July/August 2004
Minnesota Health Plan Contracting Act House: 129 yes – 3 nay Senate: 66 yes – 0 nay Governors Signature (5/29/04)
In this issue 2004 Legislative Session Overview •
Dermatology Update •
Stark II
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-AY *UNE ISSUE OF -ETRO$OCTORS AND ITS FOUR SEPARATE OPINION PIECES ABOUT EVIDENCE BASED MEDICINE BEST PRACTICES AND PAY FOR PER FORMANCE 4HESE HEADLINES CERTAINLY REmECT THE TONE AND TENOR OF THE ARTICLES h)T S THE h3YSTEMv NOT h0OOR 1UALITYv 4HAT !ILS -EDICINEv h0AY FOR 0ERFORMANCE 7ON T )MPROVE 1UALITYxv h'OVERNMENT 0RESCRIBED @"EST 0RACTICES .OT 7HAT THE $OCTOR /RDERED v 4HERE ARE SOME POINTS WITHIN THESE ARTICLES WITH WHICH MOST EVERYONE CAN AGREE 9ES THE HEALTH CARE SYSTEM NEEDS REFORM 9ES THE GREAT MAJORITY OF DOCTORS DO THEIR BEST TO PROVIDE THE BEST POSSIBLE CARE 3TILL THE ARTICLES IGNORE AN INESCAPABLE FACT 4HERE IS n PERCENT VARIATION IN HOW CARE IS PROVIDED TO SIMILAR POPULATIONS !S A RESULT THERE IS GROWING DEMAND FOR JUST WHAT THESE ARTICLES DISPARAGE 4HE ESSENTIAL DEBATE OVER THESE ISSUES IS NOT ADVANCED BY CLAIMS SUCH AS h4HERE ARE MANY CAUSES OF MEDICAL INmATION BUT POOR QUALITY OF CLINIC CARE IS NOT AMONG THEM v 4O THE CONTRARY s ! STUDY FOR THE -IDWEST "USINESS 'ROUP ON (EALTH FOUND THAT POOR HEALTH CARE QUALITY ADDS n TO ANNUAL PER EMPLOYEE HEALTH CARE COSTS s 4HE FEDERAL #ENTERS FOR -EDICARE AND -EDICAID 3ERVICES PROJECTS THAT BY THE YEARLY COST OF POOR QUALITY CARE MAY EXCEED TRILLION MORE THAN A THIRD OF TOTAL SPENDING s ! $ECEMBER 7ALL 3TREET *OURNAL REPORT QUOTES THE CHAIRMAN OF THE )NSTITUTE FOR (EALTHCARE )MPROVEMENT AS ESTIMAT ING THAT THE NATION S ANNUAL HEALTH CARE COSTS COULD BE REDUCED TO PERCENT BY IMPROVING QUALITY AND EFlCIENCY 9Ê , -Ê < "]Ê ° °]Ê Ê/ Ê " / --]Ê ° °
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4HERE ARE NO PROPOSED LAWS UNDER WHICH hPHYSICIANS WILL ESSENTIALLY WORK FOR THE GOVERN MENT lRST AND THE PATIENT SECOND v )N FACT THE hBEST PRACTICESv BILL PASSED IN -AY BY -INNE SOTA S LEGISLATURE HAS THE STATE ENCOURAGING NOT MANDATING GUIDELINES 3IMILARLY PROVIDERS AND PLANS ARE ENCOUR AGED TO HELP EDUCATE CONSUMERS 7E ALL KNOW THAT OUTCOMES CAN CERTAINLY BE LIMITED BY AND DEPENDANT ON PATIENT BEHAVIOR 7ELL INFORMED CONSUMERS WILL IN CONCERT WITH THEIR PHYSI CIANS MAKE BETTER DECISIONS ABOUT EFlCIENT APPROPRIATE CARE 6ALID TRANSPARENT AND EVIDENCE BASED INFORMATION IS GOOD MEDICINE "Y CONTRAST ANTI BEST PRACTICES HYPERBOLE IS CONTRADICTORY TO THE PURPOSE AND PRACTICE OF MEDICINE AND CON TRADICTED BY RESEARCH THAT WE DARE NOT IGNORE s ! 2AND #ORPORATION STUDY PUBLISHED IN *UNE BY THE .EW %NGLAND *OURNAL OF -EDICINE FOUND 5 3 PATIENTS NOT GETTING ONE THIRD OF RECOMMENDED IMMUNIZATIONS ONE THIRD OF THE STANDARD MEDICINES FOR HEART DISEASE AND ONE HALF OF RECOMMEND ED DIABETES CARE s )N lNDINGS PRESENTED -AY AT THE !MERI CAN (EART !SSOCIATION S 3ECOND !NNUAL 3CIENTIlC #ONFERENCE ON #OMPLIANCE IN (EALTHCARE AND 2ESEARCH RESEARCHERS FOUND THAT ONLY PERCENT OF HEART ATTACK PATIENTS TOOK BETA BLOCKERS REGULARLY DURING THE lRST DAYS AFTER THEIR HOSPITAL DISCHARGE 3IX MONTHS LATER BARELY PERCENT WERE DESPITE EVIDENCE THAT BETA BLOCKERS HELP INCREASE LONGER TERM SURVIVAL BY UP TO PERCENT )T S NO WONDER THAT SOME OF THE NATION S MOST INmUENTIAL HEALTH CARE LEADERS COLLABORATED ON AN OPEN LETTER IN $ECEMBER S (EALTH !FFAIRS URGING GOVERNMENT EMPLOYERS AND THE HEALTH CARE INDUSTRY TO MAKE PAYMENT FOR PERFORMANCE THAT IMPROVES QUALITY OF OUTCOMES A TOP NATIONAL PRIORITY
7E BELIEVE THAT THE IMPORTANT DECISION FOR PHYSICIANS IS NOT WHETHER BUT HOW !T -EDICA WE SUPPORT THE SIX KEYS TO HEALTH CARE REFORM OUTLINED BY THE )NSTITUTE OF -EDICINE IN ITS LANDMARK REPORT h#ROSS ING THE 1UALITY #HASM ! .EW (EALTH 3YSTEM FOR THE ST #ENTURYv SAFE EFFECTIVE PATIENT CENTERED TIMELY EFlCIENT AND EQUITABLE CARE 7E SUPPORT THE WORK OF THE )NSTITUTE FOR #LINICAL 3YSTEMS )MPROVEMENT )#3) 7E BE LIEVE THAT EVIDENCE BASED GUIDELINES CAN GREATLY INCREASE THE LIKELIHOOD OF THE BEST CLINICAL OUT COMES &OLLOWING THE )#3) MODEL WE BELIEVE THESE GUIDELINES ARE BEST DEVELOPED LOCALLY BY PRACTICING PHYSICIANS REGULARLY RE REVIEWED AND UPDATED AS NEEDED 7HILE PHYSICIANS MUST AND SHOULD BE IN THE LEAD A WHITE PAPER BY THE 6ANDERBILT #ENTER FOR %VIDENCE BASED -EDICINE 6ANDERBILT 3CHOOL OF -EDICINE ACKNOWLEDGES THAT HEALTH PLANS ARE UNIQUELY ABLE TO MAKE SEVERAL MEAN INGFUL AND IMPORTANT CONTRIBUTIONS (EALTH PLANS HAVE THE DATA 0LANS ARE A PRIMARY COM MUNICATIONS INTERCHANGE BETWEEN CONSUMERS PROVIDERS AND EMPLOYERS (EALTH PLANS HAVE THE lNANCING AND PAYMENT SYSTEMS 4HERE ARE lVE KEY PLAYERS IN THE HEALTH CARE EQUATION PROVIDERS PATIENTS PAYERS EMPLOYERS PLANS AND GOVERNMENT 3URELY WE ALL SHARE IN THIS COMMON GOAL TO HAVE A HEALTH CARE SYSTEM IN WHICH WASTE IS CONTINUOUSLY DECREASED WITH THE SAVINGS USED TO IMPROVE QUALITY AND ACCESS 1UALITY FOCUSED EVIDENCE BASED MEDICINE IN NO WAY DIMINISHES THE hARTv OF MEDICINE )T ONLY INCREASES THE EFlCACY OF THE SCIENCE APPLIED TO EACH ENCOUNTER )T IS A GREAT AND GOOD GOAL ,ET S WORK TOGETHER ,ET S GET IT DONE #HARLES &AZIO - $ IS CHIEF MEDICAL OFlCER SENIOR VICE PRESIDENT -EDICA 4ED ,OFTNESS - $ IS 60 MEDICAL DIRECTOR PROVIDER RELATIONS -EDICA
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/. ! 7!2- *5,9 !&4%2.//. IN THE SUMMER OF A GROUP OF REPRESENTATIVES OF PROVIDER ORGANIZATIONS MET AT THE .ICOLLET )SLAND )NN TO TALK ABOUT THE NEED FOR LEGISLATION THAT WOULD BEGIN TO RESTORE A SEMBLANCE OF FAIRNESS TO THE CONTRACTUAL RELATIONSHIP BETWEEN HEALTH PLANS AND PROVIDERS /RGANIZED BY THE (ENNEPIN -EDICAL 3OCIETY AND THE 2AMSEY -EDICAL 3OCIETY THE INITIAL MEETING INCLUDED THE !DVOCATES FOR -ARKETPLACE /PTIONS FOR -AINSTREET !-/- THE -INNESOTA -EDICAL !SSOCIATION --! THE -INNESOTA #HIROPRACTIC !SSOCIA TION THE -INNESOTA #HAPTER OF THE !MERICAN 0HYSICAL 4HERAPY !SSOCIATION THE -INNESOTA $ENTAL !SSOCIATION THE -INNESOTA -EDICAL 'ROUP -ANAGEMENT !SSOCIATION AND THE -IN NESOTA .URSES !SSOCIATION /VER THE COURSE OF THE FOLLOWING YEAR THE ORIGINAL GROUP DECIDED THAT THE -INNESOTA &AIR (EALTH 0LAN #ONTRACTING #OALITION SHOULD BE ORGANIZED AND THAT ADDITIONAL ORGANIZATIONS SHOULD BE CONTACTED MEETINGS SHOULD BE ORGANIZED AND A GOAL SHOULD BE ESTABLISHED OF DEVELOPING LEGISLATION FOR THE 3ESSION $URING THE MONTHS OF AND MEETINGS OF THE #OALITION CONTINUED TO BE HELD AND ADDITIONAL ORGANIZATIONS SUCH AS THE -INNESOTA 0ODIATRIC -EDICAL !SSOCIATION THE -INNESOTA 0HYSICIAN 0ATIENT !LLIANCE THE -INNESOTA 0SYCHIATRIC 3OCIETY THE -INNESOTA 2URAL (EALTH #OOPERATIVE AND THE .ORTHWESTERN (EALTH 3CIENCES 5NIVERSITY BECAME ACTIVE MEMBERS OF THE #OALITION 4HE --! DID PARTICIPATE IN SOME OF THE #OALITION MEETINGS AND DECIDED NOT TO JOIN AS A MEMBER AT THAT TIME !S THE SOUND OF THE OPENING GAVEL OF THE 3ESSION OF THE -INNESOTA ,EGISLATURE CAME CLOSER THE MEMBERS OF THE #OALITION ROLLED UP THEIR COLLECTIVE SLEEVES AND BEGAN TO CRAFT A BILL -EETINGS WERE HELD WITH GREATER FREQUENCY AND INTENSITY %ACH PROVIDER GROUP BROUGHT THEIR PARTICULAR PERSPECTIVE ON HEALTH PLAN CONTRACTING ISSUES TO THE TABLE #OALITION #HAIR 0HIL 2IVE NESS PROVED TO BE AN EXCELLENT CHOICE TO CHAIR THE INITIAL EFFORTS OF THE #OALITION AS HE SERVED IN THE 3TATE 3ENATE AND WORKS AS A CLINIC ADMINISTRATOR AT THE .ORAN #LINIC IN -INNEAPOLIS ! BILL WAS DRAFTED AND 3ENATOR $ALLAS 3AMS FROM 3TAPLES AND 2EPRESENTATIVE ,INDA "OU DREAU FROM &ARIBAULT AGREED TO BE CHIEF AUTHORS IN THE 3ENATE AND IN THE (OUSE (OUSE lLE AND 3ENATE lLE WAS TITLED THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT 4HE --! DECIDED TO TAKE NO POSITION ON THE BILL DUE TO CONCERNS ABOUT CONSUMER DISCLOSURE AND HEALTH PLAN LIABILITY PROVISIONS 2EPRESENTATIVE "OUDREAU SUCCESSFULLY STEERED THE BILL THROUGH ITS INITIAL HEARING IN THE (OUSE (EALTH AND (UMAN 3ERVICE 0OLICY #OMMITTEE 4HE OPPONENTS OF THE BILL THE #OUNCIL OF (EALTH 0LANS AND THE -INNESOTA #HAMBER OF #OMMERCE TESTIlED THAT THE PROVIDER GROUPS IN THE #OALITION WERE A FRINGE GROUP AND THAT NO LEGISLATION WAS NEEDED 0ASSAGE OF THE BILL OUT OF THE lRST (OUSE #OMMITTEE WAS VIEWED AS AN ACHIEVEMENT THAT GOT THE ATTENTION OF THOSE WHO SAID THE BILL WOULD NEVER RECEIVE SERIOUS CONSIDERATION 4HAT
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SUCCESS WAS FOLLOWED BY THE BILL CLEARING THE (OUSE #OMMERCE *OBS AND %CONOMIC $EVELOP MENT 0OLICY #OMMITTEE !LL THE MEMBERS OF THE #OALITION THEN FOCUSED ON WORKING TOGETHER TO PASS THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT IN THE 3ENATE AS THE BILL MOVED TO THE 3ENATE (EALTH AND &AMILY 3ECURITY #OMMITTEE 4HE BILL CONTINUED TO FACE STIFF OPPOSITION FROM THE #OUNCIL OF (EALTH 0LANS AND THE -INNESOTA #HAMBER OF #OMMERCE 4HE INCREASING OPTIMISM THAT MEMBERS OF THE #OALITION FELT AFTER THE BILL MOVED OUT OF THE 3ENATE (EALTH AND &AMILY 3ECURITY #OMMITTEE SOON TURNED INTO FRUSTRATION WHEN 3ENATOR ,INDA 3CHEID CHAIR OF THE 3ENATE #OMMERCE AND 5TILITIES #OMMITTEE REFUSED TO GIVE THE BILL A HEARING !S A RESULT THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT DIED IN THE 3ESSION WHEN ALL THE COMMITTEE DEADLINES COULD NOT BE MET DUE TO 3ENATOR 3CHEID S DECISION NOT TO HEAR THE BILL 4HE #OALITION DID ACHIEVE ONE MAJOR ACCOMPLISHMENT IN THE 3ESSION BY BLOCKING THE ATTEMPT TO MOVE THE COVERAGE OF CARE OF INJURED VICTIMS OF AUTO ACCIDENTS INTO MANAGED CARE NETWORKS #OALITION BACKED 3ENATE &ILE ADOPTED BY THE ,EGISLATURE PREVENTS HEALTH PLANS FROM FORCING PHYSICIANS UNDER CONTRACT INTO NETWORKS TO CARE FOR INJURED PERSONS COVERED BY NO FAULT AUTO INSURANCE 4HAT LEGISLATION SUPPORTED BY THE AUTO CARRIERS WORKING WITH THE MAJOR HEALTH PLANS WOULD HAVE EFFECTIVELY REDUCED REIMBURSEMENTS TO PHYSICIANS BY PERCENT 4HE MEMBERS OF THE -INNESOTA &AIR (EALTH 0LAN #ONTRACTING #OALITION VOWED TO STICK TOGETHER CONTINUE WORKING THROUGH THE SUMMER AND FALL OF AND GO BACK INTO THE 3ESSION WITH A NEW BILL 0HIL 2IVENESS STEPPED DOWN AS CHAIRPERSON AND THE MEMBERS ELECTED *ACK $AVIS (-3 #%/ TO TAKE OVER THE HELM FOR THE 3ESSION )N AN EFFORT TO RElNE THE MESSAGE OF THE #OALITION IT WAS DECIDED THAT THE #OALITION WOULD DEVELOP THE GUIDING PRINCIPLES FOR FAIR CONTRACTING BETWEEN PROVIDERS AND HEALTH PLANS !FTER WEEKS OF MEETINGS AND DISCUSSIONS THE -INNESOTA &AIR (EALTH 0LAN 0RINCIPLES OF #ONTRACTING WERE APPROVED 4HE 0RINCIPLES INCLUDED POLICY STATEMENTS ON DISCLOSURE OF CONTRACT TERMS THE ADVANCE NOTICE OF PROlLING OF PROVIDERS THE ACCOUNTABILITY OF HEALTH PLANS FOR MEDICAL DECISIONS THE PROHIBITING OF SHADOW CONTRACTING PROVIDERS AUTOMATICALLY INCLUDED IN OFFERINGS OF ADDITIONAL PRODUCT LINES THE PROHIBITING OF THE USE UNILATERAL TERMS IN CONTRACTS THE REQUIREMENT OF AN EXPLANATION OF RECOUPMENT RECOVERING OVERPAYMENTS THE TIMELY PAYMENT OF CLAIMS THE ADVANCE NOTIlCATION TO PROVIDERS OF CODING CHANGES AND THE ABILITY TO COMPLETE EFlCIENT PRIOR NOTIlCATION ON A BASIS 4HE 0RINCIPLES BECAME THE BASIS FOR MEETINGS THAT WERE HELD WITH THE HEALTH PLANS INCLUD ING "LUE #ROSS AND "LUE 3HIELD -EDICA AND (EALTH0ARTNERS TO DISCUSS THE PRINCIPLES TO BE INCLUDED IN CONTRACTS AND TO MAKE AN EFFORT TO AGREE ON THE COMPONENTS OF FAIR CONTRACTING 4HE
'OVERNOR 0AWLENTY TOOK NOTE OF THE SUPPORT FOR THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT AND SIGNED IT INTO LAWx
#ONTINUED ON PAGE
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DISCUSSIONS DID PROVIDE FOR A BETTER UNDER STANDING OF THE PRINCIPLES BY THE HEALTH PLANS AND A GREATER UNDERSTANDING OF THE HEALTH PLANS APPROACH TO CONTRACTING BY MEMBERS OF THE #OALITION 4HE HEALTH PLANS SOUGHT TO PERSUADE THE MEMBERS OF THE #OALITION THAT LEGISLATION WAS NOT NEEDED #OALITION MEMBERS DETERMINED THAT THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT SHOULD BE REVISED AND THAT THE MEM BERS WOULD WORK TO HAVE IT INTRODUCED IN THE 3ESSION 2ElNEMENTS WERE MADE TO SEVERAL SECTIONS OF THE BILL AND MEMBERS CONlDENTLY LOOKED FORWARD TO THE RENEWED EFFORT IN 4HE #OALITION WAS STRENGTHENED WITH THE ADDITION OF THE -INNESOTA 0HARMACISTS !SSOCIATION AND THE -INNESOTA /CCUPATIONAL
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4HERAPISTS !SSOCIATION BRINGING THE TOTAL TO PROVIDER ORGANIZATIONS WORKING TOGETHER TO IMPROVE THE ABILITY OF PROVIDERS TO AGREE TO A FAIR CONTRACT WITH THE HEALTH PLANS (OUSE &ILE AND 3ENATE &ILE THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT WAS INTRODUCED IN THE 3ESSION BY 2EPRESENTATIVE 3TEVE 3MITH OF 2ICHlELD IN THE (OUSE AND AGAIN BY 3ENATOR $ALLAS 3AMS OF 3TAPLES IN THE 3ENATE .OT SURPRIS INGLY THE BILLS WERE OPPOSED BY THE #OUNCIL OF (EALTH 0LANS THE -INNESOTA #HAMBER OF #OMMERCE AND THE -INNESOTA "USINESS 0ARTNERSHIP 4HE #HAMBER AND THE "USINESS 0ARTNERSHIP ASSERTED THAT REQUIRING THAT THE HEALTH PLANS MUST INFORM THE PROVIDERS OF THEIR REIMBURSEMENTS WOULD INCREASE HEALTH CARE COSTS 4HE HEALTH PLANS CONTINUED TO ARGUE THAT LEGISLATION WAS NOT NEEDED AS THEY WERE WORKING TO IMPROVE THEIR CONTRACTS !S THE 3ESSION OF THE -INNESOTA ,EGISLATURE MOVED ALONG IT WAS DOMINATED BY CONCERNS OVER THE BUDGET DElCIT THAT EX CEEDED BILLION !S A RESULT ALL LEGISLATION THAT CARRIED A lSCAL NOTE FOR STATE SPENDING ALSO BECAME A RED mAG FOR LEGISLATORS 7HILE THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT DID NOT HAVE STATE SPENDING IMPLICATIONS THE OPPONENTS SUCH AS THE #HAMBER OF #OM MERCE CONTINUED TO ASSERT THAT IT WOULD IN CREASE HEALTH CARE COSTS SINCE PROVIDERS WHO WERE FULLY INFORMED ABOUT THEIR HEALTH PLAN CONTRACTS COULD NOT BE TRUSTED TO USE HEALTH CARE RESOURCES WISELY -EMBERS OF THE #OALITION CONTINUED TO CONSIDER OPTIONS AS THE SESSION MOVED INTO -ARCH AND THE lRST #OMMITTEE DEADLINE OF !PRIL NEEDED TO BE MET )N AN EFFORT TO REACH OUT TO THE --! AND TO SEEK --! SUPPORT FOR THE BILL THE #OALITION DECIDED TO DELETE THE CONSUMER DISCLOSURE SECTION AND TO AMEND THE HEALTH PLAN LIABILITY SECTION OF THE BILL BY SUBSTITUTING REGULATORY REVIEW FOR CIVIL LIABILITY 4HE --! #OMMITTEE ON ,EG ISLATION MET AND AFTER REVIEWING THE BILL THE #OMMITTEE RECOMMENDED THAT THE --! "OARD OF 4RUSTEES SUPPORT THE #ONTRACT #O ALITION BILL AND THE PROMPT PAY BILL THE --!
