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Proceeds from MPS help to support the medical society’s operations. Please consider our business partners listed below as you look to reduce your operational costs.

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MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 1

V O L U M E 1 2 , N O . 2 M A R C H / A P R I L 2 0 1 0

Contents

eAst MetRo

27 EMMSFoundationNews

InAppreciationofFormer EMMSBoardMembers

West MetRo

28 CelebratingtheCareerofJackG.Davis, WMMSCEO

29 WestMetroSeniorPhysiciansAssociation

WMMSAlliance100thCelebration

30 HealthCareDinnerParty,Naples,FL

Page 24

Page 15

Page 8

2 Index to Advertisers/Classified Ad

3 PResident’s MessAge A Journey into Urban Health By Edward P. Ehlinger, M.D., MSPH

4 Public Health and Medicine: The Potential and Need for Collaboration By Lowell Johnson, BS, MPA

5 tCMs in ACtion By Sue Schettle, CEO

6 More Deficit, Further Challenges: 2010 Legislative Preview By Theodore Grindal, JD, and Nathaniel Mussell, JD

7 Call for Resolutions/Caucus Dates

8 Kent S. Wilson, M.D. Receives Shotwell Award

9 The Joint Commission —60 Years of Accreditation Experience By Charles A. Mowll, FACHE

11 ISO 9001 and Hospital Accreditation By Darrel J. Scott, FACHE

13 You Have a Choice in Accreditation Organizations By Michael J. Zarski, JD

15 New Health Care CEO: Arthur Gonzalez, Dr. P.H., FACHE, Hennepin County Medical Center

17 The Minnesota Health Information Exchange By Michael Ubl

19 BMP Seminar Series on Management of the Chronic Pain Patient

20 The Provider Tax By Nathaniel Mussell, JD

22 The Evolution of the Minnesota FluLine By Peter Dehnel, M.D.

24 TCMS Annual Meeting Held

25 New Members

26 In Memoriam

30 Career Opportunities

On the cover: Hospitals and health care entities can now choose from three accredita-tion organizations to obtain certification to receive pay-ments from Medicare and Medicaid programs. Articles begin on page 9.

2 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society

Physician Co-editorLeeH.Beecher,M.D.Physician Co-editorPeterJ.Dehnel,M.D.Physician Co-editorThomasB.Dunkel,M.D.Physician Co-editorMarvinS.Segal,M.D.Physician Co-editorCharlesG.Terzian,M.D.Managing Editor NancyK.BauerAssistant Editor KatieR.Snow

TCMS CEOSueA.SchettleProduction ManagerSheilaA.HatcherAdvertising Representative BetsyPierreCover Design byOutsideLineStudio

MetroDoctors(ISSN1526-4262)ispublishedbi-monthlybytheTwinCitiesMedicalSociety,1300GodwardStreetNE,BroadwayPlaceWest,Suite2000,Minneapolis,MN55413.Periodi-calpostagepaidatMinneapolis,Minnesota.Postmaster:SendaddresschangestoMetroDoc-tors,TwinCitiesMedicalSociety,1300GodwardStreetNE,BroadwayPlaceWest,Suite2000,Minneapolis,MN55413.

Topromoteitsobjectivesandservices,theTwinCitiesMedicalSocietyprintsinformationinMetroDoctorsregardingactivitiesandinterestsofthesociety.Responsibilityisnotassumedforopinionsexpressedorimpliedinsignedarticles,andbecauseofthefreedomgiventocontribu-tors,opinionsmaynotnecessarilyreflecttheofficialpositionofTCMS.

SendlettersandothermaterialsforconsiderationtoMetroDoctors,TwinCitiesMedicalSociety,1300GodwardStreetNE,BroadwayPlaceWest,Suite2000,Minneapolis,MN55413.E-mail:[email protected].

Foradvertisingratesandspacereservations,contact:BetsyPierre2318EastwoodCircleMonticello,MN55362phone:(763)295-5420fax:(763)295-2550e-mail:[email protected]

MetroDoctorsreservestherighttorejectanyarticleoradvertisingcopynotinaccordancewitheditorialpolicy.

Non-membersmaysubscribetoMetroDoctorsatacostof$15peryearor$3perissue,ifextracopiesareavailable.Forsubscriptioninforma-tion,contactKatieSnowat(612)362-3704.

March/AprilIndex to Advertisers

TCMS Officers

President EdwardP.Ehlinger,M.D.

President-electThomasD.Siefferman,M.D.

Secretary AnthonyC.Orecchia,M.D.

TreasurerMelodyA.Mendiola,M.D.

Past President RonnellA.Hansen,M.D.

TCMS Executive Staff

Sue A. Schettle,Chief Executive Officer (612)362-3799 [email protected] J. Anderson,Project Director (612)362-3752 [email protected] K. Bauer,Assistant Director, and Managing Editor, MetroDoctors (612)623-2893 [email protected] R. Dittmer,Executive Assistant (612)623-2885 [email protected] R. Snow,Administrative Coordinator (612)362-3704 [email protected]

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

AcuteCare,Inc..................................................31

BethesdaHospital...........OutsideBackCover

ClassifiedAd......................................................... 2

CrutchfieldDermatology................................23

FamilyHealthServicesMinnesota,P.A.......32

HealthcareBillingResources,Inc................14

LockridgeGrindalNauenP.L.L.P................21

MankatoClinic..................................................32

MinnesotaEpilepsyGroup,P.A....................23

MinnesotaPhysicianServices,Inc....................InsideFrontCover

TheMMICGroup................................................InsideBackCover

OpenCitiesHealthCenter,Inc...................30

PediatricHomeService........................................InsideBackCover

SafeAssureConsultants,Inc...........................18

SterlingRetirementResources,Inc...................InsideFrontCover

U.S.Army............................................................30

UptownDermatology&SkinSpa,P.A.......21

WeberLawOffice............................................... 2

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President’s Message

A Journey into Urban Health

EdwARd P. EHLINgER, M.d., MSPH

WHEN I ENTERED MEDICAL SCHOOL,myintentionwastobecomeaprimarycaredocinasmalltownsomewhereinruralAmerica.Myplansneverchangedduringmedicalschoolorduringmypediatricandinternalmedicineresidencies.Twoyears intheNationalHealthServiceCorps(NHSC)practicinginmedicallyunderservedareasineasternMontanaalsoreinforcedmyintentions. WhiletheNHSCexperiencedidn’tchangemypractice locationpreference, itsignificantlyalteredthetypeofpracticethatIwouldultimatelypursue.Thatexperience

helpedmerealizethatevenifIsaw40–60patientsperdayanddidanexcellentjoboftreatingtheinjuriesandtheacuteandchronicillnessesofthepeoplethatcamethroughmyclinicdoor,theoverallhealthofthetownwouldnotsignificantlychange.IcouldmakeadifferenceinthelivesofthepeopleItreatedbut,eveninasmalltown,thatdifferencewouldbeexperiencedbyonlyasmallpercentageofthepopulation. Ialsoquicklyrealizedthatevenamongmypatientsmymedicalinterventionsweredoinglittletoaffecttherealcausesoftheillnesses,injuries,anddiseasesIwasseeing—tobaccoandalcoholuse,unsafeworkingconditions,obesity,andavarietyofriskybehaviors.Itwasthatexperiencethathelpedmerecognizethatadifferentkindofpracticewasnecessarytoreallyimprovethehealthofruralcommunities.Itmademeconsideraddingsomepublichealthexpertisetomymedicalcareportfolio. Fortunately,Iwasabletogarnerafellowshipthatallowedmetodosomeresearchintohowtoimprovehealthcareinruralhealthcommunitieswhilealsoearningamastersdegreeinpublichealth.However,myplannednextsteptosmalltownAmericaencounteredadetourwhenmywifewasacceptedintoaPh.D.programattheUniversityofMinnesota.Figuringthatabitofurbanhealthexperiencewouldhelproundoutmyeducation,IacceptedajobwiththeMinneapolisHealthDepartmentandHCMCandmovedtotheTwinCities—anticipatinga3-5yearstay. WhatIdidn’tanticipatewasthatIwouldfallinlovewithurbanhealthcareandendupstayinginMinneapolisformorethan30years.IquicklylearnedinmyurbanpracticewiththeCityofMinneapolisandlaterwithBoyntonHealthServicethatalmostalloftheissuesthatenticedmetoconsideraruralpracticewerealsopresentinurbancommunitiesexceptinmoreconcentratedforms. IexpectedthemedicalissuestobesimilarbutIwassurprisedthatmanyofthesocialandhealthcaredeliveryproblemsinurbanandruralcommunitieswerealsoalmostidentical.Whilethedistancesandnumberofpeopleaffectedwerediffer-ent,theproblemsofphysicianshortageareas,underservedpopulations,lackoftransportation,lackofaccesstoclinicsandhospitals,underemployment,poverty,hazardousworkingconditions,isolation,andlackofinsurance,tonamejustafew,weresimilar. IalsoquicklylearnedinMinneapoliswhatIhadlearnedmoreslowlyinruralMontana;thatiftheoverallhealthofthecommunityisgoingtoimprove,itisimportantthatclinicalmedicineandpublichealthbepartnersandworkcollaboratively.Tobemaximallyeffectivebothmedicineandpublichealthcannotbeseparateentitiesrunningonparalleltracks.Theyneedtobealliesandbefunctionallyintegrated. Inmy40plusyearsofworkinginruralandurbancommunitiesIhavediscoveredoneothersimilarity—theimportanceofphysicianstothehealthofthosecommunities.Weallknowhowimportantphysiciansareinruralcommunities.Inadditiontothecaretheyprovide,theyarealsolookedtoasleadersintheircommunities.Theroleofphysiciansinurbancommunitiesisnodifferent.Theclinicalcareweprovideisofcriticalimportancetoourcommunitybutsoisourleadershipinimprovingtheconditionsthatmakeourcommunitylivableandhealthyforall.Peoplelooktophysiciansforthatleadership. Asanorganizationcomprisedofphysiciansdedicatedtoimprovingnotonlythehealthoftheirpatientsbutalsothehealthoftheurbancommunityinwhichtheyliveandwork,theTwinCitiesMedicalSociety(TCMS)hastheopportunitytocoalescethatleadershipintoapowerfulforceforcreatingahealthyurbancommunity.TCMSalsohasauniqueopportunitytointegratethefieldsofclinicalmedicineandpublichealthinawaythatcouldbeamodelforbothurbanandruralcom-munitiesthroughoutthecountry.Let’stakeadvantageoftheseopportunities.


RecentlyattheinvitationofTCMSPresidentEdEhlinger,M.D.,severalpublichealthdirectorsfromthemetroregion,alongwiththeirphysicianmedicalconsultants,metwithTCMSrepresentatives.The

meetingwasanopportunitytogetacquaintedwithoneanotherpersonallyandprofessionally,andexplorehowwemightenhancethecollaborationbetweenmedicineandpublichealth.Themeetingcouldnothavecomeatamorecriticalandopportunetime. AllacrossMinnesota,localpublichealthagenciesareimplementingaground-breakingprogramcalledtheStatewideHealthImprovementProgram(SHIP).Signedintolawin2008,SHIPisanintegralcomponentofMinnesota’sefforttoimprovehealthanddecreasehealthcarecosts.ItsgoalistohelpMinnesotanslivelonger,better,healthierlivesbypreventingthechronicdiseaseriskfactorsofphysicalinactivity,poornutrition,andtobaccouseandexposure. TheStatewideHealthImprovementProgramisgroundedinevidencebasedstrategies(or“interventions”)designedtocreatechangeinthepolicies,systemsandenvironmentswherewelearn,workandlive.LocalpublichealthagenciesareestablishingCommunityLeadershipTeamswithrepresentationfromschools,worksites,communitiesandhealthcaresettings.Theseteamsselectandleadtheinterventionswhichbestmeettheneedsofthecommunity.ThisisagreattimetoengagetheTwinCitiesMedicalSocietyinthiseffort. Inourmeetingtogether,weheardthatphysiciansarekeenlyawareofthescopeandimpactofchronicdiseaseinourcommunities.Theyseefirsthandthekidsandparentsthatstrugglewithobesityandtobacco.Theyseethefacesandknowthenamesofthepeoplebehindthestartlingstatistics.Theyunderstandhowthiscurrentgenerationofchildrenisthefirstgenera-tionintwocenturiesthatisexpectedtohaveashorterlifeexpectancythantheirparents.They’veseentheprevalenceofobesityamongchildrenandadolescentsintheU.S.quadrupleamong6-11year-oldsandmorethantripleamong12-19year-oldsoverthelast30years.Theyknowthatitwilltakesystemicchangetoeffectthesetrends. Eachdayapproximately70Minnesotansdiefromchronicdiseases.Accordingtoasurveyofadults inMinnesotacalledtheBehavioralRiskFactorSurveillanceSystem(BRFSS),63percentareeitheroverweightorobese;fewerthan25percentconsumetherecommendedservingsoffruitsandvegetables;only50percentmeettherecommendationsforphysicalac-tivity;and18percentarecurrentsmokers.Thesebehaviorsleadtothemostprevalentandcostlychronicdiseases,yettheyarealsothemostpreventableofallhealthproblems.However,healthcareprovidersfrequentlyhavelittletimetospendwithpatientsandareoftennotequippedtoofferresources

thatcouldhelppatientsquitsmoking,leadmoreactivelivesandeatmorehealthfully.Bypartneringwithlocalpublichealthagencies,physicianscanexpandtheresourcesavailabletopatientsandprovidersalike. Ashealthcarereformcontinuesitsdifficultpath,oneaspectofthesolutionisclear.Wemustinvestinpreventionifwearetomakesignificantimprovementsinpopulationhealthandcurbtheeconomicburdenonso-ciety.Wemustcontinueto“lookupstream.”Researchshowsaninvestmentof$10perpersonperyearinprovencommunity-basedprograms(suchasthoseincludedinSHIP)toincreasephysicalactivity,improvenutrition,andpreventsmokingcouldproduceannualnetsavingsof$316millionperyearinMinnesota.Thatisasixtoonereturnoninvestment!The$47millionthathasbeenappropriatedforfiscalyears2010and2011willhelp.Alllocalpublichealthdepartmentsandtribalgovernmentshavebeenawardedgrants.Now,wemustworktosecurefuturefunding.Wecannothaveashort-termprojectforaproblemsolarge. TheSHIPprogramwillbesuccessfulifappropriatetimeandresourcesareprovided.Minnesota’spublichealthsystemhasahistoryofsuccess.WhentheLegislatureinvestedinyouthtobaccopreventionprogramsin2000,localpublichealthdepartmentsquicklymobilizedandimplementedprogramsthatproduceddramaticresults.Togetherwithourstatehealthdepartment,schoolsandcommunitypartnerswereducedoverallyouthtobaccouseratesby25percentinfiveyears.Wereducedcigarettesmokinginmiddleschoolstudentsby43percentduringthistimeframe. ALegislativeReportonSHIPwillsoonbedeliveredtotheMinnesotaLegislature.Weareconfidentitwillshowthatthepublichealthsystem,withthepartnershipofourcommunities,ourschools,ourmedicalproviders,andourcitizens,hasrespondedtothechallenge.Wearehopefulthereportwillcreatemomentumneededtoobtainongoingfunding. Onbehalfofmylocalpublichealthcolleagues,andonbehalfofallMinnesotans,IwouldaskthattheTCMSmembersgetinvolvedintheirlocalcommunitySHIPprogram,supportlocalpublichealthprogramsandservices,andcontinuethisdialoguesowemightcollaboratetobringaboutmuchneededchangeinthehealthofthecom-munitiesweserve.Theopportunityisgreat.Theneedisgreater. Thankyou.

Lowell Johnson, BS, MPA, director, Washington County Department of Public Health and Envi-ronment. He currently serves as chair of the Local Public Health Association of Minnesota.

