2003mayjun

May/June 2003

Fair Contracting Coalition Bill Advances

Senate author Senator Dallas C. Sams (DFL) District 11

In this issue JCAHO Patient Safety Goals Medical Student Admissions Report BMP Complaint Review Activities 2002 MMA Resolutions Status

House author Representative Steve Smith (R) District 33A

Medical Malpractice Crisis: Managing Risk After Tort Reform Guest Speakers: Maslon Edelman Borman & Brand, LLP: John Provo, J.D. Susan Oliphant, J.D. Laurie Kindel, J.D. Morgan Stanley: Trey Seitz

Wednesday, June 11, 2003 The Metropolitan 5418 Wayzata Boulevard Minneapolis, MN 55416

Thursday, June 12, 2003 Town & Country Club 300 Mississippi River Boulevard North Saint Paul, MN 55104

All signs indicate that even the most skilled and diligent physicians will continue to face a high risk of claims for malpractice across the U.S. Congress soon will consider major legislative initiatives affecting such claims, including liability limits intended to address the growing crisis in the availability of medical malpractice liability insurance coverage. Hear four experts discuss how Congress’ action will affect:

Impact of reform on medical malpractice insurance coverage.

How your clinic’s business practices should change after tort reform.

Important steps you should take now if you plan to retire in ten years.

How to protect your family’s wealth for retirement and financial security.

Program Schedule for All 5:45 p.m.-6:00 p.m.

6:00 p.m.-7:00 p.m.

6:15 p.m.-6:30 p.m.

6:30 p.m.-7:00 p.m.

7:00 p.m.-7:30 p.m.

7:30 p.m.-8:00 p.m.

8:00 p.m.-8:15 p.m.

Dates: Registration Dinner Laurie Kindel Susan Oliphant John Provo Trey Seitz Q&A

Part I: Effect of Reform on Insurance Coverage Part II: Minimizing Your Exposure to Claims Part III: Asset Protection Strategies Morgan Stanley

Registration Form

By E-mail:

By Fax:

By Mail:

Send e-mail to jessica.bennett@maslon.com listing all of the registration and payment information stated below.

Complete the registration form and fax to Jessica Bennett at 612-642-8494.

Send complete registration form and payment to: Jessica Bennett Payment information: Maslon Edelman Borman & Brand, LLP $100 for RMS and HMS members 3300 Wells Fargo Center $150 for non-members 90 South Seventh Street Enclosed is my check for $_____________ Minneapolis, MN 55402 (Payable to Maslon Edelman Borman & Brand, LLP)

Name___________________________________________ Business______________________________________________ Address___________________________________________________________________ Phone_____________________ Attendance date_________________________ Fax__________________ Email__________________________________ Seating is limited and reservations will be made on a first received basis.

Please check box if you prefer a vegetarian meal.

Doctors MetroDoctors THE JOURNAL OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

CONTENTS VOLUME 5, NO. 3

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LETTERS

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HMS, RMS, and MMA to Relocate Offices

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How to Create a Successful Coalition

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.

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COLLEAGUE INTERVIEW

Maureen K. Reed, M.D.

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Classified Ad

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JCAHO’s National Patient Safety Goals Aim to Prevent Common Errors

13

Minnesota Board of Medical Practice Complaint Review Activities

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.

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U of M Admissions

16

Update on 2002 MMA Resolutions

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PHYSICIAN’S SOAP BOX

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AMA Code of Medical Ethics

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.net.

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2003 Winter Medical Conference

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@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.

MetroDoctors

M AY / J U N E 2 0 0 3

Canadian Universal Health Care

RAMSEY MEDICAL SOCIETY

24 25 26 27 28

President’s Message Caring Hearts for Homeless People Supply Drive New Members/In Memoriam RMS Pictorial Directory Corrections/Call for Resoltions RMS Alliance HENNEPIN MEDICAL SOCIETY

29 31 32

May/June 2003

Physician Co-editor Y. Ralph Chu, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Charles G. Terzian, 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 Betsy Pierre Cover Design by Susan Reed

Chair’s Report

Fair Contracting Coalition Bill Advances

Senate author Senator Dallas C. Sams (DFL) District 11

In this issue JCAHO Patient Safety Goals Medical Student Admissions Report BMP Complaint Review Activities 2002 MMA Resolutions Status

House author Representative Steve Smith (R) District 33A

New Members HMS Alliance

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: The Fair Health Plan Contracting Coalition demonstrates the benefits of working with a broad-based coalition of providers to secure legislation. Article begins on page 5.

May/June 2003

1

LETTERS

The Uninsured: Rx Needed Now Dear Editor: The fact that there are 42 million uninsured people in the United States does not surprise me. I see these people every day. I’m a physician at Model Cities Health Center—a federally funded community health center which offers care to anyone, regardless of their ability to pay.

My uninsured patients spend a lot of time worrying about getting sick. When they do fall ill, they anxiously experiment with home remedies and hope they can recover on their own. By the time they come in for a medical appointment, they are very sick. It’s often a case of too little, too late. An illness we could have easily treated in its early stages has now escalated into a full-blown crisis, which we may or may not be able to solve.

Here are just a few of their stories. I’ve altered some details to protect my patients’ privacy.

Their faces fall as I suggest a CAT Scan to evaluate the abdominal mass I could easily feel. Eyes welling with tears, the patient’s wife says, “but we don’t have health insurance.” My patient had lost his job of eight years just three months ago. He and his wife couldn’t afford Cobra coverage.

They came to my clinic because they didn’t want to go to the ER. “I thought it was just him always misbehaving…” said the father through his tears. His son, my patient, never seemed to be able to stick to one task; he seemed unpredictable, always racing around. He had lost 40 pounds in the last two years.

Seeing his enlarged thyroid gland, I felt good knowing that we could cure his problem with some simple tests and procedures. My hopes were dashed when I realized he doesn’t have health insurance. I wrote a letter to the state asking for medical assistance for him, but he was denied.

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May/June 2003

“I wouldn’t be bothering you if I had the money” says the 66-year-old man who comes to clinic for more samples of a medication that has totally changed his life.

Medicare doesn’t pay for the expensive prescription, but without it he has to run to the bathroom five or six times an hour. My heart sinks as I look at the empty spot in our clinic’s sample cabinet. I assure my patient that we’ll call the pharmaceutical representative for more samples. I’ll also have my staff help him fill out an application to get free pills from the medication manufacturer. Unfortunately, he may have to wait three or four weeks.

The 50ish woman on the exam table strained to retain her composure as I told her she has diabetes. She had worked all her life, supported her children and husband.

And now here she was with a low paying job with no benefits and mounting medical bills. Her application for medical assistance was turned down because she isn’t poor enough and she doesn’t have enough unpaid medical bills. I wondered just how much unpaid medical debt puts someone in the running for medical assistance. I asked a county welfare worker who told me the figure was $6,000. So all my patient had to do was to stop paying any medical bills, make a few more ER visits to rack up a medical debt of at least $6,000 and then she might qualify to get Medical Assistance.

And she’d better do it fast if she wanted medication and supplies to take care of her diabetes.

Each of the patients described are American citizens trying to do what our society requires: work full-time, provide for themselves and their families, and follow the law. Though they are doing what they are supposed to, they cannot care for their own health—it’s just too expensive.

So many of my patients are not poor enough to qualify for government programs.

MetroDoctors

They are people from all walks of life. While some of them are knocked down by illness or job-loss, most work full-time. They just have jobs with no affordable health insurance benefits. Either they work for businesses that do not offer health benefits or they simply cannot afford the benefits that are offered.

These hard-working Americans have less health care available to them than people living in Canada or Cuba. For many of them, the costs of insurance and medical care are weighed against equally essential needs like food, utilities and rent.

We are the richest country in the world.

Not one of our people should lack basic health care services. No diabetic should have to space out blood sugar testing to once a week because she can’t afford testing supplies.

No person should have to live with an untreated overactive thyroid. No one should have to deal with the nuisance and embarrassment of running to the bathroom six times an hour, when one pill could solve the problem. No one should have to wait until it’s too late to have his or her cancer treated.

The statistics are sobering. Uninsured men are nearly twice as likely to be diagnosed at a late stage of colon cancer as men with insurance. Women with breast cancer are twice as likely to die if they are uninsured.

And children without insurance are 70 percent more likely than insured children not to receive medical care for common childhood conditions like ear infections.

It will take each one of us, people both inside and outside the medical profession, to work together to make high-quality basic health care accessible for everyone. ✦ Sincerely, Jeevan Paul, M.D.

The Journal of the Hennepin and Ramsey Medical Societies

May/June Index to Advertisers

HMS, RMS, and MMA to Relocate Offices

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IN NOVEMBER the joint offices of HMS, RMS, and the MMA will move from Broadway Place East at 3433 Broadway St. NE in Minneapolis one block west to Broadway Place West at 1300 Godward St. NE. This move is necessary as the lease expires on the current space on the third floor of Broadway Place East in November and, more importantly, the space needs of all three organizations have declined.

After the move to the second floor of Broadway Place West, the three organizations

will realize a significant savings in rent costs.

Conference rooms and other meeting space will continue to be available to allow for physician members to meet at the joint offices with free parking.

In addition to the ability to downsize the space, the favorable lease terms, along with cost guarantees beyond the lease, were important factors in the decision. ✦

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

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May/June 2003

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May/June 2003

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

How to Create a Successful Coalition The Saga of the Minnesota Health Plan Contract Act

Editor’s Note: The photos on the cover of this issue of MetroDoctors depict some of the members of the Fair Health Plan Contracting Coalition.

In the upper photo (from left) are: David Kunz, Minnesota Chiropractic Association; Kathi Micheletti, lobbyist for Minnesota Medical Group Management Association; Jack Davis, Hennepin Medical Society; Senator Dallas C. Sams (DFL); Dave Renner, Minnesota Medical Association; Dominic J. Sposeto, lobbyist for Minnesota Psychiatric Society and Minnesota Dental Association; Roger Johnson, Ramsey Medical Society; and Michelle M. Barrette, J.D., Minnesota Podiatric Medical Association.

In the lower photo: 5th person from the left is Representative Steve Smith (R) pictured with the members of the Fair Health Plan Contracting Coalition listed above.

O

ON A WARM, JULY AFTERNOON in the

summer of 2000, a group of representatives of provider organizations met at the Nicollet Island Inn to talk about the need for legislation that would begin to restore a semblance of fairness to the contractual relationship between health plans and providers. Organized by the Hennepin Medical Society and the Ramsey Medical Society, the initial meeting included the Advocates for Marketplace Options for Mainstreet (AMOM), the Minnesota Medical Association (MMA), the Minnesota Chiropractic Association, the Minnesota Chapter American Physical Therapy Association, the Minnesota Dental Association, the Minnesota B Y R O G E R K . J O H N S O N , CAE CEO of the Ramsey Medical Society

MetroDoctors

Senator Dallas Sams

Medical Group Management Association, and the Minnesota Nurses Association. Over the course of the following year the original group decided that the Minnesota Fair Health Plan Contracting Coalition (MFHCC) should be organized and that additional organizations should be contacted, meetings should be organized, and a goal should be established of developing legislation for the 2002 Session.

During the months of 2000 and 2001, meetings of the MFHCC continued to be held and additional organizations such as the Minnesota Podiatric Medical Association, the Minnesota Physician Patient Alliance, the Minnesota Psychiatric Society, the Minnesota Rural Health Cooperative, and the Northwestern Health Sciences University became active members of the Coalition. Although the MMA participated in some meetings, the MMA did not officially join the Coalition.

As the sound of the opening gavel of the 2002 Session of the Minnesota Legislature came closer, the members of the Coalition rolled up their collective sleeves and began to craft a bill.

Meetings were held with greater frequency and intensity. Each provider group brought their particular perspective on health plan contract-

The Journal of the Hennepin and Ramsey Medical Societies

ing issues to the table. Coalition Chair Phil Riveness proved to be an excellent choice to chair the initial efforts of the Coalition as he served in the State Senate and works as a clinic administrator at the Noran Clinic in Minneapolis.

A bill was drafted and Senator Dallas Sams from Staples and Representative Linda Boudreau from Faribault agreed to be chief authors in the Senate and in the House. House file 2925 and Senate file 2532 were titled the Minnesota Fair Healthplan Contracting Act. The MMA decided that the bill could not be supported because of the consumer disclosure and health plan liability provisions in the bill.

Representative Boudreau successfully steered the bill through its initial hearing in the House Health and Human Service Policy Committee.