HAD NEGOTIATED WITH THE HEALTH PLANS 4HE --! "OARD CONSIDERED THE #OMMITTEE S RECOMMENDATION ON -ARCH AND VOTED TO APPROVE THE RECOMMENDATION 4HE COMBINATION OF 2EPRESENTATIVE "OUDREAU SCHEDULING THE BILL FOR A HEARING IN HER (EALTH AND (UMAN 3ERVICES 0OLICY #OMMITTEE ON -ARCH AND THE NEW SUP PORT FROM THE --! SERVED AS THE CATALYST FOR THE #OUNCIL OF (EALTH 0LANS TO BEGIN TO NEGOTIATE WITH THE #OALITION ON SPECIlC LANGUAGE IN THE BILL 4HE RESULT OF THOSE NE GOTIATING SESSIONS PRODUCED AN EXTENSIVE AMENDMENT THAT WAS INTRODUCED BY 2EPRE SENTATIVE 3MITH IN THE (OUSE (EALTH 0OLICY #OMMITTEE ON -ARCH !T THAT HEARING THE AMENDED BILL INCLUDED MUCH OF THE NEW LANGUAGE HOWEVER THE BILL WAS OPPOSED BY THE -INNESOTA #HAMBER OF #OMMERCE THE -INNESOTA "USINESS 0ARTNERSHIP AND "LUE #ROSS AND "LUE 3HIELD AS WELL AS (EALTH0ART NERS 4HE #OMMITTEE VOTED OVERWHELMINGLY TO PASS THE BILL AND THE BILL MOVED TO THE (OUSE #OMMERCE *OBS AND %CONOMIC $EVELOPMENT 0OLICY #OMMITTEE CHAIRED BY 2EPRESENTATIVE 'REGORY $AVIDS OF 0RESTON 4HE (OUSE #OMMERCE #OMMITTEE SENT THE BILL TO THE (OUSE mOOR ON !PRIL $URING THE MONTH OF !PRIL NEGOTIA TIONS ON THE SECTIONS OF THE BILL THAT ADDRESS CODING CHANGES THE PROlLING OF PROVIDERS AND REGULATORY REVIEW WERE SUCCESSFULLY COM PLETED WITH THE #OUNCIL OF (EALTH 0LANS TO INCREASE THE LIKELIHOOD OF PASSAGE OF THE BILL -EMBERS OF THE #OALITION MOVED OVER TO THE 3ENATE WHERE 3ENATOR %LLEN !NDERSON S #OMMERCE #OMMITTEE HEARD THE BILL AND MOVED IT TO THE 3ENATE mOOR ON !PRIL 5NFORTUNATELY 3 & WAS UNEXPECTEDLY LOST ON A CLOSE VOTE OF TO ON THE 3EN ATE mOOR ON -AY 5NCONlRMED REPORTS FROM THE mOOR INDICATED THAT THE GOVERNOR S OFlCE URGED 2EPUBLICAN SENATORS TO DEFEAT THE BILL /VER THE SUMMER AND FALL MONTHS OF THE MEMBERS OF THE #ONTRACTING #O ALITION WORKED TO DEVELOP STRATEGY AND TO SHORE UP SUPPORT FOR THE -INNESOTA (EALTH
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0LAN #ONTRACTING !CT IN THE 3ESSION 4HE AUTHORS 3ENATOR $ALLAS 3AMS OF 3TAPLES AND 2EPRESENTATIVE 3TEVE 3MITH OF 2ICHlELD AGREED TO CONTINUE IN THE 3ESSION ! MAJOR DECISION BY (-3 AND 2-3 TO RETIAN THE LOBBYING SERVICES OF ,OCKRIDGE 'RINDAL .AUEN 0 , , 0 OF -INNEAPOLIS TO WORK FOR PASSAGE OF THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT IN THE SESSION PROVED TO BE A MAJOR FACTOR IN PASSING THE BILL 4HE IRRITATING lSCAL NOTE FROM THE $E PARTMENT OF %MPLOYEE 2ELATIONS $/%2 REMAINED AN OBSTACLE IN THE 3ESSION !FTER IT BECAME OBVIOUS THAT THE BILL WOULD NOT PASS WITH 3ECTION ON PROlLING IN CLUDED BECAUSE $/%2 MAINTAINED THAT THE COST TO THE STATE EMPLOYEE HEALTH PLAN WOULD EXCEED MILLION THE MEMBERS OF THE #O ALITION RELUCTANTLY AGREED TO DELETE 3ECTION 7ITH 3ECTION ELIMINATED THE WAY APPEARED CLEAR TO PASS BOTH BILLS 4HE ONLY REMAINING OPPOSITION WAS THE -INNESOTA #HAMBER OF #OMMERCE ( & REMAINED ALIVE ON THE (OUSE mOOR FROM THE 3ESSION HOWEVER THE 3ENATE BILL HAD TO BE ASSIGNED A NEW BILL JACKET AND A NUMBER 3 & !CTION IN THE (OUSE WOULD BE DELAYED UNTIL THE 3ENATE BILL COULD PROGRESS TO THE mOOR /N &EBRUARY THE BILL WAS HEARD IN THE 3ENATE (EALTH AND &AMILY 3ECURITY #OMMITTEE )T EVENTU ALLY WAS CONSOLIDATED INTO ( & ( & MOVED THROUGH lVE COMMITTEES IN THE (OUSE AND EVENTUALLY WAS ADOPTED BY A VOTE OF TO THREE 4HE ACTION NOW MOVED TO THE OFlCE OF 'OVERNOR 4IM 0AWLENTY 2UMORS THAT THE GOVERNOR WOULD EITHER VETO ( & OR LET IT DIE WITHOUT A SIGNATURE STIRRED BOTH (-3 AND 2-3 AS WELL AS THE OTHER MEMBERS OF THE #OALITION TO ACTION WITH E MAILS TO MEMBERS URGING THEM TO CONTACT THE GOVERNOR ASK ING HIM TO SIGN ( & &INALLY ON -AY 'OVERNOR 0AWLENTY TOOK NOTE OF THE SUPPORT FOR THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT AND SIGNED IT INTO LAW ( & WILL BECOME A PART OF #HAPTER OF THE -INNESOTA 3TATUTES
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*AMES , 2EINERTSEN - $ HEADS 4HE 2EINERTSEN 'ROUP AN INDE PENDENT CONSULTING AND TEACHING PRACTICE FOCUSED ON IMPROVING THE CLINICAL QUALITY PERFORMANCE OF HEALTH CARE ORGANIZATIONS (E IS ALSO A 3ENIOR &ELLOW AT THE )NSTITUTE FOR (EALTH #ARE )MPROVEMENT IN "OSTON WHERE HE HEADS )() S LEADERSHIP DEVELOPMENT ACTIVITIES (E BRINGS TO HIS WORK YEARS EXPERIENCE PRACTICING RHEUMATOLOGY ALONG WITH YEARS EXPERIENCE LEADING HEALTH CARE QUALITY IMPROVEMENT IN MEDICAL GROUPS HOSPITALS AND ACADEMIC HEALTH CENTERS IN -INNEAPOLIS AND "OSTON AS THE FORMER #%/ OF 0ARK .ICOLLET (EALTH 3ERVICES #ARE'ROUP AND THE "ETH )SRAEL $EACONESS -EDICAL #ENTER AND AS THE FORMER #HAIRMAN OF THE )NSTITUTE FOR #LINICAL 3YSTEMS )MPROVEMENT $R 2EINERTSEN IS A GRADUATE OF 3T /LAF #OLLEGE AND (ARVARD -EDICAL 3CHOOL 1UESTIONS WERE PROVIDED BY $RS "RENT !SPLIN ,EE "EECHER !B DHISH "HAVSAR $ONALD *ACOBS *AMES & 0ETERS &RANK 2HAME *ANETTE 3TRATHY AND 0ETER 7ALLSKOG
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7HAT ARE YOU MOST OPTIMISTIC ABOUT WHEN IT COMES TO HEALTH CARE REFORM OVER THE NEXT YEARS 0OLITICIANS AND POLICYMAKERS NOW ARE FACED WITH TRYING TO EXPLAIN WHY WE SHOULD CONTINUE TO SEND TWO TO THREE TIMES AS MANY -EDICARE DOLLARS TO -IAMI AS WE DO TO -INNEAPOLIS WITH THE SAME OR EVEN WORSE OUTCOMES ) M OPTIMISTIC THAT OVER THE NEXT YEARS THE WORK OF 7ENNBERG &ISHER AND OTHERS WILL lNALLY BRING ABOUT A FAIRER MORE SENSIBLE DISTRIBUTION OF THE RESOURCES WE ALREADY HAVE
(OW DO YOU ENVISION OUR FUTURE HEALTH CARE SYSTEMS MANAGING THE INCREASING NEEDS OF PATIENTS WITH COMPLEX CHRONIC DISEASES 4HE 7AGNER #HRONIC $ISEASE -ODEL WOULD APPEAR TO BE THE BEST BLUE PRINT AVAILABLE FOR CARING FOR PATIENTS WITH CHRONIC COMPLEX DISEASES 7AGNER S MODEL WORKS #HRONIC DISEASE PATIENTS GET BETTER OUTCOMES WHEN INFORMED ACTIVATED PATIENTS INTERACT WITH PREPARED PROACTIVE PRACTICE TEAMS ESPECIALLY WHEN THOSE INTERACTIONS BETWEEN PATIENT AND CARE TEAM REST ON A BASE OF SELF MANAGEMENT SUPPORT REGISTRIES AND OTHER INFORMATION SYSTEM TOOLS AND REDESIGN OF THE CARE SYSTEM TO FOCUS ON CHRONIC RATHER THAN ACUTE PROBLEMS ÊÊÊÊÊ Õ ÞÉ Õ}ÕÃÌÊÓää{Ê
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$O YOU THINK THAT PRIMARY CARE SPECIALTIES WILL HAVE ROLES IN FUTURE HEALTH CARE MODELS 4HE 7AGNER CHRONIC DISEASE MODEL PROVIDES A GOOD CASE EXAMPLE OF THE PIVOTAL BUT DIFFERENT ROLE THAT THE PRIMARY CARE PHYSICIAN MIGHT PLAY IN THE FUTURE AS CAPTAIN OF A MULTIDISCIPLINARY TEAM BUT PERHAPS NOT AS AN AUTHORITARIAN hCAPTAIN OF THE SHIPv 4HE QUALITY OF RELATIONSHIPS THAT ARE BUILT BETWEEN PRIMARY PHYSICIANS AND PATIENTS HAS ALWAYS BEEN AND TO MY WAY OF THINKING WILL ALWAYS BE THE MOST POWERFUL DETERMINANT OF WHATEVER IT IS THAT MAKES OURS A HEALING PROFESSION "UT WE CAN T DO IT ALL BY OURSELVES 7E MUST ORGANIZE A SYSTEM OF CARE THAT MAKES THE HIGHEST AND BEST USE OF EVERYONE INVOLVED PATIENTS AND FAMILIES AS WELL AS PROFESSIONALS AT EVERY LEVEL AND TYPE OF TRAINING IF WE RE GOING TO CARE FOR THE ONCOMING DEMOGRAPHIC WAVE OF ELDERLY PATIENTS WITH CHRONIC CONDITIONS
)F YOU HAD TO PICK ONE CHANGE IN OUR HEALTH CARE SYSTEM THAT WOULD MAKE A DIFFERENCE WHICH WOULD BE YOUR lRST PRIORITY ) VE OFTEN ASKED THIS QUESTION OF OTHERS SO ) SUPPOSE IT S FAIR THAT ) SHOULD HAVE TO GIVE MY OWN ANSWER )F ) WERE KING WHICH THANK FULLY ) M NOT MY lRST HEALTH CARE DECREE WOULD BE TO CREATE UNIVERSAL COVERAGE FOR ALL EVIDENCE BASED PREVENTIVE AND CATASTROPHIC SERVICES AS A RIGHT OF CITIZENSHIP SUPPORTED BY A BROAD BASED TAX )N OTHER WORDS NO !MERICAN WOULD GET A PREVENTABLE ILLNESS BECAUSE OF LACK OF ABILITY TO PAY AND NO !MERICAN WOULD LOSE ALL HER SAVINGS OR THE FAMILY FARM OR THE SMALL BUSINESS BECAUSE SHE GOT REALLY SICK AND PILED UP BIG BILLS ) MIGHT BE SIMPLE MINDED BUT THAT S WHAT ) THINK OF WHEN ) HEAR THE WORD hINSURANCE v ) THINK WE COULD PAY FOR THOSE TWO ITEMS PREVENTIVE AND CATA STROPHIC INSURANCE THE LATTER ON SOME SORT OF SLIDING SCALE BASED ON INCOME WITH LESS MONEY THAN IS CURRENTLY GOING INTO THE HEALTH CARE -ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃ
SYSTEM !ND AS KING ) D MAKE IT A ROYAL SERVICE I E A SINGLE NATIONAL PAYMENT METHOD TO MINIMIZE THE RIDICULOUS ADMINISTRATIVE EXPENSES AND COMPLEXITIES THAT PLAGUE OUR CURRENT SYSTEM !ND WHAT YOU MIGHT ASK WOULD (IS -AJESTY DO ABOUT ALL THE OTHER SERVICES THAT AREN T EITHER PREVENTIVE OR CATASTROPHIC &OR EXAMPLEx s 4HE KNEE THAT ACHES AFTER YOU WALK AROUND ,AKE #ALHOUN AND FOR WHICH YOU THINK YOU OUGHT TO GET AN -2) hJUST TO SEE WHAT S GOING ON v s 4HE HEADACHE THAT WORRIES YOU ESPECIALLY SINCE YOUR NEIGHBOR HAD A BRAIN TUMOR AND YOU AREN T REALLY REASSURED BY YOUR PRIMARY -$ S EXAMINATION SO YOU WANT TO SEE A NEUROLOGIST s 4HE SPRINGTIME HAYFEVER THAT CAUSES TWO WEEKS OF SNEEZING AND EYE WATERING SO YOU WANT TO GET ALLERGY SHOTS s %TC ) D SUGGEST THAT ALL THESE NON PREVENTIVE NON CATASTROPHIC hNICE TO HAVE BUT NOT ABSOLUTELY NECESSARYv SERVICES EITHER BE BORNE AS PERSONAL EXPENSES OR BE PART OF A PRIVATE INSURANCE SYSTEM )N MY KINGDOM NO ONE WOULD HAVE TO GET A PREVENTABLE ILLNESS NO ONE WOULD GO BROKE OR LACK ACCESS TO CARE IF THEY GOT REALLY SICK AND THE PUBLIC COULD MAKE VALUE JUDGMENTS WITH THEIR OWN MONEY ON EVERYTHING ELSE
-ANY PHYSICIANS SEE ATTEMPTS TO STANDARDIZE CARE AS hCOOKBOOK MEDICINE v (OW DO YOU VIEW THESE STANDARD IZATION EFFORTS AND WHAT SUGGESTIONS DO YOU HAVE FOR PHYSI CIANS WHO CONTINUE TO STRUGGLE WITH THEM ) lND IT FASCINATING THAT WHEN PHYSICIANS E G CARDIOLOGISTS AND CARDIOVAS CULAR SURGEONS START THEIR OWN SPECIALTY HOSPITALS ONE OF THE lRST THINGS THEY OFTEN DO IS TO REQUIRE THAT ALL THE PHYSICIANS RIGOROUSLY STANDARDIZE TO ONE METHOD FOR MANY COMMON PROCESSES 4HEY QUICKLY LEARN THAT DOING COMMON THINGS IN A COMMON WAY REDUCES COMPLEXITY DECREASES ERRORS IMPROVES WORKmOW REDUCES hREWORKv AND PERSONAL HASSLES THROUGH THE DAY AND IMPROVES PATIENT OUTCOMES 9ET THE SAME PHYSICIANS RESIST STANDARDIZATION AS hCOOKBOOK MEDICINEv WHEN IT S PROMOTED BY A HOSPITAL ADMINISTRATOR OR A HEALTH PLAN MEDICAL DIRECTOR ) DON T THINK STANDARDIZATION IS A BAD THING )N FACT ) THINK THAT IF PHYSICIANS GOT TOGETHER AND DECIDED ON ONE WAY TO DO SLIDING SCALE INSULIN AND hSTART HEPARIN v AND OTHER COMMON HOSPITAL ORDERS AND DEVELOPED SIMILAR COMMON METHODS FOR USING COMMON OUTPATIENT PROCEDURES AND TREATMENTS WE WOULD SAVE PRECIOUS TIME IN OUR DAY PRODUCE FEWER ERRORS AND GET BETTER RESULTS FOR OUR PATIENTS 4HE DATA ARE VERY CLEAR NOW FROM A NUMBER OF DIFFERENT TYPES OF INSTITUTIONS THAT STANDARDIZED MEDICAL STAFF WIDE STANDING ORDER SETS ARE A KEY COMPONENT TO IMPROVING QUALITY 7E CAN T STANDARDIZE EVERYTHING %VERY PATIENT S CARE REQUIRES SOME CUSTOM CRAFTING 4HAT S THE ART OF MEDICINE "UT WE CAN STANDARDIZE WITHIN THE SCIENCE OF MEDICINE AND WE SHOULD /UR PATIENTS LIVES AND WELL BEING ARE AT STAKE ) HEARD AN INTERESTING STATEMENT FROM A NURSE QUALITY LEADER IN A 3OUTHEASTERN 5 3 HOSPITAL RECENTLY 7HEN ONE OF THE PHYSICIANS ON STAFF WAS RESISTING USING A STANDING ORDER SET FOR ACUTE -) BECAUSE HE SAW SUCH ORDER SETS AS AN INFRINGEMENT ON HIS AUTONOMY SHE ASKED h3O AM ) TO -ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃÊ
UNDERSTAND THAT YOUR AUTONOMY IS MORE IMPORTANT THAN YOUR PATIENTS OUTCOMES v ) AM BEGINNING TO THINK THAT HER QUESTION MIGHT BE THE BEST RESPONSE TO THOSE -$S WHO ARE STRUGGLING WITH THIS ISSUE
