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NEWSLETTER
JAN - MAR 2006
Reminders:
We need a hospital CEO to volunteer to be a member of the MRHC Board of Directors. This is an unpaid position. Board members can serve two consecutive three year terms, take a break, serve two consecutive
three year terms, and so on. We have two hospital representatives going off, and so far, one person is interested in serving. Please contact us by January 20th if you are interested.
Please consider attending our 2nd Annual Education Event scheduled January 20 & 21. Information included elsewhere in the newsletter. AAFP “prescribed” credits applied for.
Prior to the January 20th Education Event, MRHC staff, in conjunction with Valor Solutions consultants, will be presenting additional detail behind the Health Information Technology Planning Grant final report and will answer questions.
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Clinic and Hospital Contracting:
This last quarter we focused primarily on Blue Cross and Blue Shield. While our relationship with them regarding contracting is best
described as minimal, it seems to be increasing as a liaison function. This burgeoning liaison role may blossom into a more standard contracting role over time. This has been prompted by hospital membership concerns
over changes BCBS is considering with what they call “C class” hospitals, particularly those with annual payments in non-governmental business greater than $3 million. This limits these changes to two of our members
at this point.
Another concern with all of our membership, but particularly our critical access hospitals (20 of our 24 hospitals), is the new Medicare Advantage products and their “deemed” contracts. BCBS seems to be responding to our concerns but has not yet agreed to year end settlements. Humana has a promising new policy regarding settlements but not direct to clinic/hospital contracts yet at this point. Also, we are starting to hear some concerns from several members with MSHO payments where payment discounts are being inverted (e.g. expected 30% discounts actually being 70% discounts), which is an obvious problem we need to get figured out. You may want to check the payments of some of your MSHO (dual eligible Medicare & Medicaid) patients. These MSHO payors can be different, too, as we saw the same concern with both PrimeWest and BCBS.
In 2006 we will be reviewing our One Health Plan contract as well as beginning work on our larger multiyear contracts such as
HealthPartners, Medica, and PreferredOne.
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Pharmacy Contracting:
We have signed five contracts in 2005 and hope to have a contract soon with Walgreen’s (AARP). We also have another six contracts
being worked on at this time, and we are optimistic we will finalize several of them by the end of February 2006. We have contracted with Tom Witt, a pharmacist from Rushford, to work 50% time on building business
opportunities and assist with pharmacy contracting starting January 2006. We hope to sign an additional 10 contracts at least in 2006.
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Current Membership
Clinics
Allergy & Asthma Specialty Clinic, Willmar
Appleton Medical Clinic
CCMH - Montevideo Clinic, P.A. name change
CCMH - Mark Satz, MD New Member ‘05
CCMH - West Central Surgical Associates New Member ‘05
Counseling Associates of West Central MN, Benson
Divine Providence Clinic, Ivanhoe
ELEAH Medical Center, Elbow Lake
Family Practice Medical Center of Willmar
Glacial Ridge Medical Center, Glenwood New Member ‘05
Glencoe Regional Health Services
Hendricks Medical Clinic, P.A.
Ivanhoe Clinic
Janning ENT Center, LLP, Willmar New Member ‘05
JMHS Dawson Clinic
Lac Qui Parle Clinic, Madison
Lakeview Medical Clinic, Sauk Centre
Marshall Eye Clinic
Minnesota Pathologists Chartered, Willmar
Murray County Clinic, Slayton
Northside Medical Center, Ortonville
Paynesville Area Health Care System New Member ‘06
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 New Member ‘05
The Rose Center for Women, Willmar
Tyler Medical Clinic
Wheaton Community Clinic New Member ‘05
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
Glacial Ridge Medical Center, Glenwood New Member ‘05
Glencoe Regional Health Services Hospital
Granite Falls Municipal Hospital & Manor
Hendricks Community Hospital & Home
Johnson Memorial Health Services, Dawson
Madison Lutheran Home, Inc.
