2009sepoct

Events Schedule For All MMA Members WEDNESDAY, SEPTEMBER 16 6 pm – 7 pm Welcome Reception THURSDAY, SEPTEMBER 17 9 am – Completion 12:30 pm – 2 pm 2:15 pm –4:30 pm

ANNUAL MEETING

SEPTEMBER 16-18, 2009 | MAYO CIVIC CENTER | ROCHESTER, MN

Awards Luncheon Featured Speaker James J. Rohack, M.D., American Medical Association president, will discuss national health care reform at the Thursday awards luncheon. There is a $25 fee for non-delegate MMA members.

Reference Committee Open Hearings Awards Luncheon Educational Sessions National Health Care Reform and its Impact on Minnesota: An Update and Perspective from the Mayo Health Policy Center (CME Credit) Meaningful Use – A Physician Guide to the 2009 Health Information Technology Stimulus Funds (CME Credit) Minnesota’s New Quality Reporting and Incentive System – What to Expect in 2010 (CME Credit) Times are Tough. Is Your Retirement Plan Tougher? (No CME)

CME Credit: The Minnesota Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The MMA designates this educational activity for a maximum of 2 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

See www.MMAonline.net for more details.

REGISTER NOW

REGISTER AT: WWW.MMAONLINE.NET/FORMSHOME/ANNUALMEETINGREGISTRATION; 612/362-3764 OR 800/342-5662 EXT. 3764

Taking care of your tomorrow — today As a physician, your needs are different. We understand that. In fact, we have the exclusive endorsement by the Minnesota Medical Association and the West Metro Medical Society to provide financial planning services to MMA members. So, give us a call today to talk about the dreams of your tomorrow. You (and your future) will be glad you did.

Steven C. Finkelstein CERTIFIED FINANCIAL PLANNER™ email: scf@sterlingretirement.com

Joel Greenwald, MD CERTIFIED FINANCIAL PLANNER™ email: jsg@sterlingretirement.com

Registered Representatives offering Securities through FINANCIAL NETWORK INVESTMENT CORPORATION Full Service Broker Dealer, Member SIPC Financial Network and Sterling Retirement Resources are not affiliated.

Tel: 952 224 7160 | 1.866.297.2508 (toll free) | 1660 South Highway 100, Suite 320, St. Louis Park, MN 55416 | www.sterlingretirement.com

CONTENTS VOLUME 11, NO. 5

2

Index to Advertisers

3

EMMS and WMMS Consolidation Proposal

4

SEPTEMBER/OCTOBER 2009

FEATURE

Honoring Choices Minnesota: A Metro-wide Community Approach to Advance Care Planning

7

COLLEAGUE INTERVIEW

Laura A. Dean, M.D.

10

Minnesota Pandemic Ethics Project

By J. Eline (Ellie) Garrett, J.D.

Page 7

11

Minnesota Comprehensive Health Association—Our State’s Unique Health Plan

By Marvin S. Segal, M.D.

13

The Cost of Unallotment and Legislative Actions

By H. Theodore (Ted) Grindal, J.D., and Matt Schafer

15

Hospice Care Enhances Dignity and Peace as Life Nears its End

17

Noran Neurological Clinic’s Eco-Friendly “Green” Ways Make a Positive Difference for Employees, Patients and the Community

By Phil Riveness

19

The Prevention Paradox and a Public Health Approach to College Student Drinking

By Toben F. Nelson, ScD

Page 11

30

Members in the News Career Opportunities

On the cover: Honoring Choices Minnesota is a metro-wide community approach to advance care planning, facilitated by EMMS and WMMS. Article begins on page 4.

EAST METRO MEDICAL SOCIETY

22 23 24

President’s Message

25

Community Service Award Nomination Form

New Members Minnesota Physician Services, Inc./Senior Physicians Association/In Memoriam/Delegates Needed

WEST METRO MEDICAL SOCIETY

Page 17 MetroDoctors

The Journal of the East and West Metro Medical Societies

26 27

Chair’s Report

28

New Members/Senior Physicians Association/ In Memoriam

29

Alliance News

WMMS in Action/Kathy Dittmer Celebrates 20 Years!/ Delegates Needed

September/October 2009

1

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

Crutchfield Dermatology “Remarkable patient satisfaction from quality, service, convenience and excellent results” “Exceptional care for all skin problems”

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

Charles E. Crutchfield III, M.D. Board Certified Dermatologist

Psoriasis

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.

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 Katie Snow at (612) 362-3704.

2

September/October 2009

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September/October Index to Advertisers Alexandria Clinic, P.A. .....................................30 AmeriPride Services ..........................................21 Crutchfield Dermatology.................................. 2 Family HealthServices Minnesota, P.A. ......32 Federal Medical Center, Rochester, MN....30 Healthcare Billing Resources, Inc. ...............16 Lockridge Grindal Nauen P.L.L.P. ...............16 Mankato Clinic ..................................................31 Minnesota Epilepsy Group, P.A....................10 Minnesota Physician Services, Inc. ...................

Inside Back Cover MMA Annual Meeting.... Inside Front Cover The MMIC Group ................................................

Inside Back Cover Open Cities Health Center, Inc. ..................31 SafeAssure Consultants, Inc...........................12 Sterling Retirement Resources, Inc...................

Inside Front Cover Suburban Radiologic Consultants/Suburban Imaging................ Outside Back Cover Uptown Dermatology & SkinSpa, P.A......... 9 Wapiti Medical Group .....................................32 Weber Law Office ............................................... 2

MetroDoctors

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The Journal of the East and West Metro Medical Societies

EMMS and WMMS

Consolidation Proposal

P

ROMPTED BY A VARIETY OF FACTORS that will be outlined

below, the elected leaders of the East Metro Medical Society and the West Metro Medical Society met in the latter part of 2008 to discuss the possibility of consolidating into one medical society. The reasons for considering this merger are numerous and are described in an article that appeared in the May/June 2009 edition of our publication, MetroDoctors. (Available online at http://www.metrodoctors.com/ pubs_detail.cfm?id=68.) A resolution has been crafted (see sidebar) and will be presented to the Minnesota Medical Association House of Delegates September 17-18.

Three main factors have emerged that contribute to the medical societies entering into these discussions. 1) A significant portion of the work of the two medical societies is already accomplished jointly including our work in advocacy, public health initiatives, operations, staffing and communications. (2) The ability to execute the respective work plans of the societies while staying within our budget has become ever more challenging. Both societies have worked hard to fund their activities without increasing dues. (3) The WMMS CEO is planning to retire at the end of 2009 which provides a unique opportunity to make this kind of change in organizational structure.

After much discussion and deliberation, your Executive Committees have concluded and recommend to you that the best course of action is to consolidate the two medical societies into a single Twin Cities medical society. This action will result in a local professional association that will be better equipped to continue to accomplish the outcomes to which we have grown accustomed, and will allow us to be fiscally responsible to our respective memberships.

We encourage your support of this consolidation and invite you to express your opinion to help us create the next generation of a medical society which will continue to advocate for you, your patients and your community. Your elected leaders want to ensure an efficient, effective and well-designed organization that will continue through the 21st century.

Please contact your medical society leaders and/or executive staff with any questions or comments you may have: Ronnell Hansen, M.D., EMMS President

Thomas Siefferman, M.D., EMMS President-Elect

Sue Schettle, CEO, EMMS (sschettle@metrodoctors.com)

Richard Schmidt, M.D., WMMS Chair

Edward Ehlinger, M.D., WMMS President

Jack Davis, CEO, WMMS (jdavis@metrodoctors.com)

MetroDoctors

The Journal of the East and West Metro Medical Societies

RESOLUTION No. 103 September 2009 INTRODUCED BY: East Metro Medical Society and West Metro Medical Society SUBJECT: Consolidation of EMMS and WMMS REFERRED TO: Reference Committee A ______________________________________________________ WHEREAS, the East Metro Medical Society (EMMS) and the West Metro Medical Society (WMMS) have developed a close working relationship over the past 15 years, and WHEREAS, this working relationship has developed into collaborations that include the MetroDoctors journal, the www.MetroDoctors.com Web site, the Joint Public Policy Committee, joint Boards of Directors meetings, joint Executive Committee meetings, joint Caucuses at the MMA House of Delegates and other joint activities that exceed three fourths of the respective ongoing work plan of the two Societies, and WHEREAS, the two Societies occupy adjacent space and economically share business management, IT systems, communications and employment functions with the Minnesota Medical Association through the Minnesota Medical Joint Services Organization (MMJSO), and WHEREAS, WMMS and EMMS have learned from each others’ work on public health initiatives such as second hand smoke projects, menu labeling strategies and advance care planning standardization, and WHEREAS, membership and dues revenue for the two societies have remained flat and at the same time, expenses continue to increase which requires a greater dependence on operating reserves and philanthropic funds, and WHEREAS, the potential retirement of the WMMS CEO presents an opportunity to conveniently reduce staffing, therefore be it RESOLVED, that the Minnesota Medical Association House of Delegates support the consolidation of the EMMS and the WMMS into a single medical society, and be it further RESOLVED, that the West Metro Trustee District and the East Metro Trustee District remain separate in order to continue to fulfill the intended purposes of regional representation, and be it further RESOLVED, that the Minnesota Medical Association House of Delegates authorize the Minnesota Medical Association to continue to Charter the Twin Cities Medical Society as the successor organization of the East Metro Medical Society and the West Metro Medical Society.

September/October 2009

3

A Metro-Wide Community Approach to Advance Care Planning

O

ver the past year and a half, East Metro Medical Society (EMMS) and West Metro Medical Society (WMMS) have been spearheading a metro-wide project focusing on a comprehensive and collaborative approach to advance care planning. Advance care planning is an ongoing process of helping patients understand their medical condition and potential future complications; understanding the options for future medical care as it relates to their medical condition; having a facilitated discussion with family, loved ones and providers; and reflecting upon these choices in light of personal goals, values and beliefs, to include religious and cultural perspectives.

It is important to understand the components that comprise the advance care planning process. As the picture below shows, advance care planning is a facilitated process resulting in an advance directive document, sometimes called a health care directive. That document can then be used to develop the Physicians Order for Life Sustaining Treatment (POLST) form which translates the patient’s wishes into physician’s orders.

The EMMS Foundation is serving as the convener and coordinator of the Honoring Choices Minnesota initiative under the leadership of Kent Wilson, M.D., currently president of the EMMS Foundation Board of Directors. In late 2007, the outgoing president of the EMMS Foundation Board, Robert Moravec, M.D., suggested that the Foundation look into a program based at the Gundersen Lutheran Medical Foundation out of La Crosse, WI, called Respecting Choices®, which is a well-established advance care planning model with documented success both nationally and internationally. The Respecting Choices® program began in the mid-1990s with two otherwise competing health care organizations which agreed to work collaboratively on a community approach to advance care planning with the underlying principle to not compete. This model of community collaboration was intriguing and led to a site visit. Dr. Wilson visited Gundersen Lutheran Medical Foundation in La Crosse, and met the directors of Respecting Choices® Bud Hammes, Ph.D. and Linda Briggs, MS, MA, RN. It was clear after that visit and subsequent interactions with the faculty from Respecting

A facilitated process Advance Care Planning A patient directed document

Advance Directive

POLST

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September/October 2009

Physician’s orders used to translate patient’s wishes

MetroDoctors

The Journal of the East and West Metro Medical Societies

ChoicesÂŽ that their model of advance care planning could be implemented here in the Twin Cities and surrounding areas.

Respecting ChoicesÂŽ teaches that elements of a successful advance care planning program include community engagement, planning facilitation skills training, Bud Hammes, Ph.D., explained the principles in designing an effective advance care planning program. having systems in place to honor patientsâ&#x20AC;&#x2122; wishes, and continuous quality improvement methodologies. Their model proposes ďŹ ve promises that participating organizations should It was also suggested that we include ICSI in the process, which adopt as they enter into a comprehensive approach to advance care has since been accomplished. planning. The organization agrees that: An advisory committee was formed and ďŹ rst met in March, 2009.

1. We will initiate the conversation.

The committee includes staff from Allina Hospitals & Clinics, Heal2. We will provide assistance with advance care planning. thEast Care System, HealthPartners/Regions Hospital, Park Nicollet 3. We will make sure plans are clear.

Methodist Hospital, Fairview University Medical Center, Hennepin 4. We will maintain and retrieve plans.

