MED-Midwest Medical Edition-December 2015

Midwest Medical Edition

SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE FOR PHYSICIANS & HEALTHCARE PROFESSIONALS

DEC

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015HOLIDAY

Cyber-fraud Alert

MACRA The End of Fee-for-Service?

Meeting Planning 101Vol. 6 No. 8

A LOOK BACK

avera.org/cancer

REGULAR FEATURES 4 | From Us to You

5 | MED on the Web The Nation’s Fattest States and other content available exclusively on our website

10 | News & Notes – Recognitions, new providers, accreditations, and more

IN THIS ISSUE 9 | Generational Differences in Technology Usage

■ By Amos Kittelson Tips to help you meet your patients - and your staff - where they are on their tech journey

22 | The Future of Healthcare, Part 3

25 | Is Sitting the New Cancer? ■ By Jeff Roach

Is sitting really as bad as we’ve heard? Find out

why the studies don’t tell the whole story.”

26 | Treating Winter Allergies in Children The Allergy & Immunology Clinic at Omaha Children’s

27 | Black Hills Surgical Hospital Recognized for Joint Replacement

28 | Avera Joins WIN Consortium in Personalized Cancer Medicine Group will advance the national utilization of personalized oncology

28 | Rural Providers to Get New CT Scanners with Grant Funds

29 | Patient Tracking & Follow Up: What You Don’t Know Can Hurt You ■ By Laurette Salzman

34 | Estate Planning, Will or Trust: Which is Right for You? ■ By Lisa Maguire

By Peter Carrels

page 16

MIDWEST MEDICAL EDITION

VOLUME 6, NO. 8 ■ DECEMBER 2015

Contents

ON THE

COVER

page 12

6KEEP THE

HOLIDAYS MERRY

■ By Buzz Hillestad How to Avoid Fraudsters

and Cyber Attackers, Part 1

Did you miss any issues of MED this year? Don’t worry – we’ve got you covered with MED’s annual wrap-up of the feature stories and news events making headlines in 2015. We are now accept-ing suggestions for feature articles in 2016. Let us know what you want to see in this spot this time next year!

THE YEAR

IN REVIEW

21 DOES MACRA

SPELL THE END FOR FEE-FOR-SERVICE?

■ By Scott Leuning

32SO YOU’RE

THE MEETING PLANNER?

NOW WHAT? ■ By Carmella Biesiot

4

From Us to YouStaying in Touch with MED

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

VICE PRESIDENT

SALES & MARKETING Steffanie Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER studiofotografie

WEB DESIGN Locable

DIGITAL MEDIA

DIRECTOR Jillian Lemons

CONTRIBUTING

WRITERS Carmella Biesiot

Buzz Hillestad

Amos Kittelson

Scott Leuning

Lisa Maguire

Jeff Roach

Laurette Salzman

STAFF WRITERS Liz Boyd

Caroline Chenault

John Knies

AS WE WRAP UP ANOTHER YEAR of MED, we want

to thank you, our readers, for your continued support

of this publication and of the advertisers who make

it possible to bring it to you, month after month, free

of charge. Your patronage of their businesses shows them that

their ad dollars are being well spent here in MED, which, in turn,

keeps it coming to your mailbox. It’s a win-win-win.

In this month’s issue, not only do we wrap up the year in style

(and catch you up on anything you might have missed), but we

also bring you all of the latest medical community news as well

as useful and timely articles on:

• avoiding cyber attacks during the holidays

• generational differences in the way we use

technology (see if you can spot yourself!)

• the dangers of sitting AND how to get around them

• the implications of MACRA

• how to plan a meeting

• deciding between wills and trusts in estate planning

and more!

Here at MED, we strive to be your go-to source for medical

community news and information you can put to use right away

in your life and work. Got ideas for us? We’re all ears. And we’re

already planning for 2016. Send your feedback and suggestions

to [email protected].

Best Wishes for a Happy, Healthy Holiday Season!

Until Next Year,

—Steff, Alex, and the entire MED team

Alex Strauss

Steffanie Liston-Holtrop

CONTACT INFORMATION

Steffanie Liston-Holtrop, VP Sales & Marketing

605-366-1479 [email protected]

Alex Strauss, Editor in Chief 605-759-3295 [email protected]

Fax 605-231-0432

MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109

WEBSITE MidwestMedicalEdition.com


Paper Records? PREPARE FOR PENALTIES

When WISHING is Therapeutic

Data Security in ‘The Cloud’

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Vol. 6No. 3

Midwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical Edition

PhysicianThe Other “HEALTHCARE CRISIS”

Burnout


CYBERSECURITY ALERT: ASSUME A BREACH

NEW CANCER CENTER FOR

Marshall, MN

M

AR

CH

2015

Vol. 6No. 2

Physician Scientists

Leading Innovation at the Bench and the Bedside

Leadership Changes at Area Health Systems


MEANINGFUL USE MILESTONE in Watertown

Regional’s New CEO

Medical Education A TEAM EFFORT

JAN

UA

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FEBR

UA

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2015

Vol. 6No. 1

HIGH TECH SIGHT SAVER

JUN

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Vol. 6 No. 4


NEPAL to Rapid City . . . and Back

From

CAN YOU SPOT Drug-Seeking Behavior?

Planning for a Tech Disaster

Intergrative Therapies

FOR VETERANS

Midwest Medical Edition 4

mailto:[email protected]

2016 Advertising EDITORIAL DEADLINES

Jan/Feb Issue December 5

March Issue February 5

April/May Issue March 5

June Issue May 5

July/August Issue June 5

Sep/Oct Issue August 5

November Issue October 5

December Issue November 5 On the Website this month

The Nation’s Fattest StatesWalletHub has released its list of states with the biggest and smallest

weight problems. North Dakota and Minnesota are both on the list.

Find out how they rank and see other key weight-related stats.

Hospice and Palliative CareApproaching the end of life should not have to mean giving up quality

of life. Explore the rules and services regarding hospice and palliative

care with one of the area’s top providers of both.

5

MORE THAN A MAGAZINE A Medical Community Hub

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

MED is produced eight times a year by MED Magazine, LLC which owns the

rights to all content.

CONTACT INFORMATION

Steffanie Liston-Holtrop, VP Sales & Marketing

605-366-1479 [email protected]

Alex Strauss, Editor in Chief 605-759-3295 [email protected]

Fax 605-231-0432

MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109

WEBSITE MidwestMedicalEdition.com

Stay up-to-date between issues of MED!

Sign up for previews of upcoming articles and advance notice of the next digital edition.


NO

VEM

BER

2015

Vol. 6 No. 7

THE FUTURE of Healthcare

Pt. 2: Collaboration and Integration

How to Keep Your Best Employees

Local Doc’s Home-Brewed

Hobby

A Team Approach to Medicine

SD-IPEC South Dakota’s Interprofessional Practice and Education Collaborative

ƒ MED NOV15.indd 1 10/19/15 10:10 PM


SEPTEMB

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2015

Vol. 6No. 6

The Siouxland/Tanzania CONNECTION

Omaha’s Accredited Sleep Center

NATIONAL ATTENTION for Toxic Laundry Soap Study

Accountable Care

Quality Measures

Technology

Patient Portals

Meaningful Use

ICD-10

Reimbursements

Integration

Electronic Medical Records

Collaboration

Value-Based Medicine

FutureFuFu urureureureHealthcare

THE

of

JUN

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Vol. 6 No. 4



From




FOR VETERANS


JULY

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Vol. 6 No. 5

South Dakota

Physicalgets ao

Then & Now Father/Son Plastic Surgeons

Stay out of TroubleYour Guide to the 60-Day Rule

HOSPITAL WORKPLACE VIOLENCE

ƒ MED July August 2015 .indd 1 6/22/15 6:22 PM

December 2015 5MidwestMedicalEdition.com

http://www.midwestmedicaledition.com/




http://www.midwestmedicaledition.com/2015/11/20/93522/the-country-s-fattest-states

http://www.midwestmedicaledition.com/2015/11/20/93523/hospice-helps-patients-and-families-focus-on-quality-of-life

http://www.midwestmedicaledition.com/pages/subscribe


By Buzz Hillestad

Keep the Holidays MerryHow to Avoid Fraudsters and Cyber Attackers, Part 1

Pivoting

Privileges

Vulnerabilities

Victim is taken to a C&C website

Secure Awareness Training

Restricted Accounts

Vulnerablity Management

LAN Segmentation

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FRAUDSTERS take every advan-tage they can to steal IDs and money from people. The Holi-days are particularly brutal for

this type of activity. From social engineer-ing attacks tricking you into giving them your information to phishing attacks designed to compromise your computer, these attacks are real and do real damage to people who fall victim to them.

