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The Journal of the Hennepin and Ramsey Medical Societies

May/June 2007

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May/June 2007

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Doctors MetroDoctors THE JOURNAL OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.

CONTENTS VOLUME 9, NO. 3

2

Index to Advertisers

4

Roger K. Johnson Announces Retirement

6

Introducing the Carlson School’s Medical Industry Leadership Institute

8

China’s Health Care System

11

PHYSICIAN’S SOAP BOX

Is Obesity in the Legitimate Realm of Public Health?

13

HSA and High Deductible Plan Impact on Practice Accounts Receivables

15

Collection Challenges Ahead

17

Healthy Kids are Better Learners

18

Classified Ads

19

Wound Healing With New Technologies

21

Editorial: Opting out of Insurance Provider Agreements

23

Winter Medical Conference 2007

24

HMS and RMS Boards Meet Jointly Members in the News

RAMSEY MEDICAL SOCIETY

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (952) 903-0505 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com.

25 26 27

President’s Message/Roger Johnson’s Retirement Party Invitation

MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy.

28

Board Receives Legislative Update/Public Policy Council/ Call for Delegates, Resolutions/Derby Day

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.

2007 Caring Hearts for Homeless People Supply Drive Update on Smoke-Free Washington County/Update on Dakota County Smoke-Free Communities Partnership/ New Members

HENNEPIN MEDICAL SOCIETY

29 30 31 32

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M AY / J U N E 2 0 0 7

Chair’s Report HMS Alliance News New Members/Partnership for a Smoke-Free Scott County/ In Memoriam/Call for Delegates, Resolutions HMS Recognizes Leaders in Service, Research and Innovation

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: Roger Johnson pictured in front of the Armenian Madonna, a Persian rug donated to RMS in 1931. Article begins on page 4.

May/June 2007

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Roger K. Johnson Announces Retirement Editor’s Note: After a successful 28-year career in Minnesota organized medicine, Roger K. Johnson has announced his plan to retire on May 31, 2007. Roger was appointed to his current position as chief executive officer of the Ramsey Medical Society in May of 1994.

Prior to his CEO position with RMS, Roger spent 15 years and held various positions with the Minnesota Medical Association. His positions while at the MMA included director of Public Affairs and Communications, executive director of the Minnesota Physicians Foundation, director of Economics and Government Relations, and director of Membership Relations. Along with these positions, Roger was responsible for coordinating the North Central Medical Conference and for 17 years staffed the Minnesota Delegation to the American Medical Association. With these experiences it becomes clear why RMS leadership, in 1994, recruited Roger to guide the Society during these challenging years.

What follows is from a conversation with Roger and his reflections on his career.

What changes have you seen over the years—both good and bad?

What did you enjoy most about your position as CEO of Ramsey Medical Society?

What has been your biggest disappointment?

The one thing that is the most enjoyable about serving as CEO of RMS is being able to work with physicians who demonstrate strong qualities of dedication to the profession, concern for their patients, knowledge of the issues, and the willingness to commit their energy and time to RMS. We have been blessed each year as highly qualified, enthusiastic physicians from all specialties have come forward to serve as officers and to serve on the Board of Directors. Those physician leaders, together with an effective staff, make RMS the successful medical society it is today.

When you read and hear about the changes in medicine over the years you most often learn about the technological advances in medicine, which are truly remarkable. Those advances have certainly enhanced the abilities of physicians to both diagnose and to treat many diseases, injuries and illnesses. Along with the technological advances, we have also witnessed the migration of medical care from the physician-owned and operated practices to the large systems including hospitals, physicians, and, in some cases, health plans. We have also observed that the once very personal and often long-time relationships between a patient and their physician are no longer as sacred as they were in the past. With an evolving health care scene those long-term relationships are more difficult to maintain. And, with more intrusions on the relationship between the patient and the physician, the relationship is no longer viewed as sacred by the government, the payers and, in some cases, the legal system.

I do not have a disappointment that looms large over my retirement. I have a strong concern that physicians are overworked and thus unable to devote enough time to being involved in preserving the practice of medicine as a true profession.

What has been your most rewarding experience?

One very rewarding experience was the 125th Anniversary of RMS that was celebrated in 1995 at the Minnesota History Center. Almost 200 physicians and spouses enjoyed the Historical Presentation of the Early Days of RMS enacted by the Great American History Theater group.

The evening was a fitting tribute to RMS and its long and outstanding history.

What do you see as your greatest accomplishment?

From left: Dr. Thomas Kottke, Regions Hospital cardiologist, St. Paul Council member Dave Thune, Dr. Robert Moravec, St. Joseph’s Hospital Medical Director and Roger Johnson celebrate St. Paul’s Smoke Free Ordinance at an event March 31, 2006 at Sweeney’s in St. Paul.

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May/June 2007

Whatever I have managed to accomplish over the years must be accredited to teamwork with our physician members and leadership along with our dedicated staff. I may be guilty of overusing the term, teamwork, but I believe that we can only have an effective RMS by working as a strong team of physicians and staff.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Describe your most memorable time/opportunity.

One of the most memorable experiences in my career was standing on the stage with 28 others at the international meeting of the American Society of Association Executives in Toronto in 1988 to receive the Certified Association Executive designation. The CAE is only presented to those association executives who demonstrate a commitment to association management through their work record and who achieve a certain score on a one-day examination that requires months of preparation. I am proud of that achievement and succeeding in renewing this credential every three years since 1988.

What are your plans after you retire?

My retirement will not lead to inactivity. I hope to remain involved enough to continue to advocate for an excellent health care system both in the metropolitan Twin Cities and in Minnesota. I am looking forward to joining the Board of the Hamm Clinic at the invitation of Dr. James Jordan and his leadership. Perhaps other opportunities to serve will also surface.

Do you have any hobbies?

My personal interests are varied and they range from digital photography and watercolor painting to travel and railroading, both real trains and HO gauge scale models. Barbara and I also collect art and we hope to add

Roger Johnson, at the 2007 RMS Annual Meeting, is pictured with many of the RMS past, present and future president’s that he has worked with throughout the years. From left: Roger Johnson, Vernon Sommerdorf, M.D. (1979), Peter Wilton, M.D. (2008), James Jordan, M.D. (2006), J. Michael Gonzalez-Campoy, M.D., Ph.D. (2003), V. Stuart Cox, M.D. (2007), Peter Kelly, M.D. (2002), Charles Terzian, M.D. (2005) and Robert Geist, M.D. (1977).

Peter Daly, M.D. recognizes Roger Johnson for his 25 years of service to organized medicine in 2004.

MetroDoctors

RMS physician leaders and Roger Johnson meet frequently with Fourth District Congresswoman Betty McCollum to discuss health care issues.

The Journal of the Hennepin and Ramsey Medical Societies

to our collection in the future. Hopefully we will also continue to travel as we have many places in the world we wish to see and to experience.

The photography collection will grow with each trip. Having more time in the future will allow me to become more skilled with watercolors and for building a new model train layout.

We know you like to travel. What has been your favorite travel experience?

Barbara and I have traveled to many very interesting places, but my favorite trip began in late December of 2005 and took us to South Africa, Zambia, Botswana, and to Namibia from where we returned in early January of 2006. We flew in small planes and traveled across country in 4x4 vehicles viewing wild animals, exotic birds, and vegetation of all types. We lived in the bush as well as in five star lodges. The sunrises and sunsets alone were worth the trip and we hope to return to Africa again.

Once you have seen the leopard, the crocodile, the cheetah, the rhino, the hippo, the elephant, and the cape buffalo in Africa you develop this strong desire to go back to see them again.

For the record, I wish to thank all the physician members of RMS and the MMA with whom I have had the pleasure to work with over the past 28 years. Your commitment to the profession and to your patients has always amazed me. I wish I could name all of you but I am certain our editors do not have enough column inches for me to use.

No person who heads an organization can achieve anything without dedicated and hard working staff. My personal gratitude and thanks go to Doreen Hines whose dedicated service to RMS now extends beyond 25 years. Katie Anderson has been a terrific addition to the staff and I appreciate her daily dedication and cheerful can-do attitude. Sue Schettle will be an excellent successor to me as RMS CEO and I wish her all the best as she takes over in June.

I also wish to thank my colleagues Jack Davis, Nancy Bauer, Kathy Dittmer and Jennifer Anderson at HMS for all of the friendship and support they have provided as well as their collaboration on numerous joint projects over the years.

Thanks also go to the many staff members at the MMA who I have had the pleasure to work with, especially George Lohmer, who began his career in organized medicine a few months earlier than I did in 1978.

I owe a great big thank you to my wife, Barbara, for her love and support the past 12 years. Her understanding of early morning, evening, and weekend meetings as well as telephone calls at any Roger and Barbara Johnson hour of the day or night made my are pictured in Delhi, India in November, 2006 at a wedding. life much easier and more enjoy- Barbara is wearing her sari and Roger is wearing a jodhpur. able.

May/June 2007

5

Introducing the Carlson School’s Medical Industry Leadership Institute

T

THE U.S. HEALTH CARE SYSTEM again approaches a crossroads. Every generation or two since World War I (i.e., 1919, 1935, 1948, 1965, 1974, 1993) the nation has conducted a debate on the merits of some form of a universal coverage health insurance program. In this nearly 90-year national didactic exchange, stakeholders from what now constitutes a two trillion dollar industry in the United States make incremental changes but never take on the entire challenge of universal coverage that could reform the entire health care system.

In Minnesota, the discussion is just beginning about a state mandate for universal coverage and the financial proposals to make it feasible. In Massachusetts and California, where legislation has passed to cover nearly all citizens of the states, those looking for a national solution see these as possible interstate exports. However, a common expectation of universal coverage is a reduction in the growth rate of health care expenditures. This change will prevent public and private programs from facing the onslaught of financial pressures in the long term as Medicare and Medicaid are projected to crowd out all other government expenditures.

The Carlson School of Management at the University of Minnesota recently launched the Medical Industry Leadership Institute. The aims of this Institute are to: 1) shape the future of the medical industry; and 2) drive innovation through education and research. A casual observer might pause to ask: what do they mean “medical industry”? Given the audacity of these two aims, should the third aim of this Institute be “world peace”? And, why should a business school be concerned with universal

BY STEPHEN T. PARENTE, PH.D.

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May/June 2007

coverage and the rate of health care expenditures?

The medical industry refers to the two trillion dollar enterprise that encompasses the entire U.S. health care “system” including medical device, pharmaceuticals, biotechnology, insurance, and the delivery of care. The term medical is used instead of health care to denote the central role of the medical practitioner in this industry. Earl Bakken’s pathbreaking technologies that led to the creation of Medtronic were as much a product of medical expertise as engineering.

The aims of this Institute are to: 1) shape the future of the medical industry; and 2) drive innovation through education and research.

The objectives of the Institute are purposely audacious to inspire courageous entrepreneurs, clinicians, scientists, venture capitalists and students to keep their eye on the prize — monetary and societal reward. A subtext is that to be successful toward affecting positive societal change, you need to take a holistic view of the medical industry and realize just how interconnected it is. Even today, students and business leaders talk about the public sector expenditures of the medical industry as the root cause of pending government bankruptcy as well as the economic growth

MetroDoctors

engine of the state. Which is it? In Minnesota and elsewhere one person’s curse of a medical arms race is another medical innovator’s payday. Are both perspectives wrong? Perhaps it requires something not yet invented — a time machine — to know if half the capital fueling the medical arms race provides the critical future capital investment for life and cost saving breakthroughs in diabetes, cancer, heart disease and mental health.

So why is a business school concerned about universal coverage? The unique departments of the Carlson School include accounting, finance, marketing, strategy, human resources, operations and information systems. The graduates of this and other business schools are the executives, general managers, investors, sales force and operations experts that directly and indirectly manage the entire medical care supply chain using these core business skills. The supply chain paradigm is invoked to juxtapose a template of how nonmedical industries operate in the 21st century with every step of the process from research lab to factory floor to retail store shelf or showroom mapped with managerial command and control. That may work when the raw material is steel, cotton, grain or silicon, but when the inputs are patients and provider knowledge and all the idiosyncratic factors in between, the supply chain paradigm bogs down.

To meet the universal coverage demand, it may be unreasonable to stem the growth rate now commonly desired. But when the fiscal imbalance occurs and the consequences are discussed, it is in terms of business. As a society, we buy more national debt. We force different prices on manufacturers. We borrow to pay for technologies that will achieve breakthroughs in quality of care and cost savings. Put simply, the moral case for universal coverage

The Journal of the Hennepin and Ramsey Medical Societies

has been available for years. The business case for universal coverage needs serious investigation and national discussion. If borrowing to pay for medical care today is an investment in a technological breakthrough tomorrow, let’s put that on the table now.

As a business school with a top-tier research faculty and a medical industry environment of truly national, if not global brands, the Carlson School’s development of a medical industry curriculum to complement traditional business disciplinary training is a natural venture. But it is more than that. Conservatively, Carlson graduates over 100 students a year with graduate degrees that go on to work in the medical industry. If we ignore the preparation and training of these students given their aforementioned future role in the industry, we could be accused of societal negligence.

