2003novdec by Advocates for Better Health

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enclosed is your latest issue of

MetroDoctors A Publication and Benefit of the Ramsey and Hennepin Medical Societies

Thank you for your continued membership.

Michael B. Ainslie, M.D. Chair, Hennepin Medical Society

J. Michael Gonzalez-Campoy, M.D., Ph.D. President, Ramsey Medical Society

Nov/Dec 2003

Hospice: Compassionate Care

In This Issue: HIPAA New Developments in Ophthalmology MMA Elections, Awards, and Resolutions Inner Life of the Healer

“We’re here to guide your patients’ care and recovery.” Arterial Disease Venous Disease Lymphatic Disease Wound Care

HealthEast

va s c u l a r c e n t e r To schedule a patient for a consultation or vascular study, call:

651/232-2550 St. Paul & Maplewood Offices www.healtheast.org

W E CA N H EL P Y O U G E T Y O U R PAT I E N T S O V ER T H O S E I N E V I TA B L E L I T T L E B U M PS O N T H E R O A D T O R E C O V E RY. To a person working toward recovery, every little bump, twist, turn or rough spot in the journey can seem insurmountable. They look to you for support and guidance. That's where Hazelden can help. Hazelden Foundation offers professionals easy access to a world of adolescent and adult chemical dependency services, research, books, videos, pamphlets and education. Proven tools that can help you better ease your patients down the road. Conveniently located in Center City, Plymouth and St. Paul. Call 651-213-4200 or toll-free 800-257-7800 or visit www.hazelden.org. Hazelden. We can help. It's what we do. ©2003 Hazelden Foundation

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4O THE %DITOR 4HE RECENT LETTERS OF $R +URISKO AND $R 7INSTON ARE ILLUSTRATIVE OF THE HYPERBOLE USED BY BOTH SIDES OF THE hSINGLE PAYERv DEBATE IN THIS COUNTRY $R +URISKO CALLS THE #ANADIAN SYSTEM hSOCIALISTICv AND hIM MORAL v $R 7INSTON IS SURE THAT SINGLE PAYER HEALTH INSURANCE WOULD IMPROVE HEALTH OUTCOMES AND hALL PATIENTS WOULD BE TREATED WITH DIGNITY v $R 7INSTON USES STATISTICS WE ALL KNOW ABOUT THEM TO PROVE THAT 5 3 HEALTH CARE OUTCOMES ARE WORSE THAN #ANADA S (E NEGLECTS TO MENTION THAT THOSE STATISTICS COM PARE THE PROVERBIAL APPLES AND ORANGES )N THE 5 3 WE HAVE A RACIAL AND SOCIOECONOMIC DIVERSITY THAT #ANADA DOESN T HAVE TO THE SAME DEGREE )N THE 5 3 THE MEDICAL SYSTEM IS THE MODEL OF CHOICE FOR DEALING WITH POOR SCHOOL PERFORMANCE CRIME SUBSTANCE ABUSE AND ALL MANNER OF SOCIAL DEVIATIONS )F A KID ACTS OUT IN SCHOOL HE S SENT TO A PEDIATRIC DE VELOPMENT CENTER FOR hDIAGNOSIS v ! RAPIST IS SENT FOR hTREATMENT OF HIS SEXUAL ADDICTION v $OES #ANADA HAVE THE SAME PROPENSITIES $OES #ANADA HAVE THE SAME OUT OF CONTROL PLAINTIFF S BAR AND THE ASSOCIATED DEFENSIVE MEDICAL COSTS ) DON T KNOW FOR SURE BUT ) DOUBT THAT THE STATISTICAL COMPARISONS PROVE ANYTHING ) DO KNOW THAT #ANADIANS COME OVER THE BORDER FOR HEALTH CARE THEY CAN T GET IN #ANADA "UT HAVING SAID THAT IT WOULD NONETHE LESS BE DIFlCULT TO DEFEND OUR UNMANAGED MANAGED CARE SYSTEM ) WOULD BE MORE HOPEFUL IF THERE WERE AN hUBER COMMITTEEv THAT WOULD ERADICATE SOME OF THE ABUSES OF THE CAPITALISTIC SYSTEM OF HEALTH CARE WITHOUT THROWING OUT THE BABY WITH THE BATHWATER 4URNING OVER HEALTH CARE TO A GOVERN MENT BUREAUCRACY IS TOO SCARY TO CONTEM PLATE ) HAVE NO CONlDENCE THAT A SINGLE BUREAUCRACY WOULD ACHIEVE BETTER OUTCOMES OR PATIENT DIGNITYxBUT ) HAVE GREAT CON lDENCE THAT IT WOULD BE CUMBERSOME AND

UNRESPONSIVE AND RESTRICTIVE )T WOULD DEHU MANIZE MEDICAL CARE lNANCING AND RATIONING )T WOULD QUICKLY BECOME THE BIGGEST TARGET IN THE ENTIRE NATIONAL BUDGET FOR RAIDING POLITICIANS /NE PUSH OF THE BUTTON AND ALL MEDICAL PROVIDERS WOULD BE CUT AGAIN AND AGAIN 7HAT THE SO CALLED EXPERTS HAVE SUC CEEDED IN DOING OVER THE LAST YEARS IS TO CHANGE A SIMPLE DECENTRALIZED SATISFACTORY lNANCING SYSTEM CASH AND OR hMAJOR MEDI CALv INSURANCE INTO A COMPLEX DYSFUNCTIONAL SYSTEM (OW CAN WE POSSIBLY TRUST SUCH PEOPLE TO GET IT RIGHT IF WE MAKE A WHOLESALE CHANGE TO CENTRALIZATION 7HEN FACING A VERY SYMPTOMATIC PATIENT WHOSE DIAGNOSIS AND TREATMENT AREN T CLEAR SOME PHYSICIANS INVENT A CONVENIENT DIAGNOSIS RATHER THAN ADMIT THEY JUST DON T KNOW )NVARIABLY THAT APPROACH LEADS DOWN A VERY UNHAPPY ROAD OF UNINTENDED CONSEQUENCES 3INGLE PAYER SUPPORTERS ARE INVENTING A TREATMENT BEFORE THE UNINTENDED CONSEQUENCES ARE KNOWN OR EVEN DREAMED OF ) AM UNCONVINCED BY THE SIMPLISTIC ARGUMENTS OF EITHER $R +URISKO OR $R 7INSTON )SN T THERE A MIDDLE GROUND THAT IS BOTH REALISTIC AND JUST &OR STARTERS WE COULD STOP USING THE TAX CODE TO ENGINEER SOCIAL CHANGE 7E WILL ALSO NEED TO GET OVER THE NOTION THAT ACCESS TO ALL LEVELS OF HEALTH CARE IS AN EQUAL ENTITLEMENT 0ERHAPS WE COULD USE THE EDUCATION MODEL FOR HEALTH CARE CHOICE A COMBINATION OF PUBLIC AND PRIVATE THAT CREATES A UNIVERSAL AFFORDABLE BENElT SET FOR EVERYONE AND ACKNOWLEDGES THE REALITY OF DIFFERENT ABILITIES TO PAY FOR AND PROVIDE MORE & 3INCERELY

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s ! HOSPITAL EMPLOYEE WHOSE POSITION AT THE HOSPITAL ENTITLED HIM TO AUTHORIZED ACCESS TO SEVERAL MEDICAL RECORD DATABASES SOLD #OUNTRY SINGER 4AMMY 7YNETTE S MEDICAL RECORDS TO THE .ATIONAL %NQUIRER AND 3TAR TABLOIDS FOR s !N EDITOR OF THE -ILWAUKEE *OURNAL 3ENTI NEL FOUND DOCUMENTS REFERRING TO OVER PSYCHIATRIC PATIENTS OF 2APID #ITY 2EGIONAL (OSPITAL IN A CONVENIENCE STORE TRASH ! 5NIVERSITY OF 3OUTH $AKOTA FOURTH YEAR MEDICAL STUDENT HAD TAKEN PAPERS OUTSIDE OF THE HOSPITAL AND DUMPED THEM IN THE TRASH 4HE DOCUMENTS INCLUDED LISTS OF PATIENTS IN THE PSYCHIATRIC UNIT AND THEIR DIAGNOSES ALONG WITH THE STUDENT S HANDWRITTEN NOTES ABOUT SOME OF THE PATIENTS s ! JURY IN 7ISCONSIN FOUND THAT AN EMER GENCY MEDICAL TECHNICIAN INVADED THE PRI VACY OF AN OVERDOSE PATIENT WHEN SHE TOLD THE PATIENT S CO WORKER ABOUT THE OVERDOSE 4HE CO WORKER THEN TOLD NURSES AT ANOTHER HOSPITAL WHERE THE PATIENT WAS ALSO A NURSE ABOUT THE OVERDOSE 4HE %-4 CLAIMED THAT SHE INFORMED THE PATIENT S CO WORKER OUT OF CONCERN FOR THE PATIENT 4HE JURY HOWEVER FOUND THAT REGARDLESS OF HER INTENTIONS THE %-4 HAD NO RIGHT TO DISCLOSE CONlDENTIAL AND SENSITIVE MEDICAL INFORMATION AND DI RECTED THE %-4 AND HER EMPLOYER TO PAY FOR THE INVASION OF PRIVACY 9Ê °Ê -Ê ]Ê ° ° Ê / Ê-°Ê ," - 9]Ê ° °

!S THESE BRIEF STORIES ILLUSTRATE IT IS OFTEN TOO EASY FOR PERSONAL MEDI CAL INFORMATION TO SLIP THROUGH THE CRACKS AND BE MISUSED 4HE (EALTH )NSURANCE 0ORTABILITY AND !CCOUNT ABILITY !CT OF BETTER KNOWN AS ()0!! IS A COMPREHENSIVE SET OF FEDERAL REGULATIONS DESIGNED TO PROTECT THE CONlDENTIALITY OF HEALTH INFORMATION !S TECHNOLOGY BE COMES COMMONPLACE AND THE HEALTH CARE INDUSTRY CONTINUES TO EXPAND IT IS CRUCIAL THAT PROVIDERS TAKE STEPS TO VIGILANTLY PROTECT THEIR PATIENT S HEALTH INFORMATION

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7 >ÌÊ- Õ `Ê* ÞÃ V > ÃÊ ÜÊ L ÕÌÊ * ¶ ()0!! S PRIVACY REGULATIONS REQUIRE PROVIDERS TO ESTABLISH WRITTEN POLICIES AND PROCEDURES TO PROTECT THE CONlDENTIALITY OF THEIR PATIENT S HEALTH INFORMATION 4HESE WRITTEN POLICIES AND PROCEDURES MUST ADDRESS THE FOLLOWING KEY PRIVACY REQUIREMENTS !CCESS TO -EDICAL 2ECORDS 3UBJECT TO CERTAIN EXCEPTIONS PATIENTS SHOULD GENERALLY BE ALLOWED ACCESS TO REVIEW COPY AND REQUEST CORRECTIONS TO THEIR RECORDS 4HE 0RIVACY 2EGU LATIONS OUTLINE THE APPROPRIATE TIME AND MAN NER IN WHICH SUCH ACCESS SHOULD BE PROVIDED .OTICE OF 0RIVACY 0RACTICES 0ROVIDERS MUST DISTRIBUTE A NOTICE TO THEIR PATIENTS EXPLAINING HOW PATIENT S PERSONAL MEDICAL IN FORMATION MAY BE USED AND OUTLINING PATIENTS RIGHTS UNDER ()0!! 4HE 0RIVACY 2EGULATIONS OUTLINES THE REQUIRED CONTENT FORM AND DISTRI BUTION METHODS FOR THE PRIVACY NOTICE ,IMITS ON 5SE AND $ISCLOSURE OF 0ERSONAL -EDICAL )NFORMATION 4HE 0RIVACY 2EGULATIONS OUTLINE IN DETAIL HOW PROVIDERS MAY AND MAY NOT USE AND DISCLOSE PATIENTS PERSONAL MEDICAL INFORMATION &OR EXAMPLE SUCH INFORMATION

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MAY GENERALLY BE USED FOR PURPOSES OF TREAT MENT PAYMENT AND HEALTH CARE OPERATIONS WITHOUT OBTAINING PATIENT AUTHORIZATION (OW EVER PATIENT AUTHORIZATION IS USED FOR OTHER PURPOSES SUCH AS MARKETING OR RESEARCH 4HE 0RIVACY 2EGULATIONS OUTLINES SPECIlC REQUIRE MENTS FOR OBTAINING PATIENT AUTHORIZATION AND ALSO REQUIRE THAT ONLY THE hMINIMUM NECESSARYv INFORMATION BE USED FOR ANY GIVEN PURPOSE #ONlDENTIAL #OMMUNICATIONS 4HE 0RI VACY 2EGULATIONS ALLOW PATIENTS TO REQUEST THAT THEIR PROVIDER TAKE REASONABLE STEPS TO ENSURE THAT THEIR COMMUNICATIONS WITH THE PATIENT ARE CONlDENTIAL &OR EXAMPLE A PATIENT MAY ASK THAT HER PHYSICIAN CALL HER AT HER OFlCE RATHER THAN HER HOME 0HYSICIANS ARE EXPECTED TO COM PLY WITH SUCH REQUESTS IF THEY CAN BE REASONABLY ACCOMMODATED BUT ARE NOT OTHERWISE REQUIRED TO DO SO #OMPLAINTS 0ATIENTS ARE ENTITLED TO lLE COMPLAINTS REGARDING A PROVIDER S PRIVACY PRACTICES WITH THE (EALTH AND (UMAN 3ERVICES /FlCE FOR #IVIL 2IGHTS )N ADDITION PROVIDERS MUST INFORM PATIENTS OF THEIR RIGHT TO lLE A COMPLAINT AS WELL AS HOW TO DO SO IN THEIR NOTICE OF PRIVACY PRACTICES

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%MPLOYEE 4RAINING 0ROVIDERS MUST TRAIN THEIR EMPLOYEES AND MEMBERS OF THEIR STAFF WITH RESPECT TO THEIR WRITTEN PRIVACY POLICIES AND PROCEDURES )F AN EMPLOYEE FAILS TO FOLLOW THESE PROCEDURES A PROVIDER SHOULD TAKE APPROPRIATE DISCIPLINARY ACTION 0RIVACY /FlCER 4HE 0RIVACY 2EGULATIONS REQUIRE PROVIDERS TO APPOINT A PRIVACY OFlCER TO RECEIVE COMPLAINTS AND PROVIDE ADDITIONAL INFORMATION TO PATIENTS REGARDING MATTERS COVERED IN THE NOTICE OF PRIVACY PRACTICE 4HIS INDIVIDUAL IS ALSO RESPONSIBLE FOR THE DEVELOP MENT AND IMPLEMENTATION OF CONlDENTIALITY POLICIES AND PROCEDURES FOR THE PROVIDER 7HILE THIS LIST OF REQUIREMENTS FEELS EXTENSIVE IT IS NOT AN EXHAUSTIVE LIST OF THE REQUIREMENTS SET FORTH IN THE 0RIVACY 2EGU LATIONS )N ORDER TO SUCCESSFULLY IMPLEMENT ()0!! COMPLIANT POLICIES AND PROCEDURES PROVIDERS SHOULD ARRANGE TO UNDERSTAND ALL OF THE IMPORTANT REQUIREMENTS THAT ARE IN THE 0RIVACY 2EGULATIONS * Ê « > ViÊ v ÀVi i Ì $ESPITE THE BROAD NATURE OF THE REQUIREMENTS OUTLINED BY ()0!! THE 0RIVACY 2EGULATIONS ACTUALLY PROVIDE A HELPFUL ROADMAP TO PROVID ERS ENABLING THEM TO PROTECT THE PRIVACY OF THEIR PATIENTS IN AN EFlCIENT AND EFFECTIVE MAN NER 3OME PROVIDERS QUESTION WHETHER IT IS TRULY COST EFFECTIVE TO COMPLY WITH ()0!! BUT THE CIVIL AND CRIMINAL PENALTIES BUILT INTO ()0!! SHOULD CONVINCE MOST PROVIDERS THAT IT IS WORTH THEIR WHILE TO INVEST IN ()0!! COMPLIANCE 4HE 5NITED 3TATES $EPARTMENT OF (EALTH AND (UMAN 3ERVICES RELEASED THE %NFORCEMENT 2ULE WHICH CHARGED THE /FlCE OF #IVIL 2IGHTS /#2 WITH ENFORCING ()0!! AND EXPLAINED THAT ENFORCEMENT OF THE 0RIVACY 2EGULATIONS WOULD BE COMPLAINT DRIVEN )N OTHER WORDS IF AN INDIVIDUAL CONTACTS THE /#2 AND AL LEGES CERTAIN PRIVACY VIOLATIONS THE /#2 WILL INVESTIGATE THE SUBJECT OF THE INDIVIDUAL S COMPLAINT ()0!! S 0RIVACY 2EGULATIONS TOOK EFFECT ON !PRIL 7ITHIN TWO MONTHS THE /#2 RECEIVED OVER COMPLAINTS FROM INDIVIDUALS CONCERNING POTENTIAL ()0!! VIO LATIONS 4HE /#2 CLOSED OF THOSE CASES AND OUT OF THE OPEN CASES THE /#2 S STAFF OF INVESTIGATORS IS ACTIVELY INVESTIGATING OF THE COMPLAINTS