Public Health and Medicine: The Potential and Need for Collaboration

By Lowell Johnson, BS, MPA


SUE A. SCHETTLE, CEO

tCMs in ACtion

Consolidation AccomplishedAsreportedinthelastissueofMetroDoctors,theconsolidationoftheEastMetroMedicalSocietyandWestMetroMedicalSocietywentverysmoothlydueinlargeparttotheleadershipoftherespectiveboardsofdirec-tors.Astheendof2009approachedallofthenecessarypaperworkwasfiledwiththeSecretaryofStateandotherregulatoryagen-cies,bankaccountswereclosedandnewac-countswerecreated,moneywastransferredintotherespectivefoundations,andourneworganization,TwinCitiesMedicalSociety,startedonaverysolidfoundation.

Web site RedesignAswelookforwardtocommunicatingwithourmembersinnewandinnovativeways,weareredesigningourWebsite,www.metrodoctors.com.Anupdatedlookandnewfunctionalityincludinganenhanceddescriptionofwhoweare,ourmission,currentprojectsandcommitteeactionswillbeavailable.LookforouronlineforumandRSSfeedsthatwetrustwillkeepourmembersuptodateonthemostpertinentmedicalsocietynews.

TCMS Policy Council ThePolicyCounciloftheTwinCitiesMedi-calSocietyhasbeeninitiatedandarmedwithamissiontoreviewandcommentonissueswithinlocalandstategovernment;provideliaisonwithcountydepartments,agenciesandelectedofficialsonmattersrelatedtohealthcareandthepracticeofmedicine;fosterthedevelopmentofaworkingrelation-shipbetweenphysicians,legislatorsandothergovernmentofficials;coordinategrassrootslegislativeactivities;developandrecommendtotheTCMSBoardofDirectorsnewpublicpolicyprograms,servicesandventuresfortheorganizationtoconsider;observetheMMA’slegislativeandpublicpolicyeffortsandrecommendactionstoTCMSforpur-posesofsupportingand/orweighinginonthoseefforts.ThechairofthegroupRoger

Kathol,M.D.waselectedinJanuary.Mem-bershipisdiverseandisbasedongeographyandpracticespecialty.FollowtheworkofthePolicyCouncilbyvisitingourWebsite.

Healthy Eating Minnesota Thenation’sfamilies,onaverage,consumeone-thirdoftheircalorieseatingout,andchildreneatalmosttwiceasmanycalorieswhentheyeatamealatarestaurantcom-paredtoamealathome.ThesefactsclearlycontributetotheobesityepidemicamongchildrenandadultsintheUnitedStates.TheTwinCitiesMedicalSociety(TCMS)believesthatbyhavingaccesstonutritionalinformation,consumerswhoeatoutwillmakeinformedandhealthierchoices.Toaccomplishthatgoal,TCMS,withpartnersliketheMinneapolisDepartmentofHealthandFamilySupportandtheAmericanHeartAssociation,ispursuingregulationswherebychainrestaurantswillberequiredtolistcalo-rieinformationonmenusormenuboardsandallrestaurantswillphaseouttheuseoftransfats,anunhealthyadditiveusedcom-monlyinfastfoodandchainrestaurants.

Honoring Choices Minnesota IfyouareanavidreaderofMetroDoctors youwillalreadyknowthatthemedicalsocietyhasbeenworkingoverthepasttwoyearstoinstallinthemetroareaamethodologyandapproachtoadvancecareplanningthatstartedinLaCrosse,WI,inthe1990s.Wehavecalledourmetro-basedproject“Honor-ingChoicesMinnesota.”IthasthelookandfeeloftheLaCrosseprogrambutwithMinnesotaspecificnuances.Forexample,thehealthcaredirectivethatwehaveadoptedasacommunityemulateswhatiscurrentlyinMinnesotaStatute.PilotsitesstartedinJanuary2010.ThemedicalsocietystaffisspearheadingtheprojectwithDr.KentWilsonservingintheroleofmedicaldirec-tor.Agrantwriterhasbeenhiredwiththegoalofsecuringlong-termfundingtohelpsustaintheeffort.VisitingourWebsitecan

giveyouthemostup-to-dateinformationonthisprojectasthemonthsproceed. Dr.KentWilson,medicaldirectoroftheHonoringChoicesMinnesotaproject,wasinterviewedrecentlyontheweeklycabletelevisionprogram,A Public Health JournalhostedbyDr.EdEhlinger.TheprogramisproducedbyMinneapolisOfficeofMediaServices,UniversityofMinnesotaBoyntonHealthService,MinnesotaPublicHealthAssociation,andtheHennepinCountyHumanServicesandPublicHealthDepart-ment.EachweekDr.Ehlingerisjoinedbyavarietyofgueststodiscusshealthissuesandproblems.Theinterviewsuccinctlyexplainstheprojectthatthemedicalsocietyhasbeeninvolvedin.Toviewtheinterviewvisitthefollowingweblink:http://hennepinmn.granicus.com/MediaPlayer.php?view_id=11&clip_id=786.

Kent Wilson, M.D. was a recent guest on “Public Health Journal,” a weekly cable tele-vision program with host Ed Ehlinger. M.D.


More Deficit, Further Challenges:

2010 Legislative Preview

DESPITE NEARLY EIGHT CONTINUOUSmonthsofhealthcarereformdiscussionsdur-ingthelaterstagesofthe2009legislativeses-sionandthentheseeminglyendlessdebateoverhealthcarereformatthefederallevel,healthcaredebatewill likelyagaindominatemanydiscussionsthroughoutthe2010legislativesession.Thelegislaturefacesabevyofdifficulttasksthissession,mostnotablyattemptingtoredesigntheGeneralAssistanceMedicalCare(GAMC)programsettoexpireMarch1.Thelegislatureisalsosaddledwiththedauntingtaskoffillinga1.16billiondollardeficitgap,andifthe2009sessionprovesanyindicationoftheroadahead,thedecisionsandvoteslegislatorsfacewillnotbeeasilytaken.

Addingtothegrimpicturearetheuniquepoliticalcircumstancespresentin2010,astate-wideelectionyear.WithGov.Pawlentyposi-tioninghimselffora2012presidentialrun,hisrecurrent“nonewtaxes”pledgehasthepotentialtodoomanytaxincreasescomingacrosshisdesk.Furthercomplicatingmatters,ahandfulof lawmakers inboththeHouseandSenatestandtousethelegislativesessionasatooltoposturefortheirownrunsatthegovernorshipin2010.

What to do With GAMCNowthatthelegislaturehasconvened,mem-bersoftheHouseandSenatehealthpolicyandfinancecommitteeswillmakeeveryef-forttopasslegislationpreservingtheGAMCprogramwithinthefirstmonthofthesession.Gov.Pawlenty’sline-itemvetoandunallotmentduringthe2009legislativesessioneliminated

funding for the GAMC program effectiveMarch1,2010,leavinglegislatorsaveryshorttimeframeinwhichtofindafeasiblehealthcaresolutionforsome35,000Minnesotanssettolosehealthcarecoverage. Iflegislativeleadersareabletoreachsomeagreementearlyinthesession,theymuststillovercomethehurdleofsecuringthegovernor’ssignature.ThegovernorandHumanServicesCommissionerCalLudemanhavealreadyindi-catedtheirpreferencetomovethoseindividualscurrentlycoveredunderGAMCovertoMin-nesotaCareoncefundingforGAMCexpiresinMarch.Ifthisisanyindicationofthegovernor’swillingnesstoacceptadifferentsolution,theprospectofgettingsomethingsignedintolawpriortotheMarch1deadlineappearsgrim.

Provider tax and Health Care Access FundTheeffortsoflegislatorsandtheadministrationtofindahealthcaresolutionfortheGAMCpopulationcouldhaveimplicationsontheHealthCareAccessFund.AnydecisionbytheGovernorortheDepartmentofHumanServicestoautomaticallyenrollportionsof

theGAMCpopulationintoMinnesotaCarestandstoonlyfurtherstraintheHealthCareAccessFund,alreadyprojectedtobeginrun-ningadeficitasearlyas2012.Asseemstobethecaseannually,anincreaseinthecurrent2percentprovidertaxwillremainonthetableasapotentialrevenuesourcefor legislators,particularlyifMinnesotaCareenrollmentisin-creasedandlegislativeleadersareunabletofindasolutiontothecurrentbudgetdeficit.Groupsrepresentingmedicalproviders,includingtheMinnesotaMedicalGroupManagementAs-sociation (MMGMA) and the MinnesotaMedicalAssociation(MMA),willbemakingsignificanteffortstoensuretheprovidertaxisnotincreasedbeyonditscurrentlevels. Inyearspast,manygroupswithinthemedicalprovidercommunityhaveshownanalmostunifiedoppositiontoaprovidertaxincrease.However,thecircumstancesfacinglegislatorsinthe2010sessionhavethepotentialtodividethemedicalprovidercommunityonthisissue.CertaingroupsmayseeaprovidertaxincreaseasanacceptablecompromisetofinancearedesignedGAMCprogramandreducetheiruncompensateddebtlevels.

By H. Theodore grindal, Jd, and Nathaniel Mussell, Jd

H. Theodore Grindal, JD Nathaniel Mussell, JD


Evenifdebateoverincreasingtheprovidertaxisavoidedduringthe2010session,thereislittledoubtthatwithevenhigherdeficitshort-fallsprojectedforthecomingyears,alongwithanewadministration,theprovidercommunityneedstobeginlayingthegroundworkthisyearinanticipationoffutureproposalstoincreasetheprovidertax.

Provider ReimbursementAnotherperennialissuelikelytoresurfacedur-ingthe2010legislativesessionisfurthercutstoproviderreimbursementunderthestate’shealthcareprograms.ReimbursementrateswilllikelybediscussedduringtheinitialdiscussionsabouthowtoredesigntheGAMCprogramandaslegislatorslooktosolvethe1.2billiondollardeficit.BecausetheHealthandHumanServices(HHS)budgetaccountsforthesecondlargestportionofthestate’sgeneralfunddollars,somelegislatorsmayviewfurthercutstoproviderre-imbursementastheeasiestshort-termsolutiontoabudgetproblem.However,ithasbecomeabundantlyclearthatafterseeingnoincreaseinphysicianreimbursementoverthelastnineyearsandadramatic6.5percentratecuttospecialistsduringthe2009legislativesession,anyfurthercutswouldsimplybeunsustain-ableandcouldforcemultipleprovidersandindependentpracticesoutofbusiness.

Federal Health Care Reform: Effects in MinnesotaInadditiontotheworkbeingdoneatthestatelevel,manylegislatorshavehadtheireyesandearsonWashington,D.C.,toascertainhowapotentialfederalhealthreformbillwillaffectMinnesota.However,aftermonthsoflengthydebateanddiscussion,andonesignificantU.S.Senatespecialelection,federalhealthreformappearstobeonlifesupport.FollowingtheelectionofMassachusettsSenatorScottBrown(R),democratsintheHouseandSenateappeartobeheadedbacktothedrawingboardifanyhopeofpassingahealthreformbillremains.ThatleavesMinnesota’slegislatorsandMin-nesota’sprovidercommunitytowonderwhichofthosereformsinitiallyincludedinthehealthcarebillwillinfactremaininplacewhenandifCongressresumesdebateonfederalhealthreform.

ShouldCongressrevisithealthcarere-forminthenextyear, it isverypossibleanexpansionofthefederalMedicaidprogram

andimpositionoffederalorstateinsuranceexchangeswillbeincludedinascaledbackhealthcarebill.BothofthesereformswouldstandtohaveasignificantimpactonMin-nesota’sHealthandHumanServicesbudgetgoingforwardhelpingtoreplacestatedollarswithfederaldollarsandpotentiallyeasingthestrainontheHealthCareAccessFund.WhileMinnesota’slegislatorswillnotneedtoaddresstheimplicationsofthesereformsduringtheupcoming2010legislativesession, lookfordebateonthesereformstoresurfaceasearlyas2011.

Other Health Bills ThelikelybyproductoffurtherHHSbelt-tightening and a redesign of the GAMCprogramisthatmanylegislativeproposalsin-troducedduringthe2009sessionwillbelefton

thetable.However,legislationlikelytoappearduringthe2010sessionofparticularinteresttohealthcareprovidersincludes,medicalcopyingfeeslegislationoriginallyintroducedduringthe2009session,anadvancedpracticenursingbillalsointroducedin2009,no-faultautoinsur-ancereform,andfaircontractinglegislationbetweenprovidersandinsurancecompanies.Governingduringadeficityearisnevereasy,anditisdifficulttoimagineascenariowherephysiciansandotherprovidersarenotadverselyaffectedbylegislationinsomeway.

H. Theodore (Ted) Grindal, J.D. is the partner in charge of the Government Relations practice group; Nathaniel Mussell, J.D., is a lobbyist with Lockridge Grindal Nauen’s (LGN) government relations group with a focus primarily on health care clients.

East Metro District:Wednesday, May 12

6:00p.m.TCMSExecutiveOffice

BroadwayPlaceWest1300GodwardStreetNE,Suite2000

Minneapolis,MN55413Contact:KatieSnow,(612)362-3704,

[email protected]

Call for Resolutions

West Metro District:Wednesday, May 19

7:00a.m.BroadwayRidge

3001BroadwayStreetNE,ConferenceRoomD(lowerlevel)

Minneapolis,MN55413Contact:KathyDittmer,(612)623-2885,

[email protected]

AllmembersoftheTwinCitiesMedicalSocietyareinvitedandencouragedtobecomeengagedinsettingtheprioritiesandnextyear’sagendafororganizedmedicine.Memberscansubmitresolutions,participateinthedistrictcaucusandattendtheannualmeetingoftheMMAHouseofDelegates,September15-17,2010,atBreezyPoint,MN.

TheTCMSmembershipwillbecomprisedoftwodistricts:

East Metro District –physicianslivingand/orworkinginRamsey,Washington,oreasternDakotaCounty;and

West Metro District –physicianslivingand/orworkinginAnoka,Carver,Hennepin,ScottorwesternDakotaCounty.

Resolutions are due in the TCMS office by MONDAY, MAY 3, 2010.

SAVE THE DATES

CAUCUS DATES:


Kent S. Wilson, M.D. Receives Shotwell Award

The2009ShotwellAwardwaspresentedtoKentS.Wilson,M.D.attheJanuary5,2010meetingoftheAbbottNorth-

westernMedicalStaff.EdwardP.Ehlinger,M.D.,presidentoftheTwinCitiesMedicalSocietypre-sentedtheawardonbehalfoftheWestMetroMedicalFoundation.

TheShotwellAwardispresentedannuallytoapersonwithinthestateofMinnesotawhohasmadesignificantcontributionsinthefieldofhealthcare.

KentS.Wilson,M.D.,aretiredotolaryn-gologist inSt.Paul,hasdedicatedhismedicalcareertoimprovinghealthcareforhispatientsandthecommunity.• Inthe1970sandearly1980s,hewasa

leaderinthemovementtorequirefacialprotection,includingfacemasksanddentalguards,inbothfootballandhockeyatalllevelsofplay—elementary,highschoolandcollege. Hecarriedoutresearch,educatedthepublicontheissue,andwasengagedineffortstoimplementpoliciestoprotectathletes.

• Hewasinstrumentalindevelopingandmak-ingwidelyavailablestandardsofmedicalcareintheStateofMinnesota,designedtoprotectpatientsandphysiciansaswellasimprovequalityofcare.

• Currently,heisleadingametro-wideinitia-tive,HonoringChoicesMinnesota,focus-ingonacomprehensiveandcollaborativeadvancecareplanningprocess.Theinitiativeisamodelforimprovementinmedicalcareplanningforpatients,familiesandthehealthcarecommunity.Dr.Wilsonretiredfromactivepracticein

2006 after32 yearsofENTpracticeatMidwestEar,Nose&ThroatSpecialists,St.Paul. Atthetimeofhisretirement,however,Dr.StuartCox,thenpresidentoftheEastMetroMedicalSocietyandasoneofDr.Wilson’scol-leaguesfromMidwestENT,worriedthatDr.

