2002novdec

Nov/December 2002

PREPARING FOR THE FUTURE

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Doctors MetroDoctors THE BULLETIN OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761.

To promote their objectives and services, the Hennepin and Ramsey 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 HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. E-mail: bauerfamily@earthlink.com.

For advertising rates and space reservations, contact: Kirsten Schoeller 14953 Appaloosa Trail NE Prior Lake, MN 55372 phone: (952) 440-2997 fax: (952) 440-9662 e-mail: kirsten@pierreproductions.com.

MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy.

Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Doreen Hines at (612) 362-3705.

MetroDoctors

CONTENTS VOLUME 4, NO. 6

2

LETTERS

3

SOAPBOX

NOVEMBER/DECEMBER 2002

“Readiness to Change”

4

COLLEAGUE INTERVIEW

Brian Campion, M.D.

6

FEATURE

Transition from Managed Care to Consumer-Focused Care

10

Physician Workforce Survey – The “Brain Drain”

11

Workforce Shortages: the Road to Long Term Care Reform

14

Strategies for Recruiting Nurses Must Focus on Improving Work Environment

16

2002 MMA House of Delegates

17

Fifty Club Awards

18

Highlights of the Code of Medical Ethics of the AMA

21

Lunch ’n Learn for Medical Students

22

Falling Through the Cracks: Care Coordination for Low-Income Pregnant Women

RAMSEY MEDICAL SOCIETY

23 24 25

President’s Message

26 27

New Members/In Memoriam

RMS Candidates Elected by MMA House/Dr. Crutchfield Receives Humanity Award Meeting with Betty McCollum/St. Croix River Cruise/ RMS Annual Meeting

Nov/December 2002

Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Richard J. Morris, M.D. Physician Co-editor David L. Swanson, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Representative Kirsten Schoeller Cover Design by Susan Reed

RMS Alliance PREPARING FOR THE FUTURE

HENNEPIN MEDICAL SOCIETY

28 29 30 31 32

Chair’s Report Members Elected to MMA, AMA Positions/MMA Awards New Members In Memoriam HMS Alliance

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: Organized medicine working toward the future. Related articles begin on page 6.

November/December 2002

1

LETTERS

To the editor, First, I want to thank you for giving me the opportunity to respond to your questions in the September/October issue of your magazine. We, at Medica, are always happy to share opinions and engage in dialogue regarding health care issues and concerns. I also wanted to follow-up and respond to the one question that did not get answered.

“Health care premiums in Minnesota are higher than the national average, yet the cost of health care in Minnesota is about 82 percent of the national average. Where is the money going?”

Since we don’t have the details related to this data and how it was gathered, it is difficult to offer specific comments. Our national benchmark data confirms that

premiums are higher in Minnesota, but also shows that medical expenses are 5-7 percent higher than comparable plans around the country. Medical expense is a combination of provider fees, and utilization of health care services. Medica’s premiums are calculated to cover actual medical expenses and administrative costs with just enough margin to maintain our reserves.

When reviewing medical expense to determine where the money is going it is important to consider the following information. From 1999 through the first five months of 2002, overall utilization of health care services has increased by almost 25 percent. This includes an increase of 40 percent in the use of outpatient hospital services. When combined with higher

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November/December 2002

MetroDoctors

physician and hospital fees, this has resulted in significant increases in medical expense and premium. While Medica cannot directly affect the increased demand for health care services, we have taken aggressive steps to reduce our administrative costs by $30 million. HMOs in Minnesota are non-profit, but are required by the state to retain one to three months of claims expense and administrative expense in reserve as a protection for members. Medica currently has just over two months of expense in reserves. ✦ Sincerely, Ted Loftness, M.D., Vice President and Medical Director of Provider Relations, Medica

November/December Index to Advertisers Allina Education Services ............................ 8 Brainerd Medical Center ........................... 12 Central Medical Building-Wirth Co. ........ 19 Clary Document Destruction .......................

Inside Front Cover Classified Ads ............................................. 3 Crutchfield Dermatology .......................... 13 DAMARCO ............................................. 31 Hazelden .................................................. 11 Kampfer Management Corp. ...................... 9 Methodist Hospital .................................... 2 Minnesota Healthcare Network ................ 10 MMIC ...................................................... 20 Multicare Associates ................................... 16 RCMS Inc. ............................................... 14 U of M CME ................. Outside Back Cover Wally McCarthy Cadillac ........................... 20 Wally McCarthy Hummer .......................... 15 Weber Law Office ..................................... 13 Winter CME .................... Inside Back Cover

The Journal of the Hennepin and Ramsey Medical Societies

PHYSICIAN'S SOAP BOX

“Readiness to Change”

A

A PHRASE DU JOUR may be packing an unintended punch for both

patients and physicians.

“Readiness to Change” is heard most often these days when referring to the management of patients with chronic conditions.

Efforts are underway by both the State Health Department and some health plans to use extensive claims data to identify patients who need to be managed better, and to identify physicians and other providers who, it can be inferred, are not up to the task of that management.

At the same time, purchasers of all sizes – government and business buying groups – are in serious discussions about how to reinvent reimbursement structures so that there is “pay for performance,” a corporate phrase du jour. The purchasers are searching for how they can identify the value of what they are buying, especially since the price tag is dramatically increasing each year.

Sometimes working cooperatively, while other times sparing for the lead, health insurers and purchasers are both pushing for more rapid development of quality measurements. Government has entered the fray as well, both as purchaser and underwriter of measurement activities, from Secretary Tommy Thompson’s funding for rural health measures to the state’s new reimbursement withhold for Medicaid services.

Where does that leave physicians and their patients?

It definitely leaves them not-in-charge.

While a readiness to decrease risk factors is important for all patients, in health-payer-speak, “measurement” often means “management,” which cannot usually measure the prowess of a practitioner. How we, as a health care industry, report these proficiencies is at the heart of who will control this process. This also is the central issue on which the success or failure of consumer driven health care revolves. The consumer requires data on cost, access and quality, the latter being obviously the most difficult and most important to deliver.

If it is management that becomes the measure, patients who are healthy and/educated individuals and prefer to manage their own care will continue to be denied that opportunity. Non-compliant patients (those who have not demonstrated a “readiness to change”) may be

B Y K E N N E T H B . H E I T H O F F, M . D .

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

avoided by providers whose pay may depend on their patients’ passivity to being managed by an employee of an insurance company.

Eventually, the management may be further extended through the implementation of state “regional global budgets” that inhibit the provision of some health services.

Physicians must recognize the need for defining the value of their services in a more comprehensible manner than assuming best practices by all. The market is demanding it. If they fail to do so, physicians are both abdicating their responsibility to their patients and handing over control and management of the patient to a third party.

A coalition of providers called the Fair Contracting Coalition has shown great leadership on health plan contracting issues, including responsible provider profiling. We need to do the same with “quality” measures.

Physicians need to demand from the government and business purchasers satisfactory answers to the following questions: • When is it appropriate for a patient’s name, address, health condition and health history to be shared with the government?

• When is it appropriate for a health plan to directly contact an enrollee and suggest treatment?

• When is it appropriate for a patient to be encouraged to participate in more management of his or her care?

• What do physicians include in the value equation for their patients?

On the road to better health care, physicians should be offering the trail markers for both health plans and purchasers. Certainly, they should also be walking the trail in step with their patients, demonstrating their own readiness to not only change but also to lead the way. ✦

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November/December 2002

3

COLLEAGUE INTERVIEW

Brian Campion, M.D. Editor’s Note: Brian Campion, M.D. is full-time faculty in the College of Business at the University of St. Thomas and Academic Director of the Center for Health and Medical Affairs. He has been President and CEO at Franciscan Skemp Healthcare - Mayo Health System located in La Crosse, Wisconsin since its inception by merger in 1995. From 19891995 he served as President and CEO of Franciscan Health System.

From 1970-1995 he was Associate Professor in the University of Minnesota School of Medicine and practiced clinical cardiology at Ramsey Hospital and Clinic. Dr. Campion was Medical Director of the East Metro Emergency Medical Services Program. He received his medical degree from the University of Minnesota, trained in Internal Medicine and Cardiovascular Diseases at Mayo, and received an MPA degree from Harvard University in 1988.

Q A

As a practicing cardiologist how did you transition to a career in administrative medicine?

My successor at La Crosse used to say about his administrative career at Mayo that he complained about the coffee, was told to fix it and the rest is history. I never planned to be anything but a full time clinician, but became interested in making an improvement in the education program and gradually over 20 years found myself in a 75 percent administrative position in addition to a 75 percent clinical practice. Since that combination was physically unsustainable and incompatible with a sense of balance, I was forced to make a decision. I chose a career in administrative medicine.

In retrospect, I believe that to have been a mistake since I was a better administrator when seeing patients. Others who have had the same experience corroborate the fact that the interactions with patients coupled with leadership and management of the organization better lend themselves to keeping the patient at the center of all we do. Having said that, I agree with the notion that it is difficult to practice enough to maintain your skills. Later in my career I returned to practice in a very limited role after retooling my skills and found it very rewarding. It is my hope that today’s physician leaders will be able to continue practicing medicine. This will require creative planning by both doctors and their organizations.

4

November/December 2002

Are the demands of medical administrative positions different today than when you made your career change?

I believe the demands are far greater today than in those early times. Many doctors in our region find themselves employed in large complex organizations. To many, their organizations feel foreign and uncomfortable.

Financial margins are smaller and, hence, cost management is more of an issue. Traditional medical education does not prepare them well for the challenge these obstacles present. Younger physicians who start out within integrated systems are more comfortable since they know no other professional setting. I believe the transition, while difficult, is self-limited and, with training and experience, will largely resolve itself with older doctors retiring and younger doctors becoming leaders in the new organizations.

You have been involved in the more significant health care programs at St. Thomas for four years. What attracted you to get involved in these programs?

St. Thomas has a 15 to 20 year involvement in leadership/management education. In addition to the Mini MBA and MBA in Medical Group Management, marketing data suggested that healthcare organizations were clamoring for leadership education and increased management expertise for physicians. This observation was consistent with my own conclusions that doctors needed to provide leadership in the integrated organizations that were forming and that there were few places where this education was available. It seemed that physicians, who continued to practice medicine, paired with managers gave the best potential to improve leadership in the newly formed integrated practices. The invitation to join the faculty and develop the curriculum and serve as lead faculty for this new endeavor, the Physician Leadership College, was very exciting.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

The Leadership College (LC) is a program that takes place over an 18-month period. Can you describe some of the curriculum and organizational features that has given the student physician the most benefit?

Over the 18 months, there are 10 modules occurring approximately every two months. This process is designed to give ample time for the doctors to reflect upon and take home newly acquired knowledge. The cohort model is very effective when used in adult education. The student proceeds through the whole course with the same group of people, which allows trust and collegiality to thrive and provides the optimal environment in which to learn. The curriculum, in addition to the heavy emphasis on leadership, has many of the elements of an MBA. A clinical psychologist provides an initial assessment of the student’s leadership status and then works with the student throughout the program to accomplish goals established at the outset. An advisory and mentoring relationship is established with a physician from the program and also one from the student’s organization. Between modules, the cohort discusses materials on an asynchronous internet conference, both maintaining contact and enhancing the educational experience.

The goal of the LC is to create a community of physician leaders. What will be different in our health care system (HS) after that community is at work?

The aim of the new HS must be to provide better care to patients at the same or lower cost. Leadership, but not dominance, by physicians will require understanding of organizations in which we practice. The ability to work in teams, to change processes of care and improve quality, to speak the language of management and to understand the essential skills of leadership are crucial to the success of the program. As more physicians are trained in these endeavors the opportunity to form community is increasingly desired. Not only does the community provide support, but also it serves as a nidus for new learning and sharing of effective practices.

Our current and past students at all levels seek this community and our initial attempts at it have been well received.

Have you identified any common characteristics of successful physician leaders? Please tell us about them.

Traditionally the first and most important leadership skill is the ability to identify and communicate to others a vision for the future, which is attractive and doable. While this skill is important it must be combined with understanding oneself. In particular the courage to overcome our own fears and anxieties in today’s turbulent environment is crucial.

