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Minnesota Chapter Banner

June 2013


Dr. Gantzer's photo

Heather E. Gantzer, MD, FACP

Minnesota ACP Mission: To foster excellence, education and professionalism among all internists in our community and to work together to shape the future of healthcare in Minnesota.

Minnesota ACP Vision: To be Minnesota’s recognized leader for patient care, advocacy and education and to enhance career choice, satisfaction and collaboration for specialists and subspecialists in internal medicine.

Governor's Message

MN-ACP Progress on Strategic Plan

Over the past six months, how is Minnesota ACP progressing towards the goals set in the Vision?

  • Steps in leadership in patient care: Dr. Kris Kopski and Executive Director Katherine Cairns have ably represented the Minnesota Chapter of the ACP at state meetings regarding the practical implementation of the Patient Centered Medical Home in Minnesota.
  • Steps in advocacy: There was a more than 10% increase in the number of Minnesota ACP members who joined the ACP Advocates list in the past six months. You can join by going to the ACP website and look under Advocacy, or you can click directly on this link. Being an Advocate for Internal Medicine means you will receive updates on current national legislative issues relevant to Internal Medicine, and learn where ACP stands on issues of the day. Dr. Mark Liebow, our Public Policy lead on the MN ACP Council, sent several Public Policy updates to ACP members who have opted to be on the IM Advocate list (send an email if you wish to be on this list, which means you will get updates on Minnesota legislative issues relevant to Internal Medicine.) The ACP Governor, and Mark Liebow MD, FACP and other Minnesota physicians attended the MMA Day at the Capitol on February 27 and spoke with state legislators. Monthly telephone conference calls were held between the MN- ACP, the Minnesota chapter of the American Academy of Pediatrics and the Minnesota Academy of Family Physicians discussing legislative issues in Minnesota affecting physicians. MN-ACP also signed a letter as part of the Raise It for Health Campaign, urging the state to increase tobacco taxes and the state did pass this by increasing the tax $1.60 per pack.
  • Steps in education: A planning committee meeting was held: Dr. John Bundrick and Dr. Mary Miley are co-chairing the Annual Scientific Meeting which will take place on Friday November 8, 2013 with topics pertinent to all internists. We will be fortunate to have as our guest at the meeting Dr. Susan Hingle of Illinois, Chair of the Board of Governors of the ACP. There will be a session for completing two SEP Maintenance of Certification modules on Thursday, November 7. Also on November 7 there will be a session serving as an introduction to bedside ultrasound for the internist. This is an introductory offering (not a training or certification session) but it will include the opportunity to participate using ultrasound machines in small groups, with the goal of better understanding how this technology might be used in the hospital and the office by the internist.
  • Steps in career choice: Dr. Charlie Reznikoff is coordinating the resident and medical student poster session event for the November 8, 2013 meeting; the chapter sent four poster winners (out of 218 posters) from the 2012 state meeting to Internal Medicine 2013 in San Francisco. MN ACP continues to strongly support the Internal Medicine Interest Groups of the medical students at the University of Minnesota and the Mayo medical students. Andrew Olson, MD, Chair of the MN ACP Medical Student Committee, assisted the University of Minnesota IMIG in holding an Internal Medicine Skills night on March 12 which included hands-on stations with simulators for paracentesis, heart sounds, arthrocentesis, echocardiography and upper endoscopy. The purpose of the session was to let medical students, as they consider their career choices, experience performing some of the procedures an internist might do, and the session was given highly favorable feedback.
  • Steps in career satisfaction: Engaging in the above activities to support internists in their professional lives; sending emails to MN ACP members publicizing the increase in Medicaid reimbursement to physicians and how to apply; sending emails and mailings to internists eligible for Fellowship to consider application; inducting new Fellows from Minnesota at Convocation in San Francisco in April; hosting a reception with outstanding attendance at Internal Medicine 2013, along with the Mayo Alumni and the North Dakota ACP Chapter; Dr. Amy Holbrook is chairing the Young Physician/Early Career Committee and seeking committee members to assist in outreach/activity planning (if you would like to assist you may contact Dr. Holbrook.); Dr. Jim Langland is chairing the membership Committee and providing initial outreach to the St. Cloud and Duluth areas (if you would like to assist you may contact Dr. Langland); and requesting nominations for the 2013 state ACP Community Service/Volunteerism and the Laureate Awards(submit to Katherine Cairns)
  • Steps in collaboration for specialists and subspecialists in internal medicine: In the past six months internists of a wide variety of specialties have joined the MN ACP; some of them were in San Francisco and we look forward to meeting with our new members in Minneapolis in November. Infectious Disease specialist Dr. Randall S. Edson was awarded Mastership in the College.

