2005marapr

March/April 2005

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-ETRO$OCTORS )33. IS PUBLISHED BI MONTHLY BY THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES 'ODWARD 3TREET .% "ROADWAY 0LACE 7EST 3UITE -INNEAPOLIS -.

0ERIODICAL POSTAGE PAID AT -INNEAPOLIS

-INNESOTA 0OSTMASTER 3END ADDRESS CHANGES TO -ETRO$OCTORS (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES 'ODWARD 3TREET .% "ROADWAY 0LACE 7EST 3UITE -INNEAPOLIS -.

4O PROMOTE THEIR OBJECTIVES AND SERVICES THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES PRINT INFORMATION IN -ETRO$OCTORS REGARDING ACTIVITIES AND INTERESTS OF THE SOCIETIES 2ESPONSIBILITY IS NOT ASSUMED FOR OPINIONS EXPRESSED OR IMPLIED IN SIGNED ARTICLES AND BECAUSE OF THE FREEDOM GIVEN TO CONTRIBUTORS OPINIONS MAY NOT NECESSARILY REmECT THE OFlCIAL POSITION OF (-3 OR 2-3 3END LETTERS AND OTHER MATERIALS FOR CONSIDERATION TO -ETRO$OCTORS (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES 'ODWARD 3TREET .% "ROADWAY 0LACE 7EST 3UITE -INNEAPOLIS -. % MAIL BAUERFAMILY EARTHLINK NET &OR ADVERTISING RATES AND SPACE RESERVATIONS

CONTACT "ETSY 0IERRE %ASTWOOD #IRCLE -ONTICELLO -.

PHONE FAX E MAIL BETSY PIERREPRODUCTIONS COM -ETRO$OCTORS RESERVES THE RIGHT TO REJECT ANY ARTICLE OR ADVERTISING COPY NOT IN ACCORDANCE WITH EDITORIAL POLICY .ON MEMBERS MAY SUBSCRIBE TO -ETRO$OCTORS AT A COST OF PER YEAR OR PER ISSUE IF EXTRA COPIES ARE AVAILABLE &OR SUBSCRIPTION INFORMA TION CONTACT $OREEN (INES AT

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!N /VERVIEW AND !NALYSIS OF 'OVERNOR 0AWLENTY S (EALTH #ARE 0ROPOSALS

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-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

)NSIDE 4HIS )SSUE /NLINE !PPOINTMENT 3CHEDULING 0AIN -ANAGEMENT 3AGGING OF -EDICAL 0ROFESSION

/N THE COVER /VERVIEW AND ANALYSIS OF h3MART "UYv ALLIANCE !RTICLE BEGINS ON PAGE

-ARCH !PRIL

2E )NTERVIEW IN THE *ANUARY &EBRUARY

)SSUE OF -ETRO$OCTORS $EAR $R +ATHOL

) WAS DISAPPOINTED TO READ YOUR INTERVIEW REFERENCED ABOVE 9OU DID MAKE SOME EXCEL LENT POINTS AROUND OUTCOMES BUT THE TONE OF YOUR COMMENTS WAS VERY DISPARAGING TOWARD "(0 WHICH YOU INCORRECTLY REFERRED TO AS AN hINDEPENDENTLY MANAGED BEHAVIORAL HEALTH CARVE OUT v 4HIS INCORRECT LABEL DOES NOT REmECT OUR ROLES AND ACTIVITIES IN THE COM MUNITY AND IN THE DEVELOPMENTS WE HAVE INITIATED RELATED TO THE BEHAVIORAL CONTINUUM OF CARE &IRST OF ALL REMEMBER "(0 IS A PARTNER SHIP BETWEEN &AIRVIEW (EALTH 3ERVICES AND "EHAVIORAL -ANAGEMENT 'ROUP &AIRVIEW IS THE LARGEST COMMUNITY PROVIDER OF PSYCHIATRIC INPATIENT SERVICES IN THE STATE AND THROUGH OUR UNIQUE RELATIONSHIP ) AM NOT ONLY PRESIDENT OF "(0 BUT ALSO CLINICAL CO CHIEF

ALONG WITH 3 #HARLES 3CHULZ - $ OF THE PSYCHIATRIC SECTION AT &AIRVIEW 5NIVERSITY -EDICAL #ENTER 4HIS ALLOWS FOR A CLOSE WORK ING RELATIONSHIP BETWEEN THE SERVICE END AND THE PAYMENT END SOMETHING LONG LACKING IN OUR BUSINESS 7HEN WE WENT INTO BUSINESS IN

ONE OF OUR MAIN GOALS WAS TO ENHANCE RELATIONSHIPS BETWEEN BEHAVIORAL PROVID ERS AND PRIMARY CARE PHYSICIANS 7E HAVE HAD A NUMBER OF INITIATIVES OVER THE YEARS TO IMPROVE WHAT HAS BEEN A hBLACK HOLEv AND ALTHOUGH THERE IS OBVIOUSLY STILL ROOM FOR IMPROVEMENT NO ONE IS WORKING HARDER THAN OUR EXCELLENT PARTNERS AND OURSELVES TO ACHIEVE THE GOAL OF BETTER INTEGRATING BEHAV IORAL TREATMENT INTO PRIMARY CARE 4HIS IS IN COOPERATION WITH 5#ARE -.

0REFERRED/NE

&AIRVIEW 0HYSICIAN !SSOCIATES AND &AIRVIEW (EALTH 3ERVICES SHOWING AS WELL THAT SEVERAL HEALTH PLANS SUPPORT THE PROPER INTEGRATION OF BEHAVIORAL SERVICES AND PRIMARY CARE !

BRIEF REVIEW OF OUR INITIATIVES FOLLOWS -ARCH !PRIL

s 2ECALL ALL THE DISCUSSION TWO YEARS AGO ABOUT A 5NIVERSAL 4REATMENT 0LAN FOR BEHAVIORAL PATIENTS 7E WERE THE ONLY ONES WHO SUCCESSFULLY DEMANDED THAT THE DOCUMENT REQUIRE A PATIENT SIGNATURE FOR THE RELEASE OF INFORMATION TO THE PRIMARY CARE PHYSICIAN s /UR CURRENT PRIMARY CARE BEHAVIORAL INITIATIVE IS EXCITING 7E ARE IN THE PLAN NING STAGES OF PILOTING A PROGRAM WHERE TWO TO THREE PRIMARY CARE CLINICS WILL ACTUALLY HAVE OUR ELECTRONIC SCHEDULER IN THEIR OFlCES ALLOWING THEM INSTANTANEOUS ACCESS TO SCHEDULE DIRECTLY INTO MORE THAN PSYCHIATRISTS CHILD AND ADULT

PSYCHOTHERAPISTS AND DAY TREATMENT PROGRAMS THAT ELECTRONICALLY CONNECT TO US -ANY PERHAPS YOURSELF INCLUDED HAVE PUSHED FOR MENTAL HEALTH PROFESSIONALS TO BE PHYSICALLY PRESENT IN THE PRIMARY CARE CLINICS 7E DISAGREE WITH THIS APPROACH 7E BELIEVE THAT IMMEDIATE ELECTRONIC ACCESS NOT ONLY OFFERS MORE CHOICE FOR PATIENTS BUT ALSO MAKES AVAILABLE MORE OPTIONS FOR PATIENTS TO lND PRACTITIONERS WITH SPECIlC EXPERIENCE OR SPECIALIZATION TO ADDRESS THE PATIENT S NEEDS #OUPLED WITH A COMPREHENSIVE RELEASE OF INFORMA TION DONE BY CLINICIANS WHO HAVE A STAKE IN THEIR PATIENT S BEST CLINICAL OUTCOME

THESE SERVICES WILL RESULT IN BETTER OUT COMES FOR THE PATIENTS

s /UR ACCESS TO ALL TYPES OF BEHAVIORAL PRACTITIONERS IS OUTSTANDING BASED LARGELY ON THE ELECTRONIC SCHEDULING CAPABILITIES ALREADY MENTIONED 7E HAVE NEVER FAILED TO MEET .#1! STANDARDS FOR APPOINT MENTS 4HESE STANDARDS ARE DAYS FOR ROUTINE APPOINTMENTS HOURS FOR UR GENT APPOINTMENTS AND IMMEDIATE SAME DAY ACCESS FOR EMERGENT APPOINTMENTS !LONG WITH THE EXCHANGE OF INFORMATION

THIS ACCESS WILL SUBSTANTIALLY LIGHTEN THE BLACK HOLE s "ASED ON YOUR COMMENTS ) THINK QUALITY IS AN IMPORTANT CONCERN TO YOU BUT ) DO NOT THINK YOU ARE AWARE OF OUR INITIATIVES )N "(0 CREATED A QUALITY INDICATOR SYSTEM THAT RATES PROVIDERS ON NINE 1UAL ITY )NDICATORS AND SIX 1UALITY &LAGS AND GIVES PROVIDERS THEIR INDIVIDUAL RESULTS 4HIS HAS PROVEN TO HAVE A POSITIVE EFFECT ON NETWORK QUALITY )N PERCENT OF THE NETWORK PERFORMED BELOW "(0 STANDARDS "Y THE END OF ONLY PERCENT OF THE NETWORK PERFORMED BELOW "(0 STANDARDS 4HE IMPORTANCE OF THIS DATA LIES IN THE FACT THAT IF PSYCHOTHERA PISTS PRESENT GOOD TREATMENT PLANS AND HAVE FOLLOW UP VISITS IN A TIMELY FASHION

CUSTOMER SATISFACTION RISES SIGNIlCANTLY 4HE TABLE BELOW ILLUSTRATES THE IMPROVE MENT WITH RESULTS FROM FOUR 1UALITY )NDICATORS RELATED TO MEMBER SATISFACTION AND TREATMENT PLAN ADEQUACY s 4HE $%# AT &5-# IS A lNAL EXAMPLE OF OUR EFFORTS TO IMPROVE THE MENTAL HEALTH CARE DELIVERY SYSTEM "(0 EMPHASIZES PLACING PATIENTS AT THE LEVEL OF CARE THEIR SYMPTOMS REQUIRE IN A TIMELY FASHION 7E BELIEVE INPATIENT PSYCHIATRIC CARE IS

1UALITY )NDICATOR 3URVEY 1UESTION h7ERE YOU ABLE TO SCHEDULE YOUR lRST FOLLOW UP APPOINTMENT WITHIN DAYS !NSWER VERY DISSATISlED FOR NO AND VERY SATISlED FOR YES v 3URVEY 1UESTION h(OW SATISlED WERE YOU THAT YOUR PRACTITIONER UNDERSTOOD YOUR ISSUES v 3URVEY 1UESTION h(OW SATISlED WERE YOU WITH HOW EFFECTIVE THE THERAPY YOU RECEIVED WAS IN HELPING RESOLVE YOUR ISSUES v !DEQUACY OF TREATMENT PLANS

&AILING

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-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

A NECESSARY AND IMPORTANT LEVEL OF CARE FOR SOME PATIENTS BUT THAT OVER TIME OTHER TREATMENT ALTERNATIVES HAVE NOT BEEN ADEQUATELY DEVELOPED )N PARTICULAR

IMMEDIATE ACCESS TO OTHER LEVELS OF CARE HAS BEEN SCARCE AT BEST )N *ULY WE OPENED THE $IAGNOSTIC %VALUATION #ENTER $%# AT &AIRVIEW 5NIVERSITY -EDICAL #ENTER 4HE $%# IS STAFFED WITH LICENSED INDEPENDENT BEHAVIORAL PRACTITIONERS WHO COMPLETE A COMPREHENSIVE BEHAVIORAL ASSESSMENT 4HE ASSESSMENT IS 7EB BASED AND WITH PROPER RELEASE IS IMMEDIATELY EXCHANGED WITH OTHER INVOLVED PRACTITIO NERS VIA THE 7EB )N ADDITION THE $%# STAFF SCHEDULE FOLLOW UP APPOINTMENTS FOR ALL PATIENTS SEEN IN THE $%# 0ATIENTS WHO ARE BEING REFERRED TO AN OUTPATIENT SERVICE LEAVE THE $%# WITH A NEXT DAY APPOINTMENT !FTER YEARS OF NEGOTIA TION WITH &AIRVIEW WE ARE NOW MOVING OUR $%# OUT OF THE FAST PACED HECTIC %MERGENCY $EPARTMENT AT &5-# AND INTO ITS OWN SPACE WHILE MAINTAINING OUR RELATIONSHIP WITH THE EMERGENCY DEPARTMENT PHYSICIANS AND STAFF 4HE NEW CENTER WILL BE CALLED 4HE "EHAVIORAL !SSESSMENT 3TABILIZATION AND 2EFERRAL #ENTER TO REmECT THE SPECTRUM OF SERVICES PROVIDED 4HIS WILL ALLOW NOT ONLY FOR THE SAME QUALITY COMPREHENSIVE BEHAVIORAL ASSESSMENTS ELECTRONIC SCHEDULING AND THE EXCHANGE OF INFORMATION BUT ALSO A RESTFUL ENVIRONMENT FOR AGITATED PATIENTS TO DE ESCALATE THEIR SYMPTOMS s 7E HAVE SUCCESSFULLY ENTERED INTO AGREE MENTS WITH THE #ARVER 3COTT -ENTAL (EALTH #RISIS 0ROGRAM AND THE -INNE APOLIS 3CHOOL $ISTRICT 4HESE AGREEMENTS ALLOW FOR THE SAME QUALITY OF SERVICE TO BE DELIVERED IN THE RESPECTIVE COUNTIES AND SCHOOL DISTRICT 4HE 7EB BASED AS SESSMENT EXCHANGE OF INFORMATION AND SCHEDULING COMPONENTS THAT ARE USED IN THE $%# ARE NOW BEING USED WITHIN THESE ENTITIES 4HESE EXPANSION EFFORTS ARE AN OBVIOUS AND IMPORTANT DEMONSTRATION OF THE FOCUS WE PUT ON DELIVERING CARE IN THE COMMUNITY AND OUR CONTINUAL EFFORTS TO IMPACT THE CONTINUITY OF CARE FOR THE BENElT OF THE MEMBER

)N THE INTEREST OF TIME ) HAVE NOT COV ERED ALL OF OUR PROJECTS (OWEVER ) WANTED TO GIVE YOU AN UNDERSTANDING OF THE BREADTH OF SERVICES AND INITIATIVES "(0 HAS UNDERTAKEN AND IS ACCOMPLISHING 4HE MENTAL HEALTH SYSTEM SHOULD NOT UNDERTAKE A LARGE OVERHAUL OF HOW IT FUNCTIONS UNTIL IT COMES TO UNDER STAND WHAT IS ALREADY IN PLACE AND TO FURTHER OPTIMIZE AND DEVELOP THESE INITIATIVES 4HE COMMUNITY SHOULD APPLAUD SUCH EFFORTS AS THE $%# AND SUPPORT ITS MISSION (OPE FULLY THIS LETTER WILL SERVE AS A START FOR YOU TO UNDERSTAND AND APPRECIATE THE EXCELLENT EFFORTS WE HAVE UNDERWAY ) SUGGEST WE MEET AS SOON AS POSSIBLE IN ORDER TO FURTHER SHARE OUR ACTIVITIES AND GOALS 4HANK YOU FOR YOUR CONSIDERATION

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-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

-ARCH !PRIL

5PDATE ON THE --! 4ASK &ORCE ON 'OVERNANCE

0

0URPOSE #HARGE 4HE --! (OUSE OF $ELEGATES AUTHORIZED THE CONVENING OF A 'OVERNANCE 4ASK &ORCE CONSISTENT WITH THE FOLLOWING RESOLVE 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION --! "OARD OF 4RUSTEES CREATE A GOVERNANCE TASK FORCE TO PROVIDE RECOMMENDATIONS REGARDING CHANGES IN BYLAWS GOV ERNANCE AND STANDING COMMITTEE APPOINTMENT PROCESS FOR THE --!

AND REPORT RECOMMENDATIONS TO THE (OUSE OF $ELEGATES 4HE CHARGE OF THE 'OVERNANCE 4ASK &ORCE IS TO ASSESS AND RECOMMEND CHANGES IN --! S CURRENT GOVERNANCE STRUCTURE AND PROCESSES TO ASSURE THAT IT IS REmECTIVE OF THE --! S DIVERSE MEMBERSHIP AND RESPONSIVE TO THE MISSION OF THE --! SO THAT ISSUES THAT AFFECT --! S MEMBERSHIP AND THE CITIZENS OF -INNESOTA ARE ADDRESSED IN A TIMELY AND EFFECTIVE MANNER 4HIS CHARGE INCLUDES A COMPREHENSIVE REVIEW OF THE --! "YLAWS -EMBERSHIP "LANTON "ESSINGER - $ CHAIRPERSON

2OSEVILLE *AMES $EHEN - $ "RAINERD ' 2ICHARD 'EIER - $ 2OCHESTER -ICHAEL 'ONZALEZ #AMPOY - $ 0H $

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-ARCH !PRIL

7ORKPLAN 4HE 4ASK &ORCE PLANS TO MEET THREE OR FOUR TIMES PRIOR TO EARLY *UNE 4HE --! %X ECUTIVE #OMMITTEE AND THE --! "OARD OF 4RUSTEES WILL BE REVIEWING THE 4ASK &ORCE RECOMMENDATIONS IN *UNE AND *ULY "ETWEEN *UNE AND !UGUST THE --! WILL CONDUCT OPEN MEMBERSHIP MEETINGS TO REVIEW THE 4ASK &ORCE RECOMMENDATIONS 4HE RECOMMENDATIONS WILL BE CONSIDERED BY THE --! (OUSE OF $ELEGATES IN 3EPTEMBER 3OME OF THE ISSUES THAT THE 4ASK &ORCE WILL ADDRESS INCLUDE THE FOLLOWING s $OES THE --! (OUSE OF $ELEGATES REPRE SENT THE ENTIRE DIVERSITY OF --! MEMBER SHIP s $OES THE --! "OARD OF 4RUSTEES REPRE SENT THE ENTIRE DIVERSITY OF --! MEMBER SHIP s (OW SHOULD THE --! OFFICERS BE SE LECTED s (OW SHOULD --! MEMBERS BE NOMINATED TO SERVE ON --! COMMITTEES s (OW CAN THE (OUSE OF $ELEGATES THE "OARD OF 4RUSTEES AND THE --! #OM MITTEES BE NIMBLE AND QUICK BUT REMAIN DELIBERATIVE s !RE THERE WAYS TO INCREASE DIRECT INVOLVE MENT OF --! MEMBERS %XAMPLES INCLUDE USING THE --! 7EB SITE ELECTRONIC INTERNET BASED MEMBER SURVEYS OR DIRECT ELECTIONS s (OW SHOULD THE !-! DELEGATION BE ELECTED 4HE 4ASK &ORCE PLANS TO SURVEY OTHER STATE MEDICAL ASSOCIATIONS TO LEARN HOW THEY ARE RESPONDING TO THESE ISSUES

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

-INNESOTA 0ROVIDER #OALITION )NTRODUCES "LINKING 4AX 0ROVISION FOR 0ROVIDER 4AX

4

4(% -)..%3/4! 02/6)$%2 #OALITION

SUPPORTED BY THE (ENNEPIN AND 2AMSEY -EDI CAL 3OCIETIES ANNOUNCED THAT THE CHIEF AUTHORS IN THE -INNESOTA ,EGISLATURE HAVE SIGNED ON TO INTRODUCE A BILL THAT WILL CREATE A hBLINKING TAXv PROVISION IN STATUTE THAT WILL REGULATE THE LEVELS OF REVENUE FROM THE PROVIDER TAX INTO THE (EALTH !CCESS &UND 2EPRESENTATIVE 2ON !BRAMS OF -INNETONKA FORMER CHAIR OF THE (OUSE 4AX #OMMITTEE WILL BE THE CHIEF AUTHOR IN THE -INNESOTA (OUSE OF 2EPRESENTATIVES AND 3ENATOR $ALLAS 3AMS OF 3TAPLES CHAIR OF THE %NVIRONMENT !GRICULTURE AND #OMMUNITY $EVELOPMENT #OMMITTEE WILL BE THE CHIEF AUTHOR IN THE -INNESOTA 3ENATE 4HE BILL PROVIDES THAT THE COMMISSIONER OF lNANCE ON 3EPTEMBER OF EACH YEAR ESTIMATES THE BALANCE OF THE HEALTH ACCESS FUND IN TERMS OF TOTAL EXPENDITURES AND THE TOTAL RESOURCES AVAILABLE FOR THE lSCAL YEAR THAT BEGINS THE FOL LOWING *ULY )F THE COMMISSIONER OF lNANCE DETERMINES ON 3EPTEMBER THAT THE ESTIMATED TOTAL REVENUE AVAILABLE MEETS THE ESTIMATED TOTAL EXPENDITURES PLUS AN ADDITIONAL

THE PROVIDER TAX SHALL BE SET BY THE COMMISSIONER OF REVENUE AT PERCENT OF GROSS REVENUES RE CEIVED ON OR AFTER *ANUARY FOR THE CALENDAR YEAR IMMEDIATELY FOLLOWING THAT 3EPTEMBER )F PROJECTED REVENUES ARE ESTIMATED TO FALL SHORT OF ESTIMATED EXPENDITURES THE COMMISSIONER OF REVENUE SHALL DETERMINE THE AMOUNT NEEDED TO ELIMINATE THE DElCIT AND SHALL IMPOSE AN INCREASE FOR THE CALENDAR YEAR IMMEDIATELY FOL LOWING THAT 3EPTEMBER 4HE COMMISSIONER OF REVENUE SHALL DETERMINE THE TAX TO THE NEAR EST ONE QUARTER OF PERCENT BEGINNING AT PERCENT AND INCREASING UP TO PERCENT USING THE LOWEST RATE THAT WILL PRODUCE SUFlCIENT REVENUE TO MEET THE ESTIMATED EXPENDITURES PLUS

4HE RESULT OF THIS LEGISLATION WOULD BE THE

ELIMINATION OVER TIME OF THE LARGE SURPLUSES IN THE (EALTH #ARE !CCESS &UND WHICH BE COME hLOW HANGING FRUITv FOR GOVERNORS AND LEGISLATORS TO USE TO BALANCE THE STATE BUDGET 4HE hBLINKING TAXv APPROACH WAS SUCCESSFULLY IMPLEMENTED MANY YEARS AGO TO ELIMINATE THE SURPLUSES AND DElCITS IN THE UNEMPLOYMENT TAX PAID BY EMPLOYERS 4HE IMPLEMENTATION DATE FOR THE BILL MAY HAVE TO BE EXTENDED OUT TO OR AS THE (EALTH #ARE !CCESS &UND HAS BEEN ALLOCATED THROUGH BY THE GOVERNOR AND THE LEGISLATURE 4HE TEXT OF THE BILL IS AS FOLLOWS ! BILL FOR AN ACT RELATING TO TAXATION PROVID ING FOR CONTINGENT ADJUSTMENT OF CERTAIN -INNESOTA#ARE TAXES AMENDING -INNESOTA 3TATUTES SECTION

BY ADDING A SUBDIVISION "% )4 %.!#4%$ "9 4(% ,%')3,!452% /& 4(% 34!4% /& -)..%3/4!

3ECTION -INNESOTA 3TATUTES SEC TION IS AMENDED BY ADDING A SUBDIVI SION TO READ 3UBD ;#/.4).'%.4 %,)-).!

