MMA News
Smoke-Free Bill Signed
With Gov. Tim Pawlenty’s signing of the Freedom to Breathe Act, Minnesota’s bars and restaurants will become smoke-free as of October 1.
“This is a really good piece of legislation, and I am glad to sign it,” said Pawlenty, who was surrounded by supporters of the Freedom to Breathe Act at a May 16 signing event in Eagan.
“This is one of the most important pieces of public health legislation to be signed into law in more than 30 years,” said G. Richard Geier, M.D., president of the Minnesota Medical Association. “Over the long term, this law will do more to improve health and reduce health care costs than any of our individual physician members can do over the span of their careers.”
Earlier this year, Blue Cross and Blue Shield of Minnesota, with the Johns Hopkins School of Public Health, released a study showing that secondhand smoke kills more than 580 Minnesotans and sickens more than 66,000 each year. Additionally, the study found that secondhand smoke adds more than $215 million a year to health care costs in Minnesota.
The Freedom to Breathe legislation will bring about a public health improvement for which physicians and clean-air advocates have been striving for years. About 20 states, Washington, D.C., and Puerto Rico have passed smoke-free laws that extend to restaurants and bars.
The new law prohibits smoking in indoor workplaces and on public transportation. Exclusions include farm vehicles and construction equipment, locked psychiatric units, private homes and vehicles, and tobacco shops where customers can sample products. Indoor smoking is also allowed for scientific study, traditional Native American ceremonies, and as part of a performance.
It does not prohibit smoking on patios outside of restaurants, bars, and bingo halls, but it doesn’t prevent local governments from enacting such restrictions.
The final legislation looks much like the original bills introduced by Sen. Kathy Sheran, DFL-Mankato, and Rep. Thomas Huntley, DFL-Duluth, both of whom attended the signing event.
Huntley said getting the bill passed was a tough fight but that his goal of protecting people at work will be achieved.
The MMA has worked to eliminate smoking in workplaces since the 1970s and officially focused on the restaurant and bar issue in 2000. The effort to pass a comprehensive smoke-free bill is coming more than 30 years after Minnesota passed the nation’s first clean indoor air law in 1975, which banned smoking in most workplaces.
In recent years, the MMA has directly lobbied for a statewide smoking ban in bars and restaurants and advocated for city and county bans with the hope that such measures would encourage statewide action.
A broad coalition of supporters, including the MMA, Blue Cross and Blue Shield of Minnesota, the American Lung Association of Minnesota, ClearWay Minnesota, and the Service Employees International Union, actively worked for the bill’s passage.
Physicians and local medical societies, including those in Hennepin, Ramsey, Meeker, Blue Earth, Lake, St. Louis, Carlton, Beltrami, McLeod, Stearns, Benton, Dakota, and Olmsted counties, played a key role in convincing local officials to adopt smoke-free policies.
Physicians were seen as credible sources because they had no personal interest in seeing a smoking ban passed, said Dave Renner, MMA director of state and federal legislation. “Doctors had a lot of credibility because they could talk about the science and put a face on the story.”
Ethics Committee to Review Physician-Drug Industry Ties
Minnesota's Physician Gift Law
Minnesota law prohibits pharmaceutical manufacturers or wholesale drug distributors from giving valuable gifts to physicians and other practitioners but allows the following:
• Drug samples for patients
• Items with a combined value of not more than $50 in any calendar year
• Payment to the sponsor of a medical conference, professional meeting, or educational program, provided that the payment is not made to a practitioner and is used for an educational purpose
• Payment and reasonable honoraria to a practitioner who serves as faculty at a professional or educational conference
• Compensation for the consulting services of a practitioner in connection with a research project
• Publications and educational materials |
What is an acceptable financial relationship between a doctor and a drug company? And is there a disconnect between what the medical profession and the public consider acceptable?
Those questions have become the focus of discussion among medical groups since the March 20 release of a Journal of the American Medical Association article and subsequent media coverage that examined drug company payments to doctors that are publicly reported in Minnesota and Vermont. The money primarily was earmarked for research or for doctors to lecture other doctors about drugs.
Professional organizations such as the AMA and MMA have taken strict stands against physicians accepting valuable gifts from drug companies. Minnesota even has a law prohibiting physicians from receiving gifts valued at more than $50 in a year (that includes the cost of meals).
However, because physician participation is required for research and clinical trials and physicians need to be informed about drugs, medical professional organizations have taken a more nuanced approach to the issue of drug companies paying doctors to research drugs or to teach other doctors about them. Many have based their policies on whether the research is legitimate and whether the physicians are providing a genuine service to the drug company.
