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Maps of Healing: Rural Horizons of Tertiary Care

BY Fateh Bazerbachi, MD

A silent crisis is unfolding across America’s heartland, threatening not just rural communities but one of the nation’s most vital economic engines. Beyond the headlines of supply chain disruptions and food security lies an even more pressing challenge: rural Americans are increasingly cut off from the advanced medical care that their urban counterparts take for granted. The challenge stems from a fundamental mismatch between medical economics

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100 Most Influential: Health Care Leaders

We are pleased to present this special feature recognizing 100 leaders who help make health care in Minnesota a global model of excellence. Once every four years we invite our readers to submit the names of colleagues whose outstanding leadership can be acknowledged in these pages. We thank all those who participated in the nomination process and those who helped with the submissions.

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Assessing and Advancing Community Health: The overarching value of equity

BY Brooke Cunningham, MD, PhD

Every five years, as part of our public health accreditation process, the Minnesota Department of Health (MDH) releases the Minnesota Statewide Health Assessment (SHA). The SHA is a comprehensive examination of health in our state. Because it focuses on health, it examines health outcomes and the health-related social factors that contribute

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Health Care at the Crossroads: Securing the future of patient care

BY Lisa Schweiger, MD, and Nick Venosdel, MD

The human psyche is remarkably adept at normalizing. While this confers an exceptional capacity for resilience, this plasticity frequently allows for the disallowable. Physicians are not immune to this. Health care leadership in the United States has undergone a disturbing transformation in the past 15+ years, as it has changed from a small scale, local and regional model led by physicians, to a system increasingly dominated by multi-state, national and multi-national

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AI-Powered Olfactory Sensor Technology: The electronic nose in medicine

BY CHRIS CAMPBELL, CEO

The field of medical diagnostics is rapidly evolving with transformative advancements in every field. An area of particular significance involves the integration of artificial intelligence (AI) olfactory sensor technology. AI-powered olfactory sensor technology promises to reshape how we detect and diagnose a wide range of medical conditions,

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Hospital at Home: Inside a growing trend

BY DAVID W. PLOCHER, MD

Hospital at Home (HaH) is defined as a care management program designed to deliver acute care hospital services to medium acuity patients in their homes. While this model of care has been around for decades, there is recent growth in enthusiasm for its benefits. Its origins can be traced to the UK, Canada and Israel in the 1970s. In the United States, Johns Hopkins is credited for taking the first steps in 1995. They encountered barriers, however, with local payers,

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Physicians and Adaptive Change: The little med school on the prairie

BY CINDY FIRKINS-SMITH, MD, MHCI, FAAD

Like many physician-leaders, I did not choose the path of leadership with any deliberate intent. But as physicians we are leaders, whether we think we are or not. We lead care-delivery teams, we lead patients in shared decision-making, and we lead at home and in our communities.

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Freedom Echoing: A legislative fix for health care?

BY KIP SULLIVAN, JD

For over 50 years, Minnesota’s method of containing health care costs has not changed. Beginning with the Health Maintenance Act of 19733, we have relied on one iteration or another of the tactics pioneered by HMOs, including exposing doctors to financial incentives to reduce services, robbing doctors of their autonomy by imposing prior authorization and other forms of micromanagement, and limiting patient choice of provider.

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Serious Illness Communication: Building a statewide standard of care

BY LORI BROSTROM, MB

Atul Gawande, MD, MPH, in his ground-breaking book “Being Mortal: Medicine and What Matters in the End,” talks about how medicine so often “fails the people it is supposed to help,” especially with respect to the elderly and those with terminal illnesses.

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The Minnesota RETAIN Study: Chiropractic care in return to work issues

BY DEB ZURCHER, LAC, DC

Workplace injuries, and their resulting economic impact, make up a much larger issue than most people are aware of. According to the National Safety Council, in 2021 the financial impact was $167 billion and 70 million injuries occurred at work.

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A Crisis in Home Health Direct Care: The Minnesota Solutions Model

BY JESSE BETHKE GOMEZ, MMA

The model of the health care delivery system in the United States has hospitals, clinics and specialty medical services on one side. On the other side are home health direct-care services, along with community-based services. The home health side is facing a complex crisis at the heart of which are personal care assistants (PCAs). Among other concerns, for individuals who rely upon PCAs for daily living, there is more demand than supply.

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Shell Game Economics: Corporate medicine wins, you lose

BY DAVID FEINWACHS, MA, MHA, JD, PHD

Since 1984, most Minnesotans enrolled in Medicaid, a program funded by all taxpayers, have not really been able to choose their own doctor. For the past two years, Health Policy Advocates (HPA), a volunteer citizens’ group, has championed bills in the Minnesota legislature that would give all Medicaid enrollees the right to opt out of managed care. These bills, SF404 and HF816, could give all Medicaid recipients the freedom to choose.

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The Minnesota CANDOR Act: Addressing adverse events

BY NELS E. DYSTE

On August 1, 2023, a transformative shift in health care communication took place as the Minnesota CANDOR Act (bill SF2909) came into effect. This legislation, inspired by similar efforts in other states, aims to revolutionize the way physicians and patients navigate the aftermath of adverse medical events (AMEs). With the increasing frequency of nuclear verdicts, Candor is a welcome new too.

