JanFeb08 compressed

Doctors

Metro Doctors JanFeb08.pdf 1Metro Doctors JanFeb08.pdf 1 12/26/07 2:46:33 PM12/26/07 2:46:33 PM

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MetroDoctors The Journal of the East and West Metro Med i cal Societies January/February 2008 1

C O N T E N T SV O L U M E 1 0 , N O . 1 J A N U A R Y / F E B R U A R Y 2 0 0 8

Physician Co-editor Lee H. Beecher, M.D.Physician Co-editor Thomas B. Dunkel, M.D.Physician Co-editor Peter J. Dehnel, M.D.Physician Co-editor Charles G. Terzian, M.D.Managing Editor Nancy K. BauerAssistant Editor Doreen M. HinesWMMS CEO Jack G. DavisEMMS CEO Sue A. SchettleProduction Manager Sheila A. Hatch erAdvertising Representative Betsy PierreCover Design by Outside Line Studio

MetroDoctors (ISSN 1526-4262) is publishedbi-monthly by the East and West Metro MedicalSocieties, 1300 Godward Street NE, BroadwayPlace West, Suite 2000, Min ne ap o lis, MN55413. Periodical postage paid at Minneapolis,Minnesota. Postmaster: Send address changesto MetroDoctors, East and West Metro MedicalSocieties, 1300 Godward Street NE, BroadwayPlace West, Suite 2000, Min ne ap o lis, MN55413.

To promote their objectives and services, theEast and West Metro Medical Societies printinformation in MetroDoctors regarding activitiesand interests of the societies. Responsibility isnot assumed for opinions ex pressed or implied insigned articles, and because of the freedom givento contributors, opinions may not necessarilyrefl ect the offi cial position of EMMS or WMMS.

Send letters and other materials for considerationto MetroDoctors, East and West Metro MedicalSocieties, 1300 Godward Street NE, BroadwayPlace West, Suite 2000, Min ne ap o lis, MN55413. E-mail: [email protected].

For advertising rates and space reservations,contact: Betsy Pierre2318 Eastwood CircleMonticello, MN 55362phone: (952) 903-0505fax: (763) 295-2550e-mail: [email protected].

MetroDoctors reserves the right to reject anyarticle or advertising copy not in accordance witheditorial policy.

Non-members may subscribe to MetroDoctorsat a cost of $15 per year or $3 per issue, if extracopies are available. For subscription informa-tion, contact Doreen Hines at (612) 362-3705.

2 Ramsey Medical Society Becomes East Metro Medical Society

3 Hennepin Medical Society Becomes West Metro Medical Society

4 LETTERS

Index to Advertisers

5 Physicians Can Be a Powerful Voice for Public Health

8 Winter Medical Update 2008

9 COLLEAGUE INTERVIEWFrank J. Indihar, M.D., FACP, MBA

12 Minnesota Physicians Carry Resolutions to the AMA

13 Portico Healthnet: A Local Solution for Covering the Uninsured

15 YOUR VOICE

17 The Case for Adaptive Leadership (Part 2)

19 Major Compensation Changes Under Medicare

21 Collaborating on Statewide Cessation

23 Minnesota Ambulatory Health Care Consortium Holds Annual MeetingSocieties Sponsor Lunch ’n LearnU of M White Coat CeremonyMinnesota Health Care Dinner Party—Naples Florida

24 Members in the News

EAST METRO MEDICAL SOCIETY

25 President’s Message

26 EMMS In Action/Annual Meeting

27 2008 Election Results/New Members

28 “Ethical Issues in Pay for Performance”/New Board Member/Senior Physicians/In Memoriam/Caring Hearts

WEST METRO MEDICAL SOCIETY

29 Chair’s Report

30 WMMS In Action/Career Exploration for Students

31 Annual Board Meeting/“First a Physician” Award

32 New Members/In Memoriam

On the cover: Societieschange names to better refl ectmembership. Articles beginon page 2.

MetroDoctorsT H E J O U R N A L O F T H E E A S T A N D W E S T M E T R O M E D I C A L S O C I E T I E S

Doctors


2 January/February 2008 MetroDoctors The Journal of the East and West Metro Medical Societies

Ramsey Medical Society BecomesEast Metro Medical Society

Ramsey Medical Society officially changesits name January 1, 2008 to the East MetroMedical Society (EMMS). The reason for thechange in name is because the medical soci-ety membership has become more dispersedthroughout the three counties that we serve(Eastern Dakota, Ramsey and Washington)as communities have grown and physicianpractices have moved to those areas. Manynew members verbalized that they under-stood why they were joining the MinnesotaMedical Association, yet did not understandwhy they needed to join the Ramsey MedicalSociety when they worked/lived in Dakota orWashington Counties. This disconnect withour name was heard frequently enough by staffand others that it spawned discussions at theRMS Board of Directors in 2006 and 2007.The RMS Board discussed at great length theneed to be receptive to the disconnect feltby our members and perspective members,

but wanted to not jump into a name changewithout careful thought and discussion. Aftermuch debate, and with an ultimate vote of theRMS board, and a subsequent vote of the RMSmembership, the decision to change the namewas approved. January 1, 2008 the RamseyMedical Society officially changes its name tothe East Metro Medical Society.

With a new name comes the opportunityto have a new look. Our new logo has the circleand latin inscription that have been longstand-ing symbols of ourorganization. Inthe circle is thesymbol of the staffof Asclepius, whowas the mytholog-ical Greco-Romangod of medicine,and is considereda true symbol of

medicine. We hope you like our new nameand our new look, and the new opportunitythat awaits us.

History of Other LogosEleven physicians gathered in Dr. D. Her-man Smith’s office on Monday, February 14,1870. Their purpose was to create the RamseyCounty Medical Society by reorganizing the1860 St. Paul Academy of Medicine andSurgery, which had languished since “TheRebellion.” The new society’s stated purposewas “the cultivation of the science and art ofmedicine, the interchange of professional ex-perience, the encouragement of professionalzeal, and the promotion of a friendly feelingamong its members.”

As to the Seal of our So-ciety, there was not oneuntil about 1900 whenDr. Brewer Mattockssuggested the legend,“Dissect, observe andwrite,” in the imperative

as the Seal for the Ramsey County MedicalSociety. He wrote Arch-Bishop John Irelandto Latinize the motto. He was kind enoughto send his secretary with the suggestion thatthe imperative be changed to the infinitive,and wrote the legend as it now stands. TheSeal was presented to the Society and wasgraciously received. The microscope, scalpeland pen were designed by Pharmacist R.O.Sweeney of Sweeney’s Drug Store at KelloggBoulevard and Wabasha St.

The Latin is: Incidere (to dissect); In-spicere (to observe); and Inscribere (to write).The date MDCCCLXX is 1870.

On January 1, 1996 theRamsey County Medi-cal Society merged withWakota Medical Society.At that time the name waschanged to Ramsey MedicalSociety (the word “county”was removed) and the logo

was revised and now included the counties ofRamsey, Washington and Eastern Dakota.

INC

IDER

E

INSPICERE

INSC

RIBERE

SINCE 1870


MetroDoctors The Journal of the East and West Metro Medical Societies January/February 2008 3

Hennepin Medical Society BecomesWest Metro Medical Society

On January 1, 2008, the name of the Hen-nepin Medical Society officially changes tothe West Metro Medical Society (WMMS),incorporating the existing logo graphic withonly a color modification. The resolution pre-sented to, and approved by, the MMA Houseof Delegates last fall stated:

Whereas, the Hennepin Medical Societyrepresents physicians in Anoka, Carver, Hen-nepin, Scott and western Dakota counties; andalthough the name “Hennepin Medical Soci-ety” is recognized and respected nationwideas a front-runner in the medical associationfield, the name does not appropriately reflectthe geographic locality of its membership or or-ganization service area, therefore be it resolvedthat the name “Hennepin Medical Society” bechanged to “West Metro Medical Society.”

HistoryThe founding of the Hennepin County MedicalSociety on June 20, 1855, marks the beginningof the oldest medical organization in continuousexistence in the state of Minnesota. Minneapolis,the site of its birth, could hardly have seemed amore unlikely setting for a scientific group, beingan unorganized settlement perched on the banksof the Mississippi in the midst of a wilderness ter-ritory still three years from attaining statehood. Itsofficial name was The Saint Anthony and Min-neapolis Union Medical Society.

In 1869 the Society was incorporated and itsname changed to the Hennepin County MedicalSociety.

(The above is excerpted from the SpecialAnniversary Issue of The Bulletin of the Hen-nepin County Medical Society, 125 Years ofService, A History of the Hennepin CountyMedical Society, Supplement to Volume 51,No. 3, June 1980.)

No record can be found of the use of anofficial logo for The Saint Anthony and Min-neapolis Union Medical Society, however, acover of a program from the 1918 annualmeeting of the Hennepin County MedicalSociety showed the use of the caduceus anda picture of Minerva, the Patron Goddess ofMedicine. The use of the caduceus, and laterthe Asclepius (the single snake entwined about

a knotty staff of Asclepius, the Roman god ofmedicine and healing) was found on copiesof the letterhead of the Hennepin CountyMedical Society throughout the 1970s andearly 1980s.

In 1983, under the leadership of S. R.Maxeiner, Jr., M.D., chair of HCMS, a newlogo was selected which included a map of allthe counties. An entry from the HCMS Bulletin,May/June 1983, states:

In an action which recognizes the growingimportance of marketing physician services andthe growth of HCMS into a medical societywhich now encompasses Anoka, Scott, Carverand Hennepin Counties, the HCMS Board ofDirectors have selected a logo for HCMS let-terhead, envelopes, and other communicationvehicles. The design is intended to demonstratethe geographic area represented by HCMS.

Eleven years later, in November 1994, the

name of the HCMS was officially changed todrop the word “County” and add the tag line,“Representing physicians from Anoka, Carver,Hennepin, Scott and Western Dakota Coun-ties.” And then, in 2006, the logo was givena fresh new design that portrays each of thecounties comprising the Hennepin MedicalSociety as a segment of the whole.

We hope you agree that the name WestMetro Medical Society does, in fact, trulyreflect the inclusiveness of our membershipthroughout the west metro communities.



L E T T E R S

January/FebruaryIndex to Advertisers

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Inside Back CoverNeurosurgical Associates, Ltd...........................14Southside Community Health Services ........18Uptown Dermatology & Skin Spa .................20

U of M CME.......................Outside Back CoverWinter Medical Update 2008 ............................ 8Weber Law Office ................................................24

The recent (November/December)MetroDoctors article by Dr. Penny

Wheeler, addressing the proposed newmedical school by the University of St.Thomas and Allina Hospitals and Clinics,contains some basic misconceptions. Just asSt. Thomas unwisely created an additionallaw school several years ago, exacerbatingthe surfeit of attorneys, another medicalschool would only further contribute to ourfrightening health care cost inflation. Moredoctors equate with more costs; each newphysician generates upwards of a milliondollars in annual costs. Current health carecosts exceed 16 percent of GDP. How soonwill costs reach 20 percent? When healthcare squeezes out other vital activities, willwe then curtail the inflation? The moreimportant question, beyond cost inflation,relates to whether or not more physicians

are needed, either in primary care or anyother specialty. Does more medical careequate with increased longevity and betterhealth quality? The evidence to support thisrelationship is scant. In fact, there appearsto be only a modest proportionality betweenthe health of this nation commensurate withthe costs. Whereas health care costs in 1970amounted to almost 5 percent of a smallerGNP, it now is 16 percent of a much largerGDP. Are we that much healthier? Is ourlongevity significantly increased?

Many factors are involved to demon-strate the lack of relationship between ourhealth care costs and quality. Perhaps themajor factor is the public perception (ormisconception?) that, if we spend more re-sources and energy in health care, the healthof Americans will improve correspondingly.Although Americans regularly state that wehave the best health care in the world, datafrom other Western democracies clearlyrefute this conclusion. We are behind almostall European nations in overall mortality, in-fant mortality, obesity, and other parameters,and yet spend more money. The media,government, physicians, and the publicparrot this misconception, to the point thatwe consider any expenditure on health to beworthwhile.

A major contributor to health care costinflation is the substitution of cognitive careby expensive new medical technologies. In-stead of talking to patients, eliciting a carefulhistory and a modest physical examination,physicians order imaging and laboratory testsbefore cognitive activities. Does every stom-achache seen in the ER require a CT scanto exclude appendicitis? Wouldn’t a carefulhistory and physical exam come to the sameconclusion, but cost one-fourth as much?The justifications are that the public expectsand demands tests and affords protectionagainst malpractice litigation. Nonsense!Good medical care avoids suits and alsocosts less. Why don’t doctors use their heads,rather than write orders for more tests?

Another activity contributing to health

care cost inflation is the lack of evidence-basedmedicine (EBM). The American approachto medical practice is action, in which newtechnology is quickly introduced into everydaypractice, long before any statistically validevaluation (EBM) has been performed. As aresult, thousands of patients are subjected todiagnostic and therapeutic procedures thatare subsequently proven to have no value.Not only is this a factor in cost inflation, butit also subjects patients to the risk of adverseeffects inherent in any medical activity. Theclassic example is the now abandoned bonemarrow transplantation to augment high dosechemotherapy in women with advanced andrecurrent breast cancers. Before a federallyfunded random clinical trial was completed todemonstrate that the expensive and morbidity-producing therapy had no value as comparedto standard chemotherapy, 42,000 cases hadbeen done. Shouldn’t this formidable proce-dure be evaluated before subjecting so manypatients to a useless procedure?

Do we need more physicians in primarycare educated in a second-rate medical school?The concept of a medical school designedto “train” primary care physicians withoutmedical school research and investigation isinherently flawed. How can you attract anexcellent faculty if research is not part of thethree-hat educational environment for faculty?Will this curriculum be inherently low-keyed,turning out physicians no better than nursepractitioners or medical assistants?