Traveling together in community enhances this ability. Next, is the ability to listen and ask inquiring questions. Finally, the ability to work together in teams. Today’s problems are often more like paradoxes, which must be understood rather than solved. Successful solutions to paradox most often require many inputs from parties who alone possess only partial answers.

Many of our graduates report they have improved these skills and feel MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

better about the quality of their leadership. It is gratifying that their supervisors agree that their performance has improved.

What are the three greatest challenges physician leaders face and how does the LC prepare them?

I believe the three greatest challenges faced by physician leaders are as follows. First, today’s healthcare environment is permeated with adaptive challenges where no one knows how to define the problem or the solution.

Fear is often widespread; yet, together, we must attempt to find workable solutions. Second, we must provide a vision for the future that allows for excellent patient care, which is satisfying to our colleagues’ sense of professionalism as well as to his/her income requirements. Third, we must help physicians adapt to living within integrated practices and encourage them to become advocates for their patients as well as to work in partnership with them to heal as well as to cure. The LC provides an opportunity for experienced physician leaders to systematically study the skills and personal attributes required to lead. Many of us have studied management but have never had the opportunity to talk with others in a systematic way about leadership. In addition to the relevant part of previous answers noted above, it is the collaboration and community provided by the LC, which will hopefully provide the environment for these concepts.

Why would a physician enroll in the LC at St. Thomas instead of the MBA program?

It’s a question of balance or emphasis. The LC has a more pronounced emphasis on leadership while the MBA focuses more on management.

The question of which program is best suited to an individual physician is multifaceted depending upon the ultimate goal of the student. I talk with many physicians interested in furthering their ability to understand the current state of affairs in healthcare to best determine where they should put their energies. It is my view that the physician who wishes to lead while continuing to practice medicine is best paired with an experienced manager. The doctor provides patient care and leads while the manager is responsible for that aspect of the team’s activity. I agree that physicians who wish to be senior managers, CEOs, COOs, are more fully prepared with the management curriculum. While the MBA provides a formal degree, the LC graduate is prepared to sit for the Medical Group Management Association’s qualifying exam and can advance to their board certification - Fellow in the American College of Medical Practice Executives (FACMPE). St. Thomas’ MBA in Medical Group Management requires 27 months to complete, while the LC requires 18 months. The MBA, on average, requires 15 to 20 hours of participation per week while the LC requires four to six hours per week. The physician should select the program which best meets her or his needs.

Thank you very much for allowing me to tell my colleagues about our programs at the University of St. Thomas. The most important fact is that leading and managing is not only common sense, but a recognized discipline with a literature and science which must be studied if we are to best lead and participate in the development of the new health system. ✦

November/December 2002

5

FEATURE STORY

Preparing for the Transition from

C o n s u m e r- F o c u s e d C a r e Managed Care to Consumer-Focused Care

T

Consumers want and need information on the value of the health care service(s) they receive and for which they ultimately pay.

TO SAY HEALTH CARE IS CHANGING is a major understatement. The question is what are we changing to? Will it be better, the same, or worse? Is there anything we can learn about this change before it occurs?

The following is an excerpt from a presentation made at the Minnesota Medical Group Management Association (MMGMA) meeting held in Brainerd in August 2002 and at the Ramsey Medical Society Board of Directors in September 2002.

Physicians and health care providers need to be an integral part of the transition from managed care to consumer-focused health care.

They need to engage the patient/consumer around the concept of value. Consumers want and need information on the value of the health care service(s) they receive and for which they ultimately pay.

The Traditional Value equation: Value = Quality Cost The New Value equation: Value = Quality Outcomes + Service + Access + Convenience Cost The “new” value equation opens two opportunities for physicians to strengthen the relationships with their patients: 1. Physicians should look at the elements of the value equation to find ways to differentiate themselves in the eyes of the patient/consumer. What is unique/ different that a patient would know and care about?

2. Beyond their own services, physicians should become a more knowledgeable partner to their patients as they jointly make health care decisions in today’s complex market.

The End of Managed Care....as we’ve known and loved it

Health care costs just keep increasing. Why they continue to increase is due to the aging of our population, improved and expanded technology (including pharmaceuticals) and a disconnect between the patient/consumer and the actual cost of services being requested and provided.

BY MARK FISHER

6

November/December 2002

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

The early-managed care savings are no longer being realized.

There is disillusionment from all stakeholders. Where there is disillusionment, there is opportunity for physicians and providers by understanding and using the elements of the new value equation.

•

•

What are employers saying?

- They are demanding better and more meaningful quality information.

- They want comparative cost and performance information.

- They feel that their employees need to take greater financial responsibility for their care needs.

- They are recommending regional purchasing cooperatives be created that include small firms.

What are consumers/patients saying?

The following is excerpted from the February 24, 2002 Parade Magazine, St. Paul Pioneer Press, from an article by Dr. Isadore Rosenfeld.

Patients, know your rights.

1. Select your doctor.

2. Be fully informed about your health status.

• One may be better for you than the others – and also more affordable.

• Know and understand your options.

3. Get a second opinion – if necessary.

4. You have the right to get preventive medicine.

5. Know your surgeon’s and hospital’s track record.

How many procedures done, what are the outcomes?

The information is not posted on any bulletin board; you have to seek it out.

6. Understand the financial relationship between your doctor and your insurance company.

7. You have the right to a rapid medical review process.

For many people, health care is still perceived to be an almost free good.

How does the market regulate a free good? The simple answer is – it doesn’t, because a real marketplace

Some conclusions and realities

• • •

Health care costs are increasing at an alarming rate.

Prescription drug costs are increasing – with no end in site!

Employers want to get more value for their dollar and shift costs over to their employees whenever possible.

• Consumers are becoming more interested in information (both medical and financial) about their health care choices.

• New health care financing models rely heavily on consumers making informed choices.

It is clear that change needs to occur. In order to understand what change is necessary and how to affect such, the health care value equation needs to be viewed from within the traditional market-based system that exists in the United States.

doesn’t currently exist in health care.

Competitive and free market economy

1n 1776 Adam Smith wrote his book entitled Wealth of Nations. In that work he claimed that a market works best if it has the following attributes:

(Continued on page 8)

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

November/December 2002

7

Feature (Continued from page 7)

a. Firms are many and small in size. b. Laissez faire economics – “let the buyer beware.” c. The market functions best as if guided by an “invisible hand.” d. Individuals, rather than the government, make the majority of decisions regarding economic activities. e. The market encourages individual responsibility for decisions. f. The market provides incentives to allocate resources efficiently.

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November 2002 1

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14

The following summarizes an example of how Adam Smith’s marketplace doesn’t currently exist in health care: If the co-payment were $15, or even $75, which would you purchase, a Chevy Cavalier or a Lexus? Your choice would be based on your value equation. Given that you don’t have much skin in the game – why not choose the vehicle with the most bells and whistles, even though they may be more than you need?

The crux of this dilemma in health care is that we, as consumers, don’t have information or perhaps enough of a reason to be concerned, or even involved.

For many people, health care is still perceived to be an almost free good. How does the market regulate a free good?

The simple answer is – it doesn’t, because a real marketplace doesn’t currently exist in health care.

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November/December 2002

MetroDoctors

How could Adam Smith’s marketplace work in health care?

An underlying tenant of a marketplace is to make information available which will enable the consumer to better understand their options/choices when they make their buying decision.

Today’s patients are faced with having to make decisions without sufficient information and knowledge, which we take The Journal of the Hennepin and Ramsey Medical Societies

for granted in other buying decisions such as cars/appliances/houses, etc.

One approach to resolving the health care crisis is to capitalize on the doctor/ patient relationship. It is this relationship that has stood the test of time throughout the managed care years. It can and should be used by patients and their physicians to jointly answer the following question: “After I, as the patient, have made (with the help of my doctor) the best Quality decision, shouldn’t Service, Access, Convenience, and Cost be part of the final decision?”

An example of how value-based information is being created and used:

Minnesota Healthcare Network (MHN) is an independent provider care system made up of over 400 primary and 300 specialty physicians providing care to patients in the Twin Cities and surrounding areas.

In late 2000, MHN concluded that the physicians were not able to provide a complete response to patient questions such as where should I go, what should I do? The issues were related to a lack of information and knowledge that could be developed and shared with patients. MHN embarked on some data analysis, which began to explore the sensitivities around the value equation elements for facilities used by the MHN doctors and patients.

MHN’s data analysis of facility-based services (hospital, free-standing ambulatory and imaging centers) confirmed the following: - Quality is difficult, if not impossible, to differentiate.

- Differences do exist in service, access, and convenience.

- Substantial differences exist in the actual costs for similar services across facilities.

• Over 100 facilities’ average cost data was tiered by service type into four MetroDoctors

groups from low to high and provided to the physicians so they could become more knowledgeable in discussions with patients.

Early feedback from the physicians has been very positive. The desire for additional information that can be shared with patients has been a common theme and request.

After the first six months of providing the information to the physicians, a 12.6 percent decrease in utilization of higher cost facilities has been realized. This change represents a sizable potential decrease for both the employer and ultimately the patient/consumer.

cess, Convenience and Cost must be used in the joint decision-making process between the doctor and the patient.

Physicians have an opportunity to strengthen the patient/physician bond that is so necessary and important for maintaining the care that we’ve all come to know and expect. Linkages and alliances with organizations like Minnesota HealthCare Network (MHN) are important for the thoughtful analyses and discussions that are necessary around the value equation elements. From that base of information, physicians should be able to position themselves for success in the transition from managed care to consumer-focused health care. ✦

What did MHN learn?

What you do with the value equation information is critical for success if it answers the following internal and external questions:

Mark Fisher is the CEO for the Minnesota HealthCare Network. He can be reached at 952/883-3135, or mark@mhcn.com.

•

•

Internally: • Do the doctors and providers understand the data?

• Can the changes be monitored?

• Can adjustments and improvements be made?

• Is there an understanding of the implications of “right care, at the right place and time, at the right price,” where the determination of “right” is made jointly between the patient and physician?

Externally: “Doctor, I know I need this procedure/service...what should I do?.... where should I go?”

Conclusion and next steps:

The transition from managed care to consumer-focused health care will have a positive and meaningful impact on our current health care crisis. The value equation elements – Quality Outcomes, Service, Ac-

The Journal of the Hennepin and Ramsey Medical Societies

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November/December 2002

9

Physician Workforce Survey – The “Brain Drain”

O

OVER THE LAST SEVERAL months, HMS

and RMS representatives have had a number of conversations with Frank Cerra, M.D. of the Academic Health Center and Gregory Vercelotti, M.D. of the Medical School concerning the need to conduct a statewide physician workforce survey. The “Brain Drain” survey idea is similar to one conducted in California in 2000. A meeting took place recently between leadership and staff of HMS, RMS, MMA, Dr. Cerra and Mr. Terry Bock, Associate Vice President, AHC.

BY ROGER JOHNSON, CAE A N D J A C K G . D AV I S

At the meeting, Dr. Cerra stated that the AHC is in need of data regarding the physician workforce. The data is needed to answer questions regarding what specialties are in short supply to meet the demands; what specific disease spectrums are affecting the needs for physicians in what specialties; and, what are the demographics of the current physician workforce and what demographic components will be needed to meet future demands.

A scientifically designed survey instrument will be developed to fulfill the data needs cited and answer the following: (1) Should the current enrollment in the Medical School (Minneapolis and Duluth) of 215 per year be increased

Doctors — do you want to be independent?

Do you want to stay independent?

We want you to.

If your medical practice is interested in information about joining the MHN care system please contact: Minnesota Healthcare Network, LLC 7900 International Dr., Suite 1080 Bloomington, MN 55425-1510 Phone (952) 883-3150 Fax (952) 883-3134 E-mail info@mhcn.com

For over 20 years, Minnesota Healthcare Network has served physician groups throughout the Twin Cities and neighboring communities. We represent the interests of our member clinics in a competitive and increasingly complex marketplace. We provide a vehicle for independent clinics to contract and have good working relationships with health plans and other purchasers. We have innovative and comprehensive data systems that provide sound information, which allows our physicians to make wise medical and business decisions.

Our members are independent primary care (FP/GP, IM, Peds) and multi-specialty medical groups. We are physician-owned and governed. Over 50,000 health plan members have their care provided and coordinated by our independent physicians. This allows us to meaningfully advocate for our physician members and their patients in an era of health care where advocacy for these constituents is increasingly necessary.

