2005novdec

MetroDoctors THE JOURNAL OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

In This Issue

New Directions in Health Care Purchasing Minnesota Community Measurement Project 2005 HMS/RMS Resolutions MRSA/ Pertussis Awareness

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.

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

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/N THE COVER ! NEW BUSINESS MODEL FOR PURCHASING HEALTH CARE !RTICLE BEGINS ON PAGE

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

.OVEMBER $ECEMBER

-INNESOTA #OMMUNITY -EASUREMENT %DITOR S .OTE *IM #HASE IS THE %XECUTIVE $IRECTOR OF -. #OMMUNITY -EASUREMENT -.#- )N .OVEMBER OF -R #HASE HELPED LAUNCH -.#- S NEW PUBLIC 7EB SITE THAT REPORTS THE RESULTS OF SEVERAL HEALTH CARE QUALITY MEASURES BY MEDICAL GROUPS IN -IN NESOTA -.#- WAS STARTED BY HEALTH PLANS THREE YEARS AGO AND HAS NOW EVOLVED INTO A NEW NON PROlT ORGANIZATION 4HE FOLLOWING ARTICLE DESCRIBES HOW #OMMUNITY -EASURE MENT IS BEING RECEIVED BY PHYSICIANS AND WHAT -R #HASE PLANS FOR AND BEYOND 7HAT GOT -. #OMMUNITY -EASUREMENT STARTED

4WO THINGS WE KNOW PEOPLE ARE NOT ALWAYS GETTING THE CARE THEY SHOULD AND WE CAN DO A BETTER JOB OF REPORTING ON HEALTH CARE QUALITY )N THE PAST WE VE HAD EACH HEALTH PLAN AND SOME OTHER PAYERS MEASURING QUALITY IN DIFFERENT WAYS AND WE PROVIDED VERY LITTLE USEFUL INFOR MATION TO PATIENTS AND PROVIDERS ABOUT THEIR CARE 7E HAVE A GREAT OPPORTUNITY FOR CHANGE RIGHT NOW 7E HAVE GENERAL AGREEMENT ON THE STANDARDS OF CARE FOR MANY CHRONIC CONDITIONS AND PREVENTIVE SERVICES WE HAVE THE ABILITY TO PUT SYSTEMS IN PLACE TO GET BETTER RESULTS AND WE HAVE THE ABILITY TO MEASURE HOW WE ARE DO ING TO HELP FOCUS OUR EFFORTS WHERE CHANGE IS NEEDED MOST 7HAT HAS BEEN THE RESPONSE FROM PHY SICIANS TO #OMMUNITY -EASUREMENT 7HEN ) lRST STARTED WITH #OMMUNITY -EA SUREMENT LAST FALL ) WAS EXPECTING A LOT OF THE PHYSICIANS TO COMPLAIN ABOUT THE MEASUREMENT METHODOLOGY ) EXPECTED TO HEAR h)F WE DIDN T GET AN !

THERE MUST BE SOMETHING WRONG WITH YOUR MEASURE v )NSTEAD ) VE BEEN IMPRESSED BY HOW MANY MEDICAL GROUPS ARE STRIVING TO AD DRESS THE GAPS IN THEIR CARE 4HERE IS AGREEMENT .OVEMBER $ECEMBER

THAT WE ARE MEASURING THE RIGHT PRACTICES THAT CAN MAKE A DIFFERENCE FOR PATIENTS 4HE PHYSI CIANS IN THIS COMMUNITY WANT TO PROVIDE THE BEST CARE TO THEIR PATIENTS AND THEY ARE USING OUR DATA TO FOCUS THEIR EFFORTS (AVE THERE BEEN CRITICISMS OF #OMMUNITY -EASUREMENT S PUBLIC REPORTING 3URE THIS IS A COMPLEX UNDERTAKING AND WE HAVE SEVERAL CHALLENGES IN FRONT OF US "UT WE CAN T LET OUR DESIRE TO HAVE PERFECT MEASURES GET IN THE WAY OF PERFORMANCE /UTSIDE THE LAB

IN THE REAL WORLD THINGS ARE ALWAYS A BIT MORE COMPLICATED 4HAT IS WHY FOR MOST MEASURES WE WON T SEE PERCENT ACHIEVEMENT "UT RIGHT NOW THERE IS ROOM FOR IMPROVEMENT IN THE CARE THAT IS BEING DELIVERED AND OUR REPORTING CAN MAKE A DIFFERENCE 7HAT ARE SOME EXAMPLES OF CONCERNS Y OU HAVE HEARD 2ISK ADJUSTMENT COMES UP 3HOULD WE ADJUST OUR RESULTS TO REmECT THE POPULATION DIFFERENCES BETWEEN PRACTICES )S IT FAIR TO COMPARE GROUPS WITH DIFFERENT LEVELS OF PUBLIC PROGRAM PATIENTS

OR PATIENTS WITH COMPLICATIONS !BOVE ALL OUR EFFORTS SHOULD BE ABOUT QUALITY IMPROVEMENT

ABOUT GETTING PATIENTS THE CARE THEY NEED !

LOW INCOME PATIENT OR A PATIENT WITH COMPLICA TIONS MIGHT HAVE MORE CHALLENGES IN PLACE TO MEET THE GOALS IN OUR MEASUREMENTS BUT THAT DOESN T MEAN WE DON T WANT THEM TO GET THIS CARE 7E DON T WANT RISK ADJUSTMENT TO BE USED AS A JUSTIlCATION OF THE WAY THINGS ARE 7HAT ABOUT FEARS THAT PHY SICIANS WILL AVOID HIGHER RISK PATIENTS IF WE PUBLICLY REPORT THEIR RESULTS 7E DON T HAVE ANY EVIDENCE THAT THIS IS HAPPEN ING IN -INNESOTA ) VE HEARD FROM PHYSICIANS THAT PATIENT SELECTION IS MORE DIFlCULT AT THE

MEDICAL GROUP LEVEL WHERE WE DO OUR MEASURES 7E SHOULD CONSIDER RISK ADJUSTMENT IF WE MOVE TO INDIVIDUAL PHYSICIAN REPORTING AND MORE SPECIALIZED CONDITIONS "UT ) HOPE THIS NEVER BECOMES A REASON TO NOT REPORT RESULTS INSTEAD WE SHOULD MEASURE IN A WAY THAT ENCOURAGES GOOD PATIENT CARE AND AVOIDS OR DETECTS THIS KIND OF PROBLEM 3O WHAT MAKES A GOOD MEASURE !BOVE ALL THIS HAS TO BE ABOUT IMPROVING CARE

NOT JUST MEASURING 3O WHAT WE SELECT SHOULD BE THINGS THAT WE AGREE NEED IMPROVEMENT ) THINK GOOD MEASURES HAVE THE h -S v 4HEY MATTER ˆ THEY ARE FOR CONDITIONS THAT ARE IMPORTANT TO THE COMMUNITY 4HE MEASURES ARE MEANINGFUL THEY HAVE TO RELATE TO ACTIONS PEOPLE CAN TAKE TO IMPROVE RESULTS !ND THEY ARE MEASURABLE 7E HAVE EFlCIENT WAYS TO GET DATA THAT ARE VALID AND RELIABLE 7HAT ABOUT PROVIDERS WHO AREN T INCLUDED IN Y OUR REPORTING 7HAT S UNIQUE ABOUT OUR EFFORT IN -INNESOTA IS WE HAVE DATA FROM MOST PAYERS AND THE VAST MAJORITY OF MEDICAL GROUPS 4HERE ARE SOME SMALL PROVIDER GROUPS THAT WE JUST DON T HAVE ENOUGH DATA ON NOW TO REPORT 7E D LIKE TO INCLUDE EVERYONE BUT WE ARE GOING TO HAVE TO BALANCE THAT WITH THE COST OF DATA COLLECTION 7HAT WAS Y OUR BIGGEST SURPRISE ABOUT THE COMMUNITY S REACTION TO -.#- )T IS WONDERFUL THAT THE -INNESOTA -EDICAL !S SOCIATION HAS JOINED AS A FOUNDING MEMBER OF -.#- ) HOPE OTHER HEALTH CARE ORGANIZATIONS JOIN IN THE FUTURE TOO /UR NEW BOARD INCLUDES PHYSICIANS HOSPITALS HEALTH PLANS EMPLOYERS AND CONSUMERS )T IS CRITICAL THAT WE ALL SIT AT THE TABLE TO MAKE SURE OUR MEASURES ARE RIGHT

AND THAT THE RESULTS WE REPORT ARE RELIABLE 7E

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

NEED TO DO THIS TOGETHER SO THAT EVERYONE IN VOLVED FROM THE PROVIDER TO THE PURCHASER TO THE PATIENT CAN TRUST OUR WORK $OES -.#- PROVIDE ANY BENElT TO PHY SICIANS #OMMUNITY -EASUREMENT CAN BE A TOOL IN THE CARE IMPROVEMENT PROCESS FOR PHYSICIANS 7HEN YOU CAN SHOW PEOPLE HOW THEY ARE DOING IT MOTIVATES THEM 4HE TRACKING HELPS PHYSI CIANS TO PRACTICE EVEN BETTER ) OFTEN HEAR THAT THE PRACTICE OF MEDICINE IS HARD AND GETTING MORE CHALLENGING ) HOPE THAT WE ARE SEEN AS A HELPFUL PART OF THE SYS TEM SEEN AS A WAY TO RECOGNIZE GOOD EFFORTS TO IMPROVE )F WE ARE SEEN AS JUST ANOTHER ADMINISTRATIVE BURDEN AND IF WE DON T HELP PEOPLE IMPROVE THEIR RESULTS WE HAVE FAILED #AN PHY SICIANS TRUST THAT METHODS Y OU USE FOR MEASUREMENT ARE VALID AND REASONABLE )T S THE SAME MODEL USED NATIONALLY TO REPORT ON HEALTH PLANS WITH THE EXCEPTION THAT -.#- COLLECTS DATA BY MEDICAL GROUP INSTEAD OF HEALTH PLAN -.#- MEASURES ARE BASED ON )#3) GUIDELINES AND RESULTS ARE CALCULATED BY AN INDEPENDENT STATISTICIAN )S THE METHODOLOGY PERCENT BULLETPROOF .O BUT IT IS THE BEST WAY RIGHT NOW TO OBTAIN ACCURATE INFORMATION TO IMPROVE PATIENT CARE )N FACT SEVERAL MEDI CAL GROUPS HAVE SAID THIS INFORMATION HAS BEEN hRIGHT ONv WITH THEIR OWN STUDIES 7HAT ARE Y OU HEARING FROM EMPLOY ER GROUPS ) HOPE EMPLOYERS WILL SEE US NOT JUST AS A VENDOR OF DATA BUT AS PART OF THE PROCESS FOR IMPROVEMENT 4HEY NEED TO HELP US SET THE AGENDA AND BE ACCOUNTABLE FOR THEIR END 0ART OF THE EQUATION IS PATIENT COMPLIANCE AND WE NEED TO HELP THEM SEE WHAT STEPS THEY CAN TAKE TO GET THEIR EMPLOYEES MORE ENGAGED 4O THIS END WE VE BEEN WORKING WITH THE "UYERS (EALTH #ARE !CTION 'ROUP AND THE -INNESOTA "USINESS 0ARTNERSHIP TO lND WAYS TO ENGAGE CONSUMERS IN THE PROCESS !RE CONSUMERS ACTUALLY USING THIS INFORMATION /UR MAIN OUTREACH HAS BEEN OUR 7EB SITE 7E HAVE MORE THAN VISITS PER MONTH WITHOUT MUCH PROMOTION SO FAR 4HE AVERAGE NUMBER OF PAGE VIEWS IS 7HAT THAT MEANS IS PEOPLE ARE STAYING ON THE SITE AND LOOKING AROUND FOR INFORMATION 0EOPLE SEEM INTERESTED IN WHAT WE ARE DOING

"UT WE NEED TO DO MORE TO SHOW THE PUBLIC HOW THEY CAN USE THIS INFORMATION TO IMPROVE THEIR CARE 7E VE GOT TO HELP PATIENTS UNDERSTAND HOW THEY CAN USE THIS INFORMATION TO MAKE BETTER CHOICES FOR THEMSELVES

CESS AND EASE OF USE OF INFORMATION FOR MEDICAL GROUPS )N ADDITION WE HOPE TO HOLD A QUALITY IMPROVEMENT FORUM SO THAT MEDICAL GROUPS CAN SHARE SUCCESS STORIES AND LEARN WHAT WORKS IN OTHER SETTINGS

!RE THERE OTHER THINGS THE NEW BOARD WILL BE CONSIDERING

7HAT WOULD Y OU LIKE TO SEE FOR THE FUTURE OF #OMMUNITY -EASUREMENT

3HOULD THE COST OR VALUE OF CARE BE INCLUDED IN OUR REPORTS #ONSUMERS ARE INTERESTED IN KNOWING THE QUALITY OF CARE BUT ARE ALSO IN TERESTED IN THE COST $ETERMINING OUR ROLE IN DISCUSSING VALUE IS SOMETHING WE WILL CAREFULLY CONSIDER /UR lRST PRIORITY IS IMPROVING PATIENT CARE !S WE IDENTIFY WAYS TO ACCOMPLISH THIS WE MAY ALSO NEED TO LOOK AT VALUE 7E ALSO NEED TO LOOK AT OTHER SETTINGS ALONG WITH PHYSICIAN OFlCES FOR REPORT ING AND WHAT OTHER MEASURES MIGHT HELP IMPROVE CARE

2ESULTS IMPROVING 4HAT IS THE FOCUS 7E WOULD LIKE TO CONTINUE TO SEE HEALTH CARE IN -INNESOTA IMPROVE EVERY YEAR .EW RESULTS WILL BE REPORTED ON THE 7EB SITE ON .OVEMBER 0LEASE VISIT THE SITE AT WWW MNHEALTHCARE ORG

$O Y OU SEE A TIME WHEN -INNESOTA WILL BE PART OF A NATIONAL QUALITY REPORT ING EFFORT 4HE -EDICARE PROGRAM IS LOOKING AT NATIONAL REPORT ING FOR AMBULATORY CARE AS ARE SEVERAL OTHER GROUPS ! FEW OTHER COMMUNITIES

SUCH AS -ASSACHUSETTS 7IS CONSIN AND #ALIFORNIA HAVE BEGUN RESULT REPORTING -IN NESOTA IS DElNITELY AHEAD OF THE CURVE ) HOPE THE SUCCESS WE HAVE HERE CAN INmUENCE OTHER NATIONAL ACTIVITIES !NY NEWS ABOUT WHAT MIGHT CHANGE WITH THE REPORT 4HIS YEAR WE HAVE IMPROVED OUR SAMPLING METHODS AND SHOULD HAVE TIGHTER CONl DENCE INTERVALS AND MORE COMPARABLE DATA 7E ALSO PLAN TO ENHANCE THE 7EB SITE SO THAT THERE IS MORE INFORMATION FOR CONSUMERS ON THE SITE 7E WILL ALSO LOOK FOR WAYS TO INCREASE THE AC

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

.OVEMBER $ECEMBER

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0ATIENT !DVOCACY AND "EST IN #LASS 3PECIALTY #ARE IN (EALTH #ARE 0URCHASING

4H IS NEW DIRECTION TAKES TH E BUSINESS MODEL TH AT COMPANIES USE TO PARTNER WITH H IGH PERFORMANCE SUPPLIERS AND APPLIES IT TO TH E WAY EMPLOYERS PURCH ASE H EALTH CARE

)

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APPOINTED BY 'OVERNOR 0AWLENTY AND LED BY FORMER 5 3 3ENATOR $AVID $URENBERGER

ISSUED ITS lNAL REPORT 0ART OF THAT REPORT RECOMMENDED THAT A BROAD ALLIANCE OF PUR CHASERS BOTH PUBLIC AND PRIVATE WORK TOGETHER TO INCREASE HEALTH CARE QUALITY AND EFlCIENCY USING INNOVATIVE BUT EFFECTIVE PURCHASING STRATEGIES 4O THAT END -INNESOTA 'OVERNOR 4IM 0AWLENTY ANNOUNCED IN .OVEMBER THAT AN ALLIANCE OF HEALTH CARE PURCHASERS HAS BEEN FORMED TO PROVIDE THEIR COLLECTIVE WEIGHT PERCENT OF THE -IN NESOTA POPULATION BEHIND A NEW APPROACH TO PURCHASING HEALTH CARE 4HE h3MART "UYv !LLIANCE ANNOUNCED BY THE 'OVERNOR INCLUDES THE 3TATE OF -INNESOTA AS %MPLOYER AND THEIR -EDICAL !SSISTANCE 0ROGRAM THE ,ABOR -ANAGEMENT (EALTH #ARE #OALITION OF THE 5PPER -IDWEST ,-# THE "UYERS (EALTH #ARE !CTION 'ROUP THE -INNESOTA "USI NESS 0ARTNERSHIP -INNESOTA #HAMBER OF #OMMERCE AND !DVOCATES FOR -ARKETPLACE /PTIONS FOR -AINSTREET INCLUDES RURAL PURCHASING ALLIANCES /NE OF THE !LLIANCE S FOUR PRIORITIES FOR HEALTH CARE REFORM INCLUDES THE RECOMMENDATION THAT hHEALTH CARE PURCHAS ERS DEMAND THAT CARE PROVIDERS MEET SPECIlC STANDARDS OF CARE AND CONTRACT ONLY WITH THOSE THAT DEMONSTRATE BEST IN CLASS PERFORMANCE v 4HIS NEW DIRECTION TAKES THE BUSINESS MODEL THAT COMPANIES USE TO PARTNER WITH HIGH PERFORMANCE SUPPLIERS AND APPLIES IT TO THE WAY EMPLOYERS PURCHASE HEALTH CARE ! 0ARADIGM #HANGE

4HE TIME IS RIGHT TO EMBRACE A DIFFERENT MORE EFFECTIVE BUSINESS MODEL FOR PURCHASING HEALTH CARE 3EE COMPARISON CHART ON PAGE #ONTINUING DOUBLE DIGIT HEALTH CARE COSTS THAT THREATEN COMPANY PROlTABILITY JOBS WAGES AND GOOD LABOR RELATIONS CANNOT AND SHOULD NOT BE TOLERATED ! NEW BUSINESS MODEL FOR PURCHASING HEALTH CARE IS A STEP IN THE RIGHT DIRECTION 4ODAY MOST MANUFACTURERS AND OTHER BUSINESSES USE A COMMON PROCESS TO IDENTIFY AND SELECT HIGH PERFORMANCE SUPPLIERS BASED ON QUALITY AND VALUE 4HEY DO NOT DO BUSI NESS WITH EVERY SUPPLIER IN THE YELLOW PAGES 3UPPLY CHAIN MANAGEMENT AND PROCUREMENT EVOLVED OVER RECENT DECADES AS AN EFFECTIVE BUSINESS PROCESS FOR BOTH PURCHASERS AND SUPPLIERS )N THE QUALITY ARENA BUSINESSES HAVE FOUND THAT EVOLVING FROM INSPECTION BASED PROCESSES TO PERFORMANCE SPECIlCATIONS WHICH EMBODY CAPABLE PROCESSES THAT CONSISTENTLY ARE IN CONTROL ENSURES THAT THE END PRODUCT OR SERVICE WILL BE DEFECT FREE 7HEN DEFECT FREE SERVICES AND PRODUCTS ARE DELIVERED ALL PARTIES IN THE SUPPLY CHAIN BENElT 4HE PRODUCT OR SERVICE MEETS REQUIREMENTS IT DOESN T HAVE TO BE RE WORKED

ETC AND COSTS ARE FAR LESS "9 3%!. +%..%9 0H $

.OVEMBER $ECEMBER

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

)N HEALTH CARE NATIONAL LEADERS HAVE CHARACTERIZED THE VARIABILITY IN QUALITY AND PATIENT SAFETY NOT AS A GAP BUT AS A HUGE CHASM 4HIS CHASM RESULTS IN OR MORE LOST LIVES ANNUALLY DUE TO PREVENTABLE MEDICAL ERRORS THAT OCCUR IN THE HOSPITALS ALONE 7E DO NOT KNOW HOW MANY LIVES ARE LOST DUE TO MISTAKES IN OUTPATIENT CARE 0ERHAPS THE MOST SIGNIlCANT lNDINGS IN RECENT YEARS ARE THAT SOME PLUS PERCENT OF HEALTH COSTS ARE DUE TO POOR QUALITY AND THAT IN MOST HIGH COST SPECIALTY CARE SERVICE AREAS

