2004novdec

Nov/December 2004

Provider Tax Revenue $425 Million Diverted 2002 Minnesota Distribution of Insurance Coverage •

Racial and Ethnic Disparities •

Pain Management •

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Doctors MetroDoctors THE JOURNAL OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

Physician Co-editor Y. Ralph Chu, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Susan Reed MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: bauerfamily@earthlink.net.

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Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Doreen Hines at (612) 362-3705.

MetroDoctors

CONTENTS VOLUME 6, NO. 6

2

NOVEMBER/DECEMBER 2004

PHYSICIAN’S SOAP BOX

Managing Cardiac Disease: Need for a Paradigm Shift

4

FEATURE

Provider Tax Dollars Paying for MinnesotaCare, Roads, Bridges, State Government

9 11

2002 Minnesota Distribution of Insurance Coverage Racial and Ethnic Disparities in Utilization of Preventive Services and Barriers to Care Among Minnesota Health Care Program Enrollees

13

Pain Management Frequent Professional Barriers

16

COLLEAGUE INTERVIEW

Alan L. Goldbloom, M.D.

20

Winter Medical Conference

22

2004 MMA Annual Meeting

23

MMA Award Recipients/ Index to Advertisers

24

AMA Welcoming Picnic for Medical Students

RAMSEY MEDICAL SOCIETY

25 26 27

President’s Message

28

RMS Delegation Toasts Dr. J. Michael Gonzalez-Campoy

Commissioner Cal Ludeman Updates RMS Board New Members/In Memoriam/RMSF Grant Presented to the Hmong Refugee Health Coalition

HENNEPIN MEDICAL SOCIETY

29 30 31 32

Chair’s Report In Memoriam/New Members HMS in Action HMS Alliance

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: $425 million from the Health Care Access Fund was transferred to the state’s general fund. Article begins on page 4.

November/December 2004

1

PHYSICIAN'S SOAP BOX

Managing Cardiac Disease: Need for a Paradigm Shift

I

IN THE LAST DECADE, MARKET FORCES and population demo-

graphics have combined to create a cardiology workforce crisis. There are no easy solutions to this problem, and a paradigm shift in the care of cardiac patients needs to be considered.

In the early 1990s, as managed care swept the country, a common perception was that a surplus of cardiology specialists were graduating in the United States. In response, from 1995 to 1999, the number of cardiology training positions contracted such that, currently, the total number of adult cardiology trainees in residency programs is 13 percent below 1994 levels. As workloads for physicians have increased, many medical school graduates have come to view cardiology as too demanding in terms of hours worked and intensity, shrinking the pool of potential training program applicants.

As a parallel effect, the proportion of international medical graduates comprising the cardiology trainee pool has more than doubled from 18 percent to 40 percent. However, many of these individuals face unique employment challenges in the United States, further shrinking the number of available graduating specialists.

On the demand side, the baby boomers have begun to reach the age ranges when acquired heart disease becomes manifest, while a growing epidemic of obesity and Type II diabetes strains our system at every age level. Furthermore, technological and therapeutic advancements have exploded, placing added demands on interventional and “super-specialized” cardiac care (areas that also require additional training). Consequently, whereas it was challenging to find a cardiology position in the early 1990s, today, 40 percent of U.S. hospitals with 100 or more beds are seeking cardiologists, and 76 percent of recruiters report that it is “very difficult” to fill cardiology positions.

The American College of Cardiology supports enhancing the cardiology workforce by establishing a “short track” approach to cardiology training, by combining two years of core internal medicine with one year of cardiovascular medicine and two years of clinical cardiology. Additional training or customization of the last three years could be provided for trainees wanting to pursue interventional cardiology or electrophysiology. Although this would significantly decrease the current training schedule (three years internal medicine, usually four years cardiology training, then additional time for interventional/EP), this step is unlikely to impact the workforce shortage in time. To deal

BY ELIZABETH KLODAS, M.D., F.A.C.C.

2

November/December 2004

with these colliding realities, what is needed is not only more cardiologists but also a significant shift in the cardiac care paradigm.

Perhaps Berry et al. said it best: “Specialist physicians should do less of what generalist physicians can do, generalist physicians should do less of what non-physician providers can do, and non-physician providers should do less of what non-clinical staff can do. Each caregiver also should do less of what appropriately instructed patients and families can do for themselves.” Like it or not, the realities of the situation are such that every “should” in that statement must be replaced by “will” if we are to meet the challenges of cardiac care in the years to come.

The true implication of the statement above is that generalists will need to take over some of the duties that cardiologists provide today. Patients arriving at a cardiology office will need to be better screened, better worked-up, and more extensively managed, prior to the referral so that subsequent care under the cardiologist’s direction can be more expedited and efficient, and at a complexity level commensurate with the specialist’s skills. But such a paradigm shift will require a multi-pronged effort with generalists and cardiologists teaming up for the cause, and payers embracing the change.

Cardiologists would need to provide more support to the generalists through educational outreach, work-up and management support, and collaboration on clinical pathways and standards of care.

This cannot consist of merely printing up a guideline and mailing it to the referring physicians. Rather, this would need to involve a dedication of time and effort to truly change how cardiac care is delivered. It would mean identifying “physician champions” among the generalists and assisting them directly in expanding cardiac services and cardiac care within their practices. It would mean shifting some of the testing and management control to the generalists and educating them on appropriate uses of these resources. Cardiologists would continue to perform the bulk of cardiac testing and management, but would concentrate more on patients with complex or advanced disease (the fastest growing demographic, and exactly those patients who should be managed by specialists). Ensuring that appropriate care is delivered to the appropriate patient at the appropriate care level must be embraced by all for the paradigm shift to succeed.

Generalists would need to tailor their practices toward managing chronic diseases, not just acute care. Systems would need to be put in place for planned disease management, with planned visits becoming an important feature of practice design. Evidence based care guideMetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

lines would need to be integrated into daily practice, with reminders, updates, and ongoing tracking. Assuring state of the art work-up and therapy would mean active engagement of generalists within the cardiology community and commitment to adjust practice patterns to accomplish these goals. This would certainly require generalist “physician champions” to spearhead change and lead the interactions.

Patient tracking would be essential, probably requiring the presence of an electronic medical record to accomplish. Payers would need to recognize quality and complexity of care regardless of where it was provided.

Preventive care would need to take center stage, with principal initiation and follow-up centered at the generalist level. This would include patients with established coronary disease after input from the cardiologists, and complex lipid management patients who are on a stable medication regimen. Lipid clinics and cardiology follow-up/ initiation of preventive measures would be reserved for patients with multiple risk factors/lipid abnormalities not under optimal control despite generalists’ efforts. Payers would need to embrace preventive cardiac care with adequate reimbursement to ensure an economically sound structure for the generalists to take on this vital task. Patient responsibility and accountability would have to factor in here with appropriate rewards and consequences for compliance and behavior change. Everyone must agree that one of the best ways to mitigate the shortage of cardiologists and decrease the overall care burden would be to decrease the number of patients with disease.

The road to this vision may not be easy, but it is imperative that we start walking. Regardless of the final model, significant changes in the delivery of cardiac care must take place if we are to realistically face the burgeoning numbers of patients with new and chronic cardiac disease. ◆ Elizabeth Klodas, M.D., F.A.C.C. is a cardiologist and director of Cardiac Imaging, Center for Diagnostic Imaging.

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November/December 2004

3

FEATURE STORY

Paying for MinnesotaCare,

Provider Tax Dollars Roads, Bridges, State Government

Taxing doctors, dentists, therapists and hospitals to pay for the health care of thousands of uninsured Minnesotans is akin to taxing farmers and grocers to feed the hungry.

I

INCONSISTENCY IN VOTING BEHAVIOR is hardly new in the ornate chambers of the

Minnesota State Capitol. But when many legislators and Governor Pawlenty took a pledge to not raise taxes but allowed the provider tax to increase by 33 percent anyway, as they did in 2003, their inconsistency is glaring and must be challenged. This increase was totally unjustified as additional revenues were not needed to meet the projected expenditure requirements of MinnesotaCare, but the tax increase did create a budget surplus. Not surprisingly, this surplus was immediately “raided” to the tune of $425 million dollars, to backfill the general fund shortfall over the next four years.

The provider tax has always been a dubious method of funding health care for the uninsured. Taxing doctors, dentists, therapists and hospitals to pay for the health care of thousands of uninsured Minnesotans is akin to taxing farmers and grocers to feed the hungry.

Most early proposals to underwrite care for the uninsured did not consider a provider tax as a funding source. In fact, the first initiative to pass the Minnesota Legislature in 1991 called “The Minnesotans’ Health Care Plan” would have been financed for three years with a 7 cent per pack cigarette tax. At the end of the three-year period the Legislature would have had to come up with a plan to reauthorize, potentially expand, and refinance the plan. Governor Arne Carlson vetoed the bill, in part, because of the lack of a long-term funding plan.

In 1992, an election year for all house and senate seats, pressure grew to find a bi-partisan solution to the widely reported growing number of uninsured who lacked access to basic health care. Providers of care were among the loudest advocates to expand care to the uninsured.

Four proposals emerged in early 1992 promoted by the Health Care Commission, the HMO Council, the Insurance Federation and Governor Carlson. The Health Care Commission and Governor Carlson’s proposals utilized an increase in the cigarette tax as their funding source. The Insurance Federation required the insured to fund their own covered services solely through premiums and the HMO Council proposal contemplated a 6 percent surcharge on hospital services.

A bi-partisan group of seven legislators began negotiating a compromise bill that Governor Carlson would support and sign. This so-called “gang of seven” debated a range of controversial bill elements such as a requirement that all Minnesotans have insurance, various mechanisms to control health care inflation, and the elimination of insurance company policies that based premiums on gender, age and pre-existing health conditions.

BY PHIL RIVENESS

4

November/December 2004

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Discussions regarding the funding mechanism proved especially difficult. As I recall, the DFL members of the group argued for a broad-based funding source such as income or sales taxes. The Republican members and the Governor opposed a general tax increase, preferring a narrow dedicated tax such as the cigarette tax. The cigarette tax, however, was considered unreliable as a long-term funding tool. The compromise was to use a 5 cent increase in the cigarette tax, plus a phased-in 2 percent gross revenues tax on hospitals, health care providers and wholesale drug distributors. Public-pay programs like Medicare and Medical Assistance were exempted.

The “gang of seven” and legislative leadership in the house and senate considered the compromise agreement to be a package that could not be amended. Efforts to change the funding mechanism in the Senate Tax Committee failed because many senators were convinced that changing any major provision of the agreement would unravel the compromise. Most legislators wanted to be able to deliver an election year victory to voters who they believed were yearning for major progress in addressing rising health care costs.

On March 10, 1992 the Pioneer Press led with the banner headline “Agreement reached on health care.” The article described the bi-partisan euphoria over the agreement but noted: “In fact, the only visible opposition to the measure is from the hospitals and doctors who provide health care. That’s because they will be forced to pay a new tax to raise the $200 million a year needed to operate the program.”

Spokespersons for provider groups such as the Minnesota Medical Association declared their vehement opposition to the provider tax and indicated that their members would likely pass it on to patients. The legislature responded by specifying in statute that the tax could not be itemized on bills provided to individual patients. This provision was later modified to prohibit itemization of the tax to patients when the amount received for the services is not subject to the tax.

Thus, providers of all types: doctors, dentists, optometrists, chiropractors, physical therapists, podiatrists, hospitals and many more, were placed in the ironic position of cheering efforts to give the uninsured access to their health care services while decrying the unfairness of placing the financial burden for funding the program on their professions.

The initiative passed by large margins in the House of Representatives and Senate and was signed into law by Governor Carlson in the spring of 1992.

In 1993 efforts were again made to find an alternative for the provider tax. While these efforts were unsuccessful, a provision was added to the law allowing providers to

Contact your legislators to express your outrage over the raiding of the Health Care Access Fund and seek their support for the needed changes….

(Continued on page 6) MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

November/December 2004

5

Provider Tax (Continued from page 5)

pass the tax through to all purchasers of health care services if the revenue from those services was subject to the provider tax. (MN statutes 295.582) While the concept was sound, most health plans merely indicated that the next year’s fee schedule increase included the 2 percent pass-through, even though the increases were comparable to those of previous years and most providers remained unconvinced that a real pass-through had been included. Providers believe this tax is born directly by them and that it has a substantial financial impact on clinics and hospitals — both rural and urban.

