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Doctors MetroDoctors the Journal oF the hennepIn and ramsey medIcal socIetIes
Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.
contents VOLUME 9, NO. 2
2
Letters
Smoke Free Day at the Capitol
Index to Advertisers
3
Congressional Agenda for Health Care
5
colleague Interview
MARCH/APRIL 2007
Carl Burkland, M.D.
6
Classified Ads
8
Tobacco and Alcohol Use Among Minnesota College Students
12
FEATURE
What’s Happening With Family Physicians?
17
Reintegration of Our Military Forces Into the Community
19
JCAHO Responds to Metropolitan Hospital Physician Leadership Issues
20
An Online Balm for Office Care Points of Pain
23
Robotic Surgery Hits the Medical Marketplace Nationwide
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.
25
Status of HMS/RMS Resolutions
28
Mary Ann Blade Receives Shotwell Award
For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (952) 903-0505 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com.
Ramsey Medical Society
29 30 31
President’s Message
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.
MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. 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
Great Turnout for 2007 RMS Annual Meeting
Boeckmann Library Update/Introducing New Employee for Smoke Free Washington County/In Memoriam/Correction
32
New Members
33 35 36
Hennepin Medical Society
Chair’s Report New Members In Memoriam/HMS Alliance Annual Meeting
The Journal of the Hennepin and Ramsey Medical Societies
On the cover: There are a number of professional and business challenges facing family physicians. Article begins on page 12.
March/April 2007
March/April Index to Advertisers Advanced Healing Systems................................18 Advanced Skin Care Institute. ..........................19 Bethesda Hospital.................................................24 The Birkeland Group ......... Inside Back Cover Children’s Physician Network............................... Outside Back Cover Classified Ads........................................................... 6 Columbia Park Medical Group........................21 Crutchfield Dermatology..................................... 7 Edina Realty—Mimi Ryerse................................ 4 indigital, inc. ........................................................24 LaMettry’s Collision.............................................22 Medical Billing Professionals.............................17 MMIC ....................................................................... 2 Minnesota Oncology Hematology, P.A.. ............ Inside Front Cover Minnhealth Family Physicians......................... 15 Minnesota Physician Services, Inc.. ..................... Inside Back Cover North Memorial Health Care...........................28 Red Pine Realty.....................................................11 Southside Community Health Services.........31 Weber Law Office.................................................14
letters I read with great interest David Aughey’s article about the Teenage Medical Center – TAMS. It’s good that such a well-trained doctor in both pediatrics and adolescent medicine be the medical director. I have only one correction to make in an otherwise excellent article. It was in 1968-69 that I was invited to volunteer at the new Teenage Medical Center on 2425 Chicago Avenue South along with my partners Jay R. Olsen (Ob/Gyn), Bob Welson (Family Practice) and Don Johnson (Ob/Gyn) — all from the Bloomington Lake Clinic nearby. We
worked a half-day or more a week on our day off from the clinic. Not much organization. Many patients identified themselves by their car license numbers. One St. Patrick’s Day all had Irish names. It was only when Dr. Betty Jerome came on board — my memory was early 70s — that we became organized with records and follow-ups. Many other volunteers helped out in those days. Dr. Arne Anderson, of course, was our guiding spirit. I’m sure you will be getting some of their comments, also. Daniel C. Conlon, M.D.-retired Bloomington Lake Clinic
Smoke Free Day at the Capitol
HMS and RMS physicians participate in a successful Smoke Free Minnesota Day at the Capitol on January 30, 2007.
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March/April 2007
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The Journal of the Hennepin and Ramsey Medical Societies
Congressional Agenda for Health Care
A
As I have traveled throughout the state, I have had the opportunity to meet and talk with fellow Minnesotans about issues of concern to them. What I’ve heard is that communities are understandably concerned about the viability of their Skilled Nursing Facilities and Critical Access Hospitals, the ability of their seniors to afford their prescription drugs and long term care, whether or not their small business can afford to offer health insurance, and on and on. Clearly, health care is front and center in the minds of Minnesotans. These concerns can be divided into three main categories: Affordability, Access and Advances in medicine. These are the three A’s of my health care agenda. Looking ahead into the 110th Congress, I believe there will be many opportunities to advance this agenda. Affordability
I believe everyone should have affordable health care coverage. Does that mean a “single payer” system is the answer to affordable health care? Absolutely not. In a single payer system, not only does every taxpayer continue to pay for health care, but also all the health care choices for you and your family are made by the government. Single payer systems in Europe and elsewhere have resulted in fewer options for treatment and fewer advances in medical innovation. I don’t believe this is the solution for Minnesotans. Instead, I support more affordability through options like Health Savings Accounts, Association Health Plans, Medicare Part D and income-based tax credits for individuals and families without employerbased health insurance. In addition, I believe that we need to reform the medical liability system.
b y S enator N orm coleman
MetroDoctors
Association Health Plans would allow groups of people in civic organizations, churches, or small businesses to band together to increase their purchasing power. One example of this approach is Small Business Health Plans (SBHPs). Small businesses are the largest employers in the country and have the highest rates of uninsured. SBHPs will allow small companies to band together to negotiate on health plans, and will help them compete with bigger companies. The SBHP debate in Congress has been dominated by the question of how many mandates should exist for these plans, which by design, must cross state lines. While we need to ensure that these plans offer quality care and some baseline assurance of coverage for different conditions, we also must not miss the forest for the trees. Rather than covering a few people with Cadillac care, we should start by making sure that everybody can at least get basic care. For those customers who wish to purchase a higher level of coverage, we might look at ways to make additional options available on an a la carte basis. I am a strong supporter of Health Savings Accounts (HSAs) because they will help individuals and businesses save a substantial amount on health insurance premiums and gain more control over their health care spending. Plain and simple: HSAs help more Americans gain affordable coverage. People who set up HSAs can use tax-free money to pay for routine medical expenses, while gaining protection against major medical expenses. Health care policy in this day and age should strive to do a better job of empowering consumers to make choices about which services and service providers they want to use, and at what price. HSAs encourage consumers to make these choices. Additionally, one of the important features of the HSA is that it
The Journal of the Hennepin and Ramsey Medical Societies
is completely portable. Should a person lose or change jobs, the account moves with them. Consumers keep all the money they’ve invested to use for future medical expenses. Another issue that is gaining a lot of attention these days in Washington is the Medicare Part D program. For the first time ever, over 90 percent of seniors have drug coverage! During the first 11 months of 2006, over 547,000 Minnesotans were covered under the Medicare Part D Program. That number is expected to rise as a result of this latest open enrollment period. An additional 84,000 have other prescription drug coverage. Nationwide, there are 23.5 million seniors enrolled in a private Medicare Part D plan. This program is working to provide seniors in Minnesota and all throughout the country access to affordable prescription drugs. It is true that the program has had its fair share of glitches along the way and I have worked hard to ensure that these glitches are fixed. In the years ahead, I will continue to work with my colleagues in Washington, as well as listen closely to those on the ground in Minnesota, to find solutions to these problems. What’s remarkable is that despite these glitches, competition between plans has resulted in even lower costs to consumers and to the government than we expected. This program is working to provide seniors in Minnesota and all throughout the country access to affordable prescription drugs. A recent study showed that Medicare (Continued on page 4)
March/April 2007
Medicare Call to Action (Continued from page 3)
beneficiaries with common chronic conditions enrolled in Medicare prescription drug plans are seeing an average savings of 59 percent and maximum savings through a range of lowercost plans up to 52 percent. According to the most recent numbers, the average premium is $24 per beneficiary nationwide, rather than the original projection of $37 per person, in large part due to competition and the work of seniors — and those who have assisted them — in selecting the best individual plan. Access:
All Minnesotans deserve access to health care, which is why part of my focus in the Senate has been on meeting the health care needs of rural Minnesota. For example, technological innovations like remote monitoring can “virtually” bring the best doctors in the world to any health care setting. I intend to re-introduce the Remote Monitoring Access Act to make sure Medicare can cover physician services involved with the remote management of specific medical conditions, such as congestive heart failure and diabetes. These technologies allow physi-
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March/April 2007
cians to monitor and treat patients without a face-to-face office visit. Additionally, as Minnesotans move to a new home, travel or just see a new specialist or physician, they want to be sure that health professionals have access to important medical information about them as a patient so that medical errors can be prevented. During this session of Congress, I will work on bills that will address the interoperability and infrastructure needs relating to Health Information Technology (HIT). Health care is the most “information intensive” business there is. If our hospitals and physicians don’t have access to up-to-date information technology, we are essentially denying patients access to quality care. HIT is a critical component of improving the quality of care, and I intend on doing my part in Washington to ensure that these initiatives move forward. Advances in Medical Care:
Minnesota is a center for advancements in medical care and medical technology. Institutions like the Mayo Clinic and the University of Minnesota, along with our robust biotech industry, continue to make us a leader in this field. I believe we have a lot that we can bring to the national conversation on health care. I will continue to work with my colleagues and those in the device industry and biotech industry as they work to increase the quality and length of life of our citizens. Recently I was selected to join the U.S. Senate Special Committee on Aging, which looks out for the interests of America’s seniors. I look forward to engaging my colleagues in developing solutions for the issues that concern seniors and future seniors. As we look forward, baby boomers will be joining their ranks. This population shift will produce new challenges as well as new opportunities for the nation. For this reason, I will re-introduce legislation that starts a national discussion about how to provide for the needs of our growing population of seniors, using advances in medical technology to improve the efficacy and efficiency of their care. I introduced a bill to establish a Consortium on the Impact of Technology in Aging Services. The consortium will be charged with studying how technological advances can be used to support elders, families and communities as the demand for health care and aging services increases exponentially. Current and emerging technology may MetroDoctors
be the key to ensuring that baby boomers are able to maintain their quality of life by staying active, living in their own homes and engaging in the workforce as long as they please, well into their senior years. The appropriate use of this technology will also help us control spiraling health care costs. I am focused on finding a solution that brings the public and private sectors together to build a national infrastructure to support the health of older adults, their families and communities. Conclusion:
We have reached an important intersection in the development of our nation’s health care system. On one hand, in the last hundred years we have made exciting advances in medicine, technology, and pharmaceuticals, which have resulted in decreased morbidity and increased mortality. On the other hand, as people live longer and the Baby Boomer Generation reaches their senior years, we have a growing aging population, which places new demands on our health care system. Congress is faced with the important task of deciding how to meet the needs of our seniors and others who rely on federal health care programs, while at the same time ensuring the sustainability of these programs into the future. What is becoming obvious is that the system cannot be maintained in its current state. There are more people to cover and fewer dollars with which to cover them. With the increase in the retirement population there are fewer people remaining in the workforce — fewer taxpayers. This leaves us with an accounting problem. We are tasked with the responsibility of managing this situation so that our seniors and others are well taken care of, but also so that our children can continue to benefit from these government programs and receive the returns they deserve on the tax dollars they’ve contributed over their lifetime. This is a significant challenge, but one that we must face head on as we move forward. As we in the Senate move forward on the numerous health care policies, it is important to hear from doctors, nurses and other health care providers about how proposals will affect their ability to provide quality, affordable, and accessible health care. This is extremely important and I encourage you to stay in contact with my office and your other legislators about how policies will affect the care you provide. The Journal of the Hennepin and Ramsey Medical Societies
colleague IntervIew
Carl Burkland, M.D.
Carl Burkland, M.D., attended medical school at the University of Iowa. Both his internship and residency were completed at St. Paul Ramsey Medical Center, at which time he was the first and only family practice resident in the class (1971-73). Dr. Burkland is board certified in family practice and is a partner at Parkview Medical Clinic in New Prague, MN. Dr. Burkland is the author of Resolution 201, submitted to the MMA House of Delegates last September, on Alcohol Health Impact Tax.
Q A
What can we do to decrease DWI’s in this state? 2006 was a record year for state drunk-driving arrests — Minnesota, the land of 40,000 DWI’s. One in eight Minnesota drivers had a DWI conviction. “People are becoming anesthetized to being told not to drink and drive, and it’s going right over their heads,” according to a MADD policy advisor. “The 40,000 arrests show us that we can’t get their attention any more with education,” according to a Hennepin County corrections supervisor. To curb drunk driving some say to use better law enforcement and new, enhanced technology that prevents engines from starting if alcohol is detected on drivers. However, both these are expensive and time consuming. And, they really are only a part of the remedy to stopping DWI’s. What is really needed is a culture change where the public doesn’t accept drinking as a rite of passage into adulthood or as a safe, acceptable, healthy behavior by adults.
Isn’t the DWI problem an issue not only about the health and safety of the intoxicated individual, but also an issue of community health and safety? Dr. Edward Ehlinger has it right when he said, “just like we had community buy-in with tobacco control, we need to have the same buy-in with alcohol control.”
What factors may be creating this steadily increasing present and future pool of DWI motorists? In Minnesota, 16 percent of ninth graders, 31.7 percent of 12th graders and more than 45 percent of University of Minnesota Twin Cities campus students ages 18 to 24, and more than half of the men that age, reported that they had five or more drinks in a row within the past two weeks MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
(binge drinking). (See related article by Dr. Edward Ehlinger, “Tobacco and Alcohol Use Among Minnesota College Students,” on page 8.) According to the CDC, one out of four high school students had their first alcoholic drink before age 13. Young people who begin drinking before age 15 are four times more likely to develop alcohol dependence and are two and a half times more likely to become abusers of alcohol than those who begin drinking at age 21. Another more recent study showed that 47 percent of those who began drinking alcohol before age 14 became alcohol dependent at some time in their lives, compared with nine percent of those who waited until age 21. There were also long-term cognitive consequences to excessive drinking of alcohol in adolescence.
How is this culture of alcohol acceptance to be changed? A culture of years of acceptance of smoking was changed through public policy that used prevention, treatment and enforcement programs to decrease the significant health dangers of smoking and exposure to second-hand smoke. The public perception is that the increasing numbers of binge drinking and DWI’s are truly a worrying trend with negative health consequences that may continue to grow for years to come. Minnesotans are ready for public health policy similar to smoking public health policy, which was funded, in part, by the smoking industry. Surveys show that three out of four Minnesotans support increasing the alcohol tax to pay for public safety, prevention, and treatment of alcohol problems.
How is the MMA playing a role in ensuring this change in Minnesota’s drinking cultures occurs? The MMA, at its annual meeting of the House of Delegates last September, passed the Alcohol Health Impact Tax resolution. The MMA delegates were concerned about the public and governmental attitude of appearing to accept the status quo in regard to the state’s drinking culture. Therefore, the MMA resolved to consider alcohol abuse, particularly among underage drinkers, one of its public health priority (Continued on page 6)
March/April 2007
Colleague Interview (Continued from page 5)
issues. Furthermore, the MMA resolved to advocate for an increase in the excise tax on beer, wine and spirits by the equivalent of $0.10 a drink and that these increased funds should be used for prevention, treatment and public safety services related to alcohol abuse.
Is there evidence-based strategies for combating underage drinking? Yes, frequency and quantity of underage alcohol consumption is inversely related to the price of alcohol. In 2001, the binge drinking rate in Wisconsin was 35.6 percent and in Alaska 15.6 percent in the 18-20 year old population. Current beer-tax rates in Wisconsin, Minnesota and Alaska respectively are $0.06, $0.15 and $1.07 per gallon. From lowest to highest, Wisconsin ranks second, Minnesota 18th and Alaska 51st in current beer tax rank.