The problems in our health care systemare severe and not really responsive to short-term solutions. The public must be educatedto realize that more care is not necessarilybetter care. Physicians should use their headsdiagnostically, instead of writing orders for ad-ditional expensive tests. Above all, this nationwould not be harmed if less medical care werepracticed. We certainly would be better servedif another medical school were not created inMinnesota.Sincerely,Seymour Handler, M.D.,Department of Pathology (retired)



I

Physicians Can Be aPowerful Voice for Public Health

BY SANNE MAGNAN, M.D. , Ph.D. (Continued on page 6)

IN THE NOVEMBER/DECEMBER issue ofMetroDoctors, James Hart, M.D., and JenniferGunn, Ph.D., eloquently described the strongmarriage between public health and medicineduring the earliest years of our state. They wenton to suggest that the marriage has becomestrained in recent years, partly due to changingpriorities. They encouraged public health andmedicine to renew their vows and to form astronger union to promote the health of allMinnesotans.

In my new role as commissioner of theMinnesota Department of Health (MDH),I hope to serve as a catalyst for nurturinga closer relationship between medicine andpublic health. The mission of MDH is toprotect, maintain and improve the health ofall Minnesotans.

I provide examples in this article of howphysicians can be a powerful voice for sup-porting Minnesota’s public health priorities.My first examples are true-life stories in whichphysicians recently influenced the communitydebate on secondhand smoke.

St Louis CountySt. Louis County Commissioners began apublic hearing process in the summer of 2006on a smoke-free ordinance, similar to the cur-rent Freedom to Breathe law. The county wasthe scene of the most intense opposition eventhough public opinion polls showed 70 percentsupport for smoke-free policies.

County commissioners held hearings incities across the county. Local physicians werebriefed about the policy debate through theLake Superior and Range Medical Societies.They received training materials, including

A Physicians Guide to Influencing Health Policy,and The Science and Politics of SecondhandSmoke, an issue-based synthesis of currentresearch.

Physicians fanned out to meet the op-position head-on. They testified at hearings,presenting important research and data. Mostimportantly, they conveyed personal stories ofthe harmful effects of secondhand smoke ontheir patients. They also submitted letters tothe editor and corresponded with commission-ers and legislators. One clinic system even senta letter to commissioners signed by all medicalstaff.

Hennepin and Ramsey

Medical SocietiesMembers of the Hennepin and Ramsey Medi-cal Societies also played an important role inpromoting smoke-free policies in the TwinCities. They participated in public hearingsand community events to discuss the dangersof secondhand smoke. Their involvement wasbased on the premise that people listen tohealth professionals when important publichealth issues are discussed.

The Hennepin Medical Society also served apivotal role in implementing the Minneapolis“Done Smokin’, Still Hot” campaign, whichpromotes Minneapolis as a great place to visitwith clean indoor air. The multifaceted planincluded billboards, media events, newspaperarticles and television commercials.

The physicians of these counties, throughtheir clinic systems, medical societies, and asindividuals, really answered the call and quicklybecame masters of local advocacy. Efforts likethese across the state contributed to the ul-timate passage of the statewide Freedom toBreathe law, which is a major milestone inpublic health.

Getting EngagedWorking together, medicine and public healthcan be a powerful force. Below, I have outlinedthree priorities I intend to emphasize as com-missioner. I encourage you to consider how youcan become engaged in working on these andother important public health issues.

PreventionThe old adage, “an ounce of prevention isworth a pound of cure,” is as meaningfultoday as it was back in 1872 when Dr. Hewittestablished Minnesota’s first Board of PublicHealth in Red Wing.

We have made great strides over the pastcentury in preventing many infectious diseases.As acute diseases such as smallpox and poliodeclined in the last century, we witnessedan increase in chronic diseases such as heartdisease, diabetes, lung cancer and asthma.Likewise, obesity rates have skyrocketed andchronic conditions have worsened as peoplebecame less active and made unhealthy foodchoices.

By focusing on the top four preventablecauses of illness and death —tobacco, physicalinactivity, poor nutrition and alcohol—we canbegin to turn the tide on this growing epidemicof chronic disease. This will require a broadrange of environmental, social, public healthand medical strategies.

How to get involved:

policies. For example, present a thank-you cer-tificate to local legislators for their support ofimportant health policies, such as Freedom toBreathe.

community more walkable and bikeable.



Voice for Public Health

(Continued from page 5)

designation as “Governor’s Fit Cities” and“Governor’s Fit Schools.” Achieving thisdesignation means they have made a strongcommitment to creating environments thatpromote good health.

address the top four preventable causes ofillness and death. Measure your progressindividually and collectively for qualityimprovement.

has developed with many partners to addresssuch diseases as cardiovascular disease, diabe-tes, cancer and asthma.

about possibly serving as a medical advisor.Also, make sure you are included on theirhealth alert network.

Public Health Infrastructure and

Emergency PreparednessOver the past several years, we have witnesseda number of serious public health threats,including SARS, West Nile virus, foodborne-disease outbreaks and natural disasters. Weare also facing the real possibility of anotherinfluenza pandemic.

As a nation and state, we have made sig-nificant investments in preparing for seriousemergencies. Among other things, Minnesotahas developed a comprehensive pandemic fluplan; we established the codeReady campaign,which is encouraging Minnesotans to be pre-pared for emergencies; and MDH has beenworking with local public health departmentsand emergency management officials to planhow to respond to emergencies.

Having a strong public health infra-structure means maintaining a robust disease

surveillance system, a state-of-the-art labora-tory, sophisticated information systems, and ahighly qualified workforce of epidemiologists,researchers, sanitarians, health educators,public health nurses, doctors, statisticians andothers. We need to look for opportunities tofurther enhance our infrastructure so we caneffectively address the routine and not-so-rou-tine public health challenges that will come ourway.

How to get involved:

to become better prepared for emergencies.

emergency by signing up for the Min-

www.mnresponds.org.

the community is ready to respond to emergen-cies.

your professional associations for a strongpublic health system. For more informationabout your local Community Health Board,go to www.health.state.mn.us/trailhead.

Health Care TransformationEven though Minnesota already has a healthcare system envied by many others, we haveroom to improve. We need to move froman acute care, doctor-focused system that re-wards visits and procedures to a system that ispatient-centered, focusing on how to supportpeople staying healthy and managing chronicconditions. We need redesigned care and pay-ment models, with transparency and the rightblend of collaboration and competition to

Dr. Sanne Magnan (SAN-ee MAG-nan) was appointed Min-nesota Commissioner of Health by Governor Tim Pawlenty onSeptember 28, 2007.

Commissioner Magnan is responsible for directing the Min-nesota Department of Health. MDH is the state’s lead publichealth agency, responsible for protecting, maintaining and improv-ing the health of all Minnesotans.

The department has approximately 1,300 employees in theTwin Cities area and in seven offices in Greater Minnesota.

Professional BackgroundPrior to being appointed commissioner, Dr. Magnan served as president of the Institutefor Clinical Systems Improvement in Bloomington. An independent, non-profit organiza-tion, ICSI facilitates collaboration on health care quality improvement by medical groups,hospitals and health plans that provide health care services to people who live and workin Minnesota and adjacent states.

Commissioner Magnan has also served as a staff physician at the Tuberculosis Clinicat St. Paul-Ramsey County Department of Public Health and a clinical assistant professorof medicine at the University of Minnesota.

She was also vice president and medical director of consumer health at Blue CrossBlue Shield of Minnesota where she was responsible for case management, disease man-agement, and consumer engagement.

Commissioner Magnan also was lead physician at Lino Lakes Correctional Facilityand a staff physician at various other clinics. She has served on several boards, includingMinnesota Community Measurement.

Commissioner Magnan was named one of the 100 Influential Health Care Leadersby Minnesota Physician in 2004.

Educational BackgroundCommissioner Magnan holds a medical degree and a Ph.D. in medicinal chemistry fromthe University of Minnesota. She earned her bachelor’s degree in pharmacy from theUniversity of North Carolina.

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achieve results. The system should be flexiblefor innovation to produce desired quality andvalue outcomes.

We all know examples of underuse, misuseand overuse of health care services. Our chal-lenge is to improve quality and patient experi-ence while decreasing waste and overuse. It isclear that with increasing costs of health care,the uninsured rate rises. Our goal must beaccess to quality, affordable care for all Min-nesotans.

This will be no easy task. As Mark Mc-Clellan, M.D., Ph.D., former administrator,Centers for Medicare and Medicaid Services,said recently, “For those of you who think thereis no health care system in this country, justtry to change it.” Thankfully, in Minnesota,we have providers, consumers, health plans,employers, policy makers and public health of-ficials who want to find common ground forchange. There is a window for transformation,and we should not let it pass.

How you can get involved:-

sions related to improving our health caresystem. Anticipate a lively discussion abouthealth care transformation during the 2008session.

care and payment, such as health care homes(or medical homes) and chronic disease man-agement.

for the dollar cost) a strategy within yourorganization. Support changes within ourpayment system that allow you to design forvalue.

Your Power as a PhysicianNever underestimate your power as a physi-cian. As trusted counselors with the health ofyour community at heart, you can be effectiveadvocates in advancing health-promoting poli-cies and legislation. By joining forces aroundcommon priorities, medicine and public healthcan renew their vows so that Minnesota re-mains one of the healthiest states in the nationfor decades to come.

Sanne Magnan, M.D., Ph.D., Commissioner,Minnesota Department of Health can be reached [email protected]. The Department

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FEBRUARY 23-MARCH 1, 2008

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This resort is located on Crown Island, a private 15-acre peninsula in the seasidecommunity of Coronado. You are surrounded by water with San Diego Bay on one

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Visit: www.metrodoctors.com for complete brochure.

For further conference information call RMS/HMS-612-362-3704; email: [email protected]

For reservations call Darla at Hobbit Travel

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11th AnnualWinter Medical Update 2008

Course Highlights:

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The RMSF designates this educational activity for a maximum of 20 AMA PRA Category 1 CreditsTM.

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C O L L E A G U E I N T E R V I E W

AQ

Frank J. Indihar, M.D., FACP, MBA

Given the graying of America, what is the AMA doingto improve Medicare funding for long-term care andrehabilitation services?

It is an unfortunate reality that with the shrinking availability of healthcare funding at all levels of government reimbursement programs (Medi-care, Medicaid, etc.), the funding that has seen little or no increase hasbeen for patients requiring long-term acute care, long-term care in aTCU or SNF, or rehabilitation services. In fact, in addition to decreasingreimbursement, the governmental funding agencies have been placingan increasing regulatory burden on long-term acute care hospitals andrehabilitation units to limit the patients that are admitted. The AMAand the AHA have vigorously fought these cuts in reimbursement andregulatory issues at the federal and state levels. It has long been anagenda priority of the AMA to seek comprehensive coverage for ourpatients’ needs. I have long been interested in the issues of long-termacute care— the decreasing reimbursement, increasing regulation of theindustry, the limitation on diagnoses that we can care for have been chal-lenging. The future, of course, holds that the need for these services willburgeon, and the complexity of cares for these seriously ill individualswill become even more needed. It has taken all of our lobbying effortsto keep the long-term acute care industry solvent thus far in the face ofincreasing CMS regulation and reimbursement adjustments (downward,for the most part).

The AMA’s Council on Medical Service issued an excellent whitepaper on the financing of long-term care in December 2004. The premiseof this paper is that publicly financed programs such as Medicare andMedicaid will be financially overwhelmed by 2030, leaving millions ofAmericans unprepared for the heavy financial and non-financial bur-dens of long-term care services. The report describes and encourages theutilization of various private sector options to ameliorate this burden,including long-term care insurance, Health Savings Accounts, conver-sion of life insurance policies and development of life care communitiesacross the nation. The Council recommended targeted tax incentivesto encourage Americans to utilize these options rather than depend onshrinking Medicare and Medicaid dollars.

How can specialists in geriatrics earn a living since theyare dependent on Medicare funding and what financialincentives are there for young doctors to go into geriatrictreatment specialties?

The Medical Group Management Association has compiled data for theMidwest that indicates that the median annual income for a specialistin geriatrics is currently $184,237 with some practitioners at the 90thpercentile earning $266,027 annually. While there are other specialtiesthat have more earning potential (and many with less), the MGMA’sdata would indicate to me that a specialist in geriatric’s annual incomeis actually quite reasonable. Rather than focusing on income, however,a young doctor’s temperament, interests, and sense of fulfillment shouldbe the determinant of their life’s work focus.

Frank Indihar, M.D., FACP, MBA, is board certified in internal medi-cine and a fellow of the American College of Physicians. He is a vicepresident of HealthEast Care System and is the CEO/medical directorof Bethesda Hospital in St. Paul. Dr. Indihar is also a consultant to theSocial Security Administration’s Office of Hearings and Appeals and anadjunct professor at the University of Minnesota Medical School.

Dr. Indihar practiced general internal medicine and pulmonarymedicine with St. Paul Internists, P.A. in St. Paul from 1973 to 2000and has served as president of the Ramsey Medical Society. First electedas an alternate delegate to the AMA in 1992 and a delegate in 1996,Dr. Indihar currently serves as chair of the Minnesota delegation tothe AMA. In addition, Dr. Indihar served as the President of the Min-nesota Academy of Medicine (2006-07).

Questions were submitted by: Lee Beecher, M.D., Robert Chris-tensen, M.D., Peter Dehnel, M.D., and Lisa McGinnis, M.D.

(Continued on page 10)



How did you transition to an administrative role in health care and what characteristics makes for a good fit for pursuing a medical career through administration?

I actually spent 27 years as a practicing internist/pulmonologist with St. Paul Internists in St. Paul, where we served as hospital intensivists, internal medicine consultants, and general internists to a large cadre of office-based patients. It was this basis, I believe, that prepared me for my current administrative role as a vice-president at HealthEast and the CEO of Bethesda Hospital (where I started the Respiratory Care Unit in 1979 for ventilator patients). However, I did get my MBA in 1992 when it became apparent that to run one’s practice and speak the language of the practice managers, the additional training was needed. I also served as the medical director of Bethesda Hospital throughout this period and it was a natural transition to becoming the CEO. I’ve enjoyed both aspects of my career and view both as playing a vital role in providing health care to our patients. As a physician, I was involved in the micro-management of individual patient’s needs, but as a CEO I am involved in the macro-management of the health care of a popula-tion of patients. I strongly believe that all physicians should continually explore their personalities and make transitions throughout life that will allow them to experience the fullness and broad approaches to medical

care that exist—from providing 1:1 patient care to becoming leaders in organized medicine and the community to exploring new ways of contributing to the medical field.

