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The Journal of the East and West Metro Medical Societies

May/June 2008

1

May/June Index to Advertisers Advanced Skin Care Institute ...........................22 AmeriPride.................................................................9 Burnet Birkeland ................... Inside Back Cover Children’s Physician Network .............................1 ClassiďŹ ed Ads.........................................................17 CrutchďŹ eld Dermatology..................................... 2 HealthEast Spine Care .......................................... 5

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Inside Back Cover Minnesota Epilepsy Group, P.A.......................21 The MMIC Group ................................................ 2 Southside Community Health Services ........32 Sterling Retirement Resources, Inc.................16 University of Minnesota CME ...........................

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MetroDoctors

to help your practice thrive

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The Journal of the East and West Metro Medical Societies

Doctors MetroDoctors THE JOURNAL OF THE EAST AND WEST METRO MEDICAL SOCIETIES

Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines WMMS CEO Jack G. Davis EMMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

To promote their objectives and services, the East and West Metro Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of EMMS or WMMS. Send letters and other materials for consideration to MetroDoctors, East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (952) 903-0505 fax: (763) 295-2550 e-mail: betsy@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 10, NO. 3

2

Index to Advertisers

4

Partners in Pediatrics Opens READY CARE

7

Boynton Health Service: A Unique Service for a Unique Population

10

House Calls Serve Patients Well

11

Carol, The Care Marketplace: A Little More to the Story

13

Teaching New Models of Care at the University of Minnesota

15

SPECIALTY UPDATE

M AY / J U N E 2 0 0 8

Searching for the Silver Bullet for Prostate Cancer

17

Classified Ads

18

Regina Medical Center, Hastings, MN

20

Status of Resolutions Submitted by EMMS and WMMS to the MMA House of Delegates, 2006 and 2007

23

Joint Public Policy Council Meeting EMMS and WMMS Boards of Directors Meet Day at the Capitol Held on March 6

32

Career Opportunities 11th Annual Winter Medical Update EAST METRO MEDICAL SOCIETY

24 25

President’s Message

26 27

In Memoriam/St. Paul Radiology’s Unified Voice/New Members

New EMMS Board Members/Minnesota Physician Services, Inc./ Outgoing MPS, Inc. Board Member/Joint Public Policy Council/Professionalism and Ethics Council/EMMS Caucus Smoke-Free Washington County/Dakota County Smoke-Free Communities Partnership Update WEST METRO MEDICAL SOCIETY

28 29 30 31

Chair’s Report/Delegates Needed New Members In Memoriam Alliance News

The Journal of the East and West Metro Medical Societies

On the cover: Physicians are responding to patient demand for new ways to access health care. Articles begin on page 4.

May/June 2008

3

Partners in Pediatrics Opens READY CARE

W

WINTER IN A PEDIATRIC CLINIC. It is just like you imagine — well children who need to stay on their immunization schedule are arriving, the chronically ill children need follow-up, and the rest of the kids, and staff, have the FLU! Providers escape to CME in warm climates, so the demand for visits is up while the number of available appointments is down. Partners in Pediatrics has dealt with this for many years, but this winter was a very different one for us.

Like all primary care clinics we are challenged by the current medical-economic climate. In the past, common issues were insurance companies, reimbursement, supply and staffing costs. Competition between groups was there, but as pediatricians we were not overly concerned with territorial issues. Who would have imagined the proliferation of retail-based clinics (RCBs)? It seems they have popped up on every corner in our area. Our patients rapidly began to use this resource.

As primary care providers, we know that continuity of care is an important part of quality care, and it is also one of the elements that creates great satisfaction for us as providers. We determined we needed to react quickly to this very real threat. It has been an interesting 15 months.

In December 2006 we began the first phase of our READY CARE clinic. Our clinic motto is “READY CARE, we are READY for YOU!” We have offered evening and weekend visits for more than 20 years and felt we offered our families what they wanted. Were we surprised! They were running to the RBCs when we were open. We surveyed more than a hundred families and the primary reason they went to an RBC was because they didn’t need to call for an appointment. It wasn’t cost; it wasn’t the hours, or the drugstore. It was because they didn’t have to CALL for an appointment. We

BY HOWARD BACH, M.D.

4

May/June 2008

knew we could do better for our patients, and ourselves too.

We eliminated appointment scheduling on Saturdays and Sundays. The first Saturday we were anxious about the “rush,” and it was a little chaotic. When families called in for an appointment, like they had in the past they were told they could “just come in,” no appointment needed. They were surprised we were offering this option, and seemed a bit skeptical at first.

So were we! However, it worked very well. We surveyed patients seen in the first month and were stunned to read the most positive survey comments ever. Nothing changed, but how they accessed our care. The volume of our Saturday visits remained consistent, but Sundays became much busier. It seems having to make an appointment was a disincentive to care.

In June 2007 we expanded the READY CARE model and created an urgent care clinic within the walls of our “daytime” clinic…at all sites, all day, all evening and all weekend. Our clinic motto is “READY CARE, we are READY for YOU!” That concept presented challenges. We wanted patients to come in any time, all day and all evening for “simple illness and injuries.”

MetroDoctors

No appointment needed. We began to market this to our families. We looked at ways to accommodate this unknown quantity of patients.

Our largest sites had a provider assigned as the READY CARE provider all day — they had no scheduled appointments. Other sites had some hours when a provider was not scheduled, and they worked other READY CARE patients in as they arrived. The number of READY CARE patients has increased every month and the number seen for evaluation and management coded visits has grown. In the fall we altered the schedules again to accommodate the after school visits. This spring we will adjust again to accommodate well child exams and less demand for illness visits.

Common concerns are “who is a READY CARE patient?” It is the patient who comes for READY CARE. How should we handle those patients who arrive without an appointment for a complicated problem? Before READY CARE the needs of patients surprised us daily, like when the 2-month routine visit turned into a hospital admission for sepsis. The day is no different now. The provider will decide what care is needed, as always. Providers who have been very time conscious and who like a predictable schedule have to adjust to the random and unpredictable flow of patients. Those who work methodically and were accustomed to having a good deal of time for scheduled appointments had to modify their visit pattern to make READY CARE work well. All have had to get used to treating only the presenting complaint.

The patients will come back for follow-up. The end of the day is another concern—we all need to go home and we close at a set time.

We have done some minor marketing to our current patients with some signage in the clinic, on our phone message and on our Web site. Word of mouth has definitely been (Continued on page 6)

The Journal of the East and West Metro Medical Societies

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MetroDoctors

The Journal of the East and West Metro Medical Societies

May/June 2008

5

READY CARE (Continued from page 4)

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operational too. This service has also attracted some new patients to the clinic.

All providers share this assignment, for a half a day at a time. Any day, though, a provider may see a READY CARE patient if the assigned provider is inundated with patients.

Sometimes our support staff will recognize that a READY CARE patient would be better served if he saw his primary care provider who might be available at the time, and direct the patient ow that way. These adjustments are not new to our group; we made them before READY CARE was developed.

Many of the patients call and we offer to schedule a visit for everyone, with the provider of their choice. As the months go on, though, more opt for READY CARE. A recent survey indicated that two thirds of the patients just come in for READY CARE — they don’t call the clinic anymore.

This winter was a busy one, and the demand for READY CARE was signiďŹ cant. As in most winters, we had about six very busy weeks when everyone worked very hard, and the patients waited perhaps longer than they would have waited in the fall or summer, but not longer than they waited last winter. Our patient satisfaction surveys remained very positive, even though their wait is longer than they experienced when we surveyed originally in the early summer.

This innovative response to the challenge of retail-based clinics has been hard work. It involved a great deal of planning and cooperation to make it work. We are convinced it was a good thing to do for our patients and for the practice. What will our next step be? We plan to continue to monitor the volume and quality of the care we provide and ďŹ nd ways to enhance the service for the families by simplifying the check-in process and the rooming process. I facetiously say the next step will be well-child care without appointments, but somehow I don’t think my colleagues will agree to that change.

Howard L. Bach, M.D., FAAP, is a board certiďŹ ed pediatrician and CEO of Partners in Pediatrics, Ltd. Partners in Pediatrics, Ltd. has a provider staff of 33 pediatricians, nurse practitioners and physician assistants practicing in ďŹ ve locations in the northwest suburbs and in Uptown.

The Journal of the East and West Metro Medical Societies

Boynton Health Service: A Unique Service for a Unique Population

N

NESTLED BEHIND the Student Union in

the shadow of the Academic Health Center (both literally and figuratively) is Boynton Health Service (Boynton/BHS), a unique organization addressing the health needs of over 65,000 students, faculty and staff of the University of Minnesota. Established by the Board of Regents in 1918 as a “university” health service (as opposed to a student health service), Boynton was charged to provide medical and public health services to members of the University of Minnesota community and to “put a heart into the University.” With a 90-year commitment to that mission, Boynton is one of the few remaining organizations in Minnesota providing both public health and clinical services to a defined population.

With no tuition money or other financial support from the University, almost all of the funding for Boynton comes from student health fees and fee-for-service activities. Student health fees make up about 22 percent of the total BHS budget. Every two years the Student Health Advisory Committee (SHAC), which represents most student groups on campus, makes a recommendation concerning the appropriate level of funding for BHS to an overall university student fees committee. This latter group makes the final determination of Boynton’s level of fees funding. The Student Service Fee is viewed as a “tax” that students place on themselves to fund the services they see as necessary to maintain a safe, healthy and vibrant campus community.

The student health fee is used by Boynton to provide a broad range of public health services and to guarantee, with no additional

B Y E D W A R D P. E H L I N G E R , M . D . , MSPH

MetroDoctors

out-of-pocket costs, universal access to primary care services to all fee-paying students.

The public health services provided include many of the assessment, policy development, and assurance roles outlined by the Institute of Medicine that are carried out by state and local health departments. The blend of public health and clinical care also provides Boynton the opportunity to merge public health and clinical care in unique ways. For example, since individual disease prevention and health promotion services are not usually reimbursed by medical insurance, the student health fee allows Boynton to incorporate these services into its routine primary care clinic activities.

Fee-paying students are required to have insurance to cover health care outside of the health service — hospitalization and specialty care. Since medical problems and their associated expenses are major reasons why students drop out of school, the insurance requirement helps protect the investment in education made by students, parents, and the general public. Insurance is billed for all clinical services provided

by Boynton to students and staff. For students,

The Journal of the East and West Metro Medical Societies

most services not covered by insurance, including co-pays, co-insurance, and deductibles, are covered by the student health fee. For staff and faculty, Boynton is a contracted primary care facility in the University’s insurance plan.

Although they don’t pay a “health fee” like the students, faculty and staff benefit from the public health efforts of Boynton like the on-campus smoke-free entrances policy, elimination of tobacco sales, and enhanced bike trails. In addition, Employee Benefits provides funding for faculty and staff for programs like flu shots, wellness assessments, and Quit and Win tobacco cessation programs.

Being able to focus on the entire population, rather than just students, allows Boynton to have a true community-focus and benefit from some economies of scale.

The clinical services provided by Boynton include family medicine, internal medicine, women’s health, pediatrics, urgent care, dental, mental health, optometry, physical therapy, nutrition, massage therapy, and pharmacy. Because of the high level of international travel by students and staff, Boynton also runs a travel clinic. BHS has recently expanded its occupational health services to better meet the needs of students and employees. All of these clinical services are provided at the main clinic location on the East Bank campus. To meet the unique needs of students at the St. Paul Campus, a more focused level of service is provided on that campus through a satellite clinic.

Even though Boynton is located on a university campus, it is not an academic program. Its focus is service rather than research and teaching and its organizational home is in Student Affairs rather than in the Academic Health Center. Some research and teaching (Continued on page 9)

May/June 2008

7

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Y

ou take your shirts to the cleaners, hire someone to do your taxes and spend time with a personal trainer. But when it comes to your dating life, you’ve been trying to do that by yourself.

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May/June 2008

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from listening to the post-date feedback of her clients and using that information to select their next match. It’s a fine tuning process - the more she can understand about each of her clients, the better she knows how to match them in the future. A high percentage of the first dates arranged by Kate and the IJL staff lead to second dates. Making a connection is valuable to clients even though it doesn’t always lead to marriage. Kate says there is nothing better than hearing that the clients she’s matched plan to see each other again. Of course, news of an engagement or marriage from IJL clients is also cause for celebration in the office!

The Journal of the East and West Metro Medical Societies

Boynton Health Service (Continued from page 7)

does occur at Boynton but only if it enhances the service mission. This guarantees that the health needs of the university community get priority. To advance the service mission and assure that service is of highest quality, staffing of clinics is by board certified physicians and other fully licensed and certified practitioners who have chosen college health as a career path. All are Boynton employees.

To be good stewards of students’ fees and to maximize the benefits of other resources, Boynton strives to provide services that are efficient, effective, high quality, and focused on the unique needs of the University population. In response to identified community needs and requests and in consultation with the SHAC, Boynton has recently modified its service model. A protocol-driven “convenience care” clinic (Gopher Quick Clinic), using mid-level practitioners, was added to more efficiently address the numerous minor medical issues that present to the health service. This service has been well received and is being expanded to meet the larger-thanexpected demand. This clinic has helped reduce demand on the regular primary care practice and on the urgent care clinic that served as the overflow recipient of patients who couldn’t be seen in general primary care due to lack of appointment slots.

