Volume 7 Number 1
©Minnesota Office of Tourism Photo
Q U A R T E R LY
Spring 2005
The mission of the Office of Rural Health & Primary Care is to promote access to
quality health care for rural and underserved urban Minnesotans. From our unique position
within state government, we work as partners with communities, providers, policymakers and
other organizations. Together, we develop innovative approaches and tailor our tools and
resources to the diverse populations we serve.
Minnesota Rural Health Advisory
Committee Member Profile:
ORHPC talks with Diane Muckenhirn
Diane Muckenhirn is certified in Women’s Health and Family Practice and is a nurse
practitioner at Hutchinson Medical Center in Hutchinson, Minnesota. Diane joined the multispeciality Hutchinson Medical Center in 1986 as the first nurse practitioner and also the first
female provider. She earned her master’s in nursing from Mankato State.
For the two years prior to taking her current position, Diane was director of nursing in longterm care; but her career has been almost entirely as a nurse practitioner focusing on her
passion for women’s health and disease prevention.
Diane Muckenhirn
Diane particularly enjoys offering health provider courses and lecturing in various forums,
including in schools and through community education. The topics she covers usually concern
women in care but are often about preventive health care issues. She bases much of her patient
education and lectures on resources such as Healthy People 2010 and other preventive
guidelines that are evidenced based.
Since 1983, Hutchinson has been home to Diane and her husband Mark, who is a construction
manager for Quade Electric. Their children include Amy, who is 20 and studying nursing; Ryan,
who is 16, and Brad, who is 12. Both boys attend Hutchinson high schools. Diane’s family
hobbies include traveling, camping, fishing, hunting and taking occasional bike trips. Diane
describes her family as her own personal hobby—developing strong family ties that lead to
lasting experiences for them to enjoy with each other and friends.
Diane, what do you think are the most important issues facing rural health today?
The Rural Health Advisory Committee
advises the Commissioner of the
Minnesota Department of Health and
other state agencies on rural issues;
provides a systematic and cohesive
approach toward rural health issues;
and encourages cooperation among rural
communities and providers. Regular
meetings are held at Snelling Office
Park in St. Paul, Minnesota and are
open to the public. Dates,
times and directions are online at
www.health.state.mn.us/divs/chs/
rhac.htm or contact Tamie Rogers at
(651) 282-3856 or
[email protected].
Karen Welle, Acting Director
Mary Ann Radigan, Editor
Cirrie Byrnes, Editorial Assistant
DM: Health care costs—no question that this is very serious. Ultimately, the only means of
controlling health care cost and spending is to really be serious as individuals and as a state in
preventing disease versus paying for the outcome of disease once established.
In order to control health care cost, prevention is the real answer for today and the future. Rural
health in Minnesota has to be maintained and improved. We can do this by educating people
and promoting guidelines that stress reduction of disease. Schools, communities and public
health must be given the resources to enact and meet the objectives put forth in Healthy People
2010 and beyond. This must include delivering knowledge to all of Minnesota’s population
groups in a method that is culturally sensitive.
What one or two changes do you think would make the most difference for rural health?
DM: I want everyone to realize the importance of prevention. One example of disease
intervention or prevention is physical activity. Physical activity is one of the leading health
indicators for the nation, including Minnesota. It is one of the most important controllable
lifestyle changes that will prevent a number of chronic conditions including heart disease,
diabetes, weight control and the resulting problems of obesity along with some cancers. Early
emphasis on healthy behavior leads to healthy adults. Recent reports on physical activity in 12to 21-year-olds show that 25 percent reported no physical activity and 50 percent reported only
occasionally exercising. Only 12 percent of 65- to 74-year-olds participated in a physical activity
twice a week.
Waiting to pay for the effects of preventable disease once established will continue to drain our
health care resources in rural Minnesota along with individual financial resources and also our
quality of life. As a health care provider, I promote prevention at every opportunity with patients
and my community. As individuals we have a role in controlling our own health and health care
costs by preventing disease.
