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Vol. 6 No. 7

A Team Approach to Medicine


South Dakota’s Interprofessional Practice and Education Collaborative THE FUTURE of Healthcare Pt. 2: Collaboration and Integration

How to Keep Your

Best Employees

Local Doc’s

Home-Brewed Hobby


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.

Gastroenterology & GI Surgery Orthopedics Cardiology & Heart Surgery

MEDAd, Oct. 2015.indd 1

9/30/15 10:38 AM


Contents VOLUME 6, NO. 7 ■ N OV EM B ER 2015


The RISE of

Inter professional


5 |  MED on the Web Nurses Station and other exclusive content available this month only online

10 | N  ews & Notes – Awards, appointments, additions, and accreditations from around the Region

39 |  Learning Opportunities Upcoming Winter Conferences, Events, and CME Oportunities

IN THIS ISSUE 6 |  Legal Considerations for Employee Tracking ■ By Dave Kroon

8 |  Healthcare Still Lagging in Cybersecurity ■ By John Hohn

21 |  The Case for Collaboration ■ By Laurie Drill-Mellum Area CEOs discuss opportunities for hospital and health systems in a changing healthcare environment.

26 |  Tax Saving Strategy ■

By Kevin Eggebraaten Using a deceased spouse’s DSUE to save potential estate taxes

28 |  Sanford Recruiting for Ebola Vaccine Trial 29 |  New Tech in Sioux Falls Offers Faster Lab Results 29 |  2015 PA Salary Data The latest figures show that the PA Profession Continues to Strengthen and Grow

30 |  Avera McKennan Opens State-of-the-Art NICU 31 |  Teamwork is Key in Pulmonary Hypertension Clinic Pediatric heart and lung specialists join forces in new Omaha clinic

32 |  Skin Treatment Enhanced by Addition of Platelet Rich Plasma 35 |  Workers’ Comp 101 for Medical Providers ■ By Danyell Skillman Cover photo courtesy USD Sanford School of Medicine

By Peter Carrels

American patients tend to take for granted that a team of doctors, nurses, technicians and other healthcare staff work together to provide and monitor their care. In fact this “interprofessional” approach to healthcare, while often existent, has not always been well-organized. But as this month’s cover story illustrates, South Dakota is leading the nation in the effort to boost interprofessionalism in both medical education and care.




Part 2


Retaining Your Key Employees:

A Low Cost Solution ■ By Christie Finnegan

FF HOURS: 36 OHOME BREWED HOBBY Sioux Falls Oncologist Cooks up Award-Winning Beer in HIs Garage

On the


From Us to You Staying in Touch with MED


LTHOUGH WE AT MED make a point of not doing “themed issues”, choosing instead to cover the rapid changes in medicine as they happen, this issue comes pretty close. Our cover story focuses on South Dakota’s leadership role in the growing trend of interprofessionalism in medicine while the second part of our featured Future of Healthcare series shines a spotlight on the importance of integration and collaboration. In other words, in the evolving healthcare environment, it pays to “play well with others.” Of course, you will also find the usual assortment of timely information you have come to expect from MED, including advice on managing, tracking, and retaining good employees, saving on estate taxes, and even home brewing. (How’s that for diverse?) Be sure to also check out the News & Notes section for the region’s most comprehensive look at area medical community news. Finally, are you used to ICD-10 yet? As one physician friend told us, ICD-10 is not unlike winter on the Northern Plains - It’s harsh and takes some getting used to, but eventually you acclimate because you have to. MED wishes you an easy acclimation to both this winter! Giving thanks for you and for all the generous advertisers who continue to help bring MED to your mailbox, free of charge, —Steff and Alex

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota Steffanie Liston-Holtrop




PHOTOGRAPHER studiofotografie


DIRECTOR Jillian Lemons CONTRIBUTING Alex Strauss

Out and About with MED’s Steff Liston-Holtrop

From left to right Lifescape Foundation Golf Tournament SDMGMA Conference, Chamberlain, SD SDAHO Conference SDAHO Golf Tournament

MED is proud to help sponsor events like these in our community. 4



WRITERS Dave Kroon

John Hohn Laurie C. Drill-Mellum Christie Finnegan Kevin Eggebraaten Danyell Skillman STAFF WRITERS Liz Boyd Caroline Chenault John Knies

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

©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.

Midwest Medical Edition

MED welcomes reader submissions! 2016 Advertising EDITORIAL DEADLINES Jan/Feb Issue December 5 March Issue February 5 April/May Issue March 5 June Issue May 5 July/August Issue June 5 Sep/Oct Issue August 5

Stay up-to-date between issues of MED! Sign up for previews of upcoming articles and advance notice of the next digital edition.

On the Website this month Sanford Project’s New Leader Sanford Health’s initiative to cure type 1 diabetes has chosen a world-renowned physician, researcher and inventor as its new leader. Read about Eckhard U. Alt, MD, PhD, the new Todd and Linda Broin Distinguished Professor and Chair.

November Issue October 5

Benefits and Risks of Telemedicine

December Issue November 5

Telemedicine is expanding not only by volume, but also by services offered. One source estimates that the US telemedicine market “will grow from $240 million in revenue in 2013 to $1.9 billion in 2018”—an annual growth rate of more than 50%.


Nursing News

Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479

Awards, accolades, promotions and other Nursing News from across the region are available in an expanded online edition of our popular Nurses Station.

Alex Strauss, Editor in Chief 605-759-3295 Fax 605-231-0432 MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109 WEBSITE

MORE THAN A MAGAZINE, A Medical Community Hub

◆M  ARKETING MADE EASY – It is easy and FREE to promote new services, equipment, partners, and more in MED. Make your marketing dollars go further, connect with your colleagues, and join the conversation. Send your announcements to

◆ 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.


Stretch your ad dollars further! Low monthly rates.

Site Sponsorship opportunity. 605-366-1479

Limited spots available.


Legal Considerations

for Employee Tracking By Dave Kroon


PS OR RFID (radio frequency identification) tracking of employees in the medical setting has been gaining popularity with hospitals nationwide adopting mechanisms for tracking employees, including those in a hospital setting. Various reasons exist for utilizing tracking such as monitoring safety conditions, ensuring compliance with employer policies, improving business efficiencies and improving patient care. While valuable data can be collected, important legal considerations should not be overlooked. Employers defend GPS tracking as a legitimate means to monitor safety conditions, ensure compliance with employer policies, protect employer property, improve business efficiencies, and improve customer service. Some smartphone applications allow employees to clock in and out of work and fill out forms, but it also tracks employee movements at the same time. MED QUOTES


Although there is currently no federal legislation concerning these tracking practices, individual states have begun to consider the issue. California, Texas, Wisconsin, North Dakota, Tennessee, and Minnesota are among those states that have enacted laws regulating this practice. These state laws vary, but they typically require employee consent and include exceptions permitting the owner of a vehicle or device to track its location. While South Dakota has no legislation governing employee tracking, it does recognize the tort of invasion of privacy. Although there are many different forms of the tort of invasion of privacy, the South Dakota Supreme Court has held that to recover on an invasion of privacy claim, a claimant must show an “unreasonable, unwarranted, serious and offensive intrusion upon the seclusion of another. . . . Furthermore, the invasion must be one which would be offensive and objectionable to a reasonable man or ordinary sensibilities.” We are now beginning to see employee claims against employers alleging invasion of privacy. In a pending California lawsuit, a former sales executive for an international wire-transfer service company claimed her employer monitored her off-duty activities and bragged that it tracked employees’ driving speeds. She was disciplined and later fired for disabling the GPS-enabled tracking application on her company-issued smart phone. In her complaint, the former employee alleged that this 24/7 monitoring “would be highly offensive to a reasonable person.” It appears to be one of the first cases of

its kind and may offer some early guidance to employers. Employers should consider whether their employees have a reasonable expectation of privacy when using any equipment on which a GPS device or RFID device is installed. It may be difficult for an employer to successfully argue it has the right to track an employee’s off-duty activities. In fact, most employers I represent do not want to know the personal habits of their employees, i.e. the doctors with whom they have appointments, or their religious service habits. At a minimum, employers who wish to track the whereabouts of employer property during working hours should do so only pursuant to the terms of a specific written policy, and only after obtaining a written consent from each employee. Unless there is a legitimate business interest an employer should not monitor an employer’s activities after business hours. Until the law catches up with recent technological advances, an employer should proceed cautiously. Otherwise, it may run the risk of running afoul of an employee’s rights. Utilization of the information for employment actions should be approached carefully and with the counsel of an experienced employment law attorney. ■ David Kroon joined Woods, Fuller, Shultz and Smith PC in 1987, focusing on general business practice in health and employment law issues. He has been recognized by “The Best Lawyers in America,” “Super Lawyers,” “Chambers USA,” and a winner of the “Best Lawyer’s Sioux Falls Health Care Law Lawyer of the Year.”

A healthy attitude is contagious, but don’t wait to catch it from others. . . . Be a carrier.