With a reduced number of minor illnesses in their schedule, urgent care and primary care providers have been able to focus increased attention on more severe, complex and chronic conditions. This change in service mix is allowing better use of the training and skills of all providers. The increased severity of patients in the primary care clinic has prompted a serious discussion of increasing the length of appointments in primary care.

All of these services — urgent care, primary care, and convenience care — are co-located within Boynton Health Service.

This allows staff to direct walk-in patients to the most appropriate type of care and facilitates rapid referral to urgent care or primary care if the problem is determined to be too complex or serious for the convenience care clinic.

MetroDoctors

While still in its early stages of implementation, this model appears to be an efficient and effective way to address the needs of a university population. For the primary care clinic, it allows for continuity of care for routine preventive services and disease management for people with chronic diseases. The urgent care clinic can focus on serious and urgent conditions without being overwhelmed by walk-in patients who couldn’t be seen in primary care. The convenience care clinic responds to what most people now want for treatment of minor illnesses — quick in, quick out, and lower cost — and helps reduce the waiting time of urgent care patients. Linked with an electronic medical record, this three-pronged approach provides a range of ambulatory care options for patients without sacrificing access to continuity of care, disease management, and clinical preventive services.

For 90 years Boynton Health Service has been an innovative and high quality provider of ambulatory care and public health services for the University of Minnesota community.

Named after Ruth Boynton, M.D., director of the health service from 1936 to 1961, the health service has been continuously accredited by the Accreditation Association of Ambulatory Health Care (AAAHC) for nearly 30 years. As the health service for the largest urban university in the country, Boynton Health Service has had an impact on the health of numerous individuals, the campus, and the broader community where most students, faculty and staff live. But this impact has broadened as other college health services have adopted Boynton’s model of integrated public heath and ambulatory medical services for their campuses.

Boynton Health Service is a unique organization serving a unique population.

But the question arises, are there parts of the Boynton model that can be adapted for use by other providers of community-based health care? That question should be addressed because some of the answers to the perplexing problems of today’s health care system may come from unusual and unique places.

Edward P. Ehlinger, MD, MSPH, is the director and chief health officer, Boynton Health Service,University of Minnesota.

The Journal of the East and West Metro Medical Societies

May/June 2008

9

House Calls Serve Patients Well

K

help in cleaning his place up. He hadn’t had a phone. After helping him with these facilities, he lived there until he died in his sleep four years later.

KNOWING OUR PATIENT’S living situ-

ation and family really helps in the clinical decision-making process. Clinic visit time later on gets shortened and less stressful. As the old saying goes — a picture is worth more than a thousand words. Similarly, a house call is worth more than a thousand clinic visits. In European countries, primary doctors spend every afternoon doing house calls.

Below are a few examples of patients who have been served well by house calls.

1. A.G. is an 82-year-old lady who was brought to the clinic by her son who lives close by. She was smiling throughout the visit. She thought she was living in Alabama and the year was 1872. Her Mini-mental score was 14 out of 30. The student with me asked if she should be in a nursing home. The next day, we saw her at her place. It was an assisted living setting. She had been living there for eight years. Everything was neatly arranged; not a thing was out of place. Subsequently, we arranged for a lifeline. She was used to her daily routine for the past eight years and had many friends in the building. She continued to live there for the next five years.

Do not make life-influencing decisions without getting a proper clinical picture, which can be appropriately attained by a home visit.

2. N.H. a pleasant 95-year-old gentleman came to the clinic. He was working on his car when he spilled some gasoline on his hand.

He needed to be seen and came to the clinic.

He mentioned that he had not seen a doctor for the last 20 years. He was a World War I

BY HIMANSHU SHARMA, M.D.

10

May/June 2008

Try to keep people at home for as long as possible. To accomplish that goal, a home visit is essential.

veteran. He told us that he had been living at his place for the past 60 years and that he was very happy there. But he had been told by neighbors to make some changes at his place if he was to remain living there.

After two or three visits, we got to know each other. We scheduled a house call and he

A house call is worth more than a thousand clinic visits.

was reassured that the goal was to have him live in his home for as long as possible. He was living in a shack. He had electricity. He had an outhouse for toileting. He cooked on a gas stove, repaired his car and enjoyed his time every day.

With assistance from social services, help of an attendant was scheduled. He got some MetroDoctors

3. M.K. a 70-year-old woman was taking care of her frail husband. They had not seen a doctor for three years. He had a stroke and had left sided weakness. To get out of the house was a hardship for them and it was impossible for his frail wife to take him to the clinic. No doctor would make a house call and, in their opinion, it was neither time-effective nor costeffective. Home care couldn’t come, as they needed orders from a doctor.

We made a house call. Home OT, PT got started. A few adaptive devices were installed in his home allowing him to live there for a few more years. He was seen at his home every two to three months.

In the future, more and more services will be provided in patients’ homes. The trend is shifting from nursing home care to home care and house calls are, and will be, a critical part of medicine — especially geriatric medicine.

To get to know your patient in their living setting and thus helping them to remain at home is the ultimate reward of medicine, which can’t be equaled by any financial reimbursement. I look forward to continuing to do them.

Himanshu Sharma, M.D., faculty, United Family Practice Health Center Residency Program.

The Journal of the East and West Metro Medical Societies

Carol, The Care Marketplace: A Little More to the Story

I

IT’S ONLY BEEN a few short months since

Carol, The Care Marketplace, launched in partnership with many local health care providers to consumers in the Twin Cities. While you may have heard about the Carol concept, I’d like to tell you a little more about our story.

Carol is much more than just a Web site where area residents can go online to compare the cost and quality of health services from participating health care providers and doctors. Specifically, the Carol concept is rooted in strong relationships with local health care providers and physicians. These relationships focus on achieving a simple, but challenging vision: helping health care providers better communicate with consumers, while at the same time reaping the rewards of providing value-based — not volume-based, CPT codedefined — medical care.

The Care Package

Carol is driving toward making this vision a reality, and it all starts with the “care package.”

A care package is a bundle of related health services designed around a specific consumer need. Carol helps each health care provider and/or physician develop its own distinct, value-based story around the care packages it chooses to offer consumers.

The logical first step for participating health care providers is creating differentiated care packages for services that are paid for under existing reimbursement guidelines. As a result, early care packages Carol’s partners offer include: common immunizations, annual exams, neck and back pain diagnosis and treatment, heartburn diagnosis and treatment, health coaching, and pregnancy classes, among many others.

BY TONY MILLER, CEO

MetroDoctors

What’s interesting in health care today is that many of the aforementioned health services are being painted as commodities, when in fact there are significant differences between how each health care provider delivers medical care according to clinical guidelines. Due to the competitive nature of the Carol marketplace, care packages actually enable health care providers to de-commoditize their services by distinguishing treatment philosophies and styles to consumers. While it’s important for a certain degree of apples-to-apples comparison within a care package category, showing consumers the differences between health care providers is key to solving the desired “value equation,” much like it is in any other value-based environment.

Additionally, the intent of creating care packages and allowing consumers to “shop” for them is not to promote discount health care.

In fact, its objective is quite opposite. In an online “retail” environment, it’s easy to think consumers will base their selection primarily on price. However, according to internal and external research, the out-of-pocket cost for a service or procedure is only one variable, and not the most important variable, that enters into an individual’s decision-making process.

Other key factors include service offering breadth, quality measures, location of clinics, appointment availability and duration, and related therapies and diagnostic services. As in every other industry, the consumer cares most about receiving the best value for their dollar, which Carol hopes to facilitate with its provider partners.

Carol also strives to strengthen the physician/consumer relationship via the care package model. For example, because care packages clearly lay out the parameters of an office visit or procedure ahead of time, expecta-

The Journal of the East and West Metro Medical Societies

tions are set for everyone involved. By doing so, ambiguity related to what’s going to happen during a visit or procedure is removed, and the consumer and physician can better focus on diagnosing and treating the medical ailment or condition.

The Care Package of Tomorrow

The care package of tomorrow will be different than what we have today. In the future, care packages will be proactively created to meet a consumer’s definition of value. Valuebased care packaging strives to place a greater premium on coordinated care prevention and delivery, while rewarding physicians and consumers appropriately for positive outcomes, not according to varied and counterintuitive reimbursement schedules.

Managing Type II diabetes serves as a great example to illustrate the value-based care package concept. According to a Minnesota Community Measurement 2007 Health Care Quality Report, clinic level data supports an average of 14 percent of consumers receive optimal diabetic care .1 Can we do better? Certainly, and it’s the job of both the consumer and the health care provider, both of whom are held accountable in a value-based care package.

What is immediately evident in Table 1 is the whole-person approach for managing diabetes by applying the medical home model. Additionally, truly standardizing a complete path for managing diabetes based on clinical guidelines will improve the levels of optimal diabetic care. The flexibility of the value-based care package model also permits each health care provider to differentiate their packages within the confines of the package and clinical guidelines, for example, how to (Continued on page 12)

May/June 2008

11

Table 1

balance schedules, technology and/or staff.

Value-Based Care Package Example: Controlled Diabetes (type 2) –Tertiary Prevention

s Showcase and gauge quality—Carol allows

Diabetes Year of Care Objective: Offer a whole person approach for managing diabetes consistent with clinical guidelines Starting at $XXX

ConďŹ dential and Proprietary, Carol Corporation, 2007.

Enrollment s #ONlRM (G! C level of 8 or below without comorbidities

Â

Platform Minimums

Â

s )NCLUDES ALL TERTIARY prevention based on clinical guidelines s !PPLIES PRINCIPLES of Medical Home/ Chronic Care Model s E G 2EGULAR glucose & BP monitoring, coaching Integrated Behavioral Health s &OCUSED OUTREACH identiďŹ cation

Platform Options

Â

Results and Reporting

Â

s 0ROCESS MEASURES Nutrition Support s /UTCOME s !T HOME MEAL measures planning s 4ELEPHONIC BLOOD s %MPLOYER reporting glucose monitoring s %ND OF YEAR Education consumer s 'ROUP SESSIONS report and recommendations Medication Adherence s 2ElLL TRACKING

Consumer Contract s -AKE KEEP appointments s 4RACK LAB VALUES s 2EGULAR CHECK INS with clinical team

Value Proposition Provider commits to delivering care consistent with clinical guidelines and/or clinical goals.

Carol (Continued from page 11)

address and deliver behavioral health, nutrition support and education services.

One of Carol’s partners, Q Health-Southside Medical Clinic in Minneapolis, is already leading the charge when it comes to diabetes value-based care packages. Q Health is the ďŹ rst Carol partner to offer an entire year of diabetes care on Carol.com. Their care package includes: three visits throughout the year to monitor and support the consumer with physician, nurse and optometric services and laboratory tests and vaccinations. It also includes insulin, statin, ace-inhibitor, anti-hypertensive, generic medications (cholesterol and blood pressure) and education on self-managing diabetes. Interestingly, Q Health’s care package does not qualify for reimbursement today, yet consumers (and health care providers) have expressed tremendous interest in the package due to its comprehensive approach, even at an out-of-pocket cost of more than $2,000.

The proposition of a value-based care package model is that providers commit to, and maybe even guarantee, delivering care consistent with clinical guidelines and the consumer commits to actively participating in and adhering to the process. Consumers and physicians share the responsibility of reaching clinical success. Hopefully, better outcomes 12

May/June 2008

will lead to greater adoption of such valuebased care packages, prompting health plans and employee sponsors to re-evaluate how they reward and reimburse this improved level of consumer care.

Providing Additional Value

In addition to the long-term vision of helping health care providers better communicate with consumers and champion reimbursement change through value-based care packaging, Carol also offers health care providers of all sizes tangible short-term beneďŹ ts: s Eliminate billing confusion — Because Carol works with health care providers and health plans to provide consumers estimated out-of-pocket costs it can help eliminate billing confusion. This functionality enables health care providers to reduce bad debt by collecting a greater percentage of the consumer’s monetary responsibility post-ofďŹ ce visit or post-procedure. s Improve patient mix — Carol can help a clinic improve its consumer mix by generating awareness for higher proďŹ le care packages that establish the clinic as an expert in a certain area of medicine. s Balance office visits/procedures and staff — In an environment like Carol, health care providers can ďŹ ll slower times through various promotions, helping to MetroDoctors

health care providers and physicians to present their own quality measures, while also aggregating a variety of third-party quality data.

Early Success

Launched in late January, the Carol concept is in its infancy. However, there have been a number of early successes. In the MinneapolisSt. Paul market, we now have more than 40 health care provider partners participating in the Carol marketplace. Sample partners include: HealthPartners, Park Nicollet Health Services, MinuteClinic, Mayo Clinic Health Solutions, Ridgeview Medical Center, Twin Cities Orthopedics, Minnesota Oncology Hematology, Zel Skin and Laser Specialists, Southdale Pediatrics and many others.

