In this issue
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 website. return to top
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
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
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
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
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
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
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
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
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
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