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JUNE 2015 Vol. 6 No. 4


N EPAL to Rapid City. . . and Back CAN YOU SPOT

Drug-Seeking Behavior?

Planning for a

Tech Disaster

Intergrative Therapies



One Number Accesses Our Pediatric Surgical Specialists, Any Problem, Anytime.


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

Orthopedics Pulmonology Gastroenterology & GI Surgery Cardiology & Heart Surgery

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4/30/15 1:59 PM




N EPAL to Rapid City

VOLUME 6, NO. 4 ■ J U N E 2015

4 |

. . . and

JUN E 2015


Vol. 6 No. 4

5 |  MED on the Web

By Alex Strauss

Articles and Information available exclusively on the MED Website

8 |

N  ews & Notes

The Black Hills of South Dakota are a long way from the mountains of Nepal. But for the 12 Nepali doctors who work at Rapid City Regional Hospital, the area has come to feel almost like home. Now, in the wake of Nepal’s devastating earthquake on April 25th, some of them are making the long journey back again to help their homeland recover.

New doctors & facilities, awards, renovations, and other news from around the region

28 |

The Nurses Station

Best states for nurses, an historic gradation, honors for nursing leaders

31 |  Learning Opportunities A Spring full of Conferences, Events, and CME Courses


PACLity and Back E N to Rapid T CAN YOU SPO avior ing Beh




a Planning for r Tech Disaste

Intergrative Therapies




6 |  Surviving a HIPAA Audit


■ By Marie Ruettgers A step by step protocol for weathering a HIPAA audit.


21 |  Prairie Lakes Healthcare Now Using

New Heart Failure Monitoring Solution

22 |  Functional Job Descriptions

24 |  New Marfan Syndrome Clinic in Omaha


Raising Awareness and Saving Lives

25 |  Understanding the Physician Sunshine Act

Sanford/IBM Partnership will Advance Cancer Genomics

Planning for a Tech Disaster ■ By Jill Heyden

diversion in the Emergency Department

26 |  Palliative Care Helps Fill Service Gap for the Chronically Ill 29 |

WANT vs. NEED 20  Recognizing drug

■ By Heather Springer How will new rules about public disclosure impact your business?

Avera’s Coordinated Care Model Earns National Recognition

Integrative Health Therapies at the Sioux Falls VA

■ By Shirley Redmond The VA’s new concentration on self-care aims to empower veterans.

■ By Kelly Marshall How functional job descriptions help keep employers on the cutting edge and out of court

27 |


ON THE COVER: Rapid City Regional Hospital Hospitalists Shailesh Thapa, MD, left, and Kanchan

Karki, MD, right, are among 12 Nepali physicians employed by Regional Health who were impacted by the recent earthquake in Nepal. Both physicians have family in Kathmandu who were not injured. Dr. Thapa shows photos of he and his wife. Dr. Thapa’s wife and young son were visiting family during the earthquake and stayed in a tent on the outskirts of Kathmandu following the earthquake. Dr. Karki’s mother, in the photo she is holding, resides in Kathmandu.

What you need to know to protect yourself and your patients from drug-seeking behavior. ■ By Trish Lugtu

On the


From Us to You Staying in Touch with MED


T HAS BEEN A BUSY SPRING GROWING SEASON for us here at MED. We have travelled the region connecting with our new and long-time sponsors and contributors and creating new opportunities to help you promote your business and grow your practice. (See photos below) But first… This issue of MED is jam-packed with content we hope you’ll find interesting, informative, and valuable. In our cover story, the surprising Rapid City/Nepal connection and how it is helping that country recover from disaster. Plus… From writing legally-sound job descriptions, to facing a tech disaster or a HIPAA audit, to understanding the Physician Sunshine Act, our team of expert local contributors have you covered. You’ll also find all the medical community news in these pages. Don’t forget that you can stay on top of the news between issues of MED by visiting us online. Sign up for MED’s email list at and you’ll also be the first to know when the newest digital issue is available. And speaking of the MED website, we are excited to now offer a limited number of site sponsorship opportunities. This high-profile opportunity gives premium advertisers the chance to not only align more fully with MED’s mission to support and celebrate healthcare professionals, but also to enhance their own digital presence with links, exclusive content and more. Contact us at to learn more. In the meantime, pour yourself a lemonade and enjoy this month’s issue. Cheers, —Steff and Alex

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota






PHOTOGRAPHER studiofotografie



Trish Lugtu Kelly Marshall Shirley Redmond Marie Ruettgers Heather Springer

STAFF WRITERS Liz Boyd Caroline Chenault John Knies

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

At the Em Be Tribute to Women ce lebration in Sioux Falls . MED ’s Stef fanie Liston-Ho ltrop was among 93 area b usiness p eople recognized for outsta nding achievem ent.

At the South Dakota Medical Group Management Association meeting in Deadwood. Steff and Alex Strauss in Kure Beach, NC for the annual MED brainstorming retreat.


©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 alex@midwestmedicaledition. com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

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Here are some of the new articles

available only online… New Urgent Care for Siouxland A new orthopaedic urgent care facility is opening in Dakota Dunes.

Video Visits Get National Attention Sanford Health’s effort to connect providers with patients using video technology has earned the health system a place on InformationWeek’s Elite 100 List.

Making Credentialing Easier We have expert tips to help make this major undertaking a little easier.

High Tech Wheelchairs in Sioux City See the advanced new wheelchair technology made possible by the Mercy Foundation.

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

ONLY ON OUR WEBSITE! ◆N  EW! SITE SPONSOR OPPORTUNITY – MED has a limited number of site sponsorship opportunities for print advertisers. Includes a high profile site presence, opportunities for sponsored online content, and more. Only ten spots available. Contact us at to learn more.

◆ P ROMOTE YOUR BUSINESS WITH A FREE OR PREMIUM BUSINESS DIRECTORY LISTING – List your business with links, contact information and maps for free on MED’s growing website. Upgrade to an eye-catching premium listing for a nominal fee.

◆ S EARCHABLE ARTICLE ARCHIVE – It’s easy to reference something you’ve read in MED. Search hundreds of past articles, including many that never appeared in print, by topic, date, and more – right from the MED homepage.


Surviving a


By Marie Ruettgers



and Human Services, Office of Civil Rights (“OCR”) will soon issue HIPAA audit notices to a small number of both covered entities and business associates who handle protected health information. To paraphrase Paul Revere, “The audits are coming, the audits are coming!” The first step to surviving a HIPAA audit is, obviously, advance preparation.

THE AUDIT PROCESS Phase 2 of OCR’s Audit Program was scheduled to start in the fall of 2014 and run through June 2015, but has been delayed and is expected to start as early as the fall of 2015. Audits will be desk reviews using the OCR’s preparation protocol, found at enforcement/audit/protocol.html. Use this as an outline to help prepare for an audit. Both covered entities and business associates are subject to audits. A covered entity or business associate that receives an audit notice will have just two weeks to respond with the documentation requested. With only two weeks to gather and submit the requested information, the time to prepare for an audit is not when the audit notification arrives. How should you start preparations? Start with the OCR’s preparation protocol and organize your preparation into three key areas: Security, Privacy and Breach.



The Security module has at its primary focuses protected health information (PHI) contained in Electronic Medical Records (EMR), and measures that must be taken to ensure the confidentiality, integrity and security of EMRs. OCR provides useful checklists for Security that correlate to the three subcategories at hipaa/documents/IHS_HIPAA_Security_ Checklist.pdf.

The Privacy module audit procedure will focus on the protection of medical records and other PHI, including:

Start with the following steps, and work through the audit protocol ●C  onfirm your organization has

recently completed a Risk Assessment of potential security risks and vulnerabilities. ●C  onfirm that the action items identified

in the Risk Assessment either have been completed or are on a reasonable timeline to achieve completion. ●C  onfirm an IT asset inventory system

is in place and up to date, including all BYODs. ●C  onfirm a facility security plan has

been adopted and is in place for each physical location with access to PHI. ● Review the security plan to identify 

gaps in physical security plans, disaster recovery plans, as well as emergency access procedures. ●E  nsure all staff is routinely trained on

policies relevant to their positions.

1. Notice of privacy practices for PHI,

2. Rights to request privacy protection for PHI,

3. Access of individuals to PHI, 4. Administrative requirements, 5. Uses and disclosures of PHI, 6. Amendment of PHI, and 7. Accounting of disclosures.

