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• Relate clinical pearls from the national guideline experts, Barton Schmitt, MD and David Thompson, MD • Examine challenging triage situations: asthma control, emergency first aid, community MRSA’s, mental health problems, managing obesity, contraception, emergency planning for complex patients, assessing neurological symptoms

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• Details and registration form available at www.cpnonline.org. Or, email your request for full details to: childrenstriage@childrensmn.org.

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A limited number of Sponsorship and Exhibitor Opportunities are still available. For details, email childrenstriage@childrensmn.org or call 612-813-7435.

Children's Physician Network. The Minnesota Medical Association (MMA) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Minnesota Medical Association and

The MMA designates this educational activity for a maximum of 17.5 AMA PRA Category I credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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 Sue Schettle 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.

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

MetroDoctors

contents VOLUME 9, NO. 4

2

J U LY / A U G U S T 2 0 0 7

colleague interview

Timothy J. Crimmins, M.D.

3

Classified Ads

4

Feature

MinnesotaCare or Primary Care: Which Will Survive?

7

Opportunity to Collect from Blue Cross Blue Shield Settlement

8

2007 Session Health Report

11

physician’s soap box

Broken Mental Health System Puts Us at Risk

12

Index to Advertisers

13

One Step Closer to Long-Awaited Credentialing Reform

14

Strengthening Foodborne Disease Surveillance and Improving the Safety of Our Food Supply

15

Team Up With Your Regional Prevention Coordinator

17

Medical Students Connecting With Community Physicians

19

Four Popular Approaches to Health Care Performance Improvement

22

Members in the News

Ramsey Medical Society

23 24 25 26

President’s Message Dakota County Smoke-Free Updates Celebrating the Retirement of Roger K. Johnson

Resolutions Discussed/Board Recognizes Roger K. Johnson/ RMS Public Policy Council/In Memoriam

27

RMSF Hosts 2nd Derby Day/Foundation Awards Grants

28 29 30 31 32

Hennepin Medical Society

Chair’s Report/Call for Delegates HMS In Action/New Members Foundation Improves Public Health HMS Caucus Convenes HMS Alliance News

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: The expansion of MinnesotaCare may have a significant economic impact on primary care clinics.

Article begins on page 4.

July/August 2007

colleague interview

Timothy J. Crimmins, M.D.

Timothy J. Crimmins, M.D. joined General Mills in May of 1998 as Vice President and Director of Health, Safety and Environment. General Mills is known for its outstanding health, safety and environmental programs and has one of the best safety records in the food industry.

Dr. Crimmins earned his Doctor of Medicine from the Indiana University School of Medicine and completed a residency in Emergency Medicine at Hennepin County Medical Center. Dr. Crimmins is Board Certified by the American Board of Emergency Medicine.

Q A

What, in your opinion, are the most serious and important environmental/public health issues facing us today, and what should we, as physicians, be doing about them?

I believe diabetes will become the number one health issue facing our country in the coming two decades. As physicians, we play an important role in diabetes prevention by promoting sustainable lifestyle changes as the key to better long-term health. Education and long-term support empower patients to better manage their health by eliminating at risk behaviors, increasing physical activity and eating a diet rich in whole grains, fruits and vegetables.

Given recent outbreaks of serious foodborne illness in the United States, what additional steps do you think can and should be taken to ensure the safety of our food?

We ensure the safety of our products by using stringent safety measures throughout our production process to control E. coli and other foodborne pathogens. We support steps by Congress, such as the proposed National Uniformity of Food Act, to standardize food safety labeling requirements. The health and well-being of our consumers is the highest priority at General Mills.

What more can and should be done to prevent microbial contamination of meat and produce?

You can be assured that the canned and frozen vegetables that you buy from Green Giant and Cascadian Farm have been processed to include a “kill step” that prevents microbial contamination. But because we’re not in the meat or fresh produce business, I don’t really have enough expertise to make recommendations.

July/August 2007

At General Mills, what role do you play in ensuring the safety of the food they produce and market?

General Mills has an entire quality organization focused on ensuring the safety and quality of the food we produce. I interact with that organization on food safety issues. An example might be how a foodborne illness might present itself. I have been very involved in the leadership role General Mills has taken as a company on allergens and allergens labeling.

My role is to be very involved in the health and public health aspects of such discussions. It is a role that I feel very strongly about.

What is your response to the issues of obesity and diabetes, as it pertains to the high sugar content of many of the GM products?

Obesity and diabetes are serious health risks with many contributing factors, including the availability of food and increasingly sedentary lifestyles.

At General Mills, we believe a balanced diet and a healthy, active lifestyle are the keys to healthy living, and we are very focused on developing and offering healthy product choices. It is a very important part of our business.

We offer a broad range of food choices that both meet consumer preferences and can help maintain a healthy weight. Calories are key.

We offer more than 250 products that provide just 130 calories or fewer per serving. Clear and accurate product labeling is also important. We have very stringent standards in this regard, and we are widely viewed as an industry leader in this area.

We also support programs and initiatives — both inside and outside the company — that seek to help consumers improve overall nutrition and fitness. One of our programs, the General Mills Foundation’s MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Champions for Healthy Kids grant program, has invested more than $8 million in youth nutrition and fitness programs and has served more than 150,000 children across the country since 2002. We have also encouraged our employees to live healthier, more active lifestyles with a variety of very successful programs and resources over more than 20 years.

We want to be part of the solution, and we believe we can be.

As a large company corporate medical officer: what is your input and advice to your company’s insurance offerings to its employees; your views on the strengths and limitations of insurance payments pay-for-performance linked to (ICSI) “evidence-based” treatment guidelines; the future of consumer-driven health care HSAs and how your company would like to see this go; and support for provider fee and managed care payments transparency?

As the chief medical officer, I am quite involved, not only in helping to shape the company’s viewpoint as to how medical care should be delivered and consumed, but also in areas like wellness, prevention and consumer involvement. HSAs are growing. Companies across America are embracing the concept, and Minnesota leads the nation in that regard.

General Mills has experimented with its own consumer-driven health plan with success. As to the broader question of where we would like to see this go, we definitely have a viewpoint and would like to see some type of broader access to insurance coverage. Health care is probably

a topic of discussion inside every large company in America. That is certainly true at General Mills.

Should employees own and control their own health insurance policies?

We believe that employers can play a valuable role in health care. We believe we do that for the employees of General Mills. Not everyone works for a company like General Mills. Certainly, owning and controlling one’s own health insurance policy is better than being uninsured.

But we continue to see a positive role for employers as well.

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

to help your practice thrive

that puts you first

July/August 2007

Feature story

MinnesotaCare or

Which Will Survive?

Primary Care

...having a state-sponsored insurance card will do nothing to improve access to those who are currently uninsured, and may actually decrease access for those who are currently served through state programs.

H

“Health” — personal health. This is one of the fundamental goals in the great health care debate that is heating up in Minnesota as well as across the country. “Health care” generally refers to those services, products and interventions that are more likely to lead to future health, or to treat those conditions that are detracting from current health.

“Health insurance” is simply a method of paying for those services, products and interventions that are designed to improve health. These appear to be fairly straightforward distinctions. You can have great health with absolutely no health insurance. Conversely, great health care and comprehensive health insurance do not guarantee that you will have a healthy future.

A challenging trend for those of us who have dedicated our lives working to enhance the health of others has been the blurring of these distinctions in recent years. This blurring causes confusion among our legislators, users of health care services, purchasers of insurance and the public as a whole. Wrong thinking and incorrect solutions follow equating “health” with “health insurance” or “health insurance” with “health care system.” This blurring can also lead to some bad outcomes and poorer access for our patients, especially children and those who are economically disadvantaged.

One very real example of this in Minnesota is “universal coverage.” I am with a great majority of physicians who eagerly welcome a program that ensures access for all Minnesotans to quality health care services. I am very concerned that the Legislature’s answer to universal coverage is simply expanding MinnesotaCare as it currently exists to cover more patients. The basic concern is that simply having a state-sponsored insurance card will do nothing to improve access to those who are currently uninsured, and may actually decrease access for those who are currently served through state programs.

This contradiction of increasing insurance coverage while decreasing access is due to the underlying economics of MinnesotaCare. In order for the state to “afford” broader coverage of uninsured individuals, the Legislature is proposing reimbursement rates to clinics in the range of 5 percent above general medical assistance rates. Many primary care physicians cannot afford to see patients at these rates if they literally wish to keep their doors open. Clinics will not be able to open their waiting rooms to new MinnesotaCare patients. Their current MinnesotaCare patients are at risk because clinics may have to discontinue participation with some insurance plans such as UCare or Metropolitan Health Plan.

To get some sense of how reimbursement would be affected under an expanded MinnesotaCare, consider two examples from a 2004 American Academy of Pediatrics survey comparing reimbursement rates in Minnesota for Medicaid, Medicare and com-

by peter dehnel, m.d.

July/August 2007

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

mercial insurance. For CPT code 99213 — a very common acute care visit code in primary care — Medicaid would reimburse $28.42, Medicare would reimburse $51.12 and the median commercial plan reimbursement would be $71.91. There is an even greater disparity for well child visits. Reimbursement for CPT code 99392 — a well child visit for ages 1 to 4 years — was found to be $29.84 under Medicaid, $84.88 under Medicare and $113.24 for the median commercial plan.

The net result of this reimbursement proposal is that for every 10 percent increase in MinnesotaCare business, a primary care clinic’s overall reimbursement will go down by approximately 6 to 7 percent. This is happening at the same time that the costs of operating a primary care clinic are increasing by 3 to 5 percent per year. With other reimbursement sources being relatively flat, this is not an economically viable solution, considering the relatively tight operating margins of most clinics. For those primary care clinics that also have a significant Medicare population, projected reimbursement cuts over the next few years through that program add additional financial pressures that create a “perfect storm” in terms of near-term clinic funding and economic survival.

These economic projections are preceded by an unfavorable trend in primary care reimbursement going back to the early 1990s. Medicaid reimbursement has been basically flat, and Medicare reimbursement rose at an annual rate of slightly over 1 percent. Due to payment tightening by insurers, shifting costs from “government” patients to commercial insurance patients has been lost as an option. Most clinicians initially responded by increasing their productivity as well as streamlining their operations, but those options have now run their course.

It is important to point out that the current reimbursement picture is slightly better for procedurally based specialties and for hospitals. Some procedures are actually reimbursed better through Medicaid than commercial insurance. Hospitals are able to receive special funding and extra payments through a variety of mechanisms not available to most primary care clinics in Minnesota.

...for every 10 percent increase in MinnesotaCare business, a primary care clinic’s overall reimbursement will go down by approximately 6 to 7 percent.

A Single Payer Solution?

How should physicians be engaged in finding solutions to the issues involving “health,” “health care” and “health insurance”? According to a study reported in the February 2007 edition of Minnesota Medicine (Vol.90), 86 percent of Minnesota physicians surveyed agreed that it is the responsibility of society, through the government, to ensure that everyone has access to good medical care. Of the surveyed physicians, 64 percent favored a single payer system, 25 percent favored health savings accounts and 12 percent

(Continued on page 6) MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

July/August 2007

Feature (Continued from page 5)

Near-term Recommendations

favored managed care. Only 41 percent of physicians stated that the private insurance industry should continue to play a major role in financing health care.

There is probably little debate that a single payer system which is benevolent, well informed, evidenced-based, adequately funded and not subject to political or budgetary pressures, would be a significant improvement for primary care clinics. This system would have to be fundamentally different than MinnesotaCare, Medicaid, general medical assistance and Medicare — our current government-based solutions for health insurance — as they currently exist. This type of comprehensive solution is likely years away, as well, and would require a level of legislator understanding that is missing at this time.

Physicians genuinely want to take care of all citizens, regardless of their insurance status. It would be hypocritical of the Legislature to enact “health insurance for all” and then not adequately fund the legislation to ensure that people actually get the services they need. While not comprehensive, the following are some approaches that we, as physicians concerned about the care our patients receive, can promote right now with our elected officials: • Set state-sponsored reimbursement rates at the “median commercial rate.”

Commercial insurance payments are not generous, and commercial insurers have already reduced reimbursement to a “bare bones” rate.