Additionally, we continue to work with our partners to create and make available more care packages. We now have more than 500 care packages available on our Web site and many more in development. We also continue to work with our provider partners to push toward more value-based care packages and a tighter integration with local health plans.

As the marketplace continues to grow, we only anticipate Carol’s exposure to increase beneďŹ ting our partners and their ability to differentiate themselves from non-participants. The Carol concept has garnered a lot of attention to date, ranging from more than 260 million media impressions nationwide to more than 1,000 unique visitors to the Web site each day. We also know that the Carol concept is working, as consumers are changing their behaviors and selecting/receiving care packages from our health care provider partners, regardless of size.

The Carol concept also has caught the attention of other progressive health care markets around the country. By the end of this year and into 2009, Carol will expand into new markets.

Furthermore, consumers today already are willing to travel far and wide to receive the care they’re seeking, and it’s very possible Centers of Excellence around the country will join the Carol marketplace.

Tony Miller, CEO, Carol, The Care Marketplace.

1) Minnesota Community Measurement 2007 Health Care Quality Report, pg 19-22.

The Journal of the East and West Metro Medical Societies

Teaching New Models of Care at the University of Minnesota

A

AT THE UNIVERSITY of Minnesota Medical

School, we have launched many educational programs that promote and model patientcentered, multi-professional team-based care to improve the impact of ambulatory visits.

With student and resident participation, we evaluate our impact on individuals and defined populations with chronic illnesses.

We have learned that structured clinical experiences reinforce these new models of care more effectively than lectures. Fortunately, in Minnesota there are many examples of exemplary care. Even more fortuitous, many physicians in the state willingly volunteer to accept students and residents into practices.

As community and teaching practices gain traction on implementing these and other types of practice improvements, students and residents find more exciting examples of “best practices.” We now hear from some students entering the fourth year of medical school that they have never seen a paper medical record in any of their ambulatory experiences. Like many practices, we are challenged currently by the transition to an electronic medical record (if we could only find a time saving way to use those EMRS!).

This brief article will outline some of the educational changes at the University of Minnesota intended to reinforce practice improvements. Our continuing educational redesign will be launched more boldly in two years when we implement more fundamental innovations.

Current changes are already offering students, residents and fellows opportunities to join practicing clinicians in academic and community-wide efforts to improve patient care and experiment with “new models of care.”

BY MACARAN A. BAIRD, M.D.

MetroDoctors

Academic Health Center

Second-year medical students in the Physician and Society course participate in interprofessional small group coursework and projects on quality improvement and/or alleviating health disparities. Late in the year they present their own posters on these projects that often lead to long lasting health improvement efforts.

Similar experiences are part of small group learning sessions in third year clerkships in family medicine, internal medicine, pediatrics and psychiatry.

Third- and fourth-year medical students collaborate with students in nursing, pharmacy and dentistry in the student led initiative, CLARION. This is part of a national program to foster interprofessional teamwork that is student-driven with faculty and staff support. More detailed information on this effort is at http://www.chip.umn.edu/CHIP/ committees/clarion.html.

The Academic Health Center opened a new Center for Interprofessional Education as a focal point for educational innovations on that topic. Gwen Halaas, M.D., MBA, directs the center and is co-editor of a new journal, Journal of Research in Interprofessional Education (JRIPE). This is an open access journal that disseminates theoretical perspectives, methodologies, and evidence-based knowl-

The Journal of the East and West Metro Medical Societies

edge to inform interprofessional practice, education and research to improve health care delivery, quality of care, and health status for individuals, families and communities. This project results from collaboration between five universities: University of Sherbrooke, University of Montreal, University of British Columbia, Simon Fraser University, and University of Minnesota. Our goal is to create a peer-reviewed journal targeted to interprofessional education researchers, students and practitioners. We intend this project as a building block toward the development and dissemination of knowledge related to interprofessional collaboration. Editors are Hassan Soubhi, John Gilbert, and Gwen Halaas (http: //journals.sfu.ca/jripe/).

Residency Programs

University of Minnesota med/peds residents have a three-month block required experience in which they create group resident projects on education and clinical quality improvement.

Some have resulted in poster presentations showing improvement in care of childhood diseases and efficient, standardized discharge summaries accepted at the American College of Physicians annual meeting. Some of those improvements were recently presented at a local hospital for board approval. Other residents have been involved in Institute for Clinical Systems Improvement (ICSI) quality improvement and guideline development projects. A small group of residents has been involved with a Clinical Quality Scholars program in the University of Minnesota Department of Medicine.

All third-year psychiatry residents are involved in a year-long quality improvement (Continued on page 14)

May/June 2008

13

New Models of Care (Continued from page 13)

program focused on a topic of their choice.

They have weekly interdisciplinary team meetings and care planning conferences. Surgery residents are directly involved in grand round presentations, care conferences, and quality improvement programs that have recently been focused on standardized postoperative care pathways to improve outcomes.

All seven family medicine residency/ faculty programs, which include 130 residents and are administered by the University of Minnesota Department of Family Medicine and Community Health, have shown similar progress in moving toward the Institute of Medicine’s Six Aims of Quality Care. They are testing characteristics of practice outlined in the Future of Family Medicine Report. All family medicine programs now use an electronic medical record and have established patient registries for identifying and tracking patients with chronic conditions — beginning with diabetes and now including asthma and hypertension.

Residents know which patients are their responsibility to help improve clinical outcomes that are measured and tracked on a regular basis. Interprofessional teams meet weekly to discuss patients who are particularly challenging and who often have overlapping medical, psychiatric and psychosocial barriers.

Physicians, psychologists, family therapists, psychiatrists, social workers and pharmacists are usually part of these teams that also include nurses and office staff.

With multiple challenges facing our patients, we find that our results on measurably improving health are as humbling as they are for many community practices. However, we see our patients making progress and improving as we find creative methods of improving access to our services, provide groups to discuss common illnesses, and team with those who can translate in a patient’s native language. Of course, our patients also present with problems requiring acute care, minor trauma, and office surgery in the midst of common chronic illnesses. Therefore, several programs have developed innovative “procedure clinics” to teach ambulatory surgical and procedural skills while 14

May/June 2008

demonstrating more efficient delivery of such acute care.

Many of the patients we see in our combined faculty and resident practices are part of newly arrived immigrant families for whom we must balance our own cultural competency, a patient’s language hurdles and their stresses related to entering our American culture.

Although such challenges previously distinguished academic practices from community practices, this is much less the case as new families adapt and disperse more broadly into the community. Chronic care education has had an infusion of new energy and teamwork for the past year due to an educational grant awarded to the Medical School and the Department of Family Medicine and Community Health from the American Association of Medical Colleges.

This grant support has enhanced our ability to evaluate our chronic care teaching efforts for students and residents.

In January 2008, the Department of Family Medicine and Community Health launched our Center of Excellence in Primary Care (COEPC). This research-focused center, supported by a new Minnesota Medical Foundation endowment and the University of Minnesota Medical School, will emphasize primary care applied clinical research, evaluations and demonstrations of the effects of new models of team-based care, and innovations in linking our 18-year old Electronic PracticeBased Research Network (ePBRN) with other researchers with similar interests at the medical school and in community research institutes.

Housed within the family medicine department in collaboration with leaders in the departments of internal medicine and pediatrics, we will provide a research home for innovative demonstration projects relevant to the direct care of patients and expand our partnership with community primary care practices.

Within one month of our launch we were awarded our first grant—Improving Performance in Practice (IPIP) Award. Kevin Peterson, M.D., MS, is the principal investigator and also serves as the COEPC acting director. This $150,000 award funded by the Robert Wood Johnson Foundation and the education foundation of the American Board of Medical Specialties is “for the purpose of convening a collaborative, physician-driven initiative to improve care for chronic disease in the office MetroDoctors

setting.” It also includes ongoing support and training from the national team coordinating this effort. This grant is an excellent match for our Center of Excellence in Primary Care because it requires us to recruit practices in family medicine, internal medicine, and pediatrics to improve care of patients with diabetes and asthma as we share quality improvement ideas, coaches, and tracking methods already known to be helpful for other exemplary practices. We look forward to starting this grant as we continue our educational innovations regarding chronic care.

With new grants and energetic faculty, staff, students and residents we are moving forward steadily on the challenge of improving our delivery of primary care, redefining student and resident educational programs to enhance their skills and knowledge about team-based models of patient-centered care, and exploring new research opportunities with our community partners. We will publish our results as we move forward with research. We want our resident physicians and other health professionals to enter the workforce prepared to contribute to the rapidly evolving new models of care. By collaborating with patients, practices and communities, we believe that we will succeed.

Macaran A. Baird, M.D. is professor and head of the Department of Family Medicine and Community Health at the University of Minnesota.

References 1. AAFP Web site (www.aafp.org) Future of Family Medicine, Institute of Medicine; Priority Areas for National Action; Transforming Health Care Quality, 2003, www.ahc.gov/qualiompriorities.htm.

2. Green, LA, Jones, SM, Fetter, G, and Pugno, PA, Preparing the Personal Physician for Practice: Changing Family Medicine Residency Training to Enable New Model Practice, Academic Medicine, Vol. 82, No. 12, December 2007.

3. TransforMED Web site (www.transforMED.com).

4. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001.

5. NCQA Web site (www.ncqa.org).

6. CHIP Web site (http://www.chip.umn.edu/CHIP/ committees/clarion.html).

The Journal of the East and West Metro Medical Societies

SPECIALTY UPDATE

Searching for the Silver Bullet for Prostate Cancer: Why Some Local Men Travel Abroad for Treatment

W

“WHAT DO YOU KNOW about HIFU?”

asked my patient, Gary U., after we had just discussed a variety of mainstream treatment options for his newly diagnosed prostate cancer.

After a brief uncomfortable silence, I admitted to Gary that, even though my urologic practice focuses on prostate cancer, I didn’t know a lot. I knew that HIFU (Hi Intensity Focused Ultrasound) was a minimally invasive treatment for prostate cancer not available in the U.S. I advised Gary that it was expensive, still considered experimental, and would require going to Canada, Europe or Mexico for treatment. I also admitted that some of my other patients were considering this option, but with no encouragement from me.

A couple of weeks later, after doing more research on his own, Gary informed me that he felt HIFU therapy was his best option and didn’t want to wait until it was available in the U.S. He asked if I would support him on his decision. I was stunned: what was so attractive about this treatment that would compel Minnesota men to swim against the mainstream recommendations of their doctors and travel abroad for a $25,000 procedure that didn’t have a lot of long term supporting data?

Reluctant but intrigued, I agreed that I would assist Gary as best I could and help him choose a time and place for treatment, but only if it appeared safe and it was determined he was a good candidate.

Over the next few months, I was going to find out firsthand about this new procedure and why Gary, and subsequently three other patients of mine, had chosen HIFU for their prostate cancer treatment.

The proponents of HIFU make the procedure look attractive and relatively simple

B Y T H O M A S J . S T O R M O N T, M . D .

MetroDoctors

on their Web site and printed literature. It is portrayed as a “no-touch” technique, using no needles or incision, that is safe and effective, promises a rapid recovery that minimizes the bladder and rectal irritation unique to radiation, shortens the delay in getting back to work and minimizes the long-term urinary incontinence that plagues radical prostatectomy (RP). According to advocates, HIFU also leaves a man with every treatment option available afterward, including repeated HIFU. But probably the most intriguing claim to prospective patients is that HIFU may have one of the lowest rates of erectile dysfunction (ED) of all therapies.

While complication and cancer control data are sparsely recorded for HIFU, maturing results from the past five years did look promising, and it appeared at least to be safe. One of the treatment devices had more worldwide literature and long-term experience, so this led both Gary and me, independently via the Internet, to the same HIFU center. This center had an attractive and compelling Web site, was reasonably close, and had a reputable treating urologist and a Joint Commission-approved treating site.

After a long-distance discussion with the treating urologist about Gary’s prostate cancer specifics, it was determined that he was an appropriate candidate. While I remained skeptical, I was intrigued enough by the procedure and its claims to accept an invitation from the treating urologist to observe Gary’s surgery in Toronto, Canada as soon as Gary could get it scheduled.

The first detail that Gary needed to work out was financial. The center had a price that covered two nights in a hotel next to the treatment center, the treatment itself and the postoperative visit. The total cost needed to be paid

The Journal of the East and West Metro Medical Societies

upfront with an understanding there would be a total refund if the procedure was canceled.

He also had to consider the non-financial costs: being away from home, the flight, missing work and the unpleasant thought that if the procedure didn’t go exactly as planned, the trip could take longer. It helped Gary to have his wife along, and to know his local urologic clinic understood what he was going through and would help him with any medical complications.

By the time I had arrived in Toronto, Gary had already been to the center for a day for preoperative testing.

The next day, while I observed, Gary received a general anesthetic and lay on his side after a urethral catheter was inserted. A probe connected to the HIFU machine was inserted about six inches into his rectum. Ultrasound images were then used to devise a treatment plan, with care to avoid the rectum and external sphincter.

