Ground Level Category Archive: Health care
What's the impact of a health care system like Essentia?
Posted at 2:31 PM on May 17, 2012
by Jennifer Vogel
(0 Comments)
Filed under: Health care, Rural
Statewide, health care systems like Essentia Health and Sanford Health have been buying or striking up management contracts to run local independent hospitals. It's a trend born of increasing financial pressures and federal technological mandates that we've been following at Ground Level.
With these systems gaining control of a growing slice of rural Minnesota's health services, people are wondering what the long term impacts will be on the quality of care. The Star Tribune had an interesting piece this morning about a battle in Sandstone, where Duluth-based Essentia runs the hospital.
Apparently, locals were unhappy with Essentia's lack of investment in the aging hospital and its plans to buy the facility. They feared Essentia would close the hospital or let it languish further. So leaders threatened to pull the company's lease. That led Essentia to apologize and promise to work with the community to improve the hospital as well as the quality of health care.
How typical is this situation? According to Judith Neppel, executive director of the Minnesota Rural Health Association in Crookston, an advocacy group, most of these affiliations have benefitted locals.
"I'm hearing that generally the communities are satisfied," she said, acknowledging that it's too early to know the long term impacts. "I believe it's helped with the recruiting and retention of important professionals, specifically primary care physicians and midlevel providers. It made access better in most of these rural communities. I don't hear negatives."
Neppel says just 41 percent of the state's hospitals are independently-owned. She says her organization is conducting a survey to determine more scientifically the impacts of these growing health care systems on quality of care.
Health care reform doesn't have to be a spectator sport
Posted at 3:21 PM on April 12, 2012
by Dave Peters
(0 Comments)
Filed under: Health care
You don't have to just sit there waiting for the U.S. Supreme Court to rule on national health care reform.
You can instead sign up for one of about 40 two-hour conversations in the next several months around Minnesota that will let you talk about your own experience with the real-world balancing act among costs, care and health.
The conversations are being sponsored by the Citizens League and the Bush Foundation on the same model they used last year to let people kick around the state budget dilemma. The discussions will lead to a written report in August to the state's bipartisan health care reform task force.
That body, in turn, is expected later this year to create a plan for reforming how Minnesota delivers and pays for health care.
No matter what the Supreme Court does with the national health care reform law, the conversation will be valuable, said Citizens League president Sean Kershaw. "We're really dealing with issues of peoples' values and priorities. Citizens have a huge role in it."
Kershaw said the hope at each conversation is to provide basic factual information on health care, but then to "allow people to speak from their experiences."
So if you want to talk about your experience with the medical system, this is your chance.
The first of the community conversations the Citizens League is hosting is at 6 p.m. today in Minneapolis at the Lake of the Isles Lutheran Church Fellowship Hall. There's another one Tuesday in St. Paul at St. Anthony Park Lutheran Church, and then there's a series of them around the state. Find a the full calendar, so far, here. The organizers prefer that people register ahead of time, which you can do online.
In addition to the conversations, the Citizens League next week plans to unveil an online discussion as well.
(Disclosure: MPR News' Ground Level project receives support from the Bush Foundation.)
New study: Rural Minnesotans suffer chronic disease more, are less insured
Posted at 3:16 PM on September 1, 2011
by Dave Peters
(7 Comments)
Filed under: Health care
Rural Minnesotans smoke more than their urban cousins. They're fatter. They exercise less.
They die more frequently from diabetes, stroke and heart disease.
More of them are uninsured.
On the other hand, rural Minnesotans are less likely to suffer from venereal disease or AIDS and they get murdered less often.
Those are some highlights from a report the Minnesota Department of Health released today. Given what we know from past studies, none of the findings are particularly surprising (see our Ground Level rural health coverage), but the report updates an analysis the department did in 2005.
The report doesn't address why these differences exist, but analyst Paul Jansen, who put it together, says there could be a lot of factors. Access to primary care is one possibility. The hope, he said, is that identifying the disparities will help bring more focused attention in the areas its needed and that people will uncover causes.
To that end, one of the report's most interesting compilations is its region-by-region summaries.
The seven counties of northeastern Minnesota, for example, exhibit the highest rates of deaths due to diabetes, heart disease, cancer and cirrhosis.
Southwestern Minnesota, on the other hand, has a relatively low death rate from Alzheimer's disease but the state's highest proportion of people who say their health is only fair or poor.
WEIGH IN: Is rural health care getting better or worse?
Posted at 4:03 PM on September 7, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
UPDATE Wednesday afternoon: Here's what I had to say about this to Steven John on All Things Considered today.
When it comes to health care in rural Minnesota, are you an optimist or a pessimist?
We're having our third online conversation with a panel of nine doctors, nurses and other health professionals, trying to shine a light on what happens and what's the outlook when patient meets provider in Minnesota. This time we asked them to tell is whether care is going to get better or worse.
Read what they told us and then answer the question yourself.
The shortage of providers weighs heavily on Dr. Curt Louwagie in Marshall, but Dr. Heidi Korstad in Bigfork declares herself an optimist. Consolidation of facilities is a concern to psychologist Jane Hovland, but nurse Joyce Kramer sees hope in rural-urban partnerships.
What do you think?
(You can weigh in on the two earlier discussions as well. The first asked for examples of barriers rural residents face, and the second asked people to think about one change they would make.)
WEIGH IN: Name one thing to change rural health care
Posted at 9:54 AM on August 31, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
What's one answer to improving health care in rural Minnesota? More primary care providers? Changing how we pay for health care? Letting paramedics and nurses do more? If you have answer, tell us about it here.
Last week we asked our Ground Level panel of doctors, nurses and other health professionals to tell us an anecdote about barriers they see their patients facing. We heard a lot, both from them and readers who joined the conversation here on Ground Level and on Facebook.
Now we've asked the same nine providers to tell us one thing they would change so their patients would receive better care. Dr. Heidi Korstad in Bigfork would increase support for the state health insurance program, MNCare. Joyce Kramer, a nurse in Stillwater, would change the way we pay physicians. Ruth Pallansch, a retired nurse in Henning, thinks the answer lies in honoring and supporting nursing. Curt Louwagie, a Marshall opthalmologist, thinks making it harder to file frivolous lawsuits would help.
Read what these folks have to say here and add your own comment at the bottom.
And you can still join last week's conversation here. Just last night a nurse in Winona wrote about a woman unable to get transportation to the doctor even though she was suffering a stroke.
Next week we'll pose a third question.
Cheering and jeering for rural health
Posted at 10:57 AM on August 25, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
I feel like we've unleashed rural health care cheering and jeering sections on our Facebook page.
Hurrahs for Rochester and Springfield. Jeff prefers the clinic in Pine City to being treated in Brainerd. Carrie bypasses Waseca to go to Mankato. Angie is happy with the primary care in Fosston.
The comments were prompted after we asked nine rural health providers around the state to tell us about barriers their patients face. The nine gave us compelling examples of patients foregoing care to save money or because distances were great.
(You can hear my conversation with Phil Picardi on today's Morning Edition about them.)
The ensuing comments on Facebook are energetic, with ratings ranging from "scary" to "excellent." One person describes mistreatment of pneumonia while another points to good results from a gall bladder surgery.
It's useful to remember that most people rate their hospitals highly in the national satisfaction survey administered by the federal government, the Hospital Consumer Assessment of Healthcare Providers and Systems. Minnesota facilities rank higher than the national average on these surveys and, in fact, some of the highest ranking hospitals, when it comes to customer satisfaction, are rural hospitals.
That's often attributed to the personal touch and familiarity with patients that smaller institutions provide, although one commenter said she preferred to go somewhere where she could be more anonymous.
If you have a thought, join in.