We need to establish the cultural norm that each and every Minnesotan can make a difference
through prevention. This would result in a reduction of spending on health care and an
improved quality of life. Reducing the burden of skyrocketing health care costs by prevention is
critical to rural health in Minnesota. We must protect our most important resource—our
individual health.
2
PARTNER’S PAGE
Medicare Advantage: Mixed News for Rural Communities
The Medicare Modernization Act of 2003 changed the options for seniors interested in supplementing their Medicare
coverage through private health plans. Formerly known as Medicare+Choice, Medicare Advantage allows seniors to
receive their Medicare benefits through licensed managed care providers. Although Medicare managed care plans have
historically had few rural participants, nationally about 4.8
million people are enrolled in Medicare Advantage. Early
indications are that this number will expand because insurers
are able to provide Medicare benefits for a low monthly fee,
thus providing seniors with an incentive to switch from
traditional supplemental insurance.
On its face, Medicare Advantage may seem like a deal too
good to pass up. But upon further examination, current
provisions, if left unchanged, could have negative
consequences for rural hospitals and clinics, and for seniors.
Ultimately, it could affect access to health care services in
some rural communities.
Provisions could endanger access to services
Currently, most small rural hospitals in Minnesota are
federally designated and Medicare certified as Critical
Access Hospitals. With this designation comes a higher level
of reimbursement from Medicare to help ensure that care
continues to be available in rural areas. Minnesota has more
than 100 rural hospitals, 66 of them are Critical Access
Hospitals. This program has been a huge success story for
Minnesota, and nearly all of Minnesota’s qualifying rural
hospitals have been either designated as a Critical Access
Hospital or plan to be by the end of 2005. But a provision
of the Medicare Advantage plan may undermine or even
reverse the advantages that have come to Minnesota’s rural
hospitals as a result of Critical Access Hospital designation.
Critical Access Hospital – Minnesota
"There is concern that Medicare
Advantage might hurt small rural
and critical access hospitals. Costbased reimbursement has been an
important part of Critical Access
Hospitals' recent financial recovery
and needs to be protected."
—Terry Hill, director of the Rural Health
Resource Center in Duluth
Although negotiations between Medicare Advantage
plans and providers are in the early stages in much of
Minnesota, there is no provision in the Medicare
Modernization Act of 2003 that obligates managed care
plans to pay Critical Access Hospitals the higher
reimbursement they receive from traditional Medicare.
For a Critical Access Hospital with a disproportionate
number of Medicare patients, the revenue from other
patients doesn’t offset the losses they could experience
under Medicare Advantage.
While a number of these new Medicare Advantage plans
are initially offering lower premiums to the beneficiary,
“In the long run,” explained Rick Failing, “it may end up
hurting seniors. The lower level of reimbursement the
Critical Access Hospital will receive from these plans
may put the facility into financial straits that leads to
services being cut or hospital closure.” Failing is the
administrator of Kittson Memorial Healthcare Center in
Hallock, Minnesota. Kittson Memorial is a 15-bed
Critical Access Hospital, with an attached 77-bed nursing
home and a Rural Health Clinic. “Many of these Critical
Access Hospitals are the largest employers in the area.
Not only would access to healthcare services be affected,
so too would the entire economic health of the area.”
Failing added.
See “Medicare Advantage”
(back page)
3
PROGRAM FOCUS
Lab workforce shortage eases, but challenges persist
by Jay Fonkert
Lab employees reflect overall workforce
The Office of Rural Health & Primary Care (ORHPC)
studied Minnesota’s clinical laboratory industry and its
workers and learned that despite easing of vacancy rates,
managers of Minnesota’s clinical laboratories still report
difficulty hiring enough workers. This is especially serious
in our smallest rural facilities where the data may not
completely represent the reality of struggling to hire and
retain workers.
