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Pharmacy Contracting:
Prime Therapeutics: Remains not contracted as we must wait until after the FTC
issue is resolved before contacting them, which as noted above may not be resolved
until Jan 1, 2006, after which we will start trying to work with them. We believe
Medicare Part D as not a critical issue as patients may switch to other contracts
we have signed. It is important, but not as important as Prime Therapeutics commercial.
We are currently negotiating with Coventry Health Care, MedImpact, National
Medical Healthcare Rx, National Pharmacy Services, Navitus, Prescription Solutions,
Rx America, Walgreens both for commercial and, as appropriate, Medicare Part D.
We are also trying to use the health plan channels to work with Humana after Humana’s
PBM told us they do not work with third parties.
South Country Health Alliance: They normally run all of their business through UCare
as their Third Party Administrator (TPA) which will be using ProCare Rx as of Jan.1,
2006. For some reason they have decided to run their Minnesota Senior Health Options
(MSHO) (combines Medicare & Medical Assistance) product through Blue Plus. This
means that as of Jan.1, 2006, SCHA MSHO will be using Prime Therapeutics.
UCare: UCare will use ProCare Rx as of Jan. 1, 2006. UCare has decided to not offer
MSHO products in some of the counties they do other business in. Counties they WILL
NOT offer MSHO products (meaning they will be covered by Blue Plus & Prime
Therapeutics) include: Becker, Beltrami, Big Stone, Chippewa, Clay, Clearwater, Cook,
Douglas, Grant, Hubbard, Itasca, Koochiching, Lake, Lake of the Woods, Mahnomen,
McLeod, Meeker, Norman, Otter Tail, Pipestone, Pope, Renville, Sibley, Stevens,
Traverse, and Wilkin.
Current Membership
Clinics
Allergy & Asthma Specialty Clinic, Willmar
Appleton Medical Clinic
CCMH-Montevideo Clinic, P.A.
Counseling Associates of West Central MN, Benson
Divine Providence Clinic, Ivanhoe
ELEAH Medical Center, Elbow Lake
Family Practice Medical Center of Willmar
Glencoe Regional Health Services
Hendricks Medical Clinic, P.A.
Ivanhoe Clinic
JanningENTCenter, LLP, Willmar
JMHS Dawson Clinic
Lac Qui Parle Clinic, Madison
Lakeview Medical Clinic, Sauk Centre
Mark Satz, MD, Minneapolis
Marshall Eye Clinic
Minnesota Pathologists Chartered, Willmar
Murray County Clinic, Slayton
Northside Medical Center, Ortonville
Peter B. Meier, M.D., St. Paul
Prairie Family Practice Renville County, Olivia
Prairie Medical Associates, Morris
Rice Institute for Counseling & Education, Willmar
Sioux Valley Canby Campus Clinic
Sleepy Eye Medical Center, Sleepy Eye
Stanley C. Gallagher, D.O., P.A., Wheaton
Starbuck Clinic, PLLC
The Rose Center for Women, Willmar
Tyler Medical Clinic
Wheaton Community Clinic
West Central Radiological Associates, Willmar
White Family Practice, White, SD
Williams IntegraCare Clinic, Sartell
Hospitals
Appleton Municipal Hospital & Home
Avera Marshall Regional Medical Center, Marshall
Chippewa County Montevideo Hospital
Divine Providence Health Center, Ivanhoe
ELEAH Medical Center, Elbow Lake
Glencoe Regional Health Services Hospital
Granite Falls Municipal Hospital & Manor
Hendricks Community Hospital & Home
Johnson Memorial Health Services, Dawson
Madison Lutheran Home, Inc.
