2010 March/April by Advocates for Better Health

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Contents VOLUME 12, NO. 2

Index to Advertisers/Classified Ad

PResident’s MessAge

MARCH/APRIL 2010

A Journey into Urban Health By Edward P. Ehlinger, M.D., MSPH

Public Health and Medicine: The Potential and Need for Collaboration By Lowell Johnson, BS, MPA

tCMs in ACtion By Sue Schettle, CEO

More Deficit, Further Challenges: 2010 Legislative Preview By Theodore Grindal, JD, and Nathaniel Mussell, JD

Page 24

Call for Resolutions/Caucus Dates

Kent S. Wilson, M.D. Receives Shotwell Award

The Joint Commission—60 Years of Accreditation Experience By Charles A. Mowll, FACHE

ISO 9001 and Hospital Accreditation By Darrel J. Scott, FACHE

You Have a Choice in Accreditation Organizations By Michael J. Zarski, JD

New Health Care CEO: Arthur Gonzalez, Dr. P.H., FACHE, Hennepin County Medical Center

The Minnesota Health Information Exchange By Michael Ubl

Page 15

BMP Seminar Series on Management of the Chronic Pain Patient

The Provider Tax

On the cover: Hospitals and health care entities can now choose from three accreditation organizations to obtain certification to receive payments from Medicare and Medicaid programs. Articles begin on page 9.

eAst MetRo

By Nathaniel Mussell, JD

EMMS Foundation News

The Evolution of the Minnesota FluLine

In Appreciation of Former EMMS Board Members

By Peter Dehnel, M.D.

Page 8 MetroDoctors

TCMS Annual Meeting Held

New Members

In Memoriam

Career Opportunities

The Journal of the Twin Cities Medical Society

West MetRo

Celebrating the Career of Jack G. Davis, WMMS CEO

West Metro Senior Physicians Association WMMS Alliance 100th Celebration

Health Care Dinner Party, Naples, FL March/April 2010

March/April Index to Advertisers

Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

TCMS Officers

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 Marvin S. Segal, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Katie R. Snow TCMS 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 Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. 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 TCMS.

President Edward P. Ehlinger, M.D. President-elect Thomas D. Siefferman, M.D. Secretary Anthony C. Orecchia, M.D. Treasurer Melody A. Mendiola, M.D. Past President Ronnell A. Hansen, M.D. TCMS Executive Staff

Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@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 Katie R. Snow, Administrative Coordinator (612) 362-3704 ksnow@metrodoctors.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.

March/April 2010

WEBER

LAW OFFICE

For a complete list of TCMS Board of Directors go to www.metrodoctors.com.

Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 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

Acute Care, Inc. .................................................31 Bethesda Hospital ........... Outside Back Cover Classified Ad ......................................................... 2 Crutchfield Dermatology ................................23 Family HealthServices Minnesota, P.A. ......32 Healthcare Billing Resources, Inc. ...............14 Lockridge Grindal Nauen P.L.L.P. ...............21 Mankato Clinic ..................................................32 Minnesota Epilepsy Group, P.A. ...................23 Minnesota Physician Services, Inc. ................... Inside Front Cover The MMIC Group ................................................ Inside Back Cover Open Cities Health Center, Inc. ..................30 Pediatric Home Service ........................................ Inside Back Cover SafeAssure Consultants, Inc. ..........................18 Sterling Retirement Resources, Inc. .................. Inside Front Cover U.S. Army ............................................................30 Uptown Dermatology & SkinSpa, P.A. ......21 Weber Law Office ............................................... 2

Focusing on the legal needs of the health professional!

Classified Ad

• Licensure • Employment Law • Trial Work • Wills and Estates • Regulatory Compliance

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• Former Attorney for the Board of Medical Practice • Over Six Years as an Assistant Attorney General

612-296-8080 www.weber-law.com “Committed to the Best Legal Outcome Possible Through Diligence and Resourcefulness!”

MetroDoctors

The Journal of the Twin Cities Medical Society

President’s Message

A Journey into Urban Health EdwARd P. EHLINgER, M.d., MSPH

WHEN I ENTERED MEDICAL SCHOOL, my intention was to become a primary care doc in a small town somewhere in rural America. My plans never changed during medical school or during my pediatric and internal medicine residencies. Two years in the National Health Service Corps (NHSC) practicing in medically underserved areas in eastern Montana also reinforced my intentions. While the NHSC experience didn’t change my practice location preference, it significantly altered the type of practice that I would ultimately pursue. That experience helped me realize that even if I saw 40–60 patients per day and did an excellent job of treating the injuries and the acute and chronic illnesses of the people that came through my clinic door, the overall health of the town would not significantly change. I could make a difference in the lives of the people I treated but, even in a small town, that difference would be experienced by only a small percentage of the population. I also quickly realized that even among my patients my medical interventions were doing little to affect the real causes of the illnesses, injuries, and diseases I was seeing — tobacco and alcohol use, unsafe working conditions, obesity, and a variety of risky behaviors. It was that experience that helped me recognize that a different kind of practice was necessary to really improve the health of rural communities. It made me consider adding some public health expertise to my medical care portfolio. Fortunately, I was able to garner a fellowship that allowed me to do some research into how to improve health care in rural health communities while also earning a masters degree in public health. However, my planned next step to small town America encountered a detour when my wife was accepted into a Ph.D. program at the University of Minnesota. Figuring that a bit of urban health experience would help round out my education, I accepted a job with the Minneapolis Health Department and HCMC and moved to the Twin Cities — anticipating a 3-5 year stay. What I didn’t anticipate was that I would fall in love with urban health care and end up staying in Minneapolis for more than 30 years. I quickly learned in my urban practice with the City of Minneapolis and later with Boynton Health Service that almost all of the issues that enticed me to consider a rural practice were also present in urban communities except in more concentrated forms. I expected the medical issues to be similar but I was surprised that many of the social and health care delivery problems in urban and rural communities were also almost identical. While the distances and number of people affected were different, the problems of physician shortage areas, underserved populations, lack of transportation, lack of access to clinics and hospitals, underemployment, poverty, hazardous working conditions, isolation, and lack of insurance, to name just a few, were similar. I also quickly learned in Minneapolis what I had learned more slowly in rural Montana; that if the overall health of the community is going to improve, it is important that clinical medicine and public health be partners and work collaboratively. To be maximally effective both medicine and public health cannot be separate entities running on parallel tracks. They need to be allies and be functionally integrated. In my 40 plus years of working in rural and urban communities I have discovered one other similarity — the importance of physicians to the health of those communities. We all know how important physicians are in rural communities. In addition to the care they provide, they are also looked to as leaders in their communities. The role of physicians in urban communities is no different. The clinical care we provide is of critical importance to our community but so is our leadership in improving the conditions that make our community livable and healthy for all. People look to physicians for that leadership. As an organization comprised of physicians dedicated to improving not only the health of their patients but also the health of the urban community in which they live and work, the Twin Cities Medical Society (TCMS) has the opportunity to coalesce that leadership into a powerful force for creating a healthy urban community. TCMS also has a unique opportunity to integrate the fields of clinical medicine and public health in a way that could be a model for both urban and rural communities throughout the country. Let’s take advantage of these opportunities. MetroDoctors

The Journal of the Twin Cities Medical Society

March/April 2010

Public Health and Medicine: The Potential and Need for Collaboration

ecently at the invitation of TCMS President Ed Ehlinger, M.D., several public health directors from the metro region, along with their physician medical consultants, met with TCMS representatives. The meeting was an opportunity to get acquainted with one another personally and professionally, and explore how we might enhance the collaboration between medicine and public health. The meeting could not have come at a more critical and opportune time. All across Minnesota, local public health agencies are implementing a ground-breaking program called the Statewide Health Improvement Program (SHIP). Signed into law in 2008, SHIP is an integral component of Minnesota’s effort to improve health and decrease health care costs. Its goal is to help Minnesotans live longer, better, healthier lives by preventing the chronic disease risk factors of physical inactivity, poor nutrition, and tobacco use and exposure. The Statewide Health Improvement Program is grounded in evidence based strategies (or “interventions”) designed to create change in the policies, systems and environments where we learn, work and live. Local public health agencies are establishing Community Leadership Teams with representation from schools, worksites, communities and health care settings. These teams select and lead the interventions which best meet the needs of the community. This is a great time to engage the Twin Cities Medical Society in this effort. In our meeting together, we heard that physicians are keenly aware of the scope and impact of chronic disease in our communities. They see firsthand the kids and parents that struggle with obesity and tobacco. They see the faces and know the names of the people behind the startling statistics. They understand how this current generation of children is the first generation in two centuries that is expected to have a shorter life expectancy than their parents. They’ve seen the prevalence of obesity among children and adolescents in the U.S. quadruple among 6-11 year-olds and more than triple among 12-19 year-olds over the last 30 years. They know that it will take systemic change to effect these trends. Each day approximately 70 Minnesotans die from chronic diseases. According to a survey of adults in Minnesota called the Behavioral Risk Factor Surveillance System (BRFSS), 63 percent are either overweight or obese; fewer than 25 percent consume the recommended servings of fruits and vegetables; only 50 percent meet the recommendations for physical activity; and 18 percent are current smokers. These behaviors lead to the most prevalent and costly chronic diseases, yet they are also the most preventable of all health problems. However, health care providers frequently have little time to spend with patients and are often not equipped to offer resources

that could help patients quit smoking, lead more active lives and eat more healthfully. By partnering with local public health agencies, physicians can expand the resources available to patients and providers alike. As health care reform continues its difficult path, one aspect of the solution is clear. We must invest in prevention if we are to make significant improvements in population health and curb the economic burden on society. We must continue to “look upstream.” Research shows an investment of $10 per person per year in proven community-based programs (such as those included in SHIP) to increase physical activity, improve nutrition, and prevent smoking could produce annual net savings of $316 million per year in Minnesota. That is a six to one return on investment! The $47 million that has been appropriated for fiscal years 2010 and 2011 will help. All local public health departments and tribal governments have been awarded grants. Now, we must work to secure future funding. We cannot have a short-term project for a problem so large. The SHIP program will be successful if appropriate time and resources are provided. Minnesota’s public health system has a history of success. When the Legislature invested in youth tobacco prevention programs in 2000, local public health departments quickly mobilized and implemented programs that produced dramatic results. Together with our state health department, schools and community partners we reduced overall youth tobacco use rates by 25 percent in five years. We reduced cigarette smoking in middle school students by 43 percent during this time frame. A Legislative Report on SHIP will soon be delivered to the Minnesota Legislature. We are confident it will show that the public health system, with the partnership of our communities, our schools, our medical providers, and our citizens, has responded to the challenge. We are hopeful the report will create momentum needed to obtain ongoing funding. On behalf of my local public health colleagues, and on behalf of all Minnesotans, I would ask that the TCMS members get involved in their local community SHIP program, support local public health programs and services, and continue this dialogue so we might collaborate to bring about much needed change in the health of the communities we serve. The opportunity is great. The need is greater. Thank you. Lowell Johnson, BS, MPA, director, Washington County Department of Public Health and Environment. He currently serves as chair of the Local Public Health Association of Minnesota.

By Lowell Johnson, BS, MPA

March/April 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

tCMs in ACtion SUE A. SCHETTLE, CEO

Consolidation Accomplished

As reported in the last issue of MetroDoctors, the consolidation of the East Metro Medical Society and West Metro Medical Society went very smoothly due in large part to the leadership of the respective boards of directors. As the end of 2009 approached all of the necessary paperwork was filed with the Secretary of State and other regulatory agencies, bank accounts were closed and new accounts were created, money was transferred into the respective foundations, and our new organization, Twin Cities Medical Society, started on a very solid foundation. Web site Redesign

As we look forward to communicating with our members in new and innovative ways, we are redesigning our Web site, www. metrodoctors.com. An updated look and new functionality including an enhanced description of who we are, our mission, current projects and committee actions will be available. Look for our online forum and RSS feeds that we trust will keep our members up to date on the most pertinent medical society news. TCMS Policy Council

The Policy Council of the Twin Cities Medical Society has been initiated and armed with a mission to review and comment on issues within local and state government; provide liaison with county departments, agencies and elected officials on matters related to health care and the practice of medicine; foster the development of a working relationship between physicians, legislators and other government officials; coordinate grassroots legislative activities; develop and recommend to the TCMS Board of Directors new public policy programs, services and ventures for the organization to consider; observe the MMA’s legislative and public policy efforts and recommend actions to TCMS for purposes of supporting and/or weighing in on those efforts. The chair of the group Roger MetroDoctors

Kathol, M.D. was elected in January. Membership is diverse and is based on geography and practice specialty. Follow the work of the Policy Council by visiting our Web site. Healthy Eating Minnesota

The nation’s families, on average, consume one-third of their calories eating out, and children eat almost twice as many calories when they eat a meal at a restaurant compared to a meal at home. These facts clearly contribute to the obesity epidemic among children and adults in the United States. The Twin Cities Medical Society (TCMS) believes that by having access to nutritional information, consumers who eat out will make informed and healthier choices. To accomplish that goal, TCMS, with partners like the Minneapolis Department of Health and Family Support and the American Heart Association, is pursuing regulations whereby chain restaurants will be required to list calorie information on menus or menu boards and all restaurants will phase out the use of trans fats, an unhealthy additive used commonly in fast food and chain restaurants. Honoring Choices Minnesota

give you the most up-to-date information on this project as the months proceed. Dr. Kent Wilson, medical director of the Honoring Choices Minnesota project, was interviewed recently on the weekly cable television program, A Public Health Journal hosted by Dr. Ed Ehlinger. The program is produced by Minneapolis Office of Media Services, University of Minnesota Boynton Health Service, Minnesota Public Health Association, and the Hennepin County Human Services and Public Health Department. Each week Dr. Ehlinger is joined by a variety of guests to discuss health issues and problems. The interview succinctly explains the project that the medical society has been involved in. To view the interview visit the following web link: http://hennepinmn. granicus.com/MediaPlayer.php?view_ id=11&clip_id=786.

If you are an avid reader of MetroDoctors you will already know that the medical society has been working over the past two years to install in the metro area a methodology and approach to advance care planning that started in La Crosse, WI, in the 1990s. We have called our metro-based project “Honoring Choices Minnesota.” It has the look and feel of the La Crosse program but with Minnesota specific nuances. For example, the health care directive that we have adopted as a community emulates what is currently in Minnesota Statute. Pilot sites started in January 2010. The medical society staff is spearheading the project with Dr. Kent Wilson serving in the role of medical director. A grant writer has been hired with the goal of securing long-term funding to help sustain the effort. Visiting our Web site can

Kent Wilson, M.D. was a recent guest on “Public Health Journal,” a weekly cable television program with host Ed Ehlinger. M.D.

The Journal of the Twin Cities Medical Society

March/April 2010

More Deficit, Further Challenges:

2010 Legislative Preview DESPITE NEARLY EIGHT CONTINUOUS

months of health care reform discussions during the later stages of the 2009 legislative session and then the seemingly endless debate over health care reform at the federal level, health care debate will likely again dominate many discussions throughout the 2010 legislative session. The legislature faces a bevy of difficult tasks this session, most notably attempting to redesign the General Assistance Medical Care (GAMC) program set to expire March 1. The legislature is also saddled with the daunting task of filling a 1.16 billion dollar deficit gap, and if the 2009 session proves any indication of the road ahead, the decisions and votes legislators face will not be easily taken. Adding to the grim picture are the unique political circumstances present in 2010, a statewide election year. With Gov. Pawlenty positioning himself for a 2012 presidential run, his recurrent “no new taxes” pledge has the potential to doom any tax increases coming across his desk. Further complicating matters, a handful of lawmakers in both the House and Senate stand to use the legislative session as a tool to posture for their own runs at the governorship in 2010. What to do With GAMC

Now that the legislature has convened, members of the House and Senate health policy and finance committees will make every effort to pass legislation preserving the GAMC program within the first month of the session. Gov. Pawlenty’s line-item veto and unallotment during the 2009 legislative session eliminated

By H. Theodore grindal, Jd, and Nathaniel Mussell, Jd

March/April 2010

H. Theodore Grindal, JD

Nathaniel Mussell, JD

funding for the GAMC program effective March 1, 2010, leaving legislators a very short time frame in which to find a feasible health care solution for some 35,000 Minnesotans set to lose health care coverage. If legislative leaders are able to reach some agreement early in the session, they must still overcome the hurdle of securing the governor’s signature. The governor and Human Services Commissioner Cal Ludeman have already indicated their preference to move those individuals currently covered under GAMC over to MinnesotaCare once funding for GAMC expires in March. If this is any indication of the governor’s willingness to accept a different solution, the prospect of getting something signed into law prior to the March 1 deadline appears grim. Provider tax and Health Care Access Fund

The efforts of legislators and the administration to find a health care solution for the GAMC population could have implications on the Health Care Access Fund. Any decision by the Governor or the Department of Human Services to automatically enroll portions of

the GAMC population into MinnesotaCare stands to only further strain the Health Care Access Fund, already projected to begin running a deficit as early as 2012. As seems to be the case annually, an increase in the current 2 percent provider tax will remain on the table as a potential revenue source for legislators, particularly if MinnesotaCare enrollment is increased and legislative leaders are unable to find a solution to the current budget deficit. Groups representing medical providers, including the Minnesota Medical Group Management Association (MMGMA) and the Minnesota Medical Association (MMA), will be making significant efforts to ensure the provider tax is not increased beyond its current levels. In years past, many groups within the medical provider community have shown an almost unified opposition to a provider tax increase. However, the circumstances facing legislators in the 2010 session have the potential to divide the medical provider community on this issue. Certain groups may see a provider tax increase as an acceptable compromise to finance a redesigned GAMC program and reduce their uncompensated debt levels.

MetroDoctors

The Journal of the Twin Cities Medical Society

Even if debate over increasing the provider tax is avoided during the 2010 session, there is little doubt that with even higher deficit shortfalls projected for the coming years, along with a new administration, the provider community needs to begin laying the groundwork this year in anticipation of future proposals to increase the provider tax. Provider Reimbursement

Another perennial issue likely to resurface during the 2010 legislative session is further cuts to provider reimbursement under the state’s health care programs. Reimbursement rates will likely be discussed during the initial discussions about how to redesign the GAMC program and as legislators look to solve the 1.2 billion dollar deficit. Because the Health and Human Services (HHS) budget accounts for the second largest portion of the state’s general fund dollars, some legislators may view further cuts to provider reimbursement as the easiest short-term solution to a budget problem. However, it has become abundantly clear that after seeing no increase in physician reimbursement over the last nine years and a dramatic 6.5 percent rate cut to specialists during the 2009 legislative session, any further cuts would simply be unsustainable and could force multiple providers and independent practices out of business.

and imposition of federal or state insurance exchanges will be included in a scaled back health care bill. Both of these reforms would stand to have a significant impact on Minnesota’s Health and Human Services budget going forward helping to replace state dollars with federal dollars and potentially easing the strain on the Health Care Access Fund. While Minnesota’s legislators will not need to address the implications of these reforms during the upcoming 2010 legislative session, look for debate on these reforms to resurface as early as 2011. Other Health Bills

The likely byproduct of further HHS belttightening and a redesign of the GAMC program is that many legislative proposals introduced during the 2009 session will be left on

Federal Health Care Reform: Effects in Minnesota

In addition to the work being done at the state level, many legislators have had their eyes and ears on Washington, D.C., to ascertain how a potential federal health reform bill will affect Minnesota. However, after months of lengthy debate and discussion, and one significant U.S. Senate special election, federal health reform appears to be on life support. Following the election of Massachusetts Senator Scott Brown (R), democrats in the House and Senate appear to be headed back to the drawing board if any hope of passing a health reform bill remains. That leaves Minnesota’s legislators and Minnesota’s provider community to wonder which of those reforms initially included in the health care bill will in fact remain in place when and if Congress resumes debate on federal health reform. Should Congress revisit health care reform in the next year, it is very possible an expansion of the federal Medicaid program MetroDoctors

The Journal of the Twin Cities Medical Society

the table. However, legislation likely to appear during the 2010 session of particular interest to health care providers includes, medical copying fees legislation originally introduced during the 2009 session, an advanced practice nursing bill also introduced in 2009, no-fault auto insurance reform, and fair contracting legislation between providers and insurance companies. Governing during a deficit year is never easy, and it is difficult to imagine a scenario where physicians and other providers are not adversely affected by legislation in some way. H. Theodore (Ted) Grindal, J.D. is the partner in charge of the Government Relations practice group; Nathaniel Mussell, J.D., is a lobbyist with Lockridge Grindal Nauen’s (LGN) government relations group with a focus primarily on health care clients.

SAVE THE DATES Call for Resolutions All members of the Twin Cities Medical Society are invited and encouraged to become engaged in setting the priorities and next year’s agenda for organized medicine. Members can submit resolutions, participate in the district caucus and attend the annual meeting of the MMA House of Delegates, September 15-17, 2010, at Breezy Point, MN. Resolutions are due in the TCMS office by MONDAY, MAY 3, 2010. The TCMS membership will be comprised of two districts: East Metro District – physicians living and/or working in Ramsey, Washington, or eastern Dakota County; and West Metro District – physicians living and/or working in Anoka, Carver, Hennepin, Scott or western Dakota County.

CAUCUS DATES: East Metro District:

West Metro District:

Wednesday, May 12 6:00 p.m. TCMS Executive Office Broadway Place West 1300 Godward Street NE, Suite 2000 Minneapolis, MN 55413 Contact: Katie Snow, (612) 362-3704, ksnow@metrodoctors.com

Wednesday, May 19 7:00 a.m. Broadway Ridge 3001 Broadway Street NE, Conference Room D (lower level) Minneapolis, MN 55413 Contact: Kathy Dittmer, (612) 623-2885, kdittmer@metrodoctors.com

March/April 2010

Kent S. Wilson, M.D. Receives Shotwell Award

he 2009 Shotwell Award was presented to Kent S. Wilson, M.D. at the January 5, 2010 meeting of the Abbott Northwestern Medical Staff. Edward P. Ehlinger, M.D., president of the Twin Cities Medical Society presented the award on behalf of the West Metro Medical Foundation. The Shotwell Award is presented annually to a person within the state of Minnesota who has made significant contributions in the field of health care. Kent S. Wilson, M.D., a retired otolaryngologist in St. Paul, has dedicated his medical career to improving health care for his patients and the community. • In the 1970s and early 1980s, he was a leader in the movement to require facial protection, including facemasks and dental guards, in both football and hockey at all levels of play — elementary, high school and college. He carried out research, educated the public on the issue, and was engaged in efforts to implement policies to protect athletes. • He was instrumental in developing and making widely available standards of medical care in the State of Minnesota, designed to protect patients and physicians as well as improve quality of care. • Currently, he is leading a metro-wide initiative, Honoring Choices Minnesota, focusing on a comprehensive and collaborative advance care planning process. The initiative is a model for improvement in medical care planning for patients, families and the health care community. Dr. Wilson retired from active practice in 2006 after 32 years of ENT practice at Midwest Ear, Nose & Throat Specialists, St. Paul. At the time of his retirement, however, Dr. Stuart Cox, then president of the East Metro Medical Society and as one of Dr. Wilson’s colleagues from Midwest ENT, worried that Dr. 8

March/April 2010

Wilson would need something to do. He persuaded him to chair the East Metro Medical Society Foundation board of directors — assuring him that it would only be four meetings a year. Dr. Wilson agreed and soon embarked on what has been a very interesting two years. It became apparent when Dr. Wilson accepted the role as president of the East Metro Medical Society Foundation (EMMSF) that there was some work to do. The foundation was dubbed the “smallest foundation in North America” and was in need of some restructuring as many of the board members’ terms had expired. Under his leadership, new board members were recruited and a project emerged that has changed the focus and the presence of the foundation. Honoring Choices Minnesota, is based on a proven model that was first created in La Crosse, Wisconsin called “Respecting Choices.” This model started with a collaborative effort between two otherwise competing hospital systems in La Crosse and centered around developing a common, consistent approach to talking with patients about their values, beliefs and desires related to their end of life wishes. The approach has transformed end of life care in La Crosse, and similar improvements are expected for Minnesota. Over the last 18 months, Dr. Wilson has led the EMMSF and the Honoring Choices Minnesota advisory committee, which is comprised of representatives from health plans, hospitals, ICSI, block nurses, and many other related organizations. The advisory committee has achieved substantial milestones including a community health care directive document and patient education materials, in addition to educating 46 facilitators and 10 instructors in the La Crosse model. Dr. Wilson has spent countless hours working as a volunteer on this project. His tireless work ethic and his attention to detail are indeed

Kent S. Wilson, M.D. accepts the Shotwell Award from TCMS president, Edward Ehlinger, M.D.

remarkable. He’s a visionary and truly deserving of the Shotwell Award. Dr. Wilson received his medical degree from the University of Minnesota. He completed an internship at Denver General Hospital, Denver, CO, a surgical residency at U.S.P.H.S. Hospital, New Orleans, LA, and a fellowship in Otolaryngology at the University of Minnesota. Dr. Wilson is board certified by the American Board of Otolaryngology. He is a former president of the Minnesota Academy of Otolaryngology, Minnesota Medical Association, and the Minnesota Academy of Medicine and currently serves as president of the East Metro Medical Society Foundation.

The Shotwell Award was established by Metropolitan Medical Center in 1971 in recognition of the support and dedication of the Shotwell Family. Upon the closing of Metropolitan-Mount Sinai Medical Center in 1991, the West Metro Medical Society/ Foundation assumed responsibility for selecting the recipient of the Shotwell Award. Abbott Northwestern Hospital and Medical Staff has generously provided funding for the Shotwell Award since 2003. A plaque recognizing all the award recipients resides in the Sister Kenny Pavilion on the Abbott Northwestern campus. Wording on the plaque reads: The Shotwell Award, established in honor of Mr. and Mrs. James D. Shotwell for their contributions to the hospital, is presented yearly for a noteworthy effort in the field of health care.

MetroDoctors

The Journal of the Twin Cities Medical Society

CMs deemed status Accreditation organizations

The Joint Commission— 60 Years of Accreditation Experience Editor’s Note: In order for a health care organization to participate in and receive payment from the Medicare or Medicaid programs, it must be certified by the Centers for Medicare & Medicaid Services (CMS) as complying with the Conditions of Participation, or standards, set forth in federal regulations. However, if a national accrediting organization has and enforces standards that meet the federal Conditions of Participation, CMS may grant the accrediting organization “deeming” authority and “deem” each accredited health care organization as meeting the Medicare and Medicaid certification requirements. The three organizations currently granted deemed status to accredit hospitals and health care entities are highlighted in the following three articles.

he Joint Commission has been accrediting health care organizations for nearly 60 years and has a reputation for quality, integrity and innovation. When a physician or hospital chooses to pursue accreditation by The Joint Commission they can be assured that their organization will receive the highest level of education and support needed to improve the quality and safety of care provided to patients. The Joint Commission is the nation’s predominant accrediting body and continues to raise the bar for health care organizations in their pursuit to provide the highest quality and safety of patient care. Making patient safety an imperative in health care organizations is the prime focus of The Joint Commission’s accreditation requirements. More than 50 percent of accreditation standards across all types of organizations are directly related to safety. The Joint Commission’s approach to accreditation is patient-centered and data-driven. Joint Commission standards address the organization’s level of performance in key functional areas, By Charles A. Mowll, FACHE

MetroDoctors

such as patient rights, patient treatment, medication safety and infection control. Standards set forth performance expectations for activities that affect the safety and quality of patient care. If an organization does the right things and does them well, there is a strong likelihood that its patients will experience good outcomes. We recognize organizations have a choice when it comes to accreditation and we value our relationships with accredited organizations. Our employees are experienced health care professionals and understand the everyday challenges faced by health care organizations. The Joint Commission, a private, not-for-profit organization, is governed by a Board of Commissioners equally dedicated to the safety and well-being of patients. The board is comprised of administrators, doctors, nurses, ethicists, and members of the public. Our five corporate members represent the leading health care associations in the United States including the American Hospital Association; American Medical Association; American College of Physicians; American College of Surgeons; and American Dental Association. Joint Commission accreditation programs that may be of primary interest to physicians include hospital, critical access hospital and ambulatory care. For organizations pursuing accreditation for Medicare deemed status, the Centers for Medicare & Medicaid Services (CMS) has awarded deeming authority to our hospital; critical access hospital; ambulatory surgical center; durable medical equipment, prosthetics, orthotics and supplies (DMEPOS); home health; clinical laboratory and hospice accreditation programs. In addition, The Joint Commission also offers accreditation for behavioral health care and long

The Journal of the Twin Cities Medical Society

term care organizations. In-patient psychiatric hospitals are surveyed under the hospital standards. Whether or not an organization is pursuing accreditation for deemed status, both the providers and patients benefit from the process. Approximately 88 percent of the nation’s hospitals are currently accredited by The Joint Commission. The Joint Commission also accredits approximately 358 critical access hospitals under a unique program. The Joint Commission Ambulatory Care Accreditation program currently accredits more than 1,600 freestanding ambulatory care organizations. These organizations fall into the broad categories of surgical, medical/dental and diagnostic/therapeutic services, and represent a variety of settings including physician offices, medical practices, urgent care centers, imaging centers, sleep centers and ambulatory surgical centers. The Joint Commission has in-depth experience with providing direction and guidance on patient safety and quality to accredited organizations. From the time an organization decides to pursue accreditation they will be offered the support needed to succeed including: • A dedicated account executive; • Experienced clinicians in the Standards Interpretation Group available online and by phone to answer any standards related questions; • Surveyors who give valuable insight into best practices; (Continued on page 10)

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Joint Commission (Continued from page 9)

•

An official monthly newsletter “Joint Commission Perspectives,” and • A password protected extranet page on “Joint Commission Connect.” The Joint Commission has a cadre of more than 500 surveyors, reviewers and Life Safety Code specialists who are trained and certified, and receive continuing education on advances in quality-related performance evaluation. To earn and maintain accreditation from The Joint Commission, organizations must undergo an unannounced on-site evaluation by a Joint Commission survey team every 18-39 months, with the exception of laboratories which are surveyed every two years. The Joint Commission on-site accreditation process is centered on the Tracer Methodology. Joint Commission surveyors follow the actual experiences of a sample of patients as they interact with their health care team, and evaluate the actual provision of care provided to these patients. In addition to tracing the care of patients, The Joint Commission process includes System Tracers, which examine, in detail, specific high-risk components of the health care organization, for example, the medication management process. These activities are customized for each review. Joint Commission standards address the organization’s performance in specific areas, and specify requirements to ensure that patient care is provided in a safe manner and in a secure environment. The Joint Commission develops its standards in consultation with health care experts, providers and researchers, as well as measurement experts, purchasers and consumers. The standards-based performance areas are: • Environment of Care • Emergency Management • Human Resources • Infection Prevention and Control • Information Management • Leadership • Life Safety • Medication Management • Medical Staff (hospital only) • National Patient Safety Goals • Nursing (hospital only) • Provision of Care, Treatment, and Services • Performance Improvement • Record of Care, Treatment, and Services • Rights and Responsibilities of the Individual • Transplant Safety • Waived Testing 10

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Prior to the survey, an assigned account executive works closely with the organization to answer questions, provide specific information including the length of the future survey and the number of surveyors that will be assigned to conduct the survey. The organization also receives two lists outlining the survey activities and the initial materials surveyors will request to review at the onset of the survey. After an organization receives this information, and prior to the unannounced survey, their account executive will contact them to review the information. On the day of the unannounced survey, a letter of introduction will be posted on the organization’s secure extranet site by 7:30 a.m. The letter will include the survey agenda, as well as biographies and pictures of the assigned surveyors. When surveyors arrive they will work with the organization’s leaders to determine the best time for scheduling survey activities to coincide most effectively with patient care and administrative operations. This ensures the survey is sensitive to the time demands of the organization and staff while still providing a thorough survey of the organization. At the conclusion of the survey, the organization will receive a summary that includes preliminary findings identified during the survey. Exit conferences are held with leadership and staff to discuss survey findings. The summary of survey findings undergoes a comprehensive review by The Joint Commission’s Central Office staff. The final summary of survey findings is posted to the organization’s password protected Joint Commission Connect extranet site. The summary indicates which findings require Evidence of Standards Compliance (ESC), or corrective action, to be submitted within 45 or 60 days. Once an organization’s ESC is accepted by The Joint Commission, the accreditation decision is posted to their extranet site and within one business day it is publicly disclosed on Quality Check®, www. qualitycheck.org, a comprehensive guide to Joint Commission accredited and certified health care organizations in the United States. The routine on-site survey isn’t the only aspect of the accreditation process. Joint Commission accreditation focuses on continuous improvement and the Periodic Performance Review (PPR) is a key component in this process. The PPR helps organizations incorporate the standards into their routine operations, and allows the organization to use an automated tool so they can evaluate their compliance with the standards. For every standard an organization finds out of

compliance, they must develop a Plan of Action identifying how they will come into compliance. Some standards require Measures of Success to quantify whether a corrective action is effective and sustained. Performance measurement is also an important component of The Joint Commission’s hospital accreditation program. Hospitals are required to collect and transmit performance measurement and improvement data to The Joint Commission. Introduced in February 1997, the ORYX® initiative was designed to integrate outcomes and other performance measurement data into the accreditation process. The data is publicly reported on Quality Check® and facilitates user comparisons of hospital-specific performance and permits comparisons against overall state and national rates. In 2004, The Joint Commission and CMS began working together to align measures common to both organizations. These standardized common measures, called “National Hospital Quality Measures,” are integral to improving the quality of care provided to hospital patients and bringing value to stakeholders by focusing on the actual results of care. Measure alignment benefits hospitals by making it easier and less costly to collect and report data because the same data set can be used to satisfy CMS initiatives, the Hospital Quality Alliance (HQA), legislative, and Joint Commission requirements. It is The Joint Commission’s intention to remain in alignment with CMS so that the data collection efforts for hospitals can continue to be consolidated and minimized. All of the National Hospital Quality Measures common to The Joint Commission and CMS are endorsed by the National Quality Forum (NQF). The Joint Commission’s comprehensive approach to accreditation is the optimal way for health care organizations to focus on continuous improvement of quality and patient safety. Our accreditation is recognized as the gold standard for attracting the best health care professionals, earning managed care and insurance contracts and assuring consumers of an organization’s commitment to safety and quality. For more information on Joint Commission Accreditation please call (630) 792- 5800, or visit www.jointcommission. org. Charles A. Mowll, FACHE, executive vice president, Business Development, Government and External Relations, The Joint Commission.

MetroDoctors

The Journal of the Twin Cities Medical Society

CMs deemed status Accreditation organizations

ISO 9001 and Hospital Accreditation— Putting a Man on the Moon

fter President Kennedy established in 1962 the lofty goal of putting a man on the moon by the end of the decade, I recall a story about his tour of the Manned Spacecraft Center in Houston soon after it opened in September 1963. He approached a custodian and asked “What’s your job?” The man replied, “Sir, my job is to put a man on the moon.” While there may be variations of the story, there is no variation on the moral of the story: A lofty goal requires the full commitment of everybody involved. And so it is with our goal of creating sustainable quality in health care delivery. Quality improvement is not one person’s job, and achieving continuous quality improvement certainly requires more than a “title” within the hospital, whether it is Director of Quality, PI or Infection Control Director. We work every single day with these professionals and they will be the first to tell you that quality is a team effort. As with getting to the moon, ensuring patient safety and improving medical outcomes in our hospitals is dependent on defined, mission critical processes. One of those key processes is accreditation. Historically, in terms of its connection to quality improvement, accreditation has underperformed. Why? Because it was designed to tell you what you are not doing as opposed to encouraging innovation. The conventional approach to accreditation is essentially an inspection — one with shifting criteria and an inclination toward penalization. In 2010 it should and now can be a strategic business tool that helps fuel your quality mission. An effective accreditation program first and foremost should be something the hospital chooses, not something imposed upon it. Whereas being accredited is not, for all intents and purposes, an option for today’s hospitals, which accreditation program you use is most decidedly a choice you have and a prerogative you should exercise based

By darrel J. Scott, FACHE

MetroDoctors

on your own goals. Since DNV Healthcare, Inc. was granted deeming authority by CMS just over a year ago, the nature of those choices has changed dramatically and, we believe, in favor of hospitals seeking to use integrate accreditation into hospital-wide quality processes. The ISO 9001 Quality Management System provides that structure. It is the universal measure of quality in thousands upon thousands of businesses and industries. Almost one million organizations throughout the world (including NASA) are ISO 9001 certified including many health care entities outside the United States. It is a global success. And there is absolutely no reason hospitals in the United States cannot get on board. What is ISO? ISO, the International Organization for Standards, is a non-governmental consortium founded in 1947 to develop voluntary standards for improving industrial performance. Today, more than 90 countries are members of ISO, with the U.S. representative being the American National Standards Institute (ANSI). Initially, ISO standards focused on technical specifications geared for manufacturing and scientific industries. In 1987, ISO expanded its scope with the creation of the ISO 9001 Quality Management System, a new standard that addressed a broad range of business processes applicable to virtually any type of organization in any industry. Many readers familiar with TQM, CQI and the other acronyms created during the quality revolution in the 1990s will recognize ISO 9001 as the defining standard. Many have called it the “must have” certification for quality-driven companies.

The Journal of the Twin Cities Medical Society

The most recent update to the ISO 9001 standard is ISO 9001:2008. This is the ISO program utilized by DNV Healthcare Inc., the hospital accreditation company of Det Norske Veritas. DNV is the only health care accreditation organization tying ISO 9001 compliance with CMS-approved accreditation. How Does it Work? The basic idea of ISO 9001 is to find the things in your business that work best and turn them into standard operating procedures. The key to ISO 9001 — and the feature that makes it different from all other quality initiatives--is that it is perpetual. Unlike quality schemes of the past, it does not stop when a best practice has been identified and instituted. ISO 9001 is a way of approaching work that not only makes each activity as efficient as it can be, but also continually searches out improvements. ISO 9001 is a quality management system. It requires the organization to document and demonstrate a sequence and interaction of processes, conduct internal audits to evaluate processes, identify corrective and preventive action to improve processes, and monitor the processes to ensure there is continual improvement. For hospitals, ISO 9001 means identifying its processes and then identifying the elements in clinical and administrative practices that contribute to desirable outcomes, documenting those elements and instituting them as standard practice. Some examples of processes include inpatient and outpatient care. Examples of process elements include improved communication among staff members, (Continued on page 12) March/April 2010

DNV (Continued from page 11)

revisions to policies to reflect best practice, standardization of forms used for documentation of patient care activities, and detection of problemprone issues. ISO 9001 is designed to prevent the “backslide” that occurs in every non-systemic approach to quality. When actions are taken, ISO 9001 requires the organization to assess continual improvement. Hospitals typically maintain a database of corrective and preventive actions and apply follow-up dates to ensure that they are sustaining the improvements made. This creates more awareness for staff and requires that monitoring be in place to ensure that problems do not recur. The health care industry has a variety of initiatives that aim to improve the quality of health care and reduce errors and none of these concepts needs to be abandoned with ISO 9001. ISO is a way of ensuring that the initiatives improve practices — and that they continue to do so. The system is entirely compatible with any health care organization. A variety of factors from internal goal setting to outside pressures typically drive a hospital’s commitment to quality. Working hard to improve accreditation scores, compliance with federal and state compliance programs and utilizing best practices are examples of approaches that have been used in the past to influence the path to quality improvement. But now, communities and payors want to see quality improvement in terms that can be explained and understood. As important as various internal hospital measurements are, the public generally does not relate. Hospitals are typically huge economic factors in their communities and often the largest employer. Many other businesses in a typical community (e.g., manufacturing, automotive, supply and service companies) utilize the ISO 9001 quality management system as their quality engine and often wonder why doesn’t our hospital? A Case Study Here is an example of a DNV-accredited hospital that is also ISO 9001 certified. This hospital is a 300+ bed multi-specialty hospital located in the Midwest. It has more than 1,200 employees including over 800 physicians on staff. After making the ISO commitment at the board level, the hospital needed a partner to help in the planning and implementation of a new process.

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The organization that was selected was (the predecessor to) DNV Healthcare Inc. DNV (and its predecessor company TUV Healthcare Specialists) had a history of helping the hospital with ongoing prep for TJC surveys. A quality manager was appointed to act as the overseer on the entire ISO 9001 process. Overseer not “total doer.” The initial phase of implementing ISO 9001 involved creating a document control system for the entire hospital. This impacted policies and procedures as well as paper and electronic forms. This is one of the ISO requirements and makes the hospital use the most current document version and not allow outdated documents to creep back into the operation. The hospital said it was a great learning process to identify outdated and repetitive documents and to centralize document control so everyone was on the “same page.” The hospital created an online document system that is accessible to staff and eliminates the need to maintain several manuals in multiple locations throughout the organization. During this phase, team leaders defined and mapped the key processes and workflow in their departments. As an example, the hospital found that it was using more than a thousand words to describe their processes. The hospital went further and identified internal and external customers, staff qualification requirements, measures used to identify effectiveness and efficiency of the process, and documentation requirements (work instructions, policies, forms used, etc.). This exercise created more of a graphical representation of its processes and provided more of a macro view of the primary processes for patient care as well as the other processes that support them. Hence, a process in a hospital is inpatient care not radiology turnaround time. Much of this activity follows the “tracer” process and will be quite familiar to most hospitals. Tracer methodology was originally introduced by ISO as “tracing the processes.” The preparation for the ISO 9001 certification audit identified weaknesses throughout the organization that the hospital had always thought were in good shape. For this hospital, this initial phase took about three months. Adjustment For this hospital, most of the clinical departments adapted fairly quickly to the documentation formats and review processes required by ISO 9001. This was a pleasant surprise to the hospital but not to knowledgeable ISO 9001 practitioners. Importantly, the hospital’s clinical staff did not feel like they were being hassled. The aspect of ISO 9001 that usually requires

the most focus is its requirement that the hospital maintain its quality efforts after it starts them. Attention must be devoted to measuring, monitoring and following up on the issues that are addressed through corrective and preventive actions. This ongoing, required follow-up ensures that the actions taken have been effective in sustaining improvements and continually making them better. This is the “continual” in continual quality improvement — a fundamental tenet of ISO 9001. Culture vs. Task A hospital quickly finds out that in order to be successful, ISO 9001 becomes a culture not just a task to perform. Everyone is involved, everyone contributes. One DNV hospital referred to it as being “isotized.” Ongoing It is up to the hospital to ensure that the quality management system is effective. Internal audits are performed annually in each department by a third party to demonstrate effectiveness. It is not hard, but, it is different. There is no break — it is a constancy of purpose, it is a way of life. New DNV-accredited hospitals say they love it. The Results Measurable improvements in clinical indicators may take time to become evident. But in terms of the everyday workflow, the motivation of the staff and the dedication to quality, hospitals tell us ISO 9001 is already a small investment for a very big return. The ISO methodology helps develop a process for standardization. It is the goal of the DNV accreditation program through its Integrated Accreditation™ methodology to combine compliance with the Medicare Conditions of Participation utilizing the requirements of ISO to provide a comprehensive management system for quality and standardization throughout the hospital including a model the non-clinical departments can use. Hospitals say they are eminently more prepared than they have ever been. Hospitals do not “ramp up” for an unannounced DNV survey. They do not have to “get ready” because, as an ISO hospital, they do the same thing every day. The next time someone tells you quality is the job of someone else, remind them that it is everybody’s job. We all are “putting a man on the moon.” Darrel J. Scott, FACHE is the senior vice president for Regulatory & Legal Affairs for DNV Healthcare Inc., Cincinnati, Ohio. Mr. Scott can be reached at (513) 388-4862 or darrel.scott@dnv.com.

MetroDoctors

The Journal of the Twin Cities Medical Society

CMs deemed status Accreditation organizations

You Have a Choice in Accreditation Organizations—Who Knew?

any hospital executives don’t realize they have choices when selecting an accreditation program. It is true that The Joint Commission has sweeping brand recognition — so much so that the brand has become synonymous with the service. But for the service of accreditation, Joint Commission is not the only game in town. An alternative accreditor is the Chicago-based Healthcare Facilities Accreditation Program (HFAP). HFAP is not a new kid on the block by any means. It was founded in 1943 and began surveying hospitals in 1945. Originally founded to ensure quality patient care in osteopathic hospitals, HFAP has also been accrediting allopathic hospitals since 1966. In 1965, when Congress decided that accredited hospitals would be deemed to meet the Conditions of Participation for the newly established Medicare and Medicaid programs, HFAP applied for and was granted deeming authority. Maintaining its deeming authority continuously since the inception of Medicare, HFAP meets or exceeds the standards required by CMS/Medicare to provide accreditation to all hospitals, clinical laboratories, ambulatory surgical centers, and critical access hospitals. In addition, HFAP accredits mental health and physical rehabilitation as well as office-based surgery facilities. It also provides certification for primary stroke centers. HFAP program manuals include crosswalks to Medicare Conditions as applicable for each category of accreditation. The program offers every health care facility the tools and current safety standards to assess and demonstrate its commitment to providing quality care current to its patients. “HFAP has had a very positive impact for us at Hazleton General Hospital,” said Andrea

By Michael J. Zarski, Jd

MetroDoctors

Andrews, RN, CHCQM, director of quality care/ case management. “The HFAP process is committed to seeing that organizations are providing quality, safe care to their patients all the time. We feel the same about this, and have made quality a priority focus in our overall organization’s strategic plans and goals.” HFAP accreditation is recognized by the federal government, state departments of public health, insurance carriers and managed care organizations. It is also recognized by National Committee for Quality Assurance (NCQA) and the Accreditation Council for Graduate Medical Education (ACGME). Why would a hospital use HFAP instead of another accreditation program? “HFAP is a user-friendly, cost-effective, educationally focused accreditation alternative,” said George Reuther, chief operating officer of HFAP. “Our surveys were designed to help hospitals identify areas of excellence as well as opportunities for improvement.” Don Kerner, M.D. agrees. Eleven years ago, Dr. Kerner was chief medical officer of multiple hospitals in the Sisters of St. Francis Health System which had a total of 10 hospitals in and around Indianapolis and two in Illinois. “Indianapolis is a very competitive market,” Dr. Kerner said. “When we acquired Olympia Fields Hospital in Illinois, we found its accreditation was from HFAP. We thoroughly researched the organization and found there was absolutely no competitive disadvantage. We found HFAP very educational and consultative, and we’re very pleased.” Dr. Kerner was part of the team that changed accreditation organizations for all 12 St. Francis hospitals, and, because it is such a respected system, many other health care leaders in and around Indianapolis became curious and followed suit. Surveyors HFAP’s surveyors are experienced medical

The Journal of the Twin Cities Medical Society

professionals who understand the many aspects of a health care facility and help make the survey process more realistic and beneficial. They are practicing professionals with field experience and a supportive attitude. “Because the HFAP surveyors have worked in hospitals recently, they knew what the current challenges and issues were for our lab,” said Jeffrey L. Whitesel, administrative laboratory director, Floyd Memorial Hospital and Health Services, New Albany, IN. “When we had a question about document control, our surveyor gave us some good suggestions that we could implement immediately.” If a deficiency is identified, HFAP’s surveyors are able to draw from their experience and offer feasible solutions, usually on the spot and in real time. Also, successful accreditation is based on the facility’s ability to correct deficiencies, so there is no downside to discovery of issues during the survey process. In other words, there isn’t ever a “Gotcha!” mentality along the process. “HFAP offers a friendly process while, at the same time, holding people to the standards that have been set,” Dr. Kerner said. “We found our surveyors knowledgeable and experienced. And each one looked for teachable moments. It was an effective and non-confrontational approach.” Accreditation survey teams have an average of three surveyors: A physician serves as team captain along with a registered nurse and a hospital administrator. (Continued on page 14)

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HFAP (Continued from page 13)

To ensure surveyors maintain a high level of professional quality, HFAP requires that all surveyors attend mandatory training workshops to augment the real-world experience they bring with them. HFAP surveyor teams are not “fixed,” so surveyors work with many other surveyors. With the utmost quality as the goal, each team member scores the other team members in a variety of categories. “Beginning with the HFAP staff that set the dates for survey, to setting the day’s agenda with the survey team, HFAP recognized that our health care facility has many patient care obligations,” said Gary Ley, president and CEO of Garden City Hospital in Garden City, MI. “Survey schedules were easily rearranged to meet the needs of the hospital. Because most HFAP surveyors are actively employed in a health care system and understand the nuances and activities that occur routinely in a hospital, their insight made the survey process very comfortable and educational.”

The Process The HFAP facility accreditation process is comprehensive and straightforward. It consists of only five basic steps, from application to accreditation. The size of the facility being surveyed and the results of the actual survey determine how long the process takes and are the only reasons the process may vary. The basic steps in the accreditation surveying process include: • application • survey • deficiency report • corrective action • accreditation action If a hospital switches its accreditation to HFAP, the HFAP staff works with the hospital to ensure there is no interruption in reimbursement. Ideally, the application process should begin at least six months prior to the expiration date of the current accreditation. HFAP hospital administrators report that HFAP provides a very cost-effective approach. “Determining the accreditation survey fee is straightforward, varying only by the size and

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volume of the hospital,” Dr. Kerner said. “Because the standards are so clearly written, additional consultations and workshops are not required, but they are available. Currently, HFAP is doing a good job of incorporating important new standards of safety and quality of care. We’re moving much quicker integrating these vital standards.” In addition, HFAP standards are conducive to consistent, predictable application thereby reducing the stress level and frustration of the staff during the survey process. “From the initial contact through receipt of our final accreditation letters at both hospitals, we had excellent communication with HFAP staff,” said Angie Phillips, executive vice president and COO of GlobalRehab Hospitals, Dallas and Ft. Worth, TX. “Our questions were promptly answered and the information provided was consistent throughout the process. The surveys were thorough yet collaborative and educational. The surveyors’ approach allowed staff to feel comfortable throughout a stressful period.” Striving to assist facilities in achieving and maintaining high quality, safe patient care, HFAP extracts the hospital’s core measure data from the Hospital-Compare Web site. The data is aggregated and used during the survey process to allow hospitals to see how they measure compared to their previous reporting period as well as to other HFAP accredited hospitals nationwide. “As a smaller more nimble organization, HFAP is able to respond to the needs of its accredited facilities expediently,” said Mike Zarski, JD and CEO of HFAP. “For example, discharge planning and continuity of care is being addressed as part of an overall drive to add value to the accreditation process by enhancing patient safety.” “I really believe it’s better for the entire health system in our country that we have a choice of accreditation programs,” Dr. Kerner said. More information about HFAP may be found at http://www.hfap.org/ or by calling (312) 202-8258. Michael J. Zarski, JD is currently executive director of the American Osteopathic Information Association, which includes the Healthcare Facilities Accreditation Program. He is also the AOA’s chief information officer, responsible for the strategic integration of technology in all aspects of the AOA’s activities and serves as the staff representative for the AOA in health information technology initiatives. Prior to joining the AOA, Mr. Zarski worked as an attorney for the American Medical Association and the Department of Health and Human Services.

MetroDoctors

The Journal of the Twin Cities Medical Society

New Health Care CEO:

Arthur Gonzalez, Dr. P.H., FACHE, Hennepin County Medical Center Editor’s note: MetroDoctors is continuing to highlight newly named health care executives. Each CEO has been asked to outline his/her vision and challenges for their organization as well as offer some personal insights. Arthur Gonzalez, Dr. P.H, FACHE, became CEO of Hennepin County Medical Center in July, 2009. He has a long and distinguished career in hospital management and has led a variety of public, for-profit, not-for-profit, faith-based, and teaching hospitals during his 36 years in hospital administration.

How did you become interested in hospital administration and what is the career path that led you to Hennepin County Medical Center? I attended a health career fair in high school and at the end of the presentation and tour of the hospital I saw a young administrative resident and created an instant connection that I could do that. I have an M.S. in health care administration from Trinity University in San Antonio and a doctor of Public Health, Health Services Organization and Administration from the University of Texas. I have been the chief executive officer of Schumpert Health System in Shreveport, Louisiana; St. Joseph Hospital in Fort Worth, Texas; and Kino Community Hospital in Tucson, Arizona. During 17 years with Hospital Corporation of America I served in various administrative roles at several Texas hospitals and most recently was CEO of Tri-City Medical Center, a public health care system in Oceanside, California.

In light of the reality of significant funding decreases, we understand that some Hennepin programs are to be eliminated and that further removal and paring down of existing programs seems inevitable. How will decisions regarding these specific actions be decided administratively, and to what extent will your medical/clinical staff be involved in those judgments? Unless there is action by the legislature and governor to restore the General Assistance Medical Care (GAMC) program or provide sustainable coverage for the 35,000 people who depend on the program, or there is direct funding support for hospitals that serve a disproportionate share of those patients, we will lose approximately $40 million in 2010 and $50 MetroDoctors

The Journal of the Twin Cities Medical Society

million in 2011 — almost 10 percent of our operating revenue — when the GAMC program ends. It is important to know that a history of reduced rates and rebasing of public programs has resulted in providers today being paid inpatient rates that are based on 2002 costs, less 16 percent. Because 45 percent of our patients are on public programs, since 2002 we have had to take almost $300 million out of our system, $88 million of that in 2010. Last year we took a number of difficult steps to make it work. In 2010 we have a budgeted deficit of $25 million, and that is in addition to an intense focus on labor productivity, revenue cycle management and purchasing changes, and closing or consolidating a clinic and part of our outpatient cardiac rehab program. It is a significant challenge, and physician leadership is very engaged with administration as we make these difficult decisions.

Has the change in governance from a county department to a public subsidiary corporation benefited the medical center? We are fortunate that the county took the bold step in 2007 to create a public subsidiary corporation — Hennepin Healthcare System, Inc. — to operate the hospital and we are led by a diverse board of outstanding health care and business leaders who are able to focus solely on Hennepin. Our board includes physicians and administrative leaders who now have, or have had, prominent leadership roles in other hospitals and health care systems, the Minnesota Department of Health, city and county government, educational institutions, business, foundations, organized labor, and community organizations. Since 2007 we have changed major operational systems at the hospital including implementation of an electronic health record, new (Continued on page 16)

March/April 2010

New Health Care CEO (Continued from page 15)

purchasing and supply chain infrastructure and an entirely new human resources system. We are being transformed into a lean and flexible health system. Since 2007 our cost increases have been at or below health care inflation rates and our productivity — as measured by full time equivalent positions per adjusted occupied bed — has improved 9 percent since 2006. And, most importantly, our quality and outcomes remain at a very high level.

Hennepin has been listed as one of America’s best hospitals by U.S. News and World Report for 13 years. How do you intend to maintain that honor considering the financial restraints the hospital is under? Even as we prepared for the very difficult 2010 budget we continued to take steps to position Hennepin to survive and thrive in the changing health care environment by being at the table as health care reform models are created, strategically investing in core programs and primary care, and engaging our physician partners to work together toward a future of increased collaboration and cooperation. We have invested in our stroke program, which has some of the fastest door-to-drug times anywhere and we received Joint Commission Primary Stroke Certification last year. We continue to invest in our excellent emergency services and trauma care and in the past two years opened all new, state-of-the-art surgical and medical intensive care units featuring private rooms and the latest technology in a patient and family centered setting. We have fully adopted the latest electronic medical record technology in our inpatient, outpatient, and emergency settings. Our other medical and surgical specialties remain very strong. We are expanding and innovating in primary care and have four sites certified for Health Care Home Primary Care Coordination. This year we are opening a large new clinic in the Whittier neighborhood of South Minneapolis that will replace our current clinic on Lake Street; a new clinic that will be the cornerstone in the Village Creek neighborhood in Brooklyn Park; and we are launching a strategic partnership with Walmart to operate a convenience care clinic in their Bloomington store. Late last year we created a new foundation — called the Hennepin Health Foundation — that is engaging supporters in the community to increase awareness of what we do and raise funds to support our work. We started with internal fundraising and raised close to $300,000 from our employees, physicians, and board members. This year, look for several signature events and other activities that help tell our story and provide opportunities for the community to support the work that we do.

Are you considering creating a corporate council at Hennepin? I believe community engagement is essential, and is a two way street; we are involved in the community and the community is involved in 16

March/April 2010

their hospital. I work closely with community members on our Patient and Family Advisory Council, the Health Services Plan Advisory Board, and the Hennepin Health Foundation Board of Directors, and now the foundation is establishing a Corporate Affinity Council to involve local business leaders — and Hennepin’s business partners — in understanding and supporting Hennepin’s mission. Members of the council will receive briefings about our organization and participate in events and activities that support the medical center.

Is Hennepin taking an active role in trying to restore General Assistance Medical Care (GAMC) or other state funding? We continue to reach out and ask for help from our allies and supporters and we are getting a very positive response. Policymakers, state officials, other safety net providers, and agencies that serve GAMC patients all understand the need and are coming together to find a pathway to be successful. Our new foundation is supporting a communication campaign that uses social marketing and traditional communications to increase awareness of our situation. We launched a Web site called willyoulose. org where we explain the many statewide roles Hennepin plays, including preparing tomorrow’s physicians to work in clinics and hospitals across Minnesota and providing outstanding level 1 trauma care. We have more than 1,000 fans on our campaign Facebook page and are using Twitter, YouTube, and our main Web site to keep the conversation going and facilitate communications between concerned citizens and their legislators. Physicians and administrators have been working together to develop a solution that includes reform, innovation, and accountability.

Will national health care reform be a factor? Yes, so we are paying close attention to national health care reform and what impact that will have on Hennepin and the hospital industry more broadly. Many of the concepts like health care homes, baskets of care, and shared accountability are part of both the state and national health care reform conversations and we have been at the table since they started.

As you settle in, is there anything that you’ve discovered that has surprised you about Minnesota? I’ve discovered that I like walleye and I have discovered that the Twin Cities is a vibrant region with great variety and interesting things to see and do. What was not a surprise is the high quality of the health care organizations and the physicians who practice in Minnesota. Hennepin plays a significant role in that system of care as a provider of medical education and a trauma center, and also in the economy of the Twin Cities as an employer, purchaser of goods and supplies, and partner in a vibrant downtown Minneapolis. It is in the interest of all of us that Hennepin County Medical Center remains strong for at least another 122 years.

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The Journal of the Twin Cities Medical Society

The Minnesota Health Information Exchange Is Available to Help Providers Meet Federal and State Regulations and Provide Effective Care for Patients Health Care Reform

The implementation and adoption of health information technology (HIT) is the cornerstone of health care reform at both the federal and state level. Government has established incentives and regulations that require health care providers to implement electronic health records (EHRs) and exchange patient specific health care information with other provider organizations. Minnesota has a state mandate that requires providers to have EHRs by 2015. There are approximately 15,000 providers in Minnesota and bordering counties that are impacted by these federal and state regulations and incentive programs. Each provider will need to adopt health information technology (HIT) and exchange clinical information to qualify for federal incentive money. Secure Network for Clinical Exchange

The Minnesota Health Information Exchange (MN HIE) provides the first state-wide network that enables providers to exchange a patient’s medical information with virtually any health care organization in the covered geographic area. MN HIE is designed to share clinical and administrative patient information among providers in Minnesota and bordering states. Currently there are over four million patients in its Secure Patient Directory (SPD) and growing. A common network that is viewed as a community utility will eliminate many pointto-point solutions and enable health care organizations to leverage one network connection for a wide variety of business and clinical services. With a strong focus on standards and

By Michael Ubl MetroDoctors

interoperability of HIT at both the federal and state level, there will be significant consolidation in the networking space. MN HIE is positioned to support the proposed standards and deliver the solution in a cost-effective manner. Patients control all access to their clinical information. Patient consent is required at the point-of-care before any medical staff is permitted to access an individual’s medical information through the MN HIE environment. Better Coordination of Care

The current patient care model is undergoing change. With MN HIE, a patient’s medical information can be accessed in real-time mode at the point-of-care when patient and provider make critical decisions regarding a proper treatment program. The need for patients to carry paper medical files from one physician to another will be eliminated. Providers have quick access to a broad set of patient information from multiple data sources. Medication history is now available and new services available include patient eligibility and benefit checking, lab results, immunization history and exchange of medical record information for continuity of care. Patient safety will also be enhanced. Access to medication history, lab results, problem lists, immunizations etc. will result in more appropriate treatment programs; and eliminate adverse impacts from improper prescriptions and unneeded hospitalizations. Early Results are Positive

Providers and patients are experiencing these benefits using MN HIE today: Example 1 – A 61-year-old man entered the Emergency Department at Regions feeling sick after taking too much medication to help him sleep.

The Journal of the Twin Cities Medical Society

He reported that he takes 13 different prescription medications, including several anti-depressants, but could not remember their names. He also could not remember which ones he took to help him sleep. The Minnesota Health Information Exchange (MN HIE) medication history allowed ED staff to review a list of his medications, discuss them with him, and determine an appropriate course of treatment. Without this critical information, the ED staff may have wasted time and resources in their effort to manage this patient. Example 2 – A diabetic patient who just moved to the area arrives at her new clinic in need of medication refills. She needs her refills today but has no record of her prescription. With her permission, using MN HIE, the clinic can view her current medications and the doctor can prescribe her refills. These are just two examples of how MN HIE can help providers deliver high quality care and coordinate care between providers to help the patient. Clinical and Administrative Efficiency

MN HIE services can be embedded into an existing EMR (MN HIE information is embedded in Epic at Regions Hospital in St. Paul) or accessed online via a secure Web application. It offers administrative staff quick access to information necessary for efficient patient management. This information includes eligibility and benefit checking to multiple health plans from a single user interface.

(Continued on page 18)

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Health Information Exchange (Continued from page 17)

Public/Private Partnership

MN HIE is a not-for-profit public/private partnership. It was created, owned and governed by leading health care organizations in Minnesota. The partnership is unique in that it includes health plans, providers and state government. MN HIE’s founding partners include: Blue Cross and Blue Shield of Minnesota (www.bluecrossmn.com) was chartered in 1933 as Minnesota’s first health plan. Blue Cross is the largest health plan based in Minnesota, covering 2.9 million members in Minnesota and nationally through its health plans or plans administered by its affiliated companies. Fairview Health Services (www.fairview.org) is a not-for-profit, integrated health care network serving Minneapolis-St. Paul, as well as communities throughout greater Minnesota and the Upper Midwest. Headquartered in

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March/April 2010

Minneapolis, Fairview includes seven hospitals with more than 2,500 licensed beds, 36 primary care and 55 specialty clinics and much more. HealthPartners (www.healthpartners.com) was founded in 1957 and serves more than one million medical and dental health plan members nationwide. It is the largest consumergoverned, nonprofit health care organization in the nation, providing care, coverage, research and education to improve the health of members, patients and the community. Medica (www.medica.com) is a health insurance company with nearly 1.4 million members. The nonprofit company provides health care coverage in the employer, individual, Medicaid, Medicare and Medicare Part D markets in Minnesota and a growing number of counties in North Dakota, South Dakota and Wisconsin. The Minnesota Department of Human Services (www.dhs.state.mn.us/healthcare) ensures basic health care coverage for low-income Minnesotans through three major publicly subsidized health care assistance programs. More than half a million Minnesotans have health care coverage through Minnesota Health Care Programs. UCare (www.ucare.org) is an independent, nonprofit health plan providing health care and administrative services to more than 147,000 members. UCare addresses health care disparities and care access issues through its UCare Fund grants and a broad array of community initiatives. Status and Outlook

These six organizations have worked closely the past two years to create and implement a vision that is focused on improving the health care experience for consumers in the Minnesota community. The key objectives include: a) Patient safety; b) Improvement in quality of care; and c) Reduction in health care costs. Despite the challenges in the current health care industry, there is strong resolve and optimism among the sponsor organizations that adoption of health information technology (HIT) is about to accelerate at a rapid pace. A variety of changes have occurred in the past couple of years that have led to this

optimism and high expectations. They include the following: 1. Decreasing costs for electronic medical systems and communication networks. 2. Adoption of industry-wide standards to support interoperability among health information technology products. 3. Minnesota state government programs including: a. Creation of the Minnesota e-Health Advisory Committee with the purpose of accelerating the adoption of HIT in the health care community. b. State sponsored grant/loan programs that enable providers to plan and implement HIT products. c. Specific state regulations that mandate adoption of HIT capabilities, including interoperable health records by 2015. d. Federal programs enacted by the American Recovery and Reinvestment Act (ARRA). The federal government has allocated over 30 billion dollars in an attempt to renovate the health care system. Adoption and effective use of HIT is the core of the new federal strategy. A significant portion of this money is targeted at providers who adopt health information technology (HIT). Summary

MN HIE is positioned to support health care reform in Minnesota and assist providers to quickly and easily build the capacity to meet 2011 and 2013 meaningful use requirements currently being defined as part the ARRA legislation. Provider adoption of HIT combined with MN HIE services will significantly increase the ability to exchange health information in Minnesota. The end result will be more effective patient care for everyone with long term anticipated cost savings. Michael Ubl, is the executive director of the Minnesota Health Information Exchange.

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The Journal of the Twin Cities Medical Society

Board of Medical Practice Announces Seminar Series on Management of the Chronic Pain Patient

THE MINNESOTA BOARD of Medical

Practice has voted to once again initiate an educational outreach program on the topic of management of the chronic pain patient. The reasons surrounding this decision include: 1. Continued lack of emphasis on the topics of pain and pain management in the medical education fi eld; 2. Recent government and public attention to abuse of some of the agents legitimately used in the management of pain; 3. Sensational media surrounding drug overdose deaths of celebrities; 4. Confusing, and sometimes intimidating pronouncements by regulatory agencies at all levels of government; 5. Initiation of Minnesota’s own Prescription Monitoring Program; 6. The diffi cult clinical nature of pain management; and 7. The even more diffi cult clinical nature of the management of chronic pain patients. These seminars will be conducted by physician members of the Minnesota Board, A.V. Anderson, D.C., M.D., and Mark A. Eggen, M.D., and staff. Dr. Anderson is vice chair of the Board, chair of one of the Board’s Complaint Review Committees and a practicing pain specialist. Dr. Eggen is a member of the Board’s Licensure Committee, and a board certifi ed practicing anesthesiologist.

By Richard Auld, Executive Assistant director, MN Board of Medical Practice

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Minnesota Board of Medical Practice Chronic Pain Management Seminars 2010 These seminars are intended to provide instruction to physicians who are not specialists in the care of chronic pain patients. The seminars will be held in the First Floor Conference Room at 2829 University Avenue S.E., Minneapolis, MN 55414. The facility accommodates 30 participants per session. We request that participants schedule their attendance with the Board by contacting Cheryl Kohanek at: Cheryl.Kohanek@State.MN.US or (612) 617-2158. Schedule March 10 March 24 April 7 April 28 May 5 (If needed) Program • Buffet Supper • Introductions and Legal and Regulatory Landscape • Clinical Issues I • Break • Clinical Issues of the Chronic Pain Patient and Surgery • Clinical Issues II • Q & A • Adjourn

Timing 5:30 – 6:00 Buffet Supper 6:00 – 6:30 Richard Auld, Board Staff 6:30 – 7:00 A.V. Anderson, D.C., M.D., Board Member, Pain Specialist 7:00 – 7:15 Break 7:15 – 7:45 Mark A. Eggen, M.D., Board Member, Anesthesiologist 7:45 – 8:15 A.V. Anderson, D.C., M.D. 8:15 – 8:30 Q&A 8:30 Adjourn

Strategy All sessions will be conducted in the First Floor Conference Room of 2829 University Avenue, Minneapolis, MN 55414-3246. All participants will receive paper handouts on legal and regulatory issues, Scott M. Fishman’s Responsible Opioid Prescribing, the Anderson, Fine, Fishman monograph Opioid Prescribing: Clinical Tools and Risk Management Strategies, and CDs of Drs. Anderson and Eggen’s power point presentations. All participants will be directed to our Web site, which will contain the presentation modules, the Anderson, Fine, Fishman monograph, and the CME post test for Anderson, Fine, Fishman monograph.

March/April 2010

The Provider Tax

Questionable Past and an Uncertain Future The Minnesota provider tax has been a controversial issue for the past 18 legislative sessions for individual physicians and physician organizations. The provider tax has a rich legislative history in Minnesota dating back to 1993. Three different administrations, two Republican and one Independent, have used the provider tax and the revenues generated by it in vastly different ways, not always in line with the tax’s original intended purpose. Going into 2010, with a new administration on the horizon and federal health care reform being debated, providers should be very concerned about the provider tax’s uncertain future. What is the Provider Tax?

The provider tax, codified in law under Minn. Stat. § 295.52, imposes a 2 percent tax on gross revenues of all health care providers for patient services rendered. The list of providers taxed under this law includes physicians, dentists, nurses, psychologists, physical therapists, and chiropractors among others. The state also imposes a 2 percent tax on the gross revenues of hospitals and surgical centers. Certain patient services, including those provided under Medicare are specifically exempted from collection under this tax. Revenues generated by the tax are collected in the state’s Health Care Access Fund (HCAF), primarily used to fund the MinnesotaCare program. Since 1993, the state has collected over $3.3 billion in revenue from the provider tax (including tax on hospitals and surgical centers) in the HCAF. As the largest single revenue source in the health care access fund, provider tax collections tax have far outpaced spending from the HCAF, allowing the fund to continuously run a surplus since 1993. However, this is By Nathaniel Mussell, Jd

March/April 2010

served its original intended purpose. “It has provided a sound financial basis for the MinnesotaCare program” says former state representative Lee Greenfield. However, on multiple occasions in the years that followed, revenue in the Health Care Access Fund was diverted away from the fund, despite the strong objections from the physician community. What has Happened Since 1993?

set to change in the upcoming years, as current forecasts project a structural deficit in the fund as early as 2012. Origins of the Provider Tax

After an unsuccessful attempt at health reform in 1991, the Minnesota Legislature was able to pass a sweeping overhaul of Minnesota’s health care system in 1992. The legislation, crafted by the “Gang of Seven” established the MinnesotaCare program, formerly known as HealthRight, to offer health care coverage to Minnesota’s working poor. The “Gang of Seven” included four democrats — Sen. Linda Berglin, Sen. Pat Piper, Rep. Paul Ogren and Rep. Lee Greenfield — and three republicans, Sen. Duane Benson, Rep. Duane Gruenes, and Rep. Brad Stanius. Coming off the prior year’s defeat, the “Gang of Seven” formulated the reform legislation in 1992 with a 2 percent provider tax serving as the primary funding source. The tax generated considerable opposition from the medical community driven in large part by the MMA. Although the House attempted to substitute the narrow provider tax for a broader income tax, Governor Arnie Carlson adamantly opposed such an approach. For the most part, the revenue generated by the provider tax has

Following the provider tax’s 1992 enactment, the tax continued at a 2 percent rate up until 1998 and the Health Care Access Fund maintained a constant surplus over the course of its first five years. Because of this, the provider tax was subsequently reduced to 1.5 percent during the 1997 legislative session at the urging of House Republicans. In 1999 the reduced 1.5 percent rate was extended for another four years, before it reverted back to its original 2 percent rate in 2004. Although revenue from the provider tax has, in large part, been used to fund MinnesotaCare, there have been several instances over the past 18 years where HCAF dollars were diverted to the General Fund spending. The two most controversial examples took place during the 2003 and 2005 legislative sessions, on both occasions to help solve the state’s budget shortfalls. The HCAF surplus was seen as an easy target for legislators looking to solve the state’s budget problems, both because the political implications of raiding the fund were minimal and because the prospect of generating other new revenue was unfeasible. During the 2009 legislative session, Governor Pawlenty proposed a complete transfer of the HCAF over to the General Fund based on the rhetoric of administrative efficiency. Sen. Berglin, the only remaining member of

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What Does the Future Hold for the Provider Tax?

There are a number of unanswered and concerning questions for medical providers about the future of the provider tax and the HCAF. First, with a new administration in offi ce in 2011, there are signifi cant concerns that a provider tax increase may be on the horizon, particularly given the multi billion dollar defi cit projected for 2011 and beyond. Second and largely more of an unknown question, is what affect federal health care reform will have on the provider tax and the health care access fund. One of the major reforms in the federal bill is the expansion of the Medicaid program. The proposed expansion may have the affect of moving a signifi cant number of individuals from the MinnesotaCare program over to Medicaid, saving the HCAF signifi cant dollars, and thus lessening the need for such an extensive provider tax. Although that may be wishful thinking, those who pay the provider tax need to be critically aware of what happens at the state legislature each year in the event the tax ceases to serve its original intended purpose. Nathaniel Mussell is an attorney and lobbyist with Lockridge Grindal Nauen’s (LGN) government relations team with a focus primarily on health care clients. He is a 2004 graduate of the University of Minnesota where he studied political science and earned a Bachelor of Arts Degree. He attended William Mitchell College of Law, graduating with honors in 2008. Mr. Mussell previously worked with the LGN state government relations team during the 2005 legislative session, assisting numerous clients on health care related issues. Mr. Mussell’s policy experience is complemented by his experience working with a number of elected officials, including Minnesota Governor Tim Pawlenty, Congressman Jim Ramstad and former Minnesota Senator Dave Knutson.

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the “Gang of Seven” still serving in the legislature, balked at the Governor’s proposal. Gov. Pawlenty’s onslaught on the HCAF continued this fall when he proposed transferring almost the entire General Assistance Medical Care population, some 28,000 individuals, over to MinnesotaCare. Each of these proposals only further threatens the future of the HCAF and puts the medical community on edge over the possibility of an increase in the provider tax.

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March/April 2010

The Evolution of the Minnesota FluLine

n October 21,2009, a remarkable innovation in population health management was initiated in Minnesota. In response to the rapidly growing incidence of H1N1 influenza A, the Minnesota Department of Health (MDH) recognized that the usual means of caring for people with influenza was likely to be stretched beyond capacity. If the virus was particularly virulent, the existing clinical resources were likely to be insufficient to meet the needs of Minnesotans. Groups that lacked insurance or an established clinical provider would be significantly disadvantaged.

was extremely difficult to predict based upon its behavior up until that time. Otherwise healthy children and young adults — especially pregnant women — were having a higher incidence of severe disease than is normally experienced with a more traditional influenza outbreak. The southeast United States experienced widespread activity of moderately severe disease by midAugust with the general direction of expansion to the north. Concurrent with these developments, the CDC released a series of updates on interim recommendations for the use of antiviral

due to H1N1. The FDA permitted the use of oseltamivir in children under one year of age through an “emergency use authorization.”

this does serve as a model for future responses to urgent population health issues, and there have been many “lessons learned” through this experience.

Anticipating a serious public health need, MDH also worked to make state- and federallypurchased antiviral medications available to health care facilities that lacked supply as well as persons without health insurance. However, there was no existing mechanism for patients without insurance or timely access to a clinician to be quickly evaluated and, if indicated, receive a prescription. Additionally, a mechanism to triage individuals to the appropriate level of care was needed to prevent clinics, urgent care centers, 911 services and emergency rooms from being overwhelmed. Nationwide, an H1N1 pandemic had been declared in April based upon its widespread activity. The ultimate severity of this pandemic By Peter dehnel, M.d.

March/April 2010

The FluLine is Established

medications for individuals who had suspected H1N1 infections. Clinicians were encouraged to treat people with “influenza like illness” (ILI) with higher risk for influenza complications as soon as possible. The CDC included the recommendation that clinicians should be: “Considering empiric treatment of patients at higher risk for influenza complications based on telephone contact if hospitalization is not indicated and if this will substantially reduce delay before treatment is initiated.” Because of the declared pandemic nature of H1N1, certain other legal protections were invoked to help clinicians manage this outbreak. The “Public Readiness and Emergency Preparedness” (PREP) Act protects those who prescribe oseltamivir and zanamivir for patients with ILI symptoms that are presumably

At the beginning of September, MDH initiated the process that would eventually culminate with the rollout of the FluLine on October 21 — a toll-free telephone number that would be available for all residents of Minnesota. The overall goal of the program is to provide, on a statewide basis, telephone assessment and referral for appropriate medical care for those people who have ILI symptoms and more serious signs of illness. The FluLine would also make oseltamivir available to those individuals with mild to moderate ILI symptoms and are at higher risk for influenza complications without the requirement of first being seen at a medical facility. This fulfills the CDC’s recommendation of antiviral treatment as early as possible. The Steps to Implementation

With remarkable speed, the FluLine went from a concept without substance to a collaborative effort involving the Department of Health, the Minnesota Hospital Association, the Minnesota

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The Journal of the Twin Cities Medical Society

Council of Health Plans, a number of larger clinic systems and many of the major health insurers that have “nurse line” programs. It required the development of a universally accepted telephone algorithm that triaged callers on the basis of clinical symptoms and provided for the timely provision of oseltamivir for appropriate patients. Children’s Physician Network’s (CPN) Nurse Triage Program was contracted as the entity that would serve as the entry point for callers on a 24/7 basis. One of the real challenges to launching the program was the development of a working collaboration on a real-time basis between the different clinic and insurer telephone systems/ call centers. Calls come in through one toll-free phone number to the CPN Call Center and are then transferred directly (a “warm transfer”) to the caller’s primary site of care or insurance company as appropriate. This is an entirely new activity that had to be developed within one to two weeks. It was also implemented at a time when the level of influenza-related illness in the community was increasing exponentially, stretching everyone’s telephone resources beyond capacity. Callers that did not have a primary site of medical care or did not have insurance were triaged through CPN resources. The final hurdle was interfacing with county health departments and pharmacies (statewide) for those patients who qualified for a telephone-based prescription. MDH stockpiles of oseltamivir were made available for those callers who did not have prescription benefits and could not otherwise afford a course of this medication.

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At the time of writing, the program is under an extensive evaluation process by MDH supported by a grant from CDC. As of December 31, there have been a total of 26,263 calls presented to the MN FluLine, with about half of the callers experiencing flu symptoms. About 6 percent of the callers met the criteria for an oseltamivir prescription. This does serve as a model for future responses to urgent population health issues, and there have been many “lessons learned” through this experience. The CDC has developed a general toolkit of this development process for communities at: http:// emergency.cdc.gov/healthcare/pdf/FinalCallCenterWorkbookForWeb.pdf. Peter Dehnel, M.D., is medical director, Children’s Physician Network. MetroDoctors

The Journal of the Twin Cities Medical Society

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March/April 2010

TCMS Annual Meeting Held

he inaugural meeting of the Twin Cities Medical Society was held on Thursday, January 28, 2010 at the Town and Country Club in St. Paul. President Edward P. Ehlinger, M.D. presided over the event, introducing the Executive Committee, Board of Directors, CEO and staff. The merger of the East Metro Medical Society and West Metro Medical Society occurred on January 1, 2010 following months of deliberation and implementation. TCMS is poised and prepared to serve its members and the community through awareness, engagement and action. Ronnell Hansen, M.D. was presented with the Presidentâ&#x20AC;&#x2122;s Award as an expression of gratitude for his service as 2009 EMMS president. Outgoing leaders and board members from both the East Metro Medical Society and West Metro Medical Society were also acknowledged. The brief program provided an opportunity for the board to hear from two State Representatives: Minority Leader Kurt Zellers (R 32B) and Paul Thissen (DFL 63A) chair, Health Care and Human Services Policy and Oversight Committee. The photos capture the spirit and enthusiasm of Board members and guests as the TCMS is officially launched.

Outgoing EMMS President Ronnell Hansen, M.D. accepted the President's Award.

Sue Schettle, TCMS CEO, and Peter Wilton, M.D.

Resident representative, Clint Hawthorne, M.D. and his wife, Katie.

Minority House Leader Kurt Zellers (R 32B) addressed the Board.

Young Physician Rep. Stephanie Stanton, M.D. (center) with medical students Melanie Fearing (L) and Jessica Voight (R).

Dr. Edwin Bogonko, Executive Committee member-at-large, and his wife, Zipporah.

March/April 2010

Drs. David Estrin (AMA Alternate Delegate), Robert Geist (Chair, Professionalism and Ethics Council), and Ken Crabb (AMA Delegate).

Representative Paul Thissen (DFL 63A), chair Health Care and Human Services Policy and Oversight Committee, provided a glimpse of his agenda.

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The Journal of the Twin Cities Medical Society

New Members Active Madeline C. Almond, M.D. University of Minnesota Department of Ophthalmology Ophthalmology Peter D. Arny, M.D. University of Minnesota Department of Ophthalmology Ophthalmology Rajeev Attam, MBBS University of Minnesota Department of Medicine Gastroenterology Kathryn C. Barlow, M.D. Dermatology Consultants, P.A. Dermatology Delfin J. Beltran, M.D. Anesthesiology Harlan J. Bruner, M.D. University of Minnesota Department of Neurosurgery Neurological Surgery Roosevelt Bryant III, M.D. University of Minnesota Heart and Lung Institute Thoracic Surgery Renee M. Crichlow, M.D. University of Minnesota North Memorial Family Medicine Family Medicine Benjamin T. Dastrup, M.D. University of Minnesota Department of Ophthalmology Ophthalmology Ingeborg I. DeBecker, M.D. University of Minnesota Department of Ophthalmology Ophthalmology Alisa M. Duran-Nelson, M.D. University of Minnesota Department of Medicine Internal Medicine

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Knut Eichhorn-Mulligan, M.D. University of Minnesota Department of Ophthalmology Ophthalmology Nissa I. Erickson, M.D. University of Minnesota Department of Pediatrics Pediatrics Thomas R. Hellmich, M.D. University of Minnesota Department of Pediatrics Pediatrics Lisa R. Ide, M.D. University of Minnesota Medical Center Fairview Emergency Medicine

Theresa A. Laguna, M.D. University of Minnesota Department of Pediatrics Pediatric Pulmonology

Susanne S. Rupert, M.D. University of Minnesota Department of Anesthesiology Anesthesiology

Thokozeni Lipato, M.D. University of Minnesota Department of Medicine Internal Medicine

Arthi Sanjeevi, MBBS University of Minnesota Department of Medicine Internal Medicine

Ashley R. Loomis, M.D. University of Minnesota Department of Pediatrics Pediatrics

David G. Strike, M.D. University of Minnesota Department of Medicine Infectious Diseases

Robert A. Mittra, M.D. VitreoRetinal Surgery, P.A. Ophthalmology

Priya Verghese, M.D. University of Minnesota Department of Pediatrics Pediatrics

Christian M. Ogilvie, M.D. University of Minnesota Department of Orthopaedic Surgery Orthopaedic Surgery

Bobby Kansara, M.D. TRIA Orthopaedic Center Orthopaedic Surgery

Betul Oran, M.D. University of Minnesota Department of Medicine Internal Medicine

Elizabeth A. Kilburg, M.D. Womenâ&#x20AC;&#x2122;s Health Consultants, P.A. Obstetrics & Gynecology

Kevin P. Peterson, M.D. UMP-Phalen Village Clinic Family Medicine

Adam S. Kim, M.D. Minnesota Gastroenterology, P.A. Internal Medicine

Timothy L. Pruett, M.D. University of Minnesota Department of Surgery Internal Medicine

Paul Kleeberg, M.D. Family Medicine Badrinath R. Konety, MBBS Minnesota Urology, P.A. Urology/Urological Surgery Suma H. Konety, MBBS University of Minnesota Department of Medicine Internal Medicine Dara D. Koozekanani, M.D. University of Minnesota Department of Ophthalmology Ophthalmology Marek Kostanecki, M.D. Park Nicollet Methodist Hospital Internal Medicine

The Journal of the Twin Cities Medical Society

Christopher Reif, M.D., MPH Community-University Health Care Center Family Medicine Michelle N. Rheault, M.D. University of Minnesota Department of Pediatrics Pediatric Nephrology Steven B. Robin, M.D. University of Minnesota Department of Ophthalmology Ophthalmology Sara R. Rohr, M.D. University of Minnesota Department of Radiology Radiology

Nicole R. Vik, M.D., MPH Family HealthServices MN Family Medicine Christina M. Ward, M.D. University of Minnesota Department of Orthopaedic Surgery Orthopaedic Surgery Bryan J. Williams, M.D., Ph.D. University of Minnesota Department of Medicine Internal Medicine Chang-Jiang Zheng, M.D. Allina Medical Clinic Occupational Medicine Medical Students (University of Minnesota)

Megan E. Ahl Amin Alishahi Robert B. Andres Allison J. Appelt Allison J. Autrey Jonathan T. Avila Loren N. Bach Elizabeth M. Bauer Tricia C. Bautista Daniel R. Beacher Zachary J. Beatty Caitlin M. Becker Mackenzie M. Becker Jennifer Beck-Esmay (Continued on page 26)

March/April 2010

New Members (Continued from page 25)

Heidi Belgum John C. Benson Allison R. Berger Elizabeth M. Bernadino Amanda M. Best Michael J. Beste Hannah K. Betcher Kevin H. Boegel Colin Boettcher Brian A. Breviu Brittany J. Brindle John P. Brunkhorst Cory M. Buschmann Maureen K. Campbell Michael J. Carrigan Daniel J. Carroll Ellie M. Clarkson Tyler M. Conway Jason Cook Jill C. Crosby Nicholas A. Dahl Stewart L. Decker Carla M. Determan Joshua M. Dorn James T. Dorrian John F. Dunbar Jamie L. Dyer Derek W. Eklund Theodore S. Fagrelius Molly F. Fansler Jessica J. Fark Ryan J. Fier Michael M. Fitzgerald Robert J. Fraser Laura B. Gorsuch Casey D. Gradick Courtney A. Green Jeffrey O. Grosland Sylvia L. Groth Richard F. Guo Tricia J. Hadley Jacob M. Hakkola Laura M. Haugo Erin N. Hennen Kayli A. Henry Elizabeth J. Hermanson Caitlin D. Hill Ari Holloway-Nahum Bryce C. Holmgren Daniel G. Hottinger Krisit L. Hultman Anika M. Ingham Elizabeth S. Jacobson

