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2015 Accountable Care Quality Measures Patient Portals Meaningful Use Electronic Medical Records Reimbursements Integration ICD-10 Collaboration Value-Based Medicine

Future Healthcare Technology



The Siouxland/Tanzania CONNECTION

Omaha’s Accredited Sleep Center

NATIONAL ATTENTION for Toxic Laundry Soap Study


Vol. 6 No. 6

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

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Future Healthcare THE


VOLUME 6, NO. 6 ■ SEP T EM B ER / O C TO B ER 2015


Challenges for Hospitals, Health Systems, and Physicians

From Us to You content available this month only online

Accountable Care

10 |

News & Notes – Awards, appointments,

Vol. 6 No. 6

s Quality Measure Patient Port als

additions, and accreditations from around the Region

Meaningful Use ical Reco Electronic Med

39 |  Learning Opportunities Upcoming Winter



Conferences, Events, and CME Oportunities




Collaboration Value-Based Med

■ By Jeana Goosmann

9 |  Three Key Principles of Security

e r FHeuatltu hcare THE


How Many are You Following? ■ By Buzz Hillestad

nzania The Siouxland/Ta CONNECTION

18 |  Fraud Alert Signals Increased Scrutiny of Physician Compensation Arrangements

veterans with a health clinic designed around their unique needs.

Funding Secured for Three New Indian Health Projects

Awards bring NIH-funded studies total to thirteen

What you need to know about diamonds ■ By Riddle’s Jewelry

36 |  Transportation: A critical link to patient flow optimization ■ By Diane McCullough

38 |  The Value of Balancing Protein Throughout the Day ■ By Holly Swee, SD Beef Council



Local doctors gain

national attention with study of laundry pod toxicity

Children’s Sleep 27  Center Earns AASM

Sponsored Features

Named to “Most Wired” List

31 |  A Symbol of Everlasting Love:

In the first article of a series, MED turns to some of the region’s top healthcare administrators, from both small and large hospitals and health systems, for insights into the challenges they and their clinicians are likely to face in the coming decade.


28 |  Healthcare Systems Again Avera, UnityPoint Health, and Sanford once again make the top tech list

NTION for NATIONAL ATTE Soap Study Toxic Laundry


N  ew Women’s Health Clinic at the Sioux Falls VA Medical Center VA reaches out to the growing number of female

27 |

d Omaha’s Accredite Sleep Center


■ By Tom Johnson

20 |



6 |  A Legal Checklist to Help Physicians Sleep at Night

By Alex Strauss



5 |  MED on the Web Nurses Station and other exclusive


Dr. Steven Meyer and 30  Siouxland Tanzania

 rology Specialists of Sioux U Falls Offers Cutting Edge Cryosurgery for Renal Cancer ■ By Alex Strauss

32 Managing Indoor

Environments for Safety, Comfort, and Efficiency ■ By G & R Controls

34 Woods, Fuller, Shultz &

to “give back” in a meaningful way

On the


Smith, PC, Helps “Simplify the Complicated”

ON THE COVER: Interventional Cardiologist Puneet Sharma, MD, of Sanford Aberdeen Medical Center. Photo courtesy Sanford.

Educational Medical Ministries A local doctor’s quest

From Us to You Staying in Touch with MED


HE METHODS BY WHICH medical care is accessed, delivered and reimbursed are changing more dramatically and more quickly than anyone in the industry can remember. But who will pay for these changes and what will they mean for the health of hospitals and patients in South Dakota, Minnesota, Iowa and surrounding states? Although MED usually focuses primarily on clinicians, we have asked several top area administrators to share their insights on the weighty topic of “The Future of Healthcare” in our region. Their answers will form the basis for a series of articles this fall and winter, beginning with this month’s cover feature. This issue is also jam-packed with news, information and expert advice to make your life easier and your practice more profitable. Worried about cybersecurity in your office? The experts at Helix will introduce you to the Three Principles to help you avoid a breach. Concerned about air quality in your medical facility? G & R Controls will explain the ins and outs of maintaining a healthy indoor environment. You’ll also find valuable legal advice, specifically for medical professionals. (Where else can you get that for free?) Finally, MED welcomed a new member to the “team” in June. MED’s Steffanie Liston-Holtrop and her family welcomed Khloe Isabella Holtrop on June 29th. Mom and baby are happy and healthy and Khloe is already learning the publishing business firsthand. Please remember that if you have news to report, a story to tell, a memory or a talent to share, or even if you’ve just read a good book, MED’s 5,000+ readers want to know. Email us at or check us out online at, where you can also register to receive the digital issue as much as two weeks ahead of print. If you have picked up this issue at the SDAHO Conference, Welcome! We hope you enjoy browsing the region’s premier publication by, for, and about medical professionals. Let us know how we can support you in your business or marketing efforts. Here’s to cool nights and golden days, —Steff and Alex

Corrections In the last issue we inadvertently ran the wrong photo for Mark Schmidt, the new President of Lead-Deadwood Regional Hospital and the Lead-Deadwood Market. This is the correct photo. On the Contents Page, the author of Addressing Hospital Workplace Violence should have been listed as Lizabeth Brott.

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota






PHOTOGRAPHER studiofotografie




Buzz Hillestad Tom Johnson Diane McCullough Holly Swee 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.


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MED welcomes reader submissions! 2015 Advertising EDITORIAL DEADLINES

More than a Magazine, A Medical Community Hub

Jan/Feb Issue December 5

List your business or event for FREE with our easy only calendar and directory!

March Issue February 5 April/May Issue March 5

Here are some of the new articles

June Issue May 5

available only online…

July/August Issue June 5 Sep/Oct Issue August 5 November Issue October 5 December Issue November 5

Brookings Hospital Expansion Brookings Health System has started construction on a 62,500 square foot hospital expansion project. From New ORs to new amenities, read exactly how they’ll plan to use the new space.

The Nurses Station Online You’ll find all our local nursing news exclusively on line this month.

Cyclists Benefit Rural Healthcare – Home and Abroad CONTACT INFORMATION Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Alex Strauss, Editor in Chief 605-759-3295

30 Cyclists Conquer Mountains and Miles to Raise Funds to Improve Health Care Delivery in Rural Ecuador. Rural health clinics in our region were recognized with grants along the way.

ONLY ON OUR WEBSITE! ◆ G ET MORE ATTENDANCE AT YOUR EVENT – Spread the word about an upcoming event or conference by posting it on MED’s FREE online calendar and link it to your own site. It takes just a minute to reach thousands of website readers

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A Legal Checklist to Help Physicians Sleep at Night By Jeana Goosmann



because you wanted to take care of patients and improve the health of others, but additional stresses and concerns might keep you awake at night. To make your lives a little easier, here are six easy steps to take to give you peace of mind at the end of the day.

Form a company. In many cases, it is a smart move for physicians to form a Professional Limited Liability Company or a Professional Corporation to protect them from liability. PLCs can help protect you from disgruntled employees, accidents, compliance issues, and wrongful practice lawsuits. To help protect your assets from an unforeseen liability, forming a company can be a smart and relatively painless solution that requires only a few steps a year in order to keep it going. Just remember to refrain from intermingling personal assets with the company assets to protect yourself.

solo, is to have adequate insurance coverage to provide a safety net you want under you in case of emergency. As a healthcare professional, malpractice liability coverage is essential; you want to look at coverage not only for civil lawsuits but also administrative actions such as licensing. Cyber liability insurance, disability insurance and life insurance could be overlooked by young professionals, but they are essential to life as a doctor.

to deduct the interest thereof, can be used to reduce taxable income. Another useful strategy is tax-harvesting losses, selling assets that have decreased in value to create a capital loss that can be used to offset other capital gains, and to a limited extent, ordinary income. â– Jeana Goosmann, is CEO & Managing Partner at Goosmann Law Firm.

Tax planning is key. Failure to

To read the complete checklist, see our website.

do any tax planning is like leaving money on the table, or handing it to the government. Strategic use of mortgages, and the ability Welcome

Christopher s. huot, M.D. Ophthalmologist

Protect your family by executing a current estate plan. Estate planning is equal parts getting a plan in place and keeping it current, as recent laws might have effected old plans. Large moments in life, like marriage, having children, starting a company, mean that you should create or renew your estate plan, which has been outgrown by your lifechanging events. Setting up a Domestic Asset Protection Trust, or DAPT, in South Dakota allows a physician to create a trust for their benefit, and yet still be protected from lawsuits in a worst case scenario.