Wilsonwouldneedsome-thingtodo.HepersuadedhimtochairtheEastMetroMedicalSocietyFoundationboardofdirectors—assur-inghimthatitwouldonlybefourmeetingsayear.Dr.Wilsonagreedandsoonembarkedonwhathasbeenaveryinterest-ingtwoyears. ItbecameapparentwhenDr.Wilsonac-ceptedtheroleaspresidentoftheEastMetroMedicalSocietyFoundation(EMMSF)thattherewassomeworktodo.Thefoundationwasdubbedthe“smallestfoundationinNorthAmerica”andwasinneedofsomerestructuringasmanyoftheboardmembers’termshadexpired.Underhisleadership,newboardmemberswererecruitedandaprojectemergedthathaschangedthefocusandthepresenceofthefoundation. Honoring Choices Minnesota, is basedonaprovenmodelthatwasfirstcreatedinLaCrosse,Wisconsincalled“RespectingChoices.”Thismodelstartedwithacollaborativeeffortbe-tweentwootherwisecompetinghospitalsystemsinLaCrosseandcenteredarounddevelopingacommon,consistentapproachtotalkingwithpatientsabouttheirvalues,beliefsanddesiresrelatedtotheirendoflifewishes.TheapproachhastransformedendoflifecareinLaCrosse,andsimilarimprovementsareexpectedforMinnesota. Overthelast18months,Dr.WilsonhasledtheEMMSFandtheHonoringChoicesMinne-sotaadvisorycommittee,whichiscomprisedofrepresentativesfromhealthplans,hospitals,ICSI,blocknurses,andmanyotherrelatedorganiza-tions.Theadvisorycommitteehasachievedsub-stantialmilestonesincludingacommunityhealthcaredirectivedocumentandpatienteducationmaterials,inadditiontoeducating46facilitatorsand10instructorsintheLaCrossemodel. Dr.Wilsonhasspentcountlesshourswork-ingasavolunteeronthisproject.Histirelessworkethicandhisattentiontodetailareindeed

remarkable.He’savisionaryandtrulydeservingoftheShotwellAward.

Dr.WilsonreceivedhismedicaldegreefromtheUniversityofMinnesota.HecompletedaninternshipatDenverGeneralHospital,Denver,CO,asurgicalresidencyatU.S.P.H.S.Hospital,NewOrleans,LA,andafellowshipinOtolaryn-gologyattheUniversityofMinnesota.Dr.WilsonisboardcertifiedbytheAmericanBoardofOto-laryngology.HeisaformerpresidentoftheMin-nesotaAcademyofOtolaryngology,MinnesotaMedicalAssociation,andtheMinnesotaAcademyofMedicineandcurrentlyservesaspresidentoftheEastMetroMedicalSocietyFoundation.

The Shotwell Award was established byMetropolitanMedicalCenterin1971inrecognitionofthesupportanddedicationoftheShotwellFamily.UpontheclosingofMetropolitan-MountSinaiMedicalCenterin1991,theWestMetroMedicalSociety/Foundationassumedresponsibilityforse-lectingtherecipientoftheShotwellAward.AbbottNorthwesternHospitalandMedicalStaffhasgenerouslyprovidedfundingfortheShotwellAwardsince2003.AplaquerecognizingalltheawardrecipientsresidesintheSisterKennyPavilionontheAbbottNorthwesterncampus.

Wordingontheplaquereads:The Shotwell Award, established in honor of Mr. and Mrs. James D. Shotwell for their con-tributions to the hospital, is presented yearly for a noteworthy effort in the field of health care.

Kent S. Wilson, M.D. accepts the Shotwell Award from TCMS president, Edward Ehlinger, M.D.


CMs deemed status Accreditation organizations

The Joint Commission—60 Years of Accreditation Experience

By Charles A. Mowll, FACHE

Editor’s Note: In order for a health care organiza-tion to participate in and receive payment from the Medicare or Medicaid programs, it must be certified by the Centers for Medicare & Medicaid Services (CMS) as complying with the Conditions of Participation, or standards, set forth in federal regulations. However, if a national accrediting organization has and enforces standards that meet the federal Conditions of Participation, CMS may grant the accrediting organization “deem-ing” authority and “deem” each accredited health care organization as meeting the Medicare and Medicaid certification requirements. The three organizations currently granted deemed status to accredit hospitals and health care entities are highlighted in the following three articles.

TheJointCommissionhasbeenaccredit-inghealthcareorganizationsfornearly60yearsandhasareputationforquality,

integrityandinnovation.WhenaphysicianorhospitalchoosestopursueaccreditationbyTheJointCommissiontheycanbeassuredthattheirorganizationwillreceivethehighestlevelofedu-cationandsupportneededtoimprovethequalityandsafetyofcareprovidedtopatients.TheJointCommissionisthenation’spredominantaccredit-ingbodyandcontinuestoraisethebarforhealthcareorganizationsintheirpursuittoprovidethehighestqualityandsafetyofpatientcare.

Making patient safety an imperative inhealthcareorganizationsistheprimefocusofTheJointCommission’saccreditationrequire-ments.Morethan50percentofaccreditationstandardsacrossalltypesoforganizationsaredirectlyrelatedtosafety.

TheJointCommission’sapproachtoac-creditationis patient-centeredanddata-driven.JointCommissionstandardsaddresstheorganiza-tion’slevelofperformanceinkeyfunctionalareas,

suchaspatientrights,patient treatment,medication safetyandinfectioncontrol.Standards set forthperformance expec-tations for activitiesthataffectthesafetyandqualityofpatientcare.Ifanorganizationdoestherightthingsanddoesthemwell,thereisastronglikelihoodthatitspatientswillexperiencegoodoutcomes.

Werecognizeorganizationshaveachoicewhenitcomestoaccreditationandwevalueourrelationshipswithaccreditedorganizations.Ouremployeesareexperiencedhealthcareprofession-alsandunderstandtheeverydaychallengesfacedbyhealthcareorganizations.TheJointCommis-sion,aprivate,not-for-profitorganization, isgovernedbyaBoardofCommissionersequallydedicatedtothesafetyandwell-beingofpatients.Theboardiscomprisedofadministrators,doc-tors,nurses,ethicists,andmembersofthepublic.Ourfivecorporatemembersrepresentthelead-inghealthcareassociationsintheUnitedStatesincludingtheAmericanHospitalAssociation;AmericanMedicalAssociation;AmericanCollegeofPhysicians;AmericanCollegeofSurgeons;andAmericanDentalAssociation.

JointCommissionaccreditationprogramsthatmaybeofprimaryinteresttophysiciansincludehospital,criticalaccesshospitalandam-bulatorycare.Fororganizationspursuingaccredi-tationforMedicaredeemedstatus,theCentersforMedicare&MedicaidServices(CMS)hasawardeddeemingauthoritytoourhospital;criti-calaccesshospital;ambulatorysurgicalcenter;durablemedicalequipment,prosthetics,orthoticsandsupplies(DMEPOS);homehealth;clinicallaboratoryandhospiceaccreditationprograms.Inaddition,TheJointCommissionalsooffersaccreditationforbehavioralhealthcareandlong

termcareorganizations.In-patientpsychiatrichospitalsaresurveyedunderthehospitalstan-dards.Whetherornotanorganizationispursuingaccreditationfordeemedstatus,boththeprovid-ersandpatientsbenefitfromtheprocess.

Approximately88percentofthenation’shospitalsarecurrentlyaccreditedbyTheJointCommission.TheJointCommissionalsoac-creditsapproximately358criticalaccesshospitalsunderauniqueprogram.

TheJointCommissionAmbulatoryCareAccreditationprogramcurrentlyaccreditsmorethan1,600freestandingambulatorycareorgani-zations.Theseorganizationsfallintothebroadcategoriesofsurgical,medical/dentalanddiag-nostic/therapeuticservices,andrepresentavarietyofsettingsincludingphysicianoffices,medicalpractices,urgentcarecenters, imagingcenters,sleepcentersandambulatorysurgicalcenters.

TheJointCommissionhasin-depthexperi-encewithprovidingdirectionandguidanceonpatientsafetyandqualitytoaccreditedorgani-zations.Fromthetimeanorganizationdecidestopursueaccreditationtheywillbeofferedthesupportneededtosucceedincluding:• Adedicatedaccountexecutive;• Experienced clinicians in theStandards

InterpretationGroupavailableonlineandbyphonetoansweranystandardsrelatedquestions;

• Surveyorswhogivevaluableinsightintobestpractices;

(Continued on page 10)


• Anofficialmonthlynewsletter“JointCom-missionPerspectives,”and

• Apasswordprotectedextranetpageon“JointCommissionConnect.”TheJointCommissionhasacadreofmore

than500surveyors,reviewersandLifeSafetyCodespecialistswhoaretrainedandcertified,andreceivecontinuingeducationonadvancesinquality-relatedperformanceevaluation.ToearnandmaintainaccreditationfromTheJointCommission,organizationsmustundergoanunannouncedon-siteevaluationbyaJointCom-missionsurveyteamevery18-39months,withtheexceptionoflaboratorieswhicharesurveyedeverytwoyears.

TheJointCommissionon-siteaccreditationprocessiscenteredontheTracerMethodology.JointCommissionsurveyorsfollowtheactualexperiencesofasampleofpatientsastheyinter-actwiththeirhealthcareteam,andevaluatetheactualprovisionofcareprovidedtothesepatients.Inadditiontotracingthecareofpatients,TheJointCommissionprocessincludesSystemTrac-ers,whichexamine,indetail,specifichigh-riskcomponentsofthehealthcareorganization,forexample,themedicationmanagementprocess.Theseactivitiesarecustomizedforeachreview.

JointCommissionstandardsaddresstheorganization’sperformanceinspecificareas,andspecifyrequirementstoensurethatpatientcareisprovidedinasafemannerandinasecureen-vironment.TheJointCommissiondevelopsitsstandardsinconsultationwithhealthcareexperts,providersandresearchers,aswellasmeasure-mentexperts,purchasersandconsumers.Thestandards-basedperformanceareasare:• EnvironmentofCare• EmergencyManagement• HumanResources• InfectionPreventionandControl• InformationManagement• Leadership• LifeSafety• MedicationManagement• MedicalStaff(hospitalonly)• NationalPatientSafetyGoals• Nursing(hospitalonly)• ProvisionofCare,Treatment,andServices• PerformanceImprovement• RecordofCare,Treatment,andServices• RightsandResponsibilitiesoftheIndividual• TransplantSafety• WaivedTesting

Priortothesurvey,anassignedaccountexecutiveworkscloselywiththeorganizationtoanswerquestions,providespecificinformationincludingthelengthofthefuturesurveyandthenumberofsurveyorsthatwillbeassignedtoconductthesurvey.Theorganizationalsoreceivestwolistsoutliningthesurveyactivitiesandtheinitialmaterialssurveyorswillrequesttoreviewattheonsetofthesurvey.Afteranorganizationreceivesthis information,andpriortotheun-announcedsurvey,theiraccountexecutivewillcontactthemtoreviewtheinformation.

Onthedayoftheunannouncedsurvey,aletterofintroductionwillbepostedontheor-ganization’ssecureextranetsiteby7:30a.m.Theletterwillincludethesurveyagenda,aswellasbiographiesandpicturesoftheassignedsurveyors.Whensurveyorsarrivetheywillworkwiththeorganization’sleaderstodeterminethebesttimeforschedulingsurveyactivitiestocoincidemosteffectivelywithpatientcareandadministrativeoperations.Thisensuresthesurveyissensitivetothetimedemandsoftheorganizationandstaffwhilestillprovidingathoroughsurveyoftheorganization.

Attheconclusionofthesurvey,theorga-nizationwillreceiveasummarythatincludespreliminaryfindingsidentifiedduringthesurvey.Exitconferencesareheldwithleadershipandstafftodiscusssurveyfindings.ThesummaryofsurveyfindingsundergoesacomprehensivereviewbyTheJointCommission’sCentralOfficestaff.Thefinalsummaryofsurveyfindingsispostedtotheorganization’spasswordprotectedJointCommissionConnectextranetsite.Thesum-maryindicateswhichfindingsrequireEvidenceofStandardsCompliance(ESC),orcorrectiveac-tion,tobesubmittedwithin45or60days.Onceanorganization’sESCisacceptedbyTheJointCommission,theaccreditationdecisionispostedtotheirextranetsiteandwithinonebusinessdayitispubliclydisclosedonQualityCheck®,www.qualitycheck.org,acomprehensiveguidetoJointCommissionaccreditedandcertifiedhealthcareorganizationsintheUnitedStates.

Theroutineon-sitesurveyisn’ttheonlyaspectoftheaccreditationprocess.JointCom-missionaccreditationfocusesoncontinuousim-provementandthePeriodicPerformanceReview(PPR)isakeycomponentinthisprocess.ThePPRhelpsorganizationsincorporatethestan-dardsintotheirroutineoperations,andallowstheorganizationtouseanautomatedtoolsotheycanevaluatetheircompliancewiththestandards.Foreverystandardanorganizationfindsoutof

compliance,theymustdevelopaPlanofActionidentifyinghowtheywillcomeintocompliance.SomestandardsrequireMeasuresofSuccesstoquantifywhetheracorrectiveactioniseffectiveandsustained.

Performancemeasurementisalsoanim-portantcomponentofTheJointCommission’shospitalaccreditationprogram.HospitalsarerequiredtocollectandtransmitperformancemeasurementandimprovementdatatoTheJointCommission.IntroducedinFebruary1997,theORYX®initiativewasdesignedtointegrateout-comesandotherperformancemeasurementdataintotheaccreditationprocess.ThedataispubliclyreportedonQualityCheck®andfacilitatesusercomparisonsofhospital-specificperformanceandpermitscomparisonsagainstoverallstateandnationalrates.

In2004,TheJointCommissionandCMSbeganworkingtogethertoalignmeasurescom-montobothorganizations.Thesestandardizedcommonmeasures,called“NationalHospitalQualityMeasures,”are integraltoimprovingthequalityofcareprovidedtohospitalpatientsandbringingvaluetostakeholdersbyfocusingontheactualresultsofcare.MeasurealignmentbenefitshospitalsbymakingiteasierandlesscostlytocollectandreportdatabecausethesamedatasetcanbeusedtosatisfyCMSinitiatives,theHospitalQualityAlliance(HQA),legislative,andJointCommissionrequirements.ItisTheJointCommission’sintentiontoremaininalignmentwithCMSsothatthedatacollectioneffortsforhospitalscancontinuetobeconsolidatedandminimized.AlloftheNationalHospitalQualityMeasurescommontoTheJointCommissionandCMSareendorsedbytheNationalQualityForum(NQF).

TheJointCommission’scomprehensiveap-proachtoaccreditationistheoptimalwayforhealthcareorganizationstofocusoncontinuousimprovementofqualityandpatientsafety.Ouraccreditationisrecognizedasthegoldstandardforattractingthebesthealthcareprofessionals,earningmanagedcareandinsurancecontractsandassuringconsumersofanorganization’scommit-menttosafetyandquality.FormoreinformationonJointCommissionAccreditationpleasecall(630)792-5800,orvisitwww.jointcommission.org.

Charles A. Mowll, FACHE, executive vice president, Business Development, Government and External Relations, The Joint Commission.

Joint Commission

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AfterPresidentKennedyestablished in1962theloftygoalofputtingamanonthemoonbytheendofthedecade,I

recallastoryabouthistouroftheMannedSpace-craftCenterinHoustonsoonafteritopenedinSeptember1963.Heapproachedacustodianandasked“What’syourjob?”Themanreplied,“Sir,myjobistoputamanonthemoon.”Whiletheremaybevariationsofthestory,thereisnovariationonthemoralofthestory:Aloftygoalrequiresthefullcommitmentofeverybodyinvolved.

Andsoitiswithourgoalofcreatingsus-tainablequalityinhealthcaredelivery.Qualityimprovementisnotoneperson’sjob,andachiev-ingcontinuousqualityimprovementcertainlyrequiresmorethana“title”withinthehospital,whetheritisDirectorofQuality,PIorInfectionControlDirector.Weworkeverysingledaywiththeseprofessionalsandtheywillbethefirsttotellyouthatqualityisateameffort. Aswithgettingtothemoon,ensuringpa-tientsafetyandimprovingmedicaloutcomesinourhospitalsisdependentondefined,missioncriticalprocesses.Oneofthosekeyprocessesisaccreditation.Historically,intermsofitsconnec-tiontoqualityimprovement,accreditationhasunderperformed.Why?Becauseitwasdesignedtotellyouwhatyouarenotdoingasopposedtoen-couraginginnovation.Theconventionalapproachtoaccreditationisessentiallyaninspection—onewithshiftingcriteriaandaninclinationtowardpenalization.In2010itshouldandnowcanbeastrategicbusinesstoolthathelpsfuelyourqualitymission.