Weigh In with your rural health story
Posted at 9:30 AM on August 24, 2011
by Dave Peters
(2 Comments)
Filed under: Health care
They see patients who plead with neighbors to drive them to the hospital in order to save on the ambulance cost. They watch a heart attack victim trying to drive extra miles to an emergency room with a lower insurance co-pay. They see jawbones dissolve and vision deteriorate because people can't drive or can't afford the care to prevent it.
As part of Ground Level's coverage of rural health care, we asked nine doctors, nurses and other health professionals around Minnesota to tell us what it looks like where the patient meets the provider. As you can see, we got some compelling stories back.
You can view them on our new Weigh In page, and even better, you can add your own story by commenting at the bottom. Do you know someone who has faced a barrier to health care because of distance or money? Have you? What happened?
Join the conversation. We'll do this again in a week or so with another rural health care question so please come back.
United Health Group points to rural care shortcomings, fixes
Posted at 9:47 AM on July 28, 2011
by Dave Peters
(0 Comments)
Filed under: Broadband, Health care, Rural
United Health Group has weighed in on the simmering debate over how good rural health care is and what to do about it.
Almost a quarter of the nation's rural residents consider the health care in their communities to be only fair or poor, according to a poll commissioned by the big health care insurer. That's twice the rate for urban residents in the 2,000-respondent national telephone survey.
Earlier this month the Journal of the American Medical Association ruffled rural feathers by publishing a Harvard study indicating rural hospitals aren't as good as urban hospitals in handling heart attacks, congestive heart failure and pneumonia cases. In fact, that was cited in the United Health report.
But the researchers went further. They examined the nation's 300 "hospital referral areas," geographic regions that tend to use the same set of hospitals. Within each, they compared rural and urban doctors by looking at how often they adhered to accepted ways of handling various patient conditions. In all, they looked at 33 million opportunities for doctors to provide care that could be measured by evidence-based standards. Half of those involved hypertension, diabetes or high cholesterol.
They found that rural physicians usually performed worse.
Out of the 300 referral areas, 256 generated enough data to be comparable. Of those, 75 percent showed better performance for urban and suburban doctors. Twenty percent showed no difference and in 5 percent, rural doctors did better.
In a typical area, rural doctors were 3 percent less likely than urban and suburban doctors to provide "high-quality" care, the report says. Rural doctors did best on this comparison in the Upper Midwest and in the Northeast.
The authors highlighted a couple specifics:
--Rural service ranked lower on cervical and breast cancer screenings.
--For cholesterol and blood pressure, there wasn't a lot of difference.
The authors cite a few difficulties in interpreting the research, including noting that some rural providers could be above the national average but look bad because they're in a region with very good urban hospitals.
And Lew Sandy, senior vice president for clinical advancement for UnitedHealth Group, said it's not clear why the differences might exist. It's possible patients are sicker in rural areas, although the methodology tries to account for that. He also said there have been suggestions that the disparity could be the result of older physicians in rural areas that haven't kept up.
"But we don't really know the actual reason," he said.
The report goes on to estimate that national health care reform will result in a greater increase in insured patients in rural areas than in urban areas. This additional demand, it suggests, will add to the much-documented difficulties resulting from a shortage of rural physicians.
Again, this problem will be worse out west and down south than in the Midwest, the report says.
So what to do about all this? The report lists what it considers a promising list of possibilities. If you've looked at our Ground Level package on rural health care, you've seen much of this before:
Incentives to get more physicians into rural areas; more teamwork among doctors, nurse practitioners and others; more collaboration between rural and urban providers; greater use of health information technology and telemedicine.
The last point leads United Health to join those calling for greater availability of high-speed Internet access and specifically for physicians to do more to incorporate it into their practices.
Terry Hill, executive director of the National Rural Health Center in Duluth, said the study, taken in combination with the Harvard study, might help build momentum for initiatives to improve rural health care.
Livestock antibiotics for bronchitis? Check out rural health debate.
Posted at 10:43 AM on July 27, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
Would you take livestock antibiotics to treat bronchitis because you didn't have insurance? And when that didn't work, would you pay $300 for a doctor to tell you what you already knew?
Kim O. from central Minnesota joined the rural health care debate at Insight Now to say "yes" to the first question and "no" to the second. She wound up bargaining the doctor bill down to $125 and got the $25 prescription she needed. But she's not happy with the situation and thinks there must be a better way to use medical providers' time.
Her case is a window into what some rural Minnesotans face when it comes to health care. The Insight Now debate this week focuses on whether letting "midlevel" practitioners like highly-trained paramedics do more, might make care more widely available and reduce the cost. Not all nurses, for example, think that's a good idea, and there's a healthy back and forth going.
Here's what one participant from Fort Worth said about a program there that gives paramedics more responsibility:
The patients are much healthier, we've saved over $3 million in health care costs and reduced "9-1-1" and emergency department use by 51% in the target population. We've also returned over 11,000 bed hours to our local emergency departments for other patients awaiting care. Most of these patients need only gentle reminders about medication use and lifestyle change compliance. RNs are in very short supply and typically function in controlled hospital settings. They are also a pure cost when they are in the home settings. Paramedics can see these community health patients between calls, so there is very little marginal cost for using paramedics in this capacity - that is exactly what we are doing in Fort Worth.
Check it out.
Should paramedics help fill the rural health care gap? Check out the debate.
Posted at 10:46 AM on July 25, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
If rural Minnesota is so short of doctors, why not let other professionals, like paramedics, fill the gap, taking up duties that until now have been reserved for people with MDs?
It was one question we focused on last month with Ground Level's reporting on rural health care, and this week colleague Michael Caputo is continuing the conversation, asking it at his Insight Now debate forum.
If you haven't checked Insight Now out lately, take a look. Every week Caputo enlists two knowledgeable people to tackle an important issue and chew on it for several days. There's a semi-formal back-and-forth structure but ample opportunity for everybody to weigh in if you have a thought.
Paramedic Gary Wingrove takes the "pro" side, arguing that expanding what midlevel practitioners like paramedics do can help keep a lid on health care costs.
Carrie Mortrud, of the Minnesota Nursing Association, argues that the state's new community paramedic law will be potentially harmful by supplanting duties nurses should be doing.
Read and weigh in.
U of M researcher takes issue with Harvard criticism of rural hospitals
Posted at 1:51 PM on July 21, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
Sure, rural hospitals have room to improve, but that's pretty much what they have been doing in recent years, says a team of health researchers taking issue with this month's Harvard study finding that rural hospitals lag behind others in the care they deliver.
Some people took umbrage at the Harvard study, reported in the July 6 issue of the Journal of the American Medical Association.
This week, a team headed by Ira Moscovice at the Rural Health Research Center at the University of Minnesota weighed in, not objecting to the research but suggesting the report's tone was off. For six years, Moscovice and researchers at the University of North Carolina and the University of Southern Maine have tracked data on how well "critical access hospitals" have performed.
These are hospitals with 25 or fewer beds that operate at least 35 miles from neighboring hospitals. In an effort to lend strength to rural health care, they receive federal incentives. But the Harvard study found their care lags when it comes to the treatment of heart attacks, congestive heart failure and pneumonia.
Moscovice's team issued a short response, arguing, among other things that "what the JAMA authors fail to report is how much CAH scores on the process of care measures have improved over time." It notes improvement particularly in the area of care for pneumonia patients.
It also suggests that the Harvard study was making unhelpful comparisons.
"Rather than asking why CAHs aren't more like large tertiary teaching hospitals in Boston, the question that should be asked is, how can CAHs provide the best possible care to patients given their available resources and expertise?"