One very specific type of attack that happens during The Holidays is the DHL package claim. You get an email suppos-edly from DHL that claims you have a package they have been trying to deliver to you and that all you need to do is follow the link in the email to claim it. While DHL isn’t always the subject of this type of email, the trick and result remain the same. Sometimes the attackers use other mailing services or even online stores such as Amazon.com or eBay.com.

This type of attack is successful due to the way most computers work and are set up. Below there is a diagram of a simplified

hacker social engineering attack kill-chain. It is called a kill-chain due to the fact that it shows the path a hacker takes to get to what they want most, the data.

The first column of the diagram shows the attack vectors the attacker will try to exploit. If an attacker convinces someone in your organization to click the link in a phish-ing email, it will usually successfully drop a payload that will give the attacker what is called “shell access” to the computer. The payload is downloaded from their command and control (C&C) server out on the web. From there, the attacker can send commands to the machine to make it do basic things.

In order to completely take it over, though, the attacker has to be able to elevate privileges on the computer. Privilege elevation is required to fully take over the computer. This means that the attacker can install her own applications and weaponize the compromised workstation. If your organization is using admin accounts or local admin accounts for the users on the computers, it’s game over. If your

organization does use restricted accounts, you are protected for this first attack vector but your org is not in the clear.

If the attacker cannot gain administrator access through the compromised user credentials, she will have to exploit a vulner-ability that allows her to elevate privileges outside of normal parameters. The best defense for this is vulnerability manage-ment. How often you scan for vulnerabilities and remediate them will determine your success with vulnerability management.

Lastly, your organization can have a desktop that is completely compromised but can’t go anywhere else on the network due to proper LAN segmentation. Making sure firewalls are strategically placed between LAN segments and using proper egress and ingress filtering between those segments is critical with being successful with LAN segmentation.

The bottom line is that we need to assume our workstations will get breached. We need to plan for this assumption with the controls mentioned at the very least. The second column of the diagram completes the first column by showing protections for each of the attack vectors. If we think of these protec-tions as speed bumps, we can then focus on detection and response. Once we’ve detected our nemesis within our walls, we can figure out how they got in, with proper forensics, and how to prevent them from getting in again. Information security is a cycle not and endgame. Remember that and stay vigilant.

In the next installment of this 2 part series we will look at what the criminals can actually do with the data they steal. ■

Buzz Hillestad is Principal Consultant and

Partner at SHS, LLC in Sioux Falls.


1.800.24.SHARE (1.800.247.4273)

www.MyDonationResource.org

The gift of organ donation means more birthdays, more bike rides and more everyday blessings.

Thank you to SDAHO and all of our healthcare partners for helping us facilitate more birthdays for recipients like Mary Jo. With your help, we provide compassionate care and support for grieving families whose loved ones give the ultimate gift—the gift of life.

Mary Jo Renner, Heart RecipientYankton, South Dakota

Your partner for organ and tissue donation in South Dakota.

www.MyDonationResource.org

CENTER FOR NEUROSCIENCES, ORTHOPEDICS AND SPINE

CNOS delivers stronger, more comprehensive patient care by integrating Neurological, Orthopedic and Spine services. With an experienced team of physicians, surgeons and rehab specialists, CNOS continues to improve health throughout Siouxland.


cnos.net

www.dtbsystems.com

Generational Differences in Technology UsageHow to meet your patients – and your staff – where they are

By Amos Kittelson

AS TECHNOLOGY CHANGES and we adapt, we come to expect more of it.

Millennials, or members of Generation Y (ages 18-34), rely heavily on use of technological tools. Baby boomers (ages 51-69) may not be as familiar with certain technologies and simply may not have a desire to use them.

Generation X (ages 35-50) has seen tech-nology improve very quickly but may get stuck trying to relate to both generations on either side of it. This has created a vast divide in how generations understand and relate to technology. Each generation interacts – or interfaces – differently with technology. (Scrolling on an iPad is an example of user interface – it is the way we use that technol-ogy system.)

Patients or staff members who are Baby Boomers may be slow to adapt to a new tech-nology because they fail to completely understand its full capabilities. They may never fully embrace it or learn all that it can do. For the best experience, give baby boom-ers very basic user interface – no keyboard, no mouse, labeled buttons, touch screens with instructions. For best learning results, a user interface should offer user feedback while they interact with the device. Telling the user why the system is doing what it’s doing will help them understand it. A product manufacturer should incorporate user feedback when designing something new.

Millennials have grown up with technol-ogy that has been developed for optimal performance. It is very easy for them to reach out and have a conversation at the push of a button. Their user interface is simple, pleas-ant to the eye, and works well.

Generation X is accustomed to technol-ogy not working because it has been developed during their lifetime and they’re

used to things not working well. This may cause them to overcomplicate technology. Gen-X exists between a tech-savvy generation and one that might not readily acclimate to changes in technology. Gen-X might adapt easily, but they try to learn the new technology while simultaneously teaching their predecessors. They become mediators, but they can only be good translators by understanding generational differences and thought processes.

Baby Boomers and Millennials may be better able to relate to one another than Gen-X can relate to either of them. The communication barrier is low for both Millennials and Baby Boomers, even though their communication systems are different. Baby Boomers want one simple solution rather than several options, and are slower to adapt. Once they do adapt, they’ll hold onto it. Millennials want to consume all forms of technology and readily try new technolo-gies. Gen-X wants to know enough to have options, but without knowing too much.

The best user interface is no user inter-face. This means that having fewer – or no – barriers to operating technology will enable us to better utilize it. For technology to be used to its greatest potential, user interface must be simple and responsive. One of the simplest interfaces is one that is voice-activated – a device that can distinguish natural language. An example of this is iPhone’s Siri.

Exper t s can br idge t h a t ge n -e r a t i o n a l

technology gap, allowing everyone to share technology and communicate more effectively and efficiently. Because there’s no “one size fits all” solution, system inte-grators can customize technologies to fit anyone regardless of position, personality, or generation. Combinations of technologies – sensors, touch screens, voice recognition – can be developed with user testing. Before implementing technology solutions, busi-nesses should invite an expert system integrator to provide consultation.

More is expected of system usability and reliability than ever before. Regardless of who is learning a new technology, feedback will enable users to better understand their device and therefore maximize its capabilities. ■

FUN FACT: When we press a button, if nothing happens after 7/10 of a second (700 milliseconds), we think it’s broken and try clicking again. A system’s response time must be very fast for people to accept it.

Amos Kittelson is a Sioux Falls native, lifelong

technologist, 17 year Air Force Veteran and

owner of Sidewalk Technologies.

December 2015 9

http://sidewalktech.com/

Midwest Medical Edition

AVERA

Doctors have treated the

first patients at Avera Heart

Hospital with a newly

approved SYNERGY Everolimus-Eluting Platinum Chromium Coronary Stent from Boston Scientific making them some of the first patients within a four-state area including South Dakota, Minnesota, Nebraska and Iowa to benefit from this highly anticipated new technology. The SYNERGY Stent was approved for use by the FDA in November.

Sarah Flynn, MD,

has returned to

Avera Medical

Group University

Psychiatry

Associates after

completing her

fellowship in forensic

psychiatry at the University of

Colorado Denver School of

Medicine. Dr. Flynn completed her medical degree at The University of South Dakota Sanford School of Medicine and South Dakota State University. She completed residency in adult psychiatry and fellowship in child and adolescent psychiatry at the University of Texas Southwestern Medical Center, Dallas and is board certified in adult, child and adolescent psychiatry.

Amber Evenson,

PA-C, has joined

Avera Medical

Group. Amber is now seeing patients at Avera Medical Group

Internal Medicine Mitchell. Evenson received her Associate of Applied Science Degree in Nursing from Mount Marty College and earned her Bachelor of Science Degree in Nursing and her Master of Physician Assistant Studies from the University of South Dakota. She is a native of Scotland, SD where she and her husband now live.

Avera Heart Hospital is the

first in the region to adapt the

Volcano SyncVision, which syncs two technologies that help heart specialists further evaluate diseased heart arteries and to more precisely place coronary stents. Volcano SyncVision provides both an angiographic roadmap as well as intravascular details from the ultrasound. This co-registration provides detailed and accurate measures of vessel size, plaque area and volume, and the location of key anatomical landmarks — all valuable information while placing the stent.

