award ➎ TLaura Fleischhacker, CRN, Neonatal ICU for 21 years

he Blazing Star–Advanced Practice ➏ TNurse Award Christine Rogers, NP, Neonatal ICU for 9 years

➎

➏

➐

➑

he Supportive Star Award ➐ TMarguerite Schroeder, Patient Care Technician, Ortho/Neuro Surgery for 11 years.

Nancy Fahrenwald has been hired as the new dean of the SDSU College of Nursing. Fahrenwald has been at the University since 1995 and has been Associate Dean for Research in the College of Nursing since 2009.

22

he Luminary Nurse Advocate Award, ➑ Tintended for a non-nursing employee, was awarded to Marcia Beshara, MD, an OB/GYN physician.

Midwest Medical Edition

DAISY Award Winner Described as Kind and Patient

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

Joan Kirchhevel received the May DAISY Award for

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

Extraordinary Nurses at Rapid City Regional Hospital (RCRH). She has been a Registered Nurse in the Progressive Care Unit for six years.

Kirchhevel was nominated for the award by a patient who said irchhevel was especially kind and patient beyond the normal call of duty. “Her kindness, compassion and encouragement went a long way to help me stabilize and cooperate with treatments I often didn’t understand and/or feared,” the patient said.

Medicine is feeling the effects of regulatory and legislative changes, increasing risk, and profitability demands—all contributing to an atmosphere of uncertainty and lack of control.

What we do control as physicians: our choice of a liability partner.

Barb Thaler, LPN

Brenda Stokke, RN

I selected ProAssurance because they stand behind my good medicine. In spite of the maelstrom of change, I am protected, respected, and heard.

Patti Hanisch, RN

19. Nurses Station-Stokke.jpg

VA Nurses Recognized for Excellence

19. Nurses Station-Thaler.jpg

I believe in fair treatment—and I get it.

The Sioux Falls VA (Department of Veterans Affairs) The Sioux Falls VA (Department of Veterans Affairs) Health Care System announces the local recipients of the Secretary of VA’s Nursing Excellence Awards. These nurses were recently recognized for their compassion and dedication to their profession: Barb Thaler, LPN, Brenda Stokke, RN and Patti Hanisch, RN

July / August 2013

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

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MidwestMedicalEdition.com

23

Off Hours

Passionate Pursuits Outside the Office

BHUC “Commit to be Fit” Team members share their enthusiasm toward the Deadwood Mickelson Trail Marathon

Running Builds “Commit to be Fit”

Team Spirit Black Hills Surgical Hospital and Black Hills Urgent Care Employees Rally Around Annual Deadwood Mickelson Trail Marathon

O

n a cold day in February,

the idea of running isn’t ordinarily top-of-mind. But that’s when a committee of 20 die-hard enthusiasts at Black Hills Surgical Hospital and Black Hills Urgent Care began to plan for employee involvement in the annual Deadwood Mickelson Trail Marathon held on June 2nd. The event routinely attracts thousands of experienced runners from across the country. This year, more than 3,300 registered, with 325

participating in the full marathon.

The BHSH committee chose the theme “Commit to be Fit” to rally employees around the event and to promote overall health and wellness. Thanks to their enthusiasm and encouragement, 100 BHSH employees agreed to participate in the marathon in some way. Eighty employees chose to run – most of them in the 13.1 mile half-marathon – and another 20 turned out to volunteer. Everyone was proudly sporting matching neon-green team t-shirts.

BHUC Organizer Greg Loos crosses Marathon finish line.

24

Midwest Medical Edition

MED Quotes “Remember that not getting what you want is

We’ll take care of your business while you take care of your patients.

sometimes a wonderful stroke of luck.”

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A few of the BHUC runners and volunteers

As a corporate sponsor of the marathon, Black Hills Urgent Care staffed a “Hydration Station”, where employees and helpers distributed nearly 4,000 bottles of water to grateful runners as they ended the race. Other BHSH/BHUC volunteers served as cheerleaders along the race route. One employee, BHSH Chief Customer officer, Greg Loos, ran the 26.2 mile course in 3 hours and 18 minutes, the fastest time in his age division. An Indiana native won this year’s marathon with a total time of 2 hours, 47 minutes, 49 seconds.

