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St. Cloud Medical Group ranks high at keeping costs low

Kevin Allenspach, kallenspach@stcloudtimes.com 6:44 p.m. CDT September 19, 2015

To combat the ever-rising costs of health care, some providers are concentrating on innovations like e-visits, patient portal accounts and accountable care organizations.

St. Cloud Medical Group has been among the most successful in Minnesota at keeping expenses down, according to the second report in as many years issued by a nonprofit industry watchdog.

The total cost of care per patient, per month at St. Cloud Medical Group was $385 — eighth-lowest in the state among 132 medical groups — in results compiled by MN Community Measurement from actual patient costs last year.

That was 14 percent below the state average of $449, which increased 3.2 percent from the inaugural survey released in 2014.

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Minnesota’s medical costs rose in 2014 but varied widely clinic to clinic

Minnesota’s medical costs rose in 2014 but varied widely clinic to clinic

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The total cost of medical care varies dramatically across Minnesota — from $823 per month for patients who receive their primary care at the Mayo Clinic to just $381 at a pair of suburban Twin Cities medical groups.

The average medical bill was somewhere in between: $449 per month for the average privately insured patient, according to the second annual Total Cost of Care report, released Thursday by MN Community Measurement.

The report also found that improving quality and patient satisfaction apparently has come at a price: A 3 percent increase from 2013 to 2014 in the cost of patient care.

While unmasking high-cost providers might motivate them to change, the main goal is to learn from providers that bucked the trend and lowered costs, said Jim Chase, president of Community Measurement, a nonprofit agency, which based the data on claims paid by Minnesota’s four largest health insurers.

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Ranking: The average test price, medical bill at clinics across Minnesota

Ranking: The average test price, medical bill at clinics across Minnesota

By Shaymus McLaughlin

The price for medical tests and procedures – from an X-ray to a glucose measurement – jumped up 6 percent in 2014. And your overall medical bill likely went up too.

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State survey finds Winona Clinic, others in state give strong care, but struggle with delays

2 hours ago  • 

While patients at Winona Clinic are generally satisfied with their health care providers, they are less pleased with how long it takes to get an appointment.

According to statewide data released last week by the Minnesota Department of Health and Minnesota Community Measurement, 80 percent of surveyed patients at Winona Clinic gave their health care providers a top rating of 9 or 10 on a 10-point scale.

However, just 39 percent of respondents said they got a top level of access to care — such as timely appointments, answers to questions, and short waiting room times. That’s well below the statewide average for satisfaction with access, at 60 percent, with numbers for individual clinics across many specialties and regions ranging from 30 to 90 percent.

Winona Health CEO Rachelle Schultz said in an interview Tuesday that the access problem isn’t news to Winona Health, which has been tracking patient satisfaction for years.

As far as the most recent set of data, Schultz said it reflects national trends the industry has been anticipating: an aging population with more health care needs, a shortage of primary care physicians and health care reform.

“There’s been this kind of impending knowing, that there’s going to be this huge demand on the health care system everywhere. At the same time, when we look at workforce issues, you have the opposite thing happening,” she said.

Fewer doctors are choosing primary care, and recruiting medical school graduates can be a three-year process, Schultz said, which is not fast enough to keep up with the demand.

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Area clinics score high on patient satisfaction survey

By Jessica Bies jbies@mankatofreepress.com | Posted 7 days ago

MANKATO — With only a few exceptions, area clinics scored high on a statewide survey about the quality of patients’ experiences during appointments and interactions with staff.

Most notably, Daniels Health Center in St. Peter, a branch of Mankato Clinic, scored among the top 15 clinics in the state for having courteous and helpful office staff.

The high ranking is not a happy accident but instead the result of a concentrated effort on part of the clinic, CEO Randy Farrow said.

“We have been putting a big focus on our staff, and customer service has been a big area of focus for us,” he said Wednesday. “We do a lot of staff training around that.”

Patient opinion unchanged

This is the second time the Minnesota Department of Health and MN Community Measurement has conducted the Patient of Experience of Care Survey. It is the nation’s largest statewide patient experience survey, and 2015’s responses show that consumer opinion hasn’t changed much since 2013.