Midwest Medical Edition

When you refer your patients to Sanford Children’s, you are giving them access to every specialist in every location across Sanford. No matter the issue your patients

are facing, our team has the expertise, technology and facilities to deliver advanced, personalized treatment and get them back in your care. November 2015 012000-00260 1015



Still Lagging in Cybersecurity By John Hohn


N AN INDUSTRY KNOWN FOR making advancements, unfortunately, there’s one area healthcare hasn’t improved in yet—cybersecurity. Last year, I wrote an article about a BitSight Technologies’ study that compared security rankings in healthcare to the finance, retail and utilities industries. Healthcare came in the lowest of these four. According to Bitsight’s Security Rating Industry Index, that statement still holds true today. A November 2014 study conducted by another researcher, Bitglass, found that 44% of ALL data breaches in the U.S. involved healthcare providers. The information that was stolen was up to 50 times more valuable than credit card information. Unlike credit cards that are rendered useless after the card is cancelled by either the victim or the bank, PHI contains dates of birth, medical diagnosis, and other information that criminals can use to commit many different types of fraud. They can continue selling the information even after the victim is aware that they have been compromised. This isn’t just about compliance anymore. Today, it can be assumed your network has been or will be compromised. While we should still try to prevent this from happening, it’s now more important to be able to detect and respond to these threats. Most organizations feel a false sense of security in believing that having a firewall with endpoint security is enough. In today’s environment, it isn’t.

 REVENTION – Firewall, anti-virus, P spam filtering, patch management and use policies

It is important that these areas have continuity in order to truly mitigate risk. Don’t wait until your practice has become a victim. Your patients, your business and your reputation are at risk. It’s time for healthcare to improve its cybersecurity standings. ■

DETECTION – Real-time analysis of

John Hohn is Solutions Development Manager

security alerts using security information and event management services

with Rapid City-based Golden West Technologies.

The following three elements are critical in developing a comprehensive security plan.

R ESPONSE – Documented and practiced set of policies, processes and procedures to adhere to in the event of a security breach


“ 8

I f we could sell our experiences for what they cost us, we’d all be millionaires.

— Abigail Van Buren

Midwest Medical Edition

211 Walnut St. Yankton, SD 57078  605-260-1520

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 aware 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”.

November 2015


Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA Bob Sutton will serve as Executive Vice President and Chief Human Resources Officer at Avera Health, effective Feb.

1, 2016. Most recently, Sutton served as Regional President and CEO of Avera St. Mary’s Region which includes operations for Avera St. Mary’s Hospital, Avera Gettysburg Hospital, two longterm care facilities and a multispecialty clinic. Todd Forkel, Regional President and CEO, Avera St. Luke’s Region, will serve in the interim leadership role for Avera St. Mary’s. ● Pre-Diabetes classes are now being offered at Avera Queen of Peace Hospital with a series of two classes, one on November 18 and one on December 16. No physician

referral is required. Please call 995-2260 or 995-2525 for more information and to pre-register. ● Gareth Davies, PhD, Chief Scientific Officer and Scientific Director at the Avera Institute for Human Genetics, has been

appointed as visiting professor in the Department of Biological Psychology within the Faculty of Behavioral and Movement Sciences at the Vrije Universiteit, Amsterdam, the Netherlands. Avera’s longstanding partnership with VU has resulted in tens of thousands of DNA samples that AIHG is analyzing for the Netherlands Twin Register (NTR), the world’s largest twin study. ●


St. Michael’s Hospital Avera in Tyndall, South Dakota held a

dedication ceremony and blessing on September 2nd for a new addition that includes 12 patient rooms, a family support/hospice room, urgent care and infusion therapy, as well as a new chapel, nurses’ station and hospital pharmacy. Construction of the 7,000-square-foot, $2 million project started last summer. ● Julie Reiland, MD, Breast Surgeon with Avera Medical Group Comprehensive Breast Care of Sioux Falls,

presented on Techniques for Reconstructing Partial Mastectomy as part of the American College of Surgeons 2015 Clinical Conference Oct. 3-8 in Chicago. Oncoplasty is an approach that combines removal of the lump with plastic surgery techniques to make the breast look better. Some 30 percent of women are dissatisfied with their breasts after breast cancer surgery, compared to only 7 percent after oncoplasty. ● Avera McKennan Hospital & University Health Center and Avera St. Luke’s Hospital of Aberdeen have been awarded Community Value Leadership Awards by Cleverley + Associates, based in Columbus, Ohio. Avera McKennan was the

only hospital in South Dakota named to the Community Value 100 Hospitals list in 2015. This is a listing of the 100 hospitals that achieved the highest scores in their respective size/geographic group. ●

Avera Heart Hospital is the first in the region to adapt the Volcano SyncVision, which

syncs two technologies that help heart specialists get clearer views of diseased arteries and more precisely place stents. Volcano SyncVision provides both an angiographic roadmap and intravascular details from the ultrasound. This co-registration provides detailed and accurate measures of vessel size and lumen, plaque area and volume, and the location of key anatomical landmarks. ● The Vascular Lab at Avera McKennan Hospital & University Health Center has achieved re-accreditation for Vascular Testing through the Intersocietal Accreditation Commission. Accreditation

includes a detailed self-evaluation and completion of the application, which requires detailed information on all aspects of facility operation as well as the submission of actual case studies for review. ● Walking Forward has received a $50,000 donation from the Pink Pony Fund of the Polo Ralph Lauren Foundation.

Walking Forward is a South Dakota-based research program that is using innovative ways to address the gaps in cancer care, prevention and outcomes between the American Indian and non-American Indian populations living in the Northern Plains. Walking Forward is part of Avera’s Molecular and Experimental Medicine Program at the Avera Cancer Institute Sioux Falls. ●

Avera Sister James Care Center and Avera Yankton Care Center recently received the Excellence in Action award from My InnerView by National Research Corporation.

This honor recognizes long term-care and senior living organizations with overall resident or employee satisfaction scores that fall within the top 10 percent of the My InnerView product database. ● Avera McKennan Hospital & University Health Center is the exclusive site in South Dakota to offer a new non-surgical and incision-free weight loss system.

This new minimally-invasive weight-loss procedure, called the ORBERA Intragastric Balloon by Apollo Endoscopy, Inc., was recently FDA approved and will be performed by board-certified surgeons, Brad Thaemert, MD, and David Strand, MD. ● The Yankton Sioux Tribe in collaboration with Avera plans to open a state-of-theart dialysis center in Wagner, South Dakota in early 2016.

The new center will have eight patient stations, and will be located in a former clinic on Highway 46. Once the center is remodeled and equipped, Avera Dialysis will lease the center, and provide for staff and management of day-to-day operations. ●

Midwest Medical Edition

Casey T. Swenson, MD, and Garrett R. Cox, MD, Radiologists, have joined the Avera Queen of Peace Medical/Dental Staff.

Dr. Swenson earned his MD at Washington University School of Medicine, St. Louis, and completed a family medicine residency in Duluth and a Diagnostic radiology residency at the University of Iowa. He recently completed a fellowship in Neuroradiology at the University of Iowa. Dr. Cox earned his MD at USD School of Medicine and completed an Internship in Radiology and a residency in Diagnostic Radiology at Southern Illinois University School of Medicine. He completed a fellowship in Musculoskeletal Radiology at the University of California, San Diego. ●

Avera announced plans in September to break ground on a new primary care clinic that includes the state’s first free-standing emergency department. The new emergency

department will be part of a threestory, 70,000-square-foot Avera Family Medical Center, to be located at 28th Street and Marion Road in Sioux Falls. The ED at this location will be equipped similarly to a hospital emergency room and will be staffed 24/7 every day. ●

November 2015

BLACK HILLS Regional Health honored three caregivers in October as part of the “I Am Regional Health” campaign. The individuals are:

Kathy Young, RN,

a wound ostomy nurse in Spearfish;

Lanny Reimer, MD, a family

medicine physician in Newcastle and Upton, Wyoming; and Tina Scott, a radiation therapist at

the Rapid City Regional Hospital Cancer Care Institute. Joy M. Falkenburg, MD, recently received the prestigious University of South Dakota Sanford School of Medicine 2014-2015 Edward J. Batt, MD, Memorial Award for Outstanding Faculty Member during a surprise celebration at Custer Regional Hospital.

