September

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Vol. 5 No. 6

South Dakota and the upper MiDweSt’S Magazine for phySicianS & healthcare profeSSionalS

IndependentBut not aloneSOuth DakOta cOmmunity hOSpitalS Stay StrOng with creative cOllabOratiOn

3D MaMMography comes to aberdeen

Media interviews & medical Jargon

CalliNg patieNts’ Cell phoNes

tread carefully

One number accesses our pediatric surgical specialists, any problem, anytime.

1.855.850.KIDS (5437)Physicians’ PriOrity Line

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

ChildrensOmaha.org

Orthopedics

Pulmonology Gastroenterology & GI Surgery Cardiology & Heart Surgery

Midwest Medical Edition, August, 2014.indd 1 8/7/14 4:08 PM

vOlume 5, nO. 6 ■ September / OctOber 2014

Contentsregular FeatureS 4 | From Us to you

7 | MeD on the Web exclusive content on midwestmedicaledition.com

12 | News & Notes new doctors, certifications, clinics, and more

30 | the Nurses’ station nursing news from around the region

36 | Wine Marketplace wines for fall, bordeaux in beijing?

39 | learning opportunities upcoming conferences, events, and cme Opportunities

in thiS iSSue 6 | The Cure for Your Wi-Fi ■ By Bryan o’Neal

8 | Sioux City Doctor Says Ebola Outbreak Shows “Sacrificial” Side of Medicine

16 | Preparing for the Denial Process: tips for eliminating your icD-10 claims problems today ■ By Natalie Bertsch

24 | Is Your Business Ready for the ACA Employer Mandate? ■ By Mark lyons and Brianne sykora

26 | Mercy Medical Center Acquires Siouxland Surgical: what happens next?

27 | Children’s Hospital Receives Highest US News Ranking to Date

31 | The Ins and Outs of Managing Cybersecurity Risk ■ By eric Buzz hillestad

33 | Trailblazing Rural Physician Training: med students are coming to a community near you

35 | How Safe is Your Facility’s Water? a water quality expert offers suggestions for catching problems early to avoid a flood of problem later ■ By Nichole grasma

On the

COver

page 18

MIdwest MedIcal edItIon

September

Oc

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er

2014

Vol. 5 No. 6

South Dakota and the upper MiDweSt’S Magazine

for phySicianS & healthcare profeSSionalS

IndependentBut not aloneSOuth DakOta cOmmunity hOSpitalS Stay

StrOng with creative cOllabOratiOn

3D MaMMography

comes to aberdeen Media interviews

& medical JargonCalliNg patieNts’

Cell phoNes

tread carefully

By alex strauss

are independent community hospitals a

dying breed? in an era of changing reimbursement and rising infrastructure

costs, many say yes. but we spoke to two area ceOs

who say their independent hospitals continue to thrive

in their communities thanks, largely, to support

from many others.

But not alone

oN the CoVer: Dr. evelio garcia, interventional cardiologist, reviews a patient’s angiogram with leah le, rn

and cath lab director, at prairie lakes hospital. in 2013, the prairie lakes cath lab team received the american

college of cardiology Foundation’s ncDr actiOn registry–gwtg platinum performance achievement

award—one of only 197 hospitals nationwide to do so. photo courtesy prairie lakes.

23 Calling Patients on Their Cell Phones: why prior express consent is a must ■ By Jill heyden

29 MEDIA 101: avoid medical Jargon when talking to the press ■ By alex strauss

27 3D MAMMOgRAPHY Now Available in Aberdeen

Independent

midwest medical edition 4 midwest medical edition

From us to youStaying in touch with meD

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

Fax 605-271-5486

MAILINg ADDRESS pO box 90646 Sioux Falls, SD 57109

WEBSITE midwestmedicaledition.com

Jan/Feb issue December 5

March issue February 5

april/May issue March 5

June issue May 5

July/ august issue

June 5

sep/oct issue

august 5

November issue october 5

December issue November 5

2014 Advertising / Editorial Deadlines

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 informa-

tion, however midwest medical edition, llc cannot be held

responsible for consequences resulting from errors or omis-

sions. 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 sug-

gestions 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.

publiSher MED Magazine, LLC Sioux Falls, South Dakota

vp SaleS & marketing Steffanie Liston-Holtrop

eDitOr in chieF Alex Strauss

DeSign/art DirectiOn Angela Corbo gier Corbo Design

phOtOgrapher Kristi Shanks

web DeSign Locable

Digital meDia DirectOr Jillian Lemons

cOntributing writerS Natalie Bertsch Nichole grasma Jill Heyden Eric Buzz Hillestad Mark Lyons Bryan O’Neal Brianne Sykora

StaFF writerS Liz Boyd Caroline Chenault John Knies

SOMETIMES WE ARE ASKED WHAT THE “THEME”

is for a particular issue of MED. people are often a

little surprised when we tell them that, although

many consumer magazines have had great success

with themed issues, here at MED, we don’t do them. there

is a reason for that.

we recognize that the practice of medicine is so complex,

so diverse, and so changeable from one month to the next,

that a “theme” would limit our ability to bring you the fullest

possible spectrum of timely, relevant information to support

your practice and your life. if we did have a theme, that would

be it. and it would be the same for every issue.

in keeping with that non-theme, we welcome a diverse

group of regional contributors to this month’s MED. From

preparing for the aca employer mandate and icD-10 denials,

to ensuring the safety of your drinking water, your wi-fi, and

your automated phone calling system . . . we know you will

find their expert insights both interesting and helpful.

as always, we also encourage your submissions. if you

have practice news to share, or other expertise that could

help your fellow MED readers, let us know. through our print

and digital issues and our rapidly-expanding website, MED

has the ability to quickly and efficiently share your information

with thousands of your colleagues.

we look forward to meeting some of you at the upcoming

SDahO conference in rapid city. if you are there, be sure to

stop by the MED booth for a chance to win a $500 diamond

necklace from riddle’s Jewelry.

all the best,

—Steff and Alex

alex Strauss

Steffanie liston-holtrop

take the MeD reader survey on page 10 for a chance to win a diamond necklace!

5September / October 2014 MidwestMedicalEdition.com

2014 Advertising / Editorial Deadlines

publiSher MED Magazine, LLC Sioux Falls, South Dakota

vp SaleS & marketing Steffanie Liston-Holtrop

eDitOr in chieF Alex Strauss

DeSign/art DirectiOn Angela Corbo gier Corbo Design

phOtOgrapher Kristi Shanks

web DeSign Locable

Digital meDia DirectOr Jillian Lemons

cOntributing writerS Natalie Bertsch Nichole grasma Jill Heyden Eric Buzz Hillestad Mark Lyons Bryan O’Neal Brianne Sykora

StaFF writerS Liz Boyd Caroline Chenault John Knies

To schedule a complimentary consultation, please call us toll-free: 877.585.5307 www.dt-trak.com | 210 North Broadway | Miller, SD 57362

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Midwest Medical Edition 6

Do these symptoms sound familiar?

◆ Loss of connectivity

◆ Slow speeds

◆ Dead spots

◆ Unsupported applications

◆ Insufficient security

If any of these describe your Wireless Local Area Network (WLAN or Wi-Fi), keep reading. There is a cure.

A healthy Wi-Fi network has never been more important for healthcare. Access to patient records, medical imag-ing, and communication now all rely on a wireless connection.

However, the healthcare environment doesn’t make it easy. Interference from biomedical devices, signal-blocking build-ing construction, and the growing number of connected devices make Wi-Fi an on-going challenge for providers and IT staff alike.

Your organization doesn’t have to be crippled by Wi-Fi. Wireless technology has achieved significant advances in recent years. New solutions can monitor the air in real-time and actually steer Wi-Fi sig-nals around interference. Smarter Wi-Fi means stronger coverage, no dead-spots, and stable connections.

New Wi-Fi technology also has the ability to identify and prioritize by type of traffic and client. This means your criti-cal applications are given priority, making for a glitch-free user experience. Plus, new advances make managing separate guest networks, BYOD and security much easier.

The best part? The solution can actu-ally cost less than continuing to work with your ailing Wi-Fi. In a typical WLAN

design, you need to add as many access points as possible to try to overcome the various challenges. Now, reliable Wi-Fi can be deployed throughout your facility with less equipment, saving money and manage-ment headaches.

The cure for your Wi-Fi? Stop treating your WLAN symptoms and invest in a solution that creates a positive and produc-tive experience for your providers and patients. ■

Bryan o’Neal is a healthcare technology

consultant at golden west technologies in

rapid city.

The Cure for Your Wi-Fi NetworkBryan O’Neal

77

onthe

Now More than a Magazine, A Medical Community Hub

Med Magazine is now offered in a convenient digital format for on-the-go reading on your apple or android device. Find the link to the digital issue on the right hand side of the Med home page and sign up to get your next Med right in your Inbox!

ONLY ON OUR WeBsite!

Midwestmedicaledition.com

Find links to these articles and more on the MeD homepage.

◆ WiN a DiaMoND – take our MED reader survey in this issue or online and you’ll automatically be entered to win a diamond necklace from riddle’s Jewelry in Sioux Falls valued at $500 dollars.

◆ iNteraCtiVe DireCtory – Find and connect with area businesses and add yours to the list. it’s easy and free to put the web to work for your practice with a listing and link in MED’s online directory.

◆ CaleNDar oF eVeNts – Find local events from cme opportunities to celebrations, open houses, conferences, seminars and fundraisers. add your own event for free and reach thousands of MED readers.

◆ Digital issUe – read the newest MED on your tablet or smartphone with one click!

◆ BaCk issUes oF MeD – need to find an article you have seen in MED? every issue is now available in an easy-to-access digital format. click the ‘archives’ button on the MED home page.

Go Digital!

News you Can UseDid you know that the MED website is continually updated to bring you to very latest medical community news… and let you share your own news within hours? you no longer have to wait for the next issue of meD. Find out what’s happening now – or promote your own news to thousands of online readers, easily and quickly. add midwestmedicaledition.com to your favorites and stay informed.

get the Media to Cover your Newshealthcare is becoming more competitive and effective branding is more important than ever. even if you do no other marketing, learning to work with the media in your area is a great way to educate patients, solidify your expert standing, and improve your communication skills. intrigued? log on to our website to claim your free Quick Start guide.

Blog for MeD!attract visitors to your own blog or start a following as a guest blogger for MED. if you are a physician with something to say, contact us at info@midwestmedicaledition.com to find out how.

Midwest Medical Edition 8

The plight oF DoCtors battling the recent outbreak of Ebola in West Africa – the worst outbreak of the virus in

history – has focused attention on the very real risks that healthcare workers face when they choose to do medical missions work, especially in developing countries. Liberia alone has lost at least three doctors to the virus and 32 health workers, and, in two high-profile cases, two American doctors were flown to the US from West Africa, also suffering with Ebola.