Meeker CountyMemorial Hospital, Litchfield
Murray County Memorial Hospital, Slayton
Ortonville Area Health Services
Redwood Area Hospital
Renville County Hospital, Olivia
Rice Memorial Hospital, Willmar
St. Peter Community Hospital
Sioux Valley Canby Campus Hospital
Sleepy Eye Medical Center, Sleepy Eye
Swift County Benson Hospital
Tyler Healthcare Center
Wheaton Community Hospital
Non-Voting Members (NV)
Cheryl Hanson, LICSW, Willmar - NV
Great Plains Eye Clinic, Ltd., Sioux Falls, SD-- NV
Hennepin Faculty Associates, Minneapolis – NV
Kenneth H. Rogotzke, Watertown, SD --NV
LCM Pathologists, Sioux Falls, SD – NV
Michael J. Fischer, LICSW, Willmar - NV
Michael J. Vener, MD, PC -- NV
Patrick M. Malone, MD -- NV
Rick L. Nissen, MD, Bloomington – NV
Minnesota Rural Health Cooperative Meeting Schedule
October 5 Medi-Sota
October 19 Quarterly Quality Council Meeting
October 20 Contracting Committee Meeting
October 20 Compliance Semi-Annual Meeting
October 24 Credentialing Teleconference
October 26 SWEPT Meeting
October 27 Clinic Managers Meeting
October 27 Board of Directors Meeting
October 30 Daylight Savings Time ends
November 2 Medi-Sota
November 10 Contracting Committee Meeting
November 11 Veterans’ Day
November 14 Credentialing Teleconference
November 17 Board of Directors Meeting
November 23 SWEPT Meeting
November 24 Thanksgiving Day
December 7 Medi-Sota
December 8 Contracting Committee Meeting
December 12 Credentialing Teleconference
December 15 Board of Directors Meeting
December 22 Clinic Managers Meeting
December 25 Christmas Day
December 28 SWEPT Meeting
January 1 Happy New Year
January 4 Medi-Sota
January 12 Contracting Committee Meeting
January 18 Quarterly Quality Council Meeting
January 20 2nd Annual Education Event
January 21 2nd Annual Education Event
January 23 Credentialing Teleconference
January 25 SWEPT Meeting
January 26 Board of Directors Meeting
2004 Board Members
Brendon Cullinan, M.D., Montevideo Clinic - Chair
Larry Grong, D.O.
, Lac qui Parle Clinic– Madison– Vice Chair
Leroy Meyering, CFO, Rice Memorial Hospital – Secretary /Treasurer Willmar
Glenn Haugo, Administrator
, Johnson Memorial Health Services - Dawson
Mark Huntington, M.D., Northside Medical Center – Ortonville
Romulo Kabatay, M.D., Appleton Clinic
David Koster, Pharmacist
, Koster Pharmacy-Tyler
Dale Kruger, Administrator , Tyler Healthcare Center
Richard Mulder, M.D., Ivanhoe Clinic
Tom Richter, Administrator, Madison Hospital
Alan Roiseland M.D., Family Practice Medical Center-Willmar
James Schulte, Administrator,Redwood Area Hospital
Thomas Witt, Pharmacist, Witt’s Pharmacy --Springfield
Miscelleaneous – Chuck Ness
Shirley Anderson: Shirley, our Quality Manager from October 2004 through
September 2005, will be leaving at the end of October 2005. She was hired October
2004 to cover for Paula Soine while she assisted with the one year AHRQ HIT
Planning grant. Had we received the three year AHRQ HIT Implementation grant,
she would have stayed on but unfortunately that was not the case. Also, since future
grants take a while to process and are so uncertain we were not able to keep her on.
Thank you for your work Shirley.
HCAHPS surveys: We incorporated the 32 CMS HCAHPS questions in to our
Acute Care patient satisfaction survey last fall and began using them Jan. 1, 2005.
Twelve of our hospitals have participated in this survey, which is being run
continuously, with results being processed quarterly. We encourage our other
hospitals to consider using this FREE service (including prepaid postage). We
understand NRC Picker, to name one vendor, was offering to process these
surveys for $8,000 per survey. We give you an opportunity to remedy any issues
the CMS questions will raise before you are formally surveyed and published
by CMS.
Ambulance Surveys: The hospital quality committee is considering putting
together a patient satisfaction survey regarding their ambulance teams. If this
comes to fruition it will also be at no cost to our members.
Surgery Centers: The Board will be taking up the topic of creating a fourth
member class in the Co-op consisting of SurgeryCenters, which has unique
contracting and ownership issues.