If you are in private practice, or were and may be reconsidering that option, please contact us to find out how MHN may benefit you.

www.mhcn.com 10

November/December 2002

MetroDoctors

to meet future demands? (2) Are Minnesota practices having difficulty recruiting? If so, what are the reasons for this difficulty? (3) Are Minnesota physicians leaving practice prematurely or moving out of state? If so, for what reasons?; and (4) Influenced by Minnesota demographics, what are some of the future clinical requirements that the AHC will need to design into their curriculum? A byproduct of the survey will include the development of a base-line data set useful for: (1) future comparison and medical education planning; and (2) educating policy makers regarding the medical manpower needs.

The University is revising the current curriculum to go beyond the current approach to teaching differential diagnosis, complex decision-making, and life-long learning. Additionally, curriculum will expand the focus of “what it means to be a professional.” Consideration will be given to what molds physician lives. Dr. Cerra is convinced that physicians must become leaders in the health care marketplace to direct the systems and the health policies that will be adopted in the future.

The attendees agreed to go forward and: (1) develop a scientific survey instrument including developing the categories of information; (2) draft the questions; (3) review the draft; (4) approve the sampling methodology; (5) distribute the survey to the sample; and (6) analyze the results.

The University School of Public Health will provide the expertise to develop the survey instrument. The Center for Rural Health, directed by Terry Hill, will be contacted for assistance in rural Minnesota. Other potential medical society partners for rural Minnesota will also be contacted.

The role of organized medicine will be to distribute the survey to the sample and to secure sufficient returns for a scientifically valid result.

The goal is to have a survey instrument in the field in early 2003. ✦ The Journal of the Hennepin and Ramsey Medical Societies

Workforce Shortages: the Road to Long Term Care Reform

T

THE LONG-TERM CARE profession is at a crossroads. Older Minnesotans are the fastest growing age demographic, bringing new challenges for those providing care and for those seeking it. The number of seniors in Minnesota will double from 600,000 to 1.2 million people in the next 30 years. More importantly, the number of seniors age 85 and older will triple in that same time period. Even more telling, though, is

BY RICK CARTER

that Minnesota taxpayers are investing about $1 billion a year to support more than two-thirds of the 40,000 Minnesotans who are in nursing homes. Meanwhile, in the last 10 years, the number of nursing home beds available for seniors has been decreasing by roughly 300 to 400 each year.

Given these demographics, the long-term care profession has identified some critical questions facing Minnesota’s communities. A relevant one for the purpose of this article is how can we ensure that we have the best caregivers possible?

The nation is experiencing a shortage of nurses and other health care workers. In 2000, the U.S. Department of Health and Human Services estimated that the demand for nurses would require two million workers, but the supply was only 1.89 million – for a current worker gap of 110,000. Data cited by the Minnesota Nurses Association projects that if the status quo continues, there will be a nationwide gap of 650,000 nurses in 2020.

(Continued on page 12)

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

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©2002 Hazelden Foundation. To protect our clients’ confidentiality, the individuals shown here are models.

November/December 2002

11

Long Term Care (Continued from page 11)

This trend is bound to worsen. According to the Minnesota Department of Health, when compared to the rest of the nation, registered nurses in Minnesota are three years older than the national average, (45.3 vs. 42.4 years) and 50 percent work part-time hours. In nursing homes, 25 percent of registered nurses are over 55 years old. It makes sense that older workers in as physically demanding jobs as nursing may want to work fewer hours.

Similarly, the demand for licensed practical nurses (LPNs) also exceeds the supply. Most LPNs are employed in long-term care settings, and slightly over half of all LPNs in long-term care work in rural facilities. As LPNs age, this trend will exacerbate the need for more LPNs in rural Minnesota.

Recent economic downturns mean more people are in need of work, which gave rise to hopes that the health worker shortage would be short-lived. However, the turnover rate for nurs-

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November/December 2002

MetroDoctors

ing assistants is over 60 percent statewide and almost 75 percent in the Twin Cities metropolitan area, even during this period of higher unemployment.

The compelling problem is that front line caregivers in nursing homes perform demanding work for which they are at the mercy of the Minnesota Legislature when it comes to payment. Pay rates are essentially set by the Legislature, because over 70 percent of those receiving care are covered by Medicaid, the welfare program for indigents needing long-term care services. In addition, Minnesota has (in effect) made all residents of nursing facilities de facto welfare recipients due to a unique requirement of “rate equalization,” which means that every resident in a facility is charged the same “welfare” rate.

With limited dollars available for the cost of care of nursing home residents, the economic truth is that nursing assistant wages simply have not kept pace with salaries in other industries with similar levels of skill and education. For example, according to a recent industry survey, the average nursing assistant pay in 2002 is $10.83 an hour. Nursing assistants are engaged in a demanding job that requires an emotional investment, including an attitude of personal caring and patience, as well as high physical demands. By comparison, according to state Department of Economic Security statistics, data entry keyers in Minnesota are making an average of $11.56 an hour. Given these wages, not to mention benefit discrepancies, there is not much financial incentive to continue in nursing assistant positions.

Unless reforms occur, the disincentive to work in long-term care settings will worsen, because the pool of potential entrants into the labor market for elderly care is shrinking. In fact, the group of workers age 25-44 is growing at only half the rate of the elderly population. Care facilities are not just another business. If an office is short a worker, a few less words are typed.

If a care facility is short-staffed, older adults are shortchanged on needed daily personal and health care services.

What is the solution? An investment in caregivers is necessary if we want to attract and retain the best workers. We need to make it financially possible for providers of older adult services to offer competitive compensation, benefits and work environments.

The Journal of the Hennepin and Ramsey Medical Societies

On the federal level, President Bush recently signed the Nurse Reinvestment Act, which created a nurse scholarship program for students who agree to work in a shortage area for at least two years after completing their degree. Of critical importance to the long-term care profession is the grants to coalitions of nursing schools and health care facilities to develop and implement programs to educate nurses who provide geriatric care. Faculty loan repayment grants will be available through nursing schools to cancel up to 85 percent of the student loans of Masters or Doctoral students who agree to serve as full-time nursing faculty after completion of their degree. The American Health Care Association, our national association counterpart, supported the Nurse Reinvestment Act. However, passing the law was only a first step.

Congress still must fund the initiative.

While a national response to the nursing crisis is critical, a state response to the needs of older Minnesotans needing long-term care services is also necessary and requires a multi-faceted approach. In Minnesota, the 2001 legislature began the process of reform. An estimated $3.2 million dollars was leveraged for scholarships for staff in long-term care facilities to take a step up the health care career ladder – from nursing assistant to licensed practical nurse, for example. In addition, $300,000 was provided for a summer internship program to encourage high school and college students to explore health care careers, including long-term care settings.

The long-term care profession is working with the Health Education Industry Partnership (HEIP) to promote stronger bonds between the state’s academic centers and long-term care facilities. The need to recruit more students into health care professions, and more specifically into the long-term care arena, will continue to grow. HEIP is on the cutting edge of curriculum development for high schools to promote entry into a variety of health care disciplines.

Even if there is an influx of new nurses, other barriers to fulfilling the staffing needs of long-term care facilities remain. Many nursing facilities were built 35 to 50 years ago and, due to a variety of state regulations, their physical plants have not been upgraded to accommodate new patient care technology. Health care workers who are in high demand are less likely to consider working in a deteriorating physical MetroDoctors

environment. Therefore, we are also calling for investments to make the physical plants of existing facilities pleasant and technologically upto-date in order to benefit both the residents and the staff.

This is a complex problem requiring a variety of solutions that take time and money. The 2002 State Legislature recognized the investment that was begun in long-term care reform, and despite a budget deficit, most of the reform programs were maintained. In 2003, the profession will come forth with legislative proposals to continue to build upon the reform efforts to fund educational advancement, physical plant improvements, technology innovations, regulatory changes and, most of all, to continue our focus on employee issues with particular emphasis on salaries and benefits. If you’d like to track our progress in this campaign, please refer to our website at www.careproviders.org or see www.mnsos.com. ✦ Rick Carter is President/CEO of Care Providers of Minnesota, a long-term care trade association representing over 400 providers of health care and residential living services for Minnesota’s senior and disabled citizens.

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The Journal of the Hennepin and Ramsey Medical Societies

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Strategies for Recruiting Nurses Must Focus on Improving Work Environment

M

MINNESOTA AND THE NATION are suf-

fering from a severe shortage in the supply of nurses as we experience an unprecedented demand on the health care system. Congressional testimony labeled the lack of adequate nurse staffing a crisis situation that threatens the health of our nation, and it only promises to worsen.

While many strategies recently implemented by hospitals such as sign-on bonuses and foreign nurse recruitment serve the shortterm, we must do much more over the longterm to recruit and retain nurses.

Decades of research document that the quality of care delivered by skilled registered nurses is related to improved patient outcomes.

A recent study published in the New England Journal of Medicine showed that a shortage of registered nurses is associated with increased length of hospital stays, higher rates of infections, pneumonia, shock, internal bleeding, and even death. The care provided by registered nurses also helps keep people out of hospitals and nursing homes and in their homes and communities.

BY MONICA VOLLMUTH, MA, RN, CNP

Membership Advantages for Metro Physicians and their Practices HIPAAdocs

is an on-line HIPAA compliance tool that’s easy to use.

No HIPAA expertise required. We have negotiated the lowest discount available for the physicians in the metropolitan area. Visit their website at www.hipaadocs.com/sponsor/metrodoctors to get specific information about pricing and content.

Quest Card Services, LLC — Do you have patients who pay you using their credit cards? Have you done a comparison of the prices that you’re paying the company processing those transactions? We have found a credit card processing company who will offer members of HMS and RMS reasonable rates, and understandable statements. Receive a FREE analysis by calling HMS or RMS. AmeriPride Linen Service has been serving metropolitan physicians for a long time. We recognized that and have recently partnered with them to offer members of HMS and RMS discounts on their products and services, including medical garments, linens, among other things. If you are an existing customer, you can still benefit from our discounted pricing.

PhoneTree offers members of HMS and RMS appointment confirmation and lab results using voice messaging. We have negotiated a discount off the retail price.

Call HMS or RMS at 612-623-2889 for details.

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MetroDoctors

Minnesota’s registered nursing population grew 33 percent in the last 10 years; we have 15,000 more licensed registered nurses in our state than we did in 1992. That figure is nearly triple the general population growth of 12.4 percent between 1990 and 2000. Yet, according to the state job vacancy study, there are 3,260 vacancies for registered nurses in Minnesota. The demand for the services of skilled nursing care is far outpacing the supply and is estimated to reach a national shortfall of 500,000 by 2010.

This prediction is based on several factors.

(1) Our population is aging and getting sicker.

We are making much more use of the health care system, especially in the acute care setting.

(2) Technology and advancements in medicine are saving more lives, and the corresponding care required to bring patients through their health care situation is expanding exponentially.

(3) A growing uninsured or underinsured population is receiving inadequate preventive care and requiring more expensive and intensive life-saving measures.

(4) At an average age of 45 years (3 years higher than the national average), more than 40 percent of Minnesota’s working registered nurses will be eligible for retirement in 2015. Facing overwhelming job-related stress due to untenable working environments, most nurses take the first opt-out opportunity available to them, as shown in MNA’s Pension Plan data.

So what can be done to recruit and retain nurses?

While the problem of an inadequate nursing supply requires a multifaceted solution, the central issue we must address is the current working environment of nurses. Otherwise, other strategies will likely be unsuccessful.

The Journal of the Hennepin and Ramsey Medical Societies

Nurses at the bedside are deeply concerned about the intense work assignments and the lack of staff or resources available to support them.

Nursing is a labor-intensive profession; that is its nature and its virtue. Healing takes time and skilled nursing care. Unfortunately, both are devalued in a culture bent on immediate results and obsessed with a bottom-line mentality. An environment that recognizes and truly honors “care” is fundamental to any successful initiative.

Nursing must also be treated as a peer profession of medicine and management. Nurses are the essential link in treatment, assessment and monitoring of patients, as well as the subsequent communicating between the patient and doctor, patient and family, and patient and health care system. Nurses at the bedside can offer invaluable insight and contribute positively to improved policy and decision-making in the workplace.