Aneffectiveaccreditationprogramfirstandforemostshouldbesomethingthehospitalchooses,notsomethingimposeduponit.Whereasbeingaccreditedisnot,forallintentsandpurposes,anoptionfortoday’shospitals,whichaccreditationprogramyouuseismostdecidedlyachoiceyouhaveandaprerogativeyoushouldexercisebased

on your own goals.SinceDNVHealth-care,Inc.wasgranteddeeming authoritybyCMSjustoverayearago,thenatureofthosechoiceshaschangeddramaticallyand,webelieve,infavorofhospitalsseekingtouseintegrateaccreditationintohospital-widequalityprocesses.

TheISO9001QualityManagementSys-temprovidesthatstructure.It istheuniversalmeasure ofqualityinthousandsuponthousandsofbusinessesandindustries.Almostonemillionorganizationsthroughouttheworld(includingNASA)areISO9001certifiedincludingmanyhealthcareentitiesoutsidetheUnitedStates.Itisaglobalsuccess.AndthereisabsolutelynoreasonhospitalsintheUnitedStatescannotgetonboard.

What is ISO? ISO,theInternationalOrganizationforStan-dards,isanon-governmentalconsortiumfoundedin1947todevelopvoluntarystandardsforim-proving industrialperformance.Today,morethan90countriesaremembersofISO,withtheU.S.representativebeingtheAmericanNationalStandardsInstitute(ANSI).

Initially,ISOstandardsfocusedontechni-calspecificationsgearedformanufacturingandscientificindustries.In1987,ISOexpandeditsscopewiththecreationoftheISO9001Qual-ityManagementSystem,anewstandardthataddressedabroadrangeofbusinessprocessesapplicabletovirtuallyanytypeoforganizationinanyindustry.

ManyreadersfamiliarwithTQM,CQIandtheotheracronymscreatedduringthequalityrevolutioninthe1990swillrecognizeISO9001asthedefiningstandard.Manyhavecalleditthe“musthave”certificationforquality-drivencompanies.

ThemostrecentupdatetotheISO9001standard is ISO9001:2008.This is the ISOprogramutilizedbyDNVHealthcareInc.,thehospitalaccreditationcompanyofDetNorskeVeritas.DNVistheonlyhealthcareaccreditationorganizationtyingISO9001compliancewithCMS-approvedaccreditation.

How Does it Work?ThebasicideaofISO9001istofindthethingsinyourbusinessthatworkbestandturnthemintostandardoperatingprocedures.ThekeytoISO9001—andthefeaturethatmakesitdif-ferentfromallotherqualityinitiatives--isthatitisperpetual.Unlikequalityschemesofthepast,itdoesnotstopwhenabestpracticehasbeenidentifiedandinstituted.ISO9001isawayofapproachingworkthatnotonlymakeseachactiv-ityasefficientasitcanbe,butalsocontinuallysearchesoutimprovements. ISO9001isaqualitymanagementsystem.Itrequirestheorganizationtodocumentanddemonstrateasequenceandinteractionofpro-cesses,conductinternalauditstoevaluatepro-cesses,identifycorrectiveandpreventiveactiontoimproveprocesses,andmonitortheprocessestoensurethereiscontinual improvement.Forhospitals,ISO9001meansidentifyingitspro-cessesandthenidentifyingtheelementsinclinicalandadministrativepracticesthatcontributetodesirableoutcomes,documentingthoseelementsandinstitutingthemasstandardpractice.Someexamplesofprocessesincludeinpatientandout-patientcare.Examplesofprocesselementsincludeimprovedcommunicationamongstaffmembers,

ISO 9001 and Hospital Accreditation—Putting a Man on the Moon

By darrel J. Scott, FACHE (Continued on page 12)


revisionstopoliciestoreflectbestpractice,stan-dardizationofformsusedfordocumentationofpatientcareactivities,anddetectionofproblem-proneissues. ISO9001isdesignedtopreventthe“back-slide”thatoccursineverynon-systemicapproachtoquality.Whenactionsaretaken,ISO9001requires the organization to assess continualimprovement.Hospitals typicallymaintainadatabaseofcorrectiveandpreventiveactionsandapplyfollow-updatestoensurethattheyaresustainingtheimprovementsmade.Thiscre-atesmoreawarenessforstaffandrequiresthatmonitoringbeinplacetoensurethatproblemsdonotrecur. ThehealthcareindustryhasavarietyofinitiativesthataimtoimprovethequalityofhealthcareandreduceerrorsandnoneoftheseconceptsneedstobeabandonedwithISO9001.ISOisawayofensuringthattheinitiativesim-provepractices—andthattheycontinuetodoso.Thesystemisentirelycompatiblewithanyhealthcareorganization. Avarietyoffactorsfrominternalgoalsettingtooutsidepressurestypicallydriveahospital’scommitmenttoquality.Workinghardtoimproveaccreditationscores,compliancewithfederalandstatecomplianceprogramsandutilizingbestprac-ticesareexamplesofapproachesthathavebeenusedinthepasttoinfluencethepathtoqualityimprovement. Butnow,communitiesandpayorswanttoseequalityimprovementintermsthatcanbeexplainedandunderstood.Asimportantasvariousinternalhospitalmeasurementsare,thepublicgenerallydoesnotrelate. Hospitalsaretypicallyhugeeconomicfac-torsintheircommunitiesandoftenthelargestemployer.Manyotherbusinesses inatypicalcommunity(e.g.,manufacturing,automotive,supplyandservicecompanies)utilizetheISO9001qualitymanagementsystemastheirqual-ityengineandoftenwonderwhydoesn’tourhospital?

A Case StudyHereisanexampleofaDNV-accreditedhospitalthatisalsoISO9001certified.Thishospitalisa300+bedmulti-specialtyhospital locatedintheMidwest.Ithasmorethan1,200employeesincludingover800physiciansonstaff. AftermakingtheISOcommitmentattheboardlevel,thehospitalneededapartnertohelpintheplanningandimplementationofanewprocess.

Theorganizationthatwasselectedwas(thepredecessorto)DNVHealthcareInc.DNV(anditspredecessorcompanyTUVHealthcareSpecial-ists)hadahistoryofhelpingthehospitalwithongoingprepforTJCsurveys.Aqualitymanagerwasappointedtoactastheoverseer ontheentireISO9001process.Overseernot“totaldoer.” TheinitialphaseofimplementingISO9001involvedcreatingadocumentcontrolsystemfortheentirehospital.Thisimpactedpoliciesandproceduresaswellaspaperandelectronicforms.ThisisoneoftheISOrequirementsandmakesthehospitalusethemostcurrentdocumentver-sionandnotallowoutdateddocumentstocreepbackintotheoperation.Thehospitalsaiditwasagreatlearningprocesstoidentifyoutdatedandrepetitivedocumentsandtocentralizedocumentcontrolsoeveryonewasonthe“samepage.” Thehospitalcreatedanonlinedocumentsystemthatisaccessibletostaffandeliminatestheneedtomaintainseveralmanualsinmultiplelocationsthroughouttheorganization. Duringthisphase,teamleadersdefinedandmappedthekeyprocessesandworkflowintheirdepartments.Asanexample,thehospitalfoundthatitwasusingmorethanathousandwordstodescribetheirprocesses.Thehospitalwentfurtherandidentifiedinternalandexternalcustomers,staffqualificationrequirements,measuresusedtoidentifyeffectivenessandefficiencyoftheprocess,anddocumentationrequirements(workinstruc-tions,policies,formsused,etc.).Thisexercisecreatedmoreofagraphicalrepresentationofitsprocessesandprovidedmoreofamacroviewoftheprimaryprocessesforpatientcareaswellastheotherprocessesthatsupportthem.Hence,aprocessinahospitalisinpatientcarenotradiologyturnaroundtime. Muchofthisactivityfollowsthe“tracer”processandwillbequitefamiliartomosthos-pitals.Tracermethodologywasoriginallyintro-ducedbyISOas“tracingtheprocesses.” ThepreparationfortheISO9001certifica-tionauditidentifiedweaknessesthroughouttheorganizationthatthehospitalhadalwaysthoughtwereingoodshape.Forthishospital,thisinitialphasetookaboutthreemonths.

AdjustmentForthishospital,mostoftheclinicaldepartmentsadaptedfairlyquicklytothedocumentationfor-matsandreviewprocessesrequiredbyISO9001.ThiswasapleasantsurprisetothehospitalbutnottoknowledgeableISO9001practitioners.Importantly,thehospital’sclinicalstaffdidnotfeelliketheywerebeinghassled. TheaspectofISO9001thatusuallyrequires

themostfocusisitsrequirementthatthehos-pitalmaintain itsqualityeffortsafter itstartsthem.Attentionmustbedevotedtomeasuring,monitoringandfollowingupontheissuesthatareaddressedthroughcorrectiveandpreventiveactions.Thisongoing,requiredfollow-upensuresthattheactionstakenhavebeeneffectiveinsus-tainingimprovementsandcontinuallymakingthembetter.Thisisthe“continual”incontinualqualityimprovement—afundamentaltenetofISO9001.

Culture vs. TaskAhospitalquicklyfindsoutthatinordertobesuccessful,ISO9001becomesaculturenotjustatasktoperform.Everyoneisinvolved,everyonecontributes.OneDNVhospitalreferredtoitasbeing“isotized.”

OngoingItisuptothehospitaltoensurethatthequalitymanagementsystemiseffective.Internalauditsareperformedannuallyineachdepartmentbyathirdpartytodemonstrateeffectiveness.Itisnothard,but,itisdifferent.Thereisnobreak—itisaconstancyofpurpose,itisawayoflife.NewDNV-accreditedhospitalssaytheyloveit.

The ResultsMeasurableimprovementsinclinicalindicatorsmaytaketimetobecomeevident.Butintermsoftheeverydayworkflow,themotivationofthestaffandthededicationtoquality,hospitalstellusISO9001isalreadyasmallinvestmentforaverybigreturn. The ISO methodology helps develop aprocessforstandardization.ItisthegoaloftheDNVaccreditationprogramthroughitsInte-gratedAccreditation™methodologytocombinecompliancewiththeMedicareConditionsofParticipationutilizingtherequirementsofISOtoprovideacomprehensivemanagementsystemforqualityandstandardizationthroughoutthehospitalincludingamodelthenon-clinicalde-partmentscanuse. Hospitalssaytheyareeminentlymorepre-paredthantheyhaveeverbeen.Hospitalsdonot“rampup”foranunannouncedDNVsurvey.Theydonothaveto“getready”because,asanISOhospital,theydothesamethingeveryday. Thenexttimesomeonetellsyouqualityisthejobofsomeoneelse,remindthemthatitiseverybody’sjob.Weallare“puttingamanonthemoon.”

Darrel J. Scott, FACHE is the senior vice president for Regulatory & Legal Affairs for DNV Healthcare Inc., Cincinnati, Ohio. Mr. Scott can be reached at (513) 388-4862 or [email protected].

DNV




(Continued on page 14)By Michael J. Zarski, Jd

Manyhospitalexecutivesdon’trealizetheyhavechoiceswhenselectinganaccreditationprogram.Itistruethat

TheJointCommissionhassweepingbrandrecog-nition—somuchsothatthebrandhasbecomesynonymouswiththeservice.Butfortheserviceofaccreditation,JointCommissionisnottheonlygameintown.AnalternativeaccreditoristheChicago-basedHealthcareFacilitiesAccreditationProgram(HFAP).

HFAPisnotanewkidontheblockbyanymeans.Itwasfoundedin1943andbegansurveyinghospitalsin1945.Originallyfoundedtoensurequalitypatientcareinosteopathichos-pitals,HFAPhasalsobeenaccreditingallopathichospitalssince1966.

In1965,whenCongressdecidedthatac-creditedhospitalswouldbedeemedtomeettheConditionsofParticipationforthenewlyestab-lishedMedicareandMedicaidprograms,HFAPappliedforandwasgranteddeemingauthority.MaintainingitsdeemingauthoritycontinuouslysincetheinceptionofMedicare,HFAPmeetsorexceedsthestandardsrequiredbyCMS/Medicaretoprovideaccreditationtoallhospitals,clinicallaboratories,ambulatorysurgicalcenters,andcriticalaccesshospitals.Inaddition,HFAPac-creditsmentalhealthandphysicalrehabilitationaswellasoffice-basedsurgeryfacilities.Italsoprovidescertificationforprimarystrokecenters.

HFAPprogrammanualsincludecrosswalkstoMedicareConditionsasapplicableforeachcategoryofaccreditation.Theprogramofferseveryhealthcarefacilitythetoolsandcurrentsafetystandardstoassessanddemonstrateitscommitmenttoprovidingqualitycarecurrenttoitspatients.

“HFAPhashadaverypositiveimpactforusatHazletonGeneralHospital,”saidAndrea

Andrews,RN,CHCQM,directorofqualitycare/casemanagement.“TheHFAPprocessiscom-mittedtoseeingthatorganizationsareprovidingquality,safecaretotheirpatientsallthetime.Wefeelthesameaboutthis,andhavemadequal-ityapriorityfocusinouroverallorganization’sstrategicplansandgoals.”

HFAPaccreditationisrecognizedbythefederalgovernment,statedepartmentsofpub-lichealth,insurancecarriersandmanagedcareorganizations.ItisalsorecognizedbyNationalCommitteeforQualityAssurance(NCQA)andtheAccreditationCouncilforGraduateMedicalEducation(ACGME).

WhywouldahospitaluseHFAPinsteadofanotheraccreditationprogram?

“HFAPisauser-friendly,cost-effective,edu-cationallyfocusedaccreditationalternative,”saidGeorgeReuther,chiefoperatingofficerofHFAP.“Oursurveysweredesignedtohelphospitalsidentifyareasofexcellenceaswellasopportunitiesforimprovement.”

DonKerner,M.D.agrees.Elevenyearsago,Dr.KernerwaschiefmedicalofficerofmultiplehospitalsintheSistersofSt.FrancisHealthSys-temwhichhadatotalof10hospitals inandaroundIndianapolisandtwoinIllinois.

“Indianapolisisaverycompetitivemarket,”Dr.Kernersaid.“WhenweacquiredOlympiaFieldsHospitalinIllinois,wefounditsaccredita-tionwasfromHFAP.Wethoroughlyresearchedtheorganizationandfoundtherewasabsolutelynocompetitivedisadvantage.WefoundHFAPveryeducationalandconsultative,andwe’reverypleased.”

Dr.Kernerwaspartoftheteamthatchangedaccreditationorganizationsforall12St.Francishospitals,and,becauseitissucharespectedsys-tem,manyotherhealthcareleadersinandaroundIndianapolisbecamecuriousandfollowedsuit.

SurveyorsHFAP’s surveyors are experienced medical

professionalswhounderstandthemanyaspectsofahealthcarefacilityandhelpmakethesurveyprocessmorerealisticandbeneficial.Theyarepracticingprofessionalswithfieldexperienceandasupportiveattitude.

“BecausetheHFAPsurveyorshaveworkedinhospitalsrecently,theyknewwhatthecurrentchallengesandissueswereforourlab,”saidJeffreyL.Whitesel,administrativelaboratorydirector,FloydMemorialHospitalandHealthServices,NewAlbany, IN.“Whenwehadaquestionaboutdocumentcontrol,oursurveyorgaveussomegoodsuggestionsthatwecouldimplementimmediately.”

Ifadeficiencyisidentified,HFAP’ssurveyorsareabletodrawfromtheirexperienceandofferfeasiblesolutions,usuallyonthespotandinrealtime.Also,successfulaccreditationisbasedonthefacility’sabilitytocorrectdeficiencies,sothereisnodownsidetodiscoveryofissuesduringthesurveyprocess.Inotherwords,thereisn’tevera“Gotcha!”mentalityalongtheprocess.

