2008novdec

Introducing Dr. Annie Tan Gynecologic Oncology Surgeon Joining the Gynecologic Surgery Practice of Minnesota Oncology Hematology, P.A. Office now open at: Coon Rapids Women’s Health Clinic 3960 Coon Rapids Blvd NW, Suite 101 Coon Rapids, Minnesota 55433 612-863-8585 for appointments

Annie Tan, MD, PhD z

Medical Degree and PhD in Pathobiology from the University of Minnesota

z

Residency in OB/GYN and Reproductive Sciences, University of California at San Francisco

z

Fellowship in Gynecologic Oncology at the University of Minnesota

z

Board eligible in Gynecologic Oncology and Obstetrics-Gynecology

“The combination of the advanced surgical skills possessed by our gynecologic oncologists, and the availability of the latest national collaborative clinical trials, which incorporate state of the art chemotherapy with aggressive surgery, assures every woman the greatest chance of survival no matter how complex her disease.

We pledge to match our clinical expertise with compassion, respect, and emotional support for each patient and her family.”

Minnesota Oncology’s GYN Oncology Surgery Team Cheryl L. Bailey, M.D. Matthew P. Boente, M.D. A. Catherine Casey, M.D. John E. Savage, M.D. Annie Tan, M.D.

CONTENTS VOLUME 10, NO. 6

2

NOVEMBER/DECEMBER 2008

Index to Advertisers Classified Ads

Page 4

3

Letters

4

ISAIAH: Fostering a Radical New Approach to Health Reform

By Jeanne F. Ayers, R.N., M.P.H., and Robert H. Scott, M.D.

8 10

2008 Minnesota Medical Association Annual Meeting Homeless and Health Care in Minnesota

By Helene Freint

12

FEATURE

Your Health Care Choices in November

By Roger K. Johnson

Page 21

16

Side-by-side Comparison of the Presidential Candidate’s Health Care Proposals

18

COLLEAGUE INTERVIEW

Donald M. Jacobs, M.D.

21

On the cover: An overview and side-by-side comparison of the Presidential candidate’s health care agendas.

Articles begins on page 12.

SPECIALTY UPDATE

Dermatology Isn’t What It Used to Be

By Phil M. Ecker, M.D., and Jaime L.W. Davis, M.D., FAAD

Page 8

22

Announcing a New Web Forum

32

Career Opportunities

WEB FORUM MetroDoctors Discussion Site Pages 22

MetroDoctors

The Journal of the East and West Metro Medical Societies

EAST METRO MEDICAL SOCIETY

24 25

President’s Message

26

EMMS Foundation Has Three New Board Members/Congresswoman McCollum Meets With Physicians and Staff/Annual Meeting

27

New Members

A Community Approach to Advance Care Planning—2nd Meeting Held

WEST METRO MEDICAL SOCIETY

28 29 30 31

President’s Report Sr. Physicians Association/In Memoriam New Members Alliance News November/December 2008

1

November/December Index to Advertisers

Classified Ads

Doctors MetroDoctors THE JOURNAL OF THE EAST AND WEST METRO MEDICAL SOCIETIES

Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines WMMS CEO Jack G. Davis EMMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the East and West Metro 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, East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

To promote their objectives and services, the East and West Metro 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 EMMS or WMMS. Send letters and other materials for consideration to MetroDoctors, East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.

MEDICAL/DENTAL OFFICE SPACE of 1,500/3,000 SF available in small professional building on busy intersection in Woodbury. Oral surgeon/pediatric dentist suites in building. Direct entrance into suite off of parking lot.

Great exterior signage. Call CRES, Inc. (651) 290-8892.

PHYSICIANS’ ATTORNEY: STEVEN H. JESSER, ATTORNEY AT LAW, P.C., (800) 424-0060, (847) 212-5620 (mobile), shj@sjesser.com, www.sjesser. com. Comprehensive physicians’ legal services, including practice sales and purchases, other contracting, employment, license/disciplinary problems.

Representing physicians since 1980.

Admitted to practice in MN-WI-ILNY-NE-TX-DC-GA. Initial telephone consultation, including evenings or weekends, without charge.

Advanced Skin Care Institute .......................... 5 Apple Valley Medical Clinic...........................32 Billing Buddies ...................................................23 Burnet Birkeland .................Inside Back Cover Classified Ads........................................................ 2 Crutchfield Dermatology.................................. 2 Family HealthServices Minnesota, P.A. ......32 Healthcare Billing Resources, Inc. ...............11 Hennepin County Medical Center........Insert Lockridge Grindal Nauen P.L.L.P. ................. 7 Medical Billing Professionals, LLC................ 7 Midwest Spine Institute .................................... 3 Minnesota Epilepsy Group, P.A...................... 6 Minnesota Physician Services, Inc. ...................

Outside Back Cover Minnesota Oncology Hematology, P.A. .........

Inside Front Cover The MMIC Group ...........................................15 Neurosurgical Associates, Ltd.............................

Inside Back Cover Thank You to the Advertisers .............................

Outside Back Cover Uptown Dermatology & Skin Spa, P.A. ....23 Weber Law Office ............................................... 5

Crutchfield Dermatology “Remarkable patient satisfaction from quality, service, convenience and excellent results” “Exceptional care for all skin problems” Charles E. Crutchfield III, M.D.

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com.

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

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

Board Certified Dermatologist

Psoriasis &

Acne Specialist

Your Patients will Look Good & Feel Great with Beautiful Skin www.CrutchfieldDermatology.com

2

November/December 2008

MetroDoctors

1185 Town Centre Drive Suite 101 Eagan, MN 55123

Appointments 651-209-3600 At your request, we have same day appointments available for your patients with acute skin care needs.

The Journal of the East and West Metro Medical Societies

LETTERS

HEALTH CARE FINANCING is at a crossroads,

and the debate about our future has often been framed by two opposite camps: the free market types and the single payer types. Realistically, neither side has all the answers. The article by Drs. Ehlinger and King (“What About Single Payer?”, July/Aug 2008) is thoughtful but unbalanced.

I find compelling the fact that at least 20 percent, perhaps 30 percent or more, of health care spending now goes into administration.

What a waste! We’d all like to see that decrease to 10-15 percent as might happen with a single payer, allowing the same total dollars to cover more people. But as a physician, I worry that that would come at the expense of quality, access, and service to patients.

I find the authors’ statements that Canadians like their health care system better than Americans, to be unbelievable. It’s probably the healthy Canadians who like their system, but not the sick. De facto rationing is a reality in Canadian and other national systems, and

Big solutions through small incisions

with a single payer in the U.S. rationing would absolutely be necessary. More health care decisions would be subject to prior authorizations and denials, resulting in more erosion of physicians’ and patients’ authority. It is naïve in the extreme to believe otherwise.

Governor Pawlenty has repeatedly used designated and scarce health care dollars to balance the general operating budget. Does anyone think that wouldn’t happen on a large scale if governments controlled all health care dollars?

Most of all, I disagree with the authors that the single payer would “negotiate” (their term) providers’ reimbursements. If you define that term the way CMS “negotiates,” forget about it. It’ll be take-it-or-leave-it. If you repeal anti-trust laws, then maybe providers could collaborate in a negotiation.

Not gonna happen.

Education provides a useful model. Public schools offer a basic benefit, private schools an option. Voting citizens are able to control the flow of education dollars for their local community, and education professionals then allocate the dollars according to their needs. In order for teachers (providers) to maintain their number and quality, they have to have real

negotiating power against the administration.

Health care providers don’t have any group leverage or legal ability to negotiate. Quality and access would surely suffer. The education model has the advantage of history, transparency, accountability, and checks and balances.

A single-payer health care system would not.

Already about 60 percent of health care is financed by public dollars, but because of unrealistically low payment rates, there is a huge amount of cost-shifting to private sources. Thus the real costs of providing care are somewhere in the middle. It would be very helpful to the “negotiations” to have real unit costs of care rather than make-believe numbers.

What to do? Instead of an “either-or” debate, we could be discussing a balanced approach, something like a guaranteed, government-funded basic benefit set for all Americans (with legally-protected negotiating rights for providers) supplemented by private-pay insurance on the open market. Let’s not permit the extremists on both sides to frame the debate.

Remember these truisms: The devil is in the details.

The truth is in the middle.

Beware of unintended consequences.

Richard J. Morris, M.D., Maple Grove, MN

Breakthroughs in spine surgery give patients new options for neck and back problems.

We offer comprehensive spine care and the latest in minimally invasive surgical procedures, including spinal fusions. Benefits include: · Minimal incisions · Faster recovery · Better outcomes We also offer pain management and rehabilitation as part of our comprehensive care. When it comes to neck and back care, we can help you find the right answer for your patients.

Midwest Spine Institute Physicians specializing in spinal diseases, injuries and deformities

Eight convenient locations 651-430-3800 www.midwestspineinstitute.com

A member of the Institute for Clinical Systems Improvement (www.icsi.org)

MetroDoctors

The Journal of the East and West Metro Medical Societies

November/December 2008

3

ISAIAH: Fostering a Radical New Approach to Health Reform You shall be called the repairer of the breach, the restorer of streets to dwell in.

Isaiah 58:12

T

he health system in the United States is a complex and rapidly changing system. Multiple attempts at reform have tried and failed to improve outcomes, improve access or control costs. By many measures of community health it appears that things are actually getting worse. To create true health reform, a radical new approach is required.

Health is much broader than just access to medical care and new technology. Health goes beyond illness care and the individual, personal responsibility paradigm that has dominated health policy making over the last 30 years. This approach is based upon a growing recognition that social, environmental, and political conditions serve as the underpinnings of individual and community health and must be incorporated into effective health reform efforts.

Because of the central importance of health in people’s lives and communities, ISAIAH, an organization of 90 plus local congregations, has taken on the issue of health and health equity as one of its major policy initiatives. ISAIAH has also embraced a syndemic approach to health reform which acknowledges that all aspects of community life, like transportation, education, housing, economic development, etc., have a profound impact on health and must be part of the discussions of overall health reform. ISAIAH has taken the perspective that health is not a commodity or a static state but a system of fragile and dynamic interactions among all aspects of the community.

By Jeanne F. Ayers, R.N., M.P.H.

4

November/December 2008

s

s

What is ISAIAH?

ISAIAH is an ecumenical, multi-ethnic, democratic and non-partisan congregation-based community organization in the Twin City metro and St. Cloud areas that was formed in 2000 through the merger of three faith-based organizations. The mission of ISAIAH is to promote racial and economic justice through intentional, intensive leadership development and collective, faith-based actions with the goal of effecting systemic change. Its 90 member congregations address large regional issues as well as local community issues. ISAIAH develops leaders who can work locally, regionally, statewide as well as nationally to achieve its goal of creating healthy communities. ISAIAH is affiliated with the Gamaliel Foundation, a network of over 55 organizations like ISAIAH in 20 states and South Africa. ISAIAH has extensive experience building coalitions and organizing for change in both leadership and supportive roles.

A few of the things ISAIAH has helped achieve include: s Building public support for “keeping the promise” to Minnesota schools that resulted in an increase of almost $800 million in education funding; s Securing $68 million for polluted site redevelopment in the core cities and MetroDoctors

s

s

suburbs, which has created over 10,000 living wage jobs while leveling the playing field between core cities and developing communities; Creating a community policing agreement with the St. Cloud Police Department that drew together the area’s communities of color to negotiate a plan to address racial profiling and other policing issues of concern; Helping pass stronger living wage ordinances in both Minneapolis and St. Paul; Creating the opportunity for community involvement in selecting the police chief in St. Paul; and Organizing grassroots support for continued funding for the Central Corridor Light Rail project and dedicated state funding for public transportation that resulted in appropriations that will grow to over $100 million/year allowing the opportunity to expand the metro bus system, build new transit way corridors linking all of the metro region, and provide a dedicated funding source for Greater Minnesota public transit.

ISAIAH’s Approach to Health Reform

Building upon the lessons and techniques learned in these efforts, ISAIAH has intentionally added health reform to its agenda.

In that effort, ISAIAH has adopted a lens of “what needs to be done to create health and health equity in Minnesota communities.”

The organization has convened thousands of people to name the values they want guiding their collective efforts to create health and health care reform. In church forums, public (Continued on page 6)

The Journal of the East and West Metro Medical Societies

Dear Colleagues, There is a public health physician in southern California who claims, with some degree of accuracy, that if you give him your ZIP code, he will give you your life expectancy. Crime, poverty, education levels, transportation are all factors in determining the nature of our health. The entire community pays the price for poor health. Allina Health System is recognizing this with their funding of a ďŹ ve-year project to study the impact of the community in its backyard, thus the “BackYard Project,â€? as well as the population living in New Ulm. The former is a very diverse, multiethnic, multicultural, lower economic area with much more dynamic, uid changes, while the latter is a more uniform culturally, ethnic group that is not as uid or variable. Each has their challenges.

When a systems approach is truly applied to health care delivery it becomes clear that the responsibility for health lies squarely in the public arena. This is where people come together to craft a common world. With this fact unmasked, we cannot successfully craft a healthier future for all without recommitting to the collective efforts necessary to ensure the conditions essential for health are present in each and every instance. This includes deepening our commitment to racial, social and economic justice.

After being in the clinical practice of medicine for 41 years, I have now been retired for two years. During this time I have continued to be very interested in health care. With this interest and with more available time, I have become involved in ISAIAH and their goal of changing the delivery and very deďŹ nition and nature of health care. I have learned some new things about health care and about myself. I have been interested in “the systemâ€? for many years; however, I have long felt a personal need for better organizational skills. While I had a fairly good understanding about the problems of our system, I was not skilled in organizing signiďŹ cant numbers of people — both within and especially outside the health system.

As a result I have not been able to effectively inuence “the powers that beâ€? so as to induce positive change. I believe that this is true of many physicians. ISAIAH has been helpful in redirecting my efforts.

I believe that physicians have something to contribute in the change that is coming to health care — we need to be a part of this effort. We have a unique opportunity to help create fundamental health care reform both by working within health care institutions as well as by working with community groups and politicians. We can serve as leaders in helping the institutions reclaim and redeďŹ ne its original purpose of providing quality health care to those in need. This will require to some extent, a redeďŹ nition of just what health care is. In fact, we need to be in the forefront of redeďŹ ning the deďŹ nition of health care from the treatment of acute and chronic disease to broader public health care issues. We can help policy makers and people in the community recognize the tie between social conditions, social policies, and our collective health. While there are a few physicians who are skillful at working with politicians, many of us need assistance in making our voices heard in an effective manner.

For me that assistance came in the organizing efforts of ISAIAH. You can become part of ISAIAH by working in one committee or another. In so doing we can assist in ISAIAH’s community-wide effort to inuence the ongoing process. Physicians must serve as leaders in the community and lend a credible voice to the larger health care debate. We need to be more active in communicating to our own individual representatives in the state legislature and national government regarding what we see as the problems with the current health care system. Changes are urgently needed in the way medical care is ďŹ nanced. The insurance mechanisms currently in existence need fundamental changes. We need to insist that there is transparency in describing just where all the money in health care is currently being spent.