Last year the Minnesota Nurses Association (MNA) made staffing a central issue in contract negotiations with hospitals. One key demand for the nurses who struck the Fairview System was their authority to close a unit to more admissions based on their nursing judg-

ment. MNA also led the nation in eliminating an employer practice of using mandatory overtime, which often results in tired nurses forced to deliver care below their practice standards.

In addition to contract language introduced in 1987 prohibiting the use of mandatory overtime, Minnesota is one of five states to put language in state statute that prohibits employers from retaliating against a nurse who declines to work additional hours if she or he feels unsafe.

Private and public interests should also be encouraged to step up to the issue of inadequate staffing. A few have already done so, evidenced

by Johnson & Johnson’s multi-million dollar campaign introduced on network television during the Olympics. Which said what? The American Nurses Association spearheaded a coalition that raised funds from Fortune 500 companies and worked with J. Walter Thompson ad agency to develop the “Nurses For a Healthier Tomorrow” promotional effort. Ads are targeted for several locations around the country. Still, the ad budget for nursing pales in comparison to any campaign to introduce a new model car.

The government, too, has a responsibility

to address the short supply of nurses. On the federal level, nurses have worked to pass legislation known as the Nurse Reinvestment Act. This legislation would fund scholarships and loan repayments for nursing students who agree to work in shortage areas after they graduate. In addition, the bill would include funding for nursing faculty, career ladder programs and public service announcements aimed at promoting nursing as a career. While the legislation has passed, the funding phase will not occur until late in the fall of 2002, and funding is needed now to implement this important legislation.

All of these strategies can help us confirm as a community to value nursing and celebrate it as a vital and fulfilling career. Every day nurses in hospitals, clinics, public health agencies and people’s homes alleviate suffering, allow the elderly to maintain independence, bring in new life, and bring comfort during death and dying.

Let’s support nursing by doing more than just short-term strategies, so we can be effective in retaining the nurses we recruit. ✦ Monica Vollmuth, MA, RN, CNP, is president of the Minnesota Nurses Association.

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

November/December 2002

15

2002 MMA House of Delegates HMS Delegation and RMS Delegation Report

D

DELEGATES AND ALTERNATES represent-

ing the Hennepin Medical Society and the Ramsey Medical Society attended the Annual meeting of the Minnesota Medical Association, September 26 and 27. The HMS delegation numbered 59 and the Ramsey delegation numbered 22. Both included physicians from all types of practices and representing every metropolitan location. The delegations also included 14 medical students from the University of Minnesota Medical School.

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Many issues were brought forward from physicians in the metropolitan area. Although the final proceedings report has not been published, the following is a summary of House of Delegates actions taken on the HMS and the RMS resolutions:

#106 AMA National Advisory Council on Violence and Abuse. Sponsored by HMS, this resolution called for the AMA Delegation to submit a resolution seeking continued support of this AMA council. The House of Delegates forwarded this resolution to the MMA Board of Trustees.

#104 MMA Membership Study. The purpose of this resolution submitted by RMS was to study a two tiered membership dues schedule to allow physicians to choose whether or not they wanted to join the state medical association or the local medical society or both. This resolution was not adopted, but a substitute resolution #107 calling for a study of the issue was amended and adopted.

#207 Legislation to Prohibit Behavior/Mental Health Carveouts in Health Plans. This resolution introduced by HMS and the Minnesota Psychiatric Society was amended and adopted.

#105 MMA Choice Membership. The purpose of this resolution by HMS was to allow physicians to choose whether or not they wanted to join the state medical association or the local medical society or both. This resolution was not adopted, but a substitute resolution #107 calling for a study of the issue was amended and adopted.

#208 Opposition to Psychologist Prescribing. This resolution was submitted by the RMS, HMS, and the Minnesota Psychiatric Society calling on the MMA to strongly oppose any effort to legislate prescribing by psychologists. It was adopted as amended. #304 Global Risk Sharing Contracts Between Health Plans and Physicians. Sponsored by RMS, this resolution called on the MMA to lobby for legislation prohibiting contracts that require physicians to be global risk sharing insurance underwriters. It was not adopted.

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16

November/December 2002

HMS Reference Committee participants: Reference Committee B Chair Benjamin Whitten, M.D.; Reference Committee A, James Woodburn, M.D.; Reference Committee D, John Wust III, M.D.; and Reference Committee C, Carl Burkland, M.D. Not pictured: Reference Committee C, Merle Mark, M.D.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

#305 Consumer Cost Sharing and Information. This resolution by RMS called on the MMA to support efforts providing for the disclosure by health plans of payment information to providers for medical goods and services. The resolution was not adopted, however, Resolution 308 supported the patient’s and physician’s ability to get price and quality information in making appropriate health care decisions and it was adopted as amended. #306 Emergency Contraceptives. This resolution sponsored by HMS dealt with lobbying health plans to cover this benefit. The resolution was not adopted. The reference committee felt that most health plans already covered this benefit; MMA policy speaks to this issue and the MMA general principle opposes mandated benefits. #307 The Importance of Physical Activity for the Health Maintenance of Minnesotans.

Adopted as submitted by HMS. #308 Consumer Cost Sharing and Payment Information. This resolution dealt with the patient’s ability to get reimbursement information to aid their decision making as their cost sharing increases. As amended, the final resolution supported the patient’s and physician’s ability to get price and quality information in making appropriate health care decisions. HMS sponsored this resolution. # 309 Road Rage. The purpose of this resolution submitted by HMS was to collect data on driver behavior for the purpose of implementing public education and improve driver awareness. The resolution was adopted with a minor amendment. #400 Tort Reform Legislation for 2003 Session. This resolution sponsored by RMS was adopted as amended and states that the MMA will strongly support the AMA efforts to enact federal legislation based on the California Medical Injury Compensation Reform Act (MICRA) and that a bill be introduced in the Minnesota Legislature limiting awards for non-economic damages, limiting attorney fees, including “clear and convincing evidence” as the standard of proof, and a mandatory instruction to juries that awards are not taxable.

MetroDoctors

#401 Access to Psychiatric Beds in Minnesota. This resolution was adopted as amended. The title was changed to “Access to Psychiatric Services in Minnesota.” The purpose is to have the MMA request the Minnesota Department of Health and the Department of Human Services convene a study group to examine the shortages and barriers to psychiatric services in Minnesota and to develop recommendations. HMS, RMS and the Minnesota Psychiatric Society cosponsored the resolution.

RMS Reference Committee participants: Reference Committee B, Jamie Santilli, M.D.; Reference Committee C Chair Charles Terzian, M.D.; and Reference Committee D, Gretchen Crary. Not pictured: Reference Committee A, Teresa McCarthy, M.D.

#402 Health Plan Accountability.

This RMS resolution was not adopted, however, Resolution 403, which is similar, was adopted. #403 Health Plan Accountability for Eligibility and Coverage Decisions. This resolu-

tion sponsored by HMS resolves that the MMA develop and lobby for legislation that prohibits health plans from transferring legal liability to physicians for health plan eligibility (coverage) decisions and defines those decisions as “medical practice.” ✦

Fifty Years of Faithful Service THE MINNESOTA Medical Association annually recognizes its members who have given 50 years of service to the practice of medicine.

The following HMS and RMS members were among those recognized: Roger Eugene Anderson, M.D. (HMS) James L. Canine, M.D. (RMS) Sherman B. Child, M.D. (HMS) Donald J. Dummer, M.D. (HMS) Willis M. Duryea, Jr., M.D. (HMS) H. Harrison Eelkema, M.D. (RMS) Albert D. Fetzek, M.D. (HMS) Robert S. Flom, M.D. (RMS) Aina Galejs, M.D. (RMS) Marvin E. Goldberg, M.D. (HMS) Mildred S. Hanson, M.D. (HMS) Dean J. Hempel, M.D. (HMS) Edward G. Huppler, M.D. (RMS) William C. Jackson, M.D. (RMS) Carolyn A. Johnson, M.D., C.M.D. (RMS) Lyle V. Kragh, M.D. (HMS) Roger C. Larson, M.D. (HMS) Richard O. Leavenworth, M.D. (HMS) Robert D. Letson, M.D. (HMS) Maurice L. Lindblom, M.D. (HMS)

The Journal of the Hennepin and Ramsey Medical Societies

Anton G. Lyzenga, M.D. (HMS) J. Anthony Malerich, Jr., M.D. (RMS) Donald M. Mayberg, M.D. (HMS) Sheldon C. Reed, M.D. (HMS) Robert J. Rotenberg, M.D. (HMS) Irwin F. Schaffhausen, M.D. (HMS) Mildred J. Schaffhausen, M.D. (HMS) Robert I. Shragg, M.D. (HMS) Nadine G. Smith, M.D. (HMS) Vernon L. Sommerdorf, M.D. (RMS) Jack A. Vennes, M.D. (HMS) ✦

Drs. Robert Flom and Vernon Sommerdorf proudly display their Fifty Club Awards.

November/December 2002

17

Highlights of the Code of Medical Ethics of the American Medical Association Section E-7.00: Opinions on Physician Records The foundation for several Opinions in Section 7.00 of the Code of Medical Ethics, “Opinions on Physician Records,” can be traced back to the middle of the last century. Some considerations such as a physicians’ responsibility to transfer records to another physician with the patient’s authorization have not changed noticeably since their introduction, while others, such as patient access to their records, reflect a significant evolution in the practice of medicine.

More recently, Opinions have been developed in response to increased attention to privacy and confidentiality and to the emergence of the electronic record.

Interestingly, current Opinions continue to discuss records as the property of individual physicians, despite the growth of hospital-based care and a widespread team approach to the delivery of patient care, which draws increasingly on specialized physicians and a host of other health-care professionals. Overall, little recognition seems to be given to the likelihood that patients will receive care from multiple access points in a lifetime, possibly in more than one geographic location.

Finally, when considering this section, it is important to keep in mind that most states have enacted rules regarding medical records, and that many health care entities have developed their own record-keeping protocols, which may differ from the ethical guidelines outlined in the Code.

Fundamentally, the guidance offered in the Code should be viewed as promoting con-

tinuity of care, patient access to medical information, and confidentiality. These general considerations are drawn from two Principles of Medical Ethics: Principle IV, which calls upon physicians to safeguard patient confidences and privacy and Principle V, which encourages physicians to make relevant information available to patients as well as colleagues.

One of the main changes in this section over time is the question of patient access to medical records, which offers a clear illustration of change in the medical landscape. An excerpt from a 1946 Report of the Judicial Council states that: “Whether the contents of the [medical] report are to be given to the patient rests with the decision of the doctor who knows all the circumstances involved in the situation.” Similarly, a passage in a 1956 Report reads: “The Judicial Council does not believe that [the 1955 Principles’ requirement that the Physician “assure himself that the patient, his relatives or his responsible friends have such knowledge of the patient’s condition as will serve the best interest of the patient and the family”] intends or requires that a physician give a copy of his records to his patient. […] The Patient, however, or one responsible for him, is entitled to know the nature of the illness and the general course or regimen of therapy employed by his physician.”

In contrast with this paternalistic model where physicians were assumed to know what would be best for their patients, today’s Opinion 7.02, “Records of Physicians: Information and Patients,” requires that “on request of the patient a physician should provide a copy or a summary of the record to the patient.” The

BY LEONARD J. MORSE, M.D. A N D S A R A TA U B

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MetroDoctors

change reflects the substantial evolution of the patient’s role in the patient-physician relationship – one that can be attributed in part to the patients’ rights movement and to the growing importance of autonomy in our society, which have transformed medicine’s notion of physicians’ responsibilities toward their patients.

Today, matters such as record transfer and patient access to records elicit a large proportion of inquiries that staff members at the American Medical Association’s (AMA) Ethics Standards Group receive. For example, physicians leaving a group practice often inquire regarding appropriate mechanisms to notify their patients of the departure. These physicians generally want information to help them understand their role in a process that involves separate responsibilities for the departing physician and for the group practice.

Physicians can rely on Opinion 7.03, “Records of Physicians upon Retirement or Departure from a Group” in determining their responsibilities. The policy stresses the importance of informing patients when their physician is leaving a group so that patients can make arrangements either to follow the physician to the new practice and request a transfer of records accordingly, or to remain with the same group. While the Opinion acknowledges that there may be language in a physician’s contract that specifies to whom the responsibility of notifying patients falls, the Code is unequivocal when it states that: “It is unethical to withhold such information upon request of a patient.”