On the phone just now, Moscovice said the Harvard study was a blessing in disguise because it reminded rural health care providers that they have to continue to improve. "But the glass is 80 to 85 percent full," he said. There's no reason rural patients shouldn't expect some care equal to that found in larger hospitals, but rural hospitals should be evaluated on how well they play their particular roles in the larger system.
Lots of specialists and sophisticated equipment will never be a rural hospital's strong point, for example. So it should be measured not entirely on treatment but also on how well it stabilizes a patient and appropriately transfers him or her.
Not all those measures are easily available, Moscovice noted.
For more on the pressure that the rural health care system is facing in Minnesota, see our Ground Level section on the topic.
Study: Some rural hospital care is worse
Posted at 9:22 AM on July 7, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
Plagued by having fewer resources and less access to specialists, many of the nation's small rural hospitals provide worse care than their larger urban counterparts, a new study shows.
The study appeared this week in the Journal of the American Medical Association and examined the ability of critical access hospitals to care for patients suffering heart attacks, congestive heart failure and pneumonia.
"Critical access hospitals" are those with 25 or fewer beds and located at least 35 miles from another hospital. Concerned that rural hospitals were under too much financial pressure, the federal government in 1997 created the designation, which provides greater Medicare reimbursements and helps maintain the health safety net in isolated areas. The move enabled many small hospitals to stay in business.
The study of data from 2008 and 2009 looked at nearly 5,000 hospitals across the country, almost 1,300 of them critical access hospitals. It found the smaller rural hospitals had lower performance on standard "processes of care" and also higher mortality rates for each of the three health conditions.
Chief author Karen E. Joynt, of the Harvard School of Public Health, concluded:
"Despite more than a decade of concerted policy efforts to improve rural health care, our findings suggest that substantial challenges remain. Although CAHs provide much-needed access to care for many of the nation's rural citizens, we found that these hospitals, with their fewer clinical and technological resources, less often provided care consistent with standard quality metrics and generally had worse outcomes than non-CAHs."
The study noted that finding adequate personnel and resources is difficult for small rural hospitals. It suggested that fuller use of electronic health records and advances in telemedicine can help address the problem.
Terry Hill, executive director of the National Rural Health Resource Center in Duluth, called the study a wake-up call for rural health providers, although he noted that other data put rural care in a different light. Surveys that measure patient satisfaction, which also figure into Medicare reimbursement, for example, show rural hospitals often out-achieving urban hospitals.
Hill also said that previous studies showed critical access hospitals doing better than urban hospitals on pneumonia patients. He added that simply being in a rural setting with less access to home care and other factors beyond a hospital's control can affect the numbers in a study like this.
But "it would be a mistake to say we totally reject these findings," Hill said. The research will certainly be a prime topic at a national rural health care conference next week in Maine, he said, and could serve as an impetus to improve data collection as well as health care at rural hospitals.
For more on rural health care and how Minnesotans are dealing with its challenges, see our Ground Level collection of coverage.
Rural health providers and the need to collaborate
Posted at 5:02 PM on June 28, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
UPPATE: See note at the bottom of this post.
DULUTH -- Several hundred rural Minnesota health care leaders were urged this morning to think hard about moving toward the collaborative model of health care envisioned under the 2010 national health care reform act.
"You have to consider this if you want to be competitive," said Clinton MacKinney, assistant professor at the University of Iowa College of Public Health and a long-time analyst of the nation's rural health care system. He was addressing the Minnesota Rural Health Conference that wrapped up today.
The provision of the national health care law that "has the country in a lather," as MacKinney put it, involves the federal encouragement of networks of "accountable care organizations." Lots of rural providers worry that the move places a disproportionate burden on them.
But MacKinney described it this way: The government wants providers to deliver value to patients (as opposed to services that are paid for time after time.) And to deliver value, the government expects doctors, specialists, hospitals and others to collaborate and then be held accountable. The carrot is that health care providers get to keep a good share of the financial savings they can generate this way.
Regional networks like Sanford, Essentia, Avera and Mayo are growing by buying hospitals and clinics, and urban institutions will be on the prowl to connect with rural providers. But MacKinney insisted the collaborative arrangements don't have to involve ownership. Other kinds of networks and agreements can work as well.
Why should rural institutions think about this? MacKinney got blunt: Rural care isn't as good as it can be.
Recruiting doctors and other providers can be difficult; technology is sometimes inadequate, long-term finances can be unstable. With Medicare acting as "the big dog" in the equation and demanding better results for its patients, "People are talking about winners and losers," MacKinney said.
If two small hospitals near each other perform differently, perhaps one won't survive in the new world.
Writ smaller, the idea of collaboration at the institutional level translates to team care at the patient level, he said.
"There are doctors who don't want team-based care. They want to see a patient and move to the next. That's not going to work."
MacKinney was a forceful speaker and he acknowledged that rural hospitals and other providers have tough work ahead of them. But he made it clear that the world of living off volume of services is fading fast, and the more nebulous concept of providing value is replacing it.
Collaboration will be the key to success, he said.
For more on rural health care, see the Ground Level reporting we compiled here.
UPDATE: After reading my post, MacKinney sent me an email clarifying and expanding on his thoughts. Here are his further comments. (Thanks, Clint.)
"I believe the shift to health care value will indeed occur, but slowly, probably over a decade or more. The shift from being paid for volume (fee-for-service) to value (quality delivered efficiently) requires colossal health care provider change. The entire organizational structure (culture) of a health care provider/system must shift in very dramatic ways. Right now health care providers remain profitable by increasing service volumes (e.g., more CAT scans) and amassing market share. Hopefully, they do so by increasing necessary and high-quality services, but unfortunately the health care market does not demand quality ... yet."Just imagine how the auto industry would change if we no longer bought an individual car. Instead, we each would send a certain amount of money yearly to an auto manufacturer and that cost/price was based on how long the manufacturer's fleet of cars lasted. It's almost too different to imagine! (That analogy isn't quite right, I need to work on one, but you get the drift.)
"So the challenge health care providers face is the transition to value-based purchasing. How do you orchestrate the organizational ethos change that value-based purchasing requires when the bulk of your business remains in traditional volume-based (fee-for-service) payment? And how does our government (as the largest purchaser of health care services in the U.S.) facilitate that transition without putting some providers out of business and jeopardizing access to care? Tough questions, but just the ones we need to explore through innovative organizational structures and public policies."
Advice to rural Minnesota: Look beyond the physician
Posted at 9:15 AM on June 28, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
DULUTH -- There was talk all day here on Monday about new ways of looking at the delivery of rural health care in Minnesota.
Build community organizations to help residents lose weight and exercise more. Connect small town emergency rooms to operations centers that can lend expertise in real time. Train paramedics to do more and even make house calls. Think about team care with several patients from different parts of the state meeting at the same time.
These ideas and more were tossed out during the annual Minnesota Rural Health Conference in Duluth.
Then finally near the end of the day, Mark Schoenbaum, director of the office of rural health and primary care for the state Department of Health, summed it up this way: "We have no choice but to look beyond the physician."
He was part of an end-of-day panel discussion and was responding to moderator Julie Zenner of Almanac North, who asked about incentives to solve the rural doctor shortage.
Schools won't be able to produce enough doctors to serve the aging population in rural Minnesota, Schoenbaum said. He and others said that creates imperatives to change.
Laws and habits that seem mostly to protect turf need to change, said Marty Witrak, dean of the school of nursing at the College of St. Scholastica. That might mean nurses don't object to pharmacists giving flu shots; it might mean docotrs no longer have to sign off on hospice care.
She also told the 150 people attending the panel discussion that the one-on-one doctor-to-patient model probably needs to change. Doctors should be health care system puzzle solvers these days, she said, because what is needed are new approaches to patient care.