To guide the long-term development of the Institute we formed a National Industry Council made up of representatives from the Mayo Clinic, Medtronic, UnitedHealth Group, PďŹ zer, Merck, McKinsey and Company, and McKesson. Listening to industry leaders in the Twin Cities and across the nation, we have developed a set of courses to start to deliver our aims including: 1) an overview course of the entire industry (similar to courses offered at almost every other school in the country); 2) a newly created course called “Physiology for Managersâ€? that is taught by a physician entrepreneur. We intend to give future managers in the industry a glimpse into a clinical perspective and to recognize, as Earl Bakken did years ago, that innovation between medicine and technology begins with a respectful relationship as the basis of a successful partnership; 3) a course on medical technology evaluation, where student projects are jointly conceived by the consensus of business leaders from UnitedHealth Group, Medtronic and the Mayo Clinic — a holistic representation of the industry. We also offer courses in medical device and public policy, the pharmaceutical industry and information technology in health care. We encourage students to take advantage of more than 30 related courses available throughout the University from the schools of medicine, public policy and public health as well as the College of Liberal Arts and programs in computer science and engineering. Finally, we are moving forward with

MetroDoctors

a set of executive education opportunities in the medical industry, some of which may be offered abroad.

As Carlson embarks on this new venture, we invite the medical community to engage with the school and to offer suggestions and support for new topics and forums for discussion. And, we welcome an exchange with the medical community to identify the strategies to make the medical industry ďŹ scally sustainable, socially responsible and driven toward long term improvements in societal health and well-being.

For more information on the Carlson School’s Medical Industry Leadership Institute, go to carlsonschool.umn.edu/mili.

Stephen T. Parente, Ph.D. is the director of the Medical Industry Leadership Institute and an associate professor in the Department of Finance at the Carlson School of Management, University of Minnesota. He specializes in health economics, health insurance, health information technology, and medical technology evaluation. He holds an appointment as adjunct faculty member at Johns Hopkins University.

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China’s Health Care System

I

Prologue In a six-year interval between visits, dramatic changes in technology, infrastructure, and consumer capitalism have taken place in China.

Modern high-rise buildings fill the larger cities of Beijing and Shanghai — rivaling modern U.S. cities — where years before, a sea of more than a hundred giant building cranes stood.

Where vintage bicycles once conveyed a majorBY RONNELL A. HANSEN, M.D.

ity of the workforce, new BMW’s, Mercedes’, and Audi’s congest the overtaxed roadways.

And massive projects continue. In near record time a huge workforce now constructs the new Olympic Village and the gargantuan “Bird’s Nest” main Olympic Stadium for a 2008 deadline, and the 1.5 mile long, 40 story tall, Three Gorges hydro-electric dam has been structurally completed, displacing more than 1.5 million from their historical family homes.

Dr. Ron Hansen standing on the Badaling section of the Great Wall of China.

THE DOCTORS MADE THE DIFFERENCE! “The physicians of Hennepin County really showed leadership when they fought for our smoke-free ordinance. That was citizen action of the highest order.

I hope physicians throughout Minnesota will get involved in their communities, speaking out and telling the truth about secondhand smoke.”

RT Rybak Mayor of Minneapolis

The MMA can help make your voice heard.

Contact Rebecca Thoman at 612/362-3752, rthoman@mnmed.org; or Eric Myers at 612/362-3756, emyers@mnmed.org.

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Changes seen span August 2000 through November 2006 — this most recent visit with members of the University of Minnesota’s Cardiology Department for the 17th Great Wall International Congress of Cardiology in Beijing. The meeting, in conjunction with China University in Hong Kong, focuses on cardiac medicine and technology, and is a rare opportunity. From the University of Minnesota Hospital, we should appreciate the organizational efforts of David Benditt, M.D., Professor of Medicine and Director of the UM Arrhythmia Center, and Fei Lu, M.D./ Ph.D., Assistant Professor of Cardiology, both of whom have worked many years cultivating unique and valuable opportunities for medicine in China. International venues allowing personal cultural and professional exchange are often eye-opening and opinion changing, and are not readily replaced by correspondence or conference calls, and as colleagues, we should appreciate these multi-disciplinary efforts of our academic medical community.

FOR PUBLIC HEALTH

Editor’s Note: An excellent example of the positive impact HMS and RMS physicians make on improving the health of our communities. Contact HMS at (612) 623-2893 or RMS at (612) 362-3799 to get involved in advocacy issues.

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May/June 2007

MetroDoctors

Basic Economics The scope of change in China in such a short time has been mind boggling. The New China The Journal of the Hennepin and Ramsey Medical Societies

is increasingly critical to the world economy with each passing year. As a visitor, examining the underpinnings of the social contract for health care delivery through the shine of economic progress can be difficult. Perhaps the most challenging and destabilizing force in the Chinese economy is that the gap between rich and poor (in particular between rural and urban areas) is still growing. Many economic observers suggest this disparity is threatening social stability. Although rural incomes grew slightly more than urban incomes in the first quarter of 2006, they are still only a third of urban salaries. Average annual rural incomes in 2005 rose 6.2 percent to RMB 3,255 ($406.31 U.S.) while average annual urban incomes, at RMB 10,493 ($1,309.82 US), rose 9.6 percent. Moreover, unlike urban residents, most rural residents do not receive subsidized health care or education, and only a small percentage participates in pension systems.

A primary economic reality is that most of the financial wealth in China is disproportionately distributed to perhaps 5 percent of the population — the truly wealthy being a very small fraction of those. A majority of Chinese live in rural regions of interior China, far from the modern metropolis and economic prosperity of select downtown areas we see advertised as tourist destinations. It is this vast majority of rural China one would be unlikely to “see” as a tourist. In order to better understand the differences between the current state of financial equity and medical care delivery and expectations in China versus the U.S., it is helpful to understand the structure and size of the lesser-served workforce.

can equate to 50 cents per hour, and there are few (if any) workplace protections and little (if no), medical coverage. Such workers are often paid late, and sometimes not at all — with half a year’s wages often near $400 U.S. Often, saved wages go to educating family children, with secondary education not free — estimating $1,300 U.S. annually. Construction is dangerous, with fatalities exceeded only by coal mining deaths — with 2,607 officially reported in 2005. Many workers, due to their undocumented status in the city, will rely on illegal clinics, which are cheap but unsanitary, and are run by unlicensed doctors. The mayor of Beijing, Wang Qishan, indicates the health resources of the city are overstretched in attempting to provide some services to the vast army of migrant workers constructing mammoth projects in that city.

In scope, currently Beijing has nearly 10,000 construction sites with 1.7 billion square feet under construction — an area exceeding three times the size of Manhattan.

Tour guides paint a broader picture of the health care and city economic infrastructure in China. They estimate income of comparably wealthy city inhabitants at near $300 U.S. per year for some rural workers, and $1,200 U.S. per year for city professionals. Estimates suggest that of 1.4 billion in China, 80 percent are rural farmers, with little economic opportunity.

Western China is noted to be very poor, with little in the way of schools, clothes, food and basic utilities. Twenty-five percent (at most) of the population may have some form of insurance — some of it by private companies, some of it from employers.

Working Migrant Population Rural migrant workers drive much of the relentless economic boom in China. Those building the Olympic infrastructure work 15 hours a day, or longer, seven days a week. They sleep often 12 to a small temporary wooden room, with no provided heat, in conditions that can reach subzero with freezing winds.

These workers risk uncompensated injuries which can threaten livelihood and health, and may go years without seeing their families depending upon the demands of the building project. There are an estimated 2 million such migrant workers from rural China — and they are a formidable health care crisis. Pay

Health Care Structure Chinese health care delivery has been described conceptually as having three tiers. So-called top tier is described as Western style, relatively modern, clean, and expensive private or University hospitals which are felt by the populace to provide rapid symptom related care.

Second tier is commonly government run or intermediate level hospitals, which tend to be overcrowded and less sophisticated in available infrastructure and technology. Some such hospitals have come under some legislative scrutiny as of late for (presumed unnecessary) over prescribing practices generating additional revenue for the facilities, and as a visitor we

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

The Beijing 2008 countdown clock stands prominently in Tiananmen Square awaiting the next Olympic Games.

are reminded that regional practices in some areas of Chinese government and business can remain less than transparent.

Lowest tier would be community/rural clinics, or traditional medicine, which may have little material and technology resources and may rely on traditional treatment methods (felt by many of the populace to have potential for slow complete cure). For most of the country, such third tier (or no health care) is all that is available.

The best possible scenario is being independently wealthy and going to a private pay-as-you-go facility. Relatively few fortunate Chinese (as Americans) have this as an option. A more realistic favorable position is to have employer provided insurance similar to Western concepts — however as a twist on the paradigm, co-payment for services may be on a sliding scale depending upon total cost of services and length of employment — and can vary from 10 – 90 percent of the total cost of services. Private insurance is also available — however this can cost upwards of $60 U.S. per month, with an average of $500 U.S. per year — unaffordable for a majority of working class Chinese. Antibiotics, are relatively inexpensive, at $2.50 per half dozen, and (Continued on page 10)

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9

China’s Health Care System (Continued from page 9)

prescriptions are not required for such medications. Per similar unregulated environments, this contributes to antibiotic resistance in the region.

Socioeconomic Barrier To Care At almost all facilities — care is contingent upon demonstrating definite ability to pay.

This is difficult for many Chinese given the economic disparity. Frequently, the uninsured must scramble to family members and neighbors to obtain funds for unexpected medical costs, with the severity or acuity of the condition typically not motivating whether the facility provides treatment. Any presumption as to right of medical care as we might consider in the U.S., is a less potent factor in the Chinese system, in which health care remains, for the moment, more of a commodity service.

Recently covered in the New York Times, at least 10 people were injured when police broke up a demonstration at Guang’an City No. 2 People’s Hospital, in Sichuan Province.

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.

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May/June 2007

Faculty members included: Seated from left: Alan K. Berger, M.D., FACC; David G. Benditt, M.D., FACC; Ronnell A. Hansen, M.D.; and Bogui Sun, M.D. Standing from left: Prof. Malcolm Underwood; Jianming Li, M.D., Ph.D.; Andrew J. Boyle, M.D., FACC; Prof.

Cheuk-Man Yu; Li Wang, Ph.D.; Fei Lü, M.D., Ph.D., FACC; Dr. Jeffrey WH Fung; Dening Liao, M.D.; Prof. Gabriel Yip; and Yigang Li, M.D.

Unrest reportedly erupted after a 3-year-old boy died in the hospital, where he had been taken for emergency treatment after ingesting pesticides. Reports conflicted about how much medical care he had received. A human rights group stated that essential medical care had been denied the boy until his grandfather could pay. The boy reportedly died after the grandfather left to raise money.

Historically, the Communist Party-controlled government once offered rudimentary medical care for nominal prices in the countryside. Now, however, hospitals largely fend for themselves since the expanding market economy of the 1990s. Many have ceased providing even emergency care for people who cannot pay hospital fees in cash before treatment. The problem is challenging and socially divisive, and to date, the Chinese government has provided relatively little funding for hospital care in poor areas. It has experimented with social insurance for people who do not work for major companies — including most of the 800 million classified as peasants, but a national plan has not been introduced.

Epilogue Although China appears an emerging economic giant, health care access and delivery remains problematic for a majority of the population.

The widening economic divide affects many areas of Chinese society, and the lack of access to health care is felt to contribute significantly to social instability. Coupled and compounded

MetroDoctors

with recent increasing social unrest protesting issues from land confiscation, environmental pollution, and official corruption — the future in China will be challenging indeed. In response, the Chinese government has promised to spend more on rural development, but residents still face weak or nonexistent public services and have regular disputes with local officials over a range of inequities. In perspective, it would be wise for the U.S. to continue to work on providing equitable health care to its own citizens — as the disparate alternative, regardless of GNP, may be perilous.

Ronnell A. Hansen, M.D. is a staff radiologist at St. Paul Radiology, P.A., noting a special interest in both body imaging and information technology for radiology departments.

Faculty Members Chinese University of Hong Kong (CUHK): Prof. Cheuk-Man Yu Prof. Malcolm Underwood Prof. Wynnie Lam Prof. Gabriel Yip Dr. Jeffrey WH Fung Changsheng Ma, M.D. University of Minnesota (UMN): David G. Benditt, M.D., FACC Alan K. Berger, M.D., FACC Andrew J. Boyle, M.D., FACC Ronnell A. Hansen, M.D. Jianming Li, M.D., Ph.D. Fei Lü, M.D., Ph.D., FACC

The Journal of the Hennepin and Ramsey Medical Societies

PHYSICIAN'S SOAP BOX

Is Obesity in the Legitimate Realm of Public Health?

“The natural progress of things is for liberty to yield and government to gain ground.” Thomas Jefferson

W

hen contagious diseases were a serious threat to the health of the general populace, co-coordinated public effort was necessary and justified to quash threats that everyone had in common. Diseases such as polio, diphtheria and tuberculosis were directly transmissible from person to person. Public programs of vaccination and enforced quarantines protected everyone from disease threats held in common.