What is the AMA doing about the increasing problem of obesity in America’s children and adults?

The AMA has long been interested in the epidemic of obesity in America. A task force has been formed and a white paper written on this issue (and many other public health problems facing America) under the direction of the AMA’s Council on Scientific Affairs and Public Health. The AMA has also been the fulcrum of forming partnerships with other like-minded organizations (like the various diabetic and endocrinology societies) to examine the etiologies and formulate a plan to combat this “growing” problem. Many of the advertisements in both print and video media have occurred as a result of the AMA’s development. It should be noted that the AMA’s public health and scientific agenda is a major pillar of service to American physicians and public. The wide range of issues studied by this group is a major impetus of the AMA’s efforts and use of resources. In addition to sponsoring a National Summit on Obesity, the AMA has published, with support from the Robert Wood Johnson Foundation, and developed in collaboration with the U. S. Department of Health and Human Services, a series of booklets that provide roadmaps for clinical

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approaches to the management of obesity. Minnesota’s own J. Michael Gonzalez-Campoy, M.D., Ph.D., a former Ramsey Medical Society president and former president of the Minnesota Medical Association, has been vigorously involved in the problems of obesity at the AMA. As a Delegate to the AMA’s House of Delegates from the Minority Affairs Consortium (MAC), Mike continually addressed the subject of obesity in minority populations via active participation with the AMA Councils and brought the subject forward to the House floor and Reference Com-mittees on many occasions as a major public health hurdle.

What is the outlook for membership in the AMA and what can be done to improve membership?

Membership is the number one agenda item of the AMA’s Board of Trustees. And, indeed, their efforts are paying off as we’ve seen a gradual decline in the hemorrhaging of membership and, in certain categories, actually seen a rise in membership as new programs have been initiated to attract members. However, a number of interesting factors come into play as the AMA continues to struggle with maintaining membership (it should be mentioned, however, that the AMA is fiscally very strong and financially solvent, but membership is needed for the AMA to fulfill its mission). First, it is my observation that we in America have lost a sense of belonging to anything; memberships in most organizations have fallen in recent years as we’ve developed a more inward focus in our population. Second, and peculiar to medicine, is that the rise of large clinics and employment of physicians has decreased the need for an association to provide for our education/representation/social requirement —theseare all provided by the employer. Third, the provision of dollars to pay for associations is generally part of a smorgasbord of limited dollars provided by the employing or-ganization, which can be used for education, association dues, specialty dues, insurance plans, vacation/seminars, computers and computer educational programs, etc. Fourth, most physicians belong to their specialty organizations and rely on them for their lobbying and educational benefits. The AMA (as well as our state MMA and our county organizations) need to continu-ally provide value to the membership and this value must be proven again and again. The AMA lobbied very diligently and successfully this year to reverse the Medicare physician payment cuts proposed by CMS in January. These efforts, of course, benefited both AMA members and non-members. But, will this success be remembered by the physicians next year when we ask them to join organized medicine organizations? We must all pitch in on these expensive state and federal efforts by personally becoming members of the MMA and AMA—and recruiting others to join!

How are policy issues brought to the AMA House of Dele-gates and how can one become a candidate to serve on the Minnesota Delegation to the AMA House of Delegates?

The Minnesota AMA Delegation is nominated by the MMA’s Nominat-ing and Leadership Development Committee based on an individual’s

participation in county and state leadership roles or committee work on both levels. The Delegation’s number is based on the number of AMA members in Minnesota, with one delegate and one alternate for each 1,000 members. In Minnesota, the terms of service on the Delegation are limited, always making way for “new” members to be nominated and elected at the MMA’s Annual meeting on a rotating basis. In addition to serving as the basis for electing the delegation, all policy items that are brought to the AMA originate at the MMA’s Annual Meeting. Resolutions can be brought by individuals or counties through the reference committee process at the meeting. Those items that request AMA action are then forwarded to the AMA Speaker of the House for placement in the appropriate AMA Reference Committee where your delegates argue for the validity of the position. Eventually the Reference Committee’s disposition is brought to the full AMA House of Delegates for action.

If you could wish for one thing related to health care in the Twin Cities, what would it be?

By far and away, it is important that ALL of our citizens, whether they be low income, students looking for their first job, individuals between jobs, families, etc. HAVE health insurance and a basic coverage plan. It is unthinkable that in a country with such resources, we have not pro-vided a basic health insurance program for all of our citizens. And, we all know that the uninsured ultimately raise the cost of medical care by seeking their care in expensive settings, such as emergency rooms and that quality of care suffers since there is no one who is in “charge.” I know that the devil is in the details of providing such a plan, but the MMA’s universal coverage program is a start in the right direction. And, whatever the funding mechanism or vehicle for pro-viding this coverage might end up being, we need to s ta r t NOW. Task forces are working on this issue, as they have for my entire professional career. What we need is action and a posi-tive first step toward providing this basic coverage for all.

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Minnesota Physicians CarryResolutions to the AMA

THE MINNESOTA DELEGATION to theAmerican Medical Association’s House ofDelegates Interim Meeting, held November13-17, 2007, met with considerable successin presenting resolutions from Minnesota.The Delegates representing Minnesota at thismeeting included Frank J. Indihar, M.D.,(Chair of the Delegation), John M. VanEtta, M.D. (Vice Chair of the Delegationand Chair of the North Central MedicalConference Caucus), Kenneth Crabb, M.D.,Raymond Christensen, M.D., AnthonyJaspers, M.D., Sally Trippel, M.D., MPH,Robert Grow, M.D., (Resident Delegate)and Jason Meyers (Student Delegate). TheAlternate Delegates representing Minnesotawere John Abenstein, M.D., MSEE, GailBaldwin, M.D., Blanton Bessinger, M.D.,David Estrin, M.D., Benjamin Whitten,M.D., James J. Dehen, M.D. (Presidentof the Minnesota Medical Association) andDionne Hart, M.D. (Resident AlternateDelegate).

The Delegates strongly supported Min-nesota Resolution 815, which dealt with theJoint Commission’s Interpretation of Medi-cation Reconciliation. It was strengthened toinclude that “all Joint Commission standardsincluding medication reconciliation...” beconsistently interpreted.... The ReferenceCommittee indicated that there was strongsupportive testimony on the resolution andthat the Joint Commission representativepresent at the hearing said the Commissionrecognized the existence of the problem andwas taking steps to address the issues raisedin the resolution. Interestingly, the JointCommission recently sponsored a Summiton Medication Reconciliation where many

of these issues were raised by the AMA andothers.

The Minnesota Resolution requestingthe development of a “Tiering System forThird Party Payers” was referred to the Boardof Trustees for study. Testimony was mixedfrom the hearing attendees, with concernsbeing raised by many about the methodologyand even the feasibility of evaluating insurersand placing their offerings in a tiered rank-ing system. Many at the hearing reflectedfrustration over the related issue of insurerevaluation of physicians. It was determinedthat the Board of Trustees would need tostudy the issue and develop an advocacyapproach in a coordinated fashion.

Resolution 714, from the MinnesotaDelegation, was referred to Reference Com-mittee J where it received widespread andpassionate acceptance with the goal to allowcare for returning servicemen and womenand their families under the TRICARE sys-tem be simplified to reduce the complexitiesassociated with the contracting process. TheNorth Central Medical Conference stronglysupported this resolution and the audience atthe Reference Committee strongly empha-sized that it is the health of veterans and theirfamilies that is at stake and the governmentshould ensure that they receive the care theyneed in their local communities.

A fourth resolution, dealing with Spe-cialty Societies’ representation in the AMA’sHouse of Delegates was not heard at thismeeting, which was primarily focused onadvocacy issues. We will bring that resolu-tion to the AMA’s Annual Meeting in June,2008.



I

Portico Healthnet: A Local Solution for Covering the Uninsured

BY DEBRA HOLMGREN, M.A. , MPA

IMAGINE YOU ARE THE parent of four children and work as a dishwasher to support your family. Your spouse needs treatment for depression. One of your children needs eyeglasses. Another child suffers from severe asthma and respiratory problems, and he experiences migraines so debilitating that you need to repeatedly bring him to the emergency department. You and your family are also unin-sured. Your family does not qualify for publicly subsidized health care coverage. Health insur-ance is prohibitively expensive for your family, and it’s impossible for you to pay out-of-pocket for health care. What do you do? Fortunately, this family found Portico Healthnet. Portico currently provides coverage for the family, paying for a continuum of health care services, as well as care management. All of the children received complete physicals and recommended follow-up care within the first six months of enrollment in the program. The parent suffering from depression receives ongo-ing treatment. The family’s care management coordinator helped obtain eyeglasses for one child, and arranged for an in-home pediatric provider to treat the severely ill child, who was recently diagnosed with lead poisoning. Based on his medical condition and with advocacy by the care management coordinator from Por-tico, the child has been enrolled in the state’s Emergency Medical Assistance program, which covers all of his health care needs. The other five family members continue to access care through Portico’s coverage program—the only viable option they have. Over the past 12 years, Portico has helped hundreds of families in similar circumstances access health coverage and care. Over 6,000 uninsured children and adults have enrolled in Portico’s safety-net coverage program, and

another 5,000 have been enrolled in public coverage programs with assistance from Por-tico.

What is Portico Healthnet?Portico Healthnet (formerly MetroEast Pro-gram for Health) is a nonprofit health and human services organization created and sustained by east metro hospitals working to-gether to provide regular access to health care for community members with low incomes and no insurance. This successful partnership transcends competition among the nine hos-pitals and maintains a single focus: to reduce the number of people without coverage for health care services. Portico provides health care coverage for low-income uninsured residents of the three-county east metro area who do not qualify for public programs and who have no other afford-able options. Portico’s hospital partners pay for the medical care provided for enrollees, includ-ing primary and preventive care, specialty and urgent care, eye exams, outpatient procedures, outpatient mental health services, prescription medications, interpreter services for medical appointments, and care management. With annual contributions from hospital partners totaling approximately $1 million, Portico provides ongoing health care services for 800 to 1,000 individuals per year. In other words, at a cost of just $1,000 to $1,250 per person per year, Portico provides a continuum of preven-tive, primary and specialty medical services to uninsured people in the community, keeping them healthy and no longer dependent on emergency care. Portico’s unique model includes individu-alized, in-person care management assistance. Portico’s care management coordinators (who are licensed social workers) help enrollees navigate the health care system and use services

appropriately. Shortly after enrollment, care management coordinators meet face-to-face, one-on-one with each individual and family receiving coverage through the program. This initial meeting is the foundation for the trust-ing relationship built between care manage-ment coordinator and enrollee that ultimately results in reduced emergency department and inpatient hospital admissions.

Reaching the Uninsured In order to connect with uninsured community members before their medical needs become urgent, Portico pursues vigorous, community-based outreach. Portico’s community health workers establish relationships with hundreds of metro-area human service agencies, schools, health care organizations, workforce centers and other organizations serving the uninsured. As a result of their networking efforts, Portico’s community health workers are able to meet with uninsured individuals at numerous loca-tions throughout the Twin Cities. Portico’s community health workers screen uninsured individuals and families for a variety of coverage options. The Minnesota Department of Health estimates that over 50 percent of uninsured Minnesotans are eligible for Minnesota Health Care Programs but have not enrolled. Although one may qualify for subsidized coverage, actually applying for and enrolling in a state program can be overwhelm-ing, if not impossible, to accomplish on one’s own. The application for Minnesota Health Care Programs is 24 pages long (not includ-ing the instructions), and many applicants face obstacles as they try to obtain the required verifications and documentation. That’s why Portico also provides comprehensive enroll-ment assistance and advocacy support for those potentially eligible for public programs.




Why Coverage MattersHealth coverage and affordable access to careare key components of economic self-suf-ficiency.

The Kaiser Foundation estimates thatamong the uninsured, gaining health carecoverage can increase annual earnings by asmuch as 30 percent. Healthy workers are pro-ductive workers, and when children stay well,

parents experience less absenteeism at work.A study recently published in JAMA

found that after an injury or onset of a chroniccondition, uninsured persons, compared totheir insured counterparts, were less likely toreceive any medical care, less likely to receiverecommended follow-up care, including pre-scription medications, and less likely to fullyrecover. Survey data from Portico’s coverageenrollees consistently indicate that, as a resultof the program, participants are less likely to

utilize emergency department services, morelikely to receive complete physicals and keepimmunizations current, and less likely to behospitalized. The Kaiser Foundation estimatesthat coverage for health care would reduce themortality of the uninsured by 15 percent.

A Wise InvestmentIn addition to improving the health and qualityof life of those it serves, Portico also provides asignificant benefit to the community in termsof dollars and cents.

Over $3 million is infused into the metroarea’s health care system each year throughmedical reimbursements from MinnesotaHealth Care Programs for patients enrolledwith Portico’s assistance, reducing uncom-pensated care burden of health care providers.A recent analysis of Portico’s services found thatfor every $1 invested in Portico’s programs,there is a Return of Investment to the com-munity of about $3. This ROI was calculatedwith a model that considered: (1) the savingsresulting from decreased utilization of theemergency department among Portico enroll-ees; (2) the savings resulting from decreasedhospital admissions among Portico enrollees;(3) increased earnings of enrollees due to accessto primary care; and (4) increased care systempayments from enrolling the uninsured intopublic programs.

Former enrollee Lorna R. can’t say enoughabout Portico’s coverage program. She no lon-ger lives in the coverage program’s service area,having moved from St. Paul to Minneapolis.“It’s the best program I’ve ever seen, and thepeople there are so compassionate and car-ing,” said Lorna, owner of a coffee shop andfreelance photographer. “They’re just great atmaking you feel important and like you matterand you count, and they’re not going to leaveyou in the dust. I was just really grateful toeven have it.”

Lorna would like to see the coverage pro-gram expanded to other areas of the Twin Cit-ies. We, at Portico, want to make that happen.Until policymakers settle the debate on howto expand coverage to the uninsured, Porticooffers a solution.

Debra Holmgren, MA, MPA, is Presidentof Portico Healthnet and can be reached [email protected].

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There are serious problems in American health care. The issuesof double digit inflation and the uninsured cannot be ignored.

