Rural Health Advisory Committee Meeting Minutes
RURAL HEALTH ADVISORY COMMITTEE
Tuesday, January 22, 2008 9-11:30 a.m.
Orville Freeman Building (Video Conference Meeting)
St. Paul, Minnesota
Members Present: Thomas Boe (Moorhead), Debra Carpenter (Fergus Falls), Darrell Carter (Granite Falls), Ray Christensen (Duluth), Tom Crowley (Wabasha), Rep. Steve Gottwalt (St. Cloud), Margaret Kalina (via telephone, St Paul, MHA), Diane Muckenhirn, Chair (Glencoe), Tom Nixon (Brainerd), Nancy Stratman (Willmar)
Members Absent: John Baerg (Butterfield), Rep. Mary Ellen Otremba (Long Prairie), LaVonne Schlieman (Morris), Senator Jim Vickerman (Tracy), Senator Betsy Wergin (Princeton)
MDH Staff Present: Doug Benson, Assistant Commissioner Scott Leitz, Tamie Rogers, Anne Schloegel, Mark Schoenbaum, Angie Sechler, Kristen Tharaldson, Karen Welle, Renée S. Fredericksen (via Glencoe)
Audience: Virginia Barzan, Minnesota Academy of Family Physicians (MAFP); Larry Johnson, Care Providers of Minnesota
WELCOME AND INTRODUCTIONS
MOTION: Diane Muckenhirn moved to adopt the 2008 Chair-Elect Nominating Committee's recommendation that RHAC Operating Procedures of October 16, 2006 be amended under Elections to read: “Selection of the Chair-Elect: The chair-elect nominee will be selected by a nominating committee made up of volunteers from the Advisory Committee. The nomination will be voted on by the Committee by the last meeting of the State Fiscal Year before the chair-elect is to take office. The Advisory Committee must approve the chair-elect by a majority of the members present at the meeting. No discussion. Ray Christensen added a second. Passed.
MOTION: Deb Carpenter moved to adopt the 2008 Chair-Elect Nominating Committee recommendation on election of Tom Crowley as the 2008 Chair-Elect, beginning July 1, 2008. No discussion. Ray Christensen added a second. Passed.
MOTION: Tom Crowley moved to approve the November 27, 2007 RHAC meeting minutes. No discussion.Tom Nixon added a second. Passed.
Thomas Boe (Licensed Health Care Professional)
Two-year grant for children’s oral health out of Fergus Falls from the West Central Initiative Fund to Prime West for a teledental project where hygienists can communicate with dentists via telephone and time is billable and reimbursable.
Deb Carpenter (Consumer Member)
A Robert Wood Johnson Foundation opportunity, to address lack of nursing faculty, offers up to 15 grants and $350K for junior nursing faculty. Application deadline is April 1, 2008.
Darrell Carter (Medical Doctor Representative)
EMS Standards Project aims to standardize EMS education programs including EMR First Responders, Basic EMT, Advanced EMT and Paramedic training. Of note: in the last six to 12 months southwestern Minnesota has experienced a greater shortage of physicians in all areas including specialists who are able/willing to “take call.” It is suspected that changing lifestyles of new physicians, retirements, etc. impact the supply and thus mortality rates. The average wait in ERs is now about 12 hours. He notes that 10-12 additional hospitals are seeking Level 3 and 4 Trauma Center designation by the state. In reference to Darrell Carter’s observations on physician shortages for “taking call,” Ray observes a shortage in general and neurosurgery specialists and feels part of the problem is doctors' fear of legal risks.
Ray Christensen (Higher Education Member)
The concept of “medical home” is receiving a lot of national attention, including the discussion of how to make maximum use of health care professionals. The aim is to make improvements in quality care, especially chronic care. The American Academy of Family Physicians is expected to roll out a medical home model at the April 2008 annual meeting.