Is there evidence-based data that shows that increasing alcohol taxes decreased binge drinking, alcohol-related accidents, alcohol poisoning, alcohol-related illness and violent incidents? Yes. In March 2004, the Finnish government reduced alcohol taxes by more than 40 percent to stem the flight of residents to Russia and Estonia to purchase cheaper alcohol. Health officials subsequently reported a 10 percent growth in binge drinking in the first six months after the tax cut took effect. Overall alcohol consumption in Finland jumped by 15 percent from 2003 to 2005, and for the first time in the nation’s history, alcohol surpassed heart disease as the leading killer of males ages 15 to 64, accounting for 17 percent of all deaths in this age group in 2005. This drop in alcohol taxes had a huge negative public health impact and one would suspect that the reciprocal of that would have the opposite effect i.e., raise taxes and decrease deaths.
What is the current Minnesota tax on alcohol? How does this compare to other states? Minnesota’s excise tax on alcohol is only pennies per drink: 1.4 cents on a glass of beer, 1.2 cents on a glass of wine, and 5.9 cents on a shot of liquor. There have been only two increases in the state’s liquor tax in the past 35 years—in 1971 and 1987. Because of the percent loss in value of 40 percent in 1987, when the last alcohol excise tax increase occurred, the deflated tax rate per 12oz. serving of beer is now $0.0084. This is glaringly unacceptable to maintain this status quo of taxation. Minnesota’s alcohol taxes are low compared to other states. Fortytwo states have a higher tax on wine, and 31 states have a higher tax on beer, including three of four neighboring states. Minnesota ranks seventh of 32 states that have an excise tax on liquor. Excise tax rates (per gallon) on beer: Iowa — $0.19 Minnesota — $0.15 North Dakota — $0.16 South Dakota — $0.27 Wisconsin — $0.06 U.S. average — $0.26
Is it true that most drinkers don’t drink much and alcohol taxes don’t burden them? Yes. The top 20 percent of drinkers consume 85 percent of all alcoholic beverages. Therefore, the remaining 80 percent of moderate drinkers consume, on average, relatively little alcohol and pay a negligible amount of alcohol taxes. The alcohol excise tax falls on heavy drinkers who appropriately assume a greater share of the costs of problems caused by this drinking. This would be a true user tax, which would assure that the alcohol beverage industry was paying their fair share of the costs caused by the use of their product.
What is alcohol’s cost to society?
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Alcohol sales currently raise about $260 million per year ($65 million in excise taxes and about $195 million in sales tax revenue). Minnesotans spend at least $923 million per year for increased health care costs — that’s $385 per taxpayer each year. (Minnesota Department of Health, 2004) Raising the alcohol excise tax by a nickel a drink would yield an estimated $120 million annually.
How can we keep any alcohol tax revenue from ending up diverted to the general budget? We can’t control legislators’ priorities, however, the 5 cents a drink alcoholic beverage excise tax bill before the legislature this year (S.F. 779) earmarks alcohol-tax collected funds to be used for prevention, treatment and enforcement services related to alcohol abuse. Most states direct the revenues collected from alcohol taxes into their general funds. Twenty-four states earmark alcohol-tax revenue col-
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The Journal of the Hennepin and Ramsey Medical Societies
lections for specific uses, and of those, 10 states use the funds for alcohol programs.
How does the current tax on alcohol compare to the cigarette tax? Minnesota tax on one pack of cigarettes = $1.23 Minnesota tax on one carton of cigarettes = $12.30 12oz. beer serving = 1.4 cents x 6 = 8.4 cents/6 pack In Minnesota, the excise tax on 146.42 six packs equals the excise tax on one carton of cigarettes. Deflated tax rate on 12oz. beer serving = $0.0084 x 6 = $0.0504 cents/6 pack In Minnesota, taking into account the deflated tax rate on 12oz. beer serving since 1987, the true excise tax on 24,404 six packs equals the excise tax on one carton of cigarettes.
In light of the recent no-smoking restrictions placed on bars and restaurants, what do you anticipate the bar/ restaurant owner’s response to this action will be? The impact on these businesses, I believe, will be a lot less since the tax is added at the wholesale level, not at the retail level. Remember that the retail price of alcoholic beverages has increased since 1987, however, unlike the excise tax, industry-driven price increases do not directly contribute to the state revenues.
What can physicians do to help? Alcohol abuse has to be seen as an up close and personal problem which, like a thief in the night, can rob physicians and their patients, their families and their children of their good health and their bright futures. Like smoking, alcohol abuse affects the abuser and the innocent non-user. This is an “in your face” weekly, if not more frequent, problem which we now hear about on radio, see on TV and read about in the newspaper. We have to accept, and get the public and our legislators to accept, that like obesity and smoking, alcohol abuse is a major public health problem. We, and our legislators, have a responsibility to protect the public from harm. We need a comprehensive strategy, including but not limited to, prevention, education, treatment and enforcement to ensure that this public health problem is addressed and stopped. We have to let our peers, patients and legislators know that a legitimate and equitable amount of this funding for enactment of this comprehensive strategy should come from the alcohol beverage industry. They are not paying their fair share now. This strategy should also begin to change the social norm so that our young people, our most important asset, understand that underage drinking is not acceptable! Let your patients and legislators know that the time is right for an increase in alcohol beverage taxes to cover its costs to society. The human and societal cost of alcohol touches everyone’s life in some way.
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Are you able to gauge the political climate at the Minnesota legislature in terms of the possibilities for enacting the alcohol tax increase? I believe the climate for the state legislature to consider increasing an alcohol excise tax has never been better. The House of Representatives had a 2006 State Fair poll in which the question was asked, In general, would you support a health impact fee on alcoholic drinks to help offset alcohol-related costs to the state, such as health and safety? 55.8 percent (3,639) answered yes, 36.8 percent (2,401) answered no, and 7.4 percent (48) were undecided or had no opinion. Asking this question about the imposition of a health-impact fee on alcoholic drinks to defray alcohol related costs to the state indicates that legislators have this on their radar screen as an appropriate tax increase to be considered.
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March/April 2007
Tobacco and Alcohol Use Among Minnesota College Students
F
Following the 1998 Minnesota Tobacco
Settlement and the multi-state Master Settlement Agreement with the tobacco industry, the 18-24 year-old population became the youngest legal target for tobacco marketing. The tobacco industry quickly responded to this change by developing promotional campaigns specifically geared to this population. Tobacco company sponsorship of young adult-focused concerts, bands, bar nights, trips, clothing, and other promotional materials burgeoned. Data from the 2005 National Health Interview Survey (NHIS) demonstrate the success of those efforts. As noted in the October 26, 2006 Morbidity and Mortality Weekly Report (MMWR), the highest rate of tobacco use in the United States now occurs in the 18-24 year old age group.1 This group has a tobacco use rate of 24.4 percent compared to an overall adult tobacco use rate of 20.9 percent. The MMWR also notes that the prevalence of cigarette smoking among U.S. adults did not change from 2004 to 2005. In light of this, the MMWR raises the concern that “the adult prevalence might represent a stall in the decline in current cigarette smoking during the preceding eight years and mirrors a lack of decline in smoking among adolescents since 2002.”1 Given the relatively high rate of tobacco use among 18-24 year olds and the targeting of this age group by the tobacco industry, it appears that the long-term success of tobacco control efforts in this country may depend on what happens with this age group. Since over 40 percent of 18-24 year olds are currently enrolled in an institution of post-secondary education and over 60 percent are enrolled at sometime during that period of their lives,2 what happens to students during their college by Edward p. ehlinger, m.d., msph
March/April 2007
years will be a major determinant of the rates of tobacco use among this entire age group. Despite this major shift in strategy by the tobacco industry, tobacco control advocates were slow to shift their attention to young adults. This was due to a paucity of data about the status of tobacco use by young adults. To help correct that deficiency, Boynton Health Service at the University of Minnesota began to systematically collect, analyze, and report on data about tobacco use among students at the University of Minnesota – Twin Cities campus and at several other Twin Cities metropolitan area colleges and universities. These data have been used to modify tobacco use prevention efforts on campuses, to stimulate the development of young adult-oriented smoking cessation programs, and to encourage policy changes on- and off-campuses. On the University of Minnesota campus, these data have been influential in the development of policies that led to smoke-free residence halls, smoke-free building entrances, and the elimination of tobacco sales in the student union. The data were also helpful in the passage of smoke-free bar and restaurant ordinances in Minneapolis and Hennepin County. Because of the close link between tobacco and alcohol use and because alcohol use is also a significant problem on college campuses, the data collection has included information on both tobacco and alcohol use. In 2005, with the help of funding from the Hennepin Medical Society, the scope of these college student tobacco and alcohol-use surveys was extended to schools within 80 miles of the Twin Cities. Efforts were also made at this time to include two-year technical colleges in addition to traditional four-year post-secondary institutions. In 2005, 17 schools were surveyed. With additional funding from Blue MetroDoctors
Cross/Blue Shield of Minnesota, the scope of the surveys was made state-wide in 2006 and 12 two- and four-year post-secondary education institutions were surveyed. This article highlights the results of the 2006 survey. 2006 Survey of Minnesota College Students: Participation, Methodology, and Demographics
In March and April of 2006 a randomly selected group of students from 12 post-secondary education institutions were surveyed using the modified CORE Tobacco, Alcohol, and Other Drug Survey (CORE). The standardized CORE survey has been used since 1992 at the University of Minnesota and is used at numerous post-secondary education institutions throughout the country. Participating schools in this survey included six public two-year schools, three private four-year schools, and three public four-year schools. The combined enrollment in these schools is over 73,000 students. Participating institutions are listed in Table 1. Table 1 Participating Schools in 2006 CORE Survey
2-year public schools: • Alexandria Technical College • Anoka Technical College • Hennepin Technical College • Lake Superior College • Normandale Community College • St. Cloud Technical College 4-year private schools: • Augsburg College • Hamline University • Saint Mary’s University of Minnesota 4-year public schools: • St. Cloud State University • University of Minnesota–Twin Cities • Winona State University
The Journal of the Hennepin and Ramsey Medical Societies
Depending on the size of a school’s enrollment, a random sample of 25 percent – 66 percent of undergraduate students was surveyed at each institution. Through U.S. Mail or Campus Mail, 20,588 surveys were delivered and 7,638 were completed and returned. The overall response rate was 37.4 percent with a range from 28.9 percent to 46.3 percent among the participating schools. Selected demographics of the respondents from all schools are outlined in Table 2.
Table 2
Demographics of Survey Sample Mean Age: 22.2 years (range 18-64) 18-24 year olds: 85.5% of sample 25+: 14.5% of sample Gender: male................... 36.1% female................ 58.3% not designated..... 5.6%
Current Tobacco Use: Of all students surveyed, 27.7 percent reported that they had used tobacco within the last 30 days (current tobacco use). The current use rate by males was 32.3 percent and by females was 25.6 percent. The current tobacco use rate for 18-24 year-old students was 27.7 percent compared with 32.3 percent for students 25 years of age or older. Students in two-year schools had a current tobacco use rate of 33.8 percent compared to 25.3 percent for students in four-year schools. (Figure 1) Frequency of Tobacco Use: Among current tobacco users the frequency of use varied greatly depending on age. Younger students tended to use tobacco less frequently than students age 25 or older. Daily tobacco use was 9.5 percent for all students, 8.1 percent for 18-24 year-old students, and 17.9 percent for students age 25 and older. Daily use rate Figure 1
Current Tobacco Use
Smoking Status Related to Alcohol Use:
The survey demonstrated a strong association between tobacco use and high risk alcohol use (five or more drinks at a sitting). The high risk drinking rate among tobacco users was more than double that of non-smokers. (Figure 4) This association was true at all ages, but particularly dramatic for 18-24 year-olds.
Race/ethnicity: white.................. 88.9% non-white........... 11.1%
Findings:
Current Residence: On Campus....... 25.1% Off Campus....... 74.9%
(Continued on page 10)
was 5.9 percent among students in four-year schools and 16.5 percent in two-year schools (Figure 2) which reflects the older age of students in two-year schools.
Figure 3
Age of First Use of Tobacco Current Users: 4-year school students <18
Age at First Tobacco Use: While the majority of initiation of tobacco use continues to occur prior to going to college, over 25 percent of current users at four-year colleges started smoking after the age of 18. (Figure 3)
18-20 21+
73.2
Quit Attempts: Among 18-24 year old current tobacco users, 56.1 percent don’t consider themselves smokers. Of the 43.9 percent who defined themselves as a smoker, 57.4 percent have tried to quit within the past 12 months. Among students 25 years and older who reported be-
24.6 2.2
Figure 4
Figure 2
40
ing current smokers, 72.1 percent considered themselves smokers and 56.6 percent have tried to quit in the past 12 months. The average number of quit attempts was 3.8 among all students who consider themselves smokers.
Relationship of Tobacco Use and High Risk Alcohol Use
Daily Tobacco Use
35 30
32.2 27.7
33.8
25
Non Tobacco Users Tobacco Users
27.7 25.3
25
20
17.9
80
16.5
20
67.2
15 60
15 10
10
40
8.1
5 0
9.5 5.9
5 All 18-24 25+ 2-year Students year olds year olds
4-year
Current Tobacco Use is any tobacco use in last 30 days.
MetroDoctors
0
32.1
20 All 18-24 25+ 2-year Students year olds year olds schools
The Journal of the Hennepin and Ramsey Medical Societies
4-year schools
0
High Risk Drinking
March/April 2007
Tobacco and Alcohol Use (Continued from page 9)
Alcohol Use and High Risk Drinking: Over 80 percent of undergraduate students have consumed alcohol within the last year (annual use). Approximately 70 percent have consumed alcohol within the last 30 days (current use). (Figure 5) High risk drinking, defined as consuming five or more drinks at one occasion within that last two weeks, is associated with a variety of minor and severe negative consequences. (Figure 6) Among 1824-year olds 45.6 percent have engaged in high risk drinking. Among students 25 years of age and older only 29.2 percent have engaged in high risk drinking. (Figure 5)
Alcohol Use by Age Groups 84.4
80
Calculated Blood Alcohol Content at last party: Using information gathered by the survey on height, weight, gender, the number of drinks,
Percent of Students who engage in High Risk Drinking* by Age and Gender Male Female
50
18-24 year olds 82.3
25+ year olds 73.7
70
40 30
68.2
60
20
50
45.6
10
40 29.2
30
0
18 19 20 21 22 23 24 25 26 27 28 29 30+ *High Risk Drinking is consuming 5 or more drinks in a sitting during the previous 2 weeks.
20 10
Figure 8
0
Annual
Current Use*
High Risk Use**
Calculated Blood Alcohol Content at Last Party by Age and Gender
* Any alcohol consumption in the previous 30-day period **Five or more drinks on a single occasion in the previous 2 weeks
Male Female
0.14
Figure 6
High Risk Drinking (HRD) and rates of selected consequences Negative Consequences
All Students
Non HRD
HRD
Driven while under influence of alcohol
27.7
18.1
54.5
Argument
32.9
22.2
63.2
Poor test or project
23.8
14.5
48.6
Missed Class
29.7
18.0
62.1
Been taken advantage of sexually (includes males and females)
9.3
6.5
16.9
10
and the timeframe of consumption, a blood alcohol content (BAC) at last party was calculated for each student. Given that students often underestimate the number and size of drinks consumed, the calculated levels are most likely an underestimation. The mean BAC for males was 0.1 and for females 0.11. This means that at their last party over 50 percent of students were substantially above the legal BAC limit of 0.08 for driving an automobile. In Figure 8 the BAC levels by gender and
Figure 7
60
Figure 5
90
High risk drinking occurs at all ages among college students. Rates are particularly high between the ages of 20 and 24 during which time over half of males and over 40 percent of females are engaging in high risk drinking. (Figure 7)
0.12 0.1 0.08 0.06
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0.04 0.02 0
18 19 20 21 22 23 24 25 26 27 28 29 30+ MetroDoctors
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Discussion:
Tobacco use continues to be a significant problem on college campuses. The intensity of tobacco use is less on four-year campuses which indicates a continued need for efforts to keep intermittent tobacco use among younger students from progressing to daily use. On two-year campuses there is a greater need for cessation services. The number of students trying to quit smoking is encouraging and argues for expanded research on ways to help students quit smoking. The trend data from the University of Minnesota suggest that a comprehensive tobacco control program focused on college students can make a difference in tobacco use rates. The fact that nearly 25 percent of all tobacco users on-campus began to use tobacco after the age of 18 is evidence that college students need to be a priority group for both tobacco use prevention and cessation efforts. The strong relationship between tobacco and alcohol use suggests that the contextual aspects of tobacco use must also be addressed MetroDoctors
Percentage reporting tobacco use in the past 30 days.