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Ratings reveal Minnesota clinics with best communication, access

Nearly 80 percent awarded their doctors and clinics top marks in a 2014 survey.

By Star Tribune – August 26, 2015 — 10:56pm

Doctors might not be able to turn on the charm overnight, but new Minnesota patient survey data show it is entirely possible for them to become better at seeing and talking with patients.

The second release of patient satisfaction data by MN Community Measurement on Wednesday shows little change overall — 79 percent of patients gave top marks to their doctors in 2014, compared to 78 percent in 2012. But some clinics made substantial progress.

“It doesn’t have to be that somebody really competent should also be rude to you,” said Jim Chase, executive director of the nonprofit rating organization. “The [patient] experience still matters.”

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Local clinics score above average in patient experience

By Stephanie Dickrell, sdickrell@stcloudtimes.com 10:31 a.m. CDT August 26, 2015

Nearly 80 percent of Minnesota’s patients give their health care providers a top rating of nine or 10 on a 10-point scale, but only about 60 percent of patients said they experienced a top level of access to care.

The results of the 2015 Patient Experience of Care Survey were released Wednesday by the Minnesota Department of Health and MN Community Measurement.

Locally, CentraCare and a few other clinics were included in the survey, scoring average or above in all categories.

This is the second time that Minnesota has conducted the nation’s largest statewide patient experience survey.

Patient opinion hasn’t changed much since the first survey in 2013, according to officials.

The survey included 200,500 patients at 765 clinics in Minnesota and neighboring communities who had appointments between September 1 and November 30, 2014. This year’s survey indicates that patient opinion hasn’t changed much since the first survey in 2013.

Local results

Here are the local results. Categories include: getting care when needed, how well providers communicate, courteous and helpful office staff and providers with “most positive” rating.

  • CentraCare River Campus — Rheumatology in St. Cloud scored above average in all indicators.
  • CentraCare Health Sauk Center scored average on getting health care when needed and courteous and helpful office staff. It scored above average in providers with a “most positive” rating. Results on how well providers communicate were not available.
  • CentraCare Health — Monticello Medical Group scored average on getting care when needed and how well providers communicate. It scored above average on courteous and helpful office staff and a “most positive” rating.
  • CentraCare River Campus — Nephrology scored above average in all categories.
  • CentraCare Health Paynesville-Richmond scored above average in getting care when needed and the “most positive” category. It scored average in how well providers communicated and courteous and helpful office staff.
  • CentraCare Health Plaza — Dermatology scored scored average in getting care when needed and the “most positive” category. It scored above average in how well providers communicated and courteous and helpful office staff.
  • Lakewood Health System — Sartell Clinic scored average in getting care when needed and the “most positive” category. It scored above average in how well providers communicated and courteous and helpful office staff.
  • Williams Integracare Clinic scored average in getting care when needed and above average in the rest of the categories.

Other highlights

Though patients are generally having a good experience, the survey did find significant differences between clinics. Here are some highlights from the survey:

  • 79 percent of respondents gave their provider a top rating of nine or 10 on a 10-point scale – a statistically significant one point increase over the 2013 result. Individual clinic ratings ranged from 49 to 97 percent of providers receiving a top rating.
  • 83 percent of respondents described communication from their providers as top-level. Across individual clinics, the low score was 54 percent and the high score was 94 percent.
  • 81 percent of respondents gave the office staff at their clinics top marks for being respectful and helpful. However, a 40 percentage point difference can be seen between the highest and lowest scoring clinics.
  • Nineteen percent, or 121, more clinics participated in the survey than two years ago.
  • Clinics participating in the state’s Health Care Homes initiative included additional questions in the patient experience of care survey. For over half of all certified Health Care Homes, at least 60 percent of their patients reported a positive score in relation to shared decision making, and at least 50 percent of their patients reported a positive score in relation to attention to mental health.

Results are based on 200, 500 patient-completed surveys on patient experience of care – known as the Clinician and Group Surveys – Consumer Assessment of Healthcare Providers and Systems. Thirty-three percent of the patients surveyed responded, which is a similar response rate as 2013.

Minnesota conducts the nation’s largest statewide patient experience survey.

