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Contents VOLUME 11, NO. 3


M AY / J U N E 2 0 0 9

Index to Advertisers Call for Resolutions


The Need for Strong Local Medical Societies: Now More Than Ever! Is it Time for Consolidation? Voice Your Opinion


AMA National Advocacy Conference


Colleague IntervIew

Warren Warrick, M.D.


Minnesota Demonstrates National Leadership in Integrative Medicine By Gregory A. Plotnikoff, M.D., MTS, FACP

Page 9


The DIAMOND Initiative: A First Year Report By Gary Oftedahl, M.D.


PreferredOne By John P. Frederick, M.D.


Health Insurer Code of Conduct? By Catherine Hanson

18 Page 11

Joint Commission Issues Moratorium on National Patient Safety Goal Relating to Medication Reconcilliation By William Jacott, M.D.


Targeting Physician Behavior

On the cover: Introducing the new MetroDoctors Web Forum.

By Elizabeth A. Snelson, Esq.


Helping Your Patients Quit Smoking By Ann Wendling, M.D., M.P.H.


Announcing Web Forum


Electronic Credentialing Application Streamlines Process By Tracey Torgersen


Members in the News

east Metro MedICal soCIety

23 24

President’s Message


Advance Care Planning Project is Proceeding/ MPS Vendor Spotlight: Berry Coffee Company/ Call for Resolutions


New Members

Career Opportunities

Page 6

The Dakota County Smoke-Free Communities Partnership Closes its Doors

west Metro MedICal soCIety

Page 5 MetroDoctors

The Journal of the East and West Metro Medical Societies

27 28 29 30

Chair’s Report New Members West Metro Medical Foundation New Board Members/In Memoriam May/June 2009



Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer WMMS CEO Jack G. 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: 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: 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 Katie Snow at (612) 362-3704.

Mark Your Calendar Call for Resolutions: Due Date: Friday, May 8, 2009 East Metro Medical Society Caucus

West Metro Medical Society Caucus

Thursday, May 28, 2009

Wednesday, May 20, 2009

6:00 p.m. – 8:00 p.m. Bethesda Hospital 559 Capitol Blvd. St. Paul, MN 55103 7th floor Indihar Conference Room RSVP to Katie Snow at (612) 362-3704 or

7:00 a .m. – 8:30 a .m. Broadway Ridge Building Lower Level Conference Room D 3001 Broadway Street NE Minneapolis, MN 55413 RSVP to Kathy Dittmer at (612) 623-2885 or

Minnesota Medical Association Annual Meeting

September 16-18, 2009 Rochester, Minnesota Civic Center

Visit for more information.

May/June Index to Advertisers AmeriPride............................................................. 8 Burnet Birkeland .................Inside Back Cover Crutchfield Dermatology................................21 Family HealthServices Minnesota, P.A. ......32 Healthcare Billing Resources, Inc. ...............16 Lockridge Grindal Nauen P.L.L.P. ................. 7 Mankato Clinic ..................................................31 Midwest Spine Institute ....................................... Inside Front Cover Minnesota Epilepsy Group, P.A....................16 Minnesota Physician Services, Inc. ................... Inside Front Cover The MMIC Group ................................................ Inside Back Cover SafeAssure

........................................................... 21

University of Minnesota CME .......................... Outside Back Cover Wapiti Medical Group .....................................32


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May/June 2009


The Journal of the East and West Metro Medical Societies

The Need for Strong Local Medical Societies: Now More Than Ever! Is it Time for Consolidation? Voice Your Opinion


s your elected leaders, we realize that we are insiders into the work that is being done every day by the East Metro Medical Society (EMMS) and the West Metro Medical Society (WMMS) and the importance of that work to the practice of medicine. We also understand how critical it is to have multiple opportunities for physicians to participate in organized medicine in order to benefit their own practices and to enhance and supplement the work of the MMA and the AMA. Your local county medical societies provide you opportunities to participate by serving as leaders on boards, committees or task forces or by providing a forum for meaningful Richard D. Schmidt, M.D., Ronnell Hansen, M.D., debates and discussions. We also offer opportunities to get involved WMMS Chairman EMMS President in local public and community health efforts. EMMS and WMMS staff and physicians spearheaded metro area efforts to enact secondhand smoke ordinances in some of the largest counties in the metro area that eventually led to the state-wide Freedom to Breathe Act. We are now leading a metro area effort to make known the end of life wishes of patients by working to standardize advance care planning approaches. We have already made significant progress and have engaged the large health systems and health plans in this effort. We are also spearheading a multi-year project that would require Minneapolis restaurants to list caloric counts on their menus. These types of projects are tangible examples of what we do at EMMS and WMMS.

For more than 15 years, the EMMS and the WMMS have developed a collaborative relationship in a number of areas including infrastructure operations (staffing, office space, phone, payroll, computer system and bookkeeping), the MetroDoctors journal, our Web site (, legislative lobbying and monitoring contracts, staffing and management of the Minnesota Provider Coalition, as well as the Minnesota Ambulatory Health Care Consortium and Joint Public Policy Council. The EMMS/WMMS synergy has benefited physician members directly, through economies of scale and shared resources, effectively allowing both organizations to engage in new projects and expand advocacy efforts without significant dues increases. Despite these past efficiencies, the recent downturn in the economy has increased pressure on the resources of both medical societies, requiring a greater than anticipated use of investment reserves to continue focusing on the local medical society efforts. The success of our current collaborative efforts, along with the economic downturn, has prompted us to look seriously at consolidating organizations. Over the last two decades, the combined membership of EMMS and WMMS has gone up and down. Recently membership numbers have been fairly stable. Rather than going to our members for additional dues to deal with inflation-driven cost increases or dipping further MetroDoctors

The Journal of the East and West Metro Medical Societies

into our reserves, the leadership of the two Societies have given serious consideration to consolidating into one metropolitan medical society. With all that we already do together, all that remains to be done is to merge our Boards, consolidate our staffs, and streamline and update our governance. We already have annual joint EMMS/WMMS board meetings and joint executive committee meetings. We jointly work on public health programs — including the recent initiative related to a metro-wide community approach to advance care planning. We have collaborated on our smoke-free projects that have spanned the metro area. We jointly caucus at the MMA Annual Meeting and often co-sponsor resolutions. The impact on our financial wellbeing will help the society get back to living on its dues revenue with the goal of maintaining our current educational, advocacy and public health initiatives without having to increase dues. Over the course of the last nine months, we have discussed the financial realities of both societies openly with our respective boards and executive committee members. We have weighed options and have made some tough choices by way of staff reductions. It’s likely that the CEO of WMMS will be retiring in the not too distant future, which (Continued on page 4)

May/June 2009


Consolidation (Continued from page 3)

presents a fortunate opportunity for both societies to reduce personnel costs by consolidating the executive leadership. We have also had staff take a thorough look at our expenses and cut back in areas that we felt were reasonable. The benefits of consolidating are numerous and are not just economic. We believe that in many ways the needs of physicians in the metro area may actually be improved by giving greater voice to physician issues, enhancing leadership and member recruitment, better coordination of public health issues, and expanded advocacy efforts.

We realize, however, that despite all of the benefits there will be drawbacks and concerns. We recognize that representation on the consolidated governing board must be an important consideration as we strive to preserve the voice of physicians from the respective regions and organizations. Safeguarding the reserve funds of both organizations is also of great importance, and efforts should be made to keep those funds separate. This could be accomplished by maintaining the existing foundations of each organization (see proposed organizational chart below). MMA Trustees are assigned by district and not tied to a local medical society, so our Trustee representation on the MMA board will remain the same. Another area of concern relates to ensuring that

MMA Board of Trustees


East Metro Trustees West Metro Trustees

Governing Board of Directors Executive Committee Advocacy

WMM Foundation

Independent 501(c)(3)

• • • • •

Public Policy Council LGN legislative monitoring contract MN Ambulatory Health Care Consortium MMGMA Government Affairs Committee MN Provider Coalition

EMMS Foundation

Independent 501(c)(3)

Membership Investment Fund Collegiality • WMMS social events • Senior Physicians

Philanthropy Awards/Recognitions • Charles Bolles Bolles-Rogers Award • Shotwell Award • First a Physician Award

• • • •

Outreach activities Membership marketing Medical student & resident activities Metro Hospital Physician Leadership Committee

Communications • MetroDoctors Journal • MetroDoctors Editorial Board • MetroDoctors Web site

May/June 2009

• EMMS social events • Senior Physicians • Advance Care Planning project


• Healthy Eating Minnesota (starts Jan ’09) • Smoke-Free Dakota (ends June ’09) • Advance Care Planning project

Organized Medicine



Local Community-Based Projects

Public Health

• • • •

Boeckman Endowment

Awards/Recognitions • Community Service Award • President’s Award

Continuing Medical Education

EMMS Caucus WMMS Caucus AMA meetings MMA House of Delegates

• Advance Care Planning trainings • Other CME programs


The Journal of the East and West Metro Medical Societies

that there are ample opportunities for physicians to be involved in what would evolve into a larger component medical society. We believe these issues are extremely important, but we don’t believe that they are insurmountable and should not stand in the way of further exploring a consolidated structure. We also realize that other issues or concerns are likely to arise that we have not considered. If you have ideas or want to voice your opinions, we’d like to hear from you. At the end of this article, please look for ways for you to voice your opinion and concerns. There are some differences between the organizations. One relates to our respective reserve accounts. The East Metro Medical Society was given a large endowment that has helped to support the society throughout the years. The West Metro Medical Society has also built a reserve account with earnings that have been used in a similar fashion. Upon implementation of the proposed consolidation, the remaining endowment and reserve accounts will stay with their respective 501(c)(3) foundations to continue the medically oriented philanthropic activities for which they were originally intended (as noted in the chart).

Ways to Voice Your Opinion: • E-mail us:; We want to hear your comments. • Call us: Sue Schettle, CEO of EMMS at (612) 362-3799; Jack Davis, CEO of WMMS at (612) 623-2899. • Attend an open meeting. EMMS: May 21, 2009 at St. Joseph’s Hospital; Carondelet Room; 6 p.m.-7 p.m. WMMS: To be announced. • Visit our new forum at: Elected leaders of EMMS and WMMS will be online to answer your questions or concerns.

Next Steps We want to hear from you about the proposed consolidation. We welcome the opportunity to talk with you in person via the methods listed below. The governing boards of both organizations will make decisions related to a proposed consolidation this summer. If approved, the consolidation could be effective January 2010.

West Metro Medical Society Elected Leaders Richard D. Schmidt, M.D., Chairman Edward P. Ehlinger, M.D., President Peter J. Dehnel, M.D., President-elect Anne M. Murray, M.D., Immediate Past Chair Eric G. Christianson, M.D., Treasurer Melody Mendiola, M.D., Secretary

Signed by: East Metro Medical Society Elected Leaders Ronnell Hansen, M.D., President Thomas Siefferman, M.D., President-elect Tony Orecchia, M.D., Secretary/Treasurer Peter Wilton, M.D., Immediate Past President

EMMS and WMMS Physicians Participate In AMA National Advocacy Conference Several Minnesota physicians had the opportunity to visit with key members of Congress during the recent AMA Advocacy Conference in Washington, D.C. In addition to enjoying dinner with Rep. Betty McCollum (4th District) and her chief of staff, meetings were held with Allison Bowden, Rep. Ellison’s Legislative Assistant (5th District); Sen. Amy Klobuchar and Rep. John Kline (2nd District); Rep. Erik Paulsen (3rd District); and Rep. Tim Walz’s staff (1st District). Front from left: Mark Eggen, M.D. (WMMS), Elisa Hansen, D.O. (EMMS), and Ron Hansen, M.D. (EMMS President). Back from left: Benjamin Whitten, M.D. (WMMS and MMA President-elect); Noel Peterson, M.D. (MMA President), Richard Schmidt, M.D. (WMMS Chair); and Allison Bowden, Rep. Ellison’s Legislative Assistant. Photo Courtesy of Congressman Keith Ellison’s Office.


The Journal of the East and West Metro Medical Societies

May/June 2009



A Conversation With

Warren Warrick, M.D.


arren Warwick, M.D. began his career at the University of Minnesota in 1959 and was appointed full professor in 1978. He is recognized internationally for his expertise in the management and diagnosis of cystic fibrosis. He served as Director of the Cystic Fibrosis Center at the University of Minnesota from its establishment in 1962 until 1999, developing it into one of the largest and most respected CF centers in the country. He now serves as senior advisor. Dr. Warwick is also noted for his expertise in pulmonary physiology and interpretation of pulmonary function. He directed the Pediatric Pulmonary Function Testing (PFT) Laboratory since 1962 and continues to serve as co-director. Dr. Warwick’s research has focused on creating tools to aid in the diagnosis and management of patients with chronic lung disease and is currently studying the basic science related to high frequency chest compression (HFCC).