Be prepared: Review your insurance coverage. A key aspect for every healthcare professional, whether you are employed by a hospital, a member of a practice group, or practicing


J. Geoffrey Slingsby, M.D., P.C.

240 Minnesota Street • Rapid City SD For appointments regarding Comprehensive Ophthalmology including:

~ Cataract and Implant Surgery

~ Retinal Management and Laser/Injections ~ Plastic Surgery of the Eyelids ~ Glaucoma Management

Call 605-719-9499 Midwest Medical Edition

The Future of Surgery is Here “The Siouxland Surgery Center is now Dunes Surgical Hospital. This new name better reflects our wide range of specialty services, and world class doctors and surgeons. Our experienced, friendly staff are still the best and you can find us where we’ve always the Dunes. Our partnership with Mercy combines the strengths of two proven healthcare leaders to provide enhanced coordination, cooperation and the best care for Siouxland.”

– Ralph Reeder, M.D.

President, Dunes Surgical Hospital

600 Sioux Point Road • Dakota Dunes, South Dakota, 57049 • 605-232-3332

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”.


Midwest Medical Edition


Key Principles of Security How Many Are Your Following?

By Buzz Hillestad


IXTY THREE PERCENT of all cyber-attacks are perpetrated by criminals who want to steal the data to sell or monetize it. The fraud markets around the world are teaming with money as electronic files have made it much easier and much more lucrative to commit certain types of fraud. Why is it so easy for criminals to steal data? What can we do to make it tougher for them? Let’s take a look at a recent case to see where there might be some indicators of what IT security is doing wrong. Four and a half million people had their medical information stolen in a recent cyberattack on the UCLA Health System. An article in the LA Times about this story had this quote: “ . . . there is no indication that any information was stolen, the hospital system said, but it couldn’t rule that out.” They were able to ascertain that the attackers had been in certain spots of the network but did not know whether or not anything was exfiltrated. It’s very possible - and likely - that it was.

DETECTION IS KEY! This is the first big problem in security today: Organizations have no way to monitor what is leaving their networks. Data loss prevention systems, second gen firewalls, and log correlation can make a forensic investigator out of a savvy IT person. These technologies need to be present in enterprise networks. Otherwise, you will be left scratching your heads like UCLA was. According to The LA Times, “UCLA Health has been investigating suspicious activity on its network since October, but the intrusion wasn’t confirmed until May.”


who, what, when, where, why, and how. Log correlation and alerting along with intrusion detection systems are necessary for enterprise networks for this very reason. Having a good incident response strategy and protocol is also key. If UCLA detected intruders in October, why did they not go into incident response mode immediately? Why did they not figure out the root cause of the incident and fix it? Seven months is a very long time to have attackers roaming around on your network exfiltrating data at will.

LAYERED SECURITY IS KEY! Lastly, why are attackers so easily getting into IT networks? The answer can be found within the UCLA story again. They couldn’t stop the hackers, they couldn’t detect them initially, and they couldn’t respond to them well. Why? Because they did not have a layered security approach. If you think of each security control that you have in your enterprise as a speed bump, you might start to understand layered security.

The more speed bumps the more time you have to detect and respond to the incident. The vast majority of clients I work with initially stake their entire existence on 1 or 2 technologies or speed bumps. We have to change this problem. We have to make it tougher for these attackers to make their dollar. We are losing the war against hacking. It doesn’t have to be that way. Criminals always take the path of least resistance to make their money. Currently, electronic fraud is so easy that we have cases of drug dealers and mob bosses converting their businesses over to electronic fraud. The black market fraud players group grows on a daily basis. We have to increase our detection rates, have an appropriate response to incidents, and have as many speed bumps in our enterprise networks as budget will allow. The time to start using these three principles is now. ■ Buzz Hillestad is a Principal Consultant at Helix in South Dakota.

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Call (605) 223 - 0013 now to protect your patients.

September / October 2015


Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA


The Avera Specialty Pharmacy recently earned full URAC Specialty Pharmacy Accreditation, becoming the first

The Black Hills community has once again shown great support for Children’s Miracle Network Hospitals, with 17,000 ducks sponsored in the 26th annual Great Black Hills Duck Race on July 26th. Due to high

URAC-accredited specialty pharmacy based within a health system in South Dakota. It joins just 121 other URAC-accredited specialty pharmacies nationwide. Avera McKennan Hospital & University Health Center has acquired 69 residential properties south of the hospital campus, including homes and

vacant lots, within an area between 23rd and 26th streets and 7th and Cliff avenues in Sioux Falls. The properties were acquired from Sioux Falls Surgical Physicians LLC. The purpose of the purchase is to own land in case future expansion is needed. Pat Clark began his duties as Chair of the Board and Ryan Huber became Vice Chair of the Avera Queen of Peace Foundation Board in July.

Pat Clark is retired and formerly served as Senior Vice President and CFO at Avera Queen of Peace Hospital. Ryan Huber is the Regional President of BankWest, Inc. in Mitchell and serves on the Mitchell United Way Board of Directors.


The Avera Brain and Spine Institute at Avera McKennan Hospital & University Health Center is now a Recognized Treatment Center by The ALS Association. This designation

recognizes regional institutions for their excellent clinical care for people living with ALS. The healthcare professionals assigned to the team can provide updated medical assessment and intervention, suggestions for maintaining health, adapting to changes in speech, muscle strength and daily living skills, information about local Avera St. Benedict Hospital in Parkston, SD was recently

recognized with an Excellence through Insight for Overall Employee Satisfaction in the Small Hospital category and for Overall Emergency Department Experience in the Medium Hospital category by HealthStream, Inc. To qualify for an award, a hospital must have scored in the 75th percentile or higher and surveyed a minimum of 100 patients. Avera St. Benedict Hospital for chosen for receiving the highest ratings from among HealthStream’s clients, as well as exceeding industry standards.

water levels in Rapid Creek, this year’s Duck Race was held at the School of Mines and Technology (SDSM&T) football stadium. Football players ran ducks through an obstacle course that included a slip n’ slide, tricycle race and a steeple jump.More than $75,000 was raised to provide services and equipment for ill and injured children in the Black Hills area served by Regional Health. Three Regional Health caregivers were recognized with August as part of the year-long “I Am Regional Health” campaign. They

are H. Thomas Hermann, M.D., a Family Medicine physician in Sturgis, Annalisa Anderson, an inventory coordinator in Lead-Deadwood, and Susan Weber, Director of Physician Recruitment in Rapid City.

Regional Health is pleased to announce the addition of . . . Mohammad Alsumrain, MD,

a board certified physician in pulmonology and critical care; Troy Howard, MD, a board

certified physician in otolaryngology (ear, nose and throat);

Kari Lund, MD,

a board certified physician in family medicine;

Rodney Samuelson, MD,

a board certified physician in neurosurgery;

and Joni Hensley, PA-C, an advanced practice provider in dermatology.

Midwest Medical Edition

Westley Paxton, MBA, Certified Facility Manager, has been selected Regional Health’s Vice President of System Facilities Management and Construction. Paxton earned an

MBA from Marylhurst University in Oregon, and bachelor’s degrees in Construction Management and Design from Brigham Young University. He had been the Director of Plant Operations and Maintenance at a retirement community in Virginia Beach, Virginia. Regional Medical Clinic-Western Hills Professional Building pulmonologists Mohammad

Alsumrain, MD, Masaru Chiba, MD, James McCafferty, MD, and Daniel Rawson, MD have relocated to Regional Medical Clinic-Aspen Centre at 640 Flormann Street. The new location, just behind the Mount Rushmore Road Safeway, offers more space and resources for patients. Regional Urgent Care and Occupational Medicine open a new clinic in July at 1303 North Lacrosse Street across from Walmart. This 5,000

square foot space replaces the previous location at 408 Knollwood Drive and includes six exam rooms, on-site lab and X-ray, ample parking and an open, modern design. Stay up-to-date with new medical community news between issues. Log on!

September / October 2015

SANFORD Nate White, COO of Sanford Health, has been recognized in by Becker’s Hospital Review in the 2015 edition of “Rising Stars: 25 Healthcare Leaders Under 40”. The Becker’s Hospital

Review editorial team selected leaders through an editorial review process, which included peer nominations. All leaders were under 40 years old at the time of their nomination earlier this year. Becker’s has published a version of this list annually since 2012. Sanford Aberdeen Medical Center celebrated its third anniversary on July 16th.

Over the last three years, the 48-bed medical center has steadily expanded its service to include orthopedics and sports medicine, hematology/oncology, interventional cardiology, nephrology and urology. The center now has more than 40 full-time providers, with an additional 20 outreach providers offering specialty care at the hospital or clinic on a weekly or biweekly basis. Three new full-time providers—a general surgeon, an internal medicine physician and a cardiologist —will join the Sanford team this fall.

