med-midwest medical edition-jan/feb 2014

Midwest Medical Edition

Jan

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ry

Febr

ua

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2014

Vol. 5 No. 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

Sanford Ear, Nose & Throat Clinic1310 W 22nd Street Sioux Falls, SD 57105

Monday–Friday 8 a.m. – 5 p.m.

Andrew Terrell, MD, Otolaryngology - Head & Neck Surgery

At Sanford Ear, Nose & Throat Clinic, our cancer team provides your patients with specialized head and neck cancer care. Now, with the addition of Andrew Terrell, MD, they have expanded access to our expertise.

Our team strives to meet the individual needs of your patients while minimizing the side effects of treatment, giving them the best outcome possible and a higher quality of life. Dr. Terrell and colleagues John Lee, MD and Chad Spanos, MD utilize the most advanced surgical techniques such as robotic surgery, in combination with aggressive physical and speech rehabilitation, nutrition education, nurse navigation and survivorship care.

As part of the NCI Community Cancer Center Program, we are one of only 21 sites in the United States providing National Cancer Institute clinical trials for head and neck cancers.

Our head and neck cancer specialists know it’s more than surviving cancer. It’s about your patients’ quality of life.

Call (605) 328-8200 to refer a patient.

200-46350-0801 11/13

EXPERT CARE FOR HEAD AND NECK CANCER

Midwest Medical edition

page 8

By alex Strauss

voluMe 5, no. 1 ■ January / February 2014

Contents

Whether they are called Midlevel Providers, Advanced Practice Providers, or another similar term, Advanced Practice Nurses and Physician Assistants are playing an increasingly vital role in the delivery of healthcare on the Northern Plains. One might be a physician’s “right hand”, the other, a town’s sole provider. What does the future hold for these versatile practitioners?

advanced Practitioners

in a Changing Healthcare

environment

Playing a

RolePRimaRy

regular FeaTureS 2 | From Us to you

3 | meD on the Web what’s new exclusively on the Med website this month

4 | meet a meD Contributor dave Hewett

6 | News & Notes news and announcements from around the region

14 | off Hours now you See it, now you don’t: Sioux Falls radiologist

explores the art of Perception ■ By Sarah mcQuade

22 | The Nurses’ Station a daiSy Team award, nurses day at the legislature, Sd nursing at a glance

24 | grape expectations resolve to Take Stock of The wine “Cellar” ■ By Heather Taylor Boysen

27 | learning opportunities upcoming Symposiums, Conferences, CMe Courses

in THiS iSSue 4 | Microsoft Windows 8.1 opens new windows into Healthcare

■ By John Hohn

5 | Preparing a Budget for ICD-10 ■ By Cindy Hughes Preplanning can lessen the financial impact of iCd-10 on your practice

12 | Make-a-Wish Impact Study do those ‘wishes’ really make a measureable difference?

13 | Preview of the 2014 SD Legislative Session ■ By Dave Hewett

15 | VA Appoints New Director for Sioux Falls

16 | Prairie Lakes Receives Top Honors for Heart Attack Care

18 | Sanford Health to Run Pediatric Clinic in Kunming, China The growing city of Kunming will be home to Sanford’s latest world Clinic

19 | Mercy Installs New MRI

20 | Perks to Motivate Your Office Staff improve efficiency, reduce turnover, and serve patients more effectively with these perks to keep your medical office staff happy

21 | Food for a Healthy Heart: encouraging Patients to develop a better diet ■ By Kelly Steffen, mD on the Cover: Crystal Page, Pa-C,

buffalo regional Medical Clinic.

Photo by Turbiville Photography.

Midwest Medical edition 2

From us to youStaying in Touch with Med

ConTaCT inForMaTion

Steffanie Liston-Holtrop, VP Sales & Marketing

605-366-1479 [email protected]

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

Fax 605-271-5486

MAILINg ADDRESS Po box 90646 Sioux Falls, Sd 57109

WEBSITE MidwestMedicaledition.com

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©2011 Midwest Medical edition, llC

Midwest Medical Edition (Med Magazine) is committed

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vP SaleS & MarKeTing Steffanie Liston-Holtrop ediTor in CHieF Alex Strauss deSign/arT direCTion Corbo Design PHoTograPHer Kristi Shanks web deSign Locable ConTribuTing ediTor Darrel Fickbohm CoPy ediTor Hannah Steck

ConTribuTing wriTerS Heather Boysen Dave Hewett John Hohn Cindy Hughes Sarah McQuade Kelly Steffen STaFF wriTerS Liz Boyd Caroline Chenault John Knies

alex Strauss

Steffanie liston-Holtrop

AS We BegiN aNoTHer year oF PUBliCaTioN, we want to not only say thank you to the thousands

of loyal MED readers across the northern Plains, but

to welcome those who have recently begun receiving

MED with the expansion of our mailing list. whether you are

new to MED, or have enjoyed it since the beginning, there are

a few things we want you to know about this publication.

Five reasons to love MED

meD iS iNDePeNDeNT – because MED is not affiliated with

any medical association, health system, or organization, our

news and information is unbiased. This also makes MED an

excellent forum for open discussion of difficult or controversial

topics. got an opinion? bring it on.

meD iS reaDer-DireCTeD – MED is for, about, and often

by physician readers. we welcome reader contributions and

suggestions and take our editorial direction from an advisory

board of local doctors.

meD CoVerS a large regioN – unlike Medical associa-

tion journals that stop at the state borders, MED crosses state

lines, to explore the common interests and issues of physicians

in South dakota, northwest iowa, Southwest Minnesota, and

northeast nebraska.

meD iS more THaN a magaziNe – with the launch of a

new interactive website, MED can now provide updated news,

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an event, promote your practice, stay up-to-date, or reference

past issues – all with just a few clicks.

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with best wishes for a healthy and productive new year!

—Alex & Steff

midwestMedicaledition.com

PubliSHer MED Magazine, LLC Sioux Falls, South Dakota

vP SaleS & MarKeTing Steffanie Liston-Holtrop ediTor in CHieF Alex Strauss deSign/arT direCTion Corbo Design PHoTograPHer Kristi Shanks web deSign Locable ConTribuTing ediTor Darrel Fickbohm CoPy ediTor Hannah Steck

ConTribuTing wriTerS Heather Boysen Dave Hewett John Hohn Cindy Hughes Sarah McQuade Kelly Steffen STaFF wriTerS Liz Boyd Caroline Chenault John Knies

onthe

Now More than a Magazine, A Medical Community Hub

Enhance your MED experience! Med now offers continually updated news and calendar events on our website,

as well as an expanding free directory of area practices and businesses. Here is some of what you’ll find exclusively online this month.

Happy Staff = Happy Patients want to improve office efficiency, patient satisfaction and employee retention? Keep your staff happy. read “Three Perks for Motivating your office Staff” in this month’s Med then find more tips from the experts at aqreva online.

Protein Missing on the Plates of Adolescentsbeef may not be “what’s for dinner” on the plates of american teens. The South dakota beef industry Council has more on a study that suggests your adolescent patients may not be getting enough protein and what healthcare providers can do about it.

News & Notes . . . As They Happenif you appreciate the opportunity to stay up-to-date with MED’s popular news & notes column, visit MED on the web for all the latest news between issues. MED’s online news page is updated daily so you will always have the very latest information. if you have news to share, let MED help you tell your colleagues.

meD is actively looking for doctors who are passionate about their hobbies or an artistic pursuit to feature in upcoming columns. Write to us at [email protected] to nominate yourself or a colleague.

Online Calendarour online Calendar feature

makes it easy to find and share

local events specifically for

heathcare professionals, so you

will never miss a meeting or

course you wanted to attend.

you can even list your own up-

coming event – such as an office

open house or a presentation for

colleagues – for free.

Online Directoryusing MED’s online directory, powered by locable, you can

find and connect with area busi-

nesses that cater to healthcare

providers. it’s easy and free for

businesses and providers to be

included in the directory. with

ongoing updates to our busi-

ness identity solution tools, we

make it simple to get the most

out of the constantly-changing

online environment. being a

part of MED online allows you

to engage the online community

in new ways and put the web to

work for your practice.

Log on Now!