The award recognizes Dr. Falkenburg’s years of exceptional work with medical students during their rotations in Custer. Susan M. Anderson, MD, Associate Professor and Chair of the USD Family Medicine Department, presented the award. ●

The Regional Health Foundation and Prairie Berry Winery hosted the sixth annual Pink Slip Ball on October 3rd at the Homestead at Prairie Berry Winery in Hill City. This

community event benefitted the Regional Cancer Care Institute at Rapid City Regional Hospital. Pink was the featured color of the evening with pink décor, food, drinks and pink items available for auction. Several different live musical acts also performed. ● In response to growing demand for after-hours care, Regional Urgent Care has extended its Saturday and Sunday clinic hours. The facility will now be

open to see walk-in patients 7 a.m. to 7 p.m., 7 days a week. ● Regional Health Heart and Vascular care has received the Platinum award for the ACTION Registry from the American College of Cardiology for the second consecutive year. The

award is the highest achievement in measuring performance for heart attack patients. ● Spearfish Regional Hospital (SPRH) now offers chemotherapy treatment in the Northern Hills, improving

access to care and decreasing travel time for patients. Michael Robinson, MD, oncologist at the Rapid City Regional Hospital Cancer Care Institute in Rapid City, conducts clinic at SPRH twice a month. ●

Regional Health is pleased to announce the addition of four physicians and two caregivers.

The new physicians include:

Margaret Becker, MD, a board

certified physician in family medicine

Daniel Berens, DO, a board

certified physician in family medicine

Bhaskar Purushottam, MD, a board

certified physician in cardiology

Joshua Sole, MD,

a board certified physician in physical medicine and rehabilitation and sports medicine Troy Thompson, PA-C, family


Kelli Kartak, CNP,

family medicine


Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes SANFORD

Sanford Heart Hospital in Sioux Falls has received the Mission:

Lifeline Receiving Center – GOLD PLUS Level Recognition Award for implementing specific AHA quality improvement measures for the treatment of heart attack patients.This is the sixth consecutive year Sanford Heart Hospital has received this award. ● Hub City Radio in Aberdeen teamed up with the Children’s Miracle Network in October for the Fifth Annual Hub City Radio Power of Hope Radiothon presented by NVC. Proceeds

from the event benefit Children’s Miracle Networks and Sanford Children’s Hospital in Sioux Falls.During the 24-hour event, hosts from Sunny 97.7, Point FM 106.7 and Pheasant Country 103.7 broadcasted live from Sanford Children’s Aberdeen Clinic. Last year’s event raised more than $46,000. ● Construction began in September on a 100,000-square-foot building dedicated to Sanford Imagenetics, a program that integrates genomic medicine with primary care for adults.

When completed, the threestory building at 22nd Street and Grange Avenue will house a long list of services, including general internal medicine, medical genetics, genetic counseling, medical genetics laboratories (cytogenetics and molecular genetics), radiology and patient access management. The building will also have a new dialysis center. ●


Sanford Aberdeen recently welcomed three new physicians to its team. Rahel Alemu, MD, is a

board-certified interventional cardiologist. She received her medical degree from Addis Ababa University in Ethiopia and completed her internship and residency at Texas Health Presbyterian Hospital in Dallas. She completed a fellowship at Virginia Commonwealth University in Richmond and is board certified in both internal medicine and cardiovascular disease. Mesfin Abera, MD, specializes in internal medicine. He also received

his medical degree from Addis Ababa University and completed his internship and residency at Virginia Commonwealth University in Richmond. Jason Spjut, DO, will perform a variety of inpatient and outpatient surgical procedures in Aberdeen,

including colonoscopies, laparoscopic and endoscopic procedures, and hernia repair. Spjut earned his medical degree from Des Moines University and completed an internship and residency at Mercy Medical Center in Des Moines, Iowa. ● The Denny Sanford PREMIER Center/SMG has partnered with the Edith Sanford Breast Foundation to develop the Edith

Sanford Firefly Guitars display, which features custom-designed guitars signed by performers who have headlined at the venue. The Edith Sanford Firefly Guitars display was unveiled in September. ●


CNOS, PC is pleased to announce that Dr. Daniel Nelson is now board certified by the American Board of Orthopaedic Surgery. This

certification is valid until 2025. Originally from South Dakota, Dr. Nelson holds a bachelor’s degree from Dakota Wesleyan University in Mitchell and an MD from the USD Sanford School of Medicine. He completed his residency and internship at the University of Oklahoma Health Sciences Center and completed adult reconstruction/joint replacement fellowship training at the Southern Joint Replacement Institute/Vanderbilt University in Nashville. ● Mercy Medical Center has announced the addition of Dr. Vinod Khatri, MBBS, MD to the Critical Care Intensivist Team. Dr. Khatri

earned his MD from Bangalore Medical College. He did his residency in Internal Medicine at St. Francis Hospital in Evanston, Illinois and completed fellowships in Critical Care Medicine at the Mayo Clinic in Jacksonville, Florida and Pulmonary Medicine at Chicago Medical School. Dr. Khatri is board certified in Internal Medicine and Pulmonary Disease and is eligible for board certification in Critical Care Medicine. ●

Mercy Medical Center-Sioux City is has introduced a new and comprehensive 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. ● Diane Prieksat has been appointed Vice President of Professional and Quality Services for Mercy Medical Center-Sioux City. Prieksat most recently

served as Mercy’s Director of Quality, Informatics and Medical Staff Services since 1999. She will provide executive leadership, direction and strategic planning for Quality & Outcomes Management, Infection Control, Patient Safety, Risk Management, and other areas. ● The Hawarden Regional Healthcare Diabetes SelfManagement Education Program in Hawarden has been awarded Recognition from the American Diabetes Association (ADA) effective July 2015. Programs that

achieve recognition status have a staff of knowledgeable health professionals who can provide state-of-the-art information about diabetes management for participants. ●

Midwest Medical Edition

Mercy Medical Center dedicated and unveiled a new bronze relief sculpture in October celebrating Mercy’s 125 years of “Caring for You!” The piece was

created by artist Dale Lamphere who is known for the United 232 Memorial Sculpture at the Sioux Gateway Airport. It was paid for by a grant by the Gilchrist Foundation, the Mercy Foundation and board members of Mercy Medical Center and Mercy Medical Center Foundation. The piece is located at the 5th St. Circle Drive entrance. ● Longtime Siouxland leader Sister Elizabeth Mary Burns will be the recipient of the prestigious Dr. George G. Spellman Annual Service Award. The award will be

presented to Sr. Burns at the Mercy Foundation’s annual gala on Saturday, November 7 at the Marina Inn and Conference Center in South Sioux City. Burns retired from Mercy Medical Center in 1987 as the President and CEO. She was one of Siouxland’s first female healthcare administrators and paved the way for other women in the industry. ● Sarah Bligh, MD, has joined UnityPoint Clinic Gastroenterology.

Bligh received her MD from the USD Sanford School of Medicine and completed a residency in internal medicine and a fellowship in gastroenterology at the University of Nebraska Medical Center in Omaha. UnityPoint Clinic Gastroenterology is a new service provided to patients for the management and treatment of diseases of the gastrointestinal tract and liver. ●

November 2015

Mercy’s Cardiac Rehab program, which is housed in the

UnityPoint Health – St. Luke’s has announced Tammy Hartnett as Director for Human Resources. In

Mercy Heart Center in downtown Sioux City, earned the three year recertification following a rigorous review that verified its clinical practices. ● Sandeep Gupta, MD, has joined UnityPoint Clinic Pulmonology and Critical Care.

Gupta received a Bachelor of Medicine, Bachelor of Surgery degree from Sawai Man Singh Medical College in Jaipur, Rajasthan, India and a Master in Public Health from San Diego State University. He completed a residency in Internal Medicine at Tufts University in Boston and a fellowship in Pulmonary and Critical Care at the State University of New York. ● The Baum Harmon Mercy Hospital Diabetes SelfManagement Education Program in Primghar has been awarded Recognition from the American Diabetes Association.

The ADA Education Recognition is a voluntary process which assures that approved education programs have met the National Standards for Diabetes SelfManagement Education Programs. ● Mercy Medical Center—Sioux City provided $16.3 million in community benefit and UnityPoint Health–St. Luke’s another $10.4 million in community benefit according to a recently completed assessment by Iowa Hospital Association (IHA). The IHA report shows that

her new position, Hartnett will focus on employee engagement and retention as well as career, organization, and leadership development. She will also lead the human resources department at St. Luke’s. Hartnett has been employed at St. Luke’s for fourteen years in the human resources department. Previously she served as an Employee Relations Manager and as a Benefit/Compensation Coordinator. ● The June E. Nylen Cancer Center celebrated National Breast Cancer Awareness Month in October with educational material and pink ribbons and a reminder that the Center offers a free mammogram screening program to focus on early detection. Serving Our Sisters

(SOS) funds provide free screening mammograms for women in need or without insurance. , applicants must meet the financial guidelines, have a physician or referring agency, and be 35 or older. ● The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) has re-certified the Cardiac Rehabilitation Program at Mercy Medical Center-Sioux City.

Iowa hospitals provided community benefits in 2014 valued at over $1.2 billion. Community benefits include such services and programs as health screenings, support groups, immunizations, nutritional services and transportation programs. ●

Revathi Truong has been appointed Volunteer and Community Health Specialist at Mercy Medical Center-Sioux City.

