Rural Health Advisory Committee Meeting Minutes

Rural Health Advisory Committee Meeting Minutes

Tuesday, March 24, 2009 9-11 a.m.

Videoconference/Teleconference: Orville L. Freeman Bldg. and remote sites

Members Present: John Baerg (Butterfield); Thomas Boe, D.D.S. (Moorhead); Deb Carpenter (Erhard); Ray Christensen (Duluth); Thomas Crowley, chair (Wabasha); Jode Freyholtz (Verndale); Representative Steve Gottwalt, (St. Cloud); Jeffrey Hardwig, M.D. (International Falls); Margaret Kalina (Alexandria); Thomas Nixon (Deerwood); Senator Yvonne Prettner Solon, PhD (Duluth); Senator Julie Rosen (Fairmont); Nancy Stratman (Willmar).

Members Absent: Representative Mary Ellen Otremba (House of Representatives Member); Diane Muckenhirn (Hutchinson)

MDH Staff Present: Kristine Gjerde, Assistant Commissioner Scott Leitz, Jill Myers, Mary Ann Radigan, Tamie Rogers, Kristen Tharaldson.



John Baerg (Consumer Member) – The Governor’s proposal to reduce county administration to only 15 sites is viewed as too arbitrary by many county commissioners and will have a huge impact on how human services are delivered.

Thomas Boe (Licensed Health Care Professional) – Community members are busy sandbagging the surrounding communities to prevent flood damage. There is concern among my peers regarding the Governor’s proposal to cut dental care for all non-pregnant adults, but they are upbeat about the proposed Oral Health Practitioner Legislation.

Deb Carpenter (Consumer Member) – The community received a fast track grant to develop pre-health care curriculum to enable individuals to take child development courses locally at no charge. This helps individuals complete the courses earlier, preventing the delay and expense of completing this requirement during their health care training.

Ray Christensen (Higher Education Member) – Nationally, 7.5 percent of graduating physicians enter family practice, while UMD graduates enter at a 34 percent rate. The RPAP (Rural Physician Associate Program) had funding for only 40 sites this year and received 55 applications. Screening included reviewing whether the participant’s significant other was willing to be at the rural sites with them. It has also effectively connected metro students with the rural sites. More than 90 students have applied to the Summer Internship Program this year.  UMD is interested in exploring environmental competency as part of rural primary care. An awareness and sensitivity to environmental health is an important component to retention and satisfaction.

Jode Freyholtz (Consumer Member) – Recently attended a consumer survivor network program of the National Guard Suicide Prevention Training and Mental Health Day on the Hill. The state is looking at huge cuts in mental health services and the need is to build a strong network of peer support to counteract any cuts.

Steve Gottwalt (House of Representatives Member) – It is important to think beyond funding and work toward innovative programming. We need innovation to get primary care providers to rural areas. In St. Cloud, grocers, health care providers, Centracare, and others are partnering to get young people to be more active, eat well, and be healthier. Recently introduced bills for The Healthy Minnesota Plan and for a work group to address issues associated with the growing numbers of Alzheimer’s patients throughout the state.

Jeffrey Hardwig (Physician Member) – The children’s depression care initiative is moving forward with physicians, psychiatrists, psychologists, and other stakeholders in place. The next meeting will be April 14, 2009. Pilot program models are being developed that will be placed in rural areas without a child psychiatrist, in mid-sized cities, and in the metro area.

Margaret Kalina (Registered Nurse Member) – Spending time watching the legislative process as they review finances and programs.

Thomas Nixon (Volunteer Ambulance Service Member) – The western part of the state is focused on flood issues, including EMS services. The EMS Association awarded 55 grants to support services and for education of existing and new EMTs. First Responder education of four hours per quarter is now available free of charge to volunteers. (In response to Tom Crowley’s question about recruiting and training high school students as EMTs): There have been successful EMT courses at high schools. Rep. Gottwalt recommended contacting the local ski patrol programs and Explorer Scout programs as a resource for more information.

