2010 march/april
DESCRIPTION
MetroDoctors publicationTRANSCRIPT
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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.
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MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 3
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.
4 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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
MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 5
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.
6 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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
MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 7
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,
Call for Resolutions
West Metro District:Wednesday, May 19
7:00a.m.BroadwayRidge
3001BroadwayStreetNE,ConferenceRoomD(lowerlevel)
Minneapolis,MN55413Contact:KathyDittmer,(612)623-2885,
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:
8 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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.
MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 9
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;
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10 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
• 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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MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 11
CMs deemed status Accreditation organizations
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)
12 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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
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MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 13
CMs deemed status Accreditation organizations
(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?
14 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
HFAP
(Continued from page 13)
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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(Continued on page 16)
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
16 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
New Health Care CEO
(Continued from page 15)
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.
MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 17
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.
(Continued on page 18)
18 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
Health Information Exchange
(Continued from page 17)
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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MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 19
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
20 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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
MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 21
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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22 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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.
MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 23
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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24 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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
MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 25
New Members
(Continued on page 26)
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
26 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
New Members
(Continued from page 25)
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.
MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 27
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
28 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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.
MetroDoctors The Journal of the Twin Cities Medical Society March/April 2010 29
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.
30 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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.
32 March/April 2010 MetroDoctors The Journal of the Twin Cities Medical Society
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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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
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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
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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