)F YOU WERE THE $EAN OF A MEDICAL SCHOOL WHAT KEY CHANGES WOULD YOU INITIATE TO PREPARE PHYSICIANS FOR MANAGING PATIENT CARE INTO THE FUTURE 4HE BEST CURRENT BLUEPRINT FOR PREPARING PHYSICIANS NOT ONLY TO WORK IN BUT ALSO ON THE SYSTEM OF CARE HAS BEEN PROVIDED BY THE !#'-% UNDER THE LEADERSHIP OF $AVID ,EACH )F ) WERE THE $EAN ) WOULD ASK h(OW CAN ) PREPARE MY STUDENTS TO BE READY TO ACE THE !#'-% REQUIREMENTS THEY LL HAVE TO PASS WHEN THEY DO THEIR GRADUATE MEDICAL EDUCATION v
$O YOU FAVOR -INNESOTA LEGISLATION ALLOWING FOR PROlT INSURANCE PLANS AND (-/S INTO THE -INNESOTA MARKET PLACE %XPLAIN 4HE GENESIS OF MY ANSWER CAN PROBABLY BE UNDERSTOOD BY READING THE h)F ) WERE +INGv ANSWER ABOVE 4HE QUALITY OF CARE THAT S DELIVERED IS PRIMARILY DETERMINED BY THE CARE DELIVERY SYSTEM IN WHICH YOU GET YOUR CARE NOT BY WHICH PLAN YOU BELONG TO 3O ) lND IT HARD TO BELIEVE THAT IT WOULD MAKE MUCH DIFFERENCE ONE WAY OR THE OTHER FOR THE QUALITY OF HEALTH CARE IN -INNESOTA IF FOR PROlT PLANS CAME TO THE STATE /N THE COST SIDE HOWEVER TWO THINGS THAT TAKE DOLLARS FROM CARE WOULD GO IN THE WRONG DIRECTION ADMINISTRATIVE COSTS MAINLY ON THE PROVIDER SIDE BECAUSE THEY D HAVE TO DEAL WITH MORE PLANS MORE FEE SCHEDULESx AND ADVERTISING BUDGETS FOR ALL THE PLANS 3O ON THAT BASIS NO ) WOULDN T FAVOR IT
$O YOU FAVOR THE DEVELOPMENT AND USE OF PHYSICIAN REPORT CARDS BASED ON ADHERENCE TO CLINICAL CARE GUIDELINES SUCH AS )#3) S )F SO WHO WILL PAY FOR THEM #OULD THEY BE RELIABLE AND VALID ) HAVE LONG FELT THAT PHYSICIANS SHOULD BE HELD ACCOUNTABLE FOR THOSE QUALITY ATTRIBUTES THEY CAN CONTROL ) THINK THE TWO MAIN ASPECTS OF CARE THAT ARE UNDER PHYSICIAN CONTROL ARE THEIR KNOWLEDGE OF THEIR CRAFT AND THE QUALITY OF RELATIONSHIPS THAT THEY AND THEIR OFlCE TEAMS BUILD WITH PATIENTS 3O ) D BE /+ WITH REPORT CARDS ON BOARD SCORES SAY AND PATIENT SATISFACTION BY DOCTOR !DHERENCE TO GUIDELINES ON THE OTHER HAND IS MORE OF A GROUP PRACTICE OR OFlCE OR HOSPITAL OR hSYSTEM LEVELv ATTRIBUTE THAN AN INDI VIDUAL PHYSICIAN ATTRIBUTE 0HYSICIANS HAVE A LOT TO SAY ABOUT HOW SYSTEMS PERFORM AGAINST MEASURES LIKE hPERCENTAGE OF DIABETICS WHO GET A (B! C MEASUREMENTv BUT THESE GUIDELINE ADHERENCE MEASURES ARE ALSO POWERFULLY INmUENCED BY THE PRESENCE OR ABSENCE OF AN ELECTRONIC DIABETES REGISTRY
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A PREPARED NURSE AND OFlCE TEAM WHERE ALL MEMBERS ARE WORKING FROM THE SAME STANDARDIZED METHOD AND OTHER FACTORS THAT GO WELL BEYOND THE REACH OF ANY INDIVIDUAL PHYSICIAN ) THINK WE SHOULD HAVE REPORT CARDS ON ADHERENCE TO GUIDELINES BUT THEY SHOULD BE REPORTED BY OFlCES OR GROUPS NOT BY INDIVIDUAL PHYSICIANS 7ISCONSIN PROVIDES AN EXCELLENT MODEL FOR THIS SORT OF REPORTING 3EE HTTP WWW WIQUALITYCOLLABORATIVE ORG
)N THIS AGE OF INCREASING CONSUMERISM DO HEALTH CARE ORGANIZATIONS STILL HAVE THE SAME RESPONSIBILITY FOR STEW ARDSHIP OVER HEALTH CARE SPENDING )F SO HOW DO PROVIDERS BALANCE THE TENSION OF PROVIDING BOTH WHAT THE PATIENT NEEDS AND WHAT THE CONSUMER WANTS
#ONSUMERS HAVE ACCESS TO ENORMOUS AMOUNTS OF HEALTH CARE INFORMA TION SOME VALUABLE SOME WORTHLESS /FTEN THIS INFORMATION CREATES REQUESTS FOR SERVICES AGAIN SOME VALUABLE SOME WORTHLESS SOME EVEN HARMFUL 4HE PHYSICIANS WHO HEAR THESE REQUESTS ARE PUT INTO A VARIETY OF DIFlCULT POSITIONS FROM THE TEMPTATION TO RENDER A DESIRED UNNECESSARY BUT HIGHLY REMUNERATIVE SERVICE FOR ONE PATIENT TO THE ROLE OF HAVING TO SAY hNOv TO THE EXACT SAME SERVICE FOR THE NEXT PATIENT WHO IS IDENTICAL (EALTH CARE ECONOMICS BEAR LITTLE OR NO RELATIONSHIP TO ANYTHING LIKE A IN EVERY RESPECT TO THE lRST PATIENT EXCEPT FOR A DIFFERENT TYPE OF PLAN MARKET DRIVEN SYSTEM SO ) REALLY CAN T ANSWER THE QUESTION AS FRAMED COVERAGE AND PHYSICIAN PAYMENT CONTRACT )N HEALTH CARE A SHORTAGE OF PHYSICIANS PREDICTS LOWER COSTS AND HIGH &ROM MY PERSPECTIVE THE ONLY WAY TO DEAL WITH THESE ISSUES IS TO NUMBERS OF PHYSICIANS ARE ASSOCIATED WITH HIGHER COSTS 4HIS IS BECAUSE CREATE THE h+INGv SCENARIO DESCRIBED ABOVE IN WHICH THERE WOULD BE A WE HAVE CREATED A SYSTEM IN WHICH ONE OF THE PRIMARY FEATURES IS SO CALLED REAL MARKETPLACE FOR THOSE SERVICES WHICH FALL BETWEEN PREVENTIVE AND hSUPPLY DRIVEN DEMAND v CATASTROPHIC )N OTHER WORDS THE PERSON REQUESTING THESE hNICE TO HAVE )F ANY ASPECT OF THE lNANCING SYSTEM HAS TO CHANGE IT WOULD BE THE BUT NOT ABSOLUTELY NECESSARY OR MARGINALLY VALUABLE OR NOT EVEN INDI CURRENT PERVERSE PRACTICE EXEMPLIlED BEST BY -EDICARE OF SENDING EVEN CATEDv SERVICES WOULD ALSO BE THE PERSON WHO WAS PAYING FOR THEM 3O MORE MONEY TO OVERSUPPLIED AREAS OF THE COUNTRY THEREBY ATTRACTING EVEN THE hCONSUMERv WOULD BECOME A VALUE CONSCIOUS hCUSTOMER v AND THE PHYSICIAN WOULD BECOME A VALUE ADVISOR TO THE PATIENT 4HE ROLE OF VALUE ADVISOR WOULD STILL BE A STEWARDSHIP ROLE IN A WAY )T S JUST THAT IT WOULD BE THE PATIENT S MONEY THAT THE PHYSI CIAN WOULD BE CHARGED WITH SPENDING WISELY NOT THE HEALTH PLANS ) THINK THAT WOULD MAKE ALL THE DIFFERENCE "Y THE WAY ) DO NOT BELIEVE WE COULD OR SHOULD EVER CREATE A MARKETPLACE FOR PREVEN TIVE OR CATASTROPHIC SERVICES 4HE EVIDENCE SUGGESTS THAT PEOPLE PUT FAR TOO LOW A VALUE ON PREVENTIVE SERVICES TO PAY FOR THEM YEARS IN ADVANCE OF WHATEVER THEY MIGHT PREVENT !ND WHEN YOU RE DESPERATELY ILL IS THE VERY WORST TIME TO BECOME A VALUE SHOPPER )T S IN THE hMIDDLE ZONEv BETWEEN BASIC PREVENTION AND &**".+/ " (/%! -" "/1+-' ! * %"(, CATASTROPHIC SERVICES THAT MARKET FORCES MIGHT HAVE THE BEST CHANCE OF IMPROVING QUALITY AND VALUE IN HEALTH CARE
'IVEN THE IMPENDING SHORTAGE OF PHYSICIANS PREDICTED IN THE NEXT FEW DECADES A CONDITION USUALLY ASSOCIATED WITH HIGHER CONSUMER COSTS IN A MARKET DRIVEN SYSTEM HOW DO YOU FORESEE THE lNANCING OF HEALTH CARE SYSTEMS INTO THE FUTURE
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ADDITIONAL COMMERCIAL PRODUCTS WITH DIF FERENT TERMS TO BE AUTOMATICALLY INCLUDED UNLESS PRIOR APPROVAL FROM THE PROVIDERS IS GRANTED #ODING #HANGES 4HE HEALTH PLAN COMPANY MUST NOTIFY THE PROVIDER DAYS BEFORE CHANGING CODING GUIDELINES #LAIMS 0AYMENT 4HE HEALTH PLAN COMPANY MUST MAKE AVAILABLE TO THE PROVIDER INFOR MATION ABOUT THE STATUS OF A CLAIM AND INTEREST PAYMENTS MUST BE MADE TO THE HEALTH CARE PROVIDER NO LESS FREQUENTLY THAN QUARTERLY 4HE LEGISLATION HAS EFFECTIVE DATES OF *ULY AND
4(% ,%')3,!4)6% 3%33)/. HAS DRAWN TO AN END AND WHILE THE MAJOR BUDGET ISSUES AND BONDING BILLS WERE NOT RESOLVED THERE WERE SEVERAL INITIATIVES THAT PROVIDERS FOUGHT HARD TO GET AND WON AND SEVERAL IS SUES THAT PROVIDERS DID NOT CARE FOR THAT WERE EVENTUALLY KILLED (ERE IS A WRAP UP OF THE MAJOR HEALTH CARE ISSUES THAT WERE BEFORE THE LEGISLATURE DURING THE SESSION
Õ`}iÌÊ7 ià 4HE ,EGISLATURE BEGAN THE SESSION WITH THE KNOWLEDGE THEY WOULD NEED TO RESOLVE A PRO JECTED MILLION BUDGET DElCIT FOR 'OVERNOR 0AWLENTY UNILATERALLY ACTED TO SOLVE MILLION OF THE BUDGET DElCIT THROUGH DIREC TIVES GIVEN TO THE #OMMISSIONER OF &INANCE (E DIRECTED HIS COMMISSIONER NOT TO TRANSFER MILLION IN FEDERAL RECEIPTS TO THE (EALTH #ARE !CCESS &UND FROM THE 'ENERAL &UND (E ALSO ORDERED A PERCENT BUDGET REDUCTION FOR STATE AGENCIES EXCEPT THE $EPARTMENT OF #OR RECTIONS SAVING THE STATE MILLION (OUSE AND 3ENATE LEADERS COULD NOT AGREE ON HOW TO ERASE THE REMAINING MILLION *UST A DAY AFTER THE ,EGISLATURE ADJOURNED WITHOUT ACTING ON THE 3TATE S PROJECTED MILLION BUDGET DElCIT 'OVERNOR 0AWLENTY TOOK EXECUTIVE AC TION TO ELIMINATE THE DElCIT ON HIS OWN 4HE EXECUTIVE ACTION USES AN ADDITIONAL MILLION FROM THE (EALTH #ARE !CCESS &UND INCREASES TAX COMPLIANCE EFFORTS AT THE $EPARTMENT OF 2EVENUE AND SAVES MILLION BY DELAYING OR FREEZING THE SALE OF BONDS FOR PREVIOUSLY AUTHORIZED CAPITAL PROJECTS
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> ÀÊ ÌÀ>VÌ }Ê -° °Ê£Ç ° °ÊÈäÈ® &OR THREE YEARS MORE THAN PROFESSIONAL OR GANIZATIONS AND HEALTH ADVOCACY GROUPS WORKED TO PASS LEGISLATION THAT CREATES BALANCED HEALTH PLAN CONTRACTING PRACTICES IN -INNESOTA !FTER MANY CHANGES COMMITTEE HEARINGS AND WITH SUPPORT FROM THE -INNESOTA #OUNCIL OF (EALTH 0LANS THE -INNESOTA (EALTH 0LAN #ONTRACT ING !CT PASSED OVERWHELMINGLY IN THE (OUSE AND THE 3ENATE 4HE BILL MAKES THE FOLLOWING CHANGES TO HEALTH PLAN CONTRACTS THAT BENElT THE PROVIDER %FlCIENT .OTIlCATION 0ROHIBITS DELAYS IN PRE AUTHORIZATION OR NOTIlCATION SO PROVIDERS ARE NOT FORCED TO DELAY CARE $ISCLOSURE ! HEALTH PLAN MUST OFFER CONTRACTS WHOSE TERMS ARE FULLY DISCLOSED TO THE PRO VIDER BEFORE EXECUTION 5NILATERAL 4ERMS 4HE CONTRACT CANNOT INCLUDE UNILATERAL TERMS REGARDING TERMINATION IN DEMNIlCATION OR ARBITRATION 3HADOW #ONTRACTING 4HE CONTRACT BETWEEN A HEALTH PLAN AND A PROVIDER CANNOT ALLOW
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>} ÃÌ VÊ >} }Ê >V Ì iÃÊ i} à >Ì Ê-° °ÊÓänäÉ ° °ÊÓ£ÓÇ® ! MAJOR BATTLE THIS YEAR ENSUED BETWEEN SUR GICAL CENTERS AND DIAGNOSTIC IMAGING FACILITIES AND THE -INNESOTA (OSPITAL !SSOCIATION !S INTRODUCED THE LEGISLATION CONTAINED A CERTIl CATE OF NEED #/. PROCESS FOR SURGICAL CENTERS AND DIAGNOSTIC IMAGING FACILITIES !DDITIONALLY THE ORIGINAL LEGISLATION CONTAINED LICENSURE OF DIAGNOSTIC IMAGING FACILITIES WITH SUBSTANTIAL lNANCIAL REPORTING !FTER SEVERAL WEEKS OF MEET INGS AND HEARINGS THE COALITION OF PROVIDERS AND THE -INNESOTA (OSPITAL !SSOCIATION WERE ABLE TO REACH A COMPROMISE ON THE LEGISLA TION AND THE CERTIlCATE OF NEED PROVISION WAS REMOVED FROM THE LEGISLATION ) HAVE BROKEN THE SUMMARY INTO TWO PARTS 3URGICAL #ENTERS AND $IAGNOSTIC )MAGING &ACILITIES -ÕÀ} V> Ê i ÌiÀà 4HE LEGISLATION AS PASSED REGULATES AND LICENSES SURGICAL CENTERS IN STATUTE RATHER THAN ONLY IN #ONTINUED ON PAGE
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lNANCIAL OR ECONOMIC INTERESTS IN THE SURGI CAL CENTER THEY REFER TO ACTION MAY BE TAKEN AGAINST THE OUTPATIENT SURGICAL CENTER BY THE #OMMISSIONER &INALLY THE HEALTH CARE PROVIDER MUST POST A NOTICE OF THIS lNANCIAL OR ECONOMIC INTEREST IN THE PATIENT RECEPTION AREA WAITING ROOM OR OTHER CONSPICUOUS PUBLIC LOCATION WITHIN THE PROVIDER S FACILITY 4HE -INNESOTA "OARD OF -EDICAL 0RAC TICE STATUTE PROVIDING GROUNDS FOR PHYSICIAN DISCIPLINE WAS AMENDED TO INCORPORATE THE NEW DElNITION OF ECONOMIC OR lNANCIAL INTER EST USED FOR THE TRIGGERING EVENTS FOR DISCLOSURE TO PATIENTS 4HIS LANGUAGE REPLACED THE PRIOR STANDARD THAT LISTED ONLY THAT THE INTEREST HAD TO BE hSIGNIlCANT v ! VENDOR OF MEDICAL CARE IS FURTHER CLARIlED TO INCLUDE AN AMBULATORY SURGICAL CENTER 4HIS WAS DONE TO INSURE THAT PUBLIC PATIENTS WOULD BE TREATED UNDER -ED ICAID 2ULE WHICH REQUIRES PROVIDERS WHO TAKE STATE EMPLOYEE PLAN PARTICIPANTS AND WORKER COMPENSATION MEDICAL PATIENTS TO TREAT -EDICAID AND OTHER INDIGENT PATIENTS !LL THE EFFECTIVE DATES ARE !UGUST EXCEPT THE REQUIREMENT FOR ADVERSE HEALTH CARE
-INNESOTA 2ULES ()6 PROTOCOL REQUIREMENTS THE PATIENT BILL OF RIGHTS AND ADVERSE HEALTH CARE REPORTING WERE EXTENDED TO SURGICAL CENTERS )N ADDITION DISCLOSURES IN WRITING ARE REQUIRED FOR HEALTH CARE PROVIDERS WITH lNANCIAL INTER ESTS WHO REFER TO SURGICAL CENTERS /UTPATIENT SURGICAL CENTERS HAVE A STATE REQUIREMENT FOR NURSING STANDARDS 4HIS STANDARD IS VERY BROAD REQUIRING NURSING CARE TO BE CONSISTENT WITH NATIONALLY ACCEPTED NURSING CLINICAL STANDARDS FOR PERIOPERATIVE NURSING /UTPATIENT SURGICAL CENTERS WILL BE NOTIlED IN ADVANCE OF ROUTINE INSPECTIONS BY THE $EPARTMENT OF (EALTH AND WILL BE SUBJECT TO THE #OMMISSIONER S ABILITY TO SUSPEND REVOKE OR REFUSE TO RENEW SUCH A FACILITY S LICENSE /UTPATIENT SURGICAL CENTERS ARE INCLUDED IN THE PROVISION OF LAW REQUIR ING ONE OR MORE UNANNOUNCED INSPECTIONS BY THE $EPARTMENT OF (EALTH AT LEAST ONCE A YEAR CURRENTLY APPLIES TO HOSPITALS 4HIS AUTHORITY EXISTED PREVIOUSLY IN -INNESOTA 2ULES )F A PAT TERN OF CONDUCT IS ESTABLISHED WHERE PHYSICIANS ARE NOT PROVIDING PATIENTS WITH DISCLOSURE OF
