med-midwest medical edition-june 2015
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JUN
E 2
015
Vol. 6 No. 4
SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE FOR PHYSICIANS & HEALTHCARE PROFESSIONALS
NEPAL to Rapid City . . . and Back
From
CAN YOU SPOT Drug-Seeking Behavior?
Planning for a Tech Disaster
Intergrative Therapies
FOR VETERANS
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Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.
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Cardiology & Heart Surgery
MEDAd, May 2015.indd 1 4/30/15 1:59 PM
MIDWEST MEDICAL EDITION
VOLUME 6, NO. 4 ■ JUNE 2015
Contents
page 12
The Black Hills of South Dakota are a long way from the mountains of Nepal. But
for the 12 Nepali doctors who work at Rapid City Regional
Hospital, the area has come to feel almost like home. Now, in the wake of Nepal’s devastat-ing earthquake on April 25th, some of them are making the
long journey back again to help their homeland recover.
JUN
E 2
015
Vol. 6 No. 4
SOUTH DAKOTA AND THE UPPER MIDWEST’S MAGAZINE
FOR PHYSICIANS & HEALTHCARE PROFESSIONALS
NEPAL to Rapid City and Back
From
CAN YOU SPOT Drug-Seeking Behavior
Planning for a
Tech DisasterIntergrative
Therapies FOR VETERANS
REGULAR FEATURES 4 | From Us to You
5 | MED on the Web Articles and Information available exclusively on the MED Website
8 | News & Notes New doctors & facilities, awards, renovations, and other news from around the region
28 | The Nurses Station Best states for nurses, an historic gradation, honors for nursing leaders
31 | Learning Opportunities A Spring full of Conferences, Events, and CME Courses
IN THIS ISSUE 6 | Surviving a HIPAA Audit
■ By Marie Ruettgers A step by step protocol for weathering a HIPAA audit.
21 | Prairie Lakes Healthcare Now Using New Heart Failure Monitoring Solution
22 | Functional Job Descriptions ■ By Kelly Marshall How functional job descriptions help keep employers on the cutting edge and out of court
24 | New Marfan Syndrome Clinic in Omaha Raising Awareness and Saving Lives
25 | Understanding the Physician Sunshine Act ■ By Heather Springer How will new rules about public disclosure impact your business?
26 | Palliative Care Helps Fill Service Gap for the Chronically Ill
27 | Avera’s Coordinated Care Model Earns National Recognition
29 | Sanford/IBM Partnership will Advance Cancer Genomics
By Alex Strauss
COVER
On the
16 New Integrative Health Therapies at the Sioux Falls VA ■ By Shirley Redmond The VA’s new concentration on self-care aims to empower veterans.
18 Planning for a Tech Disaster ■ By Jill Heyden
20 WANT vs. NEED Recognizing drug diversion in the Emergency Department What you need to know to protect yourself and your patients from drug-seeking behavior.
■ By Trish Lugtu
NEPAL toRapid City . . . and Back
From
ON THE COVER: Rapid City Regional Hospital Hospitalists Shailesh Thapa, MD, left, and Kanchan Karki, MD, right, are among 12 Nepali physicians employed by Regional Health who were impacted by the recent earthquake in Nepal. Both physicians have family in Kathmandu who were not injured. Dr. Thapa shows photos of he and his wife. Dr. Thapa’s wife and young son were visiting family during the earthquake and stayed in a tent on the outskirts of Kathmandu following the earthquake. Dr. Karki’s mother, in the photo she is holding, resides in Kathmandu.
Midwest Medical Edition 4
PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota
VICE PRESIDENT
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EDITOR IN CHIEF Alex Strauss
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CONTRIBUTING
WRITERS Jill Heyden
Trish Lugtu
Kelly Marshall
Shirley Redmond
Marie Ruettgers
Heather Springer
STAFF WRITERS Liz Boyd
Caroline Chenault
John Knies
IT HAS BEEN A BUSY SPRING GROWING SEASON for us here at
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But first… This issue of MED is jam-packed with content we hope you’ll
find interesting, informative, and valuable. In our cover story, the surprising
Rapid City/Nepal connection and how it is helping that country recover
from disaster.
Plus… From writing legally-sound job descriptions, to facing a tech
disaster or a HIPAA audit, to understanding the Physician Sunshine Act, our
team of expert local contributors have you covered. You’ll also find all the
medical community news in these pages. Don’t forget that you can stay on
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Cheers,
—Steff and Alex
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From Us to YouStaying in Touch with MED
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Here are some of the new articles available only online…
New Urgent Care for SiouxlandA new orthopaedic urgent care facility is opening in Dakota Dunes.
Video Visits Get National AttentionSanford Health’s effort to connect providers with patients using video technology
has earned the health system a place on InformationWeek’s Elite 100 List.
Making Credentialing Easier We have expert tips to help make this major undertaking a little easier.
High Tech Wheelchairs in Sioux CitySee the advanced new wheelchair technology made
possible by the Mercy Foundation.
Midwest Medical Edition 6
THE DEPARTMENT OF Health and Human Services, Office of Civil Rights (“OCR”) will soon issue HIPAA audit notices to
a small number of both covered entities and business associates who handle protected health information. To para-phrase Paul Revere, “The audits are coming, the audits are coming!”
The first step to surviving a HIPAA audit is, obviously, advance preparation.
THE AUDIT PROCESSPhase 2 of OCR’s Audit Program was scheduled to start in the fall of 2014 and run through June 2015, but has been delayed and is expected to start as early as the fall of 2015.
Audits will be desk reviews using the OCR’s preparation protocol, found at http://www.hhs.gov/ocr/privacy/hipaa/enforcement/audit/protocol.html. Use this as an outline to help prepare for an audit. Both covered entities and business associates are subject to audits. A covered entity or business associate that receives an audit notice will have just two weeks to respond with the documentation requested.
With only two weeks to gather and submit the requested information, the time to prepare for an audit is not when the audit notification arrives. How should you start preparations? Start with the OCR’s prepara-tion protocol and organize your preparation into three key areas: Security, Privacy and Breach.
SECURITYThe Security module has at its primary focuses protected health information (PHI) contained in Electronic Medical Records (EMR), and measures that must be taken to ensure the confidentiality, integrity and security of EMRs. OCR provides useful checklists for Security that correlate to the three subcategories at http://www.ihs.gov/hipaa/documents/IHS_HIPAA_Security_Checklist.pdf.
Start with the following steps, and work through the audit protocol
● Confirm your organization has recently completed a Risk Assessment of potential security risks and vulnerabilities.
● Confirm that the action items identified in the Risk Assessment either have been completed or are on a reasonable timeline to achieve completion.
● Confirm an IT asset inventory system is in place and up to date, including all BYODs.
● Confirm a facility security plan has been adopted and is in place for each physical location with access to PHI.
● Review the security plan to identify gaps in physical security plans, disaster recovery plans, as well as emergency access procedures.
● Ensure all staff is routinely trained on policies relevant to their positions.
PRIVACYThe Privacy module audit procedure will focus on the protection of medical records and other PHI, including:
1. Notice of privacy practices for PHI,
2. Rights to request privacy protection for PHI,
3. Access of individuals to PHI,
4. Administrative requirements,
5. Uses and disclosures of PHI,
6. Amendment of PHI, and
7. Accounting of disclosures.
Start with the following common deficits identified in Phase 1 audits and work through the protocol:
● Ensure a complaint Notice of Privacy Practices is in place, and conduct periodic reviews to confirm employees are operating consistently with the stated notice.
● Confirm a complete listing of Business Associates exists and that each has an Agreement that limits the use and disclosure of PHI to that allowed by the standards and for specified purposes within those standards.
● Know and understand when the use of a consent versus a specific authorization is required, and document policies that indicate appropriate use.
Marie Ruettgers is Managing
Attorney at Goosmann Law Firm.
Surviving a HIPAA AuditBy Marie Ruettgers
To read Ruettgers’ advice for the third and final area of preparation, “Breach”, see the full version of this article on our website.