Physicians need to help craft social policies that ensure that the conditions are in place to support health. The success in making Minnesota a smoke-free state is a good example of just how physicians can be effective.

Health and healthy communities are possible. However, they are dependent upon a radical transformation of ourselves and our society. All physicians have a role to play. It is imperative that we all get engaged in this process.

Robert H. Scott, M.D., Internist, Retired

MetroDoctors

The Journal of the East and West Metro Medical Societies

(;3(5,(1&(' 352)(66,21$/ (;&(//(1&( ,1 '(50$72/2*< 6,1&( $// &2168/7$7,216 6((1 :,7+,1 21( :((.

6$0( '$< $332,170(176 )25 85*(17 25 $&87( &$5( 3(5 3&3 5(48(67 $ 723 5$7,1* ,1 )3$ 6859(< ,1 3$7,(17 6$7,6)$&7,21

83 72 '$7( ',$*1267,& $1' 3529(1 75($70(17 02'$/,7,(6 2))(5(' 5287,1( '(5026&23< %,2/2*,&6 ;75$& /$6(5 )25 3625,$6,6 75($70(17 )8// 6(59,&(6 2) 0(',&$//< 3529(1 &260(7,& $1' /$6(5 75($70(176

2- 5867$' 0' %2$5' &(57,),(' '(50$72/2*,67 0(',&$/ ',5(&725 03/6 67 3$8/ 723 '2& 02+6 &(57,),(' 685*(21

:+,7( %($5 /$.( $6&,

67,//:$7(5 $6&,

::: $6&, '(50 &20 &(17(59,//( 52$' :+,7( %($5 /$.( 01

:(%(5

/$: 2)),&( )RFXVLQJ RQ WKH OHJDO QHHGV RI WKH KHDOWK SURIHVVLRQDO Â&#x2021; /LFHQVXUH Â&#x2021; (PSOR\PHQW /DZ Â&#x2021; 7ULDO :RUN Â&#x2021; :LOOV DQG (VWDWHV Â&#x2021; 5HJXODWRU\ &RPSOLDQFH

0LFKDHO - :HEHU - ' Â&#x2021; )RUPHU $WWRUQH\ IRU WKH %RDUG RI 0HGLFDO 3UDFWLFH Â&#x2021; 2YHU 6L[ <HDUV DV DQ $VVLVWDQW $WWRUQH\ *HQHUDO

ZZZ ZHEHU ODZ FRP ´&RPPLWWHG WR WKH %HVW /HJDO 2XWFRPH 3RVVLEOH 7KURXJK 'LOLJHQFH DQG 5HVRXUFHIXOQHVV ¾

November/December 2008

5

ISAIAH (Continued from page 4)

gatherings with officials, meetings with public health professionals and community dialogues the questions that have been repeatedly asked are: s What is health? s Is our health improving or declining? s How do we protect and improve our health? s What can we do to create health for everyone in Minnesota? s How can we eliminate the health disparities we see between social, racial and economic groups? s What are the personal and community conditions necessary for our health? s How do we ensure these necessary conditions are in place 5, 10, 30 years from now? s Are we working to ensure the health of our children and our neighbor’s children or have we abdicated our responsibility for future generations? s What core values should guide our efforts for health reform?

These questions have required people to seek answers that have a historical perspective and have a focus beyond local geography and neighborhood makeup and recognize the deep connections between community conditions and health. They also reinforce the need to find a new way to talk and think about health that goes beyond illness care and an individual, personal responsibility paradigm and is instead guided by shared values and an understanding of the connection between social policy and health.

One model that has fit this perspective is syndemics. Developed by The Centers for Disease Control and Prevention (CDC), syndemics has provided professionals and communities with a new way to think about public health work. According to Bobby Milstein, the coordinator of the Syndemics Prevention Network at CDC, “A syndemic orientation is defined as a way of thinking about public health work that focuses on connections among health-related problems, considers those connections when developing health policies, and aligns with other avenues of social change to ensure the conditions in which all

people can be healthy.” Thus, syndemics compels people to look beyond treatment of illness to the structure of communities — housing, education, transportation, etc. The syndemics orientation highlights the importance of building community strength (power) in order to affect the conditions that support health.

ISAIAH is advancing this model through its grassroots community organizing work.

ISAIAH has also hosted numerous showings of the PBS series “Unnatural Causes, Is Inequality Making us Sick?” (www.unnaturalcauses.org). The series is a compelling and moving demonstration of the fact that people’s health cannot be separated from the environment in which they live. Conditions such as poverty, poor education, violence, substandard housing, lack of transportation, unemployment, and racism combine to make people sick. The documentary challenges the overemphasis on individual choice and points out the fact that the choices we make are tied to the distribution of resources. Economic, social and political inequality is bad for our health and is a result of social policy.

Partnerships

Minnesota Epilepsy Group is the largest and most comprehensive epilepsy program in the Midwest. As a regional referral facility, we are the recognized leader in treating epilepsy and other seizurerelated conditions in patients of all ages, from infants to the elderly.

Adult Epileptologists Deanna L. Dickens, MD Julie Hanna, MD El-Hadi Mouderres, MD Patricia E. Penovich, MD Pediatric Epileptologists Jason S. Doescher, MD Michael D. Frost, MD Frank J. Ritter, MD

www.mnepilepsy.org 225 Smith Avenue N. Suite 201 St. Paul, MN 55102

6

November/December 2008

Functional Neuro-Imaging Wenbo Zhang, MD, PhD

Appointments (651) 241-5290

MetroDoctors

To be successful in this radical new approach, ISAIAH has developed deep relationships with many organizations and groups such as labor organizations (particularly the Service Employees International Union – SEIU), academic organizations, professional associations, employers, foundations, government agencies, and health care organizations. Each of these organizations has a role to play in creating true health reform and with members of ISAIAH congregations as part of their organizations, they are encouraging their organizations to embrace this broad systems perspective.

What Can and Should Physicians Do?

Physicians need to be part of this effort. They have a unique opportunity to help create fundamental health reform by working within health care institutions where they can serve as leaders in helping the institution reclaim its original purpose of providing quality health care to those in need.

Physicians serve as leaders in the community and can lend a credible voice to the larger health care debate. They can help policy makers and people in the community recognize The Journal of the East and West Metro Medical Societies

the tie between social conditions, social policies and our collective health. Physicians can tell the story of the pain caused by the current system. They have a role in helping change the conversation and helping the community overcome their fear of change. Changes are urgently needed in the way medical care is financed and delivered. But beyond insurance there needs to be an examination of the health impact of the broader social policies that affect our communities. Physicians can partner with communities to craft social policies that help ensure the conditions are in place to support health as they have in the past, e.g., tobacco.

As leaders, physicians can tell the truth of the radical change needed and proclaim the promise of the hope and health that comes when we honor the call to serve the common good.

The ISAIAH Vision

Health is not achieved by an individual in isolation from the community. Health is not a commodity or a static state but is fragile and dynamic and closely related to the connections between social, spiritual and physical forces.

The entire community pays the price for poor health. In effect — we are one body! When a systems approach is truly applied to health and the health system, it becomes clear that the responsibility for health lies squarely in the public arena where people come together to craft a common world. With this fact unmasked, we recognize we cannot successfully craft a healthier future for all without recommitting to the collective efforts necessary to ensure the conditions essential for health are present.

This includes deepening our commitment to racial, social and economic justice. Health and healthy communities are possible but are dependent upon a radical transformation of ourselves and our society. All narrow policy debates can be set aside, while we confront a basic philosophical, spiritual and moral choice.

We either choose to live in a way that protects and promotes the health of all people in our community or we choose to continue our retreat from a commitment to our collective health. This is fundamentally the choice each of us must make.

Jeanne F. Ayers, R.N. M.P.H. serves as Co-Chair ISAIAH Health Reform and is the Director of Occupational Health at Boynton Health Service, University of Minnesota, Minneapolis.

MetroDoctors

,!79%23 4(!4 $/#4/23 42534 i` V iÊ ÃÊV « V>Ìi`°ÊÊ- Ê>ÀiÊÌ iÊ >ÜÃÊ Ì >ÌÊ ` VÌ ÀÃ]Ê Ã« Ì> ÃÊ > `Ê ÃÕÀ> ViÊ V «> iÃÊ >ÛiÊ Ì Ê > >}i°Ê Ê V À `}iÊ À `> Ê >Õi Ê ÃÊ iÊ vÊ ià Ì>½ÃÊ i>` }Ê i> Ì Ê V>ÀiÊ >ÜÊ v À ðÊÊÊÊÊÊÊÊÊÊÊÊÊÊ "ÕÀÊ i> Ì Ê V>ÀiÊ V i ÌÃÊ >ÀiÊ Ã Ê Ã>Ì Ãv i`Ê Ì iÞ½ ÊÜÀ ÌiÊÕÃÊ>ÊÀiviÀÀ> °ÊÊ

Ì>VÌÊ i À Ê iÌÌiÊ ÀÊ À VÊ/ ÃÌÀÕ`

È£Ó x È {ä J V >Ü°V Ìi}À ÌÞÊÊUÊÊ Þ> ÌÞÊÊUÊÊ ÝVi«Ì > Ê-iÀÛ Vi

The Journal of the East and West Metro Medical Societies

November/December 2008

7

2008 Minnesota Medical Association

Annual Meeting

T

he 155th Annual Meeting of the Minnesota Medical Association was called to order on Wednesday evening, September EMMS and WMMS members participate in a joint Caucus.

17, 2008 by Michael Ainslie, M.D., chair, Board of Trustees.

EMMS president, Peter Wilton, M.D. welcomed attendees to St. Paul and offered some friendly words for St. Paul’s mayor, Chris Coleman who was invited by EMMS to open the House of Delegates meeting. The invocation was offered by Gregory Plotnikoff, M.D. Thirty-one East Metro Medical Society members and 43 West Metro Medical Society members served as delegates. The format of the Annual Meeting was modified this year with the opening session of the House of Delegates occurring on Wednesday evening along with several award presentations. EMMS and WMMS physicians receiving awards included: s Minority Affairs Meritorius Service Award: Charles E. Crutchfield, Sr., M.D. s Physician Leadership in Quality: Brian Anderson, M.D. Medical society caucuses were convened early on Thursday morning, allowing for a review of the resolutions. Carl Burkland, M.D. again served as the WMMS Caucus chair, and V. Stuart Cox, M.D. chaired the EMMS Caucus. The House of Delegates was re-assembled for the purpose of the election of Noel Peterson, M.D., MMA president-elect. Open mic at the reference committees followed. Several EMMS and WMMS physicians served on the reference committees: Amy Gilbert, M.D., EMMS, Reference Committee A V. Stuart Cox, M.D., EMMS, Reference Committee B, chair Nicole J. TePoel, EMMS, Reference Committee B, medical student

Brian Anderson, M.D. was awarded the Physician Leadership in Quality Award.

Charles E. Crutchfield, Sr., M.D., received the Minority Affairs Meritorious Service Award.

Photo by Scott Smith, MMA

Amy C. Burt, M.D., WMMS, Reference Committee B Benjamin W. Chaska, M.D., WMMS, Reference Committee C

John W. Larsen, M.D. (left) and David L. Estrin, M.D. are recipients of the President’s Award.

Jo Ann Wood, M.D., EMMS, Reference Committee C Louis J. Ling, M.D., WMMS, Reference Committee D, chair Carol M. Grabowski, M.D., WMMS, Reference Committee D Robert C. Moravec, M.D., EMMS, served on the Credentials Committee

First time delegate, Lisa Erickson, M.D., testifies on behalf of her resolution on embryonic stem cell research.

Photo by Scott Smith, MMA.

8

November/December 2008

Decade Award presentations were made during the Annual Meeting luncheon. The following EMMS and WMMS physicians Robert Geist, M.D., EMMS member, and Benjamin Whitten, M.D., WMMS member and MMA President-Elect, socialize prior to dinner.

MetroDoctors

The Journal of the East and West Metro Medical Societies

who have practiced medicine and maintained their MMA membership for 50 or 60 years were recognized: Reno E. Backus, M.D. – 50 years Jeanne B. Bradley, M.D. – 50 years Richard E. Burman, M.D. – 50 years Aina Galejs Dravnieks, M.D. – 50 years John A. Hartwig, M.D. – 50 years John N. Heinz, M.D. – 50 years Kenneth V. Hodges, M.D. – 50 years John T. Kelly, M.D. – 50 years Arthur C. Klassen, M.D. – 50 years Fletcher A. Miller, Sr., M.D. – 50 years A. Bruce Sundberg, M.D. – 50 years Thomas W. Votel, M.D. – 50 years Robert M. Wagner, M.D. – 50 years Ephraim B. Cohen, M.D. – 60 years Winston R. Lindberg, M.D. – 60 years Joseph A. Resch, M.D. – 60 years An opportunity for continuing medical education was afforded throughout the afternoon with sessions on conflict management, health care homes, and motivational interviewing offered. Concluding the evening, the presidential medallion was passed to incoming MMA president, Noel R. Peterson, M.D. at the President’s Inaugural Dinner and Award Presentations ceremony.

WMMS members Drs. David L. Estrin and John W. Larsen were each honored with the President’s Service Award, given to a physician who has made outstanding contributions

to medicine and to the MMA. The final session of the House of Delegates was convened on Friday following the joint EMMS and WMMS caucus, which met to review the report and recommendations of the reference committees.

At the conclusion of the session, the Speaker of the House, Lyle Swenson, M.D. (EMMS member) stated, Drs. V. Stuart Cox (left) and Carl Burkland, facilitate the joint EMMS/WMMS Caucus. “the deliberations of the House were accomplished Vice Speaker of the House — with unprecedented speed, yet thorough, Karen K. Dickson, M.D. fashion.” Please visit our Web site, www. metrodoctors.com for a complete report of the MMA Trustees: final actions taken on the EMMS and WMMS Donald M. Jacobs, M.D., West Metro resolutions.

Beth A. Baker, M.D., MPH, West Metro The following MMA officers, trustees Charles G. Terzian, M.D., East Metro and AMA delegate positions were unaniAMA Delegates: mously elected: Kenneth W. Crabb, M.D., FACOG MMA Officers: Paul C. Matson, M.D. President-Elect — John C. VanEtta, M.D., FACP, ABIM Benjamin H. Whitten, M.D. AMA Alternate Delegates: Secretary/Treasurer — Blanton Bessinger, M.D., MBA David E. Westgard, M.D. David D. Luehr, M.D., FAAFP Speaker of the House — Benjamin H. Whitten, M.D. Lyle J. Swenson, M.D., FACC

Thank you to the following EMMS and WMMS physicians who served as delegates to the MMA. EMMS Delegates

Richard Baron, M.D. Blanton Bessinger, M.D. Peter Boosalis, M.D. Todd Brandt, M.D. V. Stuart Cox, M.D. Laura Dean, M.D. Deborah DeMarais, M.D., 1st time delegate Linnea Engel (medical student) Robert Geist, M.D. Amy Gilbert, M.D. Michael Gonzalez-Campoy, M.D., Ph.D. Ronnell Hansen, M.D. Frank Indihar, M.D. James Jordan, M.D. Matthew Sanford, M.D., 1st time delegate Stephanie Koonce (medical student) Robert Moravec, M.D. Anne Rosenberg, M.D., 1st time delegate Matthew Sanford, M.D., 1st time delegate Stephanie Stanton, M.D. Lyle Swenson, M.D. Nicky Te Poel (medical student) Charles Terzian, M.D. David Thorson, M.D. Scott Uttley, M.D.

