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Contents VOLUME 11, NO. 2

2

MARCH/APRIL 2009

Index to Advertisers Classified Ads

3

Colleague IntervIew

Benjamin H. Whitten, M.D.

6

Feature

Seeing Red in the 2009 Session

By Roger K. Johnson

11 Page 3

Minnesota’s Health Reform Initiative in 2009

By Sanne Magnan, M.D., Commissioner of Health

14

Colleague IntervIew

Leonard Read Sulik, M.D.

17

A Medical Home Relationship Connecting Psychiatry and Primary Care

By James J. Jordan, M.D., Mary Androff, M.D., and Jerry Montie, M.D.

19

New Health Care CEOs in Town: William McDonough Named as MMIC President and CEO

20

Addressing Pediatric Obesity “Minnesotans for Healthy Kids” Coalition

Page 21

On the cover: Physicians must stay engaged in health care reform discussions.

Articles begin on page 6.

By Peter J. Dehnel, M.D.

21 22

Robert A. Van Tassel, M.D. Receives 2008 Shotwell Award Joy to My World

By Kathy Hult

32

Career Opportunities

east Metro MedICal soCIety

24 25

President’s Message

26 27

New EMMS Officers Named/New Members

EMMS Annual Meeting/Thanks to Outgoing EMMS Board Members MPS Vendor Spotlight: AmeriPride Linen Services/Call for Resolutions/EMMS Says Good-Bye to Doreen Hines/ Foundation Welcomes New Volunteer/In Memoriam west Metro MedICal soCIety

Page 6

Page 22 MetroDoctors

The Journal of the East and West Metro Medical Societies

28 29

President-elect’s Report

30 31

New Members/In Memoriam

Senior Physicians Association/2008 Hoban Scholars Selected/Call for Resolutions Alliance News March/April 2009

1

Doctors MetroDoctors tHe Journal oF tHe east and west Metro MedICal soCIetIes

Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer 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: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com.

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March/April 2009

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Outside Back Cover Family HealthServices Minnesota, P.A. ......32 Healthcare Billing Resources, Inc. ...............18 Lockridge Grindal Nauen P.L.L.P. ................. 9 Midwest Spine Institute ..................................12 Minnesota Epilepsy Group, P.A...................... 2 Minnesota Physician Services, Inc. ..............16 The MMIC Group ................................................

Inside Back Cover SafeAssure

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Sterling Retirement Resources, Inc..............21 Wapiti Medical Group .....................................32 Wapiti Medical Group .....................................32 Weber Law Office .............................................13

Adult Epileptologists Deanna L. Dickens, MD Julie Hanna, MD El-Hadi Mouderres, MD Patricia E. Penovich, MD Pediatric Epileptologists Jason S. Doescher, MD Michael D. Frost, MD Frank J. Ritter, MD

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We also offer comprehensive neuropsychological assessment for a broad range of acquired or developmental neurological conditions in both adult and pediatric patients.

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.

March/April Index to Advertisers

MetroDoctors

Functional Neuro-Imaging Wenbo Zhang, MD, PhD Neuropsychologists Elizabeth Adams, PhD Robert Doss, PsyD Ann Hempel, PhD Donna Minter, PhD Gail Risse, PhD

The Journal of the East and West Metro Medical Societies

Colleague IntervIew

A Conversation With

Benjamin H. Whitten, M.D.

B

enjamin H. Whitten, M.D., FACP is board certified in internal medicine and is currently employed at Abbott Northwestern General Medicine Associates. He is on the teaching faculty at Abbott Northwestern Hospital and is an Assistant Clinical Professor of Medicine, University of Minnesota. Dr. Whitten was elected president-elect of the Minnesota Medical Association and will assume the position of MMA President in September 2009. He served as a West Metro Trustee to the MMA and has held several MMA committee appointments. He is currently an alternate delegate to the AMA. Dr. Whitten received a B.A. from Princeton University and his medical degree from the University of Minnesota. He completed his internal medicine residency at Abbott Northwestern Hospital. In addition, he served as a House Officer, Research Fellow in Therapeutics and an Honorary Senior House Officer in Medicine at the University of Nottingham, Queens Medical Centre, Nottingham, England.

Questions were provided by Drs. Lee H. Beecher, Robert W. Geist, and Donald M. Jacobs.

What is your vision of the physician/patient relationship of the future and do we need one?

I see the future relationship as one of empowerment of both sides. There will be more flexibility and less time and effort spent attempting to deliver the care within a traditional office visit framework. In the future, information will be more readily available to both patients and physicians.

For example, there is absolutely no reason why patients shouldn’t have access to their entire chart. We spend an extraordinary amount of time now simply acquiring information from disparate sources that we turn around and transmit back to the patient. In many cases this information, e.g. the result of prior evaluations, would radically change the way we do things and would save a lot of time and money in the process.

Here’s another example: radiology reports. Can anyone think of another profession or business where we would ask someone to pay for an expensive service and then not make that information directly available to them? Instead we filter radiology reports back through the ordering physician, make the patient dependent and create additional work for the physician. So, in this case, instead of primarily interpreting and explaining results, the physician also has to communicate the primary information and the patient is only put in the loop at the very end.

What do you see the potential problems are from a “right to health care” constitutional amendment?

Our view at the MMA is that people should have a right to health care insurance. To take the step of designating health care as a constitutional

MetroDoctors

The Journal of the East and West Metro Medical Societies

right would move us as a society toward the mindset that the government should not only define the scope of that right, but also become the primary guarantor and provider of health care.

We want to make health care affordable and accessible for everyone without disabusing people of the idea that they need to avidly participate in the process of maintaining healthy lifestyles and managing their medical problems.

From a practical and political point of view, such a constitutional amendment is a “hail Mary” pass. It is being touted because no one has the imagination or the political will to reform health care financing or delivery.

As an internist, you must be concerned with the current difficulty in recruiting medical school graduates into primary care specialties. Do you see opportunities to explore solutions to those issues through your leadership in the MMA and AMA? I think we all have to be concerned about this if for no other reason than most of us will need a primary care physician in the future to take care of us and our families.

The biggest barrier I see now for those who might otherwise pursue a primary care career is financial: The average medical student debt is now $170,000 or more. When you couple this fact with the disparity between what a physician would make in primary care or in some other

(Continued on page 4)

March/April 2009

3

Colleague Interview (Continued from page 3)

areas, it is easy to understand why medical school graduates aren’t going to be overly enthused about pursuing a primary care specialty.

There seems to be a recognition now that good primary care is beneficial and extremely cost effective for populations, health care systems and individuals. To the extent that we can continue to measure and quantitate our effectiveness, we will have a much better chance at obtaining the recognition and support that primary care and other specialties, like psychiatry, must have to survive.

Loan forgiveness programs may help also, as will increasing support for medical schools that traditionally send higher numbers of students into primary care. I don’t think that attempting to designate a medical school as only for training primary care physicians is a good idea.

The size of the reimbursement “pie” for physicians within health care appears unlikely to be expanding in the near future. How do you see organized medicine coming to grips with the difficult issues of payment reform within our health care system without losing the strength we have when we work together?

Somehow we are going to have to get away from the concept of getting paid for what we do or how we perform and more toward the idea of what we actually accomplish. We are spending $7,200 or more now per person per year in the U.S.A. That’s a huge amount of money. On a family level, many are spending $1,200/month or more on health insurance, and medical bills are the leading cause of bankruptcy.

Physicians of all specialties should acknowledge that we occupy a privileged place in society. We still earn a great deal more than most Americans and many physicians earn in the top 2-3 percent of Americans.

I think we can make progress toward payment reform if we can utilize our considerable and collective talents and maintain our focus, which should be on how to provide care for people at an affordable price.

We need to build on areas of success. Improved communication and reduction of duplicate or unneeded testing; greatly reduced length of stay for common surgical procedures and less time required for rehabilitation; and new and improved anesthetic techniques are just a few examples. The point is that physicians have a tremendous ability to change and improve the way things are done. If we can couple this ability with a heightened sensitivity to costs and process improvement, I’m optimistic that we can improve the quality of the care we deliver, decrease costs and make a reasonable income.

How will you advise the MMA and its members to promote and enhance effectiveness and independence of the medical staff organizations?

There’s a simple place to start. We should advise physicians that it’s extremely important to attend medical staff meetings. At my hospital

4

March/April 2009

these are annual. If physicians don’t show up they cede control to those who do.

Also, the AMA has a special section meeting for the Organized Medical Staff. I would like to see the MMA recruit more medical staff members from around the state to participate.

We’ve been lucky in Minnesota compared to states like Florida and California where some egregious things have happened. In Florida the medical staff at one hospital had to sue the hospital to get back control of its bylaws, staff privileges and bank account.

Physicians must not only be vigilant to protect their autonomy, they also have a responsibility and an opportunity to inform and guide their institutions.

How will you promote MMA policies to embrace the American Medical Association policies on health care reform (The Three Pillars http://www.voicefortheuninsured. org/amaproposal.html) The AMA has been conducting a nationwide campaign called Voice for the Uninsured. I think that our legislative and policy initiatives are closely aligned with those of the AMA on this issue. As discussed earlier in this interview the MMA believes that everyone has a right to health insurance.

Minnesota health plan Pay-for-Performance (P4P) programs were surveyed in a 2007 MMA report. Most did not meet MMA or AMA “criteria” for P4P, especially running afoul of supporting a trusting doctor-patient relationship. Do you see ethical issues or potential conflicts for doctors with insurance company or big clinic P4P? What are the remedies?

P4P is a misnomer. It should be called Incentive for Quality and it should be looked at as a partnership between physicians and health plans.

Physicians want to practice high quality medicine and to suggest that they have to be paid extra to do that is uninformed and demeaning.

Yet real differences exist about the importance of various treatment goals and the best way of achieving them.

To the extent there are areas where we are falling short of commonly accepted treatment standards, we have a huge potential for improving quality and consistency. In my field there is data indicating that patients who should be on warfarin for atrial fibrillation are not, and that patients who should be on a beta blocker after a myocardial infarction are not.

Some of these shortcomings cut across both primary care and specialty lines. We need to be thinking along the lines of giving clinicians the tools they need to monitor and enhance quality.

Unfortunately some health plans and public policy personnel have attempted to use quality guidelines as a tool for marketing, tiering or disenfranchising physicians rather than for the purpose of informing practice and effecting quality improvement.

If I give a diabetic patient with postural dizziness an additional antihypertensive to get their systolic bp <130 for the purpose of satisfying a guideline and I disregard the possibility that the risk of that might

MetroDoctors

The Journal of the East and West Metro Medical Societies

outweigh the benefits, then I will have made an ethical and a professional error. The remedy will be to ensure that performance guidelines are valid and that they are guidelines and not absolutes and that they be used solely for their intended purpose.

Minnesota, unique in the nation, has nonprofit health plans. Is this a barrier to competition among health insurance options for our citizens? Would you seek to open up access to health insurance across state lines?

No. I would not seek to open Minnesota for access by for-profit health plans. I haven’t seen any data indicating that health care is better or more cost-effective when delivered by for-profit plans. We have to look at the track records elsewhere and the gap between what is promised and what is delivered. When we do this I think that Minnesota residents will be well served by the current system.

What can the MMA do to avoid medical homes becoming little more than “at risk” gatekeeper houses controlled by a new insurance layer of “at risk” provider corporations?

Ben, you always look so happy. What do you do to keep the stresses of practice and administration in balance? Any advice for others pursuing leadership roles in organized medicine?

We have to maintain perspective. We have an opportunity to make a tremendous difference in an individual’s life with repercussions that obviously go far beyond that individual. Physicians are valued and respected members of our society and we also enjoy working conditions and remuneration considerably better than that of many Americans.

I derive a lot of satisfaction from working with other physicians, those with whom I practice and those in organized medicine. Their professionalism, knowledge and diverse talents inspire me tremendously.

I have welcomed the opportunity to participate in areas outside of direct patient care, but I have tried to focus on areas where I have a passion or an active interest. My advice here is to participate, but also know how to say “no.”

My wife, Suzy, and my family support me fully in what I do. I would not — could not do it otherwise.

Also, I’m extremely fortunate to be a member of a group that has consistently encouraged and supported me.

The MMA is working very hard right now to make sure this doesn’t happen. We don’t own the concept of the medical home and nobody even knows for sure what it is going to look like. Yet the ball is in play at the legislature and there are already some big expectations about what benefits we are going to reap from this concept. Metro Dr. Ad 9/17/08 11:12 AM Page 1 All concerned parties need to think in terms of enabling a medical home to serve its function. For example, there will be little to be gained (and much to be lost) by requiring small groups to meet patient access needs by “Remarkable patient satisfaction from quality, furnishing interpreter services. Yet if those groups could be supplied with a telephone service, convenience and excellent results” interpreter service or remote triage by RNs, we can support the group’s ability to function “Exceptional care for as a medical home or as a part of the overall all skin problems” home structure.

