2003septoct by Advocates for Better Health

Sept/Oct 2003

In this issue

Budget Blues

Medicare Overpayment and AMA Alert

Simple & Cost Effective

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%DITOR )N THE -AY *UNE ISSUE OF THIS PUBLICATION $R ,EE +URISKO PRESENTED THE #ANADIAN HEALTH CARE SYSTEM AS hCOMMUNISTICv AND hSOCIALISTIC v PLUS A SURPRISING THIRD DESCRIPTOR hIMMORAL v 7HILE HIS ANECDOTES WERE MOVING AS PHYSICIANS MOST OF US KNOW THAT THEY ARE NOT ADEQUATE IN DElNING AN ACCURATE AND USEFUL ASSESSMENT -OST CLINICIANS INCLUDING MYSELF COULD PRESENT EXAMPLES OF THE TRAGIC INTERSECTION OF HEALTH INSURANCE LACK AND POOR PATIENT OUTCOMES )N FACT $R *EEVAN 0AUL PRESENTS EXAMPLES OF THESE IN THE LETTERS SECTION OF THAT VERY ISSUE 4HE RATIONING USED BY THE 5 3 HEALTH CARE hSYSTEMv IS OPAQUE AND AFFECTS THE

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POOR AND INCREASINGLY THE MIDDLE CLASS DISPROPORTIONATELY /VER PERCENT OF UNINSURED HOUSEHOLDS INCLUDE SOMEONE WHO IS EMPLOYED FULLTIME 4HE RATIONING AND QUEUING THAT OCCURS IN #ANADA EXISTS BUT IS TRANSPARENT AND RESULTS IN ARGUABLY BETTER HEALTH CARE AND COST CONTAINMENT 4HE USE OF SPECIALIZED CENTERS FOR SOME HEALTH CARE I E ESOPHAGECTOMIES ETC RESULTS IN BETTER OUTCOMES )F THE hFREE MARKETv PRODUCES BETTER HEALTH CARE THAN RATIONING BASED ON MEDICAL DATA THEN WHERE IS THE PROOF &IVE POINTS SHOULD BE CONSIDERED THE NUMBER OF POTENTIAL YEARS OF LIFE LOST BEFORE AGE PER PEOPLE IS IN #ANADA AND IN THE 5 3 THE NUMBER OF DEATHS PER LIVE BIRTHS IS IN #ANADA AND IN THE 5 3 LIFE EXPECTANCY OF FEMALES MALES IN #ANADA IS YEARS AND IN THE 5 3 #ANADIAN HEALTH CARE INSURANCE DOES NOT RESTRICT CHANGING JOBS OR MOVING AND THE 7(/ STUDY WHICH RATED HEALTH CARE OF WORLD SYSTEMS PLACED THE 5 3 AT TH WE ARE NUMBER ONE BY A LONG SHOT IN HEALTH CARE COSTS )N THE LAST NINE YEARS AN ADDITIONAL SEVERAL MILLION !MERICANS JOINED THE RANKS OF THE UNINSURED THERE WAS A DECLINE IN CHOICE OF PROVIDERS FOR MOST PATIENTS AND AN EXPONENTIAL TRANSFER OF HEALTH CARE RESOURCES FROM PATIENT CARE TO ADMINISTRATION MARKETING AND PROlTS 4HE OVERHEAD PROlT FOR HEALTH INSURANCE RANGES FROM PERCENT (UMANA TO PERCENT 5 3 (EALTH #ARE !ETNA WHILE OVERHEAD FOR #ANADIAN -EDICARE IS PERCENT AND FOR 5 3 -EDICARE PERCENT %N ROUTE TO hMANAGINGv HEALTH CARE COSTS THE PERCENTAGE OF ADMINISTRATORS FROM TO HAS INCREASED BY PERCENT YES THAT NUMBER IS CORRECT WHILE THE NUMBER OF PHYSICIANS AND NURSES HAS INCREASED BY APPROXIMATELY PERCENT &RAUD AND ABUSE BY HEALTH CARE INSURANCE COMPANIES ARE WIDESPREAD AND HAVE BEEN SEEN IN OUR OWN STATE SEE THE RECENT 3TATE !TTORNEY 'ENERAL S REPORTS

ON -EDICA AND (EALTH0ARTNERS 3ENATE -AJORITY ,EADER 3ENATOR "ILL &RIST S FAMILY BUSINESS (#! #OLUMBIA HAS HAD MASSIVE lNES LEVIED BY -EDICARE FOR OVER CODING DIAGNOSES 4HE ECONOMIC IMPACT OF THESE EXPONENTIAL COST INCREASES IS DEVASTATING FOR OUR NATIONAL ECONOMY AS WELL AS FOR INDIVIDUALS 4HE TIE IN OF HEALTH INSURANCE TO EMPLOYMENT BENElTS HAS RESULTED IN MANY OF OUR INDUSTRIES BEING LESS COMPETITIVE IN THE WORLD MARKET !N EXAMPLE WAS THE INABILITY OF 53 3TEEL TO MEET ITS HEALTH INSURANCE OBLIGATIONS TO ITS RETIREES 4HIS PLAYED A MAJOR ROLE IN ITS BANKRUPTCY !FTER BANKRUPTCY THESE RETIREES BECAME EITHER UN OR UNDER INSURED 4HE ECONOMIC IMPACT OF THIS BUSINESS FAILURE ON THE LOCAL ECONOMY WAS DEVASTATING NOT TO MENTION THE RIPPLE EFFECT ON OUR COUNTRY 7ITH THE RECENT DECLINE IN OUR NATIONAL ECONOMY NEARLY EVERY STATE IN THE 5NION IS STRUGGLING TO CUT EXPENSES AND -EDICAID SERVICES ARE ALMOST CERTAIN TO BE REDUCED !GAIN THE BURDEN OF THESE CUTS WILL FALL ON THOSE LEAST ABLE TO WITHSTAND THEM )F A HEALTHY POPULATION AND THE HUMANE TREATMENT OF THOSE WHO DO NOT QUALIFY AS RICH IS A MORAL GOAL THEN THE LABEL OF IMMORAL IS MOST APTLY APPLIED TO THE 5 3 HEALTH CARE SYSTEM WHICH LEAVES MILLION PEOPLE UNINSURED !N HONEST ASSESSMENT OF HEALTH CARE ECONOMICS IS NOT SERVED BY USE OF TRIGGER WORDS LIKE hSOCIALISMv AND hCOMMUNISMv WHILE IGNORING THE TRUE IMPACT OF ACCELERATING COSTS WHICH RESULT IN DETERIORATING HEALTH CARE FOR PATIENTS AND FURTHER INJURY TO THE 5 3 ECONOMY ! HARD LOOK AT CORPORATE PROlTS AND THE AMOUNT OF MONEY INVOLVED REVEALS WHERE THE MOTIVATION EXISTS FOR MAINTAINING THE STATUS QUO 4HE PUBLIC EXPENSE GOVERNMENTAL BY THE 5 3 PER CAPITA IS SLIGHTLY MORE THAN THAT SPENT BY THE #ANADIAN GOVERNMENT PER CAPITA ON HEALTH 4HE #ANADIAN SYSTEM COVERS PERCENT

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OF THE POPULATION 7E SPEND AN ADDITIONAL PER CAPITA AND COVER PERCENT AND FALLING OF OUR POPULATION 4HEREFORE OUR HEALTH CARE hSYSTEMv USES A LOT OF MONEY FOR COSTS OTHER THAN HEALTH CARE ! PRIMARY GOAL OF ADMINISTRATORS HEALTH CARE MANAGERS AND ULTIMATELY HEALTH CARE INSURANCE INDUSTRY #%/S WHOSE ANNUAL INCOME MAY REACH SEVEN TO EIGHT lGURES IS TO MAXIMIZE PROlT BY RESTRICTING ACCESS TO CARE TO THE SICK %NACTED AND PROPOSED INCREMENTAL HEALTH CARE hREFORMSv (-/S 00/S MEDICAL SAVINGS ACCOUNTS HAVE RESULTED IN INCREASED COSTS DECREASED COVERAGE AND DECREASED CHOICE FOR PATIENTS 5NIVERSAL SINGLE PAYER HEALTH CARE WOULD BE A BEGINNING TO A TRULY MORAL AND lNANCIALLY CONSERVATIVE HEALTH CARE SYSTEM )T WOULD PROVIDE THE LEVERAGE TO REIN IN UNCONSCIONABLE AND TRULY IMMORAL PHARMACEUTICAL PROlTS AS THE #ANADIAN SYSTEM DOES AND IT WOULD ALLOW OTHER SECTORS OF THE ECONOMY TO COMPETE MORE FAIRLY IN THE WORLD MARKET WHILE MAINTAINING AN ACTUAL PRESENCE IN THIS COUNTRY 7E ARE THE ONLY DEVELOPED COUNTRY THAT DOES NOT ASSURE ACCESS TO HEALTH CARE FOR ALL ITS CITIZENS 7ITH UNIVERSAL SINGLE PAYER HEALTH INSURANCE WE COULD EXPECT THAT HEALTH CARE OUTCOMES WOULD IMPROVE AND ALL PATIENTS WOULD BE TREATED WITH DIGNITY 4HE SUGGESTION WAS MADE BY $R +URISKO THAT hFREE TRADEv SHOULD CONTROL MEDICAL COSTS -OST PEOPLE FAMILIAR WITH HEALTH CARE ECONOMICS ACKNOWLEDGE THAT THE FORCES THAT CONTROL THE PRICES OF TENNIS RACKETS AND #$ PLAYERS ARE NOT THE SAME AS THOSE INVOLVED IN SHAPING HEALTH CARE COSTS NOR SHOULD THEY BE !S 7ENDELL "ERRY SAYS h2ATS AND ROACHES LIVE BY THE LAWS OF SUPPLY AND DEMAND IT IS THE PRIVILEGE OF HUMAN BEINGS TO LIVE UNDER THE LAWS OF JUSTICE AND MERCY v & 3OURCES !S 3ICK !S )T 'ETS BY 2UDOLPH -UELLER - $ AND (EALTH #ARE -ELTDOWN BY "OB ,E"OW - $ - 0 ( 2OBERT 7INSTON - $ (EMATOLOGIST /NCOLOGIST WITH THE (UBERT ( (UMPHREY #ANCER #ENTER AND MEMBER OF 0HYSICIANS FOR A .ATIONAL (EALTH 0LAN WWW PNHP ORG

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EMPLOYERS AND PHYSICIANS ARE NOW BUILDING ALLIANCES TO INCREASE CONSUMERS KNOWLEDGE AND RESPONSIBILITY FOR THEIR HEALTH CARE DECISIONS $ESCRIBED AS hCONSUMERISMv IN THE POPULAR PRESS THIS MOVEMENT IS FOUNDED ON THE BELIEF THAT WELL INFORMED CONSUMERS WITH ACCESS TO PERFORMANCE AND COST DATA CAN IMPROVE QUALITY AND CONTROL COSTS 4HESE HEALTH CARE QUALITY IMPROVEMENT EFFORTS ARE A RELATIVELY NEW DEVELOPMENT IN THE NATIONAL CRUSADE TO CONTAIN DOUBLE DIGIT COST INCREASES AND BOOST QUALITY IMPROVE MENT )N THE PAST PHYSICIANS AND EMPLOYERS WERE MORE RESIGNED TO LET THEIR DIFFERENT ENVIRONMENTS AND TERMINOLOGY GET IN THE WAY OF IDENTIFYING A MEANINGFUL DIALOGUE ON HOW TO BEST HELP EACH OTHER ACHIEVE SHARED SUCCESS 7E VE LEARNED THIS ACQUIESCENCE TO THE STATUS QUO WASTED A LOT OF TIME AND MONEY )T WAS THIS BLEEDING OF RESOURCES LOWER REIMBURSEMENTS FOR DOCTORS AND HIGHER HEALTH INSURANCE PREMIUMS FOR EMPLOYERS THAT HAS PROVIDED THE IMPETUS TO CREATE A COMMON CONSUMERISM AGENDA 4ODAY EMPLOYERS AND PHYSICIANS SHARE THREE BASIC GOALS - >Ài`Ê > Ê£\ !CHIEVE THE BEST OUTCOME FOR THE PATIENT EMPLOYEE OR EMPLOYEE S FAMILY MEMBER 4HE DOCTOR SEEKS TO CURE THE EMPLOYER WANTS THE EMPLOYEE BACK AT WORK ! HEALTHY PRODUCTIVE AND SATISlED CONSUMER IS THE SHARED OBJECTIVE 3TAYING FOCUSED ON THE FUNDA MENTAL GOAL OF THE BEST POSSIBLE OUTCOME CAN HELP TO BUILD A BRIDGE WHERE EMPLOYERS AND PHYSICIANS CAN MEET AND WORK TOGETHER FOR THE BENElT OF THEIR PATIENTS EMPLOYEES - >Ài`Ê > ÊÓ\ !SSURE THE QUALITY OF THE PRODUCT OR SERVICE DELIVERED AND RECEIVED #ONTINUOUS QUALITY IMPROVEMENT #1) IS NOT A NEW CONCEPT FOR PHYSICIANS AND THEIR PROFESSIONAL COLLEAGUES &OR THEIR ENTIRE PROFESSIONAL LIVES THEY VE INVESTED IN #1) BOTH lNANCIALLY AND THROUGH TIME SPENT ON PEER REVIEW CONTINUING MEDICAL EDUCATION AND STAFF TRAINING PROFESSIONAL QUALITY COMMITTEES AND LITERATURE REVIEWS %MPLOYERS ARE INVESTING TIME AND MONEY IN DElNING AND BUILDING QUALITY MEASUREMENT SYSTEMS THAT WILL HELP THEM DElNE THE VALUE OF HEALTH CARE SERVICES 4HIS WORK IS TAKING PLACE AT THE LOCAL AND NATIONAL LEVEL IN BOTH THE PUBLIC AND PRIVATE SECTORS (ERE IN -INNESOTA SMALL BUSINESS PURCHASING ALLIANCES ARE CREATING 1UALITY #OUNCILS TO ANALYZE AGGREGATE UTILIZATION AND COST DATA ,ARGE EM PLOYERS ARE CREATING NEW COALITIONS TO ADDRESS PERFORMANCE MEASUREMENT AND INCENTIVE PROGRAMS 4HE #ENTERS FOR -EDICAID AND -EDICARE HAVE ALSO STEPPED INTO THE QUALITY 9 Ê , " 9 Ê * , Ê Ê - / Ê+1 Ê ,

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MEASUREMENT DISCUSSION AND CONTRACTED WITH GROUPS TO DESIGN hPAY FOR PERFORMANCEv PROGRAMS BASED ON SPECIlC QUALITY MEASURES !LL OF THIS ACTIVITY BY EMPLOYERS AND OTHER PURCHASERS OF HEALTH CARE SERVICES OFTEN LEAVES PHYSICIANS OUT IN THE COLD BECAUSE THE USE OF THE TERM hQUALITYv BY EMPLOYERS SEEMS SO OUT OF CONTEXT TO THE PHYSICIANS LIFETIME PURSUIT OF EXCELLENCE (OW CAN AN EMPLOYER PURCHASER hAPPRECIATEv QUALITY WITHOUT THE BENElT OF BEING IN THE OPERAT ING ROOM OR TAKING A COURSE IN ADVANCED PHARMACOLOGY !T THE SAME TIME EMPLOYERS BECOME FRUSTRATED WITH PROVIDERS WHO SCOFF AT THE EMPLOYERS ATTEMPTS TO BETTER DElNE THE VALUE OF THEIR PURCHASE )N A RECENT CONVERSATION THAT BOTH AUTHORS WITNESSED AN EMPLOYER REPRESENTATIVE STATED mATLY THAT hPROVIDERS DON T CARE ABOUT QUALITYv AND THE PHYSICIAN REPRESENTATIVE COUNTERED THAT EMPLOYERS ARE ONLY LOOKING FOR WHAT IS CHEAPEST NOT WHAT IS BEST QUALITY 4HIS DISINTEGRATION IN COMMUNICATION CAN AND MAY ALREADY HAVE BECOME AN INFECTIOUS AGENT HARMING EFFORTS TO IMPROVE THE HEALTH CARE DELIVERY SYSTEM %MPLOYER AND PHYSICIAN LEADERS MUST WORK TO SEE THAT THE INFECTION DOES NOT SPREAD FURTHER ! KEY STEP IN DOING SO IS TO ACKNOWLEDGE THAT BOTH PHYSICIANS AND EMPLOYERS ARE DEVOTED TO QUALITY SERVICES AS WE TOGETHER PURSUE COMMON DElNITIONS OF QUALITY - >Ài`Ê > ÊÎ\ 0ATIENTS %MPLOYEES MUST BECOME MORE ENGAGED IN THEIR HEALTH CARE #URRENTLY THERE IS CONSIDERABLE DEBATE ABOUT hCONSUMERISMv IN HEALTH CARE 3OME ARGUE THAT CONSUMERS AREN T INTERESTED IN BECOMING ENGAGED AND EVEN IF THEY ARE THEY RE TOO NAÉVE TO MAKE THE RIGHT CHOICE 4HESE NAYSAYERS CONTEND THAT CONSUMERS DON T PROACTIVELY CONSIDER THE IMPACT OF THEIR UNHEALTHY DECISIONS AND POINT OUT THAT MANY CONSUMERS BOTH HEALTHY AND SICK CONSUME TOO MUCH HEALTH CARE MAKING IT MORE EXPENSIVE FOR EVERYONE 4HEY ALSO CITE THE PUBLIC S hENTITLEMENT MENTALITYv EVERYBODY WANTS EVERYTHING FOR NEXT TO NOTHING v /THERS ARGUE THAT MOST CONSUMERS ADAMANTLY WANT TO BE INVOLVED IN THEIR OWN HEALTH MANAGEMENT BUT THAT THERE IS LITTLE RELIABLE INFORMATION AVAILABLE TO HELP THEM IN THEIR QUEST 4HIS CAMP WHICH USUALLY INCLUDES BOTH SMALL AND LARGE EMPLOYERS CONTENDS THAT QUALITY HEALTH CARE IS NOT APPROPRIATELY DElNED EASILY UNDERSTOOD OR ADEQUATELY MEASURED /THER BARRIERS TO CONSUMER ENGAGEMENT THAT THIS GROUP SOMETIMES LISTS ARE OUR INTEGRATED HEALTH SYSTEMS NETWORKS AND THE LACK OF COST TRANSPARENCY LIMITING BOTH CHOICE AND COST COMPARISONS ! NUMBER OF CONSUMER POLLS AND SURVEYS HAVE BEEN SPONSORED BY EMPLOYER COALITIONS TO BETTER DElNE HOW CONSUMERS CURRENTLY ARE USING AVAILABLE INFORMATION TO MAKE DECI