4)/. /& 4!8 = 4HE COMMISSIONER SHALL ESTABLISH TAX RATES FOR CALENDAR YEARS BEGIN NING ON OR AFTER *ANUARY

BASED UPON DETERMINATIONS MADE BY THE COMMISSIONER OF lNANCE REGARDING THE ESTIMATED BALANCE OF THE HEALTH CARE ACCESS FUND 4HE COMMISSIONER OF lNANCE SHALL ON 3EPTEMBER OF EACH YEAR

BEGINNING 3EPTEMBER

DETERMINE THE ESTIMATED BALANCE OF THE HEALTH CARE ACCESS FUND IN TERMS OF THE TOTAL EXPENDITURES AND THE TOTAL RESOURCES AVAILABLE FOR THE lSCAL YEAR THAT BEGINS THE FOLLOWING *ULY )F THE COMMISSIONER OF lNANCE DETERMINES ON 3EPTEMBER THAT FOR THE FOLLOWING lSCAL YEAR THE ESTIMATED TOTAL REVENUE AVAILABLE MEETS THE ESTIMATED TOTAL EXPENDITURES PLUS AN ADDITIONAL

THE

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

TAXES IMPOSED UNDER SUBDIVISIONS A

AND SHALL BE SET AT PERCENT OF THE GROSS REVENUES RECEIVED ON OR AFTER *ANUARY FOR THE CALENDAR YEAR THAT BEGINS IMMEDIATELY FOLLOW ING THAT 3EPTEMBER )F THE COMMISSIONER OF lNANCE DETERMINES ON 3EPTEMBER THAT THE TOTAL REVENUE AVAILABLE IN THE FUND WILL BE LESS THAN THE ESTIMATED EXPENDITURES FOR THE FOL LOWING lSCAL YEAR THEN THE COMMISSIONER IN CONSULTATION WITH THE COMMISSIONER OF lNANCE

SHALL DETERMINE THE AMOUNT NEEDED TO ELIMI NATE THE DElCIT AND SHALL IMPOSE AN INCREASE IN THE TAXES UNDER SUBDIVISIONS A

AND FOR THE CALENDAR YEAR THAT BEGINS IMMEDIATELY FOLLOWING THAT 3EPTEMBER 4HE COMMISSIONER SHALL DETERMINE THE RATE OF THE TAX TO THE NEAREST ONE QUARTER OF PERCENT BEGINNING AT PERCENT AND INCREASING THE RATE UP TO PERCENT USING THE LOWEST OF THE RATES THAT THE COMMISSIONER DETERMINES WILL PRODUCE SUFlCIENT REVENUE TO MEET THE ESTIMATED EXPENDITURES PLUS AN AD DITIONAL 4HE COMMISSIONER SHALL PUB LISH IN THE 3TATE 2EGISTER BY /CTOBER OF EACH YEAR BEGINNING /CTOBER

THE AMOUNT OF THE TAX TO BE IMPOSED FOR THE FOLLOWING CALENDAR YEAR )N DETERMINING THE ESTIMATED EXPENDITURES OF THE (EALTH #ARE !CCESS &UND UNDER THIS SUBDIVISION THE COMMISSIONER OF lNANCE SHALL INCLUDE ESTIMATED EXPENDITURES FOR PROVIDING COVERED SERVICES INCLUDING THE ADMINISTRATION OF THE PROGRAM AND THE COL LECTION OF THE REVENUE 4HE COMMISSIONER OF lNANCE SHALL ALSO ASSUME AN ADJUSTMENT TO THE AGGREGATE CAP FOR THE LIMITED BENElTS COVERAGE AS DESCRIBED IN SECTION , PARAGRAPH B WHEN DETERMINING THE BALANCE OF THE FUND BEGINNING ON 3EPTEMBER

FOR THE lSCAL YEAR BEGINNING *ULY

-ARCH !PRIL

&%!452% 34/29

!N /VERVIEW AND !NALYSIS OF

(EALTH #ARE 0ROPOSALS 'OVERNOR 0AWLENTY S (EALTH #ARE 0ROPOSALS

4HE BOLDEST COMPONENT OF THE GOVERNOR S INITIATIVES IS THE FORMATION OF THE h3MART "UYv PURCHASING ALLIANCE

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'/6%2./2 0!7,%.49 5.6%),%$ AMBITIOUS PLANS TO hSLOW HEALTH CARE COSTS AND IMPROVE QUALITY v )T HAS BEEN MANY YEARS SINCE ANY -INNESOTA POLITICAL LEADER HAS UNDERTAKEN SUCH A CONCERTED EFFORT TO CHANGE HOW HEALTH CARE IS DELIVERED IN -IN NESOTA 0AWLENTY S PLANS INCLUDE FORMATION OF A h3MART "UYv PURCHASING ALLIANCE PROMOTION OF (EALTH 3AVINGS !CCOUNTS (3!S AND REGULATORY REFORM 4HESE INITIATIVES WILL CERTAINLY HAVE AN EFFECT ON HOW PHYSICIANS PRACTICE IN -INNESOTA IT IS THE PURPOSE OF THIS ARTICLE TO REVIEW THESE INITIATIVES PROJECT THEIR LIKELY IMPACT AND lNALLY ASSESS WHAT S LEFT TO BE DONE IN REGARD TO ADDRESSING THE ONGOING HEALTH CARE COST CRISIS /VERVIEW OF THE 'OVERNOR S 0ROPOSALS 4HE BOLDEST COMPONENT OF THE GOVERNOR S INITIATIVES IS THE FORMATION OF THE h3MART "UYv PURCHASING ALLIANCE 4HIS IS AN ALLIANCE OF ORGANIZATIONS COLLECTIVELY REPRESENTING MORE THAN THREE lFTHS OF ALL -INNESOTANS WHICH HAVE AGREED TO COLLABORATE ON THE PURCHASING OF HEALTH CARE 4HESE ORGANIZATIONS INCLUDE THE STATE ITSELF FOUR STATEWIDE EMPLOYER GROUPS INCLUDING THE -INNESOTA #HAMBER OF #OMMERCE AND THE "UYERS (EALTH #ARE !CTION 'ROUP AND TWO LARGE UNION ORGANIZATIONS 4HE h3MART "UYv ALLIANCE IS COLLABORATING IN FOUR AREAS 4HE lRST OF THESE AREAS IS TO IDENTIFY AND REWARD hBEST IN CLASSv PROVIDERS 4HIS hBEST IN CLASSv INITIATIVE WILL MOST LIKELY FOCUS lRST ON OPEN HEART SURGERY CENTERS #ARDIAC SURGERY CENTERS HAVE BEEN THE lRST TARGET IN OTHER PARTS OF THE COUNTRY SUCH AS THE h(EART6ALUE 0ARTNERSHIPv IN )OWA AND MANY ASSERT THAT -INNESOTA S SIZE AND GEOGRAPHY DOES NOT JUSTIFY THE OPEN HEART SURGERY CENTERS WE CURRENTLY HAVE 4HE h3MART "UYv ALLIANCE WILL PROBABLY UNDERTAKE A CERTIlCATION PROCESS THAT RESULTS IN THREE TO lVE OF -INNESOTA S OPEN HEART SURGERY CENTERS BEING LABELED AS hBEST IN CLASS v 4HE ALLIANCE WILL THEN ATTEMPT TO STEER PATIENTS TO THESE CENTERS /THER SPECIALIZED PROGRAMS LIKELY TO BE TARGETED BY A SIMILAR hBEST IN CLASSv PROCESS INCLUDE ORGAN TRANSPLANT PROGRAMS AND CANCER TREATMENT )F THESE INITIATIVES ACHIEVE THE DESIRED RESULTS

IN FUTURE YEARS OTHER SURGICAL AREAS ESPECIALLY ORTHOPEDICS BARIATRIC SURGERY GASTROENTEROL OGY UROLOGY OTOLARYNGOLOGY AND OPHTHALMOLOGY MAY BE ADDRESSED AND POSSIBLY MEDICAL SPECIALTIES SUCH AS CARDIOLOGY PULMONOLOGY NEUROLOGY AND PSYCHIATRY 4HE SECOND COLLABORATIVE INITIATIVE OF THE h3MART "UYv ALLIANCE IS TO DElNE UNIFORM MEA SURES OF HEALTH CARE PROVIDER AND HEALTH PLAN PERFORMANCE AND THEN PURCHASE SERVICES BASED ON THESE MEASURES 4HE PROVIDER PORTION OF THIS INITIATIVE WILL BE RECOGNIZED BY PHYSICIANS WHO ARE FAMILIAR WITH CONCEPTS SUCH AS hPAY FOR PERFORMANCE v hBEST PRACTICES v AND ADHERENCE TO CLINICAL GUIDELINES 4HE IDEA IS THAT THE h3MART "UYv ALLIANCE WILL REQUIRE PHYSICIANS TO COLLECT AND SHARE CLINICAL STATISTICS WHICH PURPORTEDLY MEASURE COMPLIANCE WITH CLINICAL GUIDELINES AND hBEST PRACTICES v AND THEN THE ALLIANCE WILL lNANCIALLY REWARD THOSE PHYSICIANS AND PROVIDERS

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-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

WHO HAVE hGOODv STATISTICS )N A PARALLEL PROCESS THE ALLIANCE WILL BE REQUIRING PERFORMANCE DATA FROM HEALTH PLANS AND STEERING BUSINESS TO HEALTH PLANS THAT SHOW GOOD STATISTICS $IABETES CARE WILL LIKELY BE AN INITIAL FOCUS OF PROVIDER PERFORMANCE LARGELY BECAUSE ABOUT OF -INNESOTA S LARGEST CLINICS HAVE BEEN PARTICIPATING FOR MORE THAN THREE YEARS IN A DIABETES hBEST PRACTICESv INITIATIVE ORGANIZED BY THE -INNESOTA #OMMUNITY -EASUREMENT 0ROJECT !STHMA DEPRESSION PEDIATRIC CARE AND HYPERTENSION ARE LIKELY TO BE QUICKLY ADDED TO THIS hBEST PRACTICESv ENFORCEMENT EFFORT 4HE THIRD AREA OF h3MART "UYv ALLIANCE COLLABORATION WILL BE TO SHARE INFORMATION WITH THE PUBLIC ABOUT hBEST IN CLASSv PROGRAMS ADHERENCE TO hBEST PRACTICESv AND COSTS 4HIS EF FORT IS ALREADY UNDERWAY WITH THE RECENT LAUNCHING OF THE h-INNESOTA (EALTH )NFORMATIONv 7EB SITE HTTP WWW MINNESOTAHEALTHINFO ORG ! QUICK VISIT TO THIS 7EB SITE WILL REVEAL

HOWEVER THAT THERE IS MUCH WORK TO BE DONE BEFORE THIS IS A USEFUL SITE FOR CONSUMERS TO USE FOR COMPARATIVE SHOPPING &OR EXAMPLE THE INFORMATION IS OFTEN THROUGH LINKS TO OTHER 7EB SITES IS MOSTLY ABOUT THE LARGEST MEDICAL GROUPS IS VIRTUALLY NON EXISTENT IN THE AREA OF COSTS

AND IS FREQUENTLY PROPRIETARY TO THE OLIGOPOLY HEALTH PLANS 4HE FOURTH AND LAST h3MART "UYv INITIATIVE IS TO REQUIRE hTHE USE OF MODERN TECHNOLOGY IN HEALTH CARE ADMINISTRATION v 4HE ALLIANCE WANTS TO REQUIRE PROVIDERS TO INVEST IN TECHNOLOGIES SO THAT THE FOLLOWING THREE AREAS ARE FULLY AUTOMATED PRESCRIPTIONS HEALTH PLAN BENElT ELIGIBILITY VERIlCATION AND HEALTH PLAN CLAIMS SUBMISSION AND ADJUDICATION )N ADDITION TO THE h3MART "UYv ALLIANCE 'OVERNOR 0AWLENTY HAS MADE TWO OTHER PROPOSALS TO ADDRESS HEALTH CARE COSTS AND QUALITY &IRST HE HAS ASKED THE STATE LEGISLATURE TO ENACT STATE TAX INCENTIVES TO MAKE (EALTH 3AVINGS !CCOUNTS ATTRACTIVE TO CONSUMERS 3ECOND HE WANTS TO REDUCE THE BUREAUCRATIC BURDENS ON THE HEALTH CARE SYSTEM THROUGH SUCH STEPS AS STREAMLINING THE STATE S REPORTING REQUIREMENTS CENTRALIZING PROVIDER CREDENTIALING REPLACING -INNESOTA S UNIQUE ACCREDITATION REQUIREMENTS WITH NATIONAL STANDARDS SIMPLIFYING CLAIMS PROCESSING REGULATIONS AND ENHANCING ANTI FRAUD AND ANTI KICKBACK ENFORCEMENT

&IRST HE HAS ASKED THE STATE LEGISLATURE TO ENACT STATE TAX INCENTIVES TO MAKE (EALTH 3AVINGS !CCOUNTS ATTRACTIVE TO CONSUMERS

0ROSPECTS FOR 3UCCESS !SSESSING THE PROSPECTS FOR IMPLEMENTATION OF THE GOVERNOR S PLAN BEGINS WITH SEPARATING THE h3MART "UYv ALLIANCE INITIATIVES FROM THE LEGISLATIVE AND REGULATORY INITIATIVES 4HE h3MART "UYv ALLIANCE IS PRIMARILY A PRIVATE UNDERTAKING INITIATED BY THE GOVERNOR S EXECUTIVE PREROGA TIVE ITS FULL IMPLEMENTATION DEPENDS ON THE COLLECTIVE WILL AND DETERMINATION OF THE ALLIANCE ORGANIZATIONS )N CONTRAST THE LEGISLATIVE INITIATIVE TO CREATE STATE TAX INCENTIVES FOR (3!S AND THE REGULATORY INITIATIVES TO STREAMLINE BUREAUCRACY ARE PURELY POLITICAL THEY SEEM LIKELY TO BE APPROVED WITHOUT MUCH CONTROVERSY ALTHOUGH SUCH A PREDICTION MUST INCLUDE A CAVEAT THAT ALL THINGS POLITICAL ARE SUBJECT TO CHANGE

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3O HOW STRONG IS THE COLLECTIVE WILL AND DETERMINATION OF THE h3MART "UYv AL LIANCE 4HE ALLIANCE IS NOT A HOMOGENEOUS GROUP Â&#x2C6; IT INCLUDES SOME STRANGE BEDFEL LOWS MOST NOTABLY THE 3TATE AND THE 3TATE S LARGEST COLLECTIVE BARGAINING UNIT -!0% )N ADDITION THE EMPLOYER ORGANIZATIONS HAVE A MIXED HISTORY OF BEING ABLE TO CONVINCE THEIR CONSTITUENTS TO FOLLOW THEIR LEADERSHIP )N ORDER FOR THE ALLIANCE TO WORK IT MUST HAVE A COMPELLING MOTIVATION 4HE DESIRE TO SLOW THE RISE OF HEALTH CARE COSTS IS UNDOUBTEDLY A STRONG MOTIVA TOR (OWEVER IT IS LIKELY THAT UNFORESEEN DE VELOPMENTS AND UNPREDICTED OUTCOMES MAY UNDERMINE THIS MOTIVATION &OR EXAMPLE THE hBEST IN CLASSv INITIATIVE IS LIKELY TO GENERATE RESISTANCE FROM GEOGRAPHIC AREAS THAT MAY lND THEMSELVES WITHOUT A CONVENIENT hBEST IN CLASSv PROGRAM 4HE UNIONS MIGHT DRAG THEIR FEET OR INDIVIDUAL EMPLOYERS DECLINE TO PARTICIPATE IF IT S DETERMINED THAT THERE ISN T A hBEST IN CLASSv FOR A GIVEN SPECIALTY IN 3T #LOUD OR $ULUTH AND THAT CONSUMERS FROM THOSE AREAS SHOULD TRAVEL TO THE 4WIN #ITIES OR 2OCHESTER &URTHERMORE THE OTHER h3MART "UYv INITIATIVES ARE UNPROVEN AND LIKELY TO HAVE NEGATIVE CONSEQUENCES REVEALED AS THEY ARE FURTHER DEVELOPED )T DOESN T SEEM TOO FARFETCHED TO SUGGEST THAT THE h3MART "UYv ALLIANCE HAS SOME REAL CHALLENGES TO OVERCOME BEFORE THEY WILL REALIZE THEIR AGENDA 2AMIlCATIONS FOR 0HYSICIANS .EVERTHELESS THE GOVERNOR S INITIATIVE WILL ALMOST CERTAINLY CHANGE HEALTH CARE IN -IN NESOTA AS WE KNOW IT (ERE ARE A FEW OF THE MOST PROFOUND ISSUES -INNESOTA HEALTH CARE IS LIKELY TO BE CONFRONTING IN THE COM ING YEARS s -ORE hCONSUMER DRIVEN v 4HE MO MENTUM TOWARD HIGH DEDUCTIBLE INSUR ANCE WITH (EALTH 3AVINGS !CCOUNTS WAS ALREADY CONSIDERABLE AND THE GOVERNOR S INITIATIVES HAVE ONLY ADDED TO THE TREND IN THIS DIRECTION !S PATIENTS INCREAS INGLY PAY OUT OF POCKET FOR HEALTH CARE

THEIR EXPECTATIONS FROM PHYSICIANS AND HOSPITALS AS WELL AS THEIR BEHAVIOR WILL SIGNIlCANTLY CHANGE

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

s ! QUALITY QUANDARY 4HE MANAGED CARE BELIEVERS ARE PUSHING HARD TO CONVINCE PEOPLE THAT QUALITY CAN BE MEASURED THROUGH STATISTICS 4HE PROBLEM IS THAT MOST STATISTICS ABOUT PEOPLE S HEALTH TELL MORE ABOUT THE PEOPLE THAN ABOUT THE DOCTORS WHO CARE FOR THEM !ND POLICY MAKERS SEEM HEEDLESS OF WHAT SOCIAL SCIENTISTS CALL h#AMBELL S ,AWv TO WIT 4HE MORE ANY QUANTITATIVE INDICATOR IS USED FOR SOCIAL DECISION MAKING THE MORE SUBJECT IT WILL BE TO CORRUPTION PRESSURES AND THE MORE APT IT WILL BE TO DISTORT AND CORRUPT THE SOCIAL PROCESSES IT IS INTENDED TO MONITOR &OR EXAMPLE IF PHYSICIAN REIMBURSEMENT IS CLOSELY TIED TO PATIENT OBESITY THEN LOOK FOR NON COMPLIANT FAT PEOPLE lNDING IT HARD TO lND A DOCTOR WILLING TO TREAT THEM s 4ECHNOLOGY TROUBLES )N ORDER TO COL LECT THE QUALITY INFORMATION IT WANTS THE h3MART "UYv ALLIANCE NEEDS ALL PHYSICIANS AND HOSPITALS TO USE ELECTRONIC MEDICAL RECORDS 4HIS ISN T A PROBLEM FOR THE BIG GEST MEDICAL GROUPS AND HOSPITALS MOST OF WHICH HAVE ALREADY MADE THE HUGE INVESTMENTS THIS REQUIRES BUT IT WILL BE A CHALLENGE FOR MANY SMALL CLINICS AND COMMUNITY HOSPITALS WHERE TIGHT BUD GETS DON T ALLOW FOR BIG INVESTMENTS WITH QUESTIONABLE RETURNS s (EALTH 0LAN (3!S VS 0URE (3!S /NE OF THE BIG HEALTH CARE COST PROBLEMS PER HAPS THE BIGGEST IS THE ADMINISTRATIVE OVERHEAD IMPOSED BY OUR THIRD PARTY REIMBURSEMENT SYSTEM 3OME ESTIMATES ARE THAT A THIRD OR MORE OF ALL HEALTH CARE EXPENDITURES ARE CONSUMED BY THE INFRA STRUCTURE NECESSARY TO VERIFY INSURANCE ELIGIBILITY STRUCTURE PRICES SUBMIT CLAIMS

OBTAIN TREATMENT AUTHORIZATION ET CETERA -INNESOTA S HEALTH PLANS HAVE ROLLED OUT (3! PRODUCTS WHICH DO NOT ALLEVIATE THIS ADMINISTRATIVE COST PROBLEM PROVIDERS ARE STILL REQUIRED TO SUBMIT CLAIMS FOL LOW RIGID AND COMPLEX PRICING SCHEMES

AND OBTAIN AUTHORIZATIONS EVEN WHEN PAYMENT IS TO BE FROM THE PATIENT S (3!

ACCOUNT 9ET PURE (3!S WHERE INDIVIDU ALS OR PLAN SPONSORS MANAGE THEIR OWN (3! ACCOUNTS AND SEPARATELY PURCHASE

A HIGH DEDUCTIBLE HEALTH INSURANCE PLAN

FACE AN UPHILL BATTLE IN -INNESOTA BECAUSE OF THE PROVIDER DISCOUNTS THAT THE HEALTH PLANS OFFER WITH THEIR (3!S /VER THE LONG TERM PURE (3!S HAVE THE POTENTIAL TO OFFER MUCH GREATER POTENTIAL SAVINGS THAN HEALTH PLAN (3!S BECAUSE PROVIDER ADMINISTRATIVE COSTS WILL BE MUCH LOWER WHEN PEOPLE CAN PAY DIRECTLY AT THE TIME OF SERVICE WITH NO CLAIMS ELIGIBILITY VERIlCATIONS AUTHORIZATIONS OR CODING AUDITS ! KEY TREND TO WATCH IS WHETHER PURE (3!S MANAGE TO ESTABLISH A FOOT HOLD IN -INNESOTA s $OCTOR $ROP /UTS &ACED WITH HUGE TECHNOLOGY INVESTMENTS QUESTIONABLE hQUALITYv INITIATIVES AND POTENTIALLY A GROWING NUMBER OF PATIENTS WITH PURE (3!S LOOKING FOR AFFORDABLE CARE MANY PHYSICIANS AND POSSIBLY EVEN HOSPITALS MAY DECIDE TO STOP ACCEPTING HEALTH INSURANCE !CROSS THE COUNTRY A SMALL BUT GROWING NUMBER OF PHYSICIANS HAVE FOUND THAT THEY CAN DRAMATICALLY LOWER THEIR ADMINISTRATIVE COSTS AND THE PRICES THEY CHARGE TO PATIENTS AND STILL MAINTAIN THEIR INCOMES IN THIS WAY )T IS QUITE POS SIBLE THAT THE EFFORTS OF THE h3MART "UYv ALLIANCE AND THE HEALTH PLANS TO MAKE HEALTH CARE hBIGv WILL INSTEAD CAUSE A COUNTER REVOLUTION BACK TO hSMALL v 7HAT S -ISSING 4HE GOVERNOR S INITIATIVE IS AN AMBITIOUS ATTEMPT TO TACKLE THE EXCEEDINGLY COMPLEX AND DIFlCULT PROBLEM OF HEALTH CARE AFFORD ABILITY 9ET FOR ALL ITS MERITS AND FAULTS IT FAILS TO ADDRESS THREE CRUCIAL COMPONENTS OF THE PROBLEM )T DOES NOTHING TO HELP THE GROWING NUMBER OF -INNESOTANS WITHOUT HEALTH CARE COVERAGE )T DOES NOT ADDRESS THE PROBLEM OF PHARMACEUTICAL COSTS FOR EXAMPLE IT MISSES THE OPPORTUNITY FOR THE h3MART "UYv ALLIANCE TO SHARE WITH THE PUBLIC INFORMATION ABOUT THE RELATIVE EFlCACY AND COST OF DIFFERENT DRUGS &INALLY IT DOES NOT AD DRESS THE CRISIS FACING STATE SPONSORED HEALTH CARE FOR THE POOR DISABLED AND ELDERLY THE STATE S COFFERS ARE STRESSED COST SHIFTING FROM INADEQUATE STATE REIMBURSEMENT IS A HUGE PROBLEM FOR THE PRIVATELY INSURED AND THE

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

NUMBER OF -INNESOTANS COVERED IS LIKELY TO DROP EVEN WHILE THE NUMBERS NEEDING COVERAGE INCREASE 7E LIVE IN INTERESTING TIMES -INNE SOTA HEALTH CARE PROVIDERS ARE GOING TO BE CHALLENGED BY THE CHANGES DESCRIBED IN THIS ARTICLE 4HE RESULT OF THESE CHANGES MAY TURN OUT TO BE BENElCIAL TO -INNESOTANS BUT IT IS UNLIKELY THAT WE RE NEAR TO lNALLY ADDRESSING THE PROBLEMS WITH OUR HEALTH CARE SYSTEM $AVID !LLEN IS A "LOOMINGTON BASED HEALTH CARE MANAGEMENT CONSULTANT AND PRESIDENT ELECT OF THE -INNESOTA 0HYSICIAN 0ATIENT !LLIANCE (E CAN BE REACHED AT OR BY E MAIL THROUGH DWALLEN MN RR COM