County Medical Center, Hospice Minnesota, ICSI, Medica, Blue Cross 5. We will appropriately follow plans. and Blue Shield of MN, UCare, Stratis Health, and the East Metro and Since the medical societies provide neutral ground for facilitating West Metro Medical Societies. Both Park Nicollet and Allina are already discussions between health care organizations, two events were hosted. working to implement the Respecting ChoicesÂŽ model in their respecIn August of 2008, a meeting was held for members of the health care tive organizations and have staff who are familiar with the process and community who deal with advance care planning as part of their overall have greatly assisted us in our efforts. responsibilities. More than 40 attendees from various organizations The advisory committee has provided the overall guidance for the came to learn about the Respecting ChoicesÂŽ model, and in the end, project. Committee members have provided their wisdom and guidance all expressed a desire to collaborate in the Twin Cities the same way in the development of one advance directive document that facilitators that those in La Crosse had experienced when they embarked on this will use to document patient wishes and preferences as part of the overall project. One of the more telling outcomes of the August meeting was advance care planning process. Several clinics and hospitals have been that it was one thing to have the support of those who would be carryidentiďŹ ed to serve as pilot sites for the Honoring Choices Minnesota ing out the work of advance care planning, but it was quite another to program. Quality improvement measures have been agreed upon. The get the support from the most senior leaders. The following month, a advisory committee has worked to effectively engage ICSI who is reviewluncheon meeting was held for senior leadership of area hospitals and ing and updating their palliative care guidelines. health plans. Nearly every metro area hospital system was represented The next assignment for the committee is daunting but important in addition to the major health plans. Attendees were again exposed to to the overall success of the project. It is to work on the patient education the idea of collaborating and coordinating around the process of advance materials which will be available to all hospitals, health plans, hospice care planning using the Respecting ChoicesÂŽ model as our guide. In organizations, nursing homes, community health groups, etc. The health the end, we received a unanimous commitment to: care directive document and educational materials will also be translated s .OT COMPETE ON ADVANCE CARE PLANNING into four languages, (Somali, Spanish, Russian and Hmong). s #OLLABORATE IN THE DEVELOPMENT OF A COMMUNITY APPROACH USING shared materials and processes. s $EVOTE RESOURCES TOWARD THE EFFORT (Continued on page 6) MetroDoctors

The Journal of the East and West Metro Medical Societies

September/October 2009

5

Honoring Choices Minnesota (Continued from page 5)

Honoring Choices Minnesota

The Respecting Choices® program has been extensively referenced in this article as this model provides organizations with the tools, expertise, resources and proven methodologies that can be used to implement an advance care planning program.

Honoring Choices Minnesota is the name that the medical societies and the advisory committee have chosen for our metro area advance care planning project. The Honoring Choices Minnesota program consists of training and education in the Respecting Choices® model with Minnesota developed documents and systems.

Educational Programs

A workshop to prepare institutional leaders to implement an effective advance care planning program was held July 14 and 15. Respecting Choices® faculty taught the workshop to 51 participants from 12 different organizations. It was very successful and attendees came away with a shared understanding of the steps needed to design this program within their own systems.

Four different groups will initiate pilot programs in early 2010.

Those include: HealthEast, HealthPartners, HCMC and Fairview. In mid-September, the faculty from Respecting Choices® will return to the Twin Cities to check in with each pilot team and answer questions that may have arisen as they begin to build the infrastructure to effectively begin their pilots.

On November 2-4, 2009, another educational event will be held in the Twin Cities. The first day will consist of training and certification for facilitators. November 3 is the leadership day where teams will share their implementation plans for others to learn from. The last day, November 4, is solely for the instructor training (a “train the trainer” event). In early 2010 we may begin again with another workshop like the one we held in July.

committed to working collaboratively with ICSI and the health plans on this issue as we continue our progress. Another issue that we have identified is the process by which the health care directive document itself is placed in the patient’s medical record so that it is available when it is most needed. In La Crosse, where the program is working most effectively, the document has a prominent location in the patient’s electronic medical record. We would hope to achieve similar success in the metro and have had some preliminary discussion with EPIC and Minnesota Health Information Exchange (MN HIE).

EMMS and WMMS see this project as a model for future collaborative efforts among and between the health organizations and systems in the metro area with the medical societies. It is also viewed as an immense opportunity in the development of a community understanding of the importance of having patient’s wishes and preferences documented through a standardized process.

There will be much more to this project in the coming years. Stay tuned.

If you would like additional information please contact Sue Schettle, CEO of the East Metro Medical Society at (612) 362-3799; sschettle@ metrodoctors.com; or Jack Davis, CEO of the West Metro Medical Society at (612) 623-2899; jdavis@metrodoctors.com. Visit our Web site at www.metrodoctors.com and click on the “Honoring Choices MN” tab.

Kent Wilson, M.D., President, East Metro Medical Society Foundation.

Sue Schettle, CEO, East Metro Medical Society.

Barriers/Opportunities

As with most things, there are some barriers and drawbacks that we need to be mindful of as we continue to work our way through this long-term project.

Reimbursement for the facilitation process itself is vitally important for the sustainability of such a program. We are

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September/October 2009

Fifty people from the Twin Cities and surrounding areas attended the workshop.

MetroDoctors

The Journal of the East and West Metro Medical Societies

COLLEAGUE INTERVIEW

A Conversation With

Laura A. Dean, M.D.

L

aura A. Dean, M.D. is board certified by the American Board of Obstetrics and Gynecology and is currently employed at Stillwater Medical Group, P.A. Dr. Dean graduated Summa Cum Laude from the College of St. Thomas; received her Doctorate of Medicine from Mayo Medical School and completed her residency training at the University of Minnesota. She serves as chair of the Stillwater Medical Group, Department of OB/GYN, is a member of the East Metro Medical Society Board of Directors; a delegate to the Minnesota Medical Association; and an ACOG alternate delegate to the American Medical Association.

Questions were provided by Lee Beecher, M.D., Ben Whitten, M.D., Thom Siefferman, M.D. and Janette Strathy, M.D.

How does involvement and advocacy in a specialty society at the national (federal) level help with advocacy on general medical issues at the state and local level?

Perhaps it was because my Dad was a union plumber and later an education coordinator that I looked to my profession’s organizing body for direction and leadership even before I graduated from medical school.

He taught me that very high standards, organization and hard work paid off for members with a common cause.

My work with the American College of Obstetricians and Gynecologists (ACOG) has been very personally and professionally beneficial.

Serving on national practice committees and serving in national elected office through ACOG has given me the experience and voice to help with advocacy on general medical issues at all levels. Right now is an historic time to have all hands on deck as we move forward with sweeping national and statewide health care reform.

Minnesota leads the nation in health care. We are one of the healthiest states. We have the lowest numbers of uninsured. We lead in new frontiers and as Minnesotans, we have become complacent about it.

Rather than following Washington, we should lead the nation in health care reform.

Minnesota is an innovator in health care and should be allowed to continue to be so.

How do you balance or deal with conflict of interest where it might arise as relates to medical issues that have political aspects (like abortion, pharmacists who do not want to dispense certain legal prescriptions or health care reform) and your personal views?

Each physician approaches the practice of medicine with their own personal experiences and moral compass. I have chosen to be involved at a policy level. My patients are very supportive of my work there but they also know there is a clear separation between health policy and the personal care I provide to each patient.

You have written in opposition to the notion that health care is a “right” granted and guaranteed by the state and/ or federal governments. Please explain your views.

As physicians, we have invested years of training and practice to help make Minnesota’s health care the best in the world.

Physicians across the state support the Governor’s and the Legislature’s efforts to ensure that all Minnesotans have access to excellent health care. There is much to be done to lower cost, improve quality and expand access. Physicians are united in this bipartisan goal.

However, during the 2007 Minnesota Legislative session, physicians stood up when we saw the political needs of some triaged ahead of our (Continued on page 8)

MetroDoctors

The Journal of the East and West Metro Medical Societies

September/October 2009

7

Colleague Interview (Continued from page 7)

patients and our profession. That is why I, along with other physicians, led a grassroots charge to educate physicians about the proposed constitutional amendment and its potential unintended consequences.

The controversial legislation proposed a change to Minnesota’s constitution that would guarantee every Minnesota resident a right to affordable health care. No other state defines health care as a constitutional right. The goal of providing access to quality care for all Minnesotans is one we all should share.

Many thought that the amendment functioned more as a vehicle to deliver votes for politicians than to deliver health care to the uninsured.

The constitutional amendment for a “right” to care would have given politicians the ability to define what care means (a defined benefit set) and what the cost was (deemed to be affordable).

In addition, the proposed amendment raised other, larger questions: What is health care? What is affordable? Who is a resident? —Where would these questions get answered? I feared that this would lead to the courts being ensnarled, care delayed and procedures rationed.

The proposed constitutional amendment was not good public health policy. Good public health policy must go beyond rhetoric and keep politicians from getting between patients and doctors.

In the end, the vote was never brought out of the committee process. I credit front line docs who let their legislators know about the unintended consequences of such a plan.

How would you advise public policy directions to expand patient access to Minnesota health care services and health care insurance options?

Health care reform is the most important policy issue in Minnesota at this time. Our state has the highest quality health care, and the lowest rate of uninsured. We need to work hard to continue this excellence while making health care more affordable and accessible.

The doctor-patient relationship must be maintained to ensure that quality care is delivered to the right place at the right time.

Would freestanding birthing centers lower costs of normal deliveries? Would they compete with hospitals? Your comments and policy recommendations.

Freestanding birth centers have been shown to reduce costs for some patient populations. I work with midwives very well and we form a team that provides very high-touch service in an extremely safe environment for mom and baby. Freestanding centers, like home deliveries, pose certain risks for deliveries that take a bad turn. Complications are often unpredictable and life threatening complications can compromise maternal or fetal health in minutes. Research has suggested that in cases where oxygen and blood flow to the baby is suddenly compromised, fetal brain damage is more likely after 17 minutes and a non-hospital birth center cannot meet this deadline for surgical delivery. Proximity to a surgical unit is key to the safety of mom and baby.

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September/October 2009

Where will the savings come from? — Shorter stays? Less “intervention”? And what are the costs? Could one unpredictable complication wipe out all the projected savings?

My concern is all about safety. The American College of Obstetricians and Gynecologists supports birthing centers that are on the hospital campus or freestanding centers that meet the standards of the Accreditation Association of Ambulatory Health Care, the Joint Commission or the American Association of Birth Centers. These standards are high; they require a collaborative relationship with obstetricians and a relationship with a nearby hospital. It may be more cost effective and safer to support birth center concepts within the hospital setting.

My second concern is that some patients may be “steered” to birth centers simply because their care is funded by Medical Assistance or another public program. Patients deserve an equal access to high quality care whether their payer is private or public.

How would you (or would you) encourage others to go into Ob-Gyn? Obstetrics and Gynecology is a great field! It is challenging, diverse, interesting and rewarding. I strongly encourage others to go into Ob/Gyn. The American College of Obstetricians and Gynecologists has an active medical student interest group. Through this group I have participated in workshops and round table discussions with medical students as they explore various medical fields. I have also advised medical students active with the American Medical Association. Students have shadowed me at the office and hospital.

However the most important activities that I do to attract the best and the brightest into medicine are to work hard through advocacy to keep the practice of medicine strong and patient care of the highest quality.

Within your field, do you have a special area of interest?

While the entire field of Obstetrics and Gynecology is challenging, diverse and rewarding, I have a special interest in caring for patients who experience miscarriage, stillbirth and early infant loss. Losing a child deals families grief at a time when they are expecting joy. Families need help through the grieving and recovery process and it is critical that physicians not only provide excellent medical care at this time, but provide care in a sensitive and thoughtful manner. I have been involved in educational programs to help medical and other care providers learn to provide compassionate care to these patients and families. I hope to continue and expand these efforts in the future, possibly to the level of resident and medical student education.

Is there anything new and exciting coming down the road in Ob-Gyn practices?

There are many new and exciting things coming down the road in Ob/ Gyn practice. Importantly, more surgical interventions are less invasive and are being performed as outpatient and even office-based procedures.

MetroDoctors

The Journal of the East and West Metro Medical Societies

This improves the quality of life for patients! Genotyping as part of cervical cancer screening and therapy holds many possibilities. So many advances in medicine continue to improve patient care every day.

Your advice on how physicians can and should work to improve doctor-patient relationships?

Good medical care and effective treatment requires a physician-patient partnership. This cannot be achieved without excellent communication.

When I was in medical school, there was no course on â&#x20AC;&#x153;bedside manner.â&#x20AC;? However, in my 17 years of patient care, I have seen the best and the worst of it. Developing a long-term, trust-based relationship is key. First, you must be a good listener. Demonstrate true compassion and concern. Clearly explain conditions, treatments and procedures.

Answer questions. Spend the time necessary to do the best job you can!

Improving communication is critical to excellent patient care and is a worthy investment.

Many unsatisďŹ ed patients cite lack of communication as their chief complaint. Errors, misdiagnoses and litigation needlessly arise from situations where a little more empathy, consideration and listening would have nipped the problem in the bud. I am sure you know that some of the busiest physicians you know have the best relationships with their patients. It is no secret that good bedside manner prevents errors, saves time in the long run and saves money.

You are a busy physician, leader, wife and mother. What would be your response to a colleague who asks why he or she should participate in organized medicine? How would you encourage younger physicians of the value of active participation in organized medicine who are trying to balance work and family obligations?