Charles E. Some of the health plans have already Crutchfield III, M.D. attempted to provide disease management serBoard Certified Dermatologist vices. Yet these services are really not integrated into our practice and they haven’t been well Psoriasis received by the medical community. We need & to think in terms of using all the tools at our Acne Specialist disposal — not for creating obstacles/requirements for a medical home, but for enabling the 1185 Town Centre Drive people who will be supervising and/or doing Suite 101 Your Patients will Eagan, MN 55123 much of the work. We need to be thinking Look Good & Feel Great of how we can help physicians and medical Appointments groups leverage their talent, knowledge and with Beautiful Skin 651-209-3600 resources.

At your request, we have

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MetroDoctors

The Journal of the East and West Metro Medical Societies

same day appointments available for your patients with acute skin care needs.

March/April 2009

5

Feature story

Seeing Red in the 2009 Session

W

hen the 23 new members of the Minnesota House took their seats for the opening gavel of the 2009 Session of the Minnesota Legislature on January 6, 2009, they, and the other 111 members of the House, were seeing a sea of red ink. With one new senator, the 67 members of the Minnesota Senate face, along with their House colleagues, the monumental task of balancing the state’s budget. “This is without question going to be the worst deficit in modern history,” said Senator Dick Cohen, DFL-St. Paul, in the December 4, 2008 Star Tribune. He added, “We’re heading into a terrible storm, and we have nothing left to face it with.”

Governor Tim Pawlenty was forced to cut state spending in December by $271.4 million in order to balance the current biennium’s budget. The shortfall was projected at $426 million and it took the budget reserve of $155 million plus the cuts to balance spending with projected revenues. His major cuts were $73 million to Health and Human Services; $66 million to Local Aids and Credits to Cities; $44 million to Local Aids and Credits to Counties; $40 million to appropriations to the University of Minnesota and to the Minnesota State Colleges and Universities; and $40 million in unexpended operating budgets of state agencies. The governor stressed that he was protecting K-12 Education spending, the military, and veterans.

The deficit facing legislators and the governor in the 2009 Session is projected to be $4.847 billion for Fiscal Year 2010-11. When inflation is factored in that deficit could be a massive $5.5 billion. How will the governor and legislators cope with such a large deficit? First, the governor will need to draft his budget with a very sharp pencil and a keen sense of the state’s spending priorities. In order to present the legislature with a budget that will have a chance of being accepted by the DFL controlled House and Senate, the cuts to programs valued by legislators will need to be viewed as either reasonable or unavoidable.

If history is a guide, the Health and Human Services budget will be hit hard in 2009. In the 2008 session more than 70 percent of the supplementary budget cuts were made to Health and Human Services. At the end of the 2008 Session, the Health and Human Services budget was forecast to be $10.9 billion. The November forecast for Health and Human Services increased $498 million to $11.4 billion. The one state expenditure larger than Health and Human Services is K-12 Education with a projected expenditure of $13.9 billion in 2010-11. While there are many legislators who believe

By Roger K. Johnson

6

March/April 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

K-12 Education should be spared from the budget knife, a deficit of over $5 billion will most likely force disturbing cuts to K-12 Education as well.

Senator Linda Berglin (DFL-61 Minneapolis), chair of the Senate Health and Human Services Budget Division, is adamantly opposed to raiding the Health Care Access Fund and to further cuts to the Health and Human Services budget. Representative Paul Thissen (DFL-63A Richfield), chair of the House Health and Human Services Committee, also expressed strong concerns that cuts to Health and Human Services will fall on the shoulders of doctors and nurses who provide the care to Minnesotans.

Despite their concerns and the concerns of other legislators, the size of the deficit will drive the depths of the cuts to Health and Human Services.

Organizations representing providers such as the West Metro Medical Society (WMMS), the East Metro Medical Society (EMMS), the Minnesota Medical Group Managers Association (MMGMA), the Minnesota Medical Association(MMA), and the Minnesota Hospital Association (MHA) will work hard in the 2009 Session to prevent cuts to provider reimbursements for Medicaid and MinnesotaCare. Despite past legislative action increasing Medicaid funding, MMGMA determined that health plans have not been passing on Medicaid funding increases to providers as the legislature intended.

As a result, physicians have not received an increase in Medicaid reimbursement for 16 years and legislators will be reminded of that during the session.

The Health Care Access Fund (HCAF) currently has a surplus of $166.7 million for FY 2008 and that is projected to grow to $260.3 million for FY 2009. Since Governor Pawlenty has a past track record of tapping the HCAF in order to balance the budget, there is a better than excellent chance that the governor will again use the surplus HCAF monies for budget balancing in 2009. There is also the lingering fear that since the provider tax has been such a successful revenue producer, an increase in the provider tax could be proposed in 2009.

In fact, a leader of the Minnesota Hospital Association proposed a 2 percent increase in the provider tax paid by hospitals if the revenue generated would be returned to hospitals to offset the cuts to hospital reimbursements such as Medicaid and MinnesotaCare. The HCAF is projected to have only a $17.9 million surplus in FY 2013.

It remains to be seen whether or not Senator Berglin, Representative Thissen, and their supporters are able to ensure that the HCAF will be dedicated to funding health care (Continued on page 8)

MetroDoctors

The Journal of the East and West Metro Medical Societies

March/April 2009

7

Seeing Red in the 2009 Session (Continued from page 7)

for low income Minnesotans. Again, the size of the deficit may overwhelm the best intentions of legislators.

Both Commissioner of Health Dr. Sanne Magnan and Senator Linda Berglin have stated that they intend to keep the health care reform initiatives moving forward in the 2009 Session. Of the nine Health Care Reform Work Groups created or to be created, only two actually report to the 2009 Legislature. The Oral Health Practitioner Work Group finished its work in November and will recommend to the legislature that a new mid-level oral health practitioner be approved for licensure to practice at a level between a licensed dentist and a dental hygienist.

Both the University of Minnesota and Metro State will offer programs to train oral health practitioners. The Minnesota Dental Association will not be supporting the recommendations.

The second work group reporting its recommendations to the legislature in 2009 is the Health Workforce Shortage Work Group. The work group’s general principles include: • Encouraging new models of care such as health care homes that support team models of care.

• Using all primary care providers to the highest level of their education and capacity.

• Eliminate regulatory and institutional barriers that prevent advanced practice providers from referring or admitting patients to nursing homes, hospitals, home care, therapies, and other services.

• Develop new financial models and incentives for primary care, family practice, mental health, and related specialties.

8

March/April 2009

Provide payments or reimbursements aligned with the services provided without regard to the type of primary care provider providing the service.

• Attract providers to rural and underserved communities with financial incentives.

• Increase physician production in primary care, family practice, and in related specialties.

• Increase the production of nurse practitioners, other advanced practice registered nurses, physician assistants, clinical pharmacists, and other ancillary professionals.

• Support community partnerships for recruitment and training in underserved and rural areas.

If the legislature elects to enact the recommendations of the Health Workforce Shortage Work Group the following recommendations will be enacted into law: • Provide nurse practitioners, certified registered nurse anesthetists, and clinical nurse specialists the authority to prescribe within their scope of practice.

(The work group cited the difficulty of finding physician collaborators and the minimal level of complaints since advanced practice registered nurses began prescribing.)

• Eliminate the current statutory language defining “collaborative management” as “a mutually agreed upon plan between an APRN and one or more physicians or surgeons that designates the scope of collaboration necessary to manage the care of patients” and revise it to read “a mutually agreed upon plan between an APRN and one or more licensed practitioners for consultation, management, and continuation of care.”

(The work group cited the definition of collaborative management as a •

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•

•

•

•

•

plan between APRNs and physicians as somewhat restrictive and confusing. The report states that “the proposed definition would recognize the ability of APRNs to practice primary care and serve their patients without being managed by any other health practitioner.”)

Allow the supervising physician the authority to determine how many physician assistants a physician may supervise.

(The work group believes the current two to one ratio limits access to care and the members support the model of the American Academy of Family Physicians.)

Pharmacists would have delegated authority to prescribe legend drugs and perform drug therapy management under protocol with licensed practitioners.

(The work group believes allowing pharmacists to modify prescriptions for legend drugs under protocol would enhance patient care.)

Permit advance practice registered nurses and physician assistants to enter into collaborative prescribing agreements with pharmacists under protocol.

(The work group stated that adding APRNs and PAs to the list of practitioners allowed to enter into collaborative agreements with pharmacists would facilitate patient care without compromising patient safety and reflect current primary care practice.)

Physician Assistants would be licensed rather than registered.

(The work group indicated the Board of Medical Practice does not oppose the change and the change would not change the scope of practice or lead to independent practice.)

The remaining recommendations include ensuring that any statutory

The Journal of the East and West Metro Medical Societies

or regulatory modifications supersede obsolete wording to ensure the broadest application; complete a review of applicable and related statutes and rules to ensure they are not in conflict with recommended changes; and ensure that Minnesota’s medical home collaboratives are required to address health professional cultural issues, collaborative team rules, and team skill building.

The Health Workforce Shortage Work Group recommendations will place scope of practice legislation in the forefront in 2009 as this type of legislation comes with a very low price tag for the state budget.

All physicians and clinic administrators will need to follow scope of practice legislation closely in the upcoming session.

The remaining work of the Health Reform Work Groups will be reported later in 2009 or in 2010. The Baskets of Care and Health Care Homes Work Groups report in July of 2009 with the Essential Benefit Set Work Group reporting in October of 2009. Both the Consumer Engagement and the Uniform Claims Work Groups report in January of 2010.

The health care reform work groups are not the only work groups that have been meeting in 2008. Commissioner of Labor and Industry Steve Sviggum convened three work groups and a subgroup to develop recommendations for the Workers Compensation Advisory Council (WCAC) to consider for workers compensation legislation in 2009. The Employer Choice/Health Benefits Work Group is recommending a five year pilot program called the Workers Compensation Collaborative. The pilot will include up to 100 businesses with collective bargaining agreements; up to 200 businesses without collective bargaining agreements; and up to 100 public employers. The Department of Labor and Industry (DLI) MetroDoctors

would administer the program. Alternative Dispute Resolution (ADR) would be used and neutral physician examiners would be used to resolve medical and legal disputes.

One of the most radical changes included in the pilot is the proposed panel of primary care physicians selected by the commissioner who would provide the care to the injured employees. Other recommendations from the Billing and Audit Work Group and the Vocational Rehabilitation Work Group will be considered by the WCAC at its meetings in January and February.

The approved recommendations will most likely be included in the DLI workers compensation bill in the 2009 Session.

Physicians and clinics caring for injured workers will need to closely monitor workers compensation bills in 2009.

Any legislation that carries a budget price tag will likely face a short life expec-

tancy in this session. That can be both good news and bad news for physicians.

One bill, long supported by medicine and by the clinic administrators, requiring health plans to cover the costs of interpreter services has been opposed in the past two sessions because of its costs.

Apparently the costs are acceptable as long as those costs are borne by providers and not by the government or the health plans.

It is likely the same strategy will be used to oppose the interpreter bill in 2009.

On the good news side, any attempts to resurrect the Certificate of Need (CON) process in Minnesota will be met with objections of being too costly, especially in a high deficit budget year. The fact that the program was added to the scrap heap years ago due to its ineffectiveness in controlling health care costs did not deter its supporters from attempting (Continued on page 10)

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The Journal of the East and West Metro Medical Societies

March/April 2009

9

Seeing Red in the 2009 Session (Continued from page 9)

to rejuvenate this failed concept in 2004 and probably will not deter them in the future.

There is one health care legislative issue that has bipartisan support and that is administrative uniformity. The hope is that system cost savings can be achieved by simplifying the process of eligibility, billing and coding, and payment of claims. The Administrative Uniformity Committee has been functioning since 2007 as a work group supported by the Minnesota Department of Health. As this work continues, a Claims Uniformity Work Group, as included in the 2008 Health Care Reform legislation, will be developing recommendations for the legislature that are due in January of 2010.

While some legislators may wish to bide their time hoping for some type of health care reform from Washington,

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D.C., many experts predict that President Barack Obama will have more than enough to do stimulating the economy, maintaining national security, and tax reform. If and when federal health care policy will have a significant effect on Minnesota’s health care system remains to be seen. 2009 will probably not be that year.

Many legislators will be attempting to determine the amount of cost savings that will be generated by the health care reform recommendations coming out of the health reform work groups. They will be asking questions about quantifying the savings for chronic disease management, health care homes, and baskets of care as these concepts of health care reform begin to evolve. The costs of supporting numerous work groups will need to be balanced by how effective the outcomes of those expenditures will be in actual health care cost reductions.