MetroDoctors

Jessica Voight (medical student) Ann Wendling, M.D. Kent Wilson, M.D. Marie Witte, M.D. Peter Wilton, M.D. Jo Ann Wood, M.D WMMS Delegates

Michael Ainslie, M.D. Thomas Arneson, M.D. Beth Baker, M.D. Carl Burkland, M.D. Amy Burt, M.D., 1st time delegate Benjamin Chaska, M.D. Roger Day, M.D. Peter Dehnel, M.D. Karen Dickson, M.D. Laurie Drill-Mellum, M.D. Edward Ehlinger, M.D. Lisa Erickson, M.D., 1st time delegate David Estrin, M.D. Melanie Fearing (medical student) Robert Fisch, M.D., 1st time delegate Julie Gilkeson (resident), 1st time delegate Carol Grabowski, M.D. A. Stuart Hanson, M.D.

The Journal of the East and West Metro Medical Societies

Kenneth Hodges, M.D., 1st time delegate Donald Jacobs, M.D. Mary Kathol, M.D. Roger Kathol, M.D. Renee Koronkowski, M.D., 1st time delegate Brent Kudak (medical student), 1st time delegate Louis Ling, M.D. Virginia Lupo, M.D. Merle Mark, M.D. Harry Marshall, M.D. Lisa Mattson, M.D., 1st time delegate Carolyn McKay, M.D. Jason Meyers (medical student) Anne Murray, M.D. Eugene Ollila, M.D. James Peters, M.D. Richard Schmidt, M.D., 1st time delegate T. Michael Tedford, M.D. Lindsey Thomas, M.D. David Wallinga, M.D. Craig Walvatne, M.D., 1st time delegate Benjamin Whitten, M.D. Shayla Wilson (medical student), 1st time delegate John Wust, M.D. James Young, M.D.

November/December 2008

9

Supply Drive Collection Dates: February 1-28, 2009 Have your organization collect hygiene supplies and non-prescription medication to be donated to the homeless adults, youth and children at HCH.

Homeless

Call Doreen at (612) 362-3705 for details or go to www.metrodoctors.com

and Health Care in Minnesota

W

hen I say homeless, the most common image that comes to mind is a single adult standing at an intersection holding a sign. Seeing them evokes sympathy or skepticism, maybe even both. We wonder if they are truly homeless and if they plan to drink away the money generously given. What if you had a different visual image?

You’re at Health Care for the Homeless and today is a walk-in medical clinic. One patient is feeling dizzy and clammy after three days without her hypertensive medications.

A second patient was treated for an injury in a hospital emergency room and was given a written prescription for an antibiotic that he doesn’t have the money to fill. Another is a mother with a 5-year-old who reports that the child has had a temperature, lethargy and loss of appetite for several days.

These too are homeless people. Their health care needs represent a typical day at any of the 185 federally funded Health Care for the Homeless (HCH) programs that served over 600,000 homeless patients across the country last year. The Twin Cities metro area is fortunate to have two of the HCH programs right here. The east metro is served by the HCH program of the West Side Community Health Services, a community clinic located on the West Side of St. Paul. The west metro’s HCH is located in Minneapolis and is part of the Hennepin County Health Department.

On any given night, there are about 9,000 homeless men, women and children in the state of Minnesota. Of these, children account for 45 percent of the total population of homeless in the state. Another startling fact is that while African Americans comprise only 3 percent of

By Helene Freint

10

November/December 2008

the adult population in Minnesota, they represent 38 percent of the homeless adults in the state.

People are often curious to understand the causes of homelessness. The best explanation is that it is usually a set of complex circumstances that leads to a downward spiral.

But there’s an additional element that is best explored by having you ponder this situation for a moment. Imagine that you are about to lose your housing. Would you make a few phone calls and be able to find a safety net of family and community to catch you? Would they take you and your family in, store your furniture and help you until you could get back on your feet? For the people HCH serves, there is no safety net. Patients tell us that almost everyone they know is in similar distress, living on the edge of another crisis. It’s more like a free fall with no parachute.

Here is a brief presentation of what causes people to become homeless. s Poverty is the main reason. Limited income barely covers the monthly expenses and any unexpected need (e.g. car repair) causes a crisis. There’s no emergency savings. s Employment opportunities don’t pay livable wages and the jobs are less secure as well. Many of the unskilled jobs are part time and do not offer health benefits. s Public assistance programs have tightened eligibility criteria and reduced caseloads. Children and families, single adults and the disabled are all being hurt by the cuts.

MetroDoctors

Affordable housing options are very limited and waiting lists are years long. s The lack of affordable health care can lead to missing work, losing a job, inability to pay rent, eviction and homelessness. s Women fleeing domestic violence have often had to make the difficult choice between abuse and homelessness. Think again of the lack of a safety net. s People with mental illness and chemical dependency issues can have difficulty maintaining their housing and job. They often have burned bridges by misbehaviors with their personal and community resources. The danger is that their impairments make them more vulnerable.

Taking all this into consideration, HCH programs are designed to work effectively with the strengths and challenges of the population.

Here are three major components shared by all HCH programs around the country: s All HCH programs work to increase access. Both metro HCH programs accomplish this by using a walk-in model and by co-locating in shelter/drop-in sites where homeless people are already receiving other services. s All HCH programs deliver care in a respectful and non-judgmental manner that builds rapport as the starting place to make positive things happen. s All HCH programs must either provide or make direct connections for patients to chemical and mental health services.

This reflects federal understanding of the high incidence of mental health issues in the homeless population. The findings of s

The Journal of the East and West Metro Medical Societies

the 2006 Wilder Research Centerâ&#x20AC;&#x2122;s Statewide Survey on Homelessness indicate a growing percent (52 percent) of homeless adults who report a mental health diagnosis.

With that general overview in place, here is a speciďŹ c glimpse of West Sideâ&#x20AC;&#x2122;s Health Care for the Homeless program. HCH uses a multidisciplinary team that visits nine locations each week. The busiest is the clinic within the Dorothy Day Center which provides primary and urgent health care, ophthalmology, acupuncture, chiropractic, psychiatry and counseling for mental health and chemical dependency.

A formulary of commonly prescribed medications is kept onsite and dispensed at a physician dispensing clinic.

The key component of the HCH practice is to address the whole person as fully as possible in that visit. We anticipate that people may not return for follow-up because there is so much instability in being homeless. So during a patient visit, this moment is ours to make a difference.

Unique challenges of the HCH practice are dealing with serious chronic illness in a limited scope environment. Our linkage to West Side Community Health Services ensures we can connect patients to complex lab and x-ray services and more ďŹ&#x201A;exible hours of operation. Patients have walked-in for a ďŹ rst time visit needing to ďŹ nd dialysis now that theyâ&#x20AC;&#x2122;re in Minnesota, need to have their INR checked or arrive with a bag of 12 medications that they donâ&#x20AC;&#x2122;t understand how to take. One provider exclaimed that patients present with blood sugar levels and other vital sign readings that textbooks say are fatal. Yet here they are and HCH staff does what they can to treat, educate and follow-up. Another challenge HCH supports is the recommendation for bed rest which is hard to accomplish if youâ&#x20AC;&#x2122;re homeless and donâ&#x20AC;&#x2122;t have a bed. HCH can admit homeless patients to its four Rest Beds while they recuperate from illness, injury or post-hospitalization. In addition to patients we identify at HCH clinics, we also coordinate admission to the Rest Beds with hospital staff and then assist patients in completing followup visits as recommended. HCH admitted 70 homeless patients to the Rest Beds in the last 12 months.

An HCH volunteer clinician, Dr. Rene

MetroDoctors

Pelletier provides weekly eye exams to identify those who need glasses. He connects personally with each patient and wants to hear their story.

He patiently maneuvers with trial frames and the donated equipment that complements his specialty skill. Dr. Pelletier gets a special joy when patients indicate they need glasses to complete a job application. Itâ&#x20AC;&#x2122;s his contribution to helping the patient move another step toward stability. He has called a friend to help an unemployed welder connect to a job and heâ&#x20AC;&#x2122;s able to network to ďŹ nd pro bono care. Dr. Pelletierâ&#x20AC;&#x2122;s patients can get cranky waiting their turn but they are transformed during the visit and exit with a smile and a hope for tomorrow.

West Sideâ&#x20AC;&#x2122;s HCH relies on a multitude of community partnerships. The village of support is much too long to list, but some star players include HealthEast Pharmacy Downtown which leads the pack of neighborhood pharmacies that honor HCH vouchers to cover prescription costs. St. Paul Opticians accepts HCH eyeglass vouchers to cover the cost of frames and glasses. The College of St.

Catherine and U of MN Nursing schools bring nursing students year round to provide foot care that pampers the patients and introduces students to community health. HCH can make incredible things happen for patients. But it is the support of our informal partners that often cinch the deal.

Friends ask how we can keep doing this intense and challenging work. The answer is that we are trying to create a positive and respectful interaction with each and every patient that may signal that they deserve to be heard, to be seen and to have a chance at life. Even if they move on, we hope the patients take that memory of being treated with respect into their next contact. We are doing what we can to heal the world one patient at a time.

Helene Freint, program director, Health Care for the Homeless & HouseCalls, West Side Community Health Services.

â&#x2122;Ś Insurance/Patient Billing and Collection â&#x2122;Ś Accounts Receivable Management â&#x2122;Ś Accounts Payable/General Ledger â&#x2122;Ś Payroll/Fringe Benefit Management â&#x2122;Ś Experienced in over 30 Medical Specialties â&#x2122;Ś Qualified and Experienced Staff â&#x2122;Ś Owned and Managed by Experienced Healthcare Practice Management Professionals

The Journal of the East and West Metro Medical Societies

+HDOWKFDUH %LOOLQJ 5HVRXUFHV ,QF

+HDOWKFDUH %LOOLQJ 5HVRXUFHV ,QF The outsourced business office solution for your medical practice

+LJKZD\ 6XLWH (DJDQ 01

&RQWDFW 5LWD .LHIIHU

5LWD#+05 1HW

November/December 2008

11

FEATURE STORY

Your Health Care Choices in November IF YOU ARE LOOKING FOR POSITIONS to help you differentiate between the two leading presidential candidates, health care is one issue where you will find that the candidates definitely have real differences.

The basic difference is that Republican candidate, John McCain, would eliminate the ability of employers to purchase health care coverage with pre-tax dollars. The McCain plan would apply the tax to each employee for the amount of the premium. To offset the new tax, individual employees would receive a tax credit.

Business leaders are telling him that the U.S. must move away from our employer-based system as its costs can no longer be borne by employers. They compare the current health care cost problem to the problems caused by the costs to business of the defined benefit pensions which had to be phased out back in the 1980s. In response, McCain’s health care policy would alter our health care system by making major changes in the health care system by altering federal tax laws.

Senator Barack Obama takes a more traditional Democratic approach to health care by proposing to spend a large amount of money upfront in order to cover everyone as soon as possible. His plan is not pure universal coverage but it would cover more people sooner than the McCain plan. Benefits would be defined and employers would continue to provide coverage to their employees. His plan banks heavily on reducing the costs of health care by reducing the costs of uncompensated care.

The basic difference in the two approaches comes down to priorities. The McCain plan attempts to make the insurance system more affordable. The Obama plan attempts to cover more people sooner rather than later. Both candidates include improving health information technology and prevention. A review of the details in each plan may help you decide which candidate is on the right track.

The McCain Plan The McCain campaign estimates his plan would cost $7 to $10 billion.

McCain’s health care plan focuses on making health insurance more affordable and thus making it available to more people. He would lower marketing costs by creating a single health insurance policy that would be available in all 50 states. While that would lower non-medical health insurance costs he is not clear on whether he would continue state regulation or whether he would allow the health insurance companies to be more flexible in their rating systems. While healthy, young people can purchase coverage today at low cost, older people and people with chronic conditions either pay high rates or are not able to purchase health insurance. McCain’s plan does not address how to overcome the obstacles of rating, medical underwriting, or pre-existing conditions that exist in today’s health care insurance marketplace.

By Roger K. Johnson

12

November/December 2008

MetroDoctors

The Journal of the East and West Metro Medical Societies

He does support a viable health insurance market in which competition supplies the answers to consumers seeking lower cost policies. He would also continue the employer-based system that we have today. His plan is designed to stimulate the purchase of health insurance policies without a mandate to purchase health insurance.

President George Bush included a proposal for “Under the McCain plan, no longer would employending the policy of using pre-tax dollars for health insurance premiums and substituting an individual ers be able to buy insurance with pre-tax dollars. tax credit in his 2008 State of the Union Address.

These payments would be taxable to the employee, John McCain proposes a similar, but somewhat different approach. He offers a tax credit of $2,500 for just like wages.” an individual and a $5,000 tax credit for a family to Op/Ed by John C. Goodman in the Wall Street Journal, offset the additional income tax individuals would pay July 30, 2008 for the health insurance premiums that would now be taxable income. Bush proposed a tax deduction (not a credit) of $7,500 for individuals and $15,000 for families. The McCain tax credit actually gives more of a break to low-income families than the tax deduction would give them.

However, when you consider that the average cost to employers to provide health insurance to employees is $12,000 a year, the question of whether the McCain plan does enough to actually allow more individuals to purchase health insurance is clearly on the table.

McCain partially answers the cost gap question by asking the states to cooperate by developing bonuses based on “risk adjustment” in order to help supplement his tax credits and Medicaid for families with high costs and low incomes. There is no explanation offered as to how the bonuses will be funded or how the cost gap would be narrowed.

The McCain plan addresses controlling health care costs by supporting delivering care in more efficient places such as walk-in clinics in retail outlets; by allowing cheaper generic drugs to enter the U.S. market; by greater use of health information technology; and, by promoting disease prevention, healthy diets, and exercise.

The Medicare system would be used as a catalyst for changing how providers are paid.

According to McCain’s proposal, a system of bundled payments for diagnosis, prevention, and care coordination referred to as “coordinated care” would be developed for the Medicare system. A budget would be created for each bundled treatment and physicians would be at risk for delivering care within the budget. Some analysts believe this proposal is designed to move the system back to a capitated system. McCain needs to develop his Medicare payment reform proposal in more depth before it can be implemented and before he can respond to physicians and other providers who have many unanswered questions at this point.

