2014: A Year in Review
December is a time for traditions and, at MED, it has been our longstanding tradition to look back over the year in medicine in our region, as seen in the pages of MED. On the national front, healthcare reform in the shape of the Affordable Care Act took center stage. In our region, growth and expansion – of infrastructure, IT, patient populations, medical technology, etc., continued to be the “name of the game”. Following are excerpts and top stories from the pages of MED in 2014. As we plan for 2015, please share your article ideas and submissions with us!
Playing a Primary Role
Advanced Practitioners in a Changing Healthcare Environment
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.
Crystal Page, PA-C, is the one-and-only provider 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.
“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.”
“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.
The shortage means that current physicians are often over-extended in terms of patient load. In addition, most are embroiled in trying to meet new federal guidelines that leave them even less time for patient care. In many clinics, APPs are helping 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.
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 physicians to work in communities that have no hospital.
News Flash: Darwin Goodspeed is appointed as the new director of the Sioux Falls VA Health Care System
News Flash: Mercy Medical Center begins using its news 3T MRI scanner
News Flash: Prairie Lakes Healthcare System receives top honors from the American College of Cardiology for heart attack care
Imagining the Future of Medicine
“I describe it as a change in mindset, a change in how you approach patients,” says Dan Blue, MD, President of Sanford Clinic in Sioux Falls. “When you have a deeper understanding of these tools and resources, you begin to see how they apply to decisions you make regarding your patients.”
Over the course of the next few months, Sanford’s 117+ internal medicine physicians will begin to experience that change in mindset for themselves as they train to be a part of Sanford’s new genomic initiative, Sanford Imagenetics.
Sanford Imagenetics will allow internal medicine physicians to work hand-in-hand with clinical geneticists, genetic counselors and diagnostic clinical genetics laboratories to fully integrate high-tech genomic medicine into their clinical practice. Samuel Nyamu, an internal medicine physician in Aberdeen, says it is easy to imagine a myriad of ways in which he will be able to apply this technology in his practice.
“Almost every day I see someone who could benefit from this,” he says, referring to the program’s initial focus in pharmacogenetics. “Often, I see patients come back to my clinic because of drug side effects that could have been avoided had we had a better understanding of how they metabolize medicine. Without this genetic information, I have no idea how a given patient will metabolize medicine and I just have to give them a general dose and see how it goes.”
“The unique thing here is that we are making it real in terms of clinical practice,” says Gene Hoyme, MD, a board-certified geneticist and president of Sanford Research.
News Flash: South Dakota receives an overall D+ in the 2014 American College of Emergency Physicians’ (ACEP) state-by-state report card on the environment in which emergency care is delivered
News Flash: Avera Cancer Institute is approved to offer complete PROVENGE therapy for men with advanced prostate cancer
Area Experts Tackle the EHR Issue
On one hand, the federal program designed to incent physicians to buy and “meaningfully use” an electronic health record (EHR ) system has been a tremendous success. According to CMS , as of January 2014, 347,000 healthcare providers had received payment for participating in the program. On the other hand, many of these providers also admit to having annoying – and often costly – “issues” with EHR systems that they may have chosen too quickly or were inadequately prepared to use.
In this Special Section, we brought you advice from area EHR experts.
“With the federal EHR incentive program in its third year, we are bearing witness to a growing number of EHR replacement sales due to unsatisfied providers and EHR vendors’ inability to meet increased certification criteria. If you are not converting all data to your new system, remember to assess your policies against the record retention laws set in your state.” - Trish Lugtu, MMIC
“The Office of Inspector General has identified copy/paste as a potential fraud vulnerability. Do you see the same information repeated over and over again in your EHR? Is the same physical exam in the H&P, progress notes and/or discharge summary? Or is the same progress note repeated over a number of days? If so, your facility may be at risk.” - Rhoda Lagerquist, Eide Bailly, LLP
“No matter your size or location, downtime will cost you and will only get more expensive. Where is the central location of your critical data and what redundancies exist? Where and how are the servers and storage at your location backed up and how quickly could you restore that information? Does the risk of downtime warrant a second-failover connection? By performing a thorough evaluation and investing in a solid continuity plan, you can prevent downtime from truly costing your organization.” – Bryan O’Neal, Golden West Technologies
News Flash: David Basel, MD, of Sioux Falls and Scott Eccarius, MD, of Rapid City are among a select group of physicians to pass the first-ever Board Certification exam in Clinical Informatics.
The New LifeScape Offers Continuum of Services for Children and Adults with Disabilities
Both South Dakota Achieve and Children’s Care Hospital and School have long been recognized for their ability to adapt to the changing medical needs of Sioux Falls and surrounding communities. Now, these organizations have proven, once again, their ability and willingness to adapt to changing times by joining forces to form LifeScape. By combining these two demographics, the new non-profit organization has the capacity and expertise to support the varied medical, educational, emotional, mental, and social needs of patients with disabilities at any stage of life.
“Even just the fact that two non-profits were able to put their egos on the shelf and look at what was going to serve the community best is quite something,” says LifeScape CEO Anne Rieck McFarland. “We are planning to take advantage of the things these organizations have learned about serving people with disabilities.”
Although the two organizations that combined to form LifeScape will continue to provide the services that have always been associated with them, Rieck McFarland and LifeScape’s Vice President of Medical and Therapy Services, Kristin Tuttle, say LifeScape will be able to serve certain clients in ways that have not previously been possible. Hence, the “Better Together” slogan in LifeScape’s marketing.
