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July 4, 2009| Posted in Articles, Front Page Slideshow, Health Care, In the News, News Media
By Brad Swenson, Bemidji Pioneer, July 3, 2009
State cuts to health care for Minnesota’s poorest adults means a 28-year-old diabetic may go without insulin, or a 63-year-old diabetic alcoholic with cancer goes without treatment.
“You need to put a face to who this is going to impact,” Margaret Demers, North Country Regional Hospital lead social worker, told a Minnesota House panel Thursday morning about the effect of eliminating the General Assistance Medical Care program.
The 28-year-old, she said, is on two different insulins which he can’t afford without GAMC coverage. Not taking insulin will lead to more serious medical problems such as organ failure, foot wounds, amputations, and leading to losing the ability to work.
The 63-year-old is short of qualifying for Medicare. “In our area, we have a significant population of chemically dependent patients who fall into the GAMC category,” Demers said. “They struggle with life, their addiction and serious health problems. By its nature, chemical dependency affects their ability to function normally and as their illnesses progress, so do their medical problems.”
Gov. Tim Pawlenty, as part of an effort to bridge a $3 billion budget gap between the DFL-controlled Legislature’s spending bills and expected revenues for the biennium that started Wednesday, line-item vetoed funding for the GAMC program.
The program, which provides health care coverage for the state’s most destitute adults, would see funding cut as of March 1 and into the second year of the biennium. Pawlenty excised about $400 million, a figure that will be $888 million in the next biennium if it is not restored.
The House Health and Human Services Policy and Oversight Committee is traveling northern Minnesota to hear from local hospitals about the affect of losing GAMC, and was in Bemidji on Thursday.
Committee Chairman Rep. Paul Thissen, DFL-Minneapolis, and Rep. Erin Murphy, DFL-St. Paul, and panel staff met with about 25 local medical and social services officials.
Demers outlined six cases of real people on GAMC. “The person may choose to not even seek treatment or not even try because they can’t pay for it. We see that a lot with populations that don’t have coverage. They wait until its turned into a very, very huge medical problem. They don’t come in for prevention or day-to-day management.”
A survey of 10 percent of about 650 GAMC enrollees served by North Country Regional Hospital shows an average age of mid-30s, from 21 to 63, said Jim Hanko, president and CEO of the parent North Country Health Services.
Of the sample, 63 percent were self-designated as American Indians who live in Bemidji or on an area reservation. Seventy-two percent were self-designated as unemployed.
“The majority of the services — 60 percent — were provided in the emergency department,” Hanko said. “And 20 percent were in the imaging department, which is an expensive modality.”
Under a fee for service program, 652 individuals had 1,033 GAMC accounts last year, Hanko said, with gross charges of $3.2 million. State reimbursements were $1.1 million while the cost to provide services was $1.7 million.
And, under the state Pre-Paid Medical Assistance Program, only 55 percent of costs is reimbursed, he said.
“We have an estimate from the state that the total impact for GAMC in our particular locality is about $4.8 million to $4.9 million,” Hanko said. “That includes clinic services received by people at MeritCare and other clinics and includes the emergency department and any in-patient services.”
That amount will become the uncompensated care if all the GAMC patients became patients at NCRH, mostly likely through the emergency department, he said. The emergency room then becomes the safety net for all who can’t afford medical care.
Thissen said the Legislature’s focus will be on the “bigger health care reform that we need to do in this state. … We really need to focus on how we’re going to help this population — folks who are going to be with us regardless whether we’re paying for them or not.”
Murphy is floating around some ideas that may help, she said.
“A lot of them are poor because they’re sick,” she said of GAMC patients. “We know they’re poor because the income standards are so low. … A lot of them are sick and probably not able to work.”
Legislators need to understand the population in order to find solutions, Murphy said, listing off pretty sick, some mentally ill, suffering from chemical dependency, chronic diseases.
“A lot of states are looking at care coordination,” she said. “We keep hearing from hospitals that this population looks at the hospital as their primary care source, to come here to the emergency room because that’s what they know. Is it possible for us to figure out how to deliver care in an out-patient way where the patient is, get them healthier, keep them healthier so they’re not coming to the hospital in their most chronic state, and then we’re incurring these large costs.”
The benefits of coordinated care is savings to the system, delivery of better care, and allowing a better life for the GAMC population, she said. “To do it means we’ll have to work across the system – the health care system and the social services system … to do that kind of intensive coordination.”