The opponents of the bill, the Council of Health Plans and the Minnesota Chamber of Commerce, testified that the provider groups in the Coalition were a fringe group and that no legislation was needed.

Passage of the bill out of the first House Committee was viewed as an achievement that got the attention of those who said the bill would never receive serious consideration. That success was followed by the bill clearing the House Commerce, Jobs, and Economic Development Policy Committee. All the members of the Coalition then focused on working together to pass the Minnesota Fair Healthplan Contracting Act in the Senate as the bill moved to the Senate Health and Family Security Committee. The bill continued to face stiff opposition from the Council of Health Plans and the Minnesota Chamber of Commerce. The increasing optimism that members of the Coalition felt after the bill moved out of the Senate Health and Family Security Committee soon turned into (Continued on page 6)

May/June 2003

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Minnesota Fair Healthplan Contracting Coalition (Continued from page 5)

frustration when Senator Linda Scheid, chair of the Senate Commerce and Utilities Committee refused to give the bill a hearing. As a result, the Minnesota Fair Healthplan Contracting Act died in the 2002 Session when all the Committee deadlines could not be met due to Senator Scheid’s decision not to hear the bill.

The Coalition did achieve one major accomplishment in the 2002 Session by blocking the attempt to move the coverage of care of injured victims of auto accidents into managed care networks. Coalition backed Senate File 1226, which was adopted by the Legislature, prevents health plans from forcing physicians under contract into networks to care for injured persons covered by no-fault auto insurance. That legislation supported by the auto carriers working with the major health plans would have effectively reduced reimbursements to physicians by 40 percent.

The members of the Minnesota Fair Healthplan Contracting Coalition vowed to stick together, continue working through the

Representative Steve Smith

summer and fall of 2002, and go back into the 2003 Session with a new bill. Phil Riveness stepped down as chairperson and the members elected Jack Davis, HMS CEO, to take over the helm for the 2003 Session.

In an effort to refine the message of the Coalition it was decided that the Coalition would develop the guiding principles for fair contracting between providers and health plans.

After weeks of meetings and discussions, the Minnesota Fair Healthplan Principles of Contracting were approved. The Principles included

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May/June 2003

MetroDoctors

policy statements on disclosure of contract terms; the advance notice of profiling of providers; the accountability of health plans for medical decisions; the prohibiting of shadow contracting; the prohibiting of the use of unilateral terms in contracts; the requirement of an explanation of recoupment; the timely payment of claims; the advance notification to providers of coding changes; and the ability to complete efficient prior notification on a 24/7 basis.

The Principles became the basis for meetings that were held with the health plans including Blue Cross and Blue Shield, Medica, and HealthPartners to discuss the principles to be included in contracts and to make an effort to agree on the components of fair contracting.

The discussions did provide for a better understanding of the principles by the health plans and a greater understanding of the health plans’ approach to contracting by members of the Coalition. The health plans sought to persuade the members of the Coalition that legislation was not needed.

Coalition members determined that the Minnesota Fair Healthplan Contracting Act should be revised and that the members would work to have it introduced in the 2003 Session.

Refinements were made to several sections of the bill and members confidently looked forward to the renewed effort in 2003.

The Coalition was strengthened with the addition of the Minnesota Pharmacists Association and the Minnesota Occupational Therapists Association bringing the total to 15 provider organizations working together to improve the ability of providers to agree to a fair contract with the health plans.

House File 606 and Senate File 394, the Minnesota Fair Health Plan Contracting Act, was introduced in the 2003 Session by Representative Steve Smith of Richfield in the House and again by Senator Dallas Sams of Staples in the Senate. Not surprisingly, the bills were opposed by the Council of Health Plans, the Minnesota Chamber of Commerce, and the Minnesota Business Partnership. The Chamber and the Business Partnership asserted that requiring that the health plans must inform the providers of their reimbursements would increase health care costs. The health plans continued to argue that legislation was not needed as they were working to improve their contracts.

The Journal of the Hennepin and Ramsey Medical Societies

As the 2003 Session of the Minnesota Legislature moved along it was dominated by concerns over the deficit that exceeded $4 billion.

As a result all legislation that carried a fiscal note for state spending also became a red flag for legislators. While the Fair Healthplan Contracting Act did not have state spending implications, the opponents such as the Chamber of Commerce continued to assert that it would increase health care costs since providers who were fully informed about their health plan contracts could not be trusted to use health care resources wisely.

Members of the Coalition continued to consider options as the Session moved into March and the first Committee deadline of April 4 needed to be met. In an effort to reach out to the MMA and to seek MMA support for the bill, the Coalition decided to delete the consumer disclosure section and to amend the health plan liability section of the bill by substituting regulatory review for civil liability. The MMA Committee on Legislation met and after reviewing the bill, the Committee recommended that the MMA Board of Trustees support the Contract Coalition bill and the prompt pay bill the MMA had negotiated with the health plans. The MMA Board considered the Committee’s recommendation on March 22 and voted to approve the recommendation.

The combination of Representative Boudreau scheduling the bill for a hearing in her Health and Human Services Policy Committee on March 26 and the new support from the MMA served as the catalyst for the Council of Health Plans to begin to negotiate with the Coalition on specific language in the bill. The result of those negotiating sessions produced an extensive amendment that was introduced by Representative Smith in the House Health Policy Committee on March 26. At that hearing, the amended bill included much of the new language, however, the bill was opposed by the Minnesota Chamber of Commerce, the Minnesota Business Partnership, and Blue Cross and Blue Shield, as well as HealthPartners. The Committee voted overwhelmingly to pass the bill and the bill moved to the House Commerce, Jobs and Economic Development Policy Committee chaired by Representative Gregory Davids of Preston. The House Commerce Committee sent the bill to the House floor on April 3.

As this issue of MetroDoctors goes to press, negotiations on the sections of the bill that adMetroDoctors

dress coding changes, the profiling of providers, and regulatory review were successfully completed with the Council of Health Plans to increase the likelihood of passage of the bill.

Members of the Coalition moved over to the Senate where Senator Ellen Anderson’s Commerce Committee heard the bill and moved it to the Senate floor on April 4. Both H.F. 606 and S.F. 394 await votes in the House and Sen-

The Journal of the Hennepin and Ramsey Medical Societies

ate. It appears at press time that this precedentsetting legislation will be adopted and become part of Minnesota statutes. For the first time, the basic rights of physicians who contract with health plans will be established in statute. The benefits of working with a broad-based coalition of providers to secure legislation are also very evident and bode well for future legislative actions. âœŚ

May/June 2003

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COLLEAGUE INTERVIEW

Maureen K. Reed, M.D. Editor’s Note: Maureen K. Reed, M.D., is a medical director and vice president at HealthPartners. She provides health plan leadership for medical policy, care management, quality improvement, and physician relationships for medical groups affiliated with HealthPartners. In addition, Dr. Reed also practices internal medicine at Fremont Community Clinic on a part-time basis. She serves as a diplomate in internal medicine with the American Board of Internal Medicine. She is also a fellow of the American College of Physicians. In 1997, Dr. Reed was elected as a regent of the University of Minnesota and is currently serving as Chair of the Board of Regents. She is a national speaker on health care quality, service, cost, and safety.

Dr. Reed received her undergraduate and medical degrees from the University of Minnesota, where she also completed her residency.

Q A

How does your role as a health plan medical director promote your calling to medicine?

A career in medicine is, among other things, a career in self-discovery. I confess that I cannot precisely remember how I viewed my calling to medicine 25 years ago. But after reading the second Institute of Medicine report Crossing the Quality Chasm two years ago, I specifically remember thinking, “Finally! This is it. This is exactly what health care should be: safe, effective, efficient, timely, patient-centered and equitable.” The report is as energizing as it is daunting. The concept that health care must achieve all of these six aims challenges me as much in my administrative work as in my clinical or my policy work. One can’t divorce the effectiveness of a particular intervention from its timely delivery. One can’t separate the efficiency of a set of services from their equitable delivery. And one surely can’t remove patient-centeredness from safety. As a health plan medical director, I find that simultaneously advancing these six aims requires tremendous concentration and attention. The fact that health care currently falls far short of each of these aims means that committed physicians must remain steadfastly committed to their calling or the quality chasm will not be crossed.

In your role as a health plan medical director, how do you assure access and quality without denying recommended care?

ics for viral illness, increase the rates of lipid, hypertension and glycemic control in members with diabetes, and reduce unnecessary hospitalizations for members whose conditions could be treated in other ways. Any and all of these changes require that “best care” is known and is promulgated among clinicians, patients, and health plan medical directors alike.

How do you assure treatment for underserved patients, such as the mentally ill?

This question goes to the heart of the “equitable” aim of health care. From the standpoint of HealthPartners behavioral health, expansion of the provider network is a good example of addressing this concern. Also, patients with serious behavioral health diagnoses often need additional help in finding the providers best suited to caring for them. For this reason HealthPartners created the Personal Assistance Line a few months ago, thus making information about care and providers much more readily available to members with behavioral health questions and needs. So far, members and providers have been very pleased with this service. Additionally, HealthPartners has taken action to decrease the social stigma and promote better identification and treatment of mental health conditions.

In a wider societal sense, the issue of adequately serving the underserved remains a distant goal. In my internal medicine practice at Fremont Community Clinic, the plight of uninsured and under-insured patients, new Americans and marginalized fellow human beings is painfully visible. Only a strong societal commitment to reducing the formidable barriers of health care financing, geographic mismatch between providers and patients, workforce education, workforce mix, and so on will result in solutions to the problems of unequal access and disparities of care.

The solution must be to rely on the evidence that supports best care. The struggles of a medical director often revolve around issues of overuse, underuse and misuse. My time is divided between creating and implementing programs that will, for example, reduce the use of viral antibiot8

May/June 2003

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

MMA and the MN Psychiatric Society support legislation to integrate mental health and medical/surgical benefits and administration. This anti-carveout bill will permit family doctors and internists to see such patients and be paid for this. HealthPartners has advertised more choice and access to mental health professionals. Presently, however, many psychologists are paid a flat case rate of $335/case for their HealthPartners clients. Are HealthPartners enrollees seeking mental health treatment aware of these stringent care rate limitations?

For years, HealthPartners has reimbursed primary care physicians for treatment of behavioral health diagnoses, in recognition of the importance of an integrated approach to care. About two years ago, HealthPartners doubled the size of its behavioral health provider network and moved from capitation to case-rate payment for behavioral health providers. Our member satisfaction surveys demonstrate that members are significantly more satisfied with behavioral health care and access now than was the case prior to this change. Although few members seem interested in payment method information, we make such information readily available to every member upon request.

What will you do in your roles at HealthPartners and as a University Regent to protect patient care in this environment of severe government budget cutting?

Action by government is simply a manifestation of public will. Sometimes the public will is misperceived by elected officials, in which case my role is to help dispel the misconceptions. In other cases, elected officials accurately perceive the public will, but the public does not realize that the consequences of governmental action are detrimental to the ultimate public good. Those cases require that the public be educated as to the true longterm consequences. The current budget dilemma represents both of these scenarios.

In large part, it has been a massive increase in governmental spending on health care that has necessitated relatively less spending on education, transportation and the like. I find this deeply troubling. Had we already wrung the overuse, underuse, and misuse out of health care, we would not be spending anywhere near what we are currently spending, and we would be demonstrating far greater value for the dollar spent.

But here we are, facing a massive deficit. A deficit due in part to health care spending and in part to changes in tax structure. Unfortunately, the quickest action that government is inclined to take is reducing or eliminating services to the very vulnerable. The vastly more difficult action is to fundamentally reform government spending on health care so as to purchase only those services of high value.

I would like to believe that as a society we are not willing to allow our less fortunate fellow Minnesotans to fall prey to the easy action. I would like to believe that we are willing, instead, to undertake very serious reform of a vastly more equitable and sustainable nature. My role as a citizen and a health care professional is to advocate for this type of change.

How do you balance your role as chair of the University of Minnesota Board of Regents with a full time job at HealthPartners?

Sometimes not easily! It is a great privilege to serve the University in these challenging times, and it is a labor of love. I fully expected that chairing the Board of Regents would be time-consuming. What I did not anticipate was the resignation of Pres. Yudof and the presidential search that ensued. Had it not been for the extraordinary support that I received from colleagues at HealthPartners, it is likely that the search would not have gone as smoothly or as quickly as it did. The selection of Pres.

Bruininks, widely heralded as both pragmatic and visionary, will serve the University and our state exceptionally well. The University is facing unprecedented funding challenges, which have spurred very serious continued discussion about the role and value of the University to Minnesotans.