One area of service expansion under the LifeScape banner will be mental health, an area with which many service organizations for adults with disabilities struggle. Respite care to provide a break for the caregivers of adults and children with disabilities is another area of planned service expansion.
“Whether they need to be an inpatient or they are looking for rehabilitation medical supplies, we can help direct them so that they get what they need,” says Tuttle.
News Flash: Regional Health President and CEO Charles Hart retires
News Flash: Sanford Health announces plans for an integrated breast health building at its Sioux Falls campus
What we learned from…Flight 232
Twenty-five years later, two Siouxland doctors look back
“I had just finished an operation at Marion Health Center (now Mercy Medical Center) in Sioux City… and heard that there was maybe going to be an airplane crash,” recalls Quentin Durward, MD, of the events of July 19, 1989. “So, I wandered down to the ER to see what this was all about.”
The first victim of Flight 232 arrived at the Marion ER a miraculous 16 minutes after the crash at the Sioux City airport.
Dr. Ralph Reeder, who now works with Durward at the CNOS Clinic in Dakota Dunes, was the only other neurosurgeon in Sioux City at the time of the crash. He had moved to town just two weeks earlier. “I barely knew where the bathrooms were,” he says.
Fortunately, he had plenty of help. Hundreds of volunteer physicians, nurses, and medical techs flocked to the hospitals – many of them with no previous trauma experience.
“No one was concerned about hierarchy or privilege. We all just saw jobs and did what had to be done. Because you knew that if you didn’t do what you could, right then, the person was going to die,” says Dr. Reeder.
Of the 296 people on the plane, an amazing 184 survived, thanks to the phenomenal skill of the flight crew in the air and good planning, early warning, and quick thinking on the ground. When they remember the blur of non-stop workdays that followed the accident, both doctors say they are humbled by the experience.
“The community response spoke very highly of Sioux City,” says Dr. Durward. “In my career, I have never seen anything even remotely like it.”
News Flash: Make-A-Wish South Dakota celebrates its 30th anniversary
News Flash: Avera Flandreau Hospital holds its grand opening.
Independent But Not Alone
SD Community Hospitals Stay Strong with Creative Collaboration
Do a quick Google search of ‘Independent Community Hospitals’ and you’ll find two types of articles – those devoted to ways to “save” community hospitals, and those that say it can’t be done. Several long-standing independent rural hospitals in the South Dakota region are banking on the fact that the naysayers are wrong.
The environment for community hospitals is challenging. The push for expensive high-tech services and the rising expense of facility upgrades, the cost of attracting and retaining physicians, reimbursement reductions, the increasing role of managed care companies, and the move from fee-for-service to value-based healthcare all hit inordinately hard for facilities with smaller budgets and less-affluent patient populations.
While some have managed by aligning with large health systems, others have found creative alternatives such as partnerships, joint ventures, joint operating agreements, telehealth, and clinical and management service arrangements. In the case of Prairie Lakes Healthcare System in Watertown, CEO Jill Fuller says diversification of services, controlling costs, and collaboration are been keys to their independence.
“Going from competition to collaboration is the way to regionalize health services and that has been our approach,” says Fuller.
But can independence work for even smaller hospitals? Tammy Miller, CEO of the 25-bed Madison Community Hospital in Madison, South Dakota says yes – with the right structure. “I believe that the number one thing for independence is community support.”
Miller says a stable workforce and stable physician base are also critical to success as an independent.
News Flash: The first Sanford School of Medicine students start work in the new FARM rural medicine program.
Patient Portals and the Future of Provider/Patient Communication
getting patients to come and actively engage with a patient portal system, which is needed to meet meaningful use requirements, is forcing many practices to take a new look not only at portal systems and their capabilities, but also at the meaning of the word “marketing”.
“We make patients aware of our portal at the time of registration,” says Kelly King, Director of Nursing at Sioux Falls Specialty Hospital in Sioux Falls. SFSH implemented the patient portal offered through its EMR provider, McKesson Paragon, about 6 months ago. “When they register, we describe the portal, what they can do with it and how they access it. Inpatients are also made aware of the portal during our daily rounds.”
Through a patient portal, patients can get online access to their health information, including diagnoses, medication lists (in total and by condition), allergies, and recent test results. Depending on the system configuration, they may be able to access a summary of their most recent visit, including the topics discussed and the provider’s recommendations. Some may also include the date and time of the next visit and a list of scheduled tests.
“It is a great tool for engaging patients,” says Allison Wierda Suttle, MD, Chief Medical Information Officer at Sanford Health. “This lets you be more of a mentor to the patient.”
David Klocke, MD, Chief Medical Officer for Regional Health in Rapid City, says portals may benefit the profession in a less obvious way, too. “Having a portal in place increases patient engagement, but it also raises the bar for doctors,” says Klocke. “When I walk in to see a hospitalized patient, I know that they may already know their lab results, so I better know them, too!”
News Flash: Avera eCARE celebrates the 10th anniversary of the eCARE program.
News Flash: Northeast South Dakota Healthcare Foundation (NESDHCF) breaks ground on Milbank’s new $23 million healthcare campus.
Most MED articles come from the suggestions of MED readers. If you know of a physician, program, or institution that you think is worthy of coverage in MED, write to us at Info@MidwestMedicalEdition.com.