Rural Health Advisory Committee Meeting Minutes
RURAL HEALTH ADVISORY
Tuesday, January 24, 2006
9:30 a.m.-2 p.m.
Minnesota Department of Health-Snelling Office Park, Red River Room
1645 Energy Park Drive, St. Paul, MN 55108
Members Participating: Ray Christensen, Chair; Richard Failing, Maddy Forsberg, Paul Iverson, Michael Mulder, Representative Mary Ellen Otremba, Nancy Stratman, Lavonne Schlieman, Rhonda Wiering
Members Absent: Darrell Carter,Representative Brad Finstad, Steve Hansberry, Diane Muckenhirn, Senator Jim Vickerman, Senator Betsy Wergin
MDH Staff Present: Doug Benson, Lee Kingsbury, Jay McLaren, Linda Norlander, Janet Olstad, Tamie Rogers, Mark Schoenbaum, Angie Sechler, Kristen Tharaldson, Karen Welle, Assistant Commissioner Carol Woolverton
Audience: Virginia Baarzan, Minnesota Academy of Family Physicians; Mary Krinke, Minnesota Hospital Association; Abbie Laugtaug, Minnesota Pharmacists Association; Dean Loidolt, Central Minnesota Counsel on Aging; Dave Renner, Minnesota Medical Association; Darrell Shreve, Minnesota Health & Housing Alliance; Susan Stout, Minnesota Hospital Association; Kelsie Williamson, Minnesota State Council on Disability.
WECOME AND INTRODUCTIONS
Ray Christensen, Chair, introduced the members. Minutes from the November 15, 2005 meeting approved. Reviewed meeting packet, which includes a glossary of definitions on Medicare terminology, an updated memo on Office of Rural Health and Primary Care activities, a summary of the August Healthy Aging forums and a follow-up on the Rural Mental Health and Primary Care report.
Ray Christensen, Chair and Higher Education Representative
University of Minnesota is a single medical school with a program in Duluth. Working on a 2010 curriculum redesign that looks at how training takes into account the work that was put forward by the Future of Family Medicine taskforce and the Institute of Medicine’s report on quality. School has received 1,000 applications for 55 positions, with a high quality group of students applying. New training curriculum will focus on community involvement.
Reported the College of St. Scholastica is developing a doctorate program in nursing.
Minnesota Rural Health Association (MRHA) is looking for a permanent home and an executive director. University of Minnesota , Crookston has expressed interest in housing MRHA. Reiterated the importance of keeping MRHA viable because it is the only advocacy group in Minnesota dedicated to rural health issues. Julie Larson, who has been serving as an interim executive director, will be done in April. Liz Quam will be assuming the presidency of the organization in July at the annual rural health conference.
Planning is currently underway for the rural health conference jointly sponsored by MRHA, ORHPC and Rural Health Resource Center . Focus of the conference will be technology. Conference to be held in Duluth on July 17 th and 18 th.
Rick Failing, Hospital Representative
Congressman Collin Peterson’s office requested a meeting with Critical Access Hospital (CAH) CEOs. About 30 CAHs are in his congressional district. Meeting with the congressman will be held January 26 at the Holiday Inn in Detroit Lakes. Ann Gibson from the Minnesota Hospital Association and Doug Benson from ORHPC will be there along with CEOs.
Paul Iverson, Health Professional Representative
Eight pharmacists have participated in the new Loan Forgiveness Program that helps defray school loans for pharmacists practicing in rural Minnesota .
Implementation of Medicare Part D (the new Medicare drug benefit) has been problematic. Consumers are confused about the plans, pharmacists don’t have up-to-date information and phone lines to the plans have been jammed. Many pharmacists have had to dispense medications without payment, hoping the payment issue will be resolved. Many of the people who are dually eligible for Medicare and Medicaid fell through the cracks and have not been enrolled in a plan—or don’t know what plan they are in. Senior Linkage Line has been very helpful in working out some of the Medicare Part D problems.
Intravenous (IV) therapy coverage under Part D is an issue. No coverage exists for mixing and preparing the medication. Expressed concern that because pharmacists cannot afford to supply patients at home, more people will have longer hospital stays. Some regions pay for infusion services on a per diem basis. Minnesota doesn’t do that. Senator Coleman visited Iverson Corner Drug to see what is involved with IV therapy.