While the forward momentum of the University will continue, the institution will emerge from this era as a changed entity. It is the Board’s role to guide that change for the benefit of our citizens.

How can organized medicine best support the Academic Health Center at the University of Minnesota?

Three years ago the AHC developed a very ambitious strategic plan that depends on the involvement of physicians across Minnesota. Organized medicine should engage and encourage the AHC in the achievement of this plan. Furthermore, it should establish the expectation that the AHC put its research, education and service missions toward the explicit realization of safe, effective, efficient, timely, patient-centered, and equitable health care.

How should organized medicine exercise physician leadership in the creation of a better health care system?

Are there initiatives that organized medicine and health plans can work on together to achieve goals that benefit enrollees and patients?

I can think of no higher leadership role for organized medicine than to fully embrace and vigorously champion the six aims called for by the Institute of Medicine. These are aims that have the powerful potential to unite and inspire physicians. These are aims that melt away divisions.

These are aims that take us back to the reasons we chose medicine in the first place.

Although Crossing the Quality Chasm articulates the aims and sets forth some general approaches for achieving those aims, it is not a “how to” handbook. The “how to” remains in the hands of those inside and outside of health care who care enough to work together on something very, very tough.

(Continued on page 10)

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

May/June 2003

9

Colleague Interview (Continued from page 9)

Are health plans moving toward a reimbursement methodology based on physician quality and outcomes data?

MARK YOUR CALENDAR

Reimbursement for outcomes is an essential feature of achieving best outcomes. Long before the Institute of Medicine promoted outcomes payment, HealthPartners was starting down this very path. HealthPartners is currently advancing outcomes payment on multiple fronts: hospital care, primary care, and specialty care. When outcomes payment becomes truly widespread, patients and physicians will be the prime beneficiaries.

APRIL 2003 Advanced Hazmat Life Support 23-25 (AHLS) Chair: Louis Ling, MD Pillsbury Auditorium, HCMC 22.0 Credit Hours

SEPTEMBER 12 Electrocardiography (ECG) for Primary Care Physicians Chair: Kyuhyun Wang, MD Radisson Conference Center, Plymouth Approx. 7.0 Credit Hours

19-21

Medical education is a very expensive process. Could you comment on how you think medical education will be funded 20 years from now?

Update in Internal Medicine & HCMC Internal Medicine Alumni REUNION Co-Chairs: Charles Smith, MD David N. Williams, MD The Depot, Minneapolis 8.0 Credit Hours

I am no expert on the funding of medical education. However, even the casual observer can clearly see that for both undergraduate and graduate education, the current funding formulae and mechanisms do not adequately address today’s circumstances. It is hard to imagine how medical education can flourish absent national reforms that more clearly specify and separate the roles and responsibilities of private, federal and state funders. âœŚ

OCTOBER 9-10 Advanced Life Support in Obstetrics Chair: Dana Barr, MD Earle Brown Continuing Education Center, St. Paul 17.0 Credit Hours

NOVEMBER 13-15 33rd Annual Orthopaedic and Trauma Seminar Chair: Richard Kyle, MD Minneapolis Convention Center 20.0 Credit Hours

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May/June 2003

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

JCAHO’s National Patient Safety Goals Aim to Prevent Common Errors

E

tassium phosphate, sodium chloride >0.9%) from patient care units. b. Standardize and limit the number of drug concentrations available in the organization.

ERRORS OCCUR EVERY DAY. But when

mistakes happen in health care, it becomes a matter of life or death.

Advances in medical knowledge, reliance on technology, increasingly multi-faceted health care organizations and changes in the way care is delivered all contribute to a complex atmosphere that leads to errors. These errors are tragedies for victims, their families, and the health care professionals involved. Yet, many of the same errors are repeated over and over again at health care organizations across the country.

Last year, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) called together a distinguished group of physicians, along with other health care experts, to determine whether consensus could be reached on current patient safety priorities and solutions. The resulting National Patient Safety Goals are designed to give focus to evidencebased or expert consensus-based, well-defined, practical and cost-effective actions that have potential for significant improvement in the safety of individuals receiving care.

2003 National Patient Safety Goals Since Jan. 1, 2003, all JCAHO accredited health care organizations are being surveyed for implementation of the following recommendations — or acceptable alternatives — as appropriate to the services the organization provides. Alternatives must be at least as effective as the published recommendations in achieving the goals.

Failure by an organization to implement any of the applicable recommendations (or an acceptable alternative) will result in a special Type I recommendation.

B Y W I L L I A M E . J A C O T T, M . D .

Special advisor for professional relations,JCAHO

MetroDoctors

1. Improve the accuracy of patient identification. a. Use at least two patient identifiers (neither to be the patient’s room number) whenever taking blood samples or administering medications or blood products. b. Prior to the start of any surgical or invasive procedure, conduct a final verification process, such as a “time out,” to confirm the correct patient, procedure and site, using active—not passive—communication techniques.

2. Improve the effectiveness of communication among caregivers. a. Implement a process for taking verbal or telephone orders that require a verification “readback” of the complete order by the person receiving the order. b. Standardize the abbreviations, acronyms and symbols used throughout the organization, including a list of abbreviations, acronyms and symbols not to use.

3. Improve the safety of using high-alert medications. a. Remove concentrated electrolytes (including, but not limited to, potassium chloride, po-

The Journal of the Hennepin and Ramsey Medical Societies

4. Eliminate wrong-site, wrong-patient, wrong-procedure surgery. a. Create and use a preoperative verification process, such as a checklist, to confirm that appropriate documents (e.g., medical records, imaging studies) are available. b. Implement a process to mark the surgical site and involve the patient in the marking process.

5. Improve the safety of using infusion pumps. a. Ensure free-flow protection on all general-use and PCA (patient controlled analgesia) intravenous infusion pumps used in the organization.

6. Improve the effectiveness of clinical alarm systems. a. Implement regular preventive maintenance and testing of alarm systems. b. Assure that alarms are activated with appropriate settings and are sufficiently audible with respect to distances and competing noise within the unit.

Physician involvement in safety goals Accreditation is at its core a risk reduction activity, an issue that greatly affects physicians. Not only do physicians provide care themselves, but they also affect so much of what others within the organization will do clinically. Physicians’ profound influence on the processes of care in (Continued on page 12)

May/June 2003

11

JCAHO National Patient Safety Goals (Continued from page 11)

health care organizations requires that they be part of the leadership team.

JCAHO believes that physicians play a key role on a multidisciplinary health care team, providing clinical leadership and advocating for the quality and safety of patient care. For that reason, involving physicians in the accreditation process, with its focus on helping health care organizations improve the safety and quality of care, is imperative to the successful collaboration between a health care organization and JCAHO. This includes all organization efforts to comply with the National Patient Safety Goals.

Simply put, physicians must be at the very center of all team efforts to improve patient care.

Derivation of the safety goals In February 2002, the Sentinel Event Alert Advisory Group was formed to advise JCAHO in the development of the goals by assessing the evidence for and face validity of all previously issued Sentinel Event Alert recommendations,

as well as the practicality and cost-effectiveness of implementing the recommendations. Named for JCAHO’s widely read patient safety advisory, the Sentinel Event Alert Advisory Group is charged with conducting a thorough review of all Alert recommendations and identifying those that are candidates for inclusion in the annual National Patient Safety Goals.

These candidates are placed in a pool of recommendations identified by the Advisory Group as evidence- or consensus-based, costeffective and practical. Surveyors may discuss any of the recommendations in the pool with the organization as suggestions for improvement, but implementation of those recommendations that are not related to the National Patient Safety Goals will not be assessed and scored.

Each year, new recommendations from Sentinel Event Alert newsletters published in the previous year will be added to the pool. It is anticipated that the National Patient Safety Goals established in future years would also be limited to six goals and no more than 12 recommendations. Each year, the Advisory Group will

re-evaluate the goals and recommendations, and will recommend modifications, additions or deletions to the goals and recommendations for the next year. The Advisory Group’s recommendations for annual National Patient Safety Goals and associated recommendations are forwarded to JCAHO’s Board of Commissioners for approval. New goals and recommendations are announced in July and become effective on January 1 of the following year. ✦

Dr. Jacott was appointed a special advisor for professional relations to JCAHO in January 2002.

As special advisor for professional relations, Dr. Jacott serves as JCAHO’s liaison to the American Medical Association Organized Medical Staff Section, and the American Academy of Family Physicians. He also reaches out to state and specialty physician societies, hospital medical staffs and other professional organizations such as the American Medical Group Association. Dr. Jacott focuses on talking with physicians and other health care professionals in these organizations about priorities and strategies for improving the quality and safety of care.

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May/June 2003

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Minnesota Board of Medical Practice Complaint Review Activities

T

THE FUNCTION OF THE BOARD of Medi-

cal Practice is to protect the public. It does so by ensuring that no practitioner is allowed to enter practice without first demonstrating that he or she meets the minimum requirements for practice established by law, and by reviewing all complaints regarding the practice of any practitioner, and taking appropriate action to ensure that the practitioner is able to practice with reasonable skill and safety.

The complaint review process is, by far, the greatest consumer of resources, in terms of Board Member and staff time, and financial resources of any activity of the Board.

Broad categories of complaint subjects include: prescribing issues; illness and impairment; and sexual misconduct.

Throughout the years, the Board has engaged in a number of educational outreach activities intended to assist in lowering the incidence of complaints in these, and other areas. These activities include: conducting continuing medical education seminars throughout the state; offering home-study continuing medical education courses; and the publication of educational articles in the Board’s newsletter, Update.

Another activity of the Board, intended to reduce complaint volume, is its work in establishing and supporting the Health Professionals Services Program (HPSP). HPSP is Minnesota’s diversion program for impaired health care professionals, suffering from mental, physical, or chemical impairments. It is available to all credentialed health care professionals, and is funded by the health credentialing boards and the Min-

BY RICHARD L. AULD, Ph.D.

MetroDoctors

nesota Department of Health. It offers impaired professionals an opportunity to address and remediate an impairment outside the traditional complaint review, and disciplinary process, by providing recovery and practice monitoring services, which ensure that the professional practices with reasonable skill and safety.

In 1989, the Board offered seminars on Prescribing and Related Documentation in six communities. In 1993, seminars on Boundaries and Communications in the Practice of Medicine were offered in six communities. In 1994, this seminar was offered as a home-study course.

In 1995, seminars on Cancer Pain Management were offered in seven communities. In 1997, seminars on Physician Wellness were offered in four communities. In 2001, seminars on Chronic Pain Management: Critical Issues and New Directions were offered in 10 communities.

During this time, Update has contained articles related to these seminars, and specific articles on numerous other topics of interest to the practice communities of Minnesota, designed to increase professional awareness and increase practitioner knowledge.

Annual complaint volume rose steadily during the early 1980s, and then dramatically during the latter half of that decade. The peak was reached in the mid 1990s, at just under 1,300 complaints per year. The number stabilized for several years, then slowly began to decline, with the current low reached in 2001, at 775.

Several factors account for this trend in complaint volume, but the Board has reason to believe that its efforts to reduce complaints have been among them. Specifically, prescribing issues, and illness and impairment were both leading subjects of complaints, and causes for Board orders. Current complaint, and Board order sta-

The Journal of the Hennepin and Ramsey Medical Societies

tistics show both of these to represent a significantly smaller proportion of total complaint volume than previously.

Readers wanting further information about the Board of Medical Practice can call (612) 6172130. Information on HPSP, and the services it offers, can be obtained from (651) 643-2120. âœŚ Richard L. Auld, Ph.D., is assistant executive director for the Minnesota Board of Medical Practice.

May/June 2003

13

U of M Admissions Editor’s Note: The following is a report on the University of Minnesota Medical School Admissions Committee, submitted by Roger Becklund, M.D., serving as a representative of the Hennepin Medical Society. Dr. Becklund’s term on this Committee expires this year. Contact Jack Davis at the Hennepin Medical Society if you are interested in serving on this Committee (612-623-2899).

T

THE WORK OF THE 2001-2002 University of Minnesota Medical School Admissions Committee was completed with the matriculation of the Class of 2006 this past September.

A total of 1,645 applicants were received, of which 504 were Minnesota residents, and an

fell by 63 this year, giving us a significantly smaller pool from which to pick. The reasons for this are not known, but the trend seems to have been reversed for the class of 2007. MCAT scores for those admitted were about the same while the GPA rose from 3.63 to 3.67 overall.

The downward trend seems to have been reversed this current year with a total of about 1,990 applicants compared with 1,645 for this report.