One factor that will be evident in the 2009 Session is the DFL’s lack of a vetoproof majority in the Minnesota House of Representatives. The DFL needs 90 votes to override a Governor Pawlenty veto and they did not achieve that in the 2008 elections. As a result, key budget and other priority issues will require negotiations between the governor and House and Senate leaders. How effective these negotiations will be in a very tough budget year remains to be seen. Politically, the need to be bipartisan may outweigh any temptation to play politics. In tough economic times, voters usually have very little patience with partisan politics.

The leadership in the House remains with Speaker Margaret Anderson-Kelliher (DFL-60A Minneapolis) and Majority Leader Tony Sertich (DFL-5B Chisholm).

Minority Leader Marty Seifert (R-21A Marshall) was also reelected. In the Senate the caucuses did not hold elections. As a result Majority Leader Larry PogemiMetroDoctors

ller (DFL-59 Minneapolis) and Assistant Minority Leader Tarryl Clark (DFL-15 St. Cloud) continue to serve along with David Senjem (R-29 Rochester), the Minority Leader.

One thing is clear, as the budget deficit is attacked and with Health and Human Services being such a large target due to its large piece of the budget pie, physicians will need to make their priorities known early and often. Other key issues will be continuing health care reform, scope of practice, and workers compensation. The unpredictable bill that usually surfaces without fanfare and suddenly becomes a priority could also appear as long as there is no fiscal note attached.

When you decide it is time to contact your state legislator the Web site at www.leg.state.mn.us lists all the contact information for both the members of the Minnesota House and the Minnesota Senate. The Web site also provides you with information regarding the status of legislation and descriptions of all bills introduced during the session. You may also call Senate Information at (651) 296-0504 or House Information at (651) 296-2146.

The governor also has a Web site www. governor.state.mn.us.

The 2009 Session will be historic due to the largest state budget deficit in Minnesota’s history. How the governor and the legislators cope with this deficit and how their decisions affect the long term prospects for Minnesotans will make this session one for the history books.

Roger K. Johnson, Government Relations, Lockridge Grindal Nauen.

The Journal of the East and West Metro Medical Societies

Minnesota’s Health Reform Initiative in 2009: Where We Are and Where We’re Going

A

few months ago, I spent time at a major urban hospital system, listening to the physicians discuss some of their innovations — and obstacles they faced in truly improving patient care. The hospital had developed a successful chronic care center, offering a wide array of services for a diverse group of patients through the coordinated care of a variety of providers.

The center had such solid outcomes that it reduced the number of hospital admissions by a thousand — saving $30 million. While it sounded like a great success story, it also showcased one of the biggest problems in our health care system: Saving that $30 million also meant that the hospital received $30 million less in income from those admissions.

This story is not new; we know the system is broken. We know that it pays dividends for the volume of services provided, rather than for the appropriateness of those services — or for preventing the need for them in the first place. Yet, it is complicated and hard to fix, both in system and culture changes. It is good that physicians are intimately involved in thinking about these problems, and thinking of innovative ways to improve patient care and the value of health care.

Health Reform in Minnesota In 2008 the Minnesota Legislature passed and Governor Pawlenty signed into law major health reform legislation. The groundwork for the bill was built with many groups, including Healthy Minnesota, the Health Care Access Commission work groups and the Governor’s Transformation Task Force on Health Care.

Many physicians helped lead and shape these

By Sanne Magnan, M.D., Commissioner of Health

MetroDoctors

To achieve our goal for all Minnesotans, it is important to target all three aims simultaneously — the triple aim. I often say to people that as costs go up, access goes down; as access goes down, quality goes down; as quality goes down, costs go up. It is a vicious cycle that we must tackle on all fronts on behalf of our patients and our communities.

discussions. The new law addresses several components needed to reform our health care system: • An emphasis on prevention and public health through the Statewide Health Improvement Program (SHIP), targeting tobacco use and obesity.

• Reforms in the way we pay for health care, including baskets of care and a quality incentive system, and improved transparency on quality and costs.

• Creation of health care homes for more patient-centered, coordinated primary care with care coordination payments.

• Exploration of workforce shortage issues, essential benefits, consumer engagement and other health care topics.

These building blocks pave the way to the overarching goal of providing quality, affordable, accessible health care for all Minnesotans.

We have also established aims for our health reform work, and they build on similar work being done by others nationally: • Improve the patient/consumer experience.

• Improve the health of the Minnesota population.

• Improve affordability by decreasing per capita costs in health care.

The Journal of the East and West Metro Medical Societies

Challenging Times There is no question that we are facing challenging times — as a country, as a state, as individuals. During the past few months we, in state government, have worked to close a $426 million deficit in the state budget for the current fiscal year. Our state is now addressing an estimated $4.8 billion shortfall projected for the upcoming biennium.

One of the questions I am often asked is how these financial challenges will affect the implementation of health reform in Minnesota. And my response is always that we are moving forward, full steam ahead. There is still strong legislative and executive support for the implementation of the health care reforms signed into law last May. And in fact, you could argue that it is actually more crucial than ever for us to tackle this extensive health reform.

Between the years 2000 and 2006, health care spending in Minnesota increased more than 60 percent, from $19 billion to more than $30 billion. The 2008 health reform law puts us on the path to achieving significant transformations that will save the system an estimated $7 billion by 2015.

In other words, continuing our work in health reform will actually help our budget situation. These reforms aim to give us better

(Continued on page 12)

March/April 2009

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Health Reform Initiative (Continued from page 11)

value and better quality in our health care. If we can accomplish that — and provide more appropriate, affordable care and improve the patient experience — we will help the state budget. We can also help the state economy by making health care more affordable for businesses, and by improving the health of our workforce.

The urban physicians I met with last year also commented on another challenging note. Not only did they recognize the need for reformed payment incentives, but they also recognized the overlap between public health and medicine, noting that unhealthy diet, tobacco use, and obesity and physical inactivity are three major risk factors for chronic diseases.

When America’s Health Rankings came out in December, our state saw a bit of a decline that pointed toward these “upstream” factors.

While we were still ranked the fourth healthiest state in the nation, it was not as high as we have come to expect — and indicates that we

Big solutions through small incisions

face some challenges. When it comes to health determinants (personal behaviors; community and environment; public and health policies; and clinical care), we ranked fifth overall, which was worrisome because these factors contribute to health outcomes. In tobacco, we are clearly headed in the right direction.

The adult rate of smoking has dropped to a new low of 17 percent, and we now have the fifth-lowest smoking prevalence in the nation.

But we must be vigilant on tobacco since the tobacco industry is constantly looking for ways to sell its product to more Minnesotans, spending an estimated $228 million each year on marketing in Minnesota. On obesity, we are headed in the wrong direction, with a 150 percent increase since 1990.

These trends are one of the reasons why our health reform efforts have gone upstream, to prevent the avoidable health care problems that bring people into the health care system.

Our Legislature recognized the value of prevention, which is why, in the 2008 health reform legislation, lawmakers created the Statewide Health Improvement Program to reduce the

percentage of Minnesotans who are obese or overweight and to reduce the use of tobacco.

A Collaborative Journey Implementing the health reform legislation in Minnesota is a complicated process. To be successful, we need to have unprecedented collaboration between public and private entities.

We also need to have the broadest possible input from a wide range of stakeholders. I have been pleased with the overwhelming response from across the state from many public and private groups — and citizens — who want to be part of this process, and I encourage Minnesotans to participate and make their voices heard.

To build on the expertise of groups that are already working on health reforms, we issued a number of requests for proposals (RFPs) to implement pieces of the legislation.

You can find all the groups that have been awarded RFPs on our Web site (www.health. state.mn.us/healthreform), and they include the Institute for Clinical Systems Improvement, MN Community Measurement, and the

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Minnesota Academy of Pediatrics Foundation in collaboration with a number of other health organizations. Our goal is to bring outside experience and expertise into this process, so that it is a product building on Minnesotan expertise, not just government.

As we move forward with Minnesota’s health reforms, we are enlisting the help of a number of work groups and providing many opportunities for public feedback. I have been pleased at the input physicians have given, especially, as changes being considered will have a lasting effect on the health care system.

One of the areas where we have had robust discussions is in the creation of standards for health care homes. The goal of health care homes is to strengthen care coordination and improve both the patient experience and health outcomes. As the work groups have developed ideas for standards, it has been critical to think about the end goals — the outcomes — and ways to achieve them, while at the same time allowing providers to have enough flexibility to develop approaches that will best serve their patient populations. We have heard many stories of creative ideas that providers are already trying, and we want to make sure there is room for that innovation in health care homes.

We are also in the process of defining baskets of care — collections of health care services designed to treat particular health conditions or episodes of care. The steering committee and subcommittees are in the process of defining baskets of care, providing recommendations about those definitions, recommending quality measures, identifying operational and administrative challenges associated with market adoption of baskets of care, and working to develop solutions to those issues.

Offering these bundled services is a major reform in the way we pay for health care.

Two physicians co-chair this effort with other physicians already involved in that work, and we would appreciate hearing your feedback as the process continues.

This spring, MDH will be soliciting providers’ input for the peer grouping of providers on cost and quality. Physicians’ involvement will be critical to its success.

MetroDoctors

An Eye Toward Federal Reforms As the Obama administration begins in Washington, we are of course keeping a close eye on national health reforms and their potential ramifications here. But we also see our Minnesota reforms as a model for potential federal changes.

We have drawn national interest for our reforms, and my staff and I have presented throughout the country at conferences, meetings and by special invitation. We hope that the Obama administration will look at Minnesota’s innovations as it makes plans for reforms on the federal level. Recently, Governor Pawlenty was asked by the Commonwealth Fund and Modern Healthcare to provide a commentary on Minnesota’s efforts and the examples they might provide as the Obama administration tackles health reform.

Overall, I envision 2009 as a time of change and innovation in health care in Minnesota — and the nation. We have much work to do in a short timeframe, and there is no question that this will be a challenging legislative session concerning the state’s budget.

But I look forward to working with you to achieve important health care reform goals and improve health in our state. Hearing about the experiences of physicians, like those I met with last fall, is an important part of the process. If you have suggestions or thoughts that you’d like to share, please write to me at health.reform@ state.mn.us.

For more information, please visit our health reform Web site at www.health.state. mn.us/healthreform.

Dr. Sanne Magnan was appointed Minnesota Commissioner of Health by Governor Tim Pawlenty on September 28, 2007 and is responsible for directing the Minnesota Department of Health. MDH is the state’s lead public health agency, responsible for protecting, maintaining and improving the health of all Minnesotans.

Dr. Magnan holds a medical degree and a doctorate in medicinal chemistry from the University of Minnesota. She earned her bachelor’s degree in pharmacy from the University of North Carolina.

The Journal of the East and West Metro Medical Societies

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March/April 2009

13

Colleague IntervIew

A Conversation With

Leonard Read Sulik, M.D.

L

eonard Read Sulik, M.D., is the newly appointed Assistant Commissioner of the Chemical and Mental Health Services Administration of the Minnesota Department of Human Services. He attended medical school at the University of Minnesota Medical School and completed the Triple Board Residency Program in Pediatrics, Psychiatry and Child & Adolescent Psychiatry at the University of Kentucky. Prior to assuming the role at DHS, he was the Medical Director of Child and Adolescent Psychiatry at the St. Cloud Hospital/CentraCare Health System in St. Cloud.

Questions were provided by Lee Beecher, M.D., Mary Pohl, M.D., and Thomas Siefferman, M.D.

In your new role as Assistant Commissioner for Chemical and Mental Health Services at the Minnesota Department of Human Services, what is your vision for the Department and the services you oversee in the next four years? What are the main challenges facing the human services department and what do you think should be done to address these?

I have seven goals to achieve Excellence for the Chemical and Mental Health Services Administration of the Minnesota Department of Human Services as well as the state of Minnesota as a whole.

1. We need to eradicate the stigma associated with mental illness and addictions, and correct the misunderstandings and misperceptions.

2. We need to improve access to the right care at the right time for all Minnesotans with a mental illness or addictive disorder.

3. We need to obtain standards of care across all providers that are based on the best evidence and established best practices.

4. We need to integrate our systems of care including primary health care and mental health care, mental health care and chemical dependency care, chemical dependency care and primary care. We need to integrate mental health and addiction care with law enforcement, courts and corrections. We need to integrate these services as well with social services, housing and employment services.

5. We need to improve the efficiency of mental health and addiction care, reducing cost and improving our capacity to serve more indi-

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March/April 2009

6.

7.

viduals. I am not afraid of a goal of reducing cost because I believe if we improve access to the right care at the right time, establish and implement standards of care and if we integrate care, then we will improve our efficiencies and effectiveness dramatically.

We need to promote those activities that improve mental wellness and increase the efforts to prevent mental illnesses and addictive behaviors.