Meeker County Memorial Hospital, Litchfield
Murray County Memorial Hospital, Slayton
Ortonville Area Health Services
Paynesville Area Health Care System, New Member ‘06
Redwood Area Hospital
Renville County Hospital, Olivia
Rice Memorial Hospital, Willmar
St. Peter Community Hospital, New Member ‘05
Sioux Valley Canby Campus Hospital
Sleepy Eye Medical Center, Sleepy Eye, New Member ‘05
Swift County Benson Hospital
Tyler Healthcare Center
Wheaton Community Hospital
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Minnesota Rural Health Cooperative Meeting Schedule
January 1 Happy New Year
January 4 Pharmacy Contracting Teleconference
January 4 Medi-Sota Board Meeting
January 11 Pharmacy Contracting Teleconference
January 16 Martin Luther King Day
January 18 Pharmacy Contracting Teleconference
January 18 Quarterly Quality Council Meeting
January 19 Clinic & Hospital Contracting Meeting
January 20 2nd Annual Education Event
January 21 2nd Annual Education Event
January 23 Credentialing Teleconference
January 25 Pharmacy Contracting Teleconference
January 25 SWEPT Meeting
January 26 Clinic Managers Meeting
January 26 Board of Directors Meeting
February 1 Pharmacy Contracting Teleconference
February 8 Pharmacy Contracting Teleconference
February 9 Clinic & Hospital Contracting Meeting
February 14 Valentines Day
February 15 Pharmacy Contracting Teleconference
February 20 Credentialing Teleconference
February 22 Pharmacy Contracting Teleconference
February 22 SWEPT Meeting
February 23 Board of Directors Meeting
March 1 Pharmacy Contracting Teleconference
March 1 Medi-Sota Board Meeting
March 8 Pharmacy Contracting Teleconference
March 9 Clinic & Hospital Contracting Meeting
March 15 Pharmacy Contracting Teleconference
March 20 Credentialing Teleconference
March 22 Pharmacy Contracting Teleconference
March 22 SWEPT Meeting
March 23 Board of Directors Meeting
March 29 Pharmacy Contracting Teleconference
April 5 Pharmacy Contracting Teleconference
April 5 Medi-Sota Board Meeting
April 12 Pharmacy Contracting Teleconference
April 13 Contracting Committee Meeting
April 19 Pharmacy Contracting Teleconference
April 19 Quality Council Quarterly Meeting
April 20 Compliance Meeting
April 24 Credentialing Teleconference
April 26 Pharmacy Contracting Teleconference
April 26 SWEPT Meeting
April 27 MRHC Annual Meeting
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Visit our website for meeting times and places at www.mrhc.net.
If you need a user ID and password,
please contact Paula Soine
at (320) 564-9118 (ext. 12) or psoine@mrhc.net.
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Expectations MRHC has of its members:
Remaining current with signed membership contracts. We have several contracts that members sign, in addition to buying stock and paying monthly dues, to be and stay a member of the Co-operative. These
contracts initially had two year terms and would need to be re-signed every two years to stay active. We are now transitioning to “evergreen” contracts (no term date) for everyone’s convenience. The 140 day without
cause termination notice remains in place so any member, or the Co-op, could terminate a membership without cause given a 140 day written notice prior to ending a membership.
Remain current with dues or other bills. Every member should remain current with all bills including member dues and finance charges. We bill everything net 30 days and then charge 1.5% (18% annual rate) interest per month for any outstanding bills. We would hope members look at us, and treat our bills, differently than they might other vendor relationships because as a member you are a part owner of this organization. If you do not pay your bills on a timely basis you are actually taking advantage of your partners at the Co-op. The Board retains the right to reduce stock or other payouts by that member’s outstanding bills including unpaid finance charges.
