Friday, October 3, 2014

Caffeine with Dave

Once a month I have “Caffeine with Dave” with the providers in our organization.  There is a small dedicated contingent that shows up faithfully and spurs on some very intriguing free flowing conversations.   This morning was no different.   With all the changes occurring in the health care field we definitely have plenty to talk about.   We talked about missing the past, frustrations with today's practice (especially with documentation requirements and EMR), the patient first, and also SCRMC's future.

I listened intently.  It was hard at times when they relay on concerns without trying to fix them,  which many of us are driven to do.  A few concerns expressed were tied to the past which we need to let go.  I experienced many emotions related to the dialogue and what will be the future of rural medicine.  

I scribbled a few notes from this morning related to the future. 
  • Patients first!
  • Make sure there is a common ideology and goals (SCRMC and the medical group).
  • Differentiate based on innovation and creativity.
  • Let go of things we can't change and focus on the things we can.
  • Remove Sacred Cows.
  • Listen and Understand!

Monday, September 15, 2014

Larry Collins - A Wonderful Mentor

Eleanor and Larry Collins
At our September Annual Meeting, we had the opportunity to recognize Larry Collins for his service to St. Croix Regional Medical Center (SCRMC). Larry is a long term Board member and community resident in Taylor Falls/St. Croix Falls area. Larry transitioned in August from the SCRMC Board of Trustees.

Larry served on the Board for 17 years starting in 1996 with one year off for good behavior. He was the board chair for 10 of those years and treasurer since 2010. Larry also is active in many other organizations in the community. This includes River Town/Forest Heights HUD Board in which he has served 16 years and counting.

St. Croix Valley Health Care Foundation recognized Larry with the Health Care Advocate Award in 2009. In 2011, Wisconsin Hospital Assocation recognized Larry with the annual WHA Trustee Award.

Larry Collins is indicative of what you would hope for in a Trustee. Larry is committed to the patients and families we serve, the mission and vision of the organization, valued representative in the community, and someone who can bring insight and guidance when needed. For me, Larry was an excellent sounding board who brought perspective on the many challenges that we face from time to time.

Friday, August 29, 2014

Rural Can Be Health Care's Future

Tim Size, Executive Director of Rural Wisconsin Health Cooperative wrote a recent commentary related to the value of rural health. Based on my own experience working in both urban and rural health care markets, it is critical that rural health care does not disappear from the landscape but is present and viable into the future.

When you get a chance please read Tim's commentary.  He definitely expresses why rural health care is critical and is "good" for rural america.


Wednesday, July 23, 2014

Rural Means Older and Sicker, Data Confirms

John Commins, for HealthLeaders Media, July 23, 2014

Federal data confirms what we know about rural hospitals and the care they deliver, and allows those of us who care about access to make a compelling case for providing good care to this population.

New data from the National Hospital Discharge Survey provides a predictable profile of rural hospitals and who they treat.

Many rural providers who look at this compilation from 2010, the latest available data, would likely nod their heads in recognition of the landscape. The data reviewed by the Centers for Disease Control and Prevention's National Center for Health Statistics found that:

* About 60% of the 6.1 million rural residents who were hospitalized in 2010 went to rural hospitals; the remaining 40% went to urban hospitals.
* About 51% of rural residents hospitalized in rural hospitals were aged 65 and over, compared with 37% of those hospitalized in urban hospitals. No significant difference was observed in the percentage of hospitalized rural residents under age 45 who were in rural hospitals compared with urban hospitals.
* Twenty-four percent of rural residents hospitalized in rural hospitals were aged 45–64 compared with 32% of those hospitalized in urban hospitals.
* Rural residents who remained in rural areas for their hospitalization were more likely to be older and on Medicare compared with those who went to urban areas.
* Almost 75% of rural residents who traveled to urban areas received surgical or nonsurgical procedures during their hospitalization, compared with only 38% of rural residents who were hospitalized in rural hospitals.
* More than 80% of rural residents who were discharged from urban hospitals had routine discharges, generally to their homes, compared with 63% of rural residents discharged from rural hospitals.
* Seventy-four percent of hospitalized rural residents who were in urban hospitals received a surgical or nonsurgical procedure during their hospitalization, compared with only 38% of those hospitalized in rural hospitals.
* Rural residents hospitalized in urban hospitals were more than three times as likely to have three or more procedures as rural residents hospitalized in rural hospitals.

With this data, we can flesh out what's happening with rural care delivery.