Beckenhauer Construction has been providing high quality construction service to its clients for 137 years and counting. Beckenhauer Construction is a family owned general contracting firm specializing in healthcare construction and is now being directed by the fifth generation of family ownership.
Safety of the staff, the patients, visitors, and crews is always at the top of our list to control. We do so by continual training, monitoring, providing the best of equipment to assist us, and constant communication with the client so they are awary of our every move. We go above and constant communication with the client so they are awary of our every move. We go above and beyond the industry standard requirements when it comes to protecting employees, client staff, patients, and visitors. If you are not already one of Beckenhauer Construction’s clients we urge you to visit with any of our past or current clients to see what they have to say about doing business “The Beckenhauer Way”.
AVERA
Avera Medical Group Kennebec Area Clinic is now a Federally
Qualified Health Center. Created in 1991 under federal law, FQHCs are “safety net” healthcare providers that charge for services on a sliding-fee scale based on family income and size, and provide services to all regardless of their ability to pay or health insurance status. The clinic is part of a collaborative effort between Rural Health Care, Inc. and Avera which began with the Dakota Family Medical Center in Chamberlain, SD.
Jeanette Pederson, OT, Occupational Therapist at Avera McKennan Hospital & University
Health Center, has been named
USD Occupational Therapy Fieldwork Clinical Educator of the Year. Pederson has been an occupational therapist at Avera McKennan for 20 years. She graduated from North Dakota State University with a degree in psychology, and from the University of North Dakota with a degree in Occupational Therapy. She works in acute care and provides staff training for the electronic medical record system.
Avera Prince of Peace Retirement Community in Sioux Falls celebrated the grand opening of its new addition with a public open
house on May 17th. The two-story, 117,000-square-foot addition is the largest long-term care construction project in the history of South Dakota. It houses 90 beds – 64 in long-term care, 26 in rehabilitation, and 20 additional assisted living suites. Avera Prince of Peace also has 32 existing assisted living apartments as well as independent living apartments. The rest of the existing building will be repurposed.
Advanced Physical Therapy has joined Avera Queen of Peace Hospital in Mitchell, SD.
The clinic will continue to be located at 409 S. Ohlman St. in Mitchell. Jeff Lee, MPT, ATC, is a licensed physical therapist and certified athletic trainer, and has worked in both hospital and outpatient clinical settings. He is a member of the American Physical Therapy Association, the South Dakota Physical Therapy Association, the National Athletic Trainers’ Association and the National Strength and Conditioning Association and has been practicing physical therapy in Mitchell since 1998.
Dr. Benjamin Aaker, Avera Medical Group Emergency Medicine Yankton received the prestigious
Anton Hyden Award from the University of South Dakota (USD) Sanford School of
Medicine. This is the top teaching honor for clinical faculty at the School of Medicine and is voted on by the medical students. Aaker has been an assistant clinical professor for the School of Medicine for approximately three years.
Avera DeSmet Memorial Hospital recently broke ground on a new hospital addition
and renovation. In addition to upgrading the facility’s appearance and infrastructure, the $3.2 million project involves remodeling two emergency rooms, the emergency entrance, and the hospital’s inpatient wing. The PT department will be expanded and a radiology department will be established including CT and ultrasound. The project will be complete in 18 months to two years.
Avera Health has partnered with Evidence In Motion (EIM) to collaborate in the delivery of EIM’s orthopaedic and sports residencies, orthopaedic manual physical therapy fellowship, post-professional doctorate of physical therapy (DPT), and certification training
programs. As a component of this relationship, Avera becomes a network partner for EIM’s evidence-based training programs in numerous locations throughout Iowa, Minnesota, Nebraska, and North and South Dakota. EIM is available for all therapy staff at all Avera locations, giving them access to these resources.
Theranostics Health, Inc., a biotechnology company that develops and commercializes molecular diagnostic technologies to target therapies for optimal patient benefit, will expand on current research and commercial collaborations with Avera Cancer Institute
and Avera Health Plans. As part of a one-year evaluation program, Avera Health Plans will provide provisional coverage and reimbursement for the TheraLink Assay to help identify the best cancer therapy based on the functional proteomic panel. At the same time, Avera Cancer Institute is conducting multiple studies using the TheraLink Assay in their personalized medicine research program.
News & Notes
Happenings around the region
Midwest Medical Edition 8
News & NotesSouth Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
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Steve Petersen, PharmD, Vice President of Pharmacy Services at Avera Health, has been selected by the South
Dakota Society of Health-System Pharmacists as recipient of the Gary W. Karel Lecture Award
recipient for 2015. The Gary W. Karel Lecture Award is the highest lifetime achievement honor in South Dakota health-system pharmacy practice. Petersen has worked in the field of pharmacy since 1979 and has been employed at Avera for the last 15 years. He holds a doctor of pharmacy degree from the University of Nebraska College of Pharmacy.
BLACK HILLS
Regional Health has launched a yearlong campaign aimed at celebrating its nearly 5,000 physicians and caregivers.
Each month, three exceptional caregivers will be recognized for the work they do and positive impact on their communities. In May, the three individuals are Lisa Brown, MD, a Family Medicine physician in Custer; Bruce Larsen, Environmental Services in Rapid City; and Lacey Joens, RN, Emergency Services director in Spearfish.
Regional Health caregivers in Rapid City helped earn money for Wellspring, Inc., by wearing
jeans April 3. Regional Health’s Community Jeans Day Program raised $1,024 for the local organization which provides family-focused therapeutic services for youth who cannot function within their family setting, the open community and the open school setting due to mental, emotional and/or chemical dependency problems.
The South Dakota Affiliate of Susan G. Komen for the Cure has awarded a grant to the John T. Vucurevich Regional Cancer Care Institute (CCI) to assist medically underserved patients in western South Dakota with challenges during breast cancer
treatment. The grant will support the “Healing Pathways” program and will be administered through the CCI Breast Health Patient Navigation Program. Funds totaling $19,750 are available to qualifying individuals through May 1, 2016.
Mary Kolsrud, Executive Director of Susan G. Komen South Dakota, left, presents a check to Shauna Fehrenbach, R.N., Patient Navigator at the Regional Cancer Care Institute.
PRAIRIE LAKES
Prairie Lakes Healthcare System has been named a recipient of the Women’s Choice Award as one of America’s Best Hospitals for Emergency Care for a second
consecutive year. This award recognizes Prairie Lakes Healthcare System as a top performer in emergency services along with 373 other hospitals in the nation. There were 3,800 hospitals eligible for this award. The award is based on performance on publically reported quality data and outcomes of care that are important to women.
Prairie Lakes Healthcare System welcomes Occupational Therapist, Michelle Stark to the Prairie Lakes Rehabilitation
Staff. Michelle Stark has lived and worked as an Occupational Therapist for the last 17 years in
Watertown. She has extensive experience in treating all ages with orthopedic conditions, cancer-related debility, and neurological conditions. Stark is also a Certified Lymphedema Therapist.
SANFORD
Sanford Heart Hospitals in Fargo, North Dakota, and Sioux Falls,
South Dakota, now offer MitraClip, an FDA-approved, minimally invasive catheter therapy for treatment of mitral regurgitation (MR). MR is the most common heart valve insufficiency in the United States and is caused when a leaky mitral valve causes the backward flow of blood in the heart. Left untreated, this condition can lead to heart failure. Sanford Heart Hospitals in Fargo and Sioux Falls are among the first 100 heart facilities in the nation to offer this technology.
Sanford Health surgeons Dennis Glatt, MD, and Curtis Peery, MD, and the Bariatric Program at Sanford USD Medical Center recently received reaccreditation from the American College of Surgeons (ACS) and the American Society for Metabolic
and Bariatric Surgery (ASMBS). The recertification is the latest in a list of achievements for the Bariatric Program at Sanford The program is also noted as a Distinction Center for Bariatric Surgery and holds a Special Quality Award for Bariatrics from the Joint Commission.
