RHAC report recommendations – ORHPC follow‐up 9/22/11 General Surgery recommendations (published March 2011)
RHAC/ORHPC potential follow-up
Expand awareness of the impact of general surgery on patient safety and quality. Lack of  Distribute GS report to all work group
access to general surgery may lead to delayed surgical intervention and /or recognition of members and key informants
life‐threatening traumatic injuries. This impacts patient safety, quality of health, and may  Distribute GS report via ORHPC
even result in otherwise preventable death. A shortage of general surgeons is on par with website
shortages of primary care providers. Rural health advocates, hospitals, associations and  Distribute GS report via ORHPC
providers should raise this issue in appropriate forums and publications. Critical Access publications
Hospitals should speak with a unified voice to consistently raise the urgency of rural general  Distribute GS report to MHA, MRHA
surgery issues and recommendations in appropriate forums. Keep abreast of national and other state organizations
efforts to do the same.  Distribute GS report to ORHP, NRHA
and other national organizations
Identify, evaluate and promote models of multi‐hospital collaboration and rural surgery call coverage. Organizations that provide funding, consultation and technical assistance for rural hospitals should encourage collaboration and mentorship models involving larger regional hospitals and small hospitals or groups of small hospitals. The purpose of the collaboration and mentorship is to provide support, consultation and perhaps call coverage to the general surgeons practicing in small rural hospitals. Some rural hospitals are developing relationships with neighboring hospitals with the goal of sharing surgical teams and services. Efforts to collaborate should be supported, and if models are deemed replicable, details of successful collaborations should be shared. This information should be accessible on a website such as the Office of Rural Health and Primary Care’s “Models” page, and promotion and enhancement of the information should be encouraged. Develop and financially support rurally‐focused general surgery training and residency programs at institutions in and near Minnesota, including Hennepin County Medical Center, Mayo Clinic College of Medicine and the University of Minnesota. The mission of these educational programs should include a commitment to serving rural and underserved citizens. Research and experience shows that medical students are far more likely to practice in rural areas if they experience at least part of their medical training in a rural setting. At minimum, Minnesota general surgery residency opportunities need to be expanded specifically for rural settings. General surgery programs in Minnesota should include a one‐ to two‐month rural experience at sites selected by the programs. Successful implementation is dependent upon state funding.  Publicize ACS online group created to
support collaboration among rural
surgeons that will be available in May
2011
 May 23 discussion w/Essentia
 Track development of UofM rural
general surgery residency slots; checkin with Dr. Ray Christensen (RHAC),
Scott Johnson (St. Mary’s) and Dr.
Beilman (UMN) on progress
RHAC report recommendations – ORHPC follow‐up Support pre‐ and post‐surgical care practices in rural hospitals. Many rural communities are served by a general surgeon who travels to their community on a scheduled basis. In these cases, medical and nursing staff must coordinate with the surgeon and provide pre‐ and post‐surgical care. Family physicians, hospitalists, nurse practitioners and physician assistants should have opportunities for additional training in pre‐ and post‐surgical care. Rural hospitals, continuing education programs and grant programs such as the Office of Rural Health and Primary Care’s Rural Hospital Flexibility Program should support this training. Support the maintenance and expansion of funding (such as the Rural Hospital Capital Improvement Grant Program) to support the facilities and equipment necessary for general surgery services in Minnesota’s rural hospitals. Many of Minnesota’s rural hospitals struggle to maintain and keep up with necessary surgical suite and equipment needs. The work group recommends that a portion of grant funding be dedicated to facility and equipment improvements and upgrades to support general surgery programs. Promote supportive technologies. Surgical practices will continue to be interlaced with technological tools. These and other technologies should be promoted and made available by Minnesota’s telehealth networks and organizations that provide information and technical assistance regarding telemedicine as tools to maintain and increase access to general surgery in rural Minnesota. Technological advancements may provide means for addressing some barriers to rural general surgery. Televideo is a central tool for rural general surgeons to provide peer consultations, telesurgery and pre‐or post‐surgical care. Information systems and electronic medical records will ease communication with and about patients.