Save the Date:The Avera Transplant Institute Symposium will be held at the Prairie Center in Sioux Falls on March 31. To register, email [email protected] or call 605-322-7879. For more information see Avera.org/conferences

BLACK HILLS

Regional Health has announced

the three caregivers who were

recognized during the month

of November for the “I Am

Regional Health” campaign. The individuals are:

Cindy Whitaker, a medical lab technician in Custer,

Moon Hemeyer, a physical therapist in Spearfish,

Eli Christopherson, an information technology professional at the Rapid City Regional Hospital HelpDesk.

The Spearfish Regional

Hospital Auxiliary is

sponsoring a college

scholarship fund. To be eligible, interested applicants must be students in their second year of undergraduate studies in an accredited healthcare program. Applications are available in Executive Management at Spearfish Regional Hospital. Deadline for applications is Dec. 15, 2015.

Cassy Choi, RN, recently

received the September DAISY

Award for extraordinary

nurses at Rapid City Regional

Hospital (RCRH). She provides patient care on several floors at RCRH and has worked at the hospital for more than 10 years.Choi was nominated by the daughter of a recent patient.

The following advanced

practice providers have

joined Regional Health:

Karen Bryan, CNP, Family Medicine, Queen City Regional Medical Clinic, Spearfish, SD

Ashley Neisen, PA-C, Family Medicine, Regional Medical Clinic, Rapid City, SD

Rebecca Reausaw, CNP, Orthopedic Surgery Regional Orthopedics, Spearfish, SD

Connie Tschetter, CNP, Neurology and Rehabilitation, Regional Medical Clinic–Neurology & Rehabilitation, Rapid City, SD

News & Notes

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes

10

December 2015 MidwestMedicalEdition.com

Eccarius Eye

Clinic (Scott

Eccarius, MD) in

Rapid City has

been named a

2015 Guardian

of Excellence

Award winner by Press Ganey

Associates, Inc. The Guardian of Excellence Award recognizes top-performing healthcare organizations that have consistently achieved the 95th percentile or above of perfor-mance in Patient Experience.

SANFORD

Kirk Zimmer assumed duties

as president of Sanford

Health Plan on December 1. Zimmer was most recently CEO for DAKOTACARE, a health insurance provider based in South Dakota. He also held positions of chief financial officer, chief operating officer and senior vice president at DAKOTACARE. Zimmer holds a Bachelor of Science degree in accounting from St. Cloud State University and is a certified public accountant.

Sanford Aberdeen is helping

local families in need this

holiday season by hosting a

food drive. All donations will be distributed to the Salvation Army and The Journey Home, to benefit families in the Aberdeen area. The public can help by bringing any non-perishable food items to Sanford Aberdeen now through Dec. 9. Monetary donations are also accepted.

A new clinical trial at

Sanford Health is exploring

how genetic changes that

occur during breast cancer

might help healthcare

providers better identify,

treat and control the disease.

The clinical trial launched earlier this month and monitors changes in breast cancer tumor tissue at initial diagnosis and, if applicable, at recurrence. Trial participants must be newly diagnosed with breast cancer to be considered for participation in the trial. The trial is open in Fargo, Sioux Falls and Bismarck.

SIOUXLAND

Janice Harrison is the new

Inpatient Rehabilitation

Coordinator at Mercy Medical

Center-Sioux City. Harrison obtained a BA in Nursing from Creighton University in Omaha. Most recently, she served as the Clinical Manager at Siouxland Pace where she managed the onsite primary care clinic and case management. Harrison will lead the coordination of internal and external admissions to the acute inpatient rehabilitation unit.

Julie Schiltz, Therapy Manager

for Mercy Home Care, was

honored at the Trinity Home

Health Services Fall Conference

for receiving the THHS Mission

Award. This award honors individuals who embody Mercy’s mission and values by living Mercy’s commitment to justice, stewardship, integrity and reverence to those who are poor.

UnityPoint Health–St. Luke’s

Cardiology Services and

Cardiovascular Associates

welcomes Swapna Kanuri, MD

and Roque Arteaga, MD, FACC

to its cardiology staff.

Dr. Kanuri attended medical school at Shri B.M. Patil Medical College in

Bijapur, India and completed residencies in Anatomic and Clinical Pathology at Boston University Medical Center and Internal Medicine at Creighton University Medical Center in Omaha, where she also completed a fellowship in adult cardiovascular disease, also at Creighton University Medical Center.

Dr. Arteaga

earned his MD from the Universidad Catolica de Santiago de

Guayaquil in Ecuador and completed a residency in Internal Medicine at Jackson Memorial Hospital in Miami and a cardiology fellowship at the Medical College of Georgia Hospital in Augusta, Georgia before completing a clinical in cardiac electrophysiology at the University of Iowa Carver College of Medicine in Iowa City. He specializes in electrophysiology.

Paul Johnson, MD, and Mercy

Medical Center-Sioux City have

been honored along with

former patient John Dunning

by Madonna Rehabilitation

Hospital as 2015 Chairman’s

GOAL Awards Recipients. The Chairman’s GOAL Award is presented annually to honor “miracle” patients and the physicians and trauma centers behind their recovery. Mr. Dunning was seriously injured when a tornado hit Wayne, Nebraska in 2013 and Dr. Johnson was a surgeon on the trauma team.

Mercy Breast Care Center has

been awarded a three-year

term of accreditation in

mammography by the

American College of Radiology

(ACR). Mercy Breast Care Center is the only ACR Breast Imaging Center of Excellence in the Siouxland area. The designation represents ACR accreditation in Mammography, Ultrasound, and Stereotactic Breast Biopsy.

”“ Medicine is a science

of uncertainty and an art of probability. — William Osler

MED QUOTES

11


Once again, technology has often taken center stage in our publi-

cation, but MED has also tackled the problem of physician stress,

shined a spotlight on the dual roles of physician scientists, high-

lighted sight saving services at the SD Lions Eye Bank, explored the

Black Hills/Nepal connection in the wake of an earthquake, and

provided a platform for area healthcare leaders to discuss the future

of their industry. As you read this year’s Review article, please keep

in mind that we are always on the lookout for new ideas. Let us know

what stories and issues you want to read about in these pages in 2016.

IN KEEPING WITH TRADITION, WE WRAP UP OUR YEAR WITH A LOOK BACK AT THE TOP STORIES AND NEWS HEADLINES OF 2015.

IN KEEPING WITH TRADITION, WE WRAP UP OUR YEAR WITH A LOOK BACK AT THE TOP STORIES AND NEWS HEADLINES OF 2015.

High-Tech Sight SaverTHE SOUTH DAKOTA LIONS EYE AND TISSUE BANK Offers Rare Tissue Prep Technique to Restore Vision

The South Dakota Lions Eye and Tissue Bank is one of nine eye banks in the U.S. (out of 79) with the training and experience to prepare DMEK (Descemet’s Membrane Endothelial Keratoplasty) transplants for corneal surgery. The transplants are used to treat rare conditions such as Fuch’s dystrophy, bullous keratopathy, and other cause of poor endothelial function.

Unlike previous generation partial thickness corneal grafts, the ultra-thinness of DMEK grafts means they can only be prepared manu-ally. Under microscopic guidance, a specially-trained tissue preparation expert must carefully isolate and remove this miniscule layer of cells from the underside of a donor cornea.

“The average cornea is about 500 to 600 microns thick and the endothelium (the innermost layer) is absolutely the tiniest portion,” says Marie Bowden, CEBT, CTBS, Clinical Recovery Manager at the SDLETB in Sioux Falls. Bowden uses delicate instruments and a surgical microscope to prepare circular grafts that are approximately 8.25 to 8.5 millimeters in diameter, a mere 10 to 12 microns thick, and the consistency of wet tissue paper.

Not every patient is a candidate for DMEK and many surgeons are still not trained to perform the delicate procedure. While the demand for DMEK tissue is growing, DSAEK remains the graft of choice for most surgeons. The SDLETB stays busy delivering both.

“More surgeons want to be as minimally invasive as possible to restore sight,” says Bowden. “Our job is to get the grafts to surgeons that they desire and that their patient needs.” ■NEWS FLASH!