Minnesota’s laboratory workforce is female dominated,
limited in diversity and similar in age to Minnesota’s
overall working population. Eighty-five percent are female
and only 6 percent are nonwhite. Survey respondents had
a median age of 41, compared to an estimate of 43.9 for
Minnesota’s overall working population (ages 25-69). Half
said they graduated from high school before 1980.
Jon Linnell, chief executive officer of North Valley Health
Center in Warren, Minnesota explains, “We could lose
one or two RN positions—it would be tight but we could
get by; however, if we lose just one x-ray or laboratory
tech we may have to close our doors.”
Shortages may impact patient care
Shortages in the laboratory workforce can cause delays,
errors associated with heavier workloads, and increased
costs—either through higher salaries or the need for labs
to send specimens to outside reference labs.
There are more than 6,510 clinical laboratory
technologists and technicians in Minnesota, compared to
fewer than 4,000 family and general practitioners,
internists, pediatricians, obstetricians and gynecologists
combined. Clinical laboratory workers are part of the
underlying support structure helping direct care
professionals. They sample and analyze body fluids, tissues
and cells, which help physicians diagnose diseases and
monitor treatments. They are critically important for
accurate and timely diagnosis. Lab workers also include
phlebotomists, cytotechnologists, histotechnologists,
histotechnology technicians, certified medical assistants
and others.
Concern about vacancies
Vacancy rates for key clinical laboratory occupations
soared in the late 1990s, prompting serious concerns
about workforce shortages that could undermine delivery
of health care in Minnesota. Concerns turned grave when
terrorist attacks raised fears of chemical or biological
attacks that could overwhelm the state’s laboratories.
The national vacancy rate for clinical laboratory
technicians hit 14 percent by 2000. Clinical laboratory
technologist vacancy rates peaked at 11 percent. Rates
have fallen to more moderate levels since, but lab
managers still report difficulty filling positions. One-fourth
of labs with technician vacancies said the positions were
open more than six months. A third of labs with
technologist vacancies said they were vacant more than
six months. Vacancy rates compiled by the Minnesota
Department of Employment and Economic Development
fell to 3 percent or less by 2004, but some managers
believe the rates have been artificially depressed by
removing vacant positions from their budgets.
More than half of respondents reported at least a
bachelor’s degree. Fourteen percent said they planned to
leave their job within two years to seek more education,
often a master’s or doctoral degree.
The age of the laboratory workforce in 2004
14
55-64
29
45-54
35-44
24
25-34
25
7
16-24 yrs.
0
10
15
20
25
30
N=2,403
Income for laboratory workers
Laboratory jobs pay a bit more than the average
Minnesota job. The Minnesota Department of
Employment and Economic Development estimates
2004 median wages for technologists and technicians
at $22.47 and $17.62, respectively, compared to
$15.19 for all Minnesota occupations.
Survey respondents (all laboratory occupations) reported
a median wage of $18 per hour, or about $37,000
annually. Nineteen reported hourly wages of more than
$25, but 18 percent said they were paid less than $15 per
hour. Forty percent said they had household incomes
more than $65,000, but 18 percent (many single-earner
households), said they had household incomes below
$35,000. One-third of all lab workers said they were the
sole earner in their household, with men and women
reporting similar incomes.
Reported hourly wages in 2004
40%
35%
30%
25%
20%
15%
10%
5%
0%
37%
27%
17%
16%
3%
1%
less
than
$10
N = 2,065
4
5
$10$14
$15$19
$20$24
$25$29
$30 or
more
Lab workers’ environment
A third of all respondents in the survey said they had
joined their current employer since 2000, but another
third said they had been with the same employer since
before 1980. Personal experience and influence of friends
and relatives were the leading reasons for pursuing
laboratory jobs. Dissatisfaction with compensation was the
leading reason given by 17 percent who said they planned
to leave the profession within two years.