Start with the following common deficits identified in Phase 1 audits and work through the protocol: ● E  nsure a complaint Notice of Privacy

Practices is in place, and conduct periodic reviews to confirm employees are operating consistently with the stated notice. ●C  onfirm a complete listing of Business

Associates exists and that each has an Agreement that limits the use and disclosure of PHI to that allowed by the standards and for specified purposes within those standards. ●K  now and understand when the

use of a consent versus a specific authorization is required, and document policies that indicate appropriate use. Marie Ruettgers is Managing Attorney at Goosmann Law Firm.

To read Ruettgers’ advice for the third and final area of preparation, “Breach”, see the full version of this article on our website.


Midwest Medical Edition

Beckenhauer Construction has been providing high quality construction service to its clients for 137 years and counting. Beckenhauer Construction is a family owned general contracting firm specializing in healthcare construction and is now being directed by the fifth generation of family ownership. Safety of the staff, the patients, visitors, and crews is always at the top of our list to control. We do so by continual training, monitoring, providing the best of equipment to assist us, and constant communication with the client so they are awary of our every move. We go above and beyond the industry standard requirements when it comes to protecting employees, client staff, patients, and visitors. If you are not already one of Beckenhauer Construction’s clients we urge you to visit with any of our past or current clients to see what they have to say about doing business “The Beckenhauer Way”.

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA

Avera Medical Group Kennebec Area Clinic is now a Federally Qualified Health Center. Created

in 1991 under federal law, FQHCs are “safety net” healthcare providers that charge for services on a sliding-fee scale based on family income and size, and provide services to all regardless of their ability to pay or health insurance status. The clinic is part of a collaborative effort between Rural Health Care, Inc. and Avera which began with the Dakota Family Medical Center in Chamberlain, SD. Jeanette Pederson, OT, Occupational Therapist at Avera McKennan Hospital & University Health Center,

has been named USD Occupational Therapy Fieldwork Clinical Educator of the Year. Pederson has been an occupational therapist at Avera McKennan for 20 years. She graduated from North Dakota State University with a degree in psychology, and from the University of North Dakota with a degree in Occupational Therapy. She works in acute care and provides staff training for the electronic medical record system.


Avera Prince of Peace Retirement Community in Sioux Falls celebrated the grand opening of its new addition with a public open house on May 17th. The

two-story, 117,000-square-foot addition is the largest long-term care construction project in the history of South Dakota. It houses 90 beds – 64 in long-term care, 26 in rehabilitation, and 20 additional assisted living suites. Avera Prince of Peace also has 32 existing assisted living apartments as well as independent living apartments. The rest of the existing building will be repurposed. Advanced Physical Therapy has joined Avera Queen of Peace Hospital in Mitchell, SD.

The clinic will continue to be located at 409 S. Ohlman St. in Mitchell. Jeff Lee, MPT, ATC, is a licensed physical therapist and certified athletic trainer, and has worked in both hospital and outpatient clinical settings. He is a member of the American Physical Therapy Association, the South Dakota Physical Therapy Association, the National Athletic Trainers’ Association and the National Strength and Conditioning Association and has been practicing physical therapy in Mitchell since 1998.

Dr. Benjamin Aaker, Avera Medical Group Emergency Medicine Yankton received the prestigious Anton Hyden Award from the University of South Dakota (USD) Sanford School of Medicine. This is the top teaching

honor for clinical faculty at the School of Medicine and is voted on by the medical students. Aaker has been an assistant clinical professor for the School of Medicine for approximately three years.

Avera DeSmet Memorial Hospital recently broke ground on a new hospital addition and renovation. In addition

to upgrading the facility’s appearance and infrastructure, the $3.2 million project involves remodeling two emergency rooms, the emergency entrance, and the hospital’s inpatient wing. The PT department will be expanded and a radiology department will be established including CT and ultrasound. The project will be complete in 18 months to two years.

Avera Health has partnered with Evidence In Motion (EIM) to collaborate in the delivery of EIM’s orthopaedic and sports residencies, orthopaedic manual physical therapy fellowship, post-professional doctorate of physical therapy (DPT), and certification training programs. As a component of this

relationship, Avera becomes a network partner for EIM’s evidence-based training programs in numerous locations throughout Iowa, Minnesota, Nebraska, and North and South Dakota. EIM is available for all therapy staff at all Avera locations, giving them access to these resources. Theranostics Health, Inc., a biotechnology company that develops and commercializes molecular diagnostic technologies to target therapies for optimal patient benefit, will expand on current research and commercial collaborations with Avera Cancer Institute and Avera Health Plans. As

part of a one-year evaluation program, Avera Health Plans will provide provisional coverage and reimbursement for the TheraLink Assay to help identify the best cancer therapy based on the functional proteomic panel. At the same time, Avera Cancer Institute is conducting multiple studies using the TheraLink Assay in their personalized medicine research program.

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

Midwest Medical Edition

Steve Petersen, PharmD, Vice President of Pharmacy Services at Avera Health, has been selected by the South Dakota Society of Health-System Pharmacists as recipient of the Gary W. Karel Lecture Award recipient for 2015. The Gary W.

Karel Lecture Award is the highest lifetime achievement honor in South Dakota health-system pharmacy practice. Petersen has worked in the field of pharmacy since 1979 and has been employed at Avera for the last 15 years. He holds a doctor of pharmacy degree from the University of Nebraska College of Pharmacy.

BLACK HILLS Regional Health has launched a yearlong campaign aimed at celebrating its nearly 5,000 physicians and caregivers.

Each month, three exceptional caregivers will be recognized for the work they do and positive impact on their communities. In May, the three individuals are Lisa Brown, MD, a Family Medicine physician in Custer; Bruce Larsen, Environmental Services in Rapid City; and Lacey Joens, RN, Emergency Services director in Spearfish. Regional Health caregivers in Rapid City helped earn money for Wellspring, Inc., by wearing jeans April 3. Regional Health’s

Community Jeans Day Program raised $1,024 for the local organization which provides family-focused therapeutic services for youth who cannot function within their family setting, the open community and the open school setting due to mental, emotional and/or chemical dependency problems.

June 2015

The South Dakota Affiliate of Susan G. Komen for the Cure has awarded a grant to the John T. Vucurevich Regional Cancer Care Institute (CCI) to assist medically underserved patients in western South Dakota with challenges during breast cancer treatment. The grant will support

the “Healing Pathways” program and will be administered through the CCI Breast Health Patient Navigation Program. Funds totaling $19,750 are available to qualifying individuals through May 1, 2016.

Prairie Lakes Healthcare System welcomes Occupational Therapist, Michelle Stark to the Prairie Lakes Rehabilitation Staff. Michelle Stark has lived and worked as an Occupational Therapist for the last 17 years in Watertown. She has extensive

experience in treating all ages with orthopedic conditions, cancerrelated debility, and neurological conditions. Stark is also a Certified Lymphedema Therapist.

SANFORD Sanford Heart Hospitals in Fargo, North Dakota, and Sioux Falls, South Dakota, now offer Mary Kolsrud, Executive Director of Susan G. Komen South Dakota, left, presents a check to Shauna Fehrenbach, R.N., Patient Navigator at the Regional Cancer Care Institute.

PRAIRIE LAKES Prairie Lakes Healthcare System has been named a recipient of the Women’s Choice Award as one of America’s Best Hospitals for Emergency Care for a second consecutive year. This award

recognizes Prairie Lakes Healthcare System as a top performer in emergency services along with 373 other hospitals in the nation. There were 3,800 hospitals eligible for this award. The award is based on performance on publically reported quality data and outcomes of care that are important to women.

MitraClip, an FDA-approved, minimally invasive catheter therapy for treatment of mitral regurgitation (MR). MR is the most common heart valve insufficiency in the United States and is caused when a leaky mitral valve causes the backward flow of blood in the heart. Left untreated, this condition can lead to heart failure. Sanford Heart Hospitals in Fargo and Sioux Falls are among the first 100 heart facilities in the nation to offer this technology. Sanford Health surgeons Dennis Glatt, MD, and Curtis Peery, MD, and the Bariatric Program at Sanford USD Medical Center recently received reaccreditation from the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS).