It was suggested that the population could be served by more urgent care or “minute clinics,” but there is a lack of primary care providers. It’s tough to recruit new doctors to Bemidji, as rural salaries are lower and on-call hours greater than in the metro area, said NCRH Dr. Robert Rutka.
There were discussions of starting a “minute clinic” but there aren’t enough primary care physicians to staff it, he said.
State changes in credentialing are needed to allow mid-level practitioners to perform some duties now delegated to physicians or physician assistants, said Bob Verchota, NCHS vice president of human resources and ancillary services.
“From a human resources perspective, there’s one thing you could do,” he said, “and that is to support some changes in the licensure requirements through either the credentialing, certifying licensure, etc., to increase the capacity.
“We don’t have the capacity up here from an access standpoint to even get people in if we wanted to,” Verchota added. “We’re sending people … to Park Rapids and Deer River for primary care.”
Some positions are fully capable of providing primary care, such as in lab, rehab or imaging, and in mid-level area alternative to physicians, he said. The problem affects all who seek medical care, not just GAMC patients, he added.
“No supply, the price goes up,” Verchota said.
“It doesn’t make sense to pay lower reimbursement rates to rural communities that are having the hardest time attracting doctors,” said Sen. Mary Olson, DFL-Bemidji.
“We’re actually seeing an outflow of nurse practitioners,” Rutka said. Another problem is while MeritCare has an urgent care office, it closes at 5 p.m., with center referring patients to the hospital emergency room after about 3:30 or 4 p.m.
?We’ve had a net outflow of nine primary care providers in this community in the last three years,” Rutka said. “I, as a family doctor, can probably take care of 92 percent of the things that come through my door.”
Another problem, participants said, with the high percentage of American Indians on GAMC, U.S. Indian Health Service is not always paying for services.
Georgia Downwind of Beltrami County Human Services at Red Lake, said IHS once paid for most services, but the number of those seeking services has grown while money to pay for services hasn’t, forcing partial or no payment.
And, if an Indian who lives on the reservation gets a heart attack while in Bemidji, HIS won’t pay for those services, she said.
“The misperception is that Indian people in this area in the treaties that were signed 100-plus years ago the federal government guaranteed health care services to them,” said Rep. John Persell, DFL-Bemidji. “That’s not being provided, obviously.”
It’s a shortcoming of the federal government, he said. “Indian people believe, and they know because it’s written on paper, we are guaranteeing health care services. That adds to the overall complexity of the situation.”
Indian people have to apply for some other medical service and get denied before using HIS, which Persell said “befuddles” him.
Participants also said transportation was a problem, as many poor adults have no means to seek medical care if they live outside of Bemidji. And, some are homeless and the system can’t find them after they’ve sought initial care.
“In many ways it isn’t a problem of having people finding people, it’s having them stay found,” said John Pugleasa of Beltrami County Health and Human Services. Continuity of care is hard, he added. “Having this population stay found, leading to any kind of continuity, is a real challenge.”
That could be helped with more affordable housing and transitional housing, he said.
| Posted in Articles, Front Page Slideshow, In the News, News Media
By Brad Swenson, Bemidji Pioneer, July 3, 2009
Rep. Paul Thissen, center, talks to DFLers Alan Brew, left, and Jim Heltzer, Thursday morning at the Cabin Coffee House. The Minneapolis Democrat is seeking the party’s endorsement for governor in 2010, and met with local DFLers to solicit their support.
Minnesota needs to go back to its roots of being compassionate to those less fortunate, says Rep. Paul Thissen, who is seeking the Democratic endorsement for governor in 2010.
The direction of government under Gov. Tim Pawlenty for a limited role for state government and for individuals fending for themselves is wrong, Thissen said Thursday in an interview.
“One of the things we haven’t had in this state for too long is a conversation about who we are as Minnesotans and as a people,” the fourth-term Democrat from Minneapolis said. “This next election really needs to be about that; it’s time we do that. We’ve been going down a direction for too long that’s focused on this notion that we’ll all be better off if we’re able to take care of ourselves.”
Thissen was in Bemidji to hold a House Health and Human Services Policy and Oversight Committee meeting into the local effects of Pawlenty’s line-item veto of $400 million to the General Assistance Medical Care program that provides health coverage to the state’s most destitute adults.
Earlier Thursday, Thissen met with about a dozen Beltrami County DFLers to solicit their support for his gubernatorial bid.
“We need to come back to what I think has always made Minnesota successful, which is the idea that we actually do owe obligations to one another, and we have to take responsibility to fulfill those obligations,” he said.