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EVENT REPORTING BECAUSE THAT SYSTEM HAS NOT BEEN FULLY IMPLEMENTED YET AND MAY NOT BE BY THIS DATE
>} ÃÌ VÊ >} }Ê >V Ì iÃÊ $IAGNOSTIC IMAGING FACILITIES ARE REQUIRED TO AN NUALLY REPORT UTILIZATION BY PAYOR AND MEDICAL SERVICES BY PAYOR 4HE REPORTS MUST ALSO INCLUDE NAMES OF THE OWNERS OF THE CENTER $ISCLOSURES OF lNANCIAL INTEREST BY HEALTH CARE PROVIDERS IN HOSPITALS HOSPITAL PARENT CORPORATIONS HOS PITAL SUBSIDIARIES OUTPATIENT SURGICAL CENTERS OR DIAGNOSTIC IMAGING FACILITIES ARE REQUIRED IF REFERRAL OPTIONS ARE LIMITED )N THOSE INSTANCES THE HEALTH CARE PROVIDER MUST DISCLOSE IN WRIT ING SUCH INTEREST TO THE PATIENT 4HE WRITTEN DISCLOSURE MUST BE IN AT LEAST POINT BOLDFACE TYPE AND MUST READ AS FOLLOWS h9OUR HEALTH CARE PROVIDER IS REFERRING YOU TO A FACILITY OR SERVICE IN WHICH YOUR HEALTH CARE PROVIDER HAS A lNANCIAL OR ECONOMIC INTEREST v 4HE -INNESOTA "OARD OF -EDICAL 0RACTICE STATUTE PROVIDING GROUNDS FOR PHYSICIAN DISCIPLINE WAS AMENDED TO INCORPORATE THE NEW DElNITION OF ECONOMIC OR lNANCIAL INTEREST THAT WAS USED FOR THE TRIGGERING EVENTS FOR DISCLOSURE TO PATIENTS 4HIS LANGUAGE REPLACED THE PRIOR STANDARD THAT STATES ONLY THAT THE INTEREST HAD TO BE hSIGNIl CANT v ! VENDOR OF MEDICAL CARE IS CLARIlED TO INCLUDE A DIAGNOSTIC IMAGING FACILITY 4HIS WAS DONE TO INSURE THAT PUBLIC PATIENTS WOULD BE TREATED UNDER -EDICAID 2ULE WHICH REQUIRES PROVIDERS WHO TAKE STATE EMPLOYEE PLAN PARTICIPANTS AND WORKER COMPENSATION MEDICAL PATIENTS TO TREAT -EDICAID AND OTHER INDIGENT PATIENTS !LL THE EFFECTIVE DATES ARE !UGUST EXCEPT THE REQUIREMENT FOR ADVERSE HEALTH CARE EVENT REPORTING BECAUSE THAT SYSTEM HAS NOT BEEN FULLY IMPLEMENTED YET AND MAY NOT BE BY THIS DATE iÃÌÊ*À>VÌ ViÃÊEÊ Ãi>ÃiÊ > >}i i ÌÊ ° °ÊÓÓÇÇ® $URING THE LAST FEW DAYS OF THE LEGISLATIVE SES SION WHEN IT BECAME CLEAR THAT THERE WOULD NOT BE A BUDGET BILL A HEALTH CARE LICENSING BILL BECAME THE VEHICLE FOR HEALTH RELATED AMEND MENTS /NE OF THOSE AMENDMENTS WAS BEST PRACTICE GUIDELINES 4HE LEGISLATION STATES THAT STATE AGENCIES hSHALL ENCOURAGEv THE ADOPTION OF BEST PRACTICE GUIDELINES AND THE #OMMISSIONER OF (EALTH SHALL FACILITATE ACCESS TO THE GUIDELINES
-ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃ
BY IDENTIFYING AND PROMOTING LOCAL COMMUNITY BASED PHYSICIAN DESIGNATED BEST PRACTICES ACROSS THE STATE 4HE INITIAL BEST PRACTICES AND QUALITY OF CARE MEASUREMENT CRITERIA DEVELOPED SHALL INCLUDE ASTHMA DIABETES AND AT LEAST TWO OTHER PREVENTATIVE HEALTH MEASURES (YPERTENSION AND CORONARY ARTERY DISEASE SHALL BE INCLUDED WITHIN ONE YEAR !LSO INCLUDED IN THE LEGISLATION IS A PROVISION THAT STATES THE #OMMISSIONER OF (EALTH SHALL IMPLEMENT DISEASE MANAGEMENT INITIATIVES THAT SEEK TO IMPROVE PATIENT CARE AND HEALTH OUTCOMES AND REDUCE HEALTH CARE COSTS BY MANAGING THE CARE PROVIDED TO RECIPIENTS WITH CHRONIC CONDITIONS 4HE #OMMISSIONER IS REQUIRED TO DEVELOP AND IMPLEMENT THE PROGRAM FOR -EDICAL !SSISTANCE AND 'ENERAL !SSISTANCE -EDICAL #ARE PATIENTS AND ENSURE THAT HEALTH PLAN COMPANIES ALSO PROVIDE DISEASE MANAGEMENT PROGRAMS FOR -EDICAL !SSISTANCE -INNESOTA#ARE AND 'ENERAL !SSISTANCE -EDICAL #ARE UNDER THE PREPAID MANAGED CARE PROGRAM 7 À iÀÃ½Ê «i Ã>Ì Ê -° °ÊÓn{{É ° °ÊÓ £x®Ê 0ROVIDERS WORKED OVERTIME TO KILL A PROVISION IN THE 7ORKERS #OMPENSATION BILL 4HE LANGUAGE IN SECTION PARAGRAPH B OF THE BILL WOULD HAVE PERMITTED A CERTIlED MANAGED CARE PLAN TO COMPENSATE PROVIDERS FOR THEIR SERVICES AND CARE USING hDISCOUNTED FEESv DIFFERENT THAN THE FEES ON THE WORKERS COMPENSATION FEE SCALE 0ROVIDERS FELT THAT THIS LANGUAGE WOULD OPEN THE GATE FOR MANAGED CARE IN THE WORKERS COM PENSATION SYSTEM AND INJURED WORKERS WOULD EVENTUALLY HAVE NO CHOICE BUT TO ACCEPT THE CERTIlED MANAGED CARE ROSTER AS EMPLOYERS COULD CONTRACT EXCLUSIVELY WITH THE CERTIlED PLANS !S PROVIDERS WHO ARE UNABLE TO DISCOUNT THEIR FEES DROP OUT OF THE CERTIlED PLAN INJURED WORKERS WOULD HAVE FEWER AND FEWER CHOICES OF PROVIDERS 4HE BILL WENT RIGHT TO THE WIRE AND SECTION PARAGRAPH B WAS DELETED IN COM MITTEE THE LAST WEEK OF THE SESSION 4HE BILL WAS NEVER BROUGHT UP FOR A VOTE IN EITHER THE (OUSE OR THE 3ENATE AND IS DEAD FOR THE YEAR `ÛiÀÃiÊ i> Ì Ê >ÀiÊ Ûi ÌÃÊ ,i« ÀÌ }Ê-° °ÊÓÎÈxÉ ° °ÊÓxÎÇ® 4HIS LEGISLATION MAKES A NUMBER OF MODIlCA TIONS TO THE ADVERSE HEALTH CARE EVENTS REPORTING SYSTEM ADOPTED IN )T REQUIRES THE HEALTH LICENSING BOARDS THAT REGULATE PHYSICIANS
PHYSICIAN ASSISTANTS NURSES PHARMACISTS AND PODIATRISTS TO REPORT TO THE -INNESOTA $EPART MENT OF (EALTH EVENTS THAT COME TO THEIR AT TENTION THAT MAY QUALIFY AS ADVERSE HEALTH CARE EVENTS )T DElNES THE RELATIONSHIP BETWEEN THE REPORTING LAW AND THE -ALTREATMENT OF -INORS !CT )T CLASSIlES DATA REPORTED AND CREATED AS PART OF THE REPORTING SYSTEM 4HE LEGISLATION ALSO REQUIRES LICENSING BOARDS TO REPORT TO THE -INNESOTA $EPARTMENT OF (EALTH THE PHYSI CIAN PHYSICIAN ASSISTANT PHARMACIST NURSE AND PODIATRIST OF POSSIBLE ADVERSE EVENTS THAT COME TO THEIR ATTENTION 4HE REPORTING REQUIRE MENT IS EFFECTIVE UPON FULL IMPLEMENTATION OF THE ADVERSE HEALTH CARE EVENT REPORTING SYSTEM 4HE REPORTS ARE DUE ON THE SCHEDULES ESTAB LISHED IN THE APPLICABLE SECTIONS AND MUST BE FORWARDED TO THE FACILITY NAMED IN THE REPORT 4HE FACILITY UPON RECEIVING THE INFORMATION MAKES THE lNAL DETERMINATION OF WHETHER THE INCIDENT BEING REPORTED QUALIlES AS AN ADVERSE HEALTH CARE EVENT )F THE EVENT QUALIlES AND THE $EPARTMENT OF (EALTH DETERMINES THAT THE FACILITY KNEW OR SHOULD HAVE KNOWN ABOUT IT THE FACILITY IS CONSIDERED OUT OF COMPLIANCE WITH THE REPORTING ACT AND THE LAWS GOVERNING MALTREATMENT OF MINORS AND ADULTS APPLY )F THE $EPARTMENT OF (EALTH DETERMINES THAT THE FACILITY DID NOT KNOW ABOUT THE EVENT THE DATE THE FACILITY RECEIVES THE INFORMATION FROM THE $EPARTMENT OF (EALTH SERVES AS THE DATE OF DISCOVERY OF THE EVENT FOR PURPOSES OF THE REPORTING SYSTEM )F THE FACILITY DETERMINES THAT THE INCIDENT REPORTED BY ONE OF THE BOARDS DOES NOT QUALIFY AS AN ADVERSE EVENT THE FACILITY MUST NOTIFY THE $EPARTMENT OF (EALTH OF THAT DETERMINATION *À Û `iÀÊ ÃV ÃÕÀiÊ vÊ ÃÌ >Ìi`Ê*>Þ i ÌÊ ° °ÊÓÓÇÇ® 4HIS LANGUAGE AN INITIATIVE OF 2EPRESENTATIVE "RADLEY 2 2OCHESTER STATES A HEALTH CARE PRO VIDER AT THE REQUEST OF A CONSUMER PROVIDE THAT CONSUMER WITH A GOOD FAITH ESTIMATE OF THE REIMBURSEMENT THE PROVIDER EXPECTS TO RECEIVE FROM THE HEALTH PLAN COMPANY IN WHICH THE CONSUMER IS ENROLLED (EALTH PLAN COMPANIES MUST ALLOW CONTRACTED PROVIDERS TO RELEASE THIS INFORMATION ! GOOD FAITH ESTIMATE MUST ALSO BE MADE AVAILABLE AT THE REQUEST OF A CONSUMER WHO IS NOT ENROLLED IN A HEALTH PLAN 'IVING AN ESTIMATE DOES NOT CONSTITUTE A LEGALLY BINDING ESTIMATE OF THE COST OF SERVICES
-ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃÊ
i` V> Ê > «À>VÌ Vi %ARLY IN THE SESSION 2EPRESENTATIVE "RADLEY UN VEILED A MEDICAL MALPRACTICE REFORM PACKAGE (OWEVER THE REFORM WAS HIGHLY CONTROVERSIAL AND SUBSEQUENTLY THE BILL WAS NOT PASSED 4HE BILL WOULD HAVE LIMITED RECOVERY OF TOTAL DAM AGES FOR NON ECONOMIC LOSS FROM AN OCCURRENCE OF MEDICAL MALPRACTICE TO 4HE BILL WOULD HAVE PROHIBITED DISCLOSING THIS LIMIT TO THE JURY 4HE BILL ALSO LIMITED PUNITIVE DAMAGES IN MEDICAL MALPRACTICE CASES TO 4HE BILL ALSO WOULD HAVE REQUIRED THAT THE JURY NOT BE TOLD OF THIS LIMIT 4HE MEASURE ALSO REQUIRED THAT ALL PUNITIVE DAMAGES BE PAID TO THE -IN NESOTA #OMPREHENSIVE (EALTH !SSOCIATION -#(! FOR THE PURPOSE OF REDUCING ITS NEED TO ASSESS ITS MEMBERS &INALLY THE PROPOSAL PROVIDED THAT PRIVATE NONPROlT HOSPITALS WOULD NOT BE LIABLE FOR PUNITIVE DAMAGES *À Û `iÀÊ/>Ý 4HIS BILL INCREASES THE TAX ON CIGARETTES FROM TO CENTS PER PACK 4HE BILL REQUIRES THE ADDITIONAL TAX REVENUE TO BE USED TO REDUCE OR ELIMINATE THE -INNESOTA #OMPREHENSIVE (EALTH !SSOCIATION DElCIT 4HE BILL ALSO RE DUCES THE -INNESOTA#ARE TAX ON HEALTH CARE PROVIDERS FROM TO PERCENT 4HIS BILL WAS AUTHORED BY 2EPRESENTATIVE "RADLEY 2 2OCH ESTER MADE IT THROUGH THE COMMITTEE PROCESS IN THE (OUSE BUT DID NOT ULTIMATELY HAVE THE SUPPORT TO BECOME LAW
V ÕÃ Ê 7HILE THE LEGISLATIVE SESSION WAS SHORT AND LARGELY UNPRODUCTIVE THE -INNESOTA MEDI CAL COMMUNITY WAS ABLE TO STOP SEVERAL HIGHLY PROHIBITIVE MEASURES PASS A MAJOR CONTRACTING BILL AND ADVANCE THE OVERALL INTERESTS OF HEALTH CARE PROVIDERS .ORA 3TEWART IS A LOBBYIST WITH ,OCKRIDGE 'RINDAL .AUEN 0 , , 0 REPRESENTING MULTIPLE HEALTH CARE AND BUSINESS CLIENTS 3HE PREVIOUSLY WORKED AS A STAFF PERSON FOR THE -INNESOTA (OUSE OF 2EPRESENTATIVES 2EPUBLICAN #AUCUS AND THE -INNESOTA 3ENATE 2EPUBLICAN #AUCUS FOR OVER YEARS PRIOR TO BECOMING A LOBBYIST -S 3TEWART HOLDS A "ACHELOR S DEGREE IN 0OLITICAL 3CIENCE FROM THE 5NIVERSITY OF -INNESOTA AND A -ASTERS DEGREE IN 0UBLIC !DMINISTRATION AND 0UBLIC 0OLICY FROM (AMLINE 5NIVERSITY
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-EDICAID 3ERVICES PUBLISHED THE SECOND PART OF THE lNAL RULE IMPLEMENTING CERTAIN PROVISIONS OF THE FEDERAL PHYSICIAN SELF REFERRAL PROHIBI TION OR h3TARK LAW v 4HE 0HASE )) RULE WHICH BECOMES EFFECTIVE ON *ULY COMES MORE THAN THREE YEARS AFTER h0HASE ) v AND MORE THAN A DE CADE AFTER THE ORIGINAL 3TARK LAW WAS AMENDED AND EXPANDED IN h3TARK )) v 4HE 3TARK LAW ESSENTIALLY PROHIBITS PHYSI CIANS FROM MAKING REFERRALS FOR CERTAIN HEALTH 9Ê 9Ê , -/ - ]Ê /" Ê- ," ,]Ê Ê ,1 Ê " -"
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CARE SERVICES CALLED hDESIGNATED HEALTH SERVICESv OR $(3 TO ORGANIZATIONS WITH WHICH THE PHYSICIAN OR A FAMILY MEMBER HAS A lNANCIAL RELATIONSHIP 5NLESS AN EXCEPTION APPLIES THE REFERRING PHYSICIAN AND THE ENTITY RECEIVING THE REFERRAL ARE PROHIBITED FROM BILLING -EDICARE FOR THE SERVICES -EDICARE IS PROHIBITED FROM PAYING AND REFUNDS ARE REQUIRED FOR PAYMENTS ALREADY MADE 3TARK LAW VIOLATIONS CAN RESULT IN SEVERE PENALTIES UP TO PER CLAIM PLUS TWICE THE REIMBURSEMENT AMOUNT AND AN ADDITIONAL FOR SCHEMES TO CIRCUMVENT THE 3TARK LAW PLUS LIABILITY UNDER THE &ALSE #LAIMS !CT AND EXCLUSION FROM -EDICARE !S A RESULT EVEN RELATIVELY SMALL DOLLAR -EDICARE CLAIMS CAN RESULT IN BIG DOLLAR LOSSES 4HE lNAL RULE HAS BEEN AWAITED WITH SIG NIlCANT ANTICIPATION AND TREPIDATION BECAUSE 3TARK LAW ISSUES ARISE IN A WIDE VARIETY OF SET TINGS AND RELATIONSHIPS 7HILE A COMPLETE RE VIEW OF THE MANY CHANGES IN 0HASE )) IS BEYOND THE SCOPE OF THIS ARTICLE WE SUMMARIZE BELOW SEVERAL OF 0HASE )) S SIGNIlCANT IMPLICATIONS FOR PHYSICIANS
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«i Ã>Ì Ê* > Ã 0HASE )) CLARIlES THAT MEDICAL GROUP PRACTICES RELYING ON THE 3TARK LAW S EXCEPTION FOR hIN OFlCE ANCILLARY SERVICESv CAN PAY PHYSICIANS hPRODUCTIVITY BONUSESv FOR SERVICES THAT THE PHYSICIANS PERSONALLY PERFORM AND FOR SERVICES hINCIDENT TOv THOSE SERVICES .OTE HOWEVER THAT THE NEW RULE DOES NOT CHANGE THE UNDERLYING REQUIREMENTS OF -EDI CARE RELATING TO hINCIDENT TOv SERVICES AND ONLY CERTAIN TYPES OF SERVICES MAY BE FURNISHED ON AN hINCIDENT TOv BASIS