The Edith Sanford Breast Foundation has welcomed musician Thad Beaty as its newest goodwill ambassador in the fight to end breast
cancer. Beaty, guitarist for the Grammy Award-winning band Sugarland and an accomplished athlete and fitness expert, will help promote health and wellness as part of Edith Sanford’s focus on breast cancer risk reduction
As a triathlete, marathon competitor and certified running and triathlon coach, Beaty will play a key role in leading TeamEdith, the Foundation’s national fundraising team. He will engage with TeamEdith members online, sharing training and healthy lifestyle tips, and participate in TeamEdith events nationwide. Beaty’s inaugural race with TeamEdith will be June 13, 2015, at the Rock ‘n’ Roll Seattle Marathon and ½ Marathon in Seattle, Washington.
Sanford Health is recruiting participants for a study examining the role of family
history in type 1 diabetes. As a site for Type 1 Diabetes TrialNet, an international network exploring ways to fight type 1 diabetes, Type 1 diabetes is the focus of The Sanford Project, a cornerstone research initiative at Sanford Research. To be screened, which involves a blood draw from the arm, individuals must be 45 and younger with a parent, sibling or child with type 1 diabetes or be 20 and younger with a niece, nephew, aunt, uncle, grandparent, half-brother, half-sister or cousin with type 1 diabetes.
June 2015 MidwestMedicalEdition.com 9
Midwest Medical Edition 10
The Accreditation Council for Continuing Medical Education (ACCME) has awarded Sanford Health’s CME program
Accreditation with Commendation for its professional learning opportunities for physicians. Sanford Health provided more than 1,500 CME credits for clinicians in 2014. During this same time period, more than 27,000 health care professionals attended Sanford-accredited CME events, including 8,800 physicians. Sanford’s submission earned the maximum length of accreditation, six years.
Medtronic plans to develop a stent graft system for
less invasive treatment of thoracoabdominal aortic aneurysms under an exclusive patent license agreement with Sanford Health. Sanford Health vascular surgeon Patrick Kelly, MD, developed the concept for the system and has since collaborated with Medtronic to manufacture devices based on the concept. The novel system was described in the November 2014 issues of the Journal of Vascular Surgery. An investigational drug that may have the potential to use the body’s immune system to attack tumors is the focus of a Sanford Health clinical trial for head and neck cancers
called KEYNOTE 055. Sanford oncologist Steven Powell, MD, and otolaryngologist John Lee, MD, are enrolling patients across the Midwest to study the investigational drug pembrolizumab in patients with recurrent or metastatic head and neck cancers. Merck is the sponsor of the study.
Sanford Aberdeen recently welcomed a new surgeon to its team of expert medical professionals.
Amy Hiuser, MD, will perform a variety of inpatient and outpatient surgical procedures in Aberdeen, including colonoscopies, laparoscopic and endoscopic procedures and hernia repair. Hiuser earned her medical degree from Medical University of the Americas in Nevis, West Indies. She completed her general surgery residency at the Cleveland Clinic Foundation in Cleveland, Ohio, and is board certified by the American Board of General Surgery.
SIOUXLAND
Mike McCarthy has been named the new Director for the Mercy Heart Center.
Prior to his arrival at Mercy Medical
Center, McCarthy held positions as a manager of a community based outpatient clinic for the Department of Veteran Affairs in Corpus Christi, Texas and as the Deputy Director of the Critical Care Air Transport, Advanced Course for the Sustainment of Trauma and Readiness Skills at the University of Cincinnati Hospital. A native of Sioux City, McCarthy received his BSN from Morningside College and is currently enrolled in a Masters of Nursing program at Morningside College.
Dr. Daniel Kensinger, Orthopedic Trauma Surgeon at CNOS, has joined the Board of Directors at Mercy Medical
Center. Milt Avery will serve as Chairman of the Mercy Board of Directors in 2015. Other officers include Dr. Larry Volz, Vice Chair, and Sr. Maurita Soukup, Board Secretary. Reappointments effective include Douglas Boden, Annette Hamilton, Robert Houlihan,
Dr. Steven Joyce, Sr. Michon Rozmajzl, RSM, and Sr. Maurita Soukup, RSM.
Dr. Ralph Reeder
of CNOS, Milt Avery, and Sr. Maurita Soukup will continue to serve on the Mercy
Iowa regional governing board.
UnityPoint Health – St. Luke’s has been recognized as one of the nation’s top performing hospitals according to a new study by iVantage Health
Analytics. St. Luke’s is one of nine UnityPoint Health hospitals named to the list of 2015 HEALTHSTRONG Hospitals.
Christy Stinger has also joined St. Luke’s Foundation as a Development Coordinator.
Stinger will work with project management and overall philanthropy efforts.
Dr. John Beacom and Dr. Arthur Molnar have joined Mercy as Co-Medical Directors of
Anesthesia. Dr. John Beacom is a graduate of the University of Nebraska Medical Center – College of Medicine and completed his internship and residency programs through the University of Illinois in Chicago. Dr. Arthur Molnar comes to Mercy from Lincoln, Nebraska. Dr. Molnar is a graduate of the University of Illinois College of Medicine and did his internship and residency programs through the Medical College of Wisconsin.
Michael Garrett, ARNP/MSN with Mercy’s Wound Clinic, has recently obtained dual certification in wound care and
hyperbaric medicine by the American Board of Wound
Healing (ABWH). Garrett has worked for Mercy for over twenty years and has practiced in the Advanced Wound Care Clinic since 2007. He received his Master’s Degree as a Family Nurse Practitioner from South Dakota State University.
For the second straight year, Cherokee Regional Medical Center (CRMC) has been named one of the iVantage HEALTHSTRONG Top 100 Critical Access Hospitals (CAHs)
in the United States. The results recognize that the Top 100 Critical Access Hospitals provide a safety net to communities across rural America – measuring them across 62 different performance metrics, including quality, outcomes, patient perspective, affordability, population risk and efficiency.
South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes continued
Dr. Kensinger
Milt Avery
Maurita Soukup
June 2015 MidwestMedicalEdition.com 11
Susan Unger has been promoted to President of the UnityPoint Health-St.
Luke’s Foundation. She will also continue her role as Vice President of Development for UnityPoint Health–St. Luke’s. Unger joined St. Luke’s in 2004, and under her leadership, St. Luke’s Foundation has completed three capital campaigns and created a significant planned giving program. Unger also represents St. Luke’s on many boards throughout Siouxland.
Kari Kellen joins St. Luke’s Foundation as Vice President of
Major Gifts. In this role, she will focus
on long-term donor relationships, helping to expand St. Luke’s donor base. Kellen served most recently as the Executive Director for the Children’s Museum of Siouxland focusing on major gifts. She was also instrumental in development at the Sioux City Art Center.
Amy Derby has been promoted to Development Coordinator for St. Luke’s Children’s Miracle Network.
Derby will coordinate and plan St. Luke’s Children’s Miracle Network events with Anne Holmes, Director of St. Luke’s Children’s Miracle Network.
Hospice of Siouxland is taking registrations for “Camp Courage”, a summer weekend camp to help kids who have experienced the loss of a family member or
friend. The camp is for youth ages 6 to 17, and is set for June 12-14 at the Goodwill Camp near South Sioux City, Nebraska. Pre-registration is required as camp size is limited. For more information or for a registration packet, please call John at 712-233-4144 or 800-383-4545.
HEALTHCARE COMPLIANCE MATTERS JUST GOT EASIER TO UNDERSTAND.
Woods Fuller welcomes Heather Springer and her 15 years of health law expertise. Heather minimizes risk and maximizes growth for hospitals, clinics, physicians, and insurance companies through:
HEALTHCARE COMPLIANCE CONTRACT NEGOTIATIONS FORMATION, RESTRUCTURING, LABOR AND EMPLOYMENT MATTERS MERGERS
To connect with Heather Springer, call 605.336.3890 or email [email protected]
WoodsFuller.com
sfsh.com/primarycare
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NEPAL Rapid City
From
to12
Nepal
13
THE 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.
