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-ETRO$OCTORS )33. IS PUBLISHED BI MONTHLY BY THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES 'ODWARD 3TREET .% "ROADWAY 0LACE 7EST 3UITE -INNEAPOLIS -.

0ERIODICAL POSTAGE PAID AT -INNEAPOLIS

-INNESOTA 0OSTMASTER 3END ADDRESS CHANGES TO -ETRO$OCTORS (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES 'ODWARD 3TREET .% "ROADWAY 0LACE 7EST 3UITE -INNEAPOLIS -.

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4O PROMOTE THEIR OBJECTIVES AND SERVICES THE (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES PRINT INFORMATION IN -ETRO$OCTORS REGARDING ACTIVITIES AND INTERESTS OF THE SOCIETIES 2ESPONSIBILITY IS NOT ASSUMED FOR OPINIONS EXPRESSED OR IMPLIED IN SIGNED ARTICLES AND BECAUSE OF THE FREEDOM GIVEN TO CONTRIBUTORS OPINIONS MAY NOT NECESSARILY REmECT THE OFlCIAL POSITION OF (-3 OR 2-3

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3END LETTERS AND OTHER MATERIALS FOR CONSIDERATION TO -ETRO$OCTORS (ENNEPIN AND 2AMSEY -EDICAL 3OCIETIES 'ODWARD 3TREET .% "ROADWAY 0LACE 7EST 3UITE -INNEAPOLIS -. % MAIL BAUERFAMILY EARTHLINK NET &OR ADVERTISING RATES AND SPACE RESERVATIONS

CONTACT "ETSY 0IERRE %ASTWOOD #IRCLE -ONTICELLO -.

PHONE FAX E MAIL BETSY PIERREPRODUCTIONS COM -ETRO$OCTORS RESERVES THE RIGHT TO REJECT ANY ARTICLE OR ADVERTISING COPY NOT IN ACCORDANCE WITH EDITORIAL POLICY

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.ON MEMBERS MAY SUBSCRIBE TO -ETRO$OCTORS AT A COST OF PER YEAR OR PER ISSUE IF EXTRA COPIES ARE AVAILABLE &OR SUBSCRIPTION INFORMA TION CONTACT $OREEN (INES AT

/N THE COVER (EALTH PLAN hTIERINGv OF PROVIDERS !RTICLES BEGIN ON PAGE

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,ETTER TO THE %DITOR )N THE 0HYSICIAN S 3OAPBOX h! 4ALE OF 4WO #OUNTRIESv -ETRO$OCTORS *ULY !UGUST

$R ,EE +URISKO URGES ADOPTION OF hFREE MARKET CAPITALISMv AS THE SOLUTION TO OUR HEALTH CARE CRISIS %ARLY ON HE MAKES THE OFT REPEATED CLAIM THAT 5 3 HEALTH CARE IS THE BEST IN THE WORLD 9ES PERHAPS TRUE IF YOU ARE WHITE UPPER MIDDLE CLASS WELL EDUCATED

HAVE COMPREHENSIVE HEALTH CARE INSURANCE AND LIVE IN A MAJOR METROPOLITAN AREA .O IF YOU ARE ONE OF THE MILLION WITH NO INSUR ANCE OR OF THE MILLIONS MORE WITH INADEQUATE INSURANCE AT RISK FOR BANKRUPTCY SHOULD MAJOR ILLNESS STRIKE $R +URISKO USES A SINGLE CASE EXAMPLE ANECDOTE AS THE CENTERPIECE OF HIS STANCE AGAINST THE #ANADIAN SYSTEM 3UCH A hPROOFv IS UNWORTHY OF COMMENT (E ALSO HAS SOME

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SURGERY SUITE AND LAB LOCATED IN MEDICAL DENTAL BUILDING DIRECTLY ACROSS FROM 3T *OHN S (OSPITAL IN -APLEWOOD 0LEASE CALL 0AT 7OLF #2%3 )NC -%$)#!, $%.4!, /&&)#% 30!#%

3& AVAILABLE IN SMALL PROFES SIONAL BUILDING ON BUSY INTERSECTION IN 7OODBURY /RAL SURGEON PEDIATRIC DENTIST SUITES SHARE BUILDING !CCESS SPACE DIRECTLY FROM PARKING LOT 'REAT EXTERIOR SIGNAGE #ALL #2%3 )NC

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ERRONEOUS lGURES SAYING THAT 5 3 PER CAPITA EXPENDITURES ON HEALTH CARE IS hABOUT

v PER ANNUM THE PER CAPITA lGURE FROM THE 5 3 $EPT OF #OMMERCE FOR IS

OR PERCENT OF '$0 4HE HEALTH CARE CRISIS IN THE 5NITED 3TATES IS COMPLEX AND ANY SOLUTION WILL BE LESS THAN PERFECT AND WILL NOT SATISFY ALL "UT WE CAN LEARN FROM OTHER DEVELOPED COUNTRIES

BOTH FROM THEIR SUCCESSES UNIVERSAL COVER AGE LOWER ADMINISTRATIVE COSTS BETTER HEALTH OUTCOMES AND THEIR PROBLEMS CHRONIC UNDER FUNDING LEADING TO LONGER WAITS AND DETERIORATION OF MEDICAL INFRASTRUCTURE )N THE 5NITED 3TATES CONTROL OF OUR MEDICAL DEVICE COMPANIES INSURERS AND MANAGEMENT CORPORATIONS ALL OF WHOM MAXIMIZE PROlTS EITHER BY INCREASING REIMBURSED UTILIZATION OR BY LIMITING CARE 4HESE ARE POWERFUL AND WEALTHY INTERESTS lRMLY ENTRENCHED IN THE HALLS OF GOVERNMENT #HANGE WILL BE DIF lCULT )N THE 5 3 WE SPEND PLENTY OF MONEY ON HEALTH CARE 4HE PROBLEM IS THE SYSTEM

WHICH REWARDS SOME EXCESSIVELY HAS EXCESSIVE ADMINISTRATIVE COSTS AND TOLERATES GREAT DIS PARITIES IN ACCESS AND QUALITY OF CARE /THER DEVELOPED COUNTRIES WITH UNIVERSAL COVERAGE SPEND ON THE AVERAGE ABOUT HALF OF WHAT WE DO PER CAPITA BUT MANY ARE CHRONICALLY UNDER FUNDING THEIR PROGRAMS -Y OWN BIAS IS FOR A SINGLE PAYER GOVERNMENTALLY ADMINISTERED PLAN A 5 3 DESIGNED MODIlCATION AND IMPROVEMENT OF UNIVERSAL COVERAGE PLANS OF OTHER COUN TRIES ) DO NOT BELIEVE THAT HEALTH CARE LIKE EDUCATION AND lRE AND POLICE PROTECTION IS AMENDABLE OR APPROPRIATE FOR FREE MARKET CAPITALISM IF YOU CAN PAY YOU CAN GET IT IF NOT YOU DON T -Y SUGGESTION IS FOR A BIPARTISAN COM MISSION TO BE APPOINTED BY THE 0RESIDENT OF THE QUALITY OF THE COMMISSION TRULY BI PARTISAN MEMBERS NOT VULNERABLE TO POLITICAL THREATS ADEQUATE FUNDING FOR EXPERT STAFF

TO BE CHARGED WITH DEVELOPING A PLAN FOR UNIVERSAL HEALTH CARE COVERAGE FOR THE 5NITED 3TATES !T THE VERY LEAST THIS MIGHT SHINE A LIGHT ON WHAT IS BECOMING AN UNSUSTAINABLE PROBLEM 4HOMAS / 3WALLEN - $

,ETTER TO THE %DITOR 4HE RECENT h0HYSICIANS 3OAPBOXv PIECE DEMANDS A RESPONSE $R ,EE +URISKO A #ANADIAN RADIOLOGIST NOW WORKING IN THE 5NITED 3TATES ATTEMPTED TO COMPARE THE #ANADIAN AND 5NITED 3TATES HEALTH CARE SYSTEMS FROM HIS PERSONAL VANTAGE 4HE MERE FACT THAT HE LEFT #ANADA FOR GREENER PASTURES IN THIS COUNTRY ALREADY LABELS HIM AS BEING OPPOSED TO THE #ANADIAN SYSTEM (IS CRITI CISM OF OUR HEALTH INSURANCE ARRANGEMENTS SUGGESTS THAT HE IS NOT COMPLETELY ENAMORED OF OUR SYSTEM .EITHER AM ) BUT FOR ENTIRELY DIFFERENT REASONS -UCH OF $R +URISKO S COMPLAINT ABOUT THE NATIONALIZED HEALTH CARE OF #ANADA APPEARS TO BE EXCESSIVE COST CONTROL BY GOVERNMENT RESULTING IN INADEQUATE SERVICES (E SUPPORTS THIS POSITION BY CITING THE AWFUL HEALTH CARE EXPERIENCE OF HIS BROTHER AFmICTED WITH A NASOPHARYNGEAL CARCINOMA !SSUMING THAT THE DETAILS OF HIS BROTHER S EXPERIENCE IN #ANADA ARE REASONABLY FACTUAL THE EXPERIENCE IS STRICTLY AN ANECDOTE NOT NECESSARILY TYPICAL OF MEDICAL CARE IN #ANADA 4HE IMPLICATION THAT THIS ANECDOTE IS COMMON IN #ANADA

AND COULD NOT OCCUR IN THE 5NITED 3TATES IS NOT SUPPORTED BY THE FACTS $ESPITE SPENDING LESS ON HEALTH CARE IN #ANADA MOST INTERNA TIONAL COMPARISONS INDICATE THAT HEALTH IN #ANADA IS ABOUT THE SAME AS IN THE 5NITED 3TATES )N MY YEARS OF PATHOLOGY HOSPITAL PRACTICE ) ENCOUNTERED MANY ANECDOTES OF EQUALLY ABYSMAL CARE NOTED FAR MORE FOR THEIR EXPENSE THAN QUALITY ) VIVIDLY RECALL A TENNIS PLAYING FRIEND OF MINE SUFFERING FROM CHEST PAIN (E HAD CONSULTED WITH A CARDIOLOGIST WHO PERFORMED A COMPLEX SERIES OF STRESS AND ANGIOGRAPHIC PROCEDURES NONE OF WHICH EXPLAINED THE CHEST PAIN /N THE TENNIS COURT WHEN MY FRIEND DESCRIBED HIS MEDICAL EXPERIENCE HE POINTED TO A PAR TICULAR SPOT ON HIS CHEST WALL ADJACENT TO THE STERNUM 4HE SPOT WAS SLIGHTLY RAISED AND EXQUISITELY TENDER TYPICAL OF THE SELF LIMITED DISORDER CALLED 4IETZE S SYNDROME ) MADE THE DIAGNOSIS IN SECONDS AND AT NO COST 4HE CARDIOLOGIST NEVER EVEN EXAMINED HIS CHEST -ODERN CARDIOLOGY HAS BECOME A SERIES OF EXPENSIVE INTERVENTIONAL PROCEDURES 3EE ) HAVE ANECDOTES AS WELL

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! MAJOR CONTRIBUTOR TO THE FRIGHTFUL HEALTH CARE INmATION AFFECTING THIS NATION IS THE USE OF hPROCEDURESv IN DIAGNOSIS AND THERAPY INSTEAD OF CLINICAL EVALUATION 4HE lELD POSSIBLY MOST AT FAULT IS RADIOLOGY

$R +URISKO S SPECIALTY ) NEVER CEASE TO BE AMAZED AT THE TALENTS OF RADIOLOGY EQUIPMENT MANUFACTURERS AND THEIR RADIOLOGIST CUSTOM ERS TO EXPAND THE USE OF IMAGING PROCEDURES

TOO OFTEN BEFORE APPROPRIATE EVALUATION OF THEIR VALUES HAS OCCURRED 4HIS EXPANDED VOLUME IS NOT LIMITED TO IN PATIENT CARE %N TREPRENEURIAL ZEAL IN RADIOLOGY HAS STIMULATED THE CREATION OF FREE STANDING IMAGING CENTERS

WHERE PLAINTIFF ATTORNEYS CHIROPRACTORS AND WELL HEALED LAY PEOPLE ORDER THEIR OWN TEST FOR A FEE OF COURSE 3O %DINA HAS EIGHT -2) MACHINES AND THIS LARGE COMMUNITY IN #ANADA LACKS EVEN ONE ) WOULD PROPOSE THAT WITH APPROPRIATE CLINICAL INDICATION ONE MIGHT BE SUFlCIENT ) AM NOT IN FAVOR OF THE #ANADIAN SYS TEM NOR AM ) HAPPY WITH OURS 7E JUST HAVE TOO MUCH MEDICAL CARE AT EXCESSIVE COST AND WITH SCANT IMPROVEMENT IN OUTCOMES 7E SHOULD RETURN TO THE CONTEMPLATIVE PHYSICIAN OF THE PAST WILLING TO SPEND MORE TIME IN CLINICAL EVALUATION AND LESS ATTUNED TO hPRO CEDURALv MEDICINE $R +URISKO IS APPARENTLY HAPPIER WITH THE PRACTICE OF HIS ADOPTED COUNTRY HOPEFULLY FOR MORE THAN REMUNERA TIVE REASONS 3INCERELY

3EYMOUR (ANDLER - $

$EAR %DITOR 3OME PEOPLE BELIEVE THE MOST FUNDAMENTAL DIFFERENCE BETWEEN A LIBERAL AND A CONSERVA TIVE IS THAT THE FORMER BELIEVES THE hAVERAGE PERSONv NEEDS TO BE PROTECTED FROM HIM HERSELF AND THE LATTER BELIEVES THAT PERSON IS CAPABLE OF MAKING HIS HER OWN DECISIONS )N HIS 0RESIDENT S -ESSAGE h(OW 7ILL #ONSUMER $RIVEN (EALTH 0LANS !FFECT 0ATIENTS AND 0HYSICIANSv IN THE *ULY !UGUST ISSUE OF -ETRO$OCTORS $R #HARLES 4ERZIAN ASKS h7ILL THE PATIENT CHOOSE TO IGNORE THE PHYSICIAN S ADVICE FOR THE SAKE OF LESSENING HEALTH CARE COSTS 7ILL THE PATIENT DEFER THE RECOMMENDED TREATMENT AND CHOOSE A LESS

COSTLY WAY OF MANAGING THEIR CARE v ) WOULD ASK 7HAT S WRONG WITH THAT A 0HYSICIANS ARE FAR FROM INFALLIBLE IN THEIR ADVICE 7E mATTER OURSELVES IF WE THINK WE HAVE THE ANSWERS TO HEALTH PRESERVA TION 4HE LIST OF FADS GONE BAD IS VERY LONG &OR YEARS WE TOLD PEOPLE NOT TO GO SWIMMING FOR ONE HOUR AFTER EATING 7E TOLD PEOPLE TO GET AN ANNUAL CHEST 8 RAY 7E TOLD PEOPLE TO GET FREQUENT CHOLES TEROL CHECKS 7E TOLD THEM TO GET THEIR TONSILS OUT -AYBE WE NEED TO BE MORE HUMBLE ABOUT OUR WORTH B 0EOPLE MAKE DECISIONS BASED ON AFFORD ABILITY IN EVERY OTHER ASPECT OF THEIR LIVES WHY NOT THIS ONE 4HE DOLLARS ARE THEIRS 0EOPLE ALLOCATE THEIR PERSONAL RE SOURCES TIME MONEY EMOTIONAL RESERVES

ETC AS THEY SEE lT 4HEY MAY SMOKE AND EAT TOO MUCH 4HEY MAY CHOOSE TO SPEND THEIR MONEY ON SNOWMOBILES RATHER THAN MAMMOGRAMS ON 46S RATHER THAN MEDICATIONS ON CHIROPRACTORS RATHER THAN PHYSICIANS 4HEY MAY DECIDE IT S TOO EXPENSIVE TO WAIT IN THE %2 OVERNIGHT TO SEE IF THE CHEST PAIN IS CARDIAC OR NOT )T IS OUR JOB TO EDUCATE AND ADVISE NOT TO MONITOR THEIR CHECKBOOK CHOICES AT LEAST THOSE WHO ARE NOT MENTALLY IM PAIRED !REN T INDIVIDUALS RESPONSIBLE FOR MAKING THEIR OWN DENTAL APPOINTMENTS

AND FOR mOSSING AND BRUSHING 7HAT S THE DIFFERENCE 7E ARE A FREE SOCIETY NOT A TOTALITARIAN ONE THAT REGULATES ALL ASPECTS OF PEOPLE S LIVES ,IKE EATING AND DRINKING SENSIBLY PERSONAL HEALTH CARE CHOICES ARE AN INDIVIDUAL OBLIGATION WHICH WE ARE ALL FREE TO EXERCISE WISELY OR FOOLISHLY 7HAT IS THE DIFFERENCE BETWEEN PURCHASING HEALTH CARE AND PURCHASING FOOD OR EDUCATION 4HE lRST HAS NO MARKET DISCIPLINE THE LATTER TWO DO 0ICK YOUR COST REDUCING POISON BU REAUCRACY OR MARKET DISCIPLINE 0ERHAPS AN ANSWER TO THE lNANCING DILEMMA LIES SOMEWHERE IN THE MIDDLE A DElNED BENElT SET FOR PROVEN hESSENTIALSv OF PREVENTIVE CARE AND CONSUMER CHOICE FOR THE GREATER BALANCE OF OPTIONS OVERLAID WITH INSURANCE FOR CATASTROPHIC CARE 2ICHARD * -ORRIS - $