* ÞÃ V > Ê,iVÀÕ Ì i ÌÊ /NE OF THE MOST ANTICIPATED SECTIONS OF 0HASE )) IS THE EXCEPTION GOVERNING PHYSICIAN RECRUIT MENT ARRANGEMENTS !S EXPRESSED IN THE 3TARK LAW THIS EXCEPTION ALLOWS HOSPITALS TO PAY RE MUNERATION TO INDUCE A PHYSICIAN TO RELOCATE TO THE HOSPITAL S GEOGRAPHIC AREA AND BECOME A MEDICAL STAFF MEMBER 0HASE )) CLARIlES THAT THE RECRUIT S MEDI CAL PRACTICE AND NOT HIS HER RESIDENCE MUST BE RELOCATED 5NDER 0HASE )) THE PHYSICAL LOCATION OF A RECRUIT S PRACTICE MUST MOVE AT LEAST MILES OR AT LEAST PERCENT OF THE RECRUITED PHYSICIAN S REVENUES MUST BE DERIVED FROM hNEWv PATIENTS NOT SEEN AT THE PREVIOUS PRACTICE SITE 4HE RECRUITMENT EXCEPTION HAS
*À `ÕVÌ Û ÌÞÊ ÕÃià 0HASE )) ALSO CLARIlES THE CONTEXTS AND METHODS BY WHICH PHYSICIANS CAN BE PAID hPRODUCTIVITY BONUSES v 4HE 0HASE )) RULE DRAWS A DISTINC TION BETWEEN PRODUCTIVITY BONUSES THAT MAY BE PAID TO PHYSICIANS IN GROUP PRACTICES UNDER THE 3TARK LAW S IN OFlCE ANCILLARY SERVICES EXCEP TION DISCUSSED ABOVE AND THE PRODUCTIVITY BONUSES THAT CAN BE PAID IN THE CONTEXT OF OTHER RELATIONSHIPS 0HASE )) PROHIBITS THE CONSIDERATION OF hINCIDENT TOv SERVICES IN DETERMINING AND PAY ING COMPENSATION TO PHYSICIANS IN THEIR CAPAC ITY AS EMPLOYEES OR INDEPENDENT CONTRACTORS TO AN ORGANIZATION THAT FURNISHES $(3 UNLESS THEY ARE IN A GROUP PRACTICE THAT COMPLIES WITH THE
ALSO BEEN MODIlED TO CLEARLY INDICATE THAT RE CRUITS CANNOT BE PROHIBITED FROM ESTABLISHING PRIVILEGES AT A HOSPITAL OTHER THAN THE RECRUITING HOSPITAL )MPORTANTLY THE 0HASE )) RULE NOW PROVIDES AN ADDITIONAL EXCEPTION TO ALLOW RECRUITMENT ARRANGEMENTS INTO EXISTING MEDICAL PRACTICES 4HE NEW EXCEPTION IS NARROW AND IMPOSES A NUMBER OF RESTRICTIONS ON PAYMENT OF RECRUIT ING RELATED COMPENSATION TO PERSONS OTHER THAN THE RECRUIT
-ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃ
LAW S EXCEPTION FOR IN OFlCE ANCILLARY SERVICES /THERWISE THEY CAN ONLY BE COMPENSATED FOR SERVICES THAT THEY hPERSONALLY PERFORM v 0HASE )) ADOPTED A LITERAL INTERPRETATION THAT hPERSONAL PERFORMANCEv MEANS THE EFFORTS OF THE PHYSICIAN AND NO ONE ELSE
SPECIALTIES THAT GARNER RELATIVELY HIGH ANNUAL COMPENSATION LEVELS E G CARDIOLOGY AND CER TAIN SURGICAL SPECIALTIES (OWEVER PHYSICIANS ON THE OTHER END OF THE EARNINGS SCALE E G PRIMARY CARE MAY lND THAT THE SAFE HARBOR METHODS WOULD RESULT IN DECREASED HOURLY RATES
«i Ã>Ì Ê º-iÌÊ Ê `Û> Vi°» -ANY 3TARK LAW EXCEPTIONS REQUIRE THAT COM PENSATION BE hSET IN ADVANCE v 0HASE )) ELIMI NATES A CONTROVERSIAL PROVISION OF 0HASE ) THAT PERCENTAGE BASED COMPENSATION ARRANGEMENTS ARE NOT hSET IN ADVANCE v 4HE NEW RULE CLARIlES THAT EMPLOYEES INDEPENDENT CONTRACTORS AND CERTAIN OTHER PHYSICIANS CAN UNDER CERTAIN CIRCUMSTANCES BE PAID ON A PERCENTAGE OF REVENUES OR COLLECTIONS BASIS WITHOUT VIOLAT ING THE LAW 4HIS WILL COME AS WELCOME NEWS TO MANY HOSPITALS AND ACADEMIC PRACTICES THAT USED PER CENTAGE BASED METHODS TO DETERMINE PHYSICIAN PAY LEVELS (OWEVER EVEN COMPENSATION THAT IS hSET IN ADVANCEv MUST MEET OTHER APPLICABLE REQUIREMENTS INCLUDING FOR EXAMPLE THAT THE COMPENSATION BE FAIR MARKET VALUE AND NOT DETERMINED BY A FORMULA THAT DIRECTLY OR INDI RECTLY CONSIDERS THE VOLUME OR VALUE OF $(3
"Ì iÀÊ > }ià /THER IMPORTANT CHANGES IN 0HASE )) RELATED TO PHYSICIANS INCLUDE s )NCLUDING SEVERAL CATEGORIES OF SERVICES THAT WERE NOT PREVIOUSLY DElNED AS $(3 AND WERE NOT SUBJECT TO THE 3TARK LAW S PROHIBITIONS &OR EXAMPLE EFFECTIVE *ULY DEXASCAN SERVICES AND CERTAIN ADDITIONAL PHYSICAL THERAPY SERVICES ARE DElNED AS $(3 s 0ROVIDING A NEW NARROW EXCEPTION FOR hPROFESSIONAL COURTESYv TO ALLOW FOR THE PROVISION OF CERTAIN FREE OR DISCOUNTED HEALTH CARE ITEMS OR SERVICES s %STABLISHING AN EXCEPTION TO ALLOW FOR CHARITABLE DONATIONS BY PHYSICIANS s 0ROVIDING FOR LIMITED PHYSICIAN hRETENTION PAYMENTSv BY HOSPITALS AND &1(# S IN (EALTH 0ROFESSIONAL 3HORTAGE !REAS
º > ÀÊ >À iÌÊ6> Õi°» !MONG OTHER IMPORTANT CHANGES 0HASE )) DElNES A hSAFE HARBORv FOR DETERMINING FAIR MARKET VALUE HOURLY PAY RATES FOR PHYSICIAN SERVICES 5NDER THIS NEW APPROACH AN HOURLY PAYMENT FOR A PHYSICIAN S PERSONALLY PERFORMED SERVICES WILL BE CONSIDERED FAIR MARKET VALUE IF THE RATE IS EITHER s ,ESS THAN OR EQUAL TO THE HOURLY RATE FOR EMERGENCY ROOM PHYSICIAN SERVICES IN THE MARKET PROVIDED THERE ARE AT LEAST THREE EMERGENCY ROOMS IN THE MARKET OR s ,ESS THAN OR EQUAL TO AN HOURLY RATE CALCU LATED BASED ON THE AVERAGE OF MEDIAN MAR KET BASED COMPENSATION VALUES REPORTED IN NATIONAL COMPENSATION SURVEYS FOR THE SUBJECT SPECIALTY 4HIS NEW APPROACH WILL LIKELY HAVE SIG NIlCANT IMPLICATIONS FOR MEDICAL DIRECTOR AND SIMILAR SERVICES THAT ARE COMMONLY PAID ON AN HOURLY BASIS #OMPLIANCE WITH THE SAFE HARBOR METHODS IS NOT REQUIRED BUT MANY PROVIDERS ARE LIKELY TO ADOPT THE NEGOTIATING POSITION THAT THE SAFE HARBOR MUST BE FOLLOWED 5SE OF THE MARKET BASED METHOD COULD POTENTIALLY RESULT IN HIGHER COMPENSATION FOR SOME PHYSICIAN
« V>Ì Ã 0HASE )) PROVIDES MUCH NEEDED CLARIlCATION OF THE 3TARK LAW S REGULATORY LANDSCAPE &OR BETTER OR WORSE 0HASE )) NOW PROVIDES A DElNITIVE FRAMEWORK THAT CAN AND MUST BE USED TO GUIDE THE STRUCTURE OF VARIOUS BUSINESS AND OTHER RELATIONSHIPS INVOLVING PHYSICIANS HOSPITALS AND OTHER HEALTH CARE ORGANIZATIONS 4HIS SURELY WILL RESULT IN SOME MODIlCATION OF EXISTING RE LATIONSHIPS AS WELL AS SOME POTENTIALLY TOUGH DISCUSSIONS REGARDING RELATIONSHIPS ESTABLISHED IN THE FUTURE -OREOVER NOW THAT A COMPLETE lNAL RULE EXISTS MANY OBSERVERS BELIEVE THAT THE ENFORCEMENT EFFORT WHETHER BY THE GOVERN MENT OR BY QUI TAM WHISTLEBLOWERS IS LIKELY TO FOLLOW CLOSE BEHIND !N EXPANDED VERSION OF THIS ARTICLE COVERING SUPPLEMENTAL 0HASE )) TOPICS IS AVAILABLE AT WWW FAEGRE COM *AY #HRISTIANSEN 4OM 3CHROEDER AND "RUCE *OHNSON PRACTICE IN HEALTH LAW AT THE LAW lRM OF &AEGRE "ENSON 4HEY MAY BE REACHED AT JCHRI STIANSEN FAEGRE COM TSCHROEDER FAEGRE COM OR BAJOHNSON FAEGRE COM
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OBSTETRICS AND NEUROSURGERY ARE NOT PROPERLY IDENTIlED AND ANALYZED !ND EVEN IF IT IS TRUE THAT PERCENT OF PHYSICIANS ACCOUNT FOR MOST MALPRACTICE CLAIMS ANNUALLY IT S NOT THE SAME PERCENT FROM YEAR TO YEAR !LSO .0$" OVERSTATES THE NUMBER OF CASES &OR EXAMPLE CASES IN WHICH A PATIENT RECEIVES A PAYMENT FROM THE INSURANCE CARRIER A PAYMENT FROM THE #!4 FUND AND A PAYMENT FROM THE PHYSICIAN ALL FOR THE SAME EVENT OFTEN HAVE BEEN REPRESENTED IN THE .0$" DATABASE BY THREE SEPARATE REPORTS 4HEREFORE THREE hOCCURRENCESv COULD BE RECORDED FOR A SINGLE INCIDENT 4HESE AND OTHER MYTHS TURN UP IN NEWSPAPER ACCOUNTS AND IN QUESTIONS BY INTERVIEWERS 3O ) LIKE TO REMIND THE MEDIA TO FOCUS ON THE FACTS ,ET S CHALLENGE THE MEDIA TO DO REAL INVESTIGATIVE REPORTING AND NOT JUST ACCEPT AT FACE VALUE THE JUNK MATH STUDIES CHURNED OUT REGULARLY BY OUR OPPONENTS AND OFTEN RELEASED JUST BEFORE A HEARING ON MEDICAL LIABILITY REFORM ) URGE REPORTERS TO CONSULT THE !MERICAN !CADEMY OF !CTUARIES DATA SHOWING THAT CAPS ON NONECONOMIC DAMAGES WORK !ND ! - "EST S DATA SHOW THE REAL NUMBERS ABOUT THE POSITIVE RETURNS ON INSURANCE COMPANY INVESTMENTS 4HESE TRUTHS ARE FOUND IN THE DOCUMENT h-EDICAL ,IABILITY 2EFORM .OW v AVAILABLE ON THE !-! 7EB SITE HTTP WWW AMA ASSN ORG GO MLRNOW !S THE PHILOSOPHER *OHN ,OCKE WROTE h)T IS ONE THING TO SHOW A MAN THAT HE IS IN ERROR AND ANOTHER TO PUT HIM IN POSSESSION OF THE TRUTH v 4RUTH SCIENCE THE FACTS 4HESE LIGHT OUR WAY IN OUR QUEST FOR REFORM )T S A LIGHT WE CAN NEVER LET GO OUT AND WE MUST SHARE IT WITH OTHERS $R 0ALMISANO IS A GENERAL AND VASCULAR SURGEON IN PRIVATE PRACTICE IN .EW /RLEANS (E IS ALSO AN ATTORNEY 6ISIT HIS 7EB PAGE OR CONTACT HIM BY E MAIL DONALD?PALMISANO AMA ASSN ORG
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4(%2% !2% -/2% 4(!. DEMATOLOGIC DISORDERS SO A COMPRE HENSIVE REVIEW WOULD BE RATHER LENGTHY ) WILL ATTEMPT TO TOUCH UPON A FEW POPULAR AND COMMON TOPICS THAT HAVE NEW TREATMENT APPROACHES
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PERCENT OF PSORIATICS /NE THING THAT IS IMPORTANT TO NOTE IS THAT THESE TREATMENTS CAN STAND ALONE OR BE USED IN COMBINATION WITH TRADITIONAL THERAPIES 0SORIASIS IS A CHRONIC CONDITION AND THE MOST EFFECTIVE THERA PEUTIC STRATEGIES OFTEN INVOLVE A COMBINATION APPROACH INCLUDING TOPICAL MEDICATIONS SYSTEMIC MEDICATIONS AND PHOTOTHERAPEUTIC MODALITIES $ERMATOLOGY HAS NEVER BEEN IN SUCH A FAVORABLE POSITION TO OFFER SO MANY EFFECTIVE TREATMENTS FOR PSORIASIS 6ย ร ย ย ย }ย
)T IS TRULY AN EXCITING TIME IN THE TREATMENT OF PSORIASIS 2ESEARCH HAS YIELDED GREAT INSIGHT INTO THE ACTUAL MECHANISM OF A PSORIATIC STATE )N THE PAST IT WAS BELIEVED THAT THE CONDITION RESULTED FROM AN ABNORMALITY IN KERATINOCYTES CAUSING HYPERPROLIFERATIVE GROWTH 4HE NORMAL MATURATION OF THE SKIN FROM THE BASAL LAYER OF THE EPIDERMIS TO THE TOP EPIDERMAL LAYER IS APPROXIMATELY DAYS )N PSORIASIS THIS GROWTH PHASE IS ACCELERATED AND OCCURS IN APPROXIMATELY THREE TO SIX DAYS !S A RESULT THE SKIN CANNOT SHED NORMALLY AND FORMS THICKENED PLAQUES )T IS NOW KNOWN THAT THIS HYPERPROLIFERATIVE STATE IS ACTUALLY A RESULT OF 4 CELL DYSFUNCTION 4 CELLS EXIT THE VASCULAR NETWORK MIGRATE UP INTO THE SKIN PARK THEMSELVES INTERACT WITH OTHER IMMUNOMODULATORY CELLS AND PRODUCE CYTOKINES THAT INCITE AND DRIVE KERATINOCYTE HYPERPROLIFERATION 2ESEARCHERS OFTEN CALL THIS PROCESS h4 CELL TRAFlCKING v 4HE RESULT OF THIS PROCESS IS WHAT WE SEE CLINICALLY AS PSORIASIS 4HE lELD OF MOLECULAR BIOLOGY IS YIELDING MUCH FRUIT AND THERE ARE NUMEROUS NEW INJECTABLE RECOMBINANT PROTEIN AGENTS DESIGNED TO CORRECT THIS 4 CELL DYSFUNCTION AND MAY AFFECT OTHER INmAMMATORY IMMUNOMODULATRY RHEUMATOLOGIC PROCESSES 3OME HAVE BEEN &$! APPROVED AND OTHERS ARE IN THE PROCESS OF APPROVAL FOR THE TREATMENT OF PSORIASIS "ECAUSE THE PROCESS IS DRIVEN BY 4 CELLS SOME CONSIDER PSORIASIS TO BE AN AUTOIMMUNE CONDITION -ANY OF THESE NEW MEDICINES INCLUD ING %TANERCEPT %NBRELยง !LEFACEPT !MEVIVEยง %FALIZUMAB 2APTIVAยง !DALIMUMAB (UMIRAยง AND )NmIXIMAB 2EMICADEยง ARE DESIGNED TO INTERRUPT 4 CELL INVOLVEMENT 4HESE NEW TREATMENTS ARE BOTH EXCITING AND EFFECTIVE 3OME OF THE MEDICATIONS ALSO TREAT THE PSORIATIC ARTHRITIS ASSOCIATED WITH PSORIASIS WHICH CAN OCCUR TO SOME DEGREE IN UP TO
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6ITILIGO IS ONE OF THE MORE DIFlCULT CONDITIONS IN THE lELD OF DERMATOL OGY TO TREAT 4HE EXACT ETIOLOGY OF THIS CONDITION IS UNCLEAR BUT MOST EXPERTS BELIEVE THERE ARE SEVERAL SEPARATE CAUSES FOR VITILIGO 4HESE INVOLVE AN AUTOIMMUNE RESPONSE PRODUCING THE DESTRUCTION OF MELANOCYTES AND A PROGRAMMED CELL DEATH APOPTOSIS OF THE MELANOCYTES THEMSELVES .EVERTHELESS ONE MODALITY HAS REALLY CHANGED THE WAY WE TREAT VITILIGO 0HOTOTHERAPY WITH NARROW BAND ULTRAVIOLET " HAS BECOME THE NEW GOLD STANDARD IN THE TREATMENT OF VITILIGO 4HERE ARE NEWER REPORTS $R 0EARL 'RIMES THAT ALSO INDICATE THAT SOME OF THE NEW NON STEROIDAL ANTIINmAM MATORY MACROLACTAMS 0IMECROLIMUS %LIDELยง AND TACROLIMUS 0ROTOPICยง ARE ALSO BENElCIAL IN THE TREATMENT OF VITILIGO 7E USE A COMBINATION OF TOPICAL AGENTS AND NARROW BAND PHOTOTHERAPY TO ACHIEVE VERY SATISFACTORY RESULTS IN THE TREATMENT OF VITILIGO -OST PATIENTS COME IN FOR LIGHT TREAT MENT TWO TO THREE TIMES PER WEEK AND NOTICE REPIGMENTATION SOMEWHERE BETWEEN TREATMENT AND )N OUR CLINIC APPROXIMATELY PERCENT OF PATIENTS ACHIEVE ACCEPTABLE REPIGMENTATION )N THE PAST PSORALEN PLUS ULTRAVIOLET ! LIGHT WAS USED 056! BUT THIS MODALITY TOOK ANYWHERE FROM SIX TO MONTHS TO BEGIN THE REPIGMENTATION AND AS WE KNOW NOW IT IS FRAUGHT WITH LONG TERM RISKS OF SKIN CANCER FORMATION 4HAT IS WHY NARROW BAND ULTRAVIOLET " THERAPY IS A WELCOMED AND EFFECTIVE CHANGE IN OUR TREATMENT PROGRAM