Not that widening the team of providers solves everything. Ira Moscovice, professor in the division of health policy and management at the University of Minnesota, pointed out that getting nurse practitioners to rural Minnesota could be just as difficult as getting doctors there.
"It's not a simple task to get any health provider into rural areas," Moscovice said.
But part of the equation that surfaced repeatedly was that patients need to take more responsibility for their own health and make better decisions. Figuring out how to get patients to do that and make other adaptations to what Brock Slabach of the National Rural Health Association called the "era of austerity" is a work in process.
I was surprised by how often during the day I heard references to a need for better communication and more talk between communities about what's working. Clearly lots of people are engaged in preserving valuable community assets across Minnesota. Just as clearly, it seemed to me, there's a need to share what's working.
For more on rural health care in Minnesota, see our Ground Level section on the topic.
Flow of information can bring disturbance
Posted at 11:30 AM on June 27, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
If you haven't read Jennifer Vogel's story (and seen Vickie Kettlewell's video) on the renegade doctor of Osakis, Minn., check it out here.
Dr. Susan Rutten Wasson makes house calls and only takes cash or check as payment, offering up in her daily operation as a critique of the way some medical care gets dispensed and paid for these days. The story has been getting a lot of interest around the Web.
We produced the piece as part of a package on rural health care in Minnesota. The timing was appropriate because today in Duluth several hundred administrators, public health officials, academics and others are gathering to talk about the topic.
This morning, Brock Slabach, senior vice president of the National Rural Health Association in Kansas City, Kan., told attendees to imagine themselves as "islands of excellence in seas of mediocrity."
That doesn't mean he glossed over the difficulties faced by rural health care providers. Lots of people talk about the "new normal." He referred to the same notion as an "era of austerity" that is upon the rural health care industry.
Issues include workforce shortages, public insurance reimbursement rates, decaying infrastructures and health care disparities among the vulnerable that rural health care leaders need to deal with.
A key? Let information flow freely. "In some circumstances this does disturb the peace," said Slabach.
This is an interesting point to keep in mind when reading the story of Susan Rutten Wasson.
The Cornerstones of Rural Health, Minnesota Rural Health Conference takes place in Duluth today and Tuesday.
Health care reform creates new wave of IT workers
Posted at 4:41 PM on June 17, 2011
by Jennifer Vogel
(1 Comments)
Filed under: Health care
As part of the federal government's push to get hospitals and clinics to adopt electronic medical records, it's subsidizing IT training classes across the country.
Normandale Community College is one of the schools that received money to teach students how to implement electronic records systems, an onerous task for health care providers, especially in rural Minnesota.
The push for better electronic health records is a worry for outstate health officials because they think the cost burden falls disproportionately on small, rural institutions and because itmeans there's one more kind of health care professional they need to attract out of the metropolitan area.
Lisette Wright, a former therapist, just completed the Normandale course and is among the first wave of graduates in the nation. "I had no IT background," she says. "I knew as much as I needed to run a business." Wright had her own behavioral health clinic for a decade and started a nonprofit to help a town in Africa. "When the flyer came across for the [health IT] program, I thought what a neat fit."
In 2010, Normandale received an $800,000 U.S. Department of Health and Human Services grant to implement the standardized health IT curriculum. The six-month training costs $500 for students with an IT or health care background. Experts predict a need for an additional 50,000 health IT workers across the country over the next several years.
The Normandale program offers training in "IT technical skills, health care knowledge, systems theory, workflow planning, decision making, and project and time management," according to the school's website.
Though working with electronic medical records seems a long way from practicing as a therapist, Wright doesn't consider the shift radical. "It is and isn't a u-turn," she says. "The end game in all of this is improved outcomes and coordination of care for the nation's health care system. I see this as a way to provide best practices and get quality outcomes. If you have this health IT stuff set up, doctors will be able to access a patient's record so they can provide better service for that patient."
Wright says, given her medical background, she's uniquely qualified to work with providers on workflow issues and integrating electronic records into the practical aspects of providing care.
Some of her fellow Normandale students are looking for paying jobs, Wright says, but others are seeking "practicum placements" or internships, which tend to be unpaid. Wright herself has accepted such an arrangement with a large non-profit.
Though she doesn't plan to work in rural Minnesota, she says the Normandale graduates could be an especially good resource for outstate health care providers. "I'm sure there will be some of them who would say I need a practicum placement and I wouldn't mind going up to wherever for a couple of months to help implement electronic health records."
Normandale is hosting a job fair on June 30th from 7:00-9:00 pm, where potential employers can meet recent HIT graduates.
Dental therapists to fill rural gap
Posted at 10:46 AM on June 17, 2011
by Jennifer Vogel
(0 Comments)
Filed under: Health care
In rural Minnesota there are too few dentists, a fact not wasted on Jodi Hager, who was a hygienist for four years at Apple Tree Dental in Madelia before signing up for a new dental therapy program at Metropolitan State University.
"There is only one other dental clinic in southwest Minnesota accepting medical assistance patients," Hager says. "We have patients who drive from Pipestone. That's two and a half hours away. And Lake Benton."
Metro State is one of the first schools in the country to provide hygienists the additional training to fill cavities, pull some teeth and perform other services dentists normally provide (there is a similar program at the University of Minnesota). Dental therapists are often called "midlevel providers" because they fill the gap between hygienists or dental assistants and dentists. By design, they will work in underserved areas.
Dental therapy is one way the rural health care system is trying to respond to the fact that finding doctors and dentists is harder than ever.
Hager's class of seven will graduate on June 23. After that, she'll take a board exam and return to Madelia with new skills. As a hygienist, Hager says she screened kids in Head Start programs and found problems that needed to be fixed. "But then trying to find a dentist willing to fix them was challenging," she says. "This allows me to be able to do that for them."
Though some of her fellow students will work in underserved neighborhoods in the Twin Cities, Hager, who grew up in Pipestone, thinks she can do the most good in rural Minnesota, which is disproportionately poor. "I hear stories from patients who called 50 dentists and couldn't find anyone to see them... When you have people driving two and a half hours to get care, that's significant. To me that speaks volumes."
Apple Tree strives to keep its doors open to all patients, says Hager. The family of clinics supplements normal fees and insurance payments with grants and private donations so, if need be, it can provide uncompensated service.
"What we see a lot of right now, with the recession, are working poor," says Hager. "We have a lot of people who come in and they don't qualify for state aid, but they can't pay for insurance. That's one population we're trying to target. They're falling through the cracks and they're out there. We also have a large Hispanic population around Madelia. Many are migrant workers. That comes with its own set of challenges."
Once Hager accumulates 2,000 hours of clinical experience as a dental therapist, she can take an exam (which hasn't yet been devised) to become an advanced dental therapist. While all dental therapists must work under the supervision of a licensed dentist, advanced therapists don't have to have a dentist physically on site.
That will allow Hager to run a mobile dental clinic and perform services in the field, whether in a school, nursing home or church. "Apple Tree has been doing this for quite a few years," she says. "The clinic in Coon Rapids has worked this into an art." She says the mobile clinic looks like a furniture truck and is stuffed with equipment on wheels. When the clinic arrives at a location, the equipment is unloaded and set up. "It can go anywhere," she says.
Dental therapy has met some resistance from dentist associations. But Hager says the coworkers at her clinic have been very supportive. Even if they hadn't been, she says, "I haven't been worried about getting a job, there are so many areas that need help."
"With time, I think you are going to see people come around," Hager adds. "That's what happened with nurse practitioners. There was opposition to them, too. Dentists will see how we can be an asset to them."
Rural health leaders gather to worry about reform
Posted at 4:13 PM on June 16, 2011
by Dave Peters
(1 Comments)
Filed under: Health care
If you take 400 or 500 rural hospital administrators, doctors, nurses, public health officials, teachers and others and put them in a room, what are they going to talk about?