Infectious Disease Specialist Bertha Ayi, MD, head of infection control at Mercy Medical Center and a native of Ghana, has herself been involved in medical missions. As a medical student in Ghana, Dr. Ayi travelled into remote villages with Christian Medical Fellowship, to treat illnesses ranging from malaria to TB, pneumonia, elephantiasis and yaws.

“Most of the things we were treating

in this situa-tion were not things that were passed from person to person, a l t h o u g h some were,” says Dr. Ayi. “When I feel there is a risk that someone has a com-mu n icable illness, I am

very particular about wearing protective equipment.”

There is no doubt that doctors working in West Africa knew the risks of mission work and were as careful as possible to protect themselves against Ebola using what they had. But Ayi says the outbreak emphasizes the fact that there are always

limits when practicing in a third-word setting.

“It is next to impossible in most hospitals in Africa for people to protect themselves to the level that needs to happen when you are dealing with something like Ebola,” she says. “You really need support from organizations like WHO or the CDC to provide enough of things like gloves, masks, gowns, materials for proper disposal of infected bodies, etc.”

But even in the absence of these things, Ayi says, for doctors working in dangerous situations, it is not a question of underesti-mating or dismissing the risks so much as it is accepting them as an unavoidable part of serving the greater good.

“I think it brings home the fact that medi-cine – no matter where you practice – is in a way a very sacrificial job,” says Ayi. “You know you are placing yourself in harm’s way, but someone has to do it. Someone has to make up their mind that they are going to care for people, no matter what, out of the love of their heart. Otherwise, people won’t get the care they need.”

Although she has access to all of the technology, medications, and protective gear an infectious disease specialist could want in her modern Sioux City hospital, Dr Ayi says the Ebola outbreak won’t keep her from returning to Africa to carry out some big plans.

“Where I grew up, there were very few healthcare facilities and the villages had very few healthcare workers. I have a vision of helping to build a hospital for Ghana. This is what drives me – the chance to make a lasting difference in people’s lives. Because, if people feel better and are strong, they can make the world better,” she says.

As of our publication date, the Ebola outbreak centered on Guinea, Sierra Leone, and Liberia had a death rate of about 50 percent and had killed close to a thousand people. ■

SiOux city DOctOr SayS ebOla Outbreak ShOwS

“Sacrificial” Side of MedicineBy Alex Strauss

infectious Disease Specialist Bertha ayi, MD

9September / October 2014 MidwestMedicalEdition.com

SanFOrD health haS JOineD FOrceS

with the ministry of health in ghana to

improve access to healthcare in for millions

of people in rural ghana.

according to a Sanford news release in

august, the goal of the new relationship is

to help the ghanaian government improve

maternity care and reduce infant mortality.

this new agreement will give Sanford

international clinics the opportunity to

add more than 300 clinics in ghana by

2020 and is expected to serve 4.5 million

patients annually over the same time

period.

the main focus of the public-private

partnership is to improve access in

peri-urban and rural areas and allow

patients to access primary care services

closer to home. kojo taylor, president

of Sanford international clinic-ghana,

believes this new relationship will make

a significant impact.

“much of the rural population in

ghana does not have access to basic care,”

said taylor. “the addition of these clinics

will greatly change the scope of healthcare

across the nation. thousands of families

will no longer be forced to travel for basic

services.”

Sanford international clinics first

formed a relationship with the ghana

ministry of health when it opened a clinic

in cape coast in January 2012. Sanford

has since opened four additional clinics

in the country which have treated more

than 180,000 patients. ■

Sanford to Build Clinics in Ghana

  MeD Quotes

“ Keep a watch also on the faults of the patients, which often make them lie about the taking of things prescribed.” — Hippocrates

Happy 125th Birthday,South Dakota

south dakota symphony orchestra

offfffff

saturday, october 4 at 7:30 p.m.

Michael Cavanaugh: The Songs of Billy Joel and More

saturday, october 18 at 7:30 p.m.

South Dakota Symphony Orchestra2014 Annual Gala

saturday, november 8 at 6:00 p.m.

www.sdsymphony.org

CONCERT TICKETS (605) 367-6000

Reserve Gala Tickets: Call 605-335-7933 orEmail anne.blankley@sdsymphony.org

Midwest Medical Edition 10

take this Reader survey and Be entered to win a

$500 diamond necklace from Riddle’s Jewelry

please mail, fax, or email your completed survey.

mailing address: MeD Magazine, pO box 90646 Sioux Falls, SD 57109 Fax: 605-213-0432 email: info@midwestmedicaledition.com

*meD will never spam you and your information will be kept completely confidential. you will receive a complimentary subscription to meD’s monthly newsletter/digital issue notification from which you can opt out at any time.

to take this survey online see the

link on the MED homepage.

official drawing for the diamond necklace from

Riddle’s Jewelry will take place in october.

winners will be notified via the email

address provided.

Name _______________________________________________Occupation ___________________________________________Email Address* _______________________________________

thanks for your feedback! We will use it to help make

MeD even more valuable for you and your medical practice.

1. are you a regular reader of Med?

(circle one)

a ) yes

b) no

if yes, how often do you read Med?

a ) i read every issue (8x per year)

b ) at least every other issue

c ) maybe a couple times a year

d ) unsure

2. do you prefer to read Med in print

or in its new digital format?

a) print

b) Digital

c) both

3. How long does it usually take

you to read your Med?

a) i usually read through it on the day it comes

b) about a week

c) Sometime before the next issue comes

d) i never get all the way through it

4. what Med segments do you

value most? (circle up to 3)

the cover story

the news segments/news & notes

the cme/events calendar

human interest/feature articles

expert columns

Other _______________________

5. what aspects of Med are most

important to you? (circle up to 2)

it is locally produced

it features local people/institutions

i don’t have to pay for it

it makes me aware of local

businesses and services

6. On a scale of 1 to 5 (1 being irrelevant and 5

being very relevant), how relevant is the con-

tent of Med for your industry?

__________________________

7. Have you ever shared your Med with

another healthcare professional?

a) yes

b) no

8. do you ever put Med in your waiting room?

a) yes

b) no

9. Have you ever been prompted to utilize

a service or make a referral based on

something you read in Med?

a) yes

b) no

10. is there something you would like to see

more of in Med? Please explain.

________________________________________

________________________________________

________________________________________

________________________________________

Midwest Medical Edition

JAN

UA

RY

FEBR

UA

RY

2014

Vol. 5No. 1

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE

FOR PHYSICIANS & HEALTHCARE PROFESSIONALS

PREVIEW MORE MRI POWER IN SIOUXLAND

Watertown’s

Top-level Heart Care

the South Dakota

Legislative Session

PLAYING A

PRIMARY ROLE

Advanced Practitioners in a

changing healthcare environment

Vol. 5, No. 6

2013

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

Gain

without pain Ergonomics in the Medical Workplace

• Warning for SD Doctors:

Time for a Software Upgrade?

• Stress-busting

Treadmill Desks

• Black Hills Company

Keeps Provider IT Healthy

South Dakota and the upper MiDweSt’S Magazine

for phySicianS & healthcare profeSSionalS

SEpTEMbEr

Oc

TObEr

2013

Vol. 5

No. 6

Job interview skills for doctors

ICD-10 and your cash flow

TexT MessagIng

and hipaa compliance

Midwest Medical Edition

Managing

the maze Navigating Meaningful Use on the Great Plains

NO

VEM

BER

2013

Vol. 4 No. 7

South Dakota and the upper MiDweSt’S Magazine

for phySicianS & healthcare profeSSionalS

JUly

/ aU

gU

st

2014

Vol. 5 No. 5

South Dakota and the upper MiDweSt’S Magazine

for phySicianS & healthcare profeSSionalSCyberseCUrity

How Safe is Your Practice?

Why “Alarm Fatigue”

Can be DeadlyNews & Notes From around the region

232Siouxland Doctors Look Back

What We

LearneD

From

11September / October 2014 MidwestMedicalEdition.com

take this Reader survey and Be entered to win a

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G700SEHealthcare Camera

www.abbusiness.com 1-800-477-2425 support@abbusiness.com

The Ricoh G700SE Healthcare Camera is the rst solution of its kind.

Designed for the rigorous requirements of healthcare, it is industrial shock proof

and stands up to water and disinfectants. Using just the camera, a clinician can scan

patient bar codes and then use manual entry or pick lists to embed metadata into

each image le. The camera interoperates with virtually any healthcare information

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G700SEHealthcare Camera

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The Ricoh G700SE Healthcare Camera is the rst solution of its kind.

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patient bar codes and then use manual entry or pick lists to embed metadata into

each image le. The camera interoperates with virtually any healthcare information

system—including electronic medical record (EMR) systems from major vendors.

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes

happenings around the region

midwest medical edition 12

AverA

Preston Renshaw, MD, FAAFP, is the new Chief Medical Officer of Avera Health

Plans. Dr. Renshaw has been

a practicing family physician at Avera Medical Group O’Neill, Neb., for the past eight years. For the past 15 months, he also has been serving as Associate Medical Director of Avera Health Plans. He succeeds Dr. James Powell, who is retiring.

Once again, Avera has been named to the list of Health

Care’s Most Wired. As a health care system, the 2014 designation is Avera’s 15th Most Wired award. The list is based on the 16th annual Health Care’s Most Wired Survey, conducted by Hospitals & Health Networks magazine (H&HN).

Rebekka Klemme, CNP, in conjunction with Avera Medical group Liver Disease Sioux Falls, has been selected for an

NP/PA Clinical Hepatology

Fellowship with the American Association for the Study of Liver Diseases. Klemme holds an MS from South Dakota State University with specialization as a Family Nurse Practitioner, as well as a BS in nursing from SDSU. Since 2010, she has worked with Avera Transplant Institute.

The Avera Sports Institute and Kairos Elite Volleyball Club have announced a new

partnership. Kairos focuses on the skills of volleyball as well as growth of the individual to help players gain personal confidence through achievement. Kairos training sessions and events are held at the Avera Sports Center and Avera Sports Institute.

Two team members from Yankton’s Avera Sacred Heart Hospital were recently invited to Premier’s 2014 Breakthroughs Conference and Exhibition to present information to healthcare professionals.

Kathi Bietz, MLS, ASCP, quality

improvement coordinator, and Tiffany Weeks, director of pre- and post-surgical services, led a session on evidence-based care at the June event held in San Antonio, Texas.