Nearly three-quarters of the respondents said they worked
at least 32 hours per week. Nearly half said they typically
worked at least some overtime; 9 percent said they
worked more than four hours of overtime.
continue to make it difficult for labs to recruit enough
workers. And, given advances in diagnostic technology
and the need for ever more sophisticated laboratory
capacity, understaffed laboratories would cripple health
care delivery in Minnesota.
“We could lose one or two
RN positions—it would be tight
Workplace centers of clinical lab employees in 2004
but we could get by; however, if
we lose just one x-ray or
laboratory tech we may have to
close our doors.”
N = 2,429
More than half said they worked in a hospital setting, and
35 percent reported working for a clinic.
Labs are most commonly associated with clinics (43
percent), hospitals (33 percent) and physician-provider
offices (26 percent). Hospital-affiliated labs tend to be
larger than clinic-affiliated labs. Twenty-seven percent of
hospital labs had more than 15 employees, compared to
14 percent of clinic labs.
What the future holds
Clinical laboratories face the same challenges as other
employers in recruiting and retaining employees. Wage
levels may be less important for hiring entry-level
employees than for keeping employees who may be
drawn away to competing opportunities. All professions
face the challenge of retraining workers as new science
and technology enter the workplace, and this is especially
true in clinical laboratories where occupations are tied to
rapidly evolving medical science.
The clinical laboratory workforce is not unusually old and
probably has no more of a retirement crisis than most
occupations. However, increasing demand for health care
and new demands being placed on laboratories will likely
—Jon Linnell, Chief Executive Officer
—North Valley Health Center
—Warren, Minnesota
Findings from the two surveys will help the Minnesota
Department of Health, industry groups and higher
education officials identify workforce planning issues and
develop strategies to ensure adequate numbers of welltrained clinical laboratory workers.
For more information
The Office of Rural Health & Primary Care first surveyed
laboratory managers about vacancies, recruitment and
laboratory operations and then asked employees in
responding labs about demographics, education, income
and job satisfaction. A Profile of Minnesota Clinical
Laboratory Employment and Operations is available on
the Minnesota Department of Health Web site at:
http://www.health.state.mn.us/divs/chs/workdata.htm
or contact Jay Fonkert at [email protected]
or (651) 282-5642.
5
Transitions Equal Opportunities
by Karen Welle
Whenever there is change, there is opportunity. It has now been several months since Estelle
Brouwer left her position as Director of the Office of Rural Health & Primary Care. In spite of
Estelle’s departure, her vision and passion remains for doing all we can to ensure a strong
rural health system for Minnesota’s rural and underserved communities. As Estelle promised,
our staff remains committed to the goals of our Minnesota Rural Health Plan:
DIRECTOR’S CORNER
Karen Welle
•
To ensure a strong, integrated rural health system
•
To support a sound rural professional health care workforce
•
To promote effective health care networking and community collaboration
•
To foster increased capacity and resources to ensure rural health care access and quality.
As we look forward, it is natural to ask, where are we now? How are we doing? Are we
meeting our customers’ needs? Having answers to these questions is fundamental to moving
forward in a direction that makes sure we are meeting our mission as an office of rural health
and primary care.
If we had your email address, you received our February zoomerang.com stakeholder
satisfaction survey. Many thanks to those of you—all 162—who took the time to give us your
feedback. Our staff was very interested in what you had to say.
Among some of the interesting facts:
•
Getting rural health information is important to you. Our communications/Web pages
and rural health reports and fact sheets are the most-often used services.
•
Grants, Critical Access Hospital and Rural Health Clinic support, Health Professional
Shortage Area and Medically Underserved Area designations, and health workforce data
and analysis are heavily utilized.
•
Other services accessed included: loan forgiveness; health professional recruitment; rural
health policy development and planning; emergency preparedness; and community
health services planning.
•
Some of you suggested areas that we could strengthen, such as hosting more
educational opportunities, collecting more data about rural health and making sure our
Web pages are as informative as possible.