• Consider a voucher system for statesponsored programs, much like the WIC (Women, Infants, Children) Program provides for the basics of

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July/August 2007

nutrition. WIC does not require a grocery store to sell a $3.00 gallon of milk for $1.20, so why should the state expect that physicians can continue to give away their “product” at a 60 percent discount. Since many preventive services actually provide a “return on investment” to the state, those services could be provided without the need of utilizing a “voucher.”

• Pay clinicians for effective chronic disease management. This segment of the population is responsible for 70 to 80 percent of the total health care costs. Effectively and efficiently managing these individuals will enable the state to cover a much broader number of “healthy” individuals with no increase in costs.

• Automatically enroll everyone who does not have insurance into the state employee health insurance program, with premiums and co-pays based on a sliding scale according to income.

This may be expensive, but it would put access and quality on par with state employees.

• Legislate that the “provider tax” actually goes to pay for health services for the uninsured, and not just transferred over to the state’s general fund.

• Finally, spearhead the development of effective programs that encourage individuals to make healthier decisions. No health care system or insurance is ever going to give “health” to a sedentary 42year-old male who smokes, has a BMI of 39 and a family history of diabetes and heart disease.

Physicians need to become more involved in this discussion on how health care will look in Minnesota in the future.

The time is now, the urgency is great, and our current and future patients need us to be taking a lead in the solutions that will be developed. And please make no mistake: solutions will be developed — even without us.

Peter Dehnel, M.D., is the medical director for Children’s Physician Network.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Opportunity to Collect from Blue Cross Blue Shield Settlement Cash Refund Opportunity

In the past four years there have been HMO Class Action lawsuit settlements involving several large insurance companies. To date, Anthem/Wellpoint, CIGNA, Aetna, Humana, Prudential and HealthNet have settled the cases against them for more than $450 million in refunds. While every MD and DO is eligible to participate, only one-third of the eligible physicians have actually filed claims for the past settlements. Depending on the number of physicians your group practice or hospital employs, this issue can result in a significant opportunity for a retroactive cash payment.

Parallel litigation involving Blue Cross Blue Shield plans across the country has recently settled. You now have the opportunity to get your share of the $128 million pool for physician refunds set aside by Blue Cross Blue Shield.

As a benefit to you, as a member of the Hennepin or Ramsey Medical Society, Managed Care Advisory Group (MCAG), a national expert in providing Multi-district Litigation (MDL) settlement assistance to physicians, is offering its assistance to hospitals and physician practices in Minnesota to file for and recover the maximum amount under the MDL settlements that are currently pending. Contact MCAG Customer Care at (800)355-0466 for more information.

Beyond the Cash: Mandated Contracting Changes

In addition to the cash refunds, the ongoing MDL settlements are estimated to result in more than $1 billion in forward savings for physician practices due to changes in contracting and claims payment policy changes mandated by the settlements. There are many new rights and payment rules favorable to MetroDoctors

physicians in these settlements, but most physicians and hospitals are unaware of their gains and many are unwittingly negotiating these new rights away in their new payer contracts. Among other stipulations, the insurance companies agreed to: • Disclose policies regarding claim coding and payment.

• Adhere to most AMA CPT codes, guidelines, and conventions.

• Make fee schedules available to physicians.

• Adhere to more restrictions on “Silent PPOs” and the resale of pricing discounts.

• Implement more restrictive “overpayment

recovery” rules.

• Offer improved dispute resolution pro-

cedures with strict limits on the cost of Arbitration.

Members of the Hennepin and Ramsey Medical Societies should be aware of the potential financial benefit to their practices from these settlements. For further information on assistance from MCAG, including a member discount, please contact MCAG Customer Care at (800) 355-0466. Additional information is available at www.hmosettlements.com.

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The Journal of the Hennepin and Ramsey Medical Societies

July/August 2007

2007 Session Health Report

T

Throughout the 2006 election cycle,

candidates on both sides of the aisle campaigned on platforms featuring comprehensive proposals to expand access, maintain quality and contain the rising cost of health care. With Democrats gaining control of the House and padding their majority in the Senate, along with the governor expressing support for providing health coverage for children, many political observers expected ambitious expansions of public programs to provide coverage to the uninsured.

High expectations, however, underwent an inevitable decent as freshman legislators and newly minted Democratic leaders recognized that any attempt to overhaul the health industry was going to require more time, preparation and input from the public before moving forward, thus setting the stage for what may be an active 2008 legislative session.

In the initial health spending bill, House and Senate DFLers opted to craft an omnibus health bill rolling back cuts to MinnesotaCare and other public programs implemented in 2003 and 2005, authorizing a 3 percent Cost of Living Adjustment (COLA) increase and commissioning a variety of study groups looking at different health reform proposals.

Due to the volume of public program expansions and their adverse long term fiscal implications, Governor Tim Pawlenty promptly vetoed the initial proposal in early May, sending it back to the legislature for further review.

Pawlenty specifically asked legislators to cut up to $200 million out of its initial request.

Subsequent deliberations exposed the significant philosophical disparities between

BY

matthe w s . scha f er

July/August 2007

the Governor and the Senate with regard to health care reform. The views of House health conferees were in large part muted primarily because of recalcitrant personalities within the other negotiating parties.

The final product of the compromise reflected the proverbial middle ground that some of the more moderate members of the legislature promised to deliver. The Health and Human Services Omnibus Spending Bill, which the Governor’s office signed on May 25, spends about $10.2 billion in the current biennium, and authorizes a number of expansions to MinnesotaCare that legislators anticipate will result in approximately 56,000 new beneficiaries, 37,000 of whom are children.

The bill authorizes 2 percent Cost of Living Adjustment (COLA) increases in 2008 and 2009 for long term care facilities across the state, which left several legislators with multiple nursing homes in their districts underwhelmed. Hospitals will receive some financial relief from one time Federal dollars via the Medicaid Disproportionate Share Hospital (DSH) program, which provides financial support to hospitals serving a significant number of low-income patients with special needs.

Some hospitals will also receive financial assistance via the Medical Education and Research Costs (MERC) fund, which was established in 1996 to compensate hospitals and clinics for a portion of the costs of clinical training. These costs had traditionally been covered by teaching facilities charging higher rates for patient care; however, third party payers in recent years had become less willing to pay the higher charges at teaching institutions, leaving teaching facilities at a competitive disadvantage.

Early in the session, there was talk about authorizing a statewide uncompensated care MetroDoctors

fund; however, a lack of revenue prevented this vision from becoming policy. Additionally, health committee members have maintained that a large portion of uncompensated care can be alleviated by ensuring that all Minnesotans have some sort of health insurance. Missing from this discussion was the additional challenge health providers are experiencing from the low reimbursement rates offered by public health programs.

The Minnesota Medical Group Management Association (MMGMA) took the lead in advancing legislation that clarifies a current law requiring health care providers and health plan companies to provide information to consumers on payments received or provided and enrollee costs.

Originally introduced by Rep. Julie Bunn (DFL-56A) and Sen. Linda Berglin (DFL-61) in the Senate, the section changes the terminology in current statute from “reimbursement” to “allowable payment” and requires information on the amount due from the enrollee and enrollee out-of-pocket expenses to be provided in the estimate. If a consumer does not have health insurance, the health care provider must give the consumer a good faith estimate of the average allowable reimbursement the provider accepts from private third-party payers for the services specified by the consumer as well as the estimated amount the non-covered consumer will be required to pay.

The legislature stuck to its pledge to include legislation streamlining the administrative aspect of the health care delivery system by adding a provision requiring the state to develop uniform billing forms and coding requirements to be used by all payers and providers — a proposal that has also gained the support of the Governor.

Policymakers are hoping this section will The Journal of the Hennepin and Ramsey Medical Societies

result in replicating a similar system developed in Utah that allows the many different billing systems used by doctors, insurers and hospitals to communicate with one another statewide.

Additionally, the state’s competing insurers worked together to cut a list of 900 codes for accepting or denying medical claims down to 90 with common definitions. In subsequent years, Utah has been largely immune to the staggering increases in health premiums that other states have endured.

The omnibus bill also included legislation establishing a system requiring dispensers of controlled substances to electronically report specified information to the Board of Pharmacy. This proposal was crafted in conjunction with the National All Schedules Prescription Electronic Reporting Act (NASPER), and includes an amendment prohibiting the Minnesota Board of Medical Practice from using information collected in the registry to prosecute anyone who prescribes the medication.

The amendment came in response to concerns that health care providers would feel pressure to under-prescribe medications to patients to avoid arrest, however, legislators have heavily emphasized that the intent of the bill is to go after people who are abusing or selling prescription drugs.

The provision relies exclusively on federal funding, however there have been rumors circulating that there are little or no federal funds available. If this is the case, the NASPER bill would not be implemented unless the state provides funding in a future biennium.

During the health spending bill’s review on the Senate floor, Senate Health and Human Services Budget Division Chair Linda Berglin (DFL-61) added a provision authorizing a two year moratorium on the construction of any radiation facility located in 11 counties across the state. The new policy would not apply to the relocation or reconstruction of any facility owned by a hospital if the relocation or reconstruction is within one mile of the existing facility.

Missing from the Health and Human Services Omnibus legislation was a bill requiring health plans to cover the cost of language interpreters. In spite of hospitals, providers and health plans reaching a compromise on the measure, the language interpreter bill was removed from the health omnibus bill MetroDoctors

in response to a veto threat during conference committee negotiations.

The compromise included a provision authorizing an Interpreter Services Work Group to develop findings and make recommendations regarding access to and quality of interpreter services. This veto threat came in spite of widespread bipartisan support for the measure, which was viewed by many health providers as a legislative priority. Remaining undeterred, supporters of the language

interpreter bill will continue their campaign to advance this measure in 2008.

On a more positive note, Gov. Tim Pawlenty signed the Freedom to Breathe Act into law this legislative session, making Minnesota the 20th state to institute a comprehensive smoking ban at places of employment to include bars and restaurants. The law, which may very well become the most prominent new (Continued on page 10)

Restoring and maintaining our patients health and well-being

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The Journal of the Hennepin and Ramsey Medical Societies

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July/August 2007

2007 Session Health Report (Continued from page 9)

measure to pass during the 2007 legislative session, will officially go into effect October 1.

The Freedom to Breathe Act marks a significant victory for a coalition of health providers, health plans and concerned citizens who have worked tirelessly with cities, counties and state legislators garnering support for a ban. This effort has entailed advancing smoking bans in cities and counties across the state where voters could see that such a policy would prove to be a family friendly, healthy alternative to unnecessarily exposing employees and consumers to secondhand smoke.

Proponents of a statewide proposal effectively conveyed that the Freedom to Breathe Act is a common sense initiative that Minnesotans have asked for and patiently waited for. In a recent study conducted by Clearway Minnesota, 69 percent of Minnesotans said they would support a comprehensive statewide smoke-free law that includes bars and restaurants.

In the past, opponents have successfully stalled legislative efforts citing personal rights

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10

July/August 2007

and potential small business harm. Those arguments, however, have lost credibility as other states experienced revenue growth in the hospitality industry after comparable bans were implemented.

The legislature also passed a bill requiring every hospital, outpatient surgical center and nursing home across the state to adopt a written safe patient handling policy establishing the facility’s plan to achieve by January 1, 2011, the goal of minimizing manual lifting of patients by nurses and other direct patient care workers by utilizing safe patient handling equipment.

In conjunction with this undertaking, the state has allocated one million dollars over the biennium to be used for grants to aid providers in purchasing any necessary equipment to comply with the new regulations. The grants will be for up to $40,000 per applicant.

Another bill that did not pass, but will likely resurface in 2007 implements a number of recommendations made by the Workers’ Compensation Advisory Council including the reduction of reimbursement and fee schedules for workers’ compensation for all hospitals within the 11 county metro region, and seeks to require physicians to use the fee schedules utilized by the Centers for Medicare and Medicaid Services for workers’ compensation.

This bill did not receive a hearing in the House before the policy deadline, but the Department of Labor and Industry is planning to assemble a group over the summer to review this issue. This group will be just one of several planning to meet between legislative sessions that members of the health provider community should be aware of.

What Lies Ahead Although the legislature has adjourned for the 2007 session, the work is just beginning for health care providers. Representative Huntley is planning to facilitate a series of meetings where citizens and legislators will look at comprehensive and pragmatic solutions to obtaining the goals legislators campaigned on last year.

