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CONTENTS VOLUME 11, NO. 6

NOVEMBER/DECEMBER 2009

2

Index to Advertisers

3

MMA House of Delegates Votes on EMMS and WMMS Consolidation

4

FEATURE

Reflections on a Health Care Career: Interview With Jack G. Davis

By Ed Ehlinger, M.D.

8 11

MMA Annual Meeting: September 16-18, 2009 H1N1 Update

By Jean Rainbow, RN, MPH, and Jayne Griffith, MA, MPH

Page 13

13

COLLEAGUE INTERVIEW

David C. Thorson, M.D.

17

Medical Students Receive White Coats 8th Annual Minnesota Health Care Dinner Party, Naples, Florida

18

The Joint Commission’s New Agenda

By William E. Jacott, M.D.

19

New Health Care CEO in Town: Patrick Geraghty, Blue Cross and Blue Shield of Minnesota

21

No Time for Standing Around

On the cover: Jack G. Davis, retiring as CEO, on 12/31/09. Article begins on page 4.

By Maureen K. Reed, M.D., FACP

30

Career Opportunities

Page 8

EAST METRO MEDICAL SOCIETY

22 23 24

President’s Message

25

EMMS Members Honored at MMA Annual Meeting

New Members Dept. of Health Update/Community Service Award/ Meaningful Market Based Health Reform Meeting/ Senior Physicians

WEST METRO MEDICAL SOCIETY

26 27 28 29

Page 4 MetroDoctors

The Journal of the East and West Metro Medical Societies

Chair’s Report WMMS Members Honored at MMA Annual Meeting/ In Memoriam New Members/Senior Physicians Association Alliance News November/December 2009

1

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

Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Katie R. Snow

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

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 Cover Photo by Daniel Snow Photography 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 reect the ofďŹ cial position of EMMS or WMMS. Send letters and other materials for consideration to MetroDoctors, East and West Metro Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com.

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.

2

November/December 2009

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 www.mnepilepsy.org

November/December Index to Advertisers Acute Care, Inc. .................................................31 CrutchďŹ eld Dermatology................................15 ENT Specialty Care ............................................ 6 Family HealthServices Minnesota, P.A. ......32 Healthcare Billing Resources, Inc. ...............17 Lockridge Grindal Nauen P.L.L.P. ...............12 Mankato Clinic ..................................................30 Minnesota Epilepsy Group, P.A...................... 2 Minnesota Physician Services, Inc. ...................

Inside Back Cover Minnesota Timberwolves................................10 The MMIC Group ................................................

Inside Back Cover Open Cities Health Center, Inc. ..................30 SafeAssure Consultants, Inc............................. 2 University of Minnesota CME ..........................

Outside Back Cover University of Minnesota Medical Center, Fairview ................... Inside Front Cover Uptown Dermatology & SkinSpa, P.A.......20 Wapiti Medical Group .....................................32 Weber Law OfďŹ ce .............................................17

MetroDoctors

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

ON-LINE ON-LINE

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www.safeassuremedical.com

The Journal of the East and West Metro Medical Societies

MMA House of Delegates Votes on EMMS and WMMS Consolidation AT THE RECENT Minnesota Medical Association annual meeting in Rochester, MN, the proposed consolidation between the East Metro Medical Society and West Metro Medical Society was discussed and acted upon, establishing the Twin Cities Medical Society (TCMS).

In preparation for the MMA annual meeting, a work group was convened by the MMA Speaker of the House, Dr. Lyle Swenson, with the purpose of assessing the impact of the proposed consolidation on the MMA. Representatives of the work group included delegates from all of the Trustee Districts from across the state. The group was chaired by Dr. David Luehr, past president of the MMA. The findings of the work group were shared with all of delegates attending the annual meeting.

Reference Committee A was chaired by Dr. Bob Moravec and was the place where the resolution was heard and a recommendation was then made to the House of Delegates. Many physicians lined up to testify on the resolution including current EMMS and WMMS elected leaders, Ron Hansen, M.D., Peter Wilton, M.D. and Ed Ehlinger, M.D. Many others testified, all in support of the proposed consolidation. There was not one speaker who testified in opposition to the consolidation.

The Reference Committee then deliberated behind closed doors and recommended that the original resolution be amended and adopted as follows: RESOLVED, that the MMA approve the consolidation of EMMS and WMMS into a single component medical society, and be it further RESOLVED, that the MMA House of Delegates authorize the MMA to issue a charter subject to the approval of the proposed combined metro societies’ Plan of Merger to become the new Twin Cities Medical Society as the successor organization of the East Metro Medical Society and the West Metro Medical Society, and be it further, RESOLVED, that the MMA Board of Trustees study the following issues, develop Bylaws amendments as appropriate, and report back MetroDoctors

to the House of Delegates on the following questions: 1) can one component medical society be subdivided into more than one Trustee District? 2) Should there be an upper percentage limit on the number of delegates that a component medical society be allocated in the House of Delegates? And 3) Should there be an upper percentage limit on the number of trustees that can be allocated from one Trustee District to the MMA Board of Trustees?

The House of Delegates approved Reference Committee A’s report, and the Resolution was therefore approved as amended.

Boards of Directors Vote Unanimously in Support of Plan of Merger On Wednesday, October 7, 2009, the Boards of Directors from EMMS and WMMS met in a joint session and reviewed the proposed Amendments to the WMMS Articles of Incorporation (changing its name to Twin Cities Medical

Society), and the Agreement and Plan of Merger which includes the Articles of Incorporation, including the newly named board of directors, and the new Bylaws, among many other documents. Presented by Henri Minette, legal counsel, the materials were reviewed at great length. The boards voted, in separate unanimous resolutions, to adopt the documents and to also recommend to the membership that the Plan of Merger and all of its accompanying documents be adopted.

Ballots were mailed in late October to the full membership. Your vote is needed! Assuming that the membership is supportive of the merger, Twin Cities Medical Society will become operational January 1, 2010. All documents related to the Plan of Merger, Articles of Incorporation and Bylaws of Twin Cities Medical Society are available on the MetroDoctors Web site: www. metrodoctors.com. If you have any questions, please contact Sue Schettle, CEO, EMMS at (612) 362-3799, Jack Davis, CEO, WMMS at (612) 623-2899, or your elected leaders.

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The Journal of the East and West Metro Medical Societies

November/December 2009

3

Reflections on a Health Care Career: Interview With Jack G. Davis FOR 45 YEARS JACK G. DAVIS HAS WORKED IN THE HEALTH

care field. His jobs have included being an orderly, assistant hospital administrator, pharmaceutical salesman, clinic administrator, medical staff development director, HMO administrator, and medical society leader. When Jack was hired as the CEO of Hennepin Medical Society in 1995, he “thought it would be a three to four year gig.” Fifteen years later, Jack is now scheduled to retire from the longest lasting job of his career. Not coincidentally, his retirement coincides with the consolidation of the East and West Metro Medical Societies into the Twin Cities Medical Society. This new organization is the culmination of Jack’s pragmatic and visionary leadership over the last 15 years.

To get Jack’s perspective of his experiences in the medical care field, my wife, Sally, and I invited him and his wife, Marilyn, to dinner at our home in south Minneapolis, just a few blocks from Jack’s boyhood home and the venues where he went to school, played hockey, rode streetcars, and learned many of the lessons that influenced his long career. On a beautiful and mosquito-free late summer evening we talked over a meal of brats, sauerkraut, corn, and a little gewürztraminer. In this relaxed setting the discussion, often interrupted by laughter and reflective stories, ranged from Jack’s early life experiences in south Minneapolis where he started working at age 14 to his view on the future of health care.

Marilyn helped add a perspective on Jack’s career that only a partner of 44 years could provide. Here’s a small part of that conversation.

Ed: How did you get started in the health care field?

Jack: My first exposure was at Methodist Hospital where I worked as an orderly. Unlike today when everything is so segmented, I got to work with lots of different people. It was kind of a neat environment. In a hospital setting all who wear the gown are treated equally by those who provide the care. I liked the complexity of the health care business and became interested in how physicians think — what was going on in their mind.

Ed: Did you ever consider becoming a physician?

Jack: I never had any interest in going to medical school. I was always an average student and proud of it. I worked full-time while at the University and I always found myself in the middle of the curve — that was my target and I hit it perfectly.

By Ed Ehlinger, M.D.

4

November/December 2009

Ed: How did that first experience in health care influence your career?

Jack: My family was in business so I’ve gravitated toward business. That first job, working with all those physicians, got me intrigued with the business side of medicine. I also loved the entrepreneurial spirit physicians had. That has been an integral part of my career. When I now look back over my career I see that my last job as CEO of a medical society is somewhat like being an orderly. I was there to help the physician serve the patient.

Ed: I understand that your time at Methodist Hospital influenced your life a lot more than just getting started in health care.

Marilyn: Jack and I met at Methodist.

Jack: I worked with a lot of orthopedic surgeons there. Orderlies did a lot of traction and did a lot of walking patients after surgery. Since patients were often there for four to six weeks, we frequently played cribbage with the patients. I spent a lot of time on the orthopedic floor. Marilyn was an assistant head nurse on the orthopedic floor. The rest is history.

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The Journal of the East and West Metro Medical Societies

Ed: How has that entrepreneurial spirit manifested itself in your career?

Jack: Here are just a few examples. Few people know this, but when I was the assistant hospital administrator in Milaca, the lab director and I started a company that made petri dishes. For that we needed sheep blood for the blood agar plates. The lab tech was good at drawing blood so, in the evening after our regular job, we would go out and wrestle sheep so we could draw their blood to get our own raw materials to make the plates. I got very good at pouring agar plates. We started this in the second story of a drug store in downtown Milaca. We had several hospitals that we shipped to. We had a steady business from several hospitals because it was a product that if you didn’t use it, it went bad.

We called it North Central Laboratories.

Ed: Have you stayed involved with that lab?

Jack: When I got a job as a pharmaceutical rep with Squibb in northern Minnesota, I got out of the lab business. I sold my share for about $1,200. I probably should have kept my share because my partner then got some investors and grew the business and moved it to St. Cloud where it became a large reference laboratory. It was later bought out by a group of pathologists and continues on to this day — an enterprise started over a drug store in Milaca.

Ed: Any other interesting examples?

on several women physicians. I could see that the decision makers in health care were going to be women so we needed more women physicians. It’s the females who get guys to go to the doc. They also take the kids to the clinic. When I brought female family practitioners into the practice in Hibbing, their schedules would be filled instantly. This was not the case when I brought a male physician on board. Hiring women physicians may be good for a variety of reasons, but it was certainly a good marketing and business decision.

Ed: What attracted you to the medical society?

Jack: When I was in Hibbing, during the seventies, I became intrigued with what Tom Hoban was doing at the Hennepin County Medical Society with Physicians Health Plan. And over the years, as I started HMO Iowa and managed Abbott Northwestern’s Select Care, I was always fascinated with what Tom was doing. When he retired, following in his footsteps was a logical next step.

Ed: How has the physician side of medicine changed during your tenure as CEO? Jack: I’ve seen a waning in collegiality. For better or for worse, when physicians who are now in their 70s or 80s were practicing, they were almost like priests in that they made vows to their profession. They were on call, they would make rounds, they would congregate in the Doctors Lounge of the hospital. Sometimes 50 to 60 doctors would be there in

Jack: Another example is what I did in Iowa. After working in Hibbing, (Continued on page 6) I found this job as the director of medical staff development at Iowa Methodist Medical Center in Des Moines. I managed the medical staff, three residencies, and credentialing.

This was prior to the time when physicians took on these functions as Vice President of Medical Affairs. That was a pretty cool job.