About 17% of Americans live in rural areas, many of which are sparsely populated and medically underserved. The nearest provider could be 20 miles away, and the rural hospitals that provide the care are usually smaller, with low volumes, operating on a shoestring budget and with minimal staff and limited services.

The younger rural hospital patients, who are more likely to have greater mobility and access to commercial health insurance, likely seek care in urban settings because rural hospitals often don't have the funding or patient populations to support specialists or a particular area of specialty care, such as cardiac or oncology.

For the most part, these rural hospitals primarily serve an aging, poorer population admitted for low-acuity care of chronic diseases, and so they likely want to remain close to their homes and their personal physicians.

It would also be reasonable to conclude, however, that many elderly rural hospital patients get their care locally because of barriers to urban hospital access that younger rural residents can surmount. An elderly patient either may not have a car, or may not have a friend or family member who can drive them to the closest city for care.

Because more rural hospital patients are elderly and because specialty care options are limited, NCHS data also shows that rural hospital patients are more likely to be discharged into some sort of short-stay hospital or a long-term care facility.

Ultimately, this data confirms what we already know about rural hospitals and the care they deliver, which in many respects is significantly different that the care provided in urban settings. But telling us what we already know doesn't make the data any less valuable.

Rural providers may not be providing cutting-edge care for highly acute patients, but it's not realistic to expect that they would be, and it certainly doesn't negate the mission of rural providers.

This data allows those of us who care about access to healthcare in rural America to make a compelling case for the care provided and the people served.

John Commins is a senior editor with HealthLeaders Media.

Wednesday, June 25, 2014

SCRMC breaks ground at Frederic for New Community Clinic

Sunday, June 22 during the 50th annual celebration of Frederic Family Days, St. Croix Regional Medical Center held its groundbreaking ceremony for the new Frederic Clinic .

Bucking current market trends, we are focused on expanded services to residents who live in rural Frederic area. This new facility will be a tremendous asset to the community.

Expanded services will include chemotherapy, pharmacy, pulmonology, audiology, and sports medicine. This will compliment services already provided in the region that include primary care, obstetrics, and physical therapy.

The building is located on the old mill site near the Gandy Dancer Trail

Monday, May 12, 2014

Rural Hospitals Closing at Alarming Rate

In the past year alone, more rural hospitals closed than in the prior 15 years combined. When a rural hospital closes, the community often also loses affiliated rural health clinics, local ambulance service, mental health services, long-term care, rural surgery, rehab, home health and other vital services. What our nation is experiencing is the devastation, and in many cases the elimination, of the rural health safety net, writes National Rural Health Association (NRHA) CEO Alan Morgan.

The reasons are many:

- Medicare reductions included within the Affordable Care Act
- Failure to expand state Medicaid
- Medicare reductions included in sequestration
- Congressional reductions to rural Medicare payments
- Regulatory changes imposed by CMS
- Population shifts and other market force impacts

More than half of all rural hospitals are currently experiencing negative total margins.

Meanwhile, as individual states explore rural hospital rescue policies, both Congress and the Administration are exploring new ways to further cut payments to rural hospitals. This is despite the fact that according to data released at the National Rural Health Association’s 37th Annual Conference last week, rural hospital charges are 63 percent less than urban hospitals, and the Medicare program spends per beneficiary 2.5 percent less than urban.

Exactly how many rural hospitals must close to gain the attention of policy makers in Washington, D.C.?

Source: National Rural Health Association

Thursday, May 1, 2014

Wisconsin Ranks No. 7 Among State Health Systems, Minnesota No. 1

Wisconsin has the seventh best health system in the nation, improving upon its revised 2009 ranking of ninth, according to a study released Wednesday by the Commonwealth Fund.

The state ranked fourth in terms of children with a medical home, or practice they can regularly access for care, while the majority of states worsened in that category. However, Wisconsin was 42nd in private-sector health plan premium rates and struggled with helping home health patients to move more and heal from their operation wounds.

Wisconsin improved in 11 of 34 health indicators with identifiable trends, deteriorated in seven and showed no change in 16 of the measures since the Commonwealth Fund's 2009 ranking.

"To be ranked in the top 10 means [Wisconsin] has to have done well in multiple dimensions - not just one - and on multiple indicators within a dimension," said Cathy Schoen, senior vice president for policy, research and evaluation at the Commonwealth Fund.

The 2014 Scorecard on State Health System Performance evaluated states on 42 access, quality, cost and outcome metrics from 2007 to 2012. Overall, the analysis found major gains in immunizations for children and reducing hospital readmissions, but access to adult care and healthcare costs worsened. Minnesota, topped the rankings for best health system in the U.S., while Mississippi finished last.