•
And, most heartening to our talented, hard-working staff was hearing almost unanimous
agreement that you find us to be knowledgeable, professional, accessible and timely in
our responses.
We plan to use this information to help us move forward—to hire a director who will continue
to provide strong leadership for rural health in Minnesota and to ensure that we are continuing
to meet our mission of promoting access to high quality health care for all Minnesotans.
Karen Welle is Acting Director of the Office of Rural Health & Primary Care. She can be
reached at (651) 282-6336 or [email protected].
6
Join us in Duluth for the 2005 Minnesota Rural Health
Conference: “Smart Health for Rural Communities,”
where we will focus on maintaining and improving
health care services in greater Minnesota through:
Quality
“Smart Health” begins with the Institute of Medicine’s six quality
recommendations that rural health care will be safe, effective, patientcentered, timely, efficient and equitable.
Technology
Health information technology is gaining momentum through national
calls to action and funding initiatives and is a critical component of
maintaining access to health care in rural communities.
Collaboration
Collaboration is an essential component to meeting the needs of changing
rural populations and it is at the heart of the evolving rural health
infrastructure in Minnesota.
Economics
Rural communities need adequate and appropriate financial resources to
achieve stability. Maximizing access to reimbursements and capital are
critical to the viability of our community health systems.
Hosted by:
Minnesota Department of Health - Office Rural Health & Primary Care
Minnesota Rural Health Association
Rural Health Resource Center - Minnesota Center for Rural Health
Information for the July 18-19 conference in Duluth, Minnesota is online at
http://www.health.state.mn.us/divs/chs/orhconf.html or contact Sally Buck at Rural
Health Resource Center [email protected] or (800) 997-6685 ext. 225
7
To learn more about the
Office of Rural Health & Primary
Care programs, visit our Web site:
www.health.state.mn.us/divs/chs/
orh_home.htm
Medicare Advantage
(continued from page 3)
Failing is not alone among rural hospital advocates in his concern. Terry Hill, director of the
Rural Health Resource Center in Duluth adds, “There is concern that Medicare Advantage
might hurt small rural and critical access hospitals. Cost-based reimbursement has been an
important part of Critical Access Hospitals’ recent financial recovery and needs to be
protected. We aren’t denouncing Medicare Advantage, it’s probably too early to know how
this will play out in rural America, but since rural hospitals don’t have an extensive base of
experience with rural managed care we’ll be watching the Minnesota experience closely.”
The other significant risk for seniors arises if they wish to opt back into traditional Medicare.
While they can do so, after belonging to a Medicare Advantage plan for over 12 months, their
previous supplemental plan is not obligated to insure them and may charge a different
premium. Many seniors are unaware of this prior to making the switch to a Medicare
Advantage plan.
Efforts to make Advantage Plan a real advantage
This information will be made
available in alternative format –
large print, Braille, or audio tape
– upon request.
Printed on recycled paper with a
minimum of 20% post-consumer waste.
Current efforts are underway by many rural health advocacy groups that would correct what
appears to have been an oversight in the law. A bill has been introduced that would require
Medicare Advantage insurers to reimburse Critical Access Hospitals and Rural Health Clinics
for Medicare services in the same manner as provided for under those existing programs. This
solution appears to be a good one. The Office of Rural Health & Primary Care staff will
continue to monitor the situation and assist in bringing it to the attention of policymakers.
After working hard to make sure that our small hospitals and clinics are reimbursed fairly,
Minnesota cannot afford to step backwards. Access to quality rural health care depends upon
giving our rural communities the “advantage” they need to remain on a level playing field
with their urban counterparts.
More information about Critical Access Hospitals is on the Office of Rural Health & Primary
Care Web site at: http://www.health.state.mn.us/divs/chs/rhpc/cah/index.html or contact
Mark Schoenbaum at [email protected] or (651) 282-3859.
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