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5.#/-0%.3!4%$ #!2% 5# IS THE VALUE OF HEALTH CARE SERVICES THAT ARE PROVIDED BUT NOT PAID FOR EITHER BECAUSE THEY WERE PROVIDED FOR FREE CHARITY CARE OR BECAUSE A PROVIDER WAS UNABLE TO COLLECT EXPECTED PAYMENT BAD DEBT !LTHOUGH A SUBSTANTIAL FRACTION OF THE CARE PROVIDED TO PEOPLE WHO LACK HEALTH INSUR ANCE IS UNCOMPENSATED NEARLY ONE THIRD PERCENT OF THE 5# IN A GIVEN YEAR IS PROVIDED TO PEOPLE WHO DO HAVE HEALTH INSURANCE 5# IS AN ISSUE OF CONCERN TO HEALTH POLICY MAKERS BECAUSE FUNDS TO COVER THE COST OF 5# MUST BE COLLECTED FROM OTHER SOURCES 7HILE MANY DIF FERENT ENTITIES IN THE HEALTH CARE SYSTEM PROVIDE 5# IN HOSPITAL CARE ACCOUNTED FOR OVER PERCENT OF THE 5# PROVIDED IN THE NATION 4HIS ISSUE BRIEF EXAMINES RECENT TRENDS IN 5# PROVIDED BY -INNESOTA HOSPITALS )N 5# IN -INNESOTA HOSPITALS WAS MILLION SEE &IGURE !S SHOWN IN &IGURE 5# WAS RELATIVELY CONSTANT IN THE EARLY AND MID S HAD STRONG GROWTH FROM TO 5# INCREASED BY PERCENT WHILE TOTAL PATIENT REVENUE INCREASED BY ONLY PERCENT AND WAS LEVEL AGAIN IN AND /VERALL 5# INCREASED BY PERCENT FROM TO WITH AN AVERAGE AN NUAL GROWTH RATE OF PERCENT !LTHOUGH OVER MUCH OF THE S 5# TRENDS WERE SIMILAR FOR URBAN AND RURAL HOSPITALS RURAL HOSPITALS SHOWED MORE VOLATILITY IN ANNUAL 5# GROWTH "ECAUSE PERCENT OF 5# EXPENSES ARE FROM URBAN HOSPITALS THE STATEWIDE TREND IS DRIVEN LARGELY BY URBAN HOSPITALS SEE &IGURE !NOTHER PERSPECTIVE ON UNCOMPENSATED CARE IS PROVIDED BY LOOKING AT IT AS A PERCENT OF TOTAL OPERATING EXPENSES SEE &IGURE &ROM TO 5# AS A PERCENT OF TOTAL OPERATING EXPENSES FELL FROM PERCENT TO

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&IGURE 5NCOMPENSATED #ARE AS A 0ERCENT OF /PERATING %XPENSES BY (OSPITAL 3IZE

5NDER "EDS TO "EDS TO "EDS /VER "EDS 4OTAL

PROVIDED STATEWIDE !LTHOUGH ALL OF THE LARGEST PROVIDERS OF 5# ARE IN URBAN AREAS THEY ARE NOT ALL LOCATED IN THE 4WIN #ITIES 3AINT -ARYS (OSPITAL IN 2OCHESTER 3T #LOUD (OSPITAL AND 3T -ARY S -EDICAL #ENTER IN $ULUTH ARE ALL AMONG THE LARGEST PROVIDERS OF 5# !LTHOUGH A SMALL NUMBER OF HOSPITALS IS RESPONSIBLE FOR MOST OF THE HOSPITAL 5# IN -INNESOTA IT IS NOT NECESSARILY THE CASE THAT 5# AS A PERCENTAGE OF OPERATING EXPENSES AT THESE HOSPITALS IS HIGHER THAN AVERAGE SEE &IGURE )N ONLY HALF OF THE TOP PROVIDERS OF 5# HAD 5# AS A PERCENTAGE OF OPERATING EXPENSES ABOVE THE STATE AVERAGE OF PERCENT &IGURE SHOWS 5# AS A PERCENT OF OPER ATING EXPENSES BY HOSPITAL SIZE FROM TO !S SHOWN IN THE lGURE THROUGHOUT THE S THE LARGEST HOSPITALS PROVIDED 5# THAT MADE UP A LARGER PROPORTION OF THEIR EXPENSES WHEN COMPARED WITH MID SIZED AND SMALL HOS PITALS HOWEVER THIS DIFFERENCE NARROWED OVER TIME )N AND THE SMALLEST HOSPITALS HAD THE HIGHEST RATIO OF 5# TO OPERATING EXPENSE COMPARED TO HOSPITALS IN OTHER SIZE CATEGORIES

%NDNOTES (ADLEY *ACK AND (OLAHAN *OHN h4HE #OST OF #ARE FOR THE 5NINSURED 7HAT $O 7E 3PEND 7HO 0AYS AND 7HAT 7OULD &ULL #OVERAGE !DD TO -EDICAL 3PEND ING v 4HE +AISER #OMMISSION ON -EDICAID AND THE 5N INSURED -AY (ADLEY AND (OLAHAN ESTIMATE THAT UNCOMPENSATED CARE REPRESENTS PERCENT OF THE HEALTH CARE RECEIVED BY ADULTS WHO ARE UNINSURED AT ANY TIME DURING THE YEAR PERCENT OF THE HEALTH CARE RECEIVED BY ADULTS WHO ARE UNINSURED FOR A FULL YEAR AND PERCENT OF THE HEALTH CARE RECEIVED BY ADULTS WHO ARE UNINSURED FOR ONLY PART OF THE YEAR (ADLEY *ACK AND (OLAHAN *OHN h(OW -UCH -EDICAL #ARE $O 4HE 5NINSURED 5SE !ND 7HO 0AYS &OR )T v (EALTH !FFAIRS 7EB EXCLUSIVE &EBRUARY

BID )N PERCENT OF THE 5# IN THE NATION WAS INCURRED BY HOSPITALS &OR THE PURPOSES OF THIS ISSUE BRIEF UNCOMPENSATED CARE CHARGES REPORTED BY HOSPITALS ARE CONVERTED TO A COST BASIS &OR THE PURPOSES OF THIS ANALYSIS HOSPITALS LOCATED IN COUNTIES THAT ARE PART OF -ETROPOLITAN 3TATISTICAL !REAS -3!S ARE CONSIDERED URBAN AND HOSPITALS IN NON -3! COUNTIES ARE CONSIDERED RURAL 2EGIONS ARE BASED ON THE ESTABLISHED REGIONS OF THE 3TATE #OMMUNITY (EALTH 3ERVICES !DVISORY #OMMITTEE 3#(3!#

4HIS ARTICLE IS REPRINTED WITH PERMISSION FROM THE -INNESOTA $EPARTMENT OF (EALTH

3OURCE -$( (EALTH #ARE #OST )NFORMATION 3YSTEM (OSPITAL SIZE CATEGORIES BASED ON LICENSED BEDS

-ARCH !PRIL

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

/N THE 3AGGING OF -EDICAL 0ROFESSIONALISM

&

&/2 4(% 0!34 47/ $%#!$%3 MEDICINE HAS BEEN A PROFESSION

IN RETREAT PLAGUED s BY BUREAUCRACY

s BY LOSS OF AUTONOMY

s BY DIMINISHED PRESTIGE AND s BY DEEP PERSONAL DISSATISFACTION 4HESE ILLS WOULD BE BAD ENOUGH BY THEMSELVES "UT ANOTHER MALADY CONFRONTS US Â&#x2C6; THE SAGGING OF OUR PROFESSIONALISM -EDICAL PROFESSIONALISM DElES PRECISE DElNITION &UNDAMENTALLY

HOWEVER IT BOILS DOWN TO SERVICE IN THE PATIENT S BEST INTEREST !MONG ITS CENTRAL ELEMENTS ARE COMMITMENT TO EXCELLENCE ALTRUISM WITH SERVICE BEFORE SELF INTEREST AVOIDANCE OF HARM TRUSTWORTHINESS PURSUIT OF TRUTH BASED ON SCIENTIlC AND HUMANISTIC CRITERIA CLOSE COOPERATION WITH OTHERS IN THE HEALTH CARE lELD AND HUMILITY )N THIS ESSAY ) ADDRESS OUR SAGGING PROFESSIONALISM AND OFFER MY THOUGHTS ON ITS CLINICAL MANIFESTATIONS CONSEQUENCES CAUSES AND CURES #LINICAL -ANIFESTATIONS AND #ONSEQUENCES 4O ME THE MOST COMMON AND YET MOST SUBTLE EXPRESSION OF BETRAYED PROFESSIONALISM IS SERVING OURSELVES BEFORE SERVING OUR PATIENTS "Y DO ING SO WE SACRIlCE THE VERY CORE OF DOCTORING Â&#x2C6; HUMANISM !ND AS A RESULT THE PATIENT PHYSICIAN BOND BECOMES WEAKENED Â&#x2C6; OR NEVER EVEN FORMS !DDITIONAL MANIFESTATIONS INCLUDE s ABUSE OF POWER

s ARROGANCE

s LACK OF CONSCIENTIOUSNESS AND s CONmICTS OF INTEREST #ERTAIN OTHER TYPES OF BEHAVIOR DESERVE SPECIAL ATTENTION BECAUSE THEY ARE SOMETIMES INTERPRETABLE AS BEING DISHONEST &AILURE TO TAKE CHARGE IS A COMMON EXAMPLE )N SUCH CASES THE ATTENDING PHYSICIAN SHIRKS HIS OR HER RESPONSIBILITY DEFERRING TO AN ARMY OF CONSULTANTS

EACH MANAGING A PART OF THE BODY WITH NO ONE MANAGING THE WHOLE

4HIS BUCK PASSING FREQUENTLY LEADS TO A HOST OF ILL ADVISED ACTIVITIES s MORE CONSULTATIONS

s INAPPROPRIATE TESTING

s UNDOCUMENTED DIAGNOSES

s OVER PRESCRIBING OF MEDICATIONS

s UNCALLED FOR PROCEDURES

s NEEDLESSLY PROLONGED HOSPITALIZATIONS AND s UNNECESSARY OFlCE VISITS 4HE CONSULTANTS IN THESE CASES COMMONLY SHIRK THEIR RESPONSIBIL ITY AS WELL !LTHOUGH IDEALLY POSITIONED TO HALT THIS MEDICAL MERRY GO ROUND THEY RIDE IT INSTEAD -OREOVER THOSE WITH A hGIMMICKv USE IT

EVEN WHEN THEY KNOW IT ISN T INDICATED !ND LET US NOT FORGET THE FRAUDULENT REIMBURSEMENT CLAIMS TO -EDICAID AND -EDICARE OR THOSE PHYSICIANS WHO ATTRACTED BY REMU NERATION AND PERHAPS BY DESIRE FOR PUBLIC RECOGNITION SERVE AS EXPERT WITNESSES EVEN THOUGH THEY CLEARLY ARE NOT QUALIlED FOR THE ROLE &INALLY MOST PHYSICIANS SIMPLY REMAIN SILENT WHEN THEY KNOW OR SUSPECT A COLLEAGUE TO BE EMOTIONALLY DISTURBED A SUBSTANCE ABUSER OR JUST PLAIN INCOMPETENT 4HIS RELUCTANCE TO GET INVOLVED IS PARTICULARLY DEPLORABLE WHEN THEY KNOW OR SUSPECT THAT AN ASSOCIATE IS CHEATING OR LYING #AUSES #LEARLY NUMEROUS FACTORS CONTRIBUTE TO OUR SAGGING PROFESSIONAL ISM (EADING THE LIST IN MY OPINION IS A CHANGE IN SOCIETY S OVERALL PRIORITIES AND VALUES /LD FASHIONED HARD WORK DEVOTION TO DUTY AND PURSUIT OF EXCELLENCE HAVE TAKEN A BACK SEAT TO AN EMPHASIS ON LIMITED WORK HOURS AND QUESTS FOR lNANCIAL AND OTHER TYPES OF PERSONAL GAINS !S A RESULT PEOPLE AT ALL LEVELS Â&#x2C6; INCLUDING MANY PHYSICIANS Â&#x2C6; ARE SATISlED WITH MEDIOCRITY )N FACT MEDIOCRITY HAS BECOME THE STANDARD 'IVEN THIS ENVIRONMENT NO WONDER OUR PROFESSIONALISM SAGS %XTERNAL FORCES LARGELY BEYOND OUR CONTROL ALSO PLAY A ROLE %X AMPLES ARE s THE MYRIAD CONSTRAINTS IMPOSED BY INSURANCE COMPANIES s THE INCESSANT PRESSURES RESULTING FROM FEDERALLY MANDATED REGULATIONS s THE GLUT OF hFOR PROlT NOT FOR PATIENTv HOSPITAL ADMINISTRATORS s THE LAWSUITS LURKING AROUND EVERY CORNER AND s THE REAMS OF PAPERWORK REQUIRED

"9 (%2"%24 , &2%$ - $

#ONTINUED ON PAGE

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

-ARCH !PRIL

3OAP "OX #ONTINUED FROM PAGE

!TTENDING TO THESE VARIOUS DEMANDS CUTS DEEPLY INTO THE TIME WE COULD OTHERWISE SPEND ATTENDING TO OUR PATIENTS !ND COMPLICATING THE PICTURE ARE HUMAN FRAILTIES Â&#x2C6; ESPECIALLY IGNORANCE GREED FEAR OF BEING WRONG AND THE NEED FOR AGGRANDIZEMENT #URES #AN WE REMEDY OUR SAGGING PROFESSIONALISM /NLY INSOFAR AS WE ARE WILLING TO BE ROLE MODELS OF INTEGRITY AND HONESTY FOR EACH OTHER /NLY IF WE SHOW s COMMITMENT

s COMPASSION

s COMPETENCE

s CANDOR AND s COMMON SENSE /NLY IF WE UNDERSTAND AND BELIEVE THAT MEDICINE IS A CALLING

NOT A BUSINESS /NLY IF WE STRIVE DILIGENTLY TO RESTORE PRESERVE AND PROMOTE THE HUMAN ELEMENT IN MEDICINE /NLY IF WE LOOK AT LISTEN TO AND TALK WITH OUR PATIENTS WORKING AS HARD AND AS LONG AS IT TAKES TO ENSURE THEIR WELFARE /NLY IF WE ALWAYS PUT OUR PATIENTS lRST

SECOND THE PATIENT THIRD THE PATIENT FOURTH THE PATIENT lFTH THE PATIENT

AND THEN MAYBE COMES SCIENCE 7E lRST DO EVERYTHING FOR THE PATIENTx .OT ONLY DO HIS WORDS CAPTURE THE ESSENCE OF THIS ESSAY BUT THEY ALSO SERVE TO REMIND US OF THE RULING PRINCIPLE OF OUR PROFESSION

(ERBERT , &RED - $ IS A PROFESSOR $EPARTMENT OF )NTERNAL -EDICINE

4HE 5NIVERSITY OF 4EXAS (EALTH 3CIENCE #ENTER AT (OUSTON (E RECEIVED THE !MERICAN #OLLEGE OF 0HYSICIANS $ISTINGUISHED 4EACHER !WARD FOR

4HIS ARTICLE WAS ORIGINALLY PUBLISHED IN THE &ALL ISSUE OF THE 4EXAS -EDICAL "OARD "ULLETIN )T IS REPRINTED HERE WITH PERMISSION

&INAL 4HOUGHT ) LEAVE THE READER WITH A QUOTATION FROM "ELA 3CHICK

RENOWNED (UNGARIAN PEDIATRICIAN AND BACTERIOLOGIST &IRST THE PATIENT

#LASSIlED !D ).6%34 ). 3!&% 3%#52%$ 2%!, %34!4% 7E DO ALL THE WORK YOU GET GREAT RETURNS 0ERSONAL "USINESS OR 2ETIREMENT FUNDS K B 3%0 )2!

ETC 3MALL MINIMUM NO MAXIMUM INVESTMENT WWW )NVEST-Y-ONEY.OW COM

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10275 Wayzata Boulevard, Suite 300, Minnetonka, MN 55305 Tel.: 952.253.2578 â&#x2013;˛ joelg@affiancefinancial.com www.affiancefinancial.com Joel Greenwald, MD CERTIFIED FINANCIAL PLANNERâ&#x201E;˘

Registered Representative offering Securities through FINANCIAL NETWORK INVESTMENT CORPORATION A Registered Broker Dealer, Member SIPC Affiance Financial and Financial Network are not affiliated.

-ARCH !PRIL

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-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

4HE ,EGAL &ARCE OF 4ORT ,ITIGATION

4

4(% ).!"),)49 /& 4/24 ,)4)'!4)/. TO ARRIVE AT JUSTICE IS EXEMPLIlED IN RECENT STUDIES OF ASBESTOS LITIGATION AND MEDICAL MALPRACTICE !SBESTOS LITIGATION OVER THE PAST SEVERAL DECADES HAS SERVED ONLY TO BANKRUPT COMPANIES ENRICH THE ATTORNEYS ON BOTH SIDES

AND TO COMPENSATE ONLY A SMALL NUMBER OF INSURED WORKERS 4HERE IS NO QUESTION THAT MANY OF THE INVOLVED COMPANIES KNOWINGLY PLACED EMPLOYEES IN HARM S WAY IN THE INTEREST OF PROlTS 4HEY DESERVE TO BE SUED AND THE SERIOUSLY INJURED EMPLOYEES DESERVE TO BE COMPENSATED 5NFORTUNATELY AS A RESULT OF JUDICIAL DECISIONS

THE POTENTIAL PLAINTIFF GROUP HAS BEEN GREATLY EXPANDED RESULTING IN HUGE CLASS ACTION LITIGATIONS ON BEHALF OF WORKERS WITHOUT INJURY OR DISEASE 4HIS EXPANSION CREATED FOR THE MOST PART BY AVARICIOUS PLAINTIFF LAWYERS HAS GREATLY DILUTED THE AMOUNT OF MONEY AVAILABLE TO COMPENSATE TRULY INJURED WORKERS &URTHER BANKRUPT ASBESTOS COMPANIES ARE UNABLE TO lNANCE THE COMPENSATION !TTEMPTS BY #ONGRESS TO CONTROL THE EXPANSION OF LIABILITY SO THAT TRULY INJURED WORKERS CAN RECEIVE COMPENSATION ARE FRUSTRATED BY AN ALLIANCE BETWEEN ORGANIZED LABOR AND PLAINTIFF LAWYERS !N EXAMPLE OF THE UNHOLY EFFORTS OF PLAINTIFF ATTORNEYS TO EXPAND UNJUSTIlED COMPENSATION HAS RECENTLY BEEN PUBLISHED 4HE STUDY EVALUATED RADIOLOGICAL INTERPRETATION OF X RAYS OF EXPOSED WORKERS COMPARING THE READINGS OF RADIOLOGISTS IN THE EMPLOY OF PLAINTIFF ATTORNEYS WITH UNAFlLIATED RADIOLOGISTS WHO KNOW NOTH ING OF THE EMPLOYMENT HISTORY OR HEALTH OF THE LITIGANTS /VER PERCENT OF THE CASES READ BY PLAINTIFF RADIOLOGISTS WERE CONSIDERED CONSISTENT WITH ASBESTOS RELATED LUNG DAMAGE ONLY PERCENT OF IMAGES READ BY UNAFlLIATED RADIOLOGISTS WERE INTERPRETED AS SHOWING hPOSSIBLEv DAMAGE 4HIS DISCREPANCY OF INTERPRETATION IS BLATANT

BUT NEVERTHELESS IN A COURTROOM BOTH INTERPRETATIONS ARE GIVEN EQUAL CREDIBILITY )T IS OBVIOUS THAT EXPERT OPINION CAN BE hBOUGHT v )S THIS JUSTICE )S THIS A SEARCH FOR TRUTH )T IS APPARENT THAT PHYSI CIAN hEXPERTSv HIRED BY EITHER SIDE IN TORT LITIGATION ARE INmUENCED

BY WHO PAYS THEIR FEES 4ORT LITIGATION IS SORELY IN NEED OF REFORM 5NFORTUNATELY TRIAL LAWYERS HAVE A GREAT DEAL OF POLITICAL CLOUT WITH ONE MAJOR POLITICAL PARTY CREATING MAJOR DIFlCULTIES IN ACHIEVING EVEN A MINOR LEVEL OF TORT REFORM "9 3%9-/52 (!.$,%2 - $

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

-EDICAL MALPRACTICE IS ANOTHER EXAMPLE OF DElCIENCY IN TORT LITIGATION 4O A VARIABLE DEGREE MALPRACTICE CONCERNS AFFECT MEDICAL PRACTICE $EFENSIVE MEDICINE OCCURS IN WHICH PHYSICIANS PERFORM MORE TESTS AND PROCEDURES THAN INDICATED IN A MISGUIDED NOTION TO PROTECT ONESELF )N PARTS OF THE COUNTRY MALPRACTICE INSURANCE PREMIUMS BECOME PROHIBITIVE PROMPTING PHYSICIANS TO LIMIT THEIR PRACTICES OR GO ELSEWHERE 4HE MOST AFFECTED SPECIALTIES HAVE BEEN /B 'YN NEUROSURGERY AND EMERGENCY MEDICINE &ORTUNATELY

-INNESOTA PHYSICIANS HAVE BEEN LESS AFFECTED BY ENORMOUS INSUR ANCE PREMIUM RATES 0ART OF THE PROBLEM IN MALPRACTICE IS ITS DElNITION 3O OFTEN A BAD OUTCOME IS CONSIDERED NEGLIGENCE BY THE PATIENT AND ATTOR NEY WHEN THE NATURAL HISTORY OF THE PATIENT S DISORDER RESULTS IN A POOR OUTCOME 4HIS PROBLEM IS MINIMIZED BY BETTER COMMUNICA TION BETWEEN THE PHYSICIAN AND THE PATIENT 0HYSICIANS WHO MAIN TAIN EXCELLENT RAPPORT WITH THEIR PATIENTS ARE RARELY SUED DESPITE THE FACT THAT NEGLIGENT CARE MAY HAVE OCCURRED 4HIS IS A COMMON EXPERIENCE WITH CHARLATAN PRACTITIONERS WHOSE GLIB DEMEANOR EF FECTIVELY SUPPRESSES COMPLAINTS 4HE MOST FACTUAL INFORMATION ON MEDICAL MALPRACTICE IS DE SCRIBED IN THE (ARVARD -EDICAL 0RACTICE 3TUDY A REVIEW OF

MEDICAL RECORDS OF HOSPITALIZED PATIENTS IN .EW 9ORK 3TATE 4HE (ARVARD STUDY FOUND PERCENT OF hADVERSEv EVENTS OF WHICH PERCENT WERE CONSIDERED DUE TO PHYSICIAN NEGLIGENCE 4HE MAJORITY OF ADVERSE EVENTS RESULTED IN MINOR IMPAIRMENT WITH COMPLETE RECOVERY IN ONE MONTH ! TINY PERCENTAGE OF ADVERSE EVENTS LED TO TOTAL DISABILITY OR DEATH !LTHOUGH MEDICAL NEGLIGENCE SHOULD NEVER BE TOLERATED ONE MIGHT SUGGEST THAT THE VERY LOW INCI DENCE OF ADVERSE EFFECTS CAUSED BY NEGLIGENCE IS SURPRISING !FTER ALL WHAT PROFESSION OR VOCATION CAN CLAIM SUCH A LOW INCIDENCE OF POOR PERFORMANCE )F STOCKBROKER ADVICE WAS WRONG ONLY PERCENT OF THE TIME WE WOULD ALL BE RICH #AN AUTOMOBILE REPAIR PEOPLE OR PLUMBERS DO THAT WELL (OW ABOUT OUR ELECTED POLITICAL LEADERS 7OULDN T PERCENT ERROR IN JUDGMENT BE EXEMPLARY /NE MIGHT REASONABLY ARGUE THAT THE RATE OF NEGLIGENT PRACTICE IS VERY LOW

CLEARLY ON PAR OR BETTER THAN MOST OCCUPATIONS &OR SOME UNEX

#ONTINUED ON PAGE

-ARCH !PRIL

3OAP "OX #ONTINUED FROM PAGE

PLAINED REASON MEDICAL NEGLIGENCE IS SELECTED FOR CRITICISM DESPITE THE FACT THAT THE LOW INCIDENCE OF NEGLIGENCE SHOULD BE CONSIDERED LAUDATORY 4HE (ARVARD STUDY ALSO FOUND THAT THE TRUE INCIDENCE OF NEG LIGENCE RESULTING IN ADVERSE EFFECTS IS HIGHER THAN THE CORRESPOND ING INCIDENCE OF LITIGATION 4ORT ATTORNEYS WOULD ARGUE THAT THE NEGLIGENCE PROBLEM IS FAR GREATER THAN WOULD BE SUGGESTED BY THE NUMBER OF SUITS AND THAT THEREFORE TORT REFORM SHOULD INCLUDE MORE COMPENSATION FOR NEGLIGENCE THAN EXISTS 4HIS OBSERVATION IS SELF SERVING AND WOULD ONLY COMPLICATE THE CURRENT PROBLEM !NOTHER SURPRISE lNDING IN THE (ARVARD STUDY DETERMINED THAT ONLY ONE FOURTH OF MALPRACTICE CLAIMS WITH A lNANCIAL SETTLE MENT HAVE IDENTIlABLE MEDICAL NEGLIGENCE 3INCE SO MANY SUITS RESULTED IN lNANCIAL SETTLEMENT BY THE INSURANCE COMPANIES THIS WOULD INDICATE THAT MOST lNANCIAL SETTLEMENTS ARE AWARDED DESPITE THE ABSENCE OF NEGLIGENCE A FORM OF LEGAL EXTORTION )NSURANCE COMPANIES UNFORTUNATELY THINK IN THE SHORT RUN TO MINIMIZE THEIR COSTS )F THEY COULD THINK FURTHER THAN THE ANNUAL CORPORATE BAL ANCE SHEET THEY MAY lND THAT LESS WILLINGNESS TO SETTLE UNJUSTIlED CLAIMS MAY SAVE THEM MONEY IN THE LONG RUN