Avera is offering a new way for patients to become a more active partner in their own healthcare through

AveraChart, a secure Internet portal to a patient’s individual electronic medical record. Avera hospitals and clinics are now enrolling patients in AveraChart. Patients can begin the enrollment process by contacting their clinic or hospital registration staff. As of July, 30,000 patients had enrolled.

Electrophysiologist Jonathon Adams,

MD, has joined North Central Heart. Dr. Adams earned his MD from the Sanford School

of Medicine and completed a residency in internal medicine at the Mayo Clinic in Rochester and received fellowship training in cardiovascular diseases at Mayo in Scottsdale, Arizona. He completed his fellowship in cardiac electrophysiology at Stanford in Palo Alto, California.

Nathan J. Timmer, MD, has joined Theresa M. Campbell, MD, and Trevor A. Meaney, MD, at Avera Medical group

Family Medicine in Mitchell. Dr. Timmer received his BS from SDSU and his MD from the American University of the Caribbean (AUC) School of Medicine, St. Maarten. He completed his residency at the University of Nebraska Medical Center, Rural Family Medicine Residency, in Omaha and Grand Island. Dr. Timmer is a native of Mitchell and is board certified in family medicine.

Vascular Surgeon Dustin Weiss, MD, has also joined North Central

Heart. Dr. Weiss earned his MD from the University of Nebraska

Medicine Center in Omaha where he also completed a residency in general surgery. Dr. Weiss recently finished his fellowship in Vascular surgery at Yale.

Hilary R. Rockwell, MD, is the newest physician to help provide 24-hour physician coverage

in the Emergency Department at Avera Queen of

Peace Hospital Mitchell. Dr. Rockwell received her bachelor of art degree in biology from Dana College in Blair, Nebraska and completed her MD and emergency medicine residency at the University of Nebraska Medical Center, Omaha. Dr. Rockwell is board certified in Emergency Medicine.

BlAck Hills

In August, K.

Craig Hart, MD, was named the Physician of the Quarter for Customer Service Excellence at Rapid

City Regional Hospital. Dr. Hart is a hospitalist and board-certified internal medicine physician who has been a member of the Medical Staff at RCRH for nearly two years.

Regional Health has updated its brand to better represent it as an integrated health system.

Regional says the new brand is “refreshed and modernized”. Regional Health is discontinuing use of all facility and service based logos and will transition all of its branding to a single-standardized look.

South Dakota Southwest minnesota northwest iowa northeast nebraska

September / October 2014 midwestmedicaledition.com 13

Megan Franzen, Director,

Spearfish Regional Hospital

Laboratory and Kara McMachen,

Certified Registered Nurse Anesthetist (CRNA) Director, Rapid City Regional Hospital Anesthesia are the recipients of this year’s two Management Level Regional Way Leadership Awards. This recognition is awarded to employees who have demonstrated outstanding leadership and exemplify the principles of the Regional Way.

The Black Hills community once

again showed great support for

the Children’s Miracle Network

with 19,000 ducks sponsored in the 24th annual Great Black Hills Duck Race on Sunday, July 27. More than $93,000 was raised for CMN. One hundred percent of the funds raised will be used to provide services and equipment for ill and injured children in the Black Hills area served by Rapid City Regional Hospital.

Regional Health

Physicians is

pleased to

announce Nathan

Hensley, D.P.M.,

a podiatrist from Regional Medical

Clinic – Western Hills Professional Building in Rapid City, will visit Wall Regional Medical Clinic the first and third Thursday of every month. Dr. Hensley received his podiatric degree at Des Moines University in Iowa and went on to attend additional residency training at Trinity Regional Medical Center in Fort Dodge, Iowa, where he completed a 36-month comprehensive program with additional rear foot and ankle certification.

Joshua C. Lukenbill,

D.O., joined the

Regional Cancer

Care Institute

July 1. Dr. Lukenbill recently finished his hematology/

medical oncology fellowship. He received his medical degree at A.T. Still University/Kirksville College of Osteopathic Medicine in Kirksville, Missouri. He completed his internal medicine residency Cleveland Clinic, Cleveland, Ohio and then completed a fellowship in hematology and medical oncology at the Taussig Cancer Institute/Cleveland Clinic. He is board certified in internal medicine.

sAnford

Twenty-five Sanford Health

medical centers have received

“Most Wired” designations from Hospitals & Health Networks for excellence in information technology utilization. Implementing Bar-Code Medication Administration (BCMA) and My Sanford Chart were among Sanford’s IT initiatives in the past year.

Sanford Health is working

to enroll approximately 50

adult patients whose cancer

has progressed after the first

line of treatment or who have

rare cancers without standard

treatment options in a clinical trial to look for genetic information that could help customize treatment options. The Genetic Exploration of the Molecular Basis of Malignancy in Adults (GEMMA) began in the middle of May and is the beginning of a focused effort to provide patients access to novel personalized therapies.

A textbook edited by Sanford

Research President and Sanford

Imagenetics Chief Medical

Officer gene Hoyme, MD, and designed to be a comprehensive genetics resource for physicians, was published in June by Oxford University Press. Signs and Symptoms of Genetic Conditions: A Handbook outlines when and how physicians should test for genetic conditions. In addition to serving as an editor, Hoyme also co-authored a chapter.

Sanford Aberdeen

has expanded

its emergency

medicine team

with the addition

of Scott Blanchard,

DO and Dr.

Andrew gough. Dr. Blanchard specializes in emergency medicine and comes to Sanford Aberdeen from Millersburg, Ohio. Blanchard earned a doctor of osteopathic medicine degree from Kansas City University of Medicine and Biosciences, Kansas City, Missouri and completed a residency in emergency medicine at Akron General Medical Center in Akron, Ohio.

Dr. gough

specializes in

emergency

medicine and

trauma and comes

to Aberdeen from

Livonia, Michigan. He received a doctor of osteopathic medicine degree from Kirksville College of Osteopathic Medicine, Kirksville, Missouri. He completed emergency medicine residency training at St. Mary Mercy Hospital in Livonia, Michigan.

Stay up-to-date with new medical community

news between issues.

log oN!

midwest medical edition 14 midwest medical edition

Sanford Aberdeen Medical Center celebrated its second birthday on Wednesday, July 16 with a catered meal for the

staff. The birthday celebration was a time for Sanford Aberdeen employees to appreciate the community’s support over the past two years as well as reflect on the growth and hard work that has brought the facility to where it is today.

The results of The Sanford Project’s first clinical trial were published in the July edition of The Lancet Diabetes &

Endocrinology, revealing the outcome of a two-year study exploring the benefits of two drugs in treating type 1 diabetes. The Sanford Project is an emerging translational research center focused on targeted diabetes research, cures and care

Three-dimensional mammography finds significantly more invasive cancers and reduces

unnecessary recalls, according to a large, retrospective study published in the Journal of the American Medical Association (JAMA) featuring data from the Edith Sanford Breast Center and coauthored by Sioux Falls breast radiologist Thomas Cink, MD.

siouxlAnd

Designed to rate how well hospitals protect patients from accidents, errors, injuries and

infections, the latest Hospital Safety Score honored Mercy Medical Center-Sioux City with an “A”, its top grade in patient safety. The Hospital Safety Score is compiled under the guidance of the nation’s leading experts on patient safety and is administered by The Leapfrog Group (Leapfrog), an independent industry watchdog.

Two champions for cancer awareness – one who donates her birthday money to help fight the disease, the other who devotes his career to doing

so – have been chosen as race ambassadors for this year’s June E. Nylen Cancer Center Race for Hope 5k/15k Run/Walk Event on September 20. Youth Ambassador McKenna Moats has won the female division of the 1K race twice. Ambassador Mike Shea of LeMars, Iowa is a medical dosimetrist at the Cancer Center.

UnityPoint Health was recognized for the third year in a row as one of the nation’s “Most Wired Health Systems” by Hospitals & Health Networks

magazine. UnityPoint Health received the honor for its adoption of technology designed to improve and coordinate patient care, including a patient portal and electronic medical records.

This summer, Walmart and Sam’s Club associates, customers and members wrapped up a six-week campaign to raise funds for Children’s Miracle Network

Hospitals. UnityPoint Health – St. Luke’s partnered with nine Walmart stores and one Sam’s Club in a 22-county region that stretches from Norfolk, Nebraska to Spirit Lake, Iowa. During the campaign, St. Luke’s Foundation was able to raise more than $54,000 to help provide life-saving equipment and services for more than 16,000 kids and newborns each year.

The National Committee for Quality Assurance and the American Diabetes Association announced that Dr. Jeffrey Krohn has received recognition from the Diabetes Physician Recognition Program for providing quality care to his

patients with diabetes. To receive the recognition, which is valid for three years, Dr. Krohn submitted data that demonstrates performance that meets the program’s key diabetes care measures. Dr. Krohn works in the Kingsley Mercy Medical Clinic.

Mercy Health Network (MHN) Critical Access Hospitals (CAH) and their allied clinics will begin transitioning to value based care thanks to a $10.1 million CMS Health Care Innovation Award from the U.S. Department of Health

and Human Services. The 25 CAH facilities and 73 clinics are located in 37 counties in Iowa and Nebraska. They are affiliated with MHN members including Mercy Medical Center – Sioux City. This project will use the in-clinic health coach model developed by Mercy clinics in Des Moines.

St. Luke’s Sunnybrook Medical Plaza is expanding services to provide more convenience to

the area’s patients. Physical therapy will now be offered at UnityPoint Clinic Family and Internal Medicine, a clinic housed within St. Luke’s Sunnybrook Medical Plaza. The physical therapists at UnityPoint Clinic specialize in offering a full range of services customized to each patient and his or her goals.

otHer

Prairie Lakes Healthcare System announced the opening of the Prairie Lakes Ear, Nose, Throat & Facial Plastic Surgery Clinic

in August and welcomed full time ear, nose and throat specialist, Dr. Jered Mancell, to

the medical staff. Dr. Mancell received his DO from A.T. Still University – Kirksville College of Osteopathic Medicine in Kirksville, Missouri. He completed a residency in otolaryngology-facial plastic surgery at Genesys Regional Medical Center in Grand Blanc, Michigan.

The Center for Disabilities has named Dr. Eric Kurtz as the new Leadership Education in Neurodevelopmental and Related Disabilities (LEND)

director. He succeeds Dr. Joanne Van Osdel, who retired in July. LEND provides long-term graduate level specialized training which focuses on the interdisciplinary training of professionals for leadership roles in the provision of health and related services to infants, children and adolescents with neurodevelopmental and related disabilities and their families.

South Dakota Southwest minnesota northwest iowa northeast nebraska

News & Notes continued

15September / October 2014 midwestmedicaledition.com

To honor the legacy of former dean Dr. Karl Wegner, a scholarship fund for students enrolled in the USD Sanford School of Medicine has been established by the 7th District of the South Dakota Medical Association and the Sanford School

of Medicine. Scholarships will be awarded to third or fourth year medical students intending to practice in the 7th District after they graduate. The 7th District includes Sioux Falls and nearby areas.