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

Janurary / February 2014 MidwestMedicalEdition.com 3

By John Hohn

Microsoft windows 8.1 opens New Windows in Healthcare

IMagine Having an assistant that

will transcribe and dictate at the

point of care. This assistant improves

your electronic records applications

experience, is prepared to connect you to

colleagues and allows you to anywhere-

access to your research.

The newest release of the Microsoft win-

dows 8.1 operating system will enable a

tablet to be this assistant. with windows 8.1,

you can leverage the ability to work from

anywhere, store data in the cloud and stay

linked to patients and colleagues without the

confines of traditional brick and mortar

institutions.

Since its release in late october 2013, the

influence of windows 8.1 is just starting to

take form. The windows 8.1 interface is touch

centric by design and meant to be the most

intuitive system to date from Microsoft. Soft-

ware developers will be able to design

applications to take advantage of the new

interface sensitivity and features. Medical

research and data will easily be available at

the touch of a finger on a windows 8.1

system.

while the touch feature is not new, the

difference windows 8.1 brings to the health-

care industry is its ability to integrate a level

of security that ensures patient information is

safe and secured. it enhances security of

mobile devices by integrating existing technol-

ogy into its platform, allowing for:

• Seamless wireless network security and secure encryption

• Management using Microsoft’s System Center for unique mobile threats like lost devices, manage backups, security updates

• Integration with biometric authen-tication for improved security and integrity

with data secured, you can use your

windows 8.1 tablet in a variety of convenient

and flexible ways that increase your

productivity.

windows 8.1 has:

• Flexible control options based on the application or your environ-ment, including touch screen, pen stylus, voice, mouse and keyboard

• Access to growing number of cloud services and apps from Microsoft’s app store, including dictation and transcription apps such as nVOQ, SayIT and Recognosco.

• The ability to easily run multiple applications and connect to resources like medical journals or other colleagues

• Integration with other Microsoft embedded medical equipment, which increases accuracy and efficiencies

• Existing desktop programs can be easily merged onto tablets running Windows 8.1, allowing you access to critical applications while on-the-go

with the combination of ease-of-use and

data security, windows 8.1 will emerge as the

preferred tablet operating system for health-

care professionals. browse to http://windows.

microsoft.com to learn more or explore your

options for updating your operating system.

you may want to consider upgrading your

computing device to a tablet such as Fujitsu,

which is designed to run windows 8.1. either

way, it’s worth finding out for yourself if the

time is right to start using Microsoft’s newest

windows system. ■John Hohn is a data Sales engineer at golden

west Technologies.

meD: you are not originally from the Northern Plains, but you are no stranger to wide open places. Where did you come from?

dH: My dad was a dentist in the army

and got transferred to Camp Hanford in washington State. it’s the top secret place where they made pluto-nium for the nuclear bomb in world war ii. in the middle of sage brush and sand in eastern washington. That’s where i started.

MED: Did you always envision a healthcare-related career?

DH: no. My degree was in public policy and i always thought i would be a tax policy person. i was working for a state Senator in wisconsin when i got recruited into the world of healthcare in 1981 by the wisconsin Hospital association. They were looking for a lobbyist. later, i worked for the american Hospital association for a couple of years before coming here in 1997. So i have spent most of my professional life debating many aspects of healthcare policy.

MED: you say you see similarities between some of what is happening now in healthcare and what was going on in the late 1980s. How so?

DH: Then and now, we saw a move from a volume-based system to a value-based one that encourages providers to keep people well instead of just treating illness. back then, managed care took a few steps backward because people were concerned about the quality of care. That has been improved by requiring providers to report their numbers publically.

MED: What are some of the major changes you have seen since you have been here?

DH: The percentage of physicians who are employed as opposed to independents is one thing that has changed dramatically. Medicine is technologically better. also, even in the smaller communities, they are building or redesigning hospitals to be more outpatient-oriented. going forward, expanded coverage is going to be a huge issue. How many uninsured will be able to enroll in the health insurance exchange? 2014 is going to be a transformational year for South dakota.

a talk with MeD Contributer

David Hewett


By Cindy Hughes

As you undoubtedly know, the transition to ICd-10 has the potential of being a bigger financial drain on your

practice than HIPAA and 5010 combined. The cost of implementing ICD-10 will vary depending on the size of your practice and whether you outsource any of your billing and coding functions. Now that 2013 is over it is time to prepare your budget for 2014 and plan for the potential decrease in insurance payments in October 2014. We encourage you to have a line of credit in place to assist you with any delays from the payers.

Some physician practices will experience an increase in software and infrastructure costs to make the changes required to their systems. For some practices these will be significant, MGMA estimates this cost could be as much as $75,000 per physician. We have been working with our practice manage-ment system vendor to ensure necessary modifications are being addressed in a timely manner and included in the yearly mainte-nance agreements. If you use any other software in the practice that incorporates diagnosis codes – whether clinical (EHR), research or data analytics – these will also need to be reviewed for potential costs.

You should be thinking about whether your hardware will need to be upgraded due to any of the increased infrastructure. Faster computers, more RAM or hard drive space might be required.

Documentation review is a critical com-ponent to ICD-10 implementation, and there will be expenses associated with the process. Costs are related to time required by staff to conduct reviews and/or the cost to have a company like Aqreva provide a chart audit and recommend modifications to your clini-cal documentation.

Appropriate training is required for clinical and some administrative staff is an

important part of this process. You will need to allocate sufficient funds to cover training expenses.

Many physicians still rely on a superbill or encounter form for diagnosis coding. This form is typically a one-page document. In most cases, this form will need to be re-designed to accommodate the increased number of codes associated with ICD-10.

Expert studies have suggested that a clini-cians productivity declines after moving to ICD-10. This could translate into fewer patients seen with an obvious decrease in generated revenue. This productivity decline is expected to extend to your internal coding staff, even experiencing staff turnover during the transition. Some coders may decide not to be recertified for ICD-10.

Cash flow dis-ruption can directly impact operations, as seen by many practices during the transition from HIPAA 4010 elec-tronic transactions to the 5010 version. Experts anticipate a greater disruption of cash-flow with ICD-10 as claims reject from one or more health plans. Contingency plans, such as setting aside cash or postponing large capital invest-ments should be drafted to ensure that you can meet the practice’s financial commitments to staff and vendors.

Although there

are many unknowns when it comes to how ICD-10 will affect physician practices, one thing is certain. The transition will come with associated costs. Being prepared, reviewing specific clinical and administra-tive workflows, technical infrastructure and staff requirements will provide you with the information to develop the budget and have the financial resources in place to minimize the impact. Talk with your account manager for more ideas and solutions to help you with ICD-10. ■

Cindy Hughes, CmPe, is a regional

Manager with aqreva. She is an active

member of the national Medical group

Management association.

Preparing a budget for ICD-10

5Janurary / February 2014 MidwestMedicalEdition.com

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p 605.335.4397 • f [email protected] • www.dtbsystems.com

• Nurse Call Systems• Synchronized Clock Systems• Low Voltage Specialists

News & NotesSouth Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

Happenings around the region

Midwest Medical Edition

AverA

Dr. Richard Honke of Avera St. Benedict Heat Center in Parkston is the recipient

of the golden Stethoscope Preceptor Award. Sponsored by the Rural Experiences for Health Professions Students program, the award was presented to coincide with National Rural Health Day on November 21. Dr. Honke was nominated by an SDSU pharmacy student and a USDSM medical student, both of whom participated in the REHPS four-week Summer Experience Program last summer.

The Avera Medical group Crofton recently presented

Crofton Community School’s Athletic Department with a $600 gift. The money for the donation was raised from the sports physicals Avera Medical Group Crofton offered over the summer.

Jamie Miller, nurse Practitioner, avera

Medical group Crofton, presents ann

Kramer, athletic director, Crofton

Community School, with gift of $600.

Home health and hospice services offered by Avera Creighton Hospital have unified into a single agency called Avera@Home. The first agencies to go live were the home health and hospice services in Mitchell, hospice services in Sioux Falls and homemaker services in Yankton. As each agency converts into the new company they will

also begin using a new Meditech software package specifically designed to manage home- and community-based services. Over the course of a six month period, 20 of Avera’s home health and hospice agencies will join Avera@Home.