JANUARY / FEBRUARY

BRENT PHILLIPS BECOMES THE NEW CEO OF

REGIONAL HEALTH

PRAIRIE LAKES IS ONE OF ONLY 19% OF ELIGIBLE

HOSPITALS TO ATTEST TO STAGE TWO

MEANINGFUL USE


MEANINGFUL USE MILESTONE in Watertown

Regional’s New CEO

Medical Education A TEAM EFFORT

JAN

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Vol. 6No. 1

HIGH TECH SIGHT SAVER


http://issuu.com/midwestmedicaledition/docs/med_jan_feb_2015

MARCHMAPhysician ScientistsLeading Innovation at the Bench and the Bedside

PHYSICIAN SCIENTISTS WORK AT the intersection of clinical practice and scientific inquiry, uniquely poised to bring clinical insights into the lab and vice versa. This is just one of the reasons that the three local physician scientists we spoke with for this story are so passionate about what they do.

Dr. Michael Kruer is an Associate Scientist in the Children’s Health Research Center at Sanford Research and a pediatric neurologist at Sanford Children’s Hospital. In medical school at Arizona, Dr. Kruer found his niche working with children with rare movement disorders and neurodegenerative diseases and later did post-doctoral work in a neurogenomics lab.

“I was struck by how much these patients needed someone to walk with them on this difficult path and also by how grateful they are,” says Dr. Kruer.

Head and neck cancer surgeon and researcher John Lee, MD, spends three days a week seeing patients and performing surgery at Sanford USD Medical Center and two days a week studying the causes and treatments of tonsillar cancers that are triggered by the HPV virus.

“My role is to not only see the patients but to translate new informa-tion from our lab and from labs around the world into better treatments,” says Dr. Lee.

Pierre, South Dakota native and neonatologist Michelle Baack, MD, spent ten years as the only full-time pediatrician in Pierre before deciding to pursue neonatology at the University of Iowa. It was there than she was “bitten by the research bug.”

“Being a researcher makes me think about patients and their medical care in more innovative ways,” she says. ■

NEWS FLASH!MERCY MEDICAL CENTER UNVEILS THE DA VINCI XI

SURGICAL SYSTEM

USD SANFORD SCHOOL OF MEDICINE EXPANDS

ITS RURAL MEDICINE PROGRAM


CYBERSECURITY ALERT: ASSUME A BREACH

NEW CANCER CENTER FOR

Marshall, MN

M

AR

CH

2015

Vol. 6No. 2

Physician Scientists

Leading Innovation at the Bench and the Bedside

Leadership Changes at Area Health Systems

December 2015 THE YEAR IN REVIEW 15

http://issuu.com/midwestmedicaledition/docs/med_march_2015

JUNE E. NYLEN CANCER CENTER MARKS 20TH

ANNIVERSARY IN SIOUX CITY

MOST DISCUSSIONS OF THE “HEALTHCARE CRISIS” IN THE UNITED STATES include the fact that the numbers of physicians, particularly those on the front line of care such as critical care, emergency medicine and primary care, are in shorter and shorter supply.

And yet, according to several nationwide surveys in recent years, these physicians and many of their specialty colleagues are burning out at an alarming rate, impacting not only their own lives but the institutions in which they work and the patients they serve.

In 2013, an editorial in the Journal of General Internal Medicine reported burnout rates between 30 and 65 percent across all specialties.

In a 2014 survey, 68 percent of family physicians and 73 percent of internists said they would choose a different specialty if they could start over.

And in this year’s annual Medscape survey, half of all family physicians, internists and general surgeons surveyed reported feeling burned out. Bureaucracy, administrative tasks, and too much time spent at work were cited as the more frequent causes.

“We are never taught how to take care of ourselves during medical training or residency. In fact, the workaholic ‘never need help, go it alone’ mentality is praised,” says Jill Kruse, DO, Family Medicine, Avera Medical Group, Brookings, South Dakota. “So when we do have issues, many students, residents, and even seasoned doctors don’t feel comfortable asking for help.” ■

From Nepal to Rapid City . . . and BackTHE BLACK HILLS OF SOUTH DAKOTA ARE A LONG WAY FROM the mountains of Nepal. But for 12 Nepali doctors who work at Rapid City Regional Hospital, Rapid City has come to feel almost like home. Now, in the wake of Nepal’s devastating earthquake on April 25th, some of them are making the long journey back again to help their homeland recover.

RCRH Hospitalist Binod Dhungana, MD, is one of ten hospitalists and two specialists who have settled in Rapid City in the last five years. Within days of the earthquake, he became the first of the doctors to book his ticket home.

Ironically, this was the first year since moving to the US that the young doctor had decided not to use his summer vacation time to go home to Nepal. He had hoped to intro-duce his extended family to the Black Hills, where he has lived for the past two years.

By the time Dr. Dhungana left for Nepal, the American Nepal Medical Foundation had already collected more than $250,000 dollars to support the relief effort in Nepal. Some of that money came from group members, but some was directed to the foundation from other organizations, looking for a way to contribute. One of the biggest contributors was Rapid City Regional Hospital.

“It really means a lot to be part of such a great organization that is willing to help,” says Dr. Dhungana. “The support of the community has been great, too.” ■

Physician BurnoutThe Other “Healthcare Crisis”

THE SIOUX FALLS VA MEDICAL CENTER INTRODUCES NEW

INTEGRATIVE THERAPIES FOR VETS

JUNE

NEWS FLASH!

NEWS FLASH!

APRIL / MAY


Paper Records? PREPARE FOR PENALTIES

When WISHING is Therapeutic

Data Security in ‘The Cloud’

APR

IL MA

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Vol. 6No. 3

Midwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical EditionMidwest Medical Edition

PhysicianThe Other “HEALTHCARE CRISIS”

Burnout

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FOR VETERANS

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NEWS FLASH!

AUGUSTJULY/


JULY

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Vol. 6 No. 5

South Dakota

Physicalgets ao

Then & Now Father/Son Plastic Surgeons

Stay out of TroubleYour Guide to the 60-Day Rule

HOSPITAL WORKPLACE VIOLENCE

ƒ MED July August 2015 .indd 1 6/22/15 6:22 PM

South Dakota Gets a PhysicalGroundbreaking public health report

provides comprehensive look at the

state of healthcare in South Dakota

By Peter Carrels

IN THE EXECUTIVE SUMMARY OF THE REPORT TITLED “Focus on South Dakota, A Picture of Health” the following statement summarizes the scale and importance of this newly-released statewide analysis.

“South Dakota and other largely rural states face many challenges in meeting the healthcare needs of rural and underserved communi-ties, in part because data to guide improvement is often limited or unavailable. The South Dakota Health Survey provides unprecedented statewide survey data on regional patterns of behavioral health prevalence and access to care.”

Unprecedented is an ambitious word, but it is indeed likely that South Dakotans have never before been the beneficiaries of such a comprehensive analysis of their health and their access to healthcare. To conduct this health needs assessment, 7,675 randomly-selected households from across the state were surveyed by phone, mail and in-person.

The report identifies several “key” findings of special interest, including:

● South Dakota may have rates of alcohol misuse, anxiety, and post-traumatic stress disorder that are higher than national rates.

● Hospitalization use for mental health issues is high.

● Individuals utilizing hospital emergency rooms present high rates of mental health concerns.

● There are pockets of high rates of depression, heavy alcohol misuse, unmet medical needs, and adverse childhood experiences.

Survey results indicate that Buffalo, Lake, Lyman, Union and Yankton counties are the healthiest counties in the state. At the same time, surveys suggest that McPherson, Potter, Harding, Clay, and Fall River counties are among the state’s least healthy counties. ■

SANFORD INTRODUCES ENTERPRISE-WIDE

PHARMACOGENETICS SERVICE

AVERA BEGINS USING TELEHEALTH APP “AVERANOW”

17December 2015 THE YEAR IN REVIEW

http://issuu.com/midwestmedicaledition/docs/med_july_august__2015

NEWS FLASH!

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WOMEN’S CLINIC

UNITYPOINT HEALTH, AVERA, AND SANFORD AGAIN MAKE CHIME’S

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NATIONAL ATTENTION for Toxic Laundry Soap Study

Accountable Care

Quality Measures

Technology

Patient Portals

Meaningful Use

ICD-10

Reimbursements

Integration

Electronic Medical Records

Collaboration

Value-Based Medicine

FutureFuFu urureureureHealthcare

THE

of

The Future of HealthcareChallenges for Hospitals, Health Systems

and Physicians

AS WE TALKED WITH REGIONAL CEOS from both large and small health systems for our new series on The Future of Healthcare, we started by asking them to discuss what they see as the biggest challenges facing healthcare in the next five to ten years.

