Flex Advisory Committee Meeting Minutes

Flex Advisory Committee

Meeting Minutes

February 12, 2014
10:00 a.m. - 11:30 a.m.

Flex Members Present:
Rick Breuer, Community Memorial Hospital; Dave Nelson, St. Francis Healthcare; Joe Schindler, MHA; Barb Heier, TriCounty Health Care; Laura Ackman, Essentia Health - Northern Pines; Brian Carlson, Sanford Thief River Falls; Lynn Flesner, Glacial Ridge Health System; Marion Larson, Central EMS Region; Jeff Lang, United Hospital District; Karla Weng, Stratis Health; Rick Failing, Kittson Memorial Hospital; Gary Wingrove, Gold Cross Ambulance and NCEMSI; Michael Hedrix, Essentia Health - Sandstone; Stacy Barstad, Sanford Health - Tracy and Westbrook.

ORHPC Staff: Judy Bergh, Mark Schoenbaum, Tim Held, Will Wilson, Craig Baarson.

Member Updates

Laura Ackman from Essentia Health-Northern Pines in Aurora announced that a grant has been awarded to seven Northeast Minnesota counties for development of a mobile crisis team on the Iron Range. Coordination will be provided by Range Mental Health. It is anticipated that the Wellstone Center will serve as the base site, with a process developed for response to crisis calls from providers or individuals. The crisis call will trigger an assessment by phone conference or telehealth so appropriate assessment and planning can be provided by the crisis team. Mark Schoenbaum noted that the Rural Health Advisory Committee has had a related focus, resulting in a letter to the governor and legislature supporting funding for crisis teams, and an update of an EMSRB report on behavioral health transport issues.

Brian Carlson announced that Sanford-Thief River Falls is in the process of planning for a freestanding psychiatric hospital to be housed in what is now the inpatient area of the CAH. The CAH will be moving to its new site in October 2014. The planning process includes working with MDH and developing legislation allowing the addition of 25 psych beds. He noted that although they have a 10-bed psych Distinct Part Unit they turn away many potential patients, mostly from Beltrami and St. Louis Counties, illustrating that the need is widespread.

Rick Failing is retiring as CEO of Kittson Memorial Hospital in Hallock as of February 14. The Board of Directors appointed Cindy Urbaniak to fill the CEO position.

Karla Weng discussed structural changes coming in the next Quality Improvement Organization (QIO) Scope of Work. In the past, QIOs focused on quality improvement and case review. In the future, there will be two separate types of contracts and organizations are not allowed to apply to serve in both roles. The two options are:

  • Beneficiary and Family Centered Care QIOs (BFCC-QIO) which will focus on case review component of QIO efforts. For the upper Midwest, there will be a contract for a 10-state BFCC QIO.
  • Quality Improvement Network QIOs (QIN-QIO) which will focus on the quality improvement and patient safety components of QIO efforts. Contracts will be awarded to networks covering 3-6 states rather than on an individual state by state basis.

Stratis Health is applying for the QIN QIO network contract in partnership with the incumbent QIOs in Wisconsin and Michigan. The three-state network will be known as the Lake Superior Quality Improvement Network. State-level coordination and partnerships will still be a critical component of the work, but there will be increased collaboration and coordination with the other network states. The QIN QIO contracts will be for five years. QIO contracts have traditionally been for three years. The applications are due February 21, and a summer announcement of awards is expected.

Flex Program Announcements

  • Anne Schloegel has left the Office of Rural Health and Primary Care to assume full-time duties with the Office of Health Information Technology. In that role, she will continue to work closely with our office, but her Flex-specific duties will be assumed by a new position in the ORHPC.
  • A list of 2014 Flex Grant awards was distributed to members of the committee and will be posted on the Flex Program web pages.
  • Scott Reiten of South Central MN EMS, who represented regional EMS programs on the committee, has moved to a new position. Marion Larson from the Central MN EMS region will fill that position on the committee.
  • We are looking for a new representative from Rural Health Clinics on the Flex Advisory Committee, as Judy received word this week that Mick Stokes is no longer with Lakewood Health System in Staples. Judy will consult with ORHPC Primary Care staff to find a replacement, and requested that any members who would like to nominate someone for the position please let her know by email.
  • The Flex Program has contracted with SafeTech Solutions to provide a statewide EMS Leadership Training for EMS services with fewer than 5,000 runs. The contractor is notifying all rural EMS agencies as well as the regional programs about the training which will occur May 3-4 in St. Cloud.
  • The Minnesota Rural Health Conference, sponsored by ORHPC, the National Rural Health Resource Center, and the Minnesota Rural Health Association, will be held once again in Duluth, on June 23-24. Proposals for breakout sessions were due today, February 12. A review meeting to decide upon breakout sessions will be held February 26. If any committee members are interested in participating in that review, let Judy know soon, since we will make proposals available to reviewers this week. We will also soon be accepting nominations for Rural Health Hero and Rural Health Teams. Judy reminded the committee to watch the conference website for more information, and if anyone is interested in reviewing those nominations, please let her know via email.