The complete statistics are available from the University of Minnesota Medical School Admissions staff for any who are interested. ✦

802/843 female/male ratio. The mean age was 25 with the range from 18 to 51 years old.

Matriculants were 166, of which 129 were Minnesota residents (10 more than last year), 37 non-residents, and a 92/74 female/male ratio.

The mean age was 24 years with the age range from 20 years to 34 years. The 129 residents of Minnesota represent 26 counties. There are 18 Minnesota colleges and Universities of Minnesota represented of which six are public universities. Thirty multicultural students were admitted as compared to 37 last year.

There were nine fewer applicants than last year. The number of Minnesota residents matriculated increased from 119 last year to 129 this year. The number of Minnesota applicants

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May/June 2003

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

University of Minnesota Medical School-Minneapolis Admissions Statistics, 2002 Entering Class GENERAL MATRICULANTS MN Residents Non-residents

N=l66 129 37

MD/PhD Multicultural

TOTAL APPLICANTS MN Residents Non-residents

1645 504 1141

5 30

MD/PhD Multicultural

107 477

Gender Female Male

92 74

Female Male

802 843

Mean Age

24 y/o (20 – 34 y/o)

25 y/o (18 - 51 y/o) Interviewed MD/PhD

556 46

ACADEMICS Mean Scores

U of MN Applicants

U of MN Accepts

National Pool Applicants*

National Pool Accepts*

MCAT Verbal Reasoning Physical Sciences *Writing Biological Sciences

9.0 9.3 O 9.5

10.0 10.3 P 10.5

8.7 9.0 — 9.3

9.5 10.1 — 10.3

GPA Overall

3.48

3.67

3.46

3.61

* National statistics as of 9-9-02. * The Writing Sample section of the MCAT is reported on a scale of J-T (T is the highest possible score).

ENTERING CLASS DEMOGRAPHICS

U OF MN STATISTICS Year 1985 No. of Applicants 1016 Number Enrolled 204

1986 919 193

1987 786 196

Geographic Total Minnesotans enrolled Counties within Minnesota represented States represented

129 26/87 19+ 2 countries

Academic Affiliation Total U.S. colleges and universities represented Minnesota colleges and universities represented Minnesota Public Universities Minnesota private colleges Total number of majors represented

70 18 6 12 33

1988 1045 185

1989 1409 179

1990 1988 180

1991 2732 180

1992 2847 185

1993 3015 184

1994 3203 185

1995 2917 185

1996 2330 175

1997 2078 165

1998 1945 165

1999 1874 166

2000 1696 165

2001 1654 165

2002 1645 166

NATIONAL STATISTICS Year 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002* No. of Applicants 32,983 30,840 27,997 26,666 26,915 29,243 33,301 37,410 42,808 45,365 46,547 46,968 43,020 40,886 38,372 37,136 34,785 31,594 Number Enrolled 16,268 15,670 15,614 15,828 15,867 15,998 16,211 16,289 16,307 16,287 16,260 16,200 16,165 16,706 15,872 16,301 16,263

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

May/June 2003

15

Update on 2002 MMA Resolutions

S

SEVERAL MONTHS have passed since the

MMA Annual Meeting in September and the resulting implementation of HMS and RMS resolutions. Below is the status of the resolutions as of late March 2003.

#106 by HMS “AMA National Advisory Council on Violence and Abuse” RESOLVED, that the Minnesota Medical Association delegation submit a resolution to the American Medical Association (AMA) asking the AMA to: support the continued function of the AMA National Advisory Council on Violence and Abuse; reaffirm the role the AMA National Advisory Council on Violence and Abuse in bringing together medical experts from Federation and other key stakeholder organizations to identify and promote the role of health care in identifying, responding to, and preventing violence and abuse; promote, through this Advisory Council, the education and training of physicians in the recognition and treatment of the health consequences of violence and abuse; reiterate the AMA position that physicians have the responsibility to assess and treat patients who experience violence and abuse; direct that the National Advisory Council on Violence and Abuse help coordinate violence and abuse activities of the AMA. The Advisory Council will submit a report each year to the AMA Board of Trustees summarizing violence and abuse prevention and intervention activities; and direct that the National Advisory Council on Violence and Abuse advise and assist the AMA and provide advocacy in promoting and encouraging public health initiatives that improve the health and safety of all Americans regarding violence and abuse issues.

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May/June 2003

Status: MMA Board of Trustees adopted recommendation to provide reimbursement for Dr. McCollum’s travel expenses for up to two meetings of the AMA National Advisory Council on Violence and Abuse. #207 by HMS “Legislation to Prohibit Behavioral/Mental Health Carveouts in Health Plans” RESOLVED, that the Minnesota Medical Association develop legislation prohibiting mental health carveouts, taking into consideration the forthcoming American Medical Association model legislation.

Status: Bill has been drafted and introduced. #208 by RMS/HMS “Opposition to Psychologist Prescribing” RESOLVED, that, to protect the health and safety of Minnesota patients, the Minnesota Medical Association, using assistance from the American Medical Association, if necessary, strongly oppose any effort to permit prescribing privileges for psychologists in Minnesota, and be it further RESOLVED, that the Minnesota Medical Association actively publicize its opposition to legislative efforts by psychologists to gain prescription privileges in Minnesota as a threat to patient safety.

Status: Ongoing (psychologist prescribing bill has yet to be introduced). #307 by HMS “The Importance of Physical Activity for the Health Maintenance of Minnesotans”

MetroDoctors

RESOLVED, that the Minnesota Medical Association urge its physician membership to encourage and prescribe physical activity for their patients to prevent chronic disease states, and be it further RESOLVED, that the Minnesota Medical Association encourage its physician membership to increase their own daily physical activity, and be it further RESOLVED, that the Minnesota Medical Association, in cooperation with other physician organizations, develop a plan to increase awareness among physicians and Minnesotans of the importance of physical activity, and be it further RESOLVED, that the Minnesota Medical Association promote physical activity among Minnesota youth by encouraging physical education classes in grades K-12.

Status: Article scheduled for publication in May issue of Minnesota Medicine. #308 by HMS “Consumer Cost Sharing and Payment Information Disclosure” RESOLVED, that the Minnesota Medical Association recognize that changes in the health care marketplace are increasing patients’ out-ofpocket costs, and be it further RESOLVED, that the Minnesota Medical Association support patients’ ability to use cost and quality information in making appropriate health care decisions, and be it further RESOLVED, that the Minnesota Medical Association support physicians’ ability to use cost and quality information in making appropriate health care recommendations.

Status: Implement as policy statement. Complete.

The Journal of the Hennepin and Ramsey Medical Societies

#309 by HMS “Road Rage” RESOLVED, that the Minnesota Medical Association encourage the State of Minnesota to collect data on driver behaviors and highway infrastructure issues that most often lead to angry or violent responses, and use the data to implement public education programs to improve drivers’ awareness of offensive driving behaviors to thereby reduce road rage incidents.

Status: MMA to send letter to MN Dept. of Public Safety urging incorporation of data collection effort as part of current road rage campaign. #400 by RMS “Tort Reform Legislation for 2003 Session” RESOLVED, that the Minnesota Medical Association strongly support the American Medical Association’s top priority of passing Medical Injury Compensation Reform Act (MICRA) type tort reform at the federal level, and be it further RESOLVED, that the Minnesota Medical Association introduce for the 2003 Minnesota Legislature a tort reform bill that will include the following provisions: 1) a $250,000 limit on awards for non-economic damages; 2) a limit on attorneys’ fees; 3) an increase in the standard of proof to “clear and convincing evidence”; and, 4) mandatory jury instruction that awards are not taxable.

Status: 1st: HR 5 introduced in US House.

2nd: Bill introduced in Minnesota (caps on noneconomic damages); more comprehensive bill close to being introduced. #401 by RMS/HMS “Access to Psychiatric Services in Minnesota” RESOLVED, that the Minnesota Medical Association in collaboration with the Minnesota Psychiatric Society request that the Minnesota Department of Health and Department of Human Services convene a study group to include all interested parties, with a charge to: 1) examine in a coordinated manner all aspects of the shortage of psychiatric services (beds and personnel) and barriers to psychiatric care in Minnesota; and 2) develop recommendations, including possible legislation, for provider groups, health plans, state departments, and the MetroDoctors

legislature to remedy this shortage of services, and be it further RESOLVED, that, if the Minnesota Department of Health and Department of Human Services are unable to establish the study group as outlined above, the Minnesota Medical Association petition the next Minnesota governor to order such a study by the departments or by an independent “Blue Ribbon” commission.

Status: Task force roster development is completed.

First meeting held January 15, 2003. #403 by HMS “Health Plan Accountability for Eligibility and Coverage Decisions” RESOLVED, that the Minnesota Medical Association develop and lobby for legislation:

1) prohibiting health plan/clinic contracts that place legal liability onto clinics for health plan eligibility (coverage) decisions; 2) defining denial decisions by health plans on covered services as “medical practice”; and 3) holding makers of denial decisions accountable to the same regulatory and liability standards as the providers of services.

Status: MMA is supporting legislation that has already been introduced on this topic.

The Hennepin and Ramsey Medical Societies Leadership have scheduled their respective Caucuses as listed below. If you have an issue you would like to bring forward to your colleagues, by all means do so by submitting a resolution and participating in the MMA House of Delegates as a Delegate for RMS or HMS. ✦

A Call for Delegates If you are interested in serving as a Delegate, please contact us at your earliest convenience.

A Call for Resolutions Resolutions are due at the Hennepin Medical Society No later than Friday, May 9

Ramsey Medical Society No later than Friday, May 13

Caucuses Will Be Held HMS Caucus Thursday, May 15, 2003 7:00 – 8:30 a.m.

Broadway Ridge Building 3001 Broadway Street, NE Minneapolis, MN 55413 Lower Level Conference Room

RMS Caucus 7:00 a.m.

Thursday, May 29, 2003 – Children’s Hospital Auditorium Thursday, June 5, 2003 St. Joseph’s Hospital – St. Joseph’s Room

MMA Annual Meeting Wednesday-Friday, September 17-19, 2003 Kahler Hotel, Rochester, MN If you have any questions contact: Kathy Dittmer Roger Johnson Executive Assistant Chief Executive Officer Hennepin Medical Society Ramsey Medical Society 612-623-2885 612-362-3799 kdittmer@mnmed.org rjohnson@metrodoctors.com

The Journal of the Hennepin and Ramsey Medical Societies

May/June 2003

17

PHYSICIAN'S SOAP BOX

Canadian Universal Health Care – A Model for the U.S. to Follow?

“The ‘common good’…was the claim and justification of every tyranny ever established over men.” Ayn Rand “The Fountainhead”

I

IMAGINE HAVING A CRITICAL narrowing diagnosed within one of the main blood vessels to your brain and then having to wait three months for the surgery; just enough time for it to block off completely.

Imagine waiting months for your MRI only to find out that your back pain was caused by a huge tumor or rampant infection rather than a disc problem. Imagine waiting weeks or months for your CT scan to have your tumor diagnosed and then waiting weeks again for a diagnostic biopsy, while the tumor continues to grow and spread.

Are these examples of medical care in Zaire? No, they are not.

These are actual cases of medical care that I have been involved with as medical director of Diagnostic Imaging in Thunder Bay, Canada. Such are the horrors of medical care delivered under Canadian universal health care.

The current Canadian health care system began simply as a “oneparty payer” system which many have simplistically proposed as a cure for the ails of health care in the U.S. Such a proposal evades the fact that as payer for the system, the government will have a vested interest in controlling the system with an attendant loss of individual liberty for both patients and the providers of care.

At the time of the American Revolution, liberty meant freedom from the coercion of others; especially government and mob rule. The meaning of liberty has been insidiously corrupted over the last century to mean “freedom from want” implying freedom from our own economic concerns. It is in the nature of reality that we cannot be free from the coercion of others and also be free from our own economic concerns. You literally cannot have your cake and eat it too.

In Canada, to combat the economic impossibility of paying for such a system, the extent of government control over health care has increased relentlessly. When I moved from Canada 16 months ago, in the province of Ontario, 44 cents of every provincial tax dollar was earmarked for health care and continuing to increase. There is also massive federal assistance on top of this. To control costs, services such as CT and MRI scans are only available in government run hospitals (private hospitals are disallowed). This is despite the fact that waiting

BY LEE KURISKO, M.D.

18

May/June 2003

lists for imaging may be as long as 19 months. In the name of “universality,” doctors are disallowed from working outside of the system and patients are disallowed from spending their own money for better service. In essence, the system is communist in that both patients and doctors are treated as property of the state.

