Minnesota Health care News November 2011

November 2011 • Volume 9 Number 10

Your Guide to Consumer Information FREE

Pre-existingconditioninsuranceJackie Garner

Chronic venousinsufficiencyJohn Martin, MD, FASC

Medicareopen enrollmentMichele Kimball

You call it

“reminding mom to take her pills.”

You or someone you know may be a caregiver. WhatIsACaregiver.org

We call it caregiving.

Advisory Board: Minnesota Medical Association (MMA), Minnesota Hospital Association (MHA), MinnesotaMedical Group Management Association (MMGMA), Buyers Health Care Action Group (BHCAG), MinnesotaBusiness Partnership (MBP), Minnesota Healthcare Network (MHN), Advocates for Marketplace Options forMainstreet (AMOM), Minnesota HomeCare Association (MHCA), Minnesota Physician-Patient Alliance (MPPA),Physicians Service Network (PSN), Minnesota Center for Rural Health, and Minnesota Council of Health Plans.

Minnesota Health Care News is published once a month by Minnesota Physician Publishing, Inc. Our addressis 2812 East 26th Street, Minneapolis, MN 55406; phone (612) 728-8600; fax (612) 728-8601; [email protected]. We welcome the submission of manuscripts and letters for possible publication. All viewsand opinions expressed by authors of published articles are solely those of the authors and do notnecessarily represent or express the views of Minnesota Physician Publishing, Inc., or this publica-tion. The contents herein are believed accurate but are not intended to replace medical, legal, tax,business, or other professional advice and counsel. No part of this publication may be reprinted orreproduced without written permission of the publisher. Annual subscriptions (12 copies) are$36.00. Individual copies are $4.00.

NOVEMBER 2011 MINNESOTA HEALTH CARE NEWS 3

10

12

18

14

16

PUBLISHER Mike Starnes [email protected]

EDITOR Donna Ahrens [email protected]

ASSOCIATE EDITOR Mary Scarbrough Hunt [email protected]

ASSISTANT EDITOR Scott Wooldridge [email protected]

ART DIRECTOR Elaine Sarkela [email protected]

OFFICE ADMINISTRATOR Juline Birgersson [email protected]

ACCOUNT EXECUTIVE John Berg [email protected]

ACCOUNT EXECUTIVE Sharon Brauer [email protected]

ACCOUNT EXECUTIVE Iain Kane [email protected]

www.mppub.com

NOVEMBER 2011 • Volume 9 Number 10

VASCULAR MEDICINEChronic venousinsufficiencyBy John D. Martin, MD, FACS

CALENDARNational familycaregivers month

PAIN MANAGEMENTPalliative careBy Michele Fedderly, EdD

HOME CAREThere’s no placelike homeBy Amy Nelson

ONCOLOGYLymphomaFrom the Lymphoma ResearchFoundation

INSURANCEHealth insurance forpeople who can’t get itBy Jackie Garner

HOLISTIC HEALTHMedicine and the artsBy Gary A.-H. Christenson, MD

PERSPECTIVE

10 QUESTIONS

7 PEOPLE

NEWS4C O N T E N T S

Kristin Becker, ND

The NaturalPath to Health

Emily Gunderson

MOFAS

HEALTH CARE REFORMMaking headway inmental healthBy Sue Abderholden, MPH

MEDICARENavigating Medicareopen enrollmentBy Michele Kimball

30

82022

24

28

Exp. Date

� Check enclosed � Bill me � Credit card (Visa,Mastercard, American Express, or Discover)

Please mail, call in or fax your registration by 04/12/2012

MINNESOTA HEALTH CARE ROUNDTABLEMINNESOTA HEALTH CARE ROUNDTABLE

Background and focus:Medications treating chronicand/or life-threatening dis-eases are frequently newproducts, which are oftenmore expensive than genericor older, branded productsthat treat similar conditions.The term specialty pharma-cy has come to be associ-ated with these medications.Exponents claim the newtechnology improves qualityof life and lowers the costof care by reducing hospital-izations. Opponents claimthe higher per-dose costspread over larger popula-tions does not justify theexpense.

The cost of research, bothfailed and successful, is reflected in product pricing. Currentfederal guidelines allow generic equivalents marketplace accessbased on the patent date, not the release date, of a product. Thisconsiderably narrows the window in which costs of advances maybe recovered. A further complicating dynamic involves the payers.Physician reimbursement policies sometimes reward utilizinglower-cost “proven” products and cast those prescribing higher-cost products as “over-utilizers,” placing them in lower-tieredcategories of reimbursement and patient access.

Objectives: We will discuss the issues that guide the earlyadoption of new pharmaceutical therapies and how they relate tomedical devices. We will examine the role of pharmacy benefitmanagement in dealing with the costs of specialty pharmacy. Wewill explore whether it is penny-wise but pound-foolish to restrictaccess to new therapies and what level of communication withinthe industry is necessary to address these problems. With the babyboomers reaching retirement age, more people than ever will betaking prescription medications. As new products come down thedevelopment pipeline, costs and benefits will continue to esca-late. We will provide specific examples of how specialty phar-macy is at the forefront of the battle to control the cost of care.

T H I R T Y - S E V E N T H S E S S I O N

Please send me tickets at $95.00 per ticket. Mail orders to MinnesotaPhysician Publishing, 2812 East 26th Street, Minneapolis, MN 55406.Tickets may also be ordered by phone (612) 728-8600 or fax (612) 728-8601.

Name

Company

Address

City, State, Zip

Telephone/FAX

Card #

Signature

Email

Thursday, April 19, 20121:00 – 4:00 PM • Duluth Room

Downtown Mpls. Hilton and Towers

Specialtypharmacy

Controlling the cost of care

UCare, CaringBridgeForm PartnershipMinneapolis-based UCare hasannounced it will begin workingwith CaringBridge, an onlineservice that allows people withserious medical conditions toupdate friends and familiesthrough a personalized website.

CaringBridge websites arefree and not only allow patientsand their families to get informa-tion out about health conditions,but also provide a place for peo-ple to leave messages of support.It also lessens some of the stressin clinical situations, when in thepast medical staff might have tohelp notify loved ones.

According to Jeri Peters, clin-ical services director for UCare,the new partnership will allowCaringBridge officials to trainUCare support staff in how to talkto patients during difficult healthsituations and help them explorevarious options for informingothers or seeking support.

“It will be one more resourcefor us when we have members

who are challenged with a veryserious health condition,” Peterssays. “CaringBridge removessome of the burden of primarycaregivers from communicatingwith a long list of individuals. Italso helps ensure that accurateinformation and the same infor-mation is given. And peopledon’t have the cost of all of thosephone calls.”

With the announcement,UCare becomes the third insur-ance company to establish anofficial partnership with Caring-Bridge. Minnetonka-basedMedica is another insurance part-ner with CaringBridge, and thereis a long list of health systemsand hospitals that work with thegroup in Minnesota as well.

State Ranks No. 1in Long-Term CareA new report lists Minnesota asNo. 1 in the U.S. for delivery oflong-term care services and sup-port to state residents.

The report, Raising Expec-tations: A State Scorecard on

Long-Term Services and Supportsfor Older Adults, People withPhysical Disabilities, and FamilyCaregivers, was released by theAARP, the Commonwealth Fund,and the SCAN Foundation inSeptember.The analysis findswide variation in the quality ofservices and support delivered toseniors and families. It examinesfour key elements of long-termcare delivery performance: afford-ability and access; choice of set-ting and provider; quality of lifeand quality of care; and supportfor family caregivers.The reportassesses states’ performances onthose larger goals by looking at25 individual indicators.

Officials say that some of thelong-term care indicators weremeasured in the study for thefirst time. “This report will helpstates make and sustain targetedimprovements so that people canlive and age with dignity in theirown homes and communities,”says Susan Reinhard, AARP sen-ior vice president for public pol-icy. “Achieving a high-performing,long-term support and services

system will require a concertedeffort from both the public andprivate sectors.”

Minnesota,Washington, andOregon were found to be the topthree states in delivering long-term care services and support.However, officials say, even thetop states need to do more workto create higher-performing sys-tems of services and supportfor seniors.

“All states need to vastlyimprove in areas including homecare, assisted living, nursinghome care, and support for fam-ily caregivers, and more efficient-ly spend the substantial fundsthey currently allocate to long-term services and support,” thegroups say in a statement.

Minnesota ranked fourthnationally in affordability andaccess to long-term care servicesand support; third in choice ofsetting and providers; fourth inquality of life and quality of care;and fourth in support for familycaregivers.

N E W S

4 MINNESOTA HEALTH CARE NEWS NOVEMBER 2011

Grant Will Help StateMonitor Increases inInsurance PremiumsMinnesota will get nearly $4 mil-lion from the federal governmentto establish a system to monitorinsurance premium increases.

The funding was announcedlast week as part of $109 millionin grants to 28 states, a movethat federal officials say will holddown premium increases andimprove transparency.

The new program is part ofthe Affordable Care Act (ACA),and requires health insurersseeking to increase their rates by10 percent or more in the individ-ual and small group markets toundergo an evaluation to deter-mine if the rate increases are rea-sonable. Prior to this announce-ment, the U.S. Department ofHealth and Human Services(HHS) had already given $48 mil-lion to 42 states to help set uprate review systems.

“We’re committed to fightingunreasonable premium increasesand we know rate review works,”said Secretary Sebelius. “Statescontinue to have the primaryresponsibility for reviewing insur-ance rates, and these grants givethem more resources to hold in-surance companies accountable.”

Hennepin Healthcare,HFA Discuss MergerHennepin Faculty Associates(HFA), the independent medicalgroup that contracts with Hen-nepin County Medical Center(HCMC), is discussing a mergerwith the health system that ownsHCMC.

HFA has nearly 400 providermembers. It provides medicalservices at HCMC’s hospital andclinics, and owns the MinneapolisMedical Research Foundation.

In 2007 Hennepin HealthcareSystem took over day-to-day gov-ernance of HCMC and its clinicsfrom Hennepin County, whichcontinues to own the health sys-tem and its assets.

In a statement released Sept.22, Gina Flak, manager of HFA

corporate communication andmarketing, said, “HennepinFaculty Associates is exploringwith Hennepin HealthcareSystem, Inc. the possibility ofintegrating HFA into HennepinHealthcare System. At this stage… a confidentiality agreement isin place that prohibits us fromreleasing additional details.”

U of M ResearcherTo Develop Tools forMedic TrainingA University of Minnesotaresearcher will lead a new con-sortium to develop new trainingtools and methods for combatmedics.

University of Minnesotaurologic surgeon and simulationexpert Robert M. Sweet, MD,FACS, will be the principal inves-tigator on a three-year $11 milliongrant program to analyze futureneeds in medic training and todevelop simulation tools toimprove that training.

“New training capabilitiesmay potentially save the livesof service members as trainingshifts to state-of-the-art approach-es to combat medicine,” saysSweet, who also directs the U ofM Medical School’s SimulationPrograms. “With our militarypartners, we plan on providingmeans of skills assessment andrecommendations on revisingtraining curricula for some of themost critical injuries and traumaroutinely seen on the battlefield:massive bleeding (hemorrhage)and airway management.”

Officials say simulation tech-nology, which has become com-monplace for training in aviationand aerospace, is still under-developed in the health carefield.The new consortium willseek to create a unique combina-tion of medical education andrealistic simulation for medics-in-training.

“It’s one thing to effectivelyand safely perform these skills ina controlled setting; it’s anotherto do it under the duress of bat-tle,” says Sweet. “Our facilities

News to page 6NOVEMBER 2011 MINNESOTA HEALTH CARE NEWS 5

Yes, you can! Take these steps:

Lose about 10 pounds if you are overweight

Move and be active at least 30 minutes a day

Eat low fat foods and smaller portions

You don’t have to do it alone! Check out a group program near you to help make these changes:

YMCA www.ydpp.org or 612-465-0489

Other locations in Minnesota www.icanpreventdiabetes.org or 651-201-5435

Talk with your doctor to see if you are at risk for developing type 2 diabetes

In partnership with the Minnesota I CAN Prevent Diabetes and YMCA Diabetes Prevention Programs

The Minnesota Diabetes and Heart Health Collaborative: Working together to keep you informed

Minnesota Diabetes &Heart Health Collaborative

www.mn-dc.org

Bringing healthcare home.Serving all ages at home with our extensive

inventory of medical products and equipment.

We make ordering easy with our convenient monthly ordering system and knowledge of insurance billing.

We pledge to make your experience a pleasant one.You can read about our Gold Key Service Pledge on

our web page, or simply call the numbers below.We want to help you!

P: 651.792.3860 TF: 877.309.4271www.keymedicalsupply.com

Full-Selection of Diabetic

Supplies

F nFull-Selection of Diabetic

Supplies

will simulate the sights, sounds,and smells of the battlefield andour human factors team willbe monitoring medics’ stressresponses to the situation as theyperform these life-saving maneu-vers.We want them to feel likeit’s real so that they don’t freezeup the first time they have to per-form these skills in combat.”

Communities Join“do” CampaignThree metro-area communitieswill partner with Blue Cross andBlue Shield of Minnesota in an18-month project to improvehealth through good nutritionand active living choices.