After this, Gary was not touched again until the 90-minute procedure was over. Instead, the urologist turned his attention to the console, watching and occasionally adjusting the controls. I observed as the focused ultrasound beam swept across the entire prostate, turning (Continued on page 16)

May/June 2008

15

Prostate Cancer (Continued from page 15)

the gland essentially into scar tissue. Impressively, there was very little operator input once the procedure started, as it was directed and monitored by software that controlled the treatment probe, guiding the pulses of energy and accounting for subtle patient movement.

Gary was eating and walking within a couple hours of the procedure, with no significant pain or bleeding. The next day he returned to Minnesota, and shortly afterwards his catheter was removed and he returned to full activity roughly within a week; his fears of a complication laid to rest. He is now nine months following treatment, has no bladder or bowel problems and is regaining his sexual functioning. There is no evidence of active prostate cancer, based on stable PSA values near zero, and he remains satisfied to have chosen HIFU over the other standard therapies.

Prostate cancer is so common that in 2007 approximately one in six U.S. men were diagnosed with it. And though it is common, it is in no way easily understood. Many tumors

grow so slowly they are not life-threatening and since the treatments can be tough on men the decision whether to treat is never an easy one. In fact, for lower risk prostate cancers, active surveillance is becoming an increasingly valid option. Also, how to treat often presents a medical conundrum, because for most prostate cancers there is no clearly superior treatment for cancer control. Also, the numerous treatments and their newer variants (see table), have differing side effects and recovery times. Nonetheless, the pressure to treat is enormous, not only from family and friends, but from physicians, device makers and even hospitals, acknowledging the financial incentives that are present.

With newer, less invasive treatments especially, there is significant advertising and promotion involved, depending on the urologist, clinic, Web site or literature to which a patient is exposed. Many claims from these sources are unsubstantiated or misleading, further obfuscating the decision-making process.

Gary joined a growing number of men with prostate cancer looking for a silver bullet: a treatment with minimal side effects, the potential to cure that allows for many options

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16

May/June 2008

MetroDoctors

The Journal of the East and West Metro Medical Societies

if the tumor recurs. In the past 10 years since HIFU has been used for prostate cancer, the technology has improved and the worldwide experience has matured so that it is now estimated that over 20,000 men have been treated.

Like all of its more mainstream counterparts, HIFU has its downsides. Because there are no long-term studies (five years of data at best), its cancer-control efficacy remains invalidated.

Probably the most dreaded complication of all prostate cancer therapies—rectal fistula—fortunately occurs in less than one percent of patients, comparable to other therapies. In regards to ED and urinary incontinence, HIFU may hold an advantage over other treatments, but legitimate comparisons are currently difficult to make. HIFU requires the patient to wear a catheter, usually for days, but it can sometimes stretch into weeks and there is a significant chance a subsequent Transurethral Resection (TURP) may be necessary. Additionally, there are limitations to the size of the prostate that is treatable with HIFU. Despite these shortcomings, it is estimated that 700 American men will pay for their own health care and travel to a foreign country for HIFU prostate cancer treatment in the coming year.

It is remarkable that so many men in America are compelled to seek this non-FDAapproved therapy at great personal cost, and that fact alone emphasizes the dilemma they face. Being diagnosed with any cancer is stressful, but when the diagnosis is prostate cancer clear decision-making can be particularly difficult. Patients are bombarded with treatment options — that all can have permanent side effects — but with limited and inadequate comparative information.

This makes it important that the patient be wary and adopts a consumerist approach.

Every patient should cross-reference information and seek multiple physician opinions until he feels all treatment options have been explored. The ultimate treatment decision is then based upon differences in the importance that patient assigns to the perceived effectiveness, recovery, long-term side effects, convenience and cost of that particular therapy, and his level of trust in who will administer it. While there are currently multiple studies in progress that may help clarify whether there is one superior treatment option, these trials are years from completion. Most men don’t want to wait, and the perception they can be cancer-free with

The Science Behind HIFU HIFU works like “slowly frying an egg with a magnifying glass,” using high-powered ultrasound focused at a single point, raising the temperature within seconds to 212F, which denatures protein and melts cellular lipid membranes while sparing adjacent healthy tissue. Using no incision or needle, a small volume of prostate tissue destruction can be created with an energy pulse from an ultrasound crystal delivered by a thumb-sized rectal probe. The ultrasound waves do not damage the rectal wall as it passes through. Treatment of prostate cancer is accomplished by systematically pulsing energy through the entire prostate at different and overlapping locations, monitored by ultrasound imaging. There are two available devices—the Ablatherm (EDAP-TMS, Lyon, France) and the Sonoblate 500 (Focus Surgery, Indianapolis, IN). While the basic physics are similar, there are unique mechanical differences that do slightly affect the treatment, and possibly also the outcome and side effects (this is unclear from the literature as there are no comparison studies between the two devices). Neither device is FDA-approved for use in the U.S., but both are involved in independent phase III clinical trials. FDA-approval of one or both devices is anticipated sometime after 2010.

MetroDoctors

The Journal of the East and West Metro Medical Societies

a new “no touch” technique that minimizes recovery time and maintains urinary, bowel and sexual functioning, makes HIFU irresistible.

Thus, while HIFU remains an unproven therapy, the phenomenon is real and it appears to be emerging as another valid therapy in the expanding field of contenders as the “best” treatment for early prostate cancer. It is encouraging that HIFU appears safe, enjoys a quick learning curve, and exhibits promising short-term oncologic data. If eventually FDA-approved, HIFU should be covered by insurance and Medicare and will probably be available in the U.S. for the appropriate patient within several years. Until then, except for the rare patient who may qualify for a U.S. clinical trial, HIFU is now only an option for a subgroup of Internet-familiar and economically advantaged travelers searching for their own silver bullet.

Thomas Stormont, M.D. received his medical degree from the Medical College of Wisconsin (Milwaukee) and completed his residency at Mayo Clinic – Rochester. He has practiced at Lakeview for the past 15 years, introducing several new procedures, and is now a member of the Stillwater Medical Group. Dr. Stormont has been selected as a Top Doctor by Mpls/St. Paul magazine for the past eight consecutive years and was voted by his peers as an Outstanding Physician by the Twin Cities Consumers’ Checkbook in 2007.

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May/June 2008

17

Regina Medical Center, Hastings, MN

The MetroDoctors editorial board has invited several hospitals located in the east and west metro communities to submit an article that would “showcase” their hospital and community health outreach initiatives. Regina Medical Center in Hastings, MN is the second hospital to be highlighted in this series.

I

IN THE WORLD of health care, independent,

faith-based providers are a scarce commodity.

Regina Medical Center is maintaining this status with several key initiatives. But first some background on our health care organization.

The centerpiece of Regina is our acute care hospital (licensed for 57 beds) located just 20 minutes southeast of the Twin Cities in Hastings, Minnesota. When you consider our hospital, senior living component and three Allina-managed multi-specialty clinics, we are one of the largest “small” health care campuses south of the Mississippi River. Our service area is comprised of Hastings, Prescott, Wisconsin, and an array of small communities in the vicinity.

Regina’s medical staff includes 35 active staff that live and work in the Hastings/Prescott area. More than 100 physicians complete our roster, bringing specialty care to Regina’s doorstep for the convenience of our patients. We’ve grown to 700 employees in the past 54 years, and recent renovations allow all inpatients in our Family Birthing Center, ICU, and Medical/Surgical departments to have a private room with private bath, contributing to our ability to offer a personal family feel. We also offer a 10-bed inpatient geriatric behavioral health unit (operated by Sunstone Behavioral Health), and an attached senior living facility,

BY MARK WILSON, CEO Regina Medical Center

18

May/June 2008

including assisted living/memory care with 131 apartments, and a 61-bed nursing home. These services, along with the Minnesota Regional Medical Examiner’s Office that serves three quarters of a million people in eight counties, set us apart when it comes to offering basic, comprehensive health care services. And similar to many community-based health care organizations, we offer selected, full-time specialty services including gastroenterology, general surgery, OB/GYN, ophthalmology, orthopedics and pediatrics.

We’ve implemented two of three phases of our Electronic Medical Record and have continued to invest in our facility. Later this year, we will occupy an expanded emergency department, and a new outpatient procedure services department, along with 10 additional beds in our busy medical/surgical department.

But the real key to staying viable is a variety of special partnerships and collaborative efforts that we have chosen to implement.

With a grant from the state in 2006, we initiated a total enterprise improvement program focusing on the integration of strategic planning, process improvement, and sustaining a culture of continuous performance improvement. The grant provided the means to partner with Inver Hills Community College, allowing our employees the opportunity to receive education and training in the latest techniques for quality improvement. These skills provided the backdrop for amazing results: re-evaluating and streamlining our hiring process, redesigning the revenue cycle, creating labor productivity and expense supply targets, conducting a strategic pricing market analysis and implementing “just in time” inventory management.

We’ve also implemented plans to offer the best possible experience for patients. A YMCA MetroDoctors

on the Regina health care campus was built on land we donated.

Outpatients requiring physical, occupational or speech therapy are seen at Regina’s Orthopedic and Sports Therapy Center, located in the new “Y” building.

Regina is committed to a culture that promotes patient safety. We’ve implemented the Joint Commission National Patient Safety Goals, including practices focused on patient identification, infection control, and medication safety: s 7E PARTICIPATE IN THE NATIONAL h3PEAK 5Pv campaign, which encourages patients to ask safety questions and make informed decisions about their care. s 7EEKLY hENVIRONMENT OF CAREv ROUNDS ARE conducted by a team of health professionals to identify potential safety hazards and issues. s 2EGINA PARTICIPATES IN QUALITY MEASUREMENT and reporting for the conditions of heart failure, pneumonia, heart attack and surgical care. s ! Rapid Response Team is in place that can be summoned by anyone who is concerned about a change in a patient’s condition, including the family. s 2EGINA IS ACTIVE IN A STATEWIDE EFFORT TO reduce the incidence of patient falls. s 7E VE JOINED THE )NSTITUTE FOR (EALTHCARE Improvement’s new 5-Million Lives Campaign, focusing on protecting patients from incidents of medical harm. s 5NDER THE LEADERSHIP OF ,ON 0ETERSON

The Journal of the East and West Metro Medical Societies

M.D., we’ve put together a Hospitalist Service that is currently comprised of local physicians.

We value our key partnerships with specialty groups that are bringing needed services to Hastings, allowing area residents the convenience of local access to an ever-growing array of services. Our longtime relationship with Summit Orthopedics was enhanced in 2003 when Dr. Jerome Perra established his full-time practice in Hastings. Summit recently added another orthopedic surgeon and the services of Metropolitan Hand Surgery Associates, P.A., to their Hastings office. Our emergency department is now staffed with United Hospital physicians who are board certified in emergency medicine. Cardiologists from St. Paul Heart are on the weekly schedule in our Hastings clinics.

Hospital Pathology Associates, Consulting Radiologists, Ltd., and Regional Anesthesiology Services meet our ancillary needs.

Perhaps the most significant partnership occurred in 2007 with our formal plan to work collaboratively with Allina Hospitals and Clinics to strengthen and expand local health care services. By working together, we can provide easier access to medical care and bring more specialty physicians and services to patients on our health care campus. The most visible result of our collaboration is Allina’s management of the former Regina Medical Group clinics in Hastings and Prescott.

We believe it is important to continually work to improve our services and tailor them to the needs of local residents. The future undoubtedly will include continued partnerships for additional cardiac, spine and oncology services as well as recruitment of additional family practice and specialty physicians.

As a major employer, we recognize the importance of staying visible and professionally active in Hastings and the surrounding area, keeping a pulse on health care services and needs. Regina employees are involved with the Hastings, Prescott and Cottage Grove area Chamber of Commerce organizations, Hastings Family Services, and a variety of community groups. Our hospital newsletter, Vital Signs, is published four times a year, giving area residents current and local health care information.

As a non-profit organization, we participate in community benefit activities to MetroDoctors

ensure that Regina continues to meet local needs. In 2007 Regina Medical Center’s contributions to Hastings and the surrounding area was nearly a half million dollars, marking a significant benefit to local communities. Free and reduced-cost programs and services encompass everything from childbirth classes to subsidizing “Meals on Wheels,” and beyond — aiding thousands of area residents.

Most hospitals, including Regina Medical Center, see patients in the emergency department regardless of their ability to pay. The Regina Foundation funds the Portico program to assist Hastings Family Services with offering free or low cost health care benefits as well as the cost of some prescription medications.

The hospital and the Regina Foundation also offer free community health activities.

Examples include the Hastings Women’s Expo, the Cottage Grove Area Business Expo, and free screenings and educational seminars for senior citizens. Also included are free or

low cost support groups and health-related seminars and classes, tailored to community needs.

Our community benefits program and key partnerships fit with our mission of respect for human life, and promoting the health of the whole person. We will continue to assess community health needs and create programs to reflect a local focus.

Mark Wilson is the President/CEO of Regina Medical Center in Hastings, Minnesota. www.reginamedical.org.