The medical community and the general public are grateful to you for your seminal work improving the quality of life and longevity for patients with cystic fibrosis. Please tell us how you at the University of Minnesota came to understand the disease and develop innovative lifesaving treatments at a time when the diagnosis held a dire prognosis for the children affected? After two years in the Army, I came back to Minnesota to work with Professor Robert A. Good, M.D., Ph.D., who was my model of a medical scientist. Dr. Good assigned problems to each who came to work with him. He had found that a group of patients with low gamma globulin had cystic fibrosis but they made antibodies normally when immunized. His explanation was that CF children had dry mucus that kept the infected bacteria trapped in the mucus in the lungs and so the immune system was largely protected from the bacteria. I was assigned to find out why. I followed Dr. Good’s analysis that the CF patients had lung infections because their mucus was dry. This meant that CF was not a disease; that it was a problem of dryness. Even the sweat had high concentration of salt because the sweat had too little water. Since CF was dry secretion all the illnesses had to be acquired and were, therefore, preventable. That is what I taught and practiced. We were selected to be one of the first CF Centers based on my research at the clinic. When Dr. Good accepted a position in New York he told me to stay with my patients because I had opened up a notch and I must finish it.


May/June 2009

How did you think up the idea of the “vest” to help improve pulmonary toilet for patients with cystic fibrosis? The initial idea came from a group in Canada who reported that the mucus in dogs’ airways could be mobilized by piston pressures applied to the dogs’ chest. I wrote out a design for a CF patient and gave it to Leland Hansen, my genius who built many things that I dreamed up. This worked but it was tedious, so I asked Lee to make a square waveform to give a longer full pressure cycle. This square waveform was so good that it started the High Frequency Chest Therapy as a new way to treat, even to prevent, many kinds of Chronic Obstructive Pulmonary Diseases.

Your work is recognized as a model for medical care quality improvement, in part because you helped establish and maintain a patient registry for cystic fibrosis cases and treatments. Describe how the registry was created and how patient-specific data from the registry are used as a research tool. The first effective treatment of the dry mucus in the CF lungs was developed by Dr. Matthews, a gastroenterologist in Cleveland. He had patients sleep in a mist all night and claimed a survival of 10 years when the survival of the rest of the U.S. had only two years. At this time, the CF Foundation asked each CF Center to calculate their population of CF patients’ age, health, deaths, etc. At the Seattle CF Club meeting the doctors complained about this reporting and many indicated they did not believe the Cleveland data. I offered that MetroDoctors

The Journal of the East and West Metro Medical Societies

if each CF Center would send me a small amount of data the next year, I would give them their data analyzed as well as the whole United States CF Centers’ data. Dr. Matthews expected to be proved correct and the leaders expected he would be proven wrong. They all voted that the CF Foundation should fund the data and that it should be performed in Minnesota. This analysis proved that Dr. Matthews was correct. All the CF Centers used his mist tents for the next 10 years. This data analysis was so good that over the next nine years we set up registries for Canada and many European countries. Following 10 years of study in the U.S. and more than a dozen foreign countries, the CF Foundation decided that $10,000 was too expensive and canceled our annual grant. The Canadian CF Foundation took over underwriting the cost of calculating the data and, as a result, the next year there were more than 10 national data analyses including the U.S.

Cystic fibrosis was first seen as a disease of children and adolescents, yet now many patients live into their 50s and beyond. What advice do you have for doctors and what are the implications for health care systems regarding treating and co-morbidities for these aging patients?

patient’s “normal” health problems and consulting the CF doctors when the response to the common disease is not having the usual response. The primary care physician often has a better chance to help the CF patient live a normal life and can encourage CF patients to participate in lung-healthy aerobic activities such as track, swimming, cross country racing, hockey, soccer, etc., and singing. Singing has the advantage that it can be done all year, in all weather and other singers will help encourage participation. Primary care physicians also often have an established relationship with parents and can help encourage the CF patient to not smoke or drink.

Identifying the genetic underpinnings of cystic fibrosis poses opportunities and challenges for patient education and screening. Describe the current state of genetic knowledge. Do you have advice for prospective parents? Review the knowledge of recessive genes. There is one chance out of four with each pregnancy having two CF genes and have increased risk of catching the CF associated diseases, that all can catch. Then, that two of four will be carriers and one of four will not have a CF gene. The last three will have normal risks of catching the diseases that the child with two CF genes is at an increased risk of catching.The child with one CF gene has the above risks if he or she marries a person who

The critical change is to stop calling CF a disease. CF is a pattern of health problems because the exocrine cells and organs secrete less water than normal. Every one of the CF associated diseases is preventable and treatable by making the secretion of water normal by the exocrine cells and organs. Several years ago I started, with John Dodge, M.D. from the United Kingdom, the International Study of Aging CF patients. This international organization meets twice a year. We have published one paper about the success in Italy, the United Kingdom and Minnesota. In our only survey of aged patients, we were permitted to ask the age of CF patients only over age 45. We had three reported to be over age 80. I tell every family that their CF child is normal; does not have a disease; and only has Medicine is complicated. So are the laws an increased risk of catching some preventable that doctors, hospitals and insurance common diseases. Time will be needed, using companies have to manage. Lockridge current preventive treatments, to make normal Grindal Nauen is one of Minnesota’s life possible by reducing the risk of catching the leading health care law firms. CF associated diseases to the risk rate of people who have no, or only one, CF gene. Our health care clients are so satisfied Current treatments are complicated and they’ll write us a referral. the treatments tend to make such an impact that many other doctors defer to the CF Center. CF Contact Henri Minette or Eric Tostrud Center doctors usually assume that the primary care physician has transferred all the health care to the CF Center for that patient. I believe that the primary care physician should be a major member of the health care Integrity • Loyalty • Exceptional Service team of the CF patient, supervising the CF

(Continued on page 8)




The Journal of the East and West Metro Medical Societies

May/June 2009


Colleague Interview (Continued from page 7)

also has one CF gene. If the child marries a person without a CF gene, each child has a 50 percent chance of having a CF gene. Anything more complicated should be referred to the CF Center’s genetic counselor. CF genes can be identified by newborn screening and special genetic testing. The parents are taught that each pregnancy has a 25 percent chance of having a child with two CF genes. I recommend that after the child is diagnosed they should wait two years before they consider having another pregnancy, and to use those two years to find if they could take care of two patients with CF. If they answer yes, I tell them to go ahead and that no one can criticize their decision. If they don’t know, I recommend that they wait another year until they can answer yes.

What records did you keep on your CF patients and how did they help you improve your practice? There were four sheets to the medical record — the original and three copies. The original sheet became the medical record. The second page went to the referring doctor. The third went to the family/patient.The fourth went to my office record for use by nurses in the CF Center Office.This kept every person informed about what had happened, what we found, what we prescribed and what changes, if any, were recommended.

Why do you want your patients to have copies of your notes from their medical records? The challenges of CF problems, the details of the treatments, the possible complications from the medicine plus the information that the CF assistants want the patient and family to remember, are easy to forget. The sharing of the medical record helps to solve such problems and confirms that the patient and the family are members of the team to prevent the CF associated diseases with the goal of living normal lives.

What items of advice do you have for President Barack Obama regarding health care funding reform? After having worked as a doctor in the Army (drafted) for two years and having seen the health care in Canada, England, Denmark, Sweden and France, I believe that a federal run health care program should be President Obama’s target.

Our very best wishes to you. We are curious as to how you spend your days now. What advice do you have for maturing doctors to keep sharp mentally? While I am not seeing patients, I still talk to patients when they call, write or e-mail with questions. I always direct them to discuss my reply with their CF doctor and so to teach their CF doctor what I believe will help them take better care of their other patients. I sometimes get feedback that their CF doctors have started using my recommendations for all of their patients. I work full-time writing and working on the high frequency chest compression technology to increase the water secretion of the exocrine system tissues and organs so that the CF associated morbidities will occur no more frequently than will occur in people who do not have two CF genes. My advice for maturing doctors is to read a lot, write a lot, exercise daily and have fun. Do not gain weight, sleep eight hours a night and keep up your interest in medicine because you may be asked questions and, in an emergency, you may be the only person able to help. 8

May/June 2009


The Journal of the East and West Metro Medical Societies

Minnesota Demonstrates National Leadership in

Integrative Medicine President Barack Obama has stated that health care is “one of the greatest threats, not just to the well-being of our families and the prosperity of our businesses, but to the very foundation of our economy.” There is much discussion now about refocusing on prevention and wellness and moving from a sick care system to a health care system. Minnesota’s leaders in integrative medicine are contributors to this national conversation. This article describes Minnesota’s leadership in both research and clinical activities and coincides with Minnesota’s hosting this month (May) of the world’s

foremost integrative medicine research conference. Institute of Medicine’s Summit on Integrative Medicine

In February, 2009, the National Academy of Science’s Institute of Medicine convened a summit on Integrative Medicine where distinguished scientists, leading clinicians, top policy experts and industry leaders articulated principles and practices from integrative medicine that could inform effective health care reform in the Obama administration. Integrative medicine is an approach to health care that places the patient at the center of care, focuses on prevention and wellness, and attends to the physical, mental and spiritual needs of the person. “What we have now is a ‘sick care’ system that is reactive to problems,” said Ralph Snyderman, M.D., Chancellor Emeritus, Duke University School of Medicine and Summit chair. “The integrative approach flips the system on its head and puts the patient at the center, addressing not just symptoms, but the real causes of illness. It is care that is preventive, predictive and personalized.” The 600 plus participants at the Summit discussed how advancing technology is finally allowing health professionals to understand the mechanisms by which many integrative medicine interventions, such as mind-body medicine and

nutrition, actually work. For example, research by Jeffery Dusek, Ph.D., research director of the Penny George Institute, has demonstrated clinically significant gene expression changes with just eight weeks of relaxation response changes. The use of new technologies such as genomics means that new evidence is compelling. International Integrative Medicine Research Conference in Minnesota

Such research will be highlighted this month, May 12 – 15, when Minnesota hosts one thousand of the world’s leading researchers on integrative medicine at the North American Research Conference on Complementary & Integrative Medicine. This conference is sponsored by the Consortium of Academic Health Centers for Integrative Medicine with support of the National Institutes of Health. This is a follow-up to the very successful first conference presented in Edmonton, Alberta, Canada in May 2006, which was itself the third in a series of international meetings initially co-sponsored by Harvard Medical School and the University of California, San Francisco. This conference will provide a single event that attracts a critical mass of cutting-edge, peer-reviewed science and discussion in the broad field of complementary and integrative medical research. This conference will also showcase Minnesota’s many programs in integrative health including: Abbott Northwestern’s Penny George Institute for Health and Healing, HealthEast’s Woodwinds Campus, Hennepin County Medical Center’s Alterna-

(Continued on page 10)

By Gregory A. Plotnikoff, M.D., MTS, FACP


The Journal of the East and West Metro Medical Societies

May/June 2009


Integrative Medicine (Continued from page 9)

tive Medicine Clinic, Minneapolis Children’s Integrative Pediatric Clinic, Northwestern Health Sciences University’s Clinics and the University of Minnesota’s Center for Spirituality and Healing. Minnesota’s Academic Leadership in Integrative Medicine

Ten years ago, the University of Minnesota was one of seven medical schools with substantial integrative medicine programs that came together to form the Academic Consortium for Integrative Medicine. Today, 42 academic health centers, including those at Harvard, Duke, Johns Hopkins, and the University of California as well as the Mayo Clinic, have integrative medicine initiatives. Requirements for membership include active teaching and research programs plus substantive evidence of institutional support. [source: http://www.] One of the founding schools, the University of Arizona, has trained over 400 physicians, nurse practitioners, and medical residents, many of whom are now leading their own programs at other institutions in this country and around the world. They are expanding their trainings as quickly as they can, because demand for their graduates is increasing rapidly. The University of Minnesota’s residency program in family medicine at Hennepin County Medical Center has partnered with the University of Arizona as one of eight pilot sites for advanced training in integrative medicine. This training includes an additional 200 hour web-based curriculum to prepare residents to

Visit us at and To find new career opportunities, past issues of MetroDoctors and information on the latest news, events and legislative issues!