I was in the hospital about two years when the leadership of the medical staff whispered in my ear that Share Health Plan was coming to Des Moines. The leadership got some money together and asked me to start an HMO. I knew about HMOs from when I was in Hibbing and, since there wasn’t much else to do in Iowa (I couldn’t skate or ski), I figured I might as well start an HMO. I rented a space in downtown Des Moines and got funding from 200-300 or so physicians and started HMO Iowa. Iowa had little experience with HMOs so I helped the state commerce commissioner figure out what an HMO should look like and helped create some of the rules and regulations for HMOs in Iowa. Our first three clients were Iowa Methodist Medical Center, Bankers Life (the largest employer in town), and Maytag. In the first month we were profitable. The physicians eventually sold the HMO to Bankers Life.

The for-profit enterprises I started with the medical and WMMS staff share office space and jointly collaborate on several society are also an example of my entrepreneurial interests, EMMS projects. Standing from left: Nancy Bauer, managing editor, MetroDoctors; Kathy but you might be more interested in this example. When I Dittmer, WMMS Executive Assistant; Jennifer Anderson, WMMS Project Coordinator, was clinic administrator in Hibbing in the 70s, I brought Healthy Menus Minneapolis; Katie Snow, EMMS Administrative Coordinator. Seated: Jack Davis, WMMS CEO; Sue Schettle, EMMS CEO.

MetroDoctors

The Journal of the East and West Metro Medical Societies

November/December 2009

5

Jack Davis (Continued from page 5)

the morning. Today, you go to the Doctors Lounge and no one is there.

The medical society has a senior group of 400 physicians. It’s amazing to me that when they get together, the room is full of joy. They spend their time talking about their old anatomy professor in 1942. The vitality they show to each other is remarkable. They have some shared experiences.

Many of the senior physicians were trained at the U and they practiced in the same community. They may not have worked together but they never lost touch with each other or lost their respect for each other.

Medical practice today is much different. Today’s docs have trained in different places. They are on productivity. They often don’t go to the hospital anymore. Or they’ve chosen to turn their patients over to specialists or hospitalists. They don’t have a common history or opportunities to develop the collegiality that was present in the past. For example, my predecessor in the medical society used to have meetings every night. You can’t do that any more. People don’t want to go to meetings every night.

Ed: Has this led to less of a consensus on issues today than in the past?

Jack: I think the diversity of opinions was always there. It’s just more visible today. There was a different kind of respect in the past. There was a deference given to the physicians with more experience. Today, it’s much more egalitarian.

I also think that today’s physicians, at least the ones that are active in organized medicine, have become a bit edgier — especially on policy issues. They are more willing to speak up.

6

November/December 2009

Ed: Do physicians want the medical society to become more active in policy issues?

Jack: That’s what physicians want. They understand that policies at all levels affect their clinical practice. I frequently get a “thank you for the tobacco effort, thank you for the fair contracting bill, etc.” I’ve also tried to get physicians to get involved with policy work because they have the stories that help get policies passed. Unlike medicine, which relies on data and science, policies are built on the experiences of a few people. A single story can make a difference and individual physicians can make that difference with their stories.

Ed: What are some of your lesser known contributions?

Jack: I’ve tried to focus on leadership development within the membership. One of my jobs was to stage leadership over the years. Society leadership has been great. Looking forward we’ve got the leadership of the Twin Cities Medical Society in place for the next several years. (This is also good for membership because the leaders have to stay involved.)

I’ve also encouraged members to get involved in leadership positions in the MMA. In that process I’ve helped keep the voice of physicians at the table. I’ve encouraged them to be involved and active and feisty. I hope this has kept physicians from being stifled.

I’ve also added some financial stability to the medical society. When I came to the Hennepin Medical Society they had more resources than we do now, but there were modest reserves. I could see that the financial picture would change over the years, so I planned accordingly. As expenses

MetroDoctors

The Journal of the East and West Metro Medical Societies

increased without matching revenue, having a reserve has been invaluable.

Ed: Is that changing financial picture part of the reason behind the consolidation of the EMMS and the WMMS? Jack: I think the consolidation is an imperative. Few have questioned the wisdom of the move. We don’t have the resources to continue on as we’ve been going. It’s an economic issue.

The consolidation will stabilize the two medical societies and assures that physicians will continue to have a strong voice.

The issues facing the medical society are no different than the issues facing health care. We don’t have the resources to continue as we have been. We need to figure out how to get the same or better outcomes with fewer resources or find a different way of distributing existing resources. I think that’s what health care reform is going to be about. Everybody’s ox is going to be gored a little bit.

Jack Davis and his wife, Marilyn, in their garden.

Ed: Marilyn, what do you think are Jack’s biggest accomplishments with the medical society?

Marilyn: I think the smoke free bar and restaurant program was huge.

I’m also really exited about his work with the menu labeling initiative.

But I think the biggest thing is that Jack has been able to work well with physicians. He’s been able to understand their problems, where they are coming from, and really empathize with them. He has certainly enjoyed working with them.

Ed: We’re sometimes irascible. What has made you so effective in working with docs?

Jack: I’ve always been very comfortable with docs. Others might be intimidated by them but I could jawbone with the dean of orthopedic surgery at Methodist even when I was a 140 pound wet behind my ears orderly. I’ve always been interested in how they think and what goes on in their minds. That helped with selling pharmaceuticals, running a group practice, and running the medical society. In all of these areas, physicians are your most valuable resource. It is imperative to work well with them.

I’ve always been able to be upfront with physicians and they’ve been upfront with me. That’s a recipe for getting things done. For example, I remember when I was a lay manager of a physician-owned clinic. I was managing the owners of the clinic. That takes a unique skill set. I was 31 and many of the docs were in their 50s and 60s. One of the docs, a former president of the MMA, came to me when I started and said “I want you to make one promise. If you ever hear any rumblings about my losing my skills or abilities or anyone questions my judgment, I want you to tell me and I’ll be gone.” Sure enough, three or four years later some concerns were raised about his skills so I went to him and suggested that he should consider doing more office practice and wind down his surgery practice. He thanked me with great sincerely and shortly thereafter announced his retirement. He did that because he respected my opinion.

Those are tough things to do but important. He was upfront with me and I was upfront with him.

MetroDoctors

The Journal of the East and West Metro Medical Societies

Ed: What will you miss?

Jack: I’ll miss the 40 minute drive. Seriously, I will miss the intellectual challenge and interacting with people.

Ed: What are you looking forward to?

Jack: I’m looking forward to having more time to travel, work on our house, garden, and do a bit of consulting. I may also get involved with the Stillwater Bridge. They’ve been talking about that as a problem for 50 years. I’m also looking forward to spending more time with Marilyn.

We spend all of our time together now. I expect we will also after I’m done working.

Ed: Marilyn, what are you looking forward to?

Marilyn: I am looking forward to having him around more. I probably wouldn’t have said that a year ago, but I have come around and decided that that will be a good thing. We will enjoy our time together.

Jack: I’ll tell you what Marilyn is really looking forward to and you can print this. I’ve got all these years of management experience — 45 years. I started out as second in command as a hospital administrator. But since then I’ve seldom been in a subordinate role — drug detail rep, CEO of an HMO, clinic administrator, president of HMO Iowa, CEO of Select Care, CEO of WMMS. When I retire I’m going to take this wealth of experience and I am going to whip our household into shape. I’m going to get on a high stool with a megaphone and get some improved efficiency.

Marilyn: And you will be awfully lonely up there.

All: Well said: cheers!

November/December 2009

7

00$ $QQXDO 0HHWLQJ 6HSWHPEHU Lyle Swenson, M.D., speaker of the House of Delegates, called the 156th annual meeting of the Minnesota Medical Association to order on Wednesday, September 16, 2009 in Rochester, MN. East Metro Medical Society and West Metro Medical Society physicians were well represented throughout the meeting in deliberations of the reference committees as well as in celebration and recognition of accomplishments. Benjamin Whitten, M.D., (WMMS) was duly installed as the president of the Minnesota Medical Association. Included in this article is a brief recap of election results, recognition awards, and a listing of resolutions submitted by EMMS and WMMS members.

Medical Society caucuses were convened early on both Thursday and Friday mornings, allowing for a review of the resolutions and reference committee reports. Peter Wilton, M.D. served as the EMMS caucus chair, and Benjamin Chaska, M.D. chaired the WMMS caucus. Several EMMS and WMMS physicians served on the reference committees: Todd Arnsenault, M.D., EMMS, Reference Committee B Amy Burt, D.O., WMMS, Chair, Reference Committee C Anne Edwards, M.D., WMMS, Reference Committee B

Robert C. Moravec, M.D. EMMS, Chair, Reference Committee A Stephanie Stanton, M.D., EMMS, Reference Committee A Elizabeth Vogel, medical student, WMMS, Reference Committee A Sabrina Walski-Easton, M.D., WMMS, Reference Committee C Ann Wendling, M.D., MPH, EMMS, Reference Committee C Eugene Ollila, M.D., WMMS, Credentials Committee

Benjamin H. Whitten, M.D. was installed as the 143rd president of the Minnesota Medical Association.

EMMS and WMMS Physicians Receiving Awards:

MMA Election Results:

President â&#x20AC;&#x201C; Benjamin Whitten, M.D. (WMMS) President-Elect â&#x20AC;&#x201C; Patricia J. Lindholm, M.D. Secretary/Treasurer â&#x20AC;&#x201C; David E. Westgard, M.D. Speaker of the House â&#x20AC;&#x201C; Lyle J. Swenson, M.D. (EMMS) Vice Speaker of the House â&#x20AC;&#x201C; Karen Dickson, M.D. (WMMS) Chair, Board of Trustees â&#x20AC;&#x201C; David C. Thorson, M.D. (EMMS) West Metro Trustees: Drs. Benjamin W. Chaska and Roger G. Kathol East Metro Trustees: Drs. David C. Thorson and V. Stuart Cox, III AMA Alternate Delegate â&#x20AC;&#x201C; David L. Estrin, M.D. (WMMS)

Community Service Award â&#x20AC;&#x201C; Honors MMA members who are actively engaged in the practice of medicine and have an outstanding record of community service: Donald S. Asp, M.D. (EMMS) Neal R. Holtan, M.D. (EMMS) Minority Affairs Meritorious Service Award â&#x20AC;&#x201C; Honors MMA members who provide outstanding medical service to minority populations by improving their access to care, eliminating racial barriers, and understanding the health concerns of minority patients within the context of their cultures.

J. Michael Gonzalez-Campoy, M.D. (EMMS) Physician Communicator Award â&#x20AC;&#x201C; Honors a physician who demonstrates exemplary skill in communicating with the public through radio, television, or the newspapers and whose work contributes to a better understanding of medicine and health in Minnesota: Peter J. Dehnel, M.D. (WMMS)

EMMS and WMMS delegates caucused jointly on Friday morning, reviewing the reports from the Reference Committees.

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November/December 2009

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Presidentâ&#x20AC;&#x2122;s Award â&#x20AC;&#x201C; Presented to persons who have made outstanding contributions to the MMA but have never been elected to a major

The Journal of the East and West Metro Medical Societies

office or recognized by the MMA for their dedication and commitment.

Edward P. Ehlinger, M.D. (WMMS) Decade Awards – Physicians present who have practiced medicine and maintained their MMA membership for 50+ years: Charles N. Bean, M.D. – 52 years (WMMS) Joseph A. Cella, M.D. – 51 years (WMMS) Robert E. Doan, M.D. – 52 years (WMMS) Arthur K. Larson, M.D. – 52 years (WMMS) W. Wyatt Moe, M.D. – 50 Years (WMMS) Ralph H. Swanson, M.D. – 50 years (EMMS) EMMS and WMMS Resolutions:

The following resolutions were submitted by EMMS and WMMS members to the House of Delegates. Please visit our Web site, www. metrodoctors.com, for a complete report on the final actions taken on the EMMS and WMMS resolutions.

Resolution #103 Consolidation of East Metro Medical Society and West Metro Medical Society.

Resolution #201 The Role of Primary Care Medical Providers in Reducing Caries as Part of Well-Child Care.

Resolution #202 Enactment of Minnesota “Apology Laws” to Encourage Physicians to Disclose Medical Error.

Resolution #203 Payment Parity to Health Plan Patients Who See Out-of-Network Psychiatrists.

