The most powerful treatment begins with being treated well.
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Doctors MetroDoctors THE JOURNAL OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES
Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.
CONTENTS VOLUME 9, NO. 1
2
The 2007 Legislative Session
3
Medicare Update
5
Pertussis Active Surveillance Project
6
The High Cost of Not Vaccinating
7
MMA Day at the Capital
9
COLLEAGUE INTERVIEW — David Aughey, M.D.
11
Some Assistance with Helping Smoking Patients to Quit
13
Insurance Agent Transparency: The Time Has Come
14
Index to Advertisers
15
Shopping for Health Care?
16
Classified Ads
17
Magnetic Source Imaging Laboratory
19
PHYSICIAN’S SOAP BOX — What is a Health Care Provider?
21
HMS/RMS Participate in 10th Annual White Coat Ceremony
22
Winter Medical Conference 2007
23
Minneapolis Society of Internal Medicine Looks Forward
24
Infectious Diseases: Stop the Spread, Contain the Threat Conference
For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (952) 903-0505 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com.
25 26 27
President’s Message
MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy.
28
New Members/In Memoriam
Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Doreen Hines at (612) 362-3705.
MetroDoctors
JANUARY/FEBRUARY 2007
RAMSEY MEDICAL SOCIETY
2007 Election Results/RMS Winter Gala and Annual Meeting Smoke-Free Washington County/New MPS Inc. Board Member/ Dr. Wright Addresses Physicians/Senior Physicians/ RMS Board Meeting/Caring Hearts for Homeless People Drive
HENNEPIN MEDICAL SOCIETY
29 30
Chair’s Report
31 32
New Members
Charles Bolles Bolles-Rogers Award/Smoke-Free Scott County Update/Hoban Scholars/In Memoriam HMS Alliance/Senior Physicians Association
The Journal of the Hennepin and Ramsey Medical Societies
On the cover: HMS/RMS participated in the University of Minnesota Medical School’s 10th Annual “White Coat Ceremony.” Article begins on page 21.
January/February 2007
1
The 2007 Legislative Session A Look at Heath Care Policy
G
GOVERNOR TIM PAWLENTY recently out-
lined his administration’s goals with regard to health care policy, calling for universal health coverage in Minnesota, a statewide smoking ban, a ban on prescription drug advertising, financial incentives to providers who use electronic medical records and a number of other changes to the health care industry. According to the St.Paul Pioneer Press, Pawlenty stated that Minnesota’s long-term goal should be universal coverage. While he could see where a state mandate might be helpful, the governor noted that there are a number of steps that must be taken in reaching this objective. As a starting point, he urged lawmakers to advance legislation providing health coverage to the 70,000 children statewide who currently lack benefits. Rep. Paul Thissen (DFL-63A) and Sen. Yvonne Prettner Solon (DFL-7), who has been mentioned as a possible chair of the Senate Health and Family Security Committee in 2007, have each championed this proposal in their respective chambers during previous legislative sessions. The governor also called for more accountability from health plans, saying that the state must determine whether Health Maintenance Organizations (HMOs) have been successful at controlling costs and improving the quality of health care. He also voiced support for authorizing a uniform system of billing codes among insurers to reduce administrative costs and delays. Restating a goal from his first term in office, Gov. Pawlenty called for more progress in paying doctors and hospitals based on performance and quality versus the volume of procedures. Specifically, his agenda stated that doctors should be rewarded for low cost and high quality. B Y J A C K D AV I S , R O G E R J O H N S O N , A N D K AT H I M I C H E L E T T I
2
January/February 2007
Throughout the campaign trail, many DFL candidates listed expanded access to quality health care as a primary goal in Minnesota. At the beginning of the 2006 legislative session, the Senate DFL Caucus called for the state to use a current surplus in the Health Care Access Fund to restore cuts made to state run health programs in 2003 and 2005. Given the bipartisan support for a common goal, there is a good chance that the 2007 legislative session may be defined by significant reforms to the health care industry. Following the election, your medical societies’ leadership and staff began the process of outlining the legislative focuses for the 2007 session. • During the 2006 Minnesota Medical Association Annual Meeting, a resolution was passed by the MMA House of Delegates that would support legislation that would require that all funds collected as a result of the Provider Tax should be dedicated to medical purposes as originally envisioned and should not be used for other general fund purposes. Although most feel that the Provider Tax should be repealed, HMS and RMS will support the dedication of these funds for their originally intended purposes. • HMS and RMS will actively support the “Freedom to Breathe Act” in the 2007 session. This act would prohibit secondhand smoke in workplaces across the state including bars and restaurants. • The Minnesota Medical Group Management Association is again committed to lead efforts on the interpreter bill for 2007. This bill will require health plans to reimburse for interpreter services used during the rendering of medical services. RMS and HMS will actively support this legislation. • During the 2006 session, a bill was introduced that would establish a database of all controlled substance prescriptions with
information including the name of the physician who prescribed the controlled substance, the patient’s name, the drug quantity and the dispenser of the drug. This “All Schedules Prescription Electronic Reporting Program” was offered in line with the National All Prescription Electronic Reporting (NASPER) federal legislation. There would be no medical context contained in the database to address history, diagnosis, treatment plans, or any other clinical information. The information would be shared interstate and would be accessible to a broad range of entities including law enforcement. HMS and RMS leadership believe that this legislation has the potential to be very intrusive to the doctor-patient relationship and could have unintended consequences including the possibility of scrutiny of perceived inappropriate prescribing of controlled substances that, in fact, are justified. HMS and RMS will actively oppose this legislation as it currently stands. • HMS and RMS will also be monitoring potential legislation that: (1) would prohibit physician practices from billing for the pathologist professional services for anatomic and cytologic services, as such billing procedures have been deemed both appropriate and ethical; and (2) restrict the construction of independent physician facilities. Many legislators who were familiar and actively engaged in health care issues either didn’t run in 2006 or were defeated. This will require a great deal of effort to educate a new cast of legislators on the issues that are important to physicians and their patients. HMS and RMS leadership encourages all physicians to plan to attend the Minnesota Medical Association’s “Day at the Capitol” which is scheduled for March 1, 2007.
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
Medicare Update Editor’s Note: Since the writing of this article, Congress acted on Medicare. See box below for an update.
A
AS OF NOVEMBER 15, 2007, the AMA and the MMA issued an urgent Call to Action to all physicians to contact their U.S. Senators and U. S. Representatives to take action during the lame duck session of Congress to address the 10 to 15 percent Medicare physician payment cuts scheduled to become effective January 1, 2007. The cuts are due to the sustainable growth rate (SGR), the expiring geographic adjustments, the imaging cuts due to the Deficit Reduction Act of 2005, the fee schedule adjustments based on the five-year review, and changes in the practice expense methodology. The wide array of other payment changes scheduled for January of 2007 result in a reduction of total Medicare funding for physician services. For particular specialists and for certain geographic areas, these cuts further compound the SGR cuts. Other changes redistribute funding among physician services that result in a mitigating factor for SGR cuts for some specialists while increasing the cuts for others. When the 2007 physician payment revisions are examined in total, 44 percent of all physicians are looking at total cuts of 6 to 20 percent. The SGR reduction will be the Medicare Economic Index (MEI) less 7 percentage points resulting in a 5 percent cut in the conversion factor. That cut affects all physicians. The three-year floor on geographic practice cost index (GPCI) for work will end. That provision increased payment rates by an average of 1 percent and, in some localities, by 2 or 3 percent. The Deficit Reduction Act of 2005 included language stating that payment rates for technical component imaging services cannot exceed the hospital payment rate for the
BY ROGER JOHNSON, RMS CEO
MetroDoctors
Congress Acts on Medicare December 8-9, 2006 The lame duck Congress included a Medicare provision in the tax and trade bill (HR 6111) that substitutes a freeze in Medicare reimbursement at the 2006 level in place of the cuts scheduled to take effect in 2007. Funds are also set aside to avert the 2008 cuts. In addition, a physician quality reporting program is to be initiated. A 1.5 percent bonus will be paid next year to reporting physicians. As more information becomes available regarding the Medicare provisions enacted by Congress, we will provide them in a future issue of MetroDoctors.
same service. The cuts of 5 percent for radiologists and 4 percent for vascular surgeons were deeper. The RVS Update Committee (RUC) recommended and the Centers for Medicare and Medicaid Services (CMS) have proposed substantial increases in the E/M relative values. Pre- and post-operative components of global surgical packages would also receive increases in relative values. Because CMS is required to maintain budget neutrality, a 5.5 percent reduction will be applied to offset the proposed E/M and surgical increases. For certain specialties the relative value increases will exceed the budget neutrality reduction, but for other specialties the budget neutrality adjustment will only serve to increase the negative effects of the SGR and other cuts. CMS estimates that the combined work and practice expense revisions will be large enough to offset the SGR cut for five specialties, which will in fact break even. Seventeen specialties will be
The Journal of the Hennepin and Ramsey Medical Societies
adversely affected by the combined work and practice expense revisions and the SGR cuts. All tolled, the combined changes result in significant payment changes for all specialties. Four specialties will benefit positively from the payment changes. They are infectious disease (+4 percent); emergency medicine (+2 percent); pulmonary disease (+1 percent); and, endocrinology (+1 percent). No net change is predicted for family physicians. Most specialties will receive cuts, with five specialties receiving double-digit cuts of 10 to 14 percent. Radiologists will experience the deepest cuts at 14 percent. Some localities such as North and South Dakota will be receiving 17 percent cuts due to the combination of specialty cuts and the elimination of the GPCI floor. The combined effects of the 5 percent SGR cut and the other physician payment changes on Minnesota health care in 2007 include: (Continued on page 4)
January/February 2007
3
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MEDICAL DIRECTOR/HOSPITALIST This high profile leadership position provides overall medical direction and management of hospital inpatients and serves as a resource to Bethesda’s administrative team and medical staff. Requirements include MD/DO/IM with MBA (or similar advanced degree) desirable. Qualified physicians will have DEA/ MN license and long term acute care hospital experience in both administrative management and patient care. We offer an excellent salary/benefits package, plus an enviable lifestyle in beautiful St. Paul. Please call Kathy Nikunen, Physician Recruitment Coordinator, at 651-326-2009; Email: kenikunen@healtheast.org. EOE
The source for the data in this article is the AMA.
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4
January/February 2007
35 percent of Minnesota physicians face total Medicare pay cuts of 6 to 15 percent in 2007. • Minnesota will lose $40 million in health care funds due to the negative update in 2007. • Minnesota will lose a total of $2.34 billion by 2015 after 9 years of SGR cuts. • 69,767 employees, 653,771 Medicare patients, and 55,679 TRICARE patients in Minnesota will be affected by these cuts. • 37 percent of practicing physicians in Minnesota are over 50 years of age, a time that surveys indicate many physicians consider reducing their patient care activities. • The temporary GPCI increase included in the 2003 Medicare law will expire in 2007 resulting in an additional 0.46 percent cut for physicians in the Minnesota locality. If the Congress fails to take action during the lame-duck session scheduled to end around Thanksgiving, physicians will need to continue to contact the Minnesota Congressional delegation to advocate for positive changes in the SGR and in other aspects of the Medicare reimbursement system to prevent the erosion of access by Minnesota seniors. You will receive information including talking points and how to contact your member of Congress during the month of January if action needs to be taken. Physicians who are contemplating changing their Medicare status from participating (PAR) to non-participating (NONPAR) should carefully review their contractual arrangements with hospitals, health plans, or other entities as the agreements may relate to being a PAR or NONPAR physician. Minnesota law also must be carefully reviewed and understood as NONPAR Minnesota physicians are prohibited from balance billing their patients. Other restrictions relating to public programs such as Medicaid and MinnesotaCare affect NONPAR physicians as well. All physicians are urged to conduct a thorough review with their practice consultant, accountant, and attorney before taking any action regarding their Medicare status.
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
Pertussis Active Surveillance Project Encourages Health Care Providers to THINK about Pertussis, TEST, TREAT, and Stop TRANSMISSION
T
THE MINNESOTA Department of Health
(MDH), in collaboration with St. Paul-Ramsey County Department of Public Health and Dakota County Public Health Department, is implementing active surveillance for pertussis in these counties. This high profile project is funded by the Centers for Disease Control and Prevention (CDC). The purpose of the project is to better describe the true burden of pertussis disease, as pertussis tends to be under-reported and under-diagnosed. Nevertheless, in 2005, Minnesota reported 1,571 pertussis cases, the highest number since 1947 when 2,712 cases were reported. Although the number of reported pertussis cases has been lower in Minnesota during 2006 than in previous years, this was expected given that pertussis incidence cycles every three to five years. In order to understand the true burden of the disease, it is important to continue to look for pertussis even during low-incidence years. Following a successful one-year pilot phase involving 24 volunteer clinics in Ramsey and Dakota Counties, efforts are underway to expand the project to additional clinics, hospitals and schools in these counties. Information about the project was mailed to all clinics in July 2006. Hospitals and schools will also be recruited, although through different means. Project planners have developed educational materials for both health care providers and patients around the project motto: “THINK about pertussis, TEST, TREAT, and stop TRANSMISSION.” Representatives from the Ramsey and Dakota County health departments are in the process of directly following up with all clinics, hospitals and schools in their respective counties to encourage participation in the project. B Y C Y N T H I A K E N Y O N , M . P. H .
