November 20th, 2017

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News in brief

Opioid Prescription Limits Recommended for Physicians


Minnesota’s Opioid Prescribing Work Group adopted a new rule on Nov. 16 that limits opioid prescriptions for doctors who participate in the state’s Medicare program. It requires approval by Minnesota human services commissioner Emily Piper before it will take effect.


The rule states that nonsurgical physicians and dentists can have no more than half of their opioid prescriptions exceed 100 morphine milligram equivalents, which is about 20 five-milligram Vicodin or Percocet pills. Surgeons can have no more than 200 morphine milligram equivalents per outpatient prescription. The limits only apply to outpatient prescriptions meant to manage short-term or acute pain.


Those who exceed the new limits for more than half of their patients will receive warnings and go through training to help them get on track. If they don’t reduce their dosage amounts, they could face being removed from the Medicaid program.


Pediatric Hospice Facility Opens in Brooklyn Center


The first hospice and respite care facility for terminally ill children in Minnesota celebrated its grand opening on Nov. 16. While there are more than 40 similar child hospice facilities in the United Kingdom, there are only two others in the U.S., located in Arizona and California. They offer an alternative for families whose only other options include caring for terminally ill children at home or seeking end-of-life care in a hospital.


The 6,700-square-foot facility, called Crescent Cove, is located near Twin Lake in Brooklyn Center. It includes six beds, a playroom, an art room, and a small spa pool where parents can bathe with their small children, and a bedroom suite for parents who stay in the facility overnight. The building previously housed an adult residential hospice facility owned and operated by North Memorial Health.


Katie Lindenfelser, executive director for Crescent Cove, founded the organization in 2009 to offer in-home support and respite care for families of children with terminal illnesses, with a future goal of operating a standalone facility where families could bring seriously ill children for overnight respite care or as a full-service hospice facility. Crescent Cove purchased the building earlier in 2017 and began renovations in July.


Crescent Cove will open in phases—the first includes hiring one nurse and one certified nurse assistant in January, when it will take in its first child. At that point, they will be able to care for one to three children at a time. The goal is to be fully staffed and able to care for six children at a time by the end of 2018.


Services will be provided at no cost to families. Crescent Cove will cover its costs with donations, grants, and fundraising events. In addition, the licensed facility is working with the Minnesota Department of Human Services (DHS) to establish funding for families with Medicaid waivers. DHS has sent an amendment to the Centers for Medicare & Medicaid Services requesting to add Crescent Cove to waivers and they should receive a response by early 2018.


Major behavioral health organizations to ban tobacco use


Three large behavioral health organizations in Minnesota will implement a tobacco-free ground policy into all of their programs and locations by the end of 2018.


The participating organizations—Avivo (formerly called RESOURCE), Mental Health Resources, and People Incorporated—together serve about 40,0000 individuals in the state and employ an estimated 1,400 staff members. This is the largest voluntary tobacco-free initiative executed by behavioral health facilities in Minnesota.


“Studies indicate that people with a mental health disorder or substance use disorder have a higher rate of smoking and are often not given tobacco treatment resources,” said Janelle Koscinski, senior manager of tobacco programs with the American Lung Association in Minnesota. “Tobacco-free policies like the one that these behavioral health facilities will implement are proven to reduce smoking rates in these communities, which will improve the overall health of these individuals.”


The policy will be implemented in partnership with the American Lung Association in Minnesota to help line up tobacco treatment opportunities for individuals who need the services.


“We see, first-hand, the health disparities experienced by our clients,” said Jill Wiedemann-West, CEO of People Incorporated. “Tobacco treatment plays a significant role in treating the whole person—a key part of our mission and promise to our clients, staff, and communities.”


Tobacco use is the leading cause of death and disease among people living with mental illness, according to the organizations. An analysis of 26 different studies showed improved mental health with quitting smoking and found that anxiety, depression, mixed anxiety and depression, and stress significantly decreased among those who quit smoking compared to those who continued smoking. In addition, surveys conducted in the past have shown that up to 75 percent of individuals with a mental illness who smoke want to quit, compared to 60 percent of the overall population who smoke. Studies have also shown that adults with a serious mental health illness and a tobacco-related diagnosis on average died 32 years earlier than adults without a serious mental health illness and without a tobacco-related diagnosis.


“The use of tobacco and secondhand smoke exposure are proven health and safety hazards that carry very serious health risks,” said Kelly Matter, president and CEO of Avivo. “Tobacco is the leading cause of preventable death in the United States and is inconsistent with our mission to increase well-being through recovery, employment, and career advancement.”