BETTER QUALITY COSTS LESS ! RECENT (ARVARD "USINESS 2EVIEW ARTICLE 0ORTER ET AL *UNE INDI CATED EMPLOYERS ARE FOCUSING ON THE WRONG LEVEL TO MAKE COMPETITION WORK 4HE RESEARCHERS CONCLUDED THAT INSTEAD OF LEVERAGING VOLUME IN NEGOTIATING HEALTH PLAN COVERAGE AND PREMIUMS PURCHASERS SHOULD NEGOTIATE WITH THE BEST PERFORMING SPECIALTY CARE DIAGNOSTIC AND PROVIDER SYSTEMS !PPLYING THE .EW -ODEL

&ACTS ABOUT TH E ,ABOR -ANAGEMENT (EALTH #ARE #OALITION OF TH E 5PPER -IDWEST s s

s s s

"EGAN IN /VER (EALTH 7ELFARE &UNDS

0UBLIC 3ECTOR AND 3CHOOL $ISTRICT -EMBERS

!CTIVES AND #OVERED ,IVES *OINT ,ABOR AND -ANAGEMENT 'OVER NANCE 0RODUCTS !VAILABLE OR 5NDER $EVELOP MENT 0HARMACY 0"- $ENTAL 6ISION (EALTH 6ALUE 0ARTNERSHIP #ENTERS OF %XCELLENCE $IAGNOSTIC )MAGING 'ROUP -EDICAL !DVANTAGE 0LAN '-!0 &OR 2ETIREE -EDICARE #OVERAGE

!S IN BUSINESS STRATEGY THE PLACE TO BEGIN IS WHERE THE BIGGEST IMPACT CAN BE MADE IN THE SHORTEST AMOUNT OF TIME )N HEALTH CARE ABOUT PERCENT OF THE COVERED POPULATION ACCOUNTS FOR MORE THAN PERCENT OF THE COSTS ! LARGE PORTION OF THIS PLUS PERCENT IS SPENT FOR SPECIALTY CARE INCLUDING ORGAN TRANSPLANTS HIGH RISK PREGNANCY AND LOW BIRTH WEIGHT BABIES HEART CARE AND CANCER CARE 4HESE SERVICE AREAS ARE ALSO FRAUGHT WITH PROBLEMS SUCH AS HIGH VARIABILITY IN DIAGNOSTIC AND TREATMENT PROCESSES CLINICAL QUALITY OUTCOMES AND COSTS 4HERE CAN BE HUGE QUALITY OF CARE DIFFERENCES IN SPECIALTY CARE CENTERS AND GENERALLY POORER QUALITY CARE WILL BE MORE EXPENSIVE FOR BOTH EMPLOYERS AND EMPLOYEESˆBOTH INDIRECT AND DIRECT COSTS WILL BE HIGHER !LSO GENERALLY METROPOLITAN AREAS HAVE OVERCA PACITY HIGH REVENUE PRODUCING SPECIALTY CARE SERVICES SUCH AS CARDIOLOGY AND CANCER

AS THESE ARE AMONG THE MORE LUCRATIVE REVENUE SOURCES FOR PROVIDERS AND SUPPLIERS !NOTHER REASON TO FOCUS ON THESE HIGH COST SPECIALTY CARE AREAS IS THAT EMPLOYEES AND THEIR FAMILY MEMBERS WHEN DIAGNOSED WITH A NEW CONDITION SUCH AS A HEART PROBLEM OR CANCER DO NOT HAVE A RELATIONSHIP WITH A SPECIALTY CARE PROVIDER 4HE NEW MODEL WOULD HELP EMPLOYEES OR FAMILY MEMBERS WORK WITH THEIR PRIMARY CARE DOCTOR TO GET TO THE BEST PERFORMING SPECIALTY CENTER AS DETERMINED BY A CERTIlCATION PROCESS 4HIS PROCESS USES EVIDENCE BASED INFORMATION THAT IS SUPPORTED BY THE RESPECTED MEDICAL SPECIALTIES AND HEALTH CARE QUALITY RESEARCH LITERATURE AND GUIDELINES #ONTINUED ON PAGE

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

.OVEMBER $ECEMBER

(EALTH #ARE 0URCHASING #ONTINUED FROM PAGE

4HE CHART BELOW SHOWS HOW EMPLOYERS AND (EALTH AND 7ELFARE &UNDS CURRENTLY BUY HEALTH CARE AS COMPARED TO WHAT IT WOULD LOOK LIKE IF THEY APPLIED THEIR CORE BUSINESS METHODS FOR SUPPLY CHAIN MAN AGEMENT AND PROCUREMENT

4HE #ERTIlCATION 0ROCESS

&IRST OF ALL EACH EMPLOYER DOES NOT HAVE TO IMPLEMENT THIS APPROACH ALONE )N HEALTH CARE UNLIKE MANUFACTURING AND OTHER BUSINESSES EMPLOYERS AND OTHER PURCHASERS ALL SHARE COMMON SUPPLIERS 4HEREFORE THE BEST APPROACH IS TO WORK IN A PURCHASER COALITION TO GET THE BALL ROLLING 4HE ,-# WORKS IN PARTNERSHIP WITH (EALTH 3YSTEMS -ANAGEMENT (3- TO CERTIFY SPECIALTY CARE PROVIDERS FOR ITS BEN ElCIARIES (3- GREW OUT OF THE LEADERSHIP EFFORTS OF THE #ORPORATE (EALTH $IRECTOR AND (ONEYWELL -EDICAL $IRECTOR $R *OHN "URNS PRESIDENT IN OF THE 2AMSEY #OUNTY -EDICAL 3OCIETY PRIOR TO HIS WORK AT (ONEYWELL WHO PIONEERED THE h#ENTERS OF %XCELLENCEv APPROACH IN THE S 4HE #OALITION HAS SELECTED THE FOUR SPECIALTY AREAS THAT PRODUCE THE HIGH EST COSTS ˆ ORGAN TRANSPLANTS HIGH RISK PREGNANCY AND LOW BIRTH WEIGHT BABIES

HEART CARE AND CANCER CARE ˆ FOR CON CENTRATION #URRENTLY THE WORK HAS BEEN DONE FOR ORGAN TRANSPLANTS PROVIDING AN UNPARALLELED NATIONAL NETWORK FOR ORGAN TRANSPLANT PATIENTS )N -INNESOTA HEART CARE WAS THE NEXT CONDITION TO TACKLE -INNESOTA HAS OPEN HEART SURGERY CENTERS WITH VARI OUS ANNUAL VOLUME EXPERIENCES .ATIONAL MEDICAL RECOMMENDATIONS SUGGEST THAT A CENTER PERFORM AT LEAST CORONARY ARTERY BYPASS GRAFT #!"' SURGERIES EACH YEAR IN ORDER TO ESTABLISH PROlCIENCY /NLY THREE CENTERS IN -INNESOTA REACH THIS THRESHOLD -INNESOTA NEEDS ONLY lVE SURGERY CENTERS TO PERFORM AT THE RECOMMENDED LEVEL 4HE #OALITION ISSUED A REQUEST FOR INFORMATION 2&) TO ALL HEART CENTERS IN -INNESOTA LAST YEAR AND FOUR MAJOR HEART CENTERS AGREED TO CERTIlCATION 4HESE INCLUDE -AYO #LINIC 3T -ARY S $ULUTH .OVEMBER $ECEMBER

/LD HEALTH CARE PURCHASING MODEL

.EW HEALTH CARE PROCUREMENT MODEL

s /FF THE SHELF PURCHASING

s 3PECIlCATIONS DRIVEN PROCUREMENT

s -INIMAL THRESHOLDS FOR PERFORMANCE

s -AXIMUM THRESHOLDS AND OPTIMAL PERFORMANCE

s 7IDE VARIATION IN PROCESS AND OUTCOMES

s 2EDUCED VARIATION IS REWARDED

s -ORE EXPENSE FOR POOR QUALITY AND RE WORK

s ,ESS EXPENSE THROUGH QUALITY SUPPLIERS

s (EALTH SYSTEMS THAT PROVIDE INAPPROPRIATE AND s "ETTER QUALITY AND PERFORMANCE REWARDED POOR QUALITY CARE s )NVENTORY DEFECT RATE AND COSTS AND PRICING s 0URCHASERS USE EVIDENCE BASED MEDICINE AND CONTROLLED BY PROVIDERS AND SUPPLIERS OPERATIONS IN PURCHASING SPECIlCATIONS s !LL THE BUILDINGS AND PROGRAMS THE HEALTH CARE s "UILD ONLY AS NECESSARY INDUSTRY WANTS s 0OTENTIAL SUPPLIERS INCLUDE ALL WITH A SHINGLE OR s 3ELECT QUALIlED CERTIlED SUPPLIERS LISTED IN THE YELLOW PAGES

#LINIC 0ARK .ICOLLET (EALTH #ARE #ENTER

AND AN ADDITIONAL EAST METRO AREA CENTER

WHICH IS CURRENTLY IN THE PROCESS OF BE ING REVIEWED 4HE CERTIlCATION INCLUDES EXTENSIVE SHARING OF DATA ON CLINICAL STRUC TURE PROCESS AND OUTCOMES 4HESE DATA ARE THEN COMPARED TO NATIONAL MEDICAL BENCHMARKS /N SITE VISITS BY TWO EXPERTS FOR THREE TO lVE DAYS AT EACH CENTER ARE A KEY ELEMENT OF THE CERTIlCATION PROCESS 4HE QUALIFYING CENTERS COOPERATION WAS TREMENDOUS AND WE EXPECT THEY WERE ANXIOUS TO PARTICIPATE BECAUSE THEY HAD MONITORED THEIR PERFORMANCE CONTINUALLY AND KNEW THEY HAD THE RIGHT DATA AND PRO CESSES TO DEMONSTRATE EXEMPLARY QUALITY 4HE 0ROGRAM IN !CTION

,-# WILL USE BENElT DESIGN TO URGE MEM BERS AND THEIR PRIMARY CARE DOCTORS TO USE THESE THREE TO FOUR CERTIlED CENTERS 4HE PROGRAM HAS AT ITS CORE A PATIENT ADVOCACY SUPPORT SYSTEM 0!33 THAT OPERATES HOURS A DAY SEVEN DAYS A WEEK TO ASSIST MEMBERS AND THEIR FAMILIES WITH SPECIALTY CARE REFERRAL AND PROVIDER SCHEDULING 4HE /PERATING %NGINEERS ,OCAL (EALTH AND 7ELFARE &UND WAS THE lRST TO

IMPLEMENT THE PROGRAM !UGUST

4HEY ARE AMONG THE LARGEST OF #OALITION MEMBERS WITH SOME MEMBERS AND OVER LIVES ACROSS -INNESOTA AND THE $AKOTAS %ARLY RESULTS SHOW THAT WORKERS AND THEIR FAMILIES WILL TRAVEL IN ORDER TO GET TO THE BEST CARE !S AN EXAMPLE A WORKER IN FAR NORTHERN -INNESOTA WAS DUE TO HAVE A COMPLICATED ESOPHAGEAL CANCER SURGERY 7HEN THE FAMILY FOUND OUT FROM 0!33 THAT A SURGEON S VOLUME EXPERIENCE MAKES A DIFFERENCE IN OUTCOMES THEY TRAVELED TO -AYO IN 2OCHESTER BECAUSE THE SURGEON THERE HAD PERFORMED NUMEROUS SUCH PRO CEDURES LAST YEAR WHILE THE LOCAL SURGEON HAD PERFORMED ONLY A FEW IN THE PAST YEAR 7HILE THE PATIENT RECEIVED THE BEST QUALITY CARE THE HEALTH FUND CAN EXPECT TO PAY LESS FOR CARE THAT DOES NOT INCLUDE COMPLICATIONS INFECTIONS AND THE NEED FOR ADDITIONAL SURGERY ALL OF WHICH OCCUR LESS FREQUENTLY IN A HIGH PERFORMANCE SPECIALTY MEDICAL SYSTEM !NOTHER CASE INVOLVED A WIFE OF AN OPERATING ENGINEER WHO WAS DIAGNOSED WITH A BRAIN TUMOR BY HER LOCAL SPECIAL IST 7HEN MEDICATIONS DID NOT IMPROVE

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

HER NEUROLOGICAL PROBLEMS IT WAS RECOM MENDED LOCALLY THAT SHE WOULD NEED BRAIN SURGERY 3HE LEARNED OF THE &UND S h#EN TERS OF %XCELLENCEv PROGRAM AND CALLED THE PATIENT ADVOCACY NUMBER OPERATED BY (EALTH 3YSTEMS -ANAGEMENT THE #OALITION S AND (EALTH &UNDS PARTNER AND VENDOR FOR SPECIALIST REFERRAL INFORMATION )T IS ALWAYS THE PATIENT AND OR THE PRIMARY CARE DOCTOR WHO ACTS ON THE INFORMATION TO MAKE THE REFERRAL !FTER HEARING DETAILS OF HER MEDICAL CONDITION AND IMPENDING SURGERY (EALTH 3YSTEMS -ANAGEMENT PROVIDED INFORMA TION TO THE WOMAN THAT LED HER TO SELF REFER TO A #ENTER OF %XCELLENCE 4HE SUBSEQUENT BRAIN SCAN AND EXAMINATION REVEALED THAT SHE WAS PROVIDED THE WRONG MEDICATION PREVIOUSLY SHE DID NOT HAVE A TUMOR AND SURGERY WAS NOT INDICATED .OW WHAT WAS THE QUALITY RETURN TO THE MEMBER AND COST SAVINGS TO THE (EALTH AND 7ELFARE &UND 3ELF INSURED (EALTH AND 7ELFARE &UNDS

PARTICULARLY IN THE CONSTRUCTION INDUSTRY

hGET THE FACTv THAT RE WORK AND COMPLICA TIONS ARE NOT ONLY POOR QUALITY BUT ALSO THE &UND ENDS UPON PAYING FOR THESE AVOIDABLE EVENTS 'LEN *OHNSON )5/% &UND TRUSTEE AND "USINESS -ANAGER OF ,OCAL ESTIMATED THAT THE PROGRAM COULD CONSERVATIVELY SAVE THE FUND BE TWEEN

OR MORE PER YEAR )N -ARCH THE 5NITED &OOD AND #OM MERCIAL 7ORKERS 5&#7 ,OCAL

ANOTHER LARGE MEMBER OF THE #OALITION

BARGAINED FOR THE #ENTERS OF %XCELLENCE PROGRAM 4HE TRUST FUND INCLUDES OVER

WORKERS COVERED LIVES IN RETAIL STORES HEALTH CARE AND MEAT PRO CESSING IN -INNESOTA 4HE 5NION TOLD -ANAGEMENT 4RUSTEES THAT THEY WANTED TO IMPLEMENT THE PROGRAM -ANAGEMENT AGREED 4HE #OALITION BELIEVES PROVIDING THE BEST QUALITY TO MEMBERS AND SAVINGS TO &UNDS AND %MPLOYER CONTRIBUTIONS IS A PERFECT INTERSECT OF INTERESTS BETWEEN ,ABOR

AND -ANAGEMENT 4HIS PAST MONTH STATE EMPLOYEE LABOR GROUPS ALSO BARGAINED FOR THE PROGRAM AND FOLLOWING A REVIEW OF POTENTIAL VENDORS THE PROGRAM IS EXPECTED TO BE AVAILABLE TO STATE EMPLOY EES AND DEPENDENTS IN /THER &UND 4RUSTEES ARE CONSIDERING THE PROGRAM AS WELL )N THE HEART CARE AREA IT IS ESTIMATED BASED ON A STUDY CONDUCTED IN -INNESOTA

THAT AS MUCH AS TO CAN BE SAVED PER CASE BY HAVING CARE PROVIDED

BY A CERTIlED HEART CENTER 4HIS IS BENEl CIAL NOT ONLY FOR MANAGEMENT AND LABOR BUT ALSO FOR PROVIDERS WHO AS A RESULT OF DOING THE BEST JOB RECEIVE HIGHER REFERRAL VOLUME "RINGING IT 4OGETHER

4OP BUSINESS LEADERS SHOULD EXAMINE THE POTENTIAL OF USING THE CORE BUSINESS STRATE GIES THAT THEY USE IN THEIR EXTENDED ENTER PRISE WITH SUPPLIERS TO PURCHASE HEALTH

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

CARE 3UCH AN APPROACH WOULD BENElT COMPANIES EMPLOYEES DEPENDENTS AND RETIREES /THER ORGANIZATIONS SUCH AS THE h3MART "UYv !LLIANCE ANNOUNCED BY THE 'OVERNOR ARE MOBILIZING AROUND THIS NEW APPROACH 3UPPORT FROM STATEWIDE LEADERSHIP WILL REINFORCE EFFORTS AND ENCOURAGE THE PUBLIC SECTOR INCLUDING CITIES COUNTIES AND SCHOOL DISTRICTS TO ADOPT A SIMILAR APPROACH )F YOU OR YOUR ORGANIZATION WISHES MORE INFORMATION ON THE SUGGESTED APPROACH THE ,ABOR -ANAGEMENT #OALITION OR THE STATEWIDE h3MART "UYv !LLIANCE FEEL FREE TO CONTACT THE AUTHOR * " h3EANv +ENNEY 0H $ IS EXECUTIVE DIRECTOR OF THE ,ABOR -ANAGEMENT (EALTH #ARE #OALITION OF THE 5PPER -IDWEST BASED IN THE 4WIN #ITIES AND IS A CO CHAIR OF THE -INNESOTA h3MART "UYv !LLIANCE 9EARS AGO -R +ENNEY SERVED ON THE MEDICAL SCHOOL FACULTY AT THE 5 OF -. AS $IREC TOR OF 'RADUATE 3TUDIES FOR &AMILY 0RACTICE AND #OMMUNITY (EALTH 9OU MAY CONTACT HIM AT SKENNEY JREC NET OR

.OVEMBER $ECEMBER

0ERTUSSIS 3URVEILLANCE IN -INNESOTA

$

$52).'

POPULA

TION CASES OF PERTUSSIS WERE REPORTED IN -IN NESOTA 4HIS IS MORE THAN SIX TIMES THE NUMBER REPORTED IN N MORE THAN TWICE THE NUMBER REPORTED DURING THE MOST RECENT PREVIOUS PEAK YEAR OF N AND HIGHER THAN THE NUMBER OF CASES REPORTED DURING ANY YEAR SINCE N 4HE INCREASE IN REPORTED CASES ALSO OCCURRED NATIONALLY .ORTH $AKOTA REPORTED OVER CASES AND 7ISCONSIN REPORTED OVER CASES IN 4HE INCREASE IN REPORTED CASES HAS BEEN OBSERVED PRIMARILY IN ADOLESCENTS AND ADULTS AND MAY BE ATTRIBUTABLE TO SEVERAL FACTORS INCLUDING INCREASED AWARENESS OF PERTUSISS AMONG HEALTH CARE PROVIDERS AND THE GENERAL PUBLIC INCREASED AVAILABILITY OF MORE SENSITIVE DIAGNOSTIC TESTING USING 0#2 AND TRULY INCREASED INCIDENCE 0ERTUSSIS IS CONSIDERED ENDEMIC BUT IS LIKELY UNDER DIAGNOSED AND UNDER REPORTED (ISTORICALLY INCIDENCE HAS TENDED TO PEAK IN THE LATE SUMMER AND EARLY FALL HOWEVER ANNUAL PEAKS HAVE MORE RECENTLY OCCURRED DURING THE LATE FALL AND EARLY WINTER 0ERTUSSIS REMAINS A SIGNIlCANT CAUSE OF MORBIDITY IN THE 5NITED 3TATES $ESPITE HIGH VACCINATION COVERAGE LEVELS

PERTUSSIS IS THE ONLY VACCINE PREVENTABLE DISEASE WITH AN INCREASE IN OVERALL REPORTED CASES AND INFANT MORTALITY IN THE 5NITED 3TATES OVER THE PAST DECADE 0ERTUSSIS IS A TOXIN MEDIATED BACTERIAL ILL NESS INVOLVING LOCAL TISSUE DAMAGE IN THE RESPI RATORY TRACT LEADING TO A PROLONGED PAROXYSMAL COUGH LASTING UP TO DAYS WITH POST TUSSIVE VOMITING AND WHOOPING 4HE COUGH MAY PER SIST BEYOND THE INFECTIOUS PERIOD AND BEYOND TREATMENT UNTIL RESPIRATORY TISSUE HAS HEALED 4RANSMISSION OCCURS VIA RESPIRATORY DROPLETS

"9 #9.4()! +%.9/.