MetroDoctors
All participants will be offered a presentation on pertussis epidemiology, prevention, and control. Project representatives will also help integrate the program at each participating site with flexibility to meet specific clinic needs. The MDH Public Health Laboratory (PHL) provides free pertussis testing to participating clinics. State-of-the-art ultra-flexible nasopharyngeal swabs will be provided at no charge to all participating clinics, regardless of whether the MDH PHL is utilized. Expectations of participating clinics are to test and report to MDH all patients meeting a stringent suspect case definition to ensure that all pertussis cases are detected. Testing is to be performed on patients meeting the following criteria: • A persistent cough of unknown etiology lasting > 14 days, or • A paroxysmal cough lasting > 7 days with whooping, post-tussive vomiting or gagging, or apnea, or • A cough of unknown etiology in a patient who has been notified of a pertussis exposure. (Note: Pertussis is often misdiagnosed as bronchitis or upper respiratory viral infection. Anecdotally, pertussis case-patients, especially adolescents and adults, are often evaluated by a health care provider multiple times for persistent cough illness prior to receiving a diagnosis of pertussis.) With the pertussis vaccines for adolescents and adults being newly licensed, the active surveillance project provides a unique opportunity to measure the true impact of these vaccines. Furthermore, this project will help to determine the most appropriate clinical and public health strategies for case identification and prevention. Finally, the active surveillance project provides a community-based case population
The Journal of the Hennepin and Ramsey Medical Societies
With the pertussis vaccines for adolescents and adults being newly licensed, the active surveillance project provides a unique opportunity to measure the true impact of these vaccines. for epidemiologic research purposes that will also have a clinical impact. A high level of participation is essential to the success of this project. CDC selected Minnesota for this project because our state is considered a national leader in pertussis surveillance. Our success is largely due to our health care providers’ support of public health. The MDH and Ramsey and Dakota County health departments encourage health care providers in these two counties to consider participating in this important public health initiative. If your clinic is located in Ramsey or Dakota county and might be interested in participating in pertussis active surveillance, please contact one of the following agencies listed below and ask to speak with a pertussis active surveillance project representative: Minnesota Department of Health at (651) 201-5414, St. Paul-Ramsey County Department of Public Health at (651) 266-2505, or Dakota County Public Health Department at (952) 891-7500. Cynthia Kenyon, M.P.H., Epidemiologist, Vaccine-Preventable Diseases Immunization, Tuberculosis, and International Health Section, Minnesota Department of Health. January/February 2007
5
The High Cost of Not Vaccinating
I
IMMUNIZING PEOPLE against vaccine-pre-
ventable diseases has been one of the greatest overall advances in medicine in terms of reducing morbidity and mortality in the last several decades. In fact, immunizations have been described as “the single most effective health intervention after clean water and sewage disposal, and have an extraordinary safety record.” With the recent addition of the human papillomavirus (HPV) vaccine, there are now 15 diseases which we routinely immunize against in Minnesota: diphtheria, pertussis, tetanus, haemophilus influenza type B, pneumococcus, polio, hepatitis A & B, measles, mumps, rubella, varicella, influenza, meningococcus and HPV. Over the years, these vaccines have helped to prevent literally millions of episodes of these diseases in Minnesota alone, prevented the associated morbidity and mortality, and have had a huge impact on the quality of life for everyone. Further advances in the field of vaccine development make this a very dynamic area of current and future health care improvements. The HPV vaccine will significantly reduce the future incidence of cervical cancer, with some sources predicting a 70 to 80 percent reduction. Adolescent and adult pertussis vaccination will reverse the upward trend of this potentially devastating disease. Rotavirus vaccine, in its new and improved form, will have a large impact on the hospitalization rates of infants and young children for gastroenteritis and dehydration. Finally, zoster vaccination will impact this debilitating disease for seniors.
BY PETER DEHNEL, M.D.
6
January/February 2007
Vaccine Refusal Appreciating the overwhelming health benefits of immunizations with very minimal risk to the individual, a logical question is why do some people refuse vaccinations for themselves or their children? Three general categories of reasons tend to fall out: lack of appropriate information, misinformation, and failure to appreciate the risks of not vaccinating. The Internet is a veritable storehouse of bad information and intentional misinformation about vaccinations and their reported side effects. One just has to watch television for a short while to hear inaccurate stories about bad outcomes supposedly related to immunizations. Finally, people do not believe that they, or their children, will really contract the diseases for which vaccines currently exist. The Impact of Refusal While the individual right to refuse medical treatment, including immunizations, is strongly imbedded in the fabric of our society, the financial and public health costs of that decision must also be recognized. MetroDoctors
Public Health Costs From a public health standpoint, the greatest risk of any one individual refusing to vaccinate is that they can serve as an entry point of a previously controlled disease. The most recent example of this scenario is mumps on college campuses. This fall has seen a continued re-emergence of this disease on campuses around the country that had its initiation point in Iowa last spring. As of October 7, a total of 5,783 laboratory-confirmed cases of this vaccine-preventable disease have been reported to the Centers for Disease Control for 2006. This compares to a yearly average of 250 cases for each of the preceding five years. It is very likely that the final number of cases, including the unreported cases, will be considerably higher before this outbreak is controlled. Economic Costs In light of the risk that a single unimmunized individual poses to others in a given community, it is essential from a public health standpoint to track all the potential contacts of an exposed unvaccinated individual when that person develops the actual disease. Enhanced immunization of the community in which that person resides is usually a part of the effort to limit any potential disease expansion. Those efforts have a real and definable cost. A 2004 case of an unvaccinated college student traveling to India and subsequently developing measles incurred an estimated $142,000.00 for this contact tracing and enhanced immunization of this person’s community, which also had a fairly high rate of unimmunized individuals. The contact case in this situation fortunately had an uncomplicated measles course, and incurred only about $100 in medical costs.
The Journal of the Hennepin and Ramsey Medical Societies
Personal Costs The biggest risk of failure to vaccinate is the actual development of the vaccine-preventable disease. Since morbidity is generally higher for children with vaccine-preventable diseases, any long-term health impact of acquiring these diseases actually falls not on the person making the decision — the parent — but on the child. Most parents would have been vaccinated when they were children. The actual risk of acquiring these diseases is substantial for unvaccinated individuals. The risk of acquiring measles is 22 times higher for an unvaccinated compared with a vaccinated child. The risk of acquiring pertussis is six times higher for an unvaccinated child. The risk of exposure is real in Minnesota. International travel is common, and Minnesota has a large number of immigrants and international adoptees from areas where these diseases are still endemic. In light of a recent health department alert warning about the possible importation of wild-type polio from a refugee camp in Africa, the need for all recommended immunizations still exists.
MetroDoctors
Conclusions Immunizations are a vital part of high quality health care and optimally protect the public as a whole. Clinicians need to do everything possible to ensure that their patients are fully immunized. It is far too costly to do anything less. Peter Dehnel, M.D., is with Children’s Physician Network. References: Ball LK, Evans G, Bostrom A. Risky Business: Challenges in Vaccine Risk Communication. Pediatrics. 1998;101: 453-458. Feikin DR, Lezotte DC, Hamman RF, et al. Individual and Community Risks of Measles and Pertussis Associated with Personal Exemptions to Immunization. JAMA.2000;284(24):3145-3150. Edwards KM. State Mandates and Childhood Immunization. JAMA.2000;284(24):3171-3173. Diekema DS and Committee on Bioethics. Responding to Parental Refusal of Immunization of Children. Pediatrics. 2005;115(5):1428-1431. Centers for Disease Control. Preventable Measles Among U.S. Residents, 2001-2004. MMWR. 2005;54(33):817-820. Centers for Disease Control – National Immunization Program. Record of the Meeting of the ACIP. October 26&27, 2005. Accessed through www.cdc.gov/nip. Dayan GH, Ortega-Sanchez IR, LeBaron CW, et al. The Cost of Containing One Case of Measles: The Economic Impact on the Public Health Infrastructure – Iowa, 2004. Pediatrics. 2005;116(1):e1-e4. Merck & Co., Inc.. GARDASIL Package Insert. June 2006. Centers for Disease Control. Update: Mumps Activity – United States, January 1-October 7, 2006. MMWR.2006;55(42):1152-1153.
The Journal of the Hennepin and Ramsey Medical Societies
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7
8bk[ BWa[i$JWbb Jh[[i$ =h[Wj :eYjehi$ Central Lakes Medical Clinic, P.A. in Crosby, Minnesota is looking for a BC/BE Family Medicine physician with OB opportunity to join their Multi-Specialty Group. The Medical Campus in Crosby is located 14 miles northeast of Brainerd/Baxter within the coveted Brainerd Lakes area. The campus is home to Central Lakes Medical Clinic, Minneapolis Heart Institute-–Crosby, the Minnesota Institute for Minimally Invasive Surgery (MIMIS) and more. CRMC is nearing completion on a 70,000 square foot addition and renovation including a new ICU Unit, expanded birthing area, all new inpatient unit with private rooms, expanded on-site retail pharmacy and more.
Be a part of an independent practice while working collaboratively with the hospital and rest of the medical campus. Current medical staff includes 13 primary care physicians, 3 internal medicine physicians, 12 surgeons and 3 surgical physician assistants. On the Medical Campus in Crosby, it is possible to have the best of both worlds- an innovative and thriving medical career and the opportunity to live and raise your family in an area where there is a true sense of community.
FOR MORE INFORMATION PLEASE CONTACT:
Rebecca Thiesfeld, 320 East Main Street, Crosby, MN 56441 Phone: 877-546-2308 E-Mail: rthiesfeld@sisunet.org Website: www.cuyunamed.org
8
January/February 2007
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
COLLEAGUE INTERVIEW
David Aughey, M.D.
David Aughey, M.D. is the medical director, adolescent medicine, at Teen Age Medical Service, Children’s Hospitals and Clinics, Minneapolis. Dr. Aughey received his medical degree from the University of Wisconsin Medical School. He completed a pediatric internship at the University of Iowa, and then returned to the University of Wisconsin for a pediatric residency. He served an adolescent medicine and health fellowship at the University of Minnesota. Dr. Aughey also serves as the medical director for the Southwest School-based Clinic. He is board certified in Pediatrics, is a member of the Society for Adolescent Medicine, and a Fellow of the American Academy of Pediatrics. Questions were provided by Drs. Peter Bornstein, Amy Gilbert, Anne Murray, and Janette Strathy.
Q A
What is TAMS and where do its patients come from? Teen Age Medical Service (TAMS) is the adolescent outpatient clinic for Children’s Hospitals and Clinics of Minnesota located at 2425 Chicago Avenue in Minneapolis. TAMS is also part of a network of community clinics that provide “safety net” services for which TAMS targets adolescents and young adults. Our programming includes generous health education involving peer educators (students teaching their peers), street outreach (recruiting young men from non-clinic sites for STD testing, for example), and traditional outreach. Historically, TAMS began in 1978 as a family planning clinic staffed by volunteers and slowly evolved into today’s comprehensive primary care clinic which includes mental health, nutrition, nursing, and adolescent medicine staff. Most of TAMS’ patients live in the immediate areas surrounding the Minneapolis campus. The zip codes for these patients include some of the most worrisome public health outcomes in Minnesota — infant mortality, poverty, homicide and other acts of violence, Chlamydia, and so on. However, we also continue to see youth from throughout the entire metropolitan area. TAMS also staffs a schoolbased clinic that targets noninsured students who are in need of primary care services.
How is TAMS financed? Over half of TAMS’ budget is subsidized by Children’s. About 30 percent comes from a variety of grants, which include state and county funds, and approximately 15 percent is generated from third party payers. TAMS uses a sliding fee scale for uninsured patients; but most patients have family incomes below the poverty line. Like many community clinics, our external revenue sources continue to erode and disappear. MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
A new state program, the Minnesota Family Planning Program (MFPP) is replacing some of TAMS’ previous grants for reproductive care. MFPP will provide family planning services without charge for nonpregnant Minnesota residents aged 15-50 who meet eligibility income limits (200 percent of poverty: $1634/month for family of one; $3335 for family of four). On the positive side, MFPP will provide services for patients who would previously only qualify for MA if they got pregnant. The downside is that the application process is onerous and reimbursement will be about 40 cents on the dollar. We will need to hire additional staff to help patients complete the application forms. Also, patients must prove their citizenship with a birth certificate. For adolescents who have moved frequently, have lived out of Minnesota, might be estranged from their parents or who prefer to receive care confidentially, this will be a challenge. Undoubtedly coverage will be denied to some, including to children of immigrants who are here illegally. It isn’t right that these patients be denied care because of their parents’ legal status.
What do you see as the greatest service you provide for the patients seen at TAMS? I’m not sure if there’s one single service I could put my finger on. Providing medical services to noninsured adolescents or when families cannot afford their out-of-pocket expenses is an important part of our work. My impression is that the number of these families has increased dramatically in the last few years. The safety net for the uninsured is frayed to the breaking point. Being part of this unraveling net, we’re aware of what we can do — and what we can’t — and of the enormous difference between having insurance coverage, or not. This is especially true for adolescents who are often at a point in their lives where they have the most potential and promise but who often have very little support and fewer resources. Another important dimension of TAMS is that of providing confidential birth control, STD screening and treatment, and pregnancy diagnosis services to adolescents who are unwilling or unable to involve (Continued on page 10)
January/February 2007
9
Colleague Interview (Continued from page 9)
their families with these issues. The number of patients requesting confidential services has fallen dramatically over the years. It’s not at all uncommon for patients to tell us that their mothers are aware and supportive of birth control use. It’s not unusual for mothers to initiate this care for their daughters and to accompany them to the appointment. There are times where adolescents can best protect themselves by being abstinent, and this is also a dimension of confidential care. Confidential services are double-edged for us. We know that adolescents do best when they are surrounded and supported by nurturing parents and other adults. Unfortunately, however, a number of our patients cannot identify one single adult in their life whom they trust. Providing services confidentially is something we do to ensure that adolescents have access to important services. However, at the same time we are trying to provide support and encouragement for these patients to have a relationship with important adults in their lives. Preventing pregnancy is often more than a simple prescription. This leads me to a third important dimension of the work we do at TAMS. Taking care of adolescents is primarily a task of assessing psychosocial risk factors and providing interventions for them. The health problems of teenagers are primarily secondary to the behaviors they engage in. The level of risk is not assessed by blood tests or offset by vaccines or prescriptions. The most common preventive visit for adolescents relates to sports exams, which have the primary goal of protecting students from sudden cardiac death. A handful of such deaths tragically occur every year in this country. However, in Minnesota, an adolescent dies on an almost daily basis from accidents, homicides, suicides or gunfire. These have psychosocial antecedents. Shouldn’t the sports exam visit include some level of psychosocial assessment? TAMS is a resource to community providers and agencies for information regarding adolescent health care, policies, procedures, care models and for answering specific clinical questions. For example: “My 16 year old female patient has persistent dysuria and several negative urine cultures...what should I do?” Answer: “screen for Chlamydia and treat for urethritis.”