Now that such threats are largely under control, the legitimate scope of public health has been reduced. In search of validation and increasing power, the definition of public health has been strained to encompass the private issue of obesity. Obesity is the consequence of our bodies’ storing more foodstuff than is burned. It is the result not of publicly transmitted microbial agents, but of the private choices we make of the type and amount of food that we eat and the physical efforts that we make in our daily lives. Public effort to control private problems will inevitably lead to loss of liberty.

Admittedly, weight gain is a difficult problem. Many among us are filled with angst, wrestling with the best way to eat less and move more. It is easy to condescend and disparage the efforts of those that cannot quite find the way that is best for them to do this. The public health aficionados glibly claim that they can manipulate people into svelte form with strategies that will apply to everyone whether we consent or not. Through sin taxes and public expense, we see government as the omnipotent solver of all problems.

Outside of government efforts, billions of dollars are spent on a multitude of various weight loss approaches and millions of people are experimenting with what will work for them. Why should we believe that government can provide “the way” for everyone?

Traditionally, free societies recognize that government should not be the arbiter or purveyor of “truth.” That is why we have freedom of speech and a free press. It is also why the government is barred from establishing a state religion. In a free and open society, good and bad ideas alike are allowed expression. Out of this chaos of expression, good ideas tend to be adopted and bad ideas dispensed with. None of us quite knows from where the good ideas will arise or what new ideas will replace them. Eight track tapes have succumbed to cassettes

BY LEE KURISKO, M.D., FRCPC

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

which have succumbed to CD’s which are succumbing to MP3 players. Nobody had the omniscience to predict this.

Given that there is so much confusion about how best to lose weight, why should we have faith in government as the arbiter of truth or the director of our choices? We don’t allow government a say on matters of the soul. Why should we allow it a voice on the issue of our waistline? For argument’s sake, suppose Dr. Atkins was right and the best way to lose weight is to reduce dietary carbohydrate. If this is the case, the government has promoted obesity with its carbohydratebased food pyramid. Furthermore, it is no secret that government is prey to special interests that sway public policy. It is also no secret that the government subsidizes food production. If corn producers can twist the arm of government into providing them with money, it is likely that they could manipulate them into favored status on the government’s supposedly impartial food pyramid. Some believe that the pervasiveness of cheap carbohydrate based foods has fueled the obesity problem. If the subsidized production of carbohydrate foods is even partially causal, government is a culprit in the problem. Can we trust it to have the necessary objectivity to help us?

Society is highly complex with a multitude of interacting forces.

Command and control centralized planning has been proven to be a failure in the ill-fated Soviet Union and yet American apparatchiks in the United States believe that they are the chosen ones that can compel our behavior for some vague greater good. Nanny statists believe that taxes should be used to dissuade us from eating sinful foods whether or not our individual waistlines can afford the occasional indulgence. Won’t taxation of fast food provide an insidious incentive for government favoritism of the junk food industry because of the steady stream of tax revenue that this could provide? Government then has the perverse motive of seeing that society does not move past its current fixation on unhealthy food.

Urban planners believe that they should combat urban sprawl with “smart growth” to decrease vehicle use and increase walking.

This is despite the fact that Reason Foundation has published data suggesting that urban sprawl and its concomitant large yards promotes active childhood play.1 The well intentioned in government make the mistake of believing that they can guide society’s path while ignoring (Continued on page 12)

May/June 2007

11

Soap Box (Continued from page 11)

the potential for unintended negative consequences. Urban planning with zoning ordinances that restrict land uses will invariably lead to price inflation for limited property types. Predictably this will lead to cries for further government intrusion to control prices. It would be impossible to foresee any and all potential unintended consequences.

The point is that it does not make sense to distort the economy on little more than a hunch that a policy may produce a net benefit.

The fact that urban sprawl exists is proof of the fact that people like their large homes and yards. The fact that the junk food industry thrives is proof that people like their Big Mac and fries. The fact that the average person watches 23 hours of television weekly is proof that they want to watch television more than they want to go to the gym.2 In a free society, we must respect the right of others to make their own choices even if they are not the choices that we would make ourselves.

To preserve our own autonomy, we must protect everyone’s autonomy.

Society is full of incorrigible busy bodies that believe they must alter people’s behavior for the simple reason that they don’t like it. It is morally legitimate to convince or persuade others to behave by different standards. It is not legitimate to legislate behavior changes utilizing the coercive force of government. The biblical rule of “live and let live” is incompatible with the paternalistic elitism of imposing our will on others. Since government has a monopoly on the use of force, the use of government to impose our will on others implies force will be used if they do not comply. The original meaning of liberty is that

we do not have the will of others imposed upon us. Liberty is very inconvenient for those paternalists that simply can’t stand the choices that others make.

Indeed, there are great consequences to overindulgence with caloric overkill, but the consequences of obesity and poor health are borne privately by those that don’t restrain themselves. A corollary of personal freedom is that we must accept personal responsibility.

The issue of our expanding waistlines goes far beyond how we will look in a bathing suit. It opens a Pandora’s box of issues such as the legitimate scope of government and whether or not in “The Land of the Free and the Home of the Brave” we will tolerate being manipulated by others under the guise of public health. Inevitably, there are those that respond that because health care is publicly funded, intrusion into people’s lives is justified to save costs. There is no free lunch. Those that want to provide for you inevitably will want to control you. Inherent in the Communist states that existed to “provide for all” was a total loss of personal autonomy. Perhaps we should heed Jefferson’s advice and rather than worry so much about the expansion of our waistlines, we should worry more about the expansion of government.

Lee Kurisko M.D., FRCPC, is with Consulting Radiologists Ltd. based in Minneapolis.

(Footnotes) 1) Balaker T., “Do Suburbs Make You Fat?”, Privatization Watch, Reason Foundation, Vol. 30 No. 2, p. 4, 2006.

2) American Time Use Survey www.bls.gov/tus/

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The Journal of the Hennepin and Ramsey Medical Societies

HSA and High Deductible Plan Impact on Practice Accounts Receivables

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RECENT INSURANCE and health plan prod-

uct trends include the increasing use of health savings accounts (HSAs) and/or high deductible coverage options. These coverage options have become a popular tool for employers to provide their employees and their dependents with a financial incentive to utilize health care services more appropriately.

The increased use of these types of products/plan options has resulted in potentially significant issues for practice accounts receivable management. These potential issues require heightened attention by all practices in order to ensure that their accounts receivables remain effectively managed.

Under HSA and high deductible plan designs, the patient still has insurance or health plan coverage in excess of a stated deductible. However, the employer and enrollee usually are responsible for funding an account designed specifically to pay for medical expenses under a deductible dollar threshold.

If there are unused funds remaining at the end of the benefit year, the enrollee is allowed to keep/reinvest these funds. Hence, the enrollee has a theoretical financial incentive to spend wisely and appropriately. The enrollee has very generous deferred funding options under many of these plan designs, allowing them to delay funding their accounts for up to 14 months or more. However, remember, the enrollee remains liable for the medical expenses they incur under the deductible level — regardless of whether they have appropriately funded their account.

Although practices may be tempted to immediately collect directly from the patient in these cases, a number of obstacles practically preclude this option. First, as previously stated,

BY STEVEN J. KNUTSON

MetroDoctors

most payer contractual arrangements will not permit immediate direct billing to the patient.

In fact, in Minnesota, such practices run contrary to state law if the product is part of an HMO. Second, the practice has no practical way of knowing the balance of the patient’s deductible. In such cases, the practice must wait to obtain this information from the payer’s EOB Statement or Remittance Advice. Third, most practices would not know the particular payer’s reimbursement rate for a given procedure or service. Rather, this information would normally be made available on the payer’s EOB or Remittance Advice.

Under typical contractual terms, reimbursement for the services will continue to be required to be submitted to the insurer/plan, and will be processed under the reimbursement provisions reflected in the contract. Usually, the practice’s patient accounting system will initially treat such a patient account as insurance-related, not patient responsibility. In fact, this is the accurate treatment for such an account.

For these types of claims, the payer (insurance, health plan, third party administrator) will return a Remittance Advice/EOB to your practice via electronic or mail transmittal. In many cases, this information will indicate that the payer owes nothing for the services; and that the patient is liable for the entire discounted balance because of unmet deductibles or HSA coverages. It is at this precise point where practices run the risk of not fully understanding the A/R data provided by their patient accounting systems.

In such cases, depending on the type of patient accounting system used by the practice, these outstanding receivables will appear to be insurance A/R, not patient A/R. Practices are somewhat used to carrying insurance A/R

The Journal of the Hennepin and Ramsey Medical Societies

greater than 60, or even 90 days; comfortable in the knowledge that appropriate payer follow-up will eventually result in collection of the outstanding account. But we also know that as a patient A/R ages beyond even 45 days, the likelihood of routine collection begins to drop considerably. Herein lies the very problem. Many of these types of claims may actually appear in the practice’s patient accounting system as insurance A/R; when in fact, they represent patient A/R. Most practices in our market have grown very accustomed to insurance payments and have not had to be very concerned with the processes necessary to collect patient balances. Cursory review of A/R reports provided by the patient accounting system may NOT highlight these types of claims or may unintentionally underreport the value of patient responsibility A/R. Some patient accounting systems attempt to avoid this problem by converting such payer accounts to patient accounts when informed by the payer that the balance is due directly from the patient. Although such approaches may make it easier to detect such accounts, this approach potentially complicates other reporting generated from the patient accounting system, including payer mix calculations or impacting contractual adjustments.

Collecting A/R on accounts associated with these types of products is further complicated by “assignment.” HSA plans do not universally include the assignment provisions we have become accustomed to under some traditional insurers/health plans. Instead, patients having coverage with these new products directly receive the funds available to cover the services rendered by the practice. It becomes the function of the practice (or their collection (Continued on page 14)

May/June 2007

13

A Call for Delegates

HSA and High Deductible Plan Impact (Continued from page 13)

If you are interested in serving as a Delegate, please contact us as soon as possible.

A Call for Resolutions Resolutions are due at the

Hennepin Medical Society Ramsey Medical Society No later than Friday, May 11 No later than Friday, May 11 Caucuses Will Be Held HMS Caucus

RMS Caucus

Wednesday, May 23, 2007 7:00 – 8:30 a.m.

Broadway Ridge Building (1/2 mile from our office)

Wednesday, May 23, 2007 Thursday, June 7, 2007 6:30 p.m.

Location to be determined

MMA Annual Meeting Thursday-Friday, September 20-21, 2007 Mankato, MN - Midwest Wireless Civic Center If you have any questions contact Kathy Dittmer Executive Assistant Hennepin Medical Society (612) 623-2885 kdittmer@metrodoctors.com

Sue Schettle Director Ramsey Medical Society (612) 623-2889 sschettle@metrodoctors.com

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May/June 2007

agency) to obtain the funds from the patient.

We all know from experience that this scenario generally represents increased risk for practice accounts receivable management.

Expanded use of these products has several implications for practice accounts receivable management processes. Perhaps most significant is the increased volume of claims processing that must be assumed by the practice’s patient accounting staff. As these products expand, the percentage of patient service billings that have to be submitted multiple times increases as well, further stressing an already high overhead function in the practice. Part of the rationale used by insurance and managed care to justify the level of discount negotiated, is that practices can benefit from streamlined claims payment procedures. These new products run completely contrary to this rationale.

Another implication is that patient accounting systems may underestimate the percentage of the practice services that are collected as insurance A/R vs. patient A/R. Such underestimation could impact several critical administrative functions in the practice. Finally, as the use of these new products expands, practices will have to adjust their traditional expectations for how long it takes to collect payment. Instead of a single, fairly uncomplicated claims submission to one primary payer (and perhaps to a secondary payer as well), now multiple submissions will have to occur; thereby further increasing the collection cycle, and negatively impacting practice cash flow.

We recommend that all practices become more acquainted with these new product trends, and review the way these patient accounts are handled by your practice patient accounting system and staff. Anticipating and understanding the impact of such patient accounts will ensure that your practice’s accounts receivables remain effectively managed.

Steven J. Knutson is a partner with ConsentiaHealth, Inc., serving the health care insustry by providing a variety of business and managed care services. He can be reached at (651) 247-6726.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Collection Challenges Ahead

W

WITH THE EMERGENCE of consumerdriven health care, physician practices are rethinking their process of scheduling, identifying insurance benefits and discussing payment issues with patients.

As Steven Knutson points out in his informative article on page 13 on the impact to groups of health savings accounts (HSAs) and high-deductible health plans (HDHPs), practices must overhaul their accounts receivables management system to reduce bad debt and prevent unnecessary financial losses.

Insurers are heavily promoting HSAs and HDHPs as a way to control health care costs.

Along with a catastrophic-type insurance plan, people get a tax-advantaged personal health account, sometimes with an employer contribution, from which they directly pay medical expenses.

Sounds good? To us, collecting patient bills just got harder.