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SIONS 4YPICALLY THIS SURVEY RESEARCH USES THE CONSUMER S DECISION TO CHANGE HEALTH PLAN HOSPITAL OR DOCTOR AS THE LEADING IN DICATOR OF CONSUMER hINVOLVEMENT v 4HIS CHOICE OF EVALUATION ENDPOINT IS UNFORTU NATE 3WITCHING PROVIDERS DOESN T INDICATE CONSUMER EMPOWERMENT IT SIMPLY INDI CATES CONSUMER DISSATISFACTION OR CHANGE IN EMPLOYMENT STATUS 4RULY EMPOWERED CONSUMERS WOULD FEEL EQUIPPED TO HAVE AN HONEST DIALOGUE WITH THEIR DOCTOR OR CARE PROVIDER ABOUT NEEDS AND EXPECTATIONS !DDITIONALLY AS PHYSICIANS AND EMPLOYEE BENElTS MANAGERS BOTH KNOW QUALITY hINFORMATIONv IS NOT RELEVANT UNTIL HEALTH SERVICES ARE NEEDED %NLIGHTENED EMPLOYERS HAVE PROVIDED .ATIONAL #OM MITTEE FOR 1UALITY !SSURANCE ACCREDITA TION PATIENT SATISFACTION DATA EXPLANATION OF BENElTS DESIGN DIFFERENCES AND MORE )T ISN T UNTIL THE EMPLOYEE NEEDS TO ACCESS THE

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HEALTH CARE SYSTEM THAT THE INFORMATION BE COMES OF INTEREST %MPLOYEES WANT TO KNOW TYPICALLY AT THE TIME OF A MEDICAL CRISIS HOW TO PICK THE BEST PLACE AND DOCTOR TO GET THE CARE THEY NEED %MPLOYERS OF ALL SIZES WANT TO MAKE THIS INFORMATION AVAIL ABLE 4HE "UYERS (EALTH #ARE !CTION 'ROUP "(#!' AND !DVOCATES FOR -ARKETPLACE /PTIONS FOR -AINSTREET !-/- BOTH -INNESOTA BASED COALITIONS REPRESENTING LARGE AND SMALL EMPLOYERS AND PROVIDERS HAVE BEEN WORKING TOGETHER TO BRING MEANINGFUL QUALITY INFORMATION TO ALL HEALTH CARE CONSUMERS /NE INITIATIVE IS UNDERWAY IN SUPPORT OF A NATIONALLY LED PROJECT KNOWN AS ,EAP FROG 4HE ,EAPFROG 'ROUP IS WORKING TO IMPROVE PATIENT SAFETY BY ASKING HOSPITALS TO DISCLOSE INFORMATION ABOUT THREE SAFETY hLEAPSv THE USE OF COMPUTERIZED PHYSI CIAN ORDER ENTRY EMPLOYMENT OF INTEN SIVISTS AND THE PRACTICE OF EVIDENCE BASED SURGICAL REFERRAL 4HIS INFORMATION IS THEN PROVIDED TO CONSUMERS VIA WEB ACCESS (ERE IN -INNESOTA ALL HOSPITALS BOTH URBAN AND RURAL HAVE AGREED TO POST THEIR RESULTS DEMONSTRATING THEIR COM MITMENT TO HELPING THE CONSUMER MAKE INFORMED HEALTH CARE CHOICES -ORE IN FORMATION ON THE ,EAPFROG 'ROUP CAN BE FOUND AT WWW LEAPFROGGROUP ORG !NOTHER ACTIVITY THAT "(#!' IS SUPPORTING IS CONSUMER ACCESS TO QUALITY INFORMATION THROUGH THE #OMPARE 9OUR #ARE SURVEY A TOOL CREATED FOR NATIONAL USE BY &!!#4 AND SPONSORED LOCALLY BY (EALTHFRONT #OMPARE 9OUR #ARE IS AN ON LINE PATIENT SATISFACTION SURVEY THAT GIVES CONSUMERS THE OPPORTUNITY TO RATE THE CARE AND SERVICE THEY HAVE RECEIVED FROM HEALTH CARE PROVIDERS )NDIVIDUALS WHO COMPLETE THE SURVEY WILL RECEIVE VALUABLE HEALTH RE LATED INFORMATION DESIGNED TO HELP THEM UNDERSTAND THE hQUALITYv OF CARE THEY RECEIVE AND HOW TO WORK WITH THEIR CARE PROVIDER TO ENHANCE IT 4HE SURVEY CAN

BE FOUND BY ACCESSING WWW HEALTHFRONT INFO ORG AND THEN FOLLOWING THE DIRECTIONS TO THE #OMPARE 9OUR #ARE SURVEY "OTH OF THESE CONSUMER TOOLS ARE AVAILABLE BECAUSE NEW TECHNOLOGY CAPTURES THE DATA AND MAKES IT RELEVANT TO THE USER %MPLOYERS ARE ALSO USING TECHNOLOGY AND DATA TO BECOME MORE SAVVY PURCHASERS 3MALL EMPLOYER PURCHASING ALLIANCES ARE REQUIRING THAT THEIR CONTRACTED INSURERS PROVIDE THEM WITH AGGREGATE COST AND UTILIZATION DATA 4HIS INFORMATION WILL ALLOW EMPLOYERS AND EMPLOYEES TO WORK TOGETHER WITH LOCAL PROVIDERS TO ADDRESS PREVALENT HEALTH CONDITIONS OR OTHER RE GIONAL ISSUES #LEARLY EMPLOYERS ARE INTERESTED IN HEALTH IMPROVEMENT QUALITY CARE AND EMPOWERED CONSUMERS AND ARE STARTING TO DO WHAT THEY CAN TO ACHIEVE THOSE GOALS )T IS ALSO CLEAR THAT EMPLOYERS CAN ONLY GO SO FAR ON THEIR OWN 0HYSICIANS WILLING TO LEAD THEIR PROFESSION TOWARD THESE COM MON OBJECTIVES ARE NECESSARY AND POWERFUL PARTNERS IN SEEING THAT THE PATIENTS RECEIVE WHAT THEY NEED TO ACHIEVE THE BEST HEALTH OUTCOME & #AROLYN 0ARE IS #%/ OF THE "UYERS (EALTH #ARE !CTION 'ROUP "(#!' AN EMPLOYER OWNED AND EMPLOYER GOVERNED COALITION BASED IN THE 4WIN #ITIES 0ARE HAS BEEN AN ACTIVE "(#!' BOARD MEMBER SINCE WHEN SHE WAS A HU MAN RESOURCES DIRECTOR RESPONSIBLE FOR BENElTS RISK MANAGEMENT AND HUMAN RESOURCE INFORMATION SYSTEMS WITH 4ARGET #ORPORATION A FOUNDING MEMBER OF "(#!' 0ARE HAS MORE THAN YEARS OF EXPERIENCE IN BENElTS OCCUPATIONAL HEALTH AND SAFETY AND RISK MANAGEMENT %LISABETH 1UAM "ERNE IS %XECUTIVE 6ICE 0RESI DENT OF !DVOCATES FOR -ARKETPLACE /PTIONS FOR -AINSTREET !-/- A NON PROlT COALITION THAT FOSTERS MORE OPTIONS FOR HEALTH CARE PROVIDERS AND EMPLOYERS ,IZ SERVES IN HER !-/- ROLE THROUGH THE GENEROSITY OF HER FULL TIME EMPLOYER #ENTER FOR $IAGNOSTIC )MAGING WHERE SHE IS $IRECTOR OF THE #$) )NSTITUTE )N THIS ROLE SHE IS WORKING TO DEVELOP QUALITY MEASURES THAT ARE OF VALUE TO PURCHASERS 3HE IS ACTIVE IN RURAL HEALTH AND PUBLIC POLICY ISSUES

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%DITOR S .OTE 2OBERT -EICHES - $ IS THE #%/ OF THE -INNESOTA -EDICAL !SSOCIATION (E SERVED AS CHAIR OF THE --! S "OARD OF 4RUSTEES FROM AND HAS BEEN AN --! AND (ENNEPIN -EDICAL 3OCI ETY MEMBER FOR YEARS )N ADDITION $R -EICHES IS A MEMBER OF THE !-! AND THE !MERICAN 'ERIATRICS 3OCIETY (E IS A BOARD MEMBER OF -EDICAL !LLEY OF -INNESOTA AND THE -INNESOTA #ENTER FOR (EALTH #ARE %THICS 0RIOR TO HIS APPOINTMENT AS #%/ OF THE --! $R -EICHES SERVED AS THE VICE PRESIDENT OF MEDICAL AFFAIRS AND OPERATIONS AT &AIRVIEW 5NIVERSITY -EDICAL #ENTER AND &AIRVIEW (EALTH 3ERVICES $R -EICHES RECEIVED A BACHELOR OF ARTS DEGREE FROM #ARLETON #OL LEGE IN .ORTHlELD A DOCTOR OF MEDICINE DEGREE FROM THE 5NIVERSITY OF )LLINOIS !BRAHAM ,INCOLN 3CHOOL OF -EDICINE AND A MASTER S DEGREE IN BUSINESS ADMINISTRATION FROM THE 5NIVERSITY OF 3T 4HOMAS IN 3T 0AUL (E SPECIALIZES IN INTERNAL MEDICINE AND GERIATRICS 1UESTIONS WERE PROVIDED BY 4HOMAS $ 3IEFFERMAN - $ 'REGORY - 6ERCELLOTTI - $ -ICHAEL !INSLIE - $ 0AUL +ETTLER - $ +AREN $ICKSON - $ 2OBERT -ORAVEC - $ AND 7ILLIAM *ACOTT - $

7HAT NEW DIRECTIONS WILL YOU LEAD --! INTO ) AM VERY INTERESTED IN TAKING MY LEAD FROM THE MEMBERS AND ELECTED LEADERSHIP )N ADDITION TO GETTING A BETTER UNDERSTANDING OF CURRENT OPERATIONS BUDGET STAFlNG WORK ALIGNMENT ) WILL BE SPENDING A SIG NIlCANT AMOUNT OF ENERGY WORKING TO GROW OUR ADVOCACY CAPABILITIES IDENTIFYING WAYS TO BETTER MEET MEMBER NEEDS INCREASING MEMBERSHIP AND REVISITING OUR STRATEGIC DIRECTION !NY SUCCESSFUL ORGANIZATION NEEDS TO GROW AND CHANGE AND ) LOOK FORWARD TO HELPING THE --! RESHAPE ITSELF TO BE AN EVEN MORE EFFECTIVE ADVOCATE FOR PHYSICIAN MEMBERS AND FOR THE HEALTH OF OUR COMMUNITIES

7HAT DO YOU CONSIDER THE TOP PRIORITIES OF THE --! 4OP PRIORITIES OF THE --! ARE TO PROVIDE ADVOCACY ON A VAST ARRAY OF ISSUES THAT WILL HELP PHYSICIANS PROVIDE BETTER CARE TO PATIENTS 4HIS ADVO CACY COMES THROUGH COLLABORATING WITH MULTIPLE ORGANIZATIONS WORKING AT THE LEGISLATURE WITH REGULATORS AND THROUGH THE COURTS )T INVOLVES HAVING A CLEAR UNDERSTANDING OF THE STRATEGIC PRIORITIES UNDERSTANDING MEMBER PHYSICIAN NEEDS AND BEING ABLE TO DISSEMINATE KNOWLEDGE AND MOVE QUICKLY TO ADDRESS KEY ISSUES 4HE --! (OUSE OF $ELEGATES "OARD OF 4RUSTEES AND ELECTED LEADERSHIP REVIEW AND ADJUST KEY PRIORITIES $URING THE PAST LEGISLATIVE SESSION WE FOCUSED ON MANY ISSUES INCLUDING THOSE OF ACCESS TO CARE AND ELIMINATION OF THE PROVIDER TAX 7E ARE CURRENTLY WORKING HARD ON ISSUES OF TORT REFORM AND -EDICARE PAYMENTS /UR PRIMARY FOCUS WILL CONTINUE TO BE IN AREAS THAT HELP TO STRENGTHEN THE PATIENT PHYSICIAN RELATIONSHIP ADDRESS SCOPE OF PRACTICE ISSUES IMPROVE PRIVATE AND GOVERNMENT SECTOR ADVOCACY SUPPORT MEDICAL EDUCATION AND IMPROVE PUBLIC HEALTH

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#ONSIDERING THAT OUR HEALTH CARE SYSTEM IS LIKELY TO CHANGE IN FUNDAMENTAL WAYS IN THE NEXT n YEARS WHAT DO YOU FORESEE TAKING SHAPE AND HOW WILL YOU GET --! AND -INNESOTA PHYSICIANS TO BE READY /UR HEALTH CARE SYSTEM IS CONSTANTLY CHANGING -ANY OF US BELIEVE THAT THE ECONOMIC FUNDAMENTALS OF HEALTH CARE IN THE 5NITED 3TATES ARE SUBSTAN TIALLY BROKEN )T IS MY BELIEF THAT IN THE SHORT TERM WE NEED TO CONTINUE TO WORK TO IMPROVE THE SYSTEMS OF CARE BY PROVIDING EDUCATION WORKING WITH PAYERS THE LEGISLATURE REGULATORS AND OTHERS TO IMPROVE THE STATUS QUO (OWEVER IN THE INTERMEDIATE AND LONGER TERM WE NEED TO PROVIDE SIGNIlCANT LEADERSHIP TO REDESIGN THE FUNDAMENTALS OF OUR HEALTH CARE SYSTEM BECAUSE THE STATUS QUO IS NOT SUSTAINABLE )T IS MY BELIEF THAT THE --! CAN SERVE AS A CATALYST AS -INNESOTA PHYSICIANS STEP UP TO THE PLATE WITH OTHERS TO PROVIDE LEADERSHIP AND HELP EFFECT THIS CHANGE

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7HAT ARE THE TWO BIGGEST ISSUES PHYSICIANS WILL FACE IN THE NEXT lVE YEARS 7HAT CAN PHYSICIANS DO ABOUT IT 4HE lRST IS THE CONTINUED EROSION OF THE PATIENT PHYSICIAN RELATIONSHIP WHICH IS OFTEN EXPERIENCED BY PHYSICIANS AS hLOSING CONTROLv 4HIS IS THE LOSS OF AN EFFECTIVE HEALING RELATIONSHIP WHICH IS ESSENTIAL TO GOOD PATIENT CARE AND OUTCOMES 4HE SECOND ISSUE WILL BE THE CONTINUED EROSION OF THE ECONOMIC BASE LEADING TO CONTINUED PRESSURE TO DECREASE PAYMENT TO ALL HEALTH CARE PROVIDERS INCLUDING PHYSICIANS FOR THEIR SERVICES !S PHYSI CIANS WE NEED TO BE CLEAR ABOUT OUR PRIORITIES AND ADVOCATE TOGETHER TO HELP IMPROVE PATIENT CARE SYSTEMS SO THAT THEY ALLOW THE PATIENT PHYSICIAN RELATIONSHIP TO THRIVE AND ASSURE APPROPRIATE PAYMENT FOR SERVICES !S PHYSICIANS WE CAN SPEAK OUT AS INDIVIDUALS BUT TOGETHER THROUGH THE --! COMPONENT AND SPECIALTY MEDICAL SOCIETIES AND THE !-! WE CAN ENGAGE ALL PHYSICIANS AS ACTIVE PARTICIPATING MEMBERS AND BECOME MORE SUCCESSFUL IN OUR EFFORTS

-EMBERSHIP IS A SIGNIlCANT PROBLEM (OW DO YOU PLAN TO ATTRACT MORE MEMBERS 4HE -INNESOTA -EDICAL !SSOCIATION IN CONJUNCTION WITH COMPONENT MEDICAL SOCIETIES FROM AROUND THE STATE HAS JUST COMPLETED AND IS IN THE PROCESS OF REVIEWING WORK FROM A MEMBERSHIP TASK FORCE LED BY $R 0AUL -ATSON OUR PRESIDENT ELECT 4HE TASK FORCE ATTEMPTED TO UNDERSTAND KEY MEMBERSHIP ISSUES AND LEARN FROM OTHER STATE AND COUNTY SOCIETIES BEST PRACTICES FOR IMPROVING MEMBERSHIP 4HE TASK FORCE HAS MADE A NUMBER OF RECOMMENDATIONS 3OME OF THE KEY ISSUES INCLUDE 5NDERSTANDING THAT MEMBERSHIP IS MORE IMPORTANT THAN MONEY 7E SHOULD FOCUS MORE ENERGY ON HOW TO GAIN MEMBERSHIP FROM EVERY PHYSICIAN IN THE STATE RATHER THAN ON THE COST OF DUES 7E NEED TO HAVE ALL PHYSICIANS IN THE STATE BE MEMBERS OF THE --! AND COMPONENT MEDICAL SOCIETIES 7E NEED TO EXPLORE A VARIETY OF OPPORTUNITIES TO SECURE MEMBERSHIP BY OFFERING GROUP AND INDIVIDUAL DISCOUNTS 7E NEED TO DO AN EVEN BETTER JOB OF HELPING MEMBERS AND NON MEMBERS UNDERSTAND THE SERVICES PROVIDED BY THE --! AND THE TRUE VALUE OF MEMBERSHIP )NITIAL DISCUSSIONS WITH PHYSICIAN LEADERSHIP AT A NUMBER OF THE LARGE CLINICS HAVE BEEN ENCOURAGING AND THE --! WILL BE ACTIVELY ENGAGING PHYSICIANS AND PHYSICIAN LEADERS THROUGHOUT THE STATE TO ADDRESS ISSUES OF MEMBERSHIP

MEDICINE !T THE 5NIVERSITY OF -INNESOTA IN -INNEAPOLIS THERE HAS BEEN AN INCREASED EFFORT TO LINK WITH ORGANIZED MEDICINE AND AN INCREASING NUMBER OF FACULTY SERVE ON --! COMMITTEES 4HE $ULUTH FACULTY HAS HAD AN ONGOING LINKAGE WITH THE -INNESOTA -EDICAL !SSOCIATION AND IT IS MY HOPE THAT THE MEDICAL SCHOOL FACULTY AT (ENNEPIN #OUNTY -EDI CAL #ENTER WILL SEE VALUE AND INCREASE THEIR MEMBERSHIP IN THE --! AND COMPONENT MEDICAL SOCIETIES $ISCUSSION WITH SOME OF THE MEDICAL SCHOOLS AND MEDICAL SCHOOL PHYSICIAN LEADERSHIP IS OCCURRING OVER THE SUMMER

7HAT STEPS ARE YOU TAKING TO ENHANCE THE RELATIONSHIP BETWEEN --! THE COUNTY MEDICAL SOCIETIES )T IS MY FUNDAMENTAL BELIEF THAT ALL OF hMEDICINEv NEEDS TO BE WORK ING COLLABORATIVELY AND MOVING IN THE SAME DIRECTION 4HIS MEANS THAT THE --! WHICH REPRESENTS PHYSICIANS ACROSS THE STATE NEEDS TO WORK COLLABORATIVELY NOT ONLY WITH ALL COUNTY MEDICAL SOCIETIES BUT ALSO WITH SPECIALTY SOCIETIES THE -INNESOTA -EDICAL 'ROUP -ANAGEMENT !SSOCIATION AND OTHERS AS ISSUE APPROPRIATE 4HE RELATIONSHIP BETWEEN THE --! AND COMPONENT MEDICAL SOCIETIES OUTSIDE THE 4WIN #ITIES REMAINS POSITIVE AND STRONG 4HE RELATIONSHIP BETWEEN --! LEADERSHIP AND THE (ENNEPIN -EDICAL 3OCIETY AND THE 2AMSEY -EDICAL 3OCIETY HAS BEEN STRAINED OVER THE PAST FEW YEARS AND ) HAVE WORKED COLLABORATIVELY WITH 2OGER *OHNSON CHIEF EXECUTIVE OFlCER 2-3 AND *ACK $AVIS CHIEF EXECUTIVE OFlCER (-3 TO FORGE AN EVOLVING AND POSITIVE RELATIONSHIP BETWEEN THE --! AND (-3 AND 2-3 4HIS HAS INVOLVED FREQUENT DIRECT COMMUNICATIONS WHICH ARE OPEN AND HONEST A RESPECT FOR EACH OTHER S IDEAS AND AN EFFORT TO LOOK FOR WIN WIN SOLUTIONS FOR OUR COMMON MEMBERS ) BELIEVE THERE IS A COMMITMENT TO CONTINUE TO STRENGTHEN THE RELATIONSHIP TO THE BENElT OF MEMBERS OVER TIME