May/June 2009

counsel on nutrition, dietary supplements, herbal medicines and mind-body skills development. Minnesota’s Clinical Experience in Integrative Medicine

Recently, in testimony before the United States Senate Committee on Health, Education, Labor, and Pensions, integrative medicine physician Mark Hyman, M.D., reported that the University of Minnesota’s Anne Kelly, M.D. had developed a model of care based on integrative nutrition principles called the U Special Kids program. It was for the 5 percent of the sickest children who generated 60 percent of the total costs, mostly from unplanned hospitalizations. In one year, the costs incurred by that population dropped from $4 million to $250,000, or more than $50,000 per enrollee, or a 16-fold decrease in costs. Regretfully, the program was cancelled in November 2008 after one year because less than 10 percent of the high science, low tech, and high touch approach was reimbursable. This speaks to the incredible challenges in re-structuring financing and financial incentives to prioritize health care rather than sick care. At Abbott Northwestern, site of the nation’s largest hospital-based integrative medicine program, such cost effectiveness research is underway. The inpatient integrative medicine consult team which receives consults daily for non-pharmacologic treatment of pain, anxiety, insomnia, nausea, agitation, etc. recently surpassed its 50,000th patient visit. The George Institute has documented that for the first 43,726 visits, integrative care consults resulted in reduction in pain or anxiety symptom scores of at least 50 percent in greater than 60 percent of patients. In one third of patients, symptom scores were reduced to zero on a 10 point scale. This inpatient integrative medicine consult service was the subject of a case study conference in March, 2009 by medical, public health, and business leaders convened by Harvard University’s President Faust at Harvard’s Advanced Leadership Institute. Also at the Penny George Institute for Health and Healing, resilience training, an eight week group-based program for persons with chronic depression based on the Chemistry of Joy by Henry Emmons, M.D., is demonstrating powerful results. Without use MetroDoctors

of pharmaceuticals, but with the use of dietary supplements, exercise and mind-body skills training, mean PHQ-9 scores plunged from 12.3 to 3.6. More than 65 percent of participants have achieved remission (PHQ-9 scores less than 5) during this program. Long-term follow up is underway. The Future of Integrative Medicine

Last year, $2.1 trillion were spent in this country on medical care, or 16.5 percent of the gross national product, and 95 cents of every dollar were spent to treat disease after it had already occurred. In fact, as Mehmet Oz, M.D., testified before Congress, Americans spend twice as much as Europeans for health care in part because Americans as a people are twice as sick as Europeans. This is due in part because of our chronic disease burden. Heart disease, diabetes, prostate/breast cancer, and obesity account for 75 percent of our health care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle. Who will catalyze the motivation for self-care? Which health professionals will be trained in interventional nutrition? Exercise programs? Mind-body skills development? More than ever before, we physicians, as advocates for the public’s health, have a responsibility to articulate the proper transformation from a sick care system to a health care system. This will likely require teams of health professionals led by physicians literate in both high tech care as well as low-cost, low-tech fundamentals for health. We have every reason to believe that Minnesota will be at the forefront of such efforts. Gregory A. Plotnikoff, M.D., MTS, FACP, medical director of Abbott Northwestern Hospital’s Penny George Institute for Health and Healing, is a board-certified internist and pediatrician who has received international honors for his work in cross-cultural and integrative medicine. He is a graduate of Carleton College, Harvard Divinity School, and the University of Minnesota Medical School. Dr. Plotnikoff is well known for his work in interventional nutrition, herbal medicines and spirituality in clinical care. He has additional training as a hospital chaplain, in medical acupuncture, in mind-body skills and as a practitioner of Traditional East Asian Medicine. The Journal of the East and West Metro Medical Societies

The DIAMOND Initiative: A First Year Report Abstract: This article describes DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction), a program launched by the Institute for Clinical Systems Improvement (ICSI) in March 2008. DIAMOND changes how treatment for patients with depression is delivered and paid for in the primary care clinic. Background on the program’s development and an explanation of how the program works is presented. Initial results of patients enrolled in the DIAMOND program for at least six months shows a 43 percent remission rate. Other measurement data is included, as is an update on the current status of the DIAMOND initiative in Minnesota. Why DIAMOND was Developed According to the National Institute of Mental Health, severe depression affects about 8 percent of the U.S. population1, and is the leading cause of disability for ages 15-44. These numbers suggest roughly 415,000 Minnesotans may struggle with this debilitating disease. Adults suffering from depression make up one of the most underserved groups in our health care system. However, primary care providers treat about 75 percent of the patients with depression. A study published in the Journal of the American Medical Association found that primary care providers detect only 35-50 percent of adult patients with major depression. Only about half of these patients get treated, and just 20-40 percent of treated patients show substantial improvement within 12 months of diagnosis2. This is in part because more than 80 percent of them have an additional health condition or disease 3, and priBy Gary Oftedahl, M.D. MetroDoctors

mary care physicians are usually better trained to address physical versus mental health problems. The burden of this gap in care affects not only the patients who experience poor outcomes, but also employers. Employers collectively lose $44 billion per year in productivity2. One third of the economic burden of depression is direct treatment costs; two-thirds is lost productivity and disability2. Research identified multiple barriers to good depression treatment in the primary care clinic. Obstacles ranged from technical problems like unclear medical coding of depression services, to cultural challenges like primary care physicians’ unease in discussing mental health issues with their patients. Well-defined diagnostic criteria were not used. Follow-up care for depressed patients was hit or miss. And physicians who spent extra time serving their patients with depression typically were not compensated for their additional care. These multitude of factors convinced ICSI to try to develop a new model for treating patients with depression in primary care. In formulating the model, ICSI convened a steering committee with members representing medical groups, psychiatrists, health plans, purchasers, patients and the Minnesota Department of Human Services. Committee subgroups focused on care delivery, funding, measurement and integration with mental health services. Care Practice Redesign ICSI first conducted extensive research on existing care models. These included Wagner’s chronic care model for overall redesign of care delivery4, as well as a review of 37 controlled trials specifically looking at collaborative approaches to depression care (full bibliography is available at www. Many of these trials indicated that by integrating care managers and mental health professionals into primary care, outcomes of patients with depression are improved.

The Journal of the East and West Metro Medical Societies

Of all the trials examined, the most comprehensive were the work of Wayne Katon5, and by Jürgen Unützer, both of the University of Washington. The latter’s IMPACT6 model became the basis for the DIAMOND program. IMPACT offered a scientifically sound conceptual framework, an established training program, and alignment with ICSI’s goal of seeking evidencebased, collaborative, measurable and actionable solutions. ICSI’s DIAMOND model adopted the following six components of the IMPACT study: • Use of a validated screening tool — the PHQ-9 — for assessment and ongoing management of depression. • A patient registry for systematic monitoring and tracking. • Use of evidence-based guidelines and a stepped-care approach for treatment modification or intensification. • Relapse prevention plan for patients ready to move out of the care management program. • Care manager role for a clinic staff person who educates, coordinates and troubleshoots services for patients with depression. • Consulting psychiatrist role that serves as a liaison to the care manager for consultation and caseload review. (Continued on page 12)

May/June 2009


DIAMOND Initiative (Continued from page 11)

DIAMOND in Action Before a clinic can offer DIAMOND, it has to complete an operational readiness assessment, hold collaborative team meetings, help train staff, build the infrastructure for the program’s components, and agree to data submission. Certified DIAMOND clinics hire care managers, usually with nursing or mental health care experience, to help patients with education, self-management support, stepped therapy, primary care-mental health care coordination, and relapse prevention. The care manager uses telephone calls, e-mails and/or face-to-face meetings with the patient. These contacts occur more frequently than is feasible for office visits with the primary care physician. The care manager

typically contacts the patient on a weekly basis. As the patient improves, contact is scaled back. ICSI trains care managers on all aspects of the program, from using the PHQ-9 and the patient registry to assess and track patients’ progress, to knowing when to engage the consulting psychiatrist and primary care physician. The consulting psychiatrist, in collaboration with the care manager, reviews the clinic’s DIAMOND patient caseload weekly and recommends changes in treatment for patients who are not improving. The primary care physician makes all final treatment decisions and initiates changes to patient treatment plans. Recommendations from the consulting psychiatrist could include changes to medications or referrals to mental health specialists. Psychologists, social workers, and other mental health providers continue

to play a key role. Patients may be referred for therapy and other services as part of their treatment plan. In this way, DIAMOND helps ensure that patients requiring behavioral health expertise are more apt to get to specialists, while those that can be helped in primary care receive the evidence-based level of care known to get results. Care Payment Redesign The DIAMOND program could not have been implemented without also reforming payment because the care manager and consulting psychiatrist roles and services were not reimbursable under the Minnesota fee-for-service system. Four years of data from the IMPACT study indicated that while health plan costs for coverage increased the first year, after four years there was a $3,330 savings in overall health care costs

PHQ-9 — Nine Symptom Checklist Patient Name


1. Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and circle your response. a. Little interest or pleasure in doing things Not at all Several days

More than half the days

Nearly every day

b. Feeling down, depressed, or hopeless Not at all Several days

More than half the days

Nearly every day

c. Trouble falling asleep, staying asleep, or sleeping too much Not at all Several days More than half the days

Nearly every day

d. Feeling tired or having little energy Not at all Several days

More than half the days

Nearly every day

e. Poor appetite or overeating Not at all Several days

More than half the days

Nearly every day

f. Feeling bad about yourself, feeling that you are a failure, or feeling that you have let yourself or your family down Not at all Several days More than half the days Nearly every day g. Trouble concentrating on things such as reading the newspaper or watching television Not at all Several days More than half the days

Nearly every day

h. Moving or speaking so slowly that other people could have noticed. Or being so fidgety or restless that you have been moving around a lot more than usual Not at all Several days More than half the days Nearly every day i. Thinking that you would be better off dead or that you want to hurt yourself in some way Not at all Several days More than half the days Nearly every day 2. If you checked off any problem on this questionnaire so far, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not Difficult at All Somewhat Difficult Very Difficult Extremely Difficult Copyright held by Pfizer Inc, but may be photocopied ad libitum 12

May/June 2009


The Journal of the East and West Metro Medical Societies

with IMPACT7. Health plans and medical groups collaborated to create a new payment model to reimburse participating medical groups. They had to determine such things as what specific services would be covered, what patients would be eligible, how long patients would remain in the program, and how participating medical groups would be reimbursed. The bundle of services covered under DIAMOND program includes: care manager services — patient tracking, use of the registry, contacts with patients in the program, administration and use of the PHQ-9, and relapse prevention visits with the patient; and consulting psychiatrist services — weekly consultation with the care manager and case review.

The program defined patient eligibility as: adults, age 18 and older; diagnosis of major depression or dysthymia with any of three diagnosis codes — 296.2x, 296.3x and 300.4x, and a PHQ-9 score of 10 or above. Coverage of service was for 12 consecutive months. A single billing code, useable only by certified DIAMOND sites, was established. Each health plan and medical group negotiated the specific fee to be paid to avoid any violation of anti-trust law. Measurement Program measurement includes collecting of process and outcome measures, including patient enrollment, the number of PHQ-9s administered, patients in remission, and patients responding to

treatment at six and 12 months. ICSI’s measures are aligned with MN Community Measurement’s depression care quality measure, which is reported publicly and is being used by the Buyers Health Care Action Group (BHCAG) in 2009 to make awards to both providers and behavioral health physicians through the Bridges to Excellence pay-for-performance program. In addition, the National Institute of Mental Health (NIMH) has awarded HealthPartners Research Foundation a $3 million grant to study the DIAMOND initiative over five years. The study will evaluate all aspects of DIAMOND, (Continued on page 14)

PHQ-9 — Scoring Tally Sheet Date

Patient Name

1. Over the last 2 weeks, how often have you been bothered by any of the following problems? Read each item carefully, and circle your response. Not at all 0

Several days 1

More than half the days 2

Nearly every day 3

a. Little interest or pleasure in doing things b. Feeling down, depressed, or hopeless c. Trouble falling asleep, staying asleep, or sleeping too much d. Feeling tired or having little energy e. Poor appetite or overeating f. Feeling bad about yourself, feeling that you are a failure, or feeling that you have let yourself or your family down g. Trouble concentrating on things such as reading the newspaper or watching television h. Moving or speaking so slowly that other people could have noticed. Or being so fidgety or restless that you have been moving around a lot more than usual i. Thinking that you would be better off dead or that you want to hurt yourself in some way Totals 2. If you checked off any problem on this questionnaire so far, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not Difficult at All 0

Somewhat Difficult 1

Very Difficult 2

Extremely Difficult 3

Copyright held by Pfizer Inc, but may be photocopied ad libitum MetroDoctors

The Journal of the East and West Metro Medical Societies

May/June 2009


DIAMOND Initiative (Continued from page 13)

including patient satisfaction, productivity, and program cost-effectiveness. Launch and Initial Patient Results In addition to the 10 Minnesota primary care clinics that launched DIAMOND in March 2008, another 20 clinics began offering DIAMOND last September, and 18 more launched the program March 1, 2009. Additional clinics will come on board every six months until roughly 90 clinics are scheduled to offer the program in 2010. To date, more than 1,300 patients have been enrolled into the program. Of those that have been enrolled for at least six months (results did not start being collected until October, six months after launch), 183 have been contacted. Of those, 43 percent were in remission. An additional 10 percent of the 183 enrollees showed at least a 50 percent improvement in their PHQ-9

scores. These results exceed the “stretch” goals set by the ICSI DIAMOND Steering Committee for patient outcomes. ICSI and the participating clinics continue to learn from the new DIAMOND model. Best practices, such as how to make the primary care provider to care manager handoff to increase the number of patients opting in the program, are shared among existing and new DIAMOND clinics coming on board. Clinics are determining the size of patient caseloads that a care manager can handle. As the DIAMOND program completes its first year, it has proven in a real world setting that the collaborative care model indeed significantly improves the outcomes of patients with depression in the primary care setting. Continuous improvements with the model and the spread of DIAMOND to more clinics will help determine just how much impact the program will have in managing patients with depression in Minnesota in 2009 and beyond.


