January 2020, Volume XXXIII, No 10



Gunderson, Marshfield Clinic scrap merger plans

A proposed merger between Gundersen Health System and Marshfield Clinic Health System is a no-go.

Seven months after the two Wisconsin-based systems announced they were exploring a potential merger, they announced recently that they have decided to stay independent after all.

In a joint statement, the systems said the decision came after months of “productive, collaborative discussions” about how to enhance care across Wisconsin, northeast Iowa, and southeastern Minnesota.

“This was an opportunity we had to explore,” Gundersen CEO Scott Rathgaber, MD, said in a statement. “Yet, we have to make the right decision for our patients and for our organizations. We each still have a commitment to delivering the best care possible to those we serve.”

The systems said they will continue to focus on improving access in rural areas through telehealth services, enhanced critical-access hospitals and clinics, and recruiting and retaining clinicians to practice in rural areas.

Marshfield CEO Susan Turney, MD, said in a statement that bringing two entities of their size and scope together is incredibly complex.

“While we mutually decided to remain independent, we will continue to execute our strategy of smart growth as we look for opportunities to ensure residents across rural Wisconsin have access to excellent healthcare close to home,” she said.

Community-based pharmacy partnership strives to transform practices

The Community Pharmacy Foundation (CPF) and CPESN USA hope to transform community-based pharmacies through their new “Flip the Pharmacy” program. The “flip” refers to a movement away from point-in-time, prescription-level care processes and business models to longitudinal and patient-level care processes and business models.

Participants will work to sustain community-based pharmacy practice through the creation of economically viable, scalable, and sustainable care, along with business processes among clinically integrated networks who can contract with payers, purchasers, and partners for high value, reliable, and repeatable services across thousands of pharmacies. Flip the Pharmacy will also emphasize value-based care quality payments, clinical measures, and electronic care plans.

Flip the Pharmacy will award qualified Practice Transformation Teams with funding and resources to act as implementation arms for locally based community pharmacy practice transformation efforts. Six transformation domains have been identified as key components of the transformation efforts, and implementation will be supported at the pharmacy level by transformation coaches. Funding priorities include established payer relationships and lean budgeting, with consideration given to geographic and population density factors.

The five-year partnership aims to graduate more than 1,000 pharmacies from a two-year transformation process modeled after similar Centers for Medicare and Medicaid Innovation efforts in primary care practices across the country. Additional program goals include targets for non-product-based reimbursement revenue, care plan submissions, screenings for behavioral health conditions, reductions in systolic blood pressure, HbA1c percentages, and cholesterol in patients with associated chronic conditions, as well as the completion of screenings for social determinants of health.

To learn more about the program, visit www.flipthepharmacy.com.

Opioid prescribing rates improving, says DHS

Almost 16,000 providers serving patients in the Medical Assistance and MinnesotaCare programs now receive individualized reports that compare their opioid prescribing practices to those of anonymous peers and recommended thresholds. Department of Human Services (DHS) data show that the numbers of prescriptions over recommended doses have fallen off.

The most dramatic decrease occurred in the number of patients simultaneously prescribed chronic opioid therapy and benzodiazepines, a potentially lethal combination. In 2016, 2,541 public health care program enrollees had prescriptions for both drugs at the same time. That number dropped 57% to 1,091 enrollees in a one-year period ending in September 2019. Other areas of improvement include:

  • 56% fewer prescriptions written over recommended doses during the acute and post-acute pain periods
  • 51% fewer index opioid prescriptions written over recommended doses (an index opioid prescription is one written for someone who hasn’t had an opioid prescription in 90 days)
  • 33% fewer index opioid prescriptions written
  • 54% fewer patients receiving doses of chronic opioid therapy that exceed recommendations

State law requires DHS to provide the private reports each year and to manage a quality improvement program for providers whose reports show they continue to prescribe outside of community standards. The current reports, the second round since the program began in 2019, will give providers updated data before they may be required to participate in a quality improvement program when the next round of reports is released, around the end of 2020.

Because abrupt changes in opioid therapy for patients with chronic pain can be harmful, DHS warns providers to avoid rapid tapering or sudden discontinuation of opioids due to the significant risks of withdrawal.

Superior Health selected as QIN-QIO

The Centers for Medicare & Medicaid Services (CMS) has awarded a five-year contract to Superior Health Quality Alliance (Superior Health) to serve as a Quality Innovation Network-Quality Improvement Organization (QIN-QIO) in Michigan, Minnesota, and Wisconsin.

Superior Health is a consortium of eight organizations dedicated to driving achievement of Medicare quality improvement program goals. The members are Illinois Health and Hospital Association, MetaStar, Michigan Health & Hospital Association, Midwest Kidney Network, Minnesota Hospital Association (MHA), Michigan Peer Review Organization, Stratis Health, and Wisconsin Hospital Association.

