2002 Sept/October by Advocates for Better Health

Sept/October 2002

C A N D I D AT E S V I E W S

on Health Care Issues

2325 Prior Avenue North, Roseville, MN

(651) 636-6060

“THE FUSION OF DESIGN AND TECHNOLOGY”

2002 ESCALADE 345 HP — The most powerful SUV on the road today!

IT’S NOT YOUR DADDY’S CADDY ANYMORE! 2003 CTS

INSURANCE

CONTACT STEVE ALLEN FOR DETAILS

EMPLOYEE BENEFITS

C O N S U L T I N G ( Technology & Strategic)

TECHNOLOGY SOLUTIONS

The MMIC Group can orchestrate an array of finely tuned products and services. We offer you complete malpractice insurance services as well as employee benefits planning, expert healthcare information systems planning and implementation and an Internet-based medical services portal designed to meet your unique needs. MMIC, making your life a little simpler...isn’t it about time. Call 1–800–328–5532, or visit us at www.midmedical.com

The

Group

Doctors MetroDoctors THE BULLETIN OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

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: bauerfamily@earthlink.com. For advertising rates and space reservations, contact: Kirsten Schoeller 14953 Appaloosa Trail NE Prior Lake, MN 55372 phone: (952) 440-2997 fax: (952) 440-9662 e-mail: kirsten@pierreproductions.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. For subscription information, contact Doreen Hines at (612) 362-3705.

CONTENTS VOLUME 4, NO. 5

SOAPBOX

Clinical Skills Assessment Exam: A Student Perspective

Editor’s Message

U.S. Senate and Congressional Candidates’ Views on Health Care • Sen. Paul Wellstone

• Norm Coleman

• John Kline/and Index to Advertisers

• Rep. Bill Luther

• Rep. Jim Ramstad

• Rep. Betty McCollum

• Clyde E. Billington, Ph.D

• Rep. Mark Kennedy/and United Way

• Janet Robert

Candidates for Governor • Tim Pawlenty

• Tim Penny

• Ken Pentel

COLLEAGUE INTERVIEW

Theodore Loftness, M.D.

Emerging from Immunization Chaos

Retirement Plan Options for Independent Medical Groups RAMSEY MEDICAL SOCIETY

25 26 27 28

President’s Message Benefits of Membership New Members/In Memoriam/Free Hmong Audiotapes RMS Alliance

C A N D I D AT E S V I E W S

on Health Care Issues

HENNEPIN MEDICAL SOCIETY

29 30 31 32 MetroDoctors

SEPTEMBER/OCTOBER 2002

Sept/October 2002

Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Richard J. Morris, M.D. Physician Co-editor David L. Swanson, 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 Representative Kirsten Schoeller Cover Design by Susan Reed

Chair’s Report Community Internship HMS in Action HMS Alliance

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: Candidates for U.S. Senate, Congress and Governor present their views on healthcare issues. Related articles begin on page 3. Photo by Tom Olmscheid, MN House Information Office.

September/October 2002

PHYSICIAN'S SOAP BOX

Clinical Skills Assessment Exam: A Student Perspective

AS AN ACTIVE MEMBER of the University of Minnesota AMA student group and the Hennepin Medical Society, I am privileged to be on the cutting edge of issues facing students throughout their medical training. It is becoming apparent to me that my fellow students, as well as currently practicing physicians, are not up to speed on many of the same issues. In particular, the discussions about the Clinical Skills Assessment Exam (CSAE) are slipping under the radar of many health care professionals. It is a model example of the need to be actively involved within my profession. The CSAE is a national standardized patient exam proposed by the National Board of Medical Examiners (NBME). It utilizes a minimum of 10 scored cases, each lasting 30 minutes. The exam assesses data gathering and communication skills as part of Step 2 of the United States Medical Licensing Examination (USMLE). The NBME cites studies that find that poor communication, interpersonal skills, and general clinical skills have been correlated with malpractice suits, lower treatment compliance, and lower patient satisfaction. The CSAE is intended to reinforce the teaching of these traits as well as screen out physicians lacking competence in this area. As of 2004, affecting the graduating class of 2005, the National Board of Medical Examiners proposes a national standardized patient exam using the CSAE. As a student, I agree with the National Board of Medical Examiners’ concerns but not their approach to solving this problem. I have several points of contention: •

To do nothing but sit for the examination, there is a proposed cost of $975. In addition, students who must travel to one of five national testing sites nationwide (Minneapolis is NOT one of them) will incur other substantial costs. The cost-benefit analysis has yet to be empirically shown by the NBME. The data shown so far is from the mid to late 1980s and the rest of their data is considered privileged and unavailable.

•

Many medical schools have made significant curriculum changes (including the U of M) since the time of these studies. Most notably, more than 75 percent of LCME accredited schools already offer a comprehensive Objective Structured Clinical Examination (OSCE) that serves a similar purpose.

The AMA-Medical Student Section has offered its continued support for the development of standardized curricula addressing clinical skills assessments, but we oppose the current NBME proposal until further research can be done with respect to the proposal’s efficacy and validity. I stand with my fellow students in this respect. In my opinion, having the test incorporated into the accreditation of the medical school holds the school accountable for its educational practices as well as the individual student. When testing reveals individuals who have not acquired their necessary clinical skills, it may be important to examine the school’s teaching practices as well as the individual. The national exam proposal does not offer this same duality. Instead, it focuses merely on the individual student. Even if the sole goal of the CSAE were to test individual shortcomings, an exam offered by the school would be able to serve the same ends without the extra cost burden to the students at large. I do not intend to suggest that the comprehensive testing of clinical skills is unimportant, but the current CSAE proposal stands a long way from its intended goal. Instead, the current proposal ends up merely adding financial burdens to students without improving medical education and care for our profession and the general community. It would seem rash to implement a program without addressing these issues. The background information in this article can be found in the AMA-Medical Student Section official statement on the CSAE at the AMA website at www.ama-assn.org. Opinions offered are not representative of the University, the AMA-Medical Student Section, or anyone else but myself. Additional questions on this or other issues can be sent directly to me at dietz001@umn.edu.✦

BY ANDREW DIETZ, M.D./Ph.D Student, University of Minnesota

September/October 2002

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Editor’s Message Two Myths about Legislative Advocacy David L. Swanson M.D.

THIS EDITION of MetroDoctors focuses on the candidates for governor and national office. It is fascinating to compare the candidates’ opinions. One gains insight to their opinions about issues, but also a feeling for how committed they are to the issues. Are they for us, or against us, and to what degree and with what passion? As I review the responses to our surveys of the candidates, I find myself challenging my traditional political allegiances. I think that I might vote somewhat differently this November than I have in years past. Casting a vote in an election is the most important task imposed upon us by our citizenship in this great land. I suspect that nearly all of us who are physicians vote. There is another duty of citizenship that representative democracy calls for that most of us avoid. It is the duty of advocacy. We need to communicate with those who represent us. Why don’t we do this? I think it is because of the following two myths surrounding legislative advocacy.

Myth 1: It is gonna cost me money. It is definitely true that giving money to a candidate buys access, but not for you. You aren’t Arthur Anderson, the NRA, or Planned Parenthood. Your bucks are small change on their grand scale. That’s OK. It doesn’t matter if you do not give a candidate money. In fact, it is a violation of ethics for legislators to refer to donation lists in making their voting decisions. What does matter, more than anything else, is that you vote. Your opinion, and that of your voting neighbors, is in fact the only thing that matters when the vote is cast by your legislator. Truly, if you write to a legislator and your zip code is not in the district served by your legislator, your letter or e-mail is discarded

MetroDoctors

without even a look-see. If the zip code is right, your opinion is noted and seriously regarded. What your legislator wants is to be elected. The only thing that gets him or her elected is votes. The only way he or she gets votes is by responding to the wishes of the voters. Your power of influence is completely free. It costs you nothing. (On the other hand, if your legislator is good to you, there is nothing wrong with tossing in a few dollars for the next campaign.)

Myth 2: It is gonna require confrontation. I’m compassionate! I hate confrontation! Getting your opinion registered is ridiculously simple. You can e-mail your legislator through the AMA website (even if you aren’t a member). You need simply to go to their legislative page and enter your zip code. Even easier is to call the local office of your legislator. Both Dayton and Wellstone, for example, have Twin Cities’ offices staffed by eager young workers anxious to justify their existence

by forwarding any message you give them. They are friendly (they want to leave a good impression on the voters) and very accommodating. They want to hear from you, whether you are for an issue or against. After a few calls, you may even get to know them on a first name basis. Give them a call! It is so simple! You do not need to give any long-winded explanation of why you do or do not support something. They already have heard the arguments. They just want to know how you think their boss should vote. And you can tell them in two minutes or less. The truth be told, it is easier to call your legislator than it is to vote and takes less time. So when you hear of some issue affecting your patients or your practice, whether from HMS or RMS, the MMA or the AMA, the TV, or a “by the way” in the doctor’s lounge, hit your legislator’s phone number on your speed dialer and do your duty as a citizen. ✦ David L. Swanson M.D., can be reached at: Swans045@umn.edu

On July 10, 2002, the Hennepin and Ramsey Medical Societies co-sponsored an educational seminar titled, “Provider Roundtable: Public Policy Issues Affecting Consumers and Fair Provider Contracting.” Above are pictured from left, Jack Davis, Senator Dallas Sams, T. Michael Tedford, M.D., Representative Fran Bradley, and Roger Johnson. Senator Sams and Representatives Bradley and Lynda Boudreau (not pictured) were presented certificates of appreciation for their work and support of the fair health plan contracting legislative effort.

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

U.S. Senate and Congressional Candidates’ Views on Health Care Editor’s Note: Following are the responses provided by the candidates for U.S. Senate and Congress. Representative Martin Sabo is not represented here as he did not respond to our numerous requests.

working with my colleagues on the Senate Finance Committee to make sure that future payment cuts don’t happen. More importantly, I am fighting to increase physician reimbursement. I do not support H.R. 4954 because the prescription drug benefit is inadequate. I support the physician fee schedule provisions included in the bill and am advocating for an increase in physician payment of at least 6 percent. H.R. 4954 includes a prescription drug benefit for Seniors. Do you support the drug benefit provisions of H.R. 4954? Please explain your position and if you do not support H.R. 4954, please describe an alternative drug benefit that you could support.

Sen. Paul Wellstone (DFL) Candidate for re-election to the U.S. Senate

Do you support H.R. 4954, the Medicare Modernization and Prescription Drug Act which includes a 6 percent increase in physician reimbursement? I have long fought to fix the Medicare physician payment system that is so terrible for Minnesota. Currently, the physician fee schedule is projected to lead to a decrease of nearly 20 percent over three years. This would have catastrophic consequences for the Minnesota health care system, and the payment cuts must be restored. Because of the devastating impact of the physician fee schedule cuts, I am cosponsoring S.1707, the Medicare Physician Payment Fairness Act. This legislation would stop the current physician payment cuts for 2002. I am also 4

September/October 2002

I strongly support providing a prescription drug benefit under Medicare, as was promised when Medicare was created more than 40 years ago. In the Senate, many of my colleagues and I have worked to develop a prescription drug benefit that provides meaningful coverage to seniors. The Medicare Outpatient Drug Act (S. 2625) adds complete coverage of prescription drugs to Medicare – with no gaps or limits. The coverage would begin in 2004, the first year the benefit is offered. The benefit under S. 2625 would be integrated into the Medicare program to ensure its availability to all beneficiaries. Access to prescription medicines is guaranteed by S. 2625 to every region of the country. Seniors would pay a low monthly premium of $25. Assistance would begin with the first prescription filled – beneficiaries would pay no more than $10 for generic medications, and $40 for medically necessary brand-name medications. And it’s possible that these co-pays could be even lower through price negotiations with pharmaceutical makers. After a senior spends $4,000 on medicine out of his/her own

MetroDoctors

pocket, Medicare would pick-up any remaining expenses – he/she would pay nothing more. Beneficiaries with incomes below 135 percent, of poverty, about $12,000, would receive full assistance for their drug premiums and costsharing. Those with incomes from 135 percent to 150 percent of poverty would pay a reduced premium on a sliding scale basis. Under S. 2625, seniors know what they’ll pay and they know what benefits they’ll get. This plan is the real prescription drug benefit that seniors need. I do not support the drug benefit in the H.R. 4954 plan. In my view, it fails in three ways to provide seniors with the help they need to buy their medicines. First, this plan does not add a prescription drug benefit to Medicare. Instead, H.R. 4954 throws money at private health insurance plans and Medicare HMOs, trying to induce them to offer prescription drug coverage to seniors. Yet the insurance industry has repeatedly stated that it does not want to provide a drug-only insurance product. Even if some insurers do offer coverage, they would likely come in and out of the market or move to profitable market areas. It is highly probable that this would result in the same pullouts and uncertainty that we see in Medicare managed care today. Second, nowhere in H.R. 4954 does it state that the monthly premium is $35 or that the deductible will be $250. These are mere suggestions, and the plans could charge seniors whatever premium and deductible they want. That means seniors would not be able to count on a guaranteed premium or even a guaranteed plan. Third, H.R. 4954 does not provide complete coverage. Seniors would be forced to pay the full cost of their medicines when their out of pocket spending reaches $2,000. The government would only pick up the cost of their prescriptions when their spending reaches $3,700. So seniors would continue to pay a monthly premium when their spending reaches $2,000, yet they would receive no help from the government to pay their medicine bills until they spend $3,700 out of their own pockets. Antitrust laws now prevent physicians from collectively negotiating contracts with health plans. Physicians are forced to sign contracts with billion dollar, giant health care corporations that include provisions that are unfair to both patients and physicians. Will you support

The Journal of the Hennepin and Ramsey Medical Societies

legislation that equalizes the balance of power by providing relief from antitrust and allowing physicians to collectively negotiate contracts with health plans. Why or why not? The managed care system desperately needs to be reformed. Physicians and consumers are frustrated with a managed system that takes decisions out of the hands of medical professionals. It is not healthy for any group to have virtually unlimited power over a matter as significant and sensitive as the kind of medical treatment needed by an individual with an illness or injury. I support legislation that equalizes the balance of power and that would put medical decision-making in the hands of physicians and patients rather than large health plans primarily interested in profits.