What do you think about excluding adolescents from OTC Plan B emergency contraception? The FDA’s approval of Plan B for OTC status is a significant step forward for women’s health and will provide another tool for reducing abortions and unintended pregnancies. However, not legitimizing its use for adolescents is very shortsighted and unfortunate. It’s naïve to think that the availability or unavailability of Plan B will affect anyone’s sexual behaviors, especially for those teenagers who think the upcoming weekend is the future. Most adolescent girls have intercourse before they ever consider starting a method of birth control...that’s the reality in American society. The FDA missed an opportunity to decrease teen pregnancy and abortions by denying them easier access to Plan B. Requiring adolescents to obtain a prescription is not good policy. If our goal is to reduce unintended pregnancies, then Plan B should be available to all sexually active females, regardless of age.
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January/February 2007
It would be exciting if Plan B were also marketed to young men as a way for them to share some of the burden of avoiding pregnancy. It is not at all unusual to find young men who always use condoms and are responsible for their use in relationships. Wouldn’t it be nice for young men to also carry Plan B “just in case?” One unfortunate downside to Plan B’s becoming OTC is that this will increase its cost to consumers and clinics. Payers often stop covering OTC products, and it would be a surprise if this doesn’t happen for Plan B. The company that makes Plan B has said that marketing costs will increase their overall costs. Discounts between the company and community clinics will also probably disappear. If this happens, we may not be able to afford providing Plan B for our patients at TAMS.
Given the epidemic of obesity in adults, should prevention begin in adolescence or earlier? If so, how? Not only is obesity a huge problem in adults, but also so is heart disease, hypertension, diabetes, and other health problems that have their roots in lifestyle choices and bad habits. The adolescent years are stigmatized by the misperception that adolescents are generally quite healthy and only get into trouble by engaging in deviant and socially unacceptable behaviors. In truth, the influence of lifestyle on health is very similar for teenagers, their parents, and in older adults. Most adult health problems also have their roots in “bad habits” — smoking, poor diet, excessive use of alcohol, physical inactivity, and casual sexual behavior. Adolescents’ behavior simply reflects the larger world around them influenced by their home life and everyday experiences as they grow up. The answer to “how” is simply to start influencing healthy living and good habits early and often. Good parenting practices need to start in early childhood and carry forward in developmentally appropriate ways. As health care providers, our roles as educators and teachers are as important, maybe even more important, than our roles as healers. This is especially true for adolescents who often seek out guidance for their most intimate concerns, whether it’s acne, emotional pain, or STDs, from people they trust...their health care provider. Health care and parenting have a lot in common. Both provide guidance in an ongoing fashion and over time. Both also use “teachable moments” as golden opportunities to motivate positive changes.
The reality check. From our perspective at TAMS, it’s a sad state of health status for the increasing numbers of families struggling with poverty and lack of access to health services. Increasing numbers of adolescents and young adults are falling through the cracks, and their overall health is comparable to what they might have to live with in third world countries. It’s not only access to medical services but also includes rotten teeth, attending school with horrible and uncorrected poor vision, lack of food at home, obesity, feeling unsafe at home and in their neighborhoods, not being able to find work, physical abuse and emotional neglect. We can’t write prescriptions to fix these problems. Seeing a teen for asthma makes you feel fairly inadequate when these other critical issues aren’t being addressed.
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The Journal of the Hennepin and Ramsey Medical Societies
Some Assistance with Helping Smoking Patients to Quit
A
ALTHOUGH NEARLY ALL physicians un-
derstand the risks associated with tobacco use, most do not feel they can intervene effectively to treat smoking addiction. And, just like their patients, doctors get discouraged when patients are unable to quit, even after repeated attempts. Giving smoking cessation advice during office visits is perceived as a time-consuming, ineffective process. That’s unfortunate because, even using conservative estimates of effectiveness, smoking cessation interventions are much more cost-effective than other preventive strategies, such as treatment for hypertension or hypercholesterolemia. But the root of this difficulty is sometimes the way in which the intervention is attempted. The U.S. Public Health Service Guidelines recommend a five-step model for tobacco cessation treatment, known as the 5 A’s. They are: • Ask patients about tobacco use; • Advise smokers to quit; • Assess smokers’ willingness to try quitting; • Assist smokers with cessation treatment and referrals; and • Arrange follow-up contacts. A 2005 survey of more than 41,000 health maintenance organization patients, including 4,207 smokers, about whether their health care provider had followed the 5A model revealed that health care providers get A’s for the first two A’s (Ask and Advise) but not for the rest. According to Virginia P. Quinn, Ph.D., Kaiser Permanente Southern California, and her colleagues, 90 percent of smokers said their doctor had asked them about smoking in the past year, and 71 percent said their doctor had advised them to quit. But only 56 percent were B Y A N N W E N D L I N G , M . D . , M . P. H .
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assessed for their willingness to quit or given assistance with quitting (49 percent). And just 9 percent of smokers surveyed reported any follow-up on their status. Smokers who received tobacco cessation treatment — whether they intended to quit or not — said they were more satisfied with their health plans than those who received no such treatment. “There’s widespread belief in the medical culture that smokers don’t want to be bothered, and doctors don’t want to alienate their patients, but we found just the opposite,” Quinn said. “Smokers expect doctors to address smoking and are more satisfied with their health plans when doctors do that.” But there’s good news for Minnesota physicians hoping to improve their performance on A’s number four and five. ClearWay MinnesotaSM, a nonprofit organization that funds a comprehensive quit-smoking program, QUITPLAN® Services, with a small portion of the state’s 1998 tobacco settlement, recently introduced a centralized call center to connect Minnesota smokers with resources for help in quitting. When you advise someone to call the QUITPLAN Services call center, you are connecting your patient with information about the free QUITPLAN Services available in Minnesota. Patients who call 1-888-354PLAN (7526) will talk with program specialists about assistance options. Your patients can select programs based on their insurance, location and what they think will work best for them. Options available through QUITPLAN Services include phone or in-person counseling, online support, worksite group counseling and culturally specific programs. The programs are free for all uninsured Minnesotans, as well as those whose insurance doesn’t cover cessation options. If your patients’ insurance does
The Journal of the Hennepin and Ramsey Medical Societies
offer such coverage, the QUITPLAN call line will immediately connect them with their health plan’s service. All QUITPLAN Services are funded by ClearWay Minnesota. The organization offers several free brochures, with details of all QUITPLAN programs, for health professionals to distribute to their patients. Please visit www.clearwaymn.org to order. ClearWay Minnesota regularly evaluates all its stop-smoking programs. Here’s a quick look at the five QUITPLAN Services options, all of which produce quit rates well above the (Continued on page 12)
Family Practice Physician Join a team of caring individuals, providing quality healthcare to a culturally diverse patient population. Southside Community Health Services is seeking a Full-time Family Practice Physician to work in our family practice/community clinic location in Stillwater. We provide a full range of medical services, including OB care, to the underserved community. Practice is clinic based only, with weekends and holidays off. Great benefits and salary with paid malpractice. Applicants may qualify for student loan repayment programs.
Please fax or email resumes to: Kari Rabie, MD, Medical Director Telephone: 612-821-3552 Fax: 612-821-2818 Email: kari.rabie@southsidechs.org.
January/February 2007
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QUITPLAN (Continued from page 11)
3-7 percent quit rate expected for unassisted quits: QUITPLAN® Helpline
A patient who calls the QUITPLAN Helpline will talk with a specialist trained in tobacco cessation. Together, they will create a plan personalized for your patient. If it’s appropriate, the caller may receive free nicotine patches, gum or lozenges. QUITPLAN Helpline services are free to callers who are uninsured or do not have coverage for telephone counseling and/or nicotine patches, gum or lozenges through their health plan. Those who have coverage are transferred directly to their insurer’s counseling line. The QUITPLAN Helpline is available from 7 a.m. to 11 p.m., seven days a week. Call the QUITPLAN Services call center at 1-888-354-PLAN (7526) to be connected. Spanish-language options are available at the same number; for TTY service call 1-877-559-3816. The quit rate for a sample of callers to the Helpline (those who called between July 15, 2004, and August 31, 2004) was 36 percent
at six-month follow-up. Assuming that anyone who did not complete a survey was still smoking, the more conservative “intention to treat” quit rate at six months was 27 percent. These rates were virtually unchanged from the quit rates of a sample of callers to the Helpline in the summer of 2003. quitplan.com
Smokers who don’t want to use face-to-face or telephone counseling may connect with this free Web site, which offers helpful, interactive quit-smoking resources. Features include self-assessment tools and information, experts who respond to user questions within 24 hours, and a community forum of current smokers and former smokers. In addition, users can track progress, calculate savings and preview their next steps. Users also can sign up to receive e-mails that congratulate them on their progress. The quit rate for those who registered on the site between Feb. 2 and April 13, 2004, and for those who completed the follow-up survey at six months, was 20 percent at six-month follow-up. The “intention to treat” quit rate at six months was 15.6 percent.
“Minnesota Healthcare Network and Triium help keep my practice healthy.” Maintain Your Independence With Large Corporation Benefits. Unlike corporate clinics, Minnesota Healthcare Network (MHN) and Triium provide their member clinics with essential business services to get them started and help ensure their continued viability and success. MHN is a physician-owned network that provides independent physicians with a variety of services, including payor contracting, business analysis, disease management programs, and a forum representing the interests of independent practice. Serving over 150 clinics, Triium offers its members help through business resources, consulting, group purchasing, insurance & employee benefits, and employee training & education.
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January/February 2007
Located in various health care settings throughout the state, QUITPLAN Centers provide free face-to-face tobacco counseling and nicotine replacement therapy. The quit rate for QUITPLAN Center respondents who registered between December 2003 and April 2005, and who completed the follow-up survey was 29.4 percent at six-month followup and the “intention to treat” quit rate was 20.4 percent. QUITPLAN® at Work
Your patients may be able to participate in free group counseling sessions right at their place of employment. Workplaces that meet certain requirements and have at least eight employees ready to participate in the program are eligible to host stop-smoking groups right on site. Again, nicotine patches, gum and lozenges are available to those without coverage for it. The quit rate for worksite respondents who registered between January 2004 and April 2005, and who completed the follow-up survey was 24 percent at six-month follow-up. The “intention to treat” quit rate at six months was 19 percent. Those who were still smoking at six months had reduced both the frequency of use and the number of cigarettes per day. Community-Tailored QUITPLAN® Centers
Some QUITPLAN Centers offer tobacco cessation services to American Indians, Africans, African Americans, Southeast Asians and Chicano Latinos using culturally relevant materials and activities. Interested patients can learn more at www.clearwaymn.org. Dr. Ann Wendling has been Director of Intervention Programs at Clearway MinnesotaSM since 2002. She was Research Program Manager at Clearway MinnesotaSM prior to assuming her current position. Dr. Wendling was a practicing general internist prior to obtaining a Masters of Public Health Degree from the University of Minnesota and entering the field of tobacco control. Sources: Wells, Ware and Lewil. Physician’s attitude in counseling patients about smoking. Med Care 1984; 22:360.
Learn how MHN and Triium can work with you to develop turnkey solutions to help you manage, market, and grow your business.
www.mhcn.com Email: info@mhcn.com 952.883.3133
QUITPLAN® Centers
Danis and Seaton. Helping your patients to quit smoking. American Family Physician 1997; 55(4):1207-13.
www.triium.com Email: info@triium.com 952.883.3288
Quinn. Tobacco Cessation Services and Patient Satisfaction in Nine Nonprofit HMOs. American Journal of Preventive Medicine 2005; 29(2): 77-84.
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The Journal of the Hennepin and Ramsey Medical Societies
Insurance Agent Transparency: The Time Has Come
A
A FEW YEARS AGO, a group of small busi-
nesses teamed up with a network of health care providers to try to create an alternative health plan that featured a consumer-driven design without third party managed care oversight. Businesses were enthusiastic that the plan would save them money and the doctors and hospitals anticipated reasonable and hassle-free reimbursement. Yet, after investing substantial time and money, the group reluctantly concluded that the concept would not be feasible. The obstacles weren’t health plan economics; the biggest obstacle was that insurance agents were adamantly opposed. Since the widespread participation of small businesses was essential and many of these businesses relied on insurance agents for advice, the opposition of the agents was deemed a critical problem. The arguments that independent agents made against this new health plan were a little vague. Some said it was “too riskyâ€? and others said they couldn’t “in good conscienceâ€? recommend that their clients switch from insurance companies that they had used for decades to a brand new plan. But was it their conscience or something else that caused these independent agents to oppose a plan that would have manifestly beneďŹ ted both the business community and the medical community? Perhaps if there was a little more transparency in how insurance agents are compensated, the answer to this question would be clearer. Transparency is a word that has been heard a lot in recent health policy discussions. Price transparency is important so that when people shop for medical care, they can see differences in cost between hospitals, doctors and other medical services. Quality information should be transparent so that people can B Y D AV I D A L L E N
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In other words, insurance companies make extra payments to reward some insurance agents for keeping policies where they are. This raises questions about the objectivity of the advice these independent agents give their customers. And, it raises the possibility that insurers can substantially impact the competitiveness of health insurance markets, not appropriately with competitive costs and features, but rather by leveraging existing marketshare to keep out competition. (Continued on page 14)
consider whether a medical group follows clinical guidelines or a hospital has policies to minimize medical errors. It turns out that insurance agent transparency is needed as much or more as these other types of transparency. The business community relies on independent insurance agents. These agents theoretically represent multiple insurers and this, combined with their expertise, allows them to provide valuable assistance in selecting an appropriate insurance product. And, best of all, there’s no out-of-pocket cost — they’re paid by commission, right? Well, it turns out that independent agents are not paid strictly by commission. Starting in the 1990s, insurers began entering into Marketing Service Agreements (MSAs) or Placement Service Agreements (PSAs) with many independent agents. These agreements stipulate that insurers will pay independent agents, in addition to their commissions, a reward for such things as maintaining a certain volume of business or renewing certain insurance policies. For many agents, these additional payments have become a critical portion of their income.