Follow Stephanie Dickrell on Twitter @SctimesSteph, call her at 255-8749 or find more stories at www.sctimes.com/sdickrell.

Survey measures

The survey measures patient experience in terms of whether patients were:

  • Getting care when needed.
  • Being listened to and receiving understandable information and instructions.
  • Experiencing courteous and helpful office staff.
  • Satisfied with their provider.

View the original article from the SCTimes

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Mayo’s Somali health project aims to build trust with community

By Nate Gotlieb
Free Press of Mankato
Posted: 06/20/2015 11:01:05 AM CDT | Updated: 2 days ago

When Fardousa Jama and her father, Hussein, surveyed 400 Somalis last year in Mankato, Minn., they found many misunderstood and mistrusted the American health care system.

Some weren’t taking their prescribed medicine, they found, and some with diabetes were testing their blood sugar too frequently. Others faced language barriers and didn’t know how to access prescription medication.

“There is a huge gap and mistrust that happens with doctors and Somalis,” Fardousa Jama said. “We just want to help bridge the gap.”

That desire led to the Somali Health Literacy Project through Mayo Clinic Health System, which kicked off this month at the St. Peter Community Center. The project consists of 18 classes during the next 18 months on health topics ranging from defining health to diabetes and depression.

Mayo doctors said they hope the project can improve trust between providers and the Somali community and decrease emergency-room and urgent-care visits.

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Area’s Health Care is Most Expensive

By Jeff Kiger, Rochester Post Bulletin
June 18, 2015

The cost of health care in southeastern Minnesota was higher than in any other region in the state or even neighboring states in 2013.

The nonprofit MN Community Measurement released a new analysis of its Total Cost of Care report this week. Total Cost of Care, which was first released in December 2014, looked at the costs of 1.5 million patients at 1,052 clinics in Minnesota and border cities. It tracked patients covered by the four top insurers – Blue Cross & Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne.

This week’s analysis compared costs for those patients treated in six Minnesota regions, Wisconsin, North Dakota and South Dakota. It also broke the numbers down by adult patients versus pediatric ones as well as in-patient care to out-patient costs this time.

While the latest report did not reveal any new findings, it adds to the very new pool of health cost data using this new standard measurement.

“This is just another step in sharing information that we thought might be useful,” said MNCM President Jim Chase.

The average monthly cost of care per patient in Minnesota is $435. That monthly cost spiked to $535 in the southeastern area. That’s not surprising with Mayo Clinic, the most expensive provider at $826 a month per patient, based in Rochester. Olmsted Medical Center’s not far behind, as it’s ranked as seventh most expensive out of 115 medical groups.

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Somali Health Project Aims to Build Trust

By Nate Gotlieb, Mankato Free Press
June 3, 2015

Some weren’t taking their prescribed medicine, they found, and some with diabetes were testing their blood sugar too frequently. Others faced language barriers and didn’t know how to access prescription medication.

“There is a huge gap and mistrust that happens with doctors and Somalis,” Fardousa Jama said. “We just want to help bridge the gap.”

That desire led to the Somali Health Literacy Project through Mayo Clinic Health System, which kicks off Friday at the St. Peter Community Center. The project will consist of 18 classes during the next 18 months on health topics ranging from defining health to diabetes and depression.

Mayo doctors said they hope the project can improve trust between providers and the Somali community and decrease emergency-room and urgent-care visits.

“When people come into the doctor, we assume a certain understanding of health,” said Dr. Erin Westfall, who led the effort to coordinate the project. “Those assumptions aren’t accurate, and it leads to a lot of safety issues.”

Minnesota is home to about 45,000 Somalis and their children, according to state demographer Susan Brower. There isn’t an exact count of the greater Mankato Somali population, she said, though 327 kids in the Mankato Area school district reported speaking Somali at home in 2014-15, according to the state Department of Education.

Despite the relatively small numbers, Somalis have the poorest health-care outcome rates among all Minnesota minorities, according to a 2014 MN Community Measurement report. In colon cancer screening, for example, patients born in Somalia were screened at a rate of 22 percent compared to the 70 percent state average. Somalis also had the lowest health-care outcome rates in diabetes, vascular and asthma care.