Two other McCain proposals generate strong interest from physicians. The first is his proposal to allow physicians to practice across state lines. McCain believes allowing physicians to practice across state lines using Web technology will improve the quality of care. He also believes that this proposal is the least expensive way to improve quality.

The second position of McCain to generate strong physician interest is his proposal to cap damages awarded to patients in malpractice lawsuits. He would also eliminate malpractice lawsuits in cases in which the physician followed established clinical guidelines and complied with patient safety protocols.

Many questions remain to be answered before the effectiveness of McCain’s proposals can be judged. Will his proposed tax credits give poor families enough financial support to actually be able to buy health insurance? Will his cost containment proposals for Medicare, which are similar to capitation, actually work? How will he deal with the 47 million plus uninsured while the reforms he supports take years to effectively be implemented? He has adopted a collection of ideas in his health care plan, but it does appear that the plan lacks a

U

(Continued on page 14)

MetroDoctors

The Journal of the East and West Metro Medical Societies

November/December 2008

13

Health Care Choices (Continued from page 13)

cohesive message. How it is received by voters in November and how physicians and other providers embrace it remains to be seen.

Another cost reform in his plan would strengthen anti-trust laws to prevent medical malpractice carriers from overcharging physicians for their malpractice insurance. He also proposes to promote new models for improving patient safety by addressing physician errors.

The Obama plan includes a long list of initiatives to improve quality similar to the McCain list. The list includes disease management, coordinated care, cost and quality transparency, improved patient safety, enhancing incentives for excellence, comparative effectiveness reviews, and reducing disparities in treatments for similar illnesses.

The Obama plan includes support for lifting the ban on Medicare (CMS) negotiating prices for prescription drugs including those included in the Part D program. The question that is not answered in his plan is whether or not a drug can be removed from the list if the manufacturer refuses to lower its price. He would also make it more difficult for a pharmaceutical manufacturer to pay a generic manufacturer to stay out of a marketplace.

The third part of the Obama plan is promoting and strengthening public health. His plan includes encouraging employer wellness programs; a campaign against obesity to be waged in schools; expanding disease prevention programs; and, increasing the number of primary care providers. He intends to encourage all Americans to adopt healthy lifestyles.

The Obama Plan The Obama campaign estimates his plan would cost between $50 and 65 billion per year. The first part of the Obama plan addresses his stated goal of providing quality, affordable and portable health coverage for all.

The plan would establish a new public program that looks like Medicare for those under 65 for those people who do not have access to an employer provided plan or who qualify for other public programs such as Medicaid. Small employers who do not offer health insurance would also be eligible for this plan.

A government run marketing organization called the “National Health Insurance Exchange” would be created to sell insurance plans directly to those who do not qualify for an employer plan or for public coverage. Plans sold through the National Health Insurance Exchange would include minimum comprehensive benefits similar to those federal workers currently enjoy. In addition, the health insurance purchased through the Exchange would be portable. All providers would be required to participate in a data collection system Which Plan Will Work, that would include data on standards of care, how health information the McCain Plan or the Obama Plan? technology is used, and on administration.

There is no need to point out that neither plan offers solutions to all Moving in the direction of universal coverage, the Obama plan the problems in our health care system. John McCain is not likely to includes an employer pay or play component that requires an employer to either provide health insurance for its employees or to contribute toward the cost of a public plan. Parents would be required to cover all their children “Obama has proposed a plan that is intended to either in the private sector or in a public plan. move toward universal coverage without putting an He would expand eligibility for government programs like Medicaid and SCHIP. The reason unfair burden on individuals in the process.” the Obama plan is not a universal plan is that The Health Care Blog June 4, 2008 it remains optional for adults to be covered by health insurance.

The proposal includes subsidies for those individuals and families who are not eligible for propose a plan that involves massive government funding or greatly employer based coverage or for public programs. How the subsidies expanded federal involvement in health care as that is not politically would work and how they would be financed are not included in the acceptable to his Republican Party. On the other hand, the Democrats plan at this time. and Barack Obama do not wish to experience another health care While Obama’s plan would probably succeed in covering most reform failure similar to the Clinton failure by alienating all of the of those currently uninsured in the United States, questions remain stakeholders. As a result, they will build on the current system and about the costs of the plan and whether the costs are sustainable. they will invest $100 billion of federal dollars in order to cover more The second major section of the Obama plan addresses lowering people more quickly. costs and improving quality by modernizing the health care system. A The choice we are left with is limited to a choice of priorities key component of his proposal is to provide reinsurance to employer rather than a choice of total system change. If you think improvplans for catastrophic losses. Employer costs would be reduced; ing access by covering more people as soon as possible with a large however, some analysts view this approach as merely shifting those infusion of federal dollars should be the priority, then your choice costs to government.

O

14

November/December 2008

MetroDoctors

The Journal of the East and West Metro Medical Societies

should be Senator Barack Obama. The Obama planners may believe that if most everyone is covered and the costs become unsustainable, the demand for total universal coverage will no longer be able to be denied by Congress.

If you favor a more limited approach shifting the employerbased system to the individual and allowing the market to adjust so that more people can be insured, then your choice should be John McCain. The major question regarding the McCain plan is will it provide affordable coverage for enough people, particularly those who have health problems and the aging, to be effective?

Neither plan addresses the core issue of how to create a universal health care system that is affordable and sustainable into the future.

Until the economy recovers and until the political stars align, the effort to make our health care system function well for patients, for physicians, for other providers, and for the payers remains a vision on the distant horizon. One thing we can be sure of, all of the stakeholders will continue to work on the solutions and politicians will continue to debate all of them. The only question is how long the country can afford to wait?

The intent of the author is to give you enough of an overview of the candidateâ&#x20AC;&#x2122;s positions to arouse your curiosity and to inspire you to seek more information in detail.

You are encouraged to visit the sites listed below and others that search engines will ďŹ nd for you in order to review all the numerous details of each candidateâ&#x20AC;&#x2122;s plan.

The sources of information used in this article and in the side-by-side chart are as follows: BarackObama.com johnmccain.com votenader.org health08.org Green Party Web site, www.gp.org U.S. Presidential Candidates Prescriptions for a Healthier Future: A Side-by-Side Comparison. Susan J. Blumenthal, MD., et al.

HufďŹ ngton Post 07-09-07 McCain is the Radical on Health Reform. John C. Goodman in Wall Street Journal 07/30/08 politics.nytimes.com/election-guide/2008. New York Times 06/19/08 A Detailed Analysis of Barack Obamaâ&#x20AC;&#x2122;s Health Care Reform Plan. healthpolicyandmarket.blogspot.com/2008. 08/21/08 A Detailed Analysis of Senator John McCainâ&#x20AC;&#x2122;s Health Care Reform Plan. healthpolicyandmarket.blogspot.com/2008 08/21/08 Other interesting analyses you may wish to check out are: The Health Care Blog: Obamaâ&#x20AC;&#x2122;s health care plan may promise less but accomplish more; 06/04/08; thehealthcareblog.com A Fork in the Road Obama, McCain, and Health Care. BrieďŹ ng Paper 104 Cato Institute Washington, D.C. 07/29/08 Roger K. Johnson is the former CEO of the Ramsey Medical Society (East Metro Medical Society) and currently is a member of the Government Relations team of Lockridge, Grindal, Nauen in Minneapolis.

â&#x20AC;&#x153;Are you managing your practice or is IT managing you? â&#x20AC;?

Here are the top 3 reasons why many of your colleagues are choosing MMIC for their EMR and EPM.

When you choose MMIC Technology Solutions, you get: 1

local service and support that puts you ďŹ rst

2

proven track record with a trusted partner

3

streamlined systems that can connect between external care systems

MMIC Technology Solutions is an authorized reseller of the NextGenÂŽ Electronic Medical Records and Enterprise Practice Management systems.

To learn more about how MMIC Technology Solutions can help make your practice run more efďŹ ciently and proďŹ tably, call Brian Salzman at 763â&#x20AC;&#x201C;201â&#x20AC;&#x201C;0304.

Insurance, Claim & Risk Management Technology vice to protect against & prevent malpractice

MetroDoctors

The Journal of the East and West Metro Medical Societies

to help your practice thrive

that puts you ďŹ rst

November/December 2008

15

Health Care Proposals of 2008 Presidential Candidates Side-by-Side Summary John McCain — Republican

Ralph Nader — Independent

Coverage

Does not favor mandates. Would provide diverse choices by eliminating tax deductibility for employer-based health insurance and provide a tax credit to individuals and families. Plans could be purchased by individuals and employers through any association or organization. All plans would meet rigorous standards and certifications.

New Programs

Providers allowed to practice across state lines. Coverage to bridge the gap between retirement and Medicare. Veterans eligible for coverage for treatment from any health professional in the community. States free to experiment with access and risk adjusted payments as well as private insurance for Medicaid. States required to provide a “risk adjustment” bonus for low income families to supplement the tax credits. SCHIP expanded for children. Allow families to purchase health insurance across state lines and provide vigorous protections from unfair business practices.

Favors a single, comprehensive public system covering all medically necessary services including acute, long-term care, mental health, dental care, prescription drugs, and medical supplies.

Everyone would have free choice of physician. Health plans would remain private with no incentives to influence care. A transition fund would be established for employees of insurance companies who lose their jobs due to the simplification of the system.

A single, comprehensive public system for providing coverage to everyone. A Consumer Health Vigilance Association would be created to serve as a national patient watchdog and to ensure that the health care system meets the needs of patients.

Subsidies Provides a refundable tax credit of $2,500 for individuals and $5,000 for families None to Individuals for purchasing health insurance.

Subsidies to Employers

None

Tax Revisions

Payroll tax on employers of 7 percent and an income tax on Tax code reform to eliminate the deductibility of the value of health insurance plans individuals of 2 percent. The payroll tax would replace all other by employers from workers taxable income. Provide the tax credits for individuals employer expenses for employee health care. The individual and families. income tax would eliminate all current health insurance premiums, co-pays, deductibles, and other out-of-pocket expenses.

Private Insurance

Insurance would be sold across state lines to promote competition and choice. Multi- Health plans would remain in place with fewer employees year insurance products that offer innovation encouraged. Vigorous enforcement offering the simplified plan with no incentives to influence of federal protections against unfair business practices. provider behavior.

Cost Containment

Quality and IT

Financing

16

None

Malpractice reforms will be adopted that limit frivolous lawsuits and excessive awards and that provide safe harbors for practices within clinical guidelines. Providers will be required to be transparent regarding outcomes. Providers will be paid only for Reduce the costs of chronic illness through a commitment to quality. Alternative providers such as nurse practitioners will be promoted. Investprevention services. A simpler system based on a single, public ments will be made in prevention and chronic illnesses. Drug companies will be plan for coverage will be less costly to administer. required to disclose prices of drugs, drugs will be allowed to be re-imported, and the use of generics and biologics will be encouraged.

Pay only for diagnosis, prevention, and care coordination in the Medicare and Medicaid systems and do not pay for medical errors or mismanagement. Encourage coordinated care by paying for bundled services rather than individual services.

National standards will be established for measuring and recording treatments and outcomes, quality, cost, and prices. Providers’ medical outcomes, quality, costs, and prices must be transparent. Health IT would be expanded to improve chronic care and to permit practicing across state lines. Use telemedicine in rural areas if it is cost effective.

Quality will be improved by integrating prevention into the system. Prevention programs such as teaching healthy behaviors and providing a healthy environment should be provided at the community level.

The campaign estimates the costs at $7 to $10 billion.

The 7 percent tax on employer payrolls would be less than employers pay currently for employee health insurance which can be as much as 25 percent of payroll. The 2 percent income tax on individuals is less than most people currently pay for health insurance premiums, co-pays, and deductibles.

November/December 2008

MetroDoctors

The Journal of the East and West Metro Medical Societies

For comparison purposes, we have not only included the positions of Senators McCain and Obama in this side-by-side comparison chart, but also presidential candidates Ralph Nader and Cynthia McKinney.

Barack Obama — Democrat Every American to have portable, affordable, and comprehensive health care coverage in four years.

Those currently covered may maintain their coverage if they elect to continue it. The only mandated coverage will be for children. Employers would be required to offer coverage at an acceptable level or contribute a percentage of payroll to partially fund the public plan. Small businesses would be exempt.

A new national plan would be created with benefits similar to the Federal Employee Health Benefits Program (FEHBP) to cover the uninsured.

Cynthia McKinney — Green Party Supports a universal, comprehensive, national, single-payer health care system. The single-payer system would be publicly funded and administered at the state and local level. There would be a wide range of health care choices with lifetime benefits. Individuals would select their type of provider. Benefits would be comprehensive including dental, mental health, hospice, long-term care, substance abuse treatment, and prescription drug coverage.

A National Health Insurance Exchange would be created to assist those who wish to purchase health insurance from the public plan or the private market. Individuals and families who are eligible will receive subsidies based on an income-based sliding scale. Individuals with no access to group insurance, The universal, national, single-payer system. self-employed individuals, and small businesses will be eligible to be covered by the new national health plan with coverage similar to the FEBHP. Income-based subsidies provided to those individuals and families not qualified for Medicaid or SCHIP All health benefits would be portable. to allow them to purchase the public plan or a private health insurance plan.

A small business may receive a refundable tax credit of up to 50 percent of the premium paid for employee coverage if the employer provides a quality plan and pays a meaningful share of the cost. A federal The universal, single-payer system would replace the employerreinsurance plan will be offered to employers in order to offset the costs of catastrophic illnesses that based system. could cause premiums to escalate.

Tax revisions are not explained. The plan does state that by Tax cuts on dividends, capital gains, and on individual incomes over $250,000 to expire in 2010 would shifting to a universal, single-payer system that the savings not be restored. would pay for the new system.

The National Health Insurance Exchange will oversee the private insurance market by establishing rules and standards for participating private plans. Children will be covered under family coverage to age 25. A reasonable share of premiums must be paid out in markets where competition is not adequate. Insurers Private insurance would be replaced by the universal, singlewill be prevented from increasing premiums without justification. Insurers will not be allowed to deny payer public plan. coverage based on pre-existing conditions. Health plans must disclose the percentage of premiums paid for patient care and for administrative costs.

Medicare Advantage plans would be paid the same as regular Medicare. Eliminate the ban on negotiating prices with pharmaceutical manufacturers to save up to $30 billion. Promote generic drugs and allow drug reimportation. Hospitals and providers will be required to report established measures of quality and of costs. Emphasize prevention and enhance funding of school-based and community-based prevention programs. Utilize disease management systems and improve the management of chronic conditions. Reduce malpractice suits by advocating for new models for addressing physician errors and use the antitrust laws to prevent overcharging physicians for malpractice insurance. Insurance competition would be enhanced by the National Health Insurance Exchange and by regulating the percentage of premiums that must be paid out for medical services.

$700 to $850 billion could be saved by improving the nation’s food supply and improving personal eating habits. Specifically, subsidizing organic foods and eliminating sugar and caffeine snacks from schools is included in the proposal.

