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Nov/December 1999

Doctors MetroDoctors THE BULLETIN OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

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Doctors MetroDoctors THE BULLETIN OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

Physician Advisor Thomas B. Dunkel, M.D. Physician Advisor Richard J. Morris, M.D. Editor Nancy K. Bauer Assistant Editor Doreen Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Managing Editor Sheila A. Hatcher Advertising Manager Dustin J. Rossow Cover Design by Susan Reed MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. E-mail: nbauer@mnmed.org. For advertising rates and space reservations, contact Dustin J. Rossow, 4200 Parklawn Ave., #103, Edina, MN 55435; phone: (612) 8313280; fax: (612) 831-3260; e-mail: djrossow@aol.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.

CONTENTS VOLUME 1, NO. 4

NOVEMBER/DECEMBER 1999

COLLEAGUE INTERVIEW

Rebecca Thoman, M.D.

FEATURE: HEAR US ROAR

How Dallas County Medical Society Got Uncle Sam’s Ear

Managed Care Improvement Act Passes in U.S. House

Minnesota Medical Association’s Legislative Update

Collective Bargaining: Is it in Your Future?

If Not Unions, What Then?

HMS/RMS Members Active at Minnesota Medical Association Annual Meeting

RISK MANAGEMENT

Subpoenas to Search Warrants: What Should You Do?

RMS, HMS and MMGMA Collaborate to Form Metropolitan Medical Practice Forum

Classified Ads

“metrodoctors.com” Continues to Enroll Physicians

RAMSEY MEDICAL SOCIETY

24 25 26 27

President’s Message RMS News RMS Members to Elect Officers and Board for Year 2000 RMS Alliance HENNEPIN MEDICAL SOCIETY

29 30 32

HMS in Action HMS News HMS Alliance

On the cover: Physicians can make a difference by becoming involved in grassroot politics. See related stories beginning on page 2. (Capitol photo courtesy of David Oakes, Senate Media Services.) MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

November/December 1999

COLLEAGUE INTERVIEW

Rebecca Thoman, M.D.

Editor’s Note: “Colleague Interview” provides HMS and RMS members with an opportunity to ask questions of their colleagues who are in unique roles. Dr. Thoman is running for a seat in the House of Representatives in the November 2000 election.

Q A

What do you say to a physician who feels that politics are not important, i.e. that he/she wants to take care of patients and does not want to be bothered by politics and other issues? Many doctors tell me that they just want to be left alone to practice medicine. The political process is messy, complicated and unfair. With stodgy bureaucrats arguing endlessly over trivial matters, it is easy to become bored or discouraged. In spite of these truths, health care is a highly regulated industry. The government exerts influence over decisions at every level. Here in Minnesota, we operate in a health care environment that has been designed by our legislature — a consolidated market where plans define medical necessity, physicians take financial risk and continuity of patient care is compromised. Improving an individual patient’s health care requires that medicine’s values and priorities be an integral part of the systems we work in. Legislators alone will not be able to craft laws structuring a system with focus on quality and service without physician input. Additionally, the legislature is the largest purchaser of health care in the state. Decisions about how government employee plans, MinnesotaCare, Medicaid and GMAC operate have far-reaching consequences. Government health care spending drives the structure of the industry and physician contribution in the decision-making process is imperative. Dramatic changes are coming in health care. With our rapidly aging population there will be increased demand and need for services. Whatever structure the next generation of health care delivery takes, whether it is a single payer or an open market, physicians, nurses and other health care professionals must have a voice in shaping the values of the system or the system will dictate the delivery and ethics of medicine.

How can physicians get more involved in grassroots politics? Realistically, doctors have little time to spare after meeting their professional and family responsibilities. A simple way physicians can become involved in politics is to establish and maintain an ongoing relationship with their elected officials. Doctors have to discard the need for instant results and take the long view. Influencing politicians happens over time. That doesn’t mean attending dozens of meetings. It means regularly sharing individual experiences regarding the success and flaws of the health care system. Legislators do care what constituents think and are often grateful to have a willing, knowledgeable source for explanations about the technical aspects of an industry. I encourage every physician to call his or her elected officials. You don’t have to know every detail about every potential issue. Just speak from your experience. Supporting organized medicine is important, too. But it’s not enough to write a check. Lobbyists will be much more effective when their legislative alerts are acted upon by an informed membership. Physicians must write, call or e-mail legislators regularly — hold them accountable for their decisions.

Can the energy and issues identified by the Minnesota Patient Physician Alliance (MPPA) be redirected within local medical societies? Redirected? I believe that the local medical societies share the values of MPPA. And the majority of MPPA members support organized medi-

November/December 1999

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The Bulletin of the Hennepin and Ramsey Medical Societies

cine. Our goal should be to create a supportive coalition for change. Local medical societies can invest their resources to advocate for patients and defend medical professionalism. MPPA brings the patient into the equation and forges an alliance between doctors and patients. The ethics project is a good example of how the two organizations can potentiate each other. A discussion of the new ethical dilemmas that physicians face under managed care is valuable and necessary. The series of case studies sponsored by HMS elucidates many of the problems created by our modern system. The project becomes more meaningful when doctors are encouraged to act on these assessments. MPPA focuses on core patient needs such as access to care and continuity of care and advocates for elimination of financial incentives that damage doctor-patient trust — some of the chief forces underlying the ethical concerns expressed in the series.

Why have you decided to run for the Minnesota legislature? In my work as an advocate for patient protection I have discovered that few elected officials have a working understanding of Minnesota’s health care delivery system. I’ve found myself having to explain concepts like risk-sharing and capitation even to members of the Health and Human Services Committees. The majority of Minnesota legislators come from business or legal backgrounds, which are the perspectives they bring to their policy decisions. These are valuable skills. But when the issue is how to make government operate more efficiently, especially in regard to health and human services, a front-line worker can enhance the discussion and contribute practical, creative thinking. During my fellowship training, I treated outpatient adolescent sex offenders. I had first-hand experience with the medical, educational, criminal justice and social service systems surrounding their care. Insight from that work provides a context for policy decisions and an understanding of the interrelationship of systems. In my medical training I’ve learned to assimilate large amounts of information and analyze it critically. Legislators must make decisions based on accurate information supported by facts and be able to discern reliable from superficial data.

In your opinion, what are the key issues facing physicians legislatively? Please include reference to the upcoming session as well as in the future. The key issue facing Minnesota physicians is our loss of autonomy due to consolidation of the health care market. This loss of autonomy seriously threatens the physician-patient relationship and the trust that is the foundation of excellent medical care. The legislature enabled vertically integrated systems in order to contain health care costs while, at the same time, increasing access and improving quality. The intent was laudable but results have been mixed. Unfortunately, integrating systems also has consolidated economic power and physicians have lost influence. Health care professionals’ greatest challenge is to regain authority and leadership within our industry. Ultimately we must reconstruct our health care system to decrease the role of third party payers and increase emphasis on patient-centered care. During the next session, I expect the Fairness in Health Care bill to resurface. This bill, which gives patients the right to sue health plans if denials of care result in damages (the portion which receives the most media attention) also defines medical necessity by a community standard rather than allowing plans to set their own definitions. An earlier version of the bill also required that physicians who perform utilization review be board-certified, licensed in Minnesota and practicing in the same specialty as the doctor providing care. These latter components are far more significant than the right to sue and would improve accountability without added cost. While I agree that the provider tax is unfair (and this issue is likely to be revisited next session), I don’t believe it is in the best interest of doctors to make repeal of the tax our primary agenda item. Provider tax repeal is perceived by a segment of the public and the legislature as self-serving, especially while nursing and patient organizations oppose repeal. Physicians need to make patients our allies at the Capitol and develop an agenda which supports their concerns, including coverage for the uninsured as a higher priority than provider tax repeal. ✦

What perspective can a physician bring to the legislature? In the area of health care, of course, first-hand experience with the system — an inside view of emergency rooms, nursing homes, and rehab facilities. But more than that a physician can bring a set of core values to policy discussions constantly redirecting the focus of attention to the patient. In every policy area, health and health care are important factors — in education where schools are being asked to provide more and more social and special education services; in the relationship between addiction, mental health and our criminal justice system; and in the financial cost of treating illness and injury related to violence and pollution. Education, crime, immigration, housing, the environment — all these areas hold implications for public health and safety and would benefit my attention to those aspects. MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

November/December 1999

FEATURE STORY

How Dallas County Medical Society

Hear Us ROAR Got Uncle Sam’s Ear

“This was the first time a medical society has successfully challenged an insurance company and I hope this is the start of a trend.”

Editor’s Note: Earlier this year the Dallas County Medical Society led a successful, physiciandriven challenge of an insurance company penetration in Dallas & Harris County, Texas. This article describes the effectiveness of grassroots physician involvement in this campaign.

When Aetna/US Healthcare positioned itself to take over NYLCare and Prudential Healthcare, the Dallas County Medical Society (DCMS) realized the ramifications on patients and physicians, and was determined to fight. The results have been unprecedented. “This was the first time a medical society has successfully challenged an insurance company and I hope this is the start of a trend,” says Robert T. Gunby, Jr., M.D., DCMS immediate past president. The diligence and dedication of DCMS physicians and staff and their counterparts at Harris County Medical Society resulted in an agreement between the Department of Justice (DOJ) and Aetna/US Healthcare that required the divestiture of its NYLCare entity in Dallas and Houston, while the original agreement stands in all other parts of the country. In September Aetna sold its Texas NYLCare operations to Blue Cross/Blue Shield of Texas. The result benefits not only Dallas and Harris county physicians, but also those in contiguous counties. The divestiture drops Aetna’s market coverage in Dallas from 42 percent to 22 percent. “In many other places in the country, managed care companies have a much higher percentage of the market, compared to Dallas,” Dr. Gunby says. “But because the medical society requested this investigation, we got some relief. It shows the importance of people being willing to take action and fight for what they believe in.” This fight brought on a myriad of “firsts”: The first time the DOJ challenged a merger of health plans. The first time the DOJ based an enforcement action on the threat of a health plan’s monopsony power. The first case in which the DOJ alleged that competition in Dallas and Houston would suffer because Aetna would lower reimbursement rates. “When we learned Aetna was going to buy Prudential, we got calls from members who had left Aetna primarily because of the Genesis situation last summer,” says Michael Darrouzet, DCMS executive officer, referring to Aetna’s “all products” policy it forced on physicians in the Genesis Physicians Practice Association. “They had stayed with Prudential and were concerned about Prudential being pulled into Aetna/NYLCare. We contacted TMA and AMA, and issued a joint statement opposing the merger.” BY TRACY K. PULASKI DCMS Director of Public Affairs

November/December 1999

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The Bulletin of the Hennepin and Ramsey Medical Societies

Soon after, DCMS took its concerns to the DOJ, based on antitrust concerns and bad corporate conduct. A Numbers Game The DOJ relied heavily on input from physicians and employers to assess the proposed transaction. “The DOJ asked us for proof of our market share numbers and gave us suggestions on how to prove our assumptions,” Mr. Darrouzet says. “We worked with our doctors to get that information, instead of participating in a theoretical debate about the monopsony.” DOJ needed proof of the DCMS claims of Aetna/NYLCare/Prudential (ANP) market share — the percentage of a physician’s “total-patient revenue” from ANP’s HMO and POS products. Of the 3,800 active DCMS members surveyed, 2,200 responded. If the proposal were successful, 33 percent of Dallas physicians would have 25 percent or more of their practice with Aetna, NYLCare, or Prudential. DCMS then surveyed 100 of the most affected physicians — those whose practices would be 70 percent to 100 percent ANP patients — to determine the percentage of their entire practice dependent on ANP revenue. This showed the original survey was statistically accurate and the DOJ accepted the figures, Mr. Darrouzet says. Physician Involvement Physician involvement was key throughout the effort, and was the reason the DOJ considered Dallas and Houston differently from the rest of the country. “Our physicians were willing to step forward and talk candidly to the DOJ and the media about how the merger would affect them,” Mr. Darrouzet said. “Other markets have greater saturation, such as in Pennsylvania, where Independence Blue Cross has 90 percent of the market, but that went unchallenged. No doctors were willing to talk; they were afraid they would be deselected and lose 90 percent of their practices. “Our aim with opposing the merger simply was to get the government to listen to what we were saying about the marketplace; we never dreamed it would act,” Mr. Darrouzet says. Key Findings The DOJ action recognizes that physicians’ ability to negotiate with an HMO depends on their ability to terminate or threaten termination of the contract. It further acknowledges that substantial barriers exist to physicians compensating for a plan’s lost business. The DOJ acknowledged the argument that replacing lost business expeditiously is more difficult when a plan accounts for a large share of a physician’s business, and that Aetna’s “all products” policy exacerbates the situation. This limited ability for physicians to reject Aetna’s contract terms was key to the allegation of anticompetitive behavior.

“Our aim with opposing the merger simply was to get the government to listen to what we were saying about the marketplace; we never dreamed it would act.”

The Next Step Still, Aetna/Prudential will be the largest health insurer in the state and nation, with more than 21 million members nationwide — 2.5 million in Texas. On September 7 DCMS, with the AMA and TMA, sent a letter requesting that the DOJ expand the conditions by which it will allow Aetna’s acquisition of prudential in Dallas and Houston, specifically banning the “all-products” policy for five years. “The divestiture of NYLCare is a good first step,” Mr. Darrouzet says, “But it’s not enough.” ✦ MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

November/December 1999

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

Managed Care Improvement Act Passes in U.S. House A summary of the bill from Iowa Republican Congressman Greg Ganske, a physician member of the House who helped forge the coalition of Democrats and Republicans who voted for the bill.

Introduction The U. S. House of Representatives passed the Bipartisan Managed Care Improvement Act of 1999 on Thursday, October 7, 1999, by an unexpected margin of 275 to 151. The supporters included 206 Democrats, 68 Republicans, and one independent. 149 Republicans and two Democrats opposed the bill. The coalition of support was led by Republican Charles Norwood, a dentist from Georgia, and Democrat John Dingell of Michigan. Others active in the coalition included Republican Greg Ganske, a physician from Iowa, who provided us with the summary of the legislation. The AMA strongly supported the bill and will be lobbying for its passage when the Senate and House Conference Committee meets to hammer out an agreement. The first hurdle for the House version will be that House Speaker Dennis Hastert intends to attach it to another bill that includes $47 billion in tax credits to extend coverage to the 44 million Americans who have no insurance. President Clinton is opposed to the tax credits. A second major hurdle for the House version will be the Senate’s reluctance to expand the liability of the HMOs. Some predict that final Congressional action on the bill may not take place until Congress convenes in 2000. The following is an outline of the provisions of the bill as provided by Rep. Greg Ganske, M.D. Access to Care Emergency Services. Individuals should be assured that if they have an emergency, those services will be covered by their plan. The bill says that individuals must have access to emergency care, without prior authorization, in any situa-

MetroDoctors

tion that a “prudent lay person” would regard as an emergency. Specialty Care. Patients with special conditions must have access to providers who have the requisite expertise to treat their problem. The bill allows for referrals for enrollees to go out of the plan’s network for specialty care (at no extra cost to the enrollee) if there is no appropriate provider available in the network for covered services. Chronic Care Referrals. For individuals who are seriously ill or require continued care by a specialist, plans must have a process for selecting a specialist as a gatekeeper for their condition to access necessary specialty care without impediments. Women’s Protections. The bill provides direct access to ob/gyn care and services. Children’s Protections. The bill ensures that the special needs of children are met, including access to pediatric specialists and the ability for children to have a pediatrician as their primary care provider. Continuity of Care. Patients should be protected against disruptions in care because of a change in plan or a change in a provider’s network status. The bill lays out guidelines for the limited continuation of treatment in these instances. There are special protections for pregnancy, terminal illness, and individuals on a waiting list for surgery. Clinical Trials. Access to clinical trials can be crucial for treatment of an illness, especially if it is the only known treatment available. Plans must have a process for allowing certain enrollees to participate in approved clinical trials, and

The Bulletin of the Hennepin and Ramsey Medical Societies

the plan must pay for the routine patient costs associated with these trials. Drug Formularies. Prescription medications should not be one-size-fits-all. For plans that use a formulary, beneficiaries must be able to access medications that are not on the formulary when the prescribing physician dictates. Choice of Plans. Choice is one of the key components of consumer satisfaction with the health system. The bill would allow individuals to elect a point of service option when their health insurance plan did not offer access to non-network providers. Any additional costs of this option would be borne by the patient.

(Continued on page 9)

November/December 1999

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

(Continued from page 7)

Information Health Plan Information. Informed decisions about health care options can only be made by consumers who have access to information about health plans. This bill requires managed care plans to provide important information so that consumers understand their health plan’s policies, procedures, benefits, and other requirements. Grievance and Appeals Utilization Review. When a plan is reviewing the medical decisions of its practitioners, it should do so in a fair and rational manner. The bill lays out basic criteria for a good utilization review program: physician participation in development of review criteria, administration by appropriately qualified professionals, timely decisions (within 14 days for ordinary care, up to 28 days if the plan requests additional information within the first five days, or 72 hours for urgent situations), and the ability to appeal these decisions.

gagging doctors and from retaliating against providers who advocate on behalf of their patients. It protects providers in these situations from retribution. It also prevents plans from providing inappropriate incentives to providers to limit medically necessary services. Provider Selection. Providers should not be discriminated against based on the basis of license in selection for plan participation. The bill forbids discrimination against providers based on license, location, or patient base. Plans would, however, be able to limit the number and mix of providers as needed to serve enrollees for covered benefits. Prompt Payment of Claims. Health plans should operate efficiently and pay providers in a timely manner. This bill would require that claims be paid in accordance with Medicare guidelines for prompt payment. Paperwork Simplification. In order to minimize the confusion and complicated paperwork that providers face, this bill would require that the industry develop a standard form for providers to use in submitting a claim.

Accountability Insurer Liability. Health plans are not currently held accountable for decisions about patient treatment that result in injury or death. Currently, the Employee Retirement Income Security Act preempts state laws and provides essentially no remedy for injured individuals whose health plans’ decisions to limit care ultimately cause harm. If the plan was at fault, the maximum remedy is the denied benefit itself. The bill would remove ERISA’s preemption and allow patients to hold health plans accountable according to state law. However, plans that comply with an external reviewer’s decision may not be held liable for punitive damages. Additionally, any state law limits on damages or legal proceedings would apply. The provision also protects employers from liability when they were not involved in the treatment decision. It explicitly states that discretionary authority does not include a decision about what benefits to include in the plan, a decision not to address a case while an external appeal is pending or a decision to provide an extra-contractual benefit. ✦

Internal Appeals. Patients must be able to appeal plan decisions to deny, delay, or otherwise overrule doctor-prescribed care and have those concerns addressed in a timely manner. Such an appeal system must be expedient, particularly in situations that threaten the life or health of the patient, and conducted by appropriately credentialed individuals. External Appeals. Individuals must have access to an external, independent body with the capability and authority to resolve disputes for cases involving medical judgment. The plan must pay the costs of the process, and any decision is binding on the plan. If a plan refuses to comply with the external reviewer’s determination, the patient may go to federal court to enforce the decision. The court may award reasonable attorneys’ fees in addition to ordering the provision of the benefit and may assess a penalty against the plan of $1,000 per day up until the benefit is provided. Protecting the Provider-Patient Relationship Anti-Gag and Provider Incentive Plans. Consumers have the right to know all of their treatment options. The bill prohibits plans from MetroDoctors

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November/December 1999

Minnesota Medical Association’s Legislative Update

The first session of Minnesota’s experiment with tri-partisan government ended successfully on May 17, 1999. The legislature commenced in January facing huge revenue surpluses and a multi-million dollar tobacco settlement. It would have been difficult to fail. The outcome was the largest tax cut in Minnesota’s history and the creation of two endowment funds using $968 million of one-time proceeds from the tobacco settlement. The 2000 Legislative Session convenes on February 1, 2000. It will be the second year of the biennium, a nonfunding year, and will last approximately 10 weeks. The legislative agenda is typically limited to “emergency legislation” and capital bonding requests for “brick and mortar” improvement projects throughout the state. However, legislators are not prohibited from introducing legislation and in reality this session is just a scaled down funding session. Revenue forecasts for the legislative session are already projecting large budget surpluses. This will undoubtedly lead

BY DAVID RENNER AND LINDA CARROLL SHERN

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November/December 1999

to continued discussions about tax cuts. Legislative leaders have already mentioned license tabs, sales and property taxes, and the provider tax as possibly being on their agendas. Unfortunately, one of the MMA’s top priorities, the elimination of the provider “sick” tax, did not occur during the 1999 Legislative Session and lobbying efforts will continue throughout the next session. The 21member Coalition to Replace the Provider Tax, of which MMA is a founding member, will continue to educate legislative members on the issue. Since the House of Representatives and the Senate are both up for reelection in November 2000 there is always the danger that legislators will attempt to maximize political effectiveness by reducing those taxes that have high public visibility and ultimately reach more voters. To ensure the reduction or repeal of the provider tax, the issue must remain high on legislative agendas. In an attempt to respond to the issue of charity care, the legislature set aside $10 million in funding for eligible hospitals that provide a disproportionate share of uncompensated care to patients residing outside of the county in which the hospital is located. While this action by the legislature did offer some relief, it did not offer a solution to the problem beyond January 1, 2000. The Commissioner of Health will be reporting back to the legislature on data collected on uncompensated care in hospitals, surgical centers, and health care clinics located in Minnesota. Charity care becomes a concern for provider organizations who are attempting to repeal the provider tax because of competition for the monies available in the legislative budget. Only a limited number of high priced items receive funding. During the last session, Attorney General Mike Hatch initiated patient protection legislation that included a number of patient protection provisions designed to make health care more accountable and to ensure that patients were receiving high quality coverage. Among the provisions included in the legislation was health plan liability, a standardized definition of “medically necessary care,” prior authorization provisions, prohibitions against “one way indemnification clauses,” and it would have required all providers to disclose to patients in writing the precise reimbursement methodology used by the patient’s health plan. Although the bill did not pass out of committee, many of the provisions will most likely reappear during the 2000 Legislative Session. The MMA intends to pursue legislation to address the problem of delayed payments from health plans. Our recent survey shows many payers are routinely over 60 days late in payments to providers. This is unacceptable. There is no reason for clean claims not to be paid within 14 days MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

if electronic claims are used and 30 days if paper claims are used. Legislation was introduced during the last session that referred to itself as the “Complementary and Alternative Health Care Freedom of Access Act.” The language in this bill would have allowed a person referring to himself or herself as a complementary or alternative health care practitioner to practice without the threat of administrative, criminal, or civil action being taken against them. Following extensive lobbying by the Minnesota Medical Association, the bill was “laid over for interim study.” Representative Lynda Boudreau (R-Faribault), the author of the bill, is continuing to work on language and anticipates that the bill will be heard during the 2000 session. The MMA will continue to actively support legislation like the domestic abuse penalties introduced during the 1999 session. This bill was initiated by the MMA and proposed an increased penalty for any person who commits domestic assault in the presence of a child. The MMA has been meeting over the interim with the authors of the legislation in an attempt to work out concerns raised by women’s advocacy groups. The Minnesota Medical Association also had a number of other legislative issues arise at our House of Delegates. Below are a few of the major ones: • Continue to work for the elimination of the “sick” tax. • Seek changes in Minnesota law that would allow for the use of pretax dollars to fund medical savings accounts (MSAs) whether paid by an employer, an employee, or an individual. • Continue to work toward repeal of onerous abortion reporting re-

•

quirements that do not provide any public health value. Require that health plans and other third-party insurers reimburse for the preparation of additional prior authorization requests they require after the initial submission of a plan for the treatment of patients with mental health conditions. Require that a point of service option be made available to all patients who choose to see qualified providers out of network or not under contract. Develop legislation to establish a hospital bed reporting system that produces more useful data and modify the existing hospital moratorium so that hospital bed licenses are not held in a way that jeopardizes public and community interests and innovations to cost-effective care.

Overall, the 2000 Legislative Session should be fast paced and productive. With such a large projected surplus facing our elected officials, we can anticipate “one-upsmanship” on “give it back” tax proposals. Legislators will want to take care of business enabling them to get out into their districts early and start campaigning. Nearly the same conditions are present for the 2000 Legislative Session as were present for the 1999 session. Again, it will be very difficult for the Legislature to fail. ✦ David Renner, Director State and Federal Legislation, Minnesota Medical Association. Linda Carroll Shern, Associate Director State Legislation, Minnesota Medical Association.

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November/December 1999

Collective Bargaining: Is it in Your Future? A growing number of physicians feel they must collectively react to the economic power of large health plans. Introduction The 1990s have seen managed care emerge as the dominant force in health care finance and delivery. Serious questions, however, have been raised about the care patients are receiving under managed care plans. The current national debate in Congress on giving patients the right to sue HMOs is a reflection of the concern that managed care organizations may wield too much power over patients and physicians. Large health plans and insurance companies exert significant leverage over both health care providers and patients in many markets. Their economic power has substantially modified the traditional methods of practice for many physicians, especially for independent self-employed and small group physicians. A growing number of physicians feel they must collectively react to this economic power. This article reviews the recent action taken by the American Medical Association (AMA) House of Delegates, and outlines the legal framework for physicians organizing under current law and takes a look at the future. AMA Supports Collective Action Responding to intense pressure from its membership to do something about the perceived imbalance of power in the relationship between physicians and managed care organizations, the AMA House of Delegates adopted Amended Substitute Resolution 901, “Formation of a National Negotiating Organization,” on June 23, 1999. Resolution 901 contains the following significant provisions for AMA activities aimed at leveling the playing field between managed care organizations and physicians, while emphaB Y G O R D O N J . A P P L E , J .D . & P A M E L A H . G O L D M A N , M.P.H., J.D.

November/December 1999

sizing the AMA’s commitment to patient care: • AMA activities regarding negotiation by physicians will maintain the highest level of professionalism, consistent with the AMA’s Principles of Medical Ethics and Current Opinions of its Council on Ethical and Judicial Affairs. (In other statements the AMA has made it clear that it opposes use of strikes or other collective actions that would compromise patient care. It is also opposed to physicians being required to join collective bargaining units against their wishes.) • The AMA will implement a national labor organization under the National Labor Relations Act to support development and operation of local negotiating units for employed physicians. • The AMA will provide support for development of independent housestaff organizations for resident physicians. These organizations may be voluntarily recognized by hospitals, and in some states may be recognized for collective bargaining. • The AMA will vigorously support antitrust relief for independent physicians and medical groups by promoting federal legislation consistent with the principles of the Quality Health-Care Coalition Act of 1999, by working with the Department of Justice and the Federal Trade Commission, and by continuing to provide model legislation and information on the state-action doctrine to state medical associations and members. • The AMA will continue to advance private sector advocacy programs to stop egregious health plan practices. The remaining provisions of Resolution 901 are based upon the expectation of changes in federal law and will be discussed next. MetroDoctors

Legal Framework Governing Physician Unionization Under current law, physicians fall into three groups with respect to their ability to engage in collective bargaining. The first group is employed physicians in non-supervisory, nonmanagerial positions. The labor laws permit employed physicians to form collective bargaining units, which must be recognized by the NLRB. Once a collective bargaining unit is recognized, all employees who fall within the collective bargaining unit category are obliged to be represented in negotiations by representatives of the collective bargaining unit. The employer is required to engage in good-faith negotiations, and members are authorized to negotiate and take collective actions to raise and standardize wages and improve working conditions. The second group is self-employed physicians, including physicians who are owners of a group practice with some say in the management of the practice. Physicians in independent practice are considered to be independent contractors and are prohibited by the antitrust laws from engaging in collective action concerning issues such as the price of services. The antitrust laws provide for criminal sanctions and civil penalties for prohibited activities such as price-fixing. Thus, under current law, while self-employed physicians are the group most affected by the power of large health plans, they are prohibited from joining together to negotiate terms when contracting with these plans. Under current law, self-employed physicians can join labor organizations, but cannot be represented by them in collective bargaining or negotiations. The third group is resident physicians. Although resident physicians are employed by hospitals, the NLRB considers them students and they are not eligible to organize under the National Labor Relations Act. In states whose laws The Bulletin of the Hennepin and Ramsey Medical Societies

provide an exemption from the antitrust laws under the state action doctrine, residents are able to organize. Some hospitals voluntarily recognize resident organizations. A Look to the Future Much of the future of physicians being able to engage in collective action depends upon the success or failure of organized medicine and its supporters in having Congress pass the Quality Health-Care Coalition Act of 1999 (H.R. 1304). The purpose of this legislation is: “To ensure and foster continued patient safety and quality of care by making the antitrust laws apply to negotiations between groups of health care professionals and health plans and health insurance issuers in the same manner as such laws apply to collective bargaining by labor organizations under the National Labor Relations Act.” This would permit self-employed physicians to join together in negotiating with managed care plans and insurance companies. The Act does not confer any right to participate in any collective cessation of service to patients not otherwise permitted by law. The Quality Health-Care Coalition Act of 1999 was reintroduced in the House of Representatives on March 25, 1999 by Rep. Tom Campbell (R-Ca). It was referred to the House Judiciary Committee, which held a hearing in June, 1999. A vote is expected in the Judiciary Committee before the end of October and if passed, it could go to the full House for a vote before the end of 1999. Passage of this legislation would be a significant step in giving independent physicians greater bargaining power with managed care organizations. AMA House of Delegates Resolution 901 provides that if the Quality HealthCare Coalition Act of 1999 or similar legislation does not become law, the AMA will pursue new antitrust legislation to achieve the same goal. Resolution 901 further provides that when the principles of the Quality Health-Care Coalition Act of 1999 become law, the AMA will implement a national organization to support development and operation of local negotiating units as an option for self-employed physicians and medical groups. Resolution 901 also provides that at such MetroDoctors

time as the National Labor Relations Board determines that residents are authorized to organize under the National Labor Relations Act, the AMA will implement a national labor organization to support local negotiating units as an option for resident physicians. Conclusion In the future it will not be enough for opponents of physician unions to question the professional integrity of physicians who seek professional and economic empowerment through collective action. AMA policy emphasizes that the quality of health care for patients is of utmost importance in its quest to support physicians in regaining power with respect to how decisions affecting delivery of health care are made, as well as reimbursement issues. Passage of federal legislation granting antitrust relief to physicians and other health care professionals, a key component of the AMA’s recently adopted Resolution 901, does not translate into doctors going on strike for higher pay. It will give selfemployed physicians the opportunity to work

The Bulletin of the Hennepin and Ramsey Medical Societies

together to counterbalance the power currently wielded by managed care organizations and health insurance companies. ✦ Gordon J. Apple, J.D. is a health care attorney in St. Paul. He is past Chair of the Health Law Section of the Minnesota State Bar Association and a Center Associate with the Bioethics Center at the University of Minnesota. He was formerly General Counsel of Ramsey Clinic Associates. Mr. Apple has extensive hands-on experience with the legal and policy issues confronting physicians and the health care industry. Pamela H. Goldman, M.P.H., J.D. is a health care attorney in Minneapolis. She is a member of the Health Law Section of the Minnesota State Bar Association. The preceding article is a general discussion of physician union issues and is not intended to be an endorsement of physician unions or legal advice. MetroDoctors publishes this article for informational purposes only.

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November/December 1999

If Not Unions, What Then?

An article in the September/October issue of MetroDoctors discussed the reasons we thought unions were not the answer to physicians’ widespread frustration and anger. We think physicians’ interest in unions is not really for unions, in the strict sense of the term, as much as it is against the effects of managed care. But if not unions, what then? Rep. Tom Campbell (R-CA) has introduced legislation intended to improve the negotiating power of groups of physicians. Washington and Texas have their “solution” which we discussed in the last issue of this publication. These and other “solutions” to us are partial and second best, because they are all adversarial in nature. At the risk of sounding like preachers or personal counselors, our preferred answer has to do with physicians taking charge of their professional lives by taking positive actions to obtain what they want. Adversarial activities, such as organizing unions, and in other ways fighting someone else’s big health plans, are no fun, and provide no professional satisfaction. Granted, physicians of the 1960s, by default, let non-physicians usurp the practice of medicine. That is water over the proverbial dam. Now is the time for physicians to again have fun, and professional satisfaction, by retaking control of the practice of medicine. Let’s get to the basics. Control really means ownership. The most control comes with the most ownership, and control recedes as ownership declines. Retaking control of medical practice may sound like a daunting task, given the complexities of all the business details related to the providing of medical care. But, look at it this way — the essential element, or core business, of a medical care organization is what the doctor does. So why shouldn’t physicians leverage that reality in such a way that they are the center of control as well? Many would say they wouldn’t know where to begin. Not every physician needs to know, but it is essential to have visionary physician leadership. Visionary leadership knows where it is going and how to gather the resources to make it happen. The great truth is that all of the other (nonphysician) services needed to operate a medical care organization, can be purchased by physicians more easily than non-physicians can purchase the services of physicians! This is not to say there is no place for the HealthPartners of the world, for both patients and physicians. This is the place for the many physicians (probably the one in seven that are employed) who do not want the responsibilities of ownership. There is nothing wrong with being

BY MICHAEL ZEILER, J.D. A N D H A R R Y W E R N E C K E , B.B.A.-I.R., M.H.A.

November/December 1999

employed. While we do have suggestions for helping this group have more control (they could be called political in nature), the purpose of this article is to suggest that it is realistic for those physicians with the entrepreneurial spirit to take back the control of their medical practice. Of course, we are not suggesting a return to the “cottage industry” medical practices of the past, for which there is no place in the current U.S. Market. Nor are we addressing the frustrations of those few physicians, probably not located in the metropolitan area, who feel their freedom is lost to best practice guidelines and peer review. There is no room in any system for them.

Now is the time for physicians to again have fun, and professional satisfaction, by retaking control of the practice of medicine. However, physicians with some entrepreneurial spirit and desire for more control over their professional lives can associate and collaborate with other physicians and groups of physicians to provide medical services directly to employee groups, or indirectly, (through an HMO, for example) with some loss of control. Examples of well working physician’s enterprises in the Twin Cities are Minnesota Specialty Physicians and St. Croix Valley Health Care. An example of how to connect with patient groups is the Buyers Health Care Action Group (BHCAG). In addition to carrying out their mission in this metropolitan area, BHCAG is busy around the country helping similar organizations get started. We think the BHCAG concept is one whose time has come. Of course, there is a marketing function in physician enterprise. The cost of this function, even if of department status, would be much less, as a percentage of total costs, than the marketing costs of an insurance company or HMO. In fact, we’re confident that all overhead costs would be less than those of an insurance company or HMO. Two reasons are the smaller more efficient size (yes, smaller can be better, depending on the definition) and the absence of commissions. The best enterprise is the one that functions with the fewest operational problems, the fewest disagreements among the physician owners, MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

and that is the least painful, or the most satisfying, for all the physician owners and employed staff. This kind of system is based on trust, and trust is most readily found between people who already work together in mutually satisfactory relationships. This is epitomized in the St. Croix Valley Health Care Group. Their organization is no more than a formalized version of professional referral relationships that existed informally for many years. If the present network of referral relationships is not sufficiently broad, in terms of specialties, or deep, in terms of numbers of physicians, to meet the requirements of your marketplace, other individuals and groups will need to be recruited. But clearly, the starting place is with the folks most comfortable with each other. The need for capital and the problem of obtaining it, is second in importance to the knowledge of performing the core business; that is, the practice of medicine. Here again, the knowledge of how to obtain the required capital is a skill that can be bought in the marketplace by the physician owners. For successful existing physician groups the additional capital required to expand should not be a major problem. Of course, the physician owners need to be willing to invest financially in their own enterprise. Those reluctant to invest in their own professional futures need to remember that the goal is control, which comes from ownership. Remember, too, that the goal is ownership of the medical practice, not necessarily the facilities. In some situations, ownership of the physical facilities could rest in a separate non-profit organization. This arrange-

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

ment could be uncomplicating in more respects than the complicating factor of relating to it. Could physician controlled health care enterprises evolve to be like insurance companies or large HMOs? Yes, particularly if the enterprise is dominated by one or two individuals. Eternal vigilance is always necessary to maintain freedom. We believe physician controlled health care enterprises will always be distinguished in a superior and positive way from plans controlled by the “financial types,” because the two groups view problems and solutions differently. Incidentally, we also believe that the governance of a physician-owned enterprise is improved by including “consumers” and a “financial type” or two on the governing body. Space here permits only the “big picture”— which is, physicians are the center of health care — a reality that can be leveraged in such a way that physicians are also the center of the control of the health care enterprise. In this setting, the bureaucracies of government, large medical care organizations, and unions, don’t loom quite as large. ✦ Michael Zeiler, JD, is president of Professional Labor Relations Services, Inc., a national firm based in Mill Valley, CA. He has 25 years experience in labor relations for Fortune 100 companies and healthcare employers. Harry Wernecke, BBA-IR, MHA, is midwest director for PLRS. He has 45 years experience in industrial relations, hospital administration, and consulting. He lives in Roseville.

November/December 1999

HMS/RMS Members Active at Minnesota Medical Association Annual Meeting

RMS member Blanton Bessinger, M.D., was elected MMA President-Elect.

HMS member David Estrin, M.D., was elected Secretary of the MMA.

HMS member Gary Hanovich, M.D., was elected Speaker of the House.

800-235-8159

November/December 1999

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

Robert Meiches, M.D., provides testimony at a reference committee.

Duane Engstrom, M.D., and his wife, Marlene.

Dr. Thomas Dunkel (center) receives a MMA Presidentâ&#x20AC;&#x2122;s Award. Pictured here with his wife, Diane Dahl, M.D. and son, Alec Dunkel, M.D.

Lee Beecher, M.D., reference committee chair.

MetroDoctors

Dr. Lynn Ault receives a MMA Presidentâ&#x20AC;&#x2122;s Award from Judith Shank, M.D.

HMS and RMS members caucus together prior to the House of Delegates.

The Bulletin of the Hennepin and Ramsey Medical Societies

November/December 1999

RISK MANAGEMENT

Subpoenas to Search Warrants: What Should You Do?

The county sheriff has served your business manager with a civil subpoena duces tecum, ordering you to appear in court at 9:00 the following Monday. You are ordered to bring a copy of patient Jack Jackson’s medical record or, in lieu of an appearance, you are instructed to send a certified copy to the attorney named on the subpoena. Not wanting to spend half a day in court just to produce a medical record, you instruct your staff to copy the record and send it off to the attorney. You are satisfied that you’ve fulfilled your obligations. Two months later you are served with a medical malpractice summons and complaint, alleging you negligently breached Jack Jackson’s confidentiality by releasing his medical record without his consent. This is accompanied by a formal complaint to the medical licensing board. It turns out that Mr. Jackson’s attorney had responded to the subpoena with a successful motion to quash, or cancel, it. He had successfully argued that the medical records were not relevant to the divorce action and should not be seen by the other party — Mrs. Jackson. Unfortunately, you had already sent the records to Mrs. Jackson through her attorney and she was busily going all around town discussing her soon-to-be-former husband’s herpes and depression. You made a common mistake. Responding to a subpoena quickly seems the right thing to do, but protecting your patient’s confidentiality is your primary obligation. Providing medical records based on a subpoena alone is not always appropriate.

BY MIDWEST MEDICAL I N S U R A N C E C O M PA N Y R I S K MANAGEMENT COMMITTEE

November/December 1999

“This issue is hotly disputed among attorneys,” notes Debra McBride, assistant vice president of risk management. “I have heard many lawyers state that a subpoena demands sending the requested documents immediately. As attorneys, we are accustomed to thinking of subpoenas as having the power to compel action. But when releasing a patient’s confidential medical information, MMIC advises caution to protect the patient.”

Responding to a subpoena quickly seems the right thing to do, but protecting your patient’s confidentiality is your primary obligation. Ms. McBride adds, “A subpoena definitely demands a response. However, the appropriate response may be that the medical record will not be released without patient authorization or a court order.” Various court-generated documents require different actions. MMIC’s risk management department strongly encourages facilities to contact us before responding to any demand for patient records which is not accompanied by the requisite patient authorization. Some guidelines to assist in your decision making: MetroDoctors

Subpoenas There are two basic types of subpoena, “civil” subpoenas issued as part of litigation between two parties, and “criminal” subpoenas, issued as part of a criminal proceeding by the government against an individual. Subpoenas may compel an appearance in court or at a deposition, or they may demand the production of certain documents or things. Your risk management consultant can assist you in determining the type of subpoena and a recommended response. • Civil subpoenas. Appearances vary, but the caption on the document will include the names of two or more people or corporations. “Janet Jackson vs. Jack Jackson” or “Jack Jackson vs. Jesse’s Body Shop.” This indicates the lawsuit is in state civil, not criminal, court. Subpoenas may be signed by a court clerk and may or may not have an official seal. The subpoena may be a “subpoena duces tecum” (pronounced “DOO-kas TAY-kum”), literally “bring documents with you.” This type of subpoena may compel you to appear at a specified time and place to testify under oath that the produced medical records are a true and exact copy kept in the normal course of business at your facility. This testimony allows the records to be placed into evidence. An alternative is typically offered: send a certified copy of the record and skip the live testimony. Every subpoena requires a response. In the case of a subpoena for medical records, not accompanied by patient authorization, immediately tell the requesting party that you cannot release the records without patient authorization or a court order. Follow up in writing and keep it with the pa-

The Bulletin of the Hennepin and Ramsey Medical Societies

•

tient record. The burden falls on the requester to ask the court to order the records or to get the patient’s permission. “This response may anger an attorney who is frustrated by the inability to access an opponent’s medical record,” says Ms. McBride. “Providers have been shouted at and threatened with contempt citations for insisting on patient authorization before releasing a medical record. Your obligation is to protect your patient’s confidentiality and it is appropriate to be cautious and ensure that protection.” Occasionally the time frame is too short and you may have to appear at the appointed place. In that situation, we may advise you to take a sealed copy of the patient’s record, testify that you do not have authorization to release it, and let the court determine whether the requesting party may have the record. Criminal subpoena. The caption will be “State of ___ vs. Jack Jackson.” This indicates there is a criminal proceeding against the individual named. Medical records are often sought in cases charging rape, child abuse, criminal assault, or drug dealing. A criminal subpoena has the same power as a court order (covered below). MMIC recommends calling your risk management consultant to verify the criminal subpoena; typically the records are then released to the court. Court order. Civil court orders are as variable in appearance as subpoenas. The main difference is that both parties to the lawsuit (Jack and Janet Jackson) have gone before a judge and argued whether the patient’s medical records should be produced. If you receive a court order from a judge in your state to release a patient medical record, it usually means the patient lost the argument and the records must be released. Court orders from other states do not have the same power. A court order from another jurisdiction is treated like a civil subpoena; the party must obtain written authorization from the patient before the records may be released. MMIC risk management consultants can review any court order and help you determine how to best respond. Federal subpoenas. Criminal subpoenas

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•

will be captioned, “The United States vs. Jack Jackson” and civil subpoenas will name two individuals and be titled “In United States District Court.” Federal Grand Jury subpoenas will be identified as such in the title. Federal subpoenas for medical records are typically treated like state court orders and do not need to be accompanied by a patient authorization. With all subpoenas, we recommend review by your risk management consultant before responding. Search warrant. Very rarely a search warrant will be issued for patient medical records. Because there are many required legal elements for a valid search warrant, you must seek immediate advice before responding. Either your MMIC risk management consultant or your corporate legal counsel should be contacted if you are presented with a search warrant. Worker’s compensation. In most states, patient authorization is not necessary when releasing medical records pertinent to a

The Bulletin of the Hennepin and Ramsey Medical Societies

worker’s compensation injury. Occasionally worker’s compensation courts will issue subpoenas for records. State laws differ on how these subpoenas are treated; seek appropriate advice before responding. Once a medical record is released, it cannot be “unreleased.” Breaching a patient’s confidentiality may have malpractice ramifications and may result in disciplinary action by your licensing board. Protect yourself by protecting your patients. Ensure that you always either have proper patient authorization to release a medical record or that the law does not require it. MMIC’s risk management staff is your first-line resource for any medical record release question that may arise. ✦ Midwest Medical Insurance Company is a physician-owned malpractice insurer covering physicians, clinics, and hospitals in Minnesota, Illinois, Iowa, Nebraska, North Dakota, South Dakota and Wisconsin. For more information, call 1-800-328-5532.

November/December 1999

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November/December 1999

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

RMS, HMS and MMGMA Collaborate to Form Metropolitan Medical Practice Forum MMPF reviews managed care contracts for physicians

Over the last two years, the Hennepin Medical Society (HMS), the Ramsey Medical Society (RMS) and a metropolitan group of the Minnesota Medical Group Management Association (MMGMA) have collaborated on a project which reviews managed care contracts on behalf of our respective memberships. This has been viewed as an extremely successful activity and one your leadership intends to continue. In joint conversations between representatives of the above organizations, it has become evident that there are a number of other issues and activities that this group would like to pursue. It became apparent through collaboration that working together provides greater impact than any one organization could accomplish on its own. To that end, we are in the preliminary stages of formalizing this collaboration. The Metropolitan Medical Practice Forum (MMPF) is envisioned as a joint activity of RMS, HMS and MMGMA. We have identified other organizations, which may be invited to participate. They include some other components of organized medicine, consumer groups, and physician activist groups. At the onset of the organizing, the group decided to restrict membership to the three original sponsoring organizations in order to concentrate on a very focused agenda. The organizing meeting of this group took place on October 7.

The MMPF evaluated the following: •

Payer contract review. This is the activity that brought us together in the first place and brought favorable comments from the membership. Under this committee, the intent would be to continue and expand contract review to the extent of available resources. We will pursue the idea of establishing a credible benchmark to which

MetroDoctors

we can compare managed care contracts. We will evaluate whether or not the AMA model contract fits this purpose or whether or not we should establish a Minnesota model contract. Any benchmark would be well circulated to our respective members and the payer community. The end game is to advocate for equitable, understandable contracts between the physician and the various insurance products. The organizing committee deemed this issue to be the primary focus in the near term and the issue on which the MMPF will cut its teeth. •

Public Policy Activities. The cornerstone of our public policy initiative would be an extension of a successful program established by the Ramsey Medical Society. The grass roots initiative called “Evening with Your Legislator,” takes place in the home of a physician and invites physicians who reside in the legislative district. It’s a small group focus that’s intended to build a longterm personal link between physicians and their elected officials. The comment that is most often heard from the legislators is that they seldom hear from individual physicians on important health care issues. The intent is to overcome that perception. We would also coordinate with the Minnesota Medical Association any call to action and legislative alerts through these established relationships. In addition and in cooperation with the MMA, HMS and RMS has appointed physician members to a Physicians Advisory Committee for Attorney General Mike Hatch. The Advisory Committee will interact with the MMPF.

The Bulletin of the Hennepin and Ramsey Medical Societies

•

Medical Practice Business Affairs. Under this heading we have identified three areas: (1) The possibility of conducting a payer timely payment survey that effectively measures the impact or extent of arbitrarily pended claims in addition to clean claim payment measurements; (2) responding to requests from members to have their employment contracts evaluated to the same extent that we have reviewed payer contracts; and (3) the expansion of the payer relations meetings that are already in place. These activities will be pursued on a secondary basis as we focus on the contract review initiative.

As you can see, this is an ambitious undertaking, but one that is strongly supported by the leadership of the sponsoring organizations. Further updates will be forthcoming and your input, as always, is appreciated. ✦

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November/December 1999

Ramsey and Hennepin Medical Societies offer the

2000 Winter Medical Conference Mexican Riviera

Saturday, February 26-March 4, 2000 Gala Resort Playacar

The Riveria Maya is a protected area with many remembrances of the fascinating Mayan civilization. Beyond the new Gala Resort Playacar is a temple at Tulum where kings and priests vacationed more than 1,000 years ago. Even within the Resort grounds there are some amazing remains from the Mayan culture. Strategically located a short driving distance from the beautiful 250 acre ecological theme park Xcaret, the resort enjoys a gorgeous stretch of pristine coast-line. At Xcaret visitors may don life jackets and leisurely float with the cool water currents through a series of caves and streams. There is also a “Dolphinarium”, botanical garden museum and riding stables.

ALL INCLUSIVE RATES (AIR AND HOTEL) $1,849* per physician/single $1,149* per spouse/guest, double occupancy $1,069* for children 12-15 years old $829* for children 7-11 years old $349* for children under 7 years old (children under 2 years old are free) * Please add $69.00 per air seat for departure tax and fees.

(This does not include the conference registration.)

ABOUT THE RESORT The Gala Resort Playacar is a deluxe, all-inclusive resort located on a glorious sandy beach, a short distance from the village of Playa del Carmen and the ferry dock to Cozumel. Each of the 300 deluxe rooms feature airconditioning, satellite color TV, telephone, mini-bar with mineral water, soft drinks and beer, safety box, hair dryer, and a balcony with garden, partial or full ocean view. The hotel features four swimming pools (one is “Adults only”), four lighted tennis courts, gym with steam room and nautilus exercise equipment, volleyball and basketball courts, water sports center (scuba diving, snorkeling, windsurfing, kayaking and sailing), discotheque, indoor/outdoor theater, and children’s “Galaxy Kids Club”. Available at an extra cost is the game arcade, massages and beauty parlor, golf, deep sea fishing, excursions (Arqueological Sites Tulum, Ecological Park Xcaret), and wave runners.

Space is Limited: Register early to guarantee your reservation.

Call Becky at Hobbit Travel (612-338-8452 ext. 2) or RMS/HMS (612-362-3704) 22

November/December 1999

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

METRODOCTORS.COM

“metrodoctors.com” Continues to Enroll Physicians Over 3,500 physicians are currently listed in the directory

In the last 90 days, a substantial amount of progress has been made with “metrodoctors.com”. As you will recall “metrodoctors.com” is a joint project of the Ramsey and Hennepin Medical Societies and builds on the experience of RMS with their web page. As of October 1, over 3,500 physicians are listed in the directory. Physicians are listed by specialty by eight geographic areas. A search can also be done by alphabetic listing or by clinic/ practice name. The original listing included the physician’s name, practice name, specialty, practice phone number and address. In many of our communications over the last 60 days, we have requested that physicians complete a census sheet either manually and send it to us, or on-line electronically. We are pleased with the response. A large number of the HMS/RMS membership or their clinic personnel have provided the information to create their own personalized “mini” web page. For the several hundred of you that have provided the information, we thank you. Most who have completed the census form did so on-line. To review the process for on-line submission, simply go into the web site at HYPERLINK “http://www.metrodoctors.com/census” and complete the form. As a suggestion, we recommend that you be sure to complete the “practice description” and the “achievements” sections. We have found that the public is interested in this additional information when doing a search for a physician. One aspect of the web page that we haven’t spent as much time with as we would have liked is the inclusion of credible health information available to your patients. As you might imagine, this can be a maintenance nightmare. That’s one reason we have gone slowly. We are happy to report that we have had preliminary discussions with organizations that have an interest in providing and maintaining health information that would meet the general population’s and your patients’ needs. We see this as adding significantly to the value that the public and your patients get from accessing “metrodoctors.com”. The Hennepin and Ramsey Medical Societies have engaged the services of a marketing consultant to guide us in the implementation of a promotional plan. We plan to start the promotion of “metrodoctors.com” to the public in November/December. We anticipate that you will start seeing ads in the public media during this time frame. Without any promotion, “metrodoctors.com” has been visited almost 2,000 times between August 23 and October 6, a period of six weeks. We have the ability to track this information on an ongoing basis and we plan to chart the visits to measure the effectiveness of the promotional campaign. MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

A special thanks to those physicians and clinic personnel who have provided to us valuable advice and suggestions as we refine the medical societies web presence. ✦

November/December 1999

P R E S I D E N T ’ S M E S SA G E LY L E J . S W E N S O N , M . D .

RMS-Officers

President Lyle J. Swenson, M.D. President-Elect John R. Gates, M.D. Past President Thomas B. Dunkel, M.D. Secretary Robert C. Moravec, M.D. Treasurer Peter H. Kelly, M.D. RMS-Board Members

Kimberly A. Anderson, M.D. John R. Balfanz, M.D. James A. Brockberg, M.D. Charles E. Crutchfield, M.D. Peter J. Daly, M.D. Aimee George, Medical Student Michael Gonzalez-Campoy, M.D. James J. Jordan, M.D. F. Donald Kapps, M.D. Charlene E. McEvoy, M.D. Joseph L. Rigatuso, M.D. Thomas E. Rolewicz, M.D. Jamie D. Santilli, M.D. Paul M. Spilseth, M.D. Jon V. Thomas, M.D. Randy S. Twito, M.D. Russell C. Welch, M.D. Phua Xiong, M.D., Resident Physician RMS-Ex-Officio Board Members

Blanton Bessinger, M.D., MMA House of Delegates Speaker Chad Boult, M.D., Council on Professionalsim & Ethics Chair Kenneth W. Crabb, M.D., AMA Alternate Delegate Duchess Harris, Alliance Co-President Neal R. Holtan, M.D., Community Health Council Chair Nicki Hyser, Alliance Co-President Frank J. Indihar, M.D., AMA Delegate William Jacott, M.D., U of MN Representative C. Randall Nelms, M.D., AMA Specialty Delegate Robert W. Reif, M.D., Sr. Physicians Assoc. President William M. Rupp, M.D., Joint Contract Review Program Chair Melanie Sullivan, Clinic Administrator Kent S. Wilson, M.D., MMA Past President RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive Officer Doreen Hines, Assistant Director

November/December 1999

Part of the current evolutionary change in health care in the United States has been a growing reliance on legislation to modify and regulate health care delivery and financing. In the past, fundamental changes in health care have been brought about by legislation, prime examples being the Medicare and Medicaid programs on a national level, and the MinnesotaCare program in our own state. With the failure of the Clinton Health Plan in 1994, efforts at true fundamental change have largely been abandoned, and an incrementalchange approach has been accepted. In Minnesota, legislation has also had the effect of bringing incremental change to the MinnesotaCare program and to other specific issues. The trend towards more legislation to continually modify and control health care delivery and financing has both good and bad effects. One of the most contentious and highly publicized issues last year and this year has been patient protection legislation. Because large health care corporate entities have become very powerful, legislation to ensure patients’ rights serves an important purpose. On the dark side, one can envision continued growth in legislative mandates and regulations that eventually become so controlling and complex that health care delivery becomes overly complicated and unworkable. We have already seen examples of this type of complexity with the evaluation and management coding required by the Medicare program. Can incremental change through legislation solve the most difficult health care problems we face, such as over 40 million uninsured individuals, high and escalating costs, threatened viability of our academic health centers, and increasingly fragmented and confusing health care delivery environment? Probably not. The reality, however, is that our society is becoming more dependent on legislation to control and modify health care. Therefore, we as physicians must continue to be involved with these efforts, so that our perspective and interests will favorably influence legislation for our MetroDoctors

profession and our patients. Involvement can be as individuals and through physician organizations. As individuals, we must exercise our right to vote, and we must communicate our views to our elected officials. Many different physician organizations provide opportunities to be politically active at the local, state, and national level. On the local level, the physicians of the Ramsey Medical Society have recognized the need for political activism and participation in the legislative process. RMS works with the Minnesota Medical Association on state-wide issues by providing representatives to the MMA Committee on Legislation, and by promoting RMS members for MMA office, thereby providing direction to our lobbying efforts at the state capitol. RMS has been very active in engaging elected officials and candidates for public office in productive discussion at our fall and annual meetings. One of our most successful programs to increase participation in legislative efforts has been regular “get to know your legislator” events sponsored by the Public Policy Council. These are informal events in physicians’ homes, with the two state representatives and the state senator from a given legislative district invited for an open give-and-take on health care issues. It has been very helpful to coordinate these efforts with the MMA and ensure participation of MMA lobbyists. These events are held when the legislature is not in session and provide an opportunity for physicians to get to know their elected representatives and develop a working relationship with them. I encourage every physician to participate in these meetings, and also to consider hosting one of these events. The physicians of our community need to be politically involved. There are many avenues for that involvement, and your medical society provides one of the best opportunities. ✦ The Bulletin of the Hennepin and Ramsey Medical Societies

RMS NEWS Ivan W. Sletten, M.D. University of Wisconsin-Madison Psychiatry Human Services, Inc.

Applicants for Membership

Active Susan J. Austin, M.D. University of Minnesota Diagnostic Radiology St. Paul Radiology, P.A. Edwin Burrell, M.D. University of Minnesota Family Practice MinnHealth Family Physicians Arturo Camacho, M.D. University of Illinois Neurosurgery Millennium Neurosurgery Carol L. Clark, M.D. Wayne State University Emergency Medicine HealthEast St. John’s Hospital Victor S. Cox, M.D. University of Minnesota Otolaryngology Otolaryngology & Head & Neck Surgery, P.A. John S. Dickhudt, M.D. University of Minnesota Family Practice MinnHealth Family Physicians Alexander J. Dunkel, M.D. University of Minnesota Internal Medicine St. Paul Internists, P.A. Stanley C. Go, M.D. University of the Philippines Internal Medicine/Gastroenterology Minnesota Gastroenterology, P.A. John A. Green, M.D. Dartmouth Medical School Family Practice/Sports Medicine North Suburban Family Physicians, P.A.

MetroDoctors

Teresa L. Gurin, M.D. Wayne State University Physical Medicine & Rehab United Rehab Physicians

David C. Thorson, M.D. University of Minnesota Family Practice MinnHealth Family Physicians

Luann Q. Hunt, M.D. University of Minnesota Family Practice MinnHealth Family Physicians

Theresa M. Wollan, M.D. University of Minnesota Family Practice MinnHealth Family Physicians

Sawuya Lubega, M.D. Makerere University Family Practice Wilder Senior Health Care

Resident Rahul Koranne, M.D. Maulana Azad Medical College Internal Medicine Wilder Senior Health Clinic

Teresa McCarthy, M.D. University of Minnesota Internal Medicine/Geriatrics Wilder Senior Health Clinic Cameron McConnell, M.D. University of Minnesota Family Practice MinnHealth Family Physicians Jeanne M. Nelson, M.D. University of Minnesota Pulmonary Medicine Northwind Lung Specialists, P.A. James I. Nolan, M.D. University of Minnesota Family Practice MinnHealth Family Physicians Elisabeth J. Paszkiewicz, M.D. University of Texas Urology Metropolitan Urologic Specialists, P.A. Troy E. Rustad, M.D. George Washington Univ. School of Medicine & Health Sciences Dermatology Advanced Skin Care Institute/Medical, Surgical & Cosmetic Dermatology, P.A. Michael Shreve, M.D. University of Minnesota Pediatrics Children’s Respiratory & Critical Care

The Bulletin of the Hennepin and Ramsey Medical Societies

Ramsey Medical Society

We welcome these new applicants for membership to the Ramsey Medical Society.

Brett W. Teten, M.D. St. Louis University School of Medicine Internal Medicine Medical Associates of Minnesota, P.A./ St. Paul Internists, P.A.

Student (from the University of Minnesota)

Cynthia K. Brenden Donald T. Buisman Mark J. Carlson Robert T. Chapdelaine Eric C. Crabtree Thom G. Dahle Kelley C. duFord Michael P. Finch Michael R. Galle Marisa J. Getter Michelle L. Glenna Amy K. Greminger Angela K. House Patti Y. Jordan Milind Y. Junghare Tara Karan Jennifer M. Lee Michael J. Lushine Khurram J. Malik Karra M. Markley Susan M. McCarthy David R. Nascene Eric C. Pearson Matthew G. Pollema Kyla M. Rice Martin E. Richards, Jr. Jennifer B. Roberts Alexander J. Schad Sharon K. Smith Kurt E. Walstrom Laura E. Willson Charlie W. Wu ✦

November/December 1999

RMS Members to Elect Officers and Board for Year 2000 Ballots for the election of RMS Officers and Board members for the Year 2000 will be in the mail in November. RMS members will be asked to vote for three officers, two at-large Board seats, and delegates and alternate delegates to the MMA House of Delegates. Specialty Board members will be elected for Family Physicians, OB-GYN, Pediatrics, and Psychiatry by the members of each specialty. The nominees are: PRESIDENT-ELECT: Robert C. Moravec, M.D.; Emergency Medicine; medical director of HealthEast Care, Inc. and of HealthEast Medical Education; and current Secretary of RMS. SECRETARY: Jamie D. Santilli, M.D.; Family Physician; University Family Physicians-Bethesda Clinic; specialty director for Family Physicians on the RMS Board of Directors. TREASURER: Peter H. Kelly, M.D.; General Surgery; St. Paul Surgeons, Ltd.; president of HealthEast medical staff; current Treasurer of RMS. DIRECTORS-AT-LARGE Charles E. Crutchfield, III, M.D. Dermatologist, Dermatology Consultants, P.A. Russell C. Welch, M.D. Anesthesiology, Associated Anesthesiologists, P.A.

Ragnvald Mjanger, M.D. OB-GYN, St. Paul OB-GYN, Ltd.

Jeffrey Larson, M.D. Occupational Medicine, Multicare Associates

Thomas F. Rolewicz, M.D. Pediatrics, HealthPartners Medical Group

Diane Ogren, M.D. General Surgery, St. Paul Surgeons, Ltd.

MMA DELEGATES (In addition to 22 Board Members) John R. Balfanz, M.D. Pediatrics, Pediatric and Young Adult Medicine Past RMS President

Ivan Sletten, M.D. Psychiatry, Human Services, Inc.

Blanton Bessinger, M.D. Pediatrics, Children’s Hospitals and Clinics President-elect, MMA

Frank J. Indihar, M.D. Internal Medicine, St. Paul Internists, P.A. AMA Delegate William M. Rupp, M.D. General Surgery, St. Paul Surgeons, Ltd. Past RMS President MMA ALTERNATE DELEGATES Richard L. Baron, M.D. Pediatrics, Pediatric and Young Adult Medicine Chad E. Boult, M.D. Geriatrics, University of Minnesota Alexander J. Dunkel, M.D. Internal Medicine, St. Paul Internists, P.A.

Mark E. Wiest, M.D. Family Physician, MinnHealth

Robert W. Geist, M.D. Urology, Retired

November/December 1999

Peter B. Wilton, M.D. General Surgery, St. Paul Surgeons, Ltd. ✦

Kenneth W. Crabb, M.D. OB-GYN, Advanced Specialty Care for Women AMA Alternate Delegate

SPECIALTY DIRECTORS James J. Jordan, M.D. Psychiatry, Hamm Clinic

Kent S. Wilson, M.D. Otolaryngology, Otolaryngology, Head and Neck, P.A. Past RMS and MMA President

MetroDoctors

In Memoriam BUDD APPLETON, M.D., an ophthalmologist, died Saturday August 28 of a heart attack. He was 70. A graduate of the New York Medical College, he served in the Army from 1954 until he retired as colonel in 1978. Dr. Appleton was chief of the ophthalmology service at Walter Reed Medical Center from 1967 until his retirement. He also was ophthalmology consultant to the Surgeon General of the Army. Dr. Appleton was on staff at Regions and United hospitals and on the faculty at the University of Minnesota Medical School of Medicine. He was a past president of the Minnesota Academy of Ophthalmology and the Joint Commission of Allied Health on Ophthalmology. Dr. Appleton was a nationally recognized author on the effect of microwaves on the eyes. ✦ The Bulletin of the Hennepin and Ramsey Medical Societies

RMS ALLIANCE NEWS DUCHESS HARRIS, Ph.D.

In 1979 Genesis II secured long-term funding through the purchase of service contracts with both the Hennepin and Ramsey County Community Services. The program focus at this time shifted to include some women who would participate in lieu of a prison sentence and women who were part of a probation plan. As the program developed, it became obvious that rehabilitating the women as the sole focus was not truly addressing the problem. Many of the women in treatment had young children whose lives had been devastated by their mother’s problems. Furthermore, many of the women had never learned to parent. So in 1981, Genesis II added a structured parenting education component to the treatment plan. The outcomes at Genesis II are stunning. The staff, which includes licensed psychologists and social workers, report the following: only one of the women out of 96 was reported for child abuse in 1995; only three out of the 96 were reported for neglect; 70 percent of the mothers who participated in the program for at least three months demonstrated improved parenting behavior; 98.4 percent of the children in the child care program who attended for at least three months exhibited age appropriate behaviors; 66 percent of the children returned

Jeffrey Hill, RMS Alliance member, received the MMA “Stop the Violence Award” at the recent MMA Annual Meeting for his extensive volunteer work with the Sexual Violence Center (SVC). Jeffrey takes calls on the crisis line and he teaches high school students about the dangers of date rape. Jeffrey Hill is pictured with the award and he is flanked on the left by Barbara Rogers, SVC volunteer training coordinator and on the right by Lynnea Forness, SVC administration and communication coordinator. Jeffrey is the spouse of Diane Ogren, M.D.

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

home from foster care during the year. One of the wonderful components of the Genesis II program is that they have a graduate of the program on its board of directors. It was in this capacity that I was able to meet several women who have become positive parents. Why does Genesis II work? The name says it all — Genesis means beginning. With this in mind, this organization’s mission is to provide a second beginning for women who have had a difficult time in life. How many of us would like to have a second chance? Have you ever made a mistake, particularly with the rearing of your child that you’d like to undo? I have, and my child is only nine months old. Many of the women at Genesis II are learning how not to hit their children. Have you ever hit your child? Lots of parents hit their children to protect them — “Don’t touch the stove!” Some parents hit their children when they are scared — “Don’t ever run out in the street again, you could have gotten hit by that car!” But when we hit our children out of frustration, it takes on a different meaning. At our Alliance Health Fair I volunteer at the “Hands are Not for Hitting” booth. I spend an entire day telling third graders that they should not hit each other. The kids at the health fair often seem distracted, and I wonder if I make a difference. The staff at Genesis II have committed their entire careers to telling adults that even if they are getting evicted, they cannot hit their children. I stand in the shadow of excellence. I dedicate this article to the clients and the members of the staff who have faced the challenge of improving upon the most difficult job there is — parenting. For those of you who attended the Alliance’s first program, thank you for helping us do our small part to Stop America’s Violence Everywhere. ✦

November/December 1999

Ramsey Medical Society

Rumor has it that my last article engendered quite a readership. Now that I’ve gotten your attention by discussing things in a light manner, it’s time for me to take a more serious tone. The Ramsey Medical Society Alliance’s opening event was held on October 6 in honor of the AMA’s National SAVE program. SAVE is an acronym for Stop America’s Violence Everywhere, and medical society Alliances throughout the nation have been hosting programs in the month of October around this theme for several years. The event that our Alliance hosted was an art show to raise awareness and donate funds to an organization that is near and dear to my heart — Genesis II for Women, Inc. Genesis II was the first community-based corrections program for women in the state. In 1973 there was movement in the correctional field with the passage of the Community Corrections Act. This piece of legislation supported increased utilization of community resources in the treatment of the offender. The prevailing beliefs were that certain categories of offenders were not a danger to public safety, did not require incarceration, and could use a more therapeutic atmosphere than prison. Community corrections was seen as a cost effective alternative to incarceration.

November/December 1999

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

HMS IN ACTION JACK G. DAVIS, CEO

HMS-Officers

HMS-Board Members

Michael Belzer, M.D. Carl E. Burkland, M.D. Penny Chally, Alliance Co-President William Conroy, M.D. Rebecca Finne, Alliance Co-President Daniel F. Greeley, M.D. Raymond A. Hackett, M.D. James P. LaRoy, M.D. Michael Lins, M.D. Edward C. McElfresh, M.D. Joseph F. Rinowski, M.D. Marc F. Swiontkowski M.D. T. Michael Tedford, M.D. R. Douglas Thorsen, M.D. Clark Tungseth, M.D. Joan Williams, M.D. Bret Yonke, Medical Student HMS-Ex-Officio Board Members

Lyle French, M.D., Senior Physicians Association Lee Beecher, M.D., MMA-Trustee Karen Dickson, M.D., MMA-Trustee John W. Larsen, M.D., MMA-Trustee Robert K. Meiches, M.D., MMA-Trustee Henry T. Smith, M.D., MMA-Trustee Richard W. Davenport, MMGMA Rep. HMS-Executive Staff

Jack G. Davis, Chief Executive Officer Nancy K. Bauer, Associate Director

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

David Estrin, M.D. was installed as the Chair of the Hennepin Medical Society

at its annual meeting held on October 13, 1999. Virginia Lupo, M.D. succeeded to President, and Edward A. L. Spenny, M.D., became immediate past chair. Sixty-five HMS physicians served as Delegates to the Minnesota Medical Association’s annual meeting,

September 26-28 at Madden’s Resort in Brainerd, MN. Drs. Michael Ainslie and Karen Dickson served as Caucus co-chairs. HMS submitted 19 resolutions which inspired timely debate and discussion. After a successful year as MMA President, Judith Shank, M.D. transferred the medallion of leadership to John Van Etta, M.D. of Lake Superior Medical Society, Duluth. Gary Hanovich, M.D., was elected as Speaker of the House. David Estrin, M.D. was elected secretary of the MMA. Robert Meiches, M.D. and Lee Beecher, M.D. were elected to serve as west metro Trustees. Benjamin Whitten, M.D. was elected alternate delegate to the American Medical Association. Winston Wallin, retired Medtronic CEO and Chairman of the Board, received the Shotwell Award for his enthusiasm and commitment to the University of Minnesota Hospital under president, Nils Hasselmo. Joe Dowling, executive director of the Guthrie Theater, was the featured speaker at the September Senior Physicians Association quarterly meeting.

Diane A. Dahl, M.D., president of the Hennepin Medical Foundation, and Nancy Bauer, HMS associate director, presented the Thomas P. Cook Scholarship to medical student, James J. Suel, at the Minnesota Medical Foundation’s Fall Scholarship Reception. As a member of the Dakota Healthy Families steering committee, Nancy Bauer participated in a site visit by the McKnight Foundation in support of the $2 million grant request. Twenty HMS/RMS physicians attended the dialogue with Gordon Sprenger. All HMS physicians received a pre-dues letter from David Estrin, M.D. describing the activities of the society this past year and noting the importance of giving back to the profession. A brief membership survey with questions centering on dues and unification for the county and state organization was included. A non-member survey was also conducted. The Minnesota Medical Association Alliance will again be the beneficiary of the Hennepin Medical Foundation’s participation in the “Southdale Magical Evening of Giving” event to be held Sunday, November

21, 1999, 6:30-10 p.m. Each person under age 12 entering Southdale Shopping Center for an evening of discounts and entertainment must have a $5 ticket. Contact Nancy Bauer at 612-623-2893 for tickets. A joint HMS/RMS Community Internship Program is slated for November 810, 1999. (Continued on page 31)

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

November/December 1999

Hennepin Medical Society

Chair David L. Estrin, M.D. President Virginia R. Lupo, M.D. President-Elect David L. Swanson, M.D. Secretary Richard M. Gebhart, M.D. Treasurer Michael B. Ainslie, M.D. Immediate Past Chair Edward A.L. Spenny, M.D.

HMS NEWS Edwin D. Turner, M.D. Northwestern University Medical School Emergency Medicine Emergency Physicians Professional Association

Awards Presented at HMS Annual Meeting

Jill Wruble, D.O. NY College of Osteopathic Medicine Diagnostic Radiology/Abdominal Imaging Suburban Radiologic Consultants, Ltd. Alberto G. Zenti, M.D. U of Osteopathic Medicine & Health, Des Moines Family Practice Comprehensive Medical Care

Fellowships Mathew T. Baldwin, M.D. Mayo Graduate School of Medicine Radiology St. Paul Radiology, P.A.

David Estrin, M.D., incoming chair, presents Edward A.L. Spenny, M.D., outgoing chair, with the Chair’s Award.

Gordon Sprenger, president & CEO, Allina Health System (right) presents Winston Wallin with the Shotwell Award.

William B. Nelson, M.D. University of Wisconsin Hospitals and Clinics Nuclear Cardiology Minnesota Heart Clinic Mark Alan Pilot, M.D. University of Wisconsin Hospitals and Clinics Body Imaging Minneapolis Radiology Associates, Ltd. James Robert White, M.D. Wake Forest University School of Medicine Epilepsy MINCEP Epilepsy Care

New Members HMS welcomes these new members to the Society as of September 1, 1999. Schools listed indicate the institution where the medical degree was received.

David G. Hurrell, M.D. Mayo Clinic Cardiology Minneapolis Heart Institute

Kari Ann Baum, M.D. Medical College of Wisconsin General Pediatrics Southdale Pediatrics

J. Joshua Plorde, M.D. University of Washington Diagnostic Radiology/Interventional Radiology/Angiography Suburban Radiologic Consultants

Peter Burritt Chase, M.D. University of Arizona Emergency Medicine Emergency Physicians and Consultants, P.A. Susan Lynne Evans, M.D. Medical College of Wisconsin Neurology/Neuromuscular Disease Noran Neurological Clinic, P.A. David A. Evenson, M.D. University of Wisconsin-Madison Pediatrics Metropolitan Pediatric Specialists, P.A. 30

November/December 1999

Resident Krisa Keute Christian, M.D. University of Minnesota Internal Medicine Hennepin County Medical Center

Jason J. Reed, M.D. University of Iowa Internal Medicine Cardle, Vaurio & Schmidt, M.D., P.A. Leonardo A. Saavedra, M.D. University of Minnesota Emergency Medicine North Memorial Health Care Charles G. Terzian, M.D. Universidad Antencina Guadalajara, MX Internal Medicine Minneapolis Medical Arts Clinic MetroDoctors

Anna D. Guanche, M.D. Louisiana State University, New Orleans Dermatology Hennepin County Medical Center Andana Tulia Gutter, M.D. University of Medicine and Pharmacy “Iuliu Hatieganu,” Cluj, Romania Internal Medicine University of Minnesota Jacalyn Anne Kawiecki, M.D. University of Minnesota Physical Medicine & Rehabilitation Hennepin County Medical Center

The Bulletin of the Hennepin and Ramsey Medical Societies

Marc Leo Martel, M.D. Chicago Medical School Emergency Medicine Emergency Physicians Professional Association James R. Mines, M.D. Mayo Medical School Emergency Medicine Hennepin County Medical Center

Patrick M. Ridgely, M.D. University of Minnesota Psychiatry Hennepin County Medical Center Stephen W. Robinson, M.D. University of Minnesota Family Practice North Memorial Family Physicians Robert B. Rock, M.D. University of Minnesota-Twin Cities Internal Medicine Hennepin County Medical Center Carol J. Schlueter, M.D. University of IL -Urbana Pathology Fairview-University Medical Center Kristen Lee Stevens, M.D. University of Minnesota Internal Medicine Abbott Northwestern Hospital Anne L. Viestenz, M.D. University of North Dakota School of Medicine Surgery Hennepin County Medical Center Orvin P.O. Visaya, M.D. Hahnemann University School of Medicine Internal Medicine-Nephrology Kidney Disease/Critical Care Associates, P.A. David C. Wahoff, Ph.D., M.D. University of Minnesota General Surgery/Pediatric Surgery Pediatric Surgical Associates, Ltd.

Student Adam J. Boyer University of Minnesota

MetroDoctors

Jennifer Joy Fischer University of Minnesota Laura S. Mayer University of Minnesota Sue E. Mount University of Minnesota Erin C. O’Fallon University of Minnesota Sara Beth Sczepanski University of Minnesota Rochelle Ann Wolfe University of Minnesota

Transfer into HMS Joan F. Dawson, M.D. University of New England OB/GYN HealthPartners Brooklyn Center Scott Edward LeBard, M.D. Loma Linda University, California Anesthesiology Metropolitan Anesthesia Network Timothy James Pehl, M.D. University of Minnesota Family Practice Creekside Family Physicians ✦

Sr. Physicians Assoc.

HMS in Action (Continued from page 29)

Virginia Lupo, M.D. has agreed to host the first HMS “Evening with your Legislator.” The purpose of this event is for physicians to meet and dialogue casually with their legislators in advance of the legislative session. Drs. Barry Bershow and Jon Wogensen participated in a Visitation Program arranged by Daniel Greeley, M.D. The Visitation Program provides an opportunity for HMS staff to learn from the practicing physicians their concerns and ideas about the profession and the medical society in general. HMS hosted its first New Member Orientation Breakfast providing an opportunity for new members to get acquainted with the leadership, staff and activities of the medical society. Jack Davis and Roger Johnson greeted the incoming medical student class at their orientation picnic and distributed canvas bags and mousepads with the metrodoctors.com logo imprinted. Nearly 200 first and second-year medical students attended the September “Lunch ’n Learn” session sponsored by HMS and RMS. Drs. Robert Christensen, Judith Shank and Michael Gonzalez-Campoy spoke on the importance of participating in organized medicine on all levels: the AMA, MMA and county society. Jack Davis has been elected to the board of the Minnesota Visiting Nurses Association. ✦

Upcoming Meetings Tuesday, November 9 Tim Penny, former congressman and Sr. Fellow at Humphrey Institute Tuesday, April 11 Greg Plotnikoff, M.D. “Spirituality and Complementary Medicine” Tuesday, June 13 Judge Isabel Gomez ✦

The Bulletin of the Hennepin and Ramsey Medical Societies

Reminder… metrodoctors.com census sheet can be completed online. www.metrodoctors.com/census

November/December 1999

Hennepin Medical Society

Rebecca Ann Ralston, M.D. University of Minnesota Internal Medicine Hennepin County Medical Center

J. Eric Derksen University of Minnesota

HMS ALLIANCE NEWS P E N N Y C H A L LY

October is a special month for Alliances throughout the United States. It is the month designated as SAVE (Stop America’s Violence Everywhere) and Children’s Health Month. Special events or programs are showcased during this month that are related to SAVE and children’s health, even though many Alliances, like our own, have projects that are related to stopping violence and children’s/youth health during other times of the year. The Hennepin Medical Society Alliance is joining with the Minnesota Medical Association Alliance on the “You Are Gloved” project. We are collecting new mittens and gloves for pre-school through sixth grade children that will be sent to the Grand Portage Reservation Elementary School and the Leech Lake Reservation Head Start. They will be collected in October and given to Dianne Fenyk to be delivered north before the snow flies. In addition, the Hennepin Alliance has decided to extend our time of the mitten collection and to deliver additional mittens and gloves to the Banneker Community School in Minneapolis. Here is how you can help. You can send mittens or a monetary contribution made out to the Hennepin Philanthropic Alliance designated for “You Are Gloved” to Penny Chally, 2218 West Hoyt Ave. St. Paul, MN 55108. This project is an example of the connections that Alliances have with each other. Last year the North and South Dakota Alliances initiated this program to collect gloves and mittens for children on reservations in those states. This year we, in Minnesota, were asked to join them in this simple health promotion and community relations project. Please, as a physician reading this article, consider helping us with this project. In addition to the above projects, the Hennepin Medical Society Alliance held a joint event with the Ramsey Alliance on Wednesday, October 27. The day began with a tour of the Crisis Nursery in Golden Valley. Our Alliance has helped with donations to this Nursery in past years. We asked people coming to the Nurs-

November/December 1999

ery for the event to bring diapers, pull-ups, or other donations to help the babies and children served at the Nursery. After the tour, we had lunch at the Golden Valley Country Club with guest speaker, Barbara Knutson, an author and illustrator of children’s books. Other community commitments include: a donation to Success by 6® for bus tokens to be used for participants in a series of family sessions. We also gave money to the Annex Teen Clinic in Robbinsdale for “Let’s Talk Month.” Members of our Alliance attended the Minnesota Medical Association Alliance meeting on October 13. At this meeting, Dr. Mark and Judi Bolander told their story of Mark’s liver transplant. Mark is an orthopedic surgeon and a nationally recognized research scientist at the Mayo Clinic. Judi is a board member of the Season’s Hospice where she also serves as lay chaplain. Judi is also a past president of the Zumbro Valley Alliance. At this time, the Minnesota Medical Association Alliance officially launched the advocacy program on the need for organ donors called the “Live and Then Give” program. More information will be forthcoming. Did you know that there are tips for healthy kids on the Web? KidsHealth at the AMA is a compilation of current, practical and scientifically accurate health information for parents. The information starts from birth to when a child leaves for college. It is for anyone interested in learning more about health and diseases. Bonnie Chi-Lum, M.D., M.P.H. is the site’s editor in chief. She practices and teaches at Loma Linda University School of Medicine in California. Her favorite part of the site is KidsHealth, Human Atlas, and daily medical news. Men’s Health, more modules in KidsHealth, and a mini-medical school are in the pipeline. The site is www.ama-assn.org under the category Health and Fitness Information. With all that is on the Web these days, it’s good to know about this particular site that provides professional consumer-oriented health information. Share the knowledge of this site with family, friends, and patients. MetroDoctors

Thanks to Dr. Spenny from the Alliance. We appreciate all the support he has given to us. We look forward to working with Dr. Estrin and continuing the excellent relationship between the Alliance and the Society. ✦

Upcoming Events

Southdale Magical Evening of Giving Sunday, November 21, 6:30-10:00 p.m. Tickets —$5.00. When you buy a ticket, designate Hennepin Medical Foundation. The donations will be given to the Hennepin Alliance for the AIDS/ HIV educational folder for middle school students.

Holiday Tea at Tom and Susan Christiansen’s home Friday, December 10 7701 Stonewood Court, Edina We raise money for BODYWORKS (our health program for 3rd grade students) by having a silent auction at this time. To give wonderful donations to the auction or to get more information on the event, call HMS at 612/623-2881. Also visit us at our website www.hmsa.net.

The Bulletin of the Hennepin and Ramsey Medical Societies

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