Rural Health Advisory Committee Meeting Minutes

Rural Health Advisory Committee Meeting Minutes

Tuesday, January 20, 2009 9-10:45 a.m.

Teleconference: Orville L. Freeman Bldg. and remote sites

Members Present: Thomas Boe (Moorhead), Deb Carpenter (Erhard), Ray Christensen (Duluth), Thomas Crowley, Chair (Wabasha), Rep. Steve Gottwalt (St. Cloud), Jeffrey Hardwig (International Falls), Margaret Kalina (Alexandria), Diane Muckenhirn (Hutchinson), Thomas Nixon (Deerwood), [Marnie Burau Keshr for] Sen. Yvonne Prettner Solon (Duluth), Nancy Stratman (Willmar).

Members Absent: John Baerg (Butterfield), Jode Freyholtz (Verndale), Rep. Mary Ellen Otremba (Long Prairie), Sen. Julie Rosen (Fairmont).

MDH Staff Present: Doug Benson, Kris Gjerde, Scott Leitz, Jill Myers, Tamie Rogers, Mark Schoenbaum, Kristen Tharaldson, Karen Welle.


Chairman, Tom Crowley, introduced the recommendation of Margaret Kalina as the chair elect. Members moved and seconded the recommendation. It was approved unanimously.


Thomas Boe (Licensed Health Care Professional) – From the dental side, waiting to see what oral health legislation comes out this year.

Deb Carpenter (Consumer Member) – Worked with local colleges on a joint grant proposal, submitted to the Department of Labor, for increasing capacity of nursing programs.

Ray Christensen (Higher Education Member) – Summer internships are rolling out on February 12. The Rural Physician Associate class is beginning next week with 55 applications for 40 positions and funding constraints. There is no carryover financing, so cannot expand the program. Applicants have been excellent and there is a slightly lower applicant pool. Housing in rural areas may be an issue.

Thomas Crowley (Hospital Representative) – Charity care has increased by 100 percent, increased demand for emergency and home health services. St. Elizabeth's received a grant for telehealth services, plus they are building two new operating rooms with community donations and financial support by businesses such as a cement company and bricklayers.

Rep. Steven Gottwalt (House Minority Member) – The Legislature is concerned regarding budget cuts in urban and rural areas. Medical Education and Research Costs (MERC) funding is in jeopardy of going away. The American Dental Association is supportive of the oral health practitioner, but wants to make some changes. We need to keep initiatives moving forward, especially in rural areas that are fragile.

Jeffrey Hardwig (Physician Member) – St. Mary’s/Duluth Clinic is integrating with International Falls Memorial Hospital. Children’s depression care models are moving forward. Funding of $255,000 from Minnesota Department of Human Services is helping to pay for non-reimbursement. Three pilot projects in inner city, small city and rural settings with no psychiatrist are proposed and they hope to be selected as a pilot site. They have submitted a grant to the Department of Labor and Industry to partner with community colleges.

Margaret Kalina (Registered Nurse Member) – Alexandria is using an e-Health grant to look for a way to interconnect services and maintain privacy. Douglas County Hospital is adding 80,000 sq. ft. Some decreases in patient census have been experienced lately.

Diane Muckenhirn (Mid-Level Practitioner) – Hutchinson area has experienced major layoffs resulting in an increase in the number of uninsured. There has been a huge psychological impact with a need for increased funding. The community is working together to deal with this situation and support each other. Sage Grant results:  they have seen an 80 percent increase in utilization of cancer screenings since 2007, with a 50 percent increase in the use of family planning services.

Thomas Nixon (Volunteer Ambulance Service Member) – Reported the birth of his fourth daughter in December. North Memorial has cut EMS staff, as others have done. Staff hours have been changed to shifts of 16 hours instead of 8 or 12 in an effort to reduce overtime. Part-time staff has been changed to full time. Volunteer first responders are to be consolidated with paid first responders for half of the county. There is a growing volunteer group with county funding and training support.

Senator Yvonne Prettner Solon (Senate Majority Member) – (Marnie Burau Keshr) Sen. Solon has met with the American Dental Association and the Safety Net Coalition in Minnesota regarding the oral health practitioner issue.

Nancy Stratman (Long Term Health Care Member) – She is a member of the Board of Aging Services of Minnesota. Major concerns in long term care are bad debt, reimbursement to provide living wages and benefits to staff, buildings that are over 40 years old, and deteriorating infrastructure including pipes freezing on a routine basis.


Scott Leitz, Asst. Commissioner of Health

The state budget is challenging with a $5 billion deficit without inflation. The general fund is $35 billion with a deficit of 10 percent.
The primary processes right now are:  health reform, preparation for electronic, medical records, and building a strong health infrastructure. The budget deficit means that we need health reform more now than later. We want decreased cost with increased quality.

Health Reform projects

  1. Statewide Health Improvement Program (SHIP) - $47 million x 2 years. Policy and environment change strategies re: obesity and tobacco. The goal is to decrease rates of preventable illness. Grant RFP is expected to go out in February 2009.
  2. Collection of encounter data, statewide measurement
  3. Health Care Home – wish to develop standards of certification for health care homes. Each state is currently using a varied approach.
  4. The e-Health report is due to the Legislature. The questions are whether there should be standards for this. Does it contribute to the affordability of health care? This information is on the MDH Web site.
  5. Thank you to Mark Schoenbaum and staff for their work on the oral health practitioner and work force work groups.

Question:  How do you obtain standards for health care homes?
Answer:  Review through community forums, Web site information. Input is being sought through the MDH Web site. Minnesota Academy of Pediatricians assessed their readiness for health care homes and this information is on their Web site.


Ray Christensen presentation:  “Acquiring and Retaining Rural Physicians”
See PowerPoint hand out (PDF:22pgs/262KB).

1. How do you get community to become engaged in the process?

A:  You need a good strong central leader, such as the Chamber of Commerce or administrator. Use community groups such as religious or social networks. Tell them what you are doing and why. RHAC could look at the community piece. Hospital administrators need to work to bring needs to the community. Schools are an important resource for recruitment. Need to invest in the community.

2. What are the limits on medical schools?

A:  Rural Physician Associate Program (RPAP) - students should be in the community. Fee has decreased from $14,000 to $10,000. UMD is out of room. They need a new building, so this increases the cost. There is a bottleneck after admission and before graduation due to limited capacity.

3. How do we convey intrinsic needs of small communities to students?

A: Recruit students from rural areas and also have a cohort of urban students who go to rural areas. Provide a rural experience for each student.

4. Another issue is that medical students want rural health jobs, but they are too exhausted to cover older adults and OB-GYN.

A:  OB-GYN physicians usually quit OB at approximately 35 years of age. They use other professionals such as midwives or nurse practitioners.


Mark Schoenbaum, Director of Office of Rural Health & Primary Care:
ORHPC can assist communities estimate the local economic impact of health services.
Health care providers are often one of the largest employers in rural areas.

The next newsletter will announce available grants.

Jill Myers: MDH staff is currently working to create factsheets regarding volunteer support of rural health services.

The Institute for Clinical Systems Improvement has presented health measures for the state. Please review these measures and analyze their applicability to rural health providers.


The next RHAC meeting will be Tuesday, March 24, 2009, via videoconference.

Meeting adjourned at 10:45 a.m.