MED-Midwest Medical Edition- June 2016

JUNE

2016

Vol. 7 No. 4

Midwest Medical Edition THE

RISK of Filing Cabinets Employment

CONTRACT TIPS NEW

CANCER TECH for SD Hospitals

Regenerative

Medicine

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MIDWEST MEDICAL EDITION

Contents

Regenerative

Medicine

VOLUME 7, NO. 4 ■ J U N E 2016

REGULAR FEATURES

Stem Cell Therapy in Spinal Surgery at Orthopedic Institute

4 | From Us to You 5 | MED on the Web Treating minors without consent, OSHA’s new healthcare emphasis, Nursing News

35 | Learning Opportunities Summer events and a look ahead to Fall conferences and symposiums

IN THIS ISSUE 8 | Choosing the Right Financial Advisors: Why you need more than a bank ■ By Brent Reilly

17 | Spotting the Signs of Drug Diversion ■ By Amanda McKnelly and Maria Eining Even with the most robust prevention program, it is not uncommon to see a 5 percent diversion rate in a healthcare facility.

18 | HIPAA Requirements and PHI Disclosure ■ By Vanessa Mulnix When is it OK - or required - to disclose protected health information?

19 | Local Researchers Present at Vatican Cell Conference 22 | Gamma Knife Treatment Now Available in Sioux Falls 25 | Art Panels to Improve the View for Cancer Patients 27 | Life Insurance 101

■ By Mark Schlueter

29 | Grown-up ‘Wish Kids’ Look Back ■ By Alex Strauss How do Make-A-Wish recipients feel about their experience years later?

32 | Plan the Perfect Office Retreat ■ By Carmella Biesiot Create the perfect experience for your team whether you manage just a few people, or a large corporation.

6 Are File Cabinets Putting Your Business at Risk?

■ By Ritch Noble Why your paper documents may be slowing you down and costing you money

24

Regional Upgrades Cancer Treatment Regional doctors speak with MED about one of the newest TomoTherapy treatment systems in the world.

JUNE

New providers, awards, accreditations and more

2016

10 | N ews & Notes

ON THE COVER

Midwest Medical Edition

Vol. 7 No. 4

By Peter Carrels

THE

RISK

of Filing Cabinets Employment

CONTRACT TIPS NEW

CANCER TECH for SD Hospita ls

Regenerative

Medicine

Stem Cell Therapy

in Spinal Surgery

at Orthopedic Inst itute

THE SOUT H DAKO TA REGI ON’S PRE M IER FOR HEA LTHC ARE PROF ESSIO PUBL ICAT ION NAL S

■ By Faith A. Coleman and Alex Strauss

Orthopedic Institute surgeon Walter Carlson, MD, is the first of his colleagues to incorporate into his practice the use of autologous adult stem cells to treat degenerative disease of the spine. In this month’s cover feature, we take a closer look at the technique, its advantages, and the one drawback that may hold some patients back..

30 How to Negotiate an Employment Contract ■ Jeana Goosmann

page

12

From Us to You Staying in Touch with MED

A

s Spring gets into full swing in the South Dakota region, we at MED want to recognize some of the special area people and organizations with reasons to celebrate this month.

First, our congratulations to advertiser Jeremy Storm and his team at Qvidity in Sioux Falls on their recent official ribbon cutting. Qvidity is a complete telehealth solution making cutting edge technology accessible to small and rural practices. Congratulations from your friends at MED! MED was once again proud to sponsor the Dakota Lions Sight and Health (formerly South Dakota Lions Eye and Tissue Bank) 18th annual golf tournament. Funds raised during the Gifts of Sight & Health Charity event support outreach programs to educate the public on the growing need for eye and tissue transplants. Although Steff was glad to join the fun last year at 8 months MED's Steffanie Liston-Holtrop, Stefanie pregnant, she reports that this year’s Engebretson, Randy Derheim, Bobbi Nelson game was easier.

Please enjoy this complimentary issue of MED, the region’s premiere publication created exclusively for medical professionals in the Great Plains states and paid for by the advertisers who value them.

Contact us any time with your news, editorial contributions, and feedback at Info@MidwestMedicalEdition.com.

—Alex and Steff Happy Spring!

Thanks for helping MED help the world!

Our sincere thanks to the following people/organizations for their generous support of MED Editor Alex Strauss’ upcoming Habitat for Humanity project in Masachapa, Nicaragua: MMIC (Marian Hagerman) Carla Campbell Dr. Paul Amundson Corbo Design Wendy Phillips Steve Kuiper Right at Home, SE South Dakota (Tony Mau) Look for photos of Alex’s adventure in the September issue.

4

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

VICE PRESIDENT SALES & MARKETING Steffanie

Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER studiofotografie

WEB DESIGN Locable

DIGITAL MEDIA DIRECTOR Jillian Lemons

CONTRIBUTORS: Carmella Biesiot

Maria Eining Jeana Goosmann Amanda McKnelly Vanessa Mulnix Ritch Noble Brent Reilly Mark Schlueter

STAFF WRITERS Liz Boyd

Caroline Chenault John Knies Faith A. Coleman

NEWS & NOTES EDITOR Réne Anderson

ADMINISTRATIVE ASSISTANT Erika Tufton 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 steff@ midwestmedicaledition.com.

MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

MED welcomes reader submissions!

2016 Advertising EDITORIAL DEADLINES Jan/Feb Issue December 1 March Issue February 1 April/May Issue March 1 June Issue May 1 July/August Issue June 1 Sep/Oct Issue August 1 November Issue October 1 December Issue November 1

Read on the Go Want to get your MED earlier? Sign up on our homepage to receive a link to the digital issue, up to two weeks ahead of print. Read on any digital device.

On the Website this month Treating minors without parental consent What are the rules on treating minors without parental consent?

What about PHI requests? We have a Quick Reference chart from the experts at ProAssurance.

Here comes OSHA OSHA’s renewed focus on healthcare facilities has not only resulted in the addition of new offices and staff in the Midwest, but is also expected to result in additional activity, including OSHA inspections, for local employers.

CONTACT INFORMATION Steffanie Liston-Holtrop VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com

Nursing News SDSU’s West River Native American Nursing Program, a Stroke Certification for Mercy Medical Center nurse, and Award winners.

MORE THAN A MAGAZINE, A Medical Community Hub

Fax 605-231-0432 MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109 WEBSITE MidwestMedicalEdition.com

Summer Sale!

Claim a Site Sponsorship for HALF price — Become a MED website sponsor for a fraction of the cost this summer and enjoy the perks all year long.

For a low monthly fee, your logo will appear on every page of the MED website, on MED’s widely-distributed digital newsletter, here on the ‘MED on the Web’ page, and more. Plus, enjoy special opportunities to submit website content and link it to your own site.

Contact us at Info@MidwestMedicalEdition.com to learn more.

5

Are File Cabinets Putting Your Business at Risk?

By Ritch Noble

T

HE NEW YORK TIMES nearly

learned a painful lesson about the dangers of maintaining paper-only records when a pipe burst in the sub-basement housing its photo archives.

Were it not for fortuitous timing and the quick work of a news assistant who spotted the leak, the entire photo catalog—which dates back decades and had never been digitized—could easily have been lost.

That averted disaster is a dramatic example of the importance of backup and digitization, but you don’t need to be sitting on a basement full of irreplaceable Pulitzerwinning photojournalism for it to matter.

Most businesses still have vital records stored in a paper-only format.

Even if you’ve moved to fully digital processes for all of your important documents, it’s likely that your records from before the system was implemented are still sitting in a file cabinet or storage somewhere.

Physical is fragile It doesn’t require a lot of imagination to think of ways that these documents could be compromised. Fire, theft, misfiling, the aforementioned flooding; any number of natural or human forces can render your paper records unsalvageable. True, these same events could also theoretically occur at a data center where your digital records are stored. The difference is that your physical files probably don’t have a redundant backup stashed safely in a different location.

So why does it matter? You’re hopefully not contending with fires and floods on a

regular basis, and, if they’re mostly old records, it may not seem like a catastrophic loss. One problem is that even older records can be critical to ensuring that your business meets compliance standards.