BlAck Hills

Santa Claus delivered toys to hospitalized children in the Pediatrics Unit at Rapid City Regional Hospital (RCRH). Children of all ages received new toys from The Santa Fund and bears donated by Riddle’s Jewelry. The Santa Fund is a special RCRH Foundation fund that also helps pay for gifts at other times during the year for ill and injured children who are hospitalized at RCRH. Gift distribution took place on December 13.

Family Medicine physician Alexia gillen, DO joined the clinic staff of Regional Urgent Care. A Rapid City native, Dr.

Gillen has provided care in Rapid City since 2009 after graduating as chief resident of the Rapid City Regional Hospital Family Medicine Residency program. She completed her undergraduate and graduate coursework at the University of South Dakota in Vermillion, and received her medical degree at Des Moines University – Osteopathic Medical Center in Des Moines.

Valerie D. Stephens, MD, has been named the Physician of the Quarter for Customer Service Excellence at

Rapid City Regional Hospital (RCRH). Dr. Stephens is a board-certified gastroenterology physician at the Rapid City Medical Center. She has been a member of the Medical Staff at RCRH for eight years. “RCRH” says Dr. Stephens, “is a champion and leader in initiatives resulting in improved outcomes for patient care, and serves as a credible role model professionally and personally for patients, colleagues and other health professionals.”

sAnford

William Chad Spanos, MD, FACS, is among 1,622 physicians from around the world who became fellows of the American College of Surgeons (FACS) during the College’s annual Clinical Congress in October. Dr. Spanos received his MD from the University of Louisville Medical School and currently practices at Sanford Ear, Nose and Throat Clinic in Sioux Falls. He specializes in otolaryngology (head and neck surgery) and holds membership in several professional societies. Dr. Spanos is a fellow of the American Head and Neck Society and the American Academy of Otolaryngology – Head and Neck Surgery.

Dr. James Wallace, pediatric pulmonologist at Sanford Children’s Specialty Clinic, received the Friend

of Cystic Fibrosis Foundation Award at the Breath of Life Cystic Fibrosis Foundation gala. The award is given to an individual that excels at working to promote a cure for Cystic Fibrosis. The event took place in November in Minneapolis.

Stephanie Ziegler, BS, CCLS joined Sanford Aberdeen’s team of healthcare providers. As a Child Life Specialist, Ziegler ensures life remains as normal as possible for children as they spend time as patients at Sanford Aberdeen. Ziegler earned her Bachelor of Science in Human Development and Family Studies from Colorado State University, Fort Collins, CO. She went on to earn her Certified Child Life Specialist credential from the Child Life Council in 2011.

Becker’s Hospital Review named Sanford Health CEO Kelby K. Krabbenhoft as one of its 300 Hospital & Health System

Leaders to Know for 2013. This annual list recognizes men and women from a wide range of hospitals and health systems. Some have led their organizations for more than a decade, whereas others were appointed to their chief position within the past few months. The editorial team at Becker’s Hospital Review considers these men and women to be some of the most prominent healthcare executives to watch as healthcare reform unfolds.

6

Janurary / February 2014 MidwestMedicalEdition.com

Sanford Aberdeen celebrated National Rural Health Day in November with a themed lunch and tours of the medical center. With the theme “Celebrating the Power of Rural”, National Rural Health Day took place on or around November 21. Sanford Health is now the largest, rural, not-for-profit healthcare system in the nation with locations in 126 communities in nine states. The message of Rural Health Day is that rural hospitals and healthcare practices are the economic foundation of their communities. In addition to typically being the largest employers, these providers strengthen the economic health of their communities by ensuring a healthy workforce. National Rural Health Day was created in 2011 as a way to showcase rural America and increase awareness of rural health-related issues.

Edith Sanford Breast Cancer (ESBC) has announced its partnership with the Athena Breast Health Network to advance the use of a personalized breast cancer risk assessment. The innovative program includes a breast cancer risk assessment tool and a care plan for high-risk patients. Additionally, it will offer patients the opportunity to participate in research aimed at gaining a better understanding of breast cancer and its risk factors, ultimately raising the standard of care for women everywhere. Athena Breast Health Network is a collaboration among the five University of California medical centers. ESBC is its first partner outside of California and was selected because of its expertise in breast cancer genomics and its ability to integrate the risk assessment into patient care. As part of the new standard of care, prior to a breast screening (mammogram) appointment, Sanford Health patients will complete an Athena screening questionnaire online at home or in the clinic. Patients identified with an elevated risk will be referred to additional resources.

Sanford Health has joined with McKenzie County Healthcare Systems in Watford City, ND, to expand key medical services to western North Dakota. The collaboration will bring more specialty physicians to the community, expand air ambulance services and provide a new facility to support the healthcare needs of oil-producing companies. Visiting Sanford specialists will include cardiologists, orthopedic specialists and pediatricians. Other specialty services may be added depending on the need at a later date.

siouxlAnd

Proceeds from the 21st Annual Festival of Trees auction benefited the Siouxland Paramedics, Inc. Funds were used to purchase AutoPulse backboards for CPR assistance. AutoPulse allows rescuers to provide compressions while performing other lifesaving activities, resulting in the possibility of improved survival for cardiac arrest victims. The Festival of Trees has raised over $285,000 for local charities over the last 20 years. The event took place November 25 through December 5 at the Ho-Chunk Centre in Sioux City, Iowa. Highlights included live music, ballet, and an auction of donated items such as decorated holiday trees and wreaths. Charitable gifts of food and clothing were collected, which the Siouxland Paramedics distributed to people in need.

otHer

Dr. Henri Lanctin, specialist in adult and pediatric urology, has joined the Prairie Lakes Healthcare System medical

staff. Dr. Lanctin is board certified in Urology and has been practicing the specialty for the past 15 years in St. Cloud, MN. He received his medical degree from Dalhousie University in Halifax, Nova Scotia and completed his general surgery and urology residencies at the University of Ottawa in Ottawa, Ontario.

Pulmonologist Dr. Jeffrey Kowitz joined Prairie Lakes in conjunction with the opening of the region’s

first full-time clinic focused on pulmonology. The clinic opened in August. Dr. Kowitz has over 25 years of pulmonology experience and is board certified in Pulmonology and Internal Medicine. He also has extensive experience in critical care and sleep disorders. He received his medical degree from the University of Minnesota Medical School and completed both his internal medicine residency and pulmonology fellowship at the University of Wisconsin.

Emergency medicine physicians Dr. James Bear and Dr. Leighton Singh have joined the medical staff at Prairie Lakes Healthcare System in Watertown. Dr. Singh is board certified in Emergency Medicine. He received

his medical degree from the University of Missouri in Kansas City and completed his emergency medicine residency at the University of Nebraska in Omaha. Prior to joining Prairie Lakes, Dr. Singh was an emergency medicine staff physician in Sioux Falls. A Milbank native, Dr. Bear is board certified in Family Medicine. He received his medical degree from the University of Iowa Hospitals and Clinics in Iowa City and completed his family medicine residency in 1997 at the University of Minnesota in Minneapolis. Prior to joining Prairie Lakes, Dr. Bear was a family and emergency medicine physician in Alexandria, MN.

7

Playing a PRimaRy

The association of american Medical Colleges predicts that the country

will be 90,000 physicians short by

the year 2020.

“There are more and more requirements being put on Mds,

which is taking time away from caring for their patients.

This opens a whole market for Pas

and nPs to fill.”

–Jerry Schrier, Pa-C

Certified registered Nurse anesthetists like Jason Huber, CrNa, at Sanford medical Center, Fargo, are advanced practice nurses with graduate education and board certification in anesthesia. There are about 200 CrNas working in North Dakota and another 424 in South Dakota.

Six yeaRS ago Crystal Page, a certified Physician Assistant, was working in medical billing, thinking about her future in

healthcare, and noticing a trend.“I could see that the doctors around

me were always working and it seemed like the PAs had a little more time for their families,” says Page, who had wanted to be a pediatrician when she was in 4th grade. But, after she married while still in college, she decided that the faster track of a PA suited her better than medi-cal school. “PAs have a professional healthcare career just like MDs and Dos, but they always have someone to turn to when they have a question,” she says.