Resolution #204 MMA Promotion of Addiction Awareness and Community Collaborations.

Resolution #206 Obesity Carve-out Language.

Several EMMS and WMMS physicians provided testimony before the reference committees.

Pictured at the microphone: Richard Morris, M.D. (WMMS); followed by Carl Burkland, M.D. (WMMS) and Amy Gilbert, M.D. (EMMS).

MetroDoctors

Robert Moravec, M.D. (EMMS) served as chair of Reference Committee A. Stephanie Stanton, M.D. (WMMS) and Elizabeth Vogel, medical student (WMMS) also participated on the Committee.

Resolution #303 Adoption of Comprehensive Tobacco Cessation Benefits.

Resolution #308 Corporate Practice of Medicine and Fee Splitting Prohibition.

Resolution #304 Minnesota Medical Association to Support HF 1865, The Healthy Minnesota Plan.

Resolution #309 High Deductible Health Plan (HDHP) Combinations for Medical Assistance and Other Public Programs: “Medical IRAs for the Poor.”

Resolution #305 Consumer-Directed Reforms for Minnesota State Health Programs.

Resolution #306 Minimum Drinking Age. Resolution #307 Minnesota Medical Association Support the Concept of Health Reimbursement Arrangements (HRAs) and Other High Deductible Health Plans (HDHPs) for Public Sector Populations.

Resolution #310 Prohibit Payments for Volume of Referrals.

Resolution #311 Work Group to Study MMA Policy Relative to Rapid Changes in the Medical Care System.

Resolution #314 Standardized Policy and Practice on Vaccinations for Hospital Medical Staffs.

Thank you to the following EMMS and WMMS physicians who served as delegates to the MMA. EMMS Delegates Donald Asp, M.D. Richard Baron, M.D. Arthur Beisang, M.D. Blanton Bessinger, M.D. Todd Brandt, M.D. V. Stuart Cox, M.D. George Edmonson, M.D. Linnea Engel, medical student Robert Geist, M.D. Amy Gilbert, M.D. J. Michael Gonzalez-Campoy, M.D. Ronnell Hansen, M.D. Stephanie Koonce, M.D. Lynne Lillie, M.D. Nicholas Meyer, M.D. Robert Moravec, M.D. Thomas Siefferman, M.D. Stephanie Stanton, M.D. Phillip Stoltenberg, M.D. Gregory Taylor, M.D. Charles Terzian, M.D. David Thorson, M.D.

The Journal of the East and West Metro Medical Societies

Jessica Voight, medical student Ann Wendling, M.D. Kent Wilson, M.D. Peter Wilton, M.D. WMMS Delegates Michael Ainslie, M.D. Beth Baker, M.D., Lee Beecher, M.D. Carl Burkland, M.D. Amy Burt, D.O. Benjamin Chaska, M.D. Timothy Crimmins, M.D. Roger Day, M.D. Peter Dehnel, M.D. Amos Deinard, M.D. Anne Edwards, M.D. Edward Ehlinger, M.D. David Estrin, M.D. Patricia Fontaine, M.D. Aaron Friedman, M.D. Carol Grabowski, M.D. A. Stuart Hanson, M.D.

Philip Hoversten, M.D. Donald Jacobs, M.D. Mary Kathol, M.D. Roger Kathol, M.D. Kenneth Kephart, M.D. Renee Koronkowski, M.D. Louis Ling, M.D. Virginia Lupo, M.D. Jordan Marmet, M.D. Harry Marshall, M.D. Lisa Mattson, M.D. Richard Morris, M.D. Eugene Ollila, M.D. Douglas Pryce, M.D. Edward Spenny, M.D. Lynn Steiner, M.D. Karin Tansek, M.D. T. Michael Tedford, M.D. Louise Turkula, M.D. Elizabeth Vogel, medical student Craig Walvatne, M.D. Benjamin Whitten, M.D. James Young, II, M.D.

November/December 2009

9

OCTOBER 28 VS. NEW JERSEY NETS

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VS. ORLANDO

FOR MORE INFORMATION CONTACT Carrie Schmid at 612.673.1684 or email cschmid@timberwolves.com

10

November/December 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

+ 1 8SGDWH Editor’s Note: This article was prepared in early October and reflects information available at that time.

T

HE APPEARANCE OF NOVEL in-

fluenza A (H1N1) and subsequent pandemic declaration last spring will likely contribute to an unusually long and unpredictable flu season this year. Influenza activity associated with novel H1N1 peaked in the United States during May and June and declined during July and early August. Large outbreaks of novel H1N1 began again with the comingling of students in schools and universities in mid-August. Waves of seasonal influenza among the elderly will likely appear toward the end of the 2009-2010 flu season.

The novel H1N1 virus is antigenically and genetically distinct from other human influenza A (H1N1) viruses that have been circulating since 1977. As of August 1, 2009, the novel influenza A (H1N1) viruses circulating worldwide appear to be antigenically similar. Novel H1N1 virus is thought to be a reassortment of four known strains of influenza A virus found in the U.S., Europe and Asia: one human, one avian, and two swine. Transmission of this new strain is human-to-human.

Novel H1N1 overpowered seasonal strains during influenza season in most countries in the southern hemisphere this past summer and is likely to continue to replace older circulating viruses, a pattern seen in past pandemics. As of this writing, novel H1N1 accounted for 76 percent of influenza viruses circulating globally (WHO), and 96 percent of influenza strains tested in the prior week in the U.S. (CDC).

Novel H1N1 appears to be more contagious than seasonal influenza; serologic studies

By Jean Rainbow, RN, MPH, and Jayne Griffith, MA, MPH

MetroDoctors

suggest little to no immunity exists in the population, and some components of the virus that facilitate person-to-person transmission, particuJean Rainbow, RN, MPH Jayne Griffith, MA, MPH larly among children and young adults, are different than seasonal influenza. It appears seriously ill, and to reduce the risk of promoting that novel H1N1 infection results in mild, antiviral resistant novel H1N1 when antivirals self-limiting disease in most people and the are used prophylactically. As of this writing, virus has not become more virulent over time.

99.6 percent of novel H1N1 viruses tested at Those who are at high risk of complicathe CDC have been susceptible to oseltamivir tions from novel H1N1 include children and and all have been susceptible to zanamivir. pregnant women. In September 2009, the CenClinical trials to evaluate safety and dosters for Disease Control and Prevention (CDC) ing among various age groups are taking place reported on the deaths of 36 children, ages 2 at eight academic sites across the U.S., and a months to 17 years, from H1N1. Approxitrial enrolling pregnant women has just begun. mately two-thirds of the deaths occurred in Novel H1N1 vaccine is expected to be available children with nervous system disorders such as initially in limited quantities in mid-October. muscular dystrophy or cerebral palsy, or chronic The CDC’s Advisory Committee on Immulung disease. However, some were previously nization Practices (ACIP) recommends that healthy and had acquired secondary bacterial certain groups at highest risk for infection or infections (i.e., staphylococcus or streptococcus influenza-related complications should be the species caused infections) following influenza initial targets for vaccination. infection. While it is too soon to determine The CDC and state and local health dewhether H1N1 will be more deadly in children partments are conducting additional surveilthan other strains of influenza, it seems to be lance of influenza-related hospitalizations and affecting chronically ill children more than deaths during this pandemic. Specifically, surseasonal influenza typically does. veillance efforts are targeted to detect changes Due to alterations in immune, cardiovasin the virulence or reassortment of the virus, secular and respiratory systems, pregnant women verity of the illness, and resistance to antivirals. are at higher risk for influenza-associated morRoles and Expectations bidity and mortality. Six percent of H1N1 for Clinicians deaths in the U.S. have occurred in pregnant The H1N1 pandemic is constantly evolving, women; prevalence of pregnant women is requiring the Centers for Disease Control and 1 percent. Pregnant women are hospitalized Prevention (CDC) and the Minnesota Departwith H1N1 at least four times more often than ment of Health (MDH) to continually update the general population. their recommendations. Please check their Web Judicious use of antivirals for treatment and prophylaxis is encouraged to ensure an ad(Continued on page 12) equate supply is available to treat those who are

The Journal of the East and West Metro Medical Societies

November/December 2009

11

H1N1 (Continued from page 11)

sites (www.cdc.gov or www.ďŹ&#x201A;u.gov and www. state.health.mn.us) regularly. If you prefer to receive e-mail notiďŹ cations about changes, you can sign up at www.ďŹ&#x201A;u.gov for CDC announcements and at http://www.health.state.mn.us/ divs/idepc/diseases/ďŹ&#x201A;u/h1n1/index.html for updates from MDH. There are a number of disease prevention measures that clinicians can take during this yearâ&#x20AC;&#x2122;s inďŹ&#x201A;uenza season. All who are involved with direct patient care should get their annual seasonal ďŹ&#x201A;u shot and the novel H1N1 inďŹ&#x201A;uenza immunization if they have not already done so in order to protect their patients and themselves.

As always, but especially this year, it is important for health care workers to practice good infection control and to use appropriate personal protective equipment (PPE). More information about recommended infection control precautions is available at the CDC and MDH Web sites. Prophylactic antiviral medications may be advised for health care workers who have been exposed to H1N1 inďŹ&#x201A;uenza due to a breach in PPE (again check

CDC and MDH Web sites for current recommendations). Health care staff who become ill with inďŹ&#x201A;uenza-like illnesses should stay home for seven days from onset of illness or until fever has resolved for 24 hours without the use of fever-reducing drugs, whichever is longest.

As with seasonal inďŹ&#x201A;uenza, it appears that most previously healthy individuals with novel H1N1 inďŹ&#x201A;uenza will have self-limited disease and will not need medical attention.

Providers can encourage their patients with non-urgent concerns to call before presenting for care to determine if a clinic or emergency department visit is indicated. MDH is only accepting specimens for H1N1 testing from hospitalized patients or those with recent occupational or other signiďŹ cant swine contact.

Hospitalized patients are tested in order to evaluate those most seriously ill with H1N1.

Testing swine workers does not imply they contracted H1N1 from pigs; testing is done because it has been documented in swine herds in Canada, Argentina, Australia and England that the virus can be transmitted from people to swine. Refer to the MDH Web site for updates on H1N1 testing as testing parameters may change.

4HE ,AWYERS ,OBBYISTS

4HAT $OCTORS 4RUST ,OCKRIDGE 'RINDAL .AUEN HELPS OUR HEALTH CARE CLIENTS MEET THE CHALLENGES POSED BY TODAY S RAPIDLY CHANGING HEALTH CARE ENVIRONMENT 4HE FIRM S ATTORNEYS AND LOBBYISTS PROVIDE REPRESENTATION IN

Jean Rainbow, RN, MPH graduated from University of Iowa and received her Masters of Public Health in epidemiology from the University of Minnesota. She has worked at the Minnesota Department of Health in the Emerging Infections Program for 14 years on the unexplained deaths project, surveillance for invasive bacterial disease, and most recently on pandemic inďŹ&#x201A;uenza planning related to the use of antiviral medications.

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Jayne GrifďŹ th, MA, MPH is an infectious disease epidemiologist at the Minnesota Department of Health. She received her M.A. in Educational Psychology and MPH in Epidemiology from the University of Minnesota. In the absence of a pandemic, she works on bioterrorism disease surveillance and preparedness efforts.

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November/December 2009

As the inďŹ&#x201A;uenza season progresses, antiviral medications may become scarce due to heavy demand so recommendations for their use may change over time. Currently, the CDC recommends that highest priority should be placed on treating patients hospitalized with inďŹ&#x201A;uenza-like illness, persons who are at high risk for complications [pregnant women, young children (less than 5 years and especially less than 2 years old), adults over age 65 years, individuals with chronic medical conditions and residents of long-term care facilities] who have inďŹ&#x201A;uenza-like illness or may be used for prophylaxis of the same individuals who have had close contact with someone with an inďŹ&#x201A;uenza-like illness. Once again, it is best to check the CDC and MDH Web sites for the most current recommendations.