I strongly encourage all my colleagues to become involved in organized medicine. You need to have a seat at the table in order to help shape the future of the profession and the direction of patient care. Involvement is fulďŹ lling, and a way to make important contributions and to give back.

I have been very blessed with incredible professional opportunities because so many others had gone before me to clear a path that was far more difďŹ cult for women in years past.

How do you balance family, job and politics; has anything suffered that you have regrets about?

Being Mom is my biggest job and the most important one that I have. Balancing roles is very important. Both my husband and I must MetroDoctors

be very ďŹ&#x201A;exible and work together to keep everything running smoothly.

Most of my patients support their kids with at least one and sometimes two or more jobs, and for many of them, I simply do not know how they keep it all together. I am so impressed with my patients who are challenging the boundaries of work, home and professional ladders. I have learned a lot from my patients about how to keep all of the plates spinning. Of course we all learn the most from broken plates.

I tell my kids that they can have it all. But I also tell them that they can not have it all at the same time. I am a better physician because I am a Mom, and a better Mom because I am a physician.

When and what do you plan to do when you retire?

Retirement is a long way off for me. I enjoy the practice of medicine and plan to continue active patient care for many more years. As my kids get a little older, I would like to pursue more education and experience in health policy. Who knows where this will lead?

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The Journal of the East and West Metro Medical Societies

September/October 2009

9

Minnesota Pandemic Ethics Project

The Minnesota Pandemic Ethics Project is engaging stakeholders and the general public on ethical issues of rationing health resources in a severe pandemic (e.g., antiviral medications).

The Minnesota Center for Health Care Ethics and the University of Minnesota Center for Bioethics are jointly leading the project, which is sponsored by the Minnesota Department of Health. A broad-based panel of Minnesotans, with the support of five expert work groups and an implementation protocol committee, issued preliminary ethical recommendations

By J. Eline (Ellie) Garrett, J.D.

for rationing. In early 2009, these recommendations were released for public comment, kicking off a large public engagement process to be completed during the summer.

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 seizure-related conditions in patients of all ages, from infants to the elderly. We also offer comprehensive neuropsychological assessment for a broad range of acquired or developmental neurological conditions in both adult and pediatric patients.

Adult Epileptologists Deanna L. Dickens, MD Julie Hanna, MD El-Hadi Mouderres, MD Patricia E. Penovich, MD

Functional Neuro-Imaging Wenbo Zhang, MD, PhD

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

10

September/October 2009

J. Eline (Ellie) Garrett, J.D., assistant director, Health Policy & Public Health, Minnesota Center for Health Care Ethics.

Visit us at

Pediatric Epileptologists Jason S. Doescher, MD Michael D. Frost, MD Frank J. Ritter, MD

Appointments (651) 241-5290

As this issue goes to press, the current pandemic of H1N1 novel influenza virus is not yet severe in the U.S. If it remains a mild or moderate pandemic, many of the ethical choices addressed in the Minnesota Pandemic Ethics Project may not be necessary. If this pandemic, or a future one, becomes severe, ethical choices will be more difficult and the guidance offered through the Minnesota Pandemic Ethics Project will be valuable.

You can read the preliminary recommendations at www.ahc.umn.edu/mnpanflu. Keep an eye on the Web site for final recommendations, which will be issued later in the autumn.

Neuropsychologists Elizabeth Adams, PhD Robert Doss, PsyD Ann Hempel, PhD Donna Minter, PhD Gail Risse, PhD

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www.metrodoctors.com and

forum.metrodoctors.com To find new career opportunities, past issues of MetroDoctors and information on the latest news, events and legislative issues!

The Journal of the East and West Metro Medical Societies

Minnesota Comprehensive Health Association

Our State’s Unique Health Plan

premiums paid by MCHA members cover only about 50 percent of administrative costs and claims incurred by those enrollees. Premium rate recommendations by the Board are submitted to the Commissioner of Commerce for final approval, as the final rate determination authority rests with that office.

The Board of Directors is composed of 11 members, six of whom are representatives of health insurance industry organizations, and five being public members appointed by the Commissioner of Commerce.

Introduction

Each day, physicians of our metropolitan area and our state come into contact with the Minnesota Comprehensive Health Association (MCHA) in some fashion. Yet, many of them may be unaware of its long-standing presence or be hard put to define or discuss just what this insurance vehicle represents or how it functions. This article is meant to bring to the attention of our medical community many aspects of this health plan that have benefitted our population in a novel manner and have served to distinguish it as a unique member of our health care delivery system.

History

MCHA is sometimes referred to as Minnesota’s “high risk health pool.” It was created by the Minnesota Legislature in 1976, its purpose being to fill an important need for health care access to patients who are deemed uninsurable because of a serious pre-existing condition. It became operational the following year, 1977, the second such plan in the U.S. serving as a “safety net” for this population with diagnoses of significant high risk potential or actual illness. MCHA was formed as a non-profit Minnesota corporation governed by a Board of Directors. It is currently the largest, per capita, such plan of the existing 35 state mandated organizations in the U.S. Premiums and Governance

MCHA’s over 27,000 subscribers, who originally applied for and were then denied individual health insurance coverage by a Minnesota insurer or Health Maintenance Organization, receive their care via a network of contracted providers much as is the case with other health plans. All individuals who

By Marvin S. Segal, M.D.

MetroDoctors

Administration

are rejected for medical reasons by one of these insurers and whose employer does not offer group coverage are eligible for MCHA membership. Enrollment assistance on referral by a physician or through self referral can be accomplished either by accessing the MCHA Web site (www.mchamn.com) or via a Minnesota licensed health insurance agent.

It is by no means a welfare type entitlement plan such as Medicaid, but rather a private health insurer whose annual premium is actually more costly than those available in the private market. The Board of Directors determines the premiums on a yearly basis, and must set them between 101 percent and 125 percent of weighted average premiums of other health plans in the state for a comparable individual indemnity policy. Currently this figure is 120 percent.

The reason premiums are set at levels above those in the private sector is to offset the significantly higher than usual claims incurred by this high risk enrollee population. Normal practice in the private market is to set premiums at levels that will hopefully cover the cost of care. If this were the case with MCHA, the premiums would be essentially unaffordable for the large majority of subscribers. Presently,

The Journal of the East and West Metro Medical Societies

MCHA’s in-house staff is quite small and consists of a CEO, an Operations Director and an Executive Secretary/Office Manager. The above positions have been very stable — with length of service being filled by the same individuals for five to 20 years. Non-employee associations include: independent legal support, an independent medical/clinical advisor, liaison activity with state government, and independent actuarial and accounting functions.

A bidding process, last finalized in January of 2007, has determined the health care organization (the Writing Carrier) who largely administers MCHA’s day-to-day insurance business. Currently, and for the past 5+ years, that activity has been handled by Medica whose present contract runs through 2011. Medica and the in-house staff collaborate very closely to ensure the provision of various activities inherent in the efficient and effective functioning of MCHA, including: membership enrollment, premium billing and collection, claims payment, provider network maintenance, data collection and analytic report production, pharmacy management, customer service, quality of care provision and resource utilization.

(Continued on page 12)

September/October 2009

11

Minnesota Comprehensive Health Association (Continued from page 11)

Though many of the above operational aspects coincide with those of the Writing Carrier, MCHA has the latitude to independently follow different directions— an action that has been pursued from time to time. Examples of such autonomous activities include payments of previously denied and disputed claims via MCHA’s appeal process, the choosing of a separate and independent disease management firm to assist in the handling of care and case management functions, and contracting with Mayo Clinic.

Funding

There are two main sources of revenue for MCHA: premium payments (as discussed above), and assessment dollars from “contributing members” (those companies which sell group and/or individual policies of health and accident insurance in Minnesota). Importantly, there is not an on-going source of public funding.

The assessment obligation from the “contributing members,” which exists to make up

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the previously discussed shortfall, is calculated in relation to each company’s proportion of health care premium revenue reported in Minnesota. The major assessment contributors are Blue Cross and Blue Shield of Minnesota, Medica, HealthPartners and PreferredOne. Assessments for plan losses cannot be received from self-insured companies, and unfortunately at least 50 percent of market organizations are self-insured. This engenders an inequitable funding program for MCHA which hopefully can be resolved via new proposals of reimbursement. The enormity of this problem can be appreciated by the realization that in 2008, nearly $250,000,000 of claims were incurred and MCHA’s net loss prior to assessments was over $130,000,000. MCHA is in the “outlier business;” it is very expensive to take care of this populace.

Benefits

MCHA’s benefit structure is not dissimilar to most other licensed health plans and includes professional services for cognitive and procedurally oriented care and certain preventive activities, hospital services, pharmacy services, home health care and outpatient rehabilitation, behavioral health services, medical equipment, transplantation, emergency services and hospice care. Mental health conditions are addressed in the same fashion as is the case with any medical or surgical situation.

As with other health plans, a standard pre-existing condition waiting period is in place. For MCHA, that period is six months.

However, through statutory change, a series of waivers of the six month waiting period have been established for certain situations.

Six deductible plan options are available to all enrollees. These range from $500 to $10,000, and premiums vary accordingly, i.e. the higher the deductible level — the lower the premium. MCHA offers a federally qualified High Deductible Health Plan (HDHP) for members who desire to set up Health Savings Accounts (HSAs). Tobacco use incurs a higher premium payment, and premiums also understandably vary by age — but never vary according to medical history, income or gender.

Clinical Aspects

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September/October 2009

MCHA’s population contains those afflicted with some of the most complex health care problems that could possibly be encountered.

The more common of these largely chronic

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conditions include the gamut of diabetes mellitus, congestive heart failure, chronic depression, low back pain, asthma and hypertension — many of which exhibit complications and associated co-morbidities. The rare diagnoses include such conditions as Crohn’s Disease, seizure disorders and Gaucher’s Disease. These enrollees are nicely cared for by a large network of providers, essentially all of whom are Minnesota based.

As is the usual practice with health plans, MCHA contracts with a nationally known Disease Management firm who assists in the provision of ongoing care to this multifaceted group of patients. MCHA has additionally embarked on a Preventive Care Initiative, which emphasizes the importance of secondary prevention. It has been shown that secondary prevention, even in a population replete with such problematic care issues, can benefit the patient by diminishing the impact of complications and by blunting the effects of co-morbid diagnoses.

Conclusion

The chair of the National Association of Comprehensive Health Insurance Plans was recently quoted, “Adequately funded high-risk insurance pools can provide affordable coverage for persons with serious chronic conditions or with acute illnesses of shorter duration more effectively and at lower costs than do requirements for guaranteed issue and community rating.”

This has certainly been the case with MCHA who has stood the test of time while serving a vital role for our patients, our state and our medical community. The past has been successful and the future remains bright.

For more information about MCHA, go to www.mchamn.com or call 1-866-894-8053.

Dr. Marvin S. Segal has been an independent medical advisor to MCHA for five years. A cardiologist, clinical researcher and Clinical Professor of Medicine, he has served as a hospital and health plan Vice President for Medical Affairs, a health care consultant and an officer of the WMMS predecessor organization. He is a Fellow of the American College of Physicians, the American College of Cardiology and the American College of Physician Executives. He is an alumnus of the University of Minnesota Medical School and the Internal Medicine Residency and Cardiovascular Fellowship programs of U.C.L.A.

The Journal of the East and West Metro Medical Societies

The Cost of Unallotment and Legislative Actions

A

s reported in the July edition of Metrodoctors, Governor Tim Pawlenty abruptly ended all speculation of whether there would be a special session in 2009 when he announced his intentions to sign all DFL budget bills that didn’t increase taxes.

Pawlenty went on to say he would balance the remainder of the budget shortfall using unallotments and related administrative actions.

One month later, Pawlenty unveiled his plan to carry out this announcement, balancing the state’s $2.7 billion budget. The Governor’s plan largely weighted most cuts toward the second year of the 2010-2011 fiscal year (FY), thus setting the stage for what is certain to be a contentious 2011 legislative session.

The Governor’s plan includes: ; Administrative actions to K-12 Education that mimic property tax and school aid payment shifts ($1.77 billion). ; Reductions in higher education allocations to both MnSCU and University of Minnesota systems ($100 million). ; Adjustments to tax policy, aids and credits — including the elimination of the political contribution refund program, adjustments to the renters’ credit refund program, and reduction of local government aids ($168.7 million in revenue; $366.7 million in cuts). ; Reduction of approximately 2.25 percent in most state agency operating budgets ($33 million). ; An additional $236 million cut to the Health and Human Services budget (on top of nearly $870 million in cuts authorized during the 2009 legislative session).

Additional cuts include:

By H. Theodore (Ted) Grindal, J.D., and Matt Schafer

MetroDoctors

An additional 1.5 percent reduction in rates paid to providers and vendors of basic care services under MA and GAMC in FY 2010 and FY 2011, bringing the total rate reduction to 4.5 percent. The projected savings to the state for this line item is $4.885 million dollars over the biennium which will come out of the pockets of health care providers across the state. This is in addition to the projected savings of $14.3 million resulting from the original rate cut included in the Omnibus Health and Human Services bill. It should be noted that the legislature’s projected savings from its cuts assumed there would still be a GAMC program.