7HAT DO YOU ENVISION THE RELATIONSHIP BETWEEN --! THE COUNTY MEDICAL SOCIETIES TO BE IN n YEARS )T IS MY HOPE AND INTENTION TO CONTINUE TO STRENGTHEN THE RELATIONSHIP FOR THE BENElT OF MEMBERS 7HILE THE --! CLEARLY WILL TAKE THE LEAD ON THE VAST MAJORITY OF ADVOCACY ISSUES THAT AFFECT PHYSICIANS ACROSS THE STATE AT THE LEGISLATURE WITH REGULATORS AND THE COURTS THE COUNTIES HAVE AN IMPORTANT ROLE IN ADDRESSING LOCAL ISSUES AND FOCUSING ON GRASSROOTS ADVOCACY EFFORTS !LTHOUGH THERE WILL CONTINUE TO BE OVERLAP IN SOME OF THE WORK EFFORTS OF THE COUNTY AND THE --! THE MORE WE CAN ALIGN OUR EFFORTS THE MORE SUCCESSFUL WE WILL BE

7HAT ARE YOUR STRATEGIES FOR ENGAGING THE STATE S MEDICAL SCHOOLS IN ORGANIZED MEDICINE INCLUDING FACULTY RESIDENTS AND STUDENTS )N THE PAST FEW YEARS THERE HAS BEEN AN INCREASING INTEREST FROM THE STATE S MEDICAL SCHOOLS IN PARTICIPATING IN ORGANIZED MEDICINE !S AN EXAMPLE THE VAST MAJORITY OF MEDICAL STUDENTS AND A NUMBER OF RESIDENTS IN THE STATE ARE MEMBERS OF THE --! AND THEIR COMPONENT MEDICAL SOCIETIES 4HE FACULTY ORGANIZATION AT -AYO HAS LONG PROVIDED SUPPORT FOR ORGANIZED -ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃÊ

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-EDICAL !SSOCIATION --! (OUSE OF $EL EGATES PASSED 2ESOLUTION WHICH DEALT WITH A NUMBER OF VERY SENSITIVE ISSUES INCLUD ING DE UNIlCATION AND IMPROVING THE WORKING RELATIONSHIP BETWEEN THE --! AND THE COUNTY MEDICAL SOCIETIES ! TASK FORCE WAS CREATED WHICH INCLUDED REPRESENTATIVES FROM THE --! AND ALL OF THE COUNTY MEDICAL SOCIETIES $R 'RETCHEN #RARY REPRESENTED 2AMSEY -EDICAL 3OCIETY 2-3 AND $R 2ICHARD 'EBHART REP RESENTED (ENNEPIN -EDICAL 3OCIETY (-3 /THER (-3 AND 2-3 PHYSICIANS SERVED ON THIS 4ASK &ORCE AS WELL BUT IN ANOTHER CAPAC ITY 4HOSE PHYSICIANS INCLUDED $RS -ICHAEL 'ONZALEZ #AMPOY *UDITH 3HANK (ENRY 3MITH 0EGGY .AAS AND #HARLES 4ERZIAN 4HE CHARGE OF THE 4ASK &ORCE WAS TO RE VIEW RECENT NATIONAL DEVELOPMENTS AND TRENDS IN PHYSICIAN ASSOCIATION MEMBERSHIP AND STUDY ALTERNATIVE STRUCTURES FOR MEMBERSHIP IN THE --! AND COUNTY MEDICAL SOCIETIES TO MEET THE NEEDS OF ALL -INNESOTA PHYSICIANS RESIDENTS AND MEDICAL STUDENTS IN THE ST CENTURY 4HERE WERE SEVEN SPECIlC RECOMMENDATIONS THAT AC COMPANIED THE CHARGE )MPROVE THE WORKING RELATIONSHIP BETWEEN THE --! AND ALL COMPONENT MEDICAL SO CIETIES )DENTIFY NEW WAYS TO COOPERATE WITH THE COMPONENT MEDICAL SOCIETIES ON JOINT RE SPONSES TO MEMBERSHIP CHALLENGES )NVESTIGATE THE POSSIBILITY OF OFFERING DIFFER ENT MEMBERSHIP OPTIONS WHILE STILL MAIN TAINING UNIFIED ADVOCACY BY -INNESOTA PHYSICIANS )NCREASE THE VISIBILITY OF ORGANIZED MEDI CINE #OMMUNICATE THE VALUE OF ORGANIZED

9 Ê -1 Ê- //

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MEDICINE TO INDIVIDUAL PHYSICIANS AND THE LEADERSHIP OF LARGE CLINICS AND SYSTEMS %XPLORE THE DEVELOPMENT OF GRADUATED DUES STRUCTURES FOR NEW MEMBERS AND YOUNG PHY SICIANS (AVE THE --! CONSIDER APPROACHING GOVERNING BODIES OF ALL STATE MEDICAL AND SURGICAL SPECIALTY SOCIETIES WITH THE GOAL OF REGULARLY CONVENING AN --! COORDINATED JOINT MEETING OF ALL SOCIETIES 4HIS RECOM MENDATION WILL BE ADDRESSED AT A LATER TIME +NOWING THAT THE DATA WAS NEEDED IN ORDER TO CONDUCT THE ANALYSIS NECESSARY THE 4ASK &ORCE MEMBERS CREATED A SURVEY THAT WAS SENT TO ALL STATE MEDICAL ASSOCIATIONS AND LARGE COUNTY MEDICAL SOCIETIES 4HE SURVEY WAS COMPREHENSIVE AND ASKED QUESTIONS RELATED TO MEMBERSHIP TRENDS ALTERNATIVE DUES STRUCTURES COMMUNICATION VEHICLES RECRUITMENT AND RE TENTION PROGRAMS ADVOCACY AND UNIlCATION STATUS 3IXTEEN STATE MEDICAL ASSOCIATIONS AND COUNTY MEDICAL SOCIETIES RESPONDED WITH COMPLETED SURVEYS 4HE RESPONSE WAS SLIGHTLY LOWER THAN WHAT WAS DESIRED AND THE ANSWERS PROVIDED PROVED TO BE LARGELY INCONCLUSIVE (OWEVER THERE WAS SOME VERY GOOD INFORMA TION PROVIDED BY THOSE STATE ASSOCIATIONS AND COUNTY MEDICAL SOCIETIES THAT HAVE EXPERIENCED A GROWTH IN MEMBERSHIP OVER THE PAST YEARS #OLORADO +ENTUCKY -ONTANA )OWA /REGON AND )NDIANA ALL EXPERIENCED INCREASES IN REGULAR ACTIVE MEMBERSHIP AT THE STATE LEVEL (ARRIS #OUNTY IN 4EXAS !LAMEDA #ONTRA #OSTA -EDI CAL !SSOCIATION IN #ALIFORNIA AND !LLEGHENY #OUNTY -EDICAL 3OCIETY IN 0ENNSYLVANIA EXPE RIENCED INCREASES AT THE COUNTY MEDICAL SOCIETY LEVEL !LL OF THE RESPONSES WERE REVIEWED AND ANALYZED 4HE SUMMARY OBSERVATIONS OF THE RESULTS OF THE SURVEY ARE AS FOLLOWS

!SSOCIATIONS VIEWED AS hWINNERSv THOSE WITH HIGH MEMBER PENETRATION RATES SEEM TO ADD THE MOST MEMBERS (AVING MEMBERS SEEMS TO BE THE MOST IMPORTANT FACTOR IN GETTING MEMBERS 0RICE IS PROBABLY NOT A FACTOR IN DETERMINING MEMBERSHIP LEVELS h-EMBERSv ARE MORE IMPORTANT THAN MONEY 4ARGETED DUES DISCOUNT PROGRAMS THAT GEN ERATE NEW MEMBERS ARE CRITICALLY IMPORTANT TO BEING VIEWED AS SUCCESSFUL #OMMUNICATION PROGRAMS MUST REINFORCE THE MEMBERSHIP SUCCESS THEME 4ARGETED MEMBERSHIP ACTIVITIES TO NEW MEMBERS TO IMPROVE RETENTION SHOULD BE A PRIORITY 4HE -EMBERSHIP 4ASK &ORCE MET THREE TIMES FROM &EBRUARY THROUGH -AY AND DEVELOPED A SET OF RECOMMENDATIONS THAT WERE BROUGHT FORWARD AND ACCEPTED BY THE --! "OARD OF $IRECTORS AT ITS *ULY MEETING 4HE lNAL STEP WILL BE TO HAVE THE --! (OUSE OF $ELEGATES REVIEW THE -EMBERSHIP 4ASK &ORCE S REPORT AT IT UPCOMING MEETING IN 3EPTEMBER 4HE MOST SIGNIlCANT RECOMMENDATIONS IN THE REPORT INCLUDE CONTINUING UNIlED MEM BERSHIP BETWEEN THE --! AND THE COUNTY MEDICAL SOCIETIES INCREASING COMMUNICATION AND OPPORTUNITIES FOR COLLABORATION BETWEEN THE --! AND THE COUNTY MEDICAL SOCIETIES EXPLORING ALTERNATIVE DUES STRUCTURES INCREASING EMPHASIS ON MEMBERSHIP AND ADVOCACY AND ENHANCING OUR COMMUNICATION MESSAGES AND VEHICLES )F YOU ARE INTERESTED IN VIEWING THE RECOMMENDATIONS PLEASE VISIT OUR WEBSITE AT WWW METRODOCTORS COM & 3UE 3CHETTLE IS DIRECTOR OF MARKETING AND MEMBER SERVICES FOR (ENNEPIN -EDICAL 3OCIETY 2AMSEY -EDICAL 3OCIETY AND THE -INNESOTA -EDICAL !SSOCIATION

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-%$)#!2% (!3 "%%. OVERPAYING (-/S SINCE AT LEAST 4HIS CONCLUSION IS BASED ON DOZENS OF STUDIES THAT DEMONSTRATE THAT SENIORS WHO ENROLL IN -EDICARE (-/S ARE MUCH HEALTHIER THAN THE SENIORS WHO REMAIN IN FEE FOR SERVICE &&3 -EDICARE AND THAT THIS DIFFERENCE IN HEALTH CAUSES LARGE OVERPAYMENTS TO -EDICARE (-/S (ERE IS HOW THE 53 'ENERAL !CCOUNTING /FlCE SUMMARIZED THE LITERATURE ON THESE ISSUES IN A REPORT TO #ONGRESS

;.=UMEROUS STUDIES CONDUCTED BY US THE 0HYSICIAN 0AYMENT 2EVIEW #OMMISSION (#&! AND OTHERS DEMONSTRATED THAT THE -EDICARE PROGRAM SPENT MORE ON BENElCIARIES ENROLLED IN HEALTH PLANS THAN IT WOULD HAVE IF THE SAME INDIVIDUALS HAD BEEN IN &&3 4HIS UNEXPECTED RESULT OCCURRED BECAUSE -EDICARE PAYMENTS WERE BASED ON THE ESTIMATED COST OF &&3 BENElCIARIES IN AVERAGE HEALTH AND WERE NOT ADEQUATELY ADJUSTED TO REmECT THE FACT THAT PLANS TENDED TO ENROLL BENElCIARIES WITH BET TER THAN AVERAGE HEALTH x 3INCE -EDICARE S PAYMENTS TO (-/S HAVE BEEN CALCULATED AS A PERCENT OF THE COST OF INSURING THE AVERAGE &&3 -EDICARE ENROLLEE &ROM THROUGH THAT RATE WAS PERCENT BETWEEN AND THE RATE ROSE TO ABOUT PERCENT 4ODAY THE RATE IS PROBABLY HIGHER THAN PERCENT "OTH THE (OUSE AND 3ENATE -EDICARE DRUG BILLS PASSED IN LATE *UNE WOULD RAISE THIS RATE EVEN HIGHER 4ODAY THE AVERAGE COST OF INSURING &&3 -EDICARE BENElCIARIES IS ABOUT 4HAT IS ROUGHLY THE SUM THEN THAT (-/S GET TODAY

9Ê *Ê-1 6

FOR EACH SENIOR THEY LURE AWAY FROM TRADITIONAL &&3 -EDICARE 4HAT SUM IS THEN MULTIPLIED BY SIX RISK ADJUSTERS AGE GENDER DISABILITY STATUS INSTITUTIONAL STATUS WHETHER THE BENEl CIARY IS IN A NURSING HOME -EDICAID STATUS AND WORK STATUS 4HE PURPOSE OF THESE RISK ADJUSTERS IS TO REDUCE THE PAYMENT TO REmECT THE BETTER HEALTH STATUS OF THE ENROLLEES OF THE TYPICAL -EDICARE (-/ (OWEVER EXPERTS ESTIMATE THESE ADJUSTERS TOGETHER EXPLAIN ONLY TO PERCENT OF THE VARIATION IN BENElCIARY EXPENDITURES !S *OSEPH .EWHOUSE AND OTH ERS PUT IT IN A ARTICLE FOR (EALTH !FFAIRS h/N THE FACE OF IT PERCENT DOES NOT SEEM LIKE MUCH OF AN IMPROVEMENT OVER NO RISK ADJUSTMENT AT ALL AND ALTHOUGH IT IS BETTER THAN NOTHING IN FACT IT IS NOT MUCH BETTER v 4HIS MEANS IN A WORD THAT THE RISK ADJUSTERS DO VERY LITTLE TO REDUCE THE PER ENROLLEE PAYMENT TO (-/S )N TESTIMONY BEFORE #ONGRESS IN 7ILLIAM 3CANLON OF THE '!/ OFFERED THIS EXAMPLE TO ILLUSTRATE HOW THE RISK ADJUSTMENT PROCESS WORKS ;"=ENElCIARIES ARE SORTED INTO GROUPS AC CORDING TO THEIR DEMOGRAPHIC TRAITS ;AGE SEX ETC = (#&! CALCULATES A RISK FACTOR FOR EACH GROUP THE GROUP S AVERAGE COST IN RELATION TO THE COST OF ALL BENElCIARIES NATIONWIDE &OR EXAMPLE IN THE RISK FACTOR FOR YOUNGER SENIORS TO YEAR OLD MALES WAS WHEREAS FOR OLDER SENIORS YEAR OLD OR OLDER MALES IT WAS 4HE PROBLEM IS THAT SOME INDIVIDUALS WITHIN THESE AGE SEX CELLS COULD INCUR MEDICAL EXPENDITURES THAT ARE MUCH LOWER OR HIGHER THAN THESE WEIGHTS AND MULTIPLIED BY &OR EXAMPLE WITHIN THE GROUP OF TO YEAR OLD MALES SOME HEALTHY MALES

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MIGHT HAVE EXPENDITURES FAR LESS THAN TIMES WHILE OTHERS COULD INCUR EX PENDITURES MUCH HIGHER THAN TIMES ! VERY HEALTHY YEAR OLD MAN COULD INCUR NO EXPENDITURES AT ALL WHILE A YEAR OLD MAN IN NEED OF SURGERY COULD RUN UP BILLS IN THE TENS OF THOUSANDS OF DOLLARS )F THE HEALTH DIFFERENCES BETWEEN -EDI CARE &&3 AND (-/ ENROLLEES ARE LARGE AND IF THE PAYMENTS TO (-/S ARE REDUCED BY NEGLIGIBLE AMOUNTS THE RESULT WILL BE LARGE OVERPAYMENTS TO (-/S /R AS THE '!/ PUT IT h4HE lNANCIAL CONSEQUENCES OF A POOR RISK ADJUSTMENT METHODOLOGY IN THE PRESENCE OF FAVORABLE SELECTION ;A TERM WHICH MEANS AN INSURER ENROLLS PRIMARILY HEALTHY PEOPLE= ARE HUGE v (OW HUGE )T S DIFlCULT TO SAY PRECISELY BUT THE RESEARCH INDICATES (-/ OVERPAYMENTS DUE TO FAVORABLE SELECTION ARE IN THE RANGE OF TEN TO PERCENT 4HE BEST OF THE RESEARCH SUGGESTS THE OVERPAYMENT IS ON THE ORDER OF TO PERCENT WHICH WOULD MEAN THAT #-3 SHOULD BE PAYING (-/S TO PERCENT OF THE &&3 AVERAGE NOT TO PERCENT 4HE BEST RESEARCH IN THIS lELD ARE hPRIOR EXPENDITUREv STUDIES STUDIES THAT COMPARE EXPENDITURES ON A SAMPLE OF PEOPLE INSURED BY &&3 -EDICARE DURING A PERIOD OF TIME TYPI CALLY SIX MONTHS TO A YEAR BEFORE A PORTION OF THAT SAMPLE ENROLLED IN AN (-/ 0REVIOUS EXPENDITURES IS BY NO MEANS A PERFECT PREDICTOR OF FUTURE EXPENDITURES BUT IT IS SUPERIOR TO AGE SEX SELF DElNED HEALTH STATUS HISTORY OF CERTAIN DISEASES AND OTHER PREDICTORS THAT HAVE BEEN EXAMINED BY RESEARCHERS ,ET S TAKE A QUICK LOOK AT THREE PRIOR EXPENDITURE STUDIES (ERE IS HOW THE 0HYSICIAN 0AYMENT #ONTINUED ON PAGE

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-EDICARE S /VERPAYMENT TO (-/S #ONTINUED FROM PAGE

2EVIEW #OMMISSION 002# DESCRIBED WHAT MIGHT HAVE BEEN THE lRST PRIOR EXPENDITURE STUDY OF -EDICARE (-/S ! x STUDY BY %GGERS AND 0RIHODA EXAMINED THREE (-/S PARTICIPATING IN THE -EDICARE #APITATION $EMONSTRATION &ALLON #OMMUNITY (EALTH 0LAN ;IN -ASSACHUSETTS= 'REATER -ARSHFIELD #OMMUNITY (EALTH

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0LAN ;IN RURAL 7ISCONSIN= AND THE +AISER 0ERMANENTE -EDICAL 0ROGRAM OF 0ORTLAND 4HIS STUDY LOOKED AT PRE ENROLLMENT SPEND ING DURING THE PERIOD FOR AGED BENElCIARIES WHO JOINED THESE PLANS IN AND COMPARED WITH SPENDING FOR BENElCIARIES IN A FEE FOR SERVICE CONTROL GROUP !FTER ADJUSTING FOR THE RISK FACTORS USED IN -EDICARE PAYMENT THE STUDY FOUND THAT TOTAL EXPENDITURES WERE PERCENT LOWER FOR