/NE SOLUTION PROPOSED IN TORT REFORM DISCUSSION IS hNO FAULTv INSURANCE 4HIS WOULD STATE THAT NEGLIGENCE OCCURS AND SHOULD BE COMPENSATED IF AN ADVERSE EFFECT RESULTS 3UCH AN APPROACH WOULD ONLY COMPENSATE DEMONSTRATED CARE COSTS AND ECONOMIC LOSSES NOT hPAIN AND SUFFERING v 4HIS PROPOSAL HAS BEEN VIGOROUSLY OPPOSED

BY TRIAL LAWYERS BECAUSE THE LARGEST PART OF THEIR SHARE OF SETTLEMENTS IS RELATED TO hPAIN AND SUFFERING v 4HE TRIAL LAWYERS TEND TO OPPOSE ANY PROPOSAL SUGGESTING TORT REFORM 4HEY HAVE A GOOD THING GOING FOR THEM AND THEY VIEW ANY REASONABLE ATTEMPT AT REFORM AS LIKELY TO HURT THEM lNANCIALLY 4HE EXISTING PRACTICE OF TORT LITIGATION HAS FEW REDEEMING FEA TURES 4HE SYSTEM APPEARS DESIGNED BY AND FOR ATTORNEYS WITH LITTLE EVIDENCE OF A DESIRE FOR TRUTH OR JUSTICE 3OCIETY IN GENERAL IS HURT

BY CURRENT TORT LITIGATION BECAUSE BUSINESS AND INDUSTRY DECISIONS OFTEN ARE INmUENCED EXCESSIVELY BY LITIGATION CONCERNS 2ATHER THAN ATTEMPT TO DEVELOP NEW PRODUCTS AND SERVICES THAT WOULD ENTAIL RISKS BUSINESS hPLAYS IT SAFEv AND AVOIDS INNOVATIONS THAT MIGHT REPRESENT BOTH PROGRESS AND PROlT 7E SORELY NEED TORT LITIGATION REFORMS (OW IF AND WHEN IT WILL OCCUR IS UNDETERMINED 4ORT REFORM IS A TOO HIGHLY CHARGED PHENOMENON TO BE READILY SOLVED 3EYMOUR (ANDLER - $ IS A RETIRED PATHOLOGIST

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-ARCH !PRIL

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

4HE 0ROMISE OF /NLINE !PPOINTMENT 3CHEDULING

7

7(),% /.,).% 0!4)%.4 SELF SCHEDULING

IS IN ITS INFANCY IT WILL EVENTUALLY BECOME A COMMONPLACE ALTERNATIVE FOR PATIENTS WISHING TO SCHEDULE AN APPOINTMENT /NLINE APPOINT MENT SCHEDULING ALLOWS PATIENTS TO SCHEDULE THEIR OWN APPOINTMENTS FROM AN )NTERNET 7EB SITE MUCH IN THE SAME WAY A TRAVELER MIGHT BOOK A mIGHT 4HE PATIENT WOULD SEE WHAT DATES AND TIMES ARE AVAILABLE AND WOULD BOOK A TIME SLOT IN REAL TIME WITHOUT ANY CLINIC STAFF INVOLVEMENT /NLINE SCHEDULING PROVIDES A PERFECT EXAMPLE OF HOW TECHNOLOGY CAN IMPROVE PATIENT ACCESS TO CARE AND ENHANCE THE OVERALL PATIENT EXPERIENCE WHILE ALSO ALLOWING A CLINIC TO REDUCE ITS COSTS 4HE CONVENIENCE OF BEING ABLE TO SCHEDULE FREES PATIENTS TO SCHED ULE THEIR APPOINTMENTS AFTER THE WORKDAY AND AFTER DOCTORS OFlCES ARE CLOSED !T THE SAME TIME LOWER CALL VOLUME ALLOWS RECEPTION STAFF TO SHRINK OVER TIME OR ALLOWS RECEPTION STAFF TO REFOCUS ON OTHER TASKS SUCH AS CHART PULLING AND CHECK IN !N ILLUSTRATIVE EXAMPLE IN THE ABSENCE OF ONLINE SCHEDULING MIGHT BE A WORKING MOTHER WHO AWOKE TO THE SOUND OF HER CHILD WITH FEVER CRYING AT TWO IN THE MORNING 4HE TRIAGE NURSE HAS JUST TOLD HER THAT THE CHILD SHOULD BE SEEN BY THE DOCTOR BUT THE SCHEDULING LINES DON T OPEN UNTIL A M (AVING SLEPT POORLY SINCE GETTING UP WITH THE CHILD AND DUE TO WORK AT A M THE MOTHER DOESN T KNOW IF IT S WORTHWHILE GOING TO THE OFlCE OR IF THE AP POINTMENT WILL BE EARLY IN THE MORNING .OT KNOWING WHAT TIME HER CHILD CAN BE SEEN SHE JOINS THE MANY OTHER PARENTS WHO AT A M ARE ATTEMPTING TO PHONE THE DOCTOR S OFlCE

"9 -!2# &2!.£/)3 "2!$,%9 !.$ $!6)$ , %342).

- $

$ESPITE THE INCREASING UBIQUITY OF THE )N TERNET IN OUR DAILY LIVES MOST OF OUR HEALTH CARE NEEDS STILL REQUIRE THE TELEPHONE )N THE ABOVE EXAMPLE THE BENElT TO THE PATIENT OF BEING ABLE TO SCHEDULE WHEN DOCTORS OFlCES ARE CLOSED IS OBVIOUS 3CHEDULING AN APPOINTMENT REMAINS A SIGNIFICANT FRUSTRATION FOR MANY PATIENTS AND AT THE SAME TIME A CONSIDERABLE EXPENSE IN HEALTH CARE !S PATIENTS INCREASINGLY EXPECT AN EXCELLENT CUSTOMER EXPERIENCE A SLOW BUT CERTAIN SHIFT TOWARD USE OF )NTERNET TECHNOLOGY IS TAKING PLACE WITHIN HEALTH CARE 0ATIENTS UNIVERSALLY SEEM TO WANT TO SCHEDULE THEIR OWN APPOINTMENTS ONLINE 4HIS SHOULD BE NO SURPRISE GIVEN THAT TODAY NEARLY PERCENT OF LEISURE TRAVEL IS BOOKED ONLINE AND PERCENT OF !MERICAN ADULTS ARE ONLINE !FTER ALL WHY SHOULD MAKING A DOCTOR S AP POINTMENT BE MORE COMPLICATED THAN MAKING RESERVATIONS TO 3AN &RANCISCO 0ATIENT BENElTS ARE CLEAR CONVENIENCE OF SCHEDULING FROM HOME OR AT THE END OF THE WORKDAY WHEN DOCTORS OFlCES ARE USUALLY CLOSED NOT BEING FORCED TO VERBALIZE EMBARRASSING SYMPTOMS OVER THE PHONE WITH THE FEAR OF BEING OVERHEARD BY FRIENDS OR COWORKERS AND NOT HAVING TO WASTE TIME ON HOLD ! STRONG INTEREST IN ONLINE APPOINTMENT SCHEDULING WAS CONlRMED THROUGH 4WIN #ITIES PATIENT SURVEYS CONDUCTED BY (EALTH0ARTNERS IN THE FALL OF 3EPARATE STUDIES IN SEVERAL PRIMARY CARE PRACTICES IN THE SOUTHWEST MET ROPOLITAN AREA OF -INNEAPOLIS REVEALED THAT ROUGHLY PERCENT OF RESPONDING PATIENTS WOULD LIKE TO SCHEDULE ONLINE /F THESE

PERCENT STATE THEY WOULD ALWAYS SCHEDULE ON LINE 4HE REMAINING PATIENTS WOULD ONLY DO SO AS A WAY OF SCHEDULING WHEN OFlCES ARE CLOSED OR PHONE LINES ARE BUSY )MPROVING PATIENT ACCESS TO CARE THROUGH ONLINE APPOINTMENT SCHEDULING OFFERS THE

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

OPPORTUNITY TO ALSO REDUCE COSTS IN HEALTH CARE 7HILE THE MAIN COST REDUCTION IS FOUND THROUGH REDUCING OR REASSIGNING SCHEDULING STAFF OTHER LESS OBVIOUS BENElTS ARE REALIZED SCHEDULING ERRORS AND SUBSEQUENT PAYMENT DE NIALS ARE REDUCED AS PATIENTS PERSONALLY ENSURE MORE ACCURATE APPOINTMENT INFORMATION NO SHOW RATES DECREASE DUE TO E MAIL REMINDERS AND AS CANCELLATION BECOMES EASIER FOR PATIENTS

UNlLLED APPOINTMENT SLOTS RESULTING FROM LAST MINUTE CANCELLATIONS ARE MORE LIKELY TO BE lLLED AT THE LAST MINUTE 7HILE THE PATIENT BENElTS FROM MORE CONVENIENCE IN SCHEDULING OTHER PATIENTS BENElT TOO !CCORDING TO #AMI 3WANSON AD MINISTRATOR AT 3OUTHDALE )NTERNAL -EDICINE

ONLINE APPOINTMENT SCHEDULING ALSO IMPROVES QUALITY AS hREDUCED TELEPHONE CALLS LEADS TO LESS OFlCE WORK AND BETTER TIME SPENT INTERACTING WITH PATIENTS AT THE RECEPTION DESK v 7HILE TECHNOLOGY HAS BEEN GENERALLY READY TO ADDRESS THE NEEDS OF ONLINE APPOINT MENT SCHEDULING FOR SOME TIME IT IS THE MATURING OF AN ONLINE POPULATION INCREAS INGLY CAPABLE OF CARRYING OUT VARIED ELECTRONIC TRANSACTIONS THAT MAKES )NTERNET SOLUTIONS TO HEALTH CARE COMMUNICATION SO VIABLE TODAY !S TECHNOLOGICAL INNOVATION HAS LARGELY ADDRESSED OBSTACLES TRADITIONALLY RAISED TO ONLINE APPOINT MENT SCHEDULING HUMAN RELUCTANCE TO CHANGE WITHIN HEALTH CARE ORGANIZATIONS REMAINS THE TRUE CHALLENGE /NLINE APPOINTMENT SCHEDULING SOLUTIONS CURRENTLY EXIST IN SEVERAL FORMS FUNCTIONALITY ADDED TO PRACTICE MANAGEMENT SYSTEMS FUNC TIONALITY AS AN EXTENSION OF ELECTRONIC MEDICAL RECORD SYSTEMS ALSO ALLOWING PATIENTS TO VIEW PERSONAL MEDICAL INFORMATION AND PURE PLAY SYSTEMS THAT RUN ON INDEPENDENT EXTERNAL #ONTINUED ON PAGE

-ARCH !PRIL

/NLINE !PPOINTMENT 3CHEDULING #ONTINUED FROM PAGE

SERVERS %ACH APPROACH HAS ITS LIMITATIONS AND ADVANTAGES AND SELECTING THE RIGHT SOLUTION MAY DEPEND ON WHAT PRACTICE MANAGEMENT SYSTEM IS CURRENTLY INSTALLED AT THE PRACTICE )MPLEMENTATIONS HAVE BEEN SCATTERED AROUND THE 5NITED 3TATES WITH A GENERAL TREND SUGGESTING PRACTICE ADOPTION IS STRONGEST IN #ALIFORNIA WEAKEST IN THE NORTHEAST AND BEGINNING TO GAIN TRACTION IN THE -IDWEST 3EVERAL PRACTICES IN THE -INNEAPOLIS n 3T 0AUL METROPOLITAN AREA ALLOW THEIR PATIENTS TO REQUEST APPOINTMENTS ONLINE BUT UNTIL (EALTH 0ARTNERS IN THE SPRING OF NONE ALLOWED PATIENTS TO SCHEDULE APPOINTMENTS IN REAL TIME !T (EALTH0ARTNERS WITH MORE THAN

APPOINTMENTS SCHEDULED PER YEAR +EVIN 0ALAT TAO 60 OF 0ATIENT 3ERVICES REPORTS THAT MORE THAN PATIENTS REGISTERED FOR THE SERVICE OVER THE lRST SIX MONTHS THE SERVICE WAS OF FERED $UE TO RECENT PATIENT REQUESTS ONLINE APPOINTMENT SCHEDULING WILL BE EXPANDED TO INCLUDE OB GYN AND VISION APPOINTMENTS )N A PILOT PROGRAM THAT BEGAN IN /CTOBER

&AIRVIEW (EALTH 3ERVICES AFlLIATED CLIN ICS ARE OFFERING -Y#HART A FULL SUITE OF ONLINE PATIENT SERVICES $R "ARRY "ERSHOW MEDICAL DIRECTOR OF 1UALITY AND )NFORMATICS AT &AIRVIEW (EALTH 3ERVICES DESCRIBES THIS FORM OF ACCESS TO CARE FOR THE PATIENT AS ALLOWING PATIENTS TO SCHEDULE APPOINTMENTS ONLINE VIEW MEDICA TIONS AND LAB RESULTS REQUEST PRESCRIPTION RElLLS

AND CONDUCT ONLINE PATIENT DOCTOR CONSULTA

TIONS 4HIS OFFERING SHOULD BE FULLY DEPLOYED TO ALL &AIRVIEW (EALTH 3ERVICES LOCATIONS BY NEXT SUMMER !CCORDING TO +IRSTEN *ENSEN A 7EB SPECIALIST AT -ERIT#ARE WHICH WILL BE IMPLE MENTING ONLINE APPOINTMENT REQUESTS BEFORE TACKLING REAL TIME APPOINTMENT SCHEDULING IN THEIR .ORTH $AKOTA AND WESTERN -INNESOTA CARE SYSTEM THE MAIN FEAR IS THAT PATIENTS WILL SELECT AN INAPPROPRIATE DURATION OF TIME FOR THEIR APPOINTMENTS 4HIS UNDERSTANDABLE CON CERN CAN BE SQUARELY ADDRESSED IN A PRIMARY CARE SETTING WHILE BEING MORE DIFlCULT WITH SPECIALTY CARE ! PATIENT WHO KNOWS EVERYTHING REQUIRED FOR A PRIMARY CARE APPOINTMENT E G HIS OR HER CONDITION AND SYMPTOMS CAN EASILY BE ASSISTED THROUGH THE PROCESS OF SELECTING THE CORRECT AP POINTMENT TYPE IN A SOFTWARE SOLUTION )N SITU ATIONS WHERE THE RECEIPT OF INFORMATION FROM SEPARATE SOURCES E G LAB RESULTS X RAYS ETC MUST BE COMPLETE PRIOR TO THE APPOINTMENT BEING SCHEDULED IT BECOMES HARDER FOR THE PATIENT TO TAKE RESPONSIBILITY FOR ORCHESTRATING A MEANINGFUL ENCOUNTER WITH THE PHYSICIAN )N ORDER TO BE SUCCESSFUL AN ONLINE SCHEDULING SYSTEM REQUIRES TIGHT COUPLING WITH A PRACTICE S PRACTICE MANAGEMENT SYS TEM 4HIS ENSURES THE ABILITY TO HAVE REAL TIME APPOINTMENT SCHEDULING WITHOUT THE RISK OF OFlCE STAFF SCHEDULING THE SAME SLOT WITH ONE PATIENT WHILE ANOTHER ATTEMPTS TO SCHEDULE THE SLOT ONLINE 'OOD INTEGRATION BETWEEN THE TWO SYSTEMS SHOULDN T REQUIRE OFlCE STAFF TO BE RETRAINED AND ALLOWS INFORMATION MAINTAINED

$R -ICHAEL 2ECEIVES 3HOTWELL !WARD !,&2%$ & -)#(!%, - $ DEAN OF THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL

WAS AWARDED THE 3HOTWELL !WARD FOR HIS hNOTEWORTHY EFFORT IN THE lELD OF HEALTH CARE v $EAN -ICHAEL IS CREDITED WITH REVITAL IZING THE MEDICAL SCHOOL AT A TIME WHEN IT WAS MOST NEEDED AND HELPED SPREAD THE MESSAGE THAT MEDICAL EDUCATION MUST BE FUNDED TO PROVIDE FOR THE FUTURE (E ALONG WITH THE MEDICAL SCHOOL FACULTY ALUMNI AND OTHER MEMBERS OF THE UNIVERSITY S !CADEMIC (EALTH #ENTER UNDERTOOK A VIGOROUS TWO YEAR EFFORT TO EDUCATE THE PUBLIC AND THE -INNESOTA ,EGISLATURE ABOUT THE IMPOR TANCE OF MEDICAL EDUCATION

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4HE AWARD PRESENTATION WAS HELD 4UESDAY /CTOBER AT THE !BBOTT .ORTHWESTERN -EDICAL 3TAFF -EETING

-ICHAEL " "ELZER - $ RIGHT PRESENTS THE 3HOTWELL !WARD TO !LFRED & -ICHAEL - $

IN THE SCHEDULING SYSTEM TO BE USED BY THE ON LINE SYSTEM TO PRESERVE APPOINTMENT TYPE RULES AND DURATIONS SET AT THE INDIVIDUAL PHYSICIAN LEVEL 4HE MORE CONSOLIDATED THE APPOINTMENT TYPES AND RULES WITHIN A PRACTICE THE EASIER IT IS FOR PATIENTS TO SCHEDULE AND THE EASIER IT IS TO MAINTAIN THE SYSTEM OVER TIME !N ONLINE APPOINTMENT SCHEDULING SYSTEM MUST BE SIMPLE TO USE AND ABLE TO EMBRACE ALL APPOINTMENT TYPES AND RULES REQUIRED BY THE PHYSICIAN 7HILE THE IMPLEMENTATION OF SUCH A SYSTEM IMMEDIATELY PROVIDES PATIENTS WITH IMPROVED ACCESS TO CARE PHYSICIANS MUST GIVE CAREFUL THOUGHT TO HOW IT WILL BE PRESENTED TO PATIENTS 2APID PATIENT ADOPTION IS KEY TO QUICKLY CAPTURING AVAILABLE COST SAVINGS THROUGH USE OF THE SYSTEM /NLINE APPOINTMENT SCHEDULING PRESENTS A STRATEGICALLY CRITICAL THRUST INTO THE HOME

INVITING PATIENTS TO TAKE MORE RESPONSIBILITY FOR THEIR OWN HEALTH CARE WITH THE PROMISE OF INCREASED CONVENIENCE /NLINE APPOINTMENT SCHEDULING ARGUABLY REPRESENTS A BRIDGEHEAD INTO THE PATIENT S HOME CREATING THE OPPORTU NITY FOR SUBSEQUENTLY INVITING PATIENTS TO DO MORE WHETHER PROVIDING MEDICAL INFORMATION

RESPONDING TO SURVEYS VIEWING LAB RESULTS OR REQUESTING PRESCRIPTION RElLLS )MPLEMENTING AN ONLINE SCHEDULING SYSTEM FOR A PHYSICIAN PRACTICE CAN BE THE ENTR£E INTO WHAT PROMISES TO BECOME AN EXCITING FUTURE FOR ONLINE PHYSI CIANnPATIENT INTERACTION 3OURCES 0EW )NTERNET 2ESEARCH &OUNDATION 0ATIENT SURVEYS CONDUCTED BY 3OPHRONA 3OLUTIONS )NC IN 37 METRO PRACTICES )NTERVIEWS WITH +IRSTEN *ENSEN 7EB 3PECIALIST -ERIT #ARE +EN 0ALATTAO 60 0ATIENT 3ERVICES (EALTH0ARTNERS #AMI 3WANSON !DMINISTRATOR 3OUTHDALE )NTERNAL -EDICINE $R "ARRY "ERSHOW -EDICAL $IRECTOR OF 1UALITY AND )NFORMATICS &AIRVIEW (EALTH 3ERVICES

-ARC &RANÃ&#x20AC;OIS "RADLEY IS PRINCIPAL MANAGER AT 3OPHRONA 3OLUTIONS A 4WIN #ITIES BASED lRM SPECIALIZING IN ONLINE APPOINTMENT SCHEDULING AND IN IMPROVING PATIENT ACCESS TO CARE WHILE RE DUCING CLINIC COSTS 0RIOR TO THAT HE IMPLEMENTED NUMEROUS STRATEGIC SYSTEMS OVER THE LAST DECADE AT 4ARGET #ORP $AVID , %STRIN - $ IS A PEDIATRICIAN AND PARTNER PRACTICING AT 3OUTH ,AKE 0EDIATRICS (E HAS HAD LONG STANDING INTEREST AND EXPERIENCE IN THE APPLICATION OF COMPUTERS AND OTHER TECHNOL OGY TO CLINICAL PRACTICE

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

4HE !PPROPRIATE 5SE OF /PIATES FOR 0AIN -ANAGEMENT

3

3%6%2!, 9%!23 !'/ 2ICHARD 7EINER

0H $ CO FOUNDER AND EXECUTIVE DIRECTOR OF THE !MERICAN !CADEMY OF 0AIN -ANAGEMENT WAS DIAGNOSED WITH PANCREATIC CANCER FROM WHICH HE ULTIMATELY PASSED AWAY )T SEEMS LUDICROUS THAT THE EXECUTIVE DIRECTOR OF THE LARGEST PAIN MANAGEMENT ORGANIZATION WOULD HAVE TO SUFFER IN SEVERE PAIN DUE TO THE FEAR OF PHYSICIANS IN PRESCRIBING OPIATES !S PHYSICIANS WE ARE CONFRONTED ON A DAILY BASIS WITH PATIENTS WHO SUFFER FROM PAIN (OW WE APPROACH THIS AGONIZING DISOR DER SHOULD BE DETERMINED BY OUR OBLIGATION TO ASSIST THE PATIENT IN PAIN 4HE *OINT #OMMISSION OF !CCREDITATION OF (EALTHCARE /RGANIZATIONS STATES h4HE PATIENTS HAVE THE @RIGHT TO APPROPRIATE PAIN ASSESSMENT AND APPROPRIATE MANAGEMENT OF PAIN v 3TILL THERE REMAINS A SIGNIlCANT BARRIER

WHICH PERPETUATES THE LACK OF APPROPRIATE PAIN MANAGEMENT IN THE 5NITED 3TATES 4HIS ARTICLE THE THIRD IN A SERIES OF FOUR WILL ADDRESS THE PRESCRIBING OF OPIATE MEDICATIONS FOR TREATMENT OF CHRONIC INTRACTABLE PAIN !S WE DISCUSSED IN THE SECOND ARTICLE IT IS EXTREMELY IMPORTANT TO DEDICATE THE TIME TO PERFORM A THOROUGH HISTORY AND TO PROVIDE A lRST RATE PHYSICAL EXAMINATION TO SUBSTANTIATE THE NEED FOR TREATMENT OF A CHRONIC INTRACTABLE PAIN PATIENT )F A PHYSICIAN IS NOT PREPARED TO DEDICATE THE AMOUNT OF TIME AND DOCUMENTA TION NECESSARY THAT PRACTITIONER SHOULD CON SIDER REFERRING THIS POTENTIALLY COMPLICATED PATIENT TO A PRACTITIONER WHO SPECIALIZES IN THIS TYPE OF CARE &OR THE CHRONIC PAIN PATIENT WHO SUFFERS PERIODIC PAIN WITH PERIODS OF TIME IN WHICH THEY FUNCTION AT A REASONABLY HIGH LEVEL

PERIODIC SHORT TERM IMMEDIATE RELEASE PAIN "9 ! 6 !.$%23/.