In 1995, wary of the temptation that fund balance growth creates in a governor and legislature constantly starved for additional revenue, advocates for the protection of the Health Care Access Fund succeeded in amending Chapter 295 with language that prohibited nonMinnesotaCare transfers from the fund.

Section 295.581 specifically states: “Notwithstanding any law to the contrary, and notwithstanding section 645.33, money in the Health Care Access Fund shall be appropriated only for purposes that are consistent with past and current MinnesotaCare appropriations….”

How then could the 2003 Legislature pass a bill that reallocated $425 million in Health Care Access Funds to the general fund? Simple. The new law contained a “notwithstanding” caveat that nullified the effect of the fund transfer prohibition.

In fact, nothing short of a constitutional amendment dedicating this fund to the sole purpose of funding services for the uninsured can protect these dollars from reallocation.

There is one other remedy. Eliminate the temptation itself by insuring that the tax rate closely mirrors MinnesotaCare’s financial requirements. Senator Dallas Sams has had legislation drafted that would create a kind of blinking tax rate that would raise enough revenue to meet the forecasted needs of the program plus

Recipient Profile As of October 1, 2003, 154,790 individuals were enrolled in the MinnesotaCare program.

As of September 2, 2003, just under one-half of MinnesotaCare enrollees were children.

MinnesotaCare Enrollment (September 2, 2003) Adults Without Children 23%

Children (under 21) 46%

Adults With Children 31% Source: DHS Reports and Forecast Division

6

November/December 2004

MetroDoctors

a small cash cushion. The essence of the bill is as follows: Section 1. Minnesota Statutes 2002, section 295.52, is amended by adding a subdivision to read: Subd. 8. (CONTINGENT ELIMINATION OF TAX) The commissioner (of Revenue) shall establish tax rates for calendar years beginning on or after January 1, 2006 based upon determinations made by the commissioner of finance regarding the estimated balance of the Health Care Access Fund. The commissioner of finance shall, on September 1 of each year, beginning September 1, 2005 determine the estimated balance of the Health Care Access Fund in terms of the total expenditures and the total resources available for the fiscal year that begins the following July 1. If the commissioner of finance determines on September 1 that for the following fiscal year the estimated total revenue available meets the estimated total expenditures plus an additional $50,000,000, the taxes imposed under subdivisions 1, 1a, 2, 3, and 4 shall be set at 1 percent of the gross revenues received on or after January 1 for the calendar year that begins immediately following that September 1. If the commissioner of finance determines on September 1 that the total revenue available in the fund will be less than the estimated expenditures for the following fiscal year, then the commissioner, in consultation with the commissioner of finance, shall determine the amount needed to eliminate the deficit and shall impose an increase in the taxes under subdivisions 1, 1a, 2, 3, and 4 for the calendar year that begins immediately following that September 1. The commissioner shall determine the rate of the tax to the nearest one-quarter of 1 percent beginning at 1 percent and increasing the rate up to 2 percent, using the lowest of

The Journal of the Hennepin and Ramsey Medical Societies

Health Care Access Fund Date: June 29, 2004

2004 February Forecast plus Governor’s Executive Actions Figures in $ Thousands Closing FY03

Budgeted FY04

Base FY05

Projected Projected FY06 FY07

Actual and Estimated Resources Balance forward from prior year Prior year adjustments Adjusted balance forward

246,819

177,224

158,047

23,685

0

254,512

177,224

158,047

23,685

0

207,989

261,423

360,609

389,635

424,097

7,693

Revenues: 2% Provider Tax 1% Gross Premium Tax

0

21,932

61,017

65,127

69,188

22,680

25,542

28,501

37,862

39,461

0

0

2,987

6,110

6,208

Investment income

4 ,889

1,972

1,805

355

0

Federal match on administrative costs

4,291

4,080

3,008

3,008

3,008

Revenue refunds

(6,909)

(12,000)

(9,000)

(9,500)

(10,000)

Total Revenues

232,940

302,949

448,927

492,597

531,962

State share of MnCare enrollee premiums State share of prescription rebates

Transfers In: General Fund: Costs associated with cap increase

0

4,600

0

0

0

487,452

484,774

606,973

516,283

531,962

251,092

253,370

281,938

346,645

379,823

22,680

25,542

28,501

37,862

39,461

0

0

2,987

6,110

6,208

[140,983]

[163,257]

[171,963]

[98,853]

[101,235]

17,217

20,352

20,333

20,333

20,333

534

600

450

475

500

University of MN (TR out)

2,537

2,157

2,157

2,157

2,157

Department of Health

9,702

6,273

6,273

6,273

6,273

70

64

64

0

0

Total Resources Available

Actual and Estimated Uses Expenditures: MinnesotaCare direct appropriation State share of MnCare enrollee premiums State share of prescription rebates Federal Medicaid and S-CHIP offsets (non-add): Department of Human Services Interest on tax refunds

Board of Dentistry Legislature Department of Revenue DOR payment for claims issue Total Expenditures

150

128

128

128

128

2,151

1,654

1,654

1,654

1,654

0

0

39

0

0

306,133

310,140

344,524

421,637

456,537

4,094

0

0

0

0

Transfers Out: Special Revenue Fund: MAXIS/MMIS General Fund: Balance at end of ďŹ scal year

0

0

192,442

45,233

22,766

General Fund: Provider and gross premium tax expansion

0

16,587

46,322

49,413

52,659

4,094

16,587

238,764

94,646

75,425

Total Uses

310,227

326,727

583,288

516,283

531,962

BALANCE INCLUDING RESERVES

177,224

158,047

23,685

0

0

Total Transfers Out

(Continued on page 8) MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

November/December 2004

7

Provider Tax (Continued from page 7)

the rates that the commissioner determines will produce sufficient revenue to meet the estimated expenditures plus an additional $50,000,000.

This approach, if enacted, would eliminate the growth of unnecessary surpluses and result in more appropriate provider tax rates.

Some providers, who wish to continue the, heretofore, unsuccessful struggle to find a replacement tax for the provider tax, worry that this proposal will undercut the chance of winning the larger victory. In response, I say it is time we “pushed back” at this most egregious of developments; namely a tax increase on one group of citizens to cover a general fund deficit that should be the responsibility of all Minnesota taxpayers.

What should we do? Working with the broadest coalition of provider groups possible we should: • Push for an alternative to the provider

tax. Taxing tobacco seems to be the popular substitute and Representative Fran Bradley introduced a bill last session to do just that. To raise the dollars needed to cover current MinnesotaCare expenditures would require a $1 per cigarette pack increase, plus a proportionate tax increase on other tobacco products.

In 2003, the Department of Revenue estimated that these tax increases taken together would generate $322 million dollars. While this would be an appropriate source of funding for MinnesotaCare it is unlikely to be accomplished easily or in the shortterm.

• Demand that transfers from the Health Care Access Fund to the general fund cease effective January 1, 2006. Insist that the Provider Tax rate 8

November/December 2004

MetroDoctors

drop to 1 percent starting January 1, 2006, and that a variable or “blinking” tax rate be implemented to eliminate the accumulation of future excess fund balances. These are the key provisions of Senator Dallas Sams’ proposed bill.

• Contact your legislators to express your outrage over the raiding of the Health Care Access Fund and seek their support for the needed changes described above. To contact your legislator, go to the MMA website, http: //www.mmaonline.org and click on MMA at the Capitol. Click on Find your Legislator. Enter your address and zip code. Click on Search.

MinnesotaCare is a highly successful program that has extended health care coverage to some 154,790 uninsured Minnesotans, almost half of whom are children. As a result of this program, Minnesota has the lowest rate (8.7 percent) of uninsured persons in the nation. Finding a more equitable method of financing this needed care remains the critical challenge, however. Reminding the Governor and our legislators of the unfairness of the current funding scheme and advocating for short-term and long-term alternatives remains our important work. ◆ Phil Riveness served three terms in the Minnesota House of Representatives and two terms in the Minnesota Senate. He is the associate administrator of the Noran Neurological Clinic and a legislative policy advisor to the Minnesota Medical Group Management Association.

The Journal of the Hennepin and Ramsey Medical Societies

2002 Minnesota Distribution of Insurance Coverage

T

THE HEALTH Eco-

nomics Program of the Minnesota Department of Health monitors the Minnesota health care market and develops estimates of the distribution of insurance coverage among Minnesotans. This issue brief describes the distribution of coverage for 2002 and analyzes some of the recent trends.1

Figure 1: Distribution of Minnesota Population

by Primary Source of Insurance Coverage, 2002 (Population 5.0 Million) 16.3% 17.3%

Fully Insured Non-HMO

Private Insurance Fully Insured (70.6%) HMO

15.3% 15.2% 39.0% 39.1%

Self-Insured 13.3% 13.2% 10.2% 9.3%

Medicare MA, GAMC,

Public MNCare Insurance (24.0%) MCHA

0.5% 0.5%

5.4%

Uninsured Private 5.4% Insurance 0% 5% 10% 15% 20% The majority of Min2001 2002 nesotans continued to receive their health insurance from the pripercent in 1999. The slow economy coupled vate market in 2002 (see Figure 1). However, with rising premiums for private coverage are the 70.6 percent of Minnesotans who do have two factors that have likely contributed to the private coverage is down one percentage point decline. from 2001. This is a continuation of a slow Enrollment in self-insured plans 2 redecline in private coverage from a high of 72.3 mained steady in 2002, declining slightly from

Figure 2 Percent of Minnesota Population in Fully and Self-Insured Plans 45% 40% 35% 30% 25%

1995

1996

1997

1998

Fully-insured

MetroDoctors

1999

2000

2001

Self-insured

The Journal of the Hennepin and Ramsey Medical Societies

2002

25%

30%

35%

40%

45%

39.1 percent of the population percent to 39.0 percent (see Figure 2). Self-insured plans are exempt from state regulations and taxes, such as the assessment to cover losses of the Minnesota Comprehensive Health Association (MCHA).

The slight decrease in 2002 represents the second year of relative stability in self-insured enrollment after several years of rapid increases.

However, the longer term trend of the private market’s shift toward self funding means that the burden of the MCHA assessment falls on a smaller share of the market. As a share of the private market, self-insured plans represented 55 percent of enrollment in 2002, compared to 45 percent in 1995.

The decrease in private insurance came predominantly from fully insured non-HMOs (see Table 1 on the next page). Despite population increases, fully insured non-HMOs still saw a decline in enrollment of around 46,000 (Continued on page 10)

November/December 2004

9

Insurance Coverage (Continued from page 9)

Minnesotans. All other insurance categories, both public and private, saw increases in enrollment in 2002.

Public Insurance The portion of the state population enrolled in public health insurance programs rose from 23 percent in 2001 to 24 percent in 2002 (see Table 1). All three public programs for low income Minnesotans (Medical Assistance, MinnesotaCare, and GAMC) saw increased enrollment in 2002. The soft economy was likely a primary reason for rising enrollment in public health insurance in 2002. The increases in public program enrollment, along with increased spending per enrollee, contributed to the state’s projected budget shortfall for fiscal

year 2004-2005 and the resulting changes in public program benefits that were enacted during the 2003 legislative session.

Uninsured Despite slow economic growth and rapidly rising health insurance costs, there were no signs of a significant increase in Minnesota’s uninsurance rate in 2002. The Health Economics Program relies on estimates of uninsurance from a series of surveys that have been conducted in Minnesota since 1990.3 The most recent statewide survey was conducted in 2001, and showed an estimated uninsurance rate of 5.4 percent. For 2002, a separate survey of insurance status for children showed that the rate of uninsurance for children in Minnesota was stable compared to 2001; in addition, the statewide uninsurance rate estimated by

the U.S. Census Bureau’s Current Population Survey was stable.4 The Minnesota statewide survey will be repeated in 2004.

The Health Economics Program will continue to monitor Minnesota health care markets and make its findings available to the public. ◆

Endnotes 1. These estimates are periodically revised as new data becomes available and as the U.S. Census Bureau revises its Minnesota population estimates.

2. The employer or sponsor assumes the risk of any health care costs under a self-insured plan, while under a fully insured plan premiums are paid by the employer or sponsor to an insurer to cover the risk of health care expenses.