Compliance Corner
The semi-annual Compliance Gathering is set for Thursday, October 20th,
in the Minnesota Room at the ChippewaCountyMontevideoHospital from 9 to
11 am
, and you won’t want to miss it as we’ve got some great speakers lined up
with some great current topics:
Keith Halleland – “Evolving Governance Standards: Keeping Your Non-
Profit Board on the Right Path.” Mr. Halleland will talk about implications of
SOX for non-profit organizations; evolving standards for non-profit directors; and
the role of your Board of Directors in compliance and risk management – today
and tomorrow.
Jacqueline Darrah – “End of Life Decisions: The Current Legal Landscape
and Implications.” This couldn’t be more current in light of the Terri Schiavo
case earlier this spring. Ms. Darrah will speak on the legal update on state and
federal law affecting end of life decisions; balancing legal and ethical obligations;
and practice considerations for health care providers, patients, and families.
Mona Peterson-Rosow – “Medicare Part D: Are You Ready?” The biggest
new benefit in Medicare history, Part D is all the buzz these days. Ms. Peterson-
Rosow will talk about what is Medicare Part D; how is it different from Part A
and B; what are the key compliance areas of concern for providers: marketing,
formulary, and pharmacy requirements, and access issues; and sanctions under
Part D.
Clinic and Hospital Contracting:
Blue Cross Blue Shield:
· We have been advised by our attorneys to NOT try to negotiate with BCBS
until after the FTC pharmacy issue is resolved which may not occur for up to
three months or longer.
· Mike Schlichting and Pao Vang of BCBS will attend our November 10th
Contracting Committee meeting. Topics we hope to discuss include: the new C Class
hospital reimbursement methodology poised to begin January 2006, the new BCBS
Medicare Modernization Act products including MedicareBlue PPO, their Medicare
Advantage private fee for service product, and SecureBlue, their Minnesota Senior
Health Option (blends Medicare and Medical Assistance), and the ongoing MRHC
quality projects. We also seek clarification regarding the new C class hospital's
reimbursement methodology. The letter members received states that the proposed
changes will affect them if their reimbursement is greater than $3,000,000 per year.
Clarification I would like to get include: 1) $3,000,000 in gross charges, or
2) $3,000,000 in net payments or 3) does that include any year end settlements, or
4) does that include payments from self insured, associations, or other arrangements
where BCBS is just processing the claims as a third party administrator?
UCare: We received our preliminary settlement for 2004. We plan to have a
distribution ready for approval by the Board during the October Board meeting.
Medicare Advantage: We continue to try to work with Humana as our preferred
Medicare Advantage private fee-for-service carrier, assuming they will follow through
on their promise of creating a CAH friendly settlement system. As of October 17th,
CMS has not ruled on their proposed CAH year end settlement process that they
want to roll out on a nation-wide basis to take effect January 2006.
AHRQ Health Information Technology (HIT) Project Update ~ Paula Soine, Project Coordinator
The Vendor Selection Committee (Bryan Bronson – Hendricks Clinic, Judy Carruth
– Appleton Clinic, Corla Enevoldsen – Madison Lutheran Home/Lac qui Parle Clinic,
Glenn Haugo – Johnson Memorial Health Services/Dawson Clinic, Gary McDowell –
Family Practice Medical Center, Jim Schulte – Redwood Area Hospital, and Dr. Erik
Shelstad – CCMH/Montevideo Clinic), whose task is to take a good hard look at the
leading vendors and perform due diligence, began meeting in mid-July. During the course
of the four meetings they’ve had thus far, they’ve performed vendor rankings; developed
a short list of vendors that would receive the clinic and hospital RFP’s; came up with a
Top 10 criteria list for what they want to see in an EHR system (#1 – ease of use and
provides information needed for patient care); decided on what constitutes the building
blocks of a basic EHR system for a hospital; and approved and sent out clinic and
hospital RFP’s to vendors.
Clinic RFP responses from A4, eClinicalWorks, GE Centricity, Misys, and MMIC
(NextGen) are currently being analyzed. Hospital RFP responses, which went to Cerner,
Dairyland, Meditech, Quadramed, and Siemens, came in earlier this month with analysis
to began shortly. Vendor demonstrations will tentatively be set up for early November.
From the analysis we hope to arrive at a couple vendors for each setting, as it would be
unrealistic to assume with the vast number of vendors in existence today, the variety of
different facility settings, and the investments facilities have already made, we could pick
only one vendor.