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4YPICAL COMPLAINTS CONSIST OF INDIVIDUALS ALLEGING THAT THEY WERE DENIED ACCESS TO THEIR RECORDS INADEQUATE SAFEGUARDS INADEQUATE MINIMUM NECESSARY PROCEDURES OR FAILURE TO PROVIDE THE REQUISITE PRIVACY NOTICES )N ADDI TION THE /#2 HAS RECEIVED COMPLAINTS FROM INSIDERS IN ORGANIZATIONS ALLEGING THAT THEIR OFlCES WERE NOT IN COMPLIANCE 0ENALTIES FOR ()0!! VIOLATIONS RANGE FROM CIVIL PENALTIES IN THE FORM OF lNES RANGING FROM PER OFFENSE TO PER OFFENSE TO CRIMINAL PENALTIES OF UP TO YEARS IN PRISON 4HESE CIVIL AND CRIMINAL PENALTIES ARE JUST THE TIP OF THE ICEBERG WHEN IT COMES TO THE COSTS OF ()0!! NON COMPLIANCE 3TATE LAWS PROVIDE THE BASIS FOR ADDITIONAL PRIVACY VIOLATIONS WHICH MAY LEAD TO HIGH DAMAGE AWARDS ATTORNEYS FEES AND INTANGIBLE BUSINESS COSTS SUCH AS LOSS OF TIME RESOURCES AND EMPLOYEE MORALE 'IVEN THAT INFORMATION ON SUCH VIOLATIONS ARE IN THE PUBLIC DOMAIN MANY PHYSICIANS WORRY ABOUT MEDIA INVESTIGATIONS THAT MAY CAUSE IRREPARABLE DAMAGE TO A PROVIDER S REPUTATION AND DESTROY ANY SEMBLANCE OF TRUST IN THE PHYSICIAN PATIENT RELATIONSHIP ÜÊ- Õ `Ê*À Û `iÀÃÊ > ` iÊ * ¶ 4HIS INFORMATION REGARDING ENFORCEMENT AND POTENTIAL PENALTIES IS NOT INTENDED TO SET OFF ALARM BELLS FOR PHYSICIANS 2ATHER IT ILLUSTRATES THE NEED FOR INCREASED AWARENESS AND THE NEED TO COMMIT SOME RESOURCES TO ADDRESSING THESE REQUIREMENTS 4HE FIRST STEP IS TO BECOME EDUCATED AND PROVIDE YOUR STAFF WITH INFORMATION ON ()0!! S APPLICABILITY TO THEIR EVERYDAY PRACTICE 4HIS MAY BE DONE THROUGH SEMINARS HIRING A CONSULTANT TO PERFORM A COMPLIANCE ASSESSMENT OR SIMPLY PROFESSIONAL READING 4HE NEXT STEP IS TO DELEGATE THE RESPONSI BILITY OF ()0!! COMPLIANCE TO A RESPONSIBLE INDIVIDUAL WITHIN YOUR OFFICE 4YPICALLY A CLINIC MANAGER OR ADMINISTRATOR IS CHARGED WITH ACTING AS THE PROVIDER S hPRIVACY OFlCER v 4HIS PERSON IS RESPONSIBLE FOR DEVELOPING AND IMPLEMENTING ()0!! COMPLIANT POLICIES AND PROCEDURES AS WELL AS EDUCATING PROVIDERS AND STAFF AND UPDATING POLICIES AND PROCEDURES AS NECESSARY )N ADDITION TO APPOINTING A PRIVACY OFlCER PROVIDERS THEMSELVES MUST ALSO ACCEPT RESPONSIBILITY AND COMMIT TO STAYING CURRENT WITH RESPECT TO SUCH PRIVACY REGULATIONS 3TAYING UP TO DATE IS IMPORTANT TO AN EF FECTIVE COMPLIANCE PROGRAM BECAUSE ()0!!

ONLY PROVIDES A mOOR FOR PRIVACY PROTECTIONS 3TATE LAWS MAY SUPPLEMENT ()0!! S REQUIRE MENTS &OR EXAMPLE ()0!! DOES NOT REQUIRE PROVIDERS TO OBTAIN PATIENT CONSENT OR AUTHO RIZATION FOR THE RELEASE OF PROTECTED INFORMA TION FOR TREATMENT PAYMENT OR HEALTH CARE OPERATION PURPOSES (OWEVER -INNESOTA LAW REQUIRES PROVIDERS TO OBTAIN PATIENT CONSENT BEFORE DISCLOSING PROTECTED INFORMATION TO ANOTHER PROVIDER OUTSIDE THEIR ORGANIZATION FOR NON EMERGENCY PURPOSES 3INCE -IN NESOTA LAW IS STRICTER THAN ()0!! PROVIDERS MUST FOLLOW -INNESOTA LAW )N THE UPCOMING MONTHS MANY STATES WILL PASS LAWS THAT ARE STRICTER THAN ()0!! IN ORDER TO SUPPLEMENT ()0!! S PRIVACY PROTECTIONS 4HEREFORE IT IS CRUCIAL THAT DOCTORS AND THEIR PRIVACY OFlCERS STAY ABREAST OF SUCH NEW REGULATORY REQUIRE MENTS -iVÕÀ ÌÞÊ,i}Õ >Ì Ê Ã iÝÌÊ i>` i %VEN THOUGH THE 0RIVACY 2EGULATIONS REQUIRED PROVIDERS TO COMPLY WITH THE REGULATIONS BY !PRIL MANY PHYSICIANS HAVE STILL NOT ADDRESSED ()0!! .ON COMPLIANT PROVIDERS SHOULD MAKE ()0!! COMPLIANCE A PRIORITY IN THE UPCOMING MONTHS &OR THOSE PROVIDERS THAT HAVE ALREADY IMPLEMENTED THE 0RIVACY 2EGULATIONS THE NEXT STEP IS TO COMPLY WITH ()0!! S 3ECURITY 2EGU LATIONS WHICH ADDRESS IMPLEMENTING PHYSICAL ADMINISTRATIVE AND TECHNICAL SAFEGUARDS TO PROTECT HEALTH INFORMATION THAT IS MAINTAINED AND TRANSMITTED BY PROVIDERS 4HE DEADLINE FOR COMPLIANCE WITH THE 3ECURITY 2EGULATIONS IS SET FOR !PRIL )T MAY SEEM FAR AWAY NOW BUT IT WILL SURELY APPROACH QUICKLY * Ê i «Ê ÃÊ Û> >L i 7HILE ALL OF THESE REGULATIONS MAY SEEM OVERWHELMING PROVIDERS ARE NOT LEFT ALONE AND WITHOUT AVAILABLE ASSISTANCE ! PLETHORA OF RESOURCES ARE AVAILABLE TO LARGE AND SMALL PROVIDER ORGANIZATIONS AS WELL AS THEIR OFlCE STAFFS TO ASSIST IN NAVIGATING THROUGH THE WORLD OF ()0!! COMPLIANCE 0ROVIDERS CAN LOOK TO TRADE ASSOCIATIONS FOR GUIDANCE IN THE FORM OF EDUCATIONAL SEMINARS ! VARIETY OF ()0!! VEN DORS ARE AVAILABLE TO ASSIST IN TRACKING APPLICABLE STATE LAWS AND PROVIDING FORM DOCUMENTS TO ASSIST IN PREPARING POLICIES AND PROCEDURES &I NALLY HEALTH CARE CONSULTANTS AND HEALTH CARE ATTORNEYS PROVIDE AN EXCELLENT RESOURCE FOR EV ERYTHING FROM SAMPLE POLICIES AND PROCEDURES

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STUDIES MOST CLEARLY SUPPORT THE EXISTENCE OF A POSITIVE COST BENElT OF IMPROVED DISEASE MANAGEMENT AND BECAUSE DIABETES IS A MAJOR CONCERN OF THE WORKING AGE POPULATION AND THEIR EMPLOYERS 4HE OTHER hTRACKv IN THE "RIDGES TO %X CELLENCE PROGRAM ILLUSTRATES ANOTHER IMPORTANT TREND IN THIS TYPE OF REIMBURSEMENT PROGRAM 4HE .#1! S 0HYSICIAN /FlCE ,INK PROGRAM IS CLEARLY FOCUSED ON THE ISSUE OF CAPACITY BUILDING 4HIS PROGRAM IS DESIGNED TO REWARD PHYSICIANS BASED ON THEIR IMPLEMENTATION OF SPECIlC PROCESSES TO REDUCE ERRORS AND INCREASE QUALITY 5NDER THE /FlCE ,INK PROGRAM PRAC TITIONERS CAN EARN UP TO PER YEAR FOR EACH PATIENT COVERED BY A PARTICIPATING EMPLOYER OR PLAN FOR MEETING THE OFlCE CAPACITY PERFOR MANCE CRITERIA ! COMPLETE DESCRIPTION OF THE "RIDGES TO %XCELLENCE PROGRAM CAN BE FOUND AT WWW NCQA ORG 0ROGRAMS BRIDGESTOEXCELLENCE -EDICARE ALSO HAS AN INTEREST IN LOWERING THE COST OF TREATING ITS ENROLLEES WITH CHRONIC CONDITIONS 4HE FEDERAL PROGRAM IS CURRENTLY EXPERIMENTING WITH SEVERAL APPROACHES TO PAY FOR PERFORMANCE INCLUDING A PROGRAM OF EN HANCED REIMBURSEMENT FOR MEDICAL GROUPS THAT DO AN OUTSTANDING JOB OF CARING FOR -EDICARE ENROLLEES WITH CHRONIC CONDITIONS /NE DEM ONSTRATION PROGRAM WILL ALLOW UP TO DISEASE

SPECIlC hPROVIDER SPONSORED ORGANIZATIONSv TO ENROLL PATIENTS WITH SPECIlC CHRONIC CONDITIONS AND RECEIVE CAPITATION BASED ON WHAT WOULD HAVE BEEN SPENT FOR THEIR CARE UNDER TRADITIONAL -EDICARE #-3 HAS ALSO JUST ANNOUNCED WHICH MEDICAL GROUPS WILL PARTICIPATE UNDER ITS 0HY SICIAN 'ROUP 0RACTICE $EMONSTRATION 5NDER BOTH OF THESE ARRANGEMENTS PROVIDERS WHO CAN MANAGE CHRONIC DISEASE PATIENTS AT BELOW THE TOTAL COST OF TRADITIONAL -EDICARE WILL BE ABLE TO DIRECTLY SHARE IN THE HOSPITAL COST SAVINGS %NHANCED PAYMENT PER MEMBER PER MONTH AND INCREASED CAPITATION ARE JUST TWO OF THE MECHANISMS PURCHASERS AND HEALTH PLANS ARE USING TO REWARD PROVIDERS ,OCALLY MOST OF THE HEALTH PLANS ARE ENGAGED IN PAY FOR PERFORMANCE INITIATIVES TO A GREATER OR LESSER EXTENT )N (EALTH0ARTNERS WAS ONE OF THE lRST PLANS IN THE 5 3 TO OFFER lNANCIAL REWARDS FOR QUALITY IMPROVEMENT WITH ITS /UTCOMES 2ECOGNITION 0ROGRAM 4HIS PROGRAM OFFERS ANNUAL BONUS AWARDS TO PRIMARY CARE CLIN ICS THAT ACHIEVE SUPERIOR HEALTH PROMOTION AND DISEASE PREVENTION RESULTS AS COMPARED TO PLAN WIDE QUALITY IMPROVEMENT GOALS )N THIS SYSTEM ELIGIBLE PRIMARY CARE GROUPS ARE ANNUALLY ALLOCATED A POOL OF BONUS DOLLARS AND ARE REWARDED IF THE GROUP REACHES THE SPECIlC PERFORMANCE TARGETS

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0ATIENT #HOICE (EALTH #ARE )NC BASED IN 3T ,OUIS 0ARK IS ADDING AN INNOVATIVE PAY FOR PERFORMANCE MECHANISM TO ITS PAYMENT STRATEGY 0ATIENT #HOICE (EALTH #ARE )NC USES THE COST TIERED PREMIUM SHARING AP PROACH DEVELOPED BY THE "UYERS (EALTH #ARE !CTION 'ROUP WHERE ENROLLEES SELECTING LOWER COST CARE SYSTEMS HAVE LESS OF THE PREMIUM COST DEDUCTED FROM THEIR PAYCHECKS 4HE COST TIERS ARE DETERMINED BY BIDS DEVELOPED BY THE CARE SYSTEMS &OR CONTRACTS CARE SYSTEMS CAN EARN UP TO A PERCENT DISCOUNT IN THE CALCULATION OF THEIR POSITION IN THE COST TIERS FOR MEETING CERTAIN DISEASE MANAGEMENT CAPAC ITY INDICATORS OUTCOME STANDARDS AND PATIENT SATISFACTION CRITERIA /NE OF THE PROBLEMS PHYSICIANS AND RE SEARCHERS HAVE IDENTIlED IN THE APPLICATION OF PAY FOR PERFORMANCE REWARD PROGRAMS COMES FROM VARIATION IN HOW PLANS AND PURCHASERS MEASURE PERFORMANCE )F PHYSICIANS ARE SUBJECT TO SEVERAL EVEN SLIGHTLY DIFFERENT PERFORMANCE MEASUREMENT SYSTEMS THE RESULTING LACK OF hALIGNMENTv AROUND A SINGLE SET OF GOALS WILL CAUSE THE INCENTIVES TO NOT BE CLEARLY TRANSMITTED TO THE CAREGIVERS 4HIS LACK OF A CLEAR TRANSMISSION OF PERFORMANCE INCENTIVES WILL RESULT IN A LOWER THAN HOPED FOR QUALITY IMPROVEMENT RESPONSE 3EVERAL INITIATIVES HAVE BEEN ANNOUNCED TO ADDRESS THIS LACK OF hALIGN MENT v ,OCALLY THE -INNESOTA #OUNCIL OF (EALTH 0LANS DESERVES CREDIT FOR BRINGING TOGETHER PLANS AND PROVIDERS THROUGH THE #OMMUNITY -EASUREMENT #OMMITTEE TO DEVELOP COMMON STANDARDS FOR PERFORMANCE MEASUREMENT 4HE #OMMUNITY -EASUREMENT #OMMITTEE WAS ESTABLISHED TO DEVELOP A CONSENSUS ABOUT WHAT SHOULD BE MEASURED FOR THE PURPOSE OF REWARDING PERFORMANCE -INNESOTA EMPLOYERS AND PLANS HAVE LONG SOUGHT WAYS TO REWARD QUALITY /NE OF THE MOST VISIBLE EXAMPLES OF THIS EFFORT IS THE %XCELLENCE IN 1UALITY !WARDS %1! PROGRAM 4HE %1! IS A PROGRAM DESIGNED TO GIVE BOTH SIGNIlCANT CASH AWARDS AND PUBLIC RECOGNITION TO HEALTH CARE PROVIDERS WHO DEMONSTRATE AN OUTSTANDING ABILITY TO MANAGE CHRONIC DIS EASE OR EXCITING INNOVATIONS IN THE DELIVERY OF HIGH QUALITY HEALTH CARE 4HE AWARDS OF UP TO ARE BASED ON APPLICATIONS SUBMIT TED BY ELIGIBLE PROVIDER ORGANIZATIONS !NY HEALTH CARE ORGANIZATION CAPABLE OF PROVIDING

DISEASE MANAGEMENT SERVICES IS ELIGIBLE !N INDEPENDENT PANEL JUDGES APPLICATIONS 4HIS YEAR S %XCELLENCE IN 1UALITY AND )NNOVATIONS IN (EALTHCARE 1UALITY AWARDS WAS PRESENTED AT (EALTH&RONT S &ALL 3YMPOSIUM 7EDNESDAY /CTOBER 4HE %XCELLENCE IN 1UALITY !WARDS ENCOUR AGES QUALITY THROUGH TWO PARALLEL MECHANISMS 4HE SIGNIlCANT CASH AWARDS APPEAL TO THE BUSI NESS OFlCE PART OF THE HEALTH CARE ORGANIZATION !ND BECAUSE THERE ARE SIGNIlCANT DOLLARS AS SOCIATED WITH THE AWARDS THIS INCREASES THE PROFESSIONAL PRESTIGE ASSOCIATED WITH WINNING ONE /THER QUALITY INCENTIVES INCLUDE PLACING COMPENSATION AT RISK WITHHOLDS ADJUSTING FEE SCHEDULES FOR QUALITY INDICATORS MAKING QUALITY GRANTS TO ASSIST IN DEVELOPING NEEDED INFRASTRUCTURE AND PROVIDING REIMBURSEMENT FOR DESIRED ACTIVITIES SUCH AS CARE PLANNING ,ESS DIRECT STRATEGIES INCLUDE VARYING PATIENT CO PAYS TO DIRECT MARKET SHARE TO HIGHER SCOR ING PROVIDERS AND PUBLIC REPORTING OF QUAL ITY SURVEY RESULTS (EALTH&RONT IS PRESENTLY CONDUCTING A WEB BASED PATIENT SATISFACTION SURVEY AT WWW HEALTHFRONT INFO ORG AND WILL PUBLISH COMPARATIVE RESULTS LATER THIS FALL

0URCHASERS AND PLANS ALSO PROVIDE TECHNICAL AND INFORMATION SUPPORT TO PROVIDERS FOR QUALITY IMPROVEMENT ACTIVITIES 4HE APPROACH OF HEALTH PLANS FUNDING TECHNICAL SUPPORT THAT ENHANCES THE INTERNAL ABILITY OF ORGANIZATIONS TO CHANGE IS BEST EXEMPLIlED BY )NSTITUTE FOR #LINICAL 3YSTEMS )MPROVEMENT )#3)

V ÕÃ \Ê 4HE -AY )#3) SYMPOSIUM WAS ENTITLED h#ULTIVATING 1UALITYv AND USED AN AGRICULTURE THEME TO LINK THE COMPONENTS NEEDED TO IM PROVE HEALTHCARE QUALITY )N HIS INTRODUCTORY REMARKS $R 'ORDON -OSSER DElNED THOSE PRE REQUISITES AS hCOMMITMENT COLLABORATION AND CLIMATE v -INNESOTA S PROVIDERS EMPLOYERS AND PLANS HAVE LONG DEMONSTRATED A COMMITMENT TO QUALITY 0AY FOR PERFORMANCE OFFERS THE HOPE THAT THE REIMBURSEMENT hCLIMATEv CAN MORE DI RECTLY SUPPORT QUALITY IMPROVEMENT & -ICHAEL #ALLAHAN - 3 IS DIRECTOR OF QUALITY RE SEARCH AT (EALTH&RONT (E CAN BE REACHED AT OR AT MIKEC HEALTHFRONT INFO ORG "RADLEY # -ONTGOMERY IS EXECUTIVE DIRECTOR OF (EALTH&RONT (E CAN BE REACHED AT OR AT BRADM HEALTHFRONT INFO ORG