The Journal of the Hennepin and Ramsey Medical Societies
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January/February 2007
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January/February Index to Advertisers Advanced Skin Care Institute ............................. 7 AmeriPride..............................................................18 Bethesda Hospital .................................................. 4 The Birkeland Group ........ Inside Back Cover ClassiďŹ ed Ads.........................................................16 CrutchďŹ eld Dermatology...................................20 Cuyuna Regional Medical Center ..................... 8 Edina Realtyâ&#x20AC;&#x201D;Belle Davenport ......................14 InDigital, Inc. ......................................................... 4 LaMettryâ&#x20AC;&#x2122;s Collision ............................................16 MMIC .....................................................................23 Minnesota Oncology Hematology, P.A. ............. Inside Front Cover Minnesota Healthcare Network and Triium ......................................................12 Minnesota Physician Services, Inc. ...................... Inside Back Cover Southside Community Health Services ........11 University of Minnesota CME ........................... Outside Back Cover Weber Law OfďŹ ce ................................................13 Winter Medical Conference..............................22
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January/February 2007
Insurance Agent Transparency (Continued from page 13)
Hidden payments by insurers to inďŹ&#x201A;uence the representation of competing insurance products may remind some of national headlines from October 2004, when the New York state Attorney General alleged that brokers were illegally steering clients to insurers that paid the highest commissions. While no guilt was ever admitted, three of the largest brokerage ďŹ rms eventually signed settlement agreements to give restitution to clients and, from that point forward, to disclose all related payment arrangements that they had with insurers. Brokers are not the same as independent agents, but they are similar. Both are used by business to help with selection of insurance products, but a key difference is that brokers are paid by their customers while agents are paid by the insurer. Independent agents usually represent smaller clients than brokers, mostly because smaller clients tend to prefer the ďŹ nancial advantages of having the insurer pay the agentâ&#x20AC;&#x2122;s compensation. Nevertheless, the ethical concerns of insurers making hidden payments to inďŹ&#x201A;uence the advice given to business about insurance are similar for both brokers and agents. National associations that represent brokers and agents agree. The Risk and Insurance Management Society (RIMS) has made it their formal policy that brokers and agents should disclose the details of all compensation payments they receive from insurers, even if clients do not request the information. Both the Council of Insurance Agents & Brokers (CIAB) and the Independent Insurance Agents & Brokers of America (IIABA) have publicly expressed their support for broker and agent insurer compensation transparency. Yet, in Minnesota and most states, payments by insurers to agents are not voluntarily disclosed, and there is not any legal or regulatory requirement for transparency. This leads many to suspect that the market dominance of a few health plans, as well as the difďŹ culty many insurers and employers have had with launching alternative health plans, may be at least partially the result of inappropriate inďŹ&#x201A;uence on the independent agent community. Insurance premiums for virtually everyone would
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be higher if competition is being suppressed through practices like this. And physicians suffer because a few dominant health plans are able to enforce more onerous reimbursement, bureaucracy and managed care impediments than would be the case if the market were more competitive. Fixing this problem may be politically difďŹ cult, but it is administratively easy. The goal has been well-stated in a RIMS policy statement: â&#x20AC;&#x153;compensation and placement agreements should be transparent, with all sources of compensation, direct and indirect, disclosed without client request.â&#x20AC;? In other words, insurance agents should be required to tell their customers how they are being paid and by whom. This is the standard that the three largest broker ďŹ rms have already agreed to follow. Yet efforts to enact such a requirement are just getting started. The National Association of Insurance Commissioners (NAIC) created a three-pronged effort to address issues â&#x20AC;&#x153;...relating to [broker and agent] compensation disclosure and state inquiries into potential fraud, conďŹ&#x201A;icts of interest and inappropriate activity between insurance [brokers and agents] and insurance companies.â&#x20AC;? Advocates for Marketplace Options on Mainstreet (â&#x20AC;&#x153;AMOMâ&#x20AC;?), a Minnesota-based not-for-proďŹ t alliance of employers and providers dedicated to making the health plan market more competitive, issued a November 2006 call for such a requirement in Minnesota. At this writing, it is too early to tell whether the Minnesota state government is going to take the appropriate actions to require transparency in this important part of our health care system. The physician community should add its voice to those asking our government to require insurance agent compensation transparency. David Allen is a management consultant to health care provider organizations, a member of the AMOM board of directors, and an active volunteer in numerous not-for-proďŹ t and advocacy organizations. He can be reached at (952) 835-2009 or david@tcghealth.com.
The Journal of the Hennepin and Ramsey Medical Societies
Shopping for Health Care?
Consumers are requiring providers to understand and embrace the concept of a marketplace economy.
A competitive, consumer-driven health care marketplace is a good thing
The idea of going shopping for groceries, computers, cars, and the numerous other things consumers buy is commonplace. People shop for products and services based on cost, quality, service, convenience and other features important to them. As a consumer, if I am going to pay more for a product or service, I want to know what my benefit or added value will be for paying a little more. Is the quality better? Is the facility more professional? Will I receive a better buying experience? These are all typical questions the average consumer tries to answer before they make their purchasing decision. Just like in a normal retail environment, when consumers are spending their own money, they want the best value at the best price. The consumer-driven market is used in all forms of industry and business throughout the U.S., but health care consumers have not been able to make informed decisions when it comes to making their health care buying decisions. The HMO and managed care health care environments didn’t support or need a true marketplace because the consumer was either unable or didn’t care due to pre-determined selections made by the health plan, employer and in some cases, government. In the $20 co-pay environment consumers didn’t have much incentive to understand the full cost of the medical care. Cost was not an issue and quality was assumed. But as health care continues to rapidly shift toward a consumer-driven marketplace, and more and more individuals need to adapt to high-deductible health plans, consumers are seeking accurate, comparative information to
A market-based health care environment drives and ultimately facilitates a better, longer-lasting patient-doctor relationship. In an informed and competitive health care marketplace, patients will learn that not all providers are equal and to make decisions that are right for them, they need to rely on the best fit of the elements within their personal health care value equation.
BY MARK FISHER
MetroDoctors
make better, more informed health care purchasing decisions. With health care services varying in price by as much as 300 percent from one provider to another, consumers are quickly learning that having access to information can literally save them thousands of dollars in their own out-of-pocket expenses. Employers, insurance companies, payers, and government agencies are trying to entice patients to act and function more like consumers. On a recent trip to Minneapolis, President Bush signed an executive order that actually requires federal agencies to provide cost and quality transparency. Those Federal agencies account for 25 percent of the U.S. population. Any provider that is not preparing for this new competitive and transparent marketplace will soon be left far behind in the fast-growing consumer-driven health care market. In a consumer-driven marketplace, decisions are made and enhanced with information on quality, safety, service, convenience, cost, and other factors that the consumer can access. Decisions may vary over time, and once made, consumers want value for their money spent.
The Journal of the Hennepin and Ramsey Medical Societies
Value = Quality, Safety, Reliability + Service, Access, Convenience Cost To be good health care consumers means patients are: • In charge of their health care decisions, from both a medical and financial standpoint. • Able to access unbiased and accurate information that they can use when making health care purchasing decisions. (Similar to other consumer purchases). • Actively searching out their options to make the best decisions. • Actively engaging their physician/ providers around the elements of their value equation. (Continued on page 16)
January/February 2007
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Shopping for Health Care? (Continued from page 15) Patients are increasingly approaching health care as a consumer, not just a patient
In 2004, and recently in the spring of 2006, the Minnesota Legislature passed MN Statute 62J.81, which requires health care providers or their designees to provide a â&#x20AC;&#x153;good-faith-estimateâ&#x20AC;? for services when consumers inquire. But, due to the complexity of the health care organizations and the insurance contracts, most health care providers do not have the means to comply with the law even two years after it was initially passed.
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ronment. This is a key step that empowers the consumer for the ďŹ rst time to make a rational, informed health care decision while fostering a deeper doctor-patient relationship. Employers are beginning to recognize how consumer-driven health care is gaining momentum in the health care marketplace. Target Corporation and numerous other employers have informed their employees that they will be switching their health care insurance to a consumer-based, high-deductible or Health Saving Account program in the very near future.
Seventy-nine percent of Internet users are now using the Web to research medical topics from diseases to doctors according to a report issued by Pew Internet and American Life Project, a Washington, D.C. nonproďŹ t that studies the Internet. It is this push toward consumerdriven health care knowledge that is driving the popularity of online tools such as www.medcarecompare.com that allows consumer-members to locate and compare health care providers within their health insurance plan. This particular site, just being publicly launched, will allow consumers to access the needed information that is necessary to make an informed purchasing decision. Membership to the site for patients/consumers can be purchased through employers or directly. Memberships are for a one-year period at $25. Employer group discounts are also available. Health care providers can join and populate their information at no cost. Sites like the MedCare Compare Web site are trying to provide consumers with cost, quality, safety and convenience information that they will use in a similar manner to other Web sites when making major purchasing decisions from automobiles, to colleges to digital cameras. These online health care comparative tools facilitate a marketplace for providers and consumers in this new consumer-driven health care environment. SpeciďŹ cally designed for consumers while also offering a marketing tool for providers, this online comparative information allows consumers to make their health care spending decisions based on cost, quality, service, safety, access, reliability and convenience â&#x20AC;&#x201D; all being supplied by the providers in an unbiased, reliable and secure envi-
How Much Will This Cost?
That question is commonplace throughout our economy, but has been noticeably absent in the $2 trillion health care industry. The void that currently exists between the consumer and the provider is quickly being ďŹ lled with informational resources so the patient can truly become a consumer. Unlike any other time in health care, consumers now have a tremendous opportunity to improve and change the way health care is used in the United States. Those providers that are on the leading edge of this revolution will undoubtedly see the beneďŹ ts of embracing this new consumer-driven market. Mark Fisher is president of MedCare Compare, an online health care research tool for consumers and marketing tool for providers (www.medcare compare.com). He is also a principal in The Syndeo Group, a health care consulting and services organization, and is an adjunct instructor at the University of St. Thomas Health Care M.B.A. program. Mr. Fisher has a B.S.B. from the University of Minnesota, an M.B.A. from the University of St. Thomas, and is a Fellow in the American College of Medical Practice Executives (FACMPE).