Trends in Tobacco and Alcohol Use: Trend data on tobacco use among college students are limited. However, among the data that do exist, it appears that some progress is being made. Among the eight schools that participated in both the 2005 and 2006 surveys, seven have noted a decline in the smoking rates among their students. At the University of Minnesota, where tobacco use surveys have been conducted on a regular basis since 1992, a consistently positive trend in tobacco use rates has been present since 1998. (Figure 9) It was at that time that a comprehensive tobacco control program was initiated. However, similar results have not been achieved with high risk drinking rates. In all schools the rate has remained consistently high. Although it remains below the national average, the high risk drinking rate at the University of Minnesota has generally persisted at or above 40 percent since 1994. (Figure 10)
in tobacco control programs. Figure 9 Current Tobacco Use Among Age 18-24 Students It also raises hopes that University of Minnesota smoke-free bar and restauTwin Cities Campus 1992-2006 rant ordinances may have 50 an impact on smoking rates 41.8 among college students and 40 subsequently on the overall 36 35 38.1 37.9 adult tobacco use rates. 32.4 The data on high risk 30 26 28.2 27.2 alcohol use are not as encouraging. High risk drinking 24.9 20 continues to be a significant 1992 1994 1996 1998 2000 2001 2003 2004 2005 2006 problem on almost every college campus and efforts Figure 10 to reduce high risk drinking High Risk Episodic Drinking 18-24 Year Old Undergraduates rates have had limited sucUniversity of Minnesota Twin Cities 1992-2006 cess. Restricting marketing, 50 49.8 48.8 46.5 increasing price, eliminating 45.1 45 41.7 special promotions, and de42.5 43.5 41.5 39.6 40 42 veloping effective policies to 40 37 control access and use have 35 UM-Twin Cities been successful in reducing 30 National tobacco use. Perhaps the 25 same comprehensive, com20 munity-based approach 1992 1994 1996 2000 2003 2004 2005 2006 1. High Risk Episodic Drinking is defined as having 5 or more drinks on one occasion. should be used to address 2. Core Alcohol and Drug Survey, 1992, 1994, 1996, 2000, 2003, 2004, 2005, 2006. the problem of alcohol use by young adults. In addition to providing data on college WILDERNESS students, the 2005 and 2006 surveys were SHORES unique in many ways. These surveys were the first of their kind to include multiple schools (public and private) within a state. The inclusion of two-year schools has generated data on a distinct population that exist nowhere else. The fact that these surveys were funded by Hennepin Medical Society and was part of that groupâ&#x20AC;&#x2122;s efforts to address a significant public health issue is also unprecedented. These surveys and subsequent dissemination Enjoy north woods adventures from this beautiful lot with 1100 feet of the data could not have occurred without of meandering Tom Lake shoreline their involvement. The process of doing the featuring a private cove and survey and the data generated from it should stunning views. A short drive from Lake Superior, the BWCAW, be helpful in guiding prevention, cessation, and Gunflint Trail and Grand Marais. A policy initiatives, not only in Minnesota, but perfect spot for your family cabin. throughout the country. $209,000. Other affordable Percentage reporting binge drinking in the past two weeks.
age are depicted. It appears from the data in Figures 7 and 8 that while individuals under the age of 21 are less likely to engage in high risk drinking than those over the age of 21, when they do drink they drink significantly more alcohol and thus have higher BAC levels.
1. 2.
MMWR, October 27, 2006 / 55(42);1145-1148 National Center for Education Statistics 2005
Acknowlegements for their role in data collection and analysis: Katherine Lust, Ph.D., M.P.H., R.D.; David Golden, B.A.; Maria Rangel, M.P.H.; and Sara Brenner, M.P.H., Ph.D. Candidate.
The Journal of the Hennepin and Ramsey Medical Societies
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March/April 2007
11
Feature story
What’s Happening
Family Medicine With Family Physicians?
“We need to figure out how to pay for relationships and not visits,” says Schoephoerster.
F
Family physicians in Minnesota are at a crossroads. On one hand, family physicians believe they are providing high quality care, convenient access and a wide range of services to their patients. As key primary care practitioners, family physicians are trained and committed to develop long-term personal healing relationships with their patients and provide comprehensive, preventive and holistic care in a team approach. But facing inadequate reimbursements that drives down income, pressure to purchase electronic medical record systems to measure and improve quality, and a need to redesign offices and medical processes to expand access, family physicians are talking about developing a new medical model that gives them more time to spend with their patients for preventive care coaching or to treat chronic diseases. “We are paying a ton of money in this country for medical care and it is not working for many people,” says Kenneth Kephart, M.D., medical director with 10-physician Fairview Partners and Geriatric Services, Edina. “Everyone knows there needs to be changes.” Family physicians are at the front lines in the primary care delivery system. Of 492 million total office visits in 2002, family physicians accounted for 215 million, or 44 percent, according to the CDC’s National Center for Health Statistics. “We have challenges ahead. We are trying to develop a new medical home model, incorporate electronic health record systems and cope with reimbursement issues,” says David Thorson, M.D., co-medical director of Family Health Services of Minnesota, a St. Paul-based independent group of 70 physicians. FHS is a joint venture of MinnHealth Family Physicians and East Metro Family Practice. Family physicians are also struggling with payers to develop a multi-disciplinary team approach to patient care that incorporates nurse practitioners and physician assistants, says George Schoephoerster, M.D., chair of the family medicine section of 200-physician multispecialty CentraCare Clinic, St. Cloud. The clinic is affiliated with three-hospital CentraCare Health System. However, the current production-based reimbursement system hampers this patientcentered effort, he says. “Because doctors are paid by production, we are still structuring staffing around physicians because that is how they are paid. We need to figure out how to pay for relationships and not visits,” says Schoephoerster, who also is immediate past president of the Minnesota Academy of Family Physicians (MAFP) and chair of the medical practice committee of the Minnesota Medical Association. “Some doctors see 40 patients per day because they are paid for production. They are triaging patients,” Schoephoerster says. “I am not happy with the production system. We need a better system and are working on it the next year or so.” Kephart says the reimbursement system forces physicians to spend less time with patients b y J ay Greene
12
March/April 2007
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The Journal of the Hennepin and Ramsey Medical Societies
than they would like. “This goes against what patients want,” says Kephart, who also is a past president with the MAFP and a board member of the Hennepin Medical Society. “They want doctors to spend time with them, talk with them, and help them deal with their problems when they get sick.” Higher reimbursement for counseling services is needed to help family physicians recommend healthy lifestyle choices to patients, Kephart says. “There are certain times in people’s lives when they want to make changes — quit smoking, eat better and lose weight. There is zero money for things that are beneficial to patients,” he says. “To maintain the same income you have to see more patients,” says Lynne Lillie, M.D., a family physician at HealthEast’s Woodbury Clinic and incoming MAFP president. “My income and benefits have gone down, but my clinic day doesn’t change. I have an appointment slot every 18 minutes, starting at 8 a.m. and running until 4 p.m. Some patients may get two slots, depending on what they come in for. Once every two weeks I may stay until 11 p.m. to do paperwork.” But Lillie says the biggest challenge for practicing family physicians is taking care of the patient who is in front of you. “I used to practice in a small group model.…More doctors are leaving that model and going to employment at hospitals. You need a bigger system to balance reimbursement losses.” While there are no exact figures, Lillie estimates that 75 percent of family physicians in the Twin Cities are employed by hospitals. “Hospitals ask doctors to see more patients, but patients are not that excited about being in a waiting room full of patients to see their doctor for 15 minutes. It is a challenge for us,” she says. Family physicians are also concerned that fewer U.S. medical school graduates have chosen family medicine the past 10 years. USMGs in family medicine residencies in 2005 accounted for 38 percent, or 1,350, of total first-year family medicine residents. In 1997, some 2,340 USMGs, or 76 percent, chose family medicine. “Medical students aren’t going into family medicine because reimbursement is low and they have high medical school debt,” says Thorson, who also is a board member of the Ramsey Medical Society. Family physician income averages about $150,000 per year and medical school debt averages $163,000, according to the AAFP. Schoephoerster, who was a residency program director for six years, also says medical students are thinking more about lifestyles than older generations. Younger physicians also want to work fewer hours than their older peers. “It becomes easier to have a day job in radiology than in family medicine,” he says. “They also see burned out and tired family physicians who have to churn patients instead of developing relationships with them because of the way the current fragmented health care system is structured. That keeps them away.”
“Medical students aren’t going into family medicine because reimbursement is low and they have high medical school debt,” says Thorson.
(Continued on page 14) MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
March/April 2007
13
Family Physicians (Continued from page 13)
Another disturbing trend is of the 20,072 medical school graduates who selected residencies in 2006, only 3,032 chose primary care programs, including 2,318 family medicine positions for an 85 percent fill rate. Family residency slots peaked in 1997 at 2,905 for an 89 percent fill rate. “Doctors won’t go into the profession until the funding gets fixed and until there is a more even distribution of services,” Kephart says. “We need the best and the brightest going into primary care. That’s where the challenge is.” But some residency program directors believe there will be a significant increase in medical students applying for family physician residency slots in the 2007 Match, says Kathleen Macken, M.D., residency program director with the 18-resident United Family Medicine Residency Program, St. Paul. She
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March/April 2007
also practices at 12-physician United Family Practice Health Center. “Interviews are way up this year; everybody is saying that,” says Macken, who also is chair of MAFP’s academic affairs committee. “I attribute it to an evolving generation of youth who want to work in underserved, urban or international areas.” Physician staffing issues also are a concern for family physician groups in the Twin Cities. “We are offering shared positions and part-time positions,” says Paul Berrisford, chief executive of Family Health Services. “We try to accommodate doctors’ lifestyle choices.” For example, two top-notch residents wanted to be full-time mothers and work part-time at Family Health. “We recruited them into shared positions and it works beautifully for our group. We were able to retain outstanding doctors,” Berrisford says. Medicare Rate Cut Halted
cent to 18 percent in any one year and 1.5 percent to 4 percent rate increases the last several years, we survive by cutting costs, but you can only do that for so long,” Berrisford says. With a 6.3 percent increase in operating costs — driven by an 11 percent increase in information technology costs and a nine percent hike in staffing costs — operating margins declined 3.5 percent for family practice medical groups in 2005, according to the MGMA’s 2006 Cost Survey. One of the features of the compromise bill offers doctors a 1.5 percent payment bonus — to be paid in the second half of 2007 — if they report a checklist of quality information on their practices. The data reporting would be the first step toward a pay-for-performance system in Medicare. “I am not opposed to pay-for-performance if you design the system right and pay them for doing the job they are doing,” Thorson says.
Last December, Congress approved a compromise bill that would eliminate a scheduled 5 percent Medicare rate cut to physicians in 2007. The Tax Relief and Health Care Act of 2006 (H.R. 6111) freezes physician payments for 2007 and implements a 1.5 percent bonus incentive for physicians who participate in a voluntary quality reporting system, which is scheduled to start in June. While family physicians hoped Congress would reverse the scheduled cuts, Thorson says the reimbursement freeze still amounts to a cut. Physicians in 2008 face an even larger rate reduction — 5 percent to 10 percent — because Congress did not change Medicare’s formula for computing payments to doctors. “Most physicians in non-procedural specialties don’t feel reimbursement is where it should be,” Thorson says. “I get more money burning warts off a foot than taking care of a patient with diabetes. Something is broke in the system.” Medicare and Medicaid reimbursement already pays below costs and those patients must be subsidized by private payers, Berrisford says. “With medical rate inflation at 12 per-
P4P arrangements are an increasingly popular way for payers to reward doctors and hospitals for adhering to evidence-based standards of clinic care. More than half of the nation’s HMOs used pay-for-performance programs in their contracts with doctors and hospitals in 2005, according to a study in the November 2, 2006, New England Journal of Medicine. “Pay-for-performance is a hot topic,” Kephart says. “We are doing quite well with clinical outcomes measures, but we need to find ways to improve quality for patients with multiple chronic diseases.” In 2006, CMS started a voluntary quality-reporting initiative for physicians covering 36 measures, including 21 specifically for family physicians. Some doctors believe Medicare will move to a pay-for-performance system in 2008. Commercial payers in Minnesota, however, have already begun to pay doctors for quality improvement. In 2003, for example, the Minnesota Community Measurement Project was formed by seven health plans and the Minnesota Medical Association to collect
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Pay-for-Performance Coming
and report performance data of the state’s 54 medical groups. The project collects data on diabetes care, cholesterol levels, blood pressure rates, cigarette use and aspirin for patients over 40. Schoephoerster, who is on the health care delivery reform work group of Healthy Minnesota, says legislation is expected to be introduced in 2007 that could include a universal medical access program with mandated insurance coverage and medical homes for patients. Healthy Minnesota is led by a 26-member steering committee of physicians, hospitals, employers, health plans, consumers and legislators. The medical home model is a concept that many family physicians are advocating. It is designed to link patients with specific family physicians for lifetime care that includes acute, chronic and preventive care. “When a patient picks a doctor and stays with him (or her), the doctor gets a clear picture of patients’ health both socially and medically,” Berrisford says.
Movement to Electronic Medical Records Underway
In an effort to improve quality, patient safety and garner pay-for-performance dollars, family physician groups are adding EMR systems. Family Health Services purchased an electronic medical record system in 2005 for about $1.7 million for its 70 doctors and 14 clinic sites. The group also includes three mid-level practitioners, one nurse practitioner and two physician assistants. “We went totally paperless in about seven months,” Thorson says. “Did it stress doctors? Yes. But about 80 percent to 90 percent say they will not go back to paper.” To support the EMR, the practice hired an information technology director to assist its small IT billing staff. While the main reason to purchase the EMR system is to improve quality and patient safety, Thorson says the group believes pay-for-performance dollars will ultimately pay for the system.