There are steps we can take as practice managers to inform patients with HDHPs about their financial responsibility. There are changes we can make in the back-office to more efficiently process insurance claims. But we also need legislative fixes to help us manage HDHP claims and collect payments from HSAs within the existing insurance regulatory system.

Knutson points out quite correctly that state law prevents us from collecting directly from patients with HSAs and HDHPs. Providers first must bill the health plan, wait until the claim is adjudicated and the EOB is received before the patient responsibility portion may be billed and collected.

This could mean a patient with a $1,000 or $2,000 deductible left to pay would not be billed by the practice for 30 to 60 days, dependBY CANDACE SIMERSON

MetroDoctors

ing when the EOB is received. After 60 days, the patient’s incentive to pay the bill is greatly diminished because the medical issue has been resolved. And even if the patient understands the financial responsibility, the likelihood that the patient will be able to pay the balance right away is slim. The most likely scenario is that the patient will drag out payment. This means higher accounts receivables balances and additional administrative expense to go after these dollars.

More protection is needed for both the provider and consumer while waiting for the

There are steps we can take as practice managers to inform patients with HDHPs about their financial responsibility.

EOB to be generated. We would like legislation to give us the ability to immediately collect whatever deductible is outstanding. The result would be two very positive changes. One, the patient would be advised of out-of-pocket costs at the time of service. Two, the patient could choose whether or not to go ahead with the service.

If we really want the patient to have a stake in the game, making this change would connect the financial accountability to the decision-making process. It would also eliminate added collection costs and unnecessary

The Journal of the Hennepin and Ramsey Medical Societies

frustration for patients, physicians and health plans.

Knutson also is correct in writing that state law does not allow patients with HSAs to directly assign their outstanding medical bills to providers. This too can be changed by legislation.

Here’s how it should work. When a consumer with an HSA encumbers a health care expense they eventually receive a bill from a provider and submit it to their HSA manager.

Legislation would then allow the HSA manager to make direct payment to the health care provider.

Under current law and practice, HSA payments typically go to the employee. The employee submits the bill, collects and then decides whether to pay the practice. Some patients have underfunded their HSA so the money is not even there to pay medical bills.

Others view their HSA as a retirement fund and do not want to withdraw money to pay medical bills. Most eventually pay, but the process takes many weeks.

Already, however, many practices, including ours, are making changes to inform patients of their financial responsibility before services are rendered. Practices also are upgrading practice management systems.

In July 2005 we noticed that our percentage of uncollected bills of greater than 90 days jumped to 9 percent from 7percent. While bad debt did not increase, we decided to make several changes at our practice.

First, we designated an employee to check patients’ health plan eligibility and benefit levels prior to the appointment date. Patients with HSAs and HDHPs are contacted and advised of their out-of-pocket responsibility.

(Continued on page 16)

May/June 2007

15

Collection Challenges (Continued from page 15)

Any conversation with the patient is noted in their account ďŹ le within the billing system.

Practices may also want to consider developing a form that the patient would sign prior to the service, acknowledging ďŹ nancial responsibility. If we ďŹ nd an outstanding pa-

tient balance on the account, we can inform the patient and request payment at the next appointment.

Second, we began analyzing accounts receivable balances that are over 60 days instead of our prior practice of 90 days.

Third, we started offering ďŹ&#x201A;exible ďŹ nancing plans for patients with balances of $300 or more. These low-interest ďŹ nancing plans are

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May/June 2007

MetroDoctors

provided by an outside company. The practice is paid the net amount within seven days.

Patient education is a real key to success with consumer-driven health care. Do not make the mistake of assuming patients understand their health care coverage or the health care delivery system. Patients surprised by unexpected medical bills are not likely to pay immediately. They will be much more motivated to pay if they are advised of the costs in advance of any treatment.

On the topic of reimbursement, I do take issue with Knutson on his statement that â&#x20AC;&#x153;most practices would not know the particular payerâ&#x20AC;&#x2122;s reimbursement rate for a given procedure or service.â&#x20AC;? We know what payersâ&#x20AC;&#x2122; reimbursement rates are for any of our top procedures before they adjudicate the claim. We aggressively audit the payerâ&#x20AC;&#x2122;s EOB and ďŹ nd mistakes more often than one would expect.

I also donâ&#x20AC;&#x2122;t agree with Knutson on his assessment that when an insurance company returns an EOB indicating the patientâ&#x20AC;&#x2122;s deductible has not been met that our billing systems cannot account for this as a patient responsibility. Some older practice management systems may not have sophisticated abilities to distinguish charges without interfering with reports, but any relatively modern system should be able to do so.

Finally, I am also quite comfortable in saying that many practices diligently track insurance claims very closely to make sure bills are paid correctly between 30 to 45 days, and if they donâ&#x20AC;&#x2122;t, they should. Gone are the days when practices can afford to sit back and wait for insurance companies to pay accurately and in full.

As consumer-driven health care continues to evolve, patients will become savvy consumers.

It is important to continually monitor health care trends to prepare your practice for the future. As new trends evolve, adapt quickly and make the necessary changes to remain successful. This may involve creating new tools or implementing innovative ideas to address changing market demands and expectations.

Consider surveying your colleagues to see how others are coping with new health care trends.

Candace Simerson, is president and chief operating ofďŹ cer for Minnesota Eye Consultants, P.A., Minneapolis.

The Journal of the Hennepin and Ramsey Medical Societies

Healthy Kids are Better Learners Reaching Out to Help Children and Families in Need

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WHAT WOULD YOU DO if your child had a rash that wouldn’t go away? What if she needed immunizations or an athletic physical? What would you do if he ran out of medication for ADHD? If you are like the majority of Minnesotans, you would visit your primary care physician or pharmacy, present your insurance card, and your child would receive the care or medication that they need. But, what would you do if you did not have insurance and lacked the financial resources to pay for these services?

While none of these situations might be so dramatic to compel you to bring your child to an emergency center where care would be provided and the costs later written off as charity care, it is precisely this lack of access to basic primary care that thousands of children across the metro area face.

For the communities of Burnsville, Eagan and Savage, a new clinic opened in August of 2006 to help address these kinds of needs.

The Diamondhead Clinic provides basic primary care services for children and youth from birth through high school. Located in the Diamondhead Education Center of Independent School District 191, this community clinic is a collaboration involving the physicians and clinics of Park Nicollet Health Services, Park Nicollet Foundation, Burnsville-Eagan-Savage ISD 191, and Community Action Council of Dakota and Scott Counties. It is the third such clinic for children and youth operated

by Park Nicollet Clinic and supported by the Park Nicollet Foundation. The first, Central Clinic, opened in St. Louis Park in 1996 and was followed by the opening of Wayzata Community Clinic in 1999. These three clinics

BY CHRIS J. JOHNSON, M.D.

MetroDoctors

provide services at no charge to patients and families.

Each clinic developed from sustained relationships, built over several years, involving key partners from the school, community, clinic and foundation. “Through active dialogue with school, community and health leaders, it quickly becomes apparent what the needs are, and where in our current systems kids are falling through the cracks. Our mission is to connect resources to need,” says Mick Johnson, President of Park Nicollet Foundation.

Park Nicollet Clinics are actively involved in a number of Community Care Initiatives that have grown out of the “convening on need” process that Mr. Johnson describes. In addition to the three community clinics, 12 Park Nicollet Clinics work in collaboration with the school districts in their communities to provide same day facilitated access to clinic services for children in need. With a phone call from school nurses to clinic supervisors, scheduling and financial barriers are removed to ensure that the child receives care. This process of communication and facilitating access is relatively easy to establish, and often serves as the first step in gaining understanding of the scope of needs within the community.

The Journal of the Hennepin and Ramsey Medical Societies

Plans for the Diamondhead Clinic started as just such a collaboration between the Park Nicollet Clinic in Burnsville and the school district. After several years of working together to respond to health care needs for students including acute care, immunizations and athletic physicals, the opportunity to create space for a clinic in the Diamondhead Center opened up as the district considered plans for renovation and expansion of adjacent areas for early childhood programs. The school board approved the concept of the clinic in the spring of 2006, with final approval and construction beginning in early summer. The majority of construction and equipment costs for the clinic space were generously donated by contractors, tradesmen and vendors from the community.

Support for the remaining construction costs and ongoing operational expenses was provided through grants from the Foundation’s Healthy Community Fund, which is supported by donations from Park Nicollet physicians, staff, grateful patients and community members.

The Burnsville-Eagan-Savage school district provides the space and utilities for the clinic to operate.

Development of the clinic was led by the vision that healthy kids are better learners, who will also have a positive identity, be more socially competent and realize the support of a caring community. The clinic’s mission is to improve the health of children by providing access to primary care without barriers in a confidential, compassionate and respectful manner.

Care in the clinic is provided by physicians and staff of Park Nicollet Health Services, as is administrative support. However, the clinic maintains its separate identity as a community collaboration through guidance from an (Continued on page 18)

May/June 2007

17

Healthy Kids (Continued from page 17)

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advisory group and maintenance of separate medical records.

Currently, the clinic is open two afternoons a week. During a typical afternoon eight-12 children are seen with needs ranging from well child visits, athletic physicals and immunizations, to treatment of common minor medical conditions. Age appropriate health education and counseling along with initial evaluation and recommendations regarding common mental health needs such as ADHD, depression and anxiety are also provided. When problems require diagnostics or consultation beyond the capabilities of the clinic, the staff works with the family and patient to arrange for the needed care at a Park Nicollet Clinic or with other medical providers in the community.

Any child within the Burnsville, Eagan and Savage communities is eligible to be seen at Diamondhead Clinic, even if they do have insurance. According to Mick Johnson, “When we opened the first community clinic in St. Louis Park 10 years ago, we spent a lot of time discussing if we should bill the health plans of those patients who did have insurance. The staff at the clinic clearly said “no.” It would cause more hassles than it would be worth, and create barriers to the type of care they wanted to offer. We decided these clinics were about the health of all children in the community, and not just those without insurance.”

While some patients seen at the clinic do not qualify for Minnesota’s state funded health care programs, others do and either are unaware of their eligibility or afraid to apply because of the documentation and immigration status of family members. At

MEDICAL OFFICE SPACE AVAILABLE Professional office building. Great freeway access, minutes north of downtown St. Paul. Ample parking. Near several hospitals.

Please call Pam, L.S. Black Constructors, Inc. (651) 774-8445.

Clinic staff (from left): Severa Kremer, CAC Family Support Worker; Mary Peterson, CMA; LeAnn Hutchison, M.D.; and Lee Qualley, receptionist.

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The clinic is located in the lower level of the Diamondhead Education Center.

the Diamondhead Clinic, a family support worker from Community Action Council is on-site whenever the clinic is open to assist patients and families in identifying eligibility for health care programs and other community resources.

Dr. LeAnn Hutchison is a family physician with the Park Nicollet Burnsville Clinic and medical director of Diamondhead Clinic.

She staffs the clinic two afternoons each week.

A few months ago a 15-year-old girl with severe depression came to the clinic. “After speaking with her and her mother, we facilitated her admission to an inpatient psychiatric unit. She went from being suicidal and very depressed, to a much brighter young woman with hope for her future,” says Dr. Hutchison.

Because the teen still lacks insurance coverage, she comes in regularly to the clinic for medication refills until her application for Medical Assistance becomes effective. Since she can’t afford her medications, the clinic provides her with a prescription voucher that she can use at the nearby Park Nicollet Pharmacy.

“We don’t try to become the patient’s medical home, especially since we are only open limited times during the week. We are always looking for ways to connect them with insurance and a regular clinic, but sometimes it just takes a long time, or isn’t possible. Then we do fulfill that role.”

Adds Hutchison, “This clinic makes my job exceptional. I think the children and families we serve appreciate that they aren’t totally forgotten in the system. We have a very caring staff that works to meet their needs. Sometimes it’s just nice to know that there is help available.”

Chris J. Johnson, M.D., a family medicine physician, is Medical Director of Development at Park Nicollet Foundation. He can be contacted at chris.johnson@parknicollet.com.

The Journal of the Hennepin and Ramsey Medical Societies

Wound Healing With New Technologies

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AS A PHYSICIAN and geriatrician my first

thought after reading the new wound care regulations, affectionately known in nursing homes as F314, was “There’s enough rope here to hang us all.” The new “regs” are the best written, most evidence-based, and comprehensive guidelines ever to come from the bureaucracy of CMS. These wonderful guidelines struck terror in my heart because they simply insisted on excellence and perfection in a care setting that is under-funded and over-regulated. More to the point, the assessment of wound causality and severity in long term care is still quite subjective. And the guardians of F314 (our state surveyors) tend to lean in the direction of fault finding demanded by the very nature of their task. So any open area, wound, skin tear, abrasion or rash can be interpreted as a failure of the nursing home staff and labeled as “actual harm.” These presumed failures are published on Web sites for public display. Public hangings still occur in this world.

