MMA News
State Launches Time Out Campaign
The Minnesota Safe Surgery Coalition’s campaign to eliminate wrong-site, wrong-procedure, and wrong-patient events within three years is gaining momentum. More than 100 health care providers thus far have pledged to join the Minnesota Time Out Campaign, a statewide effort to eliminate mistakes by conducting a time out for every patient, during every procedure, every time, and in every health care setting. The MMA has promoted the campaign and is a member of the Safe Surgery Coalition.
The Time Out campaign asks physicians, frontline staff, and administrators to hold each other accountable for conducting effective time outs for patients undergoing invasive procedures. It is a response to the increasing number of wrong-site events that have occurred in Minnesota health care facilities. Between October 2009 and October 2010, 31 wrong-site events were reported in the state. Many of those were attributed to the lack of an effective time-out process; in a number of cases, there was no process in place.
During a time out, all activity stops, and a designated staff person verifies the patient’s name, the procedure, and the location of the procedure while referring to source documents. A staff person other than the one performing the procedure then locates and verbally confirms that he or she can see the site mark and states where it is located. The person performing the procedure then repeats that information.
“We cannot be successful without the commitment of every physician and Minnesota health care organization that conducts surgical and other invasive procedures. It is crucial that we work together to make sure the Minnesota Time Out steps are followed everywhere and all the time. Without this level of consistency and rigor across the state, we will not achieve our goal,” says Robert Meiches, M.D., MMA CEO.
The Minnesota Time Out campaign was officially launched June 15.
“We got a really great response from the provider community, and a number of specialty societies signed on,” says Rebecca Schierman, MMA manager of quality improvement. For more information about the Minnesota Time Out campaign, contact Schierman at rschierman@mnmed.org.
Meet a Member: Therese Zink, M.D., M.P.H.
Through the MMA Foundation, writer and educator Therese Zink has published a collection of Minnesota medical students’ essays and poems.
By Lisa Harden
Writing is more than a pastime for family physician Therese Zink, M.D., M.P.H., who recently edited two collections of enlightening stories and poems by physicians and medical students.
Zink, whose works have been published in Family Medicine, Academic Medicine, the Journal of American Medical Association, Minnesota Medicine, and several anthologies, says that writing helps physicians work through what they witness. “It’s important as doctors to process what you see. It makes you a better physician.”
Therese Zink at a Glance
Specialty: Family medicine
Medical School: Ohio State University, 1985; M.P.H., University of Minnesota, 1992
Residency: St. Paul Ramsey Medical Center (now Regions Hospital) Family Medicine Residency, 1985-1988
Practice: Family physician at Fairview Zumbrota Clinic; associate director of research and evaluation for the Rural Physician Associate Program, director of Global Family Medicine, and professor of family and community medicine at the University of Minnesota
MMA Involvement: Minnesota Medicine advisory committee member; editor of Becoming a Doctor: Reflections by Minnesota Medical Students, which will be distributed to all first-year Minnesota medical students beginning in 2011 and funded by the MMA Foundation
Hobbies: Writing, cross-country skiing, horseback riding, biking, running, gardening
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Zink is helping the next generation become better physicians through writing. As a faculty member in the Rural Physician Associate Program at the University of Minnesota, she reads posts on a discussion board by students on rural rotations.
In 2007, she realized that those chronicles of rural practice begged for a larger audience. She solicited stories and poems from doctors and other health professionals along with some medical students to include in The Country Doctor Revisited: A 21st Century Reader, published by Kent State University Press in 2010. The realistic depiction of rural medicine—no Marcus Welby here—received rave reviews from the medical community and is being used by the Society of Teachers of Family Medicine to prompt discussions between rural physicians and medical students about the realities of rural practice.
In her latest project, Zink has collaborated with the MMA Foundation to publish a collection of 20 stories and poems from medical students at the University of Minnesota and Mayo Medical School.
Becoming a Doctor: Reflections by Minnesota Medical Students will be given to first-year medical students at the University of Minnesota and Mayo for the next four years, as well as medical school faculty.
The book also will be sold at University of Minnesota bookstores. Proceeds will benefit the Fisch Art of Medicine Student Awards and the Vince and Mary Kay Hunt Global Health Fund. “The students’ stories remind us of the incredible privilege we have as doctors to walk side by side with patients in the best and worst of times,” Zink says. “The students are just learning to assume the mantle of that privilege.
“When you practice medicine for a while, you take that privilege for granted. When you see the students’ writing and their sense of awe, it makes you realize what a privilege it is.”
Legislative Limbo
The 2011 legislative session ended without a budget deal and significantly fewer new laws than usual. Here’s a look at some of the bills important to physicians that the MMA weighed in on this year.
BILLS THAT PASSED
Community Paramedics • Legislation was signed into law that creates a new level of provider called “community paramedics.” They’ll practice under the authority of an ambulance medical director and work with a patient’s personal physician and health care home to help with care coordination. The law directs the commissioner of human services to convene a work group to determine the types of services community paramedics will be allowed to bill for and to evaluate how they could coordinate services with health care homes. The MMA supported this legislation.
Concussion Awareness in Young Athletes • A new law requires all coaches or officials to remove athletes who are suspected of having a concussion from competition until the athlete has been assessed by a practitioner who is trained and experienced in evaluating and managing concussions. It also requires coaches and officials from school and association athletic programs to receive annual training on concussions based on information from the U.S. Centers for Disease Control and Prevention. The MMA supported this legislation.
Anatomical Gift Promotion Account • People renewing their driver’s license or car tabs will be able to donate $2 to an anatomical gift account, which will fund nonprofit organizations working to increase the number of organ, tissue, and eye donors. The MMA supported this legislation.