The recertification is the latest in a list of achievements for the Bariatric Program at Sanford The program is also noted as a Distinction Center for Bariatric Surgery and holds a Special Quality Award for Bariatrics from the Joint Commission.

The Edith Sanford Breast Foundation has welcomed musician Thad Beaty as its newest goodwill ambassador in the fight to end breast cancer. Beaty,

guitarist for the Grammy Award-winning band Sugarland and an accomplished athlete and fitness expert, will help promote health and wellness as part of Edith Sanford’s focus on breast cancer risk reduction As a triathlete, marathon competitor and certified running and triathlon coach, Beaty will play a key role in leading TeamEdith, the Foundation’s national fundraising team. He will engage with TeamEdith members online, sharing training and healthy lifestyle tips, and participate in TeamEdith events nationwide. Beaty’s inaugural race with TeamEdith will be June 13, 2015, at the Rock ‘n’ Roll Seattle Marathon and ½ Marathon in Seattle, Washington. Sanford Health is recruiting participants for a study examining the role of family history in type 1 diabetes. As a

site for Type 1 Diabetes TrialNet, an international network exploring ways to fight type 1 diabetes, Type 1 diabetes is the focus of The Sanford Project, a cornerstone research initiative at Sanford Research. To be screened, which involves a blood draw from the arm, individuals must be 45 and younger with a parent, sibling or child with type 1 diabetes or be 20 and younger with a niece, nephew, aunt, uncle, grandparent, half-brother, half-sister or cousin with type 1 diabetes.


South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes The Accreditation Council for Continuing Medical Education (ACCME) has awarded Sanford Health’s CME program

Accreditation with Commendation for its professional learning opportunities for physicians. Sanford Health provided more than 1,500 CME credits for clinicians in 2014. During this same time period, more than 27,000 health care professionals attended Sanford-accredited CME events, including 8,800 physicians. Sanford’s submission earned the maximum length of accreditation, six years. Medtronic plans to develop a stent graft system for less invasive treatment

of thoracoabdominal aortic aneurysms under an exclusive patent license agreement with Sanford Health. Sanford Health vascular surgeon Patrick Kelly, MD, developed the concept for the system and has since collaborated with Medtronic to manufacture devices based on the concept. The novel system was described in the November 2014 issues of the Journal of Vascular Surgery. An investigational drug that may have the potential to use the body’s immune system to attack tumors is the focus of a Sanford Health clinical trial for head and neck cancers called KEYNOTE 055. Sanford

oncologist Steven Powell, MD, and otolaryngologist John Lee, MD, are enrolling patients across the Midwest to study the investigational drug pembrolizumab in patients with recurrent or metastatic head and neck cancers. Merck is the sponsor of the study.


Sanford Aberdeen recently welcomed a new surgeon to its team of expert medical professionals.

Amy Hiuser, Dr. Kensinger MD, will perform a variety of inpatient and outpatient surgical procedures in Aberdeen, including colonoscopies, laparoscopic and endoscopic procedures and hernia repair. Hiuser earned her medical degree from Medical University of the Americas in Nevis, West Milt Avery Indies. She completed her general surgery residency at the Cleveland Clinic Foundation in Cleveland, Ohio, and is board certified by the American Board of General Surgery.

SIOUXLAND Mike McCarthy has been named the new Director for the Mercy Heart Center.

Prior to his arrival at Mercy Medical Center, McCarthy held positions as a manager of a community based outpatient clinic for the Department of Veteran Affairs in Corpus Christi, Texas and as the Deputy Director of the Critical Care Air Transport, Advanced Course for the Sustainment of Trauma and Readiness Skills at the University of Cincinnati Hospital. A native of Sioux City, McCarthy received his BSN from Morningside College and is currently enrolled in a Masters of Nursing program at Morningside College.

Dr. Daniel Kensinger, Orthopedic Trauma Surgeon at CNOS, has joined the Board of Directors at Mercy Medical Center. Milt

Avery will serve as Chairman of the Mercy Board of Directors in 2015. Other officers include Dr. Larry Volz, Vice Chair, and Sr. Maurita Soukup, Board Secretary. Reappointments effective include Douglas Boden, Maurita Annette Hamilton, Soukup Robert Houlihan, Dr. Steven Joyce, Sr. Michon Rozmajzl, RSM, and Sr. Maurita Soukup, RSM. Dr. Ralph Reeder of CNOS,

Milt Avery, and Sr. Maurita Soukup will continue to serve on the Mercy Iowa regional governing board. UnityPoint Health – St. Luke’s has been recognized as one of the nation’s top performing hospitals according to a new study by iVantage Health Analytics. St. Luke’s is one of

nine UnityPoint Health hospitals named to the list of 2015 HEALTHSTRONG Hospitals. Christy Stinger has also joined St. Luke’s Foundation as a Development Coordinator.

Dr. John Beacom and Dr. Arthur Molnar have joined Mercy as Co-Medical Directors of Anesthesia. Dr. John Beacom

is a graduate of the University of Nebraska Medical Center – College of Medicine and completed his internship and residency programs through the University of Illinois in Chicago. Dr. Arthur Molnar comes to Mercy from Lincoln, Nebraska. Dr. Molnar is a graduate of the University of Illinois College of Medicine and did his internship and residency programs through the Medical College of Wisconsin. Michael Garrett, ARNP/MSN with Mercy’s Wound Clinic, has recently obtained dual certification in wound care and hyperbaric medicine by the American Board of Wound Healing (ABWH). Garrett

has worked for Mercy for over twenty years and has practiced in the Advanced Wound Care Clinic since 2007. He received his Master’s Degree as a Family Nurse Practitioner from South Dakota State University. For the second straight year, Cherokee Regional Medical Center (CRMC) has been named one of the iVantage HEALTHSTRONG Top 100 Critical Access Hospitals (CAHs) in the United States. The results

recognize that the Top 100 Critical Access Hospitals provide a safety net to communities across rural America – measuring them across 62 different performance metrics, including quality, outcomes, patient perspective, affordability, population risk and efficiency.

Stinger will work with project management and overall philanthropy efforts.


Midwest Medical Edition

Susan Unger has been promoted to President of the UnityPoint Health-St. Luke’s Foundation. She will

also continue her role as Vice President of Development for UnityPoint Health–St. Luke’s. Unger joined St. Luke’s in 2004, and under her leadership, St. Luke’s Foundation has completed three capital campaigns and created a significant planned giving program. Unger also represents St. Luke’s on many boards throughout Siouxland. Kari Kellen joins St. Luke’s Foundation as Vice President of Major Gifts. In this

role, she will focus on long-term donor relationships, helping to expand St. Luke’s donor base. Kellen served most recently as the Executive Director for the Children’s Museum of Siouxland focusing on major gifts. She was also instrumental in development at the Sioux City Art Center.

Amy Derby has been promoted to Development Coordinator for St. Luke’s Children’s Miracle Network.


Derby will coordinate and plan St. Luke’s Children’s Miracle Network events with Anne Holmes, Director of St. Luke’s Children’s Miracle Network. Hospice of Siouxland is taking registrations for “Camp Courage”, a summer weekend camp to help kids who have experienced the loss of a family member or friend. The camp is for youth

Woods Fuller welcomes Heather Springer and her 15 years of health law expertise. Heather minimizes risk and maximizes growth for hospitals, clinics, physicians, and insurance companies through: HEALTHCARE COMPLIANCE FORMATION, RESTRUCTURING, MERGERS

ages 6 to 17, and is set for June 12-14 at the Goodwill Camp near South Sioux City, Nebraska. Pre-registration is required as camp size is limited. For more information or for a registration packet, please call John at 712-233-4144 or 800-383-4545.