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4HE LAST YEAR HAS BROUGHT SEVERAL NEW DEVELOPMENTS IN THE TREATMENT OF ACNE -OST NOTABLY THERE ARE &$! APPROVED LASERS FOR THE TREATMENT OF ACNE /UR CLINIC UTILIZES THE !RAMISยง GLASS ERBIUM LASER WHICH OPERATES AT A WAVELENGTH OF NM 4HE LASER S TARGET IS THE SEBACEOUS GLAND TO REDUCE THE OVERALL OIL PRODUCTION IN THE SKIN )T HAS A MECHANISM OF ACTION SIMILAR TO YET MILDER THAN !CCUTANEยง )T USUALLY REQUIRES FOUR TO SIX TREATMENTS OVER TWO TO THREE MONTHS 7E ARE SEEING SOME EXCELLENT RESULTS WITH THIS LASER BOTH ALONE AND IN COMBINATION WITH OTHER TRADI TIONAL THERAPIES INCLUDING ORAL ANTIBIOTICS AND TOPICAL RETINOIDS TOPICAL ANTIBIOTICS AND TOPICAL BACTERIOSTATIC AGENTS 4HIS LASER IS ALSO NICE FOR PATIENTS WHERE !CCUTANEยง IS A CONSIDERATION BUT FOR MULTIPLE REASONS THEY ARE NOT CANDIDATES FOR !CCUTANEยง 4HE !RAMISยง LASER IS ALSO HELPFUL IN SITUATIONS WHERE ACNE CONTROL IS NEEDED BUT THE PATIENT IS NOT A CANDIDATE FOR TRADITIONAL ACNE MEDICATIONS !LSO OF NOTE OVER THE LAST YEAR OR SO SEVERAL NEW GENERICS HAVE COME OUT FOR !CCUTANE )SOTRETINOIN 4HESE INCLUDE !MNESTEEMยง #LARAVISยง AND 3OTRETยง 4HESE THREE NEW PLAYERS IN THE )SOTRETINOIN lELD ARE ALL BIOEQUIVALENT TO !CCUTANEยง AND WE ARE SEEING GOOD RESULTS WITH THEIR USE /NCE AGAIN IN THE lELD OF ACNE TREATMENT A COMBINATION APPROACH USUALLY YIELDS THE BEST RESULTS 4HESE INCLUDE TOPICAL ORAL AND AT TIMES LASER TREATMENTS ยซย ย ร ย ย ย iร Viย Viร ย Vร ย ร Vย ยซร
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4HE 6BEAM LASER ALSO IN COMBINATION WITH THE NEW TOPICAL AGENT CREAM 3TRI6ECTIN HAVE THE ABILITY IN THE MAJORITY OF CASES TO MAKE A NOTICEABLE IMPROVEMENT IN THE LOOK OF STRETCH MARKS "OTOX STILL REMAINS KING AT TREATING UNWANTED FACIAL LINES DUE TO MUSCULAR CONTRACTION AND EXPRES SION 4HE NEW AGENT 2ESTYLANE A NATURAL SUGAR BASED HYALURONIC ACID PRODUCT IS A TERRIlC NEW TOOL 2ESTYLANE IS A lLLING AGENT USED TO lLL UNWANTED LINES THAT ARE PRESENT AT REST 4HE COMBINATION OF 2ESTYLANE AND "OTOX HAS WORKED MARVELOUSLY TO REJUVENATE THE FACE 4HE BUZZ TERM IS hMINIMALLY INVASIVE FACIAL REJUVENATION v "OTOX #OSMETIC AND 2ESTYLANE CAN BE USED IN COMBINATION TO REJUVENATE A FULL FACE AND TO TREAT UNWANTED LINES BETWEEN THE EYEBROWS 2ESTYLANE ALSO CAN BE USED TO lLL IN ACNE SCARS AND TO BEAUTIFY THE LIPS 0LEASE SEE OUR 7EB SITE LISTED BELOW FOR ADDITIONAL PHOTOS ย ร iร ย iร ร ย `ร iร ย >ร ย ย ย }ร ร ย vย ร ย >ร ย ย ย 4HERE ARE MANY ONLINE MEDICAL DISCUSSION FORUMS AND INFORMATIONAL 7EB SITES AVAILABLE 3OME OUTSTANDING EXAMPLES INCLUDE WWW MDCONSULT COM WWW DERM COM WWW DERMATLAS COM HTTP MATRIX UCDAVIS EDU AND WWW E-EDGUIDES COM 4O ADD TO THIS KNOWLEDGE BASE OUR CLINIC HAS PUT ONLINE A COMPLETE PHOTOGRAPHIC IMAGE ATLAS 7E HAVE ACCESS TO MORE THAN HIGH QUAL ITY CLINICAL PHOTOGRAPHS AND WE ARE ALLOWING ANY PHYSICIAN HEALTH CARE PROVIDER TO HAVE ACCESS AND USE THESE FREE OF CHARGE )N ADDITION WE HAVE ARCHIVED LECTURES #-% CASES OF THE MONTH AND A QUARTERLY NEWSLETTER !LL OF THESE SERVICES TO -INNESOTA PHYSICIANS AND HEALTH CARE PROVIDERS ARE OF FERED FREE OF CHARGE 3IMPLY LOG ON TO WWW #RUTCHlELD$ERMATOLOGY COM AND SIGN UP FOR THE NEWSLETTER AND DERMATOLOGY IMAGE ATLAS LIBRARY #HARLES % #RUTCHlELD ))) - $ IS MEDICAL DIRECTOR AT #RUTCHlELD $ERMATOLOGY IN %AGAN -. (E COMPLETED HIS DERMATOLOGY RESIDENCY AT THE 5NVERSITY OF -INNESOTA AND IS CURRENTLY AN ADJUNCT CLINICAL ASSOCIATE PROFESSOR OF DERMATOLOGY AT THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL (E CO AUTHORED THE DERMATOLOGY TEXTBOOK h! #LINICAL !TLAS OF #OMMON 3KIN $ISEASES v
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/N $ECEMBER 0RESIDENT 2ICHARD - .IXON SIGNED 4HE /CCUPATIONAL 3AFETY AND (EALTH !CT OF 4HIS !CT BECAME THE GOVERNING BODY OF WORKPLACE SAFETY AND HEALTH STANDARDS 7HEN THE 3AFETY AND (EALTH !CT WAS INITIATED IN !PRIL OF IT COVERED MILLION WORKERS AT MILLION WORKPLACES 4ODAY THIS NUMBER HAS INCREASED TO MORE THAN MILLION WORKERS AT MILLION WORK SITES THROUGHOUT THE 5NITED 3TATES 4HIS 3AFETY AND (EALTH !CT ESTABLISHED THE /CCUPATIONAL 3AFETY AND (EALTH !DMINISTRA TION /3(! TO SET AND ENFORCE WORKPLACE SAFETY AND HEALTH STANDARDS 4HIS h3AFETY "ILL OF 2IGHTSv ESTABLISHED STANDARDS THAT INCLUDED lRE SAFETY AND EMPLOYEE EXPOSURE LIMITS !CTUALLY THE ORIGINAL STANDARD LIMITED WORKER EXPOSURE TO ASBESTOS )MPORTANT CHANGES THAT HAVE AFFECTED ALL MEDICAL FACILITIES INCLUDE THE DECISION IN 9Ê -Ê °Ê* / ,-"
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EXPOSURE TIME LIMITATIONS MONITORING THE USE OF HAZARDOUS MATERIALS ALARMS SIGNS WARNINGS AND OF COURSE EMPLOYEE TRAINING 0ERSONAL PROTECTIVE EQUIPMENT SUCH AS RESPIRATORS HEARING PROTECTION PROTECTIVE CLOTHING SAFETY GLASSES ETC IS ACCEPTABLE AS CONTROL METHODS WHEN ENGINEERING CONTROLS ARE NOT FEASIBLE OR DO NOT TOTALLY ELIMINATE THE HAZARD WHEN SAFE WORK PRACTICES DO NOT PROVIDE SUFlCIENT ADDITIONAL PROTECTION AND DURING EMERGENCIES WHEN ENGINEERING CONTROLS MAY NOT BE FEASIBLE )N SITUATIONS WHERE THE HAZARD CANNOT BE COMPLETELY ELIMINATED A COMBINATION OF HAZ ARD CONTROLS WILL MOST LIKELY BE THE BEST SOLU TION -ANAGERS AND SUPERVISORS MUST BE AWARE THAT NOT ALL CONTROLS ARE EQUAL )NTERIM CONTROLS CAN BE USED WHEN MORE EFFECTIVE CONTROLS ARE BEING SOUGHT DEVELOPED OR EVALUATED 4HIS MAY INVOLVE CHANGING HOW EMPLOY EES PERFORM THEIR JOB S TASKS $ISCUSS YOUR RECOMMENDATIONS WITH ALL AFFECTED EMPLOYEES AND CONSIDER THEIR RESPONSES CAREFULLY )F YOU PLAN TO INTRODUCE NEW OR ALTER EXISTING JOB PROCEDURES BE SURE EMPLOYEES UNDERSTAND WHAT THEY ARE REQUIRED TO DO AND THE REASONS FOR THE CHANGES
* >ÃiÊÓ\Ê ÌÀ }Ê9 ÕÀÊ 7 À « >ViÊ >â>À`Ã /NCE AN ORGANIZATION HAS PROPERLY IDENTIlED WORKPLACE HAZARDS A PLAN MUST BE DEVELOPED TO EITHER REMOVE THE HAZARD OR PROTECT THE WORKER FROM THE HAZARD 4HE GOAL SHOULD BE TO IMPLE MENT CONTROLS AND PREVENT IDENTIlED HAZARDS FROM AFFECTING AN EMPLOYEE %NGINEERING CONTROLS THAT PHYSICALLY CHANGE A MACHINE OR WORK ENVIRONMENT TO PREVENT EMPLOYEE EXPOSURE TO A HAZARD ARE THE MOST EFFECTIVE CONTROLS 1UESTIONS TO KEEP IN MIND SHOULD BE IF WE CAN T ELIMINATE A HAZARD COULD WE MINIMIZE EXPOSURE TO THE HAZARD 5TILIZING SHEATHING NEEDLES WOULD BE ONE VERY COMMON EXAMPLE OF MINIMIZING EXPOSURE TO A HAZARD 7E HAVEN T COMPLETELY ELIMINATED THE NEEDLE STICK RISK BUT THE RISK IS CERTAINLY REDUCED 3INCE ALL WORKPLACE DANGERS CANNOT BE ELIMINATED ADMINISTRATIVE CONTROLS AND PER SONAL PROTECTIVE EQUIPMENT ALSO NEED TO BE INTRODUCED TO MINIMIZE EMPLOYEE EXPOSURE !DMINISTRATIVE CONTROLS CAN INCLUDE WRITTEN OPERATING PROCEDURES WORK PERMITS
* >ÃiÊÎ\Ê v À }Ê 9 ÕÀÊ « Þiià 7HEN WORKPLACE HAZARDS HAVE BEEN IDENTIlED AND CONTROLS INTRODUCED TO TOP MANAGEMENT SUPERVISORS SAFETY AND HEALTH PERSONNEL EM PLOYEES AND EMPLOYEE REPRESENTATIVES SHOULD BE PROVIDED WITH TRAINING THAT DESCRIBES THESE CONTROL MEASURES 3TANDARDS DEVELOPED BY THE /CCUPATIONAL 3AFETY AND (EALTH !DMINISTRATION REQUIRE THE EMPLOYER TO TRAIN EMPLOYEES IN THE SAFETY AND HEALTH ASPECTS OF THEIR JOBS INITIALLY UPON ASSIGNMENT AND OR ANNUALLY -ANY OF THESE /3(! STANDARDS MAKE IT THE EMPLOYER S RE SPONSIBILITY TO LIMIT CERTAIN JOB ASSIGNMENTS TO EMPLOYEES WHO ARE hCERTIlED v hCOMPETENTv OR hQUALIlEDv MEANING THEY HAVE HAD PREVIOUS SPECIAL TRAINING IN OR OUT OF THE WORKPLACE 4HE TERM hDESIGNATEDv PERSONNEL MEANS SELECTED OR ASSIGNED BY THE EMPLOYER OR THE EMPLOYER S REPRESENTATIVE AS BEING QUALIlED TO PERFORM SPECIlC DUTIES 4RAINING RECORDS PROVIDE EVIDENCE OF THE EMPLOYER S GOOD FAITH AND COMPLIANCE WITH /3(! STANDARDS $OCUMENTATION CAN ALSO
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SUPPLY AN ANSWER TO ONE OF THE lRST QUESTIONS AN ACCIDENT INVESTIGATOR WILL ASK h7AS THE INJURED EMPLOYEE TRAINED TO DO THE JOB v -ANY RESEARCHERS AND STUDIES CONCLUDE THAT THOSE WHO ARE NEW ON THE JOB HAVE A HIGHER RATE OF ACCIDENTS AND INJURIES THAN MORE EXPERIENCED WORKERS 4O HELP EMPLOYERS SAFETY AND HEALTH PROFESSIONALS AND TRAINING DIRECTORS CONSULTANTS CAN HELP FULlLL /3(! TRAINING RELATED REQUIREMENTS * >ÃiÊ{\Ê Ì À }Ê 9 ÕÀÊ->viÌÞÊ*À }À> ÃÊ 4HE lNAL STEP INVOLVES PERIODICALLY REVIEWING YOUR HAZARD lNDINGS AND RECOMMENDATIONS !N /RGANIZATIONAL !DMINISTRATOR 3AFETY #OM MITTEE OR 3AFETY #OORDINATOR SHOULD EXAMINE THE ORGANIZATIONAL RECORDS AND INJURY REPORTS AND APPROVE THE JOB TASKS HAZARDS AND HAZ ARD CONTROL RECOMMENDATIONS USED THROUGH OUT EACH FACILITY ! PERIODIC REVIEW INVOLVING SUPERVISORS AND DEPARTMENT HEADS ENSURES AN ORGANIZATION WILL REMAIN CURRENT WITH EXIST ING REGULATIONS AND CONTINUE TO HELP REDUCE WORKPLACE ACCIDENTS AND INJURIES 2EVIEW THE WORKPLACE HAZARD ASSESSMENT IF AN ILLNESS OR INJURY OCCURS ON A SPECIlC JOB #HANGES TO THE JOB PROCEDURE TO PREVENT SIMI LAR INCIDENTS IN THE FUTURE MIGHT BE NECESSARY 2EMEMBER THAT A COMBINATION OF CHANGES AND EXISTING CIRCUMSTANCES MAY CAUSE NEW HAZARDS TO APPEAR OR OLD HAZARDS TO REAPPEAR )F AN EMPLOYEE S FAILURE TO FOLLOW PROPER JOB PROCEDURES RESULTS IN A hCLOSE CALL v DISCUSS THE SITUATION WITH ALL EMPLOYEES WHO PERFORM THE JOB AND REMIND THEM OF PROPER PROCEDURES )T IS IMPORTANT TO TRAIN ALL EMPLOYEES AFFECTED BY CHANGES MADE IN NEW JOB METHODS PRO CEDURES OR PROTECTIVE MEASURES ADOPTED 4HE -INNESOTA /3(! FORMULA FOR COMPLIANCE IF FOLLOWED PROPERLY WILL MOST LIKELY HAVE POSITIVE EFFECTS ON AN ORGANIZATION )N CONCLUSION IF YOU RECEIVE OUTSIDE HELP OR IF YOU MEET THE /3(! REQUIREMENTS UTILIZ ING YOUR EXPERTISE YOU AND YOUR EMPLOYEES NEED TO REMAIN INVOLVED IN THE PROCESS OF IDENTIFYING AND CORRECTING HAZARDS )T SHOULD BE EVERYONE S MISSION TO CREATE AND MAINTAIN A SAFE WORKPLACE ENVIRONMENT SO THAT WE ALL LEAVE WORK AS HEALTHY AND HAPPY AS WE WERE WHEN WE ARRIVED AT WORK *AMES # 0ETERSON IS THE #%/ AND CO FOUNDER OF 3AFE!SSURE #ONSULTANTS )NC Õ ÞÉ Õ}ÕÃÌÊÓää{ÊÊÊÊÊ
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/. -!9 'OVERNOR 0AWLENTY BAL ANCED THE BUDGET ONE DAY AFTER THE ,EGISLATURE HAD ADJOURNED AND HAD FAILED TO DO THE JOB 4HE 3T 0AUL 0IONEER 0RESS LAUDED 0AWLENTY ON -AY NOTING h0AWLENTY 4AKES #ARE OF "USINESS '/0 'OVERNOR 7IPES /UT $ElCIT (IMSELFxv 4HE 3TAR 4RIBUNE ALSO HEADLINED OUR TAKE CHARGE 'OVERNOR (E HAD WIPED OUT A PROJECTED MILLION BUDGET DElCIT )SN T THAT GREAT 7E ACTU ALLY HAVE A 'OVERNOR WHO IS TOUGHER THAN OUR FORMER hMUSCLE FOR BRAINSv WRESTLER SELF PROMOT ING 'OVERNOR "UT WHO IS TAKING THE PUNCHES FROM THIS NEW KID ON THE BLOCK WHO hTAKES CARE OF BUSINESS v 7HY IT S NONE OTHER THAN THE SICK PATIENTS OF OUR STATE AND THE DOCTORS DENTISTS AND HOSPITALS WHO MINISTER TO THEIR MINDS AND BODIES 'OVERNOR 0AWLENTY USED MORE THAN MILLION FROM THE (EALTH #ARE !CCESS &UND OUR PERCENT 0ROVIDER 4AX MONEY TO BALANCE THE BUDGET AND PAY FOR EXPENDITURES IN THE 'ENERAL &UND THAT HAD NOTHING TO DO WITH HEALTH CARE 4ALK ABOUT KICKING A PATIENT AND THE DOCTOR LEANING OVER TRYING TO HELP THE PATIENT WHEN THEY RE DOWN #AN THE INJUSTICE OF THIS PROVIDER TAX GET WORSE .OW THE SICK ARE TAXED NOT ONLY TO PAY FOR INCREASED ACCESS TO HEALTH CARE -IN NESOTA#ARE PROGRAM BUT ALSO TO PAY FOR ALL THE NON HEALTH RELATED EXPENDITURES IN THE 'ENERAL &UND 0ERHAPS WE SHOULD CUT OUR 'OVERNOR SOME SLACK !FTER ALL ISN T HE SIMPLY DOING WHAT HIS PREDECESSORS HAVE DONE 3ADLY IT IS TRUE 4HE #IT IZEN S #OUNCIL ON (EALTH #ARE NOTED THAT FROM NEARLY PERCENT OF THE (EALTH #ARE !CCESS &UND S RESOURCES WERE DIVERTED FROM THE -INNESOTA#ARE SUBSIDY PROGRAM )F THIS PROVIDER TAX HAS BEEN ABUSED YEAR AFTER YEAR WHY AREN T MORE PEOPLE UP IN ARMS ABOUT ITS EXISTENCE 4HE REASON IS THAT IT IS HIDDEN FROM VIEW 0ROVIDERS ARE FORBIDDEN FROM ITEM IZING THE TAX ON BILLING STATEMENTS TO PATIENTS 0ATIENTS DON T EVEN KNOW THEY ARE BEING TAXED %VEN THOUGH PROVIDERS HAVE BEEN ALLOWED TO PASS ON THE TAX TO PATIENTS AND INSURERS THERE IS LITTLE EVIDENCE THAT INSURERS PAY THE TAX 4HE $EPART MENT OF (EALTH WHICH HAS THE REGULATORY POWER