Patients, on the other hand, often have questions regarding their right to access or obtain a copy of their medical record. In most instances, they request our policies after they have been unsuccessful in transferring or accessing their records. They can turn to Opinions The Journal of the Hennepin and Ramsey Medical Societies

7.01, “Records of Physicians: Availability of Information to Other Physicians,” and 7.02, “Records of Physicians: Information and Patients,” for assistance in understanding physicians’ responsibilities. Opinion 7.01 speaks specifically to the transfer of records, noting that, with proper authorization from the patient: “A physician who formerly treated a patient should not refuse for any reason to make records of that patient promptly available on request to another physician presently treating the patient.” (emphasis added) The Opinion highlights that even an unpaid medical bill would not provide a valid basis for withholding medical reports.

In Opinion 7.02, the focus is directed to access to the medical record by a patient or a third party designated by the patient. An underlying theme in this policy is that while patient medical records are the property of the treating physician or hospital where the patient receives care, the information contained in these records should be available to patients – not necessarily in whole, but at least in summary form. In addition, the Opinion emphasizes the nature of the medical record as a confidential document involving the patient-physician relationship. Physicians almost always need to obtain a patient’s written consent prior to sharing its content with a third party.

Opinion 7.025, “Records of Physicians: Access by Non-Treating Medical Staff,” the most recent addition to this section of the Code, was issued in December 1999. The Opinion, which limits medical record access to treating medical staff in an effort to avoid inappropriate review by others, recognizes the importance of confidentiality and of the physician’s role in designing and observing safeguards that protect it. In doing so, the Opinion responds to changes in technology, such as the advent of the electronic record, which have amplified concerns surrounding privacy and confidentiality.

In fact, some specific safeguards regarding electronic records were referred to in our review of Section 5.00 “Opinions on Confidentiality, Advertising, and Communications Media Relation.” (See MetroDoctors, March/April 2002).

Noting that “a patient’s record may be necessary to the patient in the future not only for medical care, but also for employment, insurance, litigation, or other reasons,” Opinion 7.04, “Sale of Medical Practice,” offers retiring MetroDoctors

physicians (or the estate of deceased physicians) practical advice regarding the transfer of patients’ records. Since the transfer is not in response to a patient’s request, the guidelines require physicians (or their estate) to ascertain that the entity to which records are transferred is held to the same standard of confidentiality and is lawfully permitted to act as custodian of the records.

Finally, Opinion 7.05, “Retention of Medical Records” addresses how long physicians must retain patient records. In doing so, it differentiates between different types of records – immunization records, for example, always must be kept – and between patients with different types of coverage – the records of any patient covered by Medicare or Medicaid must be kept at least five years. Physicians, however, should be mindful that more stringent legal requirements may exist that would override these guidelines. Finally, the Opinion

notes that, when appropriate, the proper way to dispose of records is to destroy them.

Recently, the Council on Ethical and Judicial Affairs has received requests to provide a definition of what constitutes a medical record as well as guidelines regarding a physicians’ options when a patient requests that information be withheld from or corrected in the medical record. The Council has not yet issued ethical guidance on these matters; however, as the Code continues to expand and medicine continues to evolve, Section 7.00 is bound to change too.

The content of the entire AMA’s Code of Medical Ethics is accessible online at www.amaassn.org/go/ceja. ✦ Leonard J. Morse, M.D., is Chair, Council on Ethical and Judicial Affairs, and Sara Taub is Staff Associate, Council on Ethical and Judicial Affairs.

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The Journal of the Hennepin and Ramsey Medical Societies

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November/December 2002

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November/December 2002

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MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Lunch ’n Learn for Medical Students

F

FIVE OR SIX TIMES a year the Hennepin

Medical Society and the Ramsey Medical Society provide a “lunch ’n learn” opportunity for the first and second year medical students. Early in the academic year, and in collaboration with the Minnesota Medical Association, the topic of the presentation is organized medicine. The U of M Medical School Chapter of the American Medical Association held its first session, An Introduction to Organized Medicine, on September 30. This year’s speakers were Carolyn

McKay, M.D., representing the AMA, Paul Sanders, M.D., who reviewed the activities of the state medical association, and Michael Gonzalez-Campoy, M.D., who provided the local medical society perspective. Each of the speakers talked about the privilege of becoming a physician and a patient advocate and the physician’s responsibility to the profession. ✦

Stephanie Stanton, chapter president, opens the meeting.

“Lunch ’n Learn” speakers. Drs. Sanders, Gonzalez-Campoy, and McKay.

Medical student leadership with speakers. (from left) David Farmin, Dr. Sanders, Dr. Gonzalez-Campoy, Janet West holding her son, Suzanne Woodward, Todd Gengerke, Stephanie Stanton, Dr. McKay and Brian Labine.

Corrections Eric Johnson, M.D., was mis-identified as Eric Anderson, M.D. in the HMS Community Internship Program photo in the September/October 2002 issue of MetroDoctors. Our sincere apologies to Dr. Johnson for this misprint.

Also in one of the HMS Community Internship photos H. Thomas Blum, M.D., HealthPartners-West Clinic, was mis-identified. We apologize to Dr. Blum for this error. ✦

MetroDoctors

Medical students line up for the “lunch ‘n learn.”

Adult Immunization Reimbursement Update In a recent article, “Emerging from Immunization Chaos” published in MetroDoctors (September/October 2002, pages 20-21), a table was included that detailed Adult Influenza and Pneumococcal Vaccine Medicare Reimbursement for 2001 and 2002. Following publication of the article, the influenza vaccine Medicare reimbursement amount for 2002 was changed from the rate of $4.92 to a new rate of $8.02. ✦

The Journal of the Hennepin and Ramsey Medical Societies

November/December 2002

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Falling Through the Cracks: An Analysis of Care Coordination for Low-Income Pregnant Women in Hennepin and Ramsey Counties

T

THE MINNESOTA Department of Health

(MDH) and The Minneapolis Department of Health and Family Support (MDHFS) have released a new report: Falling through the Cracks: An Analysis of Care Coordination for Low-Income

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November/December 2002

Pregnant Women in Hennepin and Ramsey Counties. The report outlines the findings from a 1999 system capacity study done in the two counties, where 31 organizations providing perinatal care in Hennepin and Ramsey Counties (health plans, hospitals, public health nursing agencies and community health centers) were surveyed regarding their delivery of comprehensive perinatal care coordination services. This study followed-up on two infant mortality review projects conducted in the Twin Cities area in the 1990s1 that concluded that a highly fragmented perinatal service delivery system is a factor in many urban infant deaths. Key messages from the new study are: • While Minnesota’s managed Medicaid program (PMAP) ensured prenatal care for a larger number of low-income women, it did not assure that a pregnant woman with psychosocial risk factors impacting her pregnancy would receive coordinated services to address those risk factors.

• Health care and social service systems are fragmented by institutional, bureaucratic and reimbursement barriers.

• Communication between heath care and social service systems is poor.

• Because of fragmented systems and poor communication, comprehensive perinatal care MetroDoctors

coordination is rarely provided in Hennepin and Ramsey Counties.

• A large number of pregnant women at-risk for poor birth outcomes are not being offered coordinated care by a public health nurse.

Recommendations from the report are to: (1) establish a work group to address the issues identified in the report; (2) provide adequate and stable resources to rebuild system capacity; (3) support the work of Twin Cities Healthy Start in developing “service networks” for African American and American Indian pregnant women in Minneapolis and St. Paul; and (4) provide continuous health insurance to all women of childbearing age.

Creating an ongoing and sustainable system to address the comprehensive care coordination needs of urban, low-income, pregnant women in the two counties is a critical factor in the state’s attempts to reduce racial and ethnic disparities in infant mortality.

The full report can be accessed on the web by going to: www.ci.minneapolis.mn.us/ citywork/city-coordinator/health/researchpolicy/index.

If you’re interested in more information, and/or in working on follow-up to the report, please contact: Cheryl Fogarty, MDH, 651-2819947, cheryl.fogarty@health.state.mn.us, or Megan Ellingson, MDHFS, 612-673-3817, megan.ellingson@ci.minneapolis.mn.us. ✦ 1 Minneapolis Department of Health and Family Support and St. Paul Public Health, “Project L.I.D. (Lower Infant Deaths),” 1993; Minneapolis Department of Health and St. Paul-Ramsey County Department of Public Health, “Lowering Infant Deaths: Promoting Change to Save Lives” August, 1998.

The Journal of the Hennepin and Ramsey Medical Societies

PRESIDENT’S MESSAGE P E T E R H . K E L L Y, M . D .

Caring for a Friend

H

“HEY PETE, COULD YOU LOOK at a CT

President Peter H. Kelly, M.D. President-Elect Michael Gonzalez-Campoy, M.D. Past President Robert C. Moravec, M.D. Secretary Jamie D. Santilli, M.D. Treasurer Peter J. Daly, M.D.

scan for me?”

So began a nine-month battle with cancer by one of my life-long friends, Bobby. The moment I looked at the CT scan my heart sank.

There was a very large mass in the right lung and mediastinum. I told Bobby that this did not bode well and that his only real hope is if this turned out to be a lymphoma. He asked me to help guide and support him through the process of treating the cancer, as a physician, but more importantly, as a friend. Bobby’s support system was his friends as he didn’t have a lot of family and he had never married. He allowed a small circle of friends (including his brother and sister) to form a core group to help him as he dealt with chemotherapy and the pain and weakness that developed as his cancer progressed. It was an experience that brought me in direct contact with the personal struggle of cancer and death and gave me a new appreciation for this process and the people who deal with it.

As a surgeon I deal with cancer, and to a lesser degree with death, on a daily basis. I’m often the first person to tell a patient that they have cancer, what the prognosis is and what the next steps in treatment will entail. It’s never something you get totally comfortable in doing but you do develop a certain detachment, almost in a third person sort of way. With Bobby it was quite different. I couldn’t develop a distance between us and every time bad news came along I would spend long hours explaining the meaning and what impact the findings would have on his treatment and prognosis.

At first we thought we had good news when the initial biopsy came back as lymphoma, a potentially treatable cancer. The first round of chemotherapy went as well as could be expected but the follow-up CT showed the tumor was continuing to grow. More biopsies were obtained (via a mediastinoscopy and thoracoscopy), which now revealed that the tumor was in fact a highly aggressive lung cancer. I knew what this meant and tried to explain the poor

RMS-Board Members

Kimberly A. Anderson, M.D., Specialty Director John R. Balfanz, M.D., Specialty Director Victor S. Cox, M.D., Specialty Director Gretchen S. Crary, M.D., At-Large Director Charles E. Crutchfield, III, M.D., At-Large Director Laura A. Dean, M.D., At-Large Director James J. Jordan, M.D., Specialty Director Robert V. Knowlan, M.D., At-Large Director Charlene E. McEvoy, M.D., At-Large Director Ragnvald Mjanger, M.D., Specialty Director Kenneth E. Nollet, M.D., Ph.D., At-Large Director Stephanie D. Stanton, Medical Student Lyle J. Swenson, M.D., MMA Trustee Charles G. Terzian, M.D., Specialty Director & MMA Trustee David C. Thorson, M.D., Specialty Director Russell C. Welch, M.D., At-Large Director RMS-Ex-Officio Board Members & Council Chairs

Brent R. Asplin, M.D., AMA Young Physician Section Blanton Bessinger, M.D., MMA Past President Kenneth W. Crabb, M.D., AMA Alternate Delegate Robert W. Geist, M.D., Ethics & Professionalism Council Chair *Michael Gonzalez-Campoy, M.D., Education Resource Council Chair Rebecca Gonzalez-Campoy, Alliance President Frank J. Indihar, M.D., AMA Delegate William E. Jacott, M.D., U of MN Representative Melanie Sullivan, Clinic Administrator Donald B. Swenson, M.D., Sr. Physicians Association President *Lyle J. Swenson, M.D., Public Policy Council Chair *Russell C. Welch, M.D., Communications Council Chair *Also elected RMS Board Member RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive Officer Doreen M. Hines, Membership & Web Site Coordinator Sue Schettle, Director of Marketing & Member Services

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

prognosis to Bobby without giving up hope.