Ray Christensen and the other members of RHAC complimented Paul Iverson and his profession for the extraordinary work they have done over the last month under difficult circumstances to make sure patients get their medications.
Michael Mulder, Emergency Services Representative
Federal Reserve newsletter featured an article on pharmacies in their last publication. Rural health was mentioned a few times and one of the statistics came from pharmacists in his area. A small private pharmacy closed down in Fairmount but hasn’t been sold.
Volunteer ambulance services are being retrained in Cardio-pulmonary resuscitation (CPR). Noted this is the fifth or sixth change in the last 20 years. Expressed concern that Critical Incident Stress Debriefing is losing support because of concerns over its effectiveness. Feels that it is a good program for staff on rural ambulance services who don’t deal with frequent crises.
Nancy Stratman, Nursing Home Representative
Life safety code issues are causing concern. Nursing homes are being cited more frequently for violations and correcting the issues is becoming more burdensome due to the age of many of the facilities. Average cost for a plan of correction is $50,000 per facility.
Maddy Forsberg, Consumer Representative
Medicare Part D issues include dually eligible people who have been automatically enrolled in plans that do not cover southwestern Minnesota. Pharmacists have been very helpful in trying to resolve issues.
Reports working on a survey to catalogue all the telehealth initiatives in the area. Survey will be shared with people within the southwest region of the state.
Still working with a group of discharge planners. Will be doing a training session with them on privacy issues this week. Southwest Mental Health will be applying for a grant to do a pilot program—transitional planning from the nursing home or the hospital to home. This came about from discussions with the discharge planning group. The pilot will have a network of trained volunteers to help patients transition. Volunteers will do safety checks in the home, light chores, friendly visiting and connect seniors to needed services. Referrals will be made to home health and parish nurses as needed.
In other news: A new consortium has formed in the area to do arthritis education.
Just had a transit coordination meeting to get all of their transit systems at the table to talk about boundaries, services and coordination. Grants being developed expanding telehealth and telemental health.
Mary Ellen Otremba, House of Representatives
Some state legislators are meeting informally on a weekly basis to talk about health related “Hot Topics.” Cost containment is the big issue. Current hot topics include the electronic health record. Legislators are concerned about the number of health care systems that are developing their own electronic records that cannot be easily shared across systems.
Lavonne Schlieman, Consumer Representative
Reported on issues with Medicare Part D. Some seniors signed up for plans offered through telemarketers and do not have cards or verification of the plan. Plans have not yet issued cards and the seniors don’t know who to call because they don’t know who they signed up with. Some seniors are paying out of pocket for medications until this gets straightened out.
Rhonda Wiering, Registered Nurse Representative
Reported on workforce issues. Fewer applicants for open nursing positions. For example, Marshall has had an LPN position posted for over four months. South Dakota State University in Brookings has added 17 nursing slots, but is still turning away good applicants.
Reported that she has taken a new job as the Director of Quality Initiatives for the Southwestern Region of Avera Health. Avera has a number of nursing homes and hospitals in Southwestern Minnesota, Iowa and South Dakota. Stratis Health has done a fantastic job of helping small hospitals with Medicare quality initiatives, but implementation in very small hospitals is problematic. Often the quality manager is also playing other roles including supervision and direct patient care. Reported analyzing data from a survey of front line rural hospital nurses and their understanding of the quality improvement impact on their hospitals. Found that 25 percent of the nurses didn’t know what quality initiatives were being done in their hospitals.
The capital improvement grant awarded Tyler through ORHPC has helped the hospital develop a pharmacy program. A pharmacy residency program has been established and Tyler has hired a full-time pharmacist. Reported participating on a panel at the national conference of the Clinical Pharmacy Association describing the work done in Tyler. Tremendous interest at the conference on how to bring nursing and pharmacy together.
Marshall has recruited a psychiatrist (Dr. Fernando, Western Medical Health). Plans are being developed to create psychiatric inpatient beds at the Marshall hospital.
ASSISTANT COMMISSIONER’S UPDATE
Carol Woolverton, Assistant Commissioner of Health brought greetings from Commissioner Mandernach who was unable to attend.