Participate with all Co-op health plan policies. As a member you have every right to hold health plan contracts with payers we do not have contracts with (e.g. we won’t sign with Joe’s health plan but for
local market reasons you want to) and that is fine with us. You do need to participate with all health plans we sign on your behalf and cooperate with us with any quality or other policy or program they want us to
participate with. This is currently not a big issue but with Medicare’s pay for performance programs coming we anticipate more activity in this area.
Notify us of changes in a timely basis. Due to contractual obligations including delegated credentialing with our health plan
we need to know immediately when there are employment changes or regulatory problems with providers or facilities.
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Grant Status:
We applied for a federal Rural Health Network grant on September 26th 2005 and we will be notified in May 2006 if we receive it. It is a $180,000 per year three year grant that we intend to use to implement a Co-op wide contract compliance software application into which we will load MRHC contract terms and know in real time if payors are not paying per contract. We also plan to develop written ICSI guideline based EMR templates that members can use in their systems. Our staff will also be able to help load these templates in our member systems.
We also intend to apply for a $400,000 one year USDA technology grant this coming spring. We are working with a grant writer and will
begin as soon as the application info becomes available after Jan 15th. This grant is different in that 100% can be used for technology (i.e. hardware and software) where our AHRQ HIT grant was limited to
20% technology so this grant actually will provide more funds to purchase hardware and software applications.
If we are successful with these two grants alone we will have successfully replaced our failed AHRQ HIT Implementation grant that we
lost in the fall 2005.
We also intend to apply for other grants we discover relating to technology and quality projects. If you hear of any that look like
these goals, please contact our office so we mayl follow up on them.
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EVERYTHING YOU WANTED TO KNOW ABOUT SURVEYS but were afraid to ask….
Number of surveys MRHC conducts each year: 11
Home Care Current, Home Care Discharged, Emergency Room, Same Day Surgery, Outpatient Services, Acute Care (4X – each quarter), Clinic Patient Satisfaction (2X – February and July).
PLUS an Ambulance Survey that is currently in development stage for early 2006 distribution.
Number of surveys that have been sent out for distribution in 2005: 18,685
That’s an average of 4,671 surveys and envelopes every quarter. Our copy machine gets a workout!
Average Return Rate of All MRHC Surveys: 48%
According to The Myers Group, a healthcare research firm, “Thirty percent to 35 percent is a typical response rate for a mailed survey, ” while 50% has been considered “quite high.”
Historical MRHC response rates by survey:
Same Day Surgery 50% to 60.6%; average return rate (ARR) = 55.1%
Outpatient Services 39% to 49.4%; ARR = 45.5%
Emergency Room 31% to 40%; ARR = 34.8%
Acute Care 35.9% to 50%; ARR = 41.9%
Home Care Current 50.8% to 64.8%; ARR = 58.4%
Home Care Discharged 33.4 to 44%; ARR = 40.5%
Clinic Patient Satisfaction 39% (first one) to 57.1%; ARR = 52%.
Average Facility Cost to members per MRHC Survey: $0
Which includes surveys, postage-paid return envelopes, and analysis by individual facility and
comparatively with other MRHC participating facilities. Other research firms charge between $4,000 and $8,000 PER SURVEY PER FACILITY. And we offer 11, soon to be 12. You do the math.
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Calling all ye Pharmacists!
If you’d like an up-to-date listing of the pharmacy contracts we have in place and their terms,
the PBM’s we’ve been contacting, PBM contact information,
etc., call or e-mail Paula
and provide your e-mail address. She’ll send you an
Excel file with all the information.
(320) 564-9118 x12 or psoine@mrhc.net
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GOOD NEWS!
2006 rate changes
will be out shortly.
Both per physician and bed ratios
continue to be reduced
through growth!