“HFAPoffersafriendlyprocesswhile,atthesametime,holdingpeopletothestandardsthathavebeenset,”Dr.Kernersaid.“Wefoundoursurveyorsknowledgeableandexperienced.Andeachonelookedforteachablemoments.Itwasaneffectiveandnon-confrontationalapproach.”

Accreditationsurveyteamshaveanaverageofthreesurveyors:Aphysicianservesasteamcap-tainalongwitharegisterednurseandahospitaladministrator.

You Have a Choice in Accreditation Organizations—Who Knew?


HFAP


Toensuresurveyorsmaintainahighlevelofprofessionalquality,HFAPrequiresthatallsurveyorsattendmandatorytrainingworkshopstoaugmentthereal-worldexperiencetheybringwiththem.HFAPsurveyorteamsarenot“fixed,”sosurveyorsworkwithmanyothersurveyors.Withtheutmostqualityasthegoal,eachteammemberscorestheotherteammembers inavarietyofcategories.

“BeginningwiththeHFAPstaffthatsetthedatesforsurvey,tosettingtheday’sagendawiththesurveyteam,HFAPrecognizedthatourhealthcarefacilityhasmanypatientcareobligations,”saidGaryLey,presidentandCEOofGardenCityHospital inGardenCity,MI.“Surveyscheduleswereeasilyrearrangedtomeettheneedsofthehospital.BecausemostHFAPsurveyorsareactivelyemployedinahealthcaresystemandunderstandthenuancesandactivitiesthatoccurroutinelyinahospital,theirinsightmadethesurveyprocessverycomfortableandeducational.”

The ProcessTheHFAPfacilityaccreditationprocessiscom-prehensiveandstraightforward.Itconsistsofonlyfivebasicsteps,fromapplicationtoaccreditation.Thesizeofthefacilitybeingsurveyedandtheresultsoftheactualsurveydeterminehowlongtheprocesstakesandaretheonlyreasonstheprocessmayvary. Thebasicstepsintheaccreditationsurvey-ingprocessinclude:• application• survey• deficiencyreport• correctiveaction• accreditationactionIfahospitalswitchesitsaccreditationtoHFAP,theHFAPstaffworkswiththehospitaltoensurethereisnointerruptioninreimbursement.Ideally,theapplicationprocessshouldbeginatleastsixmonthspriortotheexpirationdateofthecurrentaccreditation. HFAPhospitaladministratorsreportthatHFAPprovidesaverycost-effectiveapproach. “Determiningtheaccreditationsurveyfeeisstraightforward,varyingonlybythesizeand

volumeofthehospital,”Dr.Kernersaid.“Becausethestandardsaresoclearlywritten,additionalconsultationsandworkshopsarenotrequired,buttheyareavailable.Currently,HFAPisdoingagoodjobofincorporatingimportantnewstan-dardsofsafetyandqualityofcare.We’removingmuchquickerintegratingthesevitalstandards.”

Inaddition,HFAPstandardsareconducivetoconsistent,predictableapplicationtherebyreducingthestress levelandfrustrationofthestaffduringthesurveyprocess.

“Fromtheinitialcontactthroughreceiptofourfinalaccreditationlettersatbothhospitals,wehadexcellentcommunicationwithHFAPstaff,”saidAngiePhillips,executivevicepresidentandCOOofGlobalRehabHospitals,DallasandFt.Worth,TX.“Ourquestionswerepromptlyansweredandtheinformationprovidedwascon-sistentthroughouttheprocess.Thesurveyswerethoroughyetcollaborativeandeducational.Thesurveyors’approachallowedstafftofeelcomfort-ablethroughoutastressfulperiod.”

Strivingtoassistfacilitiesinachievingandmaintaininghighquality,safepatientcare,HFAPextractsthehospital’scoremeasuredatafromtheHospital-CompareWebsite.Thedataisaggre-gatedandusedduringthesurveyprocesstoallowhospitalstoseehowtheymeasurecomparedtotheirpreviousreportingperiodaswellastootherHFAPaccreditedhospitalsnationwide.

“Asasmallermorenimbleorganization,HFAPisabletorespondtotheneedsofitsac-creditedfacilitiesexpediently,”saidMikeZarski,JDandCEOofHFAP.“Forexample,dischargeplanningandcontinuityofcareisbeingaddressedaspartofanoveralldrivetoaddvaluetotheac-creditationprocessbyenhancingpatientsafety.”

“Ireallybelieve it’sbetter for theentirehealthsysteminourcountrythatwehaveachoiceofaccreditationprograms,”Dr.Kernersaid.

MoreinformationaboutHFAPmaybefoundathttp://www.hfap.org/orbycalling(312)202-8258.

Michael J. Zarski, JD is currently executive direc-tor of the American Osteopathic Information As-sociation, which includes the Healthcare Facilities Accreditation Program. He is also the AOA’s chief information officer, responsible for the strategic in-tegration of technology in all aspects of the AOA’s activities and serves as the staff representative for the AOA in health information technology initiatives. Prior to joining the AOA, Mr. Zarski worked as an attorney for the American Medical Association and the Department of Health and Human Services.

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New Health Care CEO:Arthur Gonzalez, Dr. P.H., FACHE,Hennepin County Medical Center

Editor’s note: MetroDoctors is continuing to highlight newly named health care executives. Each CEO has been asked to outline his/her vi-sion and challenges for their organization as well as offer some personal insights.

Arthur Gonzalez, Dr. P.H, FACHE, became CEO of Hennepin County Medical Center in July, 2009. He has a long and distinguished career in hospital management and has led a variety of public, for-profit, not-for-profit, faith-based, and teaching hospitals during his 36 years in hospital administration.

How did you become interested in hospital administration and what is the career path that led you to Hennepin County Medical Center?

Iattendedahealthcareerfair inhighschoolandattheendofthepresentationandtourofthehospitalIsawayoungadministrativeresidentandcreatedaninstantconnectionthatIcoulddothat.IhaveanM.S.inhealthcareadministrationfromTrinityUniversityinSanAntonioandadoctorofPublicHealth,HealthServicesOrganizationandAdministrationfromtheUniversityofTexas.IhavebeenthechiefexecutiveofficerofSchumpertHealthSysteminShreveport,Louisiana;St.JosephHospitalinFortWorth,Texas;andKinoCommunityHospi-talinTucson,Arizona.During17yearswithHospitalCorporationofAmericaIservedinvariousadministrativerolesatseveralTexashospitalsandmostrecentlywasCEOofTri-CityMedicalCenter,apublichealthcaresysteminOceanside,California.

In light of the reality of significant funding decreases, we understand that some Hennepin programs are to be eliminated and that further removal and paring down of existing programs seems inevitable. How will decisions regarding these specific actions be decided administratively, and to what extent will your medical/clinical staff be involved in those judgments?

UnlessthereisactionbythelegislatureandgovernortorestoretheGen-eralAssistanceMedicalCare(GAMC)programorprovidesustainablecoverageforthe35,000peoplewhodependontheprogram,orthereisdirectfundingsupportforhospitalsthatserveadisproportionateshareofthosepatients,wewillloseapproximately$40millionin2010and$50

millionin2011—almost10percentofouroperat-ingrevenue—whentheGAMCprogramends. It is important toknow that a history ofreducedratesandrebas-ingof public programshasresultedinproviderstoday being paid inpa-tientratesthatarebasedon 2002 costs, less 16percent.Because45per-centofourpatientsareonpublicprograms,since2002wehavehadtotakealmost$300millionoutofoursystem,$88millionofthatin2010.Lastyearwetookanumberofdifficultstepstomakeitwork.In2010wehaveabudgeteddeficitof$25million,andthatisinadditiontoanintensefocusonlaborproductivity,revenuecyclemanagementandpurchasingchanges,andclosingorconsolidatingaclinicandpartofouroutpatientcardiacrehabprogram.Itisasignificantchallenge,andphysicianleadershipisveryengagedwithadministrationaswemakethesedifficultdecisions.

Has the change in governance from a county depart-ment to a public subsidiary corporation benefited the medical center?

Wearefortunatethatthecountytooktheboldstepin2007tocreateapublicsubsidiarycorporation—HennepinHealthcareSystem,Inc.—tooperatethehospitalandweareledbyadiverseboardofoutstandinghealthcareandbusinessleaderswhoareabletofocussolelyonHennepin.Ourboardincludesphysiciansandadministrativeleaderswhonowhave,orhavehad,prominentleadershiprolesinotherhospitalsandhealthcaresystems,theMinnesotaDepartmentofHealth,cityandcountygovernment,educationalinstitutions,business,foundations,organizedlabor,andcommunityorganizations. Since2007wehavechangedmajoroperationalsystemsatthehospitalincludingimplementationofanelectronichealthrecord,new


New Health Care CEO


purchasingandsupplychaininfrastructureandanentirelynewhumanresourcessystem.Wearebeingtransformedintoa leanandflexiblehealthsystem.Since2007ourcost increaseshavebeenatorbelowhealthcareinflationratesandourproductivity—asmeasuredbyfulltimeequivalentpositionsperadjustedoccupiedbed—hasimproved9percentsince2006.And,mostimportantly,ourqualityandoutcomesremainataveryhighlevel.

Hennepin has been listed as one of America’s best hospitals by U.S. News and World Report for 13 years. How do you intend to maintain that honor considering the finan-cial restraints the hospital is under?

Evenaswepreparedfortheverydifficult2010budgetwecontinuedtotakestepstopositionHennepintosurviveandthriveinthechanginghealthcareenvironmentbybeingatthetableashealthcarereformmodelsarecreated,strategicallyinvestingincoreprogramsandprimarycare,andengagingourphysicianpartnerstoworktogethertowardafutureofincreasedcollaborationandcooperation. Wehaveinvestedinourstrokeprogram,whichhassomeofthefastestdoor-to-drugtimesanywhereandwereceivedJointCommissionPrimaryStrokeCertificationlastyear.Wecontinuetoinvest inourexcellentemergencyservicesandtraumacareandinthepasttwoyearsopenedallnew,state-of-the-artsurgicalandmedicalintensivecareunitsfeaturingprivateroomsandthelatesttechnologyinapatientandfam-ilycenteredsetting.Wehavefullyadoptedthelatestelectronicmedicalrecordtechnologyinourinpatient,outpatient,andemergencysettings.Ourothermedicalandsurgicalspecialtiesremainverystrong. WeareexpandingandinnovatinginprimarycareandhavefoursitescertifiedforHealthCareHomePrimaryCareCoordination.ThisyearweareopeningalargenewclinicintheWhittierneighborhoodofSouthMinneapolisthatwillreplaceourcurrentcliniconLakeStreet;anewclinicthatwillbethecornerstoneintheVillageCreekneighbor-hoodinBrooklynPark;andweare launchingastrategicpartnershipwithWalmarttooperateaconveniencecareclinicintheirBloomingtonstore.

Latelastyearwecreatedanewfoundation—calledtheHennepinHealthFoundation—thatisengagingsupportersinthecommunitytoincreaseawarenessofwhatwedoandraisefundstosupportourwork.Westartedwithinternalfundraisingandraisedcloseto$300,000fromouremployees,physicians,andboardmembers.Thisyear,lookforseveralsignatureeventsandotheractivitiesthathelptellourstoryandprovideopportunitiesforthecommunitytosupporttheworkthatwedo.

Are you considering creating a corporate council at Hennepin?

Ibelievecommunityengagementisessential,andisatwowaystreet;weareinvolvedinthecommunityandthecommunityisinvolvedin

theirhospital.IworkcloselywithcommunitymembersonourPatientandFamilyAdvisoryCouncil,theHealthServicesPlanAdvisoryBoard,andtheHennepinHealthFoundationBoardofDirectors,andnowthefoundationisestablishingaCorporateAffinityCounciltoinvolvelocalbusinessleaders—andHennepin’sbusinesspartners—inunderstandingandsupportingHennepin’smission.Membersofthecouncilwillreceivebriefingsaboutourorganizationandparticipateineventsandactivitiesthatsupportthemedicalcenter.

Is Hennepin taking an active role in trying to restore General Assistance Medical Care (GAMC) or other state funding?

Wecontinuetoreachoutandaskforhelpfromouralliesandsupportersandwearegettingaverypositiveresponse.Policymakers,stateofficials,othersafetynetproviders,andagenciesthatserveGAMCpatientsallunderstandtheneedandarecomingtogethertofindapathwaytobesuccessful. Ournewfoundationissupportingacommunicationcampaignthatusessocialmarketingandtraditionalcommunicationstoincreaseawarenessofoursituation.WelaunchedaWebsitecalledwillyoulose.orgwhereweexplainthemanystatewiderolesHennepinplays,includ-ingpreparingtomorrow’sphysicianstoworkinclinicsandhospitalsacrossMinnesotaandprovidingoutstandinglevel1traumacare.Wehavemorethan1,000fansonourcampaignFacebookpageandareus-ingTwitter,YouTube,andourmainWebsitetokeeptheconversationgoingandfacilitatecommunicationsbetweenconcernedcitizensandtheirlegislators. Physiciansandadministratorshavebeenworkingtogethertodevelopasolutionthatincludesreform,innovation,andaccountability.

Will national health care reform be a factor?

Yes,sowearepayingcloseattentiontonationalhealthcarereformandwhatimpactthatwillhaveonHennepinandthehospitalindustrymorebroadly.Manyoftheconceptslikehealthcarehomes,basketsofcare,andsharedaccountabilityarepartofboththestateandnationalhealthcarereformconversationsandwehavebeenatthetablesincetheystarted.

As you settle in, is there anything that you’ve discovered that has surprised you about Minnesota?

I’vediscoveredthatIlikewalleyeandIhavediscoveredthattheTwinCitiesisavibrantregionwithgreatvarietyandinterestingthingstoseeanddo.WhatwasnotasurpriseisthehighqualityofthehealthcareorganizationsandthephysicianswhopracticeinMinnesota.Hennepinplaysasignificantroleinthatsystemofcareasaproviderofmedicaleducationandatraumacenter,andalsointheeconomyoftheTwinCitiesasanemployer,purchaserofgoodsandsupplies,andpartnerinavibrantdowntownMinneapolis.ItisintheinterestofallofusthatHennepinCountyMedicalCenterremainsstrongforatleastanother122years.


The Minnesota Health Information ExchangeIs Available to Help Providers Meet Federal and State Regulations

and Provide Effective Care for Patients

By Michael Ubl

Health Care ReformTheimplementationandadoptionofhealthinformationtechnology(HIT)isthecorner-stoneofhealthcarereformatboththefederalandstate level.Governmenthasestablishedincentivesandregulationsthatrequirehealthcareproviderstoimplementelectronichealthrecords(EHRs)andexchangepatientspecifichealthcareinformationwithotherproviderorganizations.MinnesotahasastatemandatethatrequiresproviderstohaveEHRsby2015.

Thereareapproximately15,000providersinMinnesotaandborderingcountiesthatareimpactedbythesefederalandstateregulationsandincentiveprograms.Eachproviderwillneedtoadopthealthinformationtechnology(HIT)andexchangeclinical informationtoqualifyforfederalincentivemoney.

Secure Network for Clinical ExchangeTheMinnesotaHealthInformationExchange(MNHIE)providesthefirststate-widenet-work that enablesproviders to exchange apatient’smedical informationwithvirtuallyanyhealthcareorganizationinthecoveredgeographicarea.MNHIEisdesignedtoshareclinicalandadministrativepatientinformationamongprovidersinMinnesotaandborderingstates.CurrentlythereareoverfourmillionpatientsinitsSecurePatientDirectory(SPD)andgrowing.

Acommonnetworkthatisviewedasacommunityutilitywilleliminatemanypoint-to-pointsolutionsandenablehealthcareorga-nizationstoleverageonenetworkconnectionforawidevarietyofbusinessandclinicalser-vices.Withastrongfocusonstandardsand

interoperabilityofHITatboththefederalandstatelevel,therewillbesignificantconsolida-tioninthenetworkingspace.MNHIEispo-sitionedtosupporttheproposedstandardsanddeliverthesolutioninacost-effectivemanner.

