On Saturday, January 17, 2015 U.S. Senator Al Franken listened to several descriptions of services provided by the Sawtooth Mountain Clinic, then took questions posed to him by staff, doctors and administrators.
The meeting, which was held at the clinic, was part of the Rural Health Initiative Senator Franken kicked off last month. It is part of a series of assemblies he and his staff will conduct in rural communities throughout Minnesota in the coming weeks and months as they try to address concerns and search for answers that will improve health care for rural Minnesotans.
Franken, who co-chairs the bipartisan Senate Rural Health Care Caucus, listened attentively as concerns were brought forth, and presented some of his thoughts and ideas on how to address a few of those problems.
One of the things Senator Franken heard was that critical care hospitals, clinics and care centers like the ones in Cook County operate on slim margins. Finding enough operating money is hard and only with the continued help of state and federal money and a patchwork of grants can these institutions stay in business.
He was also told it was hard to find and hire nurses and other health care staff because pay is lower in Cook County than in cities like Duluth or in the Twin Cities.
Dr. Jenny Delfs said that with the nearest mall 110 miles away and no nearby Wal-Mart to shop at, many potential doctors rule out coming to Cook County.
And as Dr. Bruce Dahlman noted, while Cook County is lucky enough to have a handful of long-time dedicated doctors, he pointed out that within the next 10 years these doctors will be retiring. With fewer people entering medical school and fewer yet choosing to practice in rural areas, Dr. Dahlman suggested using the Rural Training Track, which is designed to train rural family physicians in an actual rural environment.
Dahlman also said government programs need to not only pay back student loans, but programs need to be geared to place doctors in rural areas for two years or more, which could give young doctors a tie with the communities they first serve and which might encourage them to stay put.
Help sought with bureaucracy
Cook County Hospital Administrator Kimber Wraalstad asked the senator to back H.R. 169, the Critical Access Hospital Relief Act that would remove the 96-hour precertification requirement for patients for critical access hospitals like Cook County’s hospital.
Currently, said Wraalstad, the 96-hour rule requires physicians to certify at the time of admission that Medicare and Medicaid patients will not be there more than 96 hours. This causes physicians to “guess,” said Wraalstad. If the doctor guesses wrong, the hospital must transfer the patient or face non-reimbursement. Neither choice serves the patient or hospital well, noted Wraalstad.
Wraalstad also asked Senator Franken to support H.R. 2801, the Rural Therapy Service Act, which would protect access to outpatient therapeutic services by adopting a default standard for general supervision rather than calling on direct supervision by doctors for outpatient services.
The Centers for Medicare and Medicaid Services (CMS) previously delayed enforcement of this rule for Critical Access Hospitals, as did Congress through 2014, but as of January 1, 2015, these rules are once again being enforced.
Because rural economies have more self-employment and small businesses that can’t pay for health insurance, more people in these areas are underinsured or not insured at all, which means these health care costs are absorbed by the rural health care facilities. Wraalstad said this is also a tough hurdle for the clinic and hospital to get over.
Remoteness of county a challenge
Also discussed was the need to bring services to people who live in the country and can’t get to the hospital or clinic; the need to use more telemedicine for diagnoses; the need to use broadband so medical records can be shared between hospitals from long distance in a short period of time; and the need to compensate volunteers who bring people in the clinic or hospital who otherwise would have no way to get there.
Representing Grand Portage, Rick Anderson cited the Grand Portage Clinic’s remoteness, but said the working relationship with the Sawtooth Mountain Clinic and North Shore Hospital was very solid.
Anderson said the ambulance crews and First Responders that served Grand Portage were invaluable. “What’s provided is invaluable,” he said.
Health disparities, where they exist, are being worked on, said Anderson.
Senator Franken asked how remote Grand Portage was and Anderson responded, “It’s 35 miles from Grand Marais. We just got cell phone service last week.”
“Now you will get the new frustration of it going out,” Franken said as the room broke up in laughter.
Other services important
Franken asked about pre-diabetic services and he suggested partnering with the YMCA because they have 16-week programs that provide nutritional and exercise components to them that could fill that need.
Another unmet or underserved need is dental care, said Dr. Dahlman.
Rita Plourde, director of the Sawtooth Mountain Clinic said that between 60 to 75 percent of people that need oral health care are on the clinic’s sliding fee scale.
Franken said that health care is “tied to education. If you don’t have glasses you can’t see the board. You can’t concentrate in school if you have a toothache.”
Senator Franken said he is also seeking an initiative to bring mental health care to schools.
“Only proper diagnoses and treatment can save a lot of heartaches,” said Franken, adding that 70 percent of the kids that need mental health care help never receive any, leading to potential problems for that child, that child’s family, and society later on.
One advantage of small town or rural health care is that doctors get to know their patients, said Dr. Dahlman. Because of that a doctor will know what tests to order and what tests not to order, saving both time and money. That’s lost in big cities when people see whichever doctor is available, he said.
More questions and concerns were brought to Franken, but at the end of the discussion he thanked the 30-40 people who came out to greet him, then he turned to Delfs and said, “You live in a beautiful place. You don’t really have to be that close to a Wal-Mart to have a quality life.”
Leave a Reply