Stratis Health and MHA play key roles in leading the work across all three states, but with an emphasis in Minnesota, from coalition building and initiative design to quality improvement and subject matter expertise.

As part of Superior Health, Stratis Health and MHA will work with communities, health systems, and nursing homes—including those serving rural and vulnerable populations—to:

  • Improve behavioral health outcomes, including opioid misuse
  • Increase patient safety
  • Increase chronic disease self-management
  • Increase the number of quality of care transitions
  • Improve nursing home quality

MHA recognizes hospitals for excellence in quality and patient safety

The Minnesota Hospital Association has recognized seven hospitals for superior performance in quality and patient safety as part of its Hospital Improvement Innovation Network (HIIN), which strives to reduce overall patient harm by 20% and 30-day hospital readmissions by 12%.

Six hospitals earned a Partnership for Patients Excellence banner. This award indicates that the hospital is reporting on 75% or more of eligible outcome measures and road maps, is meeting the HIIN reduction goal on 70% or more of eligible outcome measures, and has met patient and family engagement criteria.

Those hospitals were:

  • Alomere Health–Alexandria
  • Carris Health–Redwood Falls
  • CHI St. Francis Health–Breckenridge
  • Ridgeview Sibley Medical Center–Arlington
  • Tri-County Health Care–Wadena
  • Windom Area Health

In addition, North Memorial Health Hospital–Robbinsdale earned a Partnership for Patients Excellence certificate. This award indicates that the hospital is reporting on 75% or more of eligible outcome measures and road maps.

Zoning change opens door for Envision

The Minneapolis City Council in November unanimously approved a zoning code text amendment titled “Intentional Community Cluster Developments” as part of a strategic effort to create innovative housing types and address homelessness in the city. This amendment allows, for the first time in Minneapolis, the conditions necessary for people experiencing homelessness to live in housing designed and constructed within an attainable budget, and paves the way for the Envision Community Collaborative to build its proposed two-year demonstration community, housing between 15–30 people in homes clustered around a common house, living cooperatively as an intentional community.

William E. Walsh, MD, and Jon L. Pryor, MD, MBA, highlighted the work of Envision Community Collaborative in a prior issue of Minnesota Physician (https://tinyurl.com/mp-walsh).

In that article, the authors described stable housing as one key social determinant of health—one that can drive medical costs higher due to increased emergency department visits—and argued that it could be cost-effective for health systems to contribute to home costs. To make those numbers work, however, would require zoning changes such as those contained in the City Council amendment.

Zoning regulations such as large minimum square footages and a mandatory kitchen and bathroom in every unit drive up the cost of housing. The “Intentional Community Cluster Development” zoning change creates a new unit type in Minneapolis known as a “rooming unit” that does not require a kitchen or a bathroom, and also drops the required minimum lot square footage to 325 square feet per person in higher density zoning districts.

The demonstration project is estimated to cost 60% less to develop per person when compared to similar permanent supportive housing because of the greatly reduced building footprint and decreased utility requirement resulting from the shared facilities that are now allowed under the zoning change. 


Steven Miles, MD, has received the 2019 Shotwell Award, presented by Abbott Northwestern Hospital and the Twin Cities Medical Society Foundation. Dr. Miles, professor emeritus of medicine and bioethics at the  Center for Bioethics, University of Minnesota, has tackled controversial medical and public policy issues throughout his career.

Thomas Kottke, MD, MSPH, medical director for well-being at HealthPartners, has been elected to the Board of Directors of the National Quality Forum. A clinical cardiologist, Kottke is a researcher at the HealthPartners Institute for Education and Research. He is board-certified in internal medicine and the treatment of cardiovascular diseases.

Bill Heegaard, MD, will soon join Essentia Health as president for Essentia’s West Market, which includes eastern North Dakota and northwestern Minnesota. Most recently, Dr. Heegaard served as chief medical officer and chief clinical officer at Hennepin Health System in Minneapolis. He is a professor of Emergency Medicine at the University of Minnesota Medical School.

Adam Nielsen will join Center for Diagnostic Imaging (CDI) as the organization’s chief development officer. In this new role, Nielsen will take over senior executive responsibilities for expanding and growing CDI’s national network of outpatient-based diagnostic imaging centers through acquisitions and other partnership arrangements.

Nicholas Van Deelen, MD, has joined St. Luke’s as chief medical officer and vice president of medical affairs. Dr. Van Deelen has been practicing emergency medicine at St. Luke’s for 22 years, and will continue to practice on a limited basis in the department. He completed his emergency medicine residency at Spectrum Health in Grand Rapids, Michigan.


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The demonstration project is estimated to cost 60% less to develop per person when compared to similar permanent supportive housing because of the greatly reduced building footprint and decreased utility requirement resulting from the shared facilities that are now allowed under the zoning change.