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TO A PLACE OF SHELTER AND REST FOR WEARY OR ILL TRAVELERS ON A LONG JOURNEY (OSPICE WAS lRST INTRODUCED IN THIS COUNTRY IN WHEN $AME #ICELY 3AUNDERS A PHYSICIAN WHO WAS IN THE PROCESS OF ESTABLISHING 3T #HRISTOPHER S INPATIENT HOSPICE IN ,ONDON WAS INVITED TO GIVE A LECTURE AT 9ALE 5NIVERSITY (ER LECTURE GIVEN TO MEDICAL STUDENTS NURSES SOCIAL WORKERS AND CHAPLAINS ABOUT THE CONCEPT OF HOLISTIC HOSPICE CARE INCLUDED PHOTOS OF TERMINALLY ILL CANCER PATIENTS AND THEIR FAMILIES SHOWING THE DRAMATIC DIFFERENCES BEFORE AND AFTER THE SYMPTOM CONTROL CARE &LORENCE 7ALD DEAN OF THE 9ALE 3CHOOL OF .URSING INSPIRED BY THE LECTURE SUBSEQUENTLY DEVOTED HERSELF TO BRINGING THE HOSPICE CONCEPT TO THE 5NITED 3TATES AND IN SHE SUCCESSFULLY OPENED THE #ONNECTICUT (OSPICE 3INCE THAT TIME THE CREDIBILITY OF THE HOSPICE CONCEPT HAS GROWN TREMENDOUSLY 4ODAY THERE ARE MORE THAN HOSPICE PROGRAMS ACROSS THE 5NITED 3TATES SERVING THE TERMINALLY ILL AND THEIR FAMILIES 'ENERALLY CONSIDERED A PHILOSOPHY OR PROGRAM OF CARE RATHER THAN A PLACE HOSPICE IS A UNIQUE BLEND OF SERVICES THAT ADDRESSES THE PHYSICAL EMOTIONAL PSYCHOSOCIAL AND SPIRITUAL NEEDS OF THE TERMINALLY ILL PERSON AND HIS HER FAMILY (OSPICE CARE IS PROVIDED BY AN INTERDISCIPLINARY TEAM OF PROFESSIONALS INCLUDING PHYSICIANS REGISTERED NURSES SOCIAL WORKERS COUNSELORS HOME HEALTH AIDES AND VOLUNTEERS GUIDED BY THE GOALS OF AN INDIVIDUAL PLAN OF CARE (OSPICE CARE EMPHASIZES PALLIATIVE AND SUPPORTIVE SERVICES RATHER THAN CURE ORIENTED THERAPIES AND INTERVENTIONS 4HE .ATIONAL (OSPICE AND 0ALLIATIVE #ARE /RGANIZATION .(0#/ ESTIMATED THAT !MERICA S HOSPICES ADMITTED PATIENTS IN )T IS FURTHER ESTIMATED THAT !MERICANS DIED WHILE RECEIVING HOSPICE CARE IN 4HIS lGURE REPRESENTS ONE OUT OF EVERY FOUR PEOPLE WHO DIED IN THE 5 3 OF ALL CAUSES (OSPICE STATISTICS FROM FURTHER INDICATE THAT PERCENT OF THE HOSPICE PATIENTS WERE DIAGNOSED WITH CANCER UPON ADMISSION 4HE TOP lVE NON CANCEROUS CAUSES OF DEATH IN HOSPICE INCLUDE END STAGE HEART DISEASE PERCENT DEMENTIA PERCENT LUNG DISEASE PERCENT END STAGE KIDNEY DISEASE PERCENT AND END STAGE LIVER DISEASE PERCENT &OR THOSE WORKING TO IMPROVE ACCESS TO HOSPICE CARE IN !MERICA THESE STATISTICS REPRESENT A POSITIVE GROWTH TREND (OWEVER THESE STATISTICS FAIL TO SPEAK TO A DISTURB ING REALITY THE MEAN AND MEDIAN LENGTHS OF STAY HAVE DECREASED BY PERCENT AND PERCENT RESPECTIVELY OVER THE LAST DECADE AND PERCENT OF HOSPICE PATIENTS DIE WITHIN SEVEN DAYS OF ADMISSION )N OTHER WORDS HOSPICE IS INCREASINGLY BEING USED AS A LAST RESORT AS A CRISIS MANAGEMENT RESOURCE WHEN PATIENTS ARE IN OR NEAR THE DYING PROCESS 9Ê Ê < ,]Ê ° °Ê

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"ETTER THAN NOTHING CERTAINLY BUT NOT AT ALL THE PURPOSE FOR WHICH HOSPICE CARE WAS DESIGNED (OSPICE OF THE 4WIN #ITIES AND FOR THAT MATTER EXPERTS FROM ACROSS THE COUNTRY PASSIONATELY BELIEVE THAT hPATIENTS NEED TO BE ENROLLED IN HOSPICE FOR AT LEAST DAYS TO MAXIMIZE ITS BENElTS IN TERMS OF PAIN AND SYMPTOM MANAGEMENT AND PSYCHOLOGICAL AND SPIRITUAL SUPPORT v /VER THE PAST YEARS (OSPICE OF THE 4WIN #ITIES LOWEST 0ATIENT &AMILY 3ATISFAC TION 3CORE HAS CONSISTENTLY BEEN IN THE AREA OF TIMELY REFERRALS TO HOSPICE &AMILIES STATE AGAIN AND AGAIN THAT THEY WISHED THEY HAD KNOWN ABOUT HOSPICE SOONER )N LIGHT OF THIS ENDURING LOW SATISFACTION SCORE A 'ERIATRIC &ELLOW WORKING AT (ENNEPIN #OUNTY -EDICAL #ENTER RECENTLY COMPLETED AN ACCELERATED 1UALITY )MPROVEMENT 3TUDY FOR (OSPICE OF THE 4WIN #ITIES FOR THE PURPOSE OF IMPROVING PATIENT ACCESS TO HOSPICE CARE )NFORMATION WAS COLLECTED ON PATIENTS WITH A HOSPICE LENGTH OF STAY OF SEVEN DAYS OR LESS TO ASCERTAIN PHYSICIAN PERCEPTIONS OF BARRIERS TO EARLIER REFERRAL TO HOSPICE CARE ! SUM MARY OF THE DATA COLLECTED INDICATED OF THE PERCENT OF PHYSICIANS WHO RESPONDED THE BARRIERS THEY ENCOUNTERED WHICH PREVENTED THEM FROM REFERRING EARLIER TO HOSPICE WERE AS FOLLOWS s $IFlCULTY IN ACCURATELY PROGNOSTICATING A SIX MONTH LIFE EXPECTANCY PERCENT s !SSESSING THAT FAMILY IS NOT READY FOR HOSPICE CARE PERCENT s !SSESSING THAT PATIENT IS NOT READY FOR HOSPICE CARE PERCENT AND s $IFlCULTY IN ADDRESSING END OF LIFE CARE ISSUES WITH PATIENT FAMILY PERCENT 4HE #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3 IN A -ARCH MEMO RANDUM TO lSCAL INTERMEDIARIES SEEKS TO ALLEVIATE THESE PERCEIVED BARRIERS AND ACTUALLY URGES PHYSICIANS AND HEALTH CARE PROVIDERS IN THE COMMUNITY TO RAISE AWARENESS AMONG THEIR PATIENTS ABOUT THE HOSPICE BENElT AND ITS AVAILABILITY )N THE MEMORANDUM #-3 RECOGNIZES THAT BECAUSE PROGNOSES CAN BE UNCERTAIN AND MAY CHANGE -EDICARE S HOSPICE BENElT IS NOT LIMITED IN TERMS OF TIME (OSPICE CARE IS AVAILABLE AS LONG AS THE PATIENT S PROGNOSIS IS MEASURED IN MONTHS NOT YEARS IF THE DISEASE FOLLOWS A NORMAL COURSE 4HE GOVERNING STATUTE STATES h4HE CERTIlCATION OF TERMINAL ILLNESS OF AN INDIVIDUAL WHO ELECTS HOSPICE SHALL BE BASED ON THE PHYSICIAN S CLINICAL JUDGMENT REGARDING THE NORMAL COURSE OF THE INDIVIDUAL S ILLNESS v 4HE PERCEIVED RETICENCE ON THE PART OF PATIENT S AND FAMILIES AND FOR THAT MATTER PHYSICIANS TO CONTEMPLATE THE END OF LIFE IS NOT SURPRISING ! 0UBLIC /PINION 3URVEY CONDUCTED BY THE .ATIONAL (OSPICE &OUNDATION FOUND THAT !MERICAN S ARE HESITANT TO DISCUSS END OF LIFE CARE WITH THEIR ELDERLY PARENTS !CCORDING TO THE SURVEY

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LESS THAN ONE IN FOUR OF US HAVE PUT INTO WRITING HOW WE WISH TO BE CARED FOR AT LIFE S END !BOUT ONE IN lVE HAVE NOT CONTEMPLATED THE SUBJECT AT ALL AND A SLIGHTLY SMALLER NUMBER HAVE THOUGHT ABOUT END OF LIFE CARE WISHES BUT HAVE NOT SHARED THEIR THOUGHTS WITH OTHERS 5NFORTUNATELY THIS HESITANCY MAY RESULT IN CONFUSION AND LACK OF CLEAR DIRECTION IN ASSURING QUALITY END OF LIFE CARE

4HERE IS NO DOUBT THAT EARLIER AND MORE WIDESPREAD USE OF HOSPICE CARE WOULD BENElT PATIENTS AND FAMILIES -ANY END OF LIFE CARE EXPERTS AS WELL AS PATIENTS AND FAMILIES CONSIDER HOSPICE TO BE THE hGOLD STANDARDv IN END OF LIFE CARE IN TERMS OF BOTH QUALITY AND COST EFFECTIVENESS &AMILIES CONSISTENTLY REPORT THE QUALITY OF HOSPICE CARE TO BE EXCELLENT AND LAST YEAR PERCENT OF RESPONDENTS TO A (OSPICE OF THE 4WIN #ITIES &AMILY 3ATISFACTION 3UR VEY INDICATED THAT THEY WOULD RECOMMEND

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HOSPICE CARE TO OTHERS &ORTUNATELY THERE S A MOVEMENT AFOOT DRIVEN BY A HOPE FOR A BETTER DEATH 4HERE ARE DOCTORS NURSES SOCIAL WORKERS HOSPICE PROGRAMS AND PATIENTS THEMSELVES PUSHING TO CHANGE HOW WE CARE FOR THE DYING ! FORMER HOSPICE PATIENT SPOKE ELO QUENTLY TO THE IMMEASURABLE VALUE OF HOS PICE CARE AT THE END OF LIFE WHEN HE STATED h(OSPICE HAS TURNED AN ETERNAL SECRET INTO A LIVING PRINCIPLE WHAT IS TRULY IMPORTANT IS LIFE LIVED RICHLY DEEPLY MEANINGFULLY FOR AS LONG AS IT LASTS $IGNITY FAMILY COMFORT QUALITY AND CARING ARE HOSPICE AN IDEA WHOSE TIME HAS COME AND JUST IN TIME FOR ME v $R -ICHAEL "ELZER IS THE CHIEF MEDICAL OFlCER OF (ENNEPIN #OUNTY -EDICAL #ENTER (#-# AND SERVES AS THE MEDICAL DIRECTOR FOR (ENNEPIN #OUNTY S #OMMUNITY (EALTH $EPARTMENT (E IS A PRACTICING MEDICAL ONCOLOGIST WITH SUBSPECIALTY AND SPECIALTY BOARD CERTIlCATION IN MEDICAL ON COLOGY HEMATOLOGY AND INTERNAL MEDICINE $R "ELZER IS ALSO SERVING AS THE PRESIDENT OF THE (EN NEPIN -EDICAL 3OCIETY ,ISA !BICHT 3WENSEN - ( ! HAS SERVED AS EX ECUTIVE DIRECTOR OF (OSPICE OF THE 4WIN #ITIES SINCE -S !BICHT 3WENSEN S MORE THAN YEARS OF EXPERIENCE IN HEALTH CARE ADMINISTRATION SPANS THE LONG TERM CARE AND HOSPICE PROFESSIONS WHERE SHE HAS RESEARCHED AND IMPLEMENTED DIVERSIlED HEALTH PROGRAMS IN AN EFFORT TO EXPAND THE FULL CONTINUUM OF CARE OFFERED TO THE ELDERLY AND HOME BOUND -S !BICHT 3WENSEN IS PRESIDENT ELECT FOR (OSPICE -INNESOTA AND ALSO SITS ON THE "OARD OF $IRECTORS FOR #ARE 0ROVIDERS OF -INNESOTA Ì ÌiÃ® £Ê >Ì > Ê Ã« ViÊ > `Ê *> >Ì ÛiÊ >ÀiÊ "À}> â>Ì Ê ,iÃi>ÀV Ê i«>ÀÌ i Ì°Ê > Õ>ÀÞÊÓääÎ° ÓÊ L ` ÎÊ i iÀ> Ê VV Õ Ì }Ê "vwVi\Ê ÀiÊ i iwV >À iÃÊ 1ÃiÊ Ã« Vi]Ê 9iÌÊ > ÞÊ >VÌ ÀÃÊ ÌÀ LÕÌiÊ Ì Ê - ÀÌiÀÊ -Ì>ÞÃÊ "É - ää £nÓ®°Ê 7>Ã }Ì ]Ê

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%DITOR S .OTE !MOS 3 $EINARD - $ -0( RECEIVED HIS MEDICAL DEGREE FROM THE 5NIVERSITY OF -INNESOTA AND COMPLETED HIS RESIDENCY AND PEDIATRIC TRAINING AT THE 5NIVERSITY OF -INNESOTA (E IS AN ASSOCIATE PROFESSOR IN THE $EPT OF 0EDIATRICS AND 0ROGRAM IN -ATERNAL AND #HILD (EALTH 3CHOOL OF 0UBLIC (EALTH AT THE 5NIVERSITY OF -INNESOTA &ROM HE SERVED AS THE DIRECTOR OF THE #OMMUNITY 5NIVERSITY (EALTH #ARE #ENTER 6ARIETY #LUB #HILDREN S #LINIC 5NIVERSITY OF -INNESOTA $R $EINARD HAS BEEN THE RECIPIENT OF NUMEROUS AWARDS FOR HIS LEADER SHIP ROLE AND CONTRIBUTIONS TO COMMUNITY HEALTH AND MATERNAL AND CHILD HEALTH (E WAS MOST RECENTLY HONORED WITH RECEIVING THE *OSIE 2 *OHNSON (UMAN 2IGHTS AND 3OCIAL *USTICE !WARD AN AWARD THAT RECOGNIZES A 5NIVERSITY OF -INNESOTA FACULTY OR STAFF MEMBER WHO EXEMPLIlES $R *OSIE *OHNSON S STANDARD OF EXCELLENCE IN CREATING RESPECTFUL AND INCLUSIVE LIVING LEARNING AND WORKING ENVIRONMENTS

7HAT DO YOU CONSIDER YOUR GREATEST ACCOMPLISHMENT IN MEDICINE TO DATE

) BELIEVE THAT MY GREATEST ACCOMPLISHMENTS TO DATE AS A 5NIVERSITY FACULTY MEMBER HAVE BEEN PARTICIPATING IN ADDRESSING THE HEALTH NEEDS OF THE COMMUNITY FROM A 0UBLIC (EALTH PERSPECTIVE lRST AS THE PE DIATRIC CONSULTANT TO THE -INNEAPOLIS (EALTH $EPARTMENT S -ATERNAL AND #HILD (EALTH 0ROGRAM AND THEN AS EXECUTIVE DIRECTOR #OMMUNITY 5NIVERSITY (EALTH #ARE #ENTER 6ARIETY #HILDREN S #LINIC AND PARTICIPATING IN PUBLIC ENGAGEMENT WITH THE 0HILLIPS COMMUNITY ON TWO CLINICAL RESEARCH PROJECTS OVER THE PAST YEARS )N EACH CASE THE COMMUNITY ASKED FOR HELP AND IN EACH CASE MY 5NIVERSITY COLLEAGUES AND ) WERE ABLE AS CONSULTANTS TO ENGAGE THE COMMUNITY IN DISCUSSIONS IN WAYS THAT GAVE THE COMMUNITY CONTROL OF THE PROJECT WHILE HOLDING MY 5NIVERSITY COLLEAGUES AND ME ACCOUNTABLE FOR THE OUTCOMES )N EACH CASE THE COMMUNITY hOWNEDv THE PROJECT AND GAINED A SENSE OF ACCOMPLISHMENT FROM WORKING WITH ITS CONSULTANTS FROM THE INQUIRY STAGE THROUGH DEVELOPMENT AND IMPLEMENTATION /N BOTH OCCASIONS THE COMMUNITY WAS INITIALLY VERY OPPOSED TO THE 5NIVERSITY BECAUSE OF THE 5NIVERSITY S PRIOR INTERACTIONS OVER THE YEARS WITH THE COMMUNITY 4HESE INTERACTIONS WERE VIEWED BY THE COMMUNITY AS A CASE OF THE 5NI VERSITY WANTING SOMETHING FROM THE COMMUNITY WHILE GIVING NOTHING BACK AND PROCEEDING ON ITS TERMS WITH LITTLE OR NO ENGAGEMENT WITH THE COMMUNITY AND THEN DISAPPEARING UNTIL THE NEXT TIME OF WANT AROSE -ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃÊ

-Y COLLEAGUES AND ) HAVE HAD THE GOOD FORTUNE OF BEING ABLE TO WORK IN HARMONY WITH THE COMMUNITY ON BOTH PROJECTS 4HE lRST WHICH LASTED lVE YEARS WAS AN ATTEMPT TO USE CULTURE SPECIlC LEAD EDUCATION AS A WAY OF CONTROLLING BLOOD LEAD ELEVATIONS IN PRESCHOOL AGED CHILDREN FROM THE 0HILLIPS .EIGHBORHOOD 4HE PROJECT WAS SUPPORTED BY FEDERAL FUNDING FROM GRANTS #$# AND -#( WHICH THE COMMUNITY HELPED DEVELOP 4HE SECOND PROJECT BEGUN THREE YEARS AGO AND STILL IN PROGRESS INVOLVES ARRANGING DENTAL CARE FOR THE FAMILIES WHOSE CHILDREN ARE ENROLLED IN THE !NDERSEN 3CHOOLS AND EDUCATING THE PARENTS ABOUT CARIES ETIOLOGY AND PREVENTION