Government has also had a vested interest in controlling the number of doctors. In Canada, physicians are seen as cost centers, not because of their earnings, but because of the much larger costs of admitting patients to the hospital and ordering tests. Despite an aging population, the number of doctors allowed to be trained was decreased and the government has turned a blind eye to disgusted doctors like myself leaving for the U.S. I know specialists with two-year waiting lists. Forty percent of the population in my former home of Thunder Bay cannot access primary care because of insufficient doctors. I have seen patients first assessed for high blood pressure once they have had a massive stroke. No doctor was available to treat them prior to this catastrophe.

In the province of Quebec, government has offered buy-outs to older physicians to NOT work despite physician shortages. There is now a desperate shortage of physicians in Quebec with some emergency rooms being unstaffed at times. To solve this problem, ER physicians have been presented with bailiff delivered subpoenas commanding them to work on notice as short as 12 hours and possibly at a hospital hundreds of miles away. Failure to comply may result in a five thousand dollar fine. Given that the government is the paymaster, it is impossible to not comply. Imagine seeing a doctor that had to be “arrested” to provide you with care. Would you want your doctor working under such duress?

Shortly before leaving Canada, the Ontario Ministry of Health gave me a going-away present. It was a bill for three thousand dollars. In order to recoup costs, the government had unilaterally decreed that radiologists could no longer charge for the interpretation of coronary angiograms.

This ruling was instituted retroactively. I have hired a lawyer and requested a hearing to dispute this edict. The government has yet to even grant a date for such a hearing. The request was made 18 months ago. Under similar circumstances, a former colleague from the ER is resigned to having to pay back 100,000 dollars. When government assumes the role of benefactor, count on the fact that they will be your ruler.

Universal health care is a socialist paradigm. Socialism is the political system in which the state is both the provider and employer. It is predicated upon the collectivist notion that all citizens become one MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

another’s slave and master. Such a system is immoral because it is intrinsically based upon coercion. Someone must provide the service and someone must pay for it. Coercion is in the very fabric of socialism.

The human rights violations in the Soviet Union were predictable just as escalated loss of liberty is occurring in Canadian health care.

Morality and practicality go hand-in-hand. Witness the abysmal failure of socialist programs such as food production in the former Soviet Union or present day North Korea, the ongoing angst of public education or the financial catastrophe of American Social Security. Just as the Soviet Union had long line-ups for bread, Canadians have long line-ups for health care. If you can’t put a loaf of bread on the table with socialism, how can you expect to get your heart valve replaced?

Just as socialized food production leads to starvation, Canadians are starving for decent medical care. What then is the solution for the perceived deficiencies of the American health system where a portion of the population lacks health insurance (although not necessarily health care)? The solution to the problems in both the U.S. and Canada is opposite to the cause of the problems. Rather than having government intervene further and further, there should be a return to a free market. There is no shortage of food, tennis rackets and CD players in either country because they are delivered under a free market capitalist paradigm. In free markets, commodities tend to become cheaper with ever improving quality and variety. To paraphrase economist Milton Friedman, in free markets, people tend to get what they want. In government run systems, people get what bureaucrats allow them to have.

Just as Canadian physicians are paralyzed by government bureaucracy, U.S. physicians can hardly be considered “free” where every patient is a potential adversary and litigant. Physicians are effectively disallowed from exercising reasonable discretion for fear of the government in the form of the courts unless every problem is overinvestigated and excessively treated. A fall from a barstool may prompt thousands of dollars of imaging when a “wait and see” approach would be perfectly reasonable if American physicians had the liberty to exercise rational judgment. Such elaborate intervention drives costs increasing the ranks of the uninsured.

There are three practical reasons why Canadian universal health care is a failure. Firstly, neither physicians nor patients have any accountability for costs. The average citizen perceives health care as “free” which distorts supply and demand. If the price of apples were to be halved, demand would increase. If the price doubles, demand drops.

If a commodity has no direct cost attached to it, the demand becomes infinite. Hence the bankruptcy of the Canadian system.

Secondly, rather than being an economy-stimulating, employment-generating, resource-creating business, health care is a government run monopoly which is parasitic on the Canadian economy and whose primary purpose is to save money while maintaining the façade of providing care. Karl Marx and Frederick Engels mistakenly advocated the incorrect concept of “The Zero Sum Game.” They believe that the amount of wealth in the world is finite and fixed.

Therefore, they argued, wealth needed to be divided up evenly just as the Canadian government attempts to divide up health care resources evenly while severely limiting private investment.

As Henry Hazlitt pointed out in his 1947 book, “Economics in One Lesson,” wealth creation is the result of the surplus between the costs of raw material for a product or service and its subsequent value in a free market. For example, the raw materials of computer technology are very cheap. The computer era until recently invoked the most prosperous era in all of human history. There was more wealth in the world than at any other time in history. The Zero Sum Game has been proven wrong. The funds for Canadian health care are siphoned from the wealth that Canadians do create thereby removing capital that could further expand the economy. Health care funding is derived from a finite pool of taxderived funds. Socialized health care therefore creates the Zero Sum Game, the very thing that socialism attempts to combat.

Thirdly, health care is a major segment of the economy which government attempts to centrally plan just as the Soviet economy was centrally planned with disastrous consequences. Imagine if the government declared itself the sole provider of bread. The government alone would determine how much wheat would be grown, how many bakeries there would be, how many loaves of bread could be baked, where and when the bread could be sold. The number of loaves of bread baked would be far below public demand. People would be squabbling over those few loaves of bread. Chaos would reign. Such is the state of Canadian health care just as it was for food production in the Soviet Union. It will eventually be the same in the U.S. if universal health care is enacted. If both the Soviet Union and Canada have failed with socialism, why would the United States be successful? ✦

The solution to the problems in both the U.S. and Canada is opposite to the cause of the problems. Rather than having government intervene further and further, there should be a return to a free market.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Lee Kurisko M.D. is former medical director of Diagnostic Imaging at Thunder Bay Regional Hospital in Thunder Bay, Canada. He now works for Consulting Radiologists, Ltd. in Minneapolis.

May/June 2003

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May/June 2003

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Highlights of the Code of Medical Ethics of the American Medical Association Section E-9.00: Opinions on Professional Rights and Responsibilities The very notion of professionalism lies at the core of this section of the American Medical Association’s Code of Medical Ethics. Professionals, as beholders of expert knowledge, are entrusted to provide a service that is highly valued by society with limited external oversight so long as they self-regulate by establishing and enforcing their own standards. While many physicians may believe that this ideal of professional autonomy disappeared from medicine with the intrusion of public and private third party payers, it continues to inspire patient trust. Therefore, the guidance offered in this section, which counter-balances physicians’ individual freedom to choose whom to serve, remains crucial when fostering trust in medicine.

In particular, three broad topics will be examined: physicians’ autonomy and freedom to choose whom to serve and their obligations to treat patients in a just manner; means to address misconduct; and professional responsibilities regarding medical knowledge and innovation.

Choice and Fairness The AMA has long supported physicians’ professional autonomy in terms of their individual freedom to choose with whom to enter into a relationship, whether it is a therapeutic relationship or a professional one. In 1957, Section 5 of the Principles stated: “A physician is free to choose whom he will serve,” whereas Section 6

BY SARA TAUB, AMY M. BOVI, MA, AND LEONARD J. MORSE, M.D.

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stated: “A physician should not dispose of his services under conditions that make it impossible to render adequate service to his patients….”

Today’s Principle VI combines those two notions, stating: “A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.” Opinion 9.06,“Free Choice,” expands on this freedom, making it reciprocal, such that patients also can choose their physicians. The Opinion does acknowledge certain practical limitations, such as emergencies. Interestingly, the 1847 Code, which directed physicians to “be ever ready to obey the calls of the sick,” considered obligation to treat as more of an absolute than a matter of choice.

While the Code recognizes the importance of free choice in medicine, the obligation to provide care to the less fortunate is discussed in Opinion 9.065 “Caring for the Poor,” which stresses that charity care should be a regular part of individual physicians’ practice. Whether physicians offer care at no cost in their offices or volunteer their services at free clinics, they are required to help improve access to health care for those in the community who are impoverished.

In exercising their right to choose whom to serve, physicians are cautioned that certain conduct could constitute discrimination. For example, Opinion 9.12, “Patient-Physician Relationship: Respect for Law and Human Rights,” warns that “… Physicians who offer their services to the public may not decline to accept patients because of race, color, religion, national origin, sexual orientation, or any other basis that would constitute invidious discrimination.”

Since the onset of the AIDS epidemic, non-dis-

The Journal of the Hennepin and Ramsey Medical Societies

crimination has been expanded to protect HIV patients in Opinion 9.13 “HIV-Infected Patients and Physicians.” The Code’s concern for fairness is also captured in Opinions 9.121 “Racial Disparities in Health Care” and 9.122 “Gender Disparities in Health Care,” which remind physicians not to let their medical judgment be unduly influenced by patient characteristics such as race or gender.

The Code also recognizes that discrimination may exist among colleagues in the medical profession. Opinion 9.03 “Civil Rights and Professional Responsibility” maintains that physicians should not be denied professional opportunities because of personal characteristics and Opinion 9.035 “Gender Discrimination in the Medical Profession” emphasizes that male and female physicians should be afforded equal opportunity and compensation.

Compromised Physicians and the Requirement of Self-Regulation in Medicine Self-regulation, as opposed to government or other third party oversight, may be viewed as a privilege that is granted to a profession, but it is in fact a defining characteristic of a profession.

To this end, several Opinions in Section 9 describe how physicians should, consistent with Principle II, “report physicians deficient in character or competence, or engaging in fraud or deception.”

The notion of accountability appeared in the original 1847 Code, albeit in a different form, emphasizing honest self-appraisal and purity of character. In 1957, when the Code underwent an important reorganization, an entire section was devoted to addressing physicians’ responsibility to regulate the profession.

(Continued on page 22)

May/June 2003

21

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May/June 2003

AMA Code of Medical Ethics (Continued from page 21)

Today, Opinion 9.031 “Reporting Impaired, Incompetent, or Unethical Colleagues” proposes a range of reporting mechanisms according to the nature of the conduct and the potential impact on patient welfare. Opinion 9.04, “Discipline and Medicine,” supplements a physician’s individual obligation to expose unfit colleagues with a similar obligation on the part of medical associations. It also emphasizes the importance of due process, which is also elaborated upon under Opinion 9.05, “Due Process.” Finally, these two Opinions identify important protections including immunity for reporting physicians and confidentiality of the information regarding physicians whose conduct is being reviewed.

Opinion 9.10, “Peer Review,” describes another form of self-regulation, which although it may be perceived as interfering with absolute professional autonomy, should be recognized as necessary and ethical, so long as it balances physicians’ right to independent medical judgment with their obligation to uphold standards of the profession.

With its focus on “Physicians with Disruptive Behavior,” Opinion 9.045 is directed toward less severe behavior that nonetheless could interfere with patient care and therefore, also requires appropriate reporting and review mechanisms.

Finally, recognizing the unique power differentials that may exist in an educational setting, the Code addresses instances where a medical trainee has a complaint against a medical supervisor separately. Opinion 9.055 “Disputes between Medical Supervisors and Trainees” also emphasizes due process, noting, “retaliatory or punitive actions against those who raise complaints are unethical.”

cation” whereas physicians’ obligation to share their innovations is discussed variably in several other Opinions. Similar concerns with regard to the use and commercialization of innovations arise elsewhere in the Code, as illustrated in Opinions 2.08 “Commercial Use of Human Tissue” and 2.105 “Patenting Human Genes.”

Overall, Opinions in Section 9 discourage the patenting of medical procedures and praise the sharing of knowledge, although they also recognize the availability of patent protections for certain innovations.

Conclusion Section 9, “Opinions on Professional Rights and Responsibilities,” can help physicians identify the unique characteristics that shape medicine into a profession. More specifically, Section 9 addresses the need to balance professional autonomy with fairness and compassion; mechanisms that will help ensure self-regulation, and the importance of disseminating medical knowledge through education and innovation. While at times this section relies on important legal concepts, they each can be linked to more fundamental ethical notions, echoing the relationship between law and ethics discussed in Section 1 of the Code. Moreover, Section 9 sets the stage for the last section of the Code, where medical ethics and professionalism are examined in the context of the unique characteristics of the therapeutic alliance that joins patients and physicians. ✦ Sara Taub is a senior research assistant, Council on Ethical and Judicial Affairs, Amy M. Bovi, MA, is a senior research assistant, Council on Ethical and Judicial Affairs, and Leonard J. Morse, M.D., is chair, Council on Ethical and Judicial Affairs.