Among the other running aficionados taking part in the race was BHSH surgeon Dr. Lew Papendick, with Black Hills Orthopedic and Spine Center in Rapid City. Trained in Sports Medicine and Arthroscopic Surgery, the South Dakota native and his family are self-proclaimed “sports fanatics” who take full advantage of the region’s abundant outdoor opportunities, including hunting and fly-fishing as well as running and bike trails. In May, Dr. Papendick was inducted into the Rapid City Sports Hall of Fame in a ceremony during which he was hailed as the “Father of Sports Medicine in the Black Hills.”

The 26.2 mile Deadwood Mickelson Trail Marathon course originates in Rochford, SD, a picturesque spot next to Rapid Creek in the heart of the Black Hills. From there, the course winds its way on a gentle – but relentless – uphill grade for the first 16 miles. That vertical climb of about 1,000 feet is part of the physical demand of the marathon. Beyond the Dumont trailhead, the Mickelson Trail reaches its highest point – nearly 6,000 feet – and runners can really feel the effects of lower oxygen levels at that elevation. Fortunately, the course eventually levels off and goes downhill for the remaining distance to Deadwood. The race is critically acclaimed and sanctioned by numerous national running organizations. ■

July / August 2013

Sioux Falls, Huron & Miller, South Dakota (605) 853-2786 • dt-trak.com

Please call us anytime at (605) 853-2786 to schedule a free consultation.

South Dakota is ranked

top in the nation Our South Dakota trust services department is equipped to provide trust administration for clients to take advantage of South Dakota flexible trust drafting, income tax and asset protection laws. We work with the client’s choice of advisors.

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5032 S. Bur Oak Place, Suite 131 Sioux Falls, SD 57108 BankersTrust.com | (605) 338-5033

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The Estate Tax is Permanent . . . Right?

T

By Alice Rokahr, JD he concerns regarding

any decrease in the federal estate and gift tax exemptions were alleviated with the passage of the Taxpayer Relief Act of 2012 (ATRA) which was signed into law on January 2nd of this year. Although the tax rates for those whose estates are higher for those with estates greater than five million dollars, the estate tax is now permanent, right? If so, why are estate planning attorneys still urging their wealthy clients, including those with estates of less than five million dollars, to estate plan without further procrastination. What are their concerns and is it important enough to heed their advice?

Although ATRA appears to make the estate tax and gift law permanent, it may be prudent not to rely too heavily on permanency since Congress is currently facing some serious budget shortfall concerns in its requirement to submit a balanced budget and Congress must also address the ever

increasing national debt ceiling in a month.

As these issues are debated on Capitol Hill the concern of estate planning attorneys stems from President Obama’s budget proposal for 2013. This proposal has several aspects that could greatly impact the future of estate planning.

South Dakota, like several other states, repealed the rule that restricted the duration of a trust to approximately 90 years. Currently, by placing asset in a trust that has an unlimited duration, the assets will pass from generation to generation without the imposition of any further gift, estate or generation-skipping transfer taxes. The President’s proposal would trigger an additional accumulation tax on all of the assets in the trust every 90 years.

Another significant proposal is a change in the way an intentionally defective grantor trust is taxed. By including certain language in a trust, it is considered ‘defective’ by the IRS which means the Settlor of the trust pays the federal income tax on the assets in the

irrevocable trust even though the trust assets are not includable in the Settlor's estate for estate tax purposes at death. This favorable tax interpretation has been used for years to allow the trust assets to grow without being diluted by taxes and has the effect of further diluting that part of the Settlor’s assets subject to tax at death. It is also desirable because the tax rate for an individual is often much less than the rate of tax applied to a trust.

Many wealthy clients have used this strategy to avoid the 39% tax rate on income generated within trusts.

Valuation Discounts for the transfer of a minority interest is another tax strategy used by people with family businesses that the Obama proposal seeks to end. For families who want to leverage their gift and shift wealth to a lower generation, the use of discounts has been a valuable tool. Under the President’s proposal, family controlled entities would no longer be eligible for discounts.

If passed, this change would increase the gift tax value on a transfer of a closely held business and thereby reduce the current benefits associated with this plan. It may also mean that families are less willing to structure succession plans because there is no tax saving to do so. The idea of saving taxes has worked as a wonderful motivator.

The bottom line is that estate planning professionals continue to urge their clients to be proactive in estate planning because any legislative change will most likely happen fairly quickly and will apply to all plans on a prospective basis. Only those plans put into place before any law is passed would be exempt from the new rules. By taking actions now, the wealthy client can preserve their wealth for future generations. Betting that the current tax is permanent is a risk you can ill afford. ■ Alice Rokahr is the Wealth Planning Officer at Bankers Trust Company of South Dakota.