We need to reduce the severe consequences of mental illness and addictions.

You are responsible administratively for a wide variety of state clinical and custodial services. What are your points of reference for judging and evaluating the quality of care provided in these varied venues and settings?

As the Assistant Commissioner of the Chemical and Mental Health Services Administration for the Minnesota Department of Human Services I provide oversight over all of State Operated Services and three policy divisions: Adult Mental Health Division, Childrenâ&#x20AC;&#x2122;s Mental Health Division and the Alcohol and Drug Abuse Division. The State Operated Services consists of a widespread array of services including child and adolescent behavioral health services, adult mental health services, chemical addiction and recovery services, forensics and the Minnesota Security Hospital, neurorehabilitative services, dental services, and numerous community support services totaling over 200 different facilities across the state and about 4,400 staff members. SOS is a public health

MetroDoctors

The Journal of the East and West Metro Medical Societies

care system and establishing the clear identity as a health care system is important in order to identify the specific goals we intend to achieve with the patients under our care. Tracking outcomes across services in a standardized way has begun within SOS in some areas. I intend to see that it becomes standard across the system so that we can continuously measure our own effectiveness in achieving the treatment goals established for our patients. One of the additional goals for this administration is to excite and engage the staff across the entire administration including the three policy divisions and all of state operated services. I believe our employees need to be personally and professionally fulfilled in their work. They need to understand the vision of excellence I have laid out above and see their own individual role in helping to achieve each of these goals in the work that they do. I think this is critical to ensuring excellence in the care provided and I intend to measure staff engagement and fulfillment as we proceed.

There are 10 short length-of-stay Community Behavioral Health Hospitals (CBHHs) located throughout Minnesota. Theses were created within the past five years to replace large Regional Treatment Centers (formerly State Hospitals). What are the CBGHH links to outpatient psychiatric care before and after hospitalization at these short-term hospitals (care continuity)? What is the budget for these facilities and what percentage of their revenue comes from State appropriations, Medicare, Medicaid and private insurance?

Ten Community Behavioral Health Hospitals (CBHHs) have opened in the last several years in Minnesota as each of the large institutions have closed. The opening of these facilities is a logical step in moving away from an institution-based, and “destination-medicine” style of providing care for the seriously mentally ill. We have already begun to plan for an array of services that will allow us to better care for the individuals on the most severe or most complex end of the spectrum which will allow us to step patients down to lower levels of care, decreasing the length of the inpatient hospital stay. In so doing, patients will be at a higher level of stability when they are then transitioned back into the care of their community mental health care providers and/or their primary care providers. I am asking that consultation occurs with the community mental health care providers and the primary care providers as soon as a patient enters our system. Currently most of the budget for these facilities comes from state appropriations. Any revenue generated goes directly back into the state’s General Fund. We are currently working on completing the certification in eight of the 10 facilities, which I hope will be completed in this next year. I have been implementing a plan for coding and billing reform as well so that we can maximize the revenue generated from these hospitals. As the revenue stream improves, the overall state appropriation for these services will be able to be decreased.

The incidence and prevalence of substance abuse among persons with major mental illnesses is very high — 50 percent or more. Given the present separation of funding and programming for mental illness and chemical dependency

MetroDoctors

The Journal of the East and West Metro Medical Societies

services in Minnesota State programs, how will you advise the Commissioner and legislature about integrating mental illness and chemical dependency treatments?

I don’t think the separation of funding is the only factor that contributes to the lack of integration between mental health services and substance abuse treatment services. I think at the level of our policy divisions we can integrate better. We can integrate these services better within all of State Operated Services as well. I believe that primary care physicians need to be better trained and skilled in screening and even intervening with alcohol and drug abuse problems. Integrating mental health and chemical health is part of my fourth goal for excellence for us here in Minnesota. I hope to engage this process of improving integration on the policy and operations side of my administration so that we can influence how effectively this can be done throughout the health care system in our state.

Are there sufficient numbers of psychiatrists and nursing staff in the state system at present? What is your professional workforce recruitment strategy? Is it working?

Within the State Operated Services we do not have enough psychiatrists or child and adolescent psychiatrists. Recent changes within the Department of Human Services have led to significant improvement in compensation and benefits for physicians. My professional workforce recruitment strategy is to develop State Operated Services into an exceptional public health care system that is a model of excellence for other states. I believe strongly that many of us in medicine are drawn to work within centers of excellence. I also see great value in furthering the alliances we already have with the academic medical centers. Finally, there are ample opportunities for collaborative relationships and public-private partnerships that hopefully can expand the recruitment opportunities.

It is getting harder to hire new physicians in downtown practices as they see their production is so low that Medicaid does not even pay our costs! When you factor in the delays in reimbursements, we are going to start seeing a lot of practices stop accepting Medicaid. As this occurs, more Medicaid patients are shoved into fewer offices, ruining their ability to pay their bills, and the Emergency Rooms become overloaded providing outpatient medicine. How should we approach our legislators about this situation?

Our current economic crisis at the state and national level is impacting health care everywhere and will impact us here in Minnesota significantly. Minnesota has already acted aggressively to lower administrative costs through efforts toward administrative uniformity, and DHS has implemented enhanced electronic claims capabilities to ensure rapid payment, but more is needed. Like never before, we need to think creatively about how to best provide quality integrated outpatient care services efficiently and how to reduce unnecessary ER visits and hospitalizations. Our medical community does need to have good data (Continued on page 16)

March/April 2009

15

Colleague Interview (Continued from page 15)

that best depicts the scope of the problems. We need to engage one another to identify and implement new approaches to care that prevent the disparities that exist in medicine currently. Within DHS, I hope to see better integration between the Health Care Administration, the Continuing Care Administration and the Chemical and Mental Health Services Administration all so that we can better use data available to us to understand our health care costs better and hopefully contribute to identifying better strategies of care. I am looking forward to discussions on how we can continue to seek public/private partnerships to meet the demands for access to care that exist.

be creating a barrier to this occurring. I think there may be a role that the psychiatrists within State Operated Services can play in providing consultation to community mental health and primary care providers.

We can possibly develop the ability to provide a consultative service similar to what Massachusetts has done with the Massachusetts Child and Adolescent Psychiatry Access Program. In this program there are child and adolescent psychiatrists available to provide phone consultations with primary care providers and even consultative evaluations of patients as needed. It is worth exploring how to expand the models of primary care-psychiatry collaboration.

There is a legislative mandate for parity in coverage for physical and mental health needs. Is parity measurable so achievement can be determined?

In private practice you were successful in establishing primary care-psychiatrist collaboration in the St. Cloud area. How do you intend to expand this intervention statewide through public programs?

There have been several models of integrating primary care and mental health care here in Minnesota and around the country as well as in Canada. In fact, the Canadian model of collaborative care, known as Shared Care, has several approaches that I was modeling in Central Minnesota over the years. The Diamond Initiative is a collaborative model of care for adults with depression. In Minnesota we do have the ability to bill for consultation provided between psychiatrists and primary care providers, though it turns out to be a cumbersome process and may

In spite of our efforts here in Minnesota to overcome the disparity that exists in mental health care compared to other areas of medicine, we have room to improve. I am hopeful that what the parity bill will do for us here in Minnesota more than anything is help to address the stigma of mental illness and addictions. Minnesota has been further ahead than many other states when it comes to establishing parity at the health plan end. However, there is not parity when it comes to how health plans pay providers for mental health services and the current legislation does not address this issue. I think that will need to continue to be emphasized as we continue to strive for improvements.

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✚ A Medical Home Relationship Connecting Psychiatry and Primary Care

T

he patient-centered medical home has emerged as the cornerstone of health policy reform and is fundamental to quality health care.

The medical profession and Minnesota policy makers have recognized in legislation that patients need a long-term relationship with a primary care provider who knows them well, recognizes barriers to care, and helps to prioritize and coordinate care needs and services.

How does mental health treatment fit into the model of a medical home? This article discusses a collaborative relationship between United Family Practice Health Center (UFP) and Hamm Memorial Psychiatric Clinic (HMPC or Hamm Clinic) to enhance UFP’s ability to serve the mental health needs of their patients within their medical home. In addition, many patients followed at Hamm Clinic are in need of primary medical care. Another objective of this collaboration involves establishing a health care home at UFP for these Hamm Clinic patients.

UFP is a community health center located on West 7th Street near downtown St. Paul.

Its primary goal is to serve as a medical home for patients regardless of their health insurance status. UFP primary care providers, with their two on-site psychologists, have always managed mental health treatment for a very large number of patients. While the prevalence of depression, one of the most common psychiatric disorders in primary care, is estimated to affect 5-10 percent of patients in a typical clinic population, that percentage jumps to 20 percent in an urban poor population such as that served by UFP.

By James J. Jordan, M.D., Mary Androff, M.D. and Jerry Montie, M.D. MetroDoctors

Hamm Clinic, also located in downtown St. Paul, is a non-profit community mental health resource with the mission to provide high quality psychiatric and psychological treatment to a broad spectrum of clientele regardless of ability to pay. Psychiatric consultation and medication management are integral to the clinic’s psychotherapy services. HMPC also offers one-time psychiatric consultation to referred patients as a way to broaden its mission beyond the population the clinic is able to serve in an ongoing treatment relationship.

For better or worse, primary care clinics serve as the de facto mental health system for the majority of patients suffering from psychiatric disorders. Many reasons account for this reality: limited mental health resources and/ or difficulty accessing these services for financial/cultural/language/transportation reasons, stigma, and the somatization of psychiatric disorders. Primary care providers often feel it’s near impossible to arrange for timely outpatient psychiatric consultation. At times the crushing impact of poverty, inadequate resources, or a multiplicity of comorbid medical conditions overwhelm patients’ ability to follow through on receiving treatment in a separate setting.

So we have a situation in which primary care doctors must attend to (at times complex) psychiatric conditions while they also address all other health care needs of these patients.

Given this challenge, it is perhaps not surprising that psychiatric disorders are significantly under-diagnosed and under-treated in the primary care setting.

We also know that good mental health care is pivotal to comprehensive medical care and patient well-being. Studies have shown that the impact of depression on quality of life is greater than that of most chronic medical conditions. Patients with depression visit

The Journal of the East and West Metro Medical Societies

primary care clinics three times more than non-depressed patients and have about twice the medical costs. Every doctor has encountered situations in which depression or another untreated psychiatric condition has greatly hindered or prevented patients from adhering to treatment for a chronic medical condition, diabetes being one good example. Individuals with schizophrenia have a shorter life expectancy and higher rates of many chronic medical conditions. Emerging data suggests that psychiatric conditions can be independent risk factors for medical conditions, such as the connection between depression and coronary artery disease.

Numerous models exist to address the need for increased mental health services in the primary care setting. Many clinics, including UFP, have on-site psychologists and/ or social workers to provide psychotherapy and/or supportive services, and this certainly improves access and quality care for patients.

It is much less common to have easy access to psychiatric consultation. Wayne Katon, M.D. at the University of Washington in Seattle has developed a system of on-site consultation: The psychiatrists see patients in their medical home and are available for further consultation in support of the primary care doctor. One of Hamm Clinic’s psychiatrists, Bob Nesheim, M.D., provides this type of consultative presence at the Duluth Family Practice Center two days a week. A recent Institute for Clinical Systems Improvement initiative, the Diamond Project, utilizes depression screening tools and care managers to monitor the treatment of patients diagnosed with depression in the primary care setting. While a definite improvement over

(Continued on page 18)

March/April 2009

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Medical Home (Continued from page 17)

care as usual, this model does not provide for substantial direct psychiatric consultation.

In early 2008, UFP and Hamm Clinic began to explore a collaborative relationship to address these needs. The model, as it has evolved so far, consists of the following: • A UFP primary care provider or UFP psychologist refers a patient to the Hamm Clinic intake coordinator, providing basic referral information. Patients may already be doing psychotherapy work with an on-site UFP psychologist.

• The patient must then call Hamm Clinic and a psychiatric evaluation and consultation is scheduled with one of the staff psychiatrists. To date, 35 UFP patients have been referred. Of 21 patients scheduled, all but one has come to Hamm Clinic for the evaluation.

• The psychiatrist meets with the patient for an hour long evaluation. The interview covers current concerns, past psychiatric history, medical history, family and social history, and mental status examination.

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A copy of the full evaluation with diagnostic impressions and treatment recommendations is sent to the referring UFP provider.

The patient then follows up at UFP to discuss the recommendations with his or her primary care provider. Together, the patient and primary care provider decide how to implement these recommendations. Ongoing mental health treatment is monitored by the UFP provider. Certain patients may require direct psychiatry monitoring explained below.