We'll find out for sure later this month in Duluth when the annual Minnesota Rural Health Conference takes place. But there's a pretty good chance you'd hear some agitation over national health care reform and the fear that, no matter what you think of the debate in general, it's going to have some unintended consequences for small town health care.
Two cases in point: The national law promotes the use of "accountable care organizations" to handle patients' care in a more networked way, spreading the responsibility for care among a variety of providers. It also encourages the use of electronic medical records.
Both have the potential to save money and make care better. But a lot of people heading to Duluth June 27 and 28 will tell you the burden of paying for those two provisions falls unduly on small -- i.e., rural -- providers that have less opportunity to spread costs around.
"We're really concerned about it," says Terry Hill, executive director of the National Rural Health Resource Center, which is helping put the conference on.
As always, a variety of winds are sweeping across the rural health care landscape, and the new federal law is only one. Here at Ground Level, we're planning to launch a package of coverage on Minnesota's rural health care on Monday, both on the air and here online. It will deal with a lot of what the folks meeting in Duluth a week later are thinking about.
When organizers asked those planning to attend what concerned them, the largest group said "adequate workforce," including everything from doctors to technology whizzes. That's a longstanding issue, but it has gotten harder and more complicated. Twenty years ago, for example, hospitals didn't need to have IT experts at the ready to make medical records talk to each other. Now they do.
The survey of attendees reveals some interesting philosophical differences when it comes to the roles of business and personal responsibility.
One person was concerned that the trend toward affiliations with larger companies would leave communities out in the cold. Another saw a positive in the regional health care firms, worrying about losing the personal touch of rural health care but approving of the ability to stay alive.
Said another:
"I struggle with the concept of accountability being placed on the providers and none placed on the patient. I think there is an enormous need for much greater patient accountability for their own health.
But there was a counterpoint from another:
"The current 'tea party' culture of 'every man for himself' is very troubling to me. Rural people especially understand the critical need to band together for the common good. Do people understand that taxes are turned around into grants and low interest loans, loan forgiveness programs, etc. that will in turn benefit the lives of their families and friends? Or don't they care at all?"
So clearly, rural health care people have some common interests but -- is this a surprise? -- when you put a few hundred of them in a room, there ought to be some lively debate going on.
Challenge of electronic medical records hits rural hospitals hardest
Posted at 10:21 AM on June 7, 2011
by Jennifer Vogel
(0 Comments)
Filed under: Health care
Across the state, hospitals and clinics are struggling to get up to speed with electronic medical records systems, which are all but mandated by federal health care reform.
As MPR News' Elizabeth Stawicki reported yesterday, adopting electronic records is expensive and time consuming. A lack of health IT people hinders progress. "Some estimates put the shortfall nationally at 50,000 workers over the next five years," writes Stawicki. "The National Coordinator for Health Information Technology says a federal $84 million IT workforce program will help fill that gap."
We've reported here at Ground Level (here) that the burden of electronic records adoption is greatest for rural hospitals, which operate on tighter than average margins and often don't have access to capital or IT personnel.
Some rural hospitals have joined networks like Duluth-based SISU to make adoption easier and cheaper. Cook Hospital in Cook, northwest of Duluth, is a longstanding SISU member. Says CEO Al Vogt, "I'm not sure that even God's bank has enough money for electronic medical records. Are we working on it? We're working ourselves crazy."
We'll post more on issues facing rural health care providers in the coming weeks, including profiles of people making a difference and a video about a central Minnesota doctor who only takes cash (and the occasional pie as a tip).
Minnesota's rural health care system under new pressure
Posted at 8:34 AM on June 20, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
I was born in a rural hospital in southwestern Minnesota. I was treated for burns after a camping accident in another one in northern Minnesota. My father died in a another.
All those events were years ago, but those three hospitals still exist, two independent and one as part of a larger health system. Their survival testifies to intense demand from people in their communities, but there are new and continuing pressures on them and rural health care in general.
That's why we're launching a new Ground Level topic page on rural health care. National health care reform is putting stress on rural hospitals that already have thin financial margins; demographics make rural hospitals more reliant on Medicare and Medicaid, which are under fire; the hunt to find family practice doctors is harder than ever.
But communities are adjusting to some degree. Regional networks are helping small hospitals and clinics cope, for example, and Minnesota is trying care approaches that will let paramedics and dental therapists fill some of the physician and dentist gap.
As with our other topic pages, we hope Ground Level's project on rural health care will provide a good place to find out what's happening on the forefront of this issue. Check out our video on a cash-only doctor in Osakis and take a look at our "Up Close" feature on people who are making a difference in their communities. You can find resources for more information, and we've highlighted a half dozen spots around the state that will be interesting to watch in coming months and years.
And we especially want to hear your own stories about how health care in rural Minnesota might be changing. There's a link on the page to let you do that or you can simply go here.
Virginia hospital to join forces with Essentia
Posted at 12:54 PM on May 26, 2011
by Jennifer Vogel
(0 Comments)
Filed under: Health care
The future of Virginia Regional Medical Center, which opened its doors on the Iron Range in 1936, has been the topic of much discussion in recent months. The hospital, which is owned by the city of Virginia and employs more than 400 people, has fallen on hard times.
It's burdened with more than $7 million in debt.
Like many rural hospitals in the state, which operate on narrow margins, VRMC has found it increasingly difficult to remain independent as the health care landscape changes. MPR News' Michael Caputo held an online forum in January on this very topic. (Look for more coverage of rural health care in coming weeks from our Ground Level project.)
Now, according to Virginia Mayor Steve Peterson, the city has entered into a letter of intent with Duluth-based Essentia Health. Negotiations are ongoing and it's unclear whether the agreement will result in a merger or an outright sale of the facility.
"A stand-alone hospital just doesn't work anymore," says Peterson. "You just don't have the networking capabilities. You don't have the affiliations. You don't have the benefits when buying medical supplies and pharmaceuticals. Unless you can collaboratively work with other hospitals--and we are trying to do that with other independent hospitals--you just can't be competitive."
"We've lost 35 percent of our market share in the last two years," he says. "We need to get that back, or a portion of that back. I think we can do that with the right partner."
The letter of intent is a start. But, according to Peterson, it's a "long road ahead."
Budget cuts could hinder U's rural doctor training program
Posted at 2:21 PM on May 20, 2011
by Jennifer Vogel
(6 Comments)
Filed under: Health care
The legislature has proposed eliminating nearly all funding for a training fund called Medical Education Research Costs (MERC), writes MPR News reporter Madeleine Baran today. The proposal could contribute to an already serious shortage of physicians in greater Minnesota by eliminating millions of dollars used to train medical students in clinics and hospitals across the state.
To quote Baran's story: "Without the funding, smaller clinics might decide they cannot afford to provide medical training and the University of Minnesota Medical School might decide it cannot afford to send as many students to rural areas, said Mary Koppel, an assistant vice president in the University of Minnesota's Academic Health Center."
A few weeks ago, Ground Level ran a piece about the rural doctor training program on the University of Minnesota's Duluth campus, which turns out more small town physicians than any other school in the country.
What would MERC cuts mean to this effort? Today, Raymond Christensen, Associate Director of the Rural Physician Associate Program, said, "It's an important piece," especially for the U's preceptor program, which matches students with doctors and nurses in rural Minnesota.
MERC "really is the only clinical compensation there is for training medical students," he said.
If the fund is cut, Christensen added, "It's going to make it harder to find sites. The Hippocratic Oath says to train those who come behind. At same time, there is a lot of money in medicine. It's financially driven."