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VID !LLEN IS AN EXCELLENT OVERVIEW OF THE LATEST EVOLUTION IN HEALTH INSURANCE 7HILE THE TOTAL NUMBER OF PATIENTS CURRENTLY COVERED BY TIERED PLANS IS RELATIVELY SMALL THE CONCEPT IS LIKELY TO BE EMBRACED BY MORE EMPLOYERS IN THE NEXT FEW YEARS AND INSURERS WILL CORRESPONDINGLY PROVIDE A GREATER VARIETY OF TIERED OPTIONS (OW THIS WILL INmUENCE HEALTH CARE COSTS AND SERVICES IN THE SHORT RUN IS UNCERTAIN ESPECIALLY IF hTIER INGv IS JUST A STRATIlCATION BASED ON NON RISK ADJUSTED COSTS 4HE LONG TERM IMPACT ON HEALTH CARE COSTS QUALITY AND ACCESS ESPECIALLY FOR THOSE LEAST ABLE TO AFFORD IT OR WHO HAVE COM PLEX MEDICAL NEEDS IS EVEN MORE UNCERTAIN 4HE MOST CYNICAL OR PESSIMISTIC VIEW IS THAT IT WILL EVENTUALLY DRIVE MANY QUALIlED PHYSICIANS OUT OF THE STATE LEAD TO POORER OVERALL QUALITY

HAVE A MINIMAL IMPACT ON COSTS AND EVENTUALLY LEAD TO REDUCED ACCESS ESPECIALLY FOR THE UNIN SURED UNDERINSURED AND THOSE WITH COMPLEX MEDICAL NEEDS 4HE CHALLENGE TO US AS PHYSICIANS IS HOW WE CAN PROACTIVELY ADDRESS THE ISSUES OF HEALTH CARE COSTS AND QUALITY IN AN EFFECTIVE MANNER (EALTH CARE COSTS ARE HIGH AND RISING AND A GROWING NUMBER OF PEOPLE ARE LOSING THEIR ABILITY TO AFFORD INSURANCE COVERAGE 4RUE QUALITY OF CARE IS YET TO BE DELINEATED BUT IT IS POSSIBLE TO GO ONLINE RIGHT NOW AND lND YOUR PERSONAL hQUALITY REPORT v )MPROVING ACCESS IS AN ADMIRABLE GOAL TO BE EMBRACED BUT HOW THAT IS ACCOMPLISHED ON A PRACTICAL BASIS REMAINS AN ELUSIVE ASPIRATION 3O HOW CAN PHYSICIANS RESPOND TO THE CURRENT TREND IN HEALTH CARE INSURANCE ) BE LIEVE THAT IT IS ABSOLUTELY ESSENTIAL FOR A MUCH GREATER NUMBER OF PHYSICIANS TO BECOME IN VOLVED WITH ISSUES OF QUALITY COST AND ACCESS AT ALL LEVELS "ECOMING FULLY INFORMED IS THE lRST STEP AND THEN ACTING ON OPPORTUNITIES TO BE

COME INVOLVED IS A NECESSARY SECOND STEP 4HE (ENNEPIN -EDICAL 3OCIETY 2AMSEY -EDICAL 3OCIETY AND -INNESOTA -EDICAL !SSOCIATION ALL HAVE OPPORTUNITIES FOR INVOLVEMENT 4HERE ARE NUMEROUS OPPORTUNITIES AS WELL THROUGH OTHER ORGANIZATIONS )F WE DON T BECOME ENGAGED AT THIS TIME WE ARE LIKELY TO BE EXCHANGING hTIERSv FOR hTEARSv IN THE NEAR FUTURE AND CARE FOR OUR PATIENTS WILL ULTIMATELY SUFFER

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4HE PRESSURE FOR GREATER HEALTH CARE VALUE ORIGINATES WITH THE EMPLOYERS AND INDIVIDUALS WHO PURCHASE HEALTH INSURANCE COVERAGE

BY COST AND POSSIBLY QUALITY COULDN T BE MORE POLARIZED h)T S THE MOST COCKAMAMIE SCHEME EVER v EXCLAIMS ONE LOCAL HOSPITAL EXECUTIVE h)T S INEVITABLE v SAYS !NN 2OBINOW

VICE PRESIDENT AND GENERAL MANAGER WITH -EDICA S 0ATIENT #HOICE (EALTH #ARE (AVING CONSUMERS SHARE IN THE COST OF CARE ISN T NEW "EFORE (-/ STYLE BENElTS BECAME PREVALENT A COUPLE OF DECADES AGO DEDUCTIBLES AND COINSURANCE CAUSED PEOPLE TO PAY MORE WHEN THEIR DOCTORS AND HOSPITALS CHARGED MORE 4IERING HEALTH SYSTEMS BASED ON COST ALSO ISN T NEW &OR MANY YEARS -INNESOTA HEALTH PLANS HAVE OFFERED PRODUCTS WITH DIFFERENT PREMIUMS FOR DIFFERENT CARE SYSTEMS IF AN EMPLOYEE CHOSE A PRIMARY CARE PHYSICIAN IN A CARE SYSTEM WITH A LESS FAVORABLE HEALTH PLAN CONTRACT THE EMPLOYER OFTEN DEDUCTED MORE FROM THEIR PAYCHECK 7HAT IS NEW IS THE ANNOUNCED INTENTIONS OF LOCAL HEALTH PLANS TO hTIERv INDIVIDUAL HOSPITALS AND CLINICS AND THEN CHARGE PEOPLE MORE WHEN THEY CHOOSE PROVIDERS OF INFE RIOR COST AND OR QUALITY &OR PEOPLE COVERED BY SUCH TIERED INSURANCE PRODUCTS ALMOST EVERY DECISION THEY MAKE ABOUT WHICH HOSPITAL OR CLINIC TO USE WILL HAVE A SMALL BUT NOTICEABLE lNANCIAL CONSEQUENCE (EALTH PLAN EXECUTIVES EMPLOYERS UNIONS AND CERTAIN GOVERNMENT OFlCIALS AVER THAT TIERING IS NECESSARY THAT CONSUMERS MUST BE ENGAGED INTO CONSIDERING COSTS AND QUALITY AND THAT PROVIDERS NEED TO BE PRODDED TO OFFER BETTER hVALUEv MORE QUALITY AT LESS COST )N CONTRAST MANY PROVIDERS OBJECT THAT TALK ABOUT USING QUALITY IN TIERING IS A RUSE COST IS THE REAL ISSUE AND TIERING OF PROVIDERS IS GOING TO MAKE LOW COST MORE IMPORTANT THAN GOOD QUALITY 4HIS ARTICLE TRIES TO PUT THESE ISSUES IN PERSPECTIVE -INNESOTA HEALTH PLANS ARE INTRODUCING NEW TIERING PRODUCTS EVEN AS MORE INFORMATION ABOUT PROVIDER COSTS AND QUALITY ARE BECOMING PUBLIC )T IS IMPORTANT TO UNDERSTAND WHY TIERING IS OCCURRING

WHAT COST AND QUALITY INFORMATION DOES AND DOESN T TELL US AND WHAT THE IMPACT OF TIERING IS LIKELY TO BE

/ iÊ >ÃiÊv ÀÊ/ iÀ } 4HE ARGUMENT FOR TIERING IS THAT IT WILL ENCOURAGE CONSUMERS TO CHOOSE LOWER COST AND HIGHER QUALITY DOCTORS AND HOSPITALS h7E HAVE TO GENERATE INFORMATION FOR CONSUM ERS THAT THEY CAN USE TO MAKE DECISIONS v SAYS *ULIE "RUNNER EXECUTIVE DIRECTOR OF THE -INNESOTA #OUNCIL ON (EALTH 0LANS h7E RE AT THE VERY FRONT END OF GIVING CONSUMERS THE TOOLS THAT THEY WANT v 9Ê 6 Ê Ê

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4HE HOPE IS THAT THIS WILL CAUSE HOSPITALS AND PHYSICIANS TO IMPROVE QUALITY AND LOWER COSTS h4IERING IS A MEANS OF TRANSLATING PERFORMANCE INFORMATION INTO SOMETHING CONSUMERS CAN ACT ON v SAYS 'AIL !MUNDSON - $ & ! # 0 ASSOCIATE MEDICAL DIRECTOR OF QUALITY IMPROVEMENT AT (EALTH0ARTNERS 7E RE hNOT LOOKING SO MUCH TO GET PATIENTS TO CHANGE THEIR DOCTOR AS TO GET DOCTORS TO CHANGE THEIR CARE v 4HE PRESSURE FOR GREATER HEALTH CARE VALUE ORIGINATES WITH THE EMPLOYERS AND INDI VIDUALS WHO PURCHASE HEALTH INSURANCE COVERAGE 6ALUE IS THE QUALITY OF CARE BROADLY DElNED AS INCLUDING SUCH CONSIDERATIONS AS CONVENIENCE ACCESSIBILITY AND PERSONALIZED CARE AS WELL AS WHAT THE MEDICAL PROFESSION TRADITIONALLY CONSIDERS hQUALITYv DIVIDED

BY THE COST OF THAT CARE (EALTH PLANS READILY ADMIT THAT THEY AREN T YET ABLE TO MEASURE THE QUALITY NUMERATOR COMPLETELY OR COMPREHENSIVELY BUT THEY CERTAINLY KNOW THE COST DENOMINATOR THEY VE BEEN PAYING A LOT OF HEALTH CARE BILLS FOR A LONG TIME -ANAGED CARE CREATED TO MANAGE COSTS HASN T BEEN GETTING THE JOB DONE USING ITS CURRENT TOOLS (ISTORICALLY THERE HAVE BEEN THREE HEAVY DUTY MANAGED CARE TOOLS NEGOTIATING VOLUME DISCOUNTS WITH HEALTH CARE PROVIDERS LIMITING OR ALTERING HOW CARE IS PROVIDED BY USING TECHNIQUES LIKE UTILIZATION MANAGEMENT CARE COORDINATION

DISEASE MANAGEMENT AND PRIOR AUTHORIZATION AND CHANGING PROVIDER BEHAVIOR BY CHANGING lNANCIAL INCENTIVES 4IERING IS SEEN AS A NEW FOURTH TOOL INmUENCING PROVIDER IMPROVEMENTS IN QUALITY AND COST BY CHANGING CONSUMER INCENTIVES

4IERING IS SEEN AS A NEW FOURTH TOOL INmUENCING PROVIDER IMPROVE MENTS IN QUALITY AND COST BY CHANG ING CONSUMER INCENTIVES

*>ÃÌÊ/ iÀ }Ê Ê ià Ì> 4HE 0ATIENT#HOICE HEALTH PLAN RECENTLY ACQUIRED BY -EDICA AND THE 0REFERRED/NE (-/ PLAN HAVE OFFERED PRODUCTS THAT TIER WHOLE HEALTH SYSTEMS BY COST FOR ABOUT YEARS 4HESE PLANS ALLOWED HEALTH SYSTEMS TO PROSPECTIVELY ESTABLISH THEIR COSTS THE PLANS WOULD THEN PLACE THE SYSTEMS INTO DIFFERENT PREMIUM CATEGORIES BASED ON THEIR PROPOSED COSTS -ORE RECENTLY THE 3TATE OF -INNESOTA S $EPARTMENT OF %MPLOYEE 2E LATIONS $/%2 HAS MODIlED THE HEALTH COVERAGE OFFERED TO MOST STATE EMPLOYEES SO THAT HEALTH SYSTEMS ARE NOW ALSO TIERED BY COST !S WITH THE PLANS INTRODUCED EARLIER

INDIVIDUALS WHO CHOOSE MORE COSTLY HEALTH SYSTEMS PAY HIGHER PREMIUMS 7HAT DIFFERENTIATES THE $/%2 HEALTH PLAN FROM 0ATIENT#HOICE IS THAT THE DETER MINATION OF TIERS IS BASED ON ACTUAL COSTS NOT A PROSPECTIVE PROPOSAL IT IS RISK ADJUSTED TO TAKE INTO ACCOUNT DIFFERENCES IN POPULATIONS SERVED AND IT IS ALSO ADJUSTED IN CERTAIN CIRCUMSTANCES TO GIVE EMPLOYEES IN CERTAIN GEOGRAPHIC REGIONS ACCESS TO LOWER TIERED PROVIDERS #ONTINUED ON PAGE

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h4HERE IS A MAJOR VARIATION IN COST AT LEAST PERCENT FROM THE MOST EXPENSIVE TO THE LEAST EXPENSIVE HEALTH SYSTEMSv RE PORTS 0ETER "ENNER THE !&3#-% LABOR UNION REPRESENTATIVE WHO HELPS OVERSEE THE $/%2 PLAN 3O $/%2 TIERS THE HEALTH SYSTEMS HEALTH SYSTEMS AT PER CENT OR LESS OF THE STATE AVERAGE ARE IN THE LOWEST COST TIER BETWEEN PERCENT AND PERCENT ARE IN THE SECOND TIER BETWEEN PERCENT AND PERCENT ARE IN THE THIRD TIER AND ABOVE PERCENT ARE IN THE TIER WITH THE HIGHEST PREMIUMS h/UR TYPICAL EMPLOYEES MAKE

TO A YEAR v SAYS "ENNER

hTHE COST DIFFERENCE MOVES PEOPLE FROM HIGHER TIER CLINICS TO LOWER TIER CLINICS AT LEAST WHEN THERE S A CHOICE v 4HUS $/%2 FEELS IT IS SPENDING ITS DOLLARS MORE WISELY AND PUTTING PRESSURE ON PROVIDERS TO LOWER THEIR COSTS !ND ADDS "ENNER h7E LIKE PEOPLE CHOOSING CARE SYSTEMS RATHER THAN HEALTH PLANS v "UT "ENNER ACKNOWLEDGES THAT THE $/%2 SYSTEM HASN T YET FIGURED OUT HOW TO FACTOR QUALITY INTO THE EQUATION h4RANSPARENCY IS THE GOAL 7E HAVE A HORRIBLY IMPERFECT MEDICAL MARKET AND WE WANT DOCTORS COMPETING ON COST AND COMPETING ON QUALITY v

iÜÊ/ iÀ }Ê ««À >V ià "ENNER AND OTHERS POINT OUT THAT WIDE VARIATIONS IN HOSPITAL AND PHYSICIAN COSTS SEEM TO BE THE RESULT OF DYSFUNCTIONAL MARKETS !CROSS THE COUNTRY ORGANIZATIONS REPRESENTING PAYORS HAVE BEEN POINTING OUT COST VARIATIONS AND PRESCRIBING TIERING AS A POTENTIAL SOLUTION )N -ILWAUKEE FOR EXAMPLE RECENTLY PUBLISHED DATA REVEALS THAT THE EIGHT AREA HOSPITALS PERFORMING CORONARY BYPASS SURGERY CHARGE FROM JUST OVER TO ALMOST 4HIS MORE THAN COST DIFFERENCE IN THE SAME GEOGRAPHIC MARKET SEEMS TO EXIST BECAUSE ÊÊÊÊ-i«Ìi LiÀÉ"VÌ LiÀÊÓääxÊ

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OF A LACK OF COMPETITION BASED ON COST A MATTER OF GREAT AGGRAVATION TO HEALTH PLAN SPONSORS 9ET IN -INNESOTA DISCLOSURE OF COSTS HAS HISTORICALLY BEEN RESISTED BY THE HEALTH PLAN COMMUNITY AND EVEN SOME PROVID ERS 0HYSICIANS MAY KNOW ANECDOTALLY THAT THERE ARE SIGNIlCANT DIFFERENCES IN COST BETWEEN HOSPITALS AND DIAGNOSTIC IMAGING CENTERS BUT FOR THE MOST PART CONSUMERS AND PHYSICIANS HAVE BEEN IG NORANT OF PRECISELY WHAT DIFFERENT HEALTH SERVICES COST 4HE lRST DISPELLING OF THIS IGNORANCE BEGAN A COUPLE OF YEARS AGO WHEN "LUE #ROSS AND OTHER HEALTH PLANS BEGAN PUBLISHING VERY BROAD AND GENERAL INFORMATION ABOUT THE RELATIVELY COSTLINESS OF HOSPITALS FOR EXAMPLE h v FOR A LOW COST HOSPITAL AND h v FOR A HIGH COST HOSPITAL "UT NOW PRICE DISCLOSURE IS OC CURRING MORE RAPIDLY 0REFERRED/NE INTRODUCED A NEW PRODUCT /CTOBER CALLED 0ROVIDER #ARE !DVANTAGE WHICH GIVES CONSUMERS SPECIlC INFORMATION ABOUT THE COSTS OF INDIVIDUAL HOSPITAL OUTPATIENT FACILITY AND PHYSICIAN SERVICES %FFECTIVE *ULY OF THIS YEAR -EDICA IN CONJUNCTION WITH ITS PURCHASE OF THE 0ATIENT#HOICE HEALTH PLAN INTRODUCED A NEW PRODUCT CALLED h0ATIENT#HOICE )NSIGHTS BY -EDICAv h)N SIGHTSv "OTH THE 0REFERRED/NE PRODUCT

AND )NSIGHTS ARE A NEW TYPE OF PRODUCT FOR -INNESOTA POINT OF SERVICE TIERED PROD UCTS 4HIS MEANS THAT COVERED INDIVIDUALS PAY MORE ONLY WHEN THEY CHOOSE MORE COSTLY HEALTH CARE PROVIDERS )N ORDER TO HELP THEIR INSUREDS MAKE GOOD DECISIONS )NSIGHTS IS PUBLISHING THE PRICES IT HAS NEGOTIATED FOR CERTAIN TYPES OF HOSPITALIZATIONS AND OUTPATIENT PROCEDURES SEE 4ABLE FOR SOME EX AMPLES 4HE )NSIGHTS REPORT IS FAR FROM PERFECT IT IS HAMPERED BY THE FAILURE OF SEVERAL IMPORTANT HOSPITALS TO PROVIDE DATA EXCLUDED ARE !BBOTT .ORTHWESTERN THE #HILDREN S (OSPITALS AND 2EGIONS (OSPI TAL AND IT ADDRESSES ONLY EIGHT INPATIENT AND SEVEN OUTPATIENT PROCEDURES BUT IT IS NEVERTHELESS A GIANT STEP FORWARD IN PROVIDING -INNESOTANS WITH CONCRETE AND SPECIlC HEALTH SERVICES COST INFORMATION %VEN THE LIMITED INFORMATION IN THE )NSIGHTS REPORT CONlRMS THAT SUBSTANTIAL COST VARIATIONS EXIST IN THE -INNESOTA MAR KET &OR EXAMPLE THE REPORT SHOWS THAT THE TECHNICAL FEE FOR A #4 SCAN VARIES FROM AT SOME HOSPITALS TO AT OTHERS