Today, Page is the one-and-only pro-vider at the Buffalo Regional Medical Clinic, a do-it-all primary care clinic

serving the 350 residents of Buffalo, South Dakota in the state’s Northwest corner, 85 miles from the nearest hospital. Page’s attending physician makes the 70-mile trek from Belle Fourche to visit the clinic every three months and the two have one-on-one contact once a month. Beyond that, with the exception of the clinic recep-tionist, Page is largely on her own.

“It is great to be a PA in a small town,” she says. “I think I see greater diversity of illnesses out here. A lot of people in my community are unwilling to travel, even if the weather just looks bad. So we kind of have to stay here and just figure it out.”

Many of the 227 other South Dakota PAs working in primary care – often in the state’s smallest communities – are undoubtedly doing the same thing.

Courtesy Sanford Courtesy Turbiville Photography


advanced Practitioners in a Changing Healthcare environment

By Alex Strauss

What’S in a name?Whether they are called Midlevel

Practitioners, Advanced Practice Providers (the term preferred by Sanford), Advanced Practice Clinicians (Regional’s choice), Advanced Practitioners, or simply ‘Midlevels’, there is no doubt that their role – both in primary and specialty care – is growing along with their numbers.

As of December 2013, there were 1651 APPs working in South Dakota – 530 Physi-cian Assistants and 1121 Advanced Practice Nurses, which include Nurse Practitioners (NPs), Certified Registered Nurse Anesthe-tists (CRNAs), Clinical Nurse Specialists (CNSs) and Certified Nurse Midwives (CNMs).

“The number of APPs is growing not only because the population is growing, but also because we can’t recruit physicians fast enough,” says Sanford’s Chief Medical

Officer Dan Heinemann, MD, president of the South Dakota State Medical Association.

A quick look at the numbers makes it clear why this is. The Association of American Medical Colleges predicts that the country will be 90,000 physicians short by the year 2020. Already, hospital executives are reporting a nationwide vacancy rate for clinical professions of 17.6 percent in 2013 – up from 10.7 percent just four years ago (Source: AMN Healthcare 2013 Clinical Workforce Survey). Physicians were reported to be the most difficult professionals to recruit, followed by nurses, nurse practitio-ners and physician assistants.

The shortage means that current physi-cians are often over-extended in terms of patient load. In addition, most are embroiled in trying to meet new guidelines and

demands that leave them even less time for patient care. In many clinics, APPs are help-ing to ease some of the burden by providing follow-up patient care, rounding on hospital patients, assisting in the office or the OR, taking patient phone calls, etc.

“The care of the future is going to be less about individual care and more about popu-lations or group care,” explains Heinemann. “As we transition from taking care of dis-ease to managing populations to maintain their health, there will still be a need to see a sore throat or a sprained ankle or a com-plex diabetic, but having members of the team who can take care of multiple levels of complexity will be very helpful.”

In many cases, APPs like Page make healthcare possible in places such as Buffalo where it might not otherwise be provided. It is increasingly difficult to recruit

PRimaRyRole

Staffed by one Pa and a receptionist, the Buffalo regional medical Clinic serves a town of about 350 people in Buffalo, SD, 85 miles from the nearest South Dakota hospital.

Crystal Page, Pa-C, is the sole practitioner at the Buffalo regional medical Center. “you have

to be willing to do it all,” she says.

Courtesy Turbiville Photography

9Janurary / February 2014 MidwestMedicaledition.com

physicians to work in communities that have no hospital.

SuPPoRting the teamFor Jerry Schrier, PA-C, healthcare is a

second career. The Sioux Falls PA left news-paper journalism after he found himself doing more managing than writing. Now at Avera Medical Group Nephrology, Schrier is one of the 145 South Dakota PAs working in a subspecialty area. By seeing complex dialysis patients on a regular basis, Schrier provides his 5 physician colleagues with the freedom to concentrate on more acute problems.

“The physician can only be in one spot at a time,” says Schrier. “But these dialysis patients have complex medical histories and issues that need frequent attention. These patients are labor intensive in terms of their medical needs and our nephrologists are very busy people. I see many of these patients three times a month.”

“What Jerry does for us is invaluable, on many levels,” says Schrier’s colleague, nephrologist Arvin Santos, MD. “We utilize

our midlevel the way we might use a resident. That is how we train them and they need to be on that level. Jerry has really become our right arm.”

Schrier says his relationship is slightly different with each of the five doctors he works with and, while he sometimes has to remind himself which doctor prefers which kind of support, he has no doubt about his value in the clinic.

“All of this is being driven by patient care,” says Schrier. “As healthcare changes, there are more and more requirements being put on MDs, which is taking time away from caring for their patients. This opens a whole market for PAs and NPs to fill. If you have a patient with a complicated medical history and they can be seen more often, that is a good thing. It’s all about frequency.”

The frequency of visits made possible by having a PA on staff is not just good for patients; It’s also good for business. With Schrier on board to see dialysis patients mul-tiple times a month, the clinic can meet the four-times-per-month level required by Medicare for maximum billing.

“Dialysis patients are chronically ill and on life-sustaining therapy,” says Dr. Santos. “You need to see them quite frequently because of how sick they are, but our practice is so busy that it is practically impossible for us to see them four times a month. Medicare allows us, as physicians, to see the patients at least once a month if a midlevel sees them the other three times. From a revenue standpoint, the difference between one visit and four visits is almost half of the maximum billing.”

getting alongWhile busy doctors like Santos welcome

the help of an APP – even calling him or her their “right hand” – not everyone is happy about the increasingly central role of mid-level providers in patient care. And, although Dr. Santos says relationships between physi-cians and midlevels are generally good, tensions do sometimes arise, especially in cases where the non-physician provider has more experience than the physician with whom he or she is working.

“For instance, nurses who become NPs tend to be very smart, very driven. Most have

The care of the future is going to be less about individual care and more about populations or group care. There will still be a need to see a sore throat or a sprained ankle or a complex diabetic, but having members of the team who can take care of multiple levels of complexity will be very helpful.

anita Wilson, NP, works in mercy medical Center’s Short Term Cardiology Unit in Sioux City.

as a Family medicine provider in Sanford Hartford Clinic in Hartford, South Dakota, Troy Van overbeke, Pa-C, may see multiple generations within the same family.

– Dan Heinemann, MD

Courtesy Mercy Medical Center Courtesy Sanford

Midwest Medical Edition 10

done specialty work,” says Santos. “They might say, ‘That’s not how we did things in the ICU.’ And that can rub a younger, more headstrong physician the wrong way. But I’d say that, 95% of the time, we all do really well together.”

“Some physicians are very adamant that they don’t want their patients treated by someone with less medical education than a physician. That’s one extreme,” says Larry Sellers, MD, an Internal Medicine physician at Mercy Medical Center in Sioux City, Iowa. Sellers and his partner have a part-time PA on whom they both rely.

“On the other end of the spectrum are physicians who want to hire as many mid-levels as the law will allow because they can double or triple the amount of revenue going through their office.”

“Most of us are somewhere in the middle,” he says.

Ultimately, both Sellers and Santos say that the keys to successful and patient-ben-efitting working relationships are mutual respect and trust. “If the trust isn’t there, the relationship is not going to work,” says

Santos. “My PA was a medic in Iran,” says Dr. Sellers, as an expression of the trust he puts in his own PA. “He saw a lot more trauma than I have ever seen in my life. So he is my go-to guy for that kind of thing.”

“There is always going to be some con-tention,” concedes Dr. Heinemann. “Some APPs say ‘We can replace primary care phy-sicians’ which can make physicians bristle.” But Heinemann says, in his experience, relationships between midlevels and physi-cians tend to be even better in the Plains states than they are elsewhere in the country, largely because of the needs in rural communities.”

“Physicians from the Midwest who know how critical APPs are to providing care, espe-cially in the rural communities, sometimes shake our heads with some of our ‘big city’ colleagues who say ‘Why are you letting them do that? They shouldn’t be doing that!’

Don’t tell that to a resourceful and inde-pendent PA like Crystal Page or to the residents of Buffalo who depend on her ser-vices. “Healthcare is just not growing as quickly as the population,” observes Page.