The report doesn’t say why Somalis have such poor outcome rates, but Anne Snowden, who directed the report, said it sometimes can take foreign-born populations time to learn the U.S. health-care system.

Westfall said chronic diseases and mental illness are rare in Somalia. She noted that people without access to health care, such as those in refugee camps, aren’t used to talking about preventive efforts.

“For someone that comes from that culture, prevention efforts are looked at with suspicion because doctors may find something wrong when they feel fine,” she said in an email. “This is a difficult concept to grasp for everyone — Americans and Somali Americans alike.”

‘Risk is on you’

Jama, an interpreter at Mayo Clinic Health System, came with her family to Mankato in the late 1990s. She said her family was the first Somali family in Mankato.

Last year she and her father founded the Somali Community Barwaaqo Organization in an effort to help Somalis transition into the community. The organization has an office on Madison Avenue and offers no-cost citizenship classes, employment and housing assistance, and tutoring, among other services.

Jama said the medical system in America is better but a lot different than her home country. In Somalia people go the pharmacy to get their medicine, she said, whereas in America you need a prescription first.

“If you have the money, you can buy whatever you want,” she said. “The risk is on you.”

Abdikarim Abdulle can attest to that. He arrived in Mankato with his wife and five kids last month after spending 15 years as a refugee in South Africa. He said the hospitals in Somalia were dismantled once civil war broke out in the early 1990s.

“Once the health system gets dismantled, it goes away,” he said, with Jama interpreting. “It’s hard for the clinic to open up again.”

Interest in diversity

Westfall directs the osteopathic program for the University of Minnesota’s Mankato family medicine residency program. She secured a $5,000 grant from Enventis for the project.

Resident Dr. Vicki Zbikowski will be leading the classes. Zbikowski, who has a master’s degree in bioethics, said she is interested in cultural diversity and exploring how to best serve underrepresented health-care populations.

“It’s important to understand where this particular population is coming from in terms of what health means to them,” she said. “If we can’t understand where they’re coming from, then we’re unable to kind of meet them where they are at.”

The sessions will cover a range of topics, from defining what health is to diabetes, heart disease, immunization and more. The goal, Westfall said, is to affect at least 100 families.

The Barwaaqo organization is providing free rides to those in need. Call 507-625-2111 or visit somalicbo.org to learn more.

Read the original article in the Mankato Free Press.

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Medical Professionalism and the Future of Public Trust in Physicians

Viewpoint by Noam N. Levey, The Journal of the American Medical Association
May 12, 2015

The medical profession in the United States, by some measures, has much to be pleased about. Public confidence in the honesty and ethical standards of physicians has remained high for decades, even as other professions, including bankers, the clergy, and members of Congress, have endured a steady erosion in public trust. Even though physicians may not enjoy the exalted, even unquestioned, position they did in the middle of the last century, they remain among the most trusted professionals in the United States.

As major changes reverberate through the US health care system, however, the trust that patients have historically placed in clinicians is being challenged. A revolution in transparency in medicine is making an unprecedented amount of information available to the public, potentially undermining confidence in the profession. At the same time, the public is growing increasingly anxious about the broader health care system as increasing costs erode workers’ stagnating wages. Patients also are seeking to be more engaged in their own medical care, including how they confront the end of life, a subject that poses special challenges for the medical profession.

Together, these changes may transform expectations of physicians’ qualifications and affect how the public views organized medicine in general. That raises the stakes in the current debate over the medical profession’s systems of self-governance.

Few developments may be more transformative than the advent in recent years of new data and new federal disclosure requirements. Patients—as well as journalists, politicians and health care purchasers—can now obtain and analyze information about physicians’ billing practices, their ties to other entities in the health care industry, and the outcomes they achieve for patients in their care. This is subjecting the medical profession to a level of scrutiny that was once unimaginable.

For example, the 2014 release of Medicare physician payment data spawned multiple media reports identifying the nation’s top billers and prompted new questions about the kind of care physicians are providing. This has contributed to increased public concern about how much medical professionals and health care organizations of all kinds charge for the delivery of health care services. These data are also fueling demands that the famously opaque US health care system provide consumers with more meaningful information about how to select medical services and practitioners.