EAR TUBES VARIES FROM TO AND HOSPITALIZATION FOR A HIP REPLACEMENT VAR IES FROM TO

7HY HASN T THIS TYPE OF COST INFOR MATION BEEN PUBLISHED BEFORE )T S hAP PROPRIATE TO DISCLOSE NOW WHILE IT WASN T

4ABLE -EDICA 0ATIENT#HOICE )NSIGHTS #ONTRACTED &ACILITY 0RICING BY 0ROCEDURE WITHOUT #OMPLICATIONS SELECTED HOSPITALS AND PROCEDURES (OSPITAL

(IP 2EPLACEMENT

/UTPATIENT )NGUINAL #ORONARY -2) (ERNIA !NGIOPLASTY 2EPAIR W O -) W 3TENT

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(EALTH%AST 3T *OSEPH S (OSPITAL

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YEARS AGO BECAUSE OF THE GROWING INTEREST IN INVOLVING CONSUMERS IN MAKING MORE INFORMED CHOICES v SAYS *AN (ENNINGS

SPOKESPERSON FOR "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA $OES THIS MEAN THAT "LUE #ROSS WILL BE DISCLOSING MORE COST INFORMATION h7E HAVEN T MADE ANY DECISIONS YET WE RE STILL STUDYING OUR OP TIONS v

`` }Ê+Õ> ÌÞÊ Ì ÊÌ iÊ µÕ>Ì 7HILE IT S UNCLEAR WHETHER OTHERS WILL FOLLOW 0REFERRED/NE AND -EDICAS LEAD IN PUBLISHING DETAILED COST INFORMATION

IT IS ALSO CLEAR THAT THIS IS ONLY PART OF THE PUZZLE )NFORMATION ABOUT THE QUALITY OF CARE IS CRUCIAL IF ONE IS TO MAKE AN IN FORMED CHOICE h(IGHER QUALITY IS LOWER COST v SAYS -EDICA S 2OBINOW h!DVERSE OUTCOMES COST A LOT 4HERE S NOTHING WRONG WITH TIERING JUST ON COST BUT YOU NEED TO KNOW QUALITY ! HIGH COST HOSPITAL MIGHT BE A GOOD CHOICE IF IT S ALSO HIGH QUALITY v 7HILE MOST PHYSICIANS ARE LIKELY AWARE THAT THERE ARE SUBSTANTIAL VARIA TIONS IN THE COST OF HEALTH SERVICES MANY WOULD PROBABLY BE SURPRISED TO LEARN ABOUT HOW SUBSTANTIAL VARIATIONS IN QUAL ITY ARE ! .EW 9ORKER ARTICLE TITLED h!NNALS OF -EDICINE 4HE "ELL #URVEv WRITTEN BY !TUL 'AWANDE - $ A GENERAL SURGEON

AND PUBLISHED $ECEMBER RE PORTED )T USED TO BE ASSUMED THAT DIFFER ENCES AMONG HOSPITALS OR DOCTORS IN A PARTICULAR SPECIALTY WERE GENERALLY INSIGNIlCANT )F YOU PLOTTED A GRAPH SHOWING THE RESULTS OF ALL THE CENTERS TREATING CYSTIC lBROSIS OR ANY OTHER DISEASE FOR THAT MATTER PEOPLE EXPECTED THAT THE CURVE WOULD LOOK SOMETHING LIKE A SHARK lN WITH MOST PLACES CLUSTERED AROUND THE VERY BEST OUTCOMES "UT THE EVIDENCE HAS BEGUN TO INDICATE OTHERWISE 7HAT YOU TEND

TO lND IS A BELL CURVE A HANDFUL OF TEAMS WITH DISTURBINGLY POOR OUT COMES FOR THEIR PATIENTS A HANDFUL WITH REMARKABLY GOOD RESULTS AND A GREAT UNDISTINGUISHED MIDDLE )N ORDINARY HERNIA OPERATIONS THE CHANCES OF RECURRENCE ARE ONE IN FOR SURGEONS AT THE UNHAPPY END OF THE SPECTRUM ONE IN FOR THOSE IN THE MIDDLE MAJORITY AND UNDER ONE IN FOR A HANDFUL ! 3COTTISH STUDY OF PATIENTS WITH TREATABLE COLON CANCER FOUND THAT THE YEAR SURVIVAL RATE RANGED FROM A HIGH OF PERCENT TO A LOW OF PERCENT DEPENDING ON THE SURGEON &OR HEART BYPASS PATIENTS

EVEN AT HOSPITALS WITH A GOOD VOLUME OF EXPERIENCE RISK ADJUSTED DEATH RATES IN .EW 9ORK VARY FROM PERCENT TO UNDER PERCENT AND ONLY A VERY FEW HOSPITALS ARE DOWN NEAR THE PERCENT MORTALITY RATE 4HE PUBLISHING OF DATA ABOUT HEALTH CARE QUALITY IN -INNESOTA HAS GROWN FROM A TRICKLE TO A TORRENT 3OME INFORMATION IS COMING DIRECTLY FROM THE HEALTH PLANS

BUT MUCH MORE IS NOW mOWING FROM IN DEPENDENT ORGANIZATIONS

4HE DATA PUBLISHED BY HEALTH PLANS IS LIMITED &OR EXAMPLE "LUE #ROSS AND "LUE 3HIELD HAS AN INTERNET 7EB SITE CALLED (EALTHCARE &ACTS® THAT ALLOWS PEOPLE TO COMPARE SEVERAL DOZEN -INNESOTA HOSPI TALS ON SEVERAL VOLUME STATISTICS AND QUAL ITY INDICATORS SUCH AS THE ANNUAL NUMBER OF HEART ATTACKS TREATED CANCER CASES AND ACUTE STROKES 4HE SITE ALSO COMPARES VOL UMES FOR FOUR DIFFERENT CARDIOVASCULAR PRO CEDURES WITH THE ,EAPFROG 'ROUP S %(2 0ATIENT 3AFETY 3TANDARD FOR EXAMPLE THE ,EAPFROG MINIMUM STANDARD OF CORO NARY ARTERY BYPASS PROCEDURES IS SHOWN NEXT TO THE ACTUAL NUMBER OF PROCEDURES PERFORMED AT EACH -INNESOTA HOSPITAL WITH AN OPEN HEART SURGERY PROGRAM 4ABLE SHOWS SOME SELECT INFORMATION FROM THE (EALTHCARE &ACTS® 7EB SITE ! MORE AMBITIOUS QUALITY DATA PRO GRAM HAS BEEN UNDERTAKEN BY (EALTH0ART NERS (EALTH0ARTNERS ANNUALLY PUBLISHES h#LINICAL )NDICATORSv WHICH COMPARES PRO VIDERS MOSTLY LARGE PRIMARY CARE GROUPS

BUT ALSO SOME SPECIALTY GROUPS AND SOME HOSPITALS BY CERTAIN QUALITY MEASURES #ONTINUED ON PAGE

4ABLE "LUE #ROSS AND "LUE 3HIELD OF -INNESOTA (EALTHCARE &ACTS® SELECTED HOSPITALS AND STATISTICS (OSPITAL

2ATE OF 0ATIENT &ALLS WITH )NJURY

!NGIOPLASTIES #ORONARY PER 9EAR ARTERY BYPASS PER YEAR

(EART ATTACKS TREATED

PRIOR YEAR

&AIRVIEW 3OUTHDALE (OSPITAL

(EALTH%AST 3T *OSEPH S (OSPITAL

-ETHODIST (OSPITAL

.ORTH -EMORIAL -EDICAL #ENTER

3OURCE "LUE #ROSS (EALTHCARE &ACTS® AT HTTP WWW BLUECROSSMN COM

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4HE REPORT COVERS QUALITY RESULTS IN SOME TEN DIFFERENT DIAGNOSTIC AREAS DE PRESSION DIABETES hHEALTHY LIFESTYLES v hHEART HEALTH v HOSPITAL PERFORMANCE

IMMUNIZATIONS PHARMACY PREVENTION

SPECIALTY PERFORMANCE AND TOBACCO USE )N MOST OF THESE AREAS (EALTH0ARTNERS HAS ESTABLISHED OBJECTIVE CRITERIA MEASURED IN DIVIDUAL MEDICAL GROUP S ACHIEVEMENT OF THESE CRITERIA AND THEN LISTED FROM BEST TO WORST MEDICAL GROUP RESULTS 4ABLE SHOWS SELECT ORTHOPEDIC GROUP INFORMA TION FROM CRITERIA MEASURED IN THE hSPE CIALTY PERFORMANCEv AREA "UT INFORMATION ABOUT QUALITY IS STARTING TO GUSH OUT OF MANY ORGANIZATIONS THAT ARE OFTEN FUNDED BY HEALTH PLANS PRO VIDERS OR THE GOVERNMENT BUT OTHERWISE INDEPENDENT &OR HOSPITALS ORGANIZATIONS LIKE THE ,EAPFROG 'ROUP FOR 0ATIENT 3AFETY

(EALTH'RADES AND EVEN THE 5 3 $EPART MENT OF (EALTH AND (UMAN 3ERVICES ARE PUBLISHING DATA ABOUT HOSPITALS ON QUALITY AND PATIENT SAFETY 3TRATIS (EALTH IS A NON PROlT QUALITY IMPROVEMENT ORGANIZATION HEADQUARTERED IN "LOOMINGTON THAT CON TRACTS WITH STATE AND FEDERAL GOVERNMENT AGENCIES TO ADDRESS QUALITY ISSUES 4HE )NSTITUTE FOR #LINICAL 3YSTEMS )MPROVE MENT h)#3)v IS AN ORGANIZATION FUNDED BY -INNESOTA HEALTH PLANS AND OPERATED

BY PHYSICIANS FOR THE PURPOSE OF ESTABLISH ING AND DOCUMENTING CLINICAL GUIDELINES AND STANDARDS 0ERHAPS THE MOST IMPORTANT ORGANIZA TION REPORTING QUALITY INFORMATION ABOUT -INNESOTA PHYSICIANS IS -INNESOTA #OM MUNITY -EASUREMENT h-#-v -#- WAS ORIGINALLY STARTED BY THE HEALTH PLANS IN AND INVOLVED ABOUT OF THE LARGEST -INNESOTA MEDICAL GROUPS IN A PROJECT FOCUSED ON IMPROVING CARE FOR 4YPE )) $IABETES )N THE FIRST YEAR OF THIS PROJECT PARTICIPATING MEDI

4ABLE (EALTH0ARTNERS #LINICAL )NDICATORS !PPROPRIATE /RTHOPEDIC 0RE SURGICAL %VALUATION SELECT PHYSICIAN GROUPS 0ERCENT 2EACHING ALL 4ARGETS

-EDICAL 'ROUP #APITOL /RTHOPEDICS

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3OURCE (EALTH0ARTNERS #LINICAL )NDICATORS 2EPORT 2ESULTS 4HESE RESULTS ARE BASED ON A RANDOM SAMPLE OF MEDICAL RECORDS FOR PEOPLE WHO HAD SUBMITTED TO (EALTH0ARTNERS A CLAIM FOR LAPAROSCOPIC MENISCECTOMY ACUTE DISCECTOMY OR CARPAL TUNNEL )NDICATOR IS THE PERCENTAGE OF REVIEWED PATIENTS WHOSE MEDICAL RECORD DOCUMENTATION ESTABLISHED PRE SURGICALLY CERTAIN PATIENT REPORTED SYMPTOMS lNDINGS FROM EXAMINATION AND RADIOLOGY AND PREVIOUS ATTEMPTS AT MORE CONSERVATIVE CLINICAL MANAGEMENT

ÊÊÊÊ-i«Ìi LiÀÉ"VÌ LiÀÊÓääxÊ

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CAL GROUPS FOUND THAT PERCENT OF THE PATIENTS WITH 4YPE )) DIABETES HAD ALL OF lVE KEY CARDIOVASCULAR RISK FACTORS AT OR BELOW TARGET ! C AT OR BELOW ,$, CHOLESTEROL BELOW "0 BELOW

NO TOBACCO AND DAILY ASPIRIN )N AND PERCENT OF PATIENTS HAD ALL lVE MEASURES AT OR BELOW TARGET AND IN

PERCENT OF PATIENTS HAD FOUR OUT OF lVE FACTORS AT OR BELOW TARGET 2ECENTLY -#- HAS EXPANDED ITS SCOPE )N ADDITION TO HEALTH PLAN FUND ING -#- NOW ALSO RECEIVES FUNDING FROM THE -INNESOTA -EDICAL !SSOCIATION )N ADDITION TO DIABETES -#- HAS NOW EXPANDED TO MEASURING ABOUT OTHER QUALITY INDICATORS !ND INSTEAD OF JUST SHARING THE DATA INTERNALLY WITH PARTICI PATING MEDICAL GROUPS -#- REPORTS THE RELATIVE PERFORMANCE OF -INNESOTA MEDI CAL GROUPS PUBLICLY 4ABLE SHOWS SOME OF THE INFORMATION REPORTED BY -#- FOR SEVERAL METRO AREA MEDICAL GROUPS

ÃÊ+Õ> ÌÞÊ v À >Ì Ê i> }vÕ ¶ 4HE GROWING TORRENT OF QUALITY INFORMA TION INFORMATION THAT WILL BE USED BY HEALTH PLANS TO hTIERv PROVIDERS RAISES QUESTIONS ABOUT HOW IT SHOULD BE INTERPRETED &OR EXAMPLE NO QUALITY INFORMATION DESCRIBED IN THIS ARTICLE HAS BEEN RISK ADJUSTED 4HIS RAISES SIGNIl CANT QUESTIONS ABOUT WHETHER IT MEANS ANYTHING &OR EXAMPLE IS THE QUALITY OF CARE DELIVERED BY (ENNEPIN &ACULTY !SSOCIATES OR .EIGHBORHOOD (EALTHCARE .ETWORK LOWER THAN 0ARK .ICOLLET BECAUSE THEY HAVE A LOWER PERCENTAGE OF DIABETIC PATIENTS ACHIEVING TARGET MEASURES /R DO (&! AND .EIGHBORHOOD #LINICS SIMPLY SERVE POPULATIONS THAT TEND TO USE TOBACCO MORE FREQUENTLY OR OTHERWISE ARE LESS COM PLIANT WITH MEDICAL ADVICE ,ISA %PSON UNTIL RECENTLY THE EX ECUTIVE DIRECTOR OF THE .EIGHBORHOOD (EALTHCARE .ETWORK SAYS SHE S EXPRESSED

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4ABLE -INNESOTA #OMMUNITY -EASUREMENT $IABETES #ARE SELECT PHYSICIAN GROUPS AND MEASURES -EDICAL 'ROUP

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0ERCENT OF DIABETICS 0ERCENT OF DIABETICS WITH ! C hTOBACCO FREEv

0ERCENT OF DIABETICS MEETING ALL TARGETS

!LLINA -EDICAL 'ROUP

(ENNEPIN &ACULTY !SSOCIATES

.EIGHBORHOOD (EALTHCARE .ETWORK

0ARK .ICOLLET (EALTH 3ERVICES

3OURCE WWW MNHEALTHCARE ORG

SOME CONCERNS ABOUT THIS TO -#-

AND THAT THEY VE ACKNOWLEDGED THE LACK OF RISK ADJUSTMENT COULD BE A POTENTIAL CONCERN (OWEVER SHE SAYS IT HASN T BEEN TOO MUCH OF AN ISSUE BECAUSE THE OVERALL RESULTS ACHIEVED BY .EIGHBORHOOD (EALTH CARE .ETWORK ARE ROUGHLY COMPARABLE TO OTHER CLINICS WITHOUT CONSIDERING hTHE SOCIOECONOMIC FACTORS WE HAVE TO OVER COME v *IM #HASE EXECUTIVE DIRECTOR OF -#- ACKNOWLEDGES THAT THERE IS A LEGITIMATE QUESTION ABOUT WHETHER hRESULTS ARE FAIR TO PROVIDERS WITHOUT RISK ADJUST MENT v (OWEVER HE SAYS hWE WANT EVEN LOW INCOME PATIENTS TO ACHIEVE THE SAME RESULTS AS OTHER PATIENTS v #LEARLY HOWEVER THERE IS THE POTEN TIAL TO INmUENCE THESE QUALITY MEASURES

BY CHANGING WHICH PATIENTS ARE SEEN 7ILL PHYSICIANS EITHER AVOID NONCOMPLIANT PATIENTS OR OTHERWISE hGAMEv THE SYSTEM *IM #HASE RESPONDS hBECAUSE WE ONLY REPORT ON A CLINIC BASIS WE REMOVE SOME INCENTIVE FOR INDIVIDUAL PHYSICIANS TO AVOID PATIENTS v 4HOUGH HE ADMITS hWE MAY HAVE TO DO RISK ADJUSTMENTS IN THE FUTURE v ,ISA %PSON SAYS SHE S CONCERNED ABOUT hGAMINGv IN SOME OF THE STATISTICS BEING REPORTED BY THE HEALTH PLANS TO THE STATE FOR THE $/%2 HEALTH PLAN hWE CAN T MAKE A CONNECTION BETWEEN WHAT WE RE SEEING AND WHAT THE HEALTH PLANS ARE REPORTING TO THE STATE BUT ;FOR THE