“We are betting on the fact because we are paid for performance, we hope we will gain enough in performance dollars to pay for the system,” Berrisford says. “Safety is an issue. EMRs allow us to read and access documents better and from any clinic. Patients can go anywhere and be seen. Doctors can look up a patient’s medical record at home and can make higher quality decisions right away.” Thorson also says EMR systems can help with physician recruiting. “It helps improve quality. Instead of random chart audits, we can do queries to determine why one person is doing better than another,” he says. “I can show payers all data instead of random charts.” In addition, EMRs will help reduce certain types of medical errors and proactively plan patient visits. “We can develop templates for pay-for-performance data and build intake templates to track any criteria,” Thorson says. (Continued on page 16)
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March/April 2007
15
Family Physicians (Continued from page 15)
Berrisford says the clinic will be integrating its EMR system with HealthEast’s EMR system to allow seamless record keeping between inpatient and outpatient care. “We need to have better technology. We spend way too much time with prior authorizations, referrals, tracking and changing meds and formulary changes from payers,” he says. For example, an insurance company will send letters to doctors telling them to take a drug off the formulary. “We get a letter a few months later saying change them back. It is very confusing and dangerous. We deal with hundreds of prior authorizations for drugs,” Berrisford says. “Convenience-style” Clinics Hurt Family Physicians
Over the last several years, the “MinuteClinic” model has impacted family physicians, Berrisford says. “We see fewer colds and ears and noses and throats,” he says. MinuteClinic, a Minneapolis-based company with 21 clinics in the Twin Cities, offers quick, convenient and affordable treatment for many common family illnesses. Prices range from $39 for a pregnancy test to $110 for a meningitis vaccine. The clinics, which are staffed by certified nurse practitioners and physician assistants, are located in CVS drug store pharmacies, Cub Foods stores and other retail locations. Thorson says they are a threat to family practice groups because they take away low-intensity visits. “It puts us in a difficult situation,” he says. “We have tried to market against it in different ways.” Patient satisfaction may be high with the convenience clinics, Thorson says, but quality issues have not been addressed. “Literature says back-up throat cultures should be done because 10 percent of back-up cultures come back positive when the rapid test is negative. I am not sure they are doing back ups,” he says. Over the long term, however, Berrisford says MinuteClinic concept does not help solve the health care cost problem. 16
March/April 2007
“You squeeze one part and the other part gets bigger. We end up with chronic care management (of patients), and that gets expensive,” he says. Hospitalists
Family practitioners are also facing competition from hospitalists, or physicians who specialize in caring for hospital patients. The number of hospitalists, now at 15,000 nationally, is expected to reach 30,000 by 2010. While some practices have turned over inpatient care to hospitalists, Family Health in 2005 adopted an internal hospitalist model where family physicians take weekly turns rotating through two of HealthEast’s hospitals — St. John’s Hospital and Woodwinds.
“I take care of all our patients in the hospital for one week and decide what tests are needed and if it is OK for them to go home,” Thorson says. “It helps us have on-time starts for clinic doctors and we can provide continuity with our patients.” Using hospitalists “has some positive benefits,” Berrisford says. “Some groups do not prefer to be in the hospital. Our group on the whole feels that (inpatient care) is still in their scope of practice. It adds some concern to some physicians, who only see patients one week out of 15, but it is much more efficient, and provides better care.” Jay Greene is a freelance writer based in St. Paul. Contact him at jaywriter@comcast.net.
As the nation grapples with double-digit rising health care costs and record-high numbers of uninsured, top family physicians in the greater Twin Cities area interviewed by MetroDoctors last November and December cited a number of professional and business challenges facing the specialty. They include: • Inadequate Medicare, Medicaid and private payer reimbursement that encourage production rather than prevention and hampers developing longer-term patient care relationships. • Expensive and time-consuming administrative and paperwork requirements that increase costs and take away from clinical care. • Rising capital expenditures for new technologies like electronic medical records and additional diagnostic and therapeutic services that cut into already slim margins. • Competition from specialty carve-out services that include low-intensity convenient medical care outlets like MinuteClinics and high-tech freestanding imaging centers. • The movement to hospitalists that has the potential of interfering with the family physician-patient relationship and introducing fragmented care. • Need to develop a “medical home” for patients, thus giving doctors incentive to provide primary care, preventive services and encourage continuum of care. • A 50 percent decline in U.S. medical school graduates entering family medicine residency programs over the past 10 years. • An increasing number of younger physicians who want to work fewer hours, share jobs and work part time. • Declining income and rising medical school debt. Family physician income averages about $150,000 per year and medical school debt averages $163,000, according to the American Academy of Family Physicians.
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
Reintegration of Our Military Forces Into the Community Implications for Health Care Providers
W
With the return of more than 3,000 military personnel impending for this spring or summer, many changes are in store for those personnel and their families. To assist these valued members of our community and their families, physicians and other health care providers need to be able to recognize and identify their unique circumstances. These circumstances, which few of us can understand or comprehend, lead to unique ailments of the musculoskeletal and neurological systems, mental and behavioral health, infectious diseases, obstetrical and gynecological issues, and difficulties related to the social complexities of family and civilian life. To this end, a symposium is being organized for health care providers, focusing on primary care physicians, nurse practitioners and physician assistants but open to all health professionals, to better educate these physicians regarding these issues. While 3,000 troops are expected to return by the summer of 2007 (the return date is potentially pushed back 4 months from the expected spring return), approximately 1,200 have already returned from service in Iraq and Afghanistan. Of this number, approximately one third have service related injury or illness. While we are fortunate to have a Veteranâ&#x20AC;&#x2122;s Affairs (VA) hospital in the Twin Cities, only 28 percent of these personnel will be cared for at this facility. This leaves the majority to be cared for by civilian health care providers. One of the first challenges toward treating these individuals is simply identifying those with previous or recent military experience. Most patient intake questionnaires ask for an occupation (usually the civilian occupation)
that may not accurately reflect their recent military experience. As well, the patient may not reveal this military experience without prompting. Thus, appreciating the presence of these individuals in the community and identifying them if they present to your clinic is the first step in treating their mental and physical health appropriately. Once properly identified, the physician must understand the experiences this patient may have had when overseas. Their experiences may have included carrying equipment and packs weighing more than 70 pounds for hours, sleep deprivation, constant adrenaline
highs now countered by the â&#x20AC;&#x153;low adrenalineâ&#x20AC;? calms of non-combat life, witnessing deaths, losing loved ones, and dealing with 130oF heat. The list can go on and on. In wars past, trauma that was severe enough to cause loss of limb often also resulted in loss of life. Today, improved body armor has saved lives that may have been otherwise lost, resulting in more surviving veterans with extensive extremity injuries. These injuries, of course, are not subtle. But, imagine wearing full combat gear (vest, elbow, knee pads, helmet), carrying (Continued on page 18)
b y N icholas j . me y er , m . d . , carl a . pato w, m . d ., mph , facs , and dan johnson , pt, ma
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March/April 2007
17
Reintegration of Our Military Forces (Continued from page 17)
70-plus pounds of gear, and being crammed into a truck that barely has enough room to fit your body for hours on end. This takes a slow and subtle toll on the entire spine, tendon attachments, and joints. These injuries may present more subtly. The subtlest, and oft unrecognized, trauma is psychosocial in nature. These
injuries may be related to direct experiences of combat, the strain of a family estranged and reunited, or transitioning from a military career to a civilian occupation. A variety of feelings may manifest including depression, suicidal tendencies, maladjustment, paranoia, and difficulty maintaining relationships. More important than diagnosing these conditions are providing the military patient with the opportunity to ask for help or for the health care provider to identify a need for treatment
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(952) 831-5773 MAIN • (952) 831-7224 FAX 18
March/April 2007
or help. Being aware of the resources available for these veterans is also critical. Along with the VA Hospital and the services rendered through the VA, most military personnel are covered by an insurance program know as Tri-Care. This is an insurance program for military personnel similar to Medicare. As with any insurance program, those interested in aiding these individuals need to assure that they (or their group) accept Tri-Care insurance so as to avoid refusing these patients at first contact with the appointment line. Other community services are also available in the form of Minnesota Military Family Foundation, Minnesota Families United, the Military Family Support League, or the individual military branches’ Family Readiness Groups. For non-medical support, these groups attempt to fill the gaps by providing services to families and military personnel through financial, logistical or moral support as needed. The bottom line regarding all of this is simple: Most of us, as physicians or other health care professionals, have very little or no experience with this patient population. Yet, you will most likely cross paths with several returning veterans with unique needs and experiences. To this end, a symposium scheduled for Friday April 20, 2007 at Metropolitan State University will be conducted addressing the experiences of our returning military personnel. This symposium will discuss common behavioral and mental health issues, neurological and musculoskeletal conditions, infectious disease and Ob/Gyn concerns, as well as issues of family dynamics, available resources, and insurance coverage. For information regarding this symposium, interested individuals are encouraged to call (952) 883-6225.
MetroDoctors
Dan Johnson, P.T., M.A. is associate director for program development at HealthPartners Institute for Medical Education.
The Journal of the Hennepin and Ramsey Medical Societies
JCAHO Responds to Metropolitan Hospital Physician Leadership Issues
T
The Metropolitan Hospital Physi-
cian Leadership committee is a committee that was formed by Hennepin and Ramsey Medical Societies as a way for hospital medical directors, vice presidents of medical affairs, chiefs of staff, and chiefs of staff-elect to connect on hospital specific issues. All of the metro area hospital leaders are invited to attend the meetings which are held from 7:00-8:30 a.m. at the offices of HMS and RMS. Meeting dates for 2007 are Tuesday, February 20, May 8, August 14 and November 20. The committee has dealt with a number of issues over the past few years including the metro wide approach to collecting immunization information on physician medical staff members, credentialing issues, limiting the amount of high sugared drinks in hospital cafeterias, medication reconciliation, and the role that physicians can play when disasters strike, including the role that Minnesota physicians played during the Hurricane Katrina disaster. As a regular member of the Metropolitan Hospital Physician Leadership Committee and as Special Advisor for Professional Relations at the Joint Commission, I have had an opportunity to discuss a number of key issues. Several committee members expressed concerns regarding current Joint Commission requirements for review of prescriptions or medication orders by a pharmacist prior to dispensing and administration in the emergency department (ED). Pharmacist review of prescriptions or medication orders prior to dispensing is an established Joint Commission safety requirement in the medication management process and has been in place for many years. On behalf of the Council, I brought this issue directly to the Joint Commission Vice President for Standards. It turns out that a number of emerby william jacott, m.d.
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gency departments and organizations had also expressed the same concern. As a result, this issue with a recommended change, was on the Nov. 6, 2006 agenda of the Standards and Survey Procedures (SSP) committee. Prior to that the Joint Commission convened an expert panel and they made the recommendation to the SSP. Also, a survey was done which revealed that only 52 percent of hospitals were in compliance with this requirement. An interim action was adopted by SSP and states that in the ED, if a prospective review cannot be conducted, a pharmacist performs a retrospective review of a medication order no later than 48 hours after the medication order was written or electronically recorded. Non-urgent medications that can be administered in the emergency department without a prospective review by a pharmacist are to be identified by the hospital with the participation of a pharmacist and approved by the medical staff. This has been implemented and the entire modified Standard (MM.4.10) has been sent out for field review prior to final approval. This is a fine example of how the Metropolitan Hospital Physician Leadership committee can accomplish positive change in patient care. There are two other areas where the Metropolitan Hospital Physician Leadership committee played a role in standards change or clarification. Concerns were expressed about the evaluation of low volume practitioners. The new Joint Commission standards and elements of performance that involve credentialing and privileging deal with this issue. Through the Focused Professional Practice Evaluation and the Ongoing Professional Practice Evaluation, the organization can develop a process to evaluate and credential those individuals. Most of these standards were implemented on January 1 of this year. The other area of clarification dealt with continuing education. Standard
The Journal of the Hennepin and Ramsey Medical Societies
MS.5.10 states that all licensed independent practitioners privileged through the medical staff process participate in continuing education. These activities should relate to the type and nature of care, treatment and services offered by the hospital. Education should also be based on the findings of performance improvement activities. The exact process for reaching compliance is established by the hospital. The Metropolitan Hospital Physician Leadership committee has been proven to be an educational and effective forum. I encourage all physicians in medical staff leadership positions to attend these meetings and bring forth issues for discussion on a community-wide level. Medical, Surgical & Cosmetic Dermatology
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March/April 2007
19
An Online Balm for Office Care Points of Pain
T
There is plenty of dissatisfaction to go
around when the subject of U.S. health care delivery comes up. For various reasons, each of the three major stakeholders — patients, providers, and payers — recognize and suffer from the inefficiencies of the current delivery system for office based, out-patient care. The problem is complex, but the following discussion examines the nature of the problem and how online consultation may provide a solution. The current system of out-patient care fails to completely address all of the needs of patients, providers, or payers. Understand the failings and it becomes easier to explain the sea change that is occurring and how it is driving stakeholder change. Examples of restive change can be seen in the behavior of each of these three groups. Inconvenienced patients are opting to go to retail or convenience clinics staffed by nurse practitioners for simple problems. Frustrated providers are abandoning conventional clinic settings for concierge medicine. They seek relief from the endless paper shuffle that e-healthcare guru, Dr. Allen Wenner, has termed “administrivia.” Lastly, impatient payers are searching for ways to link reimbursement to performance. A system this out of control requires more than tinkering at the margins. A fundamental re-engineering of how out-patients’ problems are handled is necessary, and it also requires new and innovative tools to succeed. But how does all of this redesign happen? The best way to start the process is by listening to the stakeholders — the so-called “voice of the customer,” and one doesn’t need to listen very long before the points of pain are apparent.
by paul c. seel, m.d.
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March/April 2007
Online communication is one such innovative change that potentially provides a balm to soothe the boil currently afflicting out-patient health care. This review will air the voices of the customers and then look at how online communication can provide possible solutions to these points of pain. A patient portal is an online communication tool that allows secure and asynchronous communication between patients and their physicians. This can be free form and appear like a letter or conventional e-mail, or, preferably, be structured and appear much like a traditional medical history, gathered through a branched, logically formulated progression of questions. The following stakeholder vignettes bring out theses points of pain and the potential benefits of online communication. Working Mom: “I’m too busy at work to hassle with the doctor today.” Let’s start from the beginning with a patient seeking help for a complaint — a working mom seeking a solution for a simple problem. Let’s suppose our patient was awakened with the early signs of a urinary tract infection very early Monday morning. She knows the day will be busy and realizes that taking time from work won’t be an option — even if a physician’s appointment were available. She’s had this dilemma before and the longer she delays treatment, the more she will suffer from this episode. She has a parent-teacher conference late Monday afternoon. Her husband is out of town. She can’t be sick. She desperately needs a way to get past her physician’s office gatekeepers and doesn’t have time today for phone tag. A patient portal with her physician’s office would allow her to communicate her symptoms at their onset early Monday morn-
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ing. Evidence-based, best practices support a non-office-based treatment of uncomplicated urinary tract infections, and the information provided securely online would clearly document this situation more thoroughly than by phone or possibly by a routine office visit. The patient would provide a preferred pharmacy and be able to pick up her prescription later that morning. Little if any work would be missed. Prompt treatment rendered, phone tag avoided, and the total out of pocket cost in an increasingly high deductible world could be less than an office visit. Now, let’s look at this same encounter from the provider’s standpoint, hearing the different points of pain and examining how a portal may help resolve these. This same clinical situation may play out in several possible scenarios: Physician: “I spend hours a day on the phone rendering uncompensated care.” This physician spends unproductive time on the phone each day. Patient phone calls sit in various office queues awaiting attention and it may be hours old before the physician can address it. The first challenge comes from trying to reach the patient without further delays from the obligatory round of phone tag. Next, the physician faces the challenge of gathering and documenting the information. The former is constrained by the time available; the later is often neglected. Compensation presents the last hurdle. Counting office overhead and the physician’s opportunity cost, and assuming no compensation, this patient phone call may result in a net loss to the physician of about $35. In order to get paid for this service, the physician has the following options: schedule the patient for an office visit, adequately docu-
The Journal of the Hennepin and Ramsey Medical Societies
ment and attempt to bill for a phone call, or do an online consultation or eVisit. The online solution offers the potential for this physician to provide appropriate care and be paid as well. In many states, particularly Minnesota, the major payers are reimbursing for online encounters. The required patient documentation can be gathered through branched logic question sets and the patient documents their own history. In this example, our phone-challenged physician can quickly dispatch a solution in a matter of minutes. When comparing the profitability of an eVisit, vis-à-vis an office encounter, the revenue from the former is nominally less, but so is the cost of providing the service. The physician’s time to complete an eVisit is minimal and office resources can be used for other activities. Provided the physician can find other productive activities for his or her time, as well as for the office staff, he or she would be better off doing eVisits wherever applicable. The rationale that the current staff needs something to keep them busy fails to look at the big picture
of overhead, but seems to be a popular — but erroneous — way to look at this problem. Physician: “You want to see me in the office when…..????” This physician is consistently overbooked. He or she wastes time seeing patients that don’t need to be seen while failing to see those with serious concerns. They too are burdened with “administrivia.” This physician faces several unpleasant alternatives in resolving the working mom’s current dilemma: spend less time with other patients, bump a less needy patient, or stay late...again. The other alternative is to deal with the situation over the phone and face the same challenges as our first physician. The online consultation allows this physician to work more efficiently. Take, for example, obtaining a patient’s history. It’s relatively inconsequential how this information is gathered because the real value comes from accurately reviewing and interpreting the information and formulating a plan. Online consultation can be used as a tool, which allows
patients to provide and document their own histories online both for eVisits and prior to office appointments. Having the patient provide and document their own histories is analogous to a popular airline industry innovation. The airlines figured out that flyers could check themselves in for their flights; what’s more, the flyers were happy to do it for free. Just as this development increased airline efficiency, physician productivity would be increased as well. Time and/or cost to document patient histories would be reduced. Online consultation also allows physicians to match the intensity of their service with the severity of the patient’s problem and plan accordingly. Patients with straight-forward, acute problems can be cared for with minimal effort via the eVisit. eVisits may be even more applicable for patients with stable chronic diseases. Follow-up visits can potentially be avoided if the provided interim information suggests that the patient is doing well. The physician has more time (Continued on page 22)
AnotherȱTopȱDocȱNamedȱinȱYourȱCommunityȱ CongratulationsȱPaulȱKettler,ȱMD,ȱHospitalistȱ withȱColumbiaȱParkȱMedicalȱGroup,ȱforȱrecentlyȱ beingȱselectedȱasȱaȱTopȱDocȱbyȱMpls/St.ȱPaulȱȱȱ Magazine.ȱ ȱ
Withȱoverȱ90ȱphysicians,ȱ21ȱspecialtiesȱandȱfiveȱ clinicȱlocations,ȱColumbiaȱParkȱMedicalȱGroupȱisȱ dedicatedȱtoȱrespondȱtoȱtheȱuniqueȱhealthcareȱ needsȱofȱtheȱcommunitiesȱitȱserves.ȱLocatedȱinȱȱȱȱ Andover,ȱBlaine,ȱBrooklynȱPark,ȱColumbiaȱ HeightsȱandȱFridley.