The Numbers Count: Mental Disorders in America, National Institute of Mental Health 2004 data. Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, JA, Walters, E E, and Wang, PS. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA, 2003. 289 (23): 3095-3105. Kessler RC, Chir WT, Demler O, Walters EE. Prevalence, severity and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry, June 2005, 62(6):617-27. Wagner EH. Chronic disease management: What will it take to improve care for chronic illness. Effective Clinical Practice, 1998: 1(1):2-4. Katon W, Robinson P, Von Korff M, Lin E and Bush T. A multifaceted intervention to improve treatment of depression in primary care. Arch Gen Psychiatry, 1996. Unutzer J et al. Collaborative care management of latelife depression in the primary care setting: a randomized controlled trial. JAMA 2002, 288:2836-2845. Unutzer J, Katon WJ, Fan M-Y, Schoenbaum, MC, Lin, E.H.B., Della Penna RD, and Powers D. Long-term effects of collaborative care for late-life depression. The Amer. Journal of Managed Care, Feb. 2008, Vol. 14:95-100.

Gary Oftedahl, M.D., is Chief Knowledge Officer for the Institute for Clinical Systems Improvement.

How to Score PHQ-9 Scoring Method For Diagnosis

Major Depressive Syndrome is suggested if: • Of the 9 items, 5 or more are circled as at least “More than half the days” • Either item 1a or 1b is positive, that is, at least “More than half the days” Minor Depressive Syndrome is suggested if: • Of the 9 items, b, c, or d are circled as at least “More than half the days” • Either item 1a or 1b is positive, that is, at least “More than half the days”

Scoring Method For Planning And Monitoring Treatment

Question One • To score the first question, tally each response by the number value of each response: Not at all = 0 Several days = 1 More than half the days = 2 Nearly every day = 3 • Add the numbers together to total the score. • Interpret the score by using the guide listed below:

Score <4 > 5-14 >15

Action The score suggests the patient may not need depression treatment. Physician uses clinical judgment about treatment, based on patient’s duration of symptoms and functional impairment. Warrants treatment for depression, using antidepressant, psychotherapy and/or a combination of treatment.

Question Two In question two the patient responses can be one of four: not difficult at all, somewhat difficult, very difficult, extremely difficult. The last two responses suggest that the patient’s functionality is impaired. After treatment begins, the functional status is again measured to see if the patient is improving. Copyright held by Pfizer Inc, but may be photocopied ad libitum 14

May/June 2009


The Journal of the East and West Metro Medical Societies

PreferredOne A Provider-owned, Consumer-directed Health Plan Since 1984


referredOne was established by a group of Twin City hospitals and providers in 1984. Since that time the owners have varied due to mergers and other reorganizations in the Minnesota market, but PreferredOne has continuously been provider-owned for all of its 25-year history. The current owners are Fairview Health Services, North Memorial Health Care, and PreferredOne Physician Associates (PPA). PPA is a physician-owned organization with over 4,000 shares that are held by practicing physicians or their practice entity. From the start of the consumer-directed health plan movement in the late 1990s, PreferredOne has been active with product and feature offerings beginning with the small group Medical Savings Account (MSA) pilot program in early 2000. PreferredOne took on a lead market role through the immediate support of Health Reimbursement Arrangements (HRAs) announced in 2002 and Health Savings Accounts (HSAs) signed into law in 2004. From the product perspective, PreferredOne’s support is twofold: first, by way of designing qualified High Deductible Health Plans that meet minimum and maximum program parameters, and secondly, offering a number of choices with appropriate pricing to lower barriers of entry by giving employers options. Consumer-directed plans encourage or, to some, demand, more member involvement in their health care decisions. While this change may be perceived by physicians as disruptive, it is change adopted by employers through necessity. Many also view the change as a return of the high-deductible medical coverage. Acknowledging that the high-deductible medical plan has been, and likely always will

By John P. Frederick, M.D.


be, the common thread, PreferredOne continues with the development of product features driven from the company philosophy of information transparency. The primary result of this effort is the PreferredOne member Web site providing online views to claims, provider costs, deductible and out-of-pocket balances, explanation of benefit statements, provider search, pharmacy, and disease management information. The provider cost tool feature includes cost comparisons (low to high) of PreferredOne network hospitals, outpatient facilities and physicians/clinics, and the option for a clinic-by-clinic cost comparison for a market basket of common medical conditions. These tools should assist members in making important decisions about where to go for health care when considering financial costs. As health care costs increase, Preferred One keeps the consumer and the physician in the forefront of our product development. Our plans are focused on consumers having information and making informed decisions. To this end, we publish extensive price and quality information based on Minnesota Community Measurement data on our Web site for our members. We have a “Re-Price My Claim” function that allows members to choose providers in a geographic area and have a current claim priced. This allows them to compare prices for future provider selection.

The Journal of the East and West Metro Medical Societies

Based on the steady progression in utilization of our Web site over the past six months, our consumers are finding value in these products. Realizing that transparency applies to more than one side, PreferredOne’s provider Web site offers contracted facilities the ability to look up any member’s eligibility, deductible claims, and out-of-pocket status. This information allows a provider’s office to see and collect the patient’s responsibility portion of the bill. The Web site is designed to help the office understand benefits and to know how much of a deductible a person has remaining with up-to-the minute information. The site also lists benefit copays members may have. We are continually updating our site with new information that may be needed to help providers know benefits and payment amounts. With the new medical homes, we are indicating eligibility for this specifically on the first screen (Continued on page 16)

May/June 2009


♦ Insurance/Patient Billing and Collection ♦ Accounts Receivable Management ♦ Accounts Payable/General Ledger ♦ Payroll/Fringe Benefit Management ♦ Experienced in over 30 Medical Specialties ♦ Qualified and Experienced Staff ♦ Owned and Managed by Experienced Healthcare Practice Management Professionals Healthcare Billing Resources, Inc. 2854 Highway 55 Suite 130 Eagan, MN 55121

PreferredOne (Continued from page 15)

Healthcare Billing Resources, Inc.

The outsourced business office solution for your medical practice

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

Minnesota Epilepsy Group is the largest and most comprehensive epilepsy program in the Midwest. As a regional referral facility, we are the recognized leader in treating epilepsy and other seizure-related conditions in patients of all ages, from infants to the elderly. We also offer comprehensive neuropsychological assessment for a broad range of acquired or developmental neurological conditions in both adult and pediatric patients. Adult 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 Functional Neuro-Imaging Wenbo Zhang, MD, PhD

Appointments (651) 241-5290

225 Smith Avenue N St. Paul, MN 55102


May/June 2009

Neuropsychologists Elizabeth Adams, PhD Robert Doss, PsyD Ann Hempel, PhD Donna Minter, PhD Gail Risse, PhD


of the eligibility area. All of these functions are meant to assist providers in collecting what is due them at the time of service and to help prevent delays in payments. The PreferredOne contracting staff works closely with the provider relations team to prepare and address the physician’s office needs in the next contracting cycle. The contracting team works with the administrators and physicians (as appropriate) on a year-round basis, discussing changes in the market and in the industry. When issues arise midyear, it is not unusual for PreferredOne to be the leader in addressing and making the necessary changes for the physician offices to better meet the needs of our members. PreferredOne strives to make the payment methodologies understandable and in regular English terms. This may mean paying a flat rate for a service regardless of all the bells and whistles that are attached to it. This allows the member, who is likely paying for it outof-pocket, to understand their costs prior to receiving the service and the provider to know their reimbursement before the care/service is delivered. The PreferredOne network is open to new physicians who meet the community credentialing standards and who are interested in being part of a provider-owned organization. Our contracting staff can be reached at (763) 847-3339 if you are interested in becoming part of our ever-expanding network. John P. Frederick, M.D., joined PreferredOne in July 2000 and is now Executive Vice President/Chief Medical Officer for PreferredOne entities (PPO, HMO, TPA). He has served on numerous committees, task forces, and boards of physician/clinic groups and health plans in the Twin Cities. Currently he is active in Minnesota Community Measurement, Institute for Clinical Systems Improvement, and Minnesota’s health care reform subcommittees. Dr. Frederick received a degree in electrical engineering from North Dakota State University and went on to postgraduate training in biomedical engineering at NDSU. He received his Doctor of Medicine degree from the University of Minnesota and graduated from the University of Minnesota Family Practice Residency program. He became board certified in family practice in 1979 and has maintained this certification. The Journal of the East and West Metro Medical Societies

Health Insurer

Code of Conduct?


ast fall, the American Medical Association’s (AMA) House of Delegates adopted a resolution brought by the Medical Society of the State of New York (MSSNY) calling for the AMA to develop a Health Insurer Code of Conduct setting forth clear and concise principles to address both medical care policies and payment issues and seek concurrence among health insurers in complying with this code of conduct as well as develop a mechanism to monitor compliance with it. Codes of conduct are hardly a new idea. Most are self-imposed by professional organizations or trade groups on their members, often in an effort to voluntarily level up their members’ general behavior, especially in the wake of legal or political scrutiny. For example, the pharmaceutical industry substantially revised its code governing interactions with health care professionals after public and professional criticism. Much of the managed care industry, in the wake of settlements governing physician profiling with New York State Attorney General Mario Cuomo Jr., signed onto the Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs. In so doing, they joined the AMA, AARP, AFL-CIO, Leapfrog Group and several other national organizations in committing to minimum national standards for physician profiling by the industry. The unique aspect of this proposed code is that it is being developed by a work group of national medical specialty societies, state medical associations and the AMA, rather than from the managed care industry, and will ultimately convey a decidedly physician perspective. There could be many benefits from a Health Insurer Code of Conduct. Such a code could assist the AMA and its Federation partners as they: By Catherine Hanson MetroDoctors

Challenge health plans to change their restrictive practices without the need for legislative or judicial intervention; • Provide valuable data and public support for the AMA’s efforts in state capitols to achieve legislative and regulatory reform that meaningfully addresses abusive health plan practices; and • Provide businesses and the general public with an excellent tool to compare the performance of health plans for the purposes of making enrollment decisions. This AMA resolution has been well received by the press and patient advocacy groups. MSSNY has already made several thoughtful recommendations to the AMA on the construction of a Health Insurer Code of Conduct. It has urged that the code be consistent with and complementary to other AMA efforts, including AMA’s recently released National Health Insurer Report Card (NHIRC) that evaluates the health insurers’ claim processing practices. A simple, concise code of conduct that sets forth clear principles focusing not only on payment issues but also on medical care policies could enhance the value of the NHIRC. Specifically, MSSNY has suggested that the Code of Conduct include clear, general principles for the health insurance industry to follow when establishing policies and practices impacting the medical care received by their enrollees addressing each of the following four areas: •

Clinical Autonomy: Allowing physicians to make decisions based on patient needs without artificial barriers by doing such things as: • Easing burdens for UR/pre-authorization of diagnostic tests; • Developing formularies based on appropriate clinical evidence; and • Protecting patients from formulary changes.

The Journal of the East and West Metro Medical Societies

Transparency: Disclosing information regarding health plan benefits and policies to help facilitate patient decisions about which plans to join, and informing providers, regulators and the public about systems that may corrupt medical care. Such disclosures might ensure: • Transparent ranking/tiering system based upon true assessments of quality; • Disclosure of incentives to health plan employees and contractors, and to providers of care; • Disclosure of reimbursement/code review and bundling policies; and • Disclosure of factors affecting requests to change prescriptions. Corporate Integrity: Ensuring that business practices meet generally accepted standards and don’t negatively impact critical stakeholders, including requirements addressing: • The avoidance of conflicts of interest; • Appropriate allocations of premium dollars for health care; and • Fair and timely reimbursement. Patient safety and welfare: Ensuring patients are always put before profits. As the AMA prepares its report back to the House of Delegates, the AMA will give careful consideration to all the issues raised by Res. 823–I-08, including: • How the AMA should involve the health insurers? • How the AMA should involve consumers? • How the AMA should monitor adherence to the code? Catherine Hanson, Vice-President, Private Sector Advocacy and Advocacy Resource Center American Medical Association. This article is reprinted with permission from Colorado Medicine, January/February 2009. May/June 2009


Joint Commission Issues Moratorium On National Patient Safety Goal Relating to Medication Reconciliation ing, TJC Accreditation Committee approved placing a moratorium on the contribution of the medication reconciliation NPSG to an organization’s accreditation decision until such time as the goal is improved and is effective for surveys retroactive to January 2009.