Some ideas that are sure to resurface will involve capping health premiums, authorizing certificates of need and potentially expanding the hospital moratorium process to all health care providers. Legislators have opined in MetroDoctors

open forums about whether diagnostic imaging facilities and ambulatory surgical centers contribute to the rising cost of health care, and whether the growth of new freestanding surgical centers are part of the problem.

These accusations were amplified in February when the Minnesota Department of Health released a report declaring an overabundance of decisions to build medical facilities based on making money versus providing quality care to patients.

With these accusations fresh in the minds of influential policymakers across the state, it is imperative that the health care providers who wish to open their own practices step forward to tell their story.

Another initiative sure to generate conversation over the summer is the proposal to advance a constitutional amendment that grants every Minnesotan the right to affordable health care. Introduced by Rep. Huntley, the proposed amendment, which would appear on the 2008 ballots if passed, specifically states “that every resident of Minnesota has the right to health care and that it is the responsibility of the governor and the legislature to implement all necessary legislation to ensure affordable health care.”

Supporters have stated that comprehensive reforms are necessary in the health care industry to help contain the rising cost of care, and a constitutional amendment would require policymakers to take action. Opponents of the constitutional amendment have voiced concern that such an amendment may lead to a government run single payer health care delivery system which has delivered adverse and, in some cases, catastrophic effects in other countries.

Health care providers should look at the aforementioned summer forums as opportunities to ensure they have a seat at the bargaining table when discussions about the health care industry are held as their level of involvement and expertise is a crucial necessity.

As more information is obtained about these informational forums, we will work to create opportunities for health care providers to weigh in.

Matthew S. Schafer is the Grassroots Coordinator for the Government Relations team at Lockridge Grindal Nauen, PLLP.

The Journal of the Hennepin and Ramsey Medical Societies

physician's soap box

Broken Mental Health System Puts Us at Risk VA Tech and Spate of Other Killings Reveal Danger of Ignoring Mental Illness

Commentary by Arthur Caplan, Ph.D., MSNBC Contributor April 23, 2007

I

t is not just guns. In all my life I never thought I would write those words after a massacre involving a mass murder with a gun. But a week’s worth of intense media coverage of the heinous murders of students and faculty at Virginia Tech and analyses focusing on guns by innumerable experts has left me furious.

I don’t think the expert wisdom is even close to understanding what must be done to try and prevent this type of tragedy in the future. It is not just guns. We need to fix a broken, abandoned and pathetic system of mental-health care.

In the same month that Seung-Hui Cho killed and injured scores of people at Virginia Tech, a researcher at the University of Washington was shot to death in her office by a former boyfriend, who then killed himself. Rebecca Griego had gotten a restraining order against Jonathan Rowan. When he showed up at her office he fired five shots into Rebecca. A colleague at the university said it was a “psycho from her past.”

In Mandeville, LA, a man who had just had a restraining order issued against him by his estranged wife allegedly ambushed her and their three children. Police say James Magee chased his wife’s gray Toyota Scion for several blocks, ramming it repeatedly until the car crashed into a tree. As Adrienne Magee tried to get out of the vehicle, James Magee allegedly stepped out of the truck and shot her in the head with a 12-gauge shotgun loaded with buckshot, killing her instantly. He then opened fire on his children as they tried to flee the vehicle, killing his 5-year-old son and striking his 7-year-old daughter in the chest, according to police.

Magee had never gotten any help for previous violent outbursts.

And in Queens, New York, a man killed his mother, a wheelchair-bound man and a home health care worker before shooting himself dead — just minutes after the mother called 911 pleading for help.

The mother’s surviving sister blamed police for failing to protect her sister from the “mentally ill” son. “My sister was scared!” Annetta Taylor screamed. “She thought this might happen.” Cops outside the house tried to calm her, but she continued. “I blame you!” she said.

“She called and nobody would respond!” b y arthur ca p lan , p h . d .

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

The murdered mother, Sonia Taylor, had called police twice Monday during fights with her son, Wade Dawkins.

The police had been called to the home eight times since last May. During an incident this past October, Taylor told police her son, a drug abuser with no rap sheet, was throwing things around the house and acting violently. The police brought him to a local hospital for an evaluation. He was quickly sent back to her house.

All of these killings involved not just guns, all involved killers who might have benefited from mental-health treatment. None got the help they needed.

The Virginia Tech murderer was — to be blunt — totally crazy.

He fit the dreary profile all too familiar from the shootings at Columbine High School near Denver and the Nickel Mines School in Amish county near Lancaster, PA. Cho was an angry outcast, preoccupied with thoughts of violence against those whom he saw as bullying, victimizing or just plain ignoring him. From the tapes he made of himself, it is obvious that he was in the grip of paranoia. He had profound social withdrawal, suicidal thinking, destructive fantasies and was a known stalker. He scared people. But he fell through the cracks of university bureaucracy and a hodgepodge mental-health system.

Report after report over the past decade have warned that most public mental health systems have, to quote one, “all but disintegrated.” Such systems, whether local, state or federal, are badly fragmented and ill-equipped to address our nation’s mental health in a comprehensive manner.

States have been balancing their budgets on the backs of the mentally ill for years. A recent example is North Carolina, where 33 percent cuts in the state budget have been proposed. Advocates for the mentally ill there say that if the cuts hold, it means that in many towns the mental-health system will simply “collapse.”

But you don’t really need to read the reports or look at the budgets. Look out your window. Most of the homeless people wandering around America’s cities are mentally ill. Try to get help for your anorexic daughter, alcoholic brother-in-law, suicidal spouse and see what happens.

See what happens if someone threatens or harasses you repeatedly in terms of a coordinated police and mental-health response.

Serving in Iraq or Afghanistan with post-traumatic stress disorder or another mental illness? Good luck. The military’s mental-health

(Continued on page 12)

July/August 2007

11

Soap Box (Continued from page 11)

system is overwhelmed and understaffed.

The services available to our soldiers’ families are just as bad.

I don’t buy the line that says, “guns don’t kill people, people kill people.” I think there are too many guns with too much firepower that are too readily available. When the damaged and the deranged amongst us go undiagnosed and untreated in a world of guns, then fatalities result. The guns are not going anywhere. Politically, we lack the will to do anything about that problem.

But this is not the whole problem. It is time to start repairing a mental-health system that serves too few, costs too much, protects too little and cannot even find the means to help those who clearly are in desperate need. Maybe after Virginia Tech we can at least find the will to do that much.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania. © 2007 MSNBC Interactive Reprinted with permission.

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

One Step Closer to Long-Awaited Credentialing Reform

E

Efforts to create a new approach to

credentialing are advancing cautiously, as the Minnesota Medical Association’s Board of Trustees has evaluated the status of the proposed new Web-based credentialing system.

Physicians who have been frustrated for years by the laborious, error-prone and timeconsuming credentialing process look with hope at the new proposals.

Since early 2006 the MMA has been working with the Minnesota Council of Health Plans (MCHP), the Minnesota Hospital Association (MHA) and the Minnesota Medical Group Management Association (MMGMA),

as well as local hospitals and health plans to take the current standardized, online Minnesota Uniform Credentialing Application and make it into a “smart” form and to allow physicians and other practitioners to send this Web application to participating hospitals and health plans.

The goal is a credentialing form that is faster, easier, more secure and results in fewer errors. The “smart” form will check for possible common errors and it can be sent to several hospitals and health plans electronically with one click.

The information in the “smart” applica-

tion will be secure, confidential and its use and distribution will be controlled by the physician/practitioner. The information will be used by the health plan or hospital where the provider seeks credentialing. No information or decision-making will be shared across health plans or hospitals.

Clinics wishing to take part in the project testing are invited to contact George Lohmer at (612) 362-3746 or glohmer@mnmed.org.

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July/August 2007

13

Strengthening Foodborne Disease Surveillance and Improving the Safety of Our Food Supply

T

This past year has seen an unprecedented

array of national foodborne disease outbreaks, from E. coli O157:H7 in fresh-bagged spinach to Salmonella Tennessee in peanut butter. The scope of these outbreaks and the “wholesomeness” of the food vehicles associated with them raise considerable public concerns regarding the safety of the food supply, the ability of our public health system to rapidly detect these outbreaks, and the ability of our food regulatory agencies to prevent them.

Each of these areas presents challenges for evaluation and improvement. The farm-to-table supply chain for a simple meal may be more complex than the supply chain that built the car we drive to the grocery store or restaurant.

Multiple federal and state agencies are involved in regulating the production and distribution of food items and ingredients. Identifying the occurrence of a foodborne disease and finding its source requires advanced molecular characterization of the agent by public health laboratories. It also requires coordination between epidemiologists and environmental health specialists investigating the outbreak at local, state and federal levels.

Public Health Systems Research

Improving the safety of the food supply is an ongoing challenge that depends on good public health surveillance for foodborne disease.

Surveillance can lead to detection and control of outbreaks directly. More importantly, it can lead to the identification of strategies to prevent future outbreaks. The Enteric Disease Investigation Timeline Study (EDITS) led

by Dr. Craig Hedberg was a groundbreaking effort to determine how long it takes for the public health system to identify and investigate b y craig H ed b erg , p h. d .

14

July/August 2007

individual cases and outbreaks of foodborne disease.

Funded by the Food Safety Office at the Centers for Disease Control and Prevention (CDC) through a cooperative agreement with the Council of State and Territorial Epidemiologists (CSTE), EDITS demonstrated that patients with foodborne diseases who seek medical attention, tend to do so within

The farm-to-table supply chain for a simple meal may be more complex than the supply chain that built the car we drive to the grocery store or restaurant.

three to four days after onset of their illness, regardless of the cause. However, cases of E. coli O157:H7 infection tend to be reported and investigated several days sooner than do cases of Salmonella infection. Results suggest that physicians, laboratories and public health agencies all respond to E. coli O157:H7 infections with a greater sense of urgency. Despite the public health importance of these infections, the median interval from onset of symptoms to molecular subtyping by the public health laboratory is 15 days.

Improving Foodborne Outbreak Response

EDITS has given us a better understanding of how long it takes to detect widespread outMetroDoctors

breaks of foodborne diseases. It also established a baseline for measuring improvements in our foodborne disease surveillance. Toward this end, CDC in partnership with CSTE, the Association of Public Health Laboratories (APHL) and the National Association of City and County Health Officials (NACCHO) established the Council to Improve Foodborne Outbreak Response (CIFOR).

On behalf of CIFOR, Dr. Hedberg is conducting two follow-up projects to build on the results of EDITS. These include the development of performance indicators for foodborne disease surveillance, the development of guidelines for conducting multijurisdictional outbreak investigations. These projects will give local and state foodborne disease programs the tools they need to evaluate the effectiveness of their programs and to improve the efficiency and effectiveness of the complex outbreak investigations that are becoming all too common.

The projects will be used in combination with FoodSHIELD, an initiative of the National Center for Food Protection and Defense at the University of Minnesota. FoodSHIELD www.foodshield.org/ is a Web-based platform designed to create community between the various laboratories and regulatory agencies that make up our nation’s food and agricultural sectors. It is funded by a grant from the National Integrated Food Safety Initiative (NIPSI).

By Craig Hedberg, Ph.D., Associate Professor, Environmental Health Sciences, University of Minnesota School of Public Health.

Reprinted with permission. Research Brief is a monthly update of the latest research from the University of Minnesota School of Public Health faculty.

The Journal of the Hennepin and Ramsey Medical Societies

Team Up With Your Regional Prevention Coordinator

D

Did you know that Minnesota has a state

structure for prevention? We do. It involves having a Regional Prevention Coordinator (RPC) based in each of Minnesota’s seven regions. Prevention, in this sense, refers to preventing the harms associated with alcohol, tobacco and other drug use/misuse (ATOD) and abuse.

I tell you this because, as physicians, having direct contact with patients at risk for ATOD abuse you may want to extend your reach and ability to promote healthy behaviors by joining forces with the regional prevention system. We know how effective HMS and RMS have been in their efforts to reduce exposure to secondhand smoke. It is my hope that by introducing you to the regional prevention system, more of you will be moved to act — to continue educating the public about the dangers of secondhand smoke, and to broaden efforts to include raising awareness and working toward effective strategies to reduce underage alcohol use, the misuse of alcohol by adults, prescription drug abuse and illicit drug use.