The project is part of BlueCross’ ongoing “do” campaign,and will be called “do.town.”Themayors of Bloomington, Edina,and Richfield announced thecreation of do.town on Sept. 27along with officials from BlueCross and other community lead-ers.They say the goal of the ini-

tiative is to make their communi-ties places where the healthychoice is the easy choice by giv-ing residents more opportunitiesto eat right and be physicallyactive, and by creating healthierhomes, schools, and workplaces.

“We believe healthy commu-nities are strong communities,but barriers to healthy living areeverywhere,” said Edina MayorJames B. Hovland. “To help ourresidents succeed in being activeand eating well, we needed apartner with proven expertise inhelping people by making theirsurroundings—where they live,work and play—healthier.”

Blue Cross’s “do” campaignhas been part of a high-visibilityeffort to promote active lifestylesthrough a range of strategies.

With the do.town initiative,city officials will conduct outreachand listening sessions in eachcommunity to better understandwhat barriers currently exist, thenhelp community members makehealthier choices.

Officials say the campaignmay take steps such as working

to make biking or walking toschool safer; helping improveaccess to healthy foods at work,school and in faith organizations;or allowing more communitygardens to serve people with lowincomes.The initiative’s websiteis www.do-town.org.

UHG Study FindsConfusion aboutMedicareIn September, Minnetonka-basedUnitedHealthcare (UHC) releaseda study that finds a large percent-age of Medicare recipients andboomer-age Americans do nothave a good understanding ofMedicare benefits and thechanges to the program thatwill occur under the AffordableCare Act (ACA).

UHG and the NationalCouncil on Aging surveyed 1,000seniors and found that morethan half of the respondentsfound Medicare confusing or didnot understand it at all. Nineteenpercent of those enrolled in the

program said they did not knowwhat type of Medicare coveragethey have. Confusion over ACAchanges is common as well. Only12 percent of seniors said theyhad a good understanding ofwhat changes would come toMedicare under the new healthreform law.

“Without a solid grasp of thebasics of Medicare, older adultsare not well positioned to under-stand their options and find thecoverage that best meets theirneeds,” says Jim Firman, presi-dent and CEO of the NationalCouncil on Aging. “These find-ings show that Medicare benefici-aries either are not getting theinformation they need to under-stand the program or that theinformation currently availableisn’t resonating with them. Bothscenarios are worrisome todaybut also of great concern giventhe significant growth onthe horizon for Medicare asboomers age.”

News from page 5


Appointments:

Online or Call 651-439-8807

Providing care at multiple modern clinics in Minnesota and Wisconsin

In 2008, Tanzanian missionaries brought little Zawadi Rajabu to the U.S. to seek treatment for her two severely clubbed feet. A physician referred Zawadi to Dr. Mark T. Dahl of St. Croix Orthopaedics. Using the Ilizarov Method, Dr. Dahl surgically changed the course of Zawadi’s feet and her life.

Dr. David Palmer and Russ McGill, OPA-C, recently traveled to Tanzania on another of their frequent medical missionary trips. They dedicated an entire day to checking in on their partner’s patient. To their delight, they were greeted by 6-year-old Zawadi her face aglow, her healed feet dancing toward them.

Supporting Our Patients.Supporting Our Partners.SupportingYou.

David Palmer,M.D.& Zawadi’s brother

RussMcGill, OPA-C&Zawadi

multiple moderte aviding carorP innesota and n clinics in Multiple moder onsiniscWesota and

Judith Buchanan, DMD, PhD, a professor and

associate dean for academic affairs in the

University of Minnesota School of Dentistry,

has been appointed interim dean of the school.

Buchanan came to the University of Minnesota

in 2005, after serving as academic dean of

the School of Dentistry at the University of

Pennsylvania School of Dental Medicine from

1997 to 2005. Buchanan received a doctorate in

biochemistry from the University ofTexas in 1977, and her DMD

in 1980 from the University of Florida, College of Dentistry. She

served for 22 years in the military (in the National Guard and Army

reserves) and attained the rank of lieutenant colonel in the National

Guard. In 2003, she was deployed to run dental clinics in Bosnia

and Germany.

Nick Brown received the 2011 Judd Jacobson Memorial Award

from Courage Center at an award ceremony in October.The award

recognizes the pursuit or achievement of a business entrepreneurial

endeavor by a person with a physical disability or sensory impair-

ment.The 18-year-old Brown, who owns Nick’s Lawn Service in

Shakopee, has cerebral palsy and speech challenges, and uses a

power wheelchair to get around. He received $5,000 to advance

his business.

Caleb H. Creswell, MD, has joined Derma-

tology Specialists, PA, and is seeing patients at

the practice’s Edina and Eden Prairie locations.

Creswell graduated from the University of

Wisconsin Medical School and served as chief

resident at the University of Minnesota Depart-

ment of Dermatology. Creswell is a clinical

assistant professor of dermatology at the

University of Minnesota and is a member of the American Academy

of Dermatology and the Minnesota Dermatological Society. His

special interests include medical, surgical, cosmetic, and pediatric

dermatology.

Jonathan Nash, DDS, has joined Piedmont Heights Dental

Associates in Duluth in the practice of general dentistry. Nash is a

graduate of the University of Minnesota—Duluth and the University

of Minnesota School of Dentistry. He is a member of the Minnesota

Dental Association and the American Dental Association.

Chris Cintron, JD, MPA, has joined Hennepin County Medical

Center as the new chief clinic officer. Cintron has a broad background

in ambulatory leadership, most recently serving as vice president of

Ambulatory Care Services at Grady Health System in Atlanta, where

he led a division that included nine community-based, multispecialty

practices and 42 hospital-based practices. He had similar roles at

Bronx-Lebanon Hospital Center in NewYork and at NewYork

Methodist Hospital.

KimberlyTalbot has joined Orthopaedic Associates of Duluth as

a physical therapist. She specializes in orthopedic, sports medicine,

and manual techniques of the shoulder, hip, knee, foot, and spine.

Talbot has been working as a physical therapist in the area for the

past six years. She earned a master’s degree in physical therapy

from the College of St. Scholastica in Duluth, and is pursuing a

doctor of physical therapy degree, as well as additional certification

as an orthopedic specialist.

P E O P L E


Judith Buchanan,DMD, PhD

Caleb H. Creswell, MD

The Telephone Equipment Distribution Program is administered by the Department of Commerce Telecommunication Access Minnesota

(TAM) and funded by a telephone surcharge.

NOW

Do you know of family members, friends or neighbors who have difficulty using their telephone? Do they have

trouble hearing, speaking or have a physical disability that prevents them from using a standard telephone?

The Minnesota Telephone Equipment Distribution Programcan provide special telephone equipment at NO CHARGEto Minnesota residents of all ages!!

The equipment includes amplified (corded and cordless) phones, speakerphones, captioned telephones, telephone ring signalers, deafblind equipment and other special equipment.

To learn more about this program visit our Web site at: www.tedprogram.org or contact us at (800) 657-3663,(888) 206-6555 TTY.

Eligibility requirements do apply.

hear this!

To learn more call 651.842.6780www.sttheresemn.org

Palliative Senior Care with the Comforts of Home

Now Open!(Immediate availability)

Palliative care is designed to improve the quality of life at the time when an individual’s disease is not responsive to curative treatment.

rivate care suites and baths in a beautiful 8-bedroom home

-hour nursing supportastoral care programming for

Catholic and non-Catholic residents and their families

herapeutic whirlpool tubuiet and serene location close to

St. Odilia Catholic School and ChurchOngoing bereavement support for

family after the death of a loved one

Saint Therese at St. Odilia features...


EmilyGundersonMOFAS

Emily Gundersonis communica-tions director

of the MinnesotaOrganization

on Fetal AlcoholSyndrome(MOFAS).

The organizationprovides educationto professionals,parents, and othercaregivers, andworks to ensurethat all womenknow there isno safe level ofalcohol consump-

tion duringpregnancy.For more

information,please visit

www.mofas.org.

study released earlier this year in a wellrespected medical journal attracted a lotof national and local media when it sug-

gested that “light drinking” (defined as one totwo drinks per week) during pregnancy is notonly safe, but could actually be beneficial to thecognitive development of a child. Naturally,this made headlines in many newspapers andon television stations across the country.Unfortunately, these conclusions are not sup-ported by research and are just plain misleadingfor a number of reasons. The U.S. SurgeonGeneral has stated quite emphatically that thereis no safe amount or safe time to consume alco-hol during pregnancy, and studies have con-firmed this.

It is not illegal for a pregnant woman to drinkalcohol; alcohol is the most common substanceconsumed in our society today, and a womandoes have the right to make her own choices.However, it is unfair to put her in that positionwithout making sure that she has accurate, fac-tual information with whichto make her decision—espe-cially when the media saysthat it is safe for a woman todrink “lightly.” Alcohol hasbeen widely documented asa teratogen, which is anagent that can disturb thedevelopment of an embryoor fetus—i.e., it can causebirth defects or halt the preg-nancy altogether. Morespecifically, alcohol has been proven to cause arange of developmental disabilities called fetalalcohol spectrum disorders (FASD).

So, why is it so important to correct these misin-terpretations? Because prenatal alcohol expo-sure is the leading cause of preventable intellec-tual disabilities and behavioral difficulties in theUnited States. Because biological, foster, andadoptive families raising children permanentlyharmed by prenatal alcohol exposure can tell youcountless stories about how “a little alcohol” hascaused endless heartbreak for the children andtheir families.

The combination of amount of alcohol con-sumed, timing of consumption (i.e., the month ofpregnancy), and frequency (how often alcohol is

consumed) will determine the degree of prenatalalcohol exposure, but any combination of thesecan cause permanent brain damage in the devel-oping fetus, so why take a risk? Studies have con-sistently shown that alcohol use during preg-nancy poses a grave risk, so it is puzzling whysome physicians are still unwilling to issue aclear “No Safe Amount” message to theirpatients.

Here in Minnesota, as many as 8,500 babies areborn every year with prenatal alcohol exposure.Nationally, FASD affects one in every 100 livebirths. That’s more common than autism andDown syndrome combined, and it is 100 percentpreventable. The Minnesota Organization onFetal Alcohol Syndrome believes that we need toempower women with information so they canmake healthy choices while they are pregnant—particularly when it comes to alcohol.

So, getting back to the question, “How much istoo much?”—the answer is: We don’t know.

Everyone probably knowssomeone who drank duringpregnancy whose baby“turned out just fine.” Thisdoes not mean alcohol issafe, however. There isabsolutely no way of know-ing how any amount of alco-hol will affect your particularbaby. Every baby is different,just as every adult is differ-ent. Since the unborn infant’sbrain continues to develop

throughout pregnancy, it is always vulnerable tothe harmful effects of alcohol. So whether it’s you,your daughter, granddaughter, friend, or a patientwho is pregnant, please remember that noamount of alcohol is safe during pregnancy. Ifyou can remember just three simple numbers: 0,4, and 9—“Zero Alcohol For Nine Months”—youhave the power to save countless lives. Please askothers to spread the word, and together we cansave a whole generation.

There are very few things in this world that oneactually can change, but FASD is one of them.Wecan prevent the next generation from beingaffected by the many health disparities associ-ated with prenatal alcohol consumption.

How much alcohol during pregnancy is too much?“None for nine”

P E R S P E C T I V E

A

Nationally,

fetal alcohol syndrome

disorders affect one in

every 100 live births.

For more information, please visit us

at www.healthsavings.usbank.com

or call the U.S. Bank Health Savings

Solution Center at (800) 334-9207.

www.healthsavings.usbank.com

Copyright © 2006 U.S. Bank 02/2006 5009-06

Easy to implement.

In this era of escalating health carecosts, a Health Savings Account (HSA),paired with a High Deductible HealthPlan is rapidly gaining popularity withemployers and employees. Help yourorganization and your employeesmanage rising health care costs withU.S. Bank Health Savings Solution.Health Savings Solution provides thetools and support you need to offer anefficient and effective HSA program:

• Full service – custody, recordkeepingand reporting expertise

• A nationally recognized bank with a local presence

• Flexibility to address yourorganization’s specific requirements

• Proven track record ofsuccessful implementation

• Anytime account accessfor participants

U.S. Bank Health Savings Solution –offering an Institutional HSA productto employers, insurance companies,third party administrators and businessservices firms.

Easy to manage.

A proven product.Turning health care users

into smart consumers

U.S. Bank Health Savings SolutionSM

SM

Kristin Becker, ND, is founder of The Natural Path to Health in St Paul. She is also vicepresident of MNANP, the Minnesota Association of Naturopathic Practitioners.

How (and when) did naturopathic medicine begin? Nature-based medicine is thefoundation of modern medicine. But as pharmaceuticals developed and treatments such asbloodletting were used, nature-based practitioners began to distinguish themselves by usingherbs and emphasizing diet and hygiene. The term “naturopathy” was adopted in the early20th century to describe these practices. Around 1920, there were a number of naturopathicmedical schools in the U.S. (including one in Minneapolis), with thousands of naturopathicdoctors and patients using naturopathic therapies. The discovery of miracle drugs like peni-cillin, and the formation of a large medical system primarily based on pharmaceuticals, wereassociated with the temporary decline of naturopathic medicine. In the 1970s, however, theconsumer “wellness” movement led to the rebirth of naturopathic medicine in the U.S.