Patientscontrolallaccesstotheirclinicalinformation.Patientconsentisrequiredatthepoint-of-carebeforeanymedicalstaffispermit-tedtoaccessanindividual’smedicalinforma-tionthroughtheMNHIEenvironment.

Better Coordination of Care Thecurrentpatientcaremodelisundergoingchange.WithMNHIE,apatient’smedicalinformationcanbeaccessedinreal-timemodeatthepoint-of-carewhenpatientandprovidermakecriticaldecisionsregardingapropertreat-mentprogram.Theneedforpatientstocarrypapermedicalfilesfromonephysiciantoan-otherwillbeeliminated.

Providershavequickaccesstoabroadsetofpatientinformationfrommultipledatasources.Medicationhistoryisnowavailableandnewservicesavailableincludepatienteli-gibilityandbenefitchecking,labresults,im-munizationhistoryandexchangeofmedicalrecordinformationforcontinuityofcare.

Patientsafetywillalsobeenhanced.Ac-cesstomedicationhistory,labresults,problemlists, immunizationsetc.willresult inmoreappropriatetreatmentprograms;andeliminateadverseimpactsfromimproperprescriptionsandunneededhospitalizations.

Early Results are PositiveProvidersandpatientsareexperiencingthesebenefitsusingMNHIEtoday:

Example 1 – A61-year-oldmanenteredtheEmergencyDepartmentatRegions feelingsickaftertakingtoomuchmedicationtohelphimsleep.

Hereportedthathetakes13differentprescriptionmedications, includingseveralanti-depressants,butcouldnotremembertheirnames.Healsocouldnotrememberwhichoneshetooktohelphimsleep.

TheMinnesotaHealthInformationEx-change(MNHIE)medicationhistoryallowedEDstafftoreviewalistofhismedications,discussthemwithhim,anddetermineanap-propriatecourseoftreatment.

Withoutthiscriticalinformation,theEDstaffmayhavewastedtimeandresourcesintheirefforttomanagethispatient.

Example 2 – Adiabeticpatientwhojustmovedtotheareaarrivesathernewclinicinneedofmedicationrefills.Sheneedsherrefillstodaybuthasnorecordofherprescription.Withherpermission,usingMNHIE,thecliniccanviewhercurrentmedicationsandthedoctorcanprescribeherrefills. ThesearejusttwoexamplesofhowMNHIEcanhelpprovidersdeliverhighqualitycareandcoordinatecarebetweenproviderstohelpthepatient.

Clinical and Administrative EfficiencyMNHIEservicescanbeembeddedintoanexistingEMR(MNHIEinformationisembed-dedinEpicatRegionsHospitalinSt.Paul)oraccessedonlineviaasecureWebapplication.Itoffersadministrativestaffquickaccesstoinformationnecessaryforefficientpatientman-agement.Thisinformationincludeseligibilityandbenefitcheckingtomultiplehealthplansfromasingleuserinterface.



Health Information Exchange


Public/Private PartnershipMNHIEisanot-for-profitpublic/privatepart-nership.Itwascreated,ownedandgovernedbyleadinghealthcareorganizationsinMinnesota.Thepartnershipisuniqueinthatitincludeshealthplans,providersandstategovernment.MNHIE’sfoundingpartnersinclude:

Blue Cross and Blue Shield of Minnesota(www.bluecrossmn.com)wascharteredin1933asMinnesota’sfirsthealthplan.BlueCrossisthelargesthealthplanbasedinMinnesota,covering2.9millionmembers inMinnesotaandnationallythroughitshealthplansorplansadministeredbyitsaffiliatedcompanies.

Fairview Health Services(www.fairview.org)isanot-for-profit,integratedhealthcarenet-workservingMinneapolis-St.Paul,aswellascommunitiesthroughoutgreaterMinnesotaandtheUpperMidwest.Headquarteredin

optimismandhighexpectations.Theyincludethefollowing:1. Decreasingcostsforelectronicmedical

systemsandcommunicationnetworks.2. Adoptionofindustry-widestandardsto

support interoperabilityamonghealthinformationtechnologyproducts.

3. Minnesotastategovernmentprogramsincluding:a. CreationoftheMinnesotae-Health

AdvisoryCommitteewiththepur-poseofacceleratingtheadoptionofHITinthehealthcarecommunity.

b. Statesponsoredgrant/loanprogramsthatenableproviderstoplanandimplementHITproducts.

c. Specificstateregulationsthatman-dateadoptionofHITcapabilities,includinginteroperablehealthre-cordsby2015.

d. Federal programs enacted by theAmericanRecoveryandReinvest-mentAct(ARRA).Thefederalgov-ernmenthasallocatedover30billiondollarsinanattempttorenovatethehealthcaresystem.Adoptionandef-fectiveuseofHITisthecoreofthenewfederalstrategy.Asignificantportionofthismoneyistargetedatproviderswhoadopthealthinforma-tiontechnology(HIT).

SummaryMNHIEispositionedtosupporthealthcarereforminMinnesotaandassistproviderstoquicklyandeasilybuildthecapacitytomeet2011and2013meaningfuluserequirementscurrentlybeingdefinedasparttheARRAleg-islation.ProvideradoptionofHITcombinedwithMNHIEserviceswillsignificantlyin-creasetheabilitytoexchangehealthinforma-tioninMinnesota.Theendresultwillbemoreeffectivepatientcareforeveryonewithlongtermanticipatedcostsavings.

Michael Ubl, is the executive director of the Minnesota Health Information Exchange.

Minneapolis,Fairviewincludessevenhospitalswithmorethan2,500licensedbeds,36prima-rycareand55specialtyclinicsandmuchmore.

HealthPartners (www.healthpartners.com)wasfoundedin1957andservesmorethanonemillionmedicalanddentalhealthplanmem-bersnationwide.It isthelargestconsumer-governed,nonprofithealthcareorganizationinthenation,providingcare,coverage,researchandeducationtoimprovethehealthofmem-bers,patientsandthecommunity.

Medica(www.medica.com)isahealthinsur-ancecompanywithnearly1.4millionmem-bers.Thenonprofitcompanyprovideshealthcare coverage in the employer, individual,Medicaid, Medicare and Medicare Part DmarketsinMinnesotaandagrowingnumberofcounties inNorthDakota,SouthDakotaandWisconsin.

The Minnesota Department of Human Ser-vices(www.dhs.state.mn.us/healthcare)ensuresbasichealthcarecoverageforlow-incomeMin-nesotansthroughthreemajorpubliclysubsi-dizedhealthcareassistanceprograms.MorethanhalfamillionMinnesotanshavehealthcarecoveragethroughMinnesotaHealthCarePrograms.

UCare(www.ucare.org)isanindependent,nonprofithealthplanprovidinghealthcareandadministrativeservicestomorethan147,000members.UCareaddresseshealthcaredispari-tiesandcareaccessissuesthroughitsUCareFundgrantsandabroadarrayofcommunityinitiatives.

Status and Outlook ThesesixorganizationshaveworkedcloselythepasttwoyearstocreateandimplementavisionthatisfocusedonimprovingthehealthcareexperienceforconsumersintheMinnesotacommunity.Thekeyobjectivesinclude:a)Patientsafety;b)Improvementinqualityofcare;andc)Reductioninhealthcarecosts. Despite the challenges in the currenthealthcareindustry,thereisstrongresolveandoptimismamongthesponsororganizationsthatadoptionofhealthinformationtechnol-ogy(HIT)isabouttoaccelerateatarapidpace.Avarietyofchangeshaveoccurredinthepastcoupleofyearsthathaveledtothis

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THE MINNESOTA BOARD of MedicalPracticehasvotedtoonceagaininitiateaneducationaloutreachprogramonthetopicofmanagementofthechronicpainpatient.

Thereasonssurroundingthisdecisioninclude:1. Continuedlackofemphasisonthetop-

icsofpainandpainmanagementinthemedicaleducationfield;

2. Recentgovernmentandpublicattentiontoabuseofsomeoftheagentslegitimatelyusedinthemanagementofpain;

3. Sensationalmediasurroundingdrugover-dosedeathsofcelebrities;

4. Confusing,andsometimesintimidatingpronouncementsbyregulatoryagenciesatalllevelsofgovernment;

5. InitiationofMinnesota’sownPrescriptionMonitoringProgram;

6. Thedifficultclinicalnatureofpainman-agement;and

7. Theevenmoredifficultclinicalnatureofthemanagementofchronicpainpatients.

Theseseminarswillbeconductedbyphy-sicianmembersoftheMinnesotaBoard,A.V.Anderson,D.C.,M.D.,andMarkA.Eggen,M.D.,andstaff. Dr.AndersonisvicechairoftheBoard,chairofoneoftheBoard’sComplaintReviewCommitteesandapracticingpainspecialist.Dr.EggenisamemberoftheBoard’sLicensureCommittee,andaboardcertifiedpracticinganesthesiologist.

Minnesota Board of Medical PracticeChronic Pain Management Seminars 2010

Board of Medical Practice Announces Seminar Series on Management of the Chronic Pain Patient

StrategyAllsessionswillbeconductedintheFirstFloorConferenceRoomof2829UniversityAvenue,Minneapolis,MN55414-3246. Allparticipantswillreceivepaperhandoutsonlegalandregulatoryissues,ScottM.Fish-man’sResponsible Opioid Prescribing,theAnderson,Fine,FishmanmonographOpioid Prescribing: Clinical Tools and Risk Management Strategies,andCDsofDrs.AndersonandEggen’spowerpointpresentations. AllparticipantswillbedirectedtoourWebsite,whichwillcontainthepresentationmodules,theAnderson,Fine,Fishmanmonograph,andtheCMEposttestforAnderson,Fine,Fishmanmonograph.

Timing5:30–6:00BuffetSupper6:00–6:30RichardAuld,BoardStaff6:30–7:00A.V.Anderson,D.C.,M.D.,

BoardMember,PainSpecialist7:00–7:15Break7:15–7:45MarkA.Eggen,M.D.,Board

Member,Anesthesiologist7:45–8:15A.V.Anderson,D.C.,M.D.8:15–8:30Q&A8:30Adjourn

Program• BuffetSupper• IntroductionsandLegaland RegulatoryLandscape• ClinicalIssuesI• Break• ClinicalIssuesoftheChronicPain

PatientandSurgery• ClinicalIssuesII• Q&A• Adjourn

Theseseminarsareintendedtoprovideinstructiontophysicianswhoarenotspecialistsinthecareofchronicpainpatients. TheseminarswillbeheldintheFirstFloorConferenceRoomat2829UniversityAvenueS.E.,Minneapolis,MN55414.Thefacilityaccommodates30participantspersession. WerequestthatparticipantsscheduletheirattendancewiththeBoardbycontactingCherylKohanekat:[email protected](612)617-2158.

ScheduleMarch 10March 24 April 7April 28May 5(Ifneeded)

By Richard Auld, Executive Assistant director, MN Board of Medical Practice


The Provider TaxQuestionable Past and an Uncertain Future

By Nathaniel Mussell, Jd

TheMinnesotaprovidertaxhasbeenacon-troversialissueforthepast18legislativeses-sionsforindividualphysiciansandphysicianorganizations.Theprovidertaxhasarichleg-islativehistoryinMinnesotadatingbackto1993.Threedifferentadministrations,twoRepublicanandoneIndependent,haveusedtheprovidertaxandtherevenuesgeneratedbyitinvastlydifferentways,notalwaysinlinewiththetax’soriginalintendedpurpose.Goinginto2010,withanewadministrationonthehorizonandfederalhealthcarereformbeingdebated,providersshouldbeveryconcernedabouttheprovidertax’suncertainfuture.

What is the Provider Tax?Theprovidertax,codifiedinlawunderMinn.Stat.§295.52,imposesa2percenttaxongrossrevenuesofallhealthcareprovidersforpatientservicesrendered.Thelistofproviderstaxedunderthis lawincludesphysicians,dentists,nurses,psychologists,physicaltherapists,andchiropractorsamongothers.Thestatealsoim-posesa2percenttaxonthegrossrevenuesofhospitalsandsurgicalcenters.Certainpatientservices,includingthoseprovidedunderMedi-carearespecificallyexemptedfromcollectionunderthistax.

Revenuesgeneratedbythetaxarecollectedinthestate’sHealthCareAccessFund(HCAF),primarilyusedtofundtheMinnesotaCarepro-gram.Since1993,thestatehascollectedover$3.3billioninrevenuefromtheprovidertax(includingtaxonhospitalsandsurgicalcenters)intheHCAF.Asthelargestsinglerevenuesourceinthehealthcareaccessfund,providertaxcollectionstaxhavefaroutpacedspendingfromtheHCAF,allowingthefundtocontinu-ouslyrunasurplussince1993.However,thisis

settochangeintheupcomingyears,ascurrentforecastsprojectastructuraldeficitinthefundasearlyas2012.

Origins of the Provider TaxAfteranunsuccessfulattemptathealthreformin1991,theMinnesotaLegislaturewasabletopassasweepingoverhaulofMinnesota’shealthcaresystemin1992.Thelegislation,craftedbythe“GangofSeven”establishedtheMinnesotaCareprogram,formerlyknownasHealthRight,toofferhealthcarecoveragetoMinnesota’sworkingpoor.The“GangofSeven”includedfourdemocrats—Sen.LindaBerglin,Sen.PatPiper,Rep.PaulOgrenandRep.LeeGreenfield—andthreerepublicans,Sen.DuaneBenson,Rep.DuaneGruenes,andRep.BradStanius.

Comingofftheprioryear’sdefeat,the“GangofSeven”formulatedthereformlegis-lationin1992witha2percentprovidertaxservingastheprimaryfundingsource.ThetaxgeneratedconsiderableoppositionfromthemedicalcommunitydriveninlargepartbytheMMA.AlthoughtheHouseattemptedtosubstitutethenarrowprovidertaxforabroaderincometax,GovernorArnieCarlsonadamantlyopposedsuchanapproach.Forthemostpart,therevenuegeneratedbytheprovidertaxhas

serveditsoriginal intendedpurpose.“IthasprovidedasoundfinancialbasisfortheMin-nesotaCareprogram”saysformerstaterepre-sentativeLeeGreenfield.However,onmultipleoccasionsintheyearsthatfollowed,revenueintheHealthCareAccessFundwasdivertedawayfromthefund,despitethestrongobjec-tionsfromthephysiciancommunity.

What has Happened Since 1993?Followingtheprovidertax’s1992enactment,thetaxcontinuedata2percentrateupuntil1998andtheHealthCareAccessFundmain-tainedaconstantsurplusoverthecourseofitsfirstfiveyears.Becauseofthis,theprovidertaxwassubsequentlyreducedto1.5percentdur-ingthe1997legislativesessionattheurgingofHouseRepublicans.In1999thereduced1.5percentratewasextendedforanotherfouryears,beforeitrevertedbacktoitsoriginal2percentratein2004. Althoughrevenuefromtheprovidertaxhas,inlargepart,beenusedtofundMinneso-taCare,therehavebeenseveralinstancesoverthepast18yearswhereHCAFdollarsweredivertedtotheGeneralFundspending.Thetwomostcontroversialexamplestookplaceduringthe2003and2005legislativesessions,onbothoccasionstohelpsolvethestate’sbud-getshortfalls.TheHCAFsurpluswasseenasaneasytargetforlegislatorslookingtosolvethestate’sbudgetproblems,bothbecausethepoliticalimplicationsofraidingthefundwereminimalandbecausetheprospectofgeneratingothernewrevenuewasunfeasible. Duringthe2009legislativesession,Gov-ernorPawlentyproposedacompletetransferoftheHCAFovertotheGeneralFundbasedontherhetoricofadministrativeefficiency.Sen.Berglin,theonlyremainingmemberof


the“GangofSeven”stillservinginthelegis-lature,balkedattheGovernor’sproposal.Gov.Pawlenty’sonslaughtontheHCAFcontinuedthisfallwhenheproposedtransferringalmosttheentireGeneralAssistanceMedicalCarepopulation,some28,000individuals,overtoMinnesotaCare.EachoftheseproposalsonlyfurtherthreatensthefutureoftheHCAFandputsthemedicalcommunityonedgeoverthepossibilityofanincreaseintheprovidertax.