The knowledge gained through prevention research (e.g., the results of demonstration projects and program evaluations) has led to the development of formal theories, best practices, promising approaches, and rigorous evaluation methods. And, starting in the late 1990s, policies, laws and norms have been changing to influence the incidence and prevalence of drug use. Even with your help and the hard work of my fellow preventionists, drug abuse continues to pose serious threats to the health and social and economic stability of American communities. I am writing this as a call to action for health care providers and ATOD prevention specialists to combine our talents and constituencies to turn the tide on these trends. b y L ee A nn mortensen

MetroDoctors

I am LeeAnn Mortensen, the Metro area Regional Prevention Coordinator. I am based in Mounds View at the Minnesota Institute of Public Health (MIPH). My office is co-located with the Minnesota Prevention Resource Center, Central CAPT and numerous other projects. This gives me a built-in network of skilled preventionists who represent all that is good about teamwork. I have been the Metro Regional Prevention Coordinator for the seven county metro area devoted to ATOD issues since June 2006. For the preceding six years, I worked in tobacco control and prevention in northwest Hennepin County. That work included raising awareness in local communities about the dangers of secondhand smoke, passing numerous tobacco-free park policies and passing the best-in-Minnesota, citywide tobacco-free worksite ordinance.

In my capacity as the metro area RPC, working on a grant from the Minnesota Department of Human Services, Chemical Health Division, I identify current prevention efforts and needs, and provide training and technical assistance to agencies, organizations, community coalitions and others.

As we all know, substance abuse is a phenomenon that can occur when risk factors outweigh protective ones. We also know that prevention of substance abuse is most effectively accomplished by combining a variety of strategies in concert with one another.

The Journal of the Hennepin and Ramsey Medical Societies

Research supports the importance of having a community focus — including schools, families, faith-based and other organizations and individuals — in all prevention programming.

The National Institute of Drug Abuse identifies 16 prevention principles to help us think about, plan for, and deliver research-based drug abuse prevention programs. All 16 principals are relevant to my work and that of the other Regional Prevention Specialists, but three in particular have resonance. These are: • Prevention programs should enhance protective factors and reverse or reduce risk factors.

(Continued on page 16)

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July/August 2007

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Regional Prevention Coordinator (Continued from page 15)

• Prevention programs should address all

forms of drug abuse, alone or in combination, including the underage use of legal drugs (e.g. tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants), prescription medications, or over the counter drugs.

• Community prevention programs reaching

populations in multiple settings — schools, clubs, faith-based organizations, and the media — are most effective when they present consistent, community-wide messages in each setting.

To review the entire list of 16 principles, visit: http://www.nida.nih.gov/Prevention/ principles.html.

Development of Minnesota’s ATOD prevention workforce is necessary to the suc-

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July/August 2007

cess of prevention efforts. Toward that end, the Minnesota Certification Board has developed a path to certification of prevention specialists. Substance Abuse Prevention Specialist Training (SAPST) is the cornerstone of this process. SAPST was developed to contribute to the development of knowledgeable and competent prevention professionals by advancing prevention science knowledge and its application to prevention program planning. SAPST is offered several times a year and is complemented by other trainings, workshops, forums, and a statewide conference, all of which builds capacity and provides networking opportunities for those of us concerned about preventing the problems associated with ATOD abuse. For more information on upcoming training and other events, visit www.emprc.org.

Finally, if you have colleagues outside of the metro area and wish to connect them with their regional prevention coordinator, please do not hesitate to contact me and I will provide my colleague’s information. If you have questions, or believe I can be of assistance in your efforts, I hope you will contact me personally.

LeeAnn Mortensen, (763) 427-5310 x 157, or lmortensen@miph.org.

MetroDoctors

LeeAnn Mortensen is the Metro Region Prevention Coordinator.

The Journal of the Hennepin and Ramsey Medical Societies

Medical Students Connecting With Community Physicians

I

In 1999, the University of Minnesota Medical Alumni Society and Minnesota Medical Foundation rolled out a medical student mentoring program, providing an opportunity for students to connect directly with practicing physicians in the community. A year later, the Hennepin and Ramsey Medical Societies were invited to partner with the Alumni Society on this “Connections” program.

Since its inception, over 100 students annually are paired with a physician mentor.

The role of the mentor is to establish a trusting relationship and collaborative partnership with the medical student, which may last throughout the four years of medical school, and possibly beyond. This can mean being available and accessible; sharing experiences in areas of interest to the student and functional knowledge of recent trends and techniques; being a motivator and building the student’s confidence; remaining non-judgmental; and maintaining confidentiality.

Mentoring is a two-way process in which a mutual commitment of time and energy is made and an ongoing process that grows richer over time. Both formal and informal activities including social as well as professional engagements are encouraged. Don’t go into a mentoring relationship with a specific agenda — the relationship itself will set the agenda and the rewards will be mutual.

If you are interested in becoming a mentor, please contact the Minnesota Medical Foundation at (612) 625-1440, the Hennepin Medical Society at (612) 623-2893, or the Ramsey Medical Society at (612) 362-3704.

Thank you to the following physicians for their participation.

Martin Asis, M.D. Beth Baker, M.D. Cristina Baker, M.D. Berton Barrington, M.D. MetroDoctors

Physician David Cline, Class of 1962, chats with medical student Esther Kao. Photo by Tim Rummelhoff appeared in the University of Minnesota Medical Bulletin, Winter 2005.

Eric Becken, M.D. Luke Benedict, M.D. Paul Benn, M.D. Elizabeth Bisinov, M.D. Mark Bixby, M.D. Stuart Bloom, M.D. David Bucher, M.D. Steven Calvin, M.D. Bruce Cantor, M.D. Lisa Capell, M.D. Jeffrey Chipman, M.D. David Cline, M.D. John Timothy Diegel, M.D. Douglas Drake, M.D. Dimitri Drekonja, M.D. Arkadiusz Dudek, M.D. Jordan Dunitz, M.D. Jeffrey Elder, M.D. T. Bruce Ferrara, M.D. James Flink, M.D. Patrick Flynn, M.D. Les Forgosh, M.D. Laura France, M.D. Michael Freehill, M.D. Naomi Fujioka, M.D. Timothy Gibbs, M.D. Jed Gorlin, M.D. Julia Grigoriev, M.D. Nicole Groves, M.D. Heather Haakenson, M.D. Jonathan Haas, M.D.

The Journal of the Hennepin and Ramsey Medical Societies

Rex Haberman, M.D. Julia Halberg, M.D. Jeffrey Hill, M.D. Elaine Hirschfield, M.D. Stacy Hockett, M.D. Neil Hoffman, M.D. Neal Holtan, M.D. Maria Hordinsky, M.D. Craig W. S. Howe, M.D. Christine Hult, M.D. Stephen Hustead, M.D. Frank Indihar, M.D. Richard Ivance, M.D. (Continued on page 18)

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Medical Students Connecting (Continued from page 17)

Jill McCue Johnson, M.D. Courtney Jordan, M.D. Jon Joseph, M.D. Arnold Kaplan, M.D. Bertram Kasiske, M.D. Rosemary Kelly, M.D. Muhammad Khan, M.D. Thomas Kottke, M.D. Jon Krook, M.D. Cornelius Lam, M.D. Andrea Lampland, M.D. Robert LaPrade, M.D. Matthew Larson, M.D. June LaValleur, M.D. Bruce Levy, M.D. William Lisberg, M.D. Stephen Liston, M.D. Lisa Lyons, M.D. Terrence Maag, M.D. Stephen MacLeod, M.D. Mobin Malik, M.D. John McCarten, M.D. Marilyn Mellor, M.D. Alfred Michael, M.D. Steven Miles, M.D. Frank Moga, M.D.

Todd Morris, M.D. Charles Moser, M.D. J. Bart Muldowney, M.D. Timothy Myers, M.D. Ramarathinam Nagarajan, M.D. Carol Nelson, M.D. Michael Nelson, M.D. Frederic Nemer, M.D. Frank Norberg, M.D. Kathleen Ogle, M.D. Eugene Ollila, M.D. Ross Olson, M.D. Mark Oswood, M.D. Kara Pacala, M.D. Christopher Palmer, M.D. Nathaniel Payne, M.D. Patricia Penovich, M.D. Joanna Perkins, M.D. Joseph Pietrafitta, M.D. Michael Pinchback, M.D. Mary Pohl, M.D. Brian Prokosch, M.D. Douglas Pryce, M.D. Susan Quick, M.D. Brian Rank, M.D. Raghavendra Rao, M.D. Stephen Remole, M.D. Frank Rhame, M.D.

Susan Roe, M.D. James Rohde, M.D. Cary Rose, M.D. Anne Rosenberg, M.D. Leonardo Saavedra, M.D. Scott Schaefer, M.D. Paul Schanfield, M.D. Randall Schapiro, M.D. Mark Schleiss, M.D. Peter Schlesinger, M.D. Kristina Shaffer, M.D. Rajiv Shah, M.D. Terra Shockman, M.D. Sara Shumway, M.D. Ashajyothi Siddappa, M.D. Michael Smith, M.D. Arif Somani, M.D. Randall Stark, M.D. William Stauffer, M.D. Martin Stillman, M.D. Chris Stuart, M.D. Eric Swanlund, M.D. Helmer Swenson, M.D. Reetu Syal, M.D. Charles Terzian, M.D. Richard Tholen, M.D. Jon Thomas, M.D. Ezgi Tiryaki, M.D.

Medical student Deborah Hatanpa visits with her mentor, physician Susan Roe. Photo by Tim Rummelhoff appeared in the University of Minnesota Medical Bulletin, Winter 2005.

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July/August 2007

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Four Popular Approaches to Health Care Performance Improvement We compare the basic elements of today’s leading tools and techniques, including balanced scorecard, Lean, Six Sigma and Malcolm Baldrige

I

If you’ve looked at a brochure for any

health care conference in the last year, you have likely seen various performance improvement offerings touted as the next great idea for managing your health care organization. The industry is buzzing with discussions and success stories related to the balanced scorecard, Lean, Six Sigma, Malcolm Baldrige and others.

With cost, quality and regulatory pressures mounting within the health care industry, performance improvement tools and techniques are drawing increased attention from hospitals and health systems seeking more effective ways to achieve long-term results. Deciding which tool makes the most sense to invest in and apply can be a daunting task — especially in small and rural markets.

While each of these tools and techniques mentioned above address different components and approaches, they share similarities as well.

The greatest of these is the end goal: improved organizational performance. The question is not as much “Which one should we use?” but “How can we recognize when to use each, and how do we know if they are effective?”

This article provides a brief, high-level overview of four performance tools and techniques. Please note that entire books could be written on any of these approaches; this article is intended only to give you an idea of the options that are available.

Before embarking on your journey of performance improvement, there are a few important prerequisites: • Statements of mission, vision and values.

If your organization’s mission, vision and values were constructed more than a few years ago, it may be time to revisit them. b y jill myers

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These statements provide the framework for your overall strategic plan and goals.

They answer the following basic questions: Why does this organization exist?

What value do we bring to our customers?

Where do we see this organization being in five, 10 or 15 years? What qualities do the people within this organization demonstrate? Solid, applicable and updated statements of mission, vision and values provide the base from which your organization can begin assessing where to focus its improvement efforts.

• A strategic plan. Similarly, your organiza-

tion should have an up-to-date strategic plan. Just as the mission, vision and value statements determine what the organization is about, what it wants to be, and the qualities and characteristics its people demonstrate, the strategic plan maps out how your organization will go about the business of maintaining its mission and reaching toward its vision. Ideally, the strategic plan will identify opportunities for specific performance improvement initiatives.

• Leadership commitment. Leadership drives

your organization’s culture — and your performance improvement endeavor is likely to challenge the change and improvement of that culture as well as specific processes. It is essential that leadership: (1) is fully committed to any performance improvement process; (2) clearly articulates to others the need, purpose and intended outcome of the process; and (3) holds everyone (including themselves) accountable for contributing to the improvement process as necessary. Performance improvement is about strategic

The Journal of the Hennepin and Ramsey Medical Societies

change. The leadership and organizational culture have to be accepting of this type of change.