“My mom and dad live in Kathmandu. I have three sisters and a brother, too. They are all doing alright physically but, of course, they are very scared,” says Dr. Dhungana. The son of a Nepali lawyer, Dhungana moved to Kathmandu with his family when he was in high school. He attended medical school in Nepal before leaving for additional training in New York. He settled in Rapid City two years ago.
By Alex Strauss
. . . and BackNEPAL
Nepal
The Black Hills
Cou
rtesy South Dakota D
ept. of Tou
rism
Midwest Medical Edition 14
Responding to DisasterAfter he checks on family, Dr. Dhungana plans to put his medical skills to work in an area that is more rural than Kathmandu but still has an established clinic. This, he believes, will be the most efficient way to quickly start helping the medical effort.
“We will be in a remote area where they already have a small base set up,” says Dr. Dhungana. “Some of my colleagues from all over the US are going, too. Our intention is to coordinate with organizations that are already on the ground in the region.”
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. The earthquake changed that.
“As soon as the earthquake happened, I cancelled my vacation and got very active online,” says Dr. Dhungana, an active member of the American Nepal Medical Foundation. The foundation, which is made up of hundreds of Nepali American doctors,
was established two decades ago by a group of Nepali doctors and American doctors who had worked in Nepal. The mission of the volunteer group has been to support the medical education of doctors from Nepal in the United States.
The group was preparing for its annual meeting, of which Dr. Dhungana was the chief organizer, just as the earthquake hit – a fact that dramatically changed the agenda.
“One of the items on our agenda will be to revisit the mission of the organization,” says Dr. Dhungana. “We realize that we are one of the most important US organizations to help in the relief effort.”
By the time Dr. Dhungana left for Nepal a few days after the meeting, the American Nepal Medical Foundation had already col-lected 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 orga-nizations, 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. We held a press conference regarding what I am attempting to do in Nepal and that was well covered in the news.” In addition, the hos-pital quickly organized a bake sale at which they collected donations totaling more than $14,000.
Work Ahead “Part of my work in Nepal will be to
organize the funds that we have and figure out how they are going to be used,” says Dr. Dhungana who has been reading up on mistakes made in the response to the massive Haitian earthquake in 2010. “That relief effort was not well organized and there was a lot of duplication. We want to make sure that doesn’t happen in Nepal. We want to have a sense of what the long-standing needs are going to be.”
Although Nepal is prone to earthquakes, Dhungana, says the only quake he ever experienced was a barely felt tremor during his training in New York. He is, however, not a total stranger to the pressures of disaster medicine. Dhungana was an intern in the ICU at a New York hospital when Hurricane Sandy hit in 2012. When other area hospitals were flooded, his had to handle the massive overflow of patients.
“Obviously, it is very different from responding to an earthquake in Nepal, but it was similar in that we had to handle a lot of patients very quickly,” he says. “We worked 40 hours straight.”
While Dr. Dhungana spends the month of May in Nepal doing what he can to help, the hospital’s remaining Nepali doctors are working together to “hold down the fort” at home in Rapid City.
At Home in Rapid CityOne of those who will stay behind for
now is Dr. Pushpa Poudel. Dr. Poudel was the first Nepali physician to come to Rapid
An April 30th “Assisting in Nepal Bake Sale and Donation Event” at Rapid City Regional Hospital raised more than $14,800 for the relief effort. Pictured is Nepali native and RCRH hospitalist Dr. Shailesh Thapa.
Phot
o co
urte
sy R
CRH
.
15June 2015 MidwestMedicalEdition.com
City in 2010. He quickly spread the word to his colleagues about the beauty, and seclusion of what he calls this “secret place”.
“I was looking for a place that reminded me of Nepal and that had some openings,” says Dr. Poudel, who did his training in Brooklyn. “Though Rapid City is far away from Nepal, it is very spacious like Nepal. It is beautiful and mountainous. There is not much crime. The people are nice. So I invited more friends and more friends.”
Those friends now include ten RCRH hospitalists, a cardiologist, and a nephrolo-gist. Several are raising families in the Rapid City area and three have even started a Nepali restaurant together. Although they are still far from home, Poudel says the camaraderie of Nepali colleagues and the support of RCRH makes the distance easier to manage.
Dr. Poudel’s mother and married brother still live in Nepal. None of the family was hurt by the earthquake and the house, which was newly built, sustained only minor damage. Eventually, he, too, hopes to go home to do what he can to help. In the mean-time, both doctors say they are grateful for the support of the hospital they call their professional home.
“We love the hospital and the mountains remind us of home,” says Dr. Dhungana. “Most of us live in the valley.”
“The fact that the hospital would have the bake sale and gather contributions, it really encourages us,” says Dr. Poudel. “It makes us feel happy and important. This makes us feel like we are not alone.” ■
“Our intention is to coordinate with
organizations that are already on the ground
in the region.”
Phot
o co
urte
sy R
CRH
.
Hospitalists Basanta Pathak, MD, left, and Pushpa Poudel, MD, right, discuss medical protocol for Sepsis patients.
Binod Dhungana, MD Pushpa Poudel, MD
Nepal
Midwest Medical Edition 16
BORN OUT OF A COMMITMENT TO provide area Veterans with personal-ized, proactive, and patient-driven care and service, integrative health therapies available at the Sioux Falls VA are designed to help empower Veter-ans to drive their own health. Many veterans who struggle with chronic pain,
anxiety, PTSD, cancer treatment side effects, stress, insomnia, and other conditions can now find relief with few or no medications using integrative health services.
This program began seeing Veterans in June 2014 with the goal of teaching Veterans self-management and self-care skills to improve their quality of life. Current services include integrative health coaching, massage therapy, energy therapy, a mind body medicine group, aromatherapy, yoga/tai chi classes, and acupuncture. In addition, the Sioux Falls VA Medical Center has had chiropractic care since Christopher Pierson, DC, was hired in 2004.
New Integrative Health Therapies at the Sioux Falls VAConcentration on Self-Care Aims to Empower Veterans
Both VA providers and Veterans have embraced integrative health services, and more than 650 consults have been submitted since the program’s beginning. The majority (over 75%) of the consults are for Veterans who have pain that has been unmanageable with standard treatment.
A Veteran who has battled chronic pain for many years says a few months of integra-tive healthcare have helped him achieve a level of pain relief and function that he has not had in 19 years of traditional healthcare alone.
Integrative health services have also helped advance the VA’s overall goal of decreasing Veterans’ use of high risk opioids for chronic nonmalignant pain. This also helps decrease risk factors for potential negative outcomes, including overdosing, adverse reac-tions, and mental health complications.
Before beginning services, Veterans are oriented in a group meeting and learn what they can hope to achieve and the require-ments of participation. The next step is an intake appointment with the Integrative Health Coach to plan and set goals with pos-sible referral to other therapeutic modalities. Veterans may choose to continue with health coaching after the required visits.
Integrative Therapies at the VA
Those who choose massage therapy normally have four therapeutic massages with education specific to their conditions and tools to maintain the benefits at home. This is a bridge to self-care and represents a culture shift for Veterans as well as staff.
During acupuncture, Veterans receive a series of four to eight treatments based on the acupuncturist’s plan of care.
Veterans also may attend a mind body medicine group once a week for eight
By Shirley Redmond
Jenny Miller, DC, acupuncturist, checks
placement of needles used to help
James Cooper, a Veteran of Iraq, with
headaches and chronic pain in his neck
and upper back.
17June 2015 MidwestMedicalEdition.com
At MMIC, we believe patients get the best care when their doctors feel confi dent and supported. So we put our energy into creating risk solutions that everyone in your organization can get into. Solutions such as medical liability insurance, clinician well-being, health IT support and patient safety consulting. It’s our own quiet way of revolutionizing health care.
To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit MMICgroup.com.
Looking for a better wayto manage risk?
Get on board.