3. Surveys conducted in 1990, 1995, 1999, and 2001; 2002 data for children were collected through the Behavioral Risk Factor Surveillance System (BRFSS).

4. State uninsurance rates in the CPS are calculated as 3year averages. Uninsurance estimates from the CPS are generally higher than estimates from other surveys.

This article is reprinted with permission from the Minnesota Department of Health.

Table 1 Minnesota Population By Primary Source of Insurance Coverage 1995

1996

1997

1998

1999

2000

2001

2002

Total Public

24.5%

24.0%

23.3%

22.8%

22.4%

22.4%

23.0%

24.0%

Medicare

13.5%

13.5%

13.4%

13.4%

13.3%

13.3%

13.2%

13.3%

Medical Assistance

7.6%

7.2%

6.7%

6.3%

6.0%

5.9%

6.1%

6.6%

GAMC

1.0%

0.8%

0.7%

0.6%

0.5%

0.5%

0.5%

0.7%

MinnesotaCare

1.8%

1.9%

2.0%

2.1%

2.2%

2.3%

2.7%

3.0%

MCHA

0.6%

0.5%

0.5%

0.4%

0.4%

0.4%

0.5%

0.5%

Total Private

69.5%

70.0%

70.7%

71.2%

72.3%

72.3%

71.6%

70.6%

Fully Insured HMO

19.0%

20.0%

19.9%

18.9%

17.5%

15.7%

15.2%

15.3%

Fully Insured Non-HMO

18.8%

17.3%

16.7%

17.7%

18.0%

17.2%

17.3%

16.3%

Self-Insured

31.6%

32.8%

34.2%

34.7%

36.8%

39.3%

39.1%

39.0%

6.0%

6.0%

6.0%

6.0%

5.3%

5.3%

5.4%

5.4%

Uninsured*

Minnesota Population By Primary Source of Insurance Coverage 1995

1996

1997

1998

1999

2000

2001

2002

Total Public

1,143,753

1,131,021

1,110,188

1,095,794

1,092,612

1,106,142

1,145,262

1,206,741

Medicare

630,521

635,748

639,293

643,877

648,272

653,947

660,330

667,407

Medical Assistance

355,604

341,081

320,219

300,816

291,822

292,390

303,215

331,500

GAMC

47,539

39,431

33,102

27,931

23,300

22,546

26,593

33,433

MinnesotaCare

82,681

90,162

94,922

102,003

108,155

115,675

132,387

148,490

MCHA

27,408

24,599

22,653

21,167

21,063

21,585

22,738

25,912

Total Private

3,236,816

3,299,036

3,367,399

3,428,813

3,522,575

3,566,022

3,570,739

3,546,711

Fully Insured HMO

885,709

940,917

946,624

910,845

851,190

776,766

757,876

771,136

Fully Insured Non-HMO

877,344

814,306

794,061

849,784

877,585

848,831

863,409

817,701

1,473,763

1,543,813

1,626,713

1,668,184

1,793,799

1,940,425

1,949,453

1,957,875

279,611

282,770

285,803

288,805

258,294

261,483

269,201

271,339

Self-Insured Uninsured*

*Source: Minnesota Health Access Surveys, 1990, 1995, 1999, 2001. Surveys were conducted by the University of Minnesota, School of Public Health, Division of Health Services Research and Policy.

10

November/December 2004

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Racial and Ethnic Disparities in Utilization of Preventive Services and Barriers to Care Among Minnesota Health Care Program Enrollees

A

ALTHOUGH PREVENTIVE HEALTH care

services are covered for Minnesota Health Care Program (MHCP) enrollees (e.g., Medicaid and MinnesotaCare), there is concern that many people may experience barriers to using these services.

We examined disparities in service use and barriers to care in a statewide survey of 4,953 MHCP enrollees, focusing on differences in the health care experiences of American Indian, African American (U.S. born), Latino, Hmong, Somali, and European Americans adults and children. The study represents a collaborative effort between community-based researchers, the Minnesota Department of Human Services (DHS), Stratis Health, and the University of Minnesota. Our research used a community-based participatory research method that promotes active involvement of community members in all stages of the research process.

The survey was conducted by mail with a telephone follow-up between April and July 2003. The telephone survey was conducted in English, Hmong, Somali and Spanish languages. When a child was sampled, an adult within the household answered the questions about the child.

The majority of enrollees reported a visit to a doctor for preventive care in the past year (just over 70 percent of adults and 80 percent of children). However, the rate of preventive care was quite low among Hmong enrollees, both young and old (approximately 60 percent).

Some of the barriers to use of health care services are not specific to any one racial or eth-

BY DONNA D. McALPINE, Ph.D., AND KATHLEEN THIEDE CALL, Ph.D.

MetroDoctors

nic group but are observed in all communities.

For example, worries over having to pay more than expected or that insurance won’t cover the health care received are primary obstacles to seeking care. These worries are particularly acute in the Latino and Hmong communities and among adults rather than parents of child enrollees. Similarly, the inability to schedule an appointment in a timely manner emerged as an important barrier to care across all racial/ethnic and age groups. Transportation problems, in-

Perceived racial discrimination is less common than perceived discrimination based on inability to pay or enrollment in MHCP.

ability to see the chosen provider, and work or family responsibilities also ranked high on the list of barriers identified by all groups.

The results also suggest that many enrollees experience problems in their relationships with providers and the health systems, with variation across the different communities that participated in the survey. For parents of American Indian children and Latino, Hmong, and Somali adults and children, perceptions of the trustworthiness of doctors in general

The Journal of the Hennepin and Ramsey Medical Societies

present barriers to needed care. Furthermore, among African American parents, trust in their own doctor or health care provider stands out as a problem that hinders use of health care services.

Almost half of adult enrollees and a third of parents say that their perceived inability to pay or their enrollment in a MHCP cause their doctor or other health care provider to treat them unfairly. African American adults, Hmong adults, and parents of Somali children tend to perceive this form of discrimination at heightened levels vis-à-vis European American enrollees.

Perceived racial discrimination is less common than perceived discrimination based on inability to pay or enrollment in MHCP. However, many believe that their race, ethnicity, or nationality cause their health care providers to treat them unfairly. Roughly a quarter of American Indian adults and parents think they are treated unfairly due to their race, ethnicity, or nationality. For Hmong respondents, the proportion jumps to over half of adults and a third of parents. Unfair treatment due to race is also a problem for adult African American and Latino enrollees, with about a quarter to a third of respondents reporting some form of discrimination.

African American, Latino, Hmong and Somali enrollees reported that a doctor’s misunderstanding of their particular language and culture causes problems when getting services.

A provider’s understanding of religious beliefs is the least important barrier among each racial and ethnic group.

The availability and quality of interpreter services can influence the use of health care services among Latino, Hmong and Somali (Continued on page 12)

November/December 2004

11

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We offer a competitive salary/benefits package and rewarding career growth opportunities. Contact: Allina Physician Recruitment Services, 8450 City Centre Drive, Woodbury , MN 55125.

1-800-248-4921, fax: 651-714-3311 or email: recruit@allina.com. www.allina.com.

EOE

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enrollees. Of those three groups, interpreters are least available for Hmong enrollees, where over half of the adults and almost three quarters of parents do not get an interpreter when needed. Somali enrollees do not fare much better; only about one-half indicate they are provided a needed interpreter. Finally, one third of Latino enrollees are not always provided an interpreter.

Judgments of the quality of interpreter services are also negative. Hmong and Somali respondents were the least likely to believe that having an interpreter improved doctor-patient communication. Latino enrollees reported better quality interpreter services than the other groups, yet one-quarter to one-third reported problems in this area.

Addressing the barriers identified in this study requires the commitment and creativity of all actors: DHS, health plans, providers, professional associations, education systems, community members and organizations. Solutions to these problems should be formed by those from the community and tailored to the needs of the community. The challenge is to engage communities in a manner that does not suggest or encourage competition for scarce resources. ◆

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Racial and Ethnic Disparities (Continued from page 11)

This research was supported by the Minnesota Department of Human Services. Colleagues participating in this project include Tim AD APPROVAL Beebe, Heather Britt, Valeng Cha, CharMETRO DOCTORS ityPUBLICATION: Kreider, Jennifer Lundblad, Jim McRae, Betty Sirad Osman ISSUE / Moore, DATE: SATURDAY, 05/01/04 and Walter Suarez. The final report is available at: http:// SIZE: 4.8125” X 4.625” www.dhs.state.mn.us/main/groups/healthcare/ EST. COST: documents/ pub/dhs_id_008306.pdf.

WORKSHEET#:

1113708

AD McAlpine, #: 1243059Ph.D., is assistant professor, Donna D. and Kathleen ThiedeALAR Call, Ph.D., is associate AE: SALLY professor, Division of Health AD FILE NAME: AL040204PAIN Services Research andOKPolicy, University of Minnesota School of AS IS: CHANGES: Public Health APPROVED BY:

SIGNATURE: Reprinted with permission of the Division of of

This material is developed by, and is the property of, Health Services Research and Policy, School Ludlow Advertising, Inc. and is to be used only in connection with University services rendered

by Ludlow Public Health, of Minnesota.

Advertising, Inc. It is not to be copied, reproduced, published, exhibited or otherwise used without the express written consent of Ludlow Advertising, Inc.

�������������������� MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies

Pain Management: Frequent Professional Barriers

P

PAIN MANAGEMENT POSES a conundrum

to most physicians. First, as any physician with direct patient contact knows, pain is THE most frequent presenting complaint. Second, most physicians in primary care practices, and the majority in specialty practices, have little or no formal training in pain, its causes, its assessment and its management.

As a result, the bulk of the practice community has questions related to some very important aspects of pain management. Some of the most frequently posed questions are: • What is the legal and regulatory framework for pain management?

• What are the basic clinical tools for pain management?

• How do I recognize the difference between drug seeking behavior and relief seeking behavior?

• How do I manage the pain patient with complicating co-morbid conditions?

The remainder of this article is devoted to the first question, and articles appearing in successive issues will address basic clinical tools, patient behavior, and management of pain in complicated cases.

We will start by reviewing the legal and regulatory framework in Minnesota. Next, we will discuss recent regulatory developments on a national basis, and lastly, we will describe how the Minnesota Board of Medical Practice approaches a complaint regarding a physician’s management of pain cases.

Here in Minnesota, we are fortunate both in what IS NOT in the law, and in what IS. Minnesota does not have any form of “Triplicate Script” law. These types of laws

BY A.V ANDERSON, M.D., AND RICHARD L. AULD, Ph.D.

MetroDoctors

were developed during the 1980s to assist in curbing the diversion of controlled substances into the illicit drug market. Basically, such laws require physicians to issue prescriptions for controlled substances in multi-copy formats so that a government agency can review the prescriptions, and screen them against some arbitrary standard of over-use. Minnesota has never had such a law, and the Minnesota Board of Medical Practice has always opposed proposals for such legislation. States that have adopted such laws have found them to be cumbersome, and marginally useful in curbing diversion.

Further, these laws have had a chilling effect on the practice community, causing practitioners to avoid the use of controlled substances, even when they are medically indicated, out of fear of regulatory scrutiny. Some states that have had these laws in operation for some years have found it necessary to repeal them.

Both the practice community and the patient population are fortunate that Minnesota has never had these impediments to quality pain management.

Another type of law not present in Minnesota is any law that proscribes the use of specific drugs or types of agents. Examples are laws that set arbitrary dosage limits on certain drugs; laws that prohibit the prescription or dispensation of certain drugs, e.g., dilaudid, in a specific geographic area; and laws that allow the use of certain drugs only in the presence of some specific diagnosis, e.g. a law that prohibits the prescription of amphetamines, except for ADHD or narcolepsy. All of these are laws that, at one time or another, have been enacted by other states or local jurisdictions, in efforts to curb drug diversion. All of these types of laws do have, or have had, negative impacts on medically appropriate pain management where they have been applied. Again, both the doctors

The Journal of the Hennepin and Ramsey Medical Societies

and patients of Minnesota are fortunate that we have never had such statutes.

And now, for the things we DO have in Minnesota law. Minnesota does have a Medical Practice Act, Minnesota Statute 147, which specifically includes the management of pain in the definition of the practice of medicine.