• An information orientation. All perfor-

mance improvement tools and techniques require an organization to gather, monitor and measure specific data and information.

Organizations need to know, at minimum, what information is attainable, in what frequency, and in what format. Understanding the potential difficulties in getting at “good data” or making various information systems “talk to each other” will help to determine which tools and techniques to use — and to establish realistic expectations. Knowing the organization’s information abilities and issues is what is important here. Waiting until all processes are perfectly in place will result in procrastination for initiating any performance improvement technique. Recognize that some processes and strategies are difficult to measure. Resolve early on to accept an indicator that will tell most, but maybe not all, of the story.

Each of these elements must be in place before starting a major performance improvement initiative. Taking the time to assess where your organization is in relation to each of these areas will likely save your organization from frustrating roadblocks or failure.

No performance improvement tool or technique by itself can guarantee performance excellence. There are great reasons for choosing each approach and synergies and reasons for using some of them together. Here is a brief overview of four common tools and techniques: balanced scorecard, Lean Thinking & (Continued on page 20)

July/August 2007

19

Health Care Performance Improvement (Continued from page 19)

Tools, Six Sigma, and the Malcolm Baldrige Award Process.

Balanced Scorecard The balanced scorecard is a management tool used to link what the organization says it should be doing (its strategies) to what the organization really is doing (its outcomes).

The development of a balanced scorecard ensures a balanced approach to implementing strategies and measuring performance.

Organizations with balanced scorecards map out key strategies and initiatives in each of at least four areas: Learning & Growth (often the employee investment, infrastructure and cultural strategies), Internal Processes, Customer Focus and Financial.

Prioritizing the organization’s initiatives is a key part of developing and implementing a balanced scorecard, as is carefully identifying a blend of leading and lagging indicators by which to measure the progress of each initiative. The balanced scorecard is a great tool for ensuring that your strategic plan remains in the forefront and doesn’t become a nice docu-

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July/August 2007

ment in a three-ring notebook gathering dust on someone’s office shelf.

Everyone within a health care organization — from the board to management to front-line and back-office staff — report their appreciation for the balanced scorecard. This is mainly because for the end user (those receiving and reviewing the scorecard periodically), it is extremely simple to use and understand. It is commonly just one or two pages long and contains only those initiatives the organization has determined have the highest priority. It usually includes a color-coding system that demonstrates whether things are above target (green), on target (yellow), or needing improvement (red). Some scorecards also include trending graphs for historical comparisons.

The balanced scorecard is a good starting point in performance improvement. Once an organization has a mature scorecard, areas of improvement opportunity are more readily identified.

Lean Thinking and Tools Lean Thinking is a set of management principles, tools and best practices designed to identify and eliminate waste in work processes and to increase efficiency. Lean Thinking can enable an organization to provide what is needed, when it is needed, with the minimum amount of materials, equipment, labor and space.

There are five principles of Lean Thinking: 1. Define value from the patient perspective. Consider patients’ relationships with their providers and their understanding of their own treatment plans. The amount of time providers spend with patients and the amount of time patients wait to see a provider are common value points. Patients also value reliability and accuracy, customer service and cost.

2. Identify the entire value stream for each business process. A patient services value stream includes all of the actions (value and non-value added) required from admission through discharge and follow up. Mapping key processes in this way demonstrates the role each department plays and how each department impacts others. For example, mapping the value stream in order to improve performance of the emergency department will reveal that other departments also have a role in that process.

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3. Make value-creating activities flow by eliminating waste. Once each step is identified, working to eliminate those that do not provide value from the patients’ perspective will create a stronger overall value stream for that process. Common types of waste include patient waiting times and requiring redundant information on patient forms.

4. Let the patient pull the service or product.

Whenever feasible, provide patients with what they want, when they want it (e.g., flexible meal times). “Patient pulling” also applies to determining and adhering to appropriate staffing levels for each shift.

5. Pursue perfection through high-performance teams. When lean principles are leveraged, results compound exponentially.

By pursuing perfection, everyone continuously strives to improve. Complacency is not acceptable. This drive for perfection must be embedded and supported within the culture of the organization by the leadership.

Six Sigma Six Sigma is a measure of quality that strives for near perfection. Six Sigma is a disciplined, data-driven approach and methodology for eliminating defects. Six Sigma is increasingly being used in health care organizations, a complex industry prone to errors. Just as is the case for Lean, Six Sigma is based on methods that have been around for many years.

There are several Six Sigma tools; they are applied within a framework known as DMAIC (Define-Measure-Analyze-ImproveControl). This is analogous to the familiar Plan-Do-Study-Act model most hospital quality improvement programs follow.

• Define improvement activity goals. Determine what is important. At the organizational level, this may be operating margin or market share; at the department level, it may be specific patient safety measures or patient satisfaction.

• Measure performance. Establish metrics to indicate how the organization or department is progressing toward the identified goal.

• Analyze the improvement opportunity.

Study the difference between the metrics that indicate current performance, and compare to the desired goal.

• Improve performance. Be thoughtful and creative in finding ways to improve

The Journal of the Hennepin and Ramsey Medical Societies

by doing things faster, cheaper, safer (i.e., eliminating waste).

• Control performance. Ensure the new, improved process is institutionalized through documentation, training, policy development, and by establishing new goals.

In Six Sigma, the measure of process performance is the number of defects per million products or million opportunities. The goal of Six Sigma performance is to achieve a very low number of defects per million (DPM).

The ideal, less than 1 DPM, represents a score of near perfection. Not all processes can be improved to this ideal, but the closer one gets to Six Sigma, the fewer the defects and the lower the cost. A better process means higher efficiency; lower expenditures of time, money and effort; and greater customer satisfaction.

Malcolm Baldrige The Malcolm Baldrige National Quality Award is given by the U.S. President to organizations (manufacturing and service businesses, health care and education) judged to be outstanding in seven key areas: • Leadership • Strategic Planning • Focus on Patients, Other Customers and Markets • Measurement, Analysis and Knowledge Management • Human Resource Focus • Process Management • Results The application process includes, at minimum, a reviewer’s report assessing the application’s strengths and opportunities for improvement. It is the application preparation and review feedback that many applicants cite as extremely valuable in their performance improvement efforts. If the application is reviewed favorably, on-site visits and interviews follow.

Several documents, including self assessments, award-winning application summaries, and points to consider during the application process, are available for free on the Baldrige National Quality Program Web site at www. quality.nist.gov.

There are at least three purposes for going through the award process: (1) to help improve organizational performance practices, capabilities and results; (2) to facilitate communication and sharing of best practices information among health care organizations and among U.S. organizations of all types; and MetroDoctors

(3) to serve as a working tool for understanding and managing performance and for guiding organizational planning and opportunities for learning.

The application process includes an organizational profile, which sets the context for the way your organization operates. The profile is based on the key working environment, key working relationships, and strategic challenges.

Also included is an assessment of how the organization is doing in each of the seven key areas listed above. It is important to identify baseline assessments and scores in each area, document the plan for improvement, and demonstrate the improvement through data.

A balanced scorecard is an ideal tool for recording and demonstrating this information.

Organizations with a balanced scorecard will likely be in a good position for preparing an application for the Malcolm Baldrige Award.

The valuable exercise of identifying key strategies and areas of improvement, measuring them, analyzing new processes and improved performance, and institutionalizing these improvements through the establishment of new systems, policies, procedures and expectations 21727 Metro Dr. Ad 11/22/05 8:43

forms the foundation of the Malcolm Baldrige Award. This is consistent with each of the performance improvement tools included in this article.

Conclusion There are many tools and techniques for improving performance in your organization.

None of them will alone turn a troubled organization around, but several of them have the potential (especially with key leadership buy-in and understanding) to certainly make a difference. Many of the tools and techniques have strong similarities and can (and perhaps should) be used together.

An organization’s journey to excellence does not just happen; it is constant, well planned, and continuously analyzed. As Aristotle is credited with saying: “We are what we repeatedly do. Excellence then is not an act, but a habit.”

Jill Myers is a Wipfli health care manager with more than 15 years of industry experience. Her primary focus is providing solutions for rural health and critical access hospital issues. Jill can be reached at (952) 548-3396 or jlmyers@wipfli.com.

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Members in the News

The Members in the News section recognizes the appointments, presentations, awards, honors and other professional accomplishments of RMS and HMS members. Submit physician news by fax (612) 623-2888, e-mail (dhines@metrodoctors.com) or mail to Editor, MetroDoctors, 1300 Godward Street NE, Suite 2000, Minneapolis, MN 55413 for consideration by the editorial board. Questions? Call Doreen Hines at (612) 362-3705.

KATHLEEN BROOKS, M.D. is the first

chairperson of a state Health Services Advisory Council (HSAC). The council, established by the 2005 Minnesota Legislature, makes recommendations to DHS regarding the services covered under Minnesota Health Care Programs (MHCP). Since its first meeting, the council has recommended implementing specific criteria for prior authorization for CT scans and MRIs of headaches, low-back pain and knee pain. The criteria define the scenarios in which the use of high-tech imaging is most appropriate. Future efforts will include assessing prior-authorization criteria for high-tech imaging of spinal-fusion surgeries and shoulder pain, development of QCare measures for the Minnesota Senior Health Options program and evaluating coverage policy for health professionals. Dr. Brooks is the assistant dean for Continuing Medical Education (CME) at the University of Minnesota Medical School and sees her two-year tenure on the advisory council as a time for building the council’s framework and establishing a vision.

GWEN WAGSTROM HALAAS, M.D., an

assistant professor in the University of Minnesota’s Department of Family Medicine and Community Health, will lead the Academic Health Center’s new Center for Interprofessional Education. In her new position, Halaas will guide the center as it formalizes oppor22

July/August 2007

tunities for students to work across health disciplines.

The Distinguished Alumni Award recognizes University of Minnesota Medical School alumni who have made outstanding contributions to their local, regional, or national community through medical practice, teaching, research, or other humanitarian activities. The recipient of this award was MARVIN GOLDBERG, M.D. Dr. Goldberg recognized music’s soothing effect on hospital patients and staff and founded the Health Sciences Orchestra in 1994. He is currently an associate professor of radiology and a violinist. In addition to his musical endeavors, Dr. Goldberg has been involved with teaching medical students and residents at the University for the past 50 years.

JOHN Y. SONG, M.D., M.P.H., M.A.T. was

RICHARD LINDSTROM, M.D., founder and

attending surgeon of Minnesota Eye Consultants, P.A., Minneapolis, assumed responsibility as president of the American Society of Cataracts and Refractive Surgery at its annual symposium and congress on April 28.

The University of Minnesota’s Medical Alumni Society has selected the following physicians to receive awards for 2007.

The Harold S. Diehl Award is a lifetime achievement award granted to individuals who have made outstanding contributions to the medical school, the university, and the community. This year’s recipients are: • JOHN P. DELANEY, M.D., Ph.D., was honored for his commitment to his patients, students, and colleagues through his work at the University of Minnesota.

Dr. Delaney became a faculty member in the Department of Surgery in 1965 and today is a professor emeritus.

• A. STUART HANSON, M.D. was honored for his tireless devotion to improving the health of his community, especially through tobacco-cessation and violence-prevention efforts. Dr. Hanson is a pulmonologist at Park Nicollet Clinic in St. Louis Park.

• FRED A. LYON, M.D. was honored for his decades of service to the medical school and the community. Dr. Lyon began service to the school as president of his class. Now he is an emeritus clinical associate professor in the University’s Department of Obstetrics, Gynecology, and Women’s Health; a mentor to students and a member of the Minnesota Medical Foundation’s Board of Trustees.

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the recipient of the Early Distinguished Career Award. This award honors a physician for his or her exceptional accomplishments within 15 years of medical school graduation. Dr. Song was honored for his commitment to serving underserved and disadvantaged populations. He is an associate professor of medicine and member of the University’s Center for Bioethics. Dr. Song founded the Phillips Neighborhood Clinic, a free clinic that serves homeless people in Minneapolis’ poorest neighborhood. He leads students and volunteers there who strive to provide compassionate, nonjudgmental, and culturally appropriate care to patients. He also practices at the Community-University Health Care Center and is an acknowledged leader in developing an interprofessional bioethics curriculum at the University.