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Callȱ(763)ȱ572Ȭ5700ȱorȱvisitȱwww.cpmg.orgȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ toȱscheduleȱanȱappointment.ȱȱ
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The Journal of the Hennepin and Ramsey Medical Societies
March/April 2007
21
An Online Balm (Continued from page 21)
for patients with more complex problems and those who are more acutely ill. They can shift their mix to a higher level of reimbursement. This increased efficiency would not be possible if the office visit were the only option in the physician’s repertoire. Physician: “My overhead is killing me.” This physician has identified office overhead as a major problem, but he or she is unable to find a solution. There are only so many ways to rework a poorly designed paradigm. Progress requires re-engineering patient flow and rethinking exactly what resources should be utilized for a given service. Maximizing productivity occurs when the physician views the office as an expensive resource and asks the question — “What resources do I need to employ to solve this type of problem?” If increasing efficiency temporarily allows some of those resources to lie fallow, then the ultimate benefit requires adjusting those resources. Online communication offers this solution. Physicians who refrain from this exercise and defer developing more efficient ways of delivering care will be threatened by the disruptive innovation that will eventually come. To paraphrase Clayton M. Christensen in his 2002 Harvard Business Review article, “Will Disruptive Innovations Cure Health Care?”..., don’t postpone implementing innovation that may make all or part of what one currently does obsolete because someone else will. Physician: “I just noticed that the Minute Clinic is seeing my patients.” This physician needs to understand that the
ment earlier, potentially avoiding a costly ER visit or hospitalization precipitated by a delay in seeking care. Online access allows our working mom to get prompt, efficient treatment with input from her own physician. An eVisit provides an effective method to collect the patient’s history and document the encounter, potentially preventing errors and liability from poorly documented phone calls. Physicians have an acceptable alternative to either rendering care over the phone for free, or bringing the patient into the office primarily as a means of getting compensation for the care they render. In summary, online consultation offers a powerful tool to bring efficiency to out-patient care. It allows physicians to better match the resources available with the problems at hand. It provides superior documentation. It offers patients a more convenient solution for simple and straightforward problems, and may facilitate the triage and more effective disposition of more complicated patients. It is a new tool, the future potential of which may yet to be fully determined.
root cause for his or her patient’s defection to the retail, convenience clinic. This physician is not currently offering a convenient and cost-effective solution for his or her patient to deal with simple medical problems. Today, the patient’s goal may be a convenient solution for a UTI. One need only recall how the lowly Mini-Mills humbled Big Steel to wonder how long it will take the convenience clinics to offer a similarly simple and convenient solution for straightforward, chronic conditions. In the future, our working mom may try the convenience clinic’s approach for high cholesterol, or to follow-up on uncomplicated hypertension. The Disruptive Innovation Seeking Payer The third leg of our triumvirate belongs to the payer. Payers collectively look at the huge health care expenditures and often see less than optimal results. When they look at how care is being delivered, they see that simple and noncontroversial treatments such as post MI aspirin and beta blocker therapy are not being utilized. They see patients with delays in receiving the care they need paired with costly consequences. They see poor and incomplete documentation leading to redundant and wasted care. Lastly, they see patients being seen in the office for minor problems and wonder about alternatives such as the convenience clinics. All of these problems have a possible solution through a system that provides online access. Chronic disease visits done online can be structured around the best medical practice protocols. This helps address the errors of omission that currently occur. Increased access available online offers an opportunity for our working mom to get started on treat-
Dr. Paul C. Seel is currently the medical director of Sophrona Solutions’ eVisit Group (www.sophrona.com), a Minneapolis based health care technology firm focused on delivering innovative, customized patient communication solutions to health care professionals, group practices, and clinics around the country. Dr. Seel practiced nephrology for 20 years in the Twin Cities and has recently completed his M.B.A at the University of Minnesota’s Carlson School of Management. He can be contacted at pseel@sophrona.com.
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March/April 2007
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The Journal of the Hennepin and Ramsey Medical Societies
Robotic Surgery Hits the Medical Marketplace Nationwide
T
The era of robotic surgery has hit the medical marketplace nationwide, including the Twin Cities, and it is here to stay. The most high-profile system in use at present is the da Vinci Surgical System made by Intuitive Surgical. This system was first approved by the FDA in July of 2000 for general laparoscopic surgery, but its most prolific application to date has been in the performance of robotically assisted radical prostatectomies (the “da Vinci Prostatectomy”). The da Vinci prostatectomy was first developed in Europe, but rapidly made its way to the United States and is presently on track to virtually eclipse the traditional “Open Radical Retropubic Prostatectomy” in terms of numbers performed. In the 2003 calendar year, approximately 3 percent of all radical prostatectomies performed in the United States used robotic technology. In 2004 this number rose to 15 percent. In the calendar year of 2005, the number stood at approximately 30 percent, and estimates for 2006 show a 50 percent market penetration. Besides the da Vinci Radical Prostatectomy, other urologic applications include pyeloplastys, nephrectomies, and ureteral resections and ureteral reimplants. Additional urologic procedures will undoubtedly become applicable, although significant future growth for this technology will likely depend on procedural techniques currently being developed in other surgical fields. FDA-approval for mitral valve repair was obtained in November of 2002, but its use in cardiac and thoracic surgery has expanded to revascularization procedures, Esophagectomy, Lobectomy, and Thymectomies. General surgical applications including Roux-En-Y Gastric Bypass, Nissen Fundoplications, and Heller b y chris k noedler , m . d .
MetroDoctors
Myotomies are becoming more commonplace. In gynecology, significant experience has been developed with myomectomies and hysterectomies. Success in implementing robotics in any of these fields, however, is dependent not only on having access to the technology, but also on becoming skilled and proficient in its use. It takes great time and commitment on the part of the health care team to achieve that end. The da Vinci system involves what is referred to as a “master-slave” robot, with the surgeon controlling the movements of the instruments. Typically, the surgeon’s “console” is in the OR suite about 10 feet or so from the patient’s bedside. Instruments are snapped on to the robotic arms and inserted through traditionally appearing laparoscopic trocars. An assistant is required at the bedside to facilitate exposure and change out instruments when necessary. Compared to traditional laparoscopy, major advantages of the system include a 3-dimensional view of the operative field, and three, multi-joint robotic arms, with multiple degrees of movement. These multi-joint arms allow for far greater dexterity of movement, facilitating fine dissection and suturing not possible with traditional laparoscopy. In addition, all motion is free of tremor, and can be scaled down to allow for even more precision if so desired. The patient benefits from the minimally invasive nature of the incisions, the same as traditional laparoscopy. Consequently, clinical experience has demonstrated less analgesic usage, shorter hospitalizations, and quicker return to normal activities as compared to “open” surgical techniques. These findings are certainly consistent with our experience. The initial da Vinci Surgical System used by Metro Urology was purchased by the HealthEast Foundation and placed at St. John’s Northeast Hospital in Maplewood, MN in May of 2004. The first robotic prostatectomy was
The Journal of the Hennepin and Ramsey Medical Societies
performed by Metro Urology physicians in May of 2004 and, to date, we have performed over 500 prostatectomies, 33 pyeloplasties and two nephrectomies using robotic techniques. Our initial approach involved two urologic surgeons, and a dedicated anesthesia and OR nursing teams. Experience begets efficiency for everyone involved, and, by limiting the initial number of team members, inefficiencies were reduced and the team’s skill set progressed to an acceptable level within a relatively short period of time. From that point on, new team members were introduced one or two at a time, in an attempt to disseminate the skills and technology without taking a step backward in efficiency and patient care. Initial length of stay (LOS) data within our institution revealed a drop from over three days for a traditional open prostatectomy to 1.7 days for the robotic approach. More recent LOS data from the last 100 procedures now stands at 1.18 days per robotic prostatectomy, with 85 percent of the patients being discharged the following day. Average total case time for the procedure is now 2 hours and 2 minutes (122 minutes), with actual operating time of the robotic arms (“robot time”) at 1 hour and 29 minutes (89 minutes). Seven patients out of over 500 have received a blood transfusion. Average blood loss per case stands at 100 cc. Contraindications to the robotic prostatectomy procedure are few, and surgical indications basically follow similar guidelines to the open procedure. Patients with prior sigmoid resection for divirticular disease or an open abdominal aortic aneurysm repair are excluded as candidates for robotic surgery, and are treated with a traditional open procedure. In contrast, prior upper abdominal surgery, history of appendec(Continued on page 24)
March/April 2007
23
St. Paul, MN
Robotic Surgery (Continued from page 23)
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MEDICAL DIRECTOR/HOSPITALIST This high profile leadership position provides overall medical direction and management of hospital inpatients and serves as a resource to Bethesda’s administrative team and medical staff. Requirements include MD/DO/IM with MBA (or similar advanced degree) desirable. Qualified physicians will have DEA/ MN license and long term acute care hospital experience in both administrative management and patient care. We offer an excellent salary/benefits package, plus an enviable lifestyle in beautiful St. Paul. Please call Kathy Nikunen, Physician Recruitment Coordinator, at 651-326-2009; Email: kenikunen@healtheast.org. EOE
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tomy, or prior hernia repair have not posed any issues surgically. Preservation of the neurovascular bundles responsible for erectile function is routine and enhanced by the 3-D magnification of the operative field. The watertight nature of the urethral anatamosis has reduced the postoperative catheterization time to seven days and obviated the need for placing a surgical drain. Our initial experience favored patients with a Body Mass Index (BMI) of under 30. With more experience, patients with a BMI of over 30 are easily handled and presently the robotic approach is our preferred approach for obese patients due to the ease of access to the deep pelvis. Financially, the new technology represents a challenge for hospital systems and the health care system at large. Single-unit costs for the machines are upwards of 1.5 million dollars, with additional yearly service contracts and case-by-case disposable costs. Costs to the institutions involved may be potentially recouped with shorter lengths of stay and increases in volumes of procedures performed. Additional savings at a societal level may be realized with quicker recovery times and return to work. Most patients in our experience are back to normal activity or work within 14 to 21 days post-operatively. At present, four da Vinci systems are in place for clinical use in the Twin Cities hospitals, with another two delivered and soon to be up and running. Urologic use will likely predominate initially, but expansion to other fields should be expected. Urologic residencies have quickly integrated this technology into their training programs. Consequently, the next generation of urologists, as well as specialists in other surgical fields, can be expected to bring this skill set with them into practice. In addition, we can expect competition and new product development from other vendors within the industry. Continued refinements in instrumentation and additional procedure development will likely further expand the indications and usage of robotics, making robotic surgery a routine extension of many, if not most, surgeon’s practices.
Chris Knoedler, M.D. is with Metro Urology in St. Paul.
