Rural Health Advisory Committee Meeting Minutes
Tuesday, February 22, 2011 9-11:30 a.m.
Minnesota Department of Health-Freeman Conference Room B-108, St. Paul, MN
Remote sites: International Falls, Moorhead, UMN-Twin Cities
Members Present: John Baerg, Tom Boe, Ray Christensen, Tom Crowley, Jeff Hardwig, Margaret Kalina, Diane Muckenhirn,Tom Nixon, Nancy Stratman
Members Absent: Deb Carpenter, Jode Freyholtz, Steve Gottwalt, Julie Rosen
MDH Staff Present: Ellen Benavides, Judy Bergh, Paul Jansen, Jill Myers, Mark Schoenbaum, Kristen Tharaldson
Tom Crowley – Saint Elizabeth’s hospital in Wabasha is involved in the Rural Medical Scholars Program and plans to document the full experience of their student. Saint Elizabeth’s has rolled out their workplace wellness program to five local businesses. Findings to date include: (1) lack of knowledge of health biometrics guidelines (blood pressure, cholesterol, etc.); (2) need for healthy food options, such as affordable fruit, in the workplace; and (3) stress management programs are in high demand. Employers are beginning to understand the value of good health for their employees and can see a $3-6 return on each dollar invested. Employers pay $40 per employee to do the initial screening and can purchase additional programs to encourage good nutrition, stress management or clinical exams.
Tom Nixon – The Rotary Club is partnering with organizations to get AEDs out to the general public. On-call first responders are interested in a system similar to the fireman’s relief system that encourages volunteering.Tom was encouraged to see the Minnesota Ambulance Association is exploring incentives including health care insurance coverage.
Tom Boe – Dentists will soon be using dental scans to diagnose osteoporosis.
Ray Christensen – The UMN-Duluth Medical School has a new curriculum and its first class for the Rural Medical Scholars Program. It focuses on getting early clinical experiences in medical school as well as American Indian and minority health. It places students in health care systems and local communities. They learn how to do physicals and work with an interdisciplinary team. The curriculum includes two weeks in January to address basic skills and cultural competency, one week in April for preceptorships and two weeks in June for preceptorships and community assessments. The summer internship in medicine is also continuing at both Duluth and Twin Cities campuses. Rural Physician Associate Prpgram (RPAP) is selecting sites for students. There is some concern during this legislative session for RPAP and Rural Medical Scholars program funding.
Jeff Hardwig – A first year medical student worked with a nurse practitioner and in the nursing home in International Falls. This makes sense to get a variety of clinical experiences earlier in the medical school experience. The hospital recently changed the way behavioral health is managed. Family planning doctors now administer the behavioral health program. This allows them to coordinate patient care and have a say in treatment plans for their patients. A psychiatrist who loves to hunt and fish was recently recruited to the area. He will graduate in two years.
RURAL GENERAL SURGERY REPORT AND RECOMMENDATIONS
Jill Myers presented an outline of the rural general surgery report and related recommendations. Ray Christensen will help reword recommendations related to education, training and residency (#5, #6, #8). Diane Muckenhirn will help reword the recommendation regarding itinerate surgical practices and involvement of advanced practice nurses (#7).
RHAC members can provide feedback on any recommendations following the meeting. Follow through will be important as there are many groups focused on this subject, but little coordination of efforts. NRHA hopes to gain traction at the national level along with ACS, NOSORH and other health associations interested in rural general surgery issues.
RURAL HEALTH STATUS CHARTBOOK
Paul Jansen presented on the progress of the Rural Health Status Chartbook project. Information will be presented by region using Rural Urban Commuting Areas (RUCAs). RHAC members are encouraged to provide feedback on the types of health indicators proposed for this project. One suggestion was to include drug use (illicit and/or prescription drug abuse) as an additional health indicator.
COMMISSIONER’S OFFICE UPDATE
Ellen Benavides, newly appointed assistance commissioner for the Health Policy, Quality, Compliance and Health Reform Bureau, was introduced to RHAC members and staff. She comes to MDH with a range of experiences from director of a Medicaid Demonstration Project to documentary filmmaking. Her special interests include social disparities, mental health and integrating services for the homeless.
Assistant Commissioner Benavides described Commissioner Ehlinger’s priorities including balancing the budget in a fair manner, addressing health disparities and maintaining the high status of the Minnesota Department of Health. Although facing budget reductions to address the state budget shortfall, Gov. Dayton has proposed spending increases to address statewide health promotion, fetal alcohol spectrum disorders, health reform and environmental health.
Distribution of Advanced Practice Registered Nurses (APRN) project – In a recent report, The Institute of Medicine (IOM) recommended a larger role for APRNs to redesign the U.S. health system. APRNs are defined in Minnesota Statute as certified nurse practitioners, clinical nurse specialists, nurse anesthetists and nurse midwives. This report will document the characteristics and distribution of APRNs in Minnesota. Diane Muckenhirn will review the draft report, and other RHAC members are invited to comment.
New ORHPC employee Leslie Nordgren – Leslie will be responsible for studying the use of new dental therapists as they enter the workforce. She will also help coordinate evaluation of dental therapist training programs in Minnesota.
RHAC appointments – ORHPC is working closely with the governor’s office to make new appointments to the Rural Health Advisory Committee. We have applications for all except the consumer position. These appointments should be made in time for the April RHAC meeting.
Federal budget – The federal budget is favorable to most rural health programs. The only program threatened by elimination is the Small Rural Hospital Improvement Grant Program (SHIP). It currently provides $8,500 a year to assist rural hospitals to develop prospective payment systems (PPS), comply with HIPAA provisions, reduce medical errors and support quality improvement.
Spring flooding – Local governments are gearing up for spring flooding in Minnesota. The Red River Valley region near Fargo/Moorhead estimates they will need around four million sandbags this year. MDH is involved in statewide planning and emergency response efforts.
Community Paramedic legislation – EMS programs are following a bill to create a community paramedic status in state legislation.
Health Reform – State and federal health reform legislation continues to change and unfold. It is a priority for the new state legislature. It will be up to RHAC and other rural partners to make sure these programs will work for rural areas.
The meeting adjourned early at 11 a.m. The next RHAC meeting will be Friday, April 15, 2011, 9-11:30am. It will be conducted via videoconference.