The primary care provider is encouraged to seek follow-up psychiatric consultation as needed, either informally (e.g. phone consultation) or the patient could be referred back to Hamm Clinic for a follow-up consultative appointment. The Hamm Clinic psychiatrist would again send impressions and recommendations to the primary care provider at UFP. The patient follows up with the primary care provider at UFP, and ongoing mental health treatment continues to be provided through the patient’s medical home.

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In some situations the UFP primary care provider may request, and/or the Hamm Clinic psychiatrist may recommend, that ongoing mental health treatment be provided at Hamm Clinic. To date, six of the 20 UFP referred patients have started work with Hamm Clinic psychotherapy staff and ongoing medication monitoring is provided by the Hamm Clinic psychiatrist.

This collaborative relationship is one way we attempt to meet psychiatric needs within our community. While this model is still evolving, we have seen early successes through feedback from medical staff at both clinics. The no show rate for the psychiatric evaluations has been very low. This has been a surprise for some of us. Previous attempts at psychiatric consultation within UFP had a very high no show rate. It seems that patients who actually make the call for the consult are motivated.

Perhaps the idea of a one-time visit with the psychiatrist and subsequent implementation of care within the patient’s medical home (UFP) is a preferred model for some primary care patients. This model leverages the patient’s often longstanding relationship with their primary care provider and emphasizes the medical home as a source for comprehensive care for the whole person.

James J. Jordan, M.D. is a psychiatrist and the executive medical director of Hamm Clinic, St. Paul, MN. Mary Androff, M.D. is a staff psychiatrist at Hamm Clinic and also has a private psychotherapy practice in Roseville, MN. Jerry Montie, M.D. is a family physician and the medical director at United Family Practice.

References: Katon WJ, Schoenbaum M, Fan MY, et al. Cost-Effectiveness of Improving Primary Care Treatment of Late-Life Depression. Arch Gen Psychiatry. 2005 Dec;62(12):1313-1320.

Nutting PA, Gallagher K, Riley K, et al. Care management for Depression in Primary Care Practice: Findings from the RESPECT-Depression Trial. Ann Fam Med. 2008 Jan-Feb;6(1):30-37.

Rost K, Pyne JM, Dickinson LM, LoSasso AT. CostEffectiveness of Enhancing Primary Care Depression Management on an Ongoing Basis. Ann Fam Med. 2005 Jan-Feb;3(1):7-14.

Unutzer J, Schoenbaum M, Druss BJ, Katon WJ. Transforming Mental Health Care at the Interface with General Medicine: Report for the Presidents Commission. Psych Svcs. 2000 Jan:57(1);37-47.

Contact: Rita Kieffer 651-224-4930 Rita@HMR.Net

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Pirraglia PA, Rosen AB, Hermann RC, et al. Cost-Utility Analysis of Depression Management: A Systematic Review.

Am J Psychiatry. 2004 Dec;161(12);2155-62.

MetroDoctors

The Journal of the East and West Metro Medical Societies

New Health Care CEOs in Town: William “Bill” McDonough, Named as MMIC President and CEO Editor’s note: Throughout the next several issues, MetroDoctors will highlight several newly named health care executives. Each CEO has been asked to outline his/her vision and challenges for their organization in this ever-changing environment.

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n 2008, Midwest Medical Insurance Company (MMIC) under went a major leadership change while at the same time the country was going through a major financial crisis. The new leadership is providing the company with opportunities to grow and prosper; and fortunately, the financial crisis has had little impact on the company.

Last year, MMIC’s longtime President and CEO Dave Bounk retired.

After conducting a national search, the MMIC board of directors named Bill McDonough its new CEO in June of 2008. Mr. McDonough comes to MMIC with many years of executive experience, most recently as CEO of Princeton Insurance Company in New Jersey.

“To say the financial crisis was a concern to many businesses, particularly those in the financial sector, is a gross understatement,” said MMIC’s new CEO Bill McDonough. “When bonds become risky investments, Chicken Little is not far off the mark. Fortunately, for health care providers in the midwest, MMIC has a diversified portfolio and a strong asset base to withstand market fluctuations like the one that occurred in the last half of 2008. This company, like many others, was affected through its investment portfolio, though its impact in 2008 was modest.”

When asked recently about how professional liability companies are changing in response to changes in the health care community, McDonough stated, “Enormous change is occurring in all aspects of health care, and with change come challenges and opportunities.” Unprecedented opportunities exist for the company to partner with physicians and to help them take advantage of incentives designed to enhance patient safety, he added.

One of the first challenges for Mr. McDonough was to meet with the MMIC board and staff to re-evaluate the mission and vision for the organization given the changing landscape. The company’s mission for 29 years has been about advocating for physicians. “We recognize the challenges physicians are under and believe it is our responsibility to assist them in any way we can.” Reflective of the new direction, the mission statement was modified to read: “To promote and protect the practice of good medicine.”

In this context, “good” means outstanding patient care, which includes everything from clinical competence to patient interaction, to documentation and systems, stated McDonough.

MMIC is starting from an enviable position of being the leading provider of medical professional liability coverage in the upper midwest. However, sometimes success breeds complacency and a major strategic objective for the company will be to enhance the level of service the company provides to drive more value for policyholders. MMIC will strive to become an invaluable business partner to its policyholders and prospective clients. This MetroDoctors

The Journal of the East and West Metro Medical Societies

will manifest itself in a number of ways including using technology to make it easier to do business with us and finding ways to complement the strategic objectives of our customers. Other strategic objectives include delivering sustainable growth and strengthening our leadership role by influencing the practice of good medicine.

One way the company attempts to influence the practice of good medicine is through its focus on patient safety. The company will enhance its services by working closely with our Technology Solutions subsidiary on practice management and Electronic Health Record implementations. As important as it is to optimize the revenue a practice can derive from a system, it is equally as important to make sure a practice reduces risk while enhancing patient safety and patient satisfaction. In addition to performing office assessments, training, education and seminars, the risk management department will be focusing on the potential risks automation can bring along with strategies to avoid that risk.

Another way MMIC attempts to influence the practice of medicine is through its claims process. This function has been a hallmark of the company since its inception. Every claim of significance is reviewed by physicians in those specialties and presented at quarterly claim committee meetings. The findings are communicated to policyholders in a variety of ways to help reduce future risk. In addition, the company takes the position that if the committee feels we can make a reasonable defense, we defend the case. The potential settlement value rarely enters the equation. It is not uncommon to spend a multiple of what a case could be settled for to successfully defend the case. The benefits of this approach to physicians has been demonstrated for years in that it has effectively eliminated cases with little or no merit from being pursued. The effect is that the frequency of claims in the six state territory in which the company operates, is among the lowest in the country, and as a result, the rates are also among the lowest in the country.

Through its subsidiary, MMIC Technology Solutions, MMIC provides EHR software and consulting services to physicians. To help physicians who are thinking about buying EHR systems, Technology Solutions has begun consulting with physicians to answer any questions and concerns they may have about EHRs software, and to ensure proper implementation. In addition, staff are working closely with the company’s risk management department to ensure patient safety standards are adhered to when implementing EHR systems.

“MMIC plans to chart a course deeply rooted in its mission of promoting and protecting the practice of good medicine. As 2009 unfolds, additional challenges are likely to present themselves; however, we will remain diligent and nimble enough to change course as needed,” says McDonough.

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Addressing Pediatric Obesity: “Minnesotans for Healthy Kids” Coalition

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besity, as everyone knows, is a growing problem with a complex, multifactorial etiology. Pediatric obesity is a significant risk factor for adult obesity and shares a similar trend in increasing incidence in Minnesota. The present and future health care burden of this issue is staggering and finding a broad range of solutions and remedies should, in my opinion, constitute a priority for all health care professionals. To do otherwise is analogous to seeing a far-off tsunami approaching the beach upon which you are resting and then simply rearranging your beach chair to capture a better angle of the sun.

A remarkable coalition of health-related groups, headed by the Minnesota Chapter of the American Heart Association, has come together under the title of “Minnesotans for Healthy Kids.” The priority of this group for the last few years has been to encourage the Legislature to address the issue of physical activity and physical education within schools in grades kindergarten through 12th grade. The impetus for this is based upon the current state of affairs in Minnesota: • Minnesota is only one of three states that does not have statewide physical education standards, with any standards currently in place being set at the district level.

• The National Association for Sport and Physical Education (NASPE) has identified Minnesota as one of the “worst states” for physical education.

• The Centers for Disease Control (CDC) and NASPE recommend that elementary

By Peter J. Dehnel, M.D.

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students receive 150 minutes per week of physical education and older students receive 225 minutes per week. As of 2004, only 10 percent of Minnesota schools met these recommended levels.

Based upon a 2007 survey, the majority of Minnesotans agree that physical education should be a daily part of the school curriculum for every grade. Furthermore, most Minnesotans believe that physical activity actually improves academic performance.

“Minnesotans for Healthy Kids” is proposing legislation for the 2009 Legislature that includes the following components: • New legislation would create statewide standards for physical education. School districts would adopt either NASPE or Minnesota Quality Teachers Network (QTN) standards for physical education.

• Reinstate a graduation requirement of one-half credit of physical education in order to graduate from Minnesota’s high schools.

• Require that school districts post their “wellness” plans on each district’s Web site.

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Legislation containing these points passed both bodies of the Legislature in 2008 and was contained in the omnibus education policy bill. This education bill was vetoed at the last minute in May for reasons unrelated to the physical education components. Nonetheless, the physical education components were not enacted by the 2008 Legislature due to the veto.

Preventing and reducing pediatric obesity will obviously require much more than a single legislative act to increase the amount of physical education students receive. On the other hand, it is one thing that can be done with very little expenditure of resources or taxpayer money. It will also hopefully better equip students with lifelong skills to reduce the likelihood of obesity in the future.

As physicians, we can be a very influential voice for initiatives like this with our local elected officials. We can work to address the rising tide of pediatric obesity, but it will be a multi-part solution of which increasing physical education in schools is one part. Your voice, added to the “Minnesotans for Healthy Kids” coalition, will be important to ensure that initiatives like this are successful.

For further information about “Minnesotans for Healthy Kids,” contact the American Heart Association — Minnesota Advocacy Department at (952) 278-7915. You may also e-mail: Rachel.Callahan@heart.org. You can also visit their Web site at www.americanheart. org/mnadvocacy.

Peter Dehnel, M.D. can be reached at: peter.Dehnel@childrensmn.org.

The Journal of the East and West Metro Medical Societies

Robert A. Van Tassel, M.D. Receives 2008 Shotwell Award

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he 2008 Shotwell Award was presented to Robert A. Van Tassel, M.D. at the annual meeting of the Abbott Northwestern Hospital Medical Staff on January 6, 2009. The presentation of this award, which recognizes a member of the community who has made a significant contribution to the field of medicine, was made by Richard D. Schmidt, M.D., chair, West Metro Medical Society.

The Shotwell Award was established

by Metropolitan Medical Center in 1971 in recognition of the philanthropic support and dedication of Mr. and Mrs. James D. Shotwell. The West Metro Medical Society assumed responsibility for selecting the recipient of the Shotwell Award since the closing of Metropolitan-Mount Sinai Medical Center in 1991. The award is funded through the generosity of Abbott Northwestern Hospital and its Medical Staff.

The nomination of Dr. Van Tassel cited the following accomplishments: Board certified in internal medicine and cardiovascular diseases, he is a founder of the Minneapolis Heart Institute and past president of the Minneapolis Heart Institute Foundation. He currently serves as a senior consultant in cardiology at the Minneapolis Heart Institute and as a consulting cardiologist at Abbott Northwestern Hospital. He is a Clinical Professor of Medicine at the University of Minnesota.

Dr. Van Tassel holds 12 patents in the medical device field and has authored and co-authored over 50 scientific publications.

The Shotwell Award, which is not limited to physicians, is presented annually to a person

Robert A. Van Tassel, M.D. is presented with the Shotwell Award from Richard D. Schmidt, M.D., chair, West Metro Medical Society.

within the State of Minnesota. A permanent plaque can be found in the Sister Kenny pavilion, which reads: The Shotwell Award, established in honor of Mr. and Mrs. James D. Shotwell for their contributions to the hospital, is presented yearly for a noteworthy effort in the field of health care.

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A workshop presented by: Steve Finkelstein, C.F.P. and Joel Greenwald, M.D., C.F.P. Saturday, March 28 or Saturday, April 18, 2009 | 9:00 to 11:30 a.m. or Thursday, April 16, 2009 | 6:00 to 8:30 p.m.

Location: Minnesota Medical Association | 1300 Godward Street NE, Suite 2500 | Minneapolis, MN 55413 To register for one of these complimentary workshops, please contact Shari Nelson at 612/362-3725 or snelson@mnmed.org.

Some advisory services are offered through Sterling Retirement Resources.