7HAT ARE THE CHALLENGES TO INTEGRATING THE COMMUNITY WITH ACADEMIC MEDICINE 4HE BIGGEST CHALLENGE ) BELIEVE IS TO RECOGNIZE THAT THE 5NIVERSITY IS GENERALLY VIEWED IN A HOSTILE FASHION BY THE COMMUNITY BECAUSE OF PRIOR RELATIONSHIPS SEE ABOVE RESPONSE AND TO WORK THROUGH THAT HOSTILITY AND SUSPICION BY BEING ABLE TO COMMUNICATE WITH THE COMMUNITY IN A PRODUCTIVE BI DIRECTIONAL WAY 4HE COMMUNITY IN WHICH ) HAVE WORKED SINCE ARTICULATED CLEARLY WHY IT VIEWED THE 5NIVERSITY AS IT DID SEE ABOVE RESPONSE 4HE CHALLENGE IS TO AFFECT A WORKING RELATIONSHIP WITH THE COMMUNITY THAT DOESN T TRIGGER THIS KIND OF RESENTMENT OF THE 5NIVERSITY (ENCE IT IS NECESSARY TO BE ABLE TO LISTEN TO BE ABLE TO LET THE COMMUNITY ARTICULATE WHAT IT WANTS AND WHAT IT DOESN T WANT TO BE ABLE TO ACKNOWLEDGE THAT THE COMMUNITY IS KNOWLEDGEABLE AND TO BE WILLING TO WORK PATIENTLY WITH THE COMMUNITY HOWEVER LONG IT MAY TAKE TO IRON OUT DIFFERENCES SO THAT ULTIMATELY THE COMMUNITY AND THE 5NIVERSITY CAN PROCEED WITH THE PROJECT WITHOUT CONmICT 4HERE ARE SOME FACULTY MEMBERS WHO SHOULD NOT BE IN THE COMMUNITY 4HERE ARE OTHER FACULTY MEMBERS WHO WOULD VERY MUCH LIKE TO BE IN THE COMMUNITY AND SHOULD BE THERE BUT MAY NOT KNOW HOW TO PROCEED 4HE 5NIVERSITY SHOULD MAKE AVAILABLE FACULTY CONSULTANTS WHO CAN WORK WITH ASPIRING FACULTY TO HELP THEM BECOME COMFORTABLE WORKING WITH THE COMMUNITY

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7HAT ADVICE WOULD YOU GIVE TO A MEDICAL STUDENT CON SIDERING PRIMARY CARE TO SERVE POOR PATIENT POPULATIONS TODAY -Y ADVICE WOULD BE TO DO IT WITHOUT QUESTION BUT TO GET AN -0( DEGREE IN EITHER -ATERNAL AND #HILD (EALTH OR %PIDEMIOLOGY TO GAIN ADDITIONAL TOOLS AND KNOWLEDGE THAT WILL FACILITATE SUCH A CAREER 3ERVICE COULD BE PROVIDED IN THE SETTING OF A PRIVATE PRACTICE WHICH IS WILLING TO SERVE THOSE COVERED BY PUBLIC PROGRAMS -EDICAID -.#ARE AND IS ABLE TO OFFER CARE ON A SLIDING FEE SCHEDULE FOR CHILDREN OF UNINSURED FAMILIES OR AT A COMMUNITY CLINIC )N EITHER CASE THE STUDENT SHOULD GET TO KNOW THE CITY COUNTY AND STATE HEALTH DEPARTMENT STAFF AND ARRANGE TO SPEND TIME WITH THEM *OBS WITH COMMUNITY CLINICS MAY NOT PAY AS MUCH AS MIGHT BE EARNED IN PRIVATE PRACTICE BUT THE REWARDS AT LEAST FROM MY PERSPECTIVE MORE THAN MAKE UP FOR LOST REVENUE

TO LEARN HOW TO INTERACT WITH A COMMUNITY TO FURTHER THE 5NIVERSITY COMMUNITY RELATIONSHIP 4HE GOAL IS FOR THE COMMUNITY TO FEEL OWNER SHIP OF THE PROJECT AND TO FEEL THAT IT IS AN EQUAL OF THE 5NIVERSITY 4HE 5NIVERSITY CAN BRING MUCH TO THE COMMUNITY #OMMUNITIES LIKEWISE CAN BRING MUCH TO THE 5NIVERSITY E G QUESTIONS WHICH STIMULATE THOUGHT ON THE PART OF 5NIVERSITY FACULTY LEADING TO THE DEVELOPMENT OF RESEARCH PROJECTS AND OR LEARNING OPPORTUNITIES FOR UNDERGRADUATE AND GRADUATE STUDENTS lELD PLACEMENT EXPERIENCES ETC "UT COMMUNICATION BETWEEN THE TWO PARTIES MUST BE BI DIRECTIONAL SENSITIVE AND THOUGHTFUL AND PATIENCE MUST BE EXERCISED ON BOTH SIDES

#AN YOU TELL US SOMETHING ABOUT YOUR VIEWS ON DENTAL HEALTH AND ITS IMPACT ON THE UNDERSERVED POPULATION AND PATIENTS WITH CHRONIC DISEASE

4HE 3URGEON 'ENERAL S REPORT OF CLEARLY DESCRIBED THE MORBIDITY FROM DENTAL PATHOLOGY THAT IS FOUND IN THE PERCENT OF THE POPULATION THAT HAS PERCENT OF THE DISEASE 4HE POPULATION SO AFFECTED IS MADE UP PRIMARILY OF CHILDREN WHO ARE COVERED UNDER PUBLIC PROGRAMS -EDICAID (OW CAN THE 5NIVERSITY BEST SERVE THE COMMUNITY IN OR 3#()0 IN -INNESOTA -.#ARE OR WHO ARE FROM FAMILIES THAT ARE WHICH IT OPERATES UNINSURED 4HE MORBIDITY ARISES IN THE FACE OF A RATHER SIGNIlCANT EXPOSURE 4HE 5NIVERSITY OPERATES IN MANY COMMUNITIES AND PROVIDES A DIVERSE TO mUORIDATED WATER OVER PERCENT OF WATER SUPPLIES ARE mUORIDATED ARRAY OF SERVICES 4HUS THERE S NO ONE FORMULA RELATIVE TO SERVICE THAT IN -INNESOTA 5NFORTUNATELY PUBLIC PROGRAM AND UNINSURED CHILDREN WOULD APPLY TO EVERY 5NIVERSITY COMMUNITY INTERACTION )T IS IMPORTANT HAVE DIFlCULTY GAINING ACCESS TO DENTAL CARE IN PART BECAUSE THERE ARE TO RECOGNIZE THE VALUE OF PUBLIC ENGAGEMENT AND FOR 5NIVERSITY FACULTY TOO FEW DENTISTS TO SEE THE CHILDREN AND IN PART BECAUSE SOME DENTISTS ARE UNWILLING TO SEE LARGE NUMBERS OF THOSE CHILDREN )N ADDITION THE COMMUNITY CLINICS THAT HAVE DENTAL FACILITIES AND A MISSION TO SERVE THOSE POPULATIONS ARE FULL WITH MORE MOUTHS TO CARE FOR THAN THEY HAVE RESOURCES TO PROVIDE THE CARE 4HE !MERICAN !CADEMY OF 0EDIATRICS WITH SUPPORT FROM THE !MERICAN !CADEMY OF 0EDIATRIC $ENTISTRY HAS RECENTLY ISSUED A POLICY STATEMENT THAT ARTICULATES THAT MEDICAL PROVIDERS OUGHT TO BEGIN TO DO A RISK ASSESSMENT OF ALL CHILDREN STARTING AT MONTHS OF AGE AND TO PROMOTE THE ESTABLISHMENT OF A DENTAL HOME FOR ALL CHILDREN BY AGE 4HUS AS PART OF PRIMARY PREVENTION THE MEDICAL COMMUNITY CAN PROMOTE SOUND ORAL HEALTH AND REDUCTION IN INCIDENCE OF DENTAL CAR IES BY CONDUCTING THE RISK ASSESSMENT EDUCATING PARENTS ABOUT DENTAL CARIES INCLUDING THE ROLES THAT MICROORGANISMS USUALLY PASSED FROM PRIMARY ! CARE PROVIDER TO CHILD AND CONTINUAL EXPOSURE TO FERMENTABLE CARBOHYDRATES PLAY IN THE DEVELOP MENT OF CARIES AND THE IMPORTANCE OF mUORIDE IN DRINKING WATER TOOTHPASTE AND VARNISH AS WAYS TO PREVENT CARIES )F THE DENTAL COMMUNITY DOESN T PROVIDE THESE SERVICES TO ALL CHILDREN THE PROMO TION OF PRIMARY PREVENTION OF DENTAL DISEASE MUST FALL TO PRIMARY CARE MEDICAL PROVIDERS AS PART OF WELL CHILD CARE &

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!4 ! 2%#%.4 )..%2 ,)&% OF (EALERS RETREAT AN INTERNIST NAMED $AN MOVED THROUGH THE WEEK END IN ALMOST COMPLETE SILENCE !S WE GATHERED TOGETHER FOR DISCUSSIONS OR MEALS HE REMAINED QUIET AND CONTAINED 7E WONDERED WHETHER THE WEEKEND WAS GOING ALL RIGHT FOR HIM !FTER OUR CLOSING ON 3UNDAY MORNING $AN CAME UP TO US (E WANTED TO SHARE AN APOLOGY FOR BEING SO QUIET BUT ALSO A GENUINE THANK YOU FOR HAVING THE TIME TO SLOW DOWN AND LISTEN TO HIS OWN THOUGHTS !S HE EXPLAINED IT HE CAME TO THE WEEKEND TO lNALIZE HIS DECISION ABOUT LEAV ING MEDICAL PRACTICE 4HE CRUSH OF AN INCREASING PATIENT LOAD THE CONSTANT COST PRESSURE AND THE MOUNTAINS OF PAPERWORK HAD GOTTEN TO HIM (E DECIDED HE HAD TO LEAVE /VER THE WEEKEND HOWEVER HE HAD A CHANCE TO REmECT ON HOW HE WAS FEELING ABOUT THIS DECISION (E REALIZED HOW MUCH HE STILL LOVED MEDICINE AND HOW PAINFUL IT WOULD BE TO LEAVE IT 7HILE HE WASN T SURE YET HOW IT WOULD HAPPEN HE KNEW THAT HE WANTED TO THINK DEEPLY ABOUT WAYS TO KEEP DOING WHAT HE LOVED IN A WAY THAT COULD BE SUSTAINED 4HESE DAYS HOW OFTEN ARE WE ENCOURAGED TO BE BETTER LISTENERS FOR OUR PATIENTS 7E ARE TOLD OF THE IMPACT LISTENING HAS ON OUR PATIENT S EXPERI ENCE AND HIS OR HER HEALTH OUTCOME "UT HOW OFTEN DO WE CONSIDER THE IMPACT OF LISTENING TO OURSELVES AND ATTENDING TO OUR OWN WELL BEING 4HE CAUTION GIVEN AT THE BEGINNING OF AN AIRPLANE mIGHT IS WORTHY OF CONSIDERATION !S THE mIGHT ATTENDANT RATTLES THROUGH THE FAMILIAR REMINDERS HE TUGS AT A PLASTIC AIR MASK h)N THE CASE OF LOSS OF CABIN PRESSURE AN AIR MASK WILL FALL FROM THE CEILING 0LEASE PLACE THE MASK OVER YOUR FACE AND BEGIN BREATHING BEFORE HELPING OTHERS TRAVELING WITH YOU v )F WE ARE NOT TENDING TO OUR OWN NEEDS AND LISTENING WITHIN HOW CAN WE SHOW 9Ê ,9Ê " -]Ê ° ° Ê 1, Ê ]Ê

UP FULLY FOR OUR PATIENTS (OW CAN WE SUSTAIN THE LIFE WE HAD HOPED FOR IN HEALING OTHERS 4HROUGH THE )NNER ,IFE OF (EALERS PROGRAM SPONSORED BY THE 5NIVERSITY OF -INNESOTA S #ENTER FOR 3PIRITUALITY AND (EALING PHYSICIANS NURSES AND OTHER HEALTH PROFESSIONALS ARE PROVIDED WITH AN OPPORTUNITY TO SLOW DOWN AND LISTEN 4HROUGH A SERIES OF WEEKEND RETREATS PARTICIPANTS LEARN TO TAP THE POWERFUL SKILLS OF PRESENCE DEEP LISTENING RESILIENCE COMPASSION HOPE AND JOY 4HE RETREAT SERIES WAS CREATED IN RESPONSE TO THE INCREASINGLY CHALLENGING HEALTH CARE ENVIRONMENT WE ALL lND OURSELVES IN -ORE AND MORE PHYSICIANS NURSES THERA PISTS AND OTHER HEALTH PROFESSIONALS ARE STANDING UP AND SAYING h(EY WAIT A MINUTE 4HIS ISN T WHAT ) WANTED ) FEEL DRAINED BY MY PATIENTS ) HAVE NOTHING LEFT TO GIVE TO MY FAMILY 4HE MONEY ISN T COMPENSATION ENOUGH FOR ALL THAT THIS TAKES OUT OF ME ) WANT TO GET OUT v (ERE WE ARE WITH FRONT ROW SEATS TO SOME OF LIFE S GREATEST DRAMAS AND THE JOY AND MEANING OF IT ELUDES US &REDERICK "UECHNER DESCRIBED VOCATION AS WHAT HAPPENS WHEN hYOUR DEEP GLADNESS MEETS THE WORLD S GREAT NEED v 7E BECOME HEALERS FOR MANY REASONS BUT THEY ARE LARGELY REASONS OF THE HEART )F YOU HAVE THE HEART OF A HEALER YOU KNOW HOW STRONG THE PULL IS TO SOMEHOW TAKE ALL OF ONE S INDIVIDUAL GIFTS AND ATTRIBUTES AND BECOME AN INSTRUMENT OF SERVICE IN THE WORLD OF SUFFER ING (OW TROUBLING THEN TO GO THROUGH ALL THE YEARS OF TRAINING PREPARATION AND ESTABLISHING A CAREER ONLY TO lND OUT THAT THIS ISN T SO 7E ASK (OW COULD THIS HAVE HAPPENED (OW COULD WE HAVE GONE SO WRONG (OW DID WE LOSE OUR WAY 4HE USUAL EXPLANATIONS SEEM TO POINT TO SOMETHING EXTERNAL (EALTH CARE HAS BECOME A BUSINESS FOCUSED ON PRODUCTIVITY RATHER THAN HEAL ING 7E HAVE BECOME COGS IN A MACHINE 4HE STRESS OF HAVING PEOPLES LIVES IN OUR HANDS AND THE INTOLERANCE OF ERRORS ON OUR PART HAVE BECOME TOO MUCH TO BEAR 7E ARE BONE WEARY FROM THE

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HOUR DAYS AND THE NIGHTS AND WEEKENDS ON CALL %ACH OF US CAN CONTINUE THE LIST WITH OUR OWN PRESSING CONCERNS "UT THOSE WHO UNDERSTAND STRESS REALIZE THAT A COMPONENT THAT IS AT LEAST AS IMPORTANT AS THE EXTERNAL ISSUES IS WHAT IS GOING ON WITHIN IN THE REALM OF THE hINNER LIFE v )N ORDER TO DEAL SUC CESSFULLY WITH THE CHALLENGES WE FACE WE NEED TO BECOME RESILIENT AGAIN 7E MUST REDISCOVER WHAT GIVES US JOY AND MEANING AND HOPE THAT SOME OF IT IS IN THE ARENA OF WORK 7E NEED TO CREATE THE TIME AND SKILLS FOR REmECTION 7E MUST LEARN TO LISTEN DEEPLY AND AUTHENTICALLY WHERE WE HEAR MORE WITH THE HEART THAN WITH THE MIND 5NDERTAKING THIS JOURNEY OF THE HEART ALONE CAN BE OVERWHELMING 7E OFTEN HEAR FROM PHYSI CIANS HOW ALONE THEY ALREADY FEEL IN THEIR WORK /NE OF THE GREAT GIFTS OF THE )NNER ,IFE OF (EALERS PROGRAM IS THAT THIS INNER WORK DOESN T HAVE TO BE DONE IN ISOLATION 7E ARE GREATLY HELPED BY GOOD FRIENDS WHICH IS WHAT THE RETREAT COHORT BECOMES !IDED BY THE BEAUTY AND RHYTHMS OF NATURE PARTICIPANTS MEET QUARTERLY FOR lVE WEEKENDS OVER THE COURSE OF A YEAR AND A HALF TO ADDRESS SEASONAL THEMES PERTAINING TO THE INNER LIFE 4HERE IS A mOW BETWEEN BRIEF PRESENTATIONS EXPERIENTIAL EXERCISES REmECTING ON POEMS OR STORIES WRIT ING SMALL AND LARGE GROUP DISCUSSIONS SILENCE AND PERSONAL TIME %ARLY IN OUR TIME TOGETHER WE FOCUS ON THE PRACTICE OF DEEP LISTENING .EARLY EVERYONE lNDS THIS TO BE A RICH AND SURPRISING EXPERIENCE -ANY THINK THEY ARE GOOD LISTENERS BUT DISCOVER HOW OFTEN THEY ARE ONLY PARTIALLY LISTENING 7E ARE TRAINED TO ASK CERTAIN QUESTIONS AND TO BE ALWAYS THINKING OF POTENTIAL PROBLEMS AND SOLUTIONS 7HILE WE MAY BE PUTTING A LOT OF ENERGY FOCUS ING ON THE PERSON IN FRONT OF US THIS IS HARDLY THE SAME THING AS LISTENING #ONTINUED ON PAGE

