cover story one

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

BY CINDY FIRKINS-SMITH, MD, MHCI, FAAD

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

cover story one

Freedom Echoing: A legislative fix for health care?

BY KIP SULLIVAN, JD

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

cover story one

Serious Illness Communication: Building a statewide standard of care

BY LORI BROSTROM, MB

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

cover story one

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

BY DEB ZURCHER, LAC, DC

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

cover story one

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

BY JESSE BETHKE GOMEZ, MMA

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

cover story one

Shell Game Economics: Corporate medicine wins, you lose

BY DAVID FEINWACHS, MA, MHA, JD, PHD

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

cover story one

The Minnesota CANDOR Act: Addressing adverse events

BY NELS E. DYSTE

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

cover story one

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

BY CHESLEY CHEN, MS, MBA

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

cover story one

Navigating Drug Shortages: Preparedness and patient advocacy

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

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

cover story one

Moral Injury in Health Care: A growing concern

BY WENDY DEAN, MD

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