The Journal of the Hennepin and Ramsey Medical Societies
Status of HMS/RMS Resolutions
#102, An MMA Physician Finder to Link the Public to MMA Member Practice Web sites RESOLVED, that the MMA encourage its members to provide their practice Web site address for use in the Physician Finder and explore the option to advertise the Physician Finder service to the general public and patient support and advocacy organizations. Action to date: Staff analysis to include determination of the purpose of the Physician Finder and its target audience. Based on results of analysis, obtain guidance from MMA Board on next Steps (2Q07). MMA Staff: Lorrie Holmgren #103, The Independent Practice of Medicine RESOLVED, that the MMA form a task force to explore the reasons why physicians are abandoning the independent practice of medicine and are moving to an employed medical staff model of medical practice and to make recommendations to help preserve the ability of physicians to independently engage in the practice of medicine, and be it further RESOLVED, that the Minnesota AMA delegation carry a resolution to the AMA House of Delegates calling on the AMA to study all facets of the problems faced by independent physicianowned medical practices and to report back to the AMA House of Delegates with a series of recommended AMA policies to help preserve the ability of independent, physician-owned medical practices to survive and prosper. Action to date: Incorporate into analysis/study of physician practice in Minnesota (3Q07). MMA Staff: Janet Silversmith #201, Alcohol Health Impact Tax RESOLVED, that the MMA advocate for an increase in the excise tax on beer, wine, and spirits by the equivalent of $.10 a drink and that MetroDoctors
these increased funds be used for prevention, treatment, and public safety services related to alcohol abuse, and be it further RESOLVED, that the MMA support that future alcohol excise tax increases keep pace with inflation, and be it further RESOLVED, that the MMA consider alcohol abuse, particularly among under-aged drinkers, one of its public health priority issues. Action to date: 1) Support as part of legislative agenda. MMA part of broad coalition; bill to increase tax by $.05 expected to be introduced. 2) Refer to MMA Public Health & Preventive Medicine Committee for additional discussion about MMA policy and/or activity in this area. Initial discussions held with Public Health Committee 11/15/06. MMA Staff: Dave Renner/Janet Silversmith #203, Electronic Medical Records RESOLVED, that the MMA reaffirm policy 290.2483 paragraph D that states: “Payment Systems to Support Quality Practice. The MMA will advocate for the adoption and expansion of payment policies by public and private payers (sometimes referred to as “pay for use”) that will financially reward physician actions to improve their capacity and ability to deliver more efficient, effective care (e.g., the installation of electronic health records, computerized pharmacy-order entry systems, clinical decisionsupport systems, disease and case management, team-based care, etc.) BT-07/2005. Action to date: Policy statement/implemented. #204, Dysmetabolic Syndrome and Type 2 Diabetes in Children RESOLVED, that the MMA Obesity Task Force collect and disseminate information about the problem of insulin resistant Type 2 Diabetes Mellitus in children to the physicians who treat children, and be it further
The Journal of the Hennepin and Ramsey Medical Societies
RESOLVED, that the MMA delegation to the American Medical Association submit a resolution asking the American Medical Association to promote the study of the circumstances associated with this new onset of insulin-resistant Type 2 diabetes mellitus in children and recommend methods of prevention and treatment of this new public health threat. Action to date: 1) Refer to MMA Obesity Task Force for implementation. 2) Submit to AMA A-07. MMA Staff: Lorrie Holmgren/Scott Smith #205, Generic Rx P4P RESOLVED, that the MMA oppose pay-forperformance contract clauses in Minnesota health plan provider and insurance provider agreements that link increased physician or clinic reimbursements to physician prescriptions for generic medications rather than branded products. Action to date: Refer to MMA Quality Committee for consideration as part of its development of pay-for-performance principles. On February Quality Committee agenda; to be reconciled with prior P4P policy development. MMA Staff: Rebecca Schierman #206, Complete Immunization Data Availability for Children, Infants, Adults, and Geriatric Patients RESOLVED, that the MMA support statewide immunization data availability, and be it further RESOLVED, that the MMA encourage hospitals, health care providers, and long-term care facilities to enter immunization data into the Minnesota Immunization Information Connection database to maintain a complete record of immunizations that can be used by health care providers to assure complete immunization (Continued on page 26)
March/April 2007
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Status of HMS/RMS Resolutions (Continued from page 25)
and avoid duplication of immunization, and be it further, RESOLVED, that the MMA encourage members to choose electronic medical records products that are functionally interoperable with state immunization registries, or include in their vendor contracts a commitment to program for this functionality. Action to date: 1) Policy statement/implemented. 2) Communicate with related associations. 3) Develop Minnesota Medicine article on topic. Status: Completed. MMA Staff: Lorrie Holmgren #207, Generic Rx P4P, Formulary Sunshine, and Medicare Part D Regulation RESOLVED, that the MMA amend existing policy 280.17 to read as follows: The MMA will advocate that health plans and insurance companies make readily available to all enrollees and their physicians allowable payment amounts and patient co-payments for all covered tests, procedures, and pharmaceuticals in the patient’s insurance contract; such information, as well as information about provider prior authorization requirements, shall be made easily accessible to patients preferably through a Web interface. The MMA will submit a resolution to the American Medical Association requesting that the AMA advocate for patient-specific payment disclosure to patients and their treating physicians prior to receiving services. Action to date: Policy statement/implemented. #212, Fair Pay for Clinic and Hospital Payfor-Performance Services RESOLVED, that the MMA advocate that third-party payers reimburse health care providers for costs related to pay-for-performance data collection and reporting. Action to date: Communicate position during meeting with health plans. Concept is embedded in P4P principles developed by MMA Quality Committee. MMA Staff: Rebecca Schierman #300, Mandatory Health Insurance RESOLVED, that the MMA reaffirm policy from the Physicians’ Plan for a Healthy Minnesota that would require, by law, that all residents of Minnesota have health care coverage for an essential set of benefits. Action to date: Policy statement/implemented. 26
March/April 2007
#305, Mandatory Drivers’ Testing RESOLVED, that the MMA support efforts to require that Minnesota drivers 70 years and older renew their drivers license in person and not by mail; drivers 75 years and older be required to take a driving test at least every third year, and those 80 years or older to take a driving test yearly to prove continued competency to drive. Action to date: Refer to the MMA Public Health & Preventive Medicine Committee for development of recommendations for consideration by the MMA Board of Trustees (1Q07). MMA Staff: Janet Silversmith #307, Health Savings Account (HSA) or Health Reimbursement Account (HRA) Payments for Physician Services RESOLVED, that the MMA work with insurance companies to clarify that HMO or PPO contractual allowances are not appropriate for any HSA or HRA payments that are the patient’s responsibility, if the billing and collecting process is not the same and if the payments to the physician are not as timely. Action to date: Refer to the MMA Medical Practice & Planning Committee for development of recommendations for consideration by the MMA Board of Trustees (1Q07). MMA Staff: Janet Silversmith #311, High Deductible Health Plan (HDHP) Combinations for Medicaid and Other Public Programs: “Medical IRAs for the Poor” RESOLVED, that the MMA develop and lobby for a plan to use high deductible health plans (HDHPs) for applicable Medicaid populations and for other public sector programs. Action to date: Refer to the Medical Practice & Planning Committee for development of recommendations for consideration by the MMA Board of Trustees (1Q07). MMA Staff: Janet Silversmith #312, Physician Telephonic Visit RESOLVED, that the MMA establish a strategy to encourage health plans to recognize the appropriateness, safety and compensatory value of telephonic visits provided by their subscriber’s health care team, and likewise examine the use of the Internet as a valuable, reimbursable patient encounter opportunity. Action to date: MMA Center for Physician Advocacy staff to develop strategy, which may
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be implemented (in part) via health plan leadership meetings. MMA Staff: Dave Renner/Janet Silversmith #313, Seminars on the Emerging Market of High Deductible Health Plans (HDHPs) for Providers, Employers, and Public RESOLVED, that the MMA involve the component medical societies, Minnesota Medical Group Management Association (MMGMA), and others in actively organizing seminars and conferences to educate providers and the public about dealing with the emerging high deductible health plan market and variations of high deductible health plans. Action to date: MMA staff to analyze current education offerings regarding HDHPs and develop recommendation for consideration by MMA Board of Trustees (1Q07). MMA Staff: George Lohmer #314, Teenage Drivers’ Licensing RESOLVED, that the MMA endorse and introduce legislation in the Minnesota Legislature requiring the successful completion of a crash avoidance course and a more rigorous skills test before issuing a drivers license to anyone age 16 through age 17; and that drivers age 16 through age 17 would not be allowed to have other teenagers in the motor vehicle without the supervision of an adult; and that drivers age 16 through age 17 would be prohibited from driving after 11 p.m. Action to date: Refer to MMA Public Health & Preventive Medicine Committee for development of recommendations for consideration by the MMA Board of Trustees (1Q07). MMA Staff: Janet Silversmith #318, Drowsy Driving RESOLVED, that the MMA encourage physicians to inform patients reporting excessive daytime sleepiness about the connection between sleep deprivation, drowsy driving and fatal accidents, and encourage physicians to document the interaction in the medical record, and be it further RESOLVED, that the MMA encourage physicians to advise patients involved in a crash related to sleep deprivation to stop driving until the underlying condition is identified and treated, and be it further RESOLVED, that the MMA encourage all drivers education programs to use accurate sleep in-
The Journal of the Hennepin and Ramsey Medical Societies
formation in textbooks and to include warnings about the dangers of sleepiness and driving in the curriculum, and be it further RESOLVED, that the MMA send a letter to police chiefs and top law enforcement officials calling for increased awareness among rank and file officers about the dangers of sleepiness and driving and calling for officers to learn the signs of sleep-related crashes and to—when the evidence indicates it—report sleepiness as the cause of a crash, and be it further RESOLVED, that the MMA lobby to have the state of Minnesota fund a study to determine if sleep related accidents are underreported and to adopt a “drowsy driving” highway safety program that includes installing more rumble strips along roadways and more safe rest stops. Action to date: Refer to the MMA Public Health & Preventive Medicine Committee for development of recommendations for consideration by the MMA Board of Trustees. (1Q07) MMA Staff: Janet Silversmith #402, Excessive Executive MD Pay RESOLVED, that the MMA set as policy that a Minnesota Medical Association member should not accept excessive executive compensation that is not in line with the salary survey of the American College of Physician Executives. Action to date: Refer to MMA Administration & Finance Committee for development of analysis of executive compensation issues—recommendations to be submitted to the MMA Board of Trustees (1Q07). MMA Staff: George Lohmer #403, Pharmacists Refusal to Fill Prescriptions RESOLVED, that the MMA introduce and support legislation that requires pharmacies to ensure that protocols exist that provide patients with immediate access to emergency contraception in the event of a pharmacist’s refusal to fill the prescription or request, and be it further RESOLVED, that the MMA work with the Minnesota Pharmacists Association regarding this issue. Action to date: Refer to MMA Committee on Legislation for development of strategy and determination of priority. Meetings with pharmacists have occurred; potential bill language being reviewed by MMA and MPhA. MMA Staff: Dave Renner
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#404, Maternity Care Carve Outs RESOLVED, that the MMA support existing state law that prevents health insurance plan discrimination against maternity coverage. Action to date: Policy Statement/implemented. #406, Improving Health Literacy RESOLVED, that the MMA work with interested parties including the Minnesota Hospital Association and Minnesota Alliance for Patient Safety, to develop a model of informed consent document (written at an approximate 6th grade reading level) that may be used by Minnesota health care institutions, and be it further RESOLVED, that the MMA work with the interested parties to implement more readable and understandable informed consent forms through Minnesota Health Care facilities so as to improve patient safety and understandability of decisions, and be it further RESOLVED, that the MMA direct its American Medical Association delegation to submit a similar resolution to the American Medical Association House of Delegates to develop nationwide awareness and efforts through national patient safety organizations, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other interested parties to improve informed consent forms for patients with low and marginal health literacy. Action to date: Work through the Minnesota Alliance for Patient Safety, which has agreed to address this issue. MMA and MHA are coconvening the MAPS Informed Consent Work Group. Initial work products expected by May 2007. MMA Staff: Rebecca Schierman #407, Physician Education RESOLVED, that the MMA endorse the American Medical Association policy on the relationship between physicians and the pharmaceutical, device, and medical equipment industries (E-8.061), and be it further RESOLVED, that the MMA educate physicians in Minnesota and our patients about the fact that physicians, and pharmaceutical and biotechnology companies must work together to continue to improve patient care, and be it further RESOLVED, that the MMA establish a dialogue with the Pharmaceutical Research and Manufacturers of American (PhRMA) and the Office of the Attorney General to help our MMA sustain
The Journal of the Hennepin and Ramsey Medical Societies
its mission of advocacy on behalf of physicians to help ensure access to all available forms of information for all physicians in the state of Minnesota. Action to date: 1) Policy statement. 2) Develop communications on topic (Minnesota Medicine and/or via other vehicles). 3) Ongoing. MMA Staff: Robert Meiches, M.D. #408, Health Plan Regulatory Accountability RESOLVED, that the MMA develop and lobby for legislation that 1) clarifies the ability of the Board of Medical Practice to hold makers of health plan referral and treatment decisions accountable to the same regulatory review standards as other providers delivering medical services, and 2) defines referral and treatment decisions by health plans as medical practice. Action to date: Refer to MMA Committee on Legislation for development of strategy and determination of priority. MMA Staff: Dave Renner/Karolyn Stirewalt #414, National All Schedules Prescription Electronic Reporting (NASPER) RESOLVED, that the MMA educate elected officials about the negative consequences associated with legislation to establish a state controlled-substance Electronic Reporting System, and be it further RESOLVED, that the MMA actively oppose legislation to establish a state controlled-substance electronic reporting system as proposed by the National All Schedules Prescription Electronic Reporting (NASPER) law passed by Congress in 2005 in the 2007 legislation session. Action to date: Refer to the MMA Medical Practice & Planning Committee for development of recommendations for consideration by the MMA Board of Trustees. (1Q07). MMA Staff: Dave Renner
Call for Resolutions! Start working on your resolutions NOW for the MMA House of Delegates. Both the Hennepin Medical Society and Ramsey Medical Society Caucuses will be meeting in May/June.
March/April 2007
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Mary Ann Blade Receives Shotwell Award Mary Ann Blade, chief executive officer
of Minnesota Visiting Nurse Agency (MVNA) was the 2006 Shotwell Award recipient, presented on January 10, 2007 by Mick Belzer, M.D., past HMS Chair. Blade received the annual award in recognition of her role since 1990, overseeing MVNA, the largest public health home visiting nurse service in the state. Each year, Blade’s team of skilled nurses provides $1 million of charity care to metropolitan residents who would otherwise not receive nursing care. More than 95 percent of MVNA clients are below the poverty line.
Since 1971, the Shotwell Award has been given annually to honor a local individual who has made an impact on the health care industry through breakthroughs in research, a significant contribution to the field of medicine, innovations or improvements in health care delivery, or dedicated service to mankind. “I am very honored to receive the Shotwell Award,” said Blade. “All of us at MVNA have worked hard to provide compassionate, comprehensive and cost-effective nursing
North Memorial is an independent, full-service facility located in the northwest Twin Cities with more than 700 physicians in more than 40 specialties. We are known as the trauma center in the region with other notable programs including the Hubert H. Humphrey Cancer Center, North Heart Center, North Rehabilitation Center, and the Women’s and Children’s Center. We also strongly promote physician practice opportunities within our associated clinics, including those that are independently owned, joint ventures and hospital owned. Which means you can choose from large or small and multi- or single-specialty practice options in metro, suburban, or rural locations. North Memorial offers very competitive salaries and excellent fringe benefits. Sounds like the perfect job, doesn’t it?
Positions now available for BE/BC physicians in: • Family Practice • Internal Medicine • Gastroenterology • General Surgery
• Hematology/Oncology • Emergency Medicine • OB/GYN • Surgical Critical Care
• Pediatrics • Urgent Care • Dermatology • Hospitalist
For consideration to be a part of our team please e-mail cover letter and C.V. to: Mark A. Peterson, Physician Recruiter North Memorial Health Care 3300 Oakdale Avenue North • Robbinsdale, MN 55422 Phone: (763) 520-1336 E-mail: mark.peterson@northmemorial.com
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Mick Belzer, M.D., presents Mary Ann Blade with the Shotwell Award.
care and preventive health services to all. Our nurses make a significant impact on the health and wellbeing of the families they serve, and they all share with me the excitement of this wonderful honor and recognition.” Under Blade’s guidance, MVNA has grown from a struggling, $3 million operation to a healthy $22 million operation. Not only has she restored the 100-plus year-old nonprofit agency to financial health, but she also has forged strong partnerships between the public and private sector to ensure that vital care remains in place. Among Blade’s many contributions to MVNA include its annual flu vaccination program, which administers 140,000 flu shots and raises $300,000 annually to pay for charity care; and Club 100, which provides MVNA clients with the necessities of life to sustain health, such as diapers and clothing. Prior to joining MVNA, Blade was the director of nursing at River Falls Area Hospital in River Falls, WI. She also served as the director of Morrison County Public Health Service, where she developed a comprehensive, cost-effective public health department. The Journal of the Hennepin and Ramsey Medical Societies
PRESIDENT’S MESSAGE V. Stuart cox, M.D.