(-/ ENROLLEES IN TWO OF THE PLANS ;&ALLON AND +AISER= AND PERCENT HIGHER IN THE THIRD PLAN ;-ARSHlELD= 4HE FACT THAT THE -ARSHlELD (-/ EN ROLLEES INCURRED EXPENDITURES ALMOST IDENTICAL TO THE &&3 CONTROL GROUP OFFERS INTERESTING INSIGHTS INTO WHY (-/S GENERALLY ENJOY FAVORABLE SELECTION 5NLIKE MOST (-/S THE -ARSHlELD (-/ SERVED A RURAL SERVICE AREA AND AS ONE EXPERT NOTED hEMPLOY;ED= ALMOST ALL PHYSICIANS IN THE AREA v (AVING ALL THE DOCTORS IN AN AREA ON THE (-/ S PANEL WOULD REDUCE THE INCENTIVE OF THE SICK TO STAY AWAY FROM THAT (-/ 4HE RELUCTANCE OF SICK PEOPLE TO GIVE UP THEIR CHOICE OF PHYSICIAN IS A MAJOR CAUSE OF FAVORABLE SELECTION !LSO OF NOTE !CCORDING TO THE 002# -ARSHFIELD hSUBSEQUENTLY DROPPED OUT OF THE ;CAPITATION= DEMONSTRATION ;PROJECT= v )N THE 002# REPORTED THE RESULTS OF A STUDY IT HAD CONDUCTED ON TOTAL SPENDING ON APPARENTLY ALL -EDICARE BENElCIARIES FROM TO h4HE RESULTS SUBSTANTIATE THE lNDINGS OF EARLIER LITERATURE v WROTE THE 002# h3PENDING BY NEW (-/ ENROLLEES WAS ONLY PERCENT OF THAT FOR BENElCIARIES IN THE FEE FOR SERVICE CONTROL GROUP IN THE SIX MONTHS BEFORE THEY JOINED AN (-/ v )N THE .EW %NGLAND *OURNAL OF -EDICINE PUBLISHED A STUDY BY -ORGAN ET AL WHICH FOUND ENORMOUS DIFFERENCES IN PRIOR HOSPITAL EXPENDITURES BETWEEN -EDI CARE &&3 SENIORS AND -EDICARE (-/ SENIORS IN &LORIDA %VEN THOUGH THE AUTHORS ADJUSTED THE EXPENDITURES WITH RISK ADJUSTERS THAT APPEARED TO BE SUPERIOR TO THOSE USED BY -EDICARE THE STUDY FOUND THAT (-/ SENIORS INCURRED ONLY IN HOSPITAL COSTS IN THE YEAR BEFORE THEY JOINED AN (-/ COMPARED TO INCURRED BY SENIORS WHO STAYED IN TRADITIONAL -EDICARE )N PERCENTAGE TERMS THE (-/ SENIORS INCURRED ON AVERAGE JUST PERCENT OF THE COSTS INCURRED BY &&3 SENIORS 4O MAKE MATTERS WORSE -ORGAN ET AL FOUND THAT THOSE SENIORS WHO ENROLLED IN (-/S TENDED TO STAY ENROLLED ONLY AS LONG AS THEY WERE HEALTHY 7HEN THEY GOT SICK THEY DISENROLLED AND RETURNED TO TRADITIONAL -EDI CARE THUS SAVING THEIR (-/S LOTS OF MONEY AND DRIVING UP THE COST OF TRADITIONAL -EDICARE 4HIS STUDY WAS ENTITLED APPROPRIATELY ENOUGH h4HE -EDICARE (-/ REVOLVING DOOR 4HE HEALTHY GO IN AND THE SICK GO OUT v

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! REASONABLE INTERPRETATION OF THE hRE VOLVING DOORv STUDY IS THAT SENIORS IN (-/S RETURNED TO TRADITIONAL -EDICARE WHEN THEY GOT SICK BECAUSE THEIR (-/ REFUSED TO GIVE THEM THE SERVICES THEY NEEDED ! SUBSEQUENT STUDY BY -ORGAN AND OTHER AUTHORS CONlRMED THAT HYPOTHESIS 4HE STUDY REPORTED THAT &LORIDA (-/ DISENROLLEES WERE FOUR TIMES AS LIKELY AS SENIORS WHO ENROLLED IN TRADITIONAL -EDICARE TO HAVE HIP AND KNEE REPLACEMENTS IN THE THREE MONTHS AFTER THEY LEFT THEIR (-/S 4HE AUTHORS CONCLUDED h4HESE DATA PROVIDE INDIRECT EVIDENCE THAT -EDICARE (-/S ARE RATIONING ;HIP AND KNEE REPLACEMENT SURGERY= AND THAT BENElCIARIES RESPOND BY RETURNING TO THE &&3 ;-EDICARE= SYSTEM TO SEEK CARE v 4HE (-/ INDUSTRY DISPUTES THESE AND OTHER STUDIES WHICH INDICATE (-/S ARE OVER PAID BY TO PERCENT BUT ITS REPRESENTATIVES CANNOT POINT TO PEER REVIEWED STUDIES TO SUP PORT THEIR CLAIM 4HEY ARGUE INSTEAD THAT THE LITERATURE MUST BE WRONG BECAUSE (-/S HAVE BEEN WITHDRAWING IN LARGE NUMBERS FROM THE -EDICARE MARKET SINCE )F (-/S WERE IN FACT OVERPAID THEY ASK WHY WOULD (-/S BE LEAVING THE -EDICARE PROGRAM !NSWER "ECAUSE THEY RE SO INEFFICIENT COMPARED TO THE CLINICS AND HOSPITALS THAT TREAT &&3 -EDICARE PATIENTS 2ECALL THAT THE THAT (-/S CURRENTLY GET FOR EACH SENIOR THEY LURE AWAY FROM &&3 -EDICARE IS BASED ON THE AMOUNT THAT &&3 -EDICARE PAYS PER &&3 BENElCIARY "UT -EDICARE DOES NOT INCLUDE IN ITS PAYMENTS TO &&3 PROVIDERS A MARKUP TO REmECT (-/ OVERHEAD COSTS MAR KETING POLICING DOCTORS PAYING MANAGEMENT HIGH SALARIES LOBBYING PROlT ETC WHICH CURRENTLY RUN ABOUT PERCENT OF REVENUES 4HAT MEANS THAT -EDICARE (-/S START IN A HOLE EQUAL TO ROUGHLY PERCENT OF THEIR -EDI CARE PAYMENT COMPARED WITH &&3 -EDICARE (-/S MOREOVER PAY THEIR PROVIDERS ABOUT PERCENT MORE THAN -EDICARE DOES 3O NOW THE HOLE THE AVERAGE (-/ HAS TO CLIMB OUT OF VIS Ü VIS &&3 -EDICARE IS ON THE ORDER OF PERCENT OF REVENUES .OW ADD ON ONE MORE BURDEN (-/S HAVE TO OFFER BETTER COVERAGE THAN &&3 -EDI CARE TO INDUCE SENIORS TO LEAVE &&3 -EDICARE !CCORDING TO THE '!/ THESE ADDITIONAL BEN ElTS COST ON THE ORDER OF PERCENT OF THEIR -EDICARE PAYMENTS .OW THE (-/S lNANCIAL HOLE RISES TO THE PERCENT OF REVENUES LEVEL

(-/S UNQUESTIONABLY OFFSET SOME OF THESE HIGHER COSTS BY CUTTING SERVICES 2ESEARCH HAS SHOWN FOR EXAMPLE THAT (-/S PROVIDE FEWER HOME VISITS CATARACT OPERATIONS AND STROKE REHABILITATION SERVICES TO SENIORS THAN &&3 -EDICARE DOES /THER RESEARCH INDICATES THAT MANY OF THESE DENIED SERVICES WERE MEDI CALLY NECESSARY &OR EXAMPLE *OHN 7ARE ET AL REPORTED THAT SENIORS ENROLLED IN (-/S ARE TWICE AS LIKELY TO SUFFER DETERIORATION IN THEIR HEALTH AS &&3 SENIORS OVER A FOUR YEAR PERIOD (OWEVER IT IS DOUBTFUL THAT THE AVERAGE (-/ HAS BEEN CUTTING SERVICES SO AGGRESSIVELY THAT IT HAS BY RATIONING ALONE OFFSET THE PERCENT OF REVENUE COST DISADVANTAGE VIS Ü VIS &&3 -EDI CARE 4HE REST OF THE HOLE ALMOST CERTAINLY HAS TO BE lLLED IN BY THE -EDICARE OVERPAYMENT 4HE LARGE (-/ OVERPAYMENTS SHOULD GREATLY CONCERN PHYSICIANS 4HESE OVERPAY MENTS COME RIGHT OUT OF FUNDS AVAILABLE TO PAY PHYSICIANS TO TREAT &&3 -EDICARE PATIENTS 3INCE WHEN 2EPUBLICANS TOOK CONTROL OF #ONGRESS AND .EWT 'INGRICH ANNOUNCED HIS

PLAN TO MAKE &&3 -EDICARE hWITHER ON THE VINE v #ONGRESS HAS GENERALLY FOLLOWED THE RULE THAT ANY INCREASED EXPENDITURES FOR ONE PART OF -EDICARE HAVE TO BE OFFSET BY CUTS ELSEWHERE IN -EDICARE 4HIS HEADLINE IN THE *UNE EDITION OF !MERICAN -EDICAL .EWS REmECTS THE ZERO SUM GAME #ONGRESS NOW FORCES PHYSICIANS TO PLAY h-EDICARE PAYMENT OUTLOOK IS DISMAL SCARCE DOLLARS MEAN THAT A BOOST FOR RURAL DOC TORS WOULD HURT OTHER PHYSICIANS AND RELIEF FROM NEXT YEAR S EXPECTED PAY CUT WILL BE TOUGH TO GET v !N OBVIOUS QUESTION FOR PHYSICIANS TO ASK IS h7HY SHOULD DOCTORS BE UNDERPAID SO (-/S CAN BE OVERPAID v 4HE !MERICAN -EDICAL !SSOCIATION AND THE -INNESOTA -EDI CAL !SSOCIATION SHOULD IMMEDIATELY MAKE TER MINATION OF THE (-/ OVERPAYMENTS A HIGH PRIORITY +IP 3ULLIVAN IS A MEMBER OF THE BOARD OF THE -INNESOTA 0HYSICIAN 0ATIENT !LLIANCE

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AND &AMILY 3UPPORT -$(&3 IS FACING A MILLION BUDGET REDUCTION FOR AND AN EVENTUAL PLANNED PHASE OUT OF ALL MIL LION GENERAL FUND SUPPORT DOLLARS BY 4HE #ITY OF -INNEAPOLIS HAS LONG PROVIDED PUBLIC HEALTH SERVICES TO ITS RESIDENTS 4HE ANNUAL REPORT FOR THE #ITY OF -IN NEAPOLIS IN THE YEAR NOTED THAT THE MOST PREVALENT PUBLIC HEALTH PROBLEMS WERE TYPHOID SCARLET FEVER MEASLES DIPHTHERIA SMALLPOX CHICKEN POX TUBERCULOSIS AND GARBAGE AC CUMULATION #ONTROLLING THESE SAME THREATS GOES ON TO THIS DAY WITH SCHOOL BASED CLINICS AND COMMUNITY CLINICS THAT ARE ON THE FRONT LINES VACCINATING OUR CHILDREN WITH REQUIRED IMMUNIZATION 4HE VERY SUCCESSFUL h.O 3HOTS .O 3CHOOLSv CAMPAIGN HAS ENSURED THAT VIR TUALLY ALL -INNEAPOLIS 0UBLIC 3CHOOL STUDENTS HAVE UP TO DATE IMMUNIZATIONS BEFORE STARTING SCHOOL 4HE NEED FOR SUCH SERVICES HAS NEVER BEEN GREATER WITH THE LARGE NUMBER OF IMMIGRANT FAMILIES RESETTLING IN -INNESOTA S LARGEST AND ONE OF THE NATION S MOST INVITING CITIES LOW UNEMPLOYMENT AGING POPULATION IN NEED OF SERVICES EXCELLENT SCHOOLS WITH A SUBSTANTIAL AMOUNT OF PUBLIC HOUSING %XAMPLES INCLUDE HIGH MEASLES RATES IN -EXICAN IMMIGRANTS AND 3OMALI FAMILIES HAVE THE HIGHEST RATE OF TUBER CULOSIS 6ACCINATION RATES FOR NEW IMMIGRANTS IS NON MEASURABLE THUS IMMIGRANT CHILDREN REQUIRE ALL THEIR VACCINATIONS BEFORE GOING TO SCHOOL /F COURSE -INNEAPOLIS HAS OTHER HEALTH CONCERNS INCLUDING FOSTERING AND SUP PORTING HEALTHY LICENSED QUALITY DAY CARE SITES REDUCING THE HIGH RATES OF 34$S HIGH INFANT MORTALITY TEEN PREGNANCIES AND REPEAT TEEN

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PREGNANCIES -OST ALARMING IS THAT PERCENT OF -INNEAPOLIS RESIDENTS LACK HEALTH INSURANCE WHICH COMPARES WITH A PERCENT RATE IN THE METRO AND STATE AREAS (EALTH DISPARITIES ARE A MAJOR FOCUS OF THE -$(&3 SINCE MOST OF THE

PROBLEMS LISTED ABOVE DISPROPORTIONATELY AFFECT THOSE WITH LOW INCOMES AND PEOPLE OF COLOR 4HE BOTTOM LINE IS THAT CITY PROPERTY TAX MILLION DOLLARS THROUGH THE GENERAL FUND SUPPORT PERCENT OF THE -$(&3 OPERATING BUDGET IN 4HESE FUNDS IN CONJUNCTION WITH PUBLIC HEALTH AND OTHER GRANTS INCLUD ING #OMMUNITY $EVELOPMENT "LOCK 'RANT #$"' FUNDING ADD UP TO MILLION DOLLARS TO SUPPLY AN IMPRESSIVE ARRAY OF SER VICES TO MANY OF THE CITIES MOST VULNERABLE RESIDENTS 0ROPOSED CUTS FOR AN EXAMPLE SEE 4ABLE ) OVER AND WOULD ELIMINATE THE #ITY OF -INNEAPOLIS ABILITY TO LEVERAGE MILLION DOLLARS ANNUALLY OF STATE AND FED ERAL FUNDS 4HAT IS FOR EACH DOLLAR THE CITY INVESTS IN ITS MOST VULNERABLE RESIDENTS 4HE CITY S MATCHED AND LEVERAGED FUNDS ARE DISTRIBUTED TO COMMUNITY HEALTH AND HUMAN

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4ABLE ) 2EDUCTIONS 7ILL /CCUR IN THE &OLLOWING !REAS .EIGHBORHOOD (EALTH .ETWORK WHICH PROVIDES CLINICAL HEALTH SERVICES TO THE UNINSURED -INNEAPOLIS SCHOOL BASED CLINICS (EALTH EDUCATION FOR PREVENTION OF ()6 !)$3 AND TEEN PREGNANCY PREVENTION #HILD #ARE (EALTH AND 3AFETY n SUPPORT TO ENCOURAGE HEALTHY DAY CARE ENVIRONMENTS AND TO MEET LICENSING STANDARDS %ARLY #HILDHOOD 3ERVICES $OMESTIC ABUSE PROJECT SERVICES )NFANT MORTALITY REDUCTION EFFORTS -ULTICULTURAL SERVICES WHICH STRIVE TO IMPROVE ACCESS TO CITY SERVICES FOR CITY RESIDENTS WITH LIMITED %NGLISH PROlCIENCY -ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃ

SERVICES AGENCIES INCLUDING THE .EIGHBORHOOD (EALTH #ARE .ETWORK AND THE -INNESOTA 6IS ITING .URSES !GENCY )N ADDITION THE #$"' FUNDS WHICH PROVIDE SUPPORT FOR HEALTH CARE FOR UNINSURED CHILDREN S DENTAL SERVICES CHILD DEVELOPMENT AND SENIOR SERVICES ARE IN DANGER OF BEING REDIRECTED TO PAY FOR OTHER CITY PRIORITIES 0ERSPECTIVE DURING HARD TIMES MUST BE PRESERVED THUS ONE SHOULD ACKNOWLEDGE THAT -$(&3 MAKES UP LESS THAN PERCENT OF THE CITY S GENERAL FUND BUDGET #UTTING -$(&3 WILL NOT SOLVE THE CITY S BUDGET PROBLEMS BUT WILL ELIMINATE SCHOOL BASED CLINICS AND MANY OTHER ESTABLISHED VALUABLE PROGRAMS WITHIN THE CITY AT A TIME WHEN THE COUNTY AND STATE GOV ERNMENT S HEALTH AND HUMAN SERVICE BUDGETS HAVE SUFFERED MAJOR CUTS 4ABLE )) 4HE #ITY OF -INNEAPOLIS PUBLIC HEALTH NEEDS ARE UNIQUE !N EXCELLENT HEALTH INFRASTRUCTURE WITHIN THE -$(&3 ALREADY EXISTS THAT IS MAINTAINED BY A SUBSTANTIAL AMOUNT OF NON PROPERTY TAX SUP PORT AND OUTSIDE MONETARY SUPPORT TO HELP THE CHILDREN SENIORS IMMIGRANTS AND MANY OTHER PEOPLE WHOM ARE CHRONICALLY SUFFERING FROM HEALTH DISPARITIES ! CALL TO ACTION IS URGENTLY NEEDED 0LEASE CONTACT -AYOR 2YBAK AND #ITY #OUNCIL MEM BERS TO EXPRESS YOUR SUPPORT AND RELAY YOUR PER SONAL CONNECTIONS OR KNOWLEDGE OF -$(&3 PROGRAMS AND THEIR VITAL MISSION 4O IMPROVE

THE PHYSICAL MENTAL AND SOCIAL HEALTH OF -INNEAPOLIS RESIDENTS THROUGH PARTNERSHIPS WITH SCHOOLS COMMUNITY AGENCIES AND OTHER GOVERNMENT ENTITIES %LECTED OFlCIALS CAN BE CONTACTED ON THE CITY S WEBSITE WWW CI MINNEAPOLIS MN US OR BY LETTER OR PHONE -AYOR 2 4 2YBAK 3OUTH TH 3TREET #ITY (ALL -INNEAPOLIS -. PHONE #OUNCIL -EMBERS 3OUTH TH 3TREET #ITY (ALL -INNEAPOLIS -. L 7ARD 0AUL /STROW 7ARD 0AUL :EBRY 7ARD $ONALD 3AMUELS 7ARD "ARBARA *OHNSON 7ARD .ATALIE *OHNSON ,EE 7ARD $EAN :IMMERMAN 7ARD ,ISA 'OODMAN 7ARD 2OBERT ,ILLIGREN 7ARD 'ARY 3CHIFF 7ARD $AN .IZIOLEK 7ARD 3COTT "ENSON 7ARD 3ANDY #OLVIN 2OY 7ARD "ARRET ,ANE

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5NEMPLOYMENT IS RISING 5NINSURED WILL RISE DUE TO 3TATE OF -INNESOTA CUTS TO '-!# AND OTHER PUBLICLY FUNDED HEALTH INSURANCE PROGRAMS 4OBACCO &UND 'RANTS AND 9OUTH 2ISK "EHAVIOR 'RANTS HAVE BEEN ELIMINATED 4!.& 4EMPORARY !SSISTANCE TO .EEDY &AMILIES IS CUT BY PERCENT !FTER SCHOOL PROGRAMS AND PUBLIC SCHOOL RESOURCES HAVE BEEN CUT "UDGET CRISIS LOOMS FOR FOR (ENNEPIN #OUNTY AND THE 3TATE (EALTH AND (UMAN 3ERVICES 0ROGRAMS