To connect with Heather Springer, call 605.336.3890 or email


in patient care

> personalized priMarY Care > saMe-daY appointMents > QualitY tiMe with providers

We finish first when we earn the confidence of our patients. By consistently providing innovative and personalized care, Midwest Family Care continues to be a trusted leader in patient satisfaction. We offer convenience, same-day appointments and the quality time with providers your family deserves. Your satisfaction is and will always be our greatest reward. Proud to be Physician Owned and Operated

June 2015

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NRapid EPAL City to


Nepal The Black H

ills Courtesy Sout h Dakota Dept . of Tourism

By Alex Strauss


HE BLACK HILLS OF SOUTH DAKOTA are a long way from the mountains of Nepal. But for 12 Nepali doctors who work at Rapid City Regional Hospital, Rapid City has come to feel almost like home. Now, in the wake of Nepal’s devastating earthquake on April 25th, some of them are making the long journey back again to help their homeland recover. RCRH Hospitalist Binod Dhungana, MD, is one of ten hospitalists and two specialists who have settled in Rapid City in the last five years. Within days of the earthquake, he became the first of the doctors to book his ticket home. “My mom and dad live in Kathmandu. I have three sisters and a brother, too. They are all doing alright physically but, of course, they are very scared,” says Dr. Dhungana. The son of a Nepali lawyer, Dhungana moved to Kathmandu with his family when he was in high school. He attended medical school in Nepal before leaving for additional training in New York. He settled in Rapid City two years ago.

. . . and Back 13

Responding to Disaster

Photo courtesy RCRH.

After he checks on family, Dr. Dhungana plans to put his medical skills to work in an area that is more rural than Kathmandu but still has an established clinic. This, he believes, will be the most efficient way to quickly start helping the medical effort. “We will be in a remote area where they already have a small base set up,” says Dr. Dhungana. “Some of my colleagues from all over the US are going, too. Our intention is to coordinate with organizations that are already on the ground in the region.” Ironically, this was the first year since moving to the US that the young doctor had decided not to use his summer vacation time to go home to Nepal. He had hoped to introduce his extended family to the Black Hills, where he has lived for the past two years. The earthquake changed that. “As soon as the earthquake happened, I cancelled my vacation and got very active online,” says Dr. Dhungana, an active member of the American Nepal Medical Foundation. The foundation, which is made up of hundreds of Nepali American doctors,

was established two decades ago by a group of Nepali doctors and American doctors who had worked in Nepal. The mission of the volunteer group has been to support the medical education of doctors from Nepal in the United States. The group was preparing for its annual meeting, of which Dr. Dhungana was the chief organizer, just as the earthquake hit – a fact that dramatically changed the agenda. “One of the items on our agenda will be to revisit the mission of the organization,” says Dr. Dhungana. “We realize that we are one of the most important US organizations to help in the relief effort.” By the time Dr. Dhungana left for Nepal a few days after the meeting, the American Nepal Medical Foundation had already collected more than $250,000 dollars to support the relief effort in Nepal. Some of that money came from group members, but some was directed to the foundation from other organizations, looking for a way to contribute. One of the biggest contributors was Rapid City Regional Hospital. “It really means a lot to be part of such a great organization that is willing to help,”

says Dr. Dhungana. “The support of the community has been great, too. We held a press conference regarding what I am attempting to do in Nepal and that was well covered in the news.” In addition, the hospital quickly organized a bake sale at which they collected donations totaling more than $14,000.

Work Ahead “Part of my work in Nepal will be to organize the funds that we have and figure out how they are going to be used,” says Dr. Dhungana who has been reading up on mistakes made in the response to the massive Haitian earthquake in 2010. “That relief effort was not well organized and there was a lot of duplication. We want to make sure that doesn’t happen in Nepal. We want to have a sense of what the long-standing needs are going to be.” Although Nepal is prone to earthquakes, Dhungana, says the only quake he ever experienced was a barely felt tremor during his training in New York. He is, however, not a total stranger to the pressures of disaster medicine. Dhungana was an intern in the ICU at a New York hospital when Hurricane Sandy hit in 2012. When other area hospitals were flooded, his had to handle the massive overflow of patients. “Obviously, it is very different from responding to an earthquake in Nepal, but it was similar in that we had to handle a lot of patients very quickly,” he says. “We worked 40 hours straight.” While Dr. Dhungana spends the month of May in Nepal doing what he can to help, the hospital’s remaining Nepali doctors are working together to “hold down the fort” at home in Rapid City.

At Home in Rapid City An April 30th “Assisting in Nepal Bake Sale and Donation Event” at Rapid City Regional Hospital raised more than $14,800 for the relief effort. Pictured is Nepali native and RCRH hospitalist Dr. Shailesh Thapa.


One of those who will stay behind for now is Dr. Pushpa Poudel. Dr. Poudel was the first Nepali physician to come to Rapid

Midwest Medical Edition

Our intention is to coordinate with organizations that are already on the ground in the region. Binod Dhungana, MD

Pushpa Poudel, MD

City in 2010. He quickly spread the word to his colleagues about the beauty, and seclusion of what he calls this “secret place”. “I was looking for a place that reminded me of Nepal and that had some openings,” says Dr. Poudel, who did his training in Brooklyn. “Though Rapid City is far away from Nepal, it is very spacious like Nepal. It is beautiful and mountainous. There is not much crime. The people are nice. So I invited more friends and more friends.” Those friends now include ten RCRH hospitalists, a cardiologist, and a nephrologist. Several are raising families in the Rapid City area and three have even started a Nepali restaurant together. Although they are still far from home, Poudel says the camaraderie of Nepali colleagues and the support of RCRH makes the distance easier to manage. Dr. Poudel’s mother and married brother still live in Nepal. None of the family was hurt by the earthquake and the house, which was newly built, sustained only minor damage. Eventually, he, too, hopes to go home to do what he can to help. In the meantime, both doctors say they are grateful for the support of the hospital they call their professional home. “We love the hospital and the mountains remind us of home,” says Dr. Dhungana. “Most of us live in the valley.” “The fact that the hospital would have the bake sale and gather contributions, it really encourages us,” says Dr. Poudel. “It makes us feel happy and important. This makes us feel like we are not alone.” ■

June 2015

Photo courtesy RCRH.


Hospitalists Basanta Pathak, MD, left, and Pushpa Poudel, MD, right, discuss medical protocol for Sepsis patients.


New Integrative Health Therapies at the Sioux Falls VA Concentration on Self-Care Aims to Empower Veterans By Shirley Redmond

Jenny Miller, DC, acupuncturist, checks placement of needles used to help James Cooper, a Veteran of Iraq, with headaches and chronic pain in his neck and upper back.


ORN OUT OF A COMMITMENT TO provide area Veterans with personalized, proactive, and patient-driven care and service, integrative health therapies available at the Sioux Falls VA are designed to help empower Veterans to drive their own health. Many veterans who struggle with chronic pain, anxiety, PTSD, cancer treatment side effects, stress, insomnia, and other conditions can now find relief with few or no medications using integrative health services. This program began seeing Veterans in June 2014 with the goal of teaching Veterans self-management and self-care skills to improve their quality of life. Current services include integrative health coaching, massage therapy, energy therapy, a mind body medicine group, aromatherapy, yoga/tai chi classes, and acupuncture. In addition, the Sioux Falls VA Medical Center has had chiropractic care since Christopher Pierson, DC, was hired in 2004.


Both VA providers and Veterans have embraced integrative health services, and more than 650 consults have been submitted since the program’s beginning. The majority (over 75%) of the consults are for Veterans who have pain that has been unmanageable with standard treatment. A Veteran who has battled chronic pain for many years says a few months of integrative healthcare have helped him achieve a level of pain relief and function that he has not had in 19 years of traditional healthcare alone. Integrative health services have also helped advance the VA’s overall goal of decreasing Veterans’ use of high risk opioids for chronic nonmalignant pain. This also helps decrease risk factors for potential negative outcomes, including overdosing, adverse reactions, and mental health complications. Before beginning services, Veterans are oriented in a group meeting and learn what they can hope to achieve and the requirements of participation. The next step is an intake appointment with the Integrative Health Coach to plan and set goals with possible referral to other therapeutic modalities. Veterans may choose to continue with health coaching after the required visits.

Integrative Therapies at the VA Those who choose massage therapy normally have four therapeutic massages with education specific to their conditions and tools to maintain the benefits at home. This is a bridge to self-care and represents a culture shift for Veterans as well as staff. During acupuncture, Veterans receive a series of four to eight treatments based on the acupuncturist’s plan of care. Veterans also may attend a mind body medicine group once a week for eight

Midwest Medical Edition

Looking for a better way to manage risk?