Physician Responsibility toward Medical Innovation and Progress Medical expertise, another fundamental characteristic related to professionalism in medicine is covered in this section of the Code, building on Principle V, which calls upon physicians to remain dedicated to life-long learning and the sharing of knowledge. The first duty is reflected in Opinions 9.011 “Continuing Medical EduMetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

2003 Winter Medical Conference

T

THE 2003 RMS/HMS Winter Medical Con-

ference attracted more than 40 participants including 21 physicians to the warm and sunny beaches at the Paradisus Playa Conchal Beach & Golf Resort, a five star all-inclusive resort in the Guanacaste region of Costa Rica.

Sixteen hours of CME jointly sponsored with the MMA or 16 hours of prescribed credits by the American Academy of Family Physicians were offered. Some topics included: The Dysmetabolic Syndrome; Cardiovascular Disease; Abnormal Bleeding; Rhinitis; and a curbside consultation with a cardiologist and pulmonary medicine physician. The lectures were presented in the conference room high atop a hill and provided a commanding view

of the resort, the Pacific, the Catalina Islands, a location offering many interesting activities surrounding beaches, and nearby mountains. all contributed to a very high evaluation of the A beautiful sunset was enjoyed as well.

2003 Winter Medical Conference. âœŚ Many members of the group enjoyed excursions to one of the active volcanoes, the cloud forest, a walk through a rain forest, a canopy tour, horseback riding, a mud bath, deep sea fishing, or a ride on the 4wheelers up the mountainside, as well as the opportunity to golf on the championship golf course. Colorful birds, monkeys, iguanas and other wildlife were easy distractions.

The perfect weather, a beauti- Presenters for the conference are from left: A. Stuart ful resort, informative lectures and Hanson, M.D.; William F. Schoenwetter, M.D.; Lyle J. Swenson, M.D.; J. Michael Gonzalez-Campoy, M.D., Ph.D., CME chairperson; Jon S. Nielsen, M.D.; and Mark Winholtz, M.D.

The view from the Conference Center overlooking the resort was spectacular.

A river tour provided an opportunity to see many of the rainforest animals.

MetroDoctors

Nancy and Dr. Mark Winholtz are joined at Spices restaurant by Stephanie Hines to experience cooking food on hot stones.

Physician participants paying close attention during a presentation.

The Journal of the Hennepin and Ramsey Medical Societies

May/June 2003

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PRESIDENT’S MESSAGE J . M I C H A E L G O N Z A L E Z - C A M P O Y, M . D . , P h . D .

Advocate for Your Profession

W

RMS-Officers

WHAT IS IN A WORD?

President J. Michael Gonzalez-Campoy, M.D., Ph.D. President-Elect Peter J. Daly, M.D. Past President Peter H. Kelly, M.D. Secretary Jamie D. Santilli, M.D. Treasurer Charles E. Crutchfield III, MMB, M.D.

Up to 100 points, if you are a skilled Scrabble® player like my wife, Becky.

Allow me to reflect on the word Medicine.

Not the “pill” definition of medicine, but the other. Medicine is a profession. Profession is defined by the Oxford Dictionary as work that involves some branch of advanced learning or science, a calling, a vocation. The word professional has various adjectives attached to it as synonyms, including trained, practiced, veteran, experienced, qualified, licensed, competent, able, skilled, expert, and masterful. And the synonymous nouns include master, expert, specialist, authority, and proficient. In the definition of professional the dictionary has “engaged in a specified activity as one’s main paid occupation.”

Most of us are true professionals. But what constitutes, or should constitute, professional activity varies widely. Most of us competently treat our patients. This is, I would say, only a part of our profession. We all seek knowledge and keep ourselves updated with continued medical education. Some of us write or lecture to educate others. Some of us are administrators, and oversee the work environment for others. Some of us are employed by universities or pharmaceutical companies and do research.

Some of us are involved with the regulation of the profession at a higher level, ensuring the standards we set for each other are upheld. There truly is NOT one definition of a physician.

It pleases me to announce via this column, that the legislative efforts of the Ramsey and Hennepin Medical Societies are starting to pay off. We now have the endorsement of the Minnesota Medical Association and the Health Plans for our Joint Contracting Coalition bill. This will be a giant step to protect physician autonomy, and empower us to be better advocates for ourselves and our patients. The progress we have made has been possible because we have worked together, and we have allowed for positive feedback from others. There is power in numbers.

RMS-Board Members

Victor S. Cox, M.D., Specialty Director Gretchen S. Crary, M.D., At-Large Director Laura A. Dean, M.D., At-Large Director James J. Jordan, M.D., Specialty Director Robert V. Knowlan, M.D., At-Large Director Bradley C. Linden, M.D., Resident Physician Charlene E. McEvoy, M.D., At-Large Director Ragnvald Mjanger, M.D., Specialty Director Robert C. Moravec, M.D., At-Large Director Jane C. Pederson, M.D., M.S., Specialty Director Lon B. Peterson, M.D., At-Large Director Thomas D. Siefferman, M.D., Specialty Director Stephanie D. Stanton, Medical Student Lyle J. Swenson, M.D., MMA Trustee Charles G. Terzian, M.D., Specialty Director & MMA Trustee David C. Thorson, M.D., Specialty Director Peter B. Wilton, 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., AMA Alternate Delegate John M. Brown, M.D., Sr. Physicians Association President Kenneth W. Crabb, M.D., AMA Delegate Robert W. Geist, M.D., Ethics & Professionalism Council Chair *J. Michael Gonzalez-Campoy, M.D., Ph.D. Education Resource Council Chair Rebecca Gonzalez-Campoy, Alliance President Frank J. Indihar, M.D., AMA Delegate Neal R. Holtan, M.D., Community Health Council Chair William E. Jacott, M.D., U of MN Representative Melanie Sullivan, Clinic Administrator *Lyle J. Swenson, M.D., Public Policy 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

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May/June 2003

Ramsey Medical Society will have a Strategic Planning Session toward the end of the year, sometime in the fall. All of us that are involved in organized medicine place value in a professional activity that is not often compensated in dollars and cents. We value the role of being an advocate for the profession, and see tangible rewards in protecting the profession of medicine. This is a benefit to all, those who choose to support our societies, and those who don’t.

The perennial question asked of us at dues time is, “What is the Ramsey Medical Society doing for me?” At the very least, it is allowing each of us the opportunity to be advocates for the profession. Unless we each look beyond the confines of our practice, and address the constant corrosion at the essence of medicine that surrounds us, those that follow in our footsteps will be significantly challenged in their role as physicians. Indeed, it is best to ask, “What am I doing for medicine?” not “What is medicine doing for me?” The least YOU can do to be an advocate for your profession is to pay your dues, and drop us a line about what you see as challenges for the profession. Beyond that, I welcome your contributions of time and energy, and more importantly, your ideas and constructive criticism.

In formulating the strategic planning this fall, I would like to have ideas from as many of you as possible. My e-mail is drmike@mncome. com, and I look forward to hearing from each of you. ✦ Mike

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

R M S U P DAT E

2003 Supply Drive physical, emotional and mental health needs of their clients. This drive contributes the majority of supplies needed for the entire year.

Carole Nimlos coordinated the activities of the RMS Alliance members who worked hard picking up the supplies from the 13 participating medical clinics. Thank you to the clinic managers, staff, and physicians of the following clinics that participated: • • • • • • • • • • • • •

Seventh graders from St. Pascal’s School have wonderful eyes for checking expiration dates on medications.

From left: Patrice Frankfurth-Bushinski, Katie LeTourneau, Andrea Dreis, and Stephanie Hines.

MetroDoctors

Ramsey Medical Society

T

THE ELEVENTH ANNUAL “Caring Hearts for Homeless People,” sponsored by Ramsey Medical Society, Ramsey Medical Society Alliance and HealthEast Care System, began on Friday, February 7, 2003 and concluded on Monday, February 24, 2003.

This year’s drive was very successful! Thirteen medical clinics, 30 churches, HealthEast Care System, and many volunteers from the Ramsey Medical Society Alliance, and many other organizations (4-H clubs, girl scout troops, high school youth groups, elementary class groups) pitched in to collect and sort more than $40,000 worth of hygiene and medical supplies for the Health Care for the Homeless clinics, Listening House, and SafeZone. In addition, more than $1,500 in cash contributions was collected. These organizations rely heavily on donated medications, hygiene supplies, toys, juice, and monetary donations to help meet the

Allina Medical Clinic – Shoreview East Metro Family Physicians, P.A. – Maryland Gillette Children’s Specialty Healthcare Hamm Memorial Psychiatric Clinic Metropolitan Urologic Specialists, P.A. Minnesota Medical Joint Services Organization Partners Obstetrics and Gynecology, P.A. Physicians Neck & Back Clinic, P.A. Ramsey Family Physicians St. Croix Orthopaedics, P.A. St. Paul Eye Clinic, P.A. University Affiliated Family Physicians – Phalen Village Clinic University of Minnesota Medical Students ✦

Volunteers from left: Sister Marian Louwagie and Susie Andler down on their knees sorting shampoos and conditioners.

The Journal of the Hennepin and Ramsey Medical Societies

Griffin Hayes (volunteer on left) helping SafeZone employee Vontrell McSwain with the sorting of collected items.

Mark your Calendars

T

he 2004 Caring Hearts for Homeless People Supply Drive, will be held February 1 through March 1, 2004. Please call Doreen at 612-362-3705 if you would like to have your clinic added to the 2004 drive. You may even consider beginning to collect items now. One idea would be to focus on collecting one item each month (i.e., June-sunscreen; July-bug lotion; August-socks; etc.) You could also call and we could provide you with a list of some of the items that are always in short supply by the recipient organizations.

May/June 2003

25

New Members RMS welcomes these new members to the Society.

Schools listed indicate the institution where the medical degree was received.

Active Omar E. Awad, M.D. University of Minnesota Ophthalmology Lufkin Eye Clinic James A. Brockberg, M.D. University of Minnesota Obstetrics/Gynecology Allina Medical Clinic - Parkview Ob/Gyn Stephan G. Burgeson, M.D. University of Illinois Internal Medicine HealthEast Woodbury Clinic Blake A. Elmquist, M.D. University of Minnesota Anesthesiology Associated Anesthesiologists, P.A. Jonathan C. Grimes, M.D. University of Minnesota Emergency Medicine St. John’s Hospital David L. Hunter, M.D. Ohio State University Family Practice University Family Physicians-Bethesda Clinic Jay E. Kent, M.D. University of Minnesota Anesthesiology Associated Anesthesiologists, P.A. Karen L. MacKenzie, M.D. University of Minnesota Family Practice North Suburban Family Physicians, P.A.Shoreview Bronagh P. Murphy, M.D. University of Dublin, Ireland Oncology Minnesota Oncology Hematology, P.A.

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May/June 2003

Darrell W. Randle, M.D. Mayo Medical School Anesthesiology Associated Anesthesiologists, P.A.

Peter B. Wold, M.D. University of Minnesota Diagnostic Radiology St. Paul Radiology, P.A.

William B. Sweeney, M.D. Hahnemann University Colon & Rectal Surgery Colon & Rectal Surgery Associates, Ltd.

Residents

Robert D. Thomas, M.D. University of Minnesota Internal Medicine Daly, Corbett, Ogden, Abid & Olive Judith L. Trudel, M.D. University Laval, Fac De Med, Canada General Surgery Colon & Rectal Surgery Associates, Ltd. Susan M. Truman, M.D. Yale University Diagnostic Radiology St. Paul Radiology, P.A.

Michelle A. Bayne, M.D. University of Minnesota Family Practice Family Medicine Clinic Thomas R. Frerichs, M.D. University of Minnesota Diagnostic Radiology Suburban Radiologic Consultants, Ltd. Mark R. Menge, M.D. University of Minnesota Internal Medicine/Hematology/Oncology University of Minnesota Carolyn D. Sparks, M.D. Southern Illinois School of Medicine Family Practice Ramsey Family Physicians ✦

Jerald O. Van Beck, M.D. University of Minnesota Anesthesiology Associated Anesthesiologists, P.A.

1st Year Practice Shalabh Bobra, M.D. University of Minnesota Radiology St. Paul Radiology, P.A.

In Memoriam FRANK M. GAERTNER, JR., M.D. died February 19 at the age of 71. He graduated from Marquette University School of Medicine and interned at the old Miller Hospital in St. Paul. Dr. Gaertner joined the Arcade Clinic, practicing the kind of “old time” family medicine that allowed him to take time for patients and make house calls for 37 years before retiring in 1996. He joined RMS in 1961.