- $ $ # !.$ 2)#(!2$ , !5,$ 0H $

MEDICATIONS CAN BE CONSIDERED 7ITH SEVERE PERIODIC PAIN OPIATE MEDICATIONS CAN BE CON SIDERED (OWEVER IF THE PATIENT SUFFERS FROM DAILY PAIN WHICH INTERFERES WITH THE PATIENT S DAILY FUNCTION REGULAR SCHEDULED MEDICATIONS SHOULD BE IMPLEMENTED )F THE PATIENT IS UNRESPONSIVE TO NON OPIATE MEDICATIONS ONE SHOULD THEN CONSIDER PRESCRIBING TIME RELEASE OPIATE MEDICATIONS TO IMPROVE THE PATIENT S CAPABILITY TO FUNCTION 0RESCRIBING METHODS %ACH PRACTITIONER SPECIALIZING IN PAIN MAN AGEMENT MAY HAVE HIS OR HER OWN METHOD OF INSTITUTING OPIATE MEDICATION THERAPY 4HE FOLLOWING IS ONE OPTION !N IMMEDIATE RELEASE VERSION OF THE CHOSEN MEDICATION SHOULD BE GIVEN INITIALLY TO DETERMINE SENSITIVITY OR AL LERGY 7HEN AN APPROPRIATE MEDICATION HAS BEEN SELECTED YOU COULD THEN START THE PATIENT ON A LOW DOSE TIME RELEASE MEDICATION GIVEN ON A SCHEDULED BASIS 4HE PATIENT SHOULD ALSO BE GIVEN A PRESCRIPTION FOR AN IMMEDIATE RELEASE MEDICATION TO BE USED TO COVER THE PAIN THAT MAY NOT BE ADEQUATELY RELIEVED BY THE TIME RELEASE MEDICATION EXAMPLE QD 4HE NEXT APPOINTMENT SHOULD BE IN ONE TO TWO WEEKS )F THE PATIENT HAS HAD TO UTILIZE ALL OF THE BREAKTHROUGH MEDICATIONS A PROPORTIONATE IN CREASE IN THE TIME RELEASE MEDICATION IS THEN PRESCRIBED ACCORDINGLY 4HE DOSAGE IS TITRATED TO ACQUIRE PAIN CONTROL WITH MINIMUM SIDE EFFECTS -OST PAIN AUTHORITIES AGREE THAT LONG ACTING OPIOID ANALGESIC ON A TIME CONTINGENT BASIS IS PREFERRED OVER AN hAS NEEDEDv MEDICA TION (OWEVER IF A PATIENT CANNOT AFFORD TO PURCHASE THE RATHER EXPENSIVE TIME RELEASE MEDICATIONS IT MAY BE APPROPRIATE TO CONSIDER THE USE OF AN IMMEDIATE RELEASE MEDICATION FOR PAIN RELIEF TAKEN ON A PRESCRIBED SCHEDULE 3INCE IMMEDIATE RELEASE OPIOIDS MAY BE PREFERRED BY ABUSERS ONE SHOULD BE MORE CAUTIOUS IN PATIENT SELECTION

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

/RAL ADMINISTRATION IS CONSIDERED THE MOST CONVENIENT AND WITH THE EXCEPTION OF LONG TERM MEDICATIONS IT IS USUALLY CONSID ERED THE MOST COST EFFECTIVE /THER ROUTES OF ADMINISTRATION CAN BE CONSIDERED FOR INSTANCE

TRANSDERMAL FENTANYL OR TRANSMUCOSAL FENTANYL 2ECTAL MORPHINE IS AVAILABLE COMMERCIALLY AND OTHER MEDICATIONS CAN BE COMPOUNDED TO BE USED RECTALLY AND TRANSMUCOSALLY AS AN ALTERNA TIVE TO ORAL MEDICATION 4ITRATION OF THE CHOSEN MEDICATION SHOULD BE DONE TO EFFECT )F THE PATIENT HAS UNDESIR ABLE SIDE EFFECTS DURING TITRATION ANOTHER OPI ATE SHOULD BE CONSIDERED 0ATIENTS MAY HAVE SIGNIlCANT SIDE EFFECTS WITH ONE OPIATE AND NOT WITH ANOTHER OF THE SAME SCHEDULE )N THE CASE OF CHRONIC INTRACTABLE MIGRAINE HEADACHES WITH ALL OTHER AVENUES EXHAUSTED ONE SHOULD CONSIDER THE POSSIBILITY OF TREATING WITH AN OPIATE MEDICATION )N THE CASE OF MIGRAINE HEADACHES WITH VOMITING TREATMENT SHOULD BE WITH TRANSDERMAL SUPPOSITORY OR TRANSMUCOSAL PAIN MEDICATIONS )F A PATIENT SUFFERS FROM A LONG EPISODE OF HEADACHE WITH VOMITING ORAL MEDICATIONS WOULD NOT BE PRACTICAL 7HICH MEDICATION SHALL WE USE 4HERE IS A WIDE VARIETY OF SCHEDULE )) AND ))) OPIATES

EACH OF WHICH HAS SPECIlC INDIVIDUAL PROPERTIES THAT MAY BE APPROPRIATE FOR ANY GIVEN PATIENT &OLLOWING IS A BRIEF DESCRIPTION OF THE MOST COMMONLY USED PAIN MEDICATIONS -ORPHINE OFFERS THE MOST OPTIONS FOR EFFECTIVE ROUTES OF ADMINISTRATION 7HEN RAPID ONSET IS IMPORTANT )- OR SUBCUTANEOUS ADMINISTRA TION OF MORPHINE CAN BE USED -ORPHINE IS ABSORBED FROM ALL OF THE MUCOUS MEMBRANES

INCLUDING SUBLINGUAL BUCCAL AND RECTAL /RAL ABSORPTION TAKES PLACE IN THE SMALL INTESTINE

#ONTINUED ON PAGE

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0AIN -ANAGEMENT #ONTINUED FROM PAGE

WILL HAVE NO ANALGESIC EFFECT FOR THESE INDIVIDU ALS #ODEINE HAS LONG BEEN CONSIDERED THE MOST CONSTIPATING OF ALL THE OPIOIDS

AND IS VIRTUALLY COMPLETE #ONTROLLED RELEASE PREPARATIONS FOR MORPHINE OFFER GREAT ADVAN TAGES FOR LONG TERM THERAPY WITH TERMINAL CAN CER AND NON CANCER PATIENTS BECAUSE THEY CAN PROVIDE CONSTANT PLASMA LEVELS FOR LONG PERIODS OF TIME 3OME DRAWBACKS OF MORPHINE WOULD BE THE TWO MAJOR METABOLITES THAT ARE ELIMI NATED IN THE URINE AND THE BILE -ORPHINE

GLUCURONIDE MAY PLAY A PART IN THE SIDE EFFECTS OF MORPHINE )N PATIENTS WITH IMPAIRED RENAL FAILURE ACCUMULATION OF THESE METABOLITES MAY BECOME IMPORTANT CAUSING lRST INCREASED EF FECT AND THEN WITH INCREASED ACCUMULATION

TOXIC EFFECTS TEND TO DEVELOP

(YDROMORPHONE IS A SEMISYNTHETIC DERIVATIVE OF MORPHINE THAT IS CONSIDERED SIX TO EIGHT TIMES MORE POTENT WHICH MAKES IT A VERY EFFECTIVE ORAL PAIN MEDICATION $UE TO ITS HIGH SOLUBILITY IT IS PARTICULARLY USEFUL SUBCUTANEOUSLY %PI DURAL HYDROMORPHONE HAS A LONG HALF LIFE

RESEMBLING THAT OF EPIDURAL MORPHINE

#ODEINE THE MOST WIDELY USED ANALGESIA IS NOT TYPICALLY CONSIDERED TO BE EFFECTIVE IN TREATING SEVERE PAIN #ODEINE S HALF LIFE RANGES FROM TWO TO FOUR HOURS WITH ANALGESIA LASTING THREE TO SIX HOURS 4HERE IS A GENETIC DIFFERENCE IN SOME PATIENTS WHO MAY NOT BE ABLE TO CONVERT CODEINE TO MORPHINE 3UBSEQUENTLY THIS DRUG

The Beauty of Wilderness Lakeshore

Enjoy the smell of pines, expansive views of undeveloped wilderness and endless federal forest playground just outside your door. This parcel on Greenwood Lake has 220 feet of boulder shoreline and is located near Grand Marais, MN and the Gunflint Trail.

The lake is expansive with clear waters and limited private property.

Your dream cabin fits perfectly here.

The driveway and elevated building site are in place. Gentle sloping lot to a protected bay for your boat and dock.

Price: $299,900.

Gail Englund, Realtor P.O. Box 938 Grand Marais, MN 55604 e-mail: Info@RedPineRealty.com 800/387-9599 / 218/387/9599 www.RedPineRealty.com

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/XYCODONE IS MADE BY MODIFYING MORPHINE )T IS A POTENT -U AGONIST WITH ANALGESIC PO TENCY ALMOST EQUIVALENT TO THAT OF MORPHINE WHEN GIVEN PARENTERALLY )T IS NEARLY TIMES AS POTENT AS CODEINE WHEN GIVEN ORALLY /XY CODONE IS FELT TO HAVE FEWER SIDE EFFECTS THAN MORPHINE -ORPHINE TENDED TO CAUSE MORE NAUSEA COMPARED TO OXYCODONE IN A DOUBLE BLIND CROSSOVER STUDY -ETHADONE IS A SYNTHETIC OPIOID THAT IS SLIGHTLY MORE POTENT BUT CONSIDERED BY SOME TO BE LESS DEPENDENT PRODUCING THAN MORPHINE #ON CEPTUALLY METHADONE PRODUCES LESS EUPHORIA AND LESS SEDATION THAN ANY OTHER OPIOIDS 4HE CENTRAL MECHANISM OF ACTION OF METHADONE IS SIMILAR TO THAT OF MORPHINE -ETHADONE IS WELL ABSORBED ORALLY SO THERE IS LITTLE ADVANTAGE IN ADMINISTERING IT PARENTERALLY -ETHADONE HAS A LONG UNPREDICTABLE HALF LIFE RANGING FROM TO MORE THAN HOURS AND CONSEQUENTLY A LONGER DURATION OF ACTION THAN ANY OF THE AFOREMENTIONED OPIOIDS )T IS CONSIDERED THAT THE LONGER DURATION OF ACTION IS MAINLY DUE TO EXTENSIVE PLASMA BINDING "ECAUSE OF UNPREDICTABILITY OF THE HALF LIFE THIS DRUG CAN BE DIFlCULT TO TITRATE ACCURATELY /RAL DOSES OF TO MG EVERY SIX TO HOURS ARE OFTEN PRESCRIBED $OSES UP TO TO MG EVERY FOUR HOURS HAVE BEEN GIVEN WITHOUT ILL EFFECTS (OWEVER IN TERMINAL CANCER PAIN PATIENTS AND INDIVIDUALS WITH HIGH DEGREES OF TOLERANCE THE RANGE OF DOSAGE AND FREQUENCY VARIES GREATLY ACCORDING TO THE SEVERITY OF THE PAIN AND THE PATIENT S TOLERANCE 4HERE HAVE BEEN RECENT PUBLICATIONS STATING THAT METHADONE MAY BE IMPLICATED IN CARDIAC ARRHYTHMIAS WHEN GIVEN IN DOSES EXCEEDING MG PER DAY -ETHADONE HAS PROVEN ITS EFlCIENCY IN THE MANAGEMENT OF TERMINAL CANCER PATIENTS WITH PAIN AND HAS BEEN GIVEN FOR UP TO TWO YEARS IN SUCH CASES WITHOUT SIGNIlCANT INCIDENCE OF ABUSE

-EPERIDINE BECAUSE OF ITS NEURO TOXIC METABO LITES IS NOT TYPICALLY RECOMMENDED FOR THE TREAT MENT OF PAIN ESPECIALLY CHRONIC PAIN #HRONIC DOSES CAN LEAD TO ACCUMULATION OF METABOLITES THAT CAN RESULT IN #.3 IRRITABILITY AND THESE METABOLITES HAVE BEEN IMPLICATED IN SEIZURES .ALOXONE DOES NOT REVERSE MEPERIDINE INDUCED SEIZURES MAKING IT EVEN LESS APPROPRIATE FOR PAIN MANAGEMENT &ENTANYL HAS A HIGH LIPID SOLUBILITY WHICH FACILITATES TRANSFER ACROSS THE BLOOD BRAIN BAR RIER &ENTANYL IS TO TIMES MORE POTENT THAN MORPHINE 4RANSDERMAL FENTANYL GIVES THE SAME DEGREE OF PAIN CONTROL AS MORPHINE BUT IS ASSOCIATED WITH SIGNIlCANTLY LESS CON STIPATION NAUSEA AND DAYTIME DROWSINESS 4ITRATION SHOULD BE DONE SLOWLY DUE TO THE DELAYED ONSET OF ACTION 4HERE IS A PROLONGED DURATION OF ACTION CAUSED BY THE SUBCUTANEOUS hLIPID RESERVOIR v WHICH WOULD INmUENCE THE TRANSITION FROM FENTANYL TO ANOTHER OPIOID MEDICATION #OMBINATION MEDICATIONS ARE COMMONLY PRESCRIBED FOR PAIN 4HESE MEDICATIONS HAVE DOSAGE LIMITS 4HE LIMITS FOR ACETAMINOPHEN TAKEN FOR MORE THAN DAYS IS MG LESS THAN DAYS IS MG $OSAGES ABOVE THESE LEVELS ARE CONSIDERED POTENTIALLY HEPATO TOXIC !SPIRIN HAS BEEN IMPLICATED IN ') BLEEDING AND KIDNEY DAMAGE IN VARIABLE DOSAGES DEPENDING ON THE INDIVIDUAL TOLERANCE ,ONG TERM USE OF MEDICATIONS THAT ARE IN COMBINATION WITH ACETAMINOPHEN OR ASPIRIN MUST BE CAREFULLY MONITORED FOR POTENTIAL END ORGAN DAMAGE 3INCE THERE IS NO KNOWN ORGAN DAMAGE BY OPIOID MEDICATIONS TREATMENT OF CHRONIC PAIN PATIENTS SHOULD BE WITH NON COMBINA TION OPIOIDS AS MUCH AS IS POSSIBLE !S STATED IN THE SECOND ARTICLE OF THIS FOUR PART SERIES WHEN UTILIZING THE 7(/ 3TAIRSTEP 3YSTEM IN TREATING PAIN ADJUNCTIVE MEDICATION SHOULD BE CONTINUED THROUGHOUT ALL THREE STEPS ENCOURAGED BY THE 7(/ RECOMMENDATION (OWEVER IT SHOULD BE NOTED THAT SOME OF THE ADJUNCTIVE MEDICATION MIGHT CONTRIBUTE TO DROWSINESS EVEN OVER AND ABOVE THAT WHICH MIGHT BE ENCOUNTERED BY USE OF THE OPIOID TREATMENT 4YPICALLY THE DROWSINESS ASSOCIATED WITH OPIOIDS TENDS TO DECREASE AS THE TOLERANCE OF THE PATIENT INCREASES 4HE OPIATE DRUGS ACTIVATE THE OPIATE RECEPTORS THAT MIMIC THE NATURAL EFFECT OF THE ENDOGENOUS ENDORPHINS AND ENKEPHALINS 4HE

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

GREATER THE QUANTITY OF AGONISTS ADMINISTERED

THE MORE SIGNIlCANT THE ANALGESIA AND ALSO THE MORE PRONOUNCED THE ADVERSE EFFECTS MIGHT BE 2ESPIRATORY DEPRESSION IS A FEAR OF MANY CLINICIANS WHO ADMINISTER POTENT DOSES OF NARCOTICS 4HE FEAR OF RESPIRATORY DEPRESSION APPEARS TO BE MISPLACED 4HIS DOES NOT OCCUR AS FREQUENTLY WITH PATIENTS WHO HAVE BEEN ON NARCOTICS FOR AN EXTENDED PERIOD OF TIME 3IG NIlCANT RESPIRATORY DEPRESSION IS NOT COMMON IN PATIENTS WHO ARE NOT NARCOTIC NAIVE "ECAUSE CONSTIPATION IS A SIDE EFFECT OF ALL OPIOID MEDICATION A BOWEL PROGRAM SHOULD BE INITIATED ANY TIME OPIOID THERAPY IS PRESCRIBED 4HROUGHOUT THE TREATMENT PROGRAM THE CLINI CIAN SHOULD BE MOST DILIGENT IN MONITORING SIDE EFFECTS 4HIS WOULD INCLUDE CONSTIPATION

SEDATION AND UNTOWARD SIDE EFFECTS SUCH AS OUT AND OUT ALLERGIC REACTIONS 0OST 3URGERY -EDICATION FOR THE )NTRACTABLE 0AIN 0ATIENT 4HE PREOPERATIVE DOSE OF MEDICATION IS NEVER ADEQUATE FOR POSTOPERATIVE PAIN )N MOST IN STANCES THE PREOPERATIVE DOSE SHOULD BE CONTIN UED WITH AT LEAST PERCENT AND PERHAPS EVEN PERCENT INCREASE IN DOSAGE TO ADEQUATELY PROVIDE ANALGESIA /F COURSE OXYGEN SATURATION SHOULD BE MONITORED POSTOPERATIVELY ON AN ON GOING BASIS WHEN ADMINISTERING HIGH DOSES OF OPIATES !N EXAMPLE BY ,LOYD 3ABERSKI - $

4HE 0AIN #LINIC *ULY !UGUST ! PATIENT COMES TO THE /2 ON -3 #ONTIN MG QD

POSTOPERATIVELY THE -3 #ONTIN SHOULD BE CON TINUED AND THE INITIAL BREAKTHROUGH MEDICATION COULD BE MG 0/ OF RAPID RELEASE MORPHINE EVERY HOURS FOR PAIN RELIEF )F NOT EFFECTIVE

THE DOSE CAN BE ADJUSTED ACCORDINGLY &OR MORPHINE )6 THE 0/ TO )6 CONVERSION IS TO 4HE BASAL INFUSION OF MORPHINE AT ABOUT MG PER HOUR MG DAY 4HE BREAKTHROUGH DOSE IS PERCENT EVERY HOURS OR PERCENT EVERY HOURS 4HUS -3 MG )6 Q HOURS COULD BE THE INITIAL ORDERS &OR 0#!

THE BASAL INFUSION WOULD BE MG PER HOUR WITH AN INI TIAL DEMAND DOSE MG EVERY MINUTES !D JUSTMENTS WOULD BE MADE DEPENDING ON THE PATIENT S RESPONSE 4HE POST DISCHARGE DOSAGES WOULD DEPEND ON RESPONSE AND REHABILITATION EXPECTATIONS 0OST SURGICAL REHABILITATION CAN BE ENHANCED BY APPROPRIATE USE OF MEDICATION

GIVING THE PATIENT ASSURANCE OF ADEQUATE PAIN CONTROL DURING EXERCISE GRADUALLY REDUCING MEDICATION BASED ON FUNCTION

4OLERANCE AND !DDICTION 7HEN A PHYSICIAN BEGINS PRESCRIBING NARCOTICS

THERE PERSISTS A FEAR OF TOLERANCE AND ADDICTION 4HESE FEARS HAVE BEEN OVER EMPHASIZED IN POPULAR THINKING AND EVEN IN SOME LITERATURE 4HERE ARE MANY STUDIES AVAILABLE THAT SHOW THAT ADDICTION IN A PAIN PATIENT IS RELATIVELY RARE )N ONE STUDY PAIN PATIENTS WHO WERE RECEIVING NARCOTICS WERE FOLLOWED /NLY FOUR OF THE PATIENTS BECAME ADDICTED 4OLERANCE DOES NOT APPEAR TO BE COMMON AMONG PAIN SUFFERERS )NCREASING DOSES OF NARCOTICS ARE LIKELY ATTRIBUT ABLE TO THE PROGRESSION OF THE DISEASE RATHER THAN TOLERANCE 0ATIENTS ON LONG TERM NARCOTIC THERAPY MAY REQUIRE INCREASED DOSES 4HIS SHOULD NOT BE CONSIDERED A SIGN OF ADDICTION ! SUMMARY OF SEVERAL STUDIES INDICATES THAT TOXICITY AND AD DICTION ARE NOT SIGNIlCANT PROBLEMS %FlCACY IS ACHIEVABLE IN CHRONIC NONMALIGNANT PAIN PATIENTS WITH THE APPROPRIATE USE OF NARCOTIC PHARMACOTHERAPY !NOTHER MISUNDERSTANDING THAT HAS BEEN PERPETUATED IN MEDICINE HAS BEEN THAT THE PATIENT WILL hHURT THEMSELVESv BY BLOCKING PAIN WITH A NARCOTIC )T SHOULD BE NOTED THAT OPIATES RELIEVE THE SUBJECTIVE SUFFERING COMPONENT OF PAIN WITHOUT INTERFERING WITH BASIC SENSATIONS SUCH AS LIGHT TOUCH PINPRICK SENSATION TEMPERA TURE PERCEPTION POSITION ETC )N A DIFlCULT TO TREAT INTRACTABLE PAIN SYN DROME IT MAY BE NECESSARY TO CONSIDER A ROTATION FROM THE ORIGINAL OPIATE TO ANOTHER ONE 4HE RESPONSIVENESS OF AN INDIVIDUAL PATIENT TO A SPE CIlC DRUG CANNOT BE DETERMINED UNLESS THE DOSE REACHES TREATMENT LIMITING TOXICITY "ECAUSE RESPONSIVENESS MAY BE LIMITED BY TREATMENT SIDE EFFECTS THE TREATMENT OF THE SIDE EFFECTS IS AN ES SENTIAL ELEMENT OF OPIOID THERAPY )N ROTATING THE NARCOTIC ONE SHOULD SELECT THE EQUIVALENT DOSE OF THE PROPOSED NEXT THERAPEUTIC OPIOID STARTING AT APPROXIMATELY PERCENT )F THE PAIN IS SEVERE

ONE SHOULD CONSIDER LESS OF A REDUCTION OF THE EQUIANALGESIC DOSE /NE CAN CONSIDER A GREATER REDUCTION IN THE EQUIANALGESIC DOSE IF THE PATIENT IS MEDICALLY FRAIL )F CONVERTING FROM FENTANYL TO ANOTHER MEDICATION LESS OF A REDUCTION WOULD BE NECESSARY IN THE SWITCH TO ANOTHER OPIATE )F

HOWEVER SWITCHING TO METHADONE FROM ANOTHER MEDICATION YOU SHOULD REDUCE THE STARTING DOSE OF AN EQUIANALGESIC BASIS TO TO PERCENT BEFORE RE TITRATING 4HIS IS TO ASSURE THAT THE COMPLICATING OVERDOSE OF METHADONE COULD BE AVOIDED 4HE PRACTITIONER SHOULD CONTINUE TO BEAR IN MIND THAT PATIENTS RESPOND DIFFER ENTLY AND UNPREDICTABLY TO DIFFERENT -U OPIOID

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

ANALGESICS 4HIS REQUIRES INDIVIDUALIZATION OF TREATMENT )T SHOULD BE CONSIDERED THAT THERE MIGHT BE DIFFERENCES IN RESPONSE TO OPIOIDS RELATED TO GENETIC ISSUES #LINICALLY PATIENTS SHOW INCOM PLETE CROSS TOLERANCE WHEN SWITCHED FROM ONE -U ANALGESIC TO ANOTHER 4HIS MAY EXPLAIN THE ADVANTAGES OF OPIOID ROTATION IN A DIFlCULT TO MANAGE PATIENT #ONCLUSION 4HE TREATMENT OF PAIN ESPECIALLY COMPLEX INTRACTABLE PAIN PRESENTS A CONSIDERABLE CHAL LENGE BECAUSE OF THE COMPLEX NATURE OF CHRONIC PAIN INCLUDING PHYSIOLOGICAL PSYCHOLOGICAL

AND ANATOMICAL FACTORS &ORTUNATELY THERE IS A BROAD SPECTRUM OF ANALGESIC MEDICATIONS AVAIL ABLE TO THE PAIN PRACTITIONER EACH MEDICATION WITH ITS OWN PROlLE OF ADVANTAGES AND SIDE EFFECTS AND MANY AVAILABLE IN MULTIPLE PREPA RATIONS AND ROUTES OF ADMINISTRATION TO ACCOM MODATE SPECIlC NEEDS OF INDIVIDUAL PATIENTS 4HE METHODS OF USAGE SUGGESTED IN THIS ARTICLE HAVE BEEN SUPPORTED BY NUMEROUS AUTHORS AND ASSOCIATIONS /PIATES CAN BE A VALUABLE TOOL IN THE MANAGEMENT OF CHRONIC PAIN *UDICIOUS USE APPROPRIATE DOCUMENTATION AWARENESS OF POTENTIAL ABUSE AND DUE DILIGENCE IN MONITOR ING PATIENT S FUNCTION IS NECESSARY IN PRESCRIBING FOR YOUR PAIN PATIENTS

3OURCES ARE AVAILABLE UPON REQUEST !LFRED 6 !NDERSON - $ $ # IS A PAIN MAN AGEMENT AND MANIPULATIVE MEDICINE SPECIALIST AND IS ALSO A LICENSED CHIROPRACTOR (E OPERATES THE 0AIN !SSESSMENT 2EHABILITATION #ENTER ,TD IN %DINA (E IS A $IPLOMAT IN 0AIN -ANAGEMENT

THE !MERICAN !CADEMY OF 0AIN -ANAGEMENT $R !NDERSON SERVES ON THE "OARD OF $IRECTORS OF THE -INNESOTA 0HYSICIAN 0ATIENT !LLIANCE AND ON THE "OARD OF -EDICAL 0RACTICE FROM THE SECOND CONGRESSIONAL DISTRICT 2ICHARD , !ULD 0H $ HAS SERVED AS THE ASSISTANT EXECUTIVE DIRECTOR AT THE "OARD OF -EDICAL 0RACTICE SINCE (E IS PRIMARILY RESPONSIBLE FOR CONSTIT UENT OUTREACH POLICY AND PLANNING EDUCATIONAL DEVELOPMENT AND LEGISLATIVE MATTERS