“The GAMC cuts is one primary example,” Thissen said. “I’m hearing from people in greater Minnesota who think that decision of not being willing to take care of our most vulnerable citizens crossed a moral line.”
The economy is sour, but Minnesota also faces challenges of an aging population, environmental concerns, “and we need to start acting now to change the way we’re operating and to be real serious about the solutions,” he said. “We haven’t worried about the consequences.”
Also, he said, the state needs to send more decision-making to local governments.
“It’s become very clear to me that this is a big state and a very diverse state, and one-size-fits-all answers from St. Paul won’t work,” Thissen said. “A lot of the policy work I’ve done over the last year and a half has really been focused on how can we set standards at the state but let local people have a lot more control over how they actually achieve what we all want to achieve.”
Thissen this session carried the Association of Minnesota Counties’ bill to allow the state to set objectives and let counties decide how to achieve them with the state money provided.
“I think it’s really exciting possibility,” he said. “The challenge is that it changes the way the state has to think about it, and we ran into some barriers from that perspective. Folks at the state feel threatened by this new way of thinking. But that’s exactly the direction we ought to go.”
Thissen realizes that the state faces an even larger state deficit in two years, and has plans to close that gap.
“We do need to rethink our tax system” he said, adding that all DFL gubernatorial candidates will offer that idea. “We need to bring more fairness back, we need to bring more revenues into the system. I’m very comfortable talking about that and in making that case.”
Also, over the next five to six years, Minnesota needs to get its health care costs under control. “That is what is eating up our state budget.”
The increasing trend line for health care costs is almost identical to the declining state investment in higher education, he said.
“If we can get health care costs under control, not by what the governor did which is just throwing people off because we’re all paying for it anyhow, but by doing things smarter … that is what is going to save us over the long term”
Savings can also come in long-term care by keeping people in their communities and supporting informal caregivers through tax credits.
“If we can think about not just increasing revenues or cut taxes or cut services, but how can we do things smarter to save money over the next five years, that’s going to be a big part of the answer,” he said.
Some estimates put the next deficit at $7 billion.
“Part of it (closing that gap_ is jumpstarting the economy,” Thissen said. “We can grow some of this out of that. … If we look out over four years, part of it comes back to how we budget as we need to get back to four-year budgeting.”
The budget should include state and local budgets as well, he said, “so we get a picture of our whole public services from a financial budgeting perspective.”
Thissen said Pawlenty, who isn’t seeking re-election, “has left us in a very serious problem. … We did the shift in education of nearly $2 billion this year and we can’t shift any more to the next biennium. The next governor’s going to have a serious problem.
“That’s why it’s really important not to make this election just about health care or taxes or a green economy, but we have to actually make it a discussion of what do we really want the state to look like in five years,” he said. “And what are our values as Minnesotans. Who are we, because if we have that kind of conversation, not only is it good for the politics but it also lets us govern more effectively.”
He says more money needs to go to Local Government Aid to cities, something Pawlenty has cut with each of his budgets and subject to unallotment as of Wednesday.
“They need that support both from a property tax standpoint and a services perspective,” Thissen said, “and from a fairness standpoint across the state. … Another thing just as important as the money is restoring the trust relationship between local governments and the state, which has really been frayed and destroyed.”
An expert in health care policy, Thissen said he would take that reform-minded agenda to other state areas, such as education.
“Health care is the thing I’m really passionate about,” Thissen said. “But that’s not all this campaign is about, and I don’t think it can be.”
He wants to narrow the achievement gap in K-12 between families that are better off and families that are not. He also wants to narrow the gap between districts, bringing equality in areas such as transportation funding.
“Different kids learn very differently, “ he said. “We haven’t done as good a job within our public school systems of providing those different types of learning environments so that different kids can succeed.”
That needs to be the focus more so than testing and outcomes, he said.
Right now, Thissen is meeting with Democrats across the state in small groups, hoping to sway potential DFL delegates to support his endorsement among a crowd of potential and declared Democratic candidates.
An attorney, Thissen is a Harvard graduate. He and his wife have three children.
| Posted in Articles, Front Page Slideshow, Health Care, In the News, News Media
By Mike O’Rourke, Brainerd Dispatch, July 3, 2009
Area health officials told state lawmakers Thursday how their institutions will be affected by the March 1 elimination of a state medical assistance program for low-income patients without private insurance.
