MMA News
MMA in Action
In preparation for the 2012 legislative session, Dave Renner, director of state and federal legislation for the MMA, and Eric Dick, manager of legislative affairs, met with lawmakers last month to discuss the MMA’s legislative priorities, including the need to update Medical Assistance reimbursements and prohibiting the use of tanning beds by minors. On a trip to Rochester, they met with Rep. Mike Benson (R-Rochester), Rep. Duane Quam (R-Byron), and Sen. Carla Nelson (R-Rochester). In St. Paul, they met with Rep. Steve Gottwalt (R-St. Cloud), chair of the Health and Human Services Reform Committee, and Rep. Jim Abeler (R-Anoka), chair of the Health and Human Services Finance Committee.
Approximately 50 physicians, clinic administrators, and other health care leaders attended the MMA-sponsored conference “Battling Physician Burnout” on October 27. Gregory Poland, M.D, director of the Vaccine Research Group at Mayo Clinic, and his daughter, Caroline Poland, gave the keynote presentation, in which they stressed the importance of balancing one’s work and personal life. Following their talk, a panel of speakers shared ideas for promoting physician well being. The panel consisted of Karen Lawson, M.D., director of health coaching, University of Minnesota Center for Spirituality and Healing; MMA Past-President Patricia Lindholm, M.D.; William Spinelli, M.D., a fellow at the Allina Center for Health Care Innovation; Carl Patow, M.D., executive director and vice president for HealthPartners Institute for Medical Education; and Daniel Whitlock, M.D., vice president of medical affairs at CentraCare Health System in St. Cloud.
Janet Silversmith, MMA health policy director, and Dave Renner, director of state and federal legislation, met with the Minnesota Department of Health’s Assistant Commissioner for Health Policy and Reform, Lauren Gilchrist, to discuss health care reform. Silversmith also attended the first meeting of the state’s Health Care Reform Task Force.
Britta Orr, manager of public health policy for the MMA, worked with the team that is reviewing State Health Improvement Grant applications and attended the first meeting of the state’s Health Insurance Exchange Advisory Task Force. Roger Kathol, M.D., represents the MMA on the task force.
In November, MMA Manager of Quality Improvement Rebecca Schierman gave a presentation to the Twin Cities Medical Society about quality reporting in Minnesota.
Karolyn Stirewalt, J.D., the MMA’s policy counsel, represented the MMA at meetings of the Minnesota Health Professional Services Program Advisory Committee and the Minnesota Board of Medical Practice.
Meet a Member
David Johnston, M.D.
As the MMA’s representative on the University of Minnesota Medical School’s admissions committee, David Johnston has had a hand in choosing tomorrow’s physicians.
By Scott Smith
When David Johnston, M.D., was considering potential students for admission to the University of Minnesota Medical School, he looked for three things: intelligence, curiosity, and that they “sincerely give a rip about their fellow man.”
Johnston spent six years as the MMA’s representative to the medical school’s admissions committee, screening hundreds of applications from young people hoping to be part of the next generation of physicians. An emergency medicine physician at North Memorial Medical Center, Johnston stepped down earlier this year; the MMA’s new representative is Beth Baker, M.D.
David Johnston at a Glance
- Medical School: University of California San Diego School of Medicine, 1978
- Residency: Pediatrics, University of California San Diego, 1978-1981 and chief residency 1982-83; emergency medicine, Denver General and Affiliated Hospitals, 1984-1986
- Practice: Emergency medicine physician at North Memorial Medical Center, Robbinsdale
- MMA Involvement: MMA representative on the University of Minnesota Medical School Admissions Committee, 2005-2011
- Hobbies: Biking, walking his dog, reading, playing the trumpet
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Johnston says he applied to serve on the committee because he “wanted to see good people come into the profession.”
To winnow the 3,500-plus applicants a year to a class of 165, the 25 committee members take into consideration an applicant’s residency (with a strong preference given to those from Minnesota), academic achievements, written essay, medical and nonmedical work or volunteer experiences, and interview. They then debate the merits of various candidates. Johnston says he favored those with humility and a commitment to service. “It helps if you don’t have an ego because this is a service profession, and I always look for a willingness to think you might be wrong about something,” he says.
