MMA News
MMA Calls for Focus on Reform
The MMA Board of Trustees voted at its November meeting to recommit to passing health care reform legislation this year. The MMA intends to focus on ensuring health insurance for all Minnesotans and other efforts and oppose any initiatives that would distract lawmakers from achieving such goals.
The Board's Statement
After a lively discussion, the Board unanimously approved the following policy statement: “The Minnesota Medical Association supports current efforts and commitments to advance meaningful and timely health care reform, including efforts to achieve universal coverage. Adoption of a constitutional amendment of any type, at this time, will only serve to derail current cooperation and to distract and polarize policy makers and other relevant stakeholders from implementing and advancing reform during the 2008 legislative session. The MMA, therefore, will continue to provide leadership to advance health care reform and will actively oppose efforts that serve to distract attention from that important work, including passage of any constitutional amendment, such as the amendment proposed in 2007/2008 (HF683/SF2097).”
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One potential distraction is the debate over a constitutional amendment saying that every Minnesota resident has the right to health care and that it is the responsibility of the governor and the Legislature to guarantee affordable care.
The Board took up the issue in response to Resolution 316, which asked the MMA to oppose the constitutional amendment. The resolution was referred to the Board at the MMA’s annual meeting last September.
The consensus of the Board was that a campaign for a constitutional amendment could delay health care reform for years and divide policy makers at a time when cooperation is key.
The concern was that the debate would shift the focus away from how to actually fix the health care system and toward the political pros and cons of amending the constitution. If the proposed amendment passed, the Legislature would still have to do the hard work of actually trying to reform health care in order to achieve universal coverage.
“There is already a great deal of momentum toward health care reform, and the MMA is ready to assist in getting the necessary legislation passed. The debate over a constitutional amendment would just delay the work that needs to be done,” says James J. Dehen Jr., M.D., MMA president. “The Legislature already has the authority to do what it needs to do. So let’s get it done now.”
Currently, several groups convened by the Legislature and Gov. Pawlenty are developing health care reform recommendations to present to the 2008 Legislature. More than 20 physicians are participating in those groups.
Bipartisan support is building for reform that embodies ideas in the MMA’s Physician’s Plan for a Healthy Minnesota that was introduced in 2005—health insurance for all Minnesotans, strengthening the public health system, helping to implement health information technology, emphasizing disease prevention, and supporting the medical home concept in which care is coordinated especially for patients with chronic diseases.
“Trying to pass a bill to amend the constitution while these positive efforts are taking place could undermine bipartisan cooperation,” says Dave Renner, MMA director of state and federal legislation.
MMA Resolutions Well-Received by AMA
Resolutions introduced by the Minnesota Medical Association about military health coverage, tiering, and Joint Commission standards received strong support at the American Medical Association’s interim meeting last month in Honolulu.
The AMA House adopted Substitute Resolution 714, which calls on the AMA to convene a meeting with representatives of TRICARE to discuss how to improve its contracting process and reimbursement structure. The resolution, which passed, was only slightly different than the one brought from Minnesota.
The resolution was brought in response to concerns about veterans being unable to find physicians who accept TRICARE, the military’s health insurance program. The AMA will also give a report regarding TRICARE at its 2008 Interim Meeting.
Tiering the Tierers
Minnesota’s Resolution 816, which asked the AMA to develop a mechanism that state medical associations could use to rate third-party payers on value and performance, was referred to the AMA Board of Trustees.
The house generally agreed that a standardized evaluation of insurance company performance, “tiering the tierers,” would be beneficial.
But the resolution was referred to the board so the AMA Private Sector Advocacy unit could consider the issue. This group is already developing a method for assessing the value and quality of health insurance companies’ offerings using feedback from state medical associations and other groups.
Joint Commission Standards
Resolution 815 directs the AMA to advocate that all Joint Commission standards including those related to medication reconciliation be consistently interpreted by its survey team members, hospitals, and health care systems in a way that improves patient safety.
It also asks the AMA to work with other interested parties and the Joint Commission to standardize interpretation and enforcement of the commission’s medication reconciliation policies based on pre-established, uniform, specific, and consistently interpreted criteria. Testimony at the meeting indicated that the Joint Commission is already working to address the issues raised in the resolution.
Children's Health Bill Hotly Debated
In mid-November, Congress and President Bush appeared to be at a stalemate over the expansion of the State Children’s Health Insurance Program (SCHIP).
The MMA had urged Congress to override the president’s veto of a bill that would have expanded the program.