It is tempting to believe that by simply putting pen to paper we cancreate a “right” to health care and solve these problems. Sadly, such alegislative solution does not address the root cause of the issues andwill make things worse rather than better.

In all sectors of the economy outside of health care, consumersrestrain their purchases based on price and value forcing providers todrop costs and raise quality. This does not happen with health care.With first dollar payment, whether by an insurance company or thegovernment, the patient perceives costs as zero. With a perceptionof zero costs, demand is potentially infinite. Even wealthy insurancecompanies and governments do not have infinite financial resources.Patients have no incentive to function as savvy shoppers; therefore,someone must limit expenses. Any third party payment system mustdo exactly that. This holds true whether it be the British NationalHealth Service, the Canadian Ministry of Health or American insur-ance companies. No measure of compassion or “political will” canalter these economic facts.

The current government created third-party payment system hassomeone other than the patient footing the bill. Such payers attemptto pay out as little as possible. Providers bill as much as possible torecoup costs. The hapless patient without insurance may be saddledwith an enormous bill that bears no resemblance to what the costswould be if health care were a marketplace commodity where patientsfunctioned as consumers. Why not let patients’ control the moneythey spend rather than having corporate or government bureaucratsdo so? The claim that health care is too complicated is an elitist insult.Cars and computers are complex also but somehow we can all figureout when we are getting value for our dollar.

One method of attempting to guarantee a “right” to health careis a government run single-payer system. Under such a system, doctorswill not be reimbursed fairly nor will patients have their needs met. Innormal markets, the allocation of resources is determined by the intel-

ligence of the marketplace in which we all democratically partake withthe free exchange of dollars. Instead, in government systems of healthcare, resources are allocated by those few who can get their hands onthe levers of political power.

The United States was unique among nations in that it wasoriginally based upon the value of liberty. Freedom, as originallyconceived, was limited to the field of politics. The term simply meantfreedom from the coercion of others. It certainly was not a claim tothe property or labor of others. The claim that “A hungry man is notfree” is absurd. It confuses the political concept of freedom with thebiological fact that we all have needs for food and shelter. Food is evenmore necessary to sustain life than is medical care. Food is not deemeda right and yet virtually everyone in this country gets fed. In fact, thepoor in this country have a problem with obesity, not emaciation.

Liberty requires rights. Rights originally defined freedom ofaction. They were not a guarantee of being provided for. The originalrights were all “negative” rights in that they simply defined the free-dom to act. The only obligation was to refrain from interfering withthe actions of others. On the other hand, positive rights impose anobligation for someone to do something for others. All rights listed inthe Bill of Rights are negative rights. They simply allow the freedomto act with no imposed obligation. All legitimate rights are negativerights or liberty rights.

“Rights” such as health care imply that someone must act toprovide them. What of the liberty rights of the providers of healthcare? They have to be violated and therefore positive rights such ashealth care are pseudo-rights. The liberty rights of doctors, nurses,taxpayers and health care entrepreneurs must be abrogated to providesuch care. Implicit in health care as a “right” is that these people mustbe coerced.

For example, the proposed Clinton Health Security Act of 1993was based on compulsion. The word prison shows up seven timesin the legislation; penalty 111 times; fine six; enforce eight; prohibit47; mandatory 24; limit 231; obligation 51; and require 901. TheRepublican counter proposal was also based on forcing people todo what government believed to be the right thing. Prison was usedonce; enforce 37 times; penalty 64; fine 12; prohibit 19, and require482.1 It is simply inescapable that the government provision of goodsand services is based on government compulsion of its own citizens.Countries based upon coercion of its citizens, rather than liberty, havenot fared well. The lesson has been well demonstrated in the SovietUnion, China and North Korea.

Why Health Care is Not a Right

“If some men are entitled by right to the products of the work of oth-ers, it means that those others are deprived of rights and condemnedto slave labor.”

Ayn Rand

“If we can prevent the government from wasting the labors of thepeople under the pretense of caring for them, they will be happy.”

Thomas Jefferson

BY LEE KURISKO, M.D. , FRCPC (Continued on page 16)



In my home country of Canada, their system of governmentmedicine started merely as a payment system. Because no governmenthas infinite resources, government in Canada has had to insidiouslytake over and control all of health care. This necessitates a system ofSoviet-like centralized planning and co-ordination of the resources.Such a model is a proven failure with the collapse of the Sovieteconomy.

Simply look at food production and distribution in the formerU.S.S.R. versus the availability of food on Manhattan Island. In theU.S.S.R. people were starving and waiting in lines for basic itemslike eggs, milk and flour. On Manhattan Island, you can get any typeof food 24/7 whether it be Peking duck, take-out lasagna or a dietcaffeine-free Coke. This illustrates the clumsiness of central planningversus the agility of free markets. Market solutions work brilliantlyand socialism is a dismal failure. It is often mistakenly believed thathealth care is so important that we cannot entrust it to free marketswhen the reality is that because it is so important we must entrust it tofree markets.

Just as importantly, in a government system, reimbursement ison a fixed fee schedule. This is a form of wage and price controls.As Milton Friedman had said, “Wage and price controls lead toshortages— always.” That is why 16.8 percent of the Canadianpopulation has no access to primary care2 and the average wait to see aspecialist is 18.3 weeks3.

Those that really care about the current state of health care inAmerica should abandon claims of health care as a right or demandsfor a single payer system. We do not want to further empower clumsygovernment or privileged insurance companies to spend our money.The truly thoughtful should demand that patients, in conjunctionwith their doctors, be empowered to spend their own money as theysee fit to obtain the services that are needed. This can be achievedby using insurance as originally intended for unlikely events and notfor first dollar coverage of routine and expected care. Deregulatedhigh deductible insurance, and HSAs are the path to marketplaceinnovation and lower costs. Look at the prices for Lasik surgery. Lasikis not covered by most insurance policies. Costs have plummetedand ophthalmologists are paid precisely what the marketplace seesas fair payment. Public monies currently used for the poor could beredirected into HSAs for them. Such strategies could unleash the awe-some productive power of the marketplace that has created the wealth,abundance and low costs prevalent in every other sector of the mightyAmerican economy. Best of all, no one will have to have their libertysacrificed for a bogus right to health care.

(Endnotes)1) Browne, H., Why Government Doesn’t Work, St. Martin’s Press, 1995, p. 101.2) Canada AM, CTV Web site, July 4, 2007, http://www.ctv.ca/servlet/ArticleNews/story/

CTVNews/20070704/immigration_doctors_070704/20070704/3) Waiting Your Turn. Hospital Waiting Lists in Canada. 17th Edition, N. Esmail,

M.A. Walker, October 15, 2007, http://www.fraserinstitute.org/commerce.web/publication_details.aspx?pubID=4962

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Editor’s note: This is the second of a three partseries discussing adaptive leadership as a model foraddressing the difficult problems that health careorganizations face. The final article will describethe remaining principles of the model developed

Instructions to medical staff regarding EMRusage, as recently printed in a medical staffnewsletter:

“Avoid selecting any order with “HCHG” asthe first letters in the order. Any order entryitems that have “HCHG” as the first partof the order title are for charging only. Theydo not initiate an action to do a procedureor test. The majority of the time you will notsee these items because they do not appearon the initial search results list. However, ifyou choose the facility or database lists theseHCHG orders may be seen. The HCHGitems need to be available to workers to cor-rectly complete patient billing. Be observantof the wording as you select the order. Otherthan this designation, the order may appearidentical to the actual procedure order. Besure to read the full line for the order. Youwant to be sure it is the correct order and isavailable at the hospital where the patientis located.”

In the September/October 2007 issue of Metro-Doctors, we introduced the leadership modeldeveloped by Ron Heifetz, a psychiatrist work-ing at Harvard’s Kennedy School of Govern-ment. Through observation and application ofprinciples in psychology, group dynamics andorganizational behavior, he describes a modelof leadership that takes commonly encounteredobstacles to significant change into account.The model describes adaptive challenges anddistinguishes them from situations that require

technical work. He emphasizes the benefit ofunderstanding the complexity of the values anorganization holds, including values that com-pete, contrasted against the hard reality thatthe organization faces. Identifying competingvalues (i.e., meeting patient needs vs. qualityimprovement vs. cost containment) and mo-bilizing people to perform the work needed tomake progress is adaptive leadership.

In the Heifetz model, one begins toexercise leadership by determining whether asituation requires technical or adaptive work.Situations requiring a technical approach in-volve applying skills that already exist, eitherin the organization or available elsewhere, fol-lowing the formal authority’s vision. Techni-cal work can be difficult and complex, such asrunning a code, but it is work we know how todo. In technical situations the role of authorityis to provide direction, protection, role orienta-tion, conflict resolution and maintenance ofnorms.

While technical problems entail work weknow how to do, adaptive problems require usto learn something new. According to Heifetz,“adaptive work is required when our deeplyheld beliefs are challenged, when the valuesthat made us successful become less relevant,and when legitimate yet competing perspec-tives emerge.” In adaptive situations, attitudes,beliefs and behaviors must change.

Adaptive change is difficult and any ofus, whether in a clinic, hospital or boardroom,will encounter resistance in the form of avoid-ance of necessary work. Heifetz renames theresistance that we are all familiar with in thetherapeutic relationship “work avoidance.” In-dividuals facing the painful work of adaptationwill naturally avoid it. Avoidance mechanismsinclude silence, denial, holding onto the past,confusion, laying blame, sabotage, attack onauthority, fake solutions (structural adjust-

ments, task forces, disingenuous agreement,deal making) and sterile conflict that involvesno listening, curiosity or creative engagement.Work avoidance may be triggered by too littledistress — not believing that a problem isimportant, for instance — or too much dis-tress —when many problems are encounteredat once and people or systems are overloaded.Our current struggles with the electronic medi-cal record (EMR) are a springboard to discussadaptive leadership principles in action.

The Electronic Medical RecordImplementation: Technical orAdaptive Work?Patient stories are at the heart of our work.Even though we have lists of symptoms,physical findings, flow schemes and decision-making trees in our heads guiding the creationof differential diagnoses, clinical narratives areimperative to care. Often our work dependson the stories within stories. The medicalrecord is primarily a device used to advancethe patient’s care. The doctor becomes theauthor of the patient’s story that serves as ahub of human relationships when caregiversfocus attention on the patient’s needs. Creat-ing the record is a shaping process in whichthe patient’s circumstances, with emphasis ofsome aspects of the story and minimizing orcompletely eliminating others, are worked intoa manageable unit of information. The storyis then easily and effectively communicated,framing relationships between clinicians andtheir patients. As medicine uses the computeras a new recording tool, how can this essentialtask of preserving the patient’s story be bestundertaken?

There are many values tradeoffs with theEMR. The data template challenges the valueof the narrative as effective communication.

BY CASCADE PARTNERS

The Case for Adaptive Leadership

When Physicians and Their Organizations Face DifficultProblems: Electronic Medical Record Implementation




A record used to guide best care delivery isalso a business and compliance tool. Caredelivery systems use the record to balancequality of care with cost containment. Thefamiliar physician-driven written or dictatedmedical record located in one physical chartis replaced by simpler, easier workflows fornurses, pharmacists, health unit coordinators,materials management staff, available at manylocations simultaneously while also requiringphysicians to type. This challenges older physi-cians more than younger doctors. All of thesechallenges are weighed against the value of howcare is improved by the availability of the recordsimultaneously throughout the hospital andclinics.

Many efforts to implement electronicrecords have failed. Failure could be blamedsolely on technical issues, such as difficultdata entry or cumbersome usability. How-ever, behind possible technical flaws lie thequestions:

What do we want the EMR to be? Arecording tool? A quality improvement tool?A cost savings measure? A billing and coding

tool? Who decides what is the EMR’s primarypurpose?

When and how are the physicians whowill use the electronic record involved in deci-sions? In the development phase? In the imple-mentation phase? After software is purchasedand during training?

Which physicians are involved in deci-sions? Those who have computer technologicalsavvy only or also those who do not, yet willstill be required to use the EMR?

What are the unintended consequences ofimplementation of the EMR, i.e., shifting dataentry burden from clerical to medical staff?What losses and gains will ensue, such as fun-damental alterations in the physician-patientrelationship? How will these changes be dealtwith?

Ideally, each system will ask, well in ad-vance of implementation of an EMR, how dowe want to do our work? How can an electronicmedical record help us function at our best?And, what consequences of an EMR can beanticipated and planned for?

Implementing the EMR is technicaland adaptive work. Heifetz says, “the mostcommon cause of leadership failure is using atechnical fix for an adaptive challenge.” On thesurface, implementing a hardware and softwaresystem and training people to use it seems liketechnical work that a formal authority couldorchestrate, as simple as weighing the pros andcons to make a logical decision. But the manycultural and behavioral changes required by theelectronic record users makes implementationfar more complex. The exercise of leadership isrequired to hold people in the adaptive workwhen the losses become evident.

With change in attitudes, beliefs andhabits comes the pain of loss. The discomfortof adaptation is felt by the spine surgeon—andeveryone he speaks to—after he spends moretime entering postoperative orders into thecomputer than he did performing the sur-gery. The sense of loss that our colleagues feel,including the loss of sense of competence whenwe sit before a computer screen with softwarewe do not know how to use to perform thebasic functions of our work, is analogous to theloss our patients feel confronting illness or in-jury. Physicians are uniquely prepared to exer-cise adaptive leadership. Through a therapeuticrelationship based on understanding, empathyand validation, we create the environment nec-

essary for our patients to cope. We recognizetheir resistance. We pace their adaptation to afuture they do expect by carefully monitoringtheir level of distress and balancing the amountof information they need with the amount thatthey can tolerate. We draw attention to toughquestions, give people more responsibility thanthey are comfortable with and bring conflictsto the surface. We lower distress by addressingthe technical aspects of treatment, breaking theproblem into parts or temporarily reclaimingresponsibility by saying “don’t worry, we willtake care of that.” All the same principles tomaintain a productive level of distress applywhen physicians exercise leadership by helpingtheir organizations make progress on difficultproblems.