- 0 (

.OVEMBER $ECEMBER

4HE INCUBATION PERIOD IS GENERALLY DAYS

BUT CAN RANGE FROM TO DAYS 0AROXYSMAL COUGHING IS THE MOST COM MONLY REPORTED SYMPTOM OF PERTUSSIS )N

PERCENT OF THE CASES EXPERIENCED PAROXYSMAL COUGHING /VER ONE THIRD

PERCENT REPORTED WHOOPING 0OST TUSSIVE VOMITING WAS REPORTED IN PERCENT OF THE CASES 0NEUMONIA WAS DIAGNOSED IN PERCENT CASES FOUR OF WHOM WERE LESS THAN MONTHS OF AGE 4HIRTY ONE PERCENT CASES WERE HOSPITALIZED PERCENT OF THE HOSPITALIZED PATIENTS WERE YOUNGER THAN MONTHS OF AGE /NE DEATH DUE TO PERTUSSIS RELATED COMPLICATIONS WAS REPORTED IN 4HE CASE WAS A MONTH OLD WITH NO UNDERLYING MEDICAL CONDITIONS 0ERTUSSIS MAY AFFECT PERSONS OF ANY AGE $URING CASES RANGED IN AGE FROM DAYS TO YEARS PERCENT OCCURRED IN PERSONS YEARS OF AGE AND OLDER PERCENT OCCURRED IN PERSONS TO YEARS OF AGE PERCENT OCCURRED IN PERSONS YEARS PERCENT OC CURRED IN PERSON MONTHS TO YEARS AND PERCENT OCCURRED IN INFANTS LESS THAN MONTHS OF AGE !GE WAS UNKNOWN FOR ONE CASE )NFANTS AND YOUNG CHILDREN ARE AT THE HIGHEST RISK FOR SEVERE DISEASE AND COMPLICATIONS 0ERTUSSIS IS INCREASINGLY RECOGNIZED IN OLDER CHILDREN AND ADULTS 4HESE CASES IN OLDER CHILDREN AND ADULTS ARE A SOURCE OF INFECTION FOR INFANTS WHO ARE AT HIGHEST RISK OF SEVERE COMPLICATIONS 0ERTUSSIS BOOSTER VACCINES FOR PERSONS YEARS OF AGE AND OLDER WILL HELP TO DECREASE THE INCIDENCE AND TRANSMISSION OF PERTUSSIS IN THE COMMUNITY 4WO NEW 4ETANUS 4OXOID

2EDUCED $IPHTHERIA 4OXOID AND !CELLULAR 0ERTUSSIS 6ACCINE !DSORBED 4DAP PRODUCTS WERE LICENSED BY THE 5 3 &OOD AND $RUG !DMINISTRATION &$! IN AS SINGLE DOSE BOOSTER VACCINES TO PROVIDE PROTECTION AGAINST

TETANUS DIPHTHERIA AND PERTUSSIS "OOSTRIXยง

DEVELOPED BY 'LAXO3MITH+LINE IS INDICATED FOR PERSONS TO YEARS OF AGE !DACELยง

DEVELOPED BY 3ANOl 0ASTEUR IS INDICATED FOR PERSONS TO YEARS OF AGE /N *UNE

THE NATIONAL !DVISORY #OMMITTEE ON )MMUNIZATION 0RACTICES !#)0 VOTED TO RECOMMEND THE ROUTINE USE OF 4DAP VACCINES IN ADOLESCENTS AGED n YEARS IN PLACE OF TETANUS AND DIPHTHERIA TOXOIDS 4D VACCINES $ETAILED INFORMATION IS PUBLISHED ON THE 5 3 #ENTERS FOR $ISEASE #ONTROL AND 0REVENTION WEBSITE AT HTTP WWW CDC GOV NIP VACCINE TDAP TDAP?ACIP?RECS PDF !CTIVE 3URVEILLANCE FOR 0ERTUSSIS 4HE #ENTERS FOR $ISEASE #ONTROL AND 0REVEN TION HAS FUNDED THE -INNESOTA $EPARTMENT OF (EALTH -$( TO CONDUCT AN ACTIVE SUR VEILLANCE PROJECT FOR PERTUSSIS IN 2AMSEY AND $AKOTA #OUNTIES 4OGETHER THESE COUNTIES REP RESENTED PERCENT OF REPORTED CASES OF PERTUS SIS IN THE SEVEN COUNTY METROPOLITAN AREA AND PERCENT OF -INNESOTA CASES IN 4HE PURPOSE OF THIS lVE YEAR PROJECT IS TO DEVELOP AN IMPROVED PERTUSSIS SURVEILLANCE SYSTEM IN ORDER TO BETTER CHARACTERIZE THE EPIDEMIOLOGY OF PERTUSSIS DISEASE ACROSS PEDIATRIC ADOLESCENT

AND ADULT AGE GROUPS AND TO EVALUATE VACCINE EF FECTIVENESS &URTHERMORE STUDIES OF THE IMPACT OF THE NEW ADOLESCENT ADULT PERTUSSIS VACCINE CAN BE CONDUCTED IN THE PROJECT AREA 4HE GOAL IS TO EXPAND ACTIVE SURVEILLANCE TO HEALTH CARE FACILITIES THROUGHOUT 2AMSEY AND $AKOTA COUNTIES ONCE A SUCCESSFUL ACTIVE SURVEILLANCE SYSTEM HAS BEEN ESTABLISHED AMONG PARTICIPAT ING PILOT SITES

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

4HINKˆ4ESTˆ4REAT ˆ 3TOP 4RANSMISSION 4HE PERTUSSIS ACTIVE SURVEILLANCE PROJECT IS DRIVEN BY A h 4 MOTTOv 4HINK OF PERTUSSIS IN ANYONE WITH s ! PERSISTENT COUGH OF UNKNOWN ETIOLOGY LASTING MORE THAN SEVEN DAYS s 0AROXYSMAL COUGH WHOOP POST TUSSIVE VOMITING GAGGING OR APNEA s ! COUGH OF UNKNOWN ETIOLOGY WHO HAS BEEN NOTIlED OF A PERTUSSIS EXPOSURE s 0ROVIDER S SUSPICION OF PERTUSSIS 4EST FOR PERTUSSIS s 5SE A NASOPHARYNGEAL .0 SWAB APPLICATOR WITH A mEXIBLE WIRE s 'ENTLY INSERT THE SWAB INTO THE NARE AND PROCEED GENTLY TO THE POSTERIOR WALL OF THE PHARYNX $O NOT DIRECT THE SWAB UPWARD LET THE SWAB CREEP ALONG THE mOOR OF THE NASAL CAVITY $O NOT FORCE THE SWAB PAST OBSTRUCTION (OLD THE SWAB IN PLACE FOR UP TO SECONDS OR UNTIL A PAROXYSMAL COUGH IS ELICITED OR ASK PATIENT TO COUGH 4HIS SHOULD ENSURE AN ADEQUATE SPECIMEN

AND REDUCE THE POSSIBILITY OF FALSE NEGATIVE RESULTS 4REAT AND REPORT SUSPECTED AND CONlRMED CASES s %RYTHROMYCIN !ZITHROMYCIN #LARITHRO MYCIN 4RIMETHOPRIM 3ULFAMETHOXAZOLE CAN ALL BE USED s 0LEASE SEE -$( TREATMENT MATRIX FOR AP PROPRIATE USE s &OR QUESTIONS CALL YOUR RESPECTIVE LOCAL HEALTH DEPARTMENT –$AKOTA #OUNTY –3T 0AUL 2AMSEY #OUNTY

s !NTIMICROBIAL PROPHY LAXIS SAME REGIMEN AS THERAPY FOR CASES SHOULD BE GIVEN TO PATIENTS WHO ARE ASYMPTOMATIC BUT ARE CLOSE CONTACTS OF PERTUSSIS CASES – !NTIMICROBIAL PROPHYLAXIS IS RECOM MENDED IF EXPOSURE TO AN INFECTIOUS CASE OCCURRED WITHIN THE PREVIOUS DAYS THE MAXIMUM INCUBATION PERIOD FOR PERTUSSIS – !SYMPTOMATIC CONTACTS RECEIVING PRO PHYLAXIS SHOULD NOT BE EXCLUDED FROM THEIR USUAL ACTIVITIES

–3YMPTOMATIC CONTACTS SHOULD BE EVALU ATED AS SUSPECT PERTUSSIS CASES

3TOP 4RANSMISSION BY LIMITING REGULAR ACTIVITIES DURING INFECTIOUS PERIOD )NFORM YOUR PATIENTS TO STAY AT HOME AND AVOID CLOSE CONTACT WITH OTHERS UNTIL THEY HAVE s #OMPLETED THE lFTH DAY OF AN APPROPRIATE ANTIBIOTIC /2 s (AD THE COUGH FOR AT LEAST THREE WEEKS PERSONS ARE CONTAGIOUS FOR THE lRST THREE WEEKS OF COUGH )F YOUR CLINIC IS LOCATED IN 2AMSEY OR $AKOTA COUNTY AND MIGHT BE INTERESTED IN PARTICIPATING IN PERTUSSIS ACTIVE SURVEILLANCE PLEASE CONTACT 3HARON ,YNCH 3T 0AUL n 2AMSEY #OUNTY $E PARTMENT OF 0UBLIC (EALTH OR +ATHERINE +RAEGER $AKOTA #OUNTY 0UBLIC (EALTH $EPARTMENT

#Y NTHIA +ENYON - 0 ( IS WITH THE -INNESOTA $EPARTMENT OF (EALTH 3HE CAN BE REACHED AT #Y NTHIA +ENY ON HEALTH STATE MN US OR

"

"

" ! " ! " ! !

# # #

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

.OVEMBER $ECEMBER

!

4'$, '$ *1'" /$ -/& ,(7 1(-, (0 "-++(11$# 1- 1'$0$ 3 *2$0 1'$ 4'-*$ "-++2,(16 !$,$%(10 **(, -0.(1 *0 *(,("0 (0 &/-2. -%

'-0.(1 *0 ,# "*(,("0 (, (,,$0-1 ,# 4$01$/, (0"-,0(, $ /$ ./-2# -% -2/ 3 *2$0 ,# -% 1'$ #(%%$/$,"$ 4$ /$ !*$ 1- + )$ (, 1'$ *(3$0 -% + ,6 % 6-2 /$ &2(#$# !6 1'$0$ 3 *2$08

$ /$ "2//$,1*6 0$ /"'(,& %-/

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

"). %)' '"+ && *'.

!&% -

$ "# ' '*") ##"% &$ ,,, ##"% &$

)T S &LU 4IME !GAIN

7

7(%. 4(% ,%!6%3 "%'). TO TURN AND THE

WIND BEGINS TO BLOW WE -INNESOTANS KNOW THAT WINTER IS COMING "UT FOR MANY HEALTH CARE PROVIDERS IT ALSO MEANS THE mU SEASON IS COM ING AND WITH IT A MULTITUDE OF QUESTIONS 7ILL THERE BE ENOUGH VACCINE 7ILL WE BE ABLE TO BUY ANY TO GIVE TO OUR CLIENTELE 7ILL WE HAVE TO PRIORITIZE WHO GETS THE VACCINE )N THE LAST lVE YEARS THERE HAS BEEN THIS GREAT UNCERTAINTY BUT NONE WORSE THAN LAST YEAR &OR THE -INNESOTA 6ISITING .URSE !GENCY -6.!

A NON PROlT AGENCY THAT SERVES AS PART OF THE SAFETY NET FOR (ENNEPIN #OUNTY THE &LU 0ROGRAM HAS BEEN CRITICAL !S THE 0UBLIC (EALTH .URSING ARM FOR THE #ITY OF -INNEAPOLIS AND (ENNEPIN #OUNTY PROCEEDS FROM THE -6.! &LU 0RO GRAM HAVE GONE RIGHT BACK INTO THE COMMUNITY TO PROVIDE CHARITY CARE NURSING SERVICES IN THE HOMES OF OUR MOST FRAIL ,AST YEAR -6.! GAVE SHOTS DOWN FROM SHOTS THE YEAR BEFORE 4HIS PRO DUCED A REAL SHORTAGE OF DOLLARS FOR CHARITY CARE SERVICES -ANY ORGANIZATIONS AND INDIVIDUALS CAME TO THE AIDE OF -6.!

ESPECIALLY THE &REY &OUNDATION TO PROVIDE US WITH CHARITY CARE DO NATIONS WE NEEDED TO CONTINUE TO PROVIDE HOME CARE SERVICES TO THOSE WITHOUT RESOURCES 4HE 5NITED 7AY AND mU PROCEEDS HAVE BEEN OUR MAJOR SOURCE OF CHARITY CARE DOLLARS )N

THE COMMUNITY PROVIDED THE GAP DOLLARS 4HE PHYSICIANS WERE VERY SUPPORTIVE TO -6.! AND WE THANK YOU VERY MUCH 4HERE WAS SOME GOOD NEWS LAST YEAR IN THE MIDST OF THE SHORTAGE "ECAUSE OF THE -6.! CONNECTION TO THE 6ISITING .URSE !S SOCIATION OF !MERICA -6.! WAS ABLE TO BRING IN ADDITIONAL VACCINE TO OUR COMMUNITY AND REDISTRIBUTE THAT VACCINE TO OTHER COMMUNITY PROVIDERS &OLLOWING THE DIRECTION OF THE 3TATE "9 -!29 !.. ",!$%

.OVEMBER $ECEMBER

(EALTH $EPARTMENT -6.! REDISTRIBUTED OVER

DOSES OF VACCINES TO OTHER PROVIDERS AROUND THE STATE 7ITH A SEVERE SHORTAGE OF VACCINE WE -INNESOTA PROVIDERS WERE ABLE TO WORK TOGETHER TO ENSURE OUR COMMUNITIES WERE SERVED 7HAT WILL THE mU SEASON BRING 7E KNOW THAT TWO MANUFACTURERS HAVE DELIVERED VACCINE AND HOPE THE #HIRON MANUFACTURER WILL COME THROUGH SO WE DO NOT HAVE A VACCINE SHORTAGE -ANY PROVIDERS HAVE ALREADY RECEIVED THEIR VACCINES AND WILL SHORTLY BE PROVIDING IMMUNIZATIONS TO THEIR CLIENTELE -6.! WILL AGAIN PARTNER WITH (EALTH &AIR TO PROVIDE IMMUNIZATIONS AT THE #UB 3TORES THROUGHOUT THE STATE FOR THE HIGH PRIOR ITY RESIDENTS 7HAT THE 3TATE $EPARTMENT OF (EALTH LEARNED LAST YEAR IN OUR CRISIS WAS THAT THE RESIDENTS ARE CREATURES OF HABIT )F THEIR NORMAL LOCATIONS ARE REMOVED THEY DON T GET IMMUNIZED 4HE PHYSICIAN OFlCES WERE IDENTIlED AS A PRIMARY LOCATION SITE AS WELL AS THE NON TRADI TIONAL SITES SUCH AS #UB &OOD "ASED ON THE RESEARCH OF $R +RISTIN .ICHOLS THE MAJORITY OF RESIDENTS UTILIZING #UB &OOD FALL INTO THE HIGH RISK CATEGORY $URING THE MONTHS OF /CTOBER AND .OVEMBER OF WE HAVE PARTNERED WITH OVER SENIOR COMMUNITY CENTERS NURSING HOMES ASSISTED LIVING FACILITIES AND CHURCHES TO PROVIDE THE mU VACCINE )N .OVEMBER AND $ECEMBER OVER CORPORATIONS WILL RECEIVE THEIR IMMUNIZATIONS THROUGH -6.!

7E HOPE TO PARTNER WITH THE 3TATE (EALTH $EPARTMENT AND THE PHYSICIAN COMMUNITY TO MAKE US NUMBER ONE IN PROTECTING RESIDENTS FROM THE mU

-ARY !NN "LADE IS #%/ OF THE -INNESOTA 6ISITING .URSE !GENCY -ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

#OMMUNITY !SSOCIATED -ETHICILLIN 2ESISTANT 3TAPHYLOCOCCUS AUREUS -23!

"ACKGROUND 4HE -INNESOTA $EPARTMENT OF (EALTH -$( HAS RECEIVED REPORTS OF -23! INFECTIONS IN PREVIOUSLY HEALTHY PERSONS SINCE 4HESE STRAINS OF -23! ARE KNOWN AS COMMUNITY ASSOCIATED #! -23! 4HE #ENTERS FOR $ISEASE #ONTROL AND 0REVENTION #$# DElNES #!

-23! AS -23! THAT HAS BEEN ISOLATED FROM PATIENTS WHO HAVE NO HISTORY OF POSITIVE CULTURE FOR -23! FROM ANY BODY SITE OBTAINED HOURS AFTER ADMISSION TO A HOSPITAL IF HOSPITALIZED PRIOR -23! INFECTION OR COLONIZATION HOSPITALIZATION SURGERY RESI DENCY IN A LONG TERM CARE FACILITY OR DIALYSIS WITHIN THE PAST YEAR OR CURRENT INDWELLING PERCUTANEOUS DEVICES OR CATHETERS #LINICAL 0RESENTATION #! -23! SKIN AND SOFT TISSUE INFECTIONS TYPICALLY MANIFEST AS PUSTULAR LESIONS ABSCESSES

FURUNCLES CARBUNCLES BOILS AND CELLULITIS #!

-23! CAN ALSO CAUSE MORE SERIOUS INFECTIONS SUCH AS PNEUMONIA BONE JOINT AND BLOOD STREAM INFECTIONS 0ROSPECTIVE 3ENTINEL 3ITE 3URVEILLANCE FOR #! -23! )N THE -INNESOTA #OMMUNICABLE $IS EASE 2EPORTING 2ULES WERE AMENDED TO REQUIRE THAT ALL CASES OF SERIOUS ILLNESS OR DEATH DUE TO #! -23! BE REPORTED TO -$( AND THAT HOSPITAL LABORATORIES SIX IN THE SEVEN COUNTY METROPOLITAN AREA AND SIX IN NON METROPOLI TAN -INNESOTA REPORT ALL CASES OF -23! TO -$(

/F -23! CASES REPORTED IN

PERCENT WERE HEALTH CARE ASSOCIATED (!

-23!

PERCENT WERE #! -23!

AND PERCENT COULD NOT BE CLASSIlED #! -23!

PATIENTS WERE YOUNGER THAN (! -23! PA TIENTS WITH A MEDIAN AGE OF YEARS VERSUS YEARS 3KIN AND SOFT TISSUE INFECTIONS WERE MORE COMMON AMONG #! -23! CASES THAN AMONG (! -23! CASES PERCENT VS PERCENT #! -23! ISOLATES WERE MORE LIKELY THAN (! -23! ISOLATES TO BE SUSCEPTIBLE TO CIPROmOXACIN CLINDAMYCIN GENTAMICIN AND TRIMETHOPRIM SULFAMETHOXAZOLE AND WERE MORE LIKELY TO CONTAIN THE RESISTANCE GENE 3##MEC)6 AND HAVE DIFFERENT EXOTOXIN GENE PROlLES ; =

)NDUCIBLE #LINDAMYCIN 2ESISTANCE !MONG %RYTHROMYCIN 2ESISTANT

#LINDAMYCIN 3USCEPTIBLE #! -23! )SOLATES IN -INNESOTA )N MORE THAN PERCENT OF ERYTHRO MYCIN RESISTANT CLINDAMYCIN SUSCEPTIBLE #!

-23! ISOLATES HAD INDUCIBLE CLINDAMYCIN RESISTANCE )#2 IDENTIlED BY DISK DIFFUSION TESTING (OWEVER THE PROPORTION OF #! -23!