The bipartisan congressional proposal would have increased funding by $35 billion over five years and expanded the program to nearly 4 million more children by increasing the cigarette tax by 39 cents to $1. The proposal would have phased out states using SCHIP dollars to cover adults.
On the surface, the proposal sounded like a bad deal for Minnesota, which uses much of the state’s $48 million in SCHIP funds for parents of children covered by the program. However, the compromise proposal would allow Minnesota to transfer children now covered with a combination of state and Medicaid dollars through MinnesotaCare, the state’s subsidized insurance program for working families, to the SCHIP program. SCHIP dollars provide a 65 percent federal match compared with the 50 percent match Medicaid provides.
“This would be a good thing because the state could drop the money shuffle and confusion about the program,” says George Schoephoerster, M.D., MMA president-elect and a family physician in St. Cloud.
Phasing Out Adult Coverage
Minnesota is one of 11 states that uses SCHIP funds to provide adults with health coverage.
The state received a federal waiver in the late 1990s allowing it to use those dollars to provide health insurance for about 16,600 adults including pregnant women, according to the Minnesota Department of Human Services.
By the time SCHIP financing became available to all states in 1997, Minnesota had achieved one of the lowest uninsured rates for children in the nation because of the success of MinnesotaCare.
Federal law prohibited Minnesota from transferring those children covered by MinnesotaCare to SCHIP, so the state searched for other ways to spend its SCHIP allotment. Minnesota was allowed to cover the expenses of a portion of parents and caretakers of children on MinnesotaCare.
“The waiver came about because Minnesota was already covering kids, and the federal government wouldn’t allow the state to switch those kids to SCHIP,” Schoephoerster says.
The SCHIP program is funded through the end of 2007.
Pay-for-Performance Progams Fall Short
The Minnesota Medical Association has released the first report ever to examine and evaluate Minnesota’s pay-for-performance initiatives.
The MMA developed the report in response to the growing trend of linking physician payments to the achievement of clinical outcomes or use of specific processes. The report, which was released November 19 and mailed to all members, was featured in a Star Tribune, front-page article, “Doctors turn tables by ranking insurers.”
The report looked closely at the various health plan and government pay-for-performance initiatives and evaluated them using criteria established by the MMA. The MMA believes programs should improve the quality of care, strengthen the physician-patient partnership, use valid measures, and include physicians across medical specialties.
“Pay-for-performance programs in Minnesota may be meeting some of the MMA’s criteria, but there is significant room for improvement in how these programs are implemented and in how they can be effective,” James J. Dehen Jr., M.D., president of the MMA, said in a press release.
One problem is variation in pay-for-performance programs. The report found that Minnesota has nine programs that include at least 117 measures for 63 different disease states.
Health Plan P4P To-Do List
- Provide financial incentives for care coordination, especially for patients with chronic illnesses.
- Provide financial incentives for implementing health information technology and electronic medical records.
- Eliminate financial penalties for providing care that is in the patient’s best interest. A physician shouldn’t be penalized for prescribing a brand-name drug rather than a generic if that’s what the patient needs.
- Ensure that programs don’t penalize physicians who accept patients with complex and difficult conditions.
- Adopt a common measurement set, preferably one developed by MN Community Measurement, and a streamlined data-collection process in order to reduce the administrative burden.
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By asking for slightly different types of data, these nine programs create confusion and significant administrative work. For instance, HealthPartners judges physicians on whether women 50 to 80 years old had a mammogram during the past year, whereas Medica rewards physicians if women 40 to 69 years old had a mammogram during the last two years.
“Such seemingly small differences among programs actually create enormous challenges for practices resulting in unnecessary administrative burdens,” Dehen said. “And they add to health care costs.”
Another shortcoming of Minnesota’s pay-for-performance programs is that they rarely adjust for differences in the severity and complexity of patients’ conditions. This can result in an apples-to-oranges comparison that doesn’t really capture differences in the care provided.
“We need to make sure that these programs don’t financially penalize physicians who work with patients who have complex illnesses or difficult circumstances,” Dehen said.
MMA leaders met with health plan leaders days before the release of the report to discuss ways Minnesota could improve its pay-for-performance programs. In the report, the MMA urges Minnesota’s health plans, employers, and others that use pay-for-performance programs to take steps toward providing financial incentives for care coordination, implementing electronic health records, and treating patients with complex conditions.
Julie Brunner, executive director of the Minnesota Council of Health Plans, said in the Star Tribune article that insurers were working with the association to address the concerns, although they didn’t necessarily agree with all of them.
“This was not an easy conversation, but it was a good conversation,” Brunner said in the article.