All I wanted was to use my body And I got there with Bethesda Hospital, member of HealthEastŽ Care System. When a 1,600-pound tree crushed Don Obernolte, he thought everything was over. But with the help of Bethesda, he’s reinvented his life. As one of the first and largest longterm acute care hospitals in the nation, Bethesda cares for chronically ill patients or victims of catastrophic accidents, with higher-than-national-average vent wean rates. So patients can recover, relearn and restart, creating a new normal for their lives. For more information about Bethesda Hospital in St. Paul, Minnesota, visit bethesdahospital.org or call 651-232-2000.
Contents VOLUME 12, NO. 3
2
Index to Advertisers/Classified Ad
3
President’s Message
M AY / J U N E 2 0 1 0
Please Holster Your Boom Blitzers! By Edward P. Ehlinger, M.D., MSPH
4
tCMs in aCtion By Sue Schettle, CEO
6
Help Your Older Low Income Patients Eat Well to Be Well By Jill Hiebert and Neal R. Holtan, M.D.
Page 4
8
Colleague interview
Edwin N. Bogonko, M.D.
10
The Push for Health Information Technology By Paul Kleeberg, M.D.
11
HIT Assistance and Incentives Available for Minnesota and North Dakota Providers By Susan Severson
16
MediCal students Making a differenCe •
ISTOP By Carolyn Bramante, Caitlin Conboy, Nathalie Lechault, Kate Birkencamp, Emily Moody, and Ben Pederson
19
•
The Phillips Neighborhood Clinic By Benjamin Willenbring and Brian Sick, M.D.
21
•
Catalyst Program: Inspiring Tomorrow’s Physicians By Travis Moncrief and Alex Marston
Page 32
23
•
Experiencing Senior Living at Augustana Apartments By Linda Watanaskul
24
Call for Resolutions/Caucus Dates/ Physician Mentors Needed
25
Can You Give One Hour a Week? By Michael Anderson
26
New Members/In Memoriam
27
Honoring Choices Minnesota/EMMS Foundation Board
28
West Metro Medical Foundation/ Career Opportunities
32
luMinary of twin Cities MediCine
Page 21
Vernon L. Sommerdorf, M.D. MetroDoctors
The Journal of the Twin Cities Medical Society
On the cover: Medical students volunteer their time to enhance medical expertise in unique settings. Articles begin on page 16.
May/June 2010
1
May/June Index to Advertisers
Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
TCMS Officers
Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Katie R. Snow TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily refl ect the offi cial position of TCMS.
President Edward P. Ehlinger, M.D. President-elect Thomas D. Siefferman, M.D. Secretary Anthony C. Orecchia, M.D. Treasurer Melody A. Mendiola, M.D. Past President Ronnell A. Hansen, M.D. TCMS Executive Staff
Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Jennifer J. Anderson, Project Director (612) 362-3752 janderson@metrodoctors.com Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Kathy R. Dittmer, Executive Assistant (612) 623-2885 kdittmer@metrodoctors.com Katie R. Snow, Administrative Coordinator (612) 362-3704 ksnow@metrodoctors.com
MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Katie Snow at (612) 362-3704.
NEW
For a complete list of TCMS Board of Directors go to www.metrodoctors.com.
Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com. For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com
Acute Care, Inc. .................................................30 AmeriPride...........................................................15 Bethesda Hospital ............. Inside Front Cover Billing Buddies ..................................................... 7 Classifi ed Ad ......................................................... 2 Crutchfi eld Dermatology ................................13 The Davis Group ................................................ 5 Fairview Health Services .................................28 Family HealthServices Minnesota, P.A. ......31 Healthcare Billing Resources, Inc. ...............13 HealthEast Care System ..................................29 Lockridge Grindal Nauen P.L.L.P. ...............20 Mankato Clinic ..................................................31 Minnesota Epilepsy Group, P.A. ...................22 Minnesota Physician Services, Inc. ..............11 The MMIC Group ................................................ Inside Back Cover Pediatric Home Service ........................................ Inside Back Cover SafeAssure Consultants, Inc. ............................ 2 U.S. Army ............................................................29 University of Minnesota CME .......................... Outside Back Cover Uptown Dermatology & SkinSpa, P.A. ......22 Weber Law Offi ce .............................................14
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May/June 2010
MetroDoctors
The Journal of the Twin Cities Medical Society
President’s Message
Please Holster Your Boom Blitzers! EDWARD P. EhLINGER, M.D., MSPh
AS PRESIDENT OF
the Twin Cities Medical Society (TCMS), I was part of the Minnesota delegation to the Advocacy Conference of the American Medical Association. Along with getting an update on the status of health care reform and Medicare’s sustainable growth rate (SGR) policy, the real purpose of the conference was to get physicians to Capitol Hill to meet with their congressional representatives. So, with great anticipation and optimism I joined my MMA and TCMS colleagues at the Longworth House Offi ce Building where most of Minnesota’s representatives reside. However, after visiting with our representatives my mood had changed dramatically. I expected the Republicans and Democrats to be fi ghting with each other but I hadn’t anticipated the hostility that I sensed throughout congress. No one seemed to like or trust anyone else. The Blue Dog and the progressive Democrats were disparaging each other with great intensity. The antipathy between the House and the Senate was even worse. And everyone was angry with President Obama. I left Capitol Hill discouraged and wondering if any meaningful health care legislation would get passed this session. On my way back to the hotel I saw a sign in a bookstore touting the birthday of Theodor Seuss Geisel. The day’s experiences made me immediately think of one of my favorite Dr. Seuss books, The Butter Battle Book, which begins: On the last day of summer, ten hours before Fall… my grandfather took me out to the wall. For a while he stood silent. Then finally he said, with a very sad shake of his very old head, “As you know, on this side of the Wall we are Yooks. On the far other side of this Wall live the Zooks.”
“But we Yooks, as you know, when we breakfast or sup, spread our bread,” Grandpa said, “with the butter side up. That’s the right, honest way!” Grandpa gritted his teeth. “So you can’t trust a Zook who spreads bread underneath!” While the nuclear arms race was the basis of that story, Dr. Seuss could just as easily have used health care reform as his inspiration because, in Washington and throughout the country, people have unleashed their Boom Blitzers, Blue Gooers, and Big-Boy Boomeroos to throw invectives at those who think differently than they do about health care reform. And what has it gotten us — entrenched adversarial positions on the health care reform bill and mutually assured destruction of anyone who tries to bring together the warring parties. Is it possible to get away from this brinksmanship and fi nd a way to break down walls and collaboratively develop rational health policies? Given the entrenched positions in Washington, it’s probably not possible there. Perhaps it can be done at the state level; especially in a state like Minnesota which has a history of coming together for the common good. But who could provide the leadership to make this happen? The 6,000 members of TCMS (including a few Yooks and Zooks) embody the full range of divergent views on health care reform. Yet, as a newly-formed organization, TCMS has a unique opportunity to create a forum that allows and encourages all voices and perspectives on policy issues to be heard and fosters respectful and non-judgmental debate — essentials for the development of rational and effective policy recommendations. Now is the time to act on that opportunity because, as was stated in Horton Hears a Who, another of my favorite Dr. Seuss stories: “This,” cried the Mayor, “is your town’s darkest hour! The time for all Whos who have blood that is red To come to the aid of their country!”, he said. “We’ve GOT to make noises in greater amounts! So, open your mouth, lad! For every voice counts!”
Then my grandfather said, “It’s high time that you knew of the terribly horrible thing that Zooks do. In every Zook house and in every Zook town every Zook eats his bread with the butter side down!”
MetroDoctors
The Journal of the Twin Cities Medical Society
May/June 2010
3
tCMs in aCtion SUE A. SChETTLE, CEO
The Twin Cities Medical Society Board of Directors embarked on its first strategic planning retreat on Thursday, March 25, 2010 at the Broadway Ridge Building in Minneapolis. Attendance was good and the discussion was even better. The board focused on the direction that TCMS should take as it begins its work representing the physicians of the seven county metro area. The evening was facilitated by strategic planner, Jerry Spicer, Ph.D. who artfully facilitated the diverse group of leaders. Much more will be written about the results of the strategic planning meeting in the next issue of MetroDoctors, including the Mission and Vision statements of your Twin Cities Medical Society. Also look for the results of a membership survey that was sent to all members of the Twin Cities Medical Society whose email addresses we have. If you did not receive an e-mail survey questionnaire it is likely that we do not have your e-mail — so contact us! Some really interesting information was gleaned from this membership survey that
helped to guide the board in its discussions about the future direction of TCMS. American Medical Association National Advocacy Conference
Ronnell Hansen, M.D., past president of the East Metro Medical Society, Edward Ehlinger, M.D., president of the Twin Cities Medical Society and Sue Schettle, CEO of the Twin Cities Medical Society, attended the American Medical Association’s National Advocacy Conference in Washington, DC March 1-3. With all that is going on in national health care reform it is particularly important that TCMS leadership be engaged in this national discussion by way of connecting with our elected officials and being informed. TCMS leadership met with the Minnesota Congressional delegation and their staff. Web site
The updated www.metrodoctors.com Web site is nearly ready to launch. The new Web site will include much more content and will
Those attending the American Medical Association’s National Advocacy Conference in Washington, DC included (Back row from left): Robert Meiches, M.D., CEO, MMA; Benjamin Whitten, M.D., MMA President; Sue Schettle, CEO, TCMS; Blanton Bessinger, M.D., AMA Delegate; Edward Ehlinger, M.D., TCMS President; Mark Eggen, M.D. (Front row from left): Susan Meiches, M.D.; Patricia Lindholm, M.D., MMA President-elect; and Ronnell Hansen, M.D., TCMS President-elect.
4
May/June 2010
allow our members to be better informed of the work that we are doing and offer more opportunities for you to become better engaged. Healthy Menus Minneapolis Update
With the recent passage of health reform legislation comes a new national menu labeling law that mandates calories to be posted on all menus, menu boards and drive-thru areas. The legislation applies to chain restaurants with 20 or more locations, and requires them to provide additional nutritional information on request. Similar laws have been passed in the State of California, Maine, Massachusetts, New York City, Philadelphia and a host of other cities. The new federal law will supersede the patchwork of laws already in place all over the country. Menu labeling allows for full disclosure to consumers who might make healthier choices at the point of purchase. The bill exempts small businesses, and does not apply to daily or temporary menu items or customized orders. It also requires the U.S. Food and Drug Administration to promulgate specific regulations within a year from now. Healthy Menus Minneapolis will continue to follow this new law as it pertains to enforcement and regulations. For more information on Healthy Menus Minneapolis, please contact Jennifer Anderson, Project Coordinator, at janderson@ metrodoctors.com or (612) 362-3752.
MetroDoctors
The Journal of the Twin Cities Medical Society
help Your Older Low Income Patients Get the Food They Need to
Eat Well to Be Well IT’S A CHALLENGE to get patients to follow
advice about making better food choices. For example, physicians often hear that patients cannot financially afford nutritious foods such as fruits and vegetables and subsequently they rely instead on starchy, sweetened, or processed staples. Because of cost, older patients with limited budgets are particularly likely not to eat the recommended five servings of fruits and vegetables per day (ICSI Obesity Guidelines 2009). Combined with limited physical activity, sometimes from disabilities, lack of
L
enrolled out of 78,000 eligible people aged 65 and older, and participation rates have remained flat for the past 19 years. Recent program changes to reduce barriers may surprise many seniors. For example, the asset limit has been raised to $7,000 not including vehicles, IRAs or tax-deferred retirement accounts. Homebound people can easily enroll by telephone and family members can shop for them. The program increases buying power an average of $111 a month per household using a debit card that is scanned at checkout like a credit card.
luckily, physicians have a great new resource to help their low-income older patients enroll in the food support Program/snaP (formerly known as food stamps) and assist them in getting the nutritious food they need...
nutritious foods makes low-income seniors very vulnerable to progressive, entrenched obesity. The 75,000 Minnesotans over 65, with incomes below 125 percent of poverty, face the unfortunate choice of paying the bills or buying enough food. Surveys find that 46 percent of Minnesota seniors spend more than 30 percent of their income on rent and utilities, leaving little room for food in their budgets. Some seniors consider fruits and vegetables a luxury and essentially live on tea and toast. According to USDA estimates, the food stamp program serves only about 32 percent of eligible households with elderly members in Minnesota. In June 2009, there were 17,970 By Jill hiebert and Neal R. holtan, M.D.
6
May/June 2010
Luckily, physicians have a great new resource to help their low-income older patients enroll in the Food Support Program/SNAP (formerly known as Food Stamps) and assist them in getting the nutritious food they need to combat obesity and other consequences of poor nutrition. It’s called the Eat Well to Be Well program. The Greater Twin Cities United Way and hunger relief organizations developed Eat Well to Be Well specifically to improve the traditionally low participation rate of seniors in the Food Support Program (Food Stamps). They commissioned the Minnesota Institute of Public Health (MIPH) to design a campaign to increase seniors’ awareness of the financial and health benefits of the Food Support Program and to motivate them to use Food Stamps
through posters with appealing, whimsical images that effectively link diet to good health. The campaign relies on trusted advisors such as physicians to display the posters and tear-off sheets with the phone number needed to sign up for Food Support. What Can Physicians Do To Help?
•
Talk with your older patients about the availability of the Food Support Program and encourage them to call the Minnesota Food HelpLine (1-888-711-1151) to see if they qualify. • Tell seniors that the Food Support Program will enable them to buy nutritious food such as fruits and vegetables that they currently believe they cannot afford. • Make patients aware that the average monthly benefit for an eligible Minnesota senior is $111.00. • Emphasize the potential benefits of the Food Support Program in reducing obesity and other health issues like flu, infections, falls and broken bones, arthritis, heart disease, and diabetes. • Emphasize that patients with good nutrition have fewer and shorter hospital stays. • Order Eat Well To Be Well posters with tear off pads, post cards and table tents to display and distribute in your clinic. • Share the information about Eat Well To Be Well with your reception, nursing, and other staff. Materials are available in English, Spanish, Hmong and Somali. Please contact Tanya Prahl at (763) 427-5310 x126 or tprahl@miph.org for more information on how to order. Jill Hiebert, Hunger Solutions Minnesota, and Neal R. Holtan, M.D., M.P.H., Minnesota Institute of Public Health.
MetroDoctors
The Journal of the Twin Cities Medical Society
COLLEAGUE INTERVIEW
A Conversation With
Edwin N. Bogonko, M.D.
E
dwin N. Bogonko, M.D. is board certified in internal medicine currently specializing in hospital medicine as a hospitalist at St. Francis Regional Medical Center, Shakopee, MN. In addition to providing inpatient care, critical care as well as education of medical students, PA students and nurses, his current responsibilities include: clinical director of Medicine and lead physician, Hospitalist Group. He received his MB ChB from the University of Nairobi, Nairobi, Kenya in 1993 and in 2007 completed an internal medicine residency at Hennepin County Medical Center. Dr. Bogonko is a member of the Minnesota Kenya International Development Association and serves as a mentor for foreign trained medical graduates. He is also a member of the American College of Physicians, American Medical Association, Minnesota Medical Association, Society of Hospital Medicine and serves on the board and executive committee of the Twin Cities Medical Society. Questions were provided by: Drs. Macaran Baird, Edward P. Ehlinger, Donald M. Jacobs, and Elena Polukhin.
What are some of the things that you learned during your training and practice in Kenya that have been helpful to you in your U.S. practice? Patience in my daily work — coming from a resource poor environment has given me a much better perspective of utilizing the tools at my disposal every day while still parlaying what I consider to be stronger clinical skills. Focusing on the patient — In Kenya, it is an open market and so your patients will only return if satisfied with the quality of your work. I got used to that early and feel it is natural for me to keep my patients at the top of my priority list every day. Holistic practice — I learned to treat not just the patient but the family as well. It is much easier for me to address most of my patients’ concerns and take the time to understand where they are coming from. Most patients have fears, aspirations and striking the right balance goes a long way. Coming from a culture that promotes ultimate compassion to the ill and less fortunate, I feel fortunate every day to be able to extend the same to my patients.
Many young doctors in Kenya aspire to migrate and practice medicine in the U.S. What do you tell them? •
8
To consider their age, length of time since graduation and be aware of the challenges associated with medical licensure in the U.S. May/June 2010
•
• • • •
To be well prepared using the right tools in order to stand out. The earlier one starts preparing for the USMLE exams after graduation the better. Know they are competing with a global body of physicians with the same goals and dreams of coming stateside. Pursue further training elsewhere if you can before coming over — likely an added plus. Seek advice from those who have already blazed the trail. Be prepared to work twice as hard.
What are the primary challenges foreign trained health professionals face as they pursue medical licensure in Minnesota? There are several: • Financial — Cost associated with exam preparation, fees and residency interviews. Most of the doctors who have already migrated here work full time in entry level jobs as they go through the licensure process. • Difficulty to access residency due to length of time since graduation from medical school. • Lack of exposure to U.S. clinical experience and good recommendation letters. • Lack of alternative pathways where physicians who are not accepted into residency can utilize their knowledge and skills. • Learning and adapting to a new medical and practice culture. MetroDoctors
The Journal of the Twin Cities Medical Society
In what general areas of medicine do the foreign-trained unlicensed physicians most often pursue? Everyone aspires to specialize in areas of their choice but inherently it is difficult to pursue highly sought after disciplines including surgery, OB/GYN, orthopaedics and dermatology. As a result, a lot of foreign trained physicians opt for what are considered less competitive programs like family practice, pediatrics and in some markets, internal medicine. An increasing number of foreign trained physicians are also opting for primary care in under-served areas as they are more likely to be appreciated there or obtain immigration assistance.
Is there a group of foreign trained and licensed physicians in specific specialties who could be mentors and clinical preceptors for foreign trained unlicensed physicians who need clinical observerships to become successful applicants to various Minnesota residency programs? Yes. I have been associated for the past three years with the African & American Friendship Association for Cooperation and Development (AAFACD) Inc. which is already working with a few foreign trained licensed physicians on their individual capacity. Some of the foreign trained physicians are still in residency but are providing some degree of mentorship to their colleagues who are preparing for USMLE. As a result, we are now looking at a sizable number of mentors and even locally trained physicians sympathetic to the cause of foreign trained physicians.
How can community-based physicians host a Foreign Trained Health Professional in a clinical setting? By first embracing the role the foreign trained physicians can play in mitigating out health disparities and lack of access. Through organized programs such as AAFACD, foreign trained physicians can be vetted and recommended to community docs for experience and acculturation.
Do you believe that unlicensed foreign medical graduates might work in the medical field under the supervision of U.S. licensed physicians? In what capacity? Where: in rural areas, in community clinics? Yes. Unlicensed foreign trained medical graduates who are ECFMG certified can see patients under the supervision of a licensed physician in any clinical setting. A good number of them have even passed USMLE step III which is required to be state certified. Those still preparing for exams can shadow a licensed physician. At this time, any efforts to integrate foreign trained physicians into clinical practice — whether in the rural setting or in urban community clinics — will go a long way in addressing some inequalities of access to care for example. Some of the physicians can play the role of medical assistants or as PAs assisting M.D.s, under supervision. It is unconscionable that for a large African population of nearly 300,000 in Minnesota alone, there are a handful of licensed physicians
MetroDoctors
The Journal of the Twin Cities Medical Society
and countless more unlicensed because of graduating elsewhere. Something needs to be done about this as we integrate as a wider community.
Do you foresee the development of any official TCMS program that helps foreign medical graduates to work and provide care to people in need with limited registration? Something similar to the Ontario College of Physicians and Surgeons program “Reducing Barriers to Practice”? This would be a welcomed development for it will give the physicians an opportunity to have exposure to U.S. medical culture and practice which is lacking at the moment. The majority of unlicensed foreign trained physicians in Minnesota have immigrated to the states as refugees, permanent residents or asylees. They now call Minnesota home and are here to stay. “Reducing barriers to practice” for them is a win-win situation since their experience is very helpful in providing culturally appropriate care within their communities here in Minnesota. For such a program to be developed there needs to be support from the policy makers, health care providers, health management organizations, medical schools, professional associations, medical board and the department of health among others. Canada has a universal health service which is largely run by the government thus the decision-making process is much easier compared to the U.S. I do not see anything conceptually wrong with a system that identifies foreign trained physicians who meet the minimum grade (ECFMG certification) and lets them work in underserved areas under direct supervision and thereafter be presented with residency opportunities — even if restricted to primary care for a start. This will in part address the looming shortage of primary care access. At this time, organizations such as AAFACD are developing partnerships with stakeholders (residency programs, hospitals and clinics) as well as non-profits such as the Medtronic Foundation to develop a pathway for identifying, vetting and then exposing foreign trained physicians to pre-residency experience opportunities. I would argue that with such a large immigrant population, just preparing these foreign trained physicians to be attractive candidates to any training program will mean they will come back to Minnesota and serve their communities.
What role could TCMS play in helping to diversify our health care workforce? •
• • •
Supporting unlicensed foreign trained physicians by providing mentorship and clinical experiences and advocating for policies to reduce barriers to practice. Supporting the development of a diversity program, e.g. having a diversity committee to identify opportunities for involvement. Partnering with organizations such as AAFACD as well as local stakeholders to develop a long-term plan of integration. Sponsoring a resolution within the TCMS and the MMA that clearly takes a proactive position about the plight of foreign trained physicians and our possible role in providing leadership toward some practical solutions.
May/June 2010
9
The Push for Health Information Technology
P
Stimulating Exchange
robably one of the most over used pair of words in some circles in the past year has been “Meaningful Use.” If you have yet to hear about it, I would be very surprised if you don’t in short order. It has a whole bunch of folks very excited and for many of you, it will be worth knowing about. The essence of it is this: If you are able to demonstrate meaningful use of a certifi ed electronic health record, you could be eligible for up to $44,000 in incentive money from the government. If you are not able to demonstrate meaningful use of a certifi ed EHR, you may be subject to penalties of 1 percent or more of your Medicare reimbursement starting in 2015. Hospitals also have incentives as well, but we will focus on the provider incentives here. First Background:
Stimulating Adoption
As part of the American Recovery and Reinvestment Act (ARRA), Congress set aside monies to incentivize the use of interoperable Electronic Health Records (EHR)s. An interoperable EHR is one that can share patient information with a different EHR at another location of care. There were fi ve different programs that were initiated. Two to assist in the adoption of EHRs, one to facilitate the exchange of health information among providers, one to address the well documented problems to the adoption of health information technology (HIT) and one to encourage providers and hospitals to become meaningful users of certifi ed EHRs. Taken together, these programs are intended to jump start health care into the 21st century and to make patients’ information available whenever and wherever it is needed while protecting their privacy.
The fi rst program meant to stimulate adoption is the Health Information Technology Extension Center. As of this writing, 32 have been approved with the goal of creating 70 across the country. The focus of the HIT Extension Centers are to provide discounted consultative support to small primary care practices, or practices treating certain under-served populations in order that they may adopt EHRs and become meaningful users of them. An article describing in detail the Minnesota and North Dakota HIT Extension Assistance Center follows on page 14. The other program designed to facilitate adoption is the HIT Workforce Training program. This is intended to provide training to individuals at both the University and community college levels so that they may assist providers in the adoption and implementation of EHRs. A number of facilities across Minnesota including the metro area have applied for these funds.
By Paul Kleeberg, M.D.
10
May/June 2010
States are also receiving stimulus funds to set up secure methods to exchange patient health information among different points of care within the state. These Health Information Organizations (HIOs) will enable the secure look up and retrieval of health information in order to facilitate a more unifi ed record for the patient. Not everyone will choose to have their information available via the exchange, since it will respect individual’s wishes to participate, but for those who do, it will be the fi rst step in having their record available wherever and whenever it is needed. MN-HIE in the Twin Cities is planning to apply to be an HIO and there are likely to be others in the state. The Minnesota Legislature is currently working on defi nitions of an HIO, a health data intermediary (HDI) that will also aid in the exchange of these clinical transactions and a governing body that will certify both HIOs and HDIs. Refer to an article by Mike Ubl on Minnesota Health Information Exchange (MN-HIE) in the March/April 2010 issue of MetroDoctors. Addressing the Problems
The Strategic Health information technology Advanced Research Projects (SHARP) will fund projects to conduct research focusing on breakthrough advances to address well-documented problems that have impeded adoption of health IT and to accelerate progress toward achieving nationwide meaningful use of health IT. One area of research is the challenge of harnessing the power of health technology so that it integrates with, enhances, and supports clinicians’ reasoning and decision-making, rather than forces them into a mode of thinking that is natural to machines but not to people. In my mind, that means an intuitive, physicianfriendly interface. Hooray!
MetroDoctors
The Journal of the Twin Cities Medical Society
Encouraging “Meaningful Use”
The area that has created the greatest buzz among providers and hospitals has been the CMS incentives to facilitate the adoption and meaningful use of certifi ed electronic health records. These proposed rules were released on December 30, 2009, and the comment period remained open until March 15. CMS is currently working on revisions to the proposed rules and intends to release the fi nal rule sometime this spring. Taken together with the recovery act, it defi nes several things: The providers who are eligible for incentives; the hospitals that are eligible; the methods for calculating the incentives; and the criteria one must meet in order to demonstrate meaningful use. The Specifics of Meaningful Use Who is Eligible for Incentives?
Identifying eligible providers is one of the areas being debated. Congress had intended it to be any physician who was not primarily hospital based. They used the examples in the recovery act of a pathologist, anesthesiologist or an emergency physician as being hospital
based. CMS interpreted the rule in such a way that it would also exclude clinics that are part of an integrated delivery system. This would have a huge impact on the Twin Cities and is one of the most hotly debated issues. Not only would this have a fi nancial impact, it would cause a delay of achieving the vision of having a patient’s information available wherever and whenever it is needed by causing health systems to focus resources on implementations eligible for the incentives. What are the Criteria?
The proposed rules identifi ed 25 stage 1 criteria for providers to meet in order to be eligible for the incentive dollars. These criteria included things such as documenting problems, allergies, medications and vitals in the patient’s chart, providers doing direct entry of orders, the ability to provide information to patients electronically, and the beginning steps in information exchange. By meeting the stage 1 criteria in either 2011 or 2012, providers will be able to achieve the full amount of the incentive dollars. The stage 2 criteria (for 2013) and stage 3 criteria (for 2015) will be defi ned later. In
order to receive any incentives, providers must achieve stage 1 by 2014; however, all providers will need to achieve stage 3 by 2015 in order to avoid penalties. As currently proposed, providers will need to achieve all the 25 criteria for stage 1 but there has been discussion as to whether the all-or-nothing rule is appropriate. Again, we will need to wait and see what is in the fi nal rule. What are the Incentives?
For Medicare, physicians can receive 75 percent of their Medicare charges up to the payment year limit. If the provider’s fi rst payment year is in 2011 or 2012, that amount is $18K. As the payment years progress and if one’s fi rst payment year is after 2012, the maximum amount decreases. However, if by 2015 a provider is not at stage 3, they will see their Medicare charges decrease by 1 percent in 2015, 2 percent in 2016 and 3 percent in 2017. There are also incentives from Medicaid. If a provider has more than 30 percent Medicaid, or is a pediatrician with more than 20 percent Medicaid, or serves in a federally (Continued on page 12)
Proceeds from MPS help to support the medical society’s operations. Please consider our business partners listed below as you look to reduce your operational costs.
Our partners include: • AmeriPride Services (linens and apparel) • SafeAssure Consultants (OSHA compliance) • Berry Coffee (beverages and food) • AED Professionals (AED distributor) • Stanton Group (group/individual insurance) • IC System (debt collection)
T O LEARN MORE C ALL 612-362-3704 OR VISIT : WWW . METRODOCTORS . COM / SERVICES . CFM
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The Journal of the Twin Cities Medical Society
May/June 2010
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Health Information Technology (Continued from page 11)
qualified health care center with more than 30 percent needy individuals, there are Medicaid funds available. Providers must choose either Medicare or Medicaid but may switch once during the program. One particularly attractive feature of the Medicaid incentive is that the first payment year can be used to cover the cost of purchasing or upgrading EHR software. Medicaid payments can also be higher (up to $63,750) and one can receive the full incentive by starting as late as 2016 with the last payment in 2021. What about Hospitals?
Since many of you will be seeing patients in the hospital, I thought I should at least mention the hospital incentives. Hospitals are eligible to receive both Medicare and Medicaid dollars if they qualify for both. They also have criteria very similar to the provider criteria so they will be asking you to help them achieve their incentives by documenting in the chart and using the computer to manage your orders. Their incentives also start in 2011 but they can receive their full incentive if they first meet the stage 1 criteria in 2011, 2012 or 2013. As with the providers, they must meet all of the criteria to qualify. Minnesota
The Minnesota legislature also created a mandate in 2007 for providers and hospitals to have in place an interoperable EHR by 2015. Though the penalties for missing this mandate are not defined, it started many of our providers on the road to adopting interoperable health records. The incentives in the Recovery Act are a nice bonus. So What Does This all Mean for Your Practice?
Taken all together, I think to choose not to have an interoperable EHR in your practice by 2015 will be a bad business decision for the following reasons: 1. Practices will use it as a marketing tool and patients will begin to see it as an expectation. 2. Referring physicians will tend to refer to others who facilitate the exchange of patient information streamlining the referral process and post consultation follow-up care. 12
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3. Though you may not have Medicare patients and consequently not be subject to Medicare penalties, it is not unreasonable to think that other payers will choose to reduce payments in concert with Medicare. 4. The penalties for failing to meet the state mandate have yet to be defined. 5. If you wish to sell your practice, you will need to have an EHR in place if you want it to be marketable to a young physician. To choose to take the leap, it will mean decreased income for a period, but most all say they are back to their normal patient load by six weeks and by six months can have both better billing and reduced transcription costs. There is the added benefit of accessing the chart remotely (or even finding it for that matter) and, when our referral network is capable of exchange, knowing when our patient appears in the hospital or what happened to them when they were up north at the cabin. There is no denying that the implementation period is hard work. I have the experience of doing it in a large system and have talked to solo practitioners who have done it on their own. Most cut back to 50 percent patient load for two weeks, then gradually increase after that with a full load by about six weeks. To me the exciting vision is what health care will be like when we are all connected. Essentially we are in the pre-internet days of the 80s, with stand-alone machines that are pretty good at what they do but are isolated from each other. Then came the stand-alone networks, CompuServe, AOL, Prodigy, Delphi, etc. with their pay-by-the-minute business model. It was not until Web browsers came along that use of the Internet began to explode. Then the use of Alta Vista and then Google coupled with unlimited online time put the world of information at our fingertips. Now, with smart phones, it is in many of our pockets. As a result, we are much more efficient at making restaurant reservations, finding directions, paying bills and getting answers to questions. Imagine what it will be like when it will be as easy to retrieve historical information on that complicated patient we are seeing for the first time.
Glossary:
Meaningful Use: Defined in the American Recovery and Reinvestment Act as the use of an electronic health record to electronically capture health information in a coded format, use that information to track key clinical conditions, communicate that information for care coordination purposes, and initiate the reporting of clinical quality measures and public health information. Certified EHR Defined as an EHR that has been tested by an accredited body and deemed to offer the necessary technological capability, functionality, and security to help them meet the meaningful use criteria established for a given phase. The testing process is also intended to allow providers and patients to be confident that these electronic health IT products and systems are secure, can maintain data confidentially, and can work with other systems to share information. To date, the only group that was testing and certifying electronic health records was the Certification Commission for Health Information Technology (CCHIT). However, with the Recovery Act, ONC has proposed a new process for EHR certification that is currently open for comment. They are hoping to initiate the new process before this summer. Health Information Technology Regional Extension Center Funded by a grant from the Recovery Act, these centers are designed to offer technical assistance, guidance and information on best practices to support and accelerate health care providers’ efforts to adopt and become meaningful users of Electronic Health Records (EHRs). A total of 70 of these will be funded across the United States. REACH is the extension center for Minnesota. HIT Workforce Training Program There are several components to the workforce training program. Among them are: 1. Provide grants to community colleges to rapidly create health IT education and training programs to establish intensive, non-degree training programs that can be completed in six months or less. 2. Provide grants to institutions of higher education to support health information technology curriculum development and a set of health IT competency examinations.
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3. Provide assistance to individuals to rapidly increase the availability of individuals qualified to serve in specific health information technology professional roles requiring university-level training. Health Information Organizations (HIOs) “Health information organization” is defined in Minnesota statute as an organization that oversees, governs, and facilitates the exchange of health-related information among organizations according to nationally recognized standards. Health Data Intermediary (HDI) “Health data intermediary” is defined in Minnesota statute as an entity that provides the infrastructure to connect computer systems or other electronic devices used by health care providers, laboratories, pharmacies, health plans, third-party administrators, or pharmacy benefit managers to facilitate the secure transmission of health information in which uniform standards are used for sharing and synchronizing patient data across systems. The standards must be compatible with federal efforts. Strategic Health Information Technology Advanced Research Projects (SHARP) Funded by the Recovery Act, the purpose of these awards is to fund research focused on achieving breakthrough advances to address well-documented problems that have impeded adoption of EHRs: 1) Security of Health Information Technology; 2) Patient-Centered Cognitive Support; 3) Healthcare Application and Network Platform Architectures; and, 4) Secondary Use of EHR Data. Paul Kleeberg, M.D., FAAFP is the president of The Itinerant CMIO, LLC, which assists hospitals and clinics to become meaningful users of electronic health records. Dr. Kleeberg has over 16 years experience working as a family physician and in information technology. Dr. Kleeberg received his medical degree from Stanford University School of Medicine in Stanford, California and completed his residency in family medicine at the University of Minnesota. He is board certified in family medicine, is a fellow in the American Academy of Family Physicians (AAFP) and the Healthcare Information Management and Systems Society (HIMSS). He serves on several committees for HIMSS and chairs their Computerized Provider Order Entry (CPOE) Workgroup. He is also involved in the Minnesota eHealth Advisory Committee and currently co-chairs their Meaningful Use and Exchange Workgroup and has given presentations on the HITECH meaningful use criteria. MetroDoctors
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May/June 2010
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HIT Assistance and Incentives Available for Minnesota and North Dakota Providers HEALTH CARE PROvIDERS can now re-
ceive health information technology (HIT) education and technical assistance to improve the quality and value of care they deliver⎯and become eligible for bonus payments for their Medicare and Medicaid patients — by tapping into the expertise and services of the Regional Extension Assistance Center for Health Information Technology (REACH) for Minnesota and North Dakota. By Susan Severson
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Organizations like REACH are being established across the country as part of the American Recovery and Reinvestment Act (ARRA) of 2009. Key Health Alliance (KHA) has applied to serve as the federally designated HIT regional extension center for Minnesota and North Dakota. KHA is a partnership of Stratis Health, the Rural Health Resource Center, and the College of St. Scholastica. REACH will work with health care providers to improve care through the adoption and meaningful use of health information technology, specifically electronic health records (EHR). Regardless of where providers are on the continuum of HIT/EHR adoption and utilization — whether they are just beginning the search for an EHR or have implemented an EHR and are working toward meaningful use — the regional center can work with them. REACH educational and technical assistance services are available to all types and sizes of providers in all settings of care, including those who already have an EHR and those who do not. Certain primary care providers have been designated by the Office of the National Coordinator (ONC) for HIT to receive federally subsidized technical assistance, including small urban and rural practices serving medically underserved patients. John Whisney, Ridgeview Medical Center clinic director, believes that the regional extension center will be a critical resource for information and guidance in Ridgeview’s efforts to get the most out of its EHR. As with anything as new and complex as HIT, clinics need a resource they can turn to when questions arise — especially when working through the rules and regulations to ensure they are
meeting requirements. “We are probably like most organizations. We are reviewing information and identifying what we need to do and how to document what we are doing. Here is where a resource group will be most helpful,” says Whisney. To help meet national HIT Regional Extension Center Program goals, REACH plans to provide technical assistance services and support to 5,100 priority primary care providers in Minnesota and North Dakota over the next four years, with 3,600 providers targeted in the first two years. REACH currently has commitment from 4,628 providers representing 417 practices to participate in the program and receive technical assistance services. “We are excited to be able to offer assistance to those practices that can really benefit from it, and the level of interest and engagement by providers across the two states has been extraordinary,” said Jennifer Lundblad, president and CEO of Stratis Health, a founding partner of REACH. In addition to leading REACH, the three partner organizations of KHA — Stratis Health, the Rural Health Resource Center, and the College of St. Scholastica — will directly serve the needs of Minnesota. North Dakota Health Care Review, Inc., and the University of North Dakota Center for Rural Health are working with KHA to meet the unique needs of the North Dakota provider community and build a cohesive and effective program across both states. KHA partners have a long history of working together to improve health care. Each organization has unique expertise and experience in health care quality, education, patient safety initiatives, and health information technology. Collectively, the three organizations have served
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thousands of providers and organizations in advancing HIT over the past five years. This partnership formalizes the commitment of each organization to a long term, ongoing, working relationship. Serving as the regional extension center will accelerate and expand the work KHA is already engaged in. REACH has established state-based councils in Minnesota and North Dakota, which involve North Dakota HIT Advisory Committee, Minnesota Department of Health, Minnesota Department of Human Services, University of Minnesota Academic Health Center, and University of North Dakota. With the involvement of many other Minnesota and North Dakota organizations, REACH will use an open and collaborative approach in developing and implementing the regional extension center, leveraging existing committees, professional and trade organizations, and health care networks in each state to advise the program, reach providers, and disseminate information. General Assistance and Technical Assistance
The REACH program offers two levels of assistance: general support and technical assistance. General support will be offered to all primary care providers and will include outreach, education, workforce support, tools, and resources covering all aspects of HIT/EHR adoption, implementation, and achievement of meaningful use. Technical assistance will involve a variety of approaches depending on the area of service and the provider, but generally will provide indepth, hands-on consultation and assistance to providers as they work toward adoption and meaningful use of technology. Field staff and subject matter experts will lead and manage change with providers in assigned geographic areas, offer individualized technical assistance, and help providers utilize HIT as a tool to improve quality and performance. REACH will work closely with other regional centers across the nation to share best practices, tools and information. Technical services will primarily be offered through on-site visits by regional center staff, including assessment, consultation, training and mentoring, The customized technical MetroDoctors
assistance will be supplemented by provider education collaboratives and networks. Technical assistance and support will focus on the following areas: • Provider readiness and leadership support • Process mapping and workflow redesign • EHR technical specifications • Vendor identification • EHR implementation and project management support • Privacy and security practices • Health information exchange • EHR optimization and meaningful use In the first two years of the program, technical assistance will be subsidized for priority primary care providers, with nearly 90 percent of the funding for services coming from the REACH grant and 10 percent from fees paid by participating providers. For example, if a practice has five to 10 physicians, it may receive services valued at $25,000-$50,000, but pay a fee of only $2,500-$5,000. For all other providers and for priority primary care providers after the first two years, a fee scale based on services needed will be applied. Defined by ONC, priority primary care providers are physicians (internal medicine, family practice, osteopathy, obstetrics/gynecology, pediatrics) and health care professionals with prescriptive privileges (physician assistant, nurse practitioner, nurse midwife) focused on primary care in the following settings: • Individual and small group practices (10 or fewer professionals with prescriptive privileges). • Outpatient primary care services offered at public and Critical Access Hospitals. • Community health centers and rural health clinics. • Other settings that predominantly serve uninsured, underinsured, and medically underserved populations. As Stratis Health’s Director of Health Information Technology Services, Susan Severson is responsible for implementation of all contracts in this area and for setting the strategic direction of the Health Information Technology Services Center. She has led the successful adoption of HIT and electronic health records in a variety of settings, guiding providers through the process.
The Journal of the Twin Cities Medical Society
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May/June 2010
15
MEDICAL STUDENTS MAKING A DIFFERENCE
ISToP Why a group of health professional students from the University of Minnesota is spending time on the streets…and why they need your help.
Editor’s Note: University of Minnesota medical students were invited to submit an article describing unique volunteer activities they are engaged in throughout the community. This is the first of four programs highlighted in this issue of MetroDoctors.
I delivered dinners to a man and his brother who had set up residence under a bridge in Cleveland. The man had a raised red gash above his right eye, and to my untrained eye it looked badly infected. This was not the first such infection I’d seen while delivering dinners to persons experiencing homelessness. As I moved on to start medical school years later, the thought stayed with me that physicians have the tools to treat disease but often not the ability to reach those in need of care. This experience was the inspiration for creating ISTOP, a street-outreach program delivering basic medical care to the underserved of Minneapolis and St. Paul. Carolyn Bramante, second year medical student and founder ISTOP.
medical care was enthusiastically received by community partners, students, and faculty at the University of Minnesota, and thus began ISTOP — Inter-professional STreet Outreach Project. In starting this effort, we worked with many role models, mentors and existing organizations. Among them is our faculty advisor, Dr. John Song, who has worked to improve access to and quality of care for homeless individuals; and Dr. Ken McMillen, who has brought medical care to homeless camps in Minneapolis for the last decade. Other physicians have enthusiastically made our efforts possible, including our two Resident advisors, Kara Denny and Ashley Balsam, who have guided many initiatives to improve ISTOP’s services.
We began working with Streetworks Collaboration, an organization that sends outreach workers to the streets, shelters, and soup kitchens of the metro area to connect with homeless youth. Streetworks helps them access resources and social programs, while encouraging them to reduce involvement in harmful behaviors. Because Streetworks does not offer medical care, they were excited to partner with us to expand their services, and we were lucky to build on their existing relationships with the people we were hoping to reach. Another partner is Healthcare for the Homeless, a national organization that operates clinics and street outreach medical care for homeless individuals. Both organizations led training sessions to prepare students for working with homeless individuals, which included discussing
In 2006, 9,200 of our state’s individuals were homeless — 35 percent were families with children, and another 10 percent were youth under age 22 (Wilder Research, 2006). After speaking with several community organizations about whether there were medical street-outreach programs that I could join, the consistent answer was that there is dire need for more of such efforts. The idea of student-organized and preceptor-supervised delivery of basic By Carolyn Bramante, Caitlin Conboy, Nathalie Lechault, Kate Birkencamp, Emily Moody, and Ben Pederson
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May/June 2010
Medical student volunteers from left: Katie Theisen, Stewart Decker, Allie Berger, Kathy Mahan, Jacob Feigal, Gina Mittelstaedt, and Brian Park.
MetroDoctors
The Journal of the Twin Cities Medical Society
the fact that homelessness is often a transient state, rather than a permanent condition that separates individuals from the rest of society. They also emphasized that demand for health care outstripped supply and access, and that there was great need for outreach-based basic medical care. On an average Wednesday night in the basement of a Minneapolis church, dinners are being served to about 200 people free of charge. There is no requirement for proving need; nutritious meals are given to all who come and guests are only asked to maintain a respectful atmosphere. We set up a table on one side of the room and lay out samples of our simple supplies: adhesive bandages, sterile gauze and medical tape, antibiotics, blood pressure cuffs and glucose monitors, and over the counter medicines for cough, cold, and upset stomach. We set out fliers for facilities with free care, patient education, and drape a sign over the edge of the table. It reads: “Questions about your health? Have any open sores? Diabetic foot ulcers? Need any band-aids? Have a cold or cough? Stop by! We have a doctor, medical supplies, and are happy to answer any questions you have. No charge.” As families and individuals settle down with their food, we mill around letting people know that we are there and happy to help. Come talk to us. A young man visits us at our table a few minutes later. “Can you tell me what’s wrong with my finger?” he asks, showing us a fungal-infected nail. Another man tells us he has a rash on his chest. He doesn’t wait to step behind the screen we’ve assembled for privacy, or the empty room the church gave us, but immediately pulls his shirt over his head for an examination. We give out bandages and supplies to people who ask for them. Some choose to talk to us while others seem wary. We hope that by returning week after week we will build relationships and instill comfort in those who avoid us today. Over the course of weeks, the encounters run the gamut from minor wounds to serious medical conditions. An older gentleman gets an elevated blood sugar reading in the diabetic range. A young woman asks questions about relationship violence. A big part of our mission here is to identify people who need help beyond what we can provide and give them information and encouragement to seek appropriate help. ISTOP serves an important need because many persons experiencing homelessness either can’t MetroDoctors
make it to existing health care services, even if free; don’t seek them because of undignified treatment they’ve received in the past; or face other barriers to care, such as attending to immediate needs including food and safety. A large part of our mission is to provide health education; we have answered questions about good hygiene during flu season, prenatal care, concerns about STIs, and much more. Dr. Kirby Clark noted that at one outreach site, half a dozen patients have said “I was about to go to the ER before I talked to you guys.” Additionally, merely reaching out and going to them is an act of support that patients have appreciated. On our first night at St. Mark’s, 15 homeless youth came up to us saying they were fine at the moment but just wanted to thank us for being there. At another site, a volunteer experience is much like a day in a family medicine clinic, except the exam table is the floor or a chair and the simple lab consists of UA strips and pregnancy tests. Moms and their kids come to us with sore throats, headaches, back pain, rashes, questions about medications and everything in between — such as wondering if it is OK to be giving their kids adult doses of ibuprofen, and luckily we carry children’s medications that we can give them. One of our patients is a boy with severe eczema and asthma, whose mom is worried because he has been in and out of the hospital. Looking at his meds, we see two separate inhaled corticosteroids, prescribed by different physicians. He isn’t using a spacer and doesn’t have access to his nebulizer because he and his mother had to leave a violent situation at home without time to pack. We are able to work with him on his inhaler technique and counsel his mom about what to cover in his next checkup. Continuity of care is difficult in such situations, and we try to help bridge the gaps in care during unstable periods of life. ISTOP is an inter-professional program including medicine, public health, physical therapy, nursing, pharmacy, and veterinary medicine. The goal is to provide a wide range of services to patients while learning for ourselves how to approach health issues with
The Journal of the Twin Cities Medical Society
interdisciplinary collaboration. For example, a patient experiencing chronic back pain can be seen by both a medical doctor and a physical therapist. The motivation for including vet medicine among our services came from hearing from homeless individuals that many have pets that mean a great deal to them but actually keep them from getting medical care because the pets can’t be left alone or taken with. In an effort to address this barrier, we are working with the School of Veterinary Medicine to begin providing adjunct veterinary care. By volunteering with ISTOP, we gain the opportunity to develop medical skills working alongside volunteer physicians and students in other fields, and we are introduced to a group that is underrepresented in the clinics and hospitals where we will train. Meeting homeless persons outside the context of the Emergency Department is unique to this program and we hope it will foster greater understanding of the challenges that homelessness creates and how we might better serve homeless patients.
(Continued on page 18)
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ISTOP (Continued from page 17)
Volunteer Physician Mentors Needed
As students, we recognize that one of the most valuable parts of our medical education at the University of Minnesota is our local physician community, which has worked to improve the quality and access to health care in the Twin Cities. You provide us with the tools to tackle the complex clinical problems we will face in our future careers. ISTOP presents an excellent opportunity for physicians to mentor medical students outside a typical clinical setting, helping us frame our work in a social context, fostering an appreciation of community service in a rising generation of physicians. As students, we have built the framework through which service can strengthen the health of our community, and now we depend on local physicians to help realize our vision of providing care to those who are frequently overlooked. We are very excited about how our work is going so far, and about the possibility of answering Streetworks’ suggestion that we expand to new sites. We have inspiring involvement from students, residents, and faculty, but we need more preceptors to make it possible for the project to continue and grow. Once licensed, residents can precept and have appreciated the fact that our outreach shifts last between just one and one and a half hours. We appreciate their time considering their restrictive schedules. If interested in serving as a preceptor, contact us at ISTOP.umn@gmail.com.
ISTOP (Interprofessional STreet Outreach Project) is a new project in the Academic Health Center since January, 2009, providing basic health care, information, and supplies to individuals experiencing homelessness. This site-based outreach is in coordination with outreach workers from existing community organizations, allowing potential patients to approach ISTOP with the security of a street-outreach worker they already know.
Carolyn Bramante is a second year medical student at the University of Minnesota and the founder of ISTOP. Caitlin Conboy, Kate Birkencamp, Nathalie Lechault, Emily Moody, and Ben Pederson are student leaders and volunteers with ISTOP. Dr. John Song is their faculty advisor and a lifelong proponent of health care and human rights for persons experiencing homelessness.
WOMEN OF NATIONS Population: women and youth When: Every other Saturday, 9:30-11 a.m. Where: 73 Leech St., St. Paul, MN Web site: www.women-of-nations.org
Link, BG, et al. Lifetime and five-year prevalence of homelessness in the United States. Am J Public Health. 1994 Dec;84(12)1907-12.
Thank you!!
Wilder Research. Overview of Homelessness in Minnesota 2006. Amhurst Wilder Foundation. March 2007. Wilder Research. Long term homelessness among individuals and families in Minnesota in 2006. Amhurst Wilder Foundation. September 2007.
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ISTOP also seeks to educate students on the unique challenges that homeless individuals face, for example homeless persons often don’t or can’t make it to facilities with free medical care, frequently because of undignified treatment they’ve received in the past. One of ISTOP’s goals is to answer questions and concerns patients might have, including whether an illness needs to be seen immediately or can wait to be seen in a free or sliding-scale clinic, and gently encourage patients to seek medical care from an appropriate facility. A preceptor at just one site noted a “half dozen” patients who have said “I was going to go to the ER before I talked to you guys.” ISTOP currently has students from all schools in the AHC involved, providing a unique inter-professional experience, as well as a valuable chance to learn from preceptors. As a preceptor, you make this basic medical care and learning possible. Outreach sites are: ST. MARK’S Population: youth ages 12-25. When: Every other Monday, 6-7 p.m. Where: 519 Oak Grove St., Minneapolis, MN HOLY ROSARY Population: All ages When: Every other Wednesday, 5:30-6:30 p.m. Where: 2424 18th Ave S., Minneapolis, MN Web site: www.loavesandfishesmn.org
Please consider serving as a preceptor for this program. You can volunteer for one shift or make an ongoing commitment. Register and schedule your shift online at: http://spreadsheets.google.com/viewform?key=p_HjtOKv5p715KOD98e-ccA
Carolyn Bramante bram0058@umn.edu Jake Feigal feig0022@umn.edu
MetroDoctors
The Journal of the Twin Cities Medical Society
MEDICAL STUDENTS MAKING A DIFFERENCE
The Phillips Neighborhood Clinic
THE PHILLIPS NEIGHBORHOOD CLINIC
(PNC) started with the vision of Dr. John Song, an assistant professor of medicine and bioethics at the University of Minnesota. Dr. Song saw an opportunity for students to help create and operate a free health care clinic for the uninsured and underinsured of Minneapolis. The early years of the clinic involved a struggle to find space and consistent sources of funding. In 2003, the clinic found a new home in the basement of Oliver Presbyterian Church and a new name: the Phillips Neighborhood Clinic. During the 2006-2007 school year, the PNC underwent an organizational transition from a Community University Health Care Clinic (CUHCC) satellite clinic to a joint partnership between the University of Minnesota Physicians (UMP) and the University of Minnesota Medical School. The clinic reopened in June 2007 under the medical direction of Dr. Brian Sick, an assistant professor of medicine and pediatrics at the University of Minnesota and the medical director for the University of Minnesota’s Primary Care Center. While some of the details of our operation and location have changed over the years, the mission of the PNC remains the same. We are committed to providing accessible, culturally appropriate, and interdisciplinary health care services and education to all of our patients. At the same time, we seek to provide health professional students with the skills they need to effectively and compassionately serve underinsured and uninsured populations. This mission has led to the involvement of over 300 volunteers from the University of Minnesota’s Schools of Medicine, Nursing, Pharmacy,
By Benjamin Willenbring, and Brian Sick, M.D. MetroDoctors
Physical Therapy, Public Health and Social The design of the care team and clinic flow Work. Together, these volunteers provide a provides a particularly exciting opportunity diverse set of services to our patients includfor second year medical students. In our role ing medical care, physical therapy, nutrition as medical clinicians, we often see the patient counseling, a free pharmacy, lab testing, mental before the physician preceptor. Following our health counseling, and guidance for Medical presentation of the patient’s case and discusAssistance, MinnesotaCare, and General Assion regarding the differential diagnosis, the sistance Medical Care application forms. preceptor will then join the care team in seeing At least one volunteer from each of the the patient to clarify any remaining questions involved schools is also a member of the PNC through further interview or examination. administration board. The board works with (Continued on page 20) Dr. Sick and the rest of the volunteer body to provide direction and vision for the clinic. In 2009, it was the effort of the PNC administration board that helped the clinic expand to two nights of services each week. This resulted in the PNC serving 1,100 patients in 2009, which more than doubled the 512 patients seen in 2008. One of the strengths of the PNC is the interdisciplinary character of each care team. Patients in need of medical care are seen by an advocate, a pharmacy care student, a nutrition student, a medical clinician and the physician preceptor. The patient advocate role provides an exciting opportunity for first year volunteers to gain exposure to direct patient care while providing important referral resources for patients who have needs beyond the capabilities of the PNC. The rest of the students involved in the care team are second year students who work together to interview the patient and develop a plan of care. Medical students discuss patient evaluation.
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May/June 2010
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Phillips Neighborhood Clinic (Continued from page 19)
The care team then meets again to discuss the treatment plan and any appropriate labs, prescriptions or other information that will help best treat the patient. This team approach challenges students to work together and helps create the interdisciplinary environment we believe is important for the PNC and the development of future health care professionals who are comfortable and experienced working with professionals from a variety of different educational backgrounds. The involvement of our volunteers in the life of the Phillips Neighborhood also extends beyond 6:00-9:00 p.m. on Monday and Thursday evenings. Many students are involved in fund-raising for the clinic, which includes activities like the Grants Committee and our annual silent auction at the Weisman Art Museum. All volunteers also participate in community outreach projects throughout the semester. This part of the PNC volunteer experience provides
Meet, greet and triage of patients is another responsibility of medical students.
students with a more nuanced understanding of the community we serve while also allowing the PNC to provide valuable volunteers to important community organizations. Students are involved with a variety of different service opportunities including tutoring at the Franklin Public Library, conducting health education groups for young people at the Minneapolis
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American Indian Center, and working with Open Arms of Minnesota to deliver meals to homebound community members. One of the PNC’s community outreach projects, Club Sugar, has even been used by Fairview Health Services as a model for developing better diabetes group education programs. The Phillips Neighborhood Clinic has come a long way since 2001. Thanks to a passionate and committed group of students, preceptors and community members, we have developed a clinic that provides a valuable service to the community and student volunteers. As we look forward, we hope to continue to develop the services we provide for patients and the community while ensuring that the clinic is still a formative educational experience for University of Minnesota health professional students of the future. Benjamin Willenbring is a second year medical student and Brian Sick, M.D., is the medical director of the Phillips Neighborhood Clinic.
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May/June 2010
Interdisciplinary discussions occur with each patient encounter.
MetroDoctors
The Journal of the Twin Cities Medical Society
MEDICAL STUDENTS MAKING A DIFFERENCE
Catalyst Program: Inspiring Tomorrow’s Physicians CATALYST IS A STUDENT GROUP at the
University of Minnesota Medical School devoted to introducing high school students to medicine and the biomedical sciences. Our faculty mentor is Jo Peterson, Ph.D., director of the Minnesota’s Future Doctors program. High school and middle school students are invited to the medical school for a hands-on experience that includes workshops in cardiopulmonary disease, neurology, and suturing. Each workshop station utilizes a variety of diagrams, models, and gross specimens to introduce the basic physiology and pathology of these organ systems. The students find the collection of gross specimens especially fascinating, and we use these to highlight some of the differences between normal and diseased organs. Examples illustrating the pathologic differences between the lungs of a smoker and a non-smoker and a healthy heart and one with heart disease are available. Although the heart and lung specimens make a lasting impression, most students find the brain workshop to be most compelling. Feven Belaehen writes, “My favorite part was the brain. I was so interested by that!” This exercise compares the gross brain specimens of several animals, including a frog and cow, with that of a human. The students easily note the difference in brain volume; however, by pointing out the specific areas of the brain that are responsible for humans’ amazing ability to process complex problems, the students develop a deeper appreciation for just what sets us apart from the rest of the animal kingdom. During the workshops we strive to make sure the lessons are interactive by maximizing the hands on instruction. This includes a tutorial on suturing where bananas serve as By Travis Moncrief and Alex Marston
MetroDoctors
each student’s patient. The students even acquire the skills to conduct a mini physical exam. At the end of the morning, the students can take blood pressure measurements, use a stethoscope, suture, and elicit several reflexes with a reflex hammer. After finishing up the three workshop stations the students attend a lunch panel with medical students. This provides an opportunity for the students to ask any questions they may have about the day. Naturally, many of these (Continued on page 22)
Derek Smith, second year medical student, discusses neurology with an interested group of Humboldt High School students.
Annie Portilla and Mollie Lyle, both first year medical students, teach Humboldt High School students about the structure of the brain using gross specimens from the Pathology Department.
The Journal of the Twin Cities Medical Society
May/June 2010
21
Catalyst Program (Continued from page 21)
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questions pertain to medicine and what the educational requirements are for becoming a doctor. More broadly, the lunch discussion is an opportunity for the students to see how higher education can provide access to amazing opportunities and be a means for attaining their dreams. Catalyst invites students from Minneapolis and St. Paul public schools to the medical school four times per academic year with about 50 students attending each event. Most recently, we have worked closely with GEAR UP and this year we hosted two events for students in the GEAR UP program from Humboldt and Harding High Schools in St. Paul. GEAR UP is a federally funded program that works with students, parents, teachers and community members to raise educational expectations through tutoring, extracurricular activities, and personal development. The program also sponsors field trips, college visits and provides financial aid advice to encourage students to embrace their dreams and their future. Current first and second year medical students teach the workshops, which is quite a commitment as most have to miss lecture in order to share their knowledge and enthusiasm about medicine with the visiting students. The time away from lecture is well worth it because Catalyst provides a positive experience for medical students by creating an opportunity to reflect on meaningful past experiences while sharing their love of medicine. Although each student has different interests and goals, we strive to provide a unique and interactive experience that is not simply educational, but also inspiring. Kyaw Kyaw Lwin writes, “When I see this I want to learn harder things. You guys really make me want to try hard to achieve my goal.” We hope the skills the students learn in the workshop provide them with an elevated sense of confidence and a desire to continue their education beyond high school. Furthermore, with a bit of luck, we hope to help motivate some of the students to pursue higher education in science and medicine. For Arnold Mejía, I believe we have done exactly that; he writes, “I really admire you guys and someday I wish to be at the University Medical School like you.” Travis Moncrief and Alex Marston are both second year medical students.
MetroDoctors
The Journal of the Twin Cities Medical Society
MEDICAL STUDENTS MAKING A DIFFERENCE
Experiencing Senior living at Augustana Apartments I FIRST HEARD ABOUT THE UNIQUE
than themselves, where reading living experience at Augustana Senior Apartnewspapers was still the norm, and dinner began at around four ments through Dr. Ed Ratner of the Univerin the afternoon. However, this sity of Minnesota. During one of our second was a unique opportunity that year courses, we were required to attend one presented itself and it was once Wednesday afternoon at Augustana to meet a in a lifetime. I would use all these senior. Most of the seniors that we met were new experiences and differences incredibly healthy and had a unique and positive outlook on life. They were extremely good I encountered to hopefully be a teachers and felt that they had an investment in more relatable clinician to my young doctors. I realized that I had had little older patients. I had many questions before contact with these healthy seniors. As a future Lindy Watanaskul visits with her neighbor and friend, moving into Augustana — some doctor, it can be discouraging to see a patient Ethel. Photo by Emily Jensen, AHC Communications more logistical than others. I whom you cannot “fix,” and I had seen many Dept. at the U of M. wondered what the residents of these patients in the clinics and hospitals. that I would have a year to complete my service would think of a 24-year-old neighbor movI was curious about the program and decided commitment to Augustana and that I could be ing into their senior community. Would they that I had nothing to lose and a lot to gain by like me? Would I be accepted? Would they creative in finding ways to do so. I decided to this experience. take the plunge. During my first month of living at Augustana, I was in my surgery clerkship. I seldom getting to know ethel reinforced the core saw my neighbors, or even my fiancé, as I was usually at the hospital by 5 a.m. and back home reason of why i decided to live at augustana. some time after dinner. Living at Augustana i truly wanted to connect with a generation meant that I was enrolled in a course at the University of Minnesota entitled Geriatrics that i felt so distant from. Service Learning. This was the first program of its kind with little guidelines. I wasn’t quite sure what was expected of me, and through Dr. Ratner’s guidance, I found activities and I was currently living with my fiancé, now think I'm loud? Then I had other questions. programs where I could be of use. I attended husband, at the time, and his first impression I wondered what it would be like to strike game night on Tuesdays and Thursdays and up a conversation with my neighbor. I had met two lovely ladies that taught me the dice pretty much went, “You want to live where!?” Yes, the idea of living at a senior housing comsome pertinent questions to any person movgame of “Ten thousand.” I also helped gift wrap plex may have seemed strange to most twenty ing into a new environment down to some presents for a local shelter with some of the something year olds. Most young adults my silly questions such as “Would it smell old?” residents. I call myself a speedy gift-wrapper but age would feel strange where their only neighThen I wondered, as a medical student, would I learned to help neighbors who may have had bors could relate more to their grandparents I have enough time to fulfill my commitment arthritis or vision changes that needed a little at Augustana. Sometimes it is hard enough to extra help. One of the most important lessons study during medical rotations, let alone have time to eat dinner. Fortunately, I was assured
G
By Lindy Watanaskul MetroDoctors
The Journal of the Twin Cities Medical Society
(Continued on page 24)
May/June 2010
23
SAVE THE DATES Call for Resolutions All members of the Twin Cities Medical Society are invited and encouraged to become engaged in setting the priorities and next year’s agenda for organized medicine. Members can submit resolutions, participate in the medical society caucuses and attend the annual meeting of the MMA House of Delegates, September 15-17, 2010, at Breezy Point, MN. Resolutions are due in the TCMS office by MONDAY, MAY 3, 2010. The TCMS membership will be divided by geography: East Metro – physicians living and/or working in Ramsey, Washington, or eastern Dakota County; and West Metro – physicians living and/or working in Anoka, Carver, Hennepin, Scott or western Dakota County.
CAUCUS DATES: East Metro: Wednesday, May 12 6:00 p.m. TCMS Executive Offi ce Broadway Place West 1300 Godward Street NE, Suite 2000 Minneapolis, MN 55413 Contact: Kathy Dittmer, (612) 623-2885, kdittmer@metrodoctors.com
West Metro: Wednesday, May 19 7:00 a.m. Broadway Ridge 3001 Broadway Street NE, Conference Room D (lower level) Minneapolis, MN 55413 Contact: Kathy Dittmer, (612) 623-2885, kdittmer@metrodoctors.com
Physician Mentors Needed Connections
Medical Students — Community Physicians The Connections Mentoring Program, designed to provide physician mentors for all students at the University of Minnesota Medical School, is a partnership between the Medical School, the Twin Cities Medical Society, and the University of Minnesota Medical Alumni Society. The mentoring relationship might involve having the student over for a meal, meeting for an informal chat, or discussing the state of medicine and the world from your viewpoint. The interactions can be as frequent or as long as the mentor and student desire. Mentoring can re-energize a physician’s interest in medicine and supports the development of a new generation of committed physicians serving our community. To register to be a mentor, visit www.mmf.umn.edu/goto/mentor. Shadow a Physician Program
First and second year medical students are invited to personally explore the various specialties of medicine and surgery through an opportunity to “shadow a physician” in that specialty for one day. Individual rotations are assigned based on your expressed interest and availability, e.g. vacation, breaks from school, weekends, or weekdays. Contact Kathy Dittmer, Twin Cities Medical Society, kdittmer@metrodoctors.com or (612) 623-2885.
24
May/June 2010
Experiencing Senior Living (Continued from page 23)
I’ve learned here is to “take it easy.” The way of life is a bit slower paced here. But sometimes it has to be with a life of wheelchairs, walkers and canes. One of my most rewarding experiences has been meeting my 101-year-old friend and neighbor, Ethel. At fi rst glance you may see an old, frail lady. After numerous coffee and cookie dates over the past several months, I have learned that she is one of the strongest women I have ever met. At fi rst it was a little nervewracking to meet someone who was so hard of hearing. I wasn’t comfortable with speaking so loudly or felt it diffi cult to have to enunciate my words and lips so carefully. My vocal cords had never received such a workout. Getting to know Ethel reinforced the core reason of why I decided to live at Augustana. I truly wanted to connect with a generation that I felt so distant from. And, as a future medical provider, I wanted to know the different barriers and obstacles that our seniors face. Ethel taught me about the struggles she has just to get around her apartment, call for doctor appointments, and social isolation. I have been able to help her with small tasks such as watering her plants, vacuuming the fl oor, and picking up her mail. To me these are minor tasks that take a few minutes, but to her it is the small difference to be a continuing functional and independent adult. Over the past several months, I have had the extraordinary experience and privilege to be a part of the Augustana community. I have been able to learn more about the “senior” way of life than any classroom or clinic could teach me. Although immersing yourself by living at a senior community may not be the right decision for every medical student, it should be a possibility worth considering. Regardless, every medical student should have the experience of working with seniors extensively and thoroughly no matter what fi eld of medicine they are interested in. I am extremely thankful for the opportunities and experiences I have had over the past year and believe that they have greatly impacted my medical learning. Lindy Watanaskul is a third year medical student.
MetroDoctors
The Journal of the Twin Cities Medical Society
Can You Give One Hour a Week? How doctors can make a positive impact on student achievement
E
very week, people from all walks of life are giving a small amount of time that is making a big difference in the lives of St. Paul children. They are volunteers who devote an hour each week to tutoring children in need of extra academic help, as part of the Saint Paul Public Schools Foundation’s Tutoring Partnership for Academic Excellence. The Tutoring Partnership brings together tutoring providers, educators and community stakeholders to increase the quantity and quality of tutors and tutoring programs. Established in 2007, it is driven by a belief that supporting academic excellence for all students is a communitywide responsibility. “The doctors, teachers, accountants, plumbers, carpenters and scientists of tomorrow are students in our St. Paul schools today,” said Mike Anderson, executive director of the Saint Paul Public Schools Foundation. “It is in our best interest to help every child achieve his or her full potential.” James Hart, M.D., an internist who teaches public health medicine, concurs, believing that education is one of the main determinants of both individual and community health. “As physicians, taking part in education through this kind of effort to help children succeed academically is a powerful way we can personally affect community health,” he said. One focus of the Tutoring Partnership is recruiting and training new volunteers on behalf of its 21 community-based tutoring partners and nine school site programs. Gina Jacobsen, for example, is a police officer who tutors once a week at Jackson Elementary School with Project S.P.I.R.I.T., an after-school enrichment MetroDoctors
program for African American students. “I live in St. Paul and my interest in this community runs deep. I think the public schools do a great job, but I know tutors are needed. I love children and enjoy working with them,” she said. “I’m glad to bring whatever I can to the table.” In retirement, tutoring may be a rewarding option for physicians, Dr. Hart said. “Many of us may want to give back to the community in areas other than medicine through a program like this.” Big Target, Big Impact The Tutoring Partnership’s target is a persistent achievement gap in the St. Paul school district. By the time students reach 3rd grade, 40 percent cannot read at their grade level. By 8th grade, less than 60 percent of the students are capable of completing grade level math. The good news? Tutoring done well can help turn those numbers around. Independent evaluations of tutoring interventions by Tutoring Partnership providers provide evidence of its impact. For example, in a 2008 study by Wilder Research of the East Side Learning Center, over 70 percent of all student participants gained in reading comprehension at John A. Johnson and Bruce Vento Elementary schools. In another study released in 2009, data from the Minnesota Reading Corps showed students exceeded a rate of one year’s growth in one year’s time and made significant gains in Minnesota Comprehensive Assessment (MCA) tests after one year of intervention. Eighty percent of those participating children who successfully exited from the MRC program met or exceeded state standards in reading.
The Journal of the Twin Cities Medical Society
Volunteer Tutors Needed According to the Saint Paul Public Schools district, an
Through the St. Paul Public Schools Foundation’s Tutoring Partnership for Academic Excellence, these and dozens of other volunteer tutors are helping children in St. Paul improve their academic achievement, thus greatly increasing their chances of success in school and in life.
estimated 5,000 students need extra assistance to achieve grade-level proficiency in reading and math. Currently, some 4,000 children are being served through the Tutoring Partnership’s providers. “We need more caring adults to assure that all students in need of extra academic support receive it,” said Karen Woodward, program director of the Tutoring Partnership. Volunteers are asked to commit to at least one hour per week, ideally for a school year, and can choose from a variety of locations, programs and grade levels that match their interest. Training and curriculum are provided. What Can You Do? Find out more about volunteer tutoring and join the Tutoring Partnership ranks! For more information, go to www.sppsfoundation.org and click on Tutoring Partnership, or call (651) 325-4205, or e-mail tutor@sppsfoundation.org. Michael Anderson, executive director, St. Paul Public Schools Foundation. May/June 2010
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New Members Edwin N. Bogonko, M.D. Allina Medical Clinic Shakopee Internal Medicine/Hospitalist Jessica L. Grajczyk, D.O. Obstetrics, Gynecology & Infertility, P.A. Obstetrics and Gynecology Amy M. Kelly, M.D. St. Kate’s Health and Wellness Center Pediatrics Richard J. Migliori, M.D. UnitedHealth Group General Surgery, Transplant Surgery Eric A. Nagle, M.D. Ridgeview Westonka Clinic Anesthesiology Jennifer H. Rysso, M.D. Ridgeview Westonka Clinic Internal Medicine Stephen R. Setterberg, M.D. Prairie-Care Psychiatry Edward T. Su, M.D. Summit Orthopedics, Ltd. Hand Surgery, Orthopedics Mary M. Trites, M.D. Ridgeview Westonka Clinic Internal Medicine
Visit us at www.metrodoctors.com and
forum.metrodoctors.com To find new career opportunities, past issues of MetroDoctors and information on the latest news, events and legislative issues!
26
May/June 2010
In Memoriam HECTOR MASON BROWN, M.D. died on January 18, 2010 at the age of 86 after a year-long battle with cancer. Dr. Brown graduated from Cornell University Medical College, New York, in 1948 and practiced family medicine. HENRY DAHLMAN, M.D. died March 11, 2010 after three months of postop complications. He was 66. He graduated from the University of Minnesota Medical School. Dr. Dahlman specialized in emergency medicine, and he served in the U.S. Air Force. DONALD J. DUMMER, M.D. passed away February 12, 2009 at the age of 83. He served in the U.S. Army Air Corps as a navigator on a B29 in the Western Pacifi c during WWII. Following his discharge from the Army he took pre-med courses at the University of Minnesota and ultimately graduated from Creighton University Medical School in Omaha, NE in 1951. He was on the medical staff at Unity Hospital and Silver Lake Clinic. RICHARD J. JOHNSON, M.D. died on November 9, 2009, at 90 years of age. He was in the class of 1945 at the University of Minnesota Medical School. He specialized in orthopaedic surgery and practiced in St. Paul until his retirement in 1984. Dr. Johnson served on the medical staffs for Bethesda, Mounds Park, Gillette and the VA Hospitals. WARREN L. KUMP, M.D. died recently at the age of 83. He graduated from the University of Kansas School of Medicine where he graduated Phi Beta Kappa and Alpha Omega Alpha. He served as a medical offi cer with the Tenth Marine Regiment during the Korean War. After his residency in radiology at the University of Minnesota, Dr. Kump practiced at North Memorial Medical Center in Minneapolis for 39 years, serving for most of that time as chief of radiology. He also served as chief of the medical staff and chairman of the board of trustees. In 1998 the new radiology department at North Memorial was named in his honor. In the 1960s Dr. Kump described a feature of the distal tibia; that feature has come to be known in textbooks and medical literature as “Kump’s bump.” FRED A. LYON, M.D. passed away February 10, 2010 in Tucson, Arizona at the age of 81. He graduated from the University of Minnesota medical school in 1957. Dr. Lyon was an emeritus clinical associate professor in the University’s Department of Obstetrics, Gynecology, and Women’s Health; a mentor to students; and a member of the Minnesota Medical Foundation’s board of trustees. He also served as a consultant in his fi eld nationally and internationally as well as an advocate for reproductive freedom. PAUL G. POLSKI, M.D., age 97, died on January 25. He graduated from the University of Minnesota Medical School in 1941 with a degree in general practice. Dr. Polski was a physician at St. John’s Hospital and Divine Redeemer and had his own clinic in West Saint Paul. GEORGE E. SCHAFFHAUSEN, M.D., age 74, passed away quietly on one of his favorite holidays — Saint Patrick’s Day (March 17, 2010). He received his medical degree from the University of Minnesota Medical School in 1961, with a specialty in obstetrics & gynecology. Dr. Schaffhausen also worked as a business owner and operator with his family at their design and remodeling fi rm.
MetroDoctors
The Journal of the Twin Cities Medical Society
Honoring Choices Minnesota Summer 2010 Conference and 2011 Pilots
T
he Twin Cities Medical Society, through the leadership of the East Metro Medical Society Foundation, is working on a community-wide advance care planning project. The effort has been named Honoring Choices Minnesota and is modeled after the internationallyrecognized program, Respecting Choices. Honoring Choices Minnesota (HCM) has experienced great growth and success in the last year as numerous clinics, hospitals and health plans have all agreed to collaborate, as well as hospice groups, long-term care groups, and other similar organizations. Signifi cantly, the HCM Advisory Committee created a health care directive document for use across all systems, which is available publicly on our Web site at http://www.metrodoctors.com/choices. cfm. Training sessions were held in November and 45 health care professionals were certifi ed to facilitate advance care planning conversations with patients and their loved ones. Ten instructors were also certifi ed to teach future
training courses, allowing HCM to grow and move toward becoming self-sustaining. Several local hospitals and clinics are currently piloting Honoring Choices Minnesota and a second set of pilots is planned for January-June 2011. Training sessions, led by Respecting Choices faculty, will take place this fall to prepare new pilot sites. Health care organizations in the metro area are invited to consider piloting Honoring Choices Minnesota at one of three levels: •
•
First Steps — Advance Care Planning Facilitator Certification This program teaches the skills necessary for basic advance care planning discussions with any adult and the ability to assist with the completion of health care directives. Next Steps — Disease-Specific Advance Care Planning Certification This stage is for professionals to learn
•
techniques of advance care planning for patients with chronic, progressive illnesses, who are beginning to experience decline or complications. Last Steps — Physician Orders for LifeSustaining Treatment (POLST) Facilitation Certification This program gives participants the tools for discussions with frail elders or those in long-term care facilities and to help patients transfer their end of life decisions into medical orders.
On Tuesday, July 20, 2010, HCM will hold an event called “Sharing the Experience — Honoring Choices Minnesota Conference” to present progress updates and share goals of the initiative. For more information on this conference, please contact Katie Snow at KSnow@metrodoctors.com or (612) 362-3704.
EMMS Foundation Board Appoints Two New Directors
T
he East Metro Medical Society Foundation (EMMS Foundation) Board is pleased to announce two new directors who have recently begun two-year terms. Frank Indihar, M.D. is a retired internist who has served in numerous professional, academic and civic leadership roles and is very active with organized medicine. In 2008, he retired from his position as the CEO of Bethesda Hospital. John Diehl, J.D., of Larkin Hoffman Attorneys, has been involved in the Minnesota State Bar Association’s Health Law Section for over 25 years and has signifi cant experience working for health care organizations and researching health care related cases. MetroDoctors
The Journal of the Twin Cities Medical Society
Frank Indihar, M.D.
John Diehl, J.D.
May/June 2010
27
West Metro Medical Foundation SUPPORT FOR MEDICAL EDUCATION and community health programs provided the impetus for creating the Hennepin County Medical Foundation (now West Metro Medical Foundation) in November 1964. It was established as a 501(c)(3) philanthropic organization with broad general purposes to advance, foster, and promote medical science, education, and public health. Its activities over the years have ranged from granting scholarships to medical students, to providing support to community programs and projects. The West Metro Medical Foundation (WMMF) serves as the philanthropic arm of the west metro geographic component of the Twin Cities Medical Society (named as a result of the merger of the East Metro and West Metro Medical Societies on January 1, 2010.) The initial funding for the foundation came through estate giving and proceeds from a mass rubella immunization program. Funding today continues to be received through memorials, estate gifts and the annual solicitation of the medical society membership and community hospitals. The WMMF has the honor and privilege as serving as the executor of several awards and recognitions. • Charles Bolles Bolles-Rogers Award — An engraved sterling silver Revere Bowl is given to a physician, who, in the opinion of the members of the selection committee, by reason of his/her professional contribution on the basis of medical research, achievement or leadership, has become the outstanding physician of this and other years. • First a Physician Award — Through his/ her dedicated and untiring service to the profession of medicine, this unsung hero has made an outstanding contribution to community service; worked on public policy issues; played a signifi cant role in the governance and success of the Twin Cities Medical Society; or other noteworthy (local) volunteer medical service. • Shotwell Award — Dedicated service to mankind; signifi cant break-through in some
form of research or signifi cant contribution to the fi eld of medicine; and innovations and/or improvements in health care delivery are the criteria followed when selecting the award recipient. In addition, the WMMF has served as the fi scal agent of the Thomas W. and Mary Kay Hoban Scholarship Fund, established through donations in honor and recognition of the extensive and exemplary career of the 25-year Chief Executive Offi cer of the then Hennepin Medical Society, Thomas W. Hoban and his wife, Mary Kay. With 80 post-graduate students receiving scholarships since 1993, the Hoban Scholarship Fund will sunset following the educational forum in the spring of 2010.
CAREER OPPORTUNITIES
In 2009, over $15,000 in grants were given to the following community programs and scholarships: • Clarion Interprofessional Student Competition (University of Minnesota) • Greater Minneapolis Crisis Nursery • Physicians Serving Physicians • Minnesota Visiting Nurse Agency/Club 100 • SubSaharan African Youth Program • Thomas P. Cook-Medical Student Scholarship • West Metro Medical Society Alliance For more information on the West Metro Medical Foundation or to make a donation, please contact Nancy Bauer, Twin Cities Medical Society, at (612) 623-2893 or nbauer@metrodoctors.com.
see additional Career opportunities on page 29.
Fairview Health Services Opportunities to fit your life Fairview Health Services seeks physicians to improve the health of the communities we serve. We have a variety of opportunities that allow you to focus on innovative and quality care. Shape your practice to fit your life as a part of our nationally recognized, patient-centered, evidence-based care team. Whether your focus is work-life balance or participating in clinical quality initiatives, we have an opportunity that is right for you: Allergy Cardiology Dermatology Emergency Medicine Endocrinology Family Medicine Gastroenterology General Surgery Geriatric Medicine Hematology/Oncology Hospitalist
Internal Medicine Med/Peds Ob/Gyn Orthopaedic Surgery Pain Palliative Pediatrics Psychiatry Pulmonology/Critical Care Urgent Care
Visit fairview.org/physicians to explore our current opportunities, then apply online, call 800-842-6469 or e-mail recruit1@fairview.org. Sorry, no J1 opportunities.
fairview.org/physicians TTY 612-672-7300 EEO/AA Employer
By Richard K. Simmons, M.D., Chair
28
May/June 2010
MetroDoctors
The Journal of the Twin Cities Medical Society
Thank you to the following physicians for your donation to the WMMF: Bonnie K. Adkins-Finke, M.D. Howard J. Ansel, M.D. Thomas R. Arlander, M.D. Macaran A. Baird, M.D. Daniel R. Baker, M.D. Lee H. Beecher, M.D. Stuart H. Bloom, M.D. Peter J. Boardman, M.D. John L. Canfield, M.D. Robert R. Cooper, M.D. Diane A. Dahl, M.D. Robert E. Doan, M.D., CMD Dale T. Dobrin, M.D. Frederick E. Drill, M.D. Hugh A. Edmondson, M.D. Edward P. Ehlinger, M.D., MSPH E. D. Engstrom, M.D. David L. Estrin, M.D. vincent F. Garry, M.D., MS, DABT Reinhold O. Goehl, M.D. Stanley M. Goldberg, M.D. Joseph I. Hamel, M.D. John N. Heinz, M.D. Charles S. Hoyt, M.D. Gerald D. Jensen, M.D. Shirley Kaplan Mark R. Koller, M.D. Laurel A. Krause, M.D. James R. Larson, M.D. Jonathan M. Larson, M.D. G. Patrick Lilja, M.D. Charles E. Lindemann, M.D. John H. Linner, M.D. Richard C. Lussky, M.D., MPH James C. Mankey, M.D. Deane C. Manolis, M.D. H. B. Midelfort, M.D. Anne M. Murray, M.D., MSC Frederick Muschenheim, M.D. Duane L. Orn, M.D. Mark L. Ostlund, M.D. Sotirios A. Parashos, M.D., Ph.D Richard A. Pfohl, M.D. Harley J. Racer, M.D. John A. Reichert, M.D. Richard D. Schmidt, M.D. David E. Schneider, M.D. Burton S. Schwartz, M.D. Martin A. Segal, M.D. Marvin S. Segal, M.D. Ralph S. Shapiro, M.D. Richard K. Simmons, M.D. Edward A. L. Spenny, M.D. John A. St. Cyr, M.D., Ph.D Tierza Stephan, M.D. Farrell S. Stiegler, M.D. Michael B. Stiegler, M.D. Jens A. Strand, M.D. Richard W. Swenson, M.D. John A. Tobin, M.D. Joseph M. Tombers, M.D. Robert M. Wagner, M.D.
MetroDoctors
The Journal of the Twin Cities Medical Society
CAREER OPPORTUNITIES
see additional Career opportunities on page 30.
THE STRENGTH TO HEAL and get
back to what I love about family medicine. Do you remember why you became a family physician? When you practice in the Army or Army Reserve, you can focus on caring for our Soldiers and their Families. You’ll practice in an environment without concerns about your patients’ ability to pay or overhead expenses. Moreover, you’ll see your efforts making a difference. To learn more about the U.S. Army Health Care Team, call SFC Daniel Ebbers at 952-854-8489, email daniel.ebbers@usarec.army.mil, or visit healthcare.goarmy.com/info/e928.
©2009. Paid for by the United States Army. All rights reserved.
A Journey of Leadership Medical Director - Maplewood Clinic HealthEast® Care System in St. Paul, Minnesota is looking to develop and support a progressive physician leader ready to make a difference in the areas of patient satisfaction, employee engagement, clinical quality and operational efficiency in this multi-specialty Clinic. If you are an Internal Medicine or Family Medicine physician interested in collaborating with an innovative health system recognized for excellence in improving patient outcomes, a rewarding journey awaits you! For more information about physician leadership opportunities, please contact Michael Griffin at: mjgriffin@healtheast.org or call 651-232-2227.
www.healtheast.org/careers
May/June 2010
29
Career Opportunities
CAREER OPPORTUNITIES
Please also visit www.metrodoctors.com for Career opportunities.
Introducing the “Career Opportunities” section of MetroDoctors!
A great avenue for professionals to learn about job opportunities AND a perfect place for recruiters to promote openings! Recruiters, call for our special recruitment rate. Betsy Pierre, ad sales 763-295-5420 betsy@pierreproductions.com
Great Partners, Great Staff, Great Patients, Excellent Income & Lifestyle Family HealthServices Minnesota, P.A. is looking for several Board Certified/Eligible Family Physicians to fill full-time, part-time or shared positions. Join our Independent Group of 64 physicians serving 13 clinic sites.
FOR MORE INFORMATION PLEASE CONTACT:
Paul Berrisford, 2025 Sloan Place, Suite 35, St. Paul, MN 55117 651-772-1572 • email: pberrisford@fhsm.com
MetroDoctors
The Journal of the Twin Cities Medical Society
May/June 2010
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luMinary of Twin Cities Medicine By Marvin S. Segal, M.D.
VErNoN l. SoMMErDorF, M.D.
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.
We kick off this new “last page segment” of MetroDoctors by introducing Dr. Sommerdorf to those of you who didn’t have the pleasure of knowing and working with this remarkable citizen physician prior to his recent death at age 88. He was truly a “man for all seasons” who gave selfl essly of himself throughout his long, diverse and distinguished life. He was a native Upper Midwesterner with humble rural roots, hailing originally from Brownton, Minnesota before moving to his beloved St. Paul as a young man. His interest in medicine was triggered by early service in the Civilian Conservation Corps where he aided a doctor in his weekly rounding visits. After a three year stint as a Pharmacist Mate in the U.S. Navy during WWII, he attended the University of Minnesota, receiving his M.D. degree in 1952. His St. Paul medical presence was forged by an internship at the old Ancker Hospital followed by a family practice career spanning over 50 years. He suspended full time practice in 1993 while making a full recovery from Hodgkins lymphoma, though returned to part time activity over the next decade at the University of Minnesota sponsored Wilder Geriatric Clinic and St. Mary’s Health Clinic where he cared mainly for an uninsured working poor population. Doctor Sommerdorf served St. Paul’s East Side in the Minnesota House of Representatives from 1964 to 1972 while tirelessly continuing his numerous other responsibilities. He and Norma, his wife of 63 years, raised four adopted children who presented them with many grandchildren and great grandchildren. Additionally, they welcomed numerous foster children and 32
May/June 2010
students — whom they called short and long term guests — to their close and dedicated family constellation. He was devoted to the assurance of quality care for the senior population, and in later years served as a transportation volunteer — providing many elderly folks with needed rides to and from health related appointments. He played an important leadership role in his church activities, and on more than one occasion played Santa as part of holiday festivities. The pride and dedication he expressed for the medical profession played a paramount role in his life. The leadership activities in which he played a prominent role in our medical community and nationally are well documented. He was the chief of staff of Mounds Park Hospital, and served as president of the Ramsey County Academy of General Practice, the Minnesota Academy of Medicine and one of our predecessor organizations, the Ramsey County Medical Society. For many years, he was a delegate to the Minnesota Medical Association and the American Medical Association, and was an invited participant at the White House Conference on Health in 1965. This energetic physician’s multifaceted talents, caring approach to the people of his community, amiable demeanor and superb professionalism has resulted in the awarding of many accolades and tributes, perhaps the most notable of which being the prestigious 2005 Ramsey Medical Society Community Service Award. The star of Dr. Vernon Sommerdorf shines brightly as our fi rst Luminary of Twin Cities Medicine. MetroDoctors
The Journal of the Twin Cities Medical Society
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Protecting and Promoting the Practice of Good Medicine
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University of minnesota
continuing medical education
Upcoming CME Courses www.cmecourses.umn.edu Primary care
aLSO OFFereD
Palliative care Symposium for Primary care may 11, 2010 This one-day conference will outline both clinical practice processes and patient management strategies as they pertain to palliation of patients with advanced symptom challenges and end-of-life issues
advanced Pediatric Dermatology may 14, 2010 Updates on enhancing skills in the recognition and management of common and selected dermatologic problems seen in pediatric patients
Family medicine may 12 – 14, 2010 Update on common topics and on infection & respiratory, cancer, and common hospital and ER topics
SUrGery Lillehei cardiology Symposium april 19 – 20, 2010 Designed to serve the cardiovascular educational needs of all clinicians who care for patients with diseases of the heart and blood vessels Bariatric education 2010 may 26 – 27, 2010 An overview for maximizing success with bariatric surgical procedures, while minimizing complications and readmissions advances in Hepatic, Biliary, and Pancreatic Surgery June 2 – 5, 2010 Top US surgeons will provide comprehensive updates on Hepatic, Biliary, and Pancreatic Surgery
Topics and advances in Pediatrics 2010 June 10 – 11, 2010 Practical approaches in Pediatrics, Clinical Pearls, Special Lectures, Clinical Roundtables Workshops in clinical Hypnosis June 10 – 12, 2010 Instruction in the theory and application of hypnosis in a clinical setting Global Health course: clinical Tropical, migrant and Travel medicine July 6, 2010 – august 27, 2010 (in weekly modules) Prepare to work in this field with skills for providing health care in a global village Free on-line courses available for cme credit are listed below. Visit cme website at www.cme.umn.edu. • • • • • •
Fetal Alcohol Spectrum Disorders (FASD) Heart Failure in Children Supraventricular Tachycardia in Children Reducing Recurrent Preterm Birth ECG of the Week The Reality of Fibromyalgia: Pathways to Diagnosis, Therapy, and Quality of Life
All courses are held in the Twin Cities unless noted
Office of continuing medical education 612-626-7600 or 1-800-776-8636 www.cme.umn.edu email: cme@umn.edu