2001JanFeb

Jan/February 2001

Doctors MetroDoctors

Business Technology in Medicine– Predicting the Future

Doctors MetroDoctors Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Richard J. Morris, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Manager Dustin J. Rossow Cover Design by Susan Reed MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761.

To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. E-mail: nbauer@mnmed.org.

For advertising rates and space reservations, contact Dustin J. Rossow, 4200 Parklawn Ave., #103, Edina, MN 55435; phone: (612) 2377363; fax: (612) 831-3260; e-mail: djrossow@aol.com.

MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy.

Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available.

CONTENTS VOLUME 3, NO. 1

2

LETTERS

4

FEATURE: TECHNOLOGY

JANUARY/FEBRUARY 2001

Among the Changes in Healthcare, Technology has Taken Center Stage

7

Minnesota Specialty Physicians: An Advocate for Independently Practicing Specialist Physicians

8

Employers and Health Care

10

COLLEAGUE INTERVIEW

Harry F. Hull, M.D.

12

Payer Options: Anything New?

18

“Payer Alerts” are Tools for Practice Administrators

19

The Future of Minnesota’s Health is Up to You

20

Legislature Convenes January 3: Minnesota Medical Association Sets its Agenda

21

HMS and RMS Continue to Provide Centralized Credentialing Services to the Community

22

Community Interns Experience the Epicenter of Medicine

23

NOTEWORTHY

28

Caring Hearts for Homeless People Supply Drive

RAMSEY MEDICAL SOCIETY

24 25 26

President’s Message

27

RMS Alliance

RMS Annual Meeting Applicants for Membership/In Memoriam/ Introducing the 2001 RMS Officers

HENNEPIN MEDICAL SOCIETY

MetroDoctors

29 30 31

Chair’s Report

32

HMS Alliance

HMS In Action HMS News/Hoban Scholars/ Charles Bolles Bolles-Rogers Award/In Memoriam

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: Business Technology in Medicine — Predicting the Future. Articles begin on page 4.

(Artwork by Outside Line Studio, 225 So. Owasso Blvd., Roseville, MN 55113.)

January/February 2001

1

LETTERS

Dear Dr. Woellner: I thoroughly enjoyed your writing in the recent issue of MetroDoctors, describing the loss of collegiality that existed in a previous era. As a hospital-based physician, with regular exposure to the Doctors’ Lounge and other meeting places, I am appalled at the lack of participation and attendance that we saw in earlier times. Our Surgery Lounge at North Memorial, up until 10-15 years ago, was a hubbub of activity, collegiality and participation by all physicians up until noon. Now the Lounge contains only a handful of surgeons waiting to start their cases.

Part of the change relates to the

2

January/February 2001

economics of medical practice. Our vibrant primary care groups whose members came to the hospital every day to see patients and do minor surgical procedures have changed their schedules for efficiency. Currently, in a group of 15-25 primary care physicians, only one or two makes rounds each day.

That person is so overwhelmed with becoming acquainted with patients that they are unable to attend the conference or to visit with anyone else. This change is dramatically reflected in our declining census in our previously well-attended CME conferences. Even though North’s CME exercises remain better attended than most, the change has been dramatic.

Much of the little conversation which

MetroDoctors

occurs in the lounges now relate to HMO reimbursement problems, the additional imposition of government, night call responsibilities, etc. We used to talk about our “great cases.” No longer. Most of the physicians now suffer from what I have called “medical malaise.” Young physicians seeking a practice appointment once considered the professional qualities of the group. Now all they talk about is call schedules, salaries, etc.

These are indeed the times which try men’s souls. Thank you again for writing. As I read your article, I had a sense of deja vu.✦ Sincerely yours, Seymour Handler, M.D.

The Journal of the Hennepin and Ramsey Medical Societies

'HVLJQ λ 4XDOLW\ λ 3HUIRUPDQFH λ 9DOXH λ 6HOHFWLRQ λ (UJRQRPLF $VVHVVPHQWV

λ

)RU PRUH GHWDLOV FRQWDFW \RXU 86 2IILFH 3URGXFWV¶ $FFRXQW ([HFXWLYH *DU\ 3HWUR 3KRQH RU )D[ 8SSHU 0LGZHVW 'LVWULFW ,QF 2OG +LJKZD\ 1: 1HZ %ULJKWRQ 01 MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies

(QGRUVHG E\ 5DPVH\ 0HGLFDO 6RFLHW\

January/February 2001

FEATURE STORY

Among the Changes in Healthcare

Te c h n o l o g y Has Taken Center Stage

Theodore A. Groskreutz, M.D.

PTR is an electronic system that uses a computer and phone lines and acts as a private voice mail system for patients to retrieve their test results.

O

OF ALL THE NUMEROUS CHANGES in healthcare in the past decade, technology has probably been the most predominate in changing the way we provide healthcare.

These technological advances have been primarily positive changes. Technology has allowed physicians to more accurately diagnose and care for patients in ways never before possible. Most recently technology has changed the way healthcare is being delivered, allowing improved patient flow, providing more accurate patient care, and reducing healthcare costs.

In the past two years at our clinic, Crossroads Medical Centers, we have instituted three new programs, each one being new to the market. Crossroads Medical Centers, PA, is a primary care practice with clinics in Chaska, Prior Lake, and Shakopee. Our goal at Crossroads is to use technical advances which allow our clinic to provide quality healthcare while reducing costs. The three programs we have implemented include Patient Test Results (PTR), Speech Recognition Transcription, and Allscripts速 (an electronic prescription system).

Patient Test Results Of these three programs, PTR was our first. Our reason for implementing PTR was twofold: it adds patient convenience, in addition to reducing out of file charts and the time spent filing charts and calling patients. PTR is an electronic system that uses a computer and phone lines and acts as a private voice mail system for patients to retrieve their test results. Messages are recorded by either a physician or a nurse. A specific patient code is given to the patient at the time of the visit; this code remains the same for each following visit. For patients to retrieve their results, they call the PTR phone number and then enter their specific code to listen to their test results. Patients can call PTR 24-hours a day and can listen to their messages numerous times. To record patient messages, a physician or nurse calls into PTR and, with just one phone call from anywhere, can leave unlimited messages. When leaving test results on PTR, the physician or nurse has one of two options: leave a pre-recorded standard message, or a custom message. We found it very efficient for each physician to pre-record numerous standard test result messages that are used quite frequently, taking only seconds to leave a test result message.

PTR also assists with quality assurance and security. The system logs all calls and can report which messages have or have not been retrieved. The use of physician and patient codes assures security. The result is that our physicians and nurses find it very easy to leave PTR messages and enjoy using the system. The number of out of file charts has decreased

BY ERIC NIELSEN AND THEODORE A. GROSKREUTZ, M.D.

4

January/February 2001

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

and the time spent on making additional phone calls has been reduced. The only negative is that some elderly patients have a difficult time using the system, and a few patients have lost their code, but the overall response from patients has been extremely positive.

As a whole, we have been very pleased with the addition of the PTR system.

Voice Recognition Transcription The second of our recent technical initiatives is Voice Recognition Transcription. In the past year we took a giant step from rolling blank progress notes into a typewriter to computerized transcription with software that can transcribe a physician’s dictation via voice recognition. Unlike PTR, which was quick to implement, voice recognition does have a notable training period. Voice recognition is a learned software, meaning that each time the software makes a mistake in recognizing a spoken word and it is corrected, it knows the correct word next time. In our case, the new role of our transcriptionists has changed from transcribing, to editing and correcting what the computer transcribes, which we call perfecting the voice file.

Each physician establishes his/her own trained voice file. Our physicians continue to dictate into an analog dictaphone. Instead of the transcriptionist listening to the tape and typing, the computer listens to the tape and transcribes it, and then the transcriptionst edits the dictation. However, this system has required the physicians to articulate more and does require punctuation for the system to work effectively. The software sophistication not only recognizes words, but content of what is being spoken. The developers of the software state that a trained voice file can result in 98 percent perfection. We have yet to see that success, but we have seen positive results. With the physicians who started using voice recognition six months ago, we now see approximately 85 percent perfection and a drastic reduction in transcription time. It has only been a few months since we have completely implemented voice recognition for all of our physicians. We are currently staffing five full-time transcriptionists, one less than a year ago, and have added two physicians.

The second phase of this system has been the creation of physician specific templates, technically known as macros. Instead of a physician having to dictate the whole note of a regular visit, the dictation would consist of only the macro name for a specific S.O.A.P. template and then dictate any edits or additions needed to the template. This has been a real time saver for both the physician’s dictation time, and the transcriptionist’s time.

Another benefit of our voice recognition system is that it has assisted us in the start of (Continued on page 6)

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

In the past year we took a giant step from rolling blank progress notes into a typewriter to computerized transcription with software that can transcribe a physician’s dictation via voice recognition.

Eric Nielsen

January/February 2001

5

(Continued from page 5)

an EMR (Electronic Medical Record).

Each patient note is being electronically saved on our transcription server, enabling easy retrieval of patient notes, while giving our clinic a foundation for a future technical implementation, EMR. The overall result of this system also has been very positive. The transcriptionists have really enjoyed and have been very successful with this change. Most physicians adapted well, with only a few experiencing difficulties with the needed changes in dictation style.

The system has already paid for itself and the physicians are now seeing a quicker turn-around time on their dictation. We are eager and optimistic for the future of our voice recognition system as it continues to improve.

Allscripts® The most recent technical addition is Allscripts® (an electronic prescribing system). Allscripts® is still quite new on the market but it is quickly acquiring market share, especially in Minnesota. In our application of Allscripts® the software interfaces with our scheduling system so the Allscripts® system knows which patients will be seen for a specific day, which physician each patient will be seeing, and what insurance each patient has.

When a physician prescribes medication through Allscripts® the appropriate patient is selected from the wireless handheld computer. Then the physician selects the appropriate diagnosis and medication; this is called “three-touch prescribing.”

These wireless hand-held computers are controlled through both a small keyboard and a touch screen making selections quick and easy. The system notifies the prescribing physician what medications may be appropriate for the indicated diagnosis on the particular patient’s insurance formulary. Being able to easily prescribe within a 6

January/February 2001

patient’s formulary has been a significant benefit.

The Allscripts® software has also been beneficial in assisting the physician with diagnosis codes. As a physician uses Allscripts® the software learns what medications each particular physician most often prescribes for a diagnosis. It then lists them in order of most often prescribed when that specific diagnosis is selected. The software knows by a sign-in and password which database of information is associated with the signed-on physician.

Once the physician completes the prescribing process, which can take less than a minute for a basic diagnosis and prescription, the information is instantly transmitted via radio frequency to the dispensing station computer. At this point in the process, at our clinic, it is the nurse’s responsibility to do one of three options with the pending prescription. By patient’s choice, the prescription can be printed, faxed or dispensed. If the patient prefers a printed prescription, the computer prints a clearly legible script with a legal electronic signature for the patient to hand carry to their pharmacy of choice. If the patient wants the prescription to be faxed to their pharmacy, that prescription can be directly faxed from the computer to any pharmacy, saving the patient wait time at the pharmacy. The third option is to dispense the medication in the clinic.

There are two important components for dispensing medication in the office.

First, the appropriate inventory of medications must be established and monitored.

Secondly, to dispense to a patient, the patient must have insurance with a PBM (pharmacy benefit manager) that Allscripts® has a contract with in order to adjudicate the claim.

This system provides many other benefits, such as a drug history for each patient and drug interaction warnings. It also makes refills quick and easy for the physiMetroDoctors

cians and nurses. In many ways, this system is a tool for quality assurance. A statistic given by Rick Gasaway, VP of Allscripts®, is “About 3 billion prescriptions are written a year on paper by healthcare providers, of those an estimated 16 percent are illegible.” At our practice this system is already a success with our patients, but complete satisfaction from our physicians is yet to be determined. In addition to preferring e-prescribing to hand written prescriptions, a practice must dispense enough medication in-office to pay for the expense of the system. This type of system entails a huge learning curve, and is still far from perfected. However, we see it as an excellent concept and feel it truly possesses potential for the future of healthcare.

Summary As a whole, these technological initiatives we have entered into these past two years have been very successful. For such success these types of programs require complete buy-in from all involved, especially the physicians. It also requires a great deal of planning, patience, and persistence to make these initiatives a success. As we have seen at Crossroads Medical Centers, the results can be very rewarding for both the practice and its patients. ✦ Theodore A. Groskreutz, M.D. is president of Crossroads Medical Centers, P.A. He is a board certified family physician and has been with Crossroads since 1975. Eric Nielsen is the assistant administrator for Crossroads Medical Centers, P.A. He received his degree in Healthcare Administration from Concordia College, Moorhead, and is currently working on his MBA at the University of St. Thomas. Mr. Nielsen has been the recipient of the Thomas W. and Mary Kay Hoban Scholarship for the past two years.

The Journal of the Hennepin and Ramsey Medical Societies

Minnesota Specialty Physicians: An Advocate for Independently Practicing Specialist Physicians

I

IN A MARKET that is economically dominated

by consolidated health plans and systems, organizations like Minnesota Specialty Physicians (MSP) may be imperative to the survival of independently practicing physicians. MSP was formed in 1993 and now represents 52 clinics and more than 570 specialists in the Twin Cities market. In this article, we will explain what MSP does and why it is so important to our member clinics.