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0ARTICIPANTS lND IT DELIGHTFUL AND SURPRIS INGLY HARD TO REALLY LISTEN TO SOMEONE WITHOUT DISTRACTION WITHOUT THINKING ABOUT THE NEXT QUESTION OR WHAT THEY WILL SAY WHEN IT IS THEIR TURN 4HEY ALSO NOTICE HOW MUCH THEY LISTEN WHILE EVALUATING OR JUDGING WHAT THE OTHER PERSON IS SAYING )N DEEP LISTENING THEY ARE ASKED TO SIMPLY RECEIVE WHAT THE OTHER IS SAYING FULLY ATTENTIVE ACCEPTING AND OPEN HEARING IT NOT JUST WITH THE EARS OR THE MIND BUT WITH THE WHOLE OF ONE S BE ING /NCE THEY TRULY EXPERIENCE THIS THEY REALIZE WHAT A RARE AND PRECIOUS THING IT IS TO BE HEARD IN THIS WAY 4O SHARE SOMETHING PERSONAL A SURPRISE A CELEBRATION OR A CHALLENGE TO A GROUP THAT IS LISTENING IN THIS WAY CAN BE QUITE A REVELATION AND A HEALING MOMENT AS WELL 7E BELIEVE THAT EVERY HEALTH PROFESSIONAL AT EVERY STAGE OF THEIR CAREER HAS AN INNER LIFE WORTHY OF ATTENTION 4HE SOUL IS LONGING TO BE HEARD BUT IT SPEAKS SOFTLY AND IS DROWNED OUT BY THE DIN AND FRAY OF OUR TYPICAL LIVES "Y GIVING PARTICIPANTS AN OPPORTUNITY TO SLOW DOWN THEY CAN LISTEN AND LEARN FROM THE INNER TEACHER 7HILE THIS IS A SOLITARY JOURNEY IN SOME WAYS WHEN IT IS DONE IN GROUPS WHERE PEOPLE FEEL SAFE ENOUGH TO SPEAK FROM THE HEART THIS WORK TAKES ON ADDED POWER 7E EXPERIENCE OUR INNER SELVES MORE DEEPLY AND ENHANCE OUR CAPACITY FOR COMMUNITY 7HATEVER THE CIRCUMSTANCES IN WHICH WE lND OURSELVES WE BELIEVE THAT IT IS POSSIBLE TO TAKE HEART TO RECLAIM OUR OWN WHOLENESS AND TO RENEW OUR PASSION FOR HEALING 4HE EFFECTIVENESS OF THE HEALTH CARE SYSTEM DEPENDS ULTIMATELY UPON THE QUALITY OF THE HUMAN ENCOUNTER WHEN CAREGIVER MEETS PATIENT 7E NEED TO REDISCOVER AND NOURISH THAT WHICH IS MOST LIFE GIVING FOR EACH OF US 4HEN WHEN WE STAND UP IN THE MIDST OF OUR CAREERS WE CAN SAY WITH A LOOK OF DEEP CONTENTMENT h! LIFE LIVED IN SERVICE WHO WOULD NOT WANT THAT v (ENRY %MMONS - $ AND ,AURA +INKEAD ARE HEALTH CARE CONSULTANTS AND FACULTY MEMBERS OF 4HE )NNER ,IFE OF (EALERS A PROGRAM OF THE 5NIVERSITY OF -INNESOTA #ENTER FOR 3PIRITUALITY AND (EALING AT THE !CADEMIC (EALTH #ENTER &OR MORE INFORMATION ABOUT UPCOMING 7EEKEND 2ETREATS CALL OR VISIT WWW CSH UMN EDU 0ROGRAMS

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%DITOR S .OTE !N ONGOING SECTION IS BEING ADDED TO -ETRO$OCTORS WHICH IS ENVISIONED TO OFFER A BASIC UPDATE ON VARIOUS SPECIALTIES SPECIlCALLY WHAT WOULD A PRACTICING PHYSICIAN NEED TO KNOW ABOUT A GIVEN SPECIALTY ,ET US KNOW YOUR THOUGHTS ABOUT THIS NEW SECTION

4(% $%6%,/0-%.4 !.$ IMPLEMENTATION OF NEW TECHNOLOGY IN PATIENT CARE HAS BEEN ONE OF THE MOST EXCITING ASPECTS OF MEDICINE 4HE PACE OF INNOVATION SEEMS TO CONTINUE TO ACCELERATE IN ALL lELDS 4HIS HAS BEEN ESPECIALLY TRUE FOR OPHTHAL MOLOGY )N THIS BRIEF ARTICLE ) WILL DESCRIBE SOME OF THESE NEW TECHNOLOGIES AND THE NEW TREATMENT OPTIONS THEY PROVIDE ) WILL FOCUS ON CATARACT AND REFRACTIVE SURGERY MACULAR DEGENERATION AND GLAU COMA AS THEY MAY BE MORE RELEVANT TO PHYSICIANS OUTSIDE OF OPHTHALMOLOGY ,ivÀ>VÌ ÛiÊ-ÕÀ}iÀÞ "Y NOW MANY OF US KNOW OF SOMEONE WHO HAS HAD REFRACTIVE SURGERY 4HE MOST POPULAR TECHNIQUES UTILIZE THE EXCIMER LASER TO RESHAPE THE ANTERIOR CORNEAL SURFACE 7ITH ,!3)+ LASER IN SITU KERATOMILIEUSIS THE REMOVAL OF TISSUE IS PERFORMED UNDERNEATH A PROTECTIVE CORNEAL mAP 02+ PHOTOREFRACTIVE KERATECTOMY REMOVES TISSUE DIRECTLY FROM THE FRONT SURFACE OF THE COR NEA "ECAUSE THE EPITHELIAL CELLS ARE REMOVED TO PERFORM 02+ PATIENTS EXPERIENCE CORNEAL ABRA SION LIKE SYMPTOMS FOR THE lRST THREE n lVE DAYS 5LTIMATELY HOWEVER THE VISUAL RESULTS BETWEEN THE TWO TECHNIQUES ARE SIMILAR 02+ IS UTILIZED FOR PATIENTS WITH THINNER CORNEAL TISSUE PREVIOUS CORNEAL SCARRING OR RECURRENT EROSION SYNDROME "OTH 02+ AND ,!3)+ HAVE BEEN APPROVED TO TREAT MYOPIA HYPEROPIA AND ASTIGMATISM 4HE TRENDS IN REFRACTIVE SURGERY HAVE BEEN TOWARD IMPROVING QUALITY OF VISION 4HE NEWEST DEVELOPMENT IN EXCIMER LASER SURGERY HAS BEEN

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THE APPROVAL OF WAVEFRONT MEASUREMENT DEVICES 4HESE SYSTEMS BASED ON TECHNOLOGY USED IN THE (UBBLE TELESCOPE MEASURE THE OPTICAL ABERRA TIONS OF THE ENTIRE OPTICAL SYSTEM OF THE EYE 4HIS INFORMATION IS THEN TRANSFERRED DIRECTLY TO THE LASER TO GUIDE AN INDIVIDUALIZED TREATMENT FOR EACH PATIENT S EYE 4HE IMPROVED ACCURACY OF MEASUREMENT AND INDIVIDUALIZED TREATMENT PAT TERN REPRESENT THE NEXT EVOLUTION IN IMPROVING QUALITY OF VISION FOR PATIENTS &OR PATIENTS OUTSIDE THE RANGES OF 02+ AND ,!3)+ IMPLANTABLE CONTACT LENSES OR PHAKIC )/,S ARE NEARING &$! APPROVAL 4HESE MINIATURE LENSES ARE APPROVED IN %UROPE AND ARE IMPLANTED INSIDE THE EYE WITHOUT REMOVING THE NATURAL LENS FROM THE EYE 4HE BENElTS OF THESE IMPLANTS ARE THE POTENTIAL FOR IMPROVED QUALITY OF VISION IN PATIENTS WITH EXTREME DEGREES OF NEARSIGHTEDNESS AND THINNER CORNEAS #URRENTLY THERE ARE NO TECHNIQUES APPROVED FOR TREATING PRESBYOPIA OR THE NEED FOR READING GLASSES -ANY IDEAS ARE BEING RESEARCHED AS THIS REPRESENTS THE NEXT FRONTIER FOR REFRACTIVE SUR GEONS

>Ì>À>VÌÊ-ÕÀ}iÀÞ 3URGICAL TECHNIQUES HAVE GREATLY EVOLVED OVER THE LAST DECADE 0HACOEMULSIlCATION USING AN ULTRASONIC HAND PIECE TO DISRUPT THE CATARACT BEFORE ASPIRATING IT FROM THE EYE IS THE MOST COMMON TECHNIQUE USED FOR REMOVING CATARACTS

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TODAY 4HE MOST EXCITING DEVELOPMENTS ARE OC CURRING IN THE INTRAOCULAR LENS IMPLANTS USED TO REPLACE THE NATURAL LENS THAT IS REMOVED FROM THE EYE 4HE 4ECNIS )/, 0lZER IS A NEW IMPLANT THAT WAS DESIGNED UTILIZING WAVEFRONT TECHNOL OGY AND HAS BEEN SHOWN TO IMPROVE PATIENTS CONTRAST SENSITIVITY /NE OF THE COMMON AFTER EFFECTS OF IMPLANT SURGERY IS THE LOSS OF NEAR VISION 4HIS IS BECAUSE THE MOST COMMONLY USED IMPLANTS TODAY ARE MONOFOCAL 4HEREFORE ONLY ONE FOCAL POINT CAN BE CHOSEN FOR THE PATIENT AND THIS IS USUALLY DIS TANCE 4HE ONLY OPTION AVAILABLE TO PATIENTS CUR RENTLY IS A -ULTIFOCAL IMPLANT SIMILAR TO A BIFOCAL CONTACT LENS CALLED THE !RRAY LENS !-/ 4HIS LENS PROVIDES EXCELLENT FUNCTIONAL RANGE OF FOCUS BUT NOT ALL PATIENTS CAN ADAPT TO THE NEW OPTICS OF THE SYSTEM (OWEVER THERE ARE SEVERAL )/,S THAT ARE NEARING &$! APPROVAL THAT ARE DESIGNED TO NOT ONLY PROVIDE DISTANCE ACUITY BUT ALSO READ ING VISION AFTER IMPLANT SURGERY 4HE #RYSTALENS HAS HINGES THAT ALLOW THE LENS TO mEX INSIDE THE EYE TO PROVIDE SOME DEGREE OF PSEUDOACCOMODA TION /THERS ARE USING DIFFRACTIVE OPTICS TO PROVIDE RANGE OF FOCUS 4HESE ARE EXCITING TECHNOLOGIES BECAUSE IF THEY WORK FOR CATARACT PATIENTS THEY MAY BE USEFUL AS A REFRACTIVE SURGICAL MODALITY >VÕ >ÀÊ i}i iÀ>Ì 4HE GROWTH OF ABNORMAL VESSELS IN THE MACULAR AREA OF THE RETINA DUE TO CHANGES IN THE RETINAL PIGMENT EPITHELIAL LAYER ARE WHAT LEAD TO THE SE VERE LOSS OF CENTRAL VISION IN MACULAR DEGENERA TION 0ATIENTS HAVE A LARGE CENTRAL SCOTOMA BUT STILL RETAIN VARYING DEGREES OF PERIPHERAL VISION WHICH ALLOWS MANY TO AMBULATE BUT HAVE DIFlCULTY READ ING SEWING AND WATCHING 46 0HOTODYNAMIC THERAPY HAS BEEN ONE OF THE RECENT LASER SURGICAL ADVANCEMENTS TO TREAT THESE ABNORMAL BLOOD VES SELS &IRST A PHOTOSENSITIVE MOLECULE IS INJECTED INTO THE BLOODSTREAM OF PATIENTS 4HIS MOLECULE #ONTINUED ON PAGE

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COLLECTS IN THE AREA OF ABNORMAL VASCULATURE AND THEN A LASER WITH A SPECIlC WAVELENGTH COAGULATES JUST THE VESSELS WITH THE DYE SPARING HEALTHY TIS SUE 5NTIL THIS TARGETED THERAPY ALL CELLS IN THE AREA OF PHOTOCOAGULATION WERE DESTROYED INCLUDING VISUAL RECEPTORS 4HIS TYPE OF TREATMENT HAS BEEN SHOWN TO REDUCE DAMAGE TO SURROUNDING TISSUES AND SLOW VISUAL LOSS >ÕV > !DVANCEMENTS IN THE TREATMENT OF GLAUCOMA HAVE INCLUDED THE DEVELOPMENT OF NEW TOPICAL THERAPEUTIC AGENTS WITH GREATER EFlCACY AND LESS TOXICITY THAN THEIR PREDECESSORS !NTIPROSTAGLAN DINS SUCH AS 8ALATAN ,UMIGAN AND 4RAVATAN HAVE ALL BEEN RECENTLY INTRODUCED !N ALPHA AGONIST !LPHAGAN IS A POPULAR lRST LINE THERAPEUTIC AGENT IN THE TREATMENT OF GLAUCOMA DUE TO ITS HIGH SAFETY PROlLE ESPECIALLY IN PATIENTS WITH HEART DISEASE OR ASTHMA 3URGICAL TREATMENTS INCLUDE NEW LASER TECHNOLOGIES LIKE 3,4 WHICH SELECTIVELY TARGETS THE TRABECULAR MESHWORK CELLS TO IMPROVE THE DRAINAGE OF mUID FROM THE EYE THUS IMPROVING INTRAOCULAR PRESSURE WHILE MINIMIZING DAMAGE TO THE SURROUNDING OCULAR TISSUES .ONPENETRATING GLAUCOMA SURGERY IS GAINING POPULARITY BECAUSE OF ITS IMPROVED PATIENT SAFETY 7ITH THIS TECH NIQUE PATIENTS WITH MORE ADVANCED OR DIFlCULT TO CONTROL GLAUCOMA UNDERGO A DRAINAGE PROCEDURE WITHOUT COMPLETELY ENTERING THE EYE 4HIS ALLOWS FOR INTRAOCULAR PRESSURE CONTROL WHILE MINIMIZING THE RISKS OF PENETRATING INTRAOCULAR SURGERY

V ÕÃ !S WITH ALL lELDS OF MEDICINE THE DEVELOPMENT OF NEW TECHNOLOGIES AND METHODS OF IMPROVING PATIENT CARE KEEP THE lELD EXCITING 4HE PACE OF CHANGE HAS ONLY INCREASED AND KEEPING UP WITH CURRENT TRENDS IS DIFlCULT NOT ONLY IN ONE S SPECIALTY BUT ESPECIALLY ACROSS THE SPECTRUM OF MEDICINE !S MEDICINE CONTINUES TO BECOME MORE SPECIALIZED IT SEEMS HARDER TO ANSWER THE MANY QUESTIONS WE ARE CONFRONTED WITH OUTSIDE OF OUR AREAS OF EXPERTISE ) HOPE THIS ARTICLE HAS PROVIDED A CROSS SECTIONAL GLIMPSE INTO THE CUR RENT STATE OF EYECARE AND GIVEN YOU SOME USEFUL PRACTICAL INFORMATION THAT WILL BE HELPFUL TO YOU IN YOUR PRACTICE & 9 2ALPH #HU - $ IS A CLINICAL ASSISTANT PROFESSOR OF OPHTHALMOLOGY AT THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL AND IS MEDICAL DIRECTOR #HU ,ASER %YE )NSTITUTE 0 !

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-EMBERS AND $ELEGATES OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES SUBMITTED RESOLUTIONS TO THE -INNESOTA -EDICAL !SSO CIATION (OUSE OF $ELEGATES FOR CONSIDERATION AT THE !NNUAL -EETING IN 3EPTEMBER 4HESE RESOLUTIONS COVERED A NUMBER OF ISSUES IMPORTANT TO PRACTICING PHYSICIANS !CTION TAKEN BY THE --! (OUSE OF $ELEGATES IS LISTED BELOW ,iÃ ÕÌ ÊÓä{\Ê*À « ÃiÊ*À Ì }Ê

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3UBMITTED BY +ARIN - 4ANSEK - $ 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION ADOPT A POLICY THAT WOULD SUPPORT THE CREATION OF A CODE FOR LEGEND AND OVER THE COUNTER MEDICATIONS THAT WOULD INDICATE COMPOUND AND STRENGTH AND BE PRINTED ON EACH TABLET AND CAPSULE AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION DELEGATES TO THE !MERICAN -EDICAL !SSOCIATION !-! SUBMIT A RESOLUTION TO THE !-! ENDORSING &EDERAL LEGISLATION TO ENACT THIS POLICY ,iÃ ÕÌ ÃÊÓänÊ> `ÊÓ£È\Ê * ÞÃ V > Ê «ÕÌÊ> `Ê i>`iÀÃ «Ê Ê * >À >ViÕÌ V> Ê i iwÌÃÊ > >}i i ÌÊ* VÞ

3UBMITTED BY ,EE ( "EECHER - $ (ENNEPIN -EDICAL 3OCIETY AND 2OBERT 'EIST - $ 2AMSEY -EDICAL 3OCIETY 3UBSTITUTE 2ESOLUTION WAS ADOPTED 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION /PPOSE MANDATING THE USE OF hFAIL lRSTv AND STEP THERAPIES FOR PHARMACEUTICALS BASED ON ACQUISITION COSTS RATHER THAN THERAPEUTIC EF lCACY

3UPPORT -INNESOTA STATE GOVERNMENT INITIATIVES TO JOIN COALITIONS WITH OTHER STATE GOVERNMENTS TO NEGOTIATE FAVORABLE PHARMACEUTICAL PRICES FOR PRODUCTS ON THE -INNESOTA -EDICAL !SSISTANCE FORMULARY 2ECOMMEND THAT THE MEMBERSHIP OF ALL -INNESOTA HEALTH PLANS PHARMACEUTICAL BENEFITS MANAGERS STATE PHARMACY AND THERAPEUTICS COMMITTEES AND STATE DRUG UTILIZATION BOARDS CONSIST OF A MAJORITY OF PHYSICIANS WHO ARE PRIMARILY INVOLVED IN THE PROVISION OF PATIENT CARE AND BE IT FURTHER 2%3/,6%$ THAT THE TITLE OF 3UBSTITUTE 2ESO LUTION SHALL BE 0HARMACEUTICAL "ENElTS -ANAGER 0OLICY ,iÃ ÕÌ ÊÓ£x\Ê,i Û> Ê vÊ }ÀiÃÃ > Ê,iÃÌÀ VÌ ÃÊ Ê+Õ> wi`Ê `i ÌÞÊ i> Ì Ê ÃÕÀ> ViÊ*À `ÕVÌÃ