Mission Statement 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
Roger K. Johnson, CAE, Chief Executive Officer Sue Schettle, Director Katie R. Anderson, Executive Assistant Doreen M. Hines, Manager, Member Services
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The Journal of the Hennepin and Ramsey Medical Societies
significantly affects the relationship and the subsequent “health care.” Many are cynical about physicians being truly concerned about the community they work in, yet I see example after example of physicians fighting for their community. Last fall I was at the National AMA meeting. The hot topic there was the expected cuts in Medicare. The Georgia delegation drafted a resolution that basically said, “Hell no, we won’t go.” I was proud to be part of the Minnesota delegation when Sally Trippel, M.D., MPH, internal medicine/general preventive medicine, and AMA delegate, stated, “The way this is written there is nothing in here that talks about the benefit of the community. I simply cannot support something that does not positively affect the people we take care of.” One of my partners consistently brings up the need to serve the poor. Although our business almost always loses money on our Medicaid contracts, he feels it is simply our duty to take care of the underserved. For 2007 two of our (RMS and MMA) top legislative priorities include the Freedom to Breathe Act and an alcohol tax that would be dedicated to addressing alcohol abuse. This legislation would decrease the number of ill people we see and take care of, but will improve the health of the community we live in. Why are we here? A balance of reality and idealism. Ramsey Medical Society assisting physicians in the practice and profession of medicine for the benefit of the community.
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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
S
Several years ago at a board meeting Lyle Swenson asked, “Why are we here? Why does Ramsey Medical Society, or any medical society, exist?” Not long after that we went through a long-range planning process. Although I am suspicious of such things, we crafted an excellent mission statement, “Assisting physicians in the practice and profession of medicine.” There is a lot more to this than at first glance. The practice of medicine implies business — what we do to make a living. This is the reality part of the mission statement. Ramsey Medical Society is an advocate for and helps the physicians defend the practice of medicine. One of the challenges of our times is that the heart of what it means to be a physician is being usurped. Our ability to make both medical and financial decisions about the care of our patients is incrementally eroding. Some of this is inevitable. Medicine is a two trillion dollar business; you would expect businessmen to try to take complete control. However, the community is at risk when medical decisions are made by people who are primarily interested in the bottom line. Executives are several layers away from the people they make decisions for. Physicians have the gift, and the responsibility of looking in the eye of those they care for. Profession is the ideal part of the mission statement. Historically, unions and trade societies were interested in promoting their business. A professional society, while it endorses the profession, is supposed to be primarily for the benefit of the community it serves. Physicians are part of the community they live in. It takes years to develop their reputation as a good physician. We are not interchangeable cogs, as the Kaisers of the world would have us believe. Our understanding of our patient’s environment and their knowledge of our background
Great Turnout for 2007 RMS Annual Meeting
T
he Minnesota Science Museum proved to be a great location for the 2007 RMS Annual Meeting. Everyone in the great turnout of 143 enjoyed the excellent dinner catered by Lancer Catering along with all the exhibits provided both by Victor Cox, D.V.M. and by the Museum. The highlights of the evening were the installation of V. Stuart Cox, M.D., of Midwest Ear Nose and Throat, as the 137th president of RMS by outgoing president, Dr.
Past President Charles Terzian, M.D. (right) presented James Jordan, M.D., with the Outgoing President Award.
James Jordan; the presentation of the 2006 Community Service Award to Richard Anderson, M. D. of Vadnais Heights; and, the presentation of the RMS President’s Award (an engraved sword) to Dr. Robert Geist, of North Oaks as the champion defender of the profession and the practice of medicine. Dr. Stuart Cox concluded his remarks asking the question, “Why are we here? The answer is with a balance of reality and idealism. The Ramsey Medical Society’s mission is to assist physicians in the practice and profession of medicine for the benefit of the community.”
Community Service Award recipient Richard W. Anderson, M.D. and his wife, Beverly, were joined by their children and spouses.
Steve Severson, valued RMS’ endorsed vendor from AmeriPride, provided a display of their products and was also a meeting sponsor.
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Dr. James Jordan installs V. Stuart Cox, M.D. as the 137th President of the Ramsey Medical Society with the presidential medallion.
Dr. Stuart Cox is symbolically knighting Dr. Robert Geist with his sword awarded to him as the champion defender of the profession.
Physicians, spouses and their families enjoyed the RMS Winter Gala and Annual Meeting at the Science Museum on January 19, 2007.
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The Journal of the Hennepin and Ramsey Medical Societies
Boeckmann Library Update
A
Library and wish her the best for the future,” said Roger Johnson, RMS CEO. You can send a note by e-mail to Mary Sandra Tarman at tarman3000@gmail.com.
Mary Sandra Tarman (right) pictured with some of the Boeckmann Library staff, Carolyn Walkin (center) and Sharon Kambeitz (left).
In Memoriam ALFRED E. DALY, M.D. died peacefully on February 1 after enduring a 27 year disability following a closed head injury. He was 74 years old. Dr. Daly received his medical degree from the University of St. Louis Medical School and completed an orthopedic surgery residency at the VA Hospital in Minneapolis. He served as a USAF Flight Surgeon and a former Chief of Staff at St. Joseph’s Hospital in St. Paul. Dr. Daly joined RMS in 1967. WILLIAM H. HOLLINSHEAD JR., M.D. passed away on January 27. He was 94. Dr. Hollinshead received his medical degree from the University of Minnesota and completed a residency in internal medicine at the same institution. He served with the 26th General Hospital while in the U.S. Army Medical Corps. Upon returning home, he began private practice in internal medicine until retirement in 1984. During this time he served as treasurer and president of the Ramsey Medical Society. Dr. Hollinshead joined RMS in 1946. DONALD W. KOZA, M.D. died in December at the age of 84. He received his medical degree
from the University of Minnesota and completed a residency at the University of Minnesota and Mayo Clinic in physiology and internal medicine. Dr. Koza practiced 44 years as a family physician on the East Side of St. Paul retiring in 1989. He was a Master Iris Judge Gardener in his spare time. Dr. Koza joined RMS in 1952. RICHARD A. WILLIAMS, M.D. died at the age of 82 on December 9. He received his medical degree from the University of Iowa. He was a veteran of the Pacific Theatre of WWII. After completing an internship at St. Luke’s Hospital in Duluth, he began work at a small clinic in Rothsay, MN and then moved to Newport in 1954. Dr. Williams then served as a family practitioner in southern Washington County for more than 50 years retiring in 1992. He was one of the founders of Family Practitioners, which is now HealthEast Cottage Grove. Dr. Williams worked as the health officer for St. Paul Park from 1955 to 1982 and also served as a deputy to the Washington County coroner. He joined RMS in 1994 when Wakota Medical Society merged with Ramsey Medical Society.
Correction: In the January/February issue of MetroDoctors on page 27, “Dr. Wright Addresses Physicians,” Sandra Rosenberg, M.D. was misidentified as President, MMA Women Physicians. Her correct identification is: Sandra Rosenberg, M.D., President of Minnesota Women Physicians. We apologize for the error.
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
I n Ja n u a r y 2 0 0 7 , Cynthia Piette joined the Smoke Free Washington County effort as the new grassroots organizer. Cynthia will work with Sue Schettle, Director of Ramsey Medical Society, in an effort to engage and mobilize the physicians and medical community in Washington County to work toward smoke free environments in targeted communities. Cynthia comes to this effort with political organizing experience having recently worked on the gubernatorial campaigns for Peter Hutchinson and Dr. Maureen Reed among others. If you are interested in learning more about the smoke free efforts in Washington County and would consider getting involved, please contact Cynthia Piette at (651) 4393096, or e-mail her at cpiette@metrodoctors. com.
Southside Community Health Services We are seeking Full-time/Part-time Family Practice Physicians to work in our family practice/community clinic locations in South Minneapolis and Stillwater. Southside Community Health Services is a Federally Qualified Health Center with four offices located in Minneapolis and Stillwater, Minnesota. We provide a full range of medical services, including OB care, dental services, and eye care to the underserved community. Practice is clinic based only, with weekends and holidays off. We offer competitive salary and benefits with paid malpractice. Applicants may qualify for student loan repayment programs. Please fax or email resumes to: Kari Rabie, MD, Medical Director Fax: 612-821-2818 Email: kari.rabie@southsidechs.org.
March/April 2007
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Ramsey Medical Society
llina Library Services consolidated their staff at the Central Library. Mercy and Unity libraries will be self serve as well as the Boeckmann Library located at United Hospital. The Library will still be in the same location at United, but it will be mostly electronic. This means that access to the Library will be obtained by swiping a proxy card (available through Security). United’s library site will have staff available two days per week on Monday and Thursday. As a result, Mary Sandra Tarman’s position as librarian was eliminated. Ms. Tarman’s service spans 35 years having joined the staff in 1971. “We thank Mary (Sandy) for her many years of dedicated service to the Boeckmann
Introducing New Employee for Smoke Free Washington County
New Members RMS welcomes these new members to the Society. Schools listed indicate the institution where the medical degree was received.
Active Azhar T. Ali, M.D. Aga Khan Medical College, Pakistan Diagnostic Radiology St. Paul Radiology, P.A. Michael D. Ames, M.D. Boston University School of Medicine Diagnostic Radiology St. Paul Radiology, P.A. Bruce M. Berens, M.D. University of South Dakota School of Medicine Diagnostic Radiology St. Paul Radiology, P.A. Mark Bergman, M.D. University of Texas Medical School at San Antonio Medical Oncology/Hematology Minnesota Oncology Hematology, P.A. Tara S. Bowman, M.D. University of North Dakota School of Medicine Diagnostic Radiology St. Paul Radiology, P.A. Ann C. Casey, M.D. University of Minnesota Obstetrics & Gynecology/ Gynecologic Oncology Minnesota Oncology Hematology, P.A. Diana R. Danilenko, M.D. Mayo School of Medicine Obstetrics & Gynecology/ Maternal & Fetal Medicine Minnesota Perinatal Physicians Viorel Gheorghe, M.D. Institutul de Medecina si Farmacie, Tirgu Mures Internal Medicine HealthEast Woodbury Clinic Nicole W. Hartung, M.D. University of Missouri Medical Oncology Minnesota Oncology Hematology, P.A.
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Steven G. Haugen, M.D. Creighton University School of Medicine Diagnostic Radiology St. Paul Radiology, P.A.
Joseph M. Terry, M.D. Tufts University School of Medicine Ophthalmology University of Minnesota Physicians
Michael H. Hummel, M.D. Ohio State University College of Medicine Interventional Radiology St. Paul Radiology, P.A.
Don Wiese II, M.D., Ph.D. University of Michigan Medical School Diagnostic Radiology/Neuroradiology St. Paul Radiology, P.A.
Asad Irfanullah, MBBS Aga Khan Medical College, Pakistan Interventional Radiology Hennepin Faculty Associates
Carol Weitz, M.D. Tufts University School of Medicine Medical Oncology/Hematology Hennepin Faculty Associates
Ndidiamaka N. Koka, M.D. University of Cincinnati College of Medicine Family Medicine Hennepin Family Medical Center
2nd Year Active Practice Harrison P. Dilworth IV, M.D. University of Minnesota Pathology Hospital Pathology Assoc., P.A.
Subhashini J. Ladella, MBBS Christian Medical College, Madras University, Vellore, Tamil Nadu Maternal & Fetal Medicine Minnesota Perinatal Physicians
Thomas L. Folsom, M.D. University of Nebraska College of Medicine Psychiatry/Psychoanalysis HFA Psychiatry Clinic
Jeffery P. Lassig, M.D. University of Chicago Division of the Biological Sciences Interventional Radiology St. Paul Radiology, P.A.
1st Year Active Practice Thomas C. Sanneman, M.D. University of Minnesota Anesthesiology Associated Anesthesiologists, P.A.
John B. Miller, M.D. University of Tennessee Center for Health Sciences General Surgery/Vascular Surgery Minnesota Surgical Associates, P.A.
Medical Students
William B. Ogden, M.D. Northwestern University Medical School Endocrinology/Internal Medicine United Medical Specialties, St. Paul Suzanne S. Parrino, M.D. Louisiana State University Diagnostic Radiology St. Paul Radiology, P.A. Alexander Perelman, M.D. Kujbysev Medical Institute Physical Medicine & Rehabilitation Britton Center, P.A. Kendall D. Price, M.D. University of Illinois College of Medicine Central Regional Pathology Laboratories Gregory D. Taylor, M.D. Wayne State University School of Medicine Diagnostic Radiology St. Paul Radiology, P.A. MetroDoctors
(University of Minnesota)
Adebisi O. Alimi Eric P. Anderson Seyed A. Astani Andrew S. Bernhardson Michael E. Bond Jessica A. Christensen Carmen R. Dargis Andrew T. Day Patricia J. Dickmann Rebecca A. Donahue Bryan M. Donald Linnea K. Engel Suzanne C. Geier Bridgette M. Goulet Rachel A. Gramith David J. Gresback Steven J. Haasken Melissa R. Haehn Conor O. Hagen Margaret M. Hopeman Prachi Jain Susanne E. Jepsen Mohammad A. Kazemizadeh Gol James S. Kosowicz
The Journal of the Hennepin and Ramsey Medical Societies
CHAIR’S REPORT paul a. kettler, M.D.
Board of Directors Participate in Retreat and Planning Session HMS‑Officers
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 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 Eleanor Goodall, Co-Presiding Chair, HMS Alliance Donald M. Jacobs, M.D., MMA Trustee Roger G. Kathol, M.D., MMA Trustee Dawn Lunde, MMGMA Representative Jason Meyers, Medical Student Representative Richard 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 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
Dear Colleagues; On January 17th, 2007, 22 members of the Hennepin Medical Society Board of Directors participated in a six hour retreat and planning session. Below is a partial summary of the proceedings. A three-part survey was distributed to Board members in advance of the retreat, the results of which were considered throughout the planning session. Defining the Purpose of HMS The following comments regarding the question, “why does HMS exist?” were cited: • HMS has ability to focus on a specific population. This is an advantage for physicians in our geographic area, e.g. public health, patient advocacy, clinical practice needs. • Ability to identify needs and address them. • Basically a political organization — physician and patient advocacy. • Assure autonomy of physicians. • An organization to represent political views of physicians. • A place to communicate with colleagues about areas of common interest. • Everyone has a hospital and specialty, HMS is a common ground, an umbrella. • A communications vehicle. • HMS fulfills a grassroots role. Mission During the retreat and through a pre-retreat survey, participants were asked to assist in an evaluation and possible updating of the mission statement. The following is proposed: HMS is an organization of physicians dedicated to improving health care through education, support and advocacy for patients and physicians. The proposed Mission statement will be adopted or modified at the next meeting of the Board of Directors.
Vision A vision statement states what you strive to be. Proposed Vision statement: • Providing medical leadership to make this a premiere health care community. • Providing medical leadership to ensure high quality health care to our community. • Providing medical leadership to foster a healthy community. Action: Review proposed Vision statements at the next meeting of the Board of Directors. Name Change Who is our constituency and who do we represent? Name should reflect the geographic areas served (5-counties), e.g. Twin Cities West Medical Society? Action: The consensus of the retreat participants is that HMS should consider a name change, followed by a well thought-out education campaign and PR roll-out. HMS Activities A review of the survey revealed that the involvement of HMS in Public Health and Policy/Legislative initiatives was rated as very high/high. A brief overview of the following public health activities was presented: • Tobacco — a 3-year grant from Minnesota Department of Health was completed in 2006. HMS member physicians participated in smoke-free efforts resulting in smoke-free policies being implemented in the City of Minneapolis, Hennepin County, Golden Valley, Edina (parks ordinance), and Bloomington. A 3-year agreement with Blue Cross/Blue Shield of Minnesota was established in the fall of 2006, specifically focused on establishing smoke-free policies/ordinances in Scott County. Jennifer Anderson is the HMS staff for this initiative. (Continued on page 34)
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
March/April 2007
33
Hennepin Medical Society
Chair Paul A. Kettler, M.D. President Anne M. Murray, M.D. President-elect Richard D. Schmidt, M.D. Secretary Edward P. Ehlinger, M.D. Treasurer Eric G. Christianson, M.D. Immediate Past Chair James A. Rohde, M.D.