Nicole K. Groves, M.D. University of Minnesota Pediatrics Stillwater Medical Group, P.A. Karen L. Mecklenburg, M.D. University of Minnesota Anesthesiology Associated Anesthesiologists, P.A.

FRANCES P. OLSON, M.D. died at the age of 94 on May 28, 2002. Dr. Olson graduated from the University of Oklahoma School of Medicine and completed an internship at the University of Minnesota in Psychiatry. She joined RMS in 1963, moved to Fergus Falls in 1965 and then returned to RMS in 1988. ✦

Joseph J. Shaffer, M.D. University of London Dermatology Dermatology Consultants, P.A.

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The Journal of the Hennepin and Ramsey Medical Societies

RMS Pictorial Directory Additions and Corrections Please cut this section out and insert it in your directory booklet.

Page 16 Harvey C. Aaron, M.D. address is incorrect: Address should be 7300 France Ave. S., #200, Edina, MN 55435 Page 41 Christina M. Juhl, M.D. clinic is incorrect: Clinic should be Allina Medical ClinicWoodbury (not the Eye Clinic) Page 42 Kristine M. King, M.D. Updated photo Page 45 Thomas A. Lange, M.D. phone and fax is incorrect: Correct phone is (651) 254-1514.

Fax is (651) 254-1519 Robert B. Lasser, M.D. photo is incorrect.

Photo shown is Irving J. Lerner, M.D. Here is the correct photo.

Page 46 Irving J. Lerner, M.D. photo is incorrect.

Photo shown is Robert B. Lasser, M.D. Here is the correct photo.

MetroDoctors

Page 70 Photo is incorrect of Gregory M. Vercellotti, M.D. Photo shown is Michael C. Vespasiano, M.D. Here is the correct photo.

Page 76 Harold T. Arneson, M.D., Internal Medicine, University of Rochester, NY ’68, 3081 Chatsworth N., Roseville, MN 55113, (651) 484-7728 was omitted.

Page 81 John F. Alden, M.D. is now deceased.

Page 85 Thomas F. Mulrooney, M.D. should be listed in the Active Section on page 52.

Page 86 Frances Palmer Olson, M.D. is now deceased.

Independent physicians partnering with patients.

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Minnesota Healthcare Network, LLC 7900 International Dr., Suite 1080 Bloomington, MN 55425-1510 Phone (952) 883-3150 www.mhcn.com

A Call for Resolutions Resolutions are due by May 13, 2003.

A Call for Alternate Delegates If you are interested in serving as an Alternate Delegate, please contact RMS.

Page 87 Lyle A. Tongen, M.D. is now deceased.

RMS Caucus

Page 91 In the Allergy & Immunology section, please include Anthony C. Orecchia, M.D.

7:00 a.m.

Thursday, May 29, 2003 – Children’s Hospital Auditorium Thursday, June 5, 2003 – St. Joseph’s Hospital – St. Joseph’s Room

The following names should be included in the Cardiology & Cardiovascular Diseases section.

Alan J. Bank, M.D. Steven L. Benton, M.D. Thomas A. Biggs, M.D. Charles M. Cliffe, M.D. Michael D. Garr, M.D. Dennis W. Halbe, M.D. Priscilla A. Hedberg, M.D. Thomas H. Johnson, M.D. Nazifa Sajady, M.D. Thomas A. Wiberg, M.D. ✦

The Journal of the Hennepin and Ramsey Medical Societies

MMA Annual Meeting Wed.-Fri., September 17-19, 2003 Kahler Hotel, Rochester, MN Please help us to assure that your interests are accurately conveyed by contacting RMS staff to submit resolutions: phone 612-362-3799; fax 612-623-2888; or email rjohnson@metrodoctors.com

May/June 2003

27

Ramsey Medical Society

Page 15 The paragraph stating there are five sections has an incorrect reference to an emeritus member. An Emeritus Member is not a physician 65 or over who is in active practice.

Second sentence should read: The Emeritus Member section includes all physicians 65 or over who are retired, and also includes retired physicians who are under age 65.

Page 50 Sherief A. Mikhail, M.D. specialty, clinic name, address, phone and fax are incorrect.

Correct information is: Specialty is Occupational Medicine, Clinic is Minnesota Spine Rehab., Inc., 360 Sherman St., #240, St. Paul, MN 55102; (651) 209-6520.

RMS ALLIANCE NEWS REBECCA GONZALEZ-CAMPOY

Carrying Out Our Mission

I

I AM VISITING FAMILY in the Philadelphia area. While war rages in Iraq, I’m traveling from one Revolutionary War monument to the next.

While bombs fall on Baghdad, I hike through Valley Forge National Park. I take advantage of the last opportunity to take a picture by the Liberty Bell (it soon will be encased in glass). I walk where our Founding Fathers walked when they convened the Continental Congress.

Our core value was – and still is – freedom. The notion of who gets to enjoy this right and how, has evolved over time. Yet, the basic premise remains constant.

The basic premise of the Ramsey Medical Society Alliance – service to the community and to medical families – also remains constant. And, here again, the notion of who carries on this mission and how, continues to evolve.

We’re at a crossroads. Many of our members are “empty nesters” or are heading toward retirement. Their kids are in college, or graduate school, or on their own. Some members are pursuing their own education. Others are well established in their careers or are re-entering the work force. A few of us have young kids at home and are balancing the whole medical family routine.

Here’s our dilemma. Who will lead our organization and where will we go with it? And

perhaps more pressing, from where will our resources come? I addressed the question “Is the Alliance relevant?” last fall. However, the question continues to arise in conversations I have with folks in our organization as we try to come up with a leadership slate for next year.

First of all, the answer still is a resounding YES! What we do is still necessary to the community and to each other. More on that in a bit. Let me address this leadership vacuum first.

We’re poised to modify our “constitution”– or bylaws – to address our changing needs much like we Americans have done over the course of history. The current leadership of the Alliance will present an updated set of bylaws to the membership for review and approval at our annual meeting this month.

These amendments to our bylaws will allow for a more inclusive membership base and will create a new leadership structure. The idea is to get more people into the tent and be sensitive to most people’s aversion to being responsible for what they perceive to be monumental tasks. The membership changes are really just an effort to put us in line with what the Alliance is doing on State and National levels – physicians and divorced spouses can be members, for example. As for leadership, we would create a Leadership Council of up to five members that, between them, would do what the President, PresidentElect and Vice Presidents do now. This not only allows members to take on the work they do best, it invites more new members to take part with little risk of being overwhelmed. And for the record, several other Alliances around Minnesota are moving in this direction for the same reasons we are.

Why bother? Because now more than ever the work we do for our communities and each Dr. Mike and Becky Gonzalez-Campoy enjoying a other is in great demand. Thanks mud spa in Costa Rica during the RMS/HMS 2003 to state and federal economic Winter Medical Conference.

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May/June 2003

MetroDoctors

policy and budget cuts, making sure everyone has proper health care and knows how to live healthy lives falls to groups like ours. Taking care of each other, our families, and the medical profession becomes more critical with each new restriction and further invasion into the patientphysician relationship.

How we carry out our mission is up to each one of us. I will share my motto here: Those at the table get to eat. In other words, if you don’t like how an organization operates, get in there and share your ideas. It’s not going to change if you walk away or hover at the sidelines. An organization reflects who takes part.

It’s time to renew our annual membership.

The Alliance needs people who want to improve the health of the community through work and/ or simple – generous – contributions. You can be an active member and/or a supporting member. There’s room for everyone, regardless of your stage in life.

A special note to physicians: There are many more members of the Ramsey Medical Society than there are of the Alliance. Please talk with your spouse about joining the Alliance. She or he is bound to have qualities that will enhance our organization. And we provide a means to strengthen medical families and the practice of medicine. That need not be just your responsibility. For more information, please contact Doreen Hines at 612-362-3705, or dhines@metrodoctors.com.

And finally, about the picture I’ve included with this column. It obviously has nothing to do with our Founding Fathers or changing bylaws. It does, however, have to do with membership. If a picture truly is worth 1,000 words then make no mistake when you look at this one: Members of RMS and RMS Alliance also just want to have fun! ✦

The Journal of the Hennepin and Ramsey Medical Societies

CHAIR’S REPORT T. M I C H A E L T E D F O R D , M . D .

Advocacy is HMS Priority HMS-Officers

HMS-Board Members

Eric G. Christianson, M.D. Peter J. Dehnel, M.D. Drew Dietz, Medical Student Donald M. Jacobs, M.D. Jan Musich, Alliance President Ronald D. Osborn, D.O. James A. Rohde, M.D. Edwin H. Ryan, 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. HMS-Ex-Officio Board Members

Roger W. Becklund, M.D., Senior Physicians Association Lee H. Beecher, M.D., MMA-Trustee Carl E. Burkland, M.D., Member-at-Large Karen K. Dickson, M.D., MMA-Trustee David L. Estrin, M.D., MMA-Trustee John W. Larsen, M.D., MMA-Trustee Henry T. Smith, M.D., MMA-Trustee David W. Allen, Jr., MMGMA Rep.

T

THE HENNEPIN MEDICAL Society board and staff, along with the Ramsey Medical Society and the MMA, continue to advocate for physicians at the legislature and in the community.

Recently, our greatest success has been participating with a provider coalition advancing the Fair Contracting Bill through the Minnesota legislature. Scope of practice legislation is another concern, with a bill moving through the legislature that would allow optometrists to prescribe all legend drugs. We have recruited grass roots response to the chief author of that bill in the senate from the 200 HMS members who live in his district. Meanwhile, the board has completed strategic planning and has created a work plan for implementation.

Key points in the Fair Contracting Bill include: • Health plans must provide prompt access to prior authorization systems – 24 hours a day, seven days a week.

•

•

HMS-Executive Staff

Jack G. Davis, Chief Executive Officer Kathy R. Dittmer, Executive Assistant Sue Schettle, Director, Marketing & Member Services

Medical decisions by utilization review organizations or health plans are subject to the same regulatory review as a health care provider. In other words, concerns about utilization review decisions will be investigated by the Board of Medical Practice.

Amendments or changes to contracts, including reimbursement adjustments, must be disclosed at least 90 days prior to the effective date of the change.

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Shadow contracting, the requirement to participate in all the contracts a health plan offers, are outlawed.

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Health plans may not change CPT or DRG codes properly submitted by our members.

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Unilateral recoupment, the adjustment of a previous reimbursement through a current account reimbursement without proper notification and opportunity for appeal, is outlawed.

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Plans may not terminate our members’ contracts unless the company has given written notice specifying the reason for the termination or nonrenewal 120 days before the effective date.

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Health plans must pay clean claims within 30 days. If the claim is not paid or denied in 30 days, the plan must pay interest (1.5 percent per month) automatically with the original claim. The provider shall not be required to bill the health plan.

HMS Strategic Work Plan HMS will continue to advocate for our members at the legislature, with the health plans and through other public venues with guidance from the strategic work plan developed at our March board meeting. Here is a brief summary of that plan.

Strategic Outcome One: Strong Voice at the Legislature HMS engages physicians and patients in organizing efforts that result in needed changes in public policy.

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Establish a metro-wide HMS/RMS Joint Advocacy Committee. This committee is already active and is comprised of the joint executive committees of HMS and RMS with the county society representatives sitting on the MMA Legislative and Practice and Policy Committees.

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Linkage to MMA Legislative Committee, solidify our complimentary actions and forge a strong relationship with MMA.

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Develop a process to identify and determine key policy issues.

(Continued on page 30)

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

May/June 2003

29

Hennepin Medical Society

Chair T. Michael Tedford, M.D. President Michael B. Ainslie, M.D. President-elect Michael B. Belzer, M.D. Secretary James F. Peters, M.D. Treasurer Paul A. Kettler, M.D. Acting Past Chair Virginia R. Lupo, M.D.

Chair’s Report (Continued from page 29)

(e.g. medical staff newsletters, e-mail listserve, inserts in medical staff newsletters).

Strategic Outcome Two: Increased Organizational Visibility HMS increases its visibility through pro-active marketing and public relations efforts.

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Establish a Communications Committee to coordinate all visibility and communications activities, including MetroDoctors editorial board.

On-going presence in metro area physicianread publications describing HMS activities

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Contract with a marketing expert to package HMS message.

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®

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Monthly e-mail and broadcast fax to members and non-members of HMS activities and updates.

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Identify non-members through medical staff rosters.