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The Journal of the East and West Metro Medical Societies

May/June 2008

19

Status of Resolutions Submitted by EMMS and WMMS to the MMA House of Delegates, 2006 and 2007 #106, Awareness of Tricare Health Insurance RESOLVED, that the Minnesota Medical Association increase awareness of its membership that military members and their families are often cared for outside the Department of Veterans Affairs (VA) system through insurance known as TRICARE, and be it further RESOLVED, that the Minnesota Medical Association delegation to the American Medical Association submit a request to the AMA asking that the AMA work with TRICARE to decrease the complexities associated with the contracting process and to work to increase the level of reimbursement to physicians.

Proposed Action Steps: 1) Develop article for publication in MMA vehicles; discuss with MMA military liaison group. 2) Submit to AMA I-07.

Status: Substitute Resolution #714 was adopted by the AMA. RESOLVED, that our American Medical Association convene a meeting with representatives of TRICARE to discuss how to improve its contracting process and funding, in order to better the health care of veterans and their families; and be it further RESOLVED, that our AMA report back at the 2008 Interim Meeting on issues regarding TRICARE in light of the increased numbers of new veterans and their families. #107, Fair Discounting of Dues RESOLVED, that the Minnesota Medical Association promote dues discount policies that are fair to all members.

Proposed Action Steps: Implemented with 2008 dues.

Status: Completed.

20

May/June 2008

#301, Removal of Artificial Trans Fatty Acids RESOLVED, that the Minnesota Medical Association call upon all health care facilities in Minnesota to remove artificial trans fatty acids from food served on their premises by July 2008, and be it further RESOLVED, that the Minnesota Medical Association promote public awareness of the hazards of trans fatty acids in the diet through Minnesota Medical Association publications, and be it further RESOLVED, that the Minnesota Medical Association advocate along with other organizations for removal of artificial trans fatty acids from food served in hospitals and nursing homes by January 1, 2009, and that such removal be a matter of public record and reported to the Commissioner of Health.

Proposed Action Steps: 1) MMA to send a letter to all MN hospitals and nursing homes urging them to remove trans fatty acids from food served in their facilities; through MMA publications, MMA will urge all MN clinics to remove foods with trans fatty acids from their clinics (e.g., vending machines). 2) Develop article for publication in MMA vehicles, include press release to generate greater public awareness of effort. 3) MMA to work in 2008 with MHA and MHHA/Care Providers to explore strategies for implementation.

Status: Pending review and recommendation. #305, Universal Health Insurance and Appropriate Compensation RESOLVED, that the Minnesota Medical Association recognize that universal access, clinic-based chronic disease management and the concept of a medical home must include adequate funding to be successful.

MetroDoctors

Proposed Action Steps: Implement as policy statement.

Status: Completed. #309, Reducing Sexually Transmitted Infection and Unwanted Pregnancy RESOLVED, that the Minnesota Medical Association support programs that attempt to change behavior to reduce sexually transmitted infection and unwanted pregnancy when such programs are based on scientific demonstration of efficacy.

Proposed Action Steps: Implement as policy statement.

Status: Completed. #310, Essential Benefit Set RESOLVED, that the Minnesota Medical Association create a task force for the purpose of establishing a physician-defined benefit set.

Proposed Action Steps: Refer to the MMA Medical Practice & Planning Committee for initial consideration — conduct literature review, review other relevant work (e.g., AMA, specialty societies, etc.) and development of a recommendation for next steps to the MMA Board of Trustees.

Status: Pending review and recommendation. #315, Fair Payment for Vaccine Administration Under the Minnesota Vaccines for Children Program RESOLVED, that the Minnesota Medical Association pursue state legislation to increase payment for vaccine administration under the Minnesota Vaccines for Children Program that would at least take full advantage of the federal dollars available to our state.

Proposed Action Steps: Refer to MMA Committee on Legislation for development of stratThe Journal of the East and West Metro Medical Societies

egy and determination of relative priority.

Status: Pending review and recommendation. #316, Right to Health Care RESOLVED, that the Minnesota Medical Association support the development of a work group that will develop legislation that will define accessible, affordable, financially viable health care that will benefit all Minnesotans, and be it further RESOLVED, that the Minnesota Medical Association will develop the work group by the end of 2007 and hold at least one meeting by then, and be it further RESOLVED, that the Minnesota Medical Association actively oppose the constitutional amendment until the work group makes its recommendation.

Proposed Action Steps: MMA Board of Trustees to act on resolution at November 2007 meeting.

Status: Completed.

Substitute Resolution #400, Torture and Human Rights RESOLVED, that the Minnesota Medical Association endorse the American Medical Association’s policy on human rights (H65.997) and its policy against the participation of physicians in torture, including the definition of torture contained in that policy (E-2.067), and be it further RESOLVED, that the Minnesota Medical Association encourage physicians, if they observe torture, to report it.

Proposed Action Steps: Refer to MMA military liaison group for development of potential strategies for implementation.

Status: Pending review and recommendation. #402, Mental Health Access and Insurance RESOLVED, that the Minnesota Medical Association reaffirm existing MMA policy regarding psychiatric and mental health care, specifically parity, usual and customary fees, mental health carve-outs, network and HMO barriers or restrictions to patient referrals, and patient access to mental health services, and be it further RESOLVED, that the Minnesota Medical Association work with the Minnesota PsyMetroDoctors

chiatric Society to monitor health plans and insurance entities for compliance with existing regulatory law regarding mental health benefits and access, and consider needs for new rules, penalties, and criteria in law if access and reimbursement problems persist.

Proposed Action Steps: 1) Implement as policy statement; 2) Send letter to MPS asking for documentation of issues of concern and for potential strategies for implementation.

Status: 1) Completed; 2) In process. #407, Advanced Care Directive Repository RESOLVED, that the Minnesota Medical Association should encourage physicians to support a culture of assisting patients and families in developing, documenting and honoring end-of-life wishes. This should take place well before a medical crisis and be incorporated into regular health maintenance for all, especially those who are 55 and older, have a chronic or progressive illness, are at risk for medical complications and/or are expected to expire within the next six months, and be it further

RESOLVED, that the Minnesota Medical Association urge the Minnesota Legislature to establish a statewide Advanced Directive Repository with the following characteristics: s A state administered electronic database, accessible on-line 24 hours a day, for consumers over 18 to deposit advanced directives free of charge. s To ensure patient privacy, consumers should be allowed to designate a level of security for their personal information. s Clinicians needing guidance should be able to access the registry 24 hours a day to view patients’ wishes for their care. s Provision should be made that allows consumers to change their advanced directive at any time. s Funding should be provided for a statewide education campaign about the importance of documenting health care power of attorney, patient goals, values and end-of-life wishes before a medical crisis occurs.

(Continued on page 22

Minnesota Epilepsy Group is the largest and most comprehensive epilepsy program in the Midwest. As a regional referral facility, we are the recognized leader in treating epilepsy and other seizurerelated conditions in patients of all ages, from infants to the elderly.

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The Journal of the East and West Metro Medical Societies

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May/June 2008

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22

May/June 2008

Status of MMA Resolutions (Continued from page 21)

Proposed Action Steps: Refer to the MMA Ethics and Medical-Legal Affairs Committee for development of recommendation to the MMA Board of Trustees.

Status: Pending review and recommendation.

The following resolutions remain â&#x20AC;&#x153;in processâ&#x20AC;? from the 2006 House of Delegates:

#103, The Independent Practice of Medicine RESOLVED, that the MMA form a task force to explore the reasons why physicians are abandoning the independent practice of medicine and are moving to an employed medical staff model of medical practice, and to make recommendations to help preserve the ability of physicians to independently engage in the practice of medicine, and be it further RESOLVED, that the Minnesota AMA delegation carry a resolution to the AMA House of Delegates calling on the AMA to study all facets of the problem faced by independent physician-owned medical practices and to report back to the AMA House of Delegates with a series of recommended AMA policies to help preserve the ability of independent, physician-owned medical practices to survive and prosper.

Board Adopted Implementation Steps: Incorporate into analysis/study of physician practice in Minnesota.

Status: In process. #403, Pharmacists Refusal to Fill Prescriptions RESOLVED, that the MMA introduce and support legislation that requires pharmacies to ensure that protocols exist that provide patients with immediate access to emergency contraception in the event of a pharmacistâ&#x20AC;&#x2122;s refusal to ďŹ ll the prescription or request, and be it further RESOLVED, that the MMA work with the Minnesota Pharmacists Association regarding this issue.

Board Adopted Implementation Steps: Refer to MMA Committee on Legislation for deMetroDoctors

velopment of strategy and determination of priority.

Status: MN Pharmacists Association is opposed to pursuing legislation in 2007; will evaluate for 2008. #407, Physician Education RESOLVED, that the MMA endorse the AMA policy on the relationship between physicians and the pharmaceutical, device and medical equipment industries (E-8.061), and be it further RESOLVED, that the MMA educate physicians in Minnesota and our patients about the fact that physicians and pharmaceutical and biotechnology companies must work together to continue to improve patient care, and be it further RESOLVED, that the MMA establish a dialogue with the Pharmaceutical Research and Manufacturers of America (PhRMA) and the OfďŹ ce of the Attorney General to help our MMA sustain its mission of advocacy on behalf of physicians to help ensure access to all available forms of information for all physicians in the state of Minnesota.

Board Adopted Implementation Steps: 1. Policy statement; 2. Develop communications on topic (Minnesota Medicine and/or via other vehicles); 3. Ongoing.

Status: Ongoing. #408, Health Plan Regulatory Accountability RESOLVED, that the MMA develop and lobby for legislation that: 1) clariďŹ es the ability of the Board of Medical Practice to hold makers of health plan referral and treatment decisions accountable to the same regulatory review standards as other providers delivering medical services; and 2) deďŹ nes referral and treatment decisions by health plans as medical practice.

Board Adopted Implementation Steps: Refer to MMA Committee on Legislation for development of strategy and determination of priority.

Status: Not deďŹ ned as a priority issue during 2007 session.

The Journal of the East and West Metro Medical Societies

Joint Public Policy Council Meeting The EMMS and WMMS Public Policy Council met on March 4, 2008. Matt Schafer, lead lobbyist with Lockridge Nauen Grindal, PLLP, provided the group with an overview of the issues coming before the legislature followed by a discussion of priorities for the Council to monitor.

In addition, the Council amended the Mission/Vision statement as follows: The Joint Public Policy Council shall: s Review and comment on issues within local and state government; s Provide liaison with county departments, agencies and elected officials on matters related to health care and the practice of medicine; s Foster the development of a working relationship between physicians, legislators and other government officials;

s Coordinate grassroots legislative activities; s Develop and recommend to the respective

board of directors of EMMS and WMMS new public policy programs, services and ventures for the organizations to consider; and s To observe the MMA’s legislative and public policy efforts and recommend actions to EMMS and WMMS for purposes of supporting and/or weighing in on those efforts.

Drs. Arthur Beisang and Peter Boosalis serve as co-chairs of the Public Policy Council.

The Council recommended that both EMMS and WMMS leadership send letters to the legislators opposing the proposed use of the HCAF to balance the budget.

Many EMMS and WMMS Physicians Joined with other MMA Members at the

Day at the Capitol Held on March 6

Commissioner Magnan, Rep. Matt Dean and other legislators addressed physicians gathered in the Capitol rotunda.

EMMS and WMMS Boards of Directors Meet The East Metro and West Metro Boards of Directors met for a joint meeting on Tuesday, February, 19, 2008, and welcomed guests, Sanne Magnan, M.D., Ph.D., Minnesota Commissioner of Health, and Sanne Magnan, M.D., Jim Jordan, Research Minnesota Commis- and Policy Associate, sioner of Health.

Illinois Division of Insurance. Commissioner Magnan discussed the recommendations of the Governors Transformation Task Force as well as other issues on the agenda of the Minnesota Health Department. Mr. Jordan discussed the experience in reforming the health insurance markets in Illinois and contrasting the insurance offerings with Minnesota’s market.

In addition, a legislative update was provided by lobbyists, John Hustad, Lockridge Grindal Nauen, PLLP, and Sara Noznesky, Minnesota Medical Association.

An impressive number of physicians donning “white coats” were visible at the Capitol.

Dr. Peter Wilton, EMMS President, welcomed guest speaker, Jim Jordan, Research and Policy Associate, Illinois Division of Insurance.

Visit us at WMMS physicians Benjamin Whitten, Anne M. Murray, Edward Ehlinger, and Beth Baker were among the many who participated in MMA’s Day at the Capitol.

MetroDoctors

EMMS members Drs. Kenneth Crabb, Charles Terzian, Lyle Swenson and Todd Brandt visited with their legislators.

The Journal of the East and West Metro Medical Societies

www.metrodoctors.com

May/June 2008

23

PRESIDENT’S MESSAGE PETER B. WILTON, M.D.