Get on board. Massage therapist, Jessica Lund, LPN, LCMT provides Veteran Jill Baker with a therapeutic massage to assist her with stress reduction and upper back and neck pain.

weeks where they learn a variety of self-care and stress management techniques including meditation, guided imagery, breathing and movement. Concentrated distilled plant oils used in aromatherapy are designed to promote relaxation and provide relief of pain and a variety of other symptoms. Another lesser-known option is energy therapy, where a provider places his/her hands slightly above or on the Veteran to promote balancing the physical, mental, emotional, and spiritual well-being. Soft music or imagery is sometimes used to help Veterans relax more completely. Later this spring, Integrative Health plans to move into a new building just for this program. The design and furnishings will create a healing environment for comfort and relaxation. The space will accommodate room for private health coaching appointments, rooms for massage and acupuncture as well as a large room for yoga and tai chi sessions. The new location will also allow VA staff to also expand the therapeutic modalities for Veterans’ growing needs. ■

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

Shirley Redmond is Public Affairs Officer at the Sioux Falls VA Health Care System.

MED POMM 8_13_14.indd 1

June 2015

2/10/2015 9:03:23 AM


Planning for a

Log On! For Heyden’s advice on avoiding another kind of disaster when contacting patients on their cell phones.

Tech Disaster

F “

. . . critical piece of disaster recovery planning is ensuring your business partners and business associates have disaster recovery plans in place

Jill Heyden is a Business Development Specialist with AAA Collections, Sioux Falls.


By Jill Heyden OR THE LAST several

decades, organizations have increased their adoption of technology, software, and Internet related services. They have quickly become reliant on the availability of their technology. Because of this, an organization may not be able to function after a disruption or disaster without proper planning. Disasters can range from the loss of a hard drive or a power outage, to floods, tornados, fires, sabotage, or data security breaches. An organization needs to recover as quickly as possible to ensure that it can continue to provide services to its customers and patients. According to a study from the Enterprise Strategy Group, a staggering 53% of organizations can tolerate less than an hour of downtime before they experience a significant revenue loss or other adversities. Over 80% of all businesses affected by a disaster were forced to close their doors because they were not able to recover. Though it is extremely important to have a plan in all industries, health care organizations must maintain an even higher degree of system and network availability. One of the things that has highlighted disaster recovery’s importance is the growing use of electronic health records (EHRs) and the growth of networking and interconnection. If a facility loses access to its computers, it loses access to EHRs, treatment plans and other vital information that

directly affects patient care. Part of the challenge is the sheer size of electronic health records. These aren’t just electronic versions of scanned paper documents, but photographs, X-rays, videos and all sorts of associated data. Patients’ lives may depend on systems being up and running, and patients’ health could be jeopardized by lack of access to health care data in the event of system downtime. Most of us recognize that such disasters are a possibility; however the rarity and unpredictability of these events have kept some organizations from making disaster planning a priority. It is vital that a business have a disaster recovery plan to help minimize downtime and regain ‘business as normal’ as quickly and efficiently as possible.   Another critical piece of disaster recovery planning is ensuring your business partners and business associates have disaster recovery plans in place. If an important relationship with a contractor is compromised due to a disaster, this holds the potential of having long-lasting and/or devastating effects to your organization and to your bottom line. Significant security risks, financial risks, or at the very least, a tarnished reputation are dangers that organizations need to consider. O r g a n i z a t io n s

that have a disaster recovery plan implemented are often able to ride out catastrophes with very little impact, if any, on data integrity or business revenue. Organizations that do not currently have a plan in place may recognize its importance, but struggle with getting it started. There are several options available to assist in the creation a disaster recovery plan, ranging from free, online templates to consultants that specialize in disaster recovery planning. The technical staff within an organization can also be a great resource to help devise a plan specifically as it relates to their individual areas of expertise. Data backup and redundancy is absolutely crucial, but it is just one component of the recovery plan. A plan should identify the risks, the magnitude of the risks, and the actions that will follow in the unfortunate event that a disaster occurs. The best way to test the plan’s effectiveness is to practice it regularly. Learning from the tests and updating the plan accordingly can help refine recovery operations. With a well-defined and tested disaster recovery plan, an organization from any industry can endure a disaster with minimal disruption. However, without proper planning, a business may have to close its doors when disaster strikes. ■

Midwest Medical Edition

Moments of Life made possible by Hospice

Hospice focuses on living and enables special moments and memories at the end of life for patients and loved ones. Hospice of Siouxland is appropriate for anyone diagnosed with a life-limiting illness whose life expectancy is measured in months rather than years and where the primary goal has shifted to comfort-oriented care. Examples of life-limiting illnesses include lung, kidney, liver, neuromscular, end-stage heart disease, cancer, Alzheimer’s and dementia.

You Do Have a Choice!

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June 2015

Please call 712-233-4144 or visit Non-profit locally owned by UnityPoint Health-St. Luke’s and Mercy Medical Center - Sioux City


Want vs. Need

Recognizing drug diversion in the ED By Trish Lugtu


RESCRIPTION drug abuse con-

tinues to rise. Overdose deaths from prescription painkillers have quadrupled since 1999, and 1.4 million emergency department (ED) visits in 2011 were related to drug misuse, or to abuse of pharmaceuticals. According to the Centers for Disease Control (CDC), more than 22,000 deaths in the U.S. in 2010 were related to pharmaceuticals, comprising 60 percent of all drug overdose deaths and exceeding deaths by overdose of illicit drugs like heroin and cocaine. Pharmaceutical drugs make their way into the hands of illicit drug users through sharing among friends and family, doctor shopping, prescription fraud and theft — making the ED physician‑patient relationship an ideal target to exploit. ED physicians practice medicine in unique circumstances. Without a prior relationship with a patient, these physicians must quickly build trust, assess circumstances, and determine the best course of treatment, often within minutes or seconds. The short‑lived relationship between physician and patient makes the ED a perfect

target for drug‑seekers. But it is also these physicians’ excellent situational awareness that strengthens their ability to recognize potential drug‑seeking behavior, and to respond safely and effectively.

RECOGNIZING DRUG‑SEEKING BEHAVIORS The Office of Diversion Control within the Drug Enforcement Administration (DEA) published a brochure, Recognizing the Drug Abuser*, which describes the common behaviors of drug diverters in the ED. For example, they might show an unusual knowledge of controlled substances, give evasive or vague answers when questioned on medical history, show reluctance to provide reference information, claim to have no regular doctor or health insurance, or request specific controlled drugs while resisting a different recommendation. The brochure also describes the modus operandi often used by drug abusers: feigning physical or psychological symptoms and trying to apply pressure to the physician through sympathy, guilt, or even direct threat. He or she may also offer excuses for not going to their regular physician, such as claiming to be an out‑of‑town visitor, that his or her regular physician is unavailable, or other scenarios.

RESPONSIBILITIES OF THE PHYSICIAN Physicians carry legal and ethical responsibilities to uphold the law and protect society from drug abuse, a professional responsibility to prescribe controlled substances appropriately, and a personal responsibility to protect his or her organization from being a target of drug diversion. Fortunately, the burden of success is not on the provider’s shoulders alone. The Office of Diversion Control is also tasked with preventing, detecting, and investigating the diversion of controlled pharmaceuticals. Toward this effort, the DEA has developed guidelines for deterring drug diversion, and the CDC has joined in the effort with additional resources. The DEA’s guidelines include steps such as following responsible prescribing, screening for substance abuse, prescribing painkillers only when other treatments have not been effective for pain, prescribing only the quantity needed based on expected length of pain, and referencing your state’s Prescription Drug Monitoring Program. Additionally, the CDC highlights the importance of incorporating awareness of state law in strategies to deter drug diversion in the ED. ■ Trish Lugtu, BS, CPHIMS, CHP, CHSS is R & D Manager with MMIC. *Available online at Note: This article originally appeared in the Winter 2014 issue of Brink, a quarterly risk solutions magazine published by MMIC.

Log on! To read the DEA’s ‘Do’s’ and ‘Don’t’ for healthcare professionals to protect themselves against drugseeking behavior.