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January/February 2007
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
Magnetic Source Imaging Laboratory
D
DANIEL IS A 28-YEAR OLD MAN who was
diagnosed with a tumor in the left frontal part of his brain at age 17. As a result of this brain tumor, Daniel also suffered recurrent seizures. At the time of initial diagnosis, the tumor was considered inoperable because of its proximity to presumed functional language cortex. Because of concerns about loss of speech following surgery, Daniel and his family elected to treat the tumor in a more conservative manner. However, more recent evaluation of Daniel’s tumor revealed growth and surgery was considered necessary. Fortunately, Daniel and his treating physicians have been able to utilize a new functional neuroimaging technology called Magnetic Source Imaging to accurately identify both the language cortex and seizure focus in relation to his brain tumor. With this information, Daniel’s neurosurgeon, Mary Beth Dunn, M.D., was able to maximize the resection of his tumor without invading functional cortex, which ultimately led to a more favorable outcome. Magnetic Source Imaging (MSI)/ magnetoencephalography (MEG) is now being performed at United Hospital in St. Paul. (This is the only clinical site utilizing this technology in the state of Minnesota and one of 14 sites nationally). The primary indication for this stateof-the-art technology is presurgical evaluation of epilepsy and brain tumor patients. MEG is used to identify the epileptogenic zone in relaBY DEANNA DICKENS, M.D., AND R O B E RT D O S S , P S Y D
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tion to structural brain pathology, as well as to map the location of cortical functions including motor, sensory and primary language areas. MSI is the co-registration of the MEG activity data to a 3T MRI to accurately localize the seizure and functional mapping data on the MRI brain image. The MSI laboratory opened in November 2004 as part of United Hospital’s John Nasseff Neuroscience Institute. To date, nearly 130 adult and pediatric patients have undergone this safe, non-invasive, painless procedure. How does MSI work? Very small magnetic fields produced by intracellular currents in the brain are detected with an array of highly sensitive magnetometers. The technique of recording these magnetic fields is magnetoencephalography. MEG detects minute biomagnetic signals produced by the brain, either spontaneously or in response to stimulation, without use of an external magnet. The topographic distributions of the brain’s magnetic fields can be analyzed to determine the source of the activity and this information can be mapped onto the patient’s existing MRI. MEG is a direct measure of neuronal activity unlike other functional neuroimaging techniques, such as functional MRI (fMRI), PET and SPECT that reflect changes in brain metabolism. MSI has several advantages of other functional neuroimaging techniques. MEG
The Journal of the Hennepin and Ramsey Medical Societies
has very high temporal resolution. The events recorded can be measured in sub-milliseconds, whereas fMRI, PET, and SPECT measure metabolic changes in seconds to minutes. Spatial resolution is also excellent. Unlike EEG that tends to show distortion across the skull, MEG accurately localizes seizure activity with millimeter precision and can generally detect deeper seizure sources than those recorded by a chronically implanted subdural electrode array. Localization of the epileptogenic focus can help determine whether or not the patient is a good surgical candidate. MSI mapping of the functional cortex is especially useful to the neurosurgeon in planning which areas of cortex can be safely resected. This allows the surgeon to determine the safest approach to the surgical target, and in some cases, estimate potential postoperative deficits. The information from MSI can also be used to minimize the craniotomy size or use of invasive cortical mapping. This particular procedure is now widely accepted in the planning of epilepsy surgery and brain tumor treatment, and can offer critical information to maximizing a successful outcome for the patient. The procedure of MEG data recording involves having the patient lie on a bed in a magnetically-shielded room. A helmet-like dewar with 148 channels is placed over the subject’s head for recording spontaneous interictal epileptic activity and/or evoked magnetic fields produced by sensory, motor and auditory or visual tasks. For seizure localization and
(Continued on page 18)
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Magnetic Source Imaging Laboratory (Continued from page 17)
functional mapping, the entire session lasts approximately three hours. Children as young as five have been successfully mapped using the evoked language procedure. Sedation can be safely used in pediatric or mentally handicapped populations. The FDA has cleared MEG for use since 1987. HCFA approved MEGs for clinical use by issuing CPT codes of 95965, 95966 and 95967 for the use of this procedure, especially (and only) for patients with epilepsy and surgical mapping needs. Several cases illustrate the value of MSI in the presurgical evaluation of epilepsy and brain tumor patients. Patient #1 is a 53-year old, right-handed woman who was evaluated in a metro-area emergency room for recent onset of left facial numbness and tingling. Work-up for a cerebrovascular etiology revealed a large right frontal brain tumor in the premotor areas with moderate associated edema. Neurosurgical consultation led to a stereotactic brain biopsy for the patient, which resulted in diagnosis of a grade II astrocytoma. MSI was ordered to map any interictal seizure activity and sensory/motor function. The MSI revealed no identifiable seizure activity, while mapping of the left index and middle finger sensory function showed localization very near and adjacent to the tumor. Moreover, motor mapping with the left index finger showed the tumor to be infiltrating the primary motor strip. Based on these findings, a surgical option was not pursued because the patient would likely experience a significant residual left–sided motor deficit. Instead, the patient was offered radiation and chemotherapy to treat her neoplasm. In this case, MSI was invaluable in identifying eloquent motor cortex without the use of an invasive intracranial procedure. The second case involves a 13-year old, right-handed boy with epilepsy and cortical dysplasia who was referred for MSI after failing surgical treatment of his seizures. At age six, he underwent focal resective surgery of the right posterior temporal-occipital lobe but continued to have seizures on a weekly basis following his operation. The MSI showed clear epileptogenic activities involving the remaining abnormal cortex both anterior 18
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and posterior to the prior surgical cavity. The MSI findings were then corroborated by subsequent intraoperative corticography, which led to complete resection of the seizure field. Seven months following surgery, the patient remains seizure-free and has no postoperative neurologic deficits. This case demonstrates the ability of MSI to accurately define an epileptogenic seizure field, which is crucial for subsequent presurgical planning as well as negating the need for possible additional invasive procedures. MEG/MSI is a unique and effective diagnostic tool for evaluating brain function and epileptogenic seizure localization for a variety of surgical planning applications. Moreover, MSI is superior to fMRI in functional mapping for patients with vascular malformations and brain tumors given that fMRI relies on a hemodynamic response that may be disturbed in these patients. MSI is also the preferred cortical mapping procedure for large brain tumors where traditional subdural grids may be contraindicated due to concerns about increased intracranial pressure. Future applications for MEG include measuring cerebral plasticity as it relates to functional recovery from cerebrovascular events and determining biological markers for dyslexia. The Magnetic Source Imaging Laboratory is a collaborative program between Minnesota Epilepsy Group, P.A., and United Hospital. Deanna Dickens, M.D. is Medical Director of Magnetic Source Imaging and is a Neurologist within Minnesota Epilepsy Group, P.A. Robert Doss, PsyD is a Clinical Neuropsychologist within Minnesota Epilepsy Group, P.A.
The Journal of the Hennepin and Ramsey Medical Societies
PHYSICIAN'S SOAP BOX
What is a Health Care Provider?
A
wrong word/definition/title/term/ ascribed to any economic, financial, societal, professional journal or other report can assume a life of its own. The legislatively defined Health Care Provider (HCP) person must protect its professionally earned definition from illegal, identity thievery or other improper use. The HCP is expected to lead immediate and disciplined action to deal with past, current or prospective deliberate identity thievery or other misuse of the HCP definition by any party. Lack of such focused vigilance in this matter will surely diminish the respect for those persons defined as an HCP. This paper will find fault in the serious misuse of the HCP identity.
The Situation that Caused This Report to be Prepared
While reviewing the July, 2006 issue of Barron’s, the Dow Jones & Company (Dow Jones) Business and Financial weekly, (Dow Jones also publishes the Wall Street Journal), I observed that Barron’s classified United Health Group Incorporated (UHG) as a Health Care Provider (HCP). At first I was inclined not to concern myself with this designation of UHG as a HCP but then I reflected on the consistent and serious attention that our family’s physicians and other HCPs take when they carefully define and explain our personal medical matters thus helping each member of the family understand their counsel and direction. On consultation with legitimate HCPs I could not, in good conscious and professional responsibility, accept that an insurer could be defined as an HCP; and, furthermore, seeing such erroneous designation appear in the prestigious publications of Dow Jones Barron’s and, most recently and locally, in the November 26, 2006 Star Tribune Sunday newspaper. An excellent measurable reference that can easily be supported by any HCP is the fact that medical records do not present any UHG work as an HCP. Because UHG is not an HCP and, therefore, is not an authorized person in the State to practice medicine or surgery (as appropriate) or any other person determined by the Secretary of Labor to be capable of providing health care services. As such UHG is not allowed to assess/diagnose, treat and order patient care services, such as — medical tests, pharmaceutical items, perform surgical procedures, BY RICHARD J. OSZUSTOWICZ
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imaging services, etc. Some evidence of insurer (UHG) type of work resides in individual patient admitting and patient billing activities and as such does not specifically appear in HCP work recorded in the patient’s medical record. The professional opportunity to report my argument in the matter of securing the HCP definition in MetroDoctors materially complements the focus of this work in this serious matter of aligning the HCP definition/identity where it belongs. I contacted Dow Jones Barron’s and Wall Street Journal reporters and others involved in determining the use of the HCP term as well as persons reporting on UHG SOB business news. They suggested that I should review UHG’s annual reports and 10K for information regarding HCP. I did. I reviewed five years of UHG information (20012005), met with an internal, CPA credentialed, financial management person from UHG’s Health Care Services business segment named Ovations. I suggested that he perform certain financial analyses of UHG’s five prior year reports to help him understand the financial differences between hospitals and UHG.A follow-up meeting was planned to review his work. He cancelled the meeting. I also tried to contact one of its Board members for input. I did not receive a response from that person. None of this review provided me with any comfort to support Barron’s designation of UHG as a HCP. Because the prior year search of UHG information failed to find proof that its company can be classified as an HCP; the lack of business reporting regarding possible financial and other implications of UHG SOB activities on the financial and other business operations of HCPs, hospitals, pharmacies and outpatient clinics; and my personal belief that UHG, the insurer, is not an HCP, I was now even more determined to get some answers. Not only for the sake of obtaining an answer but to also add value by alerting all HCPs that action is always required to protect the HCP identity distinctiveness. I continued to search for an official source for the HCP designation believing that through my health care management, teaching, board and consulting work experiences I would be able to find information that UHG could not be designated as an HCP. The term HCP must be a term that is clear and easily understood as belonging to qualified persons. To complement this work I telephoned and met with senior management of the U.S. Department of Labor (DOL) Employment (Continued on page 20)
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Soap Box (Continued from page 19)
(2) Any other person determined by the Secretary to be capable of providing health care services. (b) Others “capable of providing health care services’’ include only: (1) Podiatrists, dentists, clinical psychologists, optometrists, and Standards Administration’s Wage and Hour Division. They provided chiropractors (limited to treatment consisting of manual me with much written information and discussion, the result of manipulation of the spine to correct a subluxation as demonwhich helped lead me to Title 29 Code of Federal Regulations (CFR), strated by X-ray to exist). Subpart A Section 825.118. This regulation defined “Health Care Authorized to practice in the State and performing within the Provider” (HCP) for national use. I learned that the historic need for scope of their practice as defined under State law; the HCP definition was initially sought to help people seeking health (2) Nurse practitioners, nurse-midwives and clinical social workcare services as provided through the Family and Medical Leave Act. ers who are authorized to practice under State law and who The Act advanced the need to define an HCP which definition was are performing within the scope of their practice as defined firmed in 29 CFR 825.118. On this discovery I determined that no under State law; further work regarding the question “Who is a Health Care Provider?” (3) Christian Science practitioners listed with the First Church needs to be done. It is clear that insurers and other persons or parties of Christ, Scientist in Boston, Massachusetts. Where an not included in this definition are not HCPs. HCP designated peremployee or family member is receiving treatment from a sons should never allow the term to be used by any other party. Christian Science practitioner, an employee may not object to any requirement from an employer that the employee or famTitle 29 — Labor ily member submit to examination (though not treatment) Chapter V — Wage and Hour Division, Department of Labor to obtain a second or third certification from a health care Part 825 — The Family and Medical Leave Act of 1993 provider other than a Christian Science practitioner except Sec. 825.118. What is a “health care provider’’? as otherwise provided under applicable State or local law or (a) The Act defines “health care provider’’ as: collective bargaining agreement. (1) A doctor of medicine or osteopathy who is authorized to (4) Any health care provider from whom an employer or the practice medicine or surgery (as appropriate) by the State in employer’s group health plan’s benefits manager will accept which the doctor practices; or certification of the existence of a serious health condition to substantiate a claim for benefits; and (5) A health care provider listed above who practices in a country other than the Unit“Remarkable patient satisfaction from quality, ed States, who is authorized to practice in service, convenience and excellent results” accordance with the law of that country, and who is performing within the scope of “Exceptional care for his or her practice as defined under such all skin problems” law (c) The phrase “authorized to practice in the Charles E. State’’ as used in this section means that the Crutchfield III, M.D. Board Certified Dermatologist provider must be authorized to diagnose and treat physical or mental health conditions without supervision by a Doctor or other & HCP.
Crutchfield Dermatology
Psoriasis
Acne Specialist
Your Patients will Look Good & Feel Great with Beautiful Skin www.CrutchfieldDermatology.com
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1185 Town Centre Drive Suite 101 Eagan, MN 55123
Appointments 651-209-3600 Prompt Appointments via Physician Requests
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Note that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) does not use the HCP designation for their accredited organizations such as hospitals. The only official HCP definition is recorded in 29 CFR 825.118 and as we learned that definition is assigned to legally qualified persons — not organizations. Richard J. Oszustowicz is the former Chief Financial Officer and Treasurer of LifeSpan Inc. The Journal of the Hennepin and Ramsey Medical Societies
HMS/RMS Participate in 10th Annual White Coat Ceremony
O
n Saturday, October 21, 2006 the University of Minnesota Medical School held its tenth “White Coat Ceremony” for 165 first year medical students. On this occasion the students were individually called forward to don their white coats, take the Minnesota Oath for New Physicians, and receive an engraved reflex hammer as a
gift from the Hennepin and Ramsey Medical Societies. The purpose of this ceremony is to initiate these future doctors into the profession, and to convey to them, as well as their families and friends, what it means to be a physician. The program emphasizes professionalism and what society expects of physicians when they wear the “white coat.”
HMS Chair James Rohde, M.D., and RMS President James Jordan, M.D., present the medical students with a gift at the “White Coat Ceremony.”
Medical students Catherine Pastorius, Will Allen and Andrew Day at the “White Coat Ceremony.”
Dear Hennepin and Ramsey Medical Society Members: Thank you for your participation in the Medical School’s tenth White Coat Ceremony on October 21, 2006. The Hennepin and Ramsey Medical Societies’ gift of a reflex hammer for the students was very much appreciated. We are especially appreciative that the medical societies are able to play a role in the professional development of student physicians. We have had a lot of highly positive feedback about this ceremony from program participants, students and students’ family members and friends. Sincerely yours,
Kathleen V. Watson, MD Associate Dean for Students and Student Learners Associate Professor of Medicine
ATTENTION all Minnesota Physicians Residing in Naples, Florida
5th Annual Minnesota Health Care Dinner Party Tuesday, March 20, 2007 Pelican Marsh Golf Club, Naples, Florida Cocktails: 6:00 p.m. Dinner: 7:00 p.m. Cost: $55.00 per person (estimated) Spouse/guest invited Contact Tom Hoban at (239) 948-4492 or th8159@earthlink.net (2006 attendees watch for a written invitation in late January)
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January/February 2007
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Winter Medical Conference 2007 ´Caring for the Aging 3RSXODWLRQµ SUNDAY, MARCH 4SUNDAY, MARCH 11, 2007
CANTO DEL SOL PLAZA VALLARTA
PUERTO VALLARTA, MEXICO
TRAVEL AND LODGING RATES (INCLUDES: AIR, HOTEL, MEALS, BEVERAGES, TRANSFERS, TAXES & GRATUITIES) PHYSICIAN/ SPOUSE/GUEST 3RD PERSON 4TH PERSON CHILDREN SINGLE DOUBLE ADULT ADULT 2-12 $1,549 $899 $1,139 $1,019 $699
SPONSORED BY RAMSEY MEDICAL SOCIETY FOUNDATION ENDORSED BY RAMSEY MEDICAL SOCIETY AND HENNEPIN MEDICAL SOCIETY
This does not include conference registration fee.