Editor’s Note: EMMS and WMMS have been fortunate to have Dr. Jacott serve on the Metropolitan Hospital Physician Leadership Committee bringing his knowledge and expertise of the Joint Commission to the table. On several occasions, Dr. Jacott has brought back to the Joint Commission concerns raised by physicians at this meeting (e.g. medication reconciliation, medical staff autonomy, low volume provider credentialing), which has resulted in revisions, or at least reconsideration, of the standards and Elements of Performance. FOR ABOUT TEN YEARS, the Joint Commission (TJC) has been promoting and developing National Patient Safety Goals (NPSG) which are used as part of the accreditation process for the many organizations that TJC reviews. Initially these were goals that an organization needed to achieve but, before long, they became standards with which compliance must be met. These goals have been developed, modified, and increased by TJC patient safety advisory committee, a panel with broad representation from the scientific and health care world. They are consistent with TJC mission “to continuously improve the safety and quality of care provided to the public.” This article presents TJCs plan for improving the medication reconciliation NPSG. In 2005, a NPSG was created to address the reconciliation of medications that a patient is taking across the continuum of care as a way to avoid medication errors. Since the introduction of this NPSG however, the health care field has had difficulty in complying with this requirement. It is consistently listed as one of the standards with the lowest compliance. In fact, our own Metropolitan Hospital Physician Leadership Council has discussed problems with it on a number of occasions. As a result, failing to reconcile medications continues to be a serious source of medication errors. Neither By William Jacott, M.D.


May/June 2009

health care organizations nor TJC has identified effective solutions. Last year, TJC tried to improve the NPSG with some revisions that became effective January 1 of this year; however, feedback from the field has indicated that TJC has not yet succeeded in creating an easily implemented, effective solution. The National Patient Safety Goal 8 simply states: Accurately and completely reconcile medications across the continuum of care. It is now divided into four standards, each with appropriate Elements of Performance: • NPSG 08.01.01: A process exists for comparing the patient’s current medications with those ordered for the patient while under the care of the organization. • NPSG 08.02.01: When a patient is referred to or transferred from one organization to another, the complete and reconciled list of medications is communicated to the next provider of service, and the communication is documented. • NPSG 08.03.01: When a patient leaves the organization’s care, a complete and reconciled list of the patient’s medications is provided directly to the patient or family and the list is explained. • NPSG 08.04.01: In settings where medications are used minimally, or prescribed for a short duration, modified medication reconciliation processes are performed. Therefore, at its February 2009 meet-


To activate the moratorium, the following plan will be implemented: 1. Surveyors will continue to score compliance with the NPSG in order to collect internal data for process improvement efforts. 2. Surveyors findings will NOT contribute to accreditation decisions. 3. Surveyors findings will not appear on the accreditation report and they will not generate Requirements for Improvement (RFI). 4. During the next several months, TJC staff will conduct additional research to further refine the NPSG on medication reconciliation. (An internal staff task force has been formed). 5. Based on the research, the NPSG will be revised and the recommendations will be submitted to TJC Standards and Survey Procedures Committee (SSP). The Joint Commision Board of Commissioners approved the plan in late February. During this moratorium, comments and feedback to TJC are encouraged. Contact Ann Blouin, This is a great opportunity for Minnesota physicians to express their concerns relating to medication reconciliation and submit their innovative recommendations for reducing medication errors. William Jacott, M.D., serves as Special Advisor for Professional Relations, The Joint Commission. Dr. Jacott is a family physician and associate professor emeritus, University of Minnesota. The Journal of the East and West Metro Medical Societies


Physician Behavior


re you paranoid — or does it seem as though you are being watched? It exceeds my scope of practice as a lawyer to assure you that you are not paranoid or otherwise crazy, but you are correct that your conduct at the hospital is under surveillance, perhaps more than ever. Here’s why: a “Sentinel Event ALERT” was circulated July 9, 2008, by the Joint Commission, the largest hospital accreditation agency in the United States, warning of “Behaviors that undermine a culture of safety.” Consequently, to meet the January 1, 2009, implementation date, hospitals ginned out “Codes of Conduct” on an emergent basis, typically focused on “disruptive physicians.” Many, if not most, create real problems for nowhere-near disruptive physicians, by setting up reprisals ranging from forced apologies to “expulsion” from hospital grounds for criticizing policies, repeating bad jokes or raising voices at the hospital. Under some codes of conduct, calling out for urgently-needed assistance to prevent a death would be punishable as “yelling;” others discipline for “actions adding to the workload of the staff” — such as admitting a patient. The Joint Commission’s ALERT clearly provides that “While most formal research centers on intimidating and disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other health care professionals, such as pharmacists, therapists, and support staff, as well as among administrators.” The focus on physicians should not cloak the real problems caused by disruptive administrators and others in hospitals. The Joint Commission Leadership stan-

dard LD.03.01.01 element of performance 4 simply states “The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors;” element of performance 5 adds, “Leaders create and implement a process for managing disruptive and inappropriate behaviors.” The Joint Commission does not define “acceptable,” “disruptive” or “inappropriate.” How hospital codes of conduct define those terms can create real disruption for physicians. To assist organized medical staffs, the American Medical Association Organized Medical Staff Section has published a Model Medical Staff Code of Conduct, available to AMA members at ama1/pub/upload/mm/21/medicalstaffcodeofconduct.pdf. The Model Code is drafted from the organized medical staff perspective, to be

adapted as medical staff bylaws. For example, the Model Code fulfills the Joint Commission requirement of defining “appropriate behavior” to protect physicians advocating for patients, recommending improvements in patient care, participating in medical staff operations, leadership or activities or engaging in professional practice including practice that may be in competition with the hospital. This language should prevent the hospital from using a Code of Conduct for economic credentialing or to impose gag clauses. Referrals of physicians for evaluation and therapy are a key component of the Model Code, to assure that aberrant behavior resulting from a physician’s physical or emotional condition leads to treatment rather than punishment. Of course, the Model Code provides for a thorough process to evaluate, correct and prevent harassment, intimidation and other actually disruptive behavior on the part of physicians and others who work in hospitals. As with all model documents, each medical staff should carefully tailor the Model Code to fit its needs. Elizabeth “Libby” Snelson, Legal Counsel for the Medical Staff PLLC, serves of counsel to the Minneapolis firm of Lockridge, Grindal and Nauen, and assisted with the development of the AMA Model Code. She can be reached in St Paul at, and blogs at BYLAWG at

Visit us at and To find new career opportunities, past issues of MetroDoctors and information on the latest news, events and legislative issues!

Elizabeth A. Snelson, Esq. MetroDoctors

The Journal of the East and West Metro Medical Societies

May/June 2009


Helping Your Patients

Quit Smoking


s more Minnesotans try to quit smoking, health care providers are among the most important sources of health information and have the potential to make a major contribution to further reducing tobacco use. Providers who take a few minutes to talk with patients about their smoking, pass along information on resources for quitting, and discuss stop-smoking medications, can help patients quit successfully. Certainly, progress has been made. According to the 2007 Minnesota Adult Tobacco Survey (MATS), 86.5 percent of current smokers who saw a health care provider in the past year were asked if they smoked, compared with 72.9 percent in 2003. In addition, more smokers are taking advantage of available behavioral counseling, nicotine replacement therapies (NRT) or prescription medications when trying to quit. In 2007, nearly half (45.5 percent) of Minnesota’s smokers used some form of stop-smoking medication and 15 percent used behavioral counseling when trying to quit. And yet, despite the clear benefits of quitting, better education on the subject, improved methods for helping people quit and policies banning smoking in public places, tobacco use remains one of the leading causes of preventable death and disease in Minnesota. We know a majority of Minnesota smokers want to quit, but have been unsuccessful in previous attempts or are unaware of the quit-smoking resources available to them. For approximately 634,000 of Minnesota’s adult residents who still use tobacco, quitting remains a challenge. The simple fact is that most people need help to quit successfully. Although some people are able to quit without assistance, professional counseling, By Ann Wendling, M.D., M.P.H.


May/June 2009

nicotine replacement therapy and medications can help increase the chance of success. A brief intervention with a patient during a doctor visit can provide the additional incentive and information needed to quit successfully. According to a published study from MATS 2003, when two or more health professionals asked about tobacco use it doubled the odds of a cigarette smoker quitting in the previous year.

STEP 2: ADVISE all tobacco users to quit. “Quitting smoking may be the best thing you can do for your health. I can help you.”

A brief tobacco intervention: STEP 1: ASK about tobacco use at every visit. Document in chart.

STEP 4: Recommend tobacco cessation counseling and pharmacotherapy, if appropriate.

Program Component QUITPLAN Helpline

STEP 3: ASSESS readiness to quit. If willing to quit, proceed to Step 4. (If unwilling to quit, discuss reasons to quit and motivation to do so.)

Services Provided

Services Guidelines

• Multi-session telephone counsel- Patients who do not have tele-


phone counseling and/or OTC

• Up to 8 weeks of nicotine replace- nicotine replacement therapy

ment therapy

available through their health

• English and Spanish (other lan- plan

guages supported through AT&T interpretive services) • TTY line available for hearing impaired (1-877-559-3816)

• Internet-based counseling, self- Patients with internet access —

help materials, internet social sup- regardless of health plan coverport, other program information age • NRT purchasing at client expense QUITPLAN Centers

• Individual and group counseling Patients who have transporta• Up to 8 weeks of NRT through tion to the nearest QUITPLAN

health plan or provided by Clear- Center Way Minnesota if no NRT benefit through health plan • Health plans are billed for services to their members Online CME Course

• Based on the Clinical Practice All health care providers

Guideline: Treating Tobacco Use and Dependence • Additional information available at


The Journal of the East and West Metro Medical Societies

Pharmacotherapy includes nicotine patch, lozenge, gum, nasal spray, inhaler or prescription medications. In Minnesota, there are numerous resources for quitting help. Every smoker in Minnesota has access to professional counseling, either through health care coverage or through ClearWay Minnesota’sSM QUITPLAN® Services. QUITPLAN Services provides one of the most comprehensive quit-smoking programs in the country. QUITPLAN Services provides free professional counseling for patients who are uninsured or who have insurance that does not cover tobacco cessation counseling. Programs include online support at quitplan. com, professional phone counseling through the QUITPLAN Helpline and face-to-face counseling at QUITPLAN Centers, located in health care settings throughout Minnesota. In addition, the Minnesota Clinic Fax Referral Program offers a streamlined approach to referring patients to a tobacco cessation phone

helpline. The program allows providers to fax a referral form to a single, tobacco cessation phone line. The fax triggers a call to the patient from the appropriate quitline service. This program is offered through Call it Quits, a collaboration among Minnesota’s health plans (Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, MMSI, PreferredOne Community Health Plan, UCare Minnesota) and QUITPLAN Services through ClearWay Minnesota. For more information about Call it Quits, call (651) 662-4054 or visit www. and click on the Call It Quits icon on the home page.Quitting smoking is a challenge for Minnesotans, but with continued support from health care providers and support programs, more smokers will have success quitting and lead longer, healthier lives.


OSHA OSHA COMPLIANCE COMPLIANCE Employee Employee Training Training L CIA y S P E Societ l a T c i Med C O U N DIS

$10 Per Employee Join Us At One of Our Upcoming “Violence in the Workplace” Seminars FOR MORE INFO CALL: SafeAssure @ 1-800-920-7233 OR East Metro Medical Society @ 612-362-3799

Ann Wendling, M.D., M.P.H., director of Intervention Programs, ClearWay Minnesota. Metro Dr. Ad

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East Metro and West Metro Medical Societies have launched a Web forum.

Charles E. Crutchfield III, M.D.

The forum, moderated by Dr. Thom Siefferman, will be a central location for discussions related to legislative issues, local health care matters, upcoming society events, the MMA Annual meeting and more. Sign up and use the forum for communication and dialogue with your colleagues! If you have comments or questions, please contact Katie Snow at (612) 3623704 or


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The Journal of the East and West Metro Medical Societies

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May/June 2009


Electronic Credentialing Application

Streamlines Process


innesota doctors and other health care practitioners may now apply for credentials online. This system can be used for initial credentialing, recredentialing and updates. More than 21 health plans and hospital systems are currently accepting electronic applications and more organizations are added every day. Minnesota is one of the only states in the nation where all health care organizations use a centralized, Web-based clearinghouse for information used in credentialing. The online product is offered through the Minnesota Credentialing Collaborative (MCC), an organization formed by the Minnesota Council of Health Plans (MCHP), Minnesota Medical Association (MMA) and the Minnesota Hospital Association (MHA). The MCC is providing an affordable online, easy-to-use way to prepare, save and send the credentialing application that is accepted by Minnesota health plans and hospitals. The Web-based application is now available statewide to all practitioners, clinics, hospitals and health plans. Register now at How it Works

Once you enter the information into the secure Web site, you select the health plan(s) or hospital(s) to receive it. You then electronically attest to the accuracy of the data and answer disclosure questions. The system then checks to ensure all required information has been included and sends the information. The “receiving” organization is notified that it has an application waiting so that the plan’s or

hospital’s internal process may begin. Once the organization receives the information and works through its process, it makes an independent decision regarding credentials or privileges on each application. The information is stored in a secure database, giving you quick access to update the details the next time an application is needed. The security of personal information was of the utmost priority in selecting a partner to work with the MCC on this technology. Security policies exceed those required by Health Insurance Portability and Accountability Act (HIPAA). The software uses encryption and authentication technologies, including Secure Sockets Layer (SSL) and digital certificates to protect the security and privacy of your information. Firewall technologies are designed to protect internal accounts from outside access. Credentialing data in your account is owned by you and can be accessed only by you (or your organization if a group account is established). This data is not shared with any outside organizations and cannot be sold.