Midwest Medical Edition


Now Using New Heart Failure Monitoring Solution PRAIRIE LAKES HEALTHCARE SYSTEM IS

one of the first facilities in South Dakota to implant a new miniaturized, wireless monitoring sensor to manage heart failure (HF). The CardioMEMS HF System is the first and only FDA-approved heart failure monitoring device that has been proven to significantly reduce hospital admissions when used by physicians to manage heart failure. Dr. Maaliki, Interventional Cardiologist, implanted the first CardioMEMS sensor on Wednesday, April 29th in a patient’s pulmonary artery (PA) during a non-surgical procedure to directly measure PA pressure. Increased PA pressures appear before weight and blood pressure changes, which are often used as indirect measures of worsening heart failure. The new system allows patients to transmit daily sensor readings

from their homes to Prairie Lakes, allowing for personalized and proactive management to reduce the likelihood of hospitalization. “Being one of the first facilities in the state to introduce this new heart failure monitoring technology demonstrates Prairie Lakes’ progressive vision to provide stateof-the-art care in our region,” said Jill Fuller, CEO. “Our cardiology team is committed to providing innovative new technology that is proven to improve patient outcomes.” Prairie Lakes brought the CardioMEMS HF System to the region in response to the high rate of heart failure patients that require medical attention. Heart failure occurs when the heart is unable to pump enough blood to meet the body’s demands. According to the Centers for Disease Control and Prevention, more than 5.1 million Americans have heart

failure, with 670,000 new cases diagnosed each year. Patients with heart failure are frequently hospitalized, have a reduced quality of life and face a higher risk of death. According to the American Heart Association, the estimated direct and indirect cost of heart failure in the U.S. for 2012 was $31 billion and that number is expected to more than double by 2030. “The CardioMEMS sensor is designed to last the lifetime of the patient and doesn’t require a battery. Data from a clinical trial showed that the CardioMEMS technology reduces heart failure hospital admissions by up to 37 percent,” said Leah Lê, Cardiology and Cath Lab Director. “The remote monitoring reduces the patients’ chances of being readmitted to the hospital, but most importantly improves their quality of life.” ■

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June 2015



Job Descriptions

By Kelly Marshall



descriptions you may have seen, job descriptions you may have written, or job descriptions you may currently be employed under. Ask yourself the following questions: • Are these job descriptions written? • Do these job descriptions include physical demand information, such as being able to lift 50 pounds? • If physical demand information is included, how was it measured? Was it measured objectively or was it simply a guess? • How are these job descriptions used? To recruit new employees? As part of the hiring process? In order to return injured employees to their jobs?

Functional job analysis utilizes a systematic approach to identify and measure the physical abilities required to perform the essential functions of a job. To do this, a job analyst goes into the workplace to


objectively measure these physical requirements, including: • Lifting forces • Grip forces • Pinch forces • Push/pull forces • Distances walked

This information can then be included in a functional job description. Separate from the professional requirements such as knowledge, skills, and cognitive abilities required for a given job, the functional portion of the job description includes the objectively measured physical demand information pertinent to that specific job title. Incorporating functional information into a job description has a variety of benefits. During the recruiting and hiring process, it allows potential employees a much clearer picture of the physicality of the work they will be required to perform. Potential employees may remove themselves from the hiring process much earlier on when they realize they do not have the physical ability to perform the demands of a particular job. Employers thereby have a better opportunity to hire the employee who is a better “match” for a job from the very beginning. Given the high rate of musculoskeletal injuries that occur within the first year of employment, this has the potential to affect turnover and decrease recruiting costs for the employer. Further benefits can be found in using functional job information in the case of an injured employee. When an employee is returning to work following any sort of physical injury,

medical providers are asked to determine if that employee can safely perform the essential functions of his or her job. When an employer does not objectively record the physical demands of a job, it becomes much more difficult for a medical provider to make a decision about that employee’s ability to safely return to work. The provider may be forced to rely on the report of the employee to determine what is physically required by their job. A functional job description can be shared or even created (just in time!) in order to reduce lost or restricted work days and ensure an injured employee can return to his or her job safely. The process of functional job analysis presents the opportunity for a variety of additional benefits. A culture of safety and understanding is promoted by investing in employees from the moment they are recruited. Incumbent employees appreciate that any new hires will be physically capable of performing the job they are being hired for. Medical providers who are asked to make employment decisions appreciate a better understanding of what a job truly requires. Recent court proceedings indicate that physical demand information should be objectively measured and job specific, especially if it is being used to make employment decisions. Job descriptions with generic measurements and physical requirements are an open door for investigation and litigation. Functional job descriptions provide objective, measurable information that can help keep employers on the cutting edge and out of the court of law. ■ Kelly Marshall is an occupational therapist and a member of the South Dakota Occupational Therapy Association and the American Occupational Therapy Association. She is a Job Analysis and Ergonomics Specialist with RAS.

Midwest Medical Edition

Did you Know? 2014


vol. 5 no. 6

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nating your Tips for elimi y s problems Toda iCd-10 Claim

By Natalie Bertsch


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MED Reprinted from


Contac t us at

877-858 -5307


JUly / aUgU st

Vol. No. 55

Risks surro u

AlAR m


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MED Maga zine


he iss ue of a ‘cente alar r m fa Tigue the las stage’ con cer n t two an d for hea paTie dec (eCri) The num nT sa named ades. in fac lthcare pro feTy ber of viders ala rm t, the patien has alarm hazard across t each emerg sig nal s as the day – the cou become ency thousa s in which Ca #1 he ntr y ove nds can tran healthcare alth Tec re resear they can throughou r facilit ch ins slate hnolog t the ies can reach to tho titute hospita y ha zar desens overwh usands sur pas l. Wh d in 201 itized, elming s severa of ile ala 3. quantit l hundre rms are alarms on The risk overwhelm every ies. so, ed or an imp s to pat can inc unit and d per it’s no ortant ient saf immune to lude fall tens of wo par the nder ety are t of The Joi sounds s, del rea ays in , and can that clinicia patient car nt Co treatme l. Common mmissi e, Januar ns can suf fer inju y 200 on sen nt, me becom from ries res 9 and dicatio ‘alarm tinel per ma e ulting June datab n errors nent fatigu from 201 loss of ase rep e.’ , or in unfor alarm functio 2. of the orts 98 tunate the wo hazard 98 rep n, and ly, the alarm rst cas s orted in Jun se occ -relate five in e – dea events e 201 urrenc d eve unexpe goal es are nts bet th. (npsg 3, the Joint cted add , 80 resulte happen ween Co d in dea ) to add npsg itional ing mo ress imp mmission th, requir care or re and establ es roving a prio extend 13 in more ished rity, est hospital and the saf freque ed stay a new ety of ablish ntly. critica . 2014 clinica a for ma l access nation l alarm l policy al pat hospita ien system and pro l leader s in hos t safety vide sta s to set pitals. alarm ff trai The ning around management alarm as safety .

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Midwest Medical Edition

June 2015


New Marfan Syndrome Clinic in Omaha Raising Awareness and Saving Lives ASK ANJI YETMAN, MD, director of

such as scoliosis, chest bone deformities, and/

After Marfan syndrome is diagnosed, a

Vascular Medicine, Cardiology at Children’s

or long fingers and toes. More critically, they

baseline echocardiogram helps evaluate the

Hospital & Medical Center, about the rewards

are predisposed to developing aortic enlarge-

size of the aorta and whether it is proportional

of treating patients with Marfan syndrome,

ments, aneurysms and dissections.

to the size of the patient. “After that initial

and she seeks out the pictures pinned around

“Marfan syndrome is just one cause of

visit, we like to see them in six months’ time

her office: an adult patient surrounded by

a dilated aorta, but it is the prototype of all

to make sure their aorta is stable. If it is stable,

her three beaming daughters, a dapper-

diseases of the aorta. It’s the one we know

they typically come in for a yearly checkup

looking teenager who, as a baby, was diag-

most about,” Dr. Yetman says.

with a visit and an echocardiogram.”

nosed with a severe form of the disease. “With the right care, he’s been able to lead a very normal life,” she shares. Marfan syndrome, a genetic disorder affecting approximately one in 5,000 men

Most patients—75 percent—inherit

The new Marfan Syndrome Clinic at

Marfan syndrome from a parent. The remain-

Children’s is working to make an impact on

der of the cases arise de novo as a result of

the front — and a very real difference in

a spontaneous mutation. Diagnosis begins

people’s lives. “Twenty years ago, Marfan

with a scoring system.

syndrome was somewhat of a death sentence

and women of all ages and ethnic groups,

“We look at the patient; we take a

impacts the body’s connective tissue, an

number of measurements and then we add

anomaly linked to the abnormal production

up points for each feature they have. If they

of fibrillin-1 protein. Patients are typically (but

have a certain score that determines that

not always) tall and thin, with long limbs.