What kind of training does a naturopathic doctor receive? NaturopathicDoctors (NDs) have a four-year undergraduate degree in “pre-med” coursework prior toattending a U.S. Department of Education-accredited four-year residential naturopathicmedical school. This education is similar to any other medical school’s education in terms ofbasic sciences and clinical courses. The training is based on general practice, with additionalcoursework in clinical and physical diagnosis, physical examinations, laboratory testing,pharmacology, and minor surgery, as well as herbal medicine, clinical nutrition, nutritionalsupplementation, lifestyle counseling, homeopathy, and physical medicine.

How does naturopathy differ from medical doctors and homeopaths?NDs are experts in holistic and natural medicines. Medical doctors are experts in pharma-ceuticals and surgery. Both forms of medicine work well together because they “speak thesame language,” as they are both trained in Western medicine and use scientific research tosupport their clinical practices. NDs are like primary care physicians or general practition-ers, in that they don’t specialize in just one system of the body. NDs emphasize preventionand promote wellness. Although the focus is on diet and lifestyle changes, natural therapeu-tic supplements and modalities, NDs are also trained in pharmaceuticals and minor surgery.Although NDs cannot prescribe pharmaceuticals in Minnesota, this expertise is vital tounderstanding drug-nutraceutical interactions. Homeopathy is a unique medicine that isused to stimulate the body’s own healing process. Naturopathic medical schools includetraining in homeopathy, which NDs may use as one of their treatment methods.

What kinds of interactions do you have with doctors from other branchesof medicine? Most NDs work in private practice and regularly consult with other practi-tioners, sometimes referring patients to specialists when deemed necessary. As experts indrug-nutraceutical interactions, we are often consulted by other doctors to ensure that it issafe for a patient to combine their medications with supplements. Some NDs work in inte-grative clinics with other conventional and holistic practitioners.

What kinds of medical conditions do you see most commonly? As generalpractitioners, NDs see patients with all kinds of ailments, from acute infections to chronicdiseases such as rheumatoid arthritis or diabetes. Naturopathic medicine has effective treat-ments for numerous conditions, including cardiovascular, autoimmune, lung, and digestive


Kristin Becker, ND

1 0 Q U E S T I O N S

Photo credit: Bruce Silcox

&

diseases, endocrine disorders, chronic pain, and allergies. Becausewe treat the underlying cause of the disease, we can succeed withhard-to-treat conditions such as fibromyalgia, chronic fatigue,migraines, skin disorders, ADHD, and syndromes that cannot beeasily diagnosed.

What kinds of treatments do you use? My treatment plansaddress diet, nutrition, and lifestyle issues, supported with nutritionalsupplements and herbal remedies. I also offer visceral manipulationand craniosacral massage therapy, and recommend hydrotherapyhome treatments. But each ND is unique, guided by our philosophiesand not just our modalities. Some NDs may use more homeopathy,Ayurvedic, or Chinese medicine.

What is meant by saying naturopathy is defined byphilosophies, not treatment methods? NDs believe in thebody’s ability to prevent and combat disease, if obstacles to healthare removed. We spend a lot of time educating patients Our focus isoptimal wellness and prevention, not just the removal of disease. Wetreat the cause and not just the symptoms of disease while doing noharm. NDs treat each individual by considering physical, mental,emotional, genetic, environmental, and social factors.

These philosophies define our profession, not the treatmentmethods we choose. NDs prefer to use the least invasive therapiesfirst. Depending on the urgency of the situation, a pharmaceuticalprescription may actually cause the least harm.

NDs are regulated by the Minnesota Board of MedicalPractice. How do they differ from naturopaths?Naturopathic Doctors must graduate from a nationally accredited,doctorate-level naturopathic medical school whose program includesan internship in a naturopathic health clinic under physician observa-tion. NDs must also pass rigorous medical boards, continue theireducation yearly, and be registered by the state. Minnesota allowsother individuals to use the title “naturopath,” provided they do notuse the term “Naturopathic Doctor.” They can have various educa-tion backgrounds and there is no minimal educational requirement.

What do you see in the future for naturopathic medicine?Increasing integration between various health practitioners andincreased use of NDs as primary care doctors. A common complaintfrom patients is that they have been told to make lifestyle changesbut are not told how to begin. NDs are highly trained in this area.

Can you describe a typical office appointment? NDs areunique in the amount of time we spend with patients: one to twohours per appointment. This allows time to listen to patients’ healthconcerns, understand their health goals, and thoroughly explain whythe prescribed changes need to be made. We conduct physical exami-nations and nutritional analyses, and use diagnostic tools such as labwork and imaging. We use the latest scientific research to develop acustomized treatment plan with and for each patient.


“ ”We treat the cause and not just the symptoms of disease while doing no harm.

“Multiple sclerosis upended the plans I had, forcing me to face uncertainty. I’ve learned to adapt and focus on what’s truly important to me.”

— Susan, diagnosed in 1995

What does MS equal to you?Join the Movement® at MSsociety.org

dreams lost. dreams rebuilt.

MS =t

S =Msstos lamred tliuebs rrebamred t.tsstos lamred tliuebs rrebamred

niJo

ahW

.t

Mta®tnemevoe Mth

qS es Meot dagroy.teicosMS

?uu?oo yl tauq


The National Alliance on Mental Illness (NAMI)has long supported strong health care reformlegislation that expands coverage to the millionsof Americans who live with mental illness. Noother group of illnesses has had such a long historyof being discriminated against, by society and byhealth insurance companies, many of which haverefused to fully cover treatment or to issue policiesat all to those with mental illness.

Recent legislation

Three important federal laws address discrimina-tion against mental health care: the Wellstone-Domenici Mental Health Parity and Addiction Actof 2008 (hereafter referred to as the Wellstone-Domenici Act); and the Patient Protection andAffordable Care Act and the Health Care andEducation Reconciliation Act of 2010, togetherreferred to as the ACA.The Wellstone-Domenici Act will affect all

health plans, including self-insured plans. [Most

Minnesotans are covered underself-insured plans, to which

Minnesota’s 1995 parity law did notapply.] The Wellstone-Domenici Act does

not mandate that insurance companies offermental health coverage, however; it onlystates that plans already covering mentalhealth cannot apply different financialrequirements or treatment limitations formental health care than for physical healthcare. This applies to copays, deductibles,and out-of-pocket limits, treatment limits(number of visits, length of stays), and non-

quantified limits (prior authorization and medical necessity criteria).

The Affordable Care Act

By expanding eligibility for health insurance, the ACA has improvedaccess to mental health treatment. It also assures eligibility for healthcoverage by prohibiting the practice of excluding people with pre-existing conditions. This took effect right away for children under theage of 19, and will expand to everyone in 2014. NAMI has learnedthat some people are being denied coverage for non-severe forms ofanxiety and depression, even if they had never been hospitalized. Forpeople with more serious forms of mental illness, having coverage fortreatment provides hope for recovery. Using Minnesota’s option forthose denied coverage—the Minnesota Comprehensive HealthAssociation—was not feasible for many because of its highdeductibles, premiums, and copays.One ACA provision is for the establishment of health care

“exchanges”—i.e., marketplaces to purchase health insurance forthose who must buy their own policies. Under these exchanges, allinsurance plans must cover mental health services—a first—and theservices must be covered in the same way as other health care condi-tions. This will make mental health care accessible to those who mustbuy individual policies, including those employed at small businesses.NAMI will be advocating for a full continuum of mental healthservices (in-home, day treatment, residential services, etc.) to beincluded in the essential benefit set.One of the ACA’s most significant contributions is the simplifica-

tion of federal Medicaid eligibility (called Medical Assistance (MA) inMinnesota). In 2014, people with incomes below 133 percent of the

H E A L T H C A R E R E F O R M

Making headway in mental healthEnding insurance discrimination

By Sue Abderholden, MPH

DDiidd yyoouu kknnooww tthhaatttthheerree aarree wwaayyss ttoo hheellpp

lloowweerr yyoouurr MMeeddiiccaarree ccoossttss??If you are under 65 with a disability and yourincome is below $1,362 there is help for you!

Call the Disability Linkage Line® at 1-866-333-2466 tolearn about Medicare Savings Programs and Extra Help

that may pay Medicare out of pocket costs.

IInntteerreesstteedd iinn WWoorrkkiinngg??Afraid of losing benefits? There are many programs that

may help you balance work and disability benefitsso you can earn more income. Visit or call the

Disability Linkage Line® to learn how Work Benefits You.

federal poverty level will automatically qualify for Medicaid. BecauseMinnesota already had General Assistance Medical Care (GAMC)—insurance for low-income residents with incomes at 75 percent of thefederal poverty level, or $8,168—it has taken advantage of early“opt-in” of Medicaid, allowing people who were on GAMC to beeligible for MA.The ACA also offers a chance to introduce innovations in

Medicaid, such as expanding home- and community-based servicesfor the disabled (including those with a serious mental illness) asalternatives to institutional care and coordinating care for peoplewith multiple chronic health conditions (including serious mentalillnesses). Minnesota is looking at several of these as alternatives tomore costly institutional care, and to prevent hospitalizations.Young adults will now have greater access to health insurance.

Unmarried and married young adults can continue to be coveredunder a parent’s plan until they are 26 years old. [Minnesota lawprovides coverage to age 25, but not for self-insured plans or stateemployee plans.] The 18–26 age group is one of the largest uninsuredgroups—the one when mental illness strikes most often. More youngadults with a mental illness are now attending college, many part-time. Part-time status used to disqualify them from being covered bytheir parent’s plan and purchasing an individual plan was tooexpensive—plus it limited mental health coverage and often coveredonly generic medications. Having coverage will result in improvedaccess to appropriate and timely mental health treatment during theyears when there is a significant risk of developing a mental illness.Insurance eligibility will be based on income rather than disabil-

ity status, too, which will streamline enrollment and foster earlierintervention. The process for certifying a disability is long andarduous, especially for people with a mental illness. For young adults,perhaps experiencing their first psychiatric hospitalization, the earlyopt-in will enable them to get treatment without having to prove tothe Social Security Administration that their illness is so disablingthat they cannot work. Now they will be able to qualify for MA,obtain care, and begin to work as they recover.Depression often co-occurs with other health conditions such as

cancer, heart disease, and diabetes. More than 500 people die bysuicide in Minnesota every year, most as a result of an untreated men-tal illness, particularly depression. Earlier intervention and access toeffective treatment can help prevent these deaths. The ACA mandatesthat health plans—and Medicare, in the future—cover preventivehealth services, which include depression screenings. It has alsoauthorized funding to support research on depression, includingpostpartum depression.Those living with a serious and persistent mental illness die on

average 25 years earlier than their peers—the same life expectancy aspeople living in Bangladesh. Minnesota has launched the “10 x 10”campaign to increase life expectancy by 10 years in 10 years. It willpromote the integration of physical and mental health care withfunding earmarked by the ACA for colocating primary and specialtycare in community-based mental health settings. Colocated caremeans coordinated care for those with mental and physical illnesses—especially important for those with chronic conditions.

Challenges remain

Much of the funding that was cut this year in Minnesota’s legislativesession was state grant money to counties for mental health care forthe uninsured or underinsured, e.g., those with high-deductible plansor those with insurance plans that don’t cover mental health care.Now people will have to “wait in line” for care that they need—meaning they might not get care at all if the funds dry up first. Themore we can move toward universal coverage and toward full cover-age of mental health care, the less we will have to rely on grants andthe less people will have to wait for care that they need and deserve.Minnesota has a severe shortage of mental health professionals—

especially in racially and ethnically diverse communities, rural areas,and in certain career fields (psychiatrists and clinical nurse special-ists). This is particularly true for children’s mental health services.The ACA has authorized grants for colleges and universities to recruitand train students in social work and interdisciplinary psychologyprograms, provided students complete an internship in child andadolescent mental health care.NAMI is looking forward to implementation of the ACA.

Wider access to mental health care and treatment will enable allpeople to function better in school, work, home, and the community.The time of discriminating against mental illness is thankfullycoming to an end.

Sue Abderholden, MPH, is the executive director of NAMI Minnesota.


We are dedicated to helping you maintain the highest quality ofhealth and life. We understand the importance of keeping you in your

home and offer unmatched medical management of your care.

• Serving the entire 7 county metro area• Nursing care provided 24/7/365• All nursing providers bonded and insured• Culturally sensitive care• Highly competitive pricing• Specialized services for trach and vent patients

Your leading choice in private dutynursing for ventilator bound patientsOffering specialized services for trach & vent patients

www.MetroHealthCareMN.com

For more information or toschedule an appointment:

Metro Health Care Services LLC1312 Burke Cir. E

Maplewood, Minnesota 55109

Phone: (651) 230-9300Fax: (651) 756-1696

[email protected]

Those living with a serious and persistent mental illness

die on average 25 years earlier than their peers.


It is that time of year again, Medicare’s open enroll-ment period—only this year it is occurring a fewweeks early. The 2011 open enrollment period

actually began on Oct. 15 and ends on Dec. 7. Thismeans that seniors only have a few weeks left to makechanges to their basic Medicare plan, Medicare Part DPlan, or Medicare Advantage Plan. Enrollees have untilDec. 7 to make changes, which will go into effect on

Jan. 1, 2012.