ISOLATES WITH )#2 DECLINED TO PERCENT BY THE END OF 4HIS CHANGE WAS MOST LIKELY DUE TO THE INTRODUCTION OF AN ADDITIONAL #! -23!

STRAIN WHICH TYPICALLY DOES NOT HAVE )#2

-INNESOTA #! -23! !NTIMICROBIAL 3USCEPTIBILITY 4RENDS 3USCEPTIBILITY TRENDS FOR -INNESOTA #! -23!

ISOLATES FROM AND WERE EXAMINED $URING THIS TIME THE PERCENTAGE OF #! -23! ISOLATES SUSCEPTIBLE TO ERYTHROMYCIN AND CIPROmOXACIN DECREASED FROM PERCENT TO PERCENT AND FROM PERCENT TO PERCENT

RESPECTIVELY !NTIMICROBIAL SUSCEPTIBILITIES OF #! -23! ISOLATES SUBMITTED FROM *ANU ARY 3EPTEMBER ARE AS FOLLOWS PERCENT SUSCEPTIBLE TO ERYTHROMYCIN PERCENT SUSCEPTIBLE TO CIPROmOXACIN PERCENT SUSCEP TIBLE TO CLINDAMYCIN PERCENT SUSCEPTIBLE TO TETRACYCLINE PERCENT SUSCEPTIBLE TO RIFAMPIN

AND PERCENT SUSCEPTIBLE TO MUPIROCIN US ING PROVISIONAL -$( BREAKPOINTS -)# MICROGRAMS ML !LL ISOLATES WERE SUSCEPTIBLE TO TRIMETHOPRIM SULFAMETHOXAZOLE GENTAMI CIN LINEZOLID SYNERCID AND VANCOMYCIN

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)F USING ANTIMICROBIALS )F AREA OF INVOLVEMENT IS EXTENSIVE OR IF SYSTEMIC SYMPTOMS ARE CLINICALLY CONCERNING OR IF THERE ARE COMPLIANCE FOLLOW UP CONCERNS p 4 3 TRIMETHOPRIM SULFAMETHOXAZOLE e 4 3 AND DOXYCYCLINE ARE NOT RECOMMENDED TREATMENTS FOR 'ROUP ! 3TREPTOCOCCUS INFECTION \\ $O $ TEST IF #! -23! ISOLATE IS ERYTHROMYCIN RESISTANT CLINDAMYCIN SUSCEPTIBLE 4HERE ARE A SIGNIFICANT NUMBER OF $ TEST POSITIVE #! -23! ISOLATES IN -INNESOTA r "ROAD EMPIRIC THERAPY MAY BE APPROPRIATE CONSULT WITH AN INFECTIOUS DISEASE SPECIALIST !!0 2ED "OOK RECOMMENDS USE OF NAFCILLIN GENTAMICIN IN ADDITION TO VANCOMYCIN FOR EMPIRIC THERAPY OF LIFE THREATENING INFECTIONS o

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5SE QUINOLONES LINEZOLID DAPTOMYCIN OR QUINUPRISTIN DALFOPRISTIN 1 $ ONLY IN CONSULTATION WITH AN INFECTIOUS DISEASE SPECIALIST )F INITIAL PARENTERAL THERAPY CONSIDER SWITCHING TO ORAL THERAPY BASED ON SUSCEPTIBILITY RESULTS IF THE PATIENT IS AFEBRILE FOR HOURS CLINICALLY IMPROVED ABLE TO TAKE ORAL THERAPY AND CLOSE FOLLOW UP IS POSSIBLE &OR SEVERE INFECTIONS CONSULT WITH AN INFECTIOUS DISEASE SPECIALIST $URATION OF TREATMENT FOR MOST SKIN AND SOFT TISSUE INFECTIONS IS DAYS BUT MAY VARY DEPENDING ON SEVERITY OF INFECTION AND CLINICAL RESPONSE #ONSIDER HOSPITALIZATION FOR INFANTS LESS THAN MONTH OF AGE /BTAIN BLOOD CULTURES ON FEBRILE INFANTS WITH SKIN INFECTION AND OTHERS AS CLINICALLY INDICATED

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RETURN VISIT IF THERE IS NO CLINICAL IMPROVEMENT WITHIN HOURS 0ATIENTS SHOULD ALSO BE INSTRUCTED TO COVER LESIONS WITH CLEAN DRY BANDAGES TO KEEP THEIR SKIN CLEAN AND INTACT AND TO CLEAN THEIR HANDS FREQUENTLY WITH SOAP AND WATER OR AN ALCOHOL BASED HAND RUB )N ADDITION PATIENTS SHOULD BE INSTRUCTED NOT TO SHARE PERSONAL ITEMS SUCH AS RAZORS TOWELS WASHCLOTHS CLOTHING OR SPORTS EQUIPMENT WITH OTHERS !T THIS TIME THERE IS NO ROUTINE RECOM MENDATION FOR DECOLONIZATION WITH MUPIRO CIN "ACTROBANยง OR SYSTEMIC ANTIMICROBIALS (OWEVER DECOLONIZATION MAY BE CONSIDERED IN PATIENTS WITH RECURRENT #! -23! INFECTION OR IN HOUSEHOLDS WHERE MULTIPLE MEMBERS HAVE SKIN AND SOFT TISSUE INFECTIONS 0ATIENTS WITH SUSPECTED SEVERE 3 AUREUS INFECTION SHOULD BE HOSPITALIZED AND EMPIRIC ANTIMICROBIAL THERAPY FOR #! -23! SHOULD BE INITIATED PROMPTLY IN AREAS WHERE #! -23!

IS KNOWN TO BE PREVALENT ! SUGGESTED INITIAL MANAGEMENT APPROACH FOR #! -23! SKIN AND SOFT TISSUE INFECTIONS IS DESCRIBED IN lGURE ON PAGE

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OUTCOMES WERE POOR AND IT WAS RESERVED FOR YOUNG PATIENTS FOR WHOM ALL OTHER FORMS OF THERAPY HAD BEEN EXHAUSTED 4ODAY THE THERAPY IS ROUTINELY APPLIED TO PATIENTS WITH ONE OF DIFFERENT BLOOD DISORDERS FROM INFANCY TO AGE

USING ADULT STEM CELLS FROM MARROW PERIPH ERAL BLOOD AND CORD BLOOD AND USING MYELOAB LATIVE AND NON MYELOABLATIVE TECHNIQUES ,AST YEAR THE .-$0 FACILITATED MORE THAN

TRANSPLANTS AT TRANSPLANT CENTERS WORLDWIDE USING DONORS FROM COUNTRIES 4HIS YEAR THAT NUMBER WILL GROW BY NEARLY PERCENT 3EE 'RAPH &OR OUR COLLEAGUES LESS FAMILIAR WITH THE THERAPY HEMATOPOIETIC CELL TRANSPLANTATION USES DONOR CELLS TO RECONSTITUTE HEMATOPOIESIS IN A PATIENT WHO HAS UNDERGONE CHEMOTHERAPY AND RADIATION TO CONTROL THE UNDERLYING DISEASE AND TO SUPPRESS THE PATIENT S UNDERLYING IMMUNE SYSTEM IN ANTICIPATION OF THE TRANSPLANT 4HE SOURCE OF THE DONATED HEMATOPOIETIC CELLS CAN BE FROM THE BONE MARROW THE PE

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OR (,! LOCI DEPENDING ON A TRANSPLANT CENTER S PROTOCOL

AND DONORS CAN COME FROM A PATIENT S FAMILY OR THEY CAN BE UNRELATED TO THE PATIENT (EMATOPOIETIC CELL TRANSPLANTS ARE CHARAC TERIZED BY THE TYPE OF DONOR PROVIDING THE CELLS !UTOLOGOUS TRANSPLANTS USE THE PATIENTS STEM CELLS HARVESTED BEFORE THERAPY TO RECONSTITUTE THE BLOOD AND IMMUNE SYSTEM !LLOGENEIC TRANSPLANTS USE A VOLUNTEER DONATION FROM A FAMILY MEMBER ALLOGENEIC RELATED OR FROM THE .-$0 ALLOGENEIC UNRELATED !LLOGENEIC TRANSPLANTS MAY USE ADULT DONORS OR UMBILICAL CORD BLOOD

)N AN ALLOGENEIC RELATED TRANSPLANT THE HEMATOPOIETIC CELLS ARE TYPICALLY PROVIDED BY A SIBLING OF THE PATIENT &ULL BIOLOGICAL SIBLINGS HAVE A PERCENT CHANCE OF HAVING AN (,!

TISSUE TYPE SIMILAR TO THE PATIENT )N AN ALLOGENEIC UNRELATED TRANSPLANT THE HEMATOPOIETIC CELLS ARE PROVIDED FROM AN UN RELATED ADULT DONOR OR CORD BLOOD UNIT !BOUT PERCENT OF PATIENTS IN NEED OF AN ALLOGENEIC TRANSPLANT WILL NEED HEMATOPOIETIC CELLS FROM AN UNRELATED ADULT DONOR OR CORD BLOOD UNIT 5NRELATED $ONOR 4RANSPLANTATION AND THE .-$0 0ATIENTS UNABLE TO lND AN (,! MATCHED DONOR WITHIN THEIR FAMILY CAN SEARCH FOR AN UNRELATED DONOR OR CORD BLOOD UNIT THROUGH THE .-$0

WHICH MAINTAINS A REGISTRY OF MORE THAN MILLION (,! TYPED INDIVIDUALS AND MORE THAN

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BLOOD BANKERS AND TRANSPLANT PHYSICIANS THE .-$0 BEGAN AT THE 3T 0AUL CHAPTER OF THE !MERICAN 2ED #ROSS )N AFlLIATION WITH THE 5NIVERSITY OF -INNESOTA AND GUIDED BY OTHER LEADERS IN BLOOD BANKING THE .-$0 HAD A MODEST BEGINNING WITH FOUR STAFF WITH 5NIVER SITY OF -INNESOTA 0ROFESSOR *EFF -C#ULLOUGH

- $ PROVIDING MEDICAL DIRECTION ALONG WITH COLLEAGUES FROM 3AN &RANCISCO AND 3EATTLE 4ODAY THE .-$0 EMPLOYS MORE THAN INDIVIDUALS IN LOCATIONS IN THE 5 3 AND 0UERTO 2ICO .EARLY OF THOSE EMPLOYEES WORK IN AN UNASSUMING SIX STORY BUILDING ON "ROADWAY 3TREET . % -INNEAPOLIS NEAR THE INTERSECTION OF (IGHWAYS AND !T THE HEART OF THE .-$0 IS ITS REGISTRY OF (,! TYPED VOLUNTEER DONORS AND CORD BLOOD UNITS THAT CAN BE USED AS A SOURCE OF HEMATOPOI ETIC CELLS FOR PATIENTS NEEDING TRANSPLANTATION !T ANY GIVEN TIME THERE ARE MORE THAN

SEARCHES OF THE .-$0 2EGISTRY IN PROCESS BY PHYSICIANS ON BEHALF OF THEIR PATIENTS 7E WORK WITH AN INTERNATIONAL NETWORK OF LEADING MEDICAL FACILITIES USING OUR STATE OF THE ART TECHNOLOGIES TO PROVIDE THE PRODUCTS AND SERVICES THAT BRING PATIENTS AND DONORS TOGETHER !ND BY ANY MEASURE OF SUCCESS THE .-$0 HAS MADE REMARKABLE PROGRESS IN ITS RELATIVELY SHORT LIFETIME )N .OVEMBER

THE .-$0 CELEBRATED ITS TH TRANS PLANT !LTHOUGH THE .-$0 HAS BEEN VERY SUC CESSFUL AT RECRUITING A LARGE REGISTRY OF VOLUNTEER DONORS AND CORD BLOOD UNITS AND FACILITATING TRANSPLANTS THE ORGANIZATION HAS MANY MORE RESOURCES AND SERVICES FOR PHYSICIANS AND PA TIENTS 4HE .-$0 SUPPORTS PATIENTS AND PHYSI CIANS THROUGH s PATIENT EDUCATION AND ADVOCACY SERVICES s PHYSICIAN EDUCATION AND CONSULTATION SERVICES AND s CLINICAL AND OBSERVATIONAL RESEARCH TO IMPROVE TRANSPLANT OUTCOMES AND INCREASE ACCESS TO TRANSPLANTATION 4HE .-$0 S RESEARCH OBJECTIVES ARE ADVANCED THROUGH ITS AFlLIATION WITH THE #ENTER FOR )N TERNATIONAL "LOOD AND -ARROW 4RANSPLANT 2ESEARCH #)"-42 WHICH IS A PARTNERSHIP BETWEEN THE .-$0 AND THE -EDICAL #OLLEGE OF 7ISCONSIN S )NTERNATIONAL "ONE -ARROW

4RANSPLANT 2EGISTRY AND !UTOLOGOUS "LOOD AND -ARROW 4RANSPLANT 2EGISTRY (OW THE .-$0 /PERATES !NY PHYSICIAN CAN REQUEST A FREE SEARCH OF THE .-$0 2EGISTRY BY SUBMITTING TO THE .-$0 A PATIENT S (,! TISSUE TYPING RESULTS /VER NIGHT lVE NIGHTS A WEEK .-$0 COMPUTERS COMPARE THE (,! TISSUE TYPING OF ALL THE PA TIENT SEARCH REQUESTS RECEIVED DURING THE DAY WITH THE (,! INFORMATION ON THE MORE THAN MILLION VOLUNTEER DONORS AND CORD BLOOD UNITS ON THE .-$0 2EGISTRY ! REPORT ON THE NUMBER OF POTENTIAL (,! MATCHED DONORS IS SENT TO THE REQUESTING PHYSICIAN BY THE NEXT BUSINESS DAY 4HE PHYSICIAN NOW HAS AN INDICA TION WHETHER THERE IS A POSSIBILITY TO USE AN UNRELATED DONOR OR CORD TO TREAT HIS OR HER PATIENT S BLOOD MARROW LYMPH OR IMMUNE SYSTEM DISEASE )F THE REPORT SHOWS THAT ONE OR MORE .-$0 DONORS OR CORD BLOOD UNITS ARE A POTENTIAL (,! MATCH WITH THE PATIENT THE DOCTOR AND PATIENT CAN DISCUSS THE OPTION OF A HEMATOPOIETIC CELL TRANSPLANT )F A DECISION IS MADE TO PROCEED WITH THE THERAPY THE .-$0 IS NOTIlED AND SO BEGINS THE PROCESS OF SELECTING THE VOLUNTEER DONOR S OR CORD BLOOD UNITS "ECAUSE OF THE LOGISTICS OF LOCATING CON TACTING AND TESTING MULTIPLE POTENTIAL DONORS FOLLOWED BY THE SELECTION OF THE OPTIMAL DONOR

THE PROCESS CAN TAKE AS MUCH AS TWO TO THREE

MONTHS 4HEREFORE THE .-$0 URGES ANY PHYSICIAN WHO MIGHT CONSIDER A HEMATOPOIETIC CELL TRANSPLANT AS A TREATMENT ALTERNATIVE FOR A PATIENT TO START A SEARCH OF THE .-$0 2EGISTRY AS SOON AS POSSIBLE EVEN IF A TRANSPLANT IS NOT IN THE INITIAL TREATMENT PLAN 4HIS SAVES VALUABLE TIME IF THE PATIENT S CONDITION CHANGES AND HE OR SHE WILL NEED A TRANSPLANT SOONER RATHER THAN LATER !ND THERE S ANOTHER REASON TO CONSIDER THE OPTION OF TRANS PLANT EARLY IN THE PROCESS .-$0 RESEARCH HAS ALSO SHOWN THAT FOR MANY DISEASES TRANSPLANTS PERFORMED EARLY IN THE DISEASE PROCESS ARE AS SOCIATED WITH LOWER RISKS OF TRANSPLANT RELATED MORTALITY AND DISEASE RECURRENCE !S THE NATURE OF THE TYPES OF DISEASES TREATED BY TRANSPLANTATION HAS CHANGED OVER THE PAST SEVERAL YEARS THE .-$0 HAS RESPONDED BY SPEEDING UP ITS RESPONSE TIME &IVE YEARS AGO

THE MOST COMMON DISEASE TRANSPLANTED WAS CHRONIC MYELOID LEUKEMIA #-, 7ITH THE ADVENT OF IMATINIB MESYLATE 'LEEVECยง #-, IS NOW THE lFTH MOST COMMONLY TRANSPLANTED DISEASE SUPPLANTED BY THE ACUTE LEUKEMIA

MYELODYSPLASTIC SYNDROME AND NON (ODGKIN S LYMPHOMA 'RAPH SHOWS THE CHANGES THAT HAVE OCCURRED IN THE NUMBER OF TRANSPLANTS PERFORMED BY DISEASE !S WE ANTICIPATED THIS CHANGE THE .-$0 REALIZED THAT PHYSICIANS WOULD NEED TO MAKE DECISIONS IN DAYS TO WEEKS ABOUT TRANSPLANT AS A POTENTIAL THERAPY 4HE .-$0 INSTITUTED AN ACCELERATED SEARCH PRO #ONTINUED ON PAGE

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THEN UMBILICAL CORD BLOOD IS A VIABLE OPTION 4HE .-$0 .ETWORK !LTHOUGH LOCATED IN NORTHEAST -INNEAPOLIS

THE .-$0 TRULY HAS AN INTERNATIONAL mAVOR .EARLY PERCENT OF THE TRANSPLANTS .-$0 FACILITATES USES AN INTERNATIONAL DONOR OR BEN ElTS AN INTERNATIONAL RECIPIENT 4HIS IS ACCOMPLISHED THROUGH A LARGE NET WORK OF MEDICAL ORGANIZATIONS COORDINATED BY THE .-$0 THAT PERFORM ALL THE TASKS NEEDED TO COMPLETE AN UNRELATED DONOR TRANSPLANT 4HE .-$0 NETWORK INCLUDES s DONOR CENTERS SEVEN INTERNATIONAL THAT RECRUIT AND MANAGE POTENTIAL DONORS s CORD BLOOD BANKS ONE INTERNATIONAL THAT COLLECT AND CRYOPRESERVE UMBILICAL CORD BLOOD

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BLOOD PROVIDES THE SOURCE OF CELLS FOR OVER PERCENT AND GROWING OF THE TRANSPLANT THE .-$0 FACILITATES /R THEY MAY RECEIVE PE RIPHERAL BLOOD STEM CELLS 0"3# PERCENT OF TRANSPLANTS WHICH AS THE NAME IMPLIES ARE HEMATOPOIETIC CELLS COLLECTED FROM A DONOR S PE RIPHERAL BLOOD )N 0"3# TRANSPLANTS AN ADULT DONOR RECEIVES lVE OR SIX DAILY INJECTIONS OF A SYNTHETIC GROWTH HORMONE THAT MOBILIZES HEMATOPOIETIC CELLS INTO THE PERIPHERAL BLOOD

WHICH ARE THEN COLLECTED THROUGH APHERESIS $ETERMINING WHICH SOURCE OF HEMATOPOI ETIC CELLS IS BEST FOR A PARTICULAR PATIENT DEPENDS ON MANY CLINICAL FACTORS AND IS BEYOND THE SCOPE OF THIS ARTICLE "UT THERE ARE ADVANTAGES AND DISADVANTAGES TO EACH SOURCE OF CELLS 4ABLE BRIEmY REVIEWS CORD BLOOD COMPARED TO ADULT DONORS #ORD BLOOD UNITS TYPICALLY HAVE FEWER HEMATOPOIETIC CELLS THAN MARROW OR 0"3# 4HEREFORE LARGER PATIENTS MAY NOT BE ABLE TO LOCATE A CORD BLOOD UNIT WITH A SUFlCIENT CELL DOSE "UT RESEARCHERS ARE PURSUING SEVERAL WAYS TO OVERCOME THIS LIMITATION INCLUDING IN VITRO EXPANSION OF CORD BLOOD PROGENITOR CELLS AND COMBINING TWO CORD BLOOD UNITS TO PRODUCE A HEMATOPOIETIC CELL GRAFT OF SUFlCIENT SIZE TO ENGRAFT ADULT PATIENTS )N FACT RECENT STUDIES COMPARING OUTCOMES OF CORD BLOOD TO MARROW IN ADULTS HAVE SHOWN SIMILAR OUTCOMES BETWEEN THE TWO CELL SOURCES 3EVERAL OTHER ADVANCES IN HEMATOPOIETIC CELL TRANSPLANTATION HAVE STEADILY IMPROVED SURVIVAL OF TRANSPLANT RECIPIENTS AND IMPROVED