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Artificial Intelligence in Medicine: A look at where we are today

BY CHESLEY CHEN, MS, MBA

There’s been a lot of interest recently in artificial intelligence (AI) and rightfully so. The technology has made rapid advancements in the last several years and is already being used to automate tasks and improve workflows. And its ability to use human language can be surprisingly good.

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Navigating Drug Shortages: Preparedness and patient advocacy

BY DAVID J. MARGRAF, PharmD, PhD AND STEPHEN W. SCHONDELMEYER, PharmD, PhD

The health care industry is faced with an alarming rate of drug shortages, posing significant challenges for physicians and patients alike. In July 2023, there were 309 drug products in shortage according to the American Society of Health-System Pharmacists (ASHP)—a record high for the last decade. A large share of these ongoing shortages are sterile injectable forms of critical acute drug products that are used in emergency situations.

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Moral Injury in Health Care: A growing concern

BY WENDY DEAN, MD

A few weeks ago, at the end of a talk about clinician distress, a physician in the audience stood up and said, “No one’s medical school application says they want to maximize profits for health systems. All of us – ok, except maybe one or two in every class who are mercenary – wanted to help people, and when we can’t do that anymore, it’s excruciating.”

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Health Care Utilization: Finding the right balance

BY ZEKE MCKINNEY, MD, MHI, MPH

Underutilization in healthcare is not a new concept, but it is one that has not received as much attention as the related problem of overutilization. In a perfect world, “correct” utilization is similar to the concept of the “five rights” of medication use, which describe ensuring the right patient gets the right medication at the right time via the right route of administration and at the right dose.

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Mission Management: Connecting hospital trustees and physicians

BY DANIEL K. ZISMER, PhD

During a presentation to a not-for-profit community health system all-boards retreat, I asked the following question of the system CFO: “What do you need as a profit margin from commercial third party payers to compensate for losses on uncompensated care, and reimbursements from governmental payers.”

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Long COVID: Facing a shadow pandemic

BY KATE MURRAY, MPH, AND RUTH LYNFIELD, MD

A middle-aged patient complains that he still hasn’t recovered from COVID-19 after several weeks. In addition to persistent digestive issues, he is sidelined by extreme fatigue after minimal activity, whereas last year he was running half-marathonsy.

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Trouble Ahead: Medicaid disenrollment looms

BY MATTHEW ANDERSON, JD

Arguably, the most significant and underappreciated health policy response to the COVID-19 pandemic is quietly coming to an end and creating the potential for the largest increase in uninsured residents in Minnesota’s history. Minnesota’s physicians, as well as health care employees from clinic receptionists to finance office staff members,

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Consolidation in Health Care: Post pandemic economics

BY DANIEL K. ZISMER, PhD

Health care trade publications are reporting that U.S. hospital-centric health systems are in for another phase of consolidation and changes in ownership control. Why? Crashing financial performance for many are driving credit rating down drafts. Threats of receivership, out-right closures, and “shotgun weddings”; i.e., forced mergers and acquisitions have returned. Additionally, a few are reporting “full beds” with negative operating financial performance.

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Connecting Primary and Specialty Care: Improving medical practice

ELIZABETH SEAQUIST, MD

Advances in medical science are increasing exponentially. New methods of diagnosing and treating illness are developed faster than they can be practically incorporated into best practice. At the same time demand for health care services exceeds supply and workforce shortage issues add difficult new dynamics to the process of keeping pace with change.

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Mending a Racket: Empower-Patient Accounts

BY ROBERT KOSHNICK, MD, FAAFP

There is a lot broken in our health insurance system. Health care costs in the U.S. are far higher than the rest of the world. Most people agree this is a problem. Health care went from 5 percent of the gross domestic product (GDP) in 1960 to 19.7 percent in 2020. These costs put a strain on the financial security of individuals and businesses as well as being the primary driver of our federal budget deficits.

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Perfect Occupancy: Why everyone needs coordinated care

BY JESSE BETHKE GOMEZ, MMA

According to the US Census Bureau’s American Community Survey 2020 estimates, there are 875,566 adults over 65 years of age and 603,886 people with disabilities in Minnesota. The State Demographer’s Office estimates that by 2030 the number of older adults will grow to over 1,260,000. Even adjusting for the fact that 30% of older adults also have some kind of disability, this still means that over 20% of our population is either older, with disabilities or both.

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The Moral Law Within: Care beyond medical services

BY JULIA JOSEPH-DI CAPRIO, MD, MPH

A significant part of each of our health is determined by what happens outside of a health care office or hospital. Some estimates suggest that as much as 80% of health status can be attributed to non-medical factors. This is why medical care alone is insufficient for achieving better health outcomes. I am a pediatrician and adolescent medicine specialist.