An additional temporary 1.5 percent rate reduction in rates paid for physician and professional services in FY 2011. This does not apply to office and outpatient services, preventive medical services and family planning services provided by certain primary care specialties. The projected savings to the state for this line item is $4.350 million over the biennium, which will come out of the pockets of health care providers across the state. This is in addition to the projected savings of $34.4 million resulting from the original five specialist physician rate cuts included in the Omnibus Health and Human Services bill. It should be noted that the legislature’s projected savings from its cuts assumed there would still be a GAMC program.

A suspension of nursing facility rebasing.

A temporary suspension of General Fund spending on the Transitional Minnesota Care program.

The Journal of the East and West Metro Medical Societies

The end of GAMC services has been moved up to March 1, 2010, which will cost Hennepin County Medical Center alone as much as $5 million.

A deferral to July 2011 for inpatient payments to hospitals that otherwise would occur in June 2011. The newly-enacted budget bill delayed most of the payments for June 2011 until July 2011; this action will defer the remainder of the payments.

A deferral of fee-for-service payments for acute care services that otherwise would be made to providers in June 2011 until July 2011. The newly-enacted budget bill already delayed one of the two rounds of payments scheduled for June 2011 until July 2011; this action defers the second round.

According to the Minnesota Management & Budget, the unallotment resulted in the state losing $72 million in federal funds for health and human services. This is in addition to the $365 million lost as a result of reductions in the Omnibus Health and Human Services budget bill enacted in May. After the adjournment of the 2009 legislative session, legislators, political observers and health care providers alike spent the better part of June asking the question, “Can the governor really balance the remainder of the budget via unallotment?” So far, the answer to this ques

(Continued on page 14)

September/October 2009

13

The Cost of Unallotment (Continued from page 13)

tion appears to be yes, and 2009 marks the third time Pawlenty has used this little known, previously seldom used tool to avoid deficits.

An allotment is an administrative limit the Commissioner of Finance puts on the spending of an appropriation. An allotment may limit the amount of an appropriation that may be spent in a specific period of time, and typically specifies limits for categories or types of spending. An unallotment is an act of not funding a legislatively mandated budget proposal. The executive branch reserves the right to unallot expenditures when revenue projections fall short of spending commitments.

In Minnesota, the roots of the executive branch’s ability to utilize emergency budget reduction powers can be traced to at least 1939.

Governor Harold Stassen proposed the ability to reduce or unallot the budget under certain circumstances in his 1939 budget address. The Minnesota Legislature made the provision law that same year.

Although the ability to unallot has been part of Minnesota law for 70 years, unallotment was apparently not utilized prior to Governor Al Quie. Over the past 30 years, the unallotment procedure has been used by three governors: Al Quie in 1980 ($195 million) and in 1981 (local government aid payments were unallotted in November and December 1981 and were reallotted and paid by February 26, 1982); Rudy Perpich in 1986 ($109 million); and Tim Pawlenty in 2003 ($281 million), 2008 ($269 million), and 2009 ($2.57 billion).

The power of unallotment gives the executive branch significant flexibility in how it can reallocate funds. The Commissioner can either reduce the payment made to fund a given program or eliminate the program altogether. The Commissioner has the flexibility to consider other sources of revenue available to recipients of state appropriations and may apply allotment reductions based on all sources of revenue available. Funding from the current biennium can also be unallotted.

While the unallotment statute does not specify a timeline, it is generally assumed unallotment would have to occur in time to make up the projected deficit within the biennium.

In applying the law, the Commissioner of Finance’s only obligation to the Legislature is to report the intention to unallot to the Legisla14

September/October 2009

tive Advisory Commission (LAC). The Commissioner must specify the amount of money to be unallotted, the agency and programs affected, the amount of any payment withheld and any other information the Commissioner determines necessary. The Legislature has no authority to approve or disapprove the Commissioner’s actions.

Complying with the requirement that the Executive Branch notify the Legislative Advisory Commission (LAC) prior to unallotting funds, Commissioner of Finance Tom Hanson subsequently testified before the Legislative Advisory Commission, and not surprisingly triggered the ire of Democratic legislators.

Sen. Linda Berglin (DFL-Minneapolis) stated that she does not believe the Governor has the authority to make all of the aforementioned cuts. While there have been whispers about lawsuits, none had yet surfaced when this article was submitted.

State Economist Tom Stinson recently stated that he anticipates that as many as 4,700 jobs are set to be lost as a result of the unallotment. Speaker of the House Margaret Anderson Kelliher (DFL-Minneapolis), however, believes that job losses may be more significant.

The LAC has since passed a resolution stating that the Commission believes “that it would be unwise and not in the state’s long term fiscal stability to adopt the unallotments put forth by the Governor.”

DFL legislators are keenly aware that GAMC recipients will receive notices on February 18, 2010, informing them that they no longer have any health coverage, and are currently working to develop a potential compromise proposal that will restore funding to this program.

Pawlenty and his legislative colleagues have continued to state that the Legislature failed to pass a budget that reflected compromises by both branches of government.

Legislators argue that the Governor never had any intention of engaging in negotiations that included revenue increases. In the end, both parties seemingly allowed partisan differences and clever political maneuvering to preclude a budget compromise. The final product is one that is certain to have broad and potentially devastating implications for health care providers, educators, local governments and other entities that rely on state funding.

If the residual effects of the Governor’s unallotments aren’t enough to generate conMetroDoctors

troversy in 2010, election politics are certain to play a role in the debate. Governor Pawlenty’s budget solution came just a couple short weeks after an announcement that he will not seek reelection to office. This announcement triggered a flood of Republicans announcing their intentions to run for Governor. House Minority Leader Marty Seifert (R-Marshall) was one of the first members to announce his intentions, and subsequently stepped down from his post as spokesman for House Republicans. Rep. Kurt Zellers (R-Maple Grove) was subsequently elected to lead the House Republicans.

Other Republicans rumored to be considering a run for Governor include: Senate Minority Leader David Senjem (R-Rochester); Sen. David Hann (R-Eden Prairie); Rep. Tom Emmer (R–Delano); Rep. Paul Kohls (RVictoria); former Speaker of the House and current Labor and Industries Commissioner Steve Sviggum; Sen. Paul Koering (R-Little Falls); and former U.S. Senator Norm Coleman. More announcements are sure to come in future months.

Not to be outdone, the DFL Party has its own stable of gubernatorial candidates vying for their party’s endorsement. Candidates and potential candidates include: Speaker of the House Margaret Anderson Kelliher (DFL-Minneapolis); Rep. Paul Thissen (DFLMinneapolis); Sen. Tom Bakk (DFL-Virginia); Sen. John Marty (DFL-Roseville); Minneapolis Mayor R.T. Rybak; St. Paul Mayor Chris Coleman; former House Minority Leader Matt Entenza; former U.S. Senator Mark Dayton; former Senator Steve Kelley; and Ramsey County Attorney Susan Gaertner.

Between gubernatorial candidates who will be introducing bills and amendments for political purposes, there is certain to be a flurry of proposals that will generate much debate, but little policy. In the meantime, the 30,000 GAMC enrollees and the providers who care for them are left to hope that the Governor and members of the Legislature come up with a mechanism to preserve the program and evade the aforementioned line item veto.

H. Theodore (Ted) Grindal, J.D. is the partner in charge of the Government Relations practice group; Matt Schafer is the Grassroots Coordinator, State Government Relations, Lockridge Grindal Nauen P.L.L.P., www.locklaw.com.

The Journal of the East and West Metro Medical Societies

Hospice Care Enhances Dignity and Peace as Life Nears its End

M

uch of the pain and sense of Hospice care that is covered by Medicare clinical judgment regarding the normal course hopelessness that may acis chosen for specified amounts of time known of the individual’s illness.” CMS recognizes company terminal illness as “election periods.” Essentially, a physician that making medical prognostication of life can be eased by services specifically designed may certify a patient for hospice care coverage expectancy is not always an exact science. to address these needs. Hospice care, a fully for two initial 90-day election periods, followed Many physicians appreciate the fact that reimbursable Medicare Part A benefits option by an unlimited number of 60-day election hospice care enables family and loved ones to for beneficiaries and providers since 1983, ofperiods. Each election period requires that the participate in the experience and to get help fers the services designed to address the physical physician certify a terminal illness. Payment is from the hospice in managing their own feeland emotional pain through effective palliative made for each day of the election period based ings and reactions to the illness. The value of treatment when cure is not possible. In the on one of four per diem rates set by Medicare, hospice care is recognized and advanced by event that a beneficiary has been advised by commensurate with the level of care. many physicians and other health professionhis/her physician, that a cure for his/her illness The hospice benefit is intended for use by als. One professional organization, the Ameriis no longer possican Academy of Hospice ble, Medicare benand Palliative Medicine eficiaries may discuss (formerly the Academy hospice care as an of Hospice Physicians), Hospice is not about death, but rather about option. Physicians focuses its efforts on the the quality of life as it nears its end, for all and other health care “prevention and relief of practitioners can be suffering among patients concerned — the patient, family and friends, encouraged that the and families” through and the health professional community.

Medicare program palliative therapy, eduincludes a hospice cation and counseling. benefit that provides Among the Academy’s coverage for a variety objectives are to “bring of services and products designed for those the hospice approach into mainstream medipatients whose prognosis is terminal, with six with terminal diagnoses. When properly certicine and eliminate the dichotomy whereby months or less of life expectancy. The Medicare fied and appropriately managed, hospice care patients receive either curative or palliative program recognizes that terminal illnesses do is a supportive and valuable covered treatment care.” not have entirely predictable courses, therefore, option.

This distinction is important because the benefit is available for extended periods of Physicians and health care providers in despite a growing appreciation for hospice care time beyond six months provided that proper the community, skilled nursing facilities, and both as a philosophy and as a fully covered certification is made at the start of each coverhospitals are urged to raise awareness among Medicare benefit, there appears to be two age period. their patients about the hospice benefit and its perceived barriers to its broader acceptance.

Recognizing that prognoses can be unavailability. Further, a beneficiary may indeFirst is an understandable reticence to certain and may change, Medicare’s benefit pendently elect hospice care. The beneficiary contemplate the end of life. The second peris not limited in terms of time. Hospice care may discuss this option in the event that he ceived barrier is a lack of knowledge on the is available as long as the patient’s prognosis or she has a terminal diagnosis; however, in part of both patients and practitioners that meets the law’s six month test. all such cases, a physician must certify that the the covered hospice benefits are both broad This test is a general one. As the governbeneficiary has a terminal diagnosis with a six and readily available virtually everywhere in ing statute says: “The certification of terminal month prognosis, if the illness runs its usual the country. illness of an individual who elects hospice shall course. be based on the physician’s or medical director’s (Continued on page 16)

H

MetroDoctors

The Journal of the East and West Metro Medical Societies

September/October 2009

15

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Hospice Care (Continued from page 15)

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As with other covered services, payments for hospice care generally are made to providers based on prospectively-set rates that are updated every year for inflation. Hospice care is primarily a specialized type of home health care, and as is the case with the home health care benefit, hospices are served by regional intermediaries for Medicare billings, payments, cost reports and audits.

Medicare covers a number of specific services as defined in regulation and in the Medicare Hospice Program Manual. Most of these services are familiar to health care professionals and other practitioners who have worked with skilled nursing facilities (SNFs) and home health services. Covered services include: s -EDICAL AND NURSING CARE s -EDICAL EQUIPMENT SUCH AS WHEELCHAIRS or walkers) s 0HARMACEUTICAL THERAPY FOR PAIN RELIEF AND symptom control s (OSPICE AIDE AND HOMEMAKER SERVICES s 3OCIAL WORK SERVICES s 0HYSICAL AND OCCUPATIONAL THERAPY s 3PEECH THERAPY s $IET COUNSELING s "EREAVEMENT AND OTHER COUNSELING services s #ASE MANAGEMENT Hospice care also is covered by Medicaid in many states.

While most hospice patients had terminal diagnoses of cancer at the inception of the benefit in 1983, the hospice setting also is appropriate for patients who suffer from terminal illnesses such as lung disease or end-stage heart ailments, cancer, Alzheimer’s disease, and terminally ill AIDS patients. Hospice is not about death, but rather about the quality of life as it nears its end, for all concerned — the patient, family and friends, and the health professional community.

For more hospice information: go online to www.medicare.gov/Publications/home.asp, or http://www.cms.hhs.gov/Hospice/.

Reprinted with permission from the Centers for Medicare & Medicaid Services.