Truong will lead the development and recruitment of Mercy’s volunteer program. She will also be responsible for growing and developing community health outreach programs, events and activities along with managing and facilitating special projects. ●


Prairie Lakes Healthcare System has received the American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Platinum Performance Achievement Award for the third consecutive

year. This award recognizes Prairie Lakes’ commitment and success in implementing a higher standard of care for heart attack patients. ● Prairie Lakes Healthcare System was recently recognized as a top-ranked Community Value Provider by Cleverley + Associates, a leading healthcare financial consulting firm specializing in operational benchmarking and performance enhancement strategies. The listing was part of

the new publication, State of the Hospital Industry - 2015 Edition. ●


Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Prairie Lakes Healthcare System welcomes Ferdinand E. K. Addo, MD, oncologist and hematologist.

Dr. Addo is board certified in medical oncology, hematology, and internal medicine and He served patients in Bismarck, North Dakota for over twenty five years. Dr. Addo received his medical degree from University of Ghana Medical School and completed residency at Howard University Hospital in Washington, DC, and fellowships in both oncology and hematology at Washington Hospital Center in Washington, DC. ●


Yankton Medical Clinic, PC, is pleased to announce the association of April K. Willman, MD, FAAP, a board certified pediatrician.

Dr. Willman is a graduate of the USD Sanford School of Medicine. She completed her residency training at the University of Missouri in Columbia. ●

LifeScape welcomes Sanford Children’s physician Kathryn Sigford, MD to its team, providing rehabilitative medical care for children and adults through outpatient and residential programs. Sigford is

a physiatrist, as well as a specialist in physical medicine and rehabilitation. Prior to joining LifeScape, Sigford completed her Pediatric Rehabilitation Medicine Fellowship through the University of Minnesota. ●

Melissa Carrier-Damon of LifeScape is now licensed as a Board Certified Specialist in Swallowing and Swallowing Disorders (BCS-S).

A BCS-S specialist provides appropriate evidence-based treatment techniques to address the swallowing problems of each individual, based upon the comprehensive swallowing assessment. Carrier-Damon is the first Speech-Language Pathologist in the state of South Dakota to become a BCS-S. ●

Midwest Medical Edition

Courtney Ehlers, MSN, CPN, director of Women and Children’s Services at Avera McKennan Hospital and

The more we get together, the happier and healthier we’ll be.

University Health Center in Sioux Falls, has been elected to a three-year term on the Make-A-Wish South Dakota Board of Directors. Ehlers will help Make-AWish toward its vision of granting wishes to every eligible child in South Dakota. ●

Opens Avera McKennan NICU

State-of-the-A rt

You Snooze

YOU . . . WIN


SOUTH time happiness, can spend more key measures of average is several efficiency, so nurses website TAL & All patient personal finance and educat ion. NNAN HOSPI according to the in patient care AVER A MCKE was celean in-depth a mobile cart that Center recently site conduc ted WalletHub. The rooms will have University Health states new l team. its happy menta of least g depart and openin most multianalysis of the designed by a brated the grand ) on Dakotans s and equip(NICU South Unit supplie that with Care found ed ve in America and Carts are equipp Neonatal Intensi adequate l. top in getting workspace. of the main hospita rank at the very ment as well as the fourth floor rates of ized unit is 16,500 Footpr ints, Big Hearts states have lower special Little three its h million Only $7 Throug The sleep. s the and only 5 t the new NICU, South Dakota Its new design feature depression than campaign to benefi square feet in size. its doors Found ation is near volunteerism. with frosted glass beat the state in Avera McKe nnan all private rooms to the space, that are home of $2 million. ■ s to have their own To find the states fundraising goal that allow familie new compared of care staff. The ans, WalletHub happiest Americ yet be within view that Columbia of areas the District er two NICU the 50 states and unit brings togeth set ranges floors, and data Our fourth . and third across 25 key metrics are currently on levels to that is health to income t third-floor unit from emotional replaces the curren floor rates. The current fourth sports participation 4,000 square feet. as overflow space. INGS unit will be kept , DAKOTA RANK and focus groups OTHER SOUTH “Based on site visits g.) s can be (1=Best; 25=Av unit so that parent r Score we designed our in intimate 9th – Hedonomete their baby’s care ent Rate more involved in ploym is Unem There erm 8th – Long-T very beginn ing. space from the Rate a sense of 7th – Divorce family, yet still h Rate privacy for each NICU 5th – Income Growt suppor t from other cohesiveness and r of ey Ehlers, Directo please visit: families,” said Courtn For the full report, Services at Avera edu/ en’s allethu Childr and http://w Women’s merica /6959/ ast-happy-states-in-a most-le nan. McKen d by the unit are groupe The 31 rooms of staff orhoods, both for color in three neighb nity. Two sense of commu efficiency and a and twins, ly equipped for rooms are special total , bringi ng the ann one room for triplets tralJeana Goosm to 35 babies. Decen ing Scott Leuning capacity of the unit CEO & Manag orhood Attorney Partner s in each neighb ized nurse station of t Over 20 Years immediate contac in stay to Health Law allow nurses Marie Ruettgers families. Experience and s ing patient with Manag latest incorporate the Attorney The new unit will e l Giraff 9 Years in Hospita logy, includ ing stration NICU techno l Admini optima room, for an OmniBeds in every ature and terms of temper environment in humidity. ed includes an enhanc Other technology and doctors, a nurses for system monitoring receive in which care staff new call system of monitor phones in case alerts on their and an of a call button, alarms or the push nnLa m badges www .Goo sma , Suite 100, Sioux Falls, SD ID system with photo advanced visitor ota Avenue 5010 S. Minnes safety in the unit. for patient and family prior to construcAn Innovation project ed staff enhanc les princip tion based on Lean st Medical Edition

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Interprof The RISE of

By Peter Carrels

Interprofessional care  occurs when multiple health workers from different professional backgrounds provide comprehensive health services by working with patients, their families,  caregivers, and communities to deliver the highest quality of care across settings. —World Health Organization

Interprofessional education occurs when learners of two or more health and/or social care professions engage in learning with, from, and about each other to improve collaboration and the delivery of care. — Institute of Medicine of the National Academies


Midwest Medical Edition

fessional s Care South Dakota Leads the Nation in a Team Approach to Medicine


R. WENDELL HOFFMAN was an early, active and visible South Dakota advocate for interprofessional training and practice in healthcare. According to Hoffman, an infectious disease specialist at Sanford Health and a highly regarded advocate for improved patient care, many physicians learn by pragmatic necessity the value of interprofessionalism as they provide care to their patients. “The first person most physicians talk to each morning is a nurse,” explains Hoffman. “That’s basic interprofessional practice.” But Hoffman worried that unless a concerted effort was undertaken by educational institutions, healthcare systems and others the advantages of expanding and increasing interprofessional relationships, consultation, and practice would not be better realized. He especially encouraged interprofessional education, so healthcare professionals could hit the ground running once they finished school and started work in the real world where patient outcomes aren’t hypothetical.

November 2015


The National Center for Interprofessional Practice and Education

An estimated 70 percent of healthcare errors are due to poor communication. In simulations like this one, professionals from multiple disciplines can work on not only their medical skills but their interprofessional communication skills, as well.

The Interprofessional Movement in South Dakota That is exactly the type of effort –focused, measured and determined - characterizing the newly invigorated campaign to propel the interprofessional movement in South Dakota. The campaign got a big boost and elevated levels of responsibility and opportunity last June when the University of South Dakota, representing South Dakota’s Interprofessional Practice and Education Collaborative (SD-IPEC), signed a Memorandum of Agreement (MOA) with the National Center for Interprofessional Practice and Education. SD-IPEC is the statewide group working to advance interprofessionalism in South Dakota. Dr. Carla Dieter, chair of the Nursing Department in the School of Health Sciences at the University of South Dakota, also serves as chair of SD-IPEC. “We are now part of a national effort to contribute to the measurement of the interprofessional education and practice through affiliation with the National Center,” says Dieter. “By working with the national center we can tap into resources that will help propel our work forward on a broader scale as well as contribute to the National Center’s Data Repository. It is exciting to be part of this important national effort.” 


Leading a National Effort South Dakota is one of only 11 states to have formalized a relationship with the national organization, and South Dakota’s level of statewide organization is a rarity among states. Out of the 11 member states, only South Dakota’s and Arizona’s initiatives involve multiple educational institutions, and South Dakota is the only member state involving practice partners in their membership. It is not hyperbole to observe that South Dakota’s initiative to advance interprofessional education and practice rates as among the most aggressive and resourceful in the nation. Carla Dieter and her colleagues in SD-IPEC are leading a singularly unique effort that has elevated the state to national prominence. One of SD-IPEC’s objectives is to further and appropriately broaden those participating in the effort. The group recognizes that the state’s rural composition and its diverse and far-flung constituencies demands greater engagement and participation. That means communities, community organizations, and local and state governmental representation in SD-IPEC is imperative. Whereas some states are pursuing interprofessional health care emphasizing specifically parochial locales, South Dakota is doing just the opposite. It truly is a statewide effort.