Yvonne Prettner-Solon (Senate Majority Member) – The state deficit is $6.4 billion, decreased by the federal stimulus package to $4.6 billion. Addressing the deficit is a huge task. Hospitals are taking big cuts, and rural hospitals may lose their DRG increase. Reimbursement for mental health services are being cut by an additional 6 percent over the already established 3 percent cut across the board. Dental health bills are being heard now, and it is unknown whether they may be included in the omnibus bill or voted on separately.

Julie Rosen (Senate Minority Member) – This legislative session is daunting. The bright spot is that health care reform is on target and improving as we go along.

Nancy Stratman (Long Term Health Care Member) – The legislative funding dilemma is obviously a concern. The Nursing Home Consortium worked with a Pay for Performance grant to keep people physically well to delay nursing home placement. Emergency preparedness is an issue with the current flood potential creating a possible need for refuge.


Jeffrey Hardwig presented “Integration of Psychiatric and Primary Care” (PDF: 470KB/17pgs). Broad discussion of mental health system and access issues ensued.  Key points included:

  • Stressful life events and psychiatric disorders lead to increased utilization of primary care services
  • Increased utilization leads to higher medical costs
  • Major depression is the leading cause of disability in America. Anxiety and depression are associated with as much or more functional impairment as chronic medical disorders such as diabetes, heart disease and COPD
  • Collaborative care leads to improved depression quality of care and outcomes (Diamond Project)
  • Chronic psychiatric illness patients have a higher prevalence of diabetes and heart disease; also die younger
  • 80 percent+ of patients with mental health and chemical dependency disorders have little or no access to psychiatric services
  • Patients are treated in the general medical sector where payment mechanisms discourage psychiatrists from delivering care
  • Untreated or poorly treated mental health disorders lead to 1) increased psychiatric treatment resistance 2) increased functional impairment 3) increased physical health service use and 4) up to $300 billion in additional health care costs nationwide
  • There are severe barriers to accessing psychiatric services – especially in rural areas
  • Managed behavioral health carve outs drive the system and are the root barrier to collaborative care
  • Health care reform must address the fragmentation that makes our system not only too expensive but also ineffective relative to other modern nations
  • Additional barriers and problems include cost shifting and prior authorizations.

Some members expressed interest in continuing this discussion, perhaps forming a task force or developing an impact statement.


Scott Leitz, Assistant Commissioner of Health, presented information about the American Recovery and Reinvestment Act of 2009, highlighting the provisions related to rural health and health information technology.


Jill Myers, ORHPC Program Planning Supervisor, noted that new workforce reports are available on dentists and registered dental assistants and a fact sheet on licensed practical nurses will be on the Workforce site soon. An evaluation report on CAHs entitled The Financial Status of Minnesota’s CAHs:  Successes, Challenges, Needs and Recommendations (PDF: 104 KB/14pgs) has been published and posted on the ORHPC Web site.

Kristen Tharaldson provided an update on the State Health Improvement Program (SHIP) conference proceedings.


Dr. Hardwig’s presentation (PDF: 470KB/17pgs)
Mental Health Professionals’ Scope of Practice (PDF: 44KB/6 pgs)
Rural Mental Health and Primary Care Report Recommendations Progress (PDF: 62KB/10 pgs)
Does Prior Authorization Work?  (PDF: 253KB/1 page) This is a supplement to Dr. Hardwig’s presentation
Minnesota’s Report Card (NAMI) (PDF: 115KB/1 pg
Minnesota Critical Access Hospital Financial Stability Report 2008 (PDF: 104 KB/14pgs


The next RHAC meeting will be Tuesday, May 19, 2009, 9:30 a.m.-2 p.m.
Location: Minnesota Department of Health, Snelling Office Park, Red River Room

Meeting was adjourned at 10:43 a.m.