Bobby was a fighter and was anxious and willing to do whatever it took to beat the cancer.

Another round of chemotherapy was recommended, but this time it was not well tolerated. A vague abdominal pain developed that couldn’t be shaken. Another CT scan revealed that the liver was now riddled with cancer.

Again, long discussions were held and it was decided to take a break from chemotherapy to see if Bobby could regain some of his strength.

During this time the nurses (in particular nurse Bobbi) at Minnesota Oncology helped him as he dealt with the complications that developed during chemotherapy and he relied on their help tremendously.

Unfortunately, Bobby never did regain his strength. The pain continued to get worse and a long series of hospitalizations and hospice care ensued. It was during this time that I came to develop a great respect for the nurses who provide care for patients during their final days. The nurses at St. Joe’s and St. John’s Hospitals provided the initial care and helped Bobby to get the pain under control. It was the first time in two months that he was somewhat free of the pain and had the care that was so hard to come by at home. The nurses provided Bobby not only the basic care he required but also provided him with the emotional support he so dearly needed.

We continued to hope and make plans for Bobby’s return home but he became increasingly weaker and the pain became harder to control.

It was decided that a stay at the HealthEast Pillars Hospice would be best and then, if he regained his strength, he would go home. He spent a month at the Pillars and ended up dying there, never making it back home.

(Continued on page 24)

November/December 2002

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Ramsey Medical Society

RMS-Officers

RMS Candidates Elected

by MMA House

T

THE 2002 MMA House of Delegates elected

Dr. Frank Indihar, Bethesda Rehabilitation Hospital, to his fourth two-year term as an AMA delegate. Dr. Kenneth Crabb, Advanced Specialty Care for Women, was elected to a twoyear term as an AMA delegate after serving three terms as an Alternate Delegate. Dr. Blanton Bessinger, Children’s Health Care, was elected to his first two-year term as an AMA Alternate Delegate.

Dr. Michael Gonzalez-Campoy, Aspen Medical Group and RMS president-elect, was elected MMA secretary. He was recently elected vice chair of the AMA Council on Minority

Affairs. Dr. Charles Terzian, United Hospital, was elected to represent the East Metro Trustee District on the MMA Board of Trustees replacing Dr. Thomas Dunkel, St. Paul Internists. Dr. Dunkel’s contributions to medicine were recognized by the House of Delegates in a Commendation Resolution. ✦ Frank Indihar, M.D.

Blanton Bessinger, M.D.

President’s Message

Michael GonzalezCampoy, M.D.

Kenneth Crabb, M.D.

Charles Terzian, M.D.

(Continued from page 23)

The care he received there was nothing short of miraculous. The nurses helped Bobby, his brother, sister and friends go through the process of preparing for death. As the final days drew near, the nurse’s support became more critical. They helped us understand what Bobby was dealing with and helped us help him through these difficult days. Several of the nurses stayed past their shift on the final evening when he slipped into a coma and we kept a death vigil until he finally drew his last breath. When I asked them how they could continuously care for dying patients and their families, all the nurses told me that they regarded it as a privilege to be allowed to assist people through this difficult and foreign experience. To all of Bobby’s friends and family these nurses were saints.

Bobby said to me when the situation became hopeless that all he wanted was to die with grace and dignity. All of the exceptional nurses involved in Bobby’s long journey allowed this to happen. I know that I speak for all of his friends and family when I say, thank you. ✦ 24

November/December 2002

Charles E. Crutchfield, M.D., Receives Service to Humanity Award

T

THE UNITED HOSPITAL Foundation presented its 2002 Service to Humanity Award to Dr. Charles E. Crutchfield at a dinner at the Radisson River Front Hotel on September 28.

Dr. Crutchfield was recognized for his selfless dedication and exemplary leadership in improving the health and welfare of St. Paul and the surrounding communities.

Former Minneapolis Mayor Sharon SaylesBelton, friend and patient of Crutchfield’s, introduced and presented him the award.

Sayles-Belton stated that the many contributions he not only made to his community, but also the “beyond the call of duty acts” such as walking three miles in a snow storm to deliver a baby, and cancelling vacation/social plans to accommodate high risk patients’ deliveries. St. Paul Mayor Randy Kelly presented a proclamation to Crutchfield claiming September 28, 2002 as “Dr. Charles Crutchfield Day” in St. Paul.

MetroDoctors

Dr. Cruthchfield and Former Minneapolis Mayor Sharon Sayles-Belton.

Dr. Crutchfield has served as a leader in Boy Scouts, in his church, in his community, and in the Minnesota Association of Black Physicians.

He is a past member of the Ramsey Medical Society Board of Directors and a past recipient of the RMS Community Service Award. Dr. Crutchfield has five children and six grandchildren. He and his wife, Pat, live in St. Paul. ✦ The Journal of the Hennepin and Ramsey Medical Societies

RMS Leaders Meet with 4th District Congresswoman Betty McCollum

M

MEDICARE REIMBURSEMENT was the

major disagreement between the Republicans and Democrats in the Congress. As a result, the Senate has passed no legislation.

RMS leaders urged Rep. McCollum to work for the physician reimbursement provisions in H.R. 4954 or in similar legislation. She indicated that she understood the problems with low Medicare reimbursement in Minnesota and she pledged to work to improve reimbursements to physicians. She said that hopefully the differences on the prescription drug benefit can be resolved and that Congress would be able to approve legislation to improve the reimbursement to physicians caring for Medicare patients.

RMS leaders meeting with Rep. McCollum

included Dr. Michael Gonzalez-Campoy, RMS president elect; Becky Gonzalez-Campoy, RMS Alliance president; Dr. Robert Moravec, RMS past president; and RMS Board members Drs. Charles Terzian, Thomas Dunkel, Lyle Swenson, and James Jordan. Medical student Board member Stephanie Stanton and RMS CEO Roger Johnson also participated in the meeting. ✦

RMS St. Croix River Cruise

O

OVER 50 RMS member physicians, spouses,

guests, and staff members braved the chilly October weather on Sunday, October 6, for a cruise on the Andiamo riverboat leaving from Stillwater. Gubernatorial candidate, Tim Penny, and his running mate, Senator Martha Robertson, were the guest speakers. Their talks

were followed by a lively question and answer session.

Everyone enjoyed hearing from the candidates and they appreciated the opportunity for collegiality with physicians and spouses from throughout the area. ✦

RMS Annual Meeting benefiting Ramsey Medical Society Foundation Please join us on

Friday, January 24, 2003 Town & Country Club 300 Mississippi River Blvd. N., St. Paul 6:00 p.m. – Social Hour 7:00 p.m. – Dinner (From left:) James VanVooren, M.D., Andrew Fink, M.D., Stuart Cox, M.D., and Kelli Cox engage in discussion with Tim Penny.

Tim Penny fields questions from attendees.

• Inauguration of J. Michael GonzalezCampoy, M.D. as the 132nd President of Ramsey Medical Society • Presentation of Community Service Award • Silent Auction 6:00-9:30

Dessert and Dancing to Follow

Sabor Tropical (From left:) Susan Hipp, Robert Geist, M.D., and Vernon Sommerdorf, M.D., visit with Bill Meyers and Senator Martha Robertson.

MetroDoctors

Lynne Ardolf, Joseph Ardolf, M.D., and Robert Knowlan, M.D., enjoying the cruise.

The Journal of the Hennepin and Ramsey Medical Societies

“Hottest Latin Orchestra” Watch your mail for further details!

November/December 2002

25

Ramsey Medical Society

main issue when leaders of RMS met with 4th District Congresswoman Betty McCollum and her legislative director, Stacy Stordahl, recently in St. Paul. The House of Representatives adopted H.R. 4954, the Medicare Modernization and Prescription Drug Act, in June on a vote of 221 to 208. The bill included increases in Medicare reimbursement for physicians and would also eliminate scheduled cuts in Medicare of 14.2 percent over the next three years.

The issue clouding the reimbursement provisions is the issue of a prescription drug benefit for Medicare enrollees. The differences over the prescription drug provisions have led to a

R M S U P D AT E

New Members RMS welcomes these new members to the Society.

Schools listed indicate the institution where the medical degree was received.

Active William G. Armstrong, M.D. University of Minnesota Internal Medicine HealthEast Downtown St. Paul

1st Year Practice Jennifer L. Belik, M.D. University of Minnesota Family Practice East Metro Family Practice-Maryland

Andrea Layman, M.D. Anesthesiology Twin Cities Anesthesia, P.A. Barbara C. LeTourneau, M.D. University of Minnesota Emergency Medicine Regions Hospital William G. Lindsay, M.D. University of Manitoba Cardiovascular Surgery/Thoracic Surgery Cardiovascular Surgeons of St. Paul Carl T. McGary, M.D. Anatomic & Clinical Pathology Central Regional Pathology Laboratories

Wen-Wei Chung, M.D. Taiwan Anatomic & Clinical Pathology Central Regional Pathology Laboratories Grace (Shing-Jia) Sha, M.D. China Medical College, Taiwan Anatomic & Clinical Pathology Central Regional Pathology Laboratories

Medical Student (University of Minnesota)

Alfredo M. Beltran, M.D. University of the East Internal Medicine HealthEast Downtown St. Paul

Sherief A. Mikhail, M.D. MPH University of Alexandria, Egypt Family Practice Minnesota Spine Rehab, Inc.

Yap-Yee (Chris) Chong, M.D. Singapore Anatomic & Clinical Pathology Central Regional Pathology Laboratories

Robert S. Nesheim, M.D. University of Minnesota Psychiatry Hamm Memorial Psychiatric Clinic

Keith G. Davies, M.D. University of Wales Neurological Surgery Neurosurgery Associates, Ltd.

Jon Craig Paulson, M.D. University of Minnesota Orthopedic Surgery/Hand Surgery/Pain Management Midwest Medical Pain

Jack A. Drogt, M.D. Northwestern University Orthopedic Surgery Summit Orthopedics, Ltd. Mary E. Dunn, M.D. Creighton University Neurological Surgery Neurosurgery Associates, Ltd. John A. Eklund, M.D. University of Chicago Neuroradiology Center for Diagnostic Imaging Henry E. Fink, M.D. University of Minnesota Internal Medicine/Geriatrics HealthPartners Como Medical & Dental Clinic

Carl Sakamoto, M.D. University of Minnesota Anesthesiology Twin Cities Anesthesia, P.A.

Transfer into RMS — Student Kerry E. Wangen ✦

Deanna K. Siliciano, M.D. University of Pennsylvania Anesthesiology Twin Cities Anesthesia, P.A.

In Memoriam

Margaret Wallenfriedman, M.D. Yale University Neurological Surgery Neurosurgery Associates, Ltd.

HERBERT C. ASHMORE, M.D., died on August 20 at the age of 84. Dr. Ashmore served in the U.S. Navy during World War II and graduated from the Indiana University School of Medicine in 1951. He was a general practitioner in Indiana for seven years, and then completed a residency in anesthesiology at the Mayo Clinic in Rochester. He joined Associated Anesthesiologists in St. Paul in 1961 and practiced there until his retirement.

Dr. Ashmore joined RMS in 1962. ✦

Steve D. Wen, M.D. Fourth Military Medical University Anesthesiology Twin Cities Anesthesia, P.A.

Miriam Yun-Mi Kim, M.D. University of Toronto Neurological Surgery Millennium Neurosurgery 26

November/December 2002

Jane E. Brumbaugh Laura Steinbruger Brunner Megan A. Clinton Jessica M. Flynn Monica A. Gaffney Halena M. Gazelka Alison K. Gray Healther C. Johnson Christopher A. Kasal Tara L. Kelly Amy C. Keranen Anthony J. Lefebvre Muaj C. Lo Nancy M. Luger Will G. Nicholson Elena J. Rosas Abby C. Stritesky Sara F. Whitehouse Shannon N. Zingula

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

RMS ALLIANCE NEWS REBECCA GONZALEZ-CAMPOY

Giving Back to the Community

I

IT ALL STARTED when a parent at my

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

they come for interviews. Again, we’re trying to promote the Alliance as a family worth joining.

Membership – manpower – really boils down to one thing – perceived value. When someone tells me they don’t want to become, or remain, a member of the Alliance (or RMS, for that matter) because of money, I don’t buy it.