March/April 2010

Wendy Y. Jin Elliot M. Johnson Kiran M. Kanth Kyrsten A. Kelley Kirsten A. Kesseboehmer Michael L. Knudsen Justin C. Kohl Adam H. Krause Lucas J. Kreuser Sam N. Kuchinka Rachel M. LaNasa Michael D. Lane Michael L. Lane Olabisi O. Lashore Nicholas B. Lehnertz Natalia Lipin Timothy A. Livett Brian J. Lovig Mollie E. Lyle David M. MacDonald Joseph M. MacDonald Erin M. Maddy Kathleen Mahan James E. MapelLentz Eduardo M. Medina David M. Melling Nicholas L. Menth Jessica A. Minke Gina M. Mittelstaedt Lilian Moalim-Nour Erin F. Morcomb Lilian E. Msambichaka Brett S. Mulawka Rajiv P. Napaul Jennifer C. Nelson Valerie Nelson Logan A. Newman Tuong-Vi T. Nguyen Rumbidzayi Nzara Patrick Odens Nicholas J. Olson Gregory M. Olszewski Fernando Ortiz Dustin L. Palm Brian J. Park Maarya Pasha Andrea L. Patineau David F. Patterson Garrison F. Pease Judit M. Perez Ortiz Justin C. Persson Tram N. Pham Phayvanh Phithaksounthone Kathleen J. Pladson Anne M. Portilla

Shawn P. Pritchard Jason S. Prudom Robert C. Pueringer James T. Regan Alexander L. Ringeisen Phil Roban Andrew N. Rosenbaum Oleg A. Ryabinin Ali R. Samikoglu Kyle V. Sanders Sameet S. Sangha Jason M. Schenkel Joseph D. Schimers Danielle D. Schlosser Jonathan D. Scrafford BrieAnna L. Siefken Andrea L. Smith Erin R. Smith Maria K. Smith Lisa M. Smrekar Divya Sood Melissa A. St. Aubin John Steubs James M. Stevens Christine Stewart Jeffrey A. Sugandi Mithun R. Suresh Leah A. Swanson Brett D. Tanning Katherine M. Theisen Vincent D. Vallera Megan A. Van Ee Ryan A. Vansickle Nicholas Venosdel Kathryn L. Vogt Ghe S. Vong Laura C. Waller Daniel P. Walsh Scott G. Warren William K. Wedin Alexa Weingarden Anthony D. Williams Anthony C. Wiseman Angela Y. Wu Razaan N. Yassin Mary K. Zatochill Chen Zhao Matthew J. Ziegelmann

In Memoriam CHARLES R. CHEDISTER, M.D., died January 10, 2010, at Mayo Hospital in Phoenix, AZ after a brief illness. He was 78. He graduated from the University of Illinois College of Medicine, Chicago. Dr. Chedister was the retired Chief of Pathology at Fairview Southdale Hospital in Minneapolis. OSKAR PETER FRIEDLIEB, M.D., 85, passed away November 20, 2009. He was born in Vienna, Austria. In 1930 his family immigrated to Yugoslavia and in 1938 they moved to Beirut, Lebanon to escape the Nazis; he attained a medical degree from the America University of Beirut. After he arrived in the U.S. he received additional surgical training at Bellvue Hospital, New York City. He served in the U.S. Army as a surgeon and received a commendation for his work. In 1957 Dr. Friedlieb moved to Minneapolis and practiced at Mount Sinai Hospital. He later moved to Virginia, Minnesota. And then in 1978, he moved to Ashland, KY to become medical director of Our Lady of Bellfonte Hospital. In 1988 he retired and moved back to Minnesota where he continued to perform medical utilization reviews into his 70s. FRED A. RICE, M.D., 89, died on December 2, 2009. He graduated from Harvard Medical School, Boston and completed specialty training at the University of Chicago Clinic. Dr. Rice was a specialist in internal medicine at the Nicollet and Park Nicollet Clinics. He was also a clinical professor of medicine at the University of Minnesota Medical School. PATRICK J. GRIFFIN, M.D. died on December 1, 2009, at the age of 76. Dr. Griffin attended St. Louis University School of Medicine and was an Alpha Omega Alpha graduate. He spent 35 years practicing in the ear, nose and throat field in Saint Paul and Maplewood. ROBERT WILLIAM OLSON, M.D., age 80, passed away November 30, 2009. He graduated from the University of Minnesota Medical School. Dr. Olson specialized in family medicine and practiced in South Minneapolis. MANLY RUBIN, M.D., 81, passed away January 16, 2010. Born and raised in Winnipeg, Canada, he received degrees in medicine from the Royal College of Physicians and Surgeons, Dublin, Ireland, and pharmacy from Apothecary Hall, Dublin, Ireland. After six years in general practice in rural Saskatchewan, Canada, he moved his family to Minneapolis where he completed his residency in dermatology at the University of Minnesota, and built a thriving practice for over 20 years. GEORGE WERNER, M.D. passed away January 11, 2010, in Florida at the age of 92. He graduated from the University of Minnesota Medical School in 1941. He served in WWII as a Navy physician on the U.S.S. Pontiac. Dr. Werner went into practice of general surgery in the Minneapolis area and helped establish Group Health (now HealthPartners) as a major health care delivery system. He was an inventor and was instrumental in bringing new medical technologies to market.

MetroDoctors

The Journal of the Twin Cities Medical Society

EMMS Foundation News

The endowment from Carl Boeckmann, M.D. has been transferred to the EMMS Foundation. In the late 1800s, Dr. Boeckmann started a cat-gut suture business. The profits from that business served as the reserve funds for the

Foundation Board Developing Gifting Criteria

The Board of Directors has formed a committee to compose gifting criteria and discuss the process of giving grants to other organizations. The foundation looks forward to assisting others now that the funds have increased.

Community Service Award Moved to Foundation

The Community Service Award was previously given by the medical society, but is now an award of the EMMS Foundation. The award is given annually and recognizes an â&#x20AC;&#x153;unsung physician hero,â&#x20AC;? a member who has volunteered and made a difference in our local community.

In Appreciation of Former EMMS Board Members The following individuals served on the East Metro Medical Society Board of Directors through December 2009. Thank you for your time and effort on behalf of your medical society!

MetroDoctors

Aaron Burnett, M.D. Resident Physician Representative, 2009

Katherine Clinch, M.D. Director, 2008-2009

Andrew Fink, M.D. Director, 2005-2009

Robert Geist, M.D. Chair, Council on Professionalism & Ethics Council, 2001- present

Mark Kleinschmidt Clinic Administrator Representative, 2003-2009

Jerome Perra, M.D. Director, 2007-2009

Lon Peterson, M.D. Director, 2003-2009

Scott Uttley, M.D. Director, 2007-2009

The Journal of the Twin Cities Medical Society

March/April 2010

Metro

Boeckmann Fund Transferred to Foundation

Ramsey County Medical Society for more than a century and will now help to expand the EMMS Foundation.

East

Some changes to the East Metro Medical Society Foundation have been made due to the consolidation of the East and West Metro Medical Societies on January 1, 2010.

Celebrating the Career of Jack G. Davis, WMMS CEO A wonderful celebration of service was held in honor of Jack G. Davis in December 2009 commemorating his retirement as CEO of the West Metro Medical Society. Past board chairs, friends, and family gathered as several individuals offered a story and a memory of their relationship with Jack. Ed Ehlinger, M.D. served as the emcee for the evening.

Jack Davis expressed his gratitude to those in attendance.

Michael Boyd, a glass artist, and Nicholas Legeros, a bronze sculptor, were invited to collaborate on a unique gift for Jack on behalf of the Board of Directors.

Virginia Lupo, M.D. presented a gift in the form of a donation to MVNA on behalf of the former WMMS Board Chairs.

Richard Frey, M.D. (left) and William Petersen, M.D. (right) celebrate years of friendship and comraderie with Jack. Symbolic Sculpture by Ed Ehlinger, M.D., President of the West Metro Medical Society 2009 Material: Catlinite Title: Supporting Physicians: the Legacy of Jack and Marilyn Davis Description: Jack Davis is symbolized by the hollowed-out triangular middle piece which supports numerous small pieces representing the large number of physicians Jack supported and encouraged over the course of his career. These smaller pieces, in turn, support the larger heart of medicine. The triangle has a hole in the middle that would allow the smaller pieces to slip through if there wasn't some other support underneath. That bottom-line support is a large heart which symbolizes Marilyn Davis who has lovingly supported Jack and his work for over 42 years. It is the teamwork of Jack and Marilyn Davis that has allowed physicians to effectively use their talents and skills in serving their patients and their communities.

March/April 2010

Ed Ehlinger, M.D. served as emcee.

MetroDoctors

The Journal of the Twin Cities Medical Society

West Metro Senior Physicians Association

W e st M e t r o

THE LAST MEETING FOR 2009 was held in November — and yes, it was still a beautiful day. Our speaker, Steven H. Miles, M.D. shared his knowledge of the “U. S. Health Care System, an International Perspective.” Dr. Miles is Professor of Medicine and Bioethics at the University of Minnesota Medical School.

SAVE THE DATES: Our meeting dates for 2010 are on the following Tuesdays — April 27, June 8, September 21, and November 9. Meetings will be held at Zuhrah Shrine Center at 11:30. WANT TO JOIN? If you are retired or contemplating retirement, 62 years or older, member or past member in good standing with TCMS/West Metro District or another county medical society, you are eligible to join! Contact Kathy Dittmer at kdittmer@metrodoctors.com or (612) 623-2885.

Richard Woellner, M.D., president-elect (right) welcomes speaker Steven H. Miles, M.D.

SAVE THE DATE

100

WMMS Alliance 100th Annual Meeting & Celebration Sunday May 16, 2010 Interlachen Country Club 1:00 - 3:00 p.m.

The WMMSA 100th Annual Meeting committee is planning a lunch, brief meeting and program to honor West Metro Medical Society Alliance (formerly Hennepin County Medical Auxiliary) past and present members for their 100 years of enduring volunteerism to promote a healthy community. Please mark your calendars now so you don’t miss this special celebration!

MetroDoctors

The Journal of the Twin Cities Medical Society

March/April 2010

CAREER OPPORTUNITIES

see Additional Career opportunities on page 32.

ATTENTION all Minnesota Physicians Residing in Naples, Florida

8th Annual Minnesota Health Care Dinner Party

Monday, March 15, 2010 Pelican Marsh Golf Club, Naples, Florida Cocktails: 6:00 p.m. Dinner: 7:00 p.m. Cost: $55.00 per person (estimated) Spouse/guest invited If you are planning to be in Naples at that time, please contact Thomas W. Hoban with your Naples address at (239) 948-4492 or th8159@earthlink.net

THE STRENGTH TO HEAL and get

back to what I love about family medicine. Do you remember why you became a family physician? When you practice in the Army or Army Reserve, you can focus on caring for our Soldiers and their Families. You’ll practice in an environment without concerns about your patients’ ability to pay or overhead expenses. Moreover, you’ll see your efforts making a difference. To learn more about the U.S. Army Health Care Team, call SFC Daniel Ebbers at 952-854-8489, email daniel.ebbers@usarec.army.mil, or visit healthcare.goarmy.com/info/e928.

Visit us at

Family Practitioner

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!

March/April 2010

Open Cities Health Center (OCHC) is in the process of expanding its services to the community and we expect to have our renovations completed by the Spring/Summer of 2010. This is an opportunity for a Family Practitioner (family practice, OB, Med/Peds, etc.) who is interested in providing cost-effective, quality health care to patients from a wide range of socioeconomic backgrounds and ethnic groups to be a part of a great clinic. 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: Lashell Barnes, Human Resources Manager 409 North Dunlap Street, St. Paul, MN 55104 651-290-9211 / 651-290-9210 (fax) lashell.barnes@ochealthcenter.com www.ochealthcenter.com

MetroDoctors

The Journal of the Twin Cities Medical Society

Career Opportunities

CAREER OPPORTUNITIES

Please also visit www.metrodoctors.com for 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. Betsy Pierre, ad sales 763-295-5420 betsy@pierreproductions.com

Great Partners, Great Staff, Great Patients, Excellent Income & Lifestyle Family HealthServices Minnesota, P.A. is looking for several Board Certified/Eligible Family Physicians to fill 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 651-772-1572 • email: pberrisford@fhsm.com

March/April 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

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the same way you do. But he knows

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Protecting and Promoting the Practice of Good Medicine

18932_MetroDrs_Kevin.indd 1

1/25/10 4:00:45 PM

All I wanted was to use my body And I got there with Bethesda Hospital, member of HealthEastÂŽ Care System. When a 1,600-pound tree crushed Don Obernolte, he thought everything was over. But with the help of Bethesda, heâ&#x20AC;&#x2122;s reinvented his life. As one of the first and largest longterm acute care hospitals in the nation, Bethesda cares for chronically ill patients or victims of catastrophic accidents, with higher-than-national-average vent wean rates. So patients can recover, relearn and restart, creating a new normal for their lives. For more information about Bethesda Hospital in St. Paul, Minnesota, visit bethesdahospital.org or call 651-232-2000.