MSP believes that physicians practicing independently in a competitive market can offer the public the best combination of quality, accessibility and affordability of patient care.

Based on this belief, MSP is committed to promoting the success of independent clinics by: • building relationships on behalf of our clinics with other parts of the health care community; • providing access to resources that individual groups may be too small to secure on their own; • leveraging our collective size to realize discounts and economies of scale; and • advocating for a “level playing field” and a competitive health care market.

Forging partnerships with others to better serve the public is a major thrust of MSP. Studies have shown that specialist physicians manage about 75 percent of health care costs. Yet it is common for specialist physicians to be excluded from meaningful input as to how and where care is provided. As a result, care is frequently not as cost-effective as it could be. For example, procedures may be performed at unnecessarily expensive facilities or diagnostic tests ordered from unnecessarily expensive locations.

MSP attempts to create relationships with health plans and primary care physicians that align fi-

BY HARRY HOPPMANN,M.D. A N D D AV I D W. A L L E N, J R .

MetroDoctors

nancial interests and provide specialists with an opportunity to contribute to a “win-win” approach to serving patients.

Our most substantial partnership to-date has been our involvement with the Minnesota Healthcare Network (MHN). MHN is a network of about 30 primary care clinics representing more than 200 Harry Hoppmann, M.D. David W. Allen, Jr. physicians. MHN has risk contracts with several health plans and MMIC, the malpractice carrier, that allows covers more than 50,000 enrollees. MSP’s partour groups to participate in risk pooling nership with MHN is a 50/50 relationship in in a manner that significantly reduces malvirtually every respect and, as a result, primary practice premiums. care physicians and specialist physicians have a • TRIIUM and MSP are also active in the shared interest in delivering optimal care. To area of informatics, providing guidance and date, we are obtaining some of the best cost information to groups on the rapidly changmanagement results of any care system in the ing information systems environment. region.

MSP also devotes substantial energies to The assistance and support that MSP probeing a public voice on issues important to invides to our member clinics is often through dependently practicing specialists. We have long our affiliate corporation, TRIIUM. TRIIUM opposed the sick tax and are working hard to offers a number of valuable services to member increase understanding of how this tax diminclinics and, in some cases (for a fee), to nonishes the quality and availability of health care member clinics: services. More recently, we have been spreading • The TRIIUM group purchasing organithe word about how consolidation of health zation has relationships with dozens of vensystems increases costs and decreases patient dors and saves groups, on average, more choice. than 15 percent off of the best prices availHealth care in the Twin Cities is at a critiable to individual groups. cal moment in history. What happens over the • TRIIUM financial management services next several years will probably determine help assure that reimbursement is consiswhether we have a competitive and vibrant tent with contractual terms entered into marketplace, or we all end up working for the by the group. government or a few big health systems. MSP • TRIIUM is now becoming licensed as an strives to be a positive force for a competitive insurance agency so that we can focus on marketplace. ✦ the unique coverage needs of medical groups, while improving the competitiveness of group’s recruiting and employee reHarry Hoppmann, M.D., is Chairman of the tention goals.

Board, MSP, and David W. Allen, Jr., is President • MSP has a long-standing relationship with and CEO.

The Journal of the Hennepin and Ramsey Medical Societies

January/February 2001

7

Employers and Health Care

A

AFTER A PERIOD of relative calm, health care

costs are once again rising rapidly. According to a Hewitt survey published in a recent edition of the Minneapolis newspaper, health care costs in Minnesota have risen 17 percent during the last 12 months, approximately twice the national average. A variety of factors may contribute to this dramatic increase: cost shifting to private employers caused by inadequate Medicare reimbursement to Minnesota providers; consolidation of health plans, hospitals and other providers; government regulations; health care taxes and assessments; increased and inappropriate utilization of services and drugs; increased prices of drugs; an aging population; consumers lack of a vested interest in the money they spend on health care; medical errors; the reluctance of many of us to adopt healthier lifestyles; and the one reason for which I believe we should be thankful — advances in medical science and technology which have improved the quality of our lives.

These factors have led some authorities to question whether we should abandon our present employer-based system. Our system appears to work reasonably well for our largest, self-insured employers, but small employers are finding it increasingly difficult to sponsor health care plans. It is important to note that most employers are small employers. Based on 1997 employment data, 52.8 percent of our citizens employed in the private sector work for firms which employ fewer than 100 employees. It is also important to note that substantially all new jobs in our economy are generated by small businesses, with fewer than 500 employees. Small employers face substantially higher costs in sponsoring health care programs for their employees than do large self-insured employers. In 1991, when we experienced the last real surge in health

BY BERNIE REISBERG

8

January/February 2001

care cost increases, costs for employers of fewer than 1,000 employees rose by 17.3 percent, while costs for employers of more than 1,000 employees rose 9.6 percent. There are a number of reasons why this is true. The deficiency in the Minnesota Comprehensive Health Association (better known as MCHA), the only source of health insurance for those individuals who are unable to purchase coverage in the commercial market, is financed by an assessment on health plans and insurance companies. Since most small employers and individuals rely on fully insured products in providing health care to their employees, it is they who pay this assessment. Because of the Federal ERISA preemption, self-insured plans escape this assessment.

By any definition of fairness this burden should be financed by a broadly based source of revenue, rather than on the already burdened base of smaller employers and individuals who rely on the fully insured market. Further, Minnesota levies a 2 percent premium tax on insurance premiums, including health insurance, the proceeds of which go directly into the general fund. With record surpluses it seems reasonable to repeal the premium tax on health care. It is clear that many small employers now attempt

to escape these costs by self-insuring their risk, when more conservative counsel would recommend otherwise. Also, the underwriting policies of insurance companies tend to create extremely large variances or swings in premium costs among small employers. It is not uncommon for small employers to experience increases one year of 35-40 percent and increases the following year of 5 percent. Large claims, such as terminal cancer, organ transplants, and premature births, cannot be stabilized unless spread over much larger populations than the typical small employer. Further, the “hidden cost shifting” of the low government reimbursement rates for public program beneficiaries seem to fall harder on small employers.

The debate will go on with respect to whether we should totally abandon our employer-based delivery system and adopt a single payer system, such as we see in the rest of the industrialized world; however, in the short run there are changes we can make in the existing system at either the state or federal level which would encourage more small employers to sponsor health care plans for their employees. Small employers should be allowed to utilize the same tools and techniques available to large employers. First, small employers must be part of a large enough population to stabilize their claim costs.

Unrelated small employers who have collective bargaining agreements with a single union can band together under the ERISA “umbrella,” selfinsure the risk of their health care plans, stabilize their claims cost, and escape state regulation, taxes and mandates. Other small employers do not enjoy this benefit. At the state level, we could find a more broadly based source of revenue with which to finance MCHA; we could repeal the tax on health insurance premiums; we could do a better job of evaluating technology before it is mandated; and we could modify our Mutual Employee Welfare Association statutes to allow

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

small employers to band together to self insure their risk, and still retain sufficient regulatory oversight to guarantee the financial integrity of the self insured funds. It is worthy to note that a provision of the Norwood Dingle bill, presently languishing in a Congressional Conference Committee, appears to provide this opportunity through Trade Association sponsored plans.

Unfortunately, the Norwood Dingle Bill (or so-call Patients Bill of Rights) also contains a provision which would adversely impact all employers but could precipitate the demise of small employer sponsored plans. This provision would impose liability on employers for decisions made by health plans, thus adding a very costly risk to all employers sponsoring health care plans. Many small employers have indicated that the imposition of such liability would lead them to drop sponsorship of health care plans.

I am confident that the insurance industry could craft additional coverage to insure employers against this risk, but at a significant additional cost. Actuarial studies show that every 1 percent increase in health insurance premiums result in 3,000 Minnesotans losing or dropping their health insurance coverage. Small employers who buy fully insured policies from state regulated insurance companies should not have to worry about being sued by a participant beneficiary. If anything, the regulatory agency should step in on the employer’s behalf. Similarly, large, self-insured employers should not have to worry about such liability if it delegates the administration and review process to an independent panel.

If these changes in the law would be made at either the state or federal level, and the liability provisions of the Norwood Dingle Bill be defeated, I believe our employer based system would continue to function well and should be retained. First, and of greatest significance, all authorities on the subject seem to acknowledge that we need the employers’ contribution to the health care system. To eliminate our present voluntary system of employer sponsorship would necessitate some sort of governmentmandated contribution from employers. I also submit that employers have a vested interest in non-occupational health of their employees, just as surely as they do in the safety of their employees while at the work place. Employer sponsorship of, and contribution to, health care plans provides them with incentive to support healthy MetroDoctors

lifestyles among their employees, to sponsor programs such as smoking cessation, prenatal care, diet and nutrition programs, and other wellness programs, as well as providing the incentive to educate their employees to use the health care system in an efficient and appropriate manner. Further, by sponsoring health insurance plans employers serve as the point of entry to the health care system for most of our citizens. If employers did not provide this service and absorb the costs, it would likely fall on some level of government.

In summary, small employers must be able to aggregate their employees into large enough populations to stabilize their claims costs, to buy specific services at competitive market prices, and resist the pressure of cost shifting from the large public programs and self-insured plans to the smaller fully insured plans. If we can achieve these changes, placing small employers on the same “level playing field” with large employers, and defend our system against unreasonable and unwarranted liability, I believe we can, within our existing system, deter further erosion in the sponsorship of plans by small employers, and hopefully expand health care benefits to employees of our smallest employers.

The Journal of the Hennepin and Ramsey Medical Societies

Here in Minnesota, the Employers Association, the Southwest Development Commission and the University of Minnesota, Crookston, are attempting to build new models of small employer group purchasing under a 1997 law called the “Community Purchasing Arrangements Act.” Under this state statute, employers can share “pooled” risk with a group of providers willing to sell their services directly to a small employer Purchasing Alliance. As has been demonstrated by large employer purchasing groups, when providers and employers work together with consumers, choice, quality, efficiency and accountability can be improved throughout the system. ✦ Mr. Reisberg is a shareholder and Chairman of the Board of Directors of Goodin Company. He is Chairman of the Board of the Employers Association of Minnesota Health Care Buyers’ Coalition; serves on the Board of Trustees of North Memorial Health Care; is a member of the Employee Benefits Committee of the U.S. Chamber of Commerce, and chairs the Health Care Policy Committee of the Minnesota Chamber of Commerce. He served on the Minnesota Health Care Commission as an employer representative from 1993 to1997.

January/February 2001

9

COLLEAGUE INTERVIEW

Harry F. Hull, M.D. Editor’s Note: “Colleague Interview” provides HMS and RMS members with an opportunity to ask questions of their colleagues who are in unique roles. Dr. Harry Hull, the new State Epidemiologist and Director of the Division of Infectious Disease Prevention and Control for the Minnesota Department of Health, is a graduate of the Johns Hopkins University School of Medicine in Baltimore, Maryland. He is a board-certified pediatrician, having served as a resident in pediatrics at the University of Arizona in Tucson and the University of Washington in Seattle. He was trained in epidemiology at the Centers for Disease Control in Atlanta, Georgia. His career has been focused on the prevention and control of infectious diseases. His previous assignments include directing the global polio eradication initiative for the World Health Organization in Geneva, Switzerland and serving as the State Epidemiologist for New Mexico. He has published nearly 100 articles in the scientific literature and is an international expert on polio, measles and bubonic plague.

Q A

Is there a concern about smallpox returning?

Smallpox was eradicated in 1977, with the last naturally occurring case in Somalia. The virus no longer exists in nature and there should be no concern that it could come back from natural sources. After all, children have not been vaccinated worldwide for more than 20 years and, if the disease were going to come back, it would already be evident. It should be pointed out, though, that the last case of smallpox actually occurred in England, resulting from an escape of variola virus from a research laboratory. Smallpox virus is still stored at the CDC in Atlanta and in Russia. Bioterrorism experts are concerned that smallpox might be used either for military or terrorist purposes. To safeguard against this possibility, the US government is creating a stockpile of smallpox vaccine.

What does the state do when pandemics occur?

A pandemic is a global resurgence of an infectious disease. The leading candidate for future pandemics that would affect Minnesota is influenza.

Approximately every 25 years, there is a major antigenic shift in the influenza virus. Because this is a new virus, the population has no immunity and a pandemic results. Influenza pandemics in the 20th century include the Asian flu of 1957, the Hong Kong flu of 1968, and the Spanish influenza 10

January/February 2001

of 1918-1919. The Spanish flu killed at least 500,000 people in the United States. A pandemic as severe as the Spanish flu could kill more than 20,000 people in Minnesota. Hospitals would be filled to overflowing and essential community services would be interrupted. The state has developed a plan for the next pandemic, which calls for government purchase of vaccine for the entire population and mass vaccination clinics.

Does the state still maintain a disease reporting system? If so, how is it used?

Yes, most definitely. The infectious disease surveillance system is a core function of the Minnesota Department of Health. State law requires all licensed health care providers to report 63 infectious diseases. Surveillance data is used to monitor disease trends, detect epidemics, design control strategies and evaluate our efforts to protect our citizens from infectious diseases. The recommendations the Department makes to Minnesota physicians on how they can best protect their patients are based on surveillance data. While many reports come directly to the Health Department from laboratories and hospital based infection control practitioners, physician reports are essential. A complete list of reportable MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

diseases can be found on the MDH website at www.health.state.mn.us/ divs/dpc/ades/ades.htm. Disease reporting forms can be downloaded from the website. Infectious diseases can also be reported by calling 1-877-676-5414.