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

THEIR QUALITY OF LIFE RESULTING IN EXPANDED PA TIENT SELECTION 4HESE ADVANCES INCLUDE s 2EDUCED INTENSITY CONDITIONING REGIMENS THAT HAVE DECREASED MORBIDITY AND MORTAL ITY s -ORE ACCURATE $.! BASED (,! TISSUE TYPING s .EW DRUGS TO TREAT POST TRANSPLANT COMPLI CATIONS s )MPROVED PROPHYLAXIS AND TREATMENT OF FUNGAL INFECTION .-$0 3ERVICES TO 0ATIENTS AND 0HYSICIANS 4HE .-$0 IS DEDICATED TO IMPROVING THE OUTCOMES OF UNRELATED DONOR HEMATOPOIETIC CELL TRANSPLANTATION AND MAKING THIS POTENTIALLY LIFE SAVING THERAPY AVAILABLE TO ALL PATIENTS WHO MIGHT BENElT FROM IT 4O MEET THESE GOALS THE .-$0 HAS INITIATED MANY PROGRAMS TO EDU CATE PHYSICIANS AND PATIENTS ON THE TRANSPLANT PROCESS AND HAS A RESEARCH PROGRAM TO PROVIDE RESEARCHERS ACCESS TO THE .-$0 TRANSPLANT OUTCOMES DATABASE 2ESEARCH USING THE .-$0 TRANSPLANT OUTCOMES DATABASE HAS BEEN PARTICULARLY USE FUL IN ADVANCING THE lELD OF HEMATOPOIETIC CELL TRANSPLANTATION $ETAILED DATA IS COLLECTED ON EVERY SEARCH AND TRANSPLANT COORDINATED BY THE .-$0 ON BOTH THE DONOR AND THE RECIPIENT 4HE .-$0 TRANSPLANT OUTCOMES DATABASE IS THEREFORE A POWERFUL TOOL TO UNDERSTANDING WHICH PRE TRANSPLANT CIRCUMSTANCES Â&#x2C6; I E

DISEASE STAGE AT TRANSPLANT (,! MATCH

CHEMOTHERAPY RADIATION REGIMENS Â&#x2C6; YIELD BETTER OUTCOMES FOR PATIENTS 4HE .-$0 AND THE !MERICAN 3OCIETY FOR "LOOD AND -ARROW 4RANSPLANTATION !3"-4 HAVE DEVELOPED GUIDELINES ESTABLISHING RECOM MENDED TIMING FOR TRANSPLANT CONSULTATION 4HESE GUIDELINES INDICATE PROGNOSTIC FACTORS FOR PATIENTS AT RISK OF DISEASE PROGRESSION USING STANDARD THERAPY AND INDICATE WHICH PATIENTS SHOULD BE EVALUATED FOR TRANSPLANTATION 4HEY CAN BE VIEWED ONLINE AT THE .-$0 7EB SITE WWW MARROW ORG

EVERY YEAR THAT DEVELOP A MEDICAL CONDITION FOR WHICH AN UNRELATED BLOOD OR MARROW TRANSPLANT IS THE ONLY HOPE FOR A LONG TERM REMISSION !S A lELD OF MEDICINE WE CONTINUE TO EXPERIENCE IN NOVATION AND PROGRESS IN IMPROVING OUTCOMES AND BROADENING THE REACH OF THESE THERAPIES TO ALL WHO MIGHT BENElT 7E CONTINUE TO BUILD ON OUR YEARS OF EXPERIENCE THE ENERGIES AND ENTHUSIASM OF OUR COLLEAGUES THE PASSION AND ALTRUISM OF OUR VOLUNTEER DONORS AND THE OPPORTUNITY TO BETTER SERVE THOSE PATIENTS FOR WHOM WE OFFER A SECOND CHANCE AT LIFE

*EFFREY 7 #HELL - $ IS THE CHIEF EXECUTIVE OF lCER FOR THE .ATIONAL -ARROW $ONOR 0ROGRAM .-$0 (E CAME TO THE .-$0 FROM !LLINA (EALTH 3Y STEM WHERE HE SERVED AS PRESIDENT AND CHAIRMAN OF THE BOARD OF THE !LLINA -EDICAL #LINIC (E ALSO SERVED CONCURRENTLY AS THE SY STEM VICE PRESIDENT FOR CLINICAL SERVICES OF THE !LLINA (EALTH 3Y STEM $R #HELL PRACTICED INTERNAL MEDICINE WITH THE #OLUMBIA 0ARK -EDICAL 'ROUP FROM THROUGH AT THE &RIDLEY 0LAZA #LINIC

4ABLE

%DUCATION AND 4RAINING 2ESOURCES FROM THE .-$0 &OR

2ESOURCES

-ORE INFORMATION

0HYSICIANS

!DVANCES IN 4RANSPLANTATION A FREE BI MONTHLY E NEWSLETTER THAT HIGHLIGHTS RECENT JOURNAL PUBLICATIONS AND RESEARCH ON TRANSPLANTATION

WWW MARROW ORG MPNEWS

%DUCATIONAL AND TRAINING #$S #-% PROGRAMS

WWW MARROW ORG MD

'RAND 2OUNDS 0ROGRAM !SSISTANCE

#ALL

7EB BASED 0HY SICIAN 2ESOURCE #ENTER PROVIDING A COMPREHENSIVE RESOURCE FOR TRANSPLANTATION

INCLUDING s /UTCOMES DATA s 2EFERRAL GUIDELINES s )NTERACTIVE ALGORITHM FOR STEPS IN AN UNRELATED TRANSPLANT

WWW MARROW ORG MD

4HE .-$0 /FlCE OF 0ATIENT !DVOCACY /0!

'ENERAL E MAIL PATIENTINFO NMDP ORG

0ATIENTS

7ORKS WITH PATIENTS AND THEIR PHYSICIANS THROUGHOUT THE SEARCH FOR AN UNRELATED DONOR FROM THE .-$0 2EGISTRY 4HE /0! IS ALSO THE DEPARTMENT WITHIN THE .-$0 TO CONTACT TO INITIATE A FREE PRELIMINARY SEARCH OF THE .-$0 2EGISTRY

2ESEARCHERS

3UMMARY 4HE .-$0 AND ITS AFlLIATED ORGANIZATIONS HAVE MUCH SUCCESS TO REmECT ON BUT A SIGNIlCANT AMOUNT YET TO ACCOMPLISH !LTHOUGH WE WILL FACILITATE CLOSE TO TRANSPLANTS THIS YEAR

THERE ARE AS MANY AS PEOPLE IN THE 5 3 -ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

4HE #ENTER FOR )NTERNATIONAL "LOOD AND -ARROW 4RANSPLANT 2ESEARCH #)"-42

#ALL 4O REQUEST A PRELIMINARY SEARCH FORM E MAIL THE /0! AT OPA?WEB NMDP ORG WWW CIBMTR ORG

4HE #)"-42 IS A PARTNERSHIP BETWEEN THE .-$0 AND THE -EDICAL #OLLEGE OF 7ISCONSIN S )NTERNATIONAL "ONE -ARROW 4RANSPLANT 2EGISTRY AND !UTOLOGOUS "LOOD AND -ARROW 4RANSPLANT 2EGISTRY 4HE #)"-42 CONDUCTS PROSPECTIVE MULTI CENTER TRIALS TO INCREASE THE SAFETY AND SUCCESS OF TRANSPLANTATION )NVESTIGATORS MAY ALSO CONTACT THE #)"-42 TO ACCESS DATA IN THE .-$0 S TRANSPLANT OUTCOMES DATABASE

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--! (OUSE OF $ELEGATES (-3 AND 2-3 2ESOLUTIONS 2EPORT

4

4(% .$ --! !NNUAL -EETING WAS GAV

ELED TO ORDER ON 4HURSDAY 3EPTEMBER

AND CONTINUED THROUGH &RIDAY 3EPTEMBER AT THE -ARRIOTT #ITY #ENTER IN -INNEAPOLIS 4HE (ENNEPIN -EDICAL 3OCIETY DELEGATION OF AND THE DELEGATES FROM THE 2AMSEY -EDICAL 3OCIETY JOINED THEIR COLLEAGUES FROM ALL OVER -INNESOTA IN THE --! (OUSE OF $ELEGATES TO VOTE ON REPORTS AND RESOLUTIONS AS WELL AS ELECT THE OFlCERS THE MEMBERS OF THE "OARD OF 4RUSTEES AND THE !-! DELEGATES AND ALTERNATE DELEGATES 4HE ACTIONS OF THE --! (OUSE OF $ELEGATES ON (-3 AND 2-3 RESOLUTIONS ARE AS FOLLOWS 3UBSTITUTE 2ESOLUTION %DUCATION !BOUT (IGH $EDUCTIBLE (EALTH 0LANS

2ESOLUTION WAS SUBMITTED BY THE :UMBRO 6ALLEY -EDICAL 3OCIETY 2ESOLUTION WAS SUB MITTED BY THE 2AMSEY -EDICAL 3OCIETY (OUSE !CTION 3UBSTITUTE 2ESOLUTION WAS ADOPTED IN LIEU OF 2ESOLUTION AND 2ESOLU TION CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION ORGANIZE PROMOTE OR PUBLICIZE EDUCATIONAL OPPORTUNITIES FOR MEMBERS AND CLINIC STAFF ABOUT HIGH DEDUCTIBLE HEALTH PLANS E G MAJOR MEDICAL INSURANCE COMBINED WITH A (EALTH 3AVINGS !CCOUNT (EALTH 2EIMBURSE

7EST -ETRO $ELEGATION LISTENING TO THE DELEGATES IN THE (OUSE OF $ELEGATES

MENT !CCOUNTS OR mEXIBLE SAVINGS ACCOUNTS AND THE IMPACT OF THESE PLANS ON THE OPERATION OF CLINICS

UNFAIR REGRESSIVE AND INAPPROPRIATE NATURE OF THIS TAX AND THE MISAPPROPRIATION OF THESE FUNDS

3UBSTITUTE 2ESOLUTION 5SE OF THE 3ICK 4AX FOR (EALTH #ARE

3UBSTITUTE 2ESOLUTION 3UPPORT OF ,ACTATION 3ERVICES IN -INNESOTA (OSPITALS

2ESOLUTION WAS SUBMITTED BY THE ,AKE 3UPERIOR -EDICAL 3OCIETY 2ESOLUTION WAS SUBMITTED BY THE ,AKE 3UPERIOR -EDICAL 3OCIETY 2ESOLUTION WAS SUBMITTED BY THE 2ANGE -EDICAL 3OCIETY 2ESOLUTION WAS SUBMITTED

BY THE 2AMSEY -EDICAL 3OCIETY (OUSE !CTION 3UBSTITUTE 2ESOLUTION WAS ADOPTED IN LIEU OF 2ESOLUTION 2ESOLUTION

2ESOLUTION AND 2ESOLUTION CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION CONTINUE TO AFlRM ITS STRONG OPPOSI TION TO THE PERCENT PROVIDER TAX AND CONTINUE ITS POSITION THAT THIS TAX BE REPEALED AND MORE APPROPRIATE SOURCES OF FUNDING FOR STATE HEALTH CARE PROGRAMS BE SOUGHT AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION DENOUNCE ALL DIVERSIONS OF PROVIDER TAX REVENUE FROM THE (EALTH #ARE !CCESS &UND

AND BE IT FURTHER

2-3 #AUCUS #HAIR $R 0ETER $ALY AND $R 3TU ART #OX 2EFERENCE #OMMITTEE " PRESENTING RESOLUTIONS PRIOR TO THE (OUSE OF $ELEGATES

2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION INFORM PATIENTS THE PUBLIC THE GOVERNOR LEGISLATORS AND THE MEDIA AS TO THE

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

2ESOLUTION WAS SUBMITTED BY THE -INNE SOTA !CADEMY OF &AMILY 0HY SICIANS 2ESOLUTION WAS SUBMITTED BY #AROLY N -C+AY - $

$ELEGATE (OUSE !CTION 3UBSTITUTE 2ESOLUTION WAS ADOPTED IN LIEU OF 2ESOLUTION AND 2ESOLUTION 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT AND COMMUNICATE A PO SITION THAT ALL -INNESOTA HOSPITALS PROVIDING MATERNITY CARE SHOULD ALSO PROVIDE LACTATION SUPPORT SERVICES FOR A DURATION OF AT LEAST SIX MONTHS POST PARTUM BY LACTATION CONSULTANTS AND SUPPORT REIMBURSEMENT OF SUCH SERVICES BY THIRD PARTY PAYERS AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION INITIATE A DIALOGUE WITH RELEVANT ORGA NIZATIONS SUCH AS THE -INNESOTA $EPARTMENT OF (EALTH THE -INNESOTA #OUNCIL OF (EALTH 0LANS THE -INNESOTA (OSPITAL !SSOCIATION THE #ONTINUED ON PAGE

.OVEMBER $ECEMBER

--! (OUSE OF $ELEGATES #ONTINUED FROM PAGE

-INNESOTA .URSES !SSOCIATION AND THE !MERI CAN !CADEMY OF 0EDIATRICS -INNESOTA #HAPTER TO DISCUSS THE IMPORTANCE MEDICALLY AND lNAN CIALLY OF IMPROVED LACTATION SERVICES 2ESOLUTION 0AYMENT $ISCLOSURE BY )NSURANCE %NTITIES TO 0ATIENTS AND 0HYSICIANS

3UBMITTED BY THE (ENNEPIN -EDICAL 3OCIETY (OUSE !CTION !DOPTED AS AMENDED 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION ADVOCATE THAT HEALTH PLANS AND INSURANCE COMPANIES MAKE READILY AVAILABLE TO ALL ENROLLEES ALLOWABLE PAYMENT AMOUNTS AND PATIENT CO PAYMENTS FOR ALL COVERED TESTS AND PROCEDURES IN THE PATIENT S INSURANCE CONTRACT

AND BE IT FURTHER 2%3/,6%$ THAT SUCH INFORMATION BE MADE EASILY ACCESSIBLE TO PATIENTS PREFERABLY THROUGH A 7EB INTERFACE AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION SUBMIT A RESOLUTION TO THE !MERICAN

-EDICAL !SSOCIATION REQUESTING THAT THE !-!

ADVOCATE FOR PATIENT SPECIlC PAYMENT DISCLO SURE TO PATIENTS AND THEIR TREATING PHYSICIANS PRIOR TO RECEIVING SERVICES 2ESOLUTION (EALTH #ARE &ACILITY &OOD AND /BESITY

3UBMITTED BY THE (ENNEPIN -EDICAL 3OCIETY (OUSE !CTION !DOPTED AS AMENDED CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION PROMOTE HEALTHY DIETS IN HEALTH CARE FACILITIES THROUGHOUT -INNESOTA AND BE IT FURTHER

2ESOLUTION ! 3TRATEGY FOR /BTAINING "ETTER 0ATIENT !DHERENCE

3UBMITTED BY #ARL % "URKLAND - $ $ELEGATE (OUSE !CTION !DOPTED AS AMENDED CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION STATE THAT PATIENT ADHERENCE TO MEDI CAL TREATMENT PROGRAMS IS NECESSARY IN ORDER TO ACHIEVE HIGH QUALITY AND COST EFFECTIVE HEALTH CARE AND BE IT FURTHER

2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION ADVOCATE THAT HEALTH CARE FACILI TIES THAT SELL AND OR SERVE FOOD HAVE HEALTHY FOOD CHOICES AVAILABLE AND LIMIT UNHEALTHY CHOICES FOR PATIENTS VISITORS AND STAFF AND BE IT FURTHER

2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION COLLABORATE WITH HEALTH INSURANCE COMPANIES GOVERNMENT ENTITIES AND CONSUMER ADVOCACY ORGANIZATIONS TO EDUCATE THE PUBLIC ABOUT THE ADVERSE CONSEQUENCES OF NON ADHER ENCE TO EVIDENCE BASED TREATMENT GUIDELINES AND PERSONALIZED PHYSICIAN RECOMMENDATIONS WHICH ARE LIKELY TO ENHANCE A PATIENT S QUALITY OF LIFE AND INCREASE LIFE EXPECTANCY AND BE IT FURTHER

2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION ENCOURAGE HEALTH CARE FACILITIES TO INCLUDE NUTRITIONAL INFORMATION ABOUT FOOD SOLD IN THESE FACILITIES

2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION SUBMIT A RESOLUTION TO THE !MERICAN -EDICAL !SSOCIATION ASKING THE !-! TO STUDY WHAT FACTORS LEAD TO PATIENT NON ADHERENCE AND

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.OVEMBER $ECEMBER

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

2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT AND LOBBY FOR AMENDING -INNESOTA 3TATUTES " TO PROVIDE FOR THE lLING OF AND THE OPEN ACCESS TO PESTICIDE AP PLICATION INFORMATION THAT MUST INCLUDE THE EXACT LOCATION WHERE PESTICIDES ARE APPLIED THE QUANTITY OF PESTICIDE THAT IS APPLIED THE DATE THE PESTICIDE IS APPLIED AND THE NAME OF THE PESTICIDE THAT IS APPLIED %AST -ETRO $ELEGATION PARTICIPATING IN THE (OUSE OF $ELEGATES

IDENTIFY TECHNIQUES TO ASSIST PHYSICIANS IN OP TIMIZING PATIENT ADHERENCE

2ESOLUTION -EDICARE 0AYMENT .EUTRALITY

3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY 2ESOLUTION -ERCURY 0OLLUTION AND /THER 0OWER 0LANT %MISSIONS

3UBMITTED BY THE (ENNEPIN -EDICAL 3OCIETY (OUSE !CTION !DOPTED AS AMENDED 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION ENDORSE THE PHASE OUT OF INTENTIONAL USES OF MERCURY CONTAINING DEVICES AND THE USE OF MERCURY IN MANUFACTURING AS FEASIBLE AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION ENDORSE !-! POLICY (

WHICH SUPPORTS FEDERAL LEGISLATION TO MEANING FULLY REDUCE THE FOLLOWING FOUR MAJOR POWER PLANT EMISSIONS MERCURY CARBON DIOXIDE

SULFUR DIOXIDE AND NITROGEN OXIDE 2ESOLUTION (EALTH #ARE 0REMIUMS FOR 5NINSURED #HILDREN

3UBMITTED BY THE (ENNEPIN -EDICAL 3OCIETY (OUSE !CTION .OT ADOPTED CONSENT CALEN DAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT EFFORTS TO MAKE THE PAY MENT OF HEATH CARE PREMIUMS FOR QUALIlED NEED CHILDREN UNDER THE AGE OF TAX DEDUCTIBLE CHARITABLE CONTRIBUTIONS FOR BOTH INDIVIDUALS AND CORPORATIONS 2ESOLUTION 2EIMBURSEMENT FOR ,ANGUAGE )NTERPRETER 3ERVICES

3UBMITTED BY THE (ENNEPIN -EDICAL 3OCIETY (OUSE !CTION !DOPTED AS AMENDED CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION ACTIVELY SUPPORT EFFORTS TO REQUIRE HEALTH PLANS TO PAY FOR LANGUAGE INTERPRETER SERVICES

(OUSE !CTION !DOPTED AS AMENDED CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION DELEGATION TO THE !-! SUBMIT A RESOLUTION TO THE !MERICAN -EDICAL !SSOCIA TION (OUSE OF $ELEGATES ASKING THE !MERICAN -EDICAL !SSOCIATION TO ADOPT POLICY CONSISTENT WITH THE POSITION OF THE -EDICARE 0AYMENT !D VISORY #OMMISSION TO SUPPORT A lNANCIALLY NEUTRAL -EDICARE PAYMENT POLICY THAT WOULD LET BENElCIARIES CHOOSE THE DELIVERY SYSTEM FEE FOR SERVICE OR -EDICARE !DVANTAGE THAT PROVIDES THEM WITH THE HIGHEST VALUE AND BE IT FURTHER 2%3/,6%$ THAT 2ESOLUTION BE TITLED -EDICARE 0AYMENT .EUTRALITY 2ESOLUTION 0ROHIBITING #ONTRACTS WITH (EALTH 0LANS THAT 3HIFT THE "URDEN OF )NSURING 5NDERWRITING #ARE TO #LINICS

3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY (OUSE !CTION .OT ADOPTED 2ESOLUTION #ITIZEN S 2IGHT TO +NOW !BOUT 0ESTICIDE !PPLICATION

2ESOLUTION (EALTH /VERSIGHT FOR 0ESTICIDES

3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY (OUSE !CTION 2EFERRED TO THE --! "OARD OF 4RUSTEES CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT AND LOBBY FOR LEGISLATION THAT PROVIDES THAT THE -INNESOTA $EPARTMENT OF (EALTH AND THE -INNESOTA $EPARTMENT OF !GRICULTURE BE GIVEN DUAL AUTHORITY TO OVERSEE REGISTRATION OF HIGH RISK PESTICIDES TO ENSURE THAT PUBLIC HEALTH IS PROTECTED AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT AND LOBBY FOR LEGISLATION THAT REQUIRES -INNESOTA STATE AGENCIES TO CON DUCT THOROUGH HEALTH RISK ASSESSMENTS AS PART OF THE REGISTRATION PROCESS FOR PESTICIDES SUCH AS CARCINOGENS AND ENDOCRINE DISRUPTORS AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT AND LOBBY FOR LEGISLATION THAT PROVIDES THE -INNESOTA $EPARTMENT OF (EALTH WITH THE AUTHORITY TO ADD RESTRICTIONS TO THE REGISTRATION AND USE OF THOSE PESTICIDES IF THE RISK TO PUBLIC HEALTH IS FOUND TO BE UNAC CEPTABLY HIGH #ONTINUED ON PAGE

3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY (OUSE !CTION 2EFERRED TO THE --! "OARD OF 4RUSTEES CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT AND LOBBY FOR LEGISLATION THAT REQUIRES THAT PESTICIDE APPLICATION RECORDS BE lLED WITH THE -INNESOTA $EPARTMENT OF !GRICULTURE -$!