The National Center and its Nexus Innovations Network are housed at the University of Minnesota, in Minneapolis. The Center was founded in 2012 to provide leadership, resources and evidence to advance interprofessional healthcare across the country, and it functions as a unique public-private partnership with funding from the Health Resources Services Administration (HRSA), the University of Minnesota, and the three private foundations: Josiah Macy Jr. Foundation, Robert Wood Johnson Foundation, and the Gordon and Betty Moore Foundation. Barbara Brandt, PhD, director of the National Center has been keenly interested and involved in South Dakota’s interprofessional initiatives, and she is delighted with the state’s direction and progress. “South Dakota,” said Brandt, “provides us a unique opportunity to see the potential of a unified, statewide collaborative of higher education and health system partners working towards the shared goal of improved population health.”

The Need for Interprofessionalism The need for interprofessional education and practice in healthcare is convincingly and poignantly described by Dr. Dieter. “Current research shows that ineffective communication among healthcare professionals is a leading cause of medical errors,” she says. ”This requires a response in how we educate healthcare students. By providing opportunities for students to learn together, they not only understand each other’s roles, but recognize the expertise of each team member and the value of their contribution.” “The ultimate goal is to educate students interprofessionally so that it becomes so ingrained in their nature to work together that when they enter practice it will translate into sound interprofessional practices and produce positive patient outcomes,” says Dr. Dieter.

Midwest Medical Edition

Photos courtesy USD Sanford School of Medicine

systems, government, regulatory bodies and commu n it y-based organizations f rom across South Dakota. This meeting was Dr. Wendell Hoffman Dr. Carla Dieter especially meaningful for several reasons. For the first time educators, practitioners and others involved in healthcare and public health were able to learn what was happening in a broad scale across the state The History of in matters related to interprofessional educaInterprofessionalism tion and practice. It was also an opportunity in South Dakota for participants to discuss their visions about The history of the interprofessional interprofessional education and practice, movement in South Dakota does not date and to discover shared perceptions and back far. As Dr. Wendell Hoffman was objectives. urging greater interprofessional progress Barbara Brandt of the National Center in the state leadership at the University of gave the Summit’s keynote address, and she South Dakota’s School of Health Sciences and Carla Dieter developed a close working recognized the need to begin organizing to relationship. accomplish that movement. In 2012 Carla Dieter organized her Establishment of the SD-IPEC colleagues in the USD School of Health The Summit also led to the establishSciences into a group they called IPE ment of South Dakota’s Interprofessional (Interprofessional Education) Champions, Practice and Education Collaborative a collective that included Dr. Michael (SD-IPEC), and that group’s mission is Lawler, dean of the School of Health straight-forward and ambitious: Organize Sciences, Dr. Bruce Vogt, director of and implement IPE efforts throughout USD’s Area Heath Education Center South Dakota. This is the group Dieter (AHEC), and leadership from the departwas selected to lead. It is a dedicated and ments of nursing, physical therapy, medical ever-evolving team comprised of health laboratory science, physician assistant studeducators and leaders from institutions ies, addiction studies, dental hygiene, across the state. occupational therapy, and social work. Key members of the group include the The group discussed matters of interUniversity of South Dakota, Augustana disciplinary education and how student University, Dakota State University, South education could be improved by collaboraDakota State University, Avera Health, and tion between departments, and the use of Sanford Health. The group organized cominterprofessional concepts and curriculum. mittees investigating various outcomes of Their deliberations led to a 2013 statewide interprofessionalism, and an advisory coungathering titled an Interprofessional Educacil has been formed to serve as a sounding tion Summit that was held in Chamberlain, board for the core team and also to allow South Dakota. team members access relevant expertise and The so-called “Summit” was attended to provide important connections to those by approximately 125 leaders and representain influential positions in South Dakota. tives from academic institutions, healthcare

November 2015

The Future of the Interprofessional Movement Next steps for the interprofessional effort in South Dakota are conducting projects that include interprofessional teams and specific objectives. These projects are pursued under the title “Nexus Innovations Network Projects”. The National Center approves Nexus projects and through these projects seeks to test new ideas and drive sustainable national change in healthcare and health professions education. A handful of projects are already planned or underway. It’s tempting to dismiss interprofessionalism as a trendy idea or some dreamy, ivory-tower-type healthcare application. But if you do so you’d be wrong. Interprofessional healthcare is serious and sincere business. It’s the next progressive step in an evolving approach to healthcare. Interprofessional might be a clumsy word, but through its training and practice it is intended to streamline and improve the delivery of healthcare services. At its root is the genuine intention to better serve patients. ■ Peter Carrels is Communications Coordinator for the University of South Dakota and the USD Sanford School of Medicine.

“The ultimate goal is to educate students interprofessionally so that it becomes . . . ingrained in their nature to work together,” says Dieter.


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Midwest Medical Edition

The Case for Collaboration By Laurie C. Drill-Mellum


S THE HEALTHCARE INDUSTRY RELIES more on advanced practice providers, how can we increase our effectiveness while minimizing risk? As chief medical officer at MMIC, I am immersed in the world of medical malpractice and an increasing volume of patients. It is through that lens that I view what is occurring in our industry. I note, for example, an increasing shortage of primary care providers. In the emergency medicine world, the shortage of physicians and the quest to provide more cost-effective, high quality care have led to more advanced practice providers (APPs) working in emergency departments (EDs), as well as the development of “medical homes” that enlist multi-disciplinary teams to deliver care. I see how these stressors play out in increased physician burnout, lack of engagement, strained communication, unspoken conflict, and short-changed patients . . . in a phrase: increased risk. Even as we accustom ourselves to the unfamiliarity of this changing landscape, we also need to think in new ways about risk, as more players become involved in providing care, and new relationships are forged among them. It is increasingly apparent that collaboration among members of these newly constituted health care teams will be key to realizing the promise and benefits of these new models, while minimizing their associated risks.

What are the risks? We are seeing more claims against APPs but there are more APPs providing care, so we would expect that. Whether the increase is disproportionate is harder to determine, primarily because many claims against APPs are dropped owing to the deeper pockets imputed to the supervising MDs, hospitals or clinics insuring the APP. It is more revealing to look at the causes of loss specified in those claims. In reviewing malpractice data from emergency medicine, where physician assistants or nurse practitioners have been named in claims or lawsuits, one thing quickly becomes evident: APPs who provide urgent and emergency medical care have many of the same “underlying causes of loss” as physicians do.

We found that, for physicians and APPs alike, the three most frequent causes of loss specified in claims are:

 elayed or missed diagnoses D Accounting for about 50 percent of paid expenses for the investigation, defense and indemnity (or payment) to the plaintiff, the majority of these cases ended in a permanent injury or death.

 reatment-related allegations T Accounting for about 30 percent of closed claims, allegations include failure to initiate the appropriate treatment, improper or negligent performance of a treatment, and improper or delayed medical management in a variety of scenarios.

Medication-prescribing allegations Including failure to recognize known contraindications to the use of certain drugs in certain clinical circumstances, dangerous adverse drug interactions, wrong medication, wrong dose, and mismanagement of patients on long-term anticoagulation therapy.

We encourage providers to do several things that research has shown reduces risks in the above areas, including:

♦ ♦ ♦ ♦

Developing better systems for tracking abnormal lab data Ensuring appropriate follow-up or consultation Developing clearer evidence-based practice guidelines Focusing on improving communication with patients and among members of the healthcare team

This last point is more important than many healthcare practitioners realize; miscommunication is an underlying cause of loss in 80 percent of malpractice cases. Not only does working effectively together reduce the risk of lawsuits … it can lead to increased patient safety and better outcomes. And MMIC can help with that. ■ Laurie C. Drill-Mellum, MD, MPh, is Vice President and Chief Medical Officer at MMIC.

This article originally appeared in the Winter 2014 issue of Brink, a quarterly risk solutions magazine published by MMIC. Published with permission.

November 2015


Top administrators from a number of health systems around the region were invited to participate in this series. This article includes insights from the following respondents (listed alphabetically): Jill Fuller, President and CEO, Prairie Lakes Healthcare System, Paul Hanson, President, Sanford USD Medical Center, Jason Merkley, CEO, Brookings Health System, Brent Phillips, President and CEO, Regional Health, Fred Slunecka, COO, Avera Health

Jill Fuller

Paul Hanson

Jason Merkley

Brent Phillips

Fred Slunecka



Fred Slunecka

Avera Health

Fragmentation has been a hallmark of healthcare delivery in the United States and a source of inefficiency and excessive expenditures. Integration is the key to success. Integrated delivery systems can improve care coordination, reduce waste and service duplication, and improve health outcomes. The success of integration depends largely on how systems work together with physicians and other clinical staff by developing shared goals and visioning as well as how well the system can operationally align service delivery and patient experience. One key way we ensure integration at Avera is through dyad physician-executive leadership in our medical group and through our service lines. Workforce shortages, continuing cost inflation and service demand intensify the call for more effective and efficient use of resources. There will be no new money, so there’s increased pressure to get more out of the dollars we do have. Everyone will need to work smarter and more closely together.



