Rural Health Advisory Committee Meeting Minutes

Rural Health Advisory Committee Meeting Minutes

Friday, April 15, 2011 9-10:30 a.m.
Webinar origination: Golden Rule Building, room 223, St. Paul, MN

Members Present: John Baerg, Ray Christensen, Jode Freyholtz, Jeff Hardwig, Margaret Kalina, Diane Muckenhirn

Members Absent: Tom Boe, Deb Carpenter, Tom Crowley, Steve Gottwalt,Tom Nixon, Sen. Julie Rosen, Nancy Stratman

MDH Staff Present: Ellen Benavides, Pamela Hayes, Paul Jansen, Jill Myers, Mark Schoenbaum, Kristen Tharaldson


John Baerg – St. James lost their VA clinic. Veterans in the area must travel to Mankato to access VA health services.

Ray Christensen – The Rural Medical Scholars Program is an expansion of a medical student preceptorship. The biggest challenge to on-site training is housing issues. The Rural Physician Associate Program (RPAP) is going well this year. There is a 52 percent family medicine match for medical school graduates from UofM-Duluth in 2011. This is much improved over the last couple of years when the match was 34 percent. An increased emphasis on primary care at national and state levels has been helpful.

Jode Freyholtz – There is a lot of legislative activity around mental health programs and most propose massive cuts to preventative programs. The key message from opponents is these cuts will not save money and in fact eventually cost more money across more sectors (schools, emergency rooms, law enforcement, etc.). The regional advisory council in Wadena recently produced a video of nine people telling their personal stories of mental health challenges and recovery. So far, 400 people have watched the video and DHS plans to distribute it for wider use. It has also been included in a nursing course curriculum and used as a tool for training county employees. Because of several factors (including limited access to mental health services and a poor economy), the utilization of mobile mental health services is skyrocketing.

Jeff Hardwig – The work of RHAC does have an impact. There has been momentum on general surgery issues even before the report is released. Essentia Health is interested in discussing rural residency possibilities. The report has been helpful in starting conversations. We may want to meet with workgroup members to discuss and propose next steps. (Mark Schoenbaum contributed the following): There is also national interest in the report through the National Rural Health Association (NRHA) and the National Organization of State Offices of Rural Health (NOSORH). Jonathon Sprague and his colleagues have been working at the national level on this issue. RHAC will distribute the final general surgery report to interested parties.

Margaret Kalina – The Minnesota Organization of Leaders in Nursing is working on an interstate license compact. This work has spanned the last eight years and progress is being made during this legislative session to pass a bill allowing for interstate licenses.

Diane Muckenhirn – McLeod County was ranked as the second healthiest county in Minnesota according to recent County Health Rankings issued by the Robert Wood Johnson Foundation. An independently-owned clinic is considering a merger with the local hospital. This would decrease administrative duplication and improve billing options. The draft Advanced Practice Registered Nurse (APRN) workforce paper was well done. Trends show aging nurses will lead to increased retirements and opportunities to train greater numbers of APRNs.


Kristen Tharaldson presented a project plan for the next RHAC workgroup on obstetric services in rural Minnesota. It is logical to follow up the general surgery workgroup with this issue since there are similar workforce and infrastructure challenges. The project purpose, focus areas, approaches and time line were discussed. Early feedback on recruitment and retention issues was shared, including decreasing numbers of family practice physicians in general and decreasing numbers of new or existing family practice physicians choosing to do obstetrics.

RHAC members are encouraged to provide feedback on the project plan, submit research or policy articles related to rural obstetric services, submit interesting obstetric service delivery models or case studies, recruit workgroup members and key informants, and join the workgroup if interested. See Rural Obstetrics Project Plan attachment (PDF: 32KB/2pgs).


Pamela Hayes from the MDH Comprehensive Cancer Control Program presented on the Minnesota Cancer Plan (PDF: 4MB/24pgs). Minnesota was one of 13 states to receive a CDC grant to implement policy, systems and environmental changes to address cancer. Roughly 21 percent of patients diagnosed with cancer suffer premature death. Recent research has shed more light on the link between cancer and environmental exposures and risks.

The American Institute for Cancer Research and the World Cancer Research Fund issued a Policy and Action for Cancer Prevention Report. They studied food and other industries to determine the impacts of smoking, poor diet/exercise and the environment on cancer rates. The report emphasizes a need to return to classic public health approaches. What was done for water and sanitation in the past (make it automatic and widely available to entire populations) needs to be done for diet and exercise today. Recent public health approaches to obesity have focused on individual choice with little results. Overweight and obesity rates have doubled in the past 40 years. However, smoking rates have declined due to increased pricing and decreased access. Only 4 percent of health spending is on prevention. It would be more effective to address chronic conditions and cancer through environmental and social conditions that reach broader populations. Interventions to improve health are most actionable when they have high impact and low cost. This includes setting defaults to healthy options. For example, in Europe people must opt out of being an organ donor whereas in the United States, people must opt in. Europe has much higher rates of organ donation and lives saved due to setting the default to the healthiest option.