So much of the practice of medicine is based on experiential education, Christensen said. "We need our preceptors."
The demise of the independent doctor
Posted at 9:39 AM on May 16, 2011
by Jennifer Vogel
(0 Comments)
Filed under: Health care
The notion of a new doctor hanging out a shingle on a small town's Main Street is fast becoming a relic of a bygone era. Like the nation, Minnesota has seen a decline in solo and small-group practitioners, with most working instead for larger clinics and hospitals, often owned by health systems, as reported today by Elizabeth Stawicki of MPR News.
Among members of the American Academy of Family Physicians, for example, the ratio of solo practitioners in the United States fell from 44 percent in 1986 to just 18 percent in 2008. In Minnesota, according to the Minnesota Medical Association, just eight percent of the state's clinics are solo practices, while a mere six percent are practices with between two and four doctors.
The trend is changing the face of medical care not only in cities, but also in rural parts of the state.
Just ask Dr. Curt Louwagie, an ophthalmologist who began practicing almost two years ago in Marshall, Minnesota, near Cottonwood where he grew up. He works in a clinic that was purchased in 2008 from an independent physician by Avera Marshall Regional Medical Center.
"Privately held practices are becoming less and less popular because of the administrative and insurance demands," Louwagie says. "You need assistance just to manage the paperwork."
When Avera hired Louwagie, it reimbursed him for his medical school costs in return for his commitment to stay in Marshall for five years. He says it's unlikely he'd be practicing in town without Avera, given the ever more byzantine health-care system, which he says requires extensive business knowledge to navigate.
"There are a lot of people coming out of the school now with no business training at all," Louwagie says, noting that during his four-year residency, he had fewer than 10 hours of business instruction.
"You don't know if you're getting a good deal or not or how to evaluate the practice," he said. "You're already cash-strapped with six-figure student loans from medical school. Then you're supposed to get a loan of hundreds of thousands of dollars to purchase the practice in an uncertain reimbursement environment. We have 80 to 85 percent Medicare patients in our practice."
Still, Louwagie debated buying the clinic or opening his own. Either would have been a daunting prospect.
"There was so much equipment that needed to be purchased," he says. "Within the first month I was here, they updated $300,000 in equipment. That was just to get the place up to speed as a modern practice."
In the end, he decided he'd rather focus on doctoring.
"It's hard enough to keep up with medicine," says Louwagie, who has no plans to leave Marshall. "I'll concentrate on being a good doctor and let someone else worry about being a good business maker."
Rural Hospitals Use Co-op Approach to Meet Tech Requirements
Posted at 8:00 AM on May 11, 2011
by Jennifer Vogel
(0 Comments)
Filed under: Health care
New regulations, flowing from federal health care reform, require hospitals and clinics to convert from paper to electronic medical records by 2015 or face fines from Medicare. The task is especially daunting for small, rural hospitals, since they operate on very narrow margins. Implementing electronic records can cost millions of dollars.
In rural Minnesota--where medical services can be scarce and communities worry that financially-strapped hospitals and clinics could fold under additional pressure--a group of hospitals is facing the requirement together, as a co-op called SISU.
Based in Duluth, SISU, which one fan says is "Finnish for chutzpah," offers its members technical equipment and support and saves money through group purchasing and volume discounts.
"A lot of pricing is based on bed size or revenue," says Jodi Nelson, SISU's chief operating officer. "These rural hospitals pay more. This was a means for us to pull together users for purchasing power and licensing agreements and to leverage the numbers."
SISU's technical staff comes in handy in rural areas, which are often short on IT professionals. Says Nelson, "Some of our members would say, even if I had the funds, I can't get the types of people, the breadth of knowledge I would need, [in my town]."
Informally started in 1982, SISU became official in 1997. Its 22 full and associate members range from Regina Medical Center in Hastings to Cook County North Shore Hospital & Care Center in Grand Marais. The organization, which operates as a non-profit, embraces system hospitals and independents alike.
It's all but impossible for a hospital to go it alone on electronic medical records, explains Nelson. "It's about cost and resources. Partnering with other organizations allows them to pool together and make more headway. The savings are incredible."
Telemental Health Fills Rural Health Care Gap
Posted at 9:42 AM on May 9, 2011
by Jennifer Vogel
(0 Comments)
Filed under: Broadband, Health care
One way rural communities are shoring up their health care options, given a notorious dearth of doctors of all stripes, is by turning to telehealth. With broadband spreading to Minnesota's smallest towns and farms, it's becoming possible for even the most remote patient to see, by camera and video monitor, a doctor hundreds of miles away.
Telehealth has been used for dermatology and endocrinology, among other specialties. But it works especially well for mental health care, say advocates, since counseling doesn't require a physical examination. Telemental health also allows rural people to receive care in a hospital or general clinic, eliminating the stigma that comes with parking in front of a therapist's office.
Often, when a patient sits before that camera for a session, the doctor they're talking to is Jane Hovland, a nurse, licensed psychologist, and associate professor at the U of M Duluth. Rural people, says Hovland, who was raised in northern Minnesota, "are such a self reliant bunch." When it comes to mental health, "We expect people to figure it out on their own."
But the fact is, some can't. The most common diagnosis Hovland makes is of major depression, followed by anxiety disorders.
Hovland notes that Minnesota has more psychologists than the national average. But they tend to practice in the city. "There are 13 counties without a single licensed psychologist," she says. "It's a matter of distribution." That's why doctors with the U's telemental health program have seen 2,300 patients over the past five years.
"I had a client who would ride a bicycle in from the woods for telemental health appointments," Hovland says, noting that because the U sees patients quickly, the no-show rate is very low. "We're trying to show that this is a sustainable model," she says.
A Rural Doctor in the Making
Posted at 11:52 AM on April 26, 2011
by Jennifer Vogel
(0 Comments)
Filed under: Health care
In rural Minnesota, doctors are hard to come by. Most medical school graduates these days zero in on specialties and practice in the city, where the hours are shorter and the pay is better. Nationally, fewer than 10 percent of graduates become general practitioners and an even smaller sliver put out a shingle in a small town.
It's a topic of great concern in outstate Minnesota, where an aging population is putting a strain on services and some hospitals have been trying to fill open positions for years. That's part of why Ground Level, in our quest to explore communities facing the big issues of the day, is adding rural health care to the topics we're focusing on.
If you ask Krista Stowe, a first year medical student at the U of M Duluth, which turns out more rural physicians than any other school in the country, she can't imagine practicing anywhere but a small community.
"A doctor here in Duluth calls all his patients himself with lab results. There are still docs in Bigfork who will do a home visit. I think that's respectful to the patient. A patient who is 84 and has potential pneumonia, you don't want them to have to travel. There is a sense of compassion and connectedness. That's what I would expect in a small community."
Stowe hails from Bemidji--the U of M Duluth favors admissions candidates from smaller towns since they are more likely to want to practice there--where both her parents are teachers. "I was very interested in science," she says. "My parents are big supporters of community involvement and giving back to the community through volunteering. I grew up thinking I wanted to help people. Medicine is the perfect combination of helping and science."
After "shadowing" doctors in Rochester and the Twin Cities, says Stowe, "I knew I really didn't like being in the big city. I like small rural Minnesota. It's what I grew up with and is a huge part of why I want to go back. I don't need two shopping centers. I like nature and there are a lot of good people in rural communities."
As a rural family doc in the making, Stowe is a hot commodity and she's been told by instructors to refrain from accepting job offers until she's further along in her schooling. (Stowe notes that she hasn't received any offers yet.)
The job will have its tough aspects too, she says, like long stretches on call and the potential heartbreak of losing a patient who is also a close friend. Also, unlike in the city, rural doctors have very little anonymity.