MED POMM 8_13_14.indd 1 2/10/2015 9:03:23 AM
weeks where they learn a variety of self-care and stress management techniques including meditation, guided imagery, breathing and movement.
Concentrated distilled plant oils used in aromatherapy are designed to promote relaxation and provide relief of pain and a variety of other symptoms.
Another lesser-known option is energy therapy, where a provider places his/her hands slightly above or on the Veteran to promote balancing the physical, mental, emotional, and spiritual well-being. Soft music or imagery is sometimes used to help Veterans relax more completely.
Later this spring, Integrative Health plans to move into a new building just for this program. The design and furnishings will create a healing environment for comfort and relaxation. The space will accommodate room for private health coaching appoint-ments, rooms for massage and acupuncture as well as a large room for yoga and tai chi sessions. The new location will also allow VA staff to also expand the therapeutic modalities for Veterans’ growing needs. ■
Shirley Redmond is Public Affairs Officer at
the Sioux Falls VA Health Care System.
Massage therapist, Jessica Lund, LPN, LCMT
provides Veteran Jill Baker with a therapeutic
massage to assist her with stress reduction and
upper back and neck pain.
Midwest Medical Edition 18
FOR THE LAST several decades, organizations have increased their adoption of technology,
software, and Internet related ser-vices. They have quickly become reliant on the availability of their technology. Because of this, an orga-nization may not be able to function after a disruption or disaster without proper planning.
Disasters can range from the loss of a hard drive or a power outage, to floods, tornados, fires, sabotage, or data security breaches. An organization needs to recover as quickly as possible to ensure that it can continue to provide services to its customers and patients. According to a study from the Enter-prise Strategy Group, a staggering 53% of organizations can tolerate less than an hour of downtime before they experience a significant revenue loss or other adversities. Over 80% of all busi-nesses affected by a disaster were forced to close their doors because they were not able to recover.
Though it is extremely important to have a plan in all industries, health care organizations must maintain an even higher degree of system and network availability. One of the things that has highlighted disaster recovery’s importance is the growing use of electronic health records (EHRs) and the growth of networking and interconnection. If a facility loses access to its computers, it loses access to EHRs, treatment plans and other vital information that
directly affects patient care. Part of the challenge is the sheer size of electronic health records. These aren’t just electronic versions of scanned paper documents, but photographs, X-rays, videos and all sorts of associ-ated data. Patients’ lives may depend on systems being up and running, and patients’ health could be jeopardized by lack of access to health care data in the event of system downtime.
Most of us recognize that such disasters are a possibility; however the rarity and unpredictability of these events have kept some organiza-tions from making disaster planning a priority. It is vital that a business have a disaster recovery plan to help minimize downtime and regain ‘business as normal’ as quickly and efficiently as possible.
Another critical piece of disaster recovery planning is ensuring your busi-ness partners and business associates have disaster recovery plans in place. If an important relationship with a contractor is compro-mised due to a disaster, this holds the potential of having long-lasting and/or devastating effects to your organization and to your bottom line. Significant security risks, financial risks, or at the very least, a tarnished reputation are dangers that organizations need
to consider. Organ izat ions
that have a disaster recovery plan implemented are often able to ride out catastrophes with very little impact, if any, on data integrity or business revenue.
Organizations that do not currently have a plan in place may recognize its importance, but struggle with getting it started. There are several options available to assist in the creation a disaster recovery plan, ranging from free, online templates to consultants that specialize in disaster recovery planning. The technical staff within an organization can also be a great resource to help devise a plan specifi-cally as it relates to their individual areas of expertise. Data backup and redundancy is absolutely crucial, but it is just one component of the recovery plan. A plan should identify the risks, the magnitude of the risks, and the actions that will follow in the unfortunate event that a disaster occurs. The best way to test the plan’s
effectiveness is to practice it regu-larly. Learning from the tests and updating the plan accordingly can help refine recovery operations.
With a well-defined and tested disaster recovery plan, an
organization from any industry can endure a
disaster with minimal disruption. However, without proper plan-ning, a business may
have to close its doors when disaster strikes. ■
Planning for a Tech Disaster
Log On! For Heyden’s advice on avoiding another kind of
disaster when contacting patients on their cell phones.
By Jill Heyden
. . . critical piece of disaster
recovery planning is
ensuring your
business partners
and business
associates have
disaster recovery
plans in place
”
“
Jill Heyden is a
Business
Development
Specialist with
AAA Collections,
Inc.in Sioux Falls.
19June 2015 MidwestMedicalEdition.com
Moments of Lifemade possible by Hospice
Hospice focuses on living and enables special moments and memories at the end of life for patients and loved ones.
Hospice of Siouxland is appropriate for anyone diagnosed with a life-limiting illness whose life expectancy is measured in months rather than years and where the primary goal has shifted to comfort-oriented care.
Examples of life-limiting illnesses include lung, kidney, liver, neuromscular, end-stage heart disease, cancer, Alzheimer’s and dementia.
The end-of-life experience should be as positive as the life lived!
Care on Your Terms.Serving Siouxland for over 30 years!
You Do Have a Choice!Your doctor, hospital, nursing home or
assisted living facility must honor your wishes when choosing hospice care.
Please call 712-233-4144 or visit www.hospiceofsiouxland.org
Non-profit locally owned by UnityPoint Health-St. Luke’s and Mercy Medical Center - Sioux City
Midwest Medical Edition 20
PRESCRIPTION drug abuse con-tinues to rise. Overdose deaths from prescription painkillers have quadrupled since 1999,
and 1.4 million emergency department (ED) visits in 2011 were related to drug misuse, or to abuse of pharmaceuticals.
According to the Centers for Disease Control (CDC), more than 22,000 deaths in the U.S. in 2010 were related to pharmaceu-ticals, comprising 60 percent of all drug overdose deaths and exceeding deaths by overdose of illicit drugs like heroin and cocaine. Pharmaceutical drugs make their way into the hands of illicit drug users through sharing among friends and family, doctor shopping, prescription fraud and theft — making the ED physician-patient relation-ship an ideal target to exploit.
ED physicians practice medicine in unique circumstances. Without a prior relationship with a patient, these physicians must quickly build trust, assess circum-stances, and determine the best course of treatment, often within minutes or seconds. The short-lived relationship between physi-cian and patient makes the ED a perfect
Want vs. Need Recognizing drug diversion in the ED
By Trish Lugtu
Log on! To read the DEA’s ‘Do’s’ and ‘Don’t’ for health-care professionals to protect
themselves against drug-seeking behavior.
target for drug-seekers. But it is also these physicians’ excellent situational awareness that strengthens their ability to recognize potential drug-seeking behavior, and to respond safely and effectively.
RECOGNIZING DRUG‑SEEKING BEHAVIORSThe Office of Diversion Control within the Drug Enforcement Administration (DEA) published a brochure, Recognizing the Drug Abuser*, which describes the common behaviors of drug diverters in the ED. For example, they might show an unusual knowledge of controlled substances, give evasive or vague answers when questioned on medical history, show reluctance to pro-vide reference information, claim to have no regular doctor or health insurance, or request specific controlled drugs while resisting a different recommendation.
The brochure also describes the modus operandi often used by drug abusers: feign-ing physical or psychological symptoms and trying to apply pressure to the physician through sympathy, guilt, or even direct threat. He or she may also offer excuses for not going to their regular physician, such as claiming to be an out-of-town visitor, that his or her regular physician is unavailable, or other scenarios.
RESPONSIBILITIES OF THE PHYSICIAN
Physicians carry legal and ethical responsibilities to uphold the law and protect society from drug abuse, a profes-sional responsibility to prescribe controlled substances appropriately, and a personal responsibility to protect his or her organiza-tion from being a target of drug diversion. Fortunately, the burden of success is not on the provider’s shoulders alone. The Office of Diversion Control is also tasked with preventing, detecting, and investigating the diversion of controlled pharmaceuticals. Toward this effort, the DEA has developed guidelines for deterring drug diversion, and the CDC has joined in the effort with additional resources.
