Tina Tvedt started her new job as Redwoods Rural Health Center's executive director on March 12, 2012, following six years with the North Coast Clinic Network (NCCN), a Eureka-based organization that assists community health clinics to improve access to healthcare.
Tvedt grew up on a third-generation family farm in South Dakota. At different times her family raised dairy and beef cattle, horses, and hogs. As a 4-H member, Tvedt raised angora rabbits, chickens, and hogs.
She attended Minnesota State University Moorhead, just across the Red River from Fargo, North Dakota, majoring in international business and minoring in Spanish. She spent a year studying in Cuernavaca, Mexico, which Alexander von Humboldt called "the City of Eternal Spring" because of its cool, sunny climate and many gardens.
After graduation Tvedt decided to move to California to live with her aunt in Marin County and look for a job in San Francisco. Her first job was with a hair transplant clinic, but she felt uncomfortable because she was expected to draw blood and give shots to patients without sufficient training.
She left that job and instead found two full-time jobs not far from her aunt's house. From 4 a.m. to 11 a.m. she was a barista at a Peet's coffee shop, and from 11 a.m. to 7 p.m. she worked as a human resources team leader at the Novato Target store.
But even with two full-time jobs she was unable to find a rental she could afford. Her high school sweetheart was living in Eureka and she often came to Humboldt County to enjoy weekends hiking, going to the beach, and attending events like Arts Alive! "I fell in love with this area," Tvedt said, so she decided to move north.
She looked for jobs in Eureka and was hired as an administrative assistant at NCCN, which works with 14 clinics in Humboldt, Del Norte, and Trinity Counties. When the executive director left, Tvedt took on some of her responsibilities, becoming the organization's grants and policy administrator.
Her duties included project oversight, the financial management of grants, and policy and advocacy, which meant organizing public outreach campaigns and meeting with public officials to lobby for more access to healthcare for people of all needs and income levels.
This experience, along with getting to know her colleagues in the Northern California Primary Care Association, fueled Tvedt's interest in healthcare administration. She knew she needed further education, but when she was accepted to the University of California's healthcare administration master's degree program, she realized she didn't want to leave her job and Humboldt County.
Instead she spent two-and-a-half years working online for a master's degree in healthcare administration from Walden University. "I had to study all the time," Tvedt recalled. "I'd be working at a festival like Reggae on the River, but I had to leave early so I could do my homework. I'd meet neat people and want to hang out with them, but instead I had to study.
"I love school, I've always been academic. I enjoy learning new things, and the whole atmosphere of education," she added.
In 2008 NCCN received a grant from the University of California San Francisco to become an Area Health Education Center. Tvedt became NCCN's director for the program, which focuses on continuing medical education, mostly through telemedicine, which is ideal for remote rural communities.
NCCN's board of directors is comprised of the administrators of the member clinics, including Redwoods Rural Health Center. "I became familiar with the challenges and successes of RRHC over the last six years," Tvedt said. "Now I'm here."
Because of knowledge and contacts gained in her previous position, Tvedt was able to help with the complicated paperwork required by the federal Health Resources and Services Administration (HRSA), which provides federal funding to RRHC, a designated Federally Qualified Health Center.
When she came on board in March, RRHC was just completing the six-month training period for its new electronic medical health records system. The proverbial steep learning curve required to become familiar with the technology had caused a sharp cutback in the health center's ability to see patients, but RRHC is now back to its regular schedule.
"I really appreciate our staff, and the patience of our clients for going through this transition and still seeking us as provider of choice," Tvedt said.
Electronic health records are already helping RRHC provide better care. For example, lab results are entered automatically in patient records so they are available more quickly. Likewise, prescriptions can be transmitted to the pharmacy electronically so that patients can get their medications sooner. Reminders about important periodic tests, such as blood sugar and cholesterol, "pop up" on patient records so the provider knows exactly when the next test is due.
Among Tvedt's goals are getting more patient input, recruiting a new physician to work with medical director Wendi Joiner, M.D., and working with a "primary care renewal team" that brings together patients and practitioners from 20 family practice providers on the North Coast to focus on improving access to care, especially for those with chronic conditions.
One new step toward improved care is the visit summary patients receive after seeing a provider at RRHC. This document describes the provider's recommendations for their care, information about medications prescribed, when to schedule their next appointment, and steps to improve their overall health.
When people aren't feeling well they often can't focus on the provider's advice or descriptions of treatment, Tvedt said, and this summary will help them to remember and understand what the provider recommends.
RRHC's financial condition is good, Tvedt said. Over the years, the health center built up a good reserve, but getting the electronic health records system up and running required a big financial investment. During the training period, the reduced schedule meant less money coming in.
All of the costs were planned for, however, and the federal government requires all practices receiving federal funds to implement electronic health records by 2014 or face penalties, so RRHC is well ahead of the deadline.
RRHC has a good relationship with the Southern Humboldt Healthcare District, which manages the Garberville clinic and Jerold Phelps Community Hospital. RRHC refers patients to SHCHD for lab work and X-rays, which reduces costs, time, and hassle for patients with urgent problems like broken bones.
Additionally, Dr. Joiner has a medical staff appointment and admitting privileges at the hospital. This means she joins the SHCHD medical staff on peer review and quality improvement discussions, and that she can admit her RRHC patients to the Garberville hospital and work with them during their stay.
The day after her interview with the Redwood Times, Tvedt left for Sacramento to meet with state legislators and learn more about two budget proposals that will have a serious impact on the health center.
First is a proposal to "restructure" payments to providers for Medicaid (known in California as "Medi-Cal"), which will undoubtedly result in less revenue.
The second proposal would make Medi-Cal a managed care system, which means that each patient would be assigned a specific provider to coordinate all of his or her care. Patients would be given a certain amount of time, probably six weeks, to select a provider, but those who don't make a choice by the deadline will be assigned.
The Affordable Healthcare Act (informally called "Obamacare") has been "fabulous" for RRHC, Tvedt said. Patients receive preventive care, at no cost to them, which leads to a healthier community.
The health center has also received some small grants to help improve patient access. Nationwide, the act provides funding for the establishment of rural health centers and underserved communities.
The U.S. Supreme Court is currently considering a legal challenge to the "individual mandate" clause of the act, which some believe is unconstitutional because it requires everyone to obtain health insurance or pay a fine.
The individual mandate is the lynchpin of the act, Tvedt said. "Unless everyone pitches in, we can't make healthcare affordable to everyone. The cost of insurance will keep rising."
A single payor healthcare system is ideal, Tvedt believes, because it would eliminate the inefficiency and cost of having to monitor and meet the requirements of the many different insurance plans and existing government programs, but the Affordable Healthcare Act is a "step in the right direction," she said.
As part of its outreach effort to improve patient care, RRHC is asking all its patients to complete a patient experience survey, which is done yearly during the month of April. The survey will be distributed to everyone who visits the health center this month. Even if you don't have an appointment, you can stop by and ask for a copy at the front desk. The survey consists of 29 questions and is confidential; names are not requested.
REDWOOD TIMES PHOTO BY VIRGINIA GRAZIANI
Tina Tvedt, Redwoods Rural Health Center's new executive director, looks forward to the challenges of running a rural clinic and improving patient care in a changing healthcare environment.