The General Assistance Medical Care program was among the unallotment cuts Gov. Tim Pawlenty made in order to balance the budget after he and lawmakers failed to reach agreement.
The discussion Thursday took place before members of the Minnesota House Health Care and Human Services Policy and Oversight Committee at St. Joseph’s Hospital in Brainerd.
Dr. David Boran, chief medical officer of the Brainerd Lakes Health System, said St. Joseph’s Medical Center cared for 530 GAMC patients this year. Sixty-two percent were seen in the Emergency Department and 20 percent of the 530 patients were admitted to the hospital. He said the gross charges for these patients exceeded $2.8 million. After partial reimbursements are made by the state the hospital costs are $1,093,259, resulting in subsidy of $420,00 to care for these patients.
he GAMC patients, Boran said, are primarily very low-income adults between the ages of 21-64, without children. They often suffer from chronic health problems such as diabetes mellitus, AIDS, heart disease, chronic mental illness or chemical dependency.
Boran noted that as a result of the governor’s veto $18 million in federal revenue in Fiscal Year 2011 will be lost across the state. This year, he said, St. Joseph’s Medical Center will receive $650,000 in Medicare payments for providing a “Disproportionate Share” of care to the poor.
“This plan is penny-wise and pound-foolish,” he said of the veto that will also result in the loss of federal matching funds.
“Minnesotans who pay federal income taxes will, in effect, be subsidizing the Medicaid programs in all those other states that do not cut their Medicaid funding,” he said.
He said the cost shifting that’s part of the health care system – charging those with private insurance more to underwrite the cost of government programs – is a hidden tax.
“This cannot go on,” he said. “Employers in Brainerd and elsewhere are stretched to the limit,” he said. Some can no longer afford to provide health insurance for their own employees, let alone underwrite the cost for others. Brainerd Lakes Health is unable to underwrite additional costs.”
Jani Wiebolt, president of St. Joseph’s Medical Center, said the hospital has implemented a wage freeze, a hiring freeze and has had workforce reductions. She said St. Joseph’s average daily census is 70 patients and noted that there are four hospitals within a 35-mile radius.
Susan Beck, Crow Wing County Community Services director, said the budget cuts would unravel the current health system and force more people to the emergency rooms for health care.
“We’re very reliant on the services of St. Joe’s,” she said. “Without St. Joe’s we lose a huge piece of the mental health puzzle.”
While Beck said she didn’t have a simple solution she told the panel care coordination would be a part of the answer. The needs of GAMC patients often include housing, employment, mental health and medical, she said.
Rep. John Ward, DFL-Brainerd, discussed the good work being done by the Region 5 Adult Mental Health Initiative.
Wiebolt said the hospital has not planned another round of layoffs. She said whatever cuts might come would likely be in the supervisory and support areas rather than “care at the bed side.”
Rep. Erin Murphy, DFL-St. Paul, said “If we don’t solve this problem hospitals are going to take a financial hit.”
Rep. Paul Thissen, DFL-Minneapolis, said an integration of services that would provide ongoing support in such areas as housing, might be part of the solution. Before March, he said after the meeting, he hoped that a different model of GAMC can be structured with an existing revenue source or reform proposals can be initiated that might lead to refunding of the program.
“It’s clear … just eliminating health care coverage is not the way to get there,” he said during the meeting.
Other lawmakers who attended the committee meeting were Rep. Al Doty, DFL-Royalton, Rep. Karla Bigham, DFL-Cottage Grove, Rep. Tom Huntley, DFL-Duluth.
June 12, 2009| Posted in Articles, Front Page Slideshow, In the News, News Media
By Tom Scheck, Minnesota Public Radio, June 12, 2009
St. Paul, Minn. — Even though the 2008 U.S. Senate race hasn’t been resolved yet, the 2010 race for governor is already ramping up.
Several DFL candidates for governor attended a forum Thursday night that focused on the environment, just a week after Republican Gov. Tim Pawlenty announced he was not seeking a third term. And one of the better known Republicans considering a run has decided against it.
The Minnesota Environmental Partnership invited 17 possible candidates from both the DFL and Republican parties to attend the forum. Only six – all Democrats – participated.
One of those participants, Minnesota House Speaker Margaret Anderson Kelliher, downplayed talk of a possible run for governor during this year’s legislative session. But she sounded like a full blown candidate at several points in the forum, most notably when talking about investing more money in transit projects.
“You need a governor who has a proven track record and capacity to get this done and stick with the tough conversations when it gets very hard with the partners who may not want to do some things,” she said.