Empiric antiviral therapy should be started for individuals with inďŹ&#x201A;uenza-like illness who are at high risk for complications. Antiviral medications are most effective when begun soon after onset of illness so it is best not to wait for test results. Rapid inďŹ&#x201A;uenza diagnostic tests are not highly sensitive so one should not assume a patient does not have inďŹ&#x201A;uenza if he or she has a negative rapid test result.

Among the most effective measures that health care providers can take and can encourage their patients to use to help minimize transmission of illness is to stay home when ill, use good hand hygiene, and use good respiratory etiquette (e.g. cover your cough).

InďŹ&#x201A;uenza season is always unpredictable, and pandemics even more so. Information will continue to evolve repeatedly so take steps to keep yourself informed.

MetroDoctors

The Journal of the East and West Metro Medical Societies

COLLEAGUE INTERVIEW

A Conversation With

David C. Thorson, M.D.

D

How did your dad’s career influence your career in medicine?

My father was a family physician. He practiced in South Minneapolis until he left private practice to help develop the Family Medicine Residency at Hennepin County Medical Center. I remember going on house calls with him and also seeing how he gave back to the community. He had many volunteer activities including student health services at Augsburg College and the YMCA. After medical school I had the unique opportunity to do my residency at Hennepin County Medical Center where he was Chief of Family Medicine. In retrospect it was during this time of my life that I really learned to appreciate him as a physician in addition to his role as a father. I saw what a great a clinician he was. I learned hands-on diagnostic skills from him. But most importantly, he taught me to listen to patients and encouraged me in the direction of family medicine and sports medicine. He supported Rob Johnson and I in the development of the sports medicine fellowship program at HCMC. In medical school, he introduced me to MAFP and the Minnesota Medical Association, and I attended many meetings of both organizations with him throughout medical school and residency. It was during these travel opportunities that I learned the value of organized medicine and the importance of specialty societies. Throughout my practice I’ve tried to emulate his style of developing long-term relationships with patients by listening, giving back to the community through volunteer activities and being active in my own specialty society and organized medicine in general.

MetroDoctors

The Journal of the East and West Metro Medical Societies

Photo by Steve Wewerka

avid C. Thorson, M.D. was recently elected Chair, MMA Board of Trustees. A board certified family physician with certificate of added qualification in sports medicine, Dr. Thorson received his medical degree from the University of Minnesota Medical School and completed a family medicine residency at Hennepin County Medical Center. He is a member of the East Metro Medical Society and Minnesota Medical Association and has served as an East Metro Trustee since 2006. In addition he has been a member of the MMA Executive Committee, Health Care Reform Oversight Committee and the EMMS Board of Directors. Dr. Thorson serves as the team physician for the St. Paul Saints, United States Ski Team, United States Freestyle Team, Mahtomedi High School and the Twin Cities Marathon.

He practices at Family HealthServices Minnesota, P.A. Questions were provided by: Drs. Lee H. Beecher, Edward P. Ehlinger, Donald M. Jacobs, and Roger G. Kathol.

Many health care observers in and out of the medical community view family medicine as a specialty looking to define its core competencies. Many primary care doctors are “specializing” in treatments or assessments, such as sports medicine. Please comment on the core values of family medicine practice and your sense of its future.

I’m not sure that family medicine as a specialty is struggling to define its core competencies as much as family physicians as individuals struggle with their own personal identity and needs within family medicine. I think a number of sub-specialists also find the need to further specialize because of their own individual needs, likes, dislikes and competencies.

As a family physician I continue to practice a broad range of family medicine and continue to do obstetrics. Personally, I completed a fellowship in sports medicine and approximately 30 percent of my practice is musculoskeletal medicine. I developed an interest in sports medicine early on in my career and have found it to add a level of enjoyment to my daily practice. It is important to me as a generalist to have an area in which I can excel and can serve as a resource for my group as well as for my patients. I think that being a generalist requires the ability to deal with uncertainty in a way that some sub-specialists can’t. I also think that some of the struggles are related to generational changes that are occurring as we change from baby boomers to generation Xers to (Continued on page 14)

November/December 2009

13

Colleague Interview (Continued from page 13)

generation Yers. Young physicians coming out of medical school and residency now have different expectations of how they want to practice medicine and how they want to integrate the practice of medicine into their lives. It is this generational change that is driving some of the transformational change within family medicine. I think the basic tenants of family medicine are to be a generalist, develop longitudinal relationships with patients and families and to provide comprehensive initial care with shared decision making. While the individual aspects of family medicine such as obstetrics, inpatient work, and being on-call all come into question episodically, the general principals as outlined above are still core principals of family medicine and remain unchanged since the beginning of family medicine programs. The future of family medicine is strong as we look at how we are going to provide value for patients. Minnesota has become known as a high value state in part because of the way Minnesotans collaborate. It is a unique situation where specialists and generalists and even insurance plans and purchasers can collaborate effectively the way we do in Minnesota. But also I think that the strong family medicine base in Minnesota contributes to this success. Many of the solutions to providing low cost, high quality care revolve around utilizing the principals of family medicine in a patient centered medical home.

One of the greatest challenges for general medical physicians is addressing the needs of patients with mental health and chemical dependence problems, nearly 60 percent of whom are seen only in primary care. Since two thirds of these patients currently receive no mental health or chemical dependence treatment, which leads to poor medical condition outcomes and high health service use, how do you propose that mental health and substance abuse professionals assist primary care physicians in medical home settings and be financially supported in the work that they do?

The integration of comprehensive mental health care in the primary care setting is indeed challenging. These challenges are not made any easier by insurance company carve-outs and societal prejudices. When you look at the data of mental illness that shows a shorter life span, higher utilization of resources, episodic care and less access to preventive medicine, it is obvious we have not dealt with individuals with mental illness very well.

As a leader in my organization, Family HealthServices Minnesota, P.A., we have been involved with the initial pilot program for the DIAMOND Project through ICSI and are looking very closely at how we can better integrate the care of mental illness into primary care and work in a more collaborative manner with psychology and psychiatry. We have developed relationships with psychologists and we have psychologists in most of our offices that are available to see our patients. Through the DIAMOND Project we have developed relationships with psychiatry in a way that allows us to have psychiatric consultations for more of our patients. I’m very pleased to report that the DIAMOND Project has

14

November/December 2009

been an overwhelming success in getting patients to remission status more quickly. However, we are still struggling with cost and reimbursement for this intensity of care. It is my hope that as we develop a clearer vision of the patient-centered medical home, we will be able to identify those patients who are at risk for or who have a mental illness, substance abuse problems or addictive behaviors earlier. Through collaboration with other health professionals such as psychology and psychiatry, we will achieve better access and improved outcomes. It is imperative that we obtain payment reform that will improve access to mental health, chemical dependency and addictive medicine specialists in a way that enhances the patient-centered medical home and improves outcomes.

What concerns and beliefs have driven you to give up practice and personal time to participate actively in “organized medicine?”

I did not suddenly wake up one morning and decide I needed to get more actively involved in organized medicine and make a decision to give up personal time and professional time to work toward this goal.

It has been a slow transition. It started as a child, watching my father’s involvement in organized medicine, going to those MAFP meetings and hearing physicians talk of the importance of being involved in organized medicine and how working together we can accomplish more than we can working separately. Those physicians felt that we needed one voice to speak out for the principles that we all felt strongly about. Listening to individual leaders within the Minnesota Academy of Family Physicians speak out about the importance of organized medicine and then reach out to me and mentor me and encourage me is what next inspired me to become more involved. In a similar way, the MMA has reached out to me. I was encouraged to get involved with the Wakota, then Ramsey, then East Metro and now, the soon to be Twin Cities Medical Society. I could not have done this if my group had not encouraged me to take time away to become more involved. The skills I’ve learned in family medicine — listening, problem solving, and “hands on” involvement — will help me become successful in my new role as chairman of the Board. I look back at past board chairs and am truly amazed that I’m in the same position as those I have looked up to over the past years.

It is my hope that my involvement will allow us to tackle challenging issues while within a framework of collaboration and open discussion.

What do you see as the key responsibilities of the MMA Board Chair and how does your background and experience prepare you for that challenge?

The roles of the board chair revolve around understanding the will of the House of Delegates. The chair needs to understand this will in order to facilitate the Board of Trustees to make decisions and set policy. At times, the chair needs to pursue, through committees, task forces and board work, statements of direction and policy that have not been addressed by the House. The chair provides oversight to the CEO and staff of the MMA and provides guidance to them on financial issues and oversight.

MetroDoctors

The Journal of the East and West Metro Medical Societies

The Minnesota Medical Association must compete with specialty medical societies and growing allegiance to clinic systems to retain members and sustain revenue. What, in your opinion, are three reasons why physicians should join the MMA or retain their membership?

If we continue to advocate for physicians to focus on what is best for patients, there will be little competition but instead common goals. The MMA presence is critical in the support of advocacy issues that affect physicians and patients. Without an organized voice, like the one the MMA provides, there is no one and no organization that speaks for all physicians without the influence of special interests.

Physicians need to come together, as often as possible, with one voice. In this regard, the AMA has it right! “Together we are stronger.” We need to have all stakeholders coming together to allow us to accomplish significant change.

There are many viewpoints on health care reform; only the MMA uniquely advocates for health care change from the perspective of physicians across the state. Membership in the MMA gives you input in this advocacy.

With any change, bringing more voices together will likely make for better solutions. More involvement helps buy in and makes success more likely.

many specialty organizations such as the American Academy of Family Physicians, as well as the American College of Pediatrics, have very similar plans. When you look closely there is great overlap and agreement. It is only by accepting the fact that health care reform must happen, and that we all will be affected by it, that we can work together to shape it in a way that will improve patient outcomes, decrease costs, and allow us to maintain our relationships with patients.

Most patients and their families are capable of engaging in cost and quality discussions with their doctors and treatment teams. Do you envision the MMA actively soliciting and responding to health care issue identification via collaborations with patients or patient advocacy groups?

The Dartmouth study has shown that shared decision making is something that works well and when patients are educated regarding their choices, they often will choose a less expensive route. By educating physicians in the shared decision making process, decisions will be individualized for each patient within the confines of the patient-physician relationship. I am uncomfortable making these types of decisions based on groups of individuals with a specific diagnosis or having these decisions made in the political venue. By providing patients with information and educating them regarding the choices available to them, the benefits, risks and costs, each patient will be able to make the best choices for themselves.

How can MMA and the Component Medical Societies help each other be most effective in meeting their missions?

In order for the Component Medical Societies and the MMA to be most effective, we need to develop more effective communication pathways that will allow us to transfer information to all levels — leadership, members, and staff — in a timely way. This timely transparent communication should allow us to work through disputes internally and present an external face that is consistent and will allow us to work toward common goals effectively.

(Continued on page 16)

Crutchfield Dermatology “Remarkable patient satisfaction from quality, service, convenience and excellent results” “Exceptional care for all skin problems” Charles E. Crutchfield III, M.D.

There is considerable disagreement among physicians on health care reform objectives.

Please indicate your understanding of areas of substantial agreement among members of the MMA.

Board Certified Dermatologist

While I acknowledge there is considerable discord among physicians on a number of health care reform objectives I think most physicians are in agreement that there needs to be payment reform in a way that maintains the patient-physician relationship, improves outcomes, appropriately utilizes limited resources and compensates physicians fairly. The MMA’s health care reform proposals and similar initiatives from the AMA,

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November/December 2009

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Colleague Interview (Continued from page 15)

Not only is the nation divided on how to solve the crisis of affordability of health care, but the “House of Medicine” is divided as well. How do we bring everyone’s views to the table and advocate for solution to these difficult issues?

