July/August 2015
Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
Evolving Practice Models Strategies for Success
Experience of Care
Population Health
Triple Aim Per Capita Cost
In This Issue: • • • •
5 Clinics Describe Their Success Collecting Patient Fees - Before it’s too Late Legislative Wrap-up Luminary of Twin Cities Medicine
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Birkeland & Burnet
01 6617 Mohawk Trail Edina $1.595M; 02 6400 Parkwood Road Edina $3.995M; 03 10956 Bell Oaks Estate Road EP $1.25M; 04 1701 Mount Curve Ave $3.5M; 05 6250 Chasewood Drive EP $1.195M; 06 NON-MLS 2201 E Lake Of The Isles Pkwy
Bruce Birkeland / 612.925.8405 / BirkelandBurnet.com
BURNET
CONTENTS VOLUME 17, NO.4
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J U LY / A U G U S T 2 0 1 5
IN THIS ISSUE
Evolving to a Value Based Care World; Creating Success in Today’s Landscape By Richard Sturgeon, M.D.
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PRESIDENT’S MESSAGE:
Preparing Your Practice for the Future By Kenneth N. Kephart, M.D. Page 23
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TCMS IN ACTION By Sue Schettle, CEO
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2015 Legislative Session Review By Nancy Haas, JD and James Clark, JD
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Healthiest State Summit EVOLVING PRACTICE MODELS
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Colleague Interview A Conversation with Robert A. Wieland, M.D.
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Consulting Radiologists—Quantity and Quality By Christopher Tillotson, M.D.
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Successfully Independent—Past, Present and Future By Dave Thorson, M.D.
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Metro Urology and the Triple Aim By Todd Brandt, M.D. and Aaron Milbank, M.D.
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Divisional Merger Business Model in Medicine: A View From the Inside By Russell Wavrin, M.D.
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Inside Steps Needed to Grow a Successful Independent Medical Group By Peter J. Daly, M.D.
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How to Navigate Faster Collections By Dawn Lunde
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Sharing the Experience 2015
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Your Voice By Carl E. Burkland, M.D.
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E-cigarette Trainings Heat Up Advance Care Planning: New Tools for Communities
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Honoring Choices 5K a Success!
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Luminary Nomination
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Twin Cities Medical Society Foundation
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New Members Senior Physician Association
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In Memoriam Career Opportunities
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LUMINARY OF TWIN CITIES MEDICINE
Joseph Tombers, M.D. The Journal of the Twin Cities Medical Society
On the Cover: Independent clinics are finding unique ways to thrive in this competitive marketplace. Articles begin on page 8. July/August 2015
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Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Robert R. Neal, Jr., M.D. Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Richard R. Sturgeon, M.D. Physician Co-editor Charles G. Terzian, M.D. Medical Student Co-editor Katherine Weir Managing Editor Nancy K. Bauer TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Andrea Farina MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at St. Paul, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.
July/August Index to Advertisers
TCMS Officers
President: Kenneth N. Kephart, M.D. President-elect: Carolyn McClain, M.D. Secretary: Thomas Kottke, M.D. Treasurer: Matthew Hunt, M.D. Past President: Lisa R. Mattson, M.D. TCMS Executive Staff
Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Nancy K. Bauer, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Barbara Greene, MPH, Community Engagement Director, Honoring Choices Minnesota (612) 623-2899 bgreene@metrodoctors.com Emily Johnson, Marketing and Communications Coordinator (612) 623-2885 ejohnson@metrodoctors.com Ellie Parker, Project Coordinator Physician Advocacy Network (612) 362-3706 eparker@metrodoctors.com Karen Peterson, BSN Director of Program Operations, Honoring Choices Minnesota (612) 362-3704 kpeterson@metrodoctors.com
Allergy and Asthma Center of MN .............22 Allina Health.......................................................31 Coldwell Banker Burnet....................................... Inside Front Cover Crutchfield Dermatology.................................. 2 Entira Family Clinics .......................................30 Fairview Health Services .................................31 Healthcare Billing Resources, Inc. ...............22 Lakeview Clinic .................................................31 Maps Pain Center................................................... Outside Back Cover Saint Therese.......................................................20 Senior LinkAge Line.............................................. Inside Front Cover St. Cloud VA Medical Center ............................ Inside Back Cover Uptown Dermatology & SkinSpa................18
Crutchfield Dermatology “Remarkable patient satisfaction from quality service, convenience and excellent results”
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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. Advertisements published in MetroDoctors do not imply endorsement or sponsorship by TCMS. 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 Andrea Farina at (612) 623-2885.
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July/August 2015
Charles E. Crutchfield III, M.D.
Board Certified Dermatologist
Psoriasis & Acne Specialist 1185 Town Centre Drive Suite 101 Eagan, MN 55123
Your Patients will Look Good & Feel Great with Beautiful Skin.
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MetroDoctors
At your request, we have same day appointments available for your patients with acute skin care needs.
The Journal of the Twin Cities Medical Society
IN THIS ISSUE...
Evolving to a Value Based Care World; Creating Success in Today’s Landscape Value Based Care: Concurrently reduce cost of care, enhance the patient experience and improve clinical quality/ population health — the Triple Aim. The term Triple Aim was coined by Dr. Donald Berwick when he was the CMS Director. This issue will be exploring the current and changing world surrounding the practice of medicine. It will illuminate formal and informal relationships, collaborative efforts, and opportunities for patient care improvements that also allow for economic survival. Five highly regarded and forward thinking metro area clinics have offered a view of their strategies for successfully remaining independent in this competitive marketplace. Perhaps you will gain a nugget or two to apply to your clinic from their insights. Efforts to increase the value of U.S. Health Care Services have been under way for at least a decade. Some commercial sector and Medicare VBC initiatives started well before the Affordable Care Act (ACA) and continue today. Most changes, with or without Obamacare, have generated their own momentum; thus the heightened pressure for providers to accommodate to Value Based Care (VBC) to improve overall performance. The ACA included permanent policies and many pilots to test value-based payment models through Medicare. By 2018, CMS/HHS VBC payment goals expect 50 percent of Medicare payments will be tied to quality-value through alternative payments such as ACOs or bundled payments. Hospital traditional Medicare payments will be 90 percent tied to quality or value. Personalized Primary Care as experienced by our parents and grandparents is difficult to provide in today’s health care environment. The EHR database substitutes for interpersonal doctor-patient relationship. While the EHR is much better at retaining key data points, it has zero emotional IQ. Practicing individualized care, one patient at a time, is difficult with population health goals and mandated
By Richard Sturgeon, M.D. Member, MetroDoctors Editorial Board
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The Journal of the Twin Cities Medical Society
uniform care protocols. Current measures are of limited help to the individual patient. Patients are more than their disease. With most QA metrics, patients are first and foremost their billing code diagnosis; the individual is only a series of DRG or CPT codes used to create a hard metric such as survival, nosocomial infection and so forth. CMS promises many competing QA reporting programs in Medicare will be consolidated and better aligned. Please stay engaged to make this happen. Another impetus for change is that Chronic Diseases has become the primary source of poor health and death today. And so evolves new teamwork approaches. Payers are beginning to pay a little for care management. While maintaining independence, one must find a way to relate to larger system-wide clinically integrated networks. That relationship will have business implications, risk sharing contracting and patient care implications. If done thoughtfully, this can be better for our patients and for us at the same time. Bob Weiland, M.D., our colleague interviewee this issue, is immersed in this very effort. His response to Editorial Board questions is most informative. Dawn Lunde describes strategies for upfront collection of patient fees and the TCMS lobbying and legislative team of Messerli and Kramer provide a summary of the 2015 legislative session. Please note that at the time of this writing a special session to complete their work has yet to be called. And finally, Joseph Tombers, M.D. is featured as our Luminary of Twin Cities Medicine. Read on. July/August 2015
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President’s Message Preparing Your Practice for the Future KENNETH N. KEPHART, M.D.
THIS ISSUE OF METRODOCTORS FEATURES INDEPENDENT PRACTICES around
the theme of “Evolving Practice Models — Ways to Thrive and Strategies for Success.” Before I comment on the potential disruptive effect of web-based direct-to-patient virtual care and other telehealth retail medicine practices, I want to give a shout out to Northwest Family Physicians in the west metro. They are a small independent practice in the west metro with 12 MDs and five midlevel practitioners at three sites. They are also my old partners as I practiced there for nine years a few decades ago. Earlier this year Stanford University’s Clinical Excellence Research Center named them one of the top 11 primary care practices in the country, providing higher quality care at lower cost among 15,000 practices considered. “Our findings challenge the belief that excellent primary care can only be provided by large healthcare organizations that are household names” said Arnold Milstein, director of the Stanford research center. The research found three distinct ways these practices distinguished themselves: Their relationships with patients are deeper; their interactions with others in the local healthcare system are more coordinated; and their practices are organized to foster teamwork. They identified 10 features that can serve as a blueprint for providing the most valuable care. 1) The practices are “always on”; 2) Physicians adhere to quality guidelines and choose tests and treatments “wisely”; 3) They treat patient complaints as gold; 4) They in-source rather than out-source some needed tests and procedures; 5) They stay close to their patients, even when referring them to specialists; 6) They close the loop with patients; 7) They maximize the abilities of staff members; 8) They work in “hived” workstations; 9) They balance compensation; and 10) They invest in people. Sounds like a good place to work. The second topic is one my adult children have driven home to me. They are all in their 30s and all have young children. They work and have busy lives. They have frequently complained to me that our current practice model doesn’t meet their needs or expectations. They feel it is doctor centric, not patient centric. Waiting for appointments, waiting in the waiting room with a bunch of other sick people, waiting in the exam room then having the doctor flash in and out in 10-15 minutes, or having the doctor spend more time working on the computer than talking to them after all of their wait is not meeting their needs. They use mobile smart phones with apps and want to know why we are still using phone, voice mail, fax and computers. In primary care and non-procedural specialty care think of all the care that could be provided virtually with apps that can measure vitals, listen to the heart, look in ears, monitor your conditions with home lab testing and then provide a “virtual consultation” on-line. The technology is all there and patients are demanding it. If you want to see what is available now go to these two websites: www. mdlive.com and www.healthtap.com. Look at the videos for patients to view and services they offer. Just swipe your Visa card and get a service. It is convenient and the cost is transparent. If you believe this is just a passing fad or won’t have staying power then look at the companies behind it: Google, Apple, Amazon, Walgreens, Walmart and CVS to name a few. I am not saying this is a great thing and doesn’t raise concerns, but I believe this is here to stay and will grow. We need to figure out how to work with technology, adapt our practices and most of all listen to and try to meet our patient’s needs. I could never figure out when the “minute clinics” next to the retail pharmacies started, why primary care didn’t move swiftly and figure out a way to provide similar care at similar cost and convenience. Since 20-40 percent of conditions people presented with at these clinics were not able to be treated there it would have been good to see a response that offered “More than a Minute” care at your local doctor. Remember the best care of a patient is actually caring about them. 4
July/August 2015
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The Journal of the Twin Cities Medical Society
TCMS IN ACTION SUE A. SCHETTLE, CEO
TCMS Board Begins Strategic Planning Discussions
TCMS recently conducted a membership survey in preparation for our May 2015 strategic planning board retreat. Nearly 400 physicians responded to the 16-question survey and gave the Board of Directors feedback on current initiatives and new ideas for additional activities that TCMS might consider tackling in the future. The good news is nearly 85 percent of respondents indicated that our population health work remains important to our membership. We also received considerable support and feedback on expanding our focus in the metro to work on advancing health equity by working to reduce health disparities. The TCMS executive committee will meet again in June and discuss the outcome of the strategic planning board meeting and work to set the framework for TCMS for the next three to five years.
TCMS Board members worked in small groups during the Strategic Planning session.
Educational Opportunities Expand for our Members
As we continue to look for ways to engage our members in the work of TCMS, three CME modules for physicians on e-cigs, hookahs and other tobacco products were just finalized. Ellie Parker, MPH, project coordinator for our e-cig education and awareness project is leading this work. If you are interested in having Ellie come to your clinic, or participate in a Grand Rounds
MetroDoctors
please connect with her at eparker@ metrodoctors.com. Ellie is working throughout the state to educate physicians and medical students on the latest science behind e-cigs and other tobacco products. Our recent membership survey showed that most physicians don’t talk to their patients about e-cig use. TCMS is also working with the University of Minnesota to engage medical students, residents and faculty on some public health programs. Specifically, we are working with David Power, M.D., MPH, Director, Family Medicine and Community Health Medical Student Education, and medical student Katie Hinderacker to expand our survey on e-cigs to medical students to find gaps in their learning and to then explore ways to get medical students more aware of e-cigs. TCMS president, Ken Kephart, M.D. and board member Ryan Greiner, M.D. are working with James Nixon, M.D., MHPE, associate professor, department of medicine and others from the U of M’s Internal Medicine department, to develop an appropriate advance care planning curriculum for medical students. The plan is to then expand this educational offering to residents and faculty at the U of M and to offer CME for all physicians. Honoring Choices Minnesota staff has just completed three videos in Hmong, Spanish and Somali. The videos discuss advance care planning in a culturally appropriate manner within these three segments of our population. The videos can be livestreamed from our website www.metrodoctors.com or DVDs can be purchased. We are excited about this new addition to our advance care planning toolkit. Contact Barbara Greene with questions, bgreene@metrodoctors.com.
The Journal of the Twin Cities Medical Society
TCMS Board and Committee Openings
We currently have a few openings on the TCMS Board of Directors, MetroDoctors editorial board, and the TCMS legislative and policy committee for practicing physicians and medical students. If you are interested in serving send your CV to TCMS @metrodoctors.com. If you have questions, please contact me directly at (612) 362-3799. Healthiest State Summit
Registration is now open for the Healthiest State Summit, to be held on Thursday, August 6, 2015, 8:00 a.m.4:00 p.m. Goals of the summit are to identify why Minnesota is losing status as the “healthiest state” in the nation, identify actions to improve health and achieve health equity in Minnesota and to encourage new partnerships to make Minnesota the healthiest state. Thomas Kottke, M.D. is the program chair. Contact Nancy Bauer for more information, nbauer@metrodoctors.com; (612) 623-2893. Register at www.metrodoctors.com. Sharing the Experience 2015
Honoring Choices’ 6th annual Advance Care Planning Conference is Thursday July 16 in Minneapolis. Join colleagues for a day focusing on ACP efforts throughout our state. This conference gets bigger and better each year! Details can be found on our website: www. metrodoctors.com.
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2015 Legislative Session Review
Session Summary
The 2015 legislative session began on January 6, 2015. With a GOP dominated House, DFL-controlled Senate and DFL Governor, many of the omnibus bills contained significant differences that had to be ironed out in conference committees. The legislature adjourned on May 18, 2015 at midnight. The last 24 hours of session were fast paced with the passage of the majority of the funding bills required to fund all aspects of state government. In the afternoon of May 19, Governor Dayton vetoed the Omnibus K-12 Education Bill, which will inevitably lead to a special session being held. While the 89th session concluded on time, it did not include passage of the top priorities of all legislative caucuses. The House GOP left without a tax bill, the DFL Senate did not achieve passage of a comprehensive transportation bill, and the Governor’s top priority of funding universal pre-k was not included in the final education bill. Budget Forecast
The February Forecast, released on February 27, set the tone of the session. The forecast projected revenues to be $42.497 billion, a $616 million (1.5 percent) increase over November estimates. As a result, the projected forecast balance for the next biennium was $1.869 billion, an increase of $832 million over the November forecast.
By Nancy Haas, JD and James Clark, JD
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July/August 2015
Key Priorities: Education, Transportation, Tax Cuts
Education, transportation and health care were the highest profile and most contentious items of the 2015 legislative session. Governor Dayton had proposed $343 million to implement universal pre-K throughout the state. The House did not include this provision in its Omnibus K-12 Education Bill, and the Senate’s omnibus bill included $70 million for schoolreadiness programs, but only $5 million for early learning scholarships. The final Omnibus K-12 Education Bill included $400 million to increase the per-pupil funding formula 1.5 percent in 2016 and 2 percent in 2017. The bill also puts $30 million into the state’s School Readiness program, and another $30 million into Early Learning Scholarships. The two bodies of the legislature were greatly divided on transportation for the vast majority of the session. Early on, the GOP rolled out a $6.6 billion plan that prioritized spending on the state’s roads
and bridges. Alternately, the Senate bill proposed a comprehensive bill including investments in roads, bridges, and transit. A key component of their plan was a gas tax that would lead to drivers paying an additional 16 cents per gallon. In the end, Republicans and Democrats could not agree on a bill and thus passed a “lights on” transportation funding bill, meaning it keeps the wheels turning on the state’s current system. Some lawmakers have disagreed with that description, however, noting that the final bill did include some new money (almost $30 million), including $12.5 million to help cities with fewer than 5,000 people with their roads. The Republican’s top priority was using the state’s almost $2 billion surplus for tax cuts. However the legislators were not able to come to an agreement and a tax bill was not passed. Speaker Kurt Daudt and Senate Majority Leader Tom Bakk have set aside almost $1 billion of the surplus on the state’s bottom line so if there is a
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special session it is possible that some of the surplus could be dedicated to tax relief. Health Care
A significant battle in the health care discussion this session included proposals to cut $1 billion from the Health and Human Services budget. Republicans had proposed to eliminate MinnesotaCare, a subsidized health care program for 90,000 working, low-income Minnesotans. In the final bill, rather than eliminating the program, a task force was set up to look into the future of it. There were also several substantive changes made to MNsure, the state’s health insurance exchange, and a call for millions in savings by cutting down on waste and fraud in program eligibility. The final conference committee report included a House provision offered by Rep. Tara Mack, Chair of the House Health and Human Services Policy Committee, providing that a federal waiver would be requested to allow individuals to purchase health plans outside of MNsure and still qualify for the premium tax credits offered through the program. Another federal waiver would be requested to allow small employers to receive the small business health care tax credit when the employer pays the premium on behalf of the employee. The final agreement will change the governance structure of the MNsure board, which was given special exemptions at its onset to help get the state’s compliance with the federal Affordable Care Act off the ground. Other MNsure reforms would include: • publicizing plan rates at least 30 days prior to open enrollment periods; • removing open meeting law exemptions put in place to kick start the program in a short timeframe; • ensuring timely appeals of MNsure determinations; and • prohibiting MNsure from offering policies that do not meet state requirements. Lastly, a key funding component that was included in the final bill was nursing facility payment reform and workforce MetroDoctors
development assistance. $138 million was directed toward the state’s nursing homes, but a 5 percent increase for home and community-based services was left out. Advance Care Planning
An Advance Care Planning Community Development Bill was included in the final House Health and Human Services Omnibus Bill. The bill provided a onetime appropriation of $250,000 in the biennium ending June 30, 2017. This would be in the form of a grant from the general fund to a “statewide advance care planning resource organization that has expertise in convening and coordinating community-based strategies to encourage individuals, families, caregivers, and health care providers to begin conversations regarding end-of-life care choices that express an individual’s health care values and preferences and are based on informed health care decisions. This was a top priority for TCMS this session and will provide critical support for Honoring Choices in the future. Prior Authorization
SF943/HF1060 was a bill authored by Sen. Melisa Franzen and Rep. Tony Albright that modifies the utilization review and prior authorization process for prescription drugs and creates prescription drug benefit transparency and management coverage requirements. The provision was included in an earlier version of the HHS Omnibus Bill but was ultimately removed. Electronic Health Records
The HHS policy bill, HF1535, was amended to include an exception for “a health care provider in private practice with no more than six additional health care providers” from participating in the electronic health records system. Sen. Sheran removed the provision on the Senate floor before the bill was passed, thus the provision was not included in the final version of the bill.
adjourned, we now face the near certainty of a special session. Toward the end of session, Governor Dayton repeatedly said that he would veto a school funding bill that didn’t include the pre-K funding, but the Legislature passed the Omnibus K-12 Education Bill without it. Governor Dayton indicated his intention to veto the bill immediately the next day. A major challenge as to when a special session might take place is the fact that the state Capitol is now under major renovation and cannot be used to house a special session. In the coming days and weeks we will know more about where a special session may take place, when, and whether or not it will just include a vetoed education bill. In the final minutes of session the jobs bill was passed with significant controversy, and a legacy bill and bonding bill were passed in one chamber but not both. When the legislature comes back in 2016 the focus will be on capital investment, as is the case in the second year of a biennium. The legislature will convene extremely late next year, Tuesday, March 8 to allow for work on the capitol. The new Senate Office building is set to open for the 2016 session; all the Capitol renovations will be completed and it will be open again for the 2017 session. Editor’s Note: At the time MetroDoctors went to print the Special Session to address unfinished business had not been scheduled. Nancy Haas, JD and James Clark, JD are the Messerli & Kramer team assisting TCMS to advance its legislative and policy goals in 2015.
Legislative Wrap-Up/ Looking Ahead
While the 2015 regular legislature has
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July/August 2015
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Evolving Practice Models
Colleague Interview: A Conversation with Robert A. Wieland, M.D.
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obert A. Wieland, M.D. (Bob) has been employed by Allina Health since 1994. He currently serves as Executive Vice President, Network/Integration, overseeing the Allina Integrated Medical Network and Strategy & Business Development, Home Care Services, care management, marketing and communications and technology integration strategies. Prior to this role, he served as the Executive Vice President of the Clinic and Community division and earlier in his career Dr. Wieland served as Vice President of medical affairs at Abbott Northwestern Hospital and as a District Medical Director within Allina Medical Clinic. He is also co-founder of the Hospitalist Service at Abbott Northwestern and practiced as a hospitalist there for 12 years before turning his focus to health care leadership. Dr. Wieland earned his bachelor’s degree in mechanical engineering at the University of Minnesota, medical degree at the University of Minnesota Medical School and Internal Medicine training at Abbott Northwestern Hospital. He serves on the Finance Committee of the Allina Board, and is a member of the Advocate Physician Partners board.
To be successful in value-based payment methodologies, clinical alignment will be important in enabling health systems (like Allina Health) to effectively care for attributed populations. What is Allina Health doing to create clinical alignment across its network to include independent physicians? Two key strategies for clinical alignment between Allina Health and independent physician groups are Clinical Service Lines (CSLs) and the Allina Integrated Medical (AIM) Network. There are 11 Clinical Service Lines within Allina Health. Examples include Virginia Piper Cancer Institute (VPCI), Courage Kenny Rehabilitation Institute, Mother-Baby and John Nasseff Neuroscience Institute. Each CSL has program committees (such as the Breast Program within VPCI) that include multiple specialties and a mix of employed and independent physicians that drive performance and clinical alignment. The program committees focus their work on quality, care process improvement and reducing unwarranted variation in patient care. A recent example of their work is the elimination of PET scan use for Stage I breast cancer. The AIM Network is a clinically integrated network which allows a health system like Allina Health, independent physician groups and independent hospitals to align together in support of population health and the triple aim — improving quality, experience and lowering costs — through new value-based payer agreements. AIM members share clinical data to leverage the 8
July/August 2015
best care for our patients, improve care coordination and reduce total cost of care. In collaboration with Blue Cross Blue Shield of Minnesota, the AIM Network launched BluePrint, a new codeveloped medical insurance product, last year. The AIM Network has grown considerably over the last four years and now has approximately 3,000 physicians and 24 hospitals. About half of the physician membership is made up of independent physicians from over 65 different groups and about half of the hospital membership is independent organizations. As a physician-led organization, the AIM Network has over 50 physicians involved in its governance. The composition of the governance is managed to achieve a balance of representation from primary care and specialist physicians, independent and employed Allina Health physicians, and geographic locations across the metro and regional markets.
In addition to an employed relationship, what are some other options for independent physicians to have an aligned relationship with a system like Allina Health? A Professional Services Agreement (PSA) model is an option that preserves some of the elements of independent practice (recruitment, partnership, compensation distribution/model, practice locations) while shifting other elements (EHR, capital investments, contracting) to the health system. There are several groups, both primary care and specialty, that are in PSA arrangements with Allina Health. MetroDoctors
The Journal of the Twin Cities Medical Society
As clinically integrated networks grow, how important is it that all providers have EHRs that can communicate with each other? What is Allina’s strategy for EHR interoperability for its network? What about interoperability between metro and regional networks? This is a big challenge across the country. I believe the level of interoperability between disparate EHRs will improve with time and that the federal government will likely mandate it. Because so many health systems in Minnesota are using Epic for their EHR, Epic Care Everywhere allows for access to clinical data across systems and its use is steadily growing. The biggest challenge in this market is data exchange with independent organizations that do not use Epic. The AIM Network has about 20 different EHRs that need an ability to share clinical information effectively and efficiently. Allina Health embarked on creating its own Health Information Exchange (HIE) about 18 months ago. At this point, we are in the early stages of adding independent physician groups from the AIM Network to the HIE. We expect it will take another 18-24 months to get the entire AIM Network connected. Broader community/statewide deployment will be explored after that.
From the health system perspective, what are some of the challenges involved in forming effective relationships with independent provider groups? Many independent physician groups have relationships with multiple health systems in the market which can mean differing care improvement strategies and/or priorities. There is also the reality that the best interests of an independent group and a health system may never be 100 percent aligned. But focusing on where we can align our interests can drive the formation of very beneficial relationships. Also, independent physician groups are at varying stages of readiness for the shift from fee-for-service to value-based payment models. Some have a more heightened sense of urgency and willingness to experiment than others. Overall, from an Allina Health perspective, I think it is going quite well.
Minnesota has a number of organizations devoted to clinical best practice development and measurement, notably ICSI and Minnesota Community Measurement. How would you characterize Minnesota’s level of clinical practice consistency and what do you think are areas of this space where more could be done? I think Minnesota is well ahead of most of the country in this area, because of MN Community Measurement and ICSI. One area of opportunity is in development of specialty quality measures. To date, much of the quality measurement has been focused on primary care. The AIM Network membership has been working to compile specialty measures over the last few years. We have shared our efforts with MNCM leadership and will continue to do so. We have also collaborated with FPA (Fairview MetroDoctors
The Journal of the Twin Cities Medical Society
Physician Associates) leadership regarding quality measurement development within three specialty areas to date including ENT, dermatology and ophthalmology.
There has been much written about the coming shift to value-based payment methodologies, yet the vast majority of health care in Minnesota is still paid for under the fee-for-service model. When do you believe we will begin to see meaningful movement in this direction? Four years ago, most of Allina’s leadership believed that by 2015, about 30 percent of our health system’s revenue would be in various value reimbursement models. That hasn’t happened. I do believe the payment transition will happen over the next four years in an accelerating fashion. There are a number of reasons for this. CMS has recently stated that they plan to have 50 percent of the Medicare payments within a value reimbursement model by 2018. The Healthcare Transformation Task Force that includes large health systems and payers is committed to driving the transition to value reimbursement. And there is continued growth of membership on public and private exchanges. A lot of foundational work has been completed and many health systems, including Allina Health, are now more willing to move faster.
How do we, as a provider community, ensure that through all of this change we continue to put the needs of the patient first? The best way to make sure the needs of the patient come first is to make sure the voice of the patient is at the table as we plan, design and implement our solutions to address all the changes with healthcare reform. This typically involves the formation of patient and family advisory councils, focus groups and patient panels. At Allina Health we have several strong patient advisory groups, which have, in some cases, had a profound impact on how we deliver care. Shortening the time it takes to receive and communicate the results of certain diagnostic tests, thus reducing the time the patient spends worrying, is just one example of how we have made changes that are the direct result of patient feedback. Truly involving these patient groups and the input they provide will be the key to improving the healthcare experience and creating value for those we serve. This is a time of profound change in virtually every area of health care. Physicians and care systems are exploring new care models. Cost is more of an issue than ever before. And consumers are increasingly empowered by information and technology to take a more active role in choosing their health coverage and care system, as well as managing their own health. As we navigate these transitions, all of us — physicians, health systems and insurers — must work together to create a system that rewards doing the right things for patients and is sustainable for the long term. I’m pleased with the progress we’ve made so far, and I’m confident Minnesota will continue to lead in this area.
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Twin Cities Medical Society and Minnesota Public Health Association Present:
Healthiest State Summit Reclaiming Minnesota’s #1 Health Ranking
Register Now! Thursday, August 6, 2015 8:00am-4:00pm
University of Minnesota Continuing Education and Conference Center In 1992, Minnesota had the #1 health ranking. Why, by 2014, did it drop to #6? Explore this question and be a part of the solution to reverse this trend. Visit www.metrodoctors.com for more information and to register. Questions call 612-623-2885.
Park Nicollet Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Office of Continuing Medical Education, Park Nicollet Institute, designates this live conference for a maximum of 6.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Objectives:
- Identify key factors resulting in
Minnesota losing status as the “healthiest state” in the nation -Discuss actions participants can take to improve health and achieve health equity in Minnesota -Propose new partnerships to make Minnesota the healthiest state.
AGENDA
8:00 -WELCOME Thomas E. Kottke, MD 8:15 – 10:00 a.m. - Opening Session: “Houston—err Minnesota—We Have a Problem!”- Commissioner Edward Ehlinger, MD, MSPH Minnesota Department of Health 9:00 - Panel – Health in all Policies: - Moderated Panel
1. Minnesota Community Measurement - Jim Chase, President, MNCM 2. Minnesota Health Care Performance Score Card – Lucas Nesse, Minnesota Business Partnership 3. Local Initiatives Support Corporation (LISC) – Andriana Abariotes, Executive Director 4. Education – early childhood to successful adult – Sameerah Bilal-Roby. African American Babies Coalition
10:15 – 10:30 – Break 10:30 – 11:00 – Culture of Health Matrix – Jerry Noyce, CEO and President, Hero 11:15 – 12:30 – Breakout Sessions
1. Binge Drinking – David Golden, Boynton Health, University of Minnesota 2. Housing – Andriana Abariotes, LISC 3. Poverty and Livable Wages – Melanie Peterson-Hickey, MPH, Center for Health Equity 4. Education – Don Samuels, co-founder the Hope Collaborative; founder the Institute for Authentic Dialogue on Race 5. Structural Racism – Stephen Nelson, MD, Children’s Hospital and Clinics of Minnesota
12:30 –1:30 p.m. – Lunch 1:00 p.m. Luncheon Speaker Heart of New Ulm, Jackie Boucher Senior Vice President and CEO, Mpls Heart Institute Foundation 1:40-3:00 p.m. – Repeat Breakout Sessions 3:15 – 4:00 p.m. –Breakout Sessions Summary and Where do we go From Here? - Thomas E. Kottke, MD 4:00 – Adjourn
Evolving Practice Models
Consulting Radiologists— Quantity and Quality Consulting Radiologists, Ltd. (CRL) is an independent radiology group based out of Minneapolis. At the time of its inception in 1971, CRL was a practice centered at Abbott-Northwestern Hospital with a radiology staff in the single digits. When I came to CRL in 1989, I was the 18th radiologist. By then CRL had expanded to Buffalo Hospital and Ridgeview Hospital in Waconia. Today CRL has 70 radiologists, 27 on-site locations and a robust teleradiology business. Our network provides on-site services from Duluth in the north, New Ulm in the south, Woodbury in the east, to Watertown (South Dakota) in the west. CRL does not operate under a professional services agreement (PSA) with any of its clients. We have simple contracts with renewal periods of one to three years and, in some cases, no contract at all. After 44 years of existence, why does CRL continue to remain a vibrant and independent practice? Before delving into some specifics about our practice, let me first say that all the strategy and tactics imaginable cannot offset poor quality and lack of service reliability. To that end, CRL is a physician-led practice with myself as President and with a Chairman of the Board and Board of Directors who are all physicians. In the past, CRL had utilized a non-physician CEO, but the group decided to change to the current
By Christopher Tillotson, M.D. MetroDoctors
format in 2009. The members of CRL knew that only through physician leadership could we fully realize our potential and be in a position to best respond to the rapidly changing health care environment in the upper Midwest. CRL also has a variety of physician-led and staffed committees in technology, quality, finance and medical staff affairs. The involvement of so many physicians in the leadership of our practice puts us in the best possible position to understand our market and clients in order to tailor our business and development plans. Also, the high degree of physician involvement promotes cohesion and more fully leverages our intrinsic talents. In addition to our physician leadership model, I would like to discuss three additional characteristics of our practice which have allowed us to remain thriving and independent: size, diversification and cooperation.
The Journal of the Twin Cities Medical Society
Size Of course CRL did not set out to be a large group first and find our business opportunities second. We have grown intentionally and incrementally over time as new opportunities became available. The value of size, and by this I mean a group of 30-40 physicians or more, is threefold. First, a larger size allows short-term flexibility in taking on new opportunities without having to specifically hire for them. The new work is distributed across a large group and incrementally there is not a marked change in any one person’s work day. This is greatly aided by our PACS system which allows work to be evenly distributed regardless of the site of origin or the location of the radiologist. This permits CRL to act on promising opportunities in the near term without having to specifically hire — a process which typically takes 6-9 months to complete. Second, a larger size allows CRL to reasonably afford a robust infrastructure in our business office. At the executive level we have a CFO, COO, CIO and Chief of Strategy and Development. There is an additional staff of over 75 employees in place for IT, billing, marketing and site and workflow management. In the same way that we distribute new work over many radiologists, there are similar economies of scale in distributing the administrative duties as (Continued on page 12)
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Evolving Practice Models Consulting Radiologists (Continued from page 11)
well. As such, it takes little incremental effort to accommodate the next new opportunity. Lastly, a larger size allows a high degree of subspecialization among the radiologists, which is necessary in a sophisticated medical community such as the Twin Cities. This has become even more essential given the current PACS environment which allows images to be easily available regardless of location. Subspecialization is also an asset for marketing to new clients, especially in out-state areas that may have been underserved in the past. CRL has fellowship-trained subspecialists in breast, body interventional, neurointerventional, musculoskeletal, diagnostic neuroradiology and nuclear medicine. We also employ a large number of general radiologists as well. This diversity and size also permits possibilities for flexible work and vacation assignments. All in all, this improves
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CRL’s ability to recruit and retain the best physicians. Diversification A second critical feature of our success is the diversification of our book of business. As mentioned above, CRL currently provides services at many locations. These locations are broadly diverse and include our flagship quaternary hospital, Abbott Northwestern, as well as multiple regional hospitals in Duluth, Hutchinson, Cambridge, Shakopee, Buffalo and Waconia. CRL also provides services at many smaller hospitals in places such as New Ulm, Faribault, Northfield, Mora and Glencoe to name a few. CRL also has several wholly-owned or joint-ventured imaging centers throughout the Twin Cities area. Lastly, CRL has over 20 teleradiology contracts throughout the local five state area providing daytime and afterhours coverage for hospitals and other radiology groups. This variety of locations, sizes, providers, modalities and payer-mixes protects CRL from being overly vulnerable to a particular source or untoward event such as the acquisition of a hospital by an entity which mandates an employment model for physicians. Diversification also exists within our internal capabilities as a result of our overall size. In addition to the usual radiology services, CRL expands its revenue stream by providing additional services to clients in areas such as billing, PACS, transcription and outside quality assurance reviews. Just as with our radiologists and management team, the next new client can be added to the pre-existing workload with very little incremental cost. Cooperation The last area I want to touch on is our effort to cooperate with several other local radiology groups which are independent as well. This initially started around the fact that CRL, as well as Suburban
Radiologic Consultants (North) and St. Paul Radiology, have all had significant commitments over many years to Allina to provide radiology services. Over time we have come to realize that it is in the best interest of ourselves and Allina that Allina’s radiology services be as uniform and integrated as possible across their entire network. In response to that need, about 12 months ago, the leadership of the three groups began meeting regularly to develop a sense of trust and common cause. Recently, these radiology groups and Allina have come together to form two new committees, one strategic and one operational in nature. These committees identify and operationalize, respectively, the changes necessary to achieve Allina’s goals. Throughout this process the lines of communication and interaction between the groups have greatly improved. This by itself is of great worth as all three groups value their independent status. By removing opportunities for misunderstanding and working together instead of against one another, we pave the way for continued satisfying, autonomous practices. In summary, as in any business, deliverable quality and reliability always comes first. We at CRL feel that through physician leadership we can best achieve this goal. By virtue of its size and diversification, CRL has managed to remain an independent, dynamic and progressive practice without outside assistance or PSAs. Through a willingness to engage and cooperate with other local radiology groups we further our ability to make progress and peacefully coexist. Christopher Tillotson, M.D. joined Consulting Radiologists Ltd. in 1989 with a subspecialty interest in musculoskeletal imaging. After many years on their Board of Directors, he currently serves as President. Dr. Tillotson can be reached at (612) 5732216 or by email: christopher.tillotson@ crlmed.com.
MetroDoctors
The Journal of the Twin Cities Medical Society
Successfully Independent— Past, Present and Future
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e have often been asked how we have successfully avoided being absorbed into larger systems. There are no simple answers. Many of the reasons involve lots of hard work, strong physician leadership, anticipating and planning for the future as well as culture, entrepreneurial focus and luck. Entira Family Clinics was formed by a number of groups that were started and built by their providers who created highly cost efficient practices. During the ’90s when hospitals were acquiring practices, a number of these St. Paul groups formed a federation to maintain independence yet compete in the market. Our federation of clinics, known then as Family HealthServices Minnesota, P.A., encouraged best practice sharing and competition between clinics. We focused on keeping health care costs low by following a number of practices such as screening referrals to ensure the best use of our scope of practice; do not simply triage and refer. Strong physician leadership and staff drove operational costs lower and did a lot of benchmarking with Medical Group Management Association. As an example, our costs for supplies and services have virtually remained flat for the past eight years. One of the pillars in our Mission Statement is to provide low cost care.
By Dave Thorson, M.D.
MetroDoctors
Once again, when quality measurement became a focus, strong physician leadership helped. We have a physician who has done an excellent job driving solid quality culture throughout our clinics. Early on, our measures were not great and providers pushed back at being measured. It only took one year near the bottom in preventive care to capture our attention. The next year we were listed as one of the best. Embracing quality is also one of the key components of our Mission Statement. One of our biggest challenges was the rising costs of health care. While it impacted all providers in the community, independent practices do not have the resources necessary to help rein in costs. In our fee-for-service environment, fee increases have not kept up with the cost of medical inflation. You cannot compensate for revenue needs through greater patient volume as illness complexity and visit lengths have increased substantially, quality improvement is more critical and the inefficiencies of the EMR have slowed down the provider.
The Journal of the Twin Cities Medical Society
To survive, we used our ability to contain costs and maintain high quality and patient satisfaction as a way to differentiate ourselves. We believed if we could be one of the best at controlling costs, improving quality and patient satisfaction, we would remain valued by the community. With pay-for-performance (P4P) contracts, we were well positioned with our quality scores. With the Total Cost of Care contracts, our cost control focus served us well when the community began rewarding for these outcomes. These contracts allowed us to acquire the resources to expand our quality initiatives, add care management and expand using the “Health Care Home” practices. We invested prudently in our practice. Beginning in 2005, P4P/Total Cost of Care dollars went into our EMR. Several payers timed the payout of award dollars to assist in smoothing out our cash flow, allowing us to reinvest in additional future improvements. To help maintain our culture, we focused on attracting entrepreneurial like-minded providers who wanted to be “owners” not simply employees. We wanted engaged decision makers. Our decision-making process is generally bottom up. Our shareholders have a lot to say about our direction and how we move forward. Our owners recognize the value of our staff. It is challenging to be competitive with pay and benefits, but we have done a reasonably good job. We (Continued on page 14)
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Evolving Practice Models Successfully Independent (Continued from page 13)
also try to stress our appreciation of the hard work and contributions of our staff. We work hard, but we strive to maintain a family atmosphere in our clinics and do what we can to break down the hierarchical nature of the medical relationships.
We began this process by participating in the ICSI DIAMOND initiative to address the management of depression in primary care. While this added cost, it provided improved care and experience in providing care management and inbetween care to patients. DIAMOND and the expanded COMPASS initiative provided us the experience to become
While care redesign is not new and others are implementing components, we believe success is in putting all of the components together into a fully functioning system. It is our goal to be able to redesign care and payment which provides value to the employer and sustainability to us.
We have now been in the P4P and Total Cost of Care system for a fair number of years and it is generally recognized this will fade out in the future. So where do we go next? We feel providing value is still the key. While “Care Systems� have a number of benefits stemming from integration, we believe we have greater flexibility in our referral choices. We do not own any ancillary services or facilities so we neither have the associated costs nor the incentive to refer to anything but the highest quality and lowest cost services. We are working on trying to develop a new way of delivering care by following the medical home and team-based care fundamentals. We invested much of our award dollars in care management personnel to improve the outcomes of care. 14
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Health Care Home Certified. Once again it improved care, but was costly as revenue did not cover the added expenses. We also invested in transitions of care initiatives to lower ER use and readmissions. We have acquired offsetting revenue from our Total Cost of Care contracts that have covered the cost of the additional personnel for Health Care Home, but that revenue will not likely be sustainable. We are working on a new care redesign model. With new care practices, new payment methods will be needed. The new care model is not captured by CPT codes so how does our practice get paid? Currently telemedicine, email care, and in-between care with care managers is not well-compensated or compensated at all, or patient copays and deductibles
force patients to opt out of such care. Protocol care is also poorly paid yet lowers the cost. If we were to lose the current P4P and Total Cost of Care dollars, we would not have the dollars to maintain the personnel investments we have made. We are working with payers to address these issues. Lastly, we need to change compensation. Physicians are generally paid for volume. It is not only the wrong incentive, but providers cannot see more patients under the current system. They are burning out and we all are at risk of seeing primary care physicians leave (or not enter) the specialty due to stress and burnout. In a team care model, they not only provide the care but supervise and direct care provided by others. Getting rewarded for team care is one of our biggest challenges ahead. While care redesign is not new and others are implementing components, we believe success is in putting all of the components together into a fully functioning system. It is our goal to be able to redesign care and payment which provides value to the employer and sustainability to us. Entira Family Clinics is a Primary Care group with 12 offices in the St Paul area. Dr. Dave Thorson is the Medical Director for Physician Relations and is responsible for physician recruiting and practice issues. Dr. Thorson can be reached at: Entira Family Clinics, 4786 Banning Ave., White Bear Lake, MN 55110. Phone (651) 426-6402, or dthorson@entirafamilyclinics.com.
MetroDoctors
The Journal of the Twin Cities Medical Society
Metro Urology and the Triple Aim
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he secret to Metro Urology’s past success is this: we provide high quality, cost-effective medical care and a great patient experience. The Triple Aim will also provide the foundation for our future success. Metro Urology is proud of its long history of providing great medical care. We believe the advantages conferred by a large-group urology practice enable us to provide the best of the Triple Aim for urology services within Minneapolis and St. Paul moving forward. Let us look at each component of the Triple Aim individually. High-Quality Care
There are four ways we believe we can provide the highest quality urologic care in our market. 1. Specialize: By having a larger number of highly-trained urologists in one practice, Metro Urology has been able to subspecialize. From robotic cancer surgery to female pelvic reconstruction to the surgical management of erectile dysfunction and male infertility we have the urologic bases covered. Patients deserve a high level of expertise and experience, especially when they are facing surgical or complex medical interventions. When a surgeon has high surgical volumes in his or her area of specialty he or she gains efficiency and achieves better outcomes. The amount
By Todd Brandt, M.D. and Aaron Milbank, M.D. MetroDoctors
Todd Brandt, M.D.
of knowledge and experience needed to master the changes in our field makes specialization necessary. Our size allows our surgeons a larger surgical volume and a higher level of expertise. Experience teaches us where our limits are. Knowing what we are good at means also knowing what we are not. We will continue to work closely with others in our medical community when a patient’s needs do not align with our skills. 2. Innovate: Urology has seen profound technological change within the last 20 years. Gone are the days of hazy IVP images to try to diagnose kidney stones or renal masses. Lasers, daVinci robotic surgery, InterStim neuromodulation, and UroNav MRI-guided prostate cancer detection are just a few of the recent advances within our specialty. Metro Urology has been on the forefront of many of these new technologies. Our larger size has given our
The Journal of the Twin Cities Medical Society
Aaron Milbank, M.D.
individual physicians the ability to focus on areas of expertise, to be early adopters of that technology, and to have the clinical volume to become proficient. 3. Mentor: Strong mentorship and development of young physicians improves the care delivered within our communities. We mentor young physicians. Whether it is through our fellowship programs for female urology and urologic oncology, the coaching of our younger partners, or the shadowing of our physicians by primary care residents or medical students, we have sought to develop, train and improve the care delivered by the young physician. 4. Provide a comprehensive level of urologic services for our areas of specialty: An illustration of this is the example of our protocol for patients facing a prostate (Continued on page 16)
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Evolving Practice Models Metro Urology (Continued from page 15)
cancer diagnosis. We have made great strides in patient recovery by adopting daVinci robotic technology, but it still takes time to recover from a radical prostatectomy. Achieving continence and resuming sexual activity can be frustrating. To empower our patients, we begin a patient’s treatment path with pre-surgical educational sessions and follow up this education with a post-procedure protocol intended to help maintain and restore both sexual function as well as urinary function. By providing a comprehensive approach both before and after surgery we believe that we have significantly improved our patients’ outcomes as well as their overall experience and sense of empowerment over their disease. Cost-Effective Care
There are three elements of cost-effective care: provide the best care at the right time for the right price. 1. Provide the best care: We reiterate our belief in the large group’s ability to specialize. Our expertise and areas of focus give us greater advantage to provide the right care to a patient. We often refer internally, and externally when necessary. 2. Provide the care at the right time: A critical element of cost-effective care requires patient access. Because we are a large organization there is almost always a convenient location for the patient who urgently needs to see a urologist. And we try to maintain short wait times for those who may not need an urgent appointment. Because we are service oriented, our goal is to see referrals promptly. 3. Provide care for the right price: Medical care will always cost money. And it should. Medical providers are highly trained individuals deserving appropriate compensation. The right price for medical care is
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that which provides the highest value. We believe the highest quality care will almost always be the most cost-effective within a competitive contracting marketplace. Through specialization we are best able to provide care efficiently and with better outcomes at the right time. Very valuable indeed. Our contracting marketplace is changing, and Metro Urology must adapt. We have always had a symbiotic relationship with our corporate partners and friends; now we will have to navigate the process of contracting in partnership with those hospitals, health systems, and other independent clinics. Yes, this will be tricky; we navigate in some uncharted waters. But we believe the patient will ultimately fare best when their care team incorporates the inherent advantages of a nimble, independent group and the resources of a hospital or health system. This is critical as we enter a new phase of “at risk” contracting: we must become inter-dependent. To survive the advent of new and more complex contracting relationships, we must provide the medical community with the highest quality AND value. We think we can do it. Patient Experience
Patients are savvy. Patients recognize authenticity. Are we caring? Are we efficient? Are we highly competent? Are we worth the money? If a patient who sees one of our providers at Metro Urology can answer yes to all of those questions we will continue to be the choice for urology services within our community. How do we know? We ask our patients. To measure our level of patient satisfaction and to help us improve the patient experience we have pursued what is now common in our marketplace: we request patient satisfaction surveys. We have made the investment, and we are pleased with the results. Patients appreciate that their surgeon has a special interest in, focus on and
expertise in their area of concern. Patients appreciate our short wait times, either to make an appointment or on the day of their appointment. Patients appreciate our office locations, friendly staff, our new patient portal and our constant focus on personal attention. We work hard. We enjoy what we do. We think patients notice. But we do not rest on our laurels. Where our scores are lower than we would like we aim to improve. Our ability to communicate with patients is changing rapidly, and we aim to keep pace. We will need to learn new skills as technology advances. Our patients expect it. Our referring providers expect it. And we expect it of ourselves. The Path Forward
Since its foundation in 1998, Metro Urology has not known a time of certainty in the business model of delivering care. Our medical group has been through turbulent times and we expect more ahead. Fortunately, the business mistakes that we have made have been offset by our successes. We are driven by our mission to be the best provider of urologic services. We have a clear focus on our vision to create an environment that allows our patients and our staff to be their healthiest selves. We are grounded by our values of excellence and compassion. We remain committed to our referring providers, our staff and, most importantly, our patients. Todd Brandt, M.D. is board certified in Urology and has practiced at Metro Urology for 15 years. Aaron Milbank, M.D., a board certified Urologist, is the president of Metro Urology and has been in practice for 10 years. They can be reached at (651) 999-6800, tbrandt@metro-urology.com; amilbank@ metro-urology.com.
MetroDoctors
The Journal of the Twin Cities Medical Society
Divisional Merger Business Model in Medicine A View From the Inside “The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.” —Albert Einstein
A
s we all know, life and the world around us is always in flux. The constant changes in our business/medical environment present frequent challenging situations for the private practitioner. If our continued goal for the private practitioner is to maintain our independence, we must keep our options clearly visible in front of us and not let viable choices pass us by without at least considering them as potential business options. Evolutionary principles — survival of the fittest, adapt or run the risk of being left behind — still carry significant weight in the current medical business environment. When many of us more seasoned physicians began practicing, fee-forservice was the standard. We have seen many changes in the method by which we are paid for our services, and we have all adapted to these changes in some manner many times in our careers. In the pursuit of maintaining the viability of private practice, the “divisional merger” is an option to be considered for the future. Obstetrics and Gynecology Associates (OGA) is a divisional merger of four previously individual obgyn private practices each of which had been in existence for decades, but have chosen to come together in this merger. OGA consists of the merger of ObGyn Specialists (OGS), Associates in Women’s Health (AWH), Obstetrics, Gynecology & Infertility (OGI), and Diamond Women’s Center (DWC). The initial merger was
of OGS and AWH in 2007, OGI and DWC joined the merger in 2011. The divisional merger is a business arrangement that allows individual practices to maintain a large degree of independence on the clinical side of the business with each division maintaining its own practice identity. The clinical aspect is seamless from a patient’s perspective. The individual divisions are able to operate independently. Each division maintains its own group of physicians who manage the day-to-day care of their patients in the same way that they did prior to the merger. The patients are not shared between divisions. Each division takes calls for its own patients; however, some divisions have made arrangements for backup call coverage between divisions. Patients see their own providers at the same locations as they did prior to the merger. Each division maintains its own nursing and support staff; however, there are specific laboratory services agreed upon by all of the divisions. Each division continues to maintain its own administrator. The administrators continue to manage the individual entities as before. Under the divisional merger, there are combined management responsibilities for OGA. The administration group manages the day-to-day operations of OGA, with individual administrators taking on the responsibility of key aspects of OGA. The administrators are able to conduct comprehensive payer contract review. The merged divisions of OGA have many combined services from a
By Russell Wavrin, M.D.
MetroDoctors
The Journal of the Twin Cities Medical Society
business perspective. The OGA Board of Directors consists of three physician representatives from each division. The board meets regularly to review recommendations made by the administrators, to review potential changes in OGA vendors, and to make long-range strategic recommendations to the divisions. The board is responsible for overseeing business aspects of OGA, and to discuss potential joint clinical opportunities that may arise in the future. Each division has its own compensation system as before the merger. Financial information is confidential between the divisions. The shared financial information is restricted to the joint OGA operations. The joint operations include billing and employee benefits which are overseen by the merged entity.
(Continued on page 18)
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Evolving Practice Models Divisional Merger Business Model in Medicine (Continued from page 17)
Because of the larger staff in the divisional merger, it is now more efficient to combine some OGA staff to specialize in specific aspects of the business side of the merger. OGA’s combined staff includes HR director, payroll and benefit administration, A/P, and credentialing, therefore eliminating redundancy between the divisions. Some shared employees in the business office make specialization of benefits from specific payers more efficient. There are combined legal services, accounting services, commercial insurance, malpractice insurance, retirement plan, and medical insurance. Because of the total number of physicians and staff there is a potential to negotiate better contracts with these vendors. The options for medical insurance including self-insurance are now possible. All of the divisions of OGA are on the same EMR with a shared server but different
The divisional merger business arrangement does provide a viable modality to help maintain independent medical practice in the current environment.
data bases for the EMR and PM. The divisions have shared contracts for technical services for the EMR. The divisional merger business arrangement does provide a viable modality to help maintain independent medical practice in the current environment. There are definite efficiencies of size which result in better patient care, cost savings by eliminating redundancy and having shared employees with more specialized skills. Quality measures are specifically monitored by OGA and reporting can be standardized.
What are the negatives to merging? Some loss of autonomy is a byproduct of merging. It requires a merger from a business aspect more than a clinical aspect. When a merger occurs, the new division may have to change retirement plans, insurance, and accounting services which they may have become accustomed to for many years. Decisions will be in the hands of the board of directors and no longer with the individual division. How does the merged business stay relevant? It must use its combined business power to stay up-to-date with all aspects of medicine. This might mean maintaining its same size or it might mean that expansion is a way to maintain a broad footprint. Divisional mergers have options as to the degree to which they decide to merge. The divisional merger allows small private practices to work together with a broader footprint. The divisions may practice in different areas of the metro as we do in OGA, and still be part of a private business. We provide services to competitive hospital systems, in multiple locations. The waves can be high for an individual group in a sea where we compete with large businesses with hundreds of providers. This type of merger does not calm the sea, but at least it dampens the waves. We must be prepared to change our way of thinking about private practice. Russell Wavrin, M.D. practices OB/GYN at Diamond Women’s Center in Edina, and is currently its President. He also serves on the Board of OGA. He can be reached at (952) 927-4045.
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MetroDoctors
The Journal of the Twin Cities Medical Society
Inside Steps Needed to Grow a Successful Independent Medical Group
A
s the Twin Cities healthcare landscape changes, so do the requirements for growing and sustaining a successful independent medical practice. Now with 570 employees, 30 physicianowners and 14 locations, Summit Orthopedics continues to navigate through seismic changes in the medical profession. To stay competitive, we’ve had to evolve and innovate rapidly. We’ve focused upon many areas to meet the shifting needs of our patients, payers and our physicians. While I can’t say there is a secret to medical practice independence, if you are a well-run organization you can stay independent. Putting the Patient First
The phrase “putting the patient first” is emblazoned across healthcare institutions across the country, and a common thread among practices. The challenge for us as physicians is finding ways to shift the paradigm from what is easy and comfortable for us operationally to what the market wants. Patients continue to have higher expectations of not only the quality of care but the service in which we deliver it. At Summit, each physician and staff member goes through rigorous training to learn advanced customer service techniques built on best practices from other industries, such as hospitality. The lines are blurring and as healthcare is consumed in a more retail fashion, physician practices will be held to higher standards from wait time to convenience to enhanced hours. One pivotal way we put the patient first is through choice. Patients are given By Peter J. Daly, M.D.
MetroDoctors
the space to evaluate options for their care from a geographic, experience, and quality standpoint, and are empowered to partner with physicians in decision making. Maintaining an independent group structure with our physicians as equity owners enables us to be healthcare providers who do what’s best for the patient. Physicians are free to tailor treatments to optimize outcomes. This flexibility of choice for patients and providers will continue to be a differentiator for independent physician practices. At Summit, each physician has a specific team dedicated to their individual practice (i.e. physician assistant, secretary, athletic trainer, medical assistant, etc.). This structure allows patients to get to know their doctors on a more personal level through seamless and integrated communication. Patients want to talk to a live person, and this team structure makes sure there is a familiar face (or voice) there for patients whether they need a prescription refilled, book an appointment, or have questions on post-op care. Improving Access to Patient Care
Specialty healthcare has a long tradition of access issues and it can be a complex challenge for any independent practice. We’ve made a concentrated effort to improve access by proactively adding physicians to build access before it becomes an issue. We hire more schedulers so we can be more responsive to appointment requests and decrease or eliminate on-hold time. We created three OrthoQUICK sites for immediate walk-in injury care with availability nights and weekends. Because
The Journal of the Twin Cities Medical Society
of these improvements, we’re in a much better position to accommodate patients on their timetables, rather than our own. Creating an Inviting Culture
The way you treat employees determines the success of your group, and has a trickledown effect to how patients are treated. Employees at all levels of an organization need to be engaged. We want Summit Orthopedics to be seen as an employer of choice, so we do whatever we can to create an environment to attract — and keep — top-level talent. We innovate to give employees access to the very best health insurance options and retirement savings available. We foster engagement by getting corporate executives interacting with front line and clinical staff. At Summit, executive leadership puts on (Continued on page 20)
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Evolving Practice Models Grow a Successful Independent Medical Group (Continued from page 19)
aprons and makes breakfast for all of our employees at one of our clinics once a month. It’s a great chance to get everyone together and show our appreciation for the hard work Summit employees put in day after day. We also make it a point to have employee recognition events. We provide non-threatening opportunities for staff to share insights of where there are gaps and recommendations for how to fix them. This creates more of an ownership mindset that helps employees feel that their voice is heard and they contribute to positive change.
agreement among physicians to establish a consistency of purpose and practice. Our physicians are active members in the practice and they all believe that one physician’s success is everyone’s success, so when a patient needs to be added and it’s 5 p.m., the physicians will accommodate it. Personal accountability motivates our physicians, and it allows us to be
Vadnais Heights. I was a part of a group of physicians tasked with redefining the total joint and advanced spine procedure experiences to align with the growing trend of right sizing the facility for the individual patient situation. This design included site visits to other parts of the country to gather best practice parameters. We were involved from start to finish in creating the
By operationalizing the Triple Aim equation of higher quality, better patient service, and reduced costs — we are able to thrive.
Relying on Physician Strengths
Involving physicians in all aspects of decision-making from how the business is run to who we hire allows for the individuals doing the day-to-day work to provide insightful leadership on how to enhance care delivery. Summit Orthopedics has always been focused on how we can have good alignment with patient’s needs and
innovative in developing and implementing new surgical techniques and shaping our unique approach to patient care. By operationalizing the Triple Aim equation of higher quality, better patient service, and reduced costs — we are able to thrive. A good example of this was the development of our newest advanced surgery center in
Saint Therese Rehab
Better Balance for a Better Life
The STR Balance program incorporates state-of-the-art balance assessments and training techniques to help your patients live a better life. STR offers: • Comprehensive Balance Evaluations • 1:1 Personal Training • Specially Trained Therapists • Computerized NeuroCom Balance • Inpatient/Outpatient Therapy Services Systems
To learn more call 763.531.5435 or visit sttheresemn.org/str. 20
July/August 2015
environment, pathways, and experience that would define the surgery center. Now by performing complex surgeries safely in an outpatient facility for otherwise healthy patients, we can provide these services and procedures at a much lower cost and with enhanced outcomes. As a result of gathering national best practice parameters for surgery centers, we’re seeing much greater patient satisfaction. Looking Ahead
Sustaining an independent practice certainly comes with its challenges, and we are forced to quickly adapt to the everchanging landscape of healthcare. However, through innovation and hard work, Summit Orthopedics and other independent medical practices show that you can add — and retain — top-quality surgeons and employees, while adjusting your internal and external practices to give patients more successful outcomes with better quality care and lower costs. Peter J. Daly, M.D., is an orthopedic surgeon and medical director of surgical services at Summit Orthopedics in Woodbury, MN, where he specializes in sports medicine and joint preservation and restoration. Dr. Daly is also the co-founder of the Holy Family Surgery Center in Honduras and was instrumental in the development of the new Vadnais Heights Surgery Center. www.summitortho.com; (651) 968-5201.
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The Journal of the Twin Cities Medical Society
How to Navigate Faster Collections
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he handwriting is on the wall… 52.5 percent of the population is age 25-64, so there are two generations that grew up on first dollar insurance coverage with the perception that health care is free. Today, 80 percent of patients are on a high deductible health plan (HDHP) with the requirement to pay an average deductible of $1,500 for an individual and $3,000 for a family, in addition to insurance premiums averaging $371/month for single coverage and $835/month for families [sources: Kaiser Family Foundation and American Health Insurance Plans]. At this point, 30 percent to 35 percent of a medical practice’s expected revenue should come from patients. This shift in financial responsibility began about ten years ago with the introduction of medical savings accounts and the now ubiquitous health savings accounts (HSAs). So what can your practice do to change this perception and stop the bleeding of your revenue cycle? Create the Right Culture: Payment is Expected
At what point do you typically discuss payment with patients? If it is any time after initial registration or appointment scheduling, then it’s too late. According to the Medical Group Management Association (MGMA), the likelihood of patients paying their full amount owed drops by 50 percent the minute they walk out your door. Take the opportunity when By Dawn Lunde MetroDoctors
initially engaging with patients to share your expectations with them. This can be done in a very positive manner and patients will appreciate feeling informed and being presented with patient payment options (credit, debit or HSA card, check or bank account, cash and even recurring payment plans or payment account-onfile, if you choose). The best part is that they are much more likely to pay. Provide Estimates
You may feel you do not have the resources to implement this strategy. Consider the wealth of knowledge you have in your business office staff. If you shift some of their responsibilities to the front-end of the process, you will collect more payments. Begin by implementing eligibility verification at numerous points in your process. In your practice management system, flag all patient accounts with a confirmed HDHP or coinsurance, or populate the copayment amount. Then, have a method to be able to share that information with the patient prior to the visit. Indicate the estimated cost for that service based upon the expected CPT codes to be billed for their type of appointment or procedure. There are numerous tools on the market to assist you with this process — some available through clearinghouses or practice management system vendors, others are stand-alone products that utilize imported fee schedule data. Since most payers use the same methodology for fee schedules as Medicare, you could download the Medicare fee schedule and calculate an average
The Journal of the Twin Cities Medical Society
of what your commercial payers pay (e.g. 150 percent of Medicare) to arrive at a reasonable estimate. Make it Easy to Pay
There are countless points of contact that patients have with your organization. Be sure to allow all forms of payment (cash, cards, checks, bank account) in all settings and give access to the right tools to all applicable staff: • Secure card (or bank account) on-file: obtain this information in a secure online form (patients complete prior to service) or at the point-of-service, then debit that account as soon as you know what the patient owes. • Point-of-service: all locations, whether via a check-in or check-out process. (Continued on page 22) July/August 2015
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Navigate Faster Collections (Continued from page 21)
•
•
• •
Patient self check-in kiosks have proven to boost collection rates by 40 percent. Online: 41 percent of all online bill payments in Secure Bill Pay are afterhours. In fact, nearly 20 percent of those are from a mobile device! Be sure they can easily find the “Pay Online” link on your website. And, if your online bill pay site does not require a login, you will obtain much higher adoption rate. Phone: accept and process eChecks and cards real-time via phone calls to your business office for patients who cannot pay online. Mail: make it very easy for a patient to mail a check to you. Scheduled payments: either pre- or post-service, allow patients to pay via a payment plan or a one-time scheduled payment. Allow patients to request the payment plan online, via phone and/or at the point-of-service. These are approved by appropriate staff and run automatically without further effort.
After several years of providing patient pay tools to clients ranging from solo practitioners to large health systems, Secure Bill Pay has observed that organizations who implement these strategies see annual double-digit increases to their patient pay revenue. Is your patient pay process fast and easy? With these strategies and the right tools, it can be. Dawn Lunde is Vice President, Secure Bill Pay (www.SecureBillPay.net). Her career in health care spans more than 20 years with positions including provider relations and contracting at health plans, IPA network administrator, consultant to independent medical practices and co-founder of Secure Bill Pay. 22
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MetroDoctors
The Journal of the Twin Cities Medical Society
Sharing the Experience 2015: 6th Annual Advance Care Planning Conference
Thursday July 16, 2015 8 am–4:30 pm Ramada Plaza, 1330 Industrial Blvd, Minneapolis, MN 55413 Join us at the 6th Annual Honoring Choices Conference featuring Advance Care Planning activities around our state. • • •
Meet and network with professionals and community members who share an interest in ACP Develop new skills and increase your ACP toolkit with updated resources Be inspired by community leaders and movers and shakers in ACP
Featuring keynote speakers Kris Maser and Ruth Bachman, concurrent sessions on a variety of ACP-related topics, reports and updates from Honoring Choices Minnesota and partner sites and systems, and much more. Last year’s attendees had this to say… “Great breadth of topics” “Nuggets from every presenter” “Extremely well-organized event” “The networking was outstanding” “I’m coming away with great ideas!” Find all the details as well as registration information online at www.MetroDoctors.com.
YOUR VOICE
Banning Children Younger Than 16 From Operating and Being Passengers on Adult 4-Wheel ATVs March 2015: Tragically, a 2 ½ year-old grandson dies 28 days after falling through the ice on a Minnesota lake with his grandfather when their Ranger ATV (All Terrain Vehicle) broke through an isolated patch of bad ice. Four-wheel ATVs are being used as tools for family bonding with their children. Yet, some ATV enthusiasts are gambling with their children’s lives. In November of 2014, the first of a five-part Star Tribune series on ATVs opened with the headline “ATV thrills drive child injuries, deaths.” Reporters investigated 139 Minnesota accidents involving young ATV drivers and riders, and found that many rode without helmets, without training, and without parental supervision. Since 2003, 34 children have been killed in off-road vehicle accidents in Minnesota and more than 700 hospitalized for injuries. All but four of the fatalities occurred when children were driving adult vehicles, often with other children as passengers. As a comparison, just five Minnesota children died on snowmobiles during the same period. Nationally, nearly 1,200 children have been killed and another 350,000 hospitalized after ATV accidents in the past decade, according to the U.S. Consumer Product Safety Commission. About 90 percent of the children who died were riding adult-sized ATVs. The ATV industry opposes driving off-road vehicles on public roadways, and it does not recommend that children under the age of six drive or ride on an ATV, even child-sized ones. The vehicles carry labels that say never operate this ATV if you are under age 16, but the warnings often go unheeded. Unfortunately, this self-regulating approach to safety offered by the ATV industry has failed to protect children. In 2002, the American Academy of Pediatrics asked the federal government to ban children younger than 16 from operating adult ATVs because of rising youth deaths. In late 2006, the Consumer Product Safety Commission voted 2 to 1 against the proposal to ban the vehicles for younger drivers, saying enforcement is a matter for the states. Currently, the federal government mandates that children younger than 16 should not ride on adult-sized vehicles because they are too impulsive, and lack the physical strength By Carl E. Burkland, M.D.
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and maturity to operate a powerful and sometimes unstable vehicle. But federal regulators have left enforcement to the states. Forty states, including Minnesota, have defied these federal standards and have instead passed laws and rules that typically allow children as young as 12 to ride an adult-sized ATV. ATV riding clubs report that these rules sailed through the legislative process with little or no public awareness or opposition. In St. Paul and other state capitols across America, ATV riders have emerged as a powerful political force, winning looser regulations for young drivers and greater access to public trails and roads. Mayo Clinic trauma surgeon Beth Ballinger, M.D., points out that unsteadiness — a “feature” of ATV design to enable the vehicle to handle rough terrain — contributes to the problem. She describes ATVs as “engines on wheels” lacking the stability or protection of a car. The high center of gravity inherent in ATV design leads to more rollovers and increases the likelihood of passengers being thrown off, resulting in high injury rates. However, change is slowly emerging. In 2010, a Massachusetts physician, spurred by the ATV death of his eight yearold patient, and with endorsements from the state’s governor and medical groups, succeeded in passing one of the nation’s toughest law for protecting children from the dangers of operating ATVs. No child younger than 10 can ride one, and children younger than 17 are banned from adult-sized ATVs. There are no exceptions based on training or adult supervision, and this law applies to all property — both public and private. My hope is that at the September 2015 MMA Annual Conference, this issue can be raised in our state. As the state’s medical association, we have the opportunity to provide leadership, calling for clear child safety guidelines which would ban children younger than 16 from operating adult ATVs, and children younger than 16 from being passengers on ATVs. If these guidelines were adopted as MMA public health policy, the platform would be referenced at the legislature and to the media whenever ATV matters arise. I believe, as physician leaders, the MMA has an obligation to help save children’s lives. By advising our state government in this matter we could decrease the incidence of injury and death for children, thereby averting the voices of devastated, heartbroken parents. MetroDoctors
The Journal of the Twin Cities Medical Society
E-cigarette Trainings Heat Up
T
he Physician Advocacy Network (PAN) hosted its first Up in Smoke Ecigarette and Other Tobacco Products toolkit training May 18 in Duluth at the University of Minnesota Duluth Medical School. Peter Dehnel, M.D. and PAN Medical Director joined me in training physicians, tobacco cessation specialists, and a mix of medical and pharmacy students. Stuart Hanson, M.D. a Physician Advocacy Network Ambassador led a 30
minute e-cigarette tobacco training to over 75 clinicians and nurses at the Park Nicollet Improving Health Outcomes in Chronic Disease Conference on May 28. All e-cigarette trainings are awarded CME credits. A variety of training options are available ranging from in-person to online webinar modules. For more information or to schedule training contact Ellie Parker, Project Coordinator at (612) 362-3706 or eparker@metrodoctors.com.
Ellie Parker, MPH, and Peter Dehnel, M.D. presented the E-cigarette and Other Tobacco Products toolkit at the University of Minnesota Duluth Medical School.
To view and download an e-cigarette toolkit visit www.metrodoctors.com Upcoming Training Dates June 24 – Willmar, MN (Affiliated Community Medical Center) July 28 – St. Cloud, MN (Stearns Benton Medical Society) August 12 – Duluth, MN (Essentia) Ellie Parker, MPH, Project Coordinator, Physician Advocacy Network.
Stuart Hanson, M.D. provided an e-cigarette training session to physicians and nurses at Park Nicollet.
Cultural Humility in Compassionate Advance Care Planning: New Tools for Communities
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hree bilingual/bicultural physicians, an anthropologist, a film maker, Hmong community liaisons and elders, a Latina social worker and patients, an Islamic studies scholar and community activist, and skilled bilingual interpreters. Not your typical health education team. Is this a new breed of community involvement in the field of advance care planning and end-of-life care? Not for the Twin Cities Medical Society and Honoring Choices Minnesota. To meet complex Hmong, Somali and Latino/Hispanic advance care planning (ACP) needs, three teams of interdisciplinary health care and cultural experts came together to design a new tool: three cross-cultural ACP video “shorts” in the Hmong, Somali and Spanish languages for members of each community. With the skilled assistance of filmmaker Chris Newberry, these teams uncovered MetroDoctors
existing myths, misperceptions and ACP realities within each group. The result is a series of three under 10 minute videos designed to stimulate conversations — and most importantly, ACP action across generations within each community. To view all videos online with English subtitles, visit www.honoringchoices.org. Our sincere thanks to Aligning Forces for
Miguel Ruiz, M.D.
Mohamed Hagi-Aden, M.D.
Quality (AF4Q) for funding the production of this new ACP video series. The intent of AF4Q is to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities, and provide models for national reform. Barbara Greene, MPH, Director of Community Engagement, Honoring Choices Minnesota.
Muaj C. Lo, M.D.
Filmmaker Chris Newberry
Cultural humility reflects complex attitude and skills to meet the needs of patients and families where patient and provider mutually have something to contribute. Meeting patients and families where they are requires learning about and from them, understanding what they believe, and learning about their expectations.
The Journal of the Twin Cities Medical Society
(Adapted from Silvia Austerlic, Markkula Center for Applied Ethics, February 2009)
July/August 2015
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Honoring Choices 5K a Success!
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n April 18, more than 50 enthusiastic runners, walkers and volunteers gathered at Roseville’s Central Park for the first-ever National Healthcare Decisions Day 5K and Community Information Fair. The weather cooperated and the morning was spent with a running race, a walk, and plenty of discussions about advance care planning. A big thank you to all who participated in NHDD events this year. Governor Dayton proclaimed it Minnesota Healthcare Decisions Day. There were many community events and activities focused on helping the public learn more about the importance of ACP. Dr. Kent and Missy Wilson participated in the first annual Honoring Choices 5K.
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MetroDoctors
The Journal of the Twin Cities Medical Society
No m
LUMINARY of Twin Cities Medicine
i n at
e
T
his last page series of MetroDoctors, Luminary of Twin Cities Medicine, is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. The Luminary gives physicians the opportunity to acknowledge their colleagues/mentors for the great things they have done for medicine.
Please forward names of physicians you would like considered for this recogntion to Nancy Bauer, managing editor, nbauer@metrodoctors.com.
Previously Featured Physicians: Arne S. Anderson, M.D. Janis C. Amatuzio, M.D. Abraham B. Baker, M.D. Moses Barron, M.D. Reuben Berman, M.D. Paul F. Bowlin, M.D. M. Elizabeth Craig, M.D. Charles E. Crutchfield, Sr., M.D. Susan E. Crutchfield-Mitsch, M.D. Amos S. Deinard, M.D. Mitchell Einzig, M.D.
MetroDoctors
The Journal of the Twin Cities Medical Society
Richard Frey, M.D. Robert W. Geist, M.D. A. Stuart Hanson, M.D. Elizabeth Jerome, M.D. Carolyn A. Johnson, M.D. Virginia R. Lupo, M.D. Richard Magraw, M.D. Deane C. Manolis, M.D. Glen Nelson, M.D. Edward Posey, M.D. Paul G. Quie, M.D.
Ernest Ruiz, M.D. Laurence A. Savett, M.D. Alvin Schultz, M.D. Vernon Sommerdorf, M.D. Valerie Ulstad, M.D. Robert A. Van Tassel, M.D. Owen H. Wangensteen, M.D. Patrick C.J. Ward, M.D. Kent S. Wilson, M.D.
July/August 2015
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Creating a New Beginning From Historical Roots Twin Cities Medical Society Foundation
E
stablishing yourself as a new foundation is never an easy task. However, when the new foundation is backed by a rich heritage, spanning nearly five decades, the challenge is a bit less daunting. Twin Cities Medical Society Foundation (TCMSF) was officially launched on January 1, 2015 following the merger of the East Metro Medical Society Foundation and the West Metro Medical Foundation. The successful model which established the Twin Cities Medical Society in 2009 provided the momentum for a small contingent of directors from the East Metro Medical Society Foundation and West Metro Medical Foundation Boards to gather for the purpose of exploring the possibility of uniting the two foundations under the TCMS umbrella. One and onehalf years later, the respective Foundation Boards voted unanimously to seal the deal. Chris Johnson, M.D., Chair, called the inaugural meeting of the TCMSF to order on February 22, 2015. With the structural foundation in place, the Board set to work crafting a mission statement, selecting a logo, and setting forth a plan for investments, a gifting policy, grant criteria and calendar. Mission Statement:
The Twin Cities Medical Society Foundation is a physician-led philanthropic organization that strives to improve the health and wellbeing of the community through strategic initiatives. A second meeting of the Board was held in May at which time members were tutored in their roles as charity board members and fiduciary responsibilities. A preliminary 28
July/August 2015
discussion about existing award recognitions and medical student scholarships reaffirmed the sentiment that medicine is a revered profession and should be reflected by the vision and activities of the Foundation. The Board will meet on a quarterly basis and will continue to define its priorities. Honoring Choices Minnesota, a community collaborative for advance care planning, remains a key initiative of the Foundation and a focus on supporting activities that improve access to care will be considered when grants are distributed annually each fall. Please consider making a donation to the Twin Cities Medical Society Foundation at any time, and particularly in honor of or in memory of a colleague, friend and/or family member. Visit our website at www.metrodoctors.com; click on the Foundation tab to make an online contribution, or mail a contribution to Twin Cities Medical Society Foundation, 1300 Godward Street NE, Suite 2000, Minneapolis, MN 55413.
TCMSF Board Members:
Officers: Chris Johnson, M.D., Chair James Jordan, M.D., Vice-Chair Robert Moravec, M.D., Treasurer Elisabeth Hurliman, M.D., Ph.D., Secretary Directors: Kenneth Britton, M.D. John Diehl, J.D. Thomas Dosland, M.D. Mark Engasser, M.D. Solveig Hagen (medical student) Chris Jackson, M.D. Martin Lipschultz, M.D. Henri Minette, J.D. Chris Perdoni (medical student) Richard Schmidt, M.D. Peter Stiles, M.D. James Struve, M.D. Andrew Thomas, M.D.
Guidelines for Awarding Grants:
1. Geographic: Grants will be awarded predominantly in the Twin Cities metropolitan area. 2. Type of Organization: The major focus of grants awarded will be to tax-exempt entities. 3. Size of Grant: Grants awarded must not exceed the gifting guidelines established by the TCMSF Board of Directors. 4. One-Time vs. Repeat Grants: Both types of grants will be given consideration. 5. One-Year vs. Multiple Year Grants: One-year grants are preferable; however, TCMSF may support multi-year grant requests on a case-by-case basis. 6. Operating Grants and Program Grants: TCMSF only supports program grants and operating grants that help to fulfill the mission. 7. Funding of Capital or Equipment Costs: Funding requests for equipment costs will be considered on a case-by-case basis.
MetroDoctors
The Journal of the Twin Cities Medical Society
Senior Physician Association Spring Meeting
New Members Pamela D. Doorenbos, M.D. North Clinic, PA – Maple Grove Family Medicine William C. Downey, M.D. Allina Palliative and Senior Care Transitions Family Medicine John D. Dryer, M.D. North Clinic, PA – Maple Grove Family Medicine Stephen L. Hollenbeck, M.D. North Memorial Clinic – Ridgedale Family Medicine
D
avid Willoughby, CEO of Clearway Minnesota, was the featured speaker at the first luncheon and meeting of the Senior Physician Association for the year, held May 19, 2015. Mr. Willoughby discussed the company’s history as well as its future direction. As a result of Minnesota’s tobacco settlement ClearWay Minnesota was created in 1998, initially named Minnesota Partnership for Action Against Tobacco (MPAAT), as an independent nonprofit with a 25-year lifespan. ClearWay has made significant
Erin King, M.D. Children’s Hospitals & Clinics of Minnesota Pediatrics
strides in creating a healthier Minnesota and sees its continuing role as helping Minnesotans to quit smoking and use of other tobacco products, and to fund tobacco-related research, programs and initiatives around the state. Next Senior Physician Association Event:
Mary G. Lawrence, M.D., MPH Address not listed Ophthalmology Mark L. Ostlund, M.D. Fairview Bloomington Lake Clinic Internal Medicine Annalisa K. Rudser, M.D. Children’s Hospitals & Clinics of Minnesota Pediatrics
SPA members listened intently at the ClearWay presentation given by Mr. Willoughby.
David Willoughby, CEO ClearWay Minnesota, guest speaker at the May Senior Physician Association gathering.
Annual Summer Outing – July 14, 2015 Speaker – Susan Leaf, author of a book on Thomas Roberts, M.D., a nineteenth century Twin Cities physician who inspired the Bell Museum at the University of Minnesota, titled A Love Affair With Birds. Contact Emily Johnson for more information and to register: ejohnson@ metrodoctors.com; (612) 623-2885.
Search for Twin Cities Medical Society on Facebook and follow us on Twitter
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The Journal of the Twin Cities Medical Society
July/August 2015
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In Memoriam WILLIAM J. KANE, M.D. passed away on March 27, 2015. He received his medical degree at Columbia University in New York. He completed an orthopedic surgery residency and received a Ph.D. at the University of Minnesota. Dr. Kane was instrumental in establishing the Orthopedic Department at the University of Minnesota. He practiced at Hennepin County Medical Center. Dr. Kane became a member of the medical society in 1988. ROGER C. LARSON, M.D. passed away on March 27, 2015. He graduated from the University of Minnesota Medical School in 1950. Dr. Larson served in the Navy during the Korean War. He was board certified in obstetrics and gynecology and
CAREER OPPORTUNITIES
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practiced with his brother, Donald. Dr. Larson joined the medical society in 1954. SELMER M. LOKEN, M.D. passed away on May 8, 2015 at the age of 102. He graduated from the University of Chicago Rush Medical Center in 1938. Dr. Loken was a Pathologist at Bethesda Hospital for several years in addition to having a private family practice. The S. M. Loken Humanitarian Medicine Award is given annually to a family practice resident who demonstrates academic excellence, medical competence, educational commitment, professional demeanor and an uncompromising concern for the welfare of all patients as exemplified by Dr. Loken. He became a member of the medical society in 1941.
“Would that you could give to those in need your knowledge, your skill, or just a kindly deed. It is not what you have, but what you give that will reward you as long as you live.� Written by Dr. Loken. RICHARD E. WILLIAMS, M.D. passed away on May 11, 2015. Dr. Williams served in the U.S. Navy during WW II. After discharge he attended St. Louis University School of Medicine where he received his medical degree in 1954 followed by a residency at Minneapolis General Hospital. Dr. Williams is a co-founder of Northwest Family Physicians in north Minneapolis. He joined the medical society in 1957.
See Additional Career Opportunities on page 31.
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CAREER OPPORTUNITIES
Please also visit www.metrodoctors.com
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July/August 2015
31
LUMINARY of Twin Cities Medicine By Marvin S. Segal, M.D.
JOSEPH TOMBERS, M.D. TIME IS ARGUABLY AMONG THE MOST VALUABLE
serviceable commodities available to mankind. Many complain to never have enough of it. Dr. Joseph Tombers, despite living an active whirlwind of a life, always seems to have more than enough of that precious element to willingly share with patients, family, friends and colleagues. Joe was born in Minneapolis and was adopted by a loving childless couple. He states, while speaking fondly of his adoptive parents, “that was the most fortunate day of my life.” College and medical school were at St. Thomas and Marquette Universities, and he served as an Air Force flight surgeon at the height of the Vietnam War. He was attracted to a gastroenterology fellowship during his medicine residency at the Minneapolis V.A. through the influence of Dr. Jack Vennes, an expert in the then new technique of Endoscopic Retrograde Cholangiopancreatography (ERCP). Joe continued work in this area of interest at our U of M, and in the early 70s allied with two other gastroenterologists, an association that would positively affect the practice of G.I. medicine in our community well into the future. Drs. Tombers, Arnold Kaplan and Cecil Chally, three bright young physicians with complementary talents, interests, and personalities founded what was to become Minnesota Gastroenterology, PA (M.G.), an independent private practice. These dedicated G.I. specialists enjoyed a wide Twin Cities presence and created a top-notch lab at Mt. Sinai Hospital that was able to perform specialized studies in addition to a full range of endoscopic procedures. They filled an existing need with what was to eventually become a 60+ person nationally renowned independent clinical organization that has more than weathered the test of time in our ever-changing medical environment. Joe modestly points to Drs. Kaplan and Chally as the leaders of their group, but in actuality, all three played prominent roles in combining superb clinical patient care with a savvy business model. The acknowledged expertise and increasing size of M.G. along with collegial relationships with other community gastroenterologists and convenient geographic coverage initially led to mutually positive contractual relationships with health plans, and comfortable relationships with Twin Cities’ hospitals. Those elements remain in place, even though competition has become more brisk in today’s complex medical marketplace. 32
July/August 2015
As a founder and leader of a successful specialty practice, one marvels at how Dr. Tombers has had the time to serve in successful Presidencies of the Hennepin County Medical Society (now TCMS), Minneapolis Society of Internal Medicine and the Fairview Southdale Medical Staff. The St. Mary’s Carondolet free clinic has also benefitted from his involvement, and even though formally retired from his private practice, he currently continues an 18-year volunteer position as the Co-Medical Director of the International Health Service in Honduras. Joe states that the most gratifying aspect of his long career, along with the enjoyment of relating to other physicians, was “being able to help patients at critical times in their lives.” Other meaningful comments shared with us from Dr. Tombers are: “there is a fine future ahead for independent practitioners,” “we should proudly encourage young committed people to choose medicine as a career” and “nurses are the unsung heroes of medicine.” When we think of Dr. Tombers in this current dynamic and complex medical milieu, we picture — pride rather than apprehension, resolve rather than despair and a bright smile rather than a furrowed brow. Whether he is ministering to a patient, spending time with his grandchildren and three accomplished daughters or playing golf with his high school buddies, Joe can be described by any of the following characteristics: caring, smart, modest, practical, quiet, strong, unassuming, obliging, optimistic and tireless. And now we can add, Joe Tombers — Luminary! This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, managing editor, nbauer@metrodoctors.com.
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10th ANNUAL
PAIN CONFERENCE
SATURDAY NOV. 14th, 2015 Westin Galleria, Edina MN
Please plan to join us for a full day educational conference that includes the latest interventional pain management treatment options, appropriate opioid prescribing information as well as many other pain related topics.
Pain Prevalence & Definition Utilizing a Multidisciplinary Approach in Pain Management Updates in Interventional Techniques and Implantable Therapies Current Pain Therapies and Treatment Plans Assessing the Difficult Headache Patient The Psychology of Pain & Patient Interview Healthcare Reform / Patient Engagement Strategies Emerging Therapies – The Direction of Pain Management
LIMITED SEATS AVAILABLE. REGISTER NOW!
www.painphysicians.com | 888.901.7246 (PAIN) / 608-604-4659 For conference registration and CME program information contact Ginny Cairns at: ginny.cairns@apmhealth.com or 608-604-4659