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September/October 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

Noran Neurological Clinic’s Eco-Friendly “Green” Ways Make a Positive Difference for Employees, Patients and the Community

F

or Dr. Thomas N. Schriefer, a boardcertified neurologist at Noran Neurological Clinic, his daily commute favors a decidedly fresh, “green” approach. Beginning around 4:45 most weekday mornings, from March through November, rain or shine (sleet or snow!), he makes the 21-mile trek by bicycle from his Orono home to and from the new “green” Noran Neurological Clinic in the heart of Minneapolis’ revitalized Chicago-Lake area. From the rolling landscapes of the West Metro, along the Luce Line, past city lakes to the Midtown Greenway corridor, the hour-plus ride offers a scenic, relaxing alternative to the congested freeways for Dr. Schriefer and an energy-conserving routine that he truly enjoys.

The added convenience of bike storage and lockers within the clinic further supports Dr. Schriefer and several other Noran Clinic professionals who find bike commuting convenient, energy-saving and healthy. For Dr. Schriefer, bike commuting extends his passion for the sport and demonstrates a healthy exercise regimen to his patients.

“Going green” is not a new trend, but rather a part of the culture of Noran Clinic that began in the 70s as a conscientious effort among its physicians and professionals to conserve energy and natural resources. Noran Clinic also has a network of home-based business office, transcription and nursing triage employees who “telecommute” from their homes as far away as Galveston, TX, each day.

These employees respond to patient needs and questions by phone and e-mail and communicate electronically to co-workers and referring practices.

By Phil Riveness

MetroDoctors

When planning for the clinic expansion began some years ago, Noran Clinic’s team defined three key attributes: s %ASY ACCESSIBILITY FOR PATIENTS AND VISITORS

with a convenient parking ramp adjacent to the clinic, as well as nearby public transportation. s ! COMFORTABLE PATIENT FRIENDLY CLINIC experience that affords privacy in the registration process. s ! COMPREHENSIVE hGREENv INITIATIVE TO rally the entire Noran Clinic team around solid, environmentally conscious practices to reduce energy and waste and improve efficiency, while continuing to focus on the highest quality patient care.

Working closely with the developer, contractors and construction teams throughout the

construction phase, these objectives were met, culminating with its new clinic and practice headquarters that opened last fall.

The “green” building initiatives are ever present in the new facility, beginning in the spacious reception area that features floor-toceiling windows on the north and east walls that harness natural heat and lighting. Thermal blinds are available to repel the sun’s heat during hot summer days, further reducing the air-conditioning demand.

Clinic hallways are bathed in natural sunlight, with warmth and light leading to the patient exam rooms. Programmable thermostats, high-efficiency lighting and high-velocity hand dryers in restrooms further add to the efficiency and cost savings.

(Continued on page 18)

Dr. Thomas N. Schriefer, board-certified neurologist and bike enthusiast, is one of a number of Noran Neurological Clinic personnel who find bike commuting convenient and energizing. Three Rivers Park District trails, the Luce Line and the Greenway Corridor offer a scenic, exhilarating departure from the city’s congested thoroughfares.

The Journal of the East and West Metro Medical Societies

September/October 2009

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Another environmentally friendly achievement at Noran Clinic has been the conversion to a picture archiving and communication system (PACS), which has eliminated the clinic’s two film processing centers. Additional savings have been realized through the reduction of film, film jackets, processing chemicals and supplies and storage space. All diagnostic images — CT scans, Noran Neurological Clinic’s spacious new reception area harnesses the warmth and natural sunlight from floor-toceiling windows overlooking the Abbott Northwestern campus.

MRI’s, x-rays and the like — are completely digital, with dial-up Noran Neurological Clinic access by physicians at all clinic and hospital to EMR’s, digital dictation, e-prescribing and (Continued from page 17) locations. further communications throughout the clinic In addition, at Noran Clinic’s new Sleep Paperless, high-tech clinic: network. Some offices have tablet-sized flat Center in Minneapolis, all sleep study tracings Achieving a near-paperless clinic environscreens, as well, for patients to view additional and recordings are completely digital. ment has been a slow, but fruitful process at information and videos.

From simple recycling measures that were Noran Clinic. As an early adopter of elecThe business office at Noran Clinic also initiated back in the 70s, Noran Clinic has had tronic medical records (EMR’s) — as early as operates on an energy-efficient, cost-saving a long history of adopting new measures to pro1997 — Noran Clinic has shrunk its former basis, replacing costly and cumbersome paper tect the environment, conserve resources and library-size filing system to just a few shelves files and practices with Web-based systems trim operating costs. Employees are encourof paper charts. Many new patients submit for accounting, claims processing, human aged and recognized with “Above and Beyond” registration materials and information forms resources, patient communications and other rewards to inspire new ideas and conservation online prior to their initial visits. All additional vital business functions. Electronic fee tickets measures to further achieve energy and cost records and files are scanned, shredded and are a significant improvement, as well as e-faxsavings. recycled. The system provides the capability ing, electronic claim filing and e-remittances.

These “green” initiatives have benefited for the transfer of critical files throughout the Standard printed EOB’s are scanned, shredded Noran Clinic by trimming operating costs clinic’s network, including affiliated hospitals and recycled — eliminating volumes of paper. by an estimated $500K annually. While the and referring practices.

Similarly, Web-based employee time records central mission of Noran Clinic is to provide Over the past few years, clinic teams and online payroll systems have further streamexcellence in care to its patients, it also has have partnered with Abbott Northwestern to lined clinic operations. been possible to focus on these environmental define the best means to further synchronize Online patient forms expedite the patient improvements by reducing waste, streamlintechnologies and achieve even greater EMR efregistration process and begin the process of ing operations and creating a positive “green” ficiencies. The collaborative process continues, building lasting and secure digital patient files environment. with the promise of even further advancements that can be accessed at anytime. in the future.

Noran Clinic’s employee break room is Phil Riveness, For patients and visitors, the large flata further testament to its commitment to a long-time associate screen monitors and information kiosks in the high-quality, paperless environment, with the administrator reception areas further evidence this paperless exclusive use of china, glass and flatware rather at Noran Clinic environment. The clinic’s Web site provides than disposable products to significantly reduce in Minneapolis, patients with information that was previously waste and costs. has been a strong available only in brochures, reducing printing Filtered water is accessible to everysupporter of the and production costs and associated paper and one — eliminating the inconvenience and clinic’s “green” inisupplies. added waste of bottled water. With a hightiatives throughout Each exam and consultation room offers efficiency dishwasher, clean up is easy and there his tenure. a high-tech workstation for immediate access is minimal disposable waste.

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September/October 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

The Prevention Paradox and a Public Health Approach to College Student Drinking Editor’s Note: A resolution on “addiction awareness” has been forwarded for debate by the MMA House of Delegates on September 17-18. The resolution calls for the MMA to support evidence-based clinical training to improve clinical recognition and treatment competencies for alcohol and drug use/abuse.

Heavy use of alcohol is the third leading cause of mortality in the United States, accounting for nearly 80,000 deaths on an annual basis.1 Heavy drinking is a particular problem among young people who attend college. More than four in five college students drink alcohol and they tend to drink more heavily than older adults and their peers who do not attend college.2-4 Beyond the risk of death, drinking causes a wide range of serious negative health and social consequences for college students who drink and for those around them.4 These negative consequences need to be prevented.

While the problems associated with college student drinking are well-documented, effective solutions remain elusive. Despite concerted effort over the past decade, no significant improvements in student alcohol use and negative consequences have been observed.4-6 The lack of progress to date in reducing student alcohol use is due, in part, to a failure to consider the problem from a public health, or population, perspective. This research brief describes the empirical basis for a fundamental concept supporting a public health approach, the Prevention Paradox, as it relates to college student drinking. These data motivate a subsequent discussion of “high-risk” and “population” approaches to addressing the problem of

By Toben F. Nelson, ScD

MetroDoctors

student drinking, with direct implications for prevention practice.

The Relationship Between Consumption and Harms: Demonstrating the Prevention Paradox

Alcohol consumption is strongly associated with negative health and social consequences including, academic difficulties, verbal, physical and sexual assault, vandalism, and alcohol overdose.4, 7 The more alcohol an individual typically consumes, the more likely he or she is to experience these negative consequences.7 In addition, widespread drinking at the college level is associated with secondhand effects of alcohol use, such as sleep disruption, assault, noise complaints and vandalism among students who don’t drink alcohol and among residents of neighborhoods near colleges.8, 9 Table 1 illustrates the relationship between alcohol consumption and harm based on responses of nearly 50,000 students who have

participated in the Harvard School of Public Health College Alcohol Study (www.hsph. harvard.edu/cas/) since it began in 1993. In this example, the number of students who reported being injured as a result of their own alcohol use is compared with the usual number of drinks they consume. Alcohol-attributable injuries are a major health problem among college students, with an estimated 600,000 occurring each year.10 The third column (% injured) shows the percentage of students who were injured as a result of drinking for each level of drinking. This evidence demonstrates the increasing likelihood of getting injured at higher levels of consumption. The relationship between consumption and harm is very stable over time and across different groups of students.7, 11

The highest percentage of injured students occurs at the highest levels of consumption, but there are few students who drink at (Continued on page 20)

Table 1. Alcohol-attributable injury by usual number of drinks when drinking Usual number of drinks

Number of students surveyed (%)

% injured

Number of students injured (%)

0

10,595 (21)

0

2 (0)

1

5,241 (11)

2

91 (2)

2

8,304 (17)

4

372 (8)

3

7,009 (14)

9

601 (12)

4

5,782 (12)

14

793 (16)

5

4,561 (9)

18

805 (16)

6

3,189 (6)

23

727 (15)

7 8 9 or more

1,696 (3) 1,191 (2) 2,080 (4)

26 30 33

442 (9) 356 (7) 692 (14)

Total/Overall

49,648 (100)

10

4,881

(Source: Harvard School of Public Health College Alcohol Study)

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College Student Drinking (Continued from page 19)

these levels. Less than 10 percent of all students usually consume seven or more drinks when they drink. The vast majority of students consume fewer drinks, but there is still a risk of being injured associated with those lower levels of consumption. This lower, but non-zero, level of risk explains why (as shown in the last column) more than two-thirds of the alcoholrelated injuries among college students occur among those who use alcohol at comparatively lower levels. The absolute risk of being injured is lower, but there are many more students who drink at this level. It is also true that the likelihood of being injured is relatively low (one in three) even for the heaviest drinkers.

The table presented here shows one example, but we have observed the same consumption-harm relationship for other measures of both consumption and harm.11 Students who consume successively higher amounts of alcohol are more likely to experience negative consequences from their drinking, regardless of whether the harm is academic problems, getting in trouble with the police, assault, vandalism or alcohol overdose. The only difference is the degree of the risk. For example, drinkers are more likely to fall behind in school as a result of their drinking than they are to engage in risky sexual behavior, but the relationship between consumption and those harms is the same — more drinking is associated with greater risk of harm.7 In addition, the consumption measures are highly correlated.

In other words, students who tend to drink frequently, also tend to consume high levels per drinking occasion and report more frequent experiences of drunkenness. Most importantly, the burden of alcohol-related harms within the population falls not among the heaviest drinkers, of which there are few, but among the many who drink at lower levels. This is true even for the most serious alcohol-related harm.

This counterintuitive phenomenon is known as the Prevention Paradox and it has been demonstrated in many studies in a wide variety of populations.12 The paradox is that the heaviest drinkers (those at “high-risk”) account for only a small percentage of the overall harms in a population. This fundamental concept 20

September/October 2009

in Public Health has direct implications for prevention and intervention and helps explain why we have not been very successful in reducing student drinking.

The High-risk Approach: A Narrow Focus

Most common prevention and intervention approaches target students at “high-risk” for alcohol-related problems. High-risk approaches are appealing, intuitive and match with the specific needs of individual students.12 Strong motivation to change those at “high-risk” exists since these individuals are most likely to experience serious negative consequences from their drinking and potentially have the most to gain from an intervention.

In a “high-risk” approach, individuals at “high-risk” are viewed as separate and distinct from the “normal” population, and are often labeled “problem drinker” or “alcoholic.” By identifying these individuals, interventions can be targeted to these “bad apples” who are “spoiling” the rest of the basket. Appropriate interventions for high-risk students include education, counseling and treatment.

There are several inherent challenges of the “high-risk” approach. Identifying students who are likely to experience harms is costly and even our best available measures identify a small fraction of those who will be harmed by alcohol. This has led some to propose using measures to identify “high-risk” students that incorporate the experience of harms as well as measures of consumption. But we won’t be successful at prevention if we have to wait around for the negative consequences to occur that we want to avoid. It also ignores how risk is distributed in a population. Even if we can successfully identify “high-risk” students few of them think they are a problem drinker or are willing to get treatment voluntarily, even among students who drink heavily and experience problems from their drinking. For those who do find their way to education, counseling or treatment programs, the success rates of those programs are quite low.