Minnesota has a regulatory standard that is clinical as opposed to some statutorily imposed arbitrary standard. The language requires treatment to be consistent with “the current and prevailing standard of care within the specialty.” This is VERY important, since the clinical standards of care in medicine are dynamic, constantly changing with the development of new technology, pharmacology, and clinical research.

Minnesota also has an “Intractable Pain” statute, Minnesota Statute 152.125, which defines intractable pain, and specifically states that physicians have the right to prescribe controlled substances, which are clinically appropriate, for the treatment of such a condition. This is a piece of legislation that the Board of Medical Practice actively lobbied for and supported.

Finally, Minnesota has a criminal code, Minnesota Statute 609.215, that recognizes the “principle of double effect” in the treatment of end-of-life suffering. This statute allows “…medications or procedures to relieve another person’s pain or discomfort, even if the medication or procedure may hasten or increase the risk of death, …unless the medication or procedure are knowingly administered, prescribed, or dispensed to cause death.”

All in all, this is a remarkably friendly environment, both for practitioners and pain patients alike.

(Continued on page 14)

November/December 2004

13

Pain Management (Continued from page 13)

What are the current regulatory developments nationally on the issue of pain management?

As many of you are aware, the Joint Commission on Accreditation of Health Care Organizations has issued guidelines regarding pain management in a number of different care settings. The Commission states “…patients have the RIGHT (emphasis added) to appropriate assessment and management of pain.”

The Commission further urges adding pain level as “the fifth vital sign.”

The Federation of State Medical Boards, the national organization for all state medical and osteopathic boards, has just published its second edition of Model Guidelines for the Use of Controlled Substances for the Treatment of Pain. These guidelines state: “…principles of quality medical practice dictate that (patients) have access to appropriate and effective pain relief.” The guidelines further state: “…the ap-

14

November/December 2004

propriate application of up-to-date knowledge and treatment (of pain) can serve to improve the quality of life for those patients who suffer from pain as well as reduce the morbidity and costs associated with untreated or inappropriately treated pain.” It urges “…all physicians should become knowledgeable about effective methods of pain treatment as well as statutory requirements for prescribing controlled substances.”

In the second edition, the Federation urges member boards to take complaints regarding under-treatment of pain as seriously as boards have traditionally taken complaints of over-treatment.

Indeed, during the past several years, a number of states, including Oregon and California, have taken action and disciplined physicians for failure to provide effective pain relief.

Clinically, a number of national clinical and research organizations, most prominently The American Pain Society, have issued clinical guidelines on the management of pain, and the use of various agents.

MetroDoctors

Most recently, the Drug Enforcement Administration has joined with a large number of clinical organizations, including the American Academy of Family Physicians, The American Cancer Society, The American Pain Foundation, The American Pain Society, and others to issue a joint consensus statement on pain management. The joint consensus includes the following statements: • “Undertreatment of pain is a serious problem in the United States, including pain among patients with chronic conditions and those who are critically ill or near death. Effective pain management is an integral and important aspect of quality medical care, and pain should be treated aggressively.

• For many patients, opioid analgesics — when used as recommended by established pain management guidelines — are the most effective way to treat their pain, and often the only treatment option that provides significant relief….

• Helping doctors, nurses, pharmacists, other health care professionals, law enforcement personnel and the general public become more aware of both the use and abuse of pain medications will enable all of us to make proper and wise decisions regarding the treatment of pain.”

OK! These are some of the recent regulatory developments regarding pain management. What are the important “red threads” that run through all of them? The first red thread is that both clinicians and regulators consider appropriate pain management to be integral to all high quality and cost effective health care delivery.

Examination of the details of these guidelines shows that the second, but perhaps most important “red thread” is that appropriate pain management can be delivered only through the diligent use of complete clinical work-ups, which include: • Complete history and physical; • All necessary testing; • Formulation of a diagnosis; • Creation of a treatment plan supported by the diagnosis; • Follow-up assessment of the patient’s response to treatment; • Adjustment of treatment as indicated by patient response; and

The Journal of the Hennepin and Ramsey Medical Societies

• Complete documentation of all diagnostic

and therapeutic steps.

Burton Schwartz, M.D., board member and practicing medical oncologist, discusses the use of this clinical work-up process in the Minnesota Board of Medical Practice’s newsletter, Update, Summer 2000. In this article, entitled “Pain Management,” Dr. Schwartz emphasizes this last step in the process: documentation.

Some of the more obvious benefits to both physician and patient derived from careful adherence to this process are as follows: • The most accurate guide possible to the underlying cause of the pain; • The most accurate guide possible to the optimum management of the pain; and • An adjustment process to fine-tune the treatment.

Some additional benefits accrue to physicians alone: First the work-up process provides a clinical protective device against drug seekers and drug diverters. How so? Simply because the diagnosis of drug seekers will emerge from careful use of this process over time with any individual patient who is manipulating the provider, just as any underlying cause of pain such as sickle cell, bone malignancy, or nerve damage would emerge from diligent application of the process.

Second, the process provides the practitioner with a detailed, step-by-step record of the entire history of the care rendered, a readymade defense in the event of any third-party review of the patient care by peer reviewers, third party-payers, malpractice attorneys, or regulators.

Regulators? This brings us to the final topic of this article: What is the Minnesota Board of Medical Practice looking for when reviewing a complaint regarding pain management? The short answer is that the Board is trying to determine how well the practitioner has applied clinical methodology to the management of a particular patient’s pain problem. How does the Board do this? By examining the record created by the practitioner during the course of examination, treatment and follow-up. That is, by reviewing the patient’s chart and comparing the care rendered to the “current and prevailing standard of care within the specialty.” How does it determine what the current standard is? By hiring outside consultants practicing in the same or similar specialties, and under the MetroDoctors

same or similar circumstances as the physician under review.

Does getting scammed by a drug seeker once, before the clinical process identifies the patient as a drug seeker, mean that the doctor will lose his or her license? No, of course not. The Board doesn’t discipline mistakes. It disciplines PATTERNS of substandard care.

That’s why, in the investigation of a single complaint, the Board often performs a random chart review to determine what pattern of care is within the doctor’s practice.

If there is a pattern of substandard care, will the doctor then lose his or her license?

Again, no. The Board’s preferred, and primary recourse in instances of substandard care is to require the physician to obtain remedial training in one or more clinical areas to ensure that future practice does indeed meet the “current and prevailing standard of care.”

The next article in this series will address basic tools in the management of pain. The last article will provide tips on distinguishing nor-

mal relief seeking behavior from drug seeking behavior, and recommendations on managing the “difficult” pain patient, that is, the patient presenting with co-morbid conditions. These are all interesting and useful discussions to any practitioner seeing patients on a regular basis. ◆ Alfred V. Anderson, M.D., D.C. is a pain management and manipulative medicine specialist and is also a licensed chiropractor. He operates the Pain Assessment & Rehabilitation Center, Ltd., in Edina. He is a Diplomat in Pain Management, the American Academy of Pain Management.

Dr. Anderson serves on the Board of Directors of the Minnesota Physician/Patient Alliance and on the Board of Medical Practice from the second congressional district.

Richard L. Auld, Ph.D. has served as the assistant executive director at the Board of Medical Practice since 1985. He is primarily responsible for constituent outreach, policy and planning, educational development and legislative matters.

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• BE/BC FP or IM Provider experienced working in a multidisciplinary setting managing patients with acute, subacute and chronic pain.

Sister Kenny Institute’s Chronic Pain Program is dedicated to helping people manage their own chronic pain. As the most established residential program in the Midwest, our program has helped thousands of patients improve their lives. Join our team today!

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Contact: Allina Physician Recruitment Services, 8450 City Centre Drive, Woodbury , MN 55125.

1-800-248-4921, fax: 651-714-3311 or email: recruit@allina.com.

EOE www.allina.com.

The Journal of the Hennepin and Ramsey Medical Societies

November/December 2004

15

COLLEAGUE INTERVIEW

Alan L. Goldbloom, M.D.

Alan L. Goldbloom, M.D., was appointed president and chief executive officer of Children’s Hospitals and Clinics, in Minneapolis and St. Paul, in January 2003. Prior to joining Children’s, Dr. Goldbloom was executive vice president and chief operating officer at The Hospital for Sick Children (HSC) in Toronto, Canada. Dr. Goldbloom graduated in Medicine from McMaster University in Hamilton, Ontario. He completed a pediatric residency at Children’s Hospital in Boston and The Hospital for Sick Children in Toronto. In 1987, Dr. Goldbloom became director of medical education at The Hospital for Sick Children and the University of Toronto. During this time, he played an active role in pediatric residency training issues at a national level, and served as chairman of the Examining Board in Pediatrics for The Royal College of Physicians and Surgeons of Canada. In 1991, he was appointed associate chairman of the Department of Pediatrics at the University of Toronto, and associate pediatrician-in-chief at The Hospital for Sick Children. In 1993, Dr. Goldbloom joined the executive management team of the hospital, and ultimately became its executive vice president and chief operating officer. He has been particularly involved in the development of new models of health care delivery for children, maximizing the use of information technology.

Q A

What do you see as the biggest challenge to children’s health today and how can the health care delivery sector best respond to it.

I continue to believe that economic and educational disparities constitute the single biggest challenge to children’s health. This translates into uninsured children, and the problem escalates when they live in families who are severely disadvantaged — not only by poverty, but also by cultural and linguistic barriers. This is a societal challenge, and requires a reprioritization of investment. As a society, we are prepared to spend vast sums of money on the care of people in the final six months of life, but we are much less supportive of children in their early years, when such investments can yield the greatest return.

16

November/December 2004

What other opportunities do you see to advance the health of children in our metro area, greater Minnesota, and perhaps beyond?

Given my role as a hospital leader, this will sound heretical. But in fact, the health of children overall has little to do with hospitals. While we provide important care to some children, the factors that really determine health are economic well-being, education (and especially literacy), nutrition, and social supports. These are societal problems. Children’s does have a role in being a powerful advocate, at the legislative and societal level, on behalf of children’s health. But it’s a responsibility we all share.

Another serious issue in Minnesota is the inadequacy of our resources for addressing mental health issues in children. This is a huge unmet need. I don’t believe it will be solved until there is an infusion of state resources to address it. The cost of doing this is far less than the cost of dealing with the later consequences of neglecting the problem.

What breakthroughs in children’s health care do you see in the next five years?

Increasingly, the major breakthroughs are emerging as we develop better understanding of the molecular and genetic basis of so many of the major diseases of childhood. Advances in both genetic and anatomical diagnosis are being supported by major breakthroughs in nanotechnology. Therapeutic interventions, whether for cancer, inborn errors of metabolism, lethal infections, mental illness, or other diseases will be driven by this new knowledge, which is also driving new developments in “designer pharmacology.” We are also seeing enormous strides in correction of a wide range of congenital abnormalities, ranging from cardiac malformations to urogenital disorders. Prenatal diagnosis is well established, and fetal treatment has already begun. Finally, I am MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

hopeful that we will see continued progress in finding ways to help the thousands of children with developmental disabilities, not necessarily through cure, but by providing better services and supports to help them maximize their potential.

What will be the role of Children’s Hospitals and Clinics in that breakthrough?

Children’s Hospitals and Clinics, being the largest provider of acute pediatric care in the region, has the opportunity to leverage its capacity in clinical research to bring new knowledge in these areas. This is a key strategy for us, and offers us the opportunity to partner with those involved in basic science research. Moving knowledge from the lab bench to the bedside is an essential step in changing the way we provide care to children. We are already active in clinical research in several areas, including neonatology, hematology-oncology and diabetes, but we are determined to expand this activity. Children’s has recently launched a new Center for Care, Innovation, and Research (CCIR). The CCIR will be the hub of our activities in clinical and health services research, outcomes measurement, care improvement, patient safety, and knowledge dissemination. One of its goals is to ensure that we rapidly translate new knowledge into improved care on a continuing basis.

When you arrived in the Twin Cities and took the reigns at Children’s, one of the challenges facing you was the relationship between Children’s and the University of Minnesota. As you were and are well aware, many of our colleagues, community leaders, and board members at Children’s have felt that there would be much to gain from a closer relationship between Children’s and the health services for children at the “U.” Could you please provide your current assessment of opportunities and challenges in this area, now that you have been CEO at Children’s for approximately 18 months?

(Please see also my response to the next question, which relates to some of the same issues.)