They simply don’t believe they’re getting what they want out of their membership – or they don’t understand the value. They haven’t realized that a fraction of the folks are doing all of the work to preserve and promote top-quality health care. And it’s time they pitched in to help.

We’re learning how to create better visibility of the Alliance and what we do through actual promotion and just by talking up the organization wherever we go. We’re also learning to listen to prospective members, really listen. Only when we understand what they’re about, will we be able to talk about a particular aspect of the Alliance that would appeal to them.

It’s a lot like making a sale. First, you identify your market. Next, you cultivate those people. Once you’ve determined their needs and wants, you match them with your product that best suits them. Then you make “the ask” – we often forget this step. And finally, you continue to nurture them once they’re on board. This is the only way the Alliance will get to stay on someone’s plate when it starts to get crowded.

Even though membership isn’t growing by leaps and bounds, Putnam of Bowling for One offers a ray of hope. He has reason to believe that we’ll be able to count on the generation currently in college, as they seem to have a community activist bent to them.

Maybe so. Meanwhile, I’m trading in both presidential gavels for some other “hats” in the Alliance and in my school district, come this spring! ✦

November/December 2002

27

Ramsey Medical Society

active, you’ve probably noticed it’s the same people doing the work at several different organizations. Each generation seems to view its privilege and obligation to “give back to the community” differently, according to Putnam.

So what’s an aging organization to do?

We’ve started by taking a serious look at the needs and attitudes of the upcoming generation of physicians’ spouses. We’re now trying to blend those attributes with the core values of current members – across all areas of the Alliance.

At the national level, the AMA Alliance just passed several changes to its bylaws in an effort to widen the membership base and to encourage greater involvement by more people in charting the Alliance course. The MMA Alliance and RMS Alliance are both updating their bylaws to reflect many of these changes. And we’ll be sure to send more people up to take part in national activities.

What appear to be matters of housekeeping really are signs that our entire organization is evolving to better reflect today’s medical families. We’re becoming an organization that works to improve the health of our communities. Yes, we’re still physicians’ spouses, but that identity now takes a back seat. We emphasize what we do, not so much who we are.

So what’s the next step? Slow and steady recruiting of new members, starting with medical student spouses and partners. Recently, the presidents of both metro area Alliances cohosted a luncheon for these women and men at the University of Minnesota Medical School, as part of their orientation. We talked a lot about medical marriages and some about the Alliance. We’ll meet with them a few more times yet this year. Our goal is to lay the foundation for future participation in organized medicine, wherever they wind up.

We also have agreed to host any The Alliances from Ramsey and Hennepin joined forces visiting medical students, residents with the U of M Medical School to host an informational lunch for incoming medical student spouses and partners. or fellows and their families when

children’s elementary school called me one day late in May. Her term as president of the Garlough Parent Teacher Organization (PTO) was about up. Would I consider serving as the next president? I had been to exactly two PTO meetings in two years – that should have clued her in to my interest. I knew nothing about how to run the group. She assured me it would be easy. She’d be there to help, etc., etc. Her final plea was, “If you don’t do it, the organization will fold.”

Three years later, I’m still president of this PTO. I’m glad to say I think I finally know what I’m doing. And I’ve gone on to serve in a variety of other (more interesting) roles within the school district, thanks to my stint with the PTO. My journey to president of the RMS Alliance was a little more deliberate; still, part of the reason I rose to the top in a just a few short years is because we, too, have a shortage of manpower. In fact, getting people to give their time and talent is a daunting task in just about any group you care to name.

In his best-selling book, Bowling for One, Robert Putnam suggests several reasons for this apparent apathy. People use their time differently than they did in years past. They spend more time in front of the TV. There are more dual-income families than ever now. And when they’re not working, parents are running their kids from one activity to the next. In the end, there’s little time left for volunteering.

There’s also a matter of attitude towards community involvement. If you’re the least bit

CHAIR’S REPORT T. M I C H A E L T E D F O R D , M . D .

Health Care Work Force Shortage HMS-Officers

Chair T. Michael Tedford, M.D. President Michael B. Ainslie, M.D. Secretary Richard M. Gebhart, M.D. Treasurer Paul A. Kettler, M.D. Immediate Past Chair David L. Swanson, M.D. HMS-Board Members

Michael Belzer, M.D. Jeffrey V. Christensen, M.D. Peter J. Dehnel, M.D. Drew Dietz, Medical Student Andrea J. Flom, M.D. Diane Gayes, Alliance Co-President Peggy Johnson, Alliance Co-President Ronald D. Osborn, D.O. James Peters, M.D. James A. Rhode, M.D. David F. Ruebeck, M.D. Richard D. Schmidt, M.D. Michael G. Thurmes, M.D. D. Clark Tungseth, M.D. Michael J. Walker, M.D. HMS-Ex-Officio Board Members

Paul F. Bowlin M.D., Senior Physicians Association Lee H. Beecher, M.D., MMA-Trustee Carl E. Burkland, M.D., Member-at-Large Karen K. Dickson, M.D., MMA-Trustee David L. Estrin, M.D., MMA-Trustee John W. Larsen, M.D., MMA-Trustee Henry T. Smith, M.D., MMA-Trustee David W. Allen, Jr., MMGMA Rep. HMS-Executive Staff

Jack G. Davis, Chief Executive Officer Kathy Dittmer, Executive Assistant Sue Schettle, Director, Marketing & Member Services

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November/December 2002

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WORKING TOGETHER, the Hennepin Medical Society and Ramsey Medical Society sponsor quarterly meetings of the metropolitan hospital physician leadership – the vice presidents of medical affairs, chiefs of staff and chiefs of staff-elect – for discussion of concerns shared by hospitals and their physicians. Last year discussion turned to the work of a Minnesota legislature task force on nursing home care and its approach to nursing home closures.

The health care work force shortage is especially keen where budgets are the tightest and nursing home bankruptcies around the state have the attention of the legislature. Like all of us, the metropolitan hospital physician leaders are concerned because limited nursing home bed space limits acute care hospital discharge and the bed shortage in hospitals means emergency rooms close and closed emergency rooms compromise patient care. To be sure health care policy makers at the legislature understand the physician perspective on the issue, we met with them at the capitol.

Our meeting was reassuring in some regards and unsettling in others. Reassuring because these legislators are clearly an informed, intelligent, committed group. They understand the dynamics at work in our environment from the perspective of the nursing homes, hospitals, physicians, nurses, support staff and patients.

The goal of their work regarding nursing home closures is to assure state resources support nursing home care geographically, so the vagaries of economics in some parts of the state do not create undue hardship. The lawmakers understand healthcare economics, the work force shortage and its impact on access and quality.

The discussion was unsettling because the lawmakers understand healthcare economics.

They know why economics is called the dismal science, the study of unlimited needs and limited resources. They know acutely that our society holds strongly and simultaneously to contradictory values. We want access to quality health care and we want lower taxes. Simple.

Right? These informed, intelligent legislators, MetroDoctors

committed to quality healthcare have good judgment and understand our needs as physicians.

They understand the wishes of their constituents. And they have to balance a budget, just like us. We were a group of physicians turning to them, hoping that explanation of our situation, the plight of our patients and society would somehow shift more state resources into healthcare. At the time, they understood our situation and knew that most people in Minnesota wanted the legislature to address education and tax relief, not healthcare. The policy makers skillfully turned our problem back to us.

They told us we were the experts in healthcare and we were the people most able to provide the solution to the problems we face. They asked us to come to them with suggestions about how they could help. And they asked us to help create the public forum to discuss these issues to prevent the crisis from worsening.

HMS and RMS have created the brain drain survey, an instrument to measure healthcare workforce needs so that discussion can continue with hard, convincing facts for the citizens of Minnesota and for the legislature. At our last board meeting, HMS created an advocacy committee to work with RMS and the MMA to address healthcare public relations and legislative issues. We are taking the discussion out of the doctors’ lounges, surgery locker rooms, and hospital hallways. ✦

The Journal of the Hennepin and Ramsey Medical Societies

HMS Members Elected to MMA and AMA Positions trist in St Louis Park, was re-elected as West Metro Trustee to the MMA board of trustees and David Estrin, M.D., pediatrician with South Lake Pediatrics in Minnetonka, was elected as a new trustee. Henry Smith, M.D., internist with Hennepin Faculty Associates in Minneapolis, was elected to the Executive Committee of the MMA board of trustees. Benjamin Whitten, M.D., an internist practicing at Abbott Northwestern Hospital, was elected to join the Minnesota Delegation to the AMA. ✦

Gary Hanovich, M.D. inaugurated as 2003 President of the Minnesota Medical Association.

HMS Physicians Receive MMA Awards Richard C. Lussky, M.D., was awarded the MMA’s 2002 Community Service Award. Dr. Lussky is a pediatrician and neonatologist who practices at HCMC. He was recognized for his efforts to improve the health of high-risk and underserved patient populations through his efforts to improve coordination among health care providers, community clinics, public health and community organizations, policy makers, professional organizations, and the community.

Dr. Lussky serves on the Board of Directors of the Minnesota Organization on Fetal Alcohol Syndrome and is involved with the March of Dimes.

Amy E. Nygaard, a fourth year medical student at the University of Minnesota Medical School, is the 2002 recipient of the MMA’s Medical Student Award.

The award is given Blanton Bessinger, M.D. to a Minnesota and Amy Nygaard. medical student who has an outstanding commitment to the medical profession. She is recognized for organizing a retreat for the students in the Rural Physician Associate Program and their mentors, MetroDoctors

Dr. House is a retired orthopedic surgeon who practiced in Minneapolis at the VA Medical Center.

Deane C. Manolis, M.D., Richard C. Lussky, M.D., and Henry T. Smith, M.D.

her efforts to provide care for an autistic child, and her leadership in charitable fund raising activities.

Deane Manolis, M.D., and James House, M.D., were awarded the 2002 President’s Award. This award is presented to MMA members who have made outstanding contributions to the association but have never been elected to office. Dr. Manolis received the award for his service as a delegate to the MMA and for his membership and efforts on the MMA Committees on Legislation, Medical Practice and Planning, and the Interspecialty Council. Dr. Manolis is a psychiatrist practicing in Minneapolis. Dr. House was recognized for his participation as a specialty society delegate to the MMA House of Delegates, and as a member of the MMA’s Workers’ Compensation Task Force, Interspecialty Council, and Legislative Network.

The Journal of the Hennepin and Ramsey Medical Societies

Henry Smith, M.D., was awarded the 2002 Minority Meritorious Service Award. Dr. Smith practices internal medicine and nephrology at Hennepin Faculty Associates where he cares for a minority patient population and is committed to reaching under-served communities. Dr. Smith has been a mentor and role model for many in the Twin Cities community. He has been a member of the MMA Minority and Cross Cultural Affairs Committee and was its chair from 1997 to 2000. This committee has developed an MMA mentoring program for junior high school students. The purpose of the program is to encourage minority students to pursue careers in medicine. Dr. Smith serves his West Metro colleagues as a member of the MMA Board of Trustees. ✦

James H. House, M.D.

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Hennepin Medical Society

DURING THE RECENT MMA Annual meeting many of your colleagues successfully pursued positions of leadership in the MMA or AMA Delegation. The following physicians are working on your behalf in new positions. Gary Hanovich, M.D., a cardiologist at Cardiovascular Consultants, Ltd. in Minneapolis, was inaugurated as the President of the Minnesota Medical Association. Michael Ainslie, M.D., endocrinologist with Park Nicollet Clinic - St. Louis Park, was re-elected as the treasurer of MMA. Lee Beecher, M.D., a practicing psychia-

HMS NEWS Bjorn P. Flygenring, M.D. Laeknadeild Haskola Islands, Reykjavik Cardiovascular Diseases Minneapolis Cardiology Assoc. Minneapolis Heart Institute

New Members HMS welcomes these new members to the Society. Schools listed indicate the institution where the medical degree was received.

Active John P. Blank, M.D. McGill University Faculty of Medicine, Montreal Pediatric Hematology-Oncology Ronald J. Brace, M.D. University of Minnesota Medical School Emergency Medicine Unity Hospital Eric G. Christianson, M.D. University of Minnesota Medical School Family Practice Fairview Riverside Med. Ctr. Urgent Care Clinic Peter S. Dahlberg, M.D. University of Minnesota Medical School Thoracic Surgery University of Minnesota Physicians

Laura H. Goetz, M.D. University of Minnesota Medical School General Surgery Lakeview Clinic, Ltd. Joel S. Greenwald, M.D. Albert Einstein College of Medicine-Yeshiva University, Bronx Internal Medicine Raymond James Financial Services, Inc.