Registered Representatives offering securities and some advisory services through FINANCIAL NETWORK INVESTMENT CORPORATION Full Service Broker Dealer, Member SIPC Financial Network is not affiliated with Sterling Retirement Resources

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The Journal of the East and West Metro Medical Societies

March/April 2009

21

Joy to My World

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hortly after I received my first service dog, Joy, a beautiful black Labrador Retriever, I decided to test how she would respond if I took a fall. So, with my best acting ability, I proceeded to fall on the floor. Joy ran to get her Frisbee and put it on my head. Obviously, this wasn’t the desired reaction. A few weeks later I tried the same test, and this time not only did she get the Frisbee, she kept hitting me with it while I lay on the floor. Several months later, I did take a hard fall — no acting involved. Joy promptly ran to me, sniffed my face, and then burrowed under my ribcage to help me to get back up. What I learned from this test is that my service dog would respond appropriately when needed; but more importantly, you can’t fool a dog.

I have always loved dogs and treasured their companionship. Yet I never imagined how much a dog would enrich my life until I received Joy. About three years after my diagnosis of amyotrophic lateral sclerosis (ALS), I applied for a service dog through Helping Paws, Inc., located in Hopkins, Minnesota.

Having a slower progression of ALS and still having a strong voice, I felt one of these trained dogs would help me to extend my level of independence.

A service dog is trained to assist those of us with physical disabilities other than sight or hearing. To receive a dog from Helping Paws requires a process that can take years. As with the majority of service dog organizations, you cannot purchase a service dog — it is a qualification process. Eligibility requirements may vary between organizations; however, the qualifications typically include the person’s ability to benefit from having a service dog,

By Kathy Hult

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March/April 2009

financial responsibility (approximately $1,000 per year) to support the veterinary costs, supplies, food and grooming for the dog, ability to provide proper care for the dog and/or to have a backup support system, attendance of training courses and more. For further details of the application process, you can check various service dog organizations’ Web sites, including Helping Paws at www.helpingpaws.org.

Once approved, the person will likely meet with various trained dogs to see if there is an easy bond between the person and the dog. Having been involved with Helping Paws for over six years, I am constantly amazed at how a particular dog is willing to work for one person but not the next. Typically, the dog will communicate their willingness to go with that person by listening to and obeying that person.

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In other words, the dog picks who they want to work for. This process is very important, as the person with the disability and the service dog need to function as a well-oiled team.

Once the match is made, the person receiving the dog will go through three weeks of extensive training with that dog. They will learn the dog’s repertoire of skills/tasks, the cues to direct the dog’s actions, proper nutrition and grooming care, methodology of how the dog was trained, establishing the leadership role and to begin the bonding process. Organizations such as Helping Paws continue to provide training support for the recipient throughout the service life of the dog.

Through the progression of my journey with ALS, Joy has adapted to my needs at each stage. She has been my walking step stool to The Journal of the East and West Metro Medical Societies

help me get up, provided balance for walking or climbing a couple steps, and has hit switches to open doors for me to get through in my wheelchair. As I have grown weaker, she picks up items as small as a dime, rises up on my lap and “hands” them to me. She will bark on cue to get attention or go find someone and bring them back to me if I need additional human help. She is my protector and constant shadow — like having a guardian angel.

It’s not only the specific skills/tasks that help me, but the emotional support. I recently needed an arterial blood draw at a doctor’s appointment. As the technician kept explaining to me that my veins were over the artery which was going to make getting the sample more difficult, I could feel my anxiety rising.

Joy got up from the floor, rested her head on my thigh and chattered at me. I knew exactly what she was telling me, so I forced myself to relax. The moment I did, she lay back down on the floor.

Joy has been a huge emotional support system for me as I’ve transitioned from owning a house to moving in to an assisted living facility. She watches over my every move with loving eyes, comforts me if I’m in pain and cheers me up with her kisses and constant wagging tail. Even though I see myself as a positive person, I am happier and even more optimistic with Joy in my life.

There is a tremendous support system to organizations that provide dogs to people with disabilities. Assistance Dogs International (ADI) is a coalition of non-profit organizations that sets standards and establishes guidelines and ethics for the training, utilization and bonding of human/assistance dog teams. Those of us that have received a service dog through a member of the ADI must pass a public access test as a team. The purpose of this Public Access Test is to ensure that dogs who have public access are stable, well-behaved, and unobtrusive to the public. In addition, the person who is teamed with the dog must have control over the dog and not be a public hazard. This test is in addition to the organization’s specific skill/ task tests for the dogs. More information on ADI and the Public Access Test is available at www. assistancedogsinternational.org.

While Guide Dogs for the blind have been trained formally for over 70 years, the training of dogs to assist people that are deaf MetroDoctors

and physically disabled is a much more recent concept. These types of assistance dogs have been covered since 1990 under the Americans with Disabilities Act (ADA) and have access to public areas where traditionally pets are not allowed, such as restaurants, hotels, retail stores, taxicabs, theaters, concert halls, and sports facilities. The ADA requires businesses to allow people with disabilities to bring their service animals onto business premises in whatever areas customers are generally allowed.

As defined by the ADA, service animals perform some of the functions and tasks that the individual with a disability cannot perform for him or herself. Guide dogs are one type of service animal, used by some individuals who are blind. This is the type of service animal with which most people are familiar. But there are service animals that assist persons with other kinds of disabilities in their day-to-day activities. Some examples include: alerting persons with hearing impairments to sounds; pulling wheelchairs; carrying and picking up things for persons with mobility impairments; or assisting persons with mobility impairments with balance. A service animal is not a pet according to the ADA. There is a recent trend for physicians/ psychiatrists to prescribe a dog for their patients for mental health purposes. A January 4, 2009 article in The New York Times Magazine discusses the current legislation of determining the use of service animals for psychiatric use.

At this time, there is discussion based on equal opportunity whether animals used for mental health purposes will be covered by the ADA, but the jury is still out.

I am concerned that there isn’t an organization similar to the ADI that establishes standards and guidelines for the breeding, training and placement of dogs for mental health purposes. Working with dogs is complex — specific breeds have different temperaments, energy levels and trainability; there are financial costs associated with proper care; the dogs need to be safe and non-aggressive around children, adults and other animals; and training is necessary.

With assistance dogs, there is an approval process in place where an organization would assist in determining if having a dog is a good option for that individual. Is there a similar process in place when prescribing a dog for

The Journal of the East and West Metro Medical Societies

mental health purposes? Attention needs to be given to the animal as well as the patient.

For example, it is extremely important that the person provide leadership to the dog, as dogs are pack animals. Without human leadership, the dog will take over and that is when behavioral problems in the dog frequently begin.

Physicians prescribing dogs to their patients should at least recommend them to take their dog to training classes — at any age of the dog. The Canine Good Citizen Program is a program of the American Kennel Club (AKC) that stresses responsible pet ownership for owners and basic good manners for dogs. Dogs who have a solid obedience education are a joy to live with — they respond well to household routines, have good manners in the presence of people and other dogs, and they fully enjoy the company of the owner who took the time to provide training, intellectual stimulation, and a high quality life. For more information on the Canine Good Citizen Program go to www.akc. org/events/cgc/index.cfm.

The human/animal bond has been a focus of research for decades — with studies showing health benefits including lower cholesterol, lower blood pressure, reduced stress and better mental health for people living with pets.

Pet therapy, primarily used in hospitals and nursing homes, can relax children, adults and the elderly as they talk to and pet the dogs. A current trend is for nursing home facilities to adopt a dog (or cat) to live in the facility to provide daily interaction with residents. In this case, the facility staff ensures the proper care of the animal.

There is no doubt that having a service dog greatly helps the public to see us rather than the disabilities and most people seem to enjoy seeing us together in public. I have a strong desire and commitment for my relationship with Joy to work, which makes us successful. Like all dogs, Joy is loyal, doesn’t care about my appearance, doesn’t hold grudges, and loves me no matter what. Having her at my side is a privilege.

Kathy Hult is a former physical education teacher and marketing executive, living with ALS.

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President’s Message Challenging Times Lie Ahead RONNELL A. HANSEN, M.D.

EMMS Officers

President Ronnell A. Hansen, M.D. President-elect Thomas D. Siefferman, M.D. Past President Peter B. Wilton, M.D. Secretary/Treasurer Anthony C. Orecchia, M.D. EMMS Executive Staff

Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Katie R. Snow, Administrative Coordinator (612) 362-3704 ksnow@metrodoctors.com For a complete list of EMMS Board of Directors go to www.metrodoctors.com.

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March/April 2009

MOST ACROSS THE POLITICAL AND PROFESSIONAL spectrum agree — these are challenging times. Huge budget deficits compounded with an overstretched health care system demand change.

If realistic change is to protect some of the patient/physician relationship, it is critical that individual Minnesota physicians: self-educate, organize, prioritize, and present our concerns to health care policy makers in a well informed and personal manner. Those with interest in a myriad of proposed health policies include patients (constituents), legislators, third party payers, medical corporate structure, nonphysician providers, and physicians — not necessarily in that order, though at times it may seem so.

The concerns we have for our patients and profession are pressing. Make no mistake, the health care policies we must soon create in order to “fix” this will have significant impact. Impact which falls not only upon those whom we care for now, but also upon the new thousands who will find themselves either out of work without insurance, or displaced from previous insurance, and onto state or federal health care programs. Current state and federal programs (Medicaid) are factually known to many of us to be economically unsustainable from an independent medical practice standpoint. Worse yet, these poorly reimbursing programs, for some, appear on the chopping block for deficit reduction — leaving no safety net at all — save the emergency room (not really free care). New health policies will certainly affect us as practicing physicians — so I suggest, as an interested party, we review the facts.

As Dr. Noel Peterson, MMA president, summarized in a recent issue of Minnesota Medicine, physicians have been operating on low reimbursement structures for quite some time. When Dr. James Young of West Metro and I served on the 2007 Reform Pooled Insurance Committee at the Legislature, many members were surprised to learn that physician Medicare Reimbursement Structure was based on a mean cost of service as determined in 1989 minus 10 percent. A 3 percent raise was provided in year 2000. Yes, the state of Minnesota has increased payments to health plans each biennium for Medicaid patients over nine years from 2000 through 2008; however, the health plans only passed on one increase in payments to providers. Historically, low physician payments in Minnesota’s public health care programs include Medical Assistance (MA), General Assistance Medical Care (GAMC), and MinnesotaCare.

In truth, nearly 25 percent of patients have some form of reimbursement that does not cover the cost of providing care, and such programs are not truly viable solutions in the financial equation of many practices. According to 2005 data, 40 percent of Minnesotans were covered by private, selfinsured plans; 27 percent by HMOs, indemnity, or BC BS; 14 percent by Medicare; 12 percent by MA, GAMC, MnCare, and MCHA (high risk); and, 7 percent were uninsured.

To place health care costs in perspective to the financial sector bailout, estimated health spending in 2007 was about 25 percent of total federal spending of $2.7 trillion, or about $675 billion. Entitlement programs make up 56 percent of the budget, vs. only about 10 percent in 1948, and nearly zero before the New Deal of the 1930s. Health care is so costly that about 18 percent of Americans under age 65 lack health insurance. A plausible estimate of duplicative or unnecessary cost (largely driven by demand): about one-third, or $225 billion. For this extra cost, by many measures, we receive no large benefit in national well-being, although we receive comparatively prompt care and few queues.

On some measures, such as breast cancer survival, we do better than many countries; on others, such as life expectancy, we do worse. However, such oft quoted statistics may relate more directly to the manner in which the data was recorded (often different abroad vs. U.S.), and lack of accounting for ethnic differences for any given health care outcome in a given population (such as fetal mortality).

Many well-intentioned in the policy arena espouse virtues of “quality care” and demand “pay-forperformance” (incentives/penalties) without evidence of effectiveness and without consideration to counterproductive effects on a dedicated, well-trained medical workforce. Evidence-based studies do show factors that correlate best with population statistics and patient-centered health outcomes: patient education, and patient financial/cultural/social status. Yes, you read that correctly — poverty and low status are bad for your health. More to follow next issue.

MetroDoctors

The Journal of the East and West Metro Medical Societies

EMMS Annual Meeting

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Metro Medical Society

2008 Community Service Award winner Dr. George Smith and his wife, Christine.

Back Row from left: Robert Weinmann, M.D., George Edmonson, M.D., Alexandra Muschenheim, M.D., Mark Berger, M.D., Kristine King, M.D., Michael Madison, M.D., and Todd Arsenault M.D. Front Row from left: David Eckmann, M.D., Frank Maquire, M.D., Audrey Caine, M.D., Ronnell Hansen, M.D., Christopher Jackson, M.D., Matthew Sanford, M.D., and Susan Truman, M.D.

Peter Wilton, M.D. places the Presidential Medallion around the neck of Ronnell Hansen, M.D.