Jill Fuller

Prairie Lakes Healthcare System


By Alex Strauss

Collaboration is our greatest opportunity. As we move into population health, we will need to partner with providers outside our own systems and organizations in order to reduce costs and improve outcomes.

Midwest Medical Edition

Part Two

Future Healthcare THE


Brent Phillips Regional Health

Sanford USD Medical Center

There are opportunities in genomics, regenerative medicine and applications for improving the quality of life. Another great opportunity is the fact that healthcare is moving from a treatment-only approach to a more balanced approach, focusing on prevention, education and treatment.

Jason Merkley

Brookings Health System The greatest opportunity is collaboration within and amongst all providers who care for and impact the patient, from the patient’s primary care provider, specialty physicians, hospital and ancillary staff to post-acute providers such as assisted living, skilled nursing, home health and everyone else in between. The structure and business strategy associated with “collaboration” can and will have many different faces of success. That said, I think the rural market will continue to see alignment and creative partnerships between hospitals, providers and others who are continuing to search for more efficient ways to care for patients.

November 2015

Choosing your partner, either professionally or personally, is one of the most important decisions that you will make in your career and life. An aligned mission and vision begin to set the course and expectations of organizations seeking integration. In addition, the move from fee-for-service to value-based services demands standardization, mass customization and safe and reliable systems and processes. This shift will challenge the historical perspective that more is better. Finally, full implementation of the ACA will continue to drive patient engagement and shift costs to the consumer. Consumers have already become more active and engaged in their care – and expectations are changing – to a heightened focus on quality healthcare that is more conveniently accessible. Relationships will become more and more virtual as systems deliver on these consumer demands. The mantra, ‘It’s your health, so take control of it,’ will continue to inform healthcare delivery models.

“ “

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Midwest Medical Edition

Retaining Your Key Employees

A Low Cost Solution By Christie Finnegan


HE KEY to success for every healthcare business, whether it is a hospital, multi-practice clinic or single practitioner is having a well-trained and professional staff. Training costs, employee engagement, burn out, retention strategies and limited talent pool are the top concerns that healthcare professionals consistently raise regarding retaining their key employees. There are many models and ways to arrange your benefits plans that take into consideration structure, tax impact and cash flow needs when creating your total rewards program. But there is sometimes an alternative, less expensive benefit that helps retain key employees and drive lifestyle behavioral changes.

Help manage your employees’ stress The latest research shows employee health directly influences employee work behavior, work attendance and on-the-job performance. Stress is the identified risk factor for 43% of the annual medical costs in low risk adults. So what is causing your employees stress? According to PricewaterhouseCoopers’ (PwC) 2015 Employee Financial Wellness Survey and the Society for Human Resource Management’s (SHRM) 2011 Promoting Well Being Report, one key aspect is their finances:

♦ ♦

Nearly one-third of employees earning $100,000 or more consistently carry balances on their credit cards 51% of employees worry about not having enough savings for an emergency expense

November 2015

33% of the nation’s full-time employees have difficulty meeting their monthly expenses

20% of employees are using credit cards for monthly necessities they otherwise could not afford

Only 43% of the workforce feels they will be able to retire when they want

Only 37% of employees have a Will. The percentage of those who have a Will increases with age, but even by age 55 to 64, only 56% have a Will

Nearly half of employees find dealing with their financial situation stressful. 35% report that their stress level related to financial issues increased over the last 12 months

37% say that at work each week, they spend 3 hours or more dealing with issues related to their personal finances.

Simply providing your employees with a higher salary is not realistic. What you can give your key employees is access to knowledge to help educate them and empower them to overcome the personal stresses that could be impacting their productivity in your business or healthcare organization.

Educate and empower your team on-site One low-cost solution to address this financial stress is to provide personalized information to help your employees make more educated decisions. Most organizations share a benefit overview annually. But just as you look at your employee population’s

most-pressing health issues, look at which of your benefits are being left on the table. When you know what your key employees are not taking advantage of within the options they have, proactively educate them on how to maximize the value of their compensation and benefit program.

Be proactive in providing peace of mind and gain loyalty In the long run, helping your key employees become educated and empowered to handle what causes them the most stress outside of work will improve their health, and thus improve their performance and your bottom line. But at its core, helping to provide your key employees peace of mind in their personal lives will be an intangible that helps increase their loyalty to your company because as the commercial says, “peace of mind . . . priceless.” ■ Christie Finnegan is the Executive Director of Estate Planning for Goosmann Trust Law Counsel, a part of Goosmann Law Firm. She was a healthcare professional for 15 years.

For some additional strategies to keep good employees happy with valuable education, see the full article on our website.


Tax Saving Strategy Using a deceased spouse’s DSUE to save potential estate taxes By Kevin Eggebraaten



Renee to avoid possible estate tax

now she is worth $10,000,000. Renee’s

bility is required to file an

issues after her death.

estate would owe estate taxes on

estate tax return (Form 706)

In our example, if the executor of

$2,140,000 less any inflation adjust-

even if the estate has a value

Kevin’s estate makes a decision to file

ment for her unused exemption. On

less than the current 2015 threshold of

for portability this allows Renee to

$2,140,000 of taxable estate her estate

$5,430,000 under Section 6018(1). Porta-

avoid estate taxes on the first

would owe over $800,000 in estate

bility is elective(2), rather than automatic,

$7,860,000 of her gross estate upon

taxes based upon the current law.

and refers to the ability of a surviving

her death. The $7,860,000 is made up

spouse to inherit the unused Federal estate

of $5,430,000 of her unused exemp-

assume that Renee remarried and her

tax exemption of a predeceased spouse.

tion as well as $2,430,000 portability

new spouse’s name is Rick. One

Why is this important? Let’s look at an

election known as DSUE.

planning opportunity, and there are


So, if all of Kevin’s net worth passes

Can this possibly be avoided? Let’s

many, would be to gift the remaining

to Renee, her net worth would be

DSUE / Portability amount of

$7,000,000 and she has available to her

$2,430,000 of the last surviving spouse

have a net worth of $7,000,000 (Kevin

$7,860,000 of exclusions. If her net

(Kevin) to the beneficiaries. She would

–$3,000,000 and Renee $4,000,000)

worth does exceed $7,860,000 at her

need to file a gift tax return to account

and Kevin passes away, there will be no

death, then her estate would not owe

for this gift. In other words, Renee

estate tax due on death. Filing Form

any income tax in our example.

doesn’t lose the DSUE / portability

If Kevin & Renee are married and

706 for portability purposes allows for

What if she lives another 5 years and

amount from Kevin until Rick dies for gift tax purposes, since it is deemed to

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Depending on Rick’s net worth, this could save Renee’s estate close to $1,000,000 in estate taxes. (2,430,000 * 40% = $972,000). If Renee doesn’t take advantage of gifting the DSUE amount from Kevin’s death prior to Rick’s death the opportunity will be lost.

Estate planning can be very complicated

IT / Compliance Auditing

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be the last surviving spouse’s death.

with your attorney and tax advisor to assure compliance and see if there may be some tax saving opportunities. Remember it is not “how much you make” but “what you get to keep or pass on” that matters. ■

Kevin Eggebraaten is a Certified Public Accountant with Casey Peterson.

Midwest Medical Edition

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November 2015


Sanford Recruiting for Ebola Vaccine Trial

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SANFORD HEALTH is seeking participants to enroll in a clinical trial testing a vaccine for the Ebola virus. The Mercksponsored study will explore the vaccine’s ability to safely generate antibodies that could protect against future exposure to the virus. The clinical trial, which is free, is open to adults age 18 to 65 who have not previously had Ebola or been in contact with someone who contracted the virus. Sanford is enrolling 30 total patients at sites in both Sioux Falls and Fargo to determine if the vaccine can trigger an immune response that might help guard against Ebola. An Ebola outbreak occurred in West Africa last year. According to the Centers for Disease Control and Prevention, Ebola is a rare virus that attacks the immune system and organs and causes internal and external bleeding. The virus, which was discovered in 1976, is highly contagious, can be transmitted by bodily fluids and currently has no vaccine Trial participants are required to receive a single shot. Ninety percent will get the vaccine, and the remaining 10 percent will receive the placebo. To monitor the body’s immune response, all participants must complete three follow-up visits during the six-month study. Enrollment is open in Fargo and Sioux Falls. For more information on how to participate, call (855) 305-5064. ■


“ 28

Be patient with patients who are not patient. — Scrubs Magazine

Midwest Medical Edition

New Tech in Sioux Falls Offers Faster Lab Results THE LABORATORY DEPARTMENT at Avera McKennan Hospital & University Health Center in Sioux Falls recently acquired an instrument that allows for rapid, accurate and inexpensive identification for bacterial and fungal organisms. MALDI-TOF, or Matrix Assisted Laser Desorption Ionization – Time Of Flight, can provide identification information up to 24 hours faster than traditional methods. After allowing a 24-hour specimen-growth period, MALDI-TOF can accurately identify bacterial or fungal specimens found in patient infections within five to 15 minutes.