Each year $10 billion would be invested in the broad adoption of a standard electronic information system including electronic medical records. $77 billion could be saved each year if hospitals and physicians adopt electronic health records. Providers who participate in the new public plans, in Medicare, in FEHB, and in the National Health Insurance Exchange will be rewarded for achieving performance marks established by physician validated outcome measures. Create an Independent Institute to oversee comparative effectiveness reviews and to improve patient safety initiatives. Quality and price transparency will be required of providers and of the health plans. Health disparities will be addressed and health plans will be required to collect and report on health care quality for disparity populations.

Eliminate waste and fraud in the Medicare system. All persons would have access to stress management training to improve the quality of public health. More funding would be made available for HIV/AIDS research, education, and treatment.

The savings generated by shifting to a national, universal, The Obama campaign estimates the total savings resulting from implementing the plan would be up to single-payer system would be more than adequate to cover the $200 billion per year. The estimated cost to implement the plan is $50 to $65 billion per year. costs of the public system.

MetroDoctors

The Journal of the East and West Metro Medical Societies

November/December 2008

17

COLLEAGUE INTERVIEW

A Conversation With

Donald M. Jacobs, M.D.

D

onald M. Jacobs, M.D. is chairman and CEO, Hennepin Faculty Associates. Board certified in surgery and surgical critical care, he received his medical degree from the University of Minnesota Medical School and completed his internship, residency and renal transplant fellowship at Hennepin County Medical Center. He is an Associate Professor in Surgery, University of Minnesota. In addition, Dr. Jacobs currently serves as a West Metro Medical Society Trustee to the Minnesota Medical Association and chairs the Healthy Minnesota Health Care Reform Task Force. He is a director, Association for Surgical Education Foundation; member of the Board of Governors, American College of Surgeons; a Safety Net Coalition representative; a member of the Minnesota Legislature Health Care Access Commission work group on payment reform; and is an appointee, Minnesota Health Care Reform Review Council.

Questions were provided by Drs. Lee H. Beecher, Edward P. Ehlinger, Roger Kathol and Stephanie Stanton.

You have published research about females in surgical specialty: “Female Medical Student’s Perceptions of their Medical School Surgical Experience and the Relationship to Female Faculty Role Models.” What led you to investigate this topic?

In recent years there has been concern that fewer medical school graduates were choosing surgery as a career choice. With a steadily increasing percentage of female medical school graduates, some of my colleagues in the Association for Surgical Education and I decided to explore the factors that might influence women to choose a career in surgery. Role models and mentors, male or female, are critical factors in that choice. We see higher percentages of women choosing surgery as a career when they had a positive female role model during medical school.

Can you describe what you think are the most interesting changes that have occurred as more women enter surgery and surgical subspecialties?

On the positive side, it has made the subspecialty positions more competitive. Applicants for these positions are better than they have ever been. I believe that the overall image of our profession, at least in surgery, is also changing, in a positive sense, with the change in gender mix. Our collective interpersonal skills are improved and we are better “team” players. On the challenging side, data thus far suggest 18

November/December 2008

women on average will not spend as much time in the workforce over their career. That has implications for future workforce needs that are particularly important now as we are looking at significant physician shortages over the next few decades.

What work still needs to be done to bring more women into surgery, especially faculty positions?

I am not sure more needs to be done, per se. The changes are well under way. I believe with time we will see significant increases in women choosing surgical specialties, both clinical and academic.

Would you say the same is true for minority physicians in surgical specialties/subspecialties?

I suspect that the same factors influence the choices of minority physicians. We will see a steady rise in minority physicians choosing surgical specialties as they become a greater percentage of our medical school classes and as they are influenced by inspiring role models when they make their career choices.

How do you balance your personal/family time with your responsibilities in organized medicine, HFA, and being a physician?

That is an area where I can claim no expertise. I am not certain I have always done that well, but I believe it is easier at this point in my MetroDoctors

The Journal of the East and West Metro Medical Societies

career than it was when I was starting out. I have been fortunate to have always had flexibility, love and support from my family and great support and encouragement from my partners.

What advice would you give to young physicians just starting out on this journey?

I would say work hard and pursue your career with passion, integrity, and an open mind. But reach out to experienced colleagues, family and friends when you need to make important decisions about your career path. Though it is often easier to just have that conversation with yourself, important career decisions should not be made in a vacuum.

The five-fold difference in the average incomes of American surgeons and primary care physicians in 2008 affects the career plans of medical students and graduates. How will these income disparities play out in meeting future physician manpower needs and professional education for physicians?

This complex issue should concern all of us in health care. It is not too difficult to see how we reached this point. The markets within health care change fairly rapidly and are driven not just by patient needs but by powerful economic interests. Mix that with a regulatory environment that is stifling and slow and an educational model that is costly yet poorly responsive to the changing demands and you have our current dilemma. Students are fleeing from primary care careers at least in part because they cannot see a way out from under a tremendous burden of school debt.

The mistake we must avoid is to believe there is a quick fix. It will take all of our society’s resolve to create an affordable, reliable and equitable national health care system. The educational models and the reform of payment systems are just two very important pieces of necessary reform. But for reform to work, all the elements must be addressed. We have seen the disastrous results of several decades of partial “fixes,” often at physicians’ and patients’ expense. Physicians must be deeply involved in our future solutions.

As head of the Hennepin Faculty Associates and leader in Minnesota health care reform policy discussions, what ought to be government strategies for substantial improvements in health care access, quality and cost containment?

How do you evaluate Minnesota legislative efforts so far and what needs to be done legislatively?

I believe in 2004 the MMA did a great job in formulating a reform platform, Physicians’ Plan for a Healthy Minnesota. The proposed model has four key features: a strong public health system to reduce the cost of preventable disease and injury; a reformed insurance market that delivers coverage for everyone; a reformed health care delivery market that is transparent and creates incentives for increasing the value of the care we provide; and enhanced systems to support the delivery of high-quality care. These principles were embraced broadly MetroDoctors

The Journal of the East and West Metro Medical Societies

by the majority of stakeholders and became the basis for much of the legislation we have seen to date.

Our legislative efforts to date have been significant, but have been hampered by the economic reality of very steep budget deficits.

Our efforts should be directed at the large amount of collaborative work that needs to be accomplished to make the reform principles realities over time.

HCMC prides itself in a dual mission of providing care for the poor and also as a safety net for emergency care. In your opinion, do these missions sometimes conflict? What are the financial realities impacting HCMC from insurance cost-shifting and current state and federal health care funding for the poor?

Our mission at HCMC is to provide the best possible care to every patient we serve every day; to search for new ways to improve the care we will provide tomorrow; to educate health care providers for the future; and to ensure access to health care for all. Providing health care, regardless of ability to pay, and providing emergency and other unique critical care services are very important roles we play as a safety net provider to the state of Minnesota. These roles are not in conflict but are all threatened by continued cuts to state and federal programs. Over 70 percent of our patients depend upon those programs, and we are seeing greater numbers of uninsured and underinsured patients every year. HCMC and HFA have become very cost-effective, high-quality providers and our outcomes for critically ill and injured patients are unparalleled in this state. We are putting enormous efforts into additional quality and service improvements in all of our clinical programs. But we will remain vulnerable if further erosion of financial support to our patients and our safety net programs occurs at the state and federal levels. This should be of concern to all Minnesotans.

Generations of physicians completed a rotating internship at Hennepin County Medical Center or Minneapolis General Hospital. Most of these physicians attest to the quality and value of this varied and intensive exposure to medical practice. In recent years, how have HCMC internship experiences been modified to accommodate residency training — what is gained and what is lost with early specialization?

The breadth and depth of capabilities within health care are growing at a tremendous rate. That has pressured training programs to narrow either focus or experience to fit the educational process into the time allotted by our federal funding mechanisms. What we have gained is a health care work force with the greatest capabilities in the world. The knowledge, innovation and progress have been staggering...and very expensive. What we have lost in many areas is a breadth of knowledge and experience in some of the “basics.” To overcome this we have to become much better at managing care in teams and as a system. To

(Continued on page 20)

November/December 2008

19

Colleague Interview (Continued from page 19)

date it appears our ability to create new knowledge and capabilities has outpaced our ability to restructure our systems into highly reliable, affordable and economically viable care models.

How has the change in governance of HCMC affected (if at all) the services it offers and its relationship to HFA? Hennepin Healthcare System, Inc. was created in Minnesota state statute two years ago to allow Hennepin County to move the governance of the hospital to a non-profit public benefit corporation with a citizen’s board. Our mission has remained the same, but our ability to manage this complex business through challenging times has improved significantly. This benefits Hennepin County, HCMC and HFA. We are strong and committed strategic partners in that mission.

How does HFA relate to the University of Minnesota medical training programs? What role does it play?

Most of HFA’s 320 physicians and dentists have academic appointments at the University of Minnesota and participate in the education of graduate and post-graduate trainees. In addition, HCMC has its own training programs in surgery, internal medicine, emergency medicine, and family medicine, and shares a psychiatry residency program with Regions Hospital. The majority of our faculty members join our organization because of their strong commitment to education and research as well as their role as a safety net provider. We partner with the University of Minnesota in that mission, and take very seriously our role in training physicians and other providers to meet the health care needs for our entire state.

What problems and challenges do you see in achieving effective statewide policy for coordinated physician and institutional responses to large-scale medical emergencies and public health events? How are we doing?

Minnesota has been a leader in emergency preparedness. We are well ahead of most states in being able to respond with coordination between our providers, institutions, emergency responders and the public. As has often been the case, however, the funding to support mandated preparation is inadequate. I believe we must enhance the financial support to our state public health systems and give those systems the resources necessary to ensure our preparedness.

What’s the optimal role that component medical societies play in advancing high quality medical care in Minnesota?

I think the most important role of our component medical societies is to get the physicians of Minnesota engaged in the stewardship of our profession. Together we are much stronger (and more effective) than we are alone. Component medical societies should provide the forums to hear all voices, to share all concerns and to advocate, not just for the health of our profession, but for the health of our citizens. I think we can do a better job of this in the future and can utilize the rapidly developing communication technologies to reach as many physicians as are willing to engage.

Thanks for giving me the opportunity to have this dialogue with my colleagues.

20

November/December 2008

MetroDoctors

The Journal of the East and West Metro Medical Societies

SPECIALTY UPDATE

Dermatology Isn’t What It Used to Be

J J J

J

Therapies that cure with the power of light.

“Facelifts” that require no surgery at all.

Treatments that activate the immune system to fight skin conditions.

Surgical techniques that remarkably decrease scarring and promote healing.

These and many more groundbreaking discoveries mean dermatology is a far cry from what you studied in medical school back in the day.

Continue reading for an overview of the breakthroughs that can make a remarkable difference in the quality of life for your patients.

A Photo Finish for Acne and Pre-Cancerous Lesions

If you think Acutane is the best way to treat acne, and the only way to treat a large area of pre-cancerous lesions is through topical chemotherapy, think again. A single treatment with ALA Blu-U photodynamic therapy can make a remarkable difference without the side effects of Acutane or the ugly outbreaks of topical chemotherapy.

Here’s how it works: a topical photosensitizing agent called 5-aminolevulinic acid (ALA) is applied to the skin. Abnormal skin cells absorb the ALA more rapidly and convert it to protoprophyrn-9. When exposed to blue light, this substance produces free radicals that

By Phil M. Ecker, M.D., and Jaime L.W. Davis, M.D., FAAD

MetroDoctors

selectively destroy abnormal cells and leaves normal skin alone. The skin is treated first with the ALA, with a contact time ranging from three minutes to 18 hours (typical incubation is one-two hours). Then, it is exposed to the Blu-U for five to 16 minutes, depending on the condition being treated, the thickness of skin, and the patient’s age.

Sun-damaged skin with telltale flakiness, actinic keratoses, skin cancers and pigment conditions can be effectively treated with ALA Blu-U in as little as one session. There have also been excellent outcomes with acne and rosacea. Most patients see significant changes in the condition of their skin with just one or two treatments.

Although ALA Blu-U photodynamic therapy is not yet approved by the FDA for anything but actinic keratoses, it should be shortly, as it offers a faster, healthier, and sometimes more effective alternative to traditional treatments for acne, pigmented lesions, and other inflammatory conditions of the skin.

Youthfulness in a Bottle

While the look may make supermodels rich, withdrawn faces and sunken cheeks, it can also give a sickly and older appearance.

The characteristics of lipodystrophy that are typical outcomes of diseases like HIV can be corrected.

The Journal of the East and West Metro Medical Societies

Fortunately, a few injections of facial fillers such as Sculptra or Juvederm can provide volume and lift without surgery, a remarkable contrast to a surgical facelift’s tight and pulled appearance.

Most fillers, which are made with hyaluronic acid, last up to a year. This acid is a natural complex sugar found in all mammals and is a major component of the connective tissue matrix in the dermis. As skin ages and is exposed to pollutants and the sun, cells lose the ability to produce hyaluronic acid. Fillers can temporarily replace this lost acid and restore the skin’s volume and smooth, natural appearance, as hyaluronic acid can absorb more than 1,000 times its weight in water. This helps to attract and maintain water within the extracellular space, hydrating skin and increasing its volume and density. Examples of such fillers include Juvederm and Restalyne.

In contrast, Sculptra, which can last years, is comprised of poly-L-lactic acid. This is synthetic, yet biocompatible and biodegradable. It has been used for almost a decade in Europe for minimizing scars and wrinkles; it was approved by the FDA in 2004 to treat lypodystrophy.

Poly-L-lactic acid is biocompatible and biodegradable. In essence, it works by causing the skin to produce collagen and plump up the area where it has been injected.

Meanwhile, there is one product on the market that is touted to last forever. That’s Artefill. It’s made from the collagen of healthy calfskins. The actual bovine collagen disintegrates, but that’s when microspheres called polymethyl methacrylate (PMMA), suspended in the collagen solution with lidocaine, start (Continued on page 22)

November/December 2008

21

Dermatology Update (Continued from page 21)

Healed! Inflammatory Skin Conditions Disappear in a Flash

working their magic. Artefill uses the body’s natural ability to encapsulate foreign bodies; in about three months connective tissue forms around the microspheres, making wrinkles disappear. PMMA has been used since the early ’30s for common procedures such as dental prosthesis, bone repair, and pacemakers.

Well, almost. The PHAROS-EX-308 Excimer phototherapy laser uses focal, concentrated ultraviolet light to heal local outbreaks. It is an effective treatment for inflammatory skin conditions such as localized alopecia areata, dermatitis, psoriasis, vitiligo, and lichen planus. Ultraviolet light has been used to treat inflammatory skin conditions for years; however, patients have to stand in a booth for treatment or have the light administered via a hand or foot unit, exposing even their healthy skin to UV rays. The PHAROSEX-308 laser targets only the areas affected by the condition; sparing the rest of the body from the impact of UV radiation as well as providing more concentrated treatments. The laser’s small, easy-to-use hand piece hones in on hard-to-reach areas such as knees, elbows, and scalp — the most common places for psoriasis to occur. This laser treatment is extremely effective and is covered by insurance nearly ubiquitously for psoriasis. Other aforementioned inflammatory skin conditions are often covered as well.