I agree that a closer relationship would be a boon to both organizations.

Indeed, we are an exception in the United States, since most major children’s hospitals are also the home base of the department of pediatrics of the regional medical school. I recognize that there is a long history behind this separation, but I am committed to looking forward, not backward. We do, in fact, collaborate with the University of Minnesota in a number of areas. The pediatric residents at the “U” do a large portion of their training at Children’s, and we share physicians in a number of subspecialties. In some areas, such as hematology-oncology, we share in (Continued on page 18)

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

November/December 2004

17

Colleague Interview (Continued from page 17)

the care of patients during different phases of treatment. In other areas, we compete vigorously! I regret that we have not been able to translate a collaborative relationship into a structural one, but there are some major obstacles that we have not been able to overcome. In the meantime, I value our relationship with the “U,” and I hope we can strengthen it to the advantage of all our patients.

What is the current status/activity in bringing about a single Children’s Health System for the Twin Cities?

Much of my first year in the Twin Cities was spent exploring opportunities for unifying some of the pediatric hospital services in the region.

Regrettably, we were not able to come to an arrangement that was satisfactory for all parties. I still feel that while each component of the pediatric care system (Children’s, Fairview, Gillette, and Shriner’s) does excellent work, the system as a whole suffers from the fragmentation. In other words, I believe the whole could be greater than the sum of its parts.

Despite the fact that all the hospitals in the Twin Cities are non-profits, they do compete vigorously. A great children’s hospital must be a resource to the entire community, and for that reason I think it must remain independent. That was a stumbling block in our last round of discussions.

Children’s is fortunate to have good working relationships with many of the adult hospital systems in our community. We are committed to continuing to look for opportunities to work more collaboratively, in the interests of using our resources wisely to provide the best care.

How does the response to children’s health needs differ between the Canadian and the U.S. systems?

I think you would find the differences in health care less noticeable in children than in adults. Any differences may be more related to extremes of wealth and poverty, which are more marked in the U.S. than in Canada. There are certainly poor families in Canada, but they have the same health insurance as everyone else, and therefore can access good care. Pediatric caregivers are a pretty motivated and dedicated group — children seem to elicit those qualities in people. Children’s hospitals are quite similar in both countries.

Are you seeing the benefits of a free market system in the U.S. versus socialized medicine as practiced in Canada?

What do you think American physicians should do to further the freedom to practice medicine without governmental intrusion like “Hillary Care” as re-proposed by Senator Kerry?

two systems. Let me correct one point. The term “socialized medicine” is not the correct description of Canada’s system. Instead, there is universal health insurance. In other words, everyone is insured through the provincial government’s health plan. However, most physicians are still in private practice, not on salary. Unlike the U.S., they only have one insurer to deal with when they send the bill in for each visit. There is actually less intervention by insurers in Canada. Patients can choose any doctor and any hospital, and there is no requirement for prior approval of services. The downside of the system is that there is a shortage of resources in some areas, which can result in delays.

In the U.S., there is certainly more competition among hospitals.

While that is supposed to drive prices down, there is no evidence that it has done so, since the U.S. spends more per capita on health care than any country in the world, and still leaves 45 million people uninsured.

The administrative and transactional costs of health care in the U.S. are far higher than Canada, and that is money that would be better spent on patient care.

There are pros and cons to both systems, and I think that each one is slowly adapting some features of the other. In other words, Canada is starting to allow more entrepreneurial activity in health care, and the U.S. has been trying to improve the safety net for those without coverage.

One feature is common to both Canada and the U.S.: in both countries, everybody complains about the health care system!

As the major hospital groups with Obstetrics are unable to join Children’s Hospitals and Clinics in the building of a one campus “Women and Children’s Hospital,” are you going to expand the St. Paul campus to its full potential or continue to pour money only into the Minneapolis campus?

The premise of this question is actually incorrect. In the five years preceding 2004, the majority of our capital expenditures have been in the St. Paul campus, not Minneapolis. For example, in St. Paul we added the Garden View Medical Building, housing clinics and offices, a brand new $10 million neonatal intensive care unit (this is a 50-bed, all private room NICU — making it the largest of its kind in the U.S.). Last year we also installed new MRI and nuclear medicine facilities in St. Paul.

In 2004, we have added clinics and operating rooms to the Minneapolis campus, and in 2005 we expect to again address some urgent needs in St. Paul. We have also recently expanded our facilities at Children’s West, in Minnetonka. As an organization, we are committed to caring for children and families in the entire metro area, and in the state and region as well, and our investment in facilities reflects that commitment.

Lots of politics behind this question! I could go on a long time about this, but I am usually careful not to be drawn into debates about the 18

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The Journal of the Hennepin and Ramsey Medical Societies

Will there be a facility for Pediatric ER, Short Stay Unit, Inpatient, and Life Support Unit in the western suburbs in the foreseeable future? In the northern suburbs? In the eastern suburbs?

providing them with immediate access to the medical record. Precise compatibility with office-based systems may be more complex, because there are many different systems out there.

We have already established ambulatory surgical facilities, rehabilitation services and diagnostic capability (CT and MRI) at Children’s West in Minnetonka, as well as rehabilitation and specialty clinics at Woodwinds Health Campus in Woodbury, serving the eastern suburbs.

Several adult systems have already declared an interest in developing health services in Maple Grove, and it is likely that Children’s would seek opportunities to partner there. In addition, Children’s has bought land in Shoreview, to the north, and is exploring opportunities to build on it. In each case, the real question is whether the activities will support in-patient or short-stay units, and we have not yet determined that.

Substantial activity is necessary in order to make such a unit viable. Our goal is to use a hub and spoke model of pediatric services, providing pediatric ambulatory services close to where families live, while maintaining high-volume core facilities for more complex care.

How can pediatricians and family practitioners help with committees and government of the Hospital Professional Staff?

Children’s has an active professional staff, and we would welcome greater participation by its members in some of the work. There are numerous active committees, as well as a Professional Staff Council, which play vital roles in the work of the hospital. Anyone who wants to become more involved need only call the Chief of Staff, Dr. Thomas Hellmich, or the Vice President of Medical Affairs, Dr. Phil Kibort, to discuss the opportunities. ◆

As hospitalists have proved themselves too expensive for pediatric medicine, and as residents, and soon, medical students, are scaling back their hours in clinical service, do you foresee a need for in-house physicians assistants to help provide continuity of care overnight?

Children’s has been at the forefront of exploring new models of care delivery within the hospital, especially as traditional models have become less viable. We currently provide pediatric hospitalists to Methodist Hospital, through a contractual relationship. In addition, Children’s has led the community in its commitment to have in-house medical staff coverage of its neonatal and pediatric intensive care units on a 24/7 basis.

We have supported the expansion of scope of practice of pediatric nurse practitioners and respiratory therapists as well. I cannot predict precisely how this issue will continue to evolve, but we are prepared to explore all options in order to ensure continuity of high quality care.

Children’s has been working on an electronic billing and charting system with Cerner and Power Chart for some time; is it also working on an Electronic Medical Record?

If so, will it try to coordinate with other Pediatric groups for cross compatibility?

Children’s has invested heavily in the development of an Electronic Medical Record, and the work that we have already done in electronic charting and billing is, in fact, a part of that project. The next phase, Provider Order Entry, will be installed in the next few months. We have also installed PACS (picture archiving and communication system) making our diagnostic imaging studies available to providers on-line. Our Remote Access tool has made the system accessible to community-based providers, so that physicians can link to the system from their offices, MetroDoctors

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Ramsey Medical Society Foundation ENDORSED BY: RAMSEY MEDICAL SOCIETY HENNEPIN MEDICAL SOCIETY

Winter Medical Conference 2005

!

NOW 4 T C A 200 , 4 R E B E NOVEM ION DEADLIN VAT RESER

SUNDAY, FEBRUARY 6-13, 2005

ROYAL CARIBBEAN CRUISE 7 NIGHT WESTERN CARIBBEAN CRUISE ON THE RADIANCE OF THE SEAS LABADEE, OCHO RIOS, JAMAICA, GEORGETOWN GRAND CAYMAN & COZUMEL

RATES (INCLUDES: AIR, CABIN, ALL MEALS, TRANSFERS, & $162 PORT FEES, TAXES & SURCHARGES)

INSIDE CABIN OUTSIDE CABIN BALCONY CABIN

PHYSICIAN

SPOUSE/GUEST

3RD PERSON

4TH PERSON

SINGLE

DOUBLE

ADULT/CHILD

ADULT/CHILD

$1,849.00 $2,249.00 $2,549.00

$449.00 $449.00 $449.00

$749.00 $749.00 $749.00

$749.00 $749.00 $749.00

Medical Conference Registration Fee: HMS/RMS Member $395; Non-Member $425

The rates do not include the conference registration fee. Deposit of $500 per person due by Thursday, November 4, 2004. Full payment due by Monday, November 22, 2004.

TRAVEL PACKAGE INCLUDES: • round trip charter air from HHH Charter Terminal Minneapolis/St. Paul to Miami - Departure: Sunday, February 6, 2005 - HHH Charter Terminal; Return: Sunday, February 13, 2005 - Miami

• • • • •

7 nights accommodations on Royal Caribbean Cruise all meals and on-board activities transfers to and from the airport and cruise ship cocktail party one evening $162 in port fees, taxes, and surcharges

Please note: Proof of citizenship is required. A passport is recommended for travel (an original or certified birth certificate with a government issued picture I.D. will also be accepted).

CONFERENCE DESCRIPTION This conference has been planned for a mixed group of primary care and specialty physicians.

The goal of the program is to address a variety of topics concerning the diagnosis and management of medical problems encountered in daily practice and to update physicians on technology issues.

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November/December 2004

QUESTIONS ABOUT THE TRIP OR TO MAKE YOUR RESERVATION: CALL Bev at Hobbit Travel (612-349-3922 ext. 3030) 1-800-294-6992 ext. 3030 or email: bevmiles@hobbittravel.com

For further information: call RMS/HMS 612-362-3704 email: dhines@metrodoctors.com website: www.metrodoctors.com

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Ramsey Medical Society Foundation Winter Medical Conference 2005 Proposed Faculty & Content ANTHONY B. FERRARA, M.D.

ALFONSO MORALES-UTRILLA, JR., M.D.

� “Current Trends in Hypertension”

� “Musculoskeletal Pain Management: An Integrative Approach”

Family Practice, East Metro Family Physicians, Inver Grove Heights 1. Describe the current standard of diagnosis and treatment of hypertension 2. Educate physicians on up-to-date effective treatment

� “Cholesterol: How Low Should We Go!” 1. Describe the current standard of diagnosis and treatment of cholesterol 2. Educate physicians on up-to-date effective treatment

ERIC W. GOAD, M.D.

Psychiatry, Park Nicollet Clinic, Bloomington

� “Psychiatric Update for Primary Care” 1. Review treatment strategies for achieving remission when treating anxiety/depression in primary care setting 2. Discuss newer developments and concerns of psychotropic medications in primary care

� “Everything You Wanted to Ask a Psychiatrist…An Open Discussion of Mental Health Issues” Facilitate open discussion of mental health problems or challenges faced in every day practice of the participants

RONNELL A. HANSEN, M.D.

Diagnostic Radiology, St. Paul Radiology, P.A., St. Paul

� “The Future of Imaging: Part 1 - Advanced Multi-Detector CT/Volumetric and 3D Image Analysis; Part 2 - New Developments/Applications in Imaging: 64-Channel CT, PET-CT, and CyberKnife RT” 1. Understand the concept, physical implementation, and the spectrum of CT scanner technology 2. Describe the differences between data acquisition and data manipulation 3. Review the emerging technologies in the acute care and therapy setting

CHARLENE E. MCEVOY, M.D., MPH

Pulmonary Disease, HealthPartners, St. Paul

�“Exercise & Asthma”

1. Understand that exercise is a trigger of asthma, not the cause of asthma 2. Describe the pathophysiology of EIB and review the diagnosis and treatment of EIB

�“COPD Management” 1. Recognize the risk factors involved in developing COPD and be able to apply the current recommendations regarding the treatment of symptomatic COPD 2. Understand the pathogenesis of COPD and prevention strategies

We reserve the right to make program changes without notice, should circumstances necessitate.

