January 2019, Volume XXXII, No 10
Mayo Clinic Health System has made the decision to close its clinics in Alden and Kiester in Southeast Minnesota effective Friday, January 25. The health system said in a press release that they reached the conclusion that they were not able to staff the two clinics at a level that will provide proper clinical care.
“This decision was not made lightly as we understand how and where people receive health care is a very important issue,” said Jay Mitchell, MD, chair of outpatient practice for Mayo Clinic Health System’s Southeast Minnesota region. “We listened to community concerns and pursued several options. With patient data showing that more than half of the patients using the Alden and Kiester clinics come from other communities, as well as less than 10 patients being seen on any given day at either clinic, we believe patients’ health care needs will be better served in other nearby clinic locations in Lake Mills, New Richland, Wells, and Albert Lea.”
The move follows Mayo Clinic’s announcement in October that due to staffing challenges, it would reduce services at the two clinics to one day a week from November through the end of 2018, after which there would not be a prescribing provider on site in either clinic. Community meetings were held with city and community leaders in both locations to discuss the challenges of rural health care and gain insight as to what level of care is needed.
Mayo Clinic says the decision continues to reflect ongoing issues affecting rural health care, including recruitment of providers. The two clinics used the one day a week they were open in January to provide education to local patients and community members on how to access care in other ways.
The Minnesota Hospital Association (MHA) has released its third annual report examining the financial health of Minnesota’s hospitals and health systems. It analyzes publicly available data from fiscal year 2017 (the most recent available) that hospitals and health systems are required to submit to the Minnesota Department of Health annually.
According to MHA, a hospital’s operating margin is the most recognizable bottom-line measure of whether it can continue to meet patient and community needs. Overall, hospitals’ operating margins improved in 2017. The trend of overall median hospital operating margin in Minnesota has remained steady in the state at just over 2 percent since 2013, but the statewide operating median operating margin moved to 2.3 percent in 2017.
Fifty-six of the state’s hospitals and health systems in the report generated positive margins in 2017, but MHA noted that 26 hospitals (31 percent of hospitals and health systems in Minnesota) experienced negative operating margins. That number is down from the previous year—29 showed negative operating margins in 2016.
MHA notes that historically, Minnesota’s urban hospitals have had higher margins than those in rural areas. However, that gap is narrowing. The median operating margin for urban hospitals was 2.8 percent, down from 3 percent in 2016. For rural hospitals, the median operating margin was 2.1 percent, up from 2 percent in 2016.
The full report is available on the MHA website.
The Fred C. and Katherine B. Andersen Foundation has awarded the Gillette Foundation a five-year grant to expand Gillette Children’s Specialty Healthcare’s spine program. It is the largest grant Gillette Foundation has ever received.
The funds will be used to grow the spine program from a regional center of clinical care to a national pediatric spine institute focused on high-quality clinical care, research, and education.
Currently, Gillette has the only spine program in the state skilled at treating all types of spinal curvature including scoliosis and kyphosis. They treat 3,500 patients each year who have scoliosis and provide 80 percent of spine surgeries for children in Minnesota age 14 and younger.
Cambridge Medical Center (CMC) has received a two-year grant from the University of Minnesota to increase the availability of clinical trials in Minnesota communities. The center is now an affiliate site for the Metro-Minnesota Community Oncology Research Consortium (MMCORC), which works with hospitals and clinics across the metro area so local physicians have access to the newest advances in cancer research and links community cancer specialists, primary care physicians, and other health care professionals to NCI-approved research studies.
“The CMC oncology team has offered clinical trials since 2014 when CMC became accredited by the Commission on Cancer Center, which requires that a certain percentage of patients diagnosed with cancer at CMC are placed on a clinical trial,” said Gary Shaw, president of Cambridge Medical Center. “Becoming an affiliate site for MMCORC will help our team connect even more patients with opportunities to participate in clinical trials.”
Arvind Vemula, MD, an oncologist and hematologist at CMC, will be the senior research investigator on the project. He has an extensive research background and previously served as the director of clinical trials and research at North Iowa Mercy Cancer Center.
According to CMC officials, they have a high population of patients who have financial challenges and many need assistance to pay for treatment. They hope that working with the MMCORC through this grant will provide more treatment options to patients that likely wouldn’t have been able to consider advanced care outside of their community.
Sanford Health has joined 11 other health systems as new founding members of Civica Rx, a not-for-profit generic drug company that will address shortages and high prices of lifesaving medications. It was established in September by seven health systems and three philanthropies, including Mayo Clinic.
Together, the 12 founding health systems represent about 300 hospitals across the U.S. When combined with hospitals represented by the initial governing members, about 800 hospitals have joined the venture so far.
“Drug shortages have become a national crisis where patient treatments and surgeries are canceled, delayed, or suboptimal,” said Martin VanTrieste, CEO of Civica Rx. “We thank these organizations for joining us to make essential generic medicines accessible and affordable in hospitals across the country.”
Civica Rx is working toward becoming an FDA-approved manufacturer, and will either directly manufacture generic drugs or subcontract manufacturing to reputable partners. It has identified 14 hospital-administered generic drugs that are the initial focus of its efforts, and expects to have its first products on the market as early as mid-2019.
According to results of a study from the Minnesota Department of Health and the University of Minnesota School of Public Health, Minnesota had a nearly seven-fold increase in telemedicine visits between 2010 and 2015, from 11,113 to 86,238.
The researchers analyzed data from the Minnesota All Payer Claims Database to determine patterns of telemedicine use. They did not look into the effectiveness of telemedicine, but discovered a rapid increase in its use.
Though less than 1 percent of patients use telemedicine, the researchers found that it has evolved to serve somewhat different uses for metro area and Greater Minnesota patients and for those with private or public insurance. Non-metro patients in Greater Minnesota more commonly used telemedicine for real-time visits initiated by providers and included specialty consultations. In metropolitan areas, including the Twin Cities, Rochester, St. Cloud, and Duluth areas, the majority of telemedicine services were online evaluation visits for primary care provided by nurse practitioners to patients with commercial insurance. A greater number of telemedicine users lived in metro areas, however the rate for telemedicine use was higher in non-metro areas for people with Medicare and Medicaid.
“This research shows that telemedicine may be emerging as an option to overcome some of the geographical barriers of accessing specialty care in Greater Minnesota, particularly in the area of mental health,” said Jan Malcolm, Minnesota commissioner of health. “We need more research to ensure quality is being maintained, but this study highlights the importance of seeking innovative ways to provide access to health care in Greater Minnesota, including thinking broadly about funding investments in the health care workforce, as well as technology such as telemedicine equipment and broadband access.”
According to the researchers, the data also indicate that Minnesota’s telemedicine market during that period was shaped in part by differences in telemedicine coverage by insurance plans rather than the differing clinical needs of patients—for example, there was very low direct-to-consumer use among Medicaid patients. During the study period, commercial plans increasingly covered patient-initiated online medical evaluations, while Medicare and Medicaid primarily covered the real-time consultations with clinicians. At the end of the study period in 2015, the Minnesota Telemedicine Act was passed that required private insurers and Minnesota Health Care Programs to provide the same coverage for telemedicine as in-person visits and removed requirements for a previous in-person visit.