Dr. Mark Huntington has been named the new program director for the Sioux Falls Family Medicine Residency program based at Center

for Family Medicine. Dr. Huntington is a graduate of the Medical Scientist Training Program at Michigan State University, with graduate work in microbiology (parasitology). He received his Family Medicine residency training and a Diploma in International Health from the University of Cincinnati in 1998. Prior to joining the CFM faculty in 2006, he was in private practice for 8 years in rural west-central Minnesota.

gretchen M. Dahlen is the new interim president/CEO of the South Dakota Association of Healthcare

Organizations. In addition to past chief executive roles in critical access and community hospitals, Dahlen has worked with tertiary healthcare systems, long term care, and home health agencies. Her most recent position was with Mayo Clinic Health System as Chief Administrative Officer for Winneshiek Medical Center in Decorah, Iowa. She replaces Dave Hewitt who left the organization this summer.

At MMIC, we believe patients get the best care when their doctors feel confident and supported. So we put our energy into creating risk solutions that everyone in your organization can get into. Solutions such as medical liability insurance, clinician well-being, health IT support and patient safety consulting. It’s our own quiet way of revolutionizing health care.

To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit MMICgroup.com.

Looking for a better way to manage risk?

Get on board.

Midwest Medical Edition 16

Preparing for the Denial Process

No oNe likes DeNials. Not only is it frustrating and a waste of time to have to resubmit claims, but waiting

for reimbursement can also cause a signifi-cant threat to an organization’s revenue and cash flow.

When ICD-10 is implemented in Oct. 2015, hospitals and clinics are likely to see an immediate effect: more claims denied and longer times waiting for resolution. This new highly detailed coding regimen is likely to affect everyone’s bottom line.

The Centers for Medicare and Medicaid Services (CMS) estimates that in the early stages of ICD-10, denial rates will rise by 100 to 200 percent. Claims error rates are expected to increase from three percent to as much as 10 percent. The average days in accounts receivable are likely to grow from 20 to as high as 40,

Successful healthcare organizations should start thinking about denials right now – before the deadline hits. Here are five tips for moving beyond traditional denial man-agement strategy to not only reduce denials, but to eliminate their causes before they happen:

TRAIN YOUR PEOPLE. Everyone who is involved with patient records should take the time to learn the stan-dardized code format they’ll need. Nurses, physicians, schedulers and anyone who touches patient records can get prepared now to integrate that code across all systems.

EVALUATE YOUR TOOLS AND SYSTEMS. Now may be a good time to shift to a new electronic medical records system. At the very least, look at what you are now using to make sure you have room for the field length and characters required for the new codes and the inclusion of more detailed records. Make sure your system is set up for physician orders, scheduling, registration and data systems that use ICD-10 coding.

UNDERSTAND YOUR DENIALS. Some codes and procedures have already been translated to ICD-10. Develop a pro-cess to identify where the denials are happening so you can determine which areas will require more training. Set up a system now to communicate this informa-tion to everyone on staff.

gET THE CODINg SUPPORT YOU NEED. The demand for skilled medical coders is already high. Look at your staffing levels now to make sure you have the coders you need or make arrangements for external

coding augmentation with a quality firm. It may be more cost-effective to contract with another company than to train large numbers of new coders.

BE FINANCIALLY READY. Have a strategy that will allow your health-care organization to weather those first few months. If your budgets are aligned and prepared, you’ll be ready for whatever happens.

Success in a post-ICD-10 world is depen-dant on your organization’s ability to adapt to a need for new levels of expertise in coding efficiency and documentation. Making the changes you need now will help you avoid problems before they happen and prepare your clinic or hospital for growth. ■

Natalie Bertsch is co-owner of Dt-trak

consulting inc., which has been providing

nationwide professional medical claims

management, revenue enhancement, training

and onsite consulting services since 2002.

By Natalie Bertsch

Tips for Eliminating Your ICD-10 Claims Problems Today

17September / October 2014 MidwestMedicalEdition.com

Preparing for the Denial Process

For more information about current cardiac research studies and additional clinical trials at Regional Health, lOg On . . .

caseypeterson.com605.348.1930909 ST. JOSEPH STREET, SUITE 101, RAPID CITY

CASEY PETERSON & ASSOCIATES, LTD.C P A S & F I N A N C I A L A D V I S O R S

Mark Lyons, CPAHealthcare Team Leader

Kevin Eggebraaten, CPA Deidre Budahl, MBA, CPA Melanie Jobgen, CPABrianne Sykora, CPA

A NATIONAL CARDIAC MEDICATION research study involving Black Hills Cardiovascular Research and four partici-pants from around the Black Hills has resulted in a new drug therapy which could have a great impact on people diagnosed with chronic heart failure.

Black Hills Cardiovascular Research was one of 60 national sites participating in Phase 2b of an investigational study for a drug therapy called MYDICAR. Fourteen potential participants from the Black Hills area were screened for the study with four

subsequently qualifying for enrollment.“Throughout the past 18 years there

have only been a handful of compounds which have received ‘Breakthrough Therapy Designation.’ This is a therapy which has the potential to provide long -term, life-changing effects for more than 350,000 heart failure patients whose treatment options are now very limited,” said Roger DeRaad, Certified Nurse Practitioner (CNP), Director of Black Hills Cardiovascular Research.

MYDICAR uses gene therapy designed

to increase the levels of SERCA2a protein in heart muscle cells with a viral carrier. SERCA2a is an important factor affecting how well heart muscle cells contract in those who suffer from heart failure. MYDICAR in patients with advanced heart failure due to a systolic dysfunction showed the therapy was safe and well tolerated.

“Now that we have the CUPID 2 Trial behind us, we are looking forward to work-ing with the Celladon Corporation on the next phase of development for this exciting therapy,” says DeRaad. ■

black hills cardiovascular research Study May Open Door to New Drug Therapy

I n d e p e n d e n t

South Dakota community hospitals

stay strong with creative collaboration

But not alone

By Alex Strauss

18

Dr. Jeffrey brindle, radiation oncologist, and kim michalski, rn, prepare a patient for tomotherapy at the prairie lakes cancer center in watertown. investment in advanced technology like tomotherapy is one of the ways prairie lakes hopes to shore up its independence in a changing healthcare environment.

Photo courtesy Prairie Lakes.

Photo Co

urtesy Mad

ison C

om

munity H

osp.

the 25-bed Madison Community hospital in madison, South Dakota has been recognized as one of the top 20 critical access hospitals in the country by the national rural health association.

Photo courtesy Prairie Lakes.

prairie lakes healthcare system is an independent, not-for-profit, healthcare system based in watertown, SD. photo courtesy prairie lakes.

Do a qUiCk google search of ‘Independent Com-munity Hospitals’ and you’ll find two types of articles – those

devoted to ways to “save” community hospi-tals, and those that say it can’t be done.

Several long-standing independent rural hospitals in the South Dakota region are bank-ing on the fact that the naysayers are wrong. Leaders at these hospitals maintain that, with good planning, supportive communities, strong finances, competitive pricing, and collaboration with other healthcare entities, they can continue to “do their own thing” for years into the future.

Case stUDy #1:

PRAIRIE LAKES HEALTHCARE SYSTEM

One of those hospitals is Prairie Lakes Healthcare System in Watertown, South Dakota. The product of a 1986 merger of two Watertown hospitals, the 85-bed facility serves a patient base of about 85,000 from 9 counties in northeast South Dakota and western Minnesota. Too big to be categorized as a “critical access hospital”, but too small to have the advantages of a big system, Prairie Lakes is what CEO Jill Fuller calls a “tweener hospital”.

“Independence is a special challenge for a hospital like ours, which typically takes care of a lot of Medicare patients,” says Fuller, who has been at the helm since 2009. “Many of our patients are in rural counties.”

As part of its strategy to stay strong in changing times, Prairie Lakes opened a cancer center in 1999 and began offering high tech tertiary cancer services such as tomotherapy. The hospital also began expanding its medical and surgical specialties and stepped up physi-cian recruiting efforts.

“We are 100 miles from Sioux Falls so people had to travel long distances for specialty care,” says Fuller. “So there was definitely a need in this area.”

In 2007, Prairie Lakes opened the state’s first interventional cardiology program without cardiac surgery on site. They now offer high tech services like placement of drug-eluting stents and have demonstrated good ER

19

midwest medical edition 20

Photo courtesy Prairie Lakes.

outcomes for cardiac patients. In recent years, the hospital has added specialty ser-vices in other areas including nephrology, neurology, and most recently, pulmonology – services not often found in smaller critical access facilities.

With a record 9 new physicians recruited in 2013 for a total of 21 employed doctors and a medical staff of 75, Prairie Lakes is clearly doing something right.

strategiC CollaBoratioN

The environment for community hospi-tals is challenging, to say the least. The push for expensive high-tech services and the rising expense of facility upgrades, the cost of attracting and retaining physicians, reimbursement reductions, the increasing role of managed care companies, and the move from fee-for-service to value-based healthcare all hit inordinately hard for facilities with smaller budgets and less-affluent patient populations.

While a growing number of facilities have managed many of these difficulties by aligning with large health systems, some

of the region’s strongest independents have found other, creative options such as partnerships, joint ventures, joint operating agreements, telehealth, and clinical and management service arrangements. In the case of Prairie Lakes, Fuller says diversifica-tion of services, controlling costs, and collaboration have been key.

“We have attempted to regionalize and form partnerships with other rural providers,” says Fuller. For example, Prairie Lakes operates dialysis units in Ortonville, Minnesota and Sisseton, South Dakota. In all, they operate 11 different outreach clinics in 8 communities. They also bring in specialists, such as Sioux Falls vascular surgeon Greg Schultz, MD, who operates at Prairie Lakes two days a week.

By putting together what Fuller calls a “mixed medical staff” including Prairie Lakes doctors as well as those from Watertown’s Brown Clinic or Sanford in Sioux Falls, the hospital is able to stay vital and meet the needs of more patients without overextending its resources.

“Going from competition to collabora-tion is the way to regionalize health services and that has been our approach,” says Fuller.

Dr. Salem maaliki,

interventional

cardiologist, assisted by

a cardiovascular tech,

performs a procedure

on a patient in the

cardiac catheterization

lab at prairie lakes

hospital. recognizing

the need for

interventional heart

care in the northeast

region of South

Dakota, prairie lakes

started a cardiology

program and opened a

cardiac catheterization

lab in 2007

Case stUDy #2: MaDisoN CoMMUNity hospital

But can independence still work for even smaller hospitals? Tammy Miller, CEO of the 25-bed Madison Community Hospital in Madison, South Dakota says yes – with the right structure.