3UBMITTED BY 2OBERT 'EIST - $ 2AMSEY -EDICAL 3OCIETY 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION CONTACT THE -INNESOTA #ONGRESSIONAL DELEGATION URGING THEM TO SUPPORT LEGISLATION THAT IS CONSISTENT WITH --! AND !-! POLICY RELATED TO MEDICAL SAVINGS ACCOUNTS AND THE TAX DEDUCTIBILITY OF INDIVIDUAL HEALTH INSURANCE PREMIUMS ,iÃ ÕÌ ÊÎäx\Ê-Õ«« ÀÌÊ i ÌiÀÃÊ v ÀÊ i` V>ÀiÊ> `Ê i` V> `Ê-iÀÛ ViÃÊ -®Ê i ÃÌÀ>Ì Ê*À iVÌ

3UBMITTED BY "ENJAMIN 7 #HASKA - $ 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION DELEGATION TO THE !MERICAN -EDICAL !SSOCIATION !-! CARRY A RESOLUTION TO THE !-! THAT DIRECTS THE !-! TO LOBBY FOR AND SUPPORT DEMONSTRATION PROJECTS FUNDED BY THE FEDERAL GOVERNMENT THROUGH THE #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES #-3 TO

-ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃÊ

REDUCE THE COST OF -EDICARE BY IMPROVING THE APPROPRIATENESS AND QUALITY OF CARE PROVIDED ,iÃ ÕÌ ÊÎä \Ê- }Ê > Ê ÞÊ iÃ Ì>Ê Õ Ì iÃ

3UBMITTED BY #OUNCIL ON #OMMUNITY (EALTH 2AMSEY -EDICAL 3OCIETY 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION --! STRONGLY RECOMMEND -INNE SOTA COUNTIES ELIMINATE SECONDHAND SMOKE ON OR IN ALL COUNTY PROPERTY INCLUDING BUILDINGS JAILS VEHICLES AND LAND AND BE IT FURTHER 2%3/,6%$ THAT THE --! URGE THE !SSOCIA TION OF -INNESOTA #OUNTIES !-# TO PROVIDE SUPPORT FOR MEMBERS IN DRAFTING AND INTRODUC ING ORDINANCES TO ELIMINATE SECONDHAND SMOKE ON COUNTY PROPERTY AND THAT THE COUNTIES WITH SMOKING RESTRICTIONS OR BANS BE COMMENDED BY THE !-# AND BE IT FURTHER 2%3/,6%$ THAT THE --! URGE THAT COUNTY EMPLOYEES WHO USE TOBACCO RECEIVE SMOKING CESSATION INFORMATION AND FOR THOSE WHO DE SIRE REFERRAL TO SMOKING CESSATION SERVICES IN CONJUNCTION WITH THEIR INSURANCE PROVIDERS AND OTHER ORGANIZATIONS AND BE IT FURTHER 2%3/,6%$ THAT THE --! URGE COUNTIES TO PURCHASE HEALTH INSURANCE COVERAGE THAT COVERS SMOKING CESSATION PROGRAMS AND BE IT FURTHER 2%3/,6%$ THAT THE --! CONVEY THESE POLICIES TO ALL ELECTED COUNTY COMMISSIONERS IN -INNESOTA

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--! (OUSE OF $ELEGATES #ONTINUED FROM PAGE ,iÃ ÕÌ ÃÊÎ££Ê> `ÊÎ£Ó\Ê « `i VÊ vÊ"LiÃ ÌÞ

3UBMITTED BY -ICHAEL 'ONZALEZ #AMPOY - $ 0H $ 2AMSEY -EDICAL 3OCIETY 3UBSTITUTE 2ESOLUTION ADOPTED IN LIEU OF 2ESOLUTIONS AND 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION --! SUPPORT THE $IABETES #ARE 0ROGRAM OF THE -INNESOTA $EPARTMENT OF (EALTH -$( IN ITS EFFORTS TO PREVENT DIABETES AND OBESITY INCLUDING DISPARITIES IN DIABETES THAT AFFECT MINORITY GROUPS AND BE IT FURTHER 2%3/,6%$ THAT THE --! ENDORSE THE GOALS OF THE -INORITY !FFAIRS #ONSORTIUM OF THE !MERICAN -EDICAL !SSOCIATION TO ADDRESS DISCREPANCIES IN OBESITY DYSMETABOLIC SYN DROME AND DIABETES AND BE IT FURTHER 2%3/,6%$ THAT THE TITLE OF 3UBSTITUTE 2ESO LUTION SHALL BE %PIDEMIC OF /BESITY ,iÃ ÕÌ ÊÎ£Î\Ê i> Ì Ê* > Ê ÛiÀ >}iÊv ÀÊÌ iÊ/Ài>Ì i ÌÊ vÊ"LiÃ ÌÞ

3UBMITTED BY -ICHAEL 'ONZALEZ #AMPOY - $ 0H $ 2AMSEY -EDICAL 3OCIETY

2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION --! CONTINUE ITS ONGOING DIALOGUE WITH THE -INNESOTA #OUNCIL OF (EALTH 0LANS TO ENCOURAGE FULL COVERAGE FOR EVIDENCE BASED OBESITY CARE IN -INNESOTA INCLUDING ANCILLARY SERVICES ,iÃ ÕÌ ÊÎ£{\Ê Ê/>Ã Ê ÀViÊv ÀÊ -ÌÕ`Þ }ÊÌ iÊ >Ã VÊ ÌiÀ >Ì ÛiÊ*À « Ã> ÃÊv ÀÊ « i i Ì }Ê1 ÛiÀÃ> Ê i> Ì Ê ÃÕÀ> ViÊ1 ®

3UBMITTED BY 2OBERT 'EIST - $ 2AMSEY -EDICAL 3OCIETY 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION --! ANALYZE THE BASIC PROPOS ALS BEING MADE FOR UNIVERSAL HEALTH INSURANCE AND REPORT BACK TO THE --! (OUSE OF $ELEGATES ,iÃ ÕÌ ÃÊ{ä{Ê> `Ê{äÇ\Ê-Ì> `>À`Ê « Þ i ÌÊ }Àii i ÌÃ

3UBMITTED BY *OHN 0 7UST ))) - $ (ENNEPIN -EDICAL 3OCIETY AND 2OBERT 'EIST - $ 2AMSEY -EDICAL 3OCIETY 3UBSTITUTE 2ESOLUTION WAS ADOPTED IN LIEU OF 2ESOLUTIONS AND 2%3/,6%$ THAT THE -INNESOTA -EDICAL

4HE --! "OARD OF 4RUSTEES ADOPTED THE FOLLOWING NEW MISSION AND STATEMENT OF PURPOSE AND VALUES AT THE !NNUAL -EETING

4HE --! WILL USE h0HYSICIANS 7ORKING FOR A (EALTHY -INNESOTAv TO EXPLAIN ITS CORE PURPOSE TO THE GENERAL PUBLIC 4HE --! S -ISSION IS TO s 0ROMOTE EXCELLENCE IN HEALTH CARE

s %NSURE A HEALTHY PRACTICE ENVIRONMENT AND s 0RESERVE THE PROFESSIONALISM OF MEDICINE THROUGH ADVOCACY EDUCATION INFORMATION AND LEADERSHIP 4HE --! S VALUES ARE s )NTEGRITY 7E WILL BE HONEST AND RELIABLE s )NCLUSIVENESS 7E WILL SEEK TO INCLUDE ALL PHYSICIANS IN THE STATE OF -INNESOTA s 0ROFESSIONALISM 7E WILL SUPPORT PHYSICIANS ABILITY TO MAKE MEDICAL DECISIONS PRE SERVE THE PHYSICIAN PATIENT RELATIONSHIP UPHOLD THE ETHICS OF THE MEDICAL PROFESSION AND PLACE THE WELFARE OF THE PROFESSION ABOVE THE WELFARE OF THE INDIVIDUAL PHYSICIAN s 3ERVICES 7E WILL RESPOND QUICKLY TO MEMBERS NEEDS AND REQUESTS SERVE AS A SOURCE OF CREDIBLE INFORMATION AND PROVIDE VALUE TO PHYSICIANS AND OUR COMMUNITIES

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!SSOCIATION DEVELOP A -INNESOTA SPECIFIC MODEL EMPLOYMENT AGREEMENT BASED UPON THE !-! S MODEL EMPLOYMENT AGREEMENT AND BE IT FURTHER 2%3/,6%$ THAT THE --! DISSEMINATE THE MODEL EMPLOYMENT AGREEMENT TO ALL --! MEMBERS AND ENCOURAGE ALL -INNESOTA OR GANIZATIONS THAT EMPLOY PHYSICIANS TO USE THE MODEL AGREEMENT AND BE IT FURTHER 2%3/,6%$ THAT THE TITLE OF 3UBSTITUTE 2ESOLUTION SHALL BE -ODEL %MPLOYMENT !GREEMENTS ,iÃ ÕÌ ÃÊ{äxÊ> `Ê{£Ó\Ê v ÀViÊ iÃ Ì>Ê >ÜÊ,iµÕ À }Ê*>Ì i ÌÊ

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3UBMITTED BY ,EE ( "EECHER - $ (ENNEPIN -EDICAL 3OCIETY AND 2OBERT 'EIST - $ 2AMSEY -EDICAL 3OCIETY 3UBSTITUTE 2ESOLUTION WAS ADOPTED IN LIEU OF 2ESOLUTIONS AND 2%3/,6%$ THAT THE --! AFlRM EXISTING --! POLICY 0ATIENT #ONSENT TO 2E LEASE -EDICAL 2ECORDS WHICH STATES 0ATIENT #ONSENT TO 2ELEASE -EDI CAL 2ECORDS 4HE -INNESOTA -EDICAL !SSOCIATION WILL NOTIFY AND EDUCATE ITS MEMBERS REGARDING THE PROVISIONS OF -INNESOTA 3TATUTES 3EC SUBDIVISION A REQUIRING PATIENT CONSENT TO RELEASE MEDICAL RECORDS TO AN INSURER HEALTH PLAN (-/ OR THIRD PARTY ADMINISTRATOR 4HE --! SUPPORTS AS POLICY AND WILL AD VOCATE FOR INCLUSION IN HEALTH PLAN CONTRACTS THE FOLLOWING LANGUAGE IN THE !-! --! -ODEL #ONTRACT 3ECTION L #ONlDENTIAL -EDICAL 2ECORDS !LL MEDI CAL RECORDS OF ENROLLEES SHALL BE MAINTAINED AS CONlDENTIAL IN ACCORDANCE WITH APPLICABLE STATE AND FEDERAL LAWS !LL MEDICAL RECORDS SHALL BELONG TO -EDICAL 3ERVICES %NTITY S 1UALIlED 0HYSICIANS CONSISTENT WITH THE DIC TATES OF MEDICAL ETHICS 4HE RELEASE DISCLOSURE REMOVAL OR TRANSFER OF SUCH RECORDS SHALL BE GOVERNED BY STATE AND FEDERAL LAW AND BY THE -EDICAL 3ERVICES %NTITY S ESTABLISHED POLICIES AND PROCEDURES 0RIOR TO THE RELEASE OF COPIES OF ANY MEDICAL RECORDS TO #OMPANY OR OTHER THIRD PARTIES #OMPANY SHALL OBTAIN FROM THE SUBJECT %NROLLEE OR THE %NROLLEE S LEGAL REP RESENTATIVE AND PRESENT TO -EDICAL 3ERVICES

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%NTITY AN EFFECTIVE WRITTEN CONSENT OR RELEASE THAT SATISlES ETHICAL CONSTRAINTS AND APPLICABLE LAWS AND IS NARROWLY TAILORED TO ACCOMPLISH THE SOLE PURPOSE OF SUCH RELEASE WHICH THE PARTIES AGREE IS TO DETERMINE WHETHER CARE WAS PROPERLY AND EFlCIENTLY RENDERED "4 AND BE IT FURTHER 2%3/,6%$ THAT THE --! CALL ON THE !T TORNEY 'ENERAL TO ENFORCE -INNESOTA 3TATUTES 3ECTION AND BE IT FURTHER 2%3/,6%$ THAT THE TITLE OF 3UBSTITUTE 2ESOLUTION SHALL BE %NFORCE -INNESOTA ,AW 2EQUIRING 0ATIENT #ONSENTS FOR -EDICAL 2ECORDS 2ELEASES

- iÊ,iÃ ÕÌ ÃÊÌ >ÌÊÜiÀiÊ ÌÊ>` «Ìi`\ 2ESOLUTIONS AND 0HYSICIANS AND $ISASTER 0REPAREDNESS

2ESOLUTION 5NIVERSAL (EALTH )NSUR ANCE 7ITHOUT 3TATE 0ARTICIPATION IN -#/ #ORPORATION 2EGULATORY 2ATIONING OF #ARE

2ESOLUTIONS AND !NY 7ILLING 0ROVIDER

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2ESOLUTION )NFORMATION FOR 0ATIENTS AND $OCTORS ON #OSTS OF 0HYSICIAN 2ECOMMENDED -EDICAL #ARE

2ESOLUTION 2EPEAL !UTHORITY FOR -INNESOTA $EPARTMENT OF (EALTH TO #OL LECT 2OUTINE 0ATIENT %NCOUNTER $ATA &

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vÌÞÊ9i>ÀÃÊ vÊ > Ì vÕ Ê-iÀÛ Vi 4HE -INNESOTA -EDICAL !SSOCIATION ANNUALLY RECOGNIZES ITS MEMBERS WHO HAVE GIVEN YEARS OF SERVICE TO THE PRACTICE OF MEDICINE 4HE FOL LOWING (-3 AND 2-3 MEMBERS WERE AMONG THOSE RECOGNIZED 2ICHARD 7 !NDERSON - $ 2-3 2USSELL 7 "AGLEY - $ (-3 0AUL & "OWLIN - $ (-3 ,OUIS ! "UIE *R - $ (-3 7ILLIAM * #ARR - $ (-3 2OBERT # $UNN - $ 2-3 $ONNA %DWARDS - $ (-3 7ILLIAM 2 'LENNY - $ 2-3 ( 7ILSON 'ODFREY - $ (-3 2ICHARD $ 'RANQUIST - $ (-3 (AROLD 7 (ANSON - $ (-3 #HARLES 3HERMAN (OYT - $ (-3 *OHN 3 (UFF - $ (-3

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'ORDON % *OHNSON - $ (-3 %VERETT ( +ARON - $ 2-3 !NATOL ,YSYJ - $ (-3 .EIL , -ACHELEDT - $ (-3 !ARON , -ARK - $ (-3 ( $AWES -ILLER - $ (-3 %LDORE " .ASH - $ (-3 -ARK , .ORMAN *R - $ (-3 *OSEPH , .ORQUIST - $ 2-3 0ETER 0OPADIUK - $ (-3 ,UMIR # 0ROSHEK - $ (-3 2ICHARD " 2AILE - $ (-3 *OSEPH 7 4EYNOR - $ (-3 &RANCIS " 4IFFANY - $ 2-3 *OHN & 7ALDRON - $ (-3 !LVIN 7 7ATERS - $ 2-3 0AUL ! 7ILLIAMS - $ (-3 2ICHARD ! 7ILLIAMS - $ 2-3 3ABINA 3 :IMERING - $ (-3 & Ûi LiÀÉ iVi LiÀÊÓääÎÊÊÊÊÊ

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i` V> Ê- V iÌ iÃÊ Û Ûi i` V> Ê-ÌÕ`i ÌÃ £ÃÌÊ9i>ÀÊ i` V> Ê-ÌÕ`i ÌÊ« V V -ONDAY !UGUST WAS A BEAUTIFUL DAY FOR THE PICNIC !S WITH MOST YEARS THE PICNIC WAS WELL ATTENDED WITH OVER HALF OF THE MEDICAL STUDENT CLASS PARTICIPATING 4HE PICNIC PROVIDES THE OPPORTUNITY FOR STUDENTS TO GET TO KNOW

ONE ANOTHER AS THEY ENTER THEIR lRST YEAR OF MEDICAL SCHOOL -ICHAEL 'ONZALEZ #AMPOY - $ 0H $ AND -ICHAEL !INSLIE - $ WERE ON HAND TO REPRESENT (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES WHO WERE CO SPONSORS OF THE EVENT

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Õ V Ê½ Ê i>À -ONDAY 3EPTEMBER WAS THE FIRST ,UNCH N ,EARN AT THE MEDICAL SCHOOL FOR lRST YEAR MEDICAL STUDENTS $RS 6IRGINIA ,UPO AND -ICHAEL 'ONZALEZ #AMPOY ADDRESSED THE GROUP AND TALKED ABOUT THE VALUE OF OR GANIZED MEDICINE AND THE REASONS FOR JOINING

-EDICAL STUDENTS ,ESLIE #ARANZA !LISA ,EE AND *EREMY #ARLSON ALSO TALKED ABOUT THEIR EXPERI ENCES WITH THE !MERICAN -EDICAL !SSOCIATION -INNESOTA -EDICAL !SSOCIATION AND (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

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* -ICHAEL 'ONZALEZ #AMPOY - $ 0H $ %DUCATION 2ESOURCE #OUNCIL #HAIR 2EBECCA 'ONZALEZ #AMPOY !LLIANCE 0RESIDENT &RANK * )NDIHAR - $ !-! $ELEGATE .EAL 2 (OLTAN - $ #OMMUNITY (EALTH #OUNCIL #HAIR 7ILLIAM % *ACOTT - $ 5 OF -. 2EPRESENTATIVE -ARK +LEINSCHMIDT #LINIC !DMINISTRATOR