Even better, the PHAROS-EX-308 requires treatments that are just a few minutes long twice a week for four to six weeks. In contrast, approximately 30 weeks of treatments lasting at times 30 minutes each are required with more traditional UV therapies.

The PHAROS-EX-308 is a medical breakthrough, as psoriasis and related conditions can be very debilitating; topical treatments are not always as effective or their use is limited by side effects. Unlike other treatments, which can thin, bruise and prematurely age skin, there are minimal side effects with the PHAROS-EX-308 and treatment is virtually painless — at most, patients will experience just a little warmth.

No Sweat — Botox for Hyperhidrosis

Botox isn’t just for crow’s feet anymore. It’s a prayer answered for people who have hyperhidrosis. To control sweating, Botox is injected into the armpits, palms, soles, groin area — anywhere excessive sweating is an issue.

Shots can be painful, so find a dermatologist who can provide effective topical anesthetics and has a board-certified anesthesiologist or properly trained dermatologist available for nerve blocks. One treatment can last eight to 12 months.

Botox for hyperhidrosis is often covered by insurance and can make a real difference for people with this debilitating condition who are refractory to or cannot tolerate more traditional approaches.

Announcing A New

WEB FORUM MetroDoctors Discussion Site

East Metro and West Metro Medical Societies are launching a Web forum this fall! The forum will be part of our Web site, www.metrodoctors.com, and it will be a central location for discussions related to legislative issues, local health care matters, upcoming society events, the MMA Annual Meeting, and more. We encourage all members to sign up and start using the forum, once it becomes available, for communication with your colleagues. If you have any comments or questions about the new forum, please contact Katie Snow at (612) 362-3704 or KSnow@ metrodoctors.com. We are eager to hear your thoughts on this new aspect of our Web site.

22

November/December 2008

Gentle on Kids, Hard on Skin Problems

When it comes to treating children, less is more. Their issues, like psoriasis or molluscum, MetroDoctors

are benign but challenging to live with. In adults, it’s easy to scrape away skin issues like molluscum; you can’t do that with kids, it’s just too traumatic. However, topical treatments like Aldara, usually applied three times a week for several weeks, activate the immune system to make the molluscum disappear. No scraping or cutting is necessary. A new injectable pharmaceutical, Enbrel, among other biologics, helps the body help itself by targeting a cytokine central to many inflammatory conditions, particularly psoriasis: TNF-alpha. A recent study published in the New England Journal of Medicine outlined the impressive efficacy and safety of this medication in children. The medication has been used for over a decade in adults with similar efficacy and safety data.

Treatments such as the Excimer Laser and the new biologic medications can gently rid children of psoriasis and other skin conditions safely and effectively.

Expertise for Less Surgical Scarring

If you want to ensure that your patient has less scarring and faster healing from surgery, consult with a dermatologist. Derm surgeons are constantly staying abreast of the latest techniques, such as Mohs micrographic surgery, that take out as little healthy skin as possible, while removing cancerous tissue. Here’s how it basically works: a biopsy is performed to confirm the diagnosis of skin cancer. For high-risk areas such as the face, Mohs surgery is often indicated. The patient’s tumor is outlined clinically and removed without safety margins, unlike the traditional approach to treatment.

The specimen is then mapped and sectioned in such a way that the entire margin is visualized via frozen technique. If any margin is involved, the derm surgeon is able to identify exactly where this is on the skin, and remove just this additional area of diseased skin, without removing healthy skin on the other side of the defect. Instead of taking the traditional margins, which often leads to larger defects and therefore larger scars, Mohs surgery allows precise, pathology-directed treatment, and is proven to in fact impart higher cure rates (98 percent for primary basal cell carcinoma, for example) than the traditional technique.

Derm surgeons are also experts in repairing the defects that ensue from Mohs surgery.

In many cases, primary closures are not appropriate or ideal for a good aesthetic outcome.

Flaps and grafts are often implemented to

The Journal of the East and West Metro Medical Societies

Great Guy. Great Dermatologist.

provide the best aesthetic and functional result.

In ďŹ&#x201A;aps, healthy skin is borrowed from adjacent areas and translocated, rotated, or transposed into place, unlike grafting where skin is actually removed completely from another area and sewn into the defect. Both ďŹ&#x201A;aps and grafts are commonly performed by the derm surgeon and can lead to a vastly superior result.

The bottom line is that Mohs surgery and advanced repairs leave the smallest defect and the smallest scar while providing instant feedback that the tumor has been successfully removed, ensuring optimized results and prognosis.

The Best Care Possible

There have been many advances in the ďŹ eld of dermatology, some of which have been listed here. These improvements in care and effectiveness are likely to continue into the foreseeable future. Dermatologic solutions to cutaneous challenges will become an increasingly important part of our patientsâ&#x20AC;&#x2122; care, especially as baby boomers reach retirement age and beyond.

Phil M. Ecker, M.D. Family Man

Phil M. Ecker, M.D. Dermatologist

Care for your skin.

Uptown Row, Suite 208 & 1221 W. Lake Street & Minneapolis, MN 55408 612-455-3200 & www.UptownDermatology.com

Phil M. Ecker, M.D., and Jaime L.W. Davis, M.D., FAAD, Uptown Dermatology & SkinSpa.

:. <+ 52*+4 %'22+? .

>

3'/2 952;:/549 (/22/4-(;**/+9 )53 &+( === (/22/4-(;**/+9 )53

$42/3/:+* 2+):854/) 2'/39 $42/3/:+* 4*/</*;'2 2'/39 ":':;9 47;/8? $42/3/:+* 4*/</*;'2 2/-/(/2/:? 47;/8? 6'?+8 9;8).'8-+ 3'? '662? $42/3/:+* '6+8 2'/39 $42/3/:+* 2+):854/) !+3/::'4)+ *</)+ =.+4 '<'/2'(2+ ,853 6'?+8 $42/3/:+* "+)54*'8? 2'/39 85)+99/4- 4</8543+4: " 5

#.+ 359: 68+99/4- /99;+ /44+95:' *5):589 '8+ ,')/4- /9 (+)53/4-

&'4: ' )56? 5, :.+ +2+):854/) 2'= )5362/'4: =/:. 5, :.+ +2+):854/) :8'49'):/549 (? &+ .'<+ ?5;8 ,'): 9.++: 9:8'/-.: ,853 :.+ ":':+ 5, 952;:/54 ,58

6+8 354:. , ?5; 9++ 6':/+4:9 6+8 *'? :./9 =/22 9'<+ /44+95:' ;9: +3'/2 ;9 ': :.+ '(5<+ ?5; 354+? 54 )2'/39 '254+ 45: :5 3+4:/54 :.+ 5:.+8 :8'49'):/549 /<+ ;9 '**8+99 '4* =8/:+ /44+95:' '= /4 ' )'22 :5*'? ': &+Âś22 -+: ?5; 9:'8:+* :Âś9 :.': +'9? :.+ 9;(0+): 2/4+ &+ =/22 68536:2?

9+4* ?5; ' )56? (')1

MetroDoctors

The Journal of the East and West Metro Medical Societies

November/December 2008

23

President’s Message

The EMMS and the MMA PETER B. WILTON, M.D.

THE RELATIONSHIP BETWEEN the Minnesota Medical Association (MMA) and its component

EMMS Officers

President Peter B. Wilton, M.D. President-elect Ronnell A. Hansen, M.D. Past President V. Stuart Cox, M.D. Treasurer Thomas Siefferman, M.D. EMMS Executive Staff

Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Katie R. Snow, Administrative Coordinator (612) 362-3704 ksnow@metrodoctors.com Doreen M. Hines, Manager, Member Services (612) 362-3705 dhines@metrodoctors.com For a complete list of EMMS Board of Directors go to www.metrodoctors.com.

24

November/December 2008

societies is a close one. The membership of the component societies comprises the membership of the state organization; we collect dues in tandem; our members constitute the various boards and committees of the MMA; and we provide the MMA with policy initiatives from the medical community for their consideration and action.

There is a certain amount of healthy dynamic tension in this relationship. Despite the similarities, there are differences of purpose between these two organizations — were this not so, there would be no need for component societies. The primary focus of the East Metro Medical Society (EMMS) is on issues that affect our membership in the East Metro. While many of the larger statewide and national medical issues are of great concern to our physicians and patients, there are also situations specific to our members that are not relevant to doctors elsewhere in the state, just as local issues affecting distant communities are beyond the purview of the EMMS. The MMA, on the other hand, necessarily concerns itself with statewide problems, and is the major voice of the profession in the state legislature. These differences, however, are a matter of focus rather than of substance; our larger goals of improving the practice of medicine and the health of our community are entirely aligned.

The past legislative session highlighted the need for cooperation between the MMA and its component societies. During the health care reform debate, events moved rapidly and timely communication between the MMA and the component societies was difficult as decisions regarding policy positions had to be made on a daily basis. At times during the negotiations between the House, the Senate and the Governor, the views of some members of the EMMS differed from the MMA position, and some members took their own views to the legislators. Ideally, there should be a mechanism for dissenting views to be made known to our legislators along with the primary policy position taken by the MMA. The physician community is not monolithic, and it should come as no surprise to our legislators that more than one medical opinion exists.

Against this backdrop, the MMA is currently investigating means to improve the interaction between itself and the component societies, with the intent of improving alignment and cooperation. While cooperation is necessary and desirable, there is a danger that alignment might be misinterpreted in a way that is stifling of minority opinion. I believe that these opinions are important, and need to be heard. If they are not, those holding such opinions will feel themselves disenfranchised and will invest their energies elsewhere, to the detriment of organized medicine.

Your society is a very active and robust organization in relation to the size of its membership.

Our strength is due to the enthusiasm and advocacy of its members, who appreciate the responsiveness of the smaller organization and believe it is an excellent vehicle for accomplishing change for their patients and their practices. On any issue of importance there is always impassioned debate with strong opinions freely expressed, and many members give countless hours of their time to attend meetings and advocate for health-related issues with representatives and leaders of the health care community. Their engagement is crucial to our future as an organization, and to the voice of the profession in the health care debate. Any restructuring of the MMA/EMMS interface should encourage this engagement, and protect the diversity of opinion of our membership.

MetroDoctors

The Journal of the East and West Metro Medical Societies

A Community Approach to Advance Care Planning — 2nd Meeting Held

T

(Continued on page 26)

Eric Anderson, M.D., medical director of Allina’s Palliative Care program asks a question during the September 10 luncheon. From Left: Brock Nelson, CEO of Regions Hospital (representing HealthPartners and Regions Hospital); Gayle Mattson, vice president of Allina’s Palliative Care program; Howard Epstein, M.D., medical director of Blue Cross and Blue Shield of Minnesota; Eric Anderson, M.D., from Allina’s Palliative Care program; Mary Lou Irvine, director of HealthPartners Hospice of the Lakes; Jim Guyn, M.D., medical director of Medica Health Plan; and Craig Christianson, M.D., associate medical director from UCare.

MetroDoctors

The Journal of the East and West Metro Medical Societies

November/December 2008

25

Metro Medical Society

Bud Hammes, Ph.D., ethicist and director of Respecting Choices©.

stated that their organization “could those who were actually in not do this alone” and suggested the trenches working with that a community-wide approach patients on advance care was a plausible solution. Others in planning, but it was quite attendance believed that it would be another to have that same important to identify key partners level of support from the early on with this project including most senior leaders from ICSI and other organizations. the hospitals and health Participants were asked to complans. It was then that we plete a questionnaire before they left decided to host the second the conference which would help to meeting. ascertain the interest level of conThe September meetKent Wilson, M.D., presiing attracted CEOs and dent of EMMS Foundation tinuing forward with this project.

Their responses are listed below: senior administrators from addresses the group of 1) In your personal opinion, do you metro area hospitals as well over 30 at the Town & feel that advance care planning is as senior administrative Country Club. an area that your health care system leaders from the major could agree to not compete? health plans. Others who attended included Answer: Yes (unanimous) board members from the East Metro Medical Society Foundation as well as leaders from 2) Would you be willing to return to your the West Metro Medical Society. Those in athealth care system and encourage their tendance represented 13 hospitals or hospital participation in collaborating on this systems and four health plans. project?

Keeping with tradition of the first comAnswer: Yes (unanimous) munity-based meeting, the second meeting 3) May we contact you within two-three was facilitated by Dr. Kent Wilson, president weeks to determine whether your organiof the East Metro Medical Society Foundation zation would want to participate in this and Dr. Bud Hammes, ethicist and director of project?

Respecting Choices© from Gundersen Lutheran Answer: Yes (unanimous) which is based in LaCrosse, Wisconsin. The Please contact Sue Schettle, EMMS CEO group listened to Dr. Hammes present the at (612) 362-3799, or e-mail: sschettle@metroadvance care planning community approach doctors.com with any questions. Please look for concept that helped him and others to create more updates in future issues of MetroDoctors the impactful Respecting Choices© model in and on our Web site, www.metrodoctors.com.

LaCrosse.

After listening to Dr. Hammes and others for approximately 45 minutes, one participant

East

he East Metro Medical Society Foundation hosted a community-wide conference on September 10, 2008 at the Town & Country Club in St. Paul. This conference was the second such conference in as many months held in the Twin Cities dealing with the concept of developing a community approach to advance care planning.

Some of you may have read this section in the September/October issue of MetroDoctors.

If so, you will recall that the EMMS Foundation hosted a community conference in August that targeted organizations representing the hospice community, senior groups, health plans, hospitals, the religious community and many others. The meeting was a success in terms of attendance and support for the community-based approach related to advance care planning, but we soon realized that more was needed to be done. We came to appreciate the fact that it was one thing to have the support of

Advance Care Planning (Continued from page 25)

There have been many questions posed to staff during the past few months. To clarify the purpose of the Advance Care Planning project, a number of common questions are responded to below.

Doesn’t every hospital or health care facility already have an advance care planning program in place?

Yes, they most likely do. What is being proposed is that we develop a common community standard by which we address the issue with patients so that it becomes the norm in how we care for them. Common training techniques, common forms, common questions and approaches can be employed.

Training could be offered locally to make it more convenient for participants.

The POLST form has already been created; wouldn’t this be a duplicative effort?

We are proposing to work to help educate families and care providers about the various aspects of advance care planning so that when the time comes that the information to complete the necessary forms are in place.

Is the Respecting Choices© model the best option?

We don’t know yet if the Respecting Choices© model is the best fit for what we’re proposing to do here in the Twin Cities. We don’t know what all of our needs are yet, and we do not

propose that we adopt any one model over another. We do know, however, that this particular model is proven and can be a framework from which we can build upon.

Should ICSI be involved?

We are optimistic that they would be interested in working with us on this project. Dr. Kent Wilson, president of the EMMS Foundation, Sue Schettle, CEO of EMMS and Jack Davis, CEO of WMMS recently met with the new CEO of ICSI, Kent Bottles, M.D. The result of the meeting was that we agreed to meet again and to develop a high level framework for what a relationship with ICSI would look like. We are hopeful that a partnership can be formed.