“Talking about ‘independence’ is really talking about your financial and operational status,” says Miller, who has served as hospital CEO in the community of 6,500 for 17 years. “It does not really refer to how you deliver care because I don’t think it is even possible to deliver care in a vacuum.”

The non-profit community hospital, which has a service area of about 16,000 people, has operated independently in Madison for nearly a century. From its modest beginnings in a local physician’s house, to its fifth home in a building still under construction, community support has been the linchpin to financial and operational independence for Madison Community Hospital.

“I believe that the number one thing for independence is community support,” says Miller. “Our present hospital was built by a group of citizens that collected funds from everyone and if you put in a certain amount of money, you had a vote. We certainly looked for that kind of support when we looked to build a new facility.”

Miller says a stable workforce and stable physician base are also critical to success as an independent. Seven independent doctors work at the hospital. And while the goal is to offer as many services as is practical close to home, like other small hospitals, Madison Community must concentrate its efforts on services likely to generate sufficient volume. It’s a balancing act between offering enough to keep the community and new and existing physicians happy – but not so much that the costs are prohibitive.

With that in mind, the new Madison Community Hospital, set to open next

“ Independent hospitals will survive as long as they are in the right market and have the right customer focus. ” —Jill Fuller

21September / October 2014 midwestmedicaledition.com

madison community hospital ceO tammy miller started work at the facility 34 years ago as a part time secretary while a student at Dakota State university. She has been ceO for 17 years.

Jill Fuller has been the president and ceO at prairie lakes healthcare System since 2009. prior to being named ceO, Fuller served as prairie lakes vice president of patient care and chief nursing Officer since 2000. photo courtesy prairie lakes.

Oncology certified nurse lisa campbell helps a patient get settled in the infusion center at the prairie lakes cancer center. Fifteen years ago the cancer center opened its doors. in 2008, the cancer center was expanded and remodeled to increase the number of chemotherapy chairs from 7 to 12 to accommodate growth of services.

summer, will have fewer inpatient beds and more square footage devoted to the OR, the ER, and outpatient services. Thanks to its partnerships, the hospital also has tenants, including Avera, Sanford and Lewis Drug, all of whom plan to also make the move to the new facility.

aDVaNtages aND Costs

In national surveys, community hospital leaders consistently say that the biggest advantage of independence is the ability to make decisions quickly, with less red tape. They say this lets them be more adaptable to the changing needs of their communities, often with nothing more than a board vote.

But experts caution that management teams need to make careful examinations of where the business stands, taking into account the implications of healthcare reform, changing patient trends, and the need for continual capital reinvestment, to decide if independence is still workable. The organizations corporate culture and how it would be affected by a partnership should also be considered. Tammy Miller says Madison is continually making these kinds of evaluations and remains open to all possibilities.

“I believe that presently it works for us to be independent in our community,” she says. “But we always want to make sure that we are open to what is the most appropriate way to deliver care.”

After all, remaining independent can come with a hefty price tag. Madison is investing heavily in its new facility. And since 2002, Prairie Lakes has invested $60 million to build a new cath lab, double the size of the emergency department, expand radiology, build a new medical office build-ing, and do extensive remodeling. “It was almost like building a new hospital onsite,” Fuller says.

The next investment will be to install more analytic capabilities that will allow the hospital to pull data from various sources and prove outcomes, as Medicare requires. As healthcare transitions toward a value-based system, that kind of data will become increasingly critical for all hospitals, but even more so for those that wish to remain independent.

When it is compiled, Fuller expects that data will provide further evidence of the value of care at Prairie Lakes Healthcare System, which has some of the lowest rates in South Dakota for 100 common treatments. Value is just one of the reasons that Fuller and Miller are convinced there is still a place – and a need – for independent hospitals like theirs.

“Independent hospitals will survive as long as they are in the right market and have the right customer focus,” she says. “We still have independent banks in our community and small, independent airlines. With a good business model and a strong financial base, I think we can thrive going forward. But I do think that we all need to collaborate.” ■

“ I believe that the number one thing for independence is community support.” —Tammy Miller

Photo courtesy Prairie Lakes.

Photo courtesy Prairie Lakes.

Photo courtesy M

adiso

n Co

mm

unity.

Midwest Medical Edition 22

23September / October 2014 MidwestMedicalEdition.com

Calling Patients on Their Cell Phones

By Jill Heyden

why priOr expreSS cOnSent iS a muSt

A CCorDiNg to a reCeNt

census bureau report, 1 in 3 households do not have a telephone landline. This

means that approximately 138 million Americans rely solely on wireless phones to receive all phone calls. In the past 23 years, technology has made significant strides as it relates to mobile devices.

TCPA AND MOBILE DEVICESHistorically, mobile device plans were

purchased and billed on a per-minute basis. This per-minute billing process was one of the reasons the United States Federal Communications Commission (FCC) decided to implement the Telephone Con-sumer Protection Act (TCPA) of 1991. The TCPA was originally adopted to prohibit telemarketing calls to mobile devices, but because of how vague the act was written, it also encompasses more than just telemarketing.

In general, the Act restricts the use of automated dialing equipment, prerecorded messages, and text messages to consumer mobile devices. These restrictions apply unless prior express consent from the con-sumer has been obtained by the person placing the call. Automated dialing equip-ment or an “auto-dialer” is equipment that works off of a database of stored informa-tion that will dial the phone number that is listed within that database at random. This technology improves efficiency and reduces errors when making calls to consumers. Once a call is received, the call might be transferred to a live agent or a prerecorded message may be left.

WHAT DOES THIS INFOR-MATION MEAN TO YOUR MEDICAL BILLINg OFFICE?

As facilities continue to grow, it is quite common that a medical office may employ the use an auto-dialer or prerecorded message system to improve office productivity. These calls are often made to remind patients of appointments, payment reminders, share test results, collections efforts, or to request a call back from the patients regarding a personal matter. If these calls are being initi-ated using an auto-dialer, this could be a TCPA violation if prior express consent has not been obtained.

WHAT DOES IT MEAN TO OBTAIN “PRIOR ExPRESS CONSENT”?

To obtain prior express consent, you must demonstrate that the patient received a clear and concise disclosure and that he or she authorized future calls to their mobile device. This disclosure should detail all the possible reasons why your office may need to contact the patient via their mobile device. There are conflicting sources on whether the consent should be verbal or written, however best practice would be to get the consent in writing.

TCPA CLAIMS RISINgRecently the number of TCPA claims

filed with the FCC has been on the rise. If a violation is found to have occurred, an intim-idating number of $500–$1000 per instance

can add up quickly. In July 2014, a TCPA class action lawsuit was settled for $75 million. At issue was a company allegedly calling “individuals on their mobile devices without their consent”.

The TCPA does not affect just healthcare. Other industries are affected as well. If school is closed due to weather, it is common for the school to call and leave a prerecorded message on your cell phone. If a geographi-cal area is without power, a utility company might use an auto-dialer to alert its custom-ers that power has been restored in their homes. A collections company also uses auto-dialers to place thousands of calls per day to maximize recovery efforts and to minimize errors.

In order to safeguard your business, prior express consent to use a patient’s mobile device is a necessity. Whether this is some-thing that you add to your consent to treat form, registration form or financial policy, a document with the patient’s signature advising that the number that they provide is the best number to reach them is a neces-sity to avoid the risk of a TCPA violation. ■

Jill heyden is a business Development

Specialist with aaa collections, inc. in Sioux

Falls.

Midwest Medical Edition 24

SiNCe its iNCeptioN in March 2010, the Affordable Care Act (ACA) has seen significant changes which have made under-

standing and applying this complex new law even more cumbersome. The purpose of this legislation is to provide healthcare benefits to all individuals in the United States. This responsibility now not only lies with heath care providers, but with employ-ers and individuals alike.

The employer mandate, which references the employer’s responsibilities under the law, has been delayed to allow time for compli-ance. The employer mandate will become effective for employers with 50-99 full-time and full-time equivalent employees begin-ning January 2016. Employers with 100 or more full-time and full-time equivalent employees will need to comply starting in January 2015. If employers have not offered affordable, minimum essential coverage to employees on or before the applicable dates, the employer may be subject to IRS penalties.

FUll tiMe Vs. FUll tiMe eqUiValeNtDetermining when the employer mandate will apply to your business requires under-standing the terms “full-time employee” and “full-time equivalent employee”. Generally, a “full-time employee” is an employee who averages 30 hours per week. Total hours worked by each employee who are not “full-time employees” are then accumulated up to 120 hours per month and divided by

120 to determine the number of “full-time equivalent employees”. Full-time and full-time equivalents are then added together to determine the number of employees. If this result is more than 50, you may be subject to the employer mandate. However, there are numerous complexities associated with this calculation including determining the period over which to accumulate hours, potential impacts of related party entities, proper determination of employee hours, potential exclusions for certain workforce, impacts of seasonal workers, and other factors.

eMployee eligiBilityDetermining which employees are eligible under the ACA can also be complex. It is common for large employers to hire employ-ees and not be certain if the employee will work 30 hours per week, making them eligible for health insurance. For example, temporary staffing agencies will have difficulties making this determination. To address this issue, the IRS has given employ-ers discretion in identifying a look-back period (the measurement period) to deter-mine if employees met the 30 hour eligibility requirement. The measurement period can be as short as three months and as long as twelve months. Employers also have the ability to categorize employee groups, which allows the employer to make “reasonable” assumptions about the need to offer insur-ance to specific groups. Properly categorizing employees and determining the measurement period can minimize the impacts of the ACA on your business.

issUes For large healthCare eMployersThe healthcare community faces numerous issues associated with analyzing and imple-menting the ACA such as how to treat on-call hours, volunteer hours, and potential issues with contract labor. Employees are credited with an hour of service related to on-call hours if they are paid for that hour, are required to remain on premise, and/or the employee’s activities are subject to restric-tions. Generally speaking, hours worked by volunteers such as emergency medical pro-viders are exempt, but the nature of the relationship should be analyzed. Independent contractor relationships also need to be ana-lyzed due to the potential employee eligibility.

start plaNNiNg NoWThe items previously discussed are only

a few examples of issues large employers should begin planning for now. Now is the time to begin reviewing plan documents, job descriptions, contract labor agreements, and relationships with related entities. The IRS is likely to scrutinize these areas when audits begin. Developing action plans and documentation to address these issues will help mitigate employer costs and risks when the employer mandate takes effect in 2015 or 2016. ■

Mark lyons, cpa, is a Shareholder, leader of

the aca team, and the healthcare industry

team leader for casey peterson & associates,

ltd. in rapid city. brianne Sykora, cpa, is a

tax accountant with casey peterson.