Receiving the correct identification faster can allow the physician to enact a treatment plan that specifically attacks the bacteria or fungi responsible for the patient’s infection or illness even sooner. MALDI-TOF uses a laser in its ID process. After the growth period, a small amount of the patient’s sample is placed on a stainless steel plate called a target. Then, a single drop of matrix is added. When the laser strikes the sample, the bacteria float to the top. This allows MALDI-TOF to read the proteins that make up the bacteria and then match the profile in its library.

After discovering a match, MALDI-TOF then confirms its finding with a confidence rating. For example, it may report a 98-percent certainty rate that the identified bacterium is E. coli or strep or staph, etc. “We can serve a large variety of patients, from those with wound infections to sepsis,” said Avera Laboratory Operations Manager Kacy Peterson. “This technology can be used for the vast majority of patients who need infectious organisms identified.” Avera McKennan is the only clinical laboratory in South Dakota with MALDITOF technology. ■

2015 PA Salary Data Compensation for America’s physician assistants (PAs), recognized as one of the top professions in the country, continues to rise, according to new data from the 2015 American Academy of Physician Assistants (AAPA) Salary Survey. The median base salary for a PA in 2014 rose to $93,800 a year, a $3,800 increase from 2012. The survey found that in addition to salary, more than half (54%) of all PAs received monetary bonuses and more than 75 percent of PAs receive some other form of additional compensation, such as research stipends, profit sharing, student loan repayment, paid relocation, tuition reimbursement or signing bonuses. The AAPA survey provides high-quality, detailed information on PA compensation and benefits, including base salary, hourly wages and bonus, by region, specialty, employer, setting and experience.

HIGHLIGHTS OF THE AAPA SALARY SURVEY 2015: ● P As at critical access hospitals ($115,000), industrial facilities ($115,000), and hospital emergency departments ($101,920) reported the highest median compensation levels. ● P As in the cardiovascular and cardiothoracic surgery specialty reported the highest median base salary ($117,000) followed by interventional radiology ($105,500), emergency medicine ($102,960) and pediatric surgery ($102,500). ● P As with less than one year of experience had a base salary of $85,000, which rose to $89,000 for those with 2 to 4 years, and $96,000 for those with 5 to 9 years’ experience. AAPA administered the online survey between February and March, 2015. More than 10,000 AAPA members and nonmembers responded.

The PA Profession Continues to Grow November 2015


Avera McKennan Opens

You Snooze

State-of-the-Art NICU

YOU . . . WIN

AVERA MCKENNAN HOSPITAL & University Health Center recently celebrated the grand opening of its new Neonatal Intensive Care Unit (NICU) on the fourth floor of the main hospital. The $7 million specialized unit is 16,500 square feet in size. Its new design features all private rooms with frosted glass doors that allow families to have their own space, yet be within view of care staff. The new unit brings together two NICU areas that are currently on third and fourth floors, and replaces the current third-floor unit that is 4,000 square feet. The current fourth floor unit will be kept as overflow space. “Based on site visits and focus groups, we designed our unit so that parents can be more involved in their baby’s care in intimate space from the very beginning. There is privacy for each family, yet still a sense of cohesiveness and support from other NICU families,” said Courtney Ehlers, Director of Women’s and Children’s Services at Avera McKennan. The 31 rooms of the unit are grouped by color in three neighborhoods, both for staff efficiency and a sense of community. Two rooms are specially equipped for twins, and one room for triplets, bringing the total capacity of the unit to 35 babies. Decentralized nurse stations in each neighborhood allow nurses to stay in immediate contact with patients and families. The new unit will incorporate the latest NICU technology, including Giraffe OmniBeds in every room, for an optimal environment in terms of temperature and humidity. Other technology includes an enhanced monitoring system for nurses and doctors, a new call system in which care staff receive alerts on their phones in case of monitor alarms or the push of a call button, and an advanced visitor ID system with photo badges for patient and family safety in the unit. An Innovation project prior to construction based on Lean principles enhanced staff



efficiency, so nurses can spend more time in patient care and education. All patient rooms will have a mobile cart that was designed by a multi-departmental team. Carts are equipped with supplies and equipment as well as workspace. Through its Little Footprints, Big Hearts campaign to benefit the new NICU, the Avera McKennan Foundation is near its fundraising goal of $2 million. ■

average is several key measures of happiness, according to the personal finance website WalletHub. The site conducted an in-depth analysis of the most and least happy states in America and found that South Dakotans rank at the very top in getting adequate sleep. Only three states have lower rates of depression than South Dakota and only 5 beat the state in volunteerism. To find the states that are home to the happiest Americans, WalletHub compared the 50 states and the District of Columbia across 25 key metrics. Our data set ranges from emotional health to income levels to sports participation rates. ■

OTHER SOUTH DAKOTA RANKINGS (1=Best; 25=Avg.) 9th – Hedonometer Score 8th – Long-Term Unemployment Rate 7th – Divorce Rate 5th – Income Growth Rate For the full report, please visit: most-least-happy-states-in-america/6959/

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Midwest Medical Edition

Teamwork is Key

in Pulmonary Hypertension Clinic A PEDIATRIC HEART specialist and pediatric lung specialist at Children’s Hospital & Medical Center in Omaha have grown accustomed to collaborating over the last year, working closely together in a crucial space where where their two disciplines intersect. Scott Fletcher, MD, medical director, Cardiovascular MRI and Exercise, and Paul Sammut, MD, clinical service chief, Pediatric Pulmonology, partnered in early 2013 to launch the Pulmonary Hypertension Clinic. “Dr. Sammut and I visit the patients together. Families hear us speak one after another. I’m listening to Dr. Sammut and Dr. Sammut is listening to me as the family is listening to both of us,” says Dr. Fletcher. “We speak with a more common voice, and our care is much more coordinated than it

November 2015

would be if there was one cardiologist seeing patients independently and one pulmonologist seeing patients independently. That is not optimal. Teamwork is critical.” Progressive and potentially fatal, pulmonary hypertension (PH) is a type of high blood pressure that can affect the arteries in the lungs and the right side of the heart. Some estimate as many as 20 percent of patients going into adulthood who have had corrected congenital heart disease have some component of PH. Diagnosis begins with an echocardiogram. If PH is suspected, the gold standard treatment is cardiac catheterization. “If we get to patients early on, we have a much better chance of keeping them from progressing to the severest forms of the disease,” Fletcher says. The Pulmonary Hypertension Clinic is

held the third Wednesday of the month. The team also includes a pulmonology nurse and a cardiology nurse. In addition to treating pediatric PH patients, both in-clinic and those admitted to the hospital, Drs. Fletcher and Sammut feel it is their job to raise awareness of PH among their colleagues. “We really feel that we have come across some children who would have died without the recognition of the problem and adequate treatment,” Dr. Sammut says. “Many have had resolution of symptoms, and that’s very gratifying.” ■


Skin Treatment Enhanced by Addition

of Platelet


OCTORS H AV E BEEN harnessing the power of platelet-enriched blood plasma to enhance healing since the 1980’s. Now, Sioux Falls plastic surgeons Richard and Tom Howard, owners of The Body Garage Medical Spa, are putting it to use to enhance skin treatments for anything from wrinkles and stretch marks to scars and burns. Platelet-rich plasma, or PRP, was developed in the 1970s and first used as part of an open heart procedure in Italy in 1987. Based on the idea that platelets contain growth factors and other cytokines that stimulate healing in bones and soft tissues, PRP is produced by drawing blood and spinning it down in a centrifuge to separate out the platelets. The result is a substance which contains five times the typical 200,000 per µL baseline blood platelet count. At the Body Garage Medical Spa, the platelets from about 23 cc of the patient’s own blood are then extracted with a syringe and applied directly to the skin. The aim is

Rich Plasma

to stimulate healing and collagen production as part of a cosmetic procedure called microneedling or collagen induction therapy (CIT). “Microneedling creates channels into the skin without disrupting the epidermal layer, so people heal quicker,” explains Body Garage medical aesthetician Sara Fiedler LE, COE. “If someone has acne scarring, it can go down and disrupt the tethering in the scar. As an antiaging treatment, it stimulates the skin underneath to produce new collagen.” With the addition of autologous PRP, which is applied topically during several sessions, Fiedler says microneedling becomes a super-charged healing treatment for a variety of skin conditions, with minimal down time. Unlike lasers, which can damage natural healing or growth factors and can thin the skin over time, CIT with PRP can safely be repeated. Mild wrinkles may be reduced with just three sessions, but more problematic issues such as serious burns or acne scarring may require more.