-#- DATA= ) DON T THINK THE CLINICS ARE MANIPULATING ANYTHING BECAUSE IT S OFF THEIR RADAR SCREEN THERE S NOT ENOUGH MONEY INVOLVED FOR THEM TO BOTHER v 7ITH THE HODGEPODGE OF QUALITY INFORMATION AVAILABLE ANOTHER CONCERN IS HOW A CONSUMER CAN MAKE SENSE OF IT &OR EXAMPLE WHILE HOSPITAL CHARGES FOR HIP SURGERY ARE APPARENTLY MUCH LOWER AT (EALTH%AST S 3T *OSEPH (OSPITAL SEE 4ABLE

SHOULD CONSUMERS BE CONCERNED THAT THE h2ATE OF 0ATIENT &ALLS WITH )NJURYv ARE HIGHER THERE SEE 4ABLE OR REASSURED THAT AN ORTHOPEDIC GROUP THAT DOES SUR GERY THERE ACHIEVES HIGH SCORES FOR PRE SURGICAL EVALUATION SEE 4ABLE h) M NOT AT ALL TROUBLED THAT WE DON T HAVE COMPLETE DATA v SAYS "ILL "LAZER VICE PRESIDENT OF THE -INNESOTA #HAMBER OF #OMMERCE AND AN ADVOCATE FOR GREATER PROVIDER ACCOUNTABILITY h9OU HAVE TO START SOMEWHERE AND WE NEED TO DO SOMETHING TO GET BETTER RESULTS v "UT MANY IN THE PROVIDER COMMUNITY ARE CONCERNED THAT QUALITY INFORMATION IS JUST NOT ADEQUATE TO MAKE GOOD JUDG MENTS h-Y CONCERN WITH TIERING IS THAT THEY LUMP ALL THE HOSPITALS TOGETHER AND COMPARE THEM BY COST v SAYS !LAN 'OLD BLOOM - $ PEDIATRICIAN AND PRESIDENT AND #%/ OF #HILDREN S (OSPITALS AND #LINICS OF -INNESOTA h4HE INSURERS ALWAYS SAY THEY ARE TIERING ON THE BASIS

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OF QUALITY AND COST BUT THE QUALITY BAR IS SET SO LOW THAT EVERY HOSPITAL MEETS THE STANDARD v 4HUS EVEN AS MORE QUALITY INFORMA TION BECOMES PUBLIC THE QUESTIONS ABOUT THE VALIDITY AND MEANING OF THIS INFOR MATION GROWS 4HERE ARE FOUR PRINCIPAL ISSUES #ONTINUED ON PAGE 'LVFRYHU *UHDWHU 0,QQHVRWD

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s )T S INCOMPLETE %VEN WITH ALL THE NEW QUALITY INFORMATION BEING PUBLISHED

ONLY A VERY NARROW RANGE OF HEALTH SERVICES ARE BEING MEASURED s )T MAY REmECT POPULATIONS SERVED MORE THAN THE CARE ITSELF 2ISK ADJUSTMENT IS DIFlCULT EXPENSIVE AND TIME CONSUM ING 9ET WITHOUT RISK ADJUSTMENT CLINI CAL OUTCOMES DATA MAY TELL MORE ABOUT THE PATIENTS TREATED THAN THE SERVICES DELIVERED s )T S OF UNCERTAIN PROFUNDITY )T IS UNCLEAR WHICH QUALITY INDICATORS ARE MEANINGFUL AND WHICH ARE TRIVIAL )T COULD DO SIGNIlCANT HARM IF PATIENTS ARE STEERED TO LOW COST PROVIDERS BASED ON QUALITY INDICATORS OF TRIVIAL IMPOR TANCE WHEN A HIGHER COST HOSPITAL OR PHYSICIAN MIGHT HAVE REALLY OFFERED BETTER QUALITY

s )T S VULNERABLE TO MANIPULATION 3OCIAL SCIENTISTS USE AN AXIOM CALLED #AMPBELL S ,AW TO WIT 4HE MORE ANY QUANTITATIVE SOCIAL INDICATOR IS USED FOR SOCIAL DECISION MAKING THE MORE SUBJECT IT WILL BE TO CORRUPTION PRESSURES AND THE MORE APT IT WILL BE TO DISTORT AND CORRUPT THE SOCIAL PROCESSES IT IS INTENDED TO MONITOR !S PROVIDER REIMBURSEMENT AND COMPETITIVENESS BECOMES MORE CLOSELY LINKED TO QUALITY INDICATORS IT SEEMS UNAVOIDABLE THAT SUCH INDICATORS WILL BE MANIPULATED THROUGH AVOIDANCE OF CERTAIN GROUPS OF PATIENTS OR OTHER FORMS OF GAMING

/ iÀ }Ê ÃÌÊ> `Ê+Õ> ÌÞ 4HE DYSFUNCTION OF OUR HEALTH CARE SYSTEM IS APPARENT 0HYSICIANS AND HOSPITALS FAIL TO ASSURE CONSISTENT ATTAINMENT OF HIGH QUALITY STANDARDS AND SOMETIMES DELIVER CARE IN WAYS THAT MAXIMIZE REVENUE RATHER

Crutchfield Dermatology Becomes First “Hot Spot” Medical Clinic In Minnesota to Offer Wi-Fi Internet Connection for Patients In the spring of 2005, Crutchfield Dermatology of Eagan, Minnesota became the first dermatology clinic in the United States to offer a WiFi internet “Hot Spot” connection space for patients in its reception area. Because the Twin Cities is ranked number 9 in the United States for WiFi ready areas, this was a natural choice for the high quality environment we desire to provide for our patients. “Based on our survey responses and patient comments, WiFi technology is extremely popular with patients and any guests who are waiting for them” says Charles E. Crutchfield III, M.D., Clinic Medical Director. For additional information on setting up a similar environment at your clinic, please contact Kristin@CrutchfieldDermatology.com.

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

Appointments 651-209-3600

www.CrutchfieldDermatology.com

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1185 Town Centre Drive Suite 101 Eagan, MN 55123

THAN VALUE (EALTH PLANS IMPOSE TREMEN DOUS OVERHEAD ON THE SYSTEM DON T REIM BURSE PROVIDERS IN WAYS THAT REWARD VALUE

AND INSULATE CONSUMERS FROM THE CONSE QUENCES OF THEIR CHOICES !ND PATIENTS ARE RELUCTANT TO ASSUME RESPONSIBILITY FOR BECOMING PRUDENT PURCHASERS OF CARE 7ILL TIERING ADDRESS THIS DYSFUNCTION 4IERING IS A BLUNT INSTRUMENT AT BEST h4IER ING IS A SMALL INCENTIVE FOR CONSUMERS TO CHOOSE ONE PROVIDER RATHER THAN ANOTHER v SAYS (EALTH0ARTNERS !MUNDSON h9OU TIER ON IMPORTANT PERFORMANCE INFORMATION )F YOU TIER ON UNIMPORTANT INFORMATION

YOU DON T GET MUCH GAIN FROM IT v h) BELIEVE TIERING COULD BE EFFECTIVE IN CASES WHERE THERE S LITTLE VARIATION OF QUALITY AND SIGNIlCANT VARIATION OF COST v SAYS ,EE "EECHER - $ A PSYCHIATRIST AND RECENT PRESIDENT OF THE -INNESOTA 0HYSI CIAN 0ATIENT !LLIANCE hBUT ) M SKEPTICAL AS TO WHETHER TIERING CAN EFFECTIVELY GUIDE CONSUMERS WHEN THERE ARE BOTH QUALITY AND COST VARIATIONS v 4HE TIERING THAT HAS BEEN DONE HISTOR ICALLY BY 0ATIENT#HOICE AND 0REFERRED/NE HASN T HAD A MARKED IMPACT ON -INNESOTA HEALTH CARE 4HE NEW TIERING INITIATIVES BE ING ROLLED OUT BY -EDICA 0REFERRED/NE AND OTHER -INNESOTA HEALTH PLANS ISN T LIKELY TO HAVE A SUBSTANTIAL IMPACT EITHER 7HAT IS CLEAR HOWEVER IS THAT PRESSURE TO REFORM THE lNANCING OF HEALTH CARE IS CONTINUING TO BUILD AND THAT A SUBSTANTIAL SOURCE OF THIS PRESSURE IS RELATED TO INEX PLICABLE VARIATIONS IN HEALTH CARE COSTS AND QUALITY )F PHYSICIANS AND HOSPITALS WANT TO PROTECT THEIR LIVELIHOODS THEN MEASUR ING AND IMPROVING QUALITY AND SETTING PRICES ACCORDINGLY SEEMS THE PRUDENT THING TO DO -R !LLEN IS A HEALTH CARE CONSULTANT PRESIDENT OF THE -INNESOTA 0HYSICIAN 0ATIENT !LLIANCE AND PLATFORM CHAIR FOR THE )NDEPENDENCE 0ARTY OF -INNESOTA (E LIVES IN "LOOMINGTON AND CAN BE REACHED AT OR BY E MAIL AT DWALLEN MN RR COM

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(EALTH .ET 0ACIl#ARE AND 7ESTERN (EALTH !DVANTAGE 0ROGRAM DATA IS COLLECTED BY THE .ATIONAL #OMMITTEE FOR 1UALITY !SSURANCE h) THINK WHAT WAS MOST NOTABLE AND ENCOURAGING IS THAT WE SAW IMPROVEMENTS IN ALL MEASURES NOTABLE AND ENCOURAGING v

SAID )(! %XECUTIVE $IRECTOR 4OM 7ILLIAMS h7E BELIEVE THE PROGRAM ITSELF HAS CAUGHT THE ATTENTION OF PHYSICIANS NOT JUST ITS lNANCIAL INCENTIVES BUT THE BREADTH OF THE PROGRAM AS WELL v 7ILLIAMS NOTED THAT THERE WAS A CORRELA TION BETWEEN THE MEDICAL GROUPS WITH THE HIGH EST )4 SCORES AND THOSE WITH THE HIGHEST CLINICAL SCORES 9ANAGIHARA SAID THAT SHE THOUGHT THE MOST SIGNIlCANT lNDING WAS THE IMPROVEMENT IN )4 SCORES INCLUDING A PERCENT JUMP IN THE INTEGRATION OF CLINICAL DATA SETS AND A PERCENT GAIN IN THE USE OF DECISION SUPPORT

9ANAGIHARA SAID THAT AN PERCENT IN CREASE IN CERVICAL CANCER SCREENING SCORES WAS ALSO SIGNIlCANT h7E THOUGHT WE WERE MAXING IT BEFORE v SHE SAID 4HE )(! REPORTED THAT THIS EQUALS MORE WOMEN GETTING TESTED 7ILLIAMS SAID PHYSICIAN FEEDBACK HAS BEEN FAVORABLE hTHOUGH IT S NOT PERCENT v (E SAID THERE HAS BEEN SOME PUSHBACK FROM THE ADDITION THIS YEAR OF A PERFORMANCE MEASURE FOR CHLAMYDIA SCREENING WHICH HE SAID WAS

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BY A STEERING COMMITTEE AFTER RECEIVING PUBLIC COMMENT AND STAKEHOLDER RECOMMENDATIONS /NE MEMBER OF THE STEERING COMMITTEE IS 3TEVE -C$ERMOTT CHIEF EXECUTIVE OFlCER OF THE 3AN 2AMON #ALIF BASED (ILL 0HYSICIANS -EDICAL 'ROUP AN INDEPENDENT NETWORK OF

PHYSICIANS WITH PATIENTS h7E RE PLEASED WITH THE RESULTS PARTICU LARLY BECAUSE THE PROGRAM IS IN ITS INFANCY AND WE BELIEVE THE RESULTS WILL BE MORE DRAMATIC AS THE PROGRAM MATURES v -C$ERMOTT SAID h0AY FOR PERFORMANCE IS STANDARD IN !MERICAN INDUSTRY IT S JUST THE MEDICAL INDUSTRY THAT S JUST CATCHING UP v )NFORMATION TECHNOLOGY IS hESSENTIALv IN MAKING HEALTH CARE PAY FOR PERFORMANCE

WORK -C$ERMOTT SAID BECAUSE OF THE DATA WAREHOUSING AND DATA MINING FUNCTIONS IT OFFERS 4HESE INCLUDE hDISEASE REGISTRIESv THAT ALLOW PHYSICIANS TO IDENTIFY AND TRACK ALL THE DIABETICS IN THEIR PRACTICE !LTHOUGH COMPUTERS ARE GENERALLY VIEWED AS THE TOOLS OF YOUNGER PHYSICIANS -C$ERMOTT SAID THEY ARE BEING ACCEPTED BY OLDER DOCTORS AND ARE BEING USED TO EXTEND THEIR CAREERS h-Y OWN PRIMARY CARE PHYSICIAN IS AN OLDER SOLO PHYSICIAN WHO WAS THINKING OF RE TIRING BECAUSE HE COULDN T KEEP UP v -C$ER MOTT SAID h.OW HE S A LIGHTER HAPPIER GUY (E ENJOYS GOING TO WORK AND IS NOT LOOKING TO RETIRE ANYTIME SOON v -C$ERMOTT PREDICTED THAT IN THE YEARS TO COME THE PERFORMANCE MEASURES USED IN THE )(! PROGRAM WILL LEAD TO A HEALTHIER POPULA TION AND A LESS COSTLY HEALTH CARE SYSTEM EVEN THOUGH THAT IS NOT NECESSARILY WHAT THE PROGRAM IS DESIGNED TO DO h0AY FOR PERFORMANCE IS NOT DESIGNED TO LOWER HEALTH CARE COSTS IT S DESIGNED TO IMPROVE

THE OVERALL PERFORMANCE OF WHAT WE RE PAYING FOR v -C$ERMOTT SAID (E ADDED HOWEVER THAT MONEY WILL FACTOR INTO THE PROGRAM S LONG TERM SUCCESS (ILL 0HYSICIANS RECEIVED MILLION IN )(! RELATED HEALTH PLAN BONUSES LAST YEAR AND -C$ERMOTT SAID HEALTH PLANS WILL EVENTUALLY NEED TO EXPAND THE BONUS POOL BEYOND THE ORIGINAL MILLION THEY PAID OUT LAST YEAR "ANGASSER WHO CHAIRS THE PROGRAM S TECHNICAL COMMITTEE AND SERVES ON THE )(!

BOARD SAID SOME PHYSICIANS HAVE COMPLAINED THAT THE BONUSES WEREN T AS LARGE AS THEY WERE HOPING FOR h"UT WE HAVEN T HEARD ANYONE SAY THEY DIDN T THINK THE PROGRAM WAS WORTHWHILE AND THEY WEREN T GOING TO PARTICIPATE ANYMORE v HE SAID

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%DITOR S .OTE )N RECOGNITION OF 7OMEN IN -EDICINE -ONTH 3EPTEM BER -ETRO$OCTORS INVITED lVE WOMEN TO PARTICIPATE IN THE #OLLEAGUE )NTERVIEW SHARING THEIR VIEWS ON TOPICS SUCH AS WHAT IS THE MOST RE WARDING ASPECT OF BEING A WOMAN IN MEDICINE WHAT ARE THE CHALLENGES WOMEN IN MEDICINE FACE TODAY AND HOW SUPPORTIVE HAS THE COMMUNITY AND YOUR COLLEAGUES BEEN OF YOUR ROLE NOT ONLY AS A PHYSICIAN BUT ALSO AS A WIFE AND MOTHER >ÕÀ iÊ À i Õ ]Ê ° ° %MERGENCY -EDICINE 2IDGEVIEW -EDICAL #ENTER 7HEN ) AM ASKED WHAT IS THE MOST REWARDING ASPECT OF BEING A WOMAN IN MEDICINE ) MUST ADMIT THAT MY lRST hGUT RESPONSEv TO THAT QUESTION IS THAT ) FEEL PRIVILEGED TO BE A DOC TOR REGARDLESS OF MY GENDER "EING INTIMATELY INVOLVED IN PATIENTS LIVES IS SOMETHING THAT ) CHERISH DEEPLY CERTAINLY THE MOST REWARDING ASPECTS ARE THOSE TIMES WHEN ) KNOW ) AM MAKING AN IMPORTANT DIFFERENCE IN SOMEONE S LIFE 7OMEN IN MEDICINE LIKE MANY OF OUR PEERS IN OTHER PROFESSIONS

FACE A MULTITUDE OF CHALLENGES &IRST WE ARE STILL PRACTICING AND WORKING IN A DOMAIN THAT WAS CREATED BY AND FOR OUR MALE COLLEAGUES /UR CHAL LENGE AS WOMEN HAS BEEN TO LEARN NOT ONLY HOW TO WORK WITHIN A SYSTEM THAT WE DIDN T CREATE BUT ALSO HOW TO QUESTION AND TRANSFORM IT TO BETTER MEET OUR NEEDS #ERTAINLY BOTH MEN AND WOMEN PHYSICIANS NEED TO LEARN HOW TO BALANCE PROFESSIONAL WITH PERSONAL RESPONSIBILITIES BUT IT IS MY OBSERVATION THAT MANY WOMEN PHYSICIANS DO NOT HAVE A SUPPORT SYSTEM AT HOME COMMENSURATE WITH THAT OF THEIR MALE COLLEAGUES 4HE VALUE OF A WOMAN S WORK WHETHER IN THE PROFESSIONAL OR PRIVATE WORLD IS USUALLY UNDERAPPRECIATED SIMILARLY MEN S WORK IS OVERVALUED 4HIS HAS BEEN DEMONSTRATED TIME AND TIME AGAIN OVER THE HISTORY OF HUMANKIND 4HE UPSHOT OF THIS ON A PERSONAL LEVEL IS THAT ) CAN NEVER DO ENOUGH EITHER IN THE PROFESSIONAL OR PRIVATE DOMAIN )T S BEEN MY PERSONAL CHALLENGE TO BALANCE THE DEMANDS OF THOSE TWO WORLDS KNOWING THAT PERFECTION IN EITHER ONE IS NOT ATTAINABLE )N MEDICINE ) HAVE SEEN A HIGH VALUE PLACED ON AUTONOMY ) THINK THAT WE AS MEDICAL STAFFS HOWEVER ARE JUST hON THE CUSPv OF STARTING TO SEE THE IMPORTANCE OF MINDFUL LEADERSHIP TRAINING AND GROOMING IF YOU WILL ) AM HAPPY TO REPORT THAT IN MY PRIVATE GROUP OF EIGHT EMERGENCY MEDICINE PRACTITIONERS WE DO VERY INTENTIONALLY SUPPORT EACH OTHER S PROFESSIONAL CAREER DEVELOPMENT