Even if you’re not in a heavily-regulated digital forms can improve record integrity industry there are plenty of scenarios where and save time for both end users and HR. the loss of records can put your business at serious risk. You may need them Many modern scanners THE REASON for tax purposes, or to defend even have the ability to your business against litigation FOR DIGITIZING seamlessly integrate with YOUR RECORDS the cloud storage or a from a disgruntled employee or IS SIMPLE: your document management customer. The onus is on you to paper documents maintain this information, so system. are putting your “the dog ate my payroll records” Mitigating risk and information at risk, is not an excuse that will fly increasing efficiency they’re costing you can obviously have with a Sarbanes-Oxley auditor. money, and they’re financial benefits for slowing your GOING DIGITAL your business, but business down. retroactively and digitizing records can proactively save you money in more direct ways, as Luckily, technology has made it a relawell. Between reducing paper and print costs, eliminating storage expenses and tively painless process to convert these freeing up office space for other uses, documents to a digital format. You can digitization can have an immediate impact even have the conversion done for you if on your bottom line. you don’t have the time or internal Ready to digitize your old records and resources to do it yourself.

Digitizing your old records will not only streamline workf lows going forward? protect against the risks discussed above, it Human Resources and Accounting are can speed up processes and provide easier great places to start moving away from access to vital information. Having these paper-based processes and take control of files in a digital format can make them availyour information. ■ able to remote workers and employees Ritch Noble is the CEO and Partner of across offices.

Active Data Systems in Sioux Falls. Noble Of course, the easiest way to ensure that focuses on services impacting document life you don’t need to worry about physical cycle, document workflow, and managed document services. records is to implement systems that digitize them as they come in or use digital workflows to begin with. Transitioning paper-heavy processes such as employee onboarding to Still nervous about going digital? Visit our website for some expert tips on overcoming “scanning anxiety”.

6

Midwest Medical Edition

Choosing the Right Financial Advisors:

WHY YOU NEED MORE THAN A BANK

V

By Brent Reilly E RY FE W P H Y S I C I A N S put themselves through med school, complete

their residencies, and build a practice because they are passionate about managing their finances. While advancing into a new, more lucrative phase of one’s career can be exciting, it is important to keep in mind that greater levels of financial prosperity bring equally great levels of financial complexity.

Keeping the following things in mind when choosing a team of financial advisors can save you money, time and stress.

Your wealth management plan is not a quilt Don’t try to patch it together. Too often, physicians and other professionals assemble the components of their financial plans piecemeal, over the course of years. If you take this approach, you’re likely to find your mortgage, insurance, and investments handled by different advisors, each with different plans and different—sometimes competing—interests.

Creating a cohesive financial plan with a tight-knit team of trusted advisors— ideally around one table—will ensure that each component is moving smoothly and in harmony with the others. And when faced with unexpected challenges, being backed by an experienced team that is always

on the same page with you can make all the difference.

One plan does not fit all Don’t try to fit your dreams into a template.

Every individual has different aspirations, resources, and priorities. From student loan management to investment strategies to estate planning, your financial situation is as unique as you are.

A good team of advisors will take the time to get to know you, work with you to personalize your financial plan, and help you to adjust it as that plan grows and evolves over the years. Think of wealth management as one continuous discussion you have with trusted advisors throughout your entire career.

Set your expectations high Your livelihood and your future are too important to take chances on. It is well worth your time to find an institution that will work best with you. A team of advisors with a wealth of experience, a strong reputation, and a clear understanding of your needs will be much more valuable to you than the short-term incentives offered by many financial institutions. Trust and integrity are priceless.

A plan is only as good as its execution Don’t expect your advisors to do all of the work. No matter how skilled and experienced your team of advisors may be, they can’t bring your plan to fruition without you. However, a strong relationship with the right financial advisors will make executing your plan seamless and transparent. Ultimately, this is your money, your career, and your life. It’s up to you to make the most of it. ■ Brent Reilly is Vice President of Private Banking with Loft Advisors in SIoux Falls

Because of an eye donor, a warm summer day is even more beautiful to those who received the gift of sight.

Consider registering as an eye, tissue, and organ donor today!

Visit www.dakotasight.org/register to learn more

8

Midwest Medical Edition

WE’D LOVE TO TALK TO YOU 605.791.7751

WE’RE GROWING AND SEEKING THE BEST

HIRING PHYSICIAN ASSISTANTS & CERTIFIED NURSE PRACTITIONERS TO JOIN OUR TEAM Black Hills Urgent Care, LLC seeks outstanding full-time physician assistants and nurse practitioners to serve a well-established and growing patient base in Rapid City, SD and the Black Hills Region. This opportunity offers a challenging, diverse scope of practice with a highly reputable company. Ideal candidates will possess strong clinical knowledge, excellent patient communication skills, and high levels of commitment to efficiency, service, and maintaining and increasing patient volumes.

Must be a graduate of an accredited Physician’s Assistant or Certified Nurse Practitioner’s program. Prior Family Practice or Urgent Care experience desired. Black Hills Urgent Care values and invests in its employees with a highly competitive and market leading compensation and benefits package.

WHY BLACK HILLS URGENT CARE? •

• •

•

WHY RAPID CITY & THE BLACK HILLS? •

Rapid City, SD is recognized as one of the Top 100 Places to Live

by Livability for 2016

•

The Black Hills offer the best outdoor activities in the region: hunting, fishing, rock climbing, down hill & cross-country skiing, and hundreds of miles of hiking and biking trails

•

Temperate weather (275 sunny days)

COMPETITIVE COMPENSATION & BENEFITS PACKAGE

•

Dynamic downtown area that features upscale urban conveniences while retaining its small town charm

•

Abundant retail and restaurant offerings

THE PREMIERE HEALTHCARE PROVIDER OF CHOICE IN THE BLACK HILLS FOR QUALITY AND SERVICE

•

High-quality education system

•

Direct flights daily to major cities

PHYSICIAN OWNED

•

Many of the nation’s most popular tourist attractions

The Black Hills is an ideal location to work and play

CLASS-LEADING RESOURCES & FACILITIES IN-HOUSE LAB IN-HOUSE IMAGING COMFORTABLE MODERN

To discuss this opportunity, please email or call: Brett Lawlor, M.D.

Lori Konst, Director

Brett.Lawlor@bhsh.com

Lori.Konst@bhsh.com

605.791.7694

605.791.7751

APPLY ONLINE AT: WWW.BHSH.COM www.BHUCare.com

Black Hills Urgent Care, LLC, is a wholly owned subsidiary of Black Hills Surgical Hospital, LLP, which is proudly owned by physicians.

EEO Employer/Protected Veteran/Disabled

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA

BLACK HILLS

Avera Queen of Peace Hospital in Mitchell has been named among the Top 100 Rural and Community Hospitals by iVantage Health Analytics. This is the first year

Black Hills Surgical Hospital has won the Healthgrades 2016 Outstanding Patient Experience Award for the fourth consecutive year.

that iVantage has named the Top 100 Rural and Community Hospitals in addition to its annual recognition of the Top 100 Critical Access Hospitals. Avera Queen of Peace also holds iVantage Health Analytics top quartile awards including Excellence in Quality and Excellence in Financial Strength.

Lucio Margallo, MD, of Avera Medical Group Internal Medicine Mitchell has been named 2016 Children’s Champion for providing care to children at Abbott House for more than 30 years. Abbott House

provides a home, school and therapeutic care for girls and young women who have been abandoned or suffer from emotional or behavioral disorders. Dr. Margallo is a graduate of USD Medical School.

Avera Health has been recognized by the Coalition for Physician Wellbeing with the new Medicus Integra Award. The award recognizes

health care organizations for an “established, comprehensive, institutional approach” to physician wellbeing. Avera is one of four sites recognized nationally.

Six new medical providers have joined Regional Health.

They are:

Christoper Seime

Karen Fryhling

Christopher McGoldrick

Heidi Glood

Melissa Traub

technology, made possible through a partnership with Beckman Coulter, will allow the laboratory to consult, troubleshoot, and review patient results from one location, which will decrease turnaround times and improve patient care.

The install will be complete system-wide by the end of July.