By Mark Lyons, CPA and Brianne Sykora, CPA

Is Your Business Prepared for the ACA Employer Mandate?

  MeD Quotes

“ At a cardiac arrest, the first procedure is to take your own pulse”  — Samuel Shem 

25September / October 2014 MidwestMedicalEdition.com

WORK IS UNDERWAY ON A NEW three-story medical office building for Avera Queen of Peace Hospital in Mitchell.

Avera Health and Avera Queen of Peace broke ground on the project in August. The new building is located just west of the Cabela’s store on land that is visible from Interstate 90. Avera leaders say the location, which is being called Grassland Health Campus, will eventually be the new home of Avera Queen of Peace Hospital and related facilities.

The 70,000-square-foot medical office building will house family practice, internal medicine, pediatrics, occupational medi-cine, urgent care, laboratory and imaging services, and a home medical equipment outlet on the first two floors. The building plan features the latest technology, including the capability for eConsult telehealth visits with physicians in a wide range of medical specialties, minimizing the need for patients to travel for specialty care. The third floor will be left open for future growth.

The building’s architectural design will reflect the prairie of the Northern Plains, similar to the Prairie Center on the campus of Avera McKennan Hospital &

University Health Center in Sioux Falls.Estimated cost of the medical office

building project is $16.5 million, in addition to the $1.6 million cost of the 30-acre tract of land, purchased from the Mitchell Area Development Corporation approximately two years ago.

“Our existing facilities are hindering us from being able to recruit physicians; our current campus is landlocked and allows no room for long-term expansion,” says Tom Clark, Regional Presi-dent and CEO of Avera Queen of Peace. “We have signed agreements with physicians joining us over the next two years, and we currently have no place to put them.”

Clark, who was named CEO in 2011, led the hospital board through an extensive strategic planning process that concluded with a long-term vision for Avera Queen of Peace. This vision became one of a new campus, starting with a medical office building and eventually accommodating Avera Queen of Peace Hospital and all its related facilities.

“Our current campus is tucked in the northeast corner of Mitchell in a residential

area. It’s hard for people from out of town to find us,” Clark says, adding that the new campus will be the most visible facility in the Avera System.

In 2014, Avera Queen of Peace inpatient, outpatient and clinic visits are projected to total more than 196,000. Outpatient and clinic visits are projected to increase between 3 and 5 percent per year, while hospital inpa-tient volumes are projected to remain flat.

The campus concept, developed by BWBR Architects of St. Paul, Minn., is one of multiple buildings located together as opposed to one large building. For the nearer future, construction of the new medical office building will open up additional space at the current Avera Queen of Peace Hospital campus which Clark says will be used to move surgical specialists closer to the hospital. ■

Construction Begins On mitchell’S new graSSlanD health campuS

“Our current campus is land-locked and allows no

room for future expansion.” tom clark, regional president

and ceO of avera Queen of peace.

Midwest Medical Edition 26

MERCY MEDICAL CENTER—Sioux City has begun hashing out the details of its new, stepped-up involve-ment in the Siouxland Surgery Center in Dakota Dunes. Mercy announced in July that it had aligned with United Surgical Partners International (USPI) to jointly acquire majority ownership of the Surgery Center in which it has been a partner for twenty years.

“In line with Mercy Health Network’s (MHN) central mission, this move allows us to deliver an even higher-quality patient experience, and in ways unprecedented in this market,” says Mercy CEO James FitzPatrick.

The 40-bed Siouxland Surgery Center is one of only 30 multi-specialty physician-owned surgical hospitals in the US and its staff comprises more than 130 of the area’s primary care and specialist physicians. Mercy has been a partner in the facility since it was started by physi-cians of the CNOS Clinic in 1994. Mercy’s partnership with USPI, a company that manages more than 215 surgi-cal centers around the country, gives the two 51 percent ownership.

“Expanding the partnership with MMC-SC and USPI demonstrates a very clear commitment of the physicians of SSC to the healthcare of the Siouxland Community,” says SSC President, Dr. Ralph Reeder, a CNOS neurosurgeon.

Greg Hagood, Senior Managing Director of SOLIC Capital Advisors, the financial advisory firm that worked with the Surgery Center’s physician owners to broker the deal, says it is an example of a nationwide trend brought on by recent changes in healthcare.

“The first is changing reimbursement, which is a par-ticular challenge for community hospitals,” says Hagood. “They are dependent on independent providers to coordi-nate care, yet their reimbursement is being held hostage. The second is physician employment patterns; it is easier to recruit physicians if you own several hospitals.”

The new arrangement, which Hagood says took a year to negotiate, ensures that Siouxland Surgery Center won’t be excluded from Mercy Health System’s managing care contracting. For its part, Mercy has pledged to invest more than $100 million in improvements to surrounding facili-ties, innovation, and technology in the area, which may include new services. ■

James FitzPatrick

Ralph Reeder

JaMes “JiM” FitzpatriCk has been appointed president and CEO of Mercy Medical Center – Sioux City. FitzPatrick has served as the interim CEO at Mercy since late March, replacing Bob Peebles who retired earlier this year.

FitzPatrick has more than 22 years of experience as a hospital and health system President/CEO. Most of those years he served at Mercy Medical Center–North Iowa in Mason City and Kossuth Regional Health Center in Algona. Prior to his assignment in Sioux City, FitzPatrick served as senior vice president for network development for Mercy Health Network (MHN).

FitzPatrick earned a BS in Public Administration from the University of Arizona, and an MA in Hospital and Health Administration from the Univer-sity of Iowa. He is a Fellow in the American College of Health Care Execu-tives and has received many honors for his work in healthcare, including the Iowa Hospital Association “Leadership in Excellence Award”, the highest award given to a hospital CEO in the state. ■

MErCY MEDICAl CENTEr APPOINTS

NEW CEO

mercy medical center plans for the Future of newly-acquired Siouxland Surgery centerTHE HEALTH SYSTEM ANNOUNCED ITS STRENgTHENED RELATIONSHIP IN JULY

“ Do not wait to strike till the iron is hot; but make it hot by striking.” — William B. Sprague

  MeD Quotes

27September / October 2014 MidwestMedicalEdition.com

ChilDreN’s hospital & MeDiCal CeNter iN

Omaha has received its highest ranking to date in U.S. News & World Report 2014-15 Best Chil-dren’s Hospitals rankings. Children’s received high marks in four categories, ranking #29 in Orthopedics, #41 in Pulmonology, #42 in Gastro-enterology and GI Surgery, and #48 in Cardiology and Heart Surgery.

U.S. News introduced the Best Children’s Hos-pitals rankings in 2007. They highlight the 50 U.S. pediatric facilities in cancer, cardiology & heart surgery, diabetes & endocrinology, gastroenterology & GI surgery, neonatology, nephrology, neurology & neurosurgery, orthopedics, pulmonology and urol-ogy. Eighty-nine hospitals ranked in at least one specialty, based on a combination of clinical data and reputation with pediatric specialists.

“We’re honored to be among this elite group of pediatric centers,” said Carl Gumbiner, MD, senior vice president of medical affairs and Children’s chief medical officer.

Five-sixths of each hospital’s score relied on patient outcomes and the care-related resources each hospital makes available. To gather clinical data, U.S. News sent a clinical questionnaire to 183 pedi-atric hospitals. The remaining one-sixth of the score derived from a survey of 450 pediatric specialists and subspecialists in each specialty over three years. The 4,500 physicians were asked where they would send the sickest children in their specialty, setting aside location and expense. ■

ChIlDrEN’S hOSPITAl rECEIvES hIGhEST US NewS rANkING TO DATE

log oN to see survival rates, adequacy of nurse staffing,

procedure volume and more from US News & World Report.

SANFORD ABERDEEN iS nOw offering

breast tomosynthesis, also known as 3D

mammography, which gives radiologists

better visualization of the breast, detects

cancer earlier, and reduces the need for

additional follow-up tests.

3D mammOgraphy Now available in aberdeen

FDa-approved breast tomosynthesis is

one of the most advanced technologies

available today for early detection of breast

cancer. it is used in conjunction with the

traditional screening mammogram (2D

mammography).

“3D mammography allows us to find

more small cancers and the advanced tech-

nology also reduces overlapping tissue

densities, which in turn decreases patient

call-backs for additional tests,” says

Director of imaging bob hagen ed.S. mSrS

r.t. (r).

During the 3D portion of the exam, the

x-ray arm moves in an arc over the breast,

taking multiple images in just seconds. it

uses advanced computer imaging and low-

dose x-rays to convert digital breast images

into a stack of very thin “slices,” of the

breast, allowing doctors to look at the

tissue one layer at a time instead of as a

single flat image. ■

Midwest Medical Edition 28

THE NATIONAL CANCER INSTITUTE has named Sanford Health an NCI Community Oncology Research Program (NCORP) community site and awarded it a five-year grant totaling more than $7.1 million to recruit participants for cancer clinical trials, quality of life studies and cancer-care delivery research.

The grant was one of 53 awarded under NCORP, a national network of investigators, cancer-care providers, academic institutions and other organizations that provide care to diverse populations in community-based healthcare practices across the country.

Sanford is among 34 community sites that will recruit participants and partner with the seven NCORP research base hubs to design and conduct multi-center cancer preven-tion, control and screening/post-treatment surveillance clinical trials and studies.

Sanford, which is the only NCORP site in the Dakotas and Nebraska, will also participate in studies that explore quality of life and cancer-care delivery involving patients, practitioners and healthcare organizations.

“Advances in cancer care make this the appropriate time to expand the outreach of clinical trials to community-based facilities, which is where most people access care,” said David Pearce, Ph.D., vice president and chief operating officer for Sanford Research. “Sanford emerged as an ideal selection for NCORP because of our history of success in recruiting patients for clinical trials, infrastructure and physician volumes already in place to support an advanced cancer program, and a research team capable and ready to contribute to research bases for the implementation of these trials.”

Besides the 34 community sites, including Sanford’s, NCORP contains seven research bases and 12 minority/underserved community sites. The program funding totals $93 million over five years.

NCORP replaces two previous NCI community-based clinical research programs, the NCI Community Clinical Oncology Program (CCOP) and the NCI Community Cancer Center Program (NCCCP). Sanford was formerly a member of both. ■

Sanford receives NIh Grant for Cancer researchawarD tOtalS mOre than

$7.1 milliOn Over Five yearS

29September / October 2014 MidwestMedicalEdition.com

awarD tOtalS mOre than

$7.1 milliOn Over Five yearS

BEINg INTERVIEWED by a member of the media can be both exciting and a little intimidating – especially for

those who don’t do it often. How do you make the most of your opportunity to pro-mote your practice, boost your brand, and educate the public? For starters, make sure you’re understood.