>À i iÊ V Û Þ]Ê ° ° 0ULMONARY -EDICINE (EALTH0ARTNERS ) WOULD HAVE TO SAY THE MOST REWARDING ASPECTS OF MEDICINE ARE THE ABILITY TO SERVE OTHERS AND AT THE SAME TIME BE INTELLECTUALLY CHALLENGED 0EOPLE AND THE HUMAN CONDITION MAKE THE JOB 4HE GREATEST CHALLENGES THAT FACE A WOMAN IN MEDICINE TODAY ARE BALANCING WORK WITH FAMILY 4IME IS ALWAYS AN ISSUE 9OUR PATIENTS BECOME YOUR FAMILY TOO SO YOU OFTEN FEEL PULLED IN TWO DIRECTIONS -Y EMPLOYER (EALTH0ARTNERS HAS BEEN GREAT ALLOWING ME TO CREATE A VERY REASONABLE REWARDING AND mEXIBLE JOB ) AM PART TIME CLINIC AND PART TIME RESEARCH WHICH IS VERY UNUSUAL IN MY SUBSPECIALTY 0ULMONARY -EDICINE ) WOULD HAVE TO SAY THE GENERAL COMMUNITY WOULD THINK ) AM CRAZY AND THERE CLEARLY IS PRESSURE FOR WOMEN TO STAY HOME WITH THE CHILDREN "UT IF ALL WOMEN STAYED HOME HOW WOULD WE AS A SOCIETY FUNCTION !LSO RARELY AS A SOCIETY DO WE ADDRESS THE IMPACT A LOSS OF A SPOUSE HAS ON A WOMAN WHO IS WORKING AT HOME CARING FOR THE CHILDREN )T IS DIFlCULT FOR HER TO GET BACK INTO THE WORK FORCE LOST YEARS OF WAGES

ETC ) SEE THE RESULTS FREQUENTLY IN MY CLINIC WHERE THE ELDERLY WIDOWS CANNOT AFFORD THEIR MEDICATIONS SINCE THEY ARE RELYING ON SOCIAL SECURITY ALONE ) GUESS WE NEED TO ALL LOOK FOR BALANCE AND WHAT CREATES THE LEAST AMOUNT OF STRESS FOR THE INDIVIDUAL -Y COLLEAGUES HAVE BEEN VERY SUPPORTIVE OF MY CAREER Ê ÕÀÀ>Þ]Ê ° ° )NTERNAL -EDICINE 'ERONTOLOGY (ENNEPIN #OUNTY -EDICAL #ENTER 4HE REWARDS FOR ME OF BEING A WOMAN IN MEDICINE ARE PROBABLY SIMILAR TO THE REWARDS FOR ANY PHYSICIAN LEARNING SOMETHING NEW EVERY DAY OFTEN FROM MY PATIENTS IMPROV ING THE QUALITY OF LIFE OF A PATIENT LISTENING TO PATIENTS STORIES TEACHING AND CONTRIBUTING TO SCIENTIlC KNOWLEDGE AND PUBLIC HEALTH THROUGH MY RESEARCH ) THINK IT IS REWARDING TO BE ABLE TO CONSIDER THE WHOLE PATIENT IN STEAD OF JUST A SPECIlC DISEASE IN THE TREATMENT DECISION MAKING PROCESS "ECAUSE THEY ARE OFTEN FORCED TO MULTI TASK MORE THAN MEN WOMEN MAY BE MORE ADEPT AT THINKING ABOUT THE WHOLE PICTURE WHEN IT COMES TO THE DAY TO DAY IMPACT OF A CHRONIC DISEASE OR NEW MEDICINE ON A PATIENT NOT JUST WHETHER THE BLOOD SUGAR OR BLOOD PRESSURE IS UNDER #ONTINUED ON PAGE

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CONTROL &OR EXAMPLE FOR A GERIATRIC PATIENT WHO IS GOING TO BUY AND ADMINISTER THE MEDICATION CAN THE PATIENT AFFORD IT AND CAN SOMEONE DRIVE THEM TO THE CLINIC FOR THEIR NEXT BLOOD PRESSURE CHECK OR BLOOD DRAW 4HE BIGGEST CHALLENGE WOMEN IN MEDICINE FACE TODAY IS JUGGLING %VEN THOUGH THE OPPORTUNITIES IN MOST ASPECTS OF MEDICINE HAVE IM PROVED FOR WOMEN THE MAJORITY OF MY FEMALE COLLEAGUES STILL PLAY THE PRIMARY ROLE AS THE CAREGIVER TO THEIR CHILDREN AND PARENTS WHILE ALSO TRYING TO BE A LOVING AND SUPPORTIVE SPOUSE OR PARTNER )T IS STILL THE CASE THAT MOST SUCCESSFUL MEN IN CLINICAL OR ACADEMIC MEDICINE HAVE A hREAL WIFEv OR PARTNER AT HOME WHO MANAGES MANY OF THE HOUSEHOLD MANAGE MENT JOBS &OR EXAMPLE MOST OF MY MALE COLLEAGUES DO NOT ASSUME THE RESPONSIBILITIES OF lNDING THE NANNY OR BABYSITTER lNDING RIDES TO THE KIDS UMPTEEN ACTIVITIES SCHEDULING THE ORTHODONTIST AND DOCTOR AP POINTMENTS SUMMER CAMP AND SPORTS ACTIVITIES TALKING TO THE TEACHERS ABOUT CONCERNS MAKING SURE THERE IS ACTUALLY FOOD IN THE REFRIGERATOR TO COME HOME TO AND THAT SAID FOOD WILL BE THE ANSWER TO hWHAT S FOR DINNER -OM v 4HESE ACTIVITIES TAKE UP HOURS OF MY WEEK YET ) M EXPECTED TO lT THEM IN AROUND A TO HOUR WORK WEEK STILL BE hPRODUCTIVE AND CREATIVEv IN MY RESEARCH AND HAVE ENERGY AT NIGHT TO TALK TO MY SPOUSE SEX -Y HUSBAND IS A TRUE EXCEPTION (E HELPS OUT WITH THE ABOVE TASKS WHENEVER HE CAN BUT HIS TYPICAL SCHEDULE HAS LITTLE mEXIBILITY (E HAS ALSO BEEN EXTREMELY SUPPORTIVE OF MY CAREER MAKING MANY SACRIlCES IN HIS OWN CAREER FOR MINE !ND ) HAVE BEEN EXCEPTIONALLY FORTUNATE THAT MY COLLEAGUES AT ALMOST EVERY JUNCTURE IN MY TRAINING AND CAREER HAVE BEEN VERY SUPPORTIVE OF MY WORK AS WELL AS MY FAMILY COMMITMENTS -ORE WOMEN LEADERS ARE NEEDED IN ORGANIZED MEDICINE ACADEMIC MEDICINE AND HOSPITAL STAFF AND ADMINISTRATIVE ROLES 4HE LANDSCAPE FOR WOMEN IN LEADERSHIP ROLES HAS UNQUESTIONABLY IMPROVED SINCE ) GRADUATED FROM MEDICAL SCHOOL IN BUT MEDICINE IS STILL VERY MUCH A MALE BASTION AT THE HIGHER LEVELS )T WILL PROBABLY TAKE ANOTHER lVE TO YEARS TO SEE BIG CHANGES IN THE PERCENTAGE OF WOMEN IN THESE ROLES IN PART BECAUSE THOSE OF US WHO WOULD LIKE TO PLAY A BIGGER PART AS LEADERS HAVE TOO MANY FAMILY COMMITMENTS UNTIL THE CHILDREN ARE IN COLLEGE -ÕÃ> Ê °Ê, i]Ê ° ° &ORENSIC 0ATHOLOGIST 2EGINA -EDICAL #ENTER ) LOVE THE INTELLECTUAL CHALLENGES OF MEDI CINE THE OPPORTUNITIES FOR GROWTH AND THE VARIETY OF MY WORK ) HAVE ALWAYS MADE AN EFFORT NOT TO DIFFERENTIATE BETWEEN MEN AND WOMEN IN MEDICINE AND HAVE FOUND FOR THE MOST PART THAT THE lELD OF MEDICINE IS AN OASIS OF EQUALITY 4HE CHALLENGES THAT FACE ALL OF US IN MEDICINE ARE lNDING BALANCE IN OUR LIVES KEEPING UP WITH EVER EXPANDING NEW INFORMATION DEALING WITH GENERAL SOCIETAL PRESSURES THAT AFFECT OUR HEALTH AND PASSING ON OUR KNOWLEDGE ) AM GRATEFUL TO THE WOMEN IN MEDICINE AHEAD OF ME WHO PAVED

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THE WAY !ND IN GENERAL HAVE FOUND THAT THE MEDICAL COMMUNITY HAS BEEN VERY SUPPORTIVE OF MY ROLE -Y HUSBAND IS A PHYSICIAN AND HAS ALWAYS BEEN UNDERSTANDING OF THE PRESSURES AND ERRATIC HOURS FACING A FORENSIC PATHOLOGIST -Y CHOICE OF CAREER AS A FORENSIC PATHOLOGIST WAS OFTEN VIEWED WITH SOME SKEPTICISM DURING THE EARLY YEARS OF MY PRACTICE 4HIS HAS CHANGED HOWEVER WITH THE RECENT POPULARITY OF FORENSIC TELEVI SION PROGRAMS ) HAVE FOUND MANY WISE AND GENEROUS MENTORS ALONG MY CAREER PATH IN MEDICINE ) AM ESPECIALLY GRATEFUL TO $R *OHN 0LESS A FORENSIC PATHOLOGIST $R (ARVEY 2OSENBERG A PEDIATRIC PATHOLOGIST $R *ACK 4ITUS A CARDIOVASCULAR PATHOLOGIST AND $R *ANICE /PHOVEN A PEDIATRIC AND FORENSIC PATHOLOGIST ) HAVE FOUND OTHER AREAS OF THE COMMUNITY THAT ) DEAL WITH AS A FORENSIC PATHOLOGIST TO NOT BE AS SUPPORTIVE OF WOMEN AS ) WOULD EXPECT THIS HAS COME AS A SURPRISE TO ME 4HERE IS STILL WORK TO BE DONE IN THESE COMMUNITIES FOR EQUALITY TO BE ACHIEVED -Y CAREER AS A FORENSIC PATHOLOGIST HAS BEEN VARIED AND REWARDING ) MEET FAMILIES IN TIMES OF GREAT STRESS IN THEIR LIVES AND MY WORK HOPE FULLY HELPS THEM WITH UNDERSTANDING WHAT HAS HAPPENED TO THEIR LOVED ONES ASSISTS WITH THEIR GRIEF PROCESS AND AT TIMES PROVIDES LIFE SAVING INFORMATION FOR SURVIVING FAMILY MEMBERS ) AM CONTINUALLY AMAZED AT THE GENEROSITY OF SPIRIT OF MANY OF THESE FAMILIES AND HOW MANY LESSONS ) HAVE LEARNED FROM THEM &OLLOWING A "USH &OUNDATION -EDICAL &ELLOW SHIP ) AM ALSO SPENDING PART OF MY TIME AS A CARDIOVASCULAR PATHOLOGIST 4HIS EXPERIENCE HAS BEEN EXCITING CHALLENGING AND HUMBLING ) LOOK FORWARD TO THE JOY OF CONTINUED LEARNING -> `À>Ê °Ê, Ãi LiÀ}]Ê ° ° 0HYSICAL -EDICINE 2EHAB (EALTH%AST 6ASCULAR #ENTER 4HE MOST REWARDING ASPECT OF BEING A WOM AN IN MEDICINE FOR ME IS THE WONDERMENT ) FEEL AND EXPERIENCE AS ) SEE THE STRENGTH OF THE HUMAN SPIRIT IN TIMES OF TRIAL !LL PHYSICIANS WHETHER MALE OR FEMALE PROB ABLY ENCOUNTER THIS !S A WOMAN IT MAY BE THAT ) HAVE MORE OF AN OPPORTUNITY TO EXPRESS MY THANKFULNESS FOR HAVING THIS AS A PART OF MY JOB 7OMEN IN MEDICINE TODAY FACE MANY CHALLENGES THAT ARE SIMILAR TO THOSE EXPERIENCED BY MANY PROFESSIONAL WOMEN 7OMEN STILL TEND TO BE THE MAIN ORGANIZERS OF THE FAMILY AND THUS AFTER BEING A hDOCTORv THEY GET TO COME HOME TO THEIR SECOND FULL TIME JOB OFTEN hBEING -OM v "ALANCING WORK AND FAMILY IS A CONSTANT OFTEN STRESSFUL ACTIVITY )NmEXIBLE SCHEDULES CAN MAKE LIFE DIFlCULT ESPECIALLY WITH YOUNG CHILDREN ,IKE IN OTHER PROFESSIONS WOMEN PHYSICIANS ARE APT TO HAVE LOWER SALARIES 4HERE STILL IS AN UNDERLYING hOLD BOYSv ATTITUDE THAT WORKING LONG HOURS WITH LONG CALL NIGHTS MAKES YOU A hBETTERv PHYSICIAN AND hBEING SENSITIVEv IS A WEAKNESS &ORTUNATELY WITH THE INmUX OF MORE AND MORE WOMEN INTO MEDICINE THIS IS CHANGING -Y FRIENDS AND FAMILY HAVE BEEN VERY SUPPORTIVE OF MY ROLE AS A PHYSICIAN WIFE AND MOTHER -Y HUSBAND ESPECIALLY HAS BEEN MY STRON GEST ADVOCATE ) AM A VERY LUCKY WOMAN !ND OVERALL MY PROFESSIONAL COLLEAGUES HAVE BEEN SUPPORTIVE AND ENCOURAGING

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Pediatric Surgery Stacy A. Roback, M.D. Glen F. Anderson, M.D. R. Hampton Rich, M.D. David G. Rustad, M.D. David J. Schmeling, M.D. David C. Wahoff, M.D., Ph.D. Brad A. Feltis, M.D., Ph.D. Steven G. Muehlstedt, M.D. Pediatric Urology James J. Wolpert, M.D. Yuri E. Reinberg, M.D. David R. Vandersteen, M.D. Joel C. Hutcheson, M.D. Pediatric Urology Nurse Specialists Julie J. Crocker, RN Heidi J. Pfefferle, RN Pam S. Hollatz, RN Retired Bernard J. Spencer, M.D. John F. Waldron, M.D. Robert L. Telander, M.D. William S. Brennom, M.D. In Memorium Oswald J. Wyatt, M.D. Felix A. McParland, M.D. Tague C. Chisholm, M.D. Executive Director Kenneth A. Palattao, Sr.

APPOINTMENTS (all locations) (612) 813-8000 1-800-992-6983 Minneapolis Office 2545 Chicago Avenue South Suite 104 Minneapolis, MN 55404-4567 (612) 813-8000 1-800-992-6983 FAX (612) 813-8005 St. Paul Office 347 Smith Avenue North Suite 502 St. Paul, MN 55102 (651) 220-6040 FAX (651) 220-6282 Other Office Locations: Burnsville Duluth Fridley Maple Grove Minnetonka St. Cloud Woodbury Business & Insurance Office 7710 Computer Avenue Suite 110 Edina, MN 55435-5417 (952) 835-9442 FAX (952) 835-9443

PEDIATRIC SURGICAL ASSOCIATES, LTD. J OEL C. H UTCHESON , M.D. We are pleased to announce the addition of Dr. Joel C. Hutcheson to our pediatric urology staff. Dr. Hutcheson is a native of Blacksburg, Virginia. He received his Bachelor of Science degree from Hampden-Sydney College in 1985, graduating summa cum laude as his class salutatorian. He received his Doctorate of Medicine from Vanderbilt University School of Medicine in 1989 and stayed on in Nashville for his internship in general surgery at Vanderbilt. For the next three years he fulfilled his obligation to the United States Navy and proudly served as Senior Medical Officer aboard USS Wasp (LHD-1) and Medical Officer at Destroyer Squadron 2. He was awarded the Naval Commendation Medal for his service. Dr. Hutcheson completed his residency at the Harvard Program in Urology (Longwood Area) in 1997. During that time, he spent nine months in training at the Childrenâ&#x20AC;&#x2122;s Hospital in Boston. From Boston, he moved to Philadelphia and spent three years as a fellow in pediatric urology at the Childrenâ&#x20AC;&#x2122;s Hospital of Philadelphia. While there, he met and married his wife, Emma.

Joel and Emma moved to Winston-Salem, North Carolina in July of 2000 after accepting a position as assistant professor of urology at Wake Forest University School of Medicine. Their son, John Chenault Hutcheson, was born on November 27, 2002.

B RAD A LLEN F ELTIS , M.D., P H .D. We are pleased to announce the addition of Dr. Brad Feltis to the staff of Pediatric Surgical Associates.

After receiving his Bachelor of Science degree from the University of Minnesota, Dr. Feltis matriculated through the University of Minnesota Medical School, receiving his Doctorate in Medicine in 1995. Dr. Feltis remained in Minneapolis to train in the specialty of General Surgery at the University of Minnesota. During this training, he published more than a dozen peer-reviewed manuscripts and was awarded extramural funding to study models of how microbial toxins influence intestinal ecology.

This work formed the thesis of his PhD, which he received in 2002. He maintains a strong interest in surgical infectious diseases and surgical outcomes.

After completing general surgery residency, Dr. Feltis trained in the sub-specialty of Pediatric Surgery at Childrens Hospital and Regional Medical Center in Seattle,Washington. In Washington, Dr. Feltis was recognized for his leadership in teaching when he was awarded Fellow Teacher of the Year from the residents in pediatric medicine at Seattle Children's Hospital.