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4(% "5$'%4 02/0/3%$ BY THE GOVERNOR AND PASSED BY THE LEGISLATURE WILL SEVERELY REDUCE STATE AID TO LOCAL GOVERNMENTS AND WILL HAVE CON SIDERABLE IMPACTS ON PUBLIC HEALTH )T ALSO RADI CALLY REDUCES STATE ASSISTANCE FOR THE UNINSURED AND UNDERINSURED 4HEIR UNADDRESSED HEALTH CONDITIONS WILL EVENTUALLY BECOME PUBLIC HEALTH PROBLEMS ONE WAY OR ANOTHER )N 2AMSEY #OUNTY THERE HAVE BEEN REDUC TIONS AND LAYOFFS AT THE $EPARTMENT OF 0UBLIC (EALTH THAT HAVE SIGNIFICANTLY DECREASED THE NUMBER OF PUBLIC HEALTH EMPLOYEES

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7HAT DO THESE BUDGET CUTS MEAN FOR PUBLIC HEALTH 7ITH LESS STAFF CHANGES WILL BE NOTICEABLE IN TERMS OF EFFORT AND OUTCOME FOR DISTRESSED AND ILL GROUPS OF PEOPLE )N DIRECT SERVICE AREAS SUCH AS TUBERCULOSIS CLINICS AND IMMUNIZATION PROGRAMS FEWER WORKERS WILL BE TRYING TO DO THE SAME AMOUNT OF WORK AS BEFORE OR MORE !ND PUBLIC HEALTH NURSING PROGRAMS THAT MONITOR ELEVATED BLOOD LEAD LEVELS IN CHILDREN WILL HAVE LESS STAFF TIME AVAILABLE FOR THE EDUCATION AND HOME VISIT ING TO ACCOMPLISH THE MEDICAL FOLLOW UP AND THE ENVIRONMENTAL LEAD REDUCTION (IGH LEVEL MAN AGEMENT POSITIONS IN PUBLIC HEALTH WILL BE ELIMI NATED OR REDUCED IN MANY HEALTH DEPARTMENTS 4HE RESULT WILL BE LESS STRATEGIC THINKING AND LESS

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COMMUNITY INVOLVEMENT BY PUBLIC HEALTH LEADERS !S IT IS PUBLIC HEALTH SEEMS TO HAVE LITTLE IMPACT ON REDUCING SOCIALLY EMBEDDED PROBLEMS SUCH AS INFANT MORTALITY TOBACCO ADDICTION AND ALCOHOL USE ABUSE )N 2AMSEY #OUNTY FOR EXAMPLE THE ONE AND ONLY HEALTH EDUCATOR ASSIGNED VERY PART TIME TO TOBACCO USE REDUCTION THE NUMBER ONE CAUSE OF MORBIDITY AND MORTALITY IN THE COUNTY HAS BEEN RE ASSIGNED TO THE ENVIRONMENTAL HEALTH PROGRAM AS PART OF THE BUDGET CUTS 4OBACCO CONTROL WILL RECEIVE NO SIGNIlCANT EFFORT AT ALL FROM THE DEPARTMENT WHICH WILL RELY INSTEAD ON hCOMMUNITY PARTNERS v 4HE REAL PROBLEM FOR PUBLIC HEALTH IS THE EFFECTS OF THE DRACONIAN CUTS IN -INNESOTA S HEALTH CARE AND SUPPORT SYSTEM FOR THE UNINSURED UNDERINSURED AND JUST PLAIN EXCLUDED SUCH AS ILLEGAL ALIENS )N THE S CUTS TO THE PUBLIC HEALTH IN FRASTRUCTURE IN THE 5NITED 3TATES HELPED TO CAUSE AN UNPRECEDENTED RESURGENCE OF TUBERCULOSIS IN THIS COUNTRY 3TUDIES SHOW THAT THE SUPPLEMENTAL FOOD FOR INFANTS AND PREGNANT WOMEN IN THE 7)# PROGRAM SAVES FOR EVERY SPENT SO THE CUTS MADE IN 7)# WILL BE COSTLY IN THE LONG RUN -EASLES VACCINE HAS A COST BENElT 4HOSE EXAMPLES AND MANY OTHERS DEMONSTRATE THAT PUBLIC HEALTH IS A GET WHAT YOU PAY FOR PROPOSI TION 4ODAY S hSAVINGSv IN CUTTING THE BUDGET FOR PUBLIC HEALTH ARE TOMORROW S INCREASED COSTS FOR HEALTH CARE AND SOCIAL DYSFUNCTION 0HYSICIANS OF ALL SPECIALTIES CAN HELP THE SITUATION BY WATCHING THE EFFECTS OF THESE CUTS IN PUBLIC HEALTH AND HEALTH CARE SPENDING IN THEIR COUNTIES AND TRYING TO COMPENSATE FOR THEM 7E CAN DEMAND ANALYSIS OF THE HEALTH CONSEQUENCES OF CUTTING PUBLIC HEALTH SERVICES AND FROM LOSING HEALTH COVERAGE FOR VULNERABLE POPULATIONS 7E CAN BE AWARE OF OUR OPPORTUNITIES TO PROVIDE MORE PUBLIC HEALTH AND PREVENTIVE MESSAGES AND SERVICES TO PATIENTS AND PARENTS EVERY DAY 7E CAN NO LONGER ASSUME THAT THE HEALTH DEPARTMENT WILL DO IT & .EAL 2 (OLTAN - $ - 0 ( - ! IS MEDICAL DIRECTOR OF 3T 0AUL 2AMSEY #OUNTY $EPARTMENT OF 0UBLIC (EALTH (E IS BOARD CERTIlED IN BOTH INTERNAL AND PREVENTIVE MEDICINE

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#/.&%2%%3 (!6% "%'5. TO RECONCILE DIFFERENCES IN THE (OUSE AND 3ENATE -EDICARE BILLS 7E ARE PLEASED TO REPORT THAT THE VERY lRST ISSUE TAKEN UP BY THE CONFERENCE COMMITTEE IS ONE OF OUR LONG TIME POLICY OBJECTIVES REGULA TORY RELIEF 4HE !-! HAS BEEN WORKING CLOSELY WITH THE &EDERATION FOR SEVERAL YEARS TO ENACT MEAN INGFUL REGULATORY REFORMS MANY OF WHICH WERE lRST INCLUDED IN THE h-%2&!v BILL AGGRESSIVELY ADVOCATED BY THE PHYSICIAN COMMUNITY 4HESE REFORMS THEN PASSED THE (OUSE TWICE DURING THE TH #ONGRESS IN THE h-EDICARE 2EGULATORY AND #ONTRACTING 2EFORM !CTv -2#2! 7HILE WE CANNOT CONlRM THE EXACT DETAILS OF THE PROVI SIONS IN THE lNAL CONFERENCE REPORT UNTIL LEGISLA TIVE LANGUAGE BECOMES AVAILABLE AS DESCRIBED THE AGREEMENT REACHED BY THE #ONFEREES WILL s ,IMIT THE USE OF EXTRAPOLATION TO ONLY THOSE CASES WHERE THERE IS A SUSTAINED OR HIGH PAY MENT ERROR RATE OR DOCUMENTED EDUCATION EFFORTS HAVE FAILED s %LIMINATE PENALTIES AND INTEREST FOR PHYSI CIANS FACED WITH ALLEGED OVERPAYMENTS WHO HAVE RELIED ON WRITTEN GUIDANCE FROM -EDI CARE s %DUCATE PHYSICIANS ABOUT INCORRECT BILLING PRACTICES AND ALLOW AN OPPORTUNITY TO CORRECT ERRORS BEFORE REPAYMENT DEMANDS ARE MADE s $ELAY REPAYMENT DEMANDS UNTIL AFTER PHYSI CIAN APPEALS HAVE BEEN CONSIDERED s /FFER PHYSICIANS INSTALLMENT PLANS FOR RE PAYMENT INSTEAD OF WITHHOLDING PAYMENT OF THEIR CLAIMS s %NSURE THAT ANY NEW DOCUMENTATION GUIDE LINES FOR EVALUATION AND MANAGEMENT CODES ARE THOROUGHLY PILOT TESTED BEFORE THEY CAN BE IMPLEMENTED AS NATIONAL POLICY s 0ROHIBIT RETROACTIVE APPLICATION OF -EDICARE RULES s 2EQUIRE CARRIERS TO PROVIDE PHYSICIANS WITH CLEAR CONCISE AND ACCURATE ANSWERS TO THEIR BILLING QUESTIONS

s %NSURE THAT PREPAYMENT REVIEWS ARE TERMI

NATED IN A TIMELY MANNER INSTEAD OF CONTINU ING ENDLESSLY s 'IVE PHYSICIANS THE RIGHT TO APPEAL IF THEIR APPLICATION FOR A -EDICARE BILLING NUMBER IS DENIED s %NSURE THAT SERVICES FURNISHED UNDER THE PRUDENT LAYPERSON STANDARD AND ACCORDING TO %-4!,! REQUIREMENTS ARE COVERED BY -EDICARE iÝÌÊ-Ìi«Ã 3TAFF AND MEMBERS WILL BE WORKING THROUGHOUT THE !UGUST RECESS IN AN ATTEMPT TO RESOLVE THE NUMEROUS ISSUES THAT ARE STILL IN DISPUTE BETWEEN THE (OUSE AND 3ENATE BILLS 0LEASE HAVE YOUR GRASSROOTS MEMBERS CON TACT THEIR 3ENATORS AND 2EPRESENTATIVES AND URGE THEM TO STRESS THESE SEVERAL MAIN POINTS 4ELL 3ENATORS AND 2EPRESENTATIVES TO SUPPORT THE (OUSE PASSED PROVISION ON THE 0HYSICIAN 0AYMENT 5PDATE TO PROVIDE FOR TWO YEARS OF POSITIVE PAYMENT UPDATES RATHER THAN TWO YEARS OF CUTS WHICH WOULD BEGIN WITH A CUT OF MORE THAN PERCENT ON *ANUARY 4ELL 3ENATORS AND 2EPRESENTATIVES TO SUPPORT THE INCLUSION OF THE -EDICARE 0HYSICIAN 0AY MENT 5PDATE lX IN THE lNAL (OUSE 3ENATE #ONFERENCE 2EPORT 4ELL 3ENATORS AND 2EPRESENTATIVES TO OPPOSE THE (OUSE PASSED PROVISION THAT WOULD GIVE #-3 THE AUTHORITY TO MANDATE THAT )#$ BE ADOPTED AS THE CODING AND REPORTING STANDARD REPLACING THE #URRENT 0ROCEDURAL 4ERMINOLOGY #04 3YSTEM 3WITCHING TO )#$ WOULD ADD SIGNIlCANT lNANCIAL AND ADMINISTRATIVE COMPLEXITY RATHER THAN PRO VIDING REGULATORY RELIEF AND WOULD REQUIRE THAT PHYSICIANS MOVE FROM CODES TO A SYSTEM WITH OVER NEW CODES 4ELL 3ENATORS AND 2EPRESENTATIVES TO OPPOSE THE (OUSE PASSED PROVISION THAT WOULD MANDATE THAT PHYSICIANS BEGIN ELECTRONIC

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PRESCRIBING BY -ANDATING A COMPLEX SYSTEM SUCH AS THIS WITH VERY LITTLE TIME AND RESOURCES TO IMPLEMENT IT CONSTITUTES AN UNFUNDED MANDATE THAT COULD HAVE ADVERSE CONSEQUENCES ON CARE FOR PATIENTS 4HE 3EN ATE PROVISION DOES NOT INCLUDE A MANDATE AND WOULD INSTEAD FOCUS ON DEVELOPING STANDARDS FOR AN E PRESCRIBING SYSTEM 0LEASE HAVE YOUR GRASSROOTS MEMBERS USE THE !-! 'RASSROOTS (OTLINE OR THE !-! IN 7ASHINGTON WEB SITE WWW AMA ASSN ORG GRASSROOTS

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)NmUENZA CAUSES DEATHS AND HOSPITALIZATIONS A YEAR IN THE HIGH RISK GROUPS 4HIS IS CRIPPLING IN TERMS OF HUMAN SUFFERING AND HEALTHCARE COSTS )NmUENZA IS HOWEVER A VACCINE PREVENTABLE DISEASE 7ITH CAREFUL PLAN NING THE RATES OF PERSONS GETTING mU SHOTS CAN IMPROVE IN -INNESOTA 7HILE mU VACCINE SUPPLIES ARE STRONG THIS YEAR THE PAST FEW YEARS HAVE PRODUCED EPISODES OF DELAY IN PRODUCTION AND DISTRIBUTION OF THE VACCINE "ECAUSE PLANNING FOR THE FALL mU SHOT SEASON IS LOGISTICALLY COMPLEX THESE DELAYS WERE

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DIFlCULT FOR THE mU PROVIDERS OF THE STATE )N RESPONSE -$( HAS DEVELOPED A YEARLY mU PLAN TO GUIDE mU PLANNING 4HIS YEAR S PLAN FOLLOWS THE !#)0 #$# S !DVISORY #OMMITTEE ON )MMUNIZATION 0RAC TICES RECOMMENDATIONS FOR DELIVERY AND TIM ING OF mU SHOTS 4HE -INNESOTA $EPARTMENT OF (EALTH ALLOWS FOR SOME mEXIBILITY IN THE STATE SO mU VACCINE RESOURCES ARE NOT WASTED %VERYONE SHOULD GIVE HIGH RISK PERSONS TOP PRIORITY IN /CTOBER ALL OTHERS WHO WISH A SHOT BECOME A PRIORITY IN .OVEMBER OR LATER !VOID MISSED OPPORTUNITIES BY NOT TURNING AWAY ANYONE EVEN IF THEY DO NOT lT INTO THE PRIORITIZATION SCHEDULE

&INALLY IT IS VITALLY IMPORTANT FOR ALL HEALTHCARE WORKERS TO BE VACCINATED AS WELL AS CONTACTS OF HIGH RISK PERSONS &LU SHOTS NOT ONLY SAVE LIVES AND REDUCE HOSPITALIZATIONS BUT THEY ALSO PROTECT OTHERS 0LEASE ENCOURAGE THESE GROUPS TO BE VACCINATED !ND DON T FORGET YOUR OWN SHOT )F YOU HAVE QUESTIONS CALL THE -INNESOTA )MMUNIZATION (OTLINE AT OR /R VISIT THE -$( WEBSITE AT WWW HEALTH STATE MN US IMMUNIZE (ARRY & (ULL - $ IS THE STATE EPIDEMIOLO GIST AND DIRECTOR $IVISION OF )NFECTIOUS $ISEASE 0REVENTION AND #ONTROL -INNESOTA $EPARTMENT OF (EALTH

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6ACCINATE PERSONS AT HIGHEST RISK FOR SERIOUS INmUENZA RELATED COMPLICATIONS AND PERSONS WHO CAN TRANSMIT INmUENZA TO THEM 3EE 0RIORITY #ATEGORY BELOW

0ERSONS IN 0RIORITY #ATEGORY SEE BELOW WHEN THERE IS ADEQUATE SUPPLY

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0RIORITY #ATEGORY

0RIORITY #ATEGORIES 0ERSONS AT HIGHEST RISK FOR SERIOUS INmUENZA RELATED COMPLICATIONS INCLUDE s 0ERSONS YEARS OF AGE OR OLDER s 2ESIDENTS OF NURSING HOMES AND OTHER CHRONIC CARE FACILITIES s !DULTS AND CHILDREN WHO HAVE DIABETES HEART DISEASE ASTHMA AND OTHER CHRONIC DISORDERS OF THE PULMONARY OR CARDIOVASCULAR SYSTEMS

s !DULTS AND CHILDREN WHO REQUIRED REGULAR MEDICAL FOLLOW UP OR HOSPITALIZATION DURING THE PRECEDING YEAR BECAUSE OF CHRONIC DISEASES s #HILDREN AGE MONTHS TO YEARS WHO ARE RECEIVING LONG TERM ASPIRIN THERAPY

s 7OMEN WHO WILL BE IN THE SECOND OR THIRD TRIMESTER OF PREGNANCY DURING THE INmUENZA SEASON s #HILDREN TO MONTHS WHEN FEASIBLE 2EMEMBER CHILDREN WHO ARE UNDER YEARS OF AGE AND ARE RECEIVING VACCINE FOR THE lRST TIME NEED A BOOSTER ONE MONTH AFTER THE INITIAL DOSE 0ERSONS LIKELY TO BE HIGH RISK s 0ERSONS TO YEARS OF AGE

0RIORITY #ATEGORY

0ERSONS WHO CAN TRANSMIT INmUENZA TO THOSE AT HIGH RISK INCLUDE s 0HYSICIANS NURSES AND OTHER STAFF IN HOSPITAL AND OUTPATIENT SETTINGS s %MPLOYEES OF NURSING HOMES AND CHRONIC CARE FACILITIES WHO HAVE CONTACT WITH PATIENTS OR RESIDENTS s %MPLOYEES OF ASSISTED LIVING AND OTHER RESIDENCES FOR PERSONS IN HIGH RISK GROUPS s 0ROVIDERS OF HOME CARE TO PEOPLE AT HIGH RISK E G VISITING NURSES AND VOLUNTEER WORKERS s (OUSEHOLD CONTACTS OF PERSONS IN GROUPS AT HIGH RISK SEE ABOVE s (OUSEHOLD CONTACTS OF CHILDREN MONTHS WHEN FEASIBLE (EALTHY PERSONS YEARS OF AGE AND OLDER WHO WISH TO REDUCE THEIR LIKELIHOOD OF BECOMING ILL WITH INmUENZA INCLUDING s 0ERSONS IN INSTITUTIONAL SETTINGS E G COLLEGE STUDENTS INCARCERATED PERSONS s %MPLOYEES OF HEALTH CARE FACILITIES WHO DO NOT PROVIDE DIRECT PATIENT CARE s 0ERSONS WHO PROVIDE ESSENTIAL COMMUNITY SERVICES s (EALTHY PERSONS IN THE WORKPLACE

)SSUED BY THE -INNESOTA $EPARTMENT OF (EALTH -$( AND ENDORSED BY -INNESOTA #OALITION ON !DULT )MMUNIZATION -$( )MMUNIZATION 0RACTICES 4ASK &ORCE -ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃÊ

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AGED TO OPTIMIZE lNANCIAL REWARDS MINIMIZE RISK AND MAXIMIZE QUALITATIVE FACTORS 4HERE ARE SO MANY hPRIORITIES v NOT TO MENTION THE LITTLE CRISES THAT SEEM TO CROP UP NEARLY EVERY DAY THAT IT IS OFTEN DIFlCULT TO DECIDE WHICH PRIORITY IS MOST IMPORTANT 'IVEN THE LIMITED ADMINISTRATIVE CAPACITY OF THE TYPICAL MEDICAL PRACTICE IT IS ESSENTIAL THAT CAREFUL ATTENTION BE GIVEN TO ASSIGNING APPROPRIATE RESOURCES TO THE RELATIVELY LONG TERM GOALS OF PRACTICE PERFORMANCE 4HERE ARE PROVEN MANAGEMENT TECHNIQUES THAT CAN BE VERY HELPFUL IN A PRIORITIZING EF FORTS TO ENHANCE PRACTICE PERFORMANCE AND B ASSURING THAT IMPLEMENTED CHANGES ARE SUSTAINED 4HESE TECHNIQUES OF MANAGEMENT SCIENCE DATE BACK NEARLY HALF A CENTURY $UR ING THE DAYS OF 7ORLD 7AR )) THE STATISTICIAN 7 %DWARDS $EMING AND OTHERS PIONEERED THE USE OF METRICS TO HONE PROCESS EFlCIENCIES AND EFFECT CONTINUOUS QUALITY IMPROVEMENT &OLLOWING THE WAR THESE METHODS OF QUALITY MANAGEMENT WERE BROADLY APPLIED lRST IN THE MANUFACTURING INDUSTRIES AND MORE RECENTLY IN SERVICE BUSINESSES LIKE HEALTHCARE 4HESE METHODOLOGIES WERE AT THE ROOT OF *APANESE PRODUCT DOMINANCE THAT EMERGED IN THE S AND S AS WELL AS !MERICAN INDUSTRY S RE SPONSE TO *APANESE COMPETITION IN THE S AND S !PPLYING THESE METHODOLOGIES TO YOUR PRACTICE CAN IMPROVE YOUR BOTTOM LINE #ONSIDER THE BASIC ECONOMIC FORMULA OF A TYPICAL MEDICAL PRACTICE 0HYSICIAN #OMPENSATION 0HYSICIAN PRODUCTIVITY 8 REIMBURSEMENT /THER 2EVENUE 3OURCES %XPENSES

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)F ONE KNOWS WHAT PREVAILING STANDARDS ARE FOR EACH OF THE ABOVE FACTORS IT S EASY TO SEE HOW MANAGEMENT CAN BECOME MORE FOCUSED 4HESE PREVAILING STANDARDS OR hBENCHMARKSv MAY BE DERIVED INTERNALLY BY LOOKING AT THE HISTORI CAL PERFORMANCE OF YOUR GROUP OR EXTERNALLY BY COMPARING YOUR PERFORMANCE WITH OTHER SIMILAR MEDICAL PRACTICES 4HE BETTER THE BENCH MARK THE MORE CLEAR IT WILL BE WHERE THERE ARE OPPORTUNITIES TO ENHANCE YOUR PRACTICE ,ET S CONSIDER AN EXAMPLE 3UPPOSE YOU LOOK AT HOW YOUR GROUP HAS PERFORMED HIS TORICALLY AND YOU OBTAIN DATA PROlLING OTHER COMPARABLE GROUPS !S YOU COLLECT AND STUDY THIS DATA YOU lND IT REVEALS THAT PHYSICIAN COMPENSATION IN YOUR GROUP IS COMPARABLE TO PEER GROUPS BUT YOUR PHYSICIANS ARE SEE ING MORE PATIENTS AND GENERATING MORE 265S THAN THEIR PEERS IN OTHER GROUPS I E THEIR hPHYSICIAN PRODUCTIVITYv IS HIGHER 3INCE COMPENSATION IS COMPARABLE TO YOUR BENCH MARK BUT PRODUCTIVITY IS HIGHER YOU ARE ABLE TO SEE THAT YOUR GROUP S HIGHER PRODUCTIVITY IS BEING OFFSET BY A LOWER REIMBURSEMENT

B LACK OF OTHER REVENUES AND OR C HIGHER EXPENSES 4HIS UNDERSTANDING IS VERY IMPORTANT TO SETTING BUSINESS GOALS AND PRIORITIES 7ITH THIS INFORMATION YOU ARE ABLE TO APPRECIATE THAT YOUR GROUP IS DOING WELL IN THE QUANTITY OF WORK IT S PERFORMING WHILE ALSO RECOGNIZ ING THAT YOU HAVE AN OPPORTUNITY TO IMPROVE EITHER YOUR REIMBURSEMENT RATES COLLECTIONS ALTERNATIVE SOURCES OF REVENUE OR OVERHEAD EXPENDITURES 9OU RE CLOSER TO FOCUSING YOUR EFFORTS WHERE THEY WILL HAVE MOST BENElT FUR THER ANALYSIS WILL ALLOW YOU TO IDENTIFY STEPS THAT WILL ACTUALLY IMPROVE COMPENSATION AND ONGOING MONITORING OF THESE METRICS WILL ASSURE THAT THE IMPROVEMENT IS SUSTAINED ! MAJOR CHALLENGE TO IMPLEMENTING THIS TECHNIQUE IS lNDING GOOD BENCHMARKING DATA !S MENTIONED ABOVE A CRUDE BUT SOMETIMES EFFECTIVE APPROACH IS SIMPLY TO USE PAST EXPE RIENCE OF YOUR GROUP AND YOUR OWN INTUITION TO SET GOALS AND MEASURE IMPROVEMENT "UT IT IS OFTEN BEST TO LOOK EXTERNALLY 4HERE ARE MANY PUBLISHED SURVEYS INCLUDING THOSE BY THE -EDICAL 'ROUP -ANAGEMENT !SSOCIATION AND SPECIALTY SOCIETIES THAT CAN BE VERY HELP FUL "Y LOOKING EXTERNALLY YOU MAY lND THAT LONG HELD ASSUMPTIONS YOU VE MADE ARE ACTUALLY MISGUIDED 0ERHAPS THE BEST WAY TO OBTAIN GOOD BENCHMARKING DATA IS TO HAVE THIS INFORMATION COLLECTED ON YOUR BEHALF FROM A SMALL COHORT OF COMPARABLE MEDICAL GROUPS ! CONSULTANT OR ACCOUNTANT CAN DO THIS THROUGH A STRAIGHTFOR WARD APPROACH THAT SHOULDN T BE VERY EXPEN SIVE 4HE REASON YOU NEED SOMEONE EXTERNAL TO DO THIS FOR YOU IS THAT IT CAN HELP PROTECT YOU FROM BEING ACCUSED OF VIOLATING ANTITRUST LAWS 4HE STEPS TO DEVELOPING SPECIALTY SPECIlC LOCAL BENCHMARKING DATA ARE AS FOLLOWS %STABLISH A #OHORT ! MINIMUM COHORT OF AT LEAST FOUR MEDICAL GROUPS ARE IDENTIlED

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THAT ARE COMPARABLE TO ONE ANOTHER AND ARE WILLING TO UNDERTAKE THE BENCHMARKING PROCESS 2ElNE -ETRICS $ATA TO BE COLLECTED IS AGREED UPON )T IS POSSIBLE THAT THE GROUPS MAY DECIDE TO START WITH A LIMITED AMOUNT OF DATA AND THEN OVER TIME EXPAND THE DATA COLLECTED #OLLECTION OF $ATA %FlCIENT METHODS ARE DEVELOPED FOR COLLECTING INFORMATION FROM EACH GROUP IN THE COHORT 3OME GROUPS MAY WANT TO DO MOST OF THE WORK THEMSELVES WHILE OTHERS MAY WISH TO HAVE THE CONSUL TANT DO MOST OF THE WORK 6ALIDATE $ATA )T IS IMPORTANT THAT THE CONSULTANT ASSURE THAT THE DATA PROVIDED IS ACCURATE 4HIS CAN BE DONE THROUGH SPOT CHECKING AS WELL AS ASKING EACH GROUP TO CONlRM THAT THE COMPILED DATA IS ACCU RATE !NALYSIS 4HE CONSULTANT PUBLISHES A UNIQUE BENCHMARKING REPORT THAT COMPARES THAT GROUP S METRICS WITH SUMMARY DATA FROM THE COHORT #OMPARING TO SUMMARY DATA PROTECTS EACH GROUP S CONlDENTIALITY AND AVOIDS VIOLATION OF ANTITRUST LAWS 2EPEAT 4YPICALLY GROUPS WILL WANT TO RE PEAT THIS PROCESS ON A REGULAR BASIS PERHAPS QUARTERLY OR ANNUALLY 4HE VALUE OF QUANTIFYING THE METRICS OF GROUP PRACTICE OPERATIONS HAS BEEN DEMON STRATED CONVINCINGLY IN MANY INDUSTRIES )N TODAY S CHALLENGING PRACTICE ENVIRONMENT IT IS CRUCIAL THAT THE BUSINESS OF MEDICAL PRACTICE OPERATES AT OPTIMAL EFlCIENCY 4HIS MEANS WORKING SMARTER NOT NECESSARILY HARDER 7ORKING SMARTER REQUIRES INTELLIGENT USE OF PROVEN MANAGEMENT SCIENCE 4HE OBJECTIVE EVIDENCE BASED BENCHMARKING APPROACH TO QUALITY MANAGEMENT IS AN IMPORTANT COMPO NENT OF MANAGEMENT SCIENCE & $AVID !LLEN IS PRESIDENT OF 0RACTICE )NFORMA TION AND %VALUATION )NC IN "LOOMINGTON A CONSULTING lRM THAT DOES BENCHMARKING AND OTHER TYPES OF MANAGEMENT CONSULTING #ON TACT $AVID AT E MAIL HIM AT DAVID ALLENPIE COM OR VISIT HIS WEB SITE AT WWW ALLENPIE COM

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!T YOUR 2AMSEY -EDICAL 3OCIETY THOSE OF US THAT HAVE BEEN TRUSTED WITH THE LEADER SHIP OF THE ORGANIZATION ACTIVELY COME UP WITH SOLUTIONS TO PROBLEMS 9OUR BOARD OF DIRECTORS AND YOUR EXECUTIVE COMMITTEE MEET REGULARLY AND ACHIEVE CONSENSUS ON PRIORITIES 9ET WHEN TIME COMES TO PUT THESE SOLUTIONS INTO PLAY THE PEOPLE POWER IS LACKING 7E HAVE TRADITIONALLY RELIED ON THE STAFF OF THE 2-3 TO SEE TO IT THAT THINGS GET DONE /NE RECENT EXAMPLE WAS SECUR ING THE LOBBYING STATUS THAT ALLOWED OUR 2-3 A DIRECT VOICE AT THE LEGISLATURE !CTION IS HARD TO COME BY 7ITHOUT THE ACTIVE PARTICIPATION OF ITS MEMBERSHIP ANY OR GANIZATION IS DOOMED TO FAIL 4HUS AS ) REmECT ON THE COLLECTIVE POWER OF SEVERAL HUNDRED .ATIVE !MERICAN PHYSICIANS AND THEIR WILL TO IMPROVE ON THE CARE OF THEIR PEOPLE ) YEARN FOR THIS ACTIVISM IN OUR MEDICAL SOCIETY ) HAVE WRITTEN BEFORE THAT AT THE VERY LEAST WE SHOULD PAY DUES TO PROVIDE THE RESOURCES FOR STAFF TO ACT ON OUR BEHALF .OW WITH THE STRATEGIC PLAN NING FOR 2-3 COMING FAST ) WRITE TO REQUEST THE PERSONAL INVOLVEMENT OF EACH OF YOU MY COLLEAGUES IN PRACTICE ) BELIEVE THAT THE KEY TO SUCCESS IS UNITY AND ACTIVISM )F THERE IS AN AREA OF MEDICAL PRACTICE THAT DOES NOT PLEASE US LET S CHANGE IT 7HETHER IT IS CONTRACT NEGOTIATION RESTRICTIVE FORMULARIES EXCLUSION FROM PATIENT POOLS OR LEGISLATIVE INTRUSION ON MEDICAL PRAC TICE YOUR ACTION IS REQUIRED FOR CHANGE 2EALIZING THAT ALL OF US WORK HARD AT PROVIDING PATIENT CARE AND THAT FURTHER TIME COMMITMENTS ARE TOUGH TO ACCOMMODATE WE WILL COUNT ON ALL OF YOU TO SURRENDER A FEW MIN UTES A MONTH TO !#4 ON THE ISSUES THAT AFFECT THE WAY WE PRACTICE MEDICINE !S YOU GO FROM THE INDIVIDUAL PRACTICE OF MEDICINE TO BEING AN ADVOCATE FOR THE PROFESSION ) TRUST YOU WILL HAVE THE SENSE OF ACCOMPLISHMENT THAT ) DO #ONTINUED ON PAGE

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$R -ICHAEL 'ONZALEZ #AMPOY IS AN ADULT ENDOCRI NOLOGIST WITH !SPEN -EDICAL 'ROUP IN 7EST 3T 0AUL (E SPECIALIZES IN THE DIAGNOSIS AND TREATMENT OF DIABETES OBESITY AND OSTEOPOROSIS (E WAS BORN IN -EXICO #ITY -EXICO AND CAME TO -INNESOTA IN (E GRADUATED WITH HONORS FROM -ACALESTER #OLLEGE IN 3T 0AUL (IS - $ AND 0H $ ARE FROM -AYO -EDICAL 3CHOOL AND -AYO 'RADUATE 3CHOOL (E COMPLETED AN INTERNAL MEDICINE RESIDENCY AT THE -AYO #LINIC AND A FELLOWSHIP IN DIA BETES ENDOCRINOLOGY AND METABOLISM AT THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL (E HAS BEEN THE RECIPIENT OF NATIONAL RESEARCH AWARDS AND NATIONAL LEADERSHIP AWARDS FROM !-! 'LAXO AND THE !MERICAN !SSOCIATION OF #LINICAL %NDOCRINOLOGISTS !!#% (E CURRENTLY SERVES ON lVE !!#% STANDING COM MITTEES (E HAS A SPECIAL INTEREST IN MINORITY AND CROSS CULTURAL AFFAIRS AS HE SERVES A LARGE (ISPANIC POPULATION MANY OF WHOM DO NOT SPEAK %NGLISH mUENTLY $R -ICHAEL 'ONZALEZ #AMPOY IS ACTIVELY CONTRIBUTING TO THE WORK OF THE !-! THE --! AND THE 2AMSEY -EDICAL 3OCIETY (E IS A MEMBER OF THE 'OV ERNING #OUNCIL OF THE !-! -INORITY !FFAIRS #ONSORTIUM (E WAS ELECTED 3ECRETARY OF THE --! IN AND HE SERVES AS A MEMBER OF THE 0HYSICIANS &OUNDATION "OARD OF $IRECTORS (E IS A PAST CHAIRPERSON OF THE --! #OMMITTEE ON -INORITY AND #ROSS #ULTURAL !FFAIRS (E HAS SERVED AS A DELEGATE IN THE --! (OUSE OF $EL EGATES FOR THE PAST SIX YEARS (E IS THE CURRENT 0RESIDENT OF THE 2AMSEY -EDICAL 3OCIETY AND HE HAS CHAIRED THE 2-3 #OUNCIL ON %DUCATION 2ESOURCES #-% #OMMITTEE FOR THE PAST THREE YEARS $R 'ONZALEZ #AMPOY RESIDES IN 3UNlSH ,AKE WITH HIS WIFE "ECKY DAUGHTER !IMEE AND SONS -ICHAEL AND $AVID &

$R ,YLE 3WENSON A BOARD CERTIFIED CARDIOLOGIST AND A FELLOW IN THE !MERICAN #OLLEGE OF #ARDIOLOGY AND THE 3OCIETY FOR #ARDIAC !NGIOGRAPHY AND )NTERVEN TIONS PRACTICES WITH 3T 0AUL #ARDIOLOGY IN 3T 0AUL (E RECEIVED HIS UNDERGRADUATE DEGREE FROM .ORTH $AKOTA 3TATE 5NIVERSITY (IS MEDICAL DEGREE IS FROM THE 5NIVERSITY OF -INNESOTA !N INTERNSHIP AND RESIDENCY WERE COMPLETED AT (ENNEPIN #OUNTY -EDICAL #ENTER $R 3WENSON THEN COMPLETED A FELLOWSHIP AT /REGON (EALTH 3CI ENCES 5NIVERSITY (E IS AN !SSISTANT 0ROFESSOR AT THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL

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$R 3WENSON HAS DEMONSTRATED HIS COMMIT MENT TO THE -INNESOTA -EDICAL !SSOCIATION AND TO THE 2AMSEY -EDICAL 3OCIETY &ROM HE SERVED ON THE "OARD OF $IREC TORS OF THE -INNESOTA -EDICAL *OINT 3ERVICES /RGANIZATION --*3/ OWNED JOINTLY BY THE --! (-3 AND 2-3 (E SERVED AS --*3/ "OARD 3ECRETARY AND 6ICE #HAIRPERSON 3INCE HE HAS SERVED AS A DELEGATE TO THE --! (OUSE OF $ELEGATES )N HE WAS ELECTED TO REPRESENT THE %AST -ETRO ON THE --! "OARD OF 4RUSTEES (E HAS SERVED ON THE --! #OM MITTEE ON ,EGISLATION SINCE &ROM TO HE SERVED AS 3ECRETARY OF 2-3 AND FROM HE WAS 4REASURER OF 2-3 !FTER A YEAR AS 2-3 0RESIDENT %LECT HE WAS 0RESIDENT OF 2-3 IN $R 3WENSON LIVES IN THE (IGHLAND 0ARK AREA OF 3T 0AUL WITH HIS WIFE *ANE AND THEIR THREE CHILDREN &

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4HE lRST TASK AT HAND FOR ALL READERS IS TO MAKE THE TIME TO MEET YOUR STATE LEGISLATORS 4HE SECOND TASK AT HAND FOR ALL READERS IS TO MAKE THE TIME TO MEET YOUR FEDERAL LEGISLATORS )T STILL HOLDS THAT PHYSICIANS COMMAND RESPECT )T STILL HOLDS THAT PHYSICIANS NOT (-/S INSURANCE COMPANIES OR EMPLOYERS PUT THE INTEREST OF THE PATIENT ABOVE ALL 3O LET S MAKE IT LOUD AND CLEAR THAT WE CONTINUE TO HAVE THE INDIVIDUAL PATIENT S HEALTH AS OUR TOP PRIORITY -OVING FORWARD WE WANT OUR PATIENTS TO HAVE ACCESS TO THE HIGH QUALITY SPECIALTY CARE THAT WE CURRENTLY ENJOY IN THE STATE 4O PROTECT THIS WE MUST ACT ON 4/24 REFORM NOW 7E MUST EMPHASIZE THE THREAT THAT OUR PATIENTS FACE WHEN CERTAIN SPECIALTIES FACE EXTINCTION DUE TO INORDINATE LIABILITY COVERAGE COSTS -OVING FORWARD LET S MAKE IT CLEAR TO THE LEGISLATURE THAT MONEY GENERATING FROM TAXING PATIENTS FOR THEIR CARE A PRACTICE WHICH WE CONTINUE TO OPPOSE SHOULD BE USED ONLY FOR PATIENT CARE ,ET S MAKE IT CLEAR THAT ANY OTHER USE OF THESE FUNDS IS ./4 APPROPRIATE -OVING FORWARD LET S EDUCATE THE #HAM BER OF #OMMERCE AND THE GOVERNOR THAT FAIR CONTRACTING IS ESSENTIAL TO OPTIMAL PATIENT CARE AND WILL BE LESS COSTLY IN THE LONG RUN ,ET S HIGHLIGHT THAT THE MONEY EMPLOYERS PAY IS GO ING TO SUSTAIN TREMENDOUS BUREAUCRACIES AND NOT NECESSARILY TO PHYSICIANS NURSES AND THE COVERAGE OF MEDICATION COSTS /NCE AGAIN SETTING THE STAGE IS THE EASY PART 0ERFORMING IS WHAT WILL SELL THE SHOW