Need to review each year

AARP recommends that all those enrolled in Medicare review theirplan each year to make sure it is still the right choice for them.People’s needs often change from year to year, and so can theirMedicare plan. A plan that may have met someone’s needs in 2011might not cover a new medication needed in 2012. “Plan X” mighthave been the most affordable option two years ago, but subsequentimprovements to competing plans may make one of them a betterchoice today.

While this might be seen as a complicated and confusing process,resources do exist to help seniors navigate the open enrollmentseason. The Medicare website www.medicare.gov/find-a-plan offersa tool that can compare national plans side by side. The MinnesotaBoard on Aging offers a free, statewide service called Senior LinkAgethat offers assistance by phone at (800) 333-2433.

It is important for seniors to explore their options each year andto understand that there are resources out there to help.

First, the basics

Before considering the details of various Medicare plans, it might behelpful to review the basics. Medicare is a government-sponsoredhealth care plan for individuals 65 and older (or any age with certaindisabilities). Medicare is separated into four separate tiers, or parts.Parts A and B are considered “traditional Medicare” and cover thecosts of most inpatient and outpatient acute care needs such asdoctor visits and hospital stays. Medicare Part D consists of privateplans that cover a portion of an enrollee’s prescription drugs. Part Cplans—also called Medicare Advantage Plans—combine traditionalMedicare with Part D so seniors can get both acute and prescriptionbenefits through one single private plan.

Each year individual Medicare plans can change. Certain benefitsmay be added and others dropped. Premiums and/or copays can alsochange from year to year. It is up to each individual to evaluate thesechanges during the open enrollment period. During open enrollment,anyone enrolled in traditional Medicare, Medicare Advantage, orMedicare Part D is eligible to switch plans. This means a senior canswitch from one Part D plan to another, or can switch from Part Dor traditional Medicare to a Medicare Advantage Plan. In order todo so, however, the changes must be made by Dec. 7, 2011.

Knowing when to switch

Knowing how and when to switch is the easy part; knowing whetherto switch, and what plan to switch to, is a bit more complicated.

Each year, Medicare enrollees will receive a “Notice of Change”letter. This letter will document what is covered under your currentplan and what parts of the plan will be changing for the upcomingyear. Because plans often change, it is important to review this lettercarefully and learn what options are available in your geographic

M E D I C A R E

Cateringby Seward Co-op

NavigatingMedicareopen enrollmentBy Michele Kimball

area, such as other traditional Medicare, Part D, or MedicareAdvantage Plans.

In 2011, 99.7 percent of Minnesotans on Medicare will haveaccess to at least one plan that is consistent with their previous plan.This means if a plan is changed significantly or even dropped, seniorswill have the security of knowing that other plans should be availablethat offer comparable benefits.

In addition to reviewing changes in certain health plans,Medicare enrollees should also carefully consider changes in theirown health status. If they’ve started new medications, been diagnosedwith a new condition, or moved to a new location, a change inMedicare plans may be necessary.

What to consider when switching plans

Once you’ve made the decision to switch Medicare plans, there arecertain key questions to ask yourself in order to choose the right planfor your particular medical needs and budget:

• How will I have to pay for premiums, deductibles, copayments,doctor visits, and hospital stays?

• Does my doctor accept this coverage? If not, are there other doctorsnearby who will?

• Do I still have a choice of healthcare providers and hospitals in aparticular network?

• Are referrals necessary to see aspecialist?

• Is there a yearly limit on out-of-pocket costs?

• Are my medications included onthe plan’s covered drug list?

• What will the prescriptions cost?

• Is my local pharmacy included inthe network? Is it possible to getprescriptions by mail?

• What happens if I get sick whenoutside my home state?

• Does the plan have a 24-hourassistance line?

• Does the plan have a good quality rating?

It is important for seniors to know that, in addition to family,friends, and financial advisors, there are resources out there to helpwith the decision-making process.

Where to find plans

Seniors who have access to the Internet should look at www.medicare.gov/find-a-plan. This website offers a simple, easy-to-usetool to find other plans in a particular geographic area, and tocompare cost and benefits with one’s current plan. For Minnesotanswithout Internet access, Senior LinkAge is an excellent resource.Its staff is dedicated to helping seniors navigate complicated issueslike Medicare. Senior LinkAge can be reached at (800) 333-2433.

Reviewing options is worth the time

One of the most common criticisms of Medicare—especially Part D—is that it is too complicated. It’s true that it can be. But if you want tosave money and find the best plan for you—i.e., get the most out ofMedicare—you need to take the time to do your research.

No one can put a price tag onhaving the right health care plan. Whilesaving money on copays and deductibles isimportant, having a plan that actually meetsyour needs is critical.

Michele Kimball is state director for AARP Minnesota and worksin St. Paul. AARP Minnesota, which has nearly 700,000 membersstatewide, is a leading advocate on health care, long-term care, and economicsecurity issues for Minnesotans over the age of 50.


When you’re told

your daughter’s esophagus isn’t connected, you think it’s the

hardest news you’ll ever have to swallow.

For Ireland’s parents, that news came after surgery, when they were told infection was threatening her life. We told them we could continue infusion therapy and beat the infection — at home. And because we focus exclusively on pediatric care, we’ve proven that we can reduce hospital and emergency department admissions, helping kids like Ireland thrive.

Meet Ireland and learn more at MeetTheMiracle.com

click

When you’re told

your daughtere told

s’ghteresophagus us

ents, that news came after s pareland’For Ir,ygersur ere told infection wwhen they w

e ce told them w. WWe told them wher lifeand beat the infection — at home

ely on pediatric carevvely on pediatric careclusiex

s, that news came after as threatening e told infection w

ue infusion therapy could contine focus . And because wat home

e can reduce en that wvven that we proe’vwre

r

uce ely on pediatric carevvely on pediatric careclusiexency dehospital and emerg

.eve Ireland thrilik

n more at Meet Ireland and lear

e can reduce en that wvven that we proe v, wre, helping kids tment admissionspar

re at MeetTheMiracle.com

click

uce ids

m

The 2011

Medicare open

enrollment period

began on Oct. 15

and ends on

December 7.


Healthy, fully functioning veins are an essentialpart of the circulatory system. Arteries carryblood away from the heart, and veins carry

blood back to the heart after oxygen has been extracted atthe tissue level. A critical element of vein function is the net-work of tiny, one-way valves inside the veins that allow for-ward blood flow while preventing backward flow. For manypeople, those valves may not be working as well as they used to,and over time the veins may become swollen and purple, appearingas varicose veins. In fact, according to the U.S. Vascular DiseaseFoundation, nearly 40 percent of women and 20 percent of menhave significant leg vein problems by the age of 50.

Chronic venous insufficiencyis a serious condition

Varicose veins usually are located onthe inside of the calf or thigh and cancontinue to enlarge over time, oftenbecoming twisted, pouched, and thick-ened. They frequently occur in womenduring pregnancy, even in women as

young as their 20s. If these veins are left untreated, additional veinsmay dilate and the person may develop a condition called chronicvenous insufficiency (CVI), which is characterized by chronicswelling, pain, and the skin changes mentioned above.

CVI is extremely common and affects millions of people in theU.S. It is different from other conditions that affect blood circula-tion in the legs such as peripheral artery disease (PAD), becauseCVI occurs in the veins rather than the arteries. It does not resultfrom hardening of the arteries (atherosclerosis).

Some factors leading to the development of varicose veins andCVI can be prevented; others, unfortunately, are unavoidable. Riskfactors include a family history of vein problems, age over 30, a his-tory of blood clots or deep venous thrombosis (DVT), previous leginjuries, multiple pregnancies, and daily activities that involve longperiods of standing or sitting. Sitting or standing for a long time canexacerbate the increased venous pressure from CVI and stretch thethin vein walls. Over time, this can weaken the walls of additionalveins, leading to the development of additional varicose veins.

Preventing CVI

There are a few simple, preventive measures that can decrease one’srisk for developing CVI. These include regular exercise, takingfrequent breaks to avoid standing or sitting for long periods of time,and maintaining a normal healthy weight. If visible changes occur inthe legs—e.g., bulging veins or increased swelling—patients shouldsee a physician.

Symptoms

Diseases like CVI often go unnoticed and can lead to more seriousproblems like DVT. Many people with CVI don’t feel any symptomsat first, but as the disease worsens, swelling, pain, or ulcers maydevelop in or on the legs that can make walking and other everydaytasks difficult. In addition to pain and swelling, other commonCVI symptoms include varicose veins, skin changes, and a feelingof heaviness in the legs.

There’s a huge difference in the kind of home care you can receive from someonewho really understands what your life is like as a senior. Your concerns and needfor independence. Someone who like you, has a little living under his or her belt.Our caring, compassionate seniors are there to help. We offer the services you

need to stay in your own home, living independently.

• Companion Care• Housekeeping Services• Meal preparation/cooking

• Respite for caregivers• Doctors appointments• Transportation and more

Mpls. area: 763-694-0765 • St. Paul area: 651-274-4285www.seniorshelpingseniors.com

© 2011 Seniors Helping Seniors. Each office is independently owned and operated.All trademarks are registered trademarks of Corporate Mutual Resources Inc. Not all services are available in all areas.

Call us today, it’s like getting a little help from your friends®

Chronic venous insufficiency:Don’t ignore leg discomfort

V A S C U L A R M E D I C I N E

By John D. Martin,MD, FACS


Early detection is key

Many people are unaware that mini-mally invasive testing is available.People often dismiss leg vein prob-lems as a normal part of getting older. But early detection is key tobeing able to resolve problems, because the sooner it is diagnosed,the more treatment options one has. Anyone experiencing prolongedleg discomfort (or any of the other symptoms previously mentioned)should contact a physician.

“In my experience, I have seen that chronic venous insufficiencycan be an extremely disabling disease that affects quality of life. Atour facilities, we emphasize that early detection and treatment canprevent many complications,” says Dr. Maria Gomes, an interven-tional radiologist at Minneapolis Vascular Physicians and medicaldirector at the Minneapolis Vein Center.

Testing is easy and quick

If a patient needs to be tested for CVI, the primary care physicianmay be able to conduct the test in the office. With this option, theprimary care physician uploads the results to a secure website wherea specialist downloads the data for interpretation, then uploads thefinal report for the primary care physician—saving the patient thetime and trouble of scheduling an additional appointment.

Tests for CVI are usually quick and painless, and help yourdoctor decide whether other medical or surgical treatments arenecessary. With today’s technologies, some tests for CVI can becompleted in fewer than 20 minutes. One type of test, for example,uses a small probe to measure the venous refill time in the lowerlimbs; if the veins refill too quickly, that could be a sign of CVI.

Treatment options

While prevention and early detection of CVI are ideal, there are anumber of treatment options for people who have already devel-oped CVI. Graduated-compression stockings are an important partof treatment. They come in a variety of sizes and colors, and mostpharmacies located within clinics and hospitals will have them forsale. (The prescribing physician will probably know which pharma-cies carry them.) These stockings are snug, but help reduce swellingand pain. Most importantly, they decrease the risk of blood clotsforming. There are also medications—even some herbal supple-ments—that are used to treat swelling and other CVI symptoms.

For patients with significant vein dilation, there is a minimallyinvasive treatment called vein ablation. This treatment closes offabnormal veins using radiofrequency or laser, which reduces pres-

sure in smaller veins. The procedure usually takes less than anhour and can provide immediate relief of symptoms. It in-volves only a tiny nick in the skin about the size of a pen tip,and most patients are able to return quickly to normal activitywith little or no pain.

“The newest technologies available make the treatmentof chronic venous insufficiency easier and more tolerable,”says Dr. Gomes. “Since most treatments can be done as an out-patient procedure, there is little to no downtime, and the pro-cedure may be covered by the patient’s insurance carrier. Weare fortunate to have these technologies to help CVI patients.”

“As confirmed by several clinical studies, patients under-going treatment for varicose veins using the latest, advancedclosure procedures experience less pain and bruising whencompared to treatments that have been used in the past,” saysBrian Verrier, vice president and general manager of VascularTherapies at Covidien, one of the largest developers of CVI

treatment technology. “Seeking treatment is important, as it canprevent disease progression and improve the quality of life.”

Today’s most advanced treatments are highly effective and resultin little to no scarring, so one should not be afraid to see a doctorabout leg vein concerns.

John Martin, MD, FACS, is medical director for BioMedix, a Minnesota-based manufacturer of health care devices, hardware, software, and onlineservices designed to detect PAD and CVI. Martin is a board-certified vascu-lar surgeon and CEO of Cardiology Associates, LLC, with offices inWashington, D.C., and throughout Maryland.

Tests for CVI, like theprobe-based test picturedleft, can be simple andpain-free. A probe, orsmall device used fortesting, can measurethe blood flow in yourveins in a matter ofminutes (below).