“We are growing and we are aging and some-one is going to have to pick up the slack.” As ICD-10 threatens to slow down productiv-ity in medical offices across the country, Page says she would not be surprised to see more people seeking care from midlevel providers in smaller clinics like hers, which may be able to offer perks like sooner appointments.

“The reality is that healthcare is going to be delivered, more and more, by non-physi-cians,” says Dr. Sellers. “As a profession, we can either stay committed to the belief that they are not as well-educated and can’t sort through the nuances and complexities at the same level as physicians. Or we can face reality and realize that they are critical to providing healthcare opportunities to our patients.”

“We know that their role is going to expand. We just don’t know exactly how,” agrees Heinemann. “I believe that APPs have a significant role to play in the future of team-based healthcare and physicians need to be open to working with them. There is no question that our patients are better served when we work together.” ■

ann gilbertson, CNm, provides gynecologic and obstetric care to women of childbearing age at Sanford Health Broadway Clinic in alexandria, minnesota. There are approximately 219 CNms practicing in minnesota and 31 in South Dakota.

Judy Bellanger-Dahl, Pa-C, practices in Sanford’s Perham Health Clinic, a large multi-specialty group that includes several aPPs in Perham, mN.

Courtesy Sanford Courtesy Sanford


MAKE-A-WISH RELEASES RESULTS OF NATIONAL IMPACT STUDYCaN a WiSH For a CHilD FaCiNg a liFe-THreaT-eNiNg meDiCal CoNDiTioN imPaCT THe CHilD’S HealTH STaTUS?

in July 2013, MaKe-a-wiSH concluded a national survey, which

included parents, volunteers and medical professionals. The final piece

was to interview former wish kids who are now adults to learn how

their wishes impacted them. The results of the survey suggest that

fulfilled wishes can empower children with life-threatening medical

conditions to fight harder against their illnesses. when they are granted

a wish, they get more than just a great experience for a day, two days,

or a week; The study results indicate that that experience can improve

their quality of life and that of their entire family.

adult former wish kids, wish parents, and attending health profes-

sionals agreed that a wish experience has the following impact on wish

kids’ health status:

• The wish experience can improve a wish kids’ physical health.

• a wish come true can mark a positive turning point in the child’s

battle for health.

• a wish come true makes kids feel stronger and more energetic.

• The wish experience helps them comply with difficult, but vital,

treatment regimens.

• in addition, a strong majority of adult former wish kids say that

the wish experience helped to save their lives.

• 83 percent of adult former wish kids say they experienced

improved physical health and strength.

• a combined 89 percent of nurses, doctors, social workers and

child life specialists surveyed say they believe the wish experi-

ence can influence wish kids’ physical health.

• 71 percent of adult former wish kids believe the wish experience

contributed to saving their lives.

• 97 percent of adult former wish kids say they experienced

improved mental and emotional health.

“i believe everyone would agree that wishes are nice for kids who are

sick, but now there is evidence that wishes do impact the status of a

child’s health,” says Paul Krueger, president and Ceo of Make-a-wish

South dakota. “These findings are significant and now more than ever,

we want to make sure that every eligible child in South dakota receives

a wish.” ■For more information about the national wish impact study, or to refer a child you are treating to make-a-Wish South Dakota, please call 605.335.8000 or 800.650.9198.

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By Dave Hewett, SDAHO

Preview of the 2014 SD Legislative Session

tHE 2014 SESSION of the South Dakota State Legislature has unofficially begun. The Gover-nor’s Budget Address last

month laid out the monetary parameters around which SDAHO’s messaging on the Budget will take shape. And then there are the other 500 bills that will likely emerge during the Session.

THis is wHaT is on our raDar THus farSome general information about healthcare costs and the directions healthcare delivery are taking in the near term and long term. The basic message is that healthcare’s cost curve is bending.

meDiCaiDSDAHO is grateful for the 3% update being proposed by the Governor. But for several of our members, we are still not back to pay-ment rates offered as far back as 2010.

Medicaid Eligibility Expansion: SDAHO continues to be a strong supporter of expan-sion. Expansion can take several forms and while the Association is not wedded to one particular model, the coverage plan must maximize federal payment for coverage and provide coverage for the entire affected popu-lation, i.e., individuals between 52% and 138% of poverty.

meDiCal SCHool eNrollmeNTThe Governor has proposed expanding class size in the Medical School by 11. SDAHO is supportive.

Other Legislation: This is a fluid list, which typically grows longer as more presentations are made. Initially we will be talking about legislation that would curtail many of the reforms made to healthcare delivery meant to moderate cost increases.

THe FeDeral SCeNeOn the Medicare “Doc Fix”, it appears that an outline for addressing the issue are coming together on a bi-partisan basis but the “pay-fors” have not yet been identified. Most are now saying that the Medicare Physician payment levels will be extended for yet another three months while a more compre-hensive package is assembled for this spring.

oNe oTHer PoiNT oF emPHaSiS The most important part of the legislative process is your participation. Typically, we have administrators, board members, and other staff contacting local legislators. Physicians, this is YOUR chance to connect with those legislators and tell them about healthcare delivery in their legislative dis-tricts. It also gives you a chance to establish or improve lines of communication during the session.

rememBer THe goalS oF aN eFFeCTiVe aDVoCaTe (1) A legislator will call you for advice on how to vote on a measure related to health-care and (2) When that legislator is speaking on the floor of the House or Senate or in Committee, he/she is doing so with your feedback in mind.

And so, the 2014 Session begins. As always, there are challenges ahead. It will be your active involvement in the Session that allows healthcare delivery and coverage to be addressed fairly and adequately over the next three months. ■Dave Hewett is President and Ceo of the

South dakota association of Healthcare

organizations.

MeD Quotes

“ It is not the mountain we conquer but ourselves.” — Edmund Hillary


WHEN DR. DAVID Schlesinger was five years old, his grandfather pulled

a coin out from behind his young ear and ignited a passion in his heart.

From then on, Schlesinger immersed himself in the science of perception and the art of illusion. He quickly started performing magic tricks and illusions, and even did

children’s birthday parties for a time.

Dr. Schlesinger is now a Fellowship-trained breast radiologist at the Breast

Health Institute at the Edith Sanford Cancer

Center and Assis-tant Clinical Professor of Radiology at the University of South Dakota School of Medi-

cine. He continues to collect, study and

occasionally perform magic tricks to the delight of his friends and family.

After all these years, Schlesinger says magic continues to inspire a sense of wonder in him. “I’m fasci-nated to learn the inner workings of each trick. There are only about 10 principles in all of magic. After that it’s just adaptations. It’s very neat to find out how these things are done. I marvel at the creative mind that creates each trick or illusion.”

Born and raised in Long Island, New York, Schlesinger and his family have lived in Sioux Falls for the last year-and-a-half. Between his work and keeping up with his busy two-year-old son, Schlesinger doesn’t have as much time to practice his magician skills these days. For now, his main magical pursuits include collecting and reading up on the latest illusions to stay current. But, when given the right moment with the right patient, Schlesinger says he occasionally does a quick magic trick to lessen anxiety during an appointment.

“I can take a bill of any denomina-tion, use a regular yellow wooden pencil and pierce the bill,” he explains. “Next, I rip the pencil

through the bill, but what you don’t know is the ripping noise is actually part of the illusion. I then fold the bill long-ways and appear to melt the pencil through it. At the end, I open up the bill and show that it’s still com-pletely whole.” He says he appreciates how a quick magic trick can give him an opportunity to break the ice and show his human side in an otherwise serious situation.

And yes–strange as it may sound, Dr. Schlesinger says he does see parallels between his profession and his hobby. “As a radiologist, my job requires a keen sense of perception so I can discern abnormalities. As a magician, I alter the audience’s per-ception and make them see something that really can’t happen.” “Magic is a visual art, and so is radi-ology. It’s looking at an image and perceiving what’s there, and then making a diagnosis. It’s not black and white. There are a lot of things that you have to let go of and accept as normal. You have to know what’s important and what’s not. In this way, there is an art to all of medicine in general.” ■

By Sarah McQuade

Now You See It, Now You Don’t

off HoursPassionate Pursuits outside the office

Sioux Falls Radiologist Explores the Art of Perception

Now You See It,


THE US DEPART-MENT of Veterans Affairs (VA) is pleased to announce the appointment of

Darwin G. Goodspeed as the new Director of the Sioux Falls VA Health Care System. Mr. Goodspeed has worked more than 16 years in healthcare leadership positions within VA, Department of Defense (DoD), and the private sector. He most recently served as Associate Director of the Louis Stokes Cleveland VA Medical Center and as Acting Director of the Chalmers P. Wylie Ambulatory Care Center, Columbus, Ohio.