BILLS THAT DIDN'T PASS
Newborn Screening Registry Repeal • S.F. 1017 would have modified the state’s newborn screening law to prohibit the Department of Health from keeping any blood samples for more than 24 months. This would have put the testing labs out of compliance with federal laws and would have ended the state’s newborn screening registry. The bill was originally included in the omnibus Health and Human Services budget bill but was removed because of opposition. The MMA opposed this proposal.
Minor Consent Repeal • Bills were introduced in both legislative bodies that would have repealed a provision in Minnesota law that allows minors to receive care for mental health, chemical dependency, and reproductive health issues without a parent’s consent. This law has been on the books in Minnesota since 1974. The Senate bill, S.F. 1017, received a hearing in the Judiciary Committee but did not go any further. The MMA opposed the repeal effort.
Freedom to breathe exemptions • H.F. 188 would have exempted bars from the state’s clean indoor-air requirements and would have allowed smoking in bars that are separated from restaurants by walls or doors. The bill never received a hearing in either body. The MMA opposed the exemptions.
Seat belt primary offense • The House approved a floor amendment to a judicial policy bill that would have repealed Minnesota’s primary offense law for failure to wear a safety belt. If passed, it would have prohibited law enforcement officials from stopping and ticketing a driver solely for failing to wear a seat belt. The Senate never adopted the amendment, so the repeal failed. The MMA opposed this amendment.
MMA in Action
Some of the recent ways MMA staff and members have worked for physicians in Minnesota.
The MMA, in conjunction with the Minnesota Academy of Family Physicians Foundation, held interpreter services training for medical students May 18 at the University of Minnesota Medical School’s Duluth campus and for physicians May 25 at Affiliated Community Medical Center (ACMC) headquarters in Willmar. Dionne Hart, M.D., chair of the MMA Minority and Cross Cultural Affairs Committee, co-presented the material at ACMC, which serves a large number of patients who speak limited English in communities throughout southwestern Minnesota. MMA member Ruth Westra, D.O., chair of the department of family medicine and community health at the medical school in Duluth, led the session in Duluth.
MMA Trustee Roger Kathol, M.D., and MMA member Terrence Cahill, M.D., represented the MMA at a provider forum on May 25 convened by the Minnesota Department of Health to discuss what information and data should be included in an insurance exchange.
Janet Silversmith, MMA director of health policy, conducted an educational session about state and federal health care reform implementation at Fairview Ridges Hospital on June 17.
Eric Dick, MMA manager of legislative affairs, attended a June 16 meeting of health care lobbyists from around the state to discuss the possible consequences for providers and patients of a state government shutdown. Participants represented hospitals and medical clinics, dental clinics, services for the disabled and seniors, mental health clinics, and medical transport services.
Karolyn Stirewalt, J.D., MMA policy counsel, represented the MMA at a meeting of the ARRA Portability Grant Task Force to develop an expedited regional process for physicians who are seeking cross- border licensing. The task force is composed of staff members from regional state medical boards and medical societies in Wisconsin, Illinois, Indiana, Iowa, Kansas, Missouri, Minnesota, Missouri, and South Dakota.
Britta Orr, J.D., MMA health policy analyst, is part of a Minnesota Cancer Alliance work group that is developing a policy agenda with regard to cancer prevention. On June 2, members of the group met with leaders of the Office of Native American Health to discuss disparities in care and health outcomes.
MMA managers of physician outreach Mandy Rubenstein and Dennis Gerhardstein represented the MMA at the University of Minnesota’s Graduate Medical Education orientation sessions June 17 and July 1.
Ten MMA members were part of the Minnesota delegation to the AMA annual meeting June 18-22 in Chicago. Also attending were MMA Board Chair Dave Thorson, M.D., and MMA President-Elect Lyle Swensen, M.D. Seven other Minnesota physicians attended the meeting as well, representing their national specialty societies. In addition, 10 Minnesota medical students attended the AMA Medical Student Section meeting, and seven residents attended the AMA-Resident Fellow Section General Assembly. MMA member Steven Darrow, M.D., was elected AMA-RFS Speaker of the House. MMA member Maya Babu, M.D., was elected RFS delegate. MMA member Jon Van Etta, M.D., an internist at St. Luke’s Internal Medicine Associates in Duluth, ran for but was not elected to the AMA Board of Trustees.
Dave Renner, MMA director of state and federal legislation, provided a legislative update to physicians at Lake-view Hospital in Stillwater on June 15. Eric Dick provided an update at Olmsted Medical Center on June 23.
Dave Thorson, M.D., and Janet Silversmith were among a dozen Minnesota health care leaders who met with Medicare and Medicaid Services Administrator Donald Berwick, M.D., June 21, to discuss new Medicare accountable care organization rules.
To contact an MMA staff member, visit our staff directory at www.mnmed.org/contact.
BCBS Contract Review Now Online
The MMA has released its summary of changes in the Blue Cross and Blue Shield of Minnesota 2011 Aware Provider Service Agreement. Providers are required to accept the terms of the agreement to be a part of the Blue Cross network
Among the changes are the addition of a new provision on quality care delivery, a reduction in the amount of advance notice (from 90 to 45 days) providers will be given when changes are made to the agreement, and a requirement that providers make information available to subscribers about advance directives.
Each year, the MMA teams up with the Twin Cities Medical Society and the Minnesota Medical Group Management Association to provide this review for members. Physicians who want to know more about how the specifics of this agreement apply to their practice should contact their attorney, accountant, or consultant.
The full report is available online at www.mnmed.org/contract.