Remember: When you talk to the media, you are not talking to your colleagues. You are not talking to the reporter. You are not even talking to a room full of patients. You are talking to one single patient. And it’s best to assume that the patient to whom you are talking is also pretty unsophisticated. If it doubt, always err on the side of simplicity.

No one knows the word ‘edema’

Of course, some people obviously know the meaning of the word “edema”, but it may be fewer people than you realize. It is vital to keep in mind, especially if you are new to working with the press, that words that may be part of your daily lexicon are likely to be totally unfamiliar to your audience.

Equally concerning is the fact that indus-try jargon may be unfamiliar to the reporter. This is a problem because you need that reporter to clearly understand you so that he or she can accurately convey your meaning to an audience.

If in doubt, don’t risk it. When you are tempted to use medical terms, research jargon, or complex words, dumb it down.

By Alex Strauss

meDia 101

And don’t worry about being too simplistic. Reporters are taught to write for a third to fifth grade audience and your goal is to make this task as easy as possible for them.

Think of your oldest, youngest, or most-confused client or patient and speak to that person. Here are some examples of medical jargon and abbreviations along with plain language (read, more press-friendly) alternatives:

Abrasion = scrape, scratch

Biopsy = tissue sample

Blood glucose = blood sugar

Edema = swelling

Excise = cut out

Hypertension = high blood pressure

Laceration = cut, tear

Palpate = feel

Having a camera or microphone in your face or a reporter frantically typing over the phone line can make it seem like the time to be at your most scientifically eloquent. Resist the temptation! Remember, your goal is to make things clear and simple – for the reporter as well as the audience. Slow down, repeat, rephrase. This is not a medical conference.

If you want to be quoted . . . or quoted again… or called back… use as much ordinary language as possible. Reporters will love you for it.

analogies and Visual aidesEspecially if a concept is likely to be tough

to grasp or unfamiliar, try to paint a picture with your words. Say things like “Imagine two metal plates rubbing together….” or “weak like a balloon that has been overinflated”. Original analogies are even better. Whatever it takes to make the point clear.

If you typically use hand gestures, models or pictures to illustrate a point for patients in the office, consider offering to do the same for the reporter. During your interview, take a cue from media darling Deepak Chopra, MD, and speak slowly, over enunciate, and pause often. And if in doubt, stop and simply ask the reporter if he or she understands your meaning.take hoMe Message: Reporters and patients want to work with people who speak in terms they can understand. Use your inter-view to demonstrate that you are that person.

when talking to the Press

avoid Medical Jargon

Midwest Medical Edition 30

stowe Joins Mercy in palliative Care kim stowe, arNp, FNp-BC, has been appointed the

palliative care nurse practitioner at mercy medical

center. Stowe has a wealth of clinical experience in a

number of areas including oncology, urology, renal

dialysis, emergency room and as a flight nurse on mercy air care.

Stowe holds a bachelor’s Degree in nursing and attained her

arnp from briar cliff university. She is a board certified Family

nurse practitioner.

Weber earns rCrh Mickelson award John Weber, rN, BsN, CCrN, CrN, recently received

the 2013 george S. mickelson award for nursing excel-

lence at rapid city regional hospital (rcrh). weber is a

clinical resource nurse (crn) with cardiac Services and

the electro physiology (ep) lab. weber began his nursing career as an

rn in the icu and has worked at the hospital for 17 years.

weber showed his commitment to the nursing profession

and the delivery of high quality care by completing the ccrn

(certified clinical resource nurse) exam and serving as a mentor

for new employees, nursing students and medical students. his

calm, unhurried approach has also earned him appreciation from

patients and families.

Binker Named rCrh employee of the year Jennifer Binker, rN, BsN, was recently recognized as

rapid city regional hospital’s employee of the year for

2013. binker is an rn in the rapid admissions unit and

has been with the organization four years.

“Jennifer has great nursing skills and is a very good teacher with

students and new staff members,” her nomination for the award stated.

the rcrh employee of the year is selected from the organiza-

tion’s employee of the month winners.

saNForD UsD MeDiCal CeNter sheri otta, rn, pacu Otta was off duty when she saved a patient’s life by starting chest compressions in the woman’s van while a family member drove them to the hospital.

lisa lubbers, cnp, nicu Lubbers showed great compassion to a distraught mother whose infant had pulled out its lines. Lubbers helped the mother get socks for the baby’s hands and stayed with her to calm her.

sara hanson, rn, labor & Delivery A patient who went into labor 3 weeks early described Hanson as an “absolute angel” for helping to mitigate the stress of preterm birth and transition to NICU.

alex hughes, rn, critical care Hughes was praised by a family she helped during the death of a loved one. Hughes facilitated the family’s goodbyes, consoled them, and readily answered questions.

rapiD City regioNal hospitalChristine piper, rn, certified Oncology nurse A patient undergoing treatment for breast cancer nominated Piper, praising her compassion and ability to comfort during a stressful time.

Julie oberlitner, rn, hospitce home care A hospice patient’s family expressed gratitude for Oberlitner’s responsiveness and compassion, which even extended to calling on weekends to check on the patient.

the nurses’ Stationnursing news from around the region SANFORD HEALTH RECEIVES

GRANT TO DEVELOP NURSING LEADERS Sanford Health was recently awarded a Nurse Education, Practice, Quality, and Retention - Interprofessional Collaborative Practice grant, funded by the Health Resources and Services Administration (HRSA).

The three-year, $1.37 million grant is designed to improve healthcare access and care for older adults, the medically underserved, and the uninsured. It will be used to help develop nurse leaders to work with clinical teams from Sanford USD Medical Cen-ter, and will collaborate with SDSU in educating graduate level and undergraduate nursing students.

The goal is to partner with patients, families and communities to help improve and sustain their health and well-being so they utilize fewer health resources and stay out of the hospital. The grant will allow Sanford to develop proactive programs for those with chronic health conditions. ■

SuMMEr DAISIES the following area nurses have been recognized with DaiSy awards for high quality nursing in recent months:

31September / October 2014 MidwestMedicalEdition.com

HackerS are taking over point-of-sale systems by compromising hvac

systems through social engineering emails.

Fraudsters are compromising electronic health record systems to use the

collected information to commit medical identity theft and steal from cmS.

Online banking account credentials are being harvested by attackers to commit ach fraud.

how do you keep your it environment safe from these actions and how do you lower

the probability of an attack being successful? knowing what risks are in your it environment

and how you are mitigating them is a great place to start.

Assessing riskRisk assessment is the practice of finding the impacts and probabilities of possible threats or vulnerabilities in your IT environ-ment and assigning controls to the risks to mitigate or lower it. When looking for a tool to help you, you’ll want to make sure the approach is appropriate for the size and complexity of your organization.

asset-based Vs process-based assessments

An asset-based risk assessment is the approach of risk assessing each asset in your IT environ-ment. Process-based risk assessments look at the processes involved in protecting informa-tion and risk rate them accordingly. A good risk assessment approach should use a hybrid of the two in order to get a good picture of where the risks are in the IT environment and scale appropriately for the size and complexity of the organization.

threat-based Vs vulnerability-based assessments

A threat-based risk assessment considers all possible threats to the Confidentiality, Integ-rity, and Availability of a system or process.

A vulnerability-based risk assessment looks at the vulnerabilities currently on a system and rates them based on their likelihood of compromise. Both assessment styles are useful, and a good hybrid approach can give you access to both styles without over-com-plicating the process.

Quantitative Vs Qualitative measurement

Assessments that use the quantitative approach are very good at showing risk across many assets or processes. Medium to very large sized companies use the quantita-tive method because it helps them separate the various high risk items from each other. Qualitative method suggests that risk can be grouped into categories such as low, medium, and high. Small organizations use qualitative method because it simplifies the risk assess-ment process.

assessment, analysis, and management

Many security companies use these terms synonymously, but they are not synonymous. Assessment is the process of

finding what risks are in your environment. Analysis is the process of looking at those risks and deciding what controls apply to mitigate risk, and whether additional controls need to be deployed. Management is the process of looking at the risk analysis and the risk portfolio as a whole and deciding where to put resources in order to lower overall risk. A good risk approach will contain elements of all three.

While risk assessment, analysis, and management can be time-consuming, they are required by HIPAA and almost every other regulatory standard. It is also a very good process to understand your IT and IS environment and find its weaknesses with concern to confidentiality, integrity, and availability. Lastly, it helps focus resources on areas that are at high risk for c. It is through this process that your organization decides not to be the “low hanging fruit” for fraudsters and hackers to exploit. ■

eric Buzz hillestad is partner at ShS, llc and

principal consultant.

By Eric Buzz Hillestad

The Ins and Outs of Managing

Cybersecurity risk

For the full version of this article, including Hillestad’s take on the pros and cons of the various risk assessment approaches, log oN.

Midwest Medical Edition 32

DR. MATT OWENS, FAMILY PRACTICE PHYSICIAN at the Redfield Clinic and Hospital and assistant professor at the University of South Dakota Sanford School of Medicine, described a unique and innovative South Dakota disaster response program to an international audience at the National Disaster Life Support Education Consortium conference in Atlanta, Georgia on July 22.

The program described by Owens trains students enrolled in various healthcare curriculums at South Dakota’s two largest universities to became part of the integrated response to large and small disasters in the state.

Developed by the University of South Dakota Sanford School of Medicine, the South Dakota State Medical Association, and the South Dakota Department of Health, the program – titled Core Disaster Life Support training – was launched in 2004 by training students at the University of South Dakota School of Medicine as disaster responders. It has since grown to include preparing students in 11 different healthcare disciplines at South Dakota State University and the University of South Dakota.

“South Dakota is the only state in the country that recognizes and trains its medical school and healthcare students as valuable and deployable assets in the event of a disaster,” says Owens. “Our very practical and useful strategy of integrating the Core Disaster Life Support training course into the various healthcare curriculums is very appealing to public and academic entities and institutions from all over the country, even the world.”

In 2014, 320 students in healthcare professional disciplines at USD and SDSU were trained in the program. Though the training is a a required part of the curriculum, disaster response is voluntary. ■

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33September / October 2014 MidwestMedicalEdition.com

Trailblazing rural Physician Training BeginsSTUDENTS FROM THE UNIVERSITY OF

South Dakota Sanford School of Medicine began their contributions and learning as participants in the medical school’s new rural healthcare initiative called FARM (Frontiers in Rural Medicine) in July.

