Rural Health Advisory Committee Meeting Minutes
Tuesday, September 28, 2010 10 a.m.-2 p.m.
Minnesota Department of Health-Snelling Office Park-Red River Room, St. Paul, MN
Members Present: John Baerg, Tom Boe, Tom Crowley, Jode Freyholtz, Steve Gottwalt, Jeff Hardwig, Margaret Kalina, Diane Muckenhirn, Nancy Stratman
Members Absent: Deb Carpenter, Ray Christensen, Tom Nixon, Mary Ellen Otremba, Yvonne Prettner-Solon, Julie Rosen
MDH Staff Present: Doug Benson, Jill Myers, Mark Schoenbaum,Kristen Tharaldson
Jeff Hardwig – Dr. Hardwig is working on promoting universal screening in children using the Children’s Depression Inventory instrument. If children are referred with symptoms of depression, the CASI tool provides a complexity evaluation. Dr. Hardwig is also working on a RFP with the Human Development Center to strengthen the partnership between clinical and mental health services. He hopes this will create more telemental health opportunities. Dr. Hardwig recently visited Germany with his son and noted the use of logs for fitness activities along bike paths. This low-cost approach to a healthy environment can be contrasted with the U.S. environment, which promotes obesity through a lack of everyday fitness opportunities, many due to liability concerns.
Tom Boe – Dr. Boe is looking at primary access to dental care in the region to identify positive and negative trends. A positive trend is more children are accessing oral health care. A negative trend is the elderly population has limited access to denture and partial denture care. Dental students are doing screenings in local high schools. A waiting list was filled after the first week of classes. Looking at potential over supply of dental hygienists and trying to get comprehensive understanding of available training programs and student placement. Many are excited by the dental therapist law and potential to obtain further education. The issue of children drinking large amounts of soda is a huge concern. The acidity levels are low, with diet sodas being worse than regular soda. There is a conflict of interest since many schools get money for sports or extra-curricular activities through vending machines. This is an issue that requires awareness and needs to be raised again within school boards.
Jode Freyholtz-London – Jode has promoted the RHAC telemental health report in several settings. A recent positive trend is to develop local mental health advisory councils. There is a lot of interest and people are wanting a voice to tell their stories. Region 5 is producing a mental health video for all local consumers that addresses myths and bias to seeking mental health services. They are currently fundraising and plan to release the video by the end of October. When state operated services (SOS) changed to 16-bed units, agencies wanted involvement and feedback opportunities. Transformation meetings were held and seven work groups were established. A final report of these work groups is due in December. Jode is on the transportation work group which has identified modes of transportation (ex: Beltrami county special transport initiative) to use other than ambulance or law enforcement.
Tom Crowley – Wabasha county is struggling with flooding and small communities seem to be most affected. There were several school closings and road closings, which contributed to a car accident that involved two school age kids (one died and one injured). Grief counseling is being provided in school and community settings. Transportation problems are receiving some attention. Cannot transport patients from hospital until get ambulance with advanced life support. The BLS versus ALS is an important quality consideration, but are missing the “golden hour” to transport some patients. It is believed that some patients could use lower level of care. Maybe there are regional solutions to be considered (ex: SMARTAC working on EMS quality issues), but there are no quick fixes. Rural EMS agency staff is 75 percent volunteers and this poses additional challenges.
John Baerg – The local clinic and hospital provides primary care to many veterans and this is seen as important to the community. Local public health is experiencing drastic changes. There will be no increase in local taxes and services are being cut. There will be further reductions in health and human services at the state and county levels. Emergency rooms are getting hit hard and this trend will continue. The county has 11,000 people and faces a $750,000 reduction in state aid. County commissioners plan to close roads and other infrastructure if necessary. John does not plan to run again for his county commissioner seat. MDH is making a move to get local public health agencies accredited following national trends. This should help with coordination of care, lower costs and lower reporting requirements.
Nancy Stratman – Long-term care is experiencing a 5 percent cut in elderly waiver services. CMS mandated changes to the Minimum Data Set must be completed by Oct. 1st. If systems do not include necessary changes, there will be delays in payment. Nursing home is exploring electronic monitoring options. The system they like can indicate a fall and other vitals such as body temperature. There are future add-ons available for telehealth (BP, weight, etc.). The current nurses system used in housing services and home visiting is accessible through internet and TV. One time set up cost per unit is $800 with monthly cost around $60. Through the Council on Aging, staff at Cokato Manor have provided “A Matter of Balance” courses in the area, and have been very well received by the community. Other programs in place address chronic disease management. A grant will enable these programs to be open to the public for individuals age 60+. Elderly waiver cuts result in facilities not being able to cover basic costs. Many people using elderly waivers could move to assisted living with high patient satisfaction. However, cannot raise rates for those with ability to pay to offset lower income individuals’ costs. Aging in place is so important and everyone agrees with this, so need greater flexibility for patients across care settings. Elders monitoring program should be added as a model on the ORHPC website.
