Trends: Demand exceeds supply in the health care industry

The ratio of population to geography is always an estimated cause for both the pros and cons of living in the Arrowhead. Low-density people can be very attractive for an adventurous lifestyle, but they have no interest in accessing health care. Health care is one of the major industries of Arrowhead region’, and as per the Department of Employment and Economic Development’s 2018 Local Workforce Regional Profile report, nursing assistants and personal care aides belong to the top occupations in demand.

The labor force of northeastern Minnesota is expected to decline over the next decade. At the same time seeing an aging population, the tight labor market for health-related workers is worsening across the board.

The difference of home health care professionals and personal care attendants is an ever-widening gap which has no apparent solutions in sight, and it is told by Teri Fritsma Mogen, a Minnesota Department of Health senior workforce analyst. According to Teri, it should be a major fret for the trickle-down effect it will have.

“If you don’t have enough home health workers to allow people to age in place, older folks will have to move to nurse homes or assisted living and that just moves the workforce shortage to another area,” she added.

There is the highest necessity of particular mental health care providers in Rural northeastern Minnesota. As per Fritsma Mogen, mainly alcohol and drug counselors and licensed mental health therapists, are needed.

“Including Duluth for alcohol and drug counselors the region has the second highest ratio in the state, and if you take Duluth out of that equation the ration is through the roof with 8,000 people to everyone drug and alcohol counselor with the average in the metro roughly 2,000 to one,” Fritsma Mogen said.

Threatening that Telehealth, the provision of healthcare distantly by the help of telecommunications technology, is not a “magic bullet,” Fritsma Mogen thinks that new legislation authorization extended reimbursement for telehealth has begun to help ease some of the need.

In 2015 the Minnesota legislature passed the Telemedicine Act, raising the list of specialized persons entitled to bill for telemedicine practices, including physicians, nurse midwives, clinical nurse specialists, dentists, and psychologists. The Telemedicine Act got the effect at the beginning of 2016, with some provisions not fully ready till 2017.

Anderson said, “Meeting remotely with clients is especially important in rural areas of the region where mental health providers are less accessible.”

She said video conferencing technology is also helping to fill a vital gap for public health nurses. Providing Direct Observed Therapy (DOT) via video conferencing is helping a lot in checking patients’ taking oral medication for treatment of tuberculosis. has fulfilled some need efficiently.

“One example of this in our region was public health staff time and travel savings of 2.5 hours per day by using (video) conferencing with a patient who lived in a remote area of the county,” Anderson told.

In the Region 3 Adult Mental Health Initiative Area, numerous counties are represented: St. Louis, Lake, Cook, Carlton, and Koochiching, which consists of 23 percent of the state’s land and contains only 6 percent of the population. This geographical area also signifies an area where health challenges like depression exceed any other major health issues two to one.

Although working on increasing videoconferencing for mental health treatment over the last six years, Lee is irritated with the slow progress of the system is taking hold. He said that technology is the same, but the attitudes are slow to change and thus small legal and technical obstacles can take a long time to take-over.

He added, “The trend is for different agencies such as, schools, jails and treatment facilities, to develop their own telehealth systems. To overcome logistics of not being able to communicate smoothly across agencies, an interoperable system, like Vidyo, should be universally adopted.”

One area in Carlton County being conducted successfully has integrated mental health treatment in the jail premises, where accessing mental health care professional by video is much more competent. Transferring a prisoner from jail, with serious mental health issues, to a psychiatrist is not easy. Therefore, there is a requirement of at least one deputy to accompany them. Simultaneously, local mental health care providers are forced to fill canceled appointment slots.

“It didn’t take a rocket scientist to figure out that we could fill no-shows and cancellations for psych appointments easily without leaving the jail via tele psychiatry,” Lee said.

County jails in Carlton, Koochiching and Lake counties, Northeast Regional Corrections Center and Arrowhead Juvenile Detention Center have all been executing some type of video conferencing for mental health treatment. But, Lee said many IT and legal problems should be cleared to make it occurred.

“I think the biggest problem is that we are so regimented in our separate professional silos and this approach doesn’t work in isolation, so we have to be open to working with community partners in new ways to solve this chronic mental health problem,” he said.

Another tech tool being used extensively by patients across most area health care systems is an entrance to get health records, observe lab results and send and receive no urgent messages from providers.

Dr. Michael Whitcomb, Essentia’s chief medical informatics officer, calculates around 40 percent of clinic patients access their patient portal, a system which has been up and running for about six years.

“Patients love to send messages through the patient portal instead of the old-fashioned phone call that can take days of phone tag,” Whitcomb said.

Though getting medical care online is not a new idea, but it has some problems for which it was unsuccessful initially after launching. Today, Essentia is getting greater success with E-Visits using a different platform.

Now, restricted to about 30 relatively basic conditions, patients connect online to E-Visit web page where they have to fill out a short form by means of a branching logic interview format. Here the patients can get replies from a doctor or nurse within an hour, and they can also get any required prescriptions sent directly to the pharmacy of the virtual patient’s choice.

Whitcomb said, “Not only is the demand by patients for immediate care with online access being met, but E-visits also decrease access problems in our ER and urgent care.”

He also told that several thousand patients have accessed the online doctor visits in the past year, and they expect to increase services to include more conditions.

“The consumer is changing their expectations for online convenience instead of going to a brick-and-mortar facility,” Whitcomb said. “The exciting thing is that technology exists where we can maintain a high quality of care.”

Maureen Ideker, senior advisor for telehealth at Essentia, told that they have a telehealth presence in all the hospitals, clinics and nursing homes all over northeastern Minnesota and northwestern Wisconsin. Additionally, they have contacts in 10 different hospital services, 30 outpatient clinic specialty consultants and they have consulted around 5,000 patients through the telehealth system last year.

Telestroke is the biggest hospital program of Essentia with its emergency departments all through the region and all connected to St. Mary’s in Duluth. Telestroke gets the stroke specialists active on a case from the beginning as the neurology specialists mainly located in Duluth, and rapid involvement of the extreme importance with the common condition.

The extended telepresence through discharge pharmacy consultations at St. Mary’s is also a time saver for the patient and the hospital.

“Discharges from the hospital in Duluth with virtual pharmacy counseling is at about 500 visits per month, saving valuable time by having a pharmacy technician bring an electronic tablet to the patient’s bedside,” Ideker added.