Sanford Aberdeen Clinic Surgical Services has earned the Joint Commission’s Gold Seal of Approval for Ambulatory Health Care Accreditation by demonstrating

continuous compliance with the Joint Commission’s nationally recognized standards. Approximately 2,100 organizations currently maintain Ambulatory Health Care Accreditation, which is awarded for a three-year period. For the first time in its history, the Sanford Sports Complex will be home to three major prep running events. The Nike

Heartland Preview, Nike Cross Heartland Regional and the South Dakota State Cross Country Meet are moving to the 162-acre campus for the fall of 2015. The Sanford Sports Complex provides a turn-heavy, flat course positioned in an open area ideal for athletes and spectators. Nofil Arain, MD, a fellowshiptrained pediatric cardiologist has joined the team at Sanford Sheldon. Arain received his MD

from the University of Debrecen Medical and Health Science Center in Hungary and did his pediatric residency at the University of South Alabama. He also completed a fellowship in pediatric cardiology at the University of Minnesota and holds certifications from the American Board of Pediatrics in pediatrics and pediatric cardiology. Arain also practices at Sanford Children’s Hospital and Sanford Children’s Specialty Clinic in Sioux Falls, South Dakota. He resides in Sioux Falls with his wife and kids.

Construction is scheduled to start October 2015 on Sanford Health’s 100,00 square foot building for its Imagenetics program. When completed, the

building will house a long list of services, including general internal medicine, dialysis, medical genetics, genetic counseling, medical genetics laboratories (cytogenetics and molecular genetics), radiology and patient access management. The Imagenetics facility will also contain teaching space for internal medicine residents, future medical genetics residents and students in the newly formed genetic counseling graduate program created in partnership with Augustana College.

SIOUXLAND Pathology Medical Services of Siouxland, PC announces the addition of Bryan Steussy, MD, to its medical staff. A Jefferson,

Iowa native, Steussy received his undergraduate degree in Biochemistry from Iowa State University and earned his MD from the University of Iowa Carver College of Medicine in Iowa City. He completed his pathology residency and fellowships in Surgical Pathology and Hematopathology at the University of Iowa Hospitals and Clinics.


Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Dr. Fayaz Hakim, board-certified cardiologist and electrophysiologist, has joined the staff of Mercy Cardiology. Dr.

Hakim comes to Mercy from Loyola University Medical Center in Chicago. Dr. Hakim earned his medical degree from Government Medical College in India. He did his residency in Internal Medicine at the Mayo School of Graduate Medical Education in Rochester and completed fellowships in Cardiovascular Disease Medicine at the Mayo Clinic in Arizona and in Clinical Cardiac Electrophysiology at Loyola University Medical Center. UnityPoint Health – St. Luke’s has been awarded a $105,000 grant

from the American Heart Association as part of Mission: Lifeline, an American Heart Association communitybased initiative aimed at improving the system of care for heart attack patients throughout rural Iowa. The Mission: Lifeline system ensures STEMI patients get the right care as quickly as possible. Mission: Lifeline focuses on improving the system of care for these and all heart attack patients in Iowa. St. Luke’s is part of the network of hospitals involved in Mission: Lifeline. Physical Therapist Emily Rohmiller, PT, DPT has joined the Mercy Medical Center rehabilitation department.

Rohmiller is a graduate of the University of South Dakota with a Doctorate of Physical Therapy.


UnityPoint Health – St. Luke’s and the ALICE Training Institute have teamed up to bring ALICE Instructor Training to St. Luke’s on Thursday, October 1 and Friday, October 2. This two day

instructor course is designed to teach proactive survival strategies for violent intruder or active shooter incidents. The goal of the ALICE program is to provide individuals with survival-enhancing options for those critical moments in the gap between when a violent situation begins and when law enforcement arrives on scene. The registration fee for this training is $595 per person and can be completed online at The nation’s leading infectious diseases professional society, the Infectious Diseases Society of America (IDSA), has recognized Dr. Bertha Ayi as one

of the distinguished physicians and scientists from the United States and around the world by conferring on her the honorable designation of Fellow of IDSA. As Medical Director of Global Infectious Disease Services, Dr. Ayi provides consultation at Mercy Medical Center and other area hospitals, where she has shown exceptional commitment to quality care in the face of a high demand for her services, authored books and book chapters and lectured at several conferences.

Longtime Siouxland physician, Dr. Jerome Pierson has returned to the practice of interventional cardiology at Mercy Cardiology.

Dr. Pierson has been a part of the Siouxland medical community since 1992. During his twenty plus years of service to the residents of Siouxland, Dr. Pierson has developed a reputation as a high-quality physician who enjoys tremendous patient loyalty and the respect of his colleagues. Since July of 2012, he has been Mercy’s Vice-President of Medical Affairs & Chief Medical Officer (CMO). Jodi Arnold of Sioux City, an employee of Mercy Medical Center-Sioux City who is pursuing her Nursing BSN degree at Briar Cliff University, has been awarded a $3,000 scholarship from the Iowa Hospital Education and Research Foundation (IHERF),

which is supported by the Iowa Hospital Association (IHA). She is among 34 outstanding students from all over Iowa who have received assistance this year from the IHERF Health Care Careers Scholarship Program. The National Committee for Quality Assurance (NCQA) and the American Diabetes Association (ADA) announced that Cindy Inman, ARNP has received recognition from the Diabetes Physician Recognition Program for providing quality care to her patients with diabetes. Ms. Inman works at

Correctionville Mercy Medical Clinic in Correctionville, Iowa.

Mercy Home Health Care-Sioux City has received 4.5 stars out of 5 stars on Home Health Compare, CMS’s public information website for Home Health Agencies. “Comparing

Mercy Home Care with home care agencies across Iowa, only 1% received a 5 star rating and nationally only 3%. We are very proud to receive the highest star rating in Siouxland”, stated Karen Vlach, Mercy Home Care Director. Hospice of Siouxland, serving the Siouxland Tri-state area, has been selected to participate in the Medicare Care Choices Model. The model provides

Medicare beneficiaries who qualify for coverage under the Medicare Hospice Benefit and dually eligible beneficiaries who qualify for the Medicaid Hospice Benefit the option to elect to receive supportive care services typically provided by hospice and continue to receive curative services at the same time. Nationwide, this is expected to enable as many as 150,000 eligible Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, human immunodeficiency virus/ acquired immunodeficiency syndrome who receive services from participating hospices to experience this new option and flexibility. Mercy Home Care has taken home healthcare to a new level by certifying 20 agency clinicians as Certified Health Coaches. To

ensure successful behavior changes, Mercy Home Care’s Certified Health Coaches specifically design a program for each patient. They educate, motivate and inspire patients to work towards their goal. The overall goal is for patients to better self-manage their health.

Midwest Medical Edition

Mercy Medical Center – Sioux City has received the American College of Cardiology’s NCDR ACTION Registry–GWTG Platinum Performance Achievement Award for 2015.

The award signifies that Mercy has reached an aggressive goal of treating heart attack patients to standard levels of care as outlined by the American College of Cardiology/American Heart Association clinical guidelines and recommendations. Mercy is one of only 319 hospitals nationwide to receive the honor. The 19th annual Siouxland Race For Hope is scheduled for Saturday September 19, 2015 at Adams Homestead and Nature Preserve in McCook Lake, South Dakota. It is expected to draw

hundreds of people and is one of the largest events of its type in Siouxland with competitive races as well as “family friendly” walking and a kid’s fun run. Last year’s event raised a record-breaking $55,000 to enhance the quality of cancer care at the June E. Nylen Cancer Center. Register at www.

OTHER 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. To receive the ACTION

Registry–GWTG Platinum Performance Achievement Award, Prairie Lakes Healthcare System consistently followed the treatment guidelines in the ACTION Registry–GWTG Premier for eight consecutive quarters and met a performance standard of 90 percent for specific performance measures. The Iowa Healthcare Collaborative, Telligen, South Dakota REC and others are partnering to become a Practice Transformation Network. Practice

Transformation Networks are established when group practices, healthcare systems, and others join forces to collectively provide quality improvement expertise, best practices, coaching and assistance to clinician practices preparing and beginning clinical and operational practice transformation.

Construction is underway on Brookings Health System’s hospital expansion and renovation project. The project will add 62,500 square

feet to the east side of Brookings Hospital. The addition’s first floor will house surgery and medical imaging, two of the most common same-day procedures. The addition’s second floor will house the obstetric and medical/surgical units. Rooms on this floor will focus on patient amenities and allow ample space for families and visitors to gather. Karen Munger, PhD has joined the Sioux Falls VA Health Care System as

The new Chief of Staff for the Sioux Falls VA Health Care System

is John M. Wempe, MD, MPH, DVM, PhD. He is a retired U.S. Army Colonel.