Medicare Reimbursement: Déja Vu All Over Again EMMS Officers

President Peter B. Wilton, M.D. President-Elect Ronnell A. Hansen, M.D. Past President V. Stuart Cox, M.D. Treasurer Thomas Siefferman, M.D. EMMS Elected Board Members

Arthur A. Beisang III, M.D., Director Peter J. Boosalis, M.D., Director Peter J. Bornstein, M.D., Director Katherine M. Clinch, M.D., Director Charles E. Crutchfield III, MMB, M.D., At-Large Director Laura A. Dean, M.D., Specialty Director, Obstetrics & Gynecology Andrew S. Fink, M.D., At-Large Director James J. Jordan, M.D., Director Nicholas J. Meyer, M.D., Director Robert C. Moravec, M.D., At-Large Director Anthony C. Orecchia, M.D., Director Jerome J. Perra, M.D., Director Lon B. Peterson, M.D., Director Christina J. Templeton, M.D., Specialty Director, Psychiatry Scott A. Uttley, M.D., Director Marie L. Witte, M.D., Director EMMS Appointed Board Members

Stephanie D. Stanton, M.D., Resident Physician Linnea K. Engel, Medical Student Jo Ann Wood, M.D., Young Physician MMA Officers and Board Members

Lyle J. Swenson, M.D., MMA Speaker of House Todd D. Brandt. M.D., MMA East Metro Trustee Charles G. Terzian, M.D., MMA East Metro Trustee David C. Thorson, M.D., MMA East Metro Trustee EMMS Ex-Officio Board Members & Council Chairs

*Arthur A. Beisang III, M.D., Public Policy Council Co-Chair Blanton Bessinger, M.D., AMA Alternate Delegate *Peter J. Boosalis, M.D., Public Policy Council Co-Chair *Peter F. Bornstein, M.D., MPS, Inc. Chair Richard J. Burton, M.D., Sr. Physicians Association President Kenneth W. Crabb, M.D., AMA Delegate Robert W. Geist, M.D., Professionalism & Ethics Council Chair Neal R. Holtan, M.D., Community Health Council Chair Frank J. Indihar, M.D., AMA Delegate, Chair of MN Delegation Mark Kleinschmidt, Clinic Administrator *Anthony C. Orecchia, M.D., Education Resource Council Chair Kent S. Wilson, M.D., EMMS Foundation President *Also elected EMMS Board Member EMMS Executive Staff

Sue A. Schettle, Chief Executive Officer Katie R. Snow, Executive Assistant Doreen M. Hines, Manager, Member Services

24

May/June 2008

“All that is necessary for the triumph of evil is that good men do nothing.” – Edmund Burke

I

I RECENTLY PARTICIPATED in a nation-

wide health care advocacy effort by physician leadership at the nation’s capital, under the auspices of the AMA. The main issue at hand was the impending Medicare reimbursement cuts, a problem with which we are all too familiar. Unless Congress acts, Medicare reimbursement to physicians is scheduled to be cut 10.6 percent on July 1, 2008 and a further 5 percent more on January 1, 2009. The cost to Minnesota over the next 18 months in reduced Medicare payment is expected to be approximately $150 million; the average cut each physician faces is $11,000. Still worse, over the next nine years, Medicare payment rates will decline about 40 percent while practice costs are estimated to rise 20 percent. With the Baby Boom population starting to be eligible for Medicare coverage during this period physicians can anticipate Medicare enrollees becoming an increasingly large proportion of their practices.

There will be several obvious consequences if no action is taken. Physicians and health care organizations will find it increasingly difficult to meet operational expenses. At the very least, the delivery of care will be slowly degraded as staff positions are cut, practice improvements are deferred, and implementation of expensive new technology such as electronic record-keeping is curtailed. Equally troubling, physicians will be forced to limit care delivery to the very population most in need of it.

Already, there are practices in the Twin Cities that no longer accept new Medicare patients, and this disturbing trend will accelerate unless Medicare reimbursement is reformed. There are almost 700,000 Medicare patients at risk in Minnesota, and an additional 65,000 military personnel insured through TriCare who are similarly affected.

Sadly, this problem has been a recurrent theme in recent years due to the flawed Sustainable Growth Rate formula which underMetroDoctors

lies Medicare payments. Inadequate Medicare reimbursement and further impending cuts result in intense lobbying efforts by the medical profession, seniors and other affected parties, followed by temporary extensions of the status quo — and recurrence of the cycle soon thereafter. The most recent temporary fix to the problem occured in December 2007, when Congress delayed reimbursement cuts for six months. Although Congress is sympathetic to our concerns, current proposals again suggest short-term “patches” rather than real reform, and will simply delay the day of reckoning.

What can be done? We must let our elected officials know that real Medicare reform is needed, rather than temporizing measures that avoid addressing the underlying faulty Sustainable Growth Rate formula and increase the difficulty of solving the problem in the future.

Take the time to send a letter to your elected members of Congress, and encourage your patients to do so as well. The power of doing so was illustrated by Rep. Shelley Berkley (herself the spouse of a physician) who addressed the physician leadership at the AMA meeting. She held up a large stack of correspondence that originated from the patients of a single physician, who had asked them to sign a letter to their representatives in his waiting-room; this tactic was used to great effect by her constituents. Personal contact from constituents carries significant weight with politicians. Let them know how these cuts will affect your practice, and how they will decrease health care access for your patients. If we do not take the trouble to act, others will do so without our input and to our detriment. If we do nothing, the consequences will be profound for our profession and our patients.

The Journal of the East and West Metro Medical Societies

EMMS UPDATE

Meet the New EMMS Board Members

he Minnesota Physician Services, Inc. (MPS) board met in March and reviewed and approved a marketing plan for 2008 that includes an aggressive statewide focus. For those of you uncertain as to what MPS is, MPS is a for-profit subsidiary of the East Metro Medical Society and exists to bring additional revenue into EMMS for purposes of offsetting operating expenses. We partner with organizations like AmeriPride Services, which

supplies lab coats and linen supplies, and Berry Coffee, which provides coffee and food services to clinics. Physician clinics receive a discount on the products and services and MPS receives a percentage of the sales. It’s an extremely valuable resource to EMMS and it is the goal in 2008 to increase revenue by 20 percent. Please visit our Web site at www.metrodoctors.com/ services.cfm to learn about the business partnerships we have.

Thanks to Outgoing MPS, Inc. Board Member

M

s. Traci Albers recently resigned from the MPS, Inc. board of directors noting her new position at Lakeview Hospital. Ms. Albers was the administrator of High Pointe Surgery

Center in Lake Elmo. We wish to thank her for her services on the MPS, Inc. board and wish her well in her new position.

Joint Public Policy Council

T

he Joint Public Policy Council met in March and discussed the many issues that are facing physicians as health care reform efforts move their way through the Legislature.

The Joint Public Policy Council is a joint effort between the East Metro Medical Society and the West Metro Medical Society and serves as a tool for the respective organizations to weigh in on legislative and public policy issues and to support positions that may have been taken by

other organizations including the Minnesota Medical Association. The group recommended to EMMS and WMMS leaders that letters be drafted to legislators asking them to oppose raiding the surplus in the Health Care Access Fund again to help balance the budget. The executive committee of EMMS approved their recommendation and as a result a letter was sent to east metro legislators. Many legislators responded positively to the letter.

Professionalism and Ethics Council

A

t the March 20, 2008 Professionalism and Ethics Council, Mr. David Allen discussed “Health Care Reform: A Modest Proposal” with a group of more than 20 attendees. After noting Jonathan Swift’s 1729 “modest proposal” for intractable problems of Irish poverty and starvations, he reviewed with the group the intractable cost problems

of health care. He noted in detail the most current statistics on the cost of health care in the U.S. and the projections for the future and the economic effect of uncontrolled inflation and the secondary effects on administrative costs, distorted supply and demand as well as declining service quality.

You’re invited to attend the

EMMS Caucus (NOTE: There will be only one caucus this year.)

Wednesday, May 21, 2008, 6:00 p.m.

Miller Room—John Nasseff Medical Center (formerly known as the Heart & Lung Center) 255 N. Smith Ave., St. Paul Call (612) 362-3704 to R.S.V.P.

MetroDoctors

The Journal of the East and West Metro Medical Societies

May/June 2008

25

Metro Medical Society

MARIE WITTE, M.D. is an internist practicing in Stillwater at the Stillwater Medical Group. She served on the EMMS board in 2007 as our Young Physician Representative but was nominated and elected to be a Director for a three-year term starting in 2008.

Dr Witte received her undergraduate degree from the University of St. Thomas in Houston, Texas. She received her medical degree from Texas A&M; started her internal medicine residency program at Indiana University School of Medicine and then transferred to the University of Minnesota to complete her final year of internal medicine residency. She is the medical director of Linden Nursing Home in Stillwater. She has been a member of EMMS since 2005.

T

East

PETER BOOSALIS, M.D. is an anesthesiologist working for Valley Anesthesiology Consultants, PA in Stillwater.

He is the current chief of staff at Lakeview Hospital in Stillwater and serves as an executive committee member to his specialty society, Minnesota Society of Anesthesiologists. Dr. Boosalis is the co-chair of the EMMS Joint Public Policy Council. He is a native of Minnesota — growing up in Mahtomedi and now living in Stillwater. He received his medical degree from the University of Minnesota, his internship from the Brooke Army Medical Center in San Antonio, Texas and his residency training at Brigham and Women’s Hospital in Boston.

He is scheduled to receive his MBA from the University of Minnesota’s Carlson School of Management in May 2008. He has been an EMMS member since 2004.

Minnesota Physician Services, Inc.

In Memoriam ROBERT M. AHRENS, M.D., SR., age 86, died February 24, 2008. Dr. Ahrens graduated from New York Medical College and practiced family medicine. He joined EMMS in 1951.

GEORGE HOTTINGER, M.D., long-time surgeon, died at the age of 78. He graduated from the University of Minnesota Medical School and completed an internship and residency at U.S. Public Health Service Hospital in Staten Island, New York and New Orleans, Louisiana.

Dr. Hottinger was board certified in colon and rectal surgery and was in private practice in St. Paul until his retirement in 1987. He joined EMMS in 1968.

LEONARD J. MICHIENZI, M.D. died December 26 at the age of 86. Dr. Michienzi graduated from Marquette University Medical School and practiced occupational medicine in the Twin Cities for over 60 years. He joined EMMS in 1948.

ALVIN W. WATERS, M.D., WWII Air Force Veteran, died at the age of 86 on March 31, 2008.

Dr. Waters graduated from the University of Minnesota Medical School. He was a talented and unique pathologist in that he was also a gifted businessman and entrepreneur. After serving as Chief of Pathology at Bethesda Hospital in St. Paul, he opened Capital Medical Lab—a successful medical lab for many years. He had recently retired as a consultant for Quest Diagnostic Laboratories. Dr. Waters joined EMMS in 1965.

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

Active Dina M. Andreotti, M.D. University of Minnesota Medical School Family Medicine University of Minnesota Physicians Bruce C. Bostrom, M.D. Mayo Medical School Pediatric Hematology Oncology/Pediatrics Children’s Hospitals and Clinics – Minneapolis Robert M. Cuddihy, M.D. University of Massachusetts School of Medicine, Worcester Internal Medicine/Endocrinology University of Minnesota Physicians Deborah A. DeMarais, M.D. University of Minnesota Medical School Pediatrics Columbia Park Medical Group – Andover Park Clinic

Gregory A. Haines, D.O. University of Osteopathic Medicine and Health Sciences Diagnostic Radiology/Vascular/ Interventional Radiology Consulting Radiologists, Ltd. Mark E. Holm, M.D. University of South Dakota School of Medicine Orthopedic Surgery/Hand Surgery Summit Orthopedics, Ltd.

St. Paul Radiology’s Unified Voice In March 2008 St. Paul Radiology (SPR) organized a letter writing campaign targeting the Governor and legislators on the issue of the planned raiding of the Health Care Access Fund to balance the general budget. Eightythree Minnesota resident physicians from SPR took the time to connect with their elected officials on this very important matter and, as a result, let their unified voice be heard.

They challenged “Minnesota physicians of all specialties to mount a similar coordinated 100 percent practice effort to speak out as one voice on this very important issue for the uninsured in Minnesota.”

The physicians of SPR have been a 100 percent member of the East Metro Medical Society for decades. Among other SPR physicians before him, Ron Hansen, M.D. has served on the board of directors. He is also the president-elect for EMMS.

Annette N. Mies, M.D. University of Minnesota Medical School Obstetrics & Gynecology Metropolitan Obstetrics & Gynecology, P.A. Matthew F. Sanford, M.D. University of North Dakota Diagnostic Radiology St. Paul Radiology, P.A.

Lynda S. Kauls, M.D. Yale University School of Medicine Dermatology Dermatology Consultants, P.A. Amy E. Kelly, M.D. Creighton University School of Medicine Obstetrics & Gynecology Metropolitan Obstetrics & Gynecology, P.A. Steven R. Kelly, M.D. Creighton University School of Medicine Anesthesiology Associated Anesthesiologists, P.A.

Denise A. Schow, M.D. University of Minnesota Medical School Family Medicine Family Health Services Minnesota, P.A. Thomas R. Smith, M.D. University of Minnesota Medical School Endocrinology/Internal Medicine HealthEast Woodbury Clinic

Erik S. Eckman, M.D. University of Minnesota Medical School Anesthesiology Associated Anesthesiologists, P.A.