Brad is married to his college sweetheart, Lori Ann. Their 1st child, Jacob Gary, was born just before he began General Surgery training. His fifth child, Zoe Ann, was born 3 months before finishing his sub-specialty training. Joining Jacob (10) and Zoe are Samuel Ernest (7), Caleb Allen (6), and Grace Karen (2).

S TEVEN G. M UEHLSTEDT, M.D. We are pleased to announce the addition of Dr. Steven G. Muehlstedt to our pediatric surgery staff.

Dr. Muehlstedt is a native of Saint Cloud, Minnesota. He received his Bachelor of Arts degree from Saint Olaf College in 1992, graduating magna cum laude and Phi Beta Kappa. He received his Doctorate in Medicine from the University of Minnesota Medical School in 1997 and remained in Minneapolis for a residency in general surgery at Hennepin County Medical Center. During his residency, he met and married his wife Saebra. Dr. Muehlstedt completed his general surgery training in 2003 after which he moved to Houston where he spent two years as a fellow in pediatric surgery at Texas Children's Hospital. He received his pediatric surgical degree from the Baylor College of Medicine in 2005.

Steven and Saebra have recently returned home to friends and family here in Minneapolis. Steven has interest and extensive experience in minimally invasive pediatric surgery and plans to begin practice in July of 2005.

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BROUGHT BUDGET TALKS TO A STANDSTILL THROUGH REGULAR AND SPECIAL SESSION WAS THE HEALTH AND HUMAN SERVICES BUDGET %ARLY IN THE YEAR THE BUDGET PROPOSED BY THE 'OVERNOR AND (OUSE MEMBERS FOCUSED ON INCREASING HEALTH CARE COSTS IN THE STATE 4HE 'OVERNOR S INITIAL BUD GET RECOMMENDATIONS CUT THE GROWTH IN HEALTH CARE SPENDING TO AROUND PERCENT ALMOST PERCENT LOWER THAN THE CURRENT GROWTH RATE 4HE (OUSE RELEASED THEIR BUDGET WITH A TARGET EVEN LOWER THAN THE 'OVERNOR S PROPOSED TARGET /NE MAJOR REFORM IN BOTH THE (OUSE PROPOSAL AND 'OVERNOR S BUDGET PROPOSAL WAS THE ELIMI NATION OF ELIGIBILITY FOR SINGLE ADULTS WITHOUT CHILDREN IN THE -INNESOTA#ARE PROGRAM !LSO PROPOSED WAS A SHIFT OF THE STATE S 'ENERAL !S SISTANCE -EDICAL #ARE PROGRAM '!-# FROM ITS CURRENT LOCATION IN THE 'ENERAL &UND TO THE (EALTH #ARE !CCESS &UND 4HE $&, CONTROLLED 3ENATE TOOK A DIF FERENT APPROACH TO THE LOOMING BUDGET CRISIS IN HEALTH CARE 4HE 3ENATE S PROPOSED BUDGET WAS OVER MILLION DOLLARS GREATER THAN THE 'OVERNOR S RECOMMENDATIONS AND ALMOST MILLION GREATER THAN THE (OUSE PROPOSAL 2ATH ER THAN ELIMINATE ELIGIBILITY FOR -INNESOTA#ARE

THE 3ENATE PROPOSED TO INCREASE THE ELIGIBILITY IN A NUMBER OF AREAS AS WELL AS REMOVING CURRENT OUTPATIENT SPENDING CAPS ALREADY IN PLACE 4HESE CIRCUMSTANCES WITH THE (OUSE AND 3ENATE ALMOST AN ASTOUNDING BILLION DOLLARS APART LED TO THE LENGTHY BUDGET STALE MATE THAT WENT THROUGH THE REGULAR SESSION

PAST A FOUR WEEK SPECIAL SESSION AND EVENTUALLY ENDED IN MID *ULY !LL THREE SIDES EVENTUALLY COMPROMISED ON A TARGET THAT PUT THE BUDGET

FOR HEALTH AND HUMAN SERVICES AT BILLION OVER THE 'OVERNOR S ORIGINAL RECOMMENDATIONS 7HILE THE 3ENATE DID NOT WIN IN TERMS OF THE AMOUNT OF MONEY THAT THEY WOULD HAVE LIKED TO SPEND IN (EALTH AND (UMAN 3ERVICES THEY WERE ABLE TO RESTORE THE ELIGIBILITY CUTS PROPOSED TO -INNESOTA#ARE /NE SIGNIlCANT ABSENCE FROM THE BUDGET WAS FUNDING FOR THE (EALTH-ATCH PROGRAM )MPLEMENTATION OF THE PROGRAM WAS DELAYED MONTHS BECAUSE OF PROGRAMMING ERRORS 4HIS ACCOUNTED FOR A SAVINGS OF MILLION DOLLARS OVER THE BIENNIUM !FTER THE LONGEST SPECIAL SESSION IN DECADES AND A GOVERNMENT SHUTDOWN THE -INNESOTA ,EGISLATURE lNALLY lNISHED THEIR BUSINESS AND ADJOURNED UNTIL -ARCH OF 4HE STATE BUD GET CRISIS IS lNALLY OVER AND THE 'OVERNOR HAS SIGNED INTO LAW THE STATE BUDGET FOR THE BIENNIUM 4HE TOTAL BUDGET FOR THE NEXT BIENNIUM IS OVER BILLION AND THE HEALTH AND HUMAN SERVICES PORTION OF THE BUDGET IS BILLION ià Ì> >ÀiÊ> `ÊÌ iÊ i> Ì Ê >ÀiÊ VViÃÃÊ Õ ` 5NDER THE BUDGET AGREEMENT THE -INNESOTA #ARE PROGRAM ELIGIBILITY LEVEL WAS NOT CUT 4HE 'OVERNOR AND THE (OUSE 2EPUBLICANS HAD PROPOSED ELIMINATING COVERAGE FOR SINGLE ADULTS WITHOUT CHILDREN WHO EARN MORE THAN PERCENT OF POVERTY AND CUTTING ELIGIBILITY FOR PARENTS OF CHILDREN TO PERCENT OF POVERTY (OWEVER AS PART OF THE lNAL AGREEMENT THERE WERE NO ELIGIBILITY CUTS TO THE -INNESOTA#ARE PROGRAM )N ADDITION THE CAP FOR OUTPATIENT SERVICES WAS REPEALED AND DIABETIC SUPPLIES AND COVERAGE FOR hPHYSICIAN ANCILLARY

CHIROPRACTIC PSYCHOLOGIST AND SOCIAL WORKERv SERVICES WAS ADDED TO THE -INNESOTA#ARE LIM

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ITED BENElT SET !NOTHER CHANGE WAS THE MAXI MUM OUT OF POCKET COST FOR DRUG CO PAYS FOR ALL PUBLIC HEALTH PROGRAMS WAS DROPPED FROM TO 4HE -INNESOTA#ARE PROGRAM DID SEE AN INCREASE IN CO PAYS AND THESE INCLUDE A CO PAY FOR PREVENTATIVE CARE AND A CO PAY FOR NON EMERGENCY %2 VISITS 4HE PREMIUMS FOR ENROLLEES OF -INNESOTA#ARE WERE RAISED FROM PERCENT TO PERCENT 4HE ENTIRE BALANCE IN THE (EALTH #ARE !CCESS &UND (#!& WAS SPENT TO PLUG HOLES IN THE BUDGET !DULTS WITHOUT CHILDREN WHO EARN BELOW PERCENT OF POVERTY WHO WERE PREVIOUSLY COVERED BY 'ENERAL !SSISTANCE -EDICAL #ARE '!-# WILL BE MOVED INTO -INNESOTA#ARE FOR AT LEAST SIX MONTHS 4HIS SHIFT WILL COST THE (EALTH #ARE !CCESS &UND MILLION BUT SAVE THE 'ENERAL &UND MILLION i> Ì Ê «>VÌÊ iiÊ ­ }>ÀiÌÌiÊ ii® ! NEW FUND IS CREATED IN THE STATE TREASURY CALLED THE h(EALTH )MPACT &UND v !LL REVENUE COLLECTED FROM THE CENT CIGARETTE TAX SHALL BE ALLOCATED TO THIS FUND "Y !PRIL OF EACH YEAR

THE #OMMISSIONER OF (UMAN 3ERVICES SHALL CER TIFY TO THE #OMMISSIONER OF &INANCE THE STATE SHARE

BY FUND OF TOBACCO USE ATTRIBUTABLE COSTS FOR THE PREVIOUS lSCAL YEAR IN -INNESOTA HEALTH CARE PROGRAMS INCLUDING MEDICAL ASSISTANCE

GENERAL ASSISTANCE MEDICAL CARE AND -IN NESOTA#ARE OR APPLICABLE EXPENDITURES 4HE CIGARETTE TAX WILL GENERATE AN ESTIMATED MILLION OVER THE BIENNIUM

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-Ì>ÌiÜ `iÊ- }Ê > p Àii` ÊÌ Ê Ài>Ì i -ANY BELIEVED THAT WOULD BE THE YEAR THAT A STATEWIDE SMOKING BAN WOULD BE VOTED ON IN THE -INNESOTA LEGISLATURE (OWEVER DE SPITE EFFORTS BY A LARGE COALITION OF PROVIDERS AND ADVOCATES THE STATEWIDE SMOKING BAN WAS DEFEATED IN THE (OUSE 2EPRESENTATIVE $OUG -ESLOW 2 7HITE "EAR ,AKE AND 3ENATOR 3COTT $IBBLE $&, -INNEAPOLIS CARRIED THE LEGISLATION )N -ARCH OF (ENNEPIN #OUNTY 2AMSEY #OUNTY "LOOMINGTON AND -INNEAPOLIS WENT SMOKE FREE /THER STATES THAT HAVE INSTITUTED A STATEWIDE BAN INCLUDE .EW 9ORK #ALIFORNIA 5TAH &LORIDA #ON NECTICUT AND -AINE ë Ì> Ê ÃÃÕiÃÊ 4HE STATE S HOSPITALS TOOK HEFTY RATE CUTS AND INCREASES IN FEES IN THIS YEAR S BUDGET BILL 4HE (OSPITAL !SSOCIATION REPORTS THAT THE RATE RE DUCTIONS IN STATE AND FEDERAL FUNDING WILL BE MILLION OVER THE NEXT TWO YEARS !DD TO THAT TWO NEW HOSPITAL LICENSURE FEES THAT WILL COST HOSPITALS MILLION MORE OVER THE NEXT TWO YEARS /NE OF THE PROGRAMS THAT WILL BE FUNDED THROUGH AN INCREASE IN HOSPITAL LICENSE FEES IS A NEW STATEWIDE TRAUMA SYSTEM 4HE NEW SYSTEM WOULD STANDARDIZE TREATMENT FOR TRAUMA PATIENTS ACROSS THE STATE 4HE -IN NESOTA $EPARTMENT OF (EALTH WILL OVERSEE THE NEW TRAUMA PROGRAM 4HE -INNESOTA (OSPITAL !SSOCIATION SHALL DEVELOP A 7EB BASED SYSTEM AVAILABLE TO THE PUBLIC FREE OF CHARGE FOR REPORTING CHARGE INFORMATION FOR -INNESOTA RESIDENTS INCLUD ING BUT NOT LIMITED TO NUMBER OF DISCHARGES

AVERAGE LENGTH OF STAY AVERAGE CHARGE AVERAGE CHARGE PER DAY AND MEDIAN CHARGE FOR EACH OF THE MOST COMMON INPATIENT DIAGNOSIS RELATED GROUPS AND THE MOST COMMON OUT PATIENT SURGICAL PROCEDURES AS SPECIlED BY THE -INNESOTA (OSPITAL !SSOCIATION 4HE 7EB SITE MUST PROVIDE INFORMATION THAT COMPARES HOS PITAL SPECIlC DATA TO HOSPITAL STATEWIDE DATA 4HE 7EB SITE MUST BE ESTABLISHED BY /CTOBER

AND MUST BE UPDATED ANNUALLY )F A HOSPITAL DOES NOT PROVIDE THIS INFORMATION TO THE -INNESOTA (OSPITAL !SSOCIATION THE COM MISSIONER MAY REQUIRE THE HOSPITAL TO DO SO

4HE COMMISSIONER SHALL PROVIDE A LINK TO THIS INFORMATION ON THE DEPARTMENT S 7EB SITE *À ÀÊ ÕÌ À â>Ì Ê > `Ê,>ÌiÊ,i`ÕVÌ 4HE $EPARTMENT OF (UMAN 3ERVICES SHALL PUT IN PLACE A MEDICAL DIRECTOR IN CONJUNCTION WITH A MEDICAL POLICY ADVISORY COUNCIL TO USE PUBLICLY AVAILABLE EVIDENCE BASED GUIDELINES DEVELOPED BY AN INDEPENDENT NONPROlT OR GANIZATION OR BY THE PROFESSIONAL ASSOCIATION OF THE SPECIALTY THAT TYPICALLY PROVIDES THE SERVICE OR BY A MULTI STATE -EDICAID EVIDENCE BASED PRACTICE CENTER 5NDER ALL PUBLIC HEALTH CARE PROGRAMS AND EFFECTIVE 3EPTEMBER

PRIOR AUTHORIZATION WILL BE REQUIRED FOR THE FOLLOWING SERVICES s %LECTIVE OUTPATIENT HIGH TECHNOLOGY IMAG ING TO INCLUDE POSITIVE EMISSION TOMOGRAPHY 0%4 SCANS s -AGNETIC RESONANCE IMAGING -2)

COMPUTIVE TOMOGRAPHY #4 AND NUCLEAR CARDIOLOGY s 3PINAL FUSION UNLESS IT IS AN EMERGENCY DUE TO TRAUMA s "ARIATRIC SURGERY s #AESAREAN SECTION OR INSERTION OF TYMPANOS TOMY TUBES EXCEPT IN EMERGENCY SITUATION s (YSTERECTOMY AND s /RTHODONTIA %FFECTIVE FOR THESE SERVICES ON OR AFTER 3EPTEMBER THE PAYMENT RATE SHALL BE REDUCED BY PERCENT FROM THE RATE IN EFFECT ON *UNE 4HIS EXPIRES ON *ULY OR UPON THE COMPLETION OF A PRIOR AUTHORIZED SYSTEM SET UP IN THE $EPART MENT OF (UMAN 3ERVICES

> ViÀÊ ÀÕ}Ê ,i« Ã Ì ÀÞÊ*À }À> Ê ! MAJOR INITIATIVE THAT MADE ITS WAY THROUGH THE LEGISLATURE WAS A NEW PROGRAM THAT SETS UP A DRUG REPOSITORY FOR CANCER DRUGS 4HE "OARD OF 0HARMACY WILL ESTABLISH AND MAINTAIN THE PROGRAM 5NDER THE PROGRAM A PERSON MAY DONATE A CANCER OR MEDICAL SUPPLY FOR USE BY AN INDIVIDUAL WHO MEETS CERTAIN REQUIREMENTS FOR PARTICIPATION 4HESE DONATIONS MAY BE DISPENSED TO AN ELIGIBLE INDIVIDUAL OR DISTRIB UTED TO ANOTHER PARTICIPATING MEDICAL FACILITY OR PHARMACY

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WHETHER OR NOT AN ANESTHETIC OR ANALGESIC WOULD ELIMINATE OR ALLEVIATE ORGANIC PAIN TO THE UNBORN CHILD CAUSED BY THE PARTICULAR ABORTIONv TO BE EMPLOYED AND THE PARTICULAR MEDICAL BENElTS AND RISKS ASSOCIATED WITH THE PARTICULAR ANESTHETIC OR ANALGESIC `ÛiÀÃiÊ i> Ì Ê Ûi ÌÃÊ ,i« ÀÌ } 4HIS SECTION OF THE LAW INCREASES THE LICENSING FEES ON HOSPITALS AND OUTPATIENT SURGICAL CEN TERS TO FUND ONGOING IMPLEMENTATION OF THE !DVERSE (EALTH %VENTS 2EPORTING ,AW 4HE FEE INCREASES RAISE PER YEAR TO FUND THE IMPLEMENTATION OF THIS LAW 4HE FEE INCREASE WAS PART OF THE 'OVERNOR S "UDGET INITIATIVE (OSPITALS SAW AN INCREASE IN THEIR BASE FEE AND A PER BED FEE WHILE OUTPATIENT SURGICAL CENTERS SAW AN INCREASE IN THEIR BASE FEE ONLY