Regional Health hosted the Children’s Miracle Network (CMN) Hospitals Radiothon, raising more than $80,828 during a 12-hour live broadcast over five local radio stations on Friday, May 6. The fundraiser

took place in Rapid City Regional Hospital’s lobby and aired on Homeslice Media Group radio stations 93.9 The Mix, KAT 98.7, The FOX 100.3, and Hot 93.1, and Smash Hits KKLS.

Michelle Wasson

Christoper Seime, PA-C, Family Medicine, Massa Berry Regional Medical Clinic, Sturgis

Mallory Strang

Heidi Glood, CNP, Oncology, Regional Cancer Care Institute, Rapid City Karen Fryhling, CNP, Orthopedics, Regional Medical Clinic, Rapid City Melissa Traub, CNP, Endocrinology, Regional Medical Clinic, Rapid City.

Christopher McGoldrick, PA-C to Rheumatology, Regional Medical Clinic-Aspen, Rapid City.

Michelle Wasson, CNP, Family Medicine, Regional Medical Clinic-Aspen, Rapid City

10

Regional Health is upgrading its lab with state-of-the-art chemistry analyzing and automation. The new

Jason Ellingson

Chris Schmit

Three Regional Health providers were recognized during the month of April for the “I Am Regional Health” campaign.

The individuals are Mallory Strang, Resident Account Representative at Sturgis Regional Senior Care; Chris Schmit, Supervisor of Environmental Services at Lead-Deadwood Regional Hospital; and Jason Ellingson, Certified Registered Nurse Anesthetist at Rapid City Regional Hospital.

SANFORD Sanford Aberdeen is the only South Dakota Facility to make the Becker’s Hospital Review list of hospitals with ER wait times of five minutes or less.

The national average is 24 minutes, but Sanford Aberdeen’s wait is just 2 minutes, placing it 8th on the list.

Sanford Aberdeen has also been recently verified as a Level III Trauma Center.

Criteria included 24 hour immediate coverage by ER physicians, coverage by general and orthopedic surgeons, anesthesiology services, acute care services, and more. Sanford Aberdeen was verified at a Level IV in 2014, just a year after opening.

Gene Hoyme, MD, chief of genetics and genomic medicine at Sanford Health, has received Gene Hoyme the American Academy of Pediatrics’ David W. Smith Award for Excellence in Genetics and Birth Defects Education. Dr. Hoyme received

the award during the American College of Medical Genetics meeting in Tampa. Hoyme joined Sanford Health in 2007 and is internationally known for his work in pediatrics and medical genetics.

Midwest Medical Edition

Sanford Health has purchased the Sanford Tracy Medical Center in Tracy, Minnesota.

Sanford previously operated the facility which was owned by the city of Tracy. Under the agreement, Sanford now owns the buildings and grounds.

The medical center includes a hospital, clinic and visiting outpatient medical specialty services.

Gary Timmerman, MD, Chair of the Surgical Department at the University of South Dakota Sanford School of Medicine, recently served as a keynote speaker at the 2016 Annual Scientific Congress sponsored by the Royal Australasian College of Surgeons. Dr. Timmerman, a

surgeon associated with Sanford Health in Sioux Falls, also served as a panel participant and a research paper reviewer at the conference, held in Brisbane, Queensland, Australia.

Sanford Research has received a National Science Foundation (NSF) grant of more than $337,000 to continue the Summer Undergraduate Research Experience (SURE) program in conjunction with Sinte Gleska University.

SURE is a unique opportunity for undergraduate students to receive hands-on research experience and mentoring in social-behavioral research in American Indian community-based projects.

Sanford Research has partnered with Professional Patient Advocates in Life Sciences Inc (PPALS) to better train patient advocates.

The two organizations have teamed to create a certified professional development program for people who either work as patient advocates or who are leaders for non-profit health patient advocacy groups.

The group held its first 3-day conference in May.

The Sanford Project’s “T-Rex” Study of cell therapy in type 1 diabetes has enrolled its first patient. Investigators in this

trial are studying the effectiveness of cell therapy with expanded regulatory T cells, or Treg cells, to treat type 1 diabetes in adolescents. Participants must be between 12 and 17 and be diagnosed in the last two months.

SIOUXLAND Tobacco/substance abuse and obesity have been identified as the top two health concerns for the Siouxland region according

to an unprecedented partnership that included the Siouxland District Health Department, Dunes Surgical Hospital, Mercy Medical Center, and UnityPoint Health-St. Luke’s. The yearlong effort was the first ever joint Community Health Needs Assessment for all four entities.

Wellmark Blue Cross and Blue Shield has selected UnityPoint Health–St. Luke’s as a Blue Distinction Center+ for Knee and Hip Replacement.

Hospitals designated as Blue Distinction Centers+ for Knee and Hip Replacement demonstrate expertise in total knee and total hip replacement surgeries, resulting in fewer patient complications and hospital readmissions. St. Luke’s is one of seven UnityPoint Health hospitals to receive the distinction.

Jacob Trierweiler is the new Manager of Nursing Services/ Oncology at Mercy Medical Center. In his position, Trierweiler will direct all aspects of Mercy’s Nursing Services, as well as the Oncology unit and associated oncology programs.

Mr. Trierweiler acquired his nursing degree from Briar Cliff University.

Kristen Ball in the new manager of Post Critical and Step-down Care Unit at Mercy Medical Center.

Ball received her Bachelor’s degree in Nursing at Nebraska Methodist College of Nursing in Omaha and began her nursing career at Mercy in 2003. She will direct all aspects of Mercy’s critical care step down unit and associated programs.

Mercy Medical Center generates 1,320 jobs and UnityPoint Health-Sioux City generates another 2,890 that together add more than $260 million to Siouxland’s economy, according

to the latest study by the Iowa Hospital Association. The IHA study examined the jobs, income, retail sales and sales tax produced by hospitals and the rest of the state’s healthcare sector. In all, the Iowa healthcare sector contributes $15.5 billion to the state’s economy

Becky Wittrock, PA-C, of the Paullina Mercy Medical Clinic and the Sutherland Mercy Medical Clinic in Northwestern Iowa and Dr. Heather Longval of Mercy Singing Hills Family Medicine have been recognized

by the Diabetes Physician Recognition Program for providing quality care for their patients with diabetes.

June 2016

MidwestMedicalEdition.com

St. Luke’s Cardiology and Cardiovascular Associates has been granted a three-year term of accreditation in

echocardiography in the area of Adult Transthoracic, Adult Stress by the Intersocietal Accreditation Commission. St Luke’s is the only accredited program in Sioux City.

This is their fourth consecutive three-year accreditation.

Karen Iseminger is the new Director of Clinic Operations at UnityPoint Clinic.

A Sioux City native, Iseminger graduated from Western Iowa Tech Community College in Sioux City. In her new position, she will focus on patient and employee satisfaction, growth opportunities, and operational efficiency.

OTHER Interventional cardiologist Richard A. Howard, MD, has joined Prairie Lakes Health care System. Dr. Howard received his MD from the University of Rochester School of Medicine in New York and completed both a residency and fellowships in cardiovascular medicine and interventional cardiology at Boston Medical Center. He comes to Prairie Lakes with more than twenty years experience in interventional cardiology, cardiovascular disease, echocardiography, internal medicine, and hypertension.

South Dakota Health Link is looking for a Clinical Engagement Consultant.

The Consultant will be a key member coordinating site visits with clients, arranging educational events, and market services. There will be travel involved up to 50% of the time and plenty of client engagement. A successful candidate must have a four-year degree and RN licensure. To apply visit https://yourfuture.sdbor.edu.

11

Regene MEDI

Stem Cell Therapy in Spinal Surgery at Orthopedic Institute

By Faith A. Coleman and Alex Strauss

rative

CINE T

HE AMERICAN POPULATION is aging more rapidly than ever before. According to US government projections, by 2030, more than 20 percent of US residents will fall into the 65-andolder age group. That compares with 13 percent in 2010 and just 9.8 percent in 1970.

As this growing group searches for ways to restore lost function and remain physically active, a new science has emerged to support them. It is known as “regenerative medicine�.