The Journal of the Hennepin and Ramsey Medical Societies

PRESIDENT’S MESSAGE V. Stuart cox, M.D.

RMS Officers

President V. Stuart Cox, M.D. President-Elect Peter B. Wilton, M.D. Past President James J. Jordan, M.D. Treasurer Ronnell A. Hansen, M.D. RMS Elected Board Members

RMS Appointed Board Members

Stephanie D. Stanton, M.D., Resident Physician Kimberly C. Viskocil, Medical Student Marie L. Witte, M.D., Young Physician MMA Officers and Board Members

Lyle J. Swenson, M.D., MMA Vice Speaker of House Todd D. Brandt. M.D., MMA East Metro Trustee Charles G. Terzian, M.D., MMA East Metro Trustee David C. Thorson, M.D., MMA East Metro Trustee RMS Ex-Officio Board Members & Council Chairs

Blanton Bessinger, M.D., AMA Alternate Delegate Peter F. Bornstein, M.D., MPS, Inc. Chair Kenneth W. Crabb, M.D., AMA Delegate Robert W. Geist, M.D., Professionalism & Ethics

Council Chair Neal R. Holtan, M.D., Community Health Council Chair Frank J. Indihar, M.D., AMA Delegate, Chair of

MN Delegation Carolyn A. Johnson, M.D., Sr. Physicians Association President Mark J. Kleinschmidt, Clinic Administrator Anthony C. Orecchia, M.D. Education Resource Council Chair RMS Executive Staff

Sue Schettle, Chief Executive Officer Katie R. Anderson, Executive Assistant Doreen M. Hines, Manager, Member Services

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The 2007 Legislative session has ended. As I write this we await possible vetoes from the Governor, which could trigger another special session (for the 4th year in a row). What were the victories and defeats for the physicians of Minnesota?

Our top legislative goal, the “Freedom to Breathe Act” passed almost completely intact. This is a triumph for our community — extrapolating from national statistics, almost 1,000 Minnesotans a year die from secondhand smoke. This was a victory especially for those who work in newly smoke-free establishments.

On the negative side, despite an agreement we had reached with the insurers, the bill for the coverage of medical interpreters did not pass.

The bill for the creation of the Health Care Access Fund Oversight Committee also failed. The Health and Human Services Bill that is on Governor Pawlenty’s desk proposes an 18.7 percent increase from two years ago. Some of this will go to nursing homes for a cost of living adjustment increase, and there should be some increase in access to state health programs, especially for children.

The most interesting legislation was the proposed amendment requiring the Governor and Legislature to provide health care to all Minnesota residents. This is both a moral as well as an economic issue. I suspect physicians are going to have widely varying viewpoints of this. The MMA’s current position is to advocate for rights to health insurance. If this amendment did go through the House and the Senate next year, it would be on the ballot for 2008. If it were to pass, it is absolutely crucial for it to be implemented correctly. This could be a panacea for the State and provide a nation-wide model for health care policy. Or, it could be a disaster and drive a large percentage of physicians to leave the state, which would lead to a significant decrease in access to providers. Unfortunately, the path of least resistance for the legislators would be to expand MinnesotaCare to cover more of the population. Dr. Peter Dehnel has a great presentation that shows how devastating this would be to physicians, especially those in primary care.

Several indicators point to 2008 as “the year” for health care legislation.

I learned two things in this legislative ses-

The Journal of the Hennepin and Ramsey Medical Societies

sion. The first is, personal relationships matter.

After expecting the Freedom to Breathe Act to be a “slam dunk,” I was amazed at how often it stalled and frequently appeared to be doomed.

When asked why there was so much difficulty with the bill, a number of legislators mentioned personal contacts, such as a bar owner who was a friend of a representative and had their ear.

Simple friendships are surprisingly powerful at the Capitol.

The second thing I learned was the lack of involvement of physicians. I heard repeatedly from legislators how surprised they were that a physician would take time to lobby. While representatives are well-meaning, most have little understanding of the nuts and bolts of health care and the wide impact health care legislation has. They are looking for help. It is a common discussion in doctors’ lounges to complain about the lack of physician input in political policy for health care. We are, at least in part, to blame for this. At the Capitol not only are there lawyers, but also teachers, plumbers, and truck drivers. We need to be there and make our voices heard. This summer call your senator and your representative, plan on getting together with them one-on-one.

Build a personal relationship and help our legislators craft the best health care policy in the country. Prepare for 2008.

It is with great sadness that we bid farewell to Roger Johnson, Ramsey Medical Society CEO for 13 years and a champion for physicians of this state for much longer. Few people have had more of an impact on organized medicine in Minnesota than Roger. I will deeply miss him, his leadership and his wisdom. However, he has assured me he will not completely disappear.

It is with great happiness that we welcome Sue Schettle who, despite her young age, has over 15 years of health care administration experience, and has already been involved in several different aspects of organized medicine. I look forward to the new leadership and fresh perspective she will provide.

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Ramsey Medical Society

Arthur A. Beisang III, M.D., Director Charles E. Crutchfield, III, MMB, M.D., At-Large Director Laura A. Dean, M.D., Specialty Director, Obstetrics & Gynecology Andrew S. Fink, M.D., At-Large Director Thomas J. Losasso, M.D., At-Large Director Nicholas J. Meyer, M.D., Director Robert C. Moravec, M.D., At-Large Director Jane C. Pederson, M.D., Specialty Director, Internal Medicine Jerome J. Perra, M.D., Director Lon B. Peterson, M.D., Director Thomas D. Siefferman, M.D., Specialty Director, Pediatrics Jacques P. Stassart, M.D., At-Large Director Christina J. Templeton, M.D., Specialty Director, Psychiatry Scott A. Uttley, M.D., Director

2008 “ “The Year” for Health Legislation—Prepare Now

Dakota County Smoke-Free Updates Eagan Citizens Make a Difference

O

n April 23, 2007, twelve community volunteers and Eagan Smoke-Free Team members called on their neighbors. Literally.

Along with Project Coordinator, Julie Johnson, and Community Organizer, Diane Tran, the volunteers placed nearly 450 phone calls within the span of two hours to reach Eagan residents in Representative Sandy Masin’s district, requesting they contact her in time for the critical vote on the House floor. The

Eagan Smoke-Free Team had been part of the efforts to engage Representative Masin on the importance of smoke-free policies throughout the legislative session and the phone-bank was one of many tactics to reach out to the Representative. Phone-bankers enjoyed pizza and refreshments, and their feedback on their way out indicated they each felt successful and personally empowered as a result of their phone-banking activity. They inspired others to action that evening and would know the passage of the Freedom to Breathe Act out of the House was their success, as well!

The phone-bankers also asked Eagan residents if they would be interested in signing up to receive the monthly Smoke-Free Dakota E-Newsletter or in posting a Smoke-Free Eagan lawn sign in their yards. If you would like a lawn sign for your yard, e-mail dtran@smokefreedakota.org, or call (651) 789-0036.

Media Spokesperson Training Held

D

r. Peter Dehnel, together with Ted Davis, from Davis Communications Management, led a Media Spokesperson Training for health care professionals on May 1 at the Minnesota Center for Obesity, Metabolism and Endocrinology Clinic in Eagan. The program educated participants on the health complications related to secondhand smoke as shown in current scientific data and trained them on how to be effective community spokespeople when speaking about the benefits of smokefree policies through earned media and during public speaking.

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July/August 2007

Regina Medical Center Offers CME to Physicians

D

r. Lon Peterson, Ramsey Medical Society, and Julie Johnson, Dakota County Smoke-Free Communities Partnership, invited Dr. Peter Dehnel to present a CME course, “Current Medical Evidence on the Adverse Health Effects of Exposure to Secondhand Smoke,” to a group of nine physicians at Regina Medical Center in Hastings on April 11, 2007.

During the presentation, he described the loss of lives due to secondhand smoke exposure in the United States each year as equivalent to 95–123 airplanes (747s) crashing each year.

He covered how strong smoking ordinances aid tobacco prevention efforts by protecting workers from exposure to secondhand smoke and by changing social norms of smoking. He stressed the importance of the role physicians have in their community as credible spokespeople and key advocates on health issues such as secondhand smoke policies. Dr. Dehnel’s presentation was covered in a news story by the Hastings Star Gazette on April 19, 2007, “Smoking ban debated at several levels,” in light of the impending legislation of the Freedom To Breathe Act. Special thanks go out to Dr. Garrick Olsen, Jeanne Reuter, and Judy Misencik of Regina Medical Center for helping to make this CME course successful.

Dr. Lon Peterson, Regina Medical Center, participates in a small group discussion during the Media Spokesperson Training.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Celebrating the Retirement of Roger K. Johnson he retirement party of Roger K. Johnson was held on Sunday, June 3, 2007 from 1:00 p.m. – 4:00 p.m. at the Jackson Street Roundhouse in St. Paul, MN. The Roundhouse was chosen as the location for his retirement party because of Roger’s longstanding interest in trains that stemmed from his early childhood.

There were many well wishers who came to the event including former governor Al Quie and Ramsey County Commissioner Toni Carter who provided Roger with a Proclamation

signed by the Ramsey County Commissioners highlighting the many accomplishments and contributions that Roger has made during his career.

Also in attendance were Roger’s family members including his wife Barbara, her son Kristofer and his wife Elka, his son Timothy and his partner Dennis, daughters, Katie and her husband Paul, and Beth and her husband Mark, and Roger’s grandchildren Maren, Travis, Nina, Jacob, Zoe and Nathan.

Roger will be missed by the staff of RMS and by the physicians that he’s worked with throughout the years. We wish him well and trust that he’ll enjoy the many trips that he has planned throughout the next couple of years.

Ramsey Medical Society

T

The Jackson Street Roundhouse Train Museum provided a unique location for Roger Johnson’s retirement party.

RMS President Dr. Stuart Cox congratulating Roger.

Roger (center) pictured with former Minnesota Governor, State Senator and U.S. Congressman Al Quie (left) and Blanton Bessinger, M.D. Roger was on the Congressional staff of Congressman Al Quie from 1971-1978.

Jack Davis, CEO, Hennepin Medical Society, presents a congratulatory Resolution to Roger.

Toni Carter, Ramsey County Commissioner, reads a Proclamation presented to Roger from the Ramsey County Board of Commissioners.

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Roger and Barbara (center couple) enjoy the day with his family.

Roger and other attendees at the Open House visiting.

The Journal of the Hennepin and Ramsey Medical Societies

All photos by Daniel Snow.

July/August 2007

25

RMS Public Policy Council

U

Resolutions Discussed at RMS Caucuses

T

he Ramsey Medical Society holds two caucuses each year where physicians can come and discuss their ideas for resolutions with their colleagues that will eventually go onto the MMA annual meeting for potential adoption. This year, the caucuses were held on Wednesday, May 23 and Thursday, June 7. The MMA annual meeting will be held this year in Mankato September 19, 20 and 21, 2007.

If you are interested in being a delegate, please contact the RMS office at (612) 3623704.

DRAFT RESOLUTIONS:

1) Acceptance of TRICARE Health Insurance by MMA Members Submitted by Dr. Nick Meyer 2) Prohibit Contracts that Pay Clinics “Incentives” Contingent on Cost of Care Profiling Submitted by Dr. David Thorson 3) CMS Subsidies Overpaying Medicare HMOs Submitted by Dr. Robert Geist 4) P4P Study Group and Surveillance Submitted by Dr. Todd Brandt 5) Reclassification of Adult Varicella Zoster Vaccine to Medicare Part B Submitted by Dr. Paul Chlebeck

6) Implementation of Provider Tobacco Cesssation Guidelines Submitted by Dr. Ann Wendling 7) Enrollee Access to Insurance/Health Plan Provider Agreement Details Submitted by HMS and Dr. Robert Geist 8) State Constitutional Amendment Submitted by Dr. Peter Boosalis, Dr. Arthur Beisang and Dr. Laura Dean 9) Health Plan Regulatory Accountability to Pay for Rx for Patients Awaiting Prior Authorization Submitted by Dr. Marie Witte 10) Right to Health Care Submitted by Dr. Arthur Beisang 11) Prohibition of Tiering Publicity Submitted by Dr. David Thorson, and Dr. Todd Brandt 12) Differences Between MMA Policy 290.07 and Constitutional Amendment Submitted by Dr. Peter Boosalis

RMS physicians debate proposed resolutions at the May 23, 2007 RMS caucus.