Physicians are trained to provide perfect care in an imperfect world. How can we support the long term care of our frail and elderly patients with wounds to achieve better outcomes? There are several new and beneficial technologies that aid accurate diagnosis and promote cost effective wound healing. I hope the pressure to learn these techniques in long term care will help your practice in outpatient and inpatient settings as well.

Accurate Diagnosis Accurate diagnosis and attention to root causes of open areas is foundational. On site (nursing home or home) evaluation and management often identifies these root causes. Wound clinics are helpful in performing vascular asBY JOHN MIELKE, M.D., CMD

MetroDoctors

sessments in the lower extremities, debriding necrotic wounds, treating osteomyelitis and many other issues. They do not see the resident in the residential setting and these clinicians can miss key details. Examples: new ill fitting shoes, inadequate mattress/support surfaces, poor wheelchair positioning, non-compliant residents or families (repositioning times), use of geri-chairs (cause shearing injuries), injuries from inadequate dressings, and (reluctantly) inattentive staff. Failure to address the root causes will negate even the best wound care protocol or new technology. We need to have “boots on the ground” to really win this battle.

Open areas on the feet and lower legs are particularly prone to misdiagnosis or “non-diagnosis.” Peripheral vascular disease, venous stasis, diabetic neuropathy and vasculopathy are all potential offenders, in addition to pressure ulcers. Fortunately, the new regulations allow us to identify multiple causative factors. So the 80-year-old woman with a hip fracture, diabetes, and a new heal ulcer may have pressure, neuropathy and vascular disease contributing to the presence and slow healing of this lesion. We can now identify this as a vascular ulcer and avoid some of the blame associated with pressure ulcers.

The use of Doppler assessment for ankle brachial indexing (ABI) is an old and time consuming technology that is sometimes used in long term care to identify peripheral vascular disease. The test helps to diagnose and direct therapy for venous stasis disease. If the ABI is less than .8 (ankle/brachial systolic pressure) compression must be used cautiously.

Four layer compression dressings (ProforeTM) should not be used and ace bandages should be reapplied TID with assessment of skin integrity. ABI measurements of less than .5 indicate severe PVD and limit compression dressings.

The Journal of the Hennepin and Ramsey Medical Societies

A new device (PV 1000TM, Omron) uses four cuffs to simultaneously measure brachial and ankle pressures and assesses pulse wave forms. This gives accurate, reproducible ABI measurements and pulse wave velocity.

The procedure takes less than five minutes to perform and has high inter- and intra-observer correlation. Pulse wave velocity correlates closely to vascular rigidity providing another assessment of peripheral vascular disease. The classic case for use of pulse wave velocity is the long standing diabetic with obvious vascular lesions on the feet but with intact peripheral pulses. Increased pulse wave velocity indicating rigid calcified blood vessels will indicate the true nature of the vascular insufficiency in these patients.

New Modalities Gone are the days of heat lamps, MaaloxTM, Betadine and even wet-to-dry dressings. Moist wound healing is the foundational wound healing principle. Most dressing product lines now feature non-stick gauze (often used with Hydrogel), adhesive foam dressings, and hydrocolloid dressings designed to either absorb excess moisture or deliver moisture to dry wounds.

Protection from soiling with stool or urine is an important component of dressings around the perineum. Any additive that injures tissue may slow or stop a healing wound. Some of the “wound cleansers” have alcohol or other substrates that inhibit granulation tissue. The drying associated with wet-to-dry dressings is especially harmful to wound closure and they are not recommended. Nursing home staff are best trained to use one product line and learn to use it well. This saves money for the facility.

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Wound Healing (Continued from page 19)

We should prescribe generic dressings when possible.

Pulsed Electromagnetic Field (PEMF) therapy is a new modality in wound healing. PEMF has been used for years to treat non-union of fractures. In the course of treating tibial fractures investigators noted the improvement in edema, pain and healing of stasis ulcers in the PEMF treatment field.

This led to investigations of venous ulcer healing, demonstrating statistically and clinically significant healing rates.1 In the laboratory several potential mechanisms of action were demonstrated: fibroblast stimulation and multiplication, tissue growth factors, angiogenesis, attraction of neutrophils, and improved wound remodeling from increased collagen deposition.2 Mayrovitz3 concludes his review of pressure ulcer treatment with PEMF with this statement, “Based on available clinical data, it appears to this author that a strong, if not conclusive, case is made for a beneficial effect of electromagnetic therapy for pressure ulcers.” He also notes that the “National Pressure Ulcer Advisory Committee has included electrotherapy as an adjunctive therapy for pressure ulcers that have failed to heal by other means.”

PEMF is rapidly gaining acceptance as an important adjunct to the care of patients with chronic ulcers from pressure, diabetes, venous and arterial etiology. It is pain-free to patients, easy to apply and allows bandages to remain intact. The coil is simply placed against the skin and the machine delivers a 30 minute treatment of 27.12 MHz field to tissues up to 8 cm from the surface. It is delivered BID until closure and one week past healing (to enhance remodeling of the wound).

Personally, I was a true skeptic when introduced to this “latest fad of wound treatment.” However, a director of nursing who had used it elsewhere convinced me to review the basic science regarding electromagnetic effects on tissue, and use it clinically in one of my homes. There is strong clinical evidence that beneficial effects happen in chronic wounds in “real life patients.” My estimate after one and a half years of experience is at least 70 percent benefit with closure of 20

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wounds in approximately half the time. The treatment is easily taught, has no adverse side effects, allows dressings to remain intact, and does not require the patient activities to be limited.

Two specific cases demonstrated the striking clinical efficacy to me. An elder woman residing on a long-term care floor had extensive venous stasis ulcers on both legs that had been present for 29 months.

Application of PEMF resulted in steady improvement in the ulcers and reduction in the edema and pain in her legs. She completely healed after three months of treatment.

Another resident with advanced dementia developed a dorsal ulcer on her great toe at the PIP joint. It perforated into the joint space. Because of her advanced dementia no surgical treatment was advised. PEMF was used as a “last resort.” The toe is now closed, with intact competent skin over the joint space after several weeks of treatment.

Accurate diagnosis, immediate intervention in root causes, simple “moist wound healing” dressings, and new diagnostic and treatment technologies are improving the wound care of our nursing home patients.

There is also increasing evidence to suggest that all costs, as well as wound complications, are reduced when nursing home staffs have the training and the tools they need to promote wound healing.

John Mielke, M.D., CMD, graduated from the University of Minnesota Medical School and the internal medicine residency at Abbott Northwestern Hospital where he served on staff for five years until joining Aspen Medical Group in 1988. He now practices full time in the long-term care setting with AspenCare nurse practitioners.

Footnotes: 1) Stiller, M.I.; Pak, Grace H.; Shupack, J.l.; Thaler, S.; Kenny, Clare; and Jondreau, Lorrie.

A portable pulsed electromagnetic field (PEMF) device to enhance healing of recalcitrant venous ulcers: A double-blind, placebo-controlled clinical trial. British Journal of Dermatology (127) 147-154.

2) Harvey N. Mayrovitz, Ph.D., In: Bioelectromagnetic Medicine, 2004 ed. PJ Rosch, MS Markov, Decker, ISBN 0-8247-4700-3 Chapter 30 pp 461-483.

3) Ibid.

The Journal of the Hennepin and Ramsey Medical Societies

Editorial: Opting out of Insurance Provider Agreements

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MINNESOTA PHYSICIANS are addicted to health plan provider agreements. This addiction is rooted in a “Financial Anxiety Disorder,” which is not listed in the DSM1V or ICD9. We doctors ask our patients, “What is your insurance?” They ask us, “Do you take my insurance?” And when considering treatment options, consultations, and referrals, we ponder, “What will insurance pay, and which doctors or facilities are in your insurance provider network?” Charles Meyer, M.D., editor of Minnesota Medicine, eloquently described his frustration in finding a psychiatrist for his patient in his January 2007 editorial, “A Broken System.”1 Dr. Meyer had a patient in his clinic who needed psychiatric care, but because no outpatient psychiatrist was available to see him the patient ended up in the hospital after going to an ER. Dr. Meyer and his patient couldn’t find an accessible psychiatrist in the patient’s insurance provider network. Why is this?

I recall the scene in Shakespeare’s Hamlet when the prince recedes offstage with his father’s ominous ghost. The officers call out to warn him and one cries, “Something is rotten in the state of Denmark!”2 Well, something is rotten in the state of Minnesota when good physicians are obliged to subordinate our professional judgments to insurance companies that define the scope of our professional practices and options for patient referrals. Insurance provider agreements set the financial terms, define “medical necessity,” and pay doctors for compliance with the corporate financial goals. These arrangements create a conflict of interest when our patients’ need for care conflict with if doctors are to be paid and how much, usually after we have already provided a medical service.

I decided to get off the managed care treadmill in 2005.3 The four major health plans wanted 10-15 minute medication checks and to sign up as a subcontractor — they’d then crowd my schedule with “referrals” for medication checks. Even if I tried to perfume this arrangement, the prospects were bleak for my private practice. I came to see that a production model drives many Minnesota psychiatrists and other physicians who provide cognitive services. Under managed care, pay for psychiatrists, family medicine physicians and pediatricians is greatly enhanced by brief patient contacts, ordering diagnostics and lab tests, and referring to others. Yet, patients told me they wanted trust-building doctor-patient relationships. That is hard to do when

BY LEE H. BEECHER, M.D.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

one’s eyes are glued to a computer screen. Every authority on psychiatric services espouses knowing the patient and using the therapeutic alliance as an essential ingredient of care. In my experience as a teacher of primary care physicians, I know that “best practices” for family medicine, general internal medicine, and primary care pediatrics also require time and individual attention to the patient. When patients engage in their care, then the doctor can give them the benefits of his or her medical training and experience. Moreover, when I was a managed care medical director and studied psychiatric utilization claims, we found no evidence of over-utilization of mental health care by patients.

I also decided that insurance company “pay-for-performance” programs, based on compliance with disease-based treatment algorithms actually compromised my professional ethics. There is simply too much individual variation in psychiatric practice for insurance companies to pay for compliance with even the best of treatment guidelines and algorithms. I came to realize a decade ago when, as a managed care medical director, the mission of managed care was cost reduction, and only secondarily quality assurance and quality improvement. So, I decided not to bite the apple of insurance company incentives to practice in variance with professional standards.

Moreover, psychologists, marriage/family therapists, and alcohol/drug counselors are not “bad guys” who need to be controlled by insurance companies. How could a corporate business manager know how to measure the severity and complexity of my patients’ illnesses, describe “best patient care,” evaluate mental health teamwork, or predict care outcomes? Been there, done that.

Since opting out of insurance provider agreements in 2005, I provide staff and support to help my patients get the money they are due from their insurance plans. My professional clinical notes and correspondence document processes in care and progress, and I give my patients copies of my clinical notes after each visit. I strive to safeguard my patients’ privacy by obtaining their consent to release all information to third parties.

How do Minnesota health plan corporations maintain power over our profession? HMO law4 allows them to control use of and contract for the benefits they insure. Having a financial interest in

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Editorial (Continued from page 21)

reducing payments for health care and deciding payments to providers poses an essential conďŹ&#x201A;ict of interest for doctors. It is important to remember that a key function of Minnesota health plan insurance corporations is to ration employer or government agency sponsored beneďŹ ts by controlling patient access to care. This is the mission to which they ascribe. Similarly they are arbitrators of access to care for many Minnesota public sector patients in Medicaid, PMAP, MCHA, and MinnesotaCare programs.

Three huge corporations are an oligopsony, which controls most of the insurance market in Minnesota. These are Medica, Blue Cross and Blue Shield of Minnesota (BCBSM) and HealthPartners (HPI).

One, BCBSM, insures most out-state Minnesotans as well. With only a few insurers, a few large companies exert a disproportionate inďŹ&#x201A;uence on the Minnesota health care insurance market. Our patients need more insurance options. Doctors also have an option. We, as physicians, can stop contracting with the insurance corporations who now control health care delivery in Minnesota.

Employer and state agencies asking for bids from HMOs to service their clientele are concerned mainly about cost containment, but managed care corporations have failed to control premium costs.

Employers have become openly skeptical about the ability of these corporations to do their cost-containing business. When one factors in provider costs to obtain insurance payments, it is estimated that 20-40 percent of health care dollars now go to administrative fees for servicing the Minnesota managed care system. Many large corporations have elected to avoid the MCOs by self-insuring employee health care, but this is an option not as feasible for small ďŹ rms.

I came to realize that my practice, like the private sector business ďŹ rms who contract with Minnesota health plans, was addicted to health insurance contracts that were not in the best interests of patients. Moreover, the survival of my psychiatric practice was in doubt.

My psychiatric practice is small, and I received assurances from my patients that they wanted personal care at a fair price.

How many Minnesota physicians or large clinics are willing to forsake contracts with a managed care corporation if it would threaten a third or more of their income? Opting out of an insurance provider contract can jeopardize the very existence of any clinic. What I did in 2005 meant facing my ďŹ nancial anxiety disorder. Perhaps my decision, like other psychiatrists who have opted out of insurance provider agreements now in cash practices, was easier because psychiatry has been marginalized by managed care companies and their clients. Is psychiatry the canary in the coal mine for the practice of health care rationing by managed care companies?