The Site Selection Committee (Bryan Bronson – Hendricks Clinic, Judy Carruth –
Appleton Clinic, Dan Swenson – AppletonHospital, and Stacey Zondervan – Family
Practice Medical Center) met once in mid-July. They came up with a set of 18 criteria
viewed as essential for EHR implementation readiness, all agreeing that the top criteria
were: a realistic understanding of upfront and ongoing costs associated with EHR adoption;
having sufficient financing; readiness to make the necessary clinical and business process
changes/redesign; significant current use of technology to support practices; and commitment
of top leadership demonstrated by EHR implementation included in strategic plan, compelling
personal commitment by administrator, leadership capacity, and responsiveness. Names of
facilities were kept anonymous from the committee to prevent prejudice or favoritism as they
reviewed how each facility fared according to the criteria. The number of criteria met were
added up and it was determined that some facilities rose to the top (most ready) while
others fell behind (not as ready). As one committee member noted: “it’s not so much the
“yes’s” as much as it’s the “no’s” that were there” regarding the facilities that fell behind.
The Committee will teleconference within the next week or two for a final determination.
The end of July saw me taking the week-long, intensive Professional Certification in Health
Information Technology course in the Cities, of which I (thankfully) passed both CPEHR
and CPHIT segments of the course. And just when we thought all our hard work was
falling into place, gearing up to receive the 3-year Implementation grant, we received word
that we didn’t get it. Our grant writer, who had worked on a number of very successful
federal grants, including another AHRQ HIT Implementation grant, and thought ours
topped those, was stunned we weren’t a slam dunk. Although we thought our plan was
solid, we are thinking we didn’t get the grant because they favor research projects. All
is not lost: When we complete our work on the grant, the finished product should be that
we would know which sites are most ready to proceed, what things would need to be in
place in order to be ready, and what systems are the best fits for most any of our member
facilities. We also have at our disposal videotaped copies of the EHR 101 sessions and
the Readiness workshops, and five different EHR Implementation books, not to mention
an ever-growing file of EHR articles on what has worked and what hasn’t worked. I think
that’s a good arsenal of knowledge to tap from one year of planning. As Chuck told
MRHC Board members: “This project isn’t over; I like to think it is just the beginning.”
Just last Month we used some planning grant information to springboard into another
grant application, a Rural Network Development Grant ($180,000/yr for 3 years,
decision in May 2006).
More HIT & RNDG grant comments – Chuck Ness
AHRQ HIT Implementation grant: Grants are fickle things. If you get one or more
hostile grant reviewers you are in trouble. We had 3 reviewers with two liking our
application and one who eviscerated it. That reviewer seemed to be an academic who
had never heard of co-ops or ICSI. This same reviewer also didn’t think our project
was innovative or interesting enough. But, in retrospect we feel we could have documented
our intentions better and took the time to explain co-ops and ICSI. Unfortunately the AHRQ
HIT Implementation grants seem to have a one opportunity window that we missed.
We’ll keep checking.
Rural Network Development Grant: We applied for this grant in September with the
goal of focusing on the MRHC infrastructure aspects of the HIT Implementation grant.
Namely, the Contract Compliance application and staff for developing the ICSI guidelines
based templates. What we are considering is paying for 3 years worth of Rycan’s Remitter
software for all of our members. Current users would get a more robust application at no
cost. Everyone would have real-time analysis verifying payers paying per contract. This
will keep our payers accurate and provide our Contracting Committee wonderful data
which will further improve our contracting efforts. The ICSI template development will
be valuable from day one but will jump start our efforts when we get additional grants
for hardware/software. Again, possible award is up to $180,000/year for three years.
USDA technology grant and others: We will be beating the bushes trying to identify
other grants to pay for the technology purchases that the HIT Implementation grant
would have. The USDA grant application is due spring of each year and is $400,000
one year grant with up to 100% available for technology which is more than the HIT
grant would have funded. Other grants will be explored too.
Quality Corner – Paula Soine
If every cloud has a silver lining, then the silver lining behind the MRHC not obtaining
the coveted 3-year AHRQ Implementation grant (see update elsewhere in this newsletter)
is that I’m back in my previous capacity as the Cooperative’s Quality Manager. I look
forward to working with all the great people who make up the Quality Council again.