Jill Fuller, Prairie Lakes Healthcare System: “Our biggest challenge will be the continued transformations in our business including the shift from inpatient to outpatient care settings and the transition from fee-for-service to reimbursement based on value.”

Paul Hanson, Sanford USD Medical Center: “One of the biggest challenges will be organizations developing a sustainable business model that balances clinical, financial and operational initiatives. Access to and management of capital, both human and financial, has never been more critical in ensuring an organization’s success.”

Jason Merkley, Brookings Health System: “The biggest challenge for healthcare organizations in the next five years is the shift from volume-based to value-based medicine and how we in rural America find ways to succeed under this reformed model and payment transition.”

Brent Phillips, Regional Health: “Recruiting and retaining a quality healthcare labor force could be a significant challenge well into the future. We have a huge shortage of several hundred thousand doctors across the United States today, and that shortage is only going to manifest itself more in the face of an aging workforce and an aging population.”

Fred Slunecka, Avera Health: “Regulatory [i.e. MACRA} and tech-nology disruption will be a challenge. From evolutions of patient medical records to advancements in genetics and the study of micro-biomes, we will understand care at completely different levels.” ■

SEPTE


http://issuu.com/midwestmedicaledition/docs/med_sept_oct_2015

The Rise of Inter- professional CareSouth Dakota Leads the Nation

in a Team Approach to Medicine

By Peter Carrels

THE CAMPAIGN TO PROPEL THE INTERPROFESSIONAL healthcare movement in South Dakota got a big boost and elevated levels of responsibility and opportunity last June when the University of South Dakota, representing South Dakota’s Interprofessional Practice and Education Collaborative (SD-IPEC), signed a Memorandum of Agree-ment (MOA) with the National Center for Interprofessional Practice and Education. SD-IPEC is the statewide group working to advance interprofessionalism in South Dakota.

Dr. Carla Dieter, chair of the Nursing Department in the School of Health Sciences at the University of South Dakota, also serves as chair of SD-IPEC.

“We are now part of a national effort to contribute to the measure-ment of the interprofessional education and practice through affiliation with the National Center,” says Dieter. “By working with the national center we can tap into resources that will help propel our work forward on a broader scale as well as contribute to the National Center’s Data Repository. It is exciting to be part of this important national effort.”

South Dakota is one of only 11 states to have formalized a relation-ship with the national organization, and South Dakota’s level of statewide organization is a rarity among states. Out of the 11 member states, only South Dakota’s and Arizona’s initiatives involve multiple educational institutions, and South Dakota is the only member state involving practice partners in their membership.

“The ultimate goal is to educate students interprofessionally so that it becomes so ingrained in their nature to work together that when they enter practice it will translate into sound interprofessional practices and produce positive patient outcomes,” says Dr. Dieter. ■

SOUTH DAKOTA RANKS ABOVE NATIONAL AVERAGE

IN KEY MEASURES OF HAPPINESS

AVERA OPENS NEW NICU

NEWS FLASH!


NO

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Vol. 6 No. 7

THE FUTURE of Healthcare

Pt. 2: Collaboration and Integration

How to Keep Your Best Employees

Local Doc’s Home-Brewed

Hobby

A Team Approach to Medicine

SD-IPEC South Dakota’s Interprofessional Practice and Education Collaborative

ƒ MED NOV15.indd 1 10/19/15 10:10 PM

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19December 2015 THE YEAR IN REVIEW

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IN THE TWO most recent issues of MED Magazine, the leadership of the major healthcare systems in South Dakota have all concurred that one of

the primary issues facing the future of healthcare is the shift in reimbursement mechanisms away from fee-for-service and toward quality-based models of payment.

The recent passage of the Medicare Access and CHIP Reauthorization Act (MACRA), a bipartisan bill that permanently repeals the Medicare sustainable growth rate (SGR) formula, takes a significant step toward eliminating fee-for-service for physician reimbursement. Medicare’s fee-for-service payment system had been long criticized for rewarding physicians who produced a high volume of services without taking into consideration the value received for those services. MACRA now creates a mechanism to shift away from fee-for-service as a primary means of reimbursing physician care under Medicare Part B and it signals a significant change in the landscape for physician reimbursement.

Under MACRA, Medicare fee-for- service reimbursement for physician services will increase annually by 0.5%, starting July 1, 2015 and going through 2019. But the focus of reimbursement takes a significant shift beginning in 2019. Medicare’s fee-for-service will continue as a reimbursement option after 2019, but reimbursement levels will remain locked at the 2019 level through 2025.

Beginning in 2019 physicians who want to receive higher Medicare reimbursement levels will have the option to participate either in a modified fee-for-service reim-bursement program or shifting to an alternative payment model. The details of these options are explained below.

OPTION 1 MERIT-BASED INCENTIVE PAYMENTS—A MODIFIED FEE-FOR-SERVICE MODEL

The Merit-Based Incentive Payment System (MIPS) closely resembles the exist-ing Medicare Physician Payment System. The MIPS option is essentially for physicians who want to continue to be paid predomi-nantly under Medicare’s fee-for-service model, with some twists.

The MIPS program consolidates three existing programs—meaningful use (MU), the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBPM)—into a single program. Under MIPS, physician performance is evaluated in four categories:

● Clinical quality (30%)

● Resource use (30%)

● Meaningful use of certified EHR technology (15%)

● clinical practice improvement activities (25%).

Based upon those assessments, each physician receives a score generated on a 0 – 100 point scale which will be used to dif-ferentiate between the best and worst performers.

OPTION 2 ALTERNATIVE PAYMENT MODEL

The alternative payment model (APM) option under MACRA facilitates and encourages physician participation in accountable care organizations, bundled payment programs or other performance-based contractual payment systems where physicians assume more risk for the cost and quality of the patient care that they provide.

The APM option provides the opportunity for physicians to receive larger financial reimbursement, but there are also more stringent rules that must be followed by physicians who choose this option.

Now Is the Time for Physicians to Plan and

Prepare for Change Under MACRA.

While MACRA does not completely eliminate fee-for-service reimbursement for Medicare providers, those physicians who stay with the current system will accept flat reimbursement starting in 2019, whereas physicians who shift to the new alternative payment options of MIPS or AMP have greater opportunity for higher reimburse-ment, along with higher risks associated with their performance.

A major shift in physician reimbursement is now on the horizon with the passage of MACRA and now is the time for physicians to plan and prepare for that shift by deciding if they are going to participate in MIPS or AMP and by determining what steps to take to be prepared for the transition that occurs in 2019. Strategic planning and decisions regarding partnerships between physician groups, health systems and hospitals should be examined to determine the best course of action during the transition period. ■Scott Leuning is an attorney at Goosmann

Law Firm.

Does MACRA Spell the End for Fee-For-Service?By Scott Leuning

For a more detailed explanation of how physicians will be paid under

the MIPS and APM models, see Scott’s full article on our website.


http://www.midwestmedicaledition.com/2015/11/20/93491/does-macra-spell-the-end-for-fee-for-service


Paul Hanson Sanford USD Medical Center “The geographic size of Sanford’s footprint can be a challenge. Larger, metro-based systems may have a 15- to 25-mile radius around their core services with a highly concentrated population base. By contrast, our system delivers services across one of the largest contiguous areas of the country. Com-munication, standardization and optimization are challenges that we work on daily. Engag-ing the medical staff and allocating capital are keys to future success.”

Brent Phillips Regional Health “Recruiting and retaining physicians and caregivers can be challenging. We have a history of being a progressive region in terms of healthcare delivery in the upper Midwest, but I would say recruitment is our biggest challenge and opportunity.

The current healthcare model must change. It needs to have a much more balanced focus that includes physician and caregiver engagement, better patient and family experiences, a culture of safety and quality care, and greater community and financial stewardship. We need focus on these key areas. As healthcare providers, we are significant shareholders in our com-munities. We have responsibilities not only in our healthcare systems, but in the greater community as well.”

Fred Slunecka Avera Health “In our specific region, the small size of rural hospitals and their fragility is extraor-dinary. Bundled payments could have a significant impact on them. Additionally, it’s hard to recruit physicians and other healthcare employees to rural communities, and our rural workforce continues to shrink.

At Avera, we are turning to technology as a solution. Telemedicine seems to be coming into its own for a variety of reasons. Consumers have grown accustomed to con-ducting many interactions remotely and online, so why not get your healthcare that way? The use of telemedicine has helped in recruiting and retaining a workforce in rural areas, allowing physicians to have greater balance and an expanded network of support. We can keep healthcare local by using Avera eCARE, and that’s impor-tant to our region.”