³7KLV DFWLYLW\ KDV EHHQ DSSURYHG IRU $0$ 35$ &DWHJRU\ &UHGLW ´ For conference information call RMS/HMS - 612-362-3704; email: dhines@metrodoctors.com For reservations call Darla at Hobbit Travel 612-349-3922 ext. 3339 or 1-800-294-6992 ext. 3339 or email: darlawilke@hobbittravel.com Visit: www.metrodoctors.com for brochure with complete listing of faculty and topics for this conference. 22
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The Journal of the Hennepin and Ramsey Medical Societies
Minneapolis Society of Internal Medicine Looks Forward
T
THE MINNEAPOLIS Society of Internal
Medicine (MSIM) has an interesting past and looks forward to an exciting future. Founded in 1949, MSIM has served as a forum for internists to meet, exchange views and share information. Today MSIM holds three meetings each year. The meetings take place at the Minikahda Club overlooking Lake Calhoun, offering an inviting atmosphere to catch up with colleagues and mentors during the social hour
and dinner. Each meeting features an invited medical speaker, and the fall meeting includes University of Minnesota medical students. The speakers offer unique subjects and presentations and are always thought-provoking. Last fall, MSIM members heard, “Pandemic Influenza: Harbinger of Things to Come?” from Michael Osterholm, Ph.D. On January 24, attendees will hear from Daniel Keyler, PharmD on the subject of venomous
snakes and snakebite medical treatment. The April 25 dinner will feature Mayo physician, Robert Kyle, M.D. presenting, “Benign Monoclonal Gammopathy and ‘Smouldering Myeloma.’” As you can see, MSIM programs are anything but dull. MSIM exists to provide unique opportunities to explore medical topics in a collegial atmosphere. Our greatest asset is our members. Call (651) 407-1873 today and join!
“ The only constant we see is change.” Learn how MMIC is continually developing ways to protect you from and to help you prevent medical malpractice lawsuits. For more than 25 years, we’ve seen how malpractice issues can challenge physicians. We’re here to help protect your assets with malpractice insurance coverage that is backed with: • Unsurpassable risk management and patient safety resources • Competitive pricing through effective underwriting • Strong defense-minded philosophy to protect your interests • Service and support that puts you first To learn more about how MMIC can help protect you, call 1.800.328.5532 “A” Excellent rating from A. M. Best Insurance, Claim & Risk Management • Technology • Customer Service to protect against & prevent malpractice
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to help your practice thrive
that puts you first
January/February 2007
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Infectious Diseases: Stop the Spread, Contain the Threat Conference
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n Saturday, October 28, 2006, the Ramsey Medical Society Foundation presented the “Infectious Diseases: Stop the Spread, Contain the Threat” Conference at the Continuing Education and Conference Center on the U of M St. Paul Campus. Forty-four physicians, RN’s, nurse practitioners, and PA’s gathered early in the morning to settle in for the day-long conference updating them on current infectious disease issues. Attendees received 6.25 AMA PRA Category 1 CreditsTM or 6.25 Prescribed Credits by AAFP.
Morning faculty from left: David R. Aughey, M.D., Peter Dehnel, M.D., moderator, and Steven Anderson, Ph.D. (not pictured: Frank S. Rhame, M.D.)
The morning began with opening remarks by moderator, Peter Dehnel, M.D. The first speaker was Frank S. Rhame, M.D., Infectious Diseases, AMC The Doctors Uptown, informed the attendees about “HIV Pointers for the Primary Care Physician.” Dr. Rhame was followed by Steven Anderson, Ph.D., Senior Vice President, Laboratory Corp. of America, who discussed “Emerging and Re-emerging Respiratory Pathogens.” He also presented after lunch on “The Role of Molecular Diagnostics in Infectious Disease.” After a short morning break David R. Aughey, M.D., Adolescent Medicine/Pediatrics, Teen Age Medical Services, Children’s Hospitals & Clinics, explained “The Epidemics of Chlamydia and PID: The Critical Role of Primary Care.” The afternoon featured presentations on: “Current Concepts in Cutaneous Infections” by Charles E. Crutchfield III, M.D., Dermatology, Crutchfield Dermatology; “Rising Burden of Resistant Staphylococcus” by Muhammad A. Khan, M.D., Infectious Diseases, St. Paul Infectious Disease Associates, Ltd.; “Clostridium Difficile: It’s a Monster” by Gary R. Kravitz, M.D., Infectious Diseases, St. Paul Infectious Disease Associates, Ltd.;
and “Containing the Threat of Vaccine Preventable Diseases: What’s New? What’s on the Horizon?” by Patsy Stinchfield, RN, MS, CPNP, Director, Pediatric Infectious Disease & Immunology Infection Control, Children’s Hospitals & Clinics. Attendees were invited to visit the exhibitor displays provided by: • AstraZeneca – Lori Anderson • GlaxoSmithKline Vaccines – Jasen McMahon • Pfizer, Inc. – Deena Laugen • Sanofi-Aventis Pharmaceuticals – Bob LaMont and Liana Duran Hennum Unrestricted educational grants were received by: • Merck & Co., Inc. • ViroMed Laboratories – A LabCorp Company
The exhibitors from left: Deena Laugen, Jasen McMahon, Liana Duran Hennum and Bob LaMont.
Afternoon faculty from left: Patsy Stinchfield, RN, MS, CPNP, Charles E. Crutchfield III, M.D., and Muhammad A. Khan, M.D.
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January/February 2007
Gary Kravitz, M.D. presenting on C. difficile.
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The group of attendees eager to learn about infectious diseases.
The Journal of the Hennepin and Ramsey Medical Societies
PRESIDENT’S MESSAGE JAMES J. JORDAN, M.D.
Catalysts for Change RMS-Officers
RMS-Board Members
Todd D. Brandt, M.D., At-Large Director and MMA Trustee Charles E. Crutchfield, III, M.D., At-Large Director Laura A. Dean, M.D., Specialty Director Andrew S. Fink, M.D., At-Large Director Ronnell A. Hansen, M.D., Specialty Director Thomas J. Losasso, M.D., At-Large Director Robert C. Moravec, M.D., At-Large Director Jane C. Pederson, M.D., M.S., Specialty Director Lon B. Peterson, M.D., At-Large Director Thomas D. Siefferman, M.D., Specialty Director Stephanie D. Stanton, M.D., Resident Physician Jacques P. Stassart, M.D., At-Large Director Christina J. Templeton, M.D., Specialty Director David C. Thorson, M.D., Specialty Director and MMA Trustee Kimberly C. Viskocil, Medical Student RMS-Ex-Officio Board Members & Council Chairs
Blanton Bessinger, M.D., AMA Alternate Delegate V. Stuart Cox, M.D., Communications Council Chair Kenneth W. Crabb, M.D., AMA Delegate Robert W. Geist, M.D., Ethics & Professionalism Council Chair J. Michael Gonzalez-Campoy, M.D., Ph.D., MMA Immediate Past President Frank J. Indihar, M.D., AMA Delegate Neal R. Holtan, M.D., Community Health Council Chair Mark J. Kleinschmidt, Clinic Administrator Anthony C. Orecchia, M.D. Education Resource Council Chair Lyle J. Swenson, M.D., Public Policy Council Chair Richard W. Anderson, M.D., Sr. Physicians Association President RMS-Executive Staff
Roger K. Johnson, CAE, Chief Executive Officer Sue Schettle, Director Katie R. Anderson, Executive Assistant Doreen M. Hines, Manager, Member Services
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will ever be a pharmaceutical panacea. I believe we need to innovate. We need to work together as medical professionals. We need to work with our patients and in their interest. Wherever systemic problems exist, physicians need to be catalysts for change. There are great minds trying to overcome barriers between reality and the ideal. Physician-lobbying groups, researchers, and politicians are trying to find ways to make health care more accessible. Doctors in practice are working to make sure that their care remains high quality. Cost is a major barrier. The solution remains elusive and its implications are daunting. A gap remains between the health care system we have and the system our patients deserve. Physicians are often responding to — not responsible for — the rising costs of health care in the United States. The AMA lists 21 states that are currently “in crisis” — based on litigation regulations. Rising insurance premiums are forcing doctors to retire, drop high-risk procedures, or move to states with more favorable laws. Patients in these states are losing necessary medical talent because capable physicians face increases of up to 50 percent in their liability premiums whether or not they have been convicted of malpractice. Doctors did not create this environment. Nor do practicing physicians control the mind-boggling insurance network that compromises our ability to appropriately care for our patients. But, because we are the front line of care, we have become the face of these problems to our patients. We, as a community of physicians, need to agree today on what is necessary and appropriate care in our respective specialties. We should define as sufficient care the level of care we would give a member of our own family. By committing to work together on behalf of our patients to innovate new solutions to problems in the health care system, we can be the patients’ advocates. As we dig deeper in our roles as doctors we can truly treat what ails our patients. January/February 2007
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Ramsey Medical Society
President James J. Jordan, M.D. President-Elect V. Stuart Cox, M.D. Past President and MMA Trustee Charles G. Terzian, M.D. Treasurer Peter B. Wilton, M.D.
MY TERM is ending and I’m losing this soapbox, this bully pulpit from which to advocate for better care for persons with mental illness. But I hope through these months I have given you some pause. I hope I have given you reason to think about the complicated needs of patients grappling with the isolation and stigma of mental illness and at the same time battling a health care industry too short-sighted to provide comprehensive and specialized treatment. But more than that, I hope I’ve piqued your interest. I hope every time you see a headline in the mass media or in a medical journal that addresses a topic of mental health, you will take the time to read more. It is only through working together we can conquer mental illness. Physicians need to be catalysts for change. Andrew Solomon made a similar point in his opinion piece, “Our Great Depression” in the New York Times in November. Solomon suggests that by applying techniques used to enhance treatment for cancer patients in the 1970s, we can dramatically enhance care for persons suffering from mental illness. Like me, Solomon is alarmed by the numbers of people receiving only cursory treatment for what are often very complex problems. Notes Solomon: “Among the thousands of depressed patients I have met with, the majority have sought treatment but feel that they are not getting good care.” Solomon advocates that research and treatment be combined into “interdisciplinary centers,” much as the National Cancer Institute did to combat cancer. Such an effort by the National Institute of Mental Health can reduce the stigma of mental illness, improve care, and increase reimbursement rates for necessary treatment. While Solomon’s model may not be applicable to every medical discipline, his ability to blend innovation with historical success may inform how we move from identifying urgent problems in health care to cultivating viable solutions. I like that idea, with modifications. First, physicians must dismiss the fantasy that there
2007 RMS Election Results Congratulations to the newly elected RMS leaders
PRESIDENT V. Stuart Cox III, M.D. Otolaryngology Midwest Ear, Nose & Throat Specialists
PRESIDENT-ELECT Peter B. Wilton, M.D. General Surgery St. Paul Surgeons, Ltd.
SECRETARY/TREASURER Ronnell A. Hansen, M.D. Diagnostic Radiology St. Paul Radiology, P.A.
DIRECTOR Arthur A. Beisang III, M.D. Pediatrics Gillette Children’s Specialty Healthcare
DIRECTOR Nicholas J. Meyer, M.D. Orthopaedic Surgery/ Hand Surgery St. Croix Orthopaedics, P.A.
The Following Have Been Appointed to a Position on the RMS Board by an MMA Section.
DIRECTOR Jerome J. Perra, M.D. Orthopaedic Surgery Summit Orthopedics, Ltd.
Delegates to MMA Elected to Serve With RMS Board Members
Richard L. Baron, M.D. Blanton Bessinger, M.D. Amy L. Gilbert, M.D. DIRECTOR Scott A. Uttley, M.D. Ophthalmology St. Paul Eye Clinic, P.A.
DIRECTOR Lon B. Peterson, M.D. Family Medicine Regina Medical Center
J. Michael GonzalezCampoy, M.D., Ph.D. Marie Witte, M.D. Appointed by the MMA Young Physician Section Internal Medicine Stillwater Medical Group
Stephanie D. Stanton, M.D. Appointed by the MMA Resident Physician Section Family Medicine United Family Practice Health Center
Kimberly C. Viskocil, MS2 Appointed by the MMA Medical Student Section
Frank J. Indihar, M.D. Kent S. Wilson, M.D.
Help us Celebrate... Installation of V. Stuart Cox III, M.D., as the 137th President of Ramsey Medical Society at the 2007 RMS Winter Gala and Annual Meeting Friday, January 19, 2007 Science Museum of Minnesota Discovery Hall, 4th Floor, 120 W. Kellogg Blvd., St. Paul — Admission to Exhibits included with your reservation—
You are encouraged to bring your children (We will have responsible teenagers available to escort your children to the 3D Cinema show during the program and award presentations. Cost per child for the show is $2.50 age 4-12; $3.00 age 13+.) — There will be a display of specimens from the University of Minnesota Veterinary Museum— Social Hour/Tour — 5:30 p.m. – 6:30 p.m. Dinner — 6:30 p.m. – 7:30 p.m. Program and Award Presentations — 7:30 p.m. – 8:00 p.m. Tour Museum/Social Time — 8:00 p.m. – 10:00 p.m. (Times may vary depending on the time of the 3D Cinema show.) Watch your mail for your invitation or call (612) 362-3704 to make a reservation.
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The Journal of the Hennepin and Ramsey Medical Societies
New MPS Inc. Board Member
Sue Schettle, Director of Ramsey Medical Society and project coordinator for the Smoke-Free Washington County project has identified office space in Stillwater, which is the county seat of Washington County. The office space is located at 1675 Greeley Street, Suite 204 in Stillwater and will accommodate
The MPS, Inc. Board of Directors welcomes Tara Bowman, M.D. to the board. Dr. Bowman is a radiologist at St. Paul Radiology and specializes in breast imaging. Dr. Bowman replaces Dr. Rick Aizpuru who is also from St. Paul Radiology.
two full-time staff members and a small area for conferences. Sue is currently recruiting for a grassroots organizer to join her in the Stillwater office. The Smoke-Free Washington County project is funded by BCBS of MN as part of the Communities for Healthy Air campaign.
Dr. Wright Addresses Physicians R. Scott Wright, M.D. former MN Senate Candidate from Rochester, District 30 spoke to a group of 40+ physicians on November 17, 2006 at United Hospital. He talked about what he learned in his bid for Senate, noting
how important the issue of health care is to citizens. The CME event was co-sponsored by RMS and the medical staffs of United and HealthEast Hospitals.