Mr. Goodspeed holds graduate degrees in Management from Webster University, St.

Louis, Missouri; a Master in Business Administration from Southern New Hamp-shire College, Manchester, New Hampshire, a Master in Healthcare Administration from Baylor University, Waco, Texas and an undergraduate degree in Business Manage-ment/Information Systems from the University of Maryland, College Park, Mary-land. He is a Fellow of the American College of Healthcare Executives.

“We are excited to bring Mr. Goodspeed on board as the new Director of the Sioux Falls VA Health Care System,” said Ms. Janet Murphy, Veterans Integrated Service Network (VISN 23) Director. “His sound leadership qualities and proven experience will be valu-able assets for the healthcare system, the

employees, volunteers, and most importantly, for the Veterans we are honored to serve.”

The Sioux Falls VA Health Care System provides healthcare to approximately 29,000 Veterans in South Dakota, southwestern Minnesota and northwestern Iowa, The healthcare system is a teaching hospital providing a full range of patient care services with state-of-the-art technology, as well as education and research, a community living center and five community-based outpatient clinics. Comprehensive healthcare is pro-vided through primary and long-term care in areas of medicine, surgery, psychiatry, physical medicine and rehabilitation, neurol-ogy, oncology, dentistry, geriatrics, and extended care. ■

VA Appoints New Director for Sioux Falls

15Janurary / February 2014 MidwestMedicaledition.com

The Prairie lakes cardiac cath lab team includes: Salem Maaliki, Md; Jennifer Jones, Md; evelio garcia, Md; leah le, rn, cath lab director; becki Jarabek, CvT; Jacklyn Karli, rn; Sheila voelsch, rn; Megan Flemming, rn; and Haley ellis, rn.

Prairie Lakes Receives ToP HoNoRS for Heart Attack CarePRAIRIE LAKES HEALTH-CARE System has received the American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Platinum Per-formance Achievement Award for 2013. It was one of only 197 hos-pitals nationwide to do so. The award signifies that Prairie Lakes has reached an aggressive goal of treating these heart attack patients according to standard levels of care as outlined by the American College of Cardiology/American Heart Association (ACC/AHA) clinical guidelines and recommendations.

To earn the award, Prairie Lakes consistently followed the treatment guidelines in the ACTION Registry–GWTG Pre-mier for 8 consecutive quarters and met a performance standard of 90% for specific performance mea-sures. Following these treatment

guidelines improves adherence to ACC/AHA Clinical Guideline rec-ommendations, monitors drug safety, and enhances the overall quality of care provided to ST-elevation myocardial infarction (STEMI) and non-STEMI patients.

“The time is right for Prairie Lakes to be focused on improving the quality of cardiovascular care by implementing ACTION Regis-try–GWTG,” said Prairie Lakes Cath Lab Director Leah Le. “The number of acute myocardial infarc-tion patients eligible for treatment is expected to grow over the next decade due to increasing incidence of heart disease and a large aging population.”

ACTION Registry-GWTG empowers healthcare provider teams to consistently treat heart attack patients according to the most current, science-based guide-lines and establishes a national

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GranT HaS BlaCK HillS CarDioVaSCUlar

reSearCH SeeKing PaTienTS For HearT aTTaCK STudyBLACK HILLS CARDIOVASCULAR RESEARCH (BHCR) has received a $390,500 grant from drug company AstraZeneca, enabling BHCR to seek participants for a clinical research study called RELATE.

The objective of RELATE is to compare the antiplatelet effects of two platelet inhibitors, ticagrelor and clopidogrel, in American Indians who have had a heart attack at least one year ago and are on a low dose of aspirin. RELATE will explore the platelet inhibiting effects of ticagrelor and clopidogrel in patients with stable coronary artery disease, specifically looking at day one and day seven platelet inhibiting effects.

James S. Walder, MD, FACC, Cardiologist and the Principal Investigator for the study explains, “Since we now know that drugs work differently in the body based on one’s genet-ics, medicine is now being studied in certain ethnic groups (Japanese, Hispanic/Latino, African-American). Roger DeRaad, CNP and our Director of Research at BHCR, wrote this research study to include another important ethnic group in our Black Hills community, the Native American population.”

Eligible study participants must be Native Americans, 18 years or older, with documented stable coronary artery disease and be taking 75-100 mg of aspirin daily. To refer a patient, contact Franco Garcia, BHCR Clinical Research Coordinator, at (605) 718-6296 for more information. A link to more information on all Regional Health research studies can be found on the MED website at www.MidwestMedicalEdition.com. ■

standard for understanding and improving the quality, safety and outcomes of care pro-vided for patients with coronary artery disease, specifically high-risk STEMI and NSTEMI patients.

“The American College of Cardiology Foundation and the American Heart Asso-ciation commend Prairie Lakes Healthcare System for its success in implementing standards of care and protocols,” stated James Jollis, MD, FACC, ACTION Regis-try-GWTG Chair and Professor of Medicine and Radiology at Duke University Hospital. “The full implementation of acute and secondary prevention guideline-recom-mended therapy is a critical step in saving the lives and improving outcomes of heart attack patients.”

ACTION Registry–GWTG is a partner-ship between the American College of Cardiology Foundation and the American Heart Association with partnering support from the American College of Emergency Physicians and the Society of Cardiovascular Patient Care. ■

leah le, Cath lab director at Prairie lakes Healthcare System, accepted an american College of Cardiology Foundation’s nCdr aCTion registry–gwTg Platinum Performance achievement award at the 2013 american Heart association Scientific Sessions on november 18 in dallas, Texas.

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605.906.1272


Sanford Health to run Pediatric Clinic in

Kunming, ChinaSANFORD HEALTH HAS announced a new collaboration with a healthcare system in the rapidly growing city of Kunming, China as part of its World Clinics initiative. Sanford and YMCI Calmette Medical Investment & Management Company, Ltd., a state-owned company of the Yunnan Provincial government, plan to develop a pediatric clinic.

With a population of more than 6 million, Kunming is the political, economic, com-munications, and cultural hub of Yunnan and the seat of the provincial government. North-ern Kunming is experiencing tremendous growth and has a significant need for primary care for children. Currently, northern Kun-ming has 60 kindergartens, 30 primary schools and 11 middle schools.

The new two-story, 18,000-square-foot Sanford World Clinic in Kunming will have the capacity to hold up to 10 primary care

pediatric physicians. YMCI Calmette may also utilize the clinic for rotating pediatric sub-specialists.

YMCI Calmette currently operates the non-profit First Hospital of Kunming, which was established in 1914 and is rated as one of the top 100 hospitals in China. YMCI Calmette is developing a new 1,100-bed hospital complex in the northern part of Kunming, which also will include a consolidated and expanded out-patient pediatric clinic in collaboration with Sanford. The hospital and clinic are expected to open in the spring of 2014.

Under the new agreement, YMCI Calmette will own the pediatric clinic, and Sanford World Clinics will manage the day-to-day operation as well as provision of medical services. The children’s clinic will also have connection to Sanford Health’s extensive clinical, research and administra-tive expertise in South Dakota.

“The decision to expand into China stems from our goal to expand healthcare services to areas of need, especially where children need healthcare,” said Dave Link, Sanford’s senior executive vice president. “This clinic also allows us to better understand how healthcare is delivered and financed around the world.”

The connection to Kunming and YMCI Calmette was made possible through Zhi-guang Guo, PhD, a research scientist with Sanford who previously worked with YMCI Calmette physicians.