If you have thoughts of additional ways the ACP can serve Minnesota internists and their patients, and if you would like to be further involved in these efforts please email me.

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Support MN-ACP by Volunteering for a Committee

Do you have an interest in serving on any of the following Minnesota ACP committees? Your involvement not only helps MN-ACP achieve its goals, but will also help you meet criteria for Fellowship (FACP) designation. Contact Katherine Cairns for more information or to indicate your interest in working on any of the following committees. All committees meet by conference call at a convenient time for committee members.

  • Medical Students
  • Resident/Fellow Members
  • Membership Recruitment
  • Early Career Physicians (defined as within 16 years of graduation from medical school and having completed training),
  • Hospitalists,
  • Women Physicians,
  • Public Policy.

We’ll put you in touch with the Committee Chair of whichever committee you are interested in. The best ideas for actions by the state chapter come from our Minnesota ACP members!

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What is ACP’s position on gun Firearm Violence?

ACP has a long-standing position on firearm violence.

Past position statements include the following:

Firearms Safety and Regulations 2013
Firearm Injury Prevention ACP Position Paper 1998

Also, Garen J. Wintenmute, MD, MPH gave a talk “Docs and Guns: A Primer” at Internal Medicine 2013. A Minnesota physician who attended this talk gave it a high rating. The podcast of this session can be purchased.

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Annals and Apps

Explore new Apps for your tablet or smartphone, free to ACP members. These include Annals of Internal Medicine, ACP Immunization Advisor, and ACP Clinical Guidelines. Look under American College of Physicians in the App store. The ACP Immunization Advisor App is particularly handy, given the recent introduction of the PCV vaccine for the prevention of pneumococcal disease in a very carefully defined subset of patients including those with asplenia, sickle cell, leukemia and several other conditions.

Also note in the March 5, 2013 issue of Annals of Internal Medicine, along with articles focusing on patient safety, was a first: an article in graphic novel form. The editors of Annals noted this story, which describes “a missed diagnosis that haunts a physician throughout his professional life” is the first ever presented in graphic novel form, and while they await readers’ responses to determine if there will be other articles in this form, they “cautiously welcome other submissions in this unique format.” Take a look in your paper edition of Annals, in the Annals app or online and tell them what you think. Or, if you are creative and artistic, send them a submission.

Note ACP now has a universal sign-in, so your name and password are the same for all ACP websites including the home site of acponline.org, Annals, Journalwise etc.

A life-saving Action

The South Dakota ACP Chapter is spearheading an effort to increase registry in blood and bone marrow donation and ask ACP members (under the age of 44) to sign up. Encourage friends to sign up, as donors for blood-forming cells, bone marrow and umbilical cord blood.

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2012 Chapter Excellence Award for the Minnesota Chapter

The Minnesota Chapter has been awarded a 2012 Chapter Excellence Award for successfully meeting the standards for managing a chapter. The Minnesota Chapter was also named as one of the Evergreen All-Stars, in recognition of our long-term participation in the John Tooker Evergreen Award program. The criteria for this honor included having at least five nominations and two winners in the twenty years of the program plus having at least one program running for more than three years.

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Convocation at Internal Medicine 2013

Convocation in San Francisco was full of color, pageantry, and deep meaning. On the stage were medical leaders from across the globe, in the traditional academic attire of their countries. The Marshall Dr. Ranita Sharma, ACP New Jersey Governor, and Assistant Marshal Julie Blehm, ACP South Dakota Governor, opened the ceremony by placing the heavy, ornamental mace (made for the College in London, with wood for the shaft coming from the wood of a tree under which Hippocrates was alleged to have taught his students over 2,000 years ago) and the placing of the silver Caduceus (a gift from the Royal College of Physicians in 1954) on stage.