Beyond these problems, the “high-risk” approach has a fundamental flaw. As Table 1 demonstrates, even the most effective intervention, appropriately targeted at “high-risk” drinkers can potentially only prevent a small proportion of the harms experienced in the MetroDoctors

entire population. This is not to suggest that we forgo treatment efforts or a “high-risk” approach. It instead means that by itself, a “high-risk” approach is not sufficient to address the majority of harms in a population.

The Population Approach: Expanding the Focus

The Population Approach has received less attention for addressing college student drinking. In contrast to “high-risk” approaches, this approach views risk as distributed throughout a population.12 As shown in the Table, even the lowest levels of drinking carry some risk.

“High-risk” drinking behavior is directly related to the level of normative drinking behavior in the population. For example, we have observed that the number of students who meet criteria for alcohol abuse disorders according to the American Psychiatric Association Diagnostic and Statistical Manual are strongly correlated with the number who use any alcohol at the college-level.13 Similarly, we have observed very consistent levels of drinking in the same colleges over time, despite surveying new groups of students each year.

The implication of these findings is that environmental conditions help shape the behavior of everyone in that environment.

The goal of a Population Approach is not to cure the most extreme group of drinkers.

Rather, Population-based interventions seek to incrementally shift the behavior of the whole population downward. By doing so, fewer overall negative consequences should result because the risk at each drinking level remains the same.

Examples of population-based interventions with the potential to create a downward shift in alcohol consumption include limiting access to alcohol through restrictions on the density of outlets for purchasing alcohol, mandatory responsible beverage service training, controls on sales of reduced price drink specials, and increased taxes. These types of interventions apply to everyone in the population and help shape everyone’s drinking behavior. Not coincidently, these interventions have the most empirical support for reducing drinking and its negative consequences.

A problem with a Population Approach is that the potential benefits to a given individual are small. A heavy drinker may cut back his or her consumption in the face of higher taxes,

The Journal of the East and West Metro Medical Societies

but he or she is likely to continue drinking at relatively high levels. Population approaches can also restrict the behavior of individuals at lower risk, who are unlikely to ever experience a negative outcome. Policymakers and other invested stakeholders may be less likely to enact population interventions because of these restrictions, despite strong evidence that they are effective.

The good news is that Population and High-risk approaches are complementary, not mutually exclusive. By understanding the distribution of risk throughout a population and integrating a Population approach with a High-risk approach we can hope to reduce the drinking-related harms that occur among college students.

Summary

The negative health and social consequences of heavy drinking among college students remains a serious problem and effective solutions are needed. To date most efforts have focused on targeting those at “high-risk.” By understanding and applying principles of a Population Approach, in addition to “High-risk” approaches, it may be possible to make progress in reducing the seemingly intractable problem of college student drinking.

For further reading: s 4HE (ARVARD 3CHOOL OF 0UBLIC (EALTH College Alcohol Study http://www.hsph. harvard.edu/cas/ s #OLLEGE STUDENT BINGE DRINKING AND THE “prevention paradox”: Implications for prevention and harm reduction http:// www.hsph.harvard.edu/cas/Documents/ paradox/ s #OLLEGE $RINKING #HANGING THE #ULTURE (National Institute on Alcohol Abuse and Alcoholism) http://www.collegedrinkingprevention.gov/ s 0REVENTING 0ROBLEMS 2ELATED TO !LCOHOL Availability: Environmental Approaches (Substance Abuse and Mental Health Services Administration) http://ncadi. samhsa.gov/govpubs/PHD822/aar.aspx?

MetroDoctors

References: 1. Mokdad, A.H., et al., Actual causes of death in the United States, 2000. JAMA, 2004. 291(10): p. 1238-45.

2. Slutske, W.S., et al., Do college students drink more than their non-college-attending peers?

Evidence from a population-based longitudinal female twin study. J Abnorm Psychol, 2004.

113(4): p. 530-40.

3. O’Malley, P.M. and L.D. Johnston, Epidemiology of alcohol and other drug use among American college students. J Stud Alcohol Suppl, 2002(14): p. 23-39.

4. Wechsler, H., et al., Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001. J Am Coll Health, 2002. 50(5): p.

203-17.

5. Johnston, L.D., et al., Monitoring the future national survey results on drug use, 1975-2006: Volume II, College students and adults ages 19-45 (NIH Publication No. 07-6206). 2007.

6. Substance Abuse and Mental Health Services Administration, Results from the 2006 National Survey on Drug Use and Health: National Findings, Office of Applied Statistics, 2007: Rockville, MD. 7. Wechsler, H. and T.F. Nelson, Relationship between level of consumption and harms in assessing drink cut-points for alcohol research: Commentary on “Many college freshmen drink at levels far beyond the binge threshold” by White et al. Alcohol Clin Exp Res, 2006. 30(6): p. 922-7.

8. Wechsler, H., et al., The adverse impact of heavy episodic drinkers on other college students. J Stud Alcohol, 1995. 56(6): p. 628-34.

9. Wechsler, H., et al., Secondhand effects of student alcohol use reported by neighbors of colleges: the role of alcohol outlets. Soc Sci Med, 2002. 55(3): p. 425-35.

10. Hingson, R., et al., Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24: changes from 1998 to 2001. Annu Rev Public Health, 2005. 26: p. 25979.

11. Weitzman, E.R. and T.F. Nelson, College student binge drinking and the “prevention paradox”: implications for prevention and harm reduction. J Drug Educ, 2004. 34(3): p. 247-65.

12. Rose, G. The Strategy of Preventive Medicine.

Oxford University Press, Oxford, 1992.

13. Nelson, T.F. and Weitzman, E.R. Alcohol treatment gap among US college students. Presented at the annual meeting of the American Public Health Association, October, 2008, San Diego, CA

Toben F. Nelson, ScD, Assistant Professor, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota.

Research Brief is published by the University of Minnesota School of Public Health, 420 Delaware Street, S.E., Minneapolis, MN 55455. www.sph.umn.edu. Reprinted with permission.

The Journal of the East and West Metro Medical Societies

September/October 2009

21

President’s Message

Should Physicians Support America’s Affordable Health Choices Act of 2009?

RONNELL A. HANSEN, M.D.

EMMS Officers

President Ronnell A. Hansen, M.D. President-elect Thomas D. Siefferman, M.D. Past President Peter B. Wilton, M.D. Secretary/Treasurer Anthony C. Orecchia, 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 For a complete list of EMMS Board of Directors go to www.metrodoctors.com.

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September/October 2009

BELOW IS AN EXCERPT FROM TESTIMONY provided to Congresswoman Betty McCollum at a recent event she hosted at the Minnesota State Capital. Dr. Hansen represented the concerns he has gathered from physicians in the metro area over many months as it relates to the national health care reform efforts.

AMA supports H.R. 3200, “America’s Affordable Health Choices Act of 2009”— but there is far from uniform agreement amongst health care providers and health care economists on whether this was the right choice to make.

What many who currently practice medicine and care for patients fear is that the proposed federal health care reform will effectively result in an expansion of public programs which enlarges the chronically under-reimbursed Medicaid-type system and moves enrollees on private plans into a federal Medicare-style public plan. Both of these options offer little comfort to the health care system as truly transformative health care reforms.

What’s wrong with the way providers are reimbursed by government programs? From a federal perspective, Medicare rates were set on a flawed formula developed many years ago. Raises in payments brought forth at the national level typically do not even cover the rate of inflation.

From a Minnesota state perspective, increases in payments by the legislature to Minnesota health plans for state programs over each biennium has occurred nine times, although an actual payment increase was passed onto providers only once. Where is the transparency on where the money is going? Perhaps these areas are where we should begin true reform.

Given what most Americans expect for their health care, there is another fundamental question which deserves consideration. Is it wise to expand the number of people in health plans with government set reimbursement rates, yet expect the current level of quality, availability, and innovation from the system? While the “health care system” appears to be the focus of a number of cost saving initiatives — as many economists also suggest, I’m not so certain overall quality is really the biggest question for our health care system — but cost and access in that system are the correct questions.

On net, H.R. 3200 adds substantially to future budget deficits — even according to the Congressional Budget Office’s Director, Doug Elmendorf. He states that reform bills fail to include the two leading strategies to reduce costs: 1) Medicare payment reform; and 2) tax code reform.

Can the value index proposal leverage against the political forces in Washington which created the inequities to begin with? Perhaps — but if widely applied through a federal insurance program which may “compete” with private plans, driving appropriately paying private insurance to very low levels or, in the end, eliminating it completely — does this leave us with a financially viable and sustainable health care system of current quality and availability?

Past attempts to manage increasing health care costs through either corporate and/or government rationing of supply (access), have been shown to not work well. In past reforms, transferring the “gatekeeper” function initially used by HMO corporations to health care providers effectively resulted in the bankrupting of clinics which were unwilling to ration care to their patients. Such mechanisms interfere and run counter to the obligation of provider decision making in the best interests of their patients.

MetroDoctors

The Journal of the East and West Metro Medical Societies

Though “Accountable Care Organizations” sound effective in concept, ACO’s in the most basic sense capitate providers on a fixed budget. Under such systems, small independent “at risk” providers will face the same dilemma as failed powerful insurance corporations: cost, quality, or access — you can have any two, but not all three.

I suspect American taxpayers likely fear the hundreds of billions of new debt introduced by the federal program — and they should, as in the future, it will burden fewer and fewer workers to pay for it. Calculations estimate, that in the next 10 years, the number of workers per Medicare beneficiary will drop from 3.7 to 2.9. Thoughtful and realistic assessment of any reform proposal must break down to basic mathematics of the economy.

As outlined, mandated insurance is interesting and attempts to address the laudable concept of improved access to care, but the economic repercussions of such a proposal are potentially onerous (refer to the financial difficulties of the Mass. Plan and the more open rationing by Oregon).

Required to “pay or play,” those businesses or individuals failing “meaningful coverage” pay a penalty (a percent of payroll near 8 percent), into a national fund providing insurance for noncovered workers. Economist’s interpretation: A disguised employment tax, as judged by Princeton University professor Uwe Reinhardt, with potential cost of 1.6 million jobs over the first five years.

Interestingly, H.R. 3200 may in fact suppress appropriately paying private individual coverage by preventing any new policies from being written after the public option becomes law. The legislation may also limit health savings accounts (HSAs) — a more “market-based” option allowing consumers direct control of their health care spending. Thus, in the final analysis, Federally backed insurance, a public option “managed care” plan (likely underpaying), would not really compete on a level playing field with private plans — most of which are only other “managed care” corporations which also have failed to control costs.

As a consequence of White House negotiations, I suspect all private pay patients will likely be impacted by the new deals aimed at cost reduction with the pharmaceutical industry and the hospital association. Most of what these interests agreed to was to take lower Medicare reimbursement rates. Due to the “cost-shift” we are now familiar with — the unpaid “cost” of lower reimbursement rates to providers are then effectively passed on to these private payers — either individuals out of pocket, or seen as higher insurance premiums by private insurance holders.

Efforts to reduce ineffective or duplicative care, primarily posed by electronic medical records (EMR) and medical homes, are admirable; however, will the massive amounts of EMR data and the construct of the medical home be used primarily for effective patient care and efficient cost reduction, or will the data and constraint allow undue scrutiny (and financial penalty) of physician “resource utilization” (money used) for patient care?

As informed policy people, we must understand individual patients are not population statistics (the data frequently invoked for such reforms), and there appears to be a frequent assumption of authenticity of such clinic statistics in policy formation. Such statistics are really only robust when derived from very large populations, “smoothing” the bell curve and lessening the financial impact of outlier events on insurance corporations. Insurance risk is actuarially sound when calculated across large groups of typically 25,000 — 50,000 at minimum, not your average practice, nor an individual physician.

Ultimately, the worries of many health care providers are: 1) the primary driver of “reform” will be financial penalty to “non-compliant” physicians, with continued unsustainable decrease in reimbursements, and 2) the continued evolution of a “reform solution” which incentivizes physicians to restrict care (save premium dollars) from “bundled services” pricing, bid down by competing large clinics/corporate providers to unsustainable levels for independent/small practices.

If poorly structured, bundled services may translate into “comprehensive care” for an episode, and splitting of capitated (bid down) fees among all providers (including the hospital) — and in some cases covering up to 90 days of patient complications. In such a system, the true price transparency and market forces remain suppressed and hidden from the users of health care.

New Members EMMS welcomes these new members to the Society.