Ramsey Medical Society Board of Directors Recognizes Roger K. Johnson

T

he RMS Board of Directors paid tribute to Roger K. Johnson, outgoing CEO of the Ramsey Medical Society, at its May 15, 2007 meeting by providing him with kind words and a clock to show their appreciation. Roger served in organized medicine for 28 years, with the last 13 as CEO of the Ramsey Medical Society. The incoming CEO of Ramsey Medical Society, Sue Schettle, assumed the reins effective June 1, 2007.

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July/August 2007

MetroDoctors

nder the leadership of co-chairs Art Beisang, M.D. and Peter Boosalis, M.D., the RMS Public Policy Council is reconvening in order to gear up for the 2007-2008 legislative session.

The first meeting of the group was held on May 23, 2007 where a framework for moving forward was discussed. The Public Policy Council will serve under the RMS Board of Directors and will review and comment on issues within local and state government, provide liaison with county departments, agencies and elected officials on matters related to health care and the practice of medicine, foster the development of a working relationship between physicians, legislators and other government officials, and develop and recommend to the RMS Board new public policy programs, services and ventures for RMS to consider. We are very excited to get this council re-energized and look forward to engaging RMS members in the legislative and public policy projects that will undoubtedly be forthcoming.

If you have questions, please call the RMS office at (612) 362-3704.

In Memoriam JAMES L. CANINE, M.D. passed away peacefully on June 1, 2007 at the age of 82. He graduated from the University of Minnesota Medical School and completed his internship in Family Practice at Ancker Hospital. Dr. Canine was a World War II Navy Veteran. He was in private practice for 17 years in South St. Paul and then became a professor at the University of Minnesota Family Practice until retiring in 1984. Dr. Canine joined RMS in 1953.

GEORGE E. MILLER, M.D. died unexpectedly of an abdominal aortic aneurysm on June 3, 2007. He was 61 years old. Dr. Miller received his medical degree from the University of Minnesota and completed an ophthalmology residency at Hennepin County Medical Center. He practiced in Virginia, Minnesota before going on to do a Vitreal-Retinal Fellowship at Wills Eye Hospital in Philadelphia, PA. Dr. Miller started his solo practice, Ophthalmology Associates, PA, in Minneapolis and St. Paul. He specialized in retinopathy of prematurity and spent countless hours at Minneapolis and St. Paul Children’s Hospitals helping premature infants. Dr. Miller transferred membership to RMS from HMS in 2005.

The Journal of the Hennepin and Ramsey Medical Societies

RMS FOUNDATION NEWS

RMSF Hosts 2nd Derby Day

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arranging a race to be named after the Ramsey Medical Society Foundation. It was a great day at the track thanks to her work.

Dr. Susan Quick, ophthalmologist, St. Paul Eye, attended the event with her father Mr. Elliot Jackson.

Ramsey Medical Society

amsey Medical Society Foundation hosted the 2nd Physician’s Derby Day fundraiser at Canterbury Park in Shakopee on Saturday, May 19. This was also the day of the Preakness. RMS physicians, staff and their family and friends attended the event and enjoyed the races and the beautiful weather. The winner of the hat contest was Dr. Lian Chang.

RMS wishes to thank the organizer of the event, Cathy DeCourcy, for all of her hard work and dedication to the Foundation.

It was through her hard work and connections that we were able to secure a private room with a terrific view of the track, a great lunch, a betting seminar, a winners circle presentation where attendees were able to meet with the jockeys and see the beautiful horses, and for

Dr. Nick Meyer, orthopedic surgeon from St. Croix Orthopedics and current RMS board member, his wife, Karen, and their two daughters, Elena and Sophia.

Foundation Awards Grants

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amsey Medical Society Foundation (RMSF) receives grant requests throughout the year from a variety of organizations and programs. At its April 18, 2007 meeting the RMSF board reviewed and approved modest grants to support: a health fair in May at the Arlington High School; a continuation of support to the HMS Alliance for the HIV/AIDS folders that are distributed to high school students; and to the Physicians Serving Physicians program to help support their overall operations. The following is a thank you letter we received for the Health Fair grant.

To the RMS Foundation, The 3rd Annual Health & Environment Fair

for St. Paul’s third graders was once again a huge success. The fair, which is put on by Arlington High School’s Health & Environment Focus Area, hosted over 900 third graders this year. The number of third graders has increased each year from 500 to 700 to over 900 students this year. These totals represent a great success, which in large part is due to the financial backing of the Ramsey Medical Society Foundation. The fair would be nearly impossible to run without the $1,000 grant given yearly by the foundation. The grant provides money for substitute teachers for two days, display boards, construction materials for student projects, copying expenses, stickers and other rewards for the third grade

students. Arlington students created over 50 projects for this year’s fair ranging in topics from fast foods to allergens in our home.

Teachers raved about the projects throughout the two days and we received thank you letters from one class of third grade students. We hope that students, both third grade and high school, move forward into the summer with a more healthy attitude toward themselves and their environment. Once again thank you to the RMSF for its continued support of St. Paul’s students.

With thanks, Michael J. Shaw Health & Environment Focus Area St. Paul Arlington High School

Visit us at www.metrodoctors.com

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

July/August 2007

27

CHAIR’S REPORT paul a. kettler, M.D.

Medicare De-imbursement HMS‑Officers

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‑Board Members

Lauren Baker, M.D. Alan L. Beal, M.D. Carl E. Burkland, M.D. Peter J. Dehnel, 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 Martha Arneson, Co-Presiding Chair, HMS Alliance Beth A. Baker, M.D., MMA Trustee Christian L. Ball, M.D., Resident Representative Karen K. Dickson, M.D., MMA Trustee David L. Estrin, M.D., AMA Alternate Delegate Donald M. Jacobs, M.D., MMA Trustee Roger G. Kathol, M.D., MMA Trustee Dawn Lunde, MMGMA Representative Jason Meyers, Medical Student Representative Richard E. Streu, 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

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Here we go again. Medicare payments to

physicians will be cut by at least 10 percent beginning January 1, 2008. Medicare payments are modified annually on the sustainable growth rate (SGR) formula. This formula is linked to the gross domestic product (GDP).

The changes in general economic conditions measured by GDP have virtually no relationship to the costs of providing patient care and services. It is this horribly flawed formula that is used to meet the congressional budget for Medicare Part B, and thus continually cuts physician payments year after year. Medicare payments to physicians cover approximately 65 percent of the actual cost of providing services.

In recent years, Congress has reacted in lame duck sessions with quick fixes to avoid cuts and provide minimal increases in fees.

They continue to lack the resolve to find any long-term action that will fix the problem facing physicians and senior patients. Poll after poll indicates more physicians will cut, limit, or drop Medicare patients due to the associated financial loss.

What can you do? Contact Senators Coleman, Klobuchar, and Representative Ramstad!

One way to do this is through the AMA Web site at www.ama-assn.org and navigate to Grassroots Advocacy. You may also contact them via their personal Web sites, writing a letter, or making a phone call. Let your congressman know physicians remain committed to providing quality health care to seniors.

Our ability to do this is threatened by current Medicare fee trends. The flawed SGR formula needs to be eliminated and replaced with one that takes into account all regulatory, legislative, and economic forces that affect physician’s operating costs. No business can survive if its costs exceed revenues, and Medicare payments to physicians are inadequate to cover average costs.

I find it ironic that it used to be the patient who couldn’t afford the doctor, now it’s the doctor who can’t afford the patient.

Call For Delegates The Minnesota Medical Association Annual Meeting and House of Delegates is scheduled for Wednesday (evening)-Friday, September 19-21 in Mankato, MN.

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

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July/August 2007

We need your participation!

Hennepin Medical Society is eligible for 87 delegates.

Twenty-one resolutions have already been submitted to the HMS Caucus.

For additional information visit metrodoctors.com — click Hennepin Medical Society — click HMS Caucus and MMA Annual Meeting Information, or contact Kathy Dittmer at (612) 623-2885/kdittmer@metrodoctors.com.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

HMS IN ACTION Jack G. Davis, CEO

Jack Davis, Nancy Bauer and Jennifer Anderson attended many Legislative hearings throughout the 2007 Legislative Session. Issues monitored included: “Freedom to Breathe;” a bill that required health plans to support the cost of interpreter services; health care reform; legislation that established electronic reporting for schedule II controlled substances; proposed legislation that would examine health plan prior authorization for imaging; a bill that would provide oversight for provider tax funds; the physician health facility issue; direct assignment for HSAs; nickel per drink tax for alcohol; and several other health related issues. See article on page 8 for a complete legislative wrap-up.

Jennifer Anderson, Project Coordinator for the Partnership for a Smoke Free Scott County, will be redirecting her effort in Scott County toward the implementation of the Statewide Freedom to Breathe Act. St. Francis Medical Center physicians and staff participate in this partnership.

A Community Internship Program, co-sponsored by the Hennepin and Ramsey Medical Societies, was held June 6-7, 2007.

Nine members of the Board of Medical Practice participated in this two-day program; each shadowing physicians in four different specialties.

Abbott Northwestern Hospital and

its medical staff have agreed to continue the funding of the Shotwell Award recognizing a person in the state of Minnesota for his/her dedicated service to mankind. A new bronze sculpture is being created by sculptor, Nicholas Legeros.

MetroDoctors

A Minnesota group of 80 physicians, health care administrators and their spouses attended an annual social gathering in Naples, Florida to renew friendships and to reflect on medicine in Minnesota. Tom and Mary Kay Hoban assisted with organizing the event. Most in attendance are current or emeritus members of the Hennepin Medical Society.

Hennepin and Ramsey Medical Society staffs are continuing to update and add functionality to the MetroDoctors Web site. The Web site has news regarding legislative and public policy issues, CME offerings, meeting schedules and minutes, membership and contact information, etc. Please go online at www.metrodoctors.com and provide us your feedback.

The Apple Valley Clinic held an open house on Saturday, April 21 to celebrate the expansion of their facilities. Expanded imaging and diagnostic services, specialty clinics, an in-house pharmacy and a patient parking ramp are included in the expansion.

The Hennepin Medical Society Senior Physician Association met on April 24. Sixty-five attendees heard a presentation by former Governor Al Quie, who talked about his horseback journey from Canada to Mexico on the continental divide. The Association meets quarterly. If you’re interested in getting on the mailing list, please contact Kathy Dittmer at HMS. The leadership of the Hennepin Medical Society has participated in a planning retreat, a Board meeting and several Executive Committee meetings since the first of the year.

One item discussed has been evaluating the pros and cons of changing the name of the Society to better reflect the geographic scope of HMS. The Society covers the counties of Hennepin, Anoka, Carver, Scott and western Dakota. Several years

The Journal of the Hennepin and Ramsey Medical Societies

ago “County” was dropped from the name.

Now’s the time to consider how to better include the growing physician members who work or live outside of Hennepin County. A recommendation will likely be made at the MMA House of Delegates this fall.

May 1 was the date for the Annual Hoban Scholarship Event. Hoban Scholars were invited to present papers on a class project to the selection committee and other invited guests. H. Thomas Blum, M.D. serves as Chair of the Selection Committee.

We were honored to have Tom and Mary Kay Hoban attend this year’s event.

Dianne Fenyk, wife of John Fenyk Jr., M.D. and past President of the Hennepin Medical Society Alliance, was installed as the President of the American Medical Association Alliance in June. A reception partially sponsored by the Minnesota Medical Association, Hennepin Medical Society and Ramsey Medical Society was held on June 25, 2007 in Chicago.

Welcome New HMS Members Active Susan J. Pearson, M.D. HCMC Psychiatry Psychiatry Muhammad Fareed K. Suri, MBBS University of Minnesota Graduate School of Medicine Psychiatry Marie V. Svetaz, M.D. Hennepin Family Medical Center Family Medicine July/August 2007

29

Hennepin Medical Society

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

HMS NEWS

Foundation Improves Public Health, and Promotes Education and Research

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he Hennepin Medical Foundation (HMF), the philanthropic arm of the Hennepin Medical Society, was established as a 501(c) (3) organization in 1968 to improve the general health of the public and promote education and research. To this end, the HMF provides grants to community initiatives and programs focused on improving the public health and to support the financially disadvantaged. Much of the HMF money is used as seed money for program development and support of struggling service organizations. Nearly $10,000 was received this year through contributions from HMS members and the area hospitals.