Dr. Christensen has heard that the Legislature wants to increase the number of medical school graduates by 20 percent. UMN Duluth is looking at the opportunity to create a rural four-year track for medical students. This is a sensitive issue given the questions around the number of physicians needed but Ray feels the Duluth Clinic alone could absorb all UMD graduates.
Thomas Crowley (Hospital Representative)
Seeks to have an adequate number of health care staff in the area, so is working with SE technical schools to train more LPNs for long-term care positions. Program trains 10th and 11th grade students as CNAs and tests them to determine needs. Most can meet criteria track through internet and online classes.
Hospital is supporting potential medical students from the area by providing opportunities to work in the ER or shadow various health care professionals. They are currently using search firms to recruit doctors.
$97K is earmarked to expand metabolic syndrome program; 35 percent of those who did the program no longer have metabolic syndrome. Early identification saves money and has other ramifications
Rep. Steve Gottwalt (House of Representatives Member)
Reviewed the status of the Legislative Commission on Health Care Access Recommendations and noted some proposals make sense for metro areas only (e.g., capitation and competitive bidding for services). He recommends a “do no harm” position and to seek common ground in consideration of the Health Transformation Task Force Recommendations. Deb Carpenter advises we do not return to gatekeeper models of the past before we examine the outcomes and implications. Ray Christensen advises we strive for the right care in the right place at the right time and asks how quality might be met without volume in rural areas. Virginia Barzan of Minnesota Academy of Physicians notes that collaborative decisions and care distinguish proposals from gatekeeper models. She advises we facilitate versus control care and uses the MDH-Minnesota Children with Special Needs model as a good example of a tested starting point.
Margaret Kalina (Registered Nurse Member)
Looks forward to working with the new Rural Health Care Delivery Model Work Group as the chair.
Diane Muckenhirn (Mid-Level Practitioner Member)
Not all DNP slots in nursing are full (St Scholastica at Duluth is only two-thirds full and Mankato is not full at this point either). Ease of access with online programs; however, little conversation to promote DNP programs among administrators and other health care professionals.
Salary is a barrier to filling public health nursing slots and may lead to cuts in programs. The National Council of Nursing notes a shortage of nursing professors, which hurts the quality of training.
Thomas Nixon (Volunteer Ambulance Service Member)
Hospital has reopened after expansion and remodeling project, including expansion of long term care mental health services. Mental health transports are still a concern for EMS because beds are few and far between. Ambulance workforce shortages increase the problem.
Discrepancy in EMS training course with boarder states; Minnesota average cost is $10K-$20K while similar programs in Chicago cost $1K and in Iowa cost $4K. High education costs deter potential paramedic students. Online classes are difficult to get and equipment is a problem.
Other states have option to buy in on bid to purchase a new ambulance; a Minnesota provision doesn’t allow this (i.e., no “bulk” deal) There are some discrepancies on how the new trauma system works, but overall there is a positive reaction; anticipating the roll out of provider criteria.
Nancy Stratman (Long Term Health Care Member)
Willmarreceived a safe patient handling grant. Minnesota Health and Housing Alliance is actively calling legislators regarding this year’s session and NF moratoriums exceptions and nursing scholarships. The new QIS survey process participant pool will be made up of 50 percent residents and 50 percent family members.
PRESENTATION: Critical Access Hospital Survey of Language Access Services, Kristen Tharaldson, Office of Rural Health and Primary Care was postponed until March meeting due to technical difficulties.
OFFICE OF RURAL HEALTH AND PRIMARY CARE REPORT
Mark Schoenbaum, Director, Office of Rural Health and Primary Care
- The Governor's new RHAC appointments are in process and news on confirmations will be forwarded as it is received.
- Ten people attended the National Policy Institute meeting in Washing DC on January 28, 2008. Visits to Minnesota’s Congressional delegations shared perspectives on HIT, veteran, trauma, and workforce issues affecting both rural and urban populations.
- The Active Living Conference scheduled for March 6, 2008 in St Cloud “MN Umph!”