May/June 2009

Reducing the time it takes to create a completed, acceptable application. Storing data so future applications can be built off of existing information.

The Cost

After the initial $600,000 investment which has been funded by the MCHP, MMA and MHA, all who benefit from the system will support it financially. Providers will pay only $25 annually for full access to the system and unlimited ability to send and receive credentialing information to participating Minnesota hospitals and health plans. Health plans and hospital systems will pay an annual licensing fee based on their organizational size. Get Started Now

Benefits of Participation • Participants highlight several benefits of • •

By Tracey Torgersen

the new system, including: Decreasing the amount of time required for credentialing/privileging work. Offering an easy and secure way for doctors and other health care providers to submit credentialing applications electronically to health plans and hospitals. MetroDoctors

See the MCC Web site, for more information, including common questions and answers, a training schedule and more. If you prefer, contact Tracey Torgersen, MCC program manager, at (651) 789-0113.

The Journal of the East and West Metro Medical Societies

President’s Message

Utilize Your Local County Medical Society 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 Katie R. Snow, Administrative Coordinator (612) 362-3704 For a complete list of EMMS Board of Directors go to

HEALTH CARE REFORM CONTINUES to gain momentum and extend into areas which may be unexpected or unanticipated. Proposals are reviewed at venues often challenging for physicians to attend, and include a spectrum of complex issues of concern to physicians, regardless of specialty. Some may significantly alter how we practice our profession. High profile discussions include: insurance coverage, payment reform/pay-for-performance (P4P), medical home, electronic medical record (EMR), bundled services, and new concept clinics such as nontraditional “birthing centers” (heavily opposed by the MMA). Recently, Senator Linda Berglin and Representative Maria Ruud introduced SF 1444/HF 1783, which eliminates requirements for health plans to reimburse providers under Medical Assistance (MA) for preventive services identified by the U.S. Preventive Services Task Force to be “ineffective.” To be sure, there is a lot going on. Why should medical students, physicians in training, and working physicians be concerned with the politics of health care, learn about these proposals, and comment to representatives of our legislature personally? I believe the compelling reasons are these: difficulty in meeting criteria for small or financially pressured practices (qualifying as a medical home), changes to the current health delivery model with apparent focus on cost versus safety (birthing centers, and potentially, “medical home” designation, with possible transfer of insurance type risk to physicians and clinics), large required financial commitments for which physicians may or may not be compensated (mandated EMR), physician/clinic financial risk for total cost of care (basket/bundled payments, state and federal payment reductions), possible significant changes in the percentage of patients insured by state or federal programs (MN state budget reductions/mandated insurance coverage), and requirements for additional administrative processes to justify patient services increasing administrative cost without offsetting reimbursement (pre-authorization and P4P proposals) — of which the primary beneficiaries of gathered data and cost savings appear to be insurance corporations. Short version: If we are not fully engaged, our profession will have two likely outcomes: 1) the primary driver of “reform” will be financial penalty to “non-compliant” physicians, with continued decrease in reimbursement, and 2) the continued evolution of a “reform solution” which incentivizes physicians to restrict care (save premium dollars) from bundled services pricing, bid down by competing large clinics/corporate providers to unsustainable levels for independent/small practices. We should be wary. If poorly structured, bundled services may translate into “comprehensive care” for an episode, and splitting of a capitated (bid down) premium amongst all provider elements (including the hospital) — and in some cases covering 90 days of complications. True price transparency and market forces in such a scenario remain suppressed. I believe efforts to reduce ineffective or duplicative care, primarily posed by EMR’s and medical homes, to be admirable, however — will the massive amounts of EMR data and the construct of the medical home be used primarily for effective patient care and efficient cost reduction, or will the data and constraint allow undue scrutiny (and penalty) of physician and patient cost to the system, and allow a mechanism to place a “home” at risk for total cost of care? As informed physicians, we must understand individual patients are not population statistics (the data frequently invoked for such reforms), and there appears to be a frequent assumption of authenticity of such clinic statistics in policy formation. Such statistics are really only robust when derived from very large populations, “smoothing” the bell curve and lessening the financial impact of outlier events on insurance corporations. Insurance risk is actuarially sound when calculated across large groups typically 25,000 – 50,000 at minimum, not your average practice, nor individual physician. Unfortunately, the reality is that policy is influenced by those who show up, and frequently it (Continued on page 26)


The Journal of the East and West Metro Medical Societies

May/June 2009


The Dakota County Smoke-Free Communities Partnership Closes its Doors A Recap of the Project’s History and Highlights


he Dakota County Smoke-Free Communities Partnership will close its doors on June 30 after an exciting and monumental four-year run. The past few years have been filled with powerful physician leadership, active citizens engaging in the political process, and the success of a smoke-free workplace law that is supported by 77 percent of Minnesotans and protects the health of hospitality workers statewide. The Partnership’s role has varied over time depending on the education, mobilizing, advocacy, implementation, and defense phases of the smoke-free law initiative, though the Partnership remained consistently focused on the physician-supported message of the healthrelated benefits of smoke-free air for Minnesota workers. Campaign Highlights: • Following passage of the Freedom to Breathe Act, the Partnership joined the six Chambers of Commerce in Dakota County and prepared a mailing to foodand beverage-licensed establishments informing them about the law and providing technical assistance and signage for the transition. • The Partnership monitored compliance of the smoke-free law by local establishments, especially after the Theater Nights movement, that exploited a loophole allowing smoking onstage during theatrical performances, spread across the state. They also successfully defended the smoke-free law from amendments and repeal in the 2008 legislative session, developing relationships with key legislators.

Partnership staff providing non-partisan GetOut-the-Vote efforts on November 4, 2008.

The Partnership became an active member of the Social Leader Action Network, a new initiative focused on encouraging collaboration between Dakota County nonprofits. Partnering with Cheerful Givers and Kids ‘n Kinship to co-host a “Birthday Bag Blitz” for National Make a Difference Day 2007, the Partnership helped spur the movement toward a larger joint venture, resulting in the first-ever Honoring Our Volunteers Day at the Dakota County Fair in August 2008. To commemorate and celebrate the one-year anniversary of the Freedom to Breathe Act, the Partnership hosted a community-wide art contest with winners’ work featured for a month at the Ring Mountain Creamery in Eagan. The Partnership also worked with 11 establishments across Dakota County to advertise and provide coupons in a oneyear anniversary event advertisement. The Partnership became engaged in the 2008 elections to leverage the opportunity to engage community members on civic issues in a non-partisan way and keep the smoke-free issue in the forefront of minds of elected officials and the public at-large. Over the course of three months, the Dakota County Election Coalition of a dozen organizations organized and hosted three legislative candidate forums, featur-

The Partnership Advisory Committee served as a resourceful and visionary stakeholder group.


May/June 2009


ing eight candidate races, attended by 75+ community members, and uploaded for online broadcasting and podcasting by local media partner, Thisweek Newspapers. In the final months of this grant year, the Partnership has and will feature several exciting projects to engage the community around health and wellness, educate the public about smoking cessation and QUITPLAN Services, and provide leadership development training for volunteer members of the County Coordinating Committee. • Tuesday, March 2 “Smoke-Free Day at the Capitol” co-hosted by ClearWay MN grantees from Goodhue County and central Minnesota. • Friday, March 27 “Kick Butts Day SelfDefense Seminar” at Raberge’s ATA Martial Arts Leadership Academy in Lakeville. • Sunday, May 31 “World No Tobacco Day 5K” at Big Rivers Regional Trail in Lilydale. The work of the Partnership has been an immense pleasure and a great success, though it certainly was not possible without the support of many. Thanks are in order to: • ClearWay MN for their continued support and visionary leadership. • Partnership Advisory Committee for their feedback and community connections. • East Metro Medical Society staff (Sue, Katie and Doreen) and physician members for their accomplished leadership and tremendous support on this project!

Partnership volunteers at Smoke-Free Day at the Capitol on March 3, 2009, pictured with Representative Rick Hansen (39A).

The Journal of the East and West Metro Medical Societies

Advance Care Planning Project is Proceeding Summer 2009 Conference In late July or early August 2009 the East Metro Medical Society Foundation, together with the West Metro Medical Society, is hosting a conference entitled “An Advance Care Planning Program that Works: A Workshop

to Prepare Leaders to Implement an Effective Advance Care Planning Program.” The purpose of the conference is to provide a clear explanation of the Respecting Choices® community-based advance care planning model which started in LaCrosse,

MPS Vendor Spotlight

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A locally owned company with over 20 years of experience and a dedicated commitment to providing the highest quality coffees and superior service makes Berry Coffee the right choice for you! Switching is easy. Simply call Bob Dilly at Berry Coffee at (952) 937-8697, or e-mail him at bob@berry Berry Coffee has been a valued business partner of the East Metro Medical Society for over five years.

The Journal of the East and West Metro Medical Societies

Do you have an issue that you would like to bring forward for debate and discussion? Consider writing a resolution. Resolutions can identify and direct a specific action that you would like 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 and concerns are heard by contacting EMMS at (612) 362-3704, or e-mail We can help you draft a resolution and guide you through the process. Call for Resolutions: Due Date Friday, May 8, 2009 EMMS Caucus: Thursday, May 28, 2009 at Bethesda Hospital’s Indihar Conference Room; 6:00 p.m. RSVP by calling EMMS at (612) 362-3704, or e-mail The MMA annual meeting is being held September 16-18 in Rochester, Minnesota.

May/June 2009


Metro Medical Society

Not pictured: Jack Davis (WMMS), Howard Epstein, M.D. (Blue Cross and Blue Shield), Leslie Frank (Medica), Jim Guyn, M.D. (Medica), Scott McRae (Park Nicollet), and James Risser, M.D. (HealthPartners).

We Want to Hear Your Ideas!


Members of the Advisory Committee are from left: Back row: Craig Christensen, M.D. (UCare), Kent Wilson, M.D. (EMMS Foundation), Dave Klevan, M.D. (Regions Hospital/Health Partners), Sandy Schellinger (Allina), Ken Kephart, M.D. (WMMS and Fairview University), Michele Fedderly (Hospice Minnesota), Sue Schettle (EMMS and EMMS Foundation). Front row: Dave Bonham, M.D. (EMMS Foundation), Linda Setterlund (ICSI), Craig Svendson, M.D. (HealthEast), and Jane Pederson, M.D. (Stratis Health).

Wisconsin, and is now employed nationally and internationally. Attendees will come away with a common understanding of the approach and the systems needed to implement an advance care planning program successfully. Teams from Allina, Park Nicollet/Methodist Hospital, HealthEast, HealthPartners/ Regions Hospital have been engaged in this project and have agreed to serve as pilot sites for the community based advance care planning project. We have also formed the Advisory Committee which will help to make some key decisions about the project including agreeing on forms and on quality measures. Members of the Advisory Committee represent the four pilot sites in addition to ICSI, Stratis Health, Hospice Minnesota, West Metro Medical Society and the East Metro Medical Society and its Foundation.