Stephen H. Hite, M.D. Northeastern Ohio University College of Medicine Pediatric Radiology Fairview-University Medical Center Gregory C. Jones, M.D. Mayo Medical School Otolaryngology Park Nicollet Clinic - St. Louis Park Rosemary F. Kelly, M.D. Pritzker School of Medicine, University of Chicago Cardiovascular Surgery University of Minnesota-CVTS Surgery

Samuel J. Dardick, M.D. University of California School of Medicine, San Francisco Internal Medicine Park Nicollet Clinic - Golden Valley

Jason John Koch, M.D. Mayo Medical School Pediatrics Southdale Pediatric Associates, Ltd.

Charles Albert Dietz, M.D. Ohio State University College of Medicine Diagnostic Radiology Fairview-University Medical Center Alison A. Eckhoff, M.D. University of Minnesota Medical School Internal Medicine Park Nicollet Clinic - Minneapolis 30

November/December 2002

Terrence F. Longe, M.D. Wayne State University School of Medicine Cardiovascular Diseases Minneapolis Cardiology Assoc. Minneapolis Heart Institute Thomas J. Marr, M.D. Loyola University Stritch School of Medicine Pediatrics HealthPartners Kari M. Miller, M.D. University of Minnesota Medical School Unspecified Specialty Crossroads Medical Centers, P.A.

Charles L. Hirt Jr., M.D. Tufts University Obstetrics & Gynecology Paul Larson OB/GYN Clinic, P.A.

Susan L. Dahlin, M.D. Chicago Medical School Obstetrics & Gynecology Associates in Women’s Health

Steven Edwin Dentz, M.D. University of Michigan Medical School Anesthesiology Northwest Anesthesia, P.A.

Jennifer L. Lewis, M.D. University of Minnesota Medical School Family Practice Crossroads Medical Centers, P.A.

Gwen K. Nazarian, M.D. Mayo Medical School Radiology Fairview-University Medical Center Charles R. Peterson, M.D. University of Minnesota Medical School Internal Medicine Park Nicollet Heart Center Guy J.A. Rudin, M.D. University of Southern California School of Medicine Orthopedic Surgery Orthopaedic Consultants, P.A. Jeffrey J. Shultz, M.D. University of Southern California School of Medicine Cardiac Electrophysiology-Internal Medicine Cardiovascular Consultants, Ltd.

Rebecca R. Kuehn, M.D. University of Wisconsin Medical School Anesthesiology Northwest Anesthesia, PA

Richard J. Sinda, D.O. University of Osteopathic Medicine and Health Sciences, Des Moines Family Practice Crossroads Medical Centers, P.A.

Stanley D. Kurisko, M.D. University of Ottawa Diagnostic Radiology Consulting Radiologists, Ltd.

Aaron J. Timmerman, M.D. University of Iowa College of Medicine Family Practice Park Nicollet Clinic - Prairie Center

George H. Landis, M.D. University of Arizona College of Medicine Plastic Surgery Landis Plastic Surgery, P.A.

Irwin D. Weisman Ph.D, M.D. University of Miami School of Medicine Diagnostic Radiology Consulting Radiologists, Ltd.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Paul M. Williams, M.D. University of Minnesota Medical School Otolaryngology Oakdale Ear, Nose, & Throat Clinic, P.A.WestHealth

Residents Rebecca Ruth Shobe French, M.D. Medical College of Wisconsin Fairview University Medical Center-University Campus

Peter W. Waldusky, M.D. University of Minnesota Medical School Internal Medicine Hennepin County Medical Center Elizabeth R. Westby, M.D. University of Minnesota Medical School Family Practice University of Minnesota Medical School

Medical Student

JESSE J. BARRON, M.D., died September 26 at the age of 78. He graduated from the University of Minnesota Medical School. He began his medical career with his father, Dr. Moses Barron, and became a geriatric specialist. He practiced in Minneapolis for nearly 50 years, making house calls until the late 1970s. Dr. Barron joined HMS in 1950.

DAVID E. CULLIGAN, M.D., died in August at the age of 65. He graduated from the University of Minnesota Medical School, completed his internship at Milwaukee County General Hospital, and his surgical residency at the Mayo Clinic. In partnership with his brother, John A. Culligan, he practiced general surgery in the Twin Cities from 1969-90, and then for a short time in Waukesha, WI. He was an associate professor at the University of Minnesota from 19792002. Dr. Culligan joined HMS in 1966.

DAVID JAMES DUNLAP, M.D., a retired Urologist, died August 24. He was 66. He graduated from Northwestern Medical School and completed his internship at Minneapolis General Hospital. He practiced for 36 years at North Memorial Hospital. Dr. Dunlap joined HMS in 1969.

WYMAN E. JACOBSON, M.D., died August 9 at the age of 86. He graduated from the University of Minnesota Medical School.

He was a past president of the St. Louis Park Medical Center (Park Nicollet Clinic) and the Twin Cities Diabetes Association. Dr. Jacobson joined HMS in 1949.

EMMA MICKELSEN, M.D., died October 2 at the age of 88. She graduated from the University of Minnesota Medical School. She enjoyed a long career in pediatrics and public health in California, Minnesota and Florida.

Dr. Mickelsen joined HMS in 1994. ✦

(University of Minnesota)

Bradley T. Bialczyk Samuel A. Bugbee Danielle L. Doro Benjamin D. Ehst David R. Fermin Todd R. Gengerke Scott Martin Grigory Kimberly K. Kvatum Brenda Rieland Larson Michael D. Miedema Julie A. Pazdernik Donny J. Peterson Shauna S. Runchey Paul J. Vollmar Sarah A. Zeller ✦

In Memoriam CALVIN BANDT, M.D., died September 15 at the age of 70. He was a forensic pathologist and director of clinical pathology at HCMC. He graduated from the University of Minnesota Medical School and completed an internship at the Minneapolis General Hospital (now Hennepin County Medical MetroDoctors

Your medical society has contracted with DAMARCO Solutions, LLC to provide OSHA compliant MSDS Management Services to members that wish to enroll.

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The Journal of the Hennepin and Ramsey Medical Societies

Need Help Managing Your Material Safety Data Sheets (MSDS)?

For more information contact: Gary Graczyk at 612-617-0999 ext. 102 or email: gary@damarco.com or visit DAMARCO s website at www.damarco.com

November/December 2002

31

Hennepin Medical Society

Virginia L. Kakacek, M.D. University of Minnesota Medical School Family Practice Creekside Family Physicians Clinic

Center). Dr. Bandt developed a toxicology lab at HCMC in the 1970s. Dr. Bandt joined HMS in 1985.

HMS ALLIANCE NEWS

Opening Event The Alliance opening social event was held in September at the home of Dr. Manny and Ophie Balcos. Guests enjoyed catching up with each other over a catered lunch and also admired Ophie’s beautiful flower gardens. Special guests included Eleanor Goodall, state president, Harriet Hodgson, state president-elect, and National Director Dianne Fenyk.

Eleanor reported on the recent state meeting where Dr. Michael Osterholm was the guest speaker. Harriet has recently authored a children’s workbook, Food Label Detective, and has donated the book to the state alliances as a health promotions project. It will be printed as soon as funds are available. Dianne reiterated the importance of county alliances maintaining our national connection. There are many resources available for county and state health projects.

Holiday Fundraiser Tickets are still available for the Alliance fundraising event in December. Gerald Charles Dickens’ one man performance of “A Christmas Carol” will be a memorable evening and your support of this fundraising effort will support on-going projects such as Body Works, a health fair for Minneapolis third graders, HIV/ AIDS education folders, and the AMA Foundation. Questions about the event can be answered by Diane Gayes or Peggy Johnson at 612-623-3030.

Diane Gayes

Peggy Johnson

Medical Student Partner (MSP) Co-President Co-President Luncheon The Hennepin and Ramsey Medical Alliances and the University of Minnesota Medical School Office of Education co-sponsored a luncheon for the spouses and partners of the incoming partner: Deena Anders, 1st year Resident medical students on August 15. Dr. Marilyn spouse/Hennepin Medical Alliance; Becky Becker, director of admissions, provided inforGonzalez-Campoy, Ramsey Medical Alliance; mation and offered support to help the spouses Diane Gayes and Jan Musich, Hennepin Mediand partners prepare for life with a medical stucal Alliance. The medical alliances have over dent. A financial officer advised them and an$500 available to sponsor medical student partswered their questions regarding finances and ner memberships in the county ($1), state ($1) financial aid during medical school. and national alliance ($10). Check the HMSA The MSP group provides support and a web page for membership information or consense of community for its members as well as tact the Hennepin and/or Ramsey Medical Alto be part of the medical alliance. The medical liances at 612-623-3030. ✦ alliance works with MSP members to organize social activities, health-orientated community service and information resources, and provides them with a valuable link to the medical school – their partner’s “home away from home.” The county, state and national medical alliances and the medical school recognize and welcome the Medical Student Partners as part of the medical family.

At the luncheon the following medical alliance members (From Left) Eleanor Goodall, MMAA president; HMSA member Harriet Hodgson, MMAA president-elect from shared their experiences and per- Zumbro Valley; and Dianne Fenyk, HMSA member, spectives on life as a medical AMAA field director.

___ YES! Please send me ____ tickets at $160 each for dinner & Gerald Charles Dickens’ performance of A Christmas Carol on December 20, 2002 at the Interlachen Country Club, Edina, Minnesota.

• I have enclosed a check payable to HMSA Philanthropic for $_____ $100 of each ticket is tax-deductible.

• Sorry, we cannot attend but enclosed please find a tax-deductible donation to HMSA Philanthropic Fund.

Your name: ________________________________________________________ Mailing address: _____________________________________________________ Phone number:______________________________________________________ Send your check and this completed form to: HMSA – Peggy Johnson, 6229 Fox Meadow Lane, Edina, MN 55436

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November/December 2002

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Ramsey and Hennepin Medical Societies offer the

2003 Winter Medical Conference February 8-15, 2003 Paradisus Playa Conchal Beach & Golf Resort Costa Rica The Melia’s Paradisus is located in the northwest section of the country, bordering the Pacific Ocean. Conchal is one of the most beautiful white-sand beaches in Costa Rica. The resort resembles an elegant, modern village, with its villas, rooms and facilities focused upon an impressive freeform pool. The white-sands of Conchal are just steps from your door, as is championship golf. This captivating resort is in the region of Guanacaste, nestled between the resort towns of Tamarindo and Flamingo. Excursions to the rain forest, the volcano region, and river rafting will be available.

ALL INCLUSIVE RATES $2,649 $1,849 $1,749 $1,399 $1,649

(AIR, HOTEL, MEALS, BEVERAGES, TAXES AND GRATUITIES) per physician/single/double per spouse/guest, double occupancy per third adult in room per child age 2-11 per child age 12-17

Deposit of $750 per person due by November 8, 2002. Full payment due by December 8, 2002.

Space is limited.

Educational Conference Fee not included in above pricing.

CALL TO SAVE YOUR SPACE. Darla at Hobbit Travel (612-252-9493 ext. 3339) Email: darlawilke@hobbittravel.com

INCLUDED IN ALL INCLUSIVE Non-stop Northwest charter round trip airfare from Minneapolis/St. Paul to Liberia, Costa Rica (frequent flier miles available) 7 nights accommodations in Junior Suites at the Paradisus Playa Conchal Beach & Golf Resort Transfers to and from the airport and hotel, baggage handling at the hotel All meals, snacks and beverages 24 hour room service 6 restaurants to enjoy all meals and snacks Unlimited Premium brand beverages Hilltop casino and disco Nightly live shows and music In room mini-bar Welcome cocktail reception Saturday evening Non-motorized water and land sports Mini Club for children Tennis courts (4 lighted) Fully-equipped health club, sauna & whirlpool All U.S. and hotel taxes plus gratuities

Green fees for the resort’s 18 hole Robert Trent Jones II designed golf course are not included.