Rural Health Advisory Committee
Friday, March 30, 2012
9 - 11:30 a.m.
Members Present: John Baerg (chair), Tom Boe, Ray Christensen, Tom Crowley, Ellen Delatorre, Jode Freyholtz-London, Margaret Kalina, Sen. Tony Lourey, Nancy Stratman, Tom Vanderwal.
Members Absent: Jeff Hardwig, Rep. Larry Hosch, Rep. Steve Gottwalt, Diane Muckenhirn, Sen. Julie Rosen.
ORPHC Staff: Judy Bergh, Paul Jansen, Anne Schloegel, Mark Schoenbaum, Kristen Tharaldson.
Guests: Virginia Barzan (Minnesota Academy of Family Physicians), Justin Bell (American Heart Association-Minnesota), Pam Biladeau (Minnesota Emergency Medical Services Regulatory Board), Rebecca Radcliffe (Essentia Health).
Welcome and Introductions
The new RHAC chair, John Baerg, welcomed Rural Health Advisory Committee (RHAC) members and guests. He thanked past chair, Jeff Hardwig, for his service to the committee. Members were asked to provide updates about their current work or region of the state.
Sen. Tony Lourey – The state health and human services omnibus bill has a provision to encourage the University of Minnesota Board of Regents to support rural primary care training programs. Rules did not allow this to be a required action, so it was included as a strong request.
Tom Boe – The community dental clinic in Moorhead recently hired a dental therapist to work with underserved populations. The dental therapist will start in April 2012.
Nancy Stratman – A private home health agency in the area has stopped taking public pay clients. County human services also will not pay for home-based support services for this population. Cokato Manor Home Health has received 40 referrals in just two weeks. It is possible this is occurring in other parts of the state as county budgets have seen large reductions in recent years. The AFrame Digital system used in Cokato includes remote monitoring and a nurse call system. There are two AFrame Digital systems in Minnesota and only 10 in use in the country.
Tom Crowley – Wabasha County is also getting out of providing home health care services. Most people who need these services will not be able to afford out-of-pocket payment for home health services. The answer may be using telehealth models to help with medication management and reduce travel expenses for caregivers. Saint Elizabeth’s has been active in a K-12 student shadow program for early identification of kids interested in health care careers. Two of these students have recently been accepted to UMN-Duluth medical school.
Tom Vanderwal – The issue of responding better to rural mental/behavioral health emergencies is on the RHAC workplan. It will be important to include this issue in the discussion on EMS leadership at a future meeting as it is an important issue to address.
Pam Biladeau (Minnesota Emergency Medical Services Regulatory Board) – EMS partners are working to finalize the Community Paramedic training program at Hennepin Technical College. Certification approval is in place and onsite approval is pending. There are nine people currently being trained through this program. EMS partners are seeking grant funds to graduate 90 additional community paramedics. The EMSRB’s state ambulance reporting system (MNSTAR) is in the first phase of a multiyear plan to collect statewide data. A public safety grant is being used to support a data analyst position. This person will be working on uniformity and usability of the data.
Rural Obstetrics Work Group
RHAC staff provided a summary of the Rural Obstetric Services Work Group project. RHAC members were asked to provide feedback on the draft recommendations and other elements that should be included in the final report. Some requests included:
- Total number of pregnancies in rural counties per year
- Total number of teen pregnancies in rural counties per year
- Identification of special populations with high birth rates (age, racial/ethnic, etc.)
- Total number/percentage of home births in Minnesota (rural & metro)
- Number of doulas practicing in Minnesota
A recommendation will be added to address the hospital issues of malpractice and liability costs. The effects of this issue vary greatly between states. Minnesota has a relatively favorable environment, so the recommendation would be to protect or maintain the current state. Hospital-based providers have their insurance paid for by the facility. Those who pay higher costs are OB/GYNs or other physicians who practice independently. MMIC is a physician-led group that provides malpractice insurance and works to keep down the costs of coverage. It began in 1980 as a result of the medical professional liability insurance crisis of the mid-1970s. MMIC provides education and services to address liability insurance, risk management and claims management.