Coordinator of Research & Development. Dr. Munger is a renal physiologist. Dr. Jeffrey Heier, a new addition to the Physician Vein Clinics team in Sioux Falls, is being officially Board Certified in Phlebology and is Board Certified by the American Board of Venous and Lymphatic Medicine.

He is also board certified in Internal Medicine and has spent the past 15 years dedicated to practicing acute care medicine in the region.

Steve Lindemann was recently selected by Brookings Health System as the organization’s new Chief Financial Officer (CFO).

Lindemann is a native of Eureka, SD, and holds a bachelor’s in accounting from the University of South Dakota. He also is a fellow of the Healthcare Financial Management Association. He most recently was the director of finance and accountable care organization director for UnityPoint Health–St. Luke’s Hospital in Sioux City.


REGIONAL CARE In an emergency, seconds count. At Prairie Lakes Healthcare System, expert care is available and ready when you need it most. Repeating awards signify our staff’s dedication. Our team’s outstanding care to heart attack patients earned Prairie Lakes the NCDR ACTION Registry–GWTG Platinum Performance Achievement Award in 2013, 2014, and 2015. And for the past two years, Prairie Lakes received the Women’s Choice Award as one of America’s Best Hospitals for Emergency Care. Prairie Lakes Healthcare System consistently followed the treatment guidelines in ACTION Registry®-GWTGTM for eight consecutive quarters in ACTION Registry-GWTG Premier and met a performance standard of 90% for specific performance measures to receive the 2015 Platinum Performance Achievement Award.


Area administrators share their insights on the future of healthcare in our region

Jill Fuller

Paul Hanson

Jason Merkley

Brent Phillips

Fred Slunecka


Jill Fuller, President and CEO

Prairie Lakes Healthcare System

Based in Watertown in northeastern South Dakota, Prairie Lakes Healthcare System provides care for a ten-county service area of 87,000 people.Â

Paul Hanson, President

Sanford USD Medical Center Located in Sioux Falls, Sanford USD Medical Center is a 545 bed hospital and Level II Trauma Emergency Care Center. It is one of 43 hospitals and 250 clinics in nine states that comprise the Sanford Health system.

Jason Merkley, CEO

Brookings Health System Brookings Health System is a non-profit, city-owned health system based in Brookings, South Dakota. It includes the 49-bed Brooking Hospital and serves Brooking and more than 18 surrounding communities.

Brent Phillips, President and CEO

Regional Health Based in Western South Dakota in Rapid City, Regional Health is comprised of more than 40 healthcare facilities, including five hospital and 24 clinics, and serves a patient base of 360,000 in the Black Hills region.

Fred Slunecka, President and CEO

Avera McKennan Hospital & University Health Center Avera McKennan Hospital is a 545 bed facility in Sioux Falls, South Dakota. It is a part of Avera Health, a regional system with 300 facilities in the 5-state region of SD, ND, MN, IA, and NE.


Midwest Medical Edition

Future Healthcare and beyond.



Challenges for Hospitals, Health Systems, and Physicians



medicine moves into its uncertain future that standing at the helm of a healthcare organization these days can feel a little like chasing a ball downhill. On one hand, providers are expected to provide better, more efficient, more technologically advanced care than ever at a lower cost than ever. On the other hand, they are being told that they must keep patients from needing care in the first place – but that they won’t be paid to do this. Although much is still uncertain about the future of healthcare in America, with issues such as the ‘meaningful use’ of Electronic Health Records, the upcoming ICD-10 rollout, regulations regarding the management and dissemination of clinical quality data, and the quantum shift from fee-for-service healthcare pending, it seems clear that the future is certain to be very different from the past. As we talked with regional CEOs (see sidebar) from both large and small health systems for our new series on The Future of Healthcare, we started by asking them to discuss what they see as the biggest challenges for hospitals and health systems – as well as for the clinicians who work within them – in the next five to ten years. By Alex Strauss

September / October 2015


Prairie Lakes Healthcare System

Quality Measures Patient Portals Meaningful Use Electronic Medical Records Reimbursements

Paul Hanson


Sanford USD Medical Center

Collaboration Value-Based Medicine Technology



One of the biggest challenges will be organizations developing a sustainable business model that balances clinical, financial and operational initiatives. Access to and management of capital, both human and financial, has never been more critical in assuring an organization’s success. Integration is key in strategic positioning within a population health model. Organizations are investing in their information technology systems at an unprecedented rate because we rely on data and the use of it to provide better care. For those systems that have made the commitment to do so nearly a decade ago, the rewards of that investment will now be realized. Sanford Health is one of those very few integrated systems that made the commitment and stayed the course. The level of connectivity within our society will continue to improve, and successful organizations must be able to adapt to these changes in a meaningful way that benefits our patients and providers.



Our biggest challenge will be the continued transformations in our business including the shift from inpatient to outpatient care settings and the transition from fee-for-service to reimbursement based on value. We will need to adapt but there are risks to changing our business model either too quickly or too slowly. 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.

Accountable Care

ON PHYSICIAN CHALLENGES ‘The cost of entry and the expertise required to operate independently as an organization or practicing physician is extremely difficult, if not nearly

impossible, for any long-term strategy. The expectations clinicians have from their patients, payers and regulatory agencies will only increase with time.”

Jason Merkley

Brookings Health System The biggest challenge for healthcare organizations in the next five years is the shift from volume-based to value-based medicine and how we in rural America find ways to succeed under this reformed model and payment transition. Secretary Burwell announced in January 2015 a goal of tying 50 percent of Medicare payments to alternative payment models such as ACOs by the end of 2018 and also to tie 90 percent of all FFS payments to quality or value targets. Secretary Burwell’s announcement will undoubtedly accelerate the transition to alternate value-based payment models. Although there is uncertainty regarding the pace of expansion of these models to rural hospitals and providers, Medicare and other third party payers are looking to contract with hospitals and providers who will collaborate to keep costs low while establishing and improving quality outcomes. In the next five to 10 years, those of us who provide healthcare to rural America will be challenged to do so under a much different strategy, model and payment system.


Jill Fuller

“Both independent clinicians and those employed by systems will need to find their role within healthcare reform and how they work with local communities to manage the health of the populations they serve given the transformation from fee-for-service to a more value-based reimbursement model.”

Brent Phillips

Regional Health

Recruiting and retaining a quality healthcare labor force could be a significant challenge well into the future. We have a huge shortage of several hundred thousand doctors across the United States today, and that shortage is only going to manifest

Midwest Medical Edition

ON PHYSICIAN CHALLENGES “The bureaucracy and regulations are a major challenge for physicians. Physicians are just as frustrated as patients. The other

September / October 2015

challenge is the ability – given the pace of change and the advance of science – to stay current with new discoveries and technology. It’s almost overwhelming.”

Fred Slunecka

Avera McKennan Hospital and University Health Center

Regulatory and technology disruption will be a challenge. An example of regulatory disruption is the passing of MACRA, the Medicare Access and CHIP Reauthorization Act, last spring. MACRA fundamentally revamps how Medicare pays physicians by linking payments with quality, value measurements, and participation in alternative payment models. The new model includes strong incentives for patient-centered medical homes, a concept Avera has been championing for many years. The payment structure involves bundled payments, like 90-day bundles with set fees for a given healthcare event, such as a knee replacement. So we’ll

see new partnerships and collaborations as healthcare providers figure out how to most effectively provide quality care while covering expenses. In the coming decade, we’ll also be continually challenged by emerging science and technology disruptions. From evolutions of patient medical records to advancements in genetics and the study of microbiomes, we will understand care at completely different levels.

itself more in the face of an aging workforce and an aging population. Equal to (the shortage of doctors) are shortages in nursing and all of the other healthcare professions. The shortage impacts rural areas such as South Dakota to a greater extent than some urban areas. In my opinion, the labor shortage exists because it is difficult to practice medicine today with all the rules, regulations, paperwork and litigiousness. To deal with the paperwork, the regulations, the insurance and all of that complexity – it’s a burden on patients, families, physicians and caregivers. It’s toughest for smaller medical practices. In order to be able to negotiate contracts with insurance companies or suppliers in the changing healthcare financing field, you have to be big. You can’t do it as a small player.