What Does the Future Hold for the Provider Tax?Thereareanumberofunansweredandcon-cerningquestionsformedicalprovidersaboutthefutureoftheprovidertaxandtheHCAF.First,withanewadministrationinofficein2011, thereare significantconcerns that aprovidertaxincreasemaybeonthehorizon,particularlygiventhemultibilliondollardeficitprojectedfor2011andbeyond.Secondandlargelymoreofanunknownquestion,iswhataffectfederalhealthcarereformwillhaveontheprovidertaxandthehealthcareaccessfund.OneofthemajorreformsinthefederalbillistheexpansionoftheMedicaidprogram.Theproposedexpansionmayhavetheaffectofmovingasignificantnumberof individualsfromtheMinnesotaCareprogramovertoMed-icaid,savingtheHCAFsignificantdollars,andthuslesseningtheneedforsuchanextensiveprovidertax.Althoughthatmaybewishfulthinking,thosewhopaytheprovidertaxneedtobecriticallyawareofwhathappensatthestatelegislatureeachyearintheeventthetaxceasestoserveitsoriginalintendedpurpose.

Nathaniel Mussell is an attorney and lobbyist with Lockridge Grindal Nauen’s (LGN) government re-lations team with a focus primarily on health care clients. He is a 2004 graduate of the University of Minnesota where he studied political science and earned a Bachelor of Arts Degree. He attended William Mitchell College of Law, graduating with honors in 2008. Mr. Mussell previously worked with the LGN state government relations team during the 2005 legislative session, assisting numerous clients on health care related issues. Mr. Mussell’s policy experi-ence is complemented by his experience working with a number of elected offi cials, including Minnesota Governor Tim Pawlenty, Congressman Jim Ramstad and former Minnesota Senator Dave Knutson.

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The Evolution of the Minnesota FluLine

By Peter dehnel, M.d.

OnOctober21,2009,aremarkablein-novationinpopulationhealthman-agementwasinitiatedinMinnesota.

InresponsetotherapidlygrowingincidenceofH1N1influenzaA,theMinnesotaDepart-mentofHealth(MDH)recognizedthattheusualmeansofcaringforpeoplewithinfluenzawaslikelytobestretchedbeyondcapacity.Iftheviruswasparticularlyvirulent,theexistingclinicalresourceswerelikelytobeinsufficienttomeettheneedsofMinnesotans.Groupsthatlackedinsuranceoranestablishedclinicalproviderwouldbesignificantlydisadvantaged.

Anticipatingaseriouspublichealthneed,MDHalsoworkedtomakestate-andfederally-purchasedantiviralmedicationsavailabletohealthcarefacilitiesthatlackedsupplyaswellaspersonswithouthealthinsurance.However,therewasnoexistingmechanismforpatientswithoutinsuranceortimelyaccesstoacliniciantobequicklyevaluatedand,ifindicated,receiveaprescription.Additionally,amechanismtotriageindividualstotheappropriatelevelofcarewasneededtopreventclinics,urgentcarecenters,911servicesandemergencyroomsfrombeingoverwhelmed. Nationwide,anH1N1pandemichadbeendeclaredinAprilbaseduponitswidespreadac-tivity.Theultimateseverityofthispandemic

wasextremelydifficulttopredictbaseduponitsbehaviorupuntilthattime.Otherwisehealthychildrenandyoungadults—especiallypreg-nantwomen—werehavingahigherincidenceofseverediseasethanisnormallyexperiencedwithamoretraditionalinfluenzaoutbreak.ThesoutheastUnitedStatesexperiencedwidespreadactivityofmoderatelyseverediseasebymid-Augustwiththegeneraldirectionofexpansiontothenorth. Concurrentwith thesedevelopments,theCDCreleasedaseriesofupdatesonin-terimrecommendationsfortheuseofantiviral

medicationsforindividualswhohadsuspectedH1N1infections.Clinicianswereencouragedtotreatpeoplewith“influenzalikeillness”(ILI)withhigherriskforinfluenzacomplicationsassoonaspossible.TheCDCincludedtherecommendationthatcliniciansshouldbe:“Consideringempirictreatmentofpatientsathigherriskforinfluenzacomplicationsbasedontelephonecontactifhospitalizationisnotindicatedandifthiswillsubstantiallyreducedelaybeforetreatmentisinitiated.” BecauseofthedeclaredpandemicnatureofH1N1,certainotherlegalprotectionswereinvokedtohelpcliniciansmanagethisout-break.The“PublicReadinessandEmergencyPreparedness”(PREP)Actprotectsthosewhoprescribeoseltamivirandzanamivirforpa-tientswithILIsymptomsthatarepresumably

duetoH1N1.TheFDApermittedtheuseofoseltamivirinchildrenunderoneyearofagethroughan“emergencyuseauthorization.”

The FluLine is EstablishedAtthebeginningofSeptember,MDHinitiatedtheprocessthatwouldeventuallyculminatewiththerolloutoftheFluLineonOctober21—atoll-freetelephonenumberthatwouldbeavailableforallresidentsofMinnesota.Theoverallgoaloftheprogramistoprovide,onastatewidebasis,telephoneassessmentandreferralforappropriatemedicalcareforthosepeoplewhohaveILIsymptomsandmorese-rioussignsofillness.TheFluLinewouldalsomakeoseltamiviravailabletothoseindividualswithmildtomoderateILIsymptomsandareathigherriskforinfluenzacomplicationswithouttherequirementoffirstbeingseenatamedicalfacility.ThisfulfillstheCDC’srecommenda-tionofantiviraltreatmentasearlyaspossible.

The Steps to ImplementationWithremarkablespeed,theFluLinewentfromaconceptwithoutsubstancetoacollaborativeeffortinvolvingtheDepartmentofHealth,theMinnesotaHospitalAssociation,theMinnesota

Tthis does serve as a model for future responses to urgent population health issues, and there have been many “lessons learned” through this experience.


CouncilofHealthPlans,anumberoflargerclinicsystemsandmanyofthemajorhealthinsurersthathave“nurseline”programs.Itrequiredthedevelopmentofauniversallyac-ceptedtelephonealgorithmthattriagedcallersonthebasisofclinicalsymptomsandpro-videdforthetimelyprovisionofoseltamivirforappropriatepatients.Children’sPhysicianNetwork’s(CPN)NurseTriageProgramwascontractedastheentitythatwouldserveastheentrypointforcallersona24/7basis.

Oneoftherealchallengestolaunchingtheprogramwasthedevelopmentofaworkingcollaborationonareal-timebasisbetweenthedifferentclinicandinsurertelephonesystems/callcenters.Callscomeinthroughonetoll-freephonenumbertotheCPNCallCenterandarethentransferreddirectly(a“warmtransfer”)tothecaller’sprimarysiteofcareorinsurancecompanyasappropriate.This isanentirelynewactivitythathadtobedevelopedwithinonetotwoweeks.Itwasalsoimplementedatatimewhenthelevelofinfluenza-relatedillnessinthecommunitywasincreasingexponen-tially,stretchingeveryone’stelephoneresourcesbeyondcapacity.CallersthatdidnothaveaprimarysiteofmedicalcareordidnothaveinsuranceweretriagedthroughCPNresources.

Thefinalhurdlewas interfacingwithcountyhealthdepartmentsandpharmacies(statewide)forthosepatientswhoqualifiedforatelephone-basedprescription.MDHstock-pilesofoseltamivirweremadeavailableforthosecallerswhodidnothaveprescriptionbenefitsandcouldnototherwiseaffordacourseofthismedication.

Results to DateAtthetimeofwriting,theprogramisunderanextensiveevaluationprocessbyMDHsup-portedbyagrantfromCDC.AsofDecember31,therehavebeenatotalof26,263callspre-sentedtotheMNFluLine,withabouthalfofthecallersexperiencingflusymptoms.About6percentofthecallersmetthecriteriaforanoseltamivirprescription.Thisdoesserveasamodelforfutureresponsestourgentpopula-tionhealthissues,andtherehavebeenmany“lessonslearned”throughthisexperience.TheCDChasdevelopedageneraltoolkitofthisde-velopmentprocessforcommunitiesat:http://emergency.cdc.gov/healthcare/pdf/FinalCall-CenterWorkbookForWeb.pdf.

Peter Dehnel, M.D., is medical director, Chil-dren’s Physician Network.

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TheinauguralmeetingoftheTwinCitiesMedicalSocietywasheldonThursday,January28,2010attheTownandCountryClubinSt.Paul.PresidentEdwardP.Ehlinger,M.D.presidedovertheevent,introducingtheExecutiveCommittee,BoardofDirectors,CEOandstaff.The

mergeroftheEastMetroMedicalSocietyandWestMetroMedicalSocietyoccurredonJanuary1,2010followingmonthsofdeliberationandimplementation.TCMSispoisedandpreparedtoserveitsmembersandthecommunitythroughawareness,engagementandaction. RonnellHansen,M.D.waspresentedwiththePresident’sAwardasanexpressionofgratitudeforhisserviceas2009EMMSpresident.OutgoingleadersandboardmembersfromboththeEastMetroMedicalSocietyandWestMetroMedicalSocietywerealsoacknowledged. Thebriefprogramprovidedanoppor-tunityfortheboardtohearfromtwoStateRepresentatives:MinorityLeaderKurtZellers(R32B)andPaulThissen(DFL63A)chair,HealthCareandHumanServicesPolicyandOversightCommittee. Thephotoscapturethespiritandenthusi-asmofBoardmembersandguestsastheTCMSisofficiallylaunched.

Outgoing EMMS President Ronnell Hansen, M.D. accepted the President's Award.

Representative Paul Thissen (DFL 63A), chair Health Care and Human Services Policy and Oversight Committee, provided a glimpse of his agenda.

Minority House Leader Kurt Zellers (R 32B) addressed the Board.

Resident representative, Clint Hawthorne, M.D. and his wife, Katie.

Sue Schettle, TCMS CEO, and Peter Wilton, M.D.

Drs. David Estrin (AMA Alternate Delegate), Robert Geist (Chair, Professionalism and Ethics Council), and Ken Crabb (AMA Delegate).

Dr. Edwin Bogonko, Executive Committee member-at-large, and his wife, Zipporah.

Young Physician Rep. Stephanie Stanton, M.D. (center) with medical students Melanie Fearing (L) and Jessica Voight (R).

TCMS Annual Meeting Held


New Members


ActiveMadeline C. Almond, M.D.UniversityofMinnesotaDepartmentofOphthalmologyOphthalmology

Peter D. Arny, M.D.UniversityofMinnesotaDepartmentofOphthalmologyOphthalmology

Rajeev Attam, MBBSUniversityofMinnesotaDepartmentofMedicineGastroenterology

Kathryn C. Barlow, M.D.DermatologyConsultants,P.A.Dermatology

Delfin J. Beltran, M.D.Anesthesiology

Harlan J. Bruner, M.D.UniversityofMinnesotaDepartmentofNeurosurgeryNeurological Surgery

Roosevelt Bryant III, M.D.UniversityofMinnesotaHeartandLungInstituteThoracic Surgery

Renee M. Crichlow, M.D.UniversityofMinnesotaNorthMemorialFamilyMedicineFamily Medicine

Benjamin T. Dastrup, M.D.UniversityofMinnesotaDepartmentofOphthalmologyOphthalmology

Ingeborg I. DeBecker, M.D.UniversityofMinnesotaDepartmentofOphthalmologyOphthalmology

Alisa M. Duran-Nelson, M.D.UniversityofMinnesotaDepartmentofMedicineInternal Medicine

Knut Eichhorn-Mulligan, M.D.UniversityofMinnesotaDepartmentofOphthalmologyOphthalmology

Nissa I. Erickson, M.D.UniversityofMinnesotaDepartmentofPediatricsPediatrics

Thomas R. Hellmich, M.D.UniversityofMinnesotaDepartmentofPediatricsPediatrics

Lisa R. Ide, M.D.UniversityofMinnesotaMedicalCenterFairviewEmergency Medicine

Bobby Kansara, M.D.TRIAOrthopaedicCenterOrthopaedic Surgery

Elizabeth A. Kilburg, M.D.Women’sHealthConsultants,P.A.Obstetrics & Gynecology

Adam S. Kim, M.D.MinnesotaGastroenterology,P.A.Internal Medicine

Paul Kleeberg, M.D.Family Medicine

Badrinath R. Konety, MBBSMinnesotaUrology,P.A.Urology/Urological Surgery

Suma H. Konety, MBBSUniversityofMinnesotaDepartmentofMedicineInternal Medicine

Dara D. Koozekanani, M.D.UniversityofMinnesotaDepartmentofOphthalmologyOphthalmology

Marek Kostanecki, M.D.ParkNicolletMethodistHospitalInternal Medicine

Theresa A. Laguna, M.D.UniversityofMinnesotaDepartmentofPediatricsPediatric Pulmonology

Thokozeni Lipato, M.D.UniversityofMinnesotaDepartmentofMedicineInternal Medicine

Ashley R. Loomis, M.D.UniversityofMinnesotaDepartmentofPediatricsPediatrics

Robert A. Mittra, M.D.VitreoRetinalSurgery,P.A.Ophthalmology

Christian M. Ogilvie, M.D.UniversityofMinnesotaDepartmentofOrthopaedicSurgeryOrthopaedic Surgery

Betul Oran, M.D.UniversityofMinnesotaDepartmentofMedicineInternal Medicine

Kevin P. Peterson, M.D.UMP-PhalenVillageClinicFamily Medicine

Timothy L. Pruett, M.D.UniversityofMinnesotaDepartmentofSurgeryInternalMedicine

Christopher Reif, M.D., MPHCommunity-UniversityHealthCareCenterFamily Medicine

Michelle N. Rheault, M.D.UniversityofMinnesotaDepartmentofPediatricsPediatric Nephrology

Steven B. Robin, M.D.UniversityofMinnesotaDepartmentofOphthalmologyOphthalmology

Sara R. Rohr, M.D.UniversityofMinnesotaDepartmentofRadiologyRadiology

Susanne S. Rupert, M.D.UniversityofMinnesotaDepartmentofAnesthesiologyAnesthesiology

Arthi Sanjeevi, MBBSUniversityofMinnesotaDepartmentofMedicineInternal Medicine

David G. Strike, M.D.UniversityofMinnesotaDepartmentofMedicineInfectious Diseases

Priya Verghese, M.D.UniversityofMinnesotaDepartmentofPediatricsPediatrics

Nicole R. Vik, M.D., MPHFamilyHealthServicesMNFamily Medicine

Christina M. Ward, M.D.UniversityofMinnesotaDepartmentofOrthopaedicSurgeryOrthopaedic Surgery

Bryan J. Williams, M.D., Ph.D.UniversityofMinnesotaDepartmentofMedicineInternal Medicine

Chang-Jiang Zheng, M.D.AllinaMedicalClinicOccupational Medicine

Medical Students(University of Minnesota)MeganE.AhlAminAlishahiRobertB.AndresAllisonJ.AppeltAllisonJ.AutreyJonathanT.AvilaLorenN.BachElizabethM.BauerTriciaC.BautistaDanielR.BeacherZacharyJ.BeattyCaitlinM.BeckerMackenzieM.BeckerJenniferBeck-Esmay


New Members


HeidiBelgumJohnC.BensonAllisonR.BergerElizabethM.BernadinoAmandaM.BestMichaelJ.BesteHannahK.BetcherKevinH.BoegelColinBoettcherBrianA.BreviuBrittanyJ.BrindleJohnP.BrunkhorstCoryM.BuschmannMaureenK.CampbellMichaelJ.CarriganDanielJ.CarrollEllieM.ClarksonTylerM.ConwayJasonCookJillC.CrosbyNicholasA.DahlStewartL.DeckerCarlaM.DetermanJoshuaM.DornJamesT.DorrianJohnF.DunbarJamieL.DyerDerekW.EklundTheodoreS.FagreliusMollyF.FanslerJessicaJ.FarkRyanJ.FierMichaelM.FitzgeraldRobertJ.FraserLauraB.GorsuchCaseyD.GradickCourtneyA.GreenJeffreyO.GroslandSylviaL.GrothRichardF.GuoTriciaJ.HadleyJacobM.HakkolaLauraM.HaugoErinN.HennenKayliA.HenryElizabethJ.HermansonCaitlinD.HillAriHolloway-NahumBryceC.HolmgrenDanielG.HottingerKrisitL.HultmanAnikaM.InghamElizabethS.Jacobson