RMS Board Meeting Christina Templeton, M.D., psychiatrist at the Hamm Clinic in St. Paul, discussed with the RMS Board, “the special stressors on women physicians as it relates to organized medicine and family life,” at its Board meeting on November 30th at United Hospital.
From left: Peter Wilton, M.D., RMS Treasurer; Sandra Rosenberg, M.D., President, MMA Women Physicians; R. Scott Wright, M.D.; and Mitch Pearlstein, Ph.D., Founder and President of Center of the American Experiment.
RMS Senior Physicians Association Approximately 30 RMS members and spouses met on October 19 for the last Senior Physicians Association meeting of the year. Terry Capistrant, M.D. spoke about the characteristics of Parkinson’s Disease and briefly about his work founding the Terrance D. Capistrant M.D. Parkinson’s Center at Bethesda Hospital in St. Paul. Dr. Capistrant is a neurologist who diagnosed himself with Parkinson’s in the 1990s, and is currently an advisor for the Parkinson’s Center. The attendees listened to Dr. Capistrant for an hour and had several questions for him before he led a tour of Bethesda’s Parkinson’s Center.
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
James Jordan, M.D., RMS President, and Christina Templeton, M.D.
Extend your Heart to the Homeless 2007 Caring Hearts for Homeless People Drive
February 1-26, 2007
Encourage your clinic staff to donate personal hygiene and over-the-counter medications.
Call Doreen at (612) 362-3705 to learn more about how your clinic could participate.
January/February 2007
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Ramsey Medical Society
Smoke-Free Washington County Office Opens
Vladimir Hugec, M.D. Lekarska Faculta Safarikova Universitz, Kosice Czechoslovakia Hematology Oncology Minnesota Oncology Hematology, P.A.
New Members RMS welcomes these new members to the Society. Schools listed indicate the institution where the medical degree was received.
Active Christian P. Anderson, M.D. University of Minnesota Family Medicine MinnHealth Family Physicians, P.A. – Shoreview Arthur A. Beisang III, M.D. St. George’s University School of Medicine, Grenada Pediatrics Gillette Children’s Specialty Healthcare Ellen E. Bellairs, M.D. Baylor College of Medicine Radiation Oncology Minnesota Oncology Hematology, P.A. Milton W. Datta, M.D. University of Michigan Medical School Anatomic Pathology Hospital Pathology Associates, P.A. Elizabeth A. Detlie, M.D. University of South Dakota School of Medicine Family Medicine MinnHealth Family Physicians, P.A. – Shoreview Christian M. DuBois, M.D. University of Chicago, Pritzker School of Medicine Orthopaedic Surgery St. Croix Orthopaedics, P.A. Steven M. Falk, M.D. University of Minnesota Anesthesiology Valley Anesthesiology Associates, P.A.
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January/February 2007
Joseph Y. Lee, D.O. University of Osteopathic Medicine and Health Sciences Internal Medicine/Nephrology Kidney Specialists of Minnesota, P.A. Vichaivood Liengswangwong, M.D. Faculty of Medicine at Chulalongkorn Hospital University of Medicine Sciences, Bangkok Radiation Oncology Minnesota Oncology Hematology, P.A. Lynn B. Lillie, M.D. University of Minnesota Family Medicine Woodwinds Health Campus MaryBeth Mahony, D.O. Chicago College of Osteopathic Medicine Pediatrics Partners in Pediatrics, Ltd. Warren A. McGuire, M.D. Michigan State University College of Human Medicine Radiation Oncology/ Pediatric Hematology Oncology Minnesota Oncology Hematology, P.A. Saeid Movahedi-Lankarani, M.D. Oregon Health Sciences University School of Medicine Anatomic/Clinical Pathology Hospital Pathology Associates, P.A. Elena L. Polukhin, M.D. Kuban Medical Institute, Krasnodar, USSR Physical Medicine/Internal Medicine Rehabilitation Consultants, Inc. Garrett R. Trobec, M.D. University of Minnesota Family Medicine MinnHealth Family Physicians, P.A. – Shoreview
MetroDoctors
In Memoriam JANE E. HODGSON, M.D., an abortionrights crusader convicted of performing an illegal abortion in St. Paul in 1970, died at the age of 91 on October 23, 2006. She graduated from the University of Minnesota Medical School and studied at the Mayo Graduate School of Medicine. Dr. Hodgson met her husband, the late Dr. Frank Quattlebaum, while serving an internship at Jersey City Medical Center. As one of the few female physicians, the obstetrician-gynecologist opened a practice in the downtown Lowry Medical Arts Building and later worked at Regions Hospital. Dr. Hodgson’s views made her a polarizing figure in the intractable debate over abortion. In retirement, Dr. Hodgson traveled the world widely and promoted public health in poorer nations. She joined RMS in 1948. NEWELL W. HOWE, M.D., died on October 31 at the age of 89. He received his medical degree from the University of Minnesota Medical School. Dr. Howe completed an internship at Milwaukee County Hospital. Upon completion of his internship, he was called up to serve in the Army. After serving in the Army Dr. Howe began his medical practice in family practice in his office in West St. Paul. Dr. Howe joined RMS in 1941. ELMER C. PAULSON, M.D., passed away on October 17, 2006. He was one day shy of 95 years old. He graduated from the University of Minnesota Medical School and began his medical practice as a “country doctor” in Dalton, Minnesota in 1939. Dr. Paulson was called to serve in the armed forces in 1942, and served for four years retiring as a Major. After the war, he settled in Elbow Lake. Later, he returned to the University of Minnesota Medical School where he completed a Fellowship in Radiology and Nuclear Medicine. Dr. Paulson began his radiology practice in Worthington and then joined St. Paul Radiology in 1953 until his retirement in 1980. During his retirement, he continued to teach and volunteered his time as a radiologist at the Shriner’s Children’s Hospital. Dr. Paulson joined RMS in 1954.
The Journal of the Hennepin and Ramsey Medical Societies
CHAIR’S REPORT PAUL A. KETTLER, M.D.
Call of the Hospitalist
HMS-Officers
HMS-Board Members
Alan L. Beal, M.D. Carl E. Burkland, M.D. Peter J. Dehnel, M.D. Sundeep Dev, M.D. Laurie Drill-Mellum, M.D. Raymond A. Gensinger, Jr., M.D. Kenneth N. Kephart, M.D. Frank S. Rhame, M.D. Janette H. Strathy, M.D. Thomas C. Tunberg, M.D. David J. Walcher, M.D. David A. Willey, M.D. HMS-Ex-Officio Board Members
Michael B. Ainslie, M.D., MMA Trustee Christian L. Ball, M.D., Resident Representative Beth A. Baker, M.D., MMA Trustee Karen K. Dickson, M.D., MMA Trustee David L. Estrin, M.D., AMA Alternate Delegate Eleanor Goodall, Co-Presiding Chair, HMS Alliance Donald M. Jacobs, M.D., MMA Trustee Roger G. Kathol, M.D., MMA Trustee Dawn Lunde, MMGMA Representative Jason Meyers, Medical Student Representative Richard K. Simmons, M.D., Sr. Physicians Association Representative Karin M. Tansek, M.D., MMA Trustee Trish Vaurio, Co-Presiding Chair, HMS Alliance Benjamin H. Whitten, M.D., AMA Alternate Delegate HMS-Executive Staff
Jack G. Davis, Chief Executive Officer Jennifer Anderson, Smoke-Free Project Coordinator Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors Kathy R. Dittmer, Executive Assistant
MetroDoctors
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MEDICINE IS IN TRANSITION and the demands made upon physicians are greater than ever. The pressure to perform, increasing patient demands, non reimbursable care, pay-for-performance, Medicare, third party payers, regulatory compliance, increasing financial burdens, decreased reimbursement, degradation of the patient-physician relationship, and physician burnout are many of the contributing factors. It is these factors that have fueled the hospitalist movement. When I finished my internal medicine training, I began a traditional general medicine practice with a large multi-specialty group. My day began at the hospital and transitioned to the clinic by late morning. Our group of internists found it difficult to manage an outpatient and inpatient practice, as we were the only internal medicine group at the hospital. Over time the inpatient service became extremely busy requiring us to change our practice. The solution was to have an internist in the hospital after morning rounds to handle all admissions and consults for the rest of the day, allowing others to focus on their outpatient clinic. Although this helped our inpatient practice, our outpatient practice became more difficult to manage due to time away from the clinic. We unintentionally had fixed one problem and caused another. We realized we could not continue practicing this way, not only for our patient’s sake but also our own. It was at that time I realized a large portion of my practice was essentially that of a “hospitalist” and decided to focus my practice exclusively to inpatient medicine. Some of my partners joined me, and others became strictly outpatient physicians. Hospitalists are physicians whose primary professional focus is the medical care of hospitalized patients. Therefore, any physician can potentially be a hospitalist. However, 89 percent of hospitalists are internal medicine trained and 5.5 percent are family medicine physicians. The remaining are typically pediatricians and medicine/pediatric physicians. Physician extenders, such as physician
The Journal of the Hennepin and Ramsey Medical Societies
assistants and nurse practitioners, are also being incorporated into practice models. Some training programs offer one-year fellowships that focus on research, teaching skills and additional clinical expertise. The Society of Hospital Medicine (SHM) has recently developed a skill set of core competencies for hospitalists. Although the American Board of Medical Specialties does not have specialty certification for hospital medicine, there may be movement toward this in the near future. Hospitalist services and programs exist in almost every market, regardless of managed care penetration. Why? Evidence shows that hospitalists are able to significantly improve efficiency and lower the cost of care while increasing the quality of care. This is accomplished by controlling over utilization through round the clock leadership in complex clinical, financial and ethical issues. These programs are embraced by hospitals, insurance companies, patients and physicians alike. Primary and specialty care physicians are able to be more efficient and are less burdened by the day-to-day management of the hospitalized patient. When the patient leaves the hospital, communication with the primary care physician is essential in providing a smooth transition and continuity of care. The hospitalist movement is here to stay. Hospital medicine is currently the fastest growing specialty in the country. Unfortunately, the demand for hospitalists is greater than the supply and fewer physicians are choosing primary care as a profession. Everyday more family physicians and other primary care specialties are becoming outpatient only caregivers. Specialists are now co-managing their surgical patients with hospitalists, resulting in lower lengths of stay and fewer non-surgical complications. Remember… when things get tough or you’re in a bind, who ya gonna call? The hospitalist.
January/February 2007
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Hennepin Medical Society
Chair Paul A. Kettler, M.D. President Anne M. Murray, M.D. President-elect Richard D. Schmidt, M.D. Secretary Edward P. Ehlinger, M.D. Treasurer Eric G. Christianson, M.D. Immediate Past Chair James A. Rohde, M.D.
HMS NEWS
Smoke Free Scott County Update
Dr. Warwick Receives Charles Bolles Bolles-Rogers Award
T
he Charles Bolles Bolles-Rogers Award was presented to Warren J. Warwick, M.D. on October 25, 2006 at the University of Minnesota Medical Center, Fairview, Medical Staff Awards Banquet. Originally called the St. Barnabas Bowl, the award was established in 1951 by the late Mr. Charles Bolles Bolles-Rogers, who served on the St. Barnabas Hospital Board of Trustees and was president of that Board for many years. The award is an engraved sterling silver Revere Bowl. The award is given to a physician who is considered to be an outstanding physician by reason of his or her professional contribution on the basis of medical research, achievement or leadership of this and other years. The nomination and selection of the recipient of this honor is made annually by nominations submitted by hospital medical staffs in Hennepin, Anoka, Carver, Scott, and Western Dakota counties. Dr. Warwick began his career at the University of Minnesota in 1959 and was appointed full professor in 1978. He is recognized internationally for his expertise in the management and diagnosis of cystic fibrosis. Dr. Warwick served as Director of the Cystic Fibrosis Center at the University of Minnesota from its establishment in 1962 until 1999, developing it into one of the largest and most respected CF centers in the country and now
serves as senior advisor. He is also noted for his expertise in pulmonary physiology and interpretation of pulmonary function. He has directed the Pediatric Pulmonary Function Testing (PFT) Laboratory since 1962 and continues to serve as co-director. His research has focused on creating tools to aid in the diagnosis and management of patients with chronic lung disease. He holds several patents with his co-inventor and is currently studying the basic science related to high frequency chest compression (HFCC). His development of sweat test technology led to collaboration with Medtronic, Inc. and resulted in the Cystic Fibrosis Indicator System sweat test, which has developed into the CF Quantum Patch in collaboration with PolyChrome Medical Inc.
2006 Hoban Scholars Selected Five University of Minnesota Masters program students were chosen as recipients of the 2006 Thomas W. and Mary Kay Hoban scholarships. The awards were presented to the students by H. Thomas Blum, M.D., chair, Hoban Scholarship Selection Committee, at the Recognition Break-
Jennifer Dobratz U of M Nutrition
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Barbara Jacobs U of M Master’s in Healthcare Administration
January/February 2007
fast on October 24, 2006. As a condition of the award, each Hoban Scholar is asked to make a presentation on a project they have completed for their coursework. This annual Hoban Scholar Educational Event will occur this spring.
Sara Johnson Rebecca Kocos U of M School of U of M Public Health Masters of Public Masters of Public Health Nutrition Health Nutrition/ Dietetic Internship for Graduate Students
With two months under our belt, the Scott County Smoke Free Project is moving forward with great success. Jennifer Anderson, Project Coordinator recently moved into new office space generously provided by St. Francis Regional Medical Center in Shakopee. Jennifer is meeting with physicians and community leaders, building a strong core coalition that will be instrumental in the success of a clean indoor air policy. Community assessments are also well underway. Community assessments define the policy environment for a smoke-free indoor ordinance. Currently, all of Scott County is being assessed to determine if a county ordinance would be pursued, or if a cityby-city approach would be more successful. If you are interested in becoming a member of the Scott County Smoke Free Coalition, please call Jennifer Anderson at (612) 578-0981 or janderson@metrodoctors.com.