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

Active David C. Anderson, M.D. University of Minnesota Medical School, Minneapolis Neurology University of Minnesota Department of Neurology

Allison E. Golnik, M.D. University of South Dakota, School of Medicine, Sioux Falls, Vermillion Pediatrics University of Minnesota Department of Pediatrics Tara L. Holm, M.D. University of Minnesota Medical School, Minneapolis Radiology University of Minnesota Department of Radiology

Hematology/Oncology University of Minnesota Department of Medicine Edward Rainier G. Santos, M.D. (No school indicated) Orthopaedic Surgery University of MN Physicians Dept. of Orthopaedic Surgery Luree A. Schneider, M.D. (No school indicated) Family Medicine Smiley’s Family Practice Clinic

Carol E. Ball, M.D. Mayo School of Medicine Obstetrics & Gynecology Planned Parenthood, Highland Park

Carol J. Holman, M.D. University of Illinois College of Medicine, Chicago Pathology-Anatomic/Clinical University of Minnesota Dept. of Lab Med & Pathology

Jonathan Sembrano, M.D. College of Medicine, University of the Philippines System, Manila Philippines Orthopaedic Surgery University of Minnesota Orthopaedic Surgery

Sally H. Berryman, M.D. Southern Illinois School of Medicine, Springfield Internal Medicine University of Minnesota Department of Medicine

Kenneth D. Kleist, M.D. University of Wisconsin, Madison Orthopaedic Surgery HealthPartners Institute for Medical Education

Zhiyi Sha, M.D., Ph.D. (No school indicated) Neurology University of Minnesota Department of Neurology

Maneesh Bhargava, M.D. King George’s Medical College, Lucknow University, Lucknow, Uttar Pradesh Internal Medicine University of Minnesota Department of Medicine

Nina W. Morrissette, M.D. University of Oklahoma College of Medicine, Oklahoma City Anesthesiology University of Minnesota Department of Anesthesiology

Julie A. Switzer, M.D. Stanford University School of Medicine, Palo Alto Orthopaedic Surgery University of Minnesota Orthopaedic Surgery

Lin Y. Chen, M.B., B.S. Faculty of Medicine University of Malaya, Singapore Internal Medicine University of Minnesota Department of Medicine Jennifer A. Flynn, D.O. Des Moines University College of Osteopathic Medicine OB/GYN Metropolitan Obstetrics & Gynecology, P.A. Allen E. Fongemie, M.D. University of Vermont College of Medicine, Burlington Family Medicine HealthPartners Como Clinic


May/June 2009

Shailendra Prasad, M.B., B.S. Mysore Medical College, Mysore University, Mysore, Karnataka Family Medicine University Family Physicians Broadway Family Med Clinic Lihong Qin, M.D. (No school indicated) Therapeutic Radiology University of Minnesota Department of Radiology Goya V. Raikar, M.D. University of Nebraska College of Medicine, Omaha Thoracic Surgery HP Regions Spec Clinics Cardiovascular & Thoracic Surgery Mustafa B. Sahin, M.D. Haceteppe University Faculty of Medicine, Ankara

Jane Van Dis, M.D. University of South Dakota, School of Medicine, Sioux Falls (No Specialty indicated) University of Minnesota Department of OB/GYN & Women’s Health Christopher A. Warlick, M.D. University of Minnesota Medical School, Minneapolis Urology Minnesota Urology, P.A. Marc L. Weber, M.D. University of Minnesota Medical School, Duluth Internal Medicine Division of Renal Diseases and Hypertension Demetris Yannopoulos, M.D. Faculty of Medicine, National University of Athens, Athens Internal Medicine University of Minnesota Department of Medicine Resident Physician Sonia K. Kalirao U of MN Graduate School of Medicine Neurology

President’s Message (Continued from page 23)

seems the system is countering our productive participation. It can be difficult to determine relevant gatherings, input periods, and deadlines. Relatively short lead times with inconvenient meeting times often confound busy physicians unable to alter clinical schedules, and we cannot easily compete with other stakeholders’ paid lobbyists. Unlike lobbyists or those staffing committees, making our concerns known costs our unreimbursed time. In this environment, the importance of our constituent medical societies cannot be overstated — as they are perhaps the most-cost effective means by which to have individual physician concerns coordinated and forwarded. Our medical societies, and their lobbyists, are what we as busy physicians can best afford, as nearly all of our professional time is required clinically to maintain viable productive practices. Questions with large ramifications now hang in the balance during this legislative session. At the state and national level, recognize that analysis of benefits and unintended consequences of any proposal may be lacking depending upon who voices opinion. Do your best now to keep informed, as the critical voice in policy decisions for your patients and your practice will be your own. This is our challenge, and we need to meet it — or acquiesce to an incrementally legislated profession. MetroDoctors

The Journal of the East and West Metro Medical Societies

Chair’s report

Advocacy and Reform 101 RiCHARD D. SCHMiDT, M.D.

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 Jennifer J. Anderson, Project Director (612) 362-3752 Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 Kathy R. Dittmer, Executive Assistant (612) 623-2885 For a complete list of WMMS Board of Directors go to


WE PHYSICIANS HAVE OUR OPINIONS ABOUT POLITICS but we really are not very political and that is not good in a year of change. Change happens, to put it mildly, and it will happen this year. Unless we are personally involved we must rely on the American Medical Association, the Minnesota Medical Association, our local medical societies, and our specialty societies to represent us, whether we like it or not. We are all free to speak for our special interests or ourselves, but in so doing it should be clear for whom we speak. I suggest that, at least, we respect the position of “organized medicine” that speaks for the whole. Having returned from Washington D.C. recently, I believe that this will be a year of change. At the Health Care Summit on March 5, 2009, President Obama said that the “status quo is not on the table.” It appears that the Democrats are enthusiastic about the White House proposals and that the Republicans are begrudgingly accepting of them. The White House, Congress and physicians agree that the problem of the Medicare Sustainable Growth Rate must be fixed. Most physicians support a multiple payer system with a Medicare-like backup for the uninsured and portability to avoid lapses of coverage. Polls indicate that patients are satisfied with their health coverage and their physicians but concerned about cost, portability and the uninsured. There are growing numbers of physicians and legislators who support a single payer system and they will be heard. Now the real issue is cost containment, but this is parsed as price, quality and value. The idea is that with proper incentives to physicians the prices will fall. With better quality, the long-term cost and value will be better. There will be many cost and quality proposals by state or national legislatures and many will be controversial to physicians. As a result, we may not speak with one voice. Ideas such as (I list these in no specific order) baskets of care, the medical home, improvements to primary care, increased independent practice by non physicians, mandatory electronic medical records and payment by best practices are being considered. For physicians, I suggest that we review our ethical guidelines. The patient comes first. While our care is considered good, we are often perceived as greedy. We don’t need to be thought of as similar to the executives of AIG. The point is that the decisions should be fair and equitable. Being equitable means cooperation amongst physicians, physician groups, patients, insurance plans, hospitals, suppliers, and with society as a whole. Lawmakers should pass laws about things they can control. We can all agree that medical care is expensive but look at the real reasons for the cost and tackle these. Medical care is given by individuals and not by machines. People are costly, but necessary. Technology is very expensive and we have all benefited, but the advertising of products and drugs direct to patients without clear evidence of efficacy should be stopped. The malpractice and court system continues to be costly due to defensive medicine and inefficiency. Administrative costs are extreme and take up to 30 percent of the health care dollar. Be careful of the quality initiatives as they can take money from patient care due to administrative costs for physician offices and hospitals. Create systems that collect valid data, especially on quality, verify that the information is correct and share this openly with physicians, hospitals and insurers. In closing, physicians are highly trained, ethical and professional. The vast majority practice ethically, with efficiency and skill but we must have reliable data and evidenced-based research in order to make the best decisions with our patients. Any health care legislation should be balanced in its approach and still encourage innovation by physicians in health care delivery, technology development and quality. Any new laws should consider the future of medicine. We need to encourage individuals to pursue careers in medicine. As our population ages, I want to assure myself of a physician.

The Journal of the East and West Metro Medical Societies

May/June 2009


Welcome New WMMS Members Active Monica M. Fisher, M.D. Allina Medical Clinic Internal Medicine Padma Gadela, M.B.B.S. Allina Medical Clinic Internal Medicine Peter G. Harper, Jr., M.D. Smiley’s Family Practice Clinic Family Medicine Suzanne S. Hecht, M.D. Smiley’s Family Practice Clinic Family Practice Douglas D. Hodgkin, M.D., Ph.D. Cardiovascular Consultants, Ltd. Internal Medicine/Cardiovascular Diseases, Cardiac Electrophysiology Bobbi L. Hoppe, M.D. Cardiovascular Consultants, Ltd. Internal Medicine, Cardiology, Cardiac Electrophysiology Kimberly J. Kardonsky, M.D. Indian Health Board of Minneapolis Family Medicine Ryan C. Oeltgen, M.D. Cardiovascular Consultants, Ltd. Internal Medicine, Cardiology, Nuclear Cardiology, Echocardiology Michael J. Pawlik, M.D. Allina Medical Clinic Internal Medicine Matthew A. Riethof, M.D. Fairview Oxboro Clinic Internal Medicine Rodrigo Rios, M.D. Children’s Heart Clinic, P.A. Pediatric Cardiology Steven Schwartz, M.D. Minnesota Urology, P.A. Urology David A. Vagneur, M.D. Allina Medical Clinic Internal Medicine Peiyi Wang, M.D. Allina Medical Clinic Internal Medicine Brandi J. Witt, M.D. Cardiovascular Consultants, Ltd. Internal Medicine, Cardiology


May/June 2009

U of M Physicians Waddah B. Al-Refaie, M.D. Department of Surgery General Surgery Kumar G. Belani, M.B.B.S. Department of Anesthesiology Anesthesiology Earl Bender, M.D. Department of Radiology Diagnostic Radiology Kevin L. Billups, M.D. Department of Medicine Urology Alain F. Broccard, M.D. Department of Medicine Critical Care Medicine

Eric J. Hoggard, M.D. Department of Radiology Radiology Mehrnaz Hojjati, M.D. Department of Medicine (no specialty listed) Matthew A. Hunt, M.D. Department of Neurosurgery Neurosurgery Kamau M. Jackson, M.D. Department of Anesthesiology General Practice Jason S. Johnson, M.D. Department of Anesthesiology Anesthesiology

Brian W. Buck, D.O. Department of Orthopaedic Surgery Orthopaedic Surgery

Amy L. Jonson, M.D. Department of OB/GYN & Women’s Health Obstetrics and Gynecology

Elizabeth H. Cameron, M.D. Department of Radiology Radiation Oncology

Samir S. Khariwala, M.D. Department of Otolaryngology Otolaryngology

Mark L. Cannon, M.D. Department of Medicine Internal Medicine

Douglas E. Koehntop, M.D. Department of Anesthesiology Anesthesiology

Umar H. Choudry, M.D. Department of Surgery General Surgery

Robert A. Kratzke, M.D. Department of Medicine Internal Medicine

Jay N. Cohn, M.D. Department of Medicine Cardiovascular Diseases

Daniel B. Leslie, M.D. Department of Surgery General Surgery

Gary S. Francis, M.D. Department of Medicine Cardiology

Navneet S. Majhail, M.D. Department of Medicine Hematologic Oncology

Barbara S. Gold, M.D. Department of Anesthesiology Anesthesiology

Cindy M. Martin, M.D. Division of Cardiology Cardiology

Jon E. Grant, M.D. Department of Psychiatry Psychiatry

Jeffrey McCullough, M.D. Dept. of Lab Med & Pathology Pathology, Clinical Pathology, Blood Banking Pathology

Sandeep Gupta, M.D. Division of Renal Diseases and Hypertension Nephrology

Susan E. McPherson, M.D., Ph.D. Department of Neurology Neurology

Mohamed A. Hassan, M.D. Department of Medicine Internal Medicine

Christopher Moertel, M.D. Department of Pediatrics Pediatric Hematology Oncology

Angela L. Henszel, M.D. Department of Anesthesiology Anesthesiology

Jerry A. Molitor, M.D., Ph.D. Department of Medicine Medicine

Patrick M. Morgan, M.D. Department of Orthopaedic Surgery Orthopaedic Surgery Phillip K. Peterson, M.D. Department of Medicine Internal Medicine/Infectious Diseases James R. Phillips, M.D. Division of Pediatric Pulmonary and Critical Care Pediatrics Kevin S. Raff, M.D. University Family Physicians Family Medicine Michael I. Reiff, M.D. Division of Pediatric Clinical Neuroscience Pediatrics Todd D. Reil, M.D. Department of Surgery Surgery Steven M. Rothman, M.D. Department of Pediatrics Pediatrics Kyriakie Sarafoglou, M.D. Department of Pediatrics Pediatrics, Pediatric Endocrinology Lisa A. Schimmenti, M.D. Department of Pediatrics Pediatrics, Medical Genetics Richard S. Spong, M.D. Department of Medicine Internal Medicine, Nephrology, Transplant Surgery William M. Stauffer, III, M.D., MSPH, DTMH Department of Medicine Pediatrics, Pediatric Emergency Medicine, Internal Medicine Maria E. Swenson, M.D. Department of Surgery General Surgery, Head & Neck Surgery, Critical Care Surgery Nancy K. Thorvilson, M.D. Department of Anesthesiology Anesthesiology Carolyn J. Torkelson, M.D. Women’s Health Center Fairview Family Medicine

(Continued on page 30) MetroDoctors

The Journal of the East and West Metro Medical Societies

West Metro Medical Foundation

Richard K. Simmons, M.D., WMMF Chair

The following organizations/programs are the 2008 benefactors of your generosity:

2008 Grants Cedar Riverside People’s Center Support the transportation needs of female patients who need mammograms and other advanced screenings and procedures. Greater Minneapolis Crisis Nursery Support of Pediatric Assessment and Medical Management program, which allows the Nursery to address the health concerns of the children


they shelter. Through this program, the Nursery is also able to educate parents on how to best care for the health needs of their children, and to help connect them with needed health care resources. MVNA — Club 100 and Club 101 The grant money, combined with other funding sources, allows MVNA to fulfill the non-medical needs requests for over 3,000 clients from newborns to older adults. Over 400 Safety Kits were distributed (which includes night lights, cabinet latches, outlet covers and door knob covers). And due to an increase in the number of clients who are suffering the physical effects of bed bug bites and infected scabs, mattress covers and bedding were purchased to control bed bugs. Sub-Saharan African Youth and Family Services in MN Two part-time staff provided SAYFSM’s culturally appropriate extended case management,

meeting the needs of African individuals living with HIV/AIDS who need longer-term, intensive support. The case managers conducted risk assessments and created care plans to address client needs from a holistic perspective. They helped clients access health services and promoted quality health outcomes, empowering them with education about HIV/AIDS, treatment, and medication options. In addition they provided assistance to necessary resources to address housing, transportation, employment, education, legal, insurance, or other needs. Thomas P. Cook Scholarship — Student Scholarship through Minnesota Medical Foundation An annual scholarship is provided to a medical student selected by the MMF for outstanding achievement and participation in organized medicine. (Continued on page 30)

Thank You For Your Donations to the West Metro Medical Foundation!! Tor C. Aasheim, M.D. Charles D. Adkins, M.D. Howard J. Ansel, M.D. Bruce J. Bart, M.D. Lee H. Beecher, M.D. Phillip Bloom, M.D. Florence J. Bouthilet, M.D. David L. Bowlin, M.D. Robert D. Christensen, M.D. Raul Cifuentes, M.D. James S. Cole, M.D. Gary Copland, M.D. James L. Craig, M.D. Michael J. Cumming, M.D. Robert E. Doan, M.D. Dale T. Dobrin, M.D. Bradley M. Doeden, M.D. Daniel H. Dunn, M.D. Thomas C. Eisenstadt, M.D. John A. Eklund, M.D. Richard J. Frey, M.D. James M. Gayes, M.D. Stanley M. Goldberg, M.D.

The Journal of the East and West Metro Medical Societies

Carol M. Grabowski, M.D. Robert A. Green, M.D. Julia V. Grigoriev, M.D. John A. Hartwig, M.D. Kristin C. Haugan, M.D. Jeffrey S. Herman, M.D. William R. Hilgedick, M.D. Neil R. Hoffman, M.D. Charles S. Hoyt, M.D. Gerald D. Jensen, M.D. David C. Johnston, M.D. Matthew P. Jones, M.D. Barbara Knoll Arndt, M.D. James R. Krause, M.D. Laurel A. Krause, M.D. John E. Kyllo, M.D. Arthur K. Larson, M.D. Richard D. Lentz, M.D. G. Patrick Lilja, M.D. Charles E. Lindemann, M.D. John H. Linner, M.D. Bradley M. Linzie, M.D. Virginia R. Lupo, M.D.

Richard C. Lussky, M.D. Deane C. Manolis, M.D. Henry C. Meeker, M.D. Duane L. Orn, M.D. Julien V. Petit, M.D. Richard A. Pfohl, M.D. Gregory A. Plotnikoff, M.D. Douglas J. Pryce, M.D. Frank S. Rhame, M.D. Patrick J. Scanlan, M.D. Richard D. Schmidt, M.D. David E. Schneider, M.D. Albert J. Schroeder, M.D. Martin A. Segal, M.D. Richard K. Simmons, M.D. Edward A. L. Spenny, M.D. Jens A. Strand, M.D. John A. Tobin, M.D. Joseph M. Tombers, M.D. C. Dwight Townes, M.D. John A. Twomey, M.D. Robert M. Wagner, M.D.

May/June 2009


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

The West Metro Medical Foundation (formerly Hennepin Medical Foundation) is the philanthropic arm of the West Metro Medical Society. The Foundation was established in 1968 as a 501(c)(3) organization to improve the general health of the public and to promote education and research. To this end, the WMMF provides grants to community initiatives and programs focused on improving the public health. Seed money is awarded for program development and support of community service organizations. The initial funding for the WMMF came through estate giving and proceeds from a mass rubella immunization program. Funding today continues to be received through memorials, estate gifts and the annual solicitation of the medical society membership and community hospitals. Gifts to the West Metro Medical Foundation can be made at any time. Please consider a donation in honor or memory of a loved one as well as a gift in the form of a bequest. Without your support, several of these organizations would not have the means to continue to provide the outreach and unique services to the families in our local community. Every dollar counts. Your generous giving is appreciated.

WMMF (Continued from page 29)

University of MinnesotaCLARION Student Case Competition CLARION seeks to develop student leaders from the Academic Health Center who will redefine health care to produce the most equitable, highest quality system possible. The CLARION curriculum is a year-long succession of experiential activities culminating in a “capstone event” — a Case Competition in which inter-professional teams of students present a root cause analysis of a fictitious sentinel event to a panel of seniorlevel health care executives and practitioners. Ultimately, CLARION has served as a catalyst for faculty across the health professions to develop ways to integrate inter-professional opportunities into the formal curricular education and experience of AHC students. West Metro Medical Society Alliance Continued funding of the STI/HIV/AIDS Education Folder Project allows for the updating and printing of the education folder. The Alliance recently celebrated the 10-year success of this project, noting that 276,000 folders have been

distributed to schools throughout the state of Minnesota. “While we have no actual proof that we have saved a life with this folder, we know in our hearts that because of our efforts at least one child has made a healthy choice!” Dianne Fenyk, project co-chair.

WMMF Board members: Richard K. Simmons, M.D., Chair Paul F. Bowlin, M.D. E. Duane Engstrom, M.D. Virginia R. Lupo, M.D. Deane C. Manolis, M.D. Burton S. Schwartz, M.D. Edward A. L. Spenny, M.D. Trish Vaurio (West Metro Medical Alliance representative) Elizabeth Hurliman, Ph.D. (medical student representative) Brian Johns, MFA (medical student representative) Richard D. Schmidt, M.D. (WMMS Board Chair) Edward P. Ehlinger, M.D. (WMMS President) Anne M. Murray, M.D. (WMMS Immediate Past Chair)

HARVEY M. MORAL, M.D. died recently at the age of 86. He graduated from Albany Medical College of Union University, Albany, NY. and completed his residency at Albany Hospital, Albany, NY and Boston, MA. He practiced general surgery at Mount Sinai, Methodist Hospital and Golden Valley Health Center and was an Associate Professor at the University of Minnesota. Dr. Moral served in the U.S. Army Medical Corp during WWII and was awarded the Bronze Star, Croix de Guerre and Fleur de Lis. MARK L. NORMAN, JR., M.D. passed away March 27, 2009 of complications after cardiac surgery in Naples, Florida. He was 84. He graduated from the Medical College of Wisconsin, Milwaukee. Dr. Norman enjoyed a busy ophthalmology practice. He served in the Navy during WWII, Pacific Theatre, commanding LSM 158, as Lieutenant junior grade. JOSEPH ANTHONY RESCH, M.D., passed away peacefully on February 28, at the age of 94 due to complications from an inoperable aortic aneurysm. He graduated from the University of Wisconsin Medical School, Madison in 1938. He served in the Army Air Corp from 1940-1946 as a flight surgeon rising to the rank of Lt. Col. Upon returning home from WWII, he completed a residency in Neurology at the University of Minnesota. Following his residency, he divided his time between teaching at the university and private practice, co-founding the Minneapolis Clinic of Neurology and Psychiatry. Dr. Resch returned full time to the University of Minnesota School of Medicine in 1962 as a professor of Neurology teaching residents and conducting research in neuroimmunology and cerebral vascular disease for which he became internationally known. As operations manager, he contributed to the neurology program becoming one of the largest in the country. In 1976 he became the second head of Neurology, stepping down in 1982. For a decade during this time he served as Assistant Vice President of Health Sciences. He was instrumental in the forming of the American Academy of Neurology (AAN), and as a board member in the 1970s helped retain their national headquarters in the Twin Cities. The AAN saluted Dr. Resch in March 2008 as it celebrated its 60th anniversary.

May/June 2009

Brian Henjum, M.D., Family Physician North Memorial Clinic-Minnetonka (Representing North Memorial Health Care)

Gregory J. Pflaster, M.D., Pediatrician Partners in Pediatrics (Representing Children’s Hospitals & Clinics Minneapolis) New Members (Continued from page 28)

in Memoriam


Introducing New WMMS Board Members


Kevin R. Walker, M.D. Department of Orthopaedic Surgery Orthopaedic Surgery, Pediatric Orthopaedic Surgery Randy K. Ward, M.D. Broadway Family Medical Clinic Pediatrics, Family Medicine Neil F. Wasserman, M.D. Department of Radiology Diagnostic Radiology Yoichi Watanabe, M.D. Department of Radiology Radiology Bevan Yueh, M.D. Department of Otolaryngology Otolaryngology Therese Zink, M.D. Department of Family Medicine and Community Health Family Medicine

Medical Students (University of Minnesota)

Heather J. Bell

Resident Physicians Taimur Khan, M.D. Shilpa Mikkilineni, M.D. Sophia L. Yohe, M.D. The Journal of the East and West Metro Medical Societies

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

BRENT ASPLIN, M.D., MPH, has accepted the position as chair of emergency medicine at Mayo Clinic, Rochester, MN. RICHARD M. BERGENSTAL, M.D. has been named president-elect of medicine and science for the American Diabetes Association. In addition, Dr. Bergenstal received the 2008 Bruce Zimmerman Diabetes Award from the Minnesota Diabetes Steering Committee and the Minnesota Department of Health Diabetes Program.

GOYA RAIKAR, M.D. was recently elected president of the Minnesota chapter of the Society of Thoracic Surgeons.

JOSEPH M. TOMBERS, M.D. was selected as the Physician of the Year (2008) by the Fairview Southdale Hospital medical staff.

TIMOTHY SIELAFF, M.D., Ph.D., FACS will become president of cancer services at Allina Hospitals and Clinics, re-named The Virginia Piper Cancer Institute to adopt Abbott Northwestern Hospital’s cancer brand name.

The December 2008 issue of Minnesota Physician featured several physicians currently serving as Bush Medical Fellows. The following EMMS or WMMS physicians described their programs of study: AMY BURT, D.O., LOIE LENARZ, M.D., TERESA QUINN, M.D., BERNARDA ZENKER, M.D.

The Orthopaedic Trauma Association has named DAVID TEMPLEMAN, M.D. as its president.

CAREER OPPORTUNITIES See Additional Career Opportunities on the next page.

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

The University of Minnesota School of Nursing recognized FRANK CERRA, M.D. as the first recipient of the Richard Olding Beard Award, noting that he has been an advocate for nursing-led and interprofessional research to improve the health of Minnesota communities. CRUTCHFIELD DERMATOLOGY (Eagan, Minnesota) was awarded the Patriotic Employer Award from the National Committee for the Employer Support of the Guard and Reserve for the development of policies that made it easier for employees to participate in the National Guard and Reserve and supporting staff members who were involved with the Army National Guard and Reserve.


The Mankato Clinic is physician owned with a service area population of over 300,000. We offer outstanding benefits including generous CME allowance, health/disability/life and medical malpractice insurance, 401(k) plan and more. Mankato has exceptional recreational and cultural activities, excellent private and public school systems and Minnesota State University, Mankato. If you would like to join our growing practice, submit a detailed CV or call Mark S. Matthias, M.D., Chief Medical Officer at 507-389-8756 or Dennis Davito, Director of Provider Placement at 507.389.8654, Fax: 507.625.4353, Email:

The 2008 Medical Staff Recognition Award for Excellence in Clinical Care was presented to JORDAN DUNITZ, M.D. by his University of Minnesota health science colleagues. MetroDoctors

Family Practice Hospitalist Internal Medicine Pediatrics

The Journal of the East and West Metro Medical Societies

MANKATO CLINIC An AAAHC-accredited Clinic

May/June 2009


Career Opportunities


Please also visit for Career Opportunities.

Introducing the “Career Opportunities” section of MetroDoctors!

A great avenue for professionals to learn about job opportunities AND a perfect place for recruiters to promote openings! Recruiters, call for our special recruitment rate. Betsy Pierre, ad sales 763-295-5420

Great Partners, Great Staff, Great Patients, Excellent Income & Lifestyle Family HealthServices Minnesota, P.A. is looking for several Board Certified/Eligible Family Physicians to fill full-time, part-time or shared positions. Join our Independent Group of 64 physicians serving 13 clinic sites.


Paul Berrisford, 2025 Sloan Place, Suite 35, St. Paul, MN 55117 651-772-1572 • email:


May/June 2009


The Journal of the East and West Metro Medical Societies






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25 Advance Care Planning Project is Proceeding/ west Metro MedICal soCIety Colleague IntervIew Members in the News east Metro MedICal soCIet...