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"URKE 4 +EALEY - $ IS ASSISTANT MEDICAL DIRECTOR HOSPITAL MEDICINE AT (EALTH0ARTNERS -EDICAL 'ROUP IN "LOOMINGTON (E GRADUATED FROM THE 5NIVERSITY OF 4EXAS (EALTH 3CIENCE #ENTER AT (OUSTON -EDICAL 3CHOOL (E COMPLETED A RESIDENCY IN INTERNAL MEDICINE AT THE 5NIVERSITY OF -INNESOTA (OSPITAL AND #LINICS 1UESTIONS WERE SUBMITTED BY *ANETTE 3TRATHY - $ 4ODD "RANDT - $ #HARLES 4ERZIAN - $ ,EE "EECHER - $ AND %D %HLINGER - $ -30(
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4HERE HAS BEEN A SIGNIlCANT GROWTH IN HOSPITALISTS IN THE METRO HOSPITALS $O YOU SEE A SHIFT IN RESIDENCY TRAINING IN THE FUTURE EMPHASIS ON OUTPATIENT VS INPATIENT CARE /VER THE YEARS WE HAVE SEEN SWINGS BACK AND FORTH ON THE EMPHASIS BE TWEEN INPATIENT AND OUTPATIENT TRAINING ESPECIALLY IN INTERNAL MEDICINE &OR MOST OF THE HISTORY OF INTERNAL MEDICINE INPATIENT MEDICINE WAS THE STRONG FOCUS 4HEN IN THE S WE SAW GREATER EMPHASIS PLACED ON OUTPATIENT MEDICINE AS THE PUSH WAS ON TO CREATE MORE PRIMARY CARE DOCTORS ) BELIEVE WE WILL SEE A SHIFT BACK TO INPATIENT MEDICINE ESPECIALLY IN THE FORM OF SPECIAL HOSPITALIST TRACTS EMBEDDED IN THE TRADITIONAL RESIDENCY PROGRAM 'IVEN THE SURGE IN RECENT YEARS OF RESIDENTS CHOOS ING HOSPITAL MEDICINE ) WOULD EXPECT TO START SEEING PROGRAMS WHOSE SOLE FOCUS IS TO TRAIN INTERNAL MEDICINE RESIDENTS WHO WISH TO BECOME INPATIENT SPECIALISTS 4HESE PROGRAMS WILL HAVE A LEG UP ON RECRUITING IN THIS NEW ERA WHERE INPATIENT SPECIALISTS ARE BECOMING MORE VALUED ,ASTLY IT IS VERY POSSIBLE THAT HOSPITAL MEDICINE WILL BECOME ITS OWN SPECIALTY WITHIN lVE n YEARS WITH BOTH TRAINING PROGRAMS AND CURRICULA DEVOTED ENTIRELY TO THE TRAINING OF HOSPITAL MEDICINE CERTIlED PHYSICIANS
7HAT DO YOU ENJOY MOST ABOUT HOSPITAL BASED CARE 7HAT DO YOU MISS ABOUT CLINIC BASED MEDICINE ) ENJOY HELPING PATIENTS OVERCOME SERIOUS CRISES )T IS QUITE REWARDING TO SEE PEOPLE BE ABLE TO LEAVE THE HOSPITAL FEELING SO MUCH BETTER THAN WHEN THEY WERE ADMITTED JUST A DAY OR TWO EARLIER 4HE OTHER THING ) REALLY ENJOY ABOUT THE HOSPITAL IS THE FEELING OF TEAMWORK !T 2EGIONS OUR mAGSHIP HOSPITAL EACH HOSPITALIST IS STATIONED ON A SPECIlC GEOGRAPHIC UNIT FOR A WEEK AT A TIME )T IS NICE TO REALLY GET ÊÊÊÊÊ > Õ>ÀÞÉ iLÀÕ>ÀÞÊÓääÈÊ
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TO KNOW AND WORK WITH ALL THE STAFF ON THAT UNIT 4HERE IS REALLY A FEELING THAT WE ARE ALL WORKING TOGETHER FOR SOMETHING IMPORTANT ) ONLY WORKED BRIEmY IN THE CLINICS EARLY IN MY CAREER BUT ) WOULD HAVE TO SAY THAT ) MISS THE CONTINUITY WITH SOME OF MY FAVORITE PATIENTS 3URPRISINGLY ) STILL ENJOY A FAIR AMOUNT OF CONTINUITY IN THE HOSPITAL WITH MANY OF OUR CHRONIC DISEASE PATIENTS WHO REQUIRE MULTIPLE HOSPITALIZA TIONS
!RE THERE ANY DOWNSIDES IN LINKING PHYSICIAN COMPENSA TION TO PATIENT OUTCOMES OR CHART DOCUMENTED PROCESSES 5LTIMATELY ) BELIEVE THIS IS THE WAY TO GO 4HE QUALITY OF CARE WE DELIVER SHOULD BE VALUED MUCH HIGHER THAN HOW MANY TIMES WE SEE A PERSON (OWEVER SINCE THIS IS ALL VERY NEW ) AM CAUTIOUS /NE DOWNSIDE IS POOR DATA CAPTURING SYSTEMS WHICH MAY INCORRECTLY INDICATE POOR QUALITY OF CARE !NOTHER PROBLEM IS THE RELIANCE ON DOCUMENTATION TO REmECT THE CARE DELIVERED 2ATHER THAN LOOK DIRECTLY AT SYSTEMS THAT ARE TRIGGERED WHEN CARE IS DELIVERED MOST DATA IS OBTAINED BY LOOKING AT HOW PROVIDERS DOCUMENT AFTER A CARE EVENT HAPPENS 4HIS SECONDARY APPROACH TO DATA COLLECTION INTRODUCES ANOTHER LAYER THAT IS RIPE FOR ERROR ) THINK WE WILL SEE SYSTEMS MATURE TO BETTER REmECT THE REALITY OF QUAL ITY DELIVERED ESPECIALLY AS GROUPS AND HOSPITALS ALL BECOME ELECTRONIC
7HAT hQUALITYv MEASURES ARE RELEVANT AND USEFUL TO PA TIENTS AND OTHERS EVALUATING POTENTIAL REFERRALS !LL HOSPITALS IN OUR COUNTRY HAVE EXISTED IN A LOW ACCOUNTABILITY ENVIRON MENT FOR FAR TOO LONG 4HEY HAVE NOT HAD TO SHOW GOOD QUALITY UNTIL VERY RECENTLY EVEN HOSPITALS THAT MAY HAVE BEEN DELIVERING IT 7HAT ) WOULD RECOMMEND IS FOR PEOPLE TO LOOK NOT SO MUCH AT WHERE A SYSTEM CURRENTLY IS BUT IF THAT HOSPITAL SYSTEM IS IMPROVING $OES THIS QUARTER S DATA LOOK BETTER THAN THE QUARTER BEFORE OR ARE THEY mAT ! HOSPITAL THAT IS CONTINUALLY STRIVING TO IMPROVE THE CARE IT DELIVERS -ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃ
AND HOW IT SHOWS THAT QUALITY TO THE WORLD IS A PLACE WHERE YOU WOULD WANT YOUR FAMILY MEMBERS TO BE 4HERE IS NO ROOM FOR COMPLACENCY IN OUR MODERN HEALTH CARE ENVIRONMENT 4HE THING ) WOULD TELL A REFERRING PHYSICIAN TO CHECK INTO WHEN DECIDING ON A HOSPITALIST GROUP IS THEIR COMMUNICATION PRACTICES 7ILL A HOSPITALIST CALL THEM BOTH ON ADMISSION AND DISCHARGE 7ILL THEY KEEP THEM APPRISED OF ANY IMPORTANT EVENTS GOING ON IN THE HOSPITAL WITH THEIR SHARED PATIENT 4RANSITION POINTS ARE THE MOST RISKY FOR PATIENTS 9OU SHOULD SEND YOUR PATIENTS TO SEE HOSPITALISTS WHO REALIZE THIS AND PLACE A PRIORITY ON KEEPING A SMOOTH AND ACCURATE INFORMATION mOW GOING BETWEEN THE HOSPITAL THE CLINIC AND THE PATIENT
VISIT WITH THE PATIENT AND FAMILY SOMETIMES JUST TO REINFORCE THE PLAN OF CARE BUT ALSO SOMETIMES TO MEDIATE WHEN SOME REALLY TOUGH DECISIONS NEED TO BE MADE
(OW DO YOU COMMUNICATE WITH A PATIENT S PRIMARY CARE PHYSICIAN (OW DO YOU ENSURE CONTINUITY OF CARE
4HIS IS A VERY INTERESTING IDEA )N INTERNAL MEDICINE A SPLIT BECAME NECES SARY AS PATIENTS BECAME MORE COMPLICATED IN THE HOSPITAL AND UNASSIGNED PATIENTS WERE ARRIVING IN GREATER NUMBERS 2ESULTANTLY CLINIC PHYSICIANS BEGAN TO MAKE THE CHOICE THAT FOCUSING ON CLINIC MADE MORE SENSE TO THEM (OWEVER THIS WOULD NEVER HAVE WORKED IF HOSPITAL MEDICINE WAS INHERENTLY UNAPPEALING AND NOBODY WOULD WANT TO DO IT &ORTUNATELY IT IS A GREAT JOB IN AND OF ITSELF AND WE ARE INCREASINGLY BECOMING THE SPECIALTY OF CHOICE FOR RESIDENTS IN INTERNAL MEDICINE )F A hLABORISTv IS A JOB THAT A LOT OF PEOPLE WOULD ENJOY DOING WITHOUT THE '9. PART OF THE EQUATION THEN ) THINK IT MAKES A LOT OF SENSE FOR THE REASONS YOU DESCRIBE )F HOWEVER THIS WORK IS SEEN AS UNATTRACTIVE AND SOMETHING PEOPLE COULD ONLY DO FOR A YEAR OR TWO BEFORE BURNING OUT THEN ) WOULD BE SKEPTICAL THAT IT COULD WORK
/UR HOSPITALIST PROGRAM IS PART OF THE (EALTH0ARTNERS -EDICAL 'ROUP (0-' !LL (EALTH0ARTNERS -EDICAL 'ROUP PHYSICIANS HAVE VOICEMAIL PAGERS FOR ROUTINE NOTIlCATION AND NON URGENT QUESTIONS &OR MORE IN DEPTH DISCUSSIONS WE PAGE THE PRIMARY PHYSICIANS AND SPEAK TO THEM DIRECTLY )N THE VERY NEAR FUTURE WE WILL HAVE IN BASKET MESSAGING THROUGH OUR %-2 WHERE WE CAN E MAIL OUR REFERRING PHYSICIANS &OR PATIENTS WHO COME TO US FROM OUTSIDE OUR SYSTEM WE CALL OR PAGE REFERRING PHYSICIANS DIRECTLY /N A SECOND LEVEL WE SEND THE DICTATED DISCHARGE SUMMARY EITHER ELECTRONICALLY OR VIA FAX WITHIN THREE DAYS TO THE PRIMARY PHYSICIAN S OF lCE USUALLY SOONER &INALLY WE ARE STARTING A TRIAL WHERE WE ARE FAXING THE DISCHARGE MEDICATION LISTS TO THE PATIENT S CLINIC AT THE TIME OF DISCHARGE 4HE CLINIC THEN CALLS THE PATIENT TO ENSURE THAT THEY ARE TAKING THE CORRECT MEDICINES THAT THE HOSPITALIST HAD PRESCRIBED TO THEM
(OW CAN PRIMARY PHYSICIANS BEST MAKE USE OF HOSPITALISTS 0RIMARY PHYSICIANS AND HOSPITALISTS SHOULD BE CLOSE PARTNERS 7E IN HOSPITAL MEDICINE ARE THEIR REPRESENTATIVES IN THE HOSPITAL 7E CAN OFTEN PROVIDE SECOND OPINIONS FOR OUR COLLEAGUES ANOTHER SET OF EYES LOOKING AT THE SAME PATIENT 7E CAN ALSO HELP REINFORCE IDEAS THAT THE PRIMARY CARE PHYSICIAN HAS BEEN WORKING ON WITH THE PATIENT 0ERHAPS WHILE THE PATIENT IS LYING IN BED WITH AN -) THEY WILL BE MORE RECEPTIVE TO THE MESSAGE ABOUT STOPPING SMOKING AND LOSING WEIGHT THAT THEIR PRIMARY DOCTOR HAS BEEN ENDORSING FOR THE LAST FEW YEARS
(OW CAN HOSPITALISTS BEST MAKE USE OF PRIMARY PHYSICIANS !GAIN THE IDEA OF A PARTNERSHIP IS CRITICAL BETWEEN THE TWO 0RIMARY PHYSICIANS INHERENTLY KNOW MORE ABOUT THEIR PATIENTS THAN THE HOSPITAL IST 4HEY NOT ONLY ARE FAMILIAR WITH THE PATIENT S MEDICAL HISTORY BUT EVEN MORE IMPORTANTLY ALSO WITH THEIR PERSONALITY AND FAMILY DYNAMICS (OSPITALISTS NEED PRIMARY CARE PARTNERS FOR THIS CRITICAL INFORMATION BUT ALSO IT IS NOT UNCOMMON THAT HOSPITALISTS NEED THEM TO STOP IN AND -ETRO$OCTORSÊÊ/ iÊ ÕÀ > Ê vÊÌ iÊ i i« Ê> `Ê,> ÃiÞÊ i` V> Ê- V iÌ iÃÊ
4HE SPECIALTY OF /" '9. IS LOOKING FOR WAYS TO DECREASE PROFESSIONAL LIABILITY ENHANCE PHYSICIAN LIFESTYLE AND BALANCE AND INCREASE MEDICAL STUDENT INTEREST IN OUR CHALLENGING SPECIALTY /NE CONCEPT IS THE hLABORIST v AN /" '9. WHO ONLY WORKS LABOR AND DELIVERY AND COVERS %2 AS A hSHIFT WORKER v I E AN OUTPATIENT PRACTICE 7HAT IS YOUR VIEW OF THE VALUE OF THIS CONCEPT
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4!+% ! #/,$ (!2$ ,//+ AT YOUR HOSPITAL PRACTICE 7HAT DOES IT MEAN TO YOUR BOTTOM LINE xTO YOUR ABILITY TO PRACTICE MEDICINE THE WAY YOU WANT TO PRACTICE )F HOS PITAL PRACTICE IS IMPORTANT TO YOU lNANCIALLY PROFESSIONALLY OR BOTH HOW YOU DEAL WITH THE HOSPITAL AND HOW IT DEALS WITH YOU ARE ISSUES THAT NEED YOUR ATTENTION ./7
7 >̽ÃÊ/ iÊ7 ÀÃÌÊ/ iÞÊ > Ê Ê/ Ê i¶ !S AN ACTIVE MEDICAL STAFF MEMBER hYOURv HOSPITAL CAN TERMINATE YOUR PRIVILEGES REPORT YOU TO THE LICENSING BOARD BLOCK YOU FROM STEPPING ONTO HOSPITAL PROPERTY REFUSE TO RENEW THE CLINICAL PRIVILEGES YOU HAVE HAD FOR YEARS SO A NEW DOCTOR CAN HAVE THOSE PRIVILEGES EXCLUSIVELY BUILD A PERMANENT FEDERAL .ATIONAL 0RACTITIONER $ATA "ANK lLE WITH YOUR NAME ON IT COMPETE WITH YOUR PRACTICE WHILE PREVENTING YOU FROM COMPET ING WITH IT MAKE YOU TAKE EMERGENCY ROOM CALLS WITHOUT COMPENSATION OR LIMIT REFUSE TO ALLOW YOU TO HIRE A PARTNER TO HELP WITH YOUR HOSPITAL PATIENTS OR THROW YOU OUT OF AN ELECTED POSITION !ND THAT S EVEN IF YOU ARE NOT AN EMPLOYEE AND HAVE NOT SIGNED A CONTRACT /F COURSE IF YOU ARE A FULL OR PART TIME HOSPITAL EMPLOYEE YOU CAN SIMPLY BE lRED )F YOU SIGNED A HOSPITAL CONTRACT THAT CAN BE TERMINATED 4HAT S IN ADDITION TO ALL THE ACTIONS MENTIONED ABOVE 0LUS A HOSPITAL CAN TAKE ON NOT JUST AN INDIVIDUAL PHYSICIAN BUT ALSO ALL THE PHYSI CIANS AND OTHER PROFESSIONALS ON THE MEDICAL STAFF EN MASSE .OT THAT ANY STATE SHOULD VIE FOR THE ACCOLADE BUT #ALIFORNIA HAS RECENTLY BEEN THE SITE FOR ONE OF THE MOST EGREGIOUS CASES OF HOSPITAL PHYSICIAN DYSFUNCTION IN THE HISTORY OF FEUDALISM !T #OMMUNITY -E MORIAL (OSPITAL A BED NON PROlT GENERAL HOSPITAL IN THE SOUTHERN #ALIFORNIA TOWN OF 6ENTURA HOSPITAL ADMINISTRATION TOOK A NUMBER OF STEPS TO ALIENATE ITS OWN MEDICAL STAFF 4HE HOSPITAL CREATED A 0ROSTATE )NSTITUTE FOR CRYOABLATION PROCEDURES FOR WHICH THERE WERE NO MEDICAL STAFF CLINICAL PRIVILEGES WITHOUT CONSULTING THE MEMBERS OF THE MEDICAL STAFF REGARDING THE EFFECTIVENESS AND CLINICAL APPROPRIATENESS OF THE SERVICES TO BE OFFERED 4HE HOSPITAL CIRCUMVENTED MEDICAL STAFF CREDENTIALING PROCEDURES IN HIRING THE 0ROSTATE )NSTITUTE S CLINICAL CHIEF AND IN REPLACING EXISTING RADIOLOGISTS PRACTICING AT THE HOSPITAL 4O FURTHER TARGET PHYSICIANS THE HOSPITAL ISSUED A #ODE OF #ONDUCT THAT DECLARED ANY lNANCIAL INTEREST IN ANY HEALTH CARE FACILITY COMPETING WITH THE HOSPITAL A CONmICT OF INTEREST FOR MEDICAL STAFF OFlCERS THEREBY DISQUALIFYING THE ORTHOPAEDIC SURGEON THEN SERVING AS CHIEF OF STAFF (E HELD A ONE PERCENT INTEREST IN AN AMBULATORY SURGERY CENTER )N ADDITION TO REPLACING THE MEDICAL STAFF LEADERSHIP THE ADMINISTRATOR BLOCKED ACCESS TO AND TOOK OVER THE MEDICAL STAFF ACCOUNT ESSENTIALLY CONlSCATING THE
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7 >ÌÊ > Ê iÊ i¶Ê 0HYSICIANS AND MEDICAL STAFFS NEED NOT STAND BY AND FOLLOW HOSPITAL ADMINISTRA s TION S ORDERS )N FACT MEDICAL STAFFS AND HOSPITALS HAVE AN OBLIGATION TO PATIENTS TO MAKE SURE THAT CLINICAL DECISIONS ARE MADE BY CLINICIANS PARTICULARLY DETERMINING WHAT CLINICIANS ARE COMPETENT TO PROVIDE WHICH SERVICES .O MATTER THE NATURE OR QUALITY OF THE RELATIONSHIP BETWEEN A PHYSICIAN AND A HOSPITAL THE PHYSICIAN S DUTY TO THE PATIENT REMAINS PARAMOUNT 3INCE ONLY PHYSICIANS CAN DETERMINE WHETHER PATIENT CARE IS UP TO PAR ONLY THE MEDICAL STAFF AS THE ORGANIZATION OF PHYSICIANS AND OTHER INDEPENDENT PROVIDERS IS ACCOUNTABLE TO THE HOSPITAL S GOVERNING BOARD FOR THE QUALITY OF PATIENT CARE 4HE *OINT #OMMISSION ON THE !CCREDITATION OF (EALTHCARE /RGANIZATIONS *#!(/ FOUNDED EARLY IN THE LAST CENTURY BY PHYSICIANS TO PROMOTE QUALITY PATIENT CARE IN HOSPITALS HAS LONG INCLUDED AMONG ITS NUMEROUS STANDARDS REQUIREMENTS FOR MEDICAL STAFF SELF GOVERNANCE )F THE MEDICAL STAFF IS NOT SELF GOVERNING AND PARTICULARLY IF ITS LEADERSHIP IS SELECTED BY THE HOSPITAL S GOVERNING BOARD ITS ABILITY TO ACCOUNT TO THE BOARD FOR QUALITY OF CARE IS COMPLETELY UNDERMINED 3ELF GOVERNANCE IS REQUIRED IN ORDER TO ENABLE AN INDEPENDENT ACCOUNTING /THERWISE THE BOARD IS TALKING TO ITSELF RECEIVING INFORMATION ONLY FROM THOSE IT SELECTS TO HEAR 4HE RECENTLY REVISED *#!(/ STANDARDS NOW LAY OUT THE FOLLOWING ELEMENTS OF MEDICAL STAFF SELF GOVERNANCE BASED PRIMARILY ON !MERICAN -EDICAL !SSOCIATION POLICY AS FOLLOWS 3ELF GOVERNANCE OF THE ORGANIZED MEDICAL STAFF INCLUDES THE FOLLOWING AND IS LOCATED IN THE MEDICAL STAFF S BYLAWS s )NITIATING DEVELOPING AND APPROVING MEDICAL STAFF BYLAWS AND RULES AND REGULA TIONS
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MENTS TO THE MEDICAL STAFF BYLAWS AND RULES AND REGULATIONS s 3ELECTING AND REMOVING MEDICAL STAFF OFlCERS s $ETERMINING THE MECHANISM FOR ES TABLISHING AND ENFORCING CRITERIA FOR DELEGATING OVERSIGHT RESPONSIBILITIES TO PRACTITIONERS WITH INDEPENDENT PRIVILEGES s $ETERMINING THE MECHANISM FOR ESTABLISHING AND MAINTAINING PATIENT CARE STANDARDS AND CREDENTIALING AND DELINEATION OF CLINICAL PRIVILEGES AND s %NGAGING IN PERFORMANCE IMPROVE MENT ACTIVITIES -EDICAL STAFF BYLAWS SHOULD BE CARE FULLY CONSTRUCTED TO MEET THESE BASIC SELF GOVERNANCE GOALS 3OME CONSULTANTS ADVISE MEDICAL STAFFS TO PLACE THE MORE CONTEN
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TIOUS ISSUES WHICH COMPRISE MEMBER S BA SIC RIGHTS TO HEARINGS AND REPRESENTATION IN SEPARATE hMANUALSv AND hPLANS v 3UCH SCHEMES ARE DESIGNED TO PREVENT THE MEDI CAL STAFF MEMBERS FROM HAVING A VOICE IN THESE KEY PROVISIONS 7HILE BYLAWS ARE SUBJECT TO THE VOTE OF THE MEMBERSHIP hPLANSv AND hMANUALSv ARE NOT /NCE THE PLANS AND MANUALS HAVE BEEN ESTABLISHED THEY ARE SUBJECT TO CHANGE BY A COMMITTEE OF THE MEDICAL STAFF AT MOST AND INVARIABLY DECREASE ANY CONTROL A PHYSICIAN HAS OVER HIS OR HER HOSPITAL PRACTICE -EDICAL STAFF BYLAWS VOTED ON BY ACTIVE MEDICAL STAFF MEMBERS ARE THE KEY TO KEEPING CLINICIANS IN THE DRIVER S SEAT !LTHOUGH *#!(/ S NEW EMPHASIS ON SELF GOVERNANCE IS PROMISING MEDI CAL STAFFS MAY FACE AN UPHILL BATTLE IN OBTAINING MEDICAL STAFF BYLAWS AMEND MENTS NECESSARY TO GET THE HOSPITAL AND PHYSICIAN RELATIONSHIP BACK ON TRACK 4O SOME DEGREE THE CHALLENGE IS INCREASED BY THE INCREASING PERCENTAGE OF PHYSI CIANS WHOSE ENTIRE INCOME IS CONTROLLED BY THE HOSPITAL 0HYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE HOSPITAL AS HOSPITALISTS OR IN OTHER SPECIALTIES MAY BE SUBJECT TO OVERWHELMING PRESSURE TO VOTE AS THE HOSPITAL SEES lT ON BYLAWS IS SUES OF MEDICAL STAFF SELF GOVERNANCE OR TO FOLLOW THE ADMINISTRATOR S DIRECTION IN LEADERSHIP POSITIONS 9ET EVEN IN A MEDI CAL STAFF CONSISTING COMPLETELY OF HOSPITAL EMPLOYEES MEDICAL STAFF SELF GOVERNANCE IS STILL A PROFESSIONAL OBLIGATION AND A HOSPITAL ACCREDITATION REQUIREMENT 4O ENCOURAGE PHYSICIANS TO CARRY OUT THEIR PROFESSIONAL RESPONSIBILITIES FOR SELF GOVER NANCE WITHOUT BEING SUBJECTED TO REPRISALS OR THREATS AGAINST THEIR LIVELIHOODS BYLAWS SHOULD PROVIDE THAT MEDICAL STAFF MEM BERS CANNOT BE lRED OR LOSE THEIR EXCLUSIVE CONTRACTS AS A RESULT OF FULlLLING MEDICAL STAFF ORGANIZATION LEADERSHIP OR MEMBER SHIP ROLES IN GOOD FAITH
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ÀiÊ Þ >ÜÃÊ Õ} ¶ %VEN WITH THE SUPPORT OF THE NEW AND IMPROVED *#!(/ SELF GOVERNANCE STAN DARDS PHYSICIANS AND MEDICAL STAFF ORGA NIZATIONS MAY SIMPLY LACK THE BARGAINING POWER AGAINST LARGE HOSPITAL AND HEALTH SYSTEMS TO NEGOTIATE SELF GOVERNING PROVI SIONS IN MEDICAL STAFF BYLAWS 6OLUNTARY ACCREDITATION STANDARDS ARE NOT THE ONLY MEANS OF ACCOMPLISHING THIS NECESSARY END 4HE #ALIFORNIA LEGISLATURE ACTED TO PLACE MINIMUM SELF GOVERNANCE REQUIRE MENTS IN STATE STATUTE EFFECTIVE IN *ANUARY 3PECIlCALLY #ALIFORNIA "USINESS AND 0ROFESSIONS #ODE 3ECTION STATES
A 4HE MEDICAL STAFF S RIGHT OF SELF GOVERNANCE SHALL INCLUDE BUT NOT BE LIMITED TO ALL OF THE FOLLOWING
)NITIATING DEVELOPING AND ADOPTING MEDICAL STAFF BYLAWS RULES AND REGULATIONS AND AMENDMENTS THERETO SUBJECT TO THE APPROVAL OF THE HOSPITAL GOV ERNING BOARD WHICH APPROVAL SHALL NOT BE UNREASONABLY WITH HELD B 4HE MEDICAL STAFF BYLAWS SHALL NOT INTERFERE WITH THE INDEPENDENT RIGHTS OF THE MEDICAL STAFF TO DO ANY OF THE FOLLOWING BUT SHALL SET FORTH THE PROCEDURES FOR 3ELECTING AND REMOVING MEDI CAL STAFF OFlCERS !SSESSING MEDICAL STAFF DUES AND UTILIZING THE MEDICAL STAFF DUES AS APPROPRIATE FOR THE PUR POSES OF THE MEDICAL STAFF
%STABLISHING IN MEDICAL STAFF BYLAWS RULES OR REGULATIONS CRI 4HE ABILITY TO RETAIN AND BE TERIA AND STANDARDSxFOR MEDICAL REPRESENTED BY INDEPENDENT LE STAFF MEMBERSHIP AND PRIVILEGES GAL COUNSEL AT THE EXPENSE OF THE AND ENFORCING THOSE CRITERIA AND MEDICAL STAFF STANDARDS C 7ITH RESPECT TO ANY DISPUTE ARIS %STABLISHING IN MEDICAL STAFF ING UNDER THIS SECTION THE MEDICAL BYLAWS RULES OR REGULATIONS STAFF AND THE HOSPITAL GOVERNING CLINICAL CRITERIA AND STANDARDS TO BOARD SHALL MEET AND CONFER IN GOOD OVERSEE AND MANAGE QUALITY ASSUR FAITH TO RESOLVE THE DISPUTE x ANCE UTILIZATION REVIEW AND OTHER MEDICAL STAFF ACTIVITIES INCLUDING 4HE STATUTE NOT ONLY ENSURES THAT BUT NOT LIMITED TO PERIODIC MEET MEDICAL STAFFS HAVE CERTAIN RIGHTS BUT INGS OF THE MEDICAL STAFF AND ITS CLEARLY STATES THAT NO MATTER WHAT POLITICAL COMMITTEES AND DEPARTMENTS AND FORCES ARE AT PLAY THE MEDICAL STAFF BYLAWS REVIEW AND ANALYSIS OF PATIENT CANNOT VIOLATE THESE BASIC ELEMENTS OF MEDICAL STAFF SELF GOVERNANCE 'IVEN THE MEDICAL RECORDS 3ELECTING AND REMOVING MEDICAL CHALLENGES TEMPTATIONS AND ECONOMIC PRESSURES BOTH MEDICAL STAFFS AND HOSPI STAFF OFlCERS TALS FACE LEGISLATION IN THE PUBLIC INTEREST !SSESSING MEDICAL STAFF DUES AND ENSURING THAT MEDICAL STAFF ORGANIZATIONS UTILIZING THE MEDICAL STAFF DUES AS ARE PROTECTED IN CLINICAL DECISION MAKING APPROPRIATE FOR THE PURPOSES OF THE CAN PROTECT ALL INVOLVED MEDICAL STAFF 4HE ABILITY TO RETAIN AND BE REPRESENTED BY INDEPENDENT LEGAL COUNSEL AT THE EXPENSE OF THE MEDI CAL STAFF
%LIZABETH ! 3NELSON %SQ PRACTICES LAW IN 3T 0AUL AND IS OF COUNSEL TO THE -INNEAPO LIS LAW lRM OF ,OCKRIDGE 'RINDAL .AUEN 0 , , 0 3HE REPRESENTS MEDICAL STAFFS AND CAN BE REACHED AT EASESQ SNELSONLAW COM
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.% /& 4(% 3)-0,% 0,%!352%3 IN MY LIFE NOW IS RECEIV ING THE .ORTH -EMORIAL -EDICAL 3TAFF .EWS ) AM COMPELLED TO CONTRIBUTE THIS AFTER READING $R !LTAFULLAH S -AY #HIEF S COLUMN AS WELL AS $R (ANDLER S COLUMN REGARDING hENTREPRE NEURIAL MEDICINE v !FTER MOVING TO &LORIDA AS MANY OF YOU KNOW THIS WAS FOR FAMILY REASONS ) HAVE COME TO REALIZE THAT ) AM hNOT IN +ANSASv ANYMORE ) COULD GO ON FOR HOURS ABOUT THE DIFFERENCES IN THE PRACTICE OF MEDICINE IN &LORIDA VS -INNESOTA ) AM STILL TRYING TO lND ONE THING ) LIKE BETTER DOWN HERE )T IS TAKING A LONG TIME TO lND ONE 4HE ENVIRONMENT OF hENTREPRENEURIAL MEDICINEv HERE IS h2%-!2+!",% v AND ) DO NOT MEAN THAT IN A GOOD WAY 7HEN ) ATTENDED THE %STES 0ARK )NSTITUTE MEETINGS ) OFTEN WONDERED WHAT SOME OF THOSE PEOPLE FROM OTHER PARTS OF THE COUNTRY WERE TALKING ABOUT .OW ) KNOW )F ANYONE UNDERSTANDS THE ATTRACTION OF BEING PAID CASH UP FRONT DOLLAR FOR DOLLAR IT WOULD BE A PLASTIC SURGEON IT COMES WITH THE TERRI TORY "UT THIS PLASTIC SURGEON IS GOING TO TELL YOU THAT ) AM WITNESSING lRST HAND THE DEGRADATION OF THE PRACTICE OF MEDICINE IN PURSUIT OF THE ALMIGHTY DOLLAR 3OME OF THE ATTITUDES HERE TRULY DISHEARTEN THE -IN NESOTAN IN ME &IRST ARE THE CARVE OUTS OR SPECIALTY HOSPITALS CENTERS )N THIS RAPIDLY GROWING COMMUNITY SOMEWHAT LARGER THAN 3T #LOUD ONE WOULD THINK THAT THE HOSPITALS AND PHYSICIANS WOULD WORK TOGETHER TO MEET THE GROWING NEEDS OF THE PATIENT POPULATION 7E ALL KNOW THAT THE COOPERATIVE EFFORTS SEEN AT .ORTH HAVE BENElTED EVERYONE ESPECIALLY THE PATIENTS 4RY THIS ONE FOR SIZE ONE OF THE HOSPITALS HAS A LARGE RENAL TRANSPLANT PROGRAM BUT NO DIALYSIS PROGRAM 7HY NOT "ECAUSE NONE OF THE PHYSICIANS WILL REFER PATIENTS TO THE HOSPITAL FOR DIALYSIS 4HERE ARE SUBSTANTIAL NEPHROLOGY PRACTICES THAT OWN LARGE BUILDINGS WITH STATE OF THE ART DIALYSIS PROGRAMS 9OU NAME IT CARDIAC TESTING SEVERAL OUTPATIENT PROGRAMS OWNED BY PHYSICIANS UROLOGY THREE LARGE INDEPENDENT PHYSICIAN OWNED SURGERY CENTERS WITH STATE OF THE ART CYSTO SUITES OPHTHALMOLOGY 4/.3 OF LENS IMPLANTS ALL DONE IN PHYSICIAN OWNED FACILITIES RADIOLOGY THERAPY AND CHEMOTHERAPY YOU GUESSED IT ALL PHYSICIAN OWNED ) CAN HARDLY GET 9Ê 6 Ê-/, / 9]Ê ° °
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ANY OPERATING ROOM TIME IN ANY OF THE OUTPATIENT SURGERY CENTERS BE CAUSE THEY ARE REPEAT AFTER ME PHYSICIAN OWNED AND HEAVILY UTILIZED BY THE PHYSICIAN OWNERS 4HE HOSPITALS CAN T COMPETE AND ARE ONLY NOW RELUCTANTLY TRYING TO OPEN AN OUTPATIENT SURGERY CENTER 7HY IS THIS BAD YOU MAY ASK !FTER ALL IT IS A FREE MARKET ECONOMY )T IS BAD BECAUSE THE PHYSICIANS WILL SELECTIVELY TAKE THE WELFARE AND NON PAY CASES TO THE HOSPITAL IF THEY WOULD EVEN AGREE TO DO THEM AT ALL MORE ON THAT IN A BIT )MAGINE HAVING ALL OF THE CONTROL OVER WHO GETS TO EAT WHAT 9OU TAKE THE GOOD FOOD AND GIVE YOUR NEIGHBOR THE ROTTING FRUIT 7HAT DO YOU THINK IS GOING TO HAPPEN WHEN YOU NEED HIS HELP ON A PROJECT 4HIS IS NOT ALL THE DOCS FAULT 0ART OF THE REASON THE CARVE OUTS BEGAN HERE IS THAT THE HOSPITAL WAS UNRESPONSIVE TO THE PHYSICIANS NEEDS "E THANKFUL FOR WHAT YOU HAVE AT .--# AND IN -INNEAPOLIS 7ORKING TOGETHER FOR A WIN WIN WIN HOSPITAL DOCTOR PATIENT SCENARIO IS WHAT IT IS ALL ABOUT /H YEAH DID ) MENTION THE PATIENTS ) AM THE ONLY PLASTIC SURGEON IN THE SURROUNDING &/52 COUNTIES WHO TAKES -EDICAID ) WAS STRONGLY ADVISED NOT TO ) WAS TOLD THAT IT WOULD RUIN MY PRACTICE "UT WHAT ABOUT THOSE PATIENTS ) HAVE BEEN ADVISED TO SIMPLY BLOW OFF THE %2 DOCTORS WHEN THEY CALL !T .ORTH THEY ARE MY &2)%.$3 (ERE THEY ARE CONSIDERED THE ENEMY .OT TO MENTION WHAT A PAIN IN THE NECK THOSE UNSAVORY PATIENTS ARE ! LARGE PORTION OF THE MEDICAL hCOMMUNITYv HERE JUST DOESN T CARE ) AM TEMPERING MY FEELINGS ABOUT THE EXTREME LIBERALISM IN -INNESOTA 9OU SHOULD SEE THE ADVERTISING /RTHOPEDIC SURGERY OPHTHALMOL OGY PODIATRY PLASTIC SURGERY REAL AND NOT REAL MORE ON THAT IN A MINUTE AND PAIN MANAGEMENT ARE ALL SECONDARY ONLY TO LAWYERS ON THE TELEVISION ) KID YOU NOT THERE MUST BE NO LESS THAN TWO DOZEN PHYSICIAN ADS DURING THE EVENING NEWS !ND OF COURSE EACH ONE IS PROFESSING TO BE THE BEST ) OFFER THAT IF DOCTORS ALL SAY THEY ARE THE BEST AT LEAST NINE OF THEM IF NOT ALL ARE LYING /NE OF THE MORE LUCRATIVE PARTS OF MEDICINE IS COSMETIC SURGERY AND ALL OF THE ASSOCIATED MEDICAL SPA STUFF 9OU WOULDN T BELIEVE WHO CALLS THEMSELVES PLASTIC SURGEONS HERE /NE DERMATOLOGIST CLAIMS TO BE AN EXPERT IN BREAST SURGERY AND DOES AUGMENTATIONS REDUCTIONS AND LIFTS IN HIS OFlCE .O HOSPITAL PRIVILEGES OR SURGICAL TRAINING NEEDED /PHTHALMOLOGISTS ORAL SURGEONS %.4S GENERAL SURGEONS DERMATOLO GISTS FAMILY PRACTITIONERS DENTISTS AND MANY OTHERS ADVERTISE THEIR EXPERTISE WITH "OTOX LASERS THERAPEUTIC LIGHT TREATMENTS AND EVEN #ONTINUED ON PAGE
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AND SUBSEQUENT STATE GOVERNMENT SHUTDOWN IN DEMOCRATS AND REPUBLICANS ALIKE ARE HOPING FOR A QUICK AND CIVIL GATHERING WHEN -INNESOTA S ,EGISLATIVE 3ESSION OFlCIALLY RECONVENES ON -ARCH -ANY INCUM BENTS ARE STILL UPSET ABOUT THE PROLONGED SPECIAL SESSION LAST YEAR AND REMAIN CONCERNED THAT THE RESIDUAL ILL WILL TOWARD THE ,EGISLATURE AS A WHOLE WILL AFFECT THE UPCOMING .OVEMBER ELECTION 7ITH THAT IN MIND ALL LEGISLATORS ARE LOOKING FORWARD TO A QUICK RESOLUTION TO THE 3ESSION SO THEY CAN BEGIN CAMPAIGNING )N ANTICIPATION OF THE LATE START DATE OF -ARCH THE 3ENATE AND (OUSE #OMMITTEES HAVE BEEN HOLDING HEARINGS THROUGHOUT THE FALL AND WE EXPECT THE COMMITTEE SCHEDULE TO PICK UP AFTER THE lRST OF THE YEAR UNTIL 3ESSION BEGINS 7HILE THEY CANNOT PASS ANY LEGISLATION YET THE INTERIM HEARINGS WILL GIVE COMMITTEES A HEAD START ONCE THE DELIBERATIONS OFlCIALLY BEGIN $ESPITE THESE HOPES THERE IS LIKELY TO BE PLENTY OF POLITICS INVOLVED !LL OF THE MEMBERS OF THE (OUSE AND 3ENATE ARE UP FOR RE ELEC TION IN "OTH CHAMBERS ARE CONTROLLED BY NARROW MAJORITIES AND A SWING OF A COUPLE OF SEATS COULD CHANGE THE LEADERSHIP IN EITHER BODY #URRENTLY THE 3ENATE IS CONTROLLED BY THE $&, WITH A FOUR SEAT MARGIN AND THE 2EPUB LICANS HOLD A TWO SEAT MAJORITY IN THE (OUSE OF 2EPRESENTATIVES )N ADDITION 'OVERNOR 0AWLENTY AND ALL OF THE STATE S CONSTITUTIONAL OFlCERS ย !TTORNEY 'ENERAL 3TATE !UDITOR AND 3ECRETARY OF 3TATE ย ARE RUNNING FOR RE ELEC TION #URRENT !TTORNEY 'ENERAL -IKE (ATCH IS CHALLENGING 0AWLENTY FOR THE 'OVERNOR SEAT COMMENCING A MATCH THAT IS EXPECTED TO CRE ATE SOME SPARKS /THER $EMOCRATS RUNNING FOR 'OVERNOR INCLUDE 3TATE 3ENATORS "ECKY ,OUREY 9ร / ร //
AND 3TEVE +ELLEY !LSO IN THE RACE FOR THE $&, NOMINATION IS +ELLY $ORAN A REAL ESTATE DE VELOPER WITH NO PREVIOUS POLITICAL EXPERIENCE 3INCE !TTORNEY 'ENERAL (ATCH IS RUNNING FOR 'OVERNOR HIS POSITION WILL BE OPEN AND (OUSE -INORITY ,EADER -ATT %NTENZA IS RUNNING FOR THIS SEAT ON THE $&, SIDE 3TATE 2EPRESENTA TIVE *EFF *OHNSON IS SEEKING THE 2EPUBLICAN NOMINATION /THER ,EGISLATORS RUNNING FOR HIGHER OFlCE INCLUDE 3TATE 2EPRESENTATIVES 0HIL +RINKIE AND *IM +NOBLACH AS WELL AS 3TATE 3ENATOR -ICHELLE "ACHMANN 4HEY ARE ALL PURSUING THE 2EPUBLICAN ENDORSEMENT FOR THE TH #ONGRESSIONAL $ISTRICT SEAT CURRENTLY HELD BY -ARK +ENNEDY #ONGRESSMAN +EN NEDY 2EPUBLICAN IS RUNNING FOR THE OPEN 5 3 3ENATE SEAT MADE POSSIBLE BY THE RETIRE MENT OF -ARK $AYTON !MY +LOBUCHAR 0ATTY 7ETTERLING AND &ORD "ELL ARE VYING FOR THE $&, ENDORSEMENT 4HE 5 3 3ENATE RACE WILL BRING NATIONAL ATTENTION TO -INNESOTA AND THE SPENDING WILL NO DOUBT TRICKLE DOWN TO OTHER STATE AND LOCAL RACES )N ADDITION THERE ARE FOUR STATE SPECIAL ELECTIONS THAT WILL TAKE PLACE BEFORE THE ,EGISLATIVE 3ESSION BEGINS ! SPECIAL ELECTION FOR TWO OPEN 3ENATE SEATS IN "IG ,AKE AND 0LYMOUTH IS SCHEDULED FOR .OVEMBER ! SECOND SPECIAL ELECTION WILL BE CALLED TO lLL A 3ENATE AND (OUSE SEAT IN 3T #LOUD
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4HE 3ESSION IS THE SECOND YEAR OF THE BIENNIUM WHEN THE ,EGISLATURE TRADITIONALLY FOCUSES ON PASSING A #APITAL )NVESTMENT BILL AS WELL AS READJUSTING THE BUDGET IF NECESSARY 4HE /CTOBER %CONOMIC 5PDATE SHOWED THE STATE S RECEIPTS UP MILLION MORE THAN PROJECTED FROM *ULYn3EPTEMBER OF 2ECEIPTS FROM ALL FOUR MAJOR REVENUE SOURCES ย INCOME SALES CORPORATE AND VEHICLE TAXES ย GENERATED MORE REVENUE THAN ANTICIPATED 4HE /CTOBER UPDATE HOWEVER DOES WARN OF SLOWER NATIONAL ECONOMIC GROWTH IN THE COMING MONTHS DUE TO (URRICANES +ATRINA AND 2ITA AS WELL AS THE INCREASED COST OF FUEL 4HE .OVEMBER FORECAST WHICH WILL BE RELEASED BY THE &INANCE $EPART MENT .OVEMBER WILL PROVIDE A MORE COM PREHENSIVE LOOK AT WHETHER THE STATE BUDGET IS ON TRACK AND IF LAWMAKERS WILL NEED TO READJUST SPENDING IN THE ,EGISLATIVE CYCLE ! STATE SURPLUS WILL SPARK A DEBATE OVER HOW TO SPEND THE EXTRA MONEY AND A DElCIT WOULD REQUIRE A lX TO KEEP THE BUDGET ON TRACK /NE AREA WHERE THE ,EGISLATURE WILL FACE PRESSURE TO INCREASE FUNDING IS TO HELP SCHOOL DISTRICTS WITH THEIR HIGH HEATING AND FUEL COSTS (OPES FOR A SPECIAL SESSION HAVE DIMMED AND A NUMBER OF ITEMS THAT LEGISLATORS WERE HOPING TO DEAL WITH IN A SPECIAL SESSION WILL HAVE TO WAIT UNTIL -ARCH 4HE 'OPHERS 4WINS AND 6IKINGS WILL ALL BE AT THE CAPITOL LOOKING FOR LEGISLATION TO BUILD NEW STADIUMS !S ALWAYS STADIUMS WILL BE A TOUGH ISSUE FOR LEGISLATORS WITH AN ELECTION JUST AROUND THE CORNER !NOTHER ISSUE THAT WAS TO BE ADDRESSED IN A SPECIAL SESSION IS SHORING UP THE -INNEAPOLIS TEACHER S RETIREMENT FUND -INNEAPOLIS LEGISLATORS HAVE BEEN HEARING FROM THEIR TEACHERS THAT THIS IS IMPORTANT AND WILL BE A TOP PRIORITY FOR THEM IN THE UPCOMING SESSION 4RANSPORTATION POLICY LEGISLATION AND A #ONTINUED ON PAGE
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BATTLE TO INCREASE THE GAS TAX WILL ALSO RE EMERGE %LECTION YEAR POLITICS WILL ALSO DRIVE THE DISCUS SION OF A PROPOSED CONSTITUTIONAL AMENDMENT TO BAN GAY MARRIAGE ,AST YEAR THE HEALTH CARE DISCUSSION AT THE CAPITOL WAS DOMINATED BY THE BUDGET AND THE EFFECT THAT PROPOSED CUTS WOULD HAVE ON PATIENTS AS WELL AS PROVIDERS 3INCE IS TECHNICALLY NOT A BUDGET YEAR THE (EALTH #OMMITTEES WILL BE ABLE TO FOCUS ON MULTIPLE POLICY ISSUES 3OME OF THE LIKELY HOT TOPICS WILL BE s &REEDOM TO "REATHE LEGISLATION ! STRONG COALITION OF PUBLIC HEALTH ADVOCATES WILL AGAIN CONTINUE THEIR PURSUIT OF A STATEWIDE SMOKING BAN 3EVERAL LOCAL ORDINANCES HAVE RECEIVED INCREASED MEDIA ATTENTION IN THE PAST WEEKS AND WE EXPECT THIS PRESSURE TO EXTEND TO THE STATE CAPITOL s 3ITING OF &REESTANDING (EALTH #ARE &A
CILITIES 4HE BATTLE BETWEEN HOSPITALS AND
PROVIDER GROUPS OVER WHO CAN CONTINUE BUILDING NEW FREESTANDING HEALTH CARE FACILITIES WILL AGAIN BE AN ISSUE AT THE LEGISLATURE 4HE 3ENATE (EALTH AND &AMILY 3ECURITY #OMMITTEE RECENTLY HELD A HEARING TO GATHER MORE INFORMATION ON THIS TOPIC INDICATING THEIR CONTINUED INTEREST IN THIS CONTROVERSIAL SUBJECT s -APLE 'ROVE HOSPITAL $URING THE LAST
LEGISLATIVE SESSION THREE GROUPS &AIRVIEW .ORTH -EMORIAL AND 4RI #ARE WERE VY ING FOR LEGISLATIVE APPROVAL OF A HOSPITAL MORATORIUM EXEMPTION TO ALLOW THEM THE RIGHT TO BUILD A NEW HOSPITAL IN THE -APLE 'ROVE AREA !LTHOUGH THIS ISSUE WAS ALIVE UNTIL THE LAST DAY OF THE SPECIAL SESSION NO PROPOSAL WAS ULTIMATELY APPROVED 3INCE THEN TWO OF THE GROUPS &AIRVIEW AND .ORTH -EMORIAL HAVE FORMED A PARTNER SHIP TO SEEK LEGISLATIVE APPROVAL TO BUILD THE HOSPITAL TOGETHER s 2EIMBURSEMENT FOR ,ANGUAGE )NTERPRETER
3ERVICES !NOTHER ISSUE THAT RECEIVED DISCUS SION LAST YEAR BUT WAS NOT RESOLVED WAS
THE ISSUE OF INSURANCE REIMBURSEMENT FOR LANGUAGE INTERPRETERS &EDERAL LAW REQUIRES HEALTH CARE PROVIDERS TO ARRANGE FOR INTER PRETER SERVICES WHEN NEEDED BUT PROVIDES NO MECHANISM TO PAY FOR THEM -INNESOTA LAW CURRENTLY REQUIRES SEVERAL PAYERS TO EI THER PROVIDE OR REIMBURSE FOR THESE SERVICES BUT THIS DOES NOT INCLUDE HEALTH PLANS 7E EXPECT A BILL TO BE INTRODUCED THAT WILL DEAL WITH REIMBURSEMENT BY HEALTH PLANS AS WELL AS THE TRAINING AND ACCREDITATION OF THE TRANSLATORS THEMSELVES )N ADDITION AS MENTIONED ABOVE "ECKY ,OUREY AND 3TEVE +ELLEY TWO CURRENT STATE 3ENATORS WHO BOTH SERVE ON THE 3ENATE (EALTH AND &AMILY 3ECURITY #OMMITTEE ARE SEEKING THE $&, 0ARTY NOMINATION FOR 'OVERNOR 4HIS WILL LIKELY MEAN A HIGHER LEVEL OF ATTENTION AND DISCUSSION ON HEALTH CARE ISSUES IN THE COMING MONTHS 3ENATOR ,OUREY HAS ALREADY PROPOSED A CONSTITUTIONAL AMENDMENT ADVOCATING FOR HEALTH CARE COVERAGE FOR ALL -INNESOTANS ,OOK FOR THIS AND OTHER ISSUES RELATED TO HEALTH CARE TO RECEIVE INCREASED MEDIA ATTENTION IN THE UPCOMING ELECTION CYCLE )F YOU WOULD LIKE TO LEARN MORE ABOUT THESE ISSUES OR INFORMATION ON THE UPCOMING LEGISLATIVE SESSION PLEASE VISIT THE STATE S 7EB SITE AT WWW LEG STATE MN US 4HIS AWARD WIN NING 7EB SITE CONTAINS A WEALTH OF INFORMATION ON INDIVIDUAL LEGISLATORS THE VARIOUS POLICY AND BUDGET COMMITTEES AS WELL AS DESCRIPTIONS OF ALL LEGISLATION INTRODUCED
+ATHLEEN -ICHELETTI IS THE MANAGER OF 3TATE 'OV ERNMENT 2ELATIONS AT ,OCKRIDGE 'RINDAL .AUEN 0 , , 0 A -INNEAPOLIS LAW lRM PROVIDING COM PREHENSIVE LEGAL AND GOVERNMENT RELATIONS SERVICES TO HEALTH CARE PROVIDERS AND ORGANIZATIONS
,i `iÀt >ÛiÊÞ ÕÊ«> `Ê Þ ÕÀÊÓääÈÊ i LiÀà «Ê`Õiö 0LEASE CALL THE MEMBERSHIP AND DUES PROCESSING SPECIALIST AT TO CHECK THE STATUS OF YOUR MEMBERSHIP
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IMPROVE BOTH MEDICAL CARE AND QUALITY OF LIFE BY GIVING HEALTH CARE PROVIDERS A lNANCIAL INCENTIVE TO SEEK MEASURABLE IMPROVEMENTS IN THE HEALTH OF THEIR PATIENTS A DIVERSE GROUP OF HEALTH LEADERS ENGAGED IN A LONG TERM NA TIONAL STUDY REPORTED ON .OVEMBER "UT THEY WARNED THAT 0 0 IS NOT A MAGIC BULLET AND THERE ARE MANY CHALLENGES TO OVERCOME FOR IT TO SUSTAIN ITS EFFECT ON THE QUALITY OF HEALTH CARE INCLUDING WHETHER IT CAN WORK IN ALL HEALTH CARE SETTINGS 4HE lNDINGS RELEASED AT A .ATIONAL 0RESS #LUB BRIElNG ARE THE COMBINED RESULT OF SEVEN EXPERIMENTAL PROJECTS DESIGNED TO TEST A VARIETY OF PAY FOR PERFORMANCE MODELS 0 0 +NOWN AS THE 2EWARDING 2ESULTS PROGRAM THE THREE YEAR EFFORT IS BOTH THE LARGEST AND MOST DIVERSE OF ITS KIND 4HE PROJECTS hPROVIDE SOME OF THE lRST TANGIBLE EVIDENCE THAT 0 0 INCENTIVES CAN RAISE THE QUALITY OF PATIENT CARE v SAYS 3UZANNE $ELBANCO #%/ OF THE ,EAPFROG 'ROUP THE ORGANIZATION PROVIDING TECHNICAL ASSISTANCE TO THE PROJECTS WHICH ARE SUPPORTED BY GRANTS FROM THE 2OBERT 7OOD *OHNSON &OUNDATION 27*& THE #ALIFORNIA (EALTH#ARE &OUNDA TION #(#& AND THE #OMMONWEALTH &UND $ELBANCO CAUTIONED THAT THE lNDINGS ALSO SHOW THAT SUCH PROGRAMS CAN BE COMPLICATED TO IMPLEMENT h0 0 CLEARLY HAS GREAT POTENTIAL FOR DRIVING QUALITY IMPROVEMENT BUT CHALLENGES PERSIST THAT CAN BE OVERCOME ONLY WITH THE KIND OF CAREFUL AND INDEPENDENT EVALUATIONS THESE PROJECTS ARE UNDERTAKING TO ASSESS THEIR PROGRESS v SHE SAYS
4HE RESULTS OF THE 2EWARDING 2ESULTS EF FORT COME AMID A mURRY OF ACTIVITY ON 0 0 IN BOTH THE PRIVATE AND PUBLIC SECTORS INCLUDING -EDICARE %ARLIER THIS MONTH THE 3ENATE PASSED A BILL THAT INCLUDES A PACKAGE OF 0 0 RELATED MEASURES FOR -EDICARE 7HAT HAS BEEN MISS ING IN THE DISCUSSIONS ACCORDING TO HEALTH QUALITY EXPERTS ARE EMPIRICAL RESULTS FROM RIGOROUSLY STUDIED PROGRAMS !S 0 0 INCREAS INGLY IS VIEWED AS A MEANS TO MOTIVATE PROVIDER BEHAVIOR CHANGE AND CARE IMPROVEMENT LEADERS FROM 2EWARDING 2ESULTS HAVE CRITICAL LESSONS TO SHARE ABOUT THE POSSIBILITIES AND CHALLENGES IT POSES
h7HETHER OR NOT YOU BELIEVE 0 0 WILL MAKE A SIGNIlCANT DIFFERENCE IT S TIME FOR PAYERS OF HEALTH CARE TO REWARD PROVIDERS WHO ARE IMPROVING QUALITY RATHER THAN TURN A BLIND EYE v h7HETHER OR NOT YOU BELIEVE 0 0 WILL MAKE A SIGNIFICANT DIFFERENCE IT S TIME FOR PAYERS OF HEALTH CARE TO REWARD PROVIDERS WHO ARE IMPROVING QUALITY RATHER THAN TURN A BLIND EYE 0AY FOR PERFORMANCE REPRESENTS THE lRST REAL ATTEMPT TO PAY PROVIDERS DIFFERENTLY BASED ON THE QUALITY OF CARE THEY GIVE TO PATIENTS AND THESE PROJECTS HAVE A LOT TO TEACH OTHERS ABOUT WHAT WORKS AND WHAT DOESN T v SAYS 27*& 0RESIDENT AND #%/ 2ISA ,AVIZZO -OUREY - $ - " !
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/NE OF THE BIGGEST QUESTIONS IS WHETHER THE 0 0 MODEL CAN BE IMPLEMENTED IN NON MANAGED CARE SETTINGS SUCH AS PREFERRED PRO VIDER ORGANIZATIONS 00/S WHERE A MAJORITY OF !MERICANS GET THEIR HEALTH CARE .EVERTHELESS THROUGH USE OF INCENTIVES THE 2EWARDING 2ESULTS PROJECTS HAVE s 3IGNIFICANTLY INCREASED PATIENT VISITS TO THE DOCTOR FOR EVERYTHING FROM ADOLESCENT CHECK UPS TO DIABETIC SCREENING AMONG PRIVATELY INSURED AND -EDICAID PATIENTS s 0USHED PHYSICIANS AND PHYSICIAN GROUPS TO EMBRACE INFORMATION TECHNOLOGY AND ELEC TRONIC MEDICAL RECORDS AT A FASTER PACE s )NCREASED THE NUMBERS OF PATIENTS WHO RECEIVE ANNUAL MAMMOGRAMS WELL CHECK UPS AND OTHER PREVENTIVE SCREENINGS s -OTIVATED PHYSICIANS TO MONITOR PATIENT CARE MORE AGGRESSIVELY PARTICULARLY FOR CHRONICALLY ILL PATIENTS h4HESE PROJECTS ARE ADVANCING THE GOAL OF A QUALITY DRIVEN HEALTH CARE SYSTEM v SAYS 3OPHIA 7 #HANG - $ DIRECTOR #HRONIC $ISEASE #ARE FOR THE #(#& h)N #ALIFORNIA ALONE WE ARE EXCITED TO SEE HOW A DIVERSITY OF 0 0 MODELS HAVE ENGAGED PHYSICIANS IN QUALITY IMPROVEMENT AND BROUGHT PATIENTS PARTICULARLY THOSE WITH CHRONIC ILLNESSES IN TO RECEIVE CRUCIAL MEDICAL CARE SOONER THAN THEY OTHERWISE WOULD HAVE v SHE ADDS h-OST AGREE THAT THE EXISTING lNANCIAL INCENTIVES IN HEALTH CARE NEED TO BE REALIGNED 4HESE PROJECTS ADD TO THE MOUNTING EVIDENCE THAT REWARDING GOOD PERFORMANCE CAN ENCOUR AGE DOCTORS TO PROVIDE APPROPRIATE CARE TO PA TIENTS TO HELP THEM LIVE LONGER AND HEALTHIER LIVES v SAYS +AREN $AVIS PRESIDENT OF THE #OMMONWEALTH &UND
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$ESPITE THOSE ACHIEVEMENTS THE PROJECTS ARE STILL GRAPPLING WITH s 7ORKING OUT WHAT SIZE lNANCIAL REWARDS ARE NEEDED TO EFFECT CHANGE s (OW TO ENGAGE PHYSICIANS CONTINUOUSLY IN QUALITY IMPROVEMENT ACTIVITIES LINKED TO 0 0 s 7HETHER THE RETURN ON INVESTMENT AND THE QUALITY GAINS OUTWEIGH THE lNANCIAL AND HUMAN EFFORT s (OW TO SUSTAIN IMPROVEMENT WITH AD EQUATE INFORMATION TECHNOLOGY AND OTHER INFRASTRUCTURE s 7HETHER 0 0 CAN WORK IN ALL SETTINGS PAR TICULARLY AN ENVIRONMENT IN WHICH THERE IS A LOOSER NETWORK OF PHYSICIANS SUCH AS A 00/ OR EVEN TRADITIONAL -EDICARE 3INCE THE SEVEN 2EWARDING 2ESULTS PROJECTS HAVE BEEN IDENTIFYING WAYS TO MEASURE DISCLOSE AND REWARD IMPROVEMENTS TO MOTIVATE PROVIDERS TO DELIVER APPROPRIATE CARE MORE EF lCIENTLY HELP CONSUMERS MAKE MORE INFORMED HEALTH CARE DECISIONS AND IMPROVE MEDICAL OUT COMES FOR PREVENTABLE AND CHRONIC ILLNESSES
/NE PROJECT IS TESTING OUT 0 0 IN -EDICAID TWO ARE STATE BASED COALITIONS INVOLVING A BROAD ARRAY OF PARTNERS ONE IS A LARGE COMMERCIAL HEALTH INSURER ONE IS A MANAGED CARE PLAN ONE IS A HOSPITAL BASED PROGRAM AND ONE IS A BRANDED EMPLOYER BASED PROJECT 0ROJECTS ARE BEING TESTED IN A VARIETY OF STATES INCLUDING -ASSACHUSETTS #ALIFORNIA .EW 9ORK -ICHIGAN 'EORGIA AND -INNESOTA
4HE ,EAPFROG 'ROUP WAS FOUNDED IN .OVEMBER BY THE "USINESS 2OUNDTABLE AND HAS SUP PORT FROM THE 2OBERT 7OOD *OHNSON &OUNDATION /VER &ORTUNE CORPORATIONS AND OTHER LARGE PRIVATE AND PUBLIC SECTOR HEALTH BENElTS PURCHASERS HAVE JOINED THE ,EAPFROG 'ROUP REPRESENTING MORE THAN MILLION ENROLLEES 4HE ,EAPFROG 'ROUP IS AN INITIATIVE DRIVEN BY ORGANIZATIONS THAT BUY HEALTH CARE WHO ARE WORK ING TO INITIATE BREAKTHROUGH IMPROVEMENTS IN THE SAFETY QUALITY AND AFFORDABILITY OF HEALTH CARE FOR !MERICANS )T IS A VOLUNTARY PROGRAM AIMED AT MOBILIZING EMPLOYER PURCHASING POWER TO ALERT !MERICA S HEALTH INDUSTRY THAT BIG LEAPS IN HEALTH CARE SAFETY QUALITY AND CUSTOMER VALUE WILL BE RECOGNIZED AND REWARDED &OR MORE INFORMATION VISIT WWW LEAPFROGGROUP ORG
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ANTI AGING MEDICINE THE MINUTE YOU WALK IN THE DOOR /H YEAH ) FORGOT TO MENTION THE GYNECOLOGISTS AFTER ALL THEY HAVE A CAPTIVE GROUP WHO WANT TUMMY TUCKS LIPOSUCTION AND ALL OF THE CELLULITE TREATMENTS ) HAVE TRIED TO TALK TO THE MEDICAL DIREC TOR OF THE LARGEST HOSPITAL ABOUT IMPROVING THE QUALITY OF RECONSTRUCTIVE SURGERY HERE (E REFUSES TO BELIEVE ) AM SERIOUS 4HE HOSPITAL LEADERS WON T EVEN CONSIDER ALLOWING ME TO PURSUE SOME THINGS 4HEY WOULD RATHER SHIFT THINGS TO 4AMPA OR -IAMI THAN DEAL WITH THEM HERE )T IS A REAL HEAD IN THE SAND APPROACH 4HEY ARE CONVINCED THAT ) WILL ABANDON ANY PROGRAM AS SOON AS ) BUILD A COSMETIC PRACTICE !FTER ALL THAT IS WHAT hENTREPRENEURIAL MEDICINEv IS ALL ABOUT ) AGREE WITH THE FREE MARKET SYSTEM AS MUCH AS ANYBODY "UT GREED LACK OF CONCERN FOR YOUR COLLEAGUES LACK OF COMPASSION FOR THE PATIENTS LACK OF COOPERATION WITH THE HOSPITAL SYSTEM AND THE COMMUNITY IN GEN ERAL ARE ALL EVIDENT IN MY NEW TOWN -AN ) MISS YOU GUYS
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%DITOR S NOTE !T PRESS TIME ON $ECEMBER THE (ENNEPIN #OUNTY #OMMISSIONERS VOTED TO ROLLBACK THE ORDINANCE TO DUPLI CATE THE 2AMSEY #OUNTY ORDINANCE ALLOWING ESTABLISHMENTS WITH PERCENT OR MORE REVENUE GENERATED FROM LIQUOR TO PERMIT SMOKING IN THEIR FACILITY
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TION IS A PUBLIC POLICY ORGANIZATION DEDICATED TO REDUCING THE HARM OF TOBACCO USE THROUGH OUT -INNESOTA )T IS A PARTNERSHIP OF HEALTH BUSINESS CIVIC AND LABOR ORGANIZATIONS AND INDIVIDUALS COMMITTED TO THREE MAIN GOALS 0REVENT CHILDREN FROM A LIFE LONG ADDIC TION TO TOBACCO (ELP THOSE WHO WANT TO QUIT SMOKING AND 0ROTECT SMOKERS FROM EXPOSURE TO SECONDHAND SMOKE 7E BELIEVE THAT STRONG PUBLIC POLICY IS THE MOST EFFECTIVE WAY TO CHANGE COMMU NITY NORMS BEHAVIORS AND ATTITUDES TOWARD TOBACCO USE AND WE WORK HARD WITH OUR MEMBERS INCLUDING THE -INNESOTA -EDI CAL !SSOCIATION (ENNEPIN -EDICAL 3OCIETY AND 2AMSEY -EDICAL 3OCIETY TO PASS STATE LAWS AND LOCAL ORDINANCES RESTRICTING THE USE OF TOBACCO PRODUCTS 4HE -INNESOTA 3MOKE &REE #OALITION HAS BEEN INSTRUMENTAL IN GAINING MANY LANDMARK POLICY VICTORIES IN -INNESOTA INCLUDING STATE LAWS THAT REQUIRE TOBACCO FREE SCHOOLS PROHIBIT SMOKING IN HOSPITALS HEALTH CARE FACILITIES DAY CARE CENTERS WORK AND PUBLIC PLACES INCLUDING RESTAURANTS AND BARS REDUCE ILLEGAL SALES OF TOBACCO TO KIDS INCREASE THE STATE CIGARETTE EXCISE TAX AND ALLOCATE STATE FUNDS TO A TOBACCO PREVENTION PROGRAM )N THE PAST YEAR AND LOOKING FORWARD TO THE -INNESOTA 3MOKE &REE #OALITION AND OUR PARTNERS HAVE BOTH ACHIEVED GREAT 9Ê Ê °Ê,1 " * ]Ê ° °
SUCCESS AND FACE EVEN GREATER CHALLENGES AS WE WORK TOWARD A HEALTHIER -INNESOTA ÓääxÊ i} Ã >Ì ÛiÊ-iÃÃ $ESPITE THE ELEVATED PARTISANSHIP DISPLAYED BY LAWMAKERS AND THE 'OVERNOR IN BOTH THE REGU LAR ,EGISLATIVE AND 3PECIAL 3ESSIONS PUB LIC HEALTH ADVOCATES SAW THE ADVANCEMENT OF SIGNIlCANT TOBACCO PREVENTION INITIATIVES LONG SOUGHT BY PARTNERS OF THE -INNESOTA 3MOKE &REE #OALITION 4HESE MEASURES INCLUDE s MILLION IN NEW REVENUE WILL BE COL LECTED BY THE STATE ON TOBACCO PRODUCTS THROUGH IMPOSITION OF A h(EALTH )MPACT &EE v 4HE FEE INCLUDES ON EVERY PACK OF CIGARETTES SOLD IN THE STATE IN ADDITION TO THE CIGARETTE TAX A TOBACCO mOOR STOCK TAX AND A PERCENT TAX ON THE SALE OF OTHER TOBACCO PRODUCTS s 4HE FEE AND SALES TAX WILL NO LONGER BE COL LECTED BY RETAILERS AT THE POINT OF SALE AND WILL INSTEAD BE IMPOSED ON THE WHOLESALE PRODUCT $ISTRIBUTORS WILL COLLECT TAX ON SALES OF CIGARETTES TO RETAILERS AND SUBJOBBERS s #REATION OF A (EALTH )MPACT &UND IN THE STATE TREASURY INTO WHICH ALL REVENUE FROM THE HEALTH IMPACT FEE AND mOOR STOCKS FEE SHALL BE DEPOSITED TO RECOVER FOR THE STATE CERTAIN HEALTH COSTS CERTIlED AS hTOBACCO USE ATTRIBUTABLE v RELATED TO OR CAUSED BY TOBACCO USE AND ALSO TO REDUCE TOBACCO USE PARTICULARLY AMONG YOUTH s -AINTAIN -INNESOTA $EPARTMENT OF (EALTH FUNDING FOR TOBACCO PREVENTION PROGRAMS FOR THE n BIENNIUM s 3ECURE THE ANNUAL DEDICATION OF NEARLY MILLION FOR THE 5NIVERSITY OF -INNESOTA TO THE !CADEMIC (EALTH #ENTER TO SUPPORT MEDICAL EDUCATION 4HIS FIXED AMOUNT APPROPRIATION SUCCEEDS IN UNCOUPLING THE FUNDING FROM A PERCENTAGE OF ACTUAL CIGA
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RETTE SALES WHICH HAVE BEEN AND CONTINUE TO DECLINE s 4HE h&REEDOM TO "REATHEv !CT GAINED SUPPORT AND MOMENTUM PASSING KEY COMMITTEES IN BOTH THE (OUSE AND 3ENATE THAT LAYS STRONG GROUNDWORK FOR A CAMPAIGN IN V> Ê ÛiÀ i ÌÊ"À` > Vià 3IGNIlCANT PUBLIC HEALTH GAINS WERE ALSO REAL IZED IN THROUGH THE IMPLEMENTATION OF LOCAL SMOKE FREE ORDINANCES 4HE FOLLOWING COMMUNITIES NOW HAVE SMOKE FREE ORDINANCES 4HE #ITIES OF "LOOMINGTON #LOQUET $ULUTH 'OLDEN 6ALLEY )NTERNATIONAL &ALLS -ANKATO -INNEAPOLIS -OOREHEAD AND -OOSE ,AKE AND "ELTRAMI (ENNEPIN -EEKER /LMSTEAD AND 2AMSEY #OUNTIES 2AMSEY #OUNTY MODELED ITS POLICY AFTER THE /LMSTEAD #OUNTY SMOKING ORDINANCE "OTH PROHIBIT SMOKING IN RESTAURANTS AND EATING ESTABLISHMENTS WHOSE FOOD SALES ARE OVER PERCENT OF THEIR EXPENDITURES WHILE PROVIDING EXEMPTIONS FOR BARS AND BUSINESSES WITH MAJORITY LIQUOR SALES !FTER EXTENSIVE LOBBYING FROM THE HOSPI TALITY INDUSTRY AND A SUMMER LONG EFFORT OF BAR OWNERS TESTIFYING AGAINST THE SMOKING BAN AT (ENNEPIN #OUNTY "OARD MEETINGS #OM MISSIONER -ARK 3TENGLEIN HAS INTRODUCED AN AMENDMENT TO ROLLBACK (ENNEPIN #OUNTY S /RDINANCE TO PROVIDE THE EXEMPTIONS FOR BARS /N .OVEMBER SEVEN HOURS OF PUBLIC TESTIMONY WAS HEARD FROM BOTH SUPPORTERS AND OPPONENTS OF THE BAN INCLUDING SEVERAL PHYSI CIANS WHO STATED THEIR STRONG OPPOSITION TO THE REINTRODUCTION OF SMOKE INTO ANY WORKPLACES IN THE COUNTY 4HE PROPOSED ROLLBACK WILL BE VOTED ON IN #OMMITTEE .OVEMBER AND POSSIBLY HEAD TO THE "OARD FOR ACTION ON $ECEMBER 4HE #ONTINUED ON PAGE
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NEW VOTES TO WEAKEN THE POLICY REST WITH #OM MISSIONERS -IKE /PAT AND 0ETER -C,AUGHLIN WHO BOTH VOTED FOR THE ORIGINAL BAN THAT TOOK EFFECT IN -ARCH BUT NOW ARE RECONSIDERING THEIR POSITIONS CITING CONCERN FOR ECONOMIC PRESSURES FACED BY SOME BAR ESTABLISHMENTS IN THE #OUNTY /N .OVEMBER 3T 0AUL #ITY #OUN CIL -EMBER $AVE 4HUNE REINTRODUCED AN ORDINANCE TO RESTRICT SMOKING IN ALL BARS AND RESTAURANTS IN THE #ITY OF 3T 0AUL WHERE OF THE LIQUOR LICENSE HOLDERS HAVE RECEIVED EXEMPTIONS TO ALLOW SMOKING IN THEIR ESTABLISH MENTS UNDER THE TERMS OF THE 2AMSEY #OUNTY BAN #OUNCIL -EMBER 4HUNE HAS FOUR CO SPONSORS TO ONCE AGAIN PASS THE STRICTER BAN THAT HAS BEEN TWICE VETOED BY OUTGOING -AYOR 2ANDY +ELLY -AYOR ELECT #HRIS #OLEMAN HAS INDICATED HE WILL SIGN THE SMOKING ORDINANCE WHEN IT REACHES HIS DESK EARLY NEXT YEAR 4HE &REEDOM TO "REATHE !CT )N PARTNERS OF THE -INNESOTA 3MOKE &REE #OALITION SUPPORTED THE &REEDOM TO
"REATHE !CT WHICH ESTABLISHES STATE POLICY TO PROTECT THE PUBLIC FROM THE HAZARDS OF SEC ONDHAND SMOKE BY ELIMINATING SMOKING IN PUBLIC PLACES PLACES OF EMPLOYMENT PUBLIC TRANSPORTATION AND AT PUBLIC MEETINGS 7HILE MANY -INNESOTA WORKERS ARE PROTECTED FROM SECONDHAND SMOKE IN THE WORKPLACE AS A RESULT OF THE -INNESOTA #LEAN )NDOOR !IR !CT THERE IS NO SUCH STATE LAW PROTECTION ENJOYED BY BAR AND RESTAURANT WORKERS OR THEIR PATRONS 4HE &REEDOM TO "REATHE !CT WAS INTRO DUCED WITH BROAD BI PARTISAN SUPPORT BY 3TATE 2EPRESENTATIVES $OUG -ESLOW 2 AND 2ON ,ATZ $&, IN THE (OUSE AND 3TATE 3ENATORS 3COTT $IBBLE $&, AND "ILL "ELANGER 2 IN THE 3ENATE AS CHIEF CO AUTHORS 4HE BILL PASSED KEY COMMITTEES AND SITS READY FOR ACTION BY THE FULL 3ENATE WHEN THE LEGISLATURE RECONVENES IN -ARCH OF )N THE (OUSE OF 2EPRESENTA TIVES &REEDOM TO "REATHE WAS PASSED OUT OF THE POWERFUL (EALTH AND (UMAN 3ERVICES &INANCE #OMMITTEE BUT WAS STALLED IN THE #OMMERCE #OMMITTEE ON A VOICE VOTE 'OVERNOR 4IM 0AWLENTY HAS INDICATED HE WILL SIGN A SMOKING BAN IF ONE IS PASSED BY THE LEGISLATURE AND SENT TO HIS DESK
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THE TOP TEN CAUSES OF DEATH AND DISABILITY IN THIS COUNTRY !#% S ARE ALSO SHOWN TO SIGNIl CANTLY CONTRIBUTE TO TOBACCO USE ALCOHOLISM CHEMICAL DEPENDENCY EARLY TEEN PREGNANCY PREGNANCY TERMINATION SUICIDE ()6 RISK POOR COMPLIANCE WITH TREATMENT FOR CHRONIC DISEASES CHRONIC PAIN SYNDROMES AND MORE !CCORDING TO $R * %DWARD (ILL CURRENT !-! PRESIDENT hxOVER CATEGORIES OF PRE SENTING COMPLAINTS DIAGNOSES AND HEALTH RISK BEHAVIORS ARE INmUENCED BY LIFETIME EXPOSURE TO VIOLENCE AND ABUSE ;4HEREFORE = IT S TIME THAT WE ACKNOWLEDGE THE RESPONSIBILITY THAT PHYSI CIANS HAVE TO BE COMPETENT IN ITS IDENTIlCATION TREATMENT AND PREVENTION v )N THE )NSTITUTE OF -EDICINE )/- PUBLISHED A REPORT ENTITLED h#ON FRONTING #HRONIC .EGLECT THE %DUCATION AND 4RAINING OF (EALTH 0ROFESSIONALS ON &AM ILY 6IOLENCE v 4HIS REPORT CHASTISED THE HEALTH CARE EDUCATION SYSTEM FOR FAILURE TO ADEQUATELY TRAIN PROVIDERS TO DEAL WITH VIOLENCE AND ABUSE ISSUES )T ALSO CALLED FOR MORE RESEARCH ON THE BEST TECHNIQUES FOR TRAINING AND FOR EVALUATION OF TRAINING PROGRAMS TO ASSESS THEIR EFlCACY AND OUTCOMES %VALUATION OF CURRENT PROGRAMS IS VIRTUALLY NON EXISTENT 4HE )/- REPORT FUR THERMORE ACKNOWLEDGED THAT THOSE WHO TAKE AN ACADEMIC INTEREST IN THIS lELD TEND TO BE
MARGINALIZED 4HEY CALLED FOR THE CREATION OF CENTERS OF EXCELLENCE FOR RESEARCH AND EDUCATION ON FAMILY VIOLENCE IN ACADEMIC HEALTH CENTERS THE DEVELOPMENT OF EXPERTS IN EVERY MEDICAL SCHOOL WHO CAN TEACH ABOUT AND CONDUCT RESEARCH IN THIS lELD AND THE CREATION OF A NEW SUBSPECIALTY IN VIOLENCE AND ABUSE %VERY HEALTH PROFESSION S STUDENTS SHOULD BE TAUGHT TO DEAL WITH THIS ISSUE IN THEIR PATIENTS !S A RESULT THE !MERICAN -EDICAL !SSOCIATION S .ATIONAL !DVISORY #OUNCIL ON 6IOLENCE AND !BUSE BEGAN TO LOOK AT HOW THEY COULD ADDRESS SOME OF THE ISSUES BROUGHT UP BY THE )/- REPORT AND INTEGRATE VIOLENCE EDUCATION INTO EVERY STUDENT S BASIC FOUNDATION OF MEDICAL KNOWLEDGE &OR YEARS THE #OUNCIL HAD BEEN WORKING TO CHANGE THE PERCEPTION OF VIOLENCE AND ABUSE IN A BROADER SENSE TO INCLUDE ALL FORMS OF ABUSE AND IN ALL PATIENT CATEGORIES )T BECAME CLEAR THAT THERE WAS A NEED FOR AN ACADEMIC PROFESSIONAL ORGANIZATION THAT COULD BRING THESE ISSUES TO THE EDUCATIONAL INSTITU TIONS FROM THE HEALTH CARE VIEWPOINT 4HUS WAS BORN THE CONCEPT OF THE !CAD EMY ON 6IOLENCE AND !BUSE !6! )N !PRIL OF ABOUT PHYSICIANS AND OTHER EXPERTS IN THIS lELD GATHERED IN 3AN &RANCISCO TO DISCUSS THE FORMATION OF THIS NEW ACADEMY )N !PRIL OF THE !6! WAS INCORPORATED IN #HANHAS
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SEN -INNESOTA -INNESOTA HAS BEEN A LEADER IN RESPONDING TO SOCIAL AND PUBLIC HEALTH ISSUES SUCH AS DOMESTIC VIOLENCE -INNESOTA NOW HAS THE OPPORTUNITY TO BE A LEADER IN DEALING WITH VIOLENCE AND ABUSE AS A HEALTH CARE ISSUE !6! IS A NATIONAL ORGANIZATION BUT LOOKS TO THE HEALTH CARE LEADERS IN -INNESOTA TO HELP MAKE THIS ORGANIZATION A SUCCESSFUL VENTURE 4HE ANNUAL MEETING OF THE !SSOCIATION OF !MERICAN -EDICAL #OLLEGES WAS HELD RECENTLY IN 7ASHINGTON $ # WHERE THE FOCUS WAS ON CHANGING HOW !MERICA S PHYSICIANS ARE EDUCATED 4HE $EANS ARE CALLING FOR A DRASTIC OVERHAUL TO CREATE MORE HUMANISTIC UNDER STANDING PHYSICIANS )N -INNESOTA MEDICAL EDUCATION IS ALSO IN A STATE OF CHANGE !T THE 5NIVERSITY OF -INNESOTA LEADERS ARE CALLING FOR A NEW WAY OF TRAINING PHYSICIANS TO HAVE A BETTER UNDERSTANDING OF PATIENT NEEDS TO BE BETTER COMMUNICATORS TO BUILD BETTER TRUSTING RELA TIONSHIPS AND TO REDUCE RISKS !S A PART OF THIS CHANGE IT SEEMS lTTING THAT WE WOULD NOW lND A WAY TO INTEGRATE THE COMPLEX UNDERSTANDING OF VIOLENCE AND ABUSE AND ITS HEALTH CARE IMPACT INTO THE CORE OF MEDICAL EDUCATION 0ATIENTS WILL lND GREATER COMFORT WITH THEIR PHYSICIANS THEY
WILL REQUIRE LESS MEDICAL CARE AND COSTS SHOULD DROP MEASURABLY BUT MOST IMPORTANTLY THEIR HEALTH WILL IMPROVE -UCH RESEARCH NEEDS TO BE DONE TO PROVE WHETHER AND HOW THIS CAN BE ACCOMPLISHED AS LITTLE DATA CURRENTLY EXIST 4HE !6! WILL STRIVE TO STIMULATE BETTER RESEARCH TO ANSWER THESE QUESTIONS AND MORE &URTHERMORE THE !CADEMY WILL WORK TO MAKE VIOLENCE AND ABUSE AN INTEGRATED TOPIC IN MEDICAL EDUCA TION 4HE ULTIMATE RESULTS WILL BE THE IMPROVED HEALTH OF OUR PATIENTS AND OUR COMMUNITIES 9OU CAN LEARN MORE ABOUT !6! DONATE AND APPLY FOR MEMBERSHIP AT WWW AVAHEALTH ORG OR E MAIL AT INFO AVAHEALTH ORG
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-INNESOTA S LARGEST HAVENS FROM DOMESTIC ABUSE &OUNDED IN BY FOUR WOMEN FROM THE .ATIVE !MERICAN COMMUNITY THEIR PROGRAMS ARE INCLU SIVE AND HOLISTIC PROVIDING CULTURALLY RESPONSIVE ASSISTANCE TO ALL WHO COME TO THEM 7/. S PRIMARY SERVICES ARE CRISIS INTERVENTION SHELTER AND ADVOCACY INCLUDING EDUCATING THE PUBLIC ON DOMESTIC VIOLENCE ISSUES 7OMEN OF .ATIONS HAS FOUR PROGRAMS s 4HE %AGLES .EST 3HELTER A SAFE SECURE HAVEN FOR BATTERED WOMEN AND THEIR CHILDREN s 4HE #OMMUNITY !DVOCACY 0ROGRAM VICTIM SUPPORT LEGAL ADVOCACY AND RESOURCES AS WELL AS COMMUNITY EDUCATION s 4HE 9OUTH #HILDREN S 0ROGRAM HELPING TO BREAK THE CYCLE OF ABUSE AND s 4HE NEW .ATIVE 9OUTH #RISIS (OTLINE A ONE OF A KIND STATEWIDE TOLL FREE PHONE SERVICE 7/. SERVES !MERICAN )NDIAN AND OTHER BATTERED WOMEN THEIR CHILDREN AND FAMILY MEMBERS AS APPROPRIATE 4HE %AGLES .EST SHELTER SERVES ALL OF -INNESOTA AND PARTS OF 3OUTH $A KOTA 4HE #OMMUNITY !DVOCACY 0ROGRAM SERVES THE SEVEN COUNTY METRO AREA -ANY WOMEN AND CHILDREN COMING TO 7/. FOR SAFETY ARRIVE WITH ONLY THE CLOTHES ON THEIR BACKS -OST ARE PEOPLE OF COLOR &LEEING DOMESTIC ABUSE THEY HAVE LEFT EV ERYTHING BEHIND TO START THEIR LIVES OVER %XECUTIVE DIRECTOR .ORMA 2ENVILLE ONE OF 7/. S ORIGINAL FOUNDING MEMBERS SAYS h,AST YEAR THE %AGLES .EST ALONE SERVED WOMEN AND CHILDREN PERCENT MORE THAN THE PREVIOUS YEAR v 7/. S OBJECTIVES INCLUDE s (ELPING BATTERED WOMEN ADDRESS THEIR
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SPECIlC NEEDS AND MAXIMIZE THEIR UNIQUE POTENTIAL s %FFECTING CHANGE IN THE COMMUNITY THAT ACCEPTS AND OFTEN JUSTIlES VIOLENCE AGAINST WOMEN s !DDRESSING THE NEED FOR AFFORDABLE HOUSING AND HOUSING BASED SERVICES FOR HOMELESS WOMEN AND CHILDREN s #HANGING PUBLIC POLICY AND INACCURATE PER CEPTIONS ABOUT VIOLENCE AND HOMELESSNESS ALIKE -UCH OF 7/. S WORK IS TO COLLABORATE WITH PARTNER AGENCIES TO PROVIDE AND DEVELOP ADDITIONAL SERVICES 4HEY WORK WITH THE 7EST TH &AMILY #ENTER -ONROE 3CHOOL WHICH PROVIDES PET THERAPY A HEALING EXPERIENCE FOR CHILDREN THAT INCLUDES SUPPORT GROUPS FOR PARENTS 7/. HAS ALSO BENElTED FROM CONTRIBUTING TO THE LOCAL WORK OF 0ARTNERS FOR 6IOLENCE 0REVENTION IN 3T 0AUL OR THE -INNESOTA #HILD 2ESPONSE )NITIATIVE AND THE !MERICAN )NDIAN 3AFETY #OUNCIL IN -INNEAPOLIS 4HE %AGLES .EST LOCATION IS ONE OF THE GROWING NUMBER OF 0EACE 0OLE SITES THIS ONE INCLUDES !MERICAN )NDIAN LANGUAGES WHICH IS UNIQUE 7/. WAS JUST GRANTED A LEAD IN COM MUNITY PLANS TO ESTABLISH A -INNEAPOLIS SHELTER FOR !MERICAN )NDIAN HOMELESS YOUTH 4HIS WILL COMPLEMENT 7/. S .ATIVE 9OUTH #RISIS (OT LINE LAUNCHED RECENTLY WITH THE !UGUST KICK OFF OF THE h(ONOR THE 9OUTH 3PIRITUAL 2UNv FROM -INNEAPOLIS TO 2ED ,AKE 4HE RUN HAS BROUGHT WIDESPREAD FOCUS TO BOTH THE HOTLINE AND THE GROWING PROBLEMS OF .ATIVE !MERICAN YOUTH SUICIDE THREE TIMES MORE PREVALENT AMONG THESE CHILDREN DRUG AND ALCOHOL ADDICTION AND VIOLENCE $OZENS OF COMMUNITY GROUPS HAVE JOINED WITH -INNESOTA AND NATIONAL AGENCIES IN THIS INTER JURISDICTIONAL EFFORT AS IT CONTINUES GATHERING ATTENTION AND SUPPORT FROM STAKEHOLD ERS AND MEDIA STATEWIDE AND NATIONALLY )N FACT ANOTHER LONGER RUN TOOK PLACE /CTOBER n h(ONOR THE 9OUTH 3PIRITUAL 2UN 2ED ,AKE TO 3TANDING 2OCK v
/NE OF THE CHILDREN IN 7/. S YOUTH PRO GRAM LEFT THESE WORDS h) AM A @PEACEMAKER ) TREAT MYSELF AND OTHERS WITH RESPECT ) LISTEN ) SHARE ) CARE FOR THE EARTH AIR WATER PLANTS AND ANIMALS ) AM IMPORTANT TO THIS WORLD ) AM A CHILD ) AM THIS WAY UNTIL TAUGHT OTHERWISE v 7/. S DOMESTIC VIOLENCE CRISIS LINE IS 4O REACH THEM TOLL FREE OR FOR THE .A TIVE 9OUTH #RISIS (OTLINE CALL (EALTH PROFESSIONALS AND OTHERS CAN ALSO ACCESS 7/. S 7EB SITE WWW 7OMEN OF .ATIONS ORG 7/. S PRINCIPAL FUNDING IS THROUGH -INNESOTA S /FFICE OF *USTICE 4HAT FUNDING HAS BEEN CUT SEVERAL YEARS IN A ROW 4O SUPPORT 7/. S COMMITMENTS TO END VIOLENCE AND PRO MOTE HEALTH CALL #ALL THIS SAME NUMBER FOR INFORMATION ON THEIR COMMUNITY OUT REACH AND EDUCATION PROGRAMS OR TO VOLUNTEER OR CONTRIBUTE IN OTHER WAYS 2OOTED IN !MERICAN )NDIAN CULTURE 7OMEN OF .ATIONS HONORS THE CULTURAL AND SPIRITUAL HERI TAGE OF ALL PEOPLE AND PROMOTES A VISION OF PEACE AND JUSTICE h7E WOULD LOVE FURTHER PARTNERSHIPS WITH CLINICS AND ORGANIZATIONS TO ADDRESS FAMILY VIOLENCE v SAYS DIRECTOR .ORMA 2ENVILLE h)T AF FECTS EVERYONE S BOTTOM LINE IN BOTH HUMAN AND lSCAL TERMS /UR WORKPLACE TRAININGS AND PROGRAM IN SERVICES CAN HELP TRANSFORM THAT 7E EACH HAVE THE OPPORTUNITY THE PRIVILEGE OF CONTRIBUTING TO 7/. S MISSION AND SUPPORTING THE LIVES HEARTS AND SPIRIT OF OUR PEOPLE )T S TO THAT KIND OF PARTNERSHIP THAT WE INVITE PHYSICIANS AND HEALTH ADMINISTRATORS v
2ICK "ERNARDO 7/. DEVELOPMENT COMMUNICA TIONS MANAGER HAS DESIGNED AND MANAGED PROJECTS AND PROGRAM EVALUATION FOR STATEWIDE PUBLIC HEALTH PROGRAMS IN -INNESOTA AND #ALIFORNIA FOCUSING ON HEALTH DISPARITIES DISMANTLING RACISM AND BUILDING CAPACITY IN VARIOUS COMMUNITY POPULATIONS
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3AFETY #!03 BOARD OF DIRECTORS UNANIMOUSLY ADOPTED A 0RINCIPLES 6ALUES AND "ELIEFS 3TATE MENT DEVELOPED DURING THE ORGANIZATION S ANNUAL MEETING AND PLANNING RETREAT IN *UNE IN #HICAGO 4HE DOCUMENT WAS THEN SHARED WITH #!03 &OUNDING !DVISORS AND INTERNA TIONAL PATIENT SAFETY AUDIENCES WHOSE INPUT WAS SOUGHT .OW lNALIZED BY THE #!03 BOARD THE 0RINCIPLES 6ALUES AND "ELIEFS 3TATEMENT WILL GUIDE AND GOVERN #!03 WORKING RELATION SHIPS WITH EACH OTHER AND WITH THE HEALTH CARE COMMUNITY h4HIS DECLARATION OF VALUES IS THE CULMINA TION OF A PRODUCTIVE AND ENERGIZING DISCUSSION ONGOING AMONG #!03 BOARD MEMBERS AND &OUNDING !DVISORS SINCE THE VERY INCEPTION OF THE ORGANIZATION v SAID 3USAN % 3HERIDAN -)- -"! #!03 CO FOUNDER AND PRESIDENT h) BELIEVE IT REmECTS IN WORDS THE VERY SOUL OF OUR ORGANIZATION )T IS OUR @NORTH STAR v h#!03 INVITES CONSUMERS AND PROVIDERS OF CARE WHO SHARE OUR PRINCIPLES VALUES AND BELIEFS TO JOIN IN A COMMITTED PARTNERSHIP v SAID #!03 $IRECTOR AND PLANNING RETREAT CO FACILITATOR *ONATHAN # 0ECK h7E BEGAN WITH A COMPELLING VISION WORTHY MISSION AND IMPORTANT GOALS 7E ARE CLEAR ABOUT WHO WE ARE AND WHAT WE ARE ABOUT #!03 HAS THE INTEGRITY TO BE A GREAT PARTNER FOR THOSE READY TO BOTH TEACH AND LEARN HOW WE CAN CREATE SAFER HEALTH CARE v h4HESE ARE STRONG STATEMENTS AND SHOULD BE READ CAREFULLY 7E ANTICIPATE THAT SOME OF THESE STATEMENTS WILL BE UNCOMFORTABLE FOR ALMOST EVERYONE v ADDED 2OGER &RITZ #!03 DIRECTOR AND PLANNING RETREAT CO FACILITATOR 4HE #!03 BOARD ADOPTED THE FOLLOWING PRINCIPLES VALUES AND BELIEFS
7E BELIEVE THAT BEING TOLD THE TRUTH AND TELL ING THE TRUTH ARE VITAL TO RESTORING HEALTH BOTH TO PATIENTS AND TO THE HEALTH CARE SYSTEM AND THAT THEY ARE ESSENTIAL TO SUSTAINING INTEGRITY AND TRUSTWORTHINESS
7E BELIEVE THAT ANGER IS AN ANTICIPATED PHASE IN THE HEALING PROCESS AND IS A SIGNAL OF HURT INVALIDATION OR UNMET NEED 7E BELIEVE IN MOVING BEYOND ANGER TO RESOLUTION AND TO A COMMITMENT FOR ACTION THAT WILL MAKE A POSI TIVE AND SIGNIlCANT DIFFERENCE
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7E BELIEVE THAT OPEN AND HONEST COMMUNICA TION BASED ON THE PRINCIPLES OF TRANSPARENCY AND FULL DISCLOSURE IS THE BEST WAY TO BUILD TRUST TO MINIMIZE BREAKDOWNS AND TO RESTORE RELATIONSHIPS WHEN BREAKDOWNS DO OCCUR *>ÀÌ iÀÃ «Ê> `Ê >L À>Ì
7E BELIEVE IN THE WISDOM SYNERGY AND POWER OF PARTNERSHIP %NGAGING IN AND FOSTERING EF FECTIVE PARTNERSHIPS WILL BE OUR PRIMARY MODE OF OPERATION AND THE ART OF COLLABORATION WILL BE OUR CORE COMPETENCY «>Ì ÞÊ> `Ê «>ÃÃ
7E BELIEVE IN THE VALUE OF EXERCISING EMPATHY AND THEREBY SEEING THE WORLD THROUGH THE EYES OF OTHERS 7E RELY ON COMPASSION TO OVERCOME BLAME AND TO GUIDE MOTIVATE AND SUSTAIN OUR WORK
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7E BELIEVE IN SERVING AS STRONG WILLED PERSIS TENT ADVOCATES FOR CHANGE IN THE HEALTH CARE SYSTEM AND IN TAKING ON COMPLEX PROBLEMS OR CONTROVERSIAL ISSUES THAT OTHERS MAY CHOOSE TO IGNORE DENY OR AVOID
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7E BELIEVE THAT DIVERSITY IN ALL OF ITS FORMS IS A VALUABLE ASSET AND A SOURCE OF STRENGTH 7E BELIEVE THAT THE CREATIVE TENSION BROUGHT ABOUT BY HONEST AND NATURAL DIFFERENCES IS A CATALYST FOR CHANGE AND GENERATES OPTIMAL SOLUTIONS
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7E BELIEVE THAT A DYNAMIC BALANCE OF AC COUNTABILITY AND FORGIVENESS CONTRIBUTES TO THE DEVELOPMENT OF PEOPLE SYSTEMS AND CULTURES THAT ARE MORE RESPONSIBLE SELF CORRECTING AND CONTINUOUSLY IMPROVING ««ÀiV >Ì Ê> `Ê* Ã Ì Ûi `i` iÃÃ
7E BELIEVE IN DISCOVERING AND CELEBRATING SIGNS OF PROGRESS IN ACKNOWLEDGING PEOPLE FOR THEIR CONTRIBUTIONS AND IN LEVERAGING WHAT IS WORK ING AS THE BEST WAY TO OVERCOME WHAT IS NOT WORKING 4HE HEALTH CARE SYSTEM WILL NEVER BE PERFECT BUT IT CAN ALWAYS BE BETTER -ÞÃÌi "À i Ìi`Ê> `Ê*>Ì i Ì i ÌiÀi`
/UR PASSION FOR PATIENT SAFETY IS FOUNDED UPON OUR BELIEF IN AND OUR ADVOCACY FOR A HEALTH CARE DELIVERY MODEL THAT IS SYSTEM ORIENTED AND PATIENT CENTERED
#ONSUMERS !DVANCING 0ATIENT 3AFETY #!03 IS A CONSUMER LED NON PROlT ORGANIZATION FORMED TO BE A COLLECTIVE VOICE FOR INDIVIDUALS FAMILIES AND HEALERS WHO WISH TO PREVENT HARM IN HEALTH CARE ENCOUNTERS THROUGH PARTNERSHIP AND COLLABORA TION #!03 ENVISIONS CREATING A HEALTH CARE SYSTEM THAT IS SAFE COMPASSIONATE AND JUST &OR MORE INFORMATION ON #ONSUMERS !DVANCING 0ATIENT 3AFETY CONTACT -ITCHELL , $VORAK -3 #!% EXECUTIVE DIRECTOR AT OR VIA E MAIL AT MDVORAK PATIENTSAFETY ORG
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TO INITIATE THE CHANGES THAT ) WISH ) COULD HAVE ACCOMPLISHED ) KNOW MORE ABOUT WHAT WE HAVE DONE AND HOW WE DID IT OVER THE LAST YEAR AND LITTLE ABOUT HOW TO CHANGE THE THINGS FOR WHICH ) HAD MORE KNOWLEDGE -ANY PRESIDENTS AS THEY LEAVE THEIR ROLE WRITE ABOUT THE POSITIVE CHANGES THAT THEY HAVE HELPED TO ACCOMPLISH AND THAT HAVE OCCURRED OVER THE PAST YEAR ) DON T NECESSARILY FEEL THAT THE CREDIT SHOULD GO TO ME BUT THAT IT SHOULD GO TO THE PHYSICIAN AND ADMINISTRATIVE LEADERSHIP THAT ARE WITHIN THE 2-3 !S PRESIDENT OF THE 2-3 ) HAVE WRITTEN LETTERS MADE PUBLIC APPEARANCES PRESIDED OVER MEETINGS AND PROVIDED DIRECTION FOR THE 2-3 )N MY ROLE ) HAVE REPRESENTED THE PHYSICIANS OF 2AMSEY 7ASHINGTON AND $AKOTA #OUNTIES ) ENVISION THAT ) AS THE PRESIDENT REPRESENT THE INTERESTS OF ALL THE PHYSICIANS WHO PRACTICE IN THESE AREAS AND THEIR PATIENTS NOT JUST THE PHYSICIAN MEMBERS OF THE MEDICAL SOCIETY /UR GOALS ARE NOT JUST TO REPRESENT THE MEMBERS BUT THE WHOLE OF PHYSICIANS 7E THE 2-3 DO NOT DIFFERENTIATE WHEN WE REPRESENT PHYSI CIANS BETWEEN MEMBERS AND NON MEMBERS 7E THE 2-3 ADDRESS PUBLIC HEALTH ISSUES I E TOBACCO SMOKING BANS HEALTH CARE REFORM I E ENSURING ADEQUATE HEALTH CARE ACCESS MEDICAL ADMINISTRATIVE ISSUES I E /3(! REQUIREMENTS AND REIMBURSEMENT ISSUES I E -INNESOTA#ARE 9ET MANY PHYSICIANS ARE NOT MEMBERS OF THE SOCIETY 4HE NUMBERS OF PHYSICIAN NON MEMBERS IS A CONSTANT FRUSTRATION FOR ME -ANY PHYSI CIANS WHO ARE MEMBERS THANK ME FOR TAKING TIME OUT OF MY SCHEDULE AND LIFE TO PROVIDE LEADERSHIP WITHIN 2-3 (OWEVER IT IS ) WHO THANK THEM FOR BEING MEMBERS 7ITHOUT THEIR SUPPORT THROUGH MEMBERSHIP WE WOULD NOT BE #ONTINUED ON PAGE
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$R $AVID ,UEHR PRESIDENT OF THE --! SPOKE TO THE 2-3 "OARD OF $IRECTORS ON 4HURSDAY $ECEMBER AT 5NITED (OSPITAL (E UP DATED "OARD MEMBERS ON THE IMPLEMENTATION
Caring Hearts for Homeless People Supply Drive February 1-February 27, 2006 We know you receive numerous requests for support, especially recently to aid people recovering from world-wide natural disasters. However, many people living in our communities are struggling with their own personal disasters and desperately need your help. In Ramsey County alone, there are more than 5,100 homeless people without basic supplies. The Caring Hearts for Homeless People supply drive requests that you collect much needed supplies within your clinic from February 1 through February 27, 2006. Some of the urgent supplies needed are ibuprofen, Aleve, cough syrup, deodorant, razors and chapstick. We will supply you with promotional materials that will include a shopping list of all items
being collected. Call the RMS office at (612) 362-3705 for more information or to let us know that your clinic is interested in participating in the drive. Arrangements will be made for all donations to be picked up at your location and delivered to the drop-off location at St. Joseph’s Hospital where they will be distributed to the homeless through the following three programs: Health Care for the Homeless — A team of medical, mental health and social service practitioners who provide patient care, medication, supplies and referrals in nine emergency shelters and drop-in sites.
Listening House — “The living room of the streets” is a day and evening shelter and community center providing hospitality, practical assistance and counsel to people who are homeless, disadvantaged or lonely. SafeZone — A non-threatening haven for youth between the ages of 11 and 21, which provides hospitality, “family,” supplies and referrals. As your clinic plans its activities for the upcoming year, please consider participation in the Caring Hearts for the Homeless People supply drive. For further information or to request the promotional materials, please contact Doreen Hines: phone (612) 362-3705, or e-mail dhines@mnmed.org. Sponsored by Ramsey Medical Society and the HealthEast Care System.
RMS President’s Message ently possess a position of authority and leader- redesigning hospital care. Demonstration proj(Continued from page 21)
able to accomplish what we do. How do I engage non-members and instill in them the value in membership? Furthermore, how do I address the growing numbers of employed non-member physicians who are shielded from a lot of the economic, regulatory and legal issues affecting the practice of medicine? Just think what the medical society could accomplish if we had more members, and thus more political clout and economic resources. Through increased membership we become stronger to tackle the constant intrusion into our practices by the government, payers and regulatory agencies. Another area where I wish I could have accomplished more during the last year was with physician activism. In my medical career I have seen the majority of my physician colleagues be reactive instead of proactive. Many physicians, whether involved with organized medicine or not are able to perceive trends and identify issues important to the profession. Physicians inher24
January/February 2006
ship. How do I, or the RMS, instill a sense of responsibility into physicians, to motivate them to get them to actively address timely issues that impact the practice of medicine? This activism can be in the form of sending a letter, making a phone call or attending a local meeting. Many physicians have contacted me throughout the last year (I wish there would have been more) with questions and comments. I wish I could have channeled their enthusiasm and comments into activism. The final area where I wish I could have accomplished more is in the area of reassessing how we function as physicians within the context of the medical society. Tradition has its role in the practice of medicine. However, we do not practice medicine today the way it was practiced 30, 20, even ten years ago, and there should be similar changes in our professional organizations. My practice is as a hospitalist. Ten years ago a handful of people could tell you what that means. The Institute of Healthcare Improvement recently held a symposium on MetroDoctors
ects on innovative health care delivery systems are taking place in this country and around the world. Technology, economics and lifestyle issues are integral parts of the equation. We need to redesign the concept and role of our medical society. I have tried to help initiate the process and the leadership that follows me will need to continue to take an active role in its transformation. All past presidents of the medical society have set goals for their leadership year. As we enter our presidential year we are all optimistic that we can accomplish our agenda. The agenda that I took upon myself to accomplish has not yet been fulfilled. I now realize that some changes take longer than others. I look forward to working toward these unfinished goals with the upcoming leadership and new president. I sincerely thank all of you for the honor of being the president of the RMS. Charles Terzian, M.D. c.terzian@att.net
The Journal of the Hennepin and Ramsey Medical Societies
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HE SCENE IS AMAZING 4HE HEARING IS TAKING PLACE ON THE TH mOOR OF THE 'OVERNMENT #ENTER IN DOWNTOWN -INNEAPOLIS 4HE CHAM BERS ARE COMFORTABLE FOR ABOUT PEOPLE BUT ) AM TOLD THAT THERE ARE PROBABLY ON THE TH mOOR AND ANOTHER PEOPLE WAITING IN THE LOBBY WATCHING THE PROCEEDINGS ON BIG SCREEN 46S 4HERE ARE NEARLY PEOPLE SIGNED UP ON THE OFlCIAL LIST OVER OF WHO WERE ORGANIZED BY (-3 4HE SECURITY GUARDS HAVE THE NAMES OF THE INDIVIDUALS WHO HAVE SIGNED UP AND WILL TAKE GROUPS OF lVE OR SIX UP TO THE TH mOOR TO TESTIFY WHEN IT S GETTING CLOSE TO THEIR TURN 4HIS IS TAKING PLACE IN THE AFTERNOON SO MOST OF THE PHYSICIANS PUBLIC OFlCIALS AND CITIZEN TESTIlERS ARE TAKING TIME AWAY FROM THEIR PRACTICES OR JOBS TO GIVE THE COMMISSIONERS THEIR OPINIONS 4HIS IS AN ISSUE THAT BRINGS OUT PASSION ON BOTH SIDES OF THE ISSUE SO SOME OF THE INDIVIDUALS NEED TO BE REMINDED TO REMAIN CIVIL 4HERE IS A SIGNIlCANT PRESENCE OF UNIFORMED OFlCERS !MIDST ALL OF THE CHAOS ON THE TH mOOR THERE IS AN INDEPENDENT lLM CREW MILLING ABOUT AS THEY SHOOT THEIR DOCUMENTARY 4HEY POUNCE ON PEOPLE AS THEY EXIT THE BOARD CHAMBERS TRYING TO GET SOUND BITES FOR THEIR PRODUCTION -OST REFUSE TO BE INTERVIEWED BUT SOME CONCEDE 4HERE ARE NEWSPAPER REPORTERS INTERVIEWING PEOPLE
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3T 0AUL #ITY #OUNCIL MEMBER $AVID 4HUNE KICKED OFF THE HEARING BY REVEALING TO THE (ENNEPIN #OUNTY #OMMISSIONERS HIS PLAN TO REINTRODUCE A COMPREHENSIVE ORDINANCE IN 3T 0AUL THAT WOULD NOW INCLUDE BARS (E NOTED THAT INCOMING 3T 0AUL -AYOR #OLEMAN HAS INDICATED THAT HE WILL SIGN THE COMPREHENSIVE ORDINANCE SO WHY WOULD (ENNEPIN #OUNTY WEAKEN THEIR ORDINANCE WHEN 3T 0AUL IS BUILD ING THEIRS UP TO MATCH (ENNEPIN #OUNTY S 4HUNE S TESTIMONY WAS FOLLOWED BY OTHER ELECTED OFFICIALS INCLUDING CITY COUNSELORS AND OR MAYORS FROM THE CITIES OF -INNEAPOLIS "LOOMINGTON %DINA AND 'OLDEN 6ALLEY !FTER THE ELECTED OFlCIALS lNISHED IT WAS TIME FOR CITIZEN OPPONENTS AND PROPONENTS TO TESTIFY &ORMER !TTORNEY 'ENERAL 3KIP (UMPHREY KICKED OFF OUR SIDE OF THE ARGUMENT FOLLOWED BY MANY INCLUDING (-3 PHYSICIANS 0ETER $EH NEL - $ -ARC -ANLEY - $ %D %HLINGER - $ "RIAN !NDERSON - $ "RIAN 2ANK - $ !LICE (ULBERT - $ "EN 7HITTEN - $ 2ICH ,USSKY - $ 3TU (ANSON - $ AND *IM 9OUNG - $ /THER TESTIlERS INCLUDED FORMER #OMMISSIONER OF (EALTH *AN -ALCOLM MANY PATRONS WORKERS OWNERS VETERANS AND VICTIMS 4HE HEARING STARTED PROMPTLY AT P M AND ENDED AT P M OVER SEVEN HOURS OF TESTIMONY 4HE COUNTY COMMISSIONERS LOOKED DAZED AS THEY RETREATED BACK TO THEIR OFlCES 4HE REASON THAT THE (-3 IS PUTTING SO MUCH EFFORT INTO THIS ISSUE IS THAT IF (ENNEPIN #OUNTY WEAKENS ITS ORDINANCE IT IS LIKELY TO HAVE A NEGATIVE EFFECT ON THE INITIATIVE TO GET A COMPREHENSIVE STATEWIDE BAN )T IS IMPORTANT TO NOTE THAT EVEN IF (ENNEPIN #OUNTY VOTES TO WEAKEN THE BAN IT WILL NOT AFFECT -INNEAPOLIS 'OLDEN 6ALLEY AND "LOOMINGTON 4HOSE CITIES #ONTINUED ON PAGE
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4HERE YOU HAVE IT 4HE (ENNEPIN -EDICAL 3OCI ETY YOUR COLLEAGUES AND STAFF CONTINUE TO MAKE CONSIDERABLE EFFORT IN SUPPORT OF RESTRICTING THE EXPOSURE TO SECONDHAND SMOKE FOR OUR PATIENTS ) WANT TO SPECIlCALLY RECOGNIZE 3UE 3CHETTLE FOR THE LEADERSHIP SHE HAS SHOWN AS OUR #OORDINATOR FOR THE #LEAN !IR -INNEAPOLIS PROJECT 4HANKS 3UE *IM
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)N A FORMAT SIMILAR TO THEIR PRESENTA TION THE 3OTILES WILL ADDRESS 5 OF - -EDICAL STUDENTS OVER THE LUNCH HOUR SPEAK TO THE RESIDENTS AND FELLOWS LATE IN THE AFTERNOON AND PRESENT A SESSION FOR FACULTY AND COMMUNITY PHYSICIANS AND THEIR SPOUSES IN THE EVENING 4OPICS TO BE COVERED IN THE EVENING SESSION INCLUDE 4HRIVING WITH #HANGE -ANAGING 9OUR $IFFERENCES 7HAT 4EAM "UILDERS 3AY AND $O 3TRESS -ANAGEMENT FOR "USY 0EOPLE +EEPING THE &LAME !LIVE AND #OMMUNICATING WITH 0ATIENTS 3TRATEGIES 4HAT 7ORK 7AYNE 3OTILE AND -ARY 3OTILE ARE THE AU THORS OF SEVERAL BOOKS INCLUDING 4HE 2ESILIENT 0HYSICIAN %FFECTIVE %MOTIONAL -ANAGEMENT FOR $OCTORS AND 4HEIR -EDICAL /RGANIZATIONS 4HE -EDICAL -ARRIAGE 3USTAINING (EALTHY 2ELA TIONSHIPS FOR 0HYSICIANS AND 4HEIR &AMILIES AND -ARRIAGE 3KILLS FOR "USY #OUPLES
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4HIS EVENING PROGRAM IS FOR PHYSICIANS AND THEIR SPOUSES PARTNERS 0LEASE JOIN US FOR THIS EXCITING EVENT OFFERED AS A BENElT OF YOUR (-3 MEMBERSHIP &OR MORE INFORMATION OR TO REGISTER PLEASE GO TO METRODOCTORS COM 3EE YOU THERE > ViÊ iÜÃo° s (-3! WAS MENTIONED AS A LEADER IN EF FECTIVELY UTILIZING A ,EADERSHIP #OUNCIL IN THE MOST RECENT ISSUE OF !-! !LLIANCE 4ODAY $IANE 'AYES (-3! COUNCIL MEMBER WAS QUOTED IN THE ARTICLE s
(-3! HAS CHOSEN &AUX 0AW THE 4ECHNO #AT )NTERNET 3AFETY 0ROGRAM AS THIS YEAR S HEALTH PROMOTION PROJECT AND WILL SOON SELECT A PILOT SCHOOL IN THE WEST METRO &AUX 0AW IS THE CREATION OF THE )NTERNET 3AFETY #OALITION WHICH IS WORKING WITH THE &IRST 3POUSES IN EVERY STATE TO BRING THIS IMPORTANT )NTERNET SAFETY MESSAGE TO ALL ELEMENTARY AGED CHILDREN
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.EW !-!! %XECUTIVE $IRECTOR *O %LLEN 0OSSELT JOINED THE STAFF ON /CT -S 0OSSELT CAME TO THE !LLIANCE FROM THE !CADEMY OF 'ENERAL $ENTISTRY WHERE SHE SERVED AS 60 OF #OMMUNICATION AND /RGANIZATIONAL -ARKETING 3HE HAS REPLACED THE LEGENDARY (AZEL ,EWIS WHO RETIRED AFTER YEARS OF SERVICE TO THE !-! !LLIANCE
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9OU MAY HAVE NOTICED THE IMPRESSIVE HEART WARMING !-! TELEVISION ADS RECENTLY AND SEEN THE NEW !-! LOGO !S PART OF THE RENEWED PARTNERSHIP COM MITMENT BETWEEN THE !LLIANCE AND THE !-! THE !LLIANCE HAS A NEW LOGO TOO 4HE WORD h!LLIANCEv lTS NEATLY BENEATH THE !-! LETTERING
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Exquisite City Homes
Beautiful Renovation!
A rare opportunity to own the Stubbs Bay school house! Completely renovated in 1999 featuring open public rooms, eat-in gourmet kitchen with adjoining family room, beautiful woodwork & charming grounds. Large walkout lower level new in 2004 with amusement/media room. Truly move-in Bruce Birkeland or Ryan condition! 4 bedrooms, 4 baths. Burnet 612-920-5605 Spectacular new construction homes designed by the acclaimed Keith Waters and Associates. Set on Groveland Terrace, this fantastic development offers the epitome of class, elegance and refinement as well as dynamic views of downtown Minneapolis.
Lowry Hill Condominium
Spectacular Setting!
Kenwood Crest
An exquisite Lowry Hill mansion conversion just 2 blocks to Lake of the Isles. Features include grand entertaining rooms, superb original details, spacious master suite, huge lower level family/ media room, hardwood floors, and ample storage/closet space. A fantastic single family home alternative! 4 bedrooms, 5 baths.
Set on a glorious 7+ acre lot with breathtaking grounds, winding driveway, rolling hill, mature trees, pool, stable, and kennels. A beautifully scaled home with gracious public rooms, main floor family room off the kitchen, impressive master suite and more. Near Spring Hill Golf Club. 6 bedrooms, 9 baths.
Elegant twin home built by the acclaimed Keith Waters & Associates. This former parade home features stunning custom finishes and quality craftsmanship at every turn. Boasting all the modern conveniences offered with new construction as well as the charm found in the historic neighborhoods of Kenwood and Lowry Hill. 3 bedrooms, 4 baths.
Landmark Lowry Hill Mansion Available for the 1st time in over 50 years! Features include exquisite original details with grand public rooms, expansive gardens and breathtaking views of park and Lake of the Isles. A distinguished residence with amazing grandeur. 6 bedrooms, 9 baths.
Go West Young Family We saved the best for last! Build the home of your dreams on a choice cut of the last piece of Prime Edina Real Estate. This is no East Edina, this is the West. These are the homes where the open spaces roam, and the lofty and soaring vaults tray. Don’t tell us about the Old World Charm. Heck, we built that, too. “Your investment will be significant in your next home, it may as well be on a home that you custom design!” There are 23 lots now available to turn your dreams into reality.
Call Scott Card John Shaw
612.209.6455
or visit us on the web at
612.720.4678
www.ParkwoodKnolls.com
Call
Bruce Birkeland 612-925-8405 www.brucebirkeland.com
Continuing Medical Education THROUGH JUNE 2006
PRIMARY CARE FOCUS
SURGERY FOCUS
Preventive Care for Adolescents February 23-24, 2006
Hands-on and High-tech Difficult Airway Workshop March 3-4, 2006
Urology for Primary Care March 3, 2006 Cardiac Arrhythmias: An Interactive Update for Internal Medicine, Family Practice and Pediatrics March 24, 2006
Advances in Hepatic, Biliary & Pancreatic Surgery 70th Annual Surgery Course June 14-16, 2006
ALSO OFFERED Schizophrenia Treatment: Bridging Science to Clinical Care April 6-7, 2006 Allergy and Clinical Immunology April 7, 2006 Family Medicine Review: Update 2006 May 1-5, 2006 Topics and Advances in Pediatrics June 15-16, 2006
Reducing Tobacco Use in Minnesota: Research Into Action February 27-28, 2006 Aging Skin May 12, 2006 Workshops in Clinical Hypnosis June 1-3, 2006 Novel Therapies in Thoracic Oncology Summer 2006
Lillehei Symposium: Cardiovascular Care for Primary Practitioners Spring 2006 This reflects our current listing. For more information contact: Continuing Medical Education 612.626.7600 or 1.800.776.8636 cmereg@umn.edu
Register Online! www.cme.umn.edu All courses listed take place in the twin cities metro area.