East

he North Oaks Country Club in North Oaks, Minnesota provided a beautiful venue for the 2009 EMMS Winter Gala and Annual Meeting. The highlights of the evening were the installation of Ronnell Hansen, M.D., St. Paul Radiology, as the 139th president of the EMMS by outgoing president, Dr. Peter Wilton and the presentation of the 2008 Community Service Award to George Smith, Jr., M.D., family physician at the Phalen Village Clinic and the University of Minnesota’s St. John’s Family Medicine Residency Program. Dr. Kent Wilson, president of the EMMS Foundation also addressed the group and offered a challenge to the attendees to help support the EMMS Foundation’s advance care planning project by way of a donation.

Some of the business partners through EMMS’ for-profit subsidiary, Minnesota Physician Services, Inc. attended the meeting and displayed their materials for attendees to peruse. We would like to say a special thank you to AmeriPride Services and SafeAssure Consultants for their sponsorship of the event.

The keynote speaker was Representative Laura Brod (R) 25A. Everyone in attendance enjoyed the excellent dinner and the wonderful entertainment that was provided by the Parisota Hot Club.

Ronnell Hansen, M.D. and his wife, Elisa Hansen, D.O.

Thanks to Outgoing EMMS Board Members Stuart Cox, M.D., past president of EMMS, presents Dr. Peter Wilton with the 2008 President’s Award.

The East Metro Medical Society Board of Directors and staff wish to thank the following outgoing board members. Their time and commitment to the governing board of the East Metro Medical Society has been greatly appreciated.

James Jordan, M.D., psychiatrist from the Hamm Clinic in St. Paul; Robert Moravec, M.D., emergency medicine physician and Medical Director of St. Joseph’s Hospital in St. Paul; Linnea Engel, medical student at the University of Minnesota; Christina Templeton, M.D., psychiatrist at the Hamm Clinic; and Linnea Frank Indihar, M.D., pulmonoloEngel gist and former CEO of Bethesda Hospital in St. Paul.

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James Jordan, M.D.

Robert Moravec, M.D.

Christina Templeton, M.D.

The Journal of the East and West Metro Medical Societies

Frank Indihar, M.D.

Kent Wilson, M.D., president of the EMMS Foundation encourages attendees to support the EMMS Foundation’s advance care planning project.

March/April 2009

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New EMMS Officers Named President Ronnell Hansen, M.D. was installed as the 139th president of the East Metro Medical Society at the EMMS Annual Meeting on January 22, 2009. Dr. Hansen is employed as a radiologist at St. Paul Radiology. Dr. Hansen has been a member of the EMMS since 2000 and has served on the board for a number of years.

He has also served as faculty for the EMMS winter medical conference and been an active member of the EMMS Education Resource Council. Dr. Hansen is married to Dr. Elisa Hansen who is a second year anesthesiology resident at the University of Minnesota. They live in Eagan.

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

Active Bruce J. Bartie, D.O. University of Osteopathic Medicine and Health Sciences, Des Moines Orthopedic Surgery St. Croix Orthopaedics, P.A. Colleen L. Casey, M.D. University of Minnesota Medical School Obstetrics/Gynecology/Reproductive Infertility Reproductive Medicine Infertility Associates Kathryn E. Farniok, M.D. University of Minnesota Medical School Radiation Oncology/Internal Medicine Minnesota Oncology Hematology, P.A. Janene R. Glyn, M.D. University of Texas, Southwestern Medical School Pediatrics Regina Medical Group – Hastings

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PresidentElect Thomas Siefferman, M.D. is a pediatrician with Pediatric & Young Adult Medicine based in the east metro. Dr. Siefferman has served on the East Metro Board of Directors since 2003. He lives in Eagan with his wife, Beverly, and their four children.

Secretary/ Treasurer Anthony Orecchia, M.D. is an allergist/ immunologist in solo practice at Family Allergy & Asthma Specialists in Inver Grove

Heights. He has served on the East Metro Board of Directors since 2004 and as the chair of the EMMS Education Resource Council.

Dr. Orecchia lives in Mendota Heights with his wife, Margaret, and their three children.

Immediate Past President Peter Wilton, M.D finished his term as EMMS president on January 22, 2009. He remains an officer to EMMS for an additional year serving as the immediate past president. Dr. Wilton is a surgeon with St. Paul Surgeons. He lives in Mendota Heights with his wife, Madee, and their four children.

John F. Grehan, M.D. University of Minnesota Medical School General Surgery Cardiovascular Surgeons of St. Paul, Ltd.

Beau G. Reiner, M.D. University of Minnesota Medical School Pediatrics Associated Anesthesiologists, P.A.

Carol J. Johnson, M.D. University of North Dakota School of Medicine Family Medicine/Obstetrics Regina Medical Group – Hastings

Mona S. Roach, M.D. University of Minnesota Medical School Family Medicine Regina Medical Group – Hastings

Kristine E. Knorp, M.D. Creighton University School of Medicine Anesthesiology Associated Anesthesiologists, P.A.

Christopher D. Robert, D.O. Nova Southeastern University Anesthesiology Hennepin Faculty Associates

Julia L. Martin, M.D. University of Minnesota Medical School Family Medicine Regina Medical Group – Hastings

Georgia K. Taggart, M.D. University of Minnesota Medical School Internal Medicine Allina Medical Clinic United Hospitalist Services

Gary A. Moody, M.D. University of Minnesota Medical School Family Medicine Regina Medical Group – Hastings

Kevin S. Wall, M.D., MPH Tulane University School of Medicine Occupational Medicine Park Nicollet Clinic – Minneapolis

David A. Olson, M.D. University of Minnesota Medical School Family Medicine Allina Medical Clinic – Cottage Grove

MetroDoctors

The Journal of the East and West Metro Medical Societies

MPS Vendor Spotlight

AmeriPride Linen Services him at steve.severson@ameripride.org. You won’t be disappointed.

Call for Resolutions: Due Date: Friday, May 8, 2009 Do you have an issue that you would like to bring forward for debate and discussion?

Consider writing a resolution that would then be brought forward to the Minnesota Medical Association at its annual meeting in September. The issue could be regulatory, clinical, related to public health or anything in between. If you have an idea, but are not sure how to get started with writing a resolution, please consider calling the staff at EMMS to ask for assistance. We are here to help you.

A resolution identifies and directs a specific issue for the Minnesota Medical Association to focus their attention on in the coming year(s). When appropriate, resolutions are forwarded to the AMA for national consideration.

Please help us to ensure that your interests are accurately conveyed by contacting EMMS phone: (612) 362-3704; fax: (612) 623-2888; or e-mail: sschettle@metrodoctors.com.

Below are some important dates to add to your calendar: EMMS Caucus This is the venue for discussing your resolution with your colleagues.

NOTE: There will be only one caucus again this year.

Thursday, May 28, 2009 6:00 p.m. – 8:00 p.m.

Bethesda Hospital 559 Capitol Blvd.

St. Paul, MN 55103 7th floor Indihar Conference Room RSVPs are required – to RSVP e-mail ksnow@metrodoctors.com

MetroDoctors

MMA Annual Meeting

September 16-18 Rochester, Minnesota Civic Center If you would like to serve as an East Metro Medical Society delegate or alternate delegate, please contact us at (612) 362-3704, or ksnow@metrodoctors.com.

The Journal of the East and West Metro Medical Societies

Foundation Welcomes New Volunteer East Metro Medical Society Foundation would like to welcome Patrice Katzenmaier, RN, CNOP, as a volunteer helping with the advance care planning initiative.

Patrice will be working as a consultant researching grant opportunities from various foundations in the Twin Cities.

In Memoriam HENRY B. BLUMBERG, M.D., 91, died in his sleep on January 3, 2009. Dr. Blumberg earned his medical degree from Northwestern University Medical School. He served as a doctor in World War II. Upon returning home he practiced internal medicine in St. Paul until his retirement in his mid-fifties. After retiring from medicine, Dr. Blumberg began a real estate management business with his brother, which he never really retired from. He joined EMMS in 1957.

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Metro Medical Society

Greg Linder and Steve Severson.

Doreen Hines’ last day with the East Metro Medical Society was Thursday, February 12, 2009. Doreen served as the Manager of Member Services for EMMS, and as the Assistant Editor for our journal, MetroDoctors. She has been a dedicated employee of EMMS for 27 years and will be missed by staff and the many physicians and their spouses that she has come into contact with during her tenure. Doreen’s never wavering commitment to doing a great job has been the cornerstone of her career at EMMS. Her can-do attitude and willingness to help her colleagues from the east and west metro will be missed, as will her stellar work and attention to detail on our journal, MetroDoctors.

Doreen lives in St. Paul with her husband, Roger. They have a son, Kevin, and a daughter, Stephanie. If you would like to wish Doreen well, please contact the EMMS office at (612) 362-3704 for her contact information.

East

AmeriPride Linen Services has been a longstanding business partner of the East Metro Medical Society through our for-profit subsidiary, Minnesota Physician Services, Inc. AmeriPride offers physicians and their clinics and organizations top quality products at a discounted price due to our relationship with them. They want your business! They offer lab coats, towels, gowns, rugs — you name it. They have what your clinic or organization needs.

AmeriPride is family owned and is recognized as one of the five largest uniform rental and linen supply companies in North America.

Are you unhappy with your current linen service? Would you like to compare prices? Call Steve Severson at (612) 362-0334, or e-mail

After 27 Years, EMMS Says Good-Bye To Doreen Hines

President-elect’s report

Now is the Time for Your Involvement PETER J. DEHNEL, M.D.

AT THE RISK OF SOUNDING too much like an “alarmist,” consider the following analogy:

WMMS Officers

Chair Richard D. Schmidt, M.D. President Edward P. Ehlinger, M.D. President-elect Peter J. Dehnel, M.D. Secretary Melody A. Mendiola, M.D. Treasurer Eric G. Christianson, M.D. Immediate Past Chair Anne M. Murray, M.D. WMMS Executive Staff

Jack G. Davis, Chief Executive Officer (612) 623-2899 jdavis@metrodoctors.com Jennifer J. Anderson, Project Director (612) 362-3752 janderson@metrodoctors.com Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Kathy R. Dittmer, Executive Assistant (612) 623-2885 kdittmer@metrodoctors.com

Imagine floating alone down a rapidly flowing river in a highly unstable canoe. You somehow did not see, or at least did not pay attention to, the signs warning of the 100-foot waterfall just ahead. Your paddle, which was undersized to begin with, was lost a few hundred yards upstream.

Your life preserver floats along side of the paddle, well out of your reach. There is one “safety cable” between you and the falls. The problem is that it is six feet above the water and will require you to stand up in your unstable canoe to reach it. So the question is, what do you do?

Welcome to the new world of Minnesota health care, state budgets, the Legislature and a projected five billion dollar state deficit that will be resolved by June 30, 2011. We are at the point where the Legislature will be making important and consequential decisions about health care and health care policy in Minnesota as a part of their deficit reduction efforts. The “Health and Human Services” budget was a ripe target in 2008 to solve last year’s one billion dollar deficit.

It is even more likely to be a place of significant reductions for the next biennium. In that sense, “the waterfall” is just ahead and we need to do some very quick work to avert the impending fall over the edge. The challenge here is to find a well-anchored “safety cable” on which to grab!

For many of us actively involved in the practice of medicine, we have not had the time, opportunity or inclination to get involved in the legislative process. For some, there may be a certain hesitancy to start doing something that we have not done before and may not feel particularly equipped to start doing. Besides, we are meeting the needs of our patients and becoming involved in “politics” will distract us from the more important work of delivering care. Alternatively, some physicians firmly believe that medicine and politics should not mix because of a whole host of ethical considerations.

I strongly encourage you to look at increased involvement with your local elected officials as a compelling need for your patients and families. Poorly reimbursed state insurance programs, regardless of how “universal” they are, will ironically reduce access to services for people covered by those plans. More hospitals in the state will have to stop participating in programs like Medicaid because they literally have to keep the lights on and their employees paid. “Baskets of care” could mean the end of independent primary care clinics as we know them today. I could go on, but I hope you get a sense that “business as usual” is not an option. Our input is essential for any hope of reasonable solutions to the health care challenges that exist in Minnesota at this time.

Thank you in advance for your participation. Meet with your legislators. Partner with groups like the West Metro and East Metro Medical Societies. It is truly in the best interest of your patients and their families.

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

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MetroDoctors

The Journal of the East and West Metro Medical Societies

Senior Physicians Association

T

Members of the 2009 Senior Physicians Executive Committee are: Edward A. Spenny, M.D., President Richard C. Woellner, M.D., President-Elect SAVE THE DATES West Metro Medical Society Caucus

Wednesday, May 20, 2009 7:00 – 8:30 a.m.