The Minnesota Chapter of the ACP was ably represented onstage with Dr. Randall S. Edson, physician of Infectious Disease, receiving Mastership in the College, and with Dr. Bob Lohr, who is a Regent of the College.. The entire Minnesota delegation marching in Convocation wore their caps and gowns with velvet representing doctoral degrees, green color representing the medical profession (green symbolizing herbs used by early healers) and hoods with the individual colors of each physician’s medical school.

Marching in Convocation were the Governor; the 2012 Chapter Laureate Amit Ghosh, MD, FACP, and a dozen new Minnesota Fellows of the College. Other Minnesota ACP members and family members were in attendance, lending support to the new Fellows.

David L. Bronson, MD, MACP, 2012-2013 President of the College, spoke about the need to connect with patients in a human and caring way even when surrounded by technology, and showed a moving video from the Cleveland Clinic Empathy: The Human Connection to Patient Care. I would say there was not a dry eye in the crowd.

The ceremony also included reading the American College of Physicians Pledge.

I encourage new Fellows to participate in Convocation (they are able to do this in any of the three years following awarding of Fellowship), and other ACP members to attend Convocation, as a way to re-center and reconnect with the ideals of the profession.

Fellows 2013

MN Fellows at Convocation, 2013

Drs Ghosh and Neal

Drs. Ghosh and Neal, assembling for Convocation

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American College of Physicians Pledge

I affirm my belief in the mission of the American College of Physicians

To preserve and maintain the highest traditions and precepts of our professional calling

And I solemnly declare that I will conform to these ideals to the utmost of my ability I therefore reaffirm my dedication to the practice of medicine

To act always in the best interests of my patients

To respect the reputation and integrity of my colleagues

To supplement my own judgment with the counsel of others when the occasion requires

To render assistance to my colleagues in every way

To extend my professional aid to the unfortunate

To increase my medical knowledge and understanding by continuing study by association with physicians of the highest intellectual and ethical standards and by the free exchange of information and experience with all of my medical colleagues

I hereby pledge to uphold the ethics of medicine as exemplified by the standards and traditions of this College

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ACP Internal Medicine 2013

More than two hundred Minnesotan physicians attended Internal Medicine 2013 in San Francisco, an excellent turnout; the total number of physicians attending was over 7,400 which is record-setting for the national annual ACP spring meeting. Do be sure you have made your submission for CME credit for the meeting online. And make plans to attend Internal Medicine 2014 in Orlando, April 10-12, 2014.

Congratulations to all the Minnesotans who spoke and who presented posters at Internal Medicine 2013 in San Francisco. You made our Minnesota chapter proud!

Speakers from Minnesota included Scott Litin, MD, MACP and a former Governor of the MN ACP leading the enormously popular Clinical Pearls sessions consisting of Brent Bauer, MD, FACP on Complementary Medicine; Ashok Patel, MD, FACP on Pulmonary Medicine; Dawn Davis, MD, FACP on Dermatology; Karen Mauck, MD, FACP on Perioperative Medicine; Stephanie Faubion, MD, FACP on Women’s Health, and John Schaffner, MD on Gastroenterology.

Minnesotans speaking further on a variety of topics in San Francisco were Jamie Newman, MD, FACP on Hospital Medicine; Steve Kopecky, MD, FACP on Cardiology; Keith Swetz, MD, FACP on End of Life Care; Jon Tilburt, MD, FACP on Stewardship of Resources; Mark Davis, MD on Dermatology; Diana Dean, MD on Endocrinology Stacy Rizza MD on Hospital Medicine; LaTonya Hickson, MD, FASN on Nephrology, and Dave Holmes, MD, FACC on Cardiology.

Mark Liebow, MD, FACP came to the rescue and spoke at this national meeting with only a few hours notice, after weather stranded the scheduled speaker in Rapid City, unable to arrive in California in time. The talk was on Hospital Readmissions. Dr. Litin also attracted a large audience with his famous talk on how to give an effective presentation.

Note that the Clinical Research category was won at the national level, for the Associates Abstract Competition Research Posters, by Karna K. Sunsted, MD of the Mayo Graduate School, Rochester MN, for an abstract on “Safety of Clopidogrel in Hip Fracture Surgery, A Historical Cohort Study.”