Jason Merkley Brookings Health System “I am not sure if this is a unique challenge of ours in the upper Midwest or not; how-ever, I will say with unemployment rates dropping, the availability of a workforce to fill the vacancies within our organizations becomes increasingly more difficult every day. While we face a nation-wide short-age of physicians and nurses, recruiting professionals to work and live in rural areas

is much more difficult than our metropolitan counterparts.

Hiring ancillary and non-professional staff, from certified nursing assistants to housekeepers and dietary aides, is probably as challenging because we live in an area where there are more job opportunities than people. We are going to have to find creative ways of competing for human resources and implement a strategy that develops the personnel necessary to functionally staff our organizations in the future.”

Jill FullerPrairie Lakes Healthcare System “Meaningful Use has caused us to change our business processes more than it is chang-ing the way we provide care. We have gained some efficiencies but we are also less effi-cient in many areas as a result. The added requirements related to security will likely have the biggest impact on our industry – along with the added risks associated with protecting data in an electronic format.” ■

MED plans to run additional Future of

Healthcare articles in the coming months

featuring leaders from other types of

healthcare organizations. Do you have

ideas for who you would like to see us

talk to? Send us an email at Info@

MidwestMedicalEdition.com.

Part ThreeFutureHealthcare

THE

ofBy Alex Strauss

In the first two parts of our Future of Healthcare series, we talked to the heads of large and small area health systems about challenges and opportunities for their organizations and for the nation as the American healthcare system continues to evolve over the coming decade.

In this third and final part of our series, we bring you their thoughts on what they see as unique considerations not only for their own organiza-tions but for providers across MED’s upper Midwest coverage area.




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M UCH HAS BEEN said and written lately about the dangers of sitting.Research on the negative

effects of prolonged sitting has shown higher incidences of heart disease, meta-bolic syndrome, diabetes, and premature mortality. For many in today’s society, time spent watching television or using the com-puter at home is added to eight or more hours of a sedentary office job.

The latest research, however, has shown that it is not sitting but the lack of movement that may be contributing to poor health outcomes. “Our study overturns current thinking on the health risks of sitting and indicates that the problem lies in the absence of movement rather than the time spent sitting itself,” Dr. Melvyn Hillsdon, of the University of Exeter, said in a press release. “Any stationary posture where energy expen-diture is low may be detrimental to health, be it sitting or standing.”

For this article, I will focus on solutions to combat the negative effects of sitting and lack of movement in the work environment.

As an ergonomics specialist, I have seen a trend of employees requesting an accom-modation (with or without a physician recommendation) for a standing desk. This likely is in response to the research mentioned above and/or from feeling discomfort after

hours of prolonged sitting at work. If the employer accommodates the request, the employee then begins standing at the fixed height workstation. Inevitably, these employees have discomfort from prolonged standing so they request anti-fatigue mats or tall stools with foot rings. This is not the ideal solution to the problem.

Height adjustable workstations are recommended as an alternative to fixed height desks. That way employees can change positions whenever they want. With this solution there should be no need for mats or tall stools. Employees simply sit or stand for a predetermined time or change positions based on mild fatigue rather than pain. If done consistently, employees should have more energy and have less discomfort at the end of the day and the end of the week. If an employee plans to stand and walk more, he or she should ensure they are wearing high quality footwear with good arch support and consider gel insoles.

To guard against the effects of a lack of movement, companies should encourage employees to walk occasionally throughout the work day. Employees should plan ahead to get up and walk during scheduled breaks, to get a drink or snack, and discuss work related matters with co-workers instead of emailing (when appropriate).

Some may be concerned about a reduction

in productivity with this sit/stand/walk approach. However, people are able to better problem solve and increase their focus with frequent changes of position. I can think of many examples of walking away from a frus-trating problem and returning to find the solution to be much more obvious. Employ-ees that develop fatigue, pain, and lack of focus with static positions are not likely to be as productive.

Now to the topic of exercise balls and treadmill desks. I do not recommend sitting on exercise balls when working due to the lack of back support and the risk of injury from falling off the balls. I would rather have employees changing positions more fre-quently than having employers investing in treadmill desks.

In summary, prolonged sitting and lack of movement is detrimental to our health. The solution does not lie with static standing at fixed height work surfaces. The solution is to change positions more frequently and move throughout the day. ■

Jeff Roach is an occupational therapist and

a member of the South Dakota Occupational

Therapy Association and the American

Occupational Therapy Association. He is an

Ergonomics and Loss Control Specialist with

RAS.

Is Sitting the New Cancer?By Jeff Roach



Sioux Falls Specialty Hospital Honored with 5-Stars in Patient Survey

Researchers Develop Model for Neurodegenerative DiseaseSANFORD RESEARCH scientists have developed a pig model for a neurodegenera-tive disease that could help better treat the disorder and other physiological conditions. The findings of the project are published in Human Molecular Genetics.

Sanford Research President David Pearce, PhD, staff scientist Rosanna Beraldi, PhD, scientist Jill Weimer, PhD, and their team of investigators engineered the pig model to replicate ataxia telangiectasia (AT), a pro-gressive multisystem disorder caused by genetic mutations in the AT-mutated gene.

AT causes neurological degeneration and motor impairment, primarily in children. Its progression is accompanied by immune disorders and increased susceptibility to cancer and respiratory infections.

“The creation of a more accurate animal

model can help bring research of this condition closer to application in human disease,” said Pearce. “We are particularly interested in the role of the AT-mutated gene in the progression of this disease and how treatment methods for similar physiological conditions might benefit from this pig model.”

While several mouse model have been produced for AT, the Sanford Research pig model better replicates the neurological characteristics of the disease, according to Pearce.

Sanford Research often replicates diseases in animal models to explore thera-peutic approaches. Last year, Pearce’s mouse model for Batten disease, a group of rare neurodegenerative disorders in children, was also outlined in Human Molecular Genetics. ■

SIOUX FALLS SPECIALTY HOSPITAL recently received a 5-Star Rating from the Hospital

Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) for 2015.

The only hospital in Sioux Falls and one of only four hospitals in the state to receive a

5-Star rating, Sioux Falls Specialty Hospital earned very high marks from patients in every

category on the survey:

● Overall Hospital Rating

● Responsiveness of Hospital Staff

● Pain Well Controlled

● Communication with Nurses

● Communication with Doctors

● Communication about Medicine

● Cleanliness of Hospital Environment

● Quietness of Hospital Environment

● Discharge Information

● Understood Their Care When

They Left the Hospital

● Would Recommend Hospital

The HCAHPS survey is the first national, standardized, publicly reported survey of

patients’ perspectives of hospital care. ■

Treating Winter Allergies in ChildrenWITH THE BEGINNING of winter come freezing temperatures that end seasonal fall pollen allergies. However, many warm weather irritants – such as pet dander, mold and mildew – are around all year, and expo-sure can peak once the furnace kicks on and the windows are closed for the winter.

Whether a patient suffers from seasonal allergies, or food, medicine or insect allergies, Hana Niebur, MD, a pediatric allergy and immunology specialist at Children’s Hospital in Omaha, says it takes a special touch to treat younger patients.

“Children may not be as understanding as adults about why they have restrictions,” she says. “I think it’s important that kids are able to play outside, to have fun and to be children. My approach is to make treatment work for what a child can tolerate on a daily basis. My goal is to make them feel like they can have a normal life.”

Allergies can affect anyone, but are generally more common in kids and tend to run in families. Confirming a diagnosis typically involves skin testing, blood testing or challenge testing, which involves taking a very small amount of allergen by mouth, inha-lation or a combination of both methods.

“Skin testing is still the most accurate form of testing for environmental allergens. For food allergies, it can be a bit trickier, but it usually requires a combination of skin testing and blood testing,” Dr. Niebur says.

Allergy sufferers may become used to chronic symptoms, but Dr. Nieber says these symptoms can usually be prevented or controlled with help from an allergy specialist. In some cases, allergy shots are needed to desensitize the immune system to the allergy. Treatments vary based on a child’s age, overall health and other factors. ■

See the website for more on the Pediatric Allergy and

Immunology Clinic at Children’s.


http://www.midwestmedicaledition.com/2015/11/20/93492/treating-winter-allergies-in-children

Black Hills Surgical Hospital Recognized for Joint ReplacementORTHOPEDIC CARE AT Black Hills Surgical Hospital (BHSH) has been recog-nized among the top 10% in the nation as measured by risk-adjusted complications, according to this year’s evaluation from Healthgrades.