9/22/11 
Include pre- and post-surgical care
team training as an example of a
FLEX supported activity in the area of
Quality Improvement

Include facility and equipment
improvements to support general
surgery programs as an example of a
grant supported activity for applicable
ORHPC grant programs
 ORHPC newsletter article/blurb to
highlight new rule for credentialing of
providers who deliver care through
telemedicine
RHAC report recommendations – ORHPC follow‐up Telemental Health recommendations (published July 2010)
9/22/11 RHAC/ORHPC potential follow-up
Expand and promote a telemental health resource hub (website) to identify best practices, and to educate, inform and provide resources for health care professionals working in telemental health. Existing organizations, such as the Great Plains Telehealth Resource and Assistance Center (GPTRAC) and the Center for Telehealth and E‐Health Law (CTel), should enhance resource availability and coordinate sharing of information to include:  Showcasing of models for integrating telemental health into existing programs (e.g., co‐location of services, billing, scheduling).  Specific health care situations in which telemental health offers a solution or helps achieve a goal (e.g., reduced overall emergency department admissions through increased access to telemental health).  Strategies for replication of successful telemental health programs.  Information about common liability risks and misconceptions about telemental health services by primary care providers (e.g., collaborative agreements and remote assessment).  Examples and potential use of videoconferencing technology for serving diverse cultures by incorporating translation and interpreter services into the telemental health service. Create a statewide committee to work on resolutions to reimbursement and regulatory issues. The purpose of the committee is to work with payers on statewide payment, administrative (including credentialing) and regulatory issues and to ensure the implementation and understanding of federal regulations affecting telemental health reimbursement and administration. Inform stakeholders of existing state, federal and foundation grant funding for starting, maintaining or enhancing telemental health services. Especially needed are funding sources for basic equipment. Consider increasing the amount of funding or dedicating a portion of grant programs to the advancement of telemental health in rural Minnesota. Potentially applicable grant programs include: Community Services and Community Services Development Grant (Minnesota Department of Human Services), Rural Flex Grant (Minnesota Department of Health), and the Telehealth Network Grant (Health Resources and Services Administration). Examples include:  Distribute TMH report to all work
group members and key informants
 Distribute TMH report via ORHPC
website
 Distribute TMH report via ORHPC
publications
 Distribute TMH report to GPTRAC,
CTel, and other key stakeholders
mentioned in the report
 Distribute TMH report to MHA,
MRHA and other state organizations
 Distribute TMH report to ORHP,
NHRA and other national
organizations  ORHPC newsletter article/blurb to
highlight new rule for credentialing of
providers who deliver care through
telemedicine
 ORHPC newsletter article/blurb to
highlight RHITND program
 Include starting, maintaining or
enhancing TMH services as an
example of a FLEX supported
activities in the area of Quality
Improvement
RHAC report recommendations – ORHPC follow‐up 
Equipment for rural mental health crisis teams to access in‐time remote psychiatric consults.  Laptops for rural mobile medical units and rural home visiting nurses to enable remote access to telemental health services.  Telemental health services for incarcerated individuals & consultations for jail health providers. Grant funding could offset costs of diagnostic assessment, medication management & discharge planning.  Strategic planning and business planning for sustainable telemental health programs. Connect psychiatric and mental health training programs with rural practice sites providing telemental health services for practicums and clinical training opportunities. Build upon and support existing programs and models in the state as demonstration projects and best practices. Create incentives and assistance in developing telehealth curriculum and training. Promote best practices and opportunities for practicing telemental health to new and upcoming graduates. Educate state policymakers on the critical need for telemental health services in rural areas. Demonstrate potential cost savings if needs are addressed and highlight proven models in other states. 9/22/11  Highlight the Center for Rural Mental
Health Studies at UofM – Duluth on
ORHPC successful models website
 Highlight the MN Consortium for
Advanced Rural Psychology Training
on ORHPC successful models website
 Distribute TMH report to state policymakers