Active Sarah A. Anderson, M.D. University of MN Dept. of Orthopedic Surgery Orthopaedic Surgery Michael J. Berger, M.D. University of MN Dept. of Lab Med & Pathology Pathology Christopher J. Fallert, M.D. University of MN Dept. of Medicine Family Medicine Daniel R. Hanson, M.D., Ph.D. University of MN Dept. of Psychiatry Psychiatry Irshad H. Jafri, M.D. HealthPartners Regions Specialty Clinics Internal Medicine Michael J. Klevay, M.D. St. Paul Infectious Disease Associates, Ltd. Internal Medicine Mojca R. Konia, M.D., Ph.D. University of MN Dept. of Anesthesiology Anesthesiology Paul M. Lafferty, M.D. University of MN Dept. of Orthopedic Surgery Orthopaedic Surgery Michael K. Loushin, M.D. University of MN Dept. of Anesthesiology Anesthesiology Gervais Patrick C. Moche, M.D. HealthEast Cottage Grove Clinic Family Medicine Daphne P. Tumaneng, D.O. Comprehensive Health Care for Women Osteopathic Manipulative Medicine Ryan E. Will, M.D. University of MN Dept. of Orthopedic Surgery Orthopaedic Surgery Kevin T. Wycoff, M.D. Fairview Oxboro Clinic Internal Medicine Resident Physician Sonia L. Karimi, M.D. Angma Internal Medicine Residency Clinic

MetroDoctors

The Journal of the East and West Metro Medical Societies

September/October 2009

23

Minnesota Physician Services, Inc. Provides Member Discounts

M

innesota Physician Services, Inc. (MPS) is the for profit subsidiary of the East Metro Medical Society that strives to provide members with discounts on products and services. MPS has entered into business relationships with a variety of business partners who offer discounts that you might not get elsewhere. Group purchasing power is offered due to the volume of physicians and practices that the medical society represents. The value to our members is the discounts that they can receive. The value to the East Metro Medical Society is that any relationship generating a

Please consider these business partners as you consider purchasing the following products and services. To learn more please visit our Web site http://www.metrodoctors.com/ services.cfm. percentage of the sales coming back to the medical society helps to offset our operating expenses. It’s a win-win. EMMS members benefit from the power that group purchasing can bring and your local medical society receives additional non-dues revenue to help support its work.

EMMS Senior Physicians Association

T

his spring, 20 retired physicians and guests met at Bethesda Hospital to socialize over lunch and to hear tales of sailing the tropical seas. When Dr. James Wall, an OB/ GYN physician from Saint Paul, retired, he spent 16 years navigating a sailboat in the Bahamas, Caribbean, and the Mediterranean. Dr. Wall shared many photos and stories of his adventures with the group.

All retired physicians and those of retirement age are invited to

join their colleagues on Thursday, October 29, 2009, at 11:30 a.m. on the 7th floor of Bethesda Hospital to hear Dr. Roland Birkebak’s presentation about a hospital he started in Nigeria.

Attendees enjoy one of the many stories shared by Dr. Wall.

ROBERT PHILIPS BUSH, M.D. died peacefully at the age of 89 on July 27, 2009 in Saint Paul. Dr. Bush earned his medical degree from the University of Pennsylvania School of Medicine, Philadelphia. He practiced psychiatry in Minnesota; notably, he was the director of the Hamm Memorial Psychiatric Clinic in Saint Paul from 1968 to 1985. He started the Hamm Clinic School Services program, which provided mental health services at no charge to nearly every college in St. Paul and Minneapolis. He worked hard on this program and was rewarded as he watched it succeed. Dr. Bush then held private practice until he retired. He had a true interest in the life of each client and acquaintance with whom he crossed paths, and a strong love for close friends and family.

September/October 2009

!MERI0RIDE ,INEN OFFERS CLINICS DISCOUNTS on linen and garment services. They are a local company and offer terrific value to the membership. s "ERRY #OFFEE OFFERS beverage services to clinics and hospitals. s 3AFE!SSURE #ONSULTANTS OFFERS CLINICS WITH on-line OSHA compliance training. s "ANK OF !MERICA PROVIDES %--3 MEM bers with credit card services. s )# 3YSTEMS OFFERS accounts receivable management expertise. s !%$ 0ROFESSIONALS IS A WHOLESALER OF AED defibrillators offering member discounts. s 3TANTON 'ROUP OFFERS group insurance for clinics.

If you have questions or ideas for new business partnerships for the medical society, please call Sue Schettle at (612) 362-3799, or e-mail her at sschettle@metrodoctors.com.

Attn: Members We Need Delegates!

The MMA Annual Meeting will take place in Rochester September 16-18.

In Memoriam

24

s

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Space is always available for members to serve as delegates.

For More Information Visit www.metrodoctors.com or call Katie at (612) 362-3704

The Journal of the East and West Metro Medical Societies

Nominate a Colleague for the Community Service Award!

East

East Metro Medical Society is now taking nominations for the 2009 Community Service Award, which will be presented to the recipient at an appropriate venue.

Please think about physicians you know who are active in the local community outside of his/her professional medical work.

Metro Medical Society

Award Criteria ■

Must be a practicing or retired EMMS member.

■

The individual should be actively volunteering with local projects or programs, participating in civic or service organizations, educational or charitable groups, or in public office(s).

Name of physician I am nominating: ___________________________________________________ If applicable, this physician practices at: _________________________________________________ This physician volunteers in the following ways:___________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

→ Fax this form to EMMS at (612) 623-2848 ← Recent Award Winners: 2008) George F. Smith Jr., M.D.

Sponsored by:

2007) Walter L. Bailey, M.D.

2006) Richard W. Anderson, M.D.

MetroDoctors

Call or e-mail Katie Snow with questions at (612) 362-3704 or KSnow@metrodoctors.com.

The Journal of the East and West Metro Medical Societies

September/October 2009

25

Chair’s Report

A Great Summer RICHARD D. SCHMIDT, M.D.

SUMMER BRINGS BACK GREAT MEMORIES. I remember growing up with the freedom to

WMMS Officers

Chair Richard D. Schmidt, M.D. President Edward P. Ehlinger, M.D. President-elect Peter J. Dehnel, M.D. Secretary Melody A. 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 J. 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.

roam the neighborhood and play with friends. We vacationed in Minnesota and went fishing, we visited our cousins in Colorado and eventually we returned to school. What a great life. It was simple and we never thought about the disparities of life. We knew that doctors had nice houses and that there were rich people, but nothing seemed out of balance. Even in high school, college and medical school life was good. We worked hard and played hard but we seemed to have enough to exist without hardship. We made next to nothing as interns and residents but life was still great. Life was moving forward in a positive way and we saw the end in sight. Finally, we were ready to venture into medical practice. We chose our specialties and joined groups and proceeded to treat our patients.

In general, we joined small groups of specialists, in our field, practiced at a few hospitals, worked hard, were independent of large organizations and the payment system paid us for what we did. There were fewer hassle rules, health plans, or oversight. Our goal was to serve the patient and the world still seemed good.

Then something changed. Medicare became a larger part of our lives. Technology took mega steps forward creating CT scanners, new powerful cancer drugs, endoscopic and arthroscopic procedures, heart valves, pacemakers, stents, and prosthetic replacements for many parts of the body. This list could stretch out to more than my allotted space, but you get the point. Health Maintenance Organizations, Health Plans, Preferred Provider Organizations, numerous supervisory organizations and think tanks bloomed or were hatched. Hospitals closed and merged, or became part of the system that paid us and finally bought our medical practices. Physicians sub-specialized and to have a greater voice merged into large groups rather than small groups.

Currently we are adapting to computer technology for our medical records, billing and payment and now for supervision and to assess quality.

Is any of this necessarily bad? I guess not. I won’t go back to black and white television and I won’t give up my computer. While there is nothing worse than a computer crashing or the power going out at a crucial moment, I survive despite the inconvenience and the complications to my life. I know, in medicine, that I won’t give up the MRI scan, my i-Phone, the technology that provides better patient outcomes and even the electronic medical record.

Our lives and our medical practices have definitely changed but I have many concerns and questions. I don’t have the answers but I will lob a few questions and concerns out there to see what happens. Has technology become our god at the cost of the patient-physician relationship?

Has greed and jealousy affected medicine the way it apparently has in the business world. (Tom Petters is close to home.) Is there too much income disparity in society? Has selling out to hospitals created loss of control and independence leading to decreased incomes? Can smaller, independent groups actually thrive in today’s market? Should hospitals have control of all surgery centers or, despite a potential conflict of interest, should physicians be able to compete in these enterprises?

Practice variation from area to area has become a hot topic. How much variation is good? Some variation is probably needed and some of the outliers may be correct after further analysis. Some discoveries and innovation have come from those we may consider odd. Do we stifle dissent from the norm?

(Continued on page 27)

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September/October 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

WMMS IN ACTION JACK G. DAVIS, CEO

Chair’s Report (Continued from page 26)

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

A few spots remain for Delegates from the West Metro Trustee district to attend the MMA Annual House of Delegates Meeting scheduled for September 16-18,

2009 in Rochester. This is your opportunity to join your colleagues from across the state to set the MMA priorities for 2010 and beyond. If you would like to attend, contact Kathy Dittmer at (612) 623-2885. WMMS is providing a $100 stipend to assist with your expenses.

The Hoban Scholarship Selection Committee, chaired by Paul Hamann, M.D., is still soliciting applications for 2010 Scholarships. If you are aware of a non-physician who is pursuing an advanced degree in administration or nutrition, which will likely lead to a position that will interact with physicians, have them contact Nancy Bauer at (612) 623-2893 or nbauer@metrodoctors.com.

Richard Schmidt, M.D., chair of the West Metro Medical Society represented WMMS

physicians at the University of Minnesota Medical School incoming class White Coat Ceremony. The event took place at Northrup Auditorium on August 7. ADC Buck Hammers were distributed on behalf of the East Metro and West Metro Medical Society members.

As WMMS gets closer to a successful consolidation with EMMS, the leadership of the two societies is choosing to leave their respective foundations virtually unchanged.

The West Metro Medical Foundation (WMMF) will remain a separate 501c3 philanthropic organization focusing its fundraising on members who practice within the MMA West Metro Trustee District and directing its philanthropy in the same geographic area. WMMF will also assume responsibility for West Metro Awards such as the Shotwell, Charles Bolles Bolles Rogers and “First a Physician.” Richard K. Simmons, M.D. is the current Chair of the West Metro Medical Foundation.

Kathy Dittmer Celebrates 20 Years!

J

uly 6, 2009, marked the 20th anniversary of Kathy Dittmer, WMMS Executive Assistant. Kathy was hired by Thomas W. Hoban, former CEO. Mr. Hoban often chided that to accept a position in this office, you were making a life-long commitment, as was reflected in the tenure of all preceding staff — an average of 30 years.

There have been several changes experienced by Kathy, including moving the office twice, a new CEO (Jack Davis), two name changes (from Hennepin County Medical Society, to Hennepin Medical Society, to West Metro Medical Society) and countless other job and responsibility shifts. Throughout it all, Kathy has maintained a positive “can-do” attitude, a willingness to always share the load of others and is the “go-to” person for all our technology and historical questions.

“Kathy is a wealth of knowledge and a dedicated employee. She is the ultimate task-master, keeping our leadership and staff scheduled and informed at all times,” says Jack Davis. In addition, her work with the Senior Physician Association and the West Metro Medical Society Alliance has been exemplary.

Thank you, Kathy!

MetroDoctors

The Journal of the East and West Metro Medical Societies

I do know there has been great change.

Who would have believed that GM would go bankrupt, that long-term pensions plans would no longer exist, that newspapers may be a thing of the past and that our news and advertising would come via the internet? While we relish the memories, they are not today’s realities. Most of us are not good at change but if medical practice life is to survive to our liking, we need to understand what is happening and adapt. We must make the necessary changes or we may become like GM. While I don’t support a single payer system, I don’t absolutely reject it. I believe that the principle in malpractice of considering the context of time, place and applying the broadly accepted principles to establish the standard of care applies to reforming our health care system.

It is unlikely that we will have a single payer because that is not how it is done in the U.S. and it is not the right time. We still believe in choice. While we were growing up we were good adapters. Can we still adapt? With all of the changes and questions, life is still good.

Attn: Members We Need Delegates!

The MMA Annual Meeting will take place in Rochester September 16-18.

Space is always available for members to serve as delegates.

For More Information contact Kathy Dittmer at (612) 623-2885 or kdittmer@metrodoctors.com

September/October 2009

27

Welcome New WMMS Members Active Shantel S. Branch-Fleming, M.D. Fairview Brooklyn Park Clinic Family Medicine R. Michael King, M.D. North Memorial Health Care General Surgery, Thoracic Surgery, Cardiovascular Surgery Jonathan M. Larson, M.D. Lakeview Clinic, Ltd. Family Medicine Jeffrey P. Louie, M.D. Children’s Hospitals-St. Paul Pediatric Emergency Medicine Sarah C. Maier, M.D. Fairview Hiawatha Clinic Family Medicine Susan E. Minette, D.O. Noran Neurological Clinic, P.A. Neurology Gauri G. Nagargoje, MB, BS Minnesota Oncology Hematology, P.A. Internal Medicine, Hematology/Oncology Mark A. Palmer, M.D. Minnesota Oncology Hematology, P.A. Internal Medicine, Hematology/Oncology Patrick M. Rock, M.D. Indian Health Board of Minneapolis Family Medicine Steven R. Sabers, M.D. Institute for Low Back & Neck Care Physical Medicine & Rehabilitation Thomas N. Schriefer, M.D. Noran Neurological Clinic, P.A. Neurology, Electrodiagnostic Medicine Lynne P. Steiner, M.D. HealthPartners — RiverWay Clinics Family Medicine Robert A. Wieland, M.D. Allina Health System Internal Medicine 28

September/October 2009

Senior Physicians Association

K

athleen V. Watson, M.D., Associate Dean for Students and Student Learning, addressed the Senior Physicians Association on “Medical Education: Endurance Course or Journey?” at the June luncheon. Her comments comparing the medical student experience of today with that of the Senior Physicians was both nostalgic and insightful.