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Midwest Medical Edition

In Review What You’re Reading, Watching, Hearing

By Victoria Sweet

God’s Hotel

A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine Reviewed by Dr. Patty Peters

G

od’s Hotel by Victoria Sweet is a physician’s own account of the 20 years she spent practicing in San Francisco’s lower-tech but human-paced Luna Honda Hospital, the last almshouse in the country and a descendant of the HotelDieu (God’s hotel) that cared for the sick in the Middle Ages. In a May, 2012 review, the New York Times called the book a “transcendent testament to health care past” and enthused that its “compulsively readable chapters go down like restorative sips of cool water, and its hard-core subversion cheers like a shot of gin”. Sioux Falls Family Doctor Patty Peters, MD, recently read the book and was eager to share her impressions with MED.

MED: Where did you first hear about God’s Hotel and what prompted you to read it?

Dr. P: It was chosen by the Friends of Augustana as one of the books they would read and discuss and the description was very interesting to me. There is so much here – history, politics, philosophy, medicine – that I knew it would be a good one for discussion. I actually finished reading it while I was at the National Congress of the Supportive Care Coalition, an organization that promotes palliative care. This book has a lot to say about meeting people where they are in their lives and meeting their needs and I ended up telling a lot of people about it at the conference.

MED: What did you find particularly enjoyable about the book?

July / August 2013

Dr. P:

It’s really a very engaging book, and not just for physicians. But, because I am a doctor, I think it was even easier for me to identify with the author. Like any of us, she has seen changes in medicine driven by government, community affairs, internal politics, etc. But a lot of what made the care excellent at her hospital was that, in many ways, it was practiced in a way that has largely disappeared. The author talks about the luxury of being able to go into the wards and see these people interacting and their lives unfolding over days and weeks. This level of personal contact and personal understanding was what enabled her to give better care. Most of us are never able to spend an hour or two with a patient, so it’s fascinating to see how this institution made it work. And it is a reminder how valuable it is to really be with patients in order to understand their issues, their family problems, and even the disease. It’s the whole ‘Tincture of Time’ idea. We don’t always have a pill or a surgery that is going to fix somebody in a week.

Sometimes we have to let nature take its course and do the healing.

MED: What is the ‘heart of medicine’, according to Dr. Sweet?

Do you agree?

Dr. P: The heart of medicine that she is talking about is the connection that you have with your patients that can only come from taking the time to listen and understand their story. Giving people time is key, time to talk and time to heal. This is something we tend to lose sight of, but yes, I agree this is the true heart. But the book is really about so much more. So many things are intertwined

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in it – including information on her study of the German nun who became something of a healthcare guru, Hildegard of Bingen. I would highly recommend this book to anyone with an interest in medicine, history, philosophy or even just human relationships.

It was fantastic. ■

!

Write toediaurevisew?

am Do you have ? m, or ar ticle fil , ok bo A opinion an t ou ab How t event? on a curren us at: to e Writ on.com tMedicalEditi es w id M @ Alex

27

Grape Expectations

The Wines of Summer

By Heather Taylor Boysen

S

ummer is finally here!

With the increase in temperature, daylight hours, and sunshine, our wine drinking habits can change tremendously. We spend more time outdoors and hopefully, more time in front of the grill and dining alfresco.

The last thing anyone wants to drink while sitting outside on a hot summer day is a big heavy red wine, but grilled meats typically call for a pretty substantial wine.

So what do you do? I have a few wines that I love to pair with grilled foods, are not Cabernets, and will still hold up to beef.

One of my favorites is the Marqués de Griñón Caliza from Spain. A blend of 65% Syrah and 35% Petit Verdot, this wine is beautifully full-bodied and silky with refreshing acidity and flavors. Syrah is fantastic with any kind of grilled meat and the Petit gives a great fruit quality to the wine that isn’t flabby or overdone. Aged Manchego cheese as a snack before dinner would also work with this wine.

The Argyle Pinot Noir from Willamette Valley is a perfect wine with grilled salmon.

I have a tendency to lean towards Oregon Pinot for a little bit of a smokier and earthier flavor that I believe pairs well with grilled products. The Argyle is “double-macerated” on grape skins, once before fermentation and then another after fermentation to extract

28

flavor and texture. This is a pinot that can also hold up to the delicate flavors of a beef or pork tenderloin.