Many of the hospitals are west metro based. Is the West Metro Medical Society interested in this project?

Peter Wilton, M.D., EMMS president listens to Congresswoman Betty McCollum address a group of EMMS physicians at a recent breakfast meeting in St. Paul.

Save the Date

Henri G. Minette joins the EMMS Foundation board as an At-Large Director. He is a partner with Lockridge Grindal Nauen and is a cum laude graduate of the University of Minnesota Law School, where he was a member of the Minnesota Law Review.

Mr. Minette also holds a masters of public health degree in health care administration and planning and a certificate in urban planning. Mr. Minette practices in the areas of health care and corporate law and regularly advises the firm’s health care clients on partnership and employment agreements, as well as compliance with federal and state regulations governing health care providers.

2009 East Metro Medical Society Winter Gala and Annual Meeting

North Oaks Golf Club 54 East Oaks Road, North Oaks

Michael M. Hummel, M.D. is an interventional radiologist from St. Paul Radiology in St. Paul. He joins the EMMS Foundation board of directors as a Director. Dr. Hummel completed his medical degree at Ohio State University College of Medicine and his residency and fellowship at the University of Nebraska Medical Center.

Thursday, January 22, 2009 Social Hour – 5:30-6:30 p.m.

Dinner – 6:30-7:30 p.m.

Program and Awards to Follow

Nate Wayne, CPA also joins the EMMS Foundation board as an At-Large Director. Mr. Wayne is a principal of DS&B and is in charge of their extensive health care practice.

He brings to the foundation his skill and experience working in health care consulting.

Mr. Wayne has a B.S. from the University of Minnesota and an M.S. from St. Cloud State University. He is an active member of the American Institute of Certified Public Accountants and the Minnesota Society of Certified Public Accountants.

November/December 2008

DFL Congresswoman Betty McCollum attended a breakfast meeting on Friday, August 22 at the Louisiana Café in St. Paul with a handful of East Metro Medical Society physicians and staff. Congresswoman McCollum represents Minnesota’s fourth district and is in her fourth term in Congress.

Physicians who attended the breakfast meeting included Peter Wilton, M.D., Ron Hansen, M.D., Bob Moravec, M.D., and Peter Bornstein, M.D. EMMS staff members included Sue Schettle and MMA staff included Dave Renner and Dennis Gerhardstein. Issues that were discussed included medical tourism, training for physicians treating veterans with traumatic brain injuries, Medicare, electronic health records and the increased security needed as a result of the Republican National Convention.

Yes, they are interested in being a key partner with the East Metro Medical Society as we move forward on this project. We understand the need to have this project be metro focused and we plan to do just that by our partnership with WMMS.

EMMS Foundation Has Three New Board Members

26

Congresswoman McCollum Meets With Physicians and Staff

Installation of Ronnell A. Hansen, M.D. as the 139th President of East Metro Medical Society.

MetroDoctors

The Journal of the East and West Metro Medical Societies

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

Active Babek Adili-Khams, M.D. Debreceni Orvostudomani Egyetem, Hungary Family Medicine

Jeannette I. Keifert, M.D. University of Minnesota Medical School Family Medicine Family HealthServices MN–Woodbury John M. Kuzma, M.D. University of Minnesota Medical School Psychiatry Regions Hospital Calley A. Lidle, M.D. University of Minnesota Medical School Pediatrics Pediatric & Young Adult Medicine, P.A. Shaban Nazarian, M.D. University of Missouri, Columbia Pediatrics/Internal Medicine Fairview Ridges Clinic Kristopher H. Olson, M.D. Rush Medical College Anesthesiology/General Surgery Avina K. Singh, MB, BS Grand Medical College and Sir JJ Group of Hospitals, India Medical Oncology/Hematology Minnesota Oncology Hematology, P.A. Margaret E. Spartz, M.D. University of Minnesota Medical School Occupational Medicine Stillwater Medical Group Marlieke Van Tyn, M.D. University of Minnesota Medical School Pediatrics Pediatric & Young Adult Medicine, P.A.

MetroDoctors

Lavanya Bellumkonda MB, BS Kakitiya Medical College, Vijayawada University of Health Sciences, India Jayashri Bhaskar, M.D. Kasturba Medical College, Mysore University, India Joshua I. Bleier, M.D. University of Pennsylvania Colorectal Surgery Colon & Rectal Surgery Associates, Ltd. Elena Bond, M.D. Oregon Health Services University School of Medicine Pediatrics

Thao T. Marquez, M.D. University of Minnesota Medical School General Surgery Caridad Martinez, M.D. Carolyn A. McClain, M.D. Johns Hopkins University School of Medicine Emergency Medicine Emergency Physicians Professional Association Benjamin J. McKinley, M.D. University of Minnesota Medical School Cardiovascular Disease/Internal Medicine St. Paul Heart Clinic, P.A. Keiichiro Narumoto, M.D. University of Tsukuba, Japan Johan Nordenstam, M.D. Rush Medical College

Jacalyn F. Chaffee, M.D. Creighton University School of Medicine Internal Medicine HealthPartners Maplewood Clinic

Katharine S. Park, M.D. University of Minnesota Medical School Anatomic, Clinical Hematopathology Hennepin County Medical Center

Jason M. Como, M.D. Ross University School of Medicine, Dominica Family Medicine West Side Community Health Services –East Side Family Clinic

Megan M. Popp, M.D. Physical Medicine & Rehabilitation

Endea J. Curry, M.D. University of Minnesota Medical School Amanda V. Engstrom, M.D. University of Minnesota Medical School Pediatrics Julie E. Hanna, M.D. Indiana University School of Medicine Neurology Minnesota Epilepsy Group, P.A. Cherrie Heinrich, M.D. Loma Linda University Plastic Surgery/Hand Surgery Jurek R. Huszczo, M.D. Wayne State University School of Medicine Christopher T. Kodl, M.D. University of Iowa College of Medicine Endocrinology/Internal Medicine HealthPartners Specialty Center

Rosemarie B. Ramirez, M.D. University of Minnesota Obstetrics/Gynecology Elizabeth Raskin, M.D. University of Nevada School of Medicine Salima Shafi, M.D. AGA Khan Medical College, Pakistan Cardiology/Internal Medicine St. Paul Heart Clinic, P.A. Steffini Stalos, D.O. University of Texas Southwestern Medical School Pathology Alicia M. Turenne, M.D. Tufts University School of Medicine Family Medicine Family HealthServices MN–Afton Road Khuong M. Vuong, M.D. University of Minnesota Medical School Internal Medicine

Resident Physicians Aaron M. Burnett, M.D. Emergency Medicine Regions Hospital Sarah E. Carlson, M.D. Family Medicine Abbott Northwestern Hospital Autumn M. Erwin, M.D. University of Minnesota Medical School Emergency Medicine Regions Hospital Alexander J. Gerbig, M.D. University of Minnesota Medical School Emergency Medicine Regions Hospital Kara S. Kim, M.D. University of Minnesota Medical School Emergency Medicine Regions Hospital

Resident Physicians (University of Minnesota) Anasooya A. Abraham, M.D. University of Minnesota Medical School Surgery Trevor Anderson, M.D. University of South Dakota Physical Medicine & Rehabilitation Emily M. Bezek, M.D. University of Minnesota Medical School Orthopaedic Surgery Nicole Birge, M.D. University of Kansas School of Medicine Pediatric Neonatology Nathan R. Brever, M.D. Family Medicine Joseph A. Browning, M.D. University of Minnesota Medical School Internal Medicine Reuben Chen, M.D. University of California, Irvine Physical Medicine & Rehabilitation Amy J. Engebretson, M.D. University of Minnesota Medical School Obstetrics/Gynecology Nicholas D. Frank, M.D. Diagnostic Radiology Preston J. Hatlestad, M.D. Family Medicine

Matthew J. Logan, M.D. University of Minnesota Medical School Family Medicine

The Journal of the East and West Metro Medical Societies

November/December 2008

27

Metro Medical Society

David B. Hale, M.D., Ph.D. University of Hawaii School of Medicine Emergency Medicine Woodwinds Health Campus

Farsad Afshinnia, M.D. Faculty of Medicine, Isfahan University, Iran Internal Medicine St. Joseph’s Hospital

East

Karin I. Armstrong, M.D. Temple University School of Medicine Medical Oncology/Hematology Minnesota Oncology Hematology, P.A.

1st Year Active Practice

PRESIDENT’S REPORT

Lessons and Lure of the Lunker EDWARD P. EHLINGER, M.D., MSPH

WMMS Officers

Chair Richard D. Schmidt, M.D. President Edward P. Ehlinger, M.D. President-elect Peter J. Dehnel, M.D. Secretary Melody Mendiola, M.D. Treasurer Eric G. Christianson, M.D. Immediate Past Chair Anne M. Murray, M.D. WMMS Executive Staff

Jack G. Davis, Chief Executive Officer (612) 623-2899 jdavis@metrodoctors.com Jennifer Anderson, Project Director (612) 362-3752 janderson@metrodoctors.com Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Kathy R. Dittmer, Executive Assistant (612) 623-2885 kdittmer@metrodoctors.com For a complete list of WMMS Board of Directors go to www.metrodoctors.com.

I WAS NEARING THE END of an early evening walk around Lake Harriet when I noticed a large crowd assembled close to the shore. Given the rash of violent events that had occurred in the city during the previous several months, my fear was that I was going to come upon another urban tragedy.

Moving closer, my fear dissipated as I sensed an excitement and a sense of community in the air that was palpable and contagious. I hadn’t observed that unique emotion in the city very often. I had felt it when the Twins won the World Series in 1987 and 1991 and I had felt it at times during big snow falls when people were helping each other cope with winter’s fury. It was the feeling of community that grows out of shared experiences; that sense of unity among diversity that springs from our primal desires to be connected with other people and be part of a community.

When I reached the crowd I could see that they were watching a fisherman trying to land a fish. From the bend in his pole and the energy that he was expending, it was obvious that he was connected to a very large fish. From the strain on his face and the fatigue evident in his movements, it was also obvious that they had been connected for a long time. One observer shared that the fisherman had been “playing” the fish for over 30 minutes.

The drama and the sense of anticipation were overwhelming. I decided to stay for the conclusion of the struggle.

The setting sun was turning the sky into a glowing canvas of orange, pink and gold. The surface of the water was becoming steely blue-gray with silver sparkles emanating from the tiny waves being generated by the gentle summer breeze. The details of the fisherman were slowly being obscured in the fading daylight and replaced with the hazy outline of a man who appeared to be gracefully directing the music of the muses of Lake Harriet or partnered in a dance with a mystical and unseen spirit. The real-life drama taking place before the onshore audience had the qualities of a cinematic dream — a slow-motion metaphorical depiction of life’s ongoing struggles.

For another 15 minutes the struggle and the drama continued. Back and forth the advantage shifted between fisherman and fish. The occasional lull in the fish’s efforts allowed the fisherman to reel in several yards of line. But, just when the man thought that he was getting the upper hand, the fish would find the energy to recapture the momentum and the length of line that had been lost. The duel continued until the skill and the strength of the fisherman finally yielded him the advantage over the exhausted fish. While continuing its now futile struggle, the fish was slowly pulled inch by inch toward shore. A final surge of energy by the fish was met with unyielding pressure by the fisherman — the contest was over.

As the fish was pulled into shallow water, I could see that it was an enormous muskellunge of well over four feet in length. I could also see that the final pull on the line had broken it but the fish was too exhausted to swim away.

The fisherman reached down and gently held the fish. Without taking the fish from the water he carefully removed the lure. The man and the fish then looked at each other for a long time. Both were exhausted but the excitement of the struggle could still be seen in their eyes.

Admiration for each other was also apparent in their interaction. The man leaned close to the fish and whispered, “Thank you.”

The fish was then released and after a few seconds began to slowly swim away. After reaching slightly deeper water the fish turned and looked at the man for several moments. It was obvious to me that the fish was also saying thank you, not only for being released but for the quality of (Continued on page 29)

28

November/December 2008

MetroDoctors

The Journal of the East and West Metro Medical Societies

Chair’s Report (Continued from page 28)

O

n August 12 members of the Sr. Physicians Association and their guests gathered for the annual Summer Get-Together, starting with lunch at Pracna on Main — Historic Dining Saloon. This is the oldest restaurant on the oldest street in Minneapolis featuring a beautiful scenic view of the river. A tour of our lovely city of Minneapolis followed aboard two Twin City Trolleys.

The September 16 luncheon welcomed former Senator David Durenberger as our speaker where he addressed “Health Policy and Physician Leadership.”

If you are a member of the West Metro Medical Society, age 62 years or older, or may have just retired, we invite you to become a member of the Sr. Physicians Association and take advantage of the mutual support, the social opportunities of meeting with your peers, and the opportunity to hear informative and interesting talks. For more information, contact Kathy Dittmer, executive assistant, at (612) 623-2885 or kdittmer@ metrodoctors.com.

In Memoriam GAIUS JACKSON SLOSSER II, M.D. died peacefully at home on August 27, 2008. He was 74. He graduated from Case Western Reserve University School of Medicine in Cleveland in 1959. He completed his internship and residency in obstetrics and gynecology in 1965, and then joined the medical staff at the St. Louis Park Medical Center. Soon after he was drafted into the United States Army. He served as a Captain in the Medical Corps in Fort Knox, KY, from 1966-1968. In 1968 he returned to Minneapolis and ultimately joined OB-GYN West P.A. He served as Chief of Staff at Methodist Hospital in St. Louis Park. He volunteered in free clinics and, as an adjunct professor, helped provide practical training for scores of University of Minnesota students.

MARIO P. PLIEGO, M.D., died at his home August 8, 2008 at the age of 79. He graduated from Facultad de Medicina de la Universidad Autonoma de Puebla in 1956. He moved to the United States in 1957 to complete an internship in Sioux Falls, SD. He completed his residencies in radiology in Connecticut and Ohio. He went on to lead a long and distinguished career at HCMC as assistant chief of Radiology and as staff radiologist at the Minneapolis VA Medical Center. He was also appointed assistant professor of Radiology at the University of Minnesota. Dr. Pliego was widely admired and respected for his diagnostic acumen, his knowledge in medicine and his eagerness to teach. The greatest joy in his career was teaching radiology.

He received the Outstanding Teacher Award in 1992 from the Department of Radiology, U of M. MetroDoctors

The Journal of the East and West Metro Medical Societies

All aboard! Senior Physicians enjoy a tour of the city on Twin City Trolleys.

Robert Doan, M.D. (right) welcomes guest speaker, Senator David Durenberger, to the September meeting of the Senior Physicians Association.

November/December 2008

29

W e st M e t r o M e d i c a l S o c i e t y

the encounter. Then, with one great flick of its tail, the fish was gone.

The crowd began to applaud. Many of the spectators had tears in their eyes.