8 Lyme Disease Seminar and SupportDr. Maloney will present on the properuse of lab testing in Lyme disease. Thediscussion includes the performance oftwo tests (Enzyme-linked immunosorbentassay (ELISA) and Western Blot), and thelimitations surrounding their use in thediagnosis of Lyme. Email questions [email protected], Nov. 8, 6:30–7:30 p.m., FirstLutheran Church of White Bear Lake,4000 Linden St., White Bear Lake

12 Food Allergy Resource FairThis free event brings many food allergy-friendly vendors together to share theirlatest products and information. Stop byto try samples, check out new products,talk with vendors, or have one-on-onetime with an allergist at our Ask theDoctor booth. For more information,email [email protected], Nov. 12, 9 a.m.–noon,Eisenhower Community Ctr., 1001 Hwy. 7,Hopkins

15 Relationships after StrokeThe discussion will include how stroke canaffect relationship roles and dynamics,communication, and intimacy in relation-ships. The educational seminar is for strokesurvivors and their care partners. For moreinformation, contact Sue Newman at 612-863-4996.Tuesday, Nov. 15, 2–3:30 p.m., AbbottNorthwestern Hospital, 800 E. 28th St.,Rm. E1220, Minneapolis

16 Nurtured Heart ApproachAre you the caregiver of a child with highenergy and high intensity? Come andlearn four effective strategies to help seeyour child’s behavior as a gift instead of achallenge. Cost: $30 per individual or $50per couple. To register, call 612-798-8331or email [email protected], Nov. 16, 1:30–3:30 p.m.,Fraser, 6344 Penn Ave. S., Richfield

18 Understanding the Grieving ProcessThe presenter will discuss various aspectsand experiences of grief and explore waysof coping with changes brought on bygrief. Rev. Tom Davis, is an ordainedpastor who has served in congregationalministry for 21 years, disaster response/recovery for six years, and hospital/hos-pice chaplaincy for five years. Call 651-298-5493 to register.Friday, Nov. 18, 10:15–11:30 a.m.,West 7th Community Ctr., 265 OneidaSt., St. Paul

19 Pulmonary Hypertension (PH)Support GroupThe Pulmonary Hypertension Associationannounces the formation of a new supportgroup in the Twin Cities for PH patients,families, and caregivers. The group willfocus on PH education and related topics.For more information, call Sean Warrenat 763-607-9276.Saturday, Nov. 19, 1–3 p.m., St. LouisPark Recreation Ctr., 3700 Monterey Dr.,St. Louis Park

29 Blood Pressure ChecksFairview Lakes Community HealthOutreach is offering free blood pressurechecks. The screenings are held everyTuesday at this location. For questions,call 612-672-7272.Tuesday, Nov. 29, 9–11 a.m., Walmart,200 12th St. S.W., Forest Lake

Send us your news:We welcome your input. If you have an event youwould like to submit for our calendar, please sendyour submission to MPP/Calendar, 2812 E. 26thSt., Minneapolis, MN 55406. Fax submissions to612-728-8601 or email them to [email protected]. Please note: We cannot guaranteethat all submissions will be used. CME, CE, andsymposium listings will not be published.

America's leadingsource of health

information online


National Family Caregivers MonthA caregiver is a relative, friend, or neighborwho provides care for an older or disabledadult. Caregiving is important work and itcan be rewarding, but it can also be over-whelming. You may also be filling the dualroles of employee and caregiver. You arenot alone. About 25 million Americansstruggle to manage the stress of workresponsibilities while caring for an elderlyrelative.If you are a caregiver, it is important foryou to realize that it is okay to ask for help.• Call the Senior LinkAge Line, at 1-800-

333-2433 and ask for a referral to a care-giver consultant. A trained professionalcan help you assess your situation andcreate a plan to help you reduce stresswhile balancing work and caregivingresponsibilities.

• The Minnesota Board on Aging has sevenregional Area Agencies on Aging that arededicated to addressing the needs of olderadults and their families. To locate servic-es and resources in your local community,visit www.mnaging.org.

• The MinnesotaHelp.info website is anonline directory of services designed tohelp people in Minnesota find informa-tion and referrals. It is especially rich inresources for seniors and their caregivers,and for people withdisabilities andtheir caregivers.

17 Caregiver Support GroupJoin us! We meet to discuss concerns, shareknowledge, and provide mutual support inour roles as caregivers. Meetings are heldthe first and third Thursdays of the month.Call 952-888-7121 for more information.Thursday, Nov. 17, 10–11:45 a.m., GideonPond, 10030 Newton Ave. S., Bloomington

November Calendar

healthpartners.com/medicare

A health plan with a Medicare contract. *NCQA’s Health Insurance Plan Rankings 2010-11 – Private. HealthPartners is also known as Group Health Inc. Released October 18, 2010. **NCQA’s Accreditation Survey. Released May 15, 2011. H2462_AdRating_164 File & Use 10/08/2011 © 2011 HealthPartners

The freedom tobe worry-free.

It’s Medicare with a plan you can trust. HealthPartners Freedom is the top-rated* Medicare

plan in Minnesota, and the only plan in the state to receive the highest accreditation from the National

Committee for Quality Assurance.** So you can feel confi dent, supported and healthy. Shop and compare

plans online. Or call us at 952-883-5601 or 800-247-7015, 8 a.m. to 8 p.m., seven days a week. TTY users

call 952-883-6060 or 800-443-0156.


Palliativecare

By Michele Fedderly, EdD

P A I N M A N A G E M E N T

Increasingly, when we answer our toll-free helpline atthe Minnesota Network of Hospice & Palliative Care,callers start the conversation with, “The doctor says my

family member does not need hospice care yet, but suggest-ed palliative care. What is that?” People attending oureducational sessions on advance care planning, hospice,and palliative care often ask for more information aboutpalliative care. This need for clarification is not surprising,since palliative care is a relatively new medical service.

Palliative care supports people with serious healthconditions, no matter what their age. Palliative care helpswith pain and other symptoms caused by a serious illnessor resulting from aggressive, curative treatment such aschemotherapy. With an overall goal to improve the qualityof life for patients and their families, palliative care is

appropriate at any time during aserious illness and can be providedtogether with curative treatment.Palliative care can be provided inhomes, hospitals, nursing homes, andassisted living facilities.

Research published in the 1999Journal of the American Medical

Association stated that people with a serious illness havethree primary concerns: They want to control their painand symptoms, have a good quality of life, and not be aburden to their families.

LIFE CHANGES . . . BUT YOUR ADDRESS DOESN’T HAVE TO

SM

Personalized In-Home OptionsMaintain Your Freedom and Lifestyle

FREE consultation. Call 320-255-1882 for information.SM

• Medication Managementand Reminders

• Personal Care –Bathing & Grooming

• Private Nursing and more

• Meal Preparation• Transportation• Light Housekeepingand Laundry

• Companionship

24-hours/day, 365-days/year • Hourly, Daily, Monthly • Satisfaction GuaranteedMedicare Certified,MN Class A Licensedwww.prhomecare.com FREE consultation. Call 763-683-0665 for information.

The palliative team is made up of the primaryphysician, specialist(s), nurse, social worker, and chap-lain, who work together to provide medical, emotional,and spiritual support to the patient and the family. Theteam may also help the patient and family navigate thehealth care system to ensure that they receive the carethey need.

Lyn Ceronsky, director of Palliative Care forFairview Health System in Minneapolis, encouragespatients with serious illnesses and their families to “asktheir doctors about palliative care, or request that apalliative care team be involved in their care.” Palliativecare teams work to decrease physical symptoms and stress and helpthe patient make important decisions. Palliative care makes a hugedifference in the quality of life for someone who is seriously ill.

The New England Journal of Medicine reported on the effec-tiveness of palliative care in a 2010 study of lung cancer patients.The researchers found that “early palliative care led to significantimprovements in both quality of life and mood. As compared withpatients receiving standard care, patients receiving early palliativecare had less aggressive care at the end of life but longer survival.”The patients lived almost three months longer that those who didnot receive palliative care.

Lack of knowledge among consumersThere is a lack of knowledge about palliative care as shown in asurvey of Minnesotans conducted in June 2010 for the MinnesotaNetwork of Hospice & Palliative Care. The survey found that 68percent of survey participants had never heard of palliative care.This percentage closely matches the findings of a national studycommissioned and conducted in 2011 by the Center to Advance

Palliative Care (CAPC). When theresearchers defined palliative care,62 percent said they would be “verylikely” to consider it for a loved onewho had a serious illness.

What is the differencebetween palliative careand hospice care?People are often confused by thesetwo terms and wonder how theydiffer. The primary difference is thateach serves a different group ofpatients. Palliative care is medicalcare for patients with any serious—but not terminal—illness, at any time

during the illness, and may coincide with curative treatment.Hospices serve only the terminally ill and work to ensure that thepatient is as comfortable as possible during his or her final days.Health insurance plans usually require separate coverage for hospicecare, as does Medicare. The Veterans Administration covers bothhospice and palliative care for veterans.

The care continuumPalliative care is considered part of a continuum of care; patientscan receive palliative care for a serious illness while getting treat-ment. If their illness become terminal, they can choose to receivepalliative care through hospice care.

Questions to askpalliative care providersWhen someone is considering palliativecare, asking the following questions canhelp with decision-making:

1. Who is part of the palliative care team?

2. How will palliative care help me andmy family?

3. How will the palliative care team workwith my current physician(s)?

4. What is the process to address pain andcontrol symptoms in an emergency?


Read usonlinewherever you are!

www.mppub.com

Palliative care to page 34

Additional information on palliative carecan be found on the following websites:• Center to Advance Palliative Care (CAPC) has a

Palliative Care Provider Directory and a list of morespecific palliative care resources:www.getpalliativecare.org

• American Academy of Hospice & PalliativeMedicine: www.palliativedoctors.org

• Minnesota Network of Hospice & Palliative Care:www.mnhpc.org

• Veterans Administration: www.va.gov

Early palliativecare led tosignificant

improvements inboth quality oflife and mood.


For all ages and many conditionsThe primary population creating the demandfor home care is seniors. As 78 million babyboomers approach retirement age, U.S. demo-graphics are shifting significantly. Seniors willsoon constitute 20 percent of the population.It’s estimated that by the year 2020, 12 mil-lion older Americans will need long-term care.

A recent consumer survey by AARPshowed that home care is the preferred carechoice for 95 percent of seniors and retiringbaby boomers. Both groups are interested instaying out of what is commonly known asthe “broken hip revolving door” of hospitals,

rehab centers, and short-term nursinghome placements.

Home care serves people of all ages,not just seniors. Many health conditionscan be managed at home. Clients includethose recovering from temporary healthchallenges as well as those who are per-manently disabled, chronically ill, or inneed of end-of-life care. Their needs maybe medical, nursing, therapeutic, or justassistance with everyday life activities.

Two growing service niches are pediatriccare (including premature babies) and young,

H O M E C A R E

There’s no place like homeBy Amy Nelson

As health care reform becomes a reality, there is a building momentum toward keep-ing patients in their homes whenever possible. Home care meets health care reformmandates—such as reducing rehospitalization rates—by allowing care recipients to

avoid expensive, institutional alternatives like hospitals and nursing homes. Patient-preferredand cost-effective, home care is becoming an integral part of the health care continuum as itbridges the clinic-based model and the actual world patients live in.

SPINE SURGEONS

Paul D. Hartleben, M.D.Board-Certi�ed Orthopedic SurgeonFellowship-Trained Spine Surgeon

Bryan J. Lynn, M.D.Board-Certi�ed Orthopedic SurgeonFellowship-Trained Spine Surgeon

Nicholas J. Wills, M.D.Fellowship Trained Spine Surgeon

NON-SURGICAL SPINE C ARE

Tom Cesarz, M.D.Board-Certi�ed Physical MedicineFellowship-Trained in spine

John A. Dowdle, M.D.Board-Certi�ed Orthopedic Surgeon

Kristen M. Zeller, M.D.Board-Certi�ed Pain ManagementFellowship-Trained Pain Management

esearch has shown that complex problems like

back and neck pain are best treated by centers

of excellence that specialize in spine. Consequently, in

2010, Summit Orthopedics created Summit Spinecare

as a regional specialty center for spine, based in a new

6,500 spine center space in Woodbury.

Summit Spinecare combines the expertise of three

non-surgical spine specialists, three fellowship-trained

spine surgeons, spine-specialized therapists, X-ray, MRI

and an injection suite — all under one roof.

We’ve also invested in patient education with an

on-line spine encyclopedia at www.SummitSpinecare.

com. Also, as a free community service, we provide a

36-page Home Remedy Book with exercises that relieve

neck and back pain. Call us and we’ll send you 20 copies

for you to provide as a resource to your patients.

By having it all in one place, the back or neck pain

sufferer no longer has to drive around town anymore.

Now isn’t that a welcome relief?