The issues of health care dividing the nation and/or the house of medicine are very real. It seems to me that these divisive issues are almost all related to reimbursement/payment issues and not directly related to United States Postal Service STATEMENT OF OWNERSHIP, MANAGEMENT, AND CIRCULATION 1. Publication Title: MetroDoctors 2. Publication Number: 1526-4262 3. Filing Date: September 28, 2009 4. Issue Frequency: Bi-monthly 5. Number of Issues Published Annually: 6 6. Annual Subscription Price: $15 7. Complete mailing address: 1300 Godward Street NE, #2000; Minneapolis, MN 55413 Contact Person: Nancy Bauer, 612-623-2893 8. Complete mailing address of Headquarters or General Business Office of Publisher: 1300 Godward Street NE, #2000; Minneapolis, MN 55413 9. Full Names and Complete Mailing Addresses of Publisher, Editor and Managing Editor Publisher: West/East Metro Medical Societies; 1300 Godward Street NE, #2000; Minneapolis, MN 55413 Editors: Lee H. Beecher, M.D.; Peter J. Dehnel, M.D.; Thomas B. Dunkel, M.D.; Charles Terzian, M.D.; 1300 Godward Street NE, #2000; Minneapolis, MN 55413 Managing Editor: Nancy K. Bauer; 1300 Godward Street NE, #2000; Minneapolis, MN 55413 10. Owner: West and East Metro Medical Societies; 1300 Godward Street NE, #2000; Minneapolis, MN 55413 11. Known Bondholders, Mortgages, and Other Security Holders Owning or Holding 1 Percent of More of Total Amount of Bonds, Mortgages, or Other Securities: NONE 12. Tax Status: Has Not Changed During Preceding 12 Months 13. Publication Title: MetroDoctors 14. Issue Date for Circulation Data: September-October 2009 15. Extent and Nature of Circulation:

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1. Mailed Outside-County Paid Subscriptions

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Date: 9/29/09

patient care. When we put patients at the center of discussions regarding health care and health care delivery, the answers become more obvious and usually less divisive. It is when we start talking about how we are going to reallocate payments, who the winners and losers are going to be in a reimbursement model, that the “house” becomes most divided.

It is my hope that we will be able to work through our differences and move forward with health care reform that truly puts the patient as the focus. I acknowledge, in the future, there may be physicians who identify themselves as losers and/or winners depending on what happens. This is unfortunate, but it is reality of all change. If the House of Medicine becomes divided and fights amongst itself, we will lose the ability to collaborate and we could drive decision making in a way that will not benefit our patients. If we are unable to come together and provide solutions not only will we as physicians lose, but our patients will also lose. So, it is my challenge, as incoming chair of the Board to keep our eyes focused on patients and try as hard as we can to work together, collaboratively, to improve health care and patient outcomes.

Perhaps a corollary to the last question: How do we engage more physicians to be active participants in shaping the future of our health care system? How will you reach out to those who have chosen not to join the MMA and how will we hold everyone together through these difficult discussions?

We need to maintain and constantly build trust in the MMA by all physicians; this can be done only by gaining a better understanding of why some are disenfranchised. We need to survey members and non-members alike in order to understand how we can be a value-added organization where members feel that they get more from the organization than it costs to belong. This can be accomplished through communication of initiatives, maintaining transparency and remaining true to our vision.

Barriers to accomplishing this are related to the challenges of finding common ground among the multiple and diverse perspectives of physicians and truly understanding where member value lies.

What do you love most about our profession? How can the MMA best offer help to those who are getting disillusioned with medicine?

I still wake up in the morning excited to be practicing medicine. I see patients everyday who hate what they do and who only continue in their jobs for the insurance or the benefits or the pay. I am still energized by the practice of medicine. I have the best job in the world; I get to talk to my friends everyday. People tell me their deepest, innermost secrets behind closed doors and trust me with knowledge about themselves, their family, and their dreams on a daily basis. That trust is truly humbling and amazing. I think the MMA needs to continue to protect those physician-patient relationships and prevent interference in that relationship from the government, third party payers and purchasers. We need to be proactive, not reactive and realize the thing that we find rewarding in our practice is collaborating with the patient for the best care possible.

When we begin feeling pessimistic, we lose sight of what is important in medicine and why most of us decided on medicine as a career.

MetroDoctors

The Journal of the East and West Metro Medical Societies

Medical Students Receive White Coats The incoming class of 169 future doctors at the University of Minnesota Medical School-Twin Cities took a big step in becoming medical professionals at the White Coat Ceremony held on August 7, 2009. With Medical School Dean Frank B. Cerra presiding, they were initiated into the values and responsibilities of the medical profession.

ATTENTION all Minnesota Physicians Residing in Naples, Florida

8th Annual Minnesota Health Care Dinner Party

Monday, March 15, 2010 Pelican Marsh Golf Club, Naples, Florida Cocktails: 6:00 p.m.

Dinner: 7:00 p.m.

Cost: $55.00 per person (estimated) Spouse/guest invited Ronnell Hansen, M.D., president EMMS, and Richard Schmidt, M.D., chair, WMMS (not pictured), presented each student with an ADC Buck Hammer on behalf of the medical societies.

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If you are planning to be in Naples at that time, please contact Thomas W. Hoban with your Naples address at (239) 948-4492 or th8159@earthlink.net

The Journal of the East and West Metro Medical Societies

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November/December 2009

17

The Joint Commission’s New Agenda

M

any believe we may experience some legislative reform of health care this year. In the midst of all the rhetoric, most people don’t realize there’s more to it than a public option or employer based health care.

In the many versions that are on the table, there are some important concepts that would be of value to organizations and physicians concerned about accreditation, patient safety, and quality. Some of the themes that hopefully will survive include prevention, wellness, public health, primary care, care coordination and rewards for efficient, high quality providers.

In addition, some bills are promoting work force enhancements, regionalized systems of emergency and trauma care, and integration of quality improvement and patient safety training into clinical curricula. A high priority in some versions is improved performance measurement calling upon the Secretary of HHS to develop a national strategy for improvement of care delivery, outcomes, and population health. New grants and contracts are outlined for quality measure development, best practices and redesigns of health care systems.

As the partisan bickering goes on, The Joint Commission has positioned itself to continue as a major player in the health care reform process and outcome. At its August meeting, The Joint Commission Board of Commissioners approved a new mission statement that more accurately reflects the business, purpose, and values of The Joint Commission.

The new statements reads: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Board also approved a new vision statement for The

By William E. Jacott, M.D.

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November/December 2009

Joint Commission enterprise which includes The Joint Commission, Joint Commission Resources, and Joint Commission International.

That new statement reads: All people always experience the safest, highest quality, best-value health care across all settings.

An exciting and innovative new initiative is the recently developed Joint Commission Center for Transforming Healthcare. This new approach holds the promise to deliver substantial progress toward our overarching goal: to transform health care into a high-reliability industry with rates of adverse events and breakdowns in routine safety processes comparable to jet air travel. The Center for Transforming Healthcare has been established by The Joint Commission to solve the most pressing quality and safety problems that are all too prevalent in health care today. Working with a cadre of hospitals and health systems, the Center will develop solutions through the application of the same robust process improvement methods and tools that other industries have long relied upon to improve quality, safety and efficiency.

These methods include Six Sigma, Lean, and Change Acceleration Process. Through the Center, The Joint Commission’s expert process improvement staff will coordinate teams among the participating hospitals. Each of these groups of teams will engage in an improvement project that focuses on developing highly MetroDoctors

effective interventions to address one of the most pressing safety or quality problems. The teams will develop and prove the effectiveness of interventions targeted to the most important of these causes. The Center will build an inventory of these interventions, tied to their respective causes.

We are discussing a series of steps to enhance the value of The Joint Commission to all the key players including physicians.

• Incorporate in the accreditation process a focus on outcomes rather than just compliance with requirements.

• Customize the requirements, standards, goals, and survey process for the type of organization being surveyed, for example, laboratory, home care, or ambulatory care.

• Ensure that surveyors and account representatives are knowledgeable, consistent and experienced in their service lines.

• Constantly document and share best practices — show organizations how to best comply with requirements and share the practices having the greatest impact on quality and safety outcomes.

• Be even more collaborative and consultative.

• Increase consumer, state, and payer understanding of and appreciation for the value of Joint Commission accreditation.

• Simplify and reduce the number of standards, focus on the most important standards and speed up new standards development, standards refinement, and interpretation.

With all of these initiatives, The Joint Commission is truly prepared to meet the challenges that will be generated by some type of health care reform.

William E. 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

New Health Care CEO in Town: Patrick Geraghty, President and CEO, Blue Cross and Blue Shield of Minnesota Editor’s note: Throughout the next several issues, MetroDoctors will highlight several newly named health care executives. Each CEO has been asked to outline his/her vision and challenges for their organization as well as offer some personal insights.

This is an exciting time to be involved in health care, especially in a state that is leading the way in innovation and reform. I came to my new job as president and CEO of Blue Cross and Blue Shield of Minnesota late last year, just before President Obama was elected and all of us started to get a glimpse of how health care might change in our country. I’ve spent more than 25 years in various positions in health care, working in the care delivery and health plan sectors. Immediately prior to coming to Minnesota, I served as a senior vice president for Horizon Blue Cross Blue Shield of New Jersey. At Horizon, I was responsible for developing a newly formed service division of 2,500 associates who supported a membership that grew from 2 million to 3.6 million during my tenure. My previous positions included serving as president of the Southeast Division; vice president of Health Plan Operations; and president of the Prudential HealthCare Pharmacy Operations with Prudential Insurance Company.

My job at Blue Cross puts me at the head of an organization that serves 2.8 million members. I believe that as the state’s largest health plan, Blue Cross has a special obligation to be an innovator in helping people live healthier lives and serving as a leader and catalyst for health reform. I’m excited about that opportunity and challenge.

Throughout my career, I have dedicated myself to helping the American health care system do a better job in delivering and financing health care. It’s one of the main reasons why I came to Blue Cross and Blue Shield of Minnesota — an organization with a national reputation for setting new standards in improving both individual and community health.

In my first few days at Blue Cross, I made it a point to go out and meet with as many employees as possible. My belief that our organization has a strong commitment to doing the right thing was completely reinforced by what our Blue Cross associates had to say. It was immediately clear to me just how strong the sense of corporate responsibility is here.

A few months ago, I got to witness this commitment firsthand when

MetroDoctors

The Journal of the East and West Metro Medical Societies

our employees contributed $54,000 and more than two tons of food to Minnesota food shelves — more than doubling last year’s contributions.

In fact, we were among the top three organizations in contributions in the Minnesota FoodShare drive — despite the fact we had recently implemented salary freezes. We were also recently the recipient of the national Jefferson Award, in recognition of our employee volunteer program and corporate philanthropy. Our employees contribute approximately 17,000 hours of volunteer paid-time-off hours a year — and this number continues to increase. I’m very proud to be associated with an organization that demonstrates this kind of community involvement.

I have also made it a point to get out into the community and meet with people in civic, government, health and community arenas, and sharing ideas about what changes are needed in health care — and learning from people across the community. Meeting with leaders from across the community has strengthened my belief that we can make great things happen in Minnesota. In fact, we can — and should — serve as a national model for how to reform health care.

Our state is already implementing many of the changes and reforms that are being debated at the national level. For example, we have the Institute for Clinical Systems Improvement (ICSI) — dedicated to helping the health care systems deliver patient-centered and value-driven patient care. Blue Cross is one of the principal sponsors of ICSI. Minnesota also has some of the country’s leading center’s of clinical excellence, not only the Mayo Clinic, but also highly integrated care systems such as Allina, Fairview and HealthEast — working to deliver the kind of coordinated care that is only beginning to occur in other parts of the country. We also have highly respected academic and research institutions, such as the University of Minnesota. We have leading businesses headquartered here, including some of the world’s best known medical device manufacturers — all working to make health care more efficient and more effective.

This is the kind of work that creates the “Minnesota Model” — a prototype for health care change that I believe can be replicated at the national level.

I am also enjoying learning about Minnesota and how much it offers in terms of quality of life. This is a state with great educational,

(Continued on page 20)

November/December 2009

19

New Health Care CEO (Continued from page 19)

that is lower than the national average (17 percent locally compared to approximately 20 percent for the entire country). And we’re working to decrease those levels even further.