How real is the threat of bioterrorism in this country/state?

The threat of bioterrorism is real, but it is difficult to quantitate how large that threat is, where it will occur, and which agents would be used. In this situation, the best strategy to pursue is to maintain an efficient, timely disease surveillance system to detect a bioterrorist event at the earliest possible moment and to have a response system organized. The state has been working closely with both local authorities and the federal government to ensure that we can respond efficiently and effectively to any eventuality.

There are an increasing number of immigrants to this country with HIV/AIDS and tuberculosis. As treatment for these diseases is available in the United States, is this a magnet issue? How can or do we pay for this?

Recently, attention has been focused on HIV positive refugees arriving in the state. The number of these persons involved is quite limited because they must qualify for refugee status — be seeking asylum because of religious or political persecution — and are being admitted to be reunified with family already here. Medical care for these people is covered for a limited period by the federal refugee program. Long-term HIV treatment for most is provided under the federal Ryan White care program. Many more immigrants are arriving in Minnesota because of the economic opportunities present here. A large proportion are from countries where tuberculosis is highly endemic. Many have latent tuberculosis infection and a few have active TB. The Department of Health is hopeful that additional funds for tuberculosis outreach can be appropriated by the legislature to ensure that all infected persons receive their full treatment and pose no risk to the public’s health.

What are your public health goals for the state?

In my role as state epidemiologist and director of the Division of Infectious Disease Prevention and Control, my priorities are to maintain the leadership of the Minnesota Health Department in controlling infectious diseases and the excellent working relationships between the Division, the medical community and the local health departments. While we have superior childhood immunization programs, there are populations within the state that have lower immunization coverage. We must reach out to them so that all children are protected. Minnesota’s adult immunization program is above the national average, but nearly half of persons over 65 are not vaccinated with the pneumococcal vaccine and a third are not vaccinated against influenza. Accordingly, we must improve our adult immunization program. There are many new vaccines in the research and regulatory pipeline. The Division must be prepared to advise both physicians and the general public on the use of these vaccines.

While we must continue our efforts to prevent new HIV infections, efforts to control other sexually transmitted diseases should be improved.

STD rates in some minority populations are 10 times the rate of the white population and we must rethink our approach to the problem. Food borne disease remains a continuing problem, as a result of changing agricultural and food processing practices and the globalization of the food supply.

Emerging diseases, re-emerging infectious agents, antimicrobial resistance and the threat of bioterrorism challenge us to improve our surveillance and our capacity to respond to epidemics. The decreasing use of cultures due to cost containment and the use of new molecular methods pose a particular challenge to our surveillance system. ✦

What is the long-term impact of the increasing use of antibacterial soaps by the public?

Questions have arisen about the use of triclosan in anti-bacterial or deodorant soaps. Although tolerance to triclosan has been demonstrated in the laboratory, there are no clinical reports of resistance. The more important question, though, is hand washing in medical settings. While Semmelweis proved the role of medical staff in transmitting infection in 19th century Vienna, hand washing in many medical facilities remains sub optimal. A recent article in the Lancet demonstrated that creating a culture of hand washing reduces nosocomial infections. Other studies have found that the practices of leaders, particularly physicians, have a strong influence on the practices of other members of the staff. Alcohol based hand washing products are increasingly being used in hospitals. Alcohol acts by a different mechanism than the antiseptic agents. No resistance to alcohol has been reported.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

January/February 2001

11

Payer Options: Anything New?

I

IN SEPTEMBER, Hennepin and Ramsey Medical Societies joined forces with Minnesota Medical Group Management Association (MMGMA), Advocates for Marketplace Options for Mainstreet (AMOM) and Midwest Medical Insurance Company, to pose the question to Minnesota’s health plans: What new options do you have for physicians?

Over 100 physicians, clinic administrators and others attended the September 19 Health Plan Forum. The purpose was “to provide physicians and medical administrators first-hand information regarding new options which may be available to them from Minnesota’s health plan companies or other payer ventures.” Allina, Blue Cross and Blue Shield of Minnesota and Wisconsin, Business Health Care Action Group, Definity Care (formerly HealtheCare), HealthPartners, and Vivius participated.

State Representative Fran Bradley, chair of the Health and Human Services Committee set the stage, with introductory comments about what is expected from the health care industry.

According to Bradley, “good science…good value for taxpayer money, and quality” are what is expected by policymakers. Bradley emphasized his continuing commitment to eliminating the “sick” tax (2 percent provider tax) and resolving the disparity in the MCHA assessment (Minnesota’s program for the uninsurable) that is currently funded by small businesses and individuals.

Other areas to focus on, according to Bradley, are prescription drugs, mandates, and “the conceptual flaws of the third party payer…with the consumer disconnected from the cost” of the care.

Debora Kunferman of Blue Cross and Blue Shield United of Wisconsin then spoke of some

BY ELISABETH QUAM BERNE

12

January/February 2001

of her company’s newer efforts, including a strategic partnership with HealthPartners in some border communities. She also said the company had a new goal of returning provider inquiries within two days and claims adjudication done within 14 days.

Participants had a chance to meet and hear from Dr. Meredith Mathews, the new interim Chief Medical Officer for Medica Health Plan.

Mathews talked of his company’s focus groups on how to make employers’ costs more predictable. He said Medica was not, at the present, making product changes because of its almost singular goal for “better operational soundness.”

He also argued that the “speed of payment” is “influenced by simplicity” throughout the system. Mathews said he was committed to “physician listening” and a “care coordination approach…the compensation system must support care coordination.” He promised there would be “more to come” on the care coordination issue in the near future.

The audience then turned its attention to a start-up venture, called Vivius. David Teckman, president and CEO of the company, explained the fundamentals of a new design model for defined contribution health care coverage. He said the company had targeted Minneapolis, Denver and Kansas City to roll out its product, which allows each enrollee to individually choose a panel of physicians, thereby offering price competition. He said the model has three components: an MSA or flexible spending account; a “personalized, prepaid primary network; and a high deductible “wrap around” health insurance coverage. With vehemence, he said that the goal of Vivius is to “open the health care marketplace.”

Ann Robinow, of Buyers Health Care Action Group (BHCAG) and principle in the affiliated Patient Choice Health Insurance (PCHI) talked of BHCAG’s decision to grow the enMetroDoctors

rollment in a care system model. Through the new PCHI, she hopes to enroll mid-sized selfinsured companies in this product design nationally. The company also hopes to eventually enter the small employer market, probably with a large insurer partner.

Dr. Tom Valdivia, Chief Medical Officer of Definity Health (formerly HealtheCare) then took the podium and described the design of his product, for a company that has many major institutional investors, from Price Waterhouse and Aon to Wells Fargo bank system. He said the Personal Care Account is much like an MSA and can be “layered with a flexible spending account.” The company’s goal is 10,000 enrollees between the Twin Cities and Chicago by January 1, 2001.

As medical director for HealthPartners, Dr. Maureen Reed, said her company was also interested in the defined contribution model.

Through focus groups, HealthPartners has found that consumers have a “distrust” of the current system and that there is a great deal of “misinformation.” She said she was “deadly serious” about finding better options, including her company’s new focus in three areas: an open access product; improving behavioral choice; and removal of prior authorization. Regarding behavioral choices, Reed said HealthPartners has set five-year goals for depression, heart disease, diabetes, tobacco, diet, and physical activity. In addition, HealthPartners has set a goal of reducing medical errors by 50 percent.

Finally, Jan Lysen, Vice President for Account and Network Management for Blue Cross and Blue Shield of Minnesota, offered a brief presentation. She said there were two ways for physicians to work with her company: through the open access products or through a Preferred Provider Network (PPN) through a clinic or care system. Lysen said her company was “not introducing major changes” in products or payment The Journal of the Hennepin and Ramsey Medical Societies

systems at this time. She said that the company was researching “affordability options” such as networks, benefits approach, contribution strategies, financial risk management and valueadded services. “We see real utilization changes with deductibles,” for the patient, Lysen said.

Health improvement goals will be focused on tobacco, heart disease and influenza.

A summary of issues raised and answers: What are the options for clinic employees looking for more affordable health care coverage now? Only the traditional health plans, Medica, the Blues and HealthPartners currently offer a product to small employers.

How could administrative costs, which some studies indicate are as much as 40 percent of the premium dollar for smaller employers, be reduced? Teckman touted Vivius’ 4 percent administrative fee (this would not include the insurer’s administrative fee for offering the accompanying high deductible coverage). Teckman also said the internet could “take a lot of the administration out of the system.”

Mathews of Medica said “reducing administrative costs” had to be a focus for the whole system.

Robinow of BHCAG focused on “data for providers,” to assure good quality, plus “more consumer responsibility, web technology, innovation in health care delivery.” She also stressed that “providers can and need to take their destiny in their own hands.”

Valdivia of Definity Care emphasized that administration costs could be much lower with his product design because there is no prior authorization, no referrals and “we do not have an incentive to withhold payments.” He said his vision was “physicians setting their own prices and consumers free to buy.”

Reed of HealthPartners said the Twin Cities is being challenged because of the “arrival of for-profit” companies. She said the affordability issue may get worse before it gets better. She suggested that there were no “quick answers” and that defined contribution may be “vitally challenging” the whole system when there are “pockets of problems” with access. She said that “keeping people healthy” and “aggressive medical intervention” were the long term solutions.

Lysen of Blue Cross and Blue Shield of Minnesota answered both questions more directly, saying “we can help you look at more MetroDoctors

and different options” for clinics struggling with employee health care cost increases. In a broad comment on previous speakers’ comments, Lysen said her company “would stick out as being serious to protect (patient) privacy” as new models and compensation formulas are developed.

As the evening grew late, and the audience yearning to hear more, it was agreed that questions would be submitted to the plans in writing for their timely response. Below are the questions and responses received to date.

Responses to the Audience’s Follow-up Questions Four companies chose to offer responses to the audience’s follow-up questions. However, these respondents did not all answer the same questions. The responses are included here with only minor editing. Including the responses in full does not necessarily indicate agreement on the assumptions and conclusions by the sponsors of the Health Plan Forum.

MED: Dr. Meredith Mathews, interim Chief Medical Officer for Medica Health Plan; BC: Jan Lysen, Vice President, Blue Cross and Blue Shield of Minnesota; HP: Dr. Maureen Reed, Medical Director for HealthPartners; and DH: Dr. Tom Valdivia, Chief Medical Officer of Definity Health (formerly HealtheCare) 1. (addressed specifically to non-health plans) Do you currently offer a product for small employers and/or individuals? If not, why not?

DH: We do not currently offer a product for the small employer. We are currently finalizing our agreement with the world’s largest insurer.

We look forward to offering small employers a product by spring of 2001.

2: (addressed specifically to non-health plans) At what rate will the physicians be paid? At a negotiated discount rate? At the usual and customary charge rate? If it is at a reduced rate, how will that rate be agreed to?

DH: There are two very different answers to this question depending on the timeframe. The first is what will be occurring in the first year, 2001. As mentioned we will be working with our partner, PreferredOne for the local market.

PreferredOne will reprice our claims and then

The Journal of the Hennepin and Ramsey Medical Societies

send them on for payment by our TPA. Claims will be repriced at the contracted rate based on your PreferredOne fee schedule. The reason we are starting this way is manifold. First, it allows us to give our local members a broad network from which to choose right away. If we had chosen to recontract the Minneapolis market directly, we would have had a relatively small offering for our current and effective 1/01 customers. Secondly, we needed to offer our customers a discount off of retail prices. As you may recall from the presentation, our members will have access to Personal Care Account dollars that they will spend on health services. Asking them to pay for services at retail prices (which few actually pay) would be untenable.

Setting compensation based on the current PPO negotiated model is not our ideal, despite its short-term advantages. Our desired model is to compensate providers for non-emergent or discretionary care based on prices that they set.

More specifically, this means moving to a true market for many health services — providers set their prices and consumers include that information when they choose their provider. We will be taking steps during 2001 to change provider contracts to allow for them to set their own prices for services and to allow us to disclose those prices to the consumer.

3: We talked about employer-based insurance.

What is happening to establish risk pools and buying cooperatives for individuals?

MED: The individual market is largely dominated by BCBSM with 56 percent marketshare using 1999 data. The next largest carrier is HealthPartners with 11 percent market share.

The current regulatory rules require community rating for pricing purposes but not guarantee issue. Therefore, only healthy individuals can purchase coverage. Individual policy rates have been increasing between 10-15 percent per year for the last few years.

Unhealthy individuals purchase coverage from the Minnesota Comprehensive Health Association (MCHA). The MCHA premiums are heavily subsidized by assessments made against all health insurance carriers operating in Minnesota [Editor’s note: MCHA assessments are passed through to small employers and individuals through a premium assessment; the assessment is not paid by large, self-insured employers].

(Continued on page 14)

January/February 2001

13

(Continued from page 13)

The regulatory environment for individual products is in a state of flux with numerous market reforms being considered. We don’t expect much change to the market until after the next legislative session.

BC: Blue Cross and Blue Shield of Minnesota today offers coverage in the individual market.

Individuals who apply for coverage are subject to health underwriting and pay premiums based on their age. Today, over 100,000 individuals are covered in the Blue Cross pool. Market reform would be needed to enable health plans to offer coverage without health underwriting.

HP: There are products available for purchase by individuals in the market today. Carriers that offer them have established risk pools to support the programs. In many ways these individual product risk pools operate very much like employer groups. HealthPartners does offer a portfolio of health insurance products to individuals. In that HealthPartners operates under a cooperative model with a consumer-run and

consumer-elected board of directors, it is in fact a buying cooperative for individuals.

Aside from carriers participating in this market, the State of Minnesota also operates a risk pool for individuals that cannot purchase health insurance at standard rates. The rates and benefits under this program are actually very competitive with those offered in the open market.

4: When will you change experience-rating approach for small business and move to a community-rated product option for small business?

Experience rating small business is what is causing the horror stories for 60-100 percent of the price increases.

ation is given to specific case experience, where the specific case is within index, and what is expected for future claims. The carrier will use a blend of actual plus block experience to finalize specific employer rates. Generally, we have seen the market limit small group rate increases to no more than 4-45 percent (moving from low rates within the index range to high).

Full Community Rating of small groups was not part of the 1993 reform in Minnesota.

Only a few states adopted Community Rating because most did not mandate coverage. Florida is moving away from Community Rating due to the financial insolvency of carriers caused in part by Community Rating.

MED: Small group reform was implemented in Minnesota in 1993. By law, all small group pricing must be within a 25 percent corridor of a filed and approved index rate. Each carrier files their index annually based on actual experience of the block adjusted for expected medical trend inflation. Average index rates have been increasing 12-20 percent for the last few years.

Specific employer rates within the block will vary more than the index filing. Consider-

BC: Small groups in Minnesota are able to buy coverage with guarantee issue for their employees. Small groups are not experience rated. Instead they are rated on the health risk of the group and the overall need of the small group pool. Small group market reform requires that rates for a small group cannot vary more than 25 percent from an index rate. This means that many groups with high claims costs are able to pay premiums at a much lower rate than if they

RMS Membership Advantages for Physicians and their Practices ➢ Office Supplies – US Office Products • 651-639-4700 25-40% discount on a full-range of office supplies and office furniture. Free delivery. www.gop.usop.com

➢ Collection Services – Allied Interstate, Inc. & First Contact, Inc. • (800) 447-2934 A medical collections agency with over 25 years of experience. www.alliedinterstate.com

➢ Auto Leasing – Boulevard Leasing, Inc. • 612-781-8449 Competitive rates and flexible lease terms on the car of your choice.

➢ Confidential Data and Material Destruction – Document Destruction Service • 612-898-3030 Discounts up to 27% for on-site shredding, destruction, disposal/recycling of all sensitive documents.

➢ RMS Gold or Platinum – MBNA America • (800) 847-7378 ext. 5000 Credit up to $100,000 for Platinum and $25,000 for Gold cards.

Products and Services Offered to RMS Members by RCMS, Inc. For more information call 612-362-3704.

14

January/February 2001

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

were experience rated. Minnesota statute also requires that health plans offering small group coverage must meet loss ratio requirements for their small employer pool. Premium increases for small groups have been related to overall health care claims trends, which have increased substantially over the last three years.

HP: The introduction of fully community-rated programs for any market segment would require dramatic restructuring of the marketplace. It will not happen under the rules currently in place.

It should be noted that fully community-rated plans used to be available. Purchasers actually chose to move to experience-rated plans instead despite the additional volatility associated with them. Small employers that are getting lower rates, and lower rate increases due to experience rating tend to prefer the experience-rating approach. Fully community-rated plans ceased to exist because the market would not support them. The small employer market in Minnesota actually is a combination of experience-rating and community-rating. Small employer groups are not rated based upon experience alone. Experience is just one component.

In fact, it is unlikely that community-rating itself would cause small employer increases to be reduced. The overall premium need does not decrease purely because of a communityrating approach. The distribution of the premium is the more likely thing to change. Under current small employer insurance law in Minnesota, the variation in rates due to health is only 67 percent. There are minimum and maximum rates for each product. Rates can vary on the basis of age demographics also, but if a group’s demographics remain relatively constant, the annual rate change is a combination of trend increase due to inflation plus any change due to health experience. It is a very rare event for any carrier to give a small employer a non-demographic increase in the 60 percent to 100 percent range. Such an increase would only be given in the event of some extenuating circumstance such as fraudulent completion of an application. Even then, an increase in the 60 percent to 100 percent range would take a group from the very lowest rates to the very highest rates available.

5: As a small employer group, our premiums for next year have significantly increased. Please explain why our reimbursement for patient care MetroDoctors

does not go up significantly or even close to premium increases?

BC: Premiums are determined by historical claims cost multiplied by projected claims trends. Claims trends have been greater than originally projected. Claims trends have been in the double-digit range going into a third year.

Claims trends have two parts: utilization and cost. Utilization trends, or the number of services used by a group, account for fully two thirds of our current trend — more office visits, tests and procedures. On the cost side of the equation, the intensity of services or “case mix” has also increased. The price increase for services is also part of the cost side of the equation and has generally been in the overall Consumer Price Index range for the past couple of years.

6: How are providers supposed to make appropriate care management decisions if they don’t know the costs between facilities? What happens for the private pay individual?

MED: We believe the appropriate care management decision are those based on clinical evidence and the health plan works to achieve the best cost at each facility for the members.

7: There has been a great deal of discussion on data and choice, yet when consumers and physicians make choices, they don’t have access to what it costs for services at hospitals. Shouldn’t we rectify this?

BC: Blue Cross’ goal is to negotiate hospital agreements that reflect the market and to that end we continuously seek to eliminate variation in hospital pricing. Blue Cross also generally does not ask physician groups to accept downside risk for the total cost of care. Blue Cross members expect that their physicians refer them to the facility that will provide the best care for their needs.

Blue Cross also takes great care in protecting information that is private or confidential and does not share contract information with unrelated organizations. Aggregate information on care is routinely provided to physician groups that have accountability for enrolled members.

DH: As noted above, we believe that the answer is “yes.” For discretionary services that occur in a hospital, the facility fees and prices

The Journal of the Hennepin and Ramsey Medical Societies

driven by the hospital should be made available to providers and consumers. Not only should consumers and providers have access to cost differences between hospitals, consumers should be made aware of cost differentials between alternative settings for the same procedure and provider. For example, a cholecystectomy performed in the hospital versus an ambulatory surgical setting will often be paid at a higher rate. Helping consumers comprehend these and many other subtleties of the care reimbursement will be an important challenge for Definity Health and other new, consumer-focused health plans.

8. How do we not insulate the patient from the true cost? Are patients being given good cost information of what their physician’s bill or even what the insurance pays?

MED: This is a very important issue for all stakeholders: health care professionals, consumers, employers, and payers. Managed care plans were developed to fill gaps in the health care system, promoting and covering routine disease screening and well baby checkups, for example. “Freedom from paperwork” was also a hallmark. The concept was that when consumers access care within a finite system, the payer/health plan can manage most reimbursement issues without patient involvement. “No claims” was very well received.

It wasn’t very long, however, as health care costs escalated, that plans and providers realized the patients had actually been insulated from the true costs of care and services. When the national debate about inequities in Medicare reimbursement to plans heated up a few years back, and the actual monthly costs were published, many Medica members were appalled to learn that their monthly premiums of under $100 were supplemented by more than $300 in monthly per-member premiums from HCFA. They had no idea what their health care was actually costing. These were members whose employers had covered their entire health plan premium, and absent coinsurance calculations and claims paperwork, they had not been kept informed.

In the area of pharmacy coverage, coverage design has also kept the member in the dark through the frequent use of fixed-dollar copayments. Publishing a formulary designed (Continued on page 16)

January/February 2001

15

(Continued from page 15)

for members, with relative cost comparisons of drugs in the various classes, is being discussed as one option.

Medica and other payers have considered a number of measures to educate consumers about cost. Explanation of Benefits, the “EOB” form that itemizes incurred expenses and ben-

efit determinations, has been re-introduced whenever a member has a financial liability. A proposal to send these EOB’s for every claim for every patient is under consideration, although the administrative costs are significant.

Many physicians and facilities have returned to monthly-itemized statements for the patient, regardless of the insurance coverage. While these statements do cause patient confusion in many

Dermatology, Gastroenterology, General Surgery, Internal Medicine, & Neurology Brainerd There are immediate openings at Br ainerd ollowing Medical Center ffor or the ffollo ollo wing specialties: Dermatology matology,, Gastroenterology Gastroenterology,, Gener General Der matology al Surgery Internal Medicine,, and Neurology Neurology..

Surger y, Inter nal Medicine

P.A. B RAINERD MEDICAL CENTER, P .A. • • • • • •

42 Physician independent multi-specialty group Located in a primary service area of 50,000 people Almost 100% fee-for-service Excellent fringe benefits Competitive compensation Exceptional services available at 162 bed local hospital, St. Joseph’s Medical Center

INNESOT TA B RAINERD, MINNESO • • • •

Surrounded by the premier lakes of Minnesota Located in central Minnesota less than 2 1/2 hours from the Twin Cities, Duluth, and Fargo Large, very progressive school district Great community for families

DMINISTRAT TOR: C ALL COLLECT TO ADMINISTRA

bmc@br ainerd.net bmc@brainerd.net www .br ainerdmedicalcenter .com www.br .brainerdmedicalcenter ainerdmedicalcenter.com

January/February 2001

BC: Blue Cross always provides an explanation of benefits to its members describing the services provided, the charges and the payment made to a provider. We also encourage employer groups to set a goal for how much cost sharing they wish to do with their employees, either through sharing in the premium cost, copays or deductibles and coinsurance.

HP: Employees’ cost sharing is becoming more pronounced as health care costs increase. Recently, defined contribution plans have gained more attention from health care experts and futurists. Under these programs, employees begin to feel more directly the economic repercussions of the choices they make. There is much room for improvement in the information patients get about the cost of care they receive.

Patients always see bills or explanations of benefits when they have some liability for payment of coinsurance or copayments payable after the date of service. If a patient has no payment liability after the date of service, there is often no communication about the full cost of the service.

DH: Today, patients are not being provided comprehensible information about the services they receive, much less pricing information. To this end, I would encourage you to examine your next EOB. Is it accurate? Does the average consumer have the tools to make the same determination? Does it clearly spell out how much the provider was actually paid? Does it say when the provider was paid?

With the Personal Care Account, Definity

Curt Nielsen (218) 828-7105 or (218) 829-4901 2024 South 6th Street Brainerd, MN 56401

16

cases about liability for charges, they serve the educational purpose.

Member communications, such as the quarterly newsletters that Medica sends all members, frequently contain educational articles about new technology, costs of pharmaceuticals, and other health care cost issues.

In the commercial (employer) market, some employers have begun considering plan choices that have different coverage and network choices, with the member bearing the cost differential in those choices. Members may then assess the value to them of larger networks, or open access over a care system approach, and pay the difference if desired.

More needs to be done to inform consumers, so that they may make the best choices for themselves and their families.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Health has begun a movement that will have consumers interested in what they pay before the service is actually obtained.

So as not to leave a misimpression, I would like to note that cost is not the only factor from which consumers are isolated. Many aspects of quality, satisfaction, access and even basic provider information are frequently not available to support the consumers’ health care decisions.

The importance of these inputs to a decision to consumer health services cannot be overstated.

marketplace, we will explore many alternatives including the language contained in the AMA model.

9. What information regarding physician performance is on the internet? Individually? As a group? Who checks for accuracy? Do physicians have a chance to review their information prior to it going on the internet site?

MED: Medica pays for interpretation for all clinic visits for Medical Assistance and General Assistance Medical Care. Medica contracts with community based interpretation vendors, and therefore, negotiates for cost effective services on a competitive basis. Despite the growing immigrant population Medica has had no problem in meeting requests for interpretative services. Medica State Public Programs also maintains dedicated language phone lines for customer service and arranging for interpretation and transportation services. The language

MED: We are not currently doing provider profiling and we do not have physician performance information posted on our internet site.

BC: As a service to its members, Blue Cross publishes provider listings on its web site, www.bluecrossmn.com. No performance information about individuals or groups of physicians is available today. Blue Cross is interested in providing information that, first of all, is meaningful to members and is credible with physicians, and is committed to meeting those goals.

11: As the immigrant population of Minnesota grows, so does the need for language interpreters in clinics. The cost of an interpreter exceeds the typical office visit reimbursement. What are you doing to address this growing need? Also, what are you doing to address the cost of American sign language interpreters?

10: The AMA has developed a “model” contract for physicians. Have any of you considered moving toward the model contract? Have any of you compared your contracts to the AMA’s model?

MED: We have the AMA model in-house and it is currently under review by attorneys who will evaluate the differences between the AMA model and our current Medica contract.

BC: Currently, Blue Cross has in place contract language that is linked to our member contracts and meets the approval of many regulators and third parties. Any changes need to be considered for benefit to our customers and likelihood to be supported by our regulators and other interested parties. At this time, we are not actively considering changes to the AMA model.

DH: As Definity Health and PreferredOne begin to re-contract with providers to allow for the above mentioned move to a health services MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

lines include Russian, Hmong, Vietnamese, and Hispanic. A Somali service representative has also been hired this past year to meet the needs of the growing Somali population. Medica pays for sign language interpreters on a similar basis, although they are not as organized as foreign language vendors.

BC: Diversity in our customer base is an opportunity and challenge for all kinds of businesses. We continue to explore how all of us can meet the needs of our diverse customers.

For members of our Blue Plus Prepaid Medical Assistance Program and MinnesotaCare program, we have contracted directly with interpreters who are available to clinics. ✦ Elisabeth Quam Berne is the Executive Vice President of Advocates for Marketplace Options for Mainstreet (AMOM)) and president of a homebased business, Quam Berne Strategies. Formerly, she served as an assistant state health commissioner, overseeing health facilities and HMO compliance.

AUTO LEASING Boulevard Leasing offers many advantages to the physician or group practice.

• • • •

Selection of any car, van or truck, foreign or domestic.

Tailormade leases, not a “program” that must be adapted.

Fair, competitive prices.

Small, local firm with responsive, personal service.

Boulevard Leasing Nancy Kapps President 2817 Anthony Lane S., #104 St. Anthony, Minnesota 55418

(612) 781-8449

Endorsed by Ramsey Medical Society

January/February 2001

17

“Payer Alerts” are Tools for Practice Administrators Editor’s Note: The Hennepin Medical Society, the Ramsey Medical Society, the Minnesota Medical Association and the Minnesota Medical Group Management Association collaborate with Healthcare Management Resources and Lockridge Grindal PLLP, to provide physicians and practice administrators with current information regarding provider agreements. “Payer Alerts” are designed to give you, your attorney and your accountant a starting point to consider the contractual decisions that could make a significant impact on your practice. For more information, contact HMS, 612/623-3030, or RMS, 612/362-3704.

T

THE ALARM GOES OFF EARLY. In the midst

of grogginess, you realize your first task of the day when you get to the office is to review those two or three provider contracts on your desk that have been there for the last few weeks. You are anticipating the opportunity to adequately review the contract language, analyze the financial repercussions and make a decision. Arriving at the office, ready for this action plan, you do a cursory review of the contracts — each of them is drafted differently, with unique language and verbiage.

In the midst of the review, you receive a call from an employee asking for assistance with a patient issue. When you finally get back to your desk, you have been bombarded with voice mail messages and e-mails. A physician calls with a request for information that is needed for a meeting later in the day, another employee issue arises, and a review of some financial figures with the accountant is completed. You glance at your watch — another day is done; yet the contract remains untouched and unsigned.

During my tenure as an administrator in medical clinics, I have found this story to be a

BY MELANIE SULLIVAN, M.B.A., CMPE

18

January/February 2001

typical scenario. Despite intentions to stay focused, the more immediate needs of the clinic take priority. Practice administrators and managers understand the intricate balance between being responsive to the needs of the physicians, employees, and patients, while overseeing all the strategic functions within the clinic that are imperative for continued success.

Traditionally, practice administrators have focused on the expense side of the practice, looking for creative ways to reduce overhead. Yet, in the current healthcare market, clinical practice revenues have stagnated. As overhead reductions are becoming increasingly difficult to affect, physician incomes have been reduced despite actual increases in their workload. Herein exists the importance of economically viable contracts to ensure adequate reimbursement for services provided.

The “Payer Alert,” distributed as a collaborative effort between the Hennepin Medical Society, the Ramsey Medical Society, the Minnesota Medical Association, and the Minnesota Medical Group Management Association, is a direct response to the growing need for relevant information that is useful in evaluating provider contracts. These organizations lend their expertise and credibility as a method of educating physicians and practice administrators about the intricacies of contracting. They collectively understand the uniqueness of the Twin Cities market and are willing to combine resources to assist medical professionals in evaluating the impact contracting issues are having on their practices.

The expert analysis of health plan contracts provided to physicians and practice administrators via the “Payer Alerts” is invaluable.

Navigating the intricacies of contract negotiation presents a challenge for all medical practices, regardless of size. While the AMA does offer a standardized contract as a baseline, many times it is difficult to make the correlation beMetroDoctors

tween the standardized approach and the specific contract provisions that present themselves to all of us annually.

The “Payer Alert” program uses a “hands on” approach. Each “Payer Alert” includes sections that explain what has changed in the new contract; which amendments require a specific response; which provisions expand the obligations of the provider; and, the provisions that affect the relationship of the provider to the health plan. The research team behind the “Payer Alert” program strives to provide an excellent review and analysis of the contract, which serves as a starting point for physicians and practice administrators to review specific contractual obligations.

The medical community in the Twin Cities should consider itself fortunate that our professional organizations support the ongoing need for relevant information. One of the advantages of being a member of the medical society is this opportunity to use the “Payer Alerts” in evaluating contracts. While the “Payer Alerts” do not make recommendations regarding the advisability of signing the contract, the “Payer Alerts” do provide the practice administrator with the ability to make an educated judgment regarding the advisability of retaining an attorney or accountant to specifically review an individual practice’s contracts.

Armed with the information in the “Payer Alert” and with specific legal and accounting advice, the physicians and the practice administrators are able to make good contract decisions. A more unified understanding of the contracting issues also helps to ensure that medical practices are financially viable in the future.✦ Melanie (Mel) Sullivan, M.B.A., CMPE is the administrator for St. Croix Orthopaedics, P.A. in Stillwater. She is a member of the MMGMA Board, and a member of the RMS Board of Directors.

The Journal of the Hennepin and Ramsey Medical Societies

The Future of Minnesota’s Health is Up to You

T

THE UNIVERSITY OF MINNESOTA Academic Health Center’s historic mandate to prepare health professionals to care for Minnesotans when they are sick and help keep families well is at risk. Without state support, our medical school must cut core programs and will no longer supply the needed physicians for the state.

Without state support, we cannot expand our pharmacy, nursing, medical technology and dental programs and work with other Minnesota colleges to meet the state’s current and future needs for those key health professionals. We’ve done the work within our own schools and colleges to realign resources and reduce costs. We’ve also listened to community leaders and worked with faculty to develop a strategic vision and plan that positions the Academic Health Center to prepare health professionals for the future.

Those health care professionals are being prepared to improve the health of communities, discover and deliver new treatments and cures, and strengthen Minnesota’s economy. Now, we need a new covenant with Minnesota and its communities to ensure the success of that vision — and a future as healthy as our past.

For more than a century, the schools and colleges that make up the Academic Health Center have fulfilled the University’s land-grant mission to train health professionals for Minnesota. We are the only institution in Minnesota that educates pharmacists, dentists, and veterinarians. In addition, we educate more physicians, public health professionals, and graduate-level nurses than any other state institution. We also conduct research to develop and deliver new ways to treat and prevent life-threatening diseases. And we provide technologies for Minnesota’s biomedical industries. The health of the Academic Health Center is vital to the

BY FRANK CERRA, M.D.

MetroDoctors

mission but we are seeking a new covenant with the state to ensure its success. The university’s legislative request, which includes funding to stabilize the medical school, rebuild its faculty, and address shortages of health professionals in Minnesota, is the first step toward realizing our vision.

health of Minnesotans and the state’s economy.

Today, however, we find ourselves at a turning point. Our own health is threatened by a nationwide crisis in funding for medical education. At the same time, changes in health care delivery and advances in clinical care and technology are creating new expectations for us and for our graduates. Shortages of health care professionals are being felt, particularly in rural areas, as our population ages. And sequencing of human and animal genomes is creating remarkable new opportunities for research and business development, as well as potential for improved quality of life.

The Academic Health Center recently completed a strategic planning process to address these challenges and to seize opportunities.

As part of this, we invited community leaders, government officials, and executives of health organizations and companies who hire our graduates to tell us what they need from us.

Within our own community, teams of faculty from every school identified how they could best align their resources to serve Minnesota’s health needs. By weaving these ideas together, we created a plan that both reaffirms our land-grant mission and charts a course for our future together.

We are committed to fulfilling our historic

The Journal of the Hennepin and Ramsey Medical Societies

How can you help?

Please call, write, e-mail, or meet with your legislators and urge them to support the University of Minnesota’s request for state funding.

To identify your Minnesota House and Senate representatives, go to: www2.pioneer planet.com/precinct or call/e-mail Tracy Novak, Medical School Communications, at 612-6251185, novak008@tc.umn.edu for help.

What should I say to my legislators?

• Let them know you live in their district and you vote. If writing a letter or e-mail, include this on your subject line.

• Tell them what you value about the University of Minnesota, what is important to you, and/or the benefits the university delivers to you, your family, and community.

• Ask for their support of the university’s request for additional funding.

• Thank them for doing a good job or for simply listening to your concerns.

• If writing a letter or e-mail, conclude with your full name, home address (including zip code) and phone number.

Thank you for your help to support the University of Minnesota and keep Minnesota healthy. ✦ Frank Cerra, M.D. is Sr. Vice President for Health Sciences, Academic Health Center, University of Minnesota.

January/February 2001

19

Legislature Convenes January 3 Minnesota Medical Association Sets its Agenda

F

FOLLOWING A WILD ELECTION the Minnesota Medical Association is shifting from our political focus to our legislative focus. In Minnesota we have replaced our U.S. Senator — Mark Dayton (D) defeated Rod Grams(R) — and we have replaced two members of Congress — Mark Kennedy(R) defeated David Minge (D) and Betty McCollum (D) replaced the late Bruce Vento (D). In the U.S. Senate we are now represented by two Democrats and in Congress we have five Democrats and three Republicans.

At the state legislature, Democrats continue control of the Minnesota Senate and Republicans continue control of the Minnesota House.

With the country so divided and the congressional majorities so slim, at the federal level it most likely means more “gridlock.” Instead of trying to come together to work on compromised ideals, both parties will be looking twoyears ahead at how they can keep or take back control. The political bickering will continue.

At the state level the elections resulted in very little change. The Republicans maintained a 69-65 majority in the House. This is a net loss of one Republican from last year. The Democrats maintained a 39-27 majority with one Independent in the Senate. This is a net loss of two Democrats from last year. With the Governor not up for re-election this year, our tri-partisan form of government will continue for at least two more years.

The Legislature convenes for its 82nd Session on January 3, 2001. The main focus of this session will be the adoption of the budget for the state’s upcoming biennium. The other possible big issues include property tax reform, the cost of prescription drugs, and privacy legislation. They are expected to complete their work and adjourn no later than “the first Monday

BY DAVE RENNER

20

January/February 2001

following the third Saturday in May,” which this year is May 21, 2001.

The MMA has been devoting a great deal of time over the last six months listening to our members to develop our priorities for the year to come. Through our Initiative 2000 program we have gone to our committee members, our component societies, specialty societies, and other interested members and asked what policy issue priorities we should pursue? This process has resulted in the following areas of focus: • Repeal of the sick tax; • Support for medical education funding; • Access and affordability activities; • Patient protection initiatives; and, • Payer/contracting issues.

As identified by the Initiative 2000 process the replacement of the 1.5 percent sick tax that is added to all patient gross revenues remains a top priority for the MMA. This tax adds nearly $200 million each year to the overall cost of health care. We cannot afford the large health insurance cost increases that we are experiencing today and the Legislature can have an immediate impact on these costs by eliminating this sick tax. Currently, the entire House of Representatives supports elimination of the sick tax.

The Senate has not made this a priority and the Governor opposes elimination of the tax. We must convince the Senate that, with the state again expecting large budget surpluses, this year is the year to replace the sick tax.

The MMA is committed to ensuring ongoing funding streams for the education of new physicians. All of our academic health centers are facing severe crises related to the cost of training medical students and residents. The state must face up to this problem and invest in our future health care providers. The request for the University of Minnesota Academic Health Center is for over $33 million over the next two

MetroDoctors

years. The MMA stands ready to provide its support for this need.

In the area of access and affordability, we intend to work with the Governor in his desire to ensure that every Minnesota child has access to necessary health care. A key aspect to the Governor’s “Big Plan” is access for all kids, and your patients need you to be there to advocate on their behalf.

In the area of patient protection, the MMA is a founding member of the Minnesota Alliance for Patient Safety (MAPS). MAPS is taking the issue of patient safety head on to design better systems to eliminate medical errors. This is a coordinated effort with the Minnesota Hospital and Healthcare Partnership, the Minnesota Department of Health, and the MMA. We also intend to actively support patient protection legislation promoted by Attorney General Mike Hatch which includes health plan liability, a standard definition of “medical necessity,” further regulates utilization review, and provides portability for insureds.

The final Initiative 2000 area of focus is related to payer and contracting issues. Legislatively, we are monitoring the laws passed last year prohibiting “contract stacking” and requiring the prompt payment of clean claims. We need to insure that these laws are implemented correctly and vigorously enforced by the state regulators.

Health care is expected to be a major legislative issue this year. The MMA intends to be center in many of these issues. Our Legislative Committee, chaired by Peter Amadio, M.D. from Rochester has already begun its work in preparation for 2001. As an organization, we can only be successful with an involved membership. Your involvement is essential to ensure that legislators do what is best for your patients. ✦ Dave Renner is MMA’s Director of State and Federal Legislation.

The Journal of the Hennepin and Ramsey Medical Societies

HMS and RMS Continue to Provide Centralized Credentialing Services to the Community

D

DECEMBER 1, 2000 MARKED the date that

Expert Practice no longer offered centralized credentialing verification services to the metropolitan area physician community. Rallying to the call, HMS and RMS leadership and staff expeditiously put into place an interim solution. Under the direction of Sue Schettle, Credentialing Manager, and with existing staff, the valuable community service of credentials verification and reappointment remains intact.

It is anticipated that a long-term solution will be in place by mid-winter.

The centralized credentialing service was envisioned and established in the west metro by the Hennepin Medical Society in 1975, and licensed to the Ramsey Medical Society in the east metro in 1976. The services were merged in 1994. Since that time the program has grown to include a reappointment component, credentialing for health plans and nursing homes, and most recently, allied health professionals. Unfortunately, the cost of doing business, e.g. technology and service demands, forced the medical societies to explore other options for maintaining this community service.

Expert Practice, formerly Digital Medical Registrar, was selected as the company that appeared to most closely reflect the goals and mission of the credentialing program (Medical Credentialing Services of Minnesota-MCSM), and purchased the assets in 1998. Unfortunately they made the decision to discontinue this portion of their business effective December 1, 2000.

The Minnesota Medical Association, Council of Health Plans, and the Minnesota Hospital and Health Care Partnership have formed the Minnesota Joint Purchasing Coalition (MJPC) to address credentialing on a statewide basis. A request for proposals (RFP) has

MetroDoctors

been distributed and responses have been received from a number of potential suppliers of credentialing services. Two options are being evaluated and considered at this time: • A “buy model,” involves the MJPC contracting with a national credentials verification organization to provide a range of verification services to its constituents.

• The “make model,” involves the MJPC providing the credentials verification ser-

The Journal of the Hennepin and Ramsey Medical Societies

vices directly to its constituents through the creation of a co-operative instead of contracting with a centralized verifications organization. This may be based on the coop model similar to the hospital laundry co-operative in St. Paul.

HMS and RMS are committed to providing the temporary solution until a long-term strategy is in place. Watch your mail for further communication updates. ✦

January/February 2001

21

Community Interns Experience the Epicenter of Medicine

S

SEVEN COMMUNITY MEMBERS working

in a variety of non-related fields participated in the November 2000 joint HMS/RMS Community Internship Program. The community internship program provides an opportunity for non-medical professionals to observe first-hand, four physicians in different specialties doing what they do best — caring for their patients.

Questions raised by the “interns” at orientation

and answers sought over the course of the program included: • How do you better manage caregiver’s time and access to information for more costeffective, high efficiency treatments?

• How can the public work with the physician community to advance patient safety in the health care community?

• What factors go into the choices a physi-

cian makes regarding the choice of treatment for a patient?

• How are physicians addressing the need for interpretive services?

• Where is health care going?

Following their experiences, the interns reconvened for an evaluation of the program and sharing of tales. Most all commented on the amount of paperwork and how technology has increased the speed to diagnosis. “I guess I wasn’t prepared to see the depth of compassion that these doctors had for their patients. I was so very impressed!” Karen Russell stated. And, Yia Xiong reflected that this experience “made me value my health care a lot more.” HMS and RMS offer community internship programs throughout the year, requiring many physicians to volunteer their time for the “intern” to observe them for one-half day. Our grateful thanks to the physician faculty listed below. If you are willing to have a community participant follow you around for a half-day, please contact Nancy Bauer, HMS (612/623-2893) or Doreen Hines, RMS (612/362-3705). ✦

Interns included: William Hooper, Vice President of Operations, Drug Delivery, Medtronic, Inc.; Yia Xiong, Constituent Advocate, Senator Paul Wellstone’s Office; Barbara Carlson, Agency Resource Manager with Lutheran Brotherhood and Chair, Park Nicollet Foundation; Karen Russell, Associate Director of State Legislation, Minnesota Medical Association; David Teckman, President and CEO, Vivius, Inc.; Lin Nelson, Government Relations Coordinator, Minnesota Department of Health; and Brad Thomas, Pilot, Northwest Airlines.

Thank you to the following physicians for participating: Ellen Bendel-Stensel, M.D. Carl Blegen, M.D. R.M. Bolman, M.D. Samuel Carlson, M.D. Gary Coon, M.D. Sandra Engwall, M.D. Steven Halloway, M.D. William Kimber, M.D.

22

January/February 2001

Patrick Lilja, M.D. Matthew R. Monsein, M.D. Bruce Norback, M.D. Dan O’Laughlin, M.D. Kenneth F. Preimesberger, M.D. Norman S. Solberg, M.D. James Amsterdam, M.D. Kenneth Crabb, M.D.

Peter Daly, M.D. Stephen England, M.D. Andrew Fink, M.D. Judy Grisard, M.D. James Hart, M.D. Jon Thomas, M.D. Peter Wilton, M.D. Patrick Wright, M.D.

MetroDoctors

Dr. Jon Thomas and intern Yia Xiong.

The Journal of the Hennepin and Ramsey Medical Societies

NOTEWORTHY

Physician’s Edition of Medicare Handbook

“Professional Projects for the Professional” • Clinics • Professional Buildings • Hospitals •

Copies of the physician’s edition of Medicare & You 2001 (the Medicare Handbook), are available at no charge. This is the national edition of the book which describes the benefits Medicare offers. For your free copy, contact Susie Butler, at the Health Care Financing Administration, at 410/786-7211, or sbutler@hcfa.gov.

Dr. Brooks Named Medicare Carrier Medical Director David Luce, Wisconsin Physicians Service (WPS) corporate medical director announced, at a November 16 Medicare Carrier Advisory Committee meeting, that Kathy Brooks, M.D. will be the new carrier medical director for Minnesota. Dr. Brooks will be responsible for devloping and implementing local medical policy for Medicare services. WPS became Minnesota’s new Medicare Part B Carrier on September 15.

Morcon Construction, Inc. 5905 Golden Valley Road Golden Valley, MN 55442 Phone: 763-546-6066 612-546-6066 Bill Jundt Medical Construction Specialist Member MMGMA/Gold Sponsor

morcon@isd.net

Great Condo Alternative

Mark Fisher Appointed Chief Executive Officer Mark Fisher has been appointed chief executive officer of Minnesota Healthcare Network, LLC. Most recently Mr. Fisher has served as administrator of the Stillwater Medical Group. Mr. Fisher will be succeeding Douglas A. Shaw, who is retiring after 32 years of service to the community. MHN is an integrated delivery system jointly sponsored by the Minnesota Primary Care Physicians and Minnesota Specialty Physicians.

New Area Codes Added to the Twin Cities Minneapolis and the western suburbs are transitioning from one area code to three. On January 14, permissive dialing will end and mandatory 10-digit dialing between area codes will begin. The area code for the Hennepin and Ramsey Medical Societies will remain 612. ✦ MetroDoctors

Perfect for golden years or young professionals. Elegant all-brick rambler on lovely private lot across from Somerset Country Club. Built

by Dr. Justice O’Hage in 1953 and beautifully maintained by second owner. 3 bedrooms, 3 bathrooms, 9 ft. coved ceilings, 2 car attached garage. Great traffic pattern. Very sunny home. $469,000.

• Distinctive • • Historic • • Second Homes • • In or Out of State • • Senior Housing •

The Journal of the Hennepin and Ramsey Medical Societies

Mary Orr GRI ESA

(651) 282-9661 email: morr@cbburnet.com

January/February 2001

23

PRESIDENT’S MESSAGE J O H N R . G AT E S , M . D .

Twenty Years of Advances in Medical Technology RMS-Officers

President John R. Gates, M.D. President-Elect Robert C. Moravec, M.D. Past President Lyle J. Swenson, M.D. Secretary Jamie D. Santilli, M.D. Treasurer Peter H. Kelly, M.D. RMS-Board Members

Kimberly A. Anderson, M.D. Charles E. Crutchfield, III, M.D. Peter J. Daly, M.D. Kelley C. du Ford, Medical Student Thomas B. Dunkel, M.D. Michael Gonzalez-Campoy, M.D. James J. Jordan, M.D. F. Donald Kapps, M.D. Kathryn M. Klingberg, M.D., Resident Physician Charlene E. McEvoy, M.D. Ragnvald Mjanger, M.D. Thomas F. Rolewicz, M.D. Paul M. Spilseth, M.D. Jon V. Thomas, M.D. David C. Thorson, M.D. Randy S. Twito, M.D. Russell C. Welch, M.D. RMS-Ex-Officio Board Members

Blanton Bessinger, M.D., MMA President-Elect Raymond Bonnabeau, M.D., Sr. Physicians Association President Kenneth W. Crabb, M.D., AMA Alternate Delegate Stephen P. England, M.D., Community Health Council Chair Michael Gonzalez-Campoy, M.D., Education Resource Council Chair Eleanor Goodall, Alliance President Frank J. Indihar, M.D., AMA Delegate William Jacott, M.D., U of MN Representative F. Donald Kapps, M.D., Council on Professionalsim & Ethics Chair Melanie Sullivan, Clinic Administrator Lyle J. Swenson, M.D., Public Policy Council Chair Russell C. Welch, M.D., Communications Council Chair RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive Officer Doreen M. Hines, Assistant Director

24

January/February 2001

A

AS A NEUROLOGY RESIDENT at the University of Minnesota over 20 years ago, the principal neuro-imaging techniques I utilized and personally performed were direct carotid-stick cerebral angiography, which had a 5-7 percent complication rate, or pneumoencephalography, which had a similar serious complication rate and a 70 percent vomiting complication. The latter procedure involved strapping the patient in a chair, putting a spinal needle in his back, sucking out quite a bit of the spinal fluid, replacing it with air, subjecting the patient to a full sommersault while strapped in the chair to get the air into the cerebral ventricles, and then taking a skull x-ray when they stopped vomiting from the irritation to the brainstem. Needless to say, you really needed a structural study before you would subject a patient to this ordeal, so I think clinical diagnostic skills were sharper then. I also can’t imagine how much the average two to three day length of stay for these procedures and their complications would cost in today’s dollars.

Now, when in doubt, scan ’em!! CT or MRI, no complications to speak of, just a dramatically reduced cost. I remember the first subdural hematoma operation performed at the

University of Minnesota based on an early CT scan (EMI- Electrical Musical Instruments manufactured) without (can you imagine!), a confirmatory angiogram. My practice now calls for MRI spectroscopy to identify the chemical shift of tissue components that confirms mesial temporal sclerosis for epilepsy surgery. PET (Positron Emission Tomography) is now routinely available in St. Paul for predominantly oncology and epilepsy applications. Our 20 dedicated epilepsy beds at United and St. Paul Children’s Hospitals are completely networked on a paperless system with on-line capability to review up to 128-channel EEG live from any of several work stations in our office or the hospital. In 1990, as in 1980, we had, for all intents and purposes, three epilepsy drugs to work with: now we have eight more since 1993. Seizure free rates from medications and surgical treatment are up and side effects/complications are down.

Yes, it has been a marvelous time to be a physician. ✦

Attention All Physicians Two opportunities for you to provide education and mentoring about your practice specialty: • The Hennepin Medical Society, Ramsey Medical Society and the Minnesota Medical School Alumni Association offer an opportunity for 1st and 2nd year medical students to “Shadow a Physician” for one day (at your mutual convenience). This usually occurs during the students’ breaks: Thanksgiving, Christmas, and spring break.

• HMS/RMS also offer a “Community Internship Program” (CIP), providing an opportunity for community and business leaders (non-physicians) to observe four different medical/ surgical experiences over a two-day period. A one-half day commitment is all that is required.

The next program is March 5-12. We will be hosting a Health Care Policy class from Macalester College (availability for 10 students). The next regular program will be May 14-17.

If you are interested in participating, contact Doreen Hines at (612) 362-3705 or dhines @mnmed.org.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

You are cordially invited to the

RMS Annual Meeting

Ramsey Medical Society

Friday, January 26, 2001 North Oaks Golf Club 54 East Oaks Road, North Oaks 6:00 p.m. Social Hour (cash bar) 6:45 p.m. Dinner ($35 per person) ($17.50 per person for RMS Medical Student/Resident Physician)

• Inauguration of Robert C. Moravec, M.D., as the 130th President of the Ramsey Medical Society • Presentation of Community Service Award to Wayne H. Thalhuber, M.D. • Presentation to Joseph L. Rigatuso, M.D.

“Escape Fire” Video by Donald M. Berwick, M.D. President and CEO, Institute for Healthcare Improvement

This will be one of the most profound call-to-action videotape lectures you will see.

Dr. Berwick describes his personal and compelling experience with healthcare and compares it to an out-of-control brush fire that is heading toward a team of smokejumpers. The smokejumpers cannot run fast enough to escape the fire and must create an extraordinary solution in which to survive. This presentation will serve as a starting point for additional discussion in our own community.

R.S.V.P. by Friday, January 19, 2001

Ramsey Medical Society Annual Meeting 6:00 p.m. Friday, January 26, 2001, North Oaks Golf Club name ______________________________________________________________ guests _____________________________________________________________ address ____________________________________________________________ telephone number _________________ amount enclosed __________ $35 per person ($17.50 per person for RMS Medical Student/Resident Physician) Please return with your check payable to: Ramsey Medical Society, PO Box 131690, St. Paul, MN 55113.

Questions? 612-362-3704 MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

January/February 2001

25

RMS UPDATE

2001 RMS Officers and New RMS Board Members, MMA Delegates and Alternate Delegates Thank you to each RMS member who cast their ballot in the recent election.

Applicants for Membership We welcome these new applicants for Ramsey Medical Society membership.

Active Rachel A. Bye, M.D. University of Minnesota Pediatrics Pediatricians for Health Janice Chua Go, M.D. Manila, Philippines Pediatrics PACE Pediatrics Christina M. Juhl, M.D. University of Minnesota Family Practice Allina Medical Clinic - Woodbury Transfer into RMS — Active Wanda P. Adefris, M.D. Temple University School of Medicine Obstetrics & Gynecology Adefris & Toppin Women’s Specialists, M.D.P.C. David A. Olson, M.D. University of Minnesota Family Practice Allina Medical Clinic—Cottage Grove Transfer into RMS — Student Mary K. Donohoe Anne M. Keating Geoffrey J. Service Transfer into RMS — Emeritus (Dues Exempt) Joseph C. Von Drasek, M.D. University of Minnesota Family Practice Retired Student (University of Minnesota)

Benjamin Bursell Todd W. Costantini 26

January/February 2001

William W. Cross III Tamara E. Duenes Carrie E. Flanagan Amy C. Fox Nathan J. Groebner Stanley J. Iyadurai Carrie L. Johnson Waller Lance W. Kansas Shawn R. Kruse Carrie L. Langstraat David A. Larsen Kia K. Lilly Michael S.K. Lockheart Joseph C. Madigan Saul A. McBroom Steven C. Miller Amanda J. Morehouse Megan M. Nolan Norman Joseph L. Schuller Paul D. Scott Dana M. Stephens Brian W. Sutter Kelly G. Swanson Michele T. Thieman Richard P. Tuohy Thomas G. Virnig Kong Xiong Amanda Ye Chloe A. Zera ✦

President Robert C. Moravec, M.D.

In Memoriam LESTER N. DALE, M.D., died October 23 at the age of 82. He graduated from the University of Minnesota, and completed his internship in the Navy during World War II. Dr. Dale practiced medicine in Crosby/Ironton for two years, Red Lake Falls for 16 years and Hastings for over 20 years. He retired from active practice in 1984 but continued practicing on a part-time basis. Dr. Dale joined the Wakota Medical Society in 1947 and joined RMS in 1994 as part of the Wakota/RMS merger. ✦ MetroDoctors

President-elect Peter H. Kelly, M.D.

Past President John R. Gates, M.D.

Secretary Jamie D. Santilli, M.D.

Treasurer Peter J. Daly, M.D.

Director at Large Charlene E. McEvoy, M.D.

Director at Large Specialty Director Kenneth E. Nollet, M.D., David C. Thorson, M.D. Ph.D. MMA Delegates Richard L. Baron, M.D. Kenneth W. Crabb, M.D. Frank J. Indihar, M.D. Stephen W. Siegel, M.D. James S. Van Vooren, M.D. Peter B. Wilton, M.D. MMA Alternate Delegates Anthony C. Orecchia, M.D. Charles G. Terzian, M.D. Specialty Director Victor S. Cox, M.D.

The Journal of the Hennepin and Ramsey Medical Societies

RMS ALLIANCE NEWS ELEANOR M. GOODALL

“Catch the Vision”

A

“Catch The Vision” A gala to benefit

The Spare Key Foundation Sponsored by:

RMS Foundation & RMS Alliance

Saturday, March 10, 2001 St. Paul Hotel

MetroDoctors

sponsor a gala fund raising event “Catch the Vision” on Saturday, March 10 at the St. Paul Hotel.

The Spare Key Foundation is a not-for-profit organization founded by Patsy and Robb Keech in memory of their son, Derian, who died five years ago, at age two and a half.

A message from Patsy and Robb Keech: “Our son Derian, was diagnosed with a syndrome call CHARGE, which affects eyes, ears, heart, nose, physical and mental development. He underwent 11 surgeries during his short life, five of which were open heart. Our life with Derian included long hospital stays, extended periods of unpaid leave from work, and demanded us to divide our attention between an ill and healthy child.

We feel Derian’s mission on earth was to show us what life is like for children and their families when a child suffers from a critical illness. We will never forget our days with Derian, or the outpouring of kindness and support people offered us. Therefore, we cannot turn our backs on the countless numbers of families who are struggling to hang onto their children and their homes. We have committed ourselves to help these families by offering financial relief.”

The Spare Key Foundation helps families by making a one time mortgage payment when a child is hospitalized for at least 21 consecutive days. The mortgage payment makes it possible for parents to spend time with their child without falling behind in their mortgage and jeopardizing their credit and their home. To qualify for a mortgage payment at least one parent must be on unpaid leave of absence from his or her job. Currently, mortgage grants are available to families whose child is hospitalized at one of several Twin Cities hospitals and grant applications are only available through a hospital social worker, who typically is very familiar with the case, the family, and their needs.

We all can imagine how tough such a situ-

The Journal of the Hennepin and Ramsey Medical Societies

ation could be. Financial worries, on top of the severe emotional trauma engendered by a very ill child, simply compounds a parent’s and a family’s stress.

No parent should have to choose between a sick child and a job!

Read what some of The Spare Key Foundation recipients have to say about their grants: • “We cannot possibly measure the peace of mind we were given through the help of The Spare Key Foundation.”

• “We hope to be able to give back to Spare Key so some other family can be helped as we were.”

• “Spare Key’s mortgage grant allowed us to focus on our son’s health instead of worrying about finances.”

Since March of 2000, Spare Key has awarded over 60 grants to families in the Twin Cities metro area. In April of 2000 the Foundation was a recipient of Oprah’s Angel Network “Use Your Life” award.

“Catch The Vision” is the theme for our gala evening of fine dining, good music, dancing, a silent auction…a time to share with your friends and colleagues and, yes, a time for you to “use your life” to help families in need.

Mark your calendars, plan to attend, bring your friends and neighbors. When you receive the invitation in the mail, “catch the vision” and respond with a resounding “Yes! I’ll be there!”

We’re planning a wonderful, exciting party. We need you to come in order to make it a success.

Sick kids and their families are counting on you.

Please don’t let them down!

If you need further information on The Spare Key Foundation, or need additional invitations to the “Catch the Vision” gala, or if you have an auction item to donate, please contact Eleanor Goodall: H (763) 441-8308 or W (651) 268-6107. Many thanks for your support! ✦

January/February 2001

27

Ramsey Medical Society

AS A PARENT OR GRANDPARENT, what would be your worst nightmare? My guess is that a terminally ill, or even critically ill hospitalized child in your family would be pretty near the top of the list.

Now add to that scenario the fact that you have to make choices about spending time with your child. Important time. Needed time. Quality time. Perhaps all too brief a time. Time that might be a healing part of the memories you have of your child. Why such difficult choices?

Because you’re a single parent, or in a family with two parents but both have to work to pay the bills. And what, typically, is the largest bill most young families face? Yes, the mortgage payments on their home. Thus, the dilemma they face is that if one of the parents takes an unpaid leave of absence from his or her job, will there still be enough money coming in to cover the everyday ordinary household expenses, the added expenses of a seriously ill child, and enough to pay the mortgage?

This is an emotionally draining time, regardless, and added economic stress places an added load on their already overburdened lives.

No one should have to even consider a choice that involves not being with a critically ill child!

Enter The Spare Key Foundation, and the Ramsey Medical Society Foundation partnering with the Ramsey Medical Society Alliance, to

It Takes a Village…

Supply Drive Collects Medical and Hygiene Supplies

T

THE PHRASE “IT TAKES A VILLAGE…”

certainly applies when looking at the wide-ranging needs of homeless people. Homelessness is not going away; indications show the problem is getting worse. A growing number of homeless people are working and could pay something toward housing, but there are no vacant units that low-income people can afford. These people remain homeless for longer periods while searching for a place to live. Studies show that women make up the largest homeless population, and the number of homeless children and youth is increasing.

HealthEast Care System, Ramsey Medical Society, and the Ramsey Medical Society Alliance have taken a leadership role in educating the community on the needs of homeless people from a medical perspective. These groups have

coordinated efforts to secure needed medical and hygiene supplies for the homeless in Ramsey County by sponsoring the annual Caring Hearts for Homeless People supply drive in February.

The Ninth Annual “Caring Hearts for the Homeless People” supply drive will kick-off on Saturday, February 10 and conclude on Sunday, February 25. The goal of the campaign is to collect more than $40,000 worth of supplies to support three St. Paul programs’ efforts to help our community’s homeless: • Health Care for the Homeless — A team of medical, mental and social health providers brings care, medicine, referrals and supplies into nine shelter and drop-in locations each week.

• Listening House — “The living room of the streets” provides nurturing space, personal

Shopping List (non-alcoholic) (trial/travel sizes)

Medications

Other

• Multicomplex vitamins (adult, children’s) • Non-alcoholic cough syrup, cold and flu tablets, cough drops, decongestants • Tylenol (adult, children’s), Ibuprofen • Ointments (antibiotic, hydrocortisone, diaper rash, antifungal) • Antacids (Maalox, Tums, Rolaids) • Pedialyte

• Foot care (corn pads, nail clippers, anti-fungal powder and cream, pumice stones, white socks) • Lip balm • Formula with iron, juice boxes, diapers (M to XL), baby wipes • Band-Aids for kids and new Ace wraps • Baby powder, baby bottles, teething rings, sippy cups, pacifiers • Insect repellent and sun screen • Winter gloves • Washcloths

Hygiene • Sanitary pads/tampons • Toothbrushes & toothpaste • Soap for sensitive skin, travel size shampoos and lotions • Ethnic hair products • Combs, brushes, deodorant & razors • Vaseline

28

January/February 2001

Sponsored By:

MetroDoctors

supplies, and a daytime sleeping place for night workers whose shelters are closed during the day.

• SafeZone — A non-threatening haven for youth between the ages of 11 and 21, SafeZone provides basic needs, case management, medical care, supplies and referrals.

Here’s how you can be a part of the village, and help combat homelessness. If every family in your clinic donates items, what a difference a village can make!

1. Committing your clinic to participate.

All we ask is that you designate a “Caring Hearts for the Homeless People” coordinator for your clinic. Have this person call Doreen at 612/3623705. We will then send you posters and a shopping list for you to post within your clinic. We suggest you designate a collection point within your facility. During the campaign, collect as many supplies on the shopping list as possible.

On Monday, February 26 or Tuesday, February 27, volunteers from the Ramsey Medical Society Alliance will pick up the supplies from your clinic and deliver them to the collection site where they will be sorted and prepared for distribution. All participating clinics will be listed in the Ramsey/Hennepin Medical Societies journal, MetroDoctors.

2. The final opportunity to help is by making a cash contribution. Just send a check payable to: Ramsey Medical Society Foundation, P.O. Box 131690, St. Paul, MN 55113-0015.

Note in the memo that it is for the Homeless Collection.

Thank you for considering this opportunity to contribute to improving the health of our most vulnerable population, the homeless.

Please call the RMS office at 612/362-3705 if you have any questions. ✦

The Journal of the Hennepin and Ramsey Medical Societies

CHAIR’S REPORT VIRGINIA R. LUPO, M.D.

T

THE MOST FREQUENT QUESTIONS I’m

Chair Virginia R. Lupo, M.D. President David L. Swanson, M.D. President-Elect T. Michael Tedford, M.D. Secretary Richard M. Gebhart, M.D. Treasurer Michael B. Ainslie, M.D. Immediate Past Chair David L. Estrin, M.D.

asked by physicians I haven’t seen in awhile is what I’m doing as chair of the Hennepin Medical Society and what, if any, are the reasons why they should join organized medicine. These are good questions.

A recently published book entitled “Bowling Alone: The collapse and revitalization of American community” by Robert D. Putnam reflects on our disconnectedness as a society.

Americans used to join bowling leagues and set aside a time each week to come together with friends in an evening. This was much more of a ritual in the past than most of us were aware of.

There are precious few bowling lanes left these days, and many of us rarely go inside them, let alone belong to a bowling league.

Indeed, most of us perceive a dwindling amount of social capital, and hoard the time and energy we do have for family or personal diversion after leaving the stresses of work. Many physicians carry those stresses in their pocket at all times, by being omni-available at the end of a beeper, in effect rarely circumscribing completely free time in which they could socialize.

We begrudgingly attend medical staff meetings because staff membership and hospital privileges are contingent on a modicum of attendance, but we aren’t a profession or a nation of socializers.

When time is available, civic engagement, whether it be involvement in a local school board or club through a church or neighborhood, often doesn’t rise to the top of the priority list. As physicians, many surveys have shown that we belong to our hospital staffs, and to our specialty medical organizations, but beyond that we’re no more a group of joiners than the rest of society.

In addition, it takes about two minutes of casual conversation at a picnic or at the grocery store to run into someone and hear their stories of disaffectedness from their practices and sometimes their entire profession. We all know a casualty of the practice of medicine, be it the adverse judgment in a litigation that shakes a physician’s confidence that their best judgment

HMS-Board Members

Ben Baechler, Medical Student Michael Belzer, M.D. Carl E. Burkland, M.D. Jeffrey Christensen, M.D. William Conroy, M.D. Dianne Fenyk, Alliance Co-President Paul A. Kettler, M.D. James P. LaRoy, M.D. Monica Mykelbust, M.D. Ronald D. Osborn, D.O. Joseph F. Rinowski, M.D. Richard D. Schmidt, M.D. Marc F. Swiontkowski M.D. D. Clark Tungseth, M.D. Trish Vaurio, Alliance Co-President Joan M. Williams, M.D. HMS-Ex-Officio Board Members

Barbara H. Subak M.D., Senior Physicians Association Lee H. Beecher, M.D., MMA-Trustee Karen K. Dickson, M.D., MMA-Trustee John W. Larsen, M.D., MMA-Trustee Robert K. Meiches, M.D., MMA-Trustee Henry T. Smith, M.D., MMA-Trustee David W. Allen, Jr., MMGMA Rep. HMS-Executive Staff

Jack G. Davis, Chief Executive Officer Nancy K. Bauer, Associate Director

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

can be relied upon anymore, or the completely reconfigured business practice of the clinic they started working at a number of years ago, that just doesn’t resonate with their way of relating to patients anymore.

I would argue that organized medicine is the single place where all physicians can come together and speak with a common voice, whether they perceive they are disenfranchised from their profession, or practice primary care in homeless shelters, or spend time exclusively in administrative settings, or see a large number of patients on a day in and day out basis. This is precisely the reason why organized medicine does not advocate for isolated political issues that favor one kind of practice over another — since we come from many walks of medicine, we are not about to advocate for one at the expense of the other.

We do speak with one voice on public health issues or public policy issues that are “good medicine” for patients as a whole. We do advocate for issues that are good for physicians as a whole — a uniform credentialing system, clear communication from third party payers regarding potentially major changes in reimbursement schemes, and equity in services allowable to Medicare patients in our geographic area. We provide a gathering place for physicians, as we become more and more segregated within individual hospital staffs, whether that be in committee meetings of HMS committees or just within the pages of our MetroDoctors publications or our web site.

So no, I don’t bowl, either — never did, as a matter of fact, but I do belong to organized medicine. Maybe bowling fell by the wayside after organized medicine successfully advocated for non-smoking in public areas. We don’t have to wear those funny striped shirts, either. Think about it. ✦ January/February 2001

29

Hennepin Medical Society

HMS-Officers

HMS IN ACTION JACK G. DAVIS, CEO

HMS in Action highlights activities that your leadership and executive office staff have participated in, or responded to, between MetroDoctors issues. We solicit your input on these activities and encourage your calls regarding issues in which you would like our involvement.

are among the list of contributing authors.

MMIC, Park Nicollet Institute for Research and Education, and the Hennepin Medical Foundation are providing the funding for this monograph.

The HMS Healthy, Abuse-Free

The Hennepin Medical Foundation Board met in November and approved over $26,000 in grants to community projects and organizations. Marvin S. Segal, M.D. was elected the new HMF President, succeeding Diane A. Dahl, M.D. The election of the Senior Physicians Association resulted in the following appointments: Paul Bowlin, M.D., President; Roger Becklund, M.D., President-Elect; John Giebenhain, M.D., Secretary/Treasurer, and members at large: Henry Quist, M.D., M. Elizabeth Craig, M.D., and Edward Segal, M.D. Barbara Subak, M.D. is immediate past president.

Two meetings of the Metropolitan Hospital and Medical Staff Leadership were held recently at which time a

presentation by Dr. Kent Neff on abusive physician behaviors was made as well as discussion about the transition of Expert Practice (the medical credentialing service) to HMS and RMS. Roger Becklund, M.D., the HMS

representative on the Medical School’s Admissions Committee, and Jack Davis met with the new Dean of Admissions, Marilyn Becker, Ph.D. She is seeking our help in generating more interest in medicine as a career throughout the state of Minnesota.

The next-in-a-series of guidebooks produced by the American Medical Association is being developed on the topic of “Healthy, abuse-free medical workplaces.” Drs. A. Stuart Hanson, David McCollum, Kathy Sweetman, and Eric Knox, along with Deborah Anderson, President, Respond2 Inc., 30

January/February 2001

Medical Workplace Committee is cosponsoring a half-day conference in May 2001 with the Healthcare Human Resources Association of Minnesota, Minnesota Health Care Coalition on Violence, Ramsey Medical Society, the Minnesota Medical Association, and Park Nicollet Institute for Research and Education, on healthy workplaces and its impact on employee retention and recruitment.

Success By 6® Phillips/Powderhorn Healthy Babies Collaborative has

agreed to transition its function to a role of networking and information sharing. A celebration of its five-year accomplishments was held in November.

Daniel Greeley, M.D., Karen Lucas, M.D. and Nancy Bauer have completed their terms on the Dakota Healthy Families Initiative steering committee. This very successful collaboration which prenatally identifies and addresses high risk families, is transitioning into a Dakota County-wide project with committed staff and resources.

David Griffin, M.D. will remain on the Board.

Drs. David Estrin, Timothy Komoto, and Dawn Martin authored a letter to primary care physicians with the reminder of school immunization requirements for Hepatitis B series for all incoming 2001-

02 school year seventh grade students. This is in addition to the existing requirement for second MMR and Td booster.

Jack Davis and Nancy Bauer had the opportunity to meet Harry Hull, M.D., the new Minnesota State Epidemiologist, and describe the activities and goals of the Hennepin Medical Society.

MetroDoctors

In the spirit of continued collaboration, HMS and RMS are putting together a joint Membership Committee exploring opportunities for economies of scale in membership recruitment and retention materials and initiatives. A joint HMS/RMS new member orientation dinner was held on Tuesday, December 12.

Thirty first- and second-year medical students have been assigned to observe physicians in various specialties for a day during the winter break through the “Shadow a Physician” program.

“Connections,” a mentoring program

linking physicians and first-year medical students, will be kicked-off at a January 12 breakfast and the annual medical student White Coat Ceremony. The program is a partnership of the University of Minnesota Medical School, Hennepin Medical Society, Ramsey Medical Society and the University of Minnesota Medical Alumni Society.

Marvin S. Segal, M.D., Hennepin Medical Foundation President, and Jack Davis attended the Minnesota Medical Foundation’s annual Scholarship and Award Reception on December 9, 2000. Christine

Braun, second year medical student, received the Thomas P. Cook Scholarship sponsored by the Hennepin Medical Foundation.

Ted Grindal, JD, Lockridge Grindal Nauen, P.L.L.P. and Tracy Novak, University of Minnesota Lobbyist, were the featured speakers at the November medical student “Lunch ’n Learn” session.

David Allen, CEO of Minnesota Specialty

Physicians (MSP), has agreed to serve as an exofficio member of the HMS Board of Directors.✦ The Journal of the Hennepin and Ramsey Medical Societies

HMS NEWS

In Memoriam

Hoban Scholars Named SIX NEW AND TWO RETURNING students were named Thomas W. and Mary Kay Hoban Scholars. The students, pursuing masters in pub-

lic health, health care or business administration, were provided education grants totaling $23,000. ✦

William Gamble, M.D. Awarded Charles Bolles Bolles-Rogers Award Colleagues and friends of William Gamble, M.D. gathered at the December meeting of the Methodist Hospital Medical Staff to honor William R. Gamble, M.D., the year 2000 Charles Bolles Bolles-Rogers Award recipient. Virginia Lupo, M.D., chair of the Hennepin Medical Society, presented the award noting that Dr. Gamble is an outstanding and compassionate surgeon with an unrelenting desire to teach.

Dr. Gamble received his medical degree from the University of Rochester, Rochester, NY and completed his surgical residency at University Hospitals of Cleveland (Case Western Reserve). He served as a Captain in the United States Air Force and Chief of Surgery at Hospital McClellan Air Force Base in California. ProMetroDoctors

fessional and academic appointments include: Professor, Department of Surgery, University of Minnesota, past president, Methodist Hospital Medical Staff, past presidents of the Mpls. Surgical Society, Minnesota Surgical Society, and Minnesota Chapter American College of Surgeons, and former Director, Division of Surgery, Park Nicollet Clinic. He has published 30 articles, three book chapters, and a laparoscopy curriculum for surgical residents.

As a volunteer with the Christian Medical Society since 1976, Dr. Gamble has made 12 trips to Honduras and one to Guatemala and recently, through World Medical Mission, traveled to Kenya and Uganda.

The Charles Bolles Bolles-Rogers Award is given annually by the Hennepin Medical Society to a physician who, by reason of his/her professional contribution on the basis of medical research, achievement, or leadership, has become the outstanding physician of this and other years. ✦

The Journal of the Hennepin and Ramsey Medical Societies

ARTHUR M. HALL, M.D., a retired family physician at the St. Anthony Falls Clinic in Minneapolis, died October 10. He was 82. He graduated from the University of Minnesota Medical School, and completed his internship at Lutheran Deaconess. In 1951 Dr. Hall went to South Africa as a missionary for the American Lutheran Church, where he worked for 13 years. He helped open the Hlabisa Lutheran Mission Hospital in Hlabisa, Zululand. Today, the hospital is known for its care of Africans with AIDS. He joined HMS in 1950.

JOHN T. MOEHN, M.D., an obstetrician, died October 21 at the age of 85. He graduated from Creighton University School of Medicine, Omaha and completed his internships at Cook County Hospital in Chicago and with the Army Air Force in Connecticut. According to his son, Tague, Dr. Moehn performed one of the first in-utero blood transfusions, and later helped pioneer what is now epidural anesthesia delivery. He retired in 1984. Dr. Moehn joined HMS in 1947.

KENNETH A. OSTERBERG, M.D., died October 16. He was 68. He graduated from the University of Minnesota and completed an internship at Minneapolis General and a neurology internship at the University of Minnesota.

He was board certified in neurology, neuropathology, anatomy, and forensic pathology; an associate pathologist at HCMC, and also served as assistant medical examiner for the Hennepin County Medical Examiner’s Office. On September 1, 1978, he suffered a cerebral hemorrhage and his career came to a tragic end. He joined HMS in 1966. ✦

January/February 2001

31

Hennepin Medical Society

Year 2000 Hoban Scholars: Eric Nielsen, Brian Cooper, Theresa Sullivan, Jessica Levine, Janiece Gray, John Jendro, and Imtiaz Aziz. Not pictured: Kim DeRosier.

REUBEN DAVID, M.D., died November 29 at the age of 86. He graduated from the University of Nebraska College of Medicine, Omaha. Dr. David interned at Swedish Hospital in Minneapolis then opened a family practice office in Hopkins. In 1969 at Methodist Hospital, he was a member of the original group founding the Emergency Physicians Professional Association. He retired in 1981. Dr. David joined HMS in 1953.

HMS ALLIANCE NEWS

H

HENNEPIN MEDICAL SOCIETY Alliance

has had a busy few months and we are proud of what we have accomplished. In September, the Alliance held our first Stepping Stones Gala to commemorate the 90th anniversary of our organization. The silent auction, which we held in conjunction with the Gala, enabled us to donate about $12,000 to three designated west suburban teen clinics.

On a cold November Monday, several of our members had a terrific lesson arranging fresh flowers into a European bouquet at Koehler and Dramm. Each of us went home with many tips, techniques, and fresh flowers, as well as treasures that we were able to purchase.

The Alliance’s annual Holiday Tea and Silent Auction on December 8 was a great success. It’s always a wonderful way to begin the holiday season and connect with friends while we have some friendly competition in the Silent Auction. The proceeds are used for our children’s health fair, Body Works.

Between the Holiday Tea and Body Works, we plan to pamper ourselves at The Marsh health spa with a fitness day. The day includes exercise, a healthy lunch and a full day pass for the spa. What a great way to spend a January day!

Of course, we will be guided by our own fitness guru, Diane Gayes, who is president of the Minnesota Medical Association Alliance.

For those of you who are unfamiliar with

Body Works, this is the Alliance’s 17th year of presenting this health fair for third grade children in the Minneapolis school system. Our motto for the kids is “Doctors can help, parents can too, but a healthy body is up to you.” The program emphasizes what the children can do for themselves in making healthy life choices.

We talk about lungs, heart, bones, the ER and safety issues, what to expect in a hospital room, nutrition and exercise, the abilities of people with disabilities, and a wrap-up called VIK to emphasize that each person is special and unique.

Lutheran Brotherhood donates its auditorium for Body Works and we are able to introduce about 2,500 children to healthy life choices. The Alliance extends an invitation to anyone who is interested, to come to Lutheran Brotherhood during the week of January 29February 2 between 9:30 a.m. and 1:00 p.m.

Hennepin Medical Society has been very supportive of this project over the years. Approximately 100 volunteers contribute their time to this very worthy effort, however we also have a great deal of fun keeping up our friendships and connections. For the children this is often their only field trip for the entire school year since funds for this kind of activity are scarce in a large city school system.

The Alliance’s final meeting this year will be the annual meeting on May 4 when we will install our officers for the next year and make

January/February 2001

Trish Vaurio Co-President

plans for carrying on projects that we continue throughout the year. Some of these are: You Are Gloved — we contribute gloves, hats and mittens to children who are in need; we collect used eyeglasses for distribution, items for the Minneapolis Crisis Nursery, and also books for the Book Buddy program.

Hennepin Medical Society Alliance has as its goal the promotion of health and well-being of our members and the community through education, advocacy, and service. We also have community outreach as our goal. In addition, we make sure that we enjoy what we do and keep our friendships strong. We would very much encourage anyone who might be interested in joining our organization of physician’s spouses to call either myself at 952/929-7360, or my co-president, Dianne Fenyk, at 763/ 377-9707. ✦ Trish Vaurio, Co-President

Carolyn Linner, a past Alliance President, and Kim-Anh Tong, Philanthropic Treasurer.

The HMS Alliance Holiday Tea at the home of Dr. Bruce and Peggy Johnson.

32

Dianne Fenyk Co-President

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies