the - ihsmn.org surgical device symposium december 7-8, ... “violence in the workplace” seminars...

• The national guideline experts, Barton Schmitt, MD and David Thompson, MD

• Focus on challenging clinic topics: infections, pregnancy, neurological symptoms, rashes, diabetes, mental health, occupational exposures, dermatology, obesity and vaccines

• In-depth learning about telehealth documentation, medical call center practices, SBAR, and translating an organization’s mission and values into action – 24/7

• Details and registration form available at www.cpnonline.org. Or, email your request for full details to: [email protected]. Or, call 952-931-3545

www.cpnonline.org

Reach for the StarsReach for the Stars

A limited number of Sponsorship and Exhibitor Opportunities are still available. For details, email [email protected] or call 612-813-7435.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Minnesota Medical Association and Children’s Physician Network. The Minnesota Medical Association (MMA) is accredited by the Accreditation

Council for Continuing Medical Education to provide continuing medical education for physicians.

The MMA designates this educational activity for a maximum of 13 AMA PRA Category I credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Children’s Physician Network is an affiliate of Children’s Hospitals and Clinics of Minnesota.

Continuing our tradition of

PRIMARY CARE

Update in Critical CareSeptember 10-11, 2009Recent research and updates on issues,barriers, and strategies for best practice.

Annual Psychiatry Review:Bipolar DisorderSeptember 14-15, 2009Experts discuss optimal pharmacologicand psychotherapeutic interventions forbipolar disorder.

Twin Cities Sports MedicineOctober 2-3, 2009Updates on the evolving field of sportsmedicine through expert talks, paneldiscussions, and hands-on workshops.

Obstetrics, Gynecology and Women’sHealth: Annual Autumn SeminarOctober 5-6, 2009Education, shared research findings,and innovations in women’s health.

Practical Dermatology:Basic and AdvancedTopics for Primary Care 2009*October 23-24, 200950 of the most common skindisorders seen in primary care.

Internal Medicine Review and UpdateNovember 11-13, 2009Experts in various sub-specialtiesshare updates on current topics.

www.cmecourses.umn.eduCME Courses - Through Fall 2009

ALSO OFFERED

Global Health: Clinical Tropical, Migrant and Travel MedicineJune 29-August 21, 2009 (wkly modules)Prepares participants to work in tropicalmedicine, travelers' health, and migranthealth.

E. T. Bell Fall Pathology SymposiumOctober 2, 2009Practical, comprehensive review oncommon problems in the practice ofSurgical Pathology.

Emerging Infections in Clinical Practice and Public HealthNovember 20, 2009Infection control forum for clinicians and public health officials.

Bakken Surgical Device SymposiumDecember 7-8, 2009

* all courses will be held in Twin Cities Metro unless

indicated with an asterisk.

SURGERY FOCUS

Transplant Immunosuppression 2009:Today’s IssuesSeptember 23-26, 2009Focus on current trends in immunosuppressiveprotocols for the care of transplant recipients,risk factors for transplantation and adjustingfor them, and care of the recipient with specificpre or post transplant issues.

DEVELOPING A CME COURSE? We offer a full range of accreditation services to include full meeting planning services (course planning, registration, marketing,evaluation, audio-visual, online learning, etc.).Please contact us to discuss how we can tailorour services to meet your needs.

Office of Continuing Medical Education612-626-7600 or 1-800-776-8636

www.cme.umn.eduemail: [email protected]

2 July/August 2009 MetroDoctors The Journal of the East and West Metro Medical Societies

Physician Co-editor Lee H. Beecher, M.D.Physician Co-editor Peter J. Dehnel, M.D.Physician Co-editor Thomas B. Dunkel, M.D.Physician Co-editor Charles G. Terzian, M.D.Managing Editor Nancy K. Bauer

WMMS CEO Jack G. DavisEMMS CEO Sue A. SchettleProduction Manager Sheila A. HatcherAdvertising Representative Betsy PierreCover Design by Outside Line Studio

MetroDoctors (ISSN 1526-4262) is published bi-monthly by the East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

To promote their objectives and services, the East and West Metro Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of EMMS or WMMS.

Send letters and other materials for consideration to MetroDoctors, East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: [email protected].

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood CircleMonticello, MN 55362 phone: (763) 295-5420fax: (763) 295-2550 e-mail: [email protected].

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 informa-tion, contact Katie Snow at (612) 362-3704.

MetroDoctorsT H E J O U R N A L O F T H E E A S T A N D W E S T M E T R O M E D I C A L S O C I E T I E S

Doctors

July/August Index to Advertisers

Brainerd Lakes Health .....................................31Burnet Birkeland .................Inside Back CoverChildren’s Physician Network ............................

Inside Front CoverCrutchfield Dermatology .................................. 6Family HealthServices Minnesota, P.A. ......32HCMC Continuing Education .........................

Outside Back CoverHealthcare Billing Resources, Inc. ................. 2International Health Service of MN ............. 8Lockridge Grindal Nauen P.L.L.P. ...............21Mankato Clinic ..................................................31Minnesota Epilepsy Group, P.A. ..................... 6Minnesota Physician Services, Inc. ..............18The MMIC Group ................................................

Inside Back CoverSafeAssure ............................................................. 2University of Minnesota CME ....................... 1Uptown Dermatology & Skin Spa ..............22Wapiti Medical Group .....................................32Weber Law Office .............................................18

HealthcareBilling Resources, Inc.2854 Highway 55Suite 130Eagan, MN 55121

Contact: Rita [email protected]

HealthcareBilling

Resources, Inc.The outsourced

business office solutionfor your

medical practice

♦ Insurance/Patient Billing andCollection

♦ Accounts Receivable Management♦ Accounts Payable/General Ledger♦ Payroll/Fringe Benefit

Management♦ Experienced in over 30 Medical

Specialties♦ Qualified and Experienced Staff♦ Owned and Managed by

Experienced Healthcare PracticeManagement Professionals

Join Us At One of Our Upcoming“Violence in the Workplace” Seminars

FOR MORE INFO CALL:SafeAssure @ 1-800-920-7233

OREast Metro Medical Society @ 612-362-3799

www.safeassuremedical.com

ON-LINEON-LINEOSHA COMPLIANCEOSHA COMPLIANCE

Employee TrainingEmployee Training

$10 Per Employee

SPECIAL

Medical Society

DISCOUNT

MetroDoctors The Journal of the East and West Metro Medical Societies July/August 2009 3

V O L U M E 1 1 , N O . 4 J U L Y / A U G U S T 2 0 0 9

Contents

2 Index to Advertisers

4 The Return of Pertussis

5 2009 Health and Human Services Wrap-up

9 MediCal Missions A “Vacation” with Gratification, By Donald S. Asp, M.D.

Orthopaedic Surgeon Begins Family Mission in the Amazon, By Peter A. Cole, M.D.

The Cost for a Smile—Priceless, By T. Bruce Ferrara, M.D.

An Experience Best Shared, By Kenneth V. Hodges, M.D.

Finding Comfort in the Midst of Despair, By Anna V. Schorer, M.D.

16 Physician Profiling: What You Don’t Know Can Hurt You By AMA Private Sector Advocacy Staff

17 The Challenge of Engaging Physicians in Accreditation By William E. Jacott, M.D.

19 New Health Care CEOs in Town: Kent Bottles, M.D., President, ICSI

20 Childhood Lead Testing and Housing-Based Prevention By Megan K. Ellingson, MHA, and Jared A. Erdmann, MPH

22 AMA and MGMA Partner to Help Members With Medicare Enrollment

31 Members in the News

Career Opportunities

east MetRo MediCal soCiety

23 President’s Message

24 New Members/In Memoriam

25 Caring Hearts 2009 Drive Report/EMMS Physicians Meet With Congresswoman McCollum26 Community Service Award/EMMS Says Goodbye to Diane Tran/2009 EMMS Resolutions

West MetRo MediCal soCiety

27 Chair’s Report

28 WMMS in Action/Jack Davis Receives MVNA Award/WMMS Holds Caucus

29 Healthy Menus Minneapolis

30 New Members/First a Physician/Senior Physicians Association/In Memoriam

On the cover: T. Bruce Ferrara, M.D. holds 1-year-old Peruvian child post-op cleft lip. Medical Missions stories begin on page 9.

Page 9

Page 20

Page 4


The Return of Pertussis:

By Peter J. Dehnel, M.D.

A RECENT OuTBREAK of pertussis in the western suburbs is an important reminder of the endemic nature of this disease in Min-nesota. Given the nickname, “the 100 day cough,” whooping cough, classically charac-terized by its paroxysmal coughing, lasts at least three weeks. It tends to be much more persistent, however, with nearly 50 percent of patients having a cough for more than nine weeks. There is a cyclical nature to the disease, with a peak in the incidence seen every three to five years. There were 759 cases reported to the Minnesota Department of Health in 2008 compared with 393 cases in 2007. 2005 was the last peak year, with 1,571 cases reported for that year. Dakota and Otter Tail counties appeared to have the highest attack rates in 2008, based upon their relative populations. Dakota was particularly hard hit and had over twice the actual cases as Hennepin County. Prior to the initiation of vaccination against pertussis in the 1940s, this was a disease of early childhood. Rarely would ado-lescents and adults be affected by the disease. Because of the uncommon nature of pertussis in adolescents and adults prior to the ’40s, it was assumed that vaccination would confer the same level of long-lasting immunity as the actual disease. This, unfortunately, was not a valid assumption and immunity based on vaccination wanes over time, with protection likely lasting only 10 to 15 years. Currently the greatest increase in the number of cases of pertussis is now seen in adolescents and young adults. The treatment of pertussis has become much easier with the recognition that a 5-day course of azithromycin can effectively treat the disease and significantly limit the potential

transmission to others. It can also be used on a preventive basis for family members and close contacts of the index case. Unfortunately for the person affected by the actual disease, while antibiotic treatment may significantly reduce its contagiousness, it does not necessarily re-duce the duration of the cough.

The Vaccination SolutionAs a response to the rising rate of pertussis in teens and adults, expansion of vaccina-tion against pertussis has been initiated by the Centers for Disease Control. The use of a combination vaccine containing tetanus toxoid, reduced diphtheria toxoid and acel-lular pertussis (Tdap) is recommended as a single dose between ages 10 and 64. Many of us have been vaccinating 11- and 12 year-olds with Tdap for a few years. That has been expanded to include all eligible people from 10 to 64 years. If it has been more than two years since the last dose of Td, re-vaccinating with Tdap is now recommended under some circumstances. This includes the possibility of contact with someone who is infected with pertussis or adults who are likely to have sig-nificant contact with infants less than one year of age — e.g., new parents.

Health care workers 64 years of age and younger who have direct patient con-tact — either in an ambulatory or hospital setting — should receive a single dose of Tdap as soon as feasible. If it has been less than two years since the last dose of Td, it is not recom-mended to receive the Tdap injection at this time. Only one dose of Tdap is recommended at the current time — subsequent tetanus boosters should be every 10 years with either the Td or TT variety. “Adacel” (Sanofi Pasteur) is the only commercially-available vaccine for individu-als 19 years or older. “Adacel” or “Boostrix” (GlaxoSmithKline — GSK) can be used in the 11 to 18 year age group.

Take Home Message:We need to be in a position to give our patients the best care possible. Just as with yearly in-fluenza vaccination of all health care workers, vaccination with Tdap should be added to the list — both for our own personal best interest as well as the best interests of our patients. Contracting whooping cough from exposure to your physician is not the kind of “quality” care anyone expects — or deserves. It is time for all of us to roll up our sleeves and become personally involved with decreasing the spread of pertussis. Who knows, you may be person-ally fortunate enough to avoid 100 days of coughing from your own infection with this persistent irritant! References and further information on this topic can be found at: www.cdc.gov; www.aap.org; and www.health.state.mn.us.

Peter Dehnel, M.D., is the medical director for Children’s Physician Network and is in private practice at All About Children Pediatrics, Eden Prairie.

It is Time to Roll Up Our Sleeves!


2009 Health and Human Services Wrap-up

By Matthew S. Schafer,Lockridge Grindal Nauen, P.L.L.P.

Since 2007, Governor Pawlenty and mem-bers of the DFL controlled House and Senate maintained a fragile yet functional

relationship when it came to policymaking. Despite vastly different political philosophies, their mutual desire to adjourn on time resulted in policymakers leaving in May with a bal-anced budget that reflected concessions made by both parties. No such balance was struck in 2009 as lawmakers focused on balancing a $6.4 billion budget deficit. DFL maintained that it wasn’t unreasonable to account for one-sixth of their budget solution with tax increases. The Gov-ernor, on the other hand, remained convinced that a balanced budget could be achieved by implementing continued disproportionate cuts to Human Services and without new revenue. With battle lines drawn, a special leg-islative session appeared imminent. That all changed in one press conference where the Governor announced he would sign all DFL budget bills, thus refusing to allow a special session or a government shut-down. Instead, the Governor said he would use his veto pen to line-item individual items in the budget bills. Pawlenty also said he would use a combination of accounting shifts and unallotments to health care, higher education and local aid. An unallotment is an act of not funding a legislatively mandated budget proposal. The executive branch reserves the seldom used right to unallot expenditures when revenue projec-tions fall short of spending commitments. Governor Pawlenty is expected to authorize unallotment cuts deeper than any Governor has made in the past, causing speculation that a special session may still be necessary. In lieu of using the final days of session to

work together on a compromise proposal, the Legislature responded to the Governor’s veto by passing a third tax bill minutes before ad-journment, which the Governor subsequently vetoed. Through line-item vetoes, Pawlenty cut hundreds of millions of dollars out of the Leg-islature’s budget bills. The largest line-itemed provision was a $381 million provision for General Assistance Medical Care (GAMC), a move that kicks off 30,000 of the poorest Minnesotan’s from the state funded program. GAMC enrollees typically make an average an-nual salary of $8,000; oftentimes have physical or mental disabilities and will inevitably seek medical care in emergency rooms. Varying estimates are projecting that Hennepin County Medical Center alone will absorb between $40 million and $108 million in increased uncompensated care expenses from this line item veto. Hospitals, however, were not alone in ab-sorbing cuts in 2009. Long term care facilities, nursing homes, public services available to the disabled community and physicians will feel the pain from the 2009 legislative session.

HF 1362 Omnibus Health and Human Services BillThe Health and Human Services bill approved by the Legislature authorized a reduction of $489 million in the next biennium to the Health and Human Services Budget. This is in addition to the $381 million additional savings resulting from the Governor’s aforementioned line item veto. One time money increasing the federal match under Medicaid by 50 percent helped avoid even deeper cuts. This increased match will only last for the next two fiscal years. The 2009 budget calls on all entities that receive state funding to make deep conces-sions, many of which will result in jobs lost, increased access problems and potentially

lives lost. Rebas-ing for both hos-pitals and nursing homes were de-layed as money saving measures.A 5 percent rate reduc t ion fo r physician special-ists was included in the bill as were rate reductions for long term care facilities, inpatient hospital care services, a three percent cut for basic care services and cuts in funding for reimbursement for dental care. The physician rate cuts generated sig-nificant conversation as legislators continued to learn over the session just how little they actually know about how health insurance companies are spending taxpayer dollars. The House Health and Human Services Omnibus bill included a prohibition on health plans passing all of its rate cuts along to health care providers. Introduced by Rep. Paul This-sen (DFL-Minneapolis), this proposal was prompted largely by a sense of fairness desired by House conferees. Members of the legislature have become increasingly aware that previous legislatures have allocated funding increases to health plans hired by the state to manage public programs. However, health care providers have not received an increase in their reimburse-ment under public programs since 2000. The Department of Human Services spoke out against requiring health plans to absorb a portion of the aforementioned physician rate cuts because such a course of action would threaten the Department’s ability to ensure that reimbursement rates for public programs remained actuarially sound.

(Continued on page 6)


Health plans and the Department, how-ever, were unable to give legislators a salient answer of how they spent the funding from revenue increases in previous years. This dis-crepancy has resulted in many legislators such as Thissen and Rep. Erin Murphy (DFL-St. Paul) to call for a more transparent system where legislators have a better sense of how the Department of Human Services and health insurance companies are spending taxpayer dollars. Murphy and Thissen worked with the Minnesota Medical Association (MMA) and Minnesota Medical Group Management Association (MMGMA) to pass legislation requiring health plans to report to the legis-lature annually on how these taxpayer dollars are being spent. As the House and Senate crafted the HHS budget, there were two sticking points that threatened to halt negotiations, both of which were Senate proposals. One section, which allowed the state to impose a $48 mil-lion assessment on health plan reserves, was removed after House conferees questioned the legality of such a move. As an alternative, the conference committee authorized a shift that delays payments to health plans for funding public programs. Language authorizing stand-alone birth-ing centers was also debated at length, and the final compromise calls for the development of licensure standards for birthing centers and a cap on facility payment rates after October 1, 2009. The cap will result in a fixed rate of $3,528 paid to manage care and county-based purchasing plans for cesarean sections “without complicating diagnosis;” “vaginal delivery with complicating diagnosis;” and “vaginal delivery without complicating diagnoses.” Also included in the portion of the bill that the Governor signed into law was a provision that authorized a rate cut for anes-thesiologists when medically directing nurse anesthetists; however, the rate reduction is scaled back considerably from the original proposal. The Senate budget originally called for a 100 percent rate cut for anesthesiologists when medically directing nurse anesthetists. This draconian proposal effectively penal-ized anesthesiologists and nurse anesthetists for working together and sparked an outcry from the physician community. Many doctors contacted their elected officials on behalf of an-

Health and Human Services Wrap-up

(Continued from page 5)

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 EpileptologistsDeanna L. Dickens, MDJulie Hanna, MDEl-Hadi Mouderres, MDPatricia E. Penovich, MD

Pediatric EpileptologistsJason S. Doescher, MDMichael D. Frost, MDFrank J. Ritter, MD

Functional Neuro-ImagingWenbo Zhang, MD, PhD

NeuropsychologistsElizabeth Adams, PhDRobert Doss, PsyDAnn Hempel, PhDDonna Minter, PhDGail Risse, PhD

Appointments(651) 241-5290225 Smith Avenue NSt. Paul, MN 55102

www.mnepilepsy.org

Crutchfield Dermatology“Remarkable patient satisfaction from quality,

service, convenience and excellent results”

Your Patients willLook Good & Feel Great

with Beautiful Skin

www.CrutchfieldDermatology.com

1185 Town Centre DriveSuite 101

Eagan, MN 55123

Appointments651-209-3600

At your request, we havesame day appointments available

for your patients with acuteskin care needs.

Psoriasis&

Acne Specialist

Charles E.Crutchfield III, M.D.Board Certified Dermatologist

“Exceptional care forall skin problems”

Metro Dr. Ad 9/17/08 11:12 AM Page 1


esthesiologists in part because of the disastrous precedent that such a proposal would have set. Nurse anesthetists also received a rate reduction in the bill when performing anesthe-siology services independently. Their rate was reduced to the same level an anesthesiologist currently receives when performing the same services independently.

No Provider Tax Increase . . . For NowAs is often the case, the silver lining in the 2009 legislative session may be the legislative proposals that did not become law. Such was the case with proposals involving the Health Care Access Fund and the Provider Tax. The Governor struck first with his initial budget proposal that recommended merging the entire Health Care Access Fund to the gen-eral fund under the guise of having government operate more efficiently. This proposal would have only made it easier for policymakers to raid monies raised by the two percent provider tax for purposes that have nothing to do with providing access to affordable health coverage to low income Minnesotans. DFL members balked at this proposal which was ultimately unsuccessful. Not to be outdone, DFL members began toying with the concept of increasing the Pro-vider Tax. Rep. Tom Huntley (DFL-Duluth) and Sen. Linda Berglin introduced legislation that officially put the proposal of a provider tax increase on the table. Senate Tax Committee Chair Tom Bakk (DFL-Virginia) subsequently added language to the Senate Omnibus Tax bill to serve as a placeholder for a provider tax hike, at Berglin’s request. Part of the rationale behind this effort was to find a tax increase that Governor Pawlenty would agree to. Advocates representing providers quickly learned that in order to successfully thwart an increase in the tax under the present budget implications, new arguments were needed. Former Minnesota Senator and current associate administrator at Noran Neurological Clinic Phil Riveness, who serves on MMGMA’s Government Relations Committee, developed a document that reminded legislators that the Provider Tax and the Surgical Center Tax are each imposed on a health care provider’s gross revenue — except for in the case of patients on Medicare. Riveness’ argument pointed out that a 1 percent increase would be the equivalent of a 10 to 20 percent corporate tax increase. (Continued on page 8)

Advocates for physicians and other health care providers were ultimately successful in defeating this proposal. Proposed Provider Tax hikes are sure to resurface, particularly in light of the Minnesota Hospital Association’s (MHA) recent endorsement of an increase. It is still unclear just how deep the impli-cations of the authorized health and human services cuts are going to be on providers and patients. Will increases in uncompensated care force hospitals to close programs the state currently benefits from? Will the dramatic rate cuts create health care access problems for low income Minnesotans? Will a special session be necessary if it is clear the aforementioned cuts were simply unsustainable? These are un-fortunate questions that are indicative of the current economic climate, and may need to be revisited by policymakers before the Legislature reconvenes in February of 2010. In addition to the budget, there were several other legislative proposals that were debated in 2009. Summaries of a number of those issues are below.

Health ReformHealth reform advocates labeled the 2008 Session the Landmark Health Reform Session. While single payer supporters were not reward-ed with a system such as the one introduced by Senator John Marty, most of the health reform agenda in 2008 was enacted. New initiatives were launched to create a health care system that now includes health care homes; a qual-ity incentive payment system to providers; reimbursement for providing a basket of care; data collection by the Minnesota Department of Health (MDH) to place providers in peer groups, a concept some label as tiering; the mandatory use of electronic patient records, electronic prescribing, and electronic claims processing; uniform administrative procedures for the health plans and providers; and an es-sential benefit set. MDH, for its part, continued during the session to host meetings for providers, health plans, and other stakeholders to inform them about the ongoing efforts to implement health reform. For more information on the ongoing implementation of the health reform bill, visit http://www.health.state.mn.us/healthreform/.

Medical Record CopyingThe demand for copies of medical records increases each year and adds to the overhead

costs of every medical practice. The current allowable charge of $.75 per page plus maxi-mum charges for employee retrieval time does not cover the costs of the time of the employee making the copies and the costs of the copying itself. Because of the current costs, it was shock-ing when Senator Mary Olson (DFL-Bemidji) introduced S.F. 857. S.F. 857 would reduce the per page cost to $.05 per page with a maximum of $10 for transmitting an electronic record. The retrieval fees would remain the same and capped at one time even if separate provider entities were retrieving records. Due to the strong opposi-tion of MMGMA and other provider groups, S.F. 857 was removed from consideration for the 2009 session and will be considered in the interim by interested legislators and willing stakeholder groups.

No-Fault AutoSenator Linda Scheid (DFL-Brooklyn Park) introduces legislation on No-Fault automobile insurance each session. In previous sessions she has attempted to pass legislation that would move No-fault automobile insurance into the managed care arena by forcing injured insured’s to use provider networks organized by the automobile insurance carriers. This session she introduced S.F. 1310 which was a scaled “reform” bill. S.F. 1310 included provisions that limited medical benefits to the lower amount actually paid or incurred on behalf of the claimant; increased the weekly disability and income loss benefit; increased the allowable funeral and burial expense; directed the court in a cause of action for negligence to deduct the value of basic or optional economic loss benefits paid; limits noneconomic damages unless the amounts actually paid exceed $4,000; and, prohibited balance billing by providers if the payer deter-mined the charges were not medically necessary or exceeded usual and customary rates. Early and strong opposition to this mea-sure by the MMGMA, trial lawyers and other provider groups prevented the more onerous proposals in this bill from moving forward.

Anesthesiology ScopeNo legislative session is complete without a scope of practice debate, and one of the more visible debates involved primary physicians, anesthesiologists and nurses. Legislation was


introduced that would have authorized mul-tiple changes to the practice requirements for advanced practice nurses including authoriza-tion for advance practice nurses to prescribe pharmacological treatment. Additionally, the bill would have authorized nurse anesthetists to prescribe and administer drugs and therapeutic devices without any type of collaborative ar-rangement with a physician. The bill was initially touted as a pro-posal resulting from the recommendations of the Health Care Workforce Shortage Study, facilitated by the Minnesota Department of Health. This however, was an inaccurate char-acterization as the legislation did not reflect the Department’s recommendations. This legisla-tive effort was unsuccessful, but it is clear that advocates for an expansion in nurses’ scope of practice will return in 2010.

Single Standardized System for Electronic Data InterchangeAnother bill that passed in 2009 authorizes the Commissioner of Health in consultation with the Minnesota Administrative Uniformity Committee to study the feasibility of a single standardized system for simplifying health care administrative transactions through electronic interchange. The study requires the recom-mendations be made on the feasibility of and barriers to establishing a single, standardized system for all group purchasers for health care administrative transactions; the identifica-tion of a range of potential technologies to accomplish a single standardized system; the relationship of technologies to the current e-prescribing statute; and an analysis of the readiness of providers and group purchasers to implement appropriate technologies in compliance with current state and federal laws and standards.

Workers CompensationDuring the summer of 2008 Commissioner of Labor and Industry Steve Sviggum appointed three work groups and one subgroup to look at the workers compensation system in order to develop recommendations for system changes that would result in a major legislative effort in the 2009 Session of the Minnesota Legis-lature. With the members representing labor, business, health care, and rehabilitation the groups worked all summer into the early winter of 2009 to attempt to develop an acceptable

framework for a major workers compensation legislative initiative. Throughout their deliberations, it became apparent that the WCAC would not adopt any major legislative agenda for 2009. The 2010 Session could be another story, however, as continued pressure on the state to save money increases.

Language Interpreter Services UpdateFor years, MMGMA and MMA have worked to educate legislators on the fact that medical groups are paying for language interpreter services for non-English speaking patients at a cost of hundreds of thousands of dollars each year. There is small compensation for Medicare and Medical Assistance patients but with costs running $60 to $100 per hour, medical groups are burdened with rising and unsustainable overhead for these services. In the 2009 Session, H.F. 1211 was introduced by Representative Maria Ruud (DFL-Minnetonka) which provided for reim-bursement to be phased in with increments of one third added each year beginning July 1, 2009. The bill also provided for an Interpreter Services Work Group to be established by the Commissioner of Health to study interpreter services in medical and dental facilities with a report back to the legislature by January 15, 2010. A companion bill, S.F. 1693, was intro-duced in the Senate by Senator Linda Higgins (DFL-Minneapolis). Given the budget deficit and large fiscal estimates by the Department of Human Services, neither bill was able to move forward in 2009.

False Claims ActIntroduced by Rep. Steve Simon (DFL-St. Louis Park) and Sen. Ron Latz (DFL-Golden Valley), the False Claims Act is legislation aimed at recovering state funds from those who knowingly submit false bills to the gov-ernment. The bill as initially introduced would not have allowed employers the ability to cure a previously submitted false claim that was newly discovered without penalty. In addition, the bill included a look back provision which would have given the new law immediate enforceability on previously submitted claims. The final compromise that passed the House and Senate included a “right to cure” provision and the look back provision was removed.

Matthew S. Schafer, grassroots coordinator and lobbyist, Lockridge Grindal Nauen P.L.L.P.

Health and Human Services Wrap-up


IHS is a non-profit, volunteer organization

providing medical and dental care to remote areas of

Honduras since 1982

Future Projects

Fall 2009 October 22- Nov 1, 2009

1 medical/dental team

Winter 2010 February 13-28, 2010 6 medical/dental teams

2 surgical teams 2 eye glass teams

www.ihsofmn.org

IHS PO Box 44339

Eden Prairie, MN 55344

International Health Service

of MN


A “Vacation” with GratificationBy Donald S. Asp, M.D.


If you have a bit of a spirit of adventure and would like to begin to understand people and cultures different from your

own, medical mission work is right for you. And it is available most everywhere. I have been involved with international medical mis-sions, international medical experiences and international medical education for over 20 years, and it has certainly enriched my career and my life. For many of these, my wife, Clara, has accompanied me and has been a valuable contributor to the missions effort. The International Health Service is a Minnesota-based medical, surgical and dental organization that serves Honduras. It is entirely a voluntary, not-for-profit organization with no paid staff. The group of volunteers is quite large at about 100 to 110 people, and divides into teams of 10 or 12 individuals including pharmacists, physicians, nurses and other workers. IHS provides all of the pharmaceu-ticals and surgical supplies. The volunteers, as in all of the mission groups, pay their own transportation and expenses or obtain fund-ing elsewhere. Nevertheless, it is a relatively inexpensive “vacation” and you are expected to and do work. There are usually two or three surgical teams and eight or nine medical teams, which require a lot of support services, so spouses and significant others and willing workers are most welcome. Their Web site is: www.ihsofmn.org. Partner for Surgery (www.partnerforsur-gery.org) provides a unique opportunity for primary care physicians. Small teams, usually comprised of two or three physicians, interpret-ers of both Spanish and one of the 21 Mayan dialects, and support staff travel to remote vil-lages in Guatemala and spend the day screening

for correctable surgical condi-tions. They also treat obvious medical and cer-tain minor sur-gical problems at the location. Partner for Sur-gery (PFS) will gather patients w i th s im i l a r conditions and bring them to a location (usually Antigua — my favorite city) where they have a hotel with lo-cal interpreters and familiar food, which allows family members to accompany the patient. For example, they may bring burn cases from a variety of villages down to Antigua for a plastic or hand surgeon, or cleft lip and cleft palate patients down for ENT or plastic surgeons. Seeing a new village in this culture-rich country each day is a most interesting and rewarding experience. Virtually all of the women and frequently the men in these villages wear tra-ditional cultural costumes. Heart to Heart is a Kansas City based organization that provides service virtually anywhere in the world, but my only experience has been in Central America. Their areas of focus are education, prevention and response to crises. On my last trip, we assembled and delivered water filters to the homes of el-ementary school children in villages around Lake Atitlan in Guatemala. We would bring

the filters to the homes and demonstrate how they were to be used. The majority of our time was spent screening the school children and eventually “deworming” all of them. The primary parasite was Ascaris and it was interest-ing how we could often diagnose the problem on physical exam because of the non-tender masses in their little stomachs. Unfortunately, the primary pathology we found was dental caries and it was present in over 90 percent of them. Dr. John Schulte, from the University of Minnesota dental school, is helping us ob-tain toothbrushes and instructions on dental hygiene to be sent to the schools. People to People is an organization started by President Eisenhower to improve relations between countries by having groups from one profession meet with professionals from a dif-

Dr. Asp examines a Guatemalan child with mother’s help.

Medical Missions


some unofficial connec-tion to the State Depart-ment. The physicians and their spouses that head these groups are from all over the country and were uniformly impressed with the competent and con-scientious physicians with whom we met and with whom we continue to cor-respond in some cases.

Educational EffortsI have been most fortunate to participate in education-al experiences organized by the office of CME at the University of Minnesota with two trips to practicing physicians in Indonesia. Also, the American Acad-emy of Family Physicians sent me to India to the Christian Medical Col-lege in Vellore as a visiting

professor when they were organizing their first family medicine residency. There are a number of hospitals operated by various churches in India and well-trained family physicians are in an optimal position to provide services to these many patients. In one morning, a second year resident and I performed two hernia repairs,

a hydrocele repair and a cesarean section. The resident administered the spinal anesthetic. Through the AAFP I have also consulted on the development of a Medical Practice Act for Albania as it is trying to enter the European Union. I returned there with one other physi-cian to conduct a week-long continuing medi-cal education course, which was eventually put into a book and provided to all primary care physicians in Albania. Overall, I have visited Honduras, Belize, and Guatemala on mission trips. I have seen India, Indonesia and Albania on educational experiences, and Cuba and China on enrich-ment projects. The medical mission experience has been the most meaningful, because you are actually treating patients, at times seeing their homes and gaining a much greater un-derstanding of their culture. People everywhere are resourceful, creative and resilient, and it has been an honor to try to provide them with some needed medical services. I would strongly encourage every physician to consider participating in medical mission work. There are multiple organizations, including those for which I have provided Web sites, that are always looking for volunteer physicians, nurses and dentists for service in areas of need.

Donald S. Asp, M.D.Family PhysicianMedical Director, HealthEast Medical Care for Seniors

Orthopaedic Surgeon Begins Family Mission in the AmazonBy Peter A. Cole, M.D.

ferent culture and country. It is primarily an educational and enrichment experience. I have led physician groups to China and Cuba with visas signed by Eisenhower’s granddaughter. It is now a private organization that retains

Scalpel At The Cross was officially born in 2004, the realization of a dream first conceived in 1988 when my wife Nancy

and I were living in Miami, Florida. At that time, Nancy ran a family counseling practice merging strategies in neuthetic Christian coun-seling with clinical psychology. I was studying at the University of Miami School of Medicine.

We met a missionary couple who invited us to visit them in Peru, which we promptly did after medical school. He was a pilot, and I dreamed that one day we could fly in and out of Amazon tribes to help the natives. After a half dozen trips over 15 years, Nancy and I bought a plot of rainforest just adjacent to the aviation compound run by our

close friends, Craig and Heather Gahagen. This was at the end of a long, winding, dirt road, and wrapped around a beautiful lagoon. It was 15 miles outside of a bustling port city on the Amazon called Pucallpa. Recognizing the possible fruition of a 17 year dream, we im-mediately went to work on the construction of a guest lodge. By Christmas of 2004, the 2,600

Successful surgery in the field with a Peace Corps’ volunteer providing light source.

Medical Missions



square foot facility was completed. I have been taking medical teams down twice per year ever since, and many times with my family to whom I am indebted for our collective work. Our purpose is simply to build a medical mission camp which serves the orthopaedic needs of Pucallpan Peruvians and tribal popula-tions in the region. Staffing such a camp with Peruvian and American health care profes-sionals provides an opportunity to enhance their medical training, surgical talent, and professional choices. Pucallpa is like one of our old “Wild West Towns” in which lawlessness and disorder reign, survival of the most powerful is the only order of the day, and the ravages of disobedi-ence are evident throughout. Alcoholism is prevalent. Gun wielding jungle bandits wreak emotional and physical turmoil on innocent bystanders, executing orders from ruthless lum-bar barons with motives of conquest. Women have litters of children born into fatherless, cruel, tattered shacks along muddy roads of affliction. On an early trip into the Hospital de Pucallpa, I expressed profound personal impact after working with the Peruvian doctors for a week, “Oh so much to accomplish in this rundown open air hospital, crowded with wail-ing patients, rickety wire frame beds, expiring medications and recycled foley tubes. Survival

prevails, and a modicum of cure, through the industrious and tidily uniformed workers who show up daily at the crack of dawn, earning a fraction of a living, serving hope to despera-tion, day in and day out.” Our medical teams primarily treat pa-tients with bone deformity, bone infection, fractures and nonunions. Given that injured patients cannot encounter any semblance of contemporary care, their broken bones are simply neglected — thus yielding profound

pathology never seen in America today. The surgeries are often life altering. It is not un-common for people who have not ambulated for years, or decades, to be able to do so, and for grotesque limb deformities to be corrected, allowing life altering function. Great attention is paid to train two local orthopaedic surgeons new techniques, and to stress fundamental principles of fracture fixation in the context of sterile technique. We take shipments of do-nated implants and instruments each trip, load-ing down every team member with equipment which can transform the Peruvian surgeons’ operative armamentarium. Generally, these surgeons were only used for simple washing out of open fractures, as well as traction and casting of broken bones. On-going electronic consults and education occurs throughout the year between me and my colleagues at the Hospital de Pucallpa. I have realized that we have gained far more, as have our friends and colleagues who have accompanied us, than even the infirm pa-tients to whom we render treatment. We always return from Peru with profound gratitude and a few degrees better directed in our lives here in Minnesota.

Peter A.Cole, M.D.Orthopaedic Trauma SurgeonChief of Orthopaedic Surgery, Regions HospitalProfessor, University of Minnesota

Guest lodge at Pucallpa, Peru.

Pictured is a Shipibo Indian family who works closely with the Coles at their mission camp outside of Pucallpa. The Cole family from left to right are Nancy and Peter, and their children Danielle (17), Peter Jr. (15), and Channing (9).


an answer I could easily identify with, “how could I say no?” His parents sold their only two goats so he would have money for his trip, and because of their other small children and lack of resources, they could not accompany him. How fortunate we all felt that we had the ability to help this remarkable young man. I could fill these and many more pages with similar stories of hope, perseverance, and gratitude from memorable patients I have been involved with throughout the world. I never re-alized the personal satisfaction and professional fulfillment I could get from volunteer work helping children who are far less fortunate than my own until I participated in these activities. Fifteen years ago at a local Arby’s, I ran into a good friend of mine from medical school who asked if I would go on a volunteer mission trip with a group of physicians and nurses from Minnesota to repair cleft lips and palates in South America. As a neonatologist who works

in a highly specialized, technology dependent field with no surgical skills, I couldn’t imagine what I could contribute on such a mission. When told their main concern was airway management in small children, I felt that I might be of help. I have subsequently gone on over 20 mis-sions to various countries in South America, Africa, Asia, and the Middle East, where I use my pediatric skills in preoperative assessments and my airway and critical care skills in the recovery room. I have been to parts of the world I never had any desire to see and met people I thought I had nothing in common with. I learned quickly that although most people in the world dress and speak differently than I, have differ-ent religious beliefs and political views than my own, and live in vastly different socioeconomic conditions than I am accustomed to, we all share a universal desire to help our children in any way we can. Whether you are a Maasia from the Rift Valley, a Bedouin from the deserts of North Africa, a Quechuan speaking native from the mountains of Peru, a Palestinian from the camps in Jordan or a Khmer from the forests of Cambodia, the most important things in your life are your children, and you very well will spend all of your money, sacrifice your job, travel vast distances under difficult conditions and do whatever you can to give your child a better life. Repairing facial deformities such as cleft lips and palates, or urological problems such as hypospadius, is a relatively quick and easy process if the surgeons are well trained with the specialized skills to perform these procedures. Safety is not a concern if the patients are scru-tinized closely preoperatively, the anesthesia personnel are experienced, the nurses are bright and dedicated, and the supplies and equipment needs are properly planned for. Months of preparation by dedicated volunteers here in our community allow mis-sions like these to take place. Generous donors provide the much needed money to provide the supplies, medicines, and underlying expenses

The Cost for a Smile—PricelessBy T. Bruce Ferrara, M.D.

A 12-year-old Moroccan boy walked 12 hours alone and his parents paid for surgery with two goats.

After practicing medicine for the past 25 years I have taken care of many unfor-gettable patients at my practice here in

Minneapolis and many from my experiences volunteering overseas. I recently helped in the care of a patient who throughout his entire life had never left his small village at the base of the Sahara desert. He walked 12 hours alone at night in 40 degree temperatures to meet with a peace corps worker that he was not sure existed, in a city he had never been to. He convinced her to drive him an additional 10 hours to a hospital where I was working — hoping to persuade my colleagues and I that we should perform an operation on him, despite the fact that he missed the screening process that determined an operating schedule that was already full before he left his home. He was 12 years old. When I asked the peace corps worker how he talked her into such a venture, she gave me


In 2005 I was invited to consider being a member of a medical mission team to Honduras, sponsored by International

Health Service of Minnesota (I.H.S.). Their mission is to improve the quality of life among the people of Central America. In the past 15 years, I.H.S. medical teams have seen over 169,000 people, filled over 404,000 prescrip-tions, performed 1,752 surgeries and distrib-uted in excess of 15,000 pairs of eyeglasses. Dental teams have extracted over 41,000 teeth, made over 200 sets of dentures, and performed over 10,000 other procedures. In addition, I.H.S. has contributed over $500,000 in medi-cines and shipped several million dollars worth of medical equipment to Honduras. All of our supplies and equipment were shipped down on “banana boats” supplied by the fruit companies several months before the February trip. I.H.S. was started by an oral surgeon, Dr. Harold Panuska, a dentist, Dr. Donald Watson (my personal dentist), and a pharmacist, Jim

Alexander in 1983. One of the first doctors was a partner of mine, Dr. Kristopher Hagen and an OB-GYN, Dr. Paul Jensen (a friend and neighbor). Over the years, I often heard from those who participated what a rewarding experience it was. When my office, Southdale Family Practice, closed in 2005, I agreed to join the trip to Honduras in 2006. Though I was 79 years old at the time, I was encouraged and welcomed to go. The annual trip to Honduras is normally held in February in order to avoid the rainy season. They normally have 100 or more volunteers from the U.S. to visit seven to nine different locations in Honduras. Each team consists of one or two physicians, one or two dentists, nurses, nurse practitioners, pharmacists and other volunteers including radio operators. That allows us to keep contact with the main base and also e-mail to and from the U.S.

An Experience Best SharedBy Kenneth V. Hodges, M.D.

required for a safe and successful mission. The impact this has on the children and their families is immeasurable. Social accept-ability is not something most of us have ever worried about. We all have had the opportu-nity to befriend our neighbors and peers, get an education, marry and have families. These innate qualities of life, which we all take for granted, are not attainable if you have a large hole in your face, or you can’t speak in tones that are understandable. Medical school, nursing school and post-graduate training allow us to have the skills to change the lives of hundreds of children in a short period of time. Organizations I have been involved with such as Children’s Surgery International and Operation Smile have given us the opportunity to utilize these skills. Every mission I have participated in I have volunteered for months in advance. Im-mediately prior to leaving I never have enough time to go, have too much to do and wish I hadn’t committed. Yet every time I return, despite the long hours and hard work, I always

feel quite fortunate. I constantly relearn things I already know — how im-portant my family is, how great my job is, and how won-derful life is. I real-ize what a privilege it is to have the abil-ity, and more im-portantly the trust and confidence of people we barely know, to help these children and their families. The burdens thrust upon us by govern-ment, insurance companies, and hospital administrations such as pre-authorization, computerized charting and CPOE to name a few, don’t exist in the world of overseas volunteer medicine. Helping patients merely because we can and should is challenging and refreshing.

Volunteering for medical missions in oth-er parts of the world does not prevent hunger, wars, and global misfortune but it does make life better for many who are less fortunate than ourselves. For me, it is invigorating and makes me feel lucky that I chose my career path.

T. Bruce Ferrara, M.D.NeonatologistPresident, Minnesota Neonatal Physicians, P.A.

Dr. Kenneth Hodges (left) with son, Mark, in Puerto Lempira, Honduras.

Dr. Bruce Ferrara celebrates with Peruvian mother and 2-year-old daughter following successful cleft lip surgery.



Each volunteer pays a fee and is respon-sible for round trip air transportation from Minnesota to La Ceiba, Honduras. La Ceiba is located about 35-minutes by plane from San Pedro, Sula. On my first trip in Febru-ary of 2006, our group went to a place called Olanchito for two to three days and then on to a valley called Esquipulas del Norte, a village that had not been visited by I.H.S. until that time. We had two doctors, two dentists, two pharmacists, two nurses and several Spanish interpreters and general helpers. We also had

our radioman with us to keep in contact with the main base back in La Ceiba. We were kept busy. My physician associate, Doug Pflaum, a family physician from Red Wing, MN actually made a house call and delivered a baby during lunch break. Each day we saw approximately 200 patients. In October of 2008, my son, Mark, and I volunteered for a small group to go to Puerto Lempira in the Moskita area of Honduras. The residents speak only Moskit. This made for a rather interesting dialogue. Dr. Marianne Serkland, a retired cardiologist from St. Cloud, MN, would ask a question in Spanish, the

interpreter would ask the patient in Moskit, receive the reply in Moskit, translate back in Spanish to Dr. Serkland who would in turn translate it to me in English. Complicated at times, but it worked.

Because of the hot and humid weather, we had to give IV fluids to several of our staff. We also gave IVs to a patient who was carried back in because of an allergic reaction to sulfa. Normally, we don’t have to break into the emergency IV meds, but it was very reassuring to find how well things were coordinated and stocked. My son, Mark, had been an orderly a few years ago at Fairview Southdale Hospital so he was quite helpful to the dental and pharmacy assistants. The main problems treated were in-testinal parasites, scabies, and dental caries. We did see a patient with bilateral parotid swelling, likely a myxoma. We also saw a nine-year-old girl with unexplained blindness. She was taken back by us to Puerto Lempira where she was scheduled for an exam by an ophthalmologist two days after we left. The yearly February trip is about two weeks in length but the final two days are spent relaxing on the island of Roatan or on the mainland of La Ceiba, Honduras. Many of the volunteers from Honduras helped to make the “expatriates” from the U.S. feel at home. They also helped us feel very needed. All in all, volunteering with I.H.S. has been a very positive and rewarding experience. Already my son has asked when we can go again. I would highly recommend considering this opportunity.

Kenneth V. Hodges, M.D.Family Physician, retired

Finding Comfort in the Midst of DespairBy Anna V. Schorer, M.D.

When you’re in medicine, you can’t help but notice how many people have really terrible problems.

Because it’s human nature to be constantly comparing situations, we are reminded daily that, whatever our problems, others’ difficulties are as bad or worse. When we have abundance,

relative to others, it is our privilege to do whatever we can to help others. We can do this professionally, but we can also embed this value of helping in our private world as well. For nearly a decade, I’ve been a volunteer and a member of the Board of Directors of Nechama-Jewish Response to Disaster. This

group was started in the 1990s by Steve Lear, a Minneapolis investment manager who had taken several friends to Des Moines in 1993 when central Iowa was flooded. Together, the friends helped clean out soggy boxes of debris from a small business in Des Moines. When they came away uplifted by a sense of helping

A school classroom is divided into exam rooms by hanging sheets on clothesline ropes. Dr. Hodges (center) and EMT (left) discuss care with a young native interpreter (seated).

Medical Missions



take care of a human problem, they decided to look for more opportunities to help, and chose the name Nechama, the Hebrew word for comfort, for the group. When I heard about Nechama in 2000, I was looking for a volunteer activity that had the immediate payback of seeing a problem get fixed. As a member of Mt. Zion’s Tzedek committee, I also was interested in something that we could do without extensive formal training or time commitment. Initially, Nechama was really just four guys. Over time they collected and bought tools, then a trailer and a truck so that they could include others in clean ups after floods and tornadoes in Minnesota and the surround-ing states. It was chartered as a non-profit organization in 1996, and joined the ranks of other voluntary organizations active in disaster (VOADs). Each state has VOAD members that work along with the state and county emer-gency managers to provide direct assistance to communities during weather crises. Almost all of the organizations are in one way or another faith-based. Nechama has, from the beginning, had Jewish leaders and has gotten most of its support from Jewish donors. The core values of Judaism include performing acts of loving kindness (Gemillut Chasidim) and repairing the world (Tikkun Olam), and our Jewish volunteers appreciate the opportunity to put their values into action, to act as a role model to our children, and to strengthen friendship and goodwill between peoples of different backgrounds. Many of our volunteers are not Jewish, and of course most of the people whose homes we clean up are not Jewish — many, especially in rural areas, have never even met a Jew before we come to help. The headlines and the greatest anxiety give the impression that “disaster” is equivalent

to cataclysmic events, like Katrina, September 11, pandemic influenza, or Nine-Mile Island. The commonest problems, affecting the most people in our region, are simple acts of weather — tor-nadoes and floods. Like most states, Minnesota has a partnership of state and private responders. In a weather emer-gency, the state emergen-cy managers will monitor the situation and set up conference calls with VOAD members. When the storm is passed and the area is cleared by first responders, the response community will set up a command center, allow residents to request help, and send out crews to do recon-naissance for damage. A Nechama staff mem-ber or volunteer will drive equipment to the area and act as a site supervisor for volunteers from the community or those who arrive from other areas. This kind of volunteer work can be done by most adults in average health — it doesn’t require any technical or professional back-ground. Often, doctors, lawyers, accountants, and writers will be working together on a team. Volunteers who haven’t operated a power washer or a pump can be quickly oriented at the scene, equipped and assigned to a help team. Nechama volunteers who are in our da-tabase will have notification by e-mail before a “deployment” and usually we will schedule a work day to start early on a Sunday — meeting at one of the Twin Cit-ies Jewish Community Centers. Our vans give the volunteers a lift out to the damaged area where they clean up debris, and then we transport them back to the Twin Cities in the late afternoon. If a disaster is very large and far away, like hurricane damage, volunteers drive

or fly to the city and stay in housing that our staff have arranged. Last year was a terrible year for storms. Between tornadoes in Hugo, floods in Iowa and Hurricane Ike in Texas, we were in the field more than 200 days. This year has been better although we did assist with sandbagging in threatened areas. I never worry about running out of people who need help, and I’m sure we will have at least one or two communities who will need us this summer. Anybody who is over 18 and able to do clean up work is welcome to join us on deployment and, of course, like all non-profits, we are belt-tightening during the economic downturn. We welcome involvement and support from people of any faith, and can be reached at www.nechama.org or at (763) 732-0610.

Anna V. Schorer, M.D.HematologistVeterans Administration Medical Center

Nechama volunteers responded when a tornado ravaged Hugo, MN.

Volunteers assisted in flood clean-up in Mason City, IA. Building homes with Habitat for Humanity.


Physician Profiling: What You Don’t Know Can Hurt You

Big news related to physician profiling came out of New York last year, when Attorney General Cuomo announced his

landmark settlements with insurers operating in his state. Resulting from these settlements, the insurers are now required to submit the rating criteria they use to place physicians in tiered networks, in which members pay lower co-pays or otherwise receive discounts for seeing favored physicians. In addition, these insurers must abide by a set of standards for their physician profil-ing programs and hire an independent Ratings Examiner to report to the Attorney General every six months or incur penalties. Shortly after the insurers signed agreements with Mr. Cuomo, members of the Consumer-Purchaser Disclosure Project adopted The Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs. Under this vol-untary agreement, health insurers will follow a set of standards, hire an independent entity to audit their programs to ensure they use valid measures to rate physicians, and work toward pooling their data. Although neither the New York settlements nor the Patient Charter is a panacea for the problems associated with physician profiling, they represent important steps forward. However, the AMA contends that all physician-profiling programs must follow standards that require the use of valid methodologies, promote transparency at all levels, and assure accurate results. In order to encourage legislation on physician profiling pro-grams, the AMA developed a model bill, which mandates profiling programs adhere to a set of standards, use valid quality standards, properly adjust for risk, use sufficient sample sizes, and correctly attribute episodes of care. Additionally, insurers must fully disclose the methodology used to profile physicians and disclose the limitations of the methodology, profile physicians at the group level, establish a reconsideration or appeal

process, and hire an independent third party to oversee the program. Recently, Colorado Gov. Bill Ritter signed legislation aimed at regulating the physician rating systems used by many of the state’s health insurers. The Colorado law requires health insur-ers to make their processes for profiling, rating or characterizing physicians more transparent, and ensure greater accuracy in the results. The law also provides for an appeal mechanism so physicians can challenge the validity of their rankings prior to their release or use by health insurers. Regulations like those adopted in New York and now Colorado, and documents such as the Patient Charter are essential to help ensure that the physician performance information that health insurers provide patients is both reliable and meaningful. They establish processes that temper some of the inherent risks that can result from physician profiling. While the AMA neither supports nor op-poses physician profiling per se, when it is done, patients and physicians have the right to under-stand how the profiles are developed as well as an expectation that the results accurately reflect the realities of the physician practice. Some health insurers have unfairly evaluated physicians’ indi-vidual work. Not only can incorrect and mislead-ing information tarnish a physician’s reputation, it is unfair to patients who may consider it when choosing a physician. Erroneous information can erode patient confidence, trust in physicians, and disrupt patients’ longstanding relationships with doctors who know them and have cared for them for years. In an effort to assist physicians engaged in programs that use physician data, the AMA Pri-vate Sector Advocacy (PSA) unit created an entire series of informational pieces designed to help physician practices understand and effectively deal with such programs:• Physician Pay-for-Performance Initiatives

is a white paper detailing all facets of the pay-for-performance movement.

• How physician incentives are used to impact medical practice describes the various incen-tive models in use and provides examples of these models in practice.

• Tiered and narrow physician networks ex-plains how these networks are constructed and gives numerous examples of programs in place.

• Pay-for-performance: A physician’s guide to evaluating incentive plans provides physi-cians with a roadmap to evaluating pay-for-performance programs.

• Optimizing outcomes and pay-for-perfor-mance: Can patient registries help? describes how patient registries may be used to en-hance pay-for-performance opportunities.

• Economic profiling of physicians: What is it? How is it done? What are the issues? is another white paper that explains how cost of care measurement is performed and what its abilities and limitations are in providing accurate results.

• How to Challenge Your “Profile” or Placement in a Tiered or Narrow Network is a one-page document that gives physicians a systematic process to follow for challenging their pro-file ratings.

• Physician Profiling: How to prepare your practice provides physician practices with steps to take to be well prepared for profiling programs.

• TO OUR PATIENTS is a poster designed for physicians’ offices to educate their patients on the problems with physician rating systems.

• A Comparison of 4 Physician Profiling Pro-grams is a chart comparing key components of The AMA model bill, the Colorado law, the Patient Charter and Mr. Cuomo’s settle-ment with CIGNA.

Written by AMA Private Sector Advocacy staff.


The Challenge of Engaging Physicians in Accreditation

By William E. Jacott, M.D.

For more than seven years, I have been Special Advisor for Professional Rela-tions at the Joint Commission. This

position was established to better engage physicians in accreditation, patient safety and quality activities. This means that I have been the chief contact between individual physi-cians, medical staffs and medical organizations on the one hand and the Joint Commission on the other. This has involved all types of com-munication including site visits, presentations, phone calls, and e-mails. Sometimes it was to settle trouble or discontent, but often there are issues or new concepts to present. There are a number of organizations where I serve as liaison, for example American Academy of Family Physicians, American College of Chest Physicians and the Society of Hospital Medicine. Most importantly, it has been a physician to physician experience. Based on all this experience, I will present my observations and conclusions about physician engagement. It is helpful to review the historical ties between physicians and the Joint Commission. In 1910, Ernest Codman, M.D., proposed the end result system of hospital standardization which was an early system of reviewing medical outcomes. The American College of Surgeons (ACS) was founded in 1913 and the end result system became a stated objective. In 1918, the ACS began onsite inspections of hospitals with only 89 of 692 hospitals surveyed meet-ing minimum standards. And finally, in 1951 the ACS entered a “joint” agreement with four other medical organizations (American Medical Association, American Hospital As-sociation, American College of Physicians, and Canadian Medical Association) to create the Joint Commission on Accreditation of Hospi-

tals (JCAH). Eight years later, the Canadians withdrew and in 1979, the American Dental Association was added. So why do physicians need to be engaged? All care in the hospital and most care in other clinical settings is under the direction of a physician. They want high quality, safe care for their patients. Physicians have the knowledge, skill and experience that is essential to meet that high standard of care. The physician is a critically important member of the health care team. In this day of increased transparency, physicians need to be up to speed on issues and events that will become public informa-tion. Physicians are committed to practicing care that is evidence based and the evidence is beginning to confirm that accredited organi-zations achieve higher success in performance measurement. And finally, if it is agreed that the patient is an important member of the health care team, the physician needs to be engaged in order to respond to patient inquiry about accreditation. The Joint Commission considers phy-sician engagement a high priority and in 2005, created a Physician Engagement Advi-sory Group (PEAG). This 24 physician group comes from a wide variety of experience, back-

ground, specialty, and geographic distribution. This group has provided important feedback and recommendations on physician engage-ment and related subjects like transitions of care, new Joint Commission standards, CMO satisfaction surveys and physician involvement during Joint Commission surveys. WMMS and EMMS have also recognized the impor-tance of physician engagement through the development and support of the Metropolitan Hospital Physician Leadership Committee. This group meets four times a year and consists of medical leaders from all of the Twin City Metro hospitals. This committee provides important recommendations that impact ac-creditation, patient safety and quality. The most significant barrier to engage-ment is physician time management which includes the fact that all surveys are now un-announced making last minute participation almost impossible with full patient schedules. Physicians lack motivation since they believe that most standards are not evidence based and are not relevant to their practice. The Joint Commission Standards are not well understood or even available to the average practicing physician. Physicians continue to believe that Joint Commission accreditation is the respon-sibility of others and they avoid educational meetings or contact with the surveyors. They fail to identify the value of the process and are skeptical about the quality gained as compared to the cost. The behavior of hospital leadership can be very important in encouraging physician commitment to change and participation in accreditation, safety, and quality activities. A vision with values must be identified and com-municated. Any changes must be integrated into all hospital systems. Physicians need to be



kept informed about issues so they can under-stand the big picture and feel welcome to pro-vide input. Leadership in a role model mode needs to demonstrate new behaviors expected of physicians. The new Leadership Chapter in Joint Commission standards implemented in January of this year outlines many of these important strategies. Incentives for physician participation need to focus on patient safety, quality and clinical care and be supported by sound evidence. There are a number of tactics that I have observed to involve physicians in these activities. Some of these include: engage the physician leadership, create the right culture, support agendas that require change, and maintain momentum once processes have been accepted. Another important tactic is to identify and empower physician champions of safety and quality. Other tactics that can be helpful include: support change or initiatives with evidence/science; validate with medical outcomes; make accreditation, safety and quality regular agenda items at physician meet-

ings; embrace transparency and identify best practices. Finally, there are some tactics that can help depending upon the organization’s mission and goals and these include: involve-ment of students and residents; facilitate the team approach to a collaborative practice; keep the agendas and meeting conduct crisp and relevant; and get physicians involved in root cause analysis of major adverse events. Physician engagement in these activities continues to be a significant challenge. Em-ployed physicians tend to be more involved than do the independently practicing physi-cians. Large health care systems and multi-spe-cialty clinics have more success in engagement. So far, payment incentives have not been the answer. The Joint Commission will continue to pursue this challenge working with physicians of all types of practice and interests to assure patients that physicians are their ambassadors for accreditation, patient safety and quality.

William E. Jacott, M.D., serves as Special Advisor for Professional Relations, the Joint Commission. Dr. Jacott is a family physician and associate professor emeritus, University of Minnesota.

Accreditation


➢ You do not need to be an EMMS member to participate

a subsidiary ofEast Metro Medical Society

Call EMMS at 612-362-3799 for details.

• Linen Services• Individual/Group Insurance• OSHA Compliance Training• IT Outsourcing and Hosting

• AED Wholesaler• Coffee and Refreshments• Credit Card• Collection Related Services

Visit www.metrodoctors.com/services.cfm to read more about ways thatyou can save through our business partnerships.

Discounts by Physicians for Physicians

WEBER LAW OFFICE

Focusing on the legal needs of the

health professional! • Licensure • Employment Law • Trial Work • Wills and Estates

• Regulatory Compliance

Michael J. Weber, J.D. • Former Attorney for the Board of Medical Practice

• Over Six Years as an Assistant Attorney General

612-296-8080 www.weber-law.com

“Committed to the Best

Legal Outcome Possible Through Diligence and Resourcefulness!”

MetroDocs sixth ad.PUB page 1

Wednesday, February 06, 2002 13:30 Composite


New Health Care CEOs in Town:Kent Bottles, M.D, President, ICSI

Editor’s note: Throughout the next several issues, MetroDoctors will highlight several newly named health care executives. Each CEO has been asked to outline his/her vision and challenges for their organization as well as offer some personal insights.

BEFORE JOINING THE Institute for Clinical Systems Improvement (ICSI) in 2008, I was Chief Medical Officer of the Iowa Health System, a $2 billion organization with 23 member hospitals. Although satisfied with my position there, I applied for the President of ICSI position because ICSI has a great reputation as a leader in evidence-based medicine, it had set a new mission to help lead the transformation of the health care system and, on a personal level, my son was attending Carleton College, in Northfield, MN. In many ways, my career path made ICSI an ideal fit. I have extensive experience in integrated health care delivery systems, research, academia, and biotech start-up companies. I’ve served as Professor and Acting Head, Department of Pathology and Laboratory Medicine, at the University of Iowa, and also was the founding medical director of managed care plans for University of Iowa employees. Still, after becoming President, I was surprised at how excited everyone in Minnesota is about transforming health care. I knew I would be involved with the Minnesota Medical Association, Minnesota Hospital Association, and Minnesota Community Measurement, but I found that there were many other stakeholders committed to decreasing the per-capita costs and increasing the quality of health care in the state. These included such orga-nizations as the state health care agencies, Chambers of Commerce, Citizens’ League, Courage Center, labor unions, Isaiah, the Council of Health Plans, The Center for Cross-Cultural Health, and LifeScience Alley. We need that kind of system-wide collaboration because one of the biggest challenges today is to figure out ways to deliver high-quality, cost-effective care to patients. As the media reminds us, health care is contributing to the current recession. It is a $2.5 trillion enterprise, and Medicare (the largest payer) is seven years away from insolvency. I think we also need to view Health 2.0 technology tools as opportuni-ties rather than as threats to better take care of patients. Things like Facebook, RSS feeds, twitter, blogs, podcasts, and wikis will help us collaborate faster and broader. They also acknowledge that a Web-savvy and engaged patient is changing how health care is being delivered. For example, at first I didn’t get twitter. Then I realized that I could follow amazing people from around the world who are smarter than me and who have excellent and progressive ideas about health care. So now I twitter a lot. You can follow me if you like by going to the kentbottles site at www.twitter.com. At ICSI, I would like to do as good a job as the previous presidents, Gordon Mosser and Sanne Magnan. I am really lucky to follow such dynamic

and successful leaders. Under my helm I would like ICSI to become the go-to place for cutting edge knowledge on health care, for convening stakeholders to solve really tough health care system problems they cannot solve on their own, and to be known as the facilitator that successfully connects patients with doctors, hospitals, health plans and other health community services. Getting that done is a full-time job. ICSI recently expanded its vision to help its 50+ medical groups and hospital members transform the health care system so we are very busy changing how we operate as an organiza-tion and implementing our strategic plan. On top of that, we have been contracted by the state on projects such as health care homes and baskets of care. Health care homes are designed to better coordinate patient care, and baskets of care addresses both care and cost issues by developing a way to pay for outcomes rather than volume. ICSI hopes to help the state build coordinated, integrated and sustainable models that are widely adopted by physicians, supported by health plans, and generate better patient outcomes. Trying to also keep track of the changes unfolding with Health 2.0 and federal health care reform means there’s not much leisure time. When there is, I consume books and food. I have most recently read Innovator’s Prescription, Wikinomics, Traffic, Outliers, The Paradox of Choice, The Black Swan, and Nothing to Be Frightened Of. I dine out a lot because I have been fortunate enough to fully partici-pate in the global economic meltdown. My house in Des Moines has been on the market for over a year. I am trying to have a positive attitude, but I must admit that problem has been the biggest frustration about the move. Still, with all my networking, I’ve found Minnesota has great restaurants. Some of my favorites are Birchwood Café, Corner Table, Signature Café, Riverview Wine Bar, Alma’s, Psycho Suzi’s, and Napa Valley Grill. When dining alone, I sometimes think of the five people I would most like to break bread with: in no particular order, Jim Harrison, the novelist; Stewart Brand, the person behind the Whole Earth Catalog; Bill Gates; Leonardo daVinci, and Winston Churchill. Being at the forefront of transformation makes ICSI an exciting and challenging place to work. I consider it an honor to lead this organization at this time. The obstacles to truly transform health care are numerous and daunting, but the time is ripe for change that addresses the quality and cost-effectiveness issues health care faces. I welcome help, suggestions, and criticism as ICSI tries to improve the delivery of health care regionally.

Kent Bottles, M.D., President, ICSI, can be reached at (952) 814-7080, or [email protected].


By Megan K. Ellingson, MHA, andJared A. Erdmann, MPH

Engaging Minneapolis Clinics in

Childhood Lead Testing and Housing-Based Prevention

The Minneapolis Department of Health and Family Support, in partnership with the Sustainable Resources Center and the Medica Foundation, conducted 25 on-site clinic visits with Minneapolis clinics from September, 2008 to March, 2009. The goals of the visits were: (1) to increase lead testing of Minneapolis children under age 6; and (2) to engage clinics in housing-based lead pre-vention activities. Project materials are available for download at http://www.ci.minneapolis.mn.us/dhfs/clinicmat.asp. Minneapolis aims to test all children for lead exposure and eliminate childhood lead poisoning. We are making headway. Over the past five years, testing rates are increasing and lead poisoning cases are decreasing. In 2008 Minneapolis had 118 new Elevated Blood Lead cases; down from 327 new cases in 2002. The Minneapolis Project for Lead-Safe Kids Clinic Outreach Project, funded by the Medica Foundation, connects clinics with the city’s lead goals through on-site clinic visits. The project engages clinic staff on their roles in testing children for lead and providing re-sources to parents to detect lead hazards in their homes prior to poisoning occurring. Eighty-five percent of Minneapolis homes are likely to contain lead, and all Minneapolis children should have their blood tested for lead at age

one, again at age two, and up to age six if they have not been tested previously. “Lead toxicity is a public health problem which can be prevented and eliminated only with the collaborative efforts of physicians and other clinicians, clinics, and public health agencies. Education, screening, diagnosis, and treatment by clinicians combined with the environmental abatement of public health agencies is the one-two punch that will finally eliminate the bane of lead poisoning among urban children.” Edward P. Ehlinger, M.D., MSPH, Director of Boynton Health Service and President of the West Metro Medical Society. The CDC’s Advisory Committee on Childhood Lead Poisoning Prevention recom-mends that clinicians “provide anticipatory guidance to parents of all young children re-garding sources of lead and help them identify sources of lead in their child’s environment.” (November, 2007.) This project aimed to give clinicians easy-to-use resources to do just this. The clinic visits lasted 30-60 minutes and covered lead poisoning surveillance data in Minneapolis, Minnesota Department of

Health lead testing guidelines, education ma-terials available to clinics in various languages, incentives and billing for lead tests and other well child checkup procedures, information about the City’s lead test follow-up process, and information about making referrals to the Sustainable Resources Center (SRC) for free in-home education visits that include dust wipe sampling of the home. The project also provided Lead Check Swabs with instructions in English, Spanish, Somali and Hmong, that clinics gave to parents to check for lead on their own. The project distributed 126 information binders and 2,440 in-home lead detection kits to clinics.

Project EvaluationClinic visits were evaluated using a post survey. Of the 111 clinic participants from the 25 clinics, 105 completed evaluations. The post survey asked participants to indicate their con-fidence level before the clinic visit and after the visit in seven knowledge, skill and ability areas. Before the clinic visit, the average of reported confidence levels of all participants indicated that they were “somewhat confident” in six of the seven knowledge, skill and abil-ity areas. Most respondents were “not at all confident” in their ability to refer families to additional lead poisoning prevention informa-tion and services before the clinic visit. Analysis of the post questions indicated that confidence levels increased in all seven knowledge, skill and ability areas. Confidence levels in the six areas in which participants had

MetroDoctors The Journal of the East and West Metro Med i cal Societies July/August 2009 21

indicated that they were “somewhat confi dent” or “not at all confi dent” improved to a level of “confi dent” after the clinic visit. Three common strengths of the presen-tations that were noted included: the binder materials provided; tips and free resources for patient education and follow-up; and knowl-edge and friendliness of the presenters. Some suggestions for improving the presentations included: requesting more time for the presen-tation to be able to cover all areas; providing content areas and data needs ahead of time so participants could come prepared; and provid-ing more materials in Spanish. For more information about this project contact Megan Ellingson at (612) 673-3817, [email protected].

Megan K. Ellingson, MHA, Health Policy and Program Coordinator, Minneapolis Department of Health and Family Support. Jared A. Erdmann, MPH, Epidemiologist, Minneapolis Department of Health and Family Support.

Post Survey Results

Knowledge, Skill or Ability AreaPre % Very Confi dent or

Confi dentPost % Very Confi dent or

Confi dent

Understanding the Minnesota Department of Health’s childhood lead testing guidelines

54% (52) 94% (91)

Awareness of the prevalence of childhood lead cases in the com-munity/neighborhood surrounding your clinic

36% (35) 92% (89)

Understanding your role in childhood lead poisoning prevention 61% (59) 93% (90)

Accessing childhood lead testing data (e.g. the childhood lead testing performance of your clinic)

45% (44) 81% (79)

Educating parents about lead poisoning prevention 48% (47) 81% (71)

Referring families to Sustainable Resources Center to receive ad-ditional lead poisoning prevention information and services

18% (17) 94% (91)

Ability to positively infl uence the childhood lead testing perfor-mance of your clinic

48% (47) 92% (89)

Minneapolis 1- and 2-year-olds tested for lead, and Elevated Blood Lead cases (>= 10 mcg/dL) for children under age 6

2002 2003 2004 2005 2006 2007 2008

% tested 55 58 64.0 65 69 72 N/AEBL cases 327 252 200 216 208 149 116

Medicine is complicated. So are the laws

that doctors, hospitals and insurance

companies have to manage. Lockridge

Grindal Nauen is one of Minnesota’s

leading health care law firms.

Our health care clients are so satisfied

they’ll write us a referral.

Contact Henri Minette or Eric Tostrud

[email protected]

Integrity • Loyalty • Exceptional Service

LAWYERSTHAT

DOCTORS TRUST


To help physician practices navigate the new requirements of the Medicare enrollment process, the American

Medical Association (AMA) and the Medical Group Management Association (MGMA) partnered to develop a new online toolkit. Free to members of AMA and MGMA, the toolkit is accessible online at AMA and MGMA’s Web sites. “This new online toolkit outlines pitfalls and provides information on how to quickly and easily navigate the complicated enroll-ment process,” said AMA Board Chair Joseph Heyman, M.D. “We are pleased to partner with MGMA to provide our members with much needed help on the Medicare enrollment process.” Many of the most drastic changes to

such as a new practice address, and their enrollment status could be revoked if they do not comply with the timeframe.

• Assuming physicians have met all theMedicare enrollment requirements, they will only be able to bill Medicare retroactively for 30 days once they are successfully enrolled, rather than up to 27 months as was previously permitted.

“Many of the changes to Medicare’s en-rollment process are cause for concern, and we are working to improve the process so physi-cians can enroll without disruption to their practice,” said Dr. Heyman. The AMA and MGMA are very pleased that Medicare has now unveiled a process for submitting applications online. This is expect-ed to make the application process much faster, but the process for staff use is still cumbersome and needs improvement. “MGMA and AMA have worked closely with the Centers for Medicare and Medicaid Services (CMS) to improve the enrollment process, and while the new online system is improved there are still trouble spots that could hamper a physician practice trying to enroll,” said Dr. Jessee.

Additional InformationMore information on the enrollment process is available to all physicians and practice staff at http://www.ama-assn.org/ama/no-index/legislation-advocacy/medicare-enrollment-process.shtml, and at http://www.mgma.com/policy/default.aspx?id=5712.The toolkit is available to AMA members at www.ama-assn.org/go/medicare-enrollment-kit, and to MGMA members at www.mgma.com/enrollmenttoolkit. For a copy of the toolkit or more infor-mation contact: Katherine M. Hatwell, AMA Media Relations at (202) 789-7419, [email protected], or Liz Johnson, MGMA Press Relations at (303) 799-1111, ext. 1347, [email protected].

AMA and MGMA Partner To Help Members With Medicare Enrollment

Medicare’s enrollment process were imple-mented April 1. The toolkit aims to make the process easier by outlining the new policies in an easy to understand format. The goal is to help physicians successfully enroll as quickly as possible without interruptions to patient care or Medicare reimbursements. “We anticipate that this new toolkit will be an essential desk reference for practice staff,” said MGMA President and CEO William F. Jessee, M.D, FACMPE. Physicians should be aware of two key changes in the enrollment process that could have a negative impact on patient access to care and Medicare reimbursement. • Physiciansnowhaveonly30daystomake

changes to their enrollment information, Upt.DermPhilM.Eckerad

4.8125x4.526

Introducing…Mohs Surgery at

Uptown Dermatology & SkinSpa.

Uptown Row, Suite 208 • 1221 W. Lake Street • Minneapolis, MN 55408612-455-3200 • www.UptownDermatology.com

Skin sparing skin cancer treatment withthe h ighes t cure ra te . Dermato logyappointments available within two weeks.We are conveniently located in UptownMinneapolis one block east of CalhounSquare. We accept al l major insuranceand of fer f ree parking . To schedulean appointment cal l us at 612-455-3200.

Care for your skin.

Phil M. Ecker, M.D.Dermatologist

Uptn. Phil ad 6/2/09 9:08 AM Page 1


President’s Message

Think Nationally—the Choice is Coming

rONNELL A. HANSEN, M.D.

EMMS Officers

President Ronnell A. Hansen, M.D.

President-elect Thomas D. Siefferman, M.D.

Past President Peter B. Wilton, M.D.

Secretary/Treasurer Anthony C. Orecchia, M.D.

EMMS Executive Staff

Sue A. Schettle, Chief Executive Officer (612) 362-3799 [email protected]

Katie R. Snow, Administrative Coordinator (612) 362-3704 [email protected]

For a complete list of EMMS Board of Directors go to www.metrodoctors.com.


THE CuRRENT FEDERAL HEALTH CARE REFORM PLAN (Democrat) is potentially oner-ous for American taxpayers, health-care providers, and our patients. End game: Initially private insurance would exist; however, medicine would be administered as a utility, with regulation of many aspects. A Federal Government (FG) run, single-payer system (Canada, Britain) may be an ultimate extension. Is this end “bad” for medicine? Let’s dig deeper… Phase 1 – Mandated: Employers must offer coverage, or individuals must buy it. A FG run Medicare-like plan will compete with private insurance, using comparative/cost-effectiveness research to impose practice guidelines and to limit coverage of “expensive” drugs and devices as in the UK. Private insurance will likely face new regulations: requirement to insure all applicants, and prohibition on pricing premiums on risk basis (community rating). FG subsidies will assist “middle earners” to purchase insurance, and FG subsidizes/manages a national system of electronic medical records. Result: Unprecedented FG control over one-sixth of the U.S. economy, and over personal and private medical decisions for Americans. Employer mandate: Required to “pay or play,” those failing “meaningful coverage” pay a penalty (% of payroll), into a national fund providing insurance for non-covered workers. Interpretation: A disguised employment tax, as judged by Princeton University professor Uwe Reinhardt (Dean of health-care economists), with potential cost of 1.6 million jobs over the first five years. Individual mandate: A similar disguised tax. Worst case for these precedents: the first falling domino leading to greater FG control of the U.S. health care system. Recent history: The Massachusetts failed plan: more expensive than expected, $1.1 B in 2008 and $1.3 B 2009, now broke and understaffed for primary care. Gov. Deval Patrick will keep this “reform” with money from safety-net providers (SNP) including public hospitals and community clinics. While those lacking insurance are reduced, surveys show substantial problems with access to care. New insurance provides improved access for some, however many low-income (previ-ously receiving free care) now face co-payments, premiums and deductibles blocking them from needed care. SNP cuts reduce resources for remaining uninsured, and those relying on SNP for services in short supply in the private sector (ED, mental health, primary care). Result: modest improvement in access for some, and for others, much poorer access. Summary: FG defines criteria for “qualifying insurance” and mandate requires purchase of specific services (heavily) regulated by the FG. At minimum, deductible levels and lifetime caps are specified, and minimum benefits will likely be defined. Result: promised “if you are happy with your current insurance, you can keep it” will be untrue. Millions satisfied with current coverage will likely have to purchase FG sanctioned insurance, even if more expensive or covering unwanted benefits. Phase 2. New FG universal-health-care Medicare-like program competes with private insur-ance. Subsidized by taxpayers, it has inherent advantage in the marketplace (potentially artificially low premiums or extra benefits), with Treasury to cover shortfalls. Result: Consumers unduly attracted to lower-cost, higher-benefit FG program. Why negative? This program’s market pres-ence allows imposition of low reimbursement rates on physicians, providers, and hospitals — ala


Medicare/Medicaid/MNCare — considerably below private insurance. Providers histori-cally recoup “lost income” by raising prices on private insurance patients. Private insured pay an estimated $89 billion annually due to this “cost-shifting” from underpaying government programs. If FG public option provides (likely) similar underpayment, an additional $36.4 billion annually could be cost-shifted. Result: Private (appropriately paying) insurance raises premiums, appearing even less competitive than the FG “taxpayer-subsidized public plan,” and an estimated 118.5 million Americans (two out of every three with insurance) shift to the FG program. Summary: Death spiral for appropriately paying private insurance. Many advocates of the “public option” have past supported a FG run single-payer sys-tem, now presuming the public option would squeeze out private insurance with end result of single payer. President Obama: “it may be that we end up transitioning to such a system.” FG cost research will define procedures/technologies as “most effective” (laudable) but, more ominously, cost-effective. Yes — there is unneeded U.S. health-care system cost, but better understanding and improvement is unlikely the cost research goal. The more likely result may be restrictions on practice of medicine. Other countries use such research as basis for rationing. Great Britain: Cancer drugs “too expensive.” The U.K.: Price tags a citizen’s life — about $44,305 (£30,000) per year, a baseline, with sometime approved treatments costing as much as $70,887 (£48,000) per year of extended life — approved only if extending life by at least three months, used for illnesses affecting fewer than 7,000 patients per year.

Undermining free market forces: New insurance regulations — driving up costs, limit-ing consumer choice (leaked proposal: a choice of four standardized insurance plans); middle-class family subsidies (family of four earning up to $83,000 per year under one proposal); FG preemption of private investment and research into health IT. Estimated cost to taxpayers: at least $1.5 trillion over the next 10 years. Competition: Patients’ Choice Act (PCA–Republican), eliminates employer tax breaks for providing health-insurance benefits, instead provides annual tax credit of $2,300 individual and $5,700 family to offset cost of health insurance. Low-incomes receive subsidy to buy into private insurance plans. In common with FG plan: Exchanges (for comparison-shopping only), and investment in prevention of chronic diseases (i.e. heart disease and diabetes — some of the largest costs — as prevention is considered cheaper than treatment with some overall population statistic cost caveats). To counter, Max Baucus (D., Mont.), leading policy overhaul, has said eliminating tax incentives for benefits “would destroy the employer-based health care system we have today.” PCA addresses tax code, em-ployer roles, chronic care, HSA shortcomings, health plan competition, affordability, health IT, risk selection, Medicare solvency, litigation, payment reform — but is far from perfect. Long-term care, federal health care benefits as minimum for all Americans (expensive), failure of integrating Medicare with health plan market, guaranteed issue regulation on health plans, and insurance exchange (not politically accountable, just comparison shopping) are all potential criticisms. End Game: Government control versus pulling popular tax subsidies which provide constituent “cheap” health care. Yes, the playing field is complex and far from level.

President’s Message(Continued from page 23)

In MemoriamKENNETH O. NIMLOS, M.D. died March 14 at the age of 86. Dr. Nimlos attended the University of Minnesota Medical School and worked first in general practice. Later, in the 1970s, he became a board certified Psychiatrist and taught family practice and psychiatry at the U of MN as an associate clinical professor. Dr. Nimlos traveled extensively, having visited 26 countries, participated in many outdoor activities, and was a gourmet food and wine enthusiast. His motto was, “work hard, be responsible, do your best, and always remember you are just an ordinary human being.” Dr. Nimlos joined EMMS in 1950.

New MembersEMMS welcomes these new members

to the Society.

Active

Curtis A. Boehm, M.D.Park Nicollet Clinic – Prairie CenterInternal Medicine

Dennis J. Callahan, M.D.Allina Medical Clinic Coon RapidsOrthopaedic Surgery

Eric J. English, M.D.Metropolitan Obstetrics & Gynecology, P.A.Obstetrics & Gynecology

David D. Hamlar, Jr., M.D., DDSUniversity of MN – Otolaryngology DepartmentOtolaryngology

Loree K. Kalliainen, M.D., FACSRegions HospitalHand Plastic Surgery

C. Scott Kammer, M.D.Allina Medical Clinic Forest LakeFamily Medicine

Stephen J. Kolar, M.D.HealthEast Care SystemInternal Medicine

Denise M. Lewis, M.D.Family HealthServices MN – Highland Family PhysiciansFamily Medicine

Thomas V. Rieser, M.D.Midwest Spine Institute, LLCOrthopaedic Surgery

Carl K. Sakamoto, M.D.Shriners Hospital for ChildrenAnesthesiology

Todd A. Stivland, M.D.Bluestone Physician ServicesFamily Medicine

Stephen B. Sundberg, M.D.Gillette Children’s Specialty HealthcareOrthopaedic Surgery

Andrew D. Thomas, M.D.Summit Orthopedics, Ltd. – Hand ClinicHand Surgery (ORS)

Daren J. Wickum, M.D.Summit Orthopedics, Ltd. – Gallery OfficeOrthopaedic Surgery


Ea

st

Me

tr

o

Me

dic

al S

oc

ie

ty

Caring Hearts 2009 Drive Report

East Metro Medical Society Founda-tion joined forces again this year with HeathEast Care System to sponsor

the “Caring Hearts for Homeless People” drive. The drive benefits Health Care for the Homeless, Listening House of Saint Paul, and

SafeZone. These groups rely heavily on dona-tions in order to stay open and provide health care services to homeless patients. This was our 17th year doing the Caring Hearts drive, and we are proud to report that $3,500 of funds was raised across the metro area, and $34,000

High Pointe Surgery Center staff enjoyed their first year of participation in the drive. From Left: Sue Roen, Lynn Pien, Aaron Johnson, Jennifer Jones, and Kandi Ruvelson. Many thanks to each

participating organization:

• AdvancedSkinCareInstitute• AllinaMedicalClinic–Shoreview• AllinaMedicalClinic–ForestLake• AllinaMedicalClinic–United Hospitalist Services• AspenMedicalGroup–Highland• AssociatedNephrologyConsultants• DermatologyConsultants,P.A.• FamilyHealthServicesMinnesota– Gorman Clinic• First Presbyterian Church of South

St. Paul• GilletteLifetimeSpecialtyHealthcare• HighPointeSurgeryCenter• MNMedicalJointServicesOrganiza-

tion (MMA, EMMS and WMMS)• PartnersOB-GYN,P.A.• St.CroixOrthopaedics,P.A.• St.PaulInfectiousDiseaseAssociates,

Ltd.• St.PaulSurgeons,Ltd.• UMP-PhalenVillageClinic

worth of health, hygiene and baby items were donated for homeless patients. If your clinic would like to participate next year, please e-mail Katie Snow at [email protected]. Donations may be sent any time through-out the year to the EMMS Foundation, PO Box 131690, Saint Paul, MN 55113. Please indicate that it is for Caring Hearts. The following volunteers collected dona-tions from each site: Barbara Balfanz, Sally Brown, Doreen Hines, Andrew McCue, and Carole Nimlos, who served as the pick up/drop off coordinator.

EMMS Physicians Meet With Congresswoman McCollumEMMS physicians met for breakfast with Congresswoman Betty McCollum on Monday, June 1, at the Downtowner Woodfire Grill in St. Paul. Congresswoman McCollum wanted to bring together EMMS physicians to discuss ideas and concerns about the national health care reform initiatives. Congresswoman McCollum is a 5th term Democrat representing Minnesota’s 4th District.

From Left: Front Row: Stephanie Stanton, M.D., Amy Gilbert, M.D., Tom Kottke, M.D., Congresswoman Betty McCollum, Ronnell Hansen, M.D., Jim Jordan, M.D.,and Joe Tashjian, M.D. Back Row: Chuck Terzian, M.D., Mark Destache, M.D., and Peter Bornstein, M.D. Not pictured: Lyle Swenson, M.D., and Art Beisang, M.D.


2009 EMMS ResolutionsEMMS will be bringing 12 resolutions to the MMA Annual Meeting in September to be held in Rochester, MN. The resolution titles are listed below. The full resolutions can be viewed in the EMMS section of our Web site at www.metrodoctors.com. If you have not attended an MMA annual meeting in the past and are interested in doing so, please contact Katie Snow at (612) 362-3704, or e-mail her at [email protected]. EMMS has 31 delegate opportunities.A. Adoption of Comprehensive Tobacco Cessation Benefits B. Enactment of MN Apology Laws to Encourage Physicians

to Disclose Medical ErrorsC. Consumer-directed Reforms for Minnesota State Health

ProgramsD. HDHP Combinations for Medicaid and Other Public

Programs: Medical IRAs for the PoorE. MMA Support the Concept of HRAs and Other High

Deductible Health Plans for Public Sector PopulationsF. MMA Promotion of Addiction Awareness and Commu-

nity CollaborationsG. Payment Parity to Health Plan Patients Who See Out-of-

Network Psychiatrists

From Left: Amy Gilbert, M.D.; Robert Moravec, M.D.; Peter Wilton, M.D.; and Thom Siefferman, M.D., listen as Jo Ann Wood, M.D., second from right, shares her view on a resolution at the May 28 EMMS Caucus.

H. Consolidation of EMMS and WMMSI. Lawsuit to Remove Obesity Carve-Outs Language from State PlansJ. Work Group to Study MMA Policy Relative to Rapid Changes in

the Medical Care SystemK. Prohibit Payments for Volume of ReferralsL. Corporate Practice of Medicine and Fee Splitting Prohibition

In June, EMMS said fare-well to Diane Tran who worked as the project lead on the Smoke Free Dakota project for the past three years. The work that Diane did in Dakota County was funded by a grant from ClearWay Minnesota that ended June 30, 2009. Diane is probably one of the more creative people that we have met when it comes to engag-ing the community around smoke-free policies. She has done that through community events like rock climbing, snow tubing, downhill skiing, 5K runs, self-defense trainings, salsa dancing — you name it, she has thought of it. She has tabled at community events and fairs and engaged high school and college students in the work she is doing. She has engaged volunteers to help her staff some of the community events and has hired interns to help perpetuate the smoke-free policy work. She has the ability to think outside of the box and to make things really fun for participants, yet at the same time hammering home the mes-sage about the importance of smoke-free policies. EMMS wishes Diane Tran the best of luck in her future endeavors.

EMMS Says Goodbye to Diane Tran

EMMS is now taking nominations for the 2009 community service award, which will be presented to the recipient at an appropriate venue. Please think about physicians you know who are active in the local community beyond his/her professional medical work.

Award Criteria

• ActiveorretiredEMMSmember

• Voluntary,localservicewithspecialprojectsorprograms,partici-pation in civic or service organizations, educational or charitable groups, or in public office(s).

Call or e-mail Katie Snow with nominations: [email protected]; (612) 362-3704 or visit our Web site to download a nomination form. www.metrodoctors.com.

Nominate a Colleague for the

Community Service Award!


WMMS Officers

Chair Richard D. Schmidt, M.D.

President Edward P. Ehlinger, M.D.

President-elect Peter J. Dehnel, M.D.

Secretary Melody A. Mendiola, M.D.

Treasurer Eric G. Christianson, M.D.

Immediate Past Chair Anne M. Murray, M.D.

WMMS Executive Staff

Jack G. Davis, Chief Executive Officer (612) 623-2899 [email protected]

Jennifer J. Anderson, Project Director (612) 362-3752 [email protected]

Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 [email protected]

Kathy R. Dittmer, Executive Assistant (612) 623-2885 [email protected]

For a complete list of WMMS Board of Directors go to www.metrodoctors.com.

Chair’s Report

Is Health Care Supersized?

rICHArD D. SCHMIDT, M.D.

OBESITY IS AN EPIDEMIC IN THE uNITED STATES. A crusty, now retired, physician was rumored to have told obese patients that they were a two-ton load on a one-ton truck. The medical marketplace seems to be the same. Just like our population and their insatiable appetite, health care has become obese. Our patients have no end of food choices. They can stop at McDonald’s, eat at the Cheesecake Factory or buy a gallon soda at the convenience store. The possibilities are endless and there is nothing to stop them other than money. Medicine is similar, with endless technology and endless choices; but there is a difference. Medical care is usually paid by a third party, so give me the latest and greatest despite the cost or proof of efficacy. There are many ways to lose weight. There are also too many diet plans to count and the result is often quick weight loss only to gain it back later. The slow and steady method has always appealed to me. There was a story in the Minneapolis Star Tribune a few years ago about a woman who became motivated, by her daughter’s example, to run a five-kilometer race. The problem was that she was 50 years old and weighed over 300 pounds. Her lunch consisted of McDonald’s, eaten at her desk. The only changes she made were to bring a light lunch from home and to go walking at noon. Over about a year she lost 150 pounds and accomplished her goal. I hope she kept the weight off. Since medical care is paid by government, employers and individuals, the burden doesn’t fall in one place like our own weight loss. It is a shared societal responsibility. Medical providers have great influence on patient decisions and therefore should make the best decisions with the patient to provide them with the maximal treatment benefit. The decisions should be free of self-enhancement for the physician. This has become more and more difficult with the Internet, direct to patient advertising and the never-ending choices of treatment, most of which are paid by someone else. Our government has helped fuel the feeding frenzy in medicine. In their efforts to provide access they have continued to add layer upon layer of medical choices each accompanied by more expense. The examples are the ancillary providers who now make a pitch for independent practice and prescribing privileges, with much less experience and training than physicians, yet billing significant fees. Add to that the chiropractors, acupuncturists, herbalists and the other alternative care providers. Examples from the current legislative session are a new type of dental provider, birthing centers and the issue regarding supervision of nurse anesthetists. I can’t believe that add-ing more and more tiers of care can be cost effective if one considers the increasing demand for services, education and training and administrative costs. Finally, society including government, medical providers and payers must consider how many choices we need. When can we have the “Big Gulp” versus a more economical size? How much access do we need? Can we drive 30 or 40 miles for care? Technology is wonderful but it is often used regardless of cost or proof of benefit. Look at the end of life issues. It is a huge cost but no one wants to address this difficult ethical issue. I work for the Veterans Administration and the government has stayed out of harms way by not dealing with this. The only area of medicine where I see rules are in transplant surgery and this is out of necessity due to lack of organs. In the United States our population gets what they want, not necessarily what is needed or what is fair. We have become the two-ton load on a one-tone truck. Our economy can’t afford it and needs a long, healthy, consistent and balanced diet.


WMMs in aCtionJACK G. DAVIS, CEO

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

WMMS Holds Caucus

In preparation for the Minnesota Medical Association’s Annual House of Delegates, the West Metro Medical Society held its Caucus on Wednesday, May 20, 2009. Benjamin W. Chaska, M.D. was elected as the Caucus Chair. WMMS is eligible for 88 members to serve as delegates. The following resolutions were pre-sented for consideration before the Caucus:• The Role of Primary Care Medical

Providers in Reducing Caries as Part of Well-Child Care

• Enactment of Minnesota “ApologyLaws” to Encourage Physicians to Disclose Medical Error

• AdoptionofComprehensiveTobaccoCessation Benefits

• Consolidation of East Metro Medi-cal Society and West Metro Medical Society

• PaymentParitytoHealthPlanPatientsWho See Out-of-Network Psychiatrists

• Consumer-DirectedReformsforMin-nesota State Health Care Programs

• MMASupporttheConceptofHRAsand Other High Deductible Health Plans for Public Sector Populations

• MMAPromotionofAddictionAware-ness and Community Collaborations

• MinimumDrinkingAge• DisabilityDiscriminationtotheMin-

nesota Board of Medical Practice The approved resolutions will be for-warded to the MMA for inclusion in the meeting materials. Resolutions can still be submitted for individual consideration and for support by the WMMS Caucus prior to the convening of the House of Delegates. Please contact Kathy Dittmer if you would like information on how to submit a resolu-tion or to register as a delegate at [email protected] or www.metrodoctors.com.

Minnesota Medical Association Annual Meeting

September 16-18, 2009Civic Center

Rochester, MN

Jack Davis, CEO, West Metro Medical Society (center) is presented with the Min-nesota Visiting Nurse Agency’s Fredrick Butterfield Chute Award by CEO, Mary Ann Blade. Richard Schmidt, M.D., WMMS Board Chair and Edward Ehlinger, M.D., President (not pictured) also attended the event.

Jack Davis Receives MVNA Award

The advanced care planning project contin-ues to gain momentum under the leadership of Kent Wilson, M.D. The name chosen is “Honoring Choices of Minnesota.” In addition to EMMS and WMMS, partners include ICSI, Stratis Health, Hospice Minne-sota, HealthPartners/Regions Hospital, Allina Hospitals, Park Nicollet Methodist Hospital, UCare, BCBSM and Medica. Other medical organizations are being recruited.

The consolidation of EMMS and WMMS as reported in the last edition of MetroDoctors is progressing as planned. Governance and financing decisions have been made, bylaws are under development and the communications plan is being pursued. A resolution has been accepted at the two medi-cal society caucuses and will be forwarded to the September meeting of the MMA House of Delegates for ratification.

MMA, WMMS, EMMS and the Minnesota Medical Group Management Association

have collaborated to create a “payer alert” for the latest BCBSM Aware contract. The document that enumerates the changes to the contract can be found at www.metrodoctors.com or the MMA Web site.

Edwin Bogonko, M.D., WMMS Board member, made a presentation to the WMMS Board of Directors on April 30, 2009 concern-ing the issues of foreign trained health professionals. Dr. Bogonko works with a collaboration of organizations which have assisted 150 foreign trained health professionals obtain the necessary training and licensing to practice their profession. He seeks the medical society members’ help in enabling this valuable resource.

The Metropolitan Physician Hospital Leadership Committee continues to meet on a quarterly basis. Issues discussed at its May meeting include the Minnesota Creden-tialing Collaborative; the Joint Commission new standard regarding disruptive health professionals; medical staff bylaws standards; the Commissions deemed status with Medi-care; and changes in medication reconciliation. Members of this committee include Chiefs of Staff, Chief Elects and Vice Presidents of Medi-cal Affairs.

The Minnesota Visiting Nurse Agency held its Fourth Annual Fundraising Breakfast on Tuesday, June 2, 2009 celebrating “There’s No Place Like Home! — Caring for the Community for Over 100 Years.” Mary Ann Blade, CEO presided over the event highlighting many of the services and personal success stories of clients served by MVNA. Three years ago, MVNA established the Fredrick Butterfield Chute Award, an award that represents acts by Board Members or their descendents that impact significantly on MVNA and its present and future activities. Jack G. Davis, CEO, West Metro Medical Society, was recognized as this year’s recipient. Jack served on the MVNA Board from 1999-2008 and as its Chair, 2002-2004. In presenting this award, Ms. Blade af-firmed, “For the leadership and entrepreneurial vision that you brought to MVNA by connecting us as partners with the physician community

with our flu shot program, leading our move to beautiful office space and helping us furnish it, supporting us through your foundation connec-tions in a time of crisis, and for your leadership with Hospice of the Twin Cities.”


Healthy Menus MinneapolisA Coalition of Organizations Concerned About Obesity

We

st M

et

ro

M

ed

ic

al S

oc

ie

ty

WMMS’ first project of the Healthy Eating Minnesota contract is Healthy Menus Minneapolis, a new coalition

of organizations concerned about the health of our families, and especially the growing obesity epidemic. One of the contributing factors of the growing national obesity epidemic is the public’s increasing reliance on fast food. Today, the nation’s children and families, on average, consume one-third of their calories eating out. Children eat almost twice as many calories when eating at a restaurant compared to a meal at home. Unfortunately, the majority of restaurants do not provide easily accessible information related to the calorie content of the food they serve, making it nearly impossible for consum-ers to make informed healthy choices. Healthy Menus Minneapolis will take the opportunity to educate consumers about daily caloric intake and how many calories are necessary to maintain a healthy lifestyle. Healthy Menus Minneapolis believes that in order to combat one of the root causes of obesity, restaurant chains should be required to provide the calorie information of the food they serve, on menu boards, drive thru menus and table menus so consumers can make healthy informed choices at the point of purchase. In an effort to address the growing obesity epidemic, several cities and counties throughout the United States have passed regulations requir-ing chain restaurants to post calorie information for the items they serve. The purpose of these regulations is to provide consumers with calorie information at the point of purchase which will help people make healthier choices. New York City became the first city in the U.S. to require fast-food and other chain restau-rants to list calories on their menus. Not only were the restaurants able to easily implement the regulation, it is very popular with custom-ers. Massachusetts just passed a statewide menu labeling law following the footsteps of California. In a recent survey, approximately half of chain restaurants in Minneapolis provided at least a limited amount of calorie information for items on their menus. However, only 23 percent had the information available at the point of

purchase, primarily in brochure format. None of the restaurants displayed the information on a menu board, where it is easiest to review as purchases are being considered. In half the sites with calorie information, it was available for only a limited set of menu items. A 2008 Minneapolis public opinion survey found: • Nearly 8 out of 10 respondents eat in a fast

food, sit down chain, or chain coffee shop at least once per week.

• On average, Minneapolis residents eat at a fast food, chain restaurant or coffee shop three times per week.

• Six out of 10 respondents (64 percent) are concerned about the amount of calories in restaurant food.

• Only 9 percent of respondents estimated correctly the number of calories in a popular children’s meal at Applebee’s Restaurant; 81 percent underestimated the calorie content of the meal.

• Seventy-nine percent of Minneapolis resi-dents support an ordinance requiring calorie

information to be posted on restaurant menus and menu boards.

• The primary reasons for supporting the ordinance include wanting more informa-tion and the belief that information will help consumers make healthier choices.

Healthy Menus Minneapolis is currently building individual and organizational support through presentations, attending community events and festivals and spreading the word about the need for a comprehensive calorie labeling ordinance for all fast-food establishments with 15 or more locations nationwide, requiring those establishments to post calorie counts on their menus, drive thru menus and table menus allow-ing consumers to make more informed decisions at the point of purchase. If you’re a physician and would like to get involved with our campaign, please contact Jen-nifer Anderson, Project Coordinator at WMMS at (612) 362-3752 or [email protected]. You can find more information and re-sources about Healthy Menus Minneapolis and calorie labeling at www.metrodoctors.com.

Jennifer Anderson, project coordinator, displays an exhibit used to educate the community about the importance of calorie labeling and the need for a local ordinance.


Welcome New WMMS Members

ActiveThomas G. Cohn, M.D.Medical Advanced Pain SpecialistsPhysical Medicine and Rehabilitation

Linda M. Eelkema, M.D.Aspen Medical Group — BloomingtonPediatrics

Mark R. Koller, M.D.Psychiatry

Jennifer S. Oberstar, M.D.Camden Physicians, Ltd.Family Medicine, Family Sports Medicine

Joseph T. Teynor, M.D.Orthopaedic ConsultantsOrthopaedic Surgery

Resident PhysiciansPatricia M. Hobday, M.D.University of MinnesotaPediatrics

Kathryn M. Manning, M.D.University of MinnesotaPsychiatry

Sarah E. Meyers, M.D.University of MinnesotaPathology

Bryan A. Whitson, M.D.University of MinnesotaGeneral Surgery

Azeb Yihune, M.D.University of Minnesota(no specialty identified)

Senior Physicians Association

In MemoriamHREIDAR AGuSTSSON, M.D. died at his Chanhassen home with his wife by his side on May 9, 2009 at the age of 90. He graduated from Laeknadeild Haskola Islands, Reykjavik, Iceland. Fol-lowing graduation, Dr. Agustsson was granted a Rockefeller Foundation scholarship to study at the University of Minnesota where he specialized in Pediatrics. In 1950 he established a thriving pediatric practice in Edina which was to become Southdale Pediatrics.

ROBERT S. CLARK, M.D. died May 18, 2009 at home surrounded by his family. He was 87. He graduated from the U of M Medical School in 1946. He completed naval service in 1949 and worked for 30 years as a psychiatrist at the Minneapolis Clinic of Psychiatry and Neurology, and for five years as a consultant for Group Health. Dr. Clark was a charter member of the Minneapolis Psychiatric Society and Life Fellow of the American Psychiatric Association. He was a clinical as-sociate professor at the U of M medical school for over 30 years.

WILLIS M. DuRYEA, JR., M.D. died in May at the age of 84. He graduated from the University of Minnesota Medical School and practiced internal medicine.

CHARLES D. OFFICER, M.D., CDR, USNR, MC (Ret) died on April 27, 2009, at the age of 81. He graduated from the University of Iowa College of Medicine in Iowa City. His service to his country as a Naval Flight Surgeon spanned six decades from WWII through Desert Storm. He practiced medicine for a half century, first in Bloomington and then as the first family doctor in Burnsville.

YANG WANG, M.D., died on April 5, 2009. He was 85. He graduated from Harvard Medical School in Boston. Dr. Wang was professor emeritus, Dept. of Cardiology at the University of Minnesota.

BRuCE J. VAN DYNE, M.D. died on April 3, 2009 at the age of 68. He graduated from North-western University Medical School in Chicago. Dr. Van Dyne was a board certified and practicing member of the American Academy of Neurology.

The Senior Physicians Association began its 27th year with a presentation by Vivian Lang-

ley, Major Gifts Officer for the University of Minnesota Athletics Department. She enlight-ened the group about her role in scholarship endowments and raising money for capital projects as well as statistics and stories about the U of M athletes, their goals and current activities. Ms. Langley presented a virtual tour of the new TCF Bank Stadium available for viewing at http://stadium.gophersports.com/. If you are 62 years of age and/or retired, you are eligible to join this group. The cost is $20 annual dues or $100 for lifetime dues. For more information, visit our Web site at www.metrodoctors.com, left margin click West Metro Medical Society, middle of the page — click 6th bullet — WMMS Senior Physicians Association. You will find more information as well as an application. If you have any questions, contact Kathy Dittmer at (612) 623-2885 or [email protected].

Deadline for submission is JuLY 7, 2009

The First a Physician Award recognizes a member of the WMMS who selflessly gives of his/her time and energy to improve the health of their patients, has made a positive impact on Organized Medicine and the medical com-munity’s ability to practice quality medicine, and/or has been instrumental in improving the lives of others in our community.

Visit www.metrodoctors.com/hms.cfm for award criteria.

Nominations Sought for First A Physician Award

Edward Spenney, M.D., Senior Physician As-sociation President, welcomed speaker, Vivian Langley, Major Gifts Officer, U of M Athletics Department.


C A R E E R O P P O R T U N I T I E S

Members in

the News

The Members in the News section recognizes the appointments, presentations, awards, hon-ors and other professional accomplishments of EMMS and WMMS members. Submit physician news by fax (612) 623-2888, e-mail ([email protected]) or mail to Editor, MetroDoctors, 1300 Godward Street NE, Suite 2000, Minneapolis, MN 55413 for consider-ation by the editorial board. Questions? Call Nancy Bauer at (612) 623-2895.

see additional Career opportunities on page 32.

WILLIAM E. JACOTT, M.D., associate professor emeritus, was awarded the 2009 President’s Award for Outstanding Service by University of Minnesota president, Robert H. Bruininks.

CHARLES CRuTCHFIELD, M.D. appeared on CNN’s “House Call” on May 30, 2009 with Dr. Sanjay Gupta discussing skin cancer and other skin conditions.

ROBERT F. WILSON, M.D. was recently named cardiovascular executive medical di-rector of University of Minnesota Physicians.

The Alliance of Independent Academic Medi-cal Centers has named CARL A. PATOW, M.D., MPH, executive director of Health-Partners Institute for Medical Education, as its president.

DAN WEISDORF, M.D., professor of medicine and director of Adult Blood and Marrow Transplant Program at the University of Minnesota, has been elected vice president of the American Society of Blood and Marrow Transplantation.

DAVID MCKENNA, M.D. has been ap-pointed scientific director of the University of Minnesota’s Molecular and Cellular Thera-peutics facility.

An addendum to the Fairview Southdale Hospital medical staff 2008 Physician of the Year Award as reported in the May/June 2009 issue of MetroDoctors: In addition to Dr. Joseph Tombers, JAMES H. SOMERVILLE, M.D. was also named as an award recipient.

Patients come �rst.But the scenery

is a close second.

come �rst.

is a close second.

You’ll �rst decide to join Brainerd Medical Center, located in Brainerd, Minnesota, because we You’ll �rst decide to join Brainerd Medical Center, located in Brainerd, Minnesota, because we You’ll �rst decide to join Brainerd Medical Center, located in Brainerd, Minnesota, because we You’ll �rst decide to join Brainerd Medical Center, located in Brainerd, Minnesota, because we provide an unparalleled level of patient care. But then you’ll see the scenery. 450 lakes. Over 100 provide an unparalleled level of patient care. But then you’ll see the scenery. 450 lakes. Over 100 miles of trails. �ousands of acres of public forest. And that’s when you’ll think to yourself, now here’s a place where I can improve the quality of life for everyone, including me.

Internal Medicine$25K Sign-On Bonus & $15K Relocation AllowanceWorking in outpatient only or inpatient/outpatient, you'll see an average of 25-30 patients per day during your 4 day workweek. Call is 1:12, but will become minimal in the next year as we �ll out our Hospitalist sta�. Enjoy friendly, collegial relationships as well as $190K �rst year salary plus production, generous bonuses, health/life insurance, CME, malpractice coverage and more!

Also seeking a Day Shi� Hospitalist: 7 on/7 o�; 24 weeks per year; $200,000 salary.

Resident stipend available to those still in Residency!To apply, we invite you to contact: Ryan Berreth at (218) 454-5800 or email: [email protected].

www.explorebrainerdlakes.comwww.brainerdlakeshealth.com

EOE/AA

MANKATO CLINIC

The Mankato Clinic is physician owned with a service area population of over300,000. We offer outstanding benefits including generous CME allowance,health/disability/life and medical malpractice insurance, 401(k) plan and more.

Mankato has exceptional recreational and cultural activities, excellentprivate and public school systems and Minnesota State University, Mankato.

If you would like to join our growing practice, submit a detailed CV or callMark S. Matthias, M.D., Chief Medical Officer at 507-389-8756 or DennisDavito, Director of Provider Placement at 507.389.8654, Fax: 507.625.4353,Email: [email protected].

An AAAHC-accredited Clinic • www.mankato-clinic.com

The Mankato Clinic, is recruiting for the following BC/BE primarycare physicians to join our well-established practice in theregion’s leading multi-specialty group:

• Family Practice• Hospitalist• Internal Medicine• Pediatrics

32 July/August 2009 MetroDoctors The Journal of the East and West Metro Med i cal Societies

C A R E E R O P P O R T U N I T I E S Please also visit www.metrodoctors.com for Career opportunities.

Great Partners, Great Staff, Great Patients, Excellent Income & Lifestyle

FOR MORE INFORMATION PLEASE CONTACT:Paul Berrisford, 2025 Sloan Place, Suite 35, St. Paul, MN 55117651-772-1572 • email: [email protected]

Family HealthServices Minnesota, P.A. is looking for

several Board Certified/Eligible Family Physicians to fill full-time, part-time or

shared positions.

Join our Independent Group of 64 physicians serving 13 clinic sites.

Ê

Contact Brad McDonald, MD 888-733-4428 or email: [email protected]

www.connecthealthinc.com

Hospitalist Opportunities in Northern Minnesota!

Skiing! Ê Hunting! Ê

Biking! Ê Fishing! Ê

$95-$143/hour $95$95Boarded IM & FP Paid Malpractice Paid MalpracticePaid MalpracticeNo Need to Relocate Strong Local Support Strong Local SupportStrong Local Support12-16 Encounters/Shift

TheÊ HospitalistÊ DivisionÊ ofÊ Ê

WapitiÊ ÊÊ Ê MedicalÊGroupÊ Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê Ê

Full or Part Time Shifts Available!

Wapiti Medical Group

ÊÊ

Call Dr. Brad McDonald, CEO

Wapiti Medical Group PO Box 523

Milbank, SD 57252 888-733-4428

Fax CV to: 605-432-5669 [email protected] WWW.ERSTAFF.COM

Many other shift combinations available at various locations.

TiredÊ ofÊ LowÊ PayÊ andÊLongÊ Hours?Ê

We offer unique full or part time opportunities in

Minnesota!

Earn up to $180K/year (working 6 24 hour shifts/mos.) (working 6 24 hour shifts/mos.)

ER Coverage Shifts ÊER Coverage Shifts

Flexible Scheduling Flexible Scheduling

No Need to Re-locate ÊNo Need to Re-locate

Paid Malpractice

BurnetBirkeland.com 612.925.8405

BURNET

Minnetonka Beach One of a kind 3 acre penin-sula site with 1600 feet of breathtaking shoreline.

Wayzata Architectural 4 BR / 4 bath on private .59 acre lot with walls of glass.

Minnetonka Extensive renovation of 6,683 FSF contemporary in Hilloway neighborhood.

Eden Prairie Nantucket in Bearpath - 6 BR/ 5 Bath Steiner Koppel-man on private .85 acre lot.

$5,250,000 $649,000 $1,495,900 $1,795,000

www.BurnetBirkeland.com

When you choose MMIC Technology Solutions, you get:

local service and support that puts you fi rst

proven track record with a trusted partner

streamlined systems that can connect between external care systems

MMIC Technology Solutions is an authorized reseller of the NextGen® Electronic Health Records and Enterprise Practice Management systems.

To learn more about how MMIC Technology Solutions can help make your practice run more effi ciently and profi tably, call Brian Salzman at 763–201–0304.

1

2

3

Are you managing your practice

or is managing you? ”“

IT

Here are the top 3 reasons why many of your colleagues are choosing MMIC for their EHR and EPM.

to protect against & prevent malpractice

Insurance, Claim & Risk Management • Technology • Customer Service

to help your practice thrive

that puts you fi rst

MMICTechnologySolutions.com

the - ihsmn.org surgical device symposium december 7-8, ... “violence in the workplace” seminars...

Documents