The forum focused primarily on environmental issues. There were no questions on Minnesota’s budget problems or about education. Instead, questions centered around global warming, eliminating dangerous chemicals and growing green jobs.
Since all of the candidates are from the same party, the differences on issues were mostly around the edges. All six said steps need to be taken to reduce greenhouse gas emissions. Former state Senator Steve Kelley called it a moral issue that everyone should be concerned about.
“When I’m talking to conservatives about this issue, I point out that being thrifty, avoiding wasting things, ought to be something we can do even if you don’t believe in climate change or global warming,” he said.
The candidates were also asked about their plans to reduce toxic chemicals. Some said better labeling would help. State Senator John Marty of Roseville said manufacturers should have to prove that products are safe before they put them on the market.
“With foods and drugs, you’re not allowed to sell them until there’s some pretty clear evidence that they’re safe,” he said. “With chemicals, you’re allowed to use them until it’s proven, almost beyond a reasonable doubt, that they’re dangerous.”
Marty also said he would not take any contributions from PACS or lobbyists. None of the other candidates made a firm commitment on whether they would take money from energy, car dealers and chemical company PACS.
Former state Representative Doug Peterson, who also heads the Minnesota Farmer’s Union, said he wanted to hear a better definition of an energy lobbyist.
“Wind energy is good,” he said, “so are you going to limit from wind energy lobbyists at that point?”
Several candidates also stressed the importance of encouraging family farms and sustainable agriculture when asked how they would balance agriculture with environmental protection.
Ramsey County Attorney Susan Gaertner said she would use the bully pulpit to influence policy.
“What the governor needs to do is set a tone for buying locally,” she said. “For respecting organic farming. For respecting sustainable farming because I think it can make a difference.”
All six candidates also said the state needs to invest more money in transit and rail projects. State Representative Paul Thissen said he’d like to see a statewide rail plan in place by 2020.
“We need to expand transit statewide much more effectively and do that in ways that fit the various regions that people are living in,” he said. “So it won’t look the same everywhere and we have to get out a mindset that St. Paul knows best and leave a lot of that to the local folks to develop but support it with funding.”
While a bipartisan group of candidates was invited to attend this event, it’s highly unlikely that any Democrats will be in Brooklyn Center this weekend, where Republican Party leadership will elect a new party chair. Any serious candidate for governor will also be striking up conversations and talking to potential delegates.
Businessman Brian Sullivan won’t be one of those candidates. Sullivan, who lost the party endorsement to Tim Pawlenty in 2002, says he’s decided against running next year. He said he couldn’t simultaneously be an effective candidate and build his medical services business.
“To run for governor is a full-time occupation and it just wasn’t possible for me step out of my business and dedicate the time necessary to be successful in a run,” he said. “There’s nothing worse than pursuing something in a way that you know won’t lead to a good outcome.”
Sullivan’s announcement surprised some Republicans because his personal wealth would have made him a serious contender for the office. He said he won’t back any candidates at this point.
May 16, 2009| Posted in Articles, Health Care, In the News, News Media
By Warren Wolfe and Chen May Yee, Star Tribune, May 9, 2009
Minnesota’s hospitals, nursing homes and community clinics — already reeling from the worst recession in nearly three decades — are bracing for a new round of cuts from the state’s biggest single purchaser of health care: state government.
As legislators and Gov. Tim Pawlenty struggle to close a $4.6 billion deficit in the state budget, they are looking to trim between $400 million and $1.8 billion from projected state payments to hospitals, health plans, nursing homes and other providers.
With just a week left in the legislative session, the size of the cut was still in play as budget deliberations continued over the weekend. But with health and human services accounting for about 27 percent of the state budget — second only to K-12 education — no one doubts that excruciating cuts are in store.
“We got battered by budget cuts in 2003 and we still haven’t recovered,” said Patricia Coldwell, policy analyst at the Association of Minnesota Counties. “There is no low-hanging fruit left.”
If the worst cuts materialize, providers say:
Residents of Stearns County could see St. Cloud Hospital close its Diabetes Center, eliminating exercise and nutrition programs, and close some dialysis centers.
Uninsured residents of the Twin Cities area, unless they live in Hennepin County, could find themselves turned away from Hennepin County Medical Center, which ordinarily provides uncompensated care to hundreds of patients from surrounding counties.
Aged and developmentally disabled residents in the Duluth area could see reduced services if St. Louis County loses nonprofit firms that serve those populations.
