April 2007 | Back to Table of Contents

MMA News

 

Statewide Obesity Initiative Proposed at Mayo Event

Jan Malcolm, former commissioner of the Minnesota Department of Health, joined former Sen. Sheila Kiscaden to present a statewide initiative to fight obesity during the keynote address at the Mayo Clinic’s Fourth Action on Obesity Summit in Rochester last month.

After making a compelling case for the need for a statewide obesity policy, they unveiled the recommendations of the Healthy Minnesota Partnership for Reform related to obesity, including creation of an obesity steering committee to coordinate statewide efforts.

Malcolm and Kiscaden suggested that the state treat obesity in the same way it has addressed highway fatalities or exposure to secondhand smoke—by educating the public and by insisting on new public health strategies and behaviors.

Some strategies for fighting obesity are included in the Healthy Minnesota bill introduced at the Capitol March 8. The bill would provide incentives to encourage urban and community planning that fosters healthy lifestyles and require physical education for high school students entering the ninth grade, starting in the 2008-09 school year.

Also speaking at the event was Tiffany Beckman, M.D., a member of the MMA Obesity Task Force, who said health plans and Medicare and Medicaid should start reimbursing physicians for consulting with patients about their weight.

She pointed out that obesity-related medical expenditures are a $1.3 billion annual drain on Minnesota’s economy and that patients are much more likely to attempt to lose weight if they are asked to do so by a health care provider. Beckman noted that Minnesota is one of 29 states that precludes coverage for weight-loss drugs and asked: “How are we to address an acknowledged epidemic when we refuse to pay for the treatments that have the best chance for success?”

Medicare only reimburses physicians when obesity is linked to conditions such as hypothyroidism, Cushing’s disease, and hypothalamic lesions.

“If I were a policymaker and not just a physician,” said Beckman, an endocrinologist and University of Minnesota assistant professor of medicine, “it would be my recommendation that obesity care and treatment be covered directly by all insurers as the illness that it is.”

Health Care Reform Bill Introduced

Some of the MMA’s ideas for health care reform became part of the debate at the Capitol with the introduction of the Healthy Minnesota bill in March. The legislation, brought forward by Healthy Minnesota: A Partnership for Reform, would require every Minnesotan to have health insurance coverage by 2011, start to reform the health care payment system by creating medical home pilot projects, accelerate adoption of health information technologies, and provide funding to make sure the state’s public health system keeps Minnesotans healthy now and in the future.

“The MMA has put a great deal of time and effort into health care reform during the past three years, and now it’s paying off, with reform ideas consistent with MMA policy being part of the important health care debate at the Capitol this session,” says MMA President G. Richard Geier, M.D.

Healthy Minnesota Members Supporting the 2007 Legislation Mark W. Banks, M.D., CEO, Blue Cross and Blue Shield of Minnesota Mary Brainerd, president and CEO, HealthPartners Frank Cerra, M.D., senior vice president for health sciences, University of Minnesota Sen. Steve Dille (R-Dassel) Nancy Feldman, president and CEO, UCare Minnesota Glenn Forbes, M.D., CEO, Mayo Clinic, Rochester Rep. Thomas Huntley (DFL-Duluth) Donald M. Jacobs, M.D., CEO, Hennepin Faculty Associates Sheila Kiscaden, former state senator Patricia Lindholm, M.D., Fergus Falls Medical Group Lawrence Massa, CEO, Rice Memorial Hospital, Willmar Noel Peterson, M.D., past president and CEO, Olmsted Medical Center Richard Pettingill, president and CEO, Allina Hospitals and Clinics Gary Cunningham, CEO, NorthPoint Health and Wellness Center Jan Malcolm, CEO, Courage Center Judy Schaubach, president, Education Minnesota Lee Graczyk, interim executive director, Minnesota Senior Federation-Metropolitan Region

In 2004, MMA leaders recognized that the state was primed to have a serious debate about health care because of steeply rising costs. They appointed Judith Shank, M.D., to chair a Health Care Reform Task Force that would create a plan for fundamentally changing Minnesota’s health care system for the better.