The HMF provided grants to the following organizations in 2006 : Center for Cross-Cultural Health. The CCCH has taken a leading role in Minnesota by developing cultural competency programs, tools and resources for medical groups. These programs serve to empower providers and health agencies with the knowledge, skills and support to effectively address and begin to reduce the significant health, social and educational disparities experienced by Minnesotans of multiple cultural and ethnic backgrounds.

Greater Minneapolis Crisis Nursery. Grants support the Pediatric Assessment and Medical Management (PAMM) Program that allows the Nursery to provide health care to children staying there and to share information about the children’s health issues with parents.

Hennepin County Medical Center — Newborn Intensive Care Unit. This year’s grant will support the purchase of two in-bed scale platforms. These scales allow the nurses to weigh extremely small and sick infants inside their isolette.

Hennepin Medical Society Alliance — HIV/ AIDS Education Folders. This education folder was designed by a high school student, has 30

July/August 2007

a format that is non-threatening, is a visually pleasing presentation of serious information, and has been distributed to over 250,000 Minnesota middle school and high school students.

In addition to offsetting the cost of printing 80,000 folders, the grant money will be used to edit and update the message information printed on the cover.

Minnesota Visiting Nurses Association.

Grants support MVNA’s expansion of their Community Outreach Projects — Club 100, Club 101 and the Adopt-A-Family Program.

Club 101 involves the community in meeting the critical but non-medical needs of their clients. Club 101 is a similar program for adults and seniors. The Adopt-A-Family Program occurs at the Holidays.

Sub-Saharan African Youth & Family Services in Minnesota (SAYFSM) — “Ijole” Youth Program (Ijole means children in Oromo). SAYFSM serves the African communities in Minnesota by providing culturally and linguistically appropriate health and social services to African-born immigrants including those infected with HIV/AIDS. This year’s funding will be used to expand their HIV outreach program.

Thomas P. Cook Scholarship. An annual scholarship is awarded to a medical student through the Minnesota Medical Foundation at the University of Minnesota.

University of Minnesota AHC CLARION Student Program. CLARION is a U of M student organization dedicated to promoting safe, efficient and high quality care for patients through inter-professional leadership development. Each activity is an opportunity for students to integrate concepts from different areas of health care such as health care management, medicine, pharmacy, nursing and public health.

Through CLARION, students gain leadership MetroDoctors

experience and the skills they need as the next generation of health professionals.

2006 Contributors to Hennepin Medical Foundation Arnold Adicoff, M.D. Charles D. Adkins, M.D. Adrian K. Almquist, M.D. W. R. Anderson, M.D. Rolf L. Andreassen, M.D. Thomas J. Arneson, M.D. Michael B. Belzer, M.D. Peter J. Benson, M.D. H. Thomas Blum, M.D. Florence J. Bouthilet, M.D. David L. Bowlin, M.D. John L. Canfield, M.D. Raul F. Cifuentes, M.D. James L. Craig, M.D. Michael J. Cumming, M.D. Diane A. Dahl, M.D. Dale T. Dobrin, M.D. Bradley Doeden, M.D. Douglas A. Drake, M.D. David M. Dvorak, M.D. Hugh A. Edmondson, M.D. Barbara J. Ehler, M.D. Edward P. Ehlinger, M.D., MSPH Thomas C. Eisenstadt, M.D. John A. Eklund, M.D. Amanada Engstrom, M.D. E. Duane Engstrom, M.D. Richard L. Engwall, M.D. Richard J. Frey, M.D. Jon D. Fuerstenberg, M.D. James M. Gayes, M.D. Raymond A. Gensinger, M.D. Reinhold O. Goehl, M.D. Joel S. Greenwald, M.D. Julia V. Grigoriev, M.D. Joseph I. Hamel, M.D. A. Stuart Hanson, M.D. Mildred S. Hanson, M.D. James C. Harvanko, M.D. Neil R. Hoffman, M.D.

The Journal of the Hennepin and Ramsey Medical Societies

THANK YOU!!

MetroDoctors

HMS Caucus Convenes

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he Hennepin Medical Society Caucus, chaired by Carl A. Burkland, M.D. was held on Wednesday, May 23, 2007. An interesting and varied list of draft resolutions was presented and reviewed by the delegates in attendance as noted below.

The MMA Annual Meeting is scheduled for Wednesday, September 19-Friday, September 21 at the Midwest Wireless Civic Center in Mankato, MN, with the House of Delegates slated to convene at 7 p.m. on Wednesday evening. Please note that this is a change in their usual format!

The west metro trustee district is represented by 87 delegates from HMS. We need your voice!

Please contact Kathy Dittmer at (612) 623-2885 or kdittmer@metrodoctors.com to register.

DRAFT RESOLUTIONS: 1. Defining and Condemning Torture 2. Reducing Sexually Transmitted Infection and Unwanted Pregnancy 3. Supporting Green Chemistry Innovation, Education and Regulatory Reform of Industrial Chemicals 4. Removal of Artificial Trans Fatty Acids 5. Advanced Care Directive Repository 6. Investigation of Military Medical Personnel Participation in Torture

(From left) James Young, II, M.D., David Wallinga, M.D., Edward Ehlinger, M.D. participate in a discussion of the resolutions.

7. Minnesota Malpractice Liability Cap and Compensation Trust Fund 8. Health Care Provider Entity Non-Profit Tax Status Requirements 9. Emergency Response and Disaster Task Force 10. Establishment of a Panel to Address the Medical Needs of Minnesota’s Military 11. Prior Authorization Procedures for Diagnostic Imaging Studies 12. Enrollee Access to Insurance/Health Plan Provider Agreement Details 13. Public Access to Pesticide Use Data to Assess Exposure Problems and to Ensure Evidence-Based Treatment of Pesticide-Related Illnesses 14. Addressing the Urgent Threat of Global Climate Change to Human Health 15. Excessive Physician Executive Pay 16. Establishing RVU’s For Medical Products and Pharmaceuticals 17. Prospective Online Enrollee Insurance Benefit and Medication Formulary Details 18. Insurance Discrimination in Minnesota Mental Health Provider Networks 19. Universal Health Insurance and Appropriate Compensation 20. Radiation Therapy Facilities

David Wallinga, M.D. discussed “green chemistry.”

Carl Burkland, M.D., Caucus Chair, discusses House of Delegates process with Frank Rhame, M.D.

The Journal of the Hennepin and Ramsey Medical Societies

Frank Rhame, M.D. presents a resolution on “Defining and Condemning Torture.”

July/August 2007

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Hennepin Medical Society

James R. Householder, M.D. Gerald D. Jensen, M.D. Alan W. Johnson, M.D. Donald A. Johnson, M.D. David Johnston, M.D. David C. Johnston, M.D. Matthew P. Jones, M.D. H. I. Katz, M.D. Barbara Knoll Arndt, M.D. G. P. Lilja, M.D. Maurice L. Lindblom, M.D. Charles E. Lindemann, M.D. John H. Linner, M.D. Bradley M. Linzie, M.D. Richard C. Lussky, M.D. David I. Lynch-Salamon, M.D. Toni Magnuson, M.D. Deane C. Manolis, M.D. Robert E. McKlveen, M.D. Henry C. Meeker, M.D. Robert K. Meiches, M.D. H. Midelfort, M.D. Timothy Miley, M.D. Anne G. Minenko, M.D. Richard A. Miner, M.D. Maryanne M. Moren, M.D. Anne M. Murray, M.D. Deborah S. Nicholson, M.D. Bruce C. Norback, M.D. Duane L. Orn, M.D. Ronald D. Osborn, M.D. Vicki M. Oster, M.D. David M. Overman, M.D. Sotirios A. Parashos, M.D., Ph.D. James J. Pattee, M.D. Richard A. Pfohl, M.D. Dominic A. Plucinski, M.D. Phillip Price, M.D. John A. Reichert, M.D. Edwin H. Ryan, M.D. Peter A. Schlesinger, M.D. Richard D. Schmidt, M.D. David Schneider, M.D. Burton S. Schwartz, M.D., FACP Martin A. Segal, M.D. Gregory L. Seifert, M.D. Rajiv R. Shah, M.D. Richard K. Simmons, M.D. Edward A. Spenny, M.D. Farrell S. Stiegler, M.D. Richard E. Streu, M.D. John A. Tobin, M.D. Joseph M. Tombers, M.D. Robert M. Wagner, M.D. Warren K. Warwick, M.D. Richard C. Waterbury, M.D. Osmund A. Wiseness, M.D.

HMS ALLIANCE NEWS martha arneson

A Time for Celebration

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When the month of May arrives we usu-

• Communication Chairs: the Leadership

ally think of celebrations: high school and college graduations, Mother’s Day, and Memorial Day. It’s also a time when most organizations have their annual meeting.

The Hennepin Medical Society Alliance, likewise, held its annual meeting May 11 at the Edina Country Club. It was also a celebration of 97 years of existence.

A very special highlight of this annual event was the recognition of long-time Alliance members. The new 40 year member was Vianne Engwall. Four women with membership for 61 years were honored: Marion Kelsey, Marion Nord, Ruth Sandt and Dorothy Horns. The remarkable milestone of 70 years of membership in HMSA has been reached by Helen Nelson and Irene Maeder. The HMSA is so proud of these women. In leading the tributes, Becky Finne commented that 46 individuals have had membership in our Alliance for more than 40 years.

The HMSA elected its Officers of the Board (Leadership Council) for 2007-2008, and the installation was led by AMAA President-elect, Dianne Fenyk. The individuals elected and installed were: • Co-Presiding Chairs: Martha Arneson and TrishVaurio; • Co-Program Chairs: Diane Gayes and Peggy Johnson; • Co-Health Promotion Chairs: Diane Gayes and Dianne Fenyk;

Council; • Recording Secretary: Carla Deinema; • Corresponding Secretary: Michele Schroeder; • Treasurer: Martha Arneson; • Philanthropic Treasurer: Ludmila Eklund; • Membership Treasurer: Marlene Ellis; • Auditor: Becky Finne; and • Immediate Past Co-Presiding Officers: Eleanor Goodall and Trish Vaurio.

For more than a year the HMSA has been celebrating the announcement of Dianne Fenyk’s election as President-elect of the AMAA. With great anticipation and pride, HMSA, MMAA and other county alliance members will travel to Chicago to participate in the Inaugural Celebration on June 25 and to witness her installation on June 26. At a luncheon at the Drake Hotel, Dianne will become President of the American Medical Association Alliance, an honor highly deserved by a remarkable person. It will be the first time in 60 years for an Alliance member from Minnesota to be elected national president.

Eleanor Goodall, has done an outstanding job of chairing the MMAA planning committee for the Inaugural Celebration. Her committee consisted of several HMSA members: Becky Finne, Diane Gayes, Dianne Fenyk, Martha Arneson, Marlene Ellis, Mary Anderson and Trish Vaurio. MMA staff members Vicki Westling and Erika Nelson were invaluable with their handling of many arrangements.

Through the generous contributions of the HMS, HMSA, RMS, MMA, MMAA, other county Alliances, and many individuals, it is possible for the MMAA to host a wonderful party to honor Dianne. Approximately 250-300 people are expected to attend. All of us extend our sincere thanks and appreciation for your support.

Dianne Fenyk, Trish Vaurio, Eleanor Goodall, and Martha Arneson at the HMSA Annual Meeting in May.

Marion Kelsey with Becky Finne at the Annual Meeting.

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July/August 2007

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

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Minnesota Physician Services, Inc.

a subsidiary of Ramsey Medical Society that offers discounts on products and services for physicians across the state.

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.

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.

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 noobligation price estimate, please contact I.C. System directly at 1-800-2793511 and let them know you are a RMS member.

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 1-800920-SAFE or visit their website at www.safeassuremedical.com for more information.

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.

Call RMS at 612-362-3704 for details.

Robert Delaune, M.D. John Wangsness, M.D.

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