Flex Advisory Committee Meeting Minutes

Flex Advisory Committee

Meeting Minutes

Monday, October 14, 2013
10:00 a.m. - 2:00 p.m.

Flex Members Present:
Laura Ackman, Essentia Health—Northern Pines, Aurora
Stacy Barstad, Sanford Tracy and Westbrook
Rick Breuer, Community Memorial Hospital, Cloquet
Sally Buck, National Rural Health Resource Center
Brian Carlson, Sanford—Thief River Falls
Rick Failing, Kittson Memorial Hospital, Hallock (by phone)
Lynn Flesner, Glacial Ridge Health System, Glenwood
Ann Gibson, Minnesota Hospital Association
Michael Hedrix, Essentia Health System, Sandstone
Barbara Heier, Minnesota Academy of Physician Assistants (TriCounty Hospital) Wadena
Scott Reiten, South Central Minnesota EMS
Joe Schindler, Minnesota Hospital Association
Karla Weng, Stratis Health
Gary Wingrove, North Central EMS and Gold Cross Ambulance

ORHPC Staff: Craig Baarson, Judy Bergh, Mark Schoenbaum, Anne Schloegel, Cindy LaMere

Guests: Gary Sabart, TSP Architects and Engineers; Melissa Heinen, MDH Injury and Violence Prevention

Introduction of New Members
Judy Bergh introduced new members to the Flex Advisory Committee. New members include:
Rick Breuer, Community Memorial Hospital, Cloquet
Jeff Lang, CEO, United Hospital District, Blue Earth
Lynne Flesner, DON, Glacial Ridge Health Center, Glenwood
Laura Ackmann, CEO, Essential Health—Northern Pines, Aurora
David Nelson, CEO, St. Francis Hospital, Breckenridge
Randy Ulseth, CEO, FirstLight Health Center, Mora
Kathy Serie, supervisor, MDH Licensing and Certification, Compliance Monitoring

Member Updates

Brian Carlson, Sanford Thief River Falls
Reported on $60 million construction project for 135,000 square foot facility combining hospital and clinic into one location. Maintaining independent, distinct part psych unit but re-licensing as free-standing psych hospital. New facility occupancy anticipated for October 2014.

Also, CMS grant of $12.5 million to Sanford to develop an integrated behavioral health and primary care service, specifically targeting chronic health conditions. There is also a focus on impacting the Native American populations in Sanford’s footprint to impact their addictive behaviors in a positive way.

Jeff Lang, United Hospital District, Blue Earth
Mentioned that United Hospital District will be changing from a district hospital to a 501(c)3 non-profit.

Rick Failing, Kittson Memorial Hospital, Hallock
Announced that he will be retiring in mid-February with Cindy Urbaniak assuming duties as CEO.

Rick Breuer, Community Memorial Hospital, Cloquet
Reported that skilled nursing facility is reducing from 88 to 44 beds. Also, a new dialysis program is being worked on, partnering with Fresenius. Wrapping up latest construction project with all private inpatient rooms, new meeting and education space, new specialty clinic and new kitchen/cafeteria.
The Foundation just completed its 25th year with Community Memorial hosting the Fall Gala. There were 240 in attendance, It was a huge task for CAH to host. The Foundation raised $200,000.

Karla Weng, Stratis Health
Flex sub-contracts for this year include working with QI, data measurement, and community action plans with CHNA. She encouraged others to visit www.ruralhealthvalue.org for information on Rural Health System Analysis and Technical Assistance (RHSATA), a project of the RUPRI Center for Rural Health Policy Analysis and Stratis Health. Also reported that the Rural Palliative Care work continues around the state. Stratis is part of an eight state pilot to support ED transfer measures.

Sally Buck, National Rural Health Resource Center
The Technical Assistance and Services Center (TASC) for all state Flex Programs just released a Performance Excellence Framework Blueprint for CAHs.  It is available at www.ruralcenter.org/tasc/resources/critical-access-hospital-blueprint-performance-excellence.The 2014 Minnesota Rural Health Conference is June 23-24, 2014 in Duluth. RFPs for breakout sessions will come out in December. REACH received word they can apply for a one year extension to provide grant supported core TA for CAH and small primary care clinics. Fifty-two percent of CAHs have achieved meaningful use.

Laura Ackman, Essentia Health—Northern Pines, Aurora
Northern Pines has a robust behavioral health program with psychiatric nurse practitioner, behavioral health coordinator and PsychD. The facility will look into establishing a telehealth link from NPMC ER to St. Mary’s ER behavioral health specialists or to a Crisis Response Team, so patients presenting to the ER with behavioral health issues can be triaged by a behavioral health specialist. This may reduce the need for hospitalization and transport. Often, patients wait for hours while ER staff  look for an open bed and then frequently ALS rigs are used to transfer, which would take them out of service for hours. The Northern St. Louis County behavioral health group includes behavioral health people, hospitals, the county, EMS, police and fire.