Pain Medicine, Central Medical Clinic, LLC, St. Paul

1. Understand the fundamentals of modern pain medicine and identify the barriers to effective pain management 2. Outline basic strategies and complexities for a treatment plan which includes elements of assessment, documentation, prescribing, and continuous evaluation 3. Discuss state-of-the-art diagnosis and management strategies for several of the major pain conditions including pain control in the office practice 4. Describe the best CAM therapies for use in pain management, their integration into treatment, and the research data that exist to support them

CARLOS H. SCHENCK, M.D. Senior Staff Psychiatrist, Minnesota Regional Sleep Disorders Center/ HCMC, Mpls./ Author: “Paradox Lost: Midnight In the Battleground of Sleep and Dreams”

� “Restless Legs Syndrome, Sleep-Related Eating Disorder, REM Sleep Behavior Disorder, and Other Surprisingly Common Parasomnias” 1. Learn how to detect the cardinal signs and symptoms of the major Parasomnias (sleep behavior disorders) 2. Discuss how to evaluate and manage RLS and other Parasomnias, and when to refer to an accredited Sleep Disorders Center

�“Insomnia, Hypersomnia, and Severe Morning Sleep Inertia” 1. Explain how to detect the cardinal signs and symptoms of insomnia, hypersomnia, and severe morning sleep inertia and their functional impact on people’s lives 2. Discuss how to evaluate and manage these sleep problems, and when to refer to an accredited Sleep Disorders Center

DOUGLAS A. SCHOW, M.D.

Urology, Minnesota Men’s Health Center, Woodbury

�“The Value of Treating Erectile Dysfunction” 1. Explain the various causes of erectile dysfunction and the appropriate testing necessary for the evaluation of men with erectile dysfunction 2. Describe the treatment options for patients with erectile dysfunction

�“Male Factor Infertility - Evaluation and Treatment in the 21st Century” 1. Explain the incidence of male infertility as well as the various causes of male infertility 2. Describe the options available for the treatment of male infertility

“ASK THE SPECIALIST: SPECIALTY ROUNDTABLE”

Group discussion with specialists from the existing faculty.

Provide a clinical update from the specialist based on the questions submitted by participants

CONTINUING MEDICAL EDUCATION CREDIT The Ramsey Medical Society Foundation (RMSF) is accredited by the Minnesota Medical Association to provide continuing medical education for physicians.

The RMSF designates this educational activity for a maximum of 16.0 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Space is Limited: Register early to guarantee your reservation.

Your deposit secures your travel reservations.

November/December 2004

21

2004 MMA Annual Meeting

G. Richard Geier, M.D., MMA board of trustees chair, presented Judith F. Shank, M.D. with the MMA’s Distinguished Service Award. This award is presented to a physician who has made outstanding contributions to medicine and to the MMA and is the highest honor bestowed on a colleague by the MMA.

J. Michael Gonzalez-Campoy, M.D. (left) was inaugurated as the new MMA president with the passing of the presidential medallion by outgoing president Paul Matson, M.D. (right) during the MMA’s Annual Meeting.

RMS and HMS candidates elected by the MMA House (from left) are: Michael Ainslie, M.D. (H) - Treasurer; Kenneth Crabb, M.D. (R) – AMA Delegate; Blanton Bessinger, M.D. (R) - AMA Alternate Delegate; Lyle Swenson, M.D. (R) Vice-President; John Larsen, M.D. (H) - Vice Speaker of the House; Frank Indihar, M.D. (R) - AMA Delegate; and Benjamin Whitten, M.D. (H) - AMA Alternate Delegate.

* (H)=Hennepin Medical Society. (R)= Ramsey Medical Society.

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November/December 2004

Hennepin and Ramsey Medical Society members reviewing the resolutions to be presented at the MMA House of Delegates meeting during their joint caucus.

Physicians representing Ramsey and Hennepin Medical Societies by serving on Reference Committees during the MMA Annual Meeting in Duluth (from left) are: Joel Arney, M.D. (H) Reference Committee B; Philip Hoversten, M.D. (H) Reference Committee D; Janet West (H) Reference Committee A; Todd Brandt, M.D. (R) Reference Committee A; Lindsey Thomas, M.D. (H) Reference Committee C; Robert Moravec, M.D. (R) Reference Committee B Chair; Jane Pederson, M.D. (R) Reference Committee D; and Richard Baron, M.D. (R) Reference Committee C. Not pictured: Scott Uttley (R) Reference Committee A and Alisa Lee (H) Reference Committee B.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

MMA Award Recipients THE MINNESOTA MEDICAL Association

presented awards to the following individuals at the Awards Luncheon during the 151st Annual Meeting in Duluth.

Decade Recognition Colleagues who have remained committed to their profession for five decades are recognized for this award.

Jose A. Abullarade, M.D. (HMS) Robert M. Ahrens, Sr., M.D. (RMS) Russell W. Bagley, M.D. (HMS) Robert David Blomberg, M.D. (HMS) Carl O. Bretzke, M.D. (RMS) Edward W. Ciriacy, M.D. (HMS) Davitt A. Felder, M.D., Ph.D. (RMS) Wendla E. Leinonen, M.D. (HMS) James J. Pattee, M.D. (HMS) Herschel L. Perlman, M.D. (HMS) William E. Price, M.D. (HMS) Gregory A. Sprafka, M.D. (RMS)

Community Service Award This award honors MMA members who are actively engaged in the practice of medicine and have an outstanding record of community service.

Thomas E. Kottke, M.D. (RMS) Medical Student Award This award honors an MMA/MSS student who has an outstanding commitment to the medical profession.

Stephanie DawnOnnerate Stanton (RMS) President’s Award This award is presented to members of the MMA who have made outstanding contributions in service but have never been elected to a major office or been recognized by the MMA for their dedication and commitment.

Lee H. Beecher, M.D. (HMS) Dianne Fenyk (HMS Alliance)

Physicians Communicator Award This award is given to a physician who demonstrates exemplary skill in communicating with the public through radio, television, or the newspapers and whose work contributes to a better understanding of medicine and health in Minnesota.

John Hallberg, M.D. (HMS) ◆

November/December Index to Advertisers Allina Health Systems ............................... 12 Allina Health Systems ............................... 15 AmeriPride .................................................. 8 Classified Ad ............................................... 3 Coldwell Banker Burnet—Bruce Birkeland ...

Inside Back Cover Computer Integration Technologies .......... 12 Crutchfield Dermatology ............................ 3 Medical Billing Professionals ..................... 24 MMIC ...................................................... 17 Minnesota Healthcare Network ................. 24 Minnesota Oncology Hematology ................

Outside Back Cover Rapid Return ................... Inside Front Cover RCMS, Inc. ............................................... 28 Red Pine Realty ................. Inside Back Cover Weber Law Office ....................................... 3 Whitesell Medical Locums, Ltd. ................ 14

Award recipients recognized at the MMA Annual Meeting in Duluth (from left) are: Lee H. Beecher, M.D. (President’s Award); Dianne Fenyk (President’s Award); Stephanie DawnOnnerate Stanton (Medical Student Award); and John Hallberg, M.D. (Physicians Communicator Award).

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Winter Medical Conference 2005 ........ 21-22

November/December 2004

23

AMA Welcoming Picnic for Medical Students THE 1ST YEAR medical student picnic was held on Tuesday, August 3 at Como Park. This event is always well attended, and is a great opportunity for 1st year medical students to meet their fellow classmates — sometimes for the first time. This fun event is hosted by the AMA Medical Student Section and the Hennepin and Ramsey Medical Societies. The HMS Alliance also participated in this event and had representatives on hand to invite partners and spouses to join the Medical Student Partners Alliance (MSP).

Attendees included: Jack Davis, CEO of HMS; Kathy Messerli, Director of Member Relations, MMA; and Peggy Johnson and Diane Gayes, HMS Alliance. ◆

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November/December 2004

1st year medical students enjoyed the welcoming picnic hosted by the AMA Medical Student Section and the Hennepin and Ramsey Medical Societies.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

PRESIDENT’S MESSAGE PETER J. DALY, M.D.

Getting the Provider Tax Eliminated will be Politically Difficult RMS-Officers

RMS-Board Members

Todd D. Brandt, M.D., At-Large Director Victor S. Cox, M.D., Specialty Director Laura A. Dean, M.D., Specialty Director Daniel Franc, Medical Student Ronnell A. Hansen, M.D., Specialty Director James J. Jordan, M.D., Specialty Director Robert V. Knowlan, M.D., At-Large Director Bradley C. Linden, M.D., Resident Physician Thomas J. Losasso, M.D., At-Large Director Robert C. Moravec, M.D., At-Large Director Jane C. Pederson, M.D., M.S., Specialty Director Lon B. Peterson, M.D., At-Large Director Thomas D. Siefferman, M.D., Specialty Director David C. Thorson, M.D., Specialty Director Peter B. Wilton, M.D., At-Large Director RMS-Ex-Officio Board Members & Council Chairs

Blanton Bessinger, M.D., AMA Alternate Delegate Kenneth W. Crabb, M.D., AMA Delegate Robert W. Geist, M.D., Ethics & Professionalism Council Chair Frank J. Indihar, M.D., AMA Delegate Neal R. Holtan, M.D., Community Health Council Chair Mark Kleinschmidt, Clinic Administrator Anthony Orecchia, M.D. Education Resource Council Chair Stephanie D. Stanton, Vice Speaker, AMA Medical Student Section Lyle J. Swenson, M.D., Public Policy Council Chair Wayne H. Thalhuber, M.D., Sr. Physicians Association President RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive Officer Katie Anderson, Executive Assistant Doreen M. Hines, Membership & Web Site Coordinator

MetroDoctors

A

AT OUR RECENT MMA meeting in Duluth on September 30, one of the reference committees debated a resolution put forward to the MMA House by the Lake Superior Medical Society:

WHEREAS, the State of Minnesota has imposed a 2% tax on medical expenditures to cover the cost of MinnesotaCare, and WHEREAS, Governor Pawlenty has used millions of dollars from this fund to balance the state budget, therefore be it RESOLVED, that the MMA lobby the State of Minnesota to impose a 2% tax on all attorney fees to cover the legal fees for low income individuals, and be it further RESOLVED, that the MMA lobby the State of Minnesota to impose a 2% tax on all realtor fees to cover the cost of low income housing, and be it further RESOLVED, that the MMA lobby the State of Minnesota to impose a 2% tax on all dental fees to cover the cost of dental care for low income individuals, and be it further RESOLVED, that the MMA lobby the State of Minnesota to impose a 2% tax on all pharmaceutical companies to cover the cost of medications for low income individuals, and be it further RESOLVED, that the MMA lobby that income from these taxes be diverted from the low income individuals they were meant to serve, and used to balance the state budget.

Unfortunately, the above resolution was not adopted by the reference committee to put forward for MMA consideration. Nonetheless it highlights the inequity inherent in the provider tax. It also highlights the immoral diversion of funds from the intended recipients.

Later in the day, Governor Pawlenty was kind enough to address the general assembly of physician delegates. He emphasized the crisis of rising costs and the stress on the budget caused by our profession. He emphasized that

The Journal of the Hennepin and Ramsey Medical Societies

he needed our help. He felt we had to work together with him. He then opened the floor to questions, the first of which was raised by a physician concerned with the provider tax.

The physician wanted to know how he planned to address this unjust tax. Governor Pawlenty responded bluntly, and tellingly, that he regarded the provider tax funds as “low hanging fruit” for his budget needs, and would readily use those monies in the future for the general state budget. There was no acknowledgement that these monies were collected for medical care to low-income Minnesotans. He even had the audacity to further respond that if we were upset by the raiding of the provider tax for general state budget needs before, we “haven’t seen nothing yet.”

It is painfully obvious that getting the provider tax eliminated will be politically difficult, if not impossible, in the near future. It is also obvious that Governor Pawlenty will be no help, and actually an obstacle to the process.

Thus, we have to be all the more resolute in our efforts to other stopgap measures such as the “blinking” aspect to the provider tax. Read the accompanying articles in this edition of MetroDoctors and help in our call to legislative action to eliminate the use of these funds for other purposes. Now is the time for all physicians to get educated on this issue, so that we ready ourselves for the upcoming legislative session. ◆ RMS Mission: Advancing the practice and profession of medicine for the benefit of the community.

