Minnesota Hospital Association


September 29, 2014

MHA Newsline: Sept. 29, 2014

In this issue 

MHA touts telehealth in rural communities

Pipestone County Medical Center and Family Clinic Avera hosted a site visit from the National Advisory Committee on Rural Health and Human Services (NACRHHS) on Sept. 25. The focus of this site visit was the role of telehealth for improving access and quality of care in rural communities. 

NACRHHS is a 21-member panel of rural health experts from across the country who make recommendations on rural health issues to the Secretary of the U.S. Department of Health and Human Services. NACRHHS members attending the site visit came from rural communities as far apart as Alaska and Maine. 

Lawrence Massa, president and CEO of the Minnesota Hospital Association (MHA), participated in the discussions to convey the importance of removing regulatory and reimbursement barriers to better leverage telehealth’s capacity to make high quality care more accessible and affordable in rural communities, as well as urban settings for services such as mental health. 

Brad Burris, CEO of Pipestone County Medical Center and Family Clinic Avera, and leaders from Avera demonstrated how the critical access hospital’s patients benefit from eEmergency services that provide real-time access to specialists in Sioux Falls via telehealth. The NACRHHS delegation later traveled to Sioux Falls to tour Avera eHelm, the health system’s telehealth center. 

For more information about NACRHHS, visit the HRSA websitereturn to top  

Hospitals working to detect, prevent and manage delirium

The statewide Delirium – Detection, Prevention and Management kickoff event was held on Wednesday Sept. 24. 

Experts shared delirium best practices and Minnesota pilot hospitals provided lessons learned and implementation strategies from their experiences with the delirium pilot project that has been underway since October 2013. The purpose of the pilot was to test best practices for detecting, preventing and managing delirium in hospitalized patients. The conference was the start of MHA’s statewide roll-out of the delirium best practices to hospitals across the state. A road map of best practices for getting started with implementing these practices within hospitals was provided and discussed and implementation tools were shared. 

For those individuals who were not able to attend, the conference was videotaped. This recording will be available for everyone to view in the next 1-2 weeks. In the meantime you may view the PowerPoint presentation

To participate in the Delirium initiative, please complete the Delirium: Detection, Prevention andManagement commitment form.  

For questions, contact Karen Olson, MHA HEN patient safety and quality coordinator, 651-603-3521. return to top   

HEARRT sustainability forum scheduled for Oct. 31

The Healthcare Environmental Awareness and Resource Reduction Team (HEARRT) is hosting “The Affordable Care Act: How Sustainability Hits the Triple Aim.” This free forum will focus on how the three facets of sustainability (society, economy and environment). MHA members will present their experiences incorporating sustainability initiatives into their business models to lower health care costs and improve population health for their communities. 

HEARRT is a public/private group including MHA members and MHA staff working to connect health care professionals to encourage and support sustainability actions that improve environmental and community health and reduce costs. 

The event takes place Oct. 31 from 12:30 - 4:30 p.m. at HealthPartners headquarters in Bloomington. Event registration is free, but space is limited. Click here to register and for more information. return to top   

DEED accepting applications for broadband grants

The Office of Broadband Development within the Minnesota Department of Employment and Economic Development (DEED) is accepting applications for funding to expand broadband infrastructure in areas of Minnesota that don’t have adequate high-speed Internet service. 

Gov. Mark Dayton signed into law the $20 million Border-to-Border Broadband Development Grant Program in May. Under the measure, groups can apply for up to $5 million in funding to build out broadband infrastructure in their communities. Applicants must have at least a 50 percent funding match for their projects. 

Applications must include information on the location of the project, the type and quantity of infrastructure that would be needed, the total cost of the project, and the sources of funding that will supplement any grant award. 

Application materials and other details are available on the DEED website. return to top

ICSI hosting Symphony and Synergy of Care Workshop

Funded by a patient experience grant from Aligning Forces for Quality (AF4Q) awarded to the Institute for Clinical Systems Improvement (ICSI) and Minnesota Community Measurement, this free one-day workshop combines motivational interviewing, shared decision-making and health coaching to change not only how you listen to your patients, but how you can compose the symphony and synergy needed to guide their choices toward health. Specialty clinicians, MDs, nurses, educators, mental health workers, and care managers are encouraged to attend.   

The workshop takes place Friday, Oct. 10 at St. Benedict's Senior Community in St. Cloud. With a blend of didactic presentation, skills training and practice sessions, plus time for team discussion, attendees will leave with a plan for how to implement these strategies in their practice. Learn more and register by Oct. 3. return to top   

Supreme Court issues opinion in guardianship case; clarifies guardian’s authority

Hospitals and other health care providers will be able to rely on the decision-making authority of guardians when making decisions about end-of-life care for patients in most cases, according to a recent decision of the Minnesota Supreme Court. The Supreme Court disagreed with an earlier decision from a Hennepin County judge that would have required court approval before a health care provider could remove a patient from life-sustaining treatment if the patient had a court-appointed guardian.  

The underlying case involved the care of a moderately-impaired patient with no responsible family members. A Minnesota court appointed a guardian to manage the patient’s medical care and other affairs. Years later, while residing in a group home, the patient suffered respiratory and cardiac arrest. Although he survived, the patient suffered severe and irreversible brain injury and became deeply comatose. The treating physician recommended withdrawal of life sustaining treatment. The hospital ethics committee and the patient’s guardian agreed. The question posed in the case was whether, under these circumstances, the hospital was required to get court approval in addition to the guardian’s authorization. The Supreme Court said that it was not. 

This decision provides more specificity to the law governing what authority a court-appointed guardian actually has over the care decisions of ward. The Supreme Court concluded that guardians have the authority to consent to the removal of life-sustaining treatment without a separate order from a court in most situations. As a result, hospitals and health care providers can generally continue to rely on the guardians for direction. 

The Supreme Court did, however, add a limitation to the authority of guardians that may not have previously been recognized by most guardians and health care providers. Under the rule announced by the Supreme Court, a guardian’s decision to remove life support needs no court approval if “all interested parties agree that removal is in the [patient’s] best interest.” For cases which involve disputes between the guardian and other interested parties such as family members, there remains some ambiguity. In those cases, providers may be better off having court involvement. This aspect of the Supreme Court’s decision may complicate family disputes related to the care of patients and reduce the authority of court-appointed guardians. However the opinion does not apply to decisions made by family members or a health care agent when the patient is not under guardianship. MHA will continue to monitor the impact of this aspect of the decision and make seek additional direction if hospitals struggle with this new caveat.  

MHA and the Minnesota Medical Association (MMA) submitted a joint amicus brief to the Minnesota Supreme Court in this case. Minnesota providers – including doctors and hospitals – explained in the amicus brief that health care providers are the most appropriate sources to evaluate a patient’s health and to provide advice to guardians about end-of-life care. Based on that advice and information, guardians – rather than judges – are in the best position to make decisions about how to proceed with treatment.   

Information provided by Ben Peltier, MHA legal counsel. Contact Ben for additional information. return to top