‘yes’ they have Marfan syndrome or ‘no’ they

They tend to have eye issues, including lens

don’t. The diagnosis, most often, is a clinical

dislocation, and certain bony abnormalities

diagnosis,” Dr. Yetman explains.

An open letter

Surgery ment Pa i n m a n a g e imaging i ly C a r e m i d w e S t Fa m a lt h digeStive he sician Proud to be Phy erated Owned and Op


and that’s not the case now,” Dr. Yetman says. ■


The Lord hath created medicines out of the earth; and he that is wise will not abhor them — Ecclesiastes 38:4

from the Ceo

tude and to express our grati to our patients, ty hospital, I wish not take the ial do ec e Sp W lls ar. fa ye st ux Sio care over the pa eir th As the new Ceo of th wi us d ste o have tru respect to those wh health and happiness lightly. ur yo of lity ibi ns po res ation through lized care and innov efforts have na rso pe ff, of sta r re ou ltu cu to r ur t commitment to ou rd work. We are proud to say that yo n. You’ve shown grea and ha in patient satisfactio ion r de ass lea mp al co , ion on reg ati a as ed niz og rec your time, dedic ing us the honor of be tient once again earned ten out of eleven pa only a five-star rating in ed us the eiv g rec kin l ita ma , sp S* ho Cm ty Sioux falls Special survey awarded by ies in the hCAhpS satisfaction categor with this high of a ranking. our ion an the approval of hospital in the reg a greater reward th for ask n’t uld co Yes. But we Do we like awards? u. yo k an Th s. nt patie Sincerely, D. l R. Blake Curd, M. Specialty Hospita ficer, Sioux Falls Chief Executive Of

r Assessment of * Hospital Consume s tem Sys nd s a der Healthcare Provi enters y administered by C (HCAHPS) surve Services (CMS). aid dic Me & are for Medic

Midwest Medical Edition

What You Need to Know About

The Physician Sunshine Act By Heather Springer



care industry should be aware of changes involving public disclosures required under the Physician Sunshine Act. The rules coming out of the Sunshine Act are the latest round of government regulations affecting the healthcare industry. This Act was actually passed in 2010 as Section 6002 of the Affordable Care Act, but regulations implementing the law were not passed until February 2013 in 42 C.F.R. 402 and 403. It has only been in the last year that the Sunshine Act has been operational, and it is important that affected parties now understand the law’s effects. Congress stated that the central purpose of the Sunshine Act was to provide for increased transparency and public awareness of financial relationships between certain healthcare providers, drug/device manufacturers and group purchasing organizations (GPOs). The law created a database, searchable by the public, that lists certain payments covered by the Sunshine Act. The Sunshine Act generally requires the following payments to be reported and listed on the database:

◆ P  ayments or other transfers of value by applicable manufacturers of covered products to physicians and teaching hospitals

◆ C  ertain ownership or investment interests by physician’s or physician’s family members in certain manufacturers and GPOs

June 2015

◆ P  ayments or other transfers of value by a GPO to physician owners or investors if the ownership or investment interest was held at any point during the reporting year. What constitutes a “payment” or “transfers of value” is defined broadly and can, for example, include reimbursement for a meal. The Sunshine Act requires the report of the payment, transfer of value or ownership interest to be made by the manufacturer or GPO to the Center of Medicare and Medicaid Services (“CMS”). Physicians and teaching hospitals, as the recipients of the payment and the Sunshine Act report, should be given under the law the opportunity to review the CMS report for accuracy. Once the review and correction process has been completed, the data is made public via CMS’s “Open Payments” website. The first data collection period under the Sunshine Act covered transactions that occurred from August 1, 2013, through December 31, 2013. The data collected for this period was required to be submitted to CMS by March 31, 2014, and was published by CMS on September 30, 2014. Following this initial data collection period, CMS will publish the Sunshine Act data on an annual basis and the data reported will include a full twelve months of payment data. Data collected for each calendar year will be published by CMS in June of the following calendar year. As a result of the Sunshine Act, the public now has access to a wide variety of payments between certain parties in the healthcare industry. While much of the industry is still

. . . the central purpose of the Sunshine Act was to provide for increased transparency and public awareness of financial relationships between certain healthcare providers, drug/device manufacturers and group purchasing organizations

unaware of the new database, the access to it by the public is already wide-spread and legal effects of that access are beginning to occur. Physicians should be aware of the rules and the reporting, including what will be reported and their rights to review reports prior to publication on the database. I am advising hospitals and healthcare facilities to incorporate these new standards into their credentialing process. Healthcare providers should also prepare its disclosures and other notices consistent with information available to the public on the database. ■ Heather Springer is an attorney with Woods Fuller Shultz and Smith, PC, in Sioux Falls. Her practice focuses on healthcare and employment matters.


Palliative Care

Helps Fill Service Gap for the Chronically Ill WHILE THE WORD “HOSPICE” is most often associated with end-of-life care, Hospice of

Siouxland also offers Palliative Care services for people with serious illnesses. “We developed our Siouxland Palliative Care program in 2001 because we saw unmet needs of individuals and families coping with advanced chronic illness,” says Hospice of Siouxland Director Linda Todd. Unlike hospice patients, patients receiving palliative care may continue active treatment and have a life expectancy greater than a few days or months. Dealing with a chronic illness can be complicated and overwhelming for both patients and caregivers. It’s not uncommon to have several healthcare providers, multiple medications, emotional stress, financial concerns, and caregivers trying to balance caring for their family member and working full time to retain insurance to pay the bills.



“Unfortunately, under our current healthcare payment system, individuals with advanced chronic illness may fall in the gaps of healthcare delivery,” says Todd. Patients may not meet eligibility requirements for home health or hospice funding for services such as day-to-day medication management, disease management or emotional support for the individual or caregivers. Because they don’t know who to call with questions or needs, these patients may have recurring emergency room visits and hospitalizations. That’s where Palliative Care Services can help.

Hospice of Siouxland takes a team approach to palliative care. A primary physician, palliative care nurse, and social worker collaborate in the development of a plan to address the needs of families and patients, alleviate suffering, and improve quality of life. This team:

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Marie Ruettgers Managing Attorney

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• Coordinates healthcare with

the patient’s primary physician

• Educates patients and families on the illness and medications

• Addresses new symptoms or problems

• Coordinates community resources such as financial applications

• Clarifies treatment goals and

helps with advance directives

One of the most important elements of this support is a nurse who is on call and available to respond by phone or in person 24/7.

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Legal Fellowship Within a Hospital

Christie Finnegan Executive Director of Estate Planning

Former Health Care Marketing Professional

Call Us Today! 605.371.2000

Palliative Care funding relies largely on public support because there is no funding from Medicare or Medicaid. Some patients pay privately based on a sliding fee scale and ability to pay. However, Todd notes, many patients do not have the ability to pay for services. No person is denied services because of an inability to pay. ■

5010 S. Minnesota Avenue, Sioux Falls, SD


Midwest Medical Edition

Avera’s Coordinated Care Model Earns Recognition AVERA’S COORDINATED Care

subspecialty practices to drive

program has been recognized

better quality and superior

among the top five of health

patient experience at a more

organizations that participated

affordable cost.

in a Center for Medicare &

Coordinated Care is specifi-

Medicaid Innovation (CMMI)

cally designed to help people

Health Care Innovation Chal-

who have significant barriers

lenge Grant.

to improved health, such as

Since 2012, Avera’s Coordinated



illness, health literacy issues, or

participated in this project,

psychosocial issues such as

through CMMI grant funding

lack of finances, depression, or

received by a collaborative

lack of health insurance.


There are eight Coordinated

VHA Inc., a national network of

Care teams throughout the



Avera system. Each team is

organizations; TransforMED, a

comprised of an RN as team

not-for-profit subsidiary of the

coordinator, a clinic care special-

American Academy of Family

ist, and a social worker. This will

Physicians; and, Phytel, Inc., a

expand to 13 teams by the






end of the year. Currently, 954

leads the field in automated,


patients are active in the

provider-led population health


improvement solutions.