This group of physicians worked throughout much of 2004 drafting a comprehensive plan that could one day become law. As part of their deliberations, they considered political realities and public opinion polls that showed Minnesotans wanted universal health care but also favored a private health care system, rather than one run by the government.

To achieve universal coverage, the task force recommended that the state require all Minnesotans to have health insurance for services that would be delivered in a competitive, private market and subsidize coverage for those who cannot afford it.

In January of 2005, the MMA Board of Trustees approved the task force report, Physicians’ Plan for a Healthy Minnesota. The key features envisioned in the MMA plan were health insurance for all Minnesotans, a strong public health system with an emphasis on disease prevention, systems that support high-quality health care, and a health care delivery market focused on value.

Strong Community Interest 
After proposing their reform plan, MMA leaders met with more than 70 groups representing government, health plans, labor, employers, consumers, and others to gauge interest in using the physicians’ plan as the basis for a broader reform effort.
Upon finding strong interest, the MMA pulled together the independent group Healthy Minnesota: A Partnership for Reform. The coalition’s 26-member steering committee met for the first time in March 2006.

The MMA provided staff to the steering committee as it spent more than a year developing its reform agenda and 2007 legislative recommendations. About 70 percent of the steering committee members voted in favor of trying to advance the recommendations during the current session.

Opponents included business representatives, whose main objection was that the proposal didn’t do enough to contain rising costs, and the Minnesota Nurses Association, which favored a single-payer system.

Launched 
On March 8, supporters of the bill held a press conference to announce the introduction of H.F. 1856 and S.F. 1689. Healthy Minnesota Chair and MMA Board Trustee Donald Jacobs, M.D., spoke along with Rep. Thomas Huntley, DFL-Duluth, Sen. Yvonne Prettner Solon, DFL-Duluth, Sen. Steve Dille, R-Dassel, and Katie Wornson. Born with cerebral palsy, Wornson explained how important a medical home is for someone with chronic disease.

Others who attended included co-sponsor Rep. Jim Abeler, R-Anoka, Noel Peterson, M.D., past president and CEO of Olmsted Medical Center, and Richard Pettingill, president and CEO of Allina Hospitals and Clinics. Peterson and Pettingill are members of the Healthy Minnesota Steering Committee.

As soon as the Healthy Minnesota plan was unveiled, some of the groups that had taken part in the deliberations spoke out against it.

Representatives of the Minnesota Chamber of Commerce, the Minnesota Business Partnership, the Minnesota Nurses Association, and Medica, as well as former state representative Fran Bradley, all of whom were on the Healthy Minnesota Steering Committee, criticized the proposed legislation, saying that it fails to address the most pressing issue in health care—cost.

Jacobs responded during public testimony at the Capitol by saying that the proposal would begin to address costs by encouraging disease management and timely treatment. He also acknowledged that the plan is only a first step and that significant work would still need to be done to address all of the causes of rising health care costs.

“But that doesn’t mean we should do nothing,” he said in an interview. “If we don’t take this first step on the road to health care reform, we’ll never get there.”

On March 11, the Star Tribune published a favorable editorial saying the four-year experiment in achieving universal coverage should be allowed to move forward.

The bill had its first hearing March 13 when Rep. Thomas Huntley, DFL-Duluth, presented the House version of the bill to the House Health Care and Human Services Policy Committee.

Ultimately, the committee voted to amend the medical home pilot project recommendations and the health information technology recommendations to other bills (H.F. 1873 and H.F. 297, respectively).

The committee decided to put aside the bill’s most controversial provisions, which include the requirement that all Minnesotans have insurance and that health insurers offer a basic set of benefits to all who apply for coverage. It also failed to approve a study of the state’s public health system.

“It appears lawmakers want to pass as much as they can this year, but they realize they will need to have further discussions and come back with a proposal in 2008,” says Dave Renner, the MMA’s director of state and federal legislation.