Peter Lee, M.D. Albert Einstein College of Medicine Radiology St. Paul Radiology, P.A.

Raymond A. Watts, M.D. University of Ottawa Faculty of Medicine, Ottawa Family Medicine Stillwater Medical Group

Thomas E. Grande, M.D. University of Minnesota Medical School Obstetrics & Gynecology Metropolitan Obstetrics & Gynecology, P.A.

Ruth Lynfield, M.D. Cornell University Medical College Pediatric Infectious Disease Minnesota Department of Health

Hershel Z. Weisberg, M.D. University of Texas Obstetrics & Gynecology Stillwater Medical Group

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May/June 2008

MetroDoctors

The Journal of the East and West Metro Medical Societies

Smoke Free Washington County Billboard Unveiling and Press Conference

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Dr. Ronnell Hansen, St. Paul Radiology, P.A. and East Metro Medical Society President Elect and Cynthia Piette, Project Coordinator for Smoke Free Washington County.

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The Smoke Free Washington County billboard on the Minnesota/Wisconsin border.

April 2 was Kick Butts Day — a day created to empower youth and families to stand up to the tobacco industry and to say no to tobacco if they haven’t started smoking and to quit if they have started. There was a time when youth and their families did not have the freedom to walk into any restaurant of their choosing or to go to a bowling alley or to countless other businesses without having their health jeopardized due to exposure to secondhand tobacco smoke. Thanks to our new smoke-free law that has changed and Smoke Free Washington County wants to celebrate that fact.

From a media perspective, we had clips on the Channel 5-KSTP and Channel 11-KARE news at 5:00, an article in the Star Tribune, the Stillwater Courier, Oakdale/Lake Elmo Review, Woodbury Bulletin, and a related article in the Stillwater Gazette.

Dakota County Smoke Free Communities Partnership Update

T

he Dakota County Smoke Free Communities Partnership has been busy following the implementation of the statewide smoke-free law in the fall. Project Coordinator, Diane Tran, has spoken with a number of community groups to update them on the implementation of the law, including the Dakota County Social Leaders Action Network, Hastings Youth First, and the Bloomington Lions Club. The Partnership has had a presence at several community activities, including the Inver Grove Heights Health Fair and numerous Chamber of Commerce functions.

Smoke Free Dakota is now a member of all six Chambers of Commerce in Dakota County, in order to more effectively reach the business community countywide.

The County Coordinating Committee (CCC), made up of community volunteers, has been active monitoring compliance of their local MetroDoctors

bars and restaurants, stepping up also to educate their friends, neighbors, and co-workers along the lines of the Minnesota Department of Health’s denouncement of the “theatrical productions” taking place across the state in attempt to circumvent the Freedom to Breathe Act. In March, several CCC members helped organize a bowling event at Cedarvale Lanes in Eagan in order to survey league bowlers on their thoughts on the changed, and newly smoke-free, atmosphere.

Bowlers were given a slice of pizza and pop in exchange for their opinions, which ranged all across the gamut, but on the whole, expressed happiness with the new environment and having to take fewer showers or do less laundry.

Smoke Free Dakota is pleased to announce a new hire as of March 2008. John Fineberg joined Smoke Free Dakota as a public and community relations associate. He is a lifelong non-smoker,

The Journal of the East and West Metro Medical Societies

but comes from a family and an extended family with many premature deaths as a result of chronic smoking habits.

John has a unique background that intertwines communications and health care. As a freelance writer with a specialty in health care, he collaborates with for-profit corporations and not-for-profit organizations in crafting their internal and external communications messages.

Then, as an “authorized provider” of American Red Cross classes, he teaches CPR, AED, first aid and bloodborne pathogens classes, both in the worksite and in his own home training center.

Plus, as a volunteer EMT on the Red Cross EMS Team, John provides hands-on care to those in need at scheduled events around the Twin Cities area.

May/June 2008

27

Metro Medical Society

Representatives from Pierce/St. Croix County Tobacco Coalition from left: Geralyn Karl, Kevin Syverson and Buck Malick.

Elect. Joining in from across the border were Geralyn Karl, Director of Pierce/St. Croix County Tobacco Coalition, Buck Malick, St. Croix County Board Chair, and Kevin Syverson, member of the Pierce/St. Croix County Tobacco Coalition.

The billboard shows a simulated satellite image of the Midwest that shows MN surrounded by smoke. It reads “With our new smoke-free law the air is cleaner here. When it comes to health, Minnesota is a leader…we put our families, our youth and our workers first.”

This sign makes clear our pride in Minnesota and the willingness of our decision makers to stand up and protect the health of our fellow citizens.

East

n the morning of April 2, 2008 Smoke Free Washington County unveiled their billboard on the Minnesota/Wisconsin border.

The billboard was funded out of the SmokeFree Washington County grant from BCBS Communities for Healthy Air project. It is one of three billboards displayed by smokefree communities. The other two are on the Minnesota/North Dakota Border and the Minnesota/South Dakota Border.

Representatives from Smoke Free Washington County held a press conference to explain the purpose of the billboard. Cynthia Piette, Project Coordinator for Smoke Free Washington County spoke first followed by Dr. Ronnell Hansen, from St. Paul Radiology and East Metro Medical Society President

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CHAIR’S REPORT ANNE M. MURRAY, M.D.

Safeguarding the Health of Our Patients

WMMS Officers

Chair Anne M. Murray, M.D. President Richard D. Schmidt, M.D. President-elect Edward P. Ehlinger, M.D. Secretary Peter J. Dehnel, M.D. Treasurer Eric G. Christianson, M.D. Immediate Past Chair Paul A. Kettler, M.D. WMMS Board Members

Alan L. Beal, M.D. Edwin N. Bogonko, M.D. Carl E. Burkland, M.D. J. Paul Carlson M.D. Laurie Drill-Mellum, M.D. Kenneth N. Kephart, M.D. Stephen MacLeod, M.D. J. Riley McCarten, M.D. Robert Mittra, M.D. S. Rita Puri, MB, BS Frank S. Rhame, M.D. Thomas C. Tunberg, M.D. David J. Walcher, M.D. WMMS Ex-Officio Board Members

Michael B. Ainslie, M.D., MMA Trustee Martha Arneson, Co-Presiding Chair, HMS Alliance Beth A. Baker, M.D., MMA Trustee Christian L. Ball, M.D., Resident Representative David L. Estrin, M.D., AMA Alternate Delegate Melanie Fearing, Medical Student Representative Donald M. Jacobs, M.D., MMA Trustee Roger G. Kathol, M.D., MMA Trustee Candace S. Simerson, MMGMA Representative Richard E. Burman, M.D., Sr. Physicians Association Representative Karin M. Tansek, M.D., MMA Trustee Trish Vaurio, Co-Presiding Chair, HMS Alliance Benjamin H. Whitten, M.D., AMA Alternate Delegate James A. Young, II, M.D., MMA Trustee WMMS Executive Staff

Jack G. Davis, Chief Executive Officer Jennifer Anderson, Smoke-Free Project Coordinator Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors Kathy R. Dittmer, Executive Assistant

28

May/June 2008

O

ONCE AGAIN the Health Care Access Fund (HCAF) has become the battleground for budget wars between the legislature and the Governor. This time both the Senate and House in a bipartisan effort have stood up to the Governor to prevent him from raiding the $298 million dollars in the HCAF to balance the budget. They also preserved the meager 2 percent long-term care facilities inflationary increase he sought to eliminate. Our voices as physicians clearly played a role in safeguarding the HCAF, as we challenged the House and Senate leaders to uphold their promise to us to preserve the HCAF. They met the challenge.

Both the House and Senate have proposed alternative means to balance the budget deficit.

In the House these include the controversial step of consuming much of the state’s cash and checking reserves, but also closing corporate tax loopholes for offshore operations. Both propose cutting expenses by lowered reimbursement for hospital outpatient facilities. The Senate anticipates additional savings of more than $30 million by reinstating caps on health plan reserves, and authorizing an assessment on the reserve monies over those caps. Payments to health plans that currently have contracts with the state’s public programs would be frozen until the plans returned the surplus monies back to the state. Although the health plans will adamantly oppose this measure, it would be clearly aligned with the declared need for more transparency on the part of health plans (and all players) by the Governor’s Health Care Transformation Task Force.

Unfortunately, the budget deficit may preclude real progress in instigating many of the recommendations of the Health Care Task Force. However, despite the Governor’s plummeting interest in pursuing the passage of reform measures, the Minnesota Senate has approved their version, with watered-down adaptations of the most controversial provisions. We still await the House version, but both appear to want to preserve requirements for improved chronic disease management, a long-awaited and much-needed change.

The tremendous upheaval over health care

MetroDoctors

reform has generated a perhaps unexpected, but welcomed positive outcome. It has awakened physicians to the need for a louder voice as stakeholders at the table of reform. In a supplementary health care reform bill, the Senate recently authorized the creation of a Technical Advisory Committee consisting of members of the Minnesota Medical Group Management Association, the Minnesota Hospital Association, and the Minnesota Medical Association. This will strengthen our voice, but the MMA needs in turn to hear now from all of us regarding your concerns about health care reform and its effect on your practice. Attend the West Metro Medical Society Caucus on May 21.

This is an opportunity to present a resolution for immediate feedback from fellow physicians that can be revised for the MMA meeting, and eventually become legislation. Your participation as a delegate to the annual MMA meeting September 17-19 is another excellent way to have your voice heard.

We need to turn back the disturbing trend in the perennial legislative budget game of balancing the budget on the back of health and human services. We will continue to need to be hyper-vigilant to prevent more health care dollars from the HCAF and other programs from being absconded to the general fund. We need your voice to do this.

Delegates Needed WMMS Caucus Wednesday, May 21, 2008 7:00 – 8:30 a.m., Broadway Ridge Building 3001 Broadway Street NE – Lower Level Conference Room D, Minneapolis, MN 55413 Resolutions are due no later than Friday, May 9.

MMA Annual Meeting Crowne Plaza, St. Paul Riverfront

Wednesday, (eve.)-Friday, Sept. 17-19.

Contact Kathy Dittmer for more information: (612) 623-2885; kdittmer@metrodoctors.com.

The Journal of the East and West Metro Medical Societies

WMMS NEWS

Richard H. Johnston, M.D. Northwest Eye Clinic Ophthalmology

Gary B. Fetzer, M.D. TRIA Orthopaedic Center Orthopedic Surgery

Praful M. Kelkar, M.D. Noran Neurological Clinic, P.A. Neurology

Active Robert M. Ahrens, Jr., M.D. Lakeview Clinic, Ltd. Obstetrics/Gynecology

Sara J. Fish, M.D. Emergency Physicians and Consultants, P.A. Emergency Medicine

Anne M. Kern, M.D. Allina Medical Clinic Champlin Obstetrics/Gynecology

David R. Anderson, M.D. Orthopedic Surgeons, Ltd. Orthopedic Surgery

Kerry A. Fox, M.D. Kerry A. Fox, M.D., P.A. Psychiatry, Child Psychiatry

Todd R. Klesert, M.D. University of Minnesota Physicians Ophthalmology

Richard M. Bergenstal, M.D. International Diabetes Center Internal Medicine/Endocrinology/Diabetes

Thomas J. Gilbert, Jr., M.D. Center for Diagnostic Imaging Diagnostic Radiology

Patricia A. Kline, M.D. Allina Medical Clinic Champlin Family Medicine

Steven M. Bernstein, M.D. Fairview Center for Bladder Control Urology

Alana L. Grajewski, M.D. University of Minnesota Physicians Ophthalmology

Pamela S. Kolacz, M.D. Fairview Plymouth Clinic Family Medicine

Glen J. Booth, M.D. Minnesota Community Hospice and Residential Care General Practice

Karla R. Grenz, M.D. Allina Medical Clinic Champlin Family Medicine

Neil W. Kooy, M.D. University of Minnesota Physicians Pediatrics

James V. Harmon, M.D. University of Minnesota Physicians General Surgery, Pathology

Stefan D. Kramarczuk, M.D. Park Nicollet Clinic Pediatrics

Sharad Chopra, M.D. Center for Diagnostic Imaging Diagnostic Radiology

Shelley O. Harper, M.D. Abbott Northwestern Hospitalist Svc. Allina Medical Clinic Internal Medicine/Hospitalist

James R. LaFerriere, M.D. Allina Medical Clinic Champlin Pediatrics

Melissa K. Craig, M.D. Allina Medical Clinic Coon Rapids Family Medicine

Douglass S. Hassell, M.D. Consulting Radiologists, Ltd. Radiology

Constance J. Dankle, D.O. Minnesota Heart Clinic Internal Medicine/Cardiology

Laurel L. Haycraft, M.D. Bloomington Lake Clinic Family Medicine/General Surgery

Laresa G. DeBoer, M.D. Emergency Physicians and Consultants, P.A. Emergency Medicine

