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CONTENTS VOLUME 11, NO. 1
2
JANUARY/FEBRUARY 2009
Index to Advertisers Classified Ads
3
Letters
4
FEATURE
The Value of the Well-Established Patient-Physician Relationship
10
SPECIALTY UPDATE
HCMC’s High Risk Pregnancy Clinic By Virginia R. Lupo, M.D., and Melody Mendiola, M.D.
Page 10
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Doctors Need to be at the Table By Ronnell Hansen, M.D., and James Young, M.D.
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COLLEAGUE PERSPECTIVE
Universal Health Insurance is Not Affordable if Care is “Free” By Robert W. Geist, M.D. Page 20
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Hennepin County Medical Center’s History Museum By Neal Holtan, M.D.
20
Hospice: A Powerful Presence in End-of-Life Care By Lisa Abicht-Swensen, M.H.A.
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Page 13
U of M Medical Students Receive White Coats
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Members in the News
36
Career Opportunities
On the cover: Patients and physicians describe the value of having an existing relationship. Article begins on page 4.
EAST METRO MEDICAL SOCIETY
26 27 28 29 30
President’s Message 2009 EMMS Annual Meeting/ Election Results Frank Indihar, M.D., Attends His Last AMA Meeting/ Medical Market Reform Presentation MPS Vendor Spotlight: SafeAssure Consultants, Inc./ Caring Hearts for Homeless People Drive/In Memoriam New Members WEST METRO MEDICAL SOCIETY
Page 17
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31 32 33
Chair’s Report
34 35
Healthy Eating Minnesota Contract
WMMS Board of Directors Annual Meeting 2008 Charles Bolles Bolles-Rogers Award/Eugene Ollila, M.D., Receives U of M Alumni Service Award/ WMMS Requests Postponement of Alcohol Vote New Members January/February 2009
1
Doctors MetroDoctors THE JOURNAL OF THE EAST AND WEST METRO MEDICAL SOCIETIES
Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines WMMS CEO Jack G. Davis EMMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.
Classified Ads
January/February Index to Advertisers
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AmeriPride...........................................................25 Burnet Birkeland .................Inside Back Cover Classified Ads........................................................ 2 Crutchfield Dermatology................................21 Family HealthServices Minnesota, P.A. ......36 Healthcare Billing Resources, Inc. ...............23 HealthEast Spine Care Center ........................... Inside Front Cover Hennepin County Medical Center..............14 Lockridge Grindal Nauen P.L.L.P. ................. 3 Medical Billing Professionals, LLC................ 2 Midwest Spine Institute ..................................11 Minnesota Epilepsy Group, P.A....................22 Minnesota Oncology Hematology, P.A. .....12 Minnesota Physician Services, Inc. ..............19 The MMIC Group ................................................ Inside Back Cover ProSource Medical Services ............................34 University of Minnesota CME .......................... Outside Back Cover Uptown Dermatology & Skin Spa, P.A. ....34 Wapiti Medical Group .....................................36 Weber Law Office .............................................23
PHYSICIANS’ ATTORNEY: STEVEN H. JESSER, ATTORNEY AT LAW, P.C., (800) 424-0060, (847) 212-5620 (mobile), shj@sjesser.com, www.sjesser. com. Comprehensive physicians’ legal services, including practice sales and purchases, other contracting, employment, license/disciplinary problems. Representing physicians since 1980. Admitted to practice in MN-WI-ILNY-NE-TX-DC-GA. Initial telephone consultation, including evenings or weekends, without charge.
To promote their objectives and services, the East and West Metro Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of EMMS or WMMS. Send letters and other materials for consideration to MetroDoctors, East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com. For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com. MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Doreen Hines at (612) 362-3705.
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LETTERS
Dear Editor: FORTY YEARS AGO when I was still working for Group Health Plan (now HealthPartners Inc. — please note the difference, I now work for my patients), I was the medical representative for the team that met with the team from the University of Minnesota School of Nursing to found a program to train RN’s as NP’s (nurse practitioners). I had the experience of working with some of our staff RN’s in initiating this practice at Group Health. Indeed they were capable of dealing with perhaps 90 percent of the patients they were confronted with. It was the remaining 10 percent or so that constituted the problem. These are patients with unusual presentations of common problems, or vague and featureless symptoms of uncommon problems. The first was a man with right upper abdominal pain and a history of alcoholism which was thought to be alcoholic hepatitis. Indeed his liver enzymes were modestly elevated, but his low grade fever and elevated white blood cell count, discounted by his NP, proved to be appendicitis. Accurate diagnosis was missed because his bowel was malpositioned placing his appendix underneath his liver. An example of an uncommon illness presenting with common symptoms were two different patients presenting with “the flu,” weakness, malaise, fatigue, muscle aches, low grade fever, etc. Except this wasn’t “the flu,” even though each of them were sent home. Instead it was Guillain Barre Syndrome (“French Polio”), from which one nearly succumbed to respiratory muscle failure. If the NP had tested muscle strength, or more specifically deep tendon reflexes, this should have triggered alarm bells. Another example of an uncommon illness with vague symptoms was a woman who complained persistently of headaches, nausea and weakness. Indeed she was probably neurotic, and this was written off as
MetroDoctors
anxiety. A physician finally determined that these symptoms remitted when she was not at home (an older house). He astutely obtained a carboxyhemoglobin level indicating carbon monoxide toxicity. The gas company was called in, discovered a faulty water heater flue, and she had no more “anxiety attacks.” A common error is to suppose that the least experienced practitioner should perform triage — deciding who (the minority) needs urgent evaluation and treatment, and who (the majority) have self-limited or less urgent conditions. The armed services discovered this years ago. The senior, experienced medical officers should triage, the junior officers can then treat. And, yet, emergency rooms everywhere have nurses or even clerks deciding who should be seen first. The late Dr. Wesley Spink (infectious disease expert) said, “The hardest job in medicine is the family doctor seeing 30 patients a day and having to decide who really needs further evaluation and care.” The dean of an eastern medical school
said of nurse practitioners, “It is unreasonable to expect that, no matter how wellmeaning, earnest, and intelligent these nurses are, they will be as proficient as practitioners with a BA degree, four years of medical school and three to six years of post doctoral education.” I don’t believe that three more semesters of education will make up that difference. In the last legislative session, pharmacists sought permission to dispense medicines without a physician’s prescription. As Jimmy Durante used to say, “Everybody wants to get in on the act!” In summary, a well-trained, adequately supervised DNP (doctor nurse practitioner) will be perfectly capable perhaps 90 percent of the time. It will be up to patients, and probably malpractice attorneys to decide whether missing 10 percent is acceptable to the American public. Sincerely, F. Douglas Whiting, M.D.
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The Journal of the East and West Metro Medical Societies
January/February 2009
3
FEATURE STORY
The Value of the Well-Established Patient-Physician Relationship Editor’s Note: This article describes personal and professional views placed on the value of a well-established patient-physician relationship. Two patients requested to remain anonymous. We encourage your comments and on-going dialogue on the importance of this relationship. Patients:
Is it important to you to be able to identify a physician who is “your doctor”? Why or why not?
BB, stay-at-home mom – It is important to have a particular doctor as your doctor. There is a level of trust and understanding that develops on both sides. It is also more convenient with scheduling and getting into the doctor if you have a pre-existing relationship. DS, computer programmer – Yes. Having a primary physician that knows my health history firsthand without having to review a new chart for each visit is comforting. RC, college student – I believe in the convenience of having one particular “go-to” doctor, though it’s not absolutely necessary unless people have a chronic illness that prompts them to have visits or check-ups more than once a year. NN, hair stylist – Yes. The relationship needs to have some personal components. I feel I would first choose a female doctor close to my age so she can relate to symptoms similar to mine, such as menopause. BP, sales and marketing – Yes. Having someone I consider my doctor (or my child’s doctor, for that matter) implies to me that there is a relationship which means to me that I can rely on them/trust them. I live in a smaller town…my doctor and our pediatrician know more about me and my family than just our health; they know about our family life, they share an interest in our community, etc. That is comforting to me. RH, pharmacist–Yes, I think so. I probably didn’t think it was when I was much younger and never needed a doctor. But once I started a family I felt it was important. How important is having access to “your doctor” in maintaining the relationship?
BB – Very important, especially with the kids’ doctor. I do not want to see one of 50 pediatricians; I want to see their pediatrician. DS – Very. Ray Hines, RPh, Pharmacist
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RC – It certainly helps, especially since they know of your history and can make better judgment calls in terms of your well-being if something comes up suddenly. NN – Very important. It is part of the relationship building process. BP – Very important. RH – Relationship implies having access. I feel it is very important, but it is also very difficult. Doctors are busy and so are patients. We need to find a way to communicate with each other better.
Nancy Nichols, Hair Stylist
Should physicians be paid for telephone and/or e-mail conversations with patients and care coordination at times when the patient is not present?
BB – Well, other professions bill for time spent on files or accounts so it would be reasonable to expect doctors to do the same. DS – Yes. RC – Perhaps if physicians coordinated with one another to set up a rotation schedule for one doctor to be available to take calls regarding general health-related questions, that could be a specified part of their job and certain fees would cover the costs of time. However, in an emergency situation, chances are the doctor will be summoned for giving care later anyway, so that is essentially a natural part of their job. NN – Yes. Time is money. BP – No, although I do wonder why we don’t get charged when I make a call into them. I suppose it is just a customer service thing. I am grateful that we do not get charged. RH – I guess I feel it is fair. For a doctor to answer my question, he/ she must not only know me, but know my medical history. It takes time to retrieve and review my chart. (Continued on page 6)
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Betsy Pierre, Sales and Marketing
January/February 2009
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Patient-Physician Relationship (Continued from page 5)
Do medical care documentation requirements (e.g. elaborate electronic medical record dictations or checklists) impair your doctor’s ability to listen to you and establish a trusting doctor-patient relationship?
BB – In my experience it has not done so and I think the quality of medical records has greatly improved with the newer requirements. DS – Not sure of my doctor’s feelings about this. RC – It appears that it has become more automated. If not utilized and with caution, doctors may become more concerned with completing forms properly than really paying attention to the patient, what they’re saying, doing, or feeling. NN – The trust is only broken if the information falls in the wrong place. I do not otherwise find it impairing. BP – I have not noticed these during my visits. RH–I am not sure. My doctor must handle that when I’m not there or incorporates it into the visit in a way that makes me unaware of it. If you don’t have a physician whom you can identify as “your doctor,” what do you do if you are sick or need medical advice?
BB – I do have a doctor, but if not I would use urgent care. DS – Generally, I call their nurse. RC – I go to the same place every time where they have my record. I don’t request anyone specific, just whoever is available at the time. Since all of my background information is readily available there, they can review it before talking to me about why I came in that day and better determine how to handle my case. NN – Urgent Care. BP – I do have one. RH – I can tell you what a lot of people do. They visit a pharmacy and ask the pharmacist for medical advice. If you don’t have a personal physician, or if for some reason you need to change physicians, how would you go about doing that?
RC – My first preference would be location, and from there I would “shop around” for doctors by setting up an appointment time to talk with them and ask general questions about how they interact with their patients and how they think their patients view them. NN – I would ask a close friend that I trust and value their opinion.
Roxanne Corbin, University of Minnesota Student
BP – Ask a friend(s) for a recommendation. RH – My physician left my clinic and recommended a new doctor; that is one way. As a pharmacist, I have had people ask me to recommend a doctor. I think people will ask other people they know about their doctor or clinic also. Should physicians tell patients about their pay-for-performance bonuses or other incentives affecting patient care, e.g. bonuses for prescribing generic medications? Does disclosure of these incentives enhance or detract from a healthy doctor-patient relationship?
BB – In my experience doctors usually do not prescribe the generic form, but that it is converted at the pharmacy per the patient’s own medical contract with the insurer. With regard to other incentives, I am not aware that any have ever affected my care or that of my kids. DS – Perhaps have a clinic staff person have the patient provide a written disclaimer, similar to a privacy policy reminder. I’m not sure about the second question…it’s always nice to know when there are special interests involved. RC – I think incentives such as these detract from a truly personal doctor-patient relationship because there is an ulterior motive involved. I believe such information should be disclosed because I believe people would want to know if their doctors are acting on behalf of a for-profit company, or in the patients’ best interest. NN – Not necessary to know that information. I would say neither enhances nor detracts.
BB – References both from medical providers I trust and friends.
BP – Tough one. I don’t think health care recommendations/treatments should be based on bonuses; it should be based on what is best.
DS – Finding one of their colleagues in a similar practice (i.e. internal medicine).
RH – Should it be mandatory that they discuss this with all of their patients — no. As long as I feel that my doctor is looking out for my
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best interest (I trust him/her) then I feel it enhances our relationship. Bonuses would imply my doctor is performing. That is good. The bottom line is am I getting better? If so, then the doctor deserves the incentives. Physicians/Providers:
What are the essential elements of a patient-physician relationship? Do doctors still think it is important?
Sam Carlson, M.D., Medical Director, Park Nicollet Clinic – It’s the trust that our profession places their interests before our own, that we’ll advocate what’s best for them as individuals, and that no economic self-interest will get in the way. Do doctors think it’s important? I think so. If we don’t honor this relationship, the permission given to us by society to do our work could be lost. Candace Simerson, Clinic Administrator, Minnesota Eye Consultants–The essential elements are competence, confidence and trust. In general, doctors still believe these elements are important, but under our current health care delivery system, the patient-physician relationship can be compromised by the intervention of health plans through various oversight and utilization systems. These intervention mechanisms can destroy trust and confidence if the health plan questions the doctor’s treatment plan and the patient becomes aware of it. Eugene Ollila, M.D., Internist, Allina Medical Clinic – The obvious major need is to answer whatever the patient is there for, a pain, an infection, or just want to talk about something. Another element is how the physician interacts/listens/ responds to that patient, which seems to be a major source of dissatisfaction of patients with their physicians. A third is the time available to do the previous interactions. This is a major source of physician dissatisfaction, as well as patient dislike. There clearly are differences in all these interactions, partly dependent on age, and how much interaction the patient needs with their physician, such as a patient Eugene Ollila, M.D. with multiple chronic problems. If there were not insurance restrictions, what would a patient-physician relationship look like?
Sam Carlson, M.D. – Currently, our relationships are constrained by the rules around payment, and that’s principally the face-to-face encounter. We could do much more if we were paid to help patients meet their health care goals in more creative ways. Many patients want to have a principle physician or clinician to manage their ongoing needs. This will involve a team of like-minded people and supporting technology. A deep knowledge of the patient and their MetroDoctors
The Journal of the East and West Metro Medical Societies
preferences will define the future relationship. Candace Simerson – There would be more freedom and more choice. Patients would be more accountable for their health care as they would be the only one responsible for payment and, therefore, would face direct consequences of non-compliance or poor health habits. Patients would be free to select their Candace Simerson physician, the physician and patient would agree about treatment strategies and payment plans. Patients would also need to be more informed and educated in order to make better decisions with their physicians. Patients would hold their physician more accountable (by being the ones responsible for payment and therefore could withhold it.) Patients would invest more time and energy in managing their care jointly with the physician due to the vested financial interest. Eugene Ollila, M.D. – Patients would be able to get their questions answered more quickly, perhaps more appropriately (such as not having non-physician filters, where more time and effort may be needed to instruct the non-provider). There clearly would be less aggravating and irritating interactions such as having to fill out pre-authorization forms without appropriate information from the insurers. There may be more appropriate ordering of tests, as in ordering a lesser test that is not diagnostic but covered, and later getting the best test anyway, because the first was already done and non-diagnostic. The clinical work of many Minnesota physicians has changed from a focus on individual patients to organizational requirements or “best practices” for populations of clients served by their employing organizations. Do you think this change poses a conflict of interest or ethical dilemma for physicians?
Sam Carlson, M.D. – I’m not sure I agree with that statement. I see organizations looking at individual improvements that roll up to population measures but never forgetting about the individual patient, at least that’s how we are looking at it here. We’ll always need to advocate for the individual patient before us, as that’s been a foundational element of the trust within the relationship. If we determine that guidelines, which are good for populations, are not in the best interest of the patient in front of us then, of course, we must do what is right for the patient. Candace Simerson – Yes it does because all patients don’t fit into the “one size fits all” model. Patients can have numerous unique circumstances which can impact whether or not the “best practice” is appropriate for them and the physician is, therefore, placed in an (Continued on page 8)
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Patient-Physician Relationship (Continued from page 7)
awkward position by deviating from the “best practices” standard and perhaps facing review by the health plan or a potential legal challenge if something goes awry with the patient’s treatment plan. Physicians should have the freedom to determine a treatment plan that is best for each individual patient based on their situation. Establishing standards of care can be beneficial if there isn’t a problem with physicians deviating from them based on individual circumstances. Eugene Ollila, M.D. – To the extent this becomes the goal, such as in “No child left behind” mindset. Many of the non-provider staff look at this as a contest, and in a way it is a game, because everyone has to do “well” or has aggravation and sometimes onerous interactions with leaders. Clearly, the “best” numbers are paraded as “it can be done, so we can all do it”! I must admit, there are some good medically justified reasons to approach this kind of number, which all staff are trained to regurgitate to others, but if we stay with only evidence-based information, we are occasionally “skating on thin ice.” This could be a much greater problem if individual physicians will become sanctioned for not meeting “goals.” In 2008 the opportunity to initiate, maintain, or terminate a physician-patient relationship is often determined by a patient’s health care funding. Describe problems you have experienced with hand-offs and information transfers between physicians when care funding changes. Your suggestions to remedy this?
Sam Carlson, M.D. – I believe that if our profession is to maintain the respect and trust of those we serve, we all must share in the care of these patients. I am distressed to hear that some are no longer accepting patients based on their health care funding, and find this a threat to our professionalism. This could certainly be a threat to the income of physicians, but not so much a threat as being seen as losing our bearings as a profession. We must work on eliminating geographic disparities and removing waste in health care wherever we see it. We can take some encouragement from the fact that most of the civilized world is able to provide health care to their population at Medicare rates or less. Candace Simerson – As a specialty practice, we have patients who obtain referrals for just specific services, but then we aren’t always allowed to treat or continue follow-up with the patient. Here’s an example. We provide eye exams for the State of Minnesota Disability Services. We had a patient come in for an eye exam who had a high intraocular pressure, an indication of glaucoma. We could have treated this patient and taken care of the problem. However, when we contacted the State of Minnesota, they had us send the patient to the ER department at a local hospital. The ER doctor then called our office after seeing the patient as he had no idea how to take care of the problem. It took a significant amount of time for one of our doctors to spend time on the phone advising the ER doctor on how to treat the problem. This is not an efficient use of health care resources; added 8
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more cost than was necessary, and doesn’t allow for continuity of care for the patient. No one seems to count the extra expense of requiring additional communication and administrative efforts to get the patient and appropriate follow-up care he/she needs. My suggestion to remedy this is to create the proper incentives in the reimbursement system to promote the best outcome for the patient and the incentives would apply to all physicians, not just certain care systems or specialties. Then we could eliminate the perceived need for unnecessary checks and balances which only add cost to the system. Eugene Ollila, M.D. – There needs to be a greater ability for the physician to “fire” a patient. Sometimes this relationship is really fractured, but the situation can usually not be changed without major threat to the provider or insurer slaps on the wrist. We have seen situations in the office where a physician was threatened, and was not able to discontinue as the physician of record. I would like a group like the Board of Medical Practice to act as a disinterested party to help in these sorts of situations. Do medical care documentation requirements (e.g. elaborate EMR dictations or checklists) impair a physician’s ability to listen to patients and establish a trusting doctor-patient relationship? Is this issue discussed and addressed by the medical staff in your office? How do we reward doctors for carefully listening to patients (reference: How Doctors Think by Jerome Groopman, MS, 2007) rather than overly focusing on the medical record instead of the patient before us?
Sam Carlson, M.D. – By consuming more time during patient contact hours it certainly can be more difficult. The real problem though is the current reimbursement system which pays only for visits and then requires elaborate justification of the level of service with accountabilities. If we were freed from our current reimbursement system base on RVUs, we could design a better system. Candace Simerson – The documentation has become a bureaucratic requirement and not one related to good patient care. Physicians have to spend too much time justifying what they charge or what they are doing instead of focusing on the patient. Here again, the current reimbursement system (CPT coding, ICD-9) should be revamped to streamline documentation requirements and allow physicians time to focus on the patients. However, with all the economic constraints facing health care, I don’t see this happening. The issue is unlimited demand versus finite resources and under the current third party payment system it would be very difficult, if not impossible, to change these dynamics. One would need to align the incentives for all parties, which would not be politically popular. Eugene Ollila, M.D. – One of the problems is how much physicians pay attention to the patient, rather than the computer. As an example, when we first went “live,” I wondered if a curved desk was available, so that the computer would be just off the view of the patient, rather than at the back of the rectangular desk. In addition, the MetroDoctors
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comfort level of the physician with typing and keyboarding becomes very important. After all, we are supposed to be there for the patient, not the computer. I look at the computer as a tool, and it does very well, but I loathe a pure point and click approach, as it really creates a less readable note. Likewise, many consultant’s notes are largely “fluff,” as the important “stuff” is usually only in the first and last paragraphs, as much of the other information is done by someone else and is just clicked in. Likewise for bringing in old notes to populate the current note, which turns out to look great but often does not add much new or beneficial information. When asked by a patient, should physicians tell patients about their pay-for-performance bonuses and other incentives affecting that patient’s care, e.g. bonuses for prescribing generic medications? If so, why? If not, why not? Does disclosure of doctor pay and incentives enhance or detract from a healthy doctor-patient relationship?
Sam Carlson, M.D. –We should be prepared to tell our patients what they want to know. A pay-for-performance discussion that aligns payment with what is good for patients should be a healthy conversation that can strengthen the relationship. Regarding generics, using equivalent drugs at a lower cost is a way of reducing waste in health care and has the goal of reducing costs and making health care more affordable. If an individual genuinely feels that a specific branded drug is necessary for them despite evidence to the contrary, you need to work out a plan that is right for that patient and doesn’t undermine the relationship. That said, there may be a point where the relationship undermines Sam Carlson, M.D. the physician’s own sense of what’s right and then you need to have a different conversation. Candace Simerson – No, I don’t believe physicians should tell patients about performance bonuses or other incentives. The system is too complex for patients to understand. We don’t ask other businesses, i.e. auto industry, attorneys or any others to disclose all incentives within their systems, so why should we expect physicians to do it? Instead, we should just be sure that performance bonuses and other incentives aren’t contrary to providing good patient care. The disclosure of doctor pay and incentives does detract from a healthy doctor-patient relationship because again, it’s too complex for patients to easily comprehend and trying to spend the time to get patients to understand it would erode trust and confidence — essential elements of the relationship. Eugene Ollila, M.D. – I have not seen the financial encouragement for generic prescribing, but there clearly are some situations where non-generics are essential. I think we should be transparent in our MetroDoctors
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payment and if a patient wants to know about these, I would have no problem with that. More importantly, physicians and patients are often in the dark why one plan covers drug A and another covers the equivalent and equally priced drug B, and we never find out the kickbacks that are involved, except by word of mouth in hushed tones. I love seeing patients, and honesty is always the best policy. Should physicians be paid for telephone conversations with patients and do care coordination at times when the patient is not present? If so, do you have suggestions for how the MMA can campaign to improve third party payments for patient-centered physician-directed care coordination activities?
Sam Carlson, M.D.–Physicians should be paid for care coordination, but only if quality improves and the numbers of patients served can be increased. If payment is added and we don’t see either of these occurring, it won’t be sustainable. So, I’d suggest the MMA be involved in advocating for measurement of quality, cost and patients served (panel size, e.g.) If we see all of these moving in the right direction, the support of the MMA could be very helpful. Candace Simerson – Physicians should not be paid for telephone conversations and care coordination efforts if it’s ancillary to the services being provided, i.e. follow-up on a test result or something which is included in the test or previous office visit charge. However, if the telephone conversation or care coordination is in lieu of a typical office visit or something which requires additional uncompensated effort, especially if it is a more effective and efficient use of resources, then, yes, physicians should be paid for it. MMA should campaign that these services are accepted standards of care for which physicians should be compensated. Most likely these services would allow employees to return to work earlier than might otherwise be the case, or perhaps remain on the job, so it should not be difficult to quantify the value for employers. Therefore, employers could be campaigned to request these services be paid by the health plans. MMA could also propose legislative mandates and even if they are not accepted, it would help raise awareness. With all of the discussion regarding reimbursement redesign, it would seem now would be the time to bring up this issue. Eugene Ollila, M.D. – Yes, there should be payment for making significant decisions and prescribing by phone just as if they came to the office. We would need to document this, but patients know they can call and often get prescriptions at will. There is a new generation of patients that live their life on a handheld device or computer, and many would love to do this much as they do their other communications and activities in life. I would hate to deal with this by having a blanket statement stating no prescriptions will be done by phone or having all off-time interactions being required to go to Urgent Care, which is often in another system, staffed by providers not familiar with the patient, and often not having that interaction evident to the primary care physician.
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SPECIALTY UPDATE
HCMC‘s High Risk Pregnancy Clinic
S
ince the early 1980s, the Ob/Gyn department at Hennepin County Medical Center has held a weekly High Risk Pregnancy clinic, serving women identified to be at risk of adverse pregnancy outcome for a variety of reasons. Women with medical problems such as hypertension, diabetes, major cardiac disease, and severe asthma were seen at first, along with those with obstetrical problems such as multiple gestation, cervical insufficiency and preterm labor. Over time, the problems have changed. At present, on a typical Thursday morning, 35 to 50 women are seen by a staff of medical students, residents and maternal-fetal faculty. Now, women with HIV infection, active substance abuse and methadone maintenance and complicated social situations are also seen. The clinic manages over half of the HIV-positive pregnancies in the state of Minnesota, by maintaining close communication with the infectious disease providers through the HCMC Positive Care Center. The clinic is able to meet the needs of a culturally and socially diverse patient population by offering a variety of services. It is fully staffed with Spanish interpreters, and Somali, Hmong, French and Amharic interpreters, among others, are readily available. A chemical dependency social worker has been part of the clinic for many years, and a general social worker is also present to assist with patients who need help with housing, obtaining a restraining order against a threatening partner, or food or transportation on short notice. The nursing staff is attentive to cultural needs, and provides invaluable patient education through the course of pregnancy. A psychiatrist specializing in women’s mental By Virginia R. Lupo, M.D., and Melody Mendiola, M.D.
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January/February 2009
Melody Mendiola, M.D. Virginia R. Lupo, M.D.
health problems has been present for several years and is able to accommodate both scheduled patients and women with acute needs. Her familiarity with the nuances of psychiatric medications and their impact on pregnancy is invaluable, and seeing women at risk of postpartum depression prior to delivery has also allowed for much quicker diagnosis and management of this problem when it strikes. And finally, in 2005, an internal medicine specialist was added to the Ob/Gyn department who also regularly attends the High Risk Obstetrics Clinic. This care model has worked tremendously well. Having an internist embedded in clinic allows for several things. Medical tune-ups for asthmatics and women with other routine medical conditions can be done immediately and seamlessly. A general internist can triage and arrange subspecialist evaluation, and communicate with the subspecialists. The internist can then follow the medical problems between subspecialist visits, thus decreasing the need for multiple visits. An internist with familiarity with medical needs and physiology specific to pregnancy can also work with the subspecialist, who may have less familiarity with pregnancy-related issues. Inpatient consultation is more efficient with someone who is more familiar with pregnancy physiology, and which medications are safe in pregnancy, and which to avoid, as many general internists are
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uncomfortable managing pregnant patients. While maternal-fetal medicine subspecialists are more familiar than internists with a number of medical problems in pregnancy such as diabetes, the availability of an internist in co-managing problems is invaluable. Having the internist present in clinic allows for real time discussion of clinical problems, leading to a more effective team approach to patient care, rather than communicating through notes, or even by phone. For instance, when a pregnant woman on chronic renal dialysis needs an antihypertensive medication added to her drug regimen, dosing considerations must take into account the fact that the woman has no urine output or renal metabolism and might have other concurrent hepatic problems. For a maternal-fetal specialist, this would usually involve several pages and conversations during an otherwise hectic clinic. Our embedded internist can immediately see the advantages of a medication and a dosing schedule that are far different than the usual first line approach for a pregnant woman. Transitioning postpartum diabetics from insulin back to oral hypoglycemic agents or sending postpartum hypertensive women home with appropriate meds is easily facilitated. Follow-up within our clinic on a short-term basis is readily available, with the internist seeing them and no immediate referral is necessary at a time when most women are pleasantly overwhelmed by the demands of a new baby at home. As many young, underinsured women are only able to seek care during pregnancy, this model allows for a more complete assessment of the patient’s medical needs. It allows us to attend to a person’s complete health care needs, including obstetric and non obstetric care. This also provides a touch point for women who may not otherwise seek primary care outside of pregnancy. The embedded internist model has also
The Journal of the East and West Metro Medical Societies
provided a valuable learning experience for both residents and students. Communication back and forth is immediate, since the entire team is present in the same work area, allowing for constant back-and-forth as we chart, eat bagels and discuss what our assessments and plans are. The chart notes written by the internist are written within the obstetrics navigator of our Epic electronic health record and are, therefore, always immediately visible to anyone looking through the current pregnancy charting information. The Ob/Gyn residents gain some familiarity with dealing with common medical presentations that they will likely encounter in practice. They have a chance to see how various issues may be addressed, and learn to triage the urgency of medical evaluation. In addition, we have had several internal medicine residents rotate through the clinic, which gives them a chance to learn principles of managing medical
Overall, from the staff to the residents to the patients, our multispecialty High Risk Obstetrics Clinic has been very successful. Patients receive better, more efďŹ cient care by having multiple resources in one location. The staff is able to use a collaborative approach to best utilize a variety of skills, and the residents and students beneďŹ t from a more cohesive and comprehensive learning experience. While this model is probably only appropriate in a large clinic setting with a concentrated at-risk population, the quantum leap in quality of care we have seen has been well worth the effort to assemble all the right people in one place every Thursday morning.
problems in pregnancy, and gives them more conďŹ dence and resources to appropriately treat pregnant patients they will encounter in their own clinic and inpatient practices.
Melody Mendiola, M.D. is a general internal medicine specialist who joined the HCMC Department of Ob/Gyn in October, 2005. She is presently the secretary of the West Metro Medical Society. Virginia Lupo, M.D. is the chair of the department of Ob/Gyn at HCMC and is a maternal-fetal medicine specialist. She is past chair of the board of the West Metro Medical Society.
! " # "
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The Journal of the East and West Metro Medical Societies
January/February 2009
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Introducing Dr. Annie Tan Gynecologic Oncology Surgeon Joining the Gynecologic Surgery Practice of Minnesota Oncology Hematology, P.A. Office now open at: Coon Rapids Women’s Health Clinic 3960 Coon Rapids Blvd NW, Suite 101 Coon Rapids, Minnesota 55433 612-863-8585 for appointments
Annie Tan, MD, PhD z
Medical Degree and PhD in Pathobiology from the University of Minnesota
z
Residency in OB/GYN and Reproductive Sciences, University of California at San Francisco
z
Fellowship in Gynecologic Oncology at the University of Minnesota
z
Board eligible in Gynecologic Oncology and Obstetrics-Gynecology
“The combination of the advanced surgical skills possessed by our gynecologic oncologists, and the availability of the latest national collaborative clinical trials, which incorporate state of the art chemotherapy with aggressive surgery, assures every woman the greatest chance of survival no matter how complex her disease. We pledge to match our clinical expertise with compassion, respect, and emotional support for each patient and her family.”
Minnesota Oncology’s GYN Oncology Surgery Team Cheryl L. Bailey, M.D. Matthew P. Boente, M.D. A. Catherine Casey, M.D. John E. Savage, M.D. Annie Tan, M.D.
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January/February 2009
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The Journal of the East and West Metro Medical Societies
Doctors Need to be at the Table
L
egislative session 2007 proved a watershed in defining the future of health care reform for Minnesota. The governor’s office and the legislature each engaged full force efforts at reform options: the Governor with the Health Care Transformation Task Force, and the legislature with the Commission on Health Care Access. Additional work groups were mandated by the 2007 legislature, including the Statewide Purchasing Pool Work Group, upon which both of us, Dr. James Young and Dr. Ronnell Hansen, served for the better part of six months. Dr. Young, a family physician/hospitalist and member of the West Metro Medical Society (and MMA Board of Trustees), was recommended by the MMA to serve as a Governor’s appointee. Dr. Hansen, a radiologist serving on the East Metro Medical Society Board, was seated at the request of legislators present at the combined EMMS/WMMS Board meeting preceding start of the work groups. Many other physicians, practicing and nonpracticing, were distributed among the health care work groups and committees of 2007 via their indicated interest and a selection process coordinated through the MMA. During the debate, the MMA, as the state physician advocacy organization, forwarded and supported positions based upon its January 2004 MMA Health Care Reform Task Force, which created the Physicians Plan for a Healthy Minnesota in January 2005. Senate Health and Human Services Budget Committee Chair Sen. Linda Berglin (DFL-Minneapolis), a primary player in creation of the Health Care Access Fund and MinnesotaCare 16 years ago, and her House counterpart Rep. Thomas Huntley (DFLBy Ronnell Hansen, M.D., and James Young, M.D.
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Duluth), chaired the testimony of committee final reports. Although many newly elected (2007) Minnesota representatives ran, at least in part, on health care initiatives, the fiscal crisis in health care painfully evident to patients, physicians, and elected officials alike, ensured some form of reform legislation would be put forth in 2008. Constituents were demanding it. The net result of the political full court press on health care issues was a near overwhelming kaleidoscope of study groups evaluating a wide range of issues from cost containment, to insurance market reform, to single payer constructs. In total, more than 25 physicians participated directly, bringing personal professional experience into the debate and recommendations for improved patient care, health care delivery, and potential cost savings. In our six month appointment, we came to two realizations which should be of particular significance to all of us as practicing physicians: First, being personally present allows unparalleled opportunity for direct physician input, which proved a cornerstone learning event for both the diverse interests seated on the committees, as well as the policy making legislators. As physician constituents, we might assume that the administrative structure charged with “reform” has an accurate understanding of the working details of health care delivery and current reimbursement structure, and frequently this is not the case. Powerful financial stakeholders, including health plans and insurance companies, have full-time staff lobbyists at the capitol constantly forwarding their agendas and political contributions, and it can be challenging, but not impossible, to compete for physician/patient concerns in such an environment. Showing up personally should
The Journal of the East and West Metro Medical Societies
not be underestimated and can be 50 percent of the battle. A well-informed physician with a broad base of knowledge on health care issues can produce a profound impact on the discussion by simply bringing the facts and realities of clinical practice and reimbursement within this “system” to the table. Simple time efficient steps we can all take, such as calling your elected officials or sending e-mail opinions at critical times in the legislative process can be of substantial influence. Concrete examples of physician influence last year included the governor’s decision to limit a raid on the Health Care Access Fund (to which we all contribute), and the Governor’s initial veto of first round health care transformation legislation, which included fixed pricing mandated “baskets of care for chronic conditions.” In the end, the baskets of care concept did remain in the legislation that passed and deserves our unbiased close collective scrutiny as an economically sustainable cost-saving vehicle in payment reform for both independent physicians as well as health systems. It is an interesting concept with a real potential for unintended consequences. Second, there are relationship and fact checking benefits to being personally involved, which your professional organization lobbyists cannot, and perhaps should not, match. A participating physician in the discussion is viewed as a collaborating stakeholder; an absent physician is perhaps more likely to be viewed as an abstract element of the weighted cost-benefit ratio, and a cost/quality center. Fact checking should be the responsibility of all of us who are affected by proposed policy. We are obligated to independently understand the positions our societies take for us, and (Continued on page 14)
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Doctors Need to be at the Table (Continued from page 13)
what our legislators propose for us as laws to practice medicine by. We cannot stress enough to our colleagues to read what affects us in the proposed bills, for as we well know, the devil can be in the details. Just some of the questions we must ask ourselves consistently in rapidly changing times: Are our collective concerns as a profession being addressed accurately and are we transparently taking the concerns of all of our colleagues into consideration?; Does our professional organizational policy match the changing times?; and Does proposed legislation make realistic and reasonable demands of the profession in exchange for potential cost savings? We should not expect sound policy, either by professional society or government, absent our individual thoughtful study and input. We should not expect others to form our opinions, and then reserve the right to complain about the outcomes. We cannot remain disengaged, and expect realistic proposals to evolve. We must educate ourselves on the issues and proposed solutions. Herein lays our greatest opportunity, and perhaps one of our greatest weaknesses as individuals within a profession to date, to personally both shape policy opinion and bring new solutions — and change direction if necessary. Let us become better informed and more active participants in the future of our profession, and let round two of health care transformation 2009 begin.
MARK YOUR CALENDAR!
MMA Day at the Capitol Thursday, February 5, 2009 1:00-4:30 p.m.
For more information, visit www.mmaonline.net
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The Journal of the East and West Metro Medical Societies
COLLEAGUE PERSPECTIVE
Universal Health Insurance is Not Affordable if Care is “Free” Following WWII good intentions to subsidize Universal Health Insurance (UHI) for medical service coverage produced unintended consequences by the 1970s. Popular tax-subsidized insurance artificially lowered the real prices of care. The appearance of “free” care skewed the medical market into demand inflation.1 Recession and Cost Control A general recession then hit the world economy in the early 1970s.2 “Free” care suddenly became too expensive. As Uwe Reinhardt, the Princeton economist, noted, international standards of “blunt regulation” were then applied to medicine.3 Nations attempted to control the politically created demand by regulating use of medical supply through price fixing, global budgeting, and use of Managed Care Organizations (MCOs) to ration access to care. The U.S. was no exception. In 1973 the U.S. congress passed the HMO Act, which created corporations modeled after National Health Service (NHS) MCOs abroad. All MCO models are similar. They say, “give us your money, and we’ll take care of you,” but then must do it on a fixed zero sum budget. It is curious that U.S. style corporate socialism, created to control costs and preferentially supported by governments and business associations, is still viewed by many as private free enterprise. The HMO system is little more than a weak version of socialized cartel systems abroad. If we keep in mind that “blunt regulation” is seen as the treatment for demand inflation without heeding its politically created insurance subsidy driver, the peregrinations of health policy become clear — follow the money. “Equity” and “quality” sophistry become the façade hiding the actions of managers, who skew resources to the numerous well (voters), while devising queues for the few sick. In this way managers can make ends meet on MCO government-like (i.e., macroeconomic) zero-sum budgets. They are always faced with the famous managed care dilemma: “Cost, quality, access — pick any two”.4 Nonetheless, many U.S. politicians and policy makers believe that managed care can be fixed through expanding its power. Their agenda is to create new cartel-like arrangements between government and MCO corporations and by transferring the onus of MCO gatekeeper functions directly to providers (called “payment reform”).
By Robert W. Geist, M.D.
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The Journal of the East and West Metro Medical Societies
Failure and “Fixes” The problem is that such command and control systems failed around the world for other microeconomic sectors, which, like medicine, are where millions of transactions occur daily between millions of people. Nations found that “managed” microeconomic sectors produced “free” but shoddy products and near national financial collapse.5 Western democracies and India survived by deregulating their microeconomic sectors, respectively, after 1980 and 1991. With the exception of totalitarian China, the totalitarian East Bloc nations, without democratic flexibility to change, suffered economic as well as political collapse after 1990. The failure of managing medical supply has led many nations to look at “privatization” — double-speak for massive management subsidies in the U.S. to Medicare HMO corporations and abroad to NHS MCOs. The HMO subsidies have proved enormously expensive. NHS inflation remains hidden by queuing (albeit, some queues did shorten with private clinic referrals),6 by continuing high tax rates for increased subsidies (a difficult trade-off for elected officials), and by infrastructure erosion of plant, personnel and technology.7 Policy makers have for years ignored the counterproductive effect of medical command and control systems, which by their nature lead to high costs and diminished quality,8 as well as to inevitable financial conflicts of interest between MCOs and patients.9 The nature of the fatal economic flaw was succinctly expressed by the economist John Cassidy (paraphrased here): no central authority, however brilliant [or good willed] the managers, can accomplish the functions of freely determined prices for the allocation of labor, capital, and human ingenuity.10 The managed “free” care microeconomic medical sector has proved to be no exception. Not only have very powerful authorities been unable to control costs, but by many measures, managed care population-centered quality statistics have diminished,8 as has the more rarely measured quality of patient-centered medical care — its personalization, timeliness, continuity of care, and trust. The “fixes” proposed then reflect policy makers’ belief in managed care whether faith-based or agenda ridden. We can see that the political calculus of many U.S. policy makers is to tinker at the margins of the status quo by increasing the power of managed care corporations with cartel-like government arrangements similar to those (Continued on page 16)
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Colleague Perspective (Continued from page 15)
abroad. Meanwhile, managed care failures are hidden by demonizing providers of care and producers of medical technologies. Culprits vs. Reality In the war on “culprits” missiles are hurled at the alleged avaricious behavior of drug and device makers and of providers “irresponsible” in conserving society’s “scarce resources” (i.e., money). In the 1970s the empty slogan was that irresponsible doctors drove up costs by practicing too much “sick care,” which has now morphed into accusations of care that is sick (too much, too little, and with too much variation). In fact, fixing low prices paid for personal clinic services has been a systematic cost control policy administered by governments and by MCO corporations. Costs have not been controlled and poor pay has resulted in a decreasing ability of clinicians to respond to politically promised “free” care demand despite heroic personal efforts. Doctors are running too fast and are often demoralized.11 Policy makers then wonder why primary care physicians are disappearing. The reality was that prior to the 1940s, the medical CPI in the U.S. rose little faster than the CPI for other goods and services. Then persistent uncontrolled medical sector inflation abruptly appeared after 1965,12 a tipping point in time when political forces driving popular tax subsidies meant insurance had been acquired by approximately 85 percent of the population (workers, seniors, and the official poor and disabled). Yet policy makers rarely ask if the regulated “free” care system, in which all players are trapped, is itself fatally flawed. The real culprit is the system, not its failed commercial but high paid corporate controllers, not its producers of technology, and not its ill-paid but highly trained and dedicated workforce. Commercialism and Gain Sharing The profession of medicine in Minnesota and elsewhere is under powerful commercial and political pressure to be society’s rationing of care gatekeepers enlisted to manage costs of care under the guise of “accountability,” “quality,” and “efficiency.” The new model would partner clinics with hospitals (or others) in at risk “Accountable Care Systems” (ACSs)13 underwriting the health insurance of populations they service. To implement collusive provider arrangements, some policy makers recommend that patient protection laws against provider fee and premium splitting practices be repealed, thus they envision “coordinated” (or “comprehensive”) providers being made financially “accountable” for society’s medical costs.13,14,15 Patient protection laws have until now prevented provider collusion to profiteer through “gain sharing” of split fees. Gain sharing was made infamous in the late 1980s when a hospital shared profits with its staff for early discharge of Medicare patients for which hospitals were (and are still) paid by a fixed fee for a diagnosis. Discharge “quicker and sicker” summed up the public view. “Gain sharing” was considered reprehensible and unprofessional 16
January/February 2009
fee splitting when providers colluded to profiteer by restricting care. The other side of the coin was gain-sharing collusion between insurance corporations and providers who could profiteer by splitting premiums, something legalized by the HMO Act of 1973.16 Gain sharing of premium dollar profits (often by coerced capitation contracts and “withholds”) is intended to “incentivize” clinicians to control costs by restricting care…or go broke should there be no “gains” but only losses. What is new is the attempt to legalize gain-sharing collusion among comprehensive “at risk” providers so that such “payment reform” will control “system” costs to assure corporate and, in Minnesota, state government “savings.”14 Some policy makers recommend creation of a federal certification commission to favor such “innovative” provider insurance corporations.15 The template for such new commercial innovations has already been constructed in Minnesota by passage of its health care reform statutes in May 2008, which creates comprehensive insurance packages for populations with organ system problems (e.g., heart, bone, lung) or for other conditions (e.g., diabetes, depression) to be serviced by equally comprehensive provider arrangements at risk for “cost and quality.”17 This has the potential to accelerate the change from a professional medical market place devoted to the care of patients to a commercial market place driven by corporate profit motives to restrict care. The Free Market The failure of managed “free” care has led to consideration of an alternative, a self-organized free market guided by prices and controlled by families. Tax-free consumer driven health plans rapidly emerging in the private sector market have fueled the response — penetration is now 20.3 percent of insured workers.18 Families with money guided by prices self-insure expected and affordable care and buy insurance against the risk of unexpected and unaffordable illness. Preliminary findings are that insurance premium inflation is significantly decreased compared to MCO “comprehensive” policies, chronic disease care is better, and preventive services are increased.19 Observations and a Question Clinicians can treat the ailments of patients, but not the ailments of a regulated “free” care system gone awry and battered by futile regulatory efforts to control supply when the problem of rising cost is politically created demand. Managed “free” care (corporate or nationalized) appears to have failed because of a fatal economic flaw, while the sick, despite “coverage,” pay a high price when queued by cost control managers. Is it possible that a free market could make quality UHI affordable if millions of families regain control of the medical market place? It is worth trying. For details on references, contact Robert W. Geist M.D. at rgeistmd@comcast.net
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The Journal of the East and West Metro Medical Societies
Minneapolis General Hospital façade, 1925.
Hennepin County Medical Center’s History Museum
T
ucked away in the basement of Hennepin County Medical Center (HCMC) in Minneapolis is a collection of historical items from that hospital’s long, proud past. The caretakers of these articles, namely, retired nursing administrators Hillie Prose and the late Audrey Kuhne, the members of the HCMC Service League, and various volunteers all work together to maintain the museum. It consists of one room jammed with artifacts, equipment, uniforms and photographs, and a nearby office filled with documents, papers, books, and scrapbooks. The entire collection is open to visitors one day a week or by appointment. HCMC’s history collection is making steady progress in becoming a professionally managed museum with a secure future. Since 2004 the Service League, under the direction of Denise Edstrom, has worked with a dozen interested volunteers, including this writer, who serve as a board of advisors. The group settled on a name for the collection, The Hennepin County Medical Center Historical Museum, and has provided strategic direc-
By Neal Holtan, M.D.
MetroDoctors
tion. Efforts to manage the museum more professionally intensified in 2005 with the part-time hiring of a series of talented Ph.D. students from the University of Minnesota’s History of Science, Technology, and Medicine program. Before moving on to permanent positions elsewhere, each of them worked hard to preserve, catalogue, interpret, and display the HCMC history collection at a level consistent with standard museum practices. They also developed the policies and procedures needed to guide the museum into the future. The HCMC Historical Museum is definitely worth a visit. Small and intimate, it is informative for anyone interested in the history of medicine and nursing in Minnesota. Members of the “family,” that is, people who have trained and worked at HCMC are sure to be moved emotionally by what they see there. Loyalty among people who have spent time in the trenches at HCMC is legendary. The museum is sure to trigger a flood of memories about their time at “The General.” The HCMC historical collection is made up of thousands of artifacts, photographs, and documents going back to 1887— the beginning of Minneapolis City Hospital. Photographs through the decades show the staff
The Journal of the East and West Metro Medical Societies
proudly posing for group portraits or engaged in caring for patients. Their faces seem to beam with pride and dedication. The class pictures of the nurses and physicians in training hint at HCMC’s record in producing workhorse health professionals to serve the citizens of Hennepin County and the State of Minnesota. The core of the museum’s collection was literally saved from the trash by people such as Audrey and Hillie. In the 1970s, they and others began to act on their own to save items that they considered important and it was they who kept the growing collection protected. Audrey Kuhne, who died on August 18, 2005, from injuries from a fall while traveling, and her longtime colleague Hillie Prose, who continues to be the heart and soul of the museum, each had long, distinguished nursing careers at the medical center before they took on the task of nurturing the museum during their retirement years. Audrey was the night supervisor of the hospital starting in 1951. In 1973 she moved to supervising the stabilization room (“stab room”) in the emergency department. Hillie Prose was the head nurse for the emergency
(Continued on page 18)
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HCMC’s History Museum (Continued from page 17)
room from 1951 to 1965 when she moved up to the position of Director of Emergency Nursing, a post she held until retirement in 1977. In 1971 she and Dr. Ernest Ruiz developed a dedicated space in the emergency room to receive the most critically ill and injured patients, provide them with life support, and stabilize them so they could be safely moved to inpatient areas elsewhere in the hospital. They used the most current technology available at the time and when that wasn’t sufficient, they improvised by manufacturing their own equipment, some of which is now on display in the museum. Their work led to HCMC’s current designation as a Level 1 Trauma Center. Timothy Rumsey, M.D., who interned at the medical center in 1974-75 wrote a set of two papers about the history of HCMC published in 1980 in Minnesota Medicine. Rumsey, now a Saint Paul family physician, covered HCMC’s past from its beginning in 1887 as the Minneapolis City Hospital in a rented house at 724 Eleventh Avenue South to its move in 1976 to its new building at
Hillie Prose, nursing school graduation.
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Seventh Street and Park Avenue. The name changed in 1920 to Minneapolis General Hospital, known affectionately as “The General.” It became Hennepin County General Hospital in 1963 and Hennepin County Medical Center in 1975 as responsibility for the hospital shifted from city to county. Between 1901 and 1915, a threestory H-shaped main hospital building was constructed facing Fifth Street on the Park Avenue side of the block. This building remained the heart of the medical center until 1976. Each of three floors had several open wards with rows of beds down each side. The hospital was usually so busy that patients were crammed into the sun porches, aisles and hallways. In 1914 construction began on a separate nine-story Contagion Building at the corner of Seventh Street and Portland Avenue to house patients with scarlet fever and diphtheria; that building, connected to the main hospital by a tunnel, was later known as “The Annex.” Its original purpose remained evident with special wards for pediatrics, tuberculosis, infectious diseases, and neurology. In 1974 elected officials concluded that the old physical plant was inadequate for the medical needs of a large urban county and made the decision to demolish the old hospital complex and build a new medical center on nearby county land. In 1976 HCMC moved three blocks to its massive new building. Although sad about losing the old buildings, HCMC employees were excited about working in the new facility. An intern at the hospital, none other than Tim Rumsey, M.D., recorded the move on film after convincing Chief of Surgery Claude Hitchcock, M.D. to provide funds to document the transition. (That film has been converted to videotape and CD formats available either from Tim or the HCMC Service
MetroDoctors
Audrey Kuhn (right) at work.
League.) The loss of the old medical buildings still saddens many people, and the memory of the lost pillared hospital façade on Fifth Street continues to haunt older visitors who see the new, ugly government buildings that replaced the old hospital. Luckily, the HCMC museum helps to dampen that sense of loss. At the time of the move, it was obvious to long-term staff members such as Hillie and Audrey that a lot of history was about to be lost. They knew they could do nothing to save the old buildings so they decided to focus on equipment and artifacts they could tag and put into storage. These items eventually became the basis of the history museum. Since then, the Service League of the medical center, formed in 1959, has provided the oversight and organizational support for the museum. It was not until 1994 that the museum was deemed ready for public viewing. Visitors have since enjoyed displays of equipment, uniforms, photographs, and documents. Retired nurses function as hosts during the limited weekly public hours of the museum and one, Rondine Mehling, is the current chairperson of the museum’s advisory committee. People are gradually beginning to appreciate the museum’s value to the medical center, its patients, its staff, and the citizens of Hennepin County. Requests for old photographs and historical documents are frequent and steadily increasing. The museum also organizes
The Journal of the East and West Metro Medical Societies
popular displays of its artifacts within the medical center. For example, an old iron lung was a popular exhibit. Doctors and nurses who trained at HCMC visit the museum, and history students and teachers in Hennepin County use the collection. Progress continues on making the holdings accessible electronically to a wider audience of students, teachers, and historians of medicine and science. The HCMC Museum is located on the lower level of the Blue Building in the medical center complex. It is open to visitors from 10:00 a.m. to 2:00 p.m. on Thursdays except July and August, and by appointment at other times. The museum constantly adds items contributed by former and present staff and trainees. The HCMC Service League is happy to accept cash donations or bequests and to discuss the gift of selected historical items connected to HCMC. In particular, they are seeking diaries, letters, photographs, and private papers that shed light on the lives and careers of those who have
part of HCMC’s past rather than its present. It is to her that this article is dedicated. She set an extraordinarily high standard for service to her beloved hospital and to the preservation of its institutional memory.
served on HCMC’s staff, the health professionals who trained there, and the patients who received care. The museum’s protectors, past and present, deserve sincere thanks for their diligence and foresight in preserving what they could from the medical center’s past. Much has been lost, but through the efforts of dedicated past and current employees of HCMC, devoted friends of the hospital, and alumni of the training programs, much has been saved. Audrey Kuhne herself has now become
Neal Holtan, M.D., a physician who trained in internal medicine at HCMC, is not sure if it is a good thing more than 30 years later that both Audrey Kuhne and Hillie Prose clearly remembered him from his time at HCMC (1973-1977). He is currently a candidate for the Ph.D. in the Program in the History of Medicine at the University of Minnesota. “Adapted from an article originally published Winter 2009, Hennepin History”. 1) Much of the content of this paper comes from interviews by the author with Audrey Kuhne and Hillie Prose and a review of their personal notes. They were kind enough to review this paper in draft form. 2) Personal communication, Hillie Prose, May 2005, about the history of the emergency department. 3) Timothy J. Rumsey, “The General”: A History of Hennepin County Medical Center, Minnesota Medicine (January 1980);Vol:17-24; (February 1980);Vol:101-106. 4) Personal communication, Rondine Mehling, retired nursing supervisor, museum volunteer, current Chair of HCMC Museum Advisory Committee. 5) Personal communication with Kuhne and Prose, June 2005.
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Call EMMS at for details. MetroDoctors
The Journal of the East and West Metro Medical Societies
January/February 2009
19
Hospice:
A Powerful Presence in End-of-Life Care
“Thank you all for making it possible for our Dad to spend the last part of his life with us in his home preparing for his well-earned reward. We would not have been able to grant his final wish without the ongoing quality care and service of the hospice team. Each contact held its own importance and we have been provided with the best of all possible attention for all of our individual and changing
provided with the kind of emotional and spiritual support they desire and need.5 Too many Americans die in fear, anxiety, and isolation without hospice or palliative care due to lack of information, misunderstandings, confusion related to treatment options, restrictive government policies, financial limitations, and numerous other factors.
needs throughout this process. This has been a unique and life altering experience. We will be ever grateful for your gentle but firm hands holding us together during this special time.” Family of a patient served by Hospice of the Twin Cities
The powerful articulation of this family’s hospice experience is overshadowed by the fact that too few dying individuals are offered quality end-of-life care in a timely manner. Last year alone, 32 percent of individuals admitted to hospice programs nationwide, died within seven days of their admission.1 Ironically, the families served by hospice who evaluated the care and service received, stated again and again they wish they had known about the availability of hospice sooner. And in 2007, 98.5 percent of Family Evaluation of Hospice Care respondents indicated they would highly recommend hospice care to others.2
is that many of our greatest fears are being realized. Too many Americans are approaching death without the timely intervention of medical, nursing, social, emotional, and spiritual support.4 In the last stage of a long struggle with an incurable progressive disease, pain is frequently untreated or at best, inadequately controlled. Sadness, depression, and the ability
HOSPICE OF THE TWIN CITIES
Dying in America Today
Large public opinion surveys have, for many years, confirmed that Americans are concerned about the circumstances of dying and the endof-life care they and their loved ones are likely to receive. Fear of loss of personal control, of being a burden, of being abandoned, and of suffering from unrelieved pain stand out among the most common worries.3 Sadly, the reality of end-of-life care today By Lisa Abicht-Swensen, M.H.A.
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January/February 2009
to cope with the end-stage disease process are rarely addressed. Physical pain and symptoms rob the dying of their energy, their dignity, and often their will to continue living. Family members who provide care are stressed, inadequately supported by professionals, and often become ill themselves by the struggle. Patients who wish to remain in familiar surroundings at home are often forced to spend their final days or weeks in a hospital or nursing home. Neither dying patients nor their families are
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Hospice Care and Services
Since its inception in the 1960s, the hospice movement has constantly evolved to meet the needs of terminally ill patients and their families. Research consistently shows hospice utilization has improved the quality of care patients receive at the end of life.6-11 The hospice multidisciplinary approach to the treatment of patients who are nearing death consists not only of physicians and nurses, but of home health aides and homemakers, social workers, spiritual support staff, bereavement counselors, volunteers and, in more recent years, the addition of complementary therapies such as music, pet, massage and healing touch therapies. In the view of most physicians today, hospice is not limited to any single disease or to any one set of life circumstances for its patients and families. Accordingly hospice has been expanding in recent years to reach people dying of something other than cancer, who lack family support systems, and who live in institutional settings. And, although it is still a separate and distinct system in many ways, hospice has become the “Gold Standard” in end-of-life care and a part of accepted and expected medical practice. While acknowledging that accurately prognosticating disease trajectories is not scientific and can be challenging and at times next to impossible, there are criteria to guide physicians in identifying patients who could benefit from the interventions of a hospice team including:
The Journal of the East and West Metro Medical Societies
Patients with a limited life expectancy, usually measured in months, not years, if the disease follows a normal course; s Patients who have decided on treatment goals directed to relief of symptoms rather that cure of the underlying disease; s Patients with documented rapid clinical progression of disease; s Patients who have had significant functional decline (FAST, PPS, Modified ADLs, NYHA class IV.), and s Patients with critical nutritional compromise. Additional conditions that could prognosticate a limited life expectancy include: s Declining functional status in three of six ADLs; s Frequent ER/physician visits/hospitalizations for dehydration, life-threatening infections, or pain management; and s Significant weight loss > 10 percent in the last four to six months. The vast majority of hospice care is paid for by the Medicare Hospice Benefit. In Minnesota, Medicaid and most private insurers also provide coverage for hospice services. In addition to the services of the hospice multidisciplinary team, the Medicare Hospice Benefit pays for durable medical equipment, medical supplies, medications for symptom control and pain relief, short-term care in the hospital, including respite and inpatient care for pain and symptom management, physical, occupational, and speech therapy, dietary counseling and grief support to assist the patient and the family in coping with the terminal illness and its associated suffering. s
regulatory burdens or scrutiny. However, as a result of dramatic growth in Medicare Hospice Benefit expenditures over the past couple of years, hospice programs have come under more intense scrutiny as evidenced by the following: s President Bush’s 2009 Budget calls for a $7.43 billion cut over five years in hospice reimbursement; s The Medicare Payment Advisory Commission (MedPAC) is examining hospice payments and costs, and is considering recommending long-term reforms to the hospice reimbursement system; s The Centers for Medicare and Medicaid Services (CMS) has released the new hospice conditions of participation effective December 2, 2008; s As of July 1, 2008, CMS requires weekly reporting of hospice visits and charges; and s The Office of Inspector General (OIG) will soon release a report on hospice plans
Patient Pearl Moen enjoys a visit from Jil Ocel.
of care and appropriate payment for services provided. On balance, it should be pointed out that the economic value of hospice care has been validated by research. An independent study released late last year by Duke University found that the use of hospice saved Medicare an average of $2,300 per patient who received this care. Cumulative maximum savings of nearly $7,000 per beneficiary with a primary diagnosis of cancer occurred after about eight weeks of hospice use. For decendents with other terminal diseases, maximum savings of
Crutchfield Dermatology “Remarkable patient satisfaction from quality, service, convenience and excellent results” “Exceptional care for all skin problems” Charles E. Crutchfield III, M.D.
Challenges and Opportunities for Hospice Providers
Today’s hospice care, like the rest of our health care system, has seen enormous growth and change. Hospice is caring for more people every year, continuously enhancing quality and providing state-of-the-art medical care and social, emotional and spiritual support. But compared with 25 years ago, more intense levels of care, shorter lengths of service, and more advanced, more expensive interventions, pharmaceuticals, and treatments are now typical of today’s hospice care. And like the rest of health care, change and progress have been accompanied by significant challenges. For most of its 25 year history, hospice providers have not been subjected to ongoing
MetroDoctors
(Continued on page 22)
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Your Patients will Look Good & Feel Great with Beautiful Skin
The Journal of the East and West Metro Medical Societies
www.CrutchfieldDermatology.com
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Appointments 651-209-3600 At your request, we have same day appointments available for your patients with acute skin care needs.
January/February 2009
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Hospice (Continued from page 21)
around $3,500 occurred when the beneficiary used hospice for the last seven weeks of life.12 In this year of imminent changes to the Medicare Hospice benefit, it is critical for hospices to share what they know, namely: s Hospice offers the services and support that Americans want when coping with life-limiting illness;13 s Nine of 10 Americans, if faced with a terminal illness, would want to remain in their homes and receive the services that hospice provides. In fact, over 80 percent of hospice care in the U.S. is provided in the home;14 s 98.5 percent of families would recommend hospice to others reflecting the high level of satisfaction with care.15 This is probably just the beginning of an arduous reimbursement and regulatory process that hospice proponents must engage in to ensure that this valuable benefit will continue as a viable service for America’s terminally ill and their families. The eloquent expressions of appreciation from families benefiting from the services of
the hospice team drive home the evidence that if we keep people from feeling abandoned, and make sure their pain is treated, remarkable things happen. Occasionally a family will describe the last month spent with a dying loved one as “the best time we’ve ever had together.” Or a patient who is within a week or so of death — and knows it — emanates a sense of genuine contentment and peace. It becomes clear that these patients, with the supportive care of a hospice team guiding them along their final journey, are being offered the opportunity to “die well” surrounded and supported by those they love and cherish. About Hospice of the Twin Cities
Hospice of the Twin Cities is a communitybased, Medicare certified, not-for-profit hospice program serving Minneapolis, St. Paul and its surrounding communities. Employing a staff of over 100 talented professionals, the hospice’s strong interdisciplinary team includes physicians, nurses, social workers, home health aides, homemakers, chaplains, music therapists, pet therapists, volunteers, bereavement counselors and support staff. Committed to excellence in end-of-life care the hospice mis-
sion is to seek out and serve individuals who have historically been underserved by hospice programs. Hospice of the Twin Cities is a wholly owned subsidiary of the Minnesota Visiting Nurse Agency. Lisa Abicht-Swensen, M.H.A., is the Chief Executive Officer of Hospice of the Twin Cities and Vice President of the Minnesota Visiting Nurse Agency. Ms. Abicht-Swensen’s more than 24 years of experience in health care administration spans the long-term care and hospice/home care professions where she has researched and implemented diversified health programs in an effort to expand the full continuum of care offered to the elderly and homebound. Ms. Abicht-Swensen currently serves as the Chairperson of the Care Providers of Minnesota Foundation Board of Trustees. In November of 2007, she received the Care Providers of Minnesota Chairperson’s Award in recognition of outstanding leadership, service, compassion and commitment to the Association, its members, the long-term care profession, and the lives of those we serve. 1)
2) 3)
4)
5) 6)
Minnesota Epilepsy Group is the largest and most comprehensive epilepsy program in the Midwest. As a regional referral facility, we are the recognized leader in treating epilepsy and other seizurerelated conditions in patients of all ages, from infants to the elderly. Adult Epileptologists Deanna L. Dickens, MD Julie Hanna, MD El-Hadi Mouderres, MD Patricia E. Penovich, MD Pediatric Epileptologists Jason S. Doescher, MD Michael D. Frost, MD Frank J. Ritter, MD
www.mnepilepsy.org 225 Smith Avenue N. Suite 201 St. Paul, MN 55102
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January/February 2009
7)
8)
9)
10)
11)
12)
Functional Neuro-Imaging Wenbo Zhang, MD, PhD
Appointments (651) 241-5290
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13)
14) 15)
National Hospice and Palliative Care Organization. Family Evaluation of Hospice Care 2007. National Average Scores. Ibid. Gallup Organization, Knowledge and Attitudes Related to Hospice Care (Arlington, Va.: National Hospice Organization, 1996). The Last Acts Coalition, Means to a Better End: A Report on Dying in America Today (Washington, D.C.: Partnership for Caring, November 2002). Ibid. Kane RL, Wales J, Bernstein L, Leibowitz A, Kaplan S. A randomized controlled trial of hospice care. Lancet 1984;1:890-894. Wu N, Miller SC, Lapane K, Gozalo P. The problem of assessment bias when measuring the hospice effect on nursing home residents’ pain. J Pain Symptom Manage 2003;26:998-1009. Munn JC, Hanson LC, Zimmerman S, Sloan PD, Mitchell CM. Is hospice associated with improved end-of-life care in nursing homes and assisted living facilities? J Am Geriatr Soc 2006;54:490-495. Miller SC, Mor V, Teno JM. Hospice enrollment and pain assessment and management in nursing homes. J Pain Symptom Manage 2003;26:791-799. Miller SC, Mor V, Wu N, Gozalo P, Lapane K. Does receipt of hospice in nursing homes improve the management of pain at the end of life? J Am Geriatr Soc 2002;50:507-515. Gozalo PL, Miller SC. Hospice enrollment and evaluation of its causal effect on hospitalization of dying nursing home residents. Health Serv Res 2007;42:587910. Taylor D, Ostermann J, Van Houtven CH, Tulsky J, Steinhauser K. What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program? Social Science & Medicine 65: (2007) 1466-1478. Gallup Organization, Knowledge and Attitudes Related to Hospice Care (Arlington, Va.: National Hospice Organization, 1996). Ibid. National Hospice and Palliative Care Organization. Family Evaluation of Hospice Care 2007. National Average Scores.
The Journal of the East and West Metro Medical Societies
U of M Medical Students Receive White Coats and Associate Dean Kathleen Watson, M.D. noted that the white coat plays an important symbolic role in the patient-doctor interactions and the respect society assigns to the physician is related to the professional values and responsibilities of this calling. The East Metro and West Metro Medical Societies are honored to be supporters of this event. An engraved reex hammer was given to each student by Edward Ehlinger, M.D., president-elect, WMMS, and Ronnell Medical students recite the Class of 2012 Statement of Hansen, M.D., president-elect, Commitment during the White Coat Ceremony. EMMS. The 2012 University of Minnesota medical student class received their white coats at a ceremony held on August 8, 2008. In the address to the class, Dean Deborah E. Powell, M.D.
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A congratulatory gift was given to each medical student at the White Coat Ceremony on behalf of the East Metro and West Metro Medical Societies by Drs. Edward Ehlinger and Ronnell Hansen (not pictured).
The Journal of the East and West Metro Medical Societies
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January/February 2009
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Members in the News
KATHLEEN D. BROOKS, M.D., MBA, MPA has been named associate dean for primary care at the University of Minnesota Medical School. She previously was assistant dean for Continuing Medical Education at the U of M Medical School, and currently serves as chairperson of the state Health Services Advisory Council, advising the Department of Human Services on health care policy. PETER DALY, M.D. was the recipient of the Lake Conference Distinguished Alumnae Award. His high school, Burnsville, is a member of the Lake Conference. He practices orthopedic surgery with Summit Orthopedics, Ltd. University of Minnesota Medical School Associate Professor JORDAN DUNITZ, M.D., was awarded the 2008 Medical Staff Recognition Award for Excellence in Clinical Care. He also directs the Adult Cystic Fibrosis Program at the University of Minnesota Medical Center. DAVID R. ECKMANN, M.D. has been inducted as a Fellow in the American College of Radiology. He is a radiologist at St. Paul Radiology. The University of Minnesota has received a $100,000 Grand Challenges Explorations grant from the Bill & Melinda Gates Foundation. The grant will support an innovative global health research project conducted by DAN S. KAUFMAN, M.D., Ph.D., associate professor of Medicine in the Division of Hematology, Oncology, and Transplantation and associate director of the Stem Cell Institute, titled, “Human embryonic stem cell-derived natural killer cells as potent mediators of antiHIV immunity.”
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January/February 2009
STEPHEN KOLAR, M.D. has been named the new senior vice president and chief medical officer of HealthEast Care System. He will assume this position on January 1. He is currently serving as vice president and executive medical director for HealthEast Clinics. THOMAS KOTTKE, M.D. joined JourneyWell as medical director of evidence-based health. JourneyWell is a new health and wellness business serving companies and employers nationwide. In his new role, Dr. Kottke will provide part-time support to prove the effectiveness of health improvement programs. He is a cardiologist with HealthPartners. MARK ODLAND, M.D. was appointed chief of surgery at Hennepin County Medical Center. He is the director of transplant services at the hospital and served as interim chief. IRVING SHAPIRO, M.D., cofounder of Phillips Eye Institute, champion of the revitalization of the Phillips neighborhood in Minneapolis and protector of children’s vision, received the 2008 Budd Appleton, M.D. Award for Service to Ophthalmology. This award recognizes exceptional patient care, significant contributions to public education and effective political advocacy. SCOTT UTTLEY, M.D. was elected president of the Minnesota Academy of Ophthalmology. He is a partner with St. Paul Eye Clinic, P.A. DAVID WALLINGA, M.D., MPA, director of the food and health program at the Institute for Agriculture and Trade Policy in Minneapolis, was the recipient of the third annual Health Leadership Award from the Blue Cross and Blue Shield of Minnesota Foundation. He is being honored for his work on environmental influences on health. MetroDoctors
Abbott Northwestern Hospital was designated an Accredited Chest Pain Center by the Society of Chest Pain Centers. The accreditation recognizes hospital processes for treatment of heart attacks and other causes of chest pain. Children’s Hospitals and Clinics of Minnesota has been cited for excellence by the Extracorporeal Life Support Organization. The award recognizes Children’s for its quality of patient care, training, and education related to the care of infants and children who need long-term heart-lung bypass for survival. The Robina Foundation has granted Abbott Northwestern Hospital $6 million to test a new primary care model. The pilot study will be among 500 patients with diabetes, heart failure and hypertension cared for in an inner-city clinic affiliated with the hospital. The care plan includes four key elements: care guide, electronic care plans, team-oriented care and coaches. The Muscular Dystrophy Clinic at the University of Minnesota Fairview Medical Center is one of 10 sites nationwide to be part of MDA’s new Clinical Research Network. The research focus is Duchenne muscular dystrophy. Regions Hospital in St. Paul has been awarded a Silver Performance Achievement Award from the American Stroke Association and the American Heart Association. The award recognizes Regions’ performance on seven measures to improve acute stroke treatment and prevent secondary events. St. Mary’s Health Clinics, a nonprofit that provides free and low cost health care to the medically underserved, and Washburn Center for Children, a nonprofit leader in helping children with social, emotional and behavThe Journal of the East and West Metro Medical Societies
ioral problems and their families, were the recipients of the 2008 Minnesota Nonprofit Excellence Award. Congratulations to the following East Metro Medical Society and West Metro Medical Society members for being one of the “100 Influential Health Care Leaders” named by Minnesota Physician. MICHAEL AINSLIE, M.D., pediatrician and pediatric endocrinologist with Park Nicollet Clinic and Minnesota Medical Association Board Chairman; JOHN ALLEN, M.D., MBA, Medical Director for Quality at Minnesota Gastroenterology and Institute for Clinical Systems Improvement Board Chairman; BRENT ASPLIN, M.D., MPH, Department Head, Emergency Medicine at Regions Hospital; MACARAN A. BAIRD, M.D., MS, Professor and Head, Department of Family Medicine and Community Health at the University of Minnesota Medical School; MARK BANKS, M.D., CEO, Blue Cross and Blue Shield of Minnesota; MICHAEL B. BELZER, M.D., Medical Director/Chief Medical Officer at Hennepin County Medical Center and Associate Dean at the University of Minnesota Medical School; BARRY A. BERSHOW, M.D., Medical Director, Quality and Informatics at Fairview Health Services; SAMUEL CARLSON, M.D., FACP, Chief Medical Officer at Park Nicollet Health Services; FRANK B. CERRA, M.D., Senior Vice President for Health Sciences at the University of Minnesota; PETER DALY, M.D., Orthopedic Surgeon with Summit Orthopedics, Ltd.; LAURA A. DEAN, M.D., FACOG, Chairman, Department of Ob/ Gyn at Stillwater Medical Group; JOHN FREDERICK, M.D., Chief Medical Officer and Executive Vice President at PreferredOne; LEO T. FURCHT, M.D., Allen-Pardee Professor and Head, Department of Laboratory Medicine and Pathology at the University of Minnesota Medical School and Board Chair, University of Minnesota Physicians; J. MICHAEL GONZALEZ-CAMPOY, M.D., Ph.D., Medical Director and CEO at Minnesota Center for Obesity, Metabolism & Endocrinology, P.A.; CAROL GRABOWSKI, M.D., Medical Director, Department of Radiation Oncology at Abbott Northwestern Hospital Virginia Piper Cancer Institute;
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DONALD M. JACOBS, M.D., Chairman and CEO at Hennepin Faculty Associates; PHILLIP M. KIBORT, M.D., MBA, Chief Medical Officer and Vice President of Medical Affairs at Children’s Hospitals and Clinics of Minnesota; LOIS (LOIE) LENARZ, M.D., Senior Vice President and Chief Clinical Officer at Fairview Health Services; LOUIS J. LING, M.D., Associate Dean for Graduate Medical Education at University of Minnesota Medical School; RUTH LYNFIELD, M.D., State Epidemiologist at the Minnesota Department of Health; ROBERT MEICHES, M.D., MBA, CEO at the Minnesota Medical Association; STEVEN H. MILES, M.D., Professor of Medicine and Ethics at the University of Minnesota Medical School and Professor at the U of M Center for Bioethics; ROBERT C. MORAVEC, M.D., Medical Director at St. Joseph’s Hospital; ANNE M. MURRAY, M.D., MSc; Chronic Disease Research Group, Hennepin County Medical Center (Hennepin Faculty Associates) and Associate Professor of Medicine and Geriatrics at the University of Minnesota Medical School; GARY OFTEDAHL, M.D., Medical Director at Institute for Clinical Systems Improvement; DEBORAH E. POWELL, M.D., Dean at the University of Minnesota Medical School; BRIAN RANK, M.D., Medical Director at HealthPartners; BURTON S. SCHWARTZ, M.D., Past President and Medical Director of East Side Clinics at Minnesota Oncology Hematology, P.A.; STEVE STERNER, M.D., FACEP, Senior Vice President at Hennepin Faculty Associates, Chief Clinic Officer at Hennepin County Medical Center and Faculty, HCMC Department of Emergency Medicine; JON THOMAS, M.D., MBA, President at Ear, Nose & Throat Specialty Care of Minnesota; TOM E. TIMMONS, M.D., Vice President of Medical Affairs at North Memorial Health Care; MICHAEL TRANGLE, M.D., Vice President of Medical Affairs at HealthPartners Regions Hospital; SELWYN M. VICKERS, M.D., Jay Phillips Professor and Chairman of the Department of Surgery at the University of Minnesota Medical School; ROBERT R. WEBER, M.D., Staff Physician at Family HealthServices of Minnesota Shoreview Clinic and President of HealthEast Medical Staff; PENNY WHEELER, M.D., Chief Clinical Officer at Allina Hospitals & Clinics.
The Journal of the East and West Metro Medical Societies
January/February 2009
25
President’s Message
Health Care Reform, Costs, and Resource Utilization PETER B. WILTON, M.D.
THE COMING YEAR PROMISES to be an interesting one for the medical profession from the
EMMS Officers
President Peter B. Wilton, M.D. President-elect Ronnell A. Hansen, M.D. Past President V. Stuart Cox, M.D. Treasurer Thomas Siefferman, M.D. EMMS Executive Staff
Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Katie R. Snow, Administrative Coordinator (612) 362-3704 ksnow@metrodoctors.com Doreen M. Hines, Manager, Member Services (612) 362-3705 dhines@metrodoctors.com For a complete list of EMMS Board of Directors go to www.metrodoctors.com.
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January/February 2009
standpoint of health care policy. It is clear that a major part of President-elect Obama’s legislative agenda involves significant health care reform. In Minnesota, the Governor and the legislature are about to implement the reforms passed in the last session. Both federal and state administrations will face significant challenges in implementing health care reforms, as the current economic downturn will curtail their ability to fund meaningful change. This will doubtlessly focus attention on the cost of medical care delivery. We can no longer afford the annual increases in the cost of health care, and the unsustainable trajectory of health care costs is a primary stimulator of reform. Because it is politically unpalatable to decrease the amount of care delivered, politicians hope to deliver more and improved health care at less expense. This proposal is worth examining. There are two major drivers of cost: increased utilization and advancing technology. Since health care costs are age-related, population demographics suggest that spending will increase due to the baby boomers’ aging. Furthermore,the related epidemics of obesity and diabetes will adversely impact health care costs for decades. Politically ambitious plans to increase health care coverage for the population are likely to compound the problem. Similarly, costs related to technological advances are also likely to increase, as the low-hanging fruit of cost-effective health care interventions such as vaccinations, X-rays and aspirin has long been picked. The incremental benefit of current high-tech advances such as PET scanners, robotic surgery and immunopharmaceuticals is relatively small and achieved at great expense. Several solutions have been proposed to improve health while saving money. These include initiatives related to consumer behavior such as high-deductible insurance and health savings accounts; physician payment proposals including single-payer systems and pay-for-performance schemes; adjustment to the mechanics of health care delivery, particularly those involving information technology systems and electronic medical records; and changes in distribution of care from acute to preventive, and from specialist to primary care medical homes. It is unlikely that any of these proposals, alone or in concert, will achieve the trifecta of cost control, broad access to care and continued medical innovation. Thus politicians will have to grapple with difficult choices. In the context of health care, not everyone can have everything. While all of us favor wise utilization of finite resources and agree that this should be a goal of policy, any mention of the “R word” — rationing — is problematic and fraught with political hazard. Nonetheless, most national health care systems utilize one or another form of rationing. Some are overt, as in third-world countries where resources are severely limited. In our system, rationing is covert — by affordability, with uninsured patients unable to pay for non-emergency care and increases in insurance premiums; by inconvenience, with health care plans demanding pre-approval of tests and procedures; and by cost shifting, using high-deductible plans to decrease utilization by decreasing the patient’s medical spending power. Whatever the cost-saving reforms, it is clear that these will have to come from policy directives and not from individual physicians. While it is incumbent upon us to be careful stewards of the health care dollar, in the final analysis our responsibility is to our patients and not to the financial health of either a health care organization or system. We can best play our part in cost control by informing health care policy development. This has been a major focus of the East Metro Medical Society, and is likely to remain so in the future. MetroDoctors
The Journal of the East and West Metro Medical Societies
2009 EMMS Election Results Congratulations to the newly elected EMMS leaders
PRESIDENT-ELECT Thomas D. Siefferman, M.D. Pediatrics Pediatric & Young Adult Medicine, P.A.
SECRETARY/TREASURER Laura A. Dean, M.D. Obstetrics/Gynecology Stillwater Medical Group
DIRECTOR V. Stuart Cox, III, M.D. Otolaryngology Midwest Ear, Nose & Throat Specialists
DIRECTOR Phillip H. Stoltenberg, M.D. Internal Medicine/ Gastroenterology Minnesota Gastroenterology Clinic and Endoscopy Center
DIRECTOR Jo Ann Wood, M.D. Internal Medicine University of Minnesota
Metro Medical Society
The Following Have Been Appointed to a Position on the EMMS Board by an MMA Section.
Delegates to MMA Elected to Serve With EMMS Board Members
Richard L. Baron, M.D. Amy L. Gilbert, M.D. J. Michael Gonzalez-Campoy, M.D., Ph.D. Stephanie D. Stanton, M.D. Appointed by the MMA Young Physician Section Family Medicine HealthEast Roselawn Clinic
Aaron M. Burnett, M.D. Appointed by the MMA Resident Physician Section Emergency Medicine Regions Hospital
Jessica M. Voight, MS2 Appointed by the MMA Medical Student Section
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James J. Jordan, M.D. Robert C. Moravec, M.D.
SAVE THE DATE
$""+ I[`fWd 9S^S S`V 3``gS^ ?WWf[`Y Installation of Ronnell A. Hansen, M.D. as the 139th President
Thursday, January 22, 2009
North Oaks Golf Club 54 East Oaks Road, North Oaks
Social Hour (cash bar)—5:30 p.m. Dinner—6:30 p.m. Program and Awards—7:30 p.m. Social to follow
Contact: Katie at 612-362-3704 Ɣ Email: ksnow@metrodoctors.com MetroDoctors
The Journal of the East and West Metro Medical Societies
January/February 2009
East
PRESIDENT Ronnell A. Hansen, M.D. Diagnostic Radiology St. Paul Radiology, P.A.
27
Frank Indihar, M.D., Attends His Last AMA Meeting
T
he American Medical Association Interim meeting was held in Orlando, Florida November 8-11. The physicians from the East Metro Medical Society who attended included outgoing Minnesota AMA Delegation Chair, Frank Indihar, M.D., and AMA delegate Ken Crabb, M.D., and AMA-alternate delegate Blanton Bessinger, M.D. The Minnesota physician delegation took time out to thank Dr. Frank Indihar for his long service on the AMA delegation and for his steady leadership as their delegation chair. Dr. Indihar’s colleagues also recognized his invaluable service as a mentor for the medical students and others. Dr. Indihar retired in February 2008 as chief executive officer for HealthEast’s Bethesda Hospital located in St. Paul. He served in various leadership roles within the East Metro Medical Society including serving as its president and treasurer. Ronnell Hansen, M.D., president-elect of EMMS and Sue Schettle, CEO of EMMS also attended the meeting and followed the two EMMS resolutions that went forward this year onto the AMA for action. The first resolution, authored by Dr. Jim Jordan, psychiatrist with Hamm Clinic, called for the AMA to educate physicians and the public about the new rights afforded to them by the passage of the Mental Health Parity Act. The AMA will develop this material and have it available on its Web site. The second resolution, authored by Dr. Bob Moravec, medical director at St. Joseph’s Hospital, called for the AMA to study the challenges in credentialing low-volume providers and work with the Joint Commission and other interested parties to develop and utilize fair and balanced criteria and methods for credentialing such providers and procedures. It was noted that the AMA Board of Trustees report on this issue, among others, is being prepared in preparation for the 2009 Annual Meeting.
Minnesota physician delegation at the AMA meeting.
East Metro Medical Society physicians include: from left – Ken Crabb, M.D., Frank Indihar, M.D., Blanton Bessinger, M.D. and Ronnell Hansen, M.D. Sue Schettle, CEO, is in the center.
Medical Market Reform that Could Actually Help Somebody Questions, anxieties, and hopes from a health economist in the Upper Midwest
A presentation Nov. 21, 2008, by Stephen Parente, Ph.D. Dr. Stephen Parente, Carlson School of Management, University of Minnesota, spoke at the fifth open public meeting of the EMMS Council on Professionalism and Ethics, chaired by Robert W. Geist, M.D., and co-sponsored with 28
January/February 2009
the medical staffs of United and HealthEast Hospitals. Why do we think comprehensive health reform is possible in 2009 when it has been impossible from Wilson’s presidency to Clinton’s? Anxieties arise when economists find that technology is good for society but a driver of costs. And actuaries find the best way to control costs is through catastrophic insurance, and yet such a real economic solution is politically unpalatable. Both presidential candidates wanted change. Is compromise then possible? While Senators ready bills for an early presidential signature, what seems more likely MetroDoctors
could be a “70/30” compromise: 70 percent Democrat and 30 percent Republican—from mandates and guaranteed issue of insurance to vouchers for catastrophic insurance with a national connector (i.e., insurance exchange). The battle lines are forming. What could alter the picture? Consider the effects if the Dow drops below 5000, unemployment rises 10 percent or more, GM is unable to emerge from bankruptcy, China collapses, or an epidemic or terror attack closes down whole cities. Barring such events, something in health care may actually happen this time. The Journal of the East and West Metro Medical Societies
MPS Vendor Spotlight
SafeAssure Consultants, Inc.
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Consider freeing up your OSHA compliance ofďŹ cer and outsourcing this important component of your safety program to the professionals from SafeAssure Services. To learn more, call 1-800-920-SAFE. SafeAssure Consultants, Inc. has ofďŹ ces in Willmar and Woodbury.
HDUW + U X R \ G ([WHQ HOHVV P R + H K W WR )HEUXDU\ Please consider the 17th Annual Caring Hearts for Homeless People drive as something your organization would like to be a part of. 3XW RXW D FROOHFWLRQ ER[ DQG DVN \RXU RUJDQL]DWLRQ¡V HPSOR\HHV WR EULQJ LQ K\JLHQH VXSSOLHV DQG RYHU WKH FRXQWHU PHGLFDWLRQV IRU WKH KRPHOHVV DGXOWV \RXWK DQG FKLOGUHQ LQ WKH (DVW 0HWUR DUHD *R WR ZZZ PHWURGRFWRUV FRP WR ILQG DGGLWLRQDO GHWDLOV RI WKH GULYH DQG D VKRSSLQJ OLVW RI LWHPV WKH RUJDQL]DWLRQV DUH UHTXHVWLQJ 'RQDWHG LWHPV ZLOO EH VRUWHG DW 6W -RVHSK¡V +RVSLWDO DQG GLVWULEXWHG WR WKH KRPHOHVV WKURXJK WKH IROORZLQJ WKUHH SURJUDPV +HDOWK &DUH IRU WKH +RPHOHVV /LVWHQLQJ +RXVH DQG 6DIH=RQH 3OHDVH FDOO 'RUHHQ +LQHV DW (DVW 0HWUR 0HGLFDO 6RFLHW\
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MetroDoctors
The Journal of the East and West Metro Medical Societies
SAMUEL W. HUNTER, M.D., pacemaker pioneer, passed away on October 22, 2008. He was 86. Dr. Hunter was a superb scholar athlete and brieďŹ&#x201A;y played professional basketball with the Rochester Royals during medical school at the University of Rochester. He then came to the University of Minnesota for graduate study in surgery with Dr. Owen Wangensteen. His training was interrupted by three years of Army service as Captain during the Korean conďŹ&#x201A;ict. After resuming and completing his residency and fellowship in cardiothoracic surgery, he joined a St. Paul private practice, and began work in heart surgery research with Dr. C. Walton Lillehei at the University of Minnesota. Dr. Hunter developed the Hunter-Roth implantable pacemaker electrode with a Medtronic engineer, and in 1959 connected an external pacemaker to a 72-year-old patient. This patient lived seven years, spurring interest in the development of long-term implantable pacemakers. He joined EMMS in 1956. JAMES JANECEK, M.D. died at the age of 75 on September 14, 2008. Dr. Janecek received his medical degree from the University of Minnesota. While establishing a private practice in St. Paul he was drafted as one of the ďŹ rst psychiatrists to serve in the Vietnam War. In the 1980s he acquired Familystyle Homes, three blocks of housing in St. Paulâ&#x20AC;&#x2122;s West 7th neighborhood, where he worked to provide transitional homes for the mentally ill. The neighborhood property owners fought the project for years, ďŹ nally forcing him to close down Familystyle. His view of providing the mentally ill with a neighborhood independent living environment as opposed to institutionalized isolation was far ahead of its time. For many years he also worked with veterans at the VA Medical Center. In retirement he found a new career posting on a number of political Web sites, along with ďŹ nancial and news forums. He was more engaged in the world at the age of 75 than he was at 25. Dr. Janecek joined EMMS in 1969. January/February 2009
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Metro Medical Society
Want to learn more? Consider sending an employee that is in charge of your OSHA compliance requirements to a FREE lunch seminar to learn more about OSHA and SafeAssureâ&#x20AC;&#x2122;s online program. The next session is scheduled for January 29, 2009, from 11:00 a.m. â&#x20AC;&#x201C; 1:00 p.m. at the East Metro Medical Society ofďŹ ces; 1300 Godward Street NE, Minneapolis 55413. Call Katie Snow at (612) 362-3704 to RSVP, or e-mail her at ksnow@metrodoctors.com.
DONALD G. ALTON, M.D. died September 27, 2008 at the age of 84. Dr. Alton earned his medical degree at the Rochester New York School of Medicine. He practiced family medicine in St. Paul for 35 years. Dr. Alton joined EMMS in 1960. East
afeAssure Consultants, Inc. is an organization specializing in OSHA compliance training. They have had a longstanding partnership with East Metro Medical Society through our for-proďŹ t subsidiary, Minnesota Physician Services (MPS). We are excited to inform you that theyâ&#x20AC;&#x2122;ve recently broadened their approach to OSHA compliance training by offering an on-line training program for your ofďŹ ce staff. For $10 per person your staff can receive OSHA compliance training when itâ&#x20AC;&#x2122;s convenient for them (and for you). Their time spent on OSHA compliance is tracked and recorded so that when theyâ&#x20AC;&#x2122;ve completed their education they can simply print off the report and add it to their ďŹ le. Training modules include: Bloodborne Pathogens, Employee Right to Know, A Workplace Accident and Injury Reduction (AWAIR), Ergonomics, and an Emergency Action Plan.
In Memoriam
New Members EMMS welcomes these new members to the Society. Schools listed indicate the institution where the medical degree was received.
Active Leslie G. Ahlers, M.D. State University of New York at Buffalo School of Medicine Family Medicine HealthEast â&#x20AC;&#x201C; St. Josephâ&#x20AC;&#x2122;s Hospital
Ganesh Pawar, M.D. Government Medical College, India (University of Minnesota) Family Medicine Sonya Haw, M.D. Medical College of Wisconsin, Milwaukee Stefan Pomrenke, M.D. Pediatrics Virginia Commonwealth University Family Medicine Jacob L. Hutchins, M.D. General Surgery Lee W. Rock, M.D. University of Minnesota Medical School Shanna M. Jagusch, M.D. Family Medicine Pathology
Resident Physicians
Cristy R. Jensen, M.D. University of Minnesota Medical School Anesthesiology
Lily G. Rodgers, M.D. Government Medical College, India Family Medicine
Kenneth E. Bloom, M.D. Wayne State University School of Medicine Dermatology/Pediatrics Dermatology Center for Children & Young Adults, P.A.
Milind Y. Junghare, M.D. University of Minnesota Medical School Nephrology
Dawn Schreifels, M.D. Sanford School of Medicine Family Medicine
Joseph Kalugdan, M.D. Family Medicine
Jennifer O. Schumann, M.D. University of Minnesota Medical School Psychiatry
Jonathan M. Cooper, D.O. Kirksville College of Osteopathic Medicine Orthopedic Surgery HealthPartners Specialty Center
Melissa M. Keller, M.D. University of Minnesota Medical School Family Medicine
Teresa A. Pena, M.D. University of California School of Medicine Family Medicine Fairview Hugo Clinic Stuart W. Steichen, D.O. Chicago College of Osteopathic Medicine Family Medicine Apple Valley Medical Clinic, Ltd. Philip W. Stoyke, M.D. Medical College of Wisconsin, Milwaukee Family Medicine HealthEast Woodbury Clinic Naveen N. Sikka, MB BS Bangalor Medical College, India St. Paul Allergy & Asthma Clinic, P.A. Stanley L. Smith, M.D. Medical College of Georgia, Augusta Family Medicine Stillwater Medical Group
Resident Physician Marla A. Dewitt, M.D. Mayo Medical School Family Medicine United Family Practice Health Center
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January/February 2009
Kashiff Khan, M.D. Medical U of the Americas, St. Kitts/Nevis Family Medicine Katie M. Larson Ode, M.D. Pediatric Endocrinology Jennifer A. Lueth, M.D. Obstetrics/Gynecology Claire L. Mallof, M.D. University of Minnesota Medical School Obstetrics/Gynecology Kathryn M. Manning, M.D. Psychiatry Jennifer McCormack, M.D. Pediatric Hematology/Oncology Amaris Moore, M.D. U of Iowa Carver College of Medicine Family Medicine Keith P. Murphy, M.D. University of Minnesota Medical School Pediatrics
Tajinder Singh, M.D. Himalayan Institute of Medical Sciences, India Family Medicine Joline E. Skinner, M.D. University of Michigan Medical School Physical Medicine & Rehabilitation Mary Skrypek, M.D. Creighton University Pediatrics Leslie J. Smith, M.D. Pediatrics Hematology/Oncology Rebecca Starling, M.D. Pediatrics Richard S. Stayner, M.D. University of Minnesota Medical School General Surgery Katie E. Thompson, M.D. Family Medicine Abigail M. Tokheim, M.D. University of Wisconsin School of Medicine Obstetrics/Gynecology
Libby M. Wagner, M.D. Family Medicine Derek R. Weiland, M.D. University of Minnesota Medical School Surgery
Medical Students (University of Minnesota) Arnoley Abcejo Yoftahe Abebe Colin Anderson Amber Andrews Dylan Bindman Elyse Brock Nicholas Brown Saydi Chahla Samuel Cramer Kenneth Dodd Adannia Enyioha Jacob Feigal Dennis Gerold, Jr. Oksana Goldman Adrienne Harden Patricia Hickey Russell Johnson Okezika Kanu Jeffrey Kendall Patrick Lally Natasha Lewis Hnouchi Lochungvu Mark A. McCarthy Rebecca Marcus Travis Moncrief Erin Norby Margaret Pain Abby Palmer Kurt Prins Julie Rolfes Megan Rooney Maura Scanlon Joseph Schmidt Ann Simones Derek Smith Thomas Stewart Jillian Suzukida Margaret Sweeney Sara Tonsager James Waters David Wen Lance Whitehair Fran Wu Tou Lee Xiong
Theresa W. Muskardin, M.D. Internal Medicine Michael Nwaneri, M.D. Pediatrics
Visit us at www.metrodoctors.com
MetroDoctors
The Journal of the East and West Metro Medical Societies
Chair’s Report
Health Care and the Veterans Administration RICHARD D. SCHMIDT, M.D.
WMMS Officers
Chair Richard D. Schmidt, M.D. President Edward P. Ehlinger, M.D. President-elect Peter J. Dehnel, M.D. Secretary Melody Mendiola, M.D. Treasurer Eric G. Christianson, M.D. Immediate Past Chair Anne M. Murray, M.D. WMMS Executive Staff
Jack G. Davis, Chief Executive Officer (612) 623-2899 jdavis@metrodoctors.com Jennifer Anderson, Project Director (612) 362-3752 janderson@metrodoctors.com Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Kathy R. Dittmer, Executive Assistant (612) 623-2885 kdittmer@metrodoctors.com For a complete list of WMMS Board of Directors go to www.metrodoctors.com.
WHAT HAS HAPPENED TO VA HEATH CARE? Why is there so much news about the VA, either positive or negative? A large majority of physicians have spent time training in a VA and have their ideas about how the system operates. How many really know what has happened to the VA and how it functions today? As chief of orthopedic surgery at the Minneapolis VA and the new chair of the West Metro Medical Society, I will attempt to explain the current status and compare it to years gone by. Does it merit the praise that it has been given? Let me first explain my perspective. I am a Minneapolis VA trained orthopedic surgeon, when there was a separate VA orthopedic residency. I practiced with Orthopedic Associates and Orthopedic Consultants for many years and had been part-time VA staff until I was appointed chief of orthopedic surgery and residency site director at the Minneapolis VA Medical Center in 2000. I was chief of staff at two local hospitals and on the board of Minnesota Medical Insurance Company. I have enjoyed all aspects of my career but have developed a strong allegiance to the veterans. To very briefly summarize the history of the VA, the government has responded after each war with aid to the veterans, going back to the War for Independence. Usually this was in the form of pensions but as veterans aged there was recognition of their need for medical care. Nursing homes and hospitals were founded in response. After the Civil War, cemeteries were added in order to properly bury the dead who were hastily buried in the battlefield. The influx of veterans from World War I prompted Congress to consolidate many of the scattered veterans benefit functions under the leadership of Brigadier General Frank Hines. This led to the building of more VA hospitals, which was repeated again after World War II. This effort was led by General Omar Bradley and Major General Paul Hawley. Dr. Hawley is credited with the establishment of residency training cooperatively with medical schools, VA research, and patient care as the mission of the VA hospitals. The VA seemed to go through a stagnant period after Vietnam with a perception of very poor care as characterized in popular motion pictures. Many of us who trained during those times remember the days of admitting every patient and putting them in a queue until their needs could be met. These issues were finally addressed when, under President Reagan, the needs of the veterans and their power was recognized. The Veterans Administration was made part of the president’s cabinet as the Department of Veterans Affairs. It is responsible for benefits, health care and cemeteries. Although the veterans had the ear of the president, nothing happened until a leader with vision and insight was appointed. Dr. Ken Kaiser, who was board certified in multiple specialties, became Under Secretary of the VA after leaving the California Department of Health to take the position. He created a “new VA” by adopting technology, recognizing the need for women’s health in the VA, reorganized into integrated service networks for more local control, assessed and changed the distribution of assets by closing some VAs and opening new ones and changing most care from inpatient to outpatient. Many of you are aware that VA outpatient clinics have opened across every state and continue to grow. The VA has the oldest, largest and fully integrated electronic medical record in the world. Furthermore, as a result of a culture change in the VA, quality comes first. Read any of the weekly news magazines such as Time or Newsweek and in the past year there has been an article about how good VA care really is. The book Best Care Anywhere by Philip Longman will add history and insight. (Continued on page 32)
MetroDoctors
The Journal of the East and West Metro Medical Societies
January/February 2009
31
WMMS Board of Directors Annual Meeting
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oard members, friends and family gathered on October 22, 2008 to celebrate the leadership of Board Chair Anne M. Murray, M.D. and congratulate Richard D. Schmidt, M.D. on his succession to this position. In addition to Drs. Murray and Schmidt, the following members serving as officers and Executive Committee members were introduced: Edward Ehlinger, M.D., president; Peter Dehnel, M.D., president-elect; Eric Christianson, M.D., treasurer; and Melody Mendiola, M.D., secretary. In his opening comments to the Board, Dr. Schmidt announced that the West Metro Medical Society continues to thrive. Our current membership is at 4,300 physicians, residents and students. He noted that 2007-08 has seen our tobacco control efforts be directed toward local policy changes in Scott County and participation in the statewide efforts culminating in the passage of Freedom to Breathe. The efforts locally, and our success statewide, is directly related to our colleagues who volunteered to get involved, testify, write letters, make phone calls and craft op-ed pieces for local newspapers. Each voiced a commitment to changing second-hand smoking policies in local communities and statewide. A new public health initiative underway is focused on healthy menus and disclosure of
Anne M. Murray, M.D. receives the out-going Chair’s award, 98.6 degrees.
nutrition information on menu boards for all food items at the point of sale. This proposal allows customers at fast food restaurants to make a more informed choice at the counter. The Medical Society continues to be a strong advocate for the profession through active advocacy at the Capitol along with the East Metro Medical Society, MMA and the Minnesota Provider Coalition, and for our patients with aggressive work in the public health arena.
Chair’s Report (Continued from page 31)
Do I believe that the VA is the best and that they should be the model for health care in the United States? I am neutral. The VA has a unique situation. Their patients are extremely loyal and are locked to the system. Once in, they don’t leave later for another health plan. When treating a chronic disease, the ability to follow the patient with clinical guidelines and performance measures, especially with an integrated electronic medical record, gives the VA an advantage. However the VA is very politically driven. When any negative event occurs, it is on the news with all of the sound bites and innuendos so commonly used by the media. Expedient decisions, forced by congress and the media, are often made in these situations without the benefit of careful study and a well-researched solution for the problem. And where would the VA be without private practice, academic medicine, and competition? The VA has been forced to change by those around them who often lead by innovation, financial motivations, and competition. Just like the VA has learned from the private sector, the private sector may learn from the VA. The one thing I can attest to is that change in the VA has occurred rapidly and improved medical care with a cost that is below Medicare and the private sector.
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January/February 2009
MetroDoctors
First a Physician The First a Physician award was presented to Carl Burkland, M.D. in recognition of the passionate work tirelessly done in support of the profession and his patients, In presenting this award, Jack Davis noted that Dr. Burkland has been a member of the WMMS Board in some capacity for over 21 years and served as Caucus Chair for the past three years. His medical practice is described as being “more akin to Marcus Welby, M.D. than to Dr. House,” but his advocacy for patients is strong. He knows exactly what it means to be a “medical home.” Dr. Burkland has often taken an active role on important public health issues such as cell phone usage while driving, second-hand smoke, alcohol tax, and the alcohol “social host” ordinance, to name a few.
Carl Burkland, M.D. accepts the 2008 First a Physician Award from Jack Davis,CEO, WMMS.
Guest Speaker Dan Lindh, President and CEO, Presbyterian Homes and Services was invited as the featured speaker for the evening. His comments drove home the value and importance of long-term care services and supports, as well as the challenge in the financing of the solutions. Dan Lindh, President and CEO, Presbyterian Homes and Services.
The Journal of the East and West Metro Medical Societies
2008 Charles Bolles Bolles-Rogers Award
J
Eugene Ollila, M.D. Receives U of M Alumni Service Award
MetroDoctors
The Journal of the East and West Metro Medical Societies
January/February 2009
33
W e st M e t r o M e d i c a l S o c i e t y
and could lead to better treatment of children and adults with leukemia. Of special note is the extensive number of trainees who have worked under his direction and are now achieving their own independent research career successes. Originally called the St. Barnabas Bowl, the award was established in 1951 by the late Mr. Charles Bolles Bolles-Rogers, who served on the St. Barnabas Hospital Board of Trustees and was President of that Board for many years. Mr. BollesRogers died in 1975 at the age of John H. Kersey, M.D. receives the Charles Bolles Bolles91 but, prior to his death, he made Rogers Award from Anne Murray, M.D., WMMS Chair. provisions for this award to be continued and it is currently funded by the West Metro Medical Society. The award is an engraved sterling silver WMMS Requests U of M Regents to Postpone Alcohol Vote Revere Bowl. The nomination and selection of the IN A LETTER to the University of Minnesota recipient of this honor is made annually by Regents and press release on November 25, nominations submitted to the WMMS Board the WMMS Board of Directors requested that of Directors by hospital medical staffs in Henthe U of M Board of Regents delay their decision regarding the selling of alcohol at several nepin, Anoka, Carver, Scott, and Western University of Minnesota venues, including the Dakota counties. new TCF Bank Stadium. The letter to Honorable Patricia S. Simmons, chair, Board of Regents, cites that because the misuse of alcohol is a major public health problem in our society and a problem on college campuses throughout the country, a decision to have alcohol available (even in controlled settings) at major athletic venues on The U of M Alumni Service Award, is given in recognition of service as a volunteer to the a public university campus should not be made University, its schools, colleges, departments, or faculty, or to the University of Minnesota quickly and not without broad community Alumni Association or any of its constituent groups. input. Community input is important because In a letter nominating Euof the major role that the University of Mingene Ollila, M.D. for the U nesota plays in setting community norms. We of M Alumni Service Award, believe that whatever decision is made will have WMMS highlighted his efforts a profound impact on the community norm in establishing the “Connections” about the link between athletics and alcohol. program, which pairs medical stuBecause of this, the WMMS Board unanidents and physicians in a mentormously passed the following resolution: ing relationship. In addition, Dr. Be it resolved that the University of MinOllila is credited for developing nesota Regents postpone for a period of six the Alumni Hosting Applicants months the decision whether or not to serve or sell alcoholic beverages at University program. Dean Deborah Powell athletic venues. The delay in this immediate stated, “His contributions will decision would allow for additional discusstrengthen relationships between From left: Margaret Carlson, CEO of the University of Minnesota Alumni Association; Medision and assessment of the broad impact and present and future physicians for cal School Dean Deborah E. Powell, M.D.; and implications of having or not having alcohol Eugene Ollila, M.D. many years to come.” available at these venues.
ohn H. Kersey, M.D., was awarded the Charles Bolles Bolles-Rogers Award at a meeting of the University of Minnesota Medical Center, Fairview medical staff, held October 7, 2008. In presenting this honor, Anne Murray, M.D., WMMS Board Chair, noted that Dr. Kersey’s unique career encompasses medical research, clinical practice, visionary leadership, and effective mentorship of young faculty. His professional contributions include providing outstanding pediatric oncology care for several decades, conducting world class research involving bone marrow transplantation and other aspects of pediatric oncology, as well as serving as the initiator and first director of the Masonic Cancer Center, an NCIdesignated Comprehensive Cancer Center at the University of Minnesota. Although he has just stepped down as director of the Masonic Cancer Center, he maintains an active research laboratory in the Center. He and his team most recently published an article in Cancer Cell describing the discovery that young stem cells are the cells at risk to develop into leukemias. This discovery has therapeutic implications
What will happen to your practice in 2009? This is NOT a time for amateurs! The healthcare industry is not immune to the economic problems we are facing. Many patients will have higher deductibles and out-of-pocket expenses in 2009. As some of your patients lose their jobs, they also lose their medical coverage. Itâ&#x20AC;&#x2122;s never made more sense to outsource your insurance and patient billing to professionals!
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January/February 2009
MetroDoctors
Healthy Eating Minnesota Contract Awarded to WMMS
I
n June 2008, the West Metro Medical Society was wrapping up its work to promote and implement Minnesotaâ&#x20AC;&#x2122;s landmark Freedom to Breathe Act. Many wondered what would Jennifer Anderson be next. Considering the statistics related to obesity in Minnesota, the answer became obvious â&#x20AC;&#x201D; promote healthy eating. Thanks to Blue Cross and Blue Shield of Minnesota (Blue Cross), WMMS was awarded a â&#x20AC;&#x153;Healthy Eating Minnesotaâ&#x20AC;? contract. The goal of this new work is to increase access to and availability of healthier foodsâ&#x20AC;&#x201D;especially fruits and vegetables â&#x20AC;&#x201D; and to help foster healthy eating among Hennepin County residents. The project is supported by Blue Cross as part of Prevention Minnesota. Prevention Minnesota is Blue Crossâ&#x20AC;&#x2122; long-term health improvement initiative funded by tobacco settlement dollars to tackle the root causes of preventable heart disease and cancer. â&#x20AC;&#x153;Two-thirds of adult Minnesotans are overweight or obese,â&#x20AC;? said Marc Manley, M.D., M.P.H., vice president and medical director of population health at Blue Cross. â&#x20AC;&#x153;If trends continue unchecked, obesity will add nearly $1 billion to Minnesotaâ&#x20AC;&#x2122;s total health care costs by 2010, and $3.7 billion by 2020. By investing in prevention and looking for ways to make it easier to eat healthfully, Minnesota stands to save signiďŹ cant health care dollars, and more importantly, lives.â&#x20AC;? WMMS is excited to begin the work of creating new norms for Minnesotans around healthy eating. Contract work for â&#x20AC;&#x153;Healthy Eating Minnesotaâ&#x20AC;? will begin in January 2009. Jennifer Anderson will serve as the project coordinator.
The Journal of the East and West Metro Medical Societies
Welcome New WMMS Members Active Elias P. Bazakos, M.D. Minneapolis Clinic of Neurology, Ltd. Neurology Luis E. Bello-Espinosa, M.D. Noran Neurological Clinic, P.A. Child Neurology, Pediatrics
Anne H. Bracey, M.D. Midwest Forensic Pathology Pathology George N. Caucutt, M.D. Twin Cities Anesthesia Associates, P.A. Anesthesiology Yi C. Chang, M.D. Pediatrics Pamela D. Doorenbos, M.D. North Clinic, P.A. Family Medicine Sonya B. Hollingsworth, M.D. Multicare Associates of Twin Cities Family Medicine MaryBeth Mahony, D.O. Partners in Pediatrics, Ltd. Pediatrics Mary K. Martinie, M.D. Oakdale OB/GYN Obstetrics/Gynecology Scott A. Reichel, M.D. Northwest Family Physicians, P.A. Family Medicine Paul A. Ruth, M.D. Family Medicine Kathryn R. Shrift, M.D. Skin Care Doctors, P.A. Dermatology Amy C. Whitson, M.D. Andrew L. Wilkey, M.D. Northwest Anesthesia, P.A. Anesthesiology MetroDoctors
(University of Minnesota)
Matthew G. Abeln, M.D. Nicholas M. Absalom, M.D. Shawn Ahmed, M.D. Naheed Alam, M.D. Shaheen Alanee, M.D. Nouredin Alebouyeh, M.D. Ahmad T. Alhammouri, M.D. Rami M. Almokayyad, M.D. Mhd Anas N. Alsawaf, M.D. Annette N. Anderson, M.D. Stephanie R. Anderson, M.D. Michelle K. Atchison, M.D. Saba Beg, M.D. Nadiya O. Beliveau, M.D. Scott P. Bender, M.D. Satya V. Bommakanti, M.D. Mariana J. Canoniero, M.D. Sarah Castaneda, M.D. Christopher Chow, M.D. Steve M. Cordina, M.D. Melissa Cortez, M.D. Cory Daignault, M.D. Noha S. Ekdawi, M.D. John Flores, M.D. Lisa A. Fox, M.D. Traci Fritz, M.D. Melissa Gabriel, M.D. Sameer D. Gadani, M.D. Priyania Gait, M.D. Rajiv J. Gandhi, M.D. Monisha P. Gidvani, M.D. Sean Glasgow, M.D. Pamela Gonzalez, M.D. Brett L. Gourley, M.D. Gilliam F. Grafton, M.D. Mohiuddin Hadi, M.D. John C. Halla, II, M.D. Matheson Harris, M.D. Michael T. Healy, M.D. Christine A. Herr, M.D. Michael D. Holth, M.D. Lydia Hsu, M.D. Naohiko Imai, M.D. Seher Iqbal, M.D. Megan A. Iverson, M.D. Vijay S. Iyer, M.D. Robert Jacobs, M.D. Ubonvan Jongwutiwes, M.D. Paramjit Kalirao, M.D. Matthew J. Kapalis, M.D. Jacklyn M. Karban, M.D. Amy B. Karger, M.D. Tarundeep Kaur, M.D. Hamza Khalid, M.D. Abdul M. Khan, M.D. Rakesh Khatri, M.D. Nahi N. Kiblawi, M.D.
The Journal of the East and West Metro Medical Societies
Rajul M. Kothari, M.D. Mellisa Kriscunas, M.D. Sonja Kuchling, M.D. Dana C. Kusnir, M.D. Angela M. Lamb, M.D. Lori LaRiviere, M.D. Vien Q. Le, M.D. Stephanie R. Lee, M.D. Curtis R. Louwagie, M.D. Monica I. Lupei, M.D. Aditya V. Maheshwari, M.D. Van Malia, M.D. Paula M. Martinez-Agredano, M.D. Benjamin J. May, M.D. Steven E. McCormack, M.D. Heather E. McDougall, M.D. Benjamin L. Mitlyng, M.D. Danielle Morgan-Goerke, M.D. Katie A. Moriarty, M.D. Andrea M. Morris, M.D. Brian K. Muthyala, M.D. Veena A. Nagar, M.D. Christopher S. Nielsen, M.D. Danah M. Oâ&#x20AC;&#x2122;Niel, M.D. Marie C. Olseth, M.D. Haejoe Park, M.D. Alicia Parks, M.D. Brandon R. Peters, M.D. Randolph K. Peterson, M.D. Katharine Pico, M.D. Isaac Porter, M.D. Elena Puscasiu, M.D. Rabi Qaiser, M.D. Angela Radulescu, M.D. Lisa Rapaport, M.D. Ayesha Rashid, M.D. Sobia Rashid, M.D. Rohini Ravindran, M.D. Kashif Raza, M.D. Krista M. Reagan, M.D.
Preetham Reddy, M.D. Aamer Rehman, M.D. Nicholas K. Reul, M.D. Samy M. Riad, M.D. Henri Roukoz, M.D. Ali A. Saab, M.D. Zohar Sachs, M.D. Kristine L. Sanow, M.D. Srinivasan Sattiraju, M.D. Saniel C. Schroyer, M.D. Poorani Sekar, M.D. Deepan Selvadurai, M.D. Ryan N. Seutter, M.D. Anish V. Sharda, M.D. Derrick Siebert, M.D. Mark E. Smith, M.D. Stephanie C. Smith, M.D. Robert L. Solberg, M.D. Stephanie M. Solberg, M.D. Melhem M. Solh, M.D. Eisa A. Stein, M.D. Monica C. Stiles, M.D. Craig E. Strauss, M.D. Takashi Takashahi, M.D. AshenaďŹ M. Tamene, M.D. Ruth Thomson, M.D. Guruprasad Tiptur Mahadevaiah, M.D. Karysse J. Trandem, M.D. Michael C. Tressler, M.D. Geoffry Tufty, M.D. Douglas Valenta, M.D. Lemuel R. Vawter, M.D. Matthew Vernon, M.D. Lourdes G. Villaume, M.D. Margaret Weisskirk, M.D. Ryan E. Williams, M.D. Haralabos Zacharatos, M.D. Renzo A. Zaldivar, M.D.
Visit us at www.metrodoctors.com Find new career opportunities, archive issues of MetroDoctors and information on the latest news, events and legislative issues!
January/February 2009
35
W e st M e t r o M e d i c a l S o c i e t y
James R. Benzie, M.D. North Memorial Clinic-Brooklyn Park Family Physicians Family Medicine
Resident Physicians
CAREER OPPORTUNITIES
Please also visit www.metrodoctors.com for Career Opportunities.
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Career Opportunities
Introducing the â&#x20AC;&#x153;Career Opportunitiesâ&#x20AC;? section of MetroDoctors!
A great avenue for professionals to learn about job opportunities AND a perfect place for recruiters to promote openings! Recruiters, call for our special recruitment rate. Betsy Pierre, ad sales 763-295-5420 betsy@pierreproductions.com
Great Partners, Great Staff, Great Patients, Excellent Income & Lifestyle (%'1 ! '.$ !,0% !Minnesota, P.A. is looking "*, -!0!, ' * , !,.%"%! '%#% '! (%'1 $1-% % )- .* "%'' "/'' .%(! + ,. .%(! *, -$ ,! +*-%.%*)- *%) */, ) !+!) !). ,*/+ *"
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36
January/February 2009
MetroDoctors
The Journal of the East and West Metro Medical Societies
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