We are doing this work to fulfill Blue Cross’ purpose of “making cultural and natural resources. My family is very excited about getting a healthy difference in people’s lives.” This is the right work for a health established here. company such as Blue Cross, and I think this work is especially relevant Making the decision to move to Minnesota was a family affair for now as the country wrestles with health reform. Our goal is to evolve from us. My wife, Heather, and I held a family meeting and discussed the being a leading health plan to being a leading health company — focusing move from New Jersey to Minnesota with our three children. We all on overall health quality, not just quality health coverage. decided that the family would stay in New Jersey during the last school In order to reach this goal, we have to be willing to introduce inyear, allowing our son, Sean, to graduate with his high school class. novative approaches. One example was our announcement that Blue He will be attending college in New York this fall, while our daughters Cross will be the first health plan in the state to offer online health care Breige and Kiera will begin high school and grade school in Minnesota. for consumers. This fall, our 10,000 employees and dependents will be As a newcomer, I still am in awe of some things that Minnethe first to use a new online care system where they can connect to medisotans — and even some of my colleagues at Blue Cross — take for cal professionals via the Internet. This is the kind of change we need to granted. Suing the tobacco industry back in 1994 is just one example. reform and redesign the health care system. Online connectivity opens When Blue Cross and the state of Minnesota filed suit, there weren’t up new care possibilities, such as monitoring chronic conditions without many individuals or organizations willing to stand up to the powerful having to go to a clinic, or access to specialists from a rural location. tobacco industry. Blue Cross did it, and it has had an enormous impact These are the kinds of initiatives we’re working on as a health company. on public health. Blue Cross’ share of the tobacco lawsuit proceeds was I have recently given presentations in Washington D.C. and have $241 million and it was used to establish our Center for Prevention. shared ideas from Minnesota and Blue Cross with national health reThe Center has led statewide efforts to decrease the use of tobacco in the form leaders, and they are very interested in what we’re doing here. I’m state, and improve physical activity and healthy eating. The knowledge, also involved in a number of community initiatives, such as serving the resources and the public health efforts generated by the lawsuit have as co-chair of the 2010 Heart Association’s Heart Walk in Minnesota, contributed directly to Minnesota now having an adult smoking rate and a vice chair of the CEOs Against Cancer event. I am so impressed with the Minnesota culture and its tradition of collaboration. This is a state where health care stakeholders can sit down and have frank but respectful conversations about needed changes.

There’s an attitude of working together to clear the roadblocks that bring both private sector innovations and good public policy to a screeching halt in many states.

An example of this collaboration is the Health Care Innovation Initiative — a group of CEOs from the state’s largest health plans and health care delivery systems. I have been co-leading this effort with Mark Eustis, CEO of Fairview Health Systems. The Initiative is committed to improving quality of care, developing Jaime Davis, M.D. Becky White, CNP Nadine Miller, M.P.A.S., PA-C new care models and creating a flattened trend Mayo Trained Board Nurse Practitioner Physician Assistant line in the cost of care.

Certified Dermatologist in Dermatology in Dermatology We don’t have all the answers yet, but I Dermatology appointments available within two weeks. We are convethink we’re making progress in developing new niently located in Uptown Minneapolis one block east of Calhoun Square. We models and setting new standards for how to accept all major insurance. To schedule an appointment call 612-455-3200. deliver and finance care. I guess people would describe me as a “glass-half-full kind of guy” Care for your skin. in how I approach issues and my job. This is a time of great change, but also of great opportunity. I’m fortunate to be at a company that’s working for positive change, and in a Uptown Row, Suite 208 • 1221 W. Lake Street • Minneapolis, MN 55408 state that has a strong record of health care 612-455-3200 • www.UptownDermatology.com quality and results.

Get a Dermatology consult within two weeks!

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November/December 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

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Editor’s Note: MetroDoctors invited Maureen Reed, M.D. to submit an article featuring her candidacy for Congress. MetroDoctors neither endorses nor supports candidates. The Editorial Board offered an opportunity for a colleague/ member in a unique position to describe her goals.

AMERICA IS FACING SOME pretty big is-

sues. Take your pick: global recession, terrorism, climate change, Afghanistan, budget deficits, health care reform. This list could be positively discouraging if we didn’t remember that in the last 150 years we’ve faced and overcome civil war, slavery, depression and world war.

Last November a newly elected President placed health care reform on the front burner of the national agenda and asked Congress to develop a reform proposal. For many of us in health care, this seems decades overdue. We’ve long taken care of patients with no or inadequate insurance. We’ve watched the costs of health care spiral out of control. We’ve logged countless hours improving our own care system’s ability to deliver good care to our patients.

We’ve seen improvement. We know it’s hard.

In early 2009, I discovered something. I couldn’t stand to stand by anymore. I personally know health care can be fixed. I know it must be fixed. And I want to go to my grave knowing it has been fixed. With America now engaged in several years of intense health care debate, I felt compelled to run for Congress in Minnesota’s 6th Congressional District.

In brief, I believe reform will be considered successful when it achieves four basic objectives: a real emphasis on prevention, an essential benefit set that covers every citizen, payment that rewards best care not more care, and insurance reform that reduces administrative expense

By Maureen K. Reed, M.D., FACP

MetroDoctors

and provides coverage that is guaranteed-issue, community rated and portable. Despite being passionate about achieving these objectives, I am much less wedded to the methods we use to achieve them. In fact, being wedded to methods can stand in the way of progress, and we’ve see plenty of evidence of that this summer.

Health care reform now rests in Congress’ lap. Yet a casual review of the Congressional Web site reveals that among the 535 U.S. Senators and Representatives, only about a dozen have practiced medicine and only another dozen have other health care backgrounds.

One would conclude that this all-important reform task is therefore not in the hands of folks who know the problems and the promise of health care. Given that few experts are on the scene, one could be forgiven for concluding that reform may be in the hands of arm-chair experts and special interests.

Today’s big issues defy easy answers, and they are interconnected. Successful health care reform is tightly linked to many other issues such as job creation, a robust economy, education, research. In Congress we need people who have deep and broad experience. Slim résumés and a few years of elected office do not naturally translate into the ability to address the complex national issues we now face.

Never would I have predicted that running a large business such as Aspen Medical Group, overseeing the University of Minnesota Board of Regents, working in Uganda on a dairymedical cooperative project, taking the helm of a revolving land trust, or being deployed to Louisiana in the wake of Rita and Katrina would add up to the broad experience necessary to understand the complexity of today’s challenges. But they have.

Whether health care, immigration or foreign competition, today’s complex issues are fraught with tension and controversy. In

The Journal of the East and West Metro Medical Societies

Congress we need people who can find the common ground in the swirl of solutions that surround today’s major controversies. Our issues are made worse by inflammatory rhetoric that paralyzes people in fear and anger. None are made better by inadequate understanding or misinformation. All will take years to fix.

Despite our small numbers in Congress, physicians are well suited for political work.

In training, we learned how to work hard and long with seemingly no end in sight. Internship was the best preparation for campaigning that has ever been devised. In the exam room, we intentionally dial down fear and anger so that patients can problem-solve and heal. We carefully gather the facts, make the diagnosis, sketch a treatment plan and amend that same plan.

In our clinics and hospitals, we deal with the politics of interdepartmental and interpersonal disputes. We know that progress is slow and success is not guaranteed.

The policy and political worlds are not distant from the health, education or business worlds that I know so well. I will bring those worlds of experience to bear on the political matters of today. I will run, not walk. And when I get to Congress, I will remember the words of my favorite senior resident as we admitted our eighth patient from the ER, “Hitch up your pantyhose, girlfriend, we’re going to be running all night.”

Maureen K. Reed, M.D., FACP, practiced internal medicine for more than 20 years, was previously the medical director at HealthPartners, served on the Governor’s Health Care Transformation Task Force 2007-2008, ran for Lt. Governor with Peter Hutchinson in 2006, and served on the University Board of Regents 1997-2008. She is running for DFL endorsement in the 6th Congressional District to face Republican incumbent Michele Bachmann in 2010.

November/December 2009

21

President’s Message

Rapid Health Care Reform Efforts Necessitate Reassessment of Existing Policy RONNELL A. HANSEN, M.D.

WHEN I COMMENT IN METRODOCTORS ON HEALTH CARE POLICY — I attempt to

EMMS Officers

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

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

22

November/December 2009

do so from a well studied and pragmatic viewpoint, bringing concerns and perspectives expressed from economic experts at Hopkins, Mass Gen, MIT, Carlson School, a variety of editorialists from Wall Street Journal/New York Times/the Economist, and many others in medical economics who have particular insight into such systems — likely more than most physicians or medical society staff who must handle many issues related to the practice of medicine to the best of their ability.

I also attempt to ascertain available economic facts — as accurate as I can find them, which is very difficult given the agendas and spin of many stakeholders. Of course, I recognize physicians are stakeholders, and I try to understand how facts may or may not realistically support systems of patient autonomy, and our professional responsibility to them — and allow or hinder both private and employed models of practice to remain economically sustainable — without forcing physician direct rationing of care, or manipulation into unwanted consolidative structures. Be assured, sifting that analysis is exceedingly challenging.

At the MMA meeting, our well studied Mayo colleagues (touted in national policy) critiqued several possible approaches to addressing health care insurance/payment reform — I wasn’t sure I took away complete support of the managed care system as is current MMA policy from this honest critique — but rather a consideration of several options with leaning toward the Federal Employee Insurance model. In fact, take home points between presentations from the current AMA President on HR 3200, and Mayo experts did not appear 100 percent congruent — and although each point of view had merits (both economic and political) — each did appear to have some room for the realities of available options, compromise, and new ways of thinking. Did I agree with each of them on everything? Not necessarily — but I did see the need for policy flexibility.

I personally do not see financial world “constructs” today in the same manner relative to years past given recent events — and likely those of you reading don’t either. Reassessing the current payment/insurance solution set policy devised in 2004 for the MMA in times of rapid national and state financial flux seems to me not only to be a good idea — but rather a necessity.

Such analysis for the MMA requires a broad based, non biased, democratically appointed, policy interested, physician based group to do so. I suggest member selection may be best based upon independent trustee districts.

Without reservation, I respect the efforts of the current MMA Health Care Reform Oversight Task Force charged with following issues on the current implementation of 2008 MN Health Care Reform. Literally juggling a myriad of policy issues, I honestly ask if committee members can realistically take stock of the literal mass of health economic information available. I appreciate the level of commitment by individuals on that committee to meet their charge, however, I can nary keep pace with health reform econ assessment while reading about two hours per day and having a prior background. Expecting in-depth expertise on medical economic options given the scope of the current charge would, in my view, simply not be a realistic expectation. As Ben Whitten, incoming MMA President commented in his acceptance address, “fulfilling everything that is expected of us as physicians by everyone is all but impossible” — so I suggest we place dedicated resources on issues which are particularly complex and important. I also recommend avoiding potential selection bias; staffing of the committee should be democratically entrusted to trustee district, with an effort to select physicians who have balanced interest and experience in economic policy.

MetroDoctors

The Journal of the East and West Metro Medical Societies

The Journal of the East and West Metro Medical Societies

EMMS welcomes these new members to the Society.

Stephanie L. Devaney, M.D. Anesthesiology Nevin Dikel, M.D. Associated Anesthesiologists, P.A. Anesthesiology John E. Doyle, Jr., M.D. Allina Medical Clinic Woodbury Family Medicine

Metro Medical Society

MetroDoctors

New Members

East

While Minnesota currently enjoys popular face time in the media for “low cost high quality health care” and a “model for the nation” via Mayo system status — we, in the land of managed care, should not be complacent in the fact we also do not have a sustainable effective model of health care coverage. Even Mayo cannot accept more Medicare and appears to deliver expensive health care for those with insurance (the standard cost shift), GMAC may remain severely curtailed by un-allotment almost assuring significant deficits in the health care access fund from the newly uninsured moving to MNCare within two years (likely impacting calls for increased demands on the provider tax, which few other states have), and we suffer from lack of transparency from insurance/health care corporations which have substantial profits/large executive pay and have failed to pass on legislative payment increases to providers for many years. United Health Care, one of the country’s most profitable and criticized health corporations is based here. We all know physicians and practice behavior are not blameless in cost, but physicians and other providers are not the only cost culprits of the entire system, and it is not clear to me that managed care is the only “great solution” to a complex system.