The future of family medicine, pediatrics and general internal medicine is also in the grip of addiction to insurance provider agreements. The ďŹ nancial health of any medical practice doing cognitive work is now in jeopardy. If we shake our addiction to insurance provider agreements and think outside the box, we can dialog with our true customers, our patients. In America we have the ďŹ nancial resources to improve patientsâ&#x20AC;&#x2122; access to physicianâ&#x20AC;&#x2122;s care. But patients, not doctors, need to write the contracts with insurance companies. We can best work for our patients by giving up our addiction to insurance provider agreements.

Lee H. Beecher, M.D., is a psychiatrist in private practice in Saint Louis Park, MN. He is the immediate past-president of the Minnesota PhysicianPatient Alliance (www.physician-patient.org) and an adjunct professor of psychiatry at the University of Minnesota. He can be reached at: http: //doctor.medscape.com/LEEBEECHERMD. References: 1.) Charles Meyer, M.D., (Editorâ&#x20AC;&#x2122;s Note) A Broken System, Minnesota Medicine Volume 90, No. 1, January 2007.

2.) William Shakespeare [Hamlet (I, iv, 90)].

3.) Lee H. Beecher, M.D., Switching to a Cash Practice, Minnesota Physician, November 2006.

4.) HMO Act of 1973. US Code chapter 42 subch. XI 330e.

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The Journal of the Hennepin and Ramsey Medical Societies

Winter Medical Conference 2007 Excellent Speakers, Great Weather

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THE WINTER MEDICAL Conference 2007

was held at the Canto Del Sol Plaza Vallarta Resort in Puerto Vallarta, Mexico from March 4 to March 11, 2007. Twenty-five physicians, nurses, nurse practitioners and physician assistants participated in the CME program that was designed to provide the participant with the latest information regarding diagnosis and treatment used for the management of day-today medical problems when dealing with the aging patient.

Winter Medical Conference 2007 was held mornings on four days, ending around 1:00 allowing conference attendees to have lunch with spouses, friends, etc. and enjoy the afternoons. The theme this year was “Caring for the Aging Population” and the faculty included eight physicians who provided 20 hours of CME. Attendees were awarded 20 Category I credits toward the AMA Physician’s Recognition Award or 20 Prescribed credits by the American Academy of Family Physicians. The evaluations rate this conference high for the remarkable opportunity for multi-disciplinary topic discussion and interactive dialogue with a didactic format.

The faculty members again received excellent evaluations for their presentations by the participants. Dr. Stuart Cox, otolaryngologist with Midwest Ear, Nose & Throat Specialtists, spoke on “Presbycusis,” “The Aging Voice (Presbylaryngus)” and on “Rhinosinusitis.”

Dr. Charles E. Crutchfield, III, dermatologist with Crutchfield Dermatology, delivered two presentations that included “Dermatology for the Wise and Mature Population” and “Cosmetic Dermatology, Rejuvenating and Restoring Youthful Skin.”

Dr. Neil Dahlquist, neurologist with Capitol Neurology, presented updates on, “Parkinsons,” “Polyneuropathy” and “Acute MetroDoctors

Faculty (left to right): Himanshu Sharma, M.D., Nicholas Schneeman, M.D., Sushila Mohan, M.D., V. Stuart Cox, M.D., Neal Dahlquist, M.D. and Ronnell Hansen, M.D. Not pictured: Charles E. Crutchfield, III, M.D., and David Ridley, M.D.

sented on “Common Infections in the Nursing Home” and “Pre-Operative Evaluation.”

Located in the heart of the hotel zone and close to all the major attractions that Puerto Vallarta has to offer, the Canto Del Sol provided excellent conference facilities as well as many amenities for the physicians and their spouses and family members who accompanied them to the conference. Our group met Sunday evening for a welcoming reception in the Lobby Bar. Excellent dining was enjoyed by all at the Canto Del Sol all-inclusive resort as well as by those who ventured out to enjoy the cuisine at well-known Puerto Vallarta restaurants such as the Vista Grill up on the cliff overlooking the town.

Excursions in and around the Puerto Vallarta area proved to be almost limitless with whale watching, swimming with the dolphins, a city bus tour, and a day trip to the Sierra Madre Mountains among the most popular for members of the group. Others tried out the canopy tour, and snorkeling/beach boat trips.

It was a 20-minute walk to the Boardwalk/ downtown and with the always-perfect weather, many enjoyed this almost daily. This conference proved no different than past conferences in that all the attendees enjoyed the collegiality and spending time visiting at the conference, during lunch, around the pool or even at dinner some evenings.

Ischemic Stroke.” Dr. Ronnell A. Hansen, radiologist with Saint Paul Radiology, also made two presentations: “Vascular Disease in Elderly Imaging” and “Options for Degenerative Disease & Pain Control in Elderly Patients.” Dr. Sushila Mohan, adult and geriatric psychiatrist with Associated Clinic of Psychology, spoke on “Geriatric Depression” and “Dementia with Behavioral Issues.” Dr. David Ridley, rheumatologist with St. Paul Rheumatology, provided an interactive presentation on “Case Studies in Rheumatoid Arthritis.”

Dr. Nicholas Schneeman, family medicine/geriatrics, Director of Department of Geriatric Services, North Clinic, delivered three presentations that included “Beyond DNR/DNI, Planning for an Acute Illness,” “Common Mishaps in Nursing Home Care (Doc, don’t just do something, stand there)” and “A Rock and a Hard Place: Where is the Transitional Care Patient Caught?” Dr. Himanshu Sharma, family medicine/geriatrics, United Conference attendees participating in one of the Family Practice Center, pre- presentations.

The Journal of the Hennepin and Ramsey Medical Societies

May/June 2007

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HMS and RMS Boards Meet Jointly

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THE HENNEPIN Medical Society and Ramsey Medical Society Boards of Directors held their annual joint meeting on Tuesday, March 27, 2007. Presentations on the activities of the Minnesota legislature were made by Ted Grindal, J.D., Lockridge Grindal Nauen, P.L.L.P., Dave Renner, Director, State and Federal Legislation, MMA, and Dawn Lunde, HMS Board Representative from the Minnesota Medical Group Management Association.

Specific mention was made of the priorities for MMA, HMS, RMS and MMGMA, including Health Care Reform, Cover All Kids legislation, Health Care Access Fund, language

interpreters, high tech imaging, workers compensation, price transparency, and the Freedom to Breathe Act. Other presentations included an update

by Peter Dehnel, M.D. on MinnesotaCare and how expanding the MinnesotaCare model could have negative consequences for primary care physicians. According to Dr. Dehnel, primary care physicians will be affected negatively and alienated if the legislature adopts legislation to expand MinnesotaCare to cover more children without adjusting the reimbursement levels to actually pay for the care that is to be delivered. The only option they will have if they wish to keep their doors open is to seek ways to reduce their participation in programs that cover children through MinnesotaCare (such as UCare). This will adversely affect patients’

Ted Grindal, J.D., Lockridge Grindal Nauen, P.L.L.P., and Dave Renner, Director, State and Federal Legislation, MMA, present an overview of the legislative activities.

access to health care services. The children will be in a position similar to dental services now — insurance on paper but no one to see them. Also discussed was an ophthalmology scope of practice issue brought forward by Drs. Lauren Baker and Scott Uttley.

HMS and RMS Board members gather for a joint meeting.

Peter Dehnel, M.D. provided an update on MinnesotaCare and its impact on pediatricians.

Members in the News VICTOR CORBETT, M.D. was a co-recipient of the 2006 Service to Humanity Award given by the United Hospital Foundation. This award is presented annually to a physician and a community member for their selfless dedication in improving the health and welfare of St. Paul and the surrounding communities.

ment Conference in Chicago. The national award, which honors a pioneering obstetrician-gynecologist, is presented biennially to a physician who demonstrates a deep compassion to those who experience pregnancy loss or infant death and who makes a difference in the community.

LAURA DEAN, M.D., an obstetrician-gynecologist with Stillwater Medical Group, was recently awarded the Dr. Joseph E. Graham and Family Outstanding Physician Award at the 15th Annual National Perinatal Bereave-

THEODORE THOMPSON, M.D., director of clinical education for the University of Minnesota Medical School, recently received the President’s Award for Outstanding Service. Dr. Thompson was honored for his accomplish-

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ments in education, rural health delivery, and developing the university’s Newborn Intensive Care Unit.

JACK TITUS, M.D., Ph.D. has received the annual John J. Anduhar Citation of Merit Award from the Texas Society of Pathologists.

This award recognizes distinguished service and teaching excellence among pathologists.

Dr. Titus is retired, but continues to serve as senior consultant to the Jesse E. Edwards Registry of Cardiovascular Disease.

The Journal of the Hennepin and Ramsey Medical Societies

PRESIDENT’S MESSAGE V. STUART COX, M.D.

A Medical Catch 22 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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Symposium focused on geriatric care. There was a thorough review of many specialty aspects, as well as discussion of the unique challenges of caring for the elderly population.

One of the speakers, Dr. Nick Schneeman, a family practice doctor who cares for the elderly, I found particularly interesting. He focused on end-of-life care, especially for those who suffer from dementia. His first argument was that much of our “pathway medical care,” practiced in the ER’s and hospitals, and to a lesser degree in the nursing homes and clinics, may not be appropriate in this population.

These pathways can often lead to medical catch 22’s that the patient and their family members would never choose.

He proposed that the first step in curing this situation and avoiding pathway disasters is to listen to the patient’s stories and, through this, understand their goals for treatment.

Then, take the time to dialogue with the family and care givers about what they want as well as what they don’t. A living will is a legal document, and if it is written with only a lawyer

and not a physician there will be gaping holes in it. Strengthening of the medical home, the relationship between the physician and patient, will lead not only to better care, but more efficient and appropriate care, especially in the elderly population.

The second challenge was for physicians to be more involved and available. “Shift medicine” may be easier and healthier for physicians, but our patients may suffer because of it.

We need to be creative in how we address this, and communication between physicians is key.

This model of health care is “old fashioned.”

At the center of it is the patient/physician relationship. We need to take back medicine from the businessmen, but the only way we will be able to do it is in concert with those we serve.

Organized medicine is here for us, and we need to continue to use it as a forum and a tool to improve medical care for our community.

Celebrate the Retirement of A L ROGER JOHNSON, RMS CEO L at the

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B O A R D

The Journal of the Hennepin and Ramsey Medical Societies

Jackson Street Roundhouse Museum 193 E. Pennsylvania Ave., St. Paul, MN 55101

Sunday, June 3, 2007 1 p.m. - 4 p.m. • Open House Check www.metrodoctors.com for further information.

May/June 2007

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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

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THE RAMSEY MEDICAL Society Winter

2007 Caring Hearts for Homeless People Supply Drive Thank you to the clinic managers, staff, and physicians of the following clinics that participated:

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ointly sponsored by Ramsey Medical Society Foundation and HealthEast Care System, the 15th annual “Caring Hearts for Homeless People,” supply drive collected personal hygiene and related items for St. Paul programs that offer services to homeless people. In addition to area clinics and HealthEast’s staff, faith congregations and area schools participated in the drive. The drive was held from February 1 through February 26, 2007.

In 2006 we collected 4,738 lbs. of donated items with an estimated value of $52,540. This year, 13 medical clinics, 25 churches, HealthEast Care System, and many volunteers from the former Ramsey Medical Society Alliance, St. Thomas Academy, Visitation, Shepherd of the Valley Church and Scandia Elementary pitched in to collect and sort over (4,560 lbs.) $56,295 worth of hygiene and medical supplies.

Supplies are distributed to Health Care for the Homeless, Listening House of St. Paul and SafeZone. In addition, over $7,000 in cash contributions was collected. These organizations rely heavily on donated medications, hygiene supplies, toys, juice and monetary donations to help meet the physical, emotional and mental health needs of their clients. This drive contributes the majority of supplies needed for the entire year.

Carole Nimlos coordinated the activities of the former RMS Alliance members who donated their time by picking up the donations from the 13 participating medical clinics and delivering items to our main drop-off site at St. Joseph’s Hospital.

Please watch for the 2008 supply drive to be held throughout the month of February.

• • • •

• • Summary of the 2007 Collection

May/June 2007

•

Approx. pounds

Approx. value

Medication

572

$17,267

Health, hygiene and baby products

3,377

$23,277

Miscellaneous

611

$8,079

Cash donations

NA

$7,312

TOTALS

4,560

$56,295

Item

• • • •

Summary of the Collection Totals for 11 Years $70,000 $63,476

$60,000

$56,295 $54,670

$52,540

$50,000 $46,670

$45,704

$40,000 $37,337 $30,813

$30,000

$29,310

$19,335

$20,000 $10,142

$10,000 $0 1997

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• •

Many volunteers begin the process of sorting donated items.