In addition to the planned clinic for Kun-ming, Sanford World Clinics has opened facilities domestically in Oklahoma, Cali-fornia and Oregon and has developed four international clinics in Ghana, Africa. San-ford also is pursuing projects in Israel and Mexico and is evaluating several other locations worldwide. ■

Sanford Health executives broker a deal with Chinese company to provide pediatric care in rapidly-growing Kunming.


Mercy Installs New MRI ScannerMERCY MEDICAL CENTER-Sioux City, Siouxland’s only Joint Commission-accredited Stroke Center, is ready to begin using its newly-installed 3.0 Tesla (3T) Magnetic Resonance Imaging Scanner. The new replacement unit and renovation are the result of a $3 million dollar investment in imaging services at Mercy.

The 3T MRI meets the high-resolution requirements of acute brain and neurovascular imaging. Emerging clinical evidence indicates perfusion imaging, diffusion tensor imaging, and MR spectroscopy are all enhanced by 3T MRI. In addition, the area’s most powerful MRI will allow Mercy to perform breast MRIs, cardiac MRIs, abdomi-nal MRI/MRA and services to bariatric patients.

Mercy’s Director of Radiology, Barb Black, says the investment will pay off for patients who might otherwise have travelled outside the region for such high-end imaging services. Mercy staff will receive onsite training and expect to be using the new MRI by January 13. ■

MeD Quotes

“ Here’s good advice for practice: go into partner-ship with nature; she does more than half the work and asks none of the fee.” — Martin H. Fischer


Perks for Motivating Your office Staff

Happy, hardworking employees are a cor-nerstone to practice success. A smiling recep-

tionist makes patients feel welcome. A cheerful attitude creates a positive team atmosphere that improves efficiency in completing daily tasks. A motivated team can improve patient satisfaction, produc-tivity, and employee retention.

But there is no “silver bullet” for motiva-tion. One employee may be motivated by a flexible work schedule while another may value public recognition for a job well done. The good news is that the basic principle for designing motivational perks that work is simple: Ask your employees what they want, and design ways for them to earn it. Here are two ideas to start the conversation.

reTHiNK WorK SCHeDUleS

Many employees appreciate the option of varied hours, flex time, or time off as a reward for good performance. This flexibility can be particularly motivating to Generation Y and those with working spouses or part-ners — the latter often prefer more time off instead of an increase in pay. Consider giving employees the opportunity to work longer days and shorter weeks, work part of their day during nontraditional office hours (such as 6 a.m. to 2 p.m.), take additional days off when physicians are on vacation, or work from home if it makes sense for their job role. If your flexible hours include evenings or weekends, you may discover that this ben-efits more than just employees. Many practices find that offering “non-traditional” hours is a competitive advantage that attracts new patients and revenue.

aSK For iNPUT, NoT FeeDBaCK

They are not the same thing. Including staff in EHR selection is more empowering than asking for feedback on the final two systems you’re considering. Shared

decision-making indicates that physicians and managers value employee opinions and expertise, and this pays big dividends in employee morale.

Include employees on committees or advisory boards. Allowing them to help design policies and programs that affect them builds a culture of trust and mutual respect. Many managers find adding employees to the practice’s advisory board for employee benefits selection was a big win.

aCCeNTUaTe THe PoSiTiVe

It takes a village to run a practice, but patient compliments about staff or the prac-tice aren’t always passed on after the physician hears them. Let “the village” hear them by sharing and celebrating the compli-ment. Even the most humble among us appreciates a pat on the back — especially

when it’s given in front of coworkers. A busy dermatologist in Massachusetts created a “Share the Limelight” initiative. Patients’ words of affirmation are shared with the practice in an effort to recognize and moti-vate staff. The initiative has created a positive buzz, and the physician insists that the weekly affirmations help staff recognize that patients care as much about them as they do about the providers — a big morale boost for everyone. ■

This article was provided by aqreva and was reprinted by permission. There is more where these ideas came from. visit the Med website for additional proven staff-motivating perks from aqreva.

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

Relax.Discover solutions thatput you at ease.


oPEN ANY CONSUMER MAGAZINE, turn on any talk show, or peruse any health-related website, and you’ll encounter an endless barrage of diet ideas. As a physician, it can be hard to convince patients that these

aren’t always the best plans of attack for a healthy lifestyle.On the whole, the diets of the American population need to improve.

Current Opinion in Cardiology reported that coronary heart disease mortality rates in seven countries show that the rate of death and cho-lesterol levels of Americans is second only to Northern Europe. According to the World Health Organization, 2.7 million deaths are attributable to diets low in fruits and vegetables. These statistics indicate how vital it is for us as physicians to encourage our cardiac patients to find the right diet.

Research indicates that one healthy way for patients to eat a cardiac-healthy diet is by following the Mediterranean Diet. This diet consists primarily of plant-based foods, including fruits, vegetables and whole grains. These foods are high in phytochemicals, low in calories, and associated with low risk of CVD. Fish and seafood are also prominent in Mediterranean cuisine instead of the red meat that is found in most American diets.

Eating meals with omega 3 fatty acids offer several benefits. These foods can have anti-arrhythmic, anti-thrombotic and anti-inflammatory effects. They have also been found to lower triglycerides, lower blood pressure, and are associated with reduced risk of CVD and sudden death. Meals included switching butter for the healthier option of olive oil. Red wine is also prevalent in a Mediterranean diet. Being high in phenolic antioxidants, red wine can raise HDL, inhibit platelet aggrega-tion and is associated with a reduced risk of CVD.

This change in diet has been shown to have positive benefits for a patient’s heart health. A 2011 study in the American Journal of Clinical Nutrition1 determined that the consumption of a Mediterranean diet induced the reduction of endothelial damage and dysfunction, which is associated with an improvement in the regenerative capacity of the endothelium. ■

Dr. Kelly Steffen is a Cardiologist with Sanford Heart Hospital.

By Kelly Steffen, DO

encouraging patients to develop a better diet

Food for a HealthyHeart

1 Marin, C, et al, “Mediterranean diet reduces endothelial damage and improves the regenerative

capacity of endothelium”, February 2011, american Journal of Clinical nutrition, pp. 267-74.

Janurary / February 2014 21MidwestMedicalEdition.com

For tickets & sponsorship information, call 605-360-2542.

Raise your voice at GoRedForWomen.org

2014 Sioux FallsGo Red For Women® Luncheon

Friday, Feb. 21Sioux Falls Convention Center

11 am - 11:30 am Silent Auction

Social Hour • Health Fair

11:30 am - 1 pm Luncheon

Keynote Speaker Dee Dee Raap: “Follow Your Heart”

Survivors and Go Red Challenge Participants

share their life-changing journey toward a heart-healthy lifestyle

locally sponsored by

WOMEN GO REDWear Red. Speak Red.

Heart disease is no match for the power of women’s voices.

©2013, American Heart Association. Also known as the Heart Fund. TM Go Red trademark of AHA, Red Dress trademark of DHHS.

2014 SFalls GRL Ad 3.4x9.375.indd 1 12/16/2013 4:33:46 PM

The nurses’ Stationnursing news from around the region

The South dakota nursing workforce

aT a GlancE• There were 16,852 licensed

nursing professionals in 2011

• average annual salary is

$55,710

• an anticipated shortfall between

the number of available nurses

and the demand for nursing

professionals of almost

23 percent is expected

in 2020.

• at $26.78 per hour, South

dakota is at the bottom of the ten

lowest paying states according to

the bureau of labor Statistics.

• South dakota follows a statewide

articulation plan, assisting nurses

with more flexibility and regard-

ing their education for advanced

degrees.

(Source: Education Career Articles)

Darling Crow, rN, recently received a DAISY AwARD for Extraordinary Nurses at Rapid City Regional Hospital (RCRH) . Crow has worked in the Oncology Department for

three years. | Crow was nominated for the award by a patient’s

family who wrote, “At the end of our mother’s life, an angel

was sent to us.” The nomination described Crow as “patient and

sincere” and considerate of the family’s needs. Crow was said

to have gone out of her way to make sure the family was aware

of what they needed to do when they took their mother home. “Darling was an awesome

example of what a true RN should be,” the family said. ■

DAISY AwARDS

Sanford recently awarded its first DAISY Team award. The prize went to

(pictured)

bili dizdarevic, PCT,

Cheryl Haack, rn Case Manager,

dr. Terri Peterson Henry,

Connie bryne olson –

Mental Health Counselor,

deb Springer, rn.