In the face of work avoidance, physiciansexercising leadership can use their formal orinformal authority to redirect attention to theadaptive challenge at hand. We can reframethe problem and focus attention on thetough aspects, drawing the issues out ratherthan quelling conflict. We can reorient ourcolleagues from their current roles to newones so different relationships develop. Wecan challenge the way we execute our duties,distinguishing values and norms that mustendure from those that should be eliminated.Basically, we can help our colleagues feel thepinch of reality, rather than protect them fromthe pain of adjustment, just as we must helpour patients face their losses.

By distinguishing technical from adaptivechallenges in health care, defining the compet-ing values that make some problems especiallydifficult and using our clinical understandingof the process of adaptation, every physicianhas the capacity to exercise leadership in ourcommunity’s effort to make progress in healthcare delivery. In the next issue of MetroDoctorswe will address the personal aspects of leader-ship.

*Heifetz, Ronald, Leadership Without Easy Answers(Cambridge, MA: The Belknap Press of Harvard UniversityPress, 1994)

CascadePartners offers leadership education andcoaching to health care professionals and the orga-nizations they serve. Cascade Partners principalsinclude: Kathleen Brooks, M.D., MBA, MPA;Tom Gilliam, R.N., MBA; Mary Jo Lewis, M.D.;Michael Tedford, M.D., MBA; Valerie Ulstad,M.D., MPA, MPH.

Adaptive Leadership


Please fax or email resumes to:

Nikki Kluver, Human Resources

Telephone: 612-821-3552

Fax: 612-821-2818

Email: [email protected].

SouthsideCommunityHealthServices

Join a team of caring individuals, providingquality healthcare to a culturally diversepatient population. Southside CommunityHealth Services is seeking Full-time/Part-time Family Practice Physicians to workin our family practice/community cliniclocations in Minneapolis. We provide a fullrange of medical services, including OB care,to the underserved community. Practice isclinic based only, with weekends andholidays off. Great benefits and salary withpaid malpractice. Applicants may qualify forstudent loan repayment programs.



T

Major Compensation Changes Under Medicare

BY RYAN S. JOHNSON, ESQ. AND KATHERINE J . DOUGLAS, ESQ.

THE CENTERS FOR Medicare and Medicaid Services (CMS) recently published the final 2008 Medicare Physician Fee Schedule (the “Fee Schedule”) and the long-awaited “Phase III” of the Stark Regulations. The Phase III rules were effective December 4, 2007 and the Fee Schedule became effective January 1, 2008. These regulations may require the re-structuring or termination of many common business arrangements within the health care industry, such as: A space and/or equipment lease between

a physician group and a hospital. This arrangement was previously acceptable as long as the payment did not take into ac-count referrals. Now, these arrangements will likely need to be restructured to meet the criteria for Stark’s lease and equipment exceptions. A medical director agreement between a specialty group and a hospital. While these agreements are still acceptable, they may need to be more formalized to meet the requirements of a Stark exception.Management services agreement between a group practice and a hospital. Unless properly structured to fit within a Stark exception, referrals between a group practice physician and the hospital will be prohibited.A physician group’s operation of an off-site diagnostic testing facility. Unless the physi-cian group furnishes “substantially the full range of services furnished by the group” in the off-site facility, the physician group will be significantly limited in its ability to mark up the professional and technical components furnished in the offsite facility.

There are also changes contained in the regulations that are beyond the scope of this article, such as changes to independent diag-nostic testing facility enrollment requirements. Without addressing all of the regulations, this article will discuss those provisions that are likely to have the biggest impact on most health care providers.

Stark Phase III

The Stark ProhibitionThe Stark law prohibits a physician from making a referral for certain designated health services to an entity with which the physi-cian (or an immediate family member) has a financial relationship, unless one of its many exceptions applies. Stark also prohibits entities from submitting claims for designated health services provided pursuant to a prohibited re-ferral. Stark is a strict liability statute, meaning that the intent of the parties is irrelevant for purposes of determining whether the law has been violated. Stark provides for penalties of $15,000 per violation, plus requires the refund of amounts paid for illegally referred designated health services.

Stand in the ShoesFor purposes of determining whether a physi-cian has a direct or indirect compensation arrangement with an entity to which the physician refers patients for designated health services, the physician will now be deemed to “stand in the shoes” of his or her physician or-ganization. A large number of business arrange-ments are likely to be affected by this change. Thus, if a hospital enters into a contract with a large physician group practice (for example, a space or equipment lease), the hospital will be deemed to have a direct compensation arrange-ment with all physicians in the groups, and the

hospital contract must fit into one of Stark’s direct compensation exceptions. Prior to Phase III, the hospital would have been viewed as having an indirect compensation arrangement with the physicians in the group, meaning that the business arrangement would be eligible for Stark’s indirect compensation exception. Compensation arrangements entered into prior to September 5, 2007 that satisfied the indirect compensation exception will not need to be amended during their current term to comply with a direct compensation exception. Such arrangements may continue to use the indirect compensation exception during the original and renewal term of the agreement. CMS has delayed the applicability of the “stand in the shoes” provision until December 4, 2008 with regard to academic medical cen-ters (AMC) and integrated 501(c)(3) health systems. For AMCs, the “stand in the shoes” provision will not apply to compensation between a faculty practice plan and another component of the same AMC. For integrated 501(c)(3) systems, the provision will not ap-ply to compensation between an affiliated designated health services entity and affiliated physician practice within the same integrated system.

Recruitment ExceptionAnother significant change contained in the Phase III regulations affects a hospital’s ability to provide recruitment assistance to physician groups. Phase II prohibited a hospital from providing financial assistance for recruitment if the physician group required the recruited


physician to enter into a noncompete agree-ment. Phase III eliminates this prohibition by allowing reasonable noncompetition restrictions.



Other revisions to the recruitment excep-tion include a modified method for determin-ing a hospital’s service area. Phase II prohibitedrecruitment payments to a physician who hadbeen practicing for more than two years. PhaseIII excepts from this prohibition paymentsmade to a physician who has practiced in aprison, Veteran’s hospital, or for the IndianHealth Service and did not maintain a privatepractice. There are also slight revisions to therequirement that a physician group allocateonly its actual, incremental costs attributableto a physician with an income guarantee. Forgroups in rural areas or health professionalshortage areas, if the recruited physician re-places a physician who left the practice andgeographic area within the previous 12 months,the group may allocate up to 20 percent of itsoverhead to the recruited physician.

2008 Fee Schedule

Anti-markup RuleEffective January 1, 2008, CMS imposed asignificant change to the anti-markup rule fordiagnostic tests. Previously, the anti-markuprule prohibited a physician/group from “mark-ing up” the fee for a diagnostic test that thephysician purchased from a third party. A phy-sician may bill Medicare no more than whatthe physician paid for the test. The previousrule applied only to the technical component ofthe test. The new rule expands the prohibitionto the professional component of such tests. Aphysician/group is prohibited from markingup technical or professional components of adiagnostic test if the test is purchased or if it isperformed in a place other than the physician/group’s office. For physician organizations (solepractitioners, physician practices and grouppractices), the “office” is the space where thephysician organization provides substantiallythe full range of patient care services that itprovides generally.

The anti-markup rules require the billingphysician/group to bill the lowest of: 1) the

performing physician’s/supplier’s net charge tothe billing entity; 2) the billing entity’s actualcharge; or 3) the fee schedule amount. The “netcharge” excludes any amounts provided to thebilling entity for lease of space and equipment.So if a physician contracts with a radiologist toperform a scan with equipment the radiologistleases from the physician, the physician mustconsider those lease payments when determin-ing the radiologist’s “net charge.”

The practical effect of the new anti-mark-up rule could be significant. For example, therule prohibits a physician group from markingup the fee for the professional component of atest performed at an off-site diagnostic testinglocation, even if the group operates the locationexclusively.

Proposed Revisions that

Were Not AdoptedCMS did not adopt many of the proposedchanges to the Stark Law that were included inthe July, 2007 proposed physician fee schedule.These include changes to the definition of“entity” under Stark, per-click arrangementrestrictions, services provided “under arrange-ments,” set in advance and percentage-basedrequirements, and the alternative criteria forsatisfying a Stark exception. However, CMSindicates that these changes will resurface infuture rulemaking. [Note that this summaryis not comprehensive.]

ConclusionBusiness arrangements among physicians/groups, hospitals and independent contrac-tors should be reviewed for compliance withthe most recent Stark law changes and theanti-markup provisions of the 2008 MedicarePhysician Fee Schedule. The changes are far-reaching and will likely have an impact onalmost all providers. Please note that this articledoes not address all of the changes that may berelevant to a particular provider. If you haveany questions about any of the other changesnot addressed in this article, please feel free tocontact the authors.

Ryan Johnson and Katherine Douglas are attorneysin Fredrikson & Byron’s Health Law Practice Group.They can be reached at [email protected] [email protected].

Medicare




O

Collaborating on Statewide Cessation:A Win-Win for Health Care Professionals and Patients

OCTOBER 1, 2007 marked the beginning of Minnesota’s statewide smoke-free law covering all indoor workplaces, including bars and restaurants. This major milestone now protects all Minnesota workers from the harms of secondhand smoke. The thousands of health care professionals, policy makers, and concerned citizens who had the courage to lead on this issue are to be commended. October 1 was significant for another rea-son as well. That day also marked the launch of a program that now makes it easier for physi-cians to help their patients who want to stop smoking. The Minnesota Clinic Fax Referral Program allows health care professionals in participating clinics across the state to easily refer a patient to stop-smoking phone coaching support, regardless of the patient’s health care coverage. The new program allows physicians to fax a single, HIPAA-compliant quitline referral form to a central triage system. The result: an outbound call to the patient from that patient’s appropriate quitline service. (Individuals without health care coverage or who are underinsured are referred to QUIT-PLAN® Services.) The outbound call explains the program and invites the patient to enroll. Prior to this system, health care providers were required to look up a patient’s insurance in order to get patients directed to the correct quitline service offered by their health plan, then identify the corresponding quitline phone number, and then give it to the patient. The process was time consuming and the patient still had to call to initiate the coaching. Telephone coaching for smoking ces-sation is available to all Minnesota residents at no charge and is an effective alternative to

face-to-face counseling with physicians in an often-busy clinical setting. We also know that when medical professionals encourage their patients to stop smoking and offer assistance, people pay attention. However, only a small fraction of tobacco users access these quitlines, and few physicians were referring patients to this valuable assistance. So to help physicians connect patients to this service, Blue Cross and Blue Shield of Minnesota led the research and the successful pilot of the new program that is now being rolled out statewide. The Minnesota Clinic Fax Referral Program is supported collaboratively by all Minnesota organizations that offer helplines to those who want to quit smoking. The col-laboration, named Call it Quits, includes the following organizations: Blue Cross and Blue Shield of Minnesota, ClearWay MinnesotaSM,HealthPartners, Medica, Metropolitan Health Plan, MMSI, PreferredOne, and UCare. Unlike some other states where a single quitline is run by the state health department, Minnesota quitlines are offered through several health plans and through ClearWay Minneso-taSM. Making referrals easier was the goal. Ask-ing a clinic to fax to seven different quitlines would not have worked. To overcome this bar-rier, Call it Quits established an integrated clinic fax referral system to a single phone number. The pilot project also explored what effect an incentive at the clinic level—otherwise known as a pay-for-performance program — would have on the physician referral rates to a single state tobacco quitline. Results from a 22-month pilot program funded by Blue Cross and directed by Lawrence An, M.D., assistant professor of medicine, Uni-versity of Minnesota, demonstrated both the feasibility and the positive impact of this refer-ral and incentive method. Forty-nine Fairview Physician Associates (FPA) clinics participated

in the pilot program. FPA was chosen because it is a large, multi-specialty group providing both primary care and specialty care in Min-nesota, and because FPA records tobacco use as a vital sign. The study used a two-group clinic ran-domized design. In the first group, 25 clinics received “usual care,” i.e., they received ces-sation information and materials and their electronic medical record (EMR) system was modified to allow for electronic “fax” referral. The “intervention” group of 24 clinics received a launch meeting, monthly feedback, and fi-nancial incentives based on the number of referrals to quitlines. The financial incentives were available to clinics that referred at least 50 patients during the study period. Charac-teristics of all clinics in both the “usual care” group and the “intervention” group did not differ significantly. The primary outcome measure was the percentage of smokers referred to phone coun-seling. A secondary measure was clinic charac-teristics including: number of providers, type of practice, presence or absence of EMR, the clinic’s past history of engagement with quality improvement activities. The final measure took into account costs, including development staff costs and computer configuration, implemen-tation costs, and financial incentives. Results showed that clinics in the “inter-vention” group had a much higher rate of refer-ral (11.4 percent) than the “usual care” group (4.2 percent). For clinics that had a history of being very engaged with quality improvement activities, the offer of financial incentives had little impact on the referral rate. In contrast, for clinics with less history of engagement with quality improvement, offering the incentives

BY MARC W. MANLEY, M.D. , M.P.H. (Continued on page 22)



substantially increased the number of patientsreferred. Attrition after referral was identical forthe “intervention” group and the “usual care”group, so the intervention did not result in ahigher rate of inappropriate referrals.

Through this study we demonstrated thatan integrated fax referral system is feasible andthat incentives do increase referral rates. In to-tal, all FPA clinics generated more than 3,000referrals to stop-smoking coaching. Those re-ferrals resulted in a 27 percent enrollment ratein stop-smoking programs, which is compa-rable to other successful recruitment strategies.As the statewide program is rolled out, BlueCross will offer incentives to those clinics thatchoose to register for the Minnesota Clinic FaxReferral Program and also participate in BlueCross’ pay-for-performance program.

Given the pilot study’s success, implemen-tation in medical clinics across the state is theCall it Quits collaboration’s main priority. As ofmid-November, 350 clinics have registered toparticipate in the Minnesota Clinic Fax Re-ferral Program. More than 400 referrals werereceived in the first month. The collaborationestimates that, at this rate, more than 4,000referrals will be received in the first year, whichcould result in approximately 1,200 enroll-ments and ultimately 350 people successfullyquitting through this program each year.

This project succeeded because all mem-bers of the collaboration were committed toremoving barriers and improving systems in acoordinated fashion, and patient-centered carewas at the very core of the effort. Together Callit Quits achieved a win-win situation for pa-tients and their caregivers. This new programshould help clinicians easily connect theirpatients who smoke to effective stop-smok-ing assistance. The collaborative hopes thatmany more smokers can quit successfully andlive healthier lives in a supportive, smoke-freeMinnesota.