-ARCH !PRIL

4IPS FOR -INIMIZING $ISPUTES IN 7ORKERS #OMPENSATION #ASES

)

)4 3)-0,9 )3 ./4 0/33)",% TO ELIMINATE DISPUTES IN WORKERS COMPENSATION CASES )NSURERS WILL ALWAYS DENY SOME LEGITIMATE CLAIMS WITH NO JUSTIlCATION (OWEVER IT IS POSSIBLE TO MINIMIZE THE LIKELIHOOD OF A DISPUTE ARISING AND MAXIMIZE YOUR CHANCES OF SUCCESSFULLY RESOLVING THE DISPUTE IN YOUR FAVOR +EEP 'OOD 2ECORDS

4HE BEST WAY TO MINIMIZE DISPUTES CONCERNING PAYMENT OF YOUR BILLS AND PAYMENT OF YOUR PATIENT S WAGE LOSS AND OTHER BENElTS IS TO MAINTAIN GOOD MEDICAL RECORDS )F YOU MAINTAIN APPROPRIATE RECORDS YOU BUILD AN AIRTIGHT CASE WHICH IS VERY DIFlCULT FOR THE INSURER TO DISPUTE 'OOD RECORDS INCLUDE THE FOLLOWING 9OUR RECORDS SHOULD BE LEGIBLE 4YPEWRITTEN RECORDS ARE BEST )F HANDWRITTEN YOUR RECORDS MUST BE LEGIBLE 9OUR RECORDS SHOULD BE EASILY UNDERSTAND ABLE 2EMEMBER THAT YOU ARE NOT CREATING YOUR RECORDS JUST FOR YOUR USE #LAIMS AD JUSTORS AND JUDGES WILL REVIEW YOUR RECORDS TO DETERMINE WHETHER OR NOT YOU GET PAID 3TAY AWAY FROM lLL IN THE BLANK OR CHECK OFF FORMS $O NOT USE ABBREVIATIONS OR SHORT HAND NOTATIONS THAT ONLY YOU AND YOUR STAFF CAN DECIPHER #ONCISE NARRATIVE ENTRIES WRIT TEN IN PLAIN %NGLISH ARE BEST 9OUR RECORDS SHOULD DOCUMENT YOUR UNDER STANDING OF YOUR PATIENT S HISTORY SO THAT IT IS CLEAR YOUR OPINION ON CAUSATION IS WELL FOUNDED 9OUR DIAGNOSIS SHOULD BE CLEARLY STATED $O NOT EXPECT JUDGES TO UNDERSTAND THE DIAGNOSIS CODES USED IN BILLING FORMS 9OUR OPINION THAT YOUR PATIENT S CONDITION WAS CAUSED BY A WORK RELATED INCIDENT SHOULD BE PLAINLY AND UNEQUIVOCALLY STATED 9OUR TREATMENT PLAN SHOULD BE CLEARLY SET FORTH ! GOOD TREATMENT PLAN INCLUDES THE

-ARCH !PRIL

MODALITIES OF TREATMENT YOU INTEND TO PROVIDE INCLUDING ANY SELF TREATMENT TECHNIQUES AND EXERCISES YOU PRESCRIBE YOUR RECOMMENDED FREQUENCY OF TREATMENT YOUR EXPECTED DURA TION OF TREATMENT UNTIL YOUR NEXT RE EXAMINA TION AND THE GOALS YOU EXPECT TO ACHIEVE WITH YOUR TREATMENT 9OUR DAILY NOTES SHOULD DEMONSTRATE THAT YOU ARE FOLLOWING YOUR TREATMENT PLAN 9OUR PATIENT S PROGRESS SUBJECTIVELY OBJEC TIVELY AND IN FUNCTIONAL STATUS SHOULD BE CLEARLY DOCUMENTED 9OUR RECORDS SHOULD DOCUMENT YOUR EFFORTS TO DECREASE THE FREQUENCY OF YOUR TREATMENT

DECREASE YOUR PATIENT S RELIANCE ON YOUR CARE

AND RETURN YOUR PATIENT TO A STATE OF INDEPEN DENCE FROM CARE )F YOUR PATIENT DOES NOT RESPOND AS QUICKLY AS NORMALLY EXPECTED YOUR RECORDS SHOULD EXPLAIN WHY NOT AND WHAT YOU INTEND TO DO ABOUT IT 9OUR RECORDS SHOULD BE TAILORED TO SHOW THAT YOU HAVE COMPLIED WITH THE TREATMENT PARAMETERS INCLUDING NOTICE REQUIREMENTS AND DEPARTURE SECTIONS IF TREATMENT CONTINUES BEYOND WEEKS 5SE THE #ORRECT "ILLING &ORM

-INN 3TAT e SUBD AND -INN 2ULE

SUBP A PROVIDE THAT YOU WILL NOT BE PAID UNLESS YOU SUBMIT YOUR CHARGES ON THE (#&! FORM &OLLOW THE 4REATMENT 0ARAMETERS AND 0ROVIDE .OTICE OF ANY $EPARTURE

4HE JUDGES WILL APPLY THE TREATMENT PARAMETERS TO DETERMINE WHETHER OR NOT YOUR BILL MUST BE PAID IN ALL BUT THE MOST EXCEPTIONAL CIRCUMSTANCES ,EARN WHAT THE TREATMENT PARAMETERS ACTUALLY SAY #OMPLY WITH THEIR REQUIREMENTS 4REATMENT BEYOND WEEKS IS ALLOWED BUT YOU HAVE TO PROVIDE NOTIlCATION TO THE INSURER AND JUSTIFY

THE ADDITIONAL CARE UNDER ONE OF THE DEPARTURE SECTIONS

)DENTIFY IN YOUR RECORDS WHICH TREATMENT PARAMETERS YOU ARE FOLLOWING AND WHY YOUR TREATMENT COMPLIES WITH THAT PARAMETER

)F YOU DECIDE TO DEPART FROM THE PARAMETERS

MAKE SURE YOU PROVIDE PROPER WRITTEN NOTIlCATION OF YOUR INTENT TO DEPART WITHIN THE TIME LIMITS SEVEN BUSINESS DAYS BEFORE THE END OF THE WEEKS OR TWO BUSINESS DAYS AFTER REINITIATION OF TREATMENT )NCLUDE IN YOUR NOTIlCATION LETTER A DETAILED DESCRIPTION OF YOUR TREATMENT PLAN AND WHY THE TREATMENT IS NECESSARY IDENTIFYING THE DEPARTURE SECTION YOU FEEL APPLIES

-AINTAIN WRITTEN DOCUMENTATION OF ALL CONTACTS WITH THE INSURER 4HIS SHOULD INCLUDE DOCUMENTATION OF ALL TELEPHONE CONVERSATIONS A COPY OF YOUR PRIOR NOTIlCATION LETTER A COPY OF ANY RESPONSE YOU RECEIVE FROM THE INSURER AND YOUR REQUEST OF THE INSURER THAT THEY OBTAIN A REVIEW OF THEIR DENIAL 0ROVIDE THE )NSURER 7ITH 9OUR 2ECORDS AND 9OUR "ILLS

-INN 3TAT e SUBD REQUIRES YOU TO SUBMIT BOTH YOUR (#&! ITEMIZED BILLING STATEMENT AND COPIES OF YOUR RECORDS TO THE IN SURER 4HE DAY PERIOD TO PAY OR DENY YOUR BILL DOES NOT BEGIN TO RUN UNTIL BOTH YOUR BILLS AND YOUR RECORDS ARE SUBMITTED )NCLUDE !CTIVE &ORMS OF 4REATMENT IN 9OUR 0LAN

4HE TREATMENT PARAMETERS STRONGLY ENCOURAGE THE USE OF hACTIVEv TREATMENT MODALITIES TO ENSURE THAT THE EMPLOYEE IS PARTICIPATING IN HIS HER OWN RECOVERY AND TO ENCOURAGE INDEPENDENCE FROM PROLONGED hPASSIVEv CARE 4HE PRIMARY FORM OF hACTIVEv TREATMENT ENCOURAGED BY THE PARAMETERS IS EXERCISE *UDGES ALWAYS LOOK TO SEE IF A PROVIDER HAS INSTRUCTED THE EMPLOYEE IN EXERCISES AND EN COURAGED THE EMPLOYEE TO PERFORM THE EXERCISES

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

IN ORDER TO REGAIN AND MAINTAIN STRENGTH AND mEX IBILITY 9OUR RECORDS SHOULD CLEARLY DEMONSTRATE WHAT EXERCISES YOU HAVE TAUGHT TO YOUR PATIENT

WHEN YOU lRST ADDED EXERCISES TO YOUR TREATMENT PLAN AND WHETHER OR NOT YOU HAVE CONTINUED TO ENCOURAGE YOUR PATIENT TO PERFORM THEIR EXERCISES THROUGHOUT THE TIME YOU TREAT THEM

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4HERE IS USUALLY A GOOD REASON WHY PATIENTS DO NOT RECOVER AS QUICKLY AS EXPECTED 4HEIR WORK ACTIVITIES MAY RESULT IN AN ONGOING AGGRAVATION OF THEIR CONDITION 4HEY MAY EXPERIENCE A mARE UP OR SET BACK WHICH TEMPORARILY UNDOES THE PROGRESS YOUR TREATMENT ACHIEVED 4HEY MAY HAVE AN UNDERLYING MEDICAL COMPLICATION SUCH AS A HERNIATED DISC CHRONIC DISEASE OR BODY HABITUS

WHICH PROLONGS THEIR RECOVERY -AKE SURE YOU CLEARLY DOCUMENT SUCH FACTORS AND EXPLAIN IN YOUR RECORDS HOW THEY PROLONGED YOUR PATIENT S RECOVERY THEREBY NECESSITATING MORE TREATMENT THAN hNORMAL v

6 -&/& ( -" */"*.&1&./ 6 "-) /+(+$4 6 )&(4 - /& " 6 (+ / ++( 6 ./-+"*/"-+(+$4 6 "*"- ( 0-$"+* 6 "-& /-& & * 6 +.,&/ (&./ +- "!.

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#ONSIDER !LTERNATE &ORMS OF #ARE AND 2EFERRALS 7HEN !PPROPRIATE

.OT EVERYONE RESPONDS TO TREATMENT AS EXPECTED 3OME PATIENTS SIMPLY WILL NOT IMPROVE DESPITE YOUR BEST EFFORTS 5NLESS YOU ARE WILLING TO PRO VIDE TREATMENT FOR FREE YOU NEED TO CHANGE YOUR TREATMENT PLAN FOR SUCH PATIENTS *UDGES WILL LOOK TO SEE IF YOU ATTEMPTED ALTERNATE FORMS OF CARE WITH TOUGH PATIENTS *UDGES HATE TO SEE MONTH AFTER MONTH OF IDENTICAL TREATMENT PROVIDED TO PATIENTS WHO SIMPLY ARE NOT GETTING BETTER !LSO CONSIDER REFERRING PATIENTS TO OTHER PROVIDERS IF THEY DO NOT RESPOND TO YOUR TREATMENT ! FRIENDLY NEUROLOGIST ORTHOPEDIST OR PHYSIATRIST MAY HAVE AN OPTION AVAILABLE FOR YOUR PATIENT OR MAY AGREE THAT CONTINUED 02. CHIROPRACTIC TREATMENT FOR mARE UPS IS THE BEST PLAN

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#ONCLUSION

$ISPUTES IN WORKERS COMPENSATION CASES WILL NEVER BE ELIMINATED (OWEVER IF YOU FOLLOW SOME SIMPLE ADVICE YOU CAN MINIMIZE THE LIKELIHOOD OF DISPUTES AND MAXIMIZE THE LIKELIHOOD THAT THE DISPUTE WILL BE RESOLVED IN YOUR FAVOR

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-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

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-ARCH !PRIL

%XIT 0LANNING 7HAT IS IT hx)N THIS WORLD NOTHING IS CERTAIN BUT DEATH TAXES AND BUSINESS PARTNERS EXITING THEIR BUSINESSES v "ENJAMIN &RANKLIN "ROWN

/

/+!9 3/ -!9"% THERE ARE A FEW OTHER

VERITIES IN LIFE BESIDES EXITING YOUR BUSINESS PRACTICE BUT FEW WILL HAVE SUCH LASTING IMPACT AND FEWER STILL CAN BE SO POSITIVELY INmUENCED

BY YOUR INPUT AND ACTION !ND YOU WILL EXIT YOUR PRACTICE SOMEDAY 5NFORTUNATELY IF YOU ARE TYPICAL OF THE MAJORITY OF PHYSICIANS WHO ARE PARTNERS IN THEIR PRACTICE YOU ARE WITHOUT A WRITTEN PLAN DESCRIBING YOUR EXIT PLANNING STRATEGY 9OU HAVE PROBABLY SPENT A FAIR AMOUNT OF TIME THINK ING ABOUT hLIFE AFTER WORKv BUT YOU HAVE DONE LITTLE TO GET YOURSELF THERE 4HE MOST COMMON REASONS WHY FEW PARTNERS TAKE THE TIME AND MAKE THE EFFORT TO PLAN ARE s .O TIME s $ON T KNOW WHAT CAN BE DONE s $ON T KNOW HOW TO ENGAGE IN PLANNING PROCESS s $ON T HAVE CLEARLY DElNED GOALS s &EAR OF THE UNKNOWN Â&#x2C6; LIFE AFTER WORK AND s .OT READY TO LEAVE THE PRACTICE SO WHY PLAN NOW 4HIS ARTICLE IS DESIGNED TO SWEEP AWAY SOME OF THE MYSTERY SURROUNDING LEAVING YOUR PRACTICE IN STYLE %XIT 0LANNING IS BASED ON THIS SIMPLE PREMISE !T SOME POINT EVERY PARTNER LEAVES HIS OR HER PRACTICE Â&#x2C6; VOLUNTARILY OR OTHERWISE !T THAT TIME EVERY PARTNER WANTS TO RECEIVE THE MAXIMUM AMOUNT OF MONEY IN ORDER TO ACCOMPLISH PERSONAL lNANCIAL INCOME AND ESTATE PLANNING GOALS 0ARTNERS BEGIN THINKING ABOUT THE %XIT 0LANNING PROCESS WHEN TWO STREAMS OF THOUGHT BEGIN TO CONVERGE 4HE lRST STREAM IS A FEELING THAT YOU WANT TO DO SOMETHING BESIDES GO TO WORK EVERY DAY Â&#x2C6; EITHER YOU WOULD LIKE TO BE SOMEPLACE ELSE Â&#x2C6; DOING SOMETHING ELSE Â&#x2C6; OR YOU SIMPLY NO LONGER GET THE SAME KICK OUT "9 $9!..% 2/33 (!.3/.

-ARCH !PRIL

OF DOING WHAT YOU ARE DOING 4HE SECOND STREAM IS THE GENERAL AWARENESS THAT YOU ARE EITHER APPROACHING lNANCIAL INDEPENDENCE OR MAKING SIGNIlCANT STRIDES TOWARD REACHING THAT GOAL OR CAN ACHIEVE lNANCIAL INDEPENDENCE BY SELLING YOUR INTEREST 7HEN THESE TWO STREAMS CONVERGE THOUGHTS FLOW INEVITABLY TOWARD EXITING THE PRACTICE (OPEFULLY WHEN THAT HAPPENS YOUR %XIT 0LAN IS IN PLACE AND YOU ARE ACTUALLY ABLE TO LEAVE THE PRACTICE WHEN YOU WANT TO 4HAT IN A NUTSHELL IS THE PURPOSE OF %XIT 0LANNING Â&#x2C6; TO LEAVE YOUR PRACTICE ON YOUR TERMS AND ON YOUR SCHEDULE "UT WHAT EXACTLY IS AN h%XIT 0LANv THAT ALLOWS A PARTNER TO LEAVE HIS HER PRACTICE IN STYLE !ND JUST HOW IS ONE CREATED /F COURSE EXACT PLANS VARY BUT PROPERLY CRAFTED EACH PLAN HAS SEVERAL COMMON ELE MENTS ) lND THAT PARTNERS BEST GRASP THESE ELEMENTS OR STEPS WHEN ) FRAME THEM AS QUESTIONS 34%0 %XIT /BJECTIVES (AVE YOU DETER MINED YOUR PRIMARY PLANNING OBJECTIVES IN LEAVING THE PRACTICE SUCH AS s $EPARTURE DATE s )NCOME NEEDED TO ACHIEVE lNANCIAL SECU RITY s 4O WHOM DO YOU WANT TO LEAVE THE PRAC TICE 34%0 6ALUATION $O YOU KNOW HOW MUCH YOUR INTEREST IS WORTH 34%0 -AKING THE 0RACTICE -ORE 6ALUABLE $O YOU KNOW HOW TO INCREASE THE VALUE OF YOUR OWNERSHIP INTEREST 34%0 4RANSFER TO %XISTING 0ARTNERS $O YOU KNOW HOW TO TRANSFER YOUR INTEREST TO CO EMPLOYEES WHILE PAYING THE LEAST POSSIBLE TAXES AND ENJOYING MAXIMUM lNANCIAL SECURITY 34%0 "USINESS #ONTINUITY 5PON $EATH OR $ISABILITY (AVE YOU IMPLEMENTED ALL

NECESSARY STEPS TO INSURE THAT THE PRACTICE CONTINUES IF YOU DON T 34%0 %STATE 0LAN (AVE YOU PROVIDED FOR YOUR FAMILY S SECURITY AND CONTINUITY SHOULD YOU DIE OR BECOME INCAPACITATED 7HILE TIME AND EXPERIENCE CAN PRODUCE OPERATIONAL BUSINESS SUCCESS IT DOES LITTLE TO EQUIP PARTNERS ON HOW TO LEAVE THEIR PRACTICES %XPERIENCE LEARNING AND hTRIAL AND ERRORv ALL REQUIRE TIME Â&#x2C6; A LUXURY MOST PARTNERS DO NOT ENJOY AS THEY APPROACH THE END OF THEIR OWNER SHIP LIVES /NCE MOST PARTNERS BEGIN TO THINK ABOUT LEAVING THEY WANT OUT SOONER RATHER THAN LATER )NSTEAD PARTNERS NEED s !N EFFECTIVE PLAN "ASE YOUR PLAN ON THE SIX STEPS MENTIONED s %XPERIENCED ADVISORS #HOOSE ADVISORS WHO HAVE SEEN AND LEARNED FROM THE FAILURES AND SUCCESSES OF OTHER PHYSICIANS LEAVING THEIR PRACTICES 4HEY SHOULD GUIDE YOU THROUGH THE EXIT PROCESS SO YOU CAN AVOID COSTLY MISTAKES s 4IME -AKE IT AN ALLY BY STARTING YOUR %XIT 0LAN NOW %XITING YOUR PRACTICE WILL BE ONE OF THE MOST IMPORTANT lNANCIAL EVENTS OF YOUR LIFE TIME &EW PARTNERS HAVE EXPERIENCED LEAVING A PRACTICE #ONSEQUENTLY FEW KNOW HOW TO APPROACH THE EXIT PROCESS WHOSE ADVICE TO TAKE OR WHEN TO BEGIN ) SUGGEST DESIGNING AN %XIT 0LAN USED BY OTHERS BEFORE YOU CHOOSE THE TYPE OF ADVISORS WHO CAN HELP YOU AT EACH STEP 4HE lNAL ELEMENT Â&#x2C6; WHEN TO BEGIN Â&#x2C6; IS UP TO YOU

$YANNE 2OSS (ANSON #,5 #&0 #(&# IS A SE NIOR ASSOCIATE WITH THE lRM OF .ORTH 3TAR 2ESOURCE 'ROUP )NC IN -INNEAPOLIS 3HE IS THE AUTHOR OF NUMEROUS ARTICLES AND LECTURES DIRECTED AT AS SISTING PHYSICIANS AND BUSINESS OWNERS AND THEIR ADVISORS ON %XIT 0LANNING 3HE CAN BE REACHED AT DYANNE ROSSHANOSN NORTHSTARlNANCIAL COM

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

02%3)$%.4 3 -%33!'% #(!2,%3 ' 4%2:)!.

- $

3TRIVING TO %NSURE A (EALTHY -EDICAL 0RACTICE %NVIRONMENT 2-3 /FlCERS

2-3 "OARD -EMBERS

4ODD $ "RANDT - $ !T ,ARGE $IRECTOR 6ICTOR 3 #OX - $ 3PECIALTY $IRECTOR ,AURA ! $EAN - $ 3PECIALTY $IRECTOR *EREMY #ARLSON -EDICAL 3TUDENT !NDREW 3 &INK - $ !T ,ARGE $IRECTOR 2ONNELL ! (ANSEN - $ 3PECIALTY $IRECTOR *AMES * *ORDAN - $ 3PECIALTY $IRECTOR "RADLEY # ,INDEN - $ 2ESIDENT 0HYSICIAN 4HOMAS * ,OSASSO - $ !T ,ARGE $IRECTOR 2OBERT # -ORAVEC - $ !T ,ARGE $IRECTOR *ANE # 0EDERSON - $ - 3 3PECIALTY $IRECTOR ,ON " 0ETERSON - $ !T ,ARGE $IRECTOR 4HOMAS $ 3IEFFERMAN - $ 3PECIALTY $IRECTOR *ACQUES 0 3TASSART - $ !T ,ARGE $IRECTOR $AVID # 4HORSON - $ 3PECIALTY $IRECTOR 0ETER " 7ILTON - $ !T ,ARGE $IRECTOR 2-3 %X /FlCIO "OARD -EMBERS #OUNCIL #HAIRS

"LANTON "ESSINGER - $ !-! !LTERNATE $ELEGATE 6ICTOR 3 #OX - $ #OMMUNICATIONS #OUNCIL #HAIR +ENNETH 7 #RABB - $ !-! $ELEGATE 2OBERT 7 'EIST - $ %THICS 0ROFESSIONALISM #OUNCIL #HAIR &RANK * )NDIHAR - $ !-! $ELEGATE .EAL 2 (OLTAN - $ #OMMUNITY (EALTH #OUNCIL #HAIR -ARK +LEINSCHMIDT #LINIC !DMINISTRATOR !NTHONY /RECCHIA - $ %DUCATION 2ESOURCE #OUNCIL #HAIR 3TEPHANIE $ 3TANTON 6ICE 3PEAKER

!-! -EDICAL 3TUDENT 3ECTION ,YLE * 3WENSON - $ 0UBLIC 0OLICY #OUNCIL #HAIR 7AYNE ( 4HALHUBER - $ 3R 0HYSICIANS !SSOCIATION 0RESIDENT 2-3 %XECUTIVE 3TAFF

2OGER + *OHNSON #!% #HIEF %XECUTIVE /FlCER +ATIE !NDERSON %XECUTIVE !SSISTANT $OREEN - (INES -EMBERSHIP 7EB 3ITE #OORDINATOR

!