MeD Quotes

“ What lies behind us and what lies before us are tiny matters compared to what lies within us.” — Ralph Waldo Emerson

Team award winners not pictured include Tammy Krogh, rn, yvonne nies, rn,

Jo wehde, rn, Michelle Mehlhaff, PCT, elizabeth Toomajian, CnP.

The largest-ever study of American nurses, the Harvard

Nurses Health Study, finds that being

obese can be hard on hearing. Surveys of

the 68,000 nurses in the study found that

those who were significantly overweight

– especially if the weight was carried

around their middle – were the most likely

to experience hearing loss. The findings

were reported in December.


February 10th and 11th will mark the 39th Annual ‘Nurses Day’ at the South dakota State legislature in Pierre.

The South dakota nurses association, the professional association representing the nearly 15,000

rns across the state, urges nurses to attend the event and have a voice in helping to shape public

healthcare policy consistent with the goals of nurses and the nursing profession. The event takes

place at the Capitol building and the ramkota Hotel and Convention Center. ■

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“ USF provided me with great insight into developing, implementing and executing patient-

centered, value-based healthcare initiatives.”

Kathy Schuler, MBA Healthcare Management

Vice President, Heart & Vascular and Surgical Services Sanford Medical Center

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■ IV Therapy■ Respiratory Treatments■ Isolation

■ Ventilator Management■ Medication Administration

Children’s Care offers 24-hour nursing care and the followingservices for your patients of all abilities from birth through age 21:

For details, call (605) 444-9556.

grape expectations

By Heather Taylor Boysen

Resolve to Take Stock of The wine “Cellar”

I LOVE THE MONTH of January. Many might ask why since it is bit-terly cold with too much snow on the ground and a lot of shoveling and

de-icing going on. I love January because it is quiet. The hustle and bustle of the holidays is behind us and it just feels as if you can take a deep breath and relax.

January is also a month for taking stock and creating resolutions. January is a great month to purge closets, clean cupboards and organize my entire household. The first place I will start organizing is my wine cellar. You might think I have an extensive wine collec-tion and cellar because I own a wine shop, but I don’t. I have some lovely wine that perhaps I’m not quite ready to drink or because I’m saving it for a special occasion, but my collection is small compared to a lot of folks I know who collect wine.

My most prized possessions in the cellar are actually two magnum bottles of Chimney Rock Reserve Cabernet in the vintage years of 2003 and 2004, the birth years of my children. My husband and I purchased them on a trip to California in 2007 in the hopes that we would open them on a special occa-sion with our children perhaps, for a 21st birthday or a wedding. We chose the large format bottles because this size actually ages

better long-term and we knew these bottles needed to cellar for at least 18 years.

I live in an older home and we have a perfect room in our basement to store wine. If you plan on cellaring or aging wine for any amount of time, storage conditions are vital for making sure your wines are living in the best environment for their well-being. Heat is enemy number one to aging wine. Our “cellar” is actually a storage closet with cinderblock walls and a cement floor. It is the Northeast corner of our home and stays cool year round. We don’t need any fancy equipment to keep the temp less than 65 degrees, which is important. Wine should be cellared at around 55 to 65 degrees. Extreme temperature fluctuations will kill a wine very quickly.

While humidity is needed to keeps corks from drying out over a long time, so many wines are being closed under screw cap to avoid cork taint, that it is possible to store wines upright with no increase in humidity for storage. I find it easier to lay everything down for ease of storage, but it no longer is a must unless there is a cork closure.

Since many wines produced today are meant to be consumed almost immediately and do not need long term storage to reach their full potential, I take stock of what is in our cellar every January. There may be people who disagree with me, but I find that 5 to 8 years out of vintage date is a good place to start when looking at what wines you need to start drinking before they start to diminish in flavor and aroma. If you do not know how long a wine can be stored, please consider contacting the winery directly to ask. It may take a little bit of time, but I’ve found email

to be valuable in this instance!My Chimney Rock Reserve Cabernet will

stay on the “do not drink” shelves in my cellar, obviously, but most of the wine I have from 2006 to 2009 will probably get moved to the “drink now drink soon” shelves. When I buy wine to lay down for a period of time I usually buy at least 6 bottles so if I move them to drink now status and find that they could still stand a little time, then I’ll move them back to hold status. If the same wine has started to diminish in flavor, they get added to the “drink fast” shelf, which is in my kitchen.

However you cellar or store your wine, consider January as the month to take inven-tory and determine what you have in your collection. Wine is meant to be consumed and leaving it on a shelf in a cellar to waste away is certainly not what anyone ever intends for those favorite bottles. ■


Med reaches more than 5000 doctors and other healthcare professionals across

our region 8 times a year. if you know of an upcoming class, seminar, webinar,

or other educational event in the region in which these clinicians may want to

participate, help us share it in Med. Send your submissions for the learning

opportunities calendar to the editor at [email protected].

learning opportunities

January / February

February 5 – 6 8:00 am – 5:00 pmFundamental Critical Care Support ProgramLocation: Avera McKennan Hospital

Information: 605-322-8950

February 10CPR for Healthcare Providers6:00 pm – 10:00 pmAvera McKennan School of EMS, Sioux Falls


March 278:00 am – 5:00 pmAvera Transplant Institute SymposiumLocation: Prairie Center, Avera McKennan

Information: [email protected]

Registration: 605-322-8950, www.Avera.org/conferences

April 48:00 am – 6:30 pmSanford Pancreatico-Biliary Symposium, Making Pancreatic Cancer HistoryLocation: Sanford USD Medical Center,

Schroeder Auditorium


[email protected]

April 58:00 am – 6:30 pmSanford GI Symposium, Current Trend in GILocation: Sanford Center, Dakota Room 2130


[email protected]

April 87:30 am – 5:00 pmPediatric Trauma SymposiumLocation: Sanford Center, Dakota Room

Information: Sanfordheart.org/ClassesandEvents

April 167:30 am – 4:00 pm.22nd Annual Avera Trauma SymposiumLocation: Sioux Falls Convention Center

Information: [email protected]

Registration: 605-322-8950, www.Avera.org/conferences

April 25 – 26Friday 3:45 pm – Saturday 5:00 pm13th Annual Sanford POWER Strength & Conditioning ClinicLocation: Sanford Fieldhouse


Registration: Sanfordhealth.org/forms/PowerStrengthCon-

ditioning

May 2 – 37:00 am – 5:15 pm8th Annual Sanford Sports Medicine SymposiumLocation: Best Western Ramkota Hotel, Sioux Falls


[email protected]

May 98:00 a – 6:00 pm19th Annual North Central Heart Vascular SymposiumLocation: Sioux Falls Convention Center

Information & Registration: 605-977-5311

www.Avera.org/conferences

Midwest Medical ediTion .com

200-46660-0115 11/13

Sanford Metabolic and Bariatric Surgery Program

If you have patients who have struggled with weight, we can help them improve their health once and for all.

Our comprehensive, multidisciplinary program offers: • Extensive experience – more than

5,000 procedures in 35 years. • Documented results – 60-80% of excess

weight loss two years after operation • Proven excellence – Bariatric Surgery Special Quality Award

from The Joint Commission – Blue Distinction Center for Bariatric Surgery®

– Bariatric Surgery Center of Excellence by Optum Healthcare Solutions

Helping your patients lose weight and regain their health.

Call us at (605) 328-3840 to refer a patient.

sanfordhealth.org

Dennis Glatt, MD

CurtisPeery, MD

54.5%saw a reduction or omission of obstructive sleep apnea

63.6%saw a reduction or resolution of Gastroesophageal Reflux Disease (GERD)

saw an improvement or resolution of diabetes

75%

saw a reduction or resolution of hyperlipidemia

saw an improvement or resolution of hypertension

84.6%

saw a reduction or resolution of one or more health problems

90.9%

Sanford Metabolic & Bariatric Surgical Program, Metabolic & Bariatric Surgery Accreditation & Quality Program (MBSAQIP) Database , March 2012-June 2013.

83.3%

med-midwest medical edition-jan/feb 2014

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