ON PHYSICIAN CHALLENGES “The rise of consumerism and consumers’ easy access to knowledge [will be a challenge for physicians]. Patients are extraordinarily resourceful and they have many options today from a watch that measures your heart beat, contact lenses that measure your blood sugar, and personal devices that monitor sleep patterns to websites that rate physicians and hospitals. So it’s a challenge for physicians to stay up to date and prepared for these very informed consumers.” ■


Fraud Alert Signals Increased Scrutiny of Physician Compensation Arrangements


By Tom Johnson

ECENT REGULATORY guidance may be causing physicians and hospital executives to lose more sleep than usual these days. In a Special Fraud Alert (Fraud Alert) issued earlier this summer, the Office of Inspector General (OIG), the Division of the Department of Health & Human Services tasked with combating healthcare fraud and abuse, reiterated its long-standing position that physician compensation arrangements are considered suspect under the Anti-kickback Statute, and by extension, the Stark Law, if the arrangement compensates a physician for his or her past or future referrals of Medicare/Medicaid business. The Fraud Alert referenced a recent settlement the OIG reached with twelve individual physicians who had entered into medical directorship and office staff arrangements that the OIG questioned. The OIG alleged that the payments made to these physicians constituted improper remuneration because, among other things, the

payments made to the physicians took the physicians’ volume or value of referrals into account and did not reflect fair market value for the services to be performed. This settlement is also notable because it was reached between the OIG and individual physicians, not a healthcare entity. While not announcing anything new, the Fraud Alert provides cause for the healthcare providers to reevaluate and scrutinize their physician compensation arrangements, notably medical directorships and office staff arrangements. Although Federal Law makes it illegal to pay, or provide value to, physicians in exchange for referrals, physician compensation arrangements can be structured to fall within a safe harbor to the Anti-kickback Statute, or an exception to the Stark Law. Falling under an applicable safe harbor or exception provides assurances that the compensation arrangement does not run afoul of Federal Law. For those hospitals and health systems currently utilizing or moving towards a direct-employment model for its physicians, compensation arrangements generally are structured to fall under the employment safe harbor to the Anti-kickback Statute and the similar bona fide employee exception to the Stark Law. Alternatively, for those hospitals and health systems following an affiliated group practice model of integration, physician compensation arrangements can be structured to fall under different safe harbors or exceptions, notably the personal services safe harbor to the Anti-kickback Statute and the similar exception to the Stark Law.

Although the applicable safe harbor or exception relied upon by a healthcare provider may vary, it is well-established that any compensation arrangement must (1) be consistent with fair market value, and (2) not be determined in a manner that takes into account the value or volume of referrals generated by the physician. Even if a particular compensation arrangement is properly in place, the contracting parties would be well-served to appropriately and adequately document the transaction and include, in the compensation contract, all the required elements of the applicable safe harbor or exception, including that total compensation is consistent with fair market value and does not take into account the volume or value of the physician’s referrals. For larger, more complex transactions, fair market value opinions from appraisers may be recommended. The integration model of healthcare organizations certainly favors the practice of contracting with staff physicians or utilizing employed physicians to provide services either as medical directors or other roles. The Fraud Alert provides a signal to the healthcare industry that the OIG may be ramping up its enforcement efforts relating to these compensation arrangements, and serves as a reminder for providers to carefully evaluate its existing compensation arrangements and ensure that any future arrangements are structured to comply with Federal Law. ■The Special Fraud Alert can be found at: Thomas Johnson is an attorney with Boyce Law Firm, LLP, in Sioux Falls.


Midwest Medical Edition





September / October 2015

| 605.217.2667 | CNOS.NET


New Women’s Health Clinic at the Sioux Falls VA Medical Center By Shirley Redmond and Charlotte McGrath


Veteran Cynthia Ault-Schmitz receiving care at the new women’s clinic.

L to R: VA Women’s Clinic staff include Margaret Devick, MD, primary care provider; Shelley Morrison, MD, gynecologist; and Lindsey Mayer, NP, primary care provider.

LTHOUGH MOST VAs, including the Sioux Falls VA Medical Center, were built to care primarily for men, women now represent about 30 percent of post-9/11 Veterans. Even though some may not consider themselves to be Veterans because they did not serve overseas or were not in combat, the Department of Veterans Affairs is making an effort to let these women know it is there for them, too. As part of its effort to be more welcoming and acknowledging of women Veterans, the Sioux Falls VA opened a new Women’s Health Clinic at the end of August. It joins more than two dozen VA women’s health centers that have opened across the country in the past five years with equitable access

to high quality comprehensive healthcare. A group of women Veterans provided input for the design, look, and feel of the local clinic, which is on the south wing of first floor of the medical center. The environment reflects their request for a clinic focused on women only in a separate, yet convenient, location with its own waiting area and a team of all female providers. VA uses a team concept of care, and women are assigned a specialized women’s health provider, RN, LPN, and scheduler. Margaret Devick, MD and Lindsey Mayer, Nurse Practitioner, are the clinic’s primary care providers. Shelley Morrison, MD, gynecologist will join the group on October 1. Additionally, women Veterans have access to a dietician, pharmacist, mental

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health professional, and social worker as part of their team. Working for and with the Veterans, the team develops a personalized health plan to help each Veteran achieve her goals. The team is working to provide timely, high-quality, comprehensive healthcare services in a sensitive and healing environment.

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Vital Statistics Sioux Falls VA Health Care System has seen the number of women Veteran users nearly double since 2007 (from 877 to 1673). ••• There are approximately 7000 women Veterans in the area served by the Sioux Falls VA Health Care System–Eastern South Dakota, Northwestern Iowa, and Southwestern Minnesota. •••

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.

Approximately 30 percent of these women receive VA medical care, with VA’s goal to provide care to 50 percent of them by 2020. •••

Active duty and recruiting data project the percentage of women Veterans to increase to almost 16 percent of the entire Veteran population by 2040.

To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit VA also has a breast surgeon and plastic surgeon on staff. Same day, after hours (early morning, late afternoon), and Saturday morning appointments are available. VA partners with community providers for obstetric care, infertility services, and mammography. Inpatient care, as well as long-term care and in-home care are also part of services available to Veterans. ■

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Midwest Medical Edition

Photos courtesy Urology Specialists

Urology Specialists of Sioux Falls Offers Cutting Edge Cryosurgery for

Renal Cancer


NYONE WHO HAS EVER SPENT TIME outdoors in a Northern Plains winter likely understands the danger of frostbite. As the temperature drops, exposed tissue first becomes tingly, then painful, then numb. If not brought back into the safe temperature range, exposed fingers, toes or ears can sustain permanent damage within minutes. Cryosurgery takes advantage of this same cellular sensitivity to freezing temperatures to target and destroy cancer cells. Boardcertified urologist Matthew Witte, MD, of Urology Specialists in Sioux Falls says the technique has changed the way he and his colleagues approach renal carcinoma – particularly for patients who are not candidates for a more invasive surgical technique.

By Alex Strauss

Sponsored Feature

Dr. Matthew Witte (right) and colleague Dr. Michael Gillett (left) using CT imaging to place the cryoprobes for surgery.


—Dr. Matthew Witte.

People tend to do better over time if you can preserve as much of the kidney as possible.

“This would typically be a patient with a solid renal mass that looks worrisome for cancer but who is elderly or has multiple comorbidities,” says Dr. Witte who performs the advanced technique along with his partner, board-certified urologist Michael Gillett, MD. “In the past, we would often have managed them with observation rather than trying to definitively treat the cancer. Now, we have another option.”

A Safer Alternative Five years ago, Urology Specialists invested in the technology that allowed Drs. Witte and Gillett to begin offering fragile or elderly cancer patients and patients with compromised kidney function, a more promising treatment approach without the risks of open or laparoscopic surgery. In addition to being less traumatic for the body, cryosurgery carries the added benefit of destroying only the cancerous portion of the kidney while leaving the rest of the organ intact. “Traditionally, patients who were candidates for surgery would have the whole kidney removed,” says Dr. Witte. “But there is more recent data that suggests that people tend to do better over time if you can preserve as much of the kidney as possible. This is the goal of a partial nephrectomy in people who are surgical candidates. Cryosurgery allows us to offer this same advantage to more people.” Unlike open or laparoscopic procedures, both of which require general anesthesia and incisions and carry the usual surgical risks of infection, pain and bleeding, cryosurgery creates only a few tiny puncture wounds. In addition, patients who undergo cryosurgery (also called cryoablation) for their kidney cancer face a lower risk blood clots, heart attacks, stroke or death, with less pain and a faster recovery. Compared to other minimally invasive ablative techniques, such a radiofrequency ablation, cryoablation has


The Cryocare console and accessories are used to freeze tumors

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People have really done great with this, . . . Out of those 130 cases, only four have required retreatment. One person had progression of their disease. None of our other patients have died from their cancer. —Dr. Matthew Witte.

less risks of damage to larger vessels, and less risk of developing a fistula. The procedure is done under sedation using local anesthetic. Although patients could often go home the same day, Dr. Witte says most are kept in the hospital overnight for monitoring since many have multiple health problems.