Second quarter reward winners were Linda Wohlenhaus at Stanley Gallagher, D.O.,
P.A., Judy Ronnie at Starbuck Clinic, PLLC, and Cheryl Reiniger at Sleepy Eye
Medical Center. The beginning of the third quarter is showing a flurry of activity with all
the quarterly complaints and the final quarter’s data for the Preventive Services and
Hyperlipidemia quality projects coming due now. Third quarter winners show a three-way
tie for first place: Trisha Anderson at WheatonCommunityMedicalCenter, Carol Brinkman
at Williams IntegraCare, and Denise Olson at Ivanhoe Clinic. And a two-way tie for second
place going to Linda Wohlenhaus at Stanley Gallagher, D.O., P.A. and Judy Ronnie at
Starbuck Clinic, PLLC. Your timeliness is much appreciated!
The next Quality Council meetings are Wednesday, October 19th: Hospital 10:30-noon;
Clinic 1:00-2:30 pm. One of the big decisions for the coming year for the clinics will be
deciding on whether to continue with the same two quality projects and if not, which
projects based on ICSI guidelines? I’m all for seeing the Preventive Service project
continue as I’ve seen slow but steady progress in all eleven categories. Among the
larger MRHC overall average increases were in the areas of tobacco use being
addressed (9%); patients 65+ who had one pneumovax (9%); male patients 35-75 who
had cholesterol total < 5 years and HDL for female patients 45-75 (8%); female patients
20-30 who had clinic breast exam < 3 years, yearly for 40+ (11%); and a 9% increase
in the percentage of patients 19-75 who were up-to-date on all 10 selected measures.
(These increases are reflective of the project after the second quarter. As of this writing,
the final third quarter data was not complete.) The goal of this project was to see a
10% increase for each measure, so keep up the great work!
AHRQ HIT planning grant wrap up - EMR / EHR vendor review – Chuck Ness
All RFPs are back with clinic system Physician Micro System and hospital system
QuadraMed opting to not participate.
Vendor demos: We will be paring down the clinic & hospital EMR vendors from
five clinic (six – one that dropped out) and four hospital (five – one that dropped out)
to three each. These vendors will be invited to show their systems to interested MRHC
members at a local venue. Depending on logistics we may either have clinic & hospital
systems at one large location on one day on one day or having the clinic vendors one
day and hospital vendors a different day. We hope to schedule this in early November.
Vendor final recommendations: We will pare down this list to one or two preferred
vendors each for clinics and hospitals. Not only will our finalist information be presented
but also background on the review and data collection process. Presentations from our
vendor, Valor Solutions, will include background on the whole selection process including
initial vendor selection, how this list was reduced, detail on the RFPs and interpretation of
the results, basically why they and the vendor selection committee came to the conclusions
they did. We hope to schedule this meeting sometime following the Thanksgiving holiday.
Patronage distributions – Chuck Ness
During 2004 through September 2005 we distributed 100% of our 2004 patronage
totaling $705,677. This $705,677 consists primarily of UCare gain share. There were
also additional dues paid in and profits from operations. Profits not easily linked to
specific members were distributed based on their ownership share in MRHC. Your
specific total amount of the patronage declared and paid to date for 2004 will be included
in the 1099-PATR form for 2005 that you will receive next January 2006. While this is
profit we are distributing from 2004, due to its timing it must be reported in 2005.
The breakdown of the current patronage distribution is as follows:
- $613,563 = UCare excess premiums
- $ 15,625 = profit from MRHC services your organization purchased
- $9,492 MCSI tech support services
- $3,100 credentials services
- $ 947 internet & e-mail services
- $ 840 privileging services
- $ 824 purchasing assistance services
- $ 240 buying group membership services
- $ 173 other services
- $ 19,477 = refunded extra dues your organization paid in September 2004
- $ 57,022 = the remaining profit split by your percentage of class shares, prorated
by the percent of membership months in 2004
Note that by returning our entire profit on these items (very unusual) it makes them
even better deals. The tech support given their low rates, limited mileage cost, and
no charge for windshield time they are 40% - 70% less than their local competitors.
Also, the internet services is a ridiculously good deal as when we return the profit to
you the cost goes to ZERO … its free. Can’t get cheaper than that.
We are working on other preferred vendor arrangements.
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