Contents VOLUME 13, NO. 5
2
Index to Advertisers
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In thIs Issue
SEPTEMBER/OCTOBER 2011
How Do YOU Measure Health? By Richard Sturgeon M.D.
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PresIdent’s Message
Art of Medicine By Thomas D. Siefferman, M.D.
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tCMs In aCtIon By Sue Schettle, CEO
Page 32
Page 5
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First a Physician Award Nomination Form
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What Is health and hoW are We MeasurIng It? IntervIeWs WIth:
Mark R. Bixby, M.D. Barbara J. Bowers, M.D. Dana Boyle, Vice President, LifeScience Alley Phillip M. Kibort, M.D., MBA Scott G. Nelson, M.D. Travis D. Olives, M.D. Phillip H. Stoltenberg, M.D., FACP, AGAF Charles G. Terzian, M.D. Jim Eppel, Sr. Vice President, BCBS Lawrence (Larry) Lee, M.D., MBA, FACP Sue Abderholden, Executive Director, NAMI Lee H. Beecher, M.D.
• • • • • • • • • • • •
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Britain’s National Institute for Clinical Excellence (NICE) By Stephen T. Parente, Ph.D.
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Recipe for Improved Health: Plain and Simple By Peter J. Dehnel, M.D.
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East Metro Medical Society Foundation Board Minnesota’s Growing Online Credentialing Service
Page 25
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Helping Create Healthy Communities...A World Away
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Twin Cities Medical Society Website
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Honoring Choices Minnesota Conference
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Senior Physicians Association
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In Memoriam/New Members
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Career Opportunities
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luMInary of tWIn CItIes MedICIne
Richard J. Frey, M.D. Page 5 MetroDoctors
The Journal of the Twin Cities Medical Society
On the cover: Twelve responses to our questionnaire exploring the definition of health and how it is measured are featured. Articles begin on page 7.
September/October 2011
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Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
September/October Index to Advertisers President: Thomas D. Siefferman, M.D.
Acute Care, Inc. .................................................31 AmeriPride...........................................................11
President-elect: Peter J. Dehnel, M.D.
Classified Ad .......................................................13
Secretary: Edwin N. Bogonko, M.D.
Crutchfield Dermatology................................23
TCMS Officers
Treasurer: Melody A. Mendiola, M.D. Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Gregory A. Plotnikoff, M.D., MTS Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Richard R. Sturgeon, 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 reflect the official position of TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.
The Davis Group .............. Inside Front Cover
Past President: Ronnell A. Hansen, M.D.
Fairview Health Services .................................30
TCMS Executive Staff
Healthcare Billing Resources, Inc. ...............18
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 Andrea Farina, Executive Assistant (612) 623-2885 afarina@metrodoctors.com Barbara Greene, MPH, Community Engagement Director, Honoring Choices Minnesota (612) 623-2899 bgreene@metrodoctors.com Katie R. Snow, Project Coordinator (612) 362-3704 ksnow@metrodoctors.com
MMIC Health IT ........... Outside Back Cover
For a complete list of TCMS Board of Directors go to www.metrodoctors.com.
Woodbury Medical Building .........................10
Lakewood Health System ...............................28 Lockridge Grindal Nauen P.L.L.P. ................. 9 Minnesota Epilepsy Group, P.A...................... 2 Minnesota Physician Services, Inc. ..............21 The MMIC Group .............Inside Back Cover Neurosurgical Associates, Ltd........................18 Pediatric Home Service .....Inside Back Cover Saint Therese.......................................................26 Uptown Dermatology & SkinSpa................26 U.S. Navy ............................................................30 Welcyon/Fitness After 50................................23
Minnesota Epilepsy Group is the largest and most comprehensive epilepsy program in the Midwest. As a regional referral facility, we are the recognized leader in treating epilepsy and other seizure-related conditions in patients of all ages, from infants to the elderly. We also offer comprehensive neuropsychological assessment for a broad range of acquired or developmental neurological conditions in both adult and pediatric patients. Adult Epileptologists Deanna L. Dickens, MD Julie Hanna, MD Patricia E. Penovich, MD
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
Pediatric Epileptologists Jason S. Doescher, MD Michael D. Frost, MD Frank J. Ritter, MD Functional Neuro-Imaging Wenbo Zhang, MD, PhD Neuropsychologists Elizabeth Adams, PhD Robert Doss, PsyD Ann Hempel, PhD Donna Minter, PhD Gail Risse, PhD
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.
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September/October 2011
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IN THIS ISSUE...
How Do YOU Measure Health? TWElvE HEAlTH CARE THOUGHT lEADERS submitted responses
to a survey asking, “What is health?” and “How are we measuring it?” You will note that “health” like beauty is “in the eye of the beholder,” subject to individual or specialty perspective. Specific quality measures of process and outcomes which pertain to their (relatively) narrow field take precedence. As well they might. Additional wider health and wellness parameters are less consistent. The WHO definition submitted by Sue Abderholden, Executive Director of NAMI (National Alliance on Mental Illness) perhaps comes closest to the collective attributes mentioned by our contributors. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Measurement is designed with two objectives: monitor patient’s health improvement and assess provider performance to goals. We make the assumption our selected measurement goals reflect and impact patients’ health. We also assume provider performance goals reflect activities which positively impact patient health. Several respondents indicate some mandated measures do not clearly result in improved quality of health. Measures can be affected by individual patient variation above and beyond the care giver impact and/or health care system performance. Quality measurement activities create significant added cost. Jim Eppel, BCBS describes efforts to utilize standard measures across health plans, actually for all stakeholders. Reducing duplicative work and creating meaningful comparative health care data is always a good idea. These reservations notwithstanding, providers are focusing efforts to deliver on these mandated measures. Fortunately, care givers’ humanism and the Art of Medicine are not being discarded. Here is a partial list of additional goals and measures they promote: trusting relationships, skilled interpersonal training-coaching, engaging patients to address their personal health and healthy life style, chronic disease model systems of care and the patient care experience. Take note of oncologist Barbara Bowers’, M.D. concern for her patients’ well being beyond cancer treatment. Dr. Phil Kibort describes functional concerns for pediatric patients with long-term chronic maladies. Mark Bixby, M.D. reminds us of patient needs for a trusting relationship. Drs. Charles Terzian, Scott Nelson, Travis Olives and several others mention desired/expected physician interaction beyond a well applied protocol. Larry Lee, M.D. describes HealthPartners work to assist patients to positive life style changes. He and others, including responses from By Richard R. Sturgeon, M.D., Member, MetroDoctors Editorial Board
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The Journal of the Twin Cities Medical Society
Dana Boyle, LifeScience Alley and Lee Beecher, M.D., emphasize the need for patient engagement and participation. Evidence based on Nurses’ Health Study provides clear direction. Elements of Dr. Peter Dehnel’s “elixir” are goals of several contributors and/or their organizations. Though immersed in specialty care, Phil Stoltenberg, M.D. and others indicate significant involvement with their patients’ general well being beyond that of their specialty. Sue Abderholden, NAMI Executive Director, makes a strong case to screen and recognize Mental Health illnesses as part of general screening. And for good reason, she espouses mental health providers add general health screening for people living with serious mental illness. Recommended steps are outlined by Sue. These wise leaders walk and talk both an even wider perspective of health and wellness. For example, Sue Abderholden specifically mentions WHO and SAMHSA measures. And others bring in overall patient well-being, the social contract, safety, food, shelter and so forth. This causes one to ponder, where does medical care end and the social contract begin? Or are they or should they be one and the same? Transition from volume-based to value-based care delivery is visible on the horizon. No one mentioned measuring cost outcomes except Steve Parente, Ph.D. in his article on NICE in Britain. That program’s signature analytic tool is cost effectiveness analysis. NICE explicitly measures health quality gained for the money spent. One’s definition and understanding of health informs the vision and mission of their organization. That vision will inform/define selected measures. What you value you measure. What you want to improve you measure. We need to ensure that our organization has identified the correct metrics. Physician leaders are uniquely qualified to remember the ultimate accountability for the individual patient. The responders producing the content for this issue deserve our thanks for participation and warrant our admiration for trusting themselves and their organization and systems to public scrutiny. We will learn something from each of them. We welcome and encourage your comments. Please send them as a Letter to the Editor, nbauer@metrodoctors.com.
September/October 2011
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President’s Message
Art of Medicine ThOMaS D. SiEffERMaN, M.D.
P
ediatricians get all the pleasure of watching children grow up and mature without the parental headaches and anxiety attacks. Not to say that we are without concerns for our patients’ well being, but just tend to have more fun at it. Frequently, I am asked by my younger patients (and parents), what do I “really do”? In the past I would give simple pat answers of being paid to torture kids with rubber reflex hammers and immunizations, and lecturing the teenagers on the dangers of “falling in love too soon.” As time has moved on, my answers are not as glib. I remind the children that my main focus is to care for their well being of body, mind and, to a slight degree, soul; and to help their parents guide them into adulthood. Minnesota Community Measurement and other insurance operatives keep track of my visits and immunizations, and if I am providing “proper guidance and information and health care directives” to my patients. And to some, this is protecting the health of my charges. The reality of providing for the health of my patients is much broader. Diagnosis, treatment and re-examination of diseases is a large part, but a better part is prevention and anticipatory guidance. To complete these, I try to engage the parents and child in healthy eating, play and learning both at school and with their peers. We have yearly discussions initially with the parent, and as the child matures with them, about healthy households, foods, and accident prevention. We are constantly “playing with the child” as a method to examine their neurological and personal developmental skills. When illnesses are found, or developmental issues arise, we treat to cure or ameliorate the symptoms, or we refer to appropriate providers to complete what we are unable to do. Sadly, some cannot afford the care needed or do not wish to take the medications recommended, or to complete a treatment usually leading to poorer health. These failures are often “measured” as a failure on my part as they assume these will average out among doctors but the reality is quite different. Some physicians “specialize” in the care of asthma or allergies; others in psychosocial issues or developmental delays. The populations measured and the rate of refusal or failure to complete care varies on socioeconomic levels and location. Pediatricians do have the burden of immunizations for which the children would rather not ever see us again; patients often present too soon for a correct diagnosis for which the parents will dwell on when considering a return to your office. Sometimes we are interrupted in thought, or are ill, and our ability to provide the best for the health of our patients is suboptimal — all are reasons for scathing criticisms and poor scores. Some patients are just unhealthy: birth trauma, metabolic disorders, previous trauma, allergic family history, or parents that are just incapable of taking care of their children. A more appropriate measure of my providing for the health of my patients then is not whether I completed all the boxes in an audit but whether my patient was actually able to avoid an illness or injury — physical, mental or spiritual. Patients can tell you there are many diagnostically capable doctors that they will never see again as they were not satisfied by the care they received. They want a physician to listen and to talk to them, to answer their spoken and, often, unspoken concerns. This is not a teachable skill, rather one learned over time in multiple patient encounters, or even in the guidance that the physician experienced growing up or learned from mentors. I am doing a “good job” of providing for the health of my patients when I keep seeing them week after week and year upon year — especially, when it is mainly for well child care. My partners keep me accountable when I see their patients on weekends or on call. My patients keep me accountable when I see in their eyes incomprehension or the eye rolls of “not that lecture again.” The coolest measurement of when I have done a good job taking care of the health of my patients is when they show up as parents themselves of another beautiful addition to the planet; although I am a little worried that the parents met getting allergy shots in my office as teenagers. 4
September/October 2011
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tCMs In aCtIon SUE a. SChETTLE, CEO
A recent working lunch with Senator
Al Franken, Congresswoman Betty McCollum and Center for Medicare and Medicaid Services Administrator Dr. Donald Berwick was held on Wednesday, August 17, 2011 at the YMCA in St. Paul. The purpose of the meeting was for Minnesota health care leaders to share innovative projects that they are working on that improve patient care and increase health outcomes while bringing down costs. Many of the health care CEOs and administrators from the metro area as well as Duluth and Rochester were in attendance. Sue Schettle, CEO of TCMS attended the meeting and spoke to Dr. Berwick about the Honoring Choices Minnesota initiative.
Sue Schettle and Donald Berwick, M.D.
Peter Dehnel, M.D., TCMS president-
The East Metro Medical Society Foundation held its strategic planning retreat in June and recently met to approve the five year strategic plan. See page 24 for further details. The West Metro Medical Foundation also held a board meeting and strategic planning retreat recently under the able leadership of Dr. Richard Schmidt. Dr. Chris Johnson was elected as secretary/treasurer. The Board is taking this opportunity to craft a mission statement and determine a future direction for the foundation. The July meeting of the TCMS Board of Directors featured a dialogue with Aaron Friedman, M.D., dean of the Medical School and vice president for Health Services, who described the challenges and opportunities faced by the Academic Health Center. In addition, a presentation on the work of the TCMS Policy Committee was made by Ms. Terri Hyduke, the Policy Committee’s facilitator. The Policy Committee is developing a White Paper that will be disseminated to all TCMS members in the coming months. There will also be a TCMS Medical Forum that will be dedicated to a discussion on a physician-driven ACO model, which is the basis for the White Paper.
elect, participated in the Medical Student White Coat Ceremony on Friday, August 6. Each first year medical student received an ADC Buck Hammer engraved with the TCMS name and logo. The Senior Physician Association, under the leadership of Richard Pfohl, M.D., president and its physician Executive Committee, continue to put forward interesting, timely, and engaging speakers at their luncheon gatherings. See article on page 28. MetroDoctors
Aaron Friedman, M.D.
The Journal of the Twin Cities Medical Society
Dr. Stuart Cox was the featured speaker at the June 15 Medical Student Lunch ‘n Learn session sponsored by TCMS and the Medical Student Section. Approximately 70 first year students attended his presentation describing the independent practice of medicine. An engaging Q&A session followed.
Stuart Cox, M.D. and medical student, Jessica van Lengerich at a recent Lunch ’n Learn program.
Honoring Choices Minnesota con-
tinues to explode with many components unfolding at the end of August. Our partner, Twin Cities Public Television, will be airing the first of three documentaries on September 16 related to end-of-life care planning. The website, www.honoringchoices.org, launched recently and is meant to be the portal for the community to learn and become more engaged in the Honoring Choices MN initiative. Kent Wilson, M.D., medical director of Honoring Choices MN is getting spread a little thin as speaking engagements continue to appear on a weekly basis. Visit our website www.metrodoctors. com to learn how you can help Kent by becoming an HCM Ambassador! We could use your help! September/October 2011
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Established in 2007, this award recognizes an unsung hero of the Twin Cities Medical Society who, through his/her dedicated and untiring service to the profession of medicine, has made an outstanding contribution to community service; worked on public policy issues; played a significant role in the governance and success of the Twin Cities Medical Society; or other noteworthy (local) volunteer medical service. NOMINATION FORM
Nominee: Name: Home Address: Home Phone: I believe he/she is deserving of this recognition and meets the qualifications of this award because
Supporting documentation would be greatly appreciated. Nomination submitted by: Name: Address: Phone Number: E-Mail Address: Entries can be submitted: By Mail:
First a Physician Award Twin Cities Medical Society 1300 Godward Street NE Suite 2000 Minneapolis, MN 55413
By E-Mail:
nbauer@metrodoctors.com
By Fax:
(612) 623-2883
Entries must be postmarked by Oct. 31, 2011
If you have any questions, contact Nancy Bauer at (612) 623-2893.
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September/October 2011
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Healthisand What Health? Wellness
What is Health and How are We Measuring It? Physician and Vendor Perspectives Mark R. Bixby, M.D., Medical Director, Clinical Services North Memorial Health Care
What is your definition of health? We understand that health is a goal for our community and the individuals within it. Health is more than freedom from illness and disease; improving health is our struggle to avoid and overcome the processes that lead to illness. How are you measuring health (not health care)? We measure health in many ways, our ability to move people toward health goals known to promote health and well-being — e.g. improvement in diabetic care, reduced hospital and emergency visits for people with asthma and many other conditions. While we focus on patient-oriented outcome measures, we also use process measures to help our staff, physicians, PAs, NPs, and our entire team to do the things more likely to lead to improved patient outcomes. We pay attention to the science of medicine to tell us those outcomes most likely to improve longevity and quality of life. Where there is good science, we strive to meet those proven goals. But we also listen to and partner with our patients — what matters in their lives, where have they succeeded, what do they need help with and what have they found to be challenging? How did you arrive at these measures? We arrive at measures by looking at the scientific evidence behind the interventions.
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We look at evidence-based guidelines and develop programs to move our patients toward health outcomes proven to make a difference. Our local organization, the Institute for Clinical Systems Improvement (ICSI), publishes important tools, but we also look to national guidelines such as those developed by the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ) and the National Preventive Services Task Force (NPSTF), among others. Pros/cons considered in these measures? Pros include the quality of the evidence behind the measures and the consistency of the quality outcomes across not only our community but across the country. Cons are sometimes the measures do not account for regional variations and approaches. How can a personal physician influence the health of his/her patients? The most important factor is the trust relationship between the patient and his/her health care team. Much of medicine can be done by protocol or guideline, but it takes using the tools within the trusting relationship that allows people to achieve their goals. Please share a notable success. One of my patients years ago came in repeatedly with complaints of pain, one pain or another, but always looking for relief in medication. I worked with the patient to identify the underlying problem, but finally had to say that I could no longer provide
The Journal of the Twin Cities Medical Society
medications as I felt sure this patient had a drug abuse problem. I lost the patient for years. But after a number of years the patient turned up on my clinic schedule again. The patient had finally run into enough difficulty and addressed the issue of drug use. The patient became drug free and was coming back to my practice because I had been successful in forming a caring relationship and that was what ultimately convinced the patient to make the needed changes. There was certainly the adherence to medication use guidelines I followed in moving the patient away from prescription medication abuse, but it was the caring trusting relationship that was ultimately successful in moving this patient toward better health.
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What is Health?
Barbara J. Bowers, M.D., Private Practice/Oncology
involved in knowing the road blocks a patient may have. The physician should be offering achievable goals and remembering to followup at the patient’s next appointment on the status of the goal. If achieved, verbally reward the patient; if not, don’t guilt the patient but encourage them to continue trying. If they know you will be following, they are more likely to have a success. It is not lost on the patient if the physician is not following his or her own advice. We must lead by example.
What is your definition of health? Perfect health can be defined as the ability of a person to live without undue suffering from medical or psychological illnesses. But obviously that’s nothing more than a fantasy. Thus, the realistic definition of health needs to take into account the contributing factors of a person’s genetics, environmental issues that may leave them more vulnerable for certain disease, and personal habits that may modify these health pitfalls both negatively (smoking, obesity) and positively (exercise, nutritional decisions). How are you measuring health (not health care)? The outcomes of a given population are a spectrum of the genetics, environment and willingness to make positive decisions to help modify their given health make up. These variables can only be measured by doing a comprehensive family and personal history, then counsel the patient on measures they can take to modify their health despite their genetics and environment. It’s important for the patient to be held accountable, but he or
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September/October 2011
she must be given goals that are achievable. The accountability is solidified by followup that is commensurate with the level of their risk. Pros/cons considered in these measures? The benefits to a patient and society can be huge — both in the decrease of pain and suffering and in the ultimate cost of medical care. Unfortunately, it is not easy or inexpensive to change societal norms where people feel that there will be a drug, surgery, or an easy fix for health issues that leaves them without a need to be responsible for those difficult changes. We can’t measure how compliant patients are; we need to rely on what they tell us. But we can measure several health parameters. How can a personal physician influence the health of his/her patients? Physicians can have an influence in his or her patients by literally being personally
Please share a notable success. I have several patients who have made significant changes in their health because of simple discussions on health risks. Since I take care predominately of breast cancer patients, I expect the majority of patients to survive their diagnosis. Thus, after the initial treatment for their diagnoses, I work on having them focus on living their life. They aren’t allowed to blame the cancer history for lack of personal accountability. One of my patients, who exemplifies this example gained excessive weight after chemo, and had a family history of diabetes. In addition to the standard health hazards of obesity, obesity increases her risk further for developing another breast cancer. She felt she couldn’t lose weight because she was too busy, ate “nothing” and still gained weight. Each visit (every 3-4 months) over four years, we set a goal she could live with. She bought into the program after she lost a few pounds after about the third visit. Then, as she continued to lose, we added more restrictions and exercise that didn’t seem too overwhelming because of the gradual change. She ultimately lost 50 pounds and has kept it off for over two years. Her hA1c is normal as well as cholesterol. Her joints don’t hurt and she has more energy. Obviously she isn’t the norm, but by giving the patient confidence they can take charge of certain things in their life, which is very gratifying.
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Dana Boyle, Vice President of Community Engagement, LifeScience Alley
What is your definition of health? Health is a state of physical, mental and emotional well-being and capacity to thrive throughout one’s life. Health relates to happiness with one’s body, mind and spirit, even relative to defined limitations, and the ability of a person to understand, anticipate and maximize the factors that contribute to being in an overall healthy state as a human organism.
more than worries masqueraded as physical problems. My physician has helped me to sort out these ailments and lay them to rest by entering into discussions, occasionally ordering a test to confirm that all is well and by encouraging me to not live in fear. She displays intelligence, humor and concern in her practice, and both the time and kindness she shares are immeasurable tools that help me stay healthy, confidant and strong as a contributor at work and for my family. Her approach makes me want to rise to the occasion and do my best to embrace wellness. (She is Dr. Danielle Montague of Allina Woodbury.)
How can a personal physician influence the health of his/her patients? A physician can play a key role by treating each patient — as much as possible — as a unique entity living with(in) a unique set of circumstances. This includes understanding a patient’s family setting, genetic and environment risk factors, major stressors and how that patient views health and wellness. It also includes applying the scientific tools of P4 Medicine — predictive, preventive, personalized and participatory — as espoused by Dr. Leroy Hood of the Institute for Systems Biology. A use of smart technologies (some yet to be discovered), combined with good psychology on the part of the physician engaging the power of the patient to contribute toward his/her own health make for the best physician/patient relationships and the most successful health outcomes. For more information on P4 Medicine visit: http://p4mi.org/. Please share a notable success. I have always enjoyed good health; however, I was widowed three years ago, which put me under a lot of pressure. As the working mother of a school-age child, I have since then experienced a rash of health concerns — all of which, fortunately, have been nothing MetroDoctors
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September/October 2011
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What is Health?
Phillip M. Kibort, M.D., MBA, Vice President Medical Affairs, Chief Medical Officer, Children’s Hospitals and Clinics of Minnesota
What is your definition of health? Health is the potential of each individual to reach their highest functioning capabilities — physically, emotionally, and intellectually. Health is the state of being free from illness or injury. It is the condition of being sound in body, mind and spirit, freedom from physical disease or pain. It is a state of complete physical, social and mental wellbeing. Health is not merely the absence of
disease or infirmity. Health is a resource which permits people to lead an individually, socially and economically productive life. Health is a resource for everyday life, not the object of living. How are you measuring health (not health care)? Unfortunately Children’s, like most health care providers, does not measure health by these definitions frequently enough or consistently enough. More often, we have a more process-oriented take on measuring health. In general pediatrics we use BMIs, asthma action plans, behavior evaluations for autism. At the same time we do measure our patients’ functional status in our hematology/ oncology service lines. Do they go to school regularly? Do they function as independent adults when they are done at Children’s? We also do this in our newborn intensive care follow-up clinics to see how our preemies function even 20 years later. Significantly we also do this in cystic fibrosis patients. We evaluate their status of health, their nutritional status, and their FEV1’s as a sign of health. Some of these measures are defined by the National Societies we participate in, others as part of our own studies. Pros/cons considered in these measures? The pros and cons of these have not been studied greatly and because there aren’t national benchmarks it is hard to know if they are correct or not. How can a personal physician influence the health of his/her patients? A personal physician can influence the health of his or her patients by not only making sure that the physical ailments, symptoms or problems they are having are dealt with, but also by working proactively and making sure preventive medicine is done. In pediatrics it is
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extremely important. It is as simple as making sure children are wearing bike helmets, seat belts, and avoiding being around smoke. It is also, of course, the discussion a pediatrician has with parents about their skills in dealing with children in a developmentally appropriate way that can have a great impact on health. Please share a notable success. I believe one of our greatest notable successes is what we’ve done with our children that have cystic fibrosis. Through the great care of our pulmonologists and our cystic fibrosis department, Children’s of Minnesota has some of the best outcomes in nutritional and FEV1’s for cystic fibrosis patients in the nation. The work we are doing is allowing these children to truly live very healthy lives, in the strongest and most important definition of the word.
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You will be surprised how little it costs to: • Promote Your Professional Image • Build Patient Confidence • Reduce Employee Turnover • Increase Office Efficiency
Scott G. Nelson, M.D. Chief Resident Internal Medicine Abbott Northwestern Hospital
What is your definition of health? In general I think it is being able to lead a life fully, i.e. being able to tap into our natural talents and affinities without excessive mental or physical limitation — a tall order perhaps but a worthy goal nonetheless. How are you measuring health (not health care)? It’s probably both a process measure and an outcome measure. Developing the skills and frames-of-mind to acquire and maintain health (e.g. exercise) as well as achieving “healthy” outcomes e.g. BMI, not smoking, and perhaps most vaguely achieving “satisfaction.” I believe in the role of tools such as the PHQ9 for depression, etc., but I suppose we are in the privileged position of listening to our patients, to be with them, and help them understand their own situations with the “medical material” as we to the best of our ability know it.
Please share a notable success. I like to think I did help an HIV patient who was otherwise very compliant with his HAART to understand that he needed to pay as much attention to his diabetes and hypertension — two areas where he was not so compliant and did not necessarily understand why compliance would matter.
How did you arrive at these measures? Concrete measures acquired during training but also by the observations and experiences made with the physicians I respected during training. How can a personal physician influence the health of his/her patients? I think you need to “push the agenda” of health as laid out by our various governing and advisory bodies — but to do that you need to be there as “the doctor” for the patient and their individual issues, and that in a way that cooperates as best as possible with the patient — it is their life in the end.
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September/October 2011
11
What is Health?
How did you arrive at these measures? Both through exposure to basic public health principles as a graduate student at the University of Minnesota, and as a resident at HCMC caring for the diverse patients for whom we serve.
Travis D. Olives, M.D. Resident, Internal Medicine/ Emergency Medicine HCMC
What is your definition of health? On a population level, it’s a community maintained free of heavy disease burden. Much of this evolves around access to care, both preventive and acute. On an individual level, it’s one’s capacity to live reasonably the life s/he chooses without the limitations exacted by disease. How are you measuring health (not health care)? It’s a process measure — everyone is at a different place in their journeys; I find it hard to consider health an “outcome” given that it is a dynamic and moving target in every sense. I’m primarily in the emergency department, and many health problems can be solved with the simple application of basic principles. Abscesses can be drained, cellulitis can be treated, and pain can be alleviated. These acute health problems, however, aren’t a measure of health in and of themselves — they are brief stops on an individual’s health care journey.
Pros/cons considered in these measures? Failure to critically appraise the literature, and to subsequently apply it, can result in poor or inadequate outcomes for patients. The pros to these measures lie in the longevity and health of our individual patients — results that come only with time.
Predictor variables must be carefully measured, applied, and validated in the population to whom they will be applied. The scientific process must be followed rigorously, and we (as providers) must be able to critically appraise the literature in a manner that enables us to apply appropriate concepts and theories — as well as exclude inappropriate concepts and theories — in the manner that furthers individual and population health.
Nominate your colleague for the First A Physician Award. See nomination form on page 6.
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September/October 2011
How can a personal physician influence the health of his/her patients? Each and every one of us is, above all else, an educator to our patients. Sincere, honest advice on healthy living goes much further, in most instances, than sending a prescription to a pharmacy. Sincere, candid words reach most patients. Please share a notable success. My first patient — ever, as a resident — screamed and yelled at me within five minutes of our first introduction for denying him a narcotic prescription. I thought I’d never see him again. A year later, to my surprise, the patient returned for further care. He apologized to me at that time, and on subsequent visits for primary care. He thanked me for listening to him, for acknowledging his successes and failures in battling substance abuse, and for continuing to care for him despite our initial interaction. It was a testament to his character that he was able to acknowledge his own shortcomings openly. We now share an open and warm physician-patient relationship, and he is one of my most cherished patients.
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The Journal of the Twin Cities Medical Society
but only add significantly to overall health care costs.
Phillip H. Stoltenberg, M.D., FACP, AGAF, Gastroenterology Minnesota Gastroenterology
What is your definition of health? For many years we have thought of health as merely the absence of disease. Now, physicians would agree that, not only is health the prevention, management and treatment of disease, but more broadly it includes a state of physical, social and mental well-being. We can also think of health in the context of the community, which includes preventive medicine, control of communicable diseases, health education, healthy lifestyles and disease management. Many of our current systems are based on older models of managing acute illness, rather than prevention and chronic disease management and these models are not applicable today. How are you measuring health? Our practice, Minnesota Gastroenterology, is an independent, specialty practice that sees people for specific types of health care problems. We have addressed quality by identifying outcome measures, which we believe are important for the overall health of our patients. These include procedural and treatment standards as well as overall health measures including obesity, tobacco and alcohol use, and immunization status. Our practice instituted an electronic medical record (EMR) system seven years ago and we have attempted to identify quality measures for every patient and every patient visit. We have used national standards for comparison and have set practice benchmarks to exceed national standards and presented results at national and international meetings. For example, two of the endoscopic quality measures we have used are nationally reported colonoscopy completion and
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How can a physician influence the health of his/her patients? The simple answer is to be proactive for the patient. We try to identify key physical and behavioral issues such as obesity, alcohol, drug and tobacco use and educate the patient on risk factors and we also identify appropriate resources to help the patient with important lifestyle changes.
adenomatous polyp find rates. Our practice’s quality benchmarks have been set to exceed the national rate, with quality parameters reported to individual physicians and the practice as a whole quarterly and summarized annually. How did you arrive at these measures? We identified national standards that could be used as benchmarks and instituted these as quality measures in our practice. Pros/cons considered in these measures? The advantages are that we can demonstrate a commitment to quality, drive better patient outcomes and exceed payer requirements. We attempt to set the standard in our industry and specialty field. The disadvantages are that these types of quality measures are expensive and require additional personnel and systems (i.e., EMR) that many independent and group practices cannot afford. In addition, many quality measures do not result in improved quality,
The Journal of the Twin Cities Medical Society
Please share a notable success. Minnesota Gastroenterology has had notable successes including our own limited, regional contribution to a significant reduction in colon cancer rates through screening colonoscopy and the removal of precancerous polyps. Also, we have introduced new protocols and treatment programs for chronic diseases, including inflammatory bowel disease and chronic hepatitis, which have improved outcomes for these patient groups.
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September/October 2011
13
What is Health?
Charles G. Terzian, M.D., Internal Medicine/Hospitalist Allina Hospitals and Clinics
What is your definition of health? Health can be defined by the individual, the family, community, society, and nation or from a global perspective. In my job as a hospitalist and a parent, I primarily look at health from the perspective of the individual and their family. This perspective does not only include the immediate family. I look at five aspects of health; what we can provide for the patient (i.e. medical surgical management), how the person feels about themselves (psychological), the support mechanism the person has available (family, friends), their nutritional status and, if important, their religious convictions. How are you measuring health (not health care)? The way I measure health as an individual is not the same as an economist, an insurer, or as the legislature measures health. I interact one-on-one with my patients and their families. It is both a process of assessment and an individual or family measure of outcome. It is based on the goals of the patient (and family if applicable). Education, available resources,
the essential elements of informed consent. In all aspects of care, whether prescribing or not prescribing a medication, advising about a procedure and/or palliative care with hospice versus aggressive intervention. Pros/cons considered in these measures? Many individuals make uneducated decisions on care options and families perceive what they think is best for family members. Rarely do individuals and family take into consideration objective and/or economic concerns in their health care decisions.
and personal goals are important in defining their individual outcome. One patient’s perception of a good outcome (health) is not necessarily the same as another person’s. Examples such as: I would rather die than lose my leg; I want everything done even if there is a low chance I will survive; I’ve lived a good life, I don’t want to suffer, just make me comfortable. My variables are subjective and are not able to be quantified. How did you arrive at these measures? Listening to my patients, asking them what they want done after presenting them with all
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September/October 2011
How can a personal physician influence the health of his/her patients? A personal physician needs to be a strong advocate for the patient and support decisions if based on reasonable rationale. If patients and families make unreasonable requests or demands for care that the individual physician feels will harm the patient then it is the physician’s role not to provide those services. This seems contradictory; however a physician should not consciously provide unreasonable care. This philosophy can go in alternative directions. Just because we can provide a service doesn’t mean we should, and just because the patient wants care doesn’t mean we should provide it. Please share a notable success. My successes are when my colleagues and I have group conferences with patients and their families. All physicians whether primary care or specialty should be involved in these meetings. In addition, my successes could not have occurred without the assistance of the nursing staff and the many ancillary services which aid in the management of my patients. These include but are not limited to rehabilitation, speech and nutritional personnel.
MetroDoctors
The Journal of the Twin Cities Medical Society
Payer’s Perspective
Jim Eppel, Senior Vice President, Health Management and Commercial Markets Blue Cross and Blue Shield of Minnesota
What is your definition of health? At its essence, health is about physical, mental and social well-being. Blue Cross takes a fairly broad definition of health, since the environments of day-to-day living — from family life to the workplace to the community at large — are critical influencers of health. As a health company, Blue Cross believes it’s our role to think about health factors in a comprehensive way, so we’re very much involved in all of these areas. How are you measuring health (not health care)? We rely on a mix of process and outcome measures. We are constantly looking for measures that accurately reflect health status. Our preference is to utilize outcome measures whenever possible, but the reality is sometimes such measures do not exist. In those cases, we start with process measurements as a proxy, assuming that the appropriate process will lead to the desired outcome. There are a variety of case-mix and risk adjustment methodologies in use. Some are better than others for specific situations (e.g. individual vs. population level risk adjustment). It is important to match the appropriate methodology to the situation and set of questions one is trying to answer. We want to ensure that we’re looking at true applesto-apples comparisons.
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How did you arrive at these measures? We’re fortunate that the broader health care community has endorsed the role of Minnesota Community Measurement in identifying a set of standard measures. We also rely on validated field test measures derived from the National Committee on Quality Assurance. We analyze new measures carefully and maintain an ongoing dialogue with our provider partners regarding emerging measurement options. Pros/cons considered in these measures? The biggest pro is that the national measures of NCQA and the Minnesota-specific measures of Minnesota Community Measurement are nearly universally accepted in our provider community. This makes the alignment of care-delivery objectives between Blue Cross and providers much more effective and efficient. We don’t want to create unnecessary work, so having measures that have been externally recognized and endorsed benefits all involved. How can a personal physician influence the health of his/her patients? We believe there is nothing more fundamental to good health than a strong doctorpatient relationship. That’s why in all of our products and network structures, we focus on supporting the critical role the physician plays in driving better health.
healthy behaviors. In the first year we saw improvements in all measured areas, including a 30 percent increase in acceptable blood pressure readings. The results are expected to help the company avoid nearly $2 million in health care costs.
Visit TCMS at www.metrodoctors.com
Please share a notable success. One of our clients, a national retailer with 3,000 employees, wanted to create a “culture of wellness” for its employees. We put in place a system that included biometric screenings and incentives for employees to focus on
The Journal of the Twin Cities Medical Society
September/October 2011
15
What is Health?
Lawrence (Larry) Lee, M.D., MBA, FACP Medical Director, Analytics and Strategy HealthPartners Health Plan
a patient. Achieving health is something that the patient largely does for himself/herself: adopting healthy lifestyle, recognizing and then controlling risks, and managing chronic conditions as guided by their personal physician. I like to remind my patients that they might spend one or two hours with me per year. Their health is really a function of what happens the other 8,758 hours.
What is your definition of health? Being at your best, physically and mentally, for yourself and those who depend on you — for the long run. How are you measuring health (not health care)? Healthy living habits are an absolute prerequisite for being healthy in the long run. Within the HealthPartners Clinical Indicators Report (an annual compendium of measures, mostly focused upon provider performance) is a battery of measures called “Optimal Lifestyle.” The data are collected via a survey instrument administered by participating clinics. http://www.healthpartners. com/files/34613.pdf. The Optimal Lifestyle measures for adults assess: • Physical activity for 30 minutes four or more days a week • Healthy eating of five or more fruits and vegetables per day • Not-excessive alcohol consumption • Non-tobacco use Since the Optimal Lifestyle measures assess behavior and habits, I think these are closer to outcomes measures. Rigorous epidemiological studies (most notably the Nurses’ Health Study from the Harvard School of Public Health, begun in 1976) demonstrate that physical activity, diet, alcohol-moderation, and tobacco avoidance improve morbidity and mortality. How did you arrive at these measures? The Optimal Lifestyle measures, like the other HealthPartners Clinical Indicators, are a product of many years of ongoing research 16
September/October 2011
and development by the HealthPartners Research Foundation and HealthPartners’ collaborations with regional and national organizations and the community of providers and health care experts. Pros/cons considered in these measures? Pro: The lifestyle elements assessed by the measure are backed up by solid scientific evidence that they really do impact health — via the physiological mechanisms of weight, blood pressure, cardiovascular fitness, sleep, and mental performance.
Please share a notable success. In 2009 a man in his 50s came to my clinic with a large foot ulcer and months of malaise. He was not known to be diabetic. In the exam room, a fingerstick confirmed severe hyperglycemia. He was shocked and devastated to learn that he had severe diabetes and end-organ damage. That first meeting, I convinced him that he could turn the situation around. We started aggressive medical management, but he also made dramatic lifestyle changes. After a year, his hemoglobin A1c was in the non-diabetic range, and he was taking only a small dose of oral medication. He felt great, had lost 20 pounds, and was working full-time. The restoration of his health was all the more important, because his wife subsequently developed a serious illness, and he became her primary caregiver. He was thankful that he was healthy and strong enough to care for her when she was in need.
Pro: The data are collected from patients. Con: The data represent what patients selfreport, which is potentially subject to reporting bias. How can a personal physician influence the health of his/her patients? The physician can convey to the patient a picture of an achievable goal and how to get there. Achieving health is NOT something that the medical profession “does to” MetroDoctors
The Journal of the Twin Cities Medical Society
Patient’s Perspective
Sue Abderholden, MPH Executive Director of NAMI Minnesota (National Alliance on Mental Illness)
What is your definition of health? I like to use the World Health Organization’s (WHO) definition of health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. It includes not just physical health but mental health and social well-being. How are you measuring health (not health care)? Since NAMI is not a direct care provider, we do not use tools within our organization. We are, however, concerned when measurement tools used by others do not involve mental health. In measuring mental health we can look at the absence/decrease of symptoms, the increase/decrease in functionality, etc. We can also measure domains of wellness such as relationships/social, involvement in meaningful activities (work, volunteer, hobbies), faith/spirituality, physical wellness (has someone’s poor health affected their ability to be involved in things such as work, relationships, etc.), intellectual and emotional (impact on relationships). The WHO’s International Classification of Functioning, Disability and Health (ICIDH-2) is a very holistic tool. The WHO tools are actually similar to the eight dimensions of wellness from the Substance Abuse Mental Health Services Administration (SAMHSA). They are: emotional, financial, social, spiritual, occupational, physical, intellectual, and environmental. It contains
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questions that rate a person’s impairments of body functions (mental, sensory, cardiovascular, etc.), body structures, activity limitations and participation restrictions (learning, self care, domestic life, relationships, etc.) environmental factors (housing, income, etc.) When NAMI talks about recovery, which is certainly a movement toward health, we ask if someone has a home, a job and a date on a Saturday night. How can a personal physician influence the health of his/her patients? Knowing that people with serious mental illnesses die 25 years earlier than their peers, and that people live with their symptoms an average of 10 years before seeking help, an important factor to influencing the health of patients is for physicians to challenge their own attitudes toward mental illnesses. Knowing that half of all cases of mental illnesses appear by age 14, physicians need to screen and recognize mental illnesses. As outlined in a new study and brochure by the national NAMI office, in the area of mental health physicians can: 1) Create a welcoming setting by displaying brochures about mental illnesses along with other illnesses; 2) Ask and address mental health needs as part of your visits with patients of all ages; 3) Encourage open communication by asking key screening questions about mental health; 4) Support people and their families by using hopeful language, by telling them that they are not alone and that it is not their fault, by showing empathy and understanding, by pointing out their strengths and finally by engaging them in decisions about treatment.
The Journal of the Twin Cities Medical Society
What would an “ideal” life or societal environment for persons with mental disorders look like? It would look similar to what your readers have: stable housing, sufficient economic resources, friends and family, paid or volunteer work and good health. What can families and communities do to reduce early death-risk factors? They can advocate for integrated physical and mental health care which includes pushing to have physical health assessment and monitoring among people who live with a serious mental illness. Mental health clinics/centers should be supported to do more monitoring of diabetes, cardiovascular diseases and obesity. (Continued on page 18) September/October 2011
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What is Health?
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September/October 2011
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Patient’s Perspective: Sue Abderholden (Continued from page 17)
What responsibility do persons themselves suffering with mental illness and chemical dependency have? Certainly all of us have responsibility for taking care of our own health, physical and mental. But it’s important to recognize that people aren’t responsible for developing a mental illness or chemical dependency and that there are barriers that exist to achieving wellness. One is accessibility. Getting exercise when you live in an unsafe neighborhood and can’t afford a gym membership is tough. Purchasing fresh fruit and vegetables when you live in poverty and there aren’t full grocery stores in your neighborhood is even tougher. Treating symptoms early is difficult when there is a three month waiting period to see a psychiatrist. Being uninsured or underinsured (recognizing the discrimination in health insurance for mental health treatment) makes it difficult to afford treatment. A second barrier is the illness itself. The symptoms of mental illness can come back even though you’ve adhered to the treatment plan. (Not a great time to receive or recall information). When your brain is impacted, say the symptoms are that you hear voices or that you don’t know that you are ill, it is hard to use the word “responsibility” any more than we would use it for someone who has epilepsy and is having a seizure. A third barrier is being involved in your treatment plan so that you have ownership. In a recent survey conducted by NAMI, most people said that they were not involved in developing their treatment plan. Patient education is critical yet few people with mental illnesses are provided with information on their illness and treatment plans and if they are, it’s only when they are discharged from the hospital. Lastly, one part of a recovery plan (WRAP) is about personal responsibility, viewed as personal empowerment, where people develop their own crisis plans, and identify triggers and what actions they will take when symptoms reappear (such as an advanced directive). If we focus on a recovery-based model, people will be supported to take responsibility for their mental health. MetroDoctors
The Journal of the Twin Cities Medical Society
Lee H. Beecher, M.D. Private Practice/Psychiatry
What is your definition of health? Human health is the current state of an individual’s biological, psychological, and social functioning, Health is also a value concept — maximizing happiness and minimizing disease and abnormality. The word “health” comes from the same IndoEuropean root as “heal,” “whole,” and “holy,” so notions of human health include social membership, belonging, and respect. How are you measuring health (not health care)? This is a multidimensional task requiring biopsycho-social assessments. We can measure biological (physiological and anatomical) functioning and variations, assess psychological functioning, and describe and quantify environmental stressors. Although the inevitable outcome of life processes is death of an individual person, one may strive for health throughout the human lifespan. For many health care and medical services, we should be concerned about gauging the nature and quality of physician-patient relationships. We need to define concepts and their limitations according to the task at hand and by using the best tools we have. This requires specification of what is to be measured and ongoing adjustments based on scientific study.
Cons: Not used widely by patients or physicians in clinical settings today. How can a personal physician influence the health of his/her patients? By practicing medicine adhering to Hippocratic ethical principles and maintaining up-to-date scientific knowledge. Spending quality time with patients. Respecting the patient as the true “decider” on critical aspects of his care.
How did you arrive at these measures? Multiaxial bio-psycho-social assessments are now used in teaching protocols. See http:// search.aol.com/aol/search?q=multiaxial+assess ment&s_it=spelling&v_t=client96_searchbox . Pros and cons considered in these measures? Pros: widely available methodology (for example see DSM multiaxial assessments). MetroDoctors
The Journal of the Twin Cities Medical Society
Please share a notable success. Mr. Jones, a 40-year-old man, presented to his primary care clinic complaining of hearing voices and believing the police were out to get him. He also had abdominal pain of two months duration which was gradually getting more severe. After a work-up, he was told that he had pancreatic cancer. He believed that God was punishing him. An oncologist said that his prognosis for survival was less than six months. He agreed to a meeting with his family, who wanted him to stay with them. He was unemployed and living in an apartment in the community. He had a history of psychiatric admissions and ER visits. His primary care physician arranged a psychiatric consultation and Mr. Jones consented to be seen. He agreed to meet with the psychiatrist for 10 session twice a week visits during which times they together considered changes in his psychotropic medications, discussed his prognosis, examined support alternatives and explored his sense of health and life experiences. Mr. Jones also prepared an advance directive. He requested the psychiatrist to make a home visit as part of the hospice team and died peacefully at home.
Nominate your colleague for the First A Physician Award. See nomination form on page 6.
September/October 2011
19
What is Health?
Britain’s National Institute for Clinical Excellence (NICE): The U.S. Template for Comparative Effectiveness Research
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n 1999, the United Kingdom’s British National Health Service (NHS) established the National Institute for Clinical Excellence (NICE) to address a problem known as “postcode lottery” whereby where you lived in England and Wales determined availability to different medical technologies based on which region of the country was served by the primary care trust operating the care system. To address this problem, NICE created a set of clinical effectiveness and cost criteria that a new or existing medical technology would have to meet to be funded by the NHS. As the Patient Protection and Affordable Care Act (PPACA) rolls out from 2010 to 2014, one of the key components to bend the cost curve down is the development of a U.S. version of NICE called the Independent Payment Advisory Board (IPAB). Similar to the UK’s NICE, the IPAB will provide expert advice to the U.S. Department of Health and Human Service’s Medicare program — regarding the cost and effectiveness of a particular technology. It will have authority to produce an annual plan to keep Medicare spending within a corridor of expenditure increases that would get expedited review by Congress. Since the NHS has a limited budget and a vast number of potential spending options, it seeks advice from NICE as to how this limited budget is spent. The major difference between the NHS and U.S. public health insurance programs like Medicare and Medicaid is that the NHS sticks rather rigidly to a budget constraint, whereas the United States does not ration by budget. If the NHS deficit financed budget busting technologies as Medicare does, there would not have been a postcode lottery problem. The signature analytic tool of NICE is cost effectiveness analysis. Specifically, NICE explicitly measures health quality gained for the money spent. The Quality-adjusted life year (QALY) is used to measure the health benefits delivered by a given treatment regime. By comparing the value of expected QALYs saved over the course of patients’ life with and without treatment, or relative to another treatment, the net and or relative health benefit derived from such a treatment can be derived. When a QALY is combined with the relative cost of treatment this produces a cost-effectiveness metric for comparing technologies for funding. One major area of controversy has been NICE’s willingness to “draw a line in the sand” on incremental cost-effectiveness ratio (ICR) By Stephen T. Parente, Ph.D.
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that would be acceptable for funding. As policy, NICE accepts as cost effective those interventions with an ICR of less than £20,000 ($32,766) per QALY ($32,766) and requires substantial additional evidence to accept interventions over a threshold of £30,000 ($49,149). The application of the European CER benchmark index is not novel to U.S. medical technology firms. Medical device manufacturers and pharmaceutical firms market their products globally and need to meet the CER benchmark of NICE to be reimbursed. Other countries have similar cost-effectiveness standards as well. And, similar to the U.S. market for medical innovation, a decision by the NHS or Medicare or a private insurer to not pay for medical treatment does not restrict the patient from seeking treatment elsewhere and paying from their own budget. Indeed, this has been one of the primary market drivers for medical tourism when a technology for a given patient is not payable through a private or public insurance program. As a template for the United States, NICE provides two powerful lessons learned. It demonstrates that an analytic approach can be used to address a budget constraint in order to steward health care cost inflation on a national level. It also shows the high level of political criticism such a technical and independent agency can engender, given there will be clear winners and losers for technologies affecting life and death. One question that frequently arises is the suitability to the UK approach to cost containment for Medicare and Medicaid programs. While the UK and U.S. share a common language, they do not share a recent contemporary history regarding health policy. The UK embarked on a National Health Service program in 1946 after nearly three decades of national health insurance experience. The U.S. had not started major publicly financed insurance programs, Medicare and Medicaid, until MetroDoctors
The Journal of the Twin Cities Medical Society
1966. Furthermore, the role of government in health care in the UK has become much more prescriptive because of budget constraints following World War II when ration coupons were still used over a decade after the war. In contrast, the U.S. had post-war experience of massive economic expansion and fiscal constraints were less top of mind (for example, see Apollo space program). Another critique of comparative effectiveness is that one can’t put a price on a life. And yet, QALY does exactly that by way of comparison of technologies. A quality adjusted life year saved means literally the highest functional level you can hope to have every year from a fixed point in time to the time you are most likely to die. If a technology can extend your life and do it in ways for you to have higher functional status (e.g., you can walk, talk, be continent and be social) better than another technology at higher cost, then as long as it is below £30,000 pounds, it will be likely to be reimbursed in the future. What are some examples where NICE has said no and the U.S. has said yes? Recently, NICE stated that three types of medication, which can give a normal life expectancy to patients with chronic myeloid leukaemia (CML), are not effective enough considering they cost up to £40,000 a year. Roughly 1,000 people in England and Wales who do not respond to the standard treatment for the disease will be affected. The three drugs named not to be covered were dasatinib, high-dose imatinib and nilotinib. However, the treatments are available in the U.S., Canada and 29 other countries. In addition, they are available in the NHS in Scotland which does not use NICE for health policy decisions.1 One thing that is similar between NICE and IPAB is their funding comes from federal sources and their staff positions are likely to be full-time positions, not just volunteer or part-time experts. Thus, NICE employs statisticians, economists and clinicians to examine substantial data resources from the NHS as well as information provided by inventors seeking to be reimbursed for their new technology. As health reform continues to deploy, the politics surrounding Britain’s U.S. cousin to NICE, in the form of IPAB, will intensify. However, the creation of IPAB at least lays accountability for medical policy decisions at the door of a defined organization similar to NICE. These decisions were made out of public sight by the civil servants or elected officials decades ago in both nations. At least NICE has made the process more transparent than in the past so that a conversation about policies to effectively address the fiscal and aging demographics challenges can advance. Stephen T. Parente, Ph.D. is professor of Finance, Minnesota Insurance Industry Chair of Health Finance, and Director of the Medical Industry Leadership Institute in Carlson School of Management, at the University of Minnesota. He was a Senior Health Adviser to Senator John McCain (R-AZ) in the 2008 Presidential election and a Legislative Fellow for Senator John D. Rockefeller (D-WV).
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1. http://www.telegraph.co.uk/health/healthnews/8495374/Leukaemia-sufferers-denieddrugs-available-in-Scotland.html
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September/October 2011
21
What is Health?
Recipe for Improved Health: Plain and Simple introducing: TCMS Elixir for Youth (This one Really Works)
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magine in the last few weeks hearing an eloquent vendor in the Grandstand Building at the Minnesota State Fair with the following sales pitch: Step right up, Ladies and Gentlemen, and purchase your very own bottle of the TCMS Elixir for Youth. For a mere $14.95 for a large six ounce bottle, you will be able to reliably reduce your chances of a fatal heart attack, stroke, diabetes and many common cancers. Simply take one teaspoon twice a day of the elixir and follow the four simple steps on the “Elixir Activation Card.” ELIXIR ACTIVATION CARD To ensure the maximum benefit from your use of this elixir, please carefully follow each one of these four steps: 1. Work to attain and maintain your BMI at or below 25. 2. Engage in 30 minutes each day of moderate physical activity. 3. Do not use tobacco products. 4. Have a diet that is higher in vegetables, fruits, nuts, legumes, whole grains and fish. Finally, consume at most only a moderate amount of alcohol to optimize the internal actions of the elixir. Start your Elixir habit right now! The results that you will see in just a few short weeks are remarkable. You will want to recommend this product to all of your friends and family members after you see the benefits in your own life! Purchase now or order online at www. TCMSElixir.com By Peter J. Dehnel, M.D., President-elect, TCMS
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September/October 2011
The claims for this particular product are, of course, spectacular and not unlike many other bogus products that have been around since the beginning of commerce. The difference is that this one will work as long as the purchaser follows the four steps on the “Elixir Activation Card.” Plain and straightforward — but extremely challenging for most adults to implement on a sustained basis. The composition of the elixir really doesn’t matter, as long as it does no harm to the individual. This “recipe for improved health” was recently confirmed in a study that was published in the Journal of the American Medical Association (JAMA 2011;306(1): 62-69). The study is entitled “Adherence to a Low-risk, Healthy Lifestyle and Risk of Sudden Cardiac Death Among Women” (Stephanie Chieve, ScD and associates) and is based on a prospective cohort study of 81,722 U.S. women in the Nurses’ Health Study. The proportion of sudden cardiac death attributable to smoking, inactivity, overweight and poor diet was 81 percent.
Other population-based studies have shown similar improvements in long-term health measures. In “Healthy Living is the Best Revenge” (Arch Intern Med. 2009; 169(15): 1355-1362), Earl Ford, M.D., MPH and colleagues demonstrated a 78 percent lower risk of developing diabetes, myocardial infarction, stroke and certain cancers among 23,153 German adults by adhering to similar lifestyle principles. This study as well as the JAMA article references a number of other population-based studies with basically the same results. The recommendations for individuals to have a higher level of health — less chronic disease — are clear. Where do physicians and the health care system play a role in ensuring the adoption of these personal lifestyle recommendations? It seems clearly in everybody’s best interest for all people to choose these recommendations. This will take a broad, collaborative effort to create an environment where people are more likely to choose healthy alternatives. Physicians and the health care system will have a role in this, as will communities, schools, employers, the faith community and insurance plan design. But at the end of the day, it takes the individual deciding to make the right choice at the right time for a better personal future. Ironically, products like the “TCMS Elixir for Youth” can provide the personal motivation needed for a small percentage of adults to really make a change in their lives. My personal suggestion is to come together as a physician community and determine how we can collaboratively make an impact in the most effective and efficient way possible. We have the evidence-based information that will benefit our patients. There does not seem to be a commercial opportunity inherent in
MetroDoctors
The Journal of the Twin Cities Medical Society
these recommendations to promote a message of better health. In fact, this will be working contrary to many of the commercial messages that bombard people everyday. Additional opportunities at the clinic level include consistent encouragement of individual patients to take one of the four areas on the “activation card” and incorporate them into their daily lives. For those familiar with the term this is an example of “motivational interviewing,” and can be utilized by many different people on staff, not just the physicians. Simply walking an extra 15 to 30 minutes per day can have a great impact on their future health, if it is adopted on a consistent basis. Advocating and collaborating with schools and community resources as a clinic can have a very positive effect for the health of your patients and their families. One word of caution, however: improvement rates in the neighborhood of 15 to 20 percent are currently considered “very successful” — please do not get discouraged with the low rates you are likely to encounter! Or we can simply start marketing the “TCMS Elixir for Youth.”
MetroDoctors
The Journal of the Twin Cities Medical Society
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September/October 2011
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East Metro Medical Society Foundation Board Completes Strategic Planning In the past several years, the focus and work of the East Metro Medical Foundation has changed greatly. The EMMF board members met twice over the summer to review and refine the vision, mission and goals of the foundation. The board looks forward to raising the level of recognition among TCMS members and developing new structures and initiatives in the near future. A survey was sent recently to Twin Cities Medical Society members who live in the
East Metro. The results were quite revealing. Most members (60 percent) were not aware of the East Metro Medical Society Foundation. Of those that were aware, only a handful had participated in activities of the Foundation and only a handful had contributed consistently to the Foundation. Honoring Choices Minnesota was ranked as the most important initiative and Health Care for the Homeless was ranked highly as a meaningful project for the Foundation to continue. The Foundation board
reviewed those results and developed strategies to increase the profile of the Foundation with our members utilizing a variety of tactics. New mission statement: To provide support and leadership in addressing society’s health issues through relevant programs given the foundation’s unique position in the medical community.
Minnesota’s Growing Online Credentialing Service Offers Free Clinic Administrator Membership The Minnesota Credentialing Collaborative (MCC) has recently experienced a dramatic increase in customers using its online credentialing and re-credentialing services, the group reports. Use by physicians and other providers jumped 121 percent in the last year to nearly 6,000 practitioners. The MCC provides a secure web-based platform for sending and receiving Minnesota Uniform Credentialing Application data. “The MCC is gaining steam and providers realize the benefit of going electronic,” said Jan Hennings, MCC board member. “We have e-newsletters, e-health, e-records, e-billing and e-prescribing. The MCC helps providers get to e-credentialing.” Free Administrator Services
Clinic staff members who coordinate credentialing for multiple providers may use a free clinic administrative account. This tool allows the administrator to access, update, upload, complete and store credentialing records for practitioners within the clinic’s system. 24
September/October 2011
“This essentially takes the place of the traditional paper file drawer. Instead of stacks of paper, the information is online making it easy to manage,” said Candice Carlson, MCC customer service technician. “Whether the doctor is down the hall or across the state, administrator accounts give credentialing staff the ability to efficiently assist providers with all their credentialing needs.” Providers who join the MCC for a $25 annual fee receive these benefits: One and done. Data is entered once. It is securely stored online and is ready for providers to send applications, updates and re-credentials. Correct. Automated rules ensure application requirements are met. Providers cannot submit applications that are missing required information, saving the hassle of re-submitting or verifying applications. Now. The tool is available all day, every day. All you need is internet access through browsers such as Internet Explorer, Safari, etc. Best practice. The credentialing community
encourages MCC use. All Minnesota nonprofit health plans and 24 hospitals, along with Minnesota’s Department of Human Services, receive online applications. More hospitals will join soon. MCC board member George Lohmer said prior to the MCC, the credentialing was timeintensive, repetitive and error-prone. Providers were required to submit paper applications to multiple health plans, hospitals, clinics and government payers. “This tedious process had to change,” Lohmer said. “When we asked how to improve credentialing, they requested a secure website for their data.” Janny Brust, MCC board chair, concluded “We listened and developed a system to meet providers’ needs. Recent enrollment increases show providers are learning about the MCC, shedding paper and moving to the electronic solution.” To learn more or to join call (612) 3609793 or go to mncred.org.
MetroDoctors
The Journal of the Twin Cities Medical Society
Helping Create Healthy Communities... A World Away The Twin Cities Obesity Prevention Coalition (TCOPC) was recently host to six international emerging public health leaders who visited the United States via the Minnesota International Center’s (MIC) International Visitor Leadership Program (IVLP). The International Visitor Leadership Program is a medium for professional and cultural exchange among emerging leaders. The majority of MIC’s participants come to Minnesota under the auspices of the U.S. Department of State. As part of a national program lasting three weeks, visitors are typically here for threefour days and MIC arranges their schedule to include such events as professional meetings, cultural activities and dinner hosting. The meeting objectives were: • To promote international cooperation on the common challenges facing the global community in preventing, treating, and managing chronic and non-communicable diseases such as stroke, heart disease, diabetes and cancer. • To examine state and local efforts at preventative screening and wellness programs. • To examine public awareness campaigns about health issues and the effects of economic downturns, poverty, and other external challenges to health care delivery systems. • To assess U.S. and international health
Dr. John Diketemena, Project Manager, Kinshasa School of Public Health, Democratic Republic of Congo, Africa, and Mr. Pradeep Paudel, Monitoring and Evaluation Advisor, Nepal Health Sector Support Program.
Group photo.
care programs and increase information sharing and transparency in global health issues. The topic of the open dialogue centered on public health issues in the United States, with a focus on the work of the Twin Cities Obesity Prevention Coalition, a project of the Twin Cities Medical Society. Visiting guests were interested in gaining a better understanding of how the coalition was created, how the project measures success, the evaluation process, and how a resolution can create healthier communities. By the end of the meeting, it was clear that even though we are separated by thousands of miles, public health issues touch every country. We learned that HIV/AIDS remains a priority for health leaders in Africa; not only caring for people affected, but also preventing the spread between adults as well as from mother to child prior to birth. We learned that obesity is not always perceived to be a negative in countries like Africa, where overweight or obese women are praised for their size as it is a reflection of how well her husband provides for her. Cultural norms aside, public health concerns persist. By sharing openly in constructive dialogue,
By Jennifer J. anderson, Ma, Project Coordinator MetroDoctors
The Journal of the Twin Cities Medical Society
solutions can come from shared communication and dedication to improving the health of all people, foreign and domestic. At the end of the meeting, we were challenged to continue the dialogue through an international partnership and we are excited to explore that request.
Dr. Peter Dehnel, TCMS President Elect, and Dr. Janette Garin, Representative, First District of Iloilo, House of Representatives, Phillipines.
Ms. Gertrude Shumba, Provincial Manager, Family AIDS Caring Trust, Zimbabwe, Africa. Mr. Agenor Paul Koffi, President, Health Coalition, Cote d’Ivoire, Africa. Mr. Patrick Mhlanga, National Coordinator, Ministry of Health and Social Welfare, Swaziland, Africa.
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Twin Cities Medical Society Website
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Have you been to our website lately? The TCMS website has undergone some changes involving several page updates and a completely new navigation structure. It is important to us that you, our member, have access to the information you need quickly and easily.
Saint Therese at St. Odilia features... • Private care suites and baths in a beautiful 8-bedroom home • 24-hour nursing support • Pastoral care programming for Catholic and non-Catholic residents and their families • Therapeutic whirlpool tub • Quiet and serene location; close to St. Odilia Catholic School and Church • Ongoing bereavement support for family after the death of a loved one
Some highlights include: New Menus – we now have two menus on
the site to allow for visitors to easily access the most common sections. Use the top drop-down menu or the Key Topics menu to the left to find what you need.
To learn more call 651.842.6780 www.sttheresemn.org
New Events Calendar – Easily see when Uptn. Rehana REH1
5/26/11
10:56 AM
your next committee meeting is, and even get directions. Google users can easily add events to their calendars.
Page 1
Uptown Dermatology & SkinSpa
View All TCMS Publications – we have a section of the site devoted to all our publications. View current and past issues of MetroDoctors, TCMS E-News, Honoring Choices Minnesota, and The Twin Cities Obesity Prevention Coalition.
Dr. Rehana Ahmed joins the staff of Uptown Dermatology. She specializes in Medical and Surgical Dermatology. Same Day urgent referrals and Same week routine appointments available at our clinic. We are located in Uptown Minneapolis, one block east of Calhoun Square. We accept all major insurance and offer discounted parking. Call us at 612-455-3200 to schedule an appointment. Healthy Skin is Gorgeous Skin.
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Social Media – TCMS is now on Twitter @
TCMSMN and on Facebook. Followers will receive up-to-date legislative news, membership updates and alerts. Much More On the Way – More upgrades
are in the works including a photo gallery, and an improved career section. Send any questions, comments, or suggestions for our website to Andrea Farina (afarina@ metrodoctors.com) or call (612) 623-2885. Stay Connected! Follow TCMS on Twitter
@TCMSMN, and “Like” us on Facebook.
Uptown Row, Suite 208 • 1221 W. Lake Street • Minneapolis, MN 55408 612-455-3200 • www.UptownDermatology.com
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September/October 2011
MetroDoctors
The Journal of the Twin Cities Medical Society
Sharing the Experience: Honoring Choices Minnesota Conference
O
n Wednesday, July 20, 2011, the second annual Sharing the Experience: Honoring Choices Minnesota Conference was held to present outcomes and learnings of organizations piloting advance care planning programs within Honoring Choices Minnesota. The energy and enthusiasm in the room was evident and it was a great day! From January through June of this year, five new locations began testing and refining the Honoring Choices Minnesota program within their system. Reports were presented to summarize their work and learnings over the past six months. Attendees also heard updates from the six systems with established programs. PowerPoint presentations from all groups can be viewed on our website at www.metrodoctors. com. Advance care planning expert, Bud Hammes, Ph.D., from Respecting Choices at Gundersen Lutheran Medical Foundation, shared national and global advance care planning news, praised the efforts here in Minnesota and offered feedback to the new pilots. Other speakers included Kent Wilson, M.D., medical director of Honoring Choices Minnesota, who discussed progress and next steps; Bill Hanley, Twin Cities Public Television, and Sean Kershaw, Citizens League, who shared the value of partnering with Honoring Choices; and Barbara Greene, MPH, who described her efforts as the Community Engagement Director for Honoring Choices and future plans for spreading the message to all Minnesotans.
Sandra Schellinger, RN, MSN, NP, Allina (left), Sue Schettle, TCMS CEO, and Kent Wilson, M.D. take a break from conference responsibilities.
In good spirits are Kent Wilson, M.D., Honoring Choices Medical Director (left), Bud Hammes, Ph.D., Respecting Choices, Gundersen Lutheran Medical Foundation and Vic Sandler, M.D., Fairview Homecare & Hospice.
The five new pilot sites are:
A lively discussion is underway between Nancy Ulvestad, U of MN School of Public Health (left), Vic Sandler, M.D.-Fairview Homecare and Hospice and Lisa Edstrom, U of MN Center on Aging.
MetroDoctors
The Journal of the Twin Cities Medical Society
lakeview Hospital North Memorial Medical Center Queen of Peace Hospital Redeemer Health and Rehab Center Ridgeview Medical Center
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Senior Physicians Association The Senior Physicians Association met on July 12, 2011 for their summer luncheon at Broadway Ridge. Members enjoyed a full course lunch meeting and socializing with fellow members. Our guest speaker for the event was Eric Dick, MMA Lobbyist, who presented the group with a wrap-up of the latest legislative session and current government activities ending his talk with a look toward the 2012 session. There was a great turnout with an engaging question and answer session after Mr. Dick’s presentation. The fall luncheon is scheduled for October 27, 2011 at the Interlachen Country Club at 11:00 a.m. Commissioner Edward Ehlinger,
M.D., MSPH will be presenting to the group a talk on the Health of the State. We are excited to have Dr. Ehlinger speak to our group and look forward to the event. The Senior Physicians Association is comprised of retired physicians 62 years or older. Our group meets four times per year for lunch, and a guest speaker. If you are retired, or contemplating retirement, 62 years or older, member or past member in good standing of the Twin Cities Medical Society or another county medical society, you are eligible
to join! Contact Andrea Farina at afarina@ metrodoctors.com or (612) 623-2885.
Dr. Richard Pfohl, SPA president, and guest speaker, Eric Dick, MMA lobbyist.
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September/October 2011
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The Journal of the Twin Cities Medical Society
In Memoriam ROBERT J. BAUMER, M.D., passed away at the age of 68 from pancreatic cancer June 9, 2011. Dr. Baumer received his medical degree in 1969 from Marquette Medical School and completed his psychiatric residency at the Mayo Clinic. He founded the Family Life Center in Anoka County in 1978, serving as the medical director for several years. Dr. Baumer then dedicated himself to his Assertive Community Treatment (ACT) team to the Mental Health Initiative in Ramsey County. In 1995, Dr. Baumer traveled to Germany to command the Mental Health Division at 67th Combat Support Hospital. Dr. Baumer became a member of TCMS in 1973. RONAlD E. BlACKMORE, M.D., age 72, passed away May 28, 2011 in St. Paul, MN. Dr. Blackmore attended the University of Minnesota Medical School graduating in 1971 and completed a pathology residency at Penrose Hospital in Colorado Springs in 1973. Dr. Blackmore was Lt. Cmdr., medical staff, at the U.S. Naval Hospital in Orlando, FL until 1975 then joined Bethesda Hospital as a pathologist from 1975–2005. Dr. Blackmore became a member of TCMS in 1978. BENITO B. DIEGO, M.D., age 85, died May 10, 2011. Born in the Philippines, Dr. Diego graduated from the College of Medicine at Manila Central University in 1954, later specializing in anesthesiology. Dr. Diego became a member in 1969. WIllIAM FOlEY, M.D., passed away peacefully on his 80th birthday May 21, 2011. Dr. Foley received his medical degree from the University of St. Thomas in 1956. Dr. Foley practiced and taught pathology, retiring from Abbott-Northwestern Hospital in 1999. He was known for his passion, dedication, and generosity. Dr. Foley became a member in 1987. FRANKlIN SIDEll, M.D., died May 3, 2011 at the age of 87. Dr. Sidell graduated from the University of Chicago Pritzker School of Medicine. He was a team physician for the MN North Stars and an aviation medical examiner practicing medicine for over 60 years. Dr. Sidell enjoyed the outdoors and taking road trips. Dr. Sidell has been a member since 1954. JACK l. TITUS, M.D., Ph.D., passed away at the age of 84 after a long illness. After serving as a sergeant in WWI, Dr. Titus completed his undergraduate studies at Notre Dame University and went on to medical school at Washington University in 1948. He began as a devoted general practitioner in Rensselaer, Indiana. With an interest in cardiovascular pathology, Dr. Titus went on to earn his Ph.D. in pathology at the University of Minnesota. He became a faculty member of the Mayo Graduate School by 1961 and a professor by 1972. Dr. Titus became the director of the Jesse E. Edwards Registry of Cardiovascular Disease at United Hospital, St. Paul, Minnesota as well as a professor of pathology at the U of M and adjunct professor at Baylor College. Dr. Titus achieved world-renowned status as an academic physician. He published extensively and was active in several professional groups and editorial boards. Dr. Titus became a member of TCMS in 1988. OSMUND A. WISNESS, M.D., passed away at the age of 91. Dr. Wisness attended Luther College in Decorah, Iowa, and received his medical degree at the University of Minnesota. After serving in the Army during World War II, he went into general practice in Comfrey, Minnesota for five years. He worked as an anesthesiologist at Swedish Hospital, Metropolitan Medical Center, and St. Francis Hospital. Dr. Wisness became a member in 1984.
MetroDoctors
The Journal of the Twin Cities Medical Society
New Members Ali Uzma, M.D. Minnesota Oncology Hematology, PA Internal Medicine, Hematology, Oncology Guiford G. Hartley, M.D. Hennepin Faculty Associates Bariatric Center Internal Medicine Elizabeth K. Hebl, M.D. Park Nicollet Clinic Family Medicine Didima C. Mon-Sprehe, M.D. Children’s Respiratory & Critical Care Specialists, PA Pediatrics, Pediatric Critical Care Medicine Mark S. Nupen, M.D. HealthPartners-Riverside Clinic Pediatrics Carol Weitz, M.D. Internal Medicine, Medical Oncology
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CAREER OPPORTUNITIES
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September/October 2011
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luMInary of Twin Cities Medicine By Marvin S. Segal, M.D.
riCHArd j. frey, M.d. A lifetime of accomplishment; a lifetime of leadership; a lifetime of service…and a lifetime of sowing seeds. These are but four of the important attributes that characterize Doctor Richard Frey. Dick’s considerable impact on the Twin Cities’ medical community and its populace began soon after his St. Paul birth…just a few years back. As one of four sons, he soon began contributing to the Frey family tradition of accomplishment. He was the class valedictorian at Cretin ROTC Academy and a summa cum laude graduate of St. Thomas University. His long and distinguished association with the U of M Medical School has been marked with honors graduation, an internal medicine residency, full time and adjunct faculty membership and current service on the Medical Foundation Board. The St. Thomas Center for Health and Medical Affairs has also benefited from his faculty association. Dr. Frey’s gifts to his profession and the public are particularly meaningful in that he actually helped to create a number of the organizations that were instrumental in his service activities. His ideas planted seeds that led to the development of a successful internal medicine practice group that still provides care to a large local population, and he was the founding chairperson of Minnesota’s Coalition on Health, its Health Care Cost Commission, and the Minnesota Health Network. Richard Frey has never been satisfied to simply acknowledge the presence of a need; he set out — and usually succeeded — in solving and satisfying that need. He was also an Army doctor, and still serves his archdiocese on their Medical Benefits Plan Board. For all of the above — and more — he’s been the deserving recipient of the Shotwell Award, and the Distinguished Service Award of our Minnesota Medical Association. And what a leader he’s been, having served as MMA chair and presidents of the Hennepin Medical Society, the Minnesota and Minneapolis Academies of Medicine, the Minneapolis Society of Internal Medicine, the Minnesota Association of Internists and the St. Barnabas Medical Staff. He continues to lead as the patriarch 32
September/October 2011
of his large family, and he takes great pleasure and pride in spending time with his successful children and grandchildren. Dick is passionate and dedicated to a number of ideals and pursuits. Though brought up as a city boy, he satisfied his agricultural interests as the energetic keeper of outstanding gardens through the years. He’s long been troubled by disparities in reimbursement compensation among various medical specialties, and is concerned about the future plight of primary care medicine and medical education. He fervently believes that patient involvement is a key element in successful clinical treatment. Dr. Frey, despite his many accomplishments and diverse talents, is a modest and humble man. Though his journey has found him to have been strikingly successful in the practice of medicine, teaching, medical administration, and innovative care delivery — when asked what area has been most gratifying to him, he swiftly answered, “I have a great crop of raspberries this year!” When further asked, given the changes, trials and tribulations in medicine, would he pursue a different professional track if given the chance? His response left no doubt, “It’s been a wonderful career; I’d like to do it all over again.” His many admirers would also love for that to happen. This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, managing editor, nbauer@metrodoctors.com.
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