Committee members then give a numeric score to each candidate, and candidates are offered admission based on those scores. Johnston’s emphasis on service goes along with a philosophical change on the part of medical schools, which now place greater emphasis on candidates’ nonacademic abilities than in the past. Johnston says when he applied to medical school in the late 1970s, it was all about academics. Today, the ability to communicate well and show empathy matter, and candidates with stellar MCAT scores can get passed over because of poor interview performances, arrogance, or a lack of service work.
“One surprising and uplifting thing about doing this was just the quality and idealism of the people who want to go into medicine,” he says.
Johnston did his own medical training in California and Colorado. He came to Minnesota in 1986 to take a job with Children’s Hospitals and Clinics of Minnesota. But he missed practicing adult emergency medicine. So he moved to North Memorial that same year and has been there ever since.
A supporter of organized medicine, Johnston has been an MMA member since the late 1980s. He admits that he has been disappointed by its lack of support for a single-payer health care system but says other benefits outweigh that negative. He says being a member of the MMA gave him entree to a meaningful volunteer experience with the university’s admissions committee. “My world is pretty limited to my colleagues at the hospital; but through this, I gained a connection to the university and met some wonderful people,” he says. And he had a chance to have a say in deciding what type of person will be the physician of tomorrow.
MN Supreme Court Rules on Newborn Screening Samples
The state of Minnesota may continue to screen newborns for various childhood diseases, but it cannot store, use, or disseminate blood samples for other research without parental consent, the Minnesota Supreme Court ruled last month.
The decision reverses two lower-court decisions and was unfavorable to researchers. “This is a disappointing result,” says Karolyn Stirewalt, J.D., MMA policy counsel. “The holding of this case will impact the resources that researchers have to further study inheritable disorders of newborns and to improve upon the tests that measure them. It could also lead to many new cases being brought against the state.”
The MMA has been a long-time advocate of newborn screening, which identifies approximately 100 babies a year who can be saved from death or disability through early treatment.
Piero Rinaldo, M.D., co-director of Mayo Clinic’s Biochemical Genetics Laboratory, said in a story in the Rochester Post-Bulletin that the samples are useful for developing new tests for potentially fatal disorders.
Health Commissioner Ed Ehlinger, M.D., said in a statement that the Department of Health was reviewing the implications of the ruling on the operations of the program, which, he said, protects Minnesota babies from serious diseases. It is not clear whether the Department of Health will be compelled to destroy its more than 800,000 samples, which are a few blood drops on a specimen card.
Court Battle
At issue in the case was the interplay between the newborn screening law (Minn. Stat. sections 144.125-.128) and the Genetic Privacy Act (Minn. Stat. section 13.386).
The Minnesota Department of Health collects blood samples from newborns to check for more than 50 diseases and disorders. A small portion is retained indefinitely for other uses unless there is a specific request to have it destroyed. Those uses include developing new tests and assuring the quality of the existing tests.
Four years ago, nine families sued the State of Minnesota, the Department of Health, and the commissioner for collecting, using, storing, and disseminating the samples and test results without obtaining written informed consent. The families alleged that this was in violation of the Genetic Privacy Act, claiming they had justification for both a tort action (for improper governmental taking) and a constitutional claim (for invasion of privacy). The district court ruled that the Genetic Privacy Act did not apply to newborn screening because the screening “was conducted on biological samples, not genetic information.” It also stated that newborn screening under the statute is exempted from the Genetic Privacy Act, which regulates the use of genetic information “unless otherwise expressly provided by law.”
The Minnesota Court of Appeals upheld the district court decision, ruling that “the informed consent provisions of [the Genetic Privacy Act], are not triggered when newborn blood is collected and tested for heritable and congenital disorders as part of the state-wide screening program mandated by [the newborn screening statute].” The court denied the plaintiffs’ claims and requests for a legal remedy.
The Minnesota Supreme Court reversed the prior courts’ opinions, ruling that blood samples collected by the Department of Health fit within the definition of “biological information collected from an individual” under Minnesota law, so the Genetic Privacy Act applies. “Unless otherwise expressly provided by law, the Department must have written informed consent to collect, use, store, or disseminate those samples,” the court said.