To learn more about Call it Quits or signup to participate in the Minnesota Clinic FaxReferral Program, call (651) 662-4054 or visitwww.preventionminnesota.com and click onthe Call It Quits icon on the home page.

-dent and medical director for Population Health,Blue Cross and Blue Shield of Minnesota.

Statewide Cessation


Minnesota Epilepsy Group is the largest and most comprehensiveepilepsy program in the Midwest. As a regional referral facility, weare the recognized leader in treating epilepsy and other seizure-related conditions in patients of all ages, from infants to the elderly.

Adult EpileptologistsDeanna L. Dickens, MDEl-Hadi Mouderres, MDPatricia E. Penovich, MDZhiyi Sha, MD, PhD

Pediatric EpileptologistsJason S. Doescher, MDMichael D. Frost, MDFrank J. Ritter, MD

Functional Neuro-ImagingWenbo Zhang, MD, PhDwww.mnepilepsy.org

225 Smith Avenue N.Suite 201

St. Paul, MN 55102Appointments

(651) 241-5290



ATTENTION all MinnesotaPhysicians Residing in

Naples, Florida

6th Annual MinnesotaHealth Care Dinner Party

Tuesday, March 18, 2008

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

Contact Tom Hoban at (239) 948-4492or [email protected]

(2007 attendees watch fora written invitation in late January)

On November 17, 2007, the University ofMinnesota Medical School class of 2011

received their white coats during a ceremonythat symbolizes the undertaking of profession-alism and responsibility in the medical profes-sion. Drs. James Rohde, past HMS Chair, andPeter Wilton, RMS president-elect, presentedeach of the 185 students with an engravedreflex hammer.

Minnesota Ambulatory Health CareConsortium Holds Annual Meeting

The Minnesota Ambulatory Health CareConsortium (MAHCC) held its annual

meeting on Thursday, November 15 at theFour Points by Sheraton in Minneapolis.Speakers included the newly appointed Minne-sota Commissioner of Health, Sanne Magnan,M.D., Ph.D.; House Minority Leader Repre-sentative Marty Seifert (R) 21A; RepresentativeErin Murphy (DFL) 64A. There were over 40physicians in attendance at the meeting repre-senting various outpatient ambulatory surgerycenters and imaging centers. Commissioner of Health,

Sanne Magnan, M.D., Ph.D.addresses the group.

Representative Marty Seifert(R) 21A .

Dr. Stuart Cox, president of the RamseyMedical Society, addressed 75 first and

second year medical students at the Universityof Minnesota campus on Wednesday, Octo-ber 24, 2007. The event was sponsored by theRamsey Medical Society and the HennepinMedical Society and addressed the role of theindependent physician in practice versus thosewho are in practice and employed by a system.The medical students had a lot of questions andsome stayed after the meeting to talk with Dr.Cox about his presentation.

Societies Sponsor Lunch ‘n Learn

A handful of first and second year medi-cal students had additional questions forDr. Cox following the meeting.

U of M White Coat Ceremony

Representative Erin Murphy(DFL) 64A.



Members in the NewsThe Members in the News section recognizesthe appointments, presentations, awards, hon-ors and other professional accomplishmentsof EMMS and WMMS members. Submitphysician news by fax (612) 623-2888, e-mail([email protected]) or mail to Editor,MetroDoctors, 1300 Godward Street NE, Suite2000, Minneapolis, MN 55413 for consider-ation by the editorial board. Questions? CallDoreen Hines at (612) 362-3705.

LEE BEECHER, M.D. was presented with theFirst a Physician Award by the Hennepin MedicalSociety at their annual Board of Directors meet-ing in October. This award recognizes a memberof the Hennepin Medical Society who exempli-fies the profession of medicine. The work of this“unsung hero” has resulted in an outstandingcontribution and/or the governance and successof the Hennepin Medical Society. Communityservice, work on public policy issues, or othernoteworthy volunteer service contributing toimproving the health of the population definesthe leadership and commitment to medicine by

this individual. Dr. Beecher is a board certifiedpsychiatrist officing in St. Louis Park.

PETER BOOSALIS, M.D. and NICHOLASMEYER, M.D. were recognized for their Distin-guished Service to the Community with an awardpresented at the Annual Meeting of LakeviewMemorial Hospital Medical Staff. Dr. Boosalisand Dr. Meyer recognized the need to providesupport to area military veterans and their fami-lies. They organized a non-profit organization,the Military Family Support League, which offersassistance to families of veterans while their lovedone is serving overseas. In addition, they wereinstrumental in promoting the need to providereturning veterans support upon discharge. Dr.Boosalis is a board certified anesthesiologist withValley Anesthesiology Consultants, P.A. and Dr.Meyer is a board certified orthopedist withspecialization in hand/wrist/elbow surgery at St.Croix Orthopaedics, P.A. This award is given an-nually by a panel of physician peers to recognizefellow physicians for their overall distinguishedservice to Lakeview Hospital, its patients and thecommunity.

DENIS CLOHISY, M.D., has been named thenew head of the Department of OrthopaedicSurgery at the University of Minnesota MedicalSchool. Since 1999, Dr. Clohisy has held theRoby C. Thompson Jr., M.D., Endowed Chairin Musculoskeletal Oncology. He became a fullprofessor in 2001.

PETER COLE, M.D. and RALPH BOVARD,M.D. have been selected to serve as the co-medi-cal directors of the 2008 U.S. Figure Skatingchampionships at the Xcel Energy Center in St.Paul, January 20-27, 2008. Dr. Cole is the chiefof orthopaedics for Regions and HealthPartnersMedical Group, and Dr. Bovard is the leadphysician for primary care orthopaedics for theHealthPartners Medical Group.

CHARLES HIPP, M.D., president of StillwaterMedical Group, was recently appointed to theBoard of Directors of the Institute for ClinicalSystems Improvement (ICSI).

CHARLES HORWITZ, M.D. and DON-ALD GLEASON, M.D. were the recipientsof the first annual Minnesota DistinguishedPathologist Award from the Minnesota Societyof Pathologists at its meeting in November. Thisaward is presented to a practicing (or retired)

pathologist in Minnesota who has had an impactin a hospital, local community, academic, local,state, national or international environment. Dr.Horwitz works at Abbott Northwestern Hospitalfor Hospital Pathology Associates, P.A. and Dr.Gleason is retired.

LOUIS LING, M.D. was elected to the Govern-ing Council of the Section on Medical Schools(SMS) of the AMA. Dr. Ling is the associatemedical director for education at HCMC.

RUTH LYNFIELD, M.D. has been named stateepidemiologist and medical director for infec-tious disease. Dr. Lynfield has worked for theMinnesota Department of Health as a medicalepidemiologist since 1997.

SANNE MAGNAN, M.D. was appointedMinnesota Health Commissioner by Gov. TimPawlenty. Dr. Magnan was president of theInstitute for Clinical Systems Improvement inBloomington prior to her appointment.

ROBERT C. MORAVEC, M.D. was one ofthe recipients of the Robert Raszkowski, M.D.,Ph.D. ACCME Hero Award. This award wasestablished to recognize volunteers who haveprovided exemplary and long-term service tothe ACCME, through service on the Board, theAccreditation Review Committee, the Commit-tee for Review and Recognition, the Monitor-ing Committee, as volunteer surveyors and/oras workshop faculty. Dr. Moravec is currentlythe medical director at St. Joseph’s Hospital inSt. Paul.

Children’s Cancer Research Fund honoredBRENDA WEIGEL, M.D., with its prestigiousButterfly Award during its 2007 Annual Meeting.This award celebrates ongoing commitment anddedication to the battle against childhood can-cer. It is presented in five categories: corporate,fundraising partners, medical, volunteers, andCare Partners. Dr. Weigel won the award for themedical category. She is an assistant professor inthe University of Minnesota’s Department ofPediatric Hematology/Oncology.

GREGORY WRIGHT, M.D., FAAP, FACC,is the new chief of the critical care division atChildren’s Hospitals and Clinics of Minnesota. Apediatric cardiologist, Dr. Wright brings 21 yearsof experience at Children’s to his new part-timeposition. He will continue his clinical practice atthe Children’s Heart Clinic.

WEBERLAW OFFICE


PRESIDENT’S MESSAGEV. STUART COX, M.D.

EMMS Officers

President V. Stuart Cox, M.D.President-Elect Peter B. Wilton, M.D.Past President James J. Jordan, M.D.Treasurer Ronnell A. Hansen, M.D.

EMMS Elected Board Members

Arthur A. Beisang III, M.D., DirectorCharles E. Crutchfield, III, MMB, M.D.,

At-Large DirectorLaura A. Dean, M.D., Specialty Director,

Obstetrics & GynecologyAndrew S. Fink, M.D., At-Large DirectorThomas J. Losasso, M.D., At-Large DirectorNicholas J. Meyer, M.D., DirectorRobert C. Moravec, M.D., At-Large DirectorJane C. Pederson, M.D., Specialty Director,

Internal MedicineJerome J. Perra, M.D., DirectorLon B. Peterson, M.D., DirectorThomas D. Siefferman, M.D., Specialty Director,

PediatricsJacques P. Stassart, M.D., At-Large DirectorChristina J. Templeton, M.D., Specialty Director,

PsychiatryScott A. Uttley, M.D., Director

EMMS Appointed Board Members

Stephanie D. Stanton, M.D., Resident PhysicianKimberly C. Viskocil, Medical StudentMarie L. Witte, M.D., Young Physician

MMA Officers and Board Members

Lyle J. Swenson, M.D., MMA Vice Speaker of HouseTodd D. Brandt. M.D.,Charles G. Terzian, M.D.,David C. Thorson, M.D.,

EMMS Ex-Officio Board Members &

Council Chairs

Blanton Bessinger, M.D., AMA Alternate DelegatePeter F. Bornstein, M.D., MPS, Inc. ChairKenneth W. Crabb, M.D., AMA DelegateRobert W. Geist, M.D.,

Council ChairNeal R. Holtan, M.D., Community Health

Council ChairFrank J. Indihar, M.D., AMA Delegate, Chair of

Carolyn A. Johnson, M.D., Sr. PhysiciansAssociation President

Mark J. Kleinschmidt, Clinic AdministratorAnthony C. Orecchia, M.D.

EMMS Executive Staff

Sue A. Schettle,Katie R. Snow,Doreen M. Hines, Manager, Member Services


INC

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I WAS A 4TH YEAR resident, so I knew enoughto be scared. It was about 2 a.m. and I had beencalled to the high risk OB floor. At this hour Imay not be able to get ahold of an attending,and even if I could, they would never be ableto make it to the hospital in time. They wereabout to start a C-section and I had been calledbecause the prenatal ultrasound had shown alarge tumor, probably a lymphangioma, whichcompletely covered the head and neck region. Ifthe baby went into respiratory distress and theywere unable to intubate, I would have to do atracheotomy. I had only assisted in one newborntrach. I had never seen a neonatal tracheotomythrough a potentially bloody tumor. It was a bighospital and I initially had a hard time findingthe unit. But after I saw a couple of people run-ning I just followed them to the center of thechaos. There were more than 20 people crammedinside the medium sized room. I pushed myway through so that I would be able to see thebaby, and then checked the room to see whereI would potentially operate and make sure thetracheotomy set was open. Within minutes thebaby was delivered. I heard the first cry and then,the first few breaths. I did not hear any stridor.Feeling relieved, I pushed further in to get a bet-ter look at the baby. Once I saw him I knew myservices would not be needed. There had been asignificant miscommunication. While there was alarge tumor, it protruded straight off his gluteus;his head and neck were perfectly clear.

We all have stories like this, although, manyof them have much more somber endings. Ac-countants and business executives do not get totell stories like this. What we do matters.

One of the negatives of organized medicineis that we tend to focus on the problems of ourprofession. We are being assailed from all sides.There have been several meetings this year that,when I left, I felt like throwing up my hands andgiving up. Even on good days I feel that we are,at best, tilting at windmills. It is easy to forgethow blessed we are in this profession.

Medical school applications nationally areat an all time high this year. Most physicians Italk to have a hard time understanding this and,in general, would not recommend that theirchildren pursue a career in medicine. I think weforget that, despite all the struggles, there are few,if any, careers that are as fulfilling.

All the more reason to keep our professionstrong. Not only for other physicians, but ourcommunity needs us to be involved. I have talkedseveral times to Dr. Ron Hansen (radiologist withSt. Paul Radiology) over the last couple of monthsabout a combined Senate and House committeehe is on. He takes an enormous amount of timeout of his personal and professional life to serveon this committee, but he is glad he has. He isconsistently astonished how poorly the practice ofmedicine is understood, and without an “insider”at the table, how poorly the advice given to thelegislators is. If our elected representatives hearonly from the insurers and business communitywe know, not only will our profession suffer, butalso the patients we serve. I continue to encour-age you to get involved. If you feel you do nothave time to serve on a committee —commit toget to know your Senator and Representative.These personal relationships matter. In general,a legislator is much more likely to listen to aphysician they know and trust, rather than a wellpaid lobbyist. We are late to a game that is playedwell by many others, especially lawyers. We needto take the time and energy to catch up. 2008will be a big year in health care legislation. Ourrepresentatives want to hear from us.

All in all, this has been an exciting (exhaust-ing) year for me. Our society has not only a newCEO, but also a new name, East Metro MedicalSociety. Our Board is turning over and it is greatto see new faces of people who want to be moreinvolved. I want to thank Roger Johnson person-ally for all he has done for organized medicine. Iwould like to thank Sue Schettle and congratulateher for carrying on a great tradition here at EastMetro. She is consistently looking for ways tomake us an even better medical society. Thankyou to Doreen Hines and Katie Snow for all thework they do that often goes unheralded. Andlastly, I want to thank the Board of Directors fortheir contribution. While the committee processcan be slow and occasionally painful, by gettingeveryone’s input we end up with the best for ourSociety and our profession.

the practice of the profession of medicine for thebenefit of our community.



RMS Foundation UpdateThe Ramsey Medical SocietyFoundation has elected a newchairman who will serve a twoyear term beginning in 2008.Dr. Kent Wilson, retiredotolaryngologist from Mid-west ENT assumed his chairmanship of thefoundation board beginning January 2008.