In Memoriam MARKHAM “MARK” FISCHER, M.D., died Wednesday, November 8, 2006 at the age of 67. He attended medical school at the University of South Dakota and at Washington University in St. Louis, Missouri. After medical school he enlisted in the U. S. Navy and served during Vietnam. Following his service he finished his training in radiology. Dr. Fischer was with Consulting Radiologists Ltd. at New Ulm Medical Center in New Ulm and Abbott Northwestern Hospital in Minneapolis. Dr. Fischer joined HMS in 1997. ROLF M. IVERSON, M.D., age 95, of Sun City West, AZ, passed away November 2, 2006. He graduated from St. Olaf College, and received his medical degree from Northwestern University Medical School. He completed a fellowship in radiology at the Mayo Clinic. Dr. Iverson joined HMS in 1941.
Kara Mitterholzer U of M School of Public Health Public Health Nutrition
MetroDoctors
RAPHAEL J. WEISBERG, M.D., died recently at the age of 92. He graduated from the University of Minnesota Medical School. Dr. Weisberg specialized in internal medicine. He joined HMS in 1948. The Journal of the Hennepin and Ramsey Medical Societies
New Members HMS welcomes these new members to the Society.
ACTIVE Sureshbabu N. Ahanya, M.D. Minnesota Perinatal Physicians Maternal Fetal Medicine, Obstetrics & Gynecology Christopher J. Altman, M.D. Metropolitan Anesthesia Network, L.L.P. Anesthesiology
Theodore M. Berman, M.D. Minnesota Lung Center Pulmonary Medicine, Sleep Disorders Martin Birth, M.D. University of Minnesota Department of Anesthesiology Anesthesiology William A. Block Jr., M.D. Minnesota Perinatal Physicians Obstetrics & Gynecology Michael J. Burke, M.D. University of Minnesota Physicians Pediatric Hematology Oncology David R. Burrus, M.D. Minnesota Perinatal Physicians Maternal Fetal Medicine, Obstetrics & Gynecology Paul M. Cammack, M.D. Northwest Orthopedic Surgeons Orthopedic Surgery
David M. Dvorak, M.D. Emergency Physicians Professional Association Emergency Medicine Sean P. Elliott, M.D. University of Minnesota Physicians Urology Helen M. Feltovich, M.D. Minnesota Perinatal Physicians Maternal Fetal Medicine Carlos E. Figari, M.D. Hennepin Family Medical Center Family Medicine, Geriatric Medicine Joan M. Fox, M.D. Minnesota Lung Center Internal Medicine, Pulmonary Medicine, Sleep Medicine Dean H. Gesme, M.D. Minnesota Oncology Hematology, P.A. Medical Oncology Christopher H. Hall, D.O. Kidney Specialists of MN, P.A. Internal Medicine, Nephrology David C. Hanson, M.D. University of Minnesota Physicians Pediatrics Kenneth C. Haycraft Jr., M.D. Bloomington Lake Clinic, Ltd., Minneapolis Family Medicine
James C. Clark, M.D. Burnsville Family Physicians P.A. Family Medicine
Robert C. Hoch, M.D. Minnesota Lung Center Pulmonary Medicine, Critical Care Medicine
Tracie C. Collins, M.D. University of Minnesota Physicians General Preventive Medicine
Tina C. Huang, M.D. University of Minnesota Physicians Otolaryngology
Yvonne M. Datta, M.D. University of Minnesota Physicians Hematology, Oncology
Jay A. Hudson, M.D. Minnesota Lung Center Pulmonary Medicine/Internal Medicine/Critical Care Medicine
Catherine A. DeMoss, D.O., M.P.H. North Memorial ClinicOccupational Health Occupational Medicine, Family Medicine MetroDoctors
Vallabh Janardhan, M.D. University of Minnesota Physicians Neurology
The Journal of the Hennepin and Ramsey Medical Societies
Eric H. Jensen, M.D. Hennepin County Medical Center Surgery
Christopher E. Ott, M.D. Fairview Oxboro Clinic Family Medicine
J. Stephen Jones, M.D. Minnesota Perinatal Physicians Maternal Fetal Medicine, Obstetrics & Gynecology
Kathleen M. PďŹ&#x201A;eghaar, M.D. Minnesota Perinatal Physicians Maternal Fetal Medicine, Obstetrics & Gynecology
Susan L. Kearney, M.D. University of Minnesota Physicians Pediatrics
Lisa L. Saul, M.D. Minnesota Perinatal Physicians Maternal Fetal Medicine, Obstetrics & Gynecology
Margaret A. Kersey-Isaacson, M.D. Hennepin County Medical Center Pediatrics Timothy P. Kinney, M.D. Hennepin County Medical Center Internal Medicine Barbara Knoll Arndt, M.D. HCMC Radiology Diagnostic Radiology Aleksandra K. Kukla, M.D. University of Minnesota Physicians Nephrology Shelley M. Lennox, M.D. Minnesota Lung Center Pulmonary Medicine, Internal Medicine Michael J. Lyons, M.D. Metropolitan Anesthesia Network, L.L.P. Anesthesiology Margaret A. MacRae, M.D. Minnesota Oncology Hematology P.A. Oncology, Hematology Sanne Magnan, M.D. Institute for Clinical Systems Improvement Internal Medicine Sapoora Manshaii, M.D. University of Minnesota Physicians General Surgery Bradley J. Nelson, M.D. University of Minnesota Physicians Orthopedic Surgery Kolawole S. Okuyemi, M.D. Smileyâ&#x20AC;&#x2122;s Family Practice Clinic Family Medicine
Thomas J. Schaefer, M.D. Metropolitan Anesthesia Network, L.L.P. Anesthesiology Sarah B. Schmitz-Burns, M.D. John A. Haugen Associates, P.A. Obstetrics & Gynecology Timothy P. Singleton, M.D. University of Minnesota Dept. of Laboratory Medicine & Pathology Pathology Ralph E. Steele, M.D. Minnesota Lung Center Pulmonary Medicine, Sleep Disorders Patsa H. Sullivan, M.D. Minnesota Radiology Oncology Group Radiology Oncology Stephen J. Swanson, M.D. Hennepin County Medical Center Pediatrics Jessica M. Swartout, M.D. University of Minnesota Physicians Obstetrics & Gynecology Selwyn M. Vickers, M.D. University of Minnesota Physicians General Surgery William E. Wagner, M.D. Minnesota Perinatal Physicians Maternal Fetal Medicine, Obstetrics & Gynecology Sabrina M. Walski-Easton, M.D. Neurosurgical Associates, Ltd. Neurosurgery Michael R. Wexler, M.D. Advancements in Allergy & Asthma Care, Ltd. Allergy & Immunology, Pediatrics January/February 2007
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Hennepin Medical Society
Laurie S. Azine, D.O. Fairview Crosstown Clinic Internal Medicine, Osteopathic Manipulative Medicine
Ty B. Dunn, M.D. University of Minnesota Physicians General Surgery, Transplantation Surgery
HMS ALLIANCE NEWS ELEANOR GOODALL
Resolve That...
N
NEW YEARS RESOLUTIONS. We all make them. And, in my experience, most of us break them. Oh, we’re pretty good about it for a while, but old habits die hard and former attitudes and ways of doing things come to the fore. Perhaps it has something to do with our resolutions often not centering around the positive attributes of our lives but more on negativity and our resolve not to do things. Did you know that the tradition of New Years resolutions goes all the way back to 153 B.C. and originally dealt with forgiveness from enemies? Pretty heavy stuff. That kind of resolve has some meat to it. Now, in this American society of ours, what do you think is the most common New Years resolution? If you guessed, “lose weight” you would be correct. The second most common is “stop smoking.” Interestingly, we have to go all the way to number 10 to find “be a
better person.” In between we cover money, more exercise, eating better, and so on. What does this mean? I’m wondering, since number 10 is “be a better person” and number one is “lose weight,” do we basically like the kind of persons we are, but feel we’re a little chubby? Or, are we obsessed with weight
HMSA members gathered to celebrate the season at the home of Dr. Patrick and Linda Smith. They also held a silent auction to raise money for their HIV/ AIDS Education project.
HMS Senior Physicians Association The HMS Senior Physicians Association final meeting for 2006 was held on November 14 at the Zuhrah Shrine Center. Jan Malcolm, CEO of Courage Center, was the featured speaker recounting her “travels through the health system” and her continued passion for health policy and public health. Richard Streu, M.D. was recognized as out-going president of the Senior Physicians Association and thanked for his service this past year. The following slate of officers was duly elected for 2007: President-elect: Robert E. Doan, M.D.; Secretary/Treasurer: Edward A. Spenny, M.D.; Member-at-large: Kenneth V. Hodges, M.D.; and Member-at-large: John Kyllo, M.D.
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January/February 2007
Please mark your calendar with these 2007 meeting dates: Tuesday, April 24 Tuesday, June 12 Tuesday, September 18 Tuesday, November 13
HMS CEO Jack Davis presents Richard Streu, M.D. with a gift in appreciation for his service as Senior Physicians Association president.
MetroDoctors
such that being slim is 10 times as important as being a nice person? I like my first interpretation of this. What can we do about it? Indeed can we do anything about it? I think we can. Here we are, members of a medical Alliance committed to helping to build healthy communities, faced with people in our communities whose number one resolve this New Years will be to lose weight, with a second resolve to stop smoking. I don’t know if we can be of much help to adults, but we certainly have the resources to work with children on these issues. The MMA Alliance has an activity book for 2nd and 3rd graders, Food Label Detective, which helps children make wise decisions about food choices. It’s a start. We also have a card for teens, Tobacco Smoke Is No Joke, with a catchy, kid-oriented anti-smoking message. Both these items are free for Alliance members to give to schools and other kid venues. Let’s make use of them! The HMS Alliance is also involved with the Smoke Free Coalition. Let’s get even more involved. We’re good at this. We’ve been working with kids, talking about and demonstrating the healthy communities theme, for years and years. We can do more! As I looked at the listing of resolutions, I have to say that I thought of an especially beneficial thing to me about the HMS Alliance. I can’t think of any of my friends in this organization that would “resolve that”...number 10. They are already the best persons I know. And, that given, I plan to “resolve that...I help the HMS Alliance help others, especially kids,” with those first two of each year’s most common resolutions. Let’s work on it, shall we? Together we can accomplish mighty things!
The Journal of the Hennepin and Ramsey Medical Societies
Fantastic Family Home
Gorgeous wood floors and cabinets, bright and open public rooms, and main floor study. Deluxe master suite and large bedrooms upstairs. Lower level family room with builtins. Beautiful yard with screened porch. 5 bedrooms, 4 baths. 649,900
Steps to Lake of the Isles
Unique Arts & Crafts influenced condo conversion. An exquisite renovation with a private patio, bright public spaces, all natural woodwork, and main floor family room. Feels like a single family home with all the amenities of condo living! 3 bedrooms, 4 baths. 999,000
Outstanding Neighborhood
Trillium Bay Cottage
Charming Prairie School
Beautiful hardwood floors and cabinets, vaulted living room with fireplace attached to main floor study. Deluxe master suite, 3 bedrooms on one level. Stunning décor throughout. Great backyard with natural wetland area. 4 bedrooms, 4 baths. 679,900
Charming 2 story set on a private lot with vaulted and beamed ceilings, 2-story stone fireplace, gourmet kitchen, large master suite, 4 bedrooms up and more. 4 bedrooms, 4 baths. 919,000
Just steps from Lake of the Isles, featuring spacious gourmet kitchen with adjoining family room and custom millwork to match the original era of architecture, stained glass, master suite addition with sitting area, landscaped yard, and new garage. 3 bedrooms, 4 baths. 949,900
Spectacular Setting Set on a 7+ acre lot with breathtaking grounds, winding driveway, rolling hill, mature trees, pool, stable, and kennels. A beautifully scaled home near Spring Hill Golf Club. 6 bedrooms, 9 baths. 2,650,000
Call: Bruce Birkeland
612-925-8405 www.brucebirkeland.com
MEMBERSHIP ADVANTAGES FOR PHYSICIANS AND THEIR PRACTICES C A L L R M S AT 61 2 - 3 6 2 - 37 0 4 F O R D E TA I L S . ɻ
AmeriPride Apparel and Linen Services is a locally owned and operated company offering rental and cleaning services of medical garments. Their organization is top notch with quality products and services. Medical society members receive a discount. For a free price quote, contact Steve Severson from AmeriPride at 612-362-0334.
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Stanton Group/Schwarz Williams Companies, Inc. offers RMS and MMA members individual and group benefits (medical, dental, life, disability) as well as human resource support services, executive benefits, retirement programs, COBRA/HIPAA/ERISA compliance, and benefit administration. For more information, contact Jim Fries at 763-591-5822 or visit their website at www.schwarzwilliams.com.
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SafeAssure Consultants recently partnered with RMS to offer the required OSHA compliance training for our members and their staffs. Medical society members receive a 50-60% discount on services and training. To meet or exceed the Minnesota OSHA and Federal OSHA requirements, talk with SafeAssure at 1-800-920-SAFE or visit their website at www.safeassuremedical.com for more information.
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IC System is a Minnesota (St. Paul) based company specializing in full-service revenue cycle management solutions for the health care industry. They are now offering RMS members effective, ethical, and cost effective solutions to collecting debts, improving cash flow and reducing costs. For more information and a no-obligation price estimate, please contact I.C. System directly at 1-800-279-3511 and let them know you are a RMS member.
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Berry Coffee Service is a valued partner of RMS and offers medical society members up to 25% off their wide array of coffee and hot beverage services. If you are interested in trying their service, contact Bob Dilly at 952-937-8697. If you are an existing customer of Berry Coffee Service, be sure that you are receiving the discounted pricing.
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