The DEA’s guidelines include steps such as following responsible prescribing, screening for substance abuse, prescribing painkillers only when other treatments have not been effective for pain, prescribing only the quantity needed based on expected length of pain, and referencing your state’s Prescription Drug Monitoring Program. Additionally, the CDC highlights the importance of incorporating awareness of state law in strategies to deter drug diversion in the ED. ■Trish Lugtu, BS, CPHIMS, CHP, CHSS
is R & D Manager with MMIC.
* Available online at http://1.usa.gov/19L18st
Note: This article originally appeared in the Winter 2014 issue of Brink, a quarterly risk solutions magazine published by MMIC.
21June 2015 MidwestMedicalEdition.com
PRAIRIE LAKES Now Using New Heart Failure Monitoring SolutionPRAIRIE LAKES HEALTHCARE SYSTEM IS
one of the first facilities in South Dakota to implant a new miniaturized, wireless moni-toring sensor to manage heart failure (HF). The CardioMEMS HF System is the first and only FDA-approved heart failure moni-toring device that has been proven to sig-nificantly reduce hospital admissions when used by physicians to manage heart failure.
Dr. Maaliki, Interventional Cardiologist, implanted the first CardioMEMS sensor on Wednesday, April 29th in a patient’s pul-monary artery (PA) during a non-surgical procedure to directly measure PA pressure. Increased PA pressures appear before weight and blood pressure changes, which are often used as indirect measures of wors-ening heart failure. The new system allows patients to transmit daily sensor readings
from their homes to Prairie Lakes, allowing for personalized and proactive management to reduce the likelihood of hospitalization.
“Being one of the first facilities in the state to introduce this new heart failure monitoring technology demonstrates Prairie Lakes’ progressive vision to provide state-of-the-art care in our region,” said Jill Fuller, CEO. “Our cardiology team is committed to providing innovative new technology that is proven to improve patient outcomes.”
Prairie Lakes brought the CardioMEMS HF System to the region in response to the high rate of heart failure patients that require medical attention. Heart failure occurs when the heart is unable to pump enough blood to meet the body’s demands. According to the Centers for Disease Control and Prevention, more than 5.1 million Americans have heart
failure, with 670,000 new cases diagnosed each year. Patients with heart failure are frequently hospitalized, have a reduced qual-ity of life and face a higher risk of death. According to the American Heart Associa-tion, the estimated direct and indirect cost of heart failure in the U.S. for 2012 was $31 billion and that number is expected to more than double by 2030.
“The CardioMEMS sensor is designed to last the lifetime of the patient and doesn’t require a battery. Data from a clinical trial showed that the CardioMEMS technol-ogy reduces heart failure hospital admissions by up to 37 percent,” said Leah Lê, Cardiology and Cath Lab Director. “The remote monitor-ing reduces the patients’ chances of being readmitted to the hospital, but most impor-tantly improves their quality of life.” ■
RESTORING MOVEMENT TO THE SPINE – FROM THE NECK TO THE LOWER BACK
CNOS.NET/TOTALMOBILITYDakota Dunes, South Dakota
TOTALMOBILITYYour Expert Spine Care
Center & Surgical Hospital
Midwest Medical Edition 22
Functional Job Descriptions By Kelly Marshall
THINK ABOUT JOB DESCRIP-
TIONS FOR A MINUTE: job descriptions you may have seen, job descriptions you may
have written, or job descriptions you may currently be employed under. Ask yourself the following questions:
• Are these job descriptions written?
• Do these job descriptions include
physical demand information, such
as being able to lift 50 pounds?
• If physical demand information is
included, how was it measured?
Was it measured objectively or
was it simply a guess?
• How are these job descriptions used?
To recruit new employees? As part of
the hiring process? In order to return
injured employees to their jobs?
Functional job analysis utilizes a sys-tematic approach to identify and measure the physical abilities required to perform the essential functions of a job. To do this, a job analyst goes into the workplace to
objectively measure these physical require-ments, including:
• Lifting forces
• Grip forces
• Pinch forces
• Push/pull forces
• Distances walked
This information can then be included in a functional job description. Separate from the professional requirements such as knowl-edge, skills, and cognitive abilities required for a given job, the functional portion of the job description includes the objectively measured physical demand information pertinent to that specific job title.
Incorporating functional information into a job description has a variety of benefits. During the recruiting and hiring process, it allows potential employees a much clearer picture of the physicality of the work they will be required to perform.
Potential employees may remove them-selves from the hiring process much earlier on when they realize they do not have the physical ability to perform the demands of a particular job. Employers thereby have a better opportunity to hire the employee who is a better “match” for a job from the very
beginning. Given the high rate of mus-culoskeletal injuries that occur
within the first year of employment, this has the potential to affect turn-
over and decrease recruiting costs for the employer.
Further benefits can be found in using functional job
information in the case of an injured employee. When an
employee is returning to work fol-lowing any sort of physical injury,
medical providers are asked to determine if that employee can safely perform the essen-tial functions of his or her job. When an employer does not objectively record the physical demands of a job, it becomes much more difficult for a medical provider to make a decision about that employee’s ability to safely return to work. The provider may be forced to rely on the report of the employee to determine what is physically required by their job. A functional job description can be shared or even created (just in time!) in order to reduce lost or restricted work days and ensure an injured employee can return to his or her job safely.
The process of functional job analysis presents the opportunity for a variety of additional benefits. A culture of safety and understanding is promoted by investing in employees from the moment they are recruited. Incumbent employees appreciate that any new hires will be physically capable of performing the job they are being hired for. Medical providers who are asked to make employment decisions appreciate a better understanding of what a job truly requires.
Recent court proceedings indicate that physical demand information should be objectively measured and job specific, especially if it is being used to make employ-ment decisions. Job descriptions with generic measurements and physical requirements are an open door for investigation and litigation. Functional job descriptions provide objec-tive, measurable information that can help keep employers on the cutting edge and out of the court of law. ■
Kelly Marshall is an occupational therapist
and a member of the South Dakota Occupational
Therapy Association and the American
Occupational Therapy Association. She is a Job
Analysis and Ergonomics Specialist with RAS.
23June 2015 MidwestMedicalEdition.com
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!
Did you Know?
Midwest Medical Edition
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
Midwest Medical Edition 24
New Marfan Syndrome Clinic in OmahaRaising Awareness and Saving LivesASK ANJI YETMAN, MD, director of
Vascular Medicine, Cardiology at Children’s
Hospital & Medical Center, about the rewards
of treating patients with Marfan syndrome,
and she seeks out the pictures pinned around
her office: an adult patient surrounded by
her three beaming daughters, a dapper-
looking teenager who, as a baby, was diag-
nosed with a severe form of the disease.
“With the right care, he’s been able to
lead a very normal life,” she shares.
Marfan syndrome, a genetic disorder
affecting approximately one in 5,000 men
and women of all ages and ethnic groups,
impacts the body’s connective tissue, an
anomaly linked to the abnormal production
of fibrillin-1 protein. Patients are typically (but
not always) tall and thin, with long limbs.
They tend to have eye issues, including lens
dislocation, and certain bony abnormalities
such as scoliosis, chest bone deformities, and/
or long fingers and toes. More critically, they
are predisposed to developing aortic enlarge-
ments, aneurysms and dissections.
“Marfan syndrome is just one cause of
a dilated aorta, but it is the prototype of all
diseases of the aorta. It’s the one we know
most about,” Dr. Yetman says.
Most patients—75 percent—inherit
Marfan syndrome from a parent. The remain-
der of the cases arise de novo as a result of
a spontaneous mutation. Diagnosis begins
with a scoring system.
“We look at the patient; we take a
number of measurements and then we add
up points for each feature they have. If they
have a certain score that determines that
‘yes’ they have Marfan syndrome or ‘no’ they
don’t. The diagnosis, most often, is a clinical
diagnosis,” Dr. Yetman explains.