Every year Healthgrades evaluates hospital performance at nearly 4,500 hospitals nationwide for 33 of the most common inpatient procedures and condi-tions. As a result of this ranking, BHSH has again received the 5-star designation for orthopedics.

Black Hills Surgical Hospital not only performs at a 5-star level in Total Knee and Total Hip Replacement, it outperforms other hospitals in the nation in Joint Replacement and as a result has been recognized with the 2016 Healthgrades Joint Replacement Excellence Award™.

The Healthgrades report demonstrates how clinical performance continues to differ dramatically between hospitals both nation-ally and regionally. This variation in care has a significant impact on health outcomes.

For example, from 2012 through 2014,

if all hospitals as a group, performed simi-larly to hospitals receiving 5 stars as a group, on average 222,392 lives could potentially have been saved and 166,086 complications could potentially have been avoided. A 5-star rating indicates that Black Hills Surgical Hospital’s clinical outcomes are statistically significantly better than expected when treating the condition or conducting the procedure being evaluated. ■

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Rural Providers to Get New CT Scanners with Grant FundsTHIRTY SEVEN RURAL healthcare providers across the upper Midwest will get new 32-slice or higher CT scanners thanks to a $14 million in grants from the Helmsley Charitable Trust.

The funding initiative was the result of a survey of Critical Access Hospitals in the Rural Healthcare Program’s seven-state funding region. According to the Trust, capital equipment, particularly CT scanners, was identified as a top capital need by many hospitals.

“Our goal is to ensure that people who live in rural America have access to quality healthcare as close to home as possible,” said Walter Panzirer, trustee of the Trust. “Rural hospitals need to be viable and they need to have up-to-date equipment so patients can receive essential healthcare services locally.”

The new CT scanners will come just in time for some hospitals as a new Medicare policy on January 1 will reduce reimbursement for certain studies on CT scanners that do not meet radiation dose requirements. Critical Access Hospitals with a 16-slice or lower CT scanner were invited to apply for grant funding to purchase new CT scanners. More than a hundred hospitals applied.

Among the MED coverage area, hospitals chosen to receive funds for new CT scanners are Sanford Chamberlain Medical Center in Chamberlain, SD, Community Memorial Hospital in Redfield, SD, and Avera Gettysburg Hospital in Gettysburg, SD. ■

Avera Joins WIN Consortium in Personalized Cancer MedicineAVERA CANCER INSTITUTE recently became the fifth medical institution in the United States to join the Worldwide Inno-vative Networking (WIN) Consortium.

The WIN Consortium is a global network of leading academic, industry, insurance and non-profit research organizations work-ing to make personalized cancer care a reality for patients worldwide.

Avera joins Memorial Sloan-Kettering Cancer Center in New York, New York University Langone Medical Center, Univer-sity of Texas MD Anderson Cancer Center and University of California San Diego Moores Cancer Center.

“Personalized medicine is a concept of giving the right drug at the right time for the right person,” said Vladimir Lazar, MD, PhD, founder and Chief Operating Officer of the WIN Consortium. “WIN was created with a goal to go beyond what is now possible. As a member of the WIN Consor-tium, Avera will be on the front line of this transition.”

To date, the approach in cancer care has

been population medicine – treatments based on what has been shown to be most effective for people with a certain type of cancer. In comparison, personalized medicine uses genomic analysis to discover the specific genetic drivers of a tumor, and target those drivers with treatment regimens.

Avera’s genomic oncology team consists of Brian Leyland-Jones, MB BS, PhD, and Casey Williams, PharmD, as well as Avera Cancer Institute physicians (surgeon, oncologist, pathologist and interventional radiologists), research scientists, experts in bioinformatics, nurse practitioners and specialized nurses and pharmacists. The team collaborates with experts from across the nation in clinical oncology, pharmacol-ogy, clinical genetics, genomic informatics, bioethics and pathology.

“This is the age of genomic medicine. We’re at a pivotal moment in cancer research, when we can apply genomic profiling to targeted therapies. This will be absolutely transformative in the history of cancer care,” Leyland-Jones said. ■

You can access the full list of recipients in 7 states on

our website.


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LAPSES in patient care, includ-ing follow up, can lead to dire consequences beyond those to patient well-being. Substantial

malpractice settlements and verdicts have been paid as a result of “lost” diagnostic reports and physicians’ failure to review and follow up.

Patients who miss or cancel appoint-ments risk undetected and untreated medical conditions, threatening continuity of care. If the patient later experiences an illness or injury, he or she may hold you responsible. The best way to prevent such lapses—and the corresponding malpractice allegations they create—is to develop written policies and procedures. The goal is to effectively track lab and diagnostic tests, as well as missed appointments and referrals.

Lab and Diagnostic TestsEstablish a tracking system that docu-

ments and follows patients referred for diagnostic imaging or laboratory testing. An effective system will verify the:

■ test is performed■ results are reported to the office■ physician reviews the results■ physician communicates the

results to the patient■ results are properly acted upon■ results are properly filed.

It is important the physician or allied health professional (AHP) review, authenti-cate, and date all diagnostic test results as soon as they are available—before filing. When test results are abnormal, it is impor-tant to let the patient know both the results and the need for follow up. If the patient does not follow through as advised, it is prudent to make—and document—repeated efforts to encourage the patient’s return.

Cancellations and No-ShowsTracking missed or cancelled appointments will help you improve patient care and reduce liability risk. When patients miss or cancel appointments, attempt to reschedule and document both the reason for cancellation and each of your efforts to reschedule.

We suggest the AHP review all missed or cancelled appointments and discuss them with the physician to determine if follow-up is necessary. More aggressive follow up may be necessary for patients with urgent condi-tions. Document all such efforts in the medical record.

Consultations/ReferralsPlan to develop an effective system to iden-tify and track patients who are scheduled for referrals and consultations. Document in the patient’s medical record all recommendations that a patient see a specialist for consultation or continued care. Include any letters or other communications between physicians in the medical record.

Types of Tracking SystemsTracking systems do not have to be complex or expensive; they just have to work. Many medical practices use simple and inexpen-sive methods, such as logbooks. Others utilize tracking functions provided in their electronic medical records system. Whatever tracking method you choose, be sure to follow up on laboratory and diagnostic tests, cancellations, no-shows, and consultations. ■Laurette Salzman, MBA, CPHRM, is Senior Risk

Resource Advisor with ProAssurance

By Laurette Salzman

Patient Tracking & Follow Up –What You Don’t Know Can Hurt You

You can purchase a digital file of any article you contribute to MED. Email it to clients, use it on your website, or print

it for a cost-effective marketing tool!

Reprinted from MED Magazine

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

management 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

standardized 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

process 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.

By Natalie Bertsch

Tips for eliminating your

iCd-10 Claims problems Today

SEptEMbER

Oc

tOb

ER

2014

vol. 5 no. 6

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. ■

Contact us at 877-858-5307 dt-trak.com

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.

Reprinted from MED Magazine

JUly

/ aU

gU

st2

014

Vol. 5 No. 5

Risks surrounding

AlARm mANAgemeNt

in the Healthcare settingT he issue of alarm faTigue and paTienT safeTy has become

a ‘center stage’ concern for healthcare providers across the country over

the last two decades. in fact, the emergency Care research institute

(eCri) named alarm hazards as the #1 health Technology hazard in 2013.

The number of alarm signals in healthcare facilities can surpass several hundred per

patient each day – which can translate to thousands of alarms on every unit and tens of

thousands throughout the hospital. While alarms are an important part of patient care,

they can reach overwhelming quantities. so, it’s no wonder that clinicians can become

desensitized, overwhelmed or immune to the sounds, and can suffer from ‘alarm fatigue.’

The risks to patient safety are real. Common injuries resulting from alarm hazards

can include falls, delays in treatment, medication errors, or in the worst case – death.

The Joint Commission sentinel database reports 98 alarm-related events between

January 2009 and June 2012. of the 98 reported events, 80 resulted in death, 13 in

permanent loss of function, and five in unexpected additional care or extended stay.

unfortunately, these occurrences are happening more and more frequently.

in June 2013, the Joint Commission established a new 2014 national patient safety

goal (npsg) to address improving the safety of clinical alarm systems in hospitals. The

npsg requires hospital and critical access hospital leaders to set alarm management as

a priority, establish a formal policy and provide staff training around alarm safety.