At last, a spine center with everything under 1 roof

R

The spine specialty center of Summit Orthopedics2090 Woodwinds Drive, Woodbury, MN 55125Appointments & Referrals:

651.738.BACKwww.SummitSpinecare.com

enip0 s05,6

noigerasa

mmuS,0102

cnellecxcefo

kcaacbR kbR

.yy. rudboon We icapr setnec

nidesabe, nipsroforetnecytty laaicepslaa

ipStimmuSdetaercscidepohtOrtim

nequesnoC.enipsniezilaicepstahtec

cybdeteaerttseberaniapkcendnak

pp

bdbkdk

ses a re adivoro pu tor yofo

ullaC.niaapkcacbdnakcenne

BydeemRemoHegge ap-63

moceerfasa,oslA.omc

depolcyyccneenipsenil-no

wenan

eracen

ni,yy, llytn

sretenec dll

.stneitar puoo ye tcruos

seipoc02uoydnesll’ewwednasu

evve eilertahtsesicrexxeehtiwkooB

aedivorpewwe e, civresytty inumm

.eracenipStimmuS.ww.wwtaai

p

SS

ejnn id ana

oegrusenips

acigrus-non

mmuS

p,

.fooe rnr oednl ule — ateiun soitice

ar-Xs, tssipaaprehtdezilaiceps-enipss, no

t-piihswwsolleffeeerhts, tsilaaicepsenipsla

oesitrepxeehtsenibmoceracenipStim

yp

emoclet a wweaht t’nsw ioN

otsahreggenolonrereffefffus

nonillatignivaavhyB

py

IRM,yy, aay

deniart

eerhtfo

?feiler

.eromnyanwoowtdnuoraeveird

niapkcenrokcabehte, calpen

py

wship elloF.Nicholas J

wshipelloFterCd-oarB

ynn, M.D. Lan JyrB

wshipelloFterCd-oarB

. Haraul DP

SPINE SURGEONS

tain Managemenained PrT--TwshipelloFtain Managementi�ed PerCd-oarB

., M.Dellerr, M.Den M. ZKrist

geonurthopedic Srti�ed OerCd-oarB., M.DdlewoJohn A. D

ained in spinerT--TwshipelloFal Medicineysicti�ed PherCd-oarB

.z, M.Desarom CT

AREAL SPINE CNON-SURGIC

geonurpine Sained SrT., M.DillsW

geonurpine Sained SrT-geonurthopedic Srti�ed O

.nn, M.D

geonurpine Sained SrT-geonurthopedic Srti�ed O

.tleben, M.D

URGEONS

moc.earcenipStimmuS.wwwKCAB.837.516

:slarrefeR&stnemtnioppA,yy, rubdooW,evirDsdniwdooW0902mmuSforetnecytlaicepsenipsehT

52155NMscidepohtrOti

disabled adults. Children who years ago would havebeen institutionalized or hospitalized long-term, or whowould not have survived at all, are now being cared forsuccessfully at home.

Advances in medical technology have increasedthe number of patients now treated at home. Chronicpatient needs being handled by home care nursesinclude tracheotomies, ventilators, gastrostomy tubes,IV therapies, and many cardiac conditions. Cancerand transplant patients are also able to recuperate athome. Skilled, private-duty nurses and case managersworking in the home regularly meet complex medicalneeds. All such nursing activities are signed off byMDs, and patient care plans are recertified at aminimum of every 60 days.

Additional technologies that improve homecare service levels include telehealth servicemanagement, electronic medical records, and avariety of assistive technologies such as home

sensors. A nurse using telehealth equipment, forinstance, can potentially make up to 15 visits a dayrather than the standard five.

John McNamara, MD, medical director ofChildren’s Home Care and Hospice Program atChildren’s Hospitals and Clinics of Minnesota,

stated, “We have sent over 400children home with trachs andvents, and find home care to be avery good alternative, with fewerinfections and low readmissionrates. Even acute illnesses have beensuccessfully cared for at home.”

A cost-effective alternativeHome care is anywhere from fiveto 20 times less expensive than

inpatient facility care. A 2009 study, published by Avalere Health,estimated that early home care use was associated with a $1.71billion reduction in Medicare post-hospitalization spending overa one-year period.

Home care is one viable solution that legislators and medicalprofessionals can leverage to maximize care capacities while mini-mizing costs. In 2009, for example, national charges by Medicarewere $135 per home care visit, $622 per day for skilled nursingfacilities, and $6,200 per day for inpatient hospital care. Thenumbers speak for themselves.

Types of home careThere are five basic home-care service options:

1. Personal care assistants provide assistance with activities of dailyliving such as dressing, bathing, feeding, getting to doctorappointments, etc., and are not licensed by the state. This type ofcare is typically paid for by Medical Assistance, Minnesota’sMedicaid program.

2. Private-duty care—basically private-pay care—provides assis-tance with nonmedical needs such as shopping, cooking, trans-portation, and companionship, and involves household manage-ment services but no hands-on medical care. Some long-term care

policies will cover such home care, but reimbursement terms andexclusion criteria vary.

3. Licensed home care agencies employ a variety of home healthcare professionals, including skilled nurses, therapists, and homehealth aides. This type of care is typically paid for by privateinsurance, Medicare, and Medicaid.

4. Medicare-certified, skilled home care is typically received onan acute, intermittent basis, i.e., following an illness, injury, orchange in disease status. Such services are physician-driven, andreimbursement is contingent on the individual demonstratingprogressive improvement while being homebound.

5. Extended-hour nursing offers high-level one-on-one care, fromfour to 24 hours per day for those with medically complex needs.

Home care ranges from a one-hour weekly visit to 24-hour live-in care. It provides a one-on-one focus, which is difficult to obtainin hospitals or group facilities. Home care also respects cultural dif-ferences and ethnic diversities by assigning staff members not onlyby skill set but also by language (from Spanish to Somali to sign)and behavioral criteria, such as not smoking or not consumingpork. In hospital settings, there is no choice as to who provides theindividual care. Home care allows the patient to select the serviceprovider upfront and provides care in a controlled setting.

Who pays for home care?Funding for home care is increasing as more people recognizeits cost competitiveness. Many insurance companies now cover

Home care

serves people

of all ages,

not just seniors.

There’s no place like home to page 27


Providing a full range of physician-directedservices for you and those close to you

Complete Home Health Services LLCCaring for your home health needs... and more

We offer:

• PCA/Home Health Aide/Homemaker —will provide care to the clients by follow-ing a care plan set by the RegisteredNurse (RN)

• Nutritional Counseling, Diabetes Educa-tion, Asthma Education

• Home Assessment— caters specifically tothe individual client

• Skilled Nursing Care—AdministeringIV drugs and wound-ostomy care

• Companion/Respite Care—We providecaregivers to relieve someone who isalready caring for a family member

For more information contact:Complete Home Health ServicesSilver Lake Plaza Building4001 Stinson BLVD NE, Suite LL32St. Anthony MN, 55421

612-PUT-CARE • www.bchhs.com


Lymphoma is the most common blood cancer in adultsand the third most common cancer overall in chil-dren. The overall term “lymphoma” is used for

more than 67 subtypes of the two main forms:Hodgkin lymphoma (HL) (formerly referred to asHodgkin’s lymphoma) and non-Hodgkin lym-phoma (NHL). There are six primary types ofHodgkin lymphoma and at least 61 types ofnon-Hodgkin lymphoma.

The lymphatic system

The lymphatic system is one of the mostimportant parts of the immune systembecause it protects the body from dis-ease and infection. It is a separatecirculatory system made up of a seriesof thin tubes called lymph vessels thatcarry lymph, a transparent fluid that containswhite blood cells called lymphocytes, which aremade in the bone marrow, spleen, and lymph nodes.

There are thousands of lymph nodes throughout thebody. Lymph flows through lymph nodes and the spleen,tonsils, bone marrow, and thymus gland. Lymph nodesfilter lymph, removing bacteria, viruses, and other foreignsubstances. If a large number of bacteria are filteredthrough a node or series of nodes, they may swell and

become tender. For example, if a person has a sore throat,the lymph nodes under the jaw and in the neck may

swell. Most swollen nodes are a reaction to infec-tion, however, and are not cancerous.

Lymphoma develops when a genetic error,or mutation, occurs in the way lymphocytesare produced. There are two types of lympho-cytes: B lymphocytes (or B-cells; “B”because B-lymphocytes come from thebone marrow), and T lymphocytes (or T-cells; “T” because T-lymphocytes nor-mally spend part of their lifespan inthe thymus gland, a small organ inthe chest). B-lymphocytes developinto cells called plasma cells that

make antibodies, which attacktoxins, bacteria, and some cancer cells

that the body then removes. T-lympho-cytes also help the body fight viral infections

and destroy abnormal or cancerous cells. Likenormal lymphocytes, cancerous lymphocytes can

grow in many parts of the body, including the lymphnodes, spleen, bone marrow, blood, or other organs.

Hodgkin lymphoma

Hodgkin lymphoma is named after ThomasHodgkin, the British physician who first identifiedthe disease in 1832. Also known as Hodgkin disease,HL is not as common as non-Hodgkin lymphoma. Infact, HL is relatively rare, accounting for less than 1percent of all cancer cases in the United States.According to the American Cancer Society, approxi-

mately 8,500 new cases of HL are projected each year. Although itcan occur in both children and adults, it is most commonly diag-nosed in young adults between the ages of 15 and 35 and in adultsover age 50. Nearly 10 to 15 percent of all Hodgkin lymphomas arediagnosed in children and teenagers. The disease is more common inmen than in women although, according to the American CancerSociety, incidence rates have decreased in men over the last 30 yearsand slightly increased in women.

Types of Hodgkin lymphoma

Hodgkin lymphomas are different from non-Hodgkin lymphomasin the way they develop, spread, and are treated. Hodgkin lym-phoma has been divided into two main classifications, classicalHodgkin lymphoma (which accounts for approximately 95 percentof all HL cases) and lymphocyte predominant HL. The type of HLone has may affect treatment choices. Within classical Hodgkin lym-phoma, there are four subtypes: nodular sclerosis (60 to 80 percentof all HL cases), mixed cellularity (15 to 30 percent of HL cases),lymphocyte depletion (<5 percent), and lymphocyte-rich (<5 percent).

The two subtypes within lymphocyte predominant Hodgkinlymphoma are nodular lymphocyte predominant (5 to 10 percent ofall HL cases) and diffuse lymphocyte predominant (extremely rare).

O N C O L O G Y

Leg Pain StudyDo your legs hurt when you walk?Does it go away when you rest?

Or, have you been diagnosed with PAD?You may have claudication, caused by lack

of blood supply to the leg musclesThe University of Minnesota is seeking volunteers

to take part in an exercise-training program,funded by the National Institutes of Health

To see if you qualify,contact the

EXERT Research Team at

612-624-7614or email [email protected] visit EXERTstudy.org

EXERTstudy.org

Lymphoma:an overview

From the Lymphoma ResearchFoundation

Symptoms of HL

Hodgkin lymphoma usually starts inthe lymph nodes and may be noticedfirst in the neck, above the collarbone,under the arms, or in the groin.Because lymph tissues are connectedall over the body, abnormal lympho-cytes can circulate, causing the lymphoma to spread from onelymph node to another.

Risk factors

Although the exact causes of Hodgkin lymphoma are unknown,research shows that certain risk factors may play a role in thedevelopment of the disease:

• Family history of Hodgkin lymphoma (though no hereditarypattern has been well established)

• Epstein-Barr virus infection (which causes mononucleosis)

• HIV infection

• Weakened immune system caused by either an inherited conditionor the use of immunosuppressants to prevent organ transplantrejection.

Even if you have one or more of these risk factors, it does notmean that you will get Hodgkin lymphoma; most people with riskfactors never develop the disease. Hodgkin lymphoma has beenstudied more than any other type of lymphoma, and the result ofthose studies has led to rapid advances in the diagnosis and treat-ment of the disease. Well over 80 percent of patients with Hodgkinlymphoma are cured.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma, like Hodgkin lymphoma, is a cancer ofthe lymphocytes. B-cell lymphomas account for 85 percent of allNHLs; T-cell lymphomas account for the remaining 15 percent.

Because there are so many different forms of NHL, they areoften grouped according to their clinical behavior and whether theyare slow-growing/low-grade or aggressive/high-grade. Slow-growinglymphomas are usually chronic and not curable. Aggressive lym-phomas, while potentially life threatening, can often be cured. Non-Hodgkin lymphoma has grown from being a relatively uncommondisease to being the fifth most common cancer in the U.S., nearlydoubling in incidence since the early 1970s and increasing amongwomen since 1991.

Risk factors

Although the exact causes of non-Hodgkin lymphoma remainunknown, some common factors appear to have an impact on risk.For example, NHL incidence increases with age. Approximately70 percent of people diagnosed with NHL are 50 years of age orolder; they are more likely to be men than women; and they aremore likely to be Caucasian than African-American. The disease isalso more common among people with depressed immune systemsand those exposed to environmental carcinogens, pesticides, herbi-cides, viruses, and certain bacteria.

Risk for developing lymphoma may behigher in individuals who:• Have a family history of NHL (though nohereditary pattern has been well established)

• Are affected by an autoimmune disease• Have received an organ transplant• Have been exposed to chemicals such as

pesticides, fertilizers or organic solvents for a long period• Have been infected with viruses such as Epstein-Barr, humanT-lymphotropic virus type 1 (HTLV-1), HIV/AIDS, hepatitis C,or certain bacteria.

Stages

Non-Hodgkin lymphoma is divided into four stages based on howfar the disease has spread:

• Stage I (early disease): The cancer is found only in a single lymphnode or in one organ or area outside the lymph node.

• Stage II (locally advanced disease): The cancer is found in two ormore lymph node regions on one side of the diaphragm.

• Stage III (advanced disease): The cancer involves lymph nodesboth above and below the diaphragm.