13

Regenerative

Medicine

A Brief Explanation

Coined by futurist Leland Kaiser of the Kaiser Institute in a 1992 paper, regenerative medicine is defined as the “process of replacing, engineering or regenerating human cells, tissues or organs to restore or establish normal function.”

Stem cells, undifferentiated biological cells with the power to differentiate into specialized cells, are a key component of regenerative medicine. These cells, which in developing embryos become all the tissues of the body, can also be found in the bone marrow, adipose tissue, and blood of adults. Globally, scientists are hard at work on the development of techniques that will utilize these powerful cells to heal injuries, regenerate damaged tissues or even produce entirely new organs.

“Regenerative medicine might be the biggest advance in healthcare I’ve seen in my thirty years as a physician,” says Walter Carlson, MD, MBA, a surgeon with Orthopedic Institute in Sioux Falls and a Clinical Professor with Sanford USD Medical School. Carlson has been incorporating stem cell therapy into select spinal fusion surgeries for the past two years.

Stem Cells in Orthopedics Promising results have already been reported using stem cells in the treatment of conditions ranging from incontinence and tendon wear and tear to stroke, Parkinson’s, cardiac insufficiency, and kidney disease.

Increasingly, regenerative medicine using adult stem cells is also playing a role in orthopedics. Many musculoskeletal conditions have few therapeutic options beyond the conventional approaches, but stem cell therapy - especially when it utilizes the patient’s own cells - offers the promise of less invasive tissue repair, faster healing, and, in some cases, the ability to delay or even avoid joint replacement surgery.

“One of the things I like most about it is that it is not dangerous,” says Dr.

14

Carlson, a graduate of the University of Minnesota Medical School and a longtime regional leader in orthopedics. “Our primary mandate is to ‘First, do no harm’ and this fits into that.”

Although spine surgery and total joints are the focus of Dr. Carlson’s practice today, he was also fellowship-trained in pediatric orthopedics at Texas Scottish Rite Hospital for Children in Dallas and was instrumental in bringing the Shriner’s Hospital for Children complimentary screening clinic to Orthopedic Institute.

Dr. Carlson is the first OI surgeon to incorporate into his practice the use of autologous adult stem cells to treat degenerative disease of the spine.

“I was looking for ways to improve the quality of the fusions I do in the lower back,” says Carlson, who recently performed his 100th successful, stem cell-augmented spinal fusion. “In the past, there have been many different ways to do

that with varying levels of success.”

One of those ways is to place a section of pelvic bone (which contain some stem cells) over the unstable vertebrae to improve the likelihood of a successful fusion. Not only does the technique require the patient to be in surgery and under anesthesia longer, but it can be painful and carries a risk of bleeding, infection, and a longer recovery.

A second option, developed to avoid some of the pain and risk associated with bone transplantation, is to use bone morphogenetic proteins (BMPs). But Carlson says these growth factors, which can induce the formation of bone and cartilage, also have their drawbacks.

“The FDA has not approved them for this application. They are also very expensive and there are potential complications such as nerve irritation, so we have moved away from that,” he says.

The Procedure Instead, Carlson now offers select patients the option of enhancing their spinal fusion procedure with a dose of their own stem cells.

Mesenchymal stem cells are of particular interest in orthopedics because of their ability to differentiate into both bone and cartilage. While these cells have been isolated from adipose tissue, periosteum, and synovial linings, Carlson prefers to extract the cells needed to support spinal fusion from the stem-cell rich marrow of the iliac bone.

During the spinal fusion procedure, while the patient is under general anesthesia, Dr. Carlson aspirates about 100 cc of the liquid bone marrow (more for a multi-level fusion) and passes the syringe to a technician who performs the centrifugation. Preparation requires only about 20 minutes, after which a concentrated dose of about 15 cc is applied to a scaffolding

“This is the future of

medicine and the possibilities are really exciting.” product at the graft site, enhancing the environment to encourage consolidation of the bone.

Not only are the autologous cells safe for patients (and FDA approved), but harvest to application requires only a single procedure, making the technique more efficient and safer than the multiple procedures that may be required when cells are extracted from a different region.

“This is not the fountain of youth or the Holy Grail,” cautions Dr. Carlson. “But even at three to six months, I’m seeing a nice development of bone where I want it to be to help to stabilize and fuse the spine.

This has been the experience of others around the country, as well, and the literature now supports the idea that stem cell supplementation in lumbar fusion is equal to or better than other techniques.”

Some stem cell procedures also use the patient’s platelets, which layer out in centrifugation. They may be injected into the surrounding soft tissue in the surgical area. Use of the platelets has been shown to reduce inflammation related to the surgery, may decrease recovery time, and help inhibit scar tissue formation.

Stem Cell Therapy For Other Clinical Applications Not every patient with back or joint pain is a candidate for stem cell therapy, but many are. While Dr. Carlson has focused his stem cell therapy efforts on spinal fusion candidates, centers around the country are already branching out,

applying the therapy in the treatment of arthritic knees, hips, ankles, elbows and other joints. After a visit to the Texas headquarters of OI’s chosen stem cell harvesting/processing system (Celling Biosciences, Inc.), Carlson says he believes that these other applications could easily be offered in Sioux Falls.

“We have gained a level of expertise here at OI, so that we can offer this here if someone is interested. We can also be a resource for patients who want to explore all the options. Many patients may not realize that this is even possible in Sioux Falls,” says Carlson.

Regardless of what area of the body is being treated, stem cell therapy may be an option for people with arthritic conditions who present with pain, but are not yet ready for full joint replacement or another surgical procedure. Often, such patients are offered cortisone injections or a synthetic lubricant such as Synvisc.

“Those are not a cure-all, nor are they 100 percent effective, although they may relieve a patient’s pain for a time,” Carlson says.

Eventually, many of these patients do end up needing surgery. Although stem cell therapy has not been proven to be more effective in the short run than other nonsurgical approaches, it does offer one very distinct advantage.

“In addition to reducing inflammation and pain and improving function, there is also the hope that stem cells might actually help restore some of the patient’s tissues back to a more normal state,” says Dr. Carlson. “I think before I would have a big back operation, I certainly would try this, if my surgeon felt like I was an appropriate candidate.”

Is There a Downside Perhaps the biggest downside to this investigational therapy is the fact that, as with other emergent techniques, it is not covered by insurance. In the case of lumbar fusion, stem cell supplementation does not necessarily add to the cost of the procedure since it can replace an alternative like BMPs or bone transplantation.

But the same is not true of other joints.

A patient who wants to try an injection of stem cells into their knee or hip, for example, could expect to pay $5000 to $6000 out of pocket.

“If a physician has a patient who is having pain in their back or is having trouble with knee or hip pain and they’re not quite ready for a joint replacement, it certainly would be worth discussing with them,” says Dr. Carlson. “The key is they are going to have to be able to pay for it.”

Carlson says OI will work with patients who are interested in the technique to help make it possible.

“Even if they buy themselves two, three, or four years before they need a total joint, many feel it’s worth it,” says Dr. Carlson.

“This is the future of medicine and the possibilities are really exciting.” ■ REFERENCES 1. Bahney CS, Miclau T, “Therapeutic potential of stem cells in orthopedics”, Indian J Orthop., Jan/Feb; 2012, 46(1):4-9 2. Schmitt A, Griensven, et al, “Application of stem cells in orthopedics”, Stem Cells Int., 2012, 394962

15

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16

Midwest Medical Edition

Spotting the Signs of Drug Diversion

By Amanda McKnelly and Maria Eining

T

HE MISUSE AND ABUSE of drugs is a

crisis in our country and around the world. By 2020, mental health and substance use disorders are expected to surpass all physical diseases as a major cause of disability worldwide.

Drug diversion, any intentional removal of a prescription medication from the legitimate channels of distribution or dispensing, is a part of that. The 2013 National Survey on Drug Use and Health (NSDUH) indicates that 15.2 million people age 12 or older used prescription drugs non-medically in the past year, and 6.5 million did so in the past month.

Pain relievers including opioid analgesics, tranquilizers, stimulants, and sedatives are the prescription drugs most often misused or diverted. Opioid analgesics are powerful painkillers with valid medical indications. However, when the patient takes the wrong dose, or the wrong person takes the opioid pain medication, consequences can be deadly.