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-%$)#).% )3 ! 02/&%33)/. lRST AND EVERYTHING ELSE SECOND ) CONTINUE TO REmECT ON THE ESSENCE OF MEDICINE BECAUSE IT ALWAYS BRINGS ME BACK TO WHAT IS RIGHT -EDICINE IN ITS PUREST FORM IS THE APPLICATION OF KNOWLEDGE AND SKILL TO PRESERVE HEALTH AND CURE DISEASE )T IS THE GIFT OF ONE PERSON TO ANOTHER )T IS SELF LESS )T PLACES THE PATIENT S WELL BEING ABOVE ALL ELSE EVEN WHEN IT INVOLVES PERSONAL SACRIlCE 4O QUOTE $R 0ATCH !DAMS WHO ) lRST MET AS A MEDICAL STUDENT h)F YOU TREAT THE DISEASE SOMETIMES YOU WIN AND SOMETIMES YOU LOSE )F YOU TREAT THE PATIENT YOU ALWAYS WIN v )T IS TIMELY FOR ME TO REmECT ON THE ABOVE BECAUSE THE PRACTICE OF MEDICINE IS BEING SUB JECTED TO VERY STRONG INmUENCES THAT WANT TO OBSTRUCT ITS CORE VALUES )T IS hA DIFFERENT WORLD v YET MANY OF THE ISSUES WE NOW FACE ARE NOT NEW )N VERY SIMPLE TERMS IF WE AS PHYSICIANS ALWAYS TREATED OUR PATIENTS THE WAY WE EXPECT TO BE TREATED THEN PATIENT CARE WOULD ALWAYS COME lRST (OWEVER FREQUENTLY PATIENT CARE IS BROKEN DOWN SO WE CAN REMOVE THE PRACTICE OF MEDICINE FROM EVERYTHING ELSE THAT COMES ALONG WITH IT !S PHYSICIANS WE SEE PATIENTS AND WE HIRE OTHERS TO DEAL WITH THE hADMINISTRATIONv OF OUR PRACTICES 7E HAVE COME TO ACCEPT THAT EVERYTHING ELSE BUT THE FACE TO FACE ENCOUNTER WITH OUR PATIENTS IS BEST DONE BY OTHERS ) WANT TO BE ON RECORD ON THIS MATTER PHYSICIANS MUST REMAIN RESPONSIBLE FOR ALL ASPECTS OF PATIENT CARE INCLUDING THE COLLECTION OF FEES AND THE INTERACTION WITH PATIENTS ON OUR BEHALF BEYOND THE ACTUAL ENCOUNTER !DDITIONALLY PHYSICIANS MUST REMAIN RESPONSIBLE FOR EDUCATING THE PUB LIC SO PUBLIC HEALTH INITIATIVES AND LEGISLATION PROTECT THE SICK ) HAD THE PLEASURE OF VISITING WITH MY COL LEAGUES OF THE -INNESOTA !SSOCIATION OF "LACK 0HYSICIANS -!"0 LAST MONTH 7E DISCUSSED THE EPIDEMIC OF OBESITY AND HOW WE AS PHYSI CIANS CAN AFFECT IT )T TOOK TWO TRIES FOR ME TO ACCOMPLISH THIS 4HE lRST TIME AROUND -IKE (ATCH THE ATTORNEY GENERAL FOR THE STATE OF -INNESOTA WAS THERE TO VISIT ALONG WITH ME (E TOOK A lVE MINUTE SPEECH AND MADE IT INTO

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MORE THAN AN HOUR LONG DISCOURSE ON HEALTH CARE DELIVERY (E STARTED WITH THE DOCTOR AND THE PATIENT ON A CHALKBOARD "Y THE TIME HE WAS DONE THERE WERE A MYRIAD OF OTHER ENTITIES ON THE BOARD STARTING WITH EMPLOYERS AND THIRD PARTY PAYERS AND lNISHING WITH lRMS THAT ARE HIRED TO OFFER ADVICE TO THE COMPANIES THAT THIRD PARTY PAYERS HIRE TO HANDLE PHARMACY BENElTS 4HE PHYSICIAN AND PATIENT WERE BUR IED IN THE BOARD 7HEN THE ISSUE OF COST COMES UP IN FOR MULATING STATE AND FEDERAL BUDGETS AND COST CONTAINMENT IS CONSIDERED THE lRST PLACE ) LOOK IS AT THE TREMENDOUS BUREAUCRACY THAT (-/S HAVE CREATED )NDEED THERE ARE THOUSANDS OF EMPLOYEES WHOSE LIVELIHOOD DEPENDS ON THE THIRD PARTY SYSTEM CONTINUING TO BE VIABLE 4HEIR LIVELIHOOD COMES FROM THE DEPRIVATION OF SERVICES AND MEDICATION TO INDIVIDUALS WHO MISTAKENLY PUT THEIR TRUST ON THEM ,ET S USE A SPECIlC EXAMPLE TO COMMENT ON THE CONSE QUENCES OF THIS SYSTEM TO MY PATIENTS 2ECENTLY ) SAW A PATIENT IN MY CLINIC WHO NEEDED AN OBESITY MEDICATION ) DISCUSSED MY RECOMMENDATION WITH THE PATIENT INCLUD ING THE INDICATIONS RISKS AND BENElTS OF THE MEDICATION 4HE PATIENT HAD A CHANCE TO ASK QUESTIONS AND ) WROTE A PRESCRIPTION FOR HER ) SUBSEQUENTLY RECEIVED A FAX FROM AN OUTlT CALLED 7ELLPOINT 0HARMACY -ANAGEMENT 4HE FAX READ hx WE CANNOT PROCESS YOUR REQUEST WITH THE INFORMATION PROVIDED 0LEASE SUBMIT A LETTER EXPLAINING THE MEDICAL COMORBIDITY THAT WARRANTS THE USE OF THE DRUG ALONG WITH SUPPORTING MEDICAL RECORDSxv 4HE LETTER WAS SIGNED BY A WOMAN WHOSE OFlCE IS IN #ALI FORNIA -Y PATIENT S PHARMACY TRYING TO GET COVERAGE FOR THIS MEDICATION HAD TO ENGAGE THIS OUTlT IN #ALIFORNIA ) NOTIlED MY PATIENT WHO #ONTINUED ON PAGE

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0RESIDENT * -ICHAEL 'ONZALEZ #AMPOY - $ 0H $ 0RESIDENT %LECT 0ETER * $ALY - $ 0AST 0RESIDENT 0ETER ( +ELLY - $ 3ECRETARY *AMIE $ 3ANTILLI - $ 4REASURER #HARLES % #RUTCHlELD ))) --" - $

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4HE 2AMSEY -EDICAL 3OCIETY &OUNDATION AND THE 2-3 "OARD OF $IRECTORS WILL SPON SOR THE Óää{Ê7 ÌiÀÊ > >Ê> `Ê Õ> Ê iiÌ } ON THE EVENING OF 3ATURDAY *ANUARY AT #IRCUS *UVENTAS IN 3T 0AUL 4HE EVENING WILL INCLUDE THE INSTALLA TION OF $R 0ETER $ALY AS THE TH PRESIDENT OF 2-3 CIRCUS PERFORMANCES BY THE #IRCUS *UVENTAS STUDENTS IN TRAINING AND THE SILENT AUCTION BENElTING THE 2-3& !LL 2-3 MEMBERS AND SPOUSE GUESTS ARE INVITED TO ENJOY AN EVENING AT THE #IRCUS *UVENTAS -ICHAEL 'ONZALEZ #AMPOY - $ 0H $ 2-3 PRESIDENT AND -ICHAEL !INSLIE - $ OF (-3 WELCOMED SOME OF THE lRST YEAR MEDICAL STUDENTS AT THE 1 ÛiÀÃ ÌÞÊ vÊ iÃ Ì>Ê Õ> Ê7i V iÊ* V V AT #OMO 0ARK ON THE EVENING OF !UGUST 4HE BRIGHT AND ENERGETIC MEDICAL STUDENTS REPRESENT THE FUTURE OF THE MEDICAL PROFESSION

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7E WILL BE ENTERTAINED WITH A CIRCUS PER FORMANCE BY THE STUDENTS IN TRAINING 3ILENT !UCTION BENElTING 2AMSEY -EDICAL 3OCIETY &OUNDATION WILL BE HELD

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/N 3EPTEMBER $R 'ONZALEZ #AM POY SPOKE TO THE MEDICAL STUDENTS AT THE 1 ÛiÀÃ ÌÞÊ vÊ iÃ Ì>Ê i` V> Ê -V Ê Õ V Ê½ Ê i>À PROGRAM SPON

SORED BY 2-3 (-3 AND THE --! $R 6IRGINIA ,UPO OF (-3 JOINED $R 'ONZALEZ #AMPOY IN THE PRESENTATION HIGHLIGHTING THE BENElTS OF PARTICIPATING IN ORGANIZED MEDICINE 4HE iVÌ ÃÊ i Ì À }Ê*À }À> ] A JOINT PROJECT OF THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL THE 5 OF - -EDICAL 3CHOOL !LUMNI !SSOCIATION 2-3 AND (-3 RECENTLY SENT OUT INVITATION LET TERS TO ALL 2-3 MEMBERS INVITING THEM TO VOLUNTEER TO BE MENTORS FOR lRST AND SECOND YEAR MEDICAL STUDENTS )N ADDITION TO THE MENTORING PROGRAM #ONNECTIONS ALSO HAS A hSHADOW A PHYSICIANv PROGRAM AND A SUMMER PRECEPTORSHIP PROGRAM AVAILABLE TO 2-3 MEMBERS $R #HARLES #RUTCHlELD ))) - $ 2-3 TREASURER AND * -ICHAEL 4EDFORD - $ OF (-3 REPRESENTED THE SOCIETIES AT THE 1 ÛiÀÃ ÌÞÊ vÊ iÃ Ì>Ê i` V> Ê -V ½ÃÊ7 ÌiÊ >ÌÊ iÀi Þ AT

.ORTHRUP !UDITORIUM ON /CTOBER %ACH lRST YEAR MEDICAL STUDENT WAS PRESENTED WITH A WHITE COAT TO SYMBOLIZE THEIR ENTERING THE MEDICAL PROFESSION 2-3 AND (-3 PRESENTED EACH STUDENT WITH A #ROSS PEN IN RECOGNITION OF THEIR ACHIEVEMENT 4HE , -Ê Õ V Ê Ê Õ ÌÞÊ i> Ì CHAIRED BY $R .EIL (OLTAN LEADS 2-3 EFFORTS TO REDUCE THE HEALTH RISKS OF TOBACCO USE !CTING ON THE RECOMMENDA TION OF THE #OUNCIL THE , -Ê >À`Ê vÊ

ÀiVÌ ÀÃÊAPPROVED A RESOLUTION THAT 2-3 WILL CONTACT THE COUNTY COMMISSIONERS IN 2AMSEY $AKOTA AND 7ASHINGTON #OUN TIES URGING THEM TO PROHIBIT SMOKING IN RESTAURANTS BARS SERVING FOOD AND IN BOWL ING ALLEYS 2-3 ALSO IS SUPPORTING A GRANT

APPLICATION TO THE -INNESOTA $EPARTMENT OF (EALTH FROM THE ,> ÃiÞÊ/ L>VV Ê

> Ì TO WORK FOR SMOKE FREE HOUS ING TOBACCO FREE SCHOOLS SMOKE FREE PUBLIC EVENTS TOBACCO FREE PARKS AND RECREATION AREAS AND SMOKE FREE RESTAURANTS /UR i> Ì Ê« > Ê Ì À }Ê>VÌ Û Ì iÃ CONTINUE AS 2-3 STAFF RECENTLY WORKED WITH (-3 AND --! STAFF TO MONITOR AN ADVERTISING CAMPAIGN LAUNCHED BY (EALTH 0ARTNERS 4HE (EALTH0ARTNERS CAMPAIGN WAS INTENDED TO CONVINCE (EALTH0ARTNER MEM BERS TO SWITCH FROM A PARTICIPATING CLINIC TO A (EALTH0ARTNERS #LINIC /UR REVIEW DISCOV ERED NO QUESTIONABLE PRACTICES ON THE PART OF (EALTH0ARTNERS 7E INTEND TO CONTINUE TO MEET WITH THE HEALTH PLANS AND TO CONTINUE TO MONITOR THEIR DECISIONS RELATED TO REDUCED STATE FUNDING FOR GOVERNMENT PROGRAMS DIS EASE MANAGEMENT AND REIMBURSEMENT BASED ON PRE ESTABLISHED QUALITY PARAMETERS "ECKY 'ONZALEZ #AMPOY REPRESENTING THE , -Ê > Vi] AND 2OGER *OHNSON 2-3 #%/ PARTICIPATED IN THE ÓääÎÊ V> ÃÊ >Ì ÃÊ1 ` ÃÊ Ê-iÀÛ V Ê 1 -®Ê Õ> Ê i iLÀ>Ì IN 3T 0AUL 4HE

KEYNOTE SPEAKER WAS *ANE , $ELGADO 0H $ - 3 THE PRESIDENT AND #%/ OF THE .ATION AL !LLIANCE FOR (ISPANIC (EALTH #,5%3 WAS NAMED THE .ATIONAL (EALTH #ARE !FlLIATE OF THE 9EAR BY THE .ATIONAL #OUNCIL OF 2AZA &

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2-3 0RESIDENT * -I CHAEL 'ONZALEZ #AM POY - $ 0H $ WAS ELECTED BY THE --! (OUSE OF $EL EGATES TO THE POSITION OF --! PRESIDENT ELECT $R 'ONZALEZ #AMPOY IS #%/ OF THE -IN NESOTA #ENTER FOR /BESITY -ETABOLISM AND %NDOCRINOLOGY IN %AGAN (E HAS SERVED AS THE SECRETARY OF THE --! FOR THE PAST YEAR AND HE IS A FORMER CHAIR OF THE --! #OMMITTEE ON -INORITY !FFAIRS (E CHAIRS THE 2-3 #OUNCIL ON %DUCATION 2ESOURCES AND HE CURRENTLY SERVES ON THE GOVERNING COUNCIL OF THE !-! -INOR ITY !FFAIRS #ONSORTIUM $R 'ONZALEZ #AMPOY LIVES WITH HIS WIFE "ECKY AND THREE CHILDREN IN 3UNlSH ,AKE

2-3 "OARD OF $IRECTORS MEMBER 'RETCHEN #RARY - $ WAS ELECTED TO REP RESENT THE %AST -ETRO 4RUSTEE $ISTRICT ON THE --! "OARD OF 4RUSTEES $R #RARY IS A PATHOLOGIST WITH (ENNEPIN &ACULTY !SSOCIATES AT THE (ENNE PIN #OUNTY -EDICAL #ENTER 3HE IS A MEMBER OF THE 2-3 #OUNCIL ON %DUCATION 2ESOURCES AND SHE SERVED ON THE --! S -EMBERSHIP 4ASK &ORCE AND -EDICAL 0RACTICE AND 0LANNING #OMMITTEE 3HE IS THE CURRENT PRESIDENT OF THE -INNESOTA 3OCIETY OF 0ATHOLOGISTS 3HE LIVES WITH HER HUSBAND $AVID AND THREE CHILDREN IN ,ITTLE #ANADA

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Ê Ü>À`ÃÊ,iV « i ÌÃ *ÀiÃ `i Ì½ÃÊ Ü>À` 4HIS AWARD IS PRESENTED TO THOSE MEMBERS OF THE -INNESOTA -EDICAL !SSOCIATION WHO HAVE

Üi Ê À>LLÊ> `Ê i iÌ Ê À>LL]Ê ° °]ÊÀiV « i ÌÊ vÊÌ iÊ Ê Õ ÌÞÊ-iÀÛ ViÊ Ü>À`]Ê> `Ê À> Ê ` >À]Ê ° °]ÊÀiV « i ÌÊ vÊÌ iÊ*ÀiÃ `i Ì½ÃÊ Ü>À`ÊÜ Ì Ê ÃÊÜ viÊ Ì>Ê*> «ÕÃV °

MADE OUTSTANDING CONTRIBUTIONS IN SERVICE BUT HAVE NEVER BEEN ELECTED TO A MAJOR OFlCE OR RECOGNIZED BY THE --! FOR THEIR DEDICATION AND COMMITMENT $R &RANK * )NDIHAR - $ A FORMER PRESIDENT OF 2-3 RECEIVED THE AWARD FROM $R 'ARY (ANOVICH --! PRESIDENT

Õ ÌÞÊ-iÀÛ ViÊ Ü>À` 4HIS AWARD HONORS --! MEMBERS WHO ARE ACTIVELY ENGAGED IN THE PRACTICE OF MEDICINE AND HAVE AN OUTSTANDING RECORD OF COMMUNITY SERVICE $R +ENNETH 7 #RABB - $ A FOR MER PRESIDENT OF 2-3 RECEIVED THE AWARD IN RECOGNITION OF HIS COMMUNITY SERVICE

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WAS HORRIlED ABOUT HER MEDICAL RECORD BEING SENT TO ANYONE ELSE ON THE FACE OF THE PLANET THAT WAS NOT HER DOCTOR 4HE MEDICATION BY THE WAY WILL BE PAID FOR OUT OF HER POCKET ) TOOK THE OPPORTUNITY TO LOOK UP 7ELL 0OINT (EALTH .ETWORKS )NC -R ,EONARD 3CHAEFFER WHO IS THE #%/ OF THIS OUTlT WHICH MY PATIENT S THIRD PARTY PAYER HAS HIRED TO ISSUE DENIALS OF COVERAGE FOR PATIENT MEDICATIONS HAS A TOTAL COMPENSATION PACKAGE OF MILLION PER YEAR %VEN WITHOUT INCENTIVES HE POCKETS MILLION A YEAR 7ITHOUT DOING THE MATH THIS SALARY ALONE WOULD PROVIDE MEDICATION TO SEVERAL THOUSAND PATIENTS OVER MANY YEARS 3O WHERE IS THE INTEREST IN THE PATIENT S CARE !ND WHERE IS THE ACCOUNTABILITY -Y PATIENT S THIRD PARTY PAYER IS A FACELESS ENTITY TO WHICH PATIENTS HAVE LITTLE ACCESS 4HE SAME IS TRUE OF MOST THIRD PARTY PAYERS ) AM BEGINNING A NEW PRACTICE IN $ECEM BER ) WILL BE ACCOUNTABLE FOR ALL THE DECISIONS THAT ARE MADE IN MY PRACTICE 4HERE ARE MANY REASONS FOR IT 4HE OVERRIDING REASON IS MY DUTY TO PROVIDE EXCELLENT PATIENT CARE "Y DElNITION WHEN A PHYSICIAN IS NOT IN CHARGE OF MAKING ÊÊÊÊ