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Optimum Medical Care: The role of telemedicine

BY WAYNE LIEBHARD, MD

Trying to determine what constitutes optimum medical care is a not an easy task. Nonetheless, this question needs to be posed, and an attempt needs to be made at an answer. Why? Because the entire endeavor of providing medical care–like so many other services–is geared toward providing not only what consumers desire, but also providing what is best for them–the optimum.

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Minnesota’s Healthcare Workforce Shortage: A growing crisis

BY TERI FRITSMA, PhD

Health care workforce shortages are not new. For years leading up to the COVID-19 pandemic, communities around Minnesota—particularly those outside major metropolitan areas—have had too few physicians, nurses, mental health, dental and direct care providers to meet both the hiring demand and the need for services.

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Co-opetition: An emerging trend in health care

BY DAVID J. VOLLER, MBA, FACHE

Co-opetition is a term that is emerging in business theory and is now gaining traction as an important part of health care. The principles and practices of co-opetition are credited to New York University and Yale business professors Adam M. Brandenburger and Barry J. Nalebuff. They introduced concepts in their book “Co-opetition,” first published in 1996.

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Health Capability: Advancing the potential to flourish and thrive

BY JENNIFER J. PRAH, PHD, MSC, MA, MSL

Medical science is evolving at an unprecedented rate. Advances in diagnostics, surgery, pharmaceuticals, technology, and more, are developing more expeditiously than the ability of the health care delivery system to keep pace. In some cases, before an important advance has become accepted best practice, new advances in the same field have already occurred. Fundamental approaches to health have not received the same attention.

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Tiered Cost-Sharing Health Insurance: Is this the Holy Grail?

BY BRYAN DOWD, PHD, TYLER BOESE, AND TIM MCDONALD

The affordability of health care and health insurance in the U.S. is a problem that is beginning to affect the middle class, including those enrolled in employer-sponsored health insurance, the Affordable Care Act Exchanges and Medicare. Prior to the COVID-19 pandemic, the average premium for family coverage health insurance in 2019 was approximately 30% of median household income.

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Health Care Supply Chain Dynamics: Finding room for improvement

BY LUIS VALADEZ

The concept of supply chain management is relatively new, first appearing in 1983. Prior to the industrial revolution, manufacture of nearly everything was local and relied on local resources. Greater production capacities brought greater supply chain needs, but they were constrained by simple exigencies such as delivery options.

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Understanding Ageism: Prejudice against our future self

BY DAWN SIMONSON, MPA

Americans are conflicted about aging. We seek longevity but fear growing older. And no wonder. According to California State University psychology professor Todd Nelson, “Old age is stereotypically perceived as a negative time–the older person suffers declines in physical attributes, mental acuity, loss of identity (retirement from job), loss of respect from society and increasing dependence on others.

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CMS Reimbursement Cuts: Congress wants your money

BY Christopher Crancer and Zachary Brunnert

Like the plot of Groundhog Day replaying itself year after year, physicians once again need to rally together to convince Congress and Centers for Medicare and Medicaid Services (CMS) that cuts, in some cases exceeding 9.75% to Medicare reimbursement, are not beneficial, particularly at a time when so much is asked of our health care system.

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Culture Care Connection: Keeping pace with change

BY SUSAN SEVERSON

To support physicians and other clinical and non-clinical health-care professionals who are serving a patient population whose members may not speak English or be familiar with or trustful of traditional U.S. medical practices, Culture Care Connection (http://culturecareconnection.org) has been reimagined and redesigned to keep pace with changing needs.

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Private Equity in Health Care: A Growing Trend

BY RANDAL SHULTZ, JD AND BEN PELTIER, JD

Now more than ever, physician groups and other health care providers are looking for ways to work with private equity funds as an opportunity to grow their practice without selling it. Hospitals and national health care entities are acquiring physician practices at an extraordinary rate. But not all physicians want to sell to these organizations. Many physicians like owning their business and leading the changes occurring in health care.

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Maternal and Infant Health Disparities: Strategies for Reductions

BY RUTH RICHARDSON, JD AND ALICE MANN, MD, MPH

In 2020, Minnesota leaders declared racism a public health crisis – including the Hennepin County Board, the Minnesota House of Representatives, the Minneapolis City Council and Mayor and the Olmsted County Board of Commissioners. The Minnesota House became the first legislature in the nation to pass a statewide declaration naming this crisis and created the House Select Committee on Racial Justice.

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Responding to Human Trafficking Victims: Core Competencies for Health Care Providers

CAROLINE PALMER, JD

Over the past decade, many states have increased their abilities to serve victims of human trafficking. For example, in Minnesota, state law and funding priorities have focused particularly on the needs of sexually exploited and trafficked youth under age 25 through the Safe Harbor program, while more recent legislation as well as federal grants.

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Ransomware in the Age of COVID-19: Addressing cybersecurity issues

BY MATTHEW C. BERTKE, CPA, MBA

2020 was a year that saw many changes and one that particularly affected the healthcare community. But while U.S. healthcare workers remained on the front lines heroically battling the COVID-19 pandemic, another hidden menace has been steadily increasing in prevalence underneath the radar.