Even Minnesotans who have private insurance could see the effect in higher premiums or larger deductibles, because unpaid costs in the public sector are often shifted to private payers.
Pawlenty and his aides say they want to limit the damage, “but the current growth in health care costs cannot be sustained,” said Human Services Commissioner Cal Ludeman. “Given our budget problems, we must act responsibly.”
Last year, the state paid roughly $7 billion for medical care and insurance, or nearly one-fourth of all health care spending in Minnesota. That $7 billion includes federal matching funds for the big public health insurance programs such as Medicaid.
Razor-thin margins
As the brawl continues in St. Paul, hospitals say they already are grappling with razor-thin margins because of fewer patients and mounting unpaid bills in the recession. More cuts, they say, mean eliminating services when they are most needed.
Since last fall, Minnesota hospitals have cut nearly 2,000 jobs, frozen or cut salaries for physicians and executives, and postponed new buildings.
Pawlenty’s proposal would directly cut $336.6 million in revenues for hospitals, according to the Minnesota Hospital Association. Indirectly, hospitals say, it would cost them another $430 million in unpaid medical bills incurred by the newly uninsured who would be dropped from MinnesotaCare but still need care. The House and Senate versions would cut between $75 million and $117.1 million from hospital payments.
Children’s Hospitals and Clinics of Minnesota, for example, would lose about $36 million over the next two years. House and Senate proposals would cut closer to $10 million. Children’s had revenue of $540 million last year, 40 percent of it from Medicaid, the state-federal program for poor and elderly patients.
“What is usually not realized is that 50 percent of Medicaid recipients in this state are children,” said Dr. Alan Goldbloom, chief executive of Children’s. “Children are the group we should be investing in. They have the biggest and longest return on investment.”
Children’s recently closed an exercise medicine program for children with chronic illnesses and cut school outreach programs. Other support services — interpreters, social workers and chaplains — would be at risk with future cuts.
For HCMC, areas at risk are mental health, dental care, HIV care and clinics, said CEO Lynn Abrahamsen.
As a safety-net hospital, HCMC derives 43 percent of its revenue from Medicaid patients. To save money after the 2003 budget cuts, it closed a therapeutic pool and a Minneapolis clinic that served mostly Hmong patients, and stopped offering dental services in Richfield.
As it is, hospital executives say, Medicaid pays only about 80 percent of the actual cost of delivering care. Hospitals make up the loss by charging private insurers and their enrollees more.
In the past, hospitals could negotiate higher prices with insurers, who would then raise premiums. But as more consumers use high-deductible insurance plans in an effort to control their premiums, they’re the ones who will face higher bills as a result of cost-shifting.
When consumers can’t pay, hospitals see bad debt rise. “That shell game has fallen apart,” said Allina spokesman David Kanihan.
Pressure on nursing homes
Nursing homes can’t shift costs to other payers because state law forbids it. A recent survey of nursing homes showed that more than one-fourth had 2008 operating margins of minus 5 percent or worse “and it will be worse this year,” said Gayle Kvenvold, CEO of Aging Services of Minnesota.
Medicaid payments for the poor are the main source of income for nursing homes, and they are likely to remain flat next biennium, although some other nursing home payments are likely to be cut.
Just as hospitals fear that health care cuts will result in more people getting care in emergency rooms, nursing homes worry that likely cuts to home-care programs will push frail people out of their homes and into nursing homes.
Said Coldwell, the analyst for the Minnesota counties group, “Some people get all upset about welfare moms. They ought to realize that — in terms of dollars and number of people — the welfare mom is your grandma in a nursing home.”
Damage to reform?
Hospital officials also worry that budget cuts could derail Minnesota’s much-touted reform efforts, passed by the Legislature in 2008. The wide-ranging reforms include coordinating care for people with chronic conditions and other services that keep them healthy and out of the hospital.
Yet those services, such as phone calls from nurses to check on patients, may not happen if finances get tighter.
Fairview Health System is working with Medica at its Eagan clinic to change the care model, breaking a large clinic into teams of doctors, nurses and aides who care for groups of patients. Fairview has committed $10 million a year over five years to reform efforts, said Fairview CEO Mark Eustis. That money is now at risk.
Despite their best arguments to legislators and the governor, health and human service providers recognize that they must endure painful cuts. The question is how damaging they will be.
For the state to cut programs that provide preventive medical care, said David Wessner, CEO at Park Nicollet Health Services, is akin to “treating diabetes by getting very good at amputation.”
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