It is gratifying to know that medicine is still considered a profession of the heart and medical students continue to experience the passion and compassion in the privilege to care for others.

Our next meeting is September 15. Your colleague, John H. Linner, M.D. will talk about his book Normandy to Okinawa — A

Navy Medical Officer’s Diary and Overview of World War Two. For additional information, contact Kathy Dittmer at (612) 623-2885 or kdittmer@metrodoctors.com.

Edward Spenny, M.D., President, Sr. Physicians Association, welcomes guest speaker, Kathleen Watson, M.D.

In Memoriam WALLACE (WALLY) EVERETT ANDERSON, M.D. passed away peacefully on June 19, 2009. He was 88. He served in the Army Air Force before receiving his medical degree from the University of Minnesota. Dr. Anderson practiced in Lakeville, Robbinsdale and Golden Valley, and then committed 11 years to the North Memorial Hospital emergency room. He used his skills as a physician to serve on many medical mission trips around the world. For 50 years, he shared his home at Green Pastures Farm in Medina with countless people who became friends and family to him.

CARL E. CHRISTENSON, M.D. died July 6, 2009, at the age of 75. He graduated from the University of Minnesota Medical School in 1956, and established a rural family practice in Clinton, MN from 1960-1969. He then returned to surgical residency at the University of Minnesota and became a colon-rectal surgeon and partner of Colon & Rectal Surgery Associates, Ltd. in Minneapolis from 1974-1992.

FRANK DIXON, CONLIN, M.D. 88, died at his home in Hilton Head Island, South Carolina on July 31, 2009. He graduated from the University of Nebraska Medical School, Omaha, and completed his internship at the Dallas Methodist Hospital, Dallas, Texas. The bulk of his orthopedic career was spent in Minneapolis where Dr. Conlin served on the staff of AbbottNorthwestern Hospital. He lectured on foot and ankle surgery in the Ramsey County Hospital teaching program and was an emeritus member of the American Orthopedic Research Society.

JOHN W. LABREE, M.D., of Edina, passed away August 1, 2009, at the age of 92. He graduated from the University of Minnesota Medical School. Dr. LaBree specialized in cardiology.

DOUGLASS A. LOWE, M.D., 77, of Sanibel, FL (formerly of Edina) passed away July 26, 2009, of Alzheimer’s, surrounded by his family. He graduated from the University of Minnesota Medical School in 1959. Following residency in psychiatry and service in the U.S. Air Force, Dr. Lowe maintained a private practice in Edina. His love of travel took him to the far corners of the earth and to six continents.

MetroDoctors

The Journal of the East and West Metro Medical Societies

ALLIANCE NEWS MARTHA ARNESON

2009 WMMSA Annual Meeting

T

Speaker, and Martha Arneson, Co-Presidential Chair.

Board installation by Linda Wiig.

MetroDoctors

The Journal of the East and West Metro Medical Societies

Martha Arneson presents Kathy Dittmer, WMMS Executive Assistant, with a gift of appreciation for her administrative support of WMMSA.

September/October 2009

29

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

hirty members and guests enjoyed a noon ficers elected for 2009-2010 are: Recording luncheon and meeting devoted to the Secretary – Carla Dienema; Treasurer – Martha election and installation of officers, the recogArneson; Philanthropic Treasurer – Ludmila nition of two new Forty-Year Members, and Eklund; Membership Treasurer – Becky Finne; A highlight of the meeting was the guest others with 41 to 72 years of membership; and Corresponding Secretary –Michelle Schroeder; speaker, Conrad Schiebel, a member of Zumthe remembrance of seven of our members. An and Auditor – Emily Wagner. The installation bro Valley MSA and recent past president of excellent program followed the business meetof officers was conducted by Linda Wiig, MMAA. Conrad took us on a photo journey ing. The Edina Country Club was the scene of MMAA President. of his three week adventure in the Canadian this enjoyable and educational event on Friday, The two Alliance members joining the Arctic. He entertained us with brilliant pictures May 8, 2009. It was a delightful opportunity group with 40 years of membership and honand amazing stories of this father/daughter to celebrate the 99th anniversary of WMMSA. ored at the meeting were Marlene Ellis and canoe trip on the Arctic River. The program Presiding for the meeting, I reported that Phyllis Holm. It was noted that 21 members was a delightful end to the meeting. the past year had been a year of change with have belonged to WMMSA for 50 or more WMMSA will celebrate its 100th ana new name and six past presidents serving years, and seven members for 60 or more years. niversary in 2010. as Presidential Chairs to provide leadership to the Alliance. Each Chair presided for meetings and activities over a two month period.

This arrangement was so effective that it will continue next year and with the same individuals as Presidential Chairs: Mary Anderson, Martha Arneson, Dianne Phyllis Holm and Marlene Ellis, new 40 year Fenyk, Diane Gayes, members.

Eleanor Goodall, and Trish Vaurio. Other of- Linda Wiig, MMAA President, Conrad Schiebel, Guest

Members in the News

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

CAREER OPPORTUNITIES

Alexandria Clinic, P.A.

Dedicated to Your Health and Wellness The Members in the News section recognizes the appointments, presentations, awards, honors and other professional accomplishments of EMMS and WMMS members. Submit physician news by fax (612) 623-2888, e-mail (nbauer@metrodoctors.com) or mail to Editor, MetroDoctors, 1300 Godward Street NE, Suite 2000, Minneapolis, MN 55413 for consideration by the editorial board. Questions? Call Nancy Bauer at (612) 623-2893.

The Alexandria Clinic, P.A. is an independent, physician-owned, multi-specialty group practice.

We are located 2 hours west of the Twin Cities on I-94 in the heart of the Central Lakes. Alexandria offers year-round recreation for the whole family!

We are home to a service area approaching 100,000 people and over 1,000 growing businesses.

Employment Opportunities: Dermatology Family Practice Hospitalist Oncology Otolaryngology

We’re easy to get to and hard to leave!

Attractive compensation and benefits package with shareholder and partnership opportunities.

The University of Minnesota Academic Health Center has announced the following changes effective July 1, 2009: MARK S. PALLER, M.D., MS, formerly assistant vice president for research, is now serving as executive vice dean for the University of Minnesota Medical School; FRANK CERRA, M.D., senior vice president for health sciences for the Academic Health Center, is now also the dean of the medical school.

The 2009 Friend of Physical Therapy Award was given to WILLIAM ROBERTS, M.D., MS by the Minnesota Chapter of the American Physical Therapy Association.

The University of Minnesota Medical Alumni Society selected the following award recipients: Harold S. Diehl Award –ROBY C. THOMPSON, JR., M.D. and the Distinguished Alumni Award – LOUIS J. LING, M.D. PATRICIA FONTAINE, M.D. has been named president of the Minnesota Academy of Family Physicians.

PETER F. BORNSTEIN, M.D. begins his term as chief of staff at St. John’s Hospital, Maplewood, MN in September.

DAVID C. THORSON, M.D. was recently elected chair, MMA Board of Trustees.

For more information, please contact: Alexandria Clinic, P.A. Attn: Tim Hunt, Administrator 610 – 30th Avenue West, Alexandria, MN 56308 Phone: (320) 763-2540 Fax: (320) 763-5749 E-mail: thunt@alexclinic.com Visit our website at alexclinic.com

Federal Medical Center, Rochester, MN

Physicians (FPs, GPs, and IMs) 40 Hour Work Week The Federal Medical Center, Rochester, MN, is an accredited Joint Commission long term, behavioral health, and ambulatory referral center for the Federal Bureau of Prisons.

Our physicians work closely with a multi-disciplinary healthcare team providing diagnostic and treatment services to federal inmates. Opportunities exist for teaching medical and allied health profession students, residents, and fellows.

The Federal Bureau of Prisons, Health Services Division, is committed to providing evidence-based clinical and behavioral health treatment and has a national impact through the use of comprehensive clinical and behavioral health guidelines.

The Federal Bureau of Prisons offers a competitive salary and benefits package, plus a 40 hour work week. The Federal Bureau of Prisons is an Equal Opportunity Employer.

Contact: Lynn Platte, Medical Recruiter (507) 424-7521 or lplatte@bop.gov

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September/October 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

Career Opportunities

CAREER OPPORTUNITIES

Introducing the “Career Opportunities” section of MetroDoctors!

A great avenue for professionals to learn about job opportunities AND a perfect place for recruiters to promote openings!

Recruiters, call for our special recruitment rate.

Family Practitioner Open Cities Health Center (OCHC) has an opening for a Family Practitioner with OB and Family Practitioner – Med/Peds. We would like to have these position filled by January 2010. OCHC provides cost-effective, quality health care to patients from a wide range of socioeconomic backgrounds and ethnic groups. We have been in existence since 1967 providing culturally competent primary and preventive health care and related services to all people throughout the Twin Cities Metropolitan Area.

Candidates must have demonstrated ability in the provision of primary medical care within the bounds of the specialty; strong personal and professional communication skills; knowledge of and desire to work within a public health/community medicine model of service delivery and; respect and concern for patients regardless of economic status, race, gender, ethnic background or disability.

Minimum qualifications: current Minnesota licensure; graduate from an accredited school of medicine; board certified or eligible and a; strong community health/public health orientation. Salary is negotiable depending upon experience and qualifications. Cover letters and CV may be submitted via fax, e-mail or mailed to:

Betsy Pierre, ad sales 763-295-5420

Attn: Lashell Barnes, Human Resources Manager Open Cities Health Center, Inc. 409 North Dunlap Street, St. Paul, MN 55104 651-290-9211 / 651-290-9210 (fax) lashell.barnes@ochealthcenter.com

betsy@pierreproductions.com

Announcing MetroDoctors

FORUM

See Additional Career Opportunities on page 32.

The Mankato Clinic, is recruiting for the following BC/BE primary care physicians to join our well-established practice in the region’s leading multi-specialty group:

http://forum.metrodoctors.com

East Metro and West Metro Medical Societies have launched a

Web forum

Family Practice Hospitalist Internal Medicine Pediatrics

The forum, moderated by Dr. Thom Siefferman, serves as a central location for discussions related to legislative issues, local health care matters, upcoming society events, the MMA Annual meeting and more.

The Mankato Clinic is physician owned with a service area population of over 300,000. We offer outstanding benefits including generous CME allowance, health/disability/life and medical malpractice insurance, 401(k) plan and more.

Sign up and use the forum for communication and dialogue with your colleagues!

If you would like to join our growing practice, submit a detailed CV or call Mark S. Matthias, M.D., Chief Medical Officer at 507-389-8756 or Dennis Davito, Director of Provider Placement at 507.389.8654, Fax: 507.625.4353, Email: ddavito@mankato-clinic.com.

If you have comments or questions, please contact Katie Snow

Mankato has exceptional recreational and cultural activities, excellent private and public school systems and Minnesota State University, Mankato.

at (612) 362-3704 or ksnow@metrodoctors.com.

MetroDoctors

The Journal of the East and West Metro Medical Societies

MANKATO CLINIC An AAAHC-accredited Clinic www.mankato-clinic.com

September/October 2009

31

CAREER OPPORTUNITIES

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

Wapiti Medical Group

The Hospitalist Division of Wapiti Medical Group

Tired of Low Pay and Long Hours?

We offer unique full or part time opportunities in Minnesota!

Earn up to $180K/year

(working 6 24 hour shifts/mos.)

ER Coverage Shifts Flexible Scheduling No Need to Re-locate Paid Malpractice Many other shift combinations available at various locations.

Call Dr. Brad McDonald, CEO Wapiti Medical Group PO Box 523 Milbank, SD 57252 888-733-4428 Fax CV to: 605-432-5669 BRAD@ERSTAFF.COM WWW.ERSTAFF.COM

Skiing!

Biking!

Hunting!

Fishing!

Hospitalist Opportunities in Northern Minnesota! $95-$143/hour

Full or Part Time Shifts Available!

Boarded IM & FP Paid Malpractice No Need to Relocate Strong Local Support 12-16 Encounters/Shift

Contact Brad McDonald, MD 888-733-4428 or email: brad@erstaff.com www.connecthealthinc.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 full-time, 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 t FNBJM QCFSSJTGPSE!Ä&#x201D;TN DPN

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September/October 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

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