Advanced Skin Care Institute Allina Medical Clinic – Shoreview Aspen Medical Group – Highland Associated Nephrology Consultants, P.A. Hamm Memorial Psychiatric Clinic Minnesota Medical Joint Services Organization (MMA, HMS, RMS) NOW Care Medical Center, Eagan Partners Obstetrics and Gynecology, P.A. Physicians Neck & Back Clinic, P.A. – Roseville St. Croix Orthopaedics, P.A. St. Paul Eye Clinic, P.A. St. Paul Infectious Disease Associates, Ltd. University Affiliated Family Physicians – Phalen Village Clinic

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MetroDoctors

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The Journal of the Hennepin and Ramsey Medical Societies

Update on Smoke-Free Washington County the Woodwinds Health Campus in Woodbury.

Woodwinds and Lakeview Hospital in Stillwater have signed on to be key partners in the smoke-free project in addition to the Stillwater Medical Group and the High Pointe Surgery Center in Lake Elmo.

Stay tuned for more information about the Smoke-Free Washington County project and ways that you can become directly involved. If you have specific questions, please call Cynthia Piette at (651) 439-3096.

Update on Dakota County Smoke-Free Communities Partnership

RMS welcomes these new members to the Society. Schools listed indicate the institution where the medical degree was received.

Active Jin-Young Han, M.D. University of Southern California Pediatrics/Pediatric Infectious Diseases University of Minnesota Physicians Mengnai Li, M.D., Ph.D. Peking University Medical School Orthopedic Surgery/Pediatric Orthopedic Surgery University of Minnesota Physicians Medical Students (University of Minnesota)

A PROJECT OF RAMSEY Medical Society,

restaurants and bars if the statewide smoking ban doesn’t succeed in 2007. Julie and Diane have also been recruiting a large base of supporters and organizations to join the effort.

So far, the coalition for the entire county has recruited 29 supporting organizations and over 560 supporters.

If you live in Dakota County and/or practice in Dakota County, please consider being involved with the Dakota Partnership as a spokesperson, physician educator, and/or helping to recruit volunteers to promote a smoke-free Dakota County. Also please consider recruiting your organization to become involved as a supporting organization. You can contact the Partnership at (651) 7890036 and also sign up through the Web site at www.smokefreedakota.org.

DCSFCP is located at Midwest ENT Specialists in Eagan.

the Dakota County Smoke-Free Communities Partnership (DCSFCP) is a broad-based coalition of health care professionals, organizations and citizens dedicated to educating the public about the dangers of secondhand smoke and the benefits of smoke-free workplace policies.

The mission of DCSFCP is a healthy community free from secondhand smoke and our goal is to enable people to exercise their right to breathe smoke-free air.

This project is in its second year and is being funded by ClearWay Minnesota (formerly MPAAT). The Coordinator, Julie Johnson, and the Community Organizer, Diane Tran, have been actively working in communities since June of 2006. They have completed three community assessments on the sociopolitical viability of advancing local smoke-free policies in Lakeville, Eagan and Mendota Heights. Diane has been organizing a core group of active community advocates in Eagan that meet each month to work toward the eventual goal of a local policy goal Julie Johnson, DCSFCP community organizer, and members of the of smoke-free Advisory Committee, discuss smoke-free strategies.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Thomas N. Kurvers James W. Lee Gregory S. Long Erin N. Louks Lauren K. Macafee Sarah A. McAvoy Laura E. Meyer Amelia R. Nelson Brent G. Nelson Mikal J. Nelson Anne M. O’Connor Catherine A. Pastorius Sara J. Polley Megan K. Raverty Kyle R. Schmitz Emily E. Sharpe Jonathan D. Shelver Daniel A. Skora Nicole J. Te Poel Jessica L. Tierney Erin P. Tracy Junior Tshibangu Nathan G. Waibel Jeffrey P. Willging Mia R. Wintheiser Molly Yang

May/June 2007

27

Ramsey Medical Society

THE RMS BASED Smoke-Free Washington County project is well underway with many community meetings happening and connections being made with various groups.

Cynthia Piette, grassroots organizer working on the project, has made some terrific progress in developing a broad-based grassroots network that will work in the end to help the efforts in targeted communities in Washington County.

The first Smoke-Free Washington County coalition meeting was held April 3, 2007 at

New Members

Board Receives Legislative Update

RMS Public Policy Council Looking for New Members

Ted Grindal, JD, from Lockridge, Grindal, Nauen, PLLP, provided the RMS Board of Directors with an update on the various legislative issues that he and his firm are monitoring on behalf of the RMS. The meeting of the RMS Board of Directors was held on February 20, 2007 at United Hospital.

The physicians of Ramsey Medical Society (RMS) have expressed an interest throughout the years in getting more directly involved with local and state political issues. One of the vehicles that we have available to interested physicians is to become part of the RMS Public Policy Council.

The Council is being co-chaired this year by two RMS physicians — Art Beisang, M.D. and Peter Boosalis, M.D. We are looking for additional members; so if you have an interest, please let us know.

The goal of the Public Policy Council is to review and comment on issues within local and state government, coordinate grassroots legislative activities, develop and recommend to the RMS Board of Directors new public policy programs, services and ventures for RMS, and to foster the development of a working relationship between physicians, legislators and other government officials.

Clockwise from top: Art Beisang, M.D., Ted Grindal, JD, Kimberly Viskocil, Carolyn Johnson, M.D., Jim Jordan, M.D., Bob Moravec, M.D., Scott Uttley, M.D., Jerome Perra, M.D., and Nick Meyer, M.D.

To learn more, please contact Sue Schettle, Director of RMS at (612) 623-2889, or e-mail her at sschettle@metrodoctors.com.

On April 13, 2007, Dr. Stuart Cox opened his home to physicians and others for the purposes of meeting and discussing health care legislation with Congresswoman Betty McCollum. The RMS Public Policy Council will work to schedule more of these types of interactions between physicians and elected officials in the coming months.

Join Us For A Call for Delegates If you are interested in serving as a Delegate, please contact us as soon as possible.

A Call for Resolutions Resolutions are due at the Ramsey Medical Society no later than Friday, May 11.

RMS Caucus Wednesday, May 23, 2007 6:30 p.m.

Thursday, June 7, 2007 6:30 p.m.

Location to be determined.

MMA Annual Meeting Thurs.-Fri., September 20-21, 2007 Mankato, MN If you have any questions contact Sue Schettle, director, at (612) 623-2889 or sschettle@metrodoctors.com

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The “Preakness” The jockeys are prepped. The excitement is growing. You can almost hear the pounding of the hoofs and they’re off...

Physician’s Derby Day Saturday, May 19, 2007 Canterbury Park We will have reserved seating in the Presidential Suite on the third floor. This is a VERY special opportunity.

Admission will include: Clubhouse admission, program, reserved seating in the Presidential Suite and lunch. Great Food and Great Fun! Special features will include: betting seminar, “Run for the Rose,” Named Race for the Group, Winners Circle Presentation, and time to chat with the trainers or jockeys. • We will also have a Hat Contest! • Children are Welcome!

Questions? Call Cathy DeCourcy at 651/455-0899 or Doreen Hines at 612/362-3705.

Check www.metrodoctors.com for registration form and full brochure!

Seating is Limited in the Presidential Suite, so please Register Early!

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

CHAIR’S REPORT PAUL A. KETTLER, M.D.

At the Core 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

MetroDoctors

I

IF YOU’VE NEVER HEARD the term “core measure” you will. The Center for Medicare and Medicaid Services (CMS) and the Joint Commission for Accreditation of Hospital Organizations (JCAHO) are jumping on the quality care bandwagon. They are defining and measuring best practices for common clinical conditions. The issue I have with “best practices” is they tend to be totally inclusive and may not accurately define quality care for the individual patient. Hospitals are now required by these credentialing organizations to report performance on predefined core measures.

The performance is publicly reported at a Web site (www.hospitalcompare.hhs.gov) for patients to compare hospitals of their choice.

CMS is also tying financial incentives for the public reporting of such data. In 2005, they distributed $8.85 million to the best performing hospitals that participated in the demonstration project.

The core measures defined by CMS and JCAHO are: Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), Community Acquired Pneumonia (CAP), and Surgical Site Infection. The Merriam Webster dictionary defines “core” as: a basic, essential, or enduring part. So who defines these basic and essential measures? Most of us would use evidence-based medicine when making these recommendations. Unfortunately, evidencebased medicine often has little to do with how we practice medicine; perhaps 15-20 percent of what we do is truly evidence based.

Many of these recommendations come from large retrospective studies and consensus statements. Some of it is just “feel good” medicine; it seems like the right thing to do even though there are no studies to support or refute it.

For example, drawing blood cultures are part of the core measures for the treatment of pneumonia. Retrospective and prospective studies are inconsistent and often find no mortality reduction, even with adjustment for severity of illness. It seems appropriate to recommend their use, but they are NOT a good benchmark for quality care based on the evidence. The assessment of oxygenation is also

The Journal of the Hennepin and Ramsey Medical Societies

part of the core measures for pneumonia care.

This would appear to be intuitive but there is no direct evidence to support doing this. Again, this is done by consensus.

Another example is the timing of antibiotics for pneumonia within the first four hours of presentation. Most studies support rapid antibiotic administration within eight hours, yet the standard is four hours based on the consensus standard set by CMS and JCAHO. There is one large retrospective study that shows a mortality difference of up to 15 percent in patients greater than 65 years in age who receive antibiotics within four hours.

However, currently we are measured on all patients regardless of age. Perhaps the standard should be to deliver antibiotics within four hours for patients over age 65, and within eight hours for all others. This is one pitfall when choosing core measures based on consensus statements. There may be unintended consequences such as administering antibiotics early and inappropriately because the work up was not yet completed (giving antibiotics for what was actually a diagnosis of heart failure).

These measurements will now be tied to payment incentives for hospitals and perhaps to individual physicians in the future. The pressure and necessity to do this is immense. Many of us realize this as we see the pay-for-performance movement gain momentum. We always need to strive and do better for our patients.

There is also a need to decrease practice variability and provide evidence-based medicine when it exists, thereby improving quality and cost. Pay-for-performance and having incentives for core measures are just two ways to help accomplish this. Is this the right way? Only time will tell. At the same time, we need to be responsible and intellectually honest realizing that “best practices” may not exist or are ever changing. This can be a good thing for our patients, but let’s all understand why we are doing this and what the limitations are…our patients certainly won’t.

May/June 2007

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Hennepin Medical Society

Chair Paul A. Kettler, M.D. President Anne M. Murray, M.D. President-elect Richard D. Schmidt, M.D. Secretary Edward P. Ehlinger, M.D. Treasurer Eric G. Christianson, M.D. Immediate Past Chair James A. Rohde, M.D.

HMS ALLIANCE NEWS ELEANOR GOODALL

We Can’t Stop the Waves, but We Can Learn to Surf

M

METAPHORICALLY SPEAKING, of course,

but I did want to grab your attention. I’m thinking about change — inexorable, pretty constant, and happening in spite of us, like the waves. Do we stand on the beach wringing our hands? Or, do we learn to surf?

There have been countless books and articles written about organizations and how they deal with change. Books on how to be change agents. Books on generational differences and how to appeal to these sub-groups of membership, or hoped-for membership. The AMA Alliance Leadership Development Conference has held many sessions on the changing needs of members. The Sotiles write and talk about medical marriages and how spouses grow and change, necessitating other compensatory changes within the marriage and individual spouses changing needs.

I’ve been part of much of this. Within the Alliance structure, I’ve read about change, listened to learned lecturers speak about change, discussed change and the changing needs of members, and so on. Yet, I feel as if I’m still standing on the beach watching the waves

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: Steve Risan, Florist Tonkadale Greenhouse

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May/June 2007

come in and wondering how to stop them.

We need to learn how to ride them!

We, of the Alliance, are not alone in our efforts. I read the other day where the AMA plans to spend at least $1.5 million on a new membership study.

So, I guess my questions are: How do we, at the local level, as members of the Hennepin Medical Society Alliance, get a handle on this?

Without spending $1.5 million, that is. Maybe we need to hash over what strategies and initiatives have been tried, what’s working, what needs to be changed. When we talk about the changing needs of Alliance members, do we know what the needs of current members are?

Are we asking the right questions? How do we give potential members a taste of how being part of the Alliance can enrich their own lives, as well as those of their fellow community residents, especially children? How do we answer the “what’s in it for me” question?

What makes the HMS Alliance, or any Alliance for that matter, such a great organization to be a part of? From your own personal perspective, give a few minutes thought as to why you join an organization. My perspective on joining the HMS Alliance was, initially, purely selfish. I had belonged to a Medical Auxiliary in North Dakota, where we lived in a small town about 115 miles from the nearest city where the meetings were held. I went to my first meeting primarily because it was in Grand Forks, and mainly as an excuse “to go shopping in the city.” Surprise! These auxiliarytype women I expected to meet turned out to be very neat people. The topic was legislative.

