Monthly Archives: March 2011

Future of Private Practice

A recent article from the Minnesota Hospital Association’s Ebriefing, by Dr. Daniel K. Zismer, who is the associate professor and director of the MHA and Executive Studies Program, conveyed why he feels that there are significant challenges to the private practice business model in our futures.

No doubt there will always be some room for private practice. He feels that there are six common challenges that are causing private practice models to be stressed and thus leading to more and more physicians wanting to be employed with hospital systems.

Those pressures are the following:

  1. the cost of electronic health records. It is staggering for groups to have to implement an electronic health record. It is neither a luxury nor a strategic differentiator any longer but is rather a required ticket to relevancy he says. We will need it to be part of an accountable care organization and to be relevant to the consumers in health care into the next decade.
  2. Health systems can outspend private practice for physicians. The larger the system the more money they have available to go out and seek the more specialists, and especially the higher end specialists, while private practice has difficulty. For those who want to be employed there is no practice investment.
  3. Reimbursement lightning strikes. The larger the organization the more they are able to handle quick strikes by the government or the payers of reimbursement problems. While the larger systems also have this difficulty it is not to the same degree.
  4. Young physicians wants and needs. Almost 85 to 95% of residents and students coming out of residency want to be employed. They no longer are looking for the private practice model.
  5. Routine practice overhead inflation curves. Groups are having a more difficult problem keeping up with the inflation cost of operations, thus physicians take home less compensation. Independent physicians will endure this dynamic until the economics of private practice become unsustainable.
  6. Routine practice recapitalization – It is getting harder to find dollars to capitalize things. These forces are out there for everyone and will continue to be a cultural change that is occurring in medicine.

Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.

New Children’s Hospitals and Clinics Report Highlights Minnesota’s Declining Immunization Rates

By Patricia Stinchfield, RN, MS, CPNP, Director of Pediatric Infectious Disease & Immunology Infection Control

The case of measles detected last week in Minnesota revives strong memories for me of Minnesota’s measles outbreak in the early 1990s. Child health care providers back then will never forget the panic among parents, the babies on ventilators, and the ones who did not survive.

We pay close attention when there is a case of measles because the disease is so highly contagious that even just one case is considered epidemic. While state health officials are still monitoring the confirmed case reported last week, it serves to show that vaccine-preventable diseases continue to be a problem. And that problem may well be due to a worrisome trend we see occurring not just in Minnesota but across the country.

Declining immunization rates.

This trend has the attention of Children’s Hospitals and Clinics of Minnesota. As part of our series of reports on the health of Minnesota’s children called “Children’s Check-Ups,” we decided to take an in-depth look at immunization rates among Minnesota’s children, where they were slipping and why. Our report, called “Check-Up 2: Vaccinations and the Challenges Confronting Minnesota Children,” is now released and can be found at

We found that Minnesota’s immunization rate for children ages 19 months to 35 months dropped 3.6 percentage points from 2007 (80.5 percent) to 2009 (76.9 percent). As a result, Minnesota’s rank in immunization dropped to 20th place in 2009 from the seventh in 2007. We saw similar drops in vaccinations against measles, mumps and rubella (MMR), diphtheria, tetanus and whooping cough (DTaP and Tdap), and chickenpox vaccine.

Quite simply, the lower the immunization rate, the more likely the disease will spread. Even a one percentage point drop is cause for concern when you consider that it means that more than 4,200 young Minnesota kids are left unprotected.

Last year, we saw a resurgence of whooping cough in Minnesota, which threatens to recur this year. Our report notes declines in whooping cough vaccination rates among young kids, and a poor showing among adolescents for the booster shot version.

We found two powerful forces contributing to declining immunization rates. The first is disparities in care, often linked to poverty, which limits access to vaccines among certain populations. The second is a growing mix of complacency, misinformation and misunderstanding that keeps parents from protecting their children against vaccine-preventable disease.

I had the opportunity to talk about these issues during Minnesota Public Radio’s Midmorning program on Tues., March 8. You can download the podcast here. We hope our report, by providing a clear, factual and in-depth look at these issues, can serve as a resource to inform parents, government leaders, health care providers and advocates about these issues, and to spark a meaningful and productive discussion of how to better protect our kids. They are counting on us to protect them.

Additional Resources:

  • Patsy Stinchfield, joins Good Enough Moms hosts Marti Erickson and Erin Erickson to discuss why vaccinations are important, how they have prevented the spread of disease in the U.S. and how being immunized also protects the people around us.