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THAT ) HAVE HEARD IS h$O THE RIGHT THING AND DO IT THE RIGHT WAY v )F WE FOLLOW THIS PREMISE IN OUR PATIENT CARE ACTIVITIES THEREFORE WE SHOULD BE PROVIDING QUALITY CARE )F WE PROVIDE hHIGH QUALITY CAREv IT SHOULD hLOWER COSTS v BASED ON ANOTHER PREMISE THAT hADVERSE OUTCOMES COST A LOT v 4HIS IS IMPLYING THAT LESS THAN HIGH QUALITY CARE COULD CAUSE ADVERSE OUTCOMES &URTHERMORE WE ANTICIPATE THAT HIGH QUALITY SHOULD BE COST EFFECTIVE CARE AND VICE VERSA 4HE END PRODUCT OF OUR HIGH QUALITY CARE SHOULD MINIMIZE VARIATION WHICH INCLUDES ADVERSE OUTCOMES PRODUCE A DESIRED RESULT GOOD OUTCOME AND BE COST EFlCIENT !CHIEVING HIGH QUALITY MIGHT NOT BE AS EASY AS SOME WOULD LIKE US TO BELIEVE 4HE PHILOSOPHY AND TEACHINGS OF THE QUALITY GURUS LIKE *URAN AND $EMING HAVE BEEN APPLIED SUCCESSFULLY FOR QUALITY IMPROVEMENT IN NON HEALTH CARE RELATED INDUSTRIES "OTH *APANESE AND !MERICAN COMPANIES HAVE INCORPORATED THESE QUALITY IMPROVEMENT TECHNIQUES IN THE MANUFACTURING OF THEIR PRODUCTS 4HEY HAVE IMPROVED THE EFlCIENCY OF THE PROCESS REDUCED VARIATION AND PRODUCED QUALITY PRODUCTS WHILE MAINTAINING REASONABLE COSTS 9ET DESPITE ENOR MOUS SUCCESS IN TECHNOLOGICAL AND MANUFACTUR ING PROCESSES NO ONE HAS BEEN ABLE TO APPLY THESE TECHNIQUES TO THE HEALTH CARE ARENA *UST LIKE IN THE MANUFACTURING PROCESS WE HAVE REGULATORY AND LEGAL ISSUES THAT NEED TO BE CONSIDERED /F UTMOST IMPORTANCE WE HAVE EVIDENCE BASED MANAGEMENT INFORMATION TO HELP GUIDE US (OWEVER MAJOR DIFFERENCES EXIST BECAUSE OF SOCIOECONOMIC FACTORS THAT NEED TO BE CONSIDERED WHEN WE COMBINE THESE ASPECTS OF HEALTH CARE AND TRY TO APPLY QUALITY PRINCIPALS 4HE PRACTICE OF MEDICINE IS A hSCIENCE AND AN ART v (OW WE SUPPLY CARE TO EVERY UNIQUE INDIVIDUAL MUST INCORPORATE THE ART WHICH AMONG VARIOUS THINGS INCLUDES SO CIOECONOMIC FACTORS AND PATIENT PREFERENCE )F MY PATIENT DECIDES TO EAT THE WRONG FOODS DESPITE MY RECOMMENDATIONS FAILS TO TAKE HIS MEDICINES AND FAILS TO FOLLOW UP WITH

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APPLICABLE AND APPROPRIATE ) READ THE ARTICLE IN THE .EW 9ORKER TITLED h!NNALS OF -EDICINE 4HE "ELL #URVEv WRITTEN BY !TUL 'AWANDE HTTP WWW NEWYORKER COM FACT CONTENT FA?FACT ) ENCOURAGE ALL OF YOU TO READ THE ARTICLE ) DO NOT KNOW ANY PHYSICIANS WHO KNOWINGLY THINK OR DECIDE TO PROVIDE LESS THAN OPTIMAL CARE TO THEIR PATIENTS 4HERE IS MARKED VARIATION IN THE CARE WE PROVIDE AND COSTS GEN ERATED BY THAT CARE 4HE MARKED VARIATIONS TAKE INTO CONSIDERATION EVIDENCE BASED GUIDELINES

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iÜ ÞÊ iVÌi`Ê, -Ê ÀiVÌ ÀÊ 3CHOOL OF -EDICINE IN ,ONDON %NGLAND IN &OLLOWING TWO YEARS OF INTERNSHIP IN ,ONDON AND TWO YEARS IN FAMILY PRACTICE $R 4EMPLETON BEGAN HER PSYCHIATRIC RESIDENCY IN THE 5 3 IN 3HE COMPLETED A FELLOWSHIP IN CHILD PSYCHIATRY AT THE 4UFTS .EW %NGLAND -EDICAL #ENTER (OSPITAL IN "OSTON IN )N SHE JOINED THE 7ILDER &OUNDATION IN 3T 0AUL AS A CHILD PSYCHIATRIST $R 4EMPLETON IS "OARD #ERTIlED IN #HILD 0SYCHIATRY AND IN 0SYCHIATRY AND .EUROLOGY /NE UNIQUE ASPECT OF $R 4EMPLETON S #6 IS THAT FROM TO SHE WAS A RESEARCH ASSOCIATE AT -AKERERE 5NIVERSITY IN +AMPALA 5GANDA IN THE ,YM PHOMA 5NIT

2/"%24 3 &,/- - $ DIED AT THE AGE OF ON *ULY AFTER COMPLICATIONS FOLLOWING HEART SURGERY (E GRADUATED FROM .ORTHWESTERN 5NIVERSITY AND PERFORMED HIS SURGICAL RESIDENCY AT !NCKER (OSPITAL $R &LOM PRACTICED FOR YEARS WITH 3T 0AUL 3URGEONS ,TD (E HAD BEEN RETIRED FOR THE LAST YEARS AND SPENT ONE HALF OF THE YEAR IN .APLES &LORIDA (E SERVED AS PRESIDENT OF THE 2AMSEY #OUNTY -EDICAL 3OCIETY AND THE -INNESOTA -EDICAL !SSOCIATION (E ALSO SERVED AS CHAIRMAN OF THE -INNESOTA DELEGATION TO THE !-! (OUSE OF $ELEGATES $R &LOM RECEIVED THE !UGUSTANA #OLLEGE !LUMNI !SSOCIATION -EDAL FOR 3ERVICE AND !CHIEVEMENT AND THE $ISTINGUISHED 3ERVICE !WARD FROM THE -IN NESOTA -EDICAL !SSOCIATION (E WAS A FOUNDER OF THE -IDWEST -EDICAL )NSURANCE #OMPANY $R &LOM WAS AN AVID READER AND CONTINUED TO STAY INFORMED ON MEDICAL ISSUES (E JOINED 2-3 IN

OF -ETRO$OCTORS BY $AVID !LLEN ADDRESSES THIS ISSUE IN DEPTH )N THIS ARTICLE COST INFORMATION IS STRESSED 4HE HEALTH PLANS WANT ALL CONSUMERS TO KNOW THE VARIATION IN COSTS BETWEEN DIFFERENT PROVIDERS 3OME PLANS WILL ASSOCIATE THESE COSTS WITH QUALITY INFORMATION /THER PLANS WILL NOW TELL CONSUMERS WHAT THEY WILL PAY FOR SERVICES 4HREE QUESTIONS FOR THE READER !RE THESE QUALITY DATA VALID RELIABLE AND APPROPRIATE 7HY HAVE THE HEALTH PLANS ALL OF A SUDDEN TAKEN SUCH AN INTEREST IN PROVIDING PATIENTS WITH THIS COST INFORMATION AND $O THE COST THEY PAY TO THE PROVIDERS RELY ON QUALITY DATA OR NEGOTI ATED VOLUME DISCOUNTS )T WAS JUST LAST YEAR WHEN ORGANIZED MEDICINE ALONG WITH A COALITION OF OTHER HEALTH PROVIDERS WERE TRYING TO LEGISLATE THE h(EALTH #ARE #ONTRACTING "ILLv AND SOME OF THE EMPLOYERS AND HEALTH PLANS WERE AGAINST A CERTAIN PROVISION IN THE BILL WHICH MANDATED THAT THE HEALTH PLANS PUBLISH THEIR REIMBURSE MENT RATES TO PROVIDERS )F THIS PROVISION HAD NOT BEEN DELETED FROM THE lNAL LEGISLATION THE BILL WOULD NEVER HAD BEEN PASSED -YSELF ) AM STILL TYING TO UNDERSTAND THE RATIONALE FOR THIS CHANGE OF POLICY /NE ALTERNATIVE TO THE WHOLE SITUATION WOULD BE FOR HEALTH PLANS TO REIMBURSE PHYSI

CIANS AND PROVIDERS AT MUCH HIGHER RATES THAN THEY HAVE IN THE PAST WITHOUT CONTINGENCIES 4HIS WOULD ALLOW PHYSICIANS TO SPEND MORE TIME WITH PATIENTS TO NOT ONLY ADDRESS MEDICAL ISSUES BUT ALSO TO UNDERSTAND SOCIOECONOMIC ISSUES INVOLVED WITH THAT PATIENTS CARE AND HAVE A BETTER UNDERSTANDING OF THEIR PERSONAL PREFERENCES )N ADDITION THE HIGHER REIMBURSE MENT WOULD ALLOW PHYSICIANS TO INVEST BETTER IN THE INFRASTRUCTURE OF THEIR PRACTICES I E STAFF DATABASES AND OTHER RESOURCES WHICH WOULD RESULT IN HIGHER QUALITY CARE !LSO THE HEALTH PLANS SHOULD COLLABORATE WITH PHYSI CIANS TO REMOVE REGULATORY AND LEGAL BARRIERS THAT IMPEDE THE DELIVERY OF HIGH QUALITY COST EFlCIENT EVIDENCE BASED CARE )F ALL CONCERNED PARTIES HAVE AS A COMMON GOAL OF IMPROVING OUR DELIVERY OF HEALTH CARE SERVICES WE COULD ACHIEVE THAT GOAL SOONER THAN PERPETUATING THE CURRENT ENVIRONMENT ) ENCOURAGE MY COLLEAGUES TO EXPRESS THEIR OPINIONS ON THESE TIMELY HEALTH CARE ISSUES 0LEASE CONTACT ME IF ) CAN BE OF ANY ASSISTANCE IN MAINTAINING THE VALUE YOU OBTAIN FROM YOUR MEMBERSHIP IN THE 2-3

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WEEKS AGO OR THE PATIENT IS ALREADY ON A STATIN 4HE 1UALITY )MPROVEMENT /RGANIZATION WILL BE CHECKING TO SEE IF IT WAS DONE ACCORDING TO THE NATIONAL GUIDELINE $UE TO LEGAL CONCERNS LABORATORY TESTS ARE DONE ON A PATIENT AS THEY ARE DISCHARGED FROM THE HOSPITAL EVEN THOUGH THEY COULD BE DONE AS AN OUTPATIENT 4HESE ARE LOW COST ITEMS BUT AS AN INTERNIST THESE ARE SOME OF THE EXAMPLES ) SEE AND ) KNOW THERE ARE EXAMPLES FOR EVERY SPECIALTY ) DO NOT HAVE TO ELABORATE ON HOW LEGAL ISSUES FAMILY CONCERNS ADVERTISING AND OUR h) WANT IT NOW SOCIETYv INmUENCE PATIENT PREFERENCES WHICH AFFECT THEIR CARE .OW EMPLOYERS AND INSURERS ARE GOING TO BE CONCENTRATING MORE EFFORT ON AFFECTING PA TIENT PREFERENCES ! (EWITT 3TUDY OF EMPLOYERS SHOWS A GROWING INTEREST IN OFFERING CONSUMER DRIVEN HEALTH PLANS 4HIS IS TO CONTROL COSTS AND PROVIDE MORE CHOICES TO EMPLOYEES (OWEVER

TO HAVE A MAJOR IMPACT ON COSTS THE EMPLOYERS NEED TO PROVIDE DECISION SUPPORT TOOLS COM MUNICATION AND EDUCATION TO THEIR EMPLOYEES &URTHERMORE THE HEALTH PLANS WILL FACILITATE PATIENT PREFERENCES BY ENCOURAGING CONSUMERS TO CHOOSE LOWER COST AND QUALITY DOCTORS AND HOSPITALS 4HE EXCELLENT ARTICLE IN THIS EDITION

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0LEASE JOIN US IN WELCOMING $R #HRISTINA 4EMPLE TON TO THE 2-3 "OARD OF $IRECTORS 3HE WAS ELECTED TO THE 2-3 "OARD OF $IRECTORS ON -AY AS A 3PECIALTY $IRECTOR FOR 0SYCHIATRY TO FULlLL THE UNEXPIRED TERM OF $R *AMES *ORDAN FOLLOWING $R *ORDAN S ELEC TION AS 2-3 0RESIDENT %LECT $R 4EMPLETON JOINED THE STAFF OF THE (AMM #LINIC IN 3HE GRADUATED FROM THE 2OYAL &REE (OSPITAL

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ALL WHO ATTENDED h0HYSICIAN S $ERBY $AYv AT #ANTERBURY 0ARK ON *UNE 4HE EVENT WAS HELD IN THE PRIVATE 4URF #LUB 3UITE AND FEA TURED A BUFFET LUNCH HAT CONTEST AND SURPRISE VISITS BY TRAINER 0ERRY 7OLF AND LEADING OWNERS +ATHY AND $EON +ISSOON !FTER THE h2AMSEY -EDICAL 3OCIETY &OUNDATION 3PRINTv GUESTS WERE INVITED TO HAVE THEIR PICTURE TAKEN IN THE 7INNER S #IRCLE 0ROCEEDS FROM THIS FUNDRAISER WILL PROVIDE GRANTS TO THE (EALTH #ARE FOR THE (OMELESS (MONG 2EFUGEE 0ROJECT AND 3T 0AUL 0UBLIC 3CHOOLS FOR HEALTH EDUCATION FOR KIDS 4HE YOUNG LADY IN THE BACK ROW TH FROM THE LEFT WON THE HAT CONTEST -ARK YOUR CALENDARS AND PLAN ON JOINING US -AY FOR THE 0REAKNESS 3TAKES AT h0HYSICIAN S $ERBY $AYv AT #ANTERBURY 0ARK

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4HANKS TO THE CLINIC MANAGERS STAFF ÊÈÌ Ê}À>`iÊV >ÃÃÊ i «ÃÊ AND PHYSICIANS OF THE Ã ÀÌÊÌ iÊ Ìi ÃÊV iVÌi`°

FOLLOWING CLINICS THAT PARTICIPATED s !LLINA -EDICAL #LINIC &OREST ,AKE s !LLINA -EDICAL #LINIC 3HOREVIEW s 'ERALD -C%LLISTREM - $ 0 ! s (AMM -EMORIAL 0SYCHIATRIC #LINIC s -ETROPOLITAN /BSTETRICS 'YNECOLOGY 0 ! s 0ARTNERS /" '9.

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4HANK YOU TO THE FOLLOWING INDIVIDUALS FOR SENDING IN CASH DONATIONS ! !BIGAIL "RODGED 3ALLY 7 "ROWN 6ELMA !NN 'RIGGS 2OGER + *OHNSON "ERNADETTE " -ASUR 3UZANNE .AGELL #AROLE .IMLOS AND 3USAN /TTERNESS

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7)4( 6%29 &%7 %8#%04)/.3 MOST WORKFORCE ASSESSMENTS OF THE NUMBER OF 5 3 PHYSICIANS NEEDED FOR THE COMING CENTURY PREDICTED THAT THE 5 3 WOULD EXPERIENCE A SUB STANTIAL EXCESS OF PHYSICIANS BY THE BEGINNING OF THE ST CENTURY )T NOW APPEARS FROM A VARIETY OF SOURCES THAT THESE PREDICTIONS WERE IN ERROR )N THE !MERICAN !SSOCIATION OF -EDICAL #OLLEGES !!-# CALLED FOR A PERCENT INCREASE IN THE NUMBER OF MEDICAL STUDENTS THAT THEIR ACCREDITED SCHOOLS TRAIN 3INCE MANY EXPERTS FEEL WE HAVE A MISDISTRIBUTION OF DOCTORS AS WELL AS TOO FEW PRIMARY CARE GIVERS IT WAS CURIOUS THAT THE !!-# TASK FORCE MADE NO RECOMMENDATIONS REGARDING SPECIALTY MIX FOR TRAINEES COMPLETING THEIR FORMAL MEDICAL TRAINING 3PECIlCALLY THERE WAS NO COMMENT ON SPECIALTY VERSUS PRIMARY CARE RATIOS FOR THE FUTURE -$S

,ET S TAKE A LOOK AT SOME NOTABLE OUTCOMES OF THE RECENT .ATIONAL 2ESIDENT -ATCHING 0ROGRAM .2-0 FOR 4HE .2-0 WAS ESTABLISHED IN TO ASSIST TRAINING PROGRAMS AND STUDENTS TO HAVE A LEVEL PLAYING lELD FOR CHOOSING AND AC CEPTING POSITIONS AND ALLOW FOR A UNIFORM DATE OF ANNOUNCEMENT FOR THE hMATCHv DECISIONS 4HE INITIAL MATCH IN OFFERED POSITIONS FOR GRADUATING SENIOR MEDICAL STUDENTS )N

THERE WERE INITIAL APPLICANTS FOR THE MORE THAT lRST YEAR POSITIONS OFFERED IN THE MATCH ! TOTAL OF RESIDENTS ARE TRAIN ING IN ACCREDITED PROGRAMS TYPICALLY YEARS IN THE 5 3 4HE .2-0 ENROLLS IN APPROXIMATELY

PROGRAMS ACROSS THE 5NITED 3TATES

4O HELP INTERPRET THESE RESULTS IT IS HELPFUL TO KNOW THAT APPROXIMATELY

SENIORS GRADUATED FROM 5 3 MEDICAL SCHOOLS IN AND MOST ENTERED THE MATCH /THER ENTRIES INTO THE MATCH INCLUDED #ANADIAN MEDICAL STUDENTS

5 3 PHYSICIANS

OSTEOPATHIC STUDENTS FOR A TOTAL OF APPROXIMATELY

APPLICANTS 4HE DIFFERENCE BETWEEN THE NUMBER OF APPLICANTS FROM THE 5 3 AND THE TOTAL NUMBER OF APPLICANTS REPRESENTS THE LARGE POOL OF INTERNATIONAL MEDICAL GRADUATES )-' FROM FOREIGN MEDICAL SCHOOLS THAT CHOOSE TO APPLY TO 5 3 RESIDENCIES )N THERE WERE OVER

GRADUATES FROM NON 5 3 MEDICAL SCHOOLS THAT ENTERED THE MATCH !PPROXIMATELY OF THOSE WERE 5 3 CITIZENS WHO ATTENDED FOREIGN MEDICAL

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SCHOOLS 4HE NUMBER OF NON 5 3 CITIZENS FROM FOREIGN MEDICAL SCHOOLS WHO SUCCESSFULLY MATCHED INCREASED BY OVER PERCENT IN