SIMILAR TO REQUIREMENTS FOR OTHER INDUSTRIES AND THAT THE RECORDS BE MADE AVAILABLE THROUGH THE STATE S OPEN RECORDS LAW TO CITIZENS FOR REVIEW AND COPY AND BE IT FURTHER

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

#ARL "URKLAND - $ LEFT AND !BDHISH "HAVSAR - $ RECEIVE INFORMATION AT THE (OUSE OF $ELEGATES

.OVEMBER $ECEMBER

--! (OUSE OF $ELEGATES #ONTINUED FROM PAGE

EXCEPTION TO THE 7OMAN S 2IGHT TO +NOW 724+ !CT THAT WOULD EXCLUDE PREGNANCIES COMPLICATED BY FETAL ANOMALIES INCOMPATIBLE WITH EXTRAUTERINE SURVIVAL

2ESOLUTION #ONTAMINATION OF $RINKING 7ATER BY 0HARMACEUTICALS AND 0ERSONAL #ARE 0RODUCTS

3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY

2ESOLUTION 4HE !UTHORIZATION OF 5NSECURED %MAIL IN #OMMUNICATING !BOUT #REDENTIALING AND 2ECREDENTIALING 7ITH (OSPITALS AND (EALTH 0LANS AND 0OSSIBLY )DENTITY 4HEFT

(OUSE !CTION !DOPTED AS AMENDED 2%3/,6%$ THAT THE -INNESOTA DELEGATION TO THE !MERICAN -EDICAL !SSOCIATION SUBMIT A RESOLUTION TO THE !MERICAN -EDICAL !S SOCIATION (OUSE OF $ELEGATES CALLING ON THE !MERICAN -EDICAL !SSOCIATION TO REQUEST THAT THE %NVIRONMENTAL 0ROTECTION !GENCY CONDUCT STUDIES ON PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN DRINKING WATER TO DETERMINE HOW HARMFUL THE LEVELS OF PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN OUR NATION S DRINK ING WATER SUPPLIES ARE TO PUBLIC HEALTH AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION STUDY THE PROPER DISPOSAL OF PHAR MACEUTICAL PRODUCTS IN HOSPITALS CLINICS AND PHYSICIAN OFlCES AND REPORT BACK TO THE (OUSE OF $ELEGATES 3UBSTITUTE ,ATE 2ESOLUTION

-INNESOTA (EALTH #ARE 0ROGRAMS #OVERAGE

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.OVEMBER $ECEMBER

(-3 MEMBER "EN 7HITTEN - $ PROVIDES TESTIMONY AT THE (OUSE OF $ELEGATES

(OUSE !CTION 3UBSTITUTE ,ATE 2ESOLUTION WAS ADOPTED IN LIEU OF ,ATE 2ESOLUTION AND ,ATE 2ESOLUTION CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT LEGISLATIVE CHANGES THAT WOULD REINSTATE -EDICAL !SSISTANCE -!

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AND -INNESOTA#ARE COVERAGE FOR CIRCUMCI SIONS AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT LEGISLATIVE CHANGES THAT WOULD ELIMINATE THE PRIOR AUTHORIZATION REQUIREMENT FOR -! '!-# AND -INNESO TA#ARE COVERAGE FOR NON EMERGENCY CESAREAN SECTIONS AND BE IT FURTHER 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION IN LIGHT OF %MERGENCY -EDICAL 4REATMENT AND !CTIVE ,ABOR !CT %-4!,!

REQUIREMENTS REVIEW THE APPROPRIATENESS OF CHANGES MADE BY THE -INNESOTA ,EGISLATURE THAT EFFECTIVE /CTOBER

ELIMINATE -! AND -INNESOTA#ARE COVERAGE FOR EMERGENCY DEPARTMENT VISITS AND SERVICES THAT ARE DETERMINED RETROSPECTIVELY TO BE NON EMERGENT OR NON URGENT AND BE IT FURTHER

3UBMITTED BY THE (ENNEPIN -EDICAL 3OCIETY (OUSE !CTION !DOPTED AS AMENDED 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION ASK THE HEALTH CARE ORGANIZATIONS

THAT REQUIRE CREDENTIALING AND RECREDENTIAL ING TO SEND SENSITIVE INFORMATION IN A SECURE MANNER 2ESOLUTION (EALTH 0LAN 2EGULATORY !CCOUNTABILITY

3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY (OUSE !CTION !DOPTED AS AMENDED 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION ENCOURAGE THE "OARD OF -EDICAL 0RACTICE TO HOLD MAKERS OF HEALTH AND TREATMENT DECISIONS ACCOUNTABLE TO THE SAME REGULATORY PLAN REFERRAL REVIEW STANDARDS AS OTHER PROVIDERS DELIVERING MEDICAL SERVICES 2ESOLUTION (EALTH 0LAN ,EGAL ,IABILITY

3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY (OUSE !CTION .OT ADOPTED CONSENT CALENDAR 2ESOLUTION (EALTH 0LAN AND #LINIC #ONTRACT ,IABILITY

3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY (OUSE !CTION .OT ADOPTED CONSENT CALENDAR

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3UBMITTED BY THE (ENNEPIN -EDICAL 3OCIETY (OUSE !CTION !DOPTED AS AMENDED CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT LEGISLATION THAT ADDS AN

3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY

2%3/,6%$ THAT THE -INNESOTA -EDICAL !SSOCIATION SUPPORT MANDATORY TESTING OF SEX OFFENDERS CONVICTED IN -INNESOTA FOR THE BLOOD BORNE DISEASES ()6 (EPATITIS " AND (EPATITIS #

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

2ESOLUTION 4ASK &ORCE TO 3TUDY THE )NTEGRATION OF 0HYSICIAN #LINICS

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3UBMITTED BY THE 2AMSEY -EDICAL 3OCIETY (OUSE !CTION 2EFERRED TO THE --! "OARD OF 4RUSTEES CONSENT CALENDAR 2%3/,6%$ THAT THE -INNESOTA -EDICAL !S SOCIATION APPOINT A 4ASK &ORCE THAT INCLUDES PHYSICIANS ATTORNEYS AND ETHICISTS TO INVESTI GATE WHETHER THE VERTICAL INTEGRATION OF A HEALTH PLAN EMPLOYED PHYSICIANS MEDICAL CLINICS AND HOSPITALS INTO A SINGLE ENTITY VIOLATES -INNE SOTA ANTI TRUST OR ANY OTHER STATE STATUTE AND WHETHER OR NOT SUCH A SYSTEM MEETS ETHICAL STANDARDS COMPATIBLE WITH THE !MERICAN -EDI CAL !SSOCIATION #ODE OF %THICS AND SUBMIT A REPORT BACK TO THE -INNESOTA -EDICAL !SSOCIATION (OUSE OF $ELEGATES

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/UTGOING --! 0RESIDENT * -ICHAEL 'ONZALEZ #AMPOY - $ 0H $ 2-3 MEMBER RIGHT WAS RECOGNIZED FOR HIS ACHIEVEMENTS DURING HIS TERM WITH AN AWARD PRESENTED TO HIM BY --! "OARD #HAIR ' 2ICHARD 'EIER - $

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--! !WARD 2ECIPIENTS 4HE -INNESOTA -EDICAL !SSOCIATION PRESENTED AWARDS TO THE FOLLOWING INDIVIDUALS AT THE !WARDS ,UNCHEON DURING THE ND !NNUAL -EETING IN -INNEAPOLIS $ECADE 2ECOGNITION #OLLEAGUES WHO HAVE REMAINED COMMITTED TO THEIR PROFESSION FOR lVE DECADES ARE RECOGNIZED FOR THIS AWARD $ONALD ' !LTON - $ 2-3 -AXWELL - "ARR - $ (-3 3OLVEIG - "ERGH - $ (-3 *OSEPH 0 #ONNOLLY - $ 2-3 +JELD / (USEBYE - $ 2-3 #HARLOTTE 4 -ERRICK - $ (-3 *ULIEN 6 0ETIT - $ (-3 !RTHUR % 3ETHRE - $ 2-3

#OMMUNITY 3ERVICE !WARD 4HIS AWARD HONORS --! MEMBERS WHO ARE ACTIVELY ENGAGED IN THE PRACTICE OF MEDICINE AND HAVE AN OUTSTANDING RECORD OF COMMUNITY SERVICE 4HOMAS 0 #OLEMAN - $ (-3 -ILTON - (URWITZ - $ 2-3 0RESIDENT S !WARD 4HIS AWARD IS PRESENTED TO MEMBERS OF THE --! WHO HAVE MADE OUTSTANDING CONTRIBU TIONS IN SERVICE BUT HAVE NEVER BEEN ELECTED TO A MAJOR OFlCE OR BEEN RECOGNIZED BY THE --!

FOR THEIR DEDICATION AND COMMITMENT "RUCE ! .ORBACK - $ (-3

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!LLINA (EALTH 3YSTEMS #LASSIlED !DS #OLDWELL "ANKER "URNETÂ&#x2C6; "RUCE "IRKELAND )NSIDE "ACK #OVER #RUTCHlELD $ERMATOLOGY 'ROVES 0HYSICAL 4HERAPY )NC (ANSEN #ONSTRUCTION OF %DINA )NC

)NSIDE "ACK #OVER +RAMER -ARTIN ,,# --)# -INNESOTA /NCOLOGY (EMATOLOGY 0 ! /UTSIDE "ACK #OVER .EW 3PACES (OUSE OF $REAMS 2#-3 )NC 2ED 0INE 2EALTY 3CHWARZ 7ILLIAMS #O )NC )NSIDE &RONT #OVER 7EBER ,AW /FlCE 7HITESELL -EDICAL ,OCUMS ,TD 7INTER -EDICAL #ONFERENCE

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

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

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4ODD $ "RANDT - $ !T ,ARGE $IRECTOR 6ICTOR 3 #OX - $ 3PECIALTY $IRECTOR ,AURA ! $EAN - $ 3PECIALTY $IRECTOR *EREMY 4 #ARLSON -EDICAL 3TUDENT !NDREW 3 &INK - $ !T ,ARGE $IRECTOR 2ONNELL ! (ANSEN - $ 3PECIALTY $IRECTOR 4HOMAS * ,OSASSO - $ !T ,ARGE $IRECTOR 2OBERT # -ORAVEC - $ !T ,ARGE $IRECTOR *ANE # 0EDERSON - $ - 3 3PECIALTY $IRECTOR ,ON " 0ETERSON - $ !T ,ARGE $IRECTOR 4HOMAS $ 3IEFFERMAN - $ 3PECIALTY $IRECTOR 3TEPHANIE $ 3TANTON - $ 2ESIDENT 0HYSICIAN *ACQUES 0 3TASSART - $ !T ,ARGE $IRECTOR #HRISTINA * 4EMPLETON - $ 3PECIALTY $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 ,YLE * 3WENSON - $ 0UBLIC 0OLICY #OUNCIL #HAIR 7AYNE ( 4HALHUBER - $ 3R 0HY SICIANS !SSOCIATION 0RESIDENT 2-3 %XECUTIVE 3TAFF

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!3 ! (/30)4!,)34 AT A TERTIARY CARE HOSPI TAL ) ADMIT A VARIETY OF PATIENTS FROM DIFFERENT HEALTH SYSTEMS AROUND THE 4WIN #ITIES THE SURROUNDING AREA AND OFTEN FROM OUTSIDE THE REGION 3INCE THE PATIENTS ARE BEING ADMITTED TO THE HOSPITAL IT IS IMPORTANT TO ESTABLISH A DATABASE ON THOSE PATIENTS 4HIS ALWAYS ENTAILS RETRIEVING AND REVIEWING PREVIOUSLY ACCUMU LATED MEDICAL INFORMATION ON THE PATIENT 4HE BIGGEST OBSTACLE ) HAVE ENCOUNTERED IN REGARD TO DOING THIS IS ()0!! ) HAVE CALLED PHARMACIES LOOKING FOR PATIENT S PRESCRIPTION RECORDS ) HAVE CALLED PHYSICIANS ASKING THEM TO SPEAK WITH ME AND SEND DOCUMENTS ) HAVE CONTACTED AMBULATORY CARE SITES IMAGING CENTERS AND HOSPITALS WHEN THEIR ATTENDING PHYSICIANS ARE NOT AVAILABLE %VERYDAY ) SPEAK WITH PERSONS WHO QUOTE ME ()0!! AS THE REASONS FOR DENYING ME ACCESS TO THE NECESSARY HEALTH INFORMATION ) NEED TO EFFECTIVELY MANAGE MY PATIENTS 7HEN THE ()0!! LEGISLATION WAS PASSED BY #ONGRESS THE LEGISLATION WAS TO FACILITATE PATIENT CARE BY ALLOWING THE TRANSFER OF MEDI CALLY NECESSARY INFORMATION )TS SECONDARY PURPOSE WAS TO PREVENT UNAUTHORIZED ENTITIES FROM CONlDENTIAL PATIENT INFORMATION ! WHOLE INDUSTRY HAS DEVELOPED AROUND THIS LEGISLATION 5NFORTUNATELY THE LAWYERS AND ENTITIES THAT PROFESS TO EDUCATE THE PUBLIC HEALTH PROFES SIONS AND HEALTH CARE ENTITIES HAVE CREATED A GENERAL CLIMATE OF MISUNDERSTANDING 4O THEIR CREDIT THE (EALTH (UMAN 3ERVICES $EPARTMENT HAS CREATED A ()0!!

7EB SITE THAT INCLUDES A SECTION THAT CONTAINS h3ELECTED 1UESTIONS AND !NSWERS REGARDING ()0!! v ) COMPARE THIS SECTION OF THE ()0!!

7EB SITE TO 5RBAN ,EGENDS 2EFERENCE 0AGES OR "REAK THE #HAIN WHOSE SOLE PURPOSE IS TO STOP MISINFORMATION ) HAVE LISTED THE 52, FOR THE ()0!! 7EB SITE AT THE BOTTOM OF THIS ARTICLE /NCE AT THE 7EB SITE CLICK ON THE LEFT HAND SIDE ON THE HYPERTEXT LABELED h!NSWERS TO YOUR &REQUENTLY !SKED 1UESTIONS v 4HESE ARE EXAMPLES FROM THE ()0!! 7EB SITE WITH THE QUESTIONS AND ANSWERS TRUNCATED FOR THIS COLUMN

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

$OES THE ()0!! 0RIVACY 2ULE PERMIT DOCTORS

NURSES AND OTHER HEALTH CARE PROVIDERS TO SHARE PATIENT HEALTH INFORMATION FOR TREATMENT PUR POSES WITHOUT THE PATIENT S AUTHORIZATION 9ES 4HE 0RIVACY 2ULE ALLOWS THOSE DOCTORS

NURSES HOSPITALS LABORATORY TECHNICIANS AND OTHER HEALTH CARE PROVIDERS THAT ARE COVERED ENTITIES TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION SUCH AS 8 RAYS LABORATORY AND PATHOLOGY REPORTS DIAGNOSES AND OTHER MEDICAL INFORMATION FOR TREATMENT PURPOSES WITHOUT THE PATIENT S AUTHORIZATION $OES A PHYSICIAN NEED A PATIENT S WRITTEN AUTHORIZATION TO SEND A COPY OF THE PATIENT S MEDICAL RECORD TO A SPECIALIST OR OTHER HEALTH CARE PROVIDER WHO WILL TREAT THE PATIENT .O 4HE ()0!! 0RIVACY 2ULE PERMITS A HEALTH CARE PROVIDER TO DISCLOSE PROTECTED HEALTH INFORMATION ABOUT AN INDIVIDUAL

WITHOUT THE INDIVIDUAL S AUTHORIZATION

TO ANOTHER HEALTH CARE PROVIDER FOR THAT PROVIDER S TREATMENT OF THE INDIVIDUAL $OES THE ()0!! 0RIVACY 2ULE STRICTLY PROHIBIT THE USE DISCLOSURE OR REQUEST OF AN ENTIRE MEDI CAL RECORD .O 4HE 0RIVACY 2ULE DOES NOT PROHIBIT THE USE DISCLOSURE OR REQUEST OF AN ENTIRE MEDI CAL RECORD AND A COVERED ENTITY MAY USE

DISCLOSE OR REQUEST AN ENTIRE MEDICAL RECORD WITHOUT A CASE BY CASE JUSTIlCATIONx ) HAVE CLIPPED AND PASTED THESE QUESTIONS AND ANSWERS AND OTHERS INTO A THREE PAGE DOCU MENT THAT ) CARRY WITH ME AT ALL TIMES WHILE WORKING IN THE HOSPITAL 4HE HEADER ON THE lRST SHEET CONTAINS INFORMATION ON HOW TO ACCESS THE 7EB SITE 4HIS HEADER INFORMATION #ONTINUED ON PAGE

.OVEMBER $ECEMBER

2AMSEY -EDICAL 3OCIETY

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

%SSENTIALS OF 0AIN -EDICINE #ONFERENCE 7ELL !TTENDED

/

N 3ATURDAY 3EPTEMBER

THE 2AMSEY -EDICAL 3OCIETY &OUNDATION PRESENTED THE h%SSENTIALS OF 0AIN -EDICINEv #ONFERENCE AT THE -INNESOTA #ENTER FOR /BESITY -ETABOLISM AND %NDOCRINOLOGY #ONFERENCE #ENTER IN %AGAN -INNESOTA &IFTY FOUR PHYSICIANS 2. S NURSE PRACTITIONERS AND PSYCHOLOGISTS GATHERED EARLY IN THE MORNING TO SETTLE IN FOR THE DAY LONG CONFERENCE ON PAIN

4HE MORNING BEGAN WITH OPENING REMARKS BY 2-3 0RESIDENT #HARLES 4ERZIAN - $ 4HE lRST SPEAKER WAS INTRODUCED AND 2ICHARD !ULD

0H $ ASSISTANT EXECUTIVE DIRECTOR -INNESOTA "OARD OF -EDICAL 0RACTICE INFORMED THE ATTEND EES ABOUT h0AIN -ANAGEMENT ,EGAL 2EGULA TORY ,ANDSCAPE v $R !ULD WAS FOLLOWED BY !LFRED 6 !NDERSON - $ $ # 0AIN -ANAGEMENT