For example, the 2006 MMA House of Delegates adopted this language from the AMA as MMA policy: “It is appropriate for faculty at conferences or meetings to accept reasonable honoraria and to accept reimbursement for reasonable travel, lodging, and meal expenses. It is also appropriate for consultants who provide genuine services to receive reasonable compensation and to accept reimbursement for reasonable travel, lodging, and meal expenses” (AMA Policy, E-8.061 (5)).
It appears, however, that the public may expect greater financial separation between doctors and drug companies. A New York Times/CBS News poll conducted in April found that 85 percent of respondents thought it was “not acceptable” for doctors to be paid by drug companies to comment on prescription drugs. Eighty-five percent also said such payments would influence doctors’ decisions about patient care.
Given the complexity of this issue, the MMA Committee on Ethics and Medical-Legal Affairs will review the MMA’s policies and recommend any changes to the MMA Board of Trustees.
Pawlenty Vetoes Health Care Budget
The MMA opposed Gov. Tim Pawlenty’s veto of the health and welfare budget bill passed by the House and Senate in May.
The $9.8 billion spending measure would have increased funding for health and welfare programs by $588 million or 21 percent in the 2008-2009 biennium. Pawlenty’s proposed budget includes $9.5 billion for health and human services.
The spending bill would have helped further MMA priorities such as providing health insurance coverage to more Minnesotans, rolling back recent cuts to health safety-net programs, and strengthening the state’s health information technology infrastructure.
The bill would have made 72,000 more people—about half of them children—eligible for state health care programs. It also called for the state to achieve universal health insurance coverage for all Minnesotans by 2011 and included a number of payment reform initiatives and pilot projects designed to encourage care coordination, the use of preventive care, and creation of medical homes that allow patients to have an ongoing relationship with a provider.
“It was not a perfect bill by any means, but we think the governor should have signed it,” said Dave Renner, the MMA’s director of state and federal legislation.
Board Approves Pay-for-Performance Guidelines
Pay-for-Performance Principles
1. Pay-for-performance programs must be designed to drive improvements to health care quality and the systems in which quality care is delivered.
2. Pay-for-performance programs must promote and strengthen the partnership between patients and physicians.
3. Pay-for-performance programs should support and facilitate broad participation and minimize barriers to participation.
4. Pay-for-performance program design and implementation must be credible, reliable, transparent, scientifically valid, administratively streamlined, and useful to patients and physicians.
5. Pay-for-performance programs should reward those physicians and clinics that make measurable improvements in the process of providing quality care; show measurable improvements in patients’ clinical outcomes; meet or exceed stated clinical goals; make efforts to improve the systems in which they practice; or work to successfully coordinate patients’ care among providers. |
The MMA Board of Trustees approved a set of principles at its May meeting that they say should be the foundation for pay-for-performance programs.
The principles are included in the report “Pay for Performance: MMA’s Principles for the Effective Application of Performance Measurement to Physician Payment Incentives,” which was the result of more than a year of discussions by the MMA Quality Committee.
The principles are to serve as a guide for creating pay-for-performance programs that do not result in negative consequences, said David Luehr, M.D., MMA past president and chair of the Quality Committee.
Physician concerns cited in the report include the potential for pay-for-performance programs to discourage them from treating high-risk patients who may not always be able to seek medical care or heed their doctor’s advice, define quality care too narrowly by using only clinical metrics, force physicians to practice medicine only to “meet the measure,” and assume that all physicians’ care is in need of improvement.
MMA policy acknowledges and supports the concept of linking financial incentives to health performance measures in order to promote quality improvement and recognize the delivery of safe, effective, timely, and patient-centered care.
“We recognize that there are differences of opinion as to the value and efficacy of pay for performance,” Luehr said. “What we’ve provided here is a tool that can be used to help ensure that pay-for-performance programs are applied ethically and in a way that will benefit patients.”
Board Discusses Constitutional Amendment
The MMA Board of Trustees discussed a proposal at its May meeting that calls for a state constitutional amendment that would make health care a right.
The proposal (H.F. 638/S.F. 2097), which is advancing in the House, would put the following question on the ballot in 2008: “Shall the Minnesota Constitution be amended to state that every resident of Minnesota has the right to health care and that it is the responsibility of the governor and the Legislature to implement all necessary legislation to ensure affordable health care?” The bill would require implementation by July 1, 2011.
During the discussion, the board stressed the MMA’s strong commitment to achieving universal health insurance coverage and noted that the MMA’s strategy during the 2007 legislative session has been to work toward that goal through the Healthy Minnesota legislation, which calls for universal coverage by 2011.
Concerns were raised about the specific language of the proposed constitutional amendment, which some saw as a first step toward a single payer. In the end, the board reaffirmed MMA policy that supports a constitutional amendment requiring the state to guarantee affordable health insurance to all Minnesotans.