Cryosurgery Overview

Because the freezing temperatures used in cryosurgery (cancer cells die between minus 20 and minus 40 degrees Celsius) are so lethal to all body tissues, precision is critical. The procedure starts with a baseline CT scan of the kidney to locate the mass and to take a core tissue sample for the pathologist to review. During the same session, lidocaine is

Dr. Witte

injected and the patient is under mild sedation. Using CT guidance, a series of cryoprobes are inserted through the skin and into the tumor. The number of probes used depends on the size and shape of the tumor. Each probe can create a spherical ice ball that extends about a centimeter around its tip. For this reason, cryosurgery is usually reserved for masses smaller than about 4 centimeters. When the probes are in place, Argon gas is circulated under pressure into a small chamber inside the tip of the needle where it expands and cools, reaching a temperature well below -100 Celsius. This produces an ice ball with a predictable size and shape. The freezing temperature is maintained for about ten minutes. Toward the end of that time, another CT scan is performed to gauge the treatment’s effect. “Usually what you can see is that the mass itself turning very dark under CT imaging,” says Dr. Witte. “Depending on the treatment effect noted on imaging, you can determine whether you need to place additional cryoprobes.” Typically, two freeze/thaw cycles are used to ensure that the maximum number of cancer cells are destroyed. The most common complication is bleeding which occurs in 2 to 3 percent of cryosurgery patients.

Drs. Witte and Gillett have some impressive outcome data to report. “People have really done great with this,” says Dr. Witte. “Out of those 130 cases, only four have required retreatment. One person had progression of their disease. None of our other patients have died from their cancer.” Urology Specialists now perform two to three cryosurgeries a month for kidney cancer and expect those numbers to continue to rise as the technique is refined and perfected. Although it is currently reserved primarily for poor surgical candidates, Dr. Witte says there are other advantages to cryosurgery that may make it a desirable option for more people in the future. “For instance, people who have recurrent disease after partial nephrectomy. It is technically very difficult to re-operate on these people and many end up with the whole kidney removed, but conceivably you can treat them with cryosurgery and preserve the remaining normal kidney,” says Dr. Witte. “Now that we are starting to have more data on the efficacy, I expect that we are going to see more people using cryosurgery as a first line treatment, even in younger patients.”

Positive Outcomes

Refer to a urologist first.

At its outset, Dr. Witte says cryosurgery was “a new technique looking for an application.” Now, five years into their experience with the technique and with more than 130 cases under their belts,


Dr. Witte has one caveat for doctors of patients with suspected kidney cancer: “If the patient has a biopsy first, it can create more problems than it solves, in that it might make it technically more difficult to do perform a partial nephrectomy later,” cautions Witte. “Because we understand the natural history of this disease and we know all the management options, we can help patients make the most informed decisions.” ■



• Lower morbidity • Overnight hospital stay • L ow pain (Usually Tylenol only)

September / October 2015

• Fewer complications • Normal activity in three weeks • Little or no change in kidney function


Local doctors gain national attention with study of laundry pods

Did you Know? 2014


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So Much care, So cloSe to hoMe.


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Children’s Sleep Center Earns AASM Accreditation THE SLEEP CENTER AT CHILDREN’S

Hospital & Medical Center in Omaha has earned accreditation from The American Academy of Sleep Medicine (AASM). Under the direction of Casey Burg, MD, a pulmonologist double-certified in pediatric pulmonology and pediatric sleep medicine, the Sleep Center offers a comprehensive sleep medicine program for young patients. In addition to Dr. Burg, staff members include board-certified pediatric pulmonologist Mark Wilson, MD, Ivan Pavkovic, MD, a pediatric neurologist double-certified in neurology and pediatric sleep medicine, Brett Kuhn, PhD, Nebraska’s only psychologist certified in behavioral sleep medicine, Amber Widstrom, PA-C, a physician assistant specially trained in pediatric sleep medicine, 10 respiratory therapists with advanced certification in sleep medicine, and a clinic RN, coordinator and supervisor who are all specifically dedicated to pediatric sleep medicine. Inadequate sleep can affect a child’s mood, academic performance and general health. The Sleep Center treats children for a variety of conditions, including sleep apnea, narcolepsy, snoring, and restless leg syndrome. Children are often referred to the Sleep Center by their pediatrician or other pediatric specialists. In many cases, sleep problems can be effectively managed and treated in the clinic through a combination of therapies including lifestyle and behavioral changes, medication management, continuous positive airway pressure (CPAP) and/or surgical recommendations. For physician-to-physician consults, referrals, admissions and transport service, contact the Physicians’ Priority Line at 855-850-5437 for a 24-hour link to pediatric specialists. ■

September / October 2015

Funding Secured for Three New Indian Health Projects | Awards bring NIH-funded studies total to Thirteen

Three projects have been selected for funding by the National Institutes of Health (NIH) as part of the Collaborative Research Center for American Indian Health (CRCAIH) and its pilot grants program.

The following projects were selected for funding: Sara DeCoteau, BA, Sisseton-Wahpeton Oyate of the Lake Traverse Reservation, Human Services/Division of Health Services Bonny Specker, PhD, South Dakota State University, Ethel Austin Martin Program

P ROJECT: Pregnancy Health Survey for Parents of Newborns on the Lake Traverse Indian Reservation Amanda Fretts, PhD, University of Washington, School of Public Health

P ROJECT: Healthy Food Healthy Families Feasibility Study Tai Mendenhall, PhD, University of Minnesota, Family Social Sciences and Kathy Denman-Wilke, MEd, St. Paul Area Council of Churches, Department of Indian Work

P ROJECT:East-Metro American Indian Diabetes Initiative: An Evaluation of Innovative Community-based Programs to Improve the Health of Native Men and Youth The CRCAIH’s pilot grant program, now in its third year, was created to fund cutting-edge transdisciplinary research addressing health disparities experienced by American Indians in South Dakota, North Dakota and Minnesota.Sanford Research and a broad base of partners in 2012 received a $13.5 million grant from the National Institute on Minority Health and Disparities to create the CRCAIH. The research center has now supported a total of 13 pilot grant awards across the region to explore how social determinants of health impact American Indians. The pilot projects were selected based on five major scoring criteria, including purpose, priorities and significance; scientific approach; innovation and potential for future funding; investigators and environment; and collaborative relationships. Researchers from the first round of pilot grants awarded in 2013 presented their findings in a spring seminar series at Sanford and the CRCAIH Annual Summit this past June in Rapid City. ■ ■

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Healthcare Systems Again Named to ‘Most Wired’ List HEALTH DATA SECURITY AND PATIENT ENGAGEMENT are

top priorities for the nation’s hospitals, according to results of the 17th annual HealthCare’s Most Wired survey from the American Hospital Association’s Health Forum and the College of Healthcare Information Management Executives (CHIME). This year marks Avera Health’s 16th year on the Most Wired list, Sanford’s fifth, and UnityPoint Health’s fourth. The survey of more than 741 participants, representing more than 2,213 hospitals, examined how organizations are leveraging IT to improve performance for value-based healthcare in the areas of infrastructure, business and administrative management, quality and safety and clinical integration. At Sanford, bar-Code Medication Administration (BCMA) was further implemented and video visits were launched to connect patients with providers over a mobile device or computer for non-emergencies. Avera also recently introduced its own video visit system, AveraNow, a mobile video visit with Avera providers, available 24/7. UnityPoint Health says it put IT to work creating “greater alignment between hospitals and physicians” and getting patients actively involved in their health and healthcare through a secure patient portal. Among some of the key findings nationally this year:

Medical professional liability insurance specialists providing a single-source solution

In 84 percent of Most Wired organizations, physicians can view and exchange other facilities’ results in the portal compared with 63 percent of hospitals surveyed. 76 percent use the portal and electronic health record (EHR) to exchange results with other EHRs and health information exchanges compared to 56 percent of those surveyed. 81 percent can communicate with patients via email or alerts in contrast to 63 percent of all respondents. 67 percent of Most Wired hospitals offer the ability to incorporate patient-generated data. 63 percent offer self-management tools for chronic conditions.             60 percent offer patient-specific education in multiple languages. HealthCare’s Most Wired™ Survey, conducted between Jan. 15 and March 15, 2015, is published annually by Health & Hospitals Network. ■


Midwest Medical Edition

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September / October 2015



Dr. Steven Meyer and Siouxland Tanzania Educational Medical Ministries EIGHTEEN YEARS AGO, Steve Myer, MD,

now an orthopedic surgeon with the CNOS clinic in Dakota Dunes, was at one of the lowest points in his life. After many years of “living the dream” as a successful surgeon, his marriage was failing and he found himself questioning his purpose, his values, and his future. That’s when a chance encounter altered the course of his life. A woman whose broken leg he was asked to attend to late one night at Mercy Hospital would eventually connect him with a Christian mission team from Arkansas and a life-changing trip to China. “While we were going to church one day in Hong Kong, I felt a hand on my head and I heard the voice of God tell me ‘It’s time. I’m calling you to work for me’,” says Dr. Meyer. Less than a year later, Meyer was leading his own mission trip to Africa, a country he had visited briefly in medical school, and the idea for STEMM – Siouxland Tanzania Educational Medical Ministries – was born.