• Stage IV (widespread disease): The cancer is found in several partsof one or more organs or tissues (in addition to the lymph nodes);or it is in the liver, blood, or bone marrow.


Don’t miss an issue...Have you subscribed to Minnesota’s best source ofhealth care information? To receive your personalcopy of Minnesota Health Care News each month,

complete and return the form below.

MPP, Inc. • 2812 East 26th Street • Minneapolis, MN 55406 • www.mppub.com

Name/Title ____________________________________________________________________

Company ______________________________________________________________________

Address ______________________________________________________________________

City/State/Zip _____________________________________________________

Phone (________)_______________________ Fax (________)_________________________

ANNUAL SUBSCRIPTION $36.00

PAID BY CREDIT CARD �� VISA �� MC ________EXP. DATE �� CHECK ENCLOSED �� BILL ME

CARD # _________________________________________________________

SIGNATURE _______________________________________________________

Credit card orders may also be phoned in to (612)728-8600 or faxed to (612)728-8601

Lymphoma to page 26

Well over 80 percent ofpatients with Hodgkinlymphoma are cured.

Common types of NHL

Because there are so many different types of NHL and because newsubtypes are continually being identified, classifying lymphoma iscomplicated, and has evolved over the years. The most commontypes of NHL currently include:

• Diffuse large B-cell lymphoma (DLBCL): 31 percent

• Follicular lymphoma: 22 percent

• Mantle cell lymphoma (MCL): 6 percent

• Chronic lymphocytic leukemia/small lymphocytic lymphoma(CLL/SLL): 6 percen

• Mucosa-associated lymphoid tissue (MALT) lymphoma:5 percent

• Peripheral T-cell lymphoma (PTCL): 6 percent

• Anaplastic large cell lymphoma (ALCL): 2 percent

• Lymphoblastic lymphoma (LL): 2 percent

• Burkitt-like lymphoma: 2 percent

• Lymphoplasmacytic lymphoma (LPL): 1 percent

Treatment options

Many effective treatment options exist for NHLpatients, including:

• Watchful waiting

• Chemotherapy

• Radiation therapy

• Stem cell transplantation

• Novel targeted agents

• Newer versions of established agents.

The form of treatment chosen depends on the type of lymphomaand the stage of the disease, as well as factors such as age, priortherapies received, and the patient’s overall health. Before startingtreatment, patients should discuss all available treatment optionswith their physician.

Participating in clinical trials

Patients interested in participating in a clinical trial shouldtalk to their physician. Contact the Lymphoma ResearchFoundation’s Helpline for an individualized clinical trial searchby calling 1-800-500-9976 or emailing [email protected].

Resources

For more information on HL and NHL, please visitthe Lymphoma Research Foundation’s website,www.lymphoma.org.

Lymphoma from page 25


• Same day scheduling

• 9 am - 9 pm • 7 days a week

• Any body part, no contrast

• Cash, check or money order only

• Sorry,we can not accept Medicare,Medicaid or other assistance

• You receive a CD of your scan,withinterpretation, that you can bring to yourfamily physician, chiropractic physicianor any other health care provider

• This may be less than your deductible formany insurance programs and is availableto anyone

• Physician and other health care providerinquiries welcome

We provide top quality MRI scansfor only $395!

Woodbury MRI6053 Hudson Road, Suite 265, Woodbury, MN 55125

651-702-0674or fax request to 651-702-2502

extended-hour nursing and care visits. A tracheotomy patient,for example, can be approved for 24-hours-per-day care forone month, then be weaned onto family care. Managed carecompanies such as Medica, Health Partners, UCare, and BlueCross Blue Shield Association have come to understand thathome care is safe, efficient, and provides the same level ofcare at a cost-effective rate.

Payment options for home care include self-pay,Medicare, Medicaid, Veterans Administration, CHAMPUS,workers’ compensation, commercial health insurancecompanies, managed care organizations, and commu-nity organizations.

Bringing it homeHome care is a critical component of collaborativecare that is increasingly moving from the periphery tothe mainstream. The types of care now being handledat home are drastically different from care models even 10years ago, and they will continue to evolve as technologiesadvance. Home is where families want their loved ones to be,because it’s where the highest quality of life can be had.

Amy Nelson is founder, president, and CEO of Accurate Home Care,a provider of both pediatric and adult home care services inMinnesota.

There’s no place like home from page 23 Finding the right matchMatching patient needs with home-care provider skillsets is a primary consideration for consumers. Thefollowing questions can help consumers find the besthome-care provider for their needs:1. What process do you use to match your staff with

clients?2. What type of training is given to your staff members?3. Does your agency have licensed social workers on

staff to address the emotional needs of clients andfamilies?

4. How closely do your supervisors evaluate thequality of care provided?

5. How are problems addressed and resolved?6. How do you manage scheduling? Is care

available around the clock if needed?7. What are the credentials of your employees

who will be in my home? Can they provideindividual references?

8. What procedures are in place in case of anemergency, such as a power failure or inclementweather?

9. Are all of your caregivers licensed in their fields?10. Can you provide references from doctors, hospital

discharge planners, and clients?11. How do you handle expenses and billing?

Has your company ever been accused of fraud?12. Will I receive a written care plan before service

begins?


A diagnosis of

Canceris

overwhelmingnews.

It raises many questions few of us are prepared to answer,such as:

• How can I take time off from work?

• Can I get help paying bills?

• What is the difference between a health care directiveand a power of attorney?

• Can I keep my health insur-ance even if I lose my job?

• And many others.

If you or a loved one is facingcancer, we are here to help.

We provide free cancer relatedlegal information on a widerange of topics.

Please visit our web site tofind out more:

www.cancerlegalline.org

educate.inform.empower

We are a nonprofit organization funded entirely

through grants and donations.Your tax-deductible

donations are welcome. Gout is the most common form of inflammatory arthritis in men and affects millions of Americans. In people with gout, uric acid levels build up in the blood and can lead to an attack, which some have described as feeling like a severe

burn. Once you have had one attack, you may be at risk for another.

Learn more about managing this chronic illness at www.goutliving.org

Living with gout?Keep enjoying life’s

simple pleasures.

If you’ve been turned down for health insurance because of apre-existing condition, or offered coverage only at an unafford-able price, you may have another option: the Pre-Existing

Condition Insurance Plan, or PCIP.PCIP is available to children and adults who have been locked

out of the health insurance market because they have cancer, heartdisease, diabetes, HIV/AIDS, asthma, or some other pre-existingmedical condition.With PCIP, you can be insured for a wide range of benefits,

including primary and specialty physicians’ services, hospital care,and prescription drugs. You won’t be charged a higher premiumbecause of your medical condition, and your eligibility isn’t basedon your income.Like commercial insurance plans, PCIP requires you to pay a

monthly premium, a deductible, and some cost-sharing expenses(copays).Minnesotans enrolled in PCIP have access to a provider network

that includes 22,264 doctors, 1,120 pharmacies, and 129 hospitalsthroughout the state.To qualify for PCIP, you must be a U.S. citizen or legal resident.

You also must have a pre-existing condition or have been deniedhealth coverage because of your health status. In addition, you must

have been without health insurance for at least sixmonths before you apply for PCIP.PCIP offers three coverage options: Standard,

Extended, and a Health Savings Account. With aHealth Savings Account, you can use pre-tax earn-ings to pay for PCIP. Premiums are based on theamount a subscriber would pay if he or she hadno pre-existing condition and was able to purchaseindividual insurance in the open market.Each plan covers the same benefits but has dif-

ferent premiums, different medical and prescriptiondrug deductibles (i.e., the amount you pay beforeyour insurance company begins to pay benefits), anddifferent prescription drug copays. You can select anyqualified network provider for your care.Choose the plan that best meets your needs and

know that you’re getting comprehensive, affordablehealth coverage.PCIP premiums were recently lowered 38 percent in Minnesota.

The current premium for the Standard option for a Minnesotaresident 35–44 years of age is $174 per month. The Standard optionpremium for a child 18 years old or younger is $96 per month. AMinnesotan 55 years old or older would pay $307 per month forthe Standard option. (For ages between 44 and 55, cost varies byyear; for details, go to “Find Your State” on the PCIP website,www.pcip.gov.)In addition to a monthly premium, you’ll pay other costs. In

2011, you’ll pay a deductible that ranges from $1,000 to $3,000—depending on which option you pick—for covered medical benefitsbefore PCIP starts to pay. Prescription drugs may have separatedeductibles. Preventive-care services, such as cancer screenings andflu shots, are covered 100 percent, with no deductible.After you pay the deductible, you’ll pay a $25 copay for doctor

visits, $4 to $40 for most prescription drugs, and 20 percent of thecosts of any other covered benefits you receive. Your out-of-pocketcosts cannot exceed $5,950 per year if you stay in the PCIP net-work, and there’s no lifetime cap on the amount that PCIP pays foryour care.Coverage always begins on the 1st day of the month. Generally,

a completed enrollment application received on or before the 15thof the month will go into effect the 1st day of the next month. Ifit’s received after the 15th but on or before the last day of themonth, your coverage will start no later than the 1st day of thesecond month.The Pre-Existing Condition Insurance Plan was created under

the Affordable Care Act. It’s a transitional program until 2014,when all Americans—regardless of health status—will have accessto affordable health insurance as the nation shifts to a new market-place. PCIP is operated by the U.S. Department of Health andHuman Services. Insurance is provided through GEHA, a nonprofitorganization that covers federal employees and retirees.

I N S U R A N C E

Health insurance for peoplewho can’t get it By Jackie Garner

In the next issue...

• Vaccination

• Sinus congestion

• Insomnia


You can apply online, by phone, or by mail. You must completean application and provide a copy of one of the

documents noted below, which must bedated within the past 12 months from thedate of your application.

• A letter from a doctor, physicianassistant, or nurse practitioner statingthat you have or had a medical condition,disability, or illness. This letter mustinclude your name and medical condition,

disability, or illness and the name,license number, state of licen-sure, and signature of theprovider.

• A denial letter from an insurancecompany for individual insurance cover-age or a letter from an insurance agent

or broker that shows you aren’t eligible for coverage from one ormore insurance companies because of your medical condition.

• An offer of individual insurance coverage that you did not acceptfrom an insurance company. This offer of coverage has a rider that

says your medical condition won’t be covered if you accept theoffer.

• If you are under age 19 (or if you live in Massachusetts orVermont), an offer of individual insurance coverage that youdid not accept from an insurance company. This offer of coveragemust show a premium that is at least twice as much as the Pre-Existing Condition Insurance Plan premium for the StandardOption in Minnesota.

PCIP is already changing the lives of Americans who don’t havehealth care coverage and need medical care. James H., who lives inTexas, was diagnosed with brain cancer in 2010. Shortly after hisdiagnosis, James’ insurance company rescinded his coverage, claim-ing that his cancer was a pre-existing condition. James knew hislack of coverage was a death sentence. Fortunately, he was able tojoin PCIP in Texas and is now receiving the treatment he needs.For more information about required documents, go to “Learn

More” at www.pcip.gov. You can also go to “Find Your State” atwww.pcip.gov to find out how PCIP works in your state. For moreinformation, go to www.pcip.gov or call (866) 717-5826 toll-free(TTY (866) 561-1604). The phones are open Monday throughFriday from 8 a.m. to 11 p.m. Eastern Standard Time.

Jackie Garner is consortium administrator at the Centers for Medicare &Medicaid Services (CMS), with oversight of the 10 Medicaid divisions inCMS’s Regional Offices. She served as acting deputy director for the Centersfor Medicaid and State Operations in 2009 during the transition betweenfederal administrations. Garner has more than 20 years of experience inhealth and human services at the state and national level, and received theSenior Executive Service Meritorious Executive Award in 2007.


Forest Lake • Lake Elmo/WoodburyLino Lakes • Maplewood • North St. PaulShoreview • Stillwater • West St. Paul

White Bear Lake• Somerset, WI

Most insurance plans accepted.

Call 651-275-4706

TherapyOSIOSI Physical

Stay in the Game.

EXCLUSIVE PROVIDERS OF ATHLETIC TRAINING SERVICES FOR THE ST. PAUL SAINTS

Active Care for Active People

www.osipt.com

With PCIP, you can

be insured for a wide

range of benefits.

Expert evaluation, diagnosis & treatment

for sleep apnea,insomnia andall other sleep

disorders

763-315-4300 MAPLE GROVE

952-997-2889 BURNSVILLE


Hospitals and clinics are by nature frightening andbrutal places. Patients would avoid them if they could.The experience could easily be characterized as a con-stellation of interrogations, physical and social isola-tion, invasion of privacy, and assaults upon the body.The truth is that some mental and physical discomfortis characteristic of the struggle to get better. However,physicians have both an interest and obligation tokeep these discomforts to a minimum. Healing dealsas much with the delivery as with the treatment.

The challenges facing patients are but a subsetof the challenges of life itself. We all deal with dailyobstacles, uncertainty, and discomfort, not only inour individual lives but also as members of society.So how do we manage these discomforts? What makeslife palatable? I would argue that a good deal of ourindividual and societal ability to cope with the myriadchallenges of life comes through the arts. We arrangeand design our living spaces, decorate our walls, listento music, read, write, dance, recite stories, joke, delveinto creative hobbies and pastimes, adorn our bodies

with styles that we find fashionable, andprepare our food in creative ways.

