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Report looks at state's high value hospitals

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Year after year, Minnesota's model of health care has pro-ven to be one of the best in the country: Minnesota ranks third in the U.S. for insuring its citizens (91.5 percent), sec-ond for life expectancy (78.8), fourth as the healthiest state and sixth in emergency care.

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The last ranking is especi-ally important, as emergency rooms have become the new primary care facilities with the number of uninsured in-creasing. The Minnesota De-partment of Health's new est-imates indicate an increase in charges of uncompensated care of nearly 16 percent from 2006 to 2007. Most impressive is that with all of these quality rankings, Minnesota placed 43rd for per-capita public health funding.

While we have maintained these rankings with sub-par public funding, eventually it will catch up to us. The number of Minnesotans over the age of 65 is expected to increase 58 percent by 2020, which will require more hospitalizations and Medicare benefits. At the same time, doctors will be retiring at a rate faster than their younger colleagues can offset the declining supply.

"Best Practices," Minnesota 2020's latest report, lists 10 hospitals that are currently in the best position moving forward based on a value and quality ranking. The quality ranking considers three criteria: mortality rates, patient satisfaction surveys and clinical condition outcomes. The value ranking used Medicare reimbursements while taking into account uncompensated care, educational expenses and cost of living expenses.

After compiling the rankings, Minnesota 2020's report finds increasing primary care labor corresponds to higher value and quality of care. By taking a holistic approach to medicine where primary care doctors encourage healthy habits, manage chronic conditions, and provide routine check-ups and immunizations, costs can be better controlled.

Moreover, the American Academy of Family Physicians estimates that adding one primary care doctor for every 20,000 people decreases the number of unexpected premature deaths by 9 percent.

However, the country is facing a major shortage of general family doctors, internists, pediatricians and obstetric/gynecologists, which are all classified as primary care professionals. These areas will be deficient 40,000 doctors by 2020. Several key factors, including being on call 24-7, laborious administrative duties, and low status in the medical community have many medical students deciding to seek a subspecialty following residency.

Exacerbating this shortage most are lower wages and in-surance reimbursements rela-tive to subspecialists. Com-bine that with high medical school debt -- in the $200,000 range -- and you have only 2 percent of medical school students looking for careers in general internal medicine, according to the president of the American Academy of Family Medicine.

Years ago a doctor could have his educational expen-ses paid in several years, usually by age 40, according to Dr. Bill Buege, a long-time family physician in Albert Lea. Now, tuition repayment is a lifetime commitment for general practitioners.

As the nation looks for ways to deliver high-quality care while controlling costs, Medicare and private insurance companies need to reprioritize their payment systems to better financially incentivize and attract the best medical minds to the front lines of health care.

In this country, insurance companies will spend hundreds of thousands on gastric bypass surgery and the supporting medical care, but offer very little incentive for primary care physicians to make sure their patients eat properly and exercise.

It's going to be essential that as we move forward we start to reward primary care doctors for their preventative and holistic approach, continue to further incentivize medical students to become primary care doctors and better reimburse hospitals that are incurring high proportions of uncompensated care.

While this report outlines 10 of Minnesota's outstanding hospitals, it should be noted that the margins between the quality rankings were, in many instances, small. Minne-sota has a phenomenal health care system and the 42 hospi-tals surveyed are all excellent health care providers.

Still, if Minnesota wants to maintain or exceed its rank-ing as the fourth healthiest state and improve the quality of its hospitals, we cannot be-gin to lop the poor and vulner-able off the insurance rolls, thus decreasing their oppor-tunity to see primary care physicians, allowing diseases to go unchecked and ultimat-ely let specialty and long-term care costs grow out of control.

For a copy of the report and rankings, visit MN2020.org.

Kyle Bauser is a graduate policy research fellow at Minnesota 2020, a progressive policy think tank.

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