RHAC Work Plan Update
Renée S. Fredericksen, Supervisor of Planning and Analysis - Committee members were asked to note the progress made on priority areas in the 2006-2007 RHAC Work Plan handout found in the meeting packet and emphasized the outcomes resulting under each priority area to date.
RHAC Health Care Delivery Work Group Update
Margaret Kalina, Chair
- The work group of about 20 members will evaluate the viability of existing models from a rural perspective including the Minnesota Academy of Physicians model. Representatives on the work group include higher education, government offices, EMS, pharmacies, RHAC members, home care, long term care and others.
- Basically, the work group will ask what’s missing in existing models, what doesn’t make sense, and how to address integration of service in a second phase. The first meeting in March will consider assets that we can build on.
- Ray Christensen notes the loss of LTC beds is stressing rural areas. Mark Schoenbaum acknowledged Ray’s comments and stated Adam Soumala of MHHA will be presenting “The LTC Imperative” report as he is available for an RHAC meeting.
- Rep. Gottwalt indicates it would be good to incorporate the work group’s observations into the legislative process around health care access and notes the system (model) must reward good practice with outcome based rewards. He indicated consideration for improvements be linked to designation of Level 1 and 2 Trauma Centers in the process of designing a new health care delivery system.
- Scott Leitz noted Level 3 Trauma Centers are critical providers in the networks. Networks make information more widely available and afford better coordination and strength to Level 3 Centers. He noted providers are concerned about the costs of quality and cost monitoring, so technical assistance will be needed for Level 3 and 4 providers. Payment may be expanded for providers where there is currently none under Transformation Task Force recommendations. The uninsured and underinsured may need a regional versus county approach to mitigate issues associated with sparse populations.
- All in all medical home requires support to pull it off for the smallest providers and because the Transformation Task Force focus is on quality not cost containment like old gatekeeper models.
Critical Access Hospital and Rural Health Conference in Duluth June 23-24, 2008
Kristen Tharaldson, RHAC and Conference Coordinator - Call for proposals has gone out and proposals are due on February 8, 2008. More details were available on the save-the-date flyer in RHAC meeting packets.
Rural Health Plan Update
Renée S. Fredericksen, Supervisor of Planning and Analysis
- Two community forums were held in northern Minnesota with attendance that represented a cross section of the areas and key informants for the rural health care networks in Minnesota. Themes were beginning to emerge that would be used together with other information to recommend goals, objectives and measurable outcomes in the Rural Health Plan being drafted for 2008.
- Two more forums were scheduled after the RHAC meeting in southern Minnesota and members were invited to attend and invite other key stakeholders in their communities to attend or submit recommendations online through the ORHPC Web site.
- The first draft will accompany the Flex grant application by April 17, 2008 and the final draft will be submitted to HRSA by November 30, 2008.
Governor’s Health Care Transformation Task Force Update
Scott Leitz, Assistant Commissioner for Policy Quality and Compliance Bureau
- Recommendations of the Governor’s Health Care Transformation Task Force are due February 1, 2008.
- Aims include:
- Reduce health care costs by 20 percent by 2011 (through cost containment)
- Cover all Minnesotans with health care
- Reduce growth in health care spending.
- Highlights of the Task Force's recommendations to include:
- Reform market for health insurance
- Expand health promotion program statewide
- EHR adoption
- Payment reform through “medical home” concept to reward cost efficiency and quality.
OTHER BUSINESS AND NEXT MEETING
Anne Schoegel was introduced as new ORHPC staff member hired to work on telehealth developments. The next Rural Health Advisory Committee meeting is scheduled for Tuesday, March 25, 2008 at the Freeman Building, 625 Robert Street, St. Paul. Members are invited to attend by video conference and asked to give advance notice of intention to attend to Tamie Rogers at ORHPC.
MEETING WAS ADJOURNED AT 11:17 a.m.