Reform Plan May Be “Bridge” 
Star Tribune Columnist Lori Sturdevant said in her March 18 column that the Healthy Minnesota plan may serve as a bridge spanning the policy divide between Gov. Tim Pawlenty and Sen. Linda Berglin, DFL-Minneapolis.

Berglin wants to give people more access to MinnesotaCare, the state’s subsidized health insurance program for the working poor.

Pawlenty dislikes the price tag of that proposal and instead wants to help individuals use pre-tax dollars to buy health insurance. He also believes in arming individuals with cost and quality information so they can be smarter health care consumers.

Sturdevant said that the Healthy Minnesota proposal may serve as a compromise solution because it includes elements favorable to both Pawlenty and Berglin, such as the idea of patients having a medical home that would coordinate care.

“Those notions look as if they could bridge the big policy gulf between Berglin and Pawlenty,” Sturdevant wrote. “If Minnesota is going to make a major move this year to make health care better and more affordable, it’s going to need just such a bridge.”

MMA Initiates Bill to Suspend Imaging "Consultations"

A Series of Responses The introduction of bills in the Minnesota House and Senate is the latest action in a series of MMA responses to new requirements for utilization review of high-tech imaging. The MMA has also written to the Minnesota commissioner of commerce, alleging that one of the third-party vendors conducting the reviews, HealthHelp, was operating in violation of Minnesota state law because it is not licensed to perform utilization review in Minnesota. The MMA also wrote to HealthPartners and Medica, urging them to end their programs. The MMA recommended  that there be a communitywide effort to collect information that will result in a clear understanding of high-tech imaging use throughout Minnesota; that data should be used to develop solutions that will address inappropriate use of high-tech imaging; and that health care providers should rapidly move toward implementing evidence-based decision-support tools at the point of care.

A bill that would place a moratorium on high-tech medical imaging notification programs until December of next year was introduced in the Minnesota Legislature on March 19.

The House bill, H.F. 2003, was sponsored by Rep. Thomas Huntley, DFL-Duluth. The Senate version, S.F. 1752, was sponsored by Sen. Sandy Pappas, DFL-St. Paul. The MMA worked with lawmakers to draft the language in both versions.

The intent of the proposed legislation is to halt health plans’ practice of requiring prior “consultations” with third-party utilization review vendors before physicians can refer patients for MRIs, CT scans, and other high-tech imaging tests. Medica and HealthPartners have been requiring these kinds of prior consultations, citing cost-containment as the reason.

Physicians have criticized the requirement, saying that the consultations waste their time and their clinics’ resources.

When the MMA invited physicians to offer feedback about these consultations, more than 100 complained that the practice is intrusive.

The bill further calls for the commissioner of health to establish a 12-member diagnostic imaging services advisory committee that would discover the causes of increased use of imaging services and make recommendations on how to improve the delivery of those services. The committee would include three physician members appointed by the MMA.

Doctors Brave Snow for Capitol Visit

Despite one of the biggest snowstorms in Minnesota in years, more than 30 physicians—many from greater Minnesota who were staying in nearby hotels—attended the March 1 MMA Day at the Capitol.

About 120 physicians had registered for the event. Those who attended met with their lawmakers and urged them to vote for pro-medicine legislation.

Meeting at the Minnesota History Center, attendees heard legislative trainer Joe Gagen of Austin, Texas, explain the right way and the wrong way to talk to lawmakers. Members were briefed by MMA Director of State and Federal Legislation Dave Renner, who explained the status of current legislation, including Freedom to Breathe, the statewide smoke-free workplace bill; Healthy Minnesota; and bills requiring plan reimbursement for interpreters and the creation of a committee to oversee use of the Health Care Access Fund.

Physicians were greeted by Sen. Tarryl Clark, DFL-St. Cloud, assistant majority leader of the Senate, at the History Center. She urged physicians to get involved because their credibility on public health issues is second to none. Following her remarks, physicians were bused in the still-falling snow to the Capitol rotunda, where they heard Sen. Kathy Sheran, DFL-Mankato, and Rep. Tom Huntley, DFL-Duluth, speak.