The court also ruled that “the newborn screening statutes [allow the Department to] administer newborn screening by testing the samples for heritable and congenital disorders, record and report those results, maintain a registry of positive cases for the purpose of follow-up services, and store those test results as required by federal law. The newborn screening statutes do not expressly authorize the Department to conduct any other use, storage, or dissemination of the blood samples.”
The Supreme Court sent the issue of an appropriate remedy for the plaintiffs back to the district court. It will determine whether any of the parties had established the facts necessary to show that their children’s blood samples had been used, stored, or disseminated in violation of the Genetic Privacy Act.
The MMA will continue to follow the case and provide updates.
Minnesota Resolutions Move Forward at AMA Meeting
Minnesota’s AMA delegation successfully moved forward two resolutions at the AMA 2011 interim meeting in New Orleans last month.
The AMA House of Delegates referred a Minnesota resolution about secure examinations for maintenance of certification to the AMA Board of Trustees for further consideration. The resolution (Res. 911) calls for the AMA to work with the American Board of Medical Specialties to remove the requirement for a secure examination as part of the Maintenance of Certification program.
2011 Minnesota Delegation to the AMA
- John Van Etta, M.D.
- Ray Christensen, M.D.
- Sally Trippel, M.D.
- Ken Crabb, M.D.
- Paul Matson, M.D.
Alternate Delegates
- John Abenstein, M.D.
- David Estrin, M.D.
- Ben Whitten, M.D.
- Will Nicholson, M.D.
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Physicians with time-limited board certifications have to take an exam every seven to 10 years. But now that maintaining certification also requires them to complete learning modules, computer-based simulations, and quality assessments, physicians are questioning whether an exam that measures factual recall, rather than diagnostic reasoning, is necessary.
“We pushed hard to get the resolution adopted, and there was a lot of sympathy to the fact that there is no evidence that these tests verify competence. But in the end, the majority view was that it made sense to have the AMA Board consider the issue and come up with the best remedy,” says Dave Renner, MMA director of state and federal legislation.
The House also passed a resolution that the Minnesota delegation co-sponsored with the American Society of Anesthesiologists. The resolution (Res. 602) calls for the AMA to ensure that the Current Procedural Terminology (CPT) Editorial Panel uses the term “physician” in a way that is consistent with AMA policy, which defines a physician as a doctor of medicine or doctor of osteopathic medicine.
The resolution is in response to the CPT Editorial Panel’s plans to review and potentially revise the CPT code set. The CPT advisors participating in the project decided, for the purpose of the systematic review, that “physician” refer to any professional who is currently allowed to report E/M services in the Medicare fee schedule. This would include registered nurse practitioners, physician assistants, certified nurse midwives, and others.
Alexandria Surgeon Gets MMA Quality Award
The MMA presented its Physician Leadership in Quality Award to Paul Dale, M.D., for his work in establishing the Joint Replacement Center at Douglas County Hospital in Alexandria.
Dale is an orthopedic surgeon with Heartland Orthopedic Specialists in Alexandria, which worked with Douglas County Hospital to open the Joint Replacement Center in 2008. Dale, now the center’s orthopedic medical director, promoted an innovative treatment approach.
Before the center was established, patients underwent their procedures and rehabilitation individually. Now, the patients go through a presurgical orientation in groups. After their surgery, they eat meals together and rehabilitate together at the center, which has a lodge-like atmosphere. The approach has paid off in lower complication rates, improved patient satisfaction scores, and better treatment outcomes. The Joint Replacement Center was one of only six programs in the state to receive the highest quality rating by the independent hospital quality evaluator, CARECHEX.
The MMA Quality Committee noted that Dale’s innovative efforts to engage patients before and after surgery is a model that could be replicated in other practices and in other specialties.
The MMA Quality Committee has been recognizing physicians who advance the quality of health care in Minnesota since 2006. This fall, the MMA Foundation presented the MMA’s quality award as well as the association’s awards for service to minority communities and excellence in journalism, and its medical student award.