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Rural health solution? Find new ideas

U.S. Sen. Al Franken of Minnesota listens to health experts give suggestions Friday, Dec. 5 about how to improve rural health care.

MINNEAPOLIS -- Perhaps some rural hospitals could just provide emergency room services, and drop full hospital services.

Maybe medical schools could recruit more rural students and government could increase money available to forgive student loans to people who practice in rural areas.

And it may be a good idea to stop paying medical providers just for performing medical procedures and, instead, pay them based on their success with patients.

Those and other ideas were the beginning of a conversation U.S. Sen. Al Franken, D-Minn., launched Friday with rural health experts as he tries to find fixes to a myriad of rural health care problems.

Franken expects the discussions with health experts to last throughout his new six-year term. He has been named co-chairman of the Senate Rural Health Caucus.

The newly re-elected senator met with eight rural Minnesota health leaders Friday, and they gave him a rundown of some major problems.

Ann Gibson of the Minnesota Hospital Association set the scene: 43 rural hospitals have closed across the country since 2010 and Minnesota's rural areas soon will be 850 doctors short of the number needed.

Everyone delivered similar dire comments.

State Rep. Tom Huntley, D-Duluth, concentrated on nursing homes.

"Nursing homes in western Minnesota are reducing their beds ... because they cannot hire people," Huntley said.

When Franken asked why they could not find workers, the state legislator had a two-word reply: "North Dakota." The oil boom there provides much higher paying jobs on that side of the border, Huntley said.

"Flipping burgers at McDonald's is a lot more fun than taking care of patients," added Dr. Raymond Christensen, who practices at the Gateway Family Health Clinic in Moose Lake and is on the University of Minnesota Duluth medical faculty.

When nursing homes pay low wages, Huntley said, it means rapid turnover and caregivers do not get to know residents and their needs.

Franken heard that rural Minnesota has a little surplus of nurses, but they frequently are hired away by Twin Cities facilities that pay more.

Technology is lacking in rural Minnesota, added Mark Schoenbaum of the Minnesota Health Department.

"There are exciting things going on in telehealth, unfortunately it is based in Sioux Falls, South Dakota," he said.

Allowing doctors and patients to interact via video, and even doctors doing long-distance surgery, long has been discussed. However, Schoenbaum said, Minnesota health providers have little of that technology available.

The experts told Franken there is hope.

For instance, health care communities in Staples and New Ulm are among those that have broken down barriers and have effective health-care services, the senator heard. In New Ulm, the hospital, clinics and county public health officials have begun working together on health issues, such as heart care, instead of each entity doing things itself.

Ira Moscovice, director of the University of Minnesota's Rural Health Research Center, was the one to suggest recruiting more health providers such as doctors from rural areas. He said those from rural areas are more likely to practice there.

Franken indicated that medical students' loan forgiveness for working in rural areas has been successful.

President Jennifer Lundblad of Stratis Health, a nonprofit that seeks health care innovation, provided the potentially controversial idea of some rural hospitals concentrating on emergency services. An ER without a full hospital can meet many needs in a community, she said, and at a lower cost.

Franken said that it is time to look at how medical professionals are paid.

Pay based on what procedure is performed does not keep people healthy, he said. Instead, he suggested, perhaps medical personnel such as doctors should be paid based on how successful they are, such as if they cure a patient, not just treat them.

Making such a change, the senator said, would save money because patients would be less likely to need further care.

Franken said that the health caucus likely will produce some bills to help rural health issues and also will lobby federal agencies to make changes.