By Alex Strauss

In the three months the clinic has been offering the combination, Fielder says the results have been encouraging. “We are seeing better results from three CIT sessions with PRP than we did with six sessions of microneedling alone,” says Fiedler, who tells clients that it typically takes 21 days after the procedure to begin to see the effects of collagen stimulation. Scars and burns must be fully healed before they can be treated with microneedling. ■

Photo courtesy Dr. PRP USA

Welcome to the

Each year, thousands choose to give the gifts of Sight and Health This season, register to be an Organ, Eye, and Tissue donor at


Midwest Medical Edition

Photo courtesy Sanford

When you need it.

Sanford Scientist Lands Grant to Support Batten Disease Research A SANFORD RESEARCH SCIENTIST has received nearly $440,000 to support her research of a rare neurodegenerative disease that affects mostly children. Jill Weimer, PhD, is the recipient of a one-year grant from the Charlotte and Gwenyth Gray Foundation to Cure Batten Disease. The Gray Foundation was created by Kristen and Gordon Gray, whose two young daughters are battling Batten disease. Weimer’s lab is among only a few in the world studying the condition, which is a group of neurodegenerative diseases most commonly found in children that can cause seizures, blindness, motor and cognitive decline and premature death. Genetic mutations disrupt the ability of cells to dispose of waste and causes abnormal accumulation of proteins and lipids within nerve cells. Weimer’s research is complimented by collaboration with leading scientists at major universities across the United States and cooperation with another Batten disease lab run by Sanford Research President David Pearce, PhD. Using cells derived from patients with Batten disease and mouse models, the grant funding will allow Weimer to screen several different treatment methods, which could include gene therapy or stem cells. “Because conditions like Batten disease are rare and may not receive the awareness they deserve, it is critical that organizations like the Gray Foundation exist to fund and advance research,” said Weimer. “By focusing our efforts on what we believe to be key therapies, we hope to expedite a clinical trial for this aggressive disease.” Weimer recently appeared with the Grays on the national television show “The Doctors” to help raise awareness of Batten disease and their foundation. ■

November 2015

Medical professional liability insurance specialists providing a single-source solution



Midwest Medical Edition

Workers’ Comp 101

for Medical Providers


By Danyell Skillman

HEN AN EMPLOYEE is injured on the job, he or she gives notice to the employer who files a claim with the employer’s workers’ compensation carrier. Once a claim is filed, the carrier assigns a claim number to be used when submitting medical claims for payment. The employee is also assigned an adjuster by the carrier who may or may not work in conjunction with a nurse case manager. The nurse case manager can help to coordinate the employee’s care, authorize treatment, and review the employee’s progress until they have recovered to their pre-injury health status.

Below are some tips that medical professionals may find helpful in better understanding workers’ compensation.

The patient provides his or her claim number, the date of injury, and the information required to file a claim to the appropriate payer. The patient’s private health insurance is not billed for services that are covered by workers’ compensation; however, non-work related treatment provided in conjunction with authorized services are billed to the patient’s own insurance.

 he adjuster may authorize services from T the employee’s regular primary care provider or the employee may be directed to receive medically necessary services from the carrier’s own network of providers.

 ach state has its own guidelines for workers’ E compensation claim payments. In states that have fee schedules, the schedules function the same as a provider contract. If the provider treats a workers’ compensation patient, the medical bills are reduced according to the fee schedule.

Like other healthcare claims, workers’ compensation claims should be submitted using the CMS-1500 Claim form. Claims may be submitted to the insurance carrier using their Payor ID and submitting the CMS-1500, along with proper records, to the appropriate electronic clearinghouse. When completing the CMS-1500, medical billers fill in the fields that indicate the patient’s condition is workrelated, the date of injury, and the date of service. Instead of an insurance ID number, the patient’s claim number is supplied to the payer to ensure that the appropriate injury is being treated and paid for.

W hen the charges are found to be appropriate, the adjuster reprices the charges in accordance with the state’s fee schedule. Unlike other insurance coverage, medical providers are not allowed to bill patients for the balance between the fee schedule and the full amount of charges submitted. Workers’ compensation insurance does not include co-insurance or co-payments. Instead, providers agree to accept the fee schedule rates as payment in full for services rendered.

Some medical providers may not have a lot of experience with workers’ compensation claims, so to answer questions and to resolve any problems, it is best to communicate with the carrier as often as necessary. ■

For more money-saving Workers’ Comp tips from RAS, see the full article on our website.

Danyell Skillman is a Claims Supervisor with RAS.

November 2015


Off Hours Passionate Pursuits Outside the Office



S A MEDICAL oncologist and researcher at Sanford in Sioux Falls, Steven Powell, MD, spends the bulk of his time trying to answer some of the trickiest questions in medicine. In his off hours, he


wants what a lot of people want–to relax with a great beer. Making a great beer, that is. “Honestly, I wasn’t even much of a beer fan until I started brewing. That is really what got me into it,” says Dr. Powell of a home-brewing hobby that started as a small stove-top operation and has now taken over the garage. “My wife bought me a home brewing kit for my birthday when we were living in Minneapolis during my first year of residency. I like to cook, so she thought it might be something I would like.” It turns out, she was right. Like most home brewers, Powell started with extract brewing small batches, a process he likens to making cake with a mix. But the

By Alex Strauss

biochemist in him was not content with this simplified version of brewing and he soon began working with whole grains instead of prepackaged extracts for more control over the finished product. “It’s actually very scientific. You use malted grain and you grind or mill the grain to crush it,” he explains. “Then you spray water over the grain, which causes it to sprout. As a brewer, you’re using water at a specific temperature to try activate certain enzymes and break down the sugars. Different grains will produce different flavors. You use a mixture of ingredients to produce the flavor you want.” As his interest–and his batch sizes–grew, Dr. Powell moved the brewing operation into

Midwest Medical Edition

I think what I and a lot of other physicians really love about brewing is that it is a blend of science and art.

Photos Courtesy Dr. Powell

the garage where he now uses propane burners to make about 10 gallons of beer every couple of months. A single batch can take 5 to 6 hours of active work, but the payoffs are big — a process he finds fun and relaxing and a product he is proud to show off and to share. “I give a lot of beer away and I have a lot of requests from family and friends,” he says. “It’s amazing how many people want to be friends with you!” He has also won more than one first-place ribbon at the Minnesota state fair (an impressive feat in a region he describes as a “hotbed” of home brewing) and recently took a chocolate coffee stout all the way to the finals in a national competition. Powell says the interplay of different grains with hops and yeast, as well as the use of exotic additions like November 2015

Dr. Steven Powell works in his garage/brewing laboratory.

fruits and flowers, allows the inspired brewer to create an almost infinite array of styles and flavors. “I think what I and a lot of other physicians really love about brewing is that it is a blend of science and art,” says Dr. Powell. “If you happen to be a science geek, you can get very involved in even little details like the chemistry of the water you use. On the artistic side, you can do all sorts of creations, focusing on how it looks and how it tastes.” While he continues to refine his own brewing process, Powell says his next goal is to fine-tune his taste buds and qualify as a certified brewing judge. “You have to take tests and sort of realign your senses, but I think that would be very cool,” he says. ■


LifeScape Welcomes Kate Sigford, MD Physical Medicine & Rehabilitation Dr. Sigford joins Julie Johnson, MD, and Charlie Broberg, PA-C, in providing rehabilitative medical care for children and adults at LifeScape Rehabilitation Center. Dr. Sigford is taking patients with cerebral palsy, spina bifida, neuromuscular disorders, spinal cord and brain injuries, congenital brain malformations, hemiparesis, gait abnormalities, musculoskeletal conditions, brachial plexus palsy and similar diagnoses.

For referrals or to schedule an appointment, call 605.444.9700. Sioux Falls & Rapid City •


Midwest Medical Edition

Learning Opportunities November November 1

Sanford Cancer Immunotherapy Symposium

8:30 am – 4:00 pm

Location: Sanford Center Dakota Room, Sioux Falls, SD



Information: Registration:



November 20

Sanford Behavioral Health Symposium

7:30 am – 4:30 pm

Location: Ramada Plaza and Suites, Fargo, ND

vol. 5 no. 6

Information: Registration:


ng and Not only is it frustrati to have to a waste of time but waiting resubmit claims, a significan also cause for reimbursement revenue an organization’s cant threat to

March 31, 2016

Avera Transplant Institute Symposium

8:15 am – 4:00 pm

Location: Prairie Center, Sioux Falls

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By Natalie Bertsch

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Through research and innovative clinical trials using immunotherapy, the team of physician scientists at Sanford Cancer Center in Sioux Falls, South Dakota, are producing some of the best survival rates in the nation.

Survival is at 98% and 92% at two and four years post-treatment for all oropharyngeal cancer patients and 100% and 95% for HPV positive patients at two and four years. These numbers are considerably higher than the national average of 72%.

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Pictured left to right: Johnathan Cohen, MD , Andrew Terrell, MD , Chad Spanos, MD , John Lee, MD

MED Midwest Medical Edition-November 2015