Rural Health Advisory Committee Meeting Minutes
RURAL HEALTH ADVISORY
Tuesday, March 20, 2007 9:30 a.m.-12 p.m.
Minnesota Department of Health Orville Freeman Building
625 Robert Street, B-106 Conference Room, St. Paul, MN
Members Participating via Video Conference: Darrell Carter (Granite Falls), Ray Christensen (Duluth), Tom Crowley (Wabasha), Maddy Forsberg (Slayton), Diane Muckenhirn (Hutchinson), Nancy Stratman, Chair (Willmar), Rhonda Wiering (Slayton) and Senator Jim Vickerman (St. Paul).
Panelists: Walt Gregg, Upper Midwest Rural Health Research Center; Bob Held, Minnesota Department of Human Services; Dr. Douglas Hiza, Blue Cross Blue Shield of Minnesota; Nancy Wolf, Stratis Health
Members Absent: Steve Hansberry, Representative Brad Finstad, Paul Iverson, Michael Mulder, Representative Mary Ellen Otremba, LaVonne Schlieman, Senator Betsy Wergin.
MDH Staff Present: Doug Benson, Linda Norlander, Tamie Rogers, Mark Schoenbaum, Angie Sechler, Kristen Tharaldson, Karen Welle, Office of Rural Health and Primary Care; Assistant Commissioner Carol Woolverton.
Audience: Rebecca Aderman, Minnesota Medical Association;Virginia Barzan, Minnesota Academy of Family Physicians; Todd Bergstrom, Care Providers of Minnesota; Vicki Kunerth, Minnesota Department of Human Services
WELCOME AND INTRODUCTIONS
Nancy Stratman, chair, welcomed members and visitors.
Darrell Carter in Granite Falls: The declining supply of health care providers in rural continues to be a problem and is made worse by urban areas siphoning off other types of medical personnel (orthopedics, EMTs). The entire supply system appears to be flawed and could be felt for the next 20 years in rural areas. Work continues on trauma designation system. The Comprehensive Advanced Life Support (CALS) program is helping rural hospitals get up to speed, but work still needs to be done to prepare rural Minnesota hospitals to receive trauma designation.
Maddy Forsberg in Slayton: Association of Area Agency on Aging (AAAs) has an aging initiative proposal in both the House and the Senate. Arthritis Foundation is having an educational event in Redwood Falls. Reported continued work on transportation issues with local clinics and hospitals to help local residents meet medical appointments.
Diane Muckenhirn in Hutchinson: Attended a recent Minnesota Nurse’s Association (MNA) Advance Practice Nursing workshop on Mental Health. Advance practice psychiatric nurses are not receiving payment from Blue Cross. This is creating confusion around the merits of the collaborative process, and places another barrier to access to mental health services. Only two advance practice psychiatric nursing programs exist in Minnesota: St. Scholastica in Duluth and the University of Minnesota in Minneapolis. Having a loan forgiveness program may encourage more advance practice and clinical nurses into the mental health field.
Ray Christensen in Duluth: Rural family physician recruitment remains a primary concern. The number of students enrolling in Duluth’s rural physician programs went down 2 percent. Discussing recruiting students from alternative academic settings like community or technical colleges. Reported little demand for the rural physician associate summer program this year.
Tom Crowley in Wabasha: A slide presentation given by St. Elizabeth’s Hospital on Metabolic Syndrome was well received by the local community and is available to interested RHAC members. An ongoing hospital wellness program that includes the monitoring of employees’ health, indicates health improvements are being achieved. The recruitment of three family practitioners continues. New money is being raised by hospital volunteers for a digital mammography machine.
Rhonda Wiering in Slayton: The closure of the Ivanhoe CAH was a significant loss for the community. Ivanhoe plans to keep its long term care facility open. Marshall Hospital is adding an inpatient psychiatric unit. Nursing positions are beginning to appear in newspapers again, but nothing that is alarming. Related working together with Linda Norlander from ORHPC on an upcoming nursing leadership summit on “Retaining and Making Best Use of the Older More Experienced Rural Nurse,” which will be held June 28 in Sioux Falls.
Senator Vickerman in St. Paul: Despite earlier state budget forecasts there is no surplus and it is unlikely there will be any funding for new programs this year. Expressed concern about the ongoing viability of nursing homes. The community of Tracy is down to one nursing home. Also has been closely following the Veterans Administration (VA) Twin Cities nursing home (found to be in violation of multiple state standards.) Discovered that nurses at the Twin Cities VA Home are being paid a lower wage than nurses at other nursing homes.
Nancy Stratman, Chair, in Willmar: Face-to-face interviews being conducted with nursing patients and families in Rice Care Center today on quality of care. The results of the interviews may be used to design a Pay-for-Performance quality standards in the skilled nursing facility setting. Will be attending an upcoming AARP conference regarding culture change that aging seniors would like to see.
Carol Woolverton, Assistant Commissioner of Health
Legislatively, MDH has critical investments in:
- Pandemic and all hazard preparedness
- Healthy Connections with DHS
- Statewide Integrated Disease Surveillance
- Increase in MERC funds
- Additional funds for TB diagnostic work.
The suggestion was made that the newly appointed Methamphetamine Coordinator for Minnesota speak to RHAC members in a future presentation.
OFFICE OF RURAL HEALTH AND PRIMARY CARE REPORT
Mark Schoenbaum, Director, ORHPC
- First trauma hospital designations have been made.
- Healthy Aging – ORHPC continues to work with Department of Human Services on the 2010 Initiative
- Upcoming rural health conference in Duluth June 18-19
- ORHPC Web site contains “Models That Work” information
- The Federal Communications Commission has $60 million available nationally to improve technology access in rural areas. ORHPC is coordinating rural stakeholders for a state grant application.
- The ORHPC moved from the Community and Family Health Division to the Health Policy Division last month.
- A large number of applications were submitted for the open RHAC seats. The Governor’s office may make final appointments by the May 2007 RHAC meeting.
PAY FOR PERFORMANCE (P4P)
Panel on initiatives and what it means for rural providers
Mark Schoenbaum introduced pay-for-performance discussion, which is a payment program that provides financial rewards to hospitals, doctors, clinics and nursing homes for meeting certain clinical standards for selected diagnoses such as diabetes.
- Nancy Wolf, Stratis Health: Spoke on the overall concepts of quality improvement and efforts initiated in Minnesota. (PowerPoint PDF: 150KB/20 slides)
- Walt Gregg, Upper Midwest Rural Health Research Center: Spoke on research done with small rural hospitals that participated in a P4P demonstration project. Challenges for rural hospitals in using P4P included small volume of patients, lack of laboratory and diagnostic capabilities increased staff hours to abstract charts. (PowerPoint PDF: 44KB/21 slides)
- Bob Held, Minnesota Department of Human Services (DHS): Outlined the efforts by DHS to develop quality standards and a P4P program in Long Term Care. (PowerPoint PDF: 78KB/15 slides)
- Dr. Douglas Hiza, Blue Cross Blue Shield: Discussed work being done by Blue Cross Blue Shield on P4P with doctors and clinics. He noted that some of the smallest clinics have had some of the best results with P4P. (PowerPoint PDF: 85KB/13 slides)
OTHER BUSINESS AND NEXT MEETING
RHAC members expressed interest in forming a study group to develop rural input on current health care reform proposals. Volunteers for the study group include:
Tom Crowley, Ray Christensen and Nancy Stratman
The next meeting of RHAC will be Tuesday, May 22, 2007.
MEETING WAS ADJOURNED AT 11:55 a.m.