Federal Update, Mark Schoenbaum and Will Wilson

During the first week of February, Mark Schoenbaum and Will Wilson attended the annual NRHA Rural Health Policy Institute in Washington D.C., where they were updated on federal rural health issues and had the opportunity to meet with Minnesota’s congressional delegation. Key issues discussed included:

  • A bill has been introduced in the Senate to repeal the CAH 96-hour rule. Senator Klobuchar has signed on as a sponsor. Will reported that when questioned about this issue, CMS spokespersons took a firm stance that if CAHs want to have CMS change their enforcement policy, they need to approach Congress with their concerns.
  • A Senate bill has passed that directs CMS to extend enforcement of the moratorium on the direct supervision rule. The future of that legislation is unknown.
  • Mark observed that many of these issue-specific rural health bills get attached to other bills rather than standing on their own, and some may get attached to the debt ceiling bill or the Sustainable Growth Rate (SGR) bill. The SGR includes changes in how physicians get reimbursed by Medicare.
  • Considerable movement is still expected in rural health issues, and Mark advised members to pay attention to how the issues are moving through the legislative process.
  • Rural Health Clinic restrictions may be loosened. The comment period for that issue is open. There may be flexibility around the every-2-week rule, allowing RHCs to have an oversight plan, which can include telemedicine. Also, the term “physician” might be expanded to include dentists, doctors of optometry and chiropractors.
  • Brian Carlson informed the group that MHA is convening a task force to identify ideas for health reform. Several members of the Flex Committee are on the task force, including Mark Schoenbaum from ORHPC.
  • Joe Schindler informed the group that on March 3 there will be an announcement from the CMS Innovation Center about the Frontier Community Integration Project, which we may want to watch. It does not include Minnesota.
  • Gary Wingrove announced that the Medicare Super Rural Bonus rate includes a 23 percent add on. This rate will expire March 31, 2014 unless Congress acts, and this would contribute to destabilizing rural ambulance services.

Helmsley Trust Opportunity, Mark Schoenbaum

The Rural Healthcare Program of The Leona M. and Harry B. Helmsley Charitable Trust seeks to replicate currently funded programs across each state in their seven-state focus area (Minnesota, Iowa, North Dakota, South Dakota, Nebraska, Montana and Wyoming). The Trust has granted funding for LUCAS devices (portable machines that perform CPR) in two of the seven target states: North Dakota and South Dakota. They seek to finish out the remaining states over time. While funding is not guaranteed, the Trust would like the Department of Health to assess how the program would look in Minnesota.

  • Mike Hedrix and Marion Larson volunteered to represent the Flex Advisory Committee as advisors to ORHPC as the Helmsley LUCAS project moves forward.

Plan for 2014-15 Federal Flex Grant Activity, Judy Bergh and members

Committee members received a copy of a two-page document summarizing Flex program focus areas and objectives in preparation for planning the next ORHPC application to HRSA for Flex Program funding. They were asked to review the document and be prepared to advise Flex staff on priorities and potential activities. The following priority areas were discussed, received both by email from members unable to attend the meeting and from those present at the meeting.

Quality Improvement

  • Violence and security issues in CAH.
  • Geriatric population needs.
  • Identification of good quality processes, determining which services to provide and measuring quality.
  • Patient and family engagement (e.g., patient experience focus groups, MHA patient safety initiatives).

 Financial and Performance Improvement

  • Payment reform: need for data analytics, service line management, cost control.
  • Mentoring of low-performing CAH: challenges to setting up mentoring relationships include geography (CAH being in same competitive area) and whether CAH belong to systems or are independent.

Health System Development and Community Engagement

  • Assistance to CAH in helping board members identify community needs and the role of CAH in addressing those needs.
  • Take advantage of MHA summary of Community Health Needs Assessments findings to identify statewide priorities. (Encourage MHA to propose a break-out session for the Rural Health Conference regarding this.)
  • Anticipate Federal Office of Rural Health Policy releasing new rural EMS performance measures.

Next Meeting
Tuesday, May 5, 2014, 10:00 a.m. - 2:00 p.m.
MN Department of Transportation Aeronautics Building
222 Plato Boulevard East
St. Paul, MN

This will be the annual joint meeting with the Rural Health Advisory Committee.


Updated Monday, August 25, 2014 at 10:03AM