!3 4(% 02%3)$%.4 OF THE 2AMSEY -EDI CAL 3OCIETY FOR ) SHOULD lRST INTRODUCE MYSELF ) AM AN )NTERNIST FUNCTIONING AS A (OSPITALIST FOR THE !LLINA -EDICAL #LINICS AT 5NITED (OSPITAL ) HAVE FUNCTIONED IN THIS ROLE FOR ALMOST lVE YEARS 0RIOR TO THIS ) SPENT ONE YEAR WORKING IN THE !LLINA -EDICAL #LINIC ON .ICOLLET !VE IN -INNEAPOLIS AND ADMITTING AND CARING FOR PATIENTS AT !BBOTT .ORTHWESTERN (OSPITAL )N MY PREVIOUS LIFE AS AN ATTENDING PHYSICIAN BEFORE MOVING TO -INNESOTA ) WAS FACULTY AT THE 5NIVERSITY OF )LLINOIS IN #HICAGO 5)# EITHER FULL TIME OR LATER AS AN EMPLOYED PHYSICIAN AT 5)# AFlLIATE ) DID MY MEDICAL TRAINING IN -EXICO &IFTH 0ATHWAY AT 2USH -EDICAL #OLLEGE AND RESIDENCIES AT VARIOUS FACILITIES )N ADDITION TO MY MEDICAL DEGREE ) HOLD A -ASTERS OF 0UBLIC (EALTH AND A (EALTH ,AW $EGREE -Y INVOLVEMENT WITH ORGANIZED MEDICINE BEGAN DURING MY RESIDENCY !T ALL TIMES ) HAVE BEEN A MEMBER OF MY COUNTY AND STATE MEDICAL SOCIETIES THE !-! AND THE !MERICAN #OLLEGE OF 0HYSICIANS )N ADDITION

) HAVE BEEN A MEMBER OF VARIOUS SPECIALTY ORGANIZATIONS THROUGHOUT THE LAST YEARS ) HAVE WORKED WITH -EDICARE AND -EDICAID ) HAVE BEEN INVOLVED WITH RESEARCH EDUCATION AND ADMINISTRATIVE MEDICINE -Y ACTIVITIES AND DEGREE OF INVOLVEMENT HAS VARIED AND MY EXPERIENCES HAVE BEEN EDUCATIONAL ENLIGHTEN ING INVIGORATING AND UNFORTUNATELY AT TIMES

SOMETIMES DISAPPOINTING

) MENTIONED ABOVE THE WORD hORGANIZEDv MEDICINE 4O SOME THE WORD DISORGANIZED MEDICINE MIGHT BE THE WAY YOU DESCRIBE IT OR BE A BETTER PHRASE TO EXPLAIN THE COORDINATION

OR LACK THEREOF BETWEEN DIFFERENT MEDICAL ORGANIZATIONS 4OO OFTEN ) HEAR OR ) AM ASKED

h7HAT DOES THE MEDICAL SOCIETY DO FOR ME 7HY SHOULD ) BELONG )T DOESN T REPRESENT MY INTERESTS v 3OMETIMES IT APPEARS EACH DIFFERENT COMPONENT ORGANIZATION HAS ITS OWN AGENDA AND WHERE DOES THE INDIVIDUAL S PRACTICE lT INTO THIS SCHEME -Y PRACTICE OF MEDICINE IS ON A LOCAL LEVEL AND THE LOCAL ISSUES HAVE THE HIGHEST PRIORITY FOR ME 4HE COUNTY MEDICAL SOCIETY IS WHERE MY INTERESTS ARE BEST REPRESENTED 4HROUGH REPRESENTATION AT THE COUNTY LEVEL

THE ISSUES ARE THEN CHANNELED IF APPROPRIATE

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

TO THE STATE AND THEN ON TO THE NATIONAL LEVEL (OWEVER ONCE AT A NATIONAL LEVEL ONE MIGHT EASILY SAY THAT THE AGENDA IS DIFFERENT THAN MINE

!S A 5 3 BORN INTERNATIONAL MEDICAL GRADUATE WHO HAS ALWAYS BEEN AN EMPLOYED PHYSICIAN WORKED FOR -EDICARE AND HELD ADMINISTRATIVE POSITIONS DO THE VARIOUS ORGA NIZATIONS TO WHICH ) BELONG REPRESENT ALL MY PREVIOUS AND CURRENT INTERESTS 9ES AND NO (OWEVER MY INVOLVEMENT AND DESIRE TO REMAIN INVOLVED WILL CONTINUE -Y INVOLVEMENT IS WITH THE HOPES AND DESIRES TO PRESERVE OUR AUTONOMY AS PHYSICIANS AND MAINTAIN MEDICINE AS A SCIENCE AND ART -Y GOAL IS TO PREVENT OTHERS MAY THEY BE LEGISLATORS ADMINISTRATORS OR REGULATORS FROM EXERTING THEIR CONTROL OVER US AND OUR PRACTICE OF MEDICINE )N ORDER TO ACHIEVE THIS GOAL ON THE LOCAL LEVEL ) NEED YOUR HELP

) KNOW MY TENURE AS 2-3 0RESIDENT IS SHORT AND THERE ARE A MULTITUDE OF AGENDA ITEMS THAT WE THE PHYSICIANS REPRESENTED BY THE 2AMSEY -EDICAL 3OCIETY NEED TO ADDRESS (OWEVER ) HOPE TO CONTINUE THE LEGACY OF MY PREDECESSOR PRESIDENTS IN STRIVING TO ENSURE A HEALTHY MEDICAL PRACTICE ENVIRONMENT ) NEED YOUR HELP TO ACHIEVE MY GOALS ) NEED YOUR ADVICE YOUR INSIGHT YOUR OPINIONS AND MOST OF ALL YOUR INVOLVEMENT

) DESIRE TO REPRESENT ALL PHYSICIANS WHO EITHER PRACTICE OR LIVE IN THE GEOGRAPHIC AREA THAT COMES UNDER THE 2AMSEY -EDICAL 3OCIETY ) AM ACCESSIBLE TO DISCUSS AN ISSUE THAT YOU FEEL NEEDS TO BE ADDRESSED OR TO SUPPLY INFORMATION ABOUT HOW WE WILL RESPOND OR TO DISCUSS HOW YOU THINK WE SHOULD RESPOND TO AN ISSUE ) WILL BE AVAILABLE TO BOTH MEMBERS AND NON MEMBERS

AND LOOK FORWARD TO WORKING WITH YOU

4HANK YOU FOR THE OPPORTUNITY AND THE HONOR TO REPRESENT YOU IN THE UPCOMING YEAR

#HARLES 4ERZIAN - $ -0( -* -OBILE (OME E MAIL C TERZIAN WORLDNET ATT NET

-ARCH !PRIL

2AMSEY -EDICAL 3OCIETY

0RESIDENT #HARLES ' 4ERZIAN - $ 0RESIDENT %LECT *AMES * *ORDAN - $ 0AST 0RESIDENT 0ETER * $ALY - $ 3ECRETARY 'RETCHEN 3 #RARY - $ 4REASURER #HARLES % #RUTCHlELD ))) --" - $

2-3 !NNUAL -EETING 0(93)#)!. !.$ -%$)#!, STUDENT MEM

BERS SPOUSES AND GUESTS ENJOYED AN EVENING DEVOTED TO INSTALLING THE TH PRESIDENT OF 2-3 THE #OMMUNITY 3ERVICE !WARD LEGISLA TIVE ISSUES ACTIVITY REPORTS AND PHYSICIAN COL LEGIALITY 4HE /AK -ARSH 'OLF #LUB IN /AKDALE WAS THE SCENE OF THE ENJOYABLE AND INFORMATIVE EVENING ON 3ATURDAY *ANUARY

$R #HARLES ' 4ERZIAN BECAME THE TH PRESIDENT OF 2-3 WITH THE PASSING OF THE PRESIDENTIAL MEDALLION AND GAVEL FROM OUTGO ING PRESIDENT $R 0ETER * $ALY $R 4ERZIAN IS A HOSPITALIST WITH THE !LLINA -EDICAL #LINICS AT 5NITED (OSPITAL $R 2ENEE 0ELLETIER RETIRED OPHTHALMOLOGIST WHO PRACTICED WITH 3AINT 0AUL %YE #LINIC RECEIVED THE 2-3 #OMMUNITY 3ERVICE !WARD FOR HIS VOLUNTEER WORK WITH THE

4ED 'RINDAL ATTORNEY AND LOBBYIST WITH THE ,OCKRIDGE 'RINDAL AND .AUEN LAW lRM EXPLAINED THE KEY HEALTH CARE ISSUES FACING THE -INNESOTA ,EGISLATURE AND URGED PHYSICIANS TO BE INVOLVED IN HEALTH CARE POLICY AND LEGISLATION

-ARCH !PRIL

HOMELESS AND THE -INNESOTA 3ERVICES FOR THE "LIND 4ED 'RINDAL ATTORNEY AND HIGHLY RECOG NIZED LOBBYIST ON HEALTH CARE ISSUES WITH THE ,OCKRIDGE 'RINDAL AND .AUEN LAW lRM SPOKE ON THE KEY ISSUES FACING THE -INNESOTA ,EGISLATURE AND THE NEED FOR PHYSICIANS TO BE INVOLVED IN HEALTH CARE POLICY AND LEGISLATION $R * -ICHAEL 'ONZALEZ #AMPOY PRESIDENT OF THE --! AND A PAST 2-3 PRESIDENT PRESENTED A PLAQUE TO OUTGOING PRESIDENT $R $ALY AND DELIVERED THE OFlCIAL GREETING FROM THE --!

AND ENCOURAGED PHYSICIANS TO PARTICIPATE IN THE --! $AY AT THE #APITOL $R 'RETCHEN #RARY 2-3 SECRETARY REPORTED ON 2-3 MEM BERSHIP AND $R #HARLES #RUTCHlELD ))) 2-3 TREASURER REPORTED ON 2-3 lNANCES 2OGER *OHNSON 2-3 #%/ REVIEWED THE HIGHLIGHTS OF 2-3 ACTIONS DURING THE PAST YEAR

2-3 0RESIDENT #HARLES ' 4ERZIAN - $

SPOKE TO THE 2-3 MEMBERS SPOUSES AND GUESTS AT THE 2-3 !NNUAL -EETING ABOUT HIS FAMILY HIS EXPERIENCES IN TRAINING

AND ABOUT HOW HE BECAME INVOLVED AS A VOLUNTEER LEADER IN ORGANIZED MEDICINE (E IS LOOKING FORWARD TO THE YEAR OF HIS PRESI DENCY AND HE ENCOURAGED 2-3 MEMBERS TO CONTACT HIM WITH THEIR IDEAS COMMENTS

AND VIEWS ON HEALTH ISSUES THE ACTIVITIES OF 2-3 AND ON HOW THE 2-3 CAN SERVE THE MEMBER S NEEDS

$R * -ICHAEL 'ONZALEZ #AMPOY FORMER 2-3 PRESIDENT AND CURRENT --!

PRESIDENT PRESENTS A PLAQUE TO OUTGOING 2-3 0RESIDENT 0ETER * $ALY

- $ IN RECOGNITION OF $R $ALY S OUTSTANDING WORK LEADING THE 2-3 DUR ING HIS PRESIDENCY

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

2AMSEY -EDICAL 3OCIETY

$R 0ETER * $ALY OUTGOING 2-3 PRESIDENT PRESENTS THE PRESIDENTIAL MEDALLION AND THE GAVEL TO INCOMING 2-3 0RESIDENT #HARLES ' 4ERZIAN - $

$R #HARLES ' 4ERZIAN HIS WIFE (ELEN

AND THEIR CHILDREN !NNA AGE AND )SABELLA AGE

*EREMY #ARLSON MEDICAL STUDENT REPRESENTATIVE ON THE 2-3 "OARD OF $IRECTORS TALKING WITH FELLOW MEDICAL STUDENT 2EBECCA !NDERSON LEFT AND HIS lANCÏE !MBER 3T 3AUVER RIGHT

/UTGOING 0RESIDENT 0ETER * $ALY - $ PRESENTS THE 2-3 #OMMUNITY 3ERVICE !WARD FOR TO $R 2ENEE 0ELLETIER FOR HIS OUTSTANDING CONTRIBUTIONS TO HEALTH CARE FOR THE HOMELESS AND HIS WORK WITH THE -IN NESOTA 3ERVICES FOR THE "LIND

$R #HARLES ' 4ERZIAN WITH HIS FAMILY AND HIS EXTENDED FAMILY WHO JOINED IN RECOGNIZING HIS INSTALLATION AS THE TH PRESIDENT OF 2-3

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

-ARCH !PRIL

2-3 50$!4%

.EW -EMBERS 2-3 WELCOMES THESE NEW MEMBERS TO THE 3OCIETY 3CHOOLS LISTED INDICATE THE INSTITUTION WHERE THE MEDICAL DEGREE WAS RECEIVED

!CTIVE *ACK - "ERT - $ 4EMPLE 5NIVERSITY 3CHOOL OF -EDICINE /RTHOPAEDIC 3URGERY 3UMMIT /RTHOPEDICS ,TD +AREN % "RUGGEMEYER - $ 5NIVERSITY OF -INNESOTA 0SYCHIATRY (UMAN 3ERVICES )NC -ICHAEL 7 #HESTOVICH - $ 5NIVERSITY OF -INNESOTA &AMILY 0RACTICE %AST -ETRO &AMILY 0RACTICE n 'ORMAN #LINIC 2 "RIAN *ONES - $ 5NIVERSITY OF -INNESOTA %MERGENCY -EDICINE %MERGENCY 0HYSICIANS 4HOMAS % +OTTKE - $ 5NIVERSITY OF -INNESOTA #ARDIOVASCULAR $ISEASES 2EGIONS (OSPITAL 3TEPHEN , ,ISTON - $ 5NIVERSITY OF -ELBOURNE /TOLARYNGOLOGY %AR .OSE 4HROAT 3PECIALTY#ARE OF -IN NESOTA 0 !

-ICHAEL $ -C$ONALD - $ 5NIVERSITY OF 5TAH #OLLEGE OF -EDICINE /RTHOPAEDIC 3URGERY #APITOL /RTHOPEDICS *EANNE - 0OULTON - $ 5NIVERSITY OF -INNESOTA &AMILY 0RACTICE 3TILLWATER -EDICAL 'ROUP 0 ! $AVID ( 7ANG - $ 5NIVERSITY OF -INNESOTA &AMILY 0RACTICE 3TILLWATER -EDICAL 'ROUP 0 !

-ARCH !PRIL

-ICHAEL , 7ILLSON - $ )NDIANA 5NIVERSITY 3CHOOL OF -EDICINE .EUROLOGICAL 3URGERY 3T 0AUL 2ADIOLOGY 0 ! !NGELINE ! 9OUNG - $ $ALHOUSIE 5NIVERSITY (ALIFAX .3 #ANADA $IAGNOSTIC 2ADIOLOGY 3T 0AUL 2ADIOLOGY 0 !

ND 9EAR IN 0RACTICE -ATTHEW $ 3EDGLEY - $ 5NIVERSITY OF -ARYLAND &AMILY 0RACTICE 3TILLWATER -EDICAL 'ROUP 0 !

*OEL 6 /BERSTAR - $ 5NIVERSITY OF -INNESOTA 0SYCHIATRY &AIRVIEW 5NIVERSITY -EDICAL #ENTERn2IVERSIDE #ASSANDRA !NN 0ALMER - $ 5NIVERSITY OF 7ISCONSIN -ADISON 'ENERAL 3URGERY (ENNEPIN #OUNTY -EDICAL #ENTER 3UDHIR * 2EDDY - $ * 3 3 -EDICAL #OLLEGE -YSORE 5 )NDIA 0SYCHIATRY (ENNEPIN #OUNTY -EDICAL #ENTER

ST 9EAR IN 0RACTICE "ETH ! !DAMS - $ &AMILY -EDICINE 3TILLWATER -EDICAL 'ROUP 0 !

"RIANNA , 3CHULTZ - $ )NTERNAL -EDICINE (ENNEPIN #OUNTY -EDICAL #ENTER

-ICHAEL " !DAMS - $ 5NIVERSITY OF #ALIFORNIA AT )RVINE &AMILY 0RACTICE 3TILLWATER -EDICAL 'ROUP 0 !

'ENA - "ONITATIBUS - $ 5NIVERSITY OF !LABAMA 3CHOOL OF -EDICINE 0EDIATRICS 3T 0AUL !LLERGY !STHMA #LINIC 0 ! ,AURA ! &RANCE - $ 5NIVERSITY OF -INNESOTA /BSTETRICS 'YNECOLOGY +ENDALL #ENTER FOR 7OMEN

2ETIRED 0HYSICIANS 2ICHARD ' 3LETTEN - $ 5NIVERSITY OF -INNESOTA /RTHOPAEDIC 3URGERY

)N -EMORIAM 2/"%24 # !(,342/- - $

DIED $ECEMBER IN "RAHAM -INNESOTA (E GRADUATED FROM THE 5NIVERSITY OF -INNESOTA IN AND PRACTICED FAMILY PRACTICE $R !HLSTROM JOINED 2-3 IN

+AREN % 2EYNOLDS - $ 5NIVERSITY OF -INNESOTA 'ENERAL 3URGERY 3TILLWATER -EDICAL 'ROUP 0 !

"RIGETTE " 2ITTER - $ 5NIVERSITY OF -INNESOTA /BSTETRICS 'YNECOLOGY 3TILLWATER -EDICAL 'ROUP 0 !

'REGORY 3IMELGOR - $ -"! /HIO 3TATE 5NIVERSITY #OLLEGE OF -EDICINE !NESTHESIOLOGY !SSOCIATED !NESTHESIOLOGISTS 0 !

-ARIE , 7ITTE - $ 4EXAS ! - #OLLEGE OF -EDICINE )NTERNAL -EDICINE 3TILLWATER -EDICAL 'ROUP 0 !

2ESIDENT 0HYSICIANS 4AIMUR 2ASHID -ALIK - $ 2AWALPINDI -EDICAL #OLLEGE

5 OF 0ANJUB 0AKISTAN 0SYCHIATRY (ENNEPIN #OUNTY -EDICAL #ENTER

&2%$%2)#+ 0 !2.9 - $ DIED *ANUARY AT THE AGE OF (E GRADUATED FROM THE 5NIVERSITY OF -INNESOTA IN (E SERVED IN THE 5 3 ! & DURING 77)) $R !RNY PRACTICED FAMILY PRACTICE MEDICINE IN 3T !NTHONY 0ARK FROM (E WAS A PAST PRESIDENT OF -IDWAY (OSPITAL STAFF $R !RNY JOINED 2-3 IN +%..%4( # #!,$7%,, - $ AGE

DIED ON *ANUARY $R #ALDWELL GRADUATED FROM THE 5NIVERSITY OF -INNESOTA IN WHERE HE ALSO RECEIVED HIS SUBSPECIALTY TRAINING IN INTER NAL MEDICINE AND HEMATOLOGY (E RECEIVED HIS SUBSPECIALTY TRAINING IN ONCOLOGY AT 4UFTS 5NI VERSITY IN "OSTON -! $R #ALDWELL WAS BOARD CERTIlED IN ALL THREE SPECIALTIES (E JOINED 2-3 IN

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

#(!)2 3 2%0/24 -)#(!%, " "%,:%2 - $

#HAINS OF 4IME AND THE h7ISDOMv OF 4RADITION 4HE 2ESIDENT 7ORK (OUR 2EDUCTION -ANDATE (-3 /FlCERS

(-3 "OARD -EMBERS

-ARY !NDERSON #O 0RESIDING #HAIR (-3 !LLIANCE !BDHISH 2 "HAVSAR - $ #ARL % "URKLAND - $ %RIC ' #HRISTIANSON - $ 0ETER * $EHNEL - $ -ARLENE %LLIS #O 0RESIDING #HAIR (-3 !LLIANCE ,ISA -C'INNIS -EDICAL 3TUDENT 2ONALD $ /SBORN $ / &RANK 3 2HAME - $ $AVID & 2UEBECK - $ 2ICHARD $ 3CHMIDT - $ *AN ( 3TRATHY - $ 4HOMAS # 4UNBERG - $ 6ALERIE + 5LSTAD - $ 0ETER ! 7ALLSKOG - $ (-3 %X /FlCIO "OARD -EMBERS

,EE ( "EECHER - $ --! 4RUSTEE +AREN + $ICKSON - $ --! 4RUSTEE $AVID , %STRIN - $ !-! !LTERNATE $ELEGATE +ENNETH " (EITHOFF - $ --! 4RUSTEE $ONALD - *ACOBS - $ --! 4RUSTEE +ARIN - 4ANSEK - $ --! 4RUSTEE "ENJAMIN ( 7HITTEN - $ !-! !LTERNATE $ELEGATE "ARBARA $AIKER --'-! 2EP (-3 %XECUTIVE 3TAFF

*ACK ' $AVIS #HIEF %XECUTIVE /FlCER +ATHY 2 $ITTMER %XECUTIVE !SSISTANT 3UE 3CHETTLE $IRECTOR -ARKETING -EMBER 3ERVICES

)

). !. 9%!2 /,$ WOMAN NAMED

,IBBY :ION DIED SIX HOURS AFTER ADMISSION TO A .EW 9ORK 4EACHING (OSPITAL (ER FATHER

A WELL KNOWN AND RESPECTED AUTHOR CLAIMED THAT INADEQUATE CARE FOR ,IBBY WAS A RESULT OF OVERWORKED AND SLEEP DEPRIVED HOUSE OFlCERS

AND THIS LED DIRECTLY TO HER DEATH 4HE GRAND JURY DID NOT SUPPORT CRIMINAL CHARGES AGAINST EITHER THE HOSPITAL OR ANY OF THE PHYSICIANS CAR ING FOR -S :ION )N WORK HOURS FOR . 9 RESIDENTS HOUR WORK WEEK NO LONGER THAN HOUR SHIFTS ETC BECAME REGULATED AS PART OF .EW 9ORK (EALTH #ODE 4HESE REGULA TIONS WERE ISSUED IN THE SPIRIT AND INTENT OF IMPROVING PATIENT SAFETY FROM SLEEP DEPRIVED RESIDENTS (OWEVER OUTSIDE OF .EW 9ORK 3TATE

MOST RESIDENCY TRAINING PROGRAMS PERSISTED WITH WORKWEEKS CONSISTING OF HOURS WITH MINIMAL LIMITS ON CONSECUTIVE HOURS OF DUTY AND FEW TO NO DAYS OFF )N THE PAST DECADE A LARGE BODY OF INFOR MATION HAS ACCUMULATED ABOUT THE SIGNIlCANT COMPLICATIONS TO THE HEALTH AND SAFETY OF THE RESIDENTS DUE TO LONG WORK HOURS AND SLEEP DE PRIVATION 4HESE INCLUDE AN INCREASE IN MOTOR VEHICLE ACCIDENTS INCIDENCE OF DEPRESSION AND PREGNANCY COMPLICATIONS ! PAPER PUBLISHED IN 4HE *OURNAL .ATURE FOUND THAT STAYING AWAKE FOR HOURS IMPAIRS COGNITIVE PSYCHOMOTOR PERFORMANCE TO THE SAME DEGREE AS HAVING A PERCENT BLOOD ALCOHOL LEVEL 5NDER THREAT OF A &EDERAL #ONGRESSIONAL LEGISLATIVE MANDATE IN *ULY THE !#'-% THE ACCREDITING BODY FOR '-% REQUIRED ALL ACCREDITED 5 3 RESIDENCY TRAINING PROGRAMS TO LIMIT DUTY HOURS SIMILAR TO THOSE OUTLINED ABOVE FOR .EW 9ORK 3TATE (OW WERE THESE DUTY HOUR LIMITS RECEIVED 'ENERALLY IN A VERY POSITIVE MANNER BY THE RESIDENT TRAINEES AND VERY MUCH LESS SO BY SU PERVISING TEACHING PHYSICIANS WHO WERE TRAINED UNDER THE hOLDv SYSTEM $UTY HOUR REDUCTIONS THEY SAID WOULD FOSTER A SHIFT WORKER MENTALITY SANCTION PATIENT ABANDONMENT WHEN RESIDENTS WERE hFORCEDv TO LEAVE THE HOSPITAL AND WOULD RESULT IN INSUF lCIENT TIME AT THE BEDSIDE OR IN THE OPERATING

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

SUITE TO GAIN THE EXPERIENCE NEEDED TO BE WELL TRAINED !FTER ALL TRAUMA AND EMERGENCIES DO NOT ALWAYS OCCUR DURING THE A M P M WORKDAY /F GREATER CONCERN TO THOSE OF US WORK ING DAILY WITH RESIDENCY TRAINING PROGRAMS WAS THE POSSIBILITY THAT MORE MEDICAL ERRORS MIGHT ACTUALLY BE GENERATED UNDER THE DUTY HOUR LIMITATIONS 4HE POTENTIAL INCREASE WOULD BE SECONDARY TO COMMUNICATION LAPSES AND THE MULTIPLE HANDOFFS THAT OCCUR WITH FREQUENT CHANGING OF CAREGIVERS AND TEAMS AS THEY ROTATE IN AND OUT OF THE HOSPITAL TO MEET THE IN HOSPITAL DUTY HOUR LIMITS !FTER NEARLY Â YEARS OF EXPERIENCE CAN ANY CONCLUSIONS BE MADE REGARDING THE BENElTS OR LIABILITIES OF THE MANDATED DUTY HOUR LIMITA TIONS 5NFORTUNATELY NONE !LTHOUGH WE DO KNOW THAT MANY TRAINING PROGRAMS ARE HAVING SIGNIlCANT DIFlCULTY MEETING THE HOUR REDUC TIONS MANDATED BY THE !#'-% /LD WAYS DIE HARD !RE THE DUTY HOURS HERE TO STAY 5NQUES TIONABLY )T IS IMPOSSIBLE TO CONVINCE ANY REASONABLE PERSON THAT HOUR WORKWEEKS ARE IN THE BEST INTEREST OF ANYONE Â&#x2C6; PATIENTS OR TRAINEES 4WO RECENT RANDOMIZED STUDIES PUBLISHED IN THE WIDELY READ AND CITED .EW %NGLAND *OURNAL OF -EDICINE CONCLUDED THAT RESIDENTS WORKING HOUR SHIFTS COMMIT TED PERCENT MORE SERIOUS MEDICAL ERRORS THAN THOSE WORKING HOUR SHIFTS AND LONGER SHIFTS RESULTED IN MORE hATTENTIONAL FAILURES v 4HE DATA ARE VERY CLEAR 3LEEP DEPRIVATION IS DANGEROUS TO BOTH PATIENT CARE AND THE RESIDENT S HEALTH 5NDER THE RESIDENT DUTY HOUR REDUCTIONS

THE FUTURE OF MEDICAL TRAINING IS NOT IN PERIL 7E NEED TO PLACE INCREASED FOCUS ON EFFECTIVE COMMUNICATION BETWEEN CAREGIVERS AND SOON THIS LOGICAL hNEW WAYv WILL BECOME THE ACCEPTED STANDARD AND BECOME ANOTHER hOLD WAY v

-ARCH !PRIL

(ENNEPIN -EDICAL 3OCIETY

#HAIR -ICHAEL " "ELZER - $ 0RESIDENT *AMES ! 2OHDE - $ 0RESIDENT ELECT 0AUL ! +ETTLER - $ 3ECRETARY %DWARD 0 %HLINGER - $ 4REASURER !NNE - -URRAY - $ )MMEDIATE 0AST #HAIR -ICHAEL " !INSLIE - $

(-3 .%73

.EW -EMBERS (-3 WELCOMES THESE NEW MEMBERS TO THE 3OCIETY

!CTIVE +ERRIE 6 !LLEN - $ &AMILY -EDICINE #ROSSROADS -EDICAL #ENTERS 0 ! .ORMAN !RSLANLAR $ / $IAGNOSTIC 2ADIOLOGY #ONSULTING 2ADIOLOGISTS ,TD "ERTON $ "ARRINGTON - $ /PHTHALMOLOGY 5NIVERSITY OF -INNESOTA $ANIEL 3COTT "EGGS - $ $IAGNOSTIC 2ADIOLOGY #ONSULTING 2ADIOLOGISTS ,TD %LISE - "INSFELD - $ &AMILY -EDICINE #OLUMBIA 0ARK -EDICAL 'ROUP &RIDLEY 0LAZA #LINIC -ICHAEL 7ILLIAM "LUST - $ !NESTHESIOLOGY .ORTHWEST !NESTHESIA 0 !