Also newly elected to theRMS Foundation board isDr. Mark Destache whois an anesthesiologist fromAssociated Anesthesiologists,PA based in St. Paul.

We would like to offer our thanks to Dr.Robert Moravec who has served as theRMS Foundation board chair for the past sixyears. His dedication and commitment to thefoundation has been appreciated. Our thanksalso go out to the three other outgoing boardmembers including Dr. Lyle Swenson, Dr.Brent Asplin and Dr. Barclay Cram fortheir longstanding commitment and service tothe foundation.

Smoke-free ProjectsSince the Freedom to Breathe Act went intoeffect October 1, Cynthia Piette, working in

Washington County, and Diane Tran, workingin Dakota County, have done terrific work incontinuing to grow their grassroots networksand engaging their respective communities byhosting community events. Across the country,when smoke-free laws go into effect there isgenerally a concerted effort by those who areagainst the smoke-free law to try and overturnit, or to add exemptions. That’s why havingthe grassroots network continually connectedinto the project is so crucial so that when theyare needed to get involved, they’ll be ready tomobilize.

Medical StudentLunch ‘n Learn LectureDr. Stuart Cox presented to a group of 1stand 2nd year medical students on October 25.The lecture was well attended. RMS and HMShave co-sponsored Medical Student Lunch ’nLearn sessions for many years.

RMS/HMS Joint PublicPolicy CouncilThe RMS/HMS joint public policy commit-tee had its third meeting in early Novemberand discussed a number of legislative issuesthat will likely come forward in the 2008 leg-islative session. This group was formed withthe purpose of being the policy arm/vehicleof RMS and HMS. Current co-chairs of the

group include Peter Boosalis, M.D. andArt Beisang, M.D.

Meetings with LegislatorsRepresentative Mindy Greiling (DFL)54-A met with physicians at the Hamm Clinicon Friday, November 30. Dr. James Jordanand Dr. Robert Nesheim provided Rep-resentative Greiling with a tour of the HammClinic and spent time talking with her aboutissues affecting mental health. RepresentativeGreiling serves as the Co-Chair of the MentalHealth Caucus, which is a bipartisan effortand includes members from the House ofRepresentatives and the Senate.

AMA MeetingThe Interim Meeting of the American Medi-cal Association was held November 9 throughNovember 14. Dr. Cox and Sue Schettle at-tended the meeting in addition to some RMSmembers who serve in various roles in theAMA. Those include Drs. Gonzalez-Campoy,Jacott, Crabb, Bessinger, Stanton and Indihar,among others.

EMMS IN ACTIONSUE A. SCHETTLE, CEO

Help us Celebrate...Installation of Peter B. Wilton, M.D., as the 138th President of Ramsey Medical Society

and the 1st President of East Metro Medical Society at the 2008 RMS Winter Gala and Annual Meeting

Friday, January 25, 2008

Town & Country Club300 Mississippi River Blvd. N., St. Paul

—Mark your calendars and plan to attend (families are welcome)—

Social Hour—5:30 p.m.–6:30 p.m.Dinner—6:30 p.m.–7:30 p.m.Program and Award Presentations—7:30 p.m.–8:00 p.m.Entertainment—8:00 p.m.–8:45 p.m.

Watch your mail for your invitation, visit www.metrodoctors.com or call (612) 362-3704 for more information.



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EMMS UPDATE

2008 EMMS Election ResultsCongratulations to the newly elected EMMS leaders

PRESIDENT-ELECT

Ronnell A. Hansen, M.D.Diagnostic Radiology

SECRETARY/TREASURER

Thomas D. Siefferman, M.D.Pediatrics

Pediatric & Young Adult Medicine, P.A.

DIRECTOR

Peter J. Boosalis, M.D.Anesthesiology

Valley Anesthesiology Consultants, P.A.

DIRECTOR

Peter F. Bornstein, M.D.Infectious Diseases

St. Paul Infectious Disease Associates, Ltd.

DIRECTOR

Katherine M. Clinch, M.D.Anesthesiology

Associated Anesthesiologists, P.A,

Richard L. Baron, M.D.

Blanton Bessinger, M.D.

Amy L. Gilbert, M.D.

J. Michael Gonzalez- Campoy, M.D., Ph.D.

Frank J. Indihar, M.D.

The Following Have Been Appointed to a Position on the RMS Board by an MMA Section.

Jo Ann Wood, M.D.Appointed by the MMA Young Physician Section

Internal MedicineUniversity of Minnesota

Stephanie D. Stanton, M.D.Appointed by the MMA

Family MedicineUnited Family Practice

Health Center

DIRECTOR

Andrew S. Fink, M.D.General Surgery/Vascular Surgery

Delegates to MMA Elected to Serve With EMMS Board Members

PRESIDENT

Peter B. Wilton, M.D.General Surgery

St. Paul Surgeons, Ltd.

DIRECTOR

Marie L. Witte, M.D.Internal Medicine

Stillwater Medical Group

EMMS welcomes these new members to the So-

ciety. Schools listed indicate the institution where

the medical degree was received.

New Members

ActiveNiladri Aichbhaumik, M.D.Wayne State University School of MedicineAllergy & ImmunologySt. Paul Allergy & Asthma Clinic, P.A.

Romaine B. Bayless, M.D.Ohio State University College of MedicineObstetrics & GynecologyReproductive Medicine Infertility Assoc.

Gena M. Bonitatibus, M.D.University of Alabama School of MedicineAllergy & Immunology/PediatricsAspen Medical Group –Bandana Square

Erin K. Micallef, M.D.University of Minnesota Medical SchoolFamily MedicineFairview Lakes North Branch Clinic

Majken A. Schwartz, M.D.University of Illinois College of MedicineFamily MedicineAllina Medical Clinic Shoreview

Steven T. Silver, M.D.University of Minnesota Medical SchoolPsychiatryHennepin Faculty Associates

Christopher J. Stadtherr, M.D.University of Minnesota Medical SchoolFamily MedicineEast Metro Family Practice– Inver Grove Heights

Resident PhysiciansJaemi R. Keith, M.D.University of California School of MedicineAnesthesiologyU of MN Graduate School

Medical Students(University of Minnesota)Ruben J. Macias



“Ethical Issues in Pay for Performance”—A Presentation by Dr. David Satin

RMS Senior Physicians

RMS senior physicians had lunch at RegionsHospital in late October and enjoyed

hearing from The Honorable Al Quie, formerMinnesota Governor, U.S. Congressman, andState Senator, about his horseback trips alongthe entire Continental Divide over multiplesummers. Mr. Quie accompanied his talk witha slideshow of trip photos for the 20 attendees,and his adventurous spirit shown through ashe retold stories of close calls on the trail. TheRMS Senior Physicians Association meets

In MemoriamMARGARET M. ANDERSON, M.D. passedaway on October 3 at her home in Sun Lakes,AZ. She was 93. Dr. Anderson graduated fromthe University of Manitoba, Canada and prac-ticed as an anesthesiologist in St. Paul. She joinedRMS in 1950.

ROY L. PETERSON, M.D. died on October 9at the age of 88. Dr. Peterson graduated fromthe University of Minnesota Medical Schooland completed his internship at the U.S. Ma-rine Hospital in Detroit, MI. He then servedthe next four years at U.S. Marine Hospitalsin Boston, MA and Mobile, AL. Dr. Petersonbegan a family medicine practice in White BearLake and remained there until his retirement.In 1969 he developed and patented a pockettracheotomy instrument designed to enablephysicians to perform emergency tracheotomiesas safely and rapidly as possible. Dr. Petersonjoined RMS in 1953.

NEIL TROTMAN, M.D. died at the age of 76on November 5 in Scottsdale, AZ. He graduatedfrom the University of Illinois College of Medi-cine. Dr. Trotman practiced general and thoracicsurgery in St. Paul until retiring in 1991. Hejoined RMS in 1965.

Dr. David Satin spoke at the open publicmeeting of the RMS Council on Pro-

fessionalism and Ethics co-sponsored withthe medical staffs of United and HealthEasthospitals on November 16, 2007.

Dr. Satin first described how a pay-for-per-formance (P4P) model of physician reimburse-ment functions. The charitable interpretationis: P4P reimburses physicians for providingquality care, and finances quality improvementinnovations. The skeptical is: P4P enables thirdparty payers to control costs by bribing physi-cians to follow prescribed practice patterns.Thetaking-it-too-personally is: Do they really thinkthat the existing moral and social incentives forproviding excellent care are insufficient—thatfinancial incentives will succeed where my pro-fessional character failed?

He discussed: the goals of goal setters;withholds to fund P4P “rewards;” the po-tential economic, social, and moral results ofP4P; the benefits claimed for P4P (enforcingquality, standardized care, and cost savings);and the burdens of P4P (expense of data col-lection and threat of an altered doctor-patientrelationship). In summary he said, “it is unclearwhether P4P will improve overall morbidityand all cause mortality.” This was a brilliantand balanced appraisal of P4P. A lively questionand answer session followed the presentation.

Meet One of the New EMMS Board Members

Jo Ann Wood, M.D.,MSEd is serving as the

Young Physician repre-sentative on the EMMSBoard of Directors. She isan associate professor ofmedicine at the Universityof Minnesota, board certified in both pediatricsand internal medicine, a Fellow of the Ameri-can Academy of Pediatrics and the AmericanCollege of Physicians. She earned her medicaldegree and completed her residency both at the

University of Louisville. Dr. Wood completeda Faculty Development Fellowship in GeneralMedicine at the University of North Carolina,Chapel Hill. She received her Master’s Degreein Education from the University of SouthernCalifornia in 2005. At the University she isleading the “Ambulatory Care Experience”Steering Committee for the MED 2010 Edu-cational Reform and she serves as the MedicineFirms Medical Director, as well as the Directorof the 7A Medical Unit at the University ofMinnesota Medical Center, Fairview.

quarterly at local hospitals. Carolyn Johnson,M.D. will be turning over the presidential titleto J. Richard Burton, M.D. at the next meetingon January 24, 2008.

Extend your Heartto the Homeless

February 1 toFebruary 29, 2008

We ask that you and your clinic staffdonate personal hygiene suppliesand over-the-counter medicationsthat will be distributed to HealthCare for the Homeless, ListeningHouse and SafeZone.

Logo

Call Doreen at (612) 362-3705to learn more about

how your clinic can participate.



PWMMS Officers

Chair Anne M. Murray, M.D.

President Richard D. Schmidt, M.D.

President-elect Edward P. Ehlinger, M.D.

Secretary Peter J. Dehnel, M.D.

Treasurer Eric G. Christianson, M.D.

Immediate Past Chair Paul A. Kettler, M.D.

WMMS Board Members

Lauren Baker, M.D.

Alan L. Beal, M.D.

Carl E. Burkland, M.D.

Laurie Drill-Mellum, M.D.

Kenneth N. Kephart, M.D.

Stephen MacLeod, M.D.

J. Riley McCarten, M.D.

Frank S. Rhame, M.D.

Janette H. Strathy, M.D.

Thomas C. Tunberg, M.D.

David J. Walcher, M.D.

David A. Willey, M.D.

WMMS Ex-Officio Board Members

Michael B. Ainslie, M.D., MMA TrusteeMartha Arneson, Co-Presiding Chair, HMS AllianceBeth A. Baker, M.D., MMA TrusteeChristian L. Ball, M.D.,

David L. Estrin, M.D., AMA Alternate DelegateMelanie Fearing,

Donald M. Jacobs, M.D., MMA TrusteeRoger G. Kathol, M.D., MMA TrusteeCandace S. Simerson,

Richard E. Streu, M.D., Sr. Physicians Association

Karin M. Tansek, M.D., MMA TrusteeTrish Vaurio, Co-Presiding Chair, HMS AllianceBenjamin H. Whitten, M.D., AMA Alternate DelegateJames A. Young, II, M.D., MMA Trustee

WMMS Executive Staff

Jack G. Davis,

Jennifer Anderson, Smoke-Free Project CoordinatorNancy K. Bauer, Assistant Director, and

Kathy R. Dittmer,

CHAIR’S REPORTANNE M. MURRAY, M.D.

The Death of Primary Care in Minnesota

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PRIMARY CARE is being hung out to dry inMinnesota. Poor reimbursement at both endsof the life spectrum is already endangering thesurvival of pediatrics and geriatrics, but nowthreatens to get worse. Recent proposals forexpansion of MinnesotaCare to cover a greaterproportion of children without an increase inphysician payments, and a 10.1 percent Medi-care reimbursement cut by Congress wouldforce many Minnesota practitioners to closetheir doors to these patient populations. Dr. Pe-ter Dehnel, a pediatrician at Children’s HealthNetwork, serves with me on the West MetroBoard of Directors. He will provide insights re:proposed expansion of MinnesotaCare. I willaddress reimbursement levels at the other endof the life spectrum—geriatrics.

Pediatric Primary Care and anExpanded MinnesotaCare ProgramOn the surface, expanding state-based healthcare insurance to cover all children is veryattractive to most of us in medicine. Whowould deny that making sure that childrenhave insurance coverage for their health careneeds is good for the state?

The irony is that by expanding state-basedinsurance programs at their current reimburse-ment rates to cover more children we will likelyreduce children’s access to health care services.This is an extremely important distinction, butone that frequently gets confused by legislatorsand the public. An insurance card is simplythat—a piece of paper that is only as good asthe program behind it. It is not a guarantee thatthere will be a preferred clinic in an accessiblelocation that will accept that card to provideservices. The family may be forced to obtainall of their care at an Emergency Department,urgent care or MinuteClinic.

Pediatric primary care clinics are underfinancial stress as are all primary care clinicsin Minnesota. Their operating margins arenow very small, due to years of relatively flatreimbursement rates while their employeeand operating costs are rising. MinnesotaCareprograms and Medicaid both reimburse atrates far below commercial insurers, generally

in the neighborhood of 25 to 30 percent of themedian commercial insurance rates. The com-mercial rate, itself, is generally well below mostclinics’ posted fee schedule. Prepaid MedicalInsurance Plan (PMAP) programs, which arestate public programs administered throughthe insurers, have received yearly increases fromthe legislature. What is not known by mostlegislators and the general public is that thoseincreases have generally not been passed on toclinicians. Instead, the PMAPs conveniently keepthe yearly rate increases for themselves. If clinicsare now confronted with seeing an increasingpercentage of children covered through Minne-sotaCare and related state-based programs, thiswill quickly become a financially non-viablesituation — clinics will literally have to stopseeing these patients to avoid bankruptcy andclinic closure.