Steve Gottwalt – Rep. Gottwalt is fielding many concerns about the implications of the federal health care reform act. He reported that it is hard to determine the immediate and long-term impact. People are anxious and unsure how to plan ahead. Small businesses have experienced double-digit increases in health care premiums. Most health insurance costs are rising and with only 3-4 to choose from, all come in at high costs. These changes have had the effect of driving up private insurance costs and increasing utilization which also drives up costs. Small companies are putting in wellness programs to lower costs. Groups need the ability to pool to control costs. The convergence of aging demographics with an era of health reform means chronic disease management is key.
Diane Muckenhirn – Health care reform has raised the question “How are we going to educate law makers to address broad scope of practice issues?” Nurse practitioners are a good fit with health care homes, but how many are inclusive of mid-level providers? Need proper legislation on scope of practice to address this as it is a stumbling block to meeting future health care needs. New language for mid-level providers is “collaborative providers” which are shown to make a practice more efficient.
Margaret Kalina – It appears there is no longer a nurse shortage in central Minnesota as there are many of new graduates looking for work. Baby-boomer retirements will start to open up jobs for recent graduates. A doctorate level nursing degree will soon be required for nurse practitioner practice. Those with a master’s will be grand-fathered in. For most, this will not represent a pay hike, but the ability to practice independently. Currently, nurse practitioners in a clinic setting are a bargain. Mental health services in Alexandria are as good as they have ever been. The hospital transitioned to an outpatient mental health model with Lakeland as the mental health provider. Region 4 has a strong adult mental health initiative. A mental health crisis line in the ER is used after the medical exam to help with practical needs. Hospital received level 3 trauma designation and has created discussions around performance improvement. Midwives are increasingly in high demand and many are homegrown practitioners who started out as RNs.
Jill Myers reviewed the issue curve generated during last year’s work plan meeting. RHAC members provided input on changes to the issue curve in 2010. Key accomplishments were discussed and current tasks identified. Work plan focus areas remain the same and include wellness/prevention, access to specific health services, health information technology and telehealth, and communication/education. A revised work plan will be sent out for RHAC review and comment.
GENERAL SURGERY WORK GROUP UPDATE
RHAC is currently convening a workgroup to look at rural general surgery issues. The initial meeting was held in July with a CRNA/workforce webinar in August. Future meeting topics include ties between rural general surgery and Minnesota’s trauma system, and education, training and residency issues. RHAC staff has gathered a lot of data and literature on the subject of rural general surgery. To highlight the Minnesota-specific data, a supplemental chart book will be created. CAHs will receive an electronic survey regarding general surgery workforce issues. RHAC staff will be making site visits to better understand general surgery models and examples of collaboration.
ORHPC DIRECTOR'S REPORT
Mark Schoenbaum reviewed Minnesota’s Health Reform bill that passed in 2008 which included (1) State Health Improvement Program – SHIP (2) health care homes (3) payment reform (4) insurance coverage (5) e-Health directives. ORHPC is utilizing a web-based activity tracking system (CATS) created by the North Dakota Center for Rural Health. This is allowing us to track activities by program, focus area, geography, and many more data points. ORHPC staff is still learning how to best use the system to create reports and maps. ORHPC is a co-sponsor for a Minnesota Veteran’s Hospice conference on October 19-20. RHAC terms are ending in 2010 for eight members (Baerg, Boe, Carpenter, Gottwalt, Kalina, Nixon, Otremba, Prettner-Solon). ORHPC requests that current members stay on until new members are appointed. With a change in governor, this process is often delayed. RHAC members may also reapply for another 4 year term on the committee. ORHPC will let RHAC members know when the open positions are posted on the Secretary of State website.
RHAC NEW MEMBER PREPARTION/FEEDBACK
Jill Myers is interested in getting feedback on the orientation book that was given to new members. RHAC staff is interested in ideas on how to support new members. One idea is to connect each new RHAC member with an experienced RHAC member.
The meeting adjourned at 1:45 p.m. The next RHAC meeting will be held on November 30 at the Snelling Office Park-Red River Room and will include an overview of 2011 legislative agendas from several health associations.