After Marfan syndrome is diagnosed, a
baseline echocardiogram helps evaluate the
size of the aorta and whether it is proportional
to the size of the patient. “After that initial
visit, we like to see them in six months’ time
to make sure their aorta is stable. If it is stable,
they typically come in for a yearly checkup
with a visit and an echocardiogram.”
The new Marfan Syndrome Clinic at
Children’s is working to make an impact on
the front — and a very real difference in
people’s lives. “Twenty years ago, Marfan
syndrome was somewhat of a death sentence
and that’s not the case now,” Dr. Yetman
says. ■
Proud to be Physician
Owned and Operated
Surgery
Pa in man agement
imaging
midweS t Family Care
d igeS t ive health
sfsh.com
An open letter from the Ceo
to our patients, As the new Ceo of Sioux falls Specialty hospital, I wish to express our gratitude and
respect to those who have trusted us with their care over the past year. We do not take the
responsibility of your health and happiness lightly.
to our staff, You’ve shown great commitment to our culture of personalized care and innovation through
your time, dedication, compassion and hard work. We are proud to say that your efforts have
once again earned us the honor of being recognized as a regional leader in patient satisfaction.
Sioux falls Specialty hospital received a five-star rating in ten out of eleven patient
satisfaction categories in the hCAhpS survey awarded by CmS*, making us the only
hospital in the region with this high of a ranking.
Do we like awards? Yes. But we couldn’t ask for a greater reward than the approval of our
patients. Thank you.
Sincerely,
R. Blake Curd, M.D.
Chief Executive Officer, Sioux Falls Specialty Hospital
* Hospital Consumer Assessment of
Healthcare Providers and Systems
(HCAHPS) survey administered by Centers
for Medicare & Medicaid Services (CMS).
“ MED QUOTES
The Lord hath created medicines out of the earth; and he that is wise will not abhor them — Ecclesiastes 38:4”
25June 2015 MidwestMedicalEdition.com
PHYSICIANS AND THE health-care industry should be aware of changes involving public disclosures required under the
Physician Sunshine Act.The rules coming out of the Sunshine
Act are the latest round of government regu-lations affecting the healthcare industry. This Act was actually passed in 2010 as Section 6002 of the Affordable Care Act, but regulations implementing the law were not passed until February 2013 in 42 C.F.R. 402 and 403. It has only been in the last year that the Sunshine Act has been operational, and it is important that affected parties now understand the law’s effects.
Congress stated that the central purpose of the Sunshine Act was to provide for increased transparency and public aware-ness of financial relationships between certain healthcare providers, drug/device manufacturers and group purchasing organizations (GPOs). The law created a database, searchable by the public, that lists certain payments covered by the Sunshine Act. The Sunshine Act generally requires the following payments to be reported and listed on the database:
◆ Payments or other transfers of value by applicable manufacturers of covered products to physicians and teaching hospitals
◆ Certain ownership or investment interests by physician’s or physician’s family members in certain manufacturers and GPOs
◆ Payments or other transfers of value by a GPO to physician owners or investors if the ownership or invest-ment interest was held at any point during the reporting year.
What constitutes a “payment” or “transfers of value” is defined broadly and can, for example, include reimbursement for a meal. The Sunshine Act requires the report of the payment, transfer of value or ownership interest to be made by the manufacturer or GPO to the Center of Medicare and Medicaid Services (“CMS”). Physicians and teaching hospitals, as the recipients of the payment and the Sunshine Act report, should be given under the law the opportunity to review the CMS report for accuracy. Once the review and correction process has been completed, the data is made public via CMS’s “Open Payments” website.
The first data collection period under the Sunshine Act covered transactions that occurred from August 1, 2013, through December 31, 2013. The data collected for this period was required to be submitted to CMS by March 31, 2014, and was published by CMS on September 30, 2014. Following this initial data collection period, CMS will publish the Sunshine Act data on an annual basis and the data reported will include a full twelve months of payment data. Data collected for each cal-endar year will be published by CMS in June of the following calendar year.
As a result of the Sunshine Act, the public now has access to a wide variety of payments between certain parties in the healthcare industry. While much of the industry is still
unaware of the new database, the access to it by the public is already wide-spread and legal effects of that access are beginning to occur.
Physicians should be aware of the rules and the reporting, including what will be reported and their rights to review reports prior to publication on the database. I am advising hospitals and healthcare facilities to incorporate these new standards into their credentialing process. Healthcare providers should also prepare its disclosures and other notices consistent with information available to the public on the database. ■Heather Springer is an attorney with Woods
Fuller Shultz and Smith, PC, in Sioux Falls. Her
practice focuses on healthcare and employment
matters.
By Heather Springer
What You Need to Know About
The Physician Sunshine Act
. . . the central purpose of the Sunshine Act
was to provide for increased transparency and public awareness of
financial relationships between certain
healthcare providers, drug/device
manufacturers and group purchasing
organizations
“
”
Midwest Medical Edition 26
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Palliative Care Helps Fill Service Gap for the Chronically IllWHILE THE WORD “HOSPICE” is most often associated with end-of-life care, Hospice of Siouxland also offers Palliative Care services for people with serious illnesses. “We developed our Siouxland Palliative Care program in 2001 because we saw unmet needs of individuals and families coping with advanced chronic illness,” says Hospice of Siouxland Director Linda Todd.
Unlike hospice patients, patients receiving palliative care may continue active treatment and have a life expectancy greater than a few days or months.
Dealing with a chronic illness can be complicated and overwhelming for both patients and caregivers. It’s not uncommon to have several healthcare providers, multiple medications, emotional stress, financial concerns, and caregivers trying to balance caring for their family member and working full time to retain insurance to pay the bills.
FILLING THE HEALTHCARE SERVICE GAP“Unfortunately, under our current healthcare payment system, individuals with advanced chronic illness may fall in the gaps of healthcare delivery,” says Todd. Patients may not meet eligibility requirements for home health or hospice funding for services such as day-to-day medication management, disease management or emotional support for the individual or caregivers.
Because they don’t know who to call with questions or needs, these patients may have recurring emergency room visits and hospitalizations. That’s where Palliative Care Services can help.
TEAMING UP TO IMPROVE CAREHospice of Siouxland takes a team approach to palliative care. A primary physi-cian, palliative care nurse, and social worker collaborate in the development of a plan to address the needs of families and patients, alleviate suffering, and improve quality of life. This team:
• Coordinates healthcare with the patient’s primary physician
• Educates patients and families on the illness and medications
• Addresses new symptoms or problems
• Coordinates community resources such as financial applications
• Clarifies treatment goals and helps with advance directives
One of the most important elements of this support is a nurse who is on call and available to respond by phone or in person 24/7.
NO ONE IS DENIED SERVICESPalliative Care funding relies largely on public support because there is no funding from Medicare or Medicaid. Some patients pay privately based on a sliding fee scale and ability to pay. However, Todd notes, many patients do not have the ability to pay for services. No person is denied services because of an inability to pay. ■
27June 2015 MidwestMedicalEdition.com
AVERA’S COORDINATED Care
program has been recognized
among the top five of health
organizations that participated
in a Center for Medicare &
Medicaid Innovation (CMMI)
Health Care Innovation Chal-
lenge Grant.
Since 2012, Avera’s Coordi-
nated Care model has
participated in this project,
through CMMI grant funding
received by a collaborative
partnership that includes
VHA Inc., a national network of
not-for-profit health care
organizations; TransforMED, a
not-for-profit subsidiary of the
American Academy of Family
Physicians; and, Phytel, Inc., a
technology company that
leads the field in automated,
provider-led population health
improvement solutions.
The grant funded a three-
year national project involving
healthcare systems, hospitals,
and provider practices through-
out 16 communities, one of
which was O’Neill, Nebraska,
home to Avera St. Anthony’s
Hospital.
The goal of the project was
to expand the concept of the
Patient-Centered Medical Home
to the Patient-Centered Medical
Neighborhood and connect
acute-care hospitals with
primary care, specialty and
subspecialty practices to drive
better quality and superior
patient experience at a more
affordable cost.