Just as any well-intended grocery storecan’t afford to sell a $4.00 gallon of milk for$1.50, caring and dedicated pediatric clinicianscan’t afford to see patients when the reimburse-ment rates are substantially below the cost ofdelivering that care. The obvious solution is forthe state to raise the physician reimbursementrates to a level on par with commercial insurers.Although that solution is not likely to be palat-able from a political sense — it would wreakhavoc on the state’s budget, and few legislatorsare willing to raise taxes sufficiently high to payfor this “fair market” level of reimbursement toclinicians—it is really the only viable solution.A mechanism is also needed to ensure that the rateincreases go directly to the physicians; not retainedby the PMAPs.

Another Proposed Cutin Medicare RatesPhysicians caring for geriatric patients havebeen writing our annual letter to our Con-gressmen requesting a vote “no” to anotherproposed Medicare cut. Once again this bill



WMMS in Action highlights activities thatyour leadership and executive office staffhave participated in, or responded to, be-tween MetroDoctors issues. We solicit yourinput on these activities and encourageyour calls regarding issues in which youwould like our involvement.

WMMS IN ACTIONJACK G. DAVIS, CEO

You will read elsewhere in the journal about theBoard decision to change the name of the Hen-nepin Medical Society to the West MetroMedical Society. This change took effecton January 1, 2008.

The Hoban Scholarship Selection Com-mittee awarded four scholarships this fall tostudents who are pursuing advanced degreesin medical administration or nutrition. Thesescholarships are awarded in the name ofThomas and Mary Kay Hoban. Tom was theExecutive Director of the Hennepin MedicalSociety from 1969 through 1994.

The Joint RMS/HMS Public PolicyCouncil recently met to review the upcominglegislative issues for the 2008 legislative session.Considerable discussion took place regardingthe potential Constitutional Amendmentfor a “right to health care,” the health carereform efforts of the Legislative Commis-sion and the Governor’s Task Force, and theprobability of an Interpreter Bill. Other issuesto be monitored include no-fault auto andworkers compensation reimbursement issues,potential non-physician scope of practice ini-tiatives, medical facilities construction control,transparency/cost disclosure, and Health CareAccess Fund oversight.

Edward Ehlinger, M.D. and Jack Davisjoined about 12 other health care constituentsin a Congressional “meet and greet” with Rep-resentative Keith Ellison of the 5thMin-nesota Congressional District. Discussion tookplace regarding the medical community’s sup-port of SCHIP and the concern of the pendingMedicare cuts due to take place on January 1,2008. Representative Ellison was supportive ofMedicine’s position on both these issues.

HMS past chair James Rohde, M.D. and in-coming RMS president Peter Wilton, M.D.presented 185 first year medical students withan engraved reflux hammer at the Universityof Minnesota Medical School’s White CoatCeremony on November 16, 2007.

Sr. Physicians AssociationMembership: Are you a physician who is retiredor contemplating retirement? Attained the ageof 62? Is a member in good standing of HMSor another medical society? If yes, you are eli-gible to join the Senior Physicians Association.Go to our Web site at www.metrodoctors.com,click Hennepin Medical Society, click HMSSenior Physicians Association, click on “ap-plication” and print a copy. Or call KathyDittmer at (612) 623-2885.

November 13 was our last meeting for2007. Brenda Iliff, MA, LADC, Clinical

Director of Hazelden enlightened us about“Addiction Treatment: It’s a lot more than 28days.”

As Richard Burman, M.D. stepsdown as President of the Senior PhysiciansAssociation, Robert E. Doan, M.D. be-gins his term as President in 2008. Our datesfor meetings are Tuesdays, April 22, June 10,September 16, and November 11 at 11:30 a.m.at the Zuhrah Shrine Center.

The Hoban Scholars are (from left): AzzaZarroug, Kara Mitterholzer, Christina Serve-tas, and Barbara Jacobs. H. Thomas Blum,M.D., is Chair, Hoban Scholarship Committee.

Two HMS member physicians were invitedto participate in “career exploration” classesat area high schools.

(Above) Lee Beecher, M.D. answeredquestions about psychiatry as a profes-sion at Osseo High School. (Not pictured):Scott Benson, M.D., Ph.D. showcased fam-ily medicine to students at Lakeville NorthHigh School.

Career Exploration forHigh School Students

The Hennepin Medical FoundationBoard of Directors met in October to awardgrants for 2007. Organizations receiving grantsinclude: the Center for Cross-Cultural Health,the Greater Minneapolis Crisis Nursery,HCMC-Newborn Intensive Care Unit, Hen-nepin Medical Society Alliance, MinnesotaVisiting Nurse Agency, Sub-Saharan AfricanYouth and Family Services in Minnesota, theThomas P. Cook Scholarship and the Univer-sity of Minnesota AHC CLARION StudentGroup. Edward Spenny, M.D. is the currentPresident of the HMF.

Brenda Iliff, Clinical Director of Hazelden,stands with Richard Burman, M.D., presi-dent of Sr. Physicians Association.



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Lee Beecher, M.D. was presented with the First A Physician Award by the Hennepin Medical Society at their annual Board of Directors meeting on October 10, 2007. In the inaugural presentation of this award, outgoing HMS Board Chair Paul A. Kettler, M.D., stated “Dr. Beecher truly embod-ies the spirit of the award. He has participated lo-cally in Hennepin Medical Society leadership and governance as well as with the Minnesota Medical Association. He truly advocates for patients and his profession and has been a major contributor and leader in his work on public policy issues. Dr. Beecher has devoted countless hours to his patients, the profession of medicine, and is well respected by his peers.” The “First A Physician” award recognizes a member of the Hennepin Medical Society who exemplifies the profession of medicine. The work of this “unsung hero” has resulted in an outstanding contribution to commu-nity and/or the governance and success of

the Hennepin Medical Society. Community service, work on public policy issues, or other noteworthy volunteer service contributing to improving the health of the population defines the leadership and commitment to medicine by this individual. Lee Beecher, M.D. is a board certified psychiatrist with an office in St. Louis Park, MN and is the immediate past chair of the Minnesota Patient Physician Alliance.

Lee Beecher, M.D., is First Recipient of “First A Physician” Award

Annual Board Meeting—Anne Murray, M.D. is New Chair

The annual meeting of the Hennepin Medical Society Board of Directors was held on October 10, 2007 at which time Anne Murray, M.D., internal medicine/geriatrics, was installed as the new Chair of the Board, succeeding Paul A. Kettler, M.D. The annual meeting provides an opportunity for incoming and outgoing Board members along with their spouse/guests, to be recognized and appreciated for their commit-ment to their professional association. As a thank you for his years of leadership of the HMS Board, Dr. Kettler was presented with the chair’s award, a specially commis-sioned sculpture by Jeff Barber.

98.6° stands as the norm for health. This sculpture symbolically interprets the degrees for temperature as degrees in angles. Variations in dimension fur-ther the notion that people are not ex-actly 98.6 degrees at all times. The adult figures balance with the angles —andare directly symbolic of those who in-tercede to maintain the critical balance of 98.6 degrees; those who have chosen medicine as their life’s interest.

Nicholas Legeros, sculptor, was the guest speaker discussing the topic, “Can Art Heal?” Mr. Legeros was commissioned by the Hen-nepin Medical Society and Abbott Northwest-ern Hospital in 2006 to create a new Shotwell Award. The original Sprites sculpture, created by Paul Grandlund, is located in the courtyard of the old Metropolitan-Mount Sinai Medi-cal Center. A smaller version was created for the Shotwell Award and has been presented to the Shotwell Award recipients since 1971.

Mr. Grandlund passed away in 2003 at which time there were only a few sculptures remaining in the HMS inventory. At his request, upon his death, his molds were destroyed. In addition, Lee Beecher, M.D. was pre-sented with the first annual, First A PhysicianAward (see related article) and James, Dehen, M.D., President of the Minnesota Medical Association, offered a few remarks on behalf of the MMA.

Paul A. Kettler, M.D. receives the outgoing Chair’s sculpture from Anne Murray, M.D., incoming HMS Chair.

Lee Beecher, M.D. is recog-nized with the First a Physician Award by Anne Murray, M.D.

was written to conform to the (everyone- rec-ognizes- clearly- flawed) Sustainable Growth Formula, which is not likely to be revised under the current administration. A recent AMA survey found that 60 percent of phy-sicians would limit the number of Medicare patients they see and half would reduce their staff if the cut takes effect. Multiple primary care practices in Minnesota already refuse to see new Medicare patients. It is already demoralizing for physicians in family practice, internal medicine, geriatrics, neurology, and any specialty caring for a large proportion of geriatric patients to have to an-nually justify our low Minnesota Medicare reimbursement for cognitive services without a further rate cut. However, reimbursement is also needed for extensive nurse telephone man-agement, coordination of care across settings, and communicating with family caregivers and with other health agencies. As Dr. Jane Potter, recent President of the American Geriatrics So-ciety states: “Too much of what is important for care of especially frail older people occurs outside of face-to-face contacts with those patients…Unless physicians and other health care providers are reimbursed for providing these essential services, there will be too few providers willing to perform these services.” (J Am Geriatr Soc. 2006;54:1453-1462). For now, we can only hope that Congress will see the proposed Medicare cut as a recipe for disaster, and that our country’s new admin-istration in 2009 will create a new formula for successful funding of geriatric care.

Chair’s Report(Continued from page 29)



Welcome NewWMMS Members

In Memoriam

ActiveJennifer H. Ambur, M.D.John A. Haugen Associates, P.A.

Stephanie L. Anderson, M.D.France Avenue Family Physicians, P.A.Family Medicine

Sachin S. Bhardwaj, M.D.Dermatology Specialists, P.A.Dermatology

Jonathan M. Cooper, DO, M.D.TRIA Orthopaedic CenterOrthopedic Surgery

Brian R. Drew, M.D.Minneapolis Otolaryngology Head & NeckSurgery, P.A.Otolaryngology

Kirsten B. Dummer, M.D.Children’s Heart Clinic, P.A.Pediatrics, Pediatric Cardiology

Maria Gomes, M.D.Minnesota Diagnostic Imaging Partners LLC

Chantel N. Hile, M.D.Minneapolis Vascular ClinicGeneral Surgery

Matthew D. Layman, M.D.Twin Cities Anesthesia Associates, P.A.Anesthesiology

William D. McMillian, M.D.Minneapolis Radiology AssociatesVascular Surgery

Joseph S. Micallef, M.D.Fairview Lakes Regional Medical CenterFamily Medicine

Corrine N. Moll, M.D.John A. Haugen Associates, P.A.

Donald A. Pine, M.D.Park Nicollet Clinic, MinnetonkaFamily Medicine

Polly A. Quiram, M.D., Ph.D.VitreoRetinal Surgery, P.A.Ophthalmology

Adnan I. Qureshi, M.B.B.S.University of Minnesota Department ofNeurology

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

Timothy G. Schaefer, M.D.Midwest Plastic SurgeryPlastic Surgery

Shannon P. Sheedy, M.D.Suburban Radiologic Consultants, Ltd.

Meskath Uddin, M.D.HealthPartners, Riverside ClinicInternal Medicine

Bernarda M. Zenker, M.D.Quello Clinic-BurnsvilleFamily Medicine

Resident PhysicianEmmanuel U. Agoh, M.D.Hennepin County Medical CenterFamily Medicine

Medical Students(University of Minnesota)Luke T. HafdahlEric K. MoekerJustin C. Peltola

HENRY W. QUIST, M.D., age 89, diedNovember 2, 2007 after a long illness. He at-tended the University of Minnesota for both hisundergraduate degree and medical school. Hegraduated in 1943 and completed his internshipat Minneapolis General Hospital. He entered theArmy and served as a medical officer in the 101stAirborne Division in France and Germany. In1948 he entered into medical practice in Min-neapolis. He practiced family medicine until hisretirement in 1991 at age 73. Dr. Quist joinedHMS in 1986.

JOHN (JACK) E. VERBY, JR., M.D., 84, diedon October 23, 2007. While attending medicalschool at the University of Minnesota, he was aNavy V-12 officer and played semi-pro baseball.He was drafted to serve in Korea as a doctor in1951. Upon return from the service, he movedto Rochester and helped start the OlmsteadMedical Group. After 19 years of practice, hewas asked to join the faculty at the University ofMinnesota Medical School in 1968. In 1970 hebecame one of the first family physicians to becertified by the National Board for Family Physi-cians. During the same year, Dr. Verby createdthe Rural Physicians Associate Program (RPAP)as an answer to a state mandate to redistributephysicians into rural Minnesota. In 1972, Dr.Verby became a Charter Fellow of the AmericanAcademy of Family Physicians (AAFP). Dr. Verbyalso wrote four editions of the Family PracticeSpecialty Board Review books, and collaboratedwith his wife, Jane, on the book How to Talk toDoctors. He joined HMS in 1950.

WILLIAM A. “BILL” WILCOX, M.D., LTC(Ret.) died peacefully on November 7, 2007 atthe age of 86. During WWII, he was commis-sioned in the U.S. Army Air Corps and servedas Weather Officer in the 55th ReconnaissanceSquadron, Long Range (Weather). He earnedhis medical degree from Northwestern Univer-sity Medical School in Chicago and was boardcertified in radiology and nuclear medicine. Dr.Wilcox practiced radiology at North MemorialMedical Center and was a clinical instructor withthe University of Minnesota and the Universityof Arizona. He served with Volunteer Doctors forVietnam in 1969 and also did volunteer medicalservice in Okinawa, Thailand and Taiwan. Dr.Wilcox joined HMS in 1961.

Visit us atwww.metrodoctors.com


You do not need to be an RMS member to participate

a subsidiary of Ramsey Medical Society

Call RMS at 612-362-3799 for details.

Visit www.metrodoctors.com/services.cfm to read moreabout ways that you can save through our

business partnerships.

Discounts by Physicians for Physicians

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