The policy will apply to all buildings and grounds associated with the organizations. Prohibited products include commercial tobacco and tobacco-like products, including cigarettes, electronic cigarettes, cigars, chewing tobacco, snuff, pipes, dissolvable tobacco products, and snus. The organizations will meet monthly with the American Lung Association to prepare for the policy implementation until it goes into effect. The American Lung Association will also provide future trainings, resources, and linkages for clients and staff on integrating tobacco treatment services into existing treatment and wellness programs.


“Addressing tobacco has to be a priority,” said Ann Henderson, vice president of Clinical Services for Mental Health Resources. “It’s a social justice issue. We as a culture have not prioritized the health of this population, to disastrous consequences.”


More than 91,000 Get Health Coverage Through MNsure


MNsure’s enrollment is up to 91,623 for 2018 coverage as of Nov. 15, two weeks into open enrollment. Minnesotans can sign up through Jan. 14, 2018.


“Our first two weeks have gone very smoothly,” said Allison O’Toole, MNsure CEO. “MNsure’s enrollment is looking strong out of the gate. This year, we have renewed twice as many people into coverage than last year, and we’re already seeing a steady stream of new customers.”


The health insurance marketplace is also seeing improvements with its website functionality and call center wait times compared to past years. More than 400,000 people have visited MNsure’s website and there have been more than 23,500 calls with an average wait time of one second before the call is answered.


MNsure is currently replacing part of its computer system, with details being finalized and development beginning by the end of 2017. It is expected to be fully implemented before open enrollment begins next fall.

New Guidelines Classify Millions More as Having Hypertension


The American College of Cardiology and the American Heart Association released new blood pressure guidelines on Nov. 13 that will classify millions more people in the U.S. as having hypertension, according to Mayo Clinic.


The new guidelines include a lowered blood pressure range for what is considered normal, meaning people whose blood pressure used to be considered high normal or prehypertension now will be considered elevated blood pressure or stage 1 hypertension. Under the old guidelines from 2003, top line, or systolic, blood pressure levels under 120 were considered normal and levels of 120 to 140 were considered high normal or prehypertension. According to the new guidelines, under 120 is still normal, but 120 to 129 is considered elevated blood pressure. The associations estimate the change will affect more than 31 million people in the U.S.


“The main difference is that high blood pressure, stage 1 hypertension starts at 130,” said Sandra Taler, MD, a nephrologist at Mayo Clinic. “So 130 to 139 systolic, 80 to 89 diastolic would be stage 1 hypertension. And then at 140 systolic and 90 diastolic, that’s now stage 2.”


Taler helped write the new guidelines, which will mean medication will be recommended to millions of people whose blood pressure classification has changed as people with state 1 hypertension may need it and those with stage 2 should be taking it.


Children’s Minnesota Names Next CEO


Marc Gorelick, MD, has been named the next chief executive officer of Children’s Minnesota. Bob Bonar, who currently holds the position, announced he would retire Dec. 8 after being with the organization since 2014. Gorelick will step into the position on Dec. 9.

Gorelick has more than 25 years of experience in pediatric emergency medicine, education and research, hospital operations, and health care leadership. He joined Children’s earlier in March as president and chief operating officer.


“Marc is a physician whose ability to manage a complex organization like Children’s is matched only by his deep compassion for patients and their families,” said Hayes Batson, chair of Children’s board of directors. “He is exactly the right person to pick up where Bob left off in pursuing the strategic goals of the system.”


Before joining Children’s, Gorelick served as chief operating officer and executive vice president of Children’s Hospital of Wisconsin. He has also served as executive vice president of Children’s Hospital and Health System and professor of pediatrics (emergency medicine) at the Medical College of Wisconsin and chief executive officer of Children’s Specialty Group and vice president of surgical services, medical director of the emergency department, and chief of pediatric medicine at the Medical College of Wisconsin. He earned his medical degree from Duke University and a master’s degree in clinical epidemiology from the University of Pennsylvania.

St. Luke’s Adds Virtual Care Clinic Services

St. Luke’s has launched St. Luke’s eCare to allow patients in the area access to online diagnosis and treatment. Patients can connect with St. Luke’s health care providers through their smartphones, tablets, or computers.


“It is more important than ever to give our patients multiple avenues to receive care,” said Sandra Barkley, vice president of clinics for St. Luke’s. “The launch of St. Luke’s eCare adds a new, convenient access point to connect patients with the care they need, when and how they need it.”


Once a patient logs in on a device, they complete a brief online interview about their symptoms and health history. A provider then reviews the results and responds with a diagnosis and treatment plan. The virtual care service is powered by Zipnosis, a Minneapolis-based company that partners with health care systems to provide virtual care and telemedicine services.