Schools are an important target for implementing policy, system and environmental changes. During the same time as a heightened emphasis on testing in schools, there were less emphasis placed on physical exercise and healthy food options. In broader society, the rates of exercise are steady or increasing, but the amount of high sugar, high fa, and high salt food and beverages has dramatically increased. Food that is energy dense but lacking nutritional content is cheaper than nutritious food. Also compounding the problem is the sedentary lifestyle that is very common today.

The Minnesota Cancer Plan includes 23 objectives. These focus on risk factors (tobacco, obesity) and reducing specific types of cancer. They are integrated with other chronic disease program approaches (including heart disease and air quality). New focus areas in this plan include radon, HPV vaccine, prostate cancer, advanced care and hospice. There will be an emphasis on integrating population based approaches with clinical health care services.

Project teams, task forces and a new cancer policy workgroup will implement the Minnesota Cancer Plan. RHAC members are encouraged to become a part of this work group by contacting Pam at or 651-201-5094.


Assistant Commissioner Benavides described the four-year agenda for the Governor’s office. Areas of emphasis include excellence, performance standards, accountability and partnerships. Some areas targeted for streamlining for increased efficiency include healthy aging initiatives, business improvement and performance improvement.

Lt. Governor Prettner-Solon is working to finalize the open RHAC appointments.

The Minnesota Senate proposed cuts to several rural programs. They have been given feedback and concerns have been forwarded, especially regarding rural workforce programs. ORHPC and the broader rural health community have allies in the MDH Executive Office and Governor Dayton’s office.

Because of the nature of rural economies and high self-employment in rural areas, MinnesotaCare should be considered a rural program. Coordinated Care Delivery Systems (CCDSs) are hospital-based service delivery systems for General Assistance Medical Care (GAMC) recipients who were formerly MinnesotaCare recipients. The four urban CCDS sites that contracted to provide health services for GAMC recipients are now releasing lessons learned. The Department of Human Services is holding a meeting of patients who were affected by the transition from MinnesotaCare to GAMC. Take Action Minnesota and the four CCDS hospitals will host this meeting. They did their best to serve patients with available resources, but were rural needs met? This discussion is a good lead in to upcoming Accountable Care Organization (ACO) discussions. What will they look like? Who will be included? How will they be organized? An RFP will be issued soon with a summer deadline for setting up ACOs.


Community Paramedic bill signed into law – Minnesota is the first state to pass a community paramedic bill. The origin of this health profession is in rural Nova Scotia. Flex funds supported the development of this profession in Minnesota. A pilot program was completed by the Shakopee Mdewakanton Sioux community. Community paramedics will become a formal provider type with the credentials EMT-CP. Two issues remain to be resolved: (1) coordination with local care teams and (2) Medicaid reimbursement levels. A DHS workgroup will issue recommendations on Medicaid reimbursement in 2012.

Minnesota legislators propose cuts to rural programs – New budget bills took aim at several rural health grant programs. The Minnesota Rural Health Association (MRHA) has stepped up to defend these programs: state and federal health professional loan forgiveness programs, Indian Health grants, Migrant Health grants, CALS training subsidy, Rural Hospital Planning and Transition grant, Summer Internship in Health opportunities, and health curriculum grants. It is good to have this support, but there is a large hole to dig out of, so response will be continuous until a budget bill is passed. See attached letter from MRHA (PDF: 68KB/1pg).

National budget impact on rural programs – The effects on rural programs are not yet clear. There was unclear language in the current budget bills. Overall, health professional programs took a large hit.

MDH Executive Offices continues to fill positions – The new Deputy Commissioner of Health Jim Koppel, comes to MDH from the Children’s Defense Fund.

ORHPC reports – The Rural General Surgery Report is now finished and posted online. The draft APRN report is in the final stages of review.

Summer Community Forums – ORHPC plans to hold two summer community forums in the Walker area and another location to be determined in southern Minnesota. These discussions will highlight needs and concerns of rural community members. RHAC members will be asked to help promote the events or host if they are near your community. Results of the forums will inform RHAC and FLEX planning as well as the next Rural Health Plan.


The meeting adjourned at 10:30 a.m. The next RHAC meeting will be held at the Rural Health Conference on June 27th. The 2011 Minnesota Rural Health Conference will be held June 27-28 in Duluth. We will have a meet and great luncheon with current and new RHAC members, staff and special guests. Reserve lodging by May 27th. Visit the conference website for information:


Updated Wednesday, November 13, 2013 at 10:22AM