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Quality Corner – Paula Soine, Quality Manager
The Quality Improvement projects for 2006 have been decided! QI Project #1 is a continuation of the Preventive Services
project started in 2005. The goal is to increase the percentage of patients who are up-to-date on each of 10 preventive services by 10% over a 12 month period. The measures:
1. BP in last 2 years
2. Tobacco use addressed
3. Tetanus booster < 10 years
4. Influenza 50+ yearly
5. Pneumovax 65+ once
6. Cholesterol total < 5 years (males 35-75) HDL < 5 years (females 45-75)
7. Colon cancer screening < 5 years if 50-80
8. Clinic breast exam < 3 years (females 20-39) yearly (females 40+)
9. Mammogram q 1-2 years (females 50-75)
10.Pap smear q 3 years (females 18-65)
+ 11. Percentage of patients who are up-to-date on all 10 of the measures listed above.
Collectively, the MRHC reached their goals on six of the 11 measures by the third quarter, and pretty darn close on the other five.
The slow but steady progress prompted quality folks to contine with this important project for another year.
The second QI project is Optimal Diabetes, which has three goals:
1) Decrease the percentage of patients with poorly controlled blood sugars and cardiovascular risk factors; 2) Increase the percentage of patients with diabetes ages 18-75 for whom recommended screening frequencies and ideal treatment goals are met. If you’ve seen the recent 2005 MN Community Measurement project (based on 2004 results), you’ll understand what the third, unwritten goal is: To increase our collective numbers on the 13 diabetes care measures that are compared with 54 provider groups (representing more than 700 clinics) throughout Minnesota and bordering counties measured for the publicly reported MN Community Measurement project. Collectively we ranked near the bottom in each category. So we’re taking up the challenge to make marked improvements in all 13 measures:
1. Hemoglobin A1c (HbA1c) tested
2. HbA1c level <= 7
3. HbA1c level <= 8
4. Eye exam (retinal) performed
5. LDL-C screening performed
6. LDL-C controlled (LDL<130 mg/dL)
7. LDL-C controlled (LDL<100 mg/dL)
8. Kidney disease (nephropathy) monitored
9. Blood pressure reading performed
10.Blood pressure reading 130/80
11.Blood pressure reading 130/85
12.Aspirin therapy if age >40
13.No tobacco use
+ 14. Percentage of patients who achieve ideal control comprehensive goals for ALL measures 1-13.
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MRHC MEMBERSHIP MIND BOGGLERS…..
IT’S ALL IN THE NUMBERS:
775 beds
385 outgoing calls per month (not counting cell)
184 meetings (that’s 15 a month or 3 ½ per week)
130 Physicians
129 Pharmacists (98 are full time, 31 are part time)
70 Pharmacies (all were added in 2005)
65 Mid-levels
31 Satellite Clinics (6 were added in 2005, 6 in 2006)
31 PBMs being contacted for pharmacy contracts
25 Primary Care Clinics (5 were added in 2005, 1 in 2006)
24 Hospitals (4 were added as members in 2005, 1 in 2006; 20 are Critical Access)
10 Specialty Clinics (2 were added in 2005)
10 Signed Health Plan Contract Agreements
5 Signed Pharmacy Contract Agreements
and
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HAVE YOU VISITED OUR WEBSITE LATELY? Some of the things you’ll find at www.mrhc.net:
- Minutes: Board, clinic managers, quality council, compliance, and HIT meetings;
- Costs and benefits of being a Coop member;
- All our newsletters;
- Listings of the books, videos and equipment from the MRHC library available to members;
- Presenter schedule, CME credit information, and registration info for the 2nd Annual Education Event;
- Listings of all Coop members with addresses, contact information, phone/fax numbers, hours of operation, maps to facilities, outreach providers
with their specialties and availabilities;
- Contract info – who are we with, contacts
- Directories: Board, MRHC staff, pharmacy owners, credentialing, contracting, quality councils, clinic managers, administrators.
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2nd Annual MRHC Education Conference
Friday & Saturday, January 20 & 21, 2006
Prairie’s Edge Casino Resort Convention Center
Granite Falls MN
Brochures with Registration forms have been sent out. Please let us know if you did not receive a brochure and would like to attend. Ten CME credits are available by attending the entire
conference.