Michael Hedrix, Essentia Health—Sandstone
It was reported that a new facilities feasibility study for the local hospital district is being conducted. EHS EMS is transporting behavioral health patients across the state. EHS has attained the highest ACO integration level (level 3) as accredited by NCQA. HealthPartners is the only other health system to attain this level in the country.

Scott Reiten, South Central EMS
The American Hospital Association Mission Lifeline grant is placing 12-lead EKG machines into the majority of ambulances in the state. This will catch STEMIs quicker and reduce the cost to the patient via quicker action taken to reduce damage to the heart and reduce stays in hospitals. This will also save more lives and help people get back to normal activity.

Lynn Flesner, Glacial Ridge Health System, Glenwood
It was reported that the current building project is underway. Also, the facility feels very lucky that they have a stable medical and hospital staff in place. Additional service lines are being built. A current issue of concern is BC/BS reimbursement.

Stacy Barstad, Sanford Tracy and Westbrook Medical Centers
The current community EMS challenges: recruiting and retaining personnel. Reimbursement challenges: CAH threats, two-midnight rule, BC/BS.

Barbara Heier, Minnesota Academy of Physician Assistants
Now four Physician Assistant programs in Minnesota: 24-28 month programs conferring Masters degrees:Augsburg, started 1992, graduating about 30 PAs/year; Mayo/University of Wisconsin, graduating about 19 PAs/year; St. Catherine’s University, admitting its second class of 32 students; Bethel College, starting first class this fall. She pointed out that MAPA works with the PA programs to provide preceptorships for students.

Overview of Flex Program in Minnesota
Judy Bergh gave an overview of the Flex Program in Minnesota (see attachment).

Community Forums
Due to time constraints, Anne Schloegel’s presentation on ORHPC Community Forums was tabled until a future meeting. She reminded members of the upcoming forums in Little Falls on October 28 and in Breckenridge on October 29.

Suicide Prevention—What Are Hospitals Doing?
Melissa Heinen, Suicide Prevention Specialist, MDH Center for Health Promotion, presented information on suicide prevention in Minnesota, including the initiative to update Minnesota’s Suicide Prevention Plan. She solicited information and advice from the committee on rural aspects of suicide prevention from the provider perspective (see attachment). For more information and an opportunity to provide feedback or input on the topic, contact Melissa at melissa.heinen@state.mn.us.

Discussion: OIG CAH Location Study
Mark Schoenbaum led a discussion about the potential future of CAH in Minnesota, focusing on the recent OIG Study on CAH Location. He solicited ideas for response strategies from the committee. Due to time limitations, there was no discussion about the CMS letter on the 96-hour rule and two-midnight rule, though committee members were provided a handout on the rule distributed by the National Rural Health Resource Center. Discussion will continue at the next Flex Advisory Committee meeting.

Some key discussion points made:

  • Important to emphasize that CAHs provide high quality care at low cost.
  • Important to emphasize the economic benefit of CAH to the region.
  • NOSORH tactic is to emphasize possibility of 100% reimbursement with bonus opportunities for performance criteria on quality, cost control and patient satisfaction, mirroring Value Based Purchasing. This group added that it would be important to have a test period for this sort of plan in order to demonstrate its feasibility. It was suggested that Minnesota might consider being a demonstration site.
  • Key to shore up the outpatient side of the payment structure.
  • Karla Weng from Stratis Health discussed the work of Rural Health System Analysis and Technical Assistance (RHSATA), a project of the RUPRI Center for Rural Health Policy Analysis (RUPRI Center), and Stratis Health. RHSATA will analyze implications of changes to the rural health system. Tools and sharing of innovative ideas will appear as approval from the Office of Rural Health Policy is obtained. Expect delays, however, due to the current federal government shut down. 

DRAFT National Organization of State Offices of Rural Health Possible Components of an Alternate Reimbursement Model for Critical Access Hospitals (PDF: 63KB/1 page).
The Flex Program in Minnesota: Medicare Rural Hospital Flexibility Program (PDF: 4.25MB/27 pages).
Suicide Prevention: Hospital's Role in Suicide Prevention (PDF: 217KB/16 pages).
RHRC Communication on the 96-Hour Medicare Condition of Payment and CAH Condition of Participation Regulation (PDF: 44KB/2 pages).


Updated Friday, December 02, 2016 at 10:43AM