It was informative, meaty and interesting. I was learning new things. As a mom of small children in an even smaller town, this group was a godsend outlet. I was hooked! (And I did get to shop!) So, I began to attend on a regular basis. Then I guess I became busier with more kids and small town volunteer activities. Plus, I began working part-time. And I stopped going.

When we moved to the Twin Cities, both of us had new demanding jobs. We built the house and the farm. Got sheep, chickens, a goat and llama, some beehives. I was meeting MetroDoctors

myself coming and going let alone trying to find time to attend a meeting.

It seemed to happen suddenly. The kids were all gone, my job less demanding, the farm routine pretty smooth by now. And, I missed having friends. So, once again selfishly, I called up the medical societies, got information and went to my first meetings. Whoa! Not only were these folks not white gloves and tea parties, they were really active in promoting community health with kids and they appeared to be having a lot of fun doing it. I was hooked again.

I liked these new friends so much I joined both metro Alliances, Hennepin and Ramsey.

Over the past 10 or so years I’ve been heavily vested in the Alliance and loved every minute of it: The easy friendships and the camaraderie; the incredible energy, good will and good work that happens when a group functions well together; the programs and projects that help build healthier communities.

All of these are an important part of my life. I wouldn’t trade these associations for anything.

I cherish the friendships and support of the physician spouses I’m involved with.

So, for the 10–15 years I was absent from any involvement with the Alliance, was I part of a “drop-out” wave? How many others are there who became members, then became dropouts? How many spouses of physicians are there in the metro area who, even though we think we’ve tried to reach you, still know little or nothing about the Alliance and the pleasures of belonging to this organization? I encourage each of you, from a purely selfish, personal point of view, to give the Alliance a try. You might get hooked!

I know the statistics about organizational dropouts; confirmed non-members in anything thank you very much; and other trends in this area. We truly can’t stop this wave. But can we ask some questions, get some answers…and maybe learn to surf?

The Journal of the Hennepin and Ramsey Medical Societies

HMS NEWS

New Members HMS welcomes these new members to the Society.

Active Bryce A. Binstadt, M.D. University of Minnesota Physicians Pediatric Rheumatology

Crystal Dexter, M.D. Columbia Park Medical Group, PA Family Medicine Neal A. Foman, M.D. University of Minnesota Physicians Dermatology Margaret A. Happel, M.D. University of Minnesota Physicians Internal Medicine/Cardiology Daniel H. Kaplan, M.D. University of Minnesota Physicians Dermatology

A Call for Delegates If you are interested in serving as a Delegate, please contact us as soon as possible.

A Call for Resolutions Resolutions are due at the Hennepin Medical Society no later than Friday, May 11.

HMS Caucus Wednesday, May 23, 2007 7:00 – 8:30 a.m.

Broadway Ridge Building (1/2 mile from our office) MMA Annual Meeting Thurs.-Fri., September 20-21, 2007 Mankato, MN If you have any questions contact Kathy Dittmer, executive assistant, at (612) 623-2885 or kdittmer@metrodoctors.com

MetroDoctors

The Partnership for a Smoke-Free Scott County has recently been established and will provide leadership in mobilizing a community based coalition of organizations and individuals who will work toward the goal of achieving a comprehensive smoke-free policy in Scott County. We are committed to reducing secondhand smoke exposure through collaborative prevention, advocacy and community education efforts.

For the past six months, Jennifer Anderson, project coordinator, has been working in

Scott County assessing the political climate and building community relationships to provide a solid foundation for the group’s work. A coalition of local physicians and community members has been formed to educate and advocate for a comprehensive smoke-free policy.

Efforts will most likely be focused on Shakopee and Savage.

Summer outreach activities are being planned with an emphasis on building the grassroots coalition to include supportive residents and businesses within Scott County.

If you’re interested in becoming a member of the Partnership for a Smoke-Free Scott County, please contact Jennifer Anderson at (612) 5780981 or janderson@metrodoctors.com.

In Memoriam JAMES E. FINSTAD, M.D. died on February 7, at the age of 70. He graduated from the University of Wisconsin Medical School in Madison. Dr. Finstad enjoyed 39 years at Consulting Radiologists Limited. He joined HMS in 1971.

PETER POPADIUK, M.D. died on March 10 following a long illness. He was 87. He was born in Krynica, Poland, and received his medical degree from Medizinische Fakultaet der Universitaet Erlangen, Erlangen, Bayern. Dr. Popadiuk was a long time Obstetrician/Gynecologist in the Minneapolis area. He served as an officer in the U.S. Army and Army Reserves. Dr. Popadiuk joined HMS in 1957.

NATALIE GAIL RETAMOZA, M.D. died on March 19, 2007 at her home in Roseville.

She was 44. She graduated from the University of Washington School of Medicine in Seattle.

She also held a Master of Divinity degree from The American Baptist Seminary of the West.

Dr. Retamoza was a family physician who was passionate about the holistic nature of family medicine. She joined HMS in 1996.

The Journal of the Hennepin and Ramsey Medical Societies

FERNANDO TORRES, M.D. died on January 21 at the age of 82. He graduated from Faculdade de Medicina de la Universidade Nacional de Colombia, Bogota, Cundianmarca. Dr. Torres was a Professor Emeritus, Dept. of Neurology, University of Minnesota Medical School, and a former Honorary Consul of Colombia. He joined HMS in 1960.

AUDREY COLLEEN TRAUB, M.D. died on January 28. She was 57. She graduated from Washington University School of Medicine in St. Louis, Missouri, and completed a residency in general surgery at St. Paul-Ramsey Medical Center. Dr. Traub practiced with Multicare Associates in Fridley, and served on their Board of Directors.

She was on the medical staff of Unity Hospital, and was elected chief of staff. She also served on Unity Hospital’s Board of Governors. Dr. Traub also served as medical director of Mercy and Unity’s High Risk Breast Diagnostic Treatment Program and chair of the hospital’s breast cancer board. In 2002, she received the hospital’s highest physician honor, The William J. Carr Award. Dr. Traub joined HMS in 1981.

May/June 2007

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Hennepin Medical Society

Gary L. Bryant, M.D. University of Minnesota Physicians Internal Medicine/Rheumatology

Partnership for a Smoke-Free Scott County Update

HMS Recognizes Leaders in Service, Research and Innovation Historically, the Hennepin Medical Society has given out two awards annually to members of the medical and health care community. At the recent Board Retreat, a third award, First A Physician, was established. Below is a summary of each of the three awards. Please also visit our Web site at www.metrodoctors.com for a complete listing of recipients to date.

Charles Bolles Bolles-Rogers Award The late Mr. Charles Bolles Bolles-Rogers established this award, originally called the St. Barnabas Bowl, in 1951. Mr. Bolles-Rogers served on the St. Barnabas Hospital Board of Trustees and was President of that Board for many years.

Mr. Bolles-Rogers died in 1975 at the age of 91, but prior to his death, he made provision for this award to be funded in perpetuity.

The award is an engraved sterling silver Revere Bowl.

The criteria states that the award is to be given to a physician who, in the opinion of the members of the selection committee, by reason of his/her professional contribution on the basis of medical research, achievement or leadership, has become the outstanding physician of this and other years.

The Chiefs of Staff of the west metro area hospitals make nominations for the Charles Bolles Bolles-Rogers Award annually. The Hennepin Medical Society Board of Directors has the honor of selecting the recipient.

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May/June 2007

Shotwell Award The Shotwell Award was established by Metropolitan Medical Center in 1971 in recognition of the support and dedication of the Shotwell Family. The late Mr. and Mrs. James D. Shotwell established the Louise Shotwell Smith Leukemia Fund for research and the Louise Shotwell Smith and Grace R. Shotwell Nursing Scholarship Funds, of Metropolitan Medical Center. Their gifts to the hospital amounted to more than $670,000.

Wording on the plaque in the hospital lobby read: “The Shotwell Award, established in honor of Mr. and Mrs. James D. Shotwell for their contributions to the hospital, is presented yearly for a noteworthy effort in the field of health care.”

The criteria states: dedicated service to mankind; significant break-through in some form of research or, significant contribution to the field of medicine; and innovations and/or improvements in health care delivery, including health care physicians. The award is not limited to physicians or other professionals in the health care field, though, of course, such persons are likely candidates.

Upon the closing of Metropolitan-Mount Sinai Medical Center in 1991, the Hennepin Medical Society requested and received approval from Metropolitan-Mount Sinai Medical Center to assume responsibility for selecting the recipient of The Shotwell Award.

This award is a bronze copy of the sculpture entitled “Sprites” created by the late Paul Granlund. The original sculpture is located in the courtyard of the MetroDoctors

old hospital, currently owned by Hennepin County Medical Center.

Abbott Northwestern Hospital has generously provided funding for the Shotwell Award since 2003. A plaque recognizing all the award recipients resides in the Sister Kenney Lobby on the Abbott Northwestern campus.

First A Physician The “First A Physician” Award, established by the Hennepin Medical Society Board of Directors in 2007, recognizes a member of the Hennepin Medical Society who exemplifies the profession of medicine as a result of an outstanding contribution to community service, work on public policy issues, significant contribution to the governance and success of the Hennepin Medical Society, or other noteworthy volunteer service contributing to improving the practice of medicine or the health of the population.

The Hennepin Medical Society Board of Directors, or other member physicians, may nominate candidates for the award. The Executive Committee shall annually review the slate of nominees and select the recipient of the award.

The “First a Physician” Award will be presented at the Annual Meeting of the Hennepin Medical Society Board of Directors.

The criteria states: Only members of the Hennepin Medical Society are eligible; the individual must embody the humanitarian spirit of the award; and outstanding contributions for effective leadership, involvement in improving the public health, and/or policy or legislative advocacy resulting in a positive impact on the practice of medicine or a healthier community, either locally, nationally or internationally, will be considered.

The award recognition piece has yet to be commissioned.

The Journal of the Hennepin and Ramsey Medical Societies

Historic Colonial

The Legends

Great Location

Sophisticated Contemporary

Architectural Masterpiece

Offered for the 1st time in over 44 years. Featuring sweeping views of Kenwood Park, grand public rooms, updated kitchen and light filled solarium addition, private back yard, skyway to garage, elevator , driveway and all sidewalks protected by snowmelt system. 5 bedrooms, 5 baths. 1,499,000

Stunning golf course and pond views in this gorgeous custom home in the Legends.

Features include cherry floors, maple woodwork, birch cabinets and builtins, indoor lap pool, gourmet kitchen with granite and top of the line appliances and more. 5 bedrooms, 5 baths. 1,549,900

Wonderful family home set on private wooded 5.22 acres with pond.

New construction feel with vaulted ceilings, large kitchen, dinette, bright living room and den. Lower level family room and more.

Gorgeous yard. 5 bedrooms, 4 baths.

849,900

Exceptional estate set on a gracious lot overlooking Lake Minnetonka’s Lafayette Bay with 236’ of west facing lakeshore in Minnetonka Beach.

Features glorious bedroom suites, home theater, wine cellar, and incredible lake views. 5 bedrooms, 10 baths.

5,995,000

A refined new construction estate with stunning details reminiscent of the renowned architect, Robert A.M. Stern. Set on prestigious Park Lane with private views of Kenilworth Channel and Cedar Lake boasting a unique combination of today’s family environments with the superb refinement of a bygone era. 4 bedrooms, 4 baths. 4,200,000

Lake of the Isles Landmark Elegant mansion boasting superb views of the water, graceful and grand entertaining spaces, updated gourmet kitchen, beautiful original details and fabulous old world charm. A true masterpiece set on an idyllic park-like lot. 7 bedrooms, 8 baths. 3,995,000

Call: Bruce Birkeland

612-925-8405 www.brucebirkeland.com

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

Berry Coffee Service is a

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.

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.

Continuing Medical Education Quality Healthcare Education for 70 years Since our beginning in 1937, the Office of Continuing Medical Education has been committed to providing the highest quality educational activities for physicians and other healthcare professionals.

Our goal is to improve the health of the public through provision of local, regional, national and international educational programs and to share the excellence and innovation of the University of Minnesota Medical School.

Fall 2007 Conferences PRIMARY CARE Geriatric Trauma Summit September 6-8, 2007 Obstetrics, Gynecology and Women's Health October 1-2, 2007 Twin Cities Sports Medicine Conference October 5-6, 2007

Internal Medicine Review and Update October 10-12, 2007 Emerging Infections in Clinical Practice and Public Health November 8-9, 2007

SURGERY

ALSO OFFERED

Transplant Immunosuppression 2007: The Ongoing Search for Improvement October 17-20, 2007

E. T. Bell Fall Pathology Symposium November 2, 2007 Update in Critical Care Fall 2007 Psychiatry Review Fall 2007

Check Out Our Full Course Calendar www.cme.umn.edu Office of Continuing Medical Education 612-626-7600 or 1-800-776-8636 email: cme@umn.edu

Heart Failure: The Update November 16-17, 2007 Practical Dermatology for Primary Care Fall 2007 (Brainerd, MN area)

Pancreas Cancer: Innovative Diagnostics and Treatment Fall 2007 Borderline Personality Disorder - Clinical and Family Perspectives Fall 2007