I love Chateau de La Chaize Brouilly with burgers and seasoned chicken. Château de la Chaize is one of the oldest, most historic estates in Burgundy's Beaujolais region. Château de la Chaize is located in the Brouilly appellation, the largest of the Beaujolais Crus, where the predominant grape planted is Gamay. On this estate, 50% of vines are older than 50 years, some as much as 75 years.

This is NOT Beaujolais Nouveux! It is deep and rich without being overwhelming and is lovely with a slight bit of refrigeration.

In fact, please consider putting your reds in the refrigerator for a little bit before serving especially in the summer. The wine will warm up quickly in the glass while outside and, if served too warm, the depth of flavor will be hidden. We always put a cold pack around the bottles of red if we bring them outside so we don’t end up drinking mulled wine!

In the summer, I want dry and refreshing whites. I also love whites that will go with just about anything, from watermelon to a Caprese salad to anything seafood or fish.

We recently had Principessa Gavia Gavi at a wine tasting and immediately recognized this as one of my summer whites. Made exclusively from the Cortese grape, Gavi was Italy’s first white wine to gain international repute and is still one of their top ranking wines today. It is bone dry, flinty and crisp with a bracing acidity and is ideal with seafood, chicken, or veal.

Another new wine in my arsenal is Airén from Bodega Latúe. Grown almost exclusively in Spain, Airen is the actual grape and is a bright yellow color with intense aromas

of white flower, green apple, and fresh citrus.

It is a real pleasure for all your summer meals or just by itself. Just a bit of fun trivia: this grape is also used in raisin and brandy production.

My summer white wine list would not be complete without a Sauvignon Blanc.

Depending on which geographic area from which the wine hails, it can be as citrusy as a grapefruit, herb like fresh mown grass or austere with tiny hints of lemon citrus.

Regardless, this is a great wine for everything but I love it with grilled chicken, fish or seafood that has any hint of a citrus marinade.

Currently my favorite is Mulderbosch Sauvignon Blanc from South Africa. I’ve served it with goat cheese, asparagus, mussels and shrimp.

I hope I’ve given you some great ideas for your summer wine list. Happy grilling and swilling! ■

Midwest Medical Edition

Learning Opportunities August • September • October August 21 – 23

SDMGMA Spring Conference

Information and Registration: www.sdmgma.org

September 9 – 12 8:00 am – 4:00 pm

Sanford Perinatal Nurse Fellowship 2013

Location: Cedar Shore Resort, Chamberlain

Location: Sanford USD Medical Center

Information: amy.l.johnson2@sanfordhealth.org, 328-7140

September 13 8:00 am – 4:00 pm

Diabetes Care Conference Location: Sanford Center, Sioux Falls

Information: Rhonda.jensen@sanfordhealth.org Registration: www.sanfordhealth.org

September 18 – 20

SDAHO Annual Convention

Location: Sioux Falls Convention Center Information: www.sdaho.org, 605-361-2281

September 27 - 28 Avera Cancer Institute 14th Annual Oncology Symposium Location: Prairie Center 8:00 am – 4:30 pm, 8:00 am – 12:30 pm Information: mckeducation@avera.org Registration: 322-8950, www.Avera.org/conferences

October 4 8:00 am – 4:15 pm

2013 Avera Women’s Health Conference Location: Prairie Center, Sr. Colman Room

Information: mckeducation@avera.org Registration: 322-8950, www.Avera.org/conferences

Note: Many of these Learning Opportunities offer CME credits to providers. Check with the individual conference coordinators to determine if credits are offered.

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.

The fertility consult that could change everything

for your patients As a health care provider, you know that fertility issues can be devastating for families. Sanford Health Fertility and Reproductive Medicine is proud to introduce Tiffany Von Wald, MD, the newest addition to its renowned team of fertility specialists.

Dr. Von Wald, with more than six years of experience in fertility care, joins Dr. Keith Hansen and is ready to partner in caring for your patients who want to grow their families.

Our extensive team also includes: • Complete lab staff including the Lab Director John Brannian, PhD, and Embryologists • Certified nurse practitioners • Mental health specialist • Genetic counselor • Fertility coordinators • Nursing staff • Financial representative

Call Tiffany Von Wald, MD at (605) 328-8800 or email womens-sf@sanfordhealth.org to schedule a consultation for your patient.

500-55000-0836 6/13