The work of investigative news organizations such as ProPublica with data on payments from the pharmaceutical and medical device industries to physicians has also focused attention on potential conflicts of interest in medicine. In the past several years, newspapers around the country have reported often unflattering stories about individual physicians in their communities.

Meanwhile, an increasing number of regional quality organizations, such as Minnesota Community Measurement and Maine Quality Counts, are collecting and posting outcome measures for local medical practices. Augmenting these data, new government and private sector payment systems such as the Medicare Shared Savings Program, although still imperfect, are publicly identifying and rewarding physicians and health care organizations that meet quality targets. These systems will increasingly allow patients to see which clinicians are lagging on key indicators.

How the public uses the new data and what precise effect the information will have remain unclear. To be sure, research suggests that even patients with chronic illnesses have limited awareness about publicly available physician quality information.

However, patients are learning more about their physicians at a time when their faith in the broader health care system and those who lead it is not high. In a recent nationwide poll of 1027 adults, just one-third of respondents expressed confidence in the US medical system, far behind other institutions, including the military, small business, and the police. Moreover, unlike residents of other industrialized nations, those in the United States are highly skeptical of the leaders of the US medical profession, a phenomenon that some researchers attribute to the perception that organized medicine has been more focused on protecting its own interests rather than working to advance broader public health goals.

Layered on top of this is a burgeoning public conversation about a disconnect between patients’ expectations for their medical care and what the health care system is configured to provide. Growing out of a decades-old consumer movement, this discussion in some sense is not new. However, the focus on some of the more complex health-related topics, such as death and dying, has raised new questions about how well the medical profession is prepared to meet patients’ desires and needs.

These may be difficult topics for individual physicians and for organized medicine to address, but the recent proliferation of articles and books on end-of-life care and dying well suggests that the public is eager to delve further into these subjects. Gawande’s moving new book about mortality, which, among other topics, explores medicine’s struggles to confront issues surrounding aging and death, has been on best-seller lists for weeks.

The medical profession has weathered other major shifts in the US health care system. Indeed, the revolution in managed care of the 1990s, which threatened to further undermine public trust in physicians, arguably had the opposite effect. Confidence in physicians, which had been slipping, stabilized as patients focused their dissatisfaction on insurers.

Today, patients may once again look to physicians as a trusted source and harbor amid the turmoil in the broader health care system, including narrowing insurance networks and rising cost-sharing requirements for consumers, as well as the ongoing political and legal battles over the Affordable Care Act. The medical profession could also emerge stronger as a result of many of the current challenges and ongoing changes in health care. Greater transparency, although threatening to some, improves performance, potentially boosting public confidence. More patient engagement should deepen the relationships between physicians and the people they care for, ultimately fortifying public trust in the medical profession.

Physicians ignore the forces shaping public expectations at their peril, however. While Americans may retain confidence in their own physicians, affording the profession some protection from threats to physicians’ credibility and authority, the shield may not be impenetrable. A national survey of 1508 adults about their views on medical care revealed some potentially troubling findings for physicians. Most survey respondents reported that physicians do not spend enough time with patients. Most respondents do not consider physician fees reasonable. Even fewer believe that physicians are trying to hold down the cost of medical care. Perhaps most relevant for the current debate over self-governance is that nearly 1 in 4 survey respondents disagreed with the statement “Doctors are usually up to date on the latest advances in medicine.”

Perhaps a new system for recertifying physicians will restore some patients’ trust, although the effect may be small. Arcane procedures by professional societies that few have heard of seem unlikely to fundamentally move public opinion. Most patients would rightfully assume that organized medicine at a bare minimum had adequate protocols for self-regulation.

More consequential may be the behavior of physicians and their willingness to adapt to the changes under way in the US health care system. Patients across the country are experiencing new models of care that are more coordinated, more transparent, more responsive, and more personal. The best of these systems not only deliver better results, they make patients happier, as anyone who has seen them can attest. If physicians are viewed as standing in the way of these models, they risk the trust the profession has worked so hard to earn.

Read the original viewpoint at The Journal of the American Medical Association.

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