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December 4, 2017

Two Qualifying Conditions Added for Minnesota’s Medical Cannabis Program


Autism spectrum disorders and obstructive sleep apnea have been added as qualifying conditions for the state’s medical cannabis program.


“Any policy decisions about cannabis are difficult due to the relative lack of published scientific evidence,” said Ed Ehlinger, MD, Minnesota commissioner of health. “However, there is increasing evidence for potential benefits of medical cannabis for those with severe autism and obstructive sleep apnea.”


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November 27, 2017

Three Health Care Organizations Partner to Form Carris Health


ACMC Health, CentraCare Health, and Rice Memorial Hospital are collaborating to create a new entity called Carris Health that will serve as a health care hub serving West Central and Southwest Minnesota.


Initial discussions about the partnership began in May, when the organizations signed a letter of intent to join forces. After months of discussion, strategy meetings, and town hall meetings, the Willmar city council voted unanimously to approve plans for the city-owned Rice Memorial Hospital to join the new health care system on Nov. 20 and ACMC Health’s board of directors and its 89 physician shareholders also voted to proceed with the integration with a final decision made at a shareholder’s meeting, also on Nov. 20. Carris Health will be a subsidiary of CentraCare Health.


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November 20, 2017

Opioid Prescription Limits Recommended for Physicians


Minnesota’s Opioid Prescribing Work Group adopted a new rule on Nov. 16 that limits opioid prescriptions for doctors who participate in the state’s Medicare program. It requires approval by Minnesota human services commissioner Emily Piper before it will take effect.


The rule states that nonsurgical physicians and dentists can have no more than half of their opioid prescriptions exceed 100 morphine milligram equivalents, which is about 20 five-milligram Vicodin or Percocet pills. Surgeons can have no more than 200 morphine milligram equivalents per outpatient prescription. The limits only apply to outpatient prescriptions meant to manage short-term or acute pain.


Read the issue

November 13, 2017

Health Licensing Boards Implement Criminal Background Check Program


The Minnesota Health Licensing Boards have cooperatively established the Criminal Background Check Program to help new applicants for licensure efficiently complete the mandatory fingerprint-based criminal background check now required by Minnesota law.


Mandatory criminal background checks for professionals regulated by the Minnesota Board of Medical Practice will be implemented in phases—on Nov. 10 for acupuncturists, traditional midwives, and respiratory therapists; on Nov. 17 for physician assistants; and Dec. 1 for physicians, surgeons, and genetic counselors.


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November 6, 2017

MHA Study Projects Physician Shortage


A new study conducted by the Minnesota Hospital Association (MHA) has confirmed that a shortage of primary care physicians will develop in the state over the next decade.


MHA collects health care workforce data from most Minnesota hospitals each year and this year, for the first time, MHA called on Towers Watson, a global professional services company, to conduct a comprehensive review of the state of the primary care physician and registered nurse workforces in Minnesota. The company used publicly available data from the Bureau of Labor Statistics and the state of Minnesota in addition to the hospital workforce data provided to MHA.


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October 30, 2017

Medica Names New Chief Medical Officer


John Mach, Jr., MD, has been named Medica’s new chief medical officer. He steps into the role on Nov. 6, succeeding Alan Spiro, who held the position since July 5, 2016.


Mach has more than 31 years of medical experience. Most recently, he served as chief medical officer for Evolent Health in Arlington, VA. Before that, he served as the president of complex care management at Univita Health Inc., based in Miramar, FL. He has also served as chief medical officer at several organizations, including UnitedHealth Group, where he also served as chairman and chief executive officer of its Evercare division. He earned his medical degree at the University of Minnesota Medical School, where he also completed a residency in internal medicine.


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October 23, 2017

International Study Shows Immune Response to Ovarian Cancer May Help Predict Survival


A type of white blood cell called tumor-infiltrating lymphocytes has been found present in the tumors of patients with high-grade ovarian cancer, according to a team of international cancer researchers led by investigators from Mayo Clinic and the University of New South Wales Sydney. The discovery may help predict a patient’s survival.


“We know that a type of tumor-infiltrating lymphocyte called cytotoxic CD8 are present in the tumors of patients with high-grade ovarian cancer,” said Matthew Block, MD, PhD, an oncologist at Mayo Clinic that co-led the research team. “However, little was known about the role in fighting high-grade ovarian cancer, compared to other clinical factors.”


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October 16, 2017

New Allina Health Hastings Clinic Opening in November


Allina Health will open its new clinic in Hastings on Nov. 6. The facility is replacing the current Allina Health Hastings First Street Clinic location.


“Our goal is for residents of Hastings and surrounding communities to receive comprehensive health care close to home and, at the same time, have access to specialists through the broader Allina Health network,” said Kevin Best, MD, lead physician for the clinic. ”


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