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0/,)4)#3 #!-% 50 !'!). IN A RECENT CONVERSATION ) HAD WITH AN !LLIANCE MEMBER 7E WERE DISCUSSING HOW TO BOOST MEM BERSHIP IN THE !LLIANCE AND HER MESSAGE TO ME WAS LET S FOCUS ON HAVING FUN 7E RE ALL OVERLOADED WITH INFORMATION FROM VARIOUS NEWS OUTLETS 7E DON T NEED TO BE EDUCATED WE ALREADY ARE ,ET S CENTER OUR MEETINGS ON PROVIDING MEMBERS WITH A CHANCE TO ESCAPE FROM THEIR DAILY ROUTINE AND RELAX WITH FRIENDS ) WAS SOMEWHAT SURPRISED BUT ) THOUGHT h/+ FAIR ENOUGH v (OWEVER WHAT SHE SAID NEXT ASTOUNDED ME 3HE TALKED ABOUT HER EXPERIENCE WORKING WITH AN IMPORTANT POLITICAL lGURE 3HE HADN T KNOWN WHO HE WAS PRIOR TO THEIR MEETING BUT SHE D HEARD OF HIM (E REASSURED HER THAT SHE HAD AMPLE COMPANY THAT MANY PEOPLE REALLY HAD NO IDEA WHO REPRESENTED THEM AND HOW .OW THAT SHE KNOWS HIM SHE FOLLOWS HIS ACTIVITIES .OW THAT SHE KNOWS HIM SHE KEEPS UP WITH WHAT HE DOES )T S ALL ABOUT RELATIONSHIPS 'RASSROOTS PARTICIPATION IN THE POLITICAL PROCESS IS A KEY COMPONENT FOR SUCCESS AT THE -INNESOTA #API TOL )T S IMPORTANT THAT LEGISLATORS HEAR FROM US THEIR CONSTITUENTS EVEN WHEN THEY ARE NOT IN SESSION .OW IS THE PERFECT TIME FOR YOU AND YOUR SPOUSE TO ESTABLISH OR STRENGTHEN A RELA TIONSHIP WITH THOSE WHO REPRESENT YOU IN 3T 0AUL 4HIS IS WHEN THEY CAN TAKE THE TIME TO LISTEN AND LEARN FROM YOU (ERE ARE SOME IDEAS TO GET YOU STARTED % 3ET UP A PERSONAL MEETING WITH YOUR LEGISLA TOR AT A LOCAL COFFEE SHOP % !TTEND TOWN MEETINGS OR OTHER FUNCTIONS WHERE YOUR LEGISLATOR WILL SPEAK MAKE SURE YOU INTRODUCE YOURSELF % )NVITE THEM TO YOUR SPOUSE S CLINIC OR HOS PITAL FOR A TOUR % %NCOURAGE YOUR MEDICAL SOCIETY TO INVITE THEM TO A MEETING OR % !TTEND FUNDRAISERS AND CONTRIBUTE OR VOL UNTEER TIME TO THEIR CAMPAIGN ÊÊÊÊ-i«Ìi LiÀÉ"VÌ LiÀÊÓääÎÊ

)F YOU ARE UNSURE WHO REPRESENTS YOU CONTACT THE --! AT /R GO TO THE --! WEB SITE AT WWW MMAONLINE NET AND CLICK ON h--! AT THE #APITOL v 4HERE YOU LL FIND EVERYTHING YOU NEED TO KNOW ABOUT HEALTHCARE POLICY LEGISLATORS AND HOW YOU CAN TAKE ACTION 9OU CAN ALSO lND LEGISLATOR INFOR MATION AT WWW LEG STATE MN US OR CALL THE 3EN ATE )NFORMATION /FlCE AT AND (OUSE )NFORMATION /FlCE AT 4HESE ARE SOME OF THE TOPICS OF INTEREST RIGHT NOW % 2ESTRICT THE (EALTHCARE 0ROVIDER OR h3ICKv 4AX % -AINTAIN PHYSICIAN INDEPENDENCE IN MEDI CAL DECISION MAKING % 3UPPORT TOBACCO PREVENTION EFFORTS AND % 0ROMOTE TORT REFORM !CCESS TO QUALITY HEALTHCARE IS WHAT S AT STAKE !ND THESE ISSUES AFFECT EVERYONE NOT JUST THOSE OF US WHO HAPPEN TO BE POLITICAL JUNKIES #ONSIDER THESE EXAMPLES )T WON T MATTER IF WE RE A LEADING CARDIOLO GIST THE 'OVERNOR OR A BUS DRIVER FOR -ETRO 4RANSIT 7E LL ALL SEE OUR HEALTHCARE LIMITED IF PATIENTS WAIT UNTIL THEY RE REALLY ILL AND GO TO THE HOSPITAL BECAUSE THEY DON T HAVE INSURANCE 4HERE S ONLY SO MUCH SPACE AND SO MANY MEDI CAL STAFF TO MEET THE NEEDS OF PEOPLE WHO ARE WHEELED THROUGH THE EMERGENCY ROOM DOORS %VERYONE PROVIDING MEDICAL SERVICES WILL HAVE TO PAY THE INCREASE IN THE SICK TAX COME *ANUARY WHEN IT GOES UP FROM PERCENT TO PERCENT 4HE MONEY ORIGINALLY WAS EARMARKED FOR LOW INCOME FAMILIES WITH NO HEALTH INSUR ANCE (OWEVER IT S A REGRESSIVE TAX THAT GETS PASSED ON TO THOSE WHO CAN LEAST AFFORD IT 7HAT S MORE THE FUND HAS A SURPLUS AND THE -INNESOTA LEGISLATURE AND GOVERNOR CUT ELIGIBIL ITY FOR FAMILIES TO RECEIVE THIS AID IN AN EFFORT TO SAVE STATE REVENUE 2AMSEY AND (ENNEPIN -EDICAL 3OCIETIES ARE WORKING TOGETHER TO BE SURE THAT THIS TAX ACTUALLY IS USED FOR PATIENT CARE AND NOT FOR SOME ROAD PROJECT OR OTHER STATE GOVERNMENT EXPENSE !LL PHYSICIANS HAVE TO PURCHASE MALPRAC

TICE INSURANCE 4HE COST OF THIS INSURANCE HAS SKYROCKETED IN MANY STATES FOR A VARIETY OF REA SONS PRIMARILY BECAUSE THERE S NO LIMIT OR CAP ON NON ECONOMIC DAMAGES WON IN MALPRACTICE LAWSUITS !S A RESULT MANY PHYSI CIANS IN THESE STATES ARE FORCED TO EITHER CLOSE UP SHOP AND MOVE TO ANOTHER STATE OR LEAVE THEIR PROFESSION ALL TOGETHER )N -INNESOTA WE HAVE SEVERAL SAFEGUARDS IN PLACE THAT KEEP THE RATES REASONABLE (OWEVER WE DON T HAVE A CAP ON THE NON ECONOMIC I E hPAIN AND SUFFERINGv DAMAGES THAT A JURY CAN AWARD SOMEONE SUING A PHYSICIAN ! COUPLE OF HUGE SETTLEMENTS COULD PUT OUR HEALTHCARE COMMU NITY IN JEOPARDY LIKE SO MANY OTHERS ACROSS THE COUNTRY 7HEN YOU CONTACT YOUR SENATOR AND REPRESENTATIVE BE SURE TO ADDRESS THE PERSON BY THE CORRECT TITLE I E ./4 CONGRESSMAN )NTRODUCE YOURSELF AND EXPLAIN WHY YOU D LIKE TO MEET WITH THEM (ERE ARE SOME TIPS WHEN MEETING WITH YOUR LEGISLATOR % %XPLAIN WHAT ISSUES ARE IMPORTANT TO YOU % /FFER TO BE A RESOURCE ON HEALTHCARE ISSUES OR TO HELP WITH THEIR CAMPAIGN % )F A LEGISLATOR ASKS A QUESTION YOU CAN T AN SWER ON THE SPOT SAY SO AND PROMISE TO GET BACK TO THE PERSON WITH THE INFORMATION % !LWAYS BE POLITE AND RESPECTFUL IF THEY DISAGREE WITH YOU AND % !LWAYS THANK THEM FOR THEIR EFFORTS !ND lNALLY BE SURE TO JOIN -%$0!# THE POLITICAL ACTION COMMITTEE THAT SUP PORTS CANDIDATES WHO SUPPORT THE MEDICAL PROFESSION 4HE COST IS FOR !LLIANCE MEMBERS FOR A FAMILY MEMBERSHIP PHYSICIAN SPOUSE &OR MORE INFORMATION LOG ON TO WWW MMAONLINE NET

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3).#% -%42/$/#4/23 WAS LAST PUBLISHED THE (-3 2-3 *OINT !DVOCACY #OMMITTEE HAS MET TO SET GOALS FOR THE COMING YEAR 4HE !DVO CACY #OMMITTEE IS COMPOSED OF THE EXECUTIVE COMMITTEES OF BOTH COUNTY SOCIETY BOARDS AND MEMBERS FROM (-3 AND 2-3 WHO SERVE ON THE --! ,EGISLATIVE #OMMITTEE AND THE 0RACTICE AND 0LANNING #OMMITTEE #URRENT MEMBERS ARE -ICHAEL " !INSLIE - $ *OEL 7 !RNEY - $ ,EE "EECHER - $ -ICHAEL " "ELZER - $ -ALCOLM "LUMENTHAL - $ "ENJAMIN 7 #HASKA - $ +ENNETH 7 #RABB - $ 'RETCHEN 3 #RARY - $ #HARLES % #RUTCHlELD ))) --" - $ 0ETER * $ALY - $ *ACK $AVIS $AVID , %STRIN - $ ' 3COTT 'IEBINK - $ * -ICHAEL 'ONZALEZ #AMPOY - $ 0H $ 2OGER + *OHNSON *AMES *ORDAN - $ -ORTON # +ANE - $ 0ETER ( +ELLY - $ 0AUL ! +ETTLER - $ -ICHAEL & +OCH - $ 6IRGINIA 2 ,UPO - $ -ERLE 3 -ARK - $ 4HERESA # -C#ARTHY - $ *AMES & 0ETERS - $ *AMIE $ 3ANTILLI - $ 3USAN 3CHETTLE 2ICHARD + 3IMMONS - $ ,YLE * 3WENSON - $ 0AUL - 4ANI - $ 4 -ICHAEL 4EDFORD - $ #HARLES 4ERZIAN - $ 4HEODORE 2 4HOMPSON - $ AND 0ATRICK * 7RIGHT - $ !DVANCING TORT REFORM LEGISLATION IN THE -INNESOTA LEGISLATURE IS ONE OF THE !DVOCACY #OMMITTEE S PRIORITIES DETERMINED DIRECTLY FROM YOUR INPUT DURING (-3 STRATEGIC PLANNING LAST WINTER +EY COMPONENTS OF THE LEGISLATION WILL INCLUDE LIMITING AWARDS FOR NON ECONOMIC DAM AGES AND CAPPING LEGAL FEES FOR MALPRACTICE CASES !LTHOUGH WE DO NOT FACE THE SAME CHALLENGES THAT COLLEAGUES IN 0ENNSYLVANIA 7EST 6IRGINIA AND .EVADA LIVE WITH IN -INNESOTA WE MAY BE ONLY A FEW JACKPOT JURY AWARDS AWAY FROM THE SAME PROBLEM !N EXCELLENT BILL INTRODUCED IN OUR STATE LEGISLATURE LAST SESSION DID NOT MOVE THROUGH COM MITTEES BECAUSE OF WIDESPREAD PUBLICITY RELATED TO A PATIENT WHO SUFFERED MISDIAGNOSIS OF BREAST CANCER -ANY OF US HAVE MIXED FEELINGS ABOUT LIMITING AWARDS TO PATIENTS WHO SUFFER DEBILITATING OR DISlGURING RESULTS OF MEDICAL TREATMENT AND THE HUMAN MISTAKES ASSOCIATED WITH DELIVERING CARE 3OME OF US SHARE THE PERSPECTIVE OF TRIAL LAWYERS WHO BELIEVE A PATIENT S RIGHTS ARE COMPROMISED

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BY LIMITING A JURY S OPTIONS !ND MOST OF US LOOK ING AT OTHER STATES UNDERSTAND THAT THE CURRENT SYSTEM CAN QUICKLY CURTAIL ACCESS TO CARE FOR HUGE COMMUNITIES OF PEOPLE 4HE lRST COMPONENT OF QUALITY MEDICAL CARE IS ACCESS 2ECENTLY ) WAS FORTUNATE TO HEAR AN ADDRESS BY 0HILIP + (OWARD AUTHOR OF THE BEST SELLING BOOK 4HE $EATH OF #OMMON 3ENSE (OW ,AW IS 3UFFOCATING !MERICA AND A NEW BOOK 4HE #OL LAPSE OF THE #OMMON 'OOD WHICH DETAILS HOW THE LAWSUIT CULTURE HAS UNDERMINED !MERICA S FREE DOM h)N PURSUIT OF FAIRNESS AT ANY COST WE HAVE CREATED A SOCIETY PARALYZED BY LEGAL FEAR $OCTORS ARE PARANOID AND PRINCIPALS ARE POWERLESS ,ITTLE LEAGUE COACHES SCARED OF LIABILITY STOP VOLUNTEER ING 3CHOOLS AND HOSPITALS START TO CRUMBLE 4HE COMMON GOOD FADES REPLACED BY A CACOPHONY OF PEOPLE CLAIMING THEIR INDIVIDUAL RIGHTS v 4O SAY SCHOOLS AND HOSPITALS ARE CRUMBLING IN !MERICA SOUNDS EXTREME AND ALARMIST (OWEVER A PREG NANT WOMAN IN .EVADA KNOWS THE REAL DETAILS OF THE WORLD (OWARD DESCRIBES (OWARD DESCRIBES THE ESSENTIAL IDEA OF LAW AS SETTING BOUNDARIES SO PEOPLE KNOW WHERE THEY STAND ,AW SHOULD MAKE US FEEL COMFORT ABLE DOING WHAT IS REASONABLE AND NERVOUS DOING WHAT IS WRONG ,AW SHOULD STAND FOR SOMETHING AND BE RELIABLE /UR LEGAL hRIGHTSv WERE INITIALLY DElNED TO PROTECT CITIZENS FROM EXCESSIVE USE OF STATE POWER .OW OUR LEGAL RIGHT TO SUE IS THE USE OR ABUSE OF STATE POWER BY ONE CITIZEN AGAINST ANOTHER 4HE RIGHT TO SUE SHOULD PROMOTE ON BALANCE OUR GENERAL WELFARE AND FREEDOM "UT WHOSE RIGHTS NEED TO BE PROTECTED THOSE OF THE VICTIM OR THE RIGHTS OF THE MILLIONS WHO NEED HEALTHCARE COVERAGE 7E HAVE A SYSTEM NOW IN WHICH THE LARGEST AWARDS ARE FOR CASES WHERE THE DOCTOR DID NOTHING WRONG AND THE RESULT IS DOC TORS LEAVING THE PRACTICE OF MEDICINE OR MOVING TO MORE FAVORABLE ENVIRONMENTS GOING ON STRIKE AND ORDERING DEFENSIVE DIAGNOSTIC TESTS #ONTINUED ON PAGE

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/N *UNE TH THE 3ENIOR 0HYSICIAN !SSOCIA TION HAD ITS QUARTERLY MEETING 3EVENTY l VE RETIRED PHYSICIANS AND GUESTS ATTENDED TO HEAR ->L >Ê< iÀ }]Ê ° ° SPEAK ABOUT HER EXPERIENCE AS A *EWISH TEENAGER IN 0OLAND DURING THE 3ECOND 7ORLD 7AR 3HE S WRITTEN A FASCINATING BOOK (IDING IN THE /PEN ! (OLOCAUST -EMOIR WHICH WAS THE BASIS OF HER TALK > ÊV>«ÌÕÀiÊ«À iVÌ IN CONJUNC TION WITH 2-3 AND THE --! (-3 IS ATTEMPTING TO CAPTURE ALL OF THE E MAIL ADDRESSES OF OUR MEMBERS AND NON MEMBERS 4HIS IS BEING HANDLED IN PHASES THE l RST OF WHICH IS TO PRE POPULATE E MAIL ADDRESSES OF PHYSICIANS WHO WORK WITHIN A LARGE SYSTEM 4HE SECOND PHASE WILL BE HANDLED WHEN THE --! SENDS OUT THEIR CENSUS TO CLINICS AND INDIVIDUAL PHYSICIANS 7E LL BE ASKING FOR E MAIL ADDRESSES ON THOSE FORMS

3UE 3CHETTLE AND *ACK $AVIS ATTENDED THE SUMMER CONFERENCE OF THE iÃ Ì>Ê i` V> Ê À Õ«Ê > >}iÀÊ ÃÃ V > Ì ° (-3 2-3 AND --! PRESENTED A

DISPLAY OF MEMBER BENEl TS FOR MEMBERSHIP IN ORGANIZED MEDICINE (-3 S INVOLVEMENT IN THE -INNESOTA &AIR (EALTH 0LAN #ONTRACT ING #OALITION WAS FAVORABLY RECOGNIZED *ACK $AVIS CONTINUES TO REPRESENT (-3 IN THE >À }Ê VÃÊ*À iVÌ° 0ARTICIPATING IN THE PROJECT IS 0ARK .ICOLLET -ETHODIST #UB 0HARMACY 3T -ARY S #LINIC AND %UGENE /TT - $ THEIR MEDICAL DIRECTOR #REEKSIDE &AMILY 0RACTICE 2ESIDENCY 0ROGRAM AND OTH ER COMMUNITY ORGANIZATIONS 4HE PURPOSE IS TO PROVIDE CARE FOR INDIVIDUALS WHO ARE NOT ELIGIBLE FOR GOVERNMENT PROGRAMS OR HAVE NO COVERAGE THROUGH THEIR EMPLOYER THE hFALL THROUGH THE CRACKSv POPULATION 4HE PROJECT IS BEING EXPANDED TO A LARGER GEOGRAPHIC AREA 4HE i i« Ê i` V> Ê Õ `>Ì Ê >À` OF $IRECTORS RECENTLY MET TO REVIEW THE OUTCOME OF THE SOLICITATION CAM PAIGN AND AUDITORS REPORT "OARD MEMBERS ATTENDING INCLUDED -ARVIN 3EGAL - $ (-& 0RESIDENT -ICHAEL " !INSLIE - $ $ALE 4 $OBRIN - $ *ANICE -USICH AND *OHN * 3TOLTENBERG - $ ,AST YEAR S GIVING

iÃ Ì>Ê i` V> Ê ÃÃ V >Ì ÕÃiÊ vÊ i i}>ÌiÃÊ iiÌ } 7EDNESDAY 3EPTEMBER 2OCHESTER -. $ELEGATES ARE STILL NEEDED )F YOU ARE INTERESTED OR HAVE QUESTIONS CONTACT +ATHY $ITTMER AT OR KDITTMER MNMED ORG

CAMPAIGN TOTALED -AJOR GIFTS WERE RECEIVED FROM THE MEDICAL STAFF ORGANIZA TIONS OF i i« Ê Õ ÌÞÊ i` V> Ê

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*ACK $AVIS MET WITH Ã>Ê ii THE NEW PRESIDENT OF THE -EDICAL 3TUDENT /RGANIZA TION ON THE -INNEAPOLIS #AMPUS 4HIS YEAR S MEDICAL STUDENT EVENTS INCLUDE THE l RST YEAR MEDICAL STUDENT 7i V }Ê* V V WAS HELD !UGUST AT #OMO 0ARK !LISA WOULD LIKE TO CONTINUE TO HAVE l VE OR SIX Õ V Ê ½ Ê i>À ÃÆ (ENNEPIN AND 2AMSEY -EDI CAL 3OCIETIES WILL PARTICIPATE IN THE 7 ÌiÊ