"For me, I do like my own personal space," Stowe says. "But I think the benefits outweigh what you give up for that. Your patients are going to see if you put two packs of Oreos in your grocery cart while you've been telling them to eat healthy. It's challenging. But you can have your home set away from the workings of the city. You can find your own meditation. That's easier in a rural community."
Minnesota's rural hospitals rank high on satisfaction, care
Posted at 1:39 PM on April 18, 2011
by Jennifer Vogel
(0 Comments)
Filed under: Health care
If you're wondering how your local hospital rates when it comes to treating heart attacks or pneumonia or whether patients feel well cared for, check out the Minnesota Hospital Quality Report, produced by the Minnesota Hospital Association and Stratis Health.
The site, around since 2006, provides an interesting glimpse of how urban hospitals fare compared to their rural counterparts. The rankings -- based on information hospitals and patients provide to the state and federal government and other entities -- vary depending on what's being measured. Not all hospitals are included, in part because some are too small to provide a reliable sampling.
But in many cases, rural hospitals come out on top. Often seen as under stress because of economic pressures and declining populations, rural hospitals nonetheless beat both state averages and urban hospitals on many measures.
For example, when it comes to providing "appropriate care" for heart failure, the best hospital in the state, according to the Quality Report, is Buffalo Hospital in Buffalo, northwest of the Twin Cities. The hospital took appropriate steps 100 percent of the time, compared to the state average of 84 percent.
When measuring patient satisfaction--by factors like communication, pain maintenance and even room quietness--one of the top hospitals in the state is Bigfork Valley Hospital in Bigfork, a town of around 500 people in northern Minnesota.
Bigfork ranked best, in fact, when patients were asked to score their hospitals overall, earning top marks 93 percent of the time, compared to the state average of 69 percent. "We're a small joint but we really take the thing seriously," says Bigfork Valley's Dr. Heidi Korstad. "Our patients understand that."
Duluth center connects players in rural health care
Posted at 2:25 PM on April 14, 2011
by Jennifer Vogel
(0 Comments)
Filed under: Health care
If you ask Terry Hill, executive director of the National Rural Health Resource Center in Duluth, connections--between people, organizations, and information--are key to the survival of rural hospitals and clinics.
"If there is a good model that might be working, we want to publicize that," says Hill, who was raised in tiny Tok Junction, Alaska, where health care options were severely limited. "We want to acquire those good models and examples and transfer them into something that can be shared."
These models might diagram methods for improving care quality, shoring up finances, or implementing electronic health records. Rural providers often operate by narrow margins and with limited staff, adding obstacles to modernization efforts.
"We are the eyes and ears of rural hospitals and rural clinics," Hill says. Through the Center, providers can find ways to help themselves and each other.
The organization began in 1985 as a healthcare consortium, with a grant from the Grand-Rapids-based Blandin Foundation, and morphed into the Minnesota Center for Rural Health and, in 1995, the National Rural Health Resource Center.
Earlier this week, the federally-funded Center held a two-day workshop that drew participants from as far away as Oregon and Arkansas, and a wide range of presenters, including Matt Womble, an emergency medical services specialist from North Carolina, and Jane Gelbmann of the Office of the National Coordinator for Health Information Technology in D.C.
Hill says the role of the Center gets more important with each new health care law that passes, making the system ever more complex. "Every piece of legislation designed for larger hospitals," he says, "almost always has a consequence for rural providers that wasn't intended."
Working in the rural healthcare field, Hill adds, "appeals to my sense of the dramatic. We are the ultimate underdogs."
Paramedics take on expanded health-care role in rural Minnesota
Posted at 3:19 PM on April 8, 2011
by Jennifer Vogel
(4 Comments)
Filed under: Health care
In the future, you may not have to call 911 to draw a paramedic to your door. Under legislation signed by Governor Mark Dayton this week, so-called "community paramedics" will be trained and certified to address minor and chronic health problems in your home, rather than automatically driving you to an emergency room.
Community paramedicine is a concept that's been popular for years in other countries, such as Canada and Australia, but has only recently taken hold in the United States. "Minnesota is the first state to recognize this with law," says Dr. Michael Wilcox, Scott County's medical director, who oversaw the state's pilot training program at Hennepin Technical College in 2008/2009.
The aim of the new law is to help alleviate a shortage of doctors and nurses in outstate Minnesota -- a growing concern in many communities -- and to save precious health-care dollars.
"When you look at the resources in a rural area," says Wilcox, "there are not enough nurses. Expanding the role of the paramedic in a rural setting, where they can do patient care between 911 dispatch calls, makes sense."
A community paramedic might suture a wound, adjust a medication, or address an asthma attack or allergic reaction. They might help a diabetic stay on an even keel or talk through a mental health issue, all on the spot. In fact, in the future, a specially-trained paramedic might make regular, preventative visits to "frequent flyers," those patients who call 911 the most and cost the system dearly.
Advocates of the approach argue it improves patient care while saving money by reducing emergency room visits. They also say it can help preserve ambulance services in remote areas by increasing the fees paramedics are paid. The new law paves the way for community paramedics to be reimbursed under the state's medical assistance program, though only after study by the state human services commissioner, who must submit a fee schedule to the legislature by January.
"I think the community paramedic legislation is a great opportunity, especially in rural Minnesota," says Mark Schoenbaum, director of the Minnesota Department of Health's office of rural health and primary care. "It's an opportunity to use the skills of our rural paramedics who, because they work in isolated and sparsely populated areas, often have time available to go and perform a variety of services they are qualified and supervised to do."
Not everyone is so jubilant. The Minnesota Nurses Association takes a dim view of the new law. While agreeing that health-care services need to be expanded in rural areas, Carrie Mortrud, the MNA's government affairs and public policy specialist, says, "Creating a brand new provider is not the answer."
Mortrud is concerned that community paramedicine merely replaces nurses with cheaper, lesser-trained personnel, at a cost to patient health. "If they would refer and get people into the right system and right care," the MNA would see the benefit, says Mortrud. "If they are going to go in and take over public health nursing, we are not OK with that."
"Paramedics are trained in algorithms," Mortrud adds. "They are trained to respond to what they find on the scene. Nursing is completely different. Nursing is about building a relationship with your patient so you can help them take care of themselves."
Gary Wingrove, governmental relations and strategic affairs specialist at Mayo Clinic Medical Transport, who helped establish the training curriculum, hopes community paramedics will be just one more member of a patient's healthcare team. "If they find something adverse," Wingrove says, "they will do the assessment such that they can call the primary care provider and talk about the care plan." That discussion can lead to a clinic visit, he says, "if they think it's appropriate."
"What's kind of happened over time, as medicine has evolved," says Wingrove, "is we've identified gaps in a community that need to be filled. EMS workers already have a skill set that's common in primary care. When there is a hole in the community and the community searches out a way to fill that gap, the best thing they can do is look to existing providers."
Driving this new approach are changes to federal health-care law. In the future, for example, Medicare will penalize hospitals for some emergency room re-admissions on the theory that they should be coordinating better outpatient care. In other states where paramedicine has been tried, such as New Mexico, it has reduced emergency room visits dramatically.
"Interest in this has exploded very quickly," says Wingrove.
In fact, the program could eventually expand into urban areas, according to Wilcox. "It's geared for rural areas, but down the line, it may give opportunities for patients even in a metro setting who can't access healthcare. There is no reason you couldn't train paramedics in a metro area to handle these patients at home."
Wilcox sees community paramedicine growing in Minnesota, especially now with a certification process in place. "I could easily see 100 (community) paramedics in the state in three to five years," he says. "We start a training program at the end of May. We're going to select 24 candidates this time around."