“I believe that God changes us not by what he does for us but by what he allows us to do for others,” says Meyer, who helped to found STEMM with his new wife and several others in 1997. He has since made 32 trips to the impoverished country, several with some of his six children. ”We try to be the hands and feet and heart of God for the people of Tanzania.” Since its founding, STEMM volunteers have performed nearly 1000 orthopedic, general and ENT surgeries in a country with only one physician for every 100,000 people and fewer than two dozen orthopedic surgeons to serve a population of 45 million. Meyer himself performed the country’s first hip and knee replacement. Although fewer than ten percent of Tanzanian children ever go to high school, STEMM has also helped send nearly 10 thousand of them to high school and university. “We have produced doctors, teachers, engineers and multiple nurses,” says Meyer. STEMM’s latest endeavor, launched in 2005, is STEMM Children’s Village, a village-style orphanage in a remote part of Tanzania. When filled to capacity, the homes on site – each complete with a “Mama” to care for the children – will accommodate up to 180 of Tanzania’s 2 million orphans. According to the group’s website, “The SCV will not merely save children from starvation, exploitation and death, but will also provide a Christian environment for them to thrive.” The next phase of construction at the SVC will add four more children’s

homes to the “village”, an on-site guest house for visiting volunteers, and, eventually, a school. STEMM also provides support to several other orphanages in the poor Arusha region. Always looking for new ways to innovate, STEMM has plans to help fund the orphanage and other ministries through a new agricultural endeavor. The group now owns 100 acres of land and a dozen dairy cows.

Dr. Meyer with his family and several children from STEMM Children’s Village. Photo courtesy Dr. Meyer

“God just keeps bringing all these amazing blessings. But it requires tons of talent and treasure and time,” says Dr. Meyer. “We need people who want to give something back who can go to Tanzania.” Meyer says the group welcomes new ideas that could help them better care for the physical, educational and spiritual needs of Tanzanians. “If someone says ‘Have you thought about this?’, we listen.” ■ For more information about STEMM and its ministries, visit their website at Visit MED’s website to see more photos from STEMM’s Tanzanian ministries.

Dr. Steven Meyer and a Tanzanian girl whose leg he surgically straightened. Photo courtesy STEMM.


Midwest Medical Edition

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Safety, Comfort and Efficiency

By G & R Controls


HEN a medical facility’s internal environment – temperature, humidity, air quality – is not what it should be, the problem can be more than uncomfortable for staff and patients; it can even be dangerous. Health conditions can be complicated by environmental conditions and contaminants can spread if ventilation systems aren’t properly managed. In addition, when a facility’s energy needs are not managed effectively, the resulting inefficiencies, while they may or may not have a direct impact on the comfort of occupants, can drive up the cost of healthcare and negatively impact the bottom line. A properly configured building automation system

can minimize these risks. P roper temper at u re controls and appropriate programming can significantly conserve energy, improve HVAC system performance, lower emissions and reduce overall operating costs, all while maintaining indoor air quality and comfort for both staff and patients. Building automation systems can be as simple or complex as you desire. The system can be set to simply heat and cool on demand or as complex as reacting to schedules and occupancy to automatically prompt the system to a set temperature and humidity level, turn the lights on and even manage access to different areas. Rooms and areas can be controlled individually. Think

of the different areas of a healthcare facility and how diverse their needs are. Patient rooms, operating rooms, laboratories and kitchens all have very different needs and schedules. Allowing each area of a hospital or clinic to be individually controlled for their respective purpose allows greater comfort for staff and patients. Building controls can automate all the important environmental aspects to ensure indoor air quality and the highest satisfaction rates of occupants as well as increase efficiency and save money.


Concerns for infectious disease control and bioterrorism are much greater today

than in the past. Hospitals and clinics need to keep patients and staff safe and comfortable while providing the highest level of care. Building automation systems can be a factor in keeping staff, patients and visitors safe. With appropriate programming, rooms can be monitored for air quality as well as security. For example, isolation rooms can be managed to prevent the spread of infectious diseases by activating alarms to alert staff of improper and unsafe conditions. The integration of security systems with building automation controls allows greater flexibility and increased safety throughout the facility. Let staff members take care of their number one job, the patients, and let the building controls monitor indoor air quality and security. Today’s healthcare needs are very different than twenty, or even ten, years ago. Building automation systems have the ability to rapidly adjust to the changing needs of the healthcare industry today and tomorrow. ■

G & R Controls engineers designing a plan for optimal environmental management.


G & R Controls is a Siemens Independent Field Office specializing in building automation and energy management since 1977.

Sponsored Feature

Midwest Medical Edition

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North Central Heart

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September / October 2015



(Woods Fuller) is a full-service law firm in Sioux Falls, South Dakota, and Sioux Center, Iowa. From business start-ups and intellectual property protection to mergers and acquisitions and litigation, we have the depth to serve entities of all sizes. With nearly 40 attorneys on staff, Woods Fuller is experienced in virtually all areas of law, including: •B  usiness Organization & Transactions •E  mployment Law •E  state Planning, Probate & Tax Law • F amily

 usiness OrganizaB tion & Transactions Woods Fuller’s business attorneys represent a variety of clients, from small, family-owned organizations to publicly traded companies. Our attorneys are passionate about helping organizations achieve their business goals by developing relationships that go beyond the boardroom. With depth and experience in all things business, answers are only a phone call away. Brad Grossenburg | Jim Wiederrich | David Kroon | Elizabeth Lewis | Dan Harmelink | Chris Lent | Greg Starnes | Carey Miller | Ryan Snell | Vince Jones

•H  ealth Law • Intellectual Property • L itigation

Employment Law Employment law is complex – especially in the healthcare industry. Woods Fuller has experienced employment law attorneys trained with extensive healthcare law experience in and out of the courtroom. From employment contracts to handbooks, Woods Fuller attorneys assist in managing organizations’ employment law compliance requirements with a high degree of proficiency. Gary Thimsen | Comet Haraldson | Jeff Shultz | David Kroon | Melanie Carpenter | Amanda Bahena | Morgan Brekke | Heather Springer

Estate Planning, Probate & Tax Law Woods Fuller is one of the few law firms in the area with licensed tax attorneys on staff. With three LL.M. attorneys, Woods Fuller is able to provide highincome individuals with the proper counsel to minimize tax liability in planning for the future. Our attorneys can assist in creating a living will and maximizing South Dakota’s trustfriendly laws to ensure clients’ legacies are passed on for generations. Merle Johnson | Brad Grossenburg | Lisa Maguire | Matt Bock | Craig Krogstad | Amanda Bahena

| Craig Krogstad | Amanda Bahena | Heather Springer


. . . Complicat 34

Midwest Medical Edition

Family Law Woods Fuller’s skilled attorneys have experience in all matters of family law and understand that excelling in this area requires a soft touch coupled with firm advocacy. Our expertise allows us to walk clients through the life-changing chapters of adoption and starting a family, as well as the dissolution of relationships including divorce and post-divorce proceedings. Kris O’Connell | Shelly Munson | Amanda Bahena

Health Law Attentive. Experienced. Knowledgeable. These are just a few of the words used to describe Woods Fuller’s experienced healthcare attorneys. Healthcare compliance is a complex field, and we have the qualifications to help clients successfully navigate constantly changing regulations. Our attorneys are well-versed in representing individuals and entities with credentialing applications, investigations and disputes, HIPAA adherence and other regulatory compliance matters. David Kroon | Kris O’Connell | Heather Springer