0AIN !SSESSMENT 2EHABILITATION #ENTER ,TD

WHO DISCUSSED h0AIN 0HYSIOLOGY AND THE

"OOK WINNERS 6INCENT 2 (UNT - $ AND *ULIET (ANSON - $ WITH $ARRIN 3WANSON CENTER 3ALES 2EPRESENTATIVE FROM %LSEVIER

$IFlCULT 0ATIENTv PREVIOUS ADDICTS UNRESPON SIVE PATIENTS !FTER A SHORT BREAK %RIC 7 'OAD

- $ PSYCHIATRY 0ARK .ICOLLET #LINIC EXPLAINED THE h0SYCHOPHARMACOLOGY OF $EPRESSION !NXIETY AND 0AINv FOLLOWED BY A PRESENTATION ON h3LEEP AND 0AIN 2ESTLESS ,EGS 3YNDROME AND THE -AN AGEMENT OF )NSOMNIAv BY #ARLOS ( 3CHENCK

- $ SENIOR STAFF PSYCHIA TRIST -INNESOTA 2EGIONAL 3LEEP $ISORDERS #ENTER

(ENNEPIN #OUNTY -EDICAL #ENTER $URING LUNCH THE ATTENDEES PARTICIPATED IN A PANEL DISCUSSION WITH THE FACULTY FROM THE MORNING

4HE AFTERNOON FEATURED PRESENTATIONS ON h-IGRAINES 5NRAVELED +NOW THE 2ULES v BY &REDERICK 2 4AYLOR

- $ NEUROLOGIST 0ARK .ICOLLET (EADACHE #LINIC AND 2ESEARCH #ENTER h$ISPARITIES IN 0AIN #AREv BY !LFONSO -ORALES 5TRILLA - $ PAIN MEDICINE #ENTRAL -EDICAL #LINIC ,,# h0ALLIATIVE #ARE ! NEW PARADIGM FOR MANAGING SERIOUS ILLNESSv BY %RIC 7 !NDER SON - $ 0AIN -EDICINE 0AIN !SSESSMENT 2EHABILITATION #ENTER ,TD AND h! 'UIDE TO )NTERVENTIONAL 0AIN -ANAGEMENT 4ECHNIQUESv BY 7ILLIAM * &ORD ))) - $ NEURORADIOLOGY

42)! /RTHOPAEDIC #ENTER

4HE CONFERENCE WAS VIDEOTAPED TO BE USED AS ENDURING MATERIAL AT A LATER DATE

%LSEVIER GRACIOUSLY DONATED TWO BOOKS TO BE USED FOR DOOR PRIZE DRAWINGS 4HE WINNERS OF THE DRAWINGS $RS 6INCENT 2 (UNT AND *ULIET (ANSON

WERE ABLE TO PICK A BOOK OF THEIR CHOICE

4HE EXHIBITORS FROM LEFT *EAN "REWSTER

0AUL 3OKHOR #ONNIE 3TOY $AVE 7OODS 2ICK / #ONNOR 3TEVE !NGELL AND !MY -UCKALA

!TTENDEES WERE INVITED TO VISIT THE EXHIBITOR DISPLAY S PROVIDED BY s #EPHALON n $AVE 7OODS AND 0AUL 3OKHOR s 'LAXO3MITH+LINE n #ONNIE 3TOY AND *EAN "REWSTER s *ANSSEN /RTHO-C.EIL n 3TEVE !NGELL s -C.EIL 0HARMACY n 2ICK / #ONNOR s 0URDUE 0HARMA n !MY -UCKALA 5NRESTRICTED EDUCATIONAL GRANTS WERE RECEIVED BY

4HE MORNING FACULTY PANEL FROM LEFT #ARLOS ( 3CHENCK - $ %RIC 7 'OAD - $ AND 2ICHARD !ULD 0H $ NOT PICTURED !LFRED 6 !NDERSON - $

.OVEMBER $ECEMBER

!FTERNOON FACULTY FROM LEFT &REDERICK 2 4AYLOR - $ !LFONSO -ORALES 5TRILLA - $ AND %RIC 7 !NDERSON - $ NOT PICTURED 7ILLIAM * &ORD ))) - $

s s s s s

!MGEN )NC !STELLAS 0HARMA 53 )NC %LI ,ILLY AND #OMPANY 'ENENTECH )NC )NTENDIS )NC

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

2-3 50$!4%

2-3 "OARD -EMBERS -EET 7ITH 3ENATOR #OLEMAN IGHTEEN 2-3 "OARD MEMBERS MET WITH 5 3 3ENATOR .ORM #OLEMAN ON -ONDAY

3EPTEMBER AT 5NITED (OSPITAL 4HE PUR POSE OF THE MEETING WAS TO SHARE THE CONCERNS OF PHYSICIANS ABOUT THE mAWED 3USTAINED 'ROWTH 2ATE 3'2 FORMULA USED TO CALCULATE PHYSICIAN REIMBURSEMENT FOR CARING FOR -EDICARE PATIENTS 4HE 3'2 FORMULA IS TIED TO THE -EDICAL %CO NOMIC )NDEX -%) AND UNFAIRLY PENALIZES PHYSI CIANS FOR THE INCREASE IN VOLUME OF SERVICES 4HE 3'2 FORMULA WILL RESULT IN A PERCENT REDUC TION IN PHYSICIAN REIMBURSEMENTS FOR -EDICARE SERVICES IN WHICH WILL REDUCE ALREADY LOW -EDICARE REIMBURSEMENTS TO -INNESOTA PHYSI CIANS BY MILLION 2-3 LEADERS EXPLAINED THE NEED FOR #ONGRESS TO REPEAL THE 3'2 FORMULA !LTERNATIVE LEGISLATION INTRODUCED IN #ONGRESS WAS REVIEWED WITH 3ENATOR #OLEMAN 3ENATOR #OLEMAN RECOGNIZED THE PROBLEM AND ADVISED THE 2-3 LEADERSHIP THAT HE WOULD CONSIDER THE VARIOUS BILLS AND CONSIDER THEIR CONCERNS WHEN THE BILLS MOVE THROUGH #ONGRESS (E URGED PHYSICIANS TO CONTACT THE -INNESOTA #ONGRESSIONAL DELEGATION TO INFORM THEM ABOUT -EDICARE LEGISLATION

2AMSEY -EDICAL 3OCIETY

%

&ROM LEFT 2OGER *OHNSON 2-3 #%/ *AMES *ORDAN - $ 0RESIDENT %LECT 2OBERT -ORAVEC

- $ !T ,ARGE $IRECTOR +ENNETH #RABB - $ !-! $ELEGATE 2OBERT 'EIST - $ #HAIR

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&RIDAY .OVEMBER

+ *AMES %HLEN - $

2-3 #OUNCIL AND "OARD -EMBERS %NJOY A .IGHT AT THE 3AINTS

7

E HAD TICKETS TO ATTEND THE 3T 0AUL 3AINTS VS +ANSAS #ITY 4 "ONES GAME AT P M ON !UGUST 7E ENDED UP WITH A BONUS OF A DOUBLE HEADER AS A PREVI OUS GAME HAD BEEN RAINED OUT IN +ANSAS #ITY WHICH MOVED GAME TIME TO P M 4WELVE "OARD -EMBERS #OUNCIL -EMBERS AND THEIR FAMILIES GATHERED AT 'ABE S BY THE 0ARK FOR AN INDOOR TAILGATE PARTY BEFORE BOARDING THE BUS TO THE STADIUM )T WAS A BEAUTIFUL EVENING TO BE SITTING OUTDOORS ENJOYING A BASEBALL GAME OR TWO 4HE 3AINTS HIT A THREE RUN HOMER WITH

h4HE (EALTH 2EFORM 4OOL "OX IS &ULL 7HAT 7ILL 7E "UILD v 5NITED (OSPITAL #ONFERENCE (ALL

TWO OUTS IN THE BOTTOM OF THE SEVENTH INNING TO LIFT THE 3T 0AUL 3AINTS TO A VICTORY AND A SWEEP OF THEIR TWI NIGHT DOUBLEHEADER 4HIS EVENT WAS HOSTED BY 2-3 AS A THANK YOU TO 2-3 "OARD -EMBERS AND #OUNCIL -EMBERS FOR THE TIME THEY CONTRIBUTE TO 2-3 AND AN OPPORTUNITY TO HAVE FUN WITH THEIR FAMILY

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

$OWNSTAIRS IN THE *OHN .ASSEF (EART (OSPITAL

. 3MITH !VE 3T 0AUL -.

A M n A M $ESIGNATED FOR CONTINUING EDUCATION CREDIT BY !LLINA (OSPITALS #LINICS

9OU DO NOT NEED TO 2360 TO ATTEND

.OVEMBER $ECEMBER

2-3 0RESIDENT S -ESSAGE #ONTINUED FROM PAGE

IS AT TIMES THE MOST IMPORTANT BECAUSE OF THE MANY DISBELIEVERS ) ENCOUNTER WITHIN MY OWN AND OTHER HEALTH SYSTEMS THAT SOMEHOW THINK ) HAVE CREATED THIS INFORMATION TO SERVE MY OWN NEEDS )T IS DIFlCULT TO EDUCATE PEOPLE WHEN MISINFORMATION mOWS SO READILY AMONG HEALTH CARE PROVIDERS AND ENTITIES ) COPY MY SHEETS FAX THEM OR SEND HARD COPIES TO THE MISINFORMED 4O PUT THE THEME OF THIS COLUMN INTO THE CONTEXT OF CURRENT EVENTS THE FEDERAL GOVERN MENT HAS MADE THE RECORDS OF (URRICANE +ATRINA VICTIMS AVAILABLE ONLINE TO DOCTORS 4HIS IS THE lRST TIME PHARMACY AND PHYSICIAN HEALTH RECORDS HAVE BEEN PLACED INTO A hCENTRALIZED DATABASE v AND ACCESSIBLE ON THE )NTERNET 4HIS IS POSSIBLE BECAUSE AS YOU NOW KNOW THERE ARE NO FEDERAL REGULATIONS REQUIRING A PATIENT TO GIVE CONSENT BEFORE THEIR MEDICAL RECORDS CAN BE SHARED FOR MEDICAL PURPOSES $R $AVID "RAILER THE COOR DINATOR OF HEALTH INFORMATION TECHNOLOGY FOR THE ((3 HAS BEEN QUOTED AS SAYING hWE THINK THIS COULD SAVE LIVES v 4HAT IS EXACTLY WHAT EVERY PHYSICIAN AND ) DO EVERYDAY AND WHY IT IS SO IMPORTANT TO STOP THIS PERPETUATION OF MISIN FORMATION ABOUT ()0!! ()0!! 7EB SITE HTTP WWW HHS GOV OCR HIPAA #HARLES 4ERZIAN - $ -AIL TO C TERZIAN ATT NET -OBILE &URTHER INFORMATION )F YOU ARE A LICENSED PHYSICIAN TREAT ING EVACUEES OF (URRICANE +ATRINA HTTP WWW KATRINAHEALTH ORG MAY HELP YOU ACCESS SOME PATIENTS PRESCRIPTION DRUG INFORMATION AND OTHER HEALTH DATA ELECTRONICALLY 4O COMPLETE THE PROCESS NECESSARY TO OBTAIN A LOGIN AND PASSWORD PLEASE CONTACT THE !-! S 5NIlED 3ERVICE #ENTER AT

WHICH IS AVAILABLE HOURS A DAY 0HYSICIANS WILL BE ASKED SPECIlC QUESTIONS TO VERIFY THEIR IDENTITY AND THAT THEY HOLD A CURRENT

UNRESTRICTED LICENSE TO PRACTICE MEDICINE IN AT LEAST ONE STATE 6ISIT HTTP ENEWS AMA ASSN ORG 5- 4 ASP ! TO ACCESS THE !-! S COMPREHENSIVE 7EB PAGES ON HURRICANE RELIEF .OVEMBER $ECEMBER

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

!CTIVE *OHN ' 3HEAREN - $ 5NIVERSITY OF -INNESOTA 'ENERAL 3URGERY -INNESOTA 3URGICAL !SSOCIATES !MITABH !RUN 4IPNIS - $ -AHATMA 'ANDHI -ISSIONS -EDICAL #OLLEGE

5NIVERSITY OF -UMBAI )NDIA 0SYCHIATRY (ENNEPIN &ACULTY !SSOCIATES -ICHAEL ! 4RANGLE - $ 5NIVERSITY OF -INNESOTA 0SYCHIATRY 60 OF -EDICAL !FFAIRS 2EGIONS (OSPITAL

ST 9EAR !CTIVE 0RACTICE (EATHER 2 #ICHANOWSKI - $ 5NIVERSITY OF -INNESOTA &AMILY -EDICINE (EALTH0ARTNERS 2EGIONS +AI ! 4UOMINEN - $ %MERGENCY -EDICINE

2ESIDENT 0HYSICIANS /GECHIKA + !LOZIE - $ -0( 5NIVERSITY OF "ENIN .IGERIA )NTERNAL -EDICINE (ENNEPIN #OUNTY -EDICAL #ENTER *OSEPH 3INGH "ASRAON - $ 4OURO 5NIVERSITY #OLLEGE OF /STEOPATHIC -EDICINE )NTERNAL -EDICINE 5 OF -. 'RADUATE 3CHOOL 3TEFAN 0 #OLLINET !DLER - $ 5NIVERSITE DE .ANCY &RANCE )NTERNAL -EDICINE (ENNEPIN #OUNTY -EDICAL #ENTER -ADHU +ANNAPIRAN - $ /HIO 3TATE 5NIVERSITY -EDICAL 3CHOOL )NTERNAL -EDICINE (ENNEPIN #OUNTY -EDICAL #ENTER *AY ,IN - $ 2ADIOLOGY (ENNEPIN #OUNTY -EDICAL #ENTER

0AULA - -ARTINEZ - $ 0SYCHIATRY (ENNEPIN #OUNTY -EDICAL #ENTER )NDIRA -IRYALA -""3 'HANDI -EDICAL 3CHOOL )NDIA )NTERNAL -EDICINE (ENNEPIN #OUNTY -EDICAL #ENTER -EGAN - .OLAN .ORMAN - $ 5NIVERSITY OF -INNESOTA !NESTHESIOLOGY (ENNEPIN #OUNTY -EDICAL #ENTER

-EDICAL 3TUDENTS 5NIVERSITY OF -INNESOTA

-OHAMED - !BDIHALIM %RIC ' !DIARTE +RISTIN . !NDERSON !NNE % "ANTLE

)N -EMORIAM */(. 2 '!4%3 - $ DIED AT THE AGE OF ON 3EPTEMBER AFTER A COURA GEOUS BATTLE WITH CANCER (E GRADUATED FROM (ARVARD 5NIVERSITY IN AND RECEIVED HIS - $ FROM THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL IN $R 'ATES COM PLETED HIS RESIDENCY IN CLINICAL NEUROLOGY AT THE 5NIVERSITY OF -INNESOTA IN (E COMPLETED FURTHER POST RESIDENCY PROGRAMS IN ,ONDON AT THE -AYO #LINIC AND AT THE 5NIVERSITY OF -INNESOTA (E WAS A FOUNDING MEMBER OF THE -INNESOTA %PILEPSY 'ROUP

0 ! IN 3T 0AUL $R 'ATES WAS A RESEARCHER AND HIS ARTICLES WERE PUBLISHED BY NUMEROUS MEDICAL JOURNALS AS WELL AS BEING A NATIONAL EXPERT ON BRAIN WAVE MAPPING USED TO TARGET THE AREAS OF THE BRAIN IN NEED OF SURGERY (E WAS KNOWN WIDELY FOR HIS ACTIVE PARTICIPA TION IN MANY ORGANIZATIONS THAT WORKED TO IMPROVE THE CARE OF EPILEPSY PATIENTS $R 'ATES WAS ALSO ACTIVE IN THE !MERICAN %PILEPSY 3OCIETY !MERICAN !CADEMY OF .EUROLOGY AND 3TRATIS (EALTH FORMERLY THE &OUNDATION FOR (EALTH #ARE %VALUATION (E CHAIRED THE 2-3 #OUNCIL ON %DUCATION 2E SOURCES AND SERVED IN THE -INNESOTA -EDICAL !SSOCIATION (OUSE OF $ELEGATES )N THE YEAR $R 'ATES SERVED AS PRESIDENT OF 2-3 !MONG HIS MANY INTERESTS HE ENJOYED mYING AS A LICENSED PILOT AND HE WAS AN AVIATION MEDICAL EXAMINER

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

#(!)2 3 2%0/24 *!-%3 7 2/($% - $

7HO IS *IM 2OHDE

(-3 /FlCERS

(-3 "OARD -EMBERS

!LAN , "EAL - $ #ARL % "URKLAND - $ %MMETT & #ARPEL - $ 0ETER * $EHNEL - $ ,AURIE $RILL -ELLUM - $ 2AYMOND ! 'ENSINGER *R - $ &RANK 3 2HAME - $ 2ICHARD $ 3CHMIDT - $ *AN ( 3TRATHY - $ 4HOMAS # 4UNBERG - $ $AVID * 7ALCHER - $ (-3 %X /FlCIO "OARD -EMBERS

-ICHAEL " !INSLIE - $ --! 4RUSTEE -ARY !NDERSON #O 0RESIDING #HAIR (-3 !LLIANCE -ARTHA !RNESON #O 0RESIDING #HAIR (-3 !LLIANCE "ETH ! "AKER - $ --! 4RUSTEE +ELLY #AWCUTT -EDICAL 3TUDENT +AREN + $ICKSON - $ --! 4RUSTEE $AVID , %STRIN - $ !-! !LTERNATE $ELEGATE $ONALD - *ACOBS - $ --! 4RUSTEE +ARIN - 4ANSEK - $ --! 4RUSTEE 3ANDY 4HILL --'-! 2EPRESENTATIVE "ENJAMIN ( 7HITTEN - $ !-! !LTERNATE $ELEGATE (-3 %XECUTIVE 3TAFF

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

(

(/7 $)$ ) '%4 4()3 */" 7ELL YOU ELECTED ME OF COURSE "UT AS WE ALL KNOW

MEDICAL LEADERSHIP ROLES ARE USUALLY NOT SOUGHT AFTER OR CONTESTED -IKE 4EDFORD

(-3 #HAIR AND *ACK $AVIS

OUR (-3 #HIEF %XECUTIVE /FlCER TALKED ME INTO TAKING THE POSITION ) WILL BE FOLLOWED BY 0AUL +ETTLER A HOSPITALIST WITH #OLUMBIA 0ARK -EDICAL 'ROUP AND !NNE -URRAY A GERIATRICIAN WITH (ENNEPIN #OUNTY -EDI CAL #ENTER 7HO IS *IM 2OHDE ,OOKING THROUGH THE (-3 MEMBERSHIP DIRECTORY ) AM AWED

BY THE THOUSANDS OF PHYSICIANS THAT BELONG TO THE SOCIETY ) KNOW A COUPLE OF HUNDRED 3O MOST OF YOU DO NOT KNOW ME 4HIS SUM MER ) COMPLETED MY TH YEAR AS A FAMILY PHYSICIAN Â&#x2C6; ALL WITH %DINA &AMILY 0HYSI CIANS !FTER MY RESIDENCY AT THE 5NIVERSITY OF -INNESOTA (OSPITAL #LINIC ) JOINED *OHN "EECHER ) PRACTICE WITH -UMTAZ +AZIM

3HELDON "URNS 4ONY 3MITH "ARB 'AMRADT AND AS OF THIS FALL ,INDA *OHNSON ) MENTION EACH OF THEM BECAUSE YOU MAY KNOW ONE OR MORE OF THIS GROUP AND THUS lND A CONNEC TION WITH ME 4HOUGH %DINA &AMILY 0HYSICIANS IS A SMALL GROUP WE ARE LARGE IN THE DIVERSITY OF OUR EXPERIENCE AND SERVICES OFFERED BY A SINGLE SPECIALTY CLINIC 7E HAVE OUR OWN SCANNERS DEXA ULTRASOUND AND STRESS TESTING 7E DO OUR OWN CHEMISTRIES MAMMOGRAMS

AND ARE NEARLY PAPERLESS WITH OUR ELECTRONIC MEDICAL RECORD FUNCTIONING THROUGHOUT THE CLINIC AND OUR HOMES $R "URNS CAN CATCH UP ON CHART WORK WHILE COVERING THE ."!