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Ramsey Medical Society

President Peter J. Daly, M.D. President-Elect Charles G. Terzian, M.D. Past President J. Michael Gonzalez-Campoy, M.D., Ph.D. Secretary Gretchen S. Crary, M.D. Treasurer Charles E. Crutchfield III, MMB, M.D.

Commissioner Cal Ludeman Updates RMS Board THE SPEAKER at the RMS Board of Directors

meeting on September 15 at Bethesda Hospital was Cal Ludeman, commissioner of employee relations and chairperson of the Governor’s Health Care Cabinet.

Commissioner Ludeman informed the Board members that the Governor’s Health Cabinet was created in late February, 2004 for the purpose of exploring the use of the buying power of the state along with partners in the private sector, to make substantive changes to Minnesota’s health care purchasing systems and cost structures. The Cabinet consists of six members, including the Commissioner of Health; the Commissioner of Human Services; the Commissioner of Finance; the Commissioner of Commerce; the Commissioner of Labor and Industry; and the Commissioner of Employee Relations. Commissioner Ludeman addressed the plans of the Cabinet for state budget development and budget setting; employee contracting; contracting with vendors and health plans; administrative and

regulatory timelines; and communications.

The Health Care Cabinet has been divided into four work groups: 1. Health Care Web site Work Group, led by Health Commissioner Dianne Mandernach; 2.

Health Care Regulation Work Group, led by Labor and Industry Commissioner Scott Brener and Commerce Commissioner Glenn Wilson; 3. State Health Care Purchasing Work Group, led by Human Services Commissioner Kevin Goodno; and 4.

Budget and Policy Work Group, led by Finance Commissioner Peggy Ingison.

The Web site Work Group has developed a prototype Web site at: www.MinnesotaHealth info.org. This Web site is a guide to health care quality and cost in Minnesota. The goal of the Regulation Work Group is to streamline, simplify, consolidate regulation, and improve

electronic transactions capabilities. The goal of the Purchasing Work Group is to promote purchase on VALUE rather than volume, and to partner with the private sector for consistent, reinforcing efforts. The Finance/Budget Work Group will evaluate Health Cabinet proposals and initiatives in the context of the state’s overall budget and finances.

There is also an Ad Hoc Work Group working to facilitate “evidence-based medicine” (practice guidelines) and electronic medical records. Advisory committees continue to meet. Send your ideas and your comments via www.maximumstrengthhealthcare.com by clicking on contact us. ◆

RMSF Needs Your Support Please remember to make your tax deductible contribution payable to the Ramsey Medical Society Foundation, P.O. Box 131690, St. Paul, MN 55113.

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The Journal of the Hennepin and Ramsey Medical Societies

RMS UPDATE

New Members RMS welcomes these new members to the Society.

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

GARY H. BAAB, M.D. died August 26, 2004, at the age of 69. Dr. Baab received his medical degree from the University of Minnesota. He then served as a general practitioner with the Reserve Corps of the U.S. Public Health Service on the Rosebud and White Earth reservations in South Dakota.

Dr. Baab completed his general surgery residency at Miller Hospital, followed by a year-long fellowship at M.D. Anderson Cancer Center in Houston. He practiced general/thoracic surgery for 26 years with St. Paul Associated Surgeons (now Minnesota Surgical Associates). Dr. Baab joined RMS in 1971.

LOUIS L. FLYNN JR., M.D. died September 13, 2004. He was 84. Dr. Flynn graduated from the University of Minnesota Medical School. He served in the Army in New York and Valley Forge, PA and returned to St. Paul to practice psychiatry. Dr. Flynn retired 13 years ago. He joined RMS in 1950.

ALEXANDER D. LOWE, M.D. died at the age of 75 on September 6, 2004. He graduated from the University of Minnesota Medical School as a family practitioner. Dr. Lowe dedicated his life to the care and healing of many generations of patients at Westview Clinic until his retirement in 1994. He joined RMS in 1959. ◆

1st Year in Practice Larry L. Baker, DDS, M.D. Oral and Maxillofacial Surgery Larry L. Baker, DDS, M.D., PC Amy Johnson Fisher, D.O. Des Moines University Obstetrics/Gynecology Allina Medical Clinic-Eagan MaryBeth Mahoney, D.O. Chicago College of Osteopathic Medicine Pediatrics Drs. Sackett & Huberty Vladimir Savcenko, M.D. Lekarska Fakulta Safarikova Univerzita, Kosice Diagnostic Radiology St. Paul Radiology, P.A.

Resident Physicians Mihnea Vasile Chiorean, M.D. Institutul de Medicina si Farmacie, Cluj Gastroenterology Regions Hospital Amy J. Voedisch, M.D. Mayo Medical School

Medical Students (University of Minnesota) R. Brian Jones ◆

MetroDoctors

RMSF Grant Presented to the Hmong Refugee Health Coalition DR. ROBERT MORAVEC, president of the Ramsey Medical Society Foundation, presented a check for $5,000 to Dr. Kathleen Culhane-Pera, principal investigator, for the research work of the Hmong Refugee Health Coalition.

The research goals of the project are: • To determine the prevalence of chronic diseases and conditions in Hmong refugees arriving from Wat Tham Krabok, Thailand.

• To determine the prevalence of risk factors for developing chronic diseases in this population.

• To prepare a database of newly arriving Hmong refugees from Wat Tham Krabok with their names and contact information in order to contact people in the future to identify the incidence of chronic diseases and the roles of risk factors in developing chronic diseases.

Additional funds are needed for this project. Contributions are tax deductible for individuals and physicians who wish to contribute. Members are encouraged to call the RMS office at (612) 362-3704. ◆

The Journal of the Hennepin and Ramsey Medical Societies

Dr. Robert Moravec (far left), president of the Ramsey Medical Society Foundation, presents a check for $5,000 to Dr. Kathleen Culhane-Pera (far right), principal investigator, for the research work of the Hmong Refugee Health Coalition. Others pictured in the center are (left to right): Mary Xiong, medical assistant/research assistant; Hli Lor Xiong, social worker, research assistant; and Kang Xiauj, M.D., co-investigator.

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Ramsey Medical Society

Active Sandra Lobo, M.D. Christian Medical College, Madras University, Vellore, Tamil Nadu Neurology St. Paul Child Neurology, P.A.

In Memoriam

RMS Delegation Toasts Dr. J. Michael Gonzalez-Campoy THE 27 DELEGATES representing RMS in

Duluth at the 2004 MMA Annual Meeting of the House of Delegates gathered on Thursday, September 30 to offer a toast to Dr. J. Michael Gonzalez-Campoy as he was about to assume the presidency of the Minnesota Medical As-

Dr. J. Michael Gonzalez-Campoy with his family.

sociation (MMA). Dr. Gonzalez-Campoy was elected president-elect of the MMA in 2003 while he was serving as president of RMS. He has continued his efforts as CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology, P.A. to make Minnesotans aware of the obesity epidemic.

In addition, he continues his work with the Minnesota Department of Health to develop programs to detect and treat diabetes.

Dr. Gonzalez-Campoy’s spouse, Becky, his children, his parents, his parents-in-law, and his sister and brother-inlaw joined him at the RMS reception. ◆

Dr. Peter Daly presents a toast to Dr. J. Michael Gonzalez-Campoy.

RMS Delegates are gathered to recognize Dr. J. Michael Gonzalez-Campoy.

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.

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November/December 2004

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

CHAIR’S REPORT MICHAEL B. AINSLIE, M.D.

“When you come to a fork in the road—take it.” Yogi Berra

HMS-Officers

HMS-Board Members

Mary Anderson, Co-Presiding Chair, HMS Alliance Abdhish R. Bhavsar, M.D. Carl E. Burkland, M.D. Eric G. Christianson, M.D. Peter J. Dehnel, M.D. Marlene Ellis, Co-Presiding Chair, HMS Alliance Lisa McGinnis, Medical Student Ronald D. Osborn, D.O. Frank S. Rhame, M.D. David F. Ruebeck, M.D. Richard D. Schmidt, M.D. Jan H. Strathy, M.D. Thomas C. Tunberg, M.D. Valerie K. Ulstad, M.D. Peter A. Wallskog, M.D. HMS-Ex-Officio Board Members

Lee H. Beecher, M.D., MMA-Trustee Karen K. Dickson, M.D., MMA-Trustee David L. Estrin, M.D., AMA Alternate Delegate Kenneth B. Heithoff, M.D., MMA-Trustee Donald M. Jacobs, M.D., MMA-Trustee Karin M. Tansek, M.D., MMA-Trustee Benjamin H. Whitten, M.D., AMA Alternate Delegate Barbara Daiker, MMGMA Rep.

T

THIS HAS BEEN an exciting and interesting year as Chair of the Hennepin Medical Society.

I want to thank all of you who have sent me kind notes and helpful criticisms of my tomes on this page. I hope I have not sounded too preachy but, when I see the medicine I love being sold another pig in a poke about practice guidelines, I feel I must speak up.

We are at a critical juncture in medicine.

We have two paths to follow.

We can be complacent and take guidelines which won’t work, and then whatever next scheme is dreamed up to not pay us until the system collapses, and then the only savior of health care will be the government run socialist kind. This best practices will be the lowest common denominator, better know as rationing. Since the public will not tolerate rationing, then a command and control system will be imposed on physicians. We will be paid about the same as residents. (They don’t complain about their salary, do they?) This is about what physicians in Great Britain or Canada are paid and why they are leaving in droves. We will have a two-tiered system of care where you can purchase best care for a price either in the country or outside it. I can envision several hospital ships off shore to treat these patients.

The rest will get the lowest common treatment from 9-5 physicians. Economics will rear its ugly head and this system will eventually fail

and die, but not before a lot of good physicians have left.

We can choose the tougher road. It will entail active involvement from all of us — both in the political arena and in the media. We need to show that patient control of health care is the best for all concerned. Getting insurance back to being just that — insurance — will be difficult, but not impossible. Patients need to control the money and its flow through the system. We, as physicians, need to be unfettered in our ability to see and help patients decide how to spend their money. This is a scary proposition for many of us. We need to become entrepreneurial businessmen and women. Only in a free market will true best practices be found. Only in a free market will quality become the true Holy Grail. Only in a free market can the spirit of competition be shown to enhance the health of all Americans.

As the wise Pogo once said: “We have met the enemy and he is us!” We need to admit our failings and give back control of the patient’s health to each patient. Only by following the basic laws of economics can true health care be found for all Americans. ◆

HMS-Executive Staff

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

MetroDoctors

Hoban Scholarship Correction:

The Journal of the Hennepin and Ramsey Medical Societies

We apologize that in the July/ August 2004 edition of MetroDoctors, we miss-identified some people in this photo. Here is the corrected version. Pictured from left: Thomas W. Hoban, Mary Kay Hoban, Darla Morris-Preble (2003 Hoban Scholar), 2004 CLARION Competition Winners: Scott Stayner, Christie Burgers, Rebecca Ogi, and Justine Ngo, Rebecca Sanchez (2003 Hoban Scholar), and H. Thomas Blum, M.D., Chair, Hoban Scholarship Selection Committee.

November/December 2004

29

Hennepin Medical Society

Chair Michael B. Belzer, M.D. President James A. Rohde, M.D. President-elect Paul A. Kettler, M.D. Secretary Edward P. Ehlinger, M.D. Treasurer Anne M. Murray, M.D. Immediate Past Chair Michael B. Ainslie, M.D.

HMS NEWS

In Memoriam W.H. “WILBUR” BITTICK, M.D., 79, died on August 9. He graduated from the University of Oregon Medical School and immediately volunteered for two years of service as a doctor in the Korean War. After a three-year residency in Obstetrics and Gynecology at Minneapolis General Hospital, he practiced in Minneapolis for 35 years. Dr. Bittick served as: medical director for Planned Parenthood in Minneapolis; city health officer for Richfield; and medical director, City of Bloomington Health Department. He joined HMS in 1959.

IEVA GRUNDMANIS, M.D., 62, died in Riga, Latvia on September 16 after a long illness. A pulmonary disease specialist, she practiced more than 25 years with the Minnesota Lung Center.