As part of the FARM program, six third-year students were selected to serve at five hospitals in five rural South Dakota communi-ties. Each student will receive nine months of intense and hands-on clinical training at a single hospital that will help them understand the opportunities and conditions of practicing

medicine in a small-town setting.“We want to expose students to rural

communities and rural healthcare,” said Dr. Susan Anderson, MD, director of the FARM program. “We’re trying to dispel the myths of rural medicine. There is a misunderstand-ing that small communities do not have modern technology or facilities. This is not true. We also want our students to experi-ence the different level of care and relationships they will have with patients in small communities.”

Approved and funded by the South

Dakota Legislature in 2012, the FARM pro-gram was specifically designed to combat the shortage of physicians in rural areas of South Dakota, a priority of the medical school and Gov. Dennis Daugaard.

“We are excited and proud of our first group of FARM students,” said Anderson. “We are also excited to partner with some excellent healthcare facilities around the state. We think this program will success-fully increase the number of physicians practicing in rural communities across South Dakota.” ■

Midwest Medical Edition 34

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35September / October 2014 MidwestMedicalEdition.com

DRINKINg WATER – also called potable water – usually gets little attention until mechan-ical or cosmetic problems

arise. But the same water-related issues that can arise with heating and cooling systems can also arise in potable water systems, although they are usually slower and more subtle. Without proper treat-ment, potable water systems degrade and may result in:

◆ Large Replacement Cost

◆ Excessive Maintenance Cost

◆ Degraded Water Quality

◆ Degraded Water Safety

For any facility, water quality concern begins with the incoming supply water. Water supplies vary significantly by source water quality, disinfectant type and concen-tration. Supply water should meet Federal, state and local drinking water standards, but while initially conforming to federal EPA guidelines, a near certainty exists that some of its properties will change or degrade within facility water systems.

What causes water degradation?

Degradation is a result of water chemis-try, mechanical or microbiology issues or a combination of all three.

When potable water degrades within a facility it can lead to scale formation within pipes, water heaters, faucets and sinks or cause corrosion resulting in leaks and general deterioration of pipes. Other common aes-thetics issues include odor, bad taste, color and turbidity.

“ i thought my water was safe.”

This assumption can lead to a false sense of required water quality and safety. Facility supply water is never sterile; the microbiol-ogy of water is highly dynamic, accelerating with rising temperature and “nutrient” availability.

Once inside a facility, if conditions are favorable, bacteria in supply water can pro-liferate, increasing the risk of waterborne pathogens. Each year illnesses due to water-borne pathogens cost the healthcare industry billions of dollars. System design, operation and water quality all affect the overall risk of waterborne pathogens in water systems.

avoiding legionellosisA microbiology issue of particular

current significance is the surveillance for waterborne pathogens and implementation of control guidelines / standards. The impending ASHRAE 188P standard for the prevention of Legionellosis in building water systems is one example. The 188P standard is intended to help facility owners and man-agers understand their water systems characteristics and design to best reduce the risk of Legionellossis.

Healthcare-acquired Legionnaires disease is directly linked to the presence of Legionella bacteria in the potable water system. Outbreaks involving Legionella have increased by 217% since the year 2000. This year Legionella outbreaks have been linked to a North Carolina nursing home, AUB Hospital in Birmingham, Alabama, and UPMC Presbyterian Hospital in Pittsburgh.

addressing problemsThe mechanical, chemical, and micro-

biological factors that threaten any potable water system can be addressed with a properly-designed water treatment program. This may include water softening, pH adjustment, iron / manganese filtration, scale and corrosion-inhibiting chemicals and secondary disinfection for microbiological control.

The good news is that, when properly employed, almost all issues can be remedi-ated or controlled. Professional assistance is strongly recommended in choosing, implementing and validating any course of action taken.

Nichole grasma is a water Quality engineer

for hOh water technology, a company which

provides water treatment and water safety

consultation to all industries including

healthcare.

By Nichole grasma

catch water problems early to avoid a Flood of problems later

midwest medical edition 36

China wants a piece of the wine-tourism pie and they’re looking the Napa Valley to see how it’s done. A recent article on the China Wines Information Website tells the story of China’s efforts to de-velop a rural wine region northwest of Beijing. The International Grape Exhibition Garden includes 750,000 square meters of vine-yards, a museum, and more than 1,000 varieties of grapes from more than 40 countries.

“We want to build our own Bordeaux in China,” the garden’s director, Pang Rongnian said.

Given the country’s wine consumption rates, it may be a good idea. According to Vinexpo, Chinese wine lovers consumed more than 1.9 billion bottle of red wine in 2013 – more than any other country in the world.

Wine Tours . . . in China?

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Wine Facts In California, wine country tours are second only to Disneyland in popularity with tourists, attracting more than 14 million visitors annually.

Chateau Montelena 2008 Potter Valley Riesling

Tasting Notes: This Riesling has a bright pale yellow hue with good depth of color. The nose is clean, rich and inviting, opening with fresh honeysuckle and apricot jam followed by peach and candied orange notes. The mouth feel is soft with big peach and apricot flavors and firm acidity. Its finish is long and fresh with a hint of clove.

Food pairings: Lobster, scallops or any rich flavorful white meat fish, roasted or grilled. A great fall wine!

Q: There is a little bit of a chill in the air these days. Does that mean it’s time to break out the reds?

A: A lot of people start transitioning to reds as the weather cools. And it makes sense because we’re often eating heartier foods with so many good things coming in from the harvest and, of course, the holidays approaching. It’s hard to beat a great glass of red on a crisp fall day while you’re sitting around in your favorite sweatshirt or hoodie.

Q: Is that what you’re drinking this time of year?

A: Well, not necessarily. Personally, I prefer a Zinfandel from Dry Creek Valley this time of year. These wines also tend to go particularly well with hearty foods like soups, stews, and beef.

Q: So how about a recommendation for a great Zinfandel to try this Fall?

A: One that I really like is the Dry Creek Valley Zinfandel from Kokomo Winery. Pedroncelli’s Zinfandel is also great and has won a couple of awards. Another one worth trying is from Mounts Family Winery. Mounts is run by a father/son team who have been farming in Dry Creek Valley for three generations. This one is known for having a bit of a floral component to it.

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Midwest Medical Edition 38

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39September / October 2014 MidwestMedicalEdition.com

meD reaches more than 5,000 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.

learning Opportunities

Log on to MED’s calendar to see the newest upcoming events or add your own.

September – november

september 11 – 12 UnMC advancing rural Primary Care Conference8:00 am – 5:00 pm location: Hilton, Omaha information: jhusted@unmc.edu, 402-559-6235 registration: https://cmetracker.net/UNMC/Catalog

september 12 sanford surgical symposium 8:00 am – 4:30 pm location: Sanford Center, Sioux Falls information: 605-328-3851, Jessica.johnson2@sanfordhealth.org

september 20 June e. nylen Cancer Center race for Hope 7:00 am – 10:30 am location: Adams Homestead, McCook Lake, SD information & registration: SiouxlandRaceforHope.com september 25 avera Cancer institute 15th annual Oncology symposium5:00 pm – 9:00 pm location: Sr. Colman Room, Prairie Center, Avera McKennan information: averaeducationevents@avera.org, 605-322-8987 registration: www.Avera.org/conferences

september 24 – 26 sdaHO 88th annual Convention8:00 am – 5:00 pm location: Rapid City Civic Center information & registration: SDAHO.org, 605-361-2281

september 25 - 26 7th annual Upper Midwest regional Pediatric Conference8:00 am – 5:00 pm location: Marina Inn & Conference Center, South Sioux City, NE information & registration: www.UMRPConference.com

October 3 avera women’s Conference for the Primary Care Provider8:00 am – 4:00 pm location: Sr. Colman Room, Prairie Center, Avera McKennan information: averaeducationevents@avera.org, 605-322-8987 registration: www.Avera.org/conferences

October 3 14th annual Community response to Child abuse Conference8:00 am – 4:30 pm location: Sioux Falls Convention Center information & registration: Elizabeth.groff@sanfordhealth.org, 605-333-2200

november 7 32nd annual north Central Heart Fall symposium8:00 am – 5:00 pm location: Sioux Falls Convention Center information: 605-977-5311 registration: Avera.org/conferences

CANCER CARE IS EVER EVOLVING. AS TECHNOLOGY IMPROVES AND MORE IS DISCOVERED ABOUT THE HUMAN BODY, THE WAY CANCER IS TARGETED WILL CHANGE. IT WILL BECOME MORE PRECISE AND MORE EFFECTIVE.

Blueprint of the bodyThe GEMMA trial is specifically for adult Sanford patients who have been diagnosed with incurable metastatic cancer or any rare cancer that has no standard of treatment. The trial will involve 50 patients and focus on finding the best treatment for them based on their DNA.

THE NEW GEMMA CLINICAL TRIAL

BRINGS THE FUTURE OF MEDICINE TO

SANFORD CANCER CENTER AND THE

MIDWEST. OPEN TO ADULT PATIENTS

WITH ADVANCED CANCER THAT HAS

PROGRESSED AFTER THE FIRST LINE OF

TREATMENT, THIS TRIAL WILL FURTHER

EXPLORE THE DNA OF EACH PERSON.

NEW CLINICAL TRIAL USES GENETIC CODE TO ATTACK CANCERCancer trial puts Sanford Health on par with the best treatment centers in the world.

200-46350-0965 8/14

• The genetic code of every participant will be thoroughly examined.

• It will be delivered by the Sanford Cancer Center team that you know and trust.

• The team of experts at Sanford will develop a personalized treatment plan based on the DNA information.

• This will be the most individualized approach to cancer care available.

Once enrolled, patients will have blood and tumor samples taken. DNA will be extracted and genetic testing done. Each person’s DNA is like a blueprint. It has all the information that determines everything from how we look to how our bodies operate. However, sometimes that code of information gets muddled and mutations occur. These slight variations can lead to a variety of diseases. But there are so many different possibilities and combinations for genetic variance that scientists do not know all of them.

Through the GEMMA trial, the team of experts at Sanford will be able to study the participants’ DNA and develop a better understanding as to what mutations caused the cancer to occur.

Forming a planOnce the results are in, they will be brought before a panel of cancer and cancer genomic experts. The Genomic Tumor Board will discuss the information with the patient’s oncologist and the team will begin to formulate a treatment plan that will work best with each patient’s particular results. The patient will then meet with their doctor to review the results and go over what they mean. It will be up to the doctor and patient whether or not to proceed with the recommended course of treatment based on the test results.

If the treatment plan is implemented, the patient will continue to meet with a research coordinator who will monitor and log the results. Even after the course of treatment has ended, patients will be checked on, either through phone calls or medical records, for the next two years.

Call Sanford Cancer Center at (605) 328-8000 to learn more and to see if you qualify for the GEMMA trial.

cancer.sanfordhealth.org