4IMBERWOLVES OR .(, 7ILD 9OU CAN SPOT HIM ON THE SIDELINES OF THE 6IKINGS 3O HOW DOES A SMALL GROUP SURVIVE IN THIS AGE OF MERGERS AND LOW REIMBURSEMENTS &IRST OF ALL WE ALL WORK LONG AND HARD AND TRY TO PROVIDE lRST CLASS CARE TO OUR PATIENTS 3ECOND WE HAVE BEEN ABLE TO HIRE LOTS OF GREAT STAFF AND PROBABLY HAVE MORE EMPLOYEES PER

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

PHYSICIAN THAN MOST GROUPS APPROXIMATELY SIX PER PHYSICIAN !ND FINALLY WE HAVE REMAINED INDEPENDENT BY SERVING MANY HEALTH PLANS AND BEING ON STAFF AT TWO HOS PITALS -ETHODIST AND &AIRVIEW 3OUTHDALE 2ECENTLY WE DID MAKE THE DECISION TO STOP TAKING NEW -EDICARE PATIENTS 4HIS WAS MADE NECESSARY BY THE ANTICIPATED REDUC TION IN -EDICARE PAYMENTS NEXT YEAR AND FOR SEVERAL YEARS TO COME DUE TO THE SUSTAINABLE GROWTH FORMULAS WHILE AT THE SAME TIME A NEARBY CLINIC 3OUTHDALE &AMILY 0HYSICIANS CLOSED !T LEAST WE HAVE NOT FOLLOWED THE EX AMPLE OF SOME CLINICS THAT ARE SEEING PRIVATE PAY hBOUTIQUE PATIENTS v -Y PRACTICE IS HEAVILY WEIGHTED BY DIS ABLED PATIENTS ON -EDICAID AND !XIS 5 #ARE #OMPLETE 4HIS IS DUE TO MY YEARS OF AFlLIATION WITH #OURAGE #ENTER #URRENTLY

) CARE FOR OVER QUADRIPLEGICS AND MANY WITH -3 #0 3PINA "IlDA AND #LOSED (EAD 4RAUMA ) AM ALSO THE FATHER OF SIX IN A BLENDED FAMILY HUSBAND TO 3HARON AND GRANDFATHER TO !LEX AND !MANDA 4HUS THE LICENSE ON MY JEEP READS h'-0!$/#v Â&#x2C6; NOT POLITICALLY WISE FOR SOMEONE WHO VOLUNTEERS IN (AITI ) AM ALSO A CANCER SURVIVOR AND HOLDER OF DEGREES FROM THREE "IG 4EN 3CHOOLS )N THESE PARAGRAPHS YOU SEE THE PART OF MY LIFE THAT ) AM MOST PROUD Â&#x2C6; MY FAMILY AND THE LESS FORTUNATE MEMBERS OF OUR WORLD THAT ) HAVE THE PRIVILEGE TO SERVE

.OVEMBER $ECEMBER

(ENNEPIN -EDICAL 3OCIETY

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

(-3 ). !#4)/. *!#+ ' $!6)3 #%/

(-3 IN !CTION HIGHLIGHTS ACTIVITIES THAT YOUR LEADERSHIP AND EXECUTIVE OFlCE STAFF HAVE PARTICIPATED IN OR RESPONDED TO BE TWEEN -ETRO$OCTORS ISSUES 7E SOLICIT YOUR INPUT ON THESE ACTIVITIES AND ENCOURAGE YOUR CALLS REGARDING ISSUES IN WHICH YOU WOULD LIKE OUR INVOLVEMENT

4HE #LEAN !IR -INNEAPOLIS LEADERSHIP COMMITTEE CONTINUES TO MONITOR AND TESTIFY IN SUPPORT OF (ENNEPIN #OUNTY S COMPRE HENSIVE SECONDHAND SMOKE ORDINANCE WHICH WENT INTO EFFECT ON -ARCH 4HE FOLLOWING (-3 MEMBERS HAVE TESTIlED THIS SUMMER AT OPEN HEARINGS 0ETER $EH NEL - $ %D %HLINGER - $ &RANK 2HAME - $ 2ICH ,USSKY - $

"RIAN !NDERSON - $ 0AUL 0ENTEL

- $ AND *IM 9OUNG - $ 4HERE

HAVE ALSO BEEN MANY (-3 MEMBERS WHO RESPONDED POSITIVELY TO OUR CALL TO ACTION TO CONTACT THEIR (ENNEPIN #OUNTY #OMMIS SIONERS VOICING THEIR OPINIONS ABOUT THE OR DINANCE 0HYSICIANS CONTINUE TO BE A DRIVING FORCE AND INmUENTIAL VOICE IN THIS DEBATE

!CADEMY ON 6IOLENCE AND !BUSE HELD ITS INAUGURAL EVENT ON 3EPTEMBER

%DWARD (ILL - $ PRESIDENT OF THE !-! WAS THE KEYNOTE SPEAKER (-3 MEM BER $AVID -C#OLLUM - $ EMERGENCY ROOM PHYSICIAN IN 7ACONIA IS ONE OF THE DRIVING FORCES BEHIND THE FORMATION OF THE !CADEMY -ORE INFORMATION CAN BE SEEN AT WWW AVAHEALTH ORG

4HE FOLLOWING (-3 MEMBERS HAVE SUCCESS FULLY BEEN ELECTED TO --! AND (-3 OFlCES

(-3 0RESIDENT %LECT !NNE -URRAY - $ %D %HLINGER - $ (-3 3ECRETARY (-3 4REASURER %RIC #HRISTIANSON - $ (-& "D -EMBER $UANE %NGSTROM - $ (-& "D -EMBER "URTON 3CHWARTZ - $ --! 4REASURER #AROLYN -C+AY - $ --! 6ICE 3PEAKER *OHN ,ARSEN - $ --! 4RUSTEE $ONALD *ACOBS - $ --! 4RUSTEE "ETH "AKER - $ --! "OARD #HAIR -ICHAEL !INSLIE - $

&ORTY FOUR (-3 MEMBERS ATTENDED THE --! !NNUAL (OUSE OF $EL EGATES MEETING IN -INNEAPOLIS 3EVERAL

RESOLUTIONS WERE SUBMITTED BY THE DELEGATION TO THE FULL (OUSE ! FULL REPORT IS CONTAINED ELSEWHERE IN THIS EDITION OF -ETRO$OCTORS 4HE (-3 3ENIOR 0HYSICIANS !SSOCIA TION LED BY 2ICHARD 3IMMONS - $

HAS HELD TWO RECENT EVENTS 4HE GROUP HAD A SOCIAL EVENT AT THE -ILL #ITY -USEUM IN THE SUMMER AND A LUNCHEON WITH SPEAKER WAS HELD ON 3EPTEMBER 4HE (OBAN 3CHOLARSHIP #OMMITTEE MET ON 3EPTEMBER AND AWARDED SEVEN SCHOLAR SHIPS 3UE 3CHETTLE (-3 $IRECTOR WAS ONE OF THE RECIPIENTS

4HE (ENNEPIN -EDICAL 3OCIETY MEMBER SHIP FOR HAS INCREASED TO

MEMBERS 4HIS REPRESENTS AN INCREASE OF APPROXIMATELY PERCENT OVER

3ENIOR 0HYSICIANS !SSOCIATION

4HE #ONNECTIONS 0ROGRAM HAS SUCCESSFULLY MATCHED AGAIN THIS YEAR ALL INTERESTED lRST YEAR MEDICAL STUDENTS WITH MENTORS WHO ARE PRACTICING PHYSICIANS #ONNECTIONS IS A JOINT PROGRAM OF (-3 2AMSEY -EDICAL 3OCIETY

5 OF - -EDICAL 3CHOOL AND THE -EDICAL !LUMNI !SSOCIATION

)F YOU ARE RETIRED OR CONTEMPLATING RETIREMENT YEARS OR OLDER MEMBER OR PAST MEMBER IN GOOD STANDING OF (-3 OR ANOTHER COUNTY MEDICAL SOCIETY YOU ARE ELIGIBLE TO JOIN

*ACK $AVIS WAS RECENTLY APPOINTED AS A VOLUNTEER BOARD MEMBER OF THE -EMORIAL "LOOD #ENTERS (E CONTINUES AS A BOARD MEMBER OF THE -INNESOTA 6ISITING .URSES !GENCY AND SERVES AS BOARD CHAIR OF 4HE (OSPICE OF THE 4WIN #ITIES

.OVEMBER $ECEMBER

4HE 3ENIOR 0HYSICIANS !SSOCIATION OF THE (ENNEPIN -EDICAL 3OCIETY IS NOW IN ITS ND YEAR AND IS PROUD OF ITS EFFORTS IN SHARING GOOD TIMES GOOD SPEAKERS AND OCCASIONALLY

OPPORTUNITIES FOR COMMUNITY SERVICE WITH ITS MEMBERS

!NNUAL $UES n OR ,IFETIME $UES n 7E MEET AT THE :UHRAH 3HRINE #ENTER IN 3OUTH -INNEAPOLIS FOR LUNCH FOUR TIMES A YEAR COST AT THIS TIME IS AND AR RANGE FOR A SPEAKER SPOUSE GUEST IS WELCOME 7E ALSO HAVE A SUMMER GET TOGETHER THAT HAS INCLUDED -ILL #ITY -USEUM -INNESOTA ,ANDSCAPE !RBORETUM 3HOWBOAT AND /LD ,OG AND #HANHASSEN $INNER 4HEATERS )F YOU WOULD LIKE MORE INFORMATION OR FOR AN APPLICATION CONTACT +ATHY $ITTMER EXECU TIVE ASSISTANT AT OR KDITTMER MNMED ORG 4HANK YOU AND WE HOPE TO SEE YOU SOON 2ICHARD + 3IMMONS - $ 0RESIDENT

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

(-3 .%7 3

3ARAH ! :ELLER - $

2ESIDENT 0HYSICIANS 5NIVERSITY OF -.

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

"ARBARA *ANE %HLER - $ 0EDIATRICS &AIRVIEW 2IDGES (OSPITAL $ANIEL 3TEVEN #OHAN $ / &AMILY -EDICINE .ORTH #LINIC 0 !

8IAOMING $ONG - $ .EUROLOGY -INNEAPOLIS #LINIC OF .EUROLOGY ,TD

2ESIDENT 0HYSICIANS (#-# 0AUL # !LLEGRA - $ 2ODERICK 4 !LSTON - $ *ENNIFER - "AHR - $ #HRISTIAN , "ALL - $ !NTHONY 0 "ASTIANELLI $ / .ATHAN - #ARTER - $ -ITCHELL ( #RIDER - $ $AVID 6 &OLDEN - $ #HANDLER ( (ILL - $ +ALPANA +AAPURAALA - $ +ATHERINE +OEPKE - $ $AVID * -ACH $ / 3UBHASHINI -AHIPATHI - $ $EAN 4 -UNNELL - $ *ONATHAN # 0OHLAND - $ 2UTH 3 0OTTA - $ &AYYAZ 1ADIR - $ 3ARAH , 2ICHARD - $ #HRISTOPHER $ 2OARK - $ #LAIRE ! 3AAD - $ $ENIS $ 3AIN - $ !NDREW , 3CHAKEL $ / $ANIEL 3 3CHNEIDER - $ 3AMIR ( 3HAH - " " 3 !LPANA 3INGH - $ ,AURA - 3KROCKI $ / -AURICE , 3OLIS - $ 7AI -ENG 3OO - $ !NITA 4HAMPY -""3 *OSE ! 6EGA 0ERALTA - $ 3HIH #HIN 4 7ANG - $ -3 #HRISTINE ( 7EINBERGER - $ "JORN # 7ESTGARD - $ *ERILOU ! 7IEDMEYER - $ $AVID % 9OMTOOB - $

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

2OSALYNN 4ORRALBA - $ 2ICHARD ,YNN 4OWER )) - $ (EATHER ! 4OWNSEND - $ -ATTHEW $ 4REFZ - $ $UNG ( 4RUONG - $ %LLIOT - 4UCKER - $ 3TEPHANIE , 4UCKER - $ *OLEEN ( 4URJA - $ 3COTT ' 4URNER - $ *ENNIFER , 4WENTE - $ +YLE - 5ITTENBOGAARD - $ *OEL % 5LLOTH - $ -ARK 7 6ELDMAN - $ 3ARA " 6ELDMAN - $ 3ARADA 6EMAREDDY - $ -ARK - 6INT - $ (EATHER # 6OTAVA - $ 4OAN 1UOC 6U - $ $EBORAH , 7ALTERS - $ 4HERESA , 7AMPLER - $ 3TEVEN 1 7ANG - $ !MY * 7ATER - $ #HARLES 2 7ATTS - $ -ARC , 7EBER - $ .ANCY 7 7EBSTER - $ -YLIN # 7EST - $ 'RAYSON 4 7ESTFALL - $ #HARLES % 7HISLER - $ $AREN * 7ICKUM - $ -ARY % 7ILDE - $ !NDREA 7ILLEY - $ *ONATHAN $ 7ITZKE - $ %DWARD (UBERT 7OLSKE - $ *ASON 4 7ONG - $ *OHNNY 7RIGHT ))) - $ &RED -ING #HIEH 7U - $ #OLLEEN ! 7UNDERLICH - $ "ILLY $ 7YATT - $ )NGRID 0 9ELKIN - $ "RET $ 9ONKE - $ %MILY * )RWIN 9ONKE - $ 2OBERT ! 9OST - $ -ARYAM :AMANIAN - $ 0AUL . :ENKER - $ - 0 ( !NNA -ARIE :IMMERMANN - $

(ENNEPIN -EDICAL 3OCIETY

!CTIVE

%RIC 2 .ELSON - $ -EE ,EE .ELSON - $ ,AN 4 .GUYEN - $ ,INH 4 .GUYEN - $ 2ANDY , .IBLETT - $ *ENNESSA - .IELSEN - $ -ICAH 0 .IERMANN - $ *OHN ! .OLL - $ #LIFFORD # .OVAK - $ *EFFREY % .OWAK - $ *AMES 7 /GILVIE *R - $ #HAD # /LINGER - $ 2EBEKAH 2 /RMSBY - $ %RIN ! /STERHOLM - $ &REDERICK 7 /TT - $ #HRISTOPHER 3 0ALMER - $ #ARRIE $ 0ARENTE - $ ,AURA * 0ATTISON - $ "OJAN 0AVLOVIC - $ 0HILIP 9 0EARSON - $ #HRISTOPHER 0REVIN 0ECK - $ *AMIE - 0ELZEL - $ ,INDSEY ! 0EPPER - $ $AVID ' 0ERDUE - $ 3EAN ) 0ERKINS - $ +AVITA 2AM 0ESHORI - $ - " " 3 !NTOINETTE - 0ETERS - $ *ULIETTE % 0ETERSEN - $ "ENJAMIN 7 0HILLIPS - $ 4YLER * 0HILLIPS - $ %MILY * 0IKE - $ #HARLES , 0INKERMAN $ / !NDREA -ARIE 0OLLEMA - $ 2AHSHANA $ 0RICE - $ ,ORA * 0RINC - $ 3OUMATHY # 0ROSPER - $ -ARY )DA 0UKITE - $ 'OPAL 6 0UNJABI - $ -ELISSA ! 1UAST - $ !HMAD 3 1URESHI - $ %RIN % 2ACI - $ %RUM 2AHEEL - $ !NUP 2AMANI - $ !SNAT 2AZIEL - $ ,UCAS 2EADINGER - $ ,AURA - 2EICH $ / 0ETER " 2EICHERT - $ +REEGAN * 2EIERSON - $ 2ACHEL -ARIE 2EUTER - $ !NTHONY 4 2EZCALLAH - $ -ICHELLE . 2HEAULT - $ *OSEPH 3 2ICHMOND - $ +ENDALL $E7AYNE 2ICKLEFS - $ $AVID * 2IES - $ 3VETLANA 2IVILIS - $ 4ANYA 2 2IZZO - $ -ATTHEW * 2OLLER - $ 3TEPHEN * 2UDOLPH - $ "RIAN % 2UPERT - $ )GOR 2YNDIN - $

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-EDICAL 3TUDENTS 5NIVERSITY OF -INNESOTA 3TEPHANIE !AMODT #HINEMEREM & !BANONU 4ITILAYO / !DEGBOYEGA *OHN 3 !LBIN 0RASANNA ' !LLURI *OHN 0ETER !MDAHL !NN - !RENS -ICHAEL (OWARD !RREDONDO #HRISTINE -ARIE !THMANN *ACLYN - "AILEY !DAM *ESS "AKKER 0HILIP 6 "ARBOSA !ARON - "ARNES #ONTINUED ON PAGE

.OVEMBER $ECEMBER

Mediterranean Urban Villa

Exceptional Renovation

Spectacular Lake Views!

Charming Dean Parkway

Lowry Hill Masterpiece

Perched overlooking Lake of the Isles sits this stately home completely renovated with spectacular views of the water and downtown Minneapolis. Features include dramatic fit and finish throughout, a rare 3car garage with handsome 2-bedroom carriage house, barrel entries, wrought iron accents, gourmet eat-in kitchen, main floor study or family room and more! 5 bedrooms, 7 baths.

A magnificent renovation with sophisticated spaces and rich, quality craftsmanship throughout. Features include a gorgeous master suite with elaborate bath and large study, gourmet kitchen with stainless appliances, adjoining main floor family room encased windows that overlook the patio & much more. 5 bedrooms, 5 baths.

Completely renovated home with wonderful views of Cedar Lake and downtown Minneapolis. Features granite kitchen with breakfast bar and maple cabinets, main floor family room, beautiful stone fireplace, paver patio, and hardwood floors.

3 bedrooms, 2 baths.

Fantastic Mediterranian just steps from three city lakes, entertainment and shopping.

Features spacious main floor family room, large backyard, flowing public rooms, and delightful sunroom. 3 bedrooms, 3 baths.

A historic antebellum architecture set in Lowry Hill. This romantic and graceful home affords rich turn-of-the-century architectural details, grand entertainment sized public rooms, flowing spaces, gorgeous chandeliers and an updated eat-in kitchen with stainless appliances and more. 5 bedrooms, 4 baths.

Call

Location, Location!

Fantastic family home in Parkwood Knolls of Edina. Features spacious public rooms, crisp eat-in kitchen, main floor family room with beamed ceilings, updated baths, lower level amusement room 5 bedrooms, 5 baths.

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

(-3 .EW -EMBERS #ONTINUED FROM PAGE

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WHERE HE WAS LATER MADE A SENIOR STAFF PHYSICIAN (E PARTICIPATED IN RESEARCH ON NEW MEDICINES TO COMBAT TUBERCULOSIS )N HE BEGAN FORMAL TRAINING IN RADIOLOGY AT THE -INNEAPOLIS 6! AND 5 OF - HOSPITALS AND AFTERWARD SERVED ON THE 6! RADIOLOGY STAFF )N HE WAS APPOINTED AS THE HEAD OF THE (#-# RADIOLOGY DEPARTMENT WHERE HE SERVED UNTIL RETIRING IN

PRACTICING PART TIME FOR SEVERAL YEARS AFTERWARD $R 4SAI WAS AN ASSOCIATE PROFESSOR OF RADIOLOGY AT THE 5 OF - (E JOINED (-3 IN -ETRO$OCTORS 4HE *OURNAL OF THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES

Amy Schorn, r.n.

Bronagh P. Murphy, m.d.

John E. Savage, m.d.

Cancer is one fierce, single-minded unitâ&#x20AC;&#x201D;so are we.

We are MOHPA. Just as our patients do not fight cancer alone, neither do we. Our single-mindedness is all about determining and delivering the most intelligent, appropriate and effective care possible. Our seven local clinics, 34 top physicians and hundreds of dedicated professionals are supported by the latest advances gathered from throughout our national network. We work as one powerful unit for each individual patient. We are taking the fight well beyond.

www.mohpa.com

CLINICS Burnsville 952.892.7190 Edina 952.928.2900 Maplewood 651.779.7978

Minneapolis Saint Paul Waconia Woodbury

612.863.8585 651.602.5200 952.442.6006 651.735.7414 An Affiliate of US Oncology