But healthcare professionals are in a unique position to educate, identify, and intervene with patients and colleagues who are at risk for prescription drug misuse and abuse.

By recognizing the signs of misuse and risk factors for drug abuse and diversion, educated healthcare

professionals can be instrumental in changing patterns and reducing this public health epidemic.

Substance use disorders have been identified as an occupational hazard for healthcare professionals.

Healthcare professionals experience substance use disorders at the same rate as the general population but have a higher-than-average rate of opioid abuse. In some cases, a healthcare professional may have an illness, injury or emotional or physical pain condition that allowed for a valid prescription prior to drug diversion.

Of course, not all who have used opioids will abuse them and not all who have abused will divert but for those that divert, the majority will divert illegally from the hospital or facility where they work. Human Resource departments often report that, when they go back and look at the habits of an individual suspected of diversion, the signs of abuse are there but went unrecognized.

Even with the most robust prevention program possible, it is not uncommon to see a 5 percent diversion rate in a healthcare facility. That rate jumps to 15 percent in the absence of monitoring.

But healthcare professionals who know the signs may notice tell-tale changes in behavior even before monitoring systems identify anomalies. If drug diversion is suspected,

Access the complete list of references and helpful links on our website.

June 2016

MidwestMedicalEdition.com

he or she should document the suspicion and make a report to a supervisor. Evidence shows that healthcare professionals whose substance abuse problems are detected early and treated have a higher likelihood of successful outcomes (NCSBN, 2011) and can continue to be a valuable member of the healthcare community and workforce. ■

Amanda McKnelly and Maria Eining are the owners of Midwest Health Management Services in Sioux Falls.

SIGNS AND SYMPTOMS OF HEALTHCARE PROFESSIONALS WHO MAY BE DIVERTING DUE TO A PRESCRIPTION DRUG SUBSTANCE USE DISORDER:

■ Coming to work on days off ■ Volunteering for overtime ■ Incorrect narcotic counts ■ Volunteering to administer medications ■ Waiting to be alone to open a narcotics cabinet ■ Not having witnesses to verify the waste of unused medications

17

HIPAA Requirements and PHI Disclosure

What should your facility do after receiving a subpoena or a court order? For the answer, see the extended version of this article on our website.

By Vanessa Mulnix

F

OLLOWING THE 2013 HIPAA

amendments, several states followed suit by amending their privacy statutes to help reduce disclosure of protected health information (PHI). That said, you may disclose PHI without patient authorization in certain situations. There also are situations where you may be obligated to disclose PHI. There are two situations (outlined by HIPAA) where a covered entity is required to disclose PHI: 1. when the patient makes a valid request 1 (with certain limited exceptions 2); and 2. when requested by the Department of Health & Human Services to do a HIPAA-compliance audit.3 In addition, one of the most common types of medical record requests is a subpoena. A subpoena differs from a court order in that it is typically signed by a court clerk or attorney, not a judge. If you receive a subpoena, consider several factors prior

Marie Ruettgers Managing Attorney 9 Years in Hospital Administration

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to responding or objecting.

HIPAA allows a covered entity to disclose PHI “in the course of any judicial or administrative proceeding” in response to an order of a court or administrative tribunal, or a subpoena, discovery request, or other lawful process.4 Each has restrictions.

A disclosure of PHI in response to an order of a court or administrative tribunal is limited to “only the PHI expressly authorized by such order.”

A subpoena signed by an attorney or court clerk must be accompanied by either a signed patient authorization or satisfactory assurances of patient approval/notice. Notice means the individual who is the subject of the PHI was notified of the request and given an opportunity to object.5 Importantly, most states provide extra protection for certain types of PHI. For example, psychotherapy notes require authorization from the patient even if there

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18

is a court order compelling production of the medical record.6 Another example of protected PHI is alcohol and/or drug abuse. Absent a few narrow exceptions, a covered entity may not disclose PHI related to alcohol and/or drug abuse without the patient’s express authorization.7 Another type of PHI request is one from a law enforcement officer for law enforcement purposes. This may include, but is not limited to, reporting certain types of wounds such as gunshot or knife wounds, grand jury subpoenas, or court-ordered warrants or subpoenas.8 HIPAA allows disclosure of limited information to law enforcement for identifying and locating suspects, fugitives, material witnesses, or missing persons.9 Information that may be disclosed is limited to name and address, date and place of birth, social security number, ABO blood type and Rh factor, type of injury, date and time of treatment, date and time of death (if applicable), and distinguishing physical characteristics.10 Your facility also may be permitted to disclose certain PHI to law enforcement officials for suspected victims of crimes, decedents, crimes on your premises, or reporting a crime in an emergency.11 Each of these instances contains specific provisions and limitations that should be reviewed prior to complying with a request. ■ Vanessa Mulnix, RN, BSN, CPHRM, CPHQ, is a ProAssurance Senior Risk Resource Advisor.

SOURCES

6 45 CFR 164.508(a)(2).

1 45 CFR 164.502(a)(2).

7 42 CFR Part 2.

2 45 CFR 164.524 & 164.528.

8 45 CFR 164.512(f)(1).

3 45 CFR 164.502(a)(2).

9 45 CFR 164.512(f)(2).

4 45 CFR 164.512(e).

10 4 5 CFR 164.512(f)(2)(i) (A-H).

5 45 CFR 164.512(e).

11 45 CFR 164.512(f)(3-6).

Midwest Medical Edition

Dr. Pearce speaks during cell therapy conference at the Vatican.

Local Researchers Present at Vatican Cell Conference SANFORD HEALTH’S WORK

in cellular therapy and regenerative medicine earned a team of its top researchers and administrators a trip to the Vatican in April as part of an international conference.

The Third International Conference on the Progress of Regenerative Medicine and its Cultural Impact is part of a collaboration between The Vatican’s Pontifical Council for Culture foundation, Science, Theology and the Ontological Quest, and The Stem For Life Foundation, a not-for-profit organization devoted to advancing global awareness of regenerative medicine and cell therapy.

“I honestly think that what they did is fantastic because there is a lot of misunderstanding around stem cell research,” Sanford’s head of research, David Pearce, PhD, told MED. “People tend to think of embryonic stem cells, but there is a great deal of potential in adult stem cell research and the church recognizes that.”

During the three-day conference, Pearce presented to a 300-person crowd of scientists,

June 2016

physicians, faith leaders, journalists and others on Sanford’s ongoing cell therapy work in rare diseases and its effort to cure type 1 diabetes through The Sanford Project.

“They were three very long days, but it was such an honor for us to be there,” says Pearce.

“We don’t necessarily always attract this kind of attention because of where we are.”

Other Sanford presenters at the conference included Jill Weimer, PhD, who spoke on progress in Batten Disease, a rare childhood condition for which Sanford Research has developed a new cell-therapy method and Eckhard Alt, MD, PhD. During the conference, Sanford was also presented with The Pontifical Key Innovation Award in recognition of medical innovation, transformative thinking, creativity and ingenuity.

Pearce and his colleagues wrapped up the experience with a concert by U2 guitarist, The Edge, in the Sistine Chapel. “We were a bit spoiled in the end,” says Pearce. ■

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Motility Disorders Require Expertise for Diagnosis, Treatment

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20

WHILE GASTROINTESTINAL MOTILITY DISORDERS in children may exhibit some of the same signs and symptoms as adult motility disorders, there are distinct differences in their diagnosis and treatment. Mark Kusek, MD, a pediatric gastroenterologist at Children’s Hospital in Omaha says the variations between the adult and pediatric versions of the same disorders can make correctly evaluating pediatric patients a challenge.

“Many primary care physicians see the conditions from the onset but lack the testing equipment or the specialization to identify the etiology,” Dr. Kusek says. Pediatric gastrointestinal motility disorders vary from less serious conditions such as chronic constipation to serious conditions including chronic intestinal pseudo obstruction, which includes symptoms such as periodic vomiting or the inability to eat normally that indicate an obstruction of the digestive system though no anatomical obstruction exists.