Broadway Ridge Building Lower Level Conference Room D 3001 Broadway Street NE Minneapolis, MN 55413 Minnesota Medical Association Annual Meeting

John E. Kyllo, M.D., Secretary/Treasurer Robert E. Doan, M.D., Past President Harold W. Hanson, M.D., Member-at-Large Kenneth V. Hodges, M.D., Member-at-Large Flora M. MacCafferty, M.D., Member-at-Large For more information about participating in the Senior Physicians Association, please contact Kathy Dittmer at (612) 623-2885 or kdittmer@metrodoctors.com.

Robert E. Doan, M.D., and guest speaker Judith Johnson, B.S.N., M.P.H., Ph.D.

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

he Senior Physicians Association concluded the 2008 season with a presentation by Judith Johnson, B.S.N., M.P.H., Ph.D. on the newly implemented “Doctor of Nursing Practice” curriculum at the College of St. Catherine.

Come join us for the 27th year of the Senior Physicians Association luncheons.

Meetings will be held on the following Tuesdays — April 28, June 9, September 15, and November 10 at the Zuhrah Shrine Center.

2008 Hoban Scholars Selected

S

even master’s degree students were selected as Hoban Scholars and awarded monetary gifts for this honor. The Thomas W. and Mary Kay Hoban Scholarship was established in recognition of the retirement of Thomas Hoban following his 25-year career as CEO of the West Metro Medical Society. H. Thomas Blum, M.D. chairs the selection committee charged with the task of reviewing numerous applications from students pursuing advanced level careers in health care administration or nutrition (Mary Kay’s career).

Seventy-two students have been designated as Hoban Scholars since the award’s inception in 1995.

Civic Center, Rochester, MN

The 2008 recipients are: Meredith Bruening, Master’s, Public Health – Nutrition Eric T. Evenson, Master’s, Health Care Administration Barbara Jacobs, Master’s, Health Care Administration Nicholas Jennings, Masters, Public Health Administration and Policy Yee Ling Mui, Master’s, Business Administration – Healthcare Heather Workman, Master’s, Public Health – Nutrition Azza Zarroug, Master’s, Public Health – Nutrition

Wednesday, September 16 Late afternoon/early evening*

Thursday, September 17 WMMS Caucus – 7:00 a.m.*

Friday, September 19 Joint WMMS/EMMS Caucus – 8:30 a.m.* * Times are tentative

Call for Resolutions

Resolutions should be submitted no later than Friday, May 8.

If you would like “A Guide to Developing Resolutions,” please request a copy from Kathy Dittmer at (612) 623-2885 or visit our Web site at www.metrodoctors.com. Click on “Calendar” in the top right margin, go to September 16-19 and click on MMA Annual Meeting. Below the date you can download these guides.

MetroDoctors

From left: Jack Davis, CEO, WMMS; Paul Bowlin, M.D. Scholarship Selection Committee member; Eric Evenson, Hoban Scholar; Yee Ling Mui, Hoban Scholar; H. Thomas Blum, M.D., Chair, Scholarship Selection Committee; Nicholas Jennings, Hoban Scholar; Meredith Bruening, Hoban Scholar; Darla Morris-Prebles, Scholarship Selection Committee; and Kathy Dittmer, Executive Assistant, WMMS.

The Journal of the East and West Metro Medical Societies

March/April 2009

29

In Memoriam

Welcome New WMMS Members Active Ashfaq Ahmad, MB BS Unity Hospital Hospitalist Bernard C. Baier, M.D. Suburban Radiologic Consultants, Ltd. Diagnostic Radiology Torrey C. Bergman, M.D. Suburban Imaging-Southdale Radiology Nathaniel S. Bowler, M.D. Emergency Care Consultants, P.A. Emergency Medicine Joseph M. Cherian, M.D. Metropolitan Cardiology Consultants, P.A. Radiology Jonathan S. Hokanson, M.D. Emergency Care Consultants, P.A. Emergency Medicine Nicholas C. Johnson, M.D. Emergency Care Consultants, P.A. Emergency Medicine Jacalyn A. Kawiecki, M.D. MHA Courage Center Physical Medicine and Rehab David G. Lang, M.D. Edina Sports Health & Wellness, P.A. Family Medicine/Sports Medicine Guruprasad Manjunath, MB BS Kidney Specialists of MN, P.A. Internal Medicine

Mary D. McLaurin, M.D. Cardiovascular Consultants, Ltd. Internal Medicine/Cardiology Susan L. Meiches, M.D. Physical Medicine and Rehab Scott S. Nielsen, M.D. Suburban Imaging – Maple Grove Radiology Steven S. Roh, M.D. Cardiovascular Consultants, Ltd. Internal Medicine/Cardiovascular Diseases Julie A. Samson, M.D. Park Nicollet Clinic – Carlson Parkway Orthopedic Surgery/Palliative Medicine Retu Saxena, M.D. Cardiovascular Consultants, Ltd. Internal Medicine/Cardiology/Nuclear Cardiology Wendy S. Shear, M.D. Cardiovascular Consultants, Ltd. Internal Medicine/Cardiovascular Diseases Robert J. Sigelman, M.D. West Metro Ophthalmology – Golden Valley Ophthalmology Resident Physicians Ahmet S. Adabag, M.D. University of Minnesota Michael A. May, M.D. Abbott Northwestern Hospital

Visit us at www.metrodoctors.com Find new career opportunities, archive issues of MetroDoctors and information on the latest news, events and legislative issues!

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March/April 2009

IGNACIO E. (DOC) FORTUNY, M.D., 81, died late in 2008. He graduated from Facultad de Ciencias Medicas, Universidad de San Carlos, Guatemala. Dr. Fortuny specialized in Medical Oncology.

N.L. (NEAL) GAULT, JR., M.D. 88, died December 11, 2008 at his St. Paul home. He was adjutant for the United States Air Force Regional Hospital, 1943-1946. He studied at Baylor University College of Medicine and graduated from the University of Minnesota Medical School in 1950. He specialized in internal medicine. Dr. Gault served as dean of the University of Minnesota Medical School, 1972-1984.

DONALD F. GLEASON, M.D., died peacefully Sunday, December 28, 2008 at the age of 88. He graduated from the University of Minnesota Medical School. Dr. Gleason specialized in Pathology-Anatomic/Clinical.

JUSTIN WALKER GOODHUE, M.D., age 30, died in his sleep unexpectedly on Christmas morning. Dr. Goodhue was a fourth year surgical resident at the University of Minnesota. He graduated from Robert Wood Johnson Medical School. He had a wide interest in music, history and arts.

Dr. Goodhue’s most recent satisfying experience was a surgical mission to Honduras.

JOHN E. “JACK” SMITH, M.D. of Edina, died December 31, 2008 at the age of 77. He died peacefully surrounded by his loving family. He graduated from the University of Minnesota Medical School and practiced family medicine with his father and oldest son. Dr. Smith was president of the Minnesota Academy of Family Physicians, Chief of Staff at St. Barnabas Hospital, and a charter staff member at Fairview Southdale Hospital.

NORMAN A., STERRIE, M.D., age 91, died at his home on December 31. He was designated a Naval Aviator in July 1940. His combat awards included the Navy Cross with two gold stars, the Distinguished Flying Cross, and Air Medal with two gold stars. Following active duty, he graduated from the University of Minnesota Medical School in 1949 and practiced in pediatrics, specializing in pediatric allergy at Park Nicollet Clinic until his retirement in 1980. Dr. Sterrie was a talented musician and played a variety of instruments in multiple bands and orchestras.

THOMAS O. SWALLEN, M.D., age 78, died on December 2, 2008 after a lengthy illness. He served in Korea in the Civil Information and Education Program for North Korean prisoners of war. He graduated from the University of Minnesota Medical School in 1959, did an internship at Minneapolis General Hospital, and completed his residency in pathology at the U of M. He then worked for 32 years at North Memorial Medical Center as a staff pathologist. He was Chief of Staff in 1987, and was the first Director of Medical Affairs in 1988. He was also an Assistant Professor of Laboratory Medicine and Pathology at the U of M from 1972-1995. One of his most satisfying volunteer roles was as the founder of the Prostate Cancer Support Group at North Memorial Hospital in 1999.

RICHARD C., WATERBURY, M.D., 69, died on Monday, November 24, 2008 at his home in Georgetown, Texas. He graduated from the University of Iowa College of Medicine in 1965. Dr. Waterbury served in the United States Navy from 1965 to 1972, achieving the rank of Lieutenant Commander. He completed a Fellowship in Pediatric Anesthesiology at Los Angeles Children’s Hospital in 1969. Dr. Waterbury joined the Minneapolis Children’s Medical Center staff in 1972, rising to the position of Chief of Anesthesiology. He was instrumental in establishing the outpatient surgical center, Children’s West, serving as its Medical Director until his retirement in 2000.

MetroDoctors

The Journal of the East and West Metro Medical Societies

allIanCe news DIANNE GAyES

STI/HIV/AIDS Education Folder Project

O

The WMMSA printed 50,000 STI/ HIV/AIDS Education folders (2008 edition) during the first week of December. Almost 7,000 folders had been ordered by Minnesota Public School Health Educators since October of 2008. On December 16, 2008, WMMSA volunteers packed the folders for shipping to

Meaning of Membership

By Michele Khouli

I was drawn to the West Metro Medical Society Alliance (WMMSA) by the unity of warm, compassionate people that have come together from their vast array of backgrounds through an affiliation with the world of medicine. We unite our talents as volunteers and leaders of the communities we serve. We act to support health-related charitable endeavors. We encourage volunteerism in activities that promote health education. I continually look forward to surrounding myself with the remarkable wisdom, creativity and determination of the WMMSA members.

The past months have been fraught with unemployment and economic stress on the people of the Twin Cities and throughout the world. It is critical during this time that we all reach out to make a difference in the lives of under-resourced individuals and families. As a new member, I was impressed to learn about the philanthropic work the incredible women of the WMMSA do in our community: providing a voice for HIV and AIDS prevention in schools throughout the state of Minnesota; providing hats and mittens to needy children; and spending tireless hours advocating for the safety of children.

It is our responsibility to look within ourselves during these difficult economic times and determine if we are going to try to make life better for someone else. As one, we can accomplish many things, but as a group we can accomplish greatness.

The future depends on each of us to lend a helping hand, offer a talent, and share our resources. Sincere thanks to those who have provided guidance and service to this organization throughout the years. Many of you have dedicated your talents and resources in ways that havenâ&#x20AC;&#x2122;t always been recognized. I now look to the future in optimism because I know that together we will continue to provide our services to benefit our community.

Michele Khouli and her husband, Dr. Wael Khouli, in Sydney.

MetroDoctors

The Journal of the East and West Metro Medical Societies

over 100 schools. From July of 1997 to January 2008, the WMMSA has printed 350,000 folders, distributed 307,000 of those folders to Minnesota schools, raised $97,000 for the project and volunteered their time to prepare the folders for shipping to the schools over these past 15 years. The WMMSA remains grateful to the WMMS and WMMF for their support and generosity that they have given and continue to give to the WMMSA STI/ HIV/AIDS Education Folder project.

Trish Vaurio, Mary Anderson, Eleanor Goodall and Diane Gayes packing folders December 16, 2008.

A few of the almost 40 Alliance members at the Holiday Tea: Front: Dianne Fenyk, and Diane Gayes. 2nd row: Mary Anderson, Candy Adams (Immediate Past President, MMAA, and a Lake Superior Medical Alliance member), Marlene Ellis, and Carolyn Linner. Back Row: Trish Vaurio, Linda Wiig (MMAA President and a Lake Superior Medical Alliance member), Kathy Larson, and Peggy Johnson.

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

n December 5, 2008, the WMMSA held its annual Holiday Tea and silent auction at the home of Diane Gayes. Approximately $1,500 was raised for the WMMSA STI/ HIV/AIDS Education Folder project. Alliance members also brought winter mittens, gloves and hats for children in need.

Career oPPortunItIes

Please also visit www.metrodoctors.com for Career opportunities.

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MetroDoctors

The Journal of the East and West Metro Medical Societies

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NATIONAL DOCTORS’ DAY March 30, 2009 marks the 76th anniversary of Doctors’ Day. The setting aside a day to honor physicians on this day is credited to Eudora B. Almond, the spouse of a physician, who suggested that the Barrow County (Georgia) Medical Society Auxiliary recognize the hard work and dedication of the physicians in her community. Since that time, Alliances and health care organizations throughout the nation continue to show their appreciation on this day for the role physicians play in caring for patients, their dedication to medicine, and improving the public health.

The date, March 30, was purposefully selected to commemorate the first use of ether anesthesia in surgery on March 30, 1842 by Dr. Crawford W. Long. The red carnation is the official flower of Doctors’ Day. On behalf of the staffs of the East Metro Medical Society and the West Metro Medical Society,

HAPPY DOCTORS’ DAY MARCH 30, 2009