Board Retreat and Planning Session (Continued from page 33)
• Freedom To Breathe Coalition — HMS is a member of this Coalition. • Alcohol Excise Tax — Legislation proposing a $.05 excise tax on alcohol is being drafted. Funds generated will be used for prevention, treatment, and law enforcement. Dr. Carl Burkland and Nancy Bauer participate on the Facing Alcohol’s Costs to Society (FACTS) Coalition representing HMS. • Obesity — Dr. Paul Pentel is working on efforts to improve the dietary offerings at hospital cafeterias, and Dr. Peter Dehnel is exploring an initiative to reduce obesity in children. The Board, in their feedback, agreed that HMS should continue its involvement in these initiatives. Future focus areas included: • Alcohol (mis)use by medical students. • Improved access to health care (currently being addressed through public policy). • Elderly driving — screening, behind the wheel requirements, etc. • Access to psychiatric care. Policy and Legislative Advocacy The consensus was that Policy and Legislative advocacy are very important activities of HMS. The following overview of the HMS/RMS 2007 Legislative/Policy Monitoring activities was presented: Freedom to Breathe – MMA top priority – Considerable opportunity to pass – HMS has joined the FTB Coalition – HMS is participating in Day at the Capitol – HMS continues to work on Scott County Project Interpreter Bill – MMGMA is taking the lead with support from MPC – MMA top priority – Health plans understand issue – Bill language is in place HSA Benefit Direct to Providers – Collections/accounts receivable issue – Require direct assignment – Allows physician to collect estimated prepayment Facing Alcohol’s Costs to Society (FACTS) – Carl Burkland, M.D. lead HMS representative 34
March/April 2007
– Nancy Bauer, HMS staff – Legislation has authors and is soon to be introduced (S.F. 779) – HMS and RMS have been asked to join “FACTS” Coalition – Resolution #210 & #201, 2006 HMS/ Burkland No Fault Auto – Continue to monitor Workers Compensation – Continue to monitor Health Care Reform – MMA reform proposal is making progress and is well established – Governor’s proposal, expansion of MNCare, modest impact and cost – Sen. Berglin’s plan, expands inadequate reimbursement, complex – Care for Minnesota’s Children (CMC) Rep. Abeler, 66,000 uncovered children, similar to an HSA Physicians Health Facilities Issue/CON – Citizen’s League recommendation – Minnesota Ambulatory Health Care Consortium – HMS will continue to monitor Health Care Access Fund Oversight – MMA’s top priority – HMS/RMS monitor Direct Billing by Pathologist – Prohibition of practices billing for pathology services – Important issue for MMGMA – MMA policy statement regarding ethically permissible practice – HMS/RMS monitor National All Schedules Prescription Electronic Reporting (NASPER) – Interventional Pain Management Specialists (MAPS) have hired a lobbyist – Minnesota Dental Association is opposed – MMA opposes current form – Resolution #414, 2006 A. Anderson, M.D., HMS member – HMS/RMS oppose – Minnesota Provider Coalition oppose – Minnesota Board of Medical Practice continues to oppose Imaging Prior Authorization – MMA has taken the lead with a strong public statement – MMA has had discussions with health plans MetroDoctors
– MMGMA opposes action by health plans – HMS/RMS has met with Jim Guyn, M.D. Medica medical director – Several members have asked that HMS oppose these processes Independent Medical Staff Governance – Board and membership education on the issue – 2007 support the analysis of two hospital staff bylaws – Engage Libby Snelson, J.D. – Plan JCAHO contact with Bill Jacott, M.D. Disclosure of Estimated Payment (Transparency) – MMGMA has drafted language to modify 62J – Minnesota Provider Coalition (MPC) supports – Permits provider to disclose allowable payment – Permits provider to discount for private pay to average allowables Action: A motion was made, seconded and carried to officially approve the involvement of HMS in the FACTS Coalition and continue the policy/legislative activities as outlined. Communications Existing communication vehicles (MetroDoctors, Web site, e-mail) are seen as valuable. Action: More frequent legislative and activity updates should be sent via e-mail and placed on the Web site. Recognition and Awards Both the Charles Bolles Bolles-Rogers Award and the Shotwell Award are considered to be very important and mean a lot to the physician/ person receiving the award. The Board believes more publicity about these awards might increase awareness and appreciation of these awards’ importance. It was suggested that Minnesota Public Health Association (or other organizations) might be invited to give an award in the HMS name for higher visibility. Action: Create an additional award — “First A Physician,” that would recognize physicians who exemplify the profession, possibly through community service or work on public policy issues. (Criteria to be determined by Board of Directors.) On behalf of the 4400 HMS members, I would like to thank the Board for taking the time to participate in this important work and David Allen for his leadership as facilitator.
The Journal of the Hennepin and Ramsey Medical Societies
HMS NEWS
New Members HMS welcomes these new members to the Society.
Active
John W. Apostol, M.D. Columbia Park Medical Group Family Medicine, General Surgery, General Practice Patrick G. Arndt, M.D. University of Minnesota Physicians Pulmonary Disease, Critical Care Medicine Jeffrey D. Baker, M.D. Daniel R. Baker, M.D., PA General Surgery, Bariatric Surgery Christopher P. Balgobin, M.D. Fairview Cedar Ridge Clinic Family Medicine Gary D. Berman, M.D. Allergy & Asthma Specialists, PA Allergy
Kimberly R. Cochran, M.D. Allina Medical Clinic-Abbott Northwestern Hospital Internal Medicine/Hospitalist John J. Connors, M.D. Hennepin County Medical Center Radiology, Neuroradiology Maria-Teresa M. Cuddihy, M.D., MPH University of Minnesota Physicians Internal Medicine Jeffrey J. Davis, M.D. Fairview Southdale Hospital Internal Medicine, Hospitalist Christine M. DeLisle, M.D. Suburban Emergency Associates, PA Emergency Medicine Benita S. Dieperink, M.D. Hennepin Faculty Associates Psychiatry Charles B. Donovan, M.D. Consulting Radiologists, Ltd. Radiology, Diagnostic Neuroradiology Elizabeth E. Doty, M.D. Hennepin County Medical Center OB/GYN
Stuart H. Bloom, M.D. Hubert H. Humphrey Cancer Center-North Memorial Campus Internal Medicine, Hematology
Eduardo Ehrenwald, M.D. Consulting Radiologists, Ltd. Interventional Radiology
Corinna W. Brancio, M.D. Columbia Park Medical Group Family Medicine
Erik J. Ekstrom, M.D. Institute for Low Back & Neck Care Pain Medicine
Christine M. Braun, M.D. Hennepin Faculty Associates OB/GYN
Scott D. Ellingson, M.D. Lakeview Clinic, Ltd. Family Medicine, Geriatic Medicine
Jonathon C. Calkwood, M.D. Minneapolis Clinic of Neurology, Ltd. Neurology
Andrew C. Engel, M.D. Northwest Anesthesia, PA Anesthesiology
John M. Carney, M.D. Advancements in Dermatology Dermatology
Mustapha Ezzeddine, M.D. Hennepin County Medical Center Neurology
Regina N. Cho, M.D. Obstetrics & Gynecology Specialists, PA OB/GYN
Manuela Fina, M.D. Paperella Ear, Head & Neck Clinic, PA Otolaryngology
MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
Teresa K. Gray, M.D. Columbia Park Medical Group Internal Medicine Eric A. Gross, M.D. Hennepin County Medical Center Emergency Medicine Peter Halvorson, M.D. Columbia Park Medical Group General Surgery Peter A. Hanson, M.D. Sports & Orthopaedic Specialists, PA Family Medicine Darren L. Huber, M.D. Suburban Emergency Associates, PA Emergency Medicine Kelly M. Jerstad, M.D. Advancements in Dermatology Dermatology Scott A. Joing, M.D. Hennepin County Medical Center Emergency Medicine Jennifer L. Kersten, M.D. Consulting Radiologists, Ltd. Radiology Bibi S. Khoyratty, M.D. Minnesota Oncology Hematology, PA Oncology David M. King, M.D. Hubert H. Humphrey Cancer Center-Unity Campus Oncology, Hematology
Brian T. Lew, M.D. Minnesota Heart Clinic Internal Medicine, Cardiology, Cardiovascular Diseases Huagui Li, M.D., Ph.D. Minnesota Heart Clinic Cardiology Joseph C. Lin, M.D. Metropolitan Cardiology Consultants, PA Internal Medicine, Cardiac Electrophysiology Laura R. Luckow, M.D. South Lake Pediatrics Pediatrics Jacqueline A. Luong, M.D. Midwest Plastic Surgery Plastic Surgery Linda J. Maag, M.D. John A. Haugen Associates, PA OB/GYN Richard C. Madlon-Kay, M.D. University of Minnesota Physicians Cardiovascular Diseases Morgan E. Mann, M.D. Columbia Park Medical Group Family Medicine Stephen C. Mann, M.D. Hubert H. Humphrey Cancer Center â&#x20AC;&#x201C;Unity Campus Hematology, Oncology
Ndidiamaka N. Koka, M.D. Hennepin Family Medical Center Family Medicine
Jordan G. Marmet, M.D. South Lake Pediatrics, Childrenâ&#x20AC;&#x2122;s West Pediatrics
Luis E. Laguna, M.D. Surgical Consultants, PA General Surgery
Sarah A. Mazig, M.D. Columbia Park Medical Group Internal Medicine
Timothy G. Larson, M.D. Hubert H. Humphrey Cancer Center-North Memorial Campus Oncology
Laurie McLeod, M.D. Columbia Park Medical Group Family Medicine
Noel Laudi, M.D. Hubert H. Humphrey Cancer Center-Mercy Campus Hematology, Oncology John H. Lee, M.D. Metropolitan Cardiology Consultants, PA Interventional Cardiology
Hennepin Medical Society
Michele L. Allen, M.D. University of Minnesota Physicians Family Medicine
Alfred L. Clavel, Jr., M.D. Fairview Pain and Palliative Care Center Neurology, Pain Medicine
Jason A. Mehling, M.D. Consulting Radiologists, Ltd. Radiology, Interventional Radiology Yvonne M. Murtha, M.D. Hennepin County Medical Center Orthopedics Elizabeth K. Musolf, M.D. Pediataric Services, PA Pediatrics (Continued on page 36)
March/April 2007
35
New Members (Continued from page 35)
James M. Mylrea, M.D. Consulting Radiologists, Ltd. Radiology Mohammed K. Nashawaty, M.D. Minnesota Oncology Hematology, PA Hematology, Oncology David M. Nelson, M.D. France Avenue Family Physicians, PA Family Medicine Deborah M. Nowak, M.D. Surgical Consultants, PA General Surgery Nina R. Perdue, M.D. Minnesota Neonatal Physicians, PA Pediatrics
Stephen C. Schmechel, M.D., Ph.D. University of Minnesota Physicians Pathology Carol C. Schoonover, M.D. Columbia Park Medical Group Internal Medicine Pradheep J. Shanker, M.D. Consulting Radiologists, Ltd. Diagnostic Radiology Shawn S. Shrawny, M.D. Consulting Radiologists, Ltd. Interventional Radiology Whitney D. Tope, M.Phil., M.D. Metropolitan Dermatology & Cutaneous Surgery, PA Dermatology, Dermatologic Surgery Dang D. Tran, M.D. Columbia Park Medical Group, PA Family Medicine
Jeffrey J. Peterson, M.D. Consulting Radiologists, Ltd. Diagnostic Neuroradiology
Dorothy Uhlman, M.D. Hubert H. Humphrey Cancer Center-Unity Campus Hematology, Oncology
Quan V. Pham, M.D. Minnesota Heart Clinic Internal Medicine, Cardiac Electrophysiology
Sidney P. Walker, Jr., M.D. Hennepin County Medical Center Diagnostic Radiology
Amy M. Putnam, M.D. Columbia Park Medical Group Pediatric Internal Medicine
David F. Williams, M.D. VitreoRetinal Surgery, PA Ophthalmology
Linda H. Riley, M.D. Hospital Pathology Associates, PA Pathology
Roman J. Zownirowycz, M.D. Columbia Park Medical Group, PA Family Medicine
Mark A. Robien, M.D. University of Minnesota Physicians Internal Medicine
Medical Students
Albert Salazar, M.D. Fairview Cedar Ridge Clinic Family Medicine Jeffrey N. Samuelson, M.D. Skin Care Doctors, PA Dermatology Mark D. Sborov, M.D. Minnesota Oncology Hematology, PA Medical Oncology Thomas J. Schaefer, M.D. Metropolitan Anesthesia Network, LLP Anesthesiology Carlos H. Schenck, M.D. Nystrom & Associates, Ltd. Psychiatry, Sleep Medicine
36
March/April 2007
(University of Minnesota) Isahaq M. Abdullahi William S. Allen, II Elizabeth M. Alm Jacob S. Ankeny Sarah A. Barnes Bjorn H. Batdorf Paul D. Bechard Luke C. Beckman Richard H. Beddingfield Charles J. Billington, Jr. Rachel K. Blackman Grant W. Botker Christina M. Brakken Thal Roy G. Bryan, Jr. Claudia Campo Soria Matthew D. Cascino Kevin P. Cavanaugh Manik S. Chhabra Vandana Chopra Amanda J. Christ
Anna A. Cox Erin M. Crimmins Christine N. Desautels Renee M. Donahue Meghann M. Duffy John T. Egan Heidi L. Erickson Ronda S. Farah Joseph L. Farnam Melanie G. Fearing Naomi N. Fennell Chad M. Ferguson Sancia K. Ferguson Amanda B. Gabrielson Nathaniel T. Gaeckle Andrew K. Gunderson Stephanie A. Hakel Donald G. Harris Katherine L. Haynes Matthew J. Healy Margot L. Herman Sing-Wei Ho Ryan D. Hochhalter Timothy R. Holden
Patrick K. Horst Krista J. Huseby Cory D. Jaques John D. Jochman Charles E. Johnson ElizabethAnn M. Johnson Jeremy D. Johnson Robyn M. Jones Jonathan S. Kenknight Nicholas Kim Carlton R. Kimmerle Kirsten J. Klevan Marit E. Knutson Austin R. Krohn Stacy B. Krueth Jennifer E. Kruse Brent A. Kudak Marcos T. Kuroki Geoffrey M. Rutledge
Resident Physician Betsy L. Schwartz, M.D. Pediatrics
In Memoriam SOLVEIG MARGARET BERGH, M.D., died on December 19, 2006 at the age of 95. She was affectionately known as “Dodie” to her family and friends. She graduated from the University of Minnesota Medical School. Dr. Bergh specialized in radiology and practiced for many years with her brother, surgeon Dr. George S. Bergh, Sr. Dr. Bergh joined HMS in 1945. ROBERT A. DORNBACH, M.D., died on December 11, 2006, at the age of 81. He was a graduate of St. Thomas Military Academy & College. He graduated summa cum laude from Georgetown Medical School in 1949. Dr. Dornbach was a veteran of WWII and the Korean Conflict, serving in the Medical Corps from 1951-1953. He specialized in occupational medicine. Dr. Dornbach joined HMS in 1963.
Hennepin Medical Society Alliance 2007 Annual Meeting Friday May 11, 2007 Edina Country Club, 5100 Wooddale, Edina 9:30 a.m. — Board Meeting 11:00 a.m. — Social, Cash Bar 11:30 a.m. — Luncheon 12:00 p.m. — Business Meeting/Installation of Officers 12:30 p.m. — Speaker (TBA)
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.
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