“Many of these conditions are chronic and can occur at any age,” Dr. Kusek says. “All are treatable, but because they can result in loss of weight or poor growth, it is very important to diagnose and begin a treatment plan as quickly as possible.”

To provide comprehensive evaluation and treatment, Children’s offers multidisciplinary subspecialty clinics within the GI department that are unique in Nebraska.

“Because the brain is such a huge component of many of these disorders, we employ comprehensive biological, psychological and social management of these issues incorporating gastrointestinal physicians, surgeons, child psychologists, dietitians and social workers,” says Dr. Kusek.

Therapy may include medication, psychology to relieve stress, anxiety or depression, or surgical management. In some cases, implantable devices such as a gastric electrical stimulator are used to help get the stomach back on track. ■

Midwest Medical Edition

Beckenhauer Construction has been providing high quality construction service to its clients for 138 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”.

Avera eCARE Now in 10 Percent of CAHs There are 1,331 certified “Critical Access Hospitals” (CAHs) across the nation, and Avera eCARE now serves more than 10 percent of these facilities through services that include Avera eICU CARE, eEmergency, ePharmacy and eConsult. Avera extends specialty care to distant rural facilities through interactive video and advanced computer monitoring technology.

“Avera’s mission through eCARE is to make healthcare more accessible to underserved

Gamma Knife Treatment Now Available in Sioux Falls

AVERA CANCER INSTITUTE SIOUX FALLS is now offering treatment for brain

tumors with a precision radiation therapy tool called the Elekta Gamma Knife Perfexion. The gamma knife allows for the delivery of the highest therapeutic doses to the smallest treatable tumors and is considered the gold standard for non-invasive treatment of brain disorders.

In addition to its precision, the gamma knife has the added advantage of shorter treatment. As opposed to other forms of radiation treatment, which may require multiple treatments over the course of three to six weeks, gamma knife is a one-time treatment.

Patients can go home the same day as the procedure. Most experience few, if any, side effects.

Common uses include treatment for cancerous brain tumors, cancer in the brain that has spread from another location, non-cancerous lesions or neurological conditions such as arteriovenous malformations and trigeminal neuralgia, and in circumstances in which traditional surgery isn’t an option due to health concerns or critical location.

“The primary treatment of most intracranial disease (brain tumors and lesions) is still surgery,” said Radiation Oncologist James Simon, MD. “Unfortunately, not all tumors or cancerous lesions can be safely removed without causing long-term side effects to the brain. In these situations, an equally effective alternative therapy is critical.”

Gamma knife’s ability to shrink tumors can also make it a valuable tool when the goal is to improve quality of life; it can be used to minimize the size of the tumor and reduce damage to critical brain functions, explains Neurosurgeon Wissam Asfahani, MD. “With the gamma knife, we’re able to control the disease as much as possible,” he said.

Previously, people in the Sioux Falls region and anywhere in the Dakotas had to choose between Rochester, Minnesota or Omaha, for this specialized level of care.

Avera began offering the gamma knife treatment to patients in May. ■

MED QUOTES

22

“

populations, most specifically, those living in rural areas. That’s why we are particularly excited to be reaching 10 percent of Critical Access Hospitals, not only in our immediate area, but across multiple states,” said Deanna Larson, Avera Health Senior Vice President of Quality and eCARE. CAHs have no more than 25 inpatient beds, and are located in a rural area, at least 35 miles away from any other hospital. CAHs focus on providing care for common conditions and outpatient care, while referring other conditions to larger hospitals.

Examples of eCARE include: ■ A patient receiving intensive care in his home community through an Avera eICU CARE “wired bed”

■ A local emergency team getting backup assistance by pushing a button on the wall to access emergency medicine specialists

■ A patient receiving a clinic visit with a specialist through eConsult at her home clinic or hospital

■ L ocal doctors and nurses relying on a pharmacist to review and approve medication orders as a check against possible medication errors.

Avera eCARE services reach across 10 states,

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”

and have been supported in development and growth by the Helmsley Charitable Trust. ■

Midwest Medical Edition

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Daniel Petereit, MD, Radiation Oncologist, informs attendees about the history and benefits of TomoTherapy for cancer patients during a news conference at Rapid City Regional Hospital in April.

Regional Upgrades Cancer Treatment Technology RAPID CITY REGIONAL HOSPITAL’S

Cancer Care Institute has upgraded its radiation treatment technology. As of April, CCI houses one of the newest TomoTherapy treatment systems in the world.

CCI was a pioneer in the field of radiation oncology when it implemented TomoTherapy, a state-of-the-art radiation delivery system, in 2004. Now, 12 years later, Regional Health has upgraded the technology with a new unit to help ensure cancer patients can continue to receive advanced cancer radiation treatment in the Black Hills without having to travel hundreds—or even thousands—of miles.

“The new unit is very similar to the old unit in its ability to deliver precise stereotactic radiosurgery but there are important improvements,” Radiation Oncologist Michael Swartz, MD, told MED. “When we are using high doses of radiation, patients sometimes have to be immobilized in relatively uncomfortable positions. The increase in efficiency means it will decrease the time that they have to be uncomfortable. We just did a case that would normally take 30 minutes and we were able to do it in under 15.”

The faster unit is also likely to be more accurate since the shorter duration reduces the chance that a patient will need to move during the treatment. Finally, the heightened precision of the upgraded unit has

24

been shown to produce fewer side effects and make it possible to treat tumors in hard to reach places in the brain, lung, liver and vertebral column.

“Where this will be especially helpful is in people who require repeat radiation because the dose is more confined just to the targeted areas,” says Dr. Swartz.

“Tomotherapy has become a game changer in the field of radiation oncology and has far surpassed expectations,” says Radiation Oncologist Daniel Petereit, MD, who was instrumental in bringing the first TomoTherapy unit to CCI. When CCI installed its first unit, it was the fifth site in the world, and the first community site to offer it. The new TomoTherapy unit is the 580th installed worldwide.

Dr. Petereit says the new technology will be especially valuable in the treatment of early stage lung cancer in people with significant comorbidities. These patients can receive three to five doses of radiation over a week to ten days instead of having to have six and a half weeks of radiation with more advanced lung cancer.

“Our goal is to make University level cancer treatments available here for people who either don’t have the resources to leave or simply don’t want to leave their home area for treatment,” says Dr. Petereit.

Regional has also been involved in TomoTherapy research. ■

Art Panels

to Improve the View for Cancer Patients

RAPID CITY REGIONAL Hospital Regional Cancer Care Institute recently unveiled four outdoor art panels as part of a collaboration with the Suzie Cappa Arts Center.

The panels painted by Suzie Cappa Art Center artists have been placed near the concrete wall on the east side of CCI to help enhance patient views from the chemotherapy room windows that face the industrial-looking area.

The project was the brainchild of senior groundskeeper Rich

MidwestMedicalEdition.com

Karsky, who approached CCI and the Arts Center with the idea.

Four artists participated in the project. Regional Health and the Rapid City Regional Hospital Auxiliary purchased the outdoor panels and supporting framework and Suzie Cappa donated the design time and supplies to paint the panels.

The Suzie Cappa Art Center is a non-profit studio that supports artists of all abilities in creating inspiring art. â–

25

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Midwest Medical Edition

Life Insurance 101

By Mark Schlueter

T

HE TWO BASIC TYPES of life

insurance are term life and permanent (cash value) life.

Term policies provide life insurance protection for a specific period of time. If you die during the coverage period, your beneficiary receives the policy’s death benefit. If you live to the end of the term, the policy simply terminates, unless it automatically renews for a new period. Term policies are typically available for periods of 1 to 30 years and may, in some cases, be renewed until you reach age 95. With guaranteed level term insurance, a popular type, both the premium and the amount of coverage remain level for a specific period of time.

Permanent insurance policies offer protection for your entire life, regardless of your health, provided you pay the premium to keep the policy in force. As you pay your premiums, a portion of each payment is placed in the cash-value account. During the early years of the policy, the cash-value contribution is a large portion of each premium payment.

As you get older, and the true cost of your insurance increases, the portion of your premium payment devoted to the cash value decreases. The cash value continues to grow—tax deferred—as long as the policy is in force. You can borrow against the cash value, but unpaid policy loans will reduce the death benefit that your beneficiary will receive. If you surrender the policy before you die (i.e., cancel your coverage), you’ll be entitled to receive the cash value, minus any loans and surrender charges.