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+ -IREILLE #HAE - $ 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL $ERMATOPATHOLOGY 4WIN #ITIES $ERMATOPATHOLOGY 'RETCHEN #OLE - $ 5NIVERSITY OF ,OUISVILLE 3CHOOL OF -EDICINE )NTERNAL -EDICINE &AIRVIEW 'ERIATRIC 3ERVICES #RAIG !NDREW -ATTICKS - $ 5NIVERSITY OF 6IRGINIA 3CHOOL OF -EDICINE %MERGENCY -EDICINE .ORTH -EMORIAL (EALTH #ARE #HAD * 2ICHARDSON - $ 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL 'ENERAL 3URGERY (#-# $EPARTMENT OF 3URGERY .EIL -C$EVITT 3KEMP - $ 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL 5ROLOGY 5ROLOGICAL 3URGERY 5ROLOGY !SSOCIATES ,TD

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Ê i À > 7!9.% , (/3%4( - $ DIED -AY AT THE AGE OF (E GRADUATED FROM THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL IN AND COMPLETED HIS RESIDENCY IN INTERNAL MEDICINE FROM (E WAS ON STAFF AT THE 5 OF - THE 6! 3WEDISH AND 3T "ARNABAS (OSPITAL AND CHIEF OF STAFF AT &AIRVIEW 3OUTH DALE (OSPITAL (E WAS IN PRIVATE PRACTICE FROM $R (OSETH JOINED (-3 IN !24(52 7 )$% *2 - $ DIED *UNE (E WAS (E GRADUATED FROM THE 5NIVERSITY OF -ICHIGAN -EDICAL 3CHOOL (E PRACTICED SURGERY IN -INNEAPOLIS AT 0ARK .ICOLLET FROM UNTIL HIS RETIREMENT IN (E WAS CHIEF OF STAFF AT %ITEL (OSPITAL AND PRESIDENT OF THE -INNEAPOLIS 3URGICAL 3OCIETY $R )DE JOINED (-3 IN 4(/-!3 % 7%)%2 - $ A PSYCHIATRIST DIED *ULY AT THE AGE OF (E GRADUATED FROM 7EST 6IRGINIA 5NIVERSITY 3CHOOL OF -EDI CINE (E SPENT YEARS AT 3T 0AUL 2AMSEY AND NEARLY YEARS AT 3T -ARY S WHERE HE SPECIALIZED IN ADDICTION AND RECOVERY (IS lNAL POSITION WAS AS MEDICAL DIRECTOR OF THE 0RIDE )NSTITUTE $R 7EIER JOINED (-3 IN

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VÌ Ûi #AROLYN ! "OWLES - $ "OSTON 5NIVERSITY 3CHOOL OF -EDICINE 2HEUMATOLOGY #AROLYN "OWLES - $

,OOKING TO CREATE A JUDICIAL SYSTEM THAT BALANCES THE RIGHTS OF THE VICTIMS TO OTHERS WHO NEED HEALTH CARE (OWARD PROPOSES A NEW SYSTEM COMPRISED OF EXPERT COURTS )N EXPERT COURTS THE JUDGE HAS MEDICAL TRAINING UNDERSTANDING THAT PEOPLE ENTER THE HEALTH CARE SYSTEM BECAUSE THEY ARE SICK OR INJURED THEY ARE NOT ENTERING AT THEIR FULL CAPACITY AND THE LOSS OF CAPACITY IS NOT CAUSED BY THOSE WHO RENDER CARE !N EXPERT COURT WOULD FUNCTION WITHIN ESTABLISHED GUIDELINES SO THE LAW WOULD STAND FOR SOMETHING RELIABLE !S /LIVER 7ENDELL (OLMES HAS STATED THE BOUNDARIES OF LAWSUITS SHOULD NOT BE hA MATTER DEPENDENT UPON THE WHIM OF THE PARTICULAR JURY OR THE ELOQUENCE OF THE PARTICULAR ADVOCATE v 7HILE 0HILIP (OWARD WORKS ON A NATIONAL LEVEL WE LIVE IN A SMALL STATE WITH TREMENDOUS OPPORTUNITY TO EFFECT SIGNIlCANT CHANGE INDE PENDENT OF HIS SUCCESS OR FAILURE NATIONALLY AND INDEPENDENT OF THE FAILURE OF A NATIONAL TORT REFORM BILL "UT TO ASK THE -INNESOTA LEGISLATURE TO CREATE AN EXPERT COURT SYSTEM TO ADDRESS THE

WRONGS IN OUR SYSTEM OF LEGAL RIGHTS WOULD BE TO ASK IT TO BITE CHEW AND SWALLOW BEYOND ITS ABILITY %VEN EXPECTING PASSAGE OF -INNESOTA TORT REFORM LEGISLATION GIVEN THE POWERFUL TRIAL LAWYER LOBBY WOULD BE OPTIMISTIC %VEN SO (-3 AND 2-3 WORKING WITH THE --! ARE STARTING THE CHALLENGING TASK /UR POLITICAL EFFECTIVENESS WILL BE DEPENDENT ON OUR ACTIVE AND ENGAGED MEMBERSHIP CREATING PERSONAL RELATIONSHIPS WITH LEGISLATIVE REPRESENTATIVES )MAGINE A GATH ERING OF SEVERAL COLLEAGUES WHO LIVE IN THE SAME LEGISLATIVE DISTRICT AT ONE OF OUR HOMES FOR SOME CASUAL SOCIALIZING AND FRANK DISCUSSION WITH YOUR REPRESENTATIVE AND SENATOR .OTHING INmUENCES THE VOTES OF LEGISLATORS MORE THAN THE INFORMED OPINION OF CONSTITUENTS ,ET S LEVERAGE OUR LIMITED RESOURCES WHERE THEY CAN DO THE MOST GOOD 4HE TORT REFORM BILL IN THE -INNESOTA LEGISLATURE LAST YEAR WAS SCHEDULED FOR ITS lRST HEARINGS IN THE (OUSE #IVIL ,AW #OMMITTEE AND THE 3ENATE *UDICIARY #OMMITTEE 4HE (OUSE #IVIL ,AW #OMMITTEE MEMBERS FROM OUR DISTRICTS ARE -ARY ,IZ (OLBERG #HAIR n ,AKEVILLE #HRIS $E,A&OREST 6ICE #HAIR n !NDOVER ,EN "IERNAT $&, ,EAD n -INNEAPOLIS *OE !TKINS n )NVER 'ROVE (EIGHTS 0AUL +OHLS n 6ICTORIA 2ON ,ATZ n 3AINT ,OUIS 0ARK %RIC ,IPMAN n ,AKE %LMO 4HOMAS 0UGH n 3OUTH 3AINT 0AUL 3TEVE 3MITH n -OUND ,YNN 7ARDLOW n %AGAN 4HE 3ENATE *UDICIARY #OMMITTEE MEMBERS FROM OUR DISTRICTS ARE $ON "ETZOLD #HAIR n &RIDLEY 7ES 3KOGLUND 6ICE #HAIR n -INNEAPOLIS 7ARREN ,IMMER RANKING MINORITY MEM BER n -APLE 'ROVE 2ICHARD #OHEN n 3AINT 0AUL $AVID (ANN n %DEN 0RAIRIE *OHN -ARTY n 2OSEVILLE *ULIANNE /RTMAN n #HANHASSEN !NN 2EST n .EW (OPE 9OU CAN SEE THAT AS METROPOLITAN PHYSICIANS WE HAVE A POWERFUL OPPORTUNITY TO ADVANCE THE BILL THROUGH THE COMMITTEE STRUCTURE OF THE LEGIS LATURE !T THE SAME TIME WE WILL BE DEVELOPING THE PERSONAL RELATIONSHIPS IN POLITICS THAT ARE CRITICAL TO ADVANCING OUR GOALS REGARDING BUDGET SUPPORT OF STATE FUNDED HEALTH CARE AND FAIR CONTRACTING PRINCIPLES ,OOK FORWARD TO HEARING FROM STAFF AND MEMBERS OF THE BOARDS OF BOTH COUNTY SOCI ETIES AND FROM THE !DVOCACY #OMMITTEE ABOUT MEETINGS WITH YOUR LEGISLATORS !ND AS ALWAYS CONTACT ME TO SHARE YOUR IDEAS

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CIETY !LLIANCE 0RESIDENT *AN -USICH ASKED ME TO WRITE THIS COLUMN FOR -ETRO $OCTORS ) WAS A BIT OVERWHELMED 7HAT COULD ) POSSIBLY HAVE TO CONVEY TO THE METRO AREA DOCTORS (OWEVER A STORY CAME TO MIND !S A CHILD POET AND AUTHOR -AYA !NGELOU WAS RAPED 7HEN SHE PROVIDED INFORMATION TO THE POLICE THE MAN RESPONSIBLE WAS ARRESTED AND RELEASED AFTER ONE DAY IN JAIL 4WO DAYS LATER POLICE CAME TO HER HOME AND TOLD HER FAMILY THAT THE MAN S BODY HAD BEEN FOUND (E HAD BEEN KICKED TO DEATH 3HE THOUGHT THAT HER VOICE KILLED HIM SO SHE STOPPED TALKING ) SHARE THIS STORY TO ILLUSTRATE HOW POWER FUL A VOICE CAN BE !S A CHILD !NGELOU FELT THAT HER VOICE WAS A NEGATIVE FORCE 3HE OVERCAME THIS CHILDHOOD TRAUMA AND TODAY SHE IS CON SIDERED ONE OF THE GREAT VOICES OF CONTEMPORARY LITERATURE /UR VOICES CAN ALSO BE POWERFUL TOOLS AND THEY SHOULD SERVE AS COMPELLING FORCES IN OUR COMMUNITY &OR PHYSICIANS ) THINK THAT THE REALIZATION OF THIS FACT IS ESSENTIAL 9OU ALONE ARE THE BEST SPOKESPEOPLE FOR YOUR PROFESSION 9OU CAN EFFECTIVELY ARTICULATE THE ISSUES THAT

ARE PARAMOUNT TO YOU AND YOUR PATIENTS SO THAT POSITIVE CHANGE CAN BE AFFECTED 9OU CAN DO THIS AS AN INDIVIDUAL OR COLLECTIVELY BUT IT IS IMPORTANT THAT YOU SHARE YOUR BELIEFS AND POSITIONS IN THE AREA OF PUBLIC POLICY 9OU ALSO SERVE AS THE PRIMARY COMMUNICA TOR WITH YOUR PATIENTS ) WAS SHOCKED TO LEARN THAT LOW HEALTH LITERACY SKILLS COST OUR HEALTH SYSTEM AN ESTIMATED BILLION ANNUALLY IN UNNECESSARY DOCTOR VISITS HOSPITALIZATION AND LONGER HOSPITAL STAYS 4HERE ARE A FEW SIMPLE AP PROACHES YOU CAN USE TO HELP YOUR PATIENTS % 3IMPLIFY WRITTEN INFORMATION % !SK FOR A FAMILY MEMBER OR FRIEND TO ACCOMPANY THEM FOR DISCUSSIONS ABOUT MEDICAL CARE % /FFER TO HELP THEM WITH WRITTEN MATERI ALS % 5SE THE TEACH BACK TECHNIQUE THAT INVOLVES ASKING PATIENTS TO REPEAT INSTRUCTIONS IN THEIR OWN WORDS % 5SE PICTURES DIAGRAMS VIDEOTAPES OR OTHER VISUALS TO COMMUNICATE INFORMATION % 7HEN IF PATIENTS ARE READY TO DISCUSS THEIR READING PROBLEMS CONSIDER REFERRALS TO LOCAL LITERACY ORGANIZATIONS AND

(ENNEPIN -EDICAL 3OCIETY !LLIANCE

/PENING %VENT 3PECIAL 4OUR -INNEAPOLIS )NSTITUTE OF !RTS 4HIRD !VENUE 3OUTH -INNEAPOLIS -.

3EPTEMBER A M A M A M

'ATHER IN THE LOBBY 4OUR !RTS#AFE h$UTCH 4REATv LUNCH

!DMISSION TO THE MUSEUM IS FREE 4HE !LLIANCE IS MAKING A DONATION TO THE -PLS )NSTITUTE OF !RTS IN APPRECIATION OF THEIR DOCENTS YOU ARE INVITED TO CONTRIBUTE

1UESTIONS #ALL -ARLENE %LLIS

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#REATE A SHAME FREE ENVIRONMENT THAT EN COURAGES PATIENTS TO ASK QUESTIONS WITHOUT FEAR 4HESE SUGGESTIONS COME FROM THE (EALTH ,ITERACY )NTRODUCTORY +IT FROM THE !-! &OUN DATION AT WWW AMAFOUNDATION ORG 4HESE ARE SIMPLE SUGGESTIONS HOWEVER IT SEEMS TO ME THAT THE lNAL ONE COULD HAVE THE MOST PROFOUND IMPACT .OT ONLY DO DOCTORS NEED TO CREATE SHAME FREE ENVIRONMENTS WE ALL NEED TO DO SO /UR VOICES CAN SPEAK FOR THOSE WHO CAN NOT SPEAK FOR THEMSELVES 7E MUST SPEAK FOR THE ELDERLY THE DISADVANTAGED THE YOUNG AND THE MANY OTHERS WHO lND THEMSELVES WITHOUT A PODIUM 7E MUST SPEAK FOR DIVERSITY 7E SHOULD CELEBRATE AND SEEK OUT DIVERSITY WITHIN OUR COMMUNITY 7E MUST CREATE A CLIMATE IN WHICH CONmICTING OPINIONS LIFE STYLES CULTURES RACES AND RELIGIONS ARE VALUED 7E MUST SPEAK ABOUT OUR CONCERNS OUR HOPES AND OUR DESIRES 7E MUST CREATE A FORUM IN WHICH IDEAS WILL BE SHARED WITH EACH OTHER AND OUR LEADERS 7E MUST SPEAK RATHER THAN REMAIN SILENT 7E MUST CHALLENGE STATEMENTS OR CONCEPTS OR SLURS RATHER THAN AGREEING WITH THEM BY OUR SILENT ASSENT 4HE NUMBER ONE FEAR AMONG !MERICANS IS PUBLIC SPEAKING )T IS AT THE TOP OF A LIST THAT INCLUDES SNAKES DOG BITES AND EVEN DEATH $O NOT LET THIS FEAR SILENCE OUR VOICES *O %LLEN IS A MEMBER OF THE (ENNEPIN -EDICAL 3OCIETY !LLIANCE AND RECIPIENT OF THE #OM MUNITY 3ERVICE !WARD OF THE -INNESOTA -EDICAL !SSOCIATION !LLIANCE 3HE HAS BEEN RECOGNIZED FOR THE STRENGTH OF HER CONTRIBUTIONS TO EDUCATION HEALTH FAITH AND THE ARTS IN THE 4WIN #ITIES

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Ramsey and Hennepin Medical Societies 2004 Winter Medical Conference February 14-21, 2004 (President’s Week) Velas Vallarta Grand Suite Resort Puerto Vallarta Mexico The Velas Vallarta is located on a lush 10 acre, ocean front site, in the most exclusive area of Puerto Vallarta, “Marina Vallarta”, just 15 minutes from downtown and within walking distance of a professional 18 hole golf course. Experience the extraordinary comfort of the luxurious 1, 2 and 3 bedroom suites with a breathtaking ocean view of the magnificent Bay of Banderas, large balconies, and fully equipped kitchens.

ALL INCLUSIVE RATES (AIR,

TRANSFERS, HOTEL, MEALS, BEVERAGES,

Space is Limited: Register early to guarantee your reservation.

TAXES AND GRATUITIES)

$2,199 $1,099 $1,449 $1,149 $599

per physician/single/double per spouse/guest, double occupancy per third adult in room per child age 4-12 per child age 2-3

Deposit of $700 per person due by October 2, 2003. Educational Conference Fee not included in above pricing.

Questions or to Reserve Space? Call: Darla at Hobbit Travel (612-252-9493 ext. 3339) or RMS (612-362-3705) or Email: darlawilke@hobbittravel.com For additional information on the resort go to: www.velasvallarta.com

SURGERY COURSES

OTHER COURSES

4TH ANNU AL MIDWEST ARTHR OPLAST Y COURSE: ANNUAL ARTHROPLAST OPLASTY REVISION KNEE may 14-16, 2004

7TH ANNU AL ANTICO AGULA TION CLINICS ANNUAL ANTICOA GULATION november 6

VANCES IN TRA UMA & 68TH ANNU AL COURSE: AD TRAUMA ANNUAL ADV GER Y CRITIC AL C ARE SUR CARE SURGER GERY CRITICAL june 16-19, 2004 PEL VIC FL OOR WORKSHOP PELVIC FLOOR september 7, 2004 ENDORECT AL UL TRASONOGRAPHY ENDORECTAL ULTRASONOGRAPHY september 8, 2004 PRINCIPLES OF COL ON & RECT AL SUR GER Y COLON RECTAL SURGER GERY September 9-11, 2004 PRIMARY CARE COURSES CURRENT ISSUES IN GERIA TRIC PS YCHIA TR Y GERIATRIC PSY CHIATR TRY november 8 THORA CIC ONCOL OG Y AND PRIMAR YC ARE THORACIC ONCOLOG OGY PRIMARY CARE march 9, 2004 FAMIL Y PRA CTICE REVIEW ATE 2004 AMILY PRACTICE REVIEW:: UPD UPDA may 3-7, 2004 *unless otherwise noted, conferences take place in Twin Cities Metro Area

CME

Continuing Medical Education Medical School

Providing quality physician education for more than 65 years…

E.T ALL P ATHOL OG YS YMPOSIUM E.T.. BELL FFALL PA THOLOG OGY SYMPOSIUM november 7 3RD ANNU AL TREA TMENT OF TTOBA OBA CCO USE ANNUAL TREATMENT OBACCO 2003 FFOR OR UM ORUM november 14 9TH ANNU AL CONFERENCE: EMER GING INFECANNUAL EMERGING GING TIONS IN CLINIC AL PRA CTICE & EMER CLINICAL PRACTICE EMERGING HEAL TH THREA T S HEALTH THREAT november 21 62ND ALLER GY AND CLINIC AL IMMUNOL OG Y ALLERG CLINICAL IMMUNOLOG OGY april 23, 2004 AGING SKIN 2004 april 30, 2004 CARDIOLOGY COURSES 16th ANNU AL C ARDIA C ARRHY THMIAS: AN ANNUAL CARDIA ARDIAC ARRHYTHMIAS: INTERA CTIVE UPD ATE FFOR OR INTERNAL MEDICINE, INTERACTIVE UPDA Y PRA CTICE AND PEDIA TRICS FAMIL AMILY PRACTICE PEDIATRICS april 9, 2004 please contact our office for more information… continuing medical education 200 oak street se, suite 190 minneapolis, mn 55455 tel: 612.626.7600 or 1-800.776.8636 fax: 612.626.7766 email: cmereg@umn.edu web: w.med.umn.edu/cme