November 6th, 2017


News in brief

The week’s top stories

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Before May 4th, 2018

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Thursday, April 26, 2018, 1-4 pm

The Minnesota Health Care Roundtable is a semi-annual conference featuring a panel of stakeholder group experts in a moderated discussion before a live audience covering topics that affect the evolution of health care policy.

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.


“The current pipeline of graduates appears adequate to replace retirements as they occur. That, coupled with projected increases in demand because of an aging population, will result in a significant talent gap for physicians,” the review concluded.


Specifically, a cumulative shortfall of nearly 850 primary care physicians is projected for the Minnesota workforce by 2024 due to the lack of annual growth in Minnesota’s graduate medical education programs, including residency or clinical training positions. The study showed that the number of openings for residency programs has been frozen since 1996. However, the supply of registered nurses will likely meet the demand, assuming that education programs continue to grow at their expected rate.


In response to the findings, MHA is urging federal and state policy makers to lift the 17-year freeze on the number of physician residency positions available under Medicare funding; oppose cuts to federal Graduate Medical Education Funding; develop a statewide health care workforce plan; seek ways to increase funding of Minnesota’s Medical Education and Research Costs program; and support development of new primary care models, including telehealth technology. In addition, MHA is encouraging the Minnesota Department of Human Services to implement temporary payment increases for primary care services delivered to Medicaid patients as called for under federal law.


“Many of our hospitals, especially those in greater Minnesota, already have difficulty attracting physicians,” said Lawrence J. Massa, president and CEO of MHA. “I hope this new information will provide an impetus to policy makers to make the urgent decisions needed on both the state and federal levels to give our health professional students access to the clinical training and residency experience they need to become licensed to practice.”


Clinical Trial Shows Promise for Recurrent Brain Cancer Treatment


Results from a Phase 1 clinical trial at the University of Minnesota Medical School have shown that more than 25 percent of patients with recurrent high-grade glioma, a form of brain cancer, were alive more than three years after treatment.


“Given the deadly nature of this disease, three-year survival is rarely reported in the recurrent setting,” said Clark Chen, MD, PhD, Lyle French Chair in Neurosurgery and head of the University of Minnesota Medical School Department of Neurosurgery, who led the clinical trial. “It is notable that the survival benefit was seen across a range of patients and not just limited to patients with specific genetic mutations. This finding indicates that many patients could benefit from this treatment.”


Two steps were involved in the treatment of the 56 clinical trial participants. First, patients were injected with Toca 511, a replicating virus that only infects actively dividing tumor cells. Once the virus is inside the cancer cell, it delivers a gene for an enzyme, cytosine deaminase (CD). As the virus replicates and spreads to other cancer cells, it programs them to produce CD. Second, patients received a pill, Toca FC, an inert compound. Once CD was inside the cancer cell, it converted Toca FC into the anticancer drug 5-fluorouracil, which killed the cancer cell. The anticancer drug not only killed the cancer cells, but also killed certain immune suppressive myeloid cells, which boosted the patients’ immune systems to recognize and attack the cancer cells.


“The treatment we tested in this clinical trial delivers local chemotherapy specifically to the brain tumor,” said Chen. “Toca 511 and Toca FC work together to turn the brain tumor into a factory that produces an anticancer drug while also activating the immune system through a combination of mechanisms, which together work to attack the cancer.”


About 43 percent of patients who underwent Toca 511 therapy derived benefit from it. According to Chen, the median survival in this trial is nearly double that of historical data. Median survival was 14.4 months, compared to about eight months for historical controls.

“Brain cancer is one of the deadliest cancers, giving urgency to finding an effective treatment,” said Chen. “The 160,000 people diagnosed with high-grade gliomas worldwide each year—and high-profile cases including U.S. Sen. John McCain, Sen. Edward Kennedy, and Beau Biden—demonstrate the high unmet needs of this disease. The data generated in the Toca 511 research provides hope for patients with brain cancer and their families.”


An ongoing randomized phase II/III trial is in progress to confirm the safety and efficacy of the treatment.


Allina Health, HealthPartners Partnership Improves Care and Lowers Costs


An analysis of the Northwest Metro Alliance, an accountable care organization (ACO) partnership between Allina Health and HealthPartners, has shown that health care costs in Anoka and southern Sherburne counties are increasing at a slower pace than the metro area average. The ACO serves a community of about 600,000 people who receive care at Allina Health and HealthPartners clinics and Mercy Hospital.