Reported on the Transform 2010 forums, a project sponsored by the Minnesota Department of Human Services, in partnership with the Minnesota Board on Aging, MDH and other agencies. Purpose of the forums to elicit ideas and feedback on how to deal with the coming age wave. The initiative fits very well with the MDH priorities around healthy aging and long term care. MDH priorities include supporting communities that offer a continuum of services for the elderly, supporting a culture change in skilled nursing facilities and encouraging communities to focus on healthy aging. Noted that the RHAC/SCHSAC workgroup on creating healthy communities for the aging populations has focused on the healthy aging component.
MDH posted the first nursing home report card on the MDH Web site. Reported 75,000 hits on the site over the first few days. The report card is based on eight quality measures for each facility. The facilities are rated on a one star to a five star scale. The data is reviewed on annual basis. Assisted living facilities are not part of the report card.
AN OVERVIEW OF HEALTH RELATED LEGISLATIVE ISSUES:
Panel members included:
- Ray Christiansen, Minnesota Rural Health Association
- Abbie Laugtug, Minnesota Pharmacists Association
- Jay McLaren, Minnesota Department of Health
- Dave Renner, Minnesota Medical Association
- Sue Stout, Minnesota Hospital Association
- Darrell Shreve, Minnesota Health & Housing Alliance
Minnesota Pharmacists Association, Abbie Laugtaug
Pursuing a restructuring of Medicaid payment rates. Looking at “conscience clause” legislation that allows pharmacists to refuse to fill prescriptions that, in their clinical judgment, could be harmful to the patient. Commented that the new pharmacist loan forgiveness program is a great positive for members. Noted that the Rural Pharmacist Planning and Transition Grant program will be starting in March.
Minnesota Hospital Association (MHA), Sue Stout
Minnesota Hospital Association agenda includes opposing an attempt to dismantle no-fault automobile insurance provisions. Because of no-fault, hospitals do not have to deal with payment disputes and delays when insurance companies are contesting personal injury claims. MHA strongly supports protection of Minnesota Care eligibility and the Health Care Access Fund. Opposed to legislation that could allow local fire departments to carve out ambulance services. Working with EMSRB to maintain current system. Supports legislation requiring health plans to pay for interpreter services. Currently, federal law requires hospitals and clinics to provide interpreter services, but they have no mechanism to recover costs. Supports a statewide smoking ban.
In non-legislative arena, MHA is meeting with Department of Human Services (DHS) on improving the coordination of access to mental health services. Looking into the creation of mental health crisis units in the emergency rooms. Also looking at ways for communities to coordinate information on bed openings with the focus of keeping individuals in their communities.
Minnesota Housing and Healthcare Alliance (MHHA), Darrell Shreve
Current issues for the nursing home industry include life safety code inspections. Due to increased inspection activity directed by the Centers for Medicare and Medicaid Services (CMS,) nursing homes are having difficulty complying with more stringent codes. Looking for reimbursement to make corrections. Also looking at funding mechanisms for emergency energy assistance due to the increase in heating costs.
Regarding regulation, looking for relief from new sex offender legislation that makes the nursing home responsible for actions by patients after they have been discharged. Would like this part of it repealed because nursing homes have no ability to follow-up on patients who are now in the community.
In housing area, discussing title protection if a facility uses the words “assisted living.” Currently, any facility can use the name “assisted living.” Would like to have that title mean that certain services are required. Currently Minnesota regulates assisted living services through Housing with Services Act.
Minnesota Medical Association (MMA), Dave Renner
MMA is launching a project to implement recommendations from its Physician’s Plan for a Healthy Minnesota. Looking at possibility of introducing legislation on this in 2007.
Wants Minnesota Legislature to repeal new prior authorization requirements for public health plans.
MMA continues to support smoke-free workplaces and would like to see a comprehensive statewide ban. Also supports the Health Impact Fee on cigarettes and tobacco because the higher prices deter use by teenagers.
Supporting legislation that would require insurance companies to pay for interpreter services provided in a hospital or clinic. Some clinics are dealing with 50 different languages and are not receiving compensation for the use of interpreters. The average payment for interpreter services is $60-$80 and could place clinics in crisis if the issue as to who pays is not resolved.
Other concerns include Medicare payment levels to physicians. Physician payments were cut by 4 percent and are at the same level they were in 1991. It’s becoming less affordable for doctors to see Medicare patients.