Thomas R. Henry, M.D. University of Minnesota Physicians Neurology

Amy R. Eastenson, M.D. Allina Medical Clinic Champlin Obstetrics/Gynecology

Matthew E. Herold, M.D. Emergency Physicians and Consultants, P.A. Emergency Medicine

Christopher Engeler, M.D. Consulting Radiologists, Ltd. Radiology

Bryon C. Holth, M.D. Allina Medical Clinic Champlin Family Medicine

Claudia M. Engeler, M.D. Consulting Radiologists, Ltd. Nuclear Medicine

Steven R. Jensen, M.D. Consulting Radiologists, Ltd. Diagnostic Radiology

Welcome New WMMS Members

Elise C. Brodin Larson, M.D., MPH Allina Medical Clinic Champlin Family Medicine

MetroDoctors

The Journal of the East and West Metro Medical Societies

W e st M e t r o M e d i c a l S o c i e t y

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

James A. Laurino, M.D. Twin Cities Occupational Health and Rehab Family Medicine/General Surgery Shonalie Leville, M.D. Southdale Pediatric Associates, Ltd. Pediatrics Charles C. Li, M.D. Fairview Cedar Ridge Clinic Family Medicine Jennifer L. Martin-McKay, M.D. Allina Medical Clinic Champlin Pediatrics Tara L. McMichael, M.D. Abbott Northwestern Hospital Internal Medicine Robert A. Morgan, M.D. University of MN Physicians Department of Orthopedic Surgery Orthopedic Surgery (Continued on page 30) May/June 2008

29

WMMS New Members (Continued from page 29)

Sarah A. Spink, M.D. Minneapolis Clinic of Neurology Neurology

Wylie H. Zhu, M.D. United Neurosurgery Associates Neurosurgery

William J. Mullin, M.D. Center for Diagnostic Imaging Diagnostic Radiology

James D. St. Louis, M.D. University of Minnesota Physicians Pediatric Cardiothoracic Surgery

Resident Physicians Farsad Afshinnia, M.D. U of MN Graduate School of Medicine

Karla G. Myhra-Bloom, M.D. Consulting Radiologists, Ltd. Diagnostic Radiology

Peter J. Terry, M.D. Fairview Plymouth Clinic Family Medicine

Derrick L. Aipoalani, D.O. U of MN Graduate School of Medicine

Daniel T. Oâ&#x20AC;&#x2122;Laughlin, M.D. Emergency Care Consultants, P.A. Emergency Medicine

Richard S. Thorpe, M.D. Emergency Care Consultants, P.A. Internal Medicine

Mrunalini D. Parvataneni, M.D. Northwest Eye Clinic Ophthalmology

Timothy E. Trude, M.D. Allina Medical Clinic Champlin Family Medicine

Suzanne E. Pauly, M.D. Silver Lake Clinic Family Medicine

Aaron J. Trygstad, M.D. Apple Valley Medical Clinic, Ltd. Family Medicine

Snigdhasmrithi S. Pusalavidyasagar, M.D. University of Minnesota Physicians Internal Medicine

Robert W. Tuttle, M.D. Orthopedic Medicine & Surgery, Ltd. Orthopedic Surgery

James L. Quale, M.D. Consulting Radiologists, Ltd. Diagnostic Radiology

Bruce J. Van Dyne, M.D. Neurologic Consulting Services Neurology

Tanya J. Rath, M.D. Consulting Radiologists, Ltd. Radiology

Katie L. Vogt, M.D. North Memorial Medical Center Emergency Medicine

Mildred A. Rotzoll, M.D. Allina Medical Clinic Champlin Family Medicine

Sing-Sing Way, M.D. University of Minnesota Physicians Pediatric Infectious Diseases

Pamela A. Sakkinen, M.D. Twin Cities Dermatopathology Dermatopathology, Pathology

Angela Wermerskirchen, M.D. Fairview Plymouth Clinic Family Medicine

Matthew M. Schaar, M.D. Suburban Radiologic Consultants, Ltd. Radiology

Paul G. Westling, M.D. Allina Medical Clinic Champlin Family Medicine

Nicholas J. Schmitt, M.D. Northwest Eye Clinic Ophthalmology

Daniel Yoon, M.D. Columbia Park Medical Group Otolaryngology

Scott D. Sidney, M.D. Consulting Radiologists, Ltd. Radiology

Nicole L. Zantek, M.D. University of Minnesota Physicians Pathology/Transfusion Medicine

Kevin E. Snyder, M.D. Center for Diagnostic Imaging Diagnostic Radiology

G. K. Zhang, M.D. Columbia Park Medical Group Urology

30

May/June 2008

Nicholas M. Edwards, M.D. Hennepin Faculty Associates David Ingham, D.O. Abbott Northwestern Hospital Medical Students (University of Minnesota)

Eric K. Moeker

In Memoriam THOMAS BURTON ARNOLD, M.D. died April 3, 2008. He was 78. He graduated from the University of Pennsylvania School of Medicine, Philadelphia and completed a fellowship at the Mayo Clinic. Dr. Arnold specialized in internal medicine. He joined WMMS in 1962.

BARBARA S. BERG, M.D., a pediatrician, died on March 22, 2008 following a battle with cancer.

She was 46. She graduated from the University of Minnesota Medical School. Dr. Berg became a partner with Southdale Pediatrics in 1985, working primarily from their Eden Prairie and Edina locations. Dr. Berg joined WMMS in 1986.

THOMAS F. CHENG, M.D., F.A.C.C. died February 25, 2008 after a prolonged illness. He was 55. He earned his medical degree from Cornell University Medical College, New York City.

After completing an internship and residency at Indiana University School of Medicine, Indianapolis, he completed a fellowship in cardiology at the University of Chicago. Dr. Cheng, a partner with Minnesota Heart Clinic, Edina, has been a dedicated cardiologist in the Twin Cities for 25 years. He was a fellow of the American College of Cardiology, and served as a clinical associate professor at the University of Minnesota Medical School. Dr. Cheng joined WMMS in 2005.

SAMUEL B. FEINBERG, M.D., a radiologist, died in January, 2008 at the age of 86. He graduated from the University of Minnesota Medical School. Dr. Feinberg joined WMMS in 1955.

MetroDoctors

The Journal of the East and West Metro Medical Societies

ALLIANCE NEWS DIANE M. GAYES

10th Anniversary STI/HIV/AIDS Education Folder Project 276,000 Folders Distributed to Minnesota School Students 1997-2007

Project goals: v To help young people make educated choices so they can develop and maintain active, healthy lives. v To prevent chronic health problems associated with STDs. v To prevent catastrophic effects of HIV/ AIDS. v To prevent teenage pregnancy. v To expand the project to a larger geographic area.

1995-1996: Minnesota Department of Education Peer Review Panel, physicians, nurses, other infectious disease experts, schoolteachers, students and parents reviewed the messages on the book cover.

1996-1997: (25,000 folders were distributed to 42 West Metro Schools) Revisions were made to include facts about STIs, alcohol/chemical use and pregnancy. The book cover format was changed to a paper pocket folder. A high school student won our graphic design contest, capturing the essence of the health education messages in a non-threatening, visually-pleasing presentation that reflects the ethnic diversity of the student population.

1997-1998: (80,000 folders distributed) A curriculum guide was developed to encourage and enhance the teachers’ use of the folder. The Minnesota Medical Association Alliance (MMAA) joined our efforts to expand the project to greater Minnesota.

MetroDoctors

1998-1999: (80,000 folders distributed) The AMAA Alliance Today magazine recognized the STI/HIV/AIDS folder as an outstanding Alliance health promotions project.

1999-2000: (15,000 folders distributed) A Web site was created for a more cost effective way of relaying information to the school health educators.

2000-2001: (40,000 folders distributed) The HIV/STI Regional Training Site, Hopkins, MN, used the folders in their training sessions with staff from the metro area suburban school districts. “The folder is a wonderful example of the implementation of two Graduation Standards in one product. The use of graphic design intertwined with the understanding of health concepts has provided a unique product for others to see and emulate,” Coordinator, Hopkins HIV/STI Training Site.

HMSA/MMAA members saw firsthand the devastating effects of HIV/AIDS on children.

Nine Alliance members traveled 9,000 miles to Chang Mai, Thailand, to deliver supplies to Agape Home, an orphanage for orphaned/ abandoned children infected with HIV/AIDS. The journey was life changing and reaffirmed that the HMSA STI/HIV/AIDS Education Project was important. An article authored by Diane Gayes, Journey of the Heart, a chronicle of the trip, was published in the AMAA Alliance Today and Minnesota Medicine.

2002-2006: No funding. (Remaining 4,500 folders were distributed) 2007-2008: We reached our funding goal, updated the folder and printed 50,000 folders.

The Minnesota Department of Education sent information about the project to 4,500 school health educators.

To date, 26,500 folders have been distributed and $8,000 of the $14,000 needed has been raised for future printing.

“While we have no actual proof that we have saved a life with this folder, we know in our hearts that because of our efforts at least one child has made a healthy choice!”

Dianne Fenyk, AMAA President, 2007-2008

The Journal of the East and West Metro Medical Societies

Student Quotes:

1998: “Stunned. It made me feel good. It makes you think twice before doing it. Felt nice to know that someone cares this much.”

2007: “It makes me think twice about sex. It made me sad and thankful I don’t have AIDS. Proud, that I am not using drugs. I love the folder.”

Teacher Quotes:

1998: “Folders were excellent, informative.

Brings forth some interesting comments and discussions! Very frank, honest and eye opening for some students. Thank you for a wonderful teaching tool.”

“More and more students are exposed to risky behaviors and many of them are engaging in these behaviors. For these youth at risk — and in today’s society, that can include nearly every junior high student — the behaviors that will cause them problems are clearly identified.

Another important part of the folder was the listing of many other choices students have, rather than engaging in behaviors that would put them at risk. This folder has been a really valuable teaching and learning tool and it is wonderful to see them in use every day at our school.”

2008: “They emphasize that there are many myths and incorrect information about AIDS. I would like to extend my thanks to you for allowing us the opportunity to get the HIV/ AIDS folders for our high school students’ health education.”

Thank you to: Florida Medical Alliance and AMA Alliance for project idea; Rebecca (Bourne)Wygonik for folder design; HMS Alliance/MMA Alliance volunteers; individual physicians and clinics; infectious disease experts; teachers/parents/students; Minnesota Department of Education/HMSA/ Hennepin Medical Foundation/MMAA/MMA and other Minnesota Medical Societies/local organizations/individuals who have donated funds ($74,000).

The collective support in the way of finances, volunteer time, creative talents, and passion to help young people remain healthy, has been responsible for the success of this project.

May/June 2008

31

W e st M e t r o M e d i c a l S o c i e t y

A Timeline October 1995–AMAA Leadership Conference, Chicago: Diane Gayes first learned about the Florida Medical Alliance HIV/AIDS Education book cover for school students. That same fall, she read the following comment by a 25-year-old man: “If adults had just given me the facts when I was a teenager instead of arguing about what to tell young people, I might not have been infected with HIV which has now become AIDS.” The HMSA felt the need to reach out to teenagers with an HIV/AIDS health education project.

Diane Gayes and Dianne Fenyk became the project co-chairs.

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Please fax or email resumes to: Bill Tendle, Human Resources Telephone: 612-821-2800 Fax: 612-821-2818 Email: bill.tendle@southsidechs.org.

11th Annual Winter Medical Update 2008: Excellent Speakers and Topics The â&#x20AC;&#x153;11th Annual Winter Medical Update 2008 was held at the beautiful Loews Coronado Bay Resort, San Diego located in Coronado, California from February 24-27, 2008. The conference was held in the mornings, which allowed for the afternoon to enjoy the California weather. Attendees were awarded 20 AMA PRA Category 1 CreditsTM or 20 Prescribed credits by the American Academy of Family Physicians.

The evaluations rate this conference high for the remarkable opportunity for multi disciplinary topic discussion and interactive dialogue with a didactic format.

Dr. Ronnell Hansen, diagnostic radiologist with St. Paul Radiology, P.A., President-elect of East Metro Medical Society and member of Education Resource Council, served as the moderator of the conference.

The faculty members again received excellent evaluations for their presentations by the participants. For a full list of faculty and topics that were presented, go to www.metrodoctors.com.

Excursions in and around the San Diego 32

May/June 2008

area provided many activities for participants to enjoy. Several families visited the San Diego Zoo, Wild Animal Park and Sea World where they took in the infamous â&#x20AC;&#x153;Shamuâ&#x20AC;? show. Some ventured up to Disneyland for a day.

Others just spent time

relaxing around the pool or walking over to the beach to enjoy the sunsets in the evening. This conference proved no different than past conferences in that all the attendees enjoyed the collegiality and the small group size of the conference, which allowed for lots of great discussions.

Dr. Luciano Kolodny during his presentation.

Faculty (left to right): Drs. Himanshu Sharma, Barbara Yawn, Robert Geist, Thomas Smith, Peter Alden and Peter Dehnel.

Faculty members (from left) Scott Jensen, M.D. and John Mielke, M.D.

MetroDoctors

Conference attendees participating in one of the presentations.

The Journal of the East and West Metro Medical Societies

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