As I walked up the hill to my house, I felt that I had been given a valuable gift. In the state’s largest city, which was experiencing a violent year, I had observed something that changed my perspective on urban life. I had seen the beauty of nature reflected in the sunset over Lake Harriet and in the glorious fish that swam under its surface. I had experienced the powerful emotion of community created by the efforts and struggles of two of its disparate members. I had witnessed the healing power of the respect, admiration and appreciation modeled by two adversaries who needed each other to manifest their interdependence. I had been part of the peace that grew out of a violent confrontation.

The experience left me with a profound feeling of hope. If the interaction between a man and a fish can create a sense of community in such a powerful and positive way, what is our potential to create a similar sense of community through our individual actions and collectively through the organizations to which we belong? Can we create a peaceful community out of the chaos, conflict and violence that surrounds us?

After watching a struggle as old as life itself, I am convinced that if we can model respectful interactions with the people with whom we work, the patients we treat, and the communities we serve, our potential is unlimited. If we can appreciate each others’ struggles as a requirement for growth, we will be well on our way toward creating a peaceful, beautiful and healthy community.

Senior Physicians Association

Welcome New WMMS Members

Adam S. Hoverman, M.D.

Active

Wajahat Khalil, MB, BS Internal Medicine/Pulmonary and Critical Care Medicine

Himanshu Agrawal, MB, BS Fairview University Medical Center Psychiatry Ansar H. Ahmed, MB, BCh HealthPartners/Riverside Clinic Neurology Sanjeev K. Akkina, M.D. University of Minnesota, Division of Renal Diseases Internal Medicine Hazmer H. Cassim, D.O. Physical Medicine Elif Cingi, M.D. Anesthesiology Benjamin M. Crandall, D.O. Consulting Radiologists, Ltd. Radiology Clinton Crowder, M.D. Pathology Mary T. Dahling, M.D. John A. Haugen Associates, P.A. Obstetrics/Gynecology Jose D. Debes, M.D. Mark W. Doyscher, M.D. Consulting Radiologists, Ltd. Diagnostic Radiology

Hans C. Jeppesen, III, M.D. Internal Medicine

Stephen Knuff, M.D. Physicial Medicine and Rehab Kimberly R. Kortuem, M.D. Associated Skin Care Specialists, P.A. Dermatology Renee C. Koronkowski, M.D. Psychiatry Neelay J. Kothari, M.D. Abbott Northwestern Hospital Infectious Diseases Karen D. Krenik, M.D. Sharpe, Dillon, Cockson & Associates, P.A. Internal Medicine Jon L. Larson, M.D. Surgery Sheryl A. Louie, M.D. Southdale OB/GYN Consultants Obstetrics/Gynecology Daniel W. Louvar, M.D. Fairview University Medical Center Internal Medicine, Nephrology Josy Mathew, M.D. Hennepin Faculty Associates Hematologic Oncology

Aaron Friedman, M.D. University of Minnesota Department of Pediatrics Pediatric Nephrology

Lisa R. Mattson, M.D. Allina Medical Clinic Obstetrics/Gynecology

Daniel L. Gatlin, M.D. General Surgery

Alberto Maud, M.D. Neurology

Elizabeth K. Gross, M.D. Surgical Consultants, P.A. Transplantation Surgery

Saul A. McBroom, M.D. Allina Medical Clinic Family Medicine

Amrit Guptan, MB, BS Internal Medicine/Cardiac Electrophysiology

Douglas McGuirk, M.D.

Marilee A. Hanson, M.D. Mildred S. Hanson, M.D., P.A. Obstetrics/Gynecology Gwen M. Hofman, M.D.

30

November/December 2008

Christopher A. Mickelson, M.D. Metropolitan Anesthesia Network, LLP Anesthesiology David J. Mills, M.D. Consulting Radiologists Radiology

Sara T. Murray, M.D. St. Paul Heart Clinic, P.A. Cardiology

Helen F. Tergin, M.D. Associated Skin Care Specialists, P.A. Dermatology

Salima Naqvi, M.D. Psychiatry

Julie A. Thompson, M.D. Internal Medicine/Gastroenterology

Lee E. Osborne, M.D. Hennepin County Medical Center Neurology/Sleep Medicine

Matthew G. Thorson, M.D. Metropolitan Anesthesia Network, LLP Anesthesiology/Pain Management

Robin J. Parker, M.D. Consulting Radiologists, Ltd. Radiology

Brandi J. Witt, M.D. Cardiovascular Consultants, Ltd. Internal Medicine/Cardiology

Trudi Parker, M.D. Consulting Radiologists, Ltd. Radiology

Michael H. Wittmer, M.D. Suburban Radiologic Consultants, Ltd. Radiology

Anne M. Reddy, M.D. Consulting Radiologists, Ltd. Radiology

Wendy E. Wallskog, M.D. Anesthesiology, P.A. Anesthesiology

Emily C. Rose, M.D.

Craig S. Walvatne, M.D. Vascular Surgery Associates General Surgery/Vascular Surgery

Frank R. Rekuski, M.D. Metropolitan Anesthesia Network, LLP Anesthesiology Kelly O. SalďŹ ti, M.D. Internal Medicine/Gastroenterology Nadim I. SalďŹ ti, M.D. Internal Medicine/Gastroenterology/ Hepatology Kathryn H. Schaefer, M.D. South Lake Pediatrics Pediatrics Clark W. Schumacher, M.D. Consulting Radiologists, Ltd. Radiology Qaisar A. Shah, MB, BS Neurology/Vascular Neurology/Endovascular Surgical Neuroradiology Linnea Spens, M.D. Surgery

Erik M. Wetter, M.D. Orthopedic Partners, P.A. Orthopedics Natalie D. Wu, M.D. Sharpe, Dillon, Cockson & Assoc., P.A. Internal Medicine

Medical Students (University of Minnesota) John M. Cox Scott M. Deeney Bryan A. Eberle Jacob W. Eiler Kathleen M. Kroschel Ryan R. Kroschel Nan Lin Jonathan D. Lofgren Minelva R. Nanton Jennifer M. Vesely Rachel L. Wagner Katherine A. Ward Shayla M. Wilson

Matthew R. Stone, M.D. Consulting Radiologists, Ltd. Radiology Alexandra E. Straight, M.D. Kidney Specialists of MN, P.A. Internal Medicine/Emergency Medicine Annie Tan, M.D. Minnesota Oncology Hematology, P.A. Obstetrics/Gynecology

MetroDoctors

The Journal of the East and West Metro Medical Societies

ALLIANCE NEWS DIANNE FENYK

Never For a Minute

The West Metro Medical Society Alliance has joined the Minnesota Medical Association Alliance to raise awareness of this issue and to help prevent it from happening. The program is called Not Even for a MINUTE — NEVER Leave Children Unattended in a Car and consists of a simple car window decal reminder and fact sheet to help educate parents and child caregivers. The decal shows a toddler strapped in her car seat; the fact sheet provides frightening statistics about how rapidly a vehicle can heat up.

WMMSA members are distributing the decals and flyers free of charge to pediatrician offices, fire departments, car dealers, childcare centers and other relevant locations. Funding for this project originated with a grant from St. Luke’s Hospital in Duluth. We are open to suggestions for other funding sources.

If you are interested in helping the Alliance distribute this important public safety information — and perhaps save the life of a child — please contact Dianne Fenyk at diannefenyk@prodigy.net.

HIV/AIDS Folder as Popular as Ever

The WMMSA HIV/AIDS educational folder is now in its twelfth year, fourth edition. In that time, 300,000 folders have been distributed free to Minnesota students! Middle and high school teachers across Minnesota continue to request the folder to use as their most up-to-date and “hip” sex education resource. Throughout the summer, project chair, Diane Gayes, worked with Kathy Dittmer in the WMMS office to create a promotional flyer that the Minnesota MetroDoctors

The Journal of the East and West Metro Medical Societies

W e st M e t r o M e d i c a l S o c i e t y

W

e have all heard the horror stories of infants and toddlers being left in the car when their stressed and distracted parents forget about them. The result is usually tragic — thermal burns, seizures, brain and kidney damage, even death.

An average of 29 children per year have died as a result of being left in unattended vehicles (McLaren, Null and Quinn, Heat Stress from Enclosed Vehicles: Moderate Ambient Temperatures Cause Significant Temperature Rise in Enclosed Vehicles, Pediatrics, 2005:116:e109-e112.). According to the CDC, infants and toddlers are the most susceptible to heat stroke and most fatalities occur in children under three. This age group is also the most vulnerable because they are unable to fend for themselves while strapped in their car seat.

Department of Health then sent to approximately 4,500 school health educators.

In September, a group of WMMSA members packed 21,000 folders for shipping to 100 requesting schools. This depleted our supply of folders and we are working diligently to secure funding for an additional printing of 50,000.

In August, the WMMSA received a grant of $2,000 from the AMA Foundation Fund for Better Health. We are extremely grateful for the long-term support and commitment of the West Metro Medical Foundation, which has generously partnered with the Alliance since the beginning of the project and has been instrumental in its success.

We believe this project is another public health and safety issue and are proud of our efforts to educate Minnesota kids about the consequences of risky sexual behavior. We know in our hearts we have saved at least one person from contracting HIV through this project.

WMMS Alliance members are honored to work with the WMMS and WMMF to make a difference in the health of our community.

November/December 2008

31

Please also visit www.metrodoctors.com for Career Opportunities.

Apple Valley Medical Clinic A full service, independent family practice clinic serving the fast-growing south suburbs of the Twin Cities, has a fulltime opening for a BC/BE family physician. In addition to our family practice program with 14 family physicians, we operate a unique 24/7 urgent care program, occupational health services, and offer convenient on-site access to medical imaging (CT, MRI, US, X-Ray & Mammography), a pharmacy, physical therapy, and full array of medical specialties on our modern campus.

Our practice is physician-owned and governed.

Please e-mail your resume to:

Career Opportunities

CAREER OPPORTUNITIES

Introducing the “Career Opportunities” section of MetroDoctors!

$ JUHDW DYHQXH IRU SURIHVVLRQDOV WR OHDUQ DERXW MRE RSSRUWXQLWLHV $1' D SHUIHFW SODFH IRU UHFUXLWHUV WR SURPRWH RSHQLQJV

aberry@applevaleymc.com Recruiters, call for our special recruitment rate.

For more information contact: Adam Berry, administrator 952-953-9285

Betsy Pierre, ad sales 763-295-5420 betsy@pierreproductions.com

Great Partners, Great Staff, Great Patients, Excellent Income & Lifestyle Family HealthServices Minnesota, P.A. is looking for several Board Certified/Eligible Family Physicians to fill fulltime, part-time or shared positions.

Join our Independent Group of 64 physicians serving 13 clinic sites.

FOR MORE INFORMATION PLEASE CONTACT: Paul Berrisford, 2025 Sloan Place, Suite 35, St. Paul, MN 55117 651-772-1572 2 email: pberrisford@fhsm.com

32

November/December 2008

MetroDoctors

The Journal of the East and West Metro Medical Societies

%851(7

www.BurnetBirkeland.com

Minneapolis

Lowry Hill

Orono

Golden Valley

Designer 3 BR / 3 Bath Grant Park City Home with sophisticated finishes.

Amazing renovation of 4 BR / 5 Bath Lowry Hill gem blocks to Lake Of The Isles.

New construction by Stonewood on Lake Minnetonka 1.61 acres, 5702 FSF.

Two prime 4 BR / 4 Bath Hidden Lakes Villa Homes on private lots.

$499,900

$1,550,000

$4,275,000

$779,900-$1,295,000

%XUQHW%LUNHODQG FRP

5HVWRULQJ DQG PDLQWDLQLQJ RXU SDWLHQWV KHDOWK DQG ZHOO EHLQJ Mahmoud Nagib, M.D. Thomas Bergman, M.D. Edward Hames, M.D., Ph.D. John Mullan, M.D. Walter Galicich, M.D. Michael McCue, M.D.,Sc.D. Charles Watts, M.D., Ph.D. Sabrina Walski-Easton,M.D. Jon McIver, M.D.

x x x x x x x x x x x

X X

For appointments call

Adult/Pediatric Neurosurgery Brain Tumors Simple & Complex Spine Surgeries Cerebrovascular Surgery Pituitary Tumors Neuro-Oncology Gamma Knife Radiosurgery Stereotactic Surgery Artificial Cervical Disc Replacement Peripheral Nerve Surgery Deep Brain Stimulation

913 East 26th St

6545 France Ave So

501 Nicollet Blvd

424 West State Hwy 5

9325 Upland Lane N

305 Piper Building

Suite 681

Suite 100

Waconia, MN 55387

Suite 205

Minneapolis, MN 55407

Edina, MN 55435

Burnsville, MN 55337

Phone: 612-871-7278

Maple Grove, MN 55369

Phone: 612-871-7278

Phone: 952-926-2711

Phone: 952-926-2711

Phone: 952-926-2711

Thank You To the Advertisers in MetroDoctors in 2008!

Advanced Skin Care Institute AmeriPride Linen and Apparel Services Apple Valley Medical Clinic Billing Buddies Burnet & Birkland Carol. com Children's Physician Network CRES, Inc. Crutchfield Dermatology Family HealthServices Minnesota, P.A. (MinnHealth Family Physicians, P.A.) Healthcare Billing Resources, Inc. HealthEast Spine Care Center Hennepin County Medical Center Independent Home Living It's Just Lunch Julie Burma Lockridge Grindal Nauen P.L.L.P.

Medical Billing Professionals, LLC Midwest Medical Insurance Company Midwest Spine Institute Minnesota Epilepsy Group, P.A. Minnesota Medical Association Minnesota Oncology Hematology, P.A. Minnesota Physician Services Neurosurgical Associates, Ltd. ProSource Reproductive Medicine & Infertility Associates Southside Community Health Services Sterling Retirement Resources, Inc. Steven H. Jesser, Attorney at Law, P.C. University of Minnesota Continuing Medical Education Uptown Dermatology & Skinspa P.A. Weber Law Office

For advertising opportunities, please call Betsy Pierre at 763-295-5420 or email Betsy@pierreproductions.com

Discounts by Physicians for Physicians You do not need to be an EMMS member to participate Â&#x2021; Â&#x2021; Â&#x2021; Â&#x2021;

/LQHQ 6HUYLFHV ,QGLYLGXDO *URXS ,QVXUDQFH 26+$ &RPSOLDQFH 7UDLQLQJ ,7 2XWVRXUFLQJ DQG +RVWLQJ

Â&#x2021; Â&#x2021; Â&#x2021; Â&#x2021;

&RIIHH DQG 5HIUHVKPHQWV &UHGLW &DUG +HDOWKFDUH 7HFKQRORJ\ 0DUNHWLQJ &ROOHFWLRQ 5HODWHG 6HUYLFHV

a subsidiary of East Metro Medical Society

Visit www.metrodoctors.com/services.cfm to read more about ways that you can save through our business partnerships.

TM

Call EMMS at 612-362-3799 for details.