$ECLINING INTEREST IN PRIMARY CARE CAREERS PERSISTS 5 3 MEDICAL STUDENTS IN CONTIN UED TO DEMONSTRATE A PREFERENCE FOR SUBSPECIALTIES OVER PRIMARY CARE CAREERS ÌiÀiÃÌ }Ê-Ì>Ì ÃÌ VÃ s PERCENT OF APPLICANTS ENTERED )NTERNAL -EDICINE RESIDENCY PROGRAMS PERCENT 0RELIMINARY ONE YEAR )NTERNAL -EDICINE PERCENT &AMILY -EDICINE PERCENT 0EDIATRICS PERCENT 'ENERAL 3URGERY PERCENT 0RELIMINARY ONE YEAR 3URGERY PERCENT 0SYCHIATRY PERCENT /RTHOPEDIC 3URGERY PERCENT 0ATHOLOGY PERCENT !NESTHESIOLOGY PERCENT 0-2 AND ONLY PERCENT ENTERED $ERMATOLOGY $IAGNOSTIC 2ADIOLOGY .EUROLOGY /PHTHALMOLOGY OR 5ROLOGY s 4HE OVERALL MATCH RATE FOR ALL APPLICANTS WAS PERCENT 4HE 5 3 SENIOR MATCH RATE WAS PERCENT AND PERCENT OF )-' AP PLICANTS MATCHED s 4HE lLL RATE FOR ALL PROGRAMS WAS PERCENT $ERMATOLOGY %MERGENCY -EDICINE AND COM BINED )NTERNAL -EDICINE %MERGENCY -EDICINE 0ROGRAMS HAD PERCENT lLL RATES s ,OOKING AT 5 3 SENIOR APPLICANTS SEVERAL TRENDS EMERGE PERCENT OF 5 3 SENIORS MATCHED AT THEIR lRST CHOICE OF PROGRAMS PERCENT OF SENIORS MATCHED AT ONE OF THEIR TOP THREE CHOICES s PERCENT OF 5 3 SENIORS CHOSE 0RIMARY #ARE 3PECIALTIES APPROXIMATELY EQUAL TO THE MATCH &EWER 5 3 SENIORS PERCENT CHOSE &AMILY -EDICINE THE EIGHTH CONSECUTIVE YEAR OF THE DECREASE 5 3 GRADUATES lLLED ONLY PERCENT OF ALL OFFERED &AMILY -EDICINE RESIDENCY POSITIONS AND ONLY PERCENT OF )NTERNAL -EDICINE POSITIONS

)T IS CLEAR THAT FACULTY FACULTY ROLE MODELING

LIFESTYLE PERCEIVED PERSONAL CAREER SATISFACTION AND SPECIALTY COMPENSATION INmUENCE THE CHOICE OF RESIDENCY BY MEDICAL STUDENTS 7ITH THE AVERAGE #ONTINUED ON PAGE

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MEDICAL STUDENT DEBT EXCEEDING

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4HE !NNUAL -EETING OF THE --! IS SCHEDULED FOR 3EPTEMBER 4HE (ENNEPIN -EDICAL 3OCIETY STILL HAS AD DITIONAL OPENINGS FOR DELEGATES TO ATTEND

>À Ê ÕÀ > `]Ê ° °]Ê >ÕVÕÃÊ > À] ENCOURAGES HIS COLLEAGUES TO ATTEND THIS IMPORTANT MEETING 4HE FUTURE AGENDA OF THE -INNESOTA -EDICAL !SSOCIATION WILL BE ESTABLISHED BY THE (OUSE OF $ELEGATES AT THIS MEETING 0LEASE CONTACT +ATHY $ITTMER AT KDITTMER METRODOCTORS COM TO LEARN MORE AND TO REGISTER (ENNEPIN -EDICAL 3OCIETY RECEIVED A GRANT FROM THE ià Ì>Ê*>ÀÌ iÀà «Êv ÀÊ VÌ Ê }> ÃÌÊ/ L>VV Ê­ * /® TO CONDUCT A POLL IN (ENNEPIN #OUNTY RELATED TO PUBLIC OPINION ABOUT THE NEWLY IMPOSED SMOKING BAN 4HE RESULTS SHOWED OVER WHELMING PERCENT SUPPORT FOR THE BAN 0OLLS WERE ALSO CONDUCTED IN 'OLDEN 6ALLEY

-INNEAPOLIS "LOOMINGTON AND "ELTRAMI #OUNTIES WITH VERY SIMILAR RESULTS ! PRESS CONFERENCE WAS HELD IN LATE *UNE RELEASING THE DATA WHERE $R %DWARD %HLINGER PLAYED A PIVOTAL ROLE 4HE (ENNEPIN -EDICAL 3OCIETY WAS ESTAB LISHED ON Õ iÊÓä]Ê£nxx°Ê(-3 PUBLISHED AN AD IN THE -INNEAPOLIS 3TAR 4RIBUNE TO PUBLICIZE THE TH ANNIVERSARY -AYOR 2 4 2YBAK PROCLAIMED THE WEEK OF *UNE

AS i i« Ê i` V> Ê- V iÌÞÊ 7ii ° 4HE "OARD OF $IRECTORS HEARD A PRESENTATION BY > Ì Ê iÃÃ }iÀ]Ê ° ° REGARDING THE lNAL RECOMMENDATION OF THE Ê ÛiÀ > ViÊ/>Ã Ê ÀVi° 4HE REPORT CAN BE VIEWED AT HTTP WWW MMAONLINE NET

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BOARD GTFDRAFT PDF 4HE REPORT WILL BE PRESENTED AND OFFERED FOR ACCEPTANCE AT THE --! (OUSE OF $ELEGATES AT ITS !NNUAL MEETING *ACK $AVIS WAS RECENTLY ELECTED TO THE "OARD OF $IRECTORS OF THE -EMORIAL "LOOD #ENTERS (-3 MEMBER , > `Ê6 i >]Ê ° °ÊIS ALSO ON THE "OARD (-3 IS ALSO CONTINUING TO WORK IN -IN NEAPOLIS IN AN EFFORT TO ENSURE THAT THE CITY COUNCIL THERE REMAINS DECISIVE WITH THEIR DECISION TO ENACT A SMOKING BAN (-3 HAS REORGANIZED THE i> Ê ÀÊ i>« ÃÊ COMMUNICATIONS EFFORTS *ACK $AVIS AND 3UE 3CHETTLE RECENTLY MET WITH >Ì ii Ê7>Ìà ]Ê ° °]Ê 1 ÛiÀà ÌÞÊ vÊ ià Ì>Ê i` V> Ê -V Ê-i ÀÊ Ãà V >ÌiÊ i> ÊAND

OTHER STAFF OF THE MEDICAL SCHOOL AND THE ALUMNI ASSOCIATION TO KICK OFF THE #ONNECTIONS -ENTORING 0ROGRAM (-3 MEMBERS CAN EXPECT A COMMUNICATION REGARDING THIS IMPORTANT PROGRAM EARLY THIS FALL )N THE LAST FEW YEARS (-3 AND THE 2AMSEY -EDICAL 3OCIETY HAVE BEEN SUCCESS FUL IN MATCHING MENTORS WITH EVERY STUDENT ENROLLED IN THE PROGRAM 4HIRTY THREE MEMBERS OF THE (ENNEPIN -EDICAL 3OCIETY 3ENIOR 0HYSICIANS !SSOCIA TION MET ON *UNE > iÊ °Ê `iÀÃ ]Ê ° °]ÊAUTHOR OF h.EVER !CT 9OUR !GEv SHARED HIS RESEARCH ON METHOD ACTING AND HOW ACTORS NEED TO GET INTO THEIR ROLE AND THEN BE ABLE TO SEPARATE THEMSELVES AFTER WARD ,ED BY ITS 0RESIDENT , V >À`Ê- Ã]Ê ° °] THE 3ENIOR 0HYSICIANS !SSOCIATION 3UMMER 'ET 4OGETHER WAS A VISIT TO -ILL #ITY -USEUM ON !UGUST 4HE EVENT INCLUDED LUNCH THE &LOUR 4OWER 4OUR AND VIEWING THE GALLERY AND EXHIBITS

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DIED *UNE $R #HESLER WAS AN INTERNATIONALLY RENOWNED PLASTIC SURGEON (E GRADUATED FROM THE 5NIVERSITY OF -INNESOTA -EDICAL 3CHOOL (E COMPLETED AN INTERNSHIP AT !NCKER (OS PITAL IN 3T 0AUL AND DID HIS RESIDENCY AT THE 6ETERANS (OSPITAL IN -INNEAPOLIS !FTER lNISH ING HIS SURGICAL TRAINING HE ENTERED THE ARMY DURING 7ORLD 7AR )) &OLLOWING THE WAR HE COMPLETED PLASTIC SURGERY TRAINING AT 4ULANE 5NIVERSITY IN .EW /RLEANS AND LATER RETURNED TO -INNEAPOLIS $URING HIS CAREER AS A PLASTIC SURGEON $R #HESLER WAS INSTRUMENTAL IN THE FORMATION OF THE #LEFT ,IP AND 0ALETTE #LINIC AT THE 5NIVERSITY OF -INNESOTA !DDITIONALLY

HE WAS A FOUNDING MEMBER OF THE )NTERNATIONAL 3OCIETY OF !ESTHETIC 0LASTIC 3URGERY (E JOINED (-3 IN

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%DINA #OMMUNITY #ENTER 2OOM .ORMANDALE "LVD %DINA s n A M 3OCIAL 'ATHERING ,IGHT "UFFET "RUNCH s A M -EET 4HE !UTHOR 3ABRINA 3 :IMERING - $ 0LEASE JOIN (ENNEPIN -EDICAL 3OCIETY !L LIANCE MEMBERS AT THEIR /PENING %VENT 4HIS SPECIAL OCCASION WILL GIVE MEMBERS AN OPPORTUNITY TO SPEND TIME TOGETHER RENEWING FRIENDSHIPS WELCOME NEW MEMBERS AND FRIENDS AND LISTEN TO THEIR SPECIAL GUEST 3ABINA :IMER ING - $ $R :IMERING WILL MAKE A PRESENTATION

READ EXCERPTS FROM HER BOOK AND ANSWER QUES TIONS (IDING IN THE /PEN ! (OLOCAUST -EMOIR

IS A STORY OF TWO *EWISH TEENAGERS THE AUTHOR AND HER SISTER WHO AFTER SPENDING THREE YEARS IN THE 0IOTRKOW 'HETTO ESCAPED HOURS BEFORE THE MASS DEPORTATION OF THE *EWS BEGAN 4HEIR 0OLISH FRIENDS AT RISK TO THEMSELVES

GAVE THE TWO SISTERS FALSE )$ S ALLOWING THEM TO PASS AS #ATHOLIC 0OLES IN .AZI 'ERMANY 4HEY WORKED IN A HOTEL FOR HIGH RANKING 'ERMAN MILITARY UNTIL THE !MERICAN ARMY LIBERATED THEM s #OST AT THE EVENT CHECKS PAYABLE TO (-3! s 2360 BY 3EPT +ATHY $ITTMER KDITTMER MNMED ORG s .EED ! 2IDE 1UESTIONS $IANE 'AYES OR *UDY .AGEL s #HILDCARE #ALL #HILDCARE #ENTER AT %## -534 PRE REGISTER

0EGGY WAS ALSO PROFILED IN -INNESOTA -ONTHLY AS 3EPTEMBER $)6!3 (EART OF THE %VENT !WARD 2ECIPIENT #HILDREN S (EART,INK #(, RECOGNIZED 0EGGY hFOR OVER TEN YEARS OF SELmESSLY VOLUNTEERING HER TIME AND ENERGY TO #(, v 3HE VOLUNTEERS AT THE #(, OFlCE ON A WEEKLY BASIS VOLUNTEERS AT THE #(, FUNDRAISING EVENTS AND HAS HOSTED #(, INTERNATIONAL GUESTS AND EVENTS AT HER HOME h%LIZABETH "ICKEL PRESIDENT OF #(, SAYS hSHE @WORKS FOR US YEAR ROUND IN WHATEVER CAPAC ITY IS NEEDED 0EGGY IS WARM COMPASSIONATE

GENTLE KIND AND GIVES FROM THE HEART v $URING -AY OF 0EGGY TRAVELED AS A VOLUNTEER WITH A (EART,INK MEDICAL MISSION TEAM TO PERFORM LIFE SAVING SURGERIES AND MEDICAL CARE FOR CHILDREN IN +ENYA %AST !FRICA

º- iÊ ÃÊ>ÌÊÌ iÊ i>ÀÌÊ vÊÜ >ÌÊ Û Õ ÌiiÀ Ã ÊÃÌ> `ÃÊv À» 0EGGY *OHNSON RECEIVED THE -INNESOTA -EDICAL !SSOCIATION !LLIANCE --!! +AREN !

4OURDOT #OMMUNITY 3ERVICE !WARD ON -AY IN 2OCHESTER 4HE --!! PRESENTS THIS AWARD TO MEMBERS WHO HAVE NEVER BEEN ELECTED --!!

OFlCERS YET AS VOLUNTEERS THEY HAVE MADE MAJOR CONTRIBUTIONS TO THEIR COMMUNITIES

i` V> Ê > ViÊ,iV } âi`Ê LÞÊÌ iÊ 4HIS ARTICLE IS REPRINTED WITH PERMISSION FROM !-.EWS THE !MERICAN -EDICAL !SSOCIATION S WEEKLY NEWSPAPER FOR PHYSICIANS

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MORE THAN (-3!

MEMBERS PUT ON THEIR HATS AND GLOVES AND CELEBRATED YEARS OF (-3! PROMOTING THE HEALTH OF THE COMMUNITY THROUGH EDUCATION

ADVOCACY AND SERVICE 4HE (-3! ESTABLISHED THE lRST MEDICAL !LLIANCE IN !MERICA /CTOBER

4HE FOLLOWING (-3! /F lCERS WERE INSTALLED BY $OROTHY (ORNS AND $IANNE &ENYK 0AST 0RESIDENTS "ECKY &INNE

!UDITOR -ARLENE %LLIS -EMBERSHIP 4REASURER -ICHELLE 3CHROEDER #ORRESPONDING 3ECRETARY *UDY .AGEL 0ROGRAM #O #HAIR 0EGGY *OHN SON 2ECORDING 3ECRETARY (EALTH 0ROMOTIONS #O #HAIR $IANE 'AYES 0ROGRAM #O #HAIR AND -ARTHA !RNESON AND -ARY !NDERSON

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!-! 0RESIDENT *OHN # .ELSON - $ - 0 ( /NE OF THE MOST HEART WARMING STIMULATING AND AWE INSPIRING ASPECTS OF THE !-! THAT

IS SUCH A SOURCE OF PRIDE FOR ME IS THE !-! !LLIANCE ) KNOW OF NO OTHER ASSOCIATION WHOSE MEMBERS SPOUSES ARE SUCH A UNIlED MOTIVATED EFFEC TIVE FORCE FOR GOOD IN !MERICA &ROM STANDING SHOULDER TO SHOULDER WITH US LITERALLY IN ALL KINDS OF WEATHER AND IN ALL KINDS OF PLACES TO MAKE OUR ADVOCACY POINTS WITH LEGISLATORS AND THE PUBLIC TO CROUCHING DOWN WITH LITTLE CHIL DREN TO MAKE THE ANTI VIOLENCE POINTS THE !LLIANCE TRULY IS A MIGHTY ALLY 4HE !LLIANCE TO ME IS LOVE WITH ITS SLEEVES ROLLED UP -EN AND WOMEN OF THE !LLIANCE EX PEND INCREDIBLE NUMBERS OF HOURS AND INVEST ENORMOUS RESOURCES OF TIME TALENT AND MONEY IN WHAT THEY DO .OT FOR THE PERSONAL RECOGNI TION OTHERS SEEK WHEN THEY MAKE SIMILAR INVEST MENTS NOT FOR EGO BUT FOR THOSE THEY SERVE 7HEN SOMEONE ASKS ME ABOUT HEROES OF MEDICINE ) THINK NOT ONLY OF THOSE WITH -$ AND $/ AFTER THEIR NAMES BUT OF THOSE WITH -RS -R AND -S IN FRONT OF THEIR NAMES !LLIANCE MEMBERS AND THEIR LEADERS ACROSS THE NATION PERFORM THOUSANDS OF INDIVIDUAL ACTS OF HEROISM THE CARING CONCERNED RESPECTFUL HEROISM OF REMARKABLE PEOPLE WITH REMARKABLE GIFTS AND AN ATTITUDE OF PURE SERVICE

(-3! h4HE !LLIANCE IS AN EDU CATIONAL AND CHARITABLE VOLUNTEER ORGANIZATION

WORKING IN PARTNERSHIP WITH OTHERS TO PROMOTE THE HEALTH AND WELL BEING OF ITS MEMBERS AND THE COMMUNITY THROUGH EDUCATION ADVOCACY AND SERVICE v -EMBERSHIP )NFORMATION -ARLENE %LLIS

(ARBOR "EACH .% 0RIOR ,AKE -.

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Country French Estate

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Set in the heart of Maplewoods in prestigious Woodland, this fantastic family home offers truly elegant spaces and many recent improvements including, a breathtaking childrenâ&#x20AC;&#x2122;s wing, gourmet kitchen with granite countertops & more. 5 bedrooms on the 2nd floor. 6 bedrooms, 6 baths.

Gorgeous Stone Arch corner 1 bedroom + den + 625 sq. ft. wrap around terrace with exquisite views. Flowing spaces overlooking bridge, falls, mill ruins.

Granite kitchen, hardwood floors & warm details. 1+ bedroom, 2 baths.

Breathtaking condo encased in glass with dynamic views of downtown. Features include hardwood floors, high ceilings, gourmet kitchen w/ maple cabinets and stainless appliances, stunning fit and finish throughout. 1 bedroom, 2 baths.

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Trillium Bay Cottage Charming 2 story set on a private lot with vaulted and beamed ceilings, 2-story stone fireplace, gourmet kitchen, large master suite, 4 bedrooms up & more. 4 baths.

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Features superb attention to detail, abundant updates, inground pool, commercial grade kitchen & much more. 5 bedrooms, 6 baths.

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