The arts are not confined to muse-ums, concert halls, and coffee books,however. They are woven into the veryfabric of what it is to be human. And ifthey are essential to human nature, thenphysicians need to recognize the arts asan additional adjunct avenue for healing,just as worthy as diet, exercise, pharma-ceuticals, and surgery. But how can thearts benefit health care?

The arts in the health care environmentUntil fairly recently, health care environmentaldesign has emphasized efficiency, practicality, andtechnology—i.e., from the perspective of health careproviders and administrators, with less attention to thepatient and family experience. The aesthetic sterility ofthe hospital ward nearly matched the necessary clinicalsterility. In this context, patients, captive and immo-

H O L I S T I C H E A L T H

ArtsMedicine and the

By Gary A.-H. Christenson, MD

Every day is a reason for a person with Down

syndrome to smile. And find joy in things the rest

of us often overlook. To learn more about the rich-

ness of knowing or raising someone with such an

enthusiasm for life, call your local Down syndrome

organization. Or visit ndsccenter.org today.

It is the mission of the Down Syndrome Association of Minnesota to provide information, resources and support to individuals with Down syndrome, their families and their communities. We offer a wide range of services, programs andmaterials at no charge. If you are interested in receiving one of our information packets for new or expectant parents, please email [email protected] or

For more information please call:

(651) 603-0720 • (800) 511-3696©2007 NationalDown SyndromeCongress

WHO’S GOT BETTER MOVES ON THEDANCE FLOOR, YOU OR ME?

bile, not only were constantly reminded where they were and whatthey faced, but were also forced to sacrifice their sense of control.Increased patient fear and anxiety were natural outcomes.

Studies have demonstrated that the use of design andvisual art not only improves the patient experience,

but can also positively influence both clinicaloutcomes and medical expenditures.

Several studies have revealed that roomsdesigned with views of nature decreaseanxiety, physical discomfort, and therequirement for pain medications,compared to rooms without suchelements. Other studies have sug-gested that artwork depictingnature can achieve similar results,although many have argued thatsoothing abstract art can be equallyeffective. Recognizing the subjectivenature of art appreciation, more and

more hospitals are offering art cartsthat allow patients to personally select

the art to grace their rooms. Art is alsobeing installed in procedure rooms, particularly

on ceilings, to provide a more soothing, less threaten-ing environment and/or serve as a pleasant distraction.Similarly, live music is being used in procedure rooms as well as

at the bedside. Music is not just an acoustic pleasantry. One studydemonstrated remarkable financial savings when music was playedwhen children underwent diagnostic procedures; cost reductionsrelated to a decreased need for nursing support, decreased need forsedation, and the greater success of the diagnostic procedure itself.

Active participation in the arts has also proved useful forpatients and families enduring the long confinement of dialysis andother lengthy medical treatments. And applications of the arts arenot confined to the interior of medical facilities: Meditative andhealing gardens, labyrinths, and sculpture gardens are increasinglybeing recognized as valuable for providing a welcomed respite forpatients, families, and staff alike.

The arts andmedical treatmentsThe arts also play a role in theactive treatment of medical condi-tions. Dance and movement thera-pies are being used to increasethe mobility of patients withParkinson’s disease and other con-ditions that diminish movement.Singing allows patients with apha-sia (loss of ability to understand orexpress speech) an avenue towardsspeech recovery. Museum visitsand art-making are being used asadjunctive approaches to the treat-ment of patients with Alzheimer’sdisease. Art, music, dance, drama,and poetry therapies have all beenused to help patients express, reflect

on, and respond to theirexperiences. Although thesecreative arts therapieswere initially appliedas variants of psy-chotherapy, their use hasexpanded to treatment ofnumerous medical conditions. Thisshould come as no surprise; whatpatient who is dealing with chronic disease isimmune from the psychological challenges that derive from physical,social, and occupational impairments?

The arts and preventionThe field of medicine has increasingly emphasized the importanceof efforts aimed at disease prevention, and the arts have a tremen-dous ability to address this goal. Dancing has been recognized asone of the best ways to fend off cognitive decline and has been pro-posed as one approach to increase exercise and address the growingobesity epidemic. An interesting variation on the theme, calledConductorcise, is a particularly enjoyable way to combine musicappreciation and exercise in a group format. In England, the GetHealthy, Get Singing program uses song and dance to improve self-esteem, combat bullying, and promote healthy eating and exercise inschools. In Africa, art murals educate about disease prevention, andhere in Minnesota, painted sidewalks have emphasized safe sex andHIV prevention.


the benefits of yoga.DiscoverRight now, new students get a FREE WEEK of unlimited yoga.

See you soon at any one of our 8 Minnesota locations

Eden Prairie • Edina • Minneapolis • Minnetonka

St. Louis Park • St. Paul • Stadium Village • Uptown

Medicine and the arts to page 32

The arts ...

are woven into

the very fabric

of what it is to

be human.

Clearly, these efforts have great potential to help individualsand communities alike. But art is not limited to addressing thephysical needs of the population. Disease trends are often associatedwith a lack of social cohesion and community health. The arts havea tremendous ability to pull communities together, as exemplifiedby beaded doll-making in AIDs-ridden villages in Africa andlantern-making in the north of England.

The arts and physiciansMost physicians entered medical school with some arts experience,such as participation in choirs, orchestras, garage bands, theater,dance, art classes, poetry, or story writing. Medical school matricu-lation often meant an abrupt end to these creative endeavors in theface of new demands for rigorous study. However, the sacrifice ofthese creative pursuits may reflect the sacrifice of skills that madethese students good candidates for medicine in the first place.Indeed, further exposure to the arts may produce better physicians.

For example, training in observational skills and art apprecia-tion has been demonstrated to improve clinical observational skills.Instruction in music appreciation has been shown to improve aphysician’s ability to listen through a stethoscope. Narrative medi-cine is being used to improve the ability of medical students tobetter understand, appreciate, and articulate their patients’ stories.Theatrical skills are being used to improve communication, empa-thy, and resilience in medical students. Locally, the University ofMinnesota offers a program that encourages medical students tocontinue in previous creative endeavors or explore new artistic

avenues, in recognition of the value that the arts play in producingwell-rounded physicians.

The personal costs of burnout, compassion fatigue, and decisionfatigue are gaining increasing attention, and discussions of what canhelp physicians stay resilient are becoming more relevant. The artsprovide a way to reflect, engage one’s creativity, and find respitefrom challenging, hectic lives.

There is value for both physicians and patients in reconnectingwith their artistic roots and/or developing new creative interests.The arts are a valuable adjunct to patient care as well as self-care.Physicians should be encouraged to learn more about the multifac-eted arts in health care movement, which recognizes the power thatthe arts can play in healing. Two useful resources are the Society forthe Arts in Healthcare (www.thesah.org), the largest internationalorganization representing the interests of all who share an interest inarts and health care approaches, and the local Midwest Arts andHealthcare Network (www.maihn.org).

Gary A.-H. Christenson, MD, is mental health director for the University ofMinnesota’s Boynton Health Service and an adjunct associate professor ofpsychiatry at the University of Minnesota Medical School. Dr. Christensonis also a Distinguished Fellow of the American Psychiatric Association,president of the Society for the Arts and Healthcare, and former co-chair ofthe Midwest Arts in Healthcare Network.

Medicine and the arts from page 31


Health Care ConsumerAssociation

Minnesota

Each month members of the Minnesota HealthCare Consumer Association are invited toparticipate in a survey that measures opinionsabout topics that affect our health caredelivery system. There is no charge to jointhe association, and everyone is invited.For more information, please visitwww.mnhcca.org. We are pleased to presentthe results of the October survey.

Per

cen

tag

eo

fto

tal

resp

on

ses

Yes No0

10

20

30

40

50

60

70

80

61.9%

38.1%

Per

cen

tag

eo

fto

tal

resp

on

ses

Very

satisfied

Satisfied Does not

apply

Unsatisfied Very

unsatisfied

0

10

20

30

40

50

14.3%

31.0%

45.2%

9.5%

0.0%

2. How satisfied were you with the medical adviceleading up to the procedure?

1. Have you, or a member of your family ever hadany type of medical device (artificial joint, stent,pacemaker, etc.) surgically implanted?

Per

cen

tag

eo

fto

tal

resp

on

ses

Very

satisfied

Satisfied Does not

apply

Unsatisfied Very

unsatisfied

0

10

20

30

40

50

23.8%

16.7%

42.9%

14.3%

2.4%

Per

cen

tag

eo

fto

tal

resp

on

ses

Very

satisfied

Satisfied Does not

apply

Unsatisfied Very

unsatisfied

0

10

20

30

40

50

28.6%

21.4%

42.9%

7.1%

0.0%

5. How satisfied have you been with theperformance of this device?

4. How would you rate the follow-up careassociated with this procedure?

Per

cen

tag

eo

fto

tal

resp

on

ses

Very

satisfied

Satisfied Does not

apply

Unsatisfied Very

unsatisfied

0

10

20

30

40

50

26.2%

16.7%

42.9%

14.3%

0.0%

3. How satisfied were you with the procedure itself?

October survey results...

“A way for you to make a difference”

Join now.

SM

Welcome to your opportunity to be heard indebates and discussions that shape the futureof health care policy. There is no cost to joinand all you need to become a member isaccess to the Internet.

Members receive a free monthly electronicnewsletter and the opportunity to participatein consumer opinion surveys.

www.mnhcca.org

Health Care ConsumerAssociation

Minnesota



5. What happens if the pain and symptoms cannot be controlled athome?

6. If my diagnosis or condition changes, will the palliative care teamstill work with me?

7. What part of the palliativecare services will be coveredby my insurance?

8. What services will we as afamily have to pay for?

9. Are there any services I amcurrently receiving that willnot be covered under pallia-tive care?

Palliative careprograms statewideThere are palliative careprograms available now in many areas of Minnesota. Most largerhealth systems have in-hospital palliative care programs. Morerecently, community palliative care programs have been created.Palliative care programs are more readily available in metropolitanareas of Minnesota, such as Minneapolis-St. Paul, Duluth,Rochester, and St. Cloud.

Several rural Minnesota communities have begun offeringpalliative care services as well. Stratis Health and Fairview HealthServices’ Palliative Care Program provides assistance to rural health

care providers, resulting in palliative care services being developedin rural areas of Minnesota. Rural communities currently buildingpalliative care programs include Bemidji, New Ulm, Olivia, RedWing, Roseau, Staples, Waconia, Wadena, Willmar, and Winona.For more information about palliative care services available in

rural Minnesota communities, visit www.stratishealth.org/expertise/longterm/palliative.html.

With the increasing availability of palliative care programs inMinnesota, patients facing a serious illness should request palliativecare because it can help them live better—and possibly longer.

Michele Fedderly, EdD, is the executive director of the Minnesota Networkof Hospice & Palliative Care, in North St. Paul.

Palliative care from page 21

Palliative care is medical care for patientswith any serious—but not terminal—illness, at any time during the illness.Hospices serve only the terminally ill.

R E G E N C Y H O S P I T A L O F M I N N E A P O L I S

R E G E N C Y PRO G R A M S A N D S E RV I C E S

Pulmonary/ventilator program

Medically complex/multi-system failure program

Wound care program (stage III and IV decubitus)

Low-tolerance rehabilitation services

Giving People �eir Lives BackRegency Hospital of Minneapolis is an intensive critical care hospital serving the needs of medically complex

patients that require acute level care for a longer period of time than traditional hospitals are set up to provide.

We are a national network of hospitals with a different way of thinking, a different way of caring, and a different

way of treating, and it shows in everything we do.

Regency Hospital of Minneapolis1300 Hidden Lakes ParkwayGolden Valley, Minnesota 55422Main: 763.588.2750Referral: 763.302.8340

©20

11 L

IFE

TIM

E F

ITN

ES

S, I

NC

. All

right

s re

serv

ed. M

HM

G10

62

rethinkmyHealthCheck by Life Time is revolutionizing wellness at work.

We combine the most comprehensive assessment, cutting-

edge coaching and results-based incentives to deliver the best

program and value in the industry.

You save on heath care costs, increase morale and decrease

sick leave. Your employees get healthier and make wellness

a meaningful part of their lives.

Welcome to the wellness revolution.

Let’s change some lives today. myhealthcheckonline.com

For information on plans with diverse benefi ts and features, please call 1-877-809-2227 (TTY users call 1-866-582-1158) from 8 a.m. to 8 p.m. daily, contact your agent or visit bluecrossmn.com/medicare.

Service representatives and licensed sales representatives are available whenyou call the number above. A Medicare-approved Part D sponsor and a healthplan with Medicare contracts. Plans are available to residents of the service area.

Blue Cross® and Blue Shield® of Minnesota is a nonprofi t independent licensee of the Blue Cross and Blue Shield Association.H2461_081511_N03 File & Use 08/29/2011; Y0052_081511_B06_MN File & Use 08/29/2011

BE AS YOUNG AS YOU FEEL. ENROLL IN A MEDICAREPLAN TODAY.

Documents

Minnesota Health care News November 2011