Minnesota Rural Health Association (MRHA), Ray Christensen
MRHA is in the process of rebuilding the organization and does not have a comprehensive legislative agenda at this time. Concerns include methamphetamine and its affect on rural health, the aging of the rural population, language and cultural interpreters, and pay for performance quality measures and how that will affect rural access to care.
Minnesota Department of Health (MDH), Jay McLaren
Reported that this legislative session will have a limited focus. MDH will present some “housekeeping” policy bills related to clarifying language from previous legislation. One will involve health care professionals. The other is related to other legislation from last year. Other items on legislative agenda include programming around tuberculosis and hepatitis B for new immigrants, tracking a bonding proposal from the Minnesota Department of Agriculture around improving the agricultural health lab making it a level three lab, and tracking legislation involving the interconnectivity of the Minneapolis and St. Paul water systems.
OFFICE of RURAL HEALTH and PRIMARY CARE REPORT
Mark Schoenbaum, Director
ORHPC staff met with the Heart Association regarding their interest in taking some of their activities out to rural Minnesota. Karen Welle traveled with a committee from the University of Minnesota to Alexandria to choose the next Area Health Education Consortium (AHEC) site. Fergus Falls was chosen.
Introduced Doug Benson as the new grants management supervisor taking over Mark’s old position. In his first week, Doug attended his first grant review committee process and then presented at a meeting in Morton on grant writing to a regional EMS conference.
An advisory committee similar to RHAC has been formed to advise on the state trauma system program. First meeting has been held. In the coming year the designation of rural hospitals as trauma centers at varying levels will begin. Advisory committee will provide guidance on this process and on quality improvement and data collection projects. Chris Ballard has been hired to work with Tim Held as the Trauma Designation Coordinator to put all this together.
ORHPC strategic planning began in December with a two-day staff retreat. Looked at the outside environment and listened to a panel of outside stakeholders share their perspectives on the work we do. The strategic plan is currently a work-in-progress and closely parallels the rural health plan written in 2004.
Rural Pharmacy and Planning and Transition grant program adopted by the legislature is now in place. ORHPC would like to spread the word about it and would appreciate suggestions.
Karen Welle has started to convene stakeholders at the state level who have an interest in telehealth. Conversations are starting to take place in the early stages. If you have an interest, please connect with Karen Welle.
End of February the National Rural Health Association is having its annual Policy Institute in Washington. ORHPC is coordinating getting people from Minnesota together.
The Center for Rural Policy in St. Peter published the first edition of a new journal of note: The Rural Minnesota Journal. Impressive roster of authors including Ray Christensen doing a piece on rural health.
Reported attending meetings throughout the state in partnership with the Minnesota Department of Human Services and the Minnesota Board on Aging on a project called Transformation 2010. Project addresses preparing for the increase in an older population in Minnesota. The Health Department has strong connections to this issue and the 2010 forums dovetailed nicely with the RHAC/SCHSAC workgroup on healthy communities for an aging population.
CREATING HEALTHY COMMUNITIES FOR SENIORS: A joint RHAC/SCHSAC Workgroup Update
Linda Norlander and RHAC workgroup participants
Presented report and recommendations from the joint workgroup held in November. Lee Kingsbury from the Office of Public Health Practice and staff person for SCHSAC expressed thanks to ORHPC staff for the work done in organizing the workgroup and writing the report. SCHSAC will be reviewing the report at its February meeting. Report will help direct local public health in areas of data and information collection.
Discussion of report by RHAC included a recommendation to continue with an RHAC subgroup that would synthesize the information in this report with the 2010 forum information and look at ways for rural communities to begin creating elder friendly environments. Sub-group members will be Rick Failing, Maddy Forsberg, LaVonne Schlieman, Nancy Stratman and Rhonda Weiring. Subgroup will issue recommendations in July to be considered at the September RHAC meeting.
Ray Christensen, Chair
The annual meeting of the National Rural Health Association meeting conflicts with the RHAC meeting scheduled for May 16. Committee agreed to change RHAC date to meet on Tuesday, May 23. Staff will arrange for meeting room and will send a notice to everyone about the change.
Meeting adjourned at 1:47 p.m.