She graduated from medical school in Adelaide, Australia, and was board certified in internal medicine and pulmonary medicine. She started in private practice in 1975 with the then Respiratory Disease Associates and continued there until the latter part of 2002. She was elected chief of the Department of Medicine at Unity Medical Center in 1984 and subsequently served as chief of staff at Unity. In 2002 she moved to Latvia and resided there until her death. Dr. Grundmanis joined HMS in 1981.

program in Hastings and practiced radiology at Abbott Northwestern Hospital. Dr. Miller joined HMS in 1991.

Joachim W. Schugel, D.O. Emergency Medicine Suburban Emergency Associates, P.A.

BROR FOLKE PEARSON, M.D., 98, died August 24 at Sunrise of Mercer Island, Washington.

Born in Sweden, he immigrated with his family to Grand Rapids, Minnesota in 1919. He graduated from the University of Minnesota Medical School. Dr. Pearson practiced family medicine in Shakopee for 42 years. He traveled throughout the world as a tourist and also as a humanitarian.

The University of Minnesota Medical Alumni Society named Dr. Pearson as a 1975 recipient of the prestigious Harold S. Diehl Award. He received the 1976 Franciscan International Award for his medical work around the world. An elementary school in Shakopee was named after him in 1970. Dr. Pearson joined HMS in 1936. ◆

James E. Stevenson, M.D. Internal Medicine Veterans Administration

New Members HMS welcomes these new members to the Society.

Active Bruce Eric Cantor, M.D. Internal Medicine Partners in Pediatrics, Ltd.

Rebecca S. Mattison, M.D. Endocrinology Amy S. Hentges, M.D. Pediatrics Columbia Park Medical Group-Brooklyn Park

Resident Physicians Ives de Chazal, M.D. Critical Care Medicine (University of Minnesota)

Brian C. Clarkowski, M.D. Emergency Medicine Suburban Emergency Associates, P.A. Christina Elaine Dewey, M.D. Pediatrics South Lake Pediatrics Andrew Freese, M.D. Neurological Surgery University of Minnesota Jeffrey S. Hill, M.D. Emergency Medicine Suburban Emergency Associates, P.A.

STEVEN JEROME MILLER, M.D., died on August 30 at the age of 46. He graduated from the University of Minnesota Medical School where he achieved Alpha Omega Alpha Honor Society, and was chief resident, Department of Radiology.

He was director of Regina Hospital’s radiology

Brian G. Prokosch, M.D. Emergency Medicine Suburban Emergency Associates, P.A.

November/December 2004

1st Year in Practice Peter Darien Kent, M.D. Rheumatology Park Nicollet Clinic

Medical Students

CHARLES F. KELLY, M.D., age 82, died of cancer at home on August 26. He attended the University of Minnesota before enlisting in the Army and re-entered the University of Minnesota after WWII, obtaining his M.D. in 1951. He operated a family practice in SW Minneapolis and Edina for 25 years. Dr. Kelly co-founded Emergency Physicians Professional Association (EPPA); served on staff at Methodist, Fairview Southdale and St. Mary’s Hospitals; and was a team doctor for the Minnesota North Stars for 20 years. He retired in 1988. Dr. Kelly joined HMS in 1953.

30

William Dean Turcotte, D.O. Family Medicine Camden Physicians, Ltd.

Ruth Lynfield, M.D. Pediatric Infectious Disease Minnesota Department of Health Yasmin A. Orandi, M.D. Family Medicine Apple Valley Medical Center James S. Parker, M.D. Emergency Medicine Suburban Emergency Associates, P.A.

Matthew J. Risken, M.D. Emergency Medicine Suburban Emergency Associates, P.A. MetroDoctors

Angela C. Brandes Erik Ryan Brodt Patricia A. Bugliosi Gregory Michael Dukinfield Cory Ray Ecklund Amy Lynn Ellingson Jon Richard Gayken Lindsey Starr Hagstrom Amber Olson Holmgren Krista R. Johnson Ben Koch Meghan Maria Kutz Katherine Bearinger Matthews Karin Min Jung McConville Doreen M. McEvoy Tara Lynn McMichael Adina Joy Miller Eric Alan Moldestad Daniel David Opheim Rhonda Lynn Peters Jeremy John Peterson Elizabeth Ann Roberts Sara J. Runge Joy Christine Taber Kristin Noelle Tapper Andrew Joel Thompson Marit Elise Thorsgard Paul Robert Tonkin Jessica Jeanne Winterfeldt Erin Margaret Withers ◆

The Journal of the Hennepin and Ramsey Medical Societies

HMS IN ACTION JACK G. DAVIS, CEO

The Hennepin Medical Society’s Senior Physician Association held its summer outing on August 10. A large group of physicians and spouses visited the Minnesota Landscape Arboretum for lunch, fellowship and a tram tour of the Arboretum.

Sue Schettle and Jack Davis attended the

Seven physicians, organized by the Medical Society, attended and testified at the Hen-

first year medical student welcoming picnic. This event is sponsored by the

Medical Student Section of the AMA as its membership recruitment activity for organized medicine. HMS is invited to present the benefits of membership in local medical societies. This event is scheduled on the first day that first year medical students are on campus. As you might expect, this is a very exciting day for the students, which makes for a fun picnic.

Several Hennepin Medical Society members attended an MMA District Dialogue with Representative Jim Rhodes in St Louis Park. These events are planned by Byron Johnson of the MMA with David Renner and Erin Sexton in attendance. District Dialogues are intended to bring together elected state office holders and constituent physicians to discuss issues important to physicians in a casual environment while the legislature in not in session. Look for more of these events to be scheduled. Several are in the works for this fall.

As a result of the second hand smoke in the workplace ordinance passing in Minneapolis, representatives of HMS have been asked to participate in an Implementation Task Force. Edward Ehlinger, M.D. and Jack Davis are participating. The effective date of the ordinance is March 31, 2005. The focus of the Task Force is to create an implementation plan designed to establish a smooth ordinance rollout.

MetroDoctors

nepin County Board of Commissioners’ hearing in support of a proposed

second hand smoke ordinance on September 14. Most testifying physicians had participated in media training organized by the society. The testimony was led by Mick Belzer, M.D., president of the Hennepin Medical Society.

The Minnesota Fair Health Plan Contracting Coalition has been meeting to organize a legislative agenda for the 2005 Minnesota Legislative session. Due to the success of the Coalition on the contracting issue, it’s likely that a new name for the Coalition will be adopted. Several issues will be evaluated by the Hennepin and Ramsey Medical Societies Joint Advocacy Committee.

September 10 was the date for this year’s first Medical Student Lunch ’n Learn.

Michael Ainslie, M.D. attended and spoke about the value of organized medicine for members of the profession, including students. HMS does quite well in engaging medical students in the society.

The MMA Annual Meeting was held in Duluth on September 29 and October 1.

A number of HMS resolutions were debated and you can go onto the MMA website to review actions taken. http://www.mma online.net/News/fullstory.cfm?recNum=3150.

HMS members were elected by the MMA House of Delegates to the following leadership positions: Michael Ainslie, M.D., Treasurer; John Larsen, M.D., Vice Speaker of the House of Delegates; and Ben Whitten, M.D., Alternate Delegate to the AMA House of Delegates.

On September 29, the Hennepin Medical Society Senior Physicians Association held a meeting where the University

of Minnesota Raptor Center provided a program and demonstration of the work of the center.

HMS members and staff mourn the passing of Rick Olson, MMA/MMJSO Network Manager, at the age of 52. Rick kept our systems working and a smile on our faces.

He will be missed. ◆

Sue Schettle and Kathy Messerli, MMA’s Director of Membership Marketing, attended this year’s Medical Student Activity Fair. This is an information session for medical students to find out more about the opportunities to participate in the activities of organized medicine.

The Journal of the Hennepin and Ramsey Medical Societies

November/December 2004

31

Hennepin Medical Society

HMS in Action highlights activities that your leadership and executive office staff have participated in, or responded to, between MetroDoctors issues. We solicit your input on these activities and encourage your calls regarding issues in which you would like our involvement.

HMS ALLIANCE NEWS DIANE GAYES

Making a Difference WorldScopes Give a Simple Stethoscope— Make a World of Difference

(Hennepin Medical Society Alliance (HMSA) & Medical Student Partners (MSP) 2004/2005 Health Promotions Project) The HMS Alliance and MSP Alliance (University of Minnesota Medical School, Minneapolis) will join efforts to collect stethoscopes for WorldScopes. Medical alliances across America are “essential partners and key supporters of WorldScopes. To date, more than 150 stethoscopes and over $10,000 have been donated through the generous efforts of local alliance chapters.

“WorldScopes is a Caring for Humanity project of the American Medical Association (AMA) and the AMA Foundation in cooperation with the AMA Alliance. WorldScopes hopes to collect 100,000 stethoscopes from U.S. physicians and distribute them — with the help of humanitarian organizations — to communities around the world where medical supplies are scarce.

“Through WorldScopes, busy hospitals like Children’s Infectious Disease Hospital in Tashkent, Uzbekistan, have received stethoscopes specially made for use on infants and children to help fight TB and other diseases. In Uganda where only $36 per person is spent annually on health care, a basic medical instrument, like a stethoscope, is a precious commodity.

There are many nations such as Afghanistan,

Kosovo and Iraq lacking basic medical services after years of war and civil strife. WorldScopes donations are helping those on the frontlines who are working to rebuild the shattered health care systems of those countries.”

HMSA and MSP members will be placing posters, collection boxes and contact information at local hospitals and clinics. To donate your stethoscope to the 2004/2005 HMSA and MSP WorldScopes projects, please contact Kathy Dittmer, HMS, (612) 6232885, kdittmer@mnmed.org; Dianne Fenyk (763) 377-9707, diannefenyk@prodigy.net; Peggy Johnson (952) 932-2963, peggy @mn.rr.com; or Diane Gayes (952) 935-2071, ladydi@mn.rr.com.

A donation of $15 (payable to WorldScopes) will buy one new stethoscope. The fair market value of used stethoscopes and the purchase price of new ones are tax deductible as contributions to the American Medical Association Foundation. For more information: www.caring4humanity.org.

Wheels for the World Wheels for the World is a missionary project that collects, restores and delivers wheelchairs to the poorest of the poor around the world.

Don Bania, our partner at Body Works for many years, is the Wheels for the World Minnesota Chair Corps Representative. The World Health Organization estimates that there is a need of over 18 million wheelchairs around the world. As of 2003, Wheels for the World distributed more than 20,000 wheelchairs to 60 countries.

If you would like to donate a wheelchair, please e-mail Don Bania at ru4jc@usfamily.net.

November/December 2004

The HMS Alliance Holiday Brunch & Silent Auction will take place at the charming home of Dr. Ted and Judy Nagel, located near Lake of the Isles. This signature event for HMSA members and friends is a time to gather, celebrate the holiday season and raise funds (approximately $1,800 annually) for HMSA Philanthropic endeavors.

For further information contact Kathy Dittmer, HMS, (612) 623-2885, kdittmer@mnmed.org; Diane Gayes, (952) 935-2071, ladydi@mn.rr.com; or Judy Nagel, (612) 374-5163, janagel3@aol.com.

For the seventh consecutive year, HMS Alliance members aim to raise funds for their philanthropic endeavors by participating in the 2004 Magical Evening of Giving. “The event is

HMSA: “The Alliance is an educational and charitable volunteer organization, working in partnership with others, to promote the health and well-being of its members and the community through education, advocacy and service.”

For membership information please contact HMSA membership treasurer, Terry Dondlinger at tdondlinger@hotmail.com. ◆

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Southdale Center, Sunday November 21

32

HMSA Holiday Brunch & Silent Auction 10:30 a.m. – 1:30 p.m., December 10

Giving the Gift of Mobility

Magical Evening of Giving Diane Gayes, Lisa Staplin, Laura Schippel (and son), Dianne Fenyk and Ariela Freedman (not pictured) discuss developing WorldScopes as a service project.

designed to support non-profit organizations” such as the HMSA. Tickets are available for $5 each and 100 percent of ticket sales by HMSA members will go into the HMSA Philanthropic Fund. Since the first Magical Evening of Giving in 1998, nearly $450,000 has been generated for non-profit organizations in the community.

“Magical Evening ticket holders will be able to receive special offers and discounts from many of Southdale’s 140 retailers, listen to holiday entertainment throughout the Center, and register to win fabulous prizes.”

To purchase tickets, contact Kathy Dittmer, HMS, (612) 623-2885, kdittmer @mnmed.org.

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