Jillyan Morano BSE, MHA

DID YOU

KNOW?

This article is not intended to provide legal advice and no attempt is made to suggest more or less appropriate medical conduct.



Sepsis Project Saving LivesA PROJECT AT AVERA HAS SUCCEEDED in reducing sepsis

mortality by 45 percent to an average mortality rate of 8.8 per-

cent – well below the national average of about 14 percent.

Sepsis, the rapid onset of organ dysfunction caused by an

overwhelming immune response to infection, accounts for one

in five hospital deaths nationwide and kills 258,000 Americans

annually. Sepsis not only puts patients at risk, but it also puts

hospitals at risk with longer lengths of stay and higher 30-day

mortality rates, which can threaten Medicare’s incentive payments

under value-based purchasing.

An Avera-wide quality work group has improved its sepsis

rates through a project called “Seeing Sepsis,” in which front-

line caregivers can quickly identify patients and ensure they get

the necessary treatment – fast. This project was done in alliance

with the Minnesota Hospital Association.

“Treatment with antibiotics is most effective within the first

hour of the onset of sepsis. For every hour that goes by, there’s

a 7 percent increase in mortality,” said Dawn Tomac, RN, Director

of Clinical Quality Initiatives for Avera Health.

THERE ARE MULTIPLE STEPS TO “SEEING SEPSIS” TO ENSURE ITS SUCCESS.

■ A nurse-driven screening protocol that’s

hardwired to the electronic medical record.

Evidence-based order sets. Antibiotics are listed

in order of which to give first for the site of

infection, rather than alphabetical order.

■ A transfer trigger tool, to help caregivers

know exactly when patients should be transferred

to ICU or a tertiary care center.

■ Education. This included videos and an

easy-to-follow 100-100-100 infographic created

by the Minnesota Hospital Association to use in

early sepsis identification.

■ Measurement and feedback ensure that sepsis

mortality rates continue to improve.

“The bottom line is that more patients are surviving sepsis

at Avera. This is the result of the hard work of hundreds of

employees,” says Tomac. ■

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Know your budget before planningWhether you have to report to a committee, a board, or just one boss, make them be clear about the amount of money they are willing to spend. There is nothing worse than detail-ing for weeks or even months, with your catering manager, audio visual crew, and hotel contact just to have to go back to the drawing board due to budget concerns. Keep

in mind that your venue crew will spend hours detailing your meeting-especially if it is a larger conference, and although some-times things just happen and reevaluating the agenda is unavoidable, going back to the drawing board wastes your time and your hotel crew’s time. Another benefit to knowing your budget prior to planning is that your sales and catering managers will be able to help you make budget-friendly decisions.

Be the Only Contact for your venue personnelNothing is more counterproductive than having too many cooks in the kitchen. One meeting planner will accomplish more than five; especially if they are not in the same office and relying on email to communicate. Have a million meetings with people who matter, but keep them from contacting your hotel personnel. It only leads to confusion.

So You’re the Meeting Planner?

Now What?By Carmella Biesiot

Planning a meeting can be daunting. These tips will save your sanity.


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• Practice includes both Urgent Care and Primary Care medicine.• Practice located in beautifully designed facilities with state of the art equipment.• Benefits include competitive compensation consisting of base pay, incentive pay based on production, and comprehensive benefit package.

Rapid City is located in the beautiful Black Hills and is a great place to live and work. Enjoy superior outdoor activities including hiking, biking, skiing, fishing, hunting, kayaking, and much more. With a population of 60,000 plus, Rapid City has the charming feel of small town, yet has abundant amenities, reasonable cost of living, low crime rate, excellent transportation access, public and private schools, and close proximity to colleges and universities.

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Too Many Agenda Items =Weaker Attendance

It is important to have a clear and detailed agenda, but too many items will exhaust your conference goers. So many meeting plan-ners want to plan activities in between sessions or after the work day, and although their intentions are great, the reality is that people are tired. They’re away from home and likely have work to catch up on. Unless it’s a cocktail hour or dinner, keep the non-conference related activities to a minimum. At the end of the day, people want to relax and have some free time to answer emails, exercise, and simply unwind. Plus, it’s less work for you, the meeting planner!

Keep Things Unique & InterestingIf you are planning a meeting or conference that is a yearly event, remember to keep things fresh. Simply having different speakers or chicken instead of beef for dinner isn’t enough. Add a different theme each year, or a different focus. Perhaps one year you provide your attendees with a goody bag filled with items that represent the city you are in (CVB’s love providing these things), or provide them with some entertainment which is unique to where you are. This can be easy if your event jumps around a region or the country, but if your event is at the same venue, it can get tricky. Don’t forget-your hotel/venue personnel are a huge resource for ideas. Ask their opinion. They want you to have a successful meeting too as it is a reflection of their work.

CelebrateYes, celebrate. Don’t forget-your attendees are away from their offices, their families, and their routine. Create an agenda item each day that celebrates them-whether it’s a spotlight on their business or industry, an awards ceremony, a cocktail mixer, or even a widely embellished “thank you” can go a long way. Treat them. Make them want to come back next year and make them glad they took time out of their life to attend. Cheers! ■

Carmella Biesiot is Director of Hotel Sales and Marketing

for The Lodge at Deadwood.



www.bhucare.com



DO YOU NEED a Will? Or a Trust? It depends upon your circumstances. For some, a Living Trust can be a useful

and practical tool. For others, it may be unnecessary. Below you will find some basic information that can help you when making this estate planning decision.

WHAT IS A WILL?A Will is a written document govern-ing distribution of property at death. It is subject to amendment during your lifetime and allows appointment of a guardian for minor children.

WHAT IS A LIVING TRUST?

A Living Trust, sometimes called a Revocable Trust, provides for property management during lifetime and after death. It is also subject to amendment during your lifetime.

A Living Trust can:

♦ Avoid probate after death

♦ Avoid costs and delays

♦ Plan for incapacity

♦ Control what happens to property after you are gone

♦ Prevent financial affairs from becoming public record

♦ Provide creditor protection for heirs

Living Trusts have some drawbacks. It is usually more expensive to set up than a typical Will and is somewhat useless unless it is funded. A Living Trust only can control assets placed into it. If assets have not been

transferred, or if you die without funding the Trust, the Trust will be of little benefit as your estate will still be subject to probate.

WILL VS. TRUST CONSIDERATIONSThere are many reasons to establish a Trust, but it will involve more upfront effort and expense. To determine if you should make the extra effort and invest in the expense of a Trust, answer these questions:

Is informal probate an available option?In South Dakota, unlike many states, probate is not a complex or burdensome process, making a Will appropriate if you do not need a Trust for other reasons.

Do you have real property in multiple states?If you have real property in other states, each state requires its own probate for such property. This may cost more in attorney’s fees, time, and trouble. If you have real property in multiple states, consider a Trust.

Do you have minor children?A Trust allows you to establish provisions specifying when a child will be entitled to assets. (In many cases, a Testamentary Trust can be included in a Will if you do not want a stand-alone Living Trust.)

Do you have children, grand-children, or other dependents with special needs?Access or control those heirs have over inherited property may need to

be limited. With a standard Will, your property can be passed on to those heirs, but a Will alone does not allow you to exercise much control over their use of the property. (Again, a Testamentary Trust in a Will might also work in this instance.)

Will your estate be subject to estate taxes?If the value of your estate exceeds the federal estate tax threshold, you might consider a Trust with tax planning provisions. Currently, the federal estate exemption amount is $5.43 million per person, and it is scheduled to increase to $5.45 million on January 1, 2016.

Will you actively manage your estate plan?If not, a Living Trust may not be a suitable solution.

In many ways, a Living Trust and a Will accomplish similar objectives. A Living Trust, however, gives you options that a Will cannot. Those advantages don’t come without a price. Whether a Living Trust is better than a Will depends on whether the additional advantages are worth the cost. One size does not fit all. Your estate plan should be prepared to address your own personal needs. ■

Lisa J. Maguire, Attorney/Shareholder, at Woods Fuller Shultz and Smith, PC practices primarily in the areas of estate planning, guardianship and conservatorship, probate and trusts. Lisa has over 17 years’ experience assisting individuals with their estate planning needs.

Estate Planning

Will Or Trust – Which Is Right For You?By Lisa Maguire


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MED-Midwest Medical Edition-December 2015

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Transcript of MED-Midwest Medical Edition-December 2015