(ANA "ONEFACIC - $ 0EDIATRICS #OLUMBIA 0ARK -EDICAL 'ROUP &RIDLEY 0LAZA #LINIC 'EORGE #HRIS #ANAS - $ )NTERNAL -EDICINE +IDNEY 3PECIALISTS OF -.

0 ! !NNE -ARIE 6 #OLE - $ )NTERNAL -EDICINE #OLUMBIA 0ARK -EDICAL 'ROUP "ROOKLYN 0ARK #LINIC (ENRY # $AHLMAN - $ %MERGENCY -EDICINE *AY ! $IRKS - $ &AMILY -EDICINE #OLUMBIA 0ARK -EDICAL 'ROUP "ROOKLYN 0ARK #LINIC

-ARCH !PRIL

3TEVEN 2 %LIAS - $ 0EDIATRICS #OLUMBIA 0ARK -EDICAL 'ROUP &RIDLEY 0LAZA #LINIC

'RANT # -ORRISON - $ &AMILY -EDICINE %DINA 3PORTS (EALTH 7ELLNESS 0 !

*ON ( %NGELKING - $ /RTHOPAEDIC 3URGERY #OLUMBIA 0ARK -EDICAL 'ROUP &RIDLEY 0LAZA #LINIC

!RVIND .EHRA - $ $IAGNOSTIC 2ADIOLOGY #ONSULTING 2ADIOLOGISTS ,TD

" +ELLY 'LEASON - $ 0EDIATRIC #ARDIOLOGY #HILDREN S (EART #LINIC 0 !

-IRTHA 0 .ESHEIM - $ &AMILY -EDICINE #AMDEN 0HYSICIANS ,TD !RBOR ,AKES -APLE 'ROVE /FlCE

$AVID 'REMMELS - $ 0EDIATRIC #ARDIOLOGY #HILDREN S (EART #LINIC 0 !

2ONALD $ /SBORN $ / !NESTHESIOLOGY -ETROPOLITAN !NESTHESIA .ETWORK

-ARK ,EE 'RIM - $ !NESTHESIOLOGY .ORTHWEST !NESTHESIA 0 !

4HOMAS & 2OLEWICZ - $ 0H $ 0EDIATRICS #OLUMBIA 0ARK -EDICAL 'ROUP &RIDLEY 0LAZA #LINIC

3 -ATTHEW (OCKETT - $ &AMILY -EDICINE #OLUMBIA 0ARK -EDICAL 'ROUP "ROOKLYN 0ARK #LINIC

-ARTIN 7ILLARD 3CHULARICK - $ $IAGNOSTIC 2ADIOLOGY #ONSULTING 2ADIOLOGISTS ,TD

+ATHERINE (UG - $ $IAGNOSTIC 2ADIOLOGY #ONSULTING 2ADIOLOGISTS ,TD

#ARLA ! 3CHWARTZ - $ &AMILY -EDICINE #OLUMBIA 0ARK -EDICAL 'ROUP &RIDLEY 0LAZA #LINIC

*OEL # (UTCHESON - $ 0EDIATRIC 5ROLOGY 0EDIATRIC 3URGICAL !SSOCIATES ,TD

*EFFREY ! 3CZUBLEWSKI - $ )NTERNAL -EDICINE 0ARK .ICOLLET #LINIC n 0LYMOUTH

4HOMAS ! *ACOBSON - $ &AMILY -EDICINE #OLUMBIA 0ARK -EDICAL 'ROUP "ROOKLYN 0ARK #LINIC

-ARK 2 3TANG - $ 0ULMONARY $ISEASE -INNESOTA ,UNG #ENTER n -AIN /FlCE 3COTT #HARLES 3TRECKENBACH - $ !NESTHESIOLOGY

+ENNETH % *OSLYN - $ - 0 ( &AMILY -EDICINE

0AMALA *EAN 7YMORE - $ $IAGNOSTIC 2ADIOLOGY #ONSULTING 2ADIOLOGISTS ,TD

+ERRY - +ALLAS - $ $IAGNOSTIC 2ADIOLOGY #ONSULTING 2ADIOLOGISTS ,TD *UNE $ENISE +RIVACH - $ $IAGNOSTIC 2ADIOLOGY #ONSULTING 2ADIOLOGISTS ,TD

2ESIDENT 0HYSICIANS $ANIEL , -ARK - $ &AMILY -EDICINE (ENNEPIN #OUNTY -EDICAL #ENTER

.ORMAN - ,UNDE - $ .EPHROLOGY +IDNEY 3PECIALISTS OF -.

0 !

+ATIE ,YNN 6OGT - $ %MERGENCY -EDICINE (ENNEPIN #OUNTY -EDICAL #ENTER

&RANCIS 8 -OGA - $ #ARDIOVASCULAR 3URGERY #HILDREN S (EART #LINIC 0 !

-EDICAL 3TUDENTS 5NIVERSITY OF -INNESOTA

*ULIA , -ONTEJO - $ !LLERGY )MMUNOLOGY #OLUMBIA 0ARK -EDICAL 'ROUP &RIDLEY 0LAZA #LINIC

*ESSICA .ILUFAR "AHARI +ASHANI *OSEPH 2 -ATEL *OSHUA (ARLEN /LSON

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

)N -EMORIAM -),4/. % "!+%2 - $ DIED ON .OVEMBER

AT THE AGE OF (E GRADUATED FROM .ORTHWESTERN 5NIVERSITY -EDICAL 3CHOOL IN #HI CAGO $R "AKER RETIRED AS THE HEAD OF /" '9. AT .ORTH -EMORIAL (OSPITAL (E WAS A FULL PROFESSOR AT THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL $R "AKER JOINED (-3 IN

%$-5.$ 0%4%2 %)#((/2. *2 - $ OF "LOOMINGTON DIED IN .OVEMBER (E WAS (E GRADUATED FROM THE 5NIVERSITY OF -IN NESOTA -EDICAL 3CHOOL $R %ICHHORN SPECIALIZED IN INTERNAL MEDICINE (E JOINED (-3 IN 34%0(%. * &2%9 - $ AGE DIED IN A ROLLOVER ACCIDENT ON .OV (E RECEIVED HIS MEDICAL DEGREE FROM THE 5NIVERSITY OF #OLO RADO IN $ENVER AND COMPLETED HIS FAMILY PRAC TICE RESIDENCY AT THE 5NIVERSITY OF 7YOMING IN #ASPER (E COMPLETED THREE YEARS OF ACTIVE DUTY SERVICE IN THE 5NITED 3TATES .AVY ON 'UAM $R &REY PRACTICED AS A FAMILY PHYSICIAN FOR SIX YEARS IN -ORTON 7ASHINGTON NINE YEARS IN 2UIDOSO

.EW -EXICO AND YEARS IN !PPLE 6ALLEY

-. (E PRACTICED A BLEND OF %ASTERN AND 7EST ERN MEDICINE (E JOINED (-3 IN * !,"%24 *!#+3/.

- $ AGE DIED .OVEMBER (E SERVED WITH THE 5 3 .AVY DURING 77)) AND THE +OREAN #ONmICT AND WAS DISCHARGED AS A ,T #OMMANDER (E RECEIVED HIS UNDERGRADUATE AND MEDICAL DEGREES FROM THE 5NIVERSITY OF 0ITTSBURGH (E GRADUATED FROM THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL IN ANES THESIOLOGY $R *ACKSON JOINED (-3 IN "25#% 2/"%24 */(.3/.

- $ OF %DINA

DIED SUDDENLY ON 3ATURDAY .OVEMBER WHILE TREKKING IN 0ATAGONIA WITH HIS WIFE 0EGGY (E WAS

'/2$/. !!-/4( - $ WAS AWARDED THE

#HARLES "OLLES "OLLES 2OGERS !WARD AT THE -EDICAL 3TAFF -EETING OF !BBOTT .ORTH WESTERN (OSPITAL ON /CTOBER $R !AMOTH WAS RECOGNIZED FOR HIS PROFESSIONAL CONTRIBUTION TO MEDICINE AND HIS NUMEROUS ACHIEVEMENTS THROUGHOUT HIS DISTINGUISHED CAREER (-3 #HAIR -ICHAEL "ELZER - $ LEFT PRESENTS THE #HARLES "OLLES "OLLES 2OGERS !WARD TO 'ORDON !AMOTH - $

$ISTRICT $IALOGUE WITH 3ENATOR +ELLEY 4(% -)..%3/4! -%$)#!, !SSOCIATION AND THE (ENNEPIN -EDICAL 3OCIETY COORDINATED A $ISTRICT $IALOGUE AT -ETHODIST (OSPITAL THAT FEATURED $&, 3ENATOR 3TEVE +ELLEY 4HE $IS TRICT $IALOGUES HAVE BEEN A FOCUS OF THE --!

FOR THE PAST YEAR AND OFFER PHYSICIANS AN OP PORTUNITY TO SPEAK DIRECTLY WITH THEIR LEGISLATOR ABOUT ISSUES THAT ARE IMPORTANT TO PHYSICIANS 4HIS EVENT LIKE OTHERS PROVED TO BE SUCCESS FUL BECAUSE THE PHYSICIANS WHO WERE INVOLVED CAME TO THE MEETING WITH QUESTIONS AND IDEAS FOR THE 3ENATOR

(E GRADUATED FROM 7ASHINGTON 5NIVERSITY 3CHOOL OF -EDICINE IN 3T ,OUIS $R *OHNSON PRACTICED CARDIOLOGY AT .ORTH -EMORIAL FOR YEARS (E JOINED (-3 IN 2)#(!2$ 3 h$)#+v 2/$'%23 - $ DIED $EC AT THE AGE OF (E RECEIVED HIS MEDICAL DEGREE FROM THE 5NIVERSITY OF -INNESOTA 3CHOOL OF -EDICINE (E WAS A GENERAL PRACTITIONER FOR YEARS IN #HIPPEWA &ALLS 7ISCONSIN $R 2ODGERS RECEIVED HIS UROLOGY TRAINING AT -AS SACHUSETTS 'ENERAL (OSPITAL IN "OSTON AND HE BEGAN A UROLOGICAL GROUP IN -INNEAPOLIS (E JOINED (-3 IN %2)#( 3#(!2-!. 7)3)/, - $ OF 'OLDEN 6ALLEY DIED .OVEMBER (E WAS (E GRADUATED FROM $ARTMOUTH #OL LEGE AND -EDICAL 3CHOOL IN AND (ARVARD -EDICAL 3CHOOL IN (IS INTEREST IN SURGERY AND NEUROLOGY LED HIM TO RESIDENCY PROGRAMS AT

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

3ENATOR 3TEVE +ELLEY HAS A CONVERSATION WITH PHYSICIANS AT -ETHODIST (OSPITAL 4HIS $ISTRICT $IALOGUE WAS COORDINATED BY THE -INNESOTA -EDICAL !SSOCIATION AND THE (ENNEPIN -EDICAL 3OCIETY

THE 5NIVERSITY OF -INNESOTA (OSPITALS THE -AYO #LINIC AND 0ETER "ENT "RIGHAM AND #HILDREN S (OSPITAL IN "OSTON (E COMPLETED HIS NEURO SURGICAL RESIDENCY IN (E THEN JOINED $R (AROLD "UCHSTEIN AND STARTED .EUROSURGICAL !S SOCIATES ,TD IN -INNEAPOLIS (E WAS A CLINICAL PROFESSOR OF NEUROSURGERY AT THE 5NIVERSITY OF -INNESOTA (E SERVED AS A CAPTAIN IN THE 5NITED 3TATES !RMY IN +AISERSLAUTERN 'ERMANY $R 7ISIOL JOINED (-3 IN ! #!"/4 7/(,2!"% - $ DIED $E CEMBER AT THE AGE OF (E GRADUATED FROM #ORNELL #OLLEGE AND RECEIVED HIS MEDICAL DEGREE FROM THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL (E SPECIALIZED IN INTERNAL MEDICINE (E SERVED AS CAPTAIN IN THE !RMY -EDICAL #ORP IN 7ORLD 7AR )) $R #ABOT JOINED HIS FATHER !RTHUR IN PRIVATE PRACTICE AND COMPLETED HIS CAREER AS MEDICAL DIRECTOR AT .7 "ELL (E JOINED (-3 IN

-ARCH !PRIL

(ENNEPIN -EDICAL 3OCIETY

2/"%24 $!6)$ ",/-"%2' - $ DIED AT . # ,ITTLE (OSPICE ON $ECEMBER

(E WAS (E RECEIVED HIS MEDICAL DEGREE FROM THE 5NIVERSITY OF -INNESOTA IN (E SERVED AS A NAVAL OFlCER IN 77)) AT 0EARL (ARBOR AND AS THE CHIEF MEDICAL OFlCER ON THE 533 4ULAGI

IN THE WESTERN 0ACIlC )N HE RETURNED TO -INNEAPOLIS WHERE HE COMPLETED HIS RESIDENCY TRAINING IN INTERNAL MEDICINE )N $R "LOMBERG BECAME CHIEF OF STAFF AND DIRECTOR OF PROFESSIONAL ACTIVITIES AT !BBOTT .ORTHWESTERN (OSPITAL $URING THIS TIME HE ASSISTED WITH ENGINEERING THE MERGER OF THESE TWO HEALTH CARE FACILITIES (E JOINED (-3 IN

'ORDON !AMOTH - $ AWARDED THE #HARLES "OLLES "OLLES 2OGERS !WARD

(-3 !,,)!.#% .%73 $)!.% '!9%3

! 9EAR OF #HANGE

4

4(% %.%2'%4)# 6/)#%3 OF MORE THAN

CHILDREN RESONATE IN MY MIND AS ) REmECT ON YEARS OF "ODY 7ORKS ) ACTUALLY MISS ALL OF THE VOLUNTEER WORK NECESSARY TO PREPARE FOR "ODY 7ORKS ) MISS THE E MAILS

PHONE CALLS AND "ODY 7ORKS UPDATES THAT KEPT OUR MEMBERSHIP CONNECTED ) MISS ANTICIPATING THE WEEK WITH THE -INNEAPOLIS THIRD GRADERS WHEN OVER (ENNEPIN -EDICAL 3OCIETY !L LIANCE (-3! VOLUNTEERS TAUGHT THEM ABOUT THEIR BODIES AND HOW TO STAY HEALTHY ) MISS BEING DIRECTLY INVOLVED WITH THE CHILDREN IN OUR COMMUNITY WHOSE HEALTH EDUCATION WE ARE TRYING TO PROMOTE ) MISS THE COLLECTIVE DEDICA TION BY THE (ENNEPIN !LLIANCE MEMBERSHIP TO MAKE IT ALL HAPPEN 9ET WITHOUT "ODY 7ORKS THE (-3!

MEMBERS CONTINUE TO BE THE MOST CARING AND ACTIVE GROUP OF PEOPLE THAT ) KNOW WHEN IT COMES TO IMPROVING THE HEALTH OF OUR COM MUNITY 3EVERAL YEARS AGO THE !LLIANCE PRODUCED

,ETTER TO THE (-3!

*ANUARY

$EAR $IANE

) WOULD LIKE TO TAKE THIS OPPORTUNITY TO THANK YOU FOR ALL OF THE GREAT SERVICE YOU AND YOUR ORGANIZATION GAVE TO THE -IN NEAPOLIS 0UBLIC 3CHOOLS 4HE "ODY 7ORKS PROGRAM HAS BEEN A HIGHLIGHT lELD TRIP FOR MANY TEACHERS AND STUDENTS 9OUR PRO GRAM TOUCHED THE LIVES OF MANY OF OUR -INNEAPOLIS CHILDREN OVER THE YEARS

A LIST OF MEMBERSHIP VOLUNTEER INVOLVEMENT OUTSIDE OF (-3! 4HE COMPLETE LIST COVERED SEVERAL PAGES #URRENTLY MOST OF OUR MEMBERS ARE FOCUSING THEIR ENERGY ON HEALTH INITIATIVES WITH THOSE OTHER ORGANIZATIONS ) REALIZE AND ACCEPT THE FACT THAT IT IS PROBABLY A RELIEF TO MANY OF OUR MEMBERS NOT TO HAVE TO PREPARE FOR ANOTHER "ODY 7ORKS 4HIS YEAR OF CHANGE FOR THE (-3! IS SIMILAR TO CHANGES THIS ORGANIZATION HAS FACED IN THE PAST 4HERE WILL ALWAYS BE A NEED FOR THE !LLIANCE TO CONTINUE ITS CHARITABLE EFFORTS TOWARD THE HEALTH OF THE COMMUNITY 4HAT IS A GIVEN "UT WITH EACH GENERATION HOW TO REACH OUT AND DEVELOP WAYS AS A VOLUNTEER ORGANIZA TION TO MEET THOSE NEEDS FOR OUR MEMBERS AND THE COMMUNITY REQUIRES INNOVATION 4HAT IS HAPPENING WITH (-3! NOW 4HE YEAR WILL BE THE TH ANNIVER SARY OF THE (ENNEPIN -EDICAL 3OCIETY !LLIANCE /UR RECORDS CLEARLY REVEAL HOW THE ORGANIZATION HAS EVOLVED ADMINISTRATIVELY SINCE 7HAT HASN T CHANGED AFTER SO MANY YEARS IS OUR MIS SION TO PROMOTE HEALTH IN THE COMMUNITY !S THE (-3! REORGANIZES WE AIM TO CONTINUE OUR WORK ON PROJECTS LIKE 7ORLD3COPES AND THE ()6 !)$3 %DUCATION &OLDER AND THE DEVELOP MENT OF OTHER HEALTH INITIATIVES TO MAINTAIN THE STRONG LEGACY OF THE (-3!

4HE (-3! (OLIDAY 4EA AND 3ILENT !UCTION RAISED MORE THAN FOR (-3!

PHILANTHROPIC PROJECTS 7E THANK $R 4ED AND *UDY .AGEL FOR SO GRACIOUSLY OFFERING THEIR HOME FOR THE ANNUAL TEA AND 4RISH 6AURIO FOR ALL HER EFFORTS REGARDING THE SILENT AUCTION 4HE (-3! WILL HOLD ITS !NNUAL -EET ING AND ,UNCHEON ON !PRIL ,OCATION AND DETAILS WILL BE IN THE NEXT 0ULSATIONS 2360 TO +ATHY $ITTMER (-3

KDITTMER MNMED ORG 4HE (ENNEPIN -EDICAL 3OCIETY !LLIANCE IS AN EDUCATIONAL AND CHARITABLE VOLUNTEER ORGANI ZATION WORKING IN PARTNERSHIP WITH OTHERS TO PROMOTE THE HEALTH AND WELL BEING OF ITS MEMBERS AND THE COMMUNITY THROUGH EDUCATION ADVOCACY AND SERVICE &OR (-3! MEMBERSHIP INFORMATION

PLEASE CONTACT $IANE 'AYES LADYDI MN RR COM

4HANK YOU *AN "RAATEN 3CHOOL (EALTH #OORDINATOR

-INNEAPOLIS 0UBLIC 3CHOOLS -ARTHA !RNESON $IANNE 3CHOTTLER 6IANNE %NGWALL AND %LEANOR 'OODALL WITH THEIR SILENT AUCTION WINNINGS

-ARCH !PRIL

(-3! MEMBERS ENJOY THE (OLIDAY 4EA AND 3ILENT !UCTION

-ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

Sophisticated Loft

Landmark Mediterranean

Hidden Lakes Villa

Fantastic closein location!

Breathtaking loft with panoramic views of downtown Minneapolis and the sculpture garden.

Set in the award winning 301 Kenwood Parkway building, this fine home features stunning custom funishes, voluminous spaces, two terraces, gourmet kitchen & more. 3 bedrooms, 3 baths.

Romantic home set upon the southern shores of Lake Harriet. Features rich interior details, accommodating public and private spaces, large master, soaring staircase with balcony, fabulous lake and skyline views. 5 bedrooms, 5 baths.

Graceful Hidden Lakes Villa home built by Charles Cudd.

Features include open and flowing public rooms, cathedral ceilings, 2 master bedrooms, a gourmet kitchen with adjoining family room, Brazilian cherry floors, and gorgeous landscaping.

4 bedrooms, 4 baths.

Features approximately 3.5 acre wooded and private lot, large gourmet kitchen with adjoining family room, spacious master suite, grand foyer, walkout lower level amusement room and more. 5 bedrooms, 5 baths.

Hidden Lakes Lakefront

Fantastic newer construction lakefront home with voluminous and elegant public rooms, huge main floor master, wonderful walkout lower level family room/recreation area with a full kitchenette & more. 5 bedrooms, 7 baths.

Call The Penthouse Breathtaking one-of-a-kind 2 bedroom + den with panoramic views of downtown Minneapolis. Features 12’ ceilings with floor to ceiling windows, concrete floors, 1559 square foot roof top terrace & more.

Go West Young Family We saved the best for last! Build the home of your dreams on a choice cut of the last piece of Prime Edina Real Estate. This is no East Edina, this is the West. These are the homes where the open spaces roam, and the lofty and soaring vaults tray. Don’t tell us about the Old World Charm. Heck, we built that, too. “Your investment will be significant in your next home, it may as well be on a home that you custom design!” There are 23 lots now available to turn your dreams into reality.

Call Scott Card John Shaw

612.209.6455

or visit us on the web at

612.720.4678

www.ParkwoodKnolls.com

Bruce Birkeland 612-925-8405 www.brucebirkeland.com

Physicians don’t prescribe the same treatment for everyone.

Neither do we.

Physicians and the employee benefit professionals at Schwarz Williams Companies agree: It’s impossible for one treatment to fit all.

Just as each patient receives a prescription for a specific health problem, every employer — including your clinic — deserves an employee benefit and strategic HR plan designed to meet the specific needs of its staff.

Group health plans are now available through Schwarz Williams, the endorsed broker of the Minnesota Medical Association, Hennepin Medical Society and Ramsey Medical Society.

The benefit and HR specialists at Schwarz Williams can tailor a plan to help you reward your staff and manage your costs. They offer broad experience in conventional, HSA/HRA consumer-driven, flexible, and voluntary health plans.

Schwarz Williams is also your one-stop source for individual insurance products and financial services for you and individuals on your staff: life and long-term care insurance, long-term disability, retirement plans, and financial and estate planning.

For more information, call Schwarz Williams at 763-591-5822 or 800-422-0504 or the MMA at 612-362-3746.

SCHWARZ WILLIAMS COMPANIES, INC.

MMA MINNESOTA MEDICAL ASSOCIATION MEDICINE’S VOICE IN MINNESOTA

When Expectations Exceed Time and Resources 8401 GOLDEN VALLEY ROAD, SUITE 300, GOLDEN VALLEY, MN 55427 PHONE: 763-591-5822 • FAX: 763-591-5812 TOLL FREE: 800-422-0504 • www.schwarzwilliams.com