Another recommendation may be added to address the length of hospital stay post-delivery. The average length of stay covered by insurance in Minnesota is two days. In Scandinavian countries, the mother and baby stay in the hospital for eight days to ensure proper bonding, successful breastfeeding and to provide new parent information.
RHAC staff will revise the draft recommendations based on this discussion. The report cover letter will highlight major rural differences in the availability of obstetric services. When the draft report is ready, RHAC and the Rural Obstetrics Work Group members will be asked to vote to approve the report.
Stroke Awareness in Rural Hospitals
Minnesota Acute Stoke System partners are working towards statewide system development. This conversation started eight years ago with a top-down orientation to system development. This work was restarted in 2010 with a bottom-up approach that is already proving to be more successful. There are national recommendations and guidelines for statewide stroke systems, but states are unique in their approaches.
In Minnesota, there are 2,000 stroke related deaths per year and 11,000 hospitalizations that amount to $367 million in hospital costs. The time from stroke onset to treatment should be within a 180-minute timeframe for best outcomes. A Minnesota Stroke Prevention Plan was developed in 2011-2012. A statewide system will minimize drive time to stroke care, improve outcomes for patients experiencing stroke that do not live near a stroke care center, improve the consistency of stroke care, and standardize and coordinate state system components. All rural hospitals can benefit from a coordinated system as they need to assess, treat and transfer stroke patients in an efficient and reliable way to improve outcomes.
The system is patient focused and inclusive of rural hospitals. It is not about creating bypass systems, but increasing local capacity for stroke care. There are 54 hospitals currently participating in meetings to develop the system. This group has a good working relationship and has been able to reach consensus on methods for system development. Recent work of the committee has been to identify expectations for EMS and hospitals, including criteria for acute stroke-ready hospitals. The next steps will be to finalize system components, identify challenges, and launch the system in a phased-in manner. It will start with voluntary participation, build capacity across the state, and eventually may include legislation to maintain the statewide stroke system.
There is overlap with other statewide systems of care in Minnesota and other states. Washington combines their trauma and stroke systems. Other states combine STEMI (heart attack) and stroke systems. Massachusetts and North Carolina have well-developed transport protocols. Arizona has been strategic about incremental system development with support from their state legislature. RHAC members are welcome to provide input and feedback into the statewide stroke system concept and implementation.
RHAC open appointments will be filled soon. Jeff Hardwig, RHAC physician member, has decided to withdraw his application to be reappointed. He wanted to thank his fellow RHAC members for their commitment to addressing important rural health policy issues. Another physician applicant has been recruited and the Governor’s Office will be making an announcement shortly.
The cover story in Minnesota Medicine for March 2012 is “Bringing Home Baby: Who Will Wo the Deliveries in Rural Minnesota?” The Rural Obstetrics Work Group was mentioned in the article as well as quotes from key work group informants and RHAC staff Paul Jansen. www.minnesotamedicine.com/CurrentIssue/BringingHomeBaby.aspx (link no longer available).
The January 2012 RHAC meeting included a discussion on the topic of Rural Health System Growth and Consolidation. A student from the UMN-Crookston is working with RHAC staff to conduct a survey of Critical Access Hospitals. This topic will be revisited at our next meeting on May 7th. Results from the survey will be available sometime in Spring 2012.
ORHPC staff has received several recent requests for RHAC reports and further information. Some of the more popular requests relate to the General Surgery report, Telemental Health report, and Mental Health & Primary Care report. A J-1 visa waiver applicant used data from the recent Rural Health Status Report to support his application. These activities demonstrate the influence of RHAC’s work and that our work plan issues are on target.
The Governor’s Workforce Work Group, a subgroup of the Health Care Reform Task Force, is gathering input on strategies to address workforce-related issues across various health care sectors. The chair of the work group is Dr. Therese Zink, last year’s Rural Health Hero at the Minnesota Rural Health Conference.
The meeting adjourned at 11:30 a.m. The next RHAC meeting is on May 7, 2012 from 10:00 a.m. - 2:00 p.m. at the Snelling Office Park, Big Fork Room. This will be a joint meeting with the Rural Hospital Flexibility Program (Flex) Advisory Committee.