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Mayo Medical School Crawfish in the Snow

On May 4th, the Mayo Medical School Internal Medicine Interest group braved the near freezing cold and 14 inches of snow, and enjoyed 90 pounds of mudbugs, with support from the Minnesota chapter of the ACP. This is the 8th annual crawfish wang dang doodle, held at the home of Jamie Newman, MD, FACP. Though New Orleans is a long float down the Mississippi, we still enjoy a giant boiling brew of red hot pepper, potatoes, corn and crustaceans. Gathered around the table, Dr Newman, Medical students and friends.

Crawfish in the Snow

Photo by Sanjay Kalra

Save the Date

November 7-8, 2013

MN-ACP Scientific Session and Pre-Sessions at the Marriott Hotel - Bloomington/Mall of America

7am on November 7th - Early Career Internist Breakfast; 8am-5pm UltraSound Pre-course; 1-5:15pm SEP Pre-Session

7am on November 8th - Women Internist Breakfast; 8am-5:30pm Scientific Session, Abstract Competition and Doctor's Dilemma Competition

August 1, 2013 - MN-ACP Community Service/Volunteerism and the Laureate Awards nominations due. Please submit to Katherine Cairns.

-Ultrasound Use Workshop
-In-Patient and Clinic Internal Medicine SEP Modules
-CME with outstanding topics/speakers
-Laureate and Community Service Awards
-Abstract Competition on Nov. 8th
-Doctor’s Dilemma competition Nov. 8th
-Exhibits

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ACP Leadership Day in Washington, DC

Minnesota was represented by a delegation of five physicians and a medical student at ACP Leadership Day on May 21-22, 2013. Heather Gantzer, MD, FACP led the delegation with Mark Liebow, MD, MPH, FACP, our Health and Public Policy Chair, and internal medicine residents Melanie Lo, MD, an HCMC resident, and Eugene Scharf, MD, a Mayo resident, and Mayo medical student Andrew Harrison. Steve Darrow, MD, a nephrology fellow at the University of Minnesota, also from Minnesota attended in his capacity as a member of the ACP Council of Resident/Fellow members. In addition to the briefing from ACP on key federal issues of concern to internal medicine, the Minnesota delegation met with staff of both Senators and of Representatives from seven of the eight Minnesota districts to advocate for these issues. They met directly with Congressman Erik Paulsen, Senator Al Franken and Congressman Rick Nolan.

2013 Leadership Day

ACP Leadership Day participants: Melanie Lo, MD, Andrew Harrison, Heather Gantzer, MD and Eugene Scharf, MD

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Minnesota Legislative Update

(Adapted from MEDPAC's legislative summary)

The 2013 Minnesota Legislative session is over. Among the bills passed was the Health and Human Services budget bill, which will spend $11 billion, that funds much of the state’s health care programming. This year’s package contained a number of very good elements, including robust funding for public health investments, resources for physician training programs, maternal depression awareness, and others. Key highlights of the session for internal medicine:

  • Tax Bill Includes Steep Increase in Tobacco Prices- The tax on a pack of cigarettes will more than double, rising from $1.23 per pack to $2.83. The increase was sought by the Raise It for Health coalition, a broad coalition of public health advocates, physicians groups, hospitals, and others. MN-ACP is a member of this coalition and signed several letters with Minnesota Health Care leaders to legislators and the Governor urging an increase of $1.60/pack in tobacco taxes. The increase in the tax moves Minnesota from the 28th highest tobacco tax to 6th. It’s been calculated that the increase will lead to 47,700 fewer youth from becoming addicted adults, and will lead 36,000 adults to quit.
  • Health Insurance Exchange Moving Forward as “MNSure”- The state’s health insurance exchange proposal was signed into law on March 20. Under the law, the exchange will be financed by a percentage of premiums of insurance products purchased within the exchange. Legislators adopted an “active selector” model to determine which insurance products would be available for purchase within the exchange. While any product may be sold within the exchange in 2014 (because there wouldn’t be time to do intelligent selections), starting in 2015, the Board of Directors will select products that would be available for purchase. In selecting those products, the Board is to include factors such as affordability, promotion of health, wellness, and reduction of health disparities, market stability and adverse selection, and other factors. The seven-member Board of Directors nominated by the Governor will oversee operation of the exchange. Governor Dayton named Kathryn Duevel, MD, a retired OB/GYN from Affiliated Community Medical Center in Willmar, to the Board.
  • Changes to APRN Scope of Practice Parked for 2013- Legislation to alter dramatically the scope of practice for advanced practice registered nurses was introduced in the House and Senate this year, though neither received committee hearings. They likely will be heard in 2014. Under the bills, APRNs would be allowed full independent practice, free of collaboration with physicians. Under current law, APRNs practice under a collaborative agreement with physicians, and only a written agreement with a physician grants them prescribing authority.
  • The Health and Human Service budget provides increased funds for physicians- The HHS budget is about one-third of the state’s entire budget. It funds health care coverage, nursing home services, welfare payments, disability programs and more for low-income Minnesotans. This is the first HHS budget bill that has increased overall spending in six years. The decrease in general fund spending was offset by increased federal matching money, more revenue from surcharges on hospitals and health plans, and increased use of the state’s Health Care Access Fund (HCAF). While we are troubled by the use of the HCAF to fund more and more of our health care programs, the increased spending for medical education, public health improvement, and physician payment rates were all priority issues for many physicians groups this year.
  • Below are some of the more notable elements of the funding package:

    • MERC-The HHS budget bill restored funding to the Medical Education and Research Cost (MERC) program to levels that existed prior to the deep cuts of 2011. The bill increases funding by $6.4 million each year. Federal matching funds will increase the new money to medical training sites by $12.8 million each year. This money is used predominantly for physician residency programs throughout the state.
    • SHIP- Funding for the State Health Improvement Programs (SHIP) increases by $17.5 million each year for the next two years. The SHIP money provides grants to cities, counties, and school districts to develop local programs to address tobacco use and obesity. These grants were established in 2008 as part of Minnesota’s health reform legislation.
    • Medicaid (MA) Payment Increases-The HHS budget bill provided a small increase for payments in the fee-for-service portion of MA, the portions of the program for the disabled and elderly, not the much larger managed care program. While not a large increase, it is the first time since 2000 that payments have been increased. Payments for services using primary care codes for MA patients will eventually see an increase of approximately 20% because of the Affordable Care Act’s requirement that these codes be paid at Medicare levels. That increase was effective on January 1, 2013. The Department of Human Services is still working on mechanisms to make those retroactive payments. Also, the 3% across the board cut that was implemented in 2011 expires on July 1 so payments will be increased by 3% at that time.
    • Basic Health Plan- HF 1233 changed the MinnesotaCare program to make it compliant with the Basic Health Plan requirements in the ACA, removing the $10,000 cap on inpatient hospital coverage, the $1,000 co-pay requirement for hospital coverage, and the requirement to be uninsured for four months before qualifying for MinnesotaCare, while modifying the sliding scale premium requirements. These changes will result in more people below 200% of the federal poverty level who are not eligible for Medicaid getting better coverage through MinnesotaCare.
    • Criminal Background Checks for Newly Licensed Physicians- The Board of Medical Practice must begin requiring criminal background checks no later than January 1, 2018 for all new applicants for initial licensure and those applying for reinstatement of a suspended license. These background checks are with the Minnesota Bureau of Criminal Apprehension (BCA) for state crimes and the FBI for federal crimes. This requires the submission to fingerprinting by the applicant. The Board must also work with the BCA to develop a plan byJanuary 1. 2017 to implement background checks to all licensees. Currently 37 state medical boards require criminal background checks for physician licensees.
    • Medicaid Expansion Signed into Law- Governor Dayton signed the Medicaid expansion bill into law onFebruary 19. MN-ACP along with other Primary Care organizations encouraged support of this bill that expands access to Medicaid for tens of thousands of low income Minnesotans. The federal government will pick up 100% of coverage costs for childless adults earning less than $15,414 annually for the first three years, and in the future will fund 90% of those costs. Many individuals currently covered by MinnesotaCare will be shifted to Medical Assistance. The savings to the state over next four years are expected to total more than $1 billion.

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Contact Information

Heather E Gantzer, MD FACP, Governor, Minnesota Chapter

Chapter Staff:
Katherine Cairns, Executive Director
1043 Grand Ave. #215
St. Paul, MN 55105
651-492-1994
Fax: 651-699-7798
Minnesota.ACP@gmail.com