An executive summary of the first seven years of the partnership shows that costs rose on average by less than 3 percent per year, compared to a more than 8 percent increase in the year before it began.

The health care systems attribute the reduction in annual cost increases to care improvements such as reducing hospital readmissions, increased use of generic medications, and expanded access to outpatient mental health care. Since the partnership began, the rate of preventable readmissions decreased by more than 25 percent, saving about $11,220 to $13,000 per readmission, and prescriptions for generic medications have increased from 75 percent to 91 percent, saving an estimated $3.4 million per year in drug costs. The Alliance also opened a short-term residential facility for mental health with 16 beds and expanded Mercy Hospital’s partial hospital day-treatment mental health program to serve more than 4,500 patients per year, helping offset the more than 5,000 visits to the Mercy Hospital emergency department each year.


“Allina and HealthPartners recognized that our patients, members, and community needed access to quality care that is more affordable,” said Andrea Walsh, president and CEO of HealthPartners. “Through our partnership we have expanded access to mental health services, reduced hospital readmissions, and lowered health care costs.”


“The Northwest Metro Alliance is an extraordinary care model because we are competitors and are collaborating to do what is best for patients,” said Penny Wheeler, MD, president and CEO of Allina Health.


The Alliance continues through 2019, with an opportunity to extend the partnership.

CentraCare Expanding in Central Minnesota


CentraCare has opened a new walk-in clinic in the Cash Wise grocery store in Waite Park and broken ground on its Coborn Cancer Center’s Coborn Healing Center in St. Cloud for patients who have experienced cancer.


The new quickClinic at Cash Wise is in partnership with Coborn’s, Inc, owner of the Cash Wise grocery store chain. It has two exam rooms and offers treatment for common health concerns, including skin conditions, cold and flu, minor injuries, vaccinations, wellness screenings, and physicals. Two more quickClinics are set to open in the coming months at Coborn’s-owned grocery stores in Foley and Sartell.


“Health care is changing—and so are the needs of our community,” said Ken Holmen, MD, president and CEO of CentraCare Health. “And by partnering with those within our community, we can achieve our goal of improving the health of every patient every day by making access to care convenient for those we serve.”

The 6,500-square-foot Coborn Healing Center will offer services for the mind, body, and spirit for people who begin or continue their cancer journey at Coborn Cancer Center. Programming will include art and music therapy, support groups, spiritual well-being, fitness classes, integrative therapy (such as acupuncture, massage, and healing touch), and an interactive kitchen/classroom. Its estimated completion date is summer 2018. The CentraCare Health Foundation raised more than $3 million over the last two years through community, private, and business donations to cover the cost of the project. No new jobs are expected in the new building, as resources will be shifted from within the CentraCare health care system.


Hot Flashes, Night Sweats in Middle Aged Women Linked to Sleep Apnea Risk


Researchers at Mayo Clinic have found that the hot flashes and night sweats that more than 80 percent of middle-aged women deal with may be linked to an increased risk of obstructive sleep apnea. This most common form of sleep apnea can affect quality of sleep and lead to serious health concerns in women, including increased risks of coronary heart disease, high blood pressure, and stroke.


For the study, researchers used the Data Registry on Experience of Aging, Menopause, and Sexuality, which contains health information on women seen at Mayo Clinic’s Women’s Health Clinic. They analyzed data for women seen between May 2015 and December 2016 and discovered that self-reported severe hot flashes and night sweats were linked to an intermediate to high risk of obstructive sleep apnea. Those who had high blood pressure and were obese were at an especially high risk, but it was also seen in women with a healthy body mass index.


“Obstructive sleep apnea is often thought of as a man’s disease, and men’s symptoms are more outwardly noticeable, in large part because of snoring,” said Stephanie Faubion, MD. “However, the risk for obstructive sleep apnea in women goes up in their menopausal years. The symptoms they face—headache, insomnia, anxiety, depression, in addition to the more common symptoms of snoring and fatigue—may not be as audible or visible to others, but they pose just as much risk to overall health.”


Two years after clinical consultations, 65 percent of women who self-reported these symptoms and demonstrated intermediate or high risk of obstructive sleep apnea had yet to be diagnosed with

the condition.


“Hot flashes and night sweats may be overlooked as a risk of something more serious,” said Faubion. “The implementation of screening tools during evaluation can help determine what symptoms women are facing, and put us on track to detect and intervene with serious health issues, such as obstructive sleep apnea, sooner.”


Minnesota Physician Publishing Inc. © 2017