Please note change of presenter order from brochure.
Friday Schedule of Presenters:
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2:00 – 4:00 PM
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Vendor display set-up
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3:00 – 4:00 PM
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Registration
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4:00 – 5:00 PM
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General Infertility
Michael Eighan. MD
- Explain the main causes of infertility
- Describe the initial work up for infertility
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5:00 – 6:00 PM
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Electronic Health Record - Why Now is the Time
Michael Morris, MD
- Describe key features of an effective, usable EHR
- Explain the preparation for implementation of EHR
- Explain the customization of EHR – templates, reports
- Describe the improvement of chronic care delivery
with EHR
- Explain the use of EHR for quality improvement
initiatives
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6:00 – 6:15 PM
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Break
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6:15 – 8:00 PM
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Dinner/Presentation
Prize Drawings
Disaster Medical Response and Katrina
Mark Huntington, MD
- Explain the medical needs in complex humanitarian
events such as hurricanes
- Describe the various disaster response groups in this
country
- Explain the importance of disaster preparedness by both
local and non-local medical professionals
Southwest Emergency Preparedness Team
Jo Coover, Education Employee Health Director
- Define what MN Incident Management System (MIMS) is
- Explain the National Emergency Response Structure
- Review what resources have been made available through
Health Resources & Services Administration (HRSA
Grant)
- Explain what the Southwest Emergency Preparedness
Team (SWEPT) does in the region
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8:00 – 10:00 PM
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Social Hour
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Saturday Schedule of Presenters:
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7:00 – 7:30 AM
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Registration
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7:30 - 8:30 AM
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Parkinson’s and Alzheimer’s Disease, Common
Neurodegenerative Disorders: What can we do?
Merlin Nelson, MD
- List the cardinal features of Parkinson’s disease
- Describe possible treatment interventions for
motor complications in Parkinson’s disease
- Explain possible treatment options for problem
behaviors in demented patients
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8:30 - 9:00 AM
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Breakfast/Vendor displays
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9:00 - 10:00 AM
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Updates on Wound Treatments
Deb Wilson, BS, RN, CWOCN
- Wound cleansing in emergency, acute and chronic care
- Management of post surgical wounds
- Choosing appropriate compression for venous
stasis ulcers
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10:00 - 11:00 AM
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Disorders of Insulin Resistance: How can I help my
short, chubby, hairy, infertile patient become
pregnant?
Diane Duckworth, MD
- Recognize the clinical spectrum of which insulin
resistance is a component
- Discuss the pathogenesis and management of polycystic
ovarian disease in adolescents and adult women
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11:00 - 11:15 AM
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Break
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11:15 AM -12:15 PM
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Relationship of Renal & Hepatic Function to
Drug Effects
April Hanson, PharmD
- Describe routes of drug elimination and metabolism
- Dosage adjustments related to a renal and hepatic function
- Possible adverse effects: patients with renal and/or hepatic insufficiency
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12:15 – 1:00 PM
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Lunch/Vendor displays
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1:00 – 2:30 PM
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Methamphetamine Awareness
Brain Cruze, CEE-VI Drug Task Force
- Describe what methamphetamine is and where it
comes from
- Describe how to identify methamphetamine,
methamphetamine users and effects on the body
- Identify drug paraphernalia that is associated
with methamphetamine
- Explain area trends on drug cases
- Describe chemicals used & production methods
Crankin’ it up – the Methamphetamine Dilemma
Dennis Peterson, MD
- Clinical management of the methamphetamine patient
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2:30 – 2:45 PM
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Break
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2:45 – 3:45 PM
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Snoring/Obstructive Sleep Apnea
Martin H. Janning, MD
- Explain anatomy and physiology of snoring
and sleep apnea
- Describe medical and surgical options in the
management of snoring and sleep apnea
- Explain the risks of untreated sleep apnea
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3:45 – 4:00 PM
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Wrap-up and Evaluations
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