What type of insurance is right for you?

Before deciding whether to buy term or permanent life insurance, consider the policy cost and potential savings that may be available.

Also keep in mind that your insurance needs will likely change as your family, job, health, and financial picture change, so you’ll want to build some flexibility into the decision-making process. In any case, here are some common reasons for buying life insurance and which type of insurance may best fit the need.

MORTGAGE OR LONG-TERM DEBT: For most people, the home is

one of the most valuable assets and also the source of the largest debt.

An untimely death may remove a primary source of income used to pay the mortgage. Term insurance can replace the lost income by providing life insurance for the length of the mortgage. If you die before the mortgage is paid off, the term life insurance pays your beneficiary an amount sufficient to pay the outstanding mortgage balance owed.

FAMILY PROTECTION: Your income not only pays for day-to-day

expenses, but also provides a source for future costs such as college education expenses and retirement income. Term life insurance of 20 years or longer can take care of immediate cash needs as well as provide income for your survivor’s future needs. Another alternative is cash value life insurance, such as universal life or variable life insurance. The cash value accumulation of these policies can be used to fund future income needs for college or retirement, even if you don’t die.

SMALL BUSINESS NEEDS: Small business owners need life insurance

Mark A Schlueter, CFP, CLTC, FIC, is a Financial Consultant with Thrivent Financial in Sioux Falls.

to protect their business interest. As a business owner, you need to consider what happens to your business should you die unexpectedly.

Life insurance can provide cash needed to buy a deceased partner’s or shareholder’s interest from his or her estate. Life insurance can also be used to compensate for the unexpected death of a key employee.

Once you purchase a life insurance policy, be sure to periodically review your coverage; over time your needs will change. ■

For a list of questions to help you estimate your insurance needs, see the extended version of this article on our website.

June 2016

MidwestMedicalEdition.com

27

Providers Asked to Support New Breastfeeding Initiative

Seek

THE SOUTH DAKOTA DEPARTMENT OF Health is asking

HELP

Find

HOPE

healthcare professionals to support a new initiative designed to make public breastfeeding or pumping at work a “non-event”.

Brookings recently became the pilot community for the new Breastfeeding-Friendly Business Initiative, a statewide push to encourage businesses to demonstrate their commitment to accommodate breastfeeding mothers, whether they are employees or customers.

“It’s essentially a goodwill pledge from businesses that helps mom’s to know that they are doing businesses with a place that supports their decision to breastfeed,” says Megan Hlavacek, MS, RDN, LN, the health department’s Healthy Foods Coordinator who is also coordinating the breastfeeding initiative. MED spoke with Hlavacek by phone in May. Brookings Health System, South Dakota State University and the Brookings Area Chamber of Commerce were the primary partners represented by the Brookings Supports Breastfeeding team and the first to sign the pledge. The City of Brookings, Brookings County, 3M, Children’s Museum of South Dakota and Hy-Vee also have also taken the breastfeeding pledge. To date, 100 businesses have taken the pledge–97 of them from Brookings.

Businesses that take the online pledge receive a Breastfeeding Friendly Business Kit including educational and staff training materials, policy language, fact sheets, and a “Breastfeeding Welcome Here” window cling.

At 45.6%, South Dakota is slightly below the national average in the number of mothers who breastfeed their babies for at least six months. The new initiative has a goal of increasing that number to 60.6% by 2020 both by lifting up business that are already “breastfeeding friendly” and by providing support and training for businesses that don’t have a policy in place.

Hlavacek says doctors and other healthcare professionals can help by making sure their own workplaces have signed the pledge and by letting patients know where they stand.

“Docs have time with moms and have such an influence,” she says. “They have the ability to support the decision to breastfeed and that really resonates with moms. It lets a woman know that she is doing a good thing.”

Although Brookings is the pilot community, the pledge is available to any SD business at www.healthsd.gov/breastfeeding.

The state is encouraging all hospitals and clinics to take the pledge to help increase awareness for breastfeeding. ■

wel

Helping Professionals Stay on Track

Midwest Health Management Services SD Health Professionals Assistance Program

ph | 605-275-4711 fax | 605-275-4715

www.mwhms.com

Med School Applications Surge Applications for enrollment

accepting two students from the

into the University of South

“Indians Into Medicine” program

Dakota Sanford School of Medi-

based in North Dakota. That

cine have reached 859, a ten-

number -69- includes the possible

year high. This represents an 89%

admission of two students in

increase in application numbers

each class who combine an MD

since 2013.

degree with a PhD degree. In

While out-of-state applications

2011 the medical school admitted

typically outnumber instate

54 students. It is expected that

applications, the medical school

71 students will be starting the

emphasizes admission to South

program in July, 2016.

Dakotans, and 93% of the

South Dakota’s only medical

students currently enrolled in

school has attracted national

the institution are from South

attention for its programs that

Dakota.

connect physicians to rural prac-

In 2015 the medical school

tice, and its community-based

formally adopted an expanded

faculty is considered a highly

class size, and admissions were

effective approach to educating

increased to 69 plus the option of

physicians. ■

28

MED QUOTES

“

leep is that golden chain that ties health S and our bodies together. —Thomas Dekker

”

Midwest Medical Edition

GROWN-UP ‘WISH KIDS’

LOOK BACK

Common conditions among Wish Kids:

By Alex Strauss

OR THE FIRST 9 YEARS of her

■

Cancer

■

Heart conditions

■

Cystic fibrosis

■

Organ transplants

■

D uchenne muscular dystrophy

What does not qualify?

■ C hronic medical conditions

manager at Children’s Scholarship Fund in Omaha. “I can’t recall medicine or treatment as part of the trip at all. I got to feel normal, but a special kind of normal. All the hardship and struggle was temporarily gone,” While there is a lingering perception that all Wish Kids are terminally ill, Sand is an example of the 70 percent of children who go on to beat their illnesses. Scotland, South Dakota native Michael Kronaizl is another.

Kronaizl was diagnosed with a germinoma brain tumor at the age of 17 after he complained of double vision. In 2009, after successful treatment for his cancer, he his parents and brother travelled to Miami to watch the Saints and Colts compete in the Super Bowl. He’s now in his second year of chiropractic school in Minnesota.

“At first, I didn’t think I qualified, but I’m so glad I decided to do it,” says Michael.

“For me, it was like a celebration that it was over. It was a great experience that I’ll remember forever.”

Medical professionals can refer a child to Make-A-Wish by visiting md.wish.org or calling Make-A-Wish South Dakota at 800-640-9198 or 605-335-8000. ■

■

M ental/psychological disorders

■

N eurobehavorial/ developmental disorders

■

O ther non-lifethreatening medical conditions

Photo courtesy Make-A-Wish.

F

Lydia Sand today

life, Lydia Sand of Sioux Falls and her family thought she was suffering from severe allergies.

When she was finally diagnosed with cystic fibrosis, there was a measure of relief at finally having some answers.

“After I got on the right medications, there was a huge turnaround in how I was feeling,” she recalls.

But there was also the new challenge of learning to live with and manage this lifethreatening genetic disease. She and her family had been dealing with that for about five years when, at a quarterly check-up, they were told that Lydia qualified for a “wish” from Make-A-Wish.

Make-A-Wish South Dakota is part of a national organization whose goal is to strengthen and empower children like Lydia by creating a bright spot of hope in their lives.

From Disney World trips and puppies to shopping sprees and celebrity meet-ups, Make-A-Wish makes a new dream come true every 35 minutes. In South Dakota, that’s about 60 wishes a year at a per-wish cost of about $7,000.

Lydia didn’t have to think long to know what hers would be.

“My wish was to meet Jennifer Garner, who was starring in the TV show ‘Alias’ at the time,” says Sand. Garner’s gutsy character inspired the young Lydia to face the challenges of her condition with courage and tenacity and Alias was her favorite show. In 2005, the family flew from Sioux Falls to Hollywood where they watched the show’s filming from the set, and spent one-on-one time with Garner.