TO ENFORCE THE TAX PASS THROUGH COMPLIANCE DOES NOT HAVE FUNDING APPROPRIATED TO MONITOR ITS PAYMENT 4HUS PATIENTS AND THEIR PROVIDERS CONTINUE TO BEAR THE BURDEN OF THE TAX 0ERHAPS WE SHOULD NOT BE UPSET AT OUR 'OVERNOR FOR USING THIS (EALTH #ARE !CCESS &UND BECAUSE THERE ARE NO MORE PROBLEMS WITH ACCESS TO HEALTH CARE IN -INNESOTA NOR ARE THERE UNINSURED IN -INNESOTA AND HEALTH CARE COSTS HAVE SUFlCIENTLY BEEN CONTROLLED IN -INNESOTA 5NFORTUNATELY THE ONLY STATE IN WHICH THESE CONDITIONS APPLY IS THE STATE OF DENIAL /UR REGULATORY MANAGED CARE SYSTEM HAS NOT WORKED IN CONTROLLING COSTS WITH ITS DELAY AND OR DENIAL OF CARE PRICE lXING AND TRANSFER OF UNDERWRIT ING RISKS TO CLINICS 9ET STATEWIDE EXPANSION OF MANAGED CARE NETWORKS CONTINUES 4HE RANKS OF THE UNINSURED CONTINUE TO SWELL (-/S REPORT RECORD PROlTS WHILE INCREASING SALARIES TO THEIR UPPER LEVEL ADMINISTRATORS AND INCREASING POLICY DEDUCTIBLES TO THEIR LOWLY PATIENT POLICYHOLDERS #LEARLY OUR HEALTH CARE lSCAL WOES ARE NOT SOLVED )T IS NOT A TIME TO BE TRANSFERRING FUNDS !7!9 FROM HEALTH CARE NEEDS 7HAT ADVICE HAVE ) FOR OUR 'OVERNOR &IRST GET ON BOARD TO GET RID OF A HIDDEN UNJUST TAX ON THE SICK AND THOSE THAT PROVIDE CARE FOR THE SICK !DMIT THAT THIS TAX DOES NOT MEET THE NEEDS OF THE UNINSURED DOES NOT IMPROVE ACCESS TO HEALTH CARE FOR A VARIETY OF REASONS AND DOES NOT CONTROL COSTS 3ECOND AS LONG AS THIS UNJUST TAX DOES EXIST RESTRICT THE USE OF SUCH FUNDS FOR HEALTH CARE NEEDS ONLY AND PROHIBIT PROVIDER TAX REVENUES FROM SUBSIDIZING 'ENERAL &UND EXPENDITURES 4HIRD IF YOU ARE GOING TO BALANCE THE BUDGET ON THE SHOULDERS OF THE SICK AND THEIR PROVIDERS AT LEAST GIVE US THE CREDIT )F THE 'OVERNOR HEEDS ANY OF THIS ADVICE ) DOUBT HE D CONSIDER IT POLITICALLY CORRECT -AYBE NEXT TIME HE WILL CONSIDER hDOING THE RIGHT THING v RATHER THAN WHAT S POLITICALLY EXPEDIENT BUT DON T HOLD YOUR BREATH
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4HE 9EAR BEGAN WITH CONTINUING WORK WITH TWO *ANUARY MEETINGS OF THE #ONTRACT #OALITION TO DEVELOP STRATEGY FOR PASSING THE
,EGISLATURE -EMBERS OF THE #ONTRACT #OALI TION ALSO MET WITH 3ENATOR $ALLAS 3AMS AUTHOR OF THE CONTRACTING BILL AND 3ENATOR "ECKY ,AUREY CHAIRPERSON OF THE 3ENATE (EALTH 0OLICY #OMMITTEE TO ESTABLISH THE GROUND RULES FOR MOVING THE BILL IN THE 3ENATE 2-3 PARTICIPATION IN THE ,> ÃiÞÊ/ L>VV Ê > Ì Ê,/ ® ALSO KICKED OFF IN *ANUARY WITH TWO MEETINGS OF THE 0LANNING #OMMITTEE 4HE 24# IS AN ORGANIZATION THAT INCLUDES THE !SSOCIATION OF .ONSMOK ERS -INNESOTA THE 3T 0AUL 2AMSEY 0UBLIC (EALTH $EPARTMENT SOCIAL SERVICE AGEN CIES THE ETHNIC MEDIA UNIONS AND LAW ENFORCEMENT 4HE 24# IS WORKING TO INmU ENCE POLICIES THAT WILL CREATE TOBACCO FREE ENVIRONMENTS IN PARK AND RECREATION AREAS IN HOUSING DEVELOPMENTS AND EVENTUALLY IN RESTAURANTS AND BARS 4HE 2-3 #OUNCIL ON #OMMUNITY (EALTH CHAIRED BY $R .EAL (OLTAN IS THE SUPPORTING ENTITY IN 2-3 4HE 2-3 "OARD BEGAN THE -ÌÀ>Ìi} VÊ * > } PROCESS ON *ANUARY WITH AN EVENING MEETING WITH #ONSULTANT 0AT 0ETER SON !DDITIONAL MEETINGS TO DEVELOP AN 2-3 -ISSION 6ISION AND 3TRATEGIC /BJECTIVES WERE PLANNED $R 0ETER $ALY AND 2OGER *OHNSON ALONG WITH --! #%/ 2OBERT -EICHES MADE A PRESENTATION TO THE >À`Ê vÊ-Ì°Ê*>Õ Ê ,>` }Þ ON *ANUARY TO GIVE THE GROUP INFORMATION ON THE VALUE OF --! AND 2-3 MEMBERSHIP 4HANKS TO -ARK +LEINSCHMIDT 3T 0AUL 2ADIOLOGY CLINIC ADMINISTRATOR WHO IS A MEMBER OF THE 2-3 "OARD !DDITIONAL MEETINGS DURING *ANUARY INCLUDED AN , -]Ê V° "OARD MEETING A iÌÀ « Ì> Ê* Þà V > Ê Ã« Ì> Ê i>`
THE -INNESOTA (OSPITAL !SSOCIATION BILL AND THE MEDICAL LIABILITY INSURANCE PROBLEM FOR TWO EMERGENCY ROOM PHYSICIAN GROUPS A MEETING ON THE MEDICAL STUDENT MENTORING PROGRAM AT THE 5NIVERSITY AND AN Ê >À`Ê vÊ/ÀÕÃÌiià MEETING ON 3ATURDAY *ANUARY *ANUARY WAS CLOSED OUT WITH THE VERY SUC CESSFUL , -Ê7 ÌiÀÊ > >Ê> `Ê Õ> Ê iiÌ } AT #IRCUS *UVENTAS ON 3ATURDAY EVENING *ANUARY $R 0ETER $ALY WAS SWORN IN AS THE TH PRESIDENT OF 2-3 $R -ARY ,OU %ZZO RECEIVED THE ÓääÎÊ Õ ÌÞÊ-iÀÛ ViÊ Ü>À`° /VER PHYSICIANS SPOUSES AND FAMILY MEMBERS ENJOYED THE (AWAIIAN THEME LUAU THE CIRCUS ACTS AND THE #RACK $RILL 4EAM FROM 3T 4HOMAS !CADEMY 4HE 3ILENT !UCTION GENER ATED OVER FOR THE ,> ÃiÞÊ i` V> Ê- V iÌÞÊ Õ `>Ì °
&EBRUARY WAS DOMINATED BY THE OPENING OF THE -iÃÃ Ê vÊÌ iÊ ià Ì>Ê i} à >ÌÕÀi° 4WO ISSUES BECAME THE TOP PRIORITIES EARLY IN THE 3ESSION 4HE lRST WAS THE BILL THAT ORIGINATED WITH THE -INNESOTA (OSPITAL !SSOCIATION -(! -° °ÊÓänäÉ ° °ÊÓ£ÓÇ® TO REGULATE OUTPATIENT SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS ! CO ALITION MADE UP OF THE --! (-3 2-3 THE -INNESOTA -EDICAL 'ROUP -ANAGERS !SSOCIATION AND THE PHYSICIAN GROUPS OP ERATING SURGERY AND IMAGING CENTERS RAPIDLY MOBILIZED TO COUNTER THE -(! LOBBYING ACTIVITIES 4HE PHYSICIAN GROUP COALITION ACHIEVED A MAJOR VICTORY WHEN A COMPROMISE WAS REACHED WITH THE -INNESOTA (OSPITAL !SSOCIATION )N MID &EBRUARY THE Óää{Ê, -É -Ê 7 ÌiÀÊ i` V> Ê viÀi Vi WAS HELD IN 0UERTO 6ALLARTA -EXICO WITH PHYSI CIANS AND A GROUP OF MORE THAN PARTICI PANTS 3IXTEEN HOURS OF #ATEGORY #-%
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CREDIT WERE OFFERED THROUGH JOINT SPONSORSHIP WITH THE --! AND THROUGH THE !MERICAN !CADEMY OF &AMILY 0HYSICIANS &ACULTY MEMBERS PRESENTED LECTURES COVERING A RANGE OF TOPICS IN ORTHOPEDIC SURGERY DERMATOL OGY RADIOLOGY NEUROLOGY SURGERY ALLERGY *#!(/ AND HEALTH CARE LEGISLATION SUCH AS THE NEW -EDICARE 0RESCRIPTION $RUG AND -ODERNIZATION !CT ! JOINT , -É -Ê >À`Ê iiÌ } WAS HELD ON &EBRUARY WHICH FEATURED TWO GUEST SPEAKERS ,i«ÀiÃi Ì>Ì ÛiÊ À> Ê À>` iÞ SPEAKING ON HIS HEALTH CARE REFORM LEGISLATIVE PROPOSALS AND -i >Ì ÀÊ Ê >ÀÌÞÊSPEAKING ON HIS LEGISLATIVE PROPOSAL TO STUDY A SINGLE PAYER HEALTH CARE SYSTEM IN -INNESOTA /THER BILLS LOOMED ON THE LEGISLATIVE RADAR SCOPE IN -ARCH 4HEY INCLUDED A 7 À iÀýÊ
«i Ã>Ì ÊL THAT INCLUDES PROVI SIONS FOR CERTIlED MANAGED CARE PLANS TO OFFER TO EMPLOYERS AND INSURERS CERTAIN MANAGED CARE SERVICES AS OPTIONS SEPARATE FROM BASIC WORKERS COMPENSATION COVERAGE AND DIS COUNTED PROVIDER FEES !NOTHER SECTION OF THE BILL WOULD REVISE THE RULE MAKING PROCEDURE FOR WORKERS COMPENSATION THAT IS USED BY THE $EPARTMENT OF ,ABOR AND )NDUSTRY 4HE OTHER CONTROVERSIAL DEVELOPMENT IN THE Óää{Ê-iÃÃ WAS THE USE OF THE i> Ì Ê VViÃÃÊ Õ `Ê«À Û `iÀÊÌ>ÝÊÀiÛi Õi®
TO BALANCE THE STATE BUDGET 4HE (OUSE BUDGET TRANSFERS MILLION PERMANENTLY TO THE 'ENERAL &UND 4HE 3ENATE BUDGET TRANS FERS MILLION TO ELIMINATE CO PAYMENTS IMPLEMENTED ONE YEAR AGO IN THE -EDICAL !SSISTANCE AND 'ENERAL !SSISTANCE -EDICAL #ARE PROGRAMS AND PROVIDES FOR A MIL #ONTINUED ON PAGE
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LION lVE DAY LOAN AT THE END OF THE BIENNIUM TO BALANCE THE BOOKS 4HE GOVERNOR USED THE (EALTH !CCESS &UND TO HELP BALANCE THE BUDGET AFTER THE LEGISLATURE FAILED TO ACT DUR ING THE REGULAR SESSION !T THE END OF -ARCH $R #HARLES 4ERZIAN AND 2OGER *OHNSON ATTENDED THE Ê `Û V>VÞÊ viÀi Vi IN 7ASHINGTON $ # 4HE #ONFERENCE SPEAKERS INCLUDED 3ENATOR "ILL &RIST THE 3ENATE MAJORITY LEADER -ARK -C#LELLAN - $ THE NEW ADMIN ISTRATOR OF THE #ENTERS FOR -EDICARE AND -EDICAID .ATIONAL )NSTITUTES OF (EALTH $I RECTOR %LIAS :ERHOUNI - $ AND !NTHONY 0RINCIPI SECRETARY OF THE 5 3 $EPARTMENT OF 6ETERANS !FFAIRS 2EPRESENTATIVES OF BOTH THE "USH AND +ERRY CAMPAIGNS SPOKE IN ADDITION TO SEVERAL OTHER MEMBERS OF #ONGRESS 4WO ISSUES DOMINATED THE CONFERENCE -EDICARE AND MEDICAL LIABILITY REFORM 4HE ACTIVITIES IN THE MONTHS OF !PRIL AND -AY WERE HEAVILY WEIGHTED WITH LEGISLA TIVE ACTION AND THE UNEXPECTED SMOKE FREE ORDINANCE IN 3AINT 0AUL 4HE Óää{Ê-iÃ Ã Ê vÊÌ iÊ ià Ì>Ê i} à >ÌÕÀi
WAS WINDING DOWN WITH BOTH THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT AND THE WORK ERS COMPENSATION BILLS IN PLAY i} Ã >Ì ÛiÊ>`Û V>VÞ WAS A TOP PRIOR
ITY IN !PRIL AND -AY $R ,YLE 3WENSON CHAIRPERSON OF THE 2-3 #OUNCIL ON 0UBLIC 0OLICY HOSTED A RECEPTION AT HIS HOME ON !PRIL FOR &OURTH $ISTRICT 2EPRESENTATIVE "ETTY -C#OLLUM -ORE THAN PHYSICIANS AND SPOUSES ATTENDED AND THEY DISCUSSED IS SUES RELATED TO -EDICARE THE WAR IN )RAQ AND THE ECONOMY WITH #ONGRESSWOMAN -C#OL LUM 4HE #OUNCIL ON 0UBLIC 0OLICY HOPES TO MEET WITH #ONGRESSMAN -ARK +ENNEDY AND #ONGRESSMAN *OHN +LINE IN THE FUTURE ! MAJOR VICTORY CAPPING OVER THREE YEARS OF WORK BY THE -INNESOTA &AIR (EALTH 0LAN #ONTRACTING #OALITION WAS ACHIEVED ON -AY WHEN ÛiÀ ÀÊ*>Ü i ÌÞÊà } i`Ê ° °ÊÈäÈ]ÊÌ iÊ ià Ì>Ê i> Ì Ê* > Ê
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/VERALL THE 3ESSION CAN BE EVALUATED AT THE TOP OF THE RATING CHARTS 4HE -IN NESOTA (OSPITAL !SSOCIATION BILL TO CRIPPLE OUTPATIENT SURGERY AND IMAGING CENTERS WAS ACCEPTABLY REVISED THE WORKERS COMPENSA TION BILL WITH THE DISCOUNTED FEE SCHEDULES WAS NOT PASSED AND THE -INNESOTA (EALTH 0LAN #ONTRACTING !CT WAS PASSED AND SIGNED INTO LAW -Ì°Ê*>Õ Ê Õ V > Ê >ÛiÊ/ Õ i
INTRODUCED AN ORDINANCE AT A NEWS CONFER ENCE ON -AY CALLING FOR SMOKE FREE BARS AND RESTAURANTS $R #HARLENE -C%VOY A PULMONOLOGIST AT 2EGIONS (OSPITAL REP RESENTED 2-3 AT THE NEWS CONFERENCE AND SHE ADDRESSED THE MEDICAL ISSUES OF SECOND HAND SMOKE 4HE NEWS CONFERENCE KICKED OFF A VERY BUSY MONTH OF ACTIVITY FOR 2-3 IN SUPPORT OF THE ORDINANCE % MAIL ALERTS WERE SENT TO MEMBERS LETTERS TO THE EDI TOR WERE CRAFTED AND STAFF PARTICIPATED IN NUMEROUS MEETINGS 4HE , -Ê Õ V Ê Ê Õ ÌÞÊ i> Ì ] CHAIRED BY $R .EAL (OLTAN COORDINATED THE 2-3 EFFORT $R ,YLE 3WENSON JOINED 2-3 #%/ 2OGER *OHNSON AND OTHER HEALTH CARE LEADERS IN A MEETING WITH -AYOR 2ANDY +ELLY ON -AY $R #HARLES % #RUTCHlELD HIS WIFE 0AT $R "ARBARA ,EONE AND 2OGER *OHNSON MET WITH #OUNCILWOMAN $EB -ONTGOMERY ON -AY ! VOTE ON THE PROPOSED ORDINANCE IS ANTICIPATED IN *UNE 4HE , -Ê Õ V Ê Ê `ÕV>Ì Ê,i à ÕÀViÃ] LED BY $R !NTHONY /RECCHIA MET ON !PRIL AND -AY 4HE #OUNCIL WAS INFORMED BY THE --! THAT THE APPLICATION FOR #-% ACCREDITATION FOR THE 2-3& WAS APPROVED FOR THE STANDARD TWO YEAR PROVI SIONAL STATUS 4HE #OUNCIL WILL BE MOVING AHEAD WITH PLANS FOR NEW #-% OPPORTUNI TIES FOR 2-3 MEMBERS i LiÀà «ÊÀiVÀÕ Ì i Ì CONTIN UED AS A HIGH PRIORITY WITH $R 0ETER $ALY AND 2OGER *OHNSON ADDRESSING THE 2EGINA -EDICAL 'ROUP AT THE INVITATION OF $R ,ON 0ETERSON IN (ASTINGS ON -AY 3EVERAL MEETINGS ALSO WERE HELD IN CONJUNCTION WITH THE SUMMER MEDICAL STUDENT MENTORING PROGRAM CO SPONSORED BY THE (ENNEPIN -EDICAL 3OCIETY 2-3 AND THE 5NIVERSITY OF -INNESOTA