Though Minnesota is far from managed care nirvana –we’re better than many states — but we propose ways to cut reimbursements by potentially bundling services which appear attractive to those seeking budget reductions. Can some such proposals work? — Maybe. Should other options be able to be considered in policy? — Absolutely. The “nation” may be following Minnesota like we have “the answer” — but where exactly is Minnesota going? That has yet to be carefully and thoughtfully determined without disenfranchising patients, physician appropriate decisions, or practice types.

For transparency and practicality, I do not consider it onerous for a dedicated member committee of the MMA to examine past years’ payment model policy in times of landmark financial upheaval — which has potential (particularly on short or emergent legislative notice) to tie our collective hands into supporting managed care in policy. From extensive reading of both domestic and international payment systems — I suggest this is neither wise nor innovative.

At the MMA meeting, outgoing Board Chair Mike Ainsle presented a number of thoughtful outcomes on the way he could see health care going — some perhaps easier for the physician/ patient relationship than others in his perspective — and some more administratively or overhead cost challenging. There was no “one way” support — but he did provide pros and cons for us all to consider for those options. Keeping patients at the top, as he pointed out, is the priority – and I agree. I also strongly support examining policy options which ensure Minnesota Patients’ and Physicians’ interests are not unduly undermined by only adherence to “systems” which have potential to: divert dollars to profits, underpay physicians by nontransparent means (having done so historically), disenfranchise the patient/physician relationship by incenting rationing, or “force” de facto practice consolidations. Will they necessarily? No. But they have in the past and we need to be honest about it.

Exploring options “outside of the traditional insurance plan/access box,” and transparently disseminating the pros and cons of such systems should be the priority. As economists and prior trial systems have recognized: 1) so-called corporate practice/physician rationing of medicine may be the unintended outcome of well intended systems; 2) national policy makers have indicated Minnesota reform policy supported provider accountable care organizations (ACO’s), which split capitated fees effectively runs counter to current state laws; and 3) “fee bidding” as in current reform law may not allow physician choice of contracting in (gatekeeper) “hospital systems” or “medical homes,” depending upon structure. I’m not suggesting some of these ideas cannot work in some way and that they cannot be placed upon us by national reform — I do suggest physician independent assessment and understanding of the economic implications of such systems is crucial as MMA policy moves forward.

Most importantly, I do not believe we, the members of the MMA, wish to necessarily have a society policy which is inflexible from a political standpoint. Secondly, I do believe it is our physician responsibility to work to understand what policy and proposed bills actually “say” in their text regarding our profession — versus relying on others to tell us what they mean. I appreciate the hard work dedicated members of the state and component societies put forth in serving all of our members on very demanding issues — but in the end, as part of our impossible task — I think we all need to read more on the facts of health care economics.

Robert T. Grossett, M.D. St. Paul Radiology, P.A. Radiology David E. Jensen, M.D. St. Paul Radiology, P.A. Radiology Thresiamma A. Joseph, M.D. Northern Lights Pediatric and Adolescent Medicine Pediatrics Ellen B. Rest, M.D. Regions Hospital Dermatopathology Kathryn A. Vidlock-Granley, M.D. Stillwater Medical Group Family Medicine

Visit us at www.metrodoctors.com and

forum.metrodoctors.com To find new career opportunities, past issues of MetroDoctors and information on the latest news, events and legislative issues!

November/December 2009

23

Department of Health Provides Update Guests from the Minnesota Department of Health attended the September 1, 2009, EMMS Board of Directors meeting at Bethesda Hospital. Carol Backstrom, Assistant to the Commissioner for Health Reform, and Scott Leitz, Assistant Commissioner of Health, gave an update about state health care reform efforts.

You’re Invited to an Open Meeting:

Meaningful Market Based Health Reform: An Odyssey Speaker: Stephen Parente, Ph.D. Sponsored jointly by East Metro Medical Society and the medical staffs of United Hospital and HealthEast Hospitals.

Friday, Nov. 20, 2009 7:30-8:30 a.m.

United Hospital John Nasseff Medical Center

From left: Ron Hansen, M.D., Carol Backstrom, and Scott Leitz.

CME and CEU credits are available.

Nominate a Colleague for the Community Service Award!

EMMS is now taking nominations for the 2009 community service award, which will be presented to the recipient at an appropriate venue. Please think about physicians you know who are active in the local community beyond his/her professional medical work.

For more information, call Katie at (612) 362-3704

Attn: Retired EMMS Members:

Save the date for the next EMMS Senior Physicians meeting

Thursday, October 29 11:30 a.m.

Award Criteria

•

Active or retired EMMS member

•

Voluntary, local service with special projects or programs, participation in civic or service organizations, educational or charitable groups, or in public office(s).

Call or e-mail Katie Snow with nominations: ksnow@metrodoctors. com; (612) 362-3704 or visit our Web site to download a nomination form. www.metrodoctors.com.

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November/December 2009

MetroDoctors

Bethesda Hospital Frank Indihar Conference Room, 7th floor Topic: Medical Volunteer Work in Nigeria Speaker: Roland Birkebak, M.D. Invitations are being mailed, or call Katie at (612) 362-3704 to register.

The Journal of the East and West Metro Medical Societies

EMMS Members Honored at MMA Annual Meeting At the recent Minnesota Medical Association Annual Meeting, several East Metro Medical Society members were recognized by their colleagues and received awards.

East

Donald Asp, M.D.

Neal Holtan, M.D.

The Community Service Award recognizes physicians who are actively engaged in the practice of medicine and have an outstanding record of community service. Donald Asp, M.D. and Neal Holtan, M.D. were recipients of this award in 2009.

Also at the MMA Annual Meeting, two EMMS physicians were approved to serve as East Metro Trustees on the Minnesota Medical Association Board of Trustees. Those physicians will also serve as East Metro representatives on the component medical society board of directors.

V. Stuart Cox, III, M.D. was elected to serve his ďŹ rst term as an East Metro Trustee.

MetroDoctors

Metro Medical Society

The Medical Student Award was presented to Nicole Te Poel for her hard work and commitment to the medical profession.

David Thorson, M.D. was elected to a second term as an East Metro Trustee. Dr. Thorson was also recently elected as Chair of the Minnesota Medical Association Board of Trustees.

The Journal of the East and West Metro Medical Societies

J. Michael Gonzalez-Campoy, M.D., Ph.D., FACE received the Minority Affairs Meritorious Service Award which is awarded to physicians for commendable service to minority populations.

The East Metro Medical Society Board of Directors and leadership wishes to thank Todd Brandt, M.D. for serving the East Metro as a Trustee on the MMA Board of Trustees and the East Metro Medical Society Board of Directors. His commitment to the profession of medicine and to the East Metro has been very much appreciated.

November/December 2009

25

Chair’s Report

In Conclusion 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 jdavis@metrodoctors.com Jennifer J. Anderson, Project Director (612) 362-3752 janderson@metrodoctors.com Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Kathy R. Dittmer, Executive Assistant (612) 623-2885 kdittmer@metrodoctors.com For a complete list of WMMS Board of Directors go to www.metrodoctors.com.

IN CONCLUSION, THIS IS MY LAST COLUMN for MetroDoctors as chairman of the West Metro Medical Society and I have the need to touch on a variety of topics. While my year has seemed hectic, not due to my duties at WMMS, but as a result of other commitments, it has been rewarding. I have always said that one gains more from serving an organization than one gives. Each time I have served whether it was a hospital staff, a medical organization or a business such as Midwest Medical Insurance Company, I have received an education in an area in which I had little experience. Even more importantly, I made new friends and discovered that the field of medicine has a great depth of talent and individuals committed to do their very best for patients.

Sometimes we are so locked into our own specialty that we don’t understand how many great physicians and thinkers populate the broad field of medicine. I encourage all physicians to serve in their own way. Now let me move on.

It appears that I will be the last chairman of the West Metro Medical Society. If things proceed as planned we will be merging with the East Metro Medical Society on January 1, 2010.

During my career, I have been an involved participant in the merger of two hospitals, the merger of two medical groups, the acquisition of two insurance companies, the closing of one hospital and opening of another. While these have worked in the long term, they were also the source of numerous frustrations. The proposed merger of WMMS and EMMS makes too much sense to ignore, especially with their close working relationship, shared services and like purpose. Add the economic realities, retirement of a CEO, a limited growth of membership and participation, and it looks like this is a merger that should work from the start.

That gets me to Jack Davis who has been the CEO for the past 15 years; Jack is retiring at the end of this year and I wish him well. Many of you probably do not know Jack, but he has done on outstanding job for the WMMS. He has been dedicated to physicians in the Twin Cities area and has served the medical community in ways that most members have little understanding. He has protected our interests with health plans and at the state legislature. He has an understanding of what it takes to keep a medical business operating and still serve patients. He has been instrumental in keeping the Visiting Nurse Association strong, serving as a board member and advisor.

The smoking ban in public places would not have happened without his insight and galvanization of the medical societies to make it happen. Fortunately, Jack will be available for advice and his protégé, Sue Schettle, appears ready to lead the combined organization.

Next. Health care reform: will it or will it not happen before this column goes to press? I certainly don’t know but I can state that physicians do not have a unified position. I have had the privilege of witnessing an e-mail chain of local physicians who debated health care reform with vigor but civility. While I cannot declare a winner, there was no loser and excellent points were made on all sides of the issues. I could not even figure out a compromise position. I do hope that the debate remains civil and that the best interests of the patients, the country, physicians and health care businesses are considered fairly and equitably when final decisions and compromises are made. Even the President hasn’t been immune from a cheap shot about physicians doing unnecessary surgery just for the dollar. He might want to acknowledge the medical personnel doing difficult work in the middle of the night, often at great sacrifice to their families and personal life.

Finally. While we have all tended to rely on our medical groups and our specialty societies to look after our interests, and that is understandable, but there is a place for our national, state and (Continued on page 27)

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November/December 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

Chair’s Report (Continued from page 26)

WMMS Members Honored at MMA Annual Meeting

local organizations to represent broad interests of the medical profession. The state and local level organizations are making contact with the legislators to lobby on our behalf. They are needed and deserve our support, accomplishing a great deal, with very little. A special thank you to Kathy Dittmer, Jennifer Anderson, Nancy Bauer and Jack Davis, the dedicated staff of the West Metro Medical Society.

WMMS Delegates offer a congratulatory toast to Benjamin Whitten, M.D., MMA President.

Edward P. Ehlinger, M.D. receives MMA President’s Award.

Photo by Steve Wewerka

Peter J. Dehnel, M.D. received the MMA’s Physician Communicator Award.

Jordan Marmet, M.D., 1st time delegate, is welcomed by AMA Alternate Delegate and SouthLake Pediatrics partner David Estrin, M.D.

JOHN JULIAN, WILD, M.D., PH.D. of St. Louis Park, formerly of London, England, died peacefully surrounded by family on September 18, 2009. He was 95. He graduated from Cambridge University Medical School, Cambridge.

Dr. Wild specialized in family medicine.

JOSEPH (JOE) P. ENGEL, M.D., of Edina, passed away at his home on September 21, 2009.

He was 91. He graduated from the University of Manitoba Medical School in 1943. During World War II, he served as a Captain in the Royal Canadian Army Medical Corps. In 1946, he worked at a rehabilitation clinic in Banff, Alberta for one year. From 1948-1950, he completed a fellowship at the Mayo Clinic. He began to practice rehabilitation medicine in 1950 in Minneapolis, which included working at the Sister Kenny Institute during the 1950s polio epidemic. He was still practicing medicine until one week prior to his death.