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PRACTICE DECISIONS PATIENT CARE IS COMPROMISED 4HE ULTIMATE DECISION IS NOT ONE THAT IS MADE BASED ON SCIENCE OR THE INDIVIDUAL PATIENT S NEEDS 2ATHER IT COMES DOWN TO WHAT IS BEST FOR THE (-/ S FORMULARY THE PRACTICE S BOTTOM LINE OR THE CONVENIENCE OF ADMINISTRATORS !S A PHYSICIAN AND PATIENT ADVOCATE ) CANNOT STAND BY AS THE BOTTOM LINE OF A PRACTICE TAKES PRIORITY OVER THE INDIVIDUAL PATIENT S WELL BEING ) THINK IT IS IMMORAL TO COMPROMISE PATIENT CARE TO MEET BUDGETS THAT LARGELY COMPENSATE LAYERS OF ADMINISTRATORS WHO CONTRIBUTE NOTHING TO THE PRACTICE OF MEDICINE ) THINK IT IS INSANE TO TURN OUR BACK ON THE CURRENT STATE OF AFFAIRS AND TO ACCEPT THE STATUS QUO ) THINK IT IS IR RESPONSIBLE TO ALLOW INDIVIDUALS WHO LACK THE MEDICAL TRAINING THAT WE HAVE TO MAKE DECI SIONS ABOUT THE PRACTICE OF MEDICINE ,ASTLY ) THINK IT IS OUR DUTY TO ASSERT OURSELVES IN THIS REGARD 0HYSICIANS MUST BE IN CHARGE OF THE DELIVERY OF CARE IN OUR COUNTRY 4O THOSE WHO CHOSE TO LIVE IN OBLIVION PRETENDING IT IS NOT UP TO THEM TO MAKE THE DECISIONS THAT SHAPE THE PRACTICE OF MEDICINE ) SAY IT S TIME TO WAKE UP 9OU ARE PROFESSIONALS 9OU HAVE TAKEN AN OATH

TO BE ADVOCATES FOR YOUR PATIENTS SOMETIMES AT THE RISK OF SELF SACRIlCE 9OU CANNOT TURN YOUR BACK ON THIS PROMISE !S IT IS MY PATIENT S INTERESTS HAVE TAKEN SECOND SEAT 4HE MONEY THAT SHE AND HER EM PLOYER PAID TO HER THIRD PARTY PAYER IS NOT BEING SPENT ON HER )T IS GOING TO PAY THE SALARIES OF WOMEN IN #ALIFORNIA hPHARMACY MANAGEMENTv OUTlTS AND THEIR OVERPAID #%/S )T GOES TO SUSTAIN THE SEVERAL THOUSAND JOBS THAT THIRD PARTY PAYERS HAVE HERE IN OUR STATE MANY OF WHICH ARE SPECIlCALLY PUT IN PLACE TO ENSURE THAT THE RECOMMENDED CARE IS NOT DELIVERED )T PAYS FOR CONSULTANTS TO THESE THIRD PARTY PAYERS )T PAYS FOR THESE THIRD PARTY PAYER LOBBYISTS !ND SO ON 4HE MONEY SHE PAID GOES TO WASTE ) AM CONVINCED THAT PUTTING PATIENTS INTEREST lRST WILL RESULT IN BETTER OUTCOMES IN FEWER LAWSUITS IN A RENEWAL OF THE PATIENT PHYSICIAN RELATIONSHIP AND CERTAINLY IN LESS COST ) AM CONVINCED THAT WE AS A COMMUNITY OF PHYSICIANS #!. MAKE A DIFFERENCE IN OUR COMMUNITIES AND OUR STATE ) AM CONVINCED THAT THE ESSENCE OF MEDICINE WILL PREVAIL &

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TO HELP YOU FOCUS YOUR ATTENTION ON WHERE IT S NEEDED MOST ) ATTENDED A FEW OF THE EVENTS OF THE -INNESOTA -EDICAL !SSOCIATION --! !NNUAL -EETING HELD IN 2OCHESTER THIS FALL BECAUSE ) M PRESIDENT ELECT OF THE --! !L LIANCE -Y SPOUSE -IKE ALSO SERVES ON THE --! "OARD OF 4RUSTEES AND IS NOW SERVING AS PRESIDENT ELECT OF THE --! 4HIS PARTICULAR ANNUAL MEETING FEATURED A CELEBRATION OF THE --! S YEARS OF SERVICE TO PHYSICIANS AND TO THE COMMUNITY (ERE S THE REALITY CHECK NOWHERE WAS THE !LLIANCE EVER MENTIONED .OT IN THE SLIDE SHOW HIGHLIGHTING THE MAJOR ACCOMPLISHMENTS AND CONTRIBUTIONS OF THOSE INVOLVED WITH THE --! OVER THE PAST CENTURY AND A HALF .OT IN -INNESOTA -EDICINE S SPECIAL EDITION ISSUE DEVOTED TO THIS YEAR MILESTONE )T WASN T UNTIL THE --! !LLIANCE 0RESIDENT AND ) ALERTED --! STAFF TO THIS OMISSION THAT ANYONE REAL IZED WE WERE MISSING !ND WE WEREN T EXCLUDED FOR ANY MALICIOUS INTENT WE WERE SIMPLY AN OVERSIGHT &ORTUNATELY OUTGOING --! 0RESI DENT 'ARY (ANOVICH MADE A SPECIAL POINT TO ACKNOWLEDGE AND COMMEND THE !LLIANCE FOR OUR ROLE IN WORKING WITH THE --! TO ACHIEVE ITS GOALS 4HE --! MISSED A GOLDEN OPPORTUNITY TO RECOGNIZE THIS PARTNERSHIP ) INTEND TO TAKE THE TIME NOW TO COMMUNICATE BETTER TO PHYSI CIANS AND SPOUSES THE ROLE OF THE !LLIANCE IN ORGANIZED MEDICINE AND IN THE COMMUNITY 3O IF YOU VE EVER WONDERED WHAT THE !L LIANCE IS AND WHY IT EXISTS HERE WE GO Ê > ViÊ"ÛiÀÛ iÜ 4HE 2AMSEY -EDICAL 3OCIETY !LLIANCE GOT ITS START YEARS AGO 7E PLAN TO KICK OFF OUR TH YEAR WITH A CELEBRATION OF OUR HISTORY AT THE !NNUAL -EETING IN -AY 7E VE EVOLVED OVER THE DECADES TO BECOME A NONPROlT ORGANIZATION THAT s %DUCATES CHILDREN AND FAMILIES IN THE COM MUNITY ABOUT HOW TO LIVE HEALTHY LIVES ÊÊÊÊ

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s #OLLABORATES WITH OTHER HEALTH RELATED ORGANIZATIONS s 0ROVIDES SUPPORT TO MEDICAL FAMILIES s 7ORKS TO STRENGTHEN THE MEDICAL PROFESSION THROUGH POLITICAL ACTIVITY AND s 2AISES FUNDS FOR THE 2AMSEY -EDICAL 3OCI ETY &OUNDATION AND THE !MERICAN -EDICAL !SSOCIATION &OUNDATION )N ESSENCE THE !LLIANCE SERVES AS THE COM MUNITY RELATIONS ARM OF THE MEDICAL SOCIETY 4HE TWO GROUPS THE MEDICAL SOCIETY AND THE !LLIANCE GO HAND IN HAND /UR MISSION IS SIMPLE WE BUILD HEALTHY COMMUNITIES 0HYSICIANS WORK TO PROVIDE THE BEST QUALITY CARE POSSIBLE 7E WORK TO HELP PEOPLE GAIN ACCESS TO THAT CARE AND TO TEACH THEM HOW TO MAINTAIN THEIR HEALTH 4HE MEDI CAL SOCIETY LOOKS OUT FOR THE PROFESSIONAL NEEDS OF PHYSICIANS 4HE !LLIANCE LOOKS OUT FOR THE SOCIAL AND PERSONAL NEEDS OF THEIR FAMILIES "OTH GROUPS WORK ON BEHALF OF PATIENTS / iÊ iÊ*À Ì 4HESE ARE GREAT OBJECTIVES 4HE MISSION IS LAUD ABLE AND SUCCINCT "UT HOW DO WE MAKE THESE THINGS HAPPEN 4HE 2AMSEY -EDICAL 3OCIETY !LLIANCE HOLDS A HEALTH FAIR EVERY YEAR FOR 3T 0AUL RD GRADERS TO LEARN ABOUT s $IET AND NUTRITION s (OW THEIR HEART WORKS s (OW TO TAKE CARE OF THEIR BONES s 7HY THEY SHOULD BE PHYSICALLY ACTIVE AND HOW s (EALTHCARE CAREERS AND s 7HAT TO EXPECT WHEN THEY VISIT THEIR DOCTOR 7E COLLABORATE WITH OTHER GROUPS TO IMPROVE THE LIVES OF THE PEOPLE IN OUR COM MUNITY 4HESE GROUPS INCLUDE s #ARING (EARTS FOR THE (OMELESS 7E COL LECT LIVING ESSENTIALS AND PREPARE THEM FOR DELIVERY s &IRST 3TEPS 3EVERAL MEMBERS VOLUNTEER WITH THIS PROGRAM SPONSORED BY #HILDREN S (OSPITAL THAT HELPS TEEN MOTHERS GET OFF TO A SOLID START PARENTING

s ,OCAL SCHOOL DISTRICTS -EMBERS USE THEIR ACCESS TO HEALTH INFORMATION TO WORK WITH SCHOOLS ON CURRICULUM VIOLENCE PREVENTION PROGRAMS EFFORTS TO IMPROVE THE QUALITY AND NUTRITION OF SCHOOL LUNCHES AND CHEMICAL HEALTH PROGRAMS 7E DEVELOP RELATIONSHIPS WITH OUR LEGISLATORS AND MEMBERS OF #ONGRESS TO HELP THEM UNDERSTAND THE ISSUES FACING PHYSICIANS AND PATIENTS 4HESE INCLUDE PROVIDING UNEN CUMBERED ACCESS TO QUALITY HEALTH CARE AND RESPECTING THE PHYSICIAN PATIENT RELATIONSHIP 2EPEALING THE SICK TAX AND PASSING STRONG TORT REFORM ALSO ARE HIGH PRIORITIES 4HIS IS JUST A SNAPSHOT OF OUR WORK 7E ALSO KNOW SPOUSES NEED SOME TIME TO JUST HAVE FUN 4HAT S WHAT WE DO AT OUR MEETINGS 7E TRY NEW RESTAURANTS 7E SWAP GOURMET RECIPES 7E HOLD LIVE AUCTIONS TO RAISE MONEY TO PAY FOR OUR HEALTH FAIR 7E GET GARDENING TIPS AT A LOCAL NURSERY 7E HOST THEME PARTIES 7E LEARN ABOUT HOW TO LOBBY AT THE LEGISLATURE 7E READ GREAT SELECTIONS FOR "OOK #LUB OR RESEARCH NEW STOCK OPPORTUNITIES FOR )NVESTMENT #LUB /UR OLDER MEMBERS HOLD 4RUSTED &RIENDS GATHERINGS 7E CATCH UP ON EACH OTHER S INTERESTS CAREERS AND ACTIVITIES 7E LISTEN AND WE UN DERSTAND !ND WE INTEND TO CONTINUE THIS STRONG TRADITION FOR ANOTHER YEARS &OR MORE INFORMATION ABOUT MEM BERSHIP PLEASE CONTACT $OREEN (INES AT DHINES MNMED ORG &

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IN THE ROAD !MERICAN MEDICINE FACES TWO FUNDAMENTAL CHOICES IN lNANCING HEALTH CARE -OST OF US FAVOR ONE OR THE OTHER FORM "OTH HAVE ADVANTAGES AND DISADVANTAGES /NE HAS BEEN TRIED AROUND THE WORLD FOR SEVERAL YEARS THE OTHER ONLY ON A LIMITED BASIS &IRST ) D LIKE TO OUTLINE A HISTORY OF HEALTH CARE lNANCING AS ) HAVE STUDIED IT &OR THE EARLY YEARS OF !MERICAN MEDICINE IT EXISTED ON A STRICT FEE FOR SERVICE OR BARTER SYSTEM 0AYMENT WAS MADE FOR THE SERVICES RENDERED BY THE PATIENT TO THE PHYSICIAN 4HE GIVE AND TAKE OF THE MARKETPLACE DETERMINED PRICES FOR THE SERVICE RENDERED ) M SURE PRICES VARIED WILDLY THROUGHOUT THE COUNTRY )N THE S AND ESPECIALLY DURING 7ORLD 7AR )) HEALTH INSURANCE WAS OFFERED FOR THE lRST TIME 4HIS INSURANCE WAS A TRUE INSURANCE FOR A CATASTROPHIC LOSS NOT THE lRST DOLLAR COVERAGE SO COMMONPLACE TODAY )T WAS TOUTED AS A BENElT TO WORKERS WHO WERE SUBJECT TO WAGE AND PRICE CONTROLS 3URGEONS OF THAT TIME FOUGHT FOR BET TER REIMBURSEMENT FOR PROCEDURES VS CONSUL TATIONS 4HIS PROCESS CONTINUED AFTER THE WAR 7ORKERS LOBBIED THEIR EMPLOYERS FOR MORE AND MORE COVERAGE ESPECIALLY CLOSER TO lRST DOLLAR COVERAGE )N THE LATE S THE (-/ MOVE MENT STARTED AND SPREAD NATIONWIDE )T WAS AN ATTEMPT TO CUT COSTS BY TAKING THE hFATv OUT OF HEALTH CARE 7HILE SOME OF THE CUTS WERE GOOD AND NECESSARY A LOT OF hMEATv WAS CUT ALSO 4HIS HAS hEVOLVEDv INTO THE hMANAGED CAREv SYSTEM WE NOW hENJOY v 0ATIENTS HAVE NO IDEA OF COSTS TO THEMSELVES NOW MOSTLY PAID FOR BY EMPLOYERS 0HYSICIANS HAVE ALMOST NO IDEA OF REIMBURSEMENT RATES THAT MAY BE ONLY PER CENT OF THE AMOUNT BILLED 4HOSE OF YOU WHO HAVE BEEN PATIENTS KNOW HOW FRUSTRATING IT IS TO DEAL WITH INSURANCE COMPANIES AND HEALTH CARE INSTITUTIONS )T IS NOT UNUSUAL TO RECEIVE A BILL FOR SOMETHING THAT OCCURRED LONG AGO )F -ARSHALL &IELDS CAN PRESENT US WITH A BILL WHEN

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WE LEAVE THE STORE WHY CAN T CLINICS AND HOSPI TALS PRESENT A BILL WHEN YOU CHECK OUT 4HEY KNOW WHAT INSURANCE WILL PAY AND COPAYS AND THE BALANCE THAT THE PATIENT IS RESPONSIBLE FOR WOULD BE KNOWN AND PAYABLE AT THAT TIME -ANY BELIEVE THAT THE SIMPLEST EVOLUTION OF THE PRESENT SYSTEM IS TO GO TO A SINGLE PAYER OPTION .ATIONAL (EALTH #ARE ) FEEL THAT THIS WOULD TAKE ALL THE BAD PARTS OF OUR SYSTEM AND MAKE THEM WORSE 4HOSE OF YOU WHO BOTHERED TO READ (ILLARY #ARE IN THE EARLY S WITHOUT YOUR BRAIN EXPLODING KNOW THAT THIS SYSTEM IS SO COMPLEX THAT IT IS IMPOSSIBLE TO UNDERSTAND (OW MANY THINK THE )23 IS SIMPLIFYING THE 4AX #ODE EVERY YEAR 4HE ONLY WAY TO CONTROL COSTS IS TO EITHER DENY CARE FORMING THE QUEUE AS MANY COUNTRIES DO OR CONTINUE TO CUT REIM BURSEMENTS TO PROVIDERS ) DON T BELIEVE THAT !MERICANS WOULD STAND A QUEUE SO THE ONLY CHOICE WILL BE TO CUT REIMBURSEMENTS TO PHYSI CIANS 4HE OTHER METHOD WOULD BE A SYSTEM WHERE PATIENTS WOULD BE RESPONSIBLE FOR COV ERAGE OF COSTS SAY UP TO FOR THAT YEAR 4HEN IF COSTS WERE MORE A CATASTROPHIC INSUR ANCE PLAN WOULD PICK UP THE REST 4HIS PLAN WOULD HAVE TWO hCOSTSv THE INITIAL FUNDING OF THE IN A -EDICAL 3AVINGS !CCOUNT 4HE OTHER IS THE PREMIUM ON THE CATASTROPHIC PLAN 4HIS IS USUALLY ABOUT FOR THE FAM ILY 0ATIENTS WOULD hPAY FOR SERVICES OUT OF THIS ACCOUNT 7HATEVER IS LEFT OVER AT THE END OF A YEAR WOULD BELONG TO THE PATIENT EITHER TO ROLL OVER TO THE NEXT YEAR OR KEPT AS AN )2! "UT THIS WOULD BE CONTROLLED BY YOU AND BE YOUR PROPERTY 4HIS WOULD IMMEDIATELY BRING THE MARKETPLACE BACK INTO MEDICINE 4HE COSTS WOULD BE BORN BY THE PATIENT AND IMMEDIATE REIMBURSEMENT TO THE PHYSICIAN 0EOPLE BELOW #ONTINUED ON PAGE

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Cardiac Arrhythmias: An Interactive Update for Internal Medicine, Family Practice and Pediatrics April 9, 2004

Minimally Invasive Approaches to Surgical Oncology April 22-23, 2004 Midwest Arthroplasty Course: Revision Knee May 14-16, 2004 Advances in Trauma & Critical Care Surgery June 16-19, 2004 Endorectal Ultrasonography September 8, 2004 Principles of Colon & Rectal Surgery September 9-11, 2004

PRIMARY CARE COURSES Current Issues in Geriatric Psychiatry November 8, 2003 Multiple Sclerosis: The Disease & Its Management March 6, 2004 Thoracic Oncology and Primary Care March 19, 2004 Family Practice Review: Update 2004 May 3-7, 2004 All conferences listed take place in the Twin Cities Metro Area.

Providing quality physician education for over 65 years

CME

Continuing Medical Education

OTHER COURSES E. T. Bell Fall Pathology Symposium November 7, 2003 Treatment of Tobacco Use Forum November 14, 2003 Emerging Infections in Clinical Practice & Emerging Health Threats November 21, 2003 Reducing Tobacco Use in Minnesota February 27, 2004 International Congress on Schizophrenia Research April 2-4, 2004 Allergy and Clinical Immunology April 23, 2004 Aging Skin 2004 April 30, 2004 WORLD Lysosomal Disease Clinical Research Network May 13-15, 2004 Neonatology Issues Conference June 11-12, 2004 Please contact our office for more information Continuing Medical Education 612.626.7600 or 1.800.776.8636 cmereg@umn.edu / www.med.umn.edu/cme fax: 612.626.7766