Ê i À > !,$2)$'% &2!.#)3 */(.3/. - $ DIED -AY AT THE AGE OF (E RECEIVED HIS -$ IN FROM THE 5NIVERSITY OF !RKAN SAS (E INTERNED AT THE 3WEDISH (OSPITAL AFTER WHICH HE SERVED IN THE .AVY UNTIL THE END OF 77 )) $R *OHNSON PRACTICED GEN ERAL MEDICINE IN )SLE -INNESOTA FROM TO THEN TOOK A RESIDENCY IN PATHOLOGY AT THE -INNEAPOLIS 6ETERANS (OSPITAL AND PRACTICED PATHOLOGY UNTIL HE RETIRED IN $R *OHNSON JOINED 2-3 IN 2/"%24 * -524!5'( - $ DIED AT THE AGE OF ON -ARCH (E COMPLETED HIS -$ DEGREE IN AT THE 5NIVERSITY OF -INNESOTA !FTER INTERNING AT -INNEAPOLIS 'ENERAL (OSPITAL HE PRACTICED IN 7ADENA -. FOR YEARS (IS CAREER CONTINUED AS $IRECTOR OF 3TUDENT (EALTH AT 3T /LAF #OLLEGE .ORTHlELD AND THEN IN A RESIDENCY IN 0SYCHIATRY AT THE 5NIVERSITY OF -INNESOTA $R -URTAUGH THEN WORKED AS )NPATIENT 0SYCHIATRIST AND #ONSULTANT AT THE -INNEAPOLIS 6! (OSPITAL FOR YEARS (E JOINED 2-3 IN &2!.+ 15!44,%"!5- - $ 0H $ A LONGTIME 3T 0AUL VASCULAR SURGEON DIED ON -ARCH AT THE AGE OF $R 1UATTLE BAUM RECEIVED HIS -$ IN FROM THE 5NIVERSITY OF 'EORGIA (E SERVED AS -EDICAL $IRECTOR AT 3T 0AUL 2AMSEY -EDICAL #ENTER FROM 5PON RETIRING IN $R 1UATTLEBAUM BECAME THE PROGRAM DIRECTOR FOR 0ROJECT (OPE IN THE 0EOPLES 2EPUBLIC OF #HINA (E AND HIS WIFE *ANE (ODGSON - $ LIVED IN #HINA FOR A YEAR LONG SERVICE WITH 0ROJECT (OPE 4HEY HAD BEEN ASSOCIATED WITH 0ROJECT (OPE FOR YEARS PRIOR TO THIS AND SERVED IN MANY COUNTRIES FOR VARIOUS LENGTHS OF TIME RANGING FROM ONE MONTH TO ONE YEAR (E JOINED 2-3 IN !24(52 * 253(!9 - $ A FAMILY PHYSICIAN DIED !PRIL AT THE AGE OF $R 2USHAY GRADUATED FROM THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL IN (E SERVED ON STAFF FOR (EALTH%AST AND 5NITED (OSPITALS $R 2USHAY JOINED 2-3 IN
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ARE BEING ASKED TO PROVIDE AND PROVE QUALITY WITHOUT BEING PAID FOR IT )NDEED WE ARE TOLD THAT IF YOU DON T FOLLOW SOME GUIDELINE WE LL EVEN TAKE MONEY AWAY FROM YOU 4HIS IS THE OLD 0(0 BAIT AND SWITCH MANY OF US WENT THROUGH SEVERAL YEARS AGO 9OU SEE ALL OUR PATIENTS WE LL PAY YOU A MINIMAL AMOUNT AND MAYBE IF WE THE (EALTH 0LAN ARE PROlTABLE WE MIGHT JUST GIVE YOU A LITTLE MORE ) VE BEEN IN lNANCE LONG ENOUGH THAT YOU CAN MAKE THE BOOKS LOOK WHATEVER WAY YOU WANT ! ZERO BOTTOM LINE IS ALWAYS POSSIBLE $OES ANYONE READING THIS PROVIDE POOR OR EVEN MEDIOCRE QUALITY FOR YOUR PATIENTS 7E ALWAYS TRY TO DO WHAT IS BEST FOR THEM .OW WE ARE BEING ASKED TO PROVE THIS BY MORE PAPER WORK 7E ARE ALL ASKED TO BECOME COMPUTER LITERATE AND PROVIDE ONLINE DOCUMENTATION OF OUR CARE ) GUESS PRIVACY ISSUES DON T APPLY TO SOME INSURANCES %VEN THOUGH THIS IS THEIR FUNCTION THEY EXPECT US TO FOOT THE BILL FOR THIS DOCUMENTATION -Y CLINIC NOW SPENDS SOMETHING LIKE A MONTH FOR ONLINE DOCUMENTATION -Y SALARY HAS FALLEN FROM PERCENT OF MY BOOKINGS TO LESS THAN PERCENT 4HIS OVERHEAD HAS TO BE PAID SOMEWHERE 4HE PERSON BEST ABLE TO JUDGE QUALITY IS LEFT OUT OF THE EQUATION 4HE ONLY THING THE PATIENT IS ASKED NOW IS IF THIS AND THAT WERE DONE )MPLICATION IS THAT IF THIS WASN T DONE OR PROVIDED THEN POOR QUALITY WAS PROVIDED DIRECTLY UNDERMINING THE DOCTOR PATIENT RELATIONSHIP 7E HAVE MADE MANY INNOVATIONS IN CARE THAT HAVE IMPROVED PATIENT CARE IMPROVED OUTCOMES AND SAVED MONEY (AVE THESE COST SAVINGS BEEN PASSED ON TO US /NE LOOK AT THE PLANS PROlTS TELLS US THE ANSWER 7E MUST HAVE THE INFRASTRUCTURE TO PRO VIDE EXCELLENT QUALITY -ANY STUDIES OF MEDI CAL ERRORS HAVE DISCOVERED THAT MOST ERRORS ARE SYSTEM ERRORS 0OOR EQUIPMENT AND RECORDS COMMUNICATION SYSTEMS THAT DON T COMMU NICATE A WORK FORCE THAT HAS NO INCENTIVE IN THE OUTCOME ARE MAJOR SOURCES OF THESE ERRORS )S THERE ANY SYSTEMATIC REFORM PROVIDED FROM THE PLANS .O 7E RE SUPPOSED TO BE PAID LESS
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PROVIDE AND DOCUMENT EXCELLENT QUALITY AND BE HAPPY WHEN WE lNALLY SEE OUR FAMILIES -EDICARE CUTBACKS PLAN WITHHOLDS lRST DOL LAR COVERAGE RAISING PATIENT EXPECTATIONS TO UNREASONABLE LEVELS AND AN OVERABUNDANCE OF HUNGRY LAWYERS HAVE ALL MADE A SYSTEM IN SERIOUS DANGER OF COLLAPSE -ANY ARE TRYING TO EXTRACT AS MUCH PROlT OUT OF THE SYSTEM BEFORE THAT HAPPENS )N THE NEXT ARTICLES ) LL DISCUSS THE !RT OF -EDICINE AND lNALLY HOW WE HAVE DONE THIS TO OURSELVES )F YOU HAVE COMMENTS ABOUT THIS AND OTHER ISSUES PLEASE E MAIL ME AINSLM PARKNICOLLET COM
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4HIS FORM OF LEADERSHIP PROVIDES MANY BENElTS 4AKES THE BURDEN OF RESPONSIBILITY FROM THE SHOULDERS OF ONE INDIVIDUAL $EVELOPS UNDERSTANDING AND FAMILIARITY OF BOTH (-3 AND (-3! FOR A LARGER GROUP OF PEOPLE 'ENERATES ENTHUSIASM AMONG MORE PEOPLE 0ROVIDES AN OPPORTUNITY FOR CREATIVITY FROM A GROUP THE OLD hTWO HEADS ARE BETTER THAN ONEv !LLOWS AN INDIVIDUAL TO COMFORTABLY TAKE ON JOBS BEST SUITED TO THEIR OWN SKILLS AND TALENTS #ONVERSELY IT ALLOWS US TO STRETCH OURSELVES BY TAKING ON THE CHALLENGE OF TRYING SOMETHING NEW KNOWING THERE IS LOTS OF SUPPORT TO HELP OUT IF NEEDED %NCOURAGEMENT AND FEEDBACK FROM A GROUP RESULTS IN HAPPIER VOLUNTEERS AND A STRONGER ORGANIZATION !NOTHER SIGNIlCANT CHANGE THIS YEAR IS A BIT TERSWEET ONE !S YOU MAY KNOW OUR METRO COUN TERPART THE 2AMSEY -EDICAL 3OCIETY !LLIANCE HAS DISBANDED 4HE (ENNEPIN -EDICAL 3OCIETY !LLI ANCE OFFERS CONTINUED !LLIANCE MEMBERSHIP TO OUR FRIENDS FROM 2-3! WE INVITE ALL FORMER 2-3! MEMBERS TO JOIN US 7E KNOW THEY TOO LOVE THE ORGANIZATION THE FRIENDSHIPS AND SUP PORT SOCIAL EVENTS AND COMMUNITY SERVICE FOUND ONLY IN !LLIANCE MEMBERSHIP 7E HOPE THEY WILL JOURNEY ACROSS THE RIVER AS OFTEN AS POSSIBLE TO ENJOY OUR EVENTS PROJECTS AND PROGRAMS BECAUSE hTHE ROAD TO A FRIEND S HOUSE IS NEVER FAR v 4WO ADDITIONAL CHANGES HAVE TAKEN PLACE RECENTLY !T THE -INNESOTA -EDICAL !SSOCIA TION !LLIANCE !NNUAL -EETING HELD -AY MEMBERS UNANIMOUSLY VOTED TO ADD THE WORD hPARTNERv TO OUR MEMBERSHIP CATEGORY BY LAWS 4HE MEMBERSHIP BY LAW NOW READSx !CTIVE MEMBERS SHALL BE 4HE SPOUSE PARTNER FORMER SPOUSE WIDOW OR WIDOWER WHO IS CURRENTLY A MEMBER AND PROVIDED SHE OR HE HAS NOT MARRIED OUTSIDE THE PROFESSION OF A PHYSICIAN WHO HOLDS ACTIVE MEMBERSHIP IN THE -INNESOTA -EDICAL !SSOCIATION
!LSO VOTED IN WAS THE OPPORTUNITY FOR PHYSICIANS TO BE ELIGIBLE FOR MEMBERSHIP IN THE !LLIANCE 4HESE CHANGES WERE RECOMMENDED BY (-3! !LL OF THESE CHANGES REPRESENT EXCITING OP PORTUNITIES FOR (-3! AND WE LOOK FORWARD TO AN EXCEPTIONAL YEAR 3TAY TUNED 4HE (-3 !LLIANCE AND (-3 0HILANTHROPIC !LLIANCE ,EADERSHIP #OUNCIL AND "OARD MEMBERS ARE 0RESIDING #HAIRS -ARY !NDERSON AND -ARLENE %LLIS 0ROGRAM #HAIRS $IANE 'AYES AND *UDY .AGEL (EALTH 0ROMOTION #HAIRS 0EGGY *OHNSON AND $IANNE &ENYK #OMMUNICATIONS #HAIRS ALL COUNCIL MEMBERS 2ECORDING 3ECRETARY 0EGGY *OHNSON #ORRESPONDING 3ECRETARY -ICHELLE 3CHROEDER 4REASURER -ARTHA !RNESON 0HILANTHROPIC !LLI ANCE 4REASURER ,UDMILA %KLUND -EMBERSHIP 4REASURER 4ERRY $ONDLINGER !UDITOR "ECKY &INNE AND )MMEDIATE 0AST 0RESIDENT *AN -USICH !S ALWAYS WE INVITE ALL PHYSICIANS AND THEIR SPOUSES TO JOIN THE (ENNEPIN -EDICAL 3OCIETY !LLIANCE THE -INNESOTA -EDICAL 3OCIETY !LLIANCE AND THE !-! !LLIANCE $UES ARE PER YEAR &OR MORE INFORMATION PLEASE CONTACT +ATHY $ITTMER AT THE (-3 OFlCE AT
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Solitude Found on Wilson Lake
Mille Lacs Lake
Spacious, 3BR rambler. Full Bsmt, 2 Fplcâ&#x20AC;&#x2122;s, 200 x 544 ft lot, Boat house with its own harbor, lg 3 car garage, $499,900.00. Call Kevin or Gene Goedker for details or check: www.BrainerdAreaRealEstate.com (Check home search for MLS#125763) or call 1-800-450-2222. C-21 Brainerd Realty, Inc.
Advertise your real estate listing to 5,400 physicians and health professionals in the metro area!
Space is limited, call Betsy today at 763-295-5420!
Build your dream lake escape on this end-of-the-road lot on beautiful Wilson Lake. Located in the Superior National Forest near Schroeder, only 20 minutes from Lake Superior. This large wilderness feeling lake has clear water and predominantly public land protecting its shore. Youâ&#x20AC;&#x2122;ll experience unmatched privacy, access to millions of acres of forest land, easy year-round access, power to your lot, and close proximity to the scenic North Shore. This lot has 312 feet of shoreline with 5.3 acres. Price: $206,500. Gail Englund, Realtor P.O. Box 938 Grand Marais, MN 55604 e-mail: Info@RedPineRealty.com 800/387-9599 / 218/387/9599 www.RedPineRealty.com
Membership Advantages for Metropolitan Physicians and their Practices AmeriPride Apparel and Linen Services is a locally owned and operated company offering rental and cleaning services of medical garments. Their organization is top notch with quality products and services. HMS and RMS members receive a discount. For a free price quote, contact Steve Severson from AmeriPride at 612-362-0334.
SafeAssure Consultants recently partnered with HMS and RMS to offer the required OSHA compliance training for our members and their staffs. Our members receive a 50-60% discount on services and training. To meet or exceed the Minnesota OSHA and the Federal OSHA requirements talk with SafeAssure at 1-800-920-SAFE or visit their website www.safeassuremedical.com for more information.
Berry Coffee Service is a valued partner of RMS and HMS and offer our members up to 25% off of their wide array of coffee and hot beverage services. If you are interested in trying their service, contact Bob Dilly at (952) 937-8697. If you are an existing customer of Berry Coffee Service, be sure that you are receiving the discounted pricing. Schwarz Williams Companies, Inc. offers RMS members individual and group benefits (medical, dental, life, disability) as well as human resource support services, executive benefits, retirement programs, COBRA/HIPAA/ERISA compliance, and benefit administration. To find out more information, contact Jim Fries at (763) 591-5822 or visit their website at www.schwarzwilliams.com.
Call HMS or RMS at 612-362-3704 for details.
Continuing Medical Education 2 0 0 4 FA L L A N D W I N T E R
Providing quality physician education for over 65 years PRIMARY CARE FOCUS
ALSO OFFERED
Annual Psychiatry Review: Women's Mental Health Across the Lifespan September 27-28, 2004
E. T. Bell Fall Pathology Symposium November 5-6, 2004
Twin Cities Marathon Sports Medicine Conference October 1-2, 2004 Topics and Advances in Pediatrics October 7-8, 2004 Thoracic Oncology & Primary Care October 8, 2004 Annual Autumn Seminar: Obstetrics, Gynecology and Womenâ&#x20AC;&#x2122;s Health October 11-12, 2004
Emerging Infections in Clinical Practice and Emerging Health Threats November 12, 2004 Advances and Controversies in Venous Thromboembolism November 19-20, 2004
SURGERY FOCUS Pelvic Floor Workshop September 7, 2004
Internal Medicine Review October 13-15, 2004
Endorectal Ultrasonography September 8, 2004
Primary Care Update in Mental Health October 22, 2004
Principles of Colon & Rectal Surgery September 9-11, 2004
C A R D I O LO G Y F O C U S
All courses listed take place in the Twin Cities Metro Area.
Preventing Cardiovascular Events: Early Detection and Treatment October 7, 2004 Lillehei Heart Institute Symposium & Poster Session October 19-20, 2004
This reflects our current listing. For more information contact: Continuing Medical Education 612.626.7600 or 1.800.776.8636 www.cme.umn.edu / cmereg@umn.edu
OUR NEWLY ENHANCED WEB SITE: WWW.CME.UMN.EDU We have recently streamlined our web site and now offer easier navigation to our course information. Access a complete conference listing, reference available conference brochures, or register for conferences through this improved site.