Intellectual Property Protect your idea, your invention and your business identity. Woods Fuller has seasoned patent, trademark, copyright, licensing and litigation professionals to assist individuals and organizations. Our attorneys stay abreast of the latest industry developments and are able to provide skilled representation based upon years of experience in the intellectual property arena. Jim Wiederrich | Tim Shattuck | Troy Leonard | Jeff Proehl | Carey Miller | Sander Morehead | Joel Engel III

Litigation Litigation is a stressful situation no company or individual ever wants to experience. Woods Fuller’s team of skillful litigators is on your side. From business or employment litigation to patent infringement and workers’ compensation, our team of talented attorneys has the knowledge to effectively represent clients in the event of litigation before administrative agencies, state courts and federal courts. Dick Gregerson | Gary Thimsen | Comet Haraldson | Jeff Shultz | Roger Damgaard | James Moore | Kris O’Connell | Tim Shattuck | Melanie Carpenter | Bill Beck | Jennifer Van Anne | Sander Morehead | Jim Power | Justin Smith | Joel Engel III | Morgan Brekke

ed Sponsored Feature


TRANSPORTATION: A Critical Link to Patient Flow Optimization


By Diane McCullough




for hospitals in the last 30 years. The economy has created financial and operational stress. Aging baby boomers on Medicare have stretched bed capacity. Pay-for-performance and more informed patients demand faster and better service. The increased volume and adverse conditions have shifted the main point of entry from admissions to the Emergency Department (ED). Yet, positive first impressions and overall patient experience continue to be critical to ensure high HCAHPS scores, patient loyalty, and increased revenue. Hospitals today must find new and costefficient ways to handle the growing patient volumes without sacrificing patient care or satisfaction. With margins stretched thin and bed capacity at a premium, expansion and adding more beds can be expensive and is often not a realistic option. So rather than increasing physical capacity, administrators look more and more at patient flow optimization.

GO WITH THE FLOW Patient flow optimization — or patient throughput — allows hospitals to increase their service capacity by improving their ability to move patients internally through the care process. A centralized and efficient f low of patients through the treatment system can significantly reduce delays and wait times, reduce complaints, and use staff time and hospital resources much more effectively, easing bed capacity issues and making them simpler to manage.


While patient tracking and other real-time location technologies are important components of patient f low optimization, administrators should not overlook the value of a centralized patient transportation department; professional transporters; and non-clinical support staff, systems, and processes in facilitating throughput efficiency and maximizing bed capacity.

HIDDEN VALUE OF PATIENT TRANSPORTATION Patient transportation sounds simple — just get patients from Point A to Point B, right? In reality, all patient flows in a hospital are interconnected, making transport the hub of patient movement and an essential ingredient to efficient and cost-effective patient flow and bed capacity optimization. Inefficient movement of patients throughout the facility, especially in the ED, causes bottlenecks and crowding, compromises care and trust, and is costly. Centralized patient transportation provides a one-stop solution for coordinating, dispatching, and delivering efficient patient movement. It automates, streamlines, manages, and simplifies the admission, transfer, and discharge processes for hospitals and patients. Patient transportation, however, is more than just technology. A key component of patient transportation is the human element. In this world of HCAHPS and pay for performance, patient experience is everything. By the nature of their job, patient transporters serve as ambassadors for the hospital,

Midwest Medical Edition

often creating the first — and most lasting — impression your patients might get of your hospital. Dedicated patient transporters not only optimize patient flow, they also provide non-clinical support for an overburdened and diminishing nursing population. Departments such as nursing and medical imaging, who often have their own staff transporting patients, may believe this structure reduces patient wait times. However, since transportation is not their core competency, patient flow management and productivity are not always properly managed and can actually be negatively impacted. Patients who are waiting to be transported to a test or are being discharged need to wait until their nurse or nursing assistant completes care to another patient — which is their first priority. This creates unnecessary wait times, while bed space remains unavailable to other patients. A lot of hospitals have mission statements that talk about operational efficiency, high quality and safety, and the desire for hope and to heal. Patient transporters can be a direct link to helping them meet these mission goals. ■ Diane McCullough is Vice President of Patient Transportation and Observation Services, ABM Healthcare Support Services.

For additional insights on patient flow including ED Capacity Challenges and the Role of Integrated Support Services, access the full article on our website.

September / October 2015

Ask ur tO Abou dge Lo e! g Packa


The Value of Balancing Protein throughout the Day By Holly Swee


MERGING RESEARCH shows spreading protein intake evenly throughout the day may be most beneficial for overall health and wellness. Meeting details from a 2013 gathering of protein researchers from around the world who explored the substantial body of evidence

that shows some people may lose weight and/ or maintain a healthy weight, support overall metabolic health and age more vibrantly when they consume 20-30 grams of high-quality protein (i.e. beef, pork, poultry, fish, eggs, and dairy products, as well as some plantbased proteins like quinoa and soy) throughout the day, within calorie goals.

Currently, most Americans consume two-thirds of their total daily protein intake at dinner, leaving other meals and snacks throughout the day low on protein. You can access the Protein Supplement that was published in the June 2015 print edition of the American Journal of Clinical Nutrition at â–

Holly Swee, RD, LN, is Director of Nutrition and Consumer Information at the South Dakota Beef Council.

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Do you have a patient who has but isn’t a good candidate for surgery


TREATMENT FOR EARLY-STAGE LUNG CANCER SBRTNEW (Stereotactic Body Radiotherapy) is a new technology that SBRTto(Stereotactic Body Radiotherapy) is a new technology that is used deliver very high doses of radiation very accurately is usedin to the deliver very Stereotactic high doses ofbody radiation very accurately to tumors body. radiotherapy is an

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Midwest Medical Edition

Learning Opportunities September – October September 19 8:00 am – 12:00 pm

The 19th Annual Siouxland Race For Hope Location: Adams Homestead and Nature Preserve in McCook Lake, SD Information and Registration:

September 23 – 25 SDAHO 89th Annual Convention 8:00 am – 5:00 pm Location: Sioux Falls Convention Center Information: 605-361-2281, 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.

September 24 – 25 16th Annual Avera Oncology Symposium Location: Avera Cancer Institute, Prairie Center, Avera McKennan nformation:, 605-322-8987 Registration: October 2 6th Annual Avera Women’s Conference for the Primary Care Provider 9:00 am – 4:15 pm Location: Sr. Colman Room, Prairie Center, Avera McKennan Information:, 605-322-8987 Registration: October 2 15th Annual Community Response to Child Abuse Conference 8:00 am – 5:00 pm Location: Sioux Falls Convention Center Registration open July 1 Information: Elizabeth Groff at 605-333-2200 October 20 Avera McKennan Social Work Conference 11:00 am – 5:30 pm Location: Sr. Colman Room, Prairie Center, Avera McKennan Information:, 605-322-8987 Registration: Save the Date: October 30, 2015 16th Annual Sanford Health Ministry Conference

MED reaches more than 5000 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at

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September / October 2015




Sanford Imagenetics Genomic Medicine Symposium Applying Genomic Medicine in Clinical Practice

Friday, September 18, 2015 The Sanford Center, 2301 E 60th St N, Sioux Falls, SD Physicians, nurses, research scientists, genetic counselors, residents and students are invited to learn from national experts in precision medicine about incorporating advances in genetics and genomics into patient care. Topics will include: genetics and genomics of complex disorders of adult life, incidental findings in genetic testing, genetic risk assessment tools in clinical practice, applying next generation sequencing in cancer care, ethical issues in genetic testing, the role of genetic counselors and nurses in the primary care healthcare workforce. Joe G. N. “Skip� Garcia, MD, Senior VP for Health Sciences, Merlin K. DuVal, MD, Endowed Chair for Leadership and Innovation, Professor of Medicine, University of Arizona College of Medicine, Tucson James P. Evans, MD, PhD, Bryson Distinguished Professor of Genetics and Medicine, University of North Carolina School of Medicine, Chapel Hill Catherine A. Hajek, MD, Internal Medicine Physician, Sanford Imagenetics, Senior Resident, University of California, Los Angeles, Medical Genetics Residency Program

Cinnamon Bloss, PhD, Medical Ethicist, Assistant Professor, Department of Psychiatry, University of California, San Diego, School of Medicine Quinn Stein, MS, CGC, Director, Augustana-Sanford Genetic Counseling Graduate Program, Associate Professor, Augustana College, Sioux Falls Laurie Badzek, BSN, JD, Professor and Director, University of North Carolina Wilmington School of Nursing

019039-00117 8/15

Lincoln Nadauld, MD, Medical Director of Cancer Genomics, Intermountain Healthcare, St. George, Utah

Contact Dana Carr at or (605) 312-6094 with questions.

MED-Midwest Medical Edition September/October 2015  
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