Young paramedics, Wilcox adds, "go into it because they like the street work and the adrenaline rush. But that gets old after a while. If you talk to them as they move along in their careers, they want to do more for a patient than load them up and move them along. This is a career path they haven't had available before."
Northeastern Minnesota's economic future: Join a forum tonight
Posted at 10:00 AM on April 5, 2011
by Dave Peters
(0 Comments)
Filed under: Arrowhead Region, Broadband, Community Development, Economic Development, Health care, Northern Minnesota
We're expecting at least a couple hundred people to show up in Duluth this evening to talk about how northeastern Minnesota's economy might look two, five or 20 years from now.
Will the Iron Range and the North Shore continue to go their separate ways economically?
Will tourism thrive forever? Mining?
How does so much growth in the health care industry square with efforts to rein in health care spending nationally?
How will the North Woods economy respond to climate change that alters the forests? Will broadband access to the Internet change the economy up the shore?
As much as any region of Minnesota, the Arrowhead is a complex brew of powerful economic forces, engaging cultural history, new ways of thinking about the environment and changing politics. If things go well tonight, a lot of that will be on display.
If you can, come to a forum this evening at the Duluth Radisson hosted by MPR News and Northlands NewsCenter. Reception starts at 6 p.m., the conversation hosted by MPR News' Cathy Wurzer runs from 7 to 8:30. Details here.
If you can't, join what promises to be a lively chatterfest/live blog at MPR News' Insight Now. Michael Caputo and Michael Olson will be blogging, tweeting and collecting comments from bloggers and tweeters around the room and the Arrowhead.
Click here for more about that or simply come back to this Ground Level post when the action starts and watch and participate through this window:
Details
Getting past the health numbers. Here's help.
Posted at 8:30 AM on April 5, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
When the annual national county health rankings came out last week, MPR News' Lorna Benson duly hit the numbers in her broadcast report. Lac qui Parle is the healthiest county in the state, Cass the least; Minnesota's southern counties tended to do better on the rankings of health outcomes than northern counties.
But her report also got past the curiosity-generating rankings and noted that everywhere from Lac qui Parle to Cass, people are taking actions, biting off small enough pieces to chew on to get community residents to exercise more, eat better, smoke less.
My instinct when a huge set of numbers like this comes out is to dive in and see what telling trends or peculiarities might be hidden after the first day of news. Who practices the safest sex? (Stevens County.) Who smokes the most? (Beltrami County.)
But the more I looked at the extensive web site compiled by the University of Wisconsin in conjunction with the Robert Wood Johnson Foundation, the more impressive was, not the numbers, but the voluminous pile of help available to anyone who wants to do something about them.
You can find the national county rankings report here. But after you poke around the numbers you should really look here to see how people can take action.
Are you an employer? There's a 12-bullet list of steps you can take, some as simple as starting a conversation.
Are you a community member? You can find nine suggestions for action and a host of links to other sources and examples.
Concerned but don't know where to start? There's advice on how to set priorities.
Do you learn by example? You can find out what Wyandotte County, Kansas, did after coming in last in that state's rankings last year. Same for Columbus County, North Carolina.
Patrick Remington is the University of Wisconsin professor who leads the work, and he's pretty straightforward that the numbers are essentially the teaser to catch interest. The point is to get people to take some action.
The action doesn't have to be huge. A physician in Juneau County, Wisconsin, started handing out readers to his young patients, an act Remington said shows how health outcomes are the result of factors well beyond health care. Economic and educational well being is a huge factor as well.
"You're almost paralyzed by how much you can do," Remington said. "We need to move the dialogue from 'We have a problem' to 'What we should do.'
"If we keep coming back and saying your county ranks at the bottom, the logical response is to do something about it."
The strategy of Remington and the foundation is a textbook example of the hope that information can lead to action. In fact, Remington thinks that as government's ability to effect public health improvements has dwindled, some of the people who want to make a difference in this area have gone into, of all things, journalism.
It always takes somebody on the ground in a place to make something happen, but information like what's available in the county ranking website is a key to starting. To help things along the Robert Wood Johnson Foundation is offering as many as 14 communities around the country up to $200,000 each to implement a health-changing plan in the next two years.
If you're interested, you have until April 27 to apply. Go here for details.
Because health care, especially when it comes to rural areas, is one of those significant, complex topics that responds to on-the-ground actions that community residents take for themselves, it's a good one for Ground Level. So over the coming weeks and months, look for more from us on how Minnesotans are dealing with the challenge.
Perhaps a year from now, the story will be less about who's on top and who's on the bottom and more about who's doing what to change.
Jobs are coming, but there is bad news
Posted at 2:28 PM on March 22, 2011
by Jennifer Vogel
(1 Comments)
Filed under: Aging, Health care, Local government finance, Young people
"We have entered the age of entitlements in Minnesota and the United States and in some respects the entire world," said state demographer Tom Gillaspy during a lunch talk on Tuesday at Minnesota Public Radio. "It's an unprecedented time."
Gillaspy was referring to an ominous trend reflected in the latest census data: The state is experiencing a dramatic increase in the number of people who are over 65 and drawing Social Security and other benefits and a decrease in the number of young people entering the workforce to pay for those benefits.
"By the end of the decade, for the first time, we'll have more people over 65 than in K-12 education," Gillaspy said.
The implications are far-reaching. The age imbalance will make it harder to rectify the state budget in the future.
"This decade, it's not going to be nursing homes that are driving the whole thing," Gillaspy said. "That's a couple of decades out. This decade the big issue will be the labor force. It's an odd thing to talk about when unemployment is high."
He predicted, quite ominously, that, "things are about to start popping" as more older people retire and fewer younger people are available to take their jobs.
"By the end of the decade, workforce growth will be essentially nil," said Gillaspy, who noted that the change won't be gradual. "We'll see a big jump in retirement next year and strong increases for a decade after that."
He said that although employment forecasts talk in terms of job growth, for the foreseeable future, employment will center on filling vacancies not creating new jobs.
"That forecast isn't that great," Gillaspy said. "People look at that and say 'There aren't many opportunities.' But when the flood of people retires, we're going to have lots of replacement openings, across every occupation. As far as I know, those will, for the first time ever, exceed the number of new job openings."
That may sound like hopeful news to those who are out of work. But without huge, coinciding increases in productivity from automation and other innovations -- which is possible -- the state and the nation will continually be handed social services bills it can't afford to pay, he said.
That could affect the retirement age, pensions, and whether retirees receive health care benefits.
"Chronic government deficits aren't going to end anytime soon," Gillaspy said. "Unless we can deal with the underlying cause, we'll be back two years later with another $5 billion deficit. And two years later, until there is virtually nothing left except things like medical assistance. We have to see some changes. This is a non-sustainable situation."
On a hopeful note, Gillaspy said that with public investment in education, infrastructure and research, we may be able to invent our way out of the problem.
"These are exciting times," he said. "This will be a more exciting decade I think than any in history. This is a time for heroes. This is a time for leaders and exceptional things. It's not a time for business as usual."
Join online conversation tackling rural health care in Virginia MN
Posted at 8:30 AM on January 28, 2011
by Dave Peters
(0 Comments)
Filed under: Health care
If you're interested in life on the Iron Range or, more broadly, the challenge of providing good health care in rural Minnesota, tune into an MPR News online forum this noon.
Michael Caputo, who runs our Insight Now conversations, has lined up health providers, residents and others to come to grips with what Virginia, Minnesota, is dealing with. The town's community-owned hospital has been running in the red and is trying to figure out its next step.
The forum, jointly sponsored by the Hometown Focus newspaper in Virginia, runs from noon until 1 p.m. and will give you a chance to learn about and weigh in on the question.
Here's what Michael wrote about it on Ground Level last week. Click here to join the conversation.
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