WendyY.JinElliotM.JohnsonKiranM.KanthKyrstenA.KelleyKirstenA.KesseboehmerMichaelL.KnudsenJustinC.KohlAdamH.KrauseLucasJ.KreuserSamN.KuchinkaRachelM.LaNasaMichaelD.LaneMichaelL.LaneOlabisiO.LashoreNicholasB.LehnertzNataliaLipinTimothyA.LivettBrianJ.LovigMollieE.LyleDavidM.MacDonaldJosephM.MacDonaldErinM.MaddyKathleenMahanJamesE.MapelLentzEduardoM.MedinaDavidM.MellingNicholasL.MenthJessicaA.MinkeGinaM.MittelstaedtLilianMoalim-NourErinF.MorcombLilianE.MsambichakaBrettS.MulawkaRajivP.NapaulJenniferC.NelsonValerieNelsonLoganA.NewmanTuong-ViT.NguyenRumbidzayiNzaraPatrickOdensNicholasJ.OlsonGregoryM.OlszewskiFernandoOrtizDustinL.PalmBrianJ.ParkMaaryaPashaAndreaL.PatineauDavidF.PattersonGarrisonF.PeaseJuditM.PerezOrtizJustinC.PerssonTramN.PhamPhayvanhPhithaksounthoneKathleenJ.PladsonAnneM.Portilla

ShawnP.PritchardJasonS.PrudomRobertC.PueringerJamesT.ReganAlexanderL.RingeisenPhilRobanAndrewN.RosenbaumOlegA.RyabininAliR.SamikogluKyleV.SandersSameetS.SanghaJasonM.SchenkelJosephD.SchimersDanielleD.SchlosserJonathanD.ScraffordBrieAnnaL.SiefkenAndreaL.SmithErinR.SmithMariaK.SmithLisaM.SmrekarDivyaSoodMelissaA.St.AubinJohnSteubsJamesM.StevensChristineStewartJeffreyA.SugandiMithunR.SureshLeahA.SwansonBrettD.TanningKatherineM.TheisenVincentD.ValleraMeganA.VanEeRyanA.VansickleNicholasVenosdelKathrynL.VogtGheS.VongLauraC.WallerDanielP.WalshScottG.WarrenWilliamK.WedinAlexaWeingardenAnthonyD.WilliamsAnthonyC.WisemanAngelaY.WuRazaanN.YassinMaryK.ZatochillChenZhaoMatthewJ.Ziegelmann

In MemoriamCHARLES R. CHEDISTER, M.D.,diedJanuary10,2010,atMayoHospitalinPhoenix,AZafterabriefillness.Hewas78.HegraduatedfromtheUniversityofIllinoisCollegeofMedicine,Chicago.Dr.ChedisterwastheretiredChiefofPathologyatFairviewSouthdaleHospitalinMinneapolis.

OSKAR PETER FRIEDLIEB, M.D.,85,passedawayNo-vember20,2009.HewasborninVienna,Austria.In1930hisfamilyimmigratedtoYugoslaviaandin1938theymovedtoBeirut,LebanontoescapetheNazis;heattainedamedicaldegreefromtheAmericaUniversityofBeirut.AfterhearrivedintheU.S.hereceivedadditionalsurgicaltrainingatBellvueHospital,NewYorkCity.HeservedintheU.S.Armyasasurgeonandreceivedacommendationforhiswork.In1957Dr.FriedliebmovedtoMinneapolisandpracticedatMountSinaiHospital.HelatermovedtoVirginia,Minnesota.Andthenin1978,hemovedtoAshland,KYtobecomemedicaldirectorofOurLadyofBellfonteHospital.In1988heretiredandmovedbacktoMinnesotawherehecontinuedtoperformmedicalutilizationreviewsintohis70s.

FRED A. RICE, M.D.,89,diedonDecember2,2009.HegraduatedfromHarvardMedicalSchool,Bostonandcom-pletedspecialtytrainingattheUniversityofChicagoClinic.Dr.RicewasaspecialistininternalmedicineattheNicolletandParkNicolletClinics.HewasalsoaclinicalprofessorofmedicineattheUniversityofMinnesotaMedicalSchool.

PATRICK J. GRIFFIN, M.D.diedonDecember1,2009,attheageof76.Dr.GriffinattendedSt.LouisUniversitySchoolofMedicineandwasanAlphaOmegaAlphagraduate.Hespent35yearspracticingintheear,noseandthroatfieldinSaintPaulandMaplewood.

ROBERT WILLIAM OLSON, M.D.,age80,passedawayNovember30,2009.HegraduatedfromtheUniversityofMinnesotaMedicalSchool.Dr.OlsonspecializedinfamilymedicineandpracticedinSouthMinneapolis.

MANLY RUBIN, M.D.,81,passedawayJanuary16,2010.BornandraisedinWinnipeg,Canada,hereceiveddegreesinmedicinefromtheRoyalCollegeofPhysiciansandSurgeons,Dublin,Ireland,andpharmacyfromApothecaryHall,Dublin,Ireland.AftersixyearsingeneralpracticeinruralSaskatch-ewan,Canada,hemovedhisfamilytoMinneapoliswherehecompletedhisresidencyindermatologyattheUniversityofMinnesota,andbuiltathrivingpracticeforover20years.

GEORGE WERNER, M.D.passedawayJanuary11,2010,inFloridaattheageof92.HegraduatedfromtheUniversityofMinnesotaMedicalSchoolin1941.HeservedinWWIIasaNavyphysicianontheU.S.S.Pontiac.Dr.WernerwentintopracticeofgeneralsurgeryintheMinneapolisareaandhelpedestablishGroupHealth(nowHealthPartners)asamajorhealthcaredeliverysystem.Hewasaninventorandwasinstrumentalinbringingnewmedicaltechnologiestomarket.


Ea

st

Me

tr

o

EMMS Foundation News

In Appreciation of Former EMMS Board Members

Some changes to the East Metro MedicalSocietyFoundationhavebeenmadeduetotheconsolidationoftheEastandWestMetroMedicalSocietiesonJanuary1,2010.

Boeckmann Fund Transferred to FoundationTheendowmentfromCarlBoeckmann,M.D.hasbeentransferredtotheEMMSFoundation.Inthelate1800s,Dr.Boeckmannstartedacat-gutsuturebusiness.Theprofitsfromthatbusinessservedasthereservefundsforthe

RamseyCountyMedicalSocietyformorethanacenturyandwillnowhelptoexpandtheEMMSFoundation.

Foundation Board Developing Gifting CriteriaTheBoardofDirectorshasformedacommit-teetocomposegiftingcriteriaanddiscusstheprocessofgivinggrantstootherorganizations.Thefoundationlooksforwardtoassistingoth-ersnowthatthefundshaveincreased.

Community Service Award Moved to FoundationTheCommunityServiceAwardwaspreviouslygivenbythemedicalsociety,butisnowanawardoftheEMMSFoundation.Theawardisgivenannuallyandrecognizesan“unsungphysicianhero,”amemberwhohasvolun-teeredandmadeadifferenceinourlocalcom-munity.

ThefollowingindividualsservedontheEastMetroMedicalSocietyBoardofDirectorsthroughDecember2009.Thankyouforyourtimeandeffortonbehalfofyourmedicalsociety!

Aaron Burnett, M.D.Resident Physician

Representative, 2009

Katherine Clinch, M.D.Director, 2008-2009

Andrew Fink, M.D.Director, 2005-2009

Robert Geist, M.D.Chair, Council on

Professionalism & Ethics Council, 2001- present

Mark KleinschmidtClinic Administrator

Representative, 2003-2009

Jerome Perra, M.D.Director, 2007-2009

Lon Peterson, M.D.Director, 2003-2009

Scott Uttley, M.D.Director, 2007-2009


Michael Boyd, a glass artist, and Nicholas Legeros, a bronze sculptor, were invited to collaborate on a unique gift for Jack on behalf of the Board of Directors.

Virginia Lupo, M.D. presented a gift in the form of a donation to MVNA on behalf of the former WMMS Board Chairs.

Ed Ehlinger, M.D. served as emcee.

Richard Frey, M.D. (left) and William Petersen, M.D. (right) celebrate years of friendship and comraderie with Jack.

Symbolic Sculpture by Ed Ehlinger, M.D., President of the West Metro Medical Society 2009Material: CatliniteTitle: Supporting Physicians: the Legacy of Jack and Marilyn Davis

Description: Jack Davis is symbolized by the hollowed-out triangular middle piece which supports numerous small pieces represent-ing the large number of physicians Jack supported and encouraged over the course of his career. These smaller pieces, in turn, support the larger heart of medicine. The triangle has a hole in the middle that would allow the smaller pieces to slip through if there wasn't some other support under-neath. That bottom-line support is a large heart which symbolizes Marilyn Davis who has lovingly supported Jack and his work for over 42 years. It is the teamwork of Jack and Marilyn Davis that has allowed physicians to effectively use their talents and skills in serving their patients and their communities.

Jack Davis expressed his gratitude to those in attendance.

Celebrating the Career of

Jack G. Davis, WMMS CEO

AwonderfulcelebrationofservicewasheldinhonorofJackG.DavisinDecember2009com-memoratinghisretirementasCEOoftheWestMetroMedicalSociety.Pastboardchairs,friends,andfamilygatheredasseveralindividualsofferedastoryandamemoryoftheirrelationshipwithJack.EdEhlinger,M.D.servedastheemceefortheevening.


Richard Woellner, M.D., president-elect (right) welcomes speaker Steven H. Miles, M.D.

We

st M

et

ro

West Metro Senior Physicians Association

100TheWMMSA100thAnnualMeetingcommitteeisplanningalunch,briefmeetingandprogramtohonorWestMetroMedicalSocietyAlliance(formerlyHennepinCountyMedi-calAuxiliary)pastandpresentmembersfortheir100yearsofenduringvolunteerismtopromoteahealthycommunity.

Please mark your calendars now so you don’t miss this special celebration!

SAVE THE DATE

WMMS Alliance 100th Annual Meeting & Celebration

Sunday May 16, 2010Interlachen Country Club 1:00 - 3:00 p.m.

THE LAST MEETING FOR 2009washeldinNovember—andyes,itwasstillabeautifulday.Ourspeaker,StevenH.Miles,M.D.sharedhisknowledgeofthe“U.S.HealthCareSystem,anInternationalPerspective.”Dr.MilesisProfessorofMedicineandBioethicsattheUniversityofMinnesotaMedicalSchool.

SAVETHEDATES:Ourmeetingdatesfor2010areonthefollowingTues-days—April27,June8,September21,andNovember9.MeetingswillbeheldatZuhrahShrineCenterat11:30.

WANTTOJOIN?Ifyouareretiredorcontemplatingretirement,62yearsorolder,memberorpastmemberingoodstandingwithTCMS/WestMetroDistrictoranothercountymedicalsociety,youareeligibletojoin!

[email protected](612)623-2885.


C A R E E R O P P O R T U N I T I E S see Additional Career opportunities on page 32.

To fi nd new career

opportunities, past issues

of MetroDoctors and

information on the latest

news, events and

legislative issues!

Visit us at www.metrodoctors.com

and

forum.metrodoctors.com

ATTENTION all Minnesota Physicians Residing in

Naples, Florida

8th Annual Minnesota Health Care Dinner Party

Monday, March 15, 2010Pelican Marsh Golf Club, Naples, Florida

Cocktails:6:00p.m.Dinner:7:00p.m.

Cost:$55.00perperson(estimated)Spouse/guestinvited

If you are planning to be in Naples at that time, please contact Thomas W. Hoban with your Naples address at

(239) 948-4492 or [email protected]

Open Cities Health Center (OCHC) is in the process of expanding its services to thecommunity and we expect to have our renovations completed by the Spring/Summerof 2010. This is an opportunity for a Family Practitioner (family practice, OB,Med/Peds, etc.) who is interested in providing cost-effective, quality health care topatients from a wide range of socioeconomic backgrounds and ethnic groups to be apart of a great clinic.

Candidates must have demonstrated ability in the provision of primary medical carewithin the bounds of the specialty; strong personal and professional communicationskills; knowledge of and desire to work within a public health/community medicinemodel of service delivery and; respect and concern for patients regardless ofeconomic status, race, gender, ethnic background or disability.

Minimum qualifications: current Minnesota licensure; graduate from an accreditedschool of medicine; board certified or eligible and a; strong community health/publichealth orientation. Salary is negotiable depending upon experience and qualifications.Cover letters and CV may be submitted via fax, e-mail or mailed to:

Lashell Barnes, Human Resources Manager409 North Dunlap Street, St. Paul, MN 55104

651-290-9211 / 651-290-9210 (fax)[email protected]

www.ochealthcenter.com

Family Practitioner

THE STRENGTH TO HEAL and get back to what I love about family medicine.

©2009. Paid for by the United States Army. All rights reserved.

Do you remember why you became a familyphysician? When you practice in the Army or ArmyReserve, you can focus on caring for our Soldiers andtheir Families. You’ll practice in an environmentwithout concerns about your patients’ ability to payor overhead expenses. Moreover, you’ll see yourefforts making a difference.

To learn more about the U.S. Army Health Care Team,call SFC Daniel Ebbers at 952-854-8489,email [email protected], orvisit healthcare.goarmy.com/info/e928.

see Additional Career opportunities on page 32.


C A R E E R O P P O R T U N I T I E S Please also visit www.metrodoctors.com for Career opportunities.

Introducing the“Career

Opportunities”section of

MetroDoctors!

A great avenue forprofessionals to learnabout job opportunitiesAND a perfect place forrecruiters to promoteopenings!

Care

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Recruiters, call for ourspecial recruitment rate.

Betsy Pierre, ad sales763-295-5420

[email protected]

Great Partners, Great Staff, Great Patients, Excellent Income & Lifestyle

FOR MORE INFORMATION PLEASE CONTACT:Paul Berrisford, 2025 Sloan Place, Suite 35, St. Paul, MN 55117651-772-1572 • email: [email protected]

Family HealthServices Minnesota, P.A. is looking for

several Board Certified/Eligible Family Physicians to fill full-time, part-time or

shared positions.

Join our Independent Group of 64 physicians serving 13 clinic sites.

The only constant we see is change.

Learn how MMIC is continually developing ways to protect you from and to help you prevent medical malpractice lawsuits.

Exclusively endorsed and recommended by the Minnesota Medical Association.

For 28 years, we’ve seen how malpractice issues can challenge physicians. We’re here to help protect your assets with medical professional liability insurance coverage that is backed with:

• Unsurpassable risk management and patient safety resources

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To learn more about how MMIC can help protect you, call 1–800–328–5532.

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Protecting and Promoting the Practice

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CHARGE Syndrome has robbed him of

his sight and hearing. But he knows where

he’s most comfortable, and that’s why we work

with his family and physicians to help him thrive

at home.

Meet the miracle at kevinthrives.com

Kevin doesn’t sense the world the same way you do.

But he knows it feels good to be home.

18932_MetroDrs_Kevin.indd 1 1/25/10 4:00:45 PM

wanted was touse my body

All I

And I got there with Bethesda Hospital, member of HealthEast® Care System.When a 1,600-pound tree crushed Don Obernolte, he thought everything was over. But with the help of Bethesda, he’s reinvented his life. As one of the first and largest long-term acute care hospitals in the nation, Bethesda cares for chronically ill patients or victims of catastrophic accidents, with higher-than-national-average vent wean rates. So patients can recover, relearn and restart, creating a new normal for their lives.

For more information about Bethesda Hospital in St. Paul, Minnesota, visit bethesdahospital.org or call 651-232-2000.

019-1065 IMC BH MetroDoc March/April.indd 1 1/8/10 3:10:49 PM

2010 march/april

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