Coordinated Care is specifi-
cally designed to help people
who have significant barriers
to improved health, such as
multiple diagnoses, catastrophic
illness, health literacy issues, or
psychosocial issues such as
lack of finances, depression, or
lack of health insurance.
There are eight Coordinated
Care teams throughout the
Avera system. Each team is
comprised of an RN as team
coordinator, a clinic care special-
ist, and a social worker. This will
expand to 13 teams by the
end of the year. Currently, 954
patients are active in the
program.
“Over the past few years,
we’ve seen great success in
patient outcomes through
the Coordinated Care concept.
The future of medicine will
center on prevention and better
management of illness, rather
than hospital treatment of
illness. Our Coordinated Care
teams are breaking new
ground to help patients over-
come significant challenges,
and return to better health,”
said Tad Jacobs, DO, Chief
Medical Officer for Avera
Medical Group. ■
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Avera’s Coordinated Care Model Earns Recognition
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Midwest Medical Edition 28
SDSU College of Nurses Honors Avera leadersThe South Dakota State University College of Nursing honored 30 nurses, including four Avera leaders at its 80th anniversary gala in April. Below are the Avera awardees.
Leadership in Clinical Practice: Darcy Sherman Justice, MS, RN, NE-BC and Kris Gaster, RN, MS, CS, CNP Sherman Justice
has been Director of Professional Development and Nursing
Integration at Avera McKennan Hospital & University Health
Center since 2004. Gaster is Assistant Vice President of Out-
patient Cancer Clinics.
Emerging Professional: Courtney Ehlers RNC, MS, BS, CPN–
After only five years as a nurse, Ehlers was promoted to the
role of manager of the pediatric/PICU unit, and is now Director
of Women’s and Children’s Services.
College of Nursing Distinguished Alumni: Deborah Soholt, MS, RN. Soholt has served as Director of Women’s Health at
Avera McKennan since 1999.
Find out how advanced education is putting some nurses on the
forefront of primary care. Log on!
The average commute time is twice as long for a nurse in Maryland as in South Dakota.
The Nurses’ StationNursing News from Around the Region
Best States for NursesPersonal finance social network WalletHub has listed Minnesota as the third best state for
nurses. WalletHub analyzed the attractiveness of each of the 50 US states and the District
of Columbia across 15 key metrics. Our data set includes such metrics as the monthly median
starting salary for nurses, the number of health care facilities per capita and nursing job
openings per capita. Minnesota was the only state in the MED coverage area to make the
list. For the full report and to see where your state ranks, visit: http://wallethub.com/
edubest-states-for-nurses/4041/
St. Luke’s College –UnityPoint Health
has named Lorraine Sacino Murphy as Department Chair of the Associate of Science in Nursing Program. Sacino
Murphy received her Bachelor of Science in Nursing from University of Wisconsin in Eau Claire, Wisconsin and her Master of Science in Nursing from Briar Cliff University in Sioux City, Iowa.
Also at St. Luke’s College–UnityPoint Health, Renae Grell is now a Nursing Instructor. Grell received an Associate
Degree in Nursing from St. Luke’s College and a Bachelor of Science in Nursing from South Dakota State University in Brookings, South Dakota.
Source: WalletHub
The Jorgen Yde Foundation
has honored Linda
Harding, RN, OCN,
as the 2015 recipient
of the JY6 Nurse
of the Year
Award. Harding,
of Avera Medical Group Oncology
and Hematology Sioux Falls, is the
third-ever recipient of the award.
USD Nursing’s historic graduationFirst group of Four-year BSN graduates on May 8
The University of South Dakota’s four-year Bachelor of Science degree in Nursing (BSN) graduated its first class of students in May. The four-year BSN program was re-instituted in 2013 by the SD Board of Regents. Fifty-five four-year BSN nursing students received their nursing pins on May 8th at USD nursing campuses in Vermillion and Sioux Falls.
USD Nursing in Vermillion and Sioux Falls started BSN pro-gramming in fall 2013. USD nursing students in Rapid City were admitted to the four-year BSN program starting in 2014, and Pierre students can begin the program in fall, 2016.
29June 2015 MidwestMedicalEdition.com
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SANFORD HEALTH IS ONE OF 14 cancer institutes across the country partnering with IBM Watson Health in an initiative to translate DNA insights into personalized treatment options for patients. The project is part of IBM’s broader Watson Health initiative to advance patient-centered care and improve health.
Across its enterprise, Sanford will utilize Watson Genomic Analytics, a cloud-based service for evidence gathering and analysis. It looks for variations in the full human genome and uses Watson’s cognitive capabilities to examine all available data sources such as treatment guidelines, research, clinical studies, journal articles and patient information.
“Customized cancer treatment based on a tumor’s genetic composition is the future of cancer therapy,” said Steven Powell, MD, Sanford Health oncologist and cancer researcher based in Sioux Falls. “However, due to the unique genetic make-up of each individual and the complexities of the cancer genome, a personalized approach can take an enormous amount of time to process. For any type of disease, rapid analysis and understanding of this complex genomic information will lead to more precise and effective treatments.”
It typically takes weeks for clinicians to analyze each genetic mutation. Watson completes the process in only a few minutes and produces a report and data visualization of the patient’s case, including recommendations and evidence-based insight on potential drugs that may be relevant to an individual patient’s unique DNA profile identified in the medical literature. The clinician can then evaluate the evidence to determine whether a targeted therapy may be more effective than standard care.
“This collaboration is about giving clinicians the ability to do for a broader population what is currently only available to a small number,” said Steve Harvey, vice president, IBM Watson Health. ■
Sanford/IBM partnership will advance cancer genomics
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Call 605-366-1479 to learn more.
This just in!
Midwest Medical Edition 30
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31June 2015 MidwestMedicalEdition.com
June 10 – 11 Collaborative Research Center for American Indian Health 3rd Annual Health Research Summit Location: Rushmore Plaza Holiday Inn, Rapid City
Information: www.CRCAIH.org
June 12 Avera McKennan Pulmonary 8:00 am – 4:00 pm and Critical Care Symposium Location: Hilton Garden Inn Sioux Falls
Information: [email protected], 605-322-8987
Registration: Avera.org/conferences
June 26-27 37th Annual Black Hills Pediatric Symposium7:00 am – 12:00 pm Location: The Lodge at Deadwood
Information: [email protected], 605-312-1067
Registration: SanfordHealth.org/ClassesandEvents
July 22 Avera Infection Prevention Day of Sharing9:15 am – 4 pm Location: Sr. Colman Room, Prairie Center, Avera McKennan
Information: [email protected], 605-322-8987
Registration: Avera.org/conferences
August 10-12 Digital Marketing for Medical Devices8:30 am – 3:45 pm Location: Hyatt Regency, Minneapolis
Information and Registration:
http://exlevents.com/digital-marketing-medical-devices/
Sept. 24-25 16th Annual Avera Oncology Symposium Location: Avera Cancer Institute, Prairie Center, Avera McKennan
Information: [email protected], 605-322-8987
Registration: Avera.org/conferences
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
June — Sept
Do you or your organization have an
event for the MED Calendar? Post it online
for free through the calendar link on our
home page.
We offer a number of treatment options and care for a variety of conditions including:
• Chronic kidney disease/acute kidney injury • Hypertension evaluation and management • Full spectrum of acute and chronic dialysis therapies • Neonatal pediatric nephrology care • Proteinuria/Hematuria • Cystic renal disease
To refer a patient, call (605) 312-1050.
012001-00168 Rev. 5/15
SpecializedNEPHROLOGY CAREfor kids
(L-R) John Sanders, MD, Justin Kastl, MD
Seeing patients in:
Sioux Falls, Sioux City, Rapid City & Fargo, ND
Sanford Children’s is here for you when your patients need advanced care. Our highly trained specialists and the advanced care options we provide allow them to receive the care they need close to home.