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Leverage opportunities to meet a variety of physician needs by gatherings that serve multiple functions (topic related programs, public policy agenda development and networking and support).

Strategic Outcome Four: Establish Leadership Role HMS is recognized as the pre-eminent voice on medical issues and a leader in the areas of collaboration, public policy and physician support.

SHARING A SINGLE FOCUS

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• Peripheral Arterial Disease • Carotid Stenosis • AAA (Abdominal Aortic Aneurysm) • Dialysis Access Device • Wound Care

Strategic Outcome Three: Increased Physician Interaction HMS uses technology and other tools to engage physicians in discussion, debate and action on relevant issues that impact them, their relationships with patients, and the healthcare industry.

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Describe leadership role in bio-terrorism, nurses’ strike, etc., as well as resource for medical and public policy issues.

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Re-establish physician’s responsibility for patient welfare; establish principles such as universal coverage.

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Provide education on how to be a leader.

Your HMS leadership is proud of our current accomplishments and enthusiastic about our direction for the future. Personally, I look forward to seeing our society exercise leadership creating a better healthcare system, maybe following the aims described by the Institute of Medicine. A health care system for the 21st century will provide care that is safe, effective, patient centered, timely, efficient and equitable.

As always, we welcome your input. Please call or e-mail with your comments or ideas. ✦

• Venous Insufficiency/Stasis • Lymphedema • DVT (Deep Vein Thrombosis) • Renal Stenosis • Uterine Fibroid Embolization

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651/232-2550 www.healtheast.org

Michael Tedford, M.D.; 952.832.5252 drtedford@drtedford.com

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

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

HMS NEWS

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

Kent D. Bergh, M.D. University of Minnesota Medical School Family Practice University Family Physicians - North Memorial Amy M. Brown, M.D. Washington University School of Medicine Obstetrics & Gynecology Obstetrics, Gynecology, & Infertility, P.A. Durand E. Burns, M.D. University of Minnesota Medical School Cardiovascular Diseases Minneapolis Cardiology Assoc. Minneapolis Heart Institute Marion L. Collins, M.D. Albert Einstein College of Medicine-Yeshiva University Pediatrics Partners in Pediatrics, Ltd. Robert J. Couser, M.D. University of North Dakota School of Medicine Pediatrics Neonatology, P.A. Ruth E. Deitz, M.D. Cornell University Medical College Family Practice Fairview Uptown Clinic Angela I. Dhruvan, M.D. Mayo Medical School Family Practice Fairview Hiawatha Clinic Stephen J. Frey, M.D. University of Colorado School of Medicine Family Practice Fairview Cedar Ridge Clinic MetroDoctors

Nathaniel R. Payne, M.D. Emory University School of Medicine Neonatal-Perinatal Medicine Neonatology, P.A.

Timothy P. Gibbs, M.D. University of Minnesota Medical School Psychiatry Abbott Northwestern Hospital

Pamela M. Persak, M.D. Chicago Medical School Pediatrics Wayzata Children’s Clinic, P.A.

Richard C. Glaze, M.D. University of Kansas School of Medicine Otolaryngology Anesthesiology, P.A.

Maren E. Peterson, M.D. Mayo Medical School Internal Medicine Park Nicollet Clinic - Plymouth

Butch M. Huston, M.D. University of Iowa College of Medicine Forensic Pathology Midwest Forensic Pathology, P.A.

Michael Ellis Pinchback, M.D. University of Arkansas School of Medicine Family Practice North Memorial Clinic–Northeast Family Physicians

Thomas Knickelbine, M.D. University of Wisconsin Medical School Cardiovascular Diseases Minneapolis Cardiology Assoc. Minneapolis Heart Institute Loie Anne Lenarz, M.D. University of Minnesota Medical School Family Practice President and Senior Medical Director, Fairview Clinics Benjamin P. Levine, M.D. University of Vermont College of Medicine Orthopaedic Surgery Park Nicollet Clinic - Meadowbrook William Russell Lundberg, M.D. Medical College of Wisconsin Orthopaedic Surgery Northwest Orthopedic Surgeons Larry A. Mathison, M.D. University of Colorado School of Medicine Family Practice Ridgeview Mound Clinic Adrienne J. Nguyen, M.D. University of Missouri School of Medicine Unspecified Specialty North Clinic, P.A. Anthonia A. Olajide-Kuku, M.D. Orvosi Fakultas Tudomanyegyetem, Budapest Pediatrics Blaine Medical Center Multicare Assoc. of the T.C. Lorinda F. Parks, M.D. University of Minnesota Medical School Family Practice University Family Physicians - North Memorial

The Journal of the Hennepin and Ramsey Medical Societies

Hennepin Medical Society

Active Bridget B. Ahles, M.D. Eastern Virginia Medical School Obstetrics & Gynecology Park Nicollet Clinic - Maple Grove

Emanuel P. Gaziano, M.D. West Virginia University School of Medicine Maternal & Fetal Medicine Minnesota Perinatal Physicians

Norman B. Ratliff III, M.D. University of Minnesota Medical School Cardiology Minneapolis Cardiology Assoc. Minneapolis Heart Institute Roger W. Rhodes, M.D. University of Minnesota Medical School Obstetrics & Gynecology Park Nicollet Clinic - Carlson Parkway Khaled Jamal Saleh, M.D. University of Western Ontario Faculty of Medicine Orthopaedic Surgery University of Minnesota Physicians Meskath Uddin, M.D. Chittagong Medical College Internal Medicine HealthPartners - Riverside Michael R. Wootten, M.D. Vanderbilt University School of Medicine Family Practice University Family Physicians - North Memorial Daniel M. Zapzalka, M.D. University of Iowa College of Medicine Urology/Urological Surgery Park Nicollet Clinic - St. Louis Park

Resident Transfer to HMS Dimitri M. Drekonja, M.D. University of Minnesota Medical School Internal Medicine ✦

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HMS ALLIANCE NEWS

HMSA Body Works – 20th Anniversary April 21-25, 2003 Body Works motto: Doctors Can Help: Parents Can Too; But a Healthy Body is up to You!

H

HENNEPIN MEDICAL SOCIETY Alliance

(HMSA) volunteers remain dedicated to their “signature” program, Body Works. Since 1983: more than 30,000 hours have been committed to Body Works by HMSA volunteers; more than 40,000 Minneapolis Public School third-graders have attended Body Works; Thrivent Financial (formerly Lutheran Brotherhood), Hennepin Medical Society, Hennepin Medical Foundation, The Minneapolis Heart Institute Foundation, local hospitals and clinics, medical companies, and individual physicians continue to support and co-sponsor Body Works. The total cost of time and materials donated to Body Works has surpassed $200,000 ($10,000/year).

In the early 1980s, the HMS Alliance realized a need for a community health service benefiting young children. After a year of considerable research and meeting with the school systems under the leadership of HMSA member, Gen Lindemann, the first Body Works program was held in April of 1983. Third-grade,

considered the ideal level for raising children’s health awareness, remains the target audience.

At this age, they are responsive, cooperative and receptive (minds like sponges) to the preventative health education presented at Body Works.

Approximately 160 students will attend each of the three, one and one-half hour sessions held each of the five days. In total, the 2003 Body Works will educate approximately 2,400 Minneapolis Public School third-graders at the Thrivent Financial auditorium, downtown Minneapolis, April 21-25 from 9:00 a.m. to 1:20 p.m. daily. Visitors are welcome to come and observe.

The students will rotate through eight areas of education: Hospital Room; Stop America’s Violence Everywhere (SAVE); Bones; Exercise/ Nutrition; Heart; Lungs; Disability; and Very Important Kid (VIK).

Highlights of 2003 Body Works: • For the First Year - Food Label Detective: Each student will receive an interactive workbook that was designed by an Alliance member to help kids be savvier about what they eat and learn to make healthy food choices. This is in addition to an activity book that reinforces the Body Works’ health education.)

• For the Third Year - HiTECH HEART: The Minneapolis Heart Institute Foundation staff the Heart Area and will educate the children using this dynamic heart model designed to provide an interactive learning experience.

The students will have a ‘hands on’ opportunity to pump the heart and see how it works.

• For the Seventh Year - PEACE RAINBOW: The students will bring signed pledges against violence: “I pledge to SAVE today and STOP AMERICA’S VIOLENCE EVERYWHERE.” Over one thousand of the pledges have been laminated to form a PEACE RAINBOW at Body Works.

Diane Gayes Co-President

Peggy Johnson Co-President

HMSA Annual Meeting and Luncheon The HMSA invites members and non-members to their 2002/2003 annual meeting and luncheon to be held at the Edina Country Club, May 2. The day begins with a 9:30 a.m. board meeting. The social hour, 10:30 a.m., will be followed by the annual luncheon and installation of the 2003/2004 HMS Board of Directors.

The guest speaker will be Janis Amatuzio, M.D., forensic pathologist for Anoka County and author of Forever Ours: a forensic pathologist’s perspective on immortality and living – a collection of real-life stories. Dr. Amatuzio’s presentation, Lessons in Living From a County Coroner, will draw on her vast experience as a county coroner, and will explore death as the great fear, great mystery, and the great teacher.

RSVP to Kathy Dittmer at 612-623-2885

by April 28. Cost $23.00.

Appreciation On behalf of the HMSA members, Diane Gayes and Peggy Johnson express their sincere appreciation for the remarkable support the medical alliance continues to receive from the Hennepin Medical Society (HMS), the Hennepin Medical Foundation, Jack Davis, CEO, HMS, and Kathy Dittmer, Executive Assistant, HMS. In addition, Diane and Peggy thank the HMS Alliance members for their continued support throughout 2002/2003. The articles in the HMSA spring newsletter, Pulsations, reflect the dedication, hard work and passion that HMSA members have to make a difference in the lives of people who live in our community, our state, and our country, in addition to those individuals who live beyond our country’s borders. ✦

Dianne Fenyk talking to third graders about healthy bones.

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The Journal of the Hennepin and Ramsey Medical Societies

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Hennepin and Ramsey Medical Societies are pleased to announce our relationship with Clary as a value added benefit to our members.

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C O N T I N U I N G

M E D I C A L

E D U C A T I O N

Continuing Education and Extension, University of Minnesota Partial 2003 CME Calendar “Current 2003 calendar information is available online at www.med.umn.edu/cme”

Family Practice Review: Update 2003 May 5-9 • Radisson Hotel Metrodome • Mpls.

Pelvic Floor Workshop Sept. 2 • Hyatt Regency • Mpls.

Endorectal Ultasonography Sept. 3 • Hyatt Regency • Mpls.

32nd Annual Clinical Hypnosis Workshops May 29-31 • Earle Brown CE Center • St. Paul

Principles of Colon and Rectal Surgery Sept. 4-6 • Hyatt Regency • Mpls.

67th Annual Surgery Course: Advances in Breast, Endocrine and Cancer Surgery June 11-13 • Hyatt Regency • Mpls.

34th Annual Seminar: Obstetrics and Gynecology Sept. 8-9 • Radisson Hotel Metrodome • Mpls.

Topics & Advances in Pediatrics June 12-13 • Radisson Hotel Metrodome • Mpls.

4th Annual Upper Midwest Brain Tumor Symposium Sept. 12 • Radisson Hotel Metrodome • Mpls.

North Central Neonatology Issues Conference (NCNIC) June 13-15 • Grand Geneva Resort • Lake Geneva, WI

Novel Therapies in Thoracic Oncology Sept. 12 • Hilton Airport Bloomington • Bloomington

Heart Failure Society of America: 7th Annual Meeting Sept. 21-24 • Mandalay Bay Resort & Casino • Las Vegas, NV Evidence-Based Healthcare Workshop: Learning to Teaching Sept. 24-28 Hyatt Regency • Mpls.

Fourth Annual Psychiatry Review: Anxiety Disorders Sept. 29-30 • Radisson Hotel Metrodome • Mpls.

Transplant Immunosuppression 2003: The Continuing Challenges October 1-4 • Radisson Hotel Metrodome • Mpls.

Sixth Annual Twin Cities Marathon Sports Medicine Conference October 3-4 Four Points Sheraton • Mpls.

Internal Medicine Review October 8-10 • Radisson Hotel Metrodome • Mpls.

9th Annual Vascular Diseases: A Primary Care Perspective October 24-25 • Radisson Hotel Metrodome • Mpls.

7th Annual Anticoagulation Clinics November 6 • Radisson Hotel Metrodome • Mpls.

28th E.T. Bell Fall Pathology Symposium November 7 • Radisson Hotel Metrodome • Mpls.

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