“Over the past few years,

The grant funded a three-

we’ve seen great success in

year national project involving

patient outcomes through

healthcare systems, hospitals,

the Coordinated Care concept.

and provider practices through-

The future of medicine will

out 16 communities, one of

center on prevention and better

which was O’Neill, Nebraska,

management of illness, rather

home to Avera St. Anthony’s

than hospital treatment of


illness. Our Coordinated Care

The goal of the project was

Ask ur tO Abou dge Lo e! g Packa





to expand the concept of the

ground to help patients over-

Patient-Centered Medical Home

come significant challenges,

to the Patient-Centered Medical

and return to better health,”

Neighborhood and connect

said Tad Jacobs, DO, Chief


Medical Officer for Avera



primary care, specialty and

Medical Group. ■


“ June 2015

multiple diagnoses, catastrophic


Medicine rests upon four pillars – philosophy, astronomy, alchemy, and ethics. — Paracelsus


The Nurses’ Station Nursing News from Around the Region

St. Luke’s College –UnityPoint Health

Best States for Nurses

Personal finance social network WalletHub has listed Minnesota as the third best state for nurses. WalletHub analyzed the attractiveness of each of the 50 US states and the District of Columbia across 15 key metrics. Our data set includes such metrics as the monthly median starting salary for nurses, the number of health care facilities per capita and nursing job openings per capita. Minnesota was the only state in the MED coverage area to make the list. For the full report and to see where your state ranks, visit: edubest-states-for-nurses/4041/

USD Nursing’s historic graduation

First group of Four-year BSN graduates on May 8 The University of South Dakota’s four-year Bachelor of Science degree in Nursing (BSN) graduated its first class of students in May. The four-year BSN program was re-instituted in 2013 by the SD Board of Regents. Fifty-five four-year BSN nursing students received their nursing pins on May 8th at USD nursing campuses in Vermillion and Sioux Falls. USD Nursing in Vermillion and Sioux Falls started BSN programming in fall 2013. USD nursing students in Rapid City were admitted to the four-year BSN program starting in 2014, and Pierre students can begin the program in fall, 2016.

SDSU College of Nurses Honors Avera leaders

The South Dakota State University College of Nursing honored 30 nurses, including four Avera leaders at its 80th anniversary gala in April. Below are the Avera awardees. Leadership in Clinical Practice: Darcy Sherman Justice, MS, RN, NE-BC and Kris Gaster, RN, MS, CS, CNP Sherman Justice has been Director of Professional Development and Nursing Integration at Avera McKennan Hospital & University Health Center since 2004. Gaster is Assistant Vice President of Outpatient Cancer Clinics. Emerging Professional: Courtney Ehlers RNC, MS, BS, CPN– After only five years as a nurse, Ehlers was promoted to the role of manager of the pediatric/PICU unit, and is now Director of Women’s and Children’s Services.

has named Lorraine Sacino Murphy as Department Chair of the Associate of Science in Nursing Program. Sacino Murphy received her Bachelor of Science in Nursing from University of Wisconsin in Eau Claire, Wisconsin and her Master of Science in Nursing from Briar Cliff University in Sioux City, Iowa. Also at St. Luke’s College–UnityPoint Health, Renae Grell is now a Nursing Instructor. Grell received an Associate Degree in Nursing from St. Luke’s College and a Bachelor of Science in Nursing from South Dakota State University in Brookings, South Dakota.

The Jorgen Yde Foundation

has honored Linda Harding, RN, OCN,

as the 2015 recipient of the JY6 Nurse of the Year Award. Harding, of Avera Medical Group Oncology and Hematology Sioux Falls, is the third-ever recipient of the award. Find out how advanced education is putting some nurses on the forefront of primary care. Log on!

College of Nursing Distinguished Alumni: Deborah Soholt, MS, RN. Soholt has served as Director of Women’s Health at Avera McKennan since 1999.

The average commute time is twice as long for a nurse in Maryland as in South Dakota. Source: WalletHub


Midwest Medical Edition


This just in!

partnership will advance cancer genomics SANFORD HEALTH IS ONE OF 14 cancer

institutes across the country partnering with IBM Watson Health in an initiative to translate DNA insights into personalized treatment options for patients. The project is part of IBM’s broader Watson Health initiative to advance patient-centered care and improve health. Across its enterprise, Sanford will utilize Watson Genomic Analytics, a cloud-based service for evidence gathering and analysis. It looks for variations in the full human genome and uses Watson’s cognitive capabilities to examine all available data sources such as treatment guidelines, research, clinical studies, journal articles and patient information. “Customized cancer treatment based on a tumor’s genetic composition is the future of cancer therapy,” said Steven Powell, MD, Sanford Health oncologist and cancer researcher based in Sioux Falls. “However, due to the unique genetic make-up of each individual and the complexities of the cancer genome, a personalized approach can take an enormous amount of time to process. For any type of disease, rapid analysis and understanding of this complex genomic information will lead to more precise and effective treatments.” It typically takes weeks for clinicians to analyze each genetic mutation. Watson completes the process in only a few minutes and produces a report and data visualization of the patient’s case, including recommendations and evidence-based insight on potential drugs that may be relevant to an individual patient’s unique DNA profile identified in the medical literature. The clinician can then evaluate the evidence to determine whether a targeted therapy may be more effective than standard care. “This collaboration is about giving clinicians the ability to do for a broader population what is currently only available to a small number,” said Steve Harvey, vice president, IBM Watson Health. ■

Print advertisers are now eligible to become one of

ten website sponsors for extra perks online and in print.

Call 605-366-1479 to learn more.


DMEK Pre-Cut Cornea DSAEK Pre-Cut Cornea Sclera preserved in Ethanol Cornea preserved in Glycerol Full-Thickness Cornea for PK

Helping to enable the restoration of the gifts of sight and health.

June 2015


Your MBA. The USF Way. Affordable. Attainable. Achievable.

° Take classes online or on campus. ° Earn degree in two years. ° $375 per credit, no fees or hidden costs. (Best value in the region!) ° Proven success since 1993. ° MBA concentrations: • Business Innovation and Marketing • General Management • Healthcare Management • Project Management » 605-331-6680 “The MBA program creates a tight-knit, collaborative learning community within the classroom. It is a very powerful and valuable learning environment when each classmate brings real world experience to the classroom setting.” Sheila Austin, MBA Healthcare Emphasis Utilization Review Manager, Avera McKennan Hospital


Midwest Medical Edition

Learning Opportunities J une — Sept June 10 – 11

Collaborative Research Center for American Indian Health

3rd Annual Health Research Summit Location: Rushmore Plaza Holiday Inn, Rapid City Information: June 12 8:00 am – 4:00 pm

Avera McKennan Pulmonary and Critical Care Symposium Location: Hilton Garden Inn Sioux Falls Information:, 605-322-8987 Registration:

37th Annual Black Hills Pediatric Symposium June 26-27 7:00 am – 12:00 pm Location: The Lodge at Deadwood Information:, 605-312-1067 Registration:

July 22 Avera Infection Prevention Day of Sharing 9:15 am – 4 pm Location: Sr. Colman Room, Prairie Center, Avera McKennan Information:, 605-322-8987 Registration:

Digital Marketing for Medical Devices August 10-12 8:30 am – 3:45 pm Location: Hyatt Regency, Minneapolis Information and Registration:

Sept. 24-25

16th Annual Avera Oncology Symposium

Location: Avera Cancer Institute, Prairie Center, Avera McKennan Information:, 605-322-8987 Registration:

Do you or your organization have an event for the MED Calendar? Post it online for free through the calendar link on our home page.

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 June 2015 Opportunities calendar to the editor at




for kids

Sanford Children’s is here for you when your patients need advanced care. Our highly trained specialists and the advanced care options we provide allow them to receive the care they need close to home. We offer a number of treatment options and care for a variety of conditions including: • Chronic kidney disease/acute kidney injury • Hypertension evaluation and management • Full spectrum of acute and chronic dialysis therapies • Neonatal pediatric nephrology care • Proteinuria/Hematuria • Cystic renal disease

To refer a patient, call (605) 312-1050. 012001-00168 Rev. 5/15

(L-R) John Sanders, MD, Justin Kastl, MD

Seeing patients in: Sioux Falls, Sioux City, Rapid City & Fargo, ND

MED-Midwest Medical Edition-June 2015  
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