“This experience was the one time in my life, when I didn’t remember that I had CF,” says Sand who, at 25, is now a program

TO QUALITY FOR A WISH, A CHILD MUST BE BETWEEN 2 AND A HALF AND 18 AND FACING A LIFE-THREATENING MEDICAL CONDITION.

Lydia Sand meeting Jennifer Garner in 2005.

June 2016

MidwestMedicalEdition.com

29

How to Negotiate an

Employment Contract

By Jeana Goosmann

H

OSPITALS ROUTINELY face

the complex dilemma of needing to add a top notch physician while working with limited funds to recruit due to a declining operating budget. In addition, physician recruitment is complicated by the legal restrictions placed on physician transactions, and the myriad key terms for mutual agreement critical to a deal. Here are some beneficial tips on how to negotiate a physician employment contract that is a win-win for physicians and employers.

First and foremost, consult an employment lawyer specializing in health law. While some sections of an employment contract may seem straightforward, close analysis is required for the terms in physician contracts that are uniquely governed by lengthy and complicated regulations. It’s best to have an experienced lawyer look over the entire agreement to ensure that it complies with regulatory issues that do not arise outside of the healthcare field.

Second, identify and communicate the culture of your organization. Peter Drucker’s quote “culture eats strategy for breakfast” is used across the nation in healthcare leadership training. If you are an employer, pitch your culture before pitching your compensation. You want to make sure that you are recruiting a physician who fits into your team.

Third, maintain open and clear communications throughout the negotiating process.

This is important whether you are the

employer or the physician looking to join an organization. If each side clearly expresses what is important to it in the negotiations, the process is more likely to be smooth without misunderstandings. Depending on the size of the employer, some employment terms may simply be non-negotiable or set by a committee rather than the executive negotiating at the table.

There are a number of terms in most physician employment contracts. Compensation usually receives the most legal attention in negotiations. But I have spent more time negotiating medical malpractice tail provisions and call coverage to wrap up an employment contract. The following terms are also important in negotiations: professional liability coverage limits, restrictive covenants addressing non-competition and non-solicitation, call coverage and shift schedules, moonlighting restrictions, outside ownership restrictions, assignment options, termination and disability, continuing medical education expenses, hospital privilege requirements and practice locations.

Because physician compensation must comply with federal fraud and abuse regulations such as the Stark Law, the AntiKickback Statute, and the False Claims Act, it is important that you work with an experienced health law attorney to mitigate

employer and physician exposure to civil and criminal penalties.

When addressing the issue of compensation, nationally published compensation data and/or opinions from compensation consultants can aid negotiations as resources to mitigate compensation “Fair Market Value” risk. However, neither should be the sole due diligence of a fair market value assessment. If the employer is a non-profit entity, it will be important that the compensation package also complies with IRS regulations. For employers, explain your compensation and bonus structure in detail even if the contract starts with a set salary for an initial period. Set the physician up for success in a productivity and/or quality measurement compensation structure in the beginning. This is where the importance of open communication and explaining organizational cultural issues is important to the negotiating process. ■ Jeana Goosmann is CEO & Managing Partner at Goosmann Law Firm

For more on exactly how to handle the moment of signing, see the extended article on our website.

30

Midwest Medical Edition

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31

Plan the Perfect Office Retreat

By Carmella Biesiot

R

ETREATS ARE becoming more

popular than ever before as employers recognize the importance of taking a break from the routine, ditching the electronics, and coming together outside of the work place. These guidelines will help you create the perfect experience for your team whether you manage just a few people, or a large corporation.

Create a “Loose” Agenda Plan, but not too much. Create an agenda that has open ended items for discussion;

after all, this is not a meeting, it is a retreat.

Allow your agenda to take off into different directions and don’t fret if an agenda item takes off into a completely different topic than intended. In fact, plan for it to happen!

Keep it Casual The atmosphere should be collected and carefree. A break from typical business attire is a must. If possible, your gathering should avoid electronics. Keep things simple and comfortable; the opposite of a conference-style setting. When people are

comfortable and relaxed, they tend to produce ideas and absorb the subject matter with positivity.

There Is No “I” in Team If you are the manager, you are used to leading and directing. I challenge you to put someone else in charge of the retreat, or have everyone take a turns at leading a topic. This will empower your team and make them take control, thus knowing that they are important. You will learn about their point of view which will make you a better boss.

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Certified Financial Planner Board of Standards Inc. owns the certification marks CFP® and CERTIFIED FINANCIAL PLANNER™ in the U.S. Insurance products issued or offered by Thrivent Financial, the marketing name for Thrivent Financial for Lutherans, Appleton, WI. Not all products are available in all states. Securities and investment advisory services are offered through Thrivent Investment Management Inc., 625 Fourth Ave. S., Minneapolis, MN 55415, a FINRA and SIPC member and a wholly owned subsidiary of Thrivent. Thrivent Financial representatives are registered representatives of Thrivent Investment Management Inc. They are also licensed insurance agents/producers of Thrivent.

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32

Midwest Medical Edition

Location is Important Obviously, your retreat is not at the office, but where do you go? I suggest taking your meeting off of the beaten path-get creative. If possible, choose an outdoor venue such as a park or pavilion. If that is not possible, think of a unique place that you might not associate a meeting place with such as a museum, art gallery, yoga studio, or even a lounge. The location of your retreat is the first thing that your attendees are going to think about prior to the event date. If it is a fun and creative venue, they will be anxious and excited before it even starts.

Keep Discussions Positive It is very important to avoid whining and ranting. All too often, when colleagues are placed in any sort of setting outside of the office, complaining occurs. Be mindful of this possibility and make it clear that this is not acceptable. If someone wants to highlight a problem or conflict, a solution must follow their statement.

Set Goals Goals are a way to keep everyone committed and focused.

Let your team know at the beginning of the retreat (or prior to) that they are to come up with two goals for the year; one personal and one professional. They will share these goals with the entire group at the end of the retreat. Follow up with those goals the following year. This will keep them engaged and focused on being better, not to mention bragging rights at the next gathering.

Carmella Biesiot is Director of Hotel Sales & Marketing at the Lodge at Deadwood Gaming Resort.

June 2016

MidwestMedicalEdition.com

33

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MED March 2016.indd 1

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Midwest Medical Edition

Learning Opportunities Summer / Fall 2016 June 9 4:00 pm–7:00 pm

Avera Sports Medicine Symposium Location: Holiday Inn City Centre, Sioux Falls

Information: 605-322-7879, AveraEducationEvents@avera.org Registration: Avera.org/conferences

June 23 – 24 10:00 am–11:30 am

South Dakota Association of Healthcare Marketing & Public Relations Spring Conference

Location: Cedar Shore Resort, Chamberlain Information: jyoder@brookingshealth.org

June 24 – 25 8:00 am–5:00 pm

38th Annual Sanford Black Hills Pediatric Symposium Location: The Lodge at Deadwood

Registration: sanfordhealth.org/forms/blackhillspediatricsymposium Information: 605-312-1067

September 8 9:00 am – 4:00 pm

4th Annual Avera & Hazelden Symposium Location: Ramkota Hotel, Sioux Falls

Information: 605-322-7879, AveraEducationEvents@avera.org Registration: Avera.org/conferences

September 12 8:30 am – 2:00 pm

Dialectical Behavior Therapy: A Day with Marsha Linehan Location: Ramkota Hotel, Sioux Falls

Information: 605-322-7879, AveraEducationEvents@avera.org Registration: Avera.org/conferences

September 21 – 23

SDAHO 90th Annual Convention

Location: Sioux Falls Convention Center

Information: SDAHO.org

September 23 8:00 am – 4:30 pm

Avera Pulmonary & Critical Care Symposium Location: Holiday Inn City Centre, Sioux Falls

Information: 605-322-7879, AveraEducationEvents@avera.org Registration: Avera.org/conferences

September 29 – 30

17th Annual Oncology Symposium

Location: Prairie Center, Avera McKennan Hospital Information: 605-322-7879, AveraEducationEvents@avera.org Registration: Avera.org/conferences

SAVE THE DATE: OCTOBER 7 16th Annual Community Response to Child Abuse 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 Alex@MidwestMedicalEdition.com.

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