LYLE V. KRAGH, M.D., 83, of Jordan, MN, formerly of Edina passed away recently. He graduated from the University of Minnesota. Dr. Kragh specialized in plastic surgery.

Joseph A. Cella, M.D. received a Decade Award for 51 years membership in the MMA.

MetroDoctors

Robert E. Doan, M.D. received a Decade Award for 52 years membership in the MMA.

The Journal of the East and West Metro Medical Societies

DONALD T. CUNDY, M.D., died peacefully August 2, 2009 at 92. He graduated from the University of Minnesota Medical School and interned at Ancker Hospital. In 1942 he was drafted into the U.S. Army and served as battalion surgeon to Patton’s 3rd Infantry Division.

He was highly decorated for his service and received the Purple Heart for wounds received at Anzio. He was honorably discharged in 1945 and completed his medical residency at the U of M, specializing in ophthalmology. Dr. Cundy later began his own medical practice and was on staff at the Metropolitan Medical Center (formerly St. Barnabas Hospital), where he was appointed Chief of Staff. He also founded Downtown Opticians. He retired in 1987.

November/December 2009

27

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

In Memoriam

Welcome New WMMS Members Active George V. Achett, M.D. Metropolitan Pediatric Specialists, P.A. Pediatrics James C. Agre, M.D. University Rehab Medicine Associates Physical Medicine & Rehabilitation William A. Bonadio, M.D. University of Minnesota – Department of Pediatrics Pediatrics Susan L. Burton, M.D. University of Minnesota – Department of Medicine Pulmonary Critical Care Medicine Parvin C. Dorostkar, M.D. University of Minnesota – Department of Pediatrics Pediatrics Judith Eckerle Kang, M.D. University of Minnesota – Department of Pediatrics Pediatrics Anne R. Edwards, M.D. Park Nicollet Clinic Pediatrics Ralph B. Fairchild, M.D. University of Minnesota – Department of Surgery General Surgery Erik B. Finger, M.D. University of Minnesota – Department of Surgery General Surgery William D. Fox, M.D. Allina Medical Clinic Family Medicine Jon D. Fuerstenberg, M.D. Emergency Care Consultants, P.A. Critical Care Surgery Jill M. Funk, M.D. Fridley Children’s & Teenager’s Medical Center Dermatology 28

November/December 2009

Jafar Golzarian, M.D. University of Minnesota – Department of Radiology Radiology Brian S. Goodman, M.D. Emergency Physicians Professional Association Emergency Medicine Marissa A. Hendrickson, M.D. University of Minnesota – Department of Pediatrics Pediatrics Radha Inampudi, M.D. Consulting Radiologists, Ltd. Diagnostic Neuroradiology

Ann M. O’Donnell, M.D. Diamond Women’s Center, P.A. Obstetrics & Gynecology

Paul A. Satterlee, M.D. Emergency Care Consultants, P.A. Emergency Medicine

Deirdre A. Palmer, M.D. University of Minnesota – Department of Medicine Internal Medicine, Nephrology

James J. Stone Johnston, M.D. University of Minnesota – Department of Surgery General Surgery

Robert A. Pollock, M.D. Consulting Radiologists, Ltd. Diagnostic Radiology

Heather J. Wade, M.D. Partners in Pediatrics, Ltd. Pediatrics

Alison C. Rudy, M.D. Anesthesiology, P.A. Anesthesiology

Brian F. Witte, D.O. Metropolitan Anesthesia Network, LLP Anesthesiology

Demosthenes N. Iskos, M.D. Minnesota Heart Clinic Internal Medicine/Cardiology Avi Katz, M.D. University of Minnesota – Department of Pediatrics Pediatrics Lazaros K. Kochilas, M.D. University of Minnesota – Department of Pediatrics Pediatric Cardiology

Sr. Physicians Association August 4 was a beautiful day for the 2009 Summer Get-Together.

Forty Sr. Physician Association members and guests boarded the Jonathan Padelford, one of the few truly authentic sternwheelers, and cruised down the Mississippi River to Fort Snelling.

Jane M. Lewis, M.D. University of Minnesota Physicians Urology/Urological Surgery Taryn M. McEvoy, M.D. Oakdale OB/GYN, P.A. Obstetrics/Gynecology Stephen D. Meade, M.D. Edina Family Physicians, P.A. Family Medicine Genevieve B. Melton-Meaux, M.D. University of Minnesota – Department of Surgery Colon & Rectal Surgery Neil Mulrooney, M.D. Minnesota Neonatal Physicians, P.A. Neonatology Nissrine A. Nakib, M.D. Minnesota Urology, P.A. Urology Patrick J. O’Brien, M.D. Consulting Radiologists, Ltd. Diagnostic Radiology

Standing from left: Drs. Ed Spenny, Richard Woellner, and Philip Worrell. Sitting: Frida and Dr. Gerald Mindrum.

The September SPA meeting featured John H. Linner, M.D. who spoke to 80 colleagues and guests about his book “Normandy to Okinawa — A Navy Medical Officer’s Diary and Overview of World War Two.” Join us on Nov. 17 for guest speaker Steven Miles, M.D.

MetroDoctors

Dr. John H. Linner and Dr. Ed Spenny.

The Journal of the East and West Metro Medical Societies

ALLIANCE NEWS MICHELE KHOULI

WMMSA Partners With Phillips Neighborhood Clinics

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patients are seen on a walk-in basis. Their mission is simple, they desire to: • Provide accessible, culturally appropriate, interdisciplinary health care services and education to reduce the burdens of poor medical access and raise the quality of life for their patients.

• Provide health professional students with the skills they need to effectively and caringly serve people who are underinsured and unstably housed.

Patients enter the clinic with various conditions. One patient may need a physical as a requirement to start a new employment opportunity; another may need access to physical therapy because their insurance won’t cover the costs. Student volunteers from the University

of Minnesota schools of medicine, pharmacy, physical therapy, nursing and public health work with each patient to provide as much care as they possibly can during the visit.

Donations are highly encouraged. The West Metro Medical Society Alliance will be collecting toiletries and new winter clothing to distribute at the Phillips Neighborhood Clinic this fall and winter. If you are interested in learning about ways that you can help the Phillips Neighborhood Clinic, please e-mail Dr. Brian Sick at sickx002@umn.edu or visit www. phillipsneighborhoodclinic.com.

Medical Students Working in Action at the PNC

MetroDoctors

The Journal of the East and West Metro Medical Societies

November/December 2009

29

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

ootball season has started, school is back in session, and the WMMSA has learned about valuable medical work being done by the Phillips Neighborhood Clinic from our September board meeting guest speaker, Dr. Brian Sick.

Imagine practicing medicine in a church basement daycare area that converts to clinic space by night two times per week. Resources are limited; however, patients are thankful to receive care. This is the reality for Phillips Neighborhood Clinic Director Dr. Brian Sick. Phillips Neighborhood Clinic (PNC) is a student-run organization overseen by the University of Minnesota Medical School and the University of Minnesota Physicians (UMP) Medical Group. Care is completely free, and

Career Opportunities

CAREER OPPORTUNITIES

Introducing the â&#x20AC;&#x153;Career Opportunitiesâ&#x20AC;? section of MetroDoctors!

$ JUHDW DYHQXH IRU SURIHVVLRQDOV WR OHDUQ DERXW MRE RSSRUWXQLWLHV $1' D SHUIHFW SODFH IRU UHFUXLWHUV WR SURPRWH RSHQLQJV Recruiters, call for our special recruitment rate.

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betsy@pierreproductions.com

Announcing MetroDoctors

FORUM http://forum.metrodoctors.com East Metro and West Metro Medical Societies have launched a

Web forum

See Additional Career Opportunities on page 32.

The Mankato Clinic, is recruiting for the following BC/BE primary care physicians to join our well-established practice in the regionâ&#x20AC;&#x2122;s leading multi-specialty group:

â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘

Family Practice Hospitalist Internal Medicine Pediatrics

The forum, moderated by Dr. Thom Siefferman, serves as a central location for discussions related to legislative issues, local health care matters, upcoming society events, the MMA Annual meeting and more.

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.

Sign up and use the forum for communication and dialogue with your colleagues!

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: ddavito@mankato-clinic.com.

If you have comments or questions, please contact Katie Snow at (612) 362-3704 or ksnow@metrodoctors.com.

Mankato has exceptional recreational and cultural activities, excellent private and public school systems and Minnesota State University, Mankato.

MANKATO CLINIC An AAAHC-accredited Clinic â&#x20AC;˘ www.mankato-clinic.com

30

November/December 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

MetroDoctors

The Journal of the East and West Metro Medical Societies

November/December 2009

31

CAREER OPPORTUNITIES

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

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32

November/December 2009

MetroDoctors

The Journal of the East and West Metro Medical Societies

“Are you managing your practice or is IT managing you? ”

Here are the top 3 reasons why many of your colleagues are choosing MMIC for their EHR and EPM.

When you choose MMIC Technology Solutions, you get: 1

local service and support that puts you first

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MMIC Technology Solutions is an authorized reseller of the NextGen® Electronic Health Records and Enterprise Practice Management systems.

To learn more about how MMIC Technology Solutions can help make your practice run more efficiently and profitably, call Brian Salzman at 763–201–0304.

MMICTechnologySolutions.com

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University of Minnesota

CONTINUING MEDICAL EDUCATION

Upcoming CME Courses www.cmecourses.umn.edu PRIMARY CARE Internal Medicine Review and Update November 11 – 13, 2009 Experts in various sub-specialties share updates on current topics.

Cardiac Arrhythmias: An Interactive Update for Primary Care April 9, 2010 Learn the recognition, evaluation and treatment of common heart rhythm problems from experts in Cardiology and Cardiac Electrophysiology Allergy and Clinical Immunology April 9, 2010 New clinical strategies for diagnosis and management of allergic conditions Family Medicine May 12 – 14, 2010 Update on common topics and on infection & respiratory, cancer, and common hospital and ER topics

SURGERY 3rd Annual Bakken Device Symposium– Minimally-Invasive Cardiac Surgery December 7 – 8, 2009 This symposium will explore the positive and negative aspects minimally invasive cardiac surgery approaches in order to assist decision making in the realm of patient care.

Lillehei Cardiology Symposium April 19 – 20, 2010 Designed to serve the cardiovascular educational needs of all clinicians who care for patients with diseases of the heart and blood vessels Bariatric Education Day May 27, 2010 An overview for maximizing success with bariatric surgical procedures, while minimizing complications and readmissions

Advances in Hepatic, Biliary, and Pancreatic Surgery June 1 – 6, 2010 Top US surgeons will provide comprehensive updates on Hepatic, Biliary, and Pancreatic Surgery

ALSO OFFERED World Symposium (Lysosomal Disease Network) February 10 – 12, 2010 (Miami, FL) Manage and understand diagnostic options for patients with lysosomal storage diseases, and identify the latest findings in the natural history of these diseases Advanced Pediatric Dermatology May 14, 2010 Updates on enhancing skills in the recognition and management of common and selected dermatologic problems seen in pediatric patients Topics and Advances in Pediatrics 2010 June 10 – 11, 2010 Practical approaches in Pediatrics, Clinical Pearls, Special Lectures, Clinical Roundtables Workshops in Clinical Hypnosis June 10 – 12, 2010 Instruction in the theory and application of hypnosis in a clinical setting Free on-line courses available for CME credit are listed below. Visit CME website at www.cme.umn.edu.

U U U U U U

Fetal Alcohol Spectrum Disorders (FASD) Heart Failure in Children Supraventricular Tachycardia in Children Dyslipidemia in Children Congenital Adrenal Hyperplasia Reducing Recurrent Preterm Birth

All courses are held in the Twin Cities unless noted

Office of Continuing Medical Education 612-626-7600 or 1-800-776-8636 www.cme.umn.edu email: cme@umn.edu