MARK YOUR CALENDAR SEPTEMBER 2002 Advanced Life Support in Obstetrics 26-27 (ALSO) Chair: Kimberly Petersen, MD Pillsbury Auditorium, HCMC 17.0 Credit Hours

OCTOBER 3-4 18th Annual Forensic Science Seminar Chair: Kathryn Berg, MD Pillsbury Auditorium, HCMC Approx. 12.0 Credit Hours

What do you think will be the most important health care related legislative agenda facing Congress in the new year? A real prescription drug benefit, parity in coverage for mental health, and helping small business provide health coverage for their employees are major areas I am working in now. Some of this work may indeed continue into the new year, and then the outcome will depend on which party controls the U.S. Senate. But perhaps the most pressing issue facing us in the future is finally figuring out a way to cover the medically uninsured. Research shows that people with health care coverage are far more likely to receive necessary care and higher quality care, yet 39 million Americans do not have any health insurance to help pay their medical bills. My contribution to the debate about how we achieve universal coverage is the Health Security for All Americans Act (S. 2888). This legislation is designed to reach the goal of universal health care coverage by allowing states to decide how to provide affordable and comprehensive health care coverage to all Americans within a specific timetable. The bill insures the uninsured and guarantees affordable health care by limiting out-of-pocket expenses. A central feature of the Health Security for All Americans Act is the promise of comprehensive care by guaranteeing a minimum benefit package equal to that enjoyed by Members of Congress. The bill also ensures quality of care by providing strong patient protections. â&#x153;Ś

Jointly sponsored with MN Coronerâ&#x20AC;&#x2122;s Assoc. and Hennepin County Medical Examiner

17-19

32nd Annual Orthopaedic and Trauma Seminar Chair: Richard Kyle, MD Minneapolis Convention Center 20.0 Credit Hours

NOVEMBER 1 HIV Care Conference Co-Chairs: Hanan J. Rosenstein, MD Ronald L. Schut, MD Abbott Northwestern Hospital 7.0 Credit Hours Jointly sponsored with Allina Hospitals & Clinics

Paradox of Prematurity Co-Chairs: Richard Lussky, MD Virginia Lupo, MD Radisson Metrodome, Minneapolis 6.0 Credit Hours Jointly sponsored with March of Dimes, MN Chapter

DECEMBER 13 11th Annual Family Practice Update Chair: Charles Anderson, MD Radisson Hotel, Roseville Approx. 7.0 Credit Hours For more information, please call HCMC Continuing Medical Education at (612) 347-2075. Fax (612) 904-4210. Toll Free 888-263-4262. www.hcmc.org

Sen. Wellstone can be reached at 651/310-9831. MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

imbursement rates reflect a more equitable, reasonable rate relative to return. H.R. 4954 includes a prescription drug benefit for seniors. Do you support the drug benefit provisions of H.R. 4954? Please explain your position and if you do not support H.R. 4954, please describe an alternative prescription drug benefit that you could support.

Norm Coleman (R) Candidate to the U.S. Senate

Do you support H.R. 4954, the Medicare Modernization and Prescription Drug Act which includes a 6 percent increase in physician reimbursement? Please explain your position. We need to strengthen our Medicare system to reflect the growing needs of today’s seniors and to prepare the program for us aging baby boomers. America has the greatest medical system in the world. We have the best physicians, best medicines, best hospitals and best clinics. It is no coincidence that in the last decade, Americans won 17 of the 22 Nobel Prizes in Medicine. Our Medicare system should maximize seniors’ access to medicine and doctors. It should strengthen physicians’ ability to do their jobs and increase choices without allowing the government to intrude on the physician-patient relationship. I support H.R. 4954 but there are gaps in coverage and we need to move forward in a bipartisan manner to provide a universal, comprehensive prescription drug benefit for Minnesota seniors. Increasing physician reimbursement is critical to maintaining the high quality of care we expect from our medical profession. Minnesota physicians are at a distinct disadvantage to other parts of the country under the current system and consistently struggle just to cover the cost of care. While H.R. 4954 raises the physician reimbursement rate over the next three years, there remain systemic issues concerning how the reimbursement is distributed that must be addressed. I will fight to ensure that future re6

September/October 2002

In July, I joined President Bush at a special event in Minneapolis where the President emphatically declared: “Too many of our seniors are forced to choose between paying for their pills or paying basic bills. That’s not right in America.” I couldn’t agree more. With my two parents on prescription drugs, this is a very real issue for me. Medicare is almost 40 years old, yet its never faced a major improvement of provisions. And it shows. The program is no longer adequately equipped to address the growing prescription drug needs of Minnesota seniors. For a prescription drug benefit to really make a difference, it must be accessible, affordable, and empower Minnesota seniors and their doctors. Our Medicare system should allow seniors and doctors to make health care decisions by maximizing choices and filling individual needs. To this end, H.R. 4954 is a good first step toward strengthening Medicare. As of this writing on July 31, it is unfortunate that partisan politics has hindered even a modest solution for seniors dealing with rising drug costs. Antitrust laws now prevent physicians from collectively negotiating contracts with health plans. Physicians are forced to sign contracts with billion dollar, giant health care corporations that include provisions that are unfair to both patients and physicians. Will you support legislation that equalizes that balance of power by providing relief from antitrust and allowing physicians to collectively negotiate contracts with health plans? Why or why not. I am interested in this issue and want to learn more about it. There are concerns with amending anti-trust laws for physicians and how that will impact access and health care costs for consumers. I understand there are options such as clinical integration that may help provide colMetroDoctors

lective bargaining leverage for physicians. I am open to working with physician groups to improve and strengthen their position with respect to health care corporations. My record as Mayor of St. Paul is one of bringing people together and getting things done. The people at the table may not always agree, and they may not always agree with me, but I am willing to work with all the parties to do what is best for Minnesota. What do you think will be the most important health care related legislative agenda facing Congress in the new year? While I hope Congress will address the issue of prescription drugs before it recesses this year, many senators have been unable to work together, jeopardizing the hope for reform this year. The issue of prescription drugs has ramifications for everyone involved in American medicine, whether it is the seniors that receive care or the doctors that provide it. We need leaders who can bring everyone to the table and get the job done. I think the prescription drug plan passed by the House is a good first step towards strengthening Medicare. But, more must to be done. Future legislation should encourage market solutions and promote private-public partnerships. The government should give doctors and patients, not bureaucrats in Washington, the power to decide what kind of health care is best. It is also time Washington address the regional discrepancies in Medicare reimbursement that unfairly discriminate against Minnesota. This discrepancy disproportionately affects access and quality of care in rural Minnesota. Also on the table should be the patient bill of rights and cost containment. One of the major factors contributing to health care costs is medical malpractice liability. Congress needs to address comprehensive tort reform, including capping attorneys’ fees and limiting punitive damage awards, that will help restore some balance and reduce health care costs. These are issues that will change the shape of the healthcare system. They are issues that require more thought than partisanship which I will bring to Washington. ✦ Norm Coleman can be reached at 651/645-0766.

The Journal of the Hennepin and Ramsey Medical Societies

medical improvements. I am also in favor of personal accounts for seniors that can have funds roll over year to year. I do support physician reimbursement. Our care providers need to be compensated for the work they perform and need to have the confidence that they will be paid for services rendered.

John Kline (R) Candidate in the 2nd Congressional District

Do you support H.R. 4954, the Medicare Modernization and Prescription Drug Act which includes a 6 percent increase in physician reimbursement? Please explain your position. I support the direction that H.R. 4954 is trying to take Medicare, but I would like to see more direct payments to hospitals in rural areas to ensure that they can keep up with changing

H.R. 4954 includes a prescription drug benefit for seniors. Do you support the drug benefit provisions of H.R. 4954? Please explain your position and if you do not support H.R. 4954, please describe an alternative prescription drug benefit that you could support. We need to do something to help seniors with the rising costs of prescription drugs. Prescription drugs ought to be covered by Medicare. What we have today is ridiculous. Medicare will cover surgery to fix an ulcer or other stomach problems. But it won’t cover the drugs that would prevent the ulcer. That just doesn’t make sense and we need to change it. Medicare was designed decades ago and we need to take advantage of significant advances made in health, like the benefits of preventative drugs.

September/October Index to Advertisers Allina Education Services .......................... 16 Brainerd Medical Center ........................... 21 Classified Ads ........................................... 10 Crutchfield Dermatology .......................... 13 DAMARCO ............................................... 8 HCMC CME ............................................. 5 HealthEast Vascular Center ....................... 23 Methodist Hospital .................................... 9 Minnesota Healthcare Network .................. 7 MMIC ............................. Inside Front Cover Multicare Associates ................................... 24 NIH web-based CME ............................... 11 Raymond James Financial .... Inside Back Cover RCMS Inc. ............................................... 15 RiverWay Clinics ...................................... 19 U of M CME ................. Outside Back Cover Wally McCarthy Cadillac ... Inside Front Cover Wally McCarthy Hummer .... Inside Back Cover Weber Law Office ..................................... 11

MetroDoctors

Antitrust laws now prevent physicians from collectively negotiating contracts with health plans. Physicians are forced to sign contracts with billion dollar, giant health care corporations that include provisions that are unfair to both patients and physicians. Will you support legislation that equalizes that balance of power by providing relief from antitrust and allowing physicians to collectively negotiate contracts with health plans? Why or why not. While I understand that physician anti-trust laws are an important and complicated issue that must be studied and analyzed, I have not yet finalized my position on this issue. What do you think will be the most important health care related legislative agenda facing Congress in the new year? We need to find a way to help more Americans find affordable health insurance to protect themselves and their families. ✦ John Kline can be reached at 952/846-0808.

Doctors — do you want to be independent? Do you want to stay independent?

We want you to. If your medical practice is interested in information about joining the MHN care system please contact: Minnesota Healthcare Network, LLC 7900 International Dr., Suite 1080 Bloomington, MN 55425-1510 Phone (952) 883-3150 Fax (952) 883-3134 E-mail info@mhcn.com

The Journal of the Hennepin and Ramsey Medical Societies

For over 20 years, Minnesota Healthcare Network has served physician groups throughout the Twin Cities and neighboring communities. We represent the interests of our member clinics in a competitive and increasingly complex marketplace. We provide a vehicle for independent clinics to contract and have good working relationships with health plans and other purchasers. We have innovative and comprehensive data systems that provide sound information, which allows our physicians to make wise medical and business decisions. Our members are independent primary care (FP/GP, IM, Peds) and multi-specialty medical groups. We are physician-owned and governed. Over 50,000 health plan members have their care provided and coordinated by our independent physicians. This allows us to meaningfully advocate for our physician members and their patients in an era of health care where advocacy for these constituents is increasingly necessary. If you are in private practice, or were and may be reconsidering that option, please contact us to find out how MHN may benefit you.

www.mhcn.com September/October 2002

Rep. Bill Luther (DFL) Formerly represented the 6th District, and now is a Candidate in the 2nd Congressional District

ued ability to provide high quality care under Medicare. That is why I am an original cosponsor of the Medicare Physician Payment Fairness Act, which would amend the current payment structure and require a study to design a new formula without the current flaws. I did not support H.R. 4954 because it failed to provide seniors with an affordable, reliable prescription medicine benefit.

allow private plans to vary price, benefit design, and availability of drug coverage all across the country. This means that a senior in Florida may pay a different premium than a senior in Minnesota for the exact same benefit. Instead, I support an alternative that offers all seniors a benefit that truly assists them with prescription drug costs, without any gaps in coverage or geographic disparities.

I have serious concerns with H.R. 4954’s prescription benefit. For example, this bill would cover less than 25 percent of Medicare beneficiaries’ estimated prescription drug costs over the next 10 years and would pay nothing for costs between $2,000 and $3,700. Additionally, there is no guaranteed premium so actual premiums could vary among plans. It would

Your medical society has contracted with DAMARCO Solutions, LLC to provide OSHA compliant MSDS Management Services to members that wish to enroll. DAMARCO has significant experience with clinics and hospitals and offers efficient, extremely cost-effective services. Enrollee cost reduces as more members enroll. Internet and toll free phone and fax access to MSDS. Toll free phone is answered at a poison center to provide information about chemical use or to advise in the event of a chemical exposure. Access to over 100,000 unique, constantly updated MSDS.

September/October 2002

Need Help Managing Your Material Safety Data Sheets (MSDS)? For more information contact: Gary Graczyk at 612-617-0999 ext. 102 or email: gary@damarco.com or visit DAMARCO s website at www.damarco.com

MetroDoctors

I believe that Congress must approach changes to antitrust laws very carefully, as these laws were designed to protect individual consumers. At the same time, I also believe it is important that physicians are not forced to sign contracts that are unfair to them and to patients. Therefore, I would need to study the details of any specific proposal before I could support or oppose it. What do you think will be the most important health care related legislative agenda facing Congress in the new year? It is difficult to say what will be the most important health care issue in the new year because there is still important work to be accomplished this year. It is my hope that we will be able to work out an acceptable compromise on a prescription medicine benefit before Congress adjourns, but if we cannot, this will be even more critical next year. I am committed to continuing my work on eliminating the current geographical disparities in Medicare rates next year. Until Minnesota seniors enjoy the same benefits at the same low cost as seniors nationwide, this will be a top health care priority for me. ✦ Rep. Luther can be reached at 651/730-4949.

The Journal of the Hennepin and Ramsey Medical Societies

Rep. Jim Ramstad (R) Candidate for re-election in the 3rd Congressional District

Do you support H.R. 4954, the Medicare Modernization and Prescription Drug Act which includes a 6 percent increase in physician reimbursement? Please explain your position. I strongly support H.R. 4954 and the 6 percent increase in payments to physicians included in the bill. We all know the current formula is not an accurate measure of physician costs and leads to arbitrary and irrational reimbursement rates. I believe the provisions in H.R. 4954 are a good first step in moving toward fair reimbursement for physicians and set the stage for comprehensively reforming the physician reimbursement formula. H.R. 4954 includes a prescription drug benefit for seniors. Do you support the drug benefit provisions of H.R. 4954? Please explain your position and if you do not support H.R. 4954, please describe an alternative prescription drug benefit that you could support. I strongly support the prescription drug benefit included in H.R. 4954. Out-of-pocket drug costs for the average senior will be reduced by $940 under this plan, or 44 percent less than what they are currently paying. Additionally, 17 percent of beneficiaries use 55 percent of all the prescription drugs consumed by the Medicare population, which makes the “stop-loss” coverage in the bill very significant to this small group of high spending individuals. And participation in this plan is completely voluntary, so seniors with nominal drug expenses can decide for themselves whether to participate in the plan. MetroDoctors

While well intentioned, I do not believe collective bargaining is the best method for improving the quality of health care in this country. In testimony before the Judiciary Committee during Congressional debate on this issue, Joel Klein, former Assistant Attorney General, Antitrust Division at the Department of Justice (DOJ), said, “It has become clear over the years that consumer welfare and patient choice are best preserved by relying on antitrust principles to assure the proper operation of health care markets just as they are in other

markets. Permitting providers to form bargaining groups in response to perceived bargaining leverage by insurers will not decrease the cost of health care or increase the quality of patient care.” What do you think will be the most important health care related legislative agenda facing Congress in the new year? The health agenda for the next Congress will be largely determined in the upcoming months, as the Senate continues to struggle to pass a prescription drug benefit. If prescription drug legislation is not signed into law this year, providing prescription drug coverage under Medicare will continue to be our top priority. Also, although we are closer than we’ve ever been to seeing a Patients’ Bill of Rights enacted, it appears this issue will continue in the next Congress and remain a leading health care priority.✦ Rep. Ramstad can be reached at 952/738-9100.

Think you have an eating disorder? We can help. The Eating Disorders Institute (EDI) offers inpatient, partial-day and outpatient programs in a newly expanded space. EDI is a partnership with Methodist Hospital and University of Minnesota physicians. Call for information — 952-993-6200 6490 Excelsior Blvd. St. Louis Park, MN 55426 www.parknicollet.com

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

Rep. Betty McCollum (DFL) Candidate for re-election in the 4th Congressional District

Do you support H.R. 4954, the Medicare Modernization and Prescription Drug Act which includes a 6 percent increase in physician reimbursement? Please explain your position. I voted against H.R. 4954, the Medicare Modernization and Prescription Drug Act, the Republican proposal to subsidize private insurance plans in hopes that they will offer prescription drug coverage to Medicare beneficiaries. This legislation included several Medicare reimbursement changes, including the 6 percent increase in physician reimbursement. While I couldn’t support H.R. 4954 because it failed to provide a guaranteed Medicare prescription drug benefit for all seniors, I strongly support an increase in physician reimbursement. I am a cosponsor of H.R. 5019, the Democratic Medicare Prescription Drug Benefit and

Classified Ads Billing Headaches? We Can Help! Medical Billing Professionals is a full practice management billing center, providing professional, comprehensive and cost-effective billing services to healthcare providers. Call (320) 9638034 today — and take control of your billing! Visit us at: www.medical-billing-professionals.com.

September/October 2002

Discount Act, which included the same 6 percent increase in physician reimbursement, as well as H.R. 3351, the Medicare Physician Payment Fairness Act. H.R. 3351 would reduce the scheduled 5.4 percent cut to 0.9 percent instead, and would order the Medicare Payment Advisory Commission to come up with a new payment formula in time for 2003. I also joined several of my colleagues in sending a letter to Speaker Hastert requesting that he ensure that the House take steps to prevent these devastating cuts from going into effect next year. Congress must act to freeze the current physician payment rate or reduce the scheduled cut until a new, more appropriate formula can be developed. If the House leadership is serious about taking action on this measure, we must pass this increase in physician reimbursement outside of controversial legislation like H.R. 4954, to ensure that the bill will pass both Houses and be signed by the President. Please know that I will continue to work with my colleagues in Congress to keep these cuts from going into effect. H.R. 4954 includes a prescription drug benefit for seniors. Do you support the drug benefit provisions of H.R. 4954? Please explain your position and if you do not support H.R. 4954, please describe an alternative prescription drug benefit that you could support. I voted against H.R. 4954, the Medicare Modernization and Prescription Drug Act because I oppose the proposed House Republican drug plan to provide prescription drug benefits to Medicare members through private insurers. Half of Minnesota seniors today have no prescription drug coverage because private insurers won’t offer policies because it is unprofitable for companies to do so. Due to unfair reimbursement formulas for health care providers, Medicare beneficiaries in other parts of the country enjoy substantially more benefits from Medicare HMOs, such as prescription drug coverage or eyeglasses. Unfortunately, the Republican plan does nothing to address this inequity and will simply ensure that Florida seniors continue to enjoy prescription drug benefits while insurance companies refuse to offer a comprehensive benefit for Minnesota seniors. The Democratic bill I’m a sponsor of provides that for a voluntary drug premium of $25

MetroDoctors

per month the government will pay 80 percent of drug costs after a $100 deductible. And no senior will have to pay more than $2,000 in costs per year. On top of that, we will be arming seniors with real protection from soaring drug costs. With forty million seniors banded together under the buying power of Medicare, we can begin to use the bargaining power to rein in high drug prices. Unfortunately, the House Republican leadership continues to deny members a vote on this legislation. Antitrust laws now prevent physicians from collectively negotiating contracts with health plans. Physicians are forced to sign contracts with billion dollar, giant health care corporations that include provisions that are unfair to both patients and physicians. Will you support legislation that equalizes the balance of power by providing relief from antitrust and allowing physicians to collectively negotiate contracts with health plans? Why or why not? I support legislation to allow physicians to collectively negotiate contracts with health plans. The dangers posed by the ever-increasing consolidation in the health insurance and managed care market are exacerbating the practice of health insurers engaging in heavy-handed negotiating tactics and requiring exclusionary contractual commitments from health care providers. These restrictive contractual terms are frequently proffered on a “take it or leave it” basis to health care providers, under the threat of the loss of the provider’s patients or exclusion from their access to other patients. By allowing physicians to negotiate with health plans, we can improve patient care and return medical decision making to physicians and patients, where it belongs. What do you think will be the most important health care related legislative agenda facing Congress in the new year? Unfortunately, the most important health care issues facing Congress next year will likely be the same issues facing our nation this year. Patient’s rights legislation remains stalled over partisan issues and the House Republican prescription drug legislation is simply an empty promise. ✦ Rep. McCollum can be reached at 651/603-1505.

The Journal of the Hennepin and Ramsey Medical Societies

Clyde E. Billington, Ph.D (R) Candidate in the 4th Congressional District

Do you support H.R. 4954, the Medicare Modernization and Prescription Drug Act which includes a 6 percent increase in physician reimbursement? Please explain your position. I do support H.R. 4954, the Medicare Modernization and Prescription Act. Physician reimbursement has been frozen for several years as a way of controlling Medicare costs. There are other means of keeping costs under control without denying physicians fair compensation for their work. Many young doctors have huge student loans that they must pay back, and many of them have also delayed having families and buying houses while in medical school. They must be fairly compensated once they finish their years of education and internships. H.R. 4954 includes a prescription drug benefit for seniors. Do you support the drug benefit provisions of H.R. 4954? Please explain your position and if you do not support H.R. 4954, please describe an alternative prescription drug benefit that you could support. I do support the prescription drug benefit in H.R. 4954. My father died of cancer three years ago, and I know how expensive drugs can be. My mother’s only income is from Social Security. She is now healthy, but I do worry about high prescription drug costs, if she should become ill.

Yes, I strongly support the right of physicians to negotiate contracts with these huge health care organizations. Even though I am a Republican, I come from a union family. I look on the right to negotiate a labor contract as a basic right. Antitrust laws that limit the right to negotiate should be repealed. My daughter is a registered nurse working in a hospital, and she has frequently complained about the heavy – and growing– workload placed on nurses. She also says that R.N.s often have such a heavy workload that it poses a danger to patients. I know that the same is true of physicians and of their workloads at many of these huge health care organizations. The right to negotiate would solve many of these problems. What do you think will be the most important health care related legislative agenda facing Congress in the new year? I am concerned about the intrusion of these huge health care organizations into the physician-patient relationship. About eight years ago, my sister-in-law had cancer, and her physician prescribed a treatment that was not covered by her medical plan. She appealed to her health care organization and was turned down. She eventually discovered that the person who turned down her request was an administrator in another state who had no medical education at all. After a great effort, she got the prescribed treatment and is still alive today. I am also concerned about the growing cost of litigation for the entire medical profession. Some method, other than lawsuits, must be developed to compensate those who are accidentally injured. The many lawsuits being filed today are driving up health care costs. Physicians are being forced to practice defensive medicine as a way of protecting themselves, and this also contributes to higher medical costs. ✦

A web-based CME course, “Gaining Control of Asthma: Diagnosis, Management, and New Therapies” will be available on the NIH Clinical Center Web Conference Hall between June 17 and December 6, 2002. The course is copresented by NIH Institutes – NHLBI and HIAID. Faculty from NHLBI are Joel Moss, M.D., Ph.D. and Stewart J. Levine, M.D. Faculty from NIAID is Calman Prussin, M.D. The course will discuss the most current guidelines for diagnosing asthma and classifying its severity, the stepwise approach to asthma management, the appropriate use of new asthma medications, the latest NIH research and future treatment trends. Participants must have an Internet connection, a Web browser, and Adobe Acrobat Reader (which can be downloaded free of charge on the conference center website). There is no charge to participate. Up to 4.5 AMA PRA category 1 credits will be awarded electronically. To complete the course, go to www.frontlinemeded.org. For more information, call 1-800-393-5936 or TTY line 301-572-0202.

WEBER

LAW OFFICE Focusing on the legal needs of the health professional! • Licensure • Employment Law • Trial Work • Wills and Estates • Regulatory Compliance

Michael J. Weber, J.D. • Former Attorney for the Board of Medical Practice • Over Six Years as an Assistant Attorney General

612-296-8080 www.weber-law.com “Committed to the Best Legal Outcome Possible Through Diligence and Resourcefulness!”

Clyde E. Billington, Ph.D can be reached at 651/493-6541. MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

sponsible approach, within budget, to help curb the expense for prescription drug costs and helps with reimbursement rates for providers, including physicians. There is more to do to strengthen Medicare, but this bill is a good start. H.R. 4954 includes a prescription drug benefit for seniors. Do you support the drug benefit provisions of H.R. 4954? Please explain your position and if you do not support H.R. 4954, please describe an alternative prescription drug benefit that you could support.

Rep. Mark Kennedy (R) Formerly represented the 2nd District, and now is a Candidate in the 6th Congressional District

Do you support H.R. 4954, the Medicare Modernization and Prescription Drug Act which includes a 6 percent increase in physician reimbursement? Please explain your position. Yes, I am a co-sponsor of H.R. 4954, which the House passed in June. This provides a re-

I am a member of the Speaker’s Prescription Drug Action Team and am proud to have helped craft the prescription drug benefit included in H.R. 4954. This bill ensures that seniors will not be forced to choose between food and medicine and deplete their life savings to buy life-saving prescriptions. Antitrust laws now prevent physicians from collectively negotiating contracts with health plans. Physicians are forced to sign contracts with billion dollar, giant health care corporations that include provisions that are unfair to

both patients and physicians. Will you support legislation that equalizes the balance of power by providing relief from antitrust and allowing physicians to collectively negotiate contracts with health plans? Why or why not. I support restoring the doctor/patient relationship in a way that does not raise costs or reduce the physicians’ ability to provide quality care. In order to achieve this, I will evaluate legislation that gives physicians the freedom to care for their patients. What do you think will be the most important health care related legislative agenda facing Congress in the new year? The most important health care issues facing Congress are strengthening Medicare and adding a prescription drug benefit for seniors, eliminating the payment disparities that have plagued Medicare for years, and enacting common sense medical liability reform that is chasing too many physicians out of the profession and driving up health costs. ✦ Rep. Kennedy can be reached at 763/682-6898.

Continue Your United Way Giving FOR YEARS, GREATER TWIN CITIES UNITED WAY has been

committed to fortifying the health of the local community by helping patients before they arrive at your waiting room. The support of both HMS and RMS physicians is essential in United Way’s many health initiatives, because the hard work we do is only as strong as the doctors that help us share knowledge with the community. For this reason, United Way has several health-related initiatives that depend on the expertise of health care professionals. • United Way Success By 6® is an early childhood development initiative, focused on providing parents the necessary tools to raise healthy children. • The Healthy Learners “No Shots, No School” partnership with Minneapolis public schools dramatically increased the immunization levels of school-age children in two years. • New Vistas High Schools connects pregnant teenagers with Pediatric Resident volunteers who teach them prenatal care while stressing the importance of personal physicians. • Healthspeak™ is a health education curriculum, begun by United Way, that brings health care professionals into classrooms

September/October 2002

to educate students on health matters. In 2000, almost 200 medical professionals volunteered, reaching approximately 110,600 fourth-grade and fifth-grade students. United Way partner, the Minnesota Red Cross, now handles its operations. Nurses from the Minnesota Visiting Nurse Agency visit thousands of seniors and people with disabilities every year. United Way also funds health-based programs through its network of agencies. We know that you see hundreds of people in your waiting rooms every day. We want to help the ones you don’t see. Without assistance from doctors like you, we could never have begun to serve those people. And without help from donors like you, we will never be able to continue helping those people. Past donations from physicians like you have been instrumental in the procedure and maintenance of the programs mentioned. Please continue to help your community. You can mail your gift to United Way Gifts, 404 South Eighth Street, Minneapolis, MN 55404 or give a secure gift online at www.unitedwaytwincities.org. Call (651) 290-4590 to donate by phone. Help us help those outside the waiting room. Thank you. ✦

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Janet Robert (DFL) Candidate in the 6th Congressional District

I appreciate that physicians are concerned about the increasing influence of HMOs in health care. Furthermore, I understand that this dynamic may make it difficult for physicians to best advocate for their patients. Where patients are being harmed by lack of access to health care,

physicians must have some recourse perhaps through a stronger patient’s bill of rights. What do you think will be the most important health care related legislative agenda facing Congress in the new year? I believe that the Congress and the President will need to address the issues of providing affordable prescription drug coverage for seniors if they do not manage to do it before the end of this year. The physician community is one of the first groups I would like to meet with as a newly elected Member of Congress so we can address these critical issues. ✦ Janet Robert can be reached at 763/712-4951.

Do you support H.R. 4954, the Medicare Modernization and Prescription Drug Act which includes a 6 percent increase in physician reimbursement? Please explain your position. I believe the provision of H.R. 4954 to increase physician reimbursements must be done because it is essential, but I do not support a bill that would create a “stand alone” prescription drug program from the existing Medicare program. H.R. 4954 includes a prescription drug benefit for seniors. Do you support the drug benefit provisions of H.R. 4954? Please explain your position and if you do not support H.R. 4954, please describe an alternative prescription drug benefit that you could support. While I support the spirit of H.R. 4954 to create affordable prescription drug coverage, I believe Congress should enact a prescription drug plan that is under the existing Medicare program. Any attempt to enact a prescription drug benefit under Medicare is complicated by the fact that we are once again running deficits due to a slowed economy. Any honest discussion of creating affordable prescription drug coverage for seniors will need to address where sources of revenue to fund the new benefit will be found. This will be a difficult task in our current budget environment but we must find a way to do it even if it is a scaled down version.

MetroDoctors

Crutchﬁeld Dermatology “Exceptional care for all skin problems”

Charles E. Crutchﬁeld III, M.D. Board Certiﬁed Dermatologist Experienced BOTOX Provider

Your Patients will Look Good & Feel Great with Beautiful Skin

The Journal of the Hennepin and Ramsey Medical Societies

www.CrutchﬁeldDermatology.com

1185 Town Centre Drive Suite 101 Eagan, MN 55123

Appointments 651-209-3600 Prompt Appointments via Physician Requests

September/October 2002

Candidates for Governor Editor’s Note: MetroDoctors provided the following background information to the gubernatorial candidates. Please note that Roger Moe was given the opportunity to answer the questions as well, but did not provide responses. There is evidence that policymakers in Minnesota will have to respond to increasing health care costs even though physicians and other providers are surviving on very low reimbursement from Medicare and the large health plan payers. The demand for high tech care by the consumer is rapidly increasing which places more demands on a system that is economically squeezed. Shortages in the health care work force such as nursing and some medical specialties such as infectious disease and neurosurgery will continue to create extreme pressures within the health care system in Minnesota. A significant problem with our current system is that three large health plans control much of the health care financial structure in Minnesota. These health plans determine what services will be covered and the reimbursement that providers will receive. The high operating costs of these large health systems are also eating up dollars that should go to patient care. The following questions relate to the Minnesota Fair Healthplan Contracting bill that was introduced in the 2002 Session of the Minnesota Legislature.

Do you support allowing providers to have a voice in establishing the termination, indemnification, and arbitration language of health plan contracts? Yes, I support allowing providers to have a voice in establishing the termination, indemnification, and arbitration language of health plan contracts. Do you support requiring that providers must be notified by the health plans of any coding changes that are made to submitted claims in advance of the payment of the claim to allow for an appeal? Yes, I support requiring providers to be notified by the health plans of any coding changes that are made to submitted claims in advance of the payment of the claim to allow for an appeal.

Tim Pawlenty (R) Do you support requiring the health plans to provide low cost, accessible means for providers to obtain required pre-authorization approvals?

Do you support requiring health plans to disclose contract terms that affect the cost and quality of care to consumers and to providers? Yes, I support requiring health plans to disclose contract terms that affect the costs and quality of care to consumers and to providers. Some of the contracting practices of some of the Minnesota health plans have been very unfair to the contracting providers of Minnesota. However, it is the expectation of the legislature that provider groups and health plans will work together to come up with some common ground on this issue. Do you support holding health plans accountable for decisions that deny care and result in adverse effects on the enrollee? Yes, I believe health plans should be held accountable for decisions they make that directly approve or reject health care decisions and have an adverse effect on patients. One important point is that there is currently appeal options for people who are denied medical care or would like to appeal a health

September/October 2002

Yes, I support requiring the health plans to provide low cost, accessible means for providers to obtain the required pre-authorization approvals. Do you support legislation that would allow providers to collectively negotiate contracts with the large health plans in an effort to level the playing field? plan decision. They can file an appeal with the health plan, file a complaint with the State, obtain an external review of the health plan decisions, and/or file a lawsuit with the court. Do you support prohibiting health plans from extending the participating provider’s contract terms to additional health plan products without the provider’s consent? Yes, I support prohibiting health plans from extending the participating provider’s contract terms to additional health plan products without the provider’s consent.

MetroDoctors

No, I have significant concerns about legislation that would allow providers to collectively negotiate contracts with the large health plans. What is the health care issue that is of the highest priority to you as a candidate? My priorities in health care include: providing competition; patient access and connection with health care providers; addressing the rising cost of health care and prescription drugs; and issues related to medical malpractice. ✦ Tim Pawlenty can be reached at 651/905-0555.

The Journal of the Hennepin and Ramsey Medical Societies

Tim Penny (IND) “I have made it a policy of my campaign not to answer questionnaires. Rather than answer questions on this specific piece of proposed legislation, I would like to share with your readers my overall thoughts on health care reform. “Given the extreme cost pressures on the health care system, and the state of our state budget deficit, health care reform will be an important issue for the next Governor. As Governor, I will work with the entire health care community to come to a bipartisan solution on how we reform our health care system for the future.” Common Sense and Straight Talk on Health Care Reform Tim Penny has been a leader on health care issues, both as an elected official and a private citizen. He recently moderated 24 town hall meetings across Minnesota on health care and long-term care reform. He was the national spokesperson for the Health Care Leadership Council, and had a close relationship with doctors and nurses throughout his elected years. In Congress, he was proud to represent and work closely with the Mayo Clinic. Health care needs Tim Penny’s strong, nonpartisan leadership from the top, especially in a time of budget crisis.

system. As Governor, Tim Penny will develop bipartisan, long-term reform proposals with the participation of the entire health care community. These changes must engage consumers in health care decisions, allowing them to make choices for themselves and their families. It also must drive toward making the delivery of health care more safe, effective and efficient.

Health Disparities and Covering Kids Minnesota does a good job insuring most Minnesotans, but we have serious racial and ethnic disparities in health care coverage – and we still have uninsured kids. Tim Penny believes that we should continue to find ways to cover the uninsured, with a focus on children and minorities.

Prevention Minnesota is the healthiest state in the nation and we should be proud. Prevention and education about staying healthy saves us money in the long-term. Tim Penny supports continued investment in prevention, including tobaccoprevention programs.

Prescription Drug Coverage Tim Penny will keep pressure on Washington to include a Medicare benefit for prescription drugs while ensuring that poor senior Minnesotans have help accessing the prescription drugs they need.

Long Term Care Our population is aging, especially in rural Minnesota. Older Minnesotans should be able to stay independent as long as possible and have access to community-based care. Tim Penny will work to ensure that older and chronically ill Minnesotans have quality and affordable care.

Workforce Shortage The growing shortage of nurses and other health professionals in Minnesota threatens the quality of care in health care institutions and drives up health care costs. As Governor, Tim Penny will work with the education and health care community to forge a creative solution to this pressing problem. ✦ Tim Penny can be reached at 1/888/507-3669.

RMS Membership Advantages for Physicians and their Practices Business AdvantEdge is a local company that offers discounts on: office supplies; Sprint PCS cell phones and plans; Compaq computers; copiers; fax machines; payroll processing (ADP); local and long distance phone service; courier services; travel; and discounts on overnight deliveries.

DAMARCO Solutions provides OSHA compliance through their Material Safety Data Sheet (MSDS) management service. MSDS are available to clinics 24/7/365 for a minimal fee.

MBNA America Credit Card offers one of the highest credit lines available (up to $100,000) through its Platinum Plus card; an introductory 0% APR on balance transfer and all cash advances; Year End Summary of charges; and around the clock Customer Service. Call 1-877-518-9007.

MLT vacations is offering physicians and their staff members and families discounts on vacation packages.

Health Care Costs All Minnesotans, including employers, consumers and state government, are experiencing extraordinary premium increases, costs which threaten to undermine the progress Minnesota has made in providing affordable health care. Tim Penny believes it’s time for thoughtful legislative changes in Minnesota’s health care MetroDoctors

World Medical Leaders is a free internet based CME program conducted by physicians who are recognized leaders in their respective fields of medicine. Check out their website at www.wml.com.

Products Offered to RMS Members by RCMS, Inc.

For more information call 612-362-3704.

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

Continuing Medical Education sponsored by Allina Hospitals & Clinics

September 2002 6

Pulmonary Update Pulmonary Critical Care Associates and United Hospital LOCATION: United Hospital, St. Paul, Minnesota

Ken Pentel (GP)

PRESENTED BY:

Do you support requiring health plans to disclose contract terms that affect the cost and quality of care to consumers and to providers? YES

25-26 A.C.L.S - Advanced Cardiac Life Support Instructor PRESENTED BY: Allina Hospitals & Clinics LOCATION: United Hospital, St. Paul, Minnesota 28

The Management of Ear and Skull Base Disease PRESENTED BY: Ear, Nose and Throat SpecialtyCare of Minnesota, P.A. LOCATION: DoubleTree Grand Hotel, Bloomington, MN

Do you support holding health plans accountable for decisions that deny care and result in adverse effects on the enrollee? YES

October 2002 12

Retina Update PRESENTED BY: LOCATION:

Phillips Eye Institute Wyndham Minneapolis Airport Hotel, Bloomington, MN

24-25 Frontline Neurology PRESENTED BY: Minneapolis Neuroscience Institute of Abbott Northwestern Hospital; the American Association of Neuroscience Nurses – Twin Cities Area Chapter LOCATION: Wyndham Minneapolis Airport Hotel, Bloomington, MN

November 2002 1

HIV Care Conference Allina Hospitals & Clinics, Hennepin County Medical Center and Midwest AIDS Training & Education LOCATION: Abbott Northwestern Hospital, Minneapolis, Minnesota PRESENTED BY:

Do you support allowing providers to have a voice in establishing the termination, indemnification, and arbitration language of health plan contracts? YES Do you support requiring that providers must be notified by the health plans of any coding changes that are made to submitted claims in advance of the payment of the claim to allow for an appeal? YES

18-19 A.T.L.S - Advanced Trauma Life Support PRESENTED BY: Allina Hospitals & Clinics LOCATION: United Hospital, St. Paul, Minnesota

December 2002 5-6

Do you support prohibiting health plans from extending the participating provider’s contract terms to additional health plan products without the provider’s consent? YES

Do you support requiring the health plans to provide low cost, accessible means for providers to obtain required pre-authorization approvals? YES, providing it is secure and verifiable.

B.L.S - Basic Life Support Instructor PRESENTED BY: Allina Hospitals & Clinics LOCATION: United Hospital, St. Paul, Minnesota

Do you support legislation that would allow providers to collectively negotiate contracts with the large health plans in an effort to level the playing field? YES

For more information contact: Allina Education Services at (612) 775-9626 or toll-free (800) 605-3744 education@allina.com

®Allina Health System

What is the health care issue that is of the highest priority to you as a candidate? A universal, one-payer healthcare system. ✦

Ken Pentel can be reached at 612/728-3734. 16

September/October 2002

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

COLLEAGUE INTERVIEW

Theodore Loftness, M.D. Editor’s Note: Theodore (Ted) J. Loftness, M.D. became vice president and medical director of provider relations for Medica in August 2001. From 1994 to August 2001, Dr. Loftness held a number of key positions with Allina Health System. Dr. Loftness continues to practice internal medicine at Litchfield Medical Clinic, where he first entered private practice in 1987 and where he was managing partner and lead physician from 1989 to 1994. He received his medical degree from the University of Minnesota.

Q A

What are your top three priorities at Medica? For the first part of 2002, Medica was focused on becoming an independent health plan. To that end, the Board of Directors has been working on completing strategic planning from the ground up, including creating comprehensive business plans for 2003. These plans are still being developed. A major priority for Medica continues to be improving provider relationships. Going forward, Medica will be focusing on successfully running the business by meeting its business goals and complying with the Memorandum of Understanding with the Attorney General’s Office. In addition, Medica will be implementing the self-funded Elect product to give our self-insured customers a greater range of options and we will be re-examining the roles, responsibilities and resources for care management and utilization management.

What are the common goals that health plans and practicing physicians share, and what are the obstacles to achieving those goals? A common goal that health plans and practicing physicians share is delivering the highest quality medical care to patients and members. I believe the variation in how health care is delivered to our patients and members who have chronic conditions is one of our biggest opportunities. Historically, the health care system built and relied on an infrastructure that was better suited to manage acute rather than chronic conditions. Chronic conditions often require around the clock support, motivation and education. We need to have more systems in place that address these concerns.

Which mechanisms are in place at Medica to assure the input of practicing physicians during policy development? Medica solicits input from providers on a variety of topics through several different mechanisms, including focus groups, provider forums, face-toface meetings and a number of committees. The Medical Policy Committee is made up of board-certified, practicing physicians in family practice, internal medicine, obstetrics and gynecology, and pediatrics, as well as a consumer representative. I assist in the appointment of these committee members. Local specialist input is requested upon creation of new utilization management policies and throughout the annual revision process. We also receive input from the Medical Advisory Committee, the Physician Specialty Panel, the Pharmacy and Therapeutics Committee and a Quality Improvement subcommittee. More than 100 external practicing physicians serve on these committees. In addition, there are three physicians that serve on Medica’s Board of Directors. And, physicians can always call me and give me their input. I can be reached at Medica at 952/992-8456.

How will you direct quality improvement initiatives now that Allina and Medica are separate entities? Medica has an annual process for establishing quality improvement priorities that is led by Medica’s Vice-President and Medical Director for Quality and Care Management. This process involves assessing the needs of the various populations insured through Medica and comparing those needs to the resources available in existing programs. The past association between Medica and Allina did not affect this prioritization process or the establishment of clinical priorities for any given year. (Continued on page 18)

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

Colleague Interview (Continued from page 17)

How will Medica balance increased demand for medical care with business demands for lower health care costs? Using resources to help prevent disease and to help prevent complications in people that have chronic conditions are important ways that we can help balance the demand. For example, in the management of diabetes, it is better to spend more on pharmacy costs now so future costs that could result from complications are avoided (myocardial infarction, amputations, etc.).

Contracts between physicians and health care plans have favored the plans in the past. What are Medica’s plans for fairer contracts and more understandable reimbursement in the future? Medica is in the process of reviewing and revising its standard physician contract with the goal of producing a contract document that clearly delineates both parties’ rights and responsibilities — using standardized contract language. We have submitted our physician contract to the MMA for their review and input and are incorporating feedback received directly from physicians and clinic administrators. Medica is also in the process of standardizing its reimbursement methodologies. We are moving toward greater use of CMS reimbursement methodologies where possible, such as RVU-based fee schedules, professional/technical fee splits, lab fee schedules, etc. Medica has also been working to get more information added to our web site to ensure that physicians have understandable detailed information on a variety of topics. Our provider newsletters, medical polices and clinical guidelines, credentialing plan, administrative manuals, formulary, etc. can all be found on our web site. Log onto www.medica.com and then click on “Provider Resources.”

What will Medica be doing to deal with the 20 percent of patients who utilize 80 percent of costs? Medica has a broad program in the area of care coordination that is addressing the needs of the 20 percent of the patients utilizing 80 percent of the resources. Patients that need or potentially need significant resources are identified through a number of different mechanisms. These include, among others, health risk assessments, chronic disease registries, hospital admission rosters, hospital admission data, and/or referrals from a variety of sources. Once identified, patients may receive many different health plan services. These could include coaching, teaching, coordination of resources, referrals to disease management programs, referrals to practitioners, consultations with practitioners, and ongoing contact with a nurse case manager, among others. The mix and intensity of interventions varies with the patient and the identified needs.

September/October 2002

Medica has been perceived as having contractual terms unfavorable to independent physicians, with those physicians having no options to negotiate more favorable terms. Will this change following the breakup of Allina and formulation of a new Medica Board of Directors? The aggregation of medical groups for contracting has created greater leverage in today’s market for these groups. At the same time, Medica has a long history of working with independent physicians to provide comparable reimbursement for comparable services. We try to balance access issues with the needs of our members. Medica has been moving toward more standardized contracts because these types of contracts can help ensure that claims are paid quickly and accurately from an operational standpoint. We also believe that standardized contractual terms across specialties are fairer to groups of like providers.

Minnesota doctors are fed up with behavioral carveouts and want access to care and consultations. Medica has been cutting its UBH clinics but not adding psychiatrists to its network. What are Medica’s plans in this area? Medica recently signed a new three-year ASO (administrative services only) contract with UBH. In this new agreement, Medica will be responsible for the cost of all mental health services. In the past year, UBH added 48 psychiatrists and 30 clinical nurse specialists to its network. In addition, UBH pays a premium to certain psychiatrists to reserve appointment slots each week for emergency cases to ensure access to care for Medica’s members. UBH has not owned or operated mental health clinics since 1996.

Will Medica follow BCBSM and HealthPartners in using the 3-judge denial review panel set up in the June 2001 Hatch/BCBSM mental health case settlement? Yes. As of March 2002, Medica began voluntarily participating in the Administrative Review Committee process. Medica members may continue to follow the regular appeals process concurrently with the ARC review process, thereby strengthening the claims-review process overall.

Medica continues to pay for out-of-network physician care but not the prescriptions from out-of-network MDs. Can you fix this? It is fixed. Out-of-network physician care and prescriptions are covered according to each member’s certificate of coverage if they have out-ofnetwork benefits. Prior to the first of this year, however, out-of-network pharmacy claims had to be filed on paper by the member. Effective January 1, 2002, after working with our pharmacy benefit partner, MedImpact, our members can now have their out-of-network pharmacists electronically process their claims for them. All members have to do is present MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

their Medica member ID card and provide the following numbers: BIN 0003583 and PCN 99500 (The Billing Information Number and the Pharmacy Carrier Number). This information allows the pharmacist to process these claims on line through MedImpact. This information was communicated to our members last fall.

This market is unusual in that hospitals receive more total health care dollars than physicians. Do you see that as an aberration that will change or will physicians continue to fall behind? In 2001, hospitals received 41 percent of Medica’s medical expenses. Physicians received 39 percent. Medica contracts with all provider types and reimburses based on where the service is performed. Physicians direct where a large amount of the care is received. If more hospital resources are utilized, more is paid to hospitals. Physician ordering patterns directly influence how resources are allocated.

What are you doing to reduce the “hassle factor” at Medica? How do you plan to speed up the payment of claims, especially claims for procedures? Medica has implemented numerous operational improvements within the past year to reduce administrative hassle and speed up claims payment. Since November 2000, Medica has reduced claims turnaround time by 40 percent. Claims payment has consistently been less than 10 days from date of receipt to date paid for all claim types this year. Also, Medica automatically pays interest on fully insured claims that have not been processed and paid within 30 days. We are also credentialing physicians faster. The average turnaround time to get provider numbers issued is now only 20 days. In addition, our coding team continues to actively engage providers in order to facilitate common understanding of procedural coding practices and AMA guidelines, focusing on those specific areas that delay claims payment and require re-work for providers.

Health care premiums in Minnesota are higher than the national average, yet the cost of health care in Minnesota is about 82 percent of the national average. Where is the money going? (Source: Alan Baumgarten’s report on HMOs in 2001) Dr. Loftness declined to answer this question at this time, however offered to give it more attention in the future. ✦

As one of the largest providers/controllers of access to physicians, hospitals and pharmaceuticals, how do you propose to reduce the segment of our community that lacks the access? Or, how do we achieve universal access to essential health care? This is a problem where the solution lies well beyond Medica. Medica has worked to develop affordable health care solutions for a variety of populations across Minnesota. We have also worked with a variety of state agencies to ensure that Minnesotans have access to health care coverage and health improvement programs.

What are your plans to improve morale and develop feelings of partnership between Medica and participating physicians? Medica is making a concerted effort to better connect with the physician community. Lots of conversations are occurring between Medica and physicians to help Medica better understand the issues physicians face. We are listening and we are taking action on what we are hearing.

Get away from the

distractions,

the noise, the traffic. But don’t get too secluded. We can offer you the best of both worlds—a small town atmosphere within a short drive of the Twin Cities. Come to RiverWay.

We are expanding and have opportunities for Family Practice, OB/Gyn, Pediatrics, and Urgent Care Physicians in the northern suburbs of Minneapolis. RiverWay Clinics is a truly dynamic organization and is part of the HealthPartners family. Please send your C.V. to: RiverWay Clinics, Attn: Steven Endrud, 1833 Second Ave. S., Anoka, MN 55303. Fax to: (763) 712-6264

The Perfect Place to Practice An Equal Opportunity Employer

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

Emerging from Immunization Chaos

AFTER YEARS OF EDUCATING the community on the value of receiving vaccinations for influenza in the fall, delays in the vaccine’s arrival over the past few years have created chaos for both physicians and their patients. Some concerns and recommendations for supporting patients in receiving this important preventive health service are addressed below. The single most effective method of making sure patients are vaccinated against influenza is still by a physician’s recommendation.

charge inflated prices (>$100 per vial). According to one manufacturer, the pneumonia vaccine will cost approximately $14.48/ dose. Q. If my clinic orders the vaccine early, why do some organizations receive the vaccine earlier? Is my clinic not a priority? A.

Q. With decreasing Medicare reimbursement, can a physician cover his/her costs for flu and pneumococcal immunizations? A.

Table 1 shows that the 2002 Medicare reimbursement for the costs of administering the vaccine decreased by $.57 for both the influenza and pneumococcal vaccines. Vaccine purchased directly from the manufacturers averages approximately $6.50/dose, and since the Medicare reimbursement is $8.62, this may cover the cost. The most important factor in keeping vaccine costs low is by ordering early. Pre-booking often begins as early as January. Influenza vaccine that is ordered at a later date may only be found through distributors and others that

Table 1:

During the past two influenza seasons, the timing of vaccine shipments has been largely influenced by the manufacturers’ ability to produce the vaccine and with vendors. When vaccine first became available for the 2001-02 flu season, the manufacturers began shipping partial shipments to all of their large volume customers and full shipments of smaller orders (e.g., <1,000 doses). On occasion, a partial shipment of vaccine to a distributor may have been subject to further adjustments.

Q. I want to vaccinate my patients, but need to make the process cost-effective and efficient. What should I do? A.

Standing orders programs constitute the most effective strategy for improving immunization rates for adults, according to Kristin

Adult Influenza and Pneumococcal Vaccine Medicare Reimbursement

Vaccine Administration fee TOTAL

L. Nichol, M.D., of the Veterans Affairs Medical Center. Standing orders automate the immunization process, removing the physician from the loop for a more streamlined system of care. (On August 1, 2002, a new law went into effect allowing LPNs to administer vaccines based on such a standing order protocol. Previously, only RNs were authorized to assess and administer vaccines under a standing order protocol. For more information about this new bill, visit the following website: www.leg.state.mn.us/ leg/legis.htm and search under Bill 3359.)

Influenza Vaccine 2001 2002 $4.92 $4.92 $4.27 $3.70 $9.19 $8.62

Pneumococcal Vaccine 2001 2002 $15.24 $15.50 $4.27 $3.70 $19.51 $19.20

Source: Wisconsin Physician Services (WPS), Medicare Part B Carrier for Minnesota.

Q. Between the reimbursement and distribution issues, my clinic can’t offer vaccines. What should we do? A.

It is anticipated that there will be enough vaccine for this flu season, however, there may be delays in delivery to some physician offices. To make sure that high-risk patients receive the vaccine early enough, even if the vaccine is unavailable at your site, send them to a non-traditional community site (e.g., local senior centers, grocery stores). Remember to follow the Minnesota Department of Health (MDH) Minnesota Flu Vaccination Plan for the 2002-2003 Season, which is as follows:

Prioritize • October – Vaccinate high-priority patients, those 65 and older, patients 6 months of age and older with chronic medical conditions such as heart disease, diabetes, asthma or HIV/AIDs—those most likely to experience serious morbidity and death if they develop influenza. In addition, children 6 to 23 months are encouraged to be vaccinated when feasible.

BY JANE PEDERSON, M.D., M.S.

September/October 2002

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

• November through the end of flu season – Continue to vaccinate high-priority patients and begin to vaccinate healthy patients. • Vaccinate through March or the end of the flu season. Recent flu seasons have arrived in late winter. It is never too late to get vaccinated, even if flu is already in the community. In order for this plan to succeed, cooperation from physicians statewide is essential. For influenza updates, refer to the Minnesota Flu Vaccination Plan at www.health.state.mn.us/immunize.

Q. Where can I get help setting up an immunization program in my facility? A.

The Minnesota Partnership for Adult Immunization has developed resources to help. For more information please contact Susan Severson, Stratis Health, at (952) 853-8538. Please help to inform your patients about the importance of getting their influenza and pneumococcal shot by recommending it to all your patients! ✦

Dermatology, Family Practice, Gastroenterology, Internal Medicine, & Neurology

Q. Is vaccination for influenza and pneumococcal really effective? Given the fast pace in office practice, what should be highest priority? A

Dr. Nichol recently noted, “compared with all other vaccine-preventable diseases, influenza and pneumococcal diseases kill more people in the United States, and 80 to 90 percent of these deaths are in the elderly population.” Dr. Nichol attributed this high percentage to a lack of recommendations from physicians and to patients’ misconceptions about vaccines. According to Dr. Gregory Poland, Director of the Mayo Vaccine Research Group at the Mayo Clinic and Foundation, “We measure the health of society by a number of indicators, one of them being immunization—and, clearly, we have inadequate vaccination coverage in adults. By giving the influenza vaccination to elderly people, we can cut the rate of influenza deaths in half.”

Q. What are the rates for the flu and pneumococcal immunization in Minnesota? A.

The Behavioral Risk Factor Surveillance Survey, a telephone survey conducted by the MDH in 2001, showed the following vaccination rates for Minnesota adults, aged 65 and older: 70.5 percent for influenza and 64.0 percent for pneumococcal. The Healthy People 2010 goal for influenza and pneumococcal immunization is 90 percent. Consequently, physicians can play a key role in accomplishing these goals.

Jane Pederson, M.D., M.S., is the Director of Medical Affairs at Stratis Health. This material was developed under Contract Number 500-99-MN02, entitled “Operation of Utilization and Quality Control Peer Review Organization (PRO) for the State of Minnesota,” sponsored by the Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services. The contents do not necessarily reflect CMS policy.

Brainerd There are immediate openings at Br ainerd ollowing Medical Center ffor or the ffollo ollo wing specialties: Dermatology matology,, F Family Practice actice,, Gastroenterology Gastroenterology,, Der matology amily Pr actice Internal Medicine,, and Neurology Neurology.. Inter nal Medicine

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

44 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

B RAINERD, MINNESO INNESOT TA • • • •

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

C ALL COLLECT TO ADMINISTRA DMINISTRAT TOR: Curt Nielsen (218) 828-7105 or (218) 829-4901 Toll Free 800-677-8262 2024 South 6th Street Brainerd, MN 56401 bmc@br ainerd.net bmc@brainerd.net www .br ainerdmedicalcenter .com www.br .brainerdmedicalcenter ainerdmedicalcenter.com Recruitment coordinated with St. Joseph’s Medical Center www.sjmcmn.org

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

Retirement Plan Options for Independent Medical Groups

PHYSICIAN GROUPS HAVE a variety of options when it comes to retirement plans. Selecting the best type, and structuring it to meet retirement goals, is as much art as science. Plan design needs to be mindful of the practice’s objectives. It might be to maximize tax deferred contributions for the physician/owners or it may be to attract and retain valuable employees. The design also needs to factor in things such as the income of the physicians, the income of other employees, the ages of the physicians and other staff. Let’s look at examples of different retirement plan structures and in what situations they make the most sense.

In addition to the employee deferral, the practice must make an employer contribution each year. This contribution goes into the physician’s accounts as well as those of the other employees. The employer contribution must be either 2 percent of salary, or a dollar-fordollar match on the first 3 percent of the salary the employee elects to defer. (This 3 percent match can be reduced to 1 percent in two out of five years and would enable a practice to decrease their obligation to fund the retirement plan if times were lean.) Therefore, a 40-yearold physician earning $160,000 could save $11,800 in a SIMPLE plan in 2002. Not bad, but we can do better.

tain features of a qualified plan. Like SIMPLE plans they are easy to implement and operate because they essentially involve establishing IRA accounts for each eligible employee. A SEP allows physicians to defer up to 25 percent of income, to a maximum of $40,000. A physician making $150,000 can defer $37,500 into their SEP and avoid income taxes on this amount. This yearly contribution is not mandatory so that each year the physicians can decide what the percentage of income to be contributed to the SEP will be. There are significant drawbacks to SEP plans that make them somewhat unpalatable for physician practices that have employees. The main drawback is that the practice must contribute the same percentage of pay for the employees as it does for the physicians. That is, if the physicians want to make the maximum contribution of 25 percent of income to their SEP

SIMPLE IRA: SEP IRAs This is a retirement plan that might be considered by a new practice. If the practice wants to (Simplified Employee Pension) have a retirement plan in place for the physiSEPs are not considered qualified plans under cians and employees, a SIMPLE IRA avoids ERISA law. They are structurally IRAs with certhe complexity and administrative requirements of a Acme Psychiatric Clinic 401(k) plan. In essence it’s Safe Harbor - Cross-tested Illustration the same as opening an Plan Year Ending 12/31/02 IRA account for everyone employed by the practice. Employer Cont. Employees, including Elective Catch-Up Includes 3% Compensation Deferrals Elections Safe Harbor the physicians, can defer $7,000 tax free in 2002. AA (Physician-25% owner) $ 200,000.00 $ 11,000.00 $ 1,000.00 $ 29,000.00 For those 50 and over there BB (Physician-25% owner) $ 180,000.00 $ 11,000.00 $ 29,000.00 is an additional $500 alCC (Physician-25% owner) $ 200,000.00 $ 11,000.00 $ 1,000.00 $ 29,000.00 DD (Physician-25% owner) $ 180,000.00 $ 11,000.00 $ 29,000.00 lowed. The base amount EE (Practice Manager) $ 80,000.00 $ 2,000.00 $ 5,280.00 will increase by $1,000 per FF $ 50,000.00 $ 2,000.00 $ 3,300.00 year until it’s $10,000 in GG $ 40,000.00 $ 2,000.00 $ 2,640.00 2005. The catch-up porHH $ 35,000.00 $ 2,000.00 $ 2,310.00 tion increases by $500 per II $ 30,000.00 $ 2,000.00 $ 1,980.00 $ 2,000.00 $ 1,980.00 JJ $ 30,000.00 year, so that in 2005 those $ 56,000.00 $ 2,000.00 $133,490.00 50 and over will be able to defer $12,000.

Employer Contribution Percentage Totals 14.50% 16.11% 14.50% 16.11% 6.60% 6.60% 6.60% 6.60% 6.60% 6.60%

$ 41,000.00 $ 40,000.00 $ 41,000.00 $ 40,000.00 $ 7,280.00 $ 5,300.00 $ 4,640.00 $ 4,310.00 $ 3,980.00 $ 3,980.00 $191,490.00

BY JOEL GREENWALD, M.D.

September/October 2002

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

accounts, they must put in 25 percent of income for each of the employees. In most practices this can be quite burdensome. For practices looking to allow the physicians to defer up to $40,000, without having to put exorbitant amounts in for the other staff, a 401(k) Profit Sharing Plan might make sense.

the maximum allowed to the 401(k), $11,000 per year. (Two physicians over age 50 also contribute the extra $1,000 catch-up amount.) The practice contributes $29,000 per physician, allowing each physician to reach the $40,000, ($41,000 for the two MDs over age 50,) allowed by law. To allow this amount to be contributed for the physician/owners, the practice

401(k) Profit Sharing Plan: The 401(k) portion allows employees to defer up to $11,000 this year, ($12,000 if they are 50 or over.) This number will go up by $1,000 per year for the next four year so that in 2006 it will be $15,000. ($20,000 for those 50 and over.) In addition to the amount that individuals can defer for themselves, the practice can make contributions as well. This can allow a physician earning $160,000 to put aside $40,000 per year into their retirement plan. In order to do this the practice will have to make contributions for all the employees. But, unlike with a SEP plan, a higher percentage of income can be contributed for the physicians as long as rules are followed that are designed to prevent discrimination against non-highly compensated employees. These plan designs include ageweighted plans, cross-tested plans and new comparability plans. In addition to which plan design is used, the amounts that the practice can contribute for physicians relative to other employees will depend to some degree on the ages of the physicians and other employees, the incomes of the physicians and other employees, as well as other factors. Again, good plan design can help address the needs of the practice. In some cases it is to get the greatest amount of money to the physicians and one or two other valued employees while minimizing the amounts being paid to other employees. In other groups the focus may be on recruitment and retention of staff. The illustration on page 22 shows what a practice might have to contribute in order to allow the physicians to be able to defer the maximum allowed. In this example there are four physicians, each a 25 percent owner of the practice. They are earning between $180,000 and $200,000. Their practice manager earns $80,000 and there are five other employees who qualify to participate in the 401(k). The physicians each defer MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

must contribute the amounts shown for the employees in the column headed “employer contribution.” Therefore this practice would contribute $17,490 for the employees so that the physician owners could maximize their pretax savings. This contribution is a tax-deduct(Continued on page 24)

SHARING A SINGLE FOCUS

As a disease management center, we offer an integrated program of diagnostics, treatment, follow-up, disease prevention and education focused on vascular patients. Partner with us to ensure your patients receive the best care possible. 651/232-2550 www.healtheast.org/vascular

Gallery Professional Building, Suite 600 17 W. Exchange St., St. Paul, MN 55102

HEALTHEAST ® WOUND CARE IS NOW LOCATED AT THE HEALTHEAST ® VASCULAR CENTER

September/October 2002

Retirement Plan Options (Continued from page 23)

ible expense for the clinic. As most physicians are in a tax bracket close to 50 percent, the ability to defer $40,000 of income free of taxes is a significant benefit. 401(k) plans are more complicated to administer and more expensive than the SIMPLE or SEP plans outlined above. These requirements include the annual filing of 5500 forms with the IRS, fiduciary obligations to review the performance of the investments offered to participants, making sure employees receive notification and education on the plan, etc. Another feature that is available since the passage of the EGTRRA law is the advantage of employing a spouse in your practice. If your spouse earns $11,000 this year working in your practice, they can have 100 percent of this go into the 401(k). If there is a profit-sharing feature then even more of their compensation can go into the plan tax-free.

Multicare Associates of the Twin Cities offers physician-owned, multispecialty clinics in Roseville, Blaine and Fridley. Currently, positions are available for BC/BE physicians in the following departments: Internal Medicine Med-Peds OB/GYN Pediatrics Excellent salary/benefits package includes paid insurance, flexible benefits plan, 401K, profit sharing, continuing medical education. Shareholder status potential after one year.

Contact: Jeannine Schlottman Administrator 7675 Madison St. NE Fridley, MN 55432 763-785-3338 www.multicare-assoc.com

Defined Benefit - Cross-Tested Cash Balance Plan Employees

Age

Compensation

Contribution

Doctor/Owner Staff Staff Staff Staff Staff

55 50 50 45 21 21

$200,000 $40,000 $30,000 $25,000 $20,000 $20,000

$120,000 $4,400 $3,300 $2,750 $2,200 $2,200

Total Staff Contributions

Something for practices currently without a retirement plan to keep in mind is the tax credits that the 2001 EGTRRA tax law allows for a new plan. For the next three years the law allows a tax credit of $500/year for the expenses of setting up a new plan. That’s a credit – dollar for dollar offset on taxes – not simply a deduction. Defined Benefit Plan: When people think of retirement plans they usually think of defined contribution plans such as 401(k) plans, SEPs, SIMPLEs, etc. In these plans what is defined is the annual contribution that the employer makes, say 3 percent of salary. Physicians often overlook defined benefit plans. These plans are somewhat more complicated, in part because they require the services of an actuary. In these plans what is defined is a projected payout in retirement. The plan is then funded to the extent needed to meet this future obligation which might be an annual payout of $150,000. Defined benefit plans were more in vogue in the past and fell out of favor because of tax law changes. The recent changes contained in EGTRRA have again made these great vehicles in certain situations. Roughly speaking, if the physicians in the practice are 45 or older and are looking to contribute more than the $40,000 allowed under defined contribution

$14,850

plans, think defined benefit. It may allow taxdeductible contributions to the retirement plan of over $100,000/year. These plans work best the older the physicians, and the younger the other employees. Above is an example of a 55year-old physician with five staff people. There are drawbacks to a defined benefit plan. One is that the contribution must be made to the plan each year. For practices that have uneven cash flow and profitability, this might be a hardship. Another drawback is the greater administrative complexity and expense. But for those looking to shelter income from current taxation, defined benefit plans can be an elegant solution. Retirement plans for physician practices is a broad topic. I’ve attempted to highlight some of the things that physicians should be aware of as they establish or review their practice’s retirement plans. The right plan for a practice needs to take into account many factors and it’s best to involve a team of independent specialists in retirement plan design and implementation. Making smart choices about retirement plans can help physicians enjoy the financial success they deserve. ✦ Joel Greenwald, M.D. is a Certified Employee Benefitsupdated Specialist with Raymond information James FinanSee contact cial Services Inc., member NASD/SIPC, Edina, for Joel Greenwald, MD in below Minnesota.

Joel Greenwald, MD, is a CERTIFIED FINANCIAL PLANNER™ professional with Greenwald Wealth Management located at 1660 South Hwy 100, Suite 270, St. Louis Park, MN. 952-641-7595. http://www.joelgreenwald.com. Securities and advisory services offered through Commonwealth Financial Netork®, Member FINRA/ September/October The Journal of the Hennepin andand Ramsey Medical SIPC, a Registered 2002 Investment Advisor. Fixed insurance products and services offered by MetroDoctors Greenwald Wealth Management are separate unrelated to Societies Commonwealth.

PRESIDENT’S MESSAGE P E T E R H . K E L L Y, M . D .

The Malpractice Insurance Crisis RMS-Officers

RMS-Board Members

Kimberly A. Anderson, M.D., Specialty Director John R. Balfanz, M.D., Specialty Director Victor S. Cox, M.D., Specialty Director Gretchen S. Crary, M.D., At-Large Director Charles E. Crutchfield, III, M.D., At-Large Director Laura A. Dean, M.D., At-Large Director Thomas B. Dunkel, M.D., MMA Trustee James J. Jordan, M.D., Specialty Director Robert V. Knowlan, M.D., At-Large Director Charlene E. McEvoy, M.D., At-Large Director Ragnvald Mjanger, M.D., Specialty Director Kenneth E. Nollet, M.D., Ph.D., At-Large Director Stephanie D. Stanton, Medical Student Lyle J. Swenson, M.D., MMA Trustee Charles G. Terzian, M.D., Specialty Director David C. Thorson, M.D., Specialty Director Russell C. Welch, M.D., At-Large Director RMS-Ex-Officio Board Members & Council Chairs

Brent R. Asplin, M.D., AMA Young Physician Section Blanton Bessinger, M.D., MMA Past President Kenneth W. Crabb, M.D., AMA Alternate Delegate Robert W. Geist, M.D., Ethics & Professionalism Council Chair *Michael Gonzalez-Campoy, M.D., Education Resource Council Chair Rebecca Gonzalez-Campoy, Alliance President Frank J. Indihar, M.D., AMA Delegate William E. Jacott, M.D., U of MN Representative Melanie Sullivan, Clinic Administrator Donald B. Swenson, M.D., Sr. Physicians Association President *Lyle J. Swenson, M.D., Public Policy Council Chair *Russell C. Welch, M.D., Communications Council Chair *Also elected RMS Board Member RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive Officer Doreen M. Hines, Membership & Web Site Coordinator Sue Schettle, Director of Marketing & Member Services

PHYSICIANS IN MINNESOTA should feel fortunate. We have not been touched by a catastrophe that has befallen many of our fellow physicians across the United States. I am speaking of the malpractice crisis that has gripped many states rendering medical services in many areas unobtainable. Our good fortune may not last and now is the time to be proactive in order to stave off this fate. Currently, physicians and hospitals in states such as Florida, West Virginia, Pennsylvania, Mississippi and Nevada are seeing skyrocketing rate increases for liability insurance or are unable to obtain insurance at all. The University of Nevada, Las Vegas recently closed down its trauma center for 10 days for lack of insurance. Patients had to be transferred to California for their care. There are no neurosurgeons left in northern Mississippi due to skyrocketing rates, which is over $250,000 per year in some areas. In many states, such as Florida and Virginia, physicians are protecting their assets and going “bare,” (going without any malpractice insurance). The St. Paul Companies has recently stopped underwriting medical malpractice insurance, leaving many practitioners unable to obtain coverage. Why is this occurring? There are several reasons; chief among them is ever increasing jury awards in medical malpractice cases. Over the past three years the median jury award has increased by 43 percent. Additionally, over 50 percent of all jury awards now exceed one million dollars in these cases. To fully understand this, one needs to know how the jury award is broken down. Essentially, there are economic and non-economic components to the malpractice case. The economic components include lost wages and medical expenses. This portion of the award is straightforward in its determination. The other component is non-economic; i.e., pain and suffering as well as punitive damages. It is this portion of the award that juries can arbitrarily determine and which turns many trials into a lottery.

Several states have passed legislation that limits the non-economic damages that juries may award. Twenty years ago California passed the Medical Injury Compensation Reform Act (MICRA) which caps non-economic damages at $250,000, limits attorney’s fees in malpractice cases and has a three-year statute of limitations in non-pediatric cases. Malpractice premiums in California are 40-50 percent lower in many specialties compared to the same specialties in other states. The American Medical Association (AMA) has recognized this national dilemma. They have listed 12 states that are in a fullblown liability crisis and 30 more as having the potential for a liability crisis in the near future. Minnesota is among this latter group. At the national level, President Bush has come out in favor of federal legislation that would: • Limit non-economic damages to $250,000 with no limits on economic damages. • Limit punitive damages to whichever is less: $250,000 or twice the economic damages. • Include a statute of limitation on malpractice cases. • Allow physicians to pay awards to patients over time instead of in one lump sum. • Require physicians to pay only the portion of damages for which they are responsible. The House of Representatives has introduced the Help Efficient, Accessible, Low Cost, Timely Health Care (HEALTH) Act of 2002 (H.R.400) which includes a national tort reform based on the MICRA model. Unfortunately, tort reform at a federal level may never happen or it may be years in the making (example, the Patient Bill of Rights). Therefore, it is imperative that we take this up (Continued on page 26)

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

Ramsey Medical Society

President Peter H. Kelly, M.D. President-Elect Michael Gonzalez-Campoy, M.D. Past President Robert C. Moravec, M.D. Secretary Jamie D. Santilli, M.D. Treasurer Peter J. Daly, M.D.

Benefits to Serve RMS Members and Their Clinics RAMSEY MEDICAL SOCIETY is a member

driven organization that exists to promote and enhance the value of physicians as members of the community. We are continually striving to provide value to our members and have launched a number of initiatives that we feel are beneficial to you as a practicing physician and for your clinics. An example is our involvement with our partners in the Minnesota Fair Health Plan Contracting Coalition. The Coalition exists to advocate for fairness in health plan contracting. We are pleased to introduce you to some of the more recent relationships that we have entered into through our for-profit subsidiary, RCMS, Inc. DAMARCO Solutions, LLC is a locally owned company that offers clinics the ability to outsource some of their OSHA compliance

President’s Message (Continued from page 25)

at a state level. The Ramsey Medical Society (RMS) is supporting a resolution at the upcoming annual Minnesota Medical Association (MMA) meeting which calls upon the MMA to develop and support tort reform legislation based on California’s MICRA. It is imperative for physicians in this state to lobby their representatives on this issue. It will be a tough fight as the trial lawyer lobby has been very effective in the past and often lawyer and lawmaker are one in the same. However, we need to make this a high priority in the 2003 Minnesota legislature if we are to avoid the skyrocketing liability insurance rates that are being seen across this country. ✦ 26

September/October 2002

requirements, namely the management of their Material Safety Data Sheets (MSDS). The Hazard Communications Standard (HCS) (19CGR 1900, 1200) is the most cited OSHA standard for non-compliance. The beauty of DAMARCO is that they realize that the majority of clinics that RMS deals with will have similar MSDS, therefore they are offering our members a discounted rate for subscribing with their program. To learn more, call Gary Graczyk at DAMARCO Solutions, LLC, at 612-627-0997, or www.damarcosolutions.com. Quest Card Services, LLC is a company that offers clinics discounts on credit card processing. If you accept credit card payments at your office then please read on. The reason we are promoting this is that their rates are probably less than what you are currently paying. Take your last statement from the credit card processing company that you are currently working with and compare it to Quest Card Services. Or, contact RMS at 612-362-3704 and we will facilitate your request. Quest Card Services offers you: • 1.67 percent + $.20 for each swiped transaction; • 2.27 percent + $.30 for keyed transactions; • 3rd level charges eliminated by using AVS; • $3 monthly statement fee; • Voice authorization fee is $1.00; • Application fee of $95 is waived; • $25 one-time set-up fee; and • No reprogramming fee. Through Quest Card Services, LLC we are also able to extend an offer for you to buy or lease the equipment necessary to process credit card payments. Call the RMS office at 612-362-3704 to learn more. HIPAAdocs offers physicians a less costly and more efficient method for complying with the upcoming Federal HIPAA regulations. The

MetroDoctors

deadline for complying is October 16, 2002. HIPAAdocs is a national company whose products are created by industry experts to lessen the burden on physicians as they try and articulate complex Federal regulations. There are on-line software and documents to help you comply with HIPAA regulations quickly and easily. They offer gap assessment tools, risk management mitigation registers, policy document generation, on-line staff training and a system for updating and alerting their customers. Their price is based on the number of physicians that you have at your clinic site. Each clinic is given a Certificate Number that they can use to utilize all of the products and services available through HIPAAdocs. Please note that if you are interested in looking into this further, you need to contact RMS directly so that we can be assured that you are receiving the discount that we have negotiated. Please call 612-362-3704. Business AdvantEdge, Inc. is an independent business services contractor who specializes in small to medium sized businesses. They are locally owned and operated and have a relationship with a multitude of companies ranging from Office Depot, Compaq Computers, Hewlett Packard, Integrated Communications, Airborne Express, Savin Corporation, Travel Cell and the list goes on. What they offer to RMS members is discounted prices. The discounts are greater than if you were to purchase the products or services independently. To learn more, contact Mary Hazzard at 651-486-8900, or visit their website at www.business-edge.net. Be sure to tell them that you are a member of Ramsey Medical Society, or that one of your physicians is a member. For other tangible member benefits go to www.metrodoctors.com and click on Ramsey Medical Society Member Benefits. If you are not a member of Ramsey Medical Society (RMS) and the Minnesota Medical Association (MMA), you are invited to join. We are a strong member-driven organization that believes wholeheartedly in advocating for the rights of physicians. If you would like to learn more about RMS contact Sue Schettle, RMS Director of Marketing and Member Services. Her telephone number is 612-623-2889, or email: sschettle@metrodoctors.com. ✦

The Journal of the Hennepin and Ramsey Medical Societies

R M S U P D AT E

New Members RMS welcomes these new members to the Society. Schools listed indicate the institution where the medical degree was received.

Kyle L. Wahlstrom, M.D. University of Minnesota General Surgery St. Paul Surgeons, Ltd.

Robert S. Nesheim, M.D. University of Minnesota Psychiatry Hamm Memorial Psychiatric Clinic/Duluth Family Practice Center

Jason J. Wirtz, M.D. University of Iowa Internal Medicine/Infectious Disease St. Paul Infectious Disease Associates, Ltd.

Maureen K. Reed, M.D. University of Minnesota Internal Medicine HealthPartners

1st Year Practice Diane M. Palkert, M.D. University of Minnesota Orthopedic Surgery Orthopaedic Foot and Ankle Center

Susan J. Roe, M.D. University of Texas Anatomic & Clinical Pathology Regina Medical Center

Jorge A. Ferreiro, M.D. Tulane University Anatomic & Clinical Pathology Hospital Pathology Associates, P.A.

Kevin T. Stieglbauer, M.D. University of Minnesota Anatomic & Clinical Pathology Hospital Pathology Associates, P.A.

Harry F. Hull, M.D. John Hopkins University Public Health Minnesota Department of Health

John M. Toso, M.D. University of Minnesota Family Practice Fairmont Community Hospital

AUDIO TAPES - Health Education FREE for the Hmong Community “Caring for your Heart and Blood Pressure” and “What happens when you go to the Hospital” These tapes are bilingual, providing information in Hmong on the first side and repeated in English on the second side. To receive FREE copies of the audiotapes, contact

Mayly Lochungvu, Interpreter St. Joseph’s Hospital 69 West Exchange St., St. Paul, MN 55102 651-232-6257 or email mlochungvu@healtheast.org Please give your name, organization, address, phone number and the desired quantity of audio-tapes. Prepared by HealthEast Care System. Made possible through a grant from UCare Minnesota.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Medical Student (University of Minnesota)

Anna Buzhaker Levon D. Olson ✦

In Memoriam REYNOLD P. FLOM, M.D., died at the age of 80. Dr. Flom graduated from the University of Minnesota Medical School in 1944 and was a U.S. Navy Veteran. He specialized in Neuropsychiatry until 1970. Dr. Flom served as Chief of Staff at Mounds-Midway Hospital in 1965. He was currently serving as director of Datron Corporation and the Treasurer and Director of Health Care Group, Inc. He joined RMS in 1949. HUGO F. SCHROECKENSTEIN, M.D., died on July 29 at the age of 90. He graduated from the University of Minnesota in 1938 and completed his internship in general surgery at Charles T. Miller Hospital in St. Paul. Dr. Schroeckenstein served in the Armed Forces from 1942-1946. He joined RMS in 1942. JOHN J. STERNER, M.D., died at the age of 86 on July 22. He graduated from the University of St. Louis in 1942. Dr. Sterner was a retired family physician and former Chief of Staff at Bethesda Hospital. He served as the Ramsey County Coroner for 29 years. He joined RMS in 1948. RICHARD B. TREGILGAS, M.D., died suddenly on May 11 at the age of 77. Dr. Tregilgas graduated from the University of Minnesota in 1947. He was a board certified internist prior to his retirement. Dr. Tregilgas joined RMS in 1954. ✦ September/October 2002

Ramsey Medical Society

Active Lisa Landon Anderson, M.D. Oral Roberts University Internal Medicine Allina Medical Clinic - Internal Medicine Specialties

Michael K. Loushin, M.D. University of Minnesota Anesthesiology Twin Cities Anesthesia Associates

RMS ALLIANCE NEWS REBECCA GONZALEZ-CAMPOY

BY NOW, YOU SHOULD HAVE received your updated voter registration card from the treasurer/auditor of your county. The card tells you where to vote and identifies the various districts in which you live. For instance, I live in Congressional District 02, Senate District 39, House District 39B, County Commissioner District 02 and School District 197. I keep my card in my wallet, where I can easily find it. The information on your voter registration card is particularly important this fall. Even though it’s not a presidential election year, it’s going to be a hot election season, thanks to redistricting. Many legislators retired after last session, leaving seats open for new faces. Several legislative and congressional incumbents will be in tight races. And many respected candidates have joined the Independence Party out of sheer frustration with various factions of their former parties. Physicians and spouses need to get involved – if only to cast informed votes – in the upcoming elections. Simply put, the future of medicine depends on it. If we don’t take part in shaping policy, someone else will decide how physicians practice medicine. That’s largely what’s been going on up to now and we’ve seen the dismal results. Any positive legislation – and there is some – comes from physicians and their families working diligently together to make it happen. Register to vote First, be sure you’re registered to vote. It’s amazingly easy in Minnesota. Just look in your telephone book in the Government Pages section under Voter Registration Information – you’ll find step-by-step instructions. The requirements are few and you can even register on Election Day at your polling place.

publish the voting records of current elected officials. Organized medicine provides a wealth of information that’s only a click away. You can join the Physicians Grassroots Network at www.ama-assn.org/grassroots to monitor what your members of Congress are doing regarding health care issues. Be sure to sign up at this web site for timely updates on important legislation pending in Washington, as well. Find out what’s going on at the Minnesota Legislature by logging on to the Minnesota Medical Association’s web site at www.mmaonline.net. There you’ll find the latest on issues important to physicians and their families here at home and across the nation. Ramsey Medical Society also passes on timely legislative information via e-mail. Contact RMS if you want to get on this mailing list. Get involved One of the biggest reasons other groups are so successful in their efforts to direct public policy is they band together and pool their money to back candidates with whom the groups believe they can work. We must do this too. I encourage you to join MEDPAC, the MMA’s bi-partisan political action committee. MEDPAC works to educate legislators and Congress members about pressing issues concerning the practice of medicine. (Individual physician membership is $150, Alliance membership is $40, or joint physician/spouse is $250.) Membership dollars go to help candidates who support medicine – on both sides of the aisle. Note: membership in MEDPAC doesn’t “buy” legislators, governors or members of Congress. It gets us a seat at the table during important discussions. And now, more than ever, physician and spouse financial support is critical to the

preservation of what little remains of the physician/patient relationship. It’s nothing short of an investment in the future of medicine. Build relationships Once you’ve determined the candidates you support, get to know them. Host fundraisers or at least attend them. Volunteer to work on their campaigns. Thousands of people vie for an elected official’s attention. Anything you do to get to know your representatives will improve your chances of being heard. Where does the RMS Alliance fit into this picture? One of our goals this year is to increase the involvement of our members in the political process. We’re devoting our January meeting to a conversation with a legislative leader who will provide insight into how we can make a difference at the State Capitol. Each of our newsletters will include information about how to get involved and develop political clout. Alliance representatives serve on MEDPAC and the MMA Legislative Committee and are valuable resources to Alliance members. A member of the Pennsylvania Medical Association Alliance recently posted a great “go get ’em” letter on the AMA Alliance listserv – yet another great source of information! Her message was this: Physicians and their spouses need to think of politics as “a prescription for the future of medicine…Hate politics? Swallow hard and consider it a pill we have to take in order to cure medicine’s myriad of ills.” You might even find you enjoy it. ✦

Learn about the candidates Both Twin Cities daily newspapers publish candidate profiles. Community newspapers do as well. Minnesota Public Radio invites candidates in for interviews and debates. Newspapers also 28

September/October 2002

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

CHAIR’S REPORT DAVID L. SWANSON, M.D.

Our Membership Challenge HMS-Officers

HMS-Board Members

Michael Belzer, M.D. Carl E. Burkland, M.D. Jeffrey V. Christensen, M.D. Drew Dietz, Medical Student Andrea J. Flom, M.D. Diane Gayes, Alliance Co-President Peggy Johnson, Alliance Co-President Ronald D. Osborn, D.O. James Peters, M.D. James A. Rhode, M.D. David F. Ruebeck, M.D. Richard D. Schmidt, M.D. Michael G. Thurmes, M.D. D. Clark Tungseth, M.D. Michael J. Walker, M.D. Joan M. Williams, M.D. HMS-Ex-Officio Board Members

Paul F. Bowlin 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 Kathy Dittmer, Executive Assistant

MetroDoctors

THIS IS THE LAST of these columns that I will write as chairman of the Hennepin Medical Society. It has been a rewarding past year overseeing the work of this very special organization, whose mission dovetails seamlessly with its partner, Ramsey Medical Society. The effectiveness of both societies as advocates of present and future physicians in the metro community continues to grow. I believe that we are seeing our societies emerge as significant players in the ever-changing local health care scene. I think, looking over this edition of MetroDoctors, anybody can see how true this is. There remains much work to be done. We can embrace a great opportunity for us to reclaim the direction of health care. But we have a problem we must first resolve–membership. For the first time in its history, the Hennepin Medical Society represents less than 50 percent of the practicing physicians in our service area. Our societies can never achieve their full potential while less than half of metro physicians belong to the societies. I believe there are three reasons why physicians, especially young, employed physicians, choose not to join our organizations. The first has to do with the definition of professionalism as opposed to employment. I think many physicians have not made the philosophical leap that defines medicine as more than a career. Medicine is a profession. Belonging to professional societies is a big part of being a professional. When physicians are asked to give expert witness, in court or before Congress for example, one of the first questions they are asked is, “To what professional societies do you belong?” The public recognizes the contextual value of physician membership in professional societies. Fortunately, our young doctors-to-be are getting the message about professionalism. We have been very successful in recruiting medical students in our organizations; they are very active and professionally sophisticated and see the value of membership. We have yet to aggressively pursue resident physicians, who may not be internalizing the importance of pro-

The Journal of the Hennepin and Ramsey Medical Societies

fessionalism in their futures. Unlike the Mayo Clinic, where virtually all residents are members of the county medical society, our local training institutions have not emphasized the value of membership in professional societies. We hope to work with the new Dean, as we did with the old, to change this. The second reason is a perception that the societies may not be giving physicians an adequate return on their membership investment. Physicians ask, “What are the societies doing on behalf of the physician?” Metro physicians demand advocacy. We have addressed this problem by changing our mission and strategic plans, as readers of MetroDoctors know. When the nursing strike threatened the care of our patients, our organization was there ready to help coordinate patient triage. When the metropolitan physician credentialing system collapsed, we filled the gap to ensure all physicians remained credentialed to practice. When bioterrorism loomed threateningly after 9/11, we sponsored programs to bring the provider network up to speed. We continue our work with the plans advocating fair contracting, a project which has been very successful so far. We remain committed to our advocacy at the Capitol, which has been a major focus over the past year. With all that we do, our major shortcoming is that we have done a poor job telling our colleagues who are not society members how valuable we are to them. It is time to aggressively market our successes and we will do this. Lastly, society membership is expensive, especially for young, salaried physicians with small kids and big debt, who pay membership fees with after-tax dollars. Making membership affordable for them requires “out-of-the-box” (Continued on page 30)

September/October 2002

Hennepin Medical Society

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

HMS NEWS

Chairâ&#x20AC;&#x2122;s Report

Community Internship Program

(Continued from page 29)

thinking. We have proposed delinking the membership requirement we have with the MMA, giving young physicians a choice of joining either the MMA or county society. Currently, a physician who wishes to join the MMA must also join the county society, and vice versa. They must pay dues to both organizations in order to belong to either one. Just as the MMA has delinked its combined membership requirement with the AMA, we have proposed that the MMA delink with the component societies. This would allow physicians to join one society or the other if they cannot afford both. Our rationale is that professional membership is much more attractive if it is affordable, and it is better for the state and local societies as a whole if together they represent a greater proportion of practicing physicians. Professionalism and advocacy are why physicians must belong to HMS, RMS, and MMA. Affordability will make it possible to bring our lost lambs into the fold. Please accept my sincere gratitude for having the opportunity to serve you in this leadership role. Also, thank you to the other physician leaders and boards of HMS and RMS for the advice and service they provide and the hours they have donated. Lastly, thank you to Jack Davis, Nancy Bauer, Kathy Dittmer, Roger Johnson and all the staff of our professional societies. You cannot imagine how much they care about you and with what high regard they hold you. â&#x153;Ś

The following participated in the June Community Internship Program sponsored by the Hennepin Medical Society: Heidi Holste, Committee Administrator, Health & Human Services Policy Committee, Minnesota House of Representatives; M. Thomas Blum, M.D., Group Health, West Clinic, CIP Faculty; Patricia Riley, CEO, Stratis Health; Michael B. Miller, JD, Senior Assistant County Attorney, Hennepin County; and Jack G. Davis, CEO, Hennepin Medical Society. Not pictured: Michael Grover, Health Care Workforce Analyst, Minnesota Department of Health.

Drs. Eric Anderson (far left) and Daniel Dunn (far right) host community interns Michael Grover and Michael Miller in surgery at Abbott-Northwestern Hospital.

David L. Swanson M.D., HMS Board Chairman, can be reached at: Swans045@umn.edu.

Dr. Walker Hinck, Bloomington Lake Clinic, discusses family medicine with community intern Heidi Holste.

September/October 2002

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

HMS IN ACTION JACK G. DAVIS, CEO

HMS and RMS Staff met with the new leadership of the University of Minnesota Medical School student group. Planning took place regarding

student activities for the upcoming school year. Our plans include a welcoming picnic in August for all the first year students, the White Coat Ceremony in October, five or six “Lunch ’n Learn” programs, student resolutions for the upcoming MMA Annual Meeting, the “Connections” mentoring program, “Shadow a Physician” program, HMS and RMS board representation and membership recruiting. We’re off and running for the 2002/2003 school year. Jack Davis, HMS CEO, was recently elected Chair of the Board for the aMinnesota Visiting Nurses Agency (MVNA). Jack has been a member of the Board of Directors for the last four years. Benjamin Whitten, M.D., Hennepin

Medical Society member, was recently nominated by the MMA Board of Trustees as Alternate Delegate to the AMA House of Delegates. An election will take place at the Annual Meeting of the MMA in September. Stuart Hanson, M.D. and Nancy Bauer, former HMS Associate Director, have been working on the final draft of an AMA Guidebook titled Diagnosing and Treating Abusive Behavior in the Medical Workplace. The guidebook is

the result of efforts of HMS members and staff over the last decade to address the problem of abuse in the medical workplace. A five-stage process has been created to address the issue and is the subject of the guidebook. The guidebook will be published this coming fall and is supported by a grant from MMIC. MetroDoctors

The Hennepin Medical Foundation held a meeting on June 4. Marvin Segal, M.D., board chair, was joined by other board members, Joseph Tombers, M.D., Peggy Johnson, Diane Gayes, and Jack Davis. The Board reviewed the investment strategy and performance of the Foundation and approved the 2001 audit. The Board also approved the 2002 member solicitation campaign. According to Dr. Segal, “this year’s campaign will be more important than ever. The soft economy may affect members giving at the very time when society’s needs are expanding.” Watch for this year’s solicitation campaign this fall. Jack Davis was recently elected by his peers to represent County Medical

Societies in an upcoming and continuing dialog with Michael Maves, M.D. EVP of the AMA. These meetings are slated to be held on a quarterly basis in Chicago. The HMS Board of Directors welcomes James “Jamie” Peters, M.D. as a new member. Dr. Peters represents the medical staff of Fairview-University Medical Center. He specializes in Family Practice and since 1995 has been a member of the full time faculty of the University of Minnesota Department of Family Practice and Community Health. Dr. Peters is located at the Smiley’s Clinic Program in Minneapolis. Dr. Peters attended Rush Medical College in Chicago and completed his residency at the University of Minnesota. In 2000, Dr. Peters received a Bush Fellowship and pursued studies in health policy and administration. Lee Beecher, M.D. has been nominated to a second term as a Hennepin Medical Society Trustee to the MMA Board of Trustees. David Estrin, M.D. has also been nominated to a first term to the MMA Board of Trustees representing HMS.

originated at Metropolitan Medical Center in 1971, has found a permanent home at Abbott Northwestern Hospital. Since the closure of Metropolitan-Mount Sinai Medical Center, the award has been housed at the Hennepin Medical Society offices. The medical society will still be active in the annual selection of the award recipient, but the commemorative plaque listing all the honorees will be publicly displayed on the Abbott Northwestern Hospital campus. David Swanson, M.D. and his wife Catharine, along with two of their three children, attended the AMA Student Section picnic at Como Park on August 12. Joining the Swansons were Michael Ainslie, M.D. and his wife Kathryn, and Michael Gonzalez-Campoy, M.D., presidentelect of the Ramsey Medical Society. The picnic occurs annually on the first day of orientation for the incoming first year medical students. The purpose of the event is to welcome the new medical students to the profession and to introduce them to the benefits of organized medicine. Roger Johnson, CEO of the Ramsey Medical Society, and Jack Davis met with Greg Vercellotti, M.D., Senior Associate Dean for Education at the University of Minnesota Medical School, and representatives of the Minnesota Medical Foundation and the Medical Alumni Society to establish this year’s “Connections” Medical Student Mentoring Program. Each member of the Ramsey and Hennepin Medical Societies will soon be receiving invitations to participate in this valuable program. ✦

The HMS Executive Committee announced that the Shotwell Award, which

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2002

Hennepin Medical Society

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.

HMS ALLIANCE NEWS

Diane Gayes Co-President

Peggy Johnson Co-President

Gerald Charles Dickens Great-great grandson of Charles Dickens presents “A Christmas Carol” A world-acclaimed one-man performance! Gerald Charles Dickens brings to life the Charles Dickens’ Christmas classic in 26 voices. His performances have been described as “powerful, energetic, and interactive.” His audiences are enthralled and respond with standing ovations. Dickens books, gifts, and collectibles offered by Jackson Enterprises, Inc. will be available for sale and signing by Mr. Dickens. Only 230 tickets are available, and are for sale NOW! Please join HMSA members, families, and friends for this HMSA sponsored event. After August 1, 2002, any remaining tickets will be available to the general public. Proceeds will benefit HMSA philanthropic endeavors such as Body Works and the AMA Foundation.

Date: Friday evening, December 20, 2002 Place: Interlachen Country Club, Edina Time: 6:00 p.m. Social Hour (cash bar) 7:00-10:00 p.m. Dinner and Performance Questions? Contact Diane Gayes or Peggy Johnson at HMSA, 612/623-3030. Event details are available at: www.jackprises.com ___ YES! Please send me ____ tickets at $160 each for dinner & Gerald Charles Dickens’ performance of A Christmas Carol on December 20, 2002 at the Interlachen Country Club, Edina, Minnesota. • I have enclosed a check payable to HMSA Philanthropic for $_____ $100 of each ticket is tax-deductible. • Sorry, we cannot attend but enclosed please find a tax-deductible donation to HMSA Philanthropic Fund. Your name: ________________________________________________________ Mailing address: _____________________________________________________ Phone number:______________________________________________________ Send your check and this completed form to: HMSA – Peggy Johnson, 6229 Fox Meadow Lane, Edina, MN 55436

September/October 2002

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

2325 Prior Avenue North, Roseville, MN

(651) 636-6060 BRED FROM THE VEHICLES YOUR MILITARY BUYS! H2, THE NEW 2003 KID ON THE BLOCK! (available July 2002) THE FEW, THE PROUD, THE SUCCESSFUL!

FOR DETAILS AND TEST DRIVES CONTACT STEVE ALLEN AT MCCARTHY’S HUMMER.

C O N T I N U I N G

M E D I CA L

E D U CA T I O N

Continuing Education and Extension, University of Minnesota Partial 2002 CME Calendar Endorectal Ultrasonography September 10 Radisson Riverfront Hotel St. Paul Pelvic Floor Workshop September 11 Radisson Riverfront Hotel/Riverside Pelvic Floor Center St. Paul

Twin Cities Marathon Sports Medicine Conference September 27-28 Four Points Sheraton Metrodome Mpls. Symposia on Parkinson s Disease

September 28 Radisson Hotel Metrodome Mpls.

Principles of Colon and Rectal Surgery September 12-14 Radisson Riverfront St. Paul

Novel Therapies in Thoracic Oncology October 3 Hilton Airport Bloomington

Radiology 2002: Strategic Imaging September 19-20 Radisson Hotel Metrodome Mpls.

Vascular Diseases: A Primary Care Perspective October 4-5 Radisson Hotel Metrodome Mpls.

Heart Failure Society of America September 22-25 Boca Raton Resort Boca Raton, FL

Psychiatry Review: Impulse Related Disorders October 7-8 Radisson Hotel Metrodome Mpls.

Internal Medicine Review October 9-11 Radisson Hotel Metrodome Mpls. Anticoagulation Clinics October 18 Radisson Hotel Metrodome Mpls. Upper Midwest Brain Tumor Symposium October 25 Doubletree Hotel Mall of America Bloomington Lymphatic Mapping and Sentinel Lymph Node Biopsy October 25 and November 22 B-646 Mayo Bldg. U of M Campus Mpls. Obstetrics and Gynecology October 28-29 Radisson Hotel Metrodome Mpls.

E.T. Bell Fall Pathology Symposium November 1 Radisson Hotel Metrodome Mpls. Mechanical Ventilation: Principles and Applications Nov. 8-10 Hyatt Regency Mpls. Mature Women s Health: Menopause November 9 Four Points Sheraton-Capital St. Paul Emerging Infections in Clinical Practice and Emerging Health Threats Nov. 15 Hyatt Regency Mpls. Cancer Pain Symposium: Strategies and Challenges Nov. 23 Airport Hilton Blmgtn.

Continuing Medical Education, Medical School, Academic Health Center 200 Oak Street SE, Suite